Long-term follow-up of patients with congenital diaphragmatic hernia.

A long-term follow-up was carried out on 30 patients who had congenital diaphragmatic hernias operated on over a 21-yr period. The review took the form of clinical examination, chest x-rays, pulmonary function tests, and lung scans. Lungs that were hypoplastic at birth remained underdeveloped as judged by pulmonary function tests and hypoperfusion on lung scan; however, children who survived birth6 and operative repair went on to live normal lives through the period studied. There was some suggestion from pulmonary function tests and lung scans that in the older group a preemphysematous state may exist but this was asymptomatic. There was no evidence of increased susceptibility to respiratory infection in the group. Ten per cent of the children were mentally retarded, evidently from hypoxia after birth.

Liver scanning in patients with suspected metastatic malignant disease.

Liver scans of 72 patients with suspected malignant disease were evaluated to determine the accuracy of the investigation in detecting disease, including metastases and also its use to the referring surgeon. A comparison between the liver scan result and clinical and biochemical findings was also made. The liver scan had an overall accuracy of 83% in diagnosing metastases, compared with 64% for the serum alkaline phosphatase (SAP) level and was more useful clinically than the SAP level. Careful classification of the liver scan patterns allowed more consistent interpretation and improved the specificity of the diagnostic information obtained. Clinical assessment of liver and spleen size by abdominal palpation was unreliable and occasionally misleading.