Bernard L. Tucker

Pleural Empyema in Children

n the late 1950’s a tremendous increase in the incidence of staphylococcal pneumonia and empyema occurred throughout many of the I pediatric centers in the country. This increase was thought to have been caused by the emergence of antibiotic-resistant strains of bacteria [3]. Several papers appeared in the literature reflecting this changing pattern [4, 6, 71, and some strict rules for surgical management were advised in order to decrease mortality in this disease [6]. Formerly, this mortality ranged from a high of 100% in some series [l] to about 25% in other centers [5, 61. The generally accepted surgical routine was to insert a chest tube in all children who exhibited pleural fluid containing gram-positive cocci. This was followed frequently by conversion to open drainage with or without rib resection, and finally decortication if there was no definite improvement in two or three weeks and a captive lung was assumed to be present. Strict adherence to these principles brought the mortality down to around 10 or 12% [6]. Since about 1962, pleural empyema in children, particularly that due to staphylococci, has become less virulent, probably entirely as the result of newer antibiotic agents. Now certain transgressions can be taken from the older rules of management in order to shorten the hospital stay and decrease the discomfort of these children. It is the purpose of this paper to review the experience with all children diagnosed as having primary pneumonia and secondary empyema over the past 20 years at the Children’s Hospital of Los Angeles, in order to compare present-day management with that practiced 10 years ago.

Postoperative Infection with the Automatic Implantable Cardioverter Defibrillator: Clinical Presentation and Use of the Gallium Scan in Diagnosis

This report describes three patients with infection involving an automatic implantable cardioverter defibrillator. All three patients presented with fever, fluid in the pulse generator pocket, leukocytosis and an elevated erythrocyte sedimentation rate. A gallium scan, together with aspiration and culture of the fluid from the pocket, confirmed the diagnosis in each case.

Renal transplantation in young children

Abstract Thirty-one children, aged one and a half to twelve years, received thirty-six renal allografts from fourteen living related donors, one living unrelated donor, and twenty-one cadaver donors during a five year period of study. Twenty-five of the thirty-one children (81 per cent) are presently alive with functioning allografts (twenty first and five second transplants); five children (16 per cent) have died and one child (3 per cent) is undergoing repetitive hemodialysis while awaiting a subsequent graft. The medical and surgical complications and rehabilitative aspects of the treatment program are delineated in detail to emphasize the acceptability of young children as candidates for renal transplantation.

Cardiopulmonary arrest: Evaluation of an active resuscitation program☆

Abstract Cardiopulmonary resuscitation efforts in response to an emergency call are analyzed as to effectiveness in 302 patients. Over a seven year period there had been a marked improvement in the success rate of resuscitation. The reasons for this are the recognition of the patients most likely to suffer cardiac arrest and the monitoring of these patients closely in special units where nurses trained in resuscitation are constantly in attendance.

Survival after embolization of a complete prosthetic aortic valve to the aortic arch

Partial dehiscence and embolization of poppets, leaflets, and discs are well-known complications of mechanical valve prostheses. Dehiscence with embolization of an entire prosthetic valve is rare. Previous reports of dehiscence and embolization of an entire prosthetic valve are associated with fatality and are the subject of autopsy reports. We report a patient who survived an operation (using cardiopulmonary bypass and total circulatory arrest) to retrieve an embolized prosthetic valve.

A Method for Insertion of a Stented Xenograft Valve in the Atrioventricular Position

To facilitate the insertion of prosthetic valves, holders are available which keep the poppet out of the area of suture insertion or keep the open ends of the struts occluded. No such holders are available for use during insertion of xenograft valves, and it seems unlikely that one could be used, for danger of damage to the valve leaflets. To obviate this problem, we have brought the flexible struts together with a suture at the time of insertion. The struts assume their original open position upon cutting the suture.

How to Shorten, Lengthen, or Untwist Saphenous Vein Grafts

A simple method is described to correct saphenous vein bypass grafts that inadvertently have been made too long or too short or have become twisted. The essential feature of the technique is the use of a Satinsky vascular clamp to hold the divided ends of the vein and maintain their alignment during the repair. The most accessible portion of the vein is used as the site for the repair, leaving the aortic and coronary artery ends of the graft intact. While we have not had need to use the technique frequently, we have found it to be a simple method and believe it to be useful when such instances arise.