Intussusception: trapped peritoneal fluid detected with US--relationship to reducibility and ischemia

PURPOSE

To determine the frequency and meaning of fluid inside the intussusception at ultrasound (US) and its relationship to irreducibility and ischemia.

MATERIALS AND METHODS

US enabled the diagnosis of intussusception in 145 cases. Shape and axial diameters of the area of fluid were determined. US-guided hydrostatic reduction was attempted in 144 cases.

RESULTS

Fluid was present in the intussusception in 20 cases (14%) and appeared on axial images as an anechoic crescent between both serosal layers of the enfolded and everted intussusceptum. No cystic structural anomaly was detected at surgery. Rates of reduction were 89% (111 of 125) in cases without fluid and 26% (five of 19) in cases with fluid (P < .001). At surgery, ischemia was absent in all 14 cases without fluid and present in 10 of 20 cases with fluid; necrosis was present in two cases with fluid. Areas of fluid greater than 14 x 5 mm, especially if associated with fluid in the dilated apex of the intussusception, were strongly related to irreducibility and ischemia (odds-likelihood ratio, 67.5).

CONCLUSION

Fluid seen inside the intussusception represented trapped peritoneal fluid. Substantial amounts of fluid were associated with irreducibility and ischemia.

Trisomy 12 and p53 deletion in chronic lymphocytic leukemia detected by fluorescence in situ hybridization: association with morphology and resistance to conventional chemotherapy

The incidence of trisomy 12 and p53 deletion was studied in a group of chronic B-lymphocytic leukemia (B-CLL) patients, using fluorescence in situ hybridization (FISH). Trisomy 12 was detected in eight of 50 patients (16%) and p53 deletion in six of 38 cases analyzed (15.8%). A statistically significant difference was observed between the incidence of trisomy 12 in patients with typical and atypical morphology (3.03% versus 41.18%). No correlation was found between this alteration and the rest of the clinical and biological parameters studied (adenopathies, hepatomegaly, splenomegaly, lymphocyte count, staging, CD11c expression, and resistance to chemotherapy). The p53 deletion was correlated with the presence of hepatomegaly and splenomegaly, advanced stage of disease, and resistance to conventional chemotherapy. The application of FISH to whole blood cell nuclei, without prior manipulation or culture, showed a higher percentage of cells with trisomy 12 than when the method was used following culture. We conclude that 1) FISH is a simple and sensitive technique for the detection of numerical and structural chromosome abnormalities; 2) Its application to uncultured samples obviates the alteration of results originated by the probable growth advantage of the normal or neoplastic cell population in vitro; 3) Trisomy 12 appears to define a B-CLL subgroup of atypical morphology; and 4) The p53 deletion is correlated with advanced stage of disease and resistance to treatment.

The safety and effectiveness of stepwise and low-dose administration of follicle stimulating hormone in WHO group II anovulatory infertile women: evidence from a large multicenter study in Spain

PURPOSE

Our goal was to investigate the safety, effectiveness, and feasibility for the practicing physician of stepwise and low-dose administration of FSH in WHO group II anovulatory infertile women.

METHODS

Infertile female patients (n = 234) suffering from WHO group II anovulation, and who failed to became pregnant with clomiphene citrate, were included in a multicenter, prospective, clinical study of treatment with a protocol of chronic low-dose and small incremental rises with urinary purified or highly purified FSH. Follicular development was monitored with ultrasonographic scans.

RESULTS

The 234 patients received a total of 534 cycles of treatment, for a mean number of 2.3 treated cycles per patient. hCG was withheld in 65 (12.2%) cyles because of no response and in 28 (5.2%) cycles because of hyperresponse. Of the remaining 441 cycles, 419 (95%) were ovulatory, and in 198 (47.3%) of these cycles a single dominant follicle developed. There were 93 pregnancies (39.7% per patient), for a cycle fecundity rate of 17.4%. Cumulative conception rate after two treated cycles was 33.5%. There were 14 (15%) pairs of twins and 10 (10.8%) spontaneous miscarriages. The prevalence of complications was low with no cases of severe OHSS. Basal LH/FSH ratio was significantly higher in the pregnant group of patients than in nonpregnant women.

CONCLUSIONS

Stepwise and chronic low-dose administration of FSH is a safe and effective method for treatment of WHO group II anovulatory infertility, mainly in those patients having high LH/FSH ratios.

[Our experience in neonatal surgery in a 15-year period. Follow-up of 1,003 cases]

From 1982 to 1994, 1.003 cases of surgical newborns have been retrospectively studied. Frequency and epidemiology have been evaluated, so as associated malformations. Prenatal diagnosis was made in 72 cases (7.1%). The most frequent entity was intestinal atresia, with 122 cases (12.1%), followed by necrotizing enterocolitis in 80 cases (7.9%), nevertheless this last one was the most frequent finding in preterm newborns. Esophageal atresia was found in 57 cases (5.6%). Association with other malformations was found in 127 cases (12.6%), and 32 cases of them (3.1%) constituted congenital malformations syndromes. The number of surgical newborns has increased in the last years, mainly due to ambulatory surgery. Global mortality of operated patients was 62 cases (5.9%); the highest mortality index was for congenital diaphragmatic hernia (33.5%), followed by necrotizing enterocolitis (28%). Mortality rate has decreased in recent years, due to improving in management and treatment of these patients, and the consolidation of surgical newborn units. Future efforts should be aimed for decreasing in mortality and improving the standard of life of these patients.

Treatment of esophageal varices by endoscopic ligation in children

Endoscopic variceal ligation (EVL) is an alternative technique to endoscopic variceal sclerotherapy (EVS) to treat esophageal varices. This method consists of mechanical ligature and thrombosis of varices using elastic rubber rings. During an 11-month period, nine pediatric patients with esophageal varices secondary to portal hypertension were treated by EVL. Extrahepatic portal vein obstruction was the cause of portal hypertension in 5 patients and in 4 cases the cause was intrahepatic disease. The average age of the patients was 8 years (range: 2-15). Five patients had bled from esophageal varices previously. Two were actively bleeding at the time of the procedure. Endoligature was performed prophylactically in four patients. Fifty varix ligations were performed in 26 separate sessions. In children older than ten years, EVL was performed under intravenous sedation. Two mild rebleeds have occurred in this group and responded to repeated ligature. Varices were reduced in grade in all patients. Six patients achieved variceal eradication. Recurrence of varices was not encountered. No major complications occurred and there were no treatment failures. These early results suggest that endoscopic ligation is a safe and effective method for the control of esophageal varices in children.

[Rectocolonic plasty using mechanical stapler as a surgical solution in complications of megacolon]

Hirschsprung's disease surgically treated with Duhamel's technique in which no mechanical suture has been used, usually presents, as main complication, cronic constipation, due to fecalomas in the rectal pouch. In our experience (30 cases plus four patients sent to our hospital for reintervention), this complication is not present when mechanical suture is introduced to the Duhamel's Technique. This allows us to assure that perineal rectocoloplasty, with auto-suture material is a precise optional treatment, with excellent results and allows the chance of not going through laparotomy in those cases that require reintervention.

[Ambulatory surgery. Experience at a pediatric surgery department]

In October 1987 we opened an Outpatient Surgical Unit, since January 1988 to December 1993 we have treated 8232 patients with an mean age (range of 2 weeks to 17 years). All the patients were given general anesthesia, loco-regional anesthetics or deep sedation. 33.5 percent of the total number of patients operated in our hospital were treated in this Unit, being 41.4 percent if related to programmed surgery. Only 2.5 percent of them were admitted in the inpatient area with no significant complications.

[Treatment of post-traumatic pancreatic pseudocyst by percutaneous Huisman's drainage]

Pancreatic pseudocysts is a complication of acute posttraumatic pancreatitis. They usually cause recurrent abdominal pain, nausea, vomiting and elevation of serum amylase levels. A history of epigastric blunt trauma, the before mentioned clinical signs and echographic or scanning studies may lead to a certain diagnosis. Although most of them resolve spontaneously, some persist and active therapeutic measures are required. Surgical internal drainage has been the operative technique of choice in children. Nevertheless, treatment can be achieved by percutaneous aspiration or drainage of pancreatic recurrent collections. We present our experience in two children with posttraumatic pancreatic pseudocyst, treated successfully by means of a percutaneous transabdominal pig-tail catheter (Huisman catheter). The technique of catheter placement and clinical aspects are discussed.

[Intestinal anastomosis by biodegradable rings]

During an 9-month period (March to November 1992), six children underwent an intestinal anastomosis by means of a biofragmentable ring (BAR). Patients ages ranged from 5 to 16 years old. There were no mayor complications at surgery. The main technical problems was the difference of size between BAR and intestinal lumen. No patients in which BAR was used have presented fistulae, dehiscence or anastomotical stenosis.

[The indications, technics and results of the use of tissue expanders in pediatric surgery]

We review our experience in tissue expansion in twenty-four pediatric patients. The most frequent indications for the use of tissue expanders included congenital nevi and burn scars, they were also used with success in alopecia, congenital abdominal wall defects, mammary hypoplasia and microtia. Tissue expanders were always placed subcutaneously. Both, surgery and body deformity during expansion, were well tolerated. We found complications in five cases, but only in one patient treatment was interrupted. Results were considered excellent in nineteen cases.

[Congenital esophageal stenosis associated with corneosclera]

One case of congenital esophageal stenosis due to tracheobronchial remnants and associated with microphthalmos and corneosclera is reported. Diagnostic and therapeutic methods employed are discussed.

[Locoregional anesthesia in surgery with day hospitalization. Our experience with 240 cases]

Locoregional anaesthesia has become an excellent complement of conventional general anaesthesia, because it results in efficient postoperative pain relief and is easy to carry out. We have performed two types of anaesthetic blockade: of peripheral nerve (dorsal nerve of the penis and abdominogenital nerve) and caudal block. Both have been employed in pediatric day surgery with good results in postoperative pain relief and with no complications. Advantages such as early recovery of oral feeding and the normal activity of the child are possible when using these techniques of locoregional anaesthesia.