ABSTRACT
Chronic obstruction of the femoral artery in children is a complication of diagnostic angiography, cardiac catheterization and umbilical artery catheterization. We have seen 22 cases and have operated on 7. The indications for operation are claudication, muscle wasting, and shortness of the lower limb. The diagnosis is confirmed by a Doppler profile and the abnormal vascular anatomy demonstrated by angiography via the contralateral femoral artery. We have done 4 ilio-femoral, two femo-femoral and one femoro-popliteal bypass grafts utilizing the long saphenous vein. Results have been good in five, the other two grafts having thrombosed.
Subject(s)
Femoral Artery , Thrombosis/surgery , Angiography/adverse effects , Arteriovenous Anastomosis , Catheterization/adverse effects , Child , Child, Preschool , Female , Femoral Artery/diagnostic imaging , Femoral Artery/surgery , Humans , Intermittent Claudication/etiology , Intermittent Claudication/surgery , Thrombosis/diagnostic imaging , Thrombosis/etiology , Umbilical ArteriesABSTRACT
Congenital spigelian hernia (SH) is a rarity. The authors present two cases of congenital SH with undescended testis, and examine the significance of the concurrence of these events.
Subject(s)
Abdominal Muscles/abnormalities , Cryptorchidism/complications , Hernia, Ventral/congenital , Hernia, Ventral/complications , Abdominal Muscles/surgery , Cryptorchidism/surgery , Hernia, Ventral/surgery , Humans , Infant, Newborn , MaleSubject(s)
General Surgery , Terminology as Topic , Humans , Semantics , Surgical Procedures, OperativeABSTRACT
Torsion of the hydatid of Morgagni in the female is discussed, together with theories on embryology. A further case is presented, complicated by infarction of the tube and ovary. SUMMARY: 1. The term hydatid of Morgagni is defined and its embryology outlined. 2. A case of torsion of the hydatid leading to infarction of the tube and ovary is reported. 3. The literature is reviewed. 4. The more typical clinical features are presented, attention being drawn to referred pain.
ABSTRACT
Torsion of the testis demands early diagnosis and urgent operative treatment. This study of all patients with torsion of the testis who were admitted to The Prince of Wales Children's Hospital, The Prince of Wales Hospital and The Prince Henry Hospital, Sydney, between 1965 and 1987, reinforces the need for urgent diagnosis and treatment and evaluates the diagnostic value of the sign of the contralateral horizontal testis. One hundred and thirty-one patients were studied; the majority was in the adolescent age-group. If operation were delayed beyond 24 hours without spontaneous relief of the symptoms or manipulative detorsion being performed, then at follow-up 5.5% of testes were normal; however, if operation were performed within 24 hours of the onset of symptoms, 90% of testes were normal at follow-up. In all cases in which it was sought, the sign of the contralateral horizontal testis was found, which confirms the bilaterality of the condition and that a high investment of the tunica vaginalis predisposes to torsion of the testis.
Subject(s)
Spermatic Cord Torsion/diagnosis , Adolescent , Adult , Atrophy , Child , Diagnosis, Differential , Epididymitis/diagnosis , Follow-Up Studies , Humans , Infant , Infant, Newborn , Intussusception/diagnosis , Male , Necrosis , Orchiectomy , Spermatic Cord Torsion/pathology , Spermatic Cord Torsion/surgery , Testicular Diseases/diagnosisABSTRACT
Congenital cystic lesions arising in the omentum are a rare finding in the paediatric age group. They are difficult to diagnose preoperatively as they have few distinct features; the diagnosis is often confirmed only at lalaparotomy. They are thought to arise due to a developmental abnormality of the lymphatic system. Two cases are presented and the literature reviewed. The treatment of choice is complete resection. Long-term follow-up is unnecessary due to their benign nature.
ABSTRACT
Spontaneous Clostridium septicum myonecrosis is an uncommon disorder that has been described in association with malignancy, immunosuppression and neutropaenia. Typical clostridial myonecrosis develops without a visible portal of entry and mortality is high. The pathogenesis is not completely understood but the clostridia may gain access to the circulation via areas of ileo-caecal ulceration secondary to enterocolitis, antibiotics or neoplasms. A 5 year old boy with congenital neutropaenia presented with spontaneous Clostridium septicum myonecrosis in the thigh. Limb salvage was achieved using antibiotics, hyberbaric oxygenation and selective debridement. The portal of entry may have been the gastrointestinal tract as colonic ulceration may occur in neutropaenia, and pre-morbid clindamycin administration may have encouraged overgrowth of colonic clostridia.
Subject(s)
Gas Gangrene/therapy , Neutropenia/congenital , Anti-Bacterial Agents/therapeutic use , Child, Preschool , Combined Modality Therapy , Debridement , Edema/microbiology , Edema/pathology , Gas Gangrene/pathology , Humans , Hyperbaric Oxygenation , Male , Thigh/pathologyABSTRACT
Seven patients with epidermolysis bullosa dystrophica and chronic and recurrent oesophageal lesions such as spasm, strictures, and complete occlusion were studied. Dysphagia could be cured with drugs if it was caused by bullae formation or spasm. If oesophageal strictures were present, endoscopy and bouginage with corticosteroid prophylaxis during the quiescent phase of the disease was a safe and useful procedure. We have also given corticosteroids, which reduced the oedema caused by bullae formation and oral phenytoin, which reduced epithelial detachment by inhibiting collagenase activity. Verapamil counteracted oesophageal spasm and pureed food during periods of dysphagia reduced blistering of the upper oesophagus.