Pectus excavatum

Pectus excavatum

262 ABSTRACTS Most cases began between three and six years of age and, although of varying fremore frequently quency, rarely occurred than every thr...

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262

ABSTRACTS

Most cases began between three and six years of age and, although of varying fremore frequently quency, rarely occurred than every three to four months. Attacks were painful and accompanied by swelling of the gland and edema of the orifice of Stensen’s duct. The attacks lasted three to seven days and the accompanying systemic reaction varied from minimal to severe. Between attacks the gland and duct appeared normal. Extensive laboratory studies in these cases were negative or normal; cultures revealed normal oral flora. Sialograms in all cases showed “sialectasis” produced by extravasation of the contrast media into the parenchyma. This occurred even with only partial filling of the duct system indicating that excessive injection pressure was not the cause. Biopsy was done in four cases and confirmed previous observations of duct epithelial hyperplasia, lymphocytic infiltrate, acinar atrophy and fibrosis. An additional finding was that of fragmentation or absence of the basement membrane, supporting the view that the acinar lining is more permeable allowing extravasation of dye in sialography. Acute attacks were treated by general supportive measures. Antibiotics, massage of the gland, use of acid sweets and chewing gum, have all been recommended. None of these measures produced obvious benefit. Meatotomy of Stensen’s duct in seven patients was without benefit. Avulsion of the auriculotemporal nerve in 17 patients was not of benefit and it is no longer done. Long-term steroids or antibiotic irrigation of the duct were not used. No patient underwent ligation of Stensen’s duct and none underwent parotidectomy. Follow up was complete on 45 patients in the Idiopathic group. Thirty have ceased having

attacks.

All

those

still having

at-

tacks are less than 1.5 years of age, but for one patient who at 18 years still has very mild attacks. It is considered that virtually 100 per cent of children in this group will be spontaneously years. The

author

“cured” by the age of 15 discusses

possible

etiologic

factors and advocates nonoperative therapy in all “allergic” and “idiopathic” types of recurrent parotitis.-Hugh V. Firor.

TIIROMBOCYTOPENIA IN A PATIENT WITH A RELATIVELYSMALL FACIALHEMANGIOMA. D. G. Corley, A. Oquendo-Cabrera, 1. M. Laura. Clin. Ped. 8:728 (Dec.) 1969.

This is a case report of a three-month-old infant with hemangiomatous involvement of left side of face associated with thrombocytopenia. Prednisone therapy was unsuccessful. Patient was then treated with 1200 rads given in four divided doses to left side of the face with subsequent rise in platelet count, associated with decrease in size of the hemangioma-Michel Gilbert.

THORAX PECTUSEXCAVATUM.G. H. Wooler, Y. A. S. Mashour, 1. B. Garcia, M. P. Holden and M. I. lonescu. Thorax 241557-562 (Sep-

tember)

1969.

The authors suggest that pectus excavatum is due to excessive negative anterior mediastinal pressure which sucks in the body of the sternum. This situation is brought about by the malposition of the heart into the left hemithorax. Surgical correction of the deformity should include, in addition to the standard procedure of resection of deformed costal cartilages, anterior wedge osteotomy and fixation of the sternal gladiolus at the sternal angle, mobilization of the redundant pericardium, with partial excision or plication, and anterior fixation so as to bring the heart into the midline and prevent recurrence. This procedure has been accomplished in three patients aged 42, 16 and 20 years since November, 1968.-WiIZiam K. Sieber. ACUTE RESPIRATORYDISTRESS AND BRONCHOGENIC CYST IN THE NEWBORNINFANT. A. Beau, 3. Pre’vot and J. P. Azambourg.

Ann. Chir. Inf. 10:495-503,

1969.

This is a description of two cases of bronchogenic cysts operated upon with success. The first one was a huge infected cyst of the bronchus of the middle lobe, which was treated by lobectomy. The second one was a little cyst of the left main bronchus, no bigger than a walnut, but producing a huge emphysema of the left lung: treatment consisted in excision of the cyst. There follows a review of the literature.-M. Bettex.