A stomal appliance for provisional ileostomy in neonates of low weight at birth who require temporary ileostomy.

In the surgical treatment of infants of low weight at birth for various congenital or acquired intestinal defects, it occasionally becomes necessary to divert intestinal contents by temporary ileostomy. There are no commercially available stomal appliances that are suitable for patients of this size. A rapid and easy method of constructing such an appliance is presented. The appliance protects peristomal skin, reduces nursing skin care time, and provides an easy and efficient method of collecting and measuring stomal affluent.     

Pyogenic osteomyelitis of axial bones following civilian gunshot wounds.

A series of forty-five patients with low velocity gunshot wounds to the spine and pelvis were followed up for at least eight weeks to determine the incidence of pyogenic osteomyelitis and the role of debridement and fragment removal in its prevention. Four cases of osteomyelitis were found, and although debridement was not frequently done, the incidence of osteomyelitis was higher following debridement than it was without debridement. The most important cause appeared to be spread of contiguous intraabdominal abscesses into the injured paravertebral muscles and spine. If an intraabdominal abscess did not develop, the presence of gastrointestinal injury did not predispose the patient to osteomyelitis. Based on this study, we can conclude that debridement and fragment removal of the spine and pelvic bones are unnecessary for low velocity missile wounds.     

Role of diagnostic tests in esophageal evaluation

In the evaluation of esophageal disease, the appropriate question must be asked before the correct tests can be selected. Reflux can be demonstrated by radiologic methods, pH testing or radioisotopic techniques. Esophageal mucosal damage is best evaluated by x-ray, endoscopy or biopsy. Chest pain is demonstrated by acid infusion or by manometry. Two algorithms are presented for the evaluation of chest pain and reflux symptoms.