Philip A. King

Bleomycin therapy for cystic hygroma

Intralesional bleomycin injection was used as sclerosant therapy for sixteen patients with cystic hygroma. An excellent (complete clinical resolution) response was obtained in seven (44%) patients, a good (> 50% response) result in seven (44%), and a poor or no response in two (12%). Minor transient side effects (fever, vomiting, cellulitis, skin discoloration) were seen in six patients, and there were no serious side effects. The results suggest that bleomycin intralesional sclerosant is effective therapy for cystic hygroma, with response rates comparable to those of surgical removal, but with the advantage of avoiding inadvertent nerve damage and scarring.

A prospective comparison of tissue glue versus sutures for circumcision

Abstract.The safety of wound closure with tissue glue after surgery has been well established. The efficacy of its use in circumcision is poorly documented. The aim of this study was to carry out a comparative study of tissue glue versus suture closure after circumcision. The duration of the operative procedure, pain score, cosmesis and postoperative complications were evaluated. There were no complications in either group. There was no statistically significant difference in the pain score in both groups. However the mean time taken for tissue glue was 16.6 minutes and the mean time taken for sutures was 23.7 minutes. (p < 0.0001) which was statistically significant. The cosmetic appearance was found to be superior in the tissue glue group as there were no suture marks on the join of the shaft skin and foreskin base.

Androgen and oestrogen receptor status of the human appendix testis.

Since the human appendix testis is a Mullerian duct derivative it has been theorised that rising oestrogen levels in puberty result in enlargement of this organ and consequent predisposition to torsion. This study sought to establish the presence or absence of both androgen and oestrogen receptors in the human appendix testis. Bilateral appendix testis specimens surgically excised from ten patients undergoing scrotal exploration for acute scrotum were stained immunohistochemically for androgen and oestrogen receptors. These were examined by light microscopy. The human appendix testis was found to express both oestrogen and androgen receptors. Marked regional variation of androgen and oestrogen receptor positivity was demonstrated. The surface epithelium and some stromal cells were androgen receptor positive, whereas oestrogen receptors were confined to ductular invaginations, gland-like structures and some stromal cells. Rising levels of androgens and oestrogens in pubertal boys may account for enlargement and the predisposition of the human appendix testis for torsion since this structure contains receptors for both.

The use of ureteral stents and suprapubic catheter in vesicoureteric reflux surgery

The use of ureteric stents in reimplantation surgery is important. The younger the patient, the more important the stenting of ureters post reimplantation becomes, because even minimal oedema following surgery will produce ureteric obstruction unless stents are in place. JJ stents are now the preferred method of choice in ureteric reimplantation surgery, but in the past the patient required another admission to hospital and general anaesthetic to have the stents removed endoscopically. We describe a technique whereby the stents are attached to the suprapubic catheter and are therefore removed prior to the patient’s discharge from hospital, thus obviating the need for a second admission and second anaesthetic for the stent removal. We have studied 23 patients with this technique and find that it is a reliable and safe method to use.

A decade of paediatric lymphangiomas

Lymphangiomas are uncommon, benign developmental tumours of the lymphatic system. Though usually symptomless, lymphangiomas can cause problems through pressure effects and may sometimes be life-threatening, especially in newborn infants with massive lesions involving the neck and mediastinum. The literature is reviewed with 33 additional cases presented. Despite the advent of more recent and innovative treatments, surgical excision is associated with the least number of complicatons and is still the most widely used and successful method of treatment.

Posterior urethral valves and testicular maldescent: An underreported association?

It is a generally held belief that posterior urethral valves (PUV) rarely coexist with anomalies other than those involving the urinary tract despite a report by Krueger et al. in 1980 of a significant association between cryptorchidism and posterior urethral valves. We reviewed 46 cases of PUV seen at our institution since 1959; 8 of these had undescended testes. Three of 4 patients with bilateral maldescent had associated syndromes or prematurity. In 5 cases (12%), there was no immediate explanation for the significantly increased incidence of maldescent (P <0.001). The presence of a large bladder or inguinoscrotal compression due to oligohydramnios may play a role.

Treatment of an aggressive haemangiomatous lesion with alpha-interferon

We report an infant who presented with an aggressive haemangiomatous lesion of the right thigh that was treated successfully with α-interferon.

Diaphragmatic injury in a child

We would like to report a patient in whom the diagnosis of diaphragmatic rupture was made 1 year fol lowing a kick to the abdomen. A 13-year-old boy sustained a kick to the left side of the abdomen. He presented to the casualty with severe abdominal pain and was observed for a few hours and discharged fol lowing resolution of his symptoms. Six months previously he had had a fall off his bicycle, and a chest radiograph at that t ime was normal. A year later he presented with severe abdominal pain and mild dyspnoea. Fol lowing abdominal and chest radiographs, a diagnosis of a left diaphragmatic hernia was made. Immedia te laparotomy revealed an 8-cm defect with ragged margins in the left posterior hemidiaphragm with abdominal contents in the chest. The defect was repaired and he made a good recovery. Al though congenital diaphragmatic defects are known to exist with a normal chest radiograph, we bel ieve that the pathology in this case was diaphragmatic rupture at the t ime of injury with delayed herniation, and illustrates that rapture can occur after relat ively minor trauma. Traumatic diaphragmatic rupture is uncommon in children [5], and is usually associated with severe trauma. The left hemidiaphragm is usually affected, with blunt t rauma often being the cause in children although penentrating injuries have also been reported [2]. Motor vehicle accidents cause up to 90% of reported cases of blunt injuries to the diaphragm [4], and the incidence of associated injuries is 75% to 90% [2, 3]. The diagnosis can be difficult and may be missed initially [1, 3, 5]; one must have a high index of suspicion for this injury in order to institute prompt treatment and avoid the morbidi ty and mortal i ty of delayed diagnosis of diaphragmatic rupture [2].

Prophylactic oesophageal calibration in oesophageal atresia surgery

Anastomotic structure is the most common complication following surgery for oesophageal atresia. The management of this problem provides a continuing challenge to paediatric surgeons. In an effort to reduce the rate as well as the morbidity and mortality associated with oesophageal stricture formation, a regime of routine postoperative prophylactic oesophageal calibration has been undertaken in Princess Margaret Hospital for Children over the last 12 years. Retrospective review of the results of this treatment modality shows low stricture (1.8%) and morbidity rates associated with the procedure.

Circumcision — Maternal attitudes

The medical profession is basically opposed to newborn circumcision. The practice is still common, however, and in an attempt to find out why this is so, a survey to determine maternal attitudes towards circumcision was carried out. In addition, the whole practice of circumcision is reviewed in an attempt to rationalize the arguments and to put the problem into perspective.