Thomas M. Holder

Vascular anomalies and tracheoesophageal compression: a single institution's 25-year experience.

BACKGROUND Vascular rings are uncommon anomalies in which preferred strategies for diagnosis and treatment may vary among institutions. In this report, we offer a description of our approach and a review of our 25-year experience. METHODS A retrospective review was conducted of all pediatric patients with symptomatic tracheoesophageal compression secondary to anomalies of the aortic arch and great vessels diagnosed from 1974 to 2000. RESULTS Thirty-one patients (38%) of eighty-two patients (mean age, 1.7 years), were identified with double aortic arch, 22 patients (27%) with right arch left ligamentum, and 20 patients (24%) with innominate artery compression. Our diagnostic approach emphasized barium esophagram, along with echocardiography. This regimen was found to be reliable for all cases except those with innominate artery compression for which bronchoscopy was preferred, and except those with pulmonary artery sling for which computed tomography or magnetic resonance imaging, in addition to bronchoscopy, were preferred. Left thoracotomy was the most common operative approach (70 of 82; 85%). Ten patients (12%) had associated heart anomalies, and 6 (7%) patients underwent repair. Complications occurred in 9 (11%) patients and led to death in 3 (4%) patients. CONCLUSIONS In our practice, barium swallow and echocardiography are sufficient in diagnosing and planning the operative strategy in the majority of cases, with notable exceptions. Definitive intraoperative delineation of arch anatomy minimizes the risk of misdiagnosis or inadequate treatment.

Hazard to health--liquid lye.

Abstract The development and promotion of a concentrated sodium hydroxide drain cleaner has resulted in a marked increase in esophageal injury due to accidental ingestion. Unlike granular-lye drain cleaners, this type causes severe injury even when only a small amount is ingested. In seven patients treated at the University of Kansas Medical Center its ingestion resulted in severe strictures that were refractory to dilatations, so that colonic Substitution was required in all seven patients. Experimentally, quantities as little as 1 ml and duration of contact of only one second are sufficient to cause full-thickness esophageal necrosis. The small amounts and the brief contact required make effective treatment impossible once ingestion has occurred. This product is sufficiently hazardous that it should be removed from the market to prevent further injuries.

The treatment of patients with esophageal strictures by local steroid injections

Abstract Ten children have been treated with intralesional injection of triamcinolone diacetate into esophageal strictures. Five have responded well, and one result remains undetermined at present. Four patients are considered failures—3 due to long strictures and one with failure to improve significantly after four injections. No systemic effect of this dose of steroid has been observed, and only one complication has resulted. The apparent good result in the short strictures warrants continued clinical trials of this form of treatment. The treatment of strictures longer than 1.5 cm. by intralesional steroid injection is not recommended.

Gastrostomy: its use and dangers in pediatric patients.

GASTROSTOMY is usually performed for one of two reasons: for gastric decompression after gastrointestinal and other major abdominal operations; or for feeding in patients who are unable to take foo...

The thal fundoplication for gastroesophageal reflux

The technique of anterior fundoplication for gastroesophageal reflux originally described by Alan Thal has been used in our institution in 605 patients. The description of the technique is the purpose of this paper. A brief description of the results in these 605 patients are also presented.

Levator repair and posterior suspension for rectal prolapse

An operative procedure for the management of rectal prolapse is described. It has the advantanges of simplicity, relative safety, short hospitalization, and lack of recurrence in the four patients presented.

Traumatic prevertebral pharyngoesophageal pseudodiverticulum in the newborn infant

Summary Traumatic pharyngoesophageal pseudodiverticulum in the newborn can present with clinical and radiographic manifestations of esophageal atresia. Accurate diagnosis of this entity is essential for proper management. History of oropharyngeal trauma, associated pneumomediastinum, lack of an airdistended proximal pouch where the catheter has been arrested, and failure to almost completely aspirate barium injected into the pouch make pseudodiverticulum quite suspicious. Attempts should be made to opacify the true esophagus with contrast material, as well as to visualize directly the perforation by endoscopy. Mediastinal drainage and gastrostomy is the treatment of choice.

Postradiation renovascular hypertension.

Radiation injury to arteries can represent a significant complication of therapeutic irradiation, even when the dosage used has not been excessive as judged by approved protocols. Children in whom therapeutic abdominal irradiation has been used should be monitored indefinitely for the development of hypertension. The presence of hypertension in such children with normal blood urea nitrogen (BUN) and creatinine, and without proteinuria, should prompt investigation for a renovascular lesion. Standard bypass procedures are usually effective, although the long-term success may be compromised by continuing changes in affected vessels.

Gasoline Immersion Burn

DESPITE its widespread use, there are few reports of injuries after prolonged immersion in gasoline. Case Report A 12-year-old boy was trapped for an hour under an overturned tractor. His clothing ...

Sonography as a diagnostic aid in the evaluation of abdominal masses in infants and children

Abstract Diagnostic ultrasound is helpful in evaluating abdominal masses in infants and children. Palpable masses may be localized and their size accurately measured. Solid masses can be differentiated from cystic masses. Occult masses may be detected. The procedure has the distinct advantage that it is safe and noninvasive, is not painful, and requires no ionizing radiation.