460 INTERNATIONAL ABSTRACTS

palate (3), and miscellaneous (8). GER occurred in 21 patients and tracheal aspiration in 10. Follow-up studies in 11 patients revealed 7 with improvement or resolution. Clinical follow-up in 44 patients revealed resolution of symptoms in 32. Three patients died, and 4 underwent surgical procedures due to GI tract symptoms (feeding gastrostomy or fundoplication).--Randall W. Powell

Surgery of Gastroesophageal Reflux. M. Carcassonne, J.M. Guys, A. Delarve, et al. World J Surg 9:269-276, (April), 1985.

The authors state that 15 years ago, gastroesophageaI reflux (GER) was only recognized as a pediatric problem in North America by Randolph and Lilly. Now, however, anti-reflux surgery is used for a range of symptoms, "some of which are presumed, but seldom proven, to be related to reflux." Citing a lack of data on the current available diagnostic modalities and the true pathologic entity, five techniques are reviewed. A barium swallow is most valuable not for evaluation of reflux (high false _+ rate) but for demonstration of associated abnormalities of the gastroesophageal junction (30%). Esophagoscopy reveals esophagitis but the correla- tion of reflux and esophagitis has not yet been fully demonstrated. Gastroesophageal scintiscan is mentioned but the authors claim insufficient data for evaluation. Twenty-four-hour pH monitoring is stated to be technically difficult in the child and perhaps associated with a greater false negative and positive rate than is generally appreciated. Manometry is said to not be useful. In a discussion of patient selection, guidelines of a more conservative nature are presented with classification into a need for immediate surgery or delayed surgery, or for children greater than one year of age. The favored technique of the authors is reviewed, basically involving 360 ~ fundoplication, anterior gastropexy, and routine pyloromyotomy. Routine division of the short gastric vessels is not employed but is frequently found to be necessary. A two-layer wrap is constructed, for a length of 3 cm in an infant and 4 em in a child. Morbidity of the procedure is reviewed, emphasizing that gas-bloat can be minimized by a not-too-tight wrap, which is less than 5 cm in length. The final conclusion again emphasizes patient selection with any poor result ascribed to "'too liberal" operative indications.--Thomas K Whalen

Jejunal Interposition for Recurrent Gastroesophageal Reflux in Children. A.R. Pasch and T. Putnam. Am J Surg 150:248-251, (August), 1985.

Recurrent gastroesophageal reflux is a problem coming to the forefront amidst an ever-increasing number of primary anti-reflux procedures, primarily the Nissen wrap in children. Four patients were evaluated for severe symptoms secondary to recurrent reflux. Two were born with esophageal atresia-tracheoesophageal fistula; one had primary reflux and a lower esophageal stricture, and one had a congenital right diaphragmatic hernia. Three of the four initially had a fundoplication, the other a Belsey. Each had at least one additional procedure before coming to the attention of the authors (stricture resection, repeat Nissen, colon segment interposi- tion, etc). Based on the theory that jejunal interposition may promote acid clearance when done isoperistaltically, this procedure was executed. Follow-up ranges from 16 months to 6 years. No recurrent symptoms of reflux have been found.--Thomas K Whalen

Comparison of Barium Swallow and Ultrasound in Diagnosis of Gastro-Oesophageal Reflux in Children. D.R. Naik, A. Bolia, and D.J. Moore. Br Med J 290:1943-1945, (June), 1985.

The authors compare the efficiency of the conventional barium swallow with an ultrasound technique in the detection of gastro- oesophageal reflux in 51 children, aged 4 days to 16 years. In 15

children, reflux was demonstrated by both techniques; in one, minimal reflux was seen, and in 24 no reflux occurred. In the remainder, four children had reflux demonstrated by ultrasound when it had not been shown by the barium swallow but two children in whom reflux had been found by the barium, had an inconclusive ultrasound result. While the authors have demonstrated that their technique will reliably demonstrate gastro-oesophageal reflux, the place of the examination in practice is uncertain. Although the ultrasound examination is cheap, noninvasive, and quick, barium studies will have to be retained to show both the complications of reflux and the presence of other lesions.--James Dickson

Barrett 's Oesophagus. T.P.J. Hennessy. Br J Surg 72:336-340, (May), 1985.

This is an excellent review of the subject. The bulk of available evidence supports the view that Barrett's oesophagus is an acquired condition due to chronic gastro-oesophageal reflux. It is possible that a few cases are congenital. Barrett's oesophagus gives rise to severe stricture and ulceration and has a significant malignant potential. Treatment is designed to prevent reflux and, if possible, to reverse the metaplastic change. Dysplasia is of ominous significance and requires careful surveillance.--Lewis Spitz

Achalasia of the Cardia in Children. R.G. Buick and L. Spitz. Br J Surg 72:341-343, (May), 1985.

Fifteen children with achalasia treated surgically over a period of 21 years are reported. All had a modified Heller's myotomy as a primary treatment. The thoracic approach was used in 5 and the abdominal route in 10. In 3 patients, the myotomy was confined to the oesophagus. Six patients had antireflux procedures at the time of initial myotomy. The mean follow-up period was 6.2 years. Nine patients had excellent results, 3 had good results, 2 had fair results, and 1 had a poor result. Of the 9 children who did not have an antireflux procedure, 3 developed symptomatic and radiologically proven gastro-oesophageal reflux. The results of myotomy in chil- dren with achalasia are satisfactory but a significant number may develop gastro-oesophageal reflux. We believe that a modified Heller's myotomy combined with a short loose Nissen fundoplication should be the primary treatment of achalasia in children.--Lewis Spitz

Gastric Teratoma in Infancy. J.J. Earnshaw. J Roy Coil Surg Edin 30:199-200, (June), 1985.

A six-week-old child was found to have a large mass in the upper abdomen. There was calcification on plain x-ray. Laparotomy revealed a teratoma of stomach, which was removed completely leaving mucosa intact. Although embryonal tissue was present, no malignancy was seen. The serum alpha feto protein, which was raised prior to operation, fell and remained normal at follow-up. Gastric teratomas account for 2% of all teratomas seen in infancy. Plain x-ray will show calcification, barium meal, a filling defect, and ultrasound cystic areas. Gastric teratoma is an important cause of an abdominal mass in infancy. It is a benign tumour with a good prognosis following excision.--W.G. Scobie

Infantile Pyloric Stenosis in the North East of Scotland. Results of Ramstedt's Operation in 264 Cases. G. Car/e and A.L Davidson. J Roy Coil Surg Ed 30:30-32, (February), 1985.

Two hundred sixty four pyloromyotomies for pyloric stenosis were performed under general anaesthesia in the Aberdeen Children's Hospital from 1967 to 1980. Almost all cases were diagnosed on clinical examination. Ultrasound investigation is recommended in doubtful cases. Two hundred twenty five had continuing vomiting postoperatively, and three required reoperation. Mucosal perfora-