[The natural history of congenital defects and deformities of the spine (II)].
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Advantages of primary fascial closure of abdominal wall defects are mainly in reducing the number of staged procedures with related complications and the need of multiple operation. Nevertheless correction of large defects still remains a challenge to pediatric surgeon. Postoperative paralysis and mechanical ventilation after intraoperative milking of intestinal content and abdominal muscles stretching have been reported to reduce the risks of "forced" primary closure. A series of 64 Omphalocele and Gastroschisis has been reviewed. Associated anomalies are still the main cause of mortality among Omphalocele. Prematurity plays a secondary role on survival of Gastroschisis cases; deaths were mainly due to sepsis. Primary respiratory insufficiency affected a large number of Giant Omphalocele cases (larger than 5 cm with herniated liver) and was associated to a restricted chest structure. All these cases died in the first weeks of life. Primary closure with or without postoperative paralysis and mechanical ventilation showed to reduce in a significant way the postoperative complication rate compared to staged procedures. Mortality and hospital stay were not significantly influenced by different kinds of surgical treatment among Omphalocele. Associated anomalies are an unavoidable limiting factor to survival. Among Giant Omphalocele the use of aggressive primary fascial closure with ventilatory support showed in our hands to be a safe procedure provided that a preoperative selection of cases on the basis of chest X-ray and blood gases has been made.
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The authors investigated a group of 109 mothers whose children with a cleft (dg. 749) were up to the age of 13-15 years in the care of the Clinic of Plastic Surgery. The cleft served as a model situation for investigation of the parents' reaction, in particular the mother's reaction, to the birth of the child with a developmental defect. The main findings: three quarters of the mothers described the birth of a damaged child as a psychic shock followed by a series of neurotic symptoms. Some mothers suffered from reactive depression which was not diagnosed and therefore not treated. It was confirmed that the poor mental condition of the mother persist in the majority of the investigated group to the time of the child's adolescence and has a marked effect on its mental prosperity. Latent or manifest negative attitudes of the parents cause mental handicapping phenomena in the children (impaired self-esteem, impaired sexual identification etc.). Aggravating factors are stigmatizing manifestations from the environment of the family and child community, which affect some three quarters of mothers and children. The authors discuss suitable forms of medical and counseling care which after delivery and later would help to reduce the psychic trauma of the parents and promote adequate somatic and mental development of the child.
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