Is there still a place for surgical sphincterotomy?
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Biomedical subjects
Publications and source records attributed to N J Laage.
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This is a report of a case of juvenile gastrointestinal polyposis consisting of widespread juvenile polyps encountered from the stomach into the rectum. Only few cases have been reported, and extra intestinal manifestations include clubbing of fingers, macrocephaly, hypotonia, hepatosplenomegaly, anemia, and protein-losing enteropathy. The outcome is usually dismal, the children barely becoming older than 2 years. Modern fibreoptic endoscopy with polypectomies performed via the upper and lower gastrointestinal intestinal tracts and via a midbowel ileostomy may offer a viable form of management.
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Gastroduodenoscopy and retrograde cholangiopancreatography has been performed on 25 occasions in 20 children aged between 7 and 16. Radiographs of the clinically relevant duct or ducts were achieved in 96% of attempts, with no complications. The diagnostic information proved useful clinically; in particular it provided a precise map if biliary or pancreatic surgery was being contemplated. Several unexpected congenital duct anomalies were found. This and other recent reports, particularly from Germany, indicate that endoscopic retrograde cholangiopancreatography deserves greater application in children, and can also be used in babies.
One hundred and twenty-three total colonoscopies were performed on 115 children with ages ranging from 3 months to 16 years. The major indications were suspected inflammatory bowel disease and unexplained rectal bleeding. Ninety-seven per cent of all procedures were carried out with sedation only. Adult colonoscopes were used in most of the patients but in babies and small children paediatric instruments were preferable. Total colonoscopy was possible in all patients with a patent colon. The terminal ileum was examined in 63 patients. Endoscopic snare polypectomy was successfully carried out in 8 children and multiple haemangiomas were electrocoagulated in one. Total colonoscopy in this paediatric series proved to be at least as easy, rapid, well-tolerated, and safe as in adults. In selected patients as single colonoscopy can give an accurate diagnosis with biopsy proof and sometimes the opportunity for definitive treatment.
Indium-111 deferoxamine was used to delineate induced abscesses or different ages in a baboon, and lymph nodes in a case of canine spontaneous lymphosarcoma, by means of gamma-scintigraphy. Positive results were obtained already 1 hr after administration of the scanning agent, and the lesion-to-background ratio improved progressively with time. The tissue distribution of the radiopharmaceutical was determined in rats, and showed a relatively high isotope retention in the kidneys.
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