Anorectal continence following sphincter reconstruction utilizing the gluteus maximus muscle: a case report

Rectal incontinence following pull-through procedure for high imperforate anus remains a difficult problem. Based on recent knowledge of the segmental neurovascular supply of the gluteus maximus muscle, the inferior half of the muscle on both sides was used for anorectal sphincter reconstruction on a 10-year-old boy who was totally incontinent following a pull-through procedure for a high imperforate anus. The technique of constructing this sphincter is simple and utilizes principles of muscle tendon transfer without jeopardizing the function of gait. Furthermore, the gluteus maximus muscle, being an accessory muscle of anal continence, is an ideal structure for this reconstruction. Colostomy can be prevented with the use of good preoperative bowel preparation and a constipating program for 1 week postoperatively. The results are directly related to the success of the operative procedure, and the maturity and degree of motivation of the child to undergo bowel-control training.

Psychological evaluation of treated females with virilizing congenital adrenal hyperplasia

The psychological development of females with congenital adrenal hyperplasia (CAH) has been previously studied by Money, et al, who found that psychological development of sex identity was consistent with sex assignment despite virilizing adrenal hormones and abnormal external genitalia requiring surgical correction. In this study, using a variety of psychological tests, we assessed the sex-dimorphic behavior, body image, cognitive functioning, and sex-role identity of nine patients ranging in age from 13 to 21, all treated with glucocorticoids and surgical correction. Four of the nine showed moderate virilization despite treatment. Psychological measures included the Wechsler Intelligence Scale for Children-Revised (WISC-R), the Bem Sex-Role Inventory, the Draw-A-Person (DAP) and an interview with patient and family. Results indicate that patients fall within the normal expectable range for this developmental period in visual-spatial and verbal cognitive functioning, in sex-role identity, and in social interpersonal early behaviors. In two areas of functioning these patients demonstrated some variance from the norms, specifically in sexual identity and early activity levels. This suggests that sexual identity and physical activity are most prone to hormonal and psychological impact but that cognition and sex-role identity are not affected. Future studies of this sample will look at personality dimensions such as ego functioning, defense and affect to consider the impact of body image concerns and conflicts.

Schneider's first rank symptoms--prevalence, diagnostic use and prognostic implications

An evaluation of the prevalence of Schneiderian first-rank symptoms, and their diagnostic and prognostic value is described. 35.2 per cent of schizophrenic patients had first-rank symptoms. The presence of first-rank symptoms did not indicate either chronicity of illness or a poor outcome.

Pediatric pyleoplasty

A series is reviewed of 153 pyeloplasties in 130 pediatric patients. Dismembering pyeloplasty was performed in most cases, usually with temporary nephrostomy drainage. A satisfactory anastomosis resulted in each case. The important technical aspects of pyeloplasty are emphasized.

Bronchial carcinoid tumor

Bronchial carcinoid tumor occurring in an 11-yr-old boy is described. Pertinent diagnostic and therapeutic considerations are discussed briefly.

Choledochal cyst with cholelithiasis: 15-yr follow-up

A 15-yr-old boy, who had had surgery for a choledochal cyst in infancy, was worked up for recurrent right upper quandrant pair. Intravenous cholangiogram and ultrasound demonstrated a choledochal cyst with stones. Angiogram showed only a distorted branch of the gastro-duodenal artery. These findings were confirmed at surgery.

Solvolytic Studies on Methylnorbornyl Systems: Investigations on the Synthesis of 2-Exo-methyl-6-norbomylideneacetic Acid

3-Nortricyclyl bromide (11) was transformed in four steps to norbornan-3,6-dione (10). Methyl 4-hydroxy-2-butynoate (19) was prepared from propargyl alcohol and its alkylation reactions with 3-methylcyclopentanone investigated. Methyl 4,4,5-triethoxycarbonylpentanoate (22) was obtained by the sequential alkylation of diethyl malonate with ethyl bromoacetate and methyl acrylate, and its base catalysed cyclization studied. Cyclopentadiene was converted to 2-exo-methylnorbornan-6-one (17) in eleven steps.