86 INTERNATIONAL ABSTRACTS

between 11 months and 15 years, one of whom, a 31/2-year-old boy, died with fulminant hepatic failure. All the children had received multiple halothane anaesthetics (range 2 to 6, median 3). In all cases other causes of liver disease were excluded, and in all but one the diagnosis was confirmed serologically by antibodies to halothane altered liver cell membrane antigens. These findings suggest that halothane hepatitis occurs in children, and the risk of halothane hepatitis should therefore be considered when choosing which agents to use in children who require multiple anesthetics.--Prem Puri

Bupivicaine Squirting. J.H. Cook. Ann R Coil Surg Engl 69:4, (January), 1987.

A concise description of a useful technique where pain relief in a freshly closed surgical wound can be obtained for several hours is described. The subcutaneous tissues are sprayed with a 0.5% solution of bupivicaine just before the wound is closed. The solution should be in contact with the raw area for about ten seconds to be effective. It presumably acts on the nerve endings exposed by the surgeon.--B.A. Madarikan

Measurement of Carbon Dioxide Production Rate in Sick Venti- lated Premature Infants. A. Lucan, Y. Nohria, and S.B. Roberts. Biol Neonate 51:138-143, (April), 1987.

A new method is described for measuring the rate of carbon dioxide production, and hence for estimating energy expenditure, in preterm infants receiving assisted ventilation. In a validation study, the mean error in carbon dioxide measurement was 1.9%. Measure- ments were made over a 45-minute period on 11 sick, ventilated subjects and carbon dioxide production rate was 5.2 _+ 0.7 (SD) mL/min/kg body weight. The authors suggest that continuous monitoring of carbon dioxide output will contribute to the clinical assessment of the effects of different ventilator settings on pulmo- nary gas exchange and that estimated values for energy expenditure will be of value in nutritional studies on sick ventilated infants.-- Prem Puri

INTEGUMENT AND CONNECTIVE TISSUE

Congenital Malignant Melanoma, N.S. Prose, T.A. Laude, E.R. Heilman, et al. Pediatrics 79:967-970, (June), 1987.

The authors report a 6-week-old girl with congenital malignant melanoma of the midepigastric area. Treatment consisted of surgical excision with 1 cm margin, and included the underlying portion of rectus sheath. Follow-up at 1 year revealed no evidence of residual disease. Childhood melanoma is discussed briefly. A literature review of seven similar cases suggests that the diagnosis is frequently delayed, but regional or distant metastatic disease does not rule out long-term survival following surgery and, in selected cases, chemo- therpy.--J.L. Zitsman

Congenital Epidermal Cyst in the Foot. L.R. Priaulx and A.H.M.E. Moustafa. J R Coil Surg (Ed) 32:120-121, (April), 1987.

A 3-year-old boy presented with a discharging sinus and swelling on the lateral aspect of his left foot that had been present since birth. X-ray showed fusion of the base of the fourth and fifth metatarsals. A sinogram revealed a subcutaneous tract extending from the base of the little toe along the lateral border of the foot, passing medially deep to the Achilles tendon, ending just above the medial malleolus. The sinus, which was mainly superficial, was completely removed. It was lined by squamous epithelium with inflammatory changes. The authors discuss other causes of cystic swellings on the foot and suggest the reported lesion is analogous to cutaneous sinuses seen in relation to the central nervous system. This is the first report of such a case. A sinogram is essential to outline the tract preoperatively. Complete excision of the sinus is necessary.--W.G. Scobie

HEAD AND NECK

CHARGE Association in Neonates Presenting With Choanal Atre- sia. G. Stewart, D.G. Young, and A.F. Azmy. Z Kinderchir 42:12- 13, (February), 1987.

The spectrum of this association of multiple anomalies includes coloboma (C), heart disease (H), atresia choanae (A), retarded growth development and/or CNS anomalies (R), genital anomalies (G), and ear anomalies/deafness (E). From this evolved the term CHARGE association. Ten consecutive patients admitted to the hospital because of nasal airway obstruction have been reviewed. Four showed four or more components of the CHARGE association, three of whom died before the age of 2 months. Infants with choanal atresia but not having other features of CHARGE association survived. In particular, the combination of choanal atresia and heart disease carries a very high risk.--Thomas A. Angerpointner

Three Dimensional Imaging in Craniofacial Disorders. D.C. Hem- my. Aust NZ J Surg 57:101-104, (February), 1987.

This article describes the role of computerized tomography in the management of craniofacial disorders. It shows by pictures and diagrams how the CT scan can be used to plan the operative procedure. The author presents and discusses one patient and shows how CT scanning was used to achieve a satisfactory cosmetic outcome.--Alasdair Mackellar

Midfacial Osteotomies in Patients With Cleft Lip, Alveolus, and Palate. W.J. Holtje. Aust NZ J Surg 57:89-99, (February), 1987.

Surgical/orthodontic strategies in patients with hypoplastic mid- faces and cleft of lip, alveolus, and palates after completion of skeletal growth are guided by cephalometric data, with the soft tissue profile playing the most important role. The Le Fort 1, the extended Le Fort 1, and less frequently the Le Fort II procedure depend on the extent of midfacial hypoplasia. Osteotomy planning should consider that in a cleft patient's maxilla, the anterior nasal spine and A point need to be advanced and caudally rotated to a larger extent than is necessary in noncleft patients. A slight overcor- rection of ANB angle is necessary to achieve a harmonious and attractive soft tissue since upper lip and nasal soft tissue require more bony support. In severe bimaxillary disturbances the midfacial advancement has to be combined with mandibular osteotomies. Stabilization after midfacial osteotomies should be done by corro- sion-resistant vitallium or titanium miniplates. This technique pro- vides sufficient stability to restore early function immediately after surgery. Intermaxillary fixation following surgery is no longer necessary. Several decisive advantages are provided by this tech- nique over the previously applied wire suspension concepts or wire suturing techniques. The most advantageous points are (1) no intermaxillary fixation is required immediately postoperatively; (2) normal soft food intake is resumed after eight to ten days when wound healing is completed; (3) rigid plate fixation leads to consid- erable improvement in bone healing, while "pumping-effects" induced by micromovements from the masticatory muscles are avoided; (4) plate fixation allows immediate functional "antirelapse- treatment" against relapse tendencies, using soft intermaxillary elastic.--Alasdair MacKellar

Tracheostomy in Childhood. J.H. Dempster, E.H. Dykes, W.C. Brown et al. J R Coil Surg (Ed) 31:359-363, (December), 1986.

Sixty-five children, 50% under 1 year of age, underwent tracheos- tomy during a 12-year period at the Royal Hospital for Sick Children, Glasgow. Thirty-one had mechanical obstruction due to infection, congenital anomaly, or tumor. Twenty-one had impaired respiration after major surgery or respiratory distress syndrome.