Peritoneal drainage and ileostomy as a treatment for the acute necrotising enterocolitis.

Between 1982 and 1987, in the "Centre néonatal" of Rocourt (Belgium), 18 cases of necrotising enterocolitis have been operated upon during the acute stage of the disease. The authors explain the advantages and the disadvantages of the classical surgical procedures: laparotomy with exploration of the colon and resection of the necrotic segments followed by immediate reanastomosis or by enterostomy above the resected area. They recommend, however, a minimal laparotomy in the right lower quadrant with ileostomy on the terminal ileum without exploration of the colon or resection of the necrotic segments. The advantages of this technique are: minimal impairment of the general condition which increases the chances of survival; possibility to perform the resection later on when general and local conditions have improved; possibility for the lesions to heal spontaneously with short stenotic segments. Only 1 death among the 18 patients during the acute stage and none during the secondary procedures. In most of the cases, an economical resection could be performed with preservation of as much as possible of the normal bowel.

Liver transplantation for biliary atresia: indications and results.

This report reviews the results of some paediatric surgical departments and points out the unsolved problems in biliary atresia disease. The authors conclude that a 5-year survival rate of 60% may be achieved in long-term follow-up, but a complete cure is observed only in 30%. Children who develop a cirrhosis and portal hypertension without or in spite of bile flow can benefit only by liver transplantation. As a result of long-term clinical experience conditions are defined that should be taken in consideration in the surgical treatment of bile duct atresia. In respect of liver transplantation the disadvantages of an external bile draining fistula to prevent cholangitis, an extensive mobilisation of the liver for HPE procedure, and the disadvantages of reoperation are discussed. By avoiding these disadvantages liver transplantation procedure will be facilitated and a 1-2 year survival rate of 80% may be achieved.

Human follicular oocytes and their maturation in vitro.

To study the maturation of follicular oocytes, germ cells were flushed from visible follicles in the ovaries of 145 oophorectomized patients 17 to 65 years of age. The number of oocytes recovered decreased (P less than 0.05) as patient age increased. More oocytes (P less than 0.05) were recovered from ovaries removed during the proliferative stage of the menstrual cycle than during the secretory stage. Of 776 oocytes obtained, 132 (17%) were examined without incubation. Two had matured in vivo and another possessed two vesicular nuclei. Of 124 oocytes incubated in tissue culture Medium 199 or Ham's F10 supplemented with 10% fetal calf serum, 52 (42%) displayed germinal vesicle breakdown and 39 (31%) progressed to metaphase of the second meiotic division within 42 hours. Neither the stage of the cycle at which ovaries were removed nor the addition of progesterone to the medium had a significant effect on maturation. The rate of maturation peaked with oocytes from women 34 to 39 years of age. Even though more oocytes were recovered from patients 17 to 33 years of age than from patients 34 to 39 years, fewer oocytes obtained from the younger patients appeared to be viable, perhaps because of a greater incidence of ovarian follicle pathology in the youngest group.