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Respiratory function studies were carried out in 22 infants who had successful repair of diaphragmatic herniae of the Bochdalek type. Thoracic gas volume was initially reduced in only 3 of these, but subsequent studies showed that improvement occurred. There were no consistent abnormalities in either dynamic compliance or mean pulmonary conductance. This is evidence that there is rapid adaptation which compensates for any alteration in the parenchymatous tissue in the lungs or abnormalities in the bronchial tree in infants soon after the repair of congenital diaphragmetic herniae. Further studies are necessary to determine the changes in these lungs with growth. [ABSTRACT FROM AUTHOR]

A total of 48 infants with abdominal wall defects referred to the South West Regional Neonatal Surgical Centre over a period of six years were reviewed. There were 27 (56%) infants with gastroschisis and 21 (44%) infants with exomphalos. At the regional centre, four pregnancies with gastroschisis were terminated following a prenatal diagnosis, one child was stillborn, and one with exomphalos and trisomy 13 died soon after birth. Of the remaining 42 live births, the one year survival for babies born with a gastroschisis was 95% (21/22) and with an exomphalos was 81% (17/20). All deaths, except one, were due to factors other than the abdominal defect. The effect on outcome of prenatal diagnosis, parental counselling, in utero transfer, mode of delivery, and methods of surgical closure was reviewed. [ABSTRACT FROM AUTHOR]

A new four-quarter match format in field hockey has meant that the locomotor activity profiles of the sport are inconsistent with the literature. The aim of this investigation was to identify the physical and physiological demands of national-level male hockey players. Thirty-two male players participated in the study. Participants were monitored with GPS and heart rate monitors. Variables analysed were total time, total distance (m), relative total distance (m.min -1 ), total distance in velocity bands (m), and activity intensity (m.min -1 ). Mean and maximum heart rate were calculated as well as total time and percentage time spent in heart rate zones relative to HR max . Players spent 52 ± 11 min in play. The total distance covered was 5986 ± 1105 m (116 ± 12 m.min -1 ) with 21.4 ± 6.8 m.min -1 of high intensity activity. Defenders covered the lowest relative total distance (p < 0.001) and attackers the highest (p < 0.001). Relative total distance in Q4 was 5% lower than in Q1and Q2 (p < 0.05) with moderate intensity exercise (8.1-15.5 km.h -1 ) being 11% lower in Q4 compared to Q1 and Q2. The mean HR and HR max of players were 167 ± 10 and 194 ± 11 bpm respectively. Players had a lower mean HR in Q3 (164bpm) and Q4 (164bpm) compared to Q1 (169bpm) and Q2 (168bpm; p < 0.001). The current study provides novel data outlining the physical and physiological activity profiles of national-level male field hockey players across playing positions as well as quarters of play. The results highlight a need to consider positional differences when implementing a training programme for players at national level., (© Journal of Sports Science and Medicine.)

We have evaluated our practice of tube caecostomies in 21 children operated on from January 1982 to December 1987 at the Royal Hospital for sick children, Bristol, and 18 children operated on at the Paediatric Surgery Unit of the Korle-Bu Teaching Hospital, Accra, Ghana from January 1989 to December 1996. The indications for surgery were, Hirschsprung's disease (36) and idiopathic constipation (3). The definitive procedures involved were Duhamel's procedure in 36, Soave's procedure in 2 and colo-anal anastomosis in 1 case. This method reduces the total number of surgical operations required by the child from 3 to 2, thereby reducing the total period of hospitalisation for the child. A sample technique of tube caecostomy is described in 39 children undergoing corrective surgery.

Objective: To describe the incidence of gastroschisis and to identify possible aetiological factors., Design: A retrospective case review study., Setting: The South West Region of England., Population: All known cases of gastroschisis were identified from the regional fetal medicine, ultrasound, pathology and neonatal surgery, databases. Datasets to be collected were agreed prospectively and included demographic, past medical, family and obstetric information for all pregnancies conceived between January 1987 and December 1995., Results: In the first eight years the incidence was 1.6/10,000 but in 1995 a highly statistically significant rise to 4.4/10,000 was found (P = 0.0009). The increased incidence was not associated with changes in maternal age, proportion of primigravidae, use of tobacco or illicit drugs, conception while taking the oral contraceptive pill, or an increase in the number of teenage pregnancies. The median maternal age at last menstrual period for pregnancies with gastroschisis was 20.4 years which was much younger than the national average of 28 years. Thirty-seven percent of these conceptions occurred during the first quarter of the year compared with the expected 25%., Conclusions: The incidence of gastroschisis has risen to a higher level than previously reported which, despite a marked association with young maternal age at conception, is not due to an increase in the teenage pregnancy rate. As the average length of inpatient stay in the neonatal intensive care unit for cases with this malformation is approximately four weeks, the rise has considerable cost implications. The increasing incidence may also offer opportunities to determine the cause of gastroschisis.

A 5-year-old girl presented with a right iliac fossa mass. Radiological investigations suggested the diagnosis of calcified mass. During laparotomy a large fecolith was found trapped below an incomplete septum in the cecum. The pathogenesis of enteroliths and the embryology of this unusual bowel anomaly are discussed.

A right ovarian cyst was detected in a 34-week-gestation fetus on antenatal ultrasound scan (USS). Postnatal USS confirmed the presence of the cyst and showed it to be 4.6 cm in diameter. The cyst failed to resolve after a period of conservative management, and therefore surgical removal was performed. During the operation a free autoamputated right ovarian cysts was found. The complication had not been detected preoperatively in spite of regular USS follow-up.

A 14-month-old boy presented with hepatoblastoma, which was completely excised. He had pulmonary metastases, diagnosed 1 year later, treated with chemotherapy followed by resection at age 2 1/2 years. At the age of 3 1/2 years a further metastasis was shown on CT scan and this was resected. Two further metastses were resected at ages 4 1/2 and 5 1/2 years. At age 9 1/2 he had a further isolated pulmonary metastasis resected and is again disease-free more than 30 months from the last thoracotomy. Prolonged survival following metastatic hepatoblastoma can be achieved with repeated thoracotomies, especially if the first recurrence is more than 6 months from diagnosis and the number of metastases is small. Follow-up examinations should be both radiological and with serum alpha fetaprotein (S alpha FP).

Background: There are two major methods of esophageal substitution for children born with long-gap esophageal atresia. This study was undertaken to see whether one method of substitution emerged as clearly superior to the other., Methods: Twenty-four UK children who received a colon transposition for esophageal atresia were compared with 15 US children with esophageal atresia who received a gastric tube. The charts of all patients were reviewed. Follow-up data were obtained by questionnaire, and more than 80% of patients were personally evaluated at follow-up clinics., Results: At follow-up US children were 3 1/2 to 18 1/2 years of age; UK children were 7 1/2 to 19 years of age. Most of the children fell at or below the 10th percentile for height and weight, reflecting the tendency for prematurity in infants with esophageal atresia. One half of the children needed to eat slowly and to avoid certain meats. Dysphagia was rare. Older children ate socially with their friends without embarrassment. Early complications were technical; there were few late complications, and no difference was apparent between the two groups., Conclusions: In subjects who were growing, no difference was noted between the two methods of substitution as far as nutrition, growth, patient acceptability, or complications, early or late. Both groups functioned well and appeared to improve with the passage of time.

Two children with disseminated malignant sacrococcygeal tumour were treated with six courses of vinblastine, cis-platinum, and bleomycin. Both had exploratory operations after four courses of treatment and no histological evidence of malignant disease was found. The two children have remained free of disease with normal alpha-fetoprotein levels for 30 months and 18 months, respectively.

The use of a plastic sump catheter for continuous suction of the blind upper pouch in esophageal atresia has been widely accepted since the method was first described. The following case illustrates a complication which resulted from the use of such a catheter, namely, perforation of the upper pouch.