The secretin-CCK test

An evaluation of the clinical relevance of an exocrine pancreatic function test in the diagnosis of nonacute pancreatic disease and an analysis of its relationship with morphological data in chronic pancreatitis. The secretin cholecystokinin (S-CCK) test has been used in the diagnosis of nonacute pancreatic disease for many years (Burton, Evans et al, 1960). Because the basal pancreatic secretion is relatively small and highly variable (DiMagno & Go, 1982), stimulation, for instance with exogenous secretin and cholecystokinin, is necessary to obtain sufficient quantities of pancreatic juice from the duodenal lumen for analysis~ Impairment of pancreatic exocrine function, measured in this way, has been demonstrated in diseases like chronic pancreatitis and tumor of the pancreas (DiMagno, 1982). The relatively hidden position of the pancreas prompted clinicians to rely on exocrine function tests for many years. Recently, the introduction of imaging techniques like ultrasound computer scan$endoscopic retrograde cholangiopancreatography (E.R.C~P.) and selective angiography of the abdominal vessels, have made the pancreas much more accessible for diagnostic purposes. Furthermore, several noninvasive tests of exocrine pancreatic function have been developed such as the Para Amino Benzoic Acid (P.A.B.A.) test (Arvanitakis, 1976). These developments might be anticipated to cause the 'classical' S-CCK test to become outmoded and lose its clinical value for the diagnosis of pancreatic disease$ However, it has become evident that the newer diagnostic modalities also have their limitations, leaving a blind area in the diagnosis especially of early chronic pancreatitis, where pancreatic function tests may provide important clues (Toskes, 1982a). A rising incidence of both chronic pancreatitis (Andersen, Pedersen et al 1982; Hoogendoorn 1978, 1983) and pancreatic cancer (Braganza & Howat, 1979; Kupchik, Reisfeld & Go, 1982) in Western Europe and the USA underlines the importance of adequate diagnostic methods. The poor prognosis of pancreatic cancer, the 'dismal disease', with a 5% 5-year survival rate, is due to the fact that at present only 10% of the patients have potentially curable disease at the time of diagnosis. Early diagnosis may improve survival rate in pancreatic cancer (Morgan & Wormsley, 1977; Moossa, 1982)~ Thus far, the new diagnostic aids have failed to improve the detection rate of pancreatic cancer(Savarino, Mansi et al, 1983). It is clear that there is still room for improvement in the diagnosis of chronic pancreatitis an pancreatic cancer in spite of the introduction of newmethods~ Therefore, we have evaluated the results of S-CCK testing performed in 300 patients between 1975 and 1982 and compared these with the data provided by the imaging techniques mentioned before to find out whether it is still worthwile to perform the S-CCK test nowadays. That is the main issue of this study

Psychological outcome and quality of life in children born with congenital diaphragmatic hernia

OBJECTIVE: To assess psychological and social functioning as well as health-related quality of life and its early determinants in children born with congenital diaphragmatic hernia (CDH). DESIGN: Cross-sectional follow-up study. SETTING: Outpatient clinic of a tertiary care hospital. PARTICIPANTS: Thirty-three CDH survivors aged 6-16 years. Main exposure: Patients who developed CDH associated respiratory distress within 24 hours after birth. MAIN OUTCOME MEASURE: Psychological and social functioning assessed with the Wechsler intelligence scale for children (WISC-R), Bourdon-Vos test, Beery Developmental Test of visual motor integration, Child Behaviour Checklist (CBCL) and Teacher Report Form (TRF). Health-related quality of life assessed with the Child Health Questionnaire (CHQ) and the Health Utilities Index (HUI). RESULTS: Normal mean total IQ (100.0 +/- 13.2) and normal visual-motor integration, but significantly lower results for sustained attention (Bourdon-Vos test (38.8 +/- 11.2 points)) were found. Learning difficulties were reported by 30% of the parents. Eight children had scores in the clinical range on the CBCL and/or TRF, indicating clinical significant behavioural problems. Except for the CHQ scale "General health", health status was not different from the reference population. No significant correlations between test results and severity of CDH were found, except an association of general health and physical functioning with length of hospital stay. CONCLUSION: CDH patients are at risk for relevant subtle cognitive and behavioural problems, probably not related to CDH severity. These may contribute to school failure and need for special educational services. Perception of general health is reduced when compared to the reference population indicating that CDH survivors and their parents believe their health is poor and likely to get wors

Surgical treatment of childhood hepatoblastoma in the Netherlands (1990–2013)

Background: Achievement of complete surgical resection plays a key role in the successful treatment of children with hepatoblastoma. The aim of this study is to assess the surgical outcomes after partial liver resections for hepatoblastoma, focusing on postoperative complications, resection margins, 30-day mortality, and long-term survival. Method: Chart reviews were carried out on all patients treated for hepatoblastoma in the Netherlands between 1990 and 2013. Results: A total of 103 patients were included, of whom 94 underwent surgery. Partial hepatectomy was performed in 76 patients and 18 patients received a liver transplant as a primary procedure. In 42 of 73 (58 %) patients, one or more complications were reported. In 3 patients, information regarding complications was not available. Hemorrhage necessitating blood transfusion occurred in 33 (45 %) patients and 9 (12 %) patients developed biliary complications, of whom 8 needed one or more additional surgical interventions. Overall, 5-year disease-specific survival was 82, 92 % in the group of patients who underwent partial hepatectomy, and 77 % in the group of patients who underwent liver transplantation. Conclusions: Partial hepatectomy after chemotherapy in children with hepatoblastoma offers good chances of survival. This type of major surgery is associated with a high rate of surgical complications (58 %), which is not detrimental to survival

Evaluation of pregnancy and delivery in 13 women who underwent resection of a sacrococcygeal teratoma during early childhood

Background: Sacrococcygeal teratoma resection often brings changes in pelvic anatomy and physiology with possible consequences for defecation, micturition and sexual function. It is unknown, whether these changes have any gynecological and obstetric sequelae. Until now four pregnancies after sacrococcygeal teratoma resection have been described and cesarean section has been suggested to be the method of choice for delivery. We evaluated the pregnancy course and mode of delivery in women previously treated for a sacrococcygeal teratoma. Methods: The records of all patients who underwent sacrococcygeal teratoma resection after 1970 in one of the six pediatric surgical centers in the Netherlands were reviewed retrospectively. Women aged 18 years and older were eligible for participation. Patient characteristics, details about the performed operation and tumor histology were retrieved from the records. Consenting participants completed a questionnaire addressing fertility, pregnancy and delivery details. Results: Eighty-nine women were eligible for participation; 20 could not be traced. Informed consent was received from 41, of whom 38 returned the completed questionnaire (92.7%). Thirteen of these 38 women conceived, all but one spontaneously. In total 20 infants were born, 17 by vaginal delivery and 3 by cesarean section, in one necessitated by previous intra-abdominal surgery as a consequence of sacrococcygeal teratoma resection. Conversion to a cesarean section was never necessary. None of the 25 women without offspring reported involuntary childlessness. Conclusions: There are no indications that resection of a sacrococcygeal teratoma in female patients is associated with reduced fertility: spontaneous pregnancy is possible and vaginal delivery is safe for mother and child, irrespective of the sacrococcygeal teratoma classification or tumor histology

Voortschrijdend inzicht in behandeling appendicitis: gebruik van antibiotica lijkt een veilige stap vooruit

Since the late 19th century, standard treatment for acute appendicitis has been an appendectomy. Recently, two new developments have induced a new paradigm. More accurate diagnosis by imaging has since overruled the old adagium: 'When in doubt, take it out.' Secondly, new insights into the pathogenesis of appendicitis have negated the theory that simple appendicitis will inevitably progress into complicated appendicitis, with associated perforation and generalised peritonitis. Four randomised controlled trials in adults have demonstrated that antibiotic treatment in selected patients is safe and effective: in two-thirds of healthy and relatively young men, antibiotics cured the appendicitis. In 15%, an operation was indicated for failure to respond and 15% relapsed within one year. These promising results need to be confirmed in other populations such as children and women. Furthermore, the establishment of prognostic factors such as the presence of a faecolith is needed before the treatment of appendicitis can be removed from the surgeon's real

Noblesse oblige-The pediatric surgeon (h)as the key to quality control and improvement

AbstractThe trust crisis in health care demands action by health care professionals. Trust is based on quality, candor, and accountability. The pediatric surgeon, as the expert in the field, should be in control of quality management. By improving quality, the trust in the health care system can be restored. Quality is defined as being on target with minimal variation. To assess these targets, performance indicators have been developed by the Association of Pediatric Surgeons in The Netherlands for 7 neonatal conditions. Variation can be distinguished as special-cause and common-cause variation using the control chart method of Walter Shewhart. The various activities in this field that have been developed and are ongoing in The Netherlands are presented