I like to think of myself as a typical practicing pediatrician who, in the course of an active practice, has encountered almost everything physical and emotional seen by the average pediatric practitioner. Of course, all of us meet with the rarer conditions from time to time. Many conditions seldom seen in practice we have either read about in the literature or have seen on the children's service at our hospitals, during our internships, or during residency. I mention this in considering the subject of this and the next issue of Pediatric Annals, because one may wonder how often surgical problems involving the sex organs occur in pediatric practice.
There are some conditions seen quite frequently, such as hydrocele. cryptorchidism, hypospadias, and mastitis of puberty. Others, such as tumors of the testes or ovaries and ambiguous sex organs, are seen infrequently.
One realizes, however, that it is not so much a matter of whether a condition is common or rare as whether the physician will recognize the condition and is capable of treating it in the most modem and successful manner.
This and the next issue of Pediatric Annals, under the guest editorship of Dr. Burton Bronsther, director of pediatric surgery at the Nassau County (N. Y.) Medical Center, consider surgical problems relative to the breast, ovaries, and testes, urogenital tumors, and ambiguous sex organs.
The first contribution - "Breast Enlargements in Children," by Dr. John Seashore of the Yale University School of Medicine - covers the subject in great detail. Emphasis is placed on the benign nodules and breast enlargements, such as postnatal enlargement, premature thelarche, prepubertal breast enlargement, mastitis of puberty, and gynecomastia. Also considered are those conditions requiring special care, such as breast enlargement due to precocious puberty and breast masses due to cysts, tumors, and inflammatory lesions. Throughout, Dr. Seashore emphasizes the avoidance of needless biopsies and surgical excision of breast masses.
Tumors of the ovaries and testes are comparatively rare in infancy and childhood, but the possibility of their occurrence must always be borne in mind. Ovarian cysts and tumors are difficult to diagnose and must be considered in all girls with lower abdominal pain.
Dr. Bronsther and Dr. Martin W. Abrams are the authors of the article "Ovarian Tumors in Childhood."
The final article, "Ambiguous Genitalia: Clitorectomy and Clitoroplasty in the Female Child," is by Dr. Judson G. Randolph, surgeon-inchief of the Children's Hospital National Medical Center in Washington, D. C. Although such abnormalities are comparatively rare, they are of the greatest interest to all pediatricians.
At the outset, Dr. Randolph discusses the various hermaphrodite syndromes, describing three distinct categories of male pseudohermaphrodites and five categories of female pseudohermaphrodites. The etiology of these various categories is presented, and the diagnostic measures are carefully discussed. The last segment of the article is given over to a description of the surgical approach to the correction of the abnormalities in female pseudohermaphrodites.
Ordinarily, in a publication such as this, devoted specifically to the needs of the practicing pediatrician, surgical techniques are not described and illustrated. However, since many pediatricians are curious as to how the corrections are made, it was felt worthwhile to present the author's description of the surgical management.
The next issue will include articles on "Urogenital Tumors in Children," by Dr. Daniel M. Hays; "Testicular Tumors in Infancy and Childhood," by Drs. Mitchell Levy, Norbert Platt, Martin Abrams, and Burton Bronsther; and "The Painful Testicle," by Dr. Stanley J. Landau.
A brief quiz on the two issues will appear next month.