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Summary A review of eight patients with congenital biliary cysts showed that the correct diagnosis was only anticipated in two, that several patients underwent prolonged nonoperative treatment because of a mistaken diagnosis of hepatitis, and that even in patients with an abdominal mass the true character of the cyst was not suspected until a detailed radiographic work-up was completed. In contrast to previous publications, a review of our own cases and 138 cases reported during the last 4 yr indicates that choledochal cysts represent only one of various biliary cystic dilations that can occur in either an isolated or a multiple form. A review of operative procedures performed during the last decade reveals that excision and duct-enterostomy carry a mortality risk no higher than cyst-enterostomies, with fewer postoperative complications in a still-limited follow-up period.

Colonic atresia is a relatively rare cause of neonatal intestinal obstruction. Diagnosis is established by barium enema. Initial treatment should consist of colostomy, if possible with exteriorization of both blind ends of bowel. Subsequent definitive repair may then be performed electively. A review of the literature disclosed eighteen reported survivors and an additional successful case is reported.

The advantages of the endorectal pull-through procedure with primary anastomosis are: (1.) The absence of any pelvic dissection; (2.) the presence of normal propulsive colon right down to the anus; (3.) the preservation of the rectal muscular cuff and its sensory receptors; (4.) few, if any, anastomotic problems; (5.) the preservation of all sphincters and (6.) simple postoperative care. Although more time and experience are required to evaluate the procedure, we believe that its relative ease of performance, inherent safety, and physiologic soundness may make it the operation of choice for Hirschsprung's disease.

Five cases of perforation of the bowel due to gangrenous appendicitis are presented. These cases emphasize the need for good exposure at the time of the original operation for gangrenous appendicitis. If perforation of the bowel is found at exploration, primary repair may be possible; however, more extensive resection or exclusion may be necessary.

A 7-yr-old with abdominal pain and melena had a barium enema which revealed a cecal lesion that proved to be a pseudolymphoma of the cecum and appendix--a site not previously reported.

A slide-rule calculator for intravenous fluid requirements is described. Starting with weight or body surface area, requirements are stated in terms of volume per square meter of body surface area. Average basic maintenance, replacement for dehydration, and initial rapid rehydration are indicated. Rapid and accurate calculations are possible, with elimination of decimal error. As a teaching tool, relationships of weight, surface area, and fluid requirements are demonstrated.

The case described here is the third case of tracheoesophageal fistula, esophageal atresia, and tricuspid atresia to be reported in the literature. Other cardiac anomalies have been found in an appreciable proportion of patients with esophageal atresia.

An easily assembled pressure device for control of frenular bleeding is described and illustrated. A technic for treatment of persistent frenular bleeding in hemophiliac patients is described. This method has been used successfully in two children with this injury who had not responded to the usual methods of treatment.

Appendectomy was safely performed in a 9-year-old boy with classic hemophilia, and hemostasis was achieved by the use of cryoprecipitated human antihemophilic globulin therapy begun preoperatively and continued for 17 days. Except for urticaria, the use of cryoprecipitated factor VIII was entirely free of side effects. Cryoprecipitated factor VIII is unique among all factor VIII concentrates prepared heretofore in that it is a by-product of plasma fractionation. It may be simply and economically prepared in any blood bank geared to plasma fractionation procedures and may be stored for months without loss of potency. As such cryoprecipitated factor VIII is soon expected to become generally available. The broad clinical use of a potent human factor VIII concentrate holds promise of further reducing the risk and morbidity of bleeding in hemophilia and of permitting safe elective as well as life-saving surgery.