Interval appendectomy for perforated appendicitis in children.

To determine the efficacy, safety, and cost of managing perforated appendicitis with intravenous antibiotics followed by an interval appendectomy, the charts of 87 children with ruptured appendicitis were retrospectively reviewed. These patients were treated with intravenous fluid resuscitation and antibiotics (consisting of clindamycin and ceftazidime) and underwent appendectomy, either on that admission (n = 46) or as a delayed interval procedure (n = 41). Antibiotics in all cases were discontinued either at home or in the hospital after the child was a febrile for 48 hours with normal white and differential blood cell counts, and the two groups were compared. Seven patients (17%) "failed" the interval appendectomy protocol. All but one "failure" was due to the development or persistence for >72 hours of a bowel obstruction. The data are described below as percent or mean +/- 1 standard deviation. [table: see text] We conclude that antibiotics and interval appendectomy is a safe effective alternative for the management of perforated appendicitis. When successful, hospitalization, charges, and morbidity are less with this approach. A persistent bowel obstruction for 72 hours is an indication to proceed with appendectomy on admission.

MR imaging differentiation of benign and malignant peripheral nerve sheath tumors: use of the target sign.

BACKGROUND: T2-weighted MR imaging of soft tissue tumors of neural origin may show round lesions with a central hypointensity and a hyperintense rim resembling a target. We define the "target sign" as a mass consisting of a solitary target, or a multicompartmental mass in which the largest component consists of multiple targets. OBJECTIVE: The objective of this study was to determine whether the target sign can differentiate benign neurofibromas and their malignant counterparts, malignant peripheral nerve sheath tumors. Materials and methods. Preoperative T2-weighted MR images of 23 neurofibromas or malignant peripheral nerve sheath tumors were retrospectively reviewed in 16 patients, aged 3 weeks to 20 years (median 15 years), without knowledge of the pathologic diagnosis. The presence or absence of a target sign was noted. RESULTS: The target sign was seen in all 12 neurofibromas and 1 of the 11 malignant peripheral nerve sheath tumors. Statistical analysis showed good differentiation of benign and malignant tumors using this sign (chi = 0.91). CONCLUSION: The target sign on T2-weighted MR imaging is helpful in differentiating neurofibromas from malignant peripheral nerve sheath tumors.

Neoplasms in Proteus syndrome.

We report on 2 children with Proteus syndrome who developed neoplasms. Patient 1 had a probable mesothelioma, although papillary carcinoma of the thyroid could not be completely ruled out. Patient 2 had bilateral ovarian serous cystadenomas with nuclear atypia. Other unusual neoplasms in Proteus syndrome are discussed, together with their etiologic and pathogenetic possibilities.

The suitability of automatic tissue morcellation for the endoscopic removal of large specimens in pediatric surgery.

UNLABELLED: Now that endoscopic removal of tumors and other solid structures from the abdomen and chest is possible, it is important to know the suitability of this technique for the removal of solid pediatric malignancies where accurate histological assessment becomes important for prognosis and staging. The authors tested an automatic tissue morcellator on a variety of pediatric tissues to assess the interpretability of the material obtained. The morcellator consists of a rotary blade within a 1-cm sleeve. When suction is applied to the morcellator and the device is activated, the solid material is shaved or morcellated into bits of tissue that are aspirated and collected for analysis. To test the interpretability of morcellated tissue, the device was used on six Wilms' tumors, three hepatoblastomas, a lung resection, a splenectomy, and a bowel resection. The average size of the pieces of tissue was 1.33 x 0.58 x 0.43 cm. In every instance, the histology was as good as the evaluation of sections from the gross tumor. It was difficult to distinguish the edge of tissue procured by the morcellator from an edge cut by the pathologist's knife. CONCLUSIONS: (1) Morcellated pediatric tissues are available by experienced pediatric pathologists. (2) The adoption of this technique should not interfere with proper histological evaluation of solid pediatric tumors.

Intracranial tuberculosis in children: CT appearance and clinical outcome.

We retrospectively evaluated the CT studies of 9 children who presented with intracranial tuberculosis during 1981-1987, and compared their radiographic appearance with the clinical outcome. The most common radiographic findings were: 1) ventriculomegaly (7/9) ,2) tuberculoma formation (6/9), and 3) infarction (4/9). Of 7 patients with ventriculomegaly, 3 required a ventricular shunt and 2 had spontaneous resolution of ventricular dilatation. Four children with ventriculomegaly were moderately or severely retarded, one had cognitive dysfunction, and one was neurologically normal. Four of six children with tuberculoma also had infarction and/or ventriculomegaly; of these four children, three were moderately or severely retarded. Two patients with tuberculoma as the only intracranial abnormality had complete resolution of the granuloma with normal neurologic outcome following antituberculous therapy. The four children with large vessel infarction also had ventriculomegaly; three had poor clinical outcome. The presence of tuberculoma alone is not necessarily predictive of poor neurologic outcome; age less than 20 months, infarct, and/or ventriculomegaly are usually associated with sequelae.