Ludvig Okmian

Submucosal perforation of the esophagus in the neonate.

Excessive salivation, with choking, coughing and cyanosis on attempts at feeding in a newborn infant reasonably suggest esophageal atresia. Yet, other less common lesions may present the same signs. Of these, the simple esophagotracheal fistula, without atresia, is well known, while instances of congenital pharyngo-esophageal and true esophageal diverticula, with or without coexisting esophagotracheal fistulae, have only occasionally been reported (BRINTNALL & KRIDELBAUGH 1950, KNOX 1951, ROBB 1952 and GRANT & ARNElL 1959). An apparently even more rare disorder in the neonate with the same symptomatology is submucosal perforation of the esophagus. The clinical features and the radiologic appearances of this lesion on the basis of experience gained from two cases recently studied will be described in this communication. During its preparation, however, the records of a third case treated in another hospital became available and were included in the study. The radiologic features and the findings at operation of this third case well support the etiologic hypothesis for the disorder.

Circumcision for phimosis ― indications and results

ABSTRACT. A follow‐up study including all boys (n= 117) operated with circumcision for phimosis during 1976 was performed. Most patients were operated on an outpatient basis. Early complications like bleeding or infection were few and mild. In 13 cases there was a postoperative stricture of the urethral orifice which had to be widened. Five patients had complaints about the cosmetic result. Eight boys expressed shyness and unwillingness to undress in school‐gym. In no instance were there any signs of a more serious psychological disorder. The operative indications are discussed and it is concluded that worried parents of boys with phimosis can be safely advised to have their boys circumcised if the prepuce is scarred or there has been recurrent balanitis, or if the boy has reached school age and the foreskin is still nnretractable.

Circumcision for Phimosis: A Follow-Up Study

All 117 boys circumcized for phimosis during one year at the Department of Pediatric Surgery in Lund were subject to a follow-up study five years postoperatively. In 45 cases the main operative indication was recurrent balanitis, in 25 cases scarring of the prepuce and in 41 cases an expressed ballooning at voiding. Early operative complications included 7 cases of postoperative haemorrhage which in 1 case necessitated reoperation. In 1 case there was a postoperative infection. 13/117 patients developed a stricture of the urethral orifice necessitating meatotomy. The study included a questionnaire which was answered by 97/117 patients, 92 of whom expressed complete satisfaction with the operation. The complaints of the others were cosmetic in nature. There was in no instance any sign of more severe psychological disorder than a certain shyness which was expressed in 8 cases. It is concluded that circumcision for phimosis in young boys is complicated by meatal stenosis in a certain frequency (13/117) but not loaded with serious complications. There seems to be no reason to fear psychological disturbances due to circumcision.

Micturition Studies in Infants and Children: Technique

A method for simultaneous and continuous registration of bladder pressure and urine flow is presented. It has been tested in infants and children of various ages. The sources of error and the reliability of the method are analysed. The pressure is measured via a suprapubic bladder puncture. The urine flow is converted into gas flow, which is registered by a pneumotachograph. The method is accurate enough for it to be used even in infants.

Mucoviscidosis and Intestinal Atresia.: A Study of Four Cases in the Same Family

Observations made during recent years have again directed attention t o such prenatal mechanical factors as volvulus, intussusception and strangulation as the cause of intestinal atresia and the recanalization theory of Tandler [21] and Forssner [lo] has been refuted [15,16,17, 191. The combination of mucoviscidosis and congenital intestinal atresia has further contributed to these etiological discussions [4, 5, 14, 241. The purpose of this paper is t o describe the pathological findings in a family in which four of five siblings suffered from mucoviscidosis and two of them also had intestinal atresia. This familial concentration and the pathological findings support the theory that intestinal atresia in mucoviscidosis is probably secondary t o meconium ileus as suggested by Bernstein e t al. [4] and they furthermore t o a certain extent make i t possible t o date the development of atresia.

Esophageal Suture Anastomosis: An Experimental Study in Piglets

End-to-end suture anastomosis of the entire wall, the mucosal layer and the muscular layers of the esophagus and selective interruption of its mucosa and muscular layers were performed in a series of piglets.Healing in suture anastomosis of the entire esophageal wall and the mucosa layer alone occurred with varying degrees of tissue fibrosis, which uniformly caused reduction of elasticity at the anastomotic site.The least extensive fibrosis was encountered in anastomoses involving only the muscular layers. In these instances no reduction of anastomotic width or elasticity could be demonstrated.Mucosal interruption alone resulted in extensive fibrosis with subsequent complete obliteration of the esophageal lumen. Conversely, interruption of the muscular layers resulted in negligible fibrosis and caused neither organic nor functional obstruction.The results of this study indicate a relationship between defective mucosal contact or mucosal damage and stricture formation.

HAEMORRHAGIC CYSTITIS COMPLICATING CYCLOPHOSPHAMIDE TREATMENT IN CHILDREN

Haemorrhagic cystitis complicating cyclo‐phosphamide treatment is a serious complication. The bladder irritation is considered to be a consequence of direct contact between bladder wall and urine containing metabolites of cyclo‐phosphamide. The early symptoms are vesical tenesmus, pollakisuria and haematuria. Endo‐scopy is the essential way of diagnosing the cyclophosphamide cystitis. High daily fluid regimen and frequent voiding must be recommended as the prophylaxis of choice. Moreover the drug must be administered as a single 24‐hour‐dose in the morning. Surgical techniques differ according to the severity of the bleeding. Administration of an anti‐fibrinolytic agent proved ineffective.

Esophageal Clamp Anastomosis: An Experimental Study in Piglets

A clamp for esophageal end-to-end anastomosis has been designed and tested experimentally in 33 piglets. Eighteen anastomoses involved the entire esophageal wall, and 15 the mucosal layer alone. The results were evaluated on the basis of clinical, cineradiographic, gross and microscopic examinations. The width of the anastomoses was assessed under standardized conditions.The experience gained from the present series indicates that the sutureless technique provides a fairly tight seal for the prevention of leak. Irrespective of the type of clamp anastomosis, healing invariably occurred with anastomotic stricture.The onset of the stricturing process was early and rapidly progressive.Cineradiographic studies provided conclusive evidence of stricture and demonstrated concurrent motility disturbances in the distal esophagus.Inflation and radiography of the specimen under a standard degree of filling consistently showed reduction of lumen and elasticity at the anastomotic line.Histologic evidence demonstrated e...

Micturition Studies in Infants and Children: Influence of an Indwelling Urethral Catheter and of Rectal Pressure Recording

The influence on micturition of a 5 F urethral catheter was studied with simultaneous measurement of intravesical pressure and urinary flow in 17 boys aged 1 month-14 years. No significant effect could be shown as regards intravesical pressure. A decrease in maximum flow, particularly in infants, was found. in certain cases, particularly those with infravesical obstruction, the degree of obstruction was less with a catheter in the urethra. Suprapubic puncture is recommended as the most suitable technique for measuring intravesical pressure in infants and children. the effect of rectal pressure measurement on detrusor function was studied in 25 children aged 7 months 14 years, with simultaneous recording of intravesical pressure, urinary flow and rectal pressure. Ano-vesical inhibition induced by rectal pressure measurement could not be shown. Measurement of rectal pressure is a suitable method for detecting intra-abdominal pressure changes, provided the children accept the rectal balloon. Impedance pneumo...

Esophageal Atresia:II. Anastomotic Disruption Following Primary Surgical Management

Among 109 patients subjected to primary repair for esophageal atresia, there were 18 who developed anastomotic disruption. This complication occurred within the first week after operation; in 12 cases during the first two postoperative days. In the majority of cases the occurrence of leak was suspected clinically. Radiological diagnosis proved more reliable, in some cases preceeding the change in clinical behavior. Treatment consisted in pleural drainage, gastrostomy for decompression, omission of oral feedings and administration of antibiotics in each case. In two patients secondary cervical esophagostomy and closure of the distal segment was performed. Ten patients died within a few days from pulmonary complications and sepsis and two died later from causes unrelated to anastomotic disruption. Of the 6 long-term survivors, 4 developed anastomotic strictures which were successfully treated by dilatations (3 cases) or resection (1 case). The remaining 2 patients made an uneventful recovery.