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In Reply .—Dr Morris is quite correct. The sentence alluded to should read "increased incidence of wound infections appears to be inappropriately feared after obstetric and gynecologic procedures."

• A review of 96 patients with the established diagnosis of childhood dermatomyositis revealed that 15 patients required surgical therapy in addition to diagnostic biopsy. Four of the patients had perforation of the esophagointestinal tract, and 11 required surgical therapy for abscesses, calcific deposits, or treatment of pneumothorax. The life-threatening lesions were perforations of the esophagus and intestine. The best surgical therapy is closure, resection, and adequate drainage. Prognosis depends on treatment of the underlying medical disease. (Arch Surg1988;123:1117-1120)

Congenital dilatation of the common bile duct or choledochal cyst is a rare condition which, until recently, was usually not recognized prior to operation. Although the number of reported cases is greater than 600, the group reported in this study may be the largest from a single institution in the United States. Ten patients with this anomaly were seen at the Childrens Hospital of Los Angeles during the two decades (1948-1968) among approximately 135,000 admissions. Clinical Series A summary of the clinical course of these ten children is found in the Table. Nine of the ten patients were females. The racial background of seven was white; two, oriental; and one, Negro. Five children developed the initial symptom during the first six months of life. In contrast, two were over 10 years of age at the time of the first recognition of their disease process. Six of the ten patients had

IMPROVEMENT in surgical techniqus and in the management of postoperative problems encountered in the usual varieties of esophageal atresia during the past decade has resulted in a striking increase in the survival rate among these infants. This has led to renewed interest in the less common anatomic types and in the unusual clinical situations where, in contrast, the mortality remains high. These include infants with overwhelming pneumonias, prematurity, complicating associated anomalies, and the "uncommon" varieties, types A, B, D, and E (Gross). 1 Several changes in therapeutic policy and technical innovations directed at the solution of problems raised by these special groups are presented. Delayed Primary Anastomosis These postponements of primary anastomosis fall into two distinct groups: (a) relatively short "delays" for acute conditions, in which the deferment is confined to a maximum of ten days to two weeks; and (b) longer delays which are designed to permit growth, elongation

Primary necrotizing enterocolitis has recently been recognized as a highly lethal inflammatory disease of the intestinal tract of infants. It is now apparent that many unexplained cases of "spontaneous" perforation of the ileum or colon in the neonate were in reality secondary to a necrotizing inflammatory process of the intestinal wall. Cruze and Snyder1reported that one third of 16 cases of spontaneous perforation of the colon collected prior to 1959 were associated with and idiopathic inflammatory process. Cases of "malignant" or "ulcerative" enterocolitis of the newborn, usually ending in death due to perforation, are reported in the European literature2,3and also fall into this category. In 1965 the first series of cases of necrotizing enterocolitis was reported in the United States by Mizrahi et al.4This report will review the experience with the syndrome at the Childrens Hospital of Los Angeles. Materials and Methods The pathology