Congenital hypertrophic pyloric stenosis. Surgical experience.

Of 132 infants who underwent surgery for congenital hypertrophic pyloric stenosis during a 13-year period, 83% were males and 31% were firstborn males. Ninety-one percent of the patients presented with projctile vomiting after feeding, and an "olive" was palpated in 92%. Upper gastrointestinal studies were not obtained in 73%. Twenty patients had positive family histories. For the entire 13 years under review, the average total hospital was 6.14 days, and the average postoperative stay was 4.45 days. For the later period 1970 to 1974, the hospital stay was 5.2 and 3.7 days, respectively. Intravenous fluids were not used in 77% of the patients and were used but not needed from a surgical standpoint in 9%. No deaths resulted from the procedure for pyloric steonsis, but there were five complications. Only 13 patients had no vomiting after operaion, whereas 105 (79%) had modest regurgitation of mild vomiting. Specific preoperative, operative, and postoperative care is important in every case.

Intra-abdominal, angiofollicular lymph node hyperplasia (plasma-cell variant) with an antierythropoietic factor.

An 11-year-old girl presented with a refractory hypochromic microcytic anemia, hypoferremia, normoblastic hyperplastic bone marrow, hypergammaglobulinemia, and growth retardation. Many varied treatments failed to produce any improvement. Ferrokinetic studies revealed rapid plasma clearance and increased plasma iron turnover, but impaired incorporation of 59Fe. Excretion of 57Co after an oral dose indicated an increased iron absorption. A (99M)Tc-sulfur colloid scintigram of the abdomen failed to demonstrate abnormal uptake. A nodal mass showing the plasma-cell variant of angiofollicular hyperplasia was removed from the gastrolienal ligament. Follow-up studies at 3 and 6 months revealed complete correction of the anemia, a 4.8-cm increase in height, and normal serum gamma-globulin levels. Serum obtained before operation inhibited the incorporation of 59Fe that was induced by a standard dose of erthyropoietin in the exhypoxic mouse system, and this inhibition persisted in serum obtained 3 days after surgery but disappeared by 6 days. The data suggest that the hyperplastic angiofollicular lymph node (plasma-cell variant) secreted a substance the inhibited erythropoiesis.

Splenorrhaphy: changing concepts for the traumatized spleen.

Established doctrine dictating splenectomy for the traumatized spleen has come under considerable critism since the report of fatal postsplenectomy sepsis by King and Shumacher in 1952. With expanding knowledge of immunologic and physiologic function, splenectomized persons have been proven at risk in different areas, but the most important impetus for splenic preservation has been the observation of overwhelming postsplenectomy sepsis. Several reports have confirmed this concern, with a documented increase in morbidity and death of splenectomized patients of 50 to 200 times the normal. Successful results with surgical repair of traumatized spleens have been reported, experimentally and clinically proving excellent healing capabilities. It is not uncommon to frequently find little if any active bleeding with such injuries; in fact, even significant bleeding can be controlled with splenic salvage. Several different techniques to accomplish this have been reported. These are reviewed, two new successful and previously unreported techniques are outlined in detail, and statistical information supporting the use of these techniques is presented.

Rectal myectomy in Hirschsprung disease: a decade of experience.

Short-segment aganglionosis is becoming more frequently recognized in view of more sophisticated diagnostic techniques, as well as the greater clinical awareness of the entity. A series of 37 patients who underwent rectal myectomy during a ten-year period was reviewed. Selected patients with short-segment aganglionosis, proved by muscle biopsy, responded well to a single transanal operation that required an overnight hospital stay. The complications were minimal, and the cure or marked improvement has persisted for as long as 11 years. When major surgery of an abdominoperineal pull-through type was required after the myectomy (four patients), no technical difficulties were encountered. Within the limits of its applicability, rectal myectomy has a definite place in the treatment of short-segment Hirschsprung disease.

Esophageal reconstruction for benign disease: a long-term appraisal.

Replacement of all or part of the esophagus, for whatever reason, requires intimate familiarity with the advantages, disadvantages, and long-term results of various techniques of reconstruction. For benign esophageal disease, because of the expected longer natural history of such lesions, long-term results should be more informative. The Mayo Clinic experience with esophageal reconstruction for benign disease is reviewed for the 15-year period of July 1955 through July 1970, critically evaluating the long-term results of from 8 to 21 years. Thirty-nine patients, with a male-to-female ratio of two to one, underwent 44 operative reconstructions. Only 41 per cent had uncomplicated postoperative courses, with a five per cent operative mortality (two patients) and a 15 per cent late related mortality. The average duration of hospitalization was three weeks. Despite the morbidity and mortality, most patients report good to excellent results, confirmed by physician assessment.

Pulmonary arteriovenous malformations in children.

Pulmonary arteriovenous malformations are a life-threatening, but curable, cause of persistent cyanosis in children. Abnormal communications may be single or multiple and are usually in the lower lobes. Three patients with pulmonary arteriovenous malformations have recently been managed at this hospital. Ranging in age from 2 to 4 yr, all were female, all were from families with Rendu-Osler-Weber syndrome, and all underwent pulmonary angiography with confirmation of diagnosis. All have had uneventful resection, one of the left lower lobe, one the right upper lobe, and the other the right middle and lower lobes.