John Bowen

The calcifying epithelioma of Malherbe in children: a 15-year experience

The calcifying epithelioma of Malherbe is a benign tumour of hair-cell matrix, from which it derives its name of pilomatrixoma. Although a relatively benign lesion, diagnostic difficulty may arise and the definitive diagnosis of these firm subcutaneous tumours is often made only after histological analysis. Over 15 years, 46 patients have had 51 lesions excised. A brief historical overview is presented.

Cholelithiasis in early infancy

This report describes three children, age range 7 weeks to 5 months, who presented with obstructive jaundice secondary to gallstones. Previous Escherichia coli septicaemia and frusemide therapy were predisposing risk factors in two of the patients. All three were successfully treated with cholecystectomy and exploration of the common bile duct.This report describes three children, age range 7 weeks to 5 months, who presented with obstructive jaundice secondary to gallstones. PreviousEscherichia coli septicaemia and frusemide therapy were predisposing risk factors in two of the patients. All three were successfully treated with cholecystectomy and exploration of the common bile duct.

Adenocarcinoma of the appendix in a child

Adenocarcinoma of the appendix is unusual at any age but occurs mostly in an elderly population. The authors report a unique case presenting in a 10-year-old child and emphasize the importance of subjecting all resected specimens to histological examination.

Splenic regeneration does not occur after sub-total splenectomy

The case of a 6-year-old male undergoing sub-total splenectomy after a trivial fall is described. Although the remaining spleen survived, no increase in splenic bulk had occurred 8 years later as measured by isotope scan.

Case report: the transvesical approach to a traumatic rectovesical fistula

Abstract. A case of traumatic rectovesical fistula in a 14-year-old boy is presented. A transvesical approach was employed to access the defect. This approach provided excellent exposure, ease of surgery, and an uncomplicated post-operative course. The operative procedure is described, and aspects of the case are discussed.

Horner’s syndrome with an ipsilateral X nerve palsy following presumed shingles

Herpes zoster is a common clinical problem but its complications, apart from post-herpetic neuralgia, are comparatively rare. We describe a case of Horner’s syndrome and ipsilateral vagal paresis following likely herpes zoster of the third and fourth cervical roots. This unusual combination has not, to our knowledge, been previously described.

The flank approach to the porcine upper urinary tract: safe and reliable

An extra-peritoneal flank approach was used to gain access to the left pelviureteric junction of 8 young pigs. The operative procedure was simple and took 15 min to complete. There were no serious complications, analgesia requirements were negligible and all animals re-established on feeds within 12 h post-operatively. The operative procedure is described; due to the above considerations the flank approach to the porcine kidney can be recommended.

A rare congenital neck lump

We describe the case and present a radiological image of a neck lump identified antenatally with ultrasound imaging. Postnatally a left-sided asymptomatic neck lump was identified in the left posterior triangle of the neck. Repeat ultrasound and CT imaging were arranged confirming a cyst adjacent to the cervical oesophagus and displacing the carotid sheath anteriorly. Complete cyst excision was achieved with no complications. Histological analysis identified a 30×22×20 mm cyst with a smooth muscle layer within the cyst wall and a lining of respiratory epithelium. These findings were consistent with a diagnosis of cervical duplication cyst (CDC). Proximity to the carotid sheath and oesophagus can make CDC excision potentially dangerous hence preoperative CT scanning was useful to establish the anatomical relations of the cyst in this case.

Venous loop fistula for vascular access in childhood haemodialysis

Seven children on chronic haemodialysis have received in-situ venous loop arterio-venous fistulae for vascular access. The saphenous vein was used in five patients and the basilic vein in two. The patency rate was 71.4% with two loops being lost due to thrombosis. Long-term needling has been successful in both sites.