Herek O

Gastroesophageal reflux: A determinant in the outcome of caustic esophageal burns

Deep circumferencial burns of the esophagus always result in stricture formation and obstruction of the lumen. The usual treatment of caustic esophageal strictures is long-term esophageal dilatations. A new method of treatment, long-term stenting of the strictured esophagus gave superior results when compared with the classic dilatation therapy (healing rates, 68% v 33%; P < .01). Although success in the stent group was very satisfactory, the 32% failure rate requires explanation. In the years between 1991 and 1993, 53 stent-treated patients were screened for gastroesophageal reflux (GER). All patients were investigated with 24-hour ambulatory distal esophageal pHmetry. In 18 patients reflux index (RI) was found to be below 4. In 14 patients RI was between 4.1 and 19. In the final group of 21 patients RI was over 20 (minimum, 21.8; maximum, 72.8). When these data were compared with the healing rates of the patients, it was found that none of the 21 patients with RI over 20 responded to the described therapy. We conclude that the esophagus, after a serious caustic insult, not only narrows but also shortens thus altering the lower esophageal sphincter function leading to serious GER. Therefore all caustic esophageal burn patients should be screened for GER periodically during the dilatation or stent therapy programs, and GER should be controlled before RI approaches 20.

Microphthalmos associated with esophageal atresia

The authors report on a neonate who had esophageal atresia and tracheoesophageal fistula associated with unilateral microphthalmos and glandular hypospadias. Primary repair of the esophageal defect was accomplished in the first week of life. This is the first report of such a combination of congenital anomalies.

Abdominoscrotal hydrocele: case report and review of the literature

Abdominoscrotal hydrocele is a collection of fluid in the tunica vaginalis extending through the inguinal canal into the abdominal cavity. Although this rare type of hydrocele was first described by Dupuytren in 1834, only 16 pediatric cases have been reported in the literature to date. On the basis of our own case and those described in the literature, the clinical features, diagnostic procedures, and operative therapy are summarized and discussed.

High-pressure oxygen insufflation to facilitate submucosal dissection in Soave's operation

The aim of the present study is to demonstrate a new, simple method of facilitating the submucosal dissetion that is the most difficult and timeconsuming part of Soaves operation. For rectal submucosal dissection, oxygen under high pressure is insufflated via a needle inserted into the submucosal space at a level just above the peritoneal reflection of the rectum down to the anal canal. The technique has been successfully used in 35 cases of Hirschsprungs disease. A considerable reduction in the operating time and the incidence of iatrogenic mucosal perforations could be achieved. We conclude that the method is time-saving and provides safety during a period of the operation where scrupulous care is needed.