Constantinos A. Hajivassiliou

Evidence of cognitive visual problems in children with hydrocephalus: a structured clinical history-taking strategy

Damage to the occipital cortex in children can result in many complex disorders of cognitive visual function. A series of clinical questions, developed from the specific problems of a cohort of children with cortical visual impairment, was asked of the parents of 200 children with no history of cerebral pathology, aged 5 to 12 years. One hundred and ninety‐two parents gave reliable consistent responses. The results show a progressive improvement in performance with age, culminating in few 11‐ and 12‐year olds having frequent problems, apart from 8% having frequent difficulty with orientation in new surroundings and 2% having problems with simultaneous perception tasks. The parents of 52 children (aged 5 to 17 years) with shunted hydrocephalus were then asked the same set of questions. Evidence of cognitive visual problems was identified in 27 of these children of whom 16 manifested multiple difficulties. The disabilities identified by our study comprised problems with: shape recognition, simultaneous perception, perception of movement, colour perception, orientation, object recognition, and face recognition. The range, nature, and combinations of these disorders are presented in this paper.

Ectomesenchymoma: One or two tumors? case report and review of the literature

Ectomesenchymoma has not previously been reported in a patient with the cutaneous nevus syndrome. A case of perineal ectomesenchymoma is presented with unusual cytogenetic findings. The significance of these is discussed and the world literature reviewed. This is the first such case reported.

Fiberoptic localization of the upper pouch in esophageal atresia

This report describes a technique that the authors developed as a simple, quick means of identifying the proximal pouch in neonates with esophageal atresia by fiberoptic instrumentation.

Central Venous Access

Approximately 200,000 central venous lines (CVLs) are inserted in the UK annually and a significant proportion are indwelling lines inserted for the administration of chemotherapy or to serve the other needs of patients with oncological problems.

Acute urinary retention in a neonate due to a mucus plug

A 12-hours postpartum male newborn with urinary retention was referred to us for assessment. There was no history of oligohydramnios, and there had been no witnessed micturition after birth. On examination, the neonate was in distress and crying. His abdomen was distended, tense, and tender. The external genitalia were normal. On gentle retraction of the foreskin, a plug of mucus-like substance was revealed, blocking the external urethral meatus (Fig. 1). After cleansing the foreskin with chlorhexidine solution, catheterization of the urethra was attempted with a 6F feeding catheter lubricated with Lignocaine gel 2%. The tip of the feeding tube was used as a probe, and the mucus plug was partially removed, revealing the normal external urethral meatus. The feeding tube was inserted easily into the urinary bladder and drained clear urine. The remaining mucus plug was gently peeled off with a chlorhexidine swab, and the catheter was removed 12 hours later. After removal of the catheter, there were no episodes of urinary retention. Urinalysis and urine cultures were normal, and a micturating cystourethrogram showed a normal outline of the urethra and the urinary bladder. On follow-up examination at 1 month, 6 months, and 1 year, micturition was reported normal by the parents. Urinary retention in the newborn is a very rare condition. The most common cause for urinary retention in the newborn is the presence of posterior urethral valves [1]. Anterior urethral valves, which can be connected with urethral diverticula [2], are a much rarer cause [3]. A case report of complete distal urethral obstruction by a meatal membrane in a newborn boy is the only reported case found in a PubMed search [4]. However, in the latter case, after removal of the membrane, a hypospadias meatus was noted, and further investigation of the patient showed that the upper urinary tracts were affected. Pathology that affects micturition and arising from the navicular fossa of the urethra could be related to the glandules of Littré in adults [5], but there is no similar reference related to newborns in the international literature. Complete obstruction of the urethra during gestation leads to the development of upper urinary tract damage. Investigation of the urinary tract in our patient was normal. Therefore, we are led to the conclusion that the mucus plug must have developed in the external urethral meatus very late in the prenatal period.

European Counterpoint to Chapter 14

There are few conditions more socially devastating than urinary incontinence. The incidence of incontinence is underreported and underestimated. It represents an enormous social and psychological problem. Many methods of treatment have been tried, including penile clamps (1,2), external collecting devices, indwelling catheters, surgery to increase the resistance of the bladder neck and urethra, electrical stimulation (3,4), and supravesical urinary diversion (5,6), but none are ideal (6). For those patients whose incontinence has failed to respond to conventional means, the best option is usually implantation of an artificial urinary sphincter (AUS).

A personal audit of pediatric surgical training before implementation of the calman guidelines

PURPOSE The purpose of this study was to audit the surgical training experience of a Higher Surgical Trainee in the United Kingdom during the tenure of the posts of Career Registrar, Research Fellow, and Senior Registrar from August 1992 to July 1997. Although the Report of the Working Party on the UK Specialist Medical Training (the Calman report) was published during this study, the training remained the same because the author elected not to transfer to the new grade. METHODS A 39-field database was designed, and the surgical experience was entered prospectively. The data were analyzed chronologically according to age of patient, condition, level of supervision, and nature of admission (emergency, elective). RESULTS Two thousand two hundred ninety patients or operations are presented. Only a small number of patients underwent surgery during the research year (1994). The pattern of operating changed from one of large numbers of supervised to one of more major procedures. The numbers of neonates and younger infants who underwent surgery increased significantly, and the level of supervision changed allowing more autonomy toward the end of the training period. This trend was reversed partially during the period of overseas secondment. The results are compared with those in a recently published USA/Canadian study. CONCLUSION The volume of work undertaken by the trainee ensures adequate exposure to a wide range of procedures to achieve a satisfactory level of competence. Changes that may affect this are discussed.