Unmet needs in pediatric surgical care in Canada

Unmet needs in pediatric surgical care in Canada

ABSTRACTS 138 GENERAL A Method of CONSIDERATIONS Central Venous Alimentation Catheter Placomont for Use in Small Infants. MJ . h/l and Marti...

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138 GENERAL A Method






Catheter Placomont for Use in Small Infants.

MJ .

h/l and



Amer. Surg. 39:323-

324 (June), 1973.

The sternoclcidomastoid muscle is gently retracted revealing the internal jugular vein. This, then, is dissected along its anterior border to the facial vein which is cannulated with a beveled silastic catheter. A 13-gauge needle is pushed from above and behind the ear into the field. The catheter is threaded through the needle and the needle is withdrawn. This method has been used in an infant as small as 700 g.-E. J. Berman Serious Systemic infection Associated With the Use



Indwelling Rubio,


Intmvenour Harris






Med. J. J&633-637 (June), 1973.

The findings in seven children with serious systemic infection associated with the use of indwelling intravenous polyethylene catheters are described. Bacteremia was proven in five patients and fungemia in one of the remaining two patients. Of those with bacterial infections, the causative agent was a gram-negative bacillus (Pseudomonas. Escherichia co/i. Enterobatter, and KlebsieNa) in four instances and Staphylococcus aureus in one. Three patients died as a result of the catheter-induced infection, and another is seriously handicapped after kidney and brain abscesses. The authors suggest the use of antibiotic ointment and early removal of the catheter to reduce colonization rates and clinical infection.-George Holcomb Prophylactic Antibiotics in


Catheterization in the Newborn. P.K.J. and



Artery van


Arch. Dis. Child. 48:296300

(April), 1973 . Attempt to pass an umbilical catheter in 250 newborn infants is reported. The catheter was passed successfully in 229 infants and the tip placed at the level of the diaphragm for arterial sampling. The infants were either given antibiotics (kanamycin, and penicillin or ampicillin) or not, on the individual consultant’s preference and not based on the condition of the infant. Of the 229 infants, 55 received antibiotics, 174 did not. The incidence of complications is reported-infection (43), clinical or autopsy signs of vascular obstruction (ll), hemorrhage (8). and two other complications. The study of infection is based on cultures

from various sites on 20 of the 55 infants given antibiotics and 66 of the other 174 infants. If Staphylococcus albus was ignored, there was a significant increase in infection in the infants given prophylactic antibiotics, and these infections were mainly by gram-negative organisms. Infections in the infants not given antibiotics were mainly by Staphylococcus aureus. Vascular obstruction occurred in 6 of 93 infants with a catheter in site for 48 hr or less and in 1 of 21 with a catheter left for more than 144 hr.D.G. Young Neonatal

Sciatic Paralysis. WJ.W.

Proc. R. Sac. Med. 66:218-219


(March), 1973.

The sciatic paralysis described in this paper followed injections of nikethamide into the umbilical cord in the immediate postnatal period in both cases. There was considerable necrosis of the sigmoid colon and skin and muscle in the gluteal region in the first case, with complete paralysis of the sciatic nerve in both cases. Spontaneous recovery eventually occurred in the second case, but there was considerable residual deformity of the lower limb in the first.-John ES. Scotr THAM vs. Sodium

Bicarbonate in Idiopathic

Respiratory Distress Syndrome. P.KJ. and J.M.








(April), 1973.

The results of treatment of the acid-base disturbance in 50 infants with severe respiratory distress syndrome are given. Two comparable groups of 25 infants were treated: correction of acidosis was achieved with THAM in one group; the other group was given sodium bicarbonate. Analysis of the results in respect of recovery from RDS and long-term survival were superior in the group treated with THAM. Biochemical data are presented which show a better rise of arterial PO, and no rise in the arterial PCo, in the THAM-treated infants; in those treated with bicarbonate the PO, did not rise but the arterial PC,* did rise. One death occurred as a result of an accidental excessive infusion of THAM. Other than this, there was no instance of toxic effects occurring in the very young infants.-D.G. Young Unmet

Needs in Pediatric Surgical Care

Canada. Colin






in J.

lD9:183 -186 (August), 1973.

An attempt is made to define pediatric surgery, and a brief outline of the development of




surgery in North America is given. Lack of recognition of pediatric surgery as a specialty in Canada is a problem, and the author provides reasons for the establishment of pediatric surgery as a specialty by The Royal College of Physicians and Surgeons of Canada. Data are provided showing that the teaching of pediatric surgery both at an undergraduate and a postgraduate level is far from satisfactory. Specific unmet needs include deficiencies in the psychological preparation of children for admission to hospital and for operation; absence of a universal policy regarding conservative or operative care in mongoloid infants with duodenal atresia, or in infants with myelomeningoceles and extensive neurological deficits; and finally a relative lack of significant pediatric surgical research.-Co/in C. Ferguson

other three are doing well and are 5, 6, and 7 yr old.-C. Bretscher-Duroit THORAX Primary Mediastinal kminoma:

A Case Report

and Review of the litemture.

1. Besznyak, M.

Sebesteny, and F. Kuchar. J. Thorac. Cardiovasc. Surg. 65:930-934

(June), 1973.

Primary anterior mediastinal germinal cell tumors are most often seen in young adult males. This rare tumor (75 reported cases) has been noted in both boys and girls. The tumors may arise in displaced germinal cells or in relation to teratoma. Symptoms are those of a mediastinal mass. Complete surgical excision followed by irradiation offers the best chance for cure. Metastasis does not exclude cure.Thomas M. Holder



Tumors of the Mandible

NECK And Maxilla in Chil-

dren. 1.P. Dehner, Cancer 31:364-384 (February), 1973.

hood: Rmnching Pattern and Structure. Alison Hislop







(March), 1973.

A series of 46 benign tumors are presented. Included are 13 giant cell granulomas, 15 fibroosseus lesions, four odontogenic tumors, three eosinophillic granulomas, two desmoplastic fibromas, two osteoblastomas, and one melanotic ectodermal tumor of infancy, one osteoma, one aneurysmal bone cyst, and one neurofibroma. The most common presentation was painless swelling. There was one death in the series from recurrent pneumonia. The authors emphasize that most of these tumors, especially the giant cell granuloma, tend to recur locally.--S. Kim Cervical lemtomas

pulmonary Arterial Development During Child-

in the Newborn. P.P. Rick-

ham. Helv. Paediatr. Acta 27:459-555



The rarest site of teratomas in childhood is the neck. Only four cases have been observed within the past 18 yr in Children’s Hospitals of Zurich and Liverpool. Etiology and embryology are still not definitely known. The tumor is already enormous at birth and might cause intrauterine death or postpartum respiratory distress and, therefore, should always be treated as an emergency. Intratumoral calcifications shown by x-rays allow differential diagnosis from cystic hygroma. Operative removal of the tumor is usually simple in spite of the size of the growth. Prognosis is satisfying. Only one of the four children described by the author died, the

In this study from the Brompton Hospital, London, the lungs of 18 subjects aged from birth to 11 yr were studied after injection of the pulmonary arteries with radiopaque medium. Their branching pattern and structure were analyzed quantitatively. Up to the age of 18 mo, as new alveoli appear, arterial branches develop within the acinus as new alveolar ducts appear. Supernumary arteries increase in number as new alveoli form up to the age of 8 yr. The vessels enlarge with increasing age, but the thickness of the wall diminishes after birth. In vessels less than 200 m in diameter the change in wall thickness is quick, but in larger vessels it may take 4 mo. The changes are probably due in part to dilatation and in pait to alteration in the growth rate of muscle cells. During childhood there are few muscular arteries to be found in the acinus, and the formation of muscle cells in the vessel wall does not correspond to the increase in arterial size.




Extmcorporeal Respimtion With


Membmne Gas Exchanger. J.A; Awad, J. Matte, and A.


J. Thoroc.



66:40-5 1 (July), 1973.

This is primarily an experimental study using a membrane oxygenator and femoral arteriovenous bypass in dogs for 24 hr. The results of adequate and suboptimal heparinization were studied. The principal results from under-