102 ABSTRACTS

Surgical Treatment of Pleuropulmonary Infection in Infants and Children. L. Perez, R. Takenaga, and J. Jimenez. 9ol Med Hosp Infant (Mex) 34:71-82 (January/February). 1977,

Pleural empyema is the most frequent problem seen in surgical pathology of the chest at the Hospital del Nifio DIF (Mexico). The authors present a retrospective analysis of 118 patients (ages 3 mo-17 yr) who underwent surgery between 1971 and 1976. Decortication with or without pulmonary resection was necessary in 58% of the cases, a figure contrasting with the limited number of cases pub- lished in countries with a high standard of living. One hundred and fourteen patients were discharged following recovery. Four patients died, one of upper gastrointestinal bleeding and three of sepsis. The destructive and irreversi- ble nature of the lesions was confirmed by the his- topathologic study of the resected parts. The authors sug- gest that the patients here discussed had lesions for which antibiotics were no longer useful and surgical treatment was indicated. This reveals a delay and inefficiency in the use of antibiotics before the patients came to the hospital. Efficient and early medical treatment could possibly avoid surgery in many patients.--Alberto Pefia

Pulmonary Resections in Children. T. E. Williams, Jr., G. A. Young, and J. W. Kilman. Arch Surg 112:481-483 (April), 1977.

Forty-eight pulmonary resections were performed in 45 children. The principal indications for surgery were bronchiectasis, congenital cysts, and lobar emphysema. Nine complications occurred in five patients and there were three deaths. Resection for malignancy is unusual. The pe- riod covered in this study was 1966 through 1976. Listed as indications for a lobectomy are bronchiectasis, congenital cysts, lobar emphysema, right middle lobe syndrome, fi- brocystic disease, chronic collapse, sequestration, and lung abscess. The indications for pneumonectomy were cystic fi- brosis, sarcoma, hypoplastic lung, hamartoma, lobar emphysema, Swyer-James syndrome, and sequestra- tion.--Edward J. Berman

Congenital Lobar Emphysema. H. H. Keith. Pediatr Ann 6:34-41 (July), 1977.

This is a good general review of the problem of congenital lobar emphysema pointing OUt that Gross and Lewis in 1945 described the first successful lobectomy for the condition and that the name "congenital lobar emphysema" was coined by Ross Robertson and E. S. James of Vancouver in 1951. The author makes the point that some cases of lobar emphysema that do not precipitate severe respiratory distress may be rather static and nonprogressive and may be managed nonoperatively. In such cases the lobe will stay about the same size and the child will grow around it and end up doing about as well or better than if it had been resected.--David L. Collins

Congenital Cystic Adenomatous Malformation of the Lung. P. Ta/a/ak, U. Boonyaprakob, and B. Chava/ittamrong. Z Kinder- chir 21:39-44 (May), 1977.

The number of cases reported with true congenital cystic adenomatous malformations of the lungs are small. The condition must be considered in the differential diagnosis of

respiratory distress in the neonatal period. The embryologic and pathologic characteristics are described. Most of the neonates affected are premature infants. Maternal hydramnios is frequently associated. Radiologic investiga- tion shows the intrapulmonary cystic mass. It is limited to one lobe. The distended cystic mass shifts across the midline displacing the mediastinal structures. Resecting the affected lobe of the lung is the treatment of choice. Lobectomy should be performed early preventing in- terference with cardiac venous return, respiratory distress and secondary infection. One 6-day-old patient presented with mild dyspnea on feeding. On roentgenographic exami- nation of the chest a solid mass was shown on the left side with multiple radiolucent areas occupying almost the whole left hemithorax with displacement of the heart to the right side. After left upper lobectomy the postoperative course was uneventful.--Karl-Ludwig Waag

Results With the Rives-Plasty in the Treatment of Congen- ital Diaphragmatic Defects and Eventration. G. Brandesky. Z Kinderchir 21 : 123-141 (June), 1977.

Twelve patients were investigated 1-11 yr after trans- thoracic repair of congenital diaphragmatic defect, hernia, or eventration. The defect was covered by a muscular flap of the latissimus dorsi (Rives' operation). At the primary repair no increased mortality occurred using the thoracic approach. Out of 17 cases 3 patients died without and three with a muscular flap. At follow-up examination little de- formation of the thorax after the Rives-plasty was seen; mainly an elevation of the scapula. On radiography, 7 patients had fusion of two ribs at the site of the tho- racotomy. Lung function tests and blood gas analyses were essentially normal. In 9 of 12 patients the diaphragms were similar in height and shape. The position of the intercostal space corresponded in 4 cases to the contralateral side, despite the muscular flap having been placed through the 9th intercostal space. On screening, the diaphragmatic movements were restricted to about 50% in 4 patients, but were completely normal in two. A marked reduction (33%) of the movement of the phrenicocostal angle was found mainly because of the muscular flap. Summarizing all inves- tigations, the functional and radiologic results were ex- cellent in 8 and satisfactory in 4 patients. Clinically, all children were symptom free without limitations of their activities and their development was normal. It is suggested that Rives-plasty gives better results in large diaphragmatic hernias than other procedures using alloplastic ma- terials.--Karl-Ludwig Waag

H E A R T A N D G R E A T V E S S E L S

Effect of Unilateral Pulmonary Artery Occlusion on the Arterial Oxygen Pressure of Children Undergoing Pulmonary Systemic Artery Shunting Procedures. D. A. Murphy. G. L. Dunn, D. A Gillis, A. R. C. Dohe//, and A. S. Wenning. Can J Surg 20:107-110 (March), 1977.

Twenty children undergoing thoracotomy had blood gas analyses performed at intervals during the operative procedure. The venous admixture was apparent upon compressing the lung to expose the mediastinal structures and was diminished on clamping the pulmonary artery to the exposed lung. The authors state that this observation