Leydig cell tumor in childhood.

Two cases (6 and 7 years old) with the chief complaints being testicular enlargement, spurt of growth and sexual precocity were reported. Investigations revealed advanced bone age and a high level of male hormone derived from the tests. Both underwent high orchidectomy with removal of the lymph nodes from the adjacent area along the testicular artery. Histologic examination of both showed Leydig cell tumor without any metastasis to the lymph nodes. The literature was also reviewed and revealed that this disease occurs infrequently especially, in children. The clinical pictures are similar in most of the cases, including ours. Because almost all are benign, simple orchidectomy is suggested as providing adequate treatment. However some features that are indicative of malignancy warrant the dissection of the retroperitoneal nodes.

Management of gastroschisis.

Reported herewith 34 patients being treated for gastroschisis during seven and a half year period from January 1982 to June 1989 at Division of Pediatric Surgery, Siriraj Hospital. The majority of patients were refered from other institutes. Only nine were born at Siriraj Hospital where the incidence of 1:15,000 livebirths. None of the patient had the diagnosis prenatally and all except three were delivered spontaneously. There were 14 male and 19 female infants, of which 22 being first-born child. The body weight varied from 1280 to 3270 gm with themedian of 2200-2300 gm. The abdominal wall defect confined on the right side of the umbilical cord in all cases. Intestinal atresia was the only associated anomaly found in one case. After admission, every measures was undertaken to prevent further heat loss and contamination, and to correct hypothermia as well as fluid and electrolytes imbalance. Surgical correction was performed in all infants which being classified into three groups, the primary fascial closure, the temporary closure using skin flap, and the temporary closure using Silastic sheet. The primary fascial closure was first attempted unless the patient’s condition was not permitted. The survival rate among patients treated by each technique was 79, 50 and 38 percent respectively.

Appendicitis in childhood.

This is a prospective study to determine the clinical features and the result of treatment of appendicitis in paediatric patient. It was carried out starting from June 1985 to December 1986, a period of one year and seven months included 183 patients. One hundred and thirteen were boy and seventy were girls making the ratio of boy to girl being 1.6 : 1. The patients were categorized in to two groups namely acute appendicitis which included 137 patients and perforated appendicitis in 46 patients essentially by physical examination. The age, symptoms and its duration, body temperature, white blood count were demonstrated in both groups. It was found that duration of symptoms is longer in group with perforated appendectomy through grid-iron muscle splitting incision, no peritoneal irrigation, copious amount of saline irrigation after closure of peritoneal layer and prior to closure of subcutaneous fat and skin. The perforated appendicitis group was also resuscitated by intravenous fluid administration plus combination of antibiotics i.e. ampicillin, gentamycin and metronidazole. The rest of the treatment by intravenous fluid administration plus combination of antibioneal cavity will be considered only in cases with localized collection and excessive exudate which was found in 59 percent of cases. Average hospital stay was 4 and 7 days for acute appendicitis and perforated appendicitis respectively. There was no mortality in neither groups. No complication was encountered in acute appendicitis group and in only one case or two percent on perforated group developed wound infection without any intraabdominal abscess or sepsis. It is concluded that our simple regimen of treatment yield a highly encouraging result.

Duodenal intubation in diagnosis of prolonged obstructive jaundice in neonates.

During the period of July 1985 to December, 1986 there were twenty-six newborns with prolonged jaundice who were requested for laparotomy and operative cholangiography due to other series of tests not being able to unequivocally diagnosis whether the baby was affected by extrahepatic biliary atresia or neonatal hepatitis syndrome. Duodenal intubation was performed and the aspirate was examined before and after stimulation by magnesium sulfate solution. There was no bile in any sample taken before stimulation, but in four patients bile was present after stimulation. These four patients presumed to have neonatal hepatitis syndrome and treated accordingly with good results. The remaining twenty-two patients underwent laparotomy and operative cholangigraphy. Twelve cases were extrahepatic biliary atresia and were treated accordingly. Ten were found to have patency of biliary tract, presumably affected with neonatal hepatitis syndrome group is counted, four out of fourteen or twenty-six patients or fifteen percent were saved from operation. If only the neonatal hepatitis syndrome group is counted, four out of fourteen or twenty-eight percent avoided operation. We conclude that duodenal intubation is an inexpensive, easy to perform test with encouraging results. It can be used in all cases in prolonged jaundice at any time process of investigation.

Necrotizing enterocolitis after operation for ileal atresia.

NEC usually affects newborns especially low birth weight often with history of perinatal stress. It usually manifests itself within five to ten days after birth with abdominal distension, bilious vomiting and bloody diarrhea. Development of NEC after operation seldom occur. It was first reported in patients underwent open-heart surgery employing hypothermia and cardiopulmonary by-pass. Later it was found to be common among gastroschisis patients post repair of abdominal wall defect. Clinical pictures of usual case of NEC and that develop after operation are partly resemble and partly differ. NEC is rarely seen after other operative procedures especially intestinal atresia. Review of the literatures revealed only eight such cases. Our report of two cases following operation for intestinal atresia with explanation both on similar and different clinical pictures from usual of NEC.