Simon N. Huddart

Sacrococcygeal teratomas: the UK Children's Cancer Study Group's experience. I. Neonatal.

Abstract.The aim of this study was to review the United Kingdom Childrens Cancer Study Group (UKCCSG) experience of sacrococcygeal teratomas (SCT) including histological presentation, response to surgery and chemotherapy, and long term effects of the tumour and treatment. This paper presents the results for those children diagnosed during the neonatal period. Children aged up to 4 weeks with biopsy proven localised or metastatic sacrococcygeal germ cell tumours were eligible. From 1st January 1989 to 31st December 1997 (9 years), 15 UKCCSG centres registered 51 neonates with SCT into GC 8901. Surgery alone was performed in all and the prognosis was good – except for 1 baby who died from massive haemorrhage at the initial operation and 1 who died from the complications of prematurity. Seven of the 51 children (14%) who had teratomas in the neonatal period (5 mature, two immature) had yolk sac tumour (YST) recurrence at: 4, 12, 15, 20, 20, 28 and 32 months of age. These children received chemotherapy in the form of etoposide/bleomycin/carboplatin (JEB) and are alive and well at review. These results emphasise the need for oncological follow-up of SCT and the good response to JEB chemotherapy of malignant teratomas and YST.

Mesh hiatal reinforcement in Nissen fundoplication.

Abstract Persistent or recurrent gastro-oesophageal reflux (GOR) following Nissen fundoplication occurs in up to one in five cases, especially if the child is neurologically impaired. We advocate the use of mesh hiatal reinforcement for patients undergoing reoperation for GOR or if the diaphragmatic crura are thought to require reinforcement at the time of the original surgery.

The unidirectional testicular tunneller: a simple, safe and novel device for orchidopexy in patients with palpable undescended testes.

PurposeInguinal orchidopexy is already considered a safe procedure, this paper describes a simple new surgical instrument designed to make the operation easier, simpler and quicker, whilst reducing tissue trauma, in particular to the deep ring. The result of its use in two centres is presented.MethodsA unidirectional testicular tunneller has been developed comprising a head, shaft and eye. At operation, following testicular mobilisation, the tunneller is passed through the groin incision into the scrotum and a dartos pouch created by cutting against the head of the instrument. This allows more of a “no-touch” technique with less back and forth movement through the inguinal canal. The testis is attached to the eye of the instrument and pulled into the scrotum before fixation.ResultsFrom November 2000 to December 2011, two surgeons operated on 592 boys using the instrument. 93 procedures were bilateral. All operations proceeded without incident and a healthy testis was safely and permanently placed in the scrotum. There were no complications related to the use of the tunneller. All were treated as day cases.ConclusionThe instrument described in this paper simplifies inguinal orchidopexy, improves procedural safety and is felt to reduce surgical trauma. In view of these advantages and the absence of complications related to this instrument, its use in inguinal orchidopexy is recommended.

Autoimmune thyrotoxicosis with achalasia cardia

We report a case of autoimmune thyrotoxocosis in an 11-year-old boy with achalasia cardia. This case explores autoimmunity as an etiological factor for achalasia based on several autoimmune conditions that have been associated with it.

Twin presentation of perianal abscess

We present the case of monochronic dizygotic twins with perianal abscesses coincident in chronology and morphology. This image typifies the features of infant perianal disease that suggest a congenital aetiology. Twin 1 (weight 3.67 kg) and Twin 2 (weight 3.91 kg) were admitted to a tertiary paediatric surgical unit on the 34th day of life following a …

Paediatric giant cervicomediastinal thymolipoma.

We report a case of a 11-year-old boy who presented with a massive soft tissue right cervical painless and progressive lesion displacing trachea to the left and extending into the anteriosuperior mediastinum which was diagnosed to be a lipomatous mass on chest CT scan. Subsequent biopsy and total excision proved it to be a giant cervicomediastinal thymolipoma. It was successfully excised with excellent prognosis and long-term results. A giant paediatric cervicomediastinal thymolipoma is a rare, benign, mediastinal mass of thymic origin. It may remain asymptomatic despite massive size and up to 50% in some series are associated with autoimmune disease. CT scan gives fat density and encapsulated benign nature and biopsy usually establishes the diagnosis. Preoperative tissue diagnosis is important as now the availability of thoracoscopic option is best suited to reduce morbidity. Treatment of choice is total excision using open surgical, minimal invasive techniques or robotic surgery and the prognosis is excellent.

Latent vitellointestinal duct sinus presenting with massive lower gastrointestinal bleeding in an adolescent.

A 12-year-old boy with a history, at birth, of a weeping pink fleshy lesion after his umbilical cord detached, requiring repeated chemical cauterisation, presented with massive lower gastrointestinal bleeding and required resuscitation and blood transfusion. Augmented Tc99m nuclear medicine scan confirmed ectopic gastric mucosa. The lateral view suggested its attachment behind the umbilicus. At exploration, a latent vitellointestinal duct sinus with ectopic gastric mucosal mass was found. Segmental resection of the sinus and mass excision with primary anastomosis and incidental appendicectomy was curative. Pink fleshy mass discharging coloured fluid at the umbilicus following detachment of umbilical cord should be considered a remnant of vitellointestinal duct unless proved otherwise. A pink lesion with yellowish discharge resistant to chemical cauterisation should raise the suspicion of embryonic structures. Latent vitellointestinal sinus is a new lesion in the spectrum of umbilical anomalies. Lateral view of the nuclear medicine scan is helpful in locating the site.

Acute care of the surgical neonate

Most neonatal surgical problems are rare. For example, gastroschisis and tracheo-oesophageal fistula, two of the most common reasons for admission to a surgical neonatal unit, occur only once per 3000-5000 live births? Despite the advances in antenatal ultrasound, the majority of surgical problems present clinically after birth and so the initial management of a surgical neonate needs to be within the ability of paediatricians, and obstetricians. Fortunately, the acute care of a neonate with a surgically correctable problem follows a small number of simple guidelines. explained. Depending on local geography, the majority of surgical neonatal problems benefit from delivery in the regional centre. With the possible exception of gastroschisis and a large sacrococcygeal teratoma, most babies can be allowed to deliver vaginally at term. It there is any suggestion that there might be respiratory distress, an experienced paediatrician should be present at the birth.