Progress in pediatric surgery最新文献

Nurses who care for infants and children undergoing thoracic surgery must function and make decisions which take into account a multiplicity of complex data. This necessitates a background of knowledge, skill and intuition which guides their nursing practice. The principles of holistic care in which the total needs of the infant and child are met within the context of the family are seen as an important approach to patient care. Selected perspectives in the care of infants with congenital and acquired thoracic anomalies are discussed, in particular infants with congenital diaphragmatic hernia and oesophageal atresia. The preparation of children for chest surgery and the postoperative nursing management are outlined and include aspects of pain management, physiotherapy and chest drain care.

Pheochromocytomas are uncommon tumors of childhood, accounting for 1% of hypertension cases in this age-group. Children have a high incidence of bilateral, multiple, or extra-adrenal tumors and a low incidence of malignancy. Alpha- and beta-blocking agents administered preoperatively have reduced complications markedly. Transabdominal resection is recommended because of the frequent extra-adrenal sites and multicentricity of the tumor in children. The mortality for removal of pheochromocytomas in childhood is currently less than 3%.

From 1970 to 1986, 51 children and adolescents aged 5-18 years were operated on for diseases of the thyroid gland, among them 42 with benign diseases (juvenile goiter 21, adenoma 17, Graves' disease 3, Hashimoto's thyroiditis 1) and nine with malignancies (papillary carcinoma 4, follicular carcinoma 3, medullary carcinoma 1, anaplastic carcinoma 1). In benign entities, females were three times as often affected as males, whereas both sexes were equally affected in malignancies. Positive family histories were found in 23.3% of the children with adenomas in 71.4% of the children with juvenile goiters. Subtotal strumectomy was carried out in 30 instances and enucleation in 12. Iodized salt and L-thyroxine were given postoperatively as recurrence prophylaxis. Recurrence was seen in two children (4.8%) who had no recurrence prophylaxis. Symptoms in children with malignancies were palpable cervical lymph nodes and solitary nodes in the thyroid gland. Total thyroidectomy was done in all instances, followed by radio-iodine treatment in eight cases and cobalt 60 irradiation in one case. Two children died, of diffuse metastases and irradiation fibrosis of the lung respectively. The peculiarities of diseases of the thyroid gland in childhood that require surgery are discussed.

This is a report on 35 cases of innominate artery compression of the trachea and its surgical correction by means of aortotruncopexy. Diagnostic procedures of choice were tracheoscopy and magnetic resonance imaging, which offers representative images of inspiration and expiration, shows the anatomical relations between aortic arch and trachea and reveals the extent of tracheal compression. Surgical treatment is indicated if narrowing of the tracheal lumen exceeds 70%. By fixation of the aortic arch and the proximal innominate artery to the back of the sternum, tracheal compression is relieved. There was no unsuccessful operation in the 35 children. One late death occurred from cardiac failure, unrelated to tracheal compression.

In the 50 years since Gross (1938) obliterated a patent ductus arteriosus, congenital cardiac surgery has come of age, synchronized with the world explosion in microtechnology and space age materials. The late 1960s and early 1970s saw Barratt-Boyes pioneering complete intracardiac repairs on infants with congenital heart disease employing modifications of the Kyoto technique (Shirotani) for profound hypothermia and circulatory arrest. The past 10-15 years have been marked by the more widespread dissemination of increasingly safe techniques, and the application of progressive incremental refinement to the entire management package of complex congenital heart disease. Many innovative methods and concepts have been added to the therapeutic armamentarium of the congenital heart team. Currently, transplantation adds the prospect of "second chance", and in the future may constitute preferred primary management in certain complex forms of congenital heart disease. In the Western world the concept of "frequency sensitivity" and the value of rationalizing congenital heart surgery facilities, such that a single unit manages a population of 8-12 million, is established, though not necessarily widely accepted and acted upon. High-volume, low-risk units emerge such that operative mortality, despite the high acceptance rate of complex problems and high rates of neonatal and infant complex repairs, has dropped below 5%. Paradoxically, the so-called simple closed surgery (neonatal coarctation, shunts and other palliative procedures in complex congenital heart disease) retain relatively high risk and must be regarded as one of the areas of challenge over the next 5-10 years.

The authors report on the biological properties and late prognosis of 16 children and juvenile patients operated on during the past 24 years for thyroid tumour who underwent regular followup. The clinical and morphological characteristics of the carcinomas are described, together with the late immune response of the patients undergoing complex treatment. The study is also concerned with the characteristics of the DNA content of the tumorous cell nuclei, the pregnancy success rate of the operated patients and the thyroid function of the children born.

This analysis concerns three groups of malformations: Congenital diaphragmatic hernia, patent ductus arteriosus, and oesophageal atresia. We registered a total mortality rate for all congenital diaphragmatic hernias and defects of 28.5%; the rate in full-term neonates was 27.6% and in premature infants 33.6%. Of 65 infants with a patent ductus arteriosus and a birth weight less than 1500 g, 14 died (21.5%). In most cases death was caused by sepsis. Among the 159 patients with oesophageal atresia who were treated in our hospital, 58 were premature infants. During the last 20 years, the total mortality rate among our patients was 28.9%. We had a mortality rate of 44.8% in premature infants and of 19.8% in full-term neonates. An analysis of the last 10 years showed a survival rate of 97% in healthy infants (group A in Waterston's classification). In group C, the most disadvantageous group (premature infants, severe anomalies), the rate was 61%.

Intralobar pulmonary sequestration is a rare congenital anomaly, comprising a mass of non-functioning lung tissue, without normal bronchial and vascular connections. The condition has two distinct clinical presentations: 1. In the 1st year of life, it may present as the site of a significant arterio-venous shunt, and then is usually associated with other cardiac anomalies, becoming defined in the course of appropriate cardiovascular investigations. 2. In older children, the condition becomes manifest because of persistent radiological changes and inadequate response to treatment, following one or more bouts of respiratory infection. Occlusion of the shunt or removal of the sequestration is the definitive management; the importance of the condition relates to the need to consider the diagnosis in evaluating the clinical presentations indicated above.