592 INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY

per cent decrease in hematocrit, reflecting the hemodilution. The arterial pH was not altered by the NaC1 infusion but was completely corrected from the acidosis of hemorrhagic shock to normal by the NaHCO~ infusion. Although the berne- dynamic improvement (cardiac output) was more marked with the hypertonic NaHCO3 than with the hypertonie NaC1, the authors conclude that the improvement in the metabolic status of the animals in shock was due more to the osmotic effect of the infusion than to the pH correction which occurred with the NaHCO3. Long-term survival was not included in the protocol, and it is difficult to be sure how the authors can exactly differentiate the good effects of correction of acidosis from the obvious intravascular volume expansion resulting from the hypertonic solutions. If one is willing to over]ook the vagaries of a shock model based upon an arbitrary arterial pressure level, the re- suits a r e striking evidence of the loss of non- cellular components of the intravascular space in shock and the good effect of hypertonie solutions in replacement. The hypertonic solutions were given either at a volume of 5 ml./Kg, in 5 rain. or were given a total volmne of 5 ml./Kg, by infusion over a 30 min. period. In a 5 Kg. infant this is 25 ml. of the hypertonic solution as a single in- jection over 5 min. or at the rate of 5 mL/Kg. over a 30 rain. period. The authors noted a striking decrease in peripheral vascular resistance after the infusion of both hypertonie solutions but do not attempt to explain this. It would be interesting to see if hemodilution alone would accomplish this, perhaps with the use of isotonic saline or isotonic dextran.--]. Alex Haller, Jr.

A N E S T H E S I A A N D I N H A L A T I O N THERAPY

I N T E G U M E N T A N D C O N N E C T I V E TISSUES

TREATMENT OF EXTENSIVE SKIN DEFECTS WITH POLYUPOETttANE SPONGE. A. Pinter, I. Pilaszano- rich and G. Kustos. Kinderchir. 4:122-430, 1967.

The authors report on the use of polyurethane sponge to cover extensive skin defects especially after burns. This method avoids the use of homo- plastic transplants. Excellent results were obtained in four patients. This method of cover achieves a good recipient surface for auto-transplantation of the skin. The article also reviews the problem of primary wound excision.--S. He[mann and H. B. Eclcstein.

H E A D A N D N E C K

CONGENITAL CHOANAL ATRESIA. N. Hobolth, G. Buchmann and L. E. Sandberg. Acta Pediat. Scand. 56:286-294, May 1967.

A series of 8 infants with choanal atresia (5 bilateral and 3 unilateral ) is reviewed. Emergency treatment was required in bilateral cboanal atresia in order to ensure free breathing. In the first 4 patients, a primary transnasal resection was per- formed; there were two recurrences requiring secondary operations. In the fifth infant, emergency treatment consisted in application of an oral air- way for 5 months, a transpalatine resection be- ing planned for the age of 18 months.

A review of the literature confirmed a high- incidence of recurrences after emergency opera- tions. The authors conclude that conservative management by oral applications followed by trans- palatinal resection at the age of about 18 months should be the treatment of ehoiee.--Th. Ehrenpreis.

"SWALLOWED" ENDOTRACHEAL TUNE: A NEW NEONATAL EMERGENCY. ]ames A. S. Dixon and Graham C. Fraser. Brit. Med. J. 2:811, 1967.

Five cases of children requiring resuscitation immediately after difficult delivery are reported, in whom a Portsmouth plastic endotracheal tube was passed and displaced into the esophagus. The shape and nonflexibility of the tube involved its sticking in a standard position where its tip lay against the greater curvature of the stomach. Re- moval was easy but involved in these cases transfer of the children to another hospital. Suggestions for modification of the tube are made.--]ames Lister.

OUR EXPERIENCE WITH THE PIERRE ROBIN SYN- DROME. L. Pinson and ]. Lasserre. Ann. Chir. Infant. 8:127-139, June 1967.

The authors report on the results of a radiologic study of the hypopharynx in normal infants and in Pierre Robin syndrome. The epiglottis in Pierre Robin syndrome lies deeper and in a more hori- zontal position than in normal infants. Operation is only indicated in the most severe cases with respiratory distress. In the less severe type adequate nursing is usually sufficient. As operation the auth- ors recommend retrolingual glossopexy, which gave them 11 excellent results in 15 patients.--M. Bettex.