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Resection of an isolated, unruptured sinus of Valsalva aneurysm is described. Detection was serendipitous in a patient with previous surgical resection and grafting of significant aortic coarctation. The philosophy and importance of proceeding with elective resection in these progressive lesions is emphasized.

The actual incidence of esophageal atresia and tracheoesophageal fistula abnormalities is difficult to assess. It is probably near 1 in 3000 births. This makes it one of the most frequent anomalies which, if not treated, will be uniformly fatal in the neonatal period.

• Ultrasonography has become an accepted diagnostic procedure, particularly in cardiology and obstetrics. It is also quite valuable in the evaluation of abdominal and retroperitoneal masses, with the unique ability to distinguish between cysts and solid tumors. The noninvasive and nonradiation-emitting features of ultrasound make it especially attractive for pediatric patients.(Am J Dis Child 129:1096-1101)

The anterior fundoplication described by Thal has been used in treating gastroesophageal reflux surgically in 362 children at The Children's Mercy Hospital and at St. Luke's Hospital in Kansas City, Missouri, because medical therapy had failed or was inappropriate. Long-term results have been evaluated in regard to relief of reflux and relief of symptoms attributed to reflux. Of the 335 patients followed from 1 to 8 years, 90% had a satisfactory initial result. Five percent required reoperation for a recurrence of reflux due to failure of the fundoplication or development of a hiatus hernia. All recurrences developed within 5 months of the initial operation. Fifteen of 335 patients (4.5%) had persistent symptoms despite correction of the gastroesophageal reflux; in these patients, attributing the symptoms to reflux was incorrect. There were no deaths in this series of patients as a result of operation. The success rate of the Thal fundoplication in children compares favorably with that of the Nissen fundoplication.

Both the mortality and morbidity associated with esophageal atresia and tracheoesophageal fistula have improved over the years. The treatment of patients with long-gap esophageal atresia by circular myotomy to the upper pouch with or without preoperative stretching has improved the care of patients with this problem.

One hundred consecutive patients with esophageal atresia or tracheoesophageal fistula, or both, were treated at The Children’s Mercy Hospital during the past 14 years. Each patient was evaluated and a plan for therapy was formulated depending on the type and urgency of concomitant disease. Healthy patients were treated by primary repair. Those with respiratory disease were treated before repair by gastrostomy, upper pouch suction, and antibiotics. In the small premature infant and the patient with major associated anomalies, repair of the esophageal atresia and tracheoesophageal fistula was postponed by gastrostomy, upper pouch suction, and parenteral nutrition while the concomitant disease was treated. Fifteen patients with life-threatening associated anomalies required operation before esophageal repair and 13 of them survived. During the initial hospitalization two deaths related to esophageal atresia occurred, whereas three prerepair and two late (2½ and 3 months) postrepair deaths related to associated anomalies occurred. Thus, 93 of the 100 patients left the hospital alive. The increased survival is due not only to improved care of esophageal atresia and tracheoesophageal fistula, but also to a more aggressive approach to the treatment of the serious associated anomalies.

IN INFANTS of diabetic mothers hyperbilirubinemia has frequently been observed.1,2 The mechanism of formation of the unconjugated bilirubin remains obscure.3 Although renal vein thrombosis has most often been described in association with diarrhea and dehydration,4-5 several authors have described this phenomenon as another of the complications of infants of diabetic mothers.6-7 Regardless of the underlying pathological condition, when renal vein thrombosis has occurred, the mortality rate has been high.8-9 The present report is related to the methodology involved in early diagnosis and surgical therapy of an infant of a diabetic mother with hyperbilirubinemia and renal vein thrombosis. REPORT OF A CASE A white boy was born after 40 weeks of gestation by elective cesarean section to a 33-year-old "brittle" diabetic mother with a history of vaginal bleeding at 32 weeks. His birth weight was 8 lb 8 oz (3,855 gm). Initially he was lethargic. Because

MASSIVE BLOOD replacement is an increasing reality and necessity. The surgeon's increasing boldness in the surgical treatment of cancer and cardiovascular abnormalities, the development of a light general anesthetic technique, and the rising incidence of massive trauma have resulted in the administration of bank blood at rates and in amounts not considered practical only a few years ago.Massive blood replacement, although it may be lifesaving, is associated with a rising mortality rate as the amount of blood given increases.1 In one series a mortality rate of 85% has been reported in patients receiving more than 11 units of bank blood in 24 hours.2 In another series the mortality rate was 25% after 12 units of bank blood had been given, and 50% after 20 units.3 Both of these series were reported in 1955. In 1965, Howland et al4 reported a series of patients in which