Robert G. Allen

Silon as a sac in the treatment of omphalocele and gastroschisis.

Abstract Four babies with prenatal exposed intestines were treated by creating a temporary sac made from dacron coated with Silastic. This material can be sutured to the fascia of the abdominal wall but at the present time it seems advisable to simply suture the prosthesis to the full thickness of the abdominal wall with no preliminary dissection. The use of gamma globulin, systemic and local antibiotics, and strict sterile precautions in the postoperative period diminish the risk of infection which accounted for one death in the series. The gradual reduction of the viscera by simple compression and ligation of the distal portion of the sac avoids the complications associated with abdominal crowding and seems to allow for earlier normal intestinal alimentation. Steroids have been used, hopefully to reduce the inflammatory state of the intestinal tract allowing for earlier intestinal motility. It is important that the extruded viscera simply be covered at the time of the first operation with little or no reduction. These babies looked well in the immediate postoperative period and had no cardiopulmonary complications. The babies stooled normally by the second to fourth day, but feedings were delayed until the abdominal wall was completely closed. Growth and development have been normal in the survivors.

Spermatic Cord Torsion in the Neonate

Abstract We describe 8 cases of spermatic cord torsion in the neonate, including the fifth and sixth reported cases of neonatal bilateral torsion. Early discovery of the torsion and orchiopexy resulted in near normal growth of the affected testicle in 1 patient at 1-year followup. Recommendations for surgical management of torsion and treatment of the uninvolved testicle in unilateral cases are discussed.

Cosmetic improvement of thoracic wall defects using a rapid setting silastic mold: A special technique

The authors present a technique for cosmetic improvement of thoracic wall defects using a rapid setting silastic mold.

Methods of management and results following surgery for coarctation of the aorta in infancy

There were 30 infants, under 1 yr of age, in refractory congestive heart failure, who underwent surgical correction for coarctation of the aorta. The series was divided into two groups, depending on the type of surgical procedure performed: Group 1, 17 patients end-to-end anastomosis; Group 2, 13 patients aortic angioplasty. Aortic angioplasty was carried out by three methods. Ten patients had a subclavian flap angioplasty as described by Waldhausen in 1966. In two patients a carotid artery flap angioplasty was used to enlarge a severely hypoplastic aortic arch distal to the left carotid artery. In one patient an onlay patch of pericardium was used to relieve obstruction across a coarcted segment. Mortality rates in this series and other series from the literature are primarily dependent upon associated cardiac anomalies. Mortality rates approach zero in infants operated on for coarctation who have no associated intracardiac anomalies. While the mortality rate was slightly lower in those patients treated by some type of angioplasty, the figures are too small to be significant. In this series and other series recoarctation is far less likely to occur after subclavian flap angioplasty in comparison to those patients undergoing end-to-end anastomosis. We would advise that in infants 1 yr of age, a subclavian or carotid flap angioplasty be used as a primary method of repair.

Idiopathic dilatation of the right atrium: Postoperative follow-up in a child

The clinical, cardiac catheterization, and operative data of a child with idiopathic dilatation of the right atrium are presented. This patient, the youngest described in the literature with this anomaly, had surgical excision of the dilated right atrium wall at 2 yr of age. Late follow-up reveals normal size of the heart on thoracic roentgenogram.

Clinical outcome as assessed by anthropometric parameters, albumin, and cellular immune function in high-risk infants receiving parenteral nutrition

Twelve infants with underlying gastrointestinal tract disorders receiving 16 courses of total parenteral nutrition were retrospectively studied. Stratification according to calorie intake provided the best means for discriminating among different outcomes. Infants receiving greater than 110 calories/kg/d experienced significantly greater increases in weight, mid-arm muscle circumference, and triceps and subscapular skinfold thicknesses than did infants receiving less than 110 calories/kg/d. Catch-up growth was only seen in infants with intakes of greater than 110 calories/kg/d. In nine of these 12 infants, in vitro cellular immune parameters were assayed. Infants in both the high- and low-calorie groups experienced similar increases in transformational responses to pokeweed mitogen (PWM) and phytohemagglutinin (PHA) and in the percentage of peripheral blood T lymphocytes. No increase in serum albumin was seen regardless of calorie intake.

Modified Blalock shunts utilizing pericardial tube grafts

In the last decade, 14 patients underwent an aorticpulmonary shunt for cyanotic heart disease, at which time the subclavian artery was either deemed too small or too short to function satisfactorily as a Blalock shunt. In each case a rectangular piece of pericardium was excised, rolled into a tube, and sutured down one edge to create a tube graft. One end of the graft was sutured to the stump of the subclavian artery near its takeoff and the other end was sutured end-to-side to the corresponding pulmonary artery. During the same period, 5 children had azygos vein grafts and 2 had Teflon grafts inserted to create a modified Blalock shunt. This article will discuss the indications, techniques, and long term results of aorticpulmonary shunts of all types, and more specifically the complications and long term results in patients where these grafts were used.

Double aortic arch associated with pulmonary sequestration.

Double aortic arch and pulmonary sequestration, both uncommon vascular malformations, were seen in a six-month-old infant. The diagnosis was made by angiography, and successful surgical correction of both lesions was performed.

Traumatic aortic aneurysm in a child

The clinical presentation and diagnostic evaluation of a 2-yr-old boy with traumatic aortic aneurysm and aortic regurgitation is presented. Traumatic aortic aneurysms are extremely rare in childhood. To our knowledge this is the youngest reported patient with such pathology.

The addition of cava pulmonary artery shunts to patients with existing systemic pulmonary artery shunts

I N THE LAST TWO DECADES various types of systemic pulmonary artery (S-PA) shunts have been used to palliate children with cyanotic heart lesions. Some eventually have been totally corrected, some have died as a result of their original anomaly or from complications of the shunt itself, and some continue reasonably well palliated. However, many of these patients have lesions not amenable to total correction, are poorly palliated and show signs of progressive deterioration. This report deals with this last group. In infants with noncorrectable cyanotic heart disease we would prefer to perform a Glenn shunt as the primary procedure. The high pulmonary vascular resistance and frequent hypoplastic pulmonary arteries found in these neonates both tend to inhibit blood flow from the cava to the pulmonary circuit. The delayed slip knot ligation of the azygos vein introduced by Bargeronl has allowed better results in small infants, but generally we prefer a high-pressure systemic pulmonary artery (S-PA) shunt in tiny babies if surgical intervention is necessary. The high pressure shunts commonly employed are the Potts-Smith, Waterston, and Blalock-Taussig. Potts and Waterston shunts are frequently associated with too much blood flow to the lungs resulting in increased heart work, congestive heart failure and pulmonary congestion. Blalock-Taussig shunts, on the other hand, are more frequently “outgrown” and fail to meet the patient’s needs. Increased pulmonary vascular resistance is a rare but serious complication of highpressure shunts, a problem not encountered with cava-pulmonary artery (C-PA) shunts. It seems feasible in those patients with high-pressure shunts who are deteriorating for any reason to convert to or add a Glenn (C-PA) shunt which has proven to be an excellent long-term palliative procedure for complex noncorrectable cyanotic heart lesions.2,3 Early in our experience in this series the plan was to obliterate the highpressure shunt and convert to a low-pressure C-PA shunt. Since this would have required bilateral thoracotomies in most cases we elected to simply add the C-PA shunt to the opposite lung. As experience grew it became apparent that the ideal palliation is derived from a C-PA shunt to one lung and a small S-PA