ABSTRACT
Lateral ventral (spigelian) hernias may not be recognized if the physician is unaware that they can occur in pediatric patients. Diagnosis depends on finding a protrusion in the spigelian fascia lateral to the rectus sheath at the junction of the arcuate and semilunar lines, below the umbilicus. We report nine such cases, to bring the total number of recorded pediatric cases to 18. Surgical repair involves a layered overlapping closure using interrupted nonabsorbable sutures. Since the rim of the defect is extremely difficult to outline once the child is asleep and relaxed, it must be outlined in indelible ink while the child is awake and straining.
Subject(s)
Hernia, Ventral/diagnosis , Child , Child, Preschool , Diagnosis, Differential , Female , Hernia, Ventral/pathology , Hernia, Ventral/surgery , Humans , Infant , Infant, Newborn , Male , Suture TechniquesABSTRACT
In 261 infants with vomiting, 11 duodenal abnormalities were diagnosed with fluid-aided ultrasound (US). These abnormalities included duodenal obstruction, malrotation with and without associated volvulus, incomplete rotation, and duodenal stenosis. US was the initial modality used in the evaluation of vomiting in these neonates and young infants. The overall sensitivity and specificity of fluid-aided US evaluation of duodenal abnormalities were 100% and 99%, respectively. (Workup bias limits the reliability of these figures.) Fluid-aided US examination of the stomach and duodenum provided a dynamic view of duodenal rotation and anatomy, and at the very least provided a method of triaging those infants who may require surgery, upper gastrointestinal series, or follow-up US to make a definitive diagnosis.
Subject(s)
Duodenal Obstruction/congenital , Intestinal Atresia/diagnosis , Ultrasonography , Duodenal Obstruction/diagnosis , Duodenum/abnormalities , Humans , Infant , Vomiting/etiology , WaterABSTRACT
Ultrasound has been used in the diagnosis of hypertrophic pyloric stenosis since the first reports of its use with contact B mode scanners. Real-time imaging has allowed measurements of pyloric diameter, length, and muscle wall thickness. Wall thickness measurements taken with the pylorus in longitudinal (elongated) view improve diagnostic accuracy. Fluid aided real-time examination of 10 cases showed the ultrasound equivalent of the "double track" sign. This finding is the result of pyloric fluid compressed into smaller tracks as it is impinged upon circumferentially by the thickened circular muscle. This sign, previously seen in barium studies, although nonspecific, may prove to be a sensitive diagnostic criterion.
Subject(s)
Pyloric Stenosis/pathology , Female , Humans , Hypertrophy , Infant , Infant, Newborn , Male , Pyloric Stenosis/diagnosis , Pyloric Stenosis/diagnostic imaging , Radiography , UltrasonographyABSTRACT
A two-month-old female with clinical manifestations of Cushing's syndrome including mild virilization exhibited an unusual steroid pattern illustrating difficulties in diagnosis of this disorder in infancy. Unequivocal abnormalities were limited to serial elevations of serum cortisol concentration, hyperresponsiveness to ACTH, resistance of serum cortisol to dexamethasone suppression, and elevation of testosterone and dehydroepiandrosterone sulfate concentration. On the other hand, twenty-four hour urinary 17-hydroxysteroid, 17-ketosteroid, free cortisol, and 6B-hydroxycortisol excretion were normal for the age. At laparotomy the adrenals were only minimally enlarged, and their architecture was normal by light microscopy. Following total adrenalectomy, adrenal slices were transplanted into the rectus abdominis muscles. Progressive hypertension developed three weeks later, suggesting adrenal regeneration. The infant then developed acute Salmonella enteritis and expired. At autopsy, the adrenal transplant showed outer cortical preservation, inner zone degeneration, and some growth into the surrounding tissue. The unfavorable outcome notwithstanding, this study adds to existing data in the adult that adrenal autotransplantation may have significant therapeutic value in Cushing's syndrome treated by bilateral adrenalectomy.
Subject(s)
Adrenal Glands/transplantation , Adrenalectomy , Cushing Syndrome/diagnosis , 17-Hydroxycorticosteroids/urine , 17-Ketosteroids/urine , Adrenal Hyperplasia, Congenital/diagnosis , Cortodoxone/blood , Cushing Syndrome/surgery , Diagnosis, Differential , Female , Humans , Hydrocortisone/blood , Infant , Transplantation, AutologousSubject(s)
Anesthesia, Local , Hernia, Inguinal/surgery , Adjuvants, Anesthesia , Adolescent , Adult , Aged , Bupivacaine , Female , Humans , Male , Methods , Middle Aged , Preanesthetic MedicationSubject(s)
Pelvis/surgery , Skin Transplantation , Twins, Conjoined/surgery , Abnormalities, Multiple , Amputation, Surgical , Artificial Limbs , Dextrocardia , Digestive System Abnormalities , Female , Femur/abnormalities , Humans , Infant, Newborn , Leg/surgery , Methods , Radiography , Transplantation, Autologous , Twins, Conjoined/diagnostic imaging , Twins, Conjoined/rehabilitation , Urinary Bladder, Neurogenic/etiologyABSTRACT
Between 1947 and 1964, 32 infants in the first two weeks of life were seen at The Hospital for Sick Children, Toronto, with radiological evidence of free air in the peritoneal cavity. The clinical picture and the radiological signs in these infants are described. Perforations were found at all levels of the gastrointestinal tract. The overall mortality rate was 59%. The stomach was the most common site of perforation; it occurred in 11 children, of whom five survived. Prompt surgery was essential for survival, but when immediate laparotomy is not practical, abdominal paracentesis may prove to be life-saving.
