There are a surprisingly large number of anatomic and developmental defects that result in urinary incontinence in infancy and childhood. While most cases of "enuresis" are merely the result of inadequate or improper training, the doubtful case should receive careful neurologic and urologic studies before psychiatric therapy in its various forms is undertaken. It is particularly important to study such cases in instances where urinary control has already been established and then the symptoms of incontinence develop.
The most dangerous cases of all are those due to some defect which results in the "dribbling incontinence" of an overdistended bladder. These are particularly dangerous, in that the "incontinence" may be regarded during the first year or two of life as only the normal lack of training on the part of the child. The difference between this and pathologic lack of control is usually easily apparent. The normal child allows his bladder to become full, empties it all at once, and then will remain dry for varying periods of time. In obstruction, with overdistention of the bladder, the lack of control is constant, is small in amount and, if this possibility is considered, diagnosis of an obstructive lesion is easy. Urethral valves may be removed, but bladder tumor has a grave prognosis. Neurologic cord lesions also present a constant, though variable degree of incontinence day and night, and careful history will bring this out. Ordinary enuresis is inconstant.
The experience at the Hospital Infantil of Mexico City in dealing with intestinal perforations and rupture of the gall bladder in typhoid fever is presented.
Four hundred and fifty-seven cases of typhoid fever among 15,688 general admissions in 3 years, with 29 cases of intestinal perforations and 4 ruptured gall bladders form the basis of this report. Twenty-one were operated on, with a survival of 9 (43% survivals with operation), 8 were not operated on. Seven of these died (85% mortality). Of four cases of rupture of the gall bladder all were operated on and one survived.
It has been pointed out in this paper that most technics which are employed successfully in adult anesthesia can be used to a large extent with the same advantages in infants and children. Therefore, in pediatric centers one finds preanesthetic medication, inhalation, intravenous, rectal, spinal and regional anesthesia employed safely and with advantage to both patient and surgeon.
Discharge outcomes of extremely low birth weight infants with spontaneous intestinal perforations
