Lewis Spitz

Experimental production of cystic dilatation of the common bile duct in neonatal lambs

A reliable experimental model for the study of cystic dilatation of the extrahepatic biliary system has been produced purely by ligation of the distal end of the common bile duct in the newborn lamb. Six of nine experimental lambs surviving the immediate postoperative period lived for periods ranging from 27 to 40 days. All six developed cystic dilatation of the common bile duct.

Idiopathic constipation in childhood is associated with thickening of the internal anal sphincter

This study was undertaken to search for a rational basis for the use of anal dilatation and internal sphincterotomy as the treatment for chronic intractable constipation in children. Sixteen children, age 5 months to 13 years, who had constipation resistant to conservative treatment were compared with 39 age-matched controls. History and current symptoms were assessed using a standard questionnaire. Internal and external and sphincter morphology was assessed on clinical examination and by anal endosonography, using a 10-MHz rotating endoprobe to provide accurate measurement of the various components of the anal canal. The control group showed a linear correlation between the thickness of the internal anal sphincter and both age and weight, increasing from 0.4 mm in infancy to 0.9 mm in adolescence. Children who had constipation displayed significant thickening of the internal sphincter (range, 0.5 to 1.9 mm, P = .005) which was independent of the length of the history (P = .103). There was no difference in the morphology of the external anal sphincters between the groups. The finding of a hypertrophied internal anal sphincter could provide a rational basis for anal dilatation and internal sphincterotomy as treatment for idiopathic constipation.

Malignant tumors of the small bowel in neonates presenting with perforation

Abstract Two cases of primary malignant small bowel tumours causing intestinal perforation in the neonatal period were treated by surgical excision only. Followup ( 5 1 2 years and 3 months) has failed to reveal recurrent disease in either case.

Ileal atresia secondary to anternatal strangulation by a ruptured omphalocele

Abstract Late intrauterine vascular catastrophe is a well-documented cause of small intestinal atresias. 1–4 In relatively few clinical situations is their pathogenesis as clearly demonstrated as in the case reported here.

The separation procedure

The various stages of the separation are carefully planned but despite this, variations which will change the schedule of the procedure may exist. In general the operation commences on the opposite side from the main procedure and then the twins are turned for the remainder of the operation. Each type of conjoined twin is different but basically thoracopagus involves the hearts, omphalopagus involves the liver and small intestine and ischiopagus involves the large intestine and genito-urinary system. Our results are presented together with interesting cases from which lessons have been learned.