Jacob Mordehai

Tracheal rupture after blunt chest trauma in a child

Blunt traumatic tracheal rupture is a life-threatening injury. The authors report on a 14-year-old boy who suffered such an injury in a road accident, underwent surgery immediately, and survived. The relevant literature is reviewed.

Isolated Torsion of the Fallopian Tube in Premenarcheal Girls

The authors report on two premenarcheal girls, ages 4 and 13 years, with isolated torsion of the fallopian tube, an extremely rare condition. The fallopian tube was salvaged by detorsion in the younger girl, the first salvage described in the English literature on children. The mechanism of the isolated torsion and the clinical implications are discussed.

Necrotizing fasciitis and myonecrosis in early childhood: a report of three patients.

Necrotizing fasciitis (NF) is a rare and life-threatening disease. It usually presents as a postoperative complication, but rarely appears following trauma or without apparent cause. Over a period of 2 years we have treated three infants with NF, aged 15, 5, and 30 months, respectively. Two patients developed this complication following minor trauma while the third was post-elective bilateral inguinal hernia repair. The micro-organisms isolated wereStaphylococcus aureus withEnterococcus durans in one patient, β-hemolytic streptococcus in a second, andStaph. aureus in the third. The cornerstone of therapy is prompt, early, aggressive surgical debridement of the massive necrotic tissue and repeated debridement if necessary, with appropriate parenteral antibiotic therapy and hyperalimentation. All three patients survived. Early recognition of this life-threatening situation is mandatory in achieving survival.

Thoracoscopic Upper Thoracic Sympathectomy for Primary Palmar Hyperhidrosis in Children and Adolescents: A Ten-Year Experience

We report our initial experience, over the past 3 years, with thoracoscopic sympathectomy for severe, primary, palmar hyperhidrosis in children and adolescents. From 1992-1995, 179 thoracoscopic sympathectomies were performed in 61 girls and 35 boys, 5.5 to 18 years old (mean 14.8). During the first 2 years the procedures were performed bilaterally but not simultaneously. During the past years, 65 underwent bilateral, simultaneous sympathectomy, using a single 10 mm subaxillary port of entry. 94 (98%) had immediate and permanent relief of palmar sweating. The immediate postoperative course was uneventful in all except 2 who had residual pneumothorax that required 24-hour intercostal drainage. These results compare favorably with the open method and are actually better in terms of less pain, early discharge, quicker return to normal activity and a smaller and less conspicuous scar. We emphasize the benefits of early surgery in children with severe, palmer hyperhidrosis, to avoid the many years of psychological, social and physical discomfort during adolescent growth and development.