Segmental dilation of the colon: a rare cause of chronic constipation

Segmental dilation of the colon is a rare entity. It should be considered in any young patient with chronic constipation. The clinical picture and radiographic examination are indistinguishable from Hirschsprung's disease and the rectal biopsy is of paramount importance. This disease can be cured by resection of the dilated segment.

Hydrometrocolpos in neonate due to distal vaginal atresia

Hydrocolpos is the result of vaginal obstruction and can become an emergency in the newborn period. The treatment of imperforate hymen is well defined, but the treatment of vaginal atresia is more complex. We encountered two cases of hydrocolpos secondary to distal vaginal atresia, that were operated on in the first days of life. One baby had distal atresia without persistance of urogenital sinus. Surgery combining abdominal perineal approaches and a posterior vaginoplasty was carried out. The second baby had hydrocolpos with persistance of urogenital sinus. Drainage through the sinus was unsuccessful because the baby developed sepsis by trapping urine in the uterus. Finally an abdominoperineal vaginal pull-through was successfully done. The embryology and literature are reviewed. The classification, indications and surgical technique are discussed.

Head and neck manifestations of the chronic graft vs. host disease

Bone marrow transplantations are being used with increasing frequency in the treatment of patients with leukemia and aplastic anemia. The graft-vs.-host disease (GVHD) is a serious complication that affects long-term survivors following bone marrow transplantation. It is the result of an immunologic reaction mounted by the grafted reticuloendothelial cells against the tissues of the recipient, and it affects multiple organ systems. Involvement of the skin and mucosal surfaces of the head and neck region, in particular the oral cavity, occurs in a large number of patients with GVHD. In this report we present four patients with GVHD in whom mucosal lesions and infections of the head and neck region were prominent features. Our observations indicate that the clinical and histological characteristics of these lesions vary according to the time elapsed from the onset of the disease. Therefore, clinical examination of the head and neck region and biopsy of the oral mucosa are important not only in the diagnosis of the GVHD, but also in the evaluation of its progress and response to treatment.

Laryngotracheoesophageal cleft. An easily missed malformation

Laryngotracheoesophageal cleft is a rare congenital anomaly characterized by a midline defect of variable length between the posterior larynx and trachea and the anterior wall of the esophagus. This report concerns the clinical course and follow-up of three patients with this anomaly and a review of the literature. Only one of these patients had a successful repair on the first attempt. The difficulty in making the diagnosis is stressed. This anomaly is associated with a high morbidity and mortality.

The mortality of congenital diaphragmatic hernia. Is total pulmonary mass inadequate, no matter what?

Much progress has been made over the past 20 years in neonatal surgery, but the mortality rate in cases of congenital diaphragmatic hernia (CDH) for babies presenting in the early hours of life has remained high. We have reviewed our experience with special reference to 40 autopsied patients. Hypoplastic lungs were seen in all patients. When the ratio of observed combined lung weight to the expected combined lung weight is calculated, the result is 0.33 +/- 0.17 when the expected lung weights are calculated from the babies' birth weight; and 0.36 +/- 0.17 when the expected lung weights are calculated from the gestational age. In all patients with high ratios, extensive pneumonia was confirmed. Those patients with pneumonia were eliminated from the calculations. We cannot state unequivocably that hypoplasia of both lungs is the cause of death in all patients with CDH. We can affirm that, in our experience, hypoplasia is present and is probably a major factor in the high mortality rate.

Hepatic hemangioma in childhood: medical management or surgical management?

Between 1955 and 1980 there were 14 patients treated at The Hospital for Sick Children with hemangiomas of the liver. Eight were seen at birth and 13 within the first 6 wk of life. The presenting clinical feature was that of massive hepatomegaly. Two children who had presented in the neonatal period were found to have had cardiac failure. Six patients were anemic and required blood transfusions. Before 1976 all patients who did not have cutaneous hemangiomas underwent laparotomy. Since 1976 only one laparotomy was done, the remaining 5 patients all having been treated symptomatically without operation. All the tumors involuted in the first year of life. Follow-up ranged from 1 to 20 yr and all are living and without symptoms. We recommend no active treatment if complications are absent. Steroids and radiotherapy are not used. If anemia and/or cardiac failure supervene, appropriate nonoperative management is necessary. Surgical treatment is indicated only if medical management fails or for rupture of the lesion.

Reaction of 1,2:5,6-di-O-isopropylidene-3-O-p-nitrophenylsulfonyl (and 3-O-p-tolylsulfonyl) α-D-glucofuranose with tetramethylammonium hydroxide in methyl sulfoxide

Treatment of 1,2:5,6-di-O-isopropylidene-3-O-p-tolylsulfonyl-α-D-glucofuranose with tetramethylammonium hydroxide in methyl sulfoxide gave 1,2:5,6-di-O-isopropylidene-α-D-glucofuranose in 89% yield. Under similar conditions, the 3-O-p-nitrobenzenesulfonate ester of 1,2:5,6-di-O-isopropylidene-α-D-glucofuranose 1, gave 3-O-[p-(3-deoxy-1,2:5,6-di-O-isopropylidene-α-D-glucofuranose-3-yl)oxyphenylsulfonyl]-1,2:5,6-di-O-isopropylidene-α-D-gluocofuranose 2, and 1,2:5,6-di-O-isopropylidene-3-O-p-nitrophenyl-α-D-glucofuranose 3. A discussion of the probable mechanism of this reaction is based on a study of the products obtained by application of the same reaction to ethyl p-nitrobenzenesulfonate.