Excessive salivation, with choking, coughing and cyanosis on attempts at feeding in a newborn infant reasonably suggest esophageal atresia. Yet, other less common lesions may present the same signs. Of these, the simple esophagotracheal fistula, without atresia, is well known, while instances of congenital pharyngo-esophageal and true esophageal diverticula, with or without coexisting esophagotracheal fistulae, have only occasionally been reported (BRINTNALL & KRIDELBAUGH 1950, KNOX 1951, ROBB 1952 and GRANT & ARNElL 1959).An apparently even more rare disorder in the neonate with the same symptomatology is submucosal perforation of the esophagus. The clinical features and the radiologic appearances of this lesion on the basis of experience gained from two cases recently studied will be described in this communication. During its preparation, however, the records of a third case treated in another hospital became available and were included in the study. The radiologic features and the findings at operation of this third case well support the etiologic hypothesis for the disorder.
A follow-up study including all boys (n = 117) operated with circumcision for phimosis during 1976 was performed. Most patients were operated on an outpatient basis. Early complications like bleeding or infection were few and mild. In 13 cases there was a postoperative stricture of the urethral orifice which had to be widened. Five patients had complaints about the cosmetic result. Eight boys expressed shyness and unwillingness to undress in school gym. In no instance were there any signs of a more serious psychological disorder. The operative indications are discussed and it is concluded that worried parents of boys with phimosis can be safely advised to have their boys circumcised if the prepuce is scarred or there has been recurrent balanitis, or if the boy has reached school age and the foreskin is still unretractable.
Cyclophosphamide is a cyclic phosphoric acid ester originating primarily from nitrogen mustard gas. The substance is activated in the organism forming cytostatically active compounds. Besides the well known haematological side effects of cytostatic drugs, cyclophospharnide has, in addition, been reported to cause haemorrhagic cystitis in frequencies between 3 and 40% in adult series (3, 6, 8, 11). Corresponding figures concerning children are lacking, despite the fact that during the last decade, the use of the drug in paediatrics hasincreased.The present report deals with cyclophospharnide therapy and haemorrhagic cystitis in childhood. One of the reported cases in addition stresses the fact that this kind of complication might induce serious situations if not given heed to in time. CASE REPORTSCase I K. L. male, 11 years of age when admitted to hospital due to macroscopic haematuria. On admission a solid orange-sized tumour was palpated above his pubic symphysis.Hb 5.6 gjl00 ml. Body weight 28 kg. Intravenous pyelogram (IVP) revealed normal conditions. Micturition cystography visualized the tumour curving into the bladder.At laparotomy the tumour was found to originate from the mesentery of the distal part of the ileum. It was rooted to the sacrum and descending colon and was also adherent to the back wall of the urinary bladder. The tumour was removed together with the involved part of the ileum, colon and lymphatic glands. Microscopic examination of the specimen revealed reticular cell sarcoma. The margins of the resected 32 -732875 Acta Pzdiat Scand 62 intestines were free of tumour but one lymphatic gland was affected.Cytostatic treatment including cyclophosphamide and vincristin was started postoperatively. A metastatic tumour was found 8 months after the first operation, engaging the pelvis and left ureter and adherent to the rectum. The tumour was removed.14 months after the cytostatic treatment had started the patient developed intermittent macroscopic haematuria. The cyclophosphamide dose was halved. Another 3 months later the boy was admitted with haematuria and discharge of blood clots. At that time the boy had had more than a total of 12 g of cyclophosphamide and 24 mg vincristin.On admission endoscopy revealed large amounts of blood clots. Open evacuation and bladder drainage was performed but without improvement. During this procedure careful examination demonstrated no tumow growth in the mucosa but pronounced oedema and diffuse capillary bleeding.Two days later another cystostomy had to be performed to release urinary obstruction and anuria caused by reappearance of blood clots. Intravenous antifibrinolytic therapy was instituted. Over the next few days the patient complained of serious pain suprapubically and in his left flank. Cystography revealed free reflux bilaterally and reappearance of blood clots in the urinary bladder. Cystostomy was performed again and large amounts of clotted blood were evacuated. This time two MalecBt catheters were inserted and treatment with continuous bladder lava...
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