Abraham J. Mares

The aberrant cervical thymus. Embryology, Pathology, and clinical implications.

Cervical thymic anomalies are not as rare as previously suggested. Six cases were encountered over a relatively short period of time, prompting us to report them and emphasize the importance of this entity. Five of the six patients were children, two of them infants less than one year old. The occurrence of thymic remnants in the neck of young children is not surprising, considering the nature and behavior of the thymus at different stages of life. After a brief embryologic survey, the various types of cervical thymus (solitary ectopic, cystic, or partially arrested descent) and their pathogenesis are discussed. The rare occurrence of thyroid and parathyroid tissue within the mass of a large cervical thymic cyst is reported and evaluated. Cervical thymic lesions can either be symptomless or cause severe dyspnea and dysphagia, especially in the young infant. Accurate diagnosis and an intelligent surgical approach in the child with a cervical mass can avoid the obvious parental apprehension and lead to the correct treatment. Symptoms due to pressure on neighoring structures are promptly eliminated after excision, and prognosis is excellent.

Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis—the combined paediatric, adolescents and adult experience

OBJECTIVE To present our experience, over the past 4 years, of thoracoscopic upper thoracic sympathectomy in patients with primary palmar hyperhidrosis. DESIGN Retrospective study. SETTING University hospital, Israel. SUBJECTS 402 thoracoscopic upper thoracic sympathectomies in 223 patients over a period of 4 years. INTERVENTIONS Thoracoscopic ablation of ganglia and severing of the sympathetic chain at the level of T2 and T3. 142 patients underwent bilateral simultaneous sympathectomy, 37 had bilateral non-simultaneous sympathectomy and 44 had unilateral sympathectomy. RESULTS 220 patients (98.7%) had an uneventful postoperative course and were discharged the following day. Three patients with residual pneumothorax required intercostal drainage and were discharged on the third postoperative day. 219 patients (98.2%) were completely satisfied, having immediate and permanent relief of palmar sweating. Four patients were dissatisfied. CONCLUSION The thoracoscopic approach to the upper thoracic sympathectomy is at present the procedure of choice. Early operation for severe palmar hyperhidrosis is indicated to save a child many years of frustration and discomfort.

The laparoscopic approach to uterine adnexal torsion in childhood.

Seven girls with adnexal torsion (of varying degrees) were treated laparoscopically during a 6-month period. All had associated adnexal pathology. Six had simple follicular cysts (> 4 cm in diameter), and one had a 10-cm dermoid cyst. Detorsion with resection of the cyst and preservation of ovarian tissue was performed in all cases. No intraoperative or postoperative complications were encountered. Video-assisted minimally invasive surgery is suitable for the treatment of adnexal pathology in children; the hospitalization period is short, the cosmetic results are excellent, and the return to normal activity is rapid.

Comparative experimental study of esophageal wall regeneration after prosthetic replacement

This study compares three prosthetic materials for potential use in patching and bridging congenital and acquired esophageal defects. The study was divided into two parts. In the first part, full-thickness, 6-cm2 cervical esophageal defects were induced in three groups of young mongrel dogs and were replaced with patches of lyophilized dura mater (Lyodura), polyethylene terephthalate (Dacron), or expanded polytetrafluoroethylene (PTFE). The dogs in the Lyodura subgroup were scheduled to be sacrificed after 1, 2, 4, 8, and 12 weeks and the dogs in the PTFE and Dacron subgroups were sacrificed after 1, 2, 3, 4, 6, and 7 months. The patched esophagus was removed for gross and microscopic examination. In the second part of the study a segment of the esophagus was excised in another three groups of dogs and replaced with 3 x 2 cm tubes of Lyodura, Dacron, or PTFE. Here the follow-up was prolonged and included radiological, endoscopic, and histological assessment. The dogs of each subgroup were scheduled to be sacrificed after 6, 8, and 12 months. Results indicated that lyophilized dura mater covered and neoepithelialized the patched area within the shortest period of time without foreign body reaction and with only slight collagen deposit, resulting in a ductile repaired esophageal wall. Therefore, its use may be considered for replacement of partial esophageal defects. For complete circumferential defects, the present study and our review of the literature showed that there is as yet no ideal prosthetic material that promotes good incorporation but is not prone to stenosis. Further studies in this area are required.

Tracheal rupture after blunt chest trauma in a child

Blunt traumatic tracheal rupture is a life-threatening injury. The authors report on a 14-year-old boy who suffered such an injury in a road accident, underwent surgery immediately, and survived. The relevant literature is reviewed.

Isolated Torsion of the Fallopian Tube in Premenarcheal Girls

The authors report on two premenarcheal girls, ages 4 and 13 years, with isolated torsion of the fallopian tube, an extremely rare condition. The fallopian tube was salvaged by detorsion in the younger girl, the first salvage described in the English literature on children. The mechanism of the isolated torsion and the clinical implications are discussed.

The use of collagen-coated vicryl mesh for reconstruction of the canine cervical esophagus.

Abstract Collagen-coated vicryl mesh (CCVM) was used experimentally to patch partial and total segmental defects in the canine cervical esophagus. The esophageal healing process over a 6-month period with successful incorporation of the CCVM and esophageal wall regeneration are described. Twenty-two (91.7%) of 24 dogs survived the procedure without any evidence of esophageal stricture or dysphagia. CCVM has proved to be a suitable material for substitution of esophageal tissue in the canine model. Its clinical use in congenital and acquired esophageal lesions should be considered only pending further experimental laboratory work.

Bridging of esophageal defects with lyophilized dura mater: An experimental study☆☆☆

The aim of this study was to investigate the use of a prosthetic biologic material-lyophilized dura mater (Lyodura) in patching esophageal defects in dogs, having in view its potential use in bridging long gap congenital esophageal atresia and patching acquired esophageal defects. To follow the incorporation process, 20 mongrel dogs had full-thickness, 6 cm2 cervical esophageal defects, patched with Lyodura. The dogs were sacrificed at different postoperative periods and the patched esophagus removed for gross and microscopic examination. In a second group of 10 dogs, a segment of the esophagus was excised and replaced by 3 cm in length and 2 cm in diameter, Lyodura tubes. In this group, prolonged follow-up was undertaken including radiologic, endoscopic, and histological assessment. Special attention was given to the swallowing function and to growth and development. This study shows that: (1) the area of prosthetic replacement was characterized by a narrowing of the esophageal wall and the histopathologic study showed that the epithelialization process was complete in about 2 months; and (2) muscle reconstruction did not take place at the patched areas. We conclude that, pending further studies and improvement, lyophilized dura mater can be considered as a successful alternative for bridging esophageal defects.

Pulmonary plasma-cell granuloma

A large pulmonary plasma-cell granuloma (PCG) mimicking a mediastinal germinal-cell tumor in a 9-year-old boy is presented. The non-specificity of the tumoral calcifications and of the radiographic and CT findings in pulmonary PCG is demonstrated.

Posterior mediastinal accessory thymus

A rare case of accessory ectopic thymus in the right upper posterior mediastinum in a 40-day-old infant is described. The clinical presentation was that of tracheal obstruction. The compression and displacement of the trachea and the identification of the mass was enabled thanks to the high KV filtration technique. The mass was further identified by ultrasonography. Surgical removal of the accessory thymus relieved the tracheal obstruction.