Videotaped fluoroscopic evaluation in the diagnosis of recurrent and missed tracheooesophageal fistula

The diagnosis of recurrent or missed tracheooesophageal fistula seems to be difficult and almost always delayed. This is because the presenting clinical features [e.g. choking and coughing with feeding, or pneumonia] involving the chest are shared by many other diseases. Mild symptoms especially in the oblique type [N-type] of fistula may be overlooked. Also, the unreliability of conventional X-ray methods, and the unavailability of experienced paediatric radiologists and endoscopists, further add to the problems in diagnosis. Recurrent or missed tracheooesophageal fistula once suspected [even with the mildest symptoms] should be put at the top of the list of differential diagnosis of causes of recurrent respiratory problems in young children. Every effort should be made to achieve the diagnosis. The videotaped fluoroscopic examination has been used in clinical practice for several years. The procedure is safe, cheap and gives very clear and reliable results. The tape can be easily replayed in theatre in front of the surgeon during the operation. This technique is a great help in diagnosis

New concept of the pathogenesis and treatment of anterior abdominal wall herniae based on anatomical and biomechanical studies. Part I- tensile properties of human anterior abdominal wall tissues concerned in herniology

The preference of various tissues used for surgical repair of hernia depends largely on clinical experience and observations. It was suggested that the criteria of preference may be put on more stable basis by actual testing of the tensile properties of these tissues. Accordingly we started by a trial to test some specimens of abdominal wall layers using some textile testing instruments with standardization of the dimensions of specimens and conditions of the test. The preliminary results indicated that the fascia transversalis was superior in its tensile properties. Peritoneum was less variable in its characteristics. A trial to use the ball burst test was conducted but according to lack of standardization it was not possible to represent the results in a com prehensive form. However this last test should be subjected to a more extensive work in the future

Part II - anatomical peculiarities of the anterior abdominal wall in the view of study of 200 halves of cadavers of still and newborns with operative observations in 300 cases of inguinal hernias and 103 cases of ventral hernias

This study was based on dissection of cadavers of still borns and newborns died shortly after birth and from observations during operations on inguinal and ventral herniae. Certain anatomical peculiarities were reported and their relation to the etiology of hernia were discussed. The presence of an accessory internal oblique muscle between the internal oblique and the transverse stratum was confirmed in many cases. It was observed that the lowermost fibres of the transversus abdominis were distributed in such a way to pull on and strengthen the fascia transversalis in the inguino-hypogastric region. In a good number of cases some of the fibres turn around the internal ring acting as a sphincter preventing the descent of intestines in a patient processus vaginalis when this latter is present. Adipose hernia can be a very important factor in many cases of herniae at all sites, ventral or inguinal. Understanding of these anatomical points concerned in the etiology of hernia helped us to decide the line of treatment. The operative techniques described in part III of this work were mainly based on the appreciation of the importance of the fascia transversalis as an efficient support for the posterior wall of the inguinal region

Part IV - spontaneous ventral hernias study of the etiology and treatment in the view of certain anatomical, clinical and operative observations in 104 cases

One hundred cases of herniae of the linea alba [midline spontaneous ventral herniae] were studied. Out of these we had 32 cases of paraumbilical hernlae which we regarded as defects in the lhiea alba nearest to the umbilicus. We believe that these herniae were due to protrusions of the extraperitoneal-fat through vascular lacunae. Vertical repair with imblication of the linea alba in its extent above the umbilicus was done using stainless steel wire. This technique proved very efficient in almost all cases. Two cases of spigelian herniae were presented and described. We had one more case of spontaneous lateral ventral hernia, due to congenital muscular deficiency