Clifford D. Benson

Congenital atresia and stenosis of the colon

Abstract To the 53 cases of successfully treated colonic atresia and stenosis 16 previously unreported cases are added. Resection and primary anastomosis is advocated for colonic atresia proximal to the splenic flexure, and proximal colostomy and subsequent resection and primary anastomosis is recommended for similar lesions beyond the splenic flexure. Routine contrast enema is suggested in all patients with jejunal or ileal atresia or stenosis to avoid overlooking an associated colonic atresia or stenosis. Of 209 infants operated upon for gastrointestinal atresias and stenosis, 22 or 10.5 per cent were colonic in a 22-year period. Sixteen of the 22 infants survived.

Infantile pyloric stenosis: A review of 1,120 cases

Abstract 1. 1. In a twenty-three year period (1940 to 1963) 1,120 infants were treated for infantile pyloric stenosis. 2. 2. The classic Ramstedt pyloromyotomy was performed in 1,119 infants with a mortality of 0.54 per cent. 3. 3. Seven deaths occurred in 1,120 patients for an over-all mortality of 0.62 per cent. 4. 4. Seven hundred seven patients were examined between the years 1940 and 1956 and 413 patients between the years 1956 and 1963. Certain comparisons between these two groups of patients are analyzed and discussed. 5. 5. Age, sex and color incidence are presented. 6. 6. Complications, recurrence and mortality are reviewed.

Bochdalek hernias in infants: factors determining mortality.

From 1950 through 1974, 76 infants with Bochdalek hernias have been surgically repaired. Mortality has been confined to those admitted at under 30 hr of age, and the highest mortality has been among those infants admitted within the first 8 hr of life. A recent increase in mortality is explained by the arrival of a new group of infants who arrived intubated, had large diaphragmatic defects, required postoperative ventilatory assistance, and had hypoplastic lungs at autopsy. Six infants might have benefited from an early intervention to hasten closure of their patent ductus arteriosus. Since we cannot be positive that intubation of these infants prior to arrival will not have a deleterious effect, we urge great discretion in choosing which infants to intubate.

Surgery of the biliary tract in infants and children

Abstract 1. 1. All infants and children with jaundice or having a history of repeated jaundice should be carefully investigated under the joint supervision of the pediatrician and surgeon. 2. 2. Surgical exploration is indicated when jaundice is present and persists. The reported good results from surgery in this condition warrant more serious consideration than they apparently have received in the past. 3. 3. In older children with persistent jaundice due to biliary tract disease, cholecystostomy and possible drainage of the common duct should be considered. 4. 4. Cases of jaundice of extrahepatic origin after clinical and laboratory investigation, fall in a group which should be considered as requiring surgical intervention.

The management and treatment of empyema in children

Abstract 1. 1. The three fundamental principles propounded by the Empyema Commission still form the basis of our modern therapy of empyema. 2. 2. A uniform method of treatment combining the principles of open and closed surgical drainage is presented. 3. 3. Four hundred and seven children with empyema were treated by this method over a ten-year period (1926–1936) with a mortality of 10.3 per cent. Thirty-five additional patients with empyema were treated by the same method during 1936–1937 with a mortality of 8.6 per cent. 4. 4. There is a definite parallel between the mortality of pneumonia and empyema in any given series of cases treated over a period of years. 5. 5. The frequent use of fluoroscopic and Roentgen observation is very necessary in the follow-up period of treatment to gain the best results. 6. 6. Patients showing evidence of scoliosis complicating the empyema should be placed on a Bradford frame. 7. 7. Where reexpansion of the lung is slow, the Wangensteen method of suction materially shortens the period of morbidity. 8. 8. In treating empyema, individualization must be practiced, since each patient demands his own particular form of therapy. 9. 9. Cases are presented illustrating the various types of empyema and their subsequent treatment including results. 10. 10. The following recommendations are made: 10.1. ( a ) The combined interest of the pediatrician, roentgenologist, and surgeon is important in the careful management of a child ill with empyema. 10.2. ( b ) Careful clinical and roentgenologic examination (anteroposterior and lateral positions) is necessary. 10.3. ( c ) Aspiration for diagnostic (culture of pus) and therapeutic purposes should be done up to the point of frank pus. 10.4. ( d ) The combined method of trocar-cannula-catheter drainage followed by open drainage is recommended. 10.5. ( e ) Attention to details which include blood transfusions as indicated, preservation of the normal water balance and nutritional status of the patient are essential to successful management.