Marvin Glicklich

Anatomic observations and etiologic and surgical considerations in choledochal cyst.

Twenty-five operative and postoperative cholangiograms in children with choledochal cysts indicated an intimate relationship between these cysts and anomalous pancreatico-biliary ductal junction. In all of these patients the distal main pancreatic duct (MPD) is excluded from the sphinctor of Oddi mechanism and free reflux of pancreatic juice up the biliary tree occurs. This leads to chronic cholangitis, which is presumed to be responsible for the formation of the choledochal cysts. Abrupt and intense exposure of the common bile duct (CBD) to pancreatic reflux may cause perforation and bile peritonitis. Long-standing exposure may induce malignant transformation in the choledochal cyst. Total cyst excision and separation of the biliary system from exposure to pancreatic reflux is suggested as the procedure of choice. Long-term results and metabolic and digestive consequences of this operation are yet to be determined.

Esophageal bougienage technique for coin ingestion in children

An analysis was performed of 46 consecutive children who received esophageal bougienage for an ingested coin lodged in the esophagus. All patients met the following clinical criteria necessary for performance of this procedure: an acutely ingested single coin, radiographically localized in the esophagus; no previous history of an esophageal disease process, surgical procedure performed or foreign body removed; and no respiratory compromise upon physical examination. All coins were successfully advanced distally into the stomach after one pass of the bougie dilator. No complications were noted during or after performance of any procedure. Esophageal bougienage is a safe and effective method used to dislodge and pass an ingested coin from the esophagus when criteria for its performance are adhered to rigidly.

Esophageal function in esophageal atresia

In order to determine the spectrum of esophageal dysfunction in repaired esophageal atresia, 14 patients were evaluated with esophageal manometry, intraluminal pH recording, and radiology. Nine patients had no difficulty in swallowing but six had symptoms suggestive of gastroesophageal (GE) reflux. On pH recording, six had evidence of GE reflux. Basal sphincter pressure was 22 mm Hg in both reflux and nonreflux patients. No patient had manometric evidence of peristalsis in the proximal esophagus, but six had peristalsis in the distal esophagus. On radiology all had a normal peristaltic stripping wave in the cervical esophagus, and peristalsis was absent in the proximal thoracic esophagus in all patients but present in the distal esophagus in five of the 10 patients studied. Esophageal dysfunction is present in all patients with repaired esophageal atresia even when symptoms are absent.

Intrahepatic biliary tract abnormalities in children with corrected extrahepatic biliary atresia

Summary Three children with surgically corrected extrahepatic biliary atresia developed recurrent cholangitis associated with bile lakes that failed to drain via the hepa-toportoenterostomy. Surgical or percutaneous drainage of these cysts was followed by both resolution of the infection and spontaneous internal drainage. We postulate that the ongoing inflammatory process resulted in intrahepatic biliary obstruction, which caused cholangitis and bile cysts. Successful treatment required not only antibiotics but drainage of the bile lakes. Development of bile cysts is a new cause of recurrent cholangitis seen in extrahepatic biliary atresia.

Sclerosing cholangitis in childhood

2. Pollock HM, and Dahlgren BJ: Distribution of streptococcal groups in clinical specimens in evaluation of bacitracin screening, Appl Microbiol 27:I41, 1974. 3. Sprunt K, Vail D, and Asnes RS: Identification of streptococcus pyogenes in a pediatric outpatient department, Pediatrics 54:718, 1974. 4. Murray PR, Wold AD, Hall MH, and Washington JA: Bacitracin differentiation for presumptive identification of 5.

Simplified radioisotope technique for assessing gastroesophageal reflux in children

There were 125 children with a strong clinical suspicion of gastroesophageal reflux and/or aspiration evaluated with gastroesophageal scintigrams. We found this examination to be more sensitive than the standard barium radiography and highly specific in detecting aspiration of gastric contents. This procedure is simple, safe and more physiologic than other available examinations. However, since gastroesophageal scintigraphy does not delineate anatomic changes as well as barium studies, structural abnormalities of the esophagus and stomach should be evaluated with barium esophagrams and upper GI series.

Steroids and bag and mask ventilation in the treatment of acute epiglottitis

A non-instrumentation treatment protocol for acute epiglottitis that features the use of dexamethasone to reduce edema and positive pressure ventilation by bag and mark to support ventilation, if needed, has been used in 40 cases, 1974--1977, with no mortality. The presence of the airway specialist (pediatric surgeon) in the Intensive Care Unit with the patient further assured the airway. The importance of having a protocol in place that is workable for the specific local circumstances of each institution is emphasized.

Technetium-99m biliary imaging in pediatric surgical problems

The results of scintigraphic imaging of the hepatobiliary system with 99mTc-PIPIDA (IDA derivative p-isopropylacetanilidoiminodiacetic acid) in forty children are reported. 99mTc-PIPIDA imaging is a noninvasive, rapid, safe examination that provides both functional and anatomical information about the hepatobiliary system. Although interpretation is limited by elevated direct serum bilirubin, this agent allows diagnostic information to be obtained with direct serum bilirubin levels up to 8 mg/dl.

Ectopic Single Ureter and Severe Renal Dysplasia: An Unusual presentation

An ectopic single ureter in the male subject is a rare anomaly, which commonly drains a dysplastic kidney to the prostatic urethra or the seminal vesicle. The further the ureteral orifice is located from the trigone of the bladder, the more severe is the ipsilateral renal dysplasia. A case is described in which an ectopic ureter and ectopic and dysplastic kidney were found at the time of inguinal herniorrhaphy. The ureter was connected to the epididymis of the testicle. This is the most severe form of ureteral ectopia and it has not been reported previously.