In the 1940s and 1950s a small band of pioneer surgeons along with fellow trailblazers in pediatrics, anesthesia, and radiology opened up an exciting new medical frontier resulting in the salvage of thousands of young victims of congenital malformation and neoplastic disease. At the conclusion of my own residency in New York City's Babies Hospital 20 years ago, pediatrie surgery was still a frontier specialty in that many of our goals still lay in unchartered wilderness. To give just a few examples:
* Most children with malignant neoplasms died within a year of diagnosis;
* Babies who could not breathe on their own or who required prolonged nutritional support following operative correction of life-threatening congenital anomalies such as tracheoesophageal fistula or duodenal atresia died. Placing a postoperative baby on a ventilator was essentially a gesture of premortem futility;
* Kidneys transplanted from non-twin donors usually lasted only a few weeks;
* Reattachment of a traumatically amputated extremity was viewed by many skeptics as a surgical stunt not likely to be widely duplicated, especially in infants and young children whose tiny vessels defied current techniques of anastomosis;
* Operations on the heart were experimental with high mortality and innumerable complications related to the new technologies;
* Children with chronic ulcerative colitis usually suffered years of debilitating disease complicated by dwarfism, malnutrition, anemia, colon cancer and toxic megacolon rather than be subjected to a leaking, foul smelling ileostomy.
In each of these areas the progress over the past 20 years has been gratifying. Successful repair of most lifethreatening congenital malformations is routine in the hands of skilled pediatrie surgeons with survival of even tiny prematures enhanced by the technologies of ventilatory and nutritional support. Advances in immunology have contributed to the success of kidney transplantation, while technical refinements in the art of microsurgery have permitted functional restoration of traumatically amputated digits and limbs. Improvements in ileostomy construction and placement and in appliance materials have raised the quality of Ufe for ileostomates and encouraged earlier referral for colectomy. The outlook for many children with malignant tumors such as embryonal rhabdomyosarcoma and Hodgkin's disease is relatively bright.
These great accomplishments have shaped a new frontier, beyond which lies the hope of salvaging those severely afflicted infants and children for whom the tools and techniques of the past are not enough. In the following pages, a group of my colleagues - frontiersmen all - chart the exciting developments in their clinics and laboratories which hold the promise of converting hope to reality.