Search

During the years 1982 through 1991, stitch granulomata complicated 15 of 2,447 inguinal herniotomies. The lesions were diagnosed 3 to 120 months (mean +/- SE, 2.46 +/- 0.65 years) following surgery. Granulomata were associated with male sex (P = .02), emergency herniotomy (P = 0.016), surgery during the neonatal period (P = 0.004), and lower mean age at the time of herniotomy (0.79 v 2.84 years, P = .000001). In 13 cases, Staphylococcus aureus was recovered either alone or in combination with Staphylococcus epidermidis; all patients responded well to incision and drainage. Stitch granuloma appears to be associated with male herniotomy, emergency surgery, and use of silk sutures.

A pilot study of active case-finding identified asymptomatic varicocele in 78 of 791 consecutively examined schoolboys, resulting in an elevenfold increase in admissions for this condition. Patients diagnosed through the program were younger (p = 0.01) and more likely to have low grade varicocele (p = 0.09) than those treated before the program. Active case-finding and early correction of pediatric varicocele may be important in the prevention of postpubertal testicular dysfunction.

A sublingual teratoid cyst was excised without complication from a 4-month-old infant. Teratoid cysts of the mouth are rare, and generally diagnosed in adults. The differential diagnosis and approach to sublingual lesions in the infant are reviewed.

The influence of surgical mask usage on bacterial contamination of the operative field was studied during 30 cardiac catheterization procedures. Mask position was varied during each procedure according to a predesigned random table. The number of bacterial colonies recoverable when no mask was worn was significantly higher than that detected when a full mask was worn (P < 0.002). Shedding of Staphylococcus epidermidis was greater when no mask was worn (mean 5.2 colonies 10 min-1) than shedding with full mask (mean 2.7 colonies 10 min-1; P < 0.004). Although mask placement below the nose was associated with higher mean colony counts than that above the nose, these differences were not statistically significant.

Capillary hemangioma of the breast parenchyma is a rare finding in the pediatric age group. The condition was diagnosed in two children, aged 18 months and three years. Such lesions have occasionally been found during histologic surveys among asymptomatic adult women. Although vascular tumors in the adult breast are often found to be sarcomatous, the pediatric lesion is benign and responds well to simple excision.

Each of tri-zygotic female triplets was found to have a right-sided sliding inguinal hernia. Although inguinal hernia has been previously diagnosed in twins, as well as in relatives of patients with hernias, a genetic basis for the condition has not been established.

The incidence of major fungal infection in recent years has paralleled increasing use of immunosuppressive drugs, broad spectrum antibiotics and implantable catheters and prostheses. The pediatric surgeon encounters fungi as agents of perioperative infection and anatomic disease requiring surgical intervention. Clinical mycology is increasingly challenged by a wide spectrum of unfamiliar fungi, fungal infections and antimycotic drugs. An overview of the expanding role of surgical mycosis in children is presented.

Thirty-three human studies concerned with antimicrobial prophylaxis in obstetric-gynecologic surgery were analyzed, with particular attention to experimental design. Eighty-two percent of the studies were prospective, 70% randomized and 39% double-blind. Patients were stratified according to underlying disease in 15%, complications of prophylaxis were mentioned in 61% of the studies, and statistical analysis was done in 55% of the studies. There was considerable variation in antibiotics employed and in the types of infection encountered. Twenty-seven of the 28 papers published after 1966 advocated prophylaxis. In contrast, less than two thirds of the papers concerned with general surgery support the use of perioperative prophylactic antibiotics. Despite some variability in methodology and antibiotic agents used, there is little controversy among the studies analyzed.

We have measured concentrations of ciprofloxacin in serum, hepatic tissue, gallbladder, and bile in 10 patients after a single oral dose of 750 mg given before cholecystectomy. Mean liver and gallbladder tissue concentrations were 12.76 micrograms X g-1 +/- 2.79 (SEM) and 5.94 micrograms X g-1 +/- 1.35, respectively. Concentrations in bile taken from the gallbladder (7 patients) ranged from 68 to 225 micrograms X ml-1, with a mean bile/serum concentration ratio of 49. Concentrations in bile taken from the common bile duct (2 patients) were 17 and 16 micrograms X ml-1.

Thirty-one children underwent appendectomy following administration of a single i.v. dose of clindamycin 10 mg/kg or metronidazole 7.5 mg/kg. The serum levels of the antibiotics at that time were comparable, but the tissue concentration of clindamycin in the appendix (mean 7.23 micrograms/g) exceeded that of metronidazole (mean 2.27 micrograms/g). The concurrent mean concentration of metronidazole in peritoneal fluid (14.26 micrograms/ml) was higher than that of clindamycin (7.72 micrograms/ml).

Although the clinical significance of a high antibiotic level of the biliary tract has not been proved, few antibiotics are both well excreted and active against the common pathogens of bile. The biliary excretion of these agents is a complex phenomenon which may be altered by a number of host factors. The results of studies on the levels of antimicrobial agents vary with respect to the timing of antibiotic measurement, type of bile sampled, presence or absence of biliary tract obstruction and assessment of data.

This is a review article concerning the surgical aspects of parasitic disease in childhood. The surgeon encounters parasitic disease for a variety of reasons. Many forms of infestation produce or mimic anatomic diseases of the gastrointestinal tract. Others are characterized by soft tissue or visceral mass lesions, lymphadenopathy, portal hypertension, etc. The surgical aspects of parasitism extend to all subspecialties, including ophthalmology, gynecology, and plastic surgery.

The study presents 93 patients in whom tubal surgery was carried out for primary or secondary mechanical infertility. A classification of these patients into five groups is suggested. Twenty-four uterine pregnancies were recorded, eighteen of which reached term. A plea for enlarging the scope and number of interventions in more patients of the older group and of the more complex pathologic group is presented and discussed. This approach may lower the the over-all success rate but may benefit some of this group of patients. Last but not least, the follow-up of these patients, who constantly move from one physician to another, seeking more treatment, is difficult. Liaison with referring gynecologists and standardization of methods would be of great help in the follow-up.