Hugh B. Lynn

Rhabdomyosarcoma in infants and children: A clinicopathologic study of 75 cases

Summary A clinicopathologic study was made of 75 patients, 15 years of age and younger, with rhabdomyosarcoma; 60 are dead; 9 have been living for 5 or more years and are apparently free of disease, while 4 have been living free of disease for periods ranging from 2 months to 31/2 years, and 2 are alive with uncontrolled metastasis. When practicable, ablative surgery appears to be the most effective treatment. When radical surgery is not feasible, irradiation combined with chemotherapy and as wide a surgical removal as possible seems to be the best alternative for control of the primary lesion. The chemotherapeutic agent most frequently used in this series was dactinomycin. Survival for 2 years after definitive treatment without evidence of recurrent or metastatic tumor is a reasonably good indication that the child may be cured.

Mediastinal Tumors and Cysts in the Pediatric Patient

The detection of mediastinal masses in children on routine roentgenograms should lead to further studies; the lack of symptoms should never be taken as an indication that the lesion is benign. The high incidence of malignancy in mediastinal tumors of infants and children makes thoracotomy a logical diagnostic and therapeutic step.

Bilateral teratoma of testis in an infant

Abstract Germ-cell tumors, which comprise more than 95% of testicular tumors, have an incidence of three per 100,000 of the male population. 1 These tumors are rare in infancy and childhood; they account for less than 5% of testicular tumors. 2,3 Nevertheless, among malignant diseases of pediatric patients, they rank seventh in frequency, 4 with most occurring during the first 4 yr of life. 2 About 30% of the testicular tumors of germinal origin found in the prepubertal period are teratomas, which occur slightly less frequently than do embryonal carcinomas or orchioblastomas. 5 In 1957, Phelan et al. 6 reviewed 464 childhood testicular tumors reported between 1923 and 1955 and found 48 teratomas; none were bilateral. Since then an additional 60 childhood teratomas have been described. Houser et al. 5 tabulated 14 of these; the remaining cases, with various degrees of documentation, are listed in Table 1. In only one case was the teratoma bilateral, but no details were provided. 2 The purpose of this report is to document a second case of bilateral testicular teratoma in a prepubertal child and to discuss the therapeutic problem posed by this rare situation.

Peptic ulceration in childhood.

The signs and symptoms of peptic ulceration in childhood are frequently misleading, and because most physicians consider the disease uncommon, the diagnosis is often not suspected until complications supervene. Experience with 81 gastric and duodenal ulcers in 78 children is reviewed.

Rupture of the bronchus

Abstract Traumatic rupture of the left main bronchus in an 11-year-old boy, with pneumothorax and recurrent lung collapse was verified by bronchoscopy and bronchography. On the fourteenth day after injury, the stenosed, perforated, and inflamed zone of bronchus was excised and end-to-end anastomosis accomplished. Complete recovery has been maintained through a 2-year follow-up. This case confirms the consensus of published reports concerning early repair.

Pulmonary arteriovenous malformations in children

Pulmonary arteriovenous malformations are a life-threatening, but curable, cause of persistent cyanosis in children. Abnormal communications may be single or multiple and are usually in the lower lobes. Three patients with pulmonary arteriovenous malformations have recently been managed at this hospital. Ranging in age from 2 to 4 yr, all were female, all were from families with Rendu-Osler-Weber syndrome, and all underwent pulmonary angiography with confirmation of diagnosis. All have had uneventful resection, one of the left lower lobe, one the right upper lobe, and the other the right middle and lower lobes.

Tracheostomy in Infants

Tracheostomy is often considered a terrifying procedure and one to be avoided at all costs in infants and small children. This contributes to the delay in delivering necessary care to the patient at the optimal time. In a child, the return to normality after tracheostomy and the possibility of a “four score and ten” survival are indeed rewarding.

Acute Pancreatitis with Biliary Disease in Erythrocyte Pyruvate-Kinase Deficiency Case Report and Comments on Management

From the Mayo Clinic and Mayo Foundation: Section of Surgery (Dr. Lynn), and of Medicine (Dr. Hill). Mayo Graduate School of Medicine (University of Minnesota), Rochester: Resident in Surgery (Dr. Mahour), Rochester, infinn. 55901. H’ E cause of most episodes of acute pancreatitis in children remains unknown; x. when evident, the cause is usually abdominal trauma.9 Acute pancreatitis secondary to biliary duct dis-

Acute Nóncalculous Cholecystitis in a Three-Year-Old Child: Report of a Case Diagnosed at Operation

Several generalizations emerge from these studies and are illustrated by our three-year-old patient. Cholecystitis in childhood is “very uncommon, probably rare,” and, “Certainly choledocholithiasi...

Simple method of elongating a colonic segment for esophageal replacement

Abstract Occasionally the surgeon is confronted with a major problem that can be solved easily if he has been alerted to an applicable and simple maneuver. Several years ago Najafi and Beattie 1 employed such a maneuver in elongating a piece of colon to bridge a gap in an adult with extensive stricture of the esophagus. Although their technique would not seem feasible with the colon of an infant, they did call attention to the fact that the teniae coli, rather than the blood supply, limited the stretching of the colonic segment. It is this point that deserves emphasis and justifies the following report.