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A prospective randomised study (I) was carried out on 130 children undergoing laparotomy for perforated appendicitis. The present study evaluates the therapeutic effectiveness of different antibiotic regimens in modifying the rate of post-operative complications (intraabdominal abscess, ileus, wound infiltration or abscess). During the first year of this study two treatment groups were used. Group A consisted of 29 children treated with Sulfometrol/Trimethoprim; the rate of postoperative complications was 44.8%. Group B consisted of 36 children treated with mezlocillin, the rate of complications being 13.8%. However, the same treatment with mezlocillin during the second year of the prospective study showed an increase of this rte to 39% (28 children--group C). The final group of 37 children was treated during the second year with mezlocillin and metronidazole (group D). The postoperative rate of complications was 10.8%. A retrospective analysis of further 80 children (study II) with perforated appendicitis treated with mezlocillin and metronidazole showed a consistent low rate of postoperative complications at 10.2%. In 6.8% of children studied, an operative intervention was necessary (four cases of ileus, four wound abscesses). The mean postoperative hospitalisation period decreased from 22.7 days in group A to 15.2 days in group D and finally to 14 days in study II. The present study shows that an effective and persistent attenuation of the rate of postoperative complications after perforated appendicitis in children depends on an early onset of therapy and on the appropriate choice of antibiotic drugs that are effective against aerobic and anaerobic microorganisms.

A 7-month-old dystrophic infant weighing 3.8 kg was investigated endoscopically in relation to recurrent pneumonia. A tracheo-esophageal cleft was demonstrated. The situation was complicated by the coexistence of achalasia of the cardia. There was also hypertelorism and malformation of the urinary tract, so that this would appear to be a case of the G-Syndrome. A Heller's operation with fundoplication and gastrostomy was performed and only after this was the tracheooesophageal cleft closed. A flap of sternomastoid muscle was interposed between the trachea and oesophagus. Stenosis was treated by dilatation.

Quantitative measurements of serum concentrations of LP-X were performed in 45 newborn and infants. The changes of LP-X concentrations before and after a 2-3 weeks' course of cholestyramine therapy differentiated extrahepatic biliary atresia (n = 6) from other causes of neonatal liver disease with a sensitivity of 100%, a specificity of 78.6 to 84.6% and an efficiency of 81.3 to 86.7%. The efficiency was decreased in children with alcoholic stools (75-80%). Cholestyramine treatment of 3-7 days did not allow to diagnose all children with extrahepatic biliary atresia. However, the test was superior to a combination of single measurements of LP-X and GGT. The changes of LP-X concentrations in serum were influenced by the individual course of the disease but not by the synthetic function of the liver (as indicated by CHE activities) or by parenteral nutrition or bacterial infections. LP-X was a valuable parameter in the management of cholestyramine therapy in infants with liver diseases.

The authors present the history of a seven-year-old male child suffering from delayed splenic rupture and fat embolism syndrome simultaneously. The conservative treatment of splenic ruptures as well as incidence and early diagnosis of fat embolism syndrome in childhood will be discussed.