A trial of full thyroid replacement therapy should precede any contemplated surgery. Indications for surgery should be strictly followed and include dysphagia, dysphonia, ulceration or hemorrhage of the lingual thyroid gland and failure of the ectopic gland to decrease in size following thyroid replacement therapy.--W. K. Sieber. CYSTS OR SINUSES OF THE THYROGLOSSAL DUCT.
W. F. Pollock and E. O. Stevenson. Amer. J. Surg. 112:225-231, August 1966.
In the Children's Hospital of Los Angeles, the recurrence rate for operations on the thyroglossal duct is 22 per cent. While this is a decrease from previous figures published, it is still not satisfactory. The development of the thyroglossal d u c t and the descent of the thyroid from the foramen caecum at the base of the tongue is described together with its relationship to the hyoid bone. Owing to the fact that the thyroid may not completely descend embryologically, it is imperative to exclude an aberrant or insufficiently descended thyroid in the differential diagnosis as removal of this may leave the patient with complete absence of thyroid tissue. The diagnosis of thyroglossal duct cysts as a mid-line swelling in the neck is emphasized. Of the cases successfully operated upon at the first operation, 77 per cent did not have drainage at the time of the operation. Of the cases which had recurrence, 55 per cent had had prior drainage. The importance of early diagnosis prior to infection is therefore emphasized. No statistical significance could be found in the type of suture used at the operation, nor as to whether a drain was used at the time of operation. Of the cases successfully treated at one operation 92 per cent had the center portion of the hyoid bone removed. The importance of removing the center portion of the hyoid bone routinely in all operations of thyroidglossal duct cysts is therefore re-emphasized.---N. K. Connolly. CYSTIC HYGROMA OF THE NECK IN INFANCY AND CHILDHOOD. H. Imdahl. Z. Kinderchir. Suppl.: 8-19, 1968. The authors report 11 personal cases (including 2 fatal ones) and regard the second trimester following birth as the optimum time for surgery. The rate of growth of the tumor should also be considered. Spontaneous regression does not occur. The operative possibilities and difficulties encountered in lesions of the neck are diseussed.--S. Ho~mann and H. B. Eckstein.
ABSTRACTS O F P E D I A T R I C SURGERY
THORAX INHALED FOREIGN BODIES IN CHILDREN. C. M. Davis. Arch. Dis. Child. 41:402--406, A series of 40 children with inhaled foreign bodies is discussed. Of 11 children under 2 years, l0 were accompanied by a reliable adult witness, and of 9 children over 8 years, 8 volunteered the information of an inhaled foreign body; but of 20 patients between 2 and 8 years, 12 presented with respiratory symptoms without any indications as to their cause. The foreign bodies took the usual distribution, three quarters of them being in the trachea or on the right side. In only 11 cases was the object opaque on radiological examination; 1 patient was not x-rayed and in 28 patients the foreign body was nonopaque, 23 of them being peanuts. The commonest radiologie finding in the lung fields was of unilateral basal collapse or consolidation. Of the 14 patients who presented with respiratory symptoms without any relevant history, a radiologic diagnosis was made in 8 by demonstration of an opaque foreign body, or obvious obstructive emphysema. In the other 6, persistent or recurrent unilateral basal collapse or consolidation lead to a suspicion of bronchial obstruction and was followed by bronchoseopy.--J. Lister. RESULTS o r OPERATIVE TREATMENT FOR PECTVS EXCAVATtr~. H. Kunz, F. Helmer and L. Howanietz. Thoraxchirurgie 14:329-337, August 1966. It is concluded from the multitude of surgical approaches to funnel chest that none is completely satisfactory. The reason is thought to be that a complex malformation involving posture and the entire thoracic cage cannot be effectively corrected by a localized attack on one part only, e.g., the sternum. It is felt that surgery must be followed by prolonged physical therapy designed to correct the functional aspects of the disease. The Ravitch method has been used as the surgical approach. Following removal of deformed rib cartilages the sternum is partly fractured and held in place by approximating the musculature of the chest wall. No internal or external fixation is used. Respiratory exercises start on the first postoperative day and are carried through the following years. The chest wall stabilizes within 2 weeks. The operation is carried out preferably at the age of 2 to 5 years. Of 28 patients treated from 1959 to 1966 20 were male, 8 female. None of 27 that were reexamined % - 7 years after operation had any symptoms. The sternum-vertebra distance was increased in 21,
OF P E D I A T R I C SURGERY
~nchanged in 3. There were 3 relapses in patients hat had not followed the regimen of prolonged ,hysical training.--E. H. Farthmann.
no operative mortality in the 21 patients reported in this study.---E. H. Farthmann. SPONTANEOUS MEDIASTINAL EMPHYSEMA IN IN-
~HYLOTHORAX AND CHYLOPERICARDIUM AS A PROBLEM IN PEDIATRIC SURGERY. I. Louhimo,
FANCY. E. Bartolomucci, G. Ardimento. Riv. Chir. Ped. 8:361-373, July-Sept., 1966.
M. Kekomaki, M. Pasila and M. Sulamaa. Z. Kindershir. Suppl. 19-28, 1966.
The authors report 11 cases of mediastinal emphysema in infants and children aged from 13 hours to 3 years. In 4 cases the syndrome occurred within the frst 2 weeks of life; in 4 cases between 2 weeks and 1 year of age and in 3 cases between 2 and 3 years of age. The severity of symptoms varied according to the extent of the mediastinal emphysenia and its combination with subcutaneous emphysema and pneumothorax. The latter complication was present in 2 instances. Conservative treatment was followed by recovery in 4 cases and surgical decompression was performed 7 times. Fatal outcome occurred in 4 of the surgically treated patients, and in 2 of these pneumothorax was also present.--C. A. Montagnani.
The authors describe 12 cases of chylothorax chich were treated in the years 1956 to 1965. In ,Re of these children there was also a chyloperiardium. In 8 of the children the cause of chylohorax was traumatic (7 of these as a result of peration), in 2 there was an obstruction, and in ', patients the chylothorax was idiopathic. The adiologic appearance of the chylous fluid is typical. In 2 patients aspiration was successful in obaining a cure. Suction drainage was used in the cases but successful in only 5 of these. Thoraotomy was carried out 5 times. Thoracotomy is adicated in those cases where simpler forms of reatment have failed to improve the situation in ; days.--S. Hoffman and H. B. Eckstein. NTRATHORACIC NEU1ROGENIC TUMORS IN CHILDREN AND ADULTS. F. Saegesser and M. Boum-
ghar. Thoraxchirurgie 14:307-322, August 1966: During a 10 year period, 21 patients with inrathoracic neurogenic tumors were treated, 11 of them were infants and children (1 neuroblastoma, ganglioneuroblastoma, 9 ganglioneuroma). Clasification is histologic: tumors of (1) sympathetic neuroblastoma, ganglioneuroma, ganglioneuroblasoma ), ( 2 ) paragangliomic ( pheochromoeytoma, ;lomus tumor), and (3) cerebrospinal origin (neu3ma, neurofibroma). Sympathetic tumors occur )redominantly in children and are usually maligrant. Symptoms are rare and, when present, usually ndicative of advanced growth involving adjacent tructures. Tumors with endocrine activity, howver, may cause symptoms (i.e., hypertension) at n early stage. Adrenaline and noradrenaline may ,e secreted in children by ganglioneuroma and [anglioneuroblastoma as well as by pheochromoeyoma. Search for their metabolites (VMA and tVA ) is therefore advisable in all cases of intrahoracic neurogenic tumors in children. If present, nalignancy should be suspected. Surgical removal )f the tumor should be attempted in every case, tecessitating in some instances a combined neurourgical and thoracosurgical approach. Radiothertpy is considered to be prophylactic and palliative. 7hemotherapy is sometimes thought to enhance he development of an embryonic tumor to a here mature and less malignant form. There was
RIGHT MIDDLE LOBE SYNDROME IN CHILDREN. S. C. Dees and A. Speck. J.A.M.A. 197:8-14, July 4, 1966. Thirty children aged 6 months to 12 years presented with cough, wheezing, and repeated attacks of pneumonia. Twenty-three were atopic and 18 had a family history of asthma. One girl with situs inversus had atelectasis of the left middle lobe. Symptoms appeared in all children by the age of 6 years and in 17 patients before the second birthday. Diagnosis was naade primarily by x-ray; bronchoscopy showed endobronchial changes in only 7 of 17 patients so examined. Ten patients subjected to lobectomy have remained well for periods up to 8 years, except for easily controlled mild asthma and hay fever. Eleven patients are well 1 to 7 years on medical managenaent of allergy and infection (including one patient with tuberculosis). The remainder await (or have refused) definitive therapy or have been inadequately followed.--R. Spencer. ALIMENTARY TRACT A RADIOLOGICAL STUDY OF THE NEURAL CONTROL OF ESOPHAGEAL VESTIBULAR FUNCTION, A. R.
Chrispin and G. W. Friedland. Thorax 21:422427, September 1966. This paper presents detailed roentgen studies of flow through the esophageal vestibule (i.e., the inferior sphincter area) in 14 children. The 5 groups of children studied included those with esophageal atresia and tracheoesophagea]