Minerva

Laparoscopic surgery usually requires the creation of pneumoperitoneum using carbon dioxide. A review of the effects of the rise in intra-abdominal pressure (British Journal of Surgery 1995;82:1-2) points out that much of the early research was done on gynaecological patients—most of whom were younger and fitter than the typical patients of a general surgeon. The diaphragm is pushed upwards with a force estimated at 50 kg, and gas may easily find its way through congenital defects or may track in the retroperitoneal space.

A prospective study of 618 children born preterm found that their systolic blood pressures at the age of 8 years were affected by their mothers smoking in pregnancy and by their gestation. The report in “Archives of Disease in Childhood” (1995;72:120-4) shows that the blood pressure in children of smoking mothers was lower in those born before 33 weeks and higher in those born after 33 weeks than in children of non-smoking mothers. These findings raise the question of whether other intrauterine factors might have different effects at different gestations.

Many children are admitted to hospital complaining of pain in the hip; the fear is that they might have septic …