Ashcraft - Pediatric Surgery

INDEX
Note: Page numbers in italics refer to illustrations; page numbers followed by (t) refer to tables.
Abdomen bile in, 920
calcification(s) in, dystrophic, 909, 912 chyle in, 920, 1049
dermoid in, 909, 912
dystrophic calcifications in, 909, 912 fluid in, 919-921
accumulation of, 920, 920 evaluation of, peritoneal tap in, 920 mesenteric-lymphangiectatic cyst
mimicking, 920
in idiopathic constipation, 426 mass(es) in, 909
calcified, 909, 912 discrete, 909, 911 evaluation of, 909
angiography in, 914, 916 barium studies in, 916, 918, 919 by zone, 910
computerized axial tomography in, 914, 915
inferior vena cavogram in, 914 intravenous pyelography in, 909, 912, 913, 914
isotope studies in, 914, 916, 917 lymphangiography in, 919, 919 plain radiography in, 909, 911, 912 total
body opacification in, 912. 914 ultrasonography in, 914, 915
nondiscrete, 909, 911
musculature of, absence of. See Prune-belly syndrome.
teratoma in, 909, 912, 969 urine in, 920, 921
wall of. See Abdominal wall.
Abdominal masses. See Abdomen, mass(es) in. Abdominal musculature deficiencies syndrome. See Prunebelly syndrome.
Abdominal wall
hernias of, 589-593, 589. See also specific hernias, e.g., Umbilical hernia.
plication of, in management of prune-belly Syndrome, 810, 812
reconstruction of, in treatment of bladder exstrophy, 741, 744, 745 Abdominoperineal pull-through, in
therapy for
imperforate anus, 411, 412, 412-413 Abdominoperineal resection, in treatment of ulcerative colitis, 469(t),
470, 470(t)
Abdominoperineal vaginal pull-through, 898, 900-903
Abrasion, friction and, in wringer injury, 112
Abscess(es) amebic, 525-527
of appendix, in appendicitis, 499 of breast, 1084
of liver, amebiasis and, 525-527 pyogenic, 527
of lung, 214-216 perianal, 430 perirectal, 430 pyogenic, of liver, 527
Abuse, of child. See Child abuse. Acalculous cholecystitis, 524, 525
Accelerator globulin (AcG), deficiency of, 66(t) Accessory nerve, spinal, cystic hygroma involving, 1043,
1043
AcG, deficiency of, 66(t) Achalasia, 257-258 diagnosis of, 257 etiology of, 257 symptoms of, 257
treatment of, 257-258
by esophagomyotomy, 258 Acid-base balance, 57-59 Acidosis
in necrotizing enterocolitis, 378
metabolic, as complication of total parenteral nutrition, 40
buffer solutions for correction of, 59 primary, 58
respiratory, corrective measures for, 59 primary, 58
ACOPP, in treatment of Hodgkin's disease, 977 Actinomycin D (dactinomycin)
in treatment of rhabdomyosarcoma, 988 in treatment of Wilms' tumor, 936 Children's Cancer Study Group
A data on, 936-937, 936(t)
National Wilms' Tumor Study-Group data on, 938, 938(t)
single-course, vs. multiple-course, 936-937, 936(t)
Actinomycosis, 218
Acute tubular necrosis, after kidney transplantation, 847
Adenitis, mesenteric, vs. appendicitis, 502 Adenocarcinoma
in alimentary tract duplications, 454 "juvenile," of breast, 1086
of breast, 1086
of colon, 495-496 diagnosis of, 496, 496
familial polyposis coli and, 487, 489
11151116 nv~Ex
Adenocarcinoma (Continued)
of endometrium, in mixed gonadal dysgenesis, 886-887, 886
of pancreas, 557
of rectum, 495-496 Adenoma
follicular, of thyroid gland, 1091, 1091
islet cell, 558
vs. nesidioblastosis, 558-559 of adrenal cortex, 1025, 1027 of liver, 953(t), 958
of salivary glands, 1032
of thyroid gland, 1091, 1091 pleomorphic, of salivary glands, 1032 Adenomatoid malformation of lung,
cystic,
congenital, 200-201, 200-201 Adenomatosis. See Multiple endocrine adenomatosis.
Adenomyoma(s), of pancreas, simulating pyloric stenosis, 318
Adrenal cortex
adenomas of, 1025, 1027
carcinoma of, and Cushing's syndrome, 1025, 1026
tumors of, 1023, 1025
and Cushing's syndrome, 1019. See also Cushing's syndrome.
Adrenal hyperplasia. See Female pseudohermaphroditism. Adrenal medulla, chromaffin tissues of,
neoplasm of. See Pheochromocytoma. Adrenogenital syndrome. See Female pseudohermaphroditism.
Adriamycin, in treatment of rhabdomyosarcoma, 988 Adult hemoglobin, 434
Adult polycystic kidney disease, 616 Adynamic ileus, chronic, vs. Hirschsprung's disease, 394
Afibrinogenemia, 66(t)
Aganglionic megacolon. See Hirschsprung's disease.
Aganglionosis, colonic, total, 398-399. See also Hirschsprung's disease.
Agenesis. See entries under specific organs, e.g., Anus, agenesis of.
Airway foreign bodies in, 192 maintenance of, 192-194
intubation in, 192-193 tracheostomy in, 193-194 malformations of, 183-195
diagnosis of, 183 bronchoscopy in, 183 radiography in, 183
obstruction of, 183-195
anomalous vasculature in, 190-192 choanal atresia in, 184
diagnosis of, 183 bronchoscopy in, 183 radiography in, 183
foreign bodies in, 192
laryngeal papillomas in, 186-187 micrognathia in, 184
Pierre Robin syndrome in, 184 subglottic hemangiomas in, 187-188 subglottic stenosis in, 185-186
supraglottic cysts in, 186
tracheal atresia in, 189-190 tracheomalacia in, 189
Alimentary tract
duplications of, 445, 445(t). See also under specific organs, e.g., Small intestine, duplication of.
defective recanalization and, 446 diagnosis of, 446-447 embryology of, 446
embryonic diverticula and, 446 malignant tumors in, 454-455 partial twinning and, 446
residua of neuroenteric canal and, 446 treatment of, 447
vertebral anomalies associated with, 447 Alkalosis
hypokalemic, in infantile hypertrophic pyloric stenosis, 318
metabolic, buffer solutions for correction of, 59
primary, 58
respiratory, corrective measures for, 59 primary, 58
Allograft(s), cadaver, in management of burn wounds, 131
Alpha-fetoprotein, produced by teratomas, 961 Alveolar pneumonia, 221-222
Alveolar rhabdomyosarcoma, 987 Alveolar soft part sarcoma, 1034-1035 Amastia, 1083
Amazia, 1083
Amebiasis, and hepatic abscess, 525-527 Amebic abscess, 525-527
Amebic dysentery, and hepatic abscess, 526 Amino acids, essential, 28, 28(t) Amniofetography, 337
Amniotic membrane(s), in management of burn wounds, 131
Ampicillin in treatment of appendicitis, 505
in treatment of esophageal burns, 262 Ampulla, of rectum, 418
Amputation, in cancer patient, 928 Amylase clearance, ratio of, to creatinine clearance, in acute
pancreatitis, 554
Anaerobic glycolysis, 11 Anal canal
anatomy of, 418, 419 sensory receptors in, 419
sphincter muscle of, involuntary, 420-421 voluntary, 420
Anal membrane imperforate, 402, 403 evaluation of, 403, 406 opening of, 409, 409 therapy for, results of,
416(t) Anastomosis
ileoanal, in treatment of familial polyposis coli, 491-492, 492
intestinal, in treatment of Crohn's disease, 475, 475, 476(t), 477(t)
in treatment of meconium ileus, 361 principles of, 342, 342
Roux-en-Y, in "chimney" enterostomy treatment of meconium ileus, 361-362, 362 Anastomotic leak,
esophageal, 279 Anastomotic stricture, esophageal, 279 Anderson-Hynes procedure, in correction of
ureteropelvic junction obstruction, 628 Androblastoma, of ovary, 1017-1018 Anemia
hemolytic, splenectomy for, 563, 564 results of, 567, 567iN~Ex 1117
Anemia (Continued)
in ulcerative colitis, 467
iron deficiency, gastroesophageal reflux and, 297
Anesthesia in pediatric surgical patient, 45-55 agents for, 45
complications of, 50-52 intraoperative monitoring of, 46-48 morbidity in, 52
mortality in, 52-54, 53(t)
preoperative medication and, 46, 46(t), 46 risks in, 52
temperature regulation and, 48 Anesthesia chart, 47
Aneuploidy, 76
Angiocardiography, in pectus excavatum, 166, 167(t)

Angiography in evaluation of abdominal masses, 914, 916 in evaluation of gastrointestinal bleeding, 435
Angioma
cirsoid, 1059, 1059 spider, 1055 Angiotensin, 829
Animal bites, 102. See also Bite(s). Annular pancreas, 551, 553 anomalies associated with, 551 "double
bubble" sign of, 553 treatment of, 553
Anoplasty and constipation, 427-428
in therapy for anal agenesis, 409-411, 410, 411
Anorectal manometry, in screening for Hirschsprung's disease, 394, 423, 426 Anorectal myectomy, in
treatment of
Hirschsprung's disease, 395-396 Anorectum
anatomy of, 418, 419 embryology of, 401-402, 401 sensory receptors in, 419
sphincter muscles of, nerve pathways for, 421-423, 422. See also Continence. Antegrade pyelography, in
evaluation of ureter, 694, 702, 702
Anterior hernia, of diaphragm, 236 Antibacterial therapy, topical, in management of burn wounds, 130
Antibiotic therapy
in treatment of appendicitis, 504-505 in treatment of burn victims, 133
in treatment of esophageal burns, 262 in treatment of human bite, 107
in treatment of trauma patients, 141 Antigen(s)
H-Y,860-861 deficiency of, and mixed gonadal dysgenesis, 882, 882
Antigen receptor, H-Y, deficiency of, and mixed gonadal dysgenesis, 882, 882 AntiFiemophilic factor,
deficiency of, 66(t] Antihemophilic globulin, deficiency of, 66(t) Antihuman thymocyte serum (ATS), in
immunosuppressive therapy, after kidney transplantation, 848-849, 849(t), 849, 850 Antireflux surgery
in patients with gastroesophageal reflux, 307, 308-309, 310. See also Fundoplication and Gastroesophageal
reflux, treatment of, operative.
Antireflux surgery (Continued)
in patients with vesicoureteral reflux, 654, 656. See also Vesicoureteral reflux, management of, operative.
Antithrombin III, values for, 68(t) Antivenom, in treatment of snake bite, 106(t), 107
Antrectomy, in treatment of peptic ulcer, 326 Antrum, gastric, web obstruction of, 313-314, 314
Ant sting(s), 108-109 Anus
abscess involving, 430 agenesis of, 402-404, 403, 404 evaluation of, 404, 406 therapy for, 409, 410
anoplasty in, 409-411, 410, 411 cut-back procedure in, 409, 410 dilatation in, 409
results of, 416(t) transplantation in, 409-410 embryology of, 401-402
fissure in, 429 fistula in, 429-430
imperforate. See Imperforate anus. normal, vs. imperforate anus, 403
prolapse ofintussusceptionthrough,439-440 prolapse of juvenile polyp through, 482, 482 protrusion of
rectum through, 430-431, 431, 432
vs. intussusception, 440 stenosis of, 402, 403 evaluation of, 403, 406 therapy for, 408-409, 408
results of, 416(t)
ulcers of, in Crohn's disease, 472, 473 Anxiety, in cancer patient, 923
Aortic arch, double, airway compression by, 190, 190, 191
Apnea, gastroesophageal reflux and, 302-303, 307
Appendectomy, 504. See also Appendicitis, treatment of.
incidental, 504
in surgical reduction of intussusception, 443 in treatment of Crohn's disease, 475, 476(t) Appendiceal
stump blowout, as complication of appendicitis, 506
Appendicitis, 498 abdominal pain in, 500 abscessed, 499, 499(t) anorexia in, 500 appendicolith in, 502
bacterial flora in, 499-500, 499(t) classification of, 499 complications of, 505-506
infectious, 499-500, 499(t), 505-506 Bacteroides fragilis and, 499-500 management of, anticipation of
possible sterility in, 506
evaluation of infection in, 506
therapy for appendiceal stump blowout in, 506
therapy for intestinal obstruction in, 506 therapy for paralytic ileus in, 506 ultrasound B-scanning in, 506,
506
diagnosis of, 500-502, 503(t) barium enema in, 502 clinical findings in, 500-501
computed tomographic scanning in, 502 interval examination in, 5011118 iN~Ex
Appendicitis (Continued]
diagnosis of, laboratory findings in, 501 laparoscopy in,502
physical findings in, 500-501 radiographic findings in, 502, 502 ultrasound B-scanning in, 502
differential diagnosis of, 502-503 focal, 498
gangrenous, 499, 499(t),501 guarding in, 501
in infants, 506-507 in neonates, 506-507 mortality rate in, 507 muscle spasm in, 501 nausea in, 500
pathology of, 498-499 perforated, 499, 499(t), 501 point tenderness in, 501
recognition of, as disease entity, history of, 498
simple, 499, 499(t) suppurative, 499, 499(t) symptoms of, 500 treatment of, 503-505
ampicillin in, 505
antibiotic therapy in, 504-505 chloramphenicol in, 505 clindamycin in, 505 gentamicin in, 505
operative technique in, 504 postoperative care in, 505 preoperative preparation in, 503-504 vomiting in,
500
vs. constipation, 502 vs. gastroenteritis, 502
vs. genitourinary infection, 502 vs. intussusception, 503
vs. measles, 503
vs. Meckel's diverticulitis, 502-503 vs. mesenteric adenitis, 502
vs. pelvic inflammatory disease, 503 vs. pneumonia, 503
vs. primary peritonitis, 503 Appendicolith, in appendicitis, 502 Appendix
abscess of, in appendicitis, 499 argentaffinoma of, 499
Ascaris lumbricoides in, 499 carcinoid of, 499
Enterobius vermicularis in, 499 gangrene in, in appendicitis, 499, 500 inflammation of. See Appendicitis.
perforation of, in appendicitis, 499, 500 pinworm in, 499
pus in, in appendicitis, 499 removal of. See Appendectomy.
stump of, blowout of, as complication of appendicitis, 506
Appendix of epididymis, torsion of, 827-828, 827
Appendix testis, torsion of, 826-827, 826 "Apple peel" deformity,'in jejunoileal atresia, 332
Apt-Downey test, 434, 434 Arch(es)
aortic, double, airway compression by, 190, 190, 191
branchial, embryology of, 1062, 1063 Arcuate pectus carinatum, 174
Areola(e), supernumerary, 1083-1084, 1083 Argentaffinoma, of appendix, 499
Arm trauma to, in delivery, 138, 138
wringer injury of, 112-113. See also Wringer arm.
Arm presentation, in delivery, 138, 138 Arrhythmia(s), gastroesophageal reflux and, 297 Arrowhead
urethra, 757
Arterial blood pressure monitoring of, during shock, 13 readings of, interpretation of, 14
Arterial carbon dioxide tension, monitoring of, 10

Arterial oxygen tension, measurement of, 8, 9 Arterial hemangioma, 1058, 1058 Arteriography
in diagnosis of liver tumors, 954, 955-956, 955 in diagnosis of renovascular hypertension, 831-832,831
in evaluation of liver trauma, 143
in evaluation of urinary tract trauma, 150 Artery (arteries)
cannulation of, during anesthesia, 47 catheterization of, to measure blood pressure, 13
to monitor blood gases, 62
hepatic, occlusion of, in treatment of benign liver tumors, 958
innominate, compression of trachea by, 191-192
pulmonary, pressure measurement in, 15 sling malformation of, 192, 192
radial, as site for blood samples in PaOz determinations, 8
catheterization of, for blood gas monitoring, 62
renal, reconstruction of, in therapy for renovascular hypertension,833-834 splenic, accessory spleen at, 565,
566(t) subclavian, right, aberrant, and notching of esophagus,l91
temporal, catheterization of, and cerebral vascular accident, 8
for blood gas monitoring, 62
for blood samples in PaOz determinations, 8 to lung, in pulmonary sequestration, 204-205 ulnar,
thrombosis of, from catheterization, 8 umbilical, as site for blood samples in Pa02
determinations, 8, 9
Arthralgia, associated with ulcerative colitis, 466
Arthritis, associated with ulcerative colitis, 466 Artificial urinary sphincter, 665, 689, 690-692 implantation
of, results of, 692 requirements for use of, 692
Ascaris lumbricoides, in appendix, 499 Ascending cholangitis, 510, 515, 520 Ascites, 919-921
bile, 920
chylous, 920, 1049 course of, 920, 920
evaluation of, peritoneal tap in, 920 in necrotizing enterocolitis, 381 mesenteric-lymphangiectatic cyst
mimicking, 920
portal hypertension and, 531-532, 533 management of, 538
urine, 920, 921
Ashcraft-Thal fundoplication, 310 Ask-Upmark kidney, 620iN~Ex 1119
Asphyxia, traumatic, 160-161 Asphyxiating thoracic dystrophy of the
newborn, 180-181, 181
Aspiration pneumonia, gastroesophageal reflux and, 300, 302
Aspiration syndrome(s), gastroesophageal reflux and, 299-303, 307
Aspirin, and inhibition of platelet function, 70 Asthma, gastroesophageal reflux and, 302, 307 Atelectasis
after pectus excavatum repair, 171, 173(t) in hyaline membrane disease, 4
Atresia. See under specific organs, e.g., Esophagus, atresia of, and Intestine, atresia of. Atropine
in improvement of urine storage, 664(t) in preoperative sedation, 46, 46(t) Atypical mycobacterial
infection, 218 Auerbach's plexus, 389, 393, 421 Augmentation mammoplasty, 1083, 1083 Autoamputation,
of juvenile polyp, 482-483 Autograft(s), in management of burn wounds, 131-132, 132
Autosomal inheritance, 78-80, 79 Autotransfusion, as response to shock from blood loss, 11
Autotransplantation of kidney, 712-713
in therapy for renovascular hypertension, 834
Avulsion, in wringer injury, 112
Axilla, cystic hygroma extending to, 1042, 1043 Aylett procedure
in treatment of Crohn's disease, 475, 476 in treatment of ulcerative colitis, 468-469, 469(t), 470(t), 471
Azathioprine, in immunosuppressive therapy, after kidney transplantation, 847, 848, 849(t) Azygos vein,
drainage to, in pulmonary sequestration, 205
Baby Bird respirator, 60 "Backwash ileitis," 467 Bacteriuria, vs. pyuria, 646 Bacteroides fragilis, and
infectious
complications of appendicitis, 499-500 Balanitis, 793
Balloon cell nevus, 1000
Band(s), Ladd's, duodenal obstruction by, 348(t), 353-354
Barbiturates, in preoperative sedation, 46, 46(t) Barium enema
in diagnosis of appendicitis, 502 in diagnosis of colitis, 392
in diagnosis of colonic atresia, 340
in diagnosis of enterocolitis, 392, 392 in diagnosis of Hirschsprung's disease, 391-392, 391, 392
in diagnosis of ileal atresia, 340 indiagnosis of juvenile polyp, 483, 483 in diagnosis of ulcerative colitis,
467, 467 Basal metabolic rate
of neonate, 2
of small for gestational age infant, 4 Bat(s), rabies in, 103
Bat bite(s), 103
Battered child. See Child abuse. Beckwith-Wiedemann syndrome, 575 Bee sting(s), 108-109
Bee venom, 108
Belsy fundoplication, 310 Bennett PR-2 respirator, 60 Benson pyloric forceps, 319
Benzalkonium chloride, effectiveness of, in killing rabies virus, 103
Bethanechol chloride, in improvement of bladder emptying, 665(t)
Bezoar(s), 121
Bicarbonate, in blood replacement, 50
Bifid clitoris, in exstrophy of bladder, 738, 739 Bile
in abdomen, 920
vomiting of, midgut volvulus and, 349 Bile ascites, 920
Bile duct(s)
atresia of, 509-511 cholangiography in, 513-514, 514 correctable, 509, 514-515 diagnosis of, 511
differential diagnosis of, 511-513 etiology of, 510-511
gallbladder in, 513, 514
infantile cholestatic jaundice in, 511-512. See also Infantile cholestatic jaundice. noncorrectable, 509, 519
therapy for, 513-515
ascending cholangitis as complication of, 510, 515, 520
hepatic fibrosis as complication of, 520 hepatic portoenterostomy in, 515, 516517
clinical outcome of, 519 modifications of, 515, 518 history of, 509-510
Kasai hypothesis in, 509-510 Kasai procedure in, 515, 516-517 clinical outcome of, 519 modifications of,
515, 518
liver transplantation in, 515
portal hypertension as complication of, 520
results of, 519-520
vs. neonatal hepatitis, 511-513, 512(t) calculi in. See Cholelithiasis.
cysts of. See Choledochal cyst(s). gallstones in. See Cholelithiasis. hypoplasia of, 515, 519
cholangiographyin,515,519 lithiasis in. See Cholelithiasis. reconstruction of, in liver transplantation, 547548,547
rhabdomyosarcoma of, 990 mimicking choledochal cyst, 990 stones in. See Cholelithiasis. Biopsy
of cervical lymph nodes, indications for, 1077 of lung, open, 222-223, 223
results of, 222(t), 223 of rectum, 393-394
in Hirschsprung's disease, 392-394, 393 in ulcerative colitis, 466
Bird Mark 14 respirator, 60 Birth trauma, 138-139 Bite(s). See also Sting(s).
and rabies, 102-104. See also Rabies. and tetanus, 102
animal, 102 bat, 103
black widow spider, 110 brown recluse spider, 109-1101120 iN~Ex
Bite(s) (Continued) coral snake, 104 dog,l02-104
incidence of, 102 treatment of, 103
fang marks in, 104-105, 106(t) "fiddleback"spider,l09-110 human, 107-108
antibiotic therapy in, 107 tetanusprophylaxisin,l07 insect, 102
Loxosceles reclusa, 109-110 pit viper, 104-105
self-inflicted, of tongue, 107-108 snake, 104-107. See also Snake bite(s). spider,l09-110
Black widow spider bite(s), 110 Bladder, 660
anomalies of, 752-756 assessment of function of, prior to undiversion, 724-725
augmentation of, cecum in, 716
as part of urinary tract reconstruction, 717-719
autonomous, 662
diverticula of, 752-754, 752-754 clinical features of, 754-755 diagnosis of, 754, 754, 755 treatment of, 755
embryology of, 752
emptying of, neuropharmacologic agents in, 664, 665(t)
endoscopy of, in evaluation of enuresis, 799 in patients with vaginal atresia, 896 exstrophy of, 738, 738,
739
bifid clitoris in, 738, 739 classification of, 738, 739 epispadiasin,738,738
repair of, 741, 745, 745 in boys, 738
in girls, 738 occurrence of, 738
position of umbilicus in, 738, 740 rectal relapse in, 745, 749 treatment of, 750-751
coaptation of symphysis pubis in, 741, 744,748,750
follow-up in, 741 history of, 740
iliac osteotomy in, 741, 742 infections of urinary tract after, 749 invagination of bladder in, 741, 743
lengthening of penis in, 745, 747, 748 mobilization of bladder in, 741, 743 presurgical management in, 741
problems in, 740
reconstruction of abdominal wall in, 741, 744, 745
reconstruction of pelvic floor in, 745 repair of epispadias in, 741, 745, 745 repair of external genitalia in,
745, 746-748 ,
results of, 587(t), 745-750
status of urinary tract after, 748-749 technique of repair in, 741, 742-744 urinary continence after, 749-750
fiap of, in augmentation of ureteral length, 716 in continence, 796-797
infections of, 646-647. See also Urinary tract, infections of.
innervation of, 660-661, 660
Bladder(Continued) in prune-belly syndrome, 806, 808 invagination of, in treatment of exstrophy, 741,743
in voiding,796-797
mobilization of, in treatment of exstrophy, 741,743
motor paralytic, 662
neck of. See Bladder neck. neuroanatomy of, 660-661, 660 neurogenic. See Neurogenic bladder.
neurophysiology of, 660-661, 660 obstruction of, at outlet, 651-652, 756-760 reflex, 662-663
rhabdomyosarcoma of, 993, 994 sensory paralytic, 662
trauma to, 152
clinical findings in, 152 radiographic evaluation of, 152 treatment of, 152
uninhibited, 662-663
urine storage by, neuropharmacologic agents in, 664(t), 664
Bladder neck
in correction of incontinence, 716, 720 obstruction of, 651-652, 756-760 stenosis of, 651-652, 756-760
Bladder outlet obstruction, 651-652, 756-760 Blastoma
of liver, 953, 953(t)
anomalies associated with, 953(t) treatment of, results of, 957, 957(t) Bleeding, gastrointestinal, 433-436.
See also
Gastrointestinal bleeding. Bleeding time
in evaluation of preoperative patient, 70 in hemorrhagic conditions, 72(t)
values for, 68(t)
Blind-ending ureter(s), 633, 634 "Blind-loop" syndrome, 342 Blood, vomiting of, 433
Blood clotting. See Coagulation factor(s) and Hemostasis.
Blood gases
as indication of lung function, 59 monitoring of, 8-11, 62
Blood pressure
arterial, monitoring of, during shock, 13 readings of, interpretation of, 14 central venous, measurement of,
15
monitoring of, during shock, 14 pulmonary artery, measurement of, 15 pulmonary wedge, measurement of,
15
Blood replacement therapy, 49-50 in burn victims, 129
Blood urea nitrogen, as indicator of renal function, 651
Blood volume in neonate, 2
in small for gestational age infant, 4 reduction of, in septic shock, 13
Blowout, appendiceal stump, as complication of appendicitis, 506
Blue nevus, 1000 removal of, 1004
Bochdalek diaphragmatic hernia. See Posterolateral hernia, of diaphragm.
Body temperature, regulation of, during surgery, 48
Body weight
in estimating fiuid and electrolyte needs, 5iN~Ex 1121
Body weight (Continued)
in monitoring fluid volume, 7 Boerema gastropexy, 310
Bony lymphangiomatosis, 1051 Booster(s)
in rabies treatment, 104
in tetanus prophylaxis, 102 Botryoid sarcoma, 987
Bougienage, of esophageal segments, in treatment of esophageal atreSia, 277 Bourns respirator, 60
Bowel. SeeIntestine. Brain, teratoma of, 971
Branchial arch(es), embryology of, 1062, 1063 Branchial cleft(s)
cysts arising from, 1064 embryology of, 1062, 1063 fistulas arising from, 1064 remnants of, 1062, 10641065
cartilaginous, 1064, 1064

sinuses arising from, 1064, 1065, 1065 Breast(s)
abscess of, 1084 absence of, 1083 accessory,l083-1084,1083 adenocarcinoma of, 1086
"juvenile," 1086
anomalies of, congenital, 1083-1084, 1083 areola(e) of, supernumerary, 1083-1084, 1083 augmentation of,
surgical, 1083, 1083 carcinoma of, 1086
cellulitis of, 1084
chicken. See Pectus carinatum. congenital anomalies of, 1083-1084, 1083 cyst(s) of, 1084
cystosarcoma phyllodes of, 1086 diseases of, 1084
fibroadenoma(s) of, 1085-1086, 1085 granular cell myoblastoma of, 1085 hemangioma of, 1084
hypertrophy of, juvenile, 1081-1082, 1081 neonatal,l080,1081 virginal,l081-1082,1081
hypoplasia of, 1083, 1083 infections of, 1084 inflammatory lesions of, 1084 in gynecomastia, 1082, 1082
intraductal papillomas of, 1084-1085 "juvenile adenocarcinoma" of, 1086 myoblastoma of, granular cell,
1085
nipple(s) of, supernumerary, 1083-1084, 1083 papillomas of, intraductal, 1084-1085 physiologic changes
in, 1080-1081
precocious puberty and, 1082-1083 premature thelarche and, 1081 pigeon. See Pectus carinatum. sarcomas
of, 1086-1087 supernumerary,l083-1084 trauma to, 1084
tumors of, benign, 1084-1086 malignant, 1086-1087
BreaSt milk, protection offered by, against necrotizing enterocolitis, 376 Bronchiectasis, 209
and hemoptysis, 211 diagnosis of, 211, 212 etiology of, 209, 211, 211(t)
in Kartagener's syndrome, 209, 210 pathogenesis of, 210
sites of, 211, 212(t) therapy for, 211-212
Bronchiectasis (Continued) therapy for, results of, 212-213
Bronchitis, gastroesophageal reflux and, 302, 307
Bronchogenic cyst(s), 245, 246 Bronchoscopy
in croup,l87
in detection of airway lesions, 183
in removal of foreign bodies, 117-118 telescopic bronchoscope in, 117, 118 Bronchus(bronchi)
embryology of, 196
endoscopy of. See Bronchoscopy. foreign bodies in, 116-118
inflammation of, gastroesophageal reflux and, 302, 307
malformations of, 196-206 trauma to, 157
Brown recluse spider bite(s), 109-110 Bruise(s)
in abused child, 70
in patients with defects of hemostasis, 69, 70 B-scan ultrasonography. See Ultrasonography. Budd-Chiari
syndrome, 530
Buffer(s), in correction of metabolic acidosis, 59
Burkitt's lymphoma, 978 Burn(s), 123-124
and corneal damage, 123 and Curling's ulcer, 134, 325 and hypermetabolism, 128-129 and hypernatremia,
128
and hyperosmolarity, 128
and inhalation injuries, 123, 124, 125, 125 chemical, 123
classification of, 123 complications of, 134-135 critical, 123
death from, 123, 134, 134 depth of, 123
electrical, 123 fiame, 123 flash, 123
friction, in wringer arm, 113 full-thickness, 123

infection in, 130, 133 inflicted by adult, 123 major, 123
management of, airway maintenance in, 124-125,124
amniotic membranes in, 131 antibacterial therapy in, 130 antibiotic therapy in, 133 autografts in, 131-132,
132 blood replacement in, 129 cadaver allografts in, 131
caloric requirements in, 128, 129 compressive dressings in, 133 debridement in, 129, 130, 131 diazepam in,
135
diuretics in, 125, 128
Doppler ultrasonic flowmeter in, 129, 130 Epigard in, 131
escharotomy in, 124, 129-130 fluid therapy in, 126-128, 126(t) estimation of requirements for, 123,
126-127, 126(t) Parkland formula in, 127 grafts in, 131-132, 132 hydrotherapy in, 129, 130 immunotherapy
in, 1331 1 22 INDEX
Burn(s) (Continued)
management of, initial care in, 124-129 intravenous therapy in, 126
mafenide in, 130
mesh grafts in, 132, 132 metabolic factors in, 128-129
monitoring of urine flow in, 126, 127, 128 nasogastric drainage in, 125-126 nasotracheal intubation in, 124,
124 nutrition in, 129
occupational therapy in, 132, 133 orotracheal intubation in, 124 physical therapy in, 132-133 physiologic
dressings in, 131 porcine xenografts in, 131
prevention of hypertrophic scar formation in, 133
protein requirements in, 128, 129 psychological factors in, 135 silver sulfadiazine in, 130
skin grafts in, 131-132, 132 splints in, 132-133
strip grafts in, 131, 132 tetanus immunization in, 133 tracheostomy in, 124-125, 125 wound care in, 129133 minor, 123
moderate, 123
of esophagus, 260-262 esophagoscopy in, 262 treatment of, 262
partial-thickness, 123
Pseudomonas aeruginosa infection in, 130 scald, 123
sepsis in, 130, 133 surface area of, 123, 126
rule of nines in estimation of, 123 vaporizational heat loss in, 128-129 wound sepsis in, 130, 133
Burn wound sepsis, 130, 133 Buttocks, rhabdomyosarcoma of, 995
Cadaver allografts, in management of burn wounds, 131
Cadaveric kidney, in transplantation, 843, 843(t) Calcification(s)
in abdomen, 909, 912
of scrotum, in meconium peritonitis, 368, 369 Calcium, deficiency of, 66(t)
Calcium chloride, in blood replacement, 50 Calcium gluconate
in blood replacement, 50
in treatment of hypocalcemia, 20 Calculus (calculi). See Cholelithiasis. Calorimeter, reflectance, for
measurement of
blood glucose level, 19
Canal(s). See under specific names, e.g., Pelvic canal.
Cancer. See Cancer patient and particular lesions, e.g.,Adenocaicinoma.
Cancer patient, 923 anxiety in, 923 death of, 930
at home, 930 follow-up in, 930-931 in hospital, 930 support prior to, 930
family of, education of, 927-928 financial burclen on. 926, 926(t), 927, 929-930
Cancer patient (Continued)

family of, marital discord in, 925-926, 925
reduction of, 929 multidisciplinary team approach to, 926-927
psychologicalregressionin,923-924 role of father in, 929
role of siblings in, 926, 929 stresses on, 925-926 reduction of, 926-931
support of, in terminal cases, 930-931 information given to, 927-928
by parents, 928 by physician, 928
multidisciplinary team approach to, 926927
noncompliance by, 924, 924 psychological regression in, 923-924 requiring amputation, 928
school attendance by, 924-925 schoolphobiain,924 stresses on, 923-925
reduction of, 928-929
Cannulation, arterial, during anesthesia, 47 Cantrell's pentalogy, 179, 179
omphalocele in, 573, 573 treatment of, results of, 586(t) Capillary hemangioma, 1056-1057, 1056 Capillary
membrane, damage to, in shock, 17 Carcinoid, of appendix, 499
Carcinoma embryonal, of ovary, 1016
follicular, of thyroid gland, 1092, 1094 hepatocellular, 953, 953(t)
anomalies associated with, 953(t) treatment of, results of, 957, 957(t) medullary, of thyroid gland; 1092,
1094-1095, 1096-1097
in multiple endocrine adenomatosis, types II and III, 1095, 1095
of adrenal cortex, and Cushing's syndrome, 1025,1026
af breast, 1086 ofcolon,495-496 diagnosis of, 496, 496
ofkidney,l0l8-1019 of liver, 953, 953(t)
anomalies associated with, 953(t) treatment of, results of, 957, 957(t) ofovary,lols
ofpancreas,557,1030-1031 ofrectum,495-496 of salivary glands, 1032
of testicles, 1009-1010
ofthyroid gland,l092,1093,1094-1095, 1094,1095,1096-1097 papillary, of thyroid gland, 1092, 1093 renal
cell, 1018-1019 yolksac,l009-1010
Cardiac failure, in shock, treatment of, 18 Cardiac output, measurement of, 15 Cardiac tamponade
chest trauma and, 159-160 mediastinal teratoma and, 969, 970 Cardiospasm. SeeAchalasia. Cardiotoxin,
105
Cartilage of rib, removal of, in treatment of pectus carinatum, 176
in treatment of pectus excavatum, 168, 169ov~Ex 1123
Cartilage (Continued)
of rib, tenderness in, in pectus carinatum, 174 of trachea, maldevelopment of, 189, 270, 280 esophageal
atresia and, 280
"seal bark" cough in, 280 Cascade humidifier, 60 Catheterization
arterial,to measure blood pressure, 13 to monitor blood gases, 62 intermittent, in treatment of neurogenic
bladder, 665-666
in urinary diversion, 666
venous, for intravenous fluid therapy, 62 Cat-scratch disease, 1076-1077
Caustic injury, of esophagus, 260-262 Cavernous hemangioma, 1057-1058, 1057 of liver, 954
Cavogram,inferiorvena,9l4 Cecal cystoplasty, 716
as part of urinary tract reconstruction, 71 7-719
Cecum duplication of, cystic, 450 foreign bodies in, 120
incomplete attachment of, 348(t), 354, 354 in cystoplasty, 716
as part of urinary tract reconstruction, 717-719
mesentery of, incomplete attachment of, 348(t), 354, 354

volvulus of, 348(t), 354, 354
Celiac arteriography, in diagnosis of liver tumors, 954, 955-956, 955
Celiotomy, and incidental discovery of Meckel's diverticulum, 457, 462-463
Cell(s), Sternberg-Reed, in Hodgkin's disease, 973
Cell surface markers, in identification of non-Hodgkin's lymphoma, 980 Cellular blue nevus, 1000
Cellulitis, of breast, 1084 Celosomia
lower, 573-574, 573
treatment of, results of, 587(t) middle, 572-573
treatment of, results of, 587(t) omphalocele in, 572-574, 573 upper,573,573
treatment of, results of, 586(t) Central feeding. See also Total parenteral nutrition (TPN).
method of, 36, 36, 37
solutions for, composition of, 34, 34(t) Central venous pressure
measurement of, 19 monitoring of, during shock, 14
Cerebral vascular accident, in catheterization of temporal artery, 8
Cerebral vomiting, 318 Chemical burn(s), 123 Chemotherapy
intreatment of Hodgkin's disease, 977
in treatment of malignant melanoma, 1005
in treatment of non-Hodgkin's lymphoma, 982 in treatment of rhabdomyosarcoma, 988
in treatment of Wilms'tumor, 936-938, 936(t), 937(t), 938(t)
Chest chylein,216,1050 duplications in, 447-449 ectopic kidney in, 612
Chest(Continued) fiail, 158
funnel. See Pectus excavatum. meningocele in, 244
normal, vs. pectus excavatum, 164 open wounds of, 159
penetrating wounds of, 159-160 sucking wounds of, 159
trauma to, 153
and asphyxia.,l60-161 and bronchial injuries, 157
and cardiac tamponade, 159-160 and diaphragm injuries, 160
and emphysema, 154 and flail chest, 158 and hemothorax, 154
and open chest wounds, 159
and penetrating chest wounds, 159-160 and pneumothorax, 154
and pulmonary contusions, 156, 158 management of, 156-157 andshocklung,l56,158
management of, 156-157 and sucking chest wounds, 159 and tension pneumothorax, 154 evaluation of, 154
fluoroscopic examination in, 155 laboratory examination in, 155 radiographic examination in, 154-155
patient monitoring in, 156
positive end-expiratory pressure in, 155 treatment of, 154
tube placement in patient with, 159 wall of. See Chest wall.
wounds of, open, 159 penetrating,l59-160 sucking,l59 Chest wall
deformities of, 162-181. See also specific deformities, e.g., Pectus carinatum and Pectus excavatum.
rhabdomyosarcoma of, 995, 996-997 trauma to, 158, 158
Chicken breast. See Pectus carinatum. Child abuse,94-95
bruise pattern noted in, 70 burnsin,l23
characteristics of, 95
clinical manifestations of, 96, 96-99 death from, 94, 96
diagnosis of, 95 history in, 95-96, 96(t) physical examination in, 96 emotional injury in, 95 emotional
neglect in, 95 family dynamics in, 95 management of, 99-100 pancreatic trauma in, 147 parents responsible
for, 95 physical injury in, 95 physical neglect in, 95 prevention of, 99-100 psychosocial injury in, 95
psychosocial neglectin,95 recurrent, 94 reporting of, 98-99 factors affecting, 94, 94(t) sexual exploitation
in, 95, 153, 905-906, 906(t) victims of, 95 Child neglect, 94, 95. See also Child abuse.
1 1 24 INDEX
Children's Cancer Study Group A, investigating dactinomycin (actinomycin D) in treatment of Wilms'
tumor, 936-937, 936(t)
"Chimney" enterostomy, in treatment of meconium ileus, 361-362, 362 Chloramphenicol, in treatment of
appendicitis, 505
Choana(e), atresia of, 184 Cholangiography in biliary atresia, 513-514, 514 in biliary hypoplasia, 515, 519
Cholangitis, ascending, 510, 515, 520 Cholecystectomy
in splenectomized patients, 525 in treatment of cholecystitis, 525 in treatment of cholelithiasis, 525
Cholecystitis, 524
acalculous, 524, 525 adult forms of, 525
associated with acute illness, 525 treatment of, cholecystectomy in, 525 Cholecystography, 524
Cholecystolithiasis. See Cholelithiasis. Choledochal cyst(s), 514, 515, 520-521, 521, 522
as premalignant lesion, 523 clinical aspects of, 522-523 complications of, 523-524 diagnosis of, 522
differential diagnosis of, 522 etiology of, 521
excision of, 515, 523 incidence of, 521 pathology of, 521-522 rhabdomyosarcoma mimicking, 990 therapy
for, 515, 523
cyst-duodenostomy in, 523 excision in, 515, 523 results of, 523
Roux-en-Y cyst-jejunostomy in, 523 Choledochocele, 522
Choledochus, cysts of. See Choledochal cyst(s). Cholelithiasis, 524
associated with chronic hemolytic diseases, 524-525, 524(t)
associated with nonhemolytic conditions, 524, 525, 525(t)
associated with sickle cell disease, 524, 524(t) associated with sickle cell-hemoglobin C disease, 524,
524(t)
associated with spherocytosis, 524, 524(t) associated with thalassemia major, 524, 524(t) treatment of,
cholecystectomy in, 525
Cholestasis, neonatal, 510(t)
Cholestatic jaundice, infantile. SeeInfantile cholestatic jaundice.
Chondrogladiolar deformity, in pectus carinatum, 174, 175
Chondromanubrial prominence, in pectus carinatum, 174
Chordee in hypospadias, 770, 771, 772 correction of, 774, 776, 778, 780 development of, 772-773
persistent, 786
without hypospadias, 787 develoument of, 772 Choriocarcinoma, of ovary, 1016 Christmas disease, 66(t)
and hemarthrosis, 69, 70
detection of, in preoperative patient, 69, 70 factor IX replacement in, 71(t), 72
Christmas disease (Continued) history suggestive of, 69
Christmas factor, deficiency of, 66(t) "Christmas tree" deformity, in jejunoileal
atresia, 332, 333 Chromatin, sex, 858
Chromosome(s), 75-78, 76, 858, 860. See also Inheritance.
abnormalities of, and intersexuality, 860-861 Y, functions of, 860, 879
Chronic adynamic ileus, vs. Hirschsprung's disease, 394
Chyle in abdomen, 920, 1049 in chest, 216, 1050
Chylopericardial tamponade, 1050 Chylothorax, 216, 1050
Chylous ascites, 920, 1049 Circumcaval ureter, 634-635 Circumcision

complications of, 153, 769, 793, 795 history of, 793
indications for, 793 neonatal, 795 prophylactic, 795 pros and cons of, 795 technique of, 794
Cirrhosis, and intrahepatic portal hypertension, 538. See also Portal hypertension, intrahepatic.
Cirsoid angioma, 1059, 1059
Clear cell sarcoma, melanotic, 1034 Cleft(s)
branchial. See Branchial cleft(s). laryngotracheoesophageal,280-281 sternal. See Sternum, cleft(s) of.
Cleft lip, repair of, and airway obstruction, 51 Cleft palate, repair of, and airway obstruction, 51
Clindamycin, in treatment of appendicitis, 505 Clitoris
bifid, in exstrophy of bladder, 738, 739 recession of, 863, 865
Cloaca dysgenesis of, 897
anomalies associated with, 897 classification of, 897, 897 clinical aspects of, 897 diagnosis of, 897
physical findings in, 897 treatment of, 898, 900-903 exstrophy of, 573-574, 573
treatment of, results of, 587(t)
Closure of gastroschisis. See Gastroschisis, treatment of, surgical.
of omphalocele. See Omphalocele, treatment of, surgical.
Clotting, of blood. See Coagulation factor(s) and Hemostasis.
Clubbing of fingers, gastroesophageal refiux and, 297 in Crohn's disease, 472, 473
Coagulation factor(s), 65-67 deficiencies of, 66, 66(t)
in hemorrhagic conditions, 72(t) replacement of, in hemophilia, 70-71, 71(t), 72
values for, 68(t)
vitamin K-dependent, 67 Coccygeus muscle, 419-420, 420ov~Ex 1125
Coccyx, excision of, in therapy for sacrococcygealteratoma,964,966,968
Coffee ground vomitus, 433 Colectomy
subtotal, in treatment of Crohn's disease, 476, 476(t), 477(t)
in treatment of ulcerative colitis, 468, 469(t), 470(t)
total, in treatment of Crohn's disease, 476, 476(t), 477(t), 477
in treatment of ulcerative colitis, 469, 469(t), 470, 470(t)
Colitis Crohn's, treatment of, 476, 477 diagnosis of, barium enema in, 392 ulcerative. See Ulcerative colitis.
Colloid(s)
in blood replacement, 50
in resuscitation fluid for treatment of shock, 16 Colloid oncotic pressure, in shock, 16
Colon adenocarcinoma of, 495-496 diagnosis of, 496, 496
familial polyposis coli and, 487, 489 aganglionosis of, total, 398-399. See also Hirschsprung's disease.
atresia of, 332, 334
diagnosis of, barium enema in, 340 management of, 343
colostomy in, 343 results of, 344(t) carcinoma of, 495-496
diagnosis of, 496, 496 duplication of, cystic, 454, 454 tubular,454,454,455
endoscopy of, in removal of juvenile polyp, 483, 484
excision of. See Colectomy.
in esophagealreplacement,284-286,536.See alsoEsophagus, substitution of colon segment for.
infiammation of. See specific infiammatory conditions, e.g., Ulcerative colitis. intramural air in, in
necrotizing enterocolitis, 380
left, in esophageal replacement, 286 nonrotation of, 349, 353
pneumatosis in, in necrotizing enterocolitis, 380
pseudopolyp formation in, ulcerative colitis and, 465, 466, 467

reverse rotation of, 348(t), 352, 352
right, in esophageal replacement, 284-286, 285
sigmoid. See Sigmoid colon. trauma to, 147
treatment of, colostomy in, 147 ulceration of. See Ulcerative colitis.
Colonoscopy, in removal of juvenile polyp, 483,
484 Colostomy
in m~nagement of colonic atresia, 343 in treatment of colonic trauma, 147
in treatment of Hirschsprung's disease, 394-395
"leveling," 395
Colotomy, in removal of juvenile polyp, 483-484
Coma, hyperosmolar nonketotic, as complication of elemental diets, 31 Compound nevus, 1000
Compression, and contusion, in wringer injury, 112
Compressive dressings, in management of burn wounds,l33
Computed tomographic scanning in diagnosis of appendicitis, 502
in evaluation of ebdominal masses, 914, 915 Conduit
ileal, 676, 678, 679
and urinary undiversion, 725, 726-730 complications of, 676, 693
jejunal, joining renal pelves, 708, 708 sigmoid, 679-680, 680, 681
Congenital cystic adenomatoid malformation, of lung,200-201,200-201 Congenital cystic disease, of lung,
198-200, 198, 199
Congenital hemolytic anemia splenectomy for, 563, 564
results of, 567, 567 Congenital laryngeal stridor, 184 Congenital lobar emphysema, 201-204, 203 Conical
urethra, 757
Conjoined twins, 1104
classification of, 1104-1105, 1106(t) clinical presentation in, 1105-1106, 1107, 1108
delivery of, 1109
diagnosis of, prenatal, 1106, 1109 embryology of, 1104-1105 incidence of, 1104
separation of, 1109 emergency, 1109
ethical considerations in, 1109
history of, 1104 pianning of, 1109-1110 preoperative evaluation in, 1109 results of, 1110, 1112
team approach to, 1109-1110 timing of, 1109
Constipation anoplasty and,427-428 idiopathic, 424
abdomen in, 426 and dysuria, 426 and enuresis, 426 and megacolon,427
anorectal manometry findings in, 423, 426 clinical course of, 424, 425, 426
diagnosis of, 426 dyscheziain,424,425 encopresis in, 424, 425
etiology of, 424, 425, 426 hard stools in, 424 long-term, 427
paradoxical diarrheain,424,425 radiologic findings in, 426
rectal examination findings in, 426 scybala in, 424, 425
short-term, 426-427 signs of, 424, 426 symptoms of, 424, 426 treatment of, 426-428
vs. constipation in Hirschsprung's disease, 394, 423, 426
in Hirschsprung's disease, 390, 394
vs. idiopathic constipation, 394, 423, 426 rectoplasty and, 427-428
vs. appendicitis, 502
Continence bladderin,796-7971126 ov~Ex
Continence (Continued) mechanism of, 423

nerve pathways for, 421-423, 422 physiology of, 422-423
cortical arc in, 422, 423 spinalarcin,422-423,423 urethra in, 796
urinary, after treatment of bladder exstrophy, 749-750
after treatment of urethral valves, 767 Continent ileostomy, 469, 469 Continuous positive airway pressure,
in
management of pulmonary contusion (shock lung), 156
Contusion(s) compression and, in wringer injury, 112 pulmonary,l56,158
managem nt of, 156-157 Copperhead,l0
Coral snake(s), 104
neurotoxic venom of, 104, 105 Cornea, damage to, in burn victim, 123 Corticosteroid therapy
in immunosuppression, after kidney transplantation, 848-850, 849(t), 850(t) in treatment of esophageal
burns, 262 in treatment of shock, 17
Cortisol, defective biosynthesis of, in female pseudohermaphroditism, 863, 864 Cotton-mouth moccasin,
104
Cough gastroesophageal refiux and, 303 "seal bark," 270, 280 Counseling
genetic, 75. See also Chromosome(s) and Inheritance.
of cancer patient and family, 923-931. See also Cancer patient.
Craniopagus, 1105, 1106, 1107 Cranium, teratoma within, 971
Creatinine clearance, ratio of amylase clearance to, in acute pancreatitis, 554
Creatinine level(s), serum, as indicator of renal function, 651
Crepitus, in neck, 259 Cricoid ring
stenosis within, 185-186, 187
subtotal resection of, in treatment of subglottic stenosis, 186, 187
Cricopharyngeal diverticula, of esophagus, 256 Crohn's colitis, treatment of, 476, 477
Crohn's disease, 471
anal ulcers in, 472, 473 complications of, 473-474 diagnosis of, radiographic, 473, 473 etiology of, 471
extraintestinal manifestations of, 472 finger clubbing associated with, 472, 473 ileal granulomas in, 472
ileal ulcers in, 471, 472 incidence of, 471 laboratory findings in, 473 natural history in, 472 pathology of,
471-472, 472 physical examination in, 472-473 recurrence of, 478
remission of, 474
therapy for, nonoperative, 474 operative, 474-478 appendectomy in, 475, 476(t) Aylett procedure in, 475,
476
Crohn's disease (Continued)
therapy for, operative, complications of, 478 ileostomy in, 475, 476, 476(t), 477(t), 477 indications for, 474
intestinal resection and anastomosis in, 475, 475, 476(t), 477(t)
results of, 478
subtotal colectomy in, 476, 476(t), 477(t) total colectomy in, 47s, 47s(t), 477(t), 477 Crotalid(s), 104-105
Croup,l87 bronchoscopy in,187 Cryptorchidism. See Undescended testis (testes).
Crystalloids, in blood replacement, 50 Culp-Scardino procedure,in correction of ureteropelvic junction
obstruction, 628
Curling's ulcer, burns and, 134, 325 Cushing's disease, 1019
treatment of, 1022
vs. Cushing's syndrome, 1021, 1021 Cushing's syndrome, 1019
adrenal cortical carcinoma and, 1025, 1026 clinical manifestations of, 1020
diagnosis of, 1020-1021 differential diagnosis of, 1021 etiology of, 1020, 1022 pathogenesis of, 1019
vs. Cushing's disease, 1021, 1021 Cushing's ulcer, 325
Cutaneous pyelostomy, 672, 673 Cutaneous ureterostomy
end, 672, 673, 674, 676, 676, 677
in urinary diversion, 671, 672, 672, 673, 674, 676, 676, 677
loop, 671, 672
Cutaneous urinary diversion, 674-680 Cutaneous vesicostomy, 668, 670-671
in management of prune-belly syndrome, 810, 811
Cut-back procedure, in therapy for anal agenesis, 409, 410 Cyclophosphamide, in treatment of
rhabdomyosarcoma, 988 Cylinder urethra, 757 Cyst(s)
as dysplastic condition, in kidney, 618. See also Multicystic kidney.
branchial, 1064 bronchogenic,245,246 dermoid. See Dermoid(s). developmental, of esophagus, 247
duplication. See under specific organs, e.g.,
Colon, duplication of, cystic. epidermoid,l070-1071,1070 vs. dermoid, 1070
multilocular, of kidney, 616-617 solitary, 617
neuroenteric, 448, 448 of breast, 1084
of choledochus. See Choledochal cyst(s). of esophagus, developmental, 247
of kidney, 614-619. See also Kidney(s), cyst(s) of.
of liver, 953(t), 958
of lung(s). See Lung(s), cyst(s) of. of mediastinum, 447-448
of mesentery, 1048-1049, 1048 mimicking ascites, 920
of ovary, 1014, 10141126 ov~Ex
in
Coral snake(s), 104
104

remission of, 474
476
results of, 478
obstruction, 628
treatment of, 1022
end, 672, 673, 674, 676, 676, 677
loop, 671, 672
of liver, 953(t), 958
of ovary, 1014, 10141126 ov~Ex

in
Coral snake(s), 104
104
remission of, 474
476
results of, 478
obstruction, 628
treatment of, 1022
end, 672, 673, 674, 676, 676, 677
loop, 671, 672
of liver, 953(t), 958
of ovary, 1014, 10141126 ov~Ex
in
Coral snake(s), 104
104

remission of, 474
476
results of, 478
obstruction, 628
treatment of, 1022
end, 672, 673, 674, 676, 676, 677
loop, 671, 672
of liver, 953(t), 958
of ovary, 1014, 10141128 ov~Ex

Diverticulitis Meckel's, 457, 460, 461
vs. appendicitis, 502-503 Diverticulosis, of esophagus, 256 Diverticulum (diverticula)
cricopharyngeal,256 false, of esophagus, 256
in scar tissue, of esophagus, 256 Meckel's. See Meckel's diverticulum.
of bladder, 752-754, 752-754. See also Bladder, diverticula of.
of esophagus, 256. See also Esophagus, diverticula of.
of ileum. See Meckel's diverticulum. of intestine, embryonic, 446
of ureter, 634
of urethra, 768, 768, 769
as complication of treatment of hypospadias,786 paraureteral, in patient with vesicoureteral refiux, 654,
655
pulsion, of esophagus, 256 traction, of esophagus, 256 vesicourachal, 756
Divorce, marital stress and, in family of cancer patient, 925-926, 926, 929
Dog(s), rabies in, 103 Dogbite(s), 102-104 andrabies,l02-104 incidence of, 102 treatment of, 103
"Doll's kidney," 620 Donor(s)
for kidney transplantation, 839-843 informed consent of, in kidney transplantation, 840
Dopamine, in treatment of cardiac failure, 18 Doppler pickup, as monitoring device in anesthesia, 47
Doppler ultrasonic flowmeter, in assessment of blood fiow to burned sites, 129, 130
Double aortic arch, airway compression by, 190, 190, 191
"Double bubble" sign
in duodenal obstruction, 339 of annular pancreas, 553 Double gallbladder, 449, 449 Down's syndrome
associated with Hirschsprung's disease, 390 in patients with duodenal atresia, 336-337 Drainage,
nasogastric, in treatment of burn victim, 125-126
Dressing(s) compressive, in management of burn wounds, 133
physiologic, in management of burn wounds, 131
DTIC, in treatment of malignant melanoma, 1005
Duck embryo vaccine, in treatment of rabies, 104 Duct(s), thyroglossal, embryology of, 1067-1068. See
also Thyroglossal duct cyst. Duhamel operation
in treatment of Hirschsprung's disease, 395, 396
modification of, 396-398, 396, 397 "Dumbbell" tumors, of mediastinum, 244 Duodenoduodenostomy, in
management of
duodenal atresia, 341 Duodenojejunostomy, in management of duodenal atresia, 341
Duodenum atresia of, 331, 332
anomalies associated with, 336-337 congenital heart disease in patients with, 337
diagnosis of, ultrasonography in, 337, 338 Down's syndrome in patients with, 336-337 embryology of, 335
management of, 341 duodenoduodenostomy in, 341 duodenojejunostomy in, 341 enteroplasty in, 342
postoperative parenteral nutrition in, 343-344
results of, 344, 344(t) pathogenesis of, 335 polyhydramnios in, 337
VATER syndrome in patients with, 337 weight pattern in babies with, 336, 336 duplication of, cystic, 449,
449
foreign bodies in, 120, 120 hematoma of, 146-147 treatment of, 147, 147
nonrotation of, 348(t), 351-352, 351 obstruction of, by Ladd's bands, 348(t), 353-354
"double bubble" sign in, 339
reverse rotation of, 348(t), 352-353, 352, 353 stenosis of, 332
trauma to, 145

treatment of, 145, 146-147, 147 Duplication.
of ureter(s), 635-637, 635, 636
correction of, 636-637, 708, 709, 710-711 Duplication cyst(s). See under specific organs, e.g., Colon,
duplication of, cystic. Dyschezia,424,425
Dysentery, amebic, and hepatic abscess, 526 Dysfibrinogenemia, 66(t)
Dysfunction, myocardial, in septic shock, 13 Dysgenesis
cloacal. See Cloaca, dysgenesis of. gonadal, mixed. See Mixed gonadal dysgenesis.
Dysgerminoma, 1015-1016
in mixed gonadal dysgenesis, 881, 885, 885, 886
Dysmorphism, renal, in prune-belly syndrome, 805,805
Dysphagia esophageal atresia and, 280 tracheoesophageal fistula and, 280 Dysplasia
mesenchymal. See Prune-belly syndrome. renal, 617-618. See also Multicystic kidney. with lower urinary
tract obstruction, 619-620
Dystrophic calcification(s), in abdomen, 909, 912
Dystrophy, thoracic, asphyxiating, of newborn, 180-181,181
Dysuria, idiopathic constipation and, 426
Eagle-Barrett syndrome. See Prune-belly syndrome.
Ear, middle, rhabdomyosarcoma of, 989 Echocardiography
in mitral valve prolapse, 165-166, 166 in pectus excavatum, 165-166, 166ov~Ex 1129
Ectopia cordis, 177, 179-180
Edema, as complication of elemental diets, 32 Ehlers-Danlos syndrome, 70
Elapid(s), 104 Electrical burn(s), 123 Electrocardiography
in monitoring of anesthesia, 47 in pectus excavatum, 165, 166(t) Electrolyte management, in pediatric
surgical patient, 5-7
Elemental diets, 31-33, 32(t)
use of, in patients with short-gut syndrome, 42 Elevator(s), Welch pectus excavatum, 171 Embryonal
carcinoma, of ovary, 1016 Embryonal rhabdomyosarcoma, 987
Emesis. See Vomiting.
Emotional abuse, of child, 95. See also Child abuse.
Emotional neglect, of child, 95. See also Child abuse.
Emphysema chest trauma and, 154 in neck, 259
lobar, congenital, 201-204, 203 infantile, 201-204, 203 Empyema thoracis, 213
etiology of, 213 exudative stage of, 213 fibrinopurulent stage of, 213 Hemophilus infection and, 215
organizing stage of, 213 pathology of, 213
therapy for, 214 Encephalopathy, hepatic, 532 Encopresis, 424, 425
End cutaneous ureterostomy, 672, 673, 674, 676, 676, 677
End-expiratory pressure, positive, 155 Endodermal sinus tumor, of ovary, 1016 Endometrium,
adenocarcinoma of, in mixed
gonadal dysgenesis, 886-887, 886 Endoscopy. See specific techniques, e.g., Bronchoscopy and
Esophagoscopy.
Endotracheal intubation, 51, 61, 192-193 End-stage renal disease program, 839, 840(t). See also Kidney
transplantation.
Enema barium. See Barium enema.
Gastrografin, in treatment of meconium ileus, 360,360
Enflurane, as anesthetic agent, 45 Engstrom respirator-. 60
Entamoeba histolytica, and hepatic abscess, 525, 526

Enterectomy, in treatment of Crohn's disease, 475, 475, 476(t), 477(t)
Enteritis. See Crohn's disease.
Enterobius vermicularis, in appendix, 499 Enterocolitis
diagnosis of, barium enema in, 392, 392 in Hirschsprung's disease, 390-391 necrotizing. See Necrotizing
enterocolitis.
Enteropathy, protein-losing, gastroesophageal reflux and, 297
Enteroplasty, in management of intestinal atresia, 342
Enterostomy in treatment of meconium ileus, 361 "chimney" approaches in, 361-362, 362
Enterotomy, in treatment of meconium ileus, 361
Enuresis, 796 causes of, 797
anatomic defects as, 797 concepts of, 797-798 controversy over, 797
evaluation of, 798-799 physical examination in, 798 urinalysis in, 798
urodynamic studies in, 799, 799, 800 urography in, 798-799
family history in, 798
idiopathic constipation and, 426 treatment of, 799-801 imipramine in, 800
voiding pattern in, 798 Envenomation, 105-107 severity of, grading of, 106(t) symptoms of, 105
treatment of, 105-107 antivenom in, 106(t), 107 tetanus prophylaxis in, 106 tourniquetin,l05 wound
excision in, 106-107 Enzyme(s)
in pancreas, 553 in venom, 105
Eosinophilia, as complication of total parenteral nutrition, 41
Ephedrine sulfate, in improvement of urine storage, 664(t)
Epidermoid(s), 1070-1071, 1070 vs. dermoid, 1070
Epididymis, appendix of, torsion of, 827-828, 827
Epigard, in management of burn wounds, 131 Epigastric hernia, 592, 592
Epiglottis, "omega" shape of, in congenital laryngeal stridor, 184
Epignathus, 971, 971 Epispadias in exstrophy of bladder, 738, 738
repair of, 741, 745, 745
Escharotomy, in management of burns, 124, 129-130
Esophageal manometry, in diagnosis of gastroesophageal reflux, 305
Esophageal sphincter, lower, 293-294, 294(t) Esophagitis, 259
gastroesophageal reflux and, 294, 295-299, 307
Esophagogastroscopy, in evaluation of gastrointestinal bleeding, 435 Esophagography, in demonstration of
varices, 533, 534
Esophagomyotomy, 258 Esophagoscopy,263,263 in esophageal burns, 262
in evaluation of gastrointestinal bleeding, 436 in gastroesophageal reflux, 305-306
in removal of foreign bodies, 118-119 Esophagus,253
absence of relaxation in. See Achalasia. acquired lesions of, 257-259
anatomy of, 253-254, 254, 273 anomalies of, congenital, 255-257 atresia of, 266
and dysphagia, 280
and gastroesophageal reflux, 303 and pneumonitis, 270, 274
and reflux into trachea, 270-271 and tracheomalacia, 2801130 iN~Ex
Esophagus(Continued) atresia of, anomalies associated with, 273
associated with imperforate anus, 405 classification of, 268-270
diagnosis of, 271-272, 272
embryologic insult and, 266-267, 266, 267 Grunewald theory of, 266-267, 267 familial occurrence of, 267
hydramnios in, 270, 271
in critically ill infant, treatment of, 275-276 in premature infant, treatment of, 275-276 isolated, 268, 268
pathophysiology of, 270-271 "seal bark" cough in, 270 tracheoesophageal fistula and, 267, 267 treatment
of, 274-278
anatomic factors in, 273
and gastroesophageal reflux, 279-280 bougienage in, 277
complications of, 279-280
in critically ill infant, 275-276 in premature infant, 275-276 operative, 274-275, 276-277
approach selected in, 275 technique used in, 275, 276-277 parenteral nutrition in, 276 preoperative, 274
primary repair in, 275 results of, 280 staging in, 275-276
stretching of esophageal segments in, 277-278
with tracheoesophageal fistula, 268-269, 268, 269
bougienage of, in treatment of esophageal atresia, 277
burns of, 260-262 esophagoscopy in, 262 treatment of, 262
congenital anomalies of, 255-257 cyst(s) of, developmental, 247 diverticula of, 256
arising from scar tissue, 256 cricopharyngeal, 256
false, 256 pulsion, 256
sinus tracts mimicking, trauma and, 256 traction, 256
treatment of, 256 diverticulosis of, intramural, 256 duplication of, 247, 256 embryology of, 253, 266, 266
endoscopy of. See Esophagoscopy. fistula of. See Tracheoesophageal fistula. foreign bodies in, 118-119,
119
passage of, into stomach, 119 function of, 254-255, 255
in deglutition, 254-255, 255 infection of, fascial planes in, 258, 259 inflammation of, 259
gastroesophageal reflux and, 294, 295-299, 307
injury of, caustic, 260-262 external, 259
internal, 259-260 radiation, 259 muscles of, 257
notching of, aberrant right subclavian artery and,l91
perforation of, 259, 260 repair of, 262-263
Esophagus(Continued) perforation of, repair of, pedicle flap in. 263
pleural flap in, 260, 261 rupture of, 259-260
scarring of, diverticula arising from, 256 spasm of, gastroesophageal reflux and, 296, 296
stenosis of, congenital, 255-256 stretching of, in treatment of esophageal atresia, 277-278
stricture of, gastroesophageal reflux and, 297, 298-299, 307
treatment of, 311
substitution of colon segment for, 284-286 indications for, 284
in management of portal hypertension, 536 left colon in, 286
results of, 289-290 289(t), 290 right colon in, 284-286, 285
surgical considerations in, 284-286, 285 substitution of gastric tube for, 286-288 indications for, 284
results of, 289-290, 289
surgical considerations in, 286-288, 286, 287
surgical approach to,262-263 suturing of, 262, 263
trauma to, 259-262 birth injury and, 139
varices of, bleeding from, poital hypertension and, 530-531, 533
management of, 534-539 operative approaches to, 536 roentgenographic demonstration of, 533, 534
weak areas of, 256, 257 web obstruction of, 256 Esterase(s), in venom, 105
Euglobin lysis time, values for, 68(t) Eventration, of diaphragm, 236-237 Ewing's sarcoma, extraosseous,
987 Excretory urography,l49-150
in diagnosis of infantile polycystic kidney disease,6l4-615,615 in diagnosis of pelvic kidney, 612, 612
in diagnosis of urethral valves, 764 Expressivity, 79
Exstrophy ofbladder. See Bladder, exstrophy of. of cloaca, 573-574, 573
treatment of, results of, 587(t) Exteriorization, Mikulicz, in management of intestinal atresia, 343
Extrahepatic portal hypertension. See Portal hypertension, extrahepatic.
Extralobar pulmonary sequestration, 204 arterial supply to, 204
venous drainage from, 205
Extremities, rhabdomyosarcoma of, 992-993 Eye(s), orbit of, rhabdomyosarcoma of, 989, 990
Face, rhabdomyosarcoma of, 989 Factor(s), coagulation. See Coagulation factor(s).
Factor VII deficiency, 66(t)
Factor VIII inhibitor(s), in classic hemophilia, 71-72
Factor VIII replacement. in hemophilia. 70-71, 71(t), 72iN~Ex 1131
Factor IX replacement, in Christmas disease, 71(t), 72
Factor X deficiency, 66(t) Factor XI deficiency, 66(t) Factor XII deficiency, 66(t) Factor XIII deficiency,
66(t)
Failure to thrive, gastroesophageal reflux and, 295,295
False diverticulum, of esophagus, 256 Familial incomplete male pseudohermaphroditism, 872, 873
Familial polyposis coli, 487, 489-492 and colonic adenocarcinoma, 487, 489 diagnosis of, 490, 490
Gardner's syndrome as variant of, 489 incidence of, 481, 489 polypsin,490,491
symptoms of, 490 treatment of, 491-492
ileoanal anastomosis in, 491-492, 492 Fang marks, from snake bite, 104-105, 106(t) Fascia
Gerota's, in renal injuries, 150 planes of, in neck, 258
and spread of infection to esophagus. 259 Fatty acids, 28
deficiency of, as complication of total parenteral nutrition, 40
Feeding. See also Total parenteral nutrition (TPN).
central, method of, 36, 36, 37
solutions for, composition of, 34, 34(t) peripheral, methods for, 37, 37, 38
Female pseudohermaphroditism, 862-863, 862 correction of, 863, 888
clitoral recession in, 863, 865 flap vaginoplasty in, 863, 866 labioscrotal reduction in, 863, 868 pullthrough vaginoplasty in, 863, 867
defective biosynthesis of cortisol in, 863, 864 etiology of, 859
Femoral hernia, 594, 599, 606 Fetal fibrinogen, 67
Fetal hemoglobin, 434 Fetus in fetu, 1106, 1108 surgical management of, 1112
Fiberoptic esophagogastroscopy, in evaluation of gastrointestinal bleeding, 435
Fibrin degradation products of, in hemorrhagic conditions, 72(t)
values for, 68(t)
formation of, in hemostasis, 67(t) Fibrinogen
deficiency of, 66(t)
degradation products of, in hemorrhagic conditions, 72(t)
values for, 68(t) fetal, 67
measurement of, 68
values for, 68(t)
Fibrinolysis, in hemostasis, 65, 67(t)

Fibrin stabilizing factor, deficiency of, 66(t) Fibroadenoma(s), of breast, 1085-1086, 1085 Fibroadhesive
meconium peritonitis, 368 Fibroplasia, retrolental, as complication of anesthesia, 51
Fibrosarcoma, 1033, 1033(t) Fibrosis
cystic. See Cystic fibrosis.
hepatic, as complication of therapy for biliary atresia, 520
Fibrous histiocytoma, malignant, 1034 "Fiddleback" spider bite(s), 109-110 Filter(s), in blood replacement,
50 Finger(s)
clubbing of, gastroesophageal reflux and, 297 in Crohn's disease, 472, 473 fishhookin,l22
Fingernail(s), splinter under, 122 Fishhook(s), in skin, 122 Fissure(s), anal, 429
Fissure in ano, 429 Fistula(s)
anal, 429-430
arteriovenous, 1058-1059, 1058 branchial, 1064
enteroumbilical, 459
in imperforate anus, 403-404, 404, 405(t) tracheoesophageal.See Tracheoesophageal fistula.
urethral, as complication of treatment of hypospadias, 785-786, 785(t)
Fistula in ano, 429-430
Fitzgerald factor, deficiency of, 66(t) Fixation
of hepatic flexure, incomplete, 348(t), 353-354,353
of intestine, 346 abnormal, 348(t)
at progressive embryonal stages, 347, 348(t)
Flail chest, 158 Flame burn(s), 123 Flap
bladder, in augmentation of ureteral length, 716
pedicle, in repair of esophageal perforation, 263
perineal, in construction of distal urethra from vaginal wall, 716, 722-723
pleural, in repair of esophageal perforation, 260, 261
Flap closure, skin, in treatment of omphalocele, 579,581
Flap vaginoplasty,863,866 Flash burn(s), 123
Fletcher factor, deficiency of, 66(t)
Flexible fiberoptic esophagogastroscopy, in evaluation of gastrointestinal bleeding, 435
Flexure, hepatic, incomplete fixation of, 348(t), 353-354,353
Flow generator respirator, 59
Flowmeter, Doppler ultrasonic, in assessment of blood flow to burned sites, 129, 130
Fluid, resuscitation, in treatment of shock, 16-18
Fluid management, in pediatric surgical patient, 5-7
Fluid therapy
inburnvictims, 126-128, 127(t) estimation of requirements for, 123, 126-127, 126(t)
Parkland formula in, 127
Fluoroscopy, in examination for chest trauma, 155
Focal appendicitis, 498
Foley Y-V plasty, in correction of ureteropelvic junction obstruction, 629
Follicular adenoma, of thyroid gland, 1091, 1091
Follicular carcinoma, of thryoid gland, 1092,
10941132 iN~Ex
Foot (feet)
glass fragments in, 122 needlesin,l22 Foramen of Bochdalek, 228 Forceps, Benson pyloric, 319
Foreign body (bodies). See entries under specific organs, e.g., Trachea, foreign bodies in. Foreskin
infiammation of, 793
removal of. See Circumcision. retraction of, 793
tightness of, 793 Formula(s) infant, composition of, 30, 31(t)
use of, in patients with short-gut syndrome, 42
Fracture(s), rib, 158, 158
Friction, and abrasion, in wringer injury, 112 Friction burn(s), in wringer injury, 113 Fundoplication
Ashcraft-Thal, 310 Belsy, 310 Nissen,308-309,310
Funnel chest. See Pectus excavatum. Furosemide washout test, in diagnosis of ureteropelvic junction
obstruction, 625
Fusiform megalourethra, in prune-belly syndrome, 808
Fusiform urethra, 757
Gallbladder double, 449, 449
in biliary atresia, 513, 514 inflammation of, See Cholecystitis. removal of. See Cholecystectomy. stones in.
See Cholelithiasis. Gallium scanning
in evaluation of Hodgkin's disease, 975
in evaluation of non-Hodgkin's lymphoma, 980
Gallstone(s). See Cholelithiasis. Ganglion (ganglia) hypogastric, 421
pelvic, 421 rectal, 421-422 Ganglioneuroblastomas, of mediastinum, 243-244,243
Gangrene, in appendix, in appendicitis, 499, 500 Gardner's syndrome, 489
Garment nevus, 999
Gastrectomy, total, in treatment of Zollinger-Ellison syndrome, 326, 1030 Gastrin, 294
Gastrinoma, 557-558 Gastroenteritis, vs. appendicitis, 502 Gastroesophageal junction, anatomy of, 292-293
Gastroesophageal refiux, 292 anemia in, iron deficiency, 297 apneain,302-303,307 arrhythmias in, 297
as complication of treatment of esophageal atresia, 279-280
as complication of treatment of tracheoesophagealfistula,279-280 aspiration pneumonia in, 300, 302
aspiration syndromes in, 299-303, 307 asthma in, 302, 307
bronchitis in, 302, 307
Gastroesophageal reflux (Continued) clubbing of fingers in, 297 consequencesof,294 coughin,303
diagnosis of, 303
barium study in, 303-304, 304 esophagoscopyin,305-306 gastroesophageal scintiscan in, 304-305
manometric studies in, 305
pH probe monitoring in, 305 radiologic studies in, 303-305 emesis in, 295, 307
esophageal atresia and, 303 esophagealspasm in,296,296
esophageal stricture in, 297, 298-299, 307 treatment of, 311
esophagitisin,294,295-299,307 failure to thrive in, 295, 295 finger clubbing in, 297 gastrointestinal
bleeding in, 297 grading of, radiologic, 304 heartburn in, 296
hoarseness in, 303
iron deficiency anemia in, 297 mechanisms preventing, 293-294 movement disorders in, 297 natural
history in, 306 pathophysiology of, 292-294 pneumoniain,299-300,299-300,301,302, 307
protein-losing enteropathy in, 297 rumination in, 295, 307
Sandifer's syndrome in, 296-297, 297, 307 seizures in, 297
simulating pyloric stenosis, 318 spasmodic torticollis in, 296-297, 297, 307 sudden infant death syndrome
in, 303, 307 symptoms of, 294-303, 295(t)
in patient with esophageal stricture, 311 medical, 306-307

operative, 307, 308-309, 310 Ashcraft-Thal fundoplication in, 310 Belsy fundoplication in, 310 Boerema
gastropexy in, 310 complications of, 310
indications for, 307, 307(t)
Nissen fundoplication in, 308-309, 310 results of, 306-307, 310-311, 310(t) vomiting in, 295, 307
Gastroesophagealscintiscan,304-305 Gastrografin enema, in treatment of meconium ileus, 360, 360
Gastrointestinal bleeding, 433
causes of, in children and adolescents, 435(t) evaluation of, angiography in, 435 Apt-Downey test in, 434,
434
barium examination in, 436 coffee ground vomitus in, 433 esophagogastroscopyin,435
esophagoscopyin,436 hematemesis in, 433 hematochezia in, 433
melena in, 433
nasogastric tube aspiration in, 435 patient history in, 433
physical examination in, 433-434 sigmoidoscopy in, 436 technetium scanning in, 435-436
gastroesophageal refiux and, 297 in adolescents, 435-436nv~Ex 1133
(~astrointestinal bleeding (Continued) in children,435-436
in newborn, 434 management of, 434-435 Gastrointestinal tract
anomalies of, in prune-belly syndrome, 809 bleeding from 433-436. See also Gastrointestinal bleeding.
duplication of, thoracoabdominal, 247 foreign bodiesin,ll9-121,120 Gastropexy, Boerema, 310
Gastroschisis, 576
anatomy of, 575
anomalies associated with, 575 embryology of, 574-575 incidence of, 577
mortality rate in, 584 treatment of, 584, 588
management decisions in, 577-578 nonoperative, 578-579 preliminary management in, 577 results of, 584,
587(t)
secondary closure of ventral hernias in, 582, 584
surgical, 579
primary layered closure in, 579 staged Silastic pouch (silo) closure in, 579-582
vs. omphal,ocele, 574-575, 576(t) Gastrosplenic ligament, accessory spleen at, 565, 566(t)
Gastrostomy, 327-328, 327, 328 Generalized meconium peritonitis, 368 Genetics, 75-83. See also
Chromosome(s) and Inheritance.
Genitalia ambiguous, evaluation of, 887-888. See also Intersexuality.
anomalies of, associated with imperforate anus, 405(t)
embryology of, 861-862
repair of, in exstrophy of bladder, 745, 746-748
trauma to, 153, 904-906
sexual abuse and, 153, 905-906, 906(t). See also Child abuse.
Gentamicin, in treatment of appendicitis, 505 GER. See Gastroesophageal reflux.
Gerota's fascia, in renal injuries, 150 Gestational age
weight appropriate to, in babies with duodenal atresia, 336, 336
in babies with jejunoileal atresia, 336, 336 Giant cell interstitial pneumonia, 222
Giant hemangioma, 72 Giantnevus,999,1000,1001-1002,1002 Giant pigmented nevus, 999, 1000, 10011002, 1002
Gigantism, hemangiomatous, 1058-1059 Gland(s). See under specific glands, e.g., Thyroid gland.
Glass, fragments of, in skin, 122 Globulin
accelerator, deficiency of, 66(t) antihemophilic, deficiency of, 66(t) Glottis
cysts above, 186

hemangiomas beneath, 187-188, 188 papillomas of, 186-187
stenosis of airway beneath, 185-186 Glycogen storage disease (type I), 559-560, 560 Glycolysis, anaerobic,
11
Goiter congenital, 1091
histologic findings in, 1090 simple, 1090
toxic. See Graves' disease. Gonad(s)
asymmetric, in mixed gonadal dysgenesis, 884-885
dysgenesis of, mixed. See Mixed gonadal dysgenesis.
streak, in mixed gonadal dysgenesis, 879, 884, 884
removal of, 888
in Turner's syndrome, 884, 884 Gonadectomy, in treatment of mixed gonadal dysgenesis, 888
Gonadoblastoma, 1010
in mixed gonadal dysgenesis, 885, 885, 886 Graft(s), in management of burn wounds, 131-132,132
Granular cell myoblastoma, of breast, 1085 Granuloma(s)
ileal, Crohn's disease and, 472 umbilical, 463
Granulosa-theca cell tumor(s), of ovary, 1017, 1017
Graves' disease, 1095, 1098 histologic findings in, 1099 physical findings in, los8, 1098 treatment of, 1098
drug therapy in, 1098 methimazole in, 1098 propranololin,ll00 propylthiouracil in, 1098
radioactive iodine therapy in, 1098-1099 surgicaltherapyin,l099-1100 Greater omentum, accessory spleen
at, 565, 566(t)
Groin, hernias of. See specific types, e.g., Indirect inguinal hernia(s).
Growth, after kidney transplantation, 851-852, 852 (t)
Grunewald theory of cause of esophageal atresia, 266-267,267
Gubernaculum,8l6 Gynecomastia, 1082, 1082
Hageman factor, deficiency of, 66(t) Hair, in bezoar, 121
Halo nevus, 1000-1001 Halothane
as anesthetic agent, 45 hepatotoxicity of, 52 Hamartoma, of liver, 953(t), 958 Hand(s)
fishhookin,l22 glass fragments in, 122 needlesin,l22
Hashimoto's thyroiditis, 1089-1090 histologic findings in, 1089, 1090 Head
rhabdomyosarcoma of, 988-990 meningeal involvement in, 989-990 Heart
abnormalities of, in pectus excavatum, 165-166, 166(t), 166, 167(t) compression of. See Cardiac
tamponade. defects of, in prune-belly syndrome, 809 effect of hypothermia on, 481134 iN~Ex
Heartburn, gastroesophageal reflux and, 296 Heart failure, in shock, treatment of, 18
Heat loss, vaporizational, through burn wounds, 128-129
Heel stick, for arterial blood sampling, 62 Hegar dilator, in therapy for imperforate anus, 408,408,409
Heller esophagomyotomy, 258 Hemangioendothelioma of liver, 954
treatment of, 958 Hemangioma(s), 1054-1055
and gigantism, in patient with arteriovenous fistulas, 1058-1059
appearing as neonatal staining, 1055 arterial, with arteriovenous fistulas, 1058, 1058
capillary,l056-1057,1056 cavernous,l057-1058,1057 of liver, 954
classification of, 1055(t) giant, 72
in internal organs, 1059 intradermal, 1055 juvenile,l055-1058 of breast, 1084
of liver, 953(t), 954, 1059 treatment of, 958
of salivary glands, 1031 racemose, 1059, 1059
resection of, disseminated intravascular coagulation after, 1059

subglottic, 187-188, 188 treatment of, 1059-1060 Hemarthrosis, hemophilia and, 69, 70 Hematemesis, 433
Hematobilia, liver trauma and, 145 Hematochezia, 433
Hematocrit, in monitoring fiuid volume, 7 Hematoma(s)
defects of hemostasis and, 70 duodenal,l46-147 treatment of, 147, 147
Hemiazygos vein, drainage to, in pulmonary sequestration, 205
Hemodialysis priorto kidneytransplantation,844-845,844 vascularaccessin,844-845,844
Hemodilution, during blood replacement, 50 Hemoglobin, 434
functions of, 56, 57 Hemoglobin dissociation curve, 9 Hemolytic anemia
splenectomy for, 563, 564 results of, 567, 567
Hemophilia. See also Christmas disease and von Willebrand's disease.
classic, 66(t), 70
detection of, in preoperative patient, 69, 70 factor VIII inhibitor activity in, 71-72 factor VIII replacement
in, 70-71, 71(t) history suggestive of, 69
management of, in surgical patients, 70-72, 71 (t)
Hemophilia A. See Hemophilia, classic. Hemophilia B. See Christmas disease. Hemophilia C, 66(t)
Hemophilus infection, and empyema thoracis, 215
Hemophilus influenzae type B, infection by, 187
Hemoptysis, bronchiectasis and, 211 Hemorrhage, gastrointestinal. See
Gastrointestinal bleeding. Hemorrhagin(s), 105
Hemosiderosis, pulrnonary, idiopathic, 222 Hemostasis, 65-67
activation of, in sepsis, 12 coagulation in, 65, 67(t) defects of, and bruising, 69, 70
and deep hemotoma formation, 70 and disseminated intravascular coagulation, 72-73
and petechia formation, 69, 70 and purpura, 70
and recurrent hemorrhage, 69
and skin changes with scar formation, 70 classification of, 69(t)
management of, in surgical patients, 70-73 patient history of, 69
replacement therapy in, 70-73, 71(t) evaluation of, in preoperative patient, 69-70 laboratory tests in, 68-69,
70. See also
specific tests, e.g., Platelet count(s). patient history in, 69
physical examination in, 69-70 fibrin formation in, 67(t) fibrinolysis in, 65, 67(t)
in newborns, 67-68 vitamin K and, 67
in premature babies, 68
laboratory tests of, 68-69, 68(t). See also specific tests, e.g., Prothrombin time (PT). plasma stage of, 65,
67(t)
platelet phase of, 65, 67(t)
defects of, management of, in surgical patient, 70
petechia formation in, 69, 70 effects of sepsis on, 12 inhibition of, by aspirin, 70
theories of, 65-67
thrombin formation in, 67(t) vascular phase of, 67(t) vitamin K and, 67
Hemothorax, 154 Henderson-Hassalbalch equation, 57 Henle's plexus, 389
Henoch-Schonlein purpura, signs of, 70 Hepatic artery, occlusion of, in treatment of benign liver tumors,
958
Hepatic encephalopathy 532

Hepatic fiexure, incomplete fixation of, 348(t), 353-354,353
Hepatic portoenterostomy
in therapy for biliary atresia, 515, 516-517 clinical outcome of, 519
modifications of, 515, 518 Hepatitis
neonatal, etiology of, 510-511
infantile cholestatic jaundice in, 512-513 vs.biliaryatresia, 511-513, 512(t) Hepatoblastoma, 953, 953(t)
anomalies associated with, 953(t) treatment of, results of, 957, 957(t) Hepatocellular carcinoma, 953, 953(t)
anomalies associated with, 953(t) treatment of, results of, 957, 957(t) Hereditary spherocytosis,
splenectomy for, 563-564
Heredity. See Chromosome(s) and Inheritance. Hermaphroditism, 873, 874-877INDEX
Hermaphroditism (Continued) etiology of, 859, 878-879 histologic findings in, 878 treatment of, 888
XX karyotype in, 860 Hernia(s)
abdominal wall, 589-593, 589. See also specific hernias, e.g., Umbilical hernia. Bochdalek. See
Posterolateral hernia, of diaphragm.
diaphragmatic, anterior, 236
associated with pulmonary sequestration, 205
Bochdalek. See PosterolateraI hernia, of diaphragm.
posterolateral. See Posterolateral hernia, of diaphragm.
traumatic, 238 epigastric, 592, 592 femoral, 594, 599, 606
groin. See specific types, e.g., Indirect inguinal hernia(s).
history of repair of, 594 inguinal, direct, 594, 606
indirect. See Indirect inguinal hernia(s). lumbar, 593, 593
paraduodenal,352-353,354-355 secondary to treatment of gastroschisis, closure of, 582, 584
secondary to treatment of omphalocele, closure of, 582, 584, 585-586 sliding, 598, 606
Spigelian, 592-593 supraumbilical, 592, 592 traumatic, of diaphragm, 238 umbilical, 589-592. See also
Umbilical hernia.
"Herniograms," in diagnosis of indirect inguinalhernia,598-599,599,605 Heteropagus, 1106, 1108
Hilum, of spleen, accessory spleen at, 565, 566(t)
Hip(s), dislocation of, in prune-belly syndrome, 809
Hirschsprung's disease, 389 absence of rectoanal reflex in, 423 Auerbach's plexus in, 389, 393 clinical
findings in, 390-391, 391 constipation in, 390, 394
vs. idiopathic constipation, 394, 423, 426 diagnosis of, 391-394
barium enema in, 391-392, 391, 392 rectalbiopsyin,392-394,393 diarrheain,390
differential diagnosis of, 394
Down's syndrome associated with, 390 enterocolitis in, 390-391
etiology of, 389-390 Henle's plexus in, 389 Meissner's plexus in, 389 nonsurgical management of, 394
pathology of, 389-390
rectum in, 389
screening for, anorectal manometry in, 394, 423, 426
sigmoid colon in, 389, 389 "skip areas"in,389-390 surgical treatment of, 394, 395
anorectal myectomy in, 395-396 colostomy in, 394-395
deferment of, in patient with enterocolitis, 390-391
Hirschsprung's disease (Continued)
surgical treatment of, Duhamel operation in, 395, 396
modification of, 396-398, 396, 397 Martin operation in, 396-398, 396, 397 results of, 398
Soave operation in, 395, 396 State operation in, 395, 396 Swenson operation in, 395, 396
vs. chronic adynamic ileus, 394
vs. meconium plug syndrome, 366-367, 394 Histiocytoma, fibrous, malignant, 1034 Histocompatibility
typing, in kidney
transplantation, 84o(t)-842(t), 841 Histoplasmosis, 218-219
Hoarseness, gastroesophageal reflux and, 303 Hodgkin's disease, 245, 973
classification of, 973 clinical presentation in, 974 diagnosis of, 974 evaluation of, 974-975
biochemical tests in, 976 clinical findings in, 975 gallium scanning in, 975 hematologic examination in,
975 lymphangiography in, 975 radiographic findings in, 975 staging laparotomy in, 976-977 incidence of,
973
of mediastinum, 245 pathology of, 973 staging of, 974 Sternberg-Reed cell in, 973 treatment of, 977
ACOPP in, 977 chemotherapyin, 977 MOPP in, 977 radiotherapy in, 977 results of, 977-978 splenectomy
in, 564 Hormone(s)
affecting lower esophageal sphincter, 294, 294(t)
thyroid-stimulating, 1088
Horse immune globulin, in treatment of rabies, 104
Horseshoe kidney,6l3-614,613
diagnosis of, intravenous pyelography in, 613, 613
Host defenses, of neonate, 2
Hot water bypass, humidification provided by, 60
Huch oxygen sensor, 10 Human bite(s), 107-108 antibiotic therapy in, 107 tetanus prophylaxis in, 107
Human immune globulin, in treatment of rabies, 104
Humidity, in ventilatory management, 60 Hyaline membrane disease, in newborn surgical patients, 4
H-Y antigen, 860-861
deficiency of, and mixed gonadal dysgenesis, 882,882
H-Y antigen receptor, deficiency of, and mixed gonadal dysgenesis, 882, 882
Hydatid of Morgagni, torsion of, 826-827, 826 Hydramnios, in patients with esophageal atresia, 270, 271
Hydrocele,606-607 associated with indirect inguinal hernia, 596, 6071136 INDEX
Hydrocele (Continued) embryology of, 594-595, 595
incomplete obliteration of processus vaginalis and, 595, 595
treatment of, 607
Hydrocolpos, 892. See also Hydrometrocolpos. Hydrometrocolpos, 892
clinical aspects of, 892, 892, 893 diagnosis of, 892, 894, 895 radiographic findings in, 892, 894, 895
Hydronephrosis, 623. See also ~lreteropelvic junction, obstruction of.
Hydrostatic pressure, in reduction of intussusception,440-442,441 Hydrotherapy, in management of burn
wounds, 129, 130
Hygroma, cystic. See Cystic hygroma. Hymen
embryology of, 891, 891 imperforate, 892, 893, 895 embryology of, 895 treatment of, 895
microperforate, 895 Hymenectomy, 895 Hymenoptera sting(s), 108-109
hypersensitivity to, 108-109 immunotherapy for, 109 Hymenoptera venom, 108 Hymenotomy, 895
Hyperalimentation, peripheral, 34(t), 35(t), 35. See also Total parenteral nutrition (TPN).
Hyperammonemia, as complication of
total-parenteral nutrition, 40 Hyperamylasemia, in pancreatitis, 554 Hypercalcemia
as complication of elemental diets, 31
as complication of total parenteral nutrition, 41
hyperparathyroidism and, 1100-1101 Hyperglycemia, as complication of total parenteral nutrition, 40

Hypermetabolism, in burn victims, 128-129 Hypernatremia, in burn victims, 128 Hypernephroma, 10181019 Hyperosmolarity, in burn victims, 128 Hyperosmolar nonketotic coma, as complication of elemental
diets, 31
Hyperparathyroidism, 1100-1101 and hypercalcemia, 1100-1101 osseous manifestations of, 1100, 1100
treatment of, 1101
hypocalcemia after, 1101 Hyperphosphatemia, as complication of total parenteral nutrition, 41
Hyperplasia adrenal. See Female pseudohermaphroditism. renal, 620
Hypersensitivity, to insect stings, 108-109 Hypertelorism-hypospadias. 773 Hypertension
after kidney transplantation, 853 portal. See Portal hypertension. renal injury and, 150, 151
renovascular.See Renovascular hypertension.
Hyperthermia, 48 malignant, 49
Hyperthyroidism. See Graves' disease. Hypertrophic pyloric stensois, infantile. See Infantile hypertrophic
pyloric stenosis.
Hypertrophic scar(s), burn wound healing and, 133
Hypertrophy, of intestinal villi, in jejunal atresia, 334-335, 334-335 Hypertrophy of breast
juvenile,l081-1082,1081 neonatal,l080,1081 virginal,l081-1082,1081
Hypocalcemia, 19
after parathyroidectomy, 1101
pathophysiology of, 19 physiology of, 19
vs. hypoglycemia, 20
Hypodermic needle(s), breaking of, in subcutaneous tissue, 122 Hypofibrinogenemia, 66(t) Hypogastric
ganglion, 421 Hypoglycemia, 18
glycogen storage disease (type I) and, 559-560,560
in small for gestational age infant, 4 islet cell adenoma and, 558 nesidioblastosis and, 558-559
pathophysiology of, 18
physiology of, 18
vs. hypocalcemia, 20 Hypokalemic alkalosis, in infantile hypertrophic pyloric stenosis, 318
Hypomagnesemia, as complication of total parenteral nutrition, 40 Hypophosphatemia, as complication of
total
parenteral nutrition, 41 Hypoplasia
renal, 620 ureteral, 633 Hypoprothrombinemia, 66(t)
as complication of elemental diets, 32 Hypospadias, 770
anomalies associated with, 773-774 chordee in, 770, 771, 772 development of, 772-773
clinical features of, 770, 771, 772 development of, 772-773 etiology of, 773
evaluation of intersex states in, 773-774 evaluation of testes in, 772
evaluation of urinary tract in, 774 incidence of, 770
in hypertelorism, 773
in Reifenstein's syndrome, 773 site of meatus in, 770, 770(t) treatment of, 774-775
chordee correction in, 774, 776, 778, 780 complications of, 785-787, 785(t)
fistula formation after, 785-786, 785 (t) meatal retraction after, 786
meatal stenosis after, 786 meatotomy in, 776, 778 objectives of, 774 one-stage repair in, 775 persistent
chordee after, 786 postoperative measures in, 777 results of, 776, 777, 785-787 sexual function after, 786
techniques of, 776
temporary urinary diversion in, 776 timing of, patient's age in, 775INDEX 1137
Hypospadias (Continued)
treatment of, two-stage repair in, 775-776 urethral diverticulum after, 786
urethral sacculation after, 786 urethral strictures after, 786 urethroplasty in, 776, 781-784
Hypotension, induced, during blood replacement, 50
Hypothermia, 48 Hypoxia, 8
Imipramine hydrochloride, in improvement of urine storage, 664(t), 800
Immune hemolytic anemia, splenectomy for, 564
Immunization, tetanus, 102 Immunosuppressive therapy. See also Immunotherapy.
after kidney transplantation, 847-850, 849(t), 850(t)
antihuman thymocyte serum in, 848-849,
Idiopathic pneumonia, 221-222 Idiopathic pulmonary hemosiderosis, 222 Idiopathic thrombocytopenia
splenectomy for, 563 results of, 566, 566 Ileal conduit
and urinary diversion, 676, 678, 679 complications of, 676, 693
and urinary undiversion, 725, 726-730 Ileitis
"backwash," 467
regional. See Crohn's disease. terminal. See Crohn's disease.
Ileostomy continent, 469, 469
in treatment of Crohn's disease, 475, 476, 476(t), 477(t), 477
in treatment of ulcerative colitis, 468-471 469(t), 469, 470(t)
Kock procedure for, 469, 469 Ileum
as conduit, and urinary diversion, 676, 678, 679
complications of, 676, 693
and urinary undiversion, 725, 726-730 atresia of, 332, 332(t), 333
anomalies associated with 336-337 "apple peel" deformity in, 332 "Christmas tree" deformity in, 332, 333
diagnosis of, barium enema in, 340 embryology of, 334-335
management of, 342-343 Mikulicz exteriorization in, 343 postoperative parenteral nutrition in, 343-344
results of, 344, 344(t)
meconium ileus in patients with, 337 pathogenesis of, 334-335
pathology of, 334-335 types of, 332, 333
weight pattern in babies with, 336, 336 diverticulum of. See Meckel's diverticulum. duplication of, cystic,
450, 451
foreign bodies in, 120
granulomas in, Crohn's disease and, 472 inflammation of, "backwash," 467 granulomatou~. See Crohn's
disease.
stenosis of, 332, 332(t) trauma to, 145
ulcers in, Crohn's disease and, 471, 472 Ileus
adynamic, chronic, vs. Hirschsprung's disease, 394
meconium. See Meconium ileus.
paralytic, as complication of appendicitis, 506 Iliac osteotomy, in treatment of exstrophy of bladder, 741,
742
Iliococcygeus muscle, 419-420, 420
849(t), 849, 850
azathioprine in, 847, 848, 849(t) corticosteroids in, 848-850, 849(t),
850(t) prednisone in, 847, 848, 849(t), 850(t)
Immunotherapy. See also Immunosuppressive therapy.

for protection of persons hypersensitive to insect stings, 109
in treatment of burn victims, 133
in treatment of malignant melanoma, 1005 Imperforate anal membrane, 402, 403 evaluation of, 403, 406
opening of, 409, 409 therapy for, results of, 416(t) Imperforate anus, 401
anomalies associated with, 404-405, 405(t) cardiovascular defects associated with,
405 classification of, 402-404, 402(t), 403, 404 complications of, 414-415
diagnostic evaluation of, intravenous pyelography in, 407-408 physical examination in, 406 radiography in,
406-407, 406, 407 urology in, 407-408, 408
voiding cystourethrography in, 408, 408 embryology of, 401-402
esophageal atresia associated with, 405 fistulas in, 403-404, 404, 405(t) gastrointestinal maldevelopment
associated with, 405
genitourinary abnormalities associated with, 405
high supralevator types of 402(t), 403, 404, 404, 407
intestinal atresia associated with, 405 intestinal malrotation associated with, 405 low infralevator types of,
402-404, 402(t), 403, 404, 406-407
prognosis in, 416
skeletal deformities associated with, 405 therapy for, abdominoperineal pull-through in,411,412,412-413
anoplasty in, 409-411, 410, 411 complications of, 415
cut-back procedure in, 409, 410 dilatation in, 408, 408, 409 Hegar dilator in, 408, 408, 409 postoperative
care in, 414 results of, 415-416, 415(t), 416(t) sacroabdominoperineal pull-through i.n,
412-413 sacroperineal pull-through in, 414 secondary operation in, 412-413, 414 transanal excision in, 412
transplantation in, 409-410
vs. normal anus, 403 Imperforate hymen, 892, 893, 895 embryology of, 895
treatment of, 8951138 ovoEx
Incarceration of intestine, in indirect inguinal hernia, 596,
598, 598, 599-600 reduction of, 600, 604
in umbilical hernia, 590, 591 Incomplete male pseudohermaphroditism, familial, 872, 873
Incontinence correction of, 716 bladderneckin,716,720 construction of distal urethra from vaginal
wall in, 716, 721-722 perineal flap and, 716, 722-723 urinary. See also Enuresis.
after treatment of bladder exstrophy, 749-750
after treatment of urethral valves, 767 Indirect inguinal hernia(s), 594
bilateral, 604-605
exploration for, 604-605, 605(t) incidence of, 596, 596(t)
clinical presentation of, 596, 597, 598 cryptorchidism associated with, treatment of, 600
diagnosis of, 598-600 "herniograms" in, 598, 599, 605 physical findings in, 598
embryology of, 594-595, 595
exploration for, 604-605, 605(t) hydrocele associated with, 596, 607 incarceration of intestine in, 596, 598,
598, 599-600
reduction of, 600, 604 incidence of 595-596, 596(t)
incomplete obliteration of processus vaginalis and,595,595
recurrence of, 605-606 silk glove sign in, 598 therapy for, 600
complications of, 606, 606(t) exploration in, 604-605, 605(t) operativetechniquein,600,601-604
orchiopexyin,600 reduction of incarcerated intestine in, 600, 604
treatment of cryptorchidism in, 600 unilateral repair in, and need for subsequent operation, 605
undescended testicle associated with, treatment of, 600
Infantformula(s) composition of, 30, 31(t)

use of, in patients with short-gut syndrome, 42
Infantile cholestatic jaundice evaluation of, 511(t), 512-513 isotope studies in, 511 (t), 513 serum studies
in, 511(t), 512-513
in biliary atresia, 511-512
in neonatal hepatitis, 512-513
Infantile hypertrophic pyloric stenosis, 314-315 clinical course of, 31`6, 318
diagnosis of, radiographic examination in, 316, 31 7
etiology of, 315
gastric contractions in, 316 hypokalemic alkalosis in, 318 incidence of, 314-315 jaundice in, 316, 318
pathology of, 315-316, 315 projectile vomiting in, 316 pyloric tumor in, 316 shoulder sign in, 316
Infantile hypertrophic pyloric stenosis (Continued)
"string sign" in, 316 syndromes simulating, 318 treatment of, nonoperative, 318-319
surgical, 319-320, 320
Benson pyloric forceps in, 319 complications of, 320-321, 321 postoperative management in, 320
preoperative management in, 319 pyloromyotomy in, 319, 320, 321 results of, 321
Infantile lobar emphysema, 201-204, 203 Infantile polycystic kidney disease, 614-616 clinicalfeatures
of,614-615,614
cysts in, 615, 615
diagnosis of, excretory urography in, 614-615,615
pathology of,615-616,615 "sunray" effectin,6l4-615,615 treatment of, 616
Inferior vena cavogram, 914
Infertility, undescended testis (testes) and, 818 Inflammatory polyp(s), 486-487
Informed consent, of donor, in kidney transplantation, 840
Infusion pyelography, 149 Inguinal hernia(s)
direct, 594, 606
indirect. See Indirect inguinal hernia(s). Inguinal pouch, superficial, testes in, 816 Inhalation injury, burns
and, 123, 124, 125, 125 Inheritance
autosomal dominant, 78-79, 79 autosomal recessive, 79-80, 79
expressivity in, 80 multifactorial, 82
of single gene defects, 78-82 penetrance in, 80
sporadic, 82
X-linked dominant, 81-82, 81 X-linked recessive, 80-81, 81
Injury (injuries), 139-161. See also trauma entries under specific organs-e.g., Liver, trauma to-and specific
types of injuries-e.g., Burn(s).
Innominate artery, compression of trachea by, 191-192
Insect bite(s), 102 Insect sting(s), 108-109 hypersensitivity to, 108-109
immunotherapy for, 109 Insect venom, 108
Intensive care unit, risk of airway problems in, 51
Intersexuality. See also Hermaphroditism, Mixed gonadal dysgenesis, and Pseudohermaphroditism.
biochemical defects and, 862 choice of gender in, 858
chromosome abnormalities and, 860-861 diagnosis of, 858, 858, 859
embryonic events in, 861-862 enzymatic defects and, 859, 862 etiology of, 858, 859, 860-861
in patients with hypospadias, 773-774 Interstitial pneumonia, 221-222 desquamative, 222, 222
giant cell, 222 lymphoid, 222
Interstitial pneumonitis, 219(t) Intestine
anastomotic repair of, 342, 342iN~Ex 1139

Intestine (Continued)
anastomotic repair of, in treatment of Crohn's disease, 475, 475, 476(t), 477(t)
in treatment of meconium ileus, 361 atresia of, 331
anomalies associated with, 336-337 "apple peel" deformity in, 332 associated with imperforate anus, 405
"Christmas tree" deformity in, 332, 333 diagnosis of, 337-341
embryology of, 335-336 management of, 341-345 anastomosis in, 342, 342 operative procedures in, 341343 postoperative care in, 343-344, 343
parenteral nutrition in, 343-344, 343 preoperative care in, 341
results of, 344-345, 344(t) pathogenesis of, 335-336 pathology of, 332-337 bezoar in, 121
diverticula of, embryonic, 446 embryology of, defective recanalization in, 446
fixation of, 346 abnormal, 348(t)
at progressive embryonal stages, 347, 348(t) foreign bodies in, 120
incarceration of, in indirect inguinal hernia, 596, 598, 598, 599-600
reduction of, 600, 604
in umbilical hernia, 590, 591 inflammation of. See specific infiammatory conditions, e.g., Necrotizing
enterocolitis.
infolding of. See Intussusception.
in Hirschsprung's disease, 389. See also Hirschsprung's disease.
intramural air in, in necrotizing enterocolitis, 379
leukemic infiltration of, vs. lymphoid polyps, 486
loops of, radiographic appearance of, in necrotizing enterocolitis, 380, 381 lymphangiectasia of, 1050
lymphosarcoma of, vs. lymphoid polyps, 486 malrotations of, 346-355, 348(t). See also specific errors of
rotation, e.g., Nonrotation and Reverse rotation.
nonrotation of. See Nonrotation, of intestine, and Midgut volvulus.
obstructive complications of appendicitis in, 506
obstructive complications of Meckel's diverticulum in, 457, 461
pneumatosis in, in necrotizing enterocolitis, 379
polyps of. See specific lesions, e.g., Juvenile polyp(s) and Lymphoid polyp(s). protrusion of, at umbilicus.
See Gastroschisis and Omphalocele.
resection of, in treatment of Crohn's disease, 495, 475, 476(t), 477(t)
rotation of, 347, 347
at progressive embryonal stages, 347, 348(t) errors in 346-355, 348(t). See also specific abnormalities, e.g.,
Nonrotation and Reverse rotation.
small. See Small intestine. stenosis of, 331
diagnosis of, 337-341 pathology of, 332-337
stricture of, necrotizing enterocolitis and, 386
Intestine (Continued) trauma to, 145
birth injury and, 139 treatment of, 145-146, 146
villus hypertrophy in, jejunal atresia and, 334-335,334-335
volvulus of. See Midgut volvulus. Intradermal hemangiomas, 1055 Intradermal nevus, 1000
Intraductal papilloma(s), of breast, 1084-1085 Intrahepatic portal hypertension. See Portal hypertension,
intrahepatic.
Intralobar pulmonary sequestration, 204 arterial supply to, 204
venous drainage from, 205 Intrarenal reflux (IRR), 647 Intravascular coagulation
disseminated, 72-73, 72(t)
after resection of hemangioma, 1059 Intravenous nutrition. See Total parenteral nutrition (TPN).
Intravenous pyelography, 149-150
in diagnosis of horseshoe kidney, 613, 613 in diagnosis of neuroblastoma, 946, 947
in evaluation of abdominal masses, 909, 912, 913, 914
in evaluation of urinary tract infections, 648, 649, 650
in patients with imperforate anus, 407-408 in screening for renovascular hypertension, 831
Intravenous slough(s), 113-114 clinical aspects of, 114 diagnosis of, 114 mechanism of injury in, 114
therapy for, 114-115
results of, 115 Intravenous therapy
and sloughing of skin, 113-115. See also Intravenous slough(s).
in burn victim, 126 veins used in, 62 Intubation
Davis, in correction of ureteropelvic junction obstruction, 629
endotracheal, 51, 61, 192-193
nasogastric, in evaluation of gastrointestinal bleeding, 435
in burn victim, 124, 124 nasotracheal, 193 orotracheal, 192-193
in burn victim, 124 Intussusception, 438 clinical findings in, 439 cystic fibrosis and, 438 diagnosis of, 439440
radiographic studies in, 440, 440, 441 etiology of, 438, 438(t)
incidence of, 438-439 by age, 438, 439(t)
by gender, 438, 439(t)
in patients with non-Hodgkin's lymphoma, 979, 981
laboratory studies in, 440 lead point for, 438, 438(t) Meckel's diverticulum and, 461 necrosis in, 443, 444
Peutz-Jeghers polyp and, 488, 489 physical examination in, 439-440 prolapse of, through anus, 439-440
reduction of, hydrostatic pressure, 440-442, 4411140 iN~Ex
Intussusception (Continued) reduction of, surgical, 442-443, 442
appendectomy in, 443 swelling of Peyer's patches and, 438 symptoms of, intermittent nature of, 439 vs.
appendicitis, 503
vs. rectal prolapse, 440
Iodine, radioactive, in treatment of Graves' disease,l098-1099 Iron deficiency anemia, gastroesophageal
refiux and,297
IRR, 647 Ischiopagus,ll06,1107 Islet cell adenoma, 558
vs. nesidioblastosis, 558-559 Islet cell tumor(s), 557-558 Isofiurane, as anesthetic agent, 45 Isolated
esophageal atresia, 268, 268
Isolated tracheoesophageal fistula, diagnosis of, 272.273
Jadassohn-Tieche nevus, 1000 Jaundice
cholestatic, infantile. See Infantile cholestatic jaundice.
in infantile hypertrophic pyloric stenosis, 316, 318
"physiologic," in preterm baby, 3
Jejunal conduit, joining renal pelves, 708, 708 Jejunoplasty, 342
Jejunum as conduit joining renal pelves, 708, 708 atresia of, 332, 332(t), 333
anomalies associated with, 336-337 "apple peel" deformity in, 332 "Christmas tree" deformity in, 332, 333
diagnosis of, radiology in, 339, 339, 341 embryology of, 334-335
management of, 342-343 enteroplasty in, 342
Mikulicz exteriorization in, 343 postoperative parenteral nutrition in, 343-344
results of, 344, 344(t) meconium ileus in, 337 pathogenesis of, 334-335 pathology of, 334-335
polyhydramnios in, 337 types of, 332, 333
villus hypertrophy in, 334-335, 334-335 weight pattern in babies with, 336, 336 stenosis of, 332, 332(t)
trauma to, 145
Jeune's disease, 180-181, 181 Joint(s), sacroiliac, trauma to, 152 Jugular vein
in administering central parenteral nutrition,
36,36 percutaneous catheterization of, 62
Junction, ureteropelvic. See Ureteropelvic junction.
Junctional nevus, 999-1000
"Juvenile adenocarcinoma," of breast, 1086 Juvenile hemangiomas, 1055-1058
Juvenile hypertrophy of breast, 1081-1082, 1081 Juvenile melanoma of Spitz, 1001
Juvenile myasthenia gravis, surgical treatmEnt of, 247-249
Juvenile polyp(s), 481-484, 484 and rectal bleeding, 482-483
Juvenile polyp(s) (Continued) autoamputation of, 482-483 benignity of, 481
diagnosis of, 483
barium enema in, 483, 483 histology of, 481, 482, 483, 484 incidence of, 481, 481 multiple, 482, 484-485
prolapse of, through anus, 482, 482 treatment of, 483-484 colonoscopyin,483,484 colotomy in, 483-484
sigmoidoscopy in, 483, 484
Juvenile polyposis, 482, 484-485
Kartagener's syndrome, bronchiectasis in, 209, 210
Karyotyping, 858, 860 indications for, 77-78, 78(t)
in patients with mixed gonadal dysgenesis, 879, 879(t)
Kasabach-Merritt syndrome, 72
Kasai hypothesis of therapy for biliary atresia, 509-510
Kasai procedure
in therapy for biliary atresia, 515, 516-517 clinical outcome of, 519
modifications of, 515, 518
Ketamine hydrochloride, as anesthetic agent, 45 Kidney(s)
agenesis of, 609 bilateral, 609-610 unilateral, 610, 610, 611
anomalies of, developmental, 609-611 positional, 611-614
aplasia of, vs. pelvic kidney, 612, 612 Ask-Upmark, 620
autotransplantation of, 712-713
in therapy for renovascular hypertension, 834
cadaveric, in transplantation, 843, 843(t) carcinoma of, 1018-1019
concentrating ability of, 6 cyst(s) of, 614-619
as dysplastic condition, 618. See also Multicystic kidney.
in adult polycystic kidney disease, 616
in infantile polycystic kidney disease, 615, 615. See also Infantile polycystic kidney disease.
multilocular, 616-617 solitary, 617 unilocular (simple), 617
developmental anomalies of, 609-611 "disc," 612
"doll's," 620
dysmorphism of, in prune-belly syndrome, 805,805
dysplasia of, 617-618. See also Multicystic kidney.
with lower urinary tract obstruction, 619-620
ectopia of, 611-612, 611, 612 crossed,6l2-613,613 diagnosis of, retrograde pyelography in, 613, 613
embryology of, 609
end-stage disease of, incidence of, 838 management of, 839, 840(t), 843-851iNoEx 1141
Kidney(s) (Continued)
end-stage disease of, transplantation for, 838-839, 839(t), 845-851
evaluation of functioning of, blood urea nitrogen in, 651
in renovascular hypertension, 832 serum creatinine levels in, 651
growth of, charting of, in management of vesicoureteral reflux, 654, 654 horseshoe,6l3-614,613
diagnosis of, intravenous pyelography in, 613,613
hyperplasia of, 620 hypoplasia of, 620 infections of, 654, 656-657
in prune-belly syndrome, 805-806, 805 in renovascular hypertension. See Renovascular hypertension.
intrathoracic, 612
jejunal conduit joining pelves of, 708, 708 "lump," 612
"miniature," 620
mobilization of, to obtain ureteral length, 708, 712, 712
psoas hitch as adjunct to, 712, 713 multicystic, 618-619. See also Multicystic kidney.
pelvic,6l1-612,611,612 diagnosis of, excretory urography in, 612, 612
vs. renal aplasia, 612, 612 polycystic disease of, adult, 616 infantile, 614-616. See also Infantile
polycystic kidney disease. positional anomalies of, 611-614 removal of, in therapy for renovascular
hypertension, 833
salvage of, after trauma, 150-151 supernumerary, 611 transplantation of. See Kidney
transplantation. trauma to, 149-150
and hypertension, 150, 151 complications of, 150, 151 Gerota's fascia in, 150 salvage rate in, 150-151
tumor of, Wilms'. See Wilms' tumor. Kidney transplantation, 838
acute tubular necrosis after, 847 cadaveric kidney in, 843, 843(t) complications of, 852-854
diet after, 847
diuresis after, 846-847 donor selection in, 839-843 informed consent in, 840
growth after, 851-852, 852 hemodialysis prior to, 844-845, 844 vascularaccessin,844-845,844
histocompatibility typing in, 840(t)-842(t), 841
hypertension after, 853 immunosuppressive therapy after, 847-850, 849(t), 850(t)
antihuman thymocyte serum (ATS) in, 848-849, 849(t), 849, 850 azathioprine in, 847, 848, 849(t)
corticosteroids in, 848-850, 849(t), 850(t) prednisone in, 847, 848, 849(t), 850(t)
infection after, 852-853
operative procedurein,845-846,845 postoperative management in, 846-851
Kidney transplantation (Continued) postoperative monitoring in, 850-851, 851
technetium scanning in, 851, 851 preoperative requirements in, 843-845 preparation for, 839, 844-845, 844
recurrent disease after, 854
rejection in, 852, 852(t), 853-854 methylprednisolone for, 852, 852(t) results of, 850, 851
cell-mediated immunity and, 842(t), 843 survival rate after, 850, 851
tumor development after, 853 Kingsnake,l04
Kininogen, high molecular weight, deficiency of, 66(t)
Klinefelter's syndrome, 76 Kock ileostomy, 469, 469
Labioscrotum, reduction of, 863, 868
Labium (labia), trauma to, straddle injury and, 153
Lactic acid, production of, in shock, 14
Ladd's bands, duodenal obstruction by, 348(t), 353-354
Laparoscopy, in diagnosis of appendicitis, 502 Laparotomy
second look, timing of, in non-Hodgkin's lymphoma, 982

staging, in evaluation of Hodgkin's disease, 976-977
Laryngeal stridor, congenital, 184 Laryngitis, 187
Laryngoscopy, in removal of foreign bodies, 116 Laryngotracheoesophageal cleft, 280-281 Larynx
endoscopy of, in removal of foreign bodies, 116
foreign bodies in, 116 inflammation of, 187 papillomas of, 186-187 rhabdomyosarcoma of, 989
Lavage, peritoneal, in trauma patient, 140-141 Layered closure
primary, in treatment of gastroschisis, 579 in treatment of omphalocele, 579, 580 Leak, anastomotic,
esophageal, 279
Left colon, in esophageal replacement, 286 Leukemia, infiltrating intestine, vs. lymphoid polyps, 486
Levator ani muscle, 419-420, 420 "Leveling colostomy," 395 Leydig cell tumor(s), 1010 Ligament(s)
gastrosplenic, accessory spleen at, 565, 566(t)
splenocolic, accessory spleen at, 565, 566(t) splenorenal, accessory spleen at, 565-566, 566(t)
Ligament of Treitz, as problem site, in passage of foreign bodies, 120
Linoleic acid, 28
Lip, cleft, repair of, and airway obstruction, 51 Lipomeningocele, vs. sacrococcygeal teratoma, 964
Liposarcoma, 1034-1035 Lithiasis. See Cholelithiasis. Liver
abscess of, amebiasis and, 525-527 pyogenic, 527
adenoma of, 953(t), 9581142 iN~Ex
Liver (Continued) Lobectomy, hepatic, in treatment of liver
nign tumors, 956 artery of, occlusion of, in treatment of be
liver tumors, 958 blastoma of, 953, 953(t)
anomalies associated with, 953(t) treatment of, results of, 957, 957(t) carcinoma of, 953, 953(t)
anomalies associated with, 953(t) treatment of, results of, 957, 957(t) cavernous hemangioma of, 954
cyst(s) of, 953(t), 958
fibrosis of, as complication of therapy for hiliary atresia, 520
functioning of, abnormal, as complicati total parenteral nutrition, 41 hamartoma of, 953(t), 958
hemangioendothelioma of, 954 treatment of, 958
hemangioma of, 953(t), 954, 1059
on of
cavernous,954 treatment of, 958 lymphangioma of, 1051 resection of, in treatment of tumors, 956-957,
957(t), 958 rhabdomyosarcoma of, 953-954 sarcoma of, 953, 953(t) toxic effects of halothane on, 52
transplantation of. See Liver transplantation. trauma to, 143 and hematobilia, 145 birth injury and, 138-139
classification of, 143
diagnosis of, arteriography in, 143 radiographic evaluation in, 143
surgical
management of, 143-144 complications of, 144-145 postoperative care in, 144 tumors of, 953 benign,
953(t), 954
treatment of, 958 clinical aspects of, 954-956
diagnosis of, 954-955
celiac
arteriography in, 954, 955-956, 955
malignant, 953-954, 953(t)
treatment of, 956-958,
957(t) pathology of, 953-954
symptoms of, 954
treatment of, chemotherapy in, 957 hepatic
artery occlusion in, 958 lobectomy in, 956
radiotherapy in, 957
resection in, 956-957,
957(t), 958 types of, 953-954, 953(t) Liver transplantation, 543 auxiliary, 543-544, 544 paravertebral
gutter in, 543, 544 results of, 543 retention of native liver in, 543-544
usefulness of, 544 bile
duct reconstruction in, 547-548, 547 clinical aspects of, 545-548 immunologic aspects of, 545
indicationsfor,545-546 in therapy for biliary atresia, 515 orthotopic, 544, 544 indications for, 545-546,
545(t) results of, 545(t), 549, 549(t) postoperative management in, 548 rejection in, 545, 548 results of,
543, 545(t), 549, 549(t) surgical considerations in, 546-548 Lobar emphysema, 201-204, 203
Loop cutaneous ureterostomy, 671, 672 Loop nephrostomy, 670, 670
Lower celosomia, 573-574, 573 treatment of, results of, 587(t)
Lower esophageal sphincter, 293-294, 294(t) Loxosceles reclusa bite(s), 109-110
Lumbar hernia, 593, 593

Lumbar puncture needle(s), breaking of, in spine, 122
"Lump" kidney, 612 Lung(s)
abnormalities of, in pectus excavatum, 166, 167(t), 167, 168
abscess of, 214-216
adenomatoid malformation of, cystic, congenital, 200-201, 200-201 agenesis of, 196-197, 197
diagnosis of, 197 prognosis in, 197
vs. dextrocardia, 197 biopsy of, open, 222-223, 223
results of, 222(t), 223
congenital cystic adenomatoid malformation of,200-201,200-201 congenital cystic disease of, 198-200,
198, 199
cystic adenomatoid malformation of, congenital, 200-201,200-201 cystic fibrosis involving, 216-217
cyst(s) of, acquired, vs. congenital cyst, 199, 199, 213
vs. posterolateral diaphragmatic hernia, 231
adenomatoid,200-201,200-201 congenital, 198-200, 198, 199 secondary infection of, 199
vs. acquired cyst, 199, 199, 213
vs. posterolateral diaphragmatic hernia, 231
embryology of, 196
function of, blood gases as indication of, 59 hemosiderosis of, idiopathic, 222
lobe(s) of, agenesis of, 197-198
cyctic adenomatoid malformation of, congenital,200-201,200-201 lymphangiectasia of, 1050-1051
lymphangioma of, 1051
malformations of, 196-206
cystic adenomatoid, congenital, 200-201, 200-201
in prune-belly syndrome, 809 metastases to, from sarcoma, 1035 treatment of, 1035-1037, 1036
from Wilms' tumor, 933, 933 mycobacteriosis of, 218
of preterm baby, 3
of small for gestational age infant, 4 sequestration of, 204
anomalies associated with, 205 clinical presentation of, 205 diagnosis of, 205-206
diaphragmatic hernia associated with, 205 etiology of, 204
extralobar, 204
arterial supply to, 204 venous drainage from, 205 incidence of, 204
intralobar, 204
arterial supply to, 204 venous drainage from, 205INDEX 1143
Lung(s) (Continued)
sequestration of, pathology of, 205 treatment of, 206 vascularsupplyin,204-205 shock,l56,158
management of, 156-157 tuberculosis of, 217-218 Lymphadenectomy, in treatment of
rhabdomyosarcoma, 991, 992, 1011, 1011 Lymphadenitis, 1074
acute,l074-1075 chronic,l075 mycobacterial,l075-1076 suppurative, 1074-1075 tuberculous,l075-1076
Lymphangiectasia ofintestine,l050 oflungs,l050-1051
Lymphangiography in evaluation of abdominal masses, 919, 919
in evaluation of Hodgkin's disease, 975 Lymphangioma, 1044-1045 characteristics of, 1045, 1045
of bone, 1051 of liver, 1051 oflungs,l051
of mesentery,l048-1049,1048
of parotid gland, 1047-1048, 1047
of salivary glands, 1031, 1047-1048, 1047 of solid organs, 1051

ofspleen,l051 oftongue,l046-1047,1046 and deformation of mandible, 1046, 1047 of trachea, 1051
sites of occurrence of, 1044(t), 1045 treatment of, 1045-1046
in profoundly affected patients, 1046, 1046 Lymphatic system, malformations of. See specific lesions, e.g.,
Cystic hygroma, Lymphangioma, and Lymphedema. Lymphedema, 1051
congenital, 1051, 1052
anomalies associated with, 1052 hereditary, 1051 pathophysiology of, 1052
sites of occurrence of, 1052, 1052, 1053 treatment of, 1053
vs. lymphedema praecox, 1052 primary, 1051-1054 secondary,l054
Lymphedema praecox, 1053, 1053 pathophysiology of, 1052 treatment of, 1053-1054
vs. congenital lymphedema, 1052 Lymphedema tarda, 1051
Lymph node(s) ofneck,l074 biopsy of, indications for, 1077 in cat-scratch disease, 1076-1077 inflammation
of. See Lymphadenitis.
Lymphoid interstitial pneumonia, 222 Lymphoid polyp(s), 485-486, 485, 486 incidence of, 481, 481, 485
umbilication in, 485, 486
vs. intestinal lymphosarcoma, 486
vs. leukemic infiltration of intestine, 486
Lymphoma Burkitt's, 978
malignant. See Hodgkin's disease and Non-Hodgkin's lymphoma.
Lymphoma (Continued) non-Hodgkin's. See Non-Hodgkin's lymphoma.
of mediastinum, 245
Malabsorption syndrome, necrotizing enterocolitis and, 386
Male pseudohermaphroditism, 868 choice of gender in, 873
defective biosynthesis of testosterone and, 864,869,869
etiology of, 859, 864, 868-869, 869, 873 incomplete, familial, 872, 873 Reifenstein's syndrome as, 872, 873
testicular feminization syndrome as, 870-871, 873
treatment of, 888
types of, differentiation of, 887, 887(t) Malnutrition, serum albumin levels in detection of, 30
Malrotation, of intestine, 346-355, 348(t). See also specific abnormalities, e.g., Nonrotation and Reverse
rotation.
Maltreatment syndrome. See Child abuse. Mammoplasty, augmentation, 1083, 1083 Mandible,
deformation of, lymphangioma and, 1046,1047
Manometry anorectal, in screening for Hirschsprung's disease,394,423,426
esophageal, in diagnosis of gastroesophageal reflux, 305
Marfan's disease, pectus excavatum in, 163 Martin operation, in treatment of Hirschsprung's disease, 396398, 396, 397
Masculinization, of female. See Female pseudohermaphroditism. McBurney's point, 498
tenderness at, in appendicitis, 501
McIndoe technique, of vaginal reconstruction, 898,899
Measles, vs. appendicitis, 503
Meatotomy, in treatment of hypospadias, 776, 778
Meatus urethral, retraction of, as complication of hypospadias treatment, 786
site of, in hypospadias, 770, 770(t). See also Hypospadias.
stenosis of, 768-769
as complication of hypospadias treatment, 786
ulceration of, 769
Meckel's diverticulitis, 457, 460, 461 vs. appendicitis, 502-503 Meckel's diverticulum, 457, 458-459
anatomy of, 457
and intestinal obstruction, 457, 461 andintussusception,461 as incidental finding at celiotomy, 457, 462-463
asymptomatic, 457, 458
clinical presentation in, 457, 461 diagnosis of, 461
technetium scanning in, 461-462, 462 embryology of, 457
excision of, 462
gastric mucosa in, 457, 458 giant, 460, 461 hemorrhage in, 457, 4611144 iN~Ex
Meckel's diverticulum (ContinuedJ incidence of, 457
incidental, therapy for, 462-463 inflammation of, 457, 460, 461 vs. appendicitis, 502-503
pancreatic mucosa in, 457, 458 pathology of, 457
risk of disease from, 457 symptomatic, therapy for, 462, 463 symptoms of, 457, 461
therapy for, 462-463 results of, 463
umbilical abnormalities associated with, 457, 461
Meconium ileus, 356
clinical aspects of, 358-359 complicated, 357, 357, 358(t), 359 diagnosis of, 359-360
incidence of, 356
in patients with jejunoileal atresia, 337 microcolon in, 357, 359
pathogenesis of, 356 pathology of, 356-358
recognition of, as disease entity, history of, 356
simple, 356-357, 357, 358
therapy for, nonoperative, 360-361 Gastrografin enema treatment in, 360, 360 operative, 361-363
complications of, 363-364 enterostomy in, 361 "chimney" 361-362, 362
Roux-en-Y anastomosis in, 361-362, 362
enterotomy and irrigation in, 361 Mikulicz resection in, 361 primary anastomosis in, 361
postoperative care in, 363 results of, 363-364, 363(t), 364(t) Meconium ileus equivalent, 364-365, 364
Meconium peritonitis, 367-368
calcification in, 368, 368, 369 causes of, 367, 367(t)
clinical aspects of, 369 cystic, 368
fibroadhesive, 368 generalized, 368 pathology of, 368-369 roentgenographic findings in, 368, 369 therapy
for, 369-370
results of, 369-370, 369(t) Meconium plug syndrome, 365 clinical aspects of, 365-367 differential
diagnosis of, 366-367 incidence of, 365
in cystic fibrosis, 367 passage of plug in, 366, 366 pathogenesis of, 365 roentgenographic findings in, 365,
366 therapy for, 367
results of, 367
vs. Hirschsprung's disease, 366-367, 394 Mediastinitis, perforation of neck and, 259 Mediastinum
anatomy of, 242 anterior, 242, 242 tumors of, 247
cystic hygroma extending into, 249-250, 250 cyst(s) in, 447-448
bronchogenic, 246, 246 esophageal, 245, 247 thymic, 247
Mediastinum (Continued) dermoids of, 249 ganglioneuroblastomas of, 243-244, 243 Hodgkin's disease of,
245
inflammation of, perforation of neck and, 259 lymphomas of, 245
lymphosarcoma of, 245 meningocele as mass in, 244 middle, 242
tumors of, 244-245 neuroblastomas of, 243-244, 945, 946 neurofibromas of, plexiform, 244 pancreatic
pseudocyst extending into, 556-557
paravertebral sulcus of, 242, 242 tumors of, 243-244, 243 perforation of, 259
plexiform neurofibromas of, 244 teratomas of, 249, 249
and cardiac tamponade, 969, 970 diagnosis of, 969, 970
therapy for, 969-970 thymomas of, 247
thymus enlargement in, 247 tumors of, 189, 241-242 classification of, 242 "dumbbell," 244 incidence of,
241
in children, vs. incidence in general population, 241
neurogenic, 243-244, 243 patient survival in, 242(t) factors affecting, 241
presenting symptoms in, 241-242 Medullary carcinoma
of thyroid gland, 1092, 1094-1095, 1096-1097 in multiple endocrine adenomatosis, types II and III, 1095,
1095
Mefanide, as protection against burn wound sepsis, 130
Megacolon aganglionic. See Hirschsprung's disease. chronic constipation and, 427
toxic, ulcerative colitis and, 467-468 Megalourethra, 768
fusiform, 808
in prune-belly syndrome, 808 scaphoid, 808
Megaureter, 693-694 causes of, 694
correction of, complications of, 703
lower ureter repair in, 694, 694-701, 701 results of, 703, 703, 704
upper ureter repair in, 701-703, 702 obstructive, 693-694, 694
refluxing, 693-694, 694 types of, 693, 694 Meigs' syndrome, 1017 Meissner's plexus, 389, 421 Melanoma
juvenile, 1001 malignant, 1004-1005 classification of, 1004(t) staging of, 1004
treatment of, chemotherapy in, 1005 dimethyltriazenoimidazole carboxamide (DTIC)in,1005
immunotherapy in, 1005 surgical procedures in, 1005
vs. spindle-epithelioid cell nevus, 1001 vs. Spitz nevus, 1001
Melanotic clear cell sarcoma, 1034nv~Ex 1145
Melanotic spotting, in Peutz-Jeghers syndrome, 487, 487
Melena, 433 Membrane(s) amniotic, in management of burn wounds, 131
anal, imperforate, 402, 403 evaluation of, 403, 406 opening of, 409, 409 therapy for, results of, 416(t)
capillary, damage to, in shock, 17 Meninges, rhabdomyosarcoma affecting, 989-990
Meningocele,thoracic,244 Mesenchymal dysplasia. See Prune-belly syndrome.
Mesenchymoma, malignant, 1034-1035 Mesenteric-lymphangiectatic cyst, mimicking ascites, 920
Mesentery adenitis of, vs. appendicitis, 502 cysts of, 1048-1049, 1048
mimicking ascites, 920 lymphangioma of, 1048-1049, 1048
of cecum, incomplete attachment of, 348(t), 354,354
Mesoblastic nephroma, vs. Wilms' tumor, 935 Mesocaval shunt(s), 536, 537, 540
Mesh grafts, in management of burn wounds, 132, 132
Metabolic acidosis
as complication of total parenteral nuttition,
40 buffer solutions for correction of, 59 primary, 58
Metabolic alkalosis
buffer solutions for correction of, 59
primary, 58 Metabolic rate
basal, of neonate, 2
of small for gestational age infant, 4
in estimating fluid and electrolyte needs, 6 Methimazole, in treatment of Graves' disease; 1098
Methylprednisolone for rejection, in kidney transplantation, 852, 852 (t)
in treatment of shock, 17
Metocurine iodide, as anesthetic agent, 45 Microcirculation, changes in, from sepsis, 12 Microcolon, in
meconium ileus, 357, 359 Micrognathia, 181, 184
Microperforate hymen, 895
Micturition cystourethrography. See Voiding cvstourethrography.
Middle celosomia, 572-573 treatment of, results of, 587(t) Middle ear, rhabdomyosarcoma of, 989 Midgut
volvulus, 349, 350
and bilious vomiting, 349 as surgical emergency, 349 diagt~osis of, 349
treatment of, operative, 350-351, 350-351 stabilization in, 350-351, 351 preliminary measures in, 349
Mikulicz exteriorization, in management of intestinal atresia, 343
Mikulicz resection, in treatment of meconium ileus, 361
Milk, breast, protection offered by, against necrotizing enterocolitis, 376
Milroy's disease, 1051 "Miniature kidney," 620
Mitral valve prolapse, 165-166, 166
Mixed gonadal dysgenesis, 879, 880-881, 882 adenocarcinoma of endometrium in, 886-887, 886
asymmetric gonads in, 884-885 dysgerminoma in, 881, 885, 885, 886 etiology of, 859, 882-883, 882
gonadoblastoma in, 885, 885, 886 histologic findings in, 883
H-Y antigen deficiency and, 882, 882
H-Y antigen receptor deficiency and, 882, 882 karyotypes in, 879, 879(t)
laterality in, 884-885
morphology of genitalia in, 879, 879(t) mosaicism and, 882
neoplastic transformation in, 885-887, 885, 886
seminoma in, 885
streak gonad in, 879, 880, 883, 884, 884 removal of, 888
testicular dysfunction in, pathogenesis of, 882 treatment of, 888
45,XI46,XY mosaic karyotype in, 860 Molestation, 153, 905-906, 906(t). See also Child abuse.
MOPP, in treatment of Hodgkin's disease, 977 Morgagnian hydatid, torsion of, 826-827, 826 Morphine, use
of, in preoperative sedation, 46, 46(t)
Mosaicism, 76-77
Movement disorders, gastroesophageal reflux and, 297
Mucoviscidosis. See Cystic Fibrosis. Multicystic kidney, 618-619
clinical features of, 618
pathology of, 618, 619 prognosis in, 618-619 radiopaque rings in, 618, 618 treatment of, 619
Multidisciplinary team approach, to cancer patient and family, 926-927 Multifactorial inheritance, 82
Multiple endocrine adenomatosis
type II, medullary carcinoma of thyroid gland in, 1095
pheochromocytoma in, 1026 type III, medullary carcinoma of thyroid gland in, 1095, 1095 Murmur in
pectus carinatum, 174 in pectus excavatum, 165 Muscle(s) abdominal, absence of. See Prune-belly
syndrome.
coccygeus,4l9-420,420 esophageal, 257 iliococcygeus, 419-420, 420 levator ani, 419-420, 420 pelvic canal,
419-420, 420 pharyngeal, 257 pubococcygeus,4l9-420,420 puborectalis, 419-420, 420 rectus, displacement
of, 592 sphincter, of anal canal, 420-421
of anorectum, nerve pathways for, 421-423, 422. See also Continence. sternocleidomastoid, fibrous
"tumor" of, in
torticollis, 1071, 1072, 1072, 1073 Muscle relaxants, in pediatric anesthesia, 451146 iN~Ex
Myasthenia gravis, surgical treatment of, 247-249
Mycobacterial infection, atypical, 218 Mycobacterial lymphadenitis, 1075-1076 Mycobacteriosis,
pulmonary, 218 Myectomy, anorectal, in treatment of
Hirschsprung's disease, 395-396 Myelomeningocele, vs. sacrococcygeal teratoma, 964, 965
Myoblastoma, granular cell, of breast, 1085 Myocardial dysfunction, in septic shock, 13
Nasogastric drainage, in treatment of burn victim, 125-126
Nasogastric intubation, in evaluation of gastrointestinal bleeding, 435 Nasopharynx, rhabdomyosarcoma of,
989 Nasotracheal intubation, 193
in burn victim, 124, 124
National Wilms' Tumor Study-Group, 937 investigating dactinomycin (actinomycin D) in treatment of
Wilms' tumor, 938, 938(t)
investigating prognosis in Wilms' tumor, 938-939, 939(t)
investigating radiotherapy in treatment of Wilms' tumor, 937-938, 937(t) investigating vincristine in
treatment of
Wilms' tumor, 938, 938(t)
Nebulization, humidification provided by, 60 Neck
crepitus in, 259
cystic hygroma of, 1042, 1043 duplications in, cystic, 447 emphysema in, 259
lymph nodes of, 1074
biopsy of, indications for, 1077 in cat-scratch disease, 1076-1077 inflammation of. See Lymphadenitis.
of bladder. See Bladder neck. perforation of, and mediastinitis, 259 rhabdomyosarcoma of, 988-989
teratoma of, 970-971, 970
Necrotizing enterocolitis, 374 acidosis in, 378
and intestinal stricture, 386
and malabsorption syndrome, 386 and short-gut syndrome, 386 ascites in, 381
bacteriology of, 376-377 clinical aspects of, 377
diagnosis of, acid-base status in, 378 carbohydrate malabsorption in, 378 isotopic evaluation in, 378
laboratory studies in, 377-378 radiologic, 378, 379(t), 379-383, 384
histology of, 374-375
intestinal loops in, radiographic appearance of, 380, 381 pathogenesis of, 375-376 pathology of, 374-375,
374, 375(t) pathophysiology of, 375-376 pneumatosis in, 379, 380 pneumoperitoneum in, 382, 383
protection against, breast milk in, 376 recognition of, as disease entity, history of, 374
sequelae of, 386 signs of, 377(t)
stress factors in, 375(t)
Necrotizing enterocolitis (Continued) symptoms of, 377(t)
therapy for, 384
surgical management in, 385-386 indications for, 384-385 results of, 386
Needle as foreign object in soft tissues, 121-122 hypodermlc, breaking of, in subcutaneous tissue, 122
lumbar puncture, breaking of, in spine, 122 Neglect, of child, 95. See also Child abuse. Neonatal
cholestasis, 510(t)
Neonatal hepatitis etiology of, 510-511
infantile cholestatic jaundice in, 512-513 vs. biliary atresia, 511-513, 512(t) Neonatal hypertrophy of
breast, 1080, 1081 Neonatal staining, 1055
Nephrectomy, in therapy for renovascular hypertension, 833
Nephroblastoma. See Wilms' tumor. Nephroma, mesoblastic, vs. Wilms' tumor, 935 Nephrostomy
in urinary diversion, 667, 669-670, 669, 670 loop,670,670

open,669,669 percutaneous, 669-670 Nerve(s)
accessory, spinal, cystic hygroma involving, 1043,1043
phrenic, distribution of, within diaphragm, 237
Nesidioblastosis, 558-559
vs. islet cell adenoma, 558-559 Neurilemoma(s), 243 Neuroblastoma, 944
and "dancing eye" syndrome, 945 and elevated VMA levels, 947, 950 appearance of, on plain radiography,
909, 911, 912
clinical presentation in, 945, 946 diagnosis of, 946-948
intravenous pyelographyin,946,947 etiology of, 944
incidence of, 944 maturation of, 944 metastasis of, 946, 949, 950
of mediastinum, 243-244, 945, 946 pathology of, 944
prognosisin,945,951-952,951,952 related to patient's age, 945 pseudocapsule of, 948-949, 948 sites of, 944945
spread of, 946, 949, 950 staging of, 945 survivalratein,944,945,951-952,951,952 therapyfor,948-952
nonsurgicalproceduresin,950-951 surgicalproceduresin,948-949,948,949 Neuroenteric canal, residua of,
446 Neuroenteric cyst(s), 448, 448 Neurofibroma(s), plexiform, of mediastinum, 244
Neurofibrosarcoma, 1034 Neurogenic bladder classification of, 662-663 diagnosis of, 662 etiology of, 661662 failing to empty, 663 failing to store urine, 663iN~Ex 1147
Neurogenic bladder (Continued) occult, 661-662
intermittent catheterization in, 665-666 neuropharmacologic agents in, 663-664, 664(t), 664, 665(t)
urinary diversion in. See Urinary diversion Neurogenic vesical dysfunction. See Neurogenic bladder.
Neurotoxic venom, of coral snakes, 104, 105 Nevus (nevi), 999
acquired, 999-1001, 999(t) treatment of, 1002, 1004 balloon cell, 1000
blue, 1000 removal of, 1004 cellular blue, 1000 classification of, 999(t) clinical features of, 999-1001
compound, 1000
congenital, 999, 999(t) treatment of, 1002, 1003 garment, 999
giant,999,1000,1001-1002,1002 halo, 1000-1001
histology of, 999-1001 intradermal, 1000 Jadassohn-Tieche,l000 junctional, 999-1000 pigmented, 999
giant, 999, 1000, 1001-1002, 1002 treatment of, 1001-1004
shave excision of, 1004 spindle-epithelioid cell, 1001 removal of, 1004
vs. malignant melanoma, 1001 Spitz, 1001
removal of, 1004
vs. malignant melanoma, 1001 Nipple(s), supernumerary, 1083-1084, 1083 Nissen fundoplication, 308309, 310 Nitrofurantoin, in prevention of urinary tract infections, 653
Nitrogen balance, of patient, during total parenteral feeding, 39, 39
Nitrous oxide, use of, in anesthesia, 45 Nocardiosis, 218
Node(s), lymph. See Lymph node(s]. Noncompliance, by cancer patient, 924, 924 Nondisjunction, 76
Non-Hodgkin's lj~mphoma, 973, 978 and intussusception, 979, 981
cell surface markers in identification of, 980 clinical presentation in, 978-979
diagnosis of, 979 evaluation of, 979-980 biochemical tests in, 980 clinical findings in, 980 gallium
scanning in, 980 hematologic examination in, 980 radiographic findings in, 980 incidence of, 978
pathology of, 978 staging of, 978
treatment of, and timing of second look laparotomy, 982
chemotherapy in, 981-982 radiotherapy in, 982 results of, 982
surgical procedures in, 981 Nonketotic coma, hyperosmolar, as complication of elemental diets, 31
Nonpoisonous snake(s), pupils in, vs. pupils in poisonous snakes, 104
Nonrotation of colon, 349, 353
of duodenum, 348(t), 351-352, 351
of intestine, 346, 348(t), 349-351, 349
and midgut volvulus. See Midgut volvulus. anomalies associated with, 349
as surgical emergency, 349 diagnosis of, 349
treatment of, operative, 350-351 preliminary measures in, 349 Notching, of esophagus, aberrant right
subclavian artery and, 191 Nutrition
as management factor, in burn victims, 129 intravenous. See Total parenteral nutrition (TPN).
of pediatric surgical patient, 27-43 carbohydrate requirement in, 28 elemental diets in, 31-33, 32(t) fat
requirement in, 28
kilocalorie requirement in, 27-28, 27(t) mineral requirement in, 28, 29(t) postoperative oral feedings in, 30,
31(t) protein requirement in, 27(t), 28
total parental nutrition in. See Total parenteral nutrition (TPN). vitamin requirement in, 28-29, 29(t) water
requirement in, 27, 27(t)
with short-gut syndrome, 42-43
total parenteral. See Total parenteral nutrition (TPN).
Oblique pectus carinatum, 174 Occupational therapy, in treatment of burn victims, 132, 133
"Omega" shape, of epiglottis, in congenital laryngeal stridor, 184
Omentum, greater, accessory spleen at, 565, 566(t)
Omphalitis, and extrahepatic portal hypertension, 533
Omphalocele, 572 anatomy of, 572
anomalies associated with, 575, 576(t), 577 embryology of, 572
in Beckwith-Wiedemann syndrome, 575 incidence of, 577
in exstrophy of cloaca, 573-574, 573 in lower celosomia, 573-574, 573
in middle celosomia, 572-573
in pentalogy of Cantrell, 573, 573 in upper celosomia, 573, 573 rupture of, 574, 574
treatment of, 584, 588 history of, 572
management decisions in, 577-578 nonoperative, 578-579, 578 preliminary management in, 577 result of,
584, 587(t)
secondary closure of ventral hernias in, 582, 584,585-586
surgical, 579
primary layered closure in, 579, 580 staged Silastic pouch (silo) closure in, 579-582, 582, 583, 584
staged skin fiap closure in, 579, 581 vs. gastroschisis, 574-575, 576(t) Omphalopagus, 1105, 11061148
INDEX
Oncotic pressure, colloid, in shock, 16 Opacification, total body, 912, 914 Open chest wounds, 159
Open cystostomy, 667, 668 Open lung biopsy, 222-223, 223 results of, 222(t), 223
Open nephrostomy, 669, 669
Orbit, rhabdomyosarcoma of, 989, 990 Orchiectomy, 822
in treatment of testicular tumors, 1008 Orchiopexy,819,820-821,821-822 in repair of indirect inguinal
hernia, 600
Orotrachealintubation,l92-193 in burn victim, 124
Osmotic diuresis, as complication of total parenteral nutrition, 41
Osteogenic sarcoma metastasis of, to lungs, 1035 treatment of, 1035-1037, 1036 Osteotomy
in treatment of bladder exstrophy, 741, 742 in treatment of pectus carinatum, 176
in treatment of pectus excavatum, 1 70-171 Ovary (ovaries)

androblastoma of, 1017-1018 carcinoma of, embryonal, 1016 choriocarcinoma of, 1016
cystadenocarcinoma of, 1018 cystadenoma of, 1018, 1018 cysts of, 1014, 1014 dysgerminoma of, 10151016 embryonal carcinoma of, 1016 endodermal sinus tumor of, 1016 germ cell tumors of, 1016-1017
granulosa-theca cell tumors of, 1017, I017 teratomas of, 1012, 1014-1015
tumors of, 1012 diagnosis of, 1013 endodermal sinus, 1016 germ cell, 1016-1017 granulosa-theca cell,
1017, I027 signs of, 1012-1013
staging of, 1015(t) symptoms of, 1012-1013 types of, 1013-1018, 1013(t) Overfeeding, 318
Oxybutynin chloride, in improvement of urine storage, 664(t)
Oxygen monitoring of, in anesthesia, 47 transcutaneous, measurement of, 10
monitoring of, during shock, 14 Oxygenation
improvement of, by positive end-expiratory pressure, 61
of arterial blood, evaluation and monitoring of, 8-10
Oxygen-hemoglobin dissociation curve, 56 Oxygen saturation, measurement of, 9 Oxygen sensor, Huch, 10
Oxygen therapy, 56
Oxygen toxicity, as complication of respiratory therapy, 63
Pad sign, 916, 918
Palate, cleft, repair of, and airway obstruction, 51
Pancreas accessory spleen at, 565, 566(t)
Pancreas(Continued) adenocarcinoma of, 557 adenoma of, islet cell, 558
vs. nesidioblastosis, 558-559 adenomyoma of, simulating pyloric stenosis, 318
anatomy of, 551 anriular, 551, 553
anomalies associated with, 551 "double bubble" sign of, 553 treatment of, 553
anomalies of, congenital, 551, 553 carcinoma of, 557, 1030-1031 congenital anomalies of, 551, 553 cystic
fibrosis of. See Cystic fibrosis. cysts of, 556
development of, 551, 552 ectopia of, 551, 553 enzymes in, 553
inflammation of. See Pancreotitis. in pylorus, 551, 553
simulating pyloric stenosis, 318 nesidioblastosis in, 558-559
vs. islet cell adenoma, 558-559 pseudocysts of, 148, 556, 557 diagnosis of, 148, 148 pancreatic trauma and,
147 treatment of, 148-149
with mediastinal extension, 556-557 tail of, accessory spleen at, 565, 566(t) transplantation of, 560-561
trauma to, 147 diagnosis of, 147-148 infiicted by adult, 147 treatment of, 148
tumors of, 557-558 islet cell, 557-558 Pancreatitis
acute, 553-554 diagnosis of, 554
ratio of amylase clearance to creatinine clearance in, 554
treatment of, 554-555 chronic;555-556 hyperamylasemia in, 554 mortality rate in, 553
serum amylase levels in, 554 traumatic, 147
diagnosis of, 147-148 treatment of, 148 Pancreatography, retrograde, 555, 556 Pancuronium bromide, as
anesthetic agent, 45 Papillary carcinoma, of thyroid gland, 1092, 1093
Papilloma(s) intraductal, 1084-1085 of breast, 1084-1085 of glottis, 186-187
of larynx, 186-187
Paraduodenal hernias, 352-353, 354-355 Parahemophilia, 66(t)
Paralysis, of diaphragm, 237-238
Paralytic ileus, as complication of appendicitis, 506
Paranasal sinuses, rhabdomyosarcoma of, 989 Paraphimosis, 793
Parasympathetic nervous system, supplying bladder, 660, 660
Parathormone, 19, 1100, 1101 Parathyroidectomy, 1101 hypocalcemia after, 1101INDEX 1149
Parathyroid glands, 1088
hyperfunction of, 1100-1101. See also Hyperparathyroidism. Paraureteral diverticulum, in patient with
vesicoureteral reflex, 654, 655 Paravertebral sulcus, 242, 242 tumors of, 243-244, 243
Parenteral nutrition, total. See Total parenteral nutrition (TPN).
Parkland formula, for estimating fluid requirements, in burn victims, 127
Parotid gland, lymphangioma of, 1047-1048, 1047
Partial thromboplastin time (PTT), 66, 68 in evaluation of preoperative patient, 70 in hemorrhagic
conditions, 72(t)
values for, 68(t)
vs. prothrombin time, 66 Patch(es)
Peyer's, swelling of, and intussusception, 438 salmon, 1055
PBS. See Prune-belly syndrome. Pectus carinatum, 173-174
and scoliosis, 174 arcuate, 174
cartilage tenderness in, 174 chest pain in, 174
chondrogladiolar deformity in, 174, 175 chondromanubrial prominence in, 174 murmur in, 174
oblique, 174
repair of, 174-175, 176 complications in, 175-176 results of, assessment of, 176
symptoms of, 174 Pectus excavatum, 162 and scoliosis, 163, 165
cardiopulmonary abnormalities in, 165(t) angiocardiographic detection of, 166, 167(t) echocardiographic
detection of, 165-166, 166
electrocardiographic detection of, 165, 166 (t)
lung scanning for, 166, 166(t), 166, 167 pulmonary function tests for, 166 surgical approach to, 168
etiology of, 163
in Marfan's disease, 163 in Turner's syndrome, 163
in Werdnig-Hoffman myopathy, 163 mitral valve prolapse in, 165-166, 166 murmur in, 165
pathophysiology of, 163, 165-168 recurrence of, 172-173
surgical treatment of, 168, 169-171 atelectasis after, 171, 173(t) complications of, 171-173, 173(t) history
of, 162
ideal age for, 162
in severely affected patients, 168, 172, 173 osteotomy in, 170-171
removal of rib cartilage in, 168, 169 results of, 174(t)
assessment of, 173 Steinmann's pin in, 168
Welch pectus excavatum elevators in, 1 71 symptoms of, 163, 165(t)
vs. normal chest, 164 Pediatrics
and quality of life, 90, s1-92 and sanctity of life, 90-91
Pediatrics (Continued)
counseling of cancer patient and family in. See Cancer patient.
emotional considerations in, 84-88 ethical considerations in, 90-93
in cases of conjoined twins, 1109 legal considerations in, 90-93 patient-surgeon relationship in, 84-88
physiologic considerations in, 1-21. See also
speciBc physiologic mechanisms, e.g., Hemostasis.
religious considerations in, 90-91 Pedicle flap, in closure of esophageal perforation, 263
PEEP, 61, 155 Pelvic canal, 418
levator ani muscle of, 419-420, 420 voluntary muscles of, 419-420, 420 Pelvic ganglion, 421
Pelvis ectopic kidney in, 611-612, 611, 612 diagnosis of, excretory urography in, 612, 612
vs. renal aplasia, 612, 612
floor of, reconstruction of, in treatment of bladder exstrophy, 745
inflammatory disease of, vs. appendicitis, 503 renal, jejunal conduit at, 708, 708 rhabdomyosarcoma of,
993-995
"spider," 616 trauma to, 152 Penetrance, 79
Penetrating chest wounds, 159-160 Penicillin, requirement for, as prophylaxis in splenectomy, 569
Penis inflammation of, 793
lengthening of, in treatment of bladder exstrophy, 745, 747, 748
trauma to, 153
Pentalogy of Cantrell, 179, 179 omphalocele in, 573, 573 treatment of, results of, 586(t)
Peptic ulcer, 324 acute, 325, 326 chronic,325,326 clinical course of, 325 Curling's, 325 Cushing's, 325
diagnosis of, 325-326 etiology of, 324-325 pathology of, 324-325 treatment of, 326
antrectomy in, 326 pyloroplasty in, 326 results of, 326 vagotomy in, 326
Percutaneous catheterization of jugular vein, 62
of subclavian vein, 62
Percutaneous cystostomy, 666-667, 667 Percutaneous nephrostomy, 669-670 Perforation(s)
of appendix, in appendicitis, 499, 500
of esophagus. See Esophagus, perforation of. of mediastinum, 259
of neck, 259
of stomach, in newborn, 323-324 Perineal canal, 418
Perineal flap, in construction of distal urethra from vaginal wall, 716, 722-7231 1 'rJ0 INDEX
Peripheral feeding. See also Total parenteral nutrition (TPN).
methods for, 37, 37, 38
solutions for, composition of, 34, 35, 35, 35(t) Peripheral hyperalimentation, 34(t), 35(t), 35. See also Total
parenteral nutrition (TPN). Peristalsis, 254
nerve pathways for, 421-423, 422 Peritoneal burn, 12
Peritoneal lavage, in trauma patient, 140-141 Peritoneal tap, in evaluation of ascites, 920 Peritonitis
meconium. See Meconium peritonitis. primary, vs. appendicitis, 503 Petechia(e), platelet defects and, 69,
70 Peutz-Jeghers polyp(s), 487-489, 488
and intussusception, 488, 489 and melanotic spotting, 487, 487 incidence of, 481
Peyer's patches, swelling of, and intussusception, 438
Pharynx muscles of, 257
trauma to, birth injury and, 139 weak areas of, 256, 257 Phenoxybenzamine hydrochloride,in
improvement of bladder emptying, 666(t) Phenylpropanolamine hydrochloride, in improvement of urine
storage, 664(t)
Pheochromocytoma, 1025 diagnosis of, 1027-1028
familial occurrence of, 1025-1026 incidence of, 1025
in multiple endocrine adenomatosis, type II, 1026
in Sipple's syndrome, 1026
in von Hippel-Lindau disease, 1026 malignant, 1030
recurrence of, 1030 symptoms of, 1026-1027 treatment of, 1028-1029
follow-up care in, 1029-1030 operative technique in, 1029 results of, 1029-1030 Phimosis, 793
Phlebitis, as complication of total parenteral nutrition, 42
pH probe monitoring, in gastroesophageal reflux, 305
Phrenic nerve, distribution of, within diaphragm, 237

Physical abuse, of child, 95. See also Child abuse.
Physical neglect, of child, 95. See also Child abuse.
Physical therapy, in treatment of burn victims, 132-133
Physiologic dressings, in management of burn wounds,l31
"Physiologic" jaundice, in preterm baby, 3 Phytobezoar, 121
Pierre Robin syndrome, 184 symptom complex mimicking, 181 Pigeon breast. See Pectus carinatum.
Pigmented nevus, 999
giant, 999, 1000, 1001-1002, 1002 treatment of, 1001-1004 Pinworm, in appendix, 499
Pit viper(s), 104-105
Pit viper antivenom, 107
Plain radiography
in detection of neuroblastoma, 909, 911, 912 in evaluation of abdominal masses, 909, 911, 912
Plasma thromboplastin antecedent, deficiency of, 66(t)
Plasma thromboplastin component (PTC), deficiency of, 66(t)
Plasma volume, in neonate, 2
Platelet(s), in hemostasis. See Hemostasis, platelet phase of.
Platelet count(s)
after splenectomy, for congenital hemolytic anemia, 567, 567
for idiopathic thrombocytopenia, 566, 566 in evaluation of preoperative patient, 70
in hemorrhagic conditions, 72(t) values for, 68(t)
Pleomorphic adenoma, of salivary glands, 1032
Pleomorphic rhabdomyosarcoma, 987 Pleural flap, for repair of esophageal perforation, 260, 261
Plexiform neurofibroma(s), of mediastinum, 244
Plexus Auerbach's, 389, 393, 421 Henle's, 389
Meissner's, 389, 421
Plication, abdominal wall, in management of prune-belly syndrome, 810, 812
Plug, meconium, 366, 366.
See also Vleconium plug syndrome. Plummer-Vinson syndrome, 256 Plunging ranula, 1072
Pneumatocele staphylococcal pneumonia and, 199, 199, 213,214
vs. congenital cyst of lung, 199, 199, 213 Pneumatosis, in necrotizing enterocolitis, 379, 380
Pneumococcal vaccine, requirement for, as prophylaxis in splenectomy, 569 Pneumocystis carinii
pneumonia, 219-221, 220, 221
Pneumomediastinum, as complication of respiratory therapy, 63
Pneumonia alveolar, 221-222
aspiration, gastroesophageal reflux and, 300, 302
chronic,idiopathic,221-222 gastroesophageal reflux and, 299-300, 299-300, 301, 302, 307
idiopathic, 221-222 interstitial, 221-222 desquamative, 222, 222 giant cell, 222 lymphoid, 222
Pneumocystis carinii, 219-221, 220, 221 prevention of, in patients with prune-belly syndrome, 812
staphylococcal, and pneumatocele, 199, 199, 213, 214
vs. appendicitis, 503 Pneumonitis esophageal atresia and, 270, 274 idiopathic, 221-222. See also Interstitial
pneumonia.
interstitial, 219(t) iNoEx 1151
Pneumopericardium, as complication of respiratory therapy, 63
Pneumoperitoneum, in necrotizing enterocolitis, 382, 383 Pneumothorax, 154
after treatment of posterolateral diaphragmatic hernia, 234

as complication of respiratory therapy, 63 tension, 154
Point tenderness, in appendicitis, 501 Poisonous snake(s), 104-105. ~See also Snake(s) and Snake bite(s).
pupils in, vs. pupils in nonpoisonous snakes, 104
Poland's syndrome, 176, 177 Polycystic kidney disease adult, 616
infantile, 614-616. See also Infantile polycystic kidney disease. Polyhydramnios, 337
Polymastia, 1083 Polyp(s)
inflammatory, 486-487
inherited. See Familial polyposis coli and Peutz-Jeghers polyp(s).
juvenile. See Juvenile polyp(s). lymphoid, 485-486, 485, 486 incidence of, 481, 481, 485 umbilication in,
485, 486
vs. intestinal lymphosarcoma, 486
vs. leukemic infiltration of intestine, 486 of intestine. See specific lesions, e.g., Juvenile polyp(s) and
Lymphoid polyp(s).
Peutz-Jeghers, 487-489, 488 and intussusception, 488, 489 and melanotic spotting, 487, 487 incidence of,
481
Polypectomy colonoscopy in, 483, 484 colotomy in, 483-484 sigmoidoscopy in, 483
Polypeptides, in venom, 105 Polyposis
familial. See Familial polyposis coli. juvenile, 482, 484-485
Polythelia, 1083
Polyvalent pit viper antivenom, 107 Porcine xenografts, in management of burn wounds,l31
Portacaval shunt(s), 537, 540 Portal hypertension, 530 and ascites, 531-532, 533
management of, 538
and bleeding esophageal varices, 530-531, 533
management of, 534-539
and hepatic encephalopathy, 532 and hypersplenism, 531
as complication of therapy for biliary atresia, 520
clinical manifestations of, 533, 538 diagriosis of, 533-534, 534, 535, 538, 539 extrahepatic, 532-533
clinical manifestations of, 533 diagnosis of, 533-534 esophagography in,533,534 splenoportography in,
534, 535
management of, control of acute bleeding in, 534
control of ascites in, 538 long-term, 534-538
Portal hypertension (Continued) extrahepatic, management of, nonsurgical, 534-536
operative approaches to "unshuntable" patients in, 536
portosystemic shunts in, 536, 537, 538 results of, 536
timing of, 536
substitution of colon segment for esophagus in, 536
omphalitis and, 533 intrahepatic, 538 cirrhosis and, 538
clinical manifestations of, 538 diagnosis of, 538 splenoportography in, 538, 539
management of, assessment of cirrhosis in, 538
control of acute bleeding in, 538-539 long-term, 539-540
portosystemic shunts in, 537, 540 management of, 534-540 pathophysiology of, 530-532, 531
Portoenterostomy
hepatic, in therapy for biliary atresia, 515, 516-517
clinical outcome of, 519 modifications of, 515, 518 Portosystemic shunt(s), 536, 537, 538, 540
results of, 536, 540 timing of, 536 Port wine stain, 1055
Positive end-expiratory pressure (PEEP), 61, 155 Posterolateral hernia
of diaphragm, 227
anatomy of, 228-229, 229 anomalies associated with, 229 classification of, 235
clinical picture in, 230, 231 diagnosis of, 231, 231 differential diagnosis of, 231 embryology of, 228
etiology of, 229 incidence of, 229 physiology of, 229-230, 230 treatment of, 231-232
history of, 227
operation used in, 232, 233 pneumothorax after, 234 postoperative care in, 232, 234-235
chest tube management and, 234-235, 235
preoperative care in, 231-232 results of, 233, 234, 235-236 in Class III patients, 235-236
survival prediction in, 232
vs. pulmonary cystic lesions, 231 Posthitis, 793
Potassiu-m balance, of patient, during total parenteral feeding, 39
Pouch, inguinal, testes in, 816 Pouch closure
Silastic, in treatment of gastroschisis, 579-582 in treatment of omphalocele, 579-582, 582, 583, 584
Povidone-iodine, use of, during central parenteral feeding, 36
Preauricular cyst(s), 1006-1067, 1066 Precocious puberty,l082-1083
Prednisolone, in treatment of esophageal burns, 2621152 iNoEx
Prednisone in immunosuppressive therapy, after kidney
transplantation, 847, 848, 849(t), 850(t) in treatment of esophageal burns, 262 Prekallikrein, deficiency of,
66(t) Premature thelarche, 1081
Prepuce inflammation of, 793
removal of. See Circumcision. retraction of, 793
tightness of, 793
Presacral space, examination of, 964, 965 Presacral teratomas, genetic, 969 Pressure
airway, continuous positive, 156
arterial blood, monitoring of, during shock, 13 readings of, interpretation of, 14
blood. See Blood pressure.
central venous, measurement of, 15 monitoring of, during shock, 14 colloid oncotic, in shock, 16 endexpiratory, positive, 61, 155 hydrostatic, in reduction of intussusception, 440-442,441
pulmonary artery, measurement of, 15 pulmonary wedge, measurement of, 15 Pressure generator respirator,
59 Preterm infant(s)
deficient hemostasis in, 68
esophageal atresia in, treatment of, 275276
physiologic problems of, 3 tracheoesophageal fistula in, treatment of, 275-276
Preureteral vena cava,634-635 Primary layered closure
in treatment of gastroschisis, 579
in treatment of omphalocele, 579, 580 Proaccelerin, deficiency of, 66(t) Processus vaginalis
embryology of, 594-595
obliteration of, incomplete, consequences of, 595, 595
Proconvertin, deficiency of, 66(t)
Projectile vomiting, in infantile hypertrophic pyloric stenosis, 316
Prolapse of ectopic ureterocele, 642, 642 ofintussusception,through anus,439-440 of juvenile polyp,
through anus, 482, 482
of mitral valve, in pectus excavatum, 165-166, 166
ofrectum,430-431,431,432 in exstrophy of bladder, 745, 749 vs. intussusception, 440

Propantheline bromide, in improvement of urine storage, 664(t)
Propranolol, in treatment of Graves' disease, 1100
Propylthiouracil, in treatment of Graves' disease, 1098
Prostate in prune-belly syndrome, 806 rhabdomyosarcoma of, 993
Prostatic urethra, in prune-belly syndrome, 806, 808
Protease(s) in septic shock, 13 in venom, 105
Protein, requirements for, in burn victims, 128, 129
Protein-losing enteropathy, gastroesophageal reflux and, 297
Prothrombin deficiency of, 66(t) values for, 68(t)
Prothrombin conversion accelerator, deficiency of, 66(t)
Prothrombin time (PT), 65, 68
in evaluation of preoperative patient, 70 in hemorrhagic conditions, 72 (t)
values for, 68(t)
vs. partial thromboplastin time, 66 Prune-belly syndrome, 802, 803, 813-814 abdominal musculature in,
804-805 anomalies associated with, 804-809 anterior urethra in, 806, 808 bladderin,806,808 cardiovascular
defects in, 809
clinical manifestations of, 804 cryptorchidism in, 808-809 etiology of, 802-804
fusiform megalourethra in, 808 gastrointestinal abnormalities in, 809 hip dislocation in, 809
incidence of, 802 kidneysin,805-806,805 lung malformations in, 809 management of, 809-812
abdominal wall plication in, 810, 812 control of infection in, 810
correction of vesicoureteral reflux in; 812 cutaneous vesicostomy in, 810, 811 delayed intervention in, 809810
in neonatal period, 809-810 investigation in, 809 observation in, 809-810 reduction cystoplasty in, 812
respiratory care in, 812 results of, 813
sphincterotomy in, 812 urethrotomy in, 812 megalourethra in, 808 mortality rate in, 802 orthopedic
problems in, 809 prostate in, 806
prostatic urethra in, 806, 808 "pseudoprune" as incomplete manifestation of, 804
renal dysmorphism in, 805, 805 scaphoid megalourethra in, 808 somatic derangement in, 804, 804
undescended testis in, 808-809 ureters in, 806, 807
urethra in, 806, 808, 808
Pseudocapsule, of neuroblastoma, 948-949, 948 Pseudocyst(s)
pancreatic, 148, 556, 557 diagnosis of, 148, 148 pancreatic trauma and, 147 treatment of, 148-149
with mediastinal extension, 556-557 Pseudodiverticula, traumatic, of esophagus, 256
Pseudohermaphroditism female, 862-863, 862
correction of, 863, 888
clitoral recession in, 863, 865 flap vaginoplasty in, 863, 866 labioscrotal reduction in, 863, 868 pullthrough vaginoplasty in, 863, 867
defective biosynthesis of cortisol in, 863, 864INDEX 1 1 'rJ3
Pseudohermaphroditism (Continued) female, etiology of, 859
male, 868
choice of gender in, 873
defective biosynthesis of testosterone and, 864,869,869
etiology of, 859, 864, 868-869, 869, 873 incomplete, familial, 872, 873 Reifenstein's syndrome as, 872, 873
testicular feminization syndrome as, 870-871,873
treatment of, 888
types of, differentiation of, 887, 887(t) Pseudomonas aeruginosa infection, of burn wounds,l30
Pseudopolyp(s), in colon, ulcerative colitis and, 465,466,467
"Pseudoprune," as incomplete manifestation of prune-belly syndrome, 804
Pseudosexual assault, 905 Psoas hitch, 712, 713
Psychological stress(es), in cancer patient and family, 923-931. See also Cancer patient. Psychosocial
abuse, of child, 95. See also Child abuse.
Psychosocial neglect, of child, 95. See also Child abuse.
Psychotherapy, in patients with ulcerative colitis, 468
PT. See Prothrombin time (PT). PTC, deficiency of, 66(t)
PTT. See Partial thromboplastin time (PTT). Puberty, precocious, 1082-1083 Pubococcygeus muscle,4l9420,420 Puborectalis muscle, 419-420, 420 Pull-through
abdominoperineal,411,412,412-413 sacroabdominoperineal, 412-413 sacroperineal, 414
vaginal, abdominoperineal, 898, 900-903 Pull-through vaginoplasty, 863, 867 Pulmonary artery pressure,
measurement of, 15 Pulmonary artery sling, 192, 192
Pulmonary contusion(s), 156, 158 management of, 156-157
Pulmonary failure, from septic shock, 13 Pulmonary function test(s), in pectus excavatum, 166
Pulmonary hemosiderosis, idiopathic, 222 Pulmonary sequestration, 204-206, 206. See also Lung(s),
sequestration of.
Pulmonary wedge pressure, measurement of, 15 "Pulse VAC" therapy, in treatment of rhabdomyosarcoma,
988
Pulsion diverticula,.rof esophagus, 256 Pupil(s), in snakes, 104
Purpura fulminans, signs of, 70 Pus
in appendix, in appendicitis, 499
in pleural space. See Empyema thoracis. Pyelography
antegrade, in evaluation of ureter, 694, 702, 702
infusion, 149
intravenous. See Intravenous pyelography. retrograde, in diagnosis of crossed renal ectopia, 613, 613
in evaluation of urinary tract trauma, 150 Pyeloplasty, in correction of ureteropelvic junction obstruction,
626-627, 628-629, 631
Pyelostomy, cutaneous, 672, 673
Pygopagus,ll06,1107 Pyloricforceps,Benson,3l9 Pyloromyotomy, 319, 320, 321
Pyloroplasty, in treatment of peptic ulcer, 326 Pylorospasm, simulating pyloric stenosis, 318 Pylorus
antral web obstructing, 313-314, 314 atresia of, 313
duplication of, simulating pyloric stenosis, 318, 449
foreign bodies in, 120 pancreatic tissue in, 551, 553
stenosis of. See Infantile hypertrophic pyloric stenosis.
tumor of, in infantile hypertrophic pyloric stenosis, 316
Pyothorax. See Empyema thoracis. Pyuria, vs. bacteriuria, 646
Rabies, 102-104 diagnosis of, 103 in bats, 103
in dogs, 103
protection against, benzalkonium chloride in, 103
risk assessment in, 104 treatment of, boosters in, 104 duck embryo vaccine in, 104 horse immune globulin
in, 104 human immune globulin in, 104
vaccination of animals against, 103 Racemose hemangioma, 1059, 1059 Radial artery
as site for blood samples in Pa02 determinations, 8
Radiation injury, of esophagus, 259

Radiation toxicity, in treatment of W ilms' tumor, 940-941
Radioactive iodine, in treatment of Graves' disease,l098-1099 Radiographic studies. See particular studies,
e.g., Intravenous pyelography. Radiotherapy
in treatment of Hodgkin's disease, 977
in treatment of non-Hodgkin's lymphoma, 982 in treatment of rhabdomyosarcoma, 988
in treatment of testicular tumors, 1008-1009 in treatment of Wilms' tumor, 940-941 before surgery, 941
National Wilms' Tumor Study-Group data on, 937-938, 937(t)
toxicity of, 940-941 Ranula,l071-1072 plunging,l072
Rattlesnake(s), 104
Receptor, H-Y antigen, and mixed gonadal dysgenesis, 882, 882
Recession, clitoral, 863, 868
Recovery room, risk of airway problems in, 51 Rectal temperature, in monitoring thermal balance,21
Rectoanal reflex, absence of, in Hirschsprung's disease,324
Rectoplasty, and constipation, 427-428 Rectum
abscess involving, 430 adenocarcinoma of, 495-4961154 ov~Ex
Rectum (Continued) agenesis of, 403, 404, 404
evaluation of, 404, 406
therapy for, abdominoperineal pullthrough in, 411, 412-413 results of, 416(t)
sacroabdominoperineal pull-through in,
412-413 ampulla of, 418 anatomy of, 418 atresia of, 403, 404
evaluation of, 406 therapy for, 412 results of, 416(t)
biopsy of, 393-394
in Hirschsprung's disease, 392-394, 393 in ulcerative colitis, 466
bleeding from, juvenile polyp and, 482-483 carcinoma of, 495-496
duplications of, 454 embryology of, 401-402
excision of, in treatment of ulcerative colitis, 471
ganglia of, intrinsic, 421-422 in Hirschsprung's disease, 389 prolapse of, 430-431, 431, 432
in exstrophy of bladder, 745, 749 vs.intussusception,440 protrusion of, through anus, 430-431, 431, 432
vs. intussusception, 440 sensory receptors in, 419 trauma to, birth injury and, 139
Rectus muscle(s), displacement of, 592 Red blood cell volume
in neonate, 2
in small for gestational age infant, 4 Reduction, labioscrotal, 863, 868 Reduction cystoplasty, in
management of
prune-belly syndrome, 812
Reflectance calorimeter, for measurement of blood glucose level, 19
Reflex(es), rectoanal, absence of, in Hirschsprung's disease, 423 Reflux
gastroesophageal. See Gastroesophageal reflux.
intrarenal, 647
vesicoureteral. See Vesicoureteral reflux. Refractometer, for total protein measurements, in monitoring
fluid volume, 7
Regional enteritis. See Crohn's disease. Regional ileitis. See Crohn's disease. Regression, psychological, in
cancer patient and parent,923-924
Reifenstein's syndrome, 872, 873 hypospadiasin,773 Rejection
in kidney transplantation, 852, 852(t), 853-854
methylprednisolone for, 852, 852(t) Renal arteriography, in patients with renovascularhypertension,831832,831

Renal cell carcinoma, 1018-1019 Renal function studies, 651
in renovascular hypertension, 832
Renal pelves, jejunal conduit joining, 708, 708 Renin,829
Renin-angiotensin system
in renovascular hypertension, 829 tests of, 832
Renovascularhypertension,829 causesof,830-831 clinical aspects of, 830-831 diagnosis of, 831-833
renal arteriography in, 831-832, 831 renin-angiotensin system tests in, 832 split-renal function tests in, 832
incidence of, 830
pathophysiology of, 829-830 renin-angiotensin system in, 829 tests of, 832
screening for, 831
intravenous pyelography in, 831 sodium excretion in, 829-830 therapyfor,833-834
autotransplantation of kidney in, 834 local operation on arterial obstruction in, 833
medical management in, 833 nephrectomy in, 833
renal arterial reconstruction in, 833-834 results of, 834
risk of recurrence after, 834 vascular volume in, 829-830 vasoactive renal substances in, 829, 830
Respirator(s), 59
settings for, 60 Respiratory acidosis corrective measures for, 59
primary, 58 Respiratory alkalosis
corrective measures for, 59
primary, 58
Respiratory distress syndrome, and diaphragmatic paralysis, 238 Respiratory failure, 7-11
evaluation and monitoring of oxygenation in, 8-10
pathophysiology of, 7
Respiratory support. See Ventilation, management of.
Respiratory system, embryology of, 196 Resuscitation, of trauma patients, 141 Resuscitation fiuids, in
treatment of shock, 16-18
Retina, damage to, from high levels of oxygen, in preterm baby, 3
Retractile testis (testes), 816, 817 vs. undescended testis, 816, 817 Retrocaval ureter, 634-635 Retrograde
pancreatography,555,556 Retrograde pyelography
in diagnosis of crossed renal ectopia, 613, 613 in evaluation of urinary tract trauma, 150 Retrolental
fibroplasia, as complication of anesthesia, 51
Retroperitoneum, rhabdomyosarcoma of, 997 Reverse rotation
of colon, 348(t), 352, 352
of duodenum, 348(t), 352-353, 352, 353 Rhabdomyosarcoma, 985
alveolar, 987 cell types in, 987
correlated with survival rate, 987-988 clinical presentation in, 988-997 embryonal, 987
incidence of, 985 metastatic, 997 of bile ducts, 990
mimicking choledochal cyst, 990 of bladder, 993. 994INDEX 11
Rhabdomyosarcoma (Continued) of buttocks, 995
of chest wall, 995, 996-997 of extremities, 992-993
of face, 989 ofhead,988-990 meningeal involvement in, 989-990 oflarynx,989
of liver, 953-954 of middle ear, 989 ofnasopharynx,989 of neck, 988-989
of orbit, 989, 990
of paranasal sinuses, 989 of pelvis, 993-995
of prostate, 993
of retroperitoneum, 997 of spermatic cord, 990 of testicle, 1010-1012 ofvagina,993-994 paratesticular, 990992, 992 pathology of, 987-988 perianal,990,991 pleomorphic, 987
sites of occurrence of, 985-986, 986 correlated with survival rate, 986 staging of, 986
~orrelated with survival rate, 986-987, 986(t), 987(t)
survival rate in, 985
correlated with cell type, 987-988 correlated with site of occurrence, 986 correlated with stage of disease,
986-987, 986(t), 987(t)
treatment of, 988-997 Adriamycin in, 988 chemotherapy in, 988 cyclophosphamidein,988 dactinomycin
(actinomycin D) in, 988 lymphadenectomy in, 991, 992, 1011, 1011 "pulse VAC" program in, 988
radiotherapy in, 988
vincristine in, 988 trismus in, 989 undifferentiated, 987 Rib(s)
cartilage of, removal of, in treatment of pectus carinatum, 176
in treatment of pectus excavatum, 168, 169
tenderness in, in pectus carinatum, 174 defects in, combined with spinal defects, 181
fractures of, 158, 158 gapsin,and micrognathia,l81 trauma to, 158, 158
and flail chest, 158
Right colon, in esophageal replacement, 284-286,285
Right mesenteric pouch, 348(t), 352-353, 353 Right subclavian artery, aberrant, and notching of esophagus,
191
Ring(s) vascular, compression of airway by, 190-192, 190-192
obstruction of esophagus by, 256-257 Ringer's lactate solution, in resuscitation fluid for treatment of shock,
17
Rotation of intestine, 347, 347
at progressive embryonal stages, 347, 348(t)
Rotation (Continued)
of intestine, errors in, 346-355, 348(t). See also specific abnormalities, e.g., Nonrotation and Reverse
rotation.
Roux-en-Y anastomosis, in "chimney" enterostomy treatment of meconium ileus, 361-362,362
Roux-en-Y cyst-jejunostomy, 523
Rule of nines, in estimation of surface area of burns,l23
Rumination, gastroesophageal reflux and, 295, 307
Rupture ofesophagus,259-260 of omphalocele, 574, 574 of spleen, 141, 569(t)
diagnosis of, 141-142, 142 operative approach to, 142-143
Sacculation, of urethra, as complication of treatment of hypospadias, 786
Sacroabdominoperineal pull-through, in therapy for imperforate anus, 412-413 Sacrococcyx, teratomas of,
963-969. See also
Teratoma(s), of sacrococcyx. Sacroiliac joint, trauma to, 152 Sacroperineal pull-through, in therapy for
imperforate anus, 414
Saddle injury, and urethral trauma, 152 Salivary gland(s)
adenoma of, pleomorphic, 1032 carcinoma of, 1032 hemangioma of, 1031
lymphangioma of, 1031, 1047-1048, 1047 tumors of, 1031-1033, 1032(t)
Salmon patch, 1055
Sandifer's syndrome, gastroesophageal reflux and, 296-297, 297, 307
Sarcoma(s). See also Rhabdomyosarcoma. alveolar soft part, 1034-1035
botryoid, 987
clear cell, melanotic, 1034 Ewing's extraosseous, 987 metastasis of, to lungs, 1035
treatment of, 1035-1037, 1036 of breast, 1086-1087
of liver, 953(t)
of soft tissue, 1033 treatment of, 1034 types of, 1034-1035
osteogenic, metastasis of, to lungs, 1035 treatment of, 1035-1037, 1036 small cell, 987
synovial cell, 1034 undifferentiated, 1035 Scald(s), 123
Scanning gallium, in evaluation of Hodgkin's disease, 975
in evaluation of non-Hodgkin's lymphoma, 980
technetium. See Technetium scanning. tomographic, in diagnosis of appendicitis, 502
in evaluation of abdominal masses, 914, 915 ultrasonographic. See Ultrasonography. xenon, in pectus
excavatum, 166, 166(t), 166, 167
Scaphoid megalourethra, in prune-belly syndrome, 808iN~Ex 1157
Small cell sarcoma, 987
Small for gestational age baby, physiologic problems of, 4
Small intestine
as ureter replacement, 715-716 duplication of, cystic, 450 tubular,451,451-453
size of, in newborn, 42 Snake(s). See also Snake bite. copperhead,l04 coral,l04
neurotoxic venom of, 104, 105 cotton-mouth moccasin, 104 king, 104
nonpoisonous,l04 poisonous,l04-105 pupils in, 104 rattler breeds of, 104 venom of, 105
Snake bite(s), 104-107 clinical symptoms of, 105 fang marks in, 104-105, 106(t) incidence of, 102, 104
severity of, grading of, 106(t) symptoms of, 105
treatment of, 105-107 antivenom in, 106(t), 107 tetanusprophylaxisin,l06 tourniquetin,l05 wound excision
in, 106-107
Snake venom, 105
Soave operation, in treatment of Hirschsprung's disease,395, 396
Sodium bicarbonate, in correction of metabolic acidosis, 59
Southwest Cancer Chemotherapy Group, investigating vincristine in treatment of Wilms' tumor, 936
Spasmodic torticollis, gastroesophageal reflux and, 296-297, 297, 307
SPCA, deficiency of, 66(t) Spermatic cord rhabdomyosarcoma of, 990 torsion of, 825-826, 826
Spermatogenesis, in patient with undescended testis (testes), 818
Spherocytosis cholelithiasis associated with, 524, 524(t) treatment of, splenectomy in, 524, 563-564
and timing of cholecystectomy, 525 Sphincter(s)
anal canal, 420-421
anorectal, nerve pathways for, 421-423, 422. See also Continence.
esophageal, lower, 293-294, 294(t) urinary, artificial, 665, 689, 690-692 implantation of, results of, 692
requirements for use of, 692
Sphincterotomy, in management of prune-belly syndrome, 812
Spider angiomas, 1055 Spider bite(s)
black widow, 110 brown recluse, 109-110 "fiddleback," 109-110 Loxosceles reclusa, 109-110
"Spider pelvis," 616 Spider venom, 109, 110 Spigelian hernia, 592-593
Spinal accessory nerve, cystic hygroma involving,l043,1043
Spindle-epithelioid cell nevus, 1001 removal of, 1004
vs. malignant melanoma, 1001 Spine
defects in, combined with rib defects, 181 lumbar puncture needle in, breaking of, 122 Spitz nevus, 1001
removal of, 1004
vs. malignant melanoma, 1001 Spleen(s)

accessory, incidence of, 565, 565(t), 565 location of, 565-566, 566(t)
number of, 565, 565(t), 565
search for, in splenectomy, 565-566 cysts of, splenectomy for, 564
hilum of, accessory spleen at, 565, 566(t) in resistance to infection, 568-569 lymphangioma of, 1051
removal of. See Splenectomy. rupture of, 141, 569(t) diagnosis of, 141-142, 142 operative approach to,
142-143
torsion of, splenectomy for, 564 trauma to, 141, 569, 570, 571
assessment of, technetium scanning in, 569, 570, 571
birth injury and, 138-139 diagnosis of, 141-142, 142 management of, nonoperative, 569, 571
operative, 142-143, 570 Splenectomy, 563
and sepsis, 568-569
elective, mortality rate in, 567
factors contraindicating, 139, 142-143
for congenital hemolytic anemia, 563, 564 results of, 567, 567
for Hodgkin's disease, 564
for idiopathic thrombocytopenia, 563 results of, 566, 566
for immune hemolytic anemia, 564 for spherocytosis, 524, 563-564
and timing of cholecystectomy, 525 for splenic cysts, 564
for thalassemia major, 564 for torsion of spleen, 564 indications for, 563-564, 563(t) methods of, 564-566
search for accessory spleens in, 565-566. See also Spleen(s), accessory. mortality rate in, 567-568
patient's age at, related to primary diagnosis, 564(t)
prophylaxis required with, penicillin in, 569 pneumococcal vaccine in, 569
results of, 566-568, 566-567
platelet counts reflecting, 566-567, 566-567
Splenic artery, accessory spleen at, 565, 566(t) Splenocolic ligament, accessory spleen at, 565, 566(t)
Splenoportography in diagnosis of extrahepatic portal hypertension, 534, 535
in diagnosis of intrahepatic portal hypertension, 538, 539
Splenorenal ligament, accessory spleen at, 565-566, 566(t)
Splenorenal shunt(s), 536, 537, 540
Splint(s), in treatment of burn victims, 132-133 Splinter(s)
steel, in soft tissues, 122ov~Ex 1159
Suture(s) in esophagealsurgery,262,263
stabilizing, in operation for midgut volvulus, 350-351,351
Swallowing, 254-255, 255 Swenson operation, in treatment of Hirschsprung's disease, 395, 396
Symbiotic regression, in cancer patient and parent, 923-924
Sympathetic nervous system, supplying bladder,sso-ssl,sso Symphysis pubis
coaptation of, in treatment of bladder exstrophy, 741, 744, 748, 750 trauma to, 152
Synechia vulvae, 899 Synovial cell sarcoma, 1034
T3, 1088 T4, 1088 Tamponade
cardiac, chest trauma and, 159-160 mediastinal teratoma and, 969, 970 chylopericardial, 1050
Tapering jejunoplasty, 342
TCT. See Thrombin clotting time (TCT). Technetium scanning
in diagnosis of Meckel's diverticulum, 461-462,462
in evaluation of gastrointestinal bleeding, 435-436
in evaluation of splenic injury, 569, 570, 571 in monitoring of kidney transplant, 851, 851 Telescopic
bronchoscope, 117, 118 Temperature
body, regulation of, during surgery, 48 rectal, in monitoring thermal balance, 21 skin, in monitoring
thermal balance, 21 Temporal artery
catheterization of, and cerebral vascular accident, 8
for blood gas monitoring, 62
for blood samples in PaOz determinations 8
Temporary physiologic dressings, in management of burn wounds, 131 Tension pneumothorax, 154
Teratogens, environmental, 82-83 Teratoma(s), 960, 971
alpha-fetoprotein produced by, 961 concepts of, history of, 960 embryology of, 960
endocrinologic effects of, 961, 963 epignathous, 971, 971
in abdomen, 909, 912, 969 intracranial, 971 malignant, 968, 968(t)
of brain, 971
of mediastinum, 249, 249
arid cardiac tamponade, 969, 970 diagnosis of, 969, 970 therapyfor,969-970
of neck, 970-971, 970 ofovary,l012,1014-1015 ofsacrococcyx,963
diagnosis of, 963-964, 964, 965 excision of, 964, 966-967, 968 malignant components in, 968, 968(t)
palpation of, 964, 965
therapy for, 964, 966-967, 968
Teratoma(s) (Continued) ofsacrococcyx,therapyfor,excision ofcoccyx
in, 964, 966, 968 postoperative care in, 968-969 vs. lipomeningocele, 964
vs. myelomeningocele, 964, 965 of testicles, 1010
of thyroid gland, 970 pathology of, 961, 962(t), 963(t) physiologic effects of, 961 presacral, genetic, 969
sites of occurrence of, 960, 961, 963
tissue types in, 9s1, ssz(t), ss3(t) Terminal enteritis. See Crohn's disease. Terminal ileitis. See Crohn's
disease. Test(s)
Apt-Downey, 434, 434
furosemide washout, in diagnosis of ureteropelvic junction obstruction, 625 of hemostasis, 68-69, 68(t).
See also specific
laboratory measures, e.g., Platelet count(s) and Prothrombin time (PT).
of pulmonary function, in pectus excavatum, 166
of renal function, 651
in renovascular hypertension, 832 ofthyroidfunction,l088-1089 Whitaker, in diagnosis of ureteropelvic
junction obstruction, 625 Testicle(s)
carcinoma of, yolk sac, 1009-1010 germ cell tumors of, 1009(t) gonadoblastoma of, 1010
Leydig cell tumors of, 1010 nongerminal tumors of, 1009(t), 1010 removal of, 822
in treatment of tumors, 1008 rhabdomyosarcoma of, 1010-1012 Sertoli cell tumors of, 1010 teratoma of,
1010
torsion of, 824
differential diagnosis of, 824-825 pathophysiology of, 824
trauma to, 153 tumors of, 1007-1012 diagnosis of, 1007-1008 etiology of, 1007
germ cell, 1009(t) Leydig cell, 1010 nongerminal, 1009(t), 1010 Sertoli cell, 1010 treatment of, 1008-1009
orchiectomy in, 1008 radiotherapyin,l008-1009 types of, 1009-1012, 1009(t)
undescended. See Undescended testis (testes).
yolk sac carcinoma of, 1009-1010 Testicular feminization syndrome, 598 Testis (testes)
appendix, torsion of, 826-827, 826 evaluation of, in hypospadias, 772 in superficial inguinal pouch, 816
malignantchangein,8l8-819 retractile, 816, 817
vs. undescended testis, 816, 817
torsion of, 824. See also Testicle(s), torsion of. trauma to, 153
undescended. See Undescended testis (testes).
Testosterone, defective biosynthesis of, and male pseudohermaphroditism, 864, 869, 8691160 iN~Ex
Tetanus, 102
protection against, in human bites, 107 in snake bite victim, 106
Tetanus immune globulin, 102 Tetanus toxoid, 102
administration of, in burn victims, 133 Thalassemia major
cholelithiasis associated with, 524, 524(t) splenectomy for, 564
THAM, in correction of metabolic acidosis, 59 Thelarche, premature, 1081
Thermal balance, 20
Thermal imbalance, pathophysiology of, 20
Thermal neutrality, of infant, 21 Thermodilution technique, for estimating cardiac output, 15
Thoracic dystrophy, asphyxiating, of newborn, 180-181,181
Thoracopagus,ll05-1106 separation of, 1104, 1110, 1111, 1112 Thoracostomy tube(s), placement of, in
patient
with chest trauma, 159 Thorax. See Chest.
Thrombin, formation of, in hemostasis, 67(t) Thrombin clotting time (TCT), 68
Thrombocytopenia idiopathic, splenectomy for, 563 results of, 566, 566
Thromboplastin, tissue, deficiency of 66(t) Thromboplastin antecedent, plasma, deficiency of, 66(t)
Thromboplastin component, plasma, deficiency of, 66(t)
"Thumbprinting," in ulcerative colitis, 467 Thymectomy, in treatment of myasthenia gravis, 248-249
Thymocyte serum, antihuman, in immunosuppressive therapy, after kidney transplantation, 848-849,
849(t), 849, 850
Thymoma(s), of mediastinum, 247 Thymus gland
cyst(s) of, 247 enlargement of, 247
removal of, in treatment of myasthenia gravis, 248-249
Thyroglossal duct, embryology of, 1067-1068.
See also Thyroglossal duct cyst. Thyroglossal duct cyst, 1067
clinical aspects of, 1068 diagnosis of, 1068 embryology of, 1067-1068 histopathology of, 1068 treatment
of, 1068, 1069, 1070
results of, 1070
Thyroidectomy, for thyroid gland tumors, 1092 Thyroid gland, 1088
adenoma of, 1091, 1091
carcinoma of, 1092, 1093, 1094-1095, 1094,
1095, 1096-1097 cyst of, 1091 ectopic, 1067, 1068
cancerin,l070 embryonic path of descent of, 1067 enlargement of. See Goiter. follicular adenoma of, 1091,
1091 follicular can;inoma of, 1092, 1094 functioning oP, abnormal, in Graves' disease
See Graves' disease.
Thyroid gland (Continued) functioning of, tests of, 1088-1089 infiammation of. See Thyroiditis. medullary
carcinoma of, 1092, 1094-1095, 1096-1097
papillary carcinoma of, 1092, 1093 physiology of, 1088
removal of, in treatment of tumors, 1092 teratoma of, 970

tumors of, 1091-1092 surgical treatment of, 1092 thyroidectomy for, 1092 Thyroiditis
acute,l089 chronic,l089-1090 Hashimoto's, 1089-1090
histologic findings in, 1089, 1090 Thyroid-stimulating hormone (TSH), 1088 Thyroid teratoma, 970
Thyrotoxicosis. See Graves' disease. Thyroxine, 1088
Tissue thromboplastin, deficiency of, 66(t) Toenail(s), splinter under, 122
Tohoku C.B.A. Test Score system, for distinguishing biliary atresia from neonatal hepatitis, 512(t)
Tomographic scanning
in diagnosis of appendicitis, 502
in evaluation of abdominal masses, 914, 915 Tongue
bite wounds of, 107-108 lymphangioma of, 1046-1047, 1046
and deformation of mandible, 1046, 1047 Torsion
of appendix of epididymis, 827-828, 827 of appendix testis, 826-827, 826
of hydatid of Morgagni, 826-827, 826 of spermatic cord, 825-826, 826
of spleen, splenectomy for, 564 of stomach, 322
of testicle(s), 824. See also Testicle(s), torsion of.
of testis (testes), 824. See also Testicle(s), torsion of.
of undescended testis, 819, 825 Torticollis, 1074
and craniofacial asymmetry, 1071, 1072-1073 diagnosis of, 1073
etiology of, 1072-1073
fibrous "tumor" in, 1071, 1072, 1072, 1073 spasmodic, gastroesophageal reflux and, 296-297, 297, 307
treatment of, 1073-1074, 1073 Total body opacification, 912, 914 Total colectomy
in treatment of Crohn's disease, 476, 476(t), 477(t), 477
Total colonic aganglionosis, 398-399. See also Hirschsprung's disease.
Total gastrectomy, in treatment of Zollinger-Ellison syndrome, 326, 1030 Total parenteral nutrition (TPN),
33-42
after operative management of intestinal atresia, 343-344, 343
complications of, 40-42, 40(t) history of, 33
indications for, 331160 iN~Ex
Tetanus, 102
Thermal balance, 20
patient

849(t), 849, 850
of, 1068, 1069, 1070
results of, 1070
carcinoma of, 1092, 1093, 1094-1095, 1094,
1095, 1096-1097 cyst of, 1091 ectopic, 1067, 1068
carcinoma of, 1092, 1094-1095, 1096-1097
33-42
Tetanus, 102
Thermal balance, 20
patient
849(t), 849, 850
of, 1068, 1069, 1070
results of, 1070
carcinoma of, 1092, 1093, 1094-1095, 1094,
1095, 1096-1097 cyst of, 1091 ectopic, 1067, 1068

carcinoma of, 1092, 1094-1095, 1096-1097
33-42
Tetanus, 102
Thermal balance, 20
patient
849(t), 849, 850
of, 1068, 1069, 1070
results of, 1070
carcinoma of, 1092, 1093, 1094-1095, 1094,
1095, 1096-1097 cyst of, 1091 ectopic, 1067, 1068
carcinoma of, 1092, 1094-1095, 1096-1097

33-42
indications for, 331162 ovoEx
Ulcerative colitis (Continued)
diagnosis of, radiographic, "thumbprinting" in, 467
etiology of, 465
extraintestinal manifestations of, 466 laboratory findings in, 467
natural history in, 466 pathology of, 465-466 physical examination in, 466 pseudopolyp formation in, 465,
466, 467 remission of, 466, 468
signs of, 466 symptoms of, 466
therapy for, nonoperative, 467-468 psychological considerations in, 468 operative, 468-471
abdominoperineal resection in, 469(t), 470, 470(t)
Aylett procedure in, 468-469, 469(t), 470(t), 471
complications of, 471. excision of rectum in, 471 ileostomy in, 468-471, 469(t), 470(t)
continent, 469, 469
Kock procedure for, 469, 469 indications for, 468
results of, 471
subtotal colectomy in, 468, 469(t), 470(t) total colectomy in, 469, 469(t), 470, 470(t) Ulnar artery,
thrombosis of, from catheterization, 8
Ultrasonography in diagnosis of appendicitis, 502
in diagnosis of duodenal atresia, 337, 338 in evaluation of abdominal masses, 914, 915 in evaluation of
urinary tract trauma, 150 in management of complications of
appendicitis, 506, 506 Umbilical artery
as site for blood samples in PaOz determinations, 8, 9
Umbilical hernia anatomy of, 589-590 appearance of, 590, 590 complications of, 590 diagnosis of, 590
embryology of, 589-590 incarceration of intestine in, 590, 591 incidence of, 590
spontaneous closure of, 590, 591 therapy for, 591
operative technique in, 591-592, 591 Umbilication, in lymphoid polyps, 485, 486 Umbilicus
abnormalities of, associated with Meckel's diverticulum, 457, 461
bulging at, in umbilical hernia, 590. See also Umbilical hernia.
granuloma of, 463 .
infiammation of, and extrahepatic portal hypertension, 533
position of, in exstrophy of bladder, 738, 740 protrusion of intestine at. See Gastroschisis and
Omphalocele.
Undescended testis (testes), 816 and infertility, 818
associated with indirect inguinal hernia, treatment of, 600
diagnosis of, 817-818 embryology of, 816 incidence of, 817
Undescended testis (testes) (Continued) in prune-belly syndrome, 808-809 malignant change in, 818-819
pathology of, 816-817
seminoma of, 819 spermatogenesis of, 818 torsion of, 819, 825 trauma to, 819
treatment of, nonsurgical, 819 surgical, 819, 820-821, 821-822
emotional considerations in, 819 indications for, 818-819
in repair of indirect inguinal hernia, 600 orchiectomy in, 822
orchiopexy in, 819, 820-821, 821-822 timing of, 818, 819
vs. retractile testis, 816, 817
Undiversion, urinary. See Urinary undiversion. Upper celosomia, 573, 573
treatment of, results of, 586(t) Urachus
anomalies of, 755-756 cyst of, 756 embryology of, 752 patent, 756, 756
sinus of, 756 Uracratia after treatment of bladder exstrophy, 749750
after treatment of urethral valves, 767 Ureter(s), 633
atresia of, 633
augmentation of length of, bladder flap in, 716 mobilization in, 708, 712, 712
psoas hitch in, 712, 713 blind-ending, 633, 634 circumcaval, 634-635 diverticulum of, 634
duplication of, 635-637, 635, 636 correction of, 636-637, 708, 709, 710-711 ectopia of, 637-640, 639
correction of, 640 diagnosis of, 638-640
in females, 637-638, 638, 640 in males, 637, 638, 640 embryology of, 633
enlarged. See Megaureter.
evaluation of antegrade pyelography in, 694, 702,702
hypoplasia of, 633
in extensive urinary tract reconstruction, 712, 714-715
in prune-belly syndrome, 806, 807 mobilization of, 708, 712, 712
psoas hitch as adjunct to, 712, 713 reimplantation of, in patient with vesicoureteral reflux, 704-706
two ureters as single unit in, 708, 709 repair of, in correction of megaureter. See Megaureter, correction of.
retrocaval, 634-635
separation of, surgical, 708, 710-711
small intestine segment as replacement for, 715-716
stenosis of, 633-634 trauma to, 151 treatment of, 151-152
triplication of, 637 valves of, 634 V-type, 635, 635 Y-type, 635, 635
inverted, 637iN~Ex 1163
Ureter(s) (Continued)
Y-type, "yo-yo effect" in, 635 Ureterocele,6l9-620,640-643 adult, 640-641, 641 ectopic,641-643,641,642
management of, 643 prolapse of, 642, 642 incidence of, 640 simple, 640-641, 641
management of, 641 types of, 640, 641 Ureteropelvic junction
embryology of, 623 histology of, 623 obstruction of, 624
causes of, 624
clinical features of, 624-625
correction of, Anderson-Hynes procedure in,628
Culp-Scardino procedure in, 628 Davis intubation in, 629

Foley Y-V plasty in, 629 indications for, 626
pyeloplasty in,626-627,628-629, 631
results of, 627, 630, 631 techniquesof,626-627,628-629 diagnosis of, 625-626
furosemide washout test in, 625 intravenous urography in, 625 voiding cystourethrography in, 626
Whitaker test in, 625
pathology of, 624 pathophysiology of, 623-624 physiology of, 623-624
Ureterosigmoidostomy, 680, 682, 682 Ureterostomy
cutaneous, end, 672, 673, 674, 676, 676, 677
loop,671,672 in urinary diversion, 670, 671-672, 672, 673, 674, 676, 676, 677
transureterocutaneous, 673, 676 undiversion from, 725, 731-734, 735 Y-type, 671-672
Ureterostomy in situ, 670 Urethra
anatomy of, 772-773 anomalies of, 760-769 arrowhead, 757
caliber of, in girls, 651, 652(t) conical, 757
construction of, from vaginal wall, 716, 721-722
perineal flap and, 716, 722-723 cylinder, 757
diverticula of, 768, 768, 769
as complication of treatment of hypospadias,786 embryology of, 772-773
female, caliber of, 651, 652(t) shape of, during voiding, 757
fistula of, as complication of treatment of hypospadias, 785-786, 785(t) fusiform, 757
in continence, 796
in prune-belly syndrome, 806, 808, 808 in voiding, 796
male, shape of, during voiding, 758 meatus of, retraction of, as complication of treatment of hypospadias,
786
Urethra (Continued)
meatus of, site of, in hypospadias, 770, 770(t). See also Hypospadias.
stenosis of, 768-769
as complication of treatment of hypospadias, 786
ulceration of, 769
prostatic, in prune-belly syndrome, 806, 808 sacculation of, as complication of treatment of hypospadias,
786
shape of, during voiding, 757-758 stenosis of, 651-652, 756-760 and urinary tract infection, 652 in girls,
651-652
strictures of, as complication of treatment of hypospadias, 786
trauma to, 152
clinical findings in, 152 radiographic evaluation of, 152 saddle injury and, 152 treatment of, 152-153
valves of, 703-706, 760
and vesicoureteral reflux, 704, 705, 767 classification of, 760-762
clinical features of, 762
diagnosis of, 762-766 endoscopyin,764-765 excretory urography in, 764
voiding cystourethrography in, 763-764, 763, 764
and subsequent need for surgery, 767 drainage procedures in, 765
effect of, on urinary tract, 767 endoscopic resection in, 765-766 incomplete removal in, 767-768
nonoperative rupture in, 766 open operation in, 766
results of, 766-768 urinary diversion in, 765 urinary incontinence after, 767
mortality rate in, 766-767, 766(t) pathology of, 760-762, 760, 762 Type I, 760-761, 760
diagnosis of, 763, 763 Type II, 760
Type III, 761-762, 762
and blockage of instrumentation upward,
761 diagnosis of, 764, 764
wine glass, 757
Urethroplasty, in treatment of hypospadias, 776, 781-784
Urethroscopy, in evaluation of enuresis, 799
Urethrotomy, in management of prune-belly syndrome, 812
Urinalysis, in evaluation of enuresis, 798
Urinary bladder. See Bladder. Urinary diversion, 666
catheterization in, 666 cutaneous,674-680
cutaneous pyelostomy in, 672, 673
cutaneous ureterostomy in, 671, 672, 672, 673, 674,676,676,677
cutaneous vesicostomy in, 668, 670-671
in patients with prune-belly syndrome, 810, 811
cystostomy in, 666-667, 667, 668
end cutaneous ureterostomy in, 673, 674, 676,
676, 677
follow-up after, 682-683
ileal conduit in, 676, 678, 679 complications of, 676, 6931164 iN~Ex
Urinary diversion (Continued)
in management of urethral valves, 765 internal,680,682
intubated,666-670 loop cutaneous ureterostomy in, 671, 672 loop nephrostomy in, 670, 670
nephrostomyin,667,669-670,669,670 nonintubated,670-674 open cystostomy in, 667, 668
open nephrostomy in, 669, 669 percutaneous cystostomy in, 666-667, 667 percutaneous nephrostomy in,
669-670 permanent,674-682
artificial urinary sphincter as alternative to. SeeArtificial urinarysphincter. long-term care after, 682-683
pyelostomy in, 672, 673 refunctionalization of bladder after. See Urinary undiversion.
sigmoid conduit in, 679-680, 680, 681 stoma construction in, 675-676, 675 stoma site selection in, 674-675
suprapubic cystostomy in, 666-667, 667, 668 temporary, 666-674
in treatment of hypospadias, 776 transureterocutaneous ureterostomy in, 673, 676
ureterosigmoidostomy in, 680, 682, 682 ureterostomy in, 670, 671-672, 672, 673, 674, 676, 676, 677
ureterostomy in situ in, 670 urethralcatheterin,666 vesicostomy in, 668, 670-671
in patients with prune-belly syndrome, 810, 811
Y-ureterostomy in, 671-672 Urinary sphincter
artificial, 665, 689, 690-692 implantation of, results of, 692 requirements for use of, 692 Urinary tract
anomalies of, associated with imperforate anus, 405, 405(t)
evaluation of, in hypospadias, 774 infections of, 645, 657
after treatment of bladder exstrophy, 749 bacteriuria vs. pyuria in, 646
diagnosis of, 645-646 criteria for, 645 pitfalls in, 645(t)
urine specimens in, 645-646 vaginal voiding and, 645, 646 etiology of, 646-647
evaluation of, intravenous pyelography in, 648, 649, 650

physical examination in, 647, 649 radiographic studies in, 648, 649, 650, 651, 651
voiding cystourethrography in, 648, 649, 650, 651
incidence of, 645 in girls, 645, 647 management of, 646, 657 natural history in, 647 prevention of, 653
nitrofurantoin in, 653 sulfisoxazole in, 653 trimethoprim-sulfamethoxazole in, 653-654
recurrent, without underlying abnormalities, 652
Urinary tract (Continued)
infections of, renal function studies in, 651 symptoms of, 647
urethral stenosis and, 652
vesicoureteral reflux and, 653, 653. See also Vesicoureteral reflux.
vs. appendicitis, 502
obstruction of, renal dysplasia with, 619-620 trauma to, 149, 152-153. See also Bladder, trauma to, and
Urethra, trauma to.
complications of, 151
evaluation of, arteriography in, 150 excretory urography in, 149-150 infusion pyelography in, 149
intravenous pyelography in, 149-150 laboratory findings in, 149
physical findings in, 149 renal scan in, 150
retrograde pyelography in, 150 ultrasonography in, 150 treatment of, 150-151
Urinary undiversion, 716, 724, 724
in patients with ileal loop diversion, 725, 725, 726-730
in patients with ureterostomy, 725, 731-734, 735
preoperative assessment of bladder function in,724-725
Urine flow of, in burn victim, monitoring of, 126, 127, 128
in abdomen, 920, 921
osmolality of, in monitoring fluid volume, 6 retention of, acute, 769-770
specific gravity of, in monitoring fiuid volume, 6
Urine ascites, 920, 921
Urine fiow rate, in monitoring fluid volume, 6 Urodynamic studies, in evaluation of enuresis, 799, 799, 800
Urography, excretory. See Excretory urography. Urorectal septum, 401-402, 401
Uterus distention of, due to retained secretions, 892. See also Hydrometrocolpos.
embryology of, 891, 891
Vaccination, rabies, 103
Vaccine(s), pneumococcal, requirement for, as prophylaxis in splenectomy, 569
Vagina atresia of, 894, 896
anomalies associated with, 897 identification of, 896 clinical aspects of, 896 cystoscopy in, 896
diagnosis of, 896 embryology of, 896
treatment of, 898-899, 900-903
distention of, due to retained secretions, 892. See also Hydrometrocolpos.
embryology of, 891, 891 foreign bodies of, 906 reconstruction of, 898
abdominoperineal vaginal pull-through in, 898, 900-903
McIndoe technique in, 898, 899 results of, 898-899 rhabdomyosarcoma of, 993-994w~Ex 1 165
Vagina (Continued)
septate, 895. See also Septum (septa), vaginal. clinical aspects of, 896
embryology of, 895-896 physical findings in, 896 treatment of, 896
wall of, in construction of distal urethra, 716, 721-722
perineal flap and, 716, 722-723 Vaginal pull-through, abdominoperineal, 898, 900-903
Vaginal voiding, 645, 646 Vaginoplasty flap, 863, 866 pull-through, ss3, as7
Vagotomy, in treatment of peptic ulcer, 326 Valve(s)
ureteral, 634
urethral. See Urethra, valves of. Vanillylmandelic acid (VMA), levels of, in patients with neuroblastoma,
947, 950
Vaporizational heat loss, through burn wounds, 128-129
Varix (varices)
esophageal, bleeding from, portal hypertension and, 530-531, 533 management of, 534-539
operative approaches to, 536 roentgenographic demonstration of, 533, 534
Vascular ring
compression of airway by, 190-192, 190-192 obstruction of esophagus by, 256-257 VATER syndrome, in
patients with duodenal atresia, 337
Vegetable(s), in bezoar, 121 Vein(s)
azygos, drainage to, in pulmonary sequestration, 205
hemiazygos, drainage to, in pulmonary sequestration, 205
in intravenous therapy, 62
jugular, in administering central parenteral nutrition, 36, 36
percutaneous catheterization of, 62 subclavian, percutaneous catheterization of, 62 _
Vena cava, preureteral, 634-635 Venom, 105
bee, 108 hymenoptera, 108 insect, 108
neurotoxic, in coral snakes, 104, 105 snake. See Envenomation. spider,l09,110
Venous pressure
central, measurement of, 15 monitoring of, during shock, 14 Ventilation
blood gas monitoring in, 62 complications of, 62 endotracheal intubation for, 61 humidity in, 60
oxygen therapy and, 56
positive end-expiratory pressure (PEEP) in, 61
ventilators for, 59 respiratory settings in, 60 Ventilators, 59
settings for, 60
Vermiform appendix. SeeAppendix and Appendicitis.
Vertebra(e), anomalies of, associated with alimentary tract duplications, 447
Vesical exstrophy. See Bladder, exstrophy of. Vesicostomy
cutaneous, 668, 670-671
Vesicourachal diverticulum, 756 Vesicoureteral reflux, 652-654
and urinary tract infection, 653, 653 complete, 652, 653
grades of, 652-653, 652, 653, 654
in patients with paraureteral diverticulum, 654,655
in patients with urethral valves, 704, 705, 767 management of, nonoperative, 653, 653(t) operative, 654,
656
indications for, 654, 654(t)
in patients with prune-belly syndrome, 810
ureteral reimplantation in, 704-706 prevention of infection in, 653. See also Urinary tract, infections of,
prevention of.
renal growth chart in, 654, 654 massive, 652

severe,652 urethral valves and, 704, 705, 767
Villus (villi), hypertrophy of, in jejunal atresia, 334-335,334-335
Vincristine in treatment of rhabdomyosarcoma, 988 in treatment of Wilms' tumor, 936, 938
Southwest Cancer Chemotherapy Group study of, 936
Viper(s), 104-105 Viper antivenom, 107
Virginal hypertrophy ofbreast, 1081-1082, 1081 Vitamin K
administration of, to newborns, 67 and hemostasis, 67
Vitamin K-dependent coagulation factors, 67 Vitelline duct, persistence of, 457, 459. See also Meckel's
diverticulum.
VMA, levels of, in patients with neuroblastoma, 947, 950
Voiding, See also Enuresis. bladderin,796-797 shape of urethra during, 757-758 urethra in, 796
vaginal, 645, 646
Voiding cystourethrography
in diagnosis of ureteropelvic junction obstruction, 626
in diagnosis of urethral valves, 763-764, 763, 764
in evaluation of enuresis, 799
in evaluation of urinary tract infections, 648, 649,650,651
in patients with imperforate anus, 408, 408 Volvulus
of cecum, 348(t), 354, 354
of intestine. See Midgut volvulus. of stomach, 322, 323
Vomiting as complication of elemental diets, 31 cerebral, 318
gastroesophageal reflux and, 295, 3071166 iN~Ex
Vomiting (Continued)
of bile, midgut volvulus and, 349 of blood, 433
projectile, in infantile hypertrophic pyloric stenosis, 316
Vomitus, coffee ground, 433
von Hippel-Lindau disease, 1026 von Willebrand's disease, 66(t),'72 factor VIII replacement in, 71 (t), 72
V-type ureter, 635, 635 Vulva, synechia of, 899 Vulvovaginitis, 899, 904
differential diagnosis of, 904(t)
Waddell's triad, 140
Washout test, furosemide, in diagnosis of ureteropelvic junction obstruction, 625 Wasp sting(s), 108-109
Web(s) antral, 313-314, 314
esophageal, 256 windsock,341
Wedge pressure, pulmonary, measurement of, 15
Weigert-Meyer law, 636
Welch pectus excavatum elevators, 171 Werdnig-Hoffman myopathy, pectus excavatum in,163
Whitaker test, in diagnosis of ureteropelvic junction obstruction, 625
Wilms' tumor bilateral, 941-942
classification of, grouping schema used in, 937(t)
clinical characteristics of, 932-933 diagnosis of, 933-935, 934 laboratory studies in, 934-935
differential diagnosis of, 935, 935(t) incidence of, 932
laterality of, 932 metastases of, 933 to lungs, 933, 933
occurrence of, on left side, 932 pathology of, 935
prognosis in, National Wilms' Tumor Study-Group data on, 938-939, 939(t) recognition of, as disease
entity, history of, 932
spread of, distant, 933, 934 local, 933
treatment of, 936
dactinomycin (actinomycin D) in, 936 Children's Cancer Study Group A data on, 936-937, 936(t)
single-course, vs. multiple-course, 936-937, 936(t)
history of, 932, 936 late effects of, 941 progressin,939 radiation toxicity in, 940-941
Wilms' tumor (Continued)
treatment of, radiotherapy in, 940-941 National Wilms' Tumor Study-Group data on, 937-938, 937(t)
preoperative, 941 toxicity of, 940-941 surgery in, 939-940 vincristine in, 936, 938
Southwest Cancer Chemotherapy Group study of, 93s
vs. mesoblastic nephroma, 935 Windsock web, 341
Wine glass urethra, 757
Wood, splinters of, in soft tissue, 122 Wound(s). See Chest, wounds of, and specific types of wounds, e.g.,
Burn(s).
Wringer arm, 112 avulsion in, 112
clinical aspects of, 112-113 complex injury in, 112 compression-related contusion in, 112 critical injury in,
112
cutaneous injury in, 112 diagnosis of, 113 friction burns in, 113 friction-related abrasion in, 112 mechanism
of injury in, 112 therapy for, 113
Xenograft(s), porcine, in management of burn wounds, 131
Xenon scanning, in pectus excavatum, 166, 166(t), 166, 167
Xeroradiography, in detection of foreign bodies in skin, 121, 122
Xiphopagus,ll04 X-linked inheritance, 80-82, 81
XX karyotype, in hermaphrodites, 860 45,XI46,XY mosaic karyotype, in mixed gonadal dysgenesis, 860
Y chromosome, functions of, 860, 879
Yellow jacket sting(s), 108-109 Yolk sac carcinoma, 1009-1010
Yolk stalk, persistence of, 457. See also Meckel's diverticulum.
"Yo-yo effect," in Y-type ureter, 635 Y-type ureter, 635, 635
inverted, 637
"yo-yo effect" in, 635 Y-ureterostomy, 671-672
Y-V plasty, Foley, in correction of ureteropelvic junction obstruction, 629
Zollinger-Ellison syndrome, 557-558, 1030 treatment of, total gastrectomy in, 326, 1030

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INDEX

Angiocardiography, in pectus excavatum, 166, 167(t)

Arterial carbon dioxide tension, monitoring of, 10

cartilaginous, 1064, 1064

friction, in wringer arm, 113 full-thickness, 123

Cancer patient (Continued)

mesentery of, incomplete attachment of, 348(t), 354, 354

Chylous ascites, 920, 1049 Circumcaval ureter, 634-635 Circumcision

pseudopolyp formation in, ulcerative colitis and, 465, 466, 467

Continence (Continued) mechanism of, 423

stenosis within, 185-186, 187

of ovary, 1014, 10141126 ov~Ex

stenosis within, 185-186, 187

of ovary, 1014, 10141128 ov~Ex

trauma to, 145

Entamoeba histolytica, and hepatic abscess, 525, 526

Fibrinolysis, in hemostasis, 65, 67(t)

in patient with esophageal stricture, 311 medical, 306-307

cysts above, 186

resection of, disseminated intravascular coagulation after, 1059

Hepatic encephalopathy 532

hyperparathyroidism and, 1100-1101 Hyperglycemia, as complication of total parenteral nutrition, 40

Immunotherapy. See also Immunosuppressive therapy.

Infantformula(s) composition of, 30, 31(t)

anastomotic repair of, 342, 342iN~Ex 1139

second look, timing of, in non-Hodgkin's lymphoma, 982

Lumbar hernia, 593, 593

of salivary glands, 1031, 1047-1048, 1047 of solid organs, 1051

in urinary diversion, 667, 669-670, 669, 670 loop,670,670

in treatment of pectus excavatum, 1 70-171 Ovary (ovaries)

Phrenic nerve, distribution of, within diaphragm, 237

after treatment of posterolateral diaphragmatic hernia, 234

ofrectum,430-431,431,432 in exstrophy of bladder, 745, 749 vs. intussusception, 440

Radiation injury, of esophagus, 259

methylprednisolone for, 852, 852(t) Renal arteriography, in patients with renovascularhypertension,831832,831

vs. malignant melanoma, 1001 Spleen(s)

removal of, in treatment of tumors, 1092 teratoma of, 970

Thrombocytopenia idiopathic, splenectomy for, 563 results of, 566, 566

See Graves' disease.

of testicle(s), 824. See also Testicle(s), torsion of.

Culp-Scardino procedure in, 628 Davis intubation in, 629

evaluation of, intravenous pyelography in, 648, 649, 650

renal growth chart in, 654, 654 massive, 652

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