Between 1973 and 1983 6 children with portal hypertension were treated at the University Children's Hospital Medical Centre in Teheran by transpositioning the spleen into the thorax. In one case with splenomegaly, ascites and 4 years of severe bleeding, this procedure was not possible. We therefore performed a partial splenectomy 7 years ago, with the view of a transpositioning into the thorax at a later date. Follow-up examinations revealed disappearance of the symptoms of portal hypertension. This led us to believe that this procedure could be adopted for the treatment of portal hypertension as an alternative to splenic transpositioning into the thorax and shunt operation. The precipitation and increase in collateral circulation with this method leads to rapid improvement.

Within 12 years, 165 cases of urolithiasis were observed at the Children's University Hospital of Teheran. The incidence of urolithiasis amounts to 1 case in 300 paediatric hospitalizations. 160 calculi from 121 children were analysed by various methods: semiquantitative chemical analysis (Mercognost), x-ray diffraction, polarising microscopy on thin sections. In about 25% of the cases metabolic disorders or malformations were found responsible for urolithiasis. In 100 cases, stone formation was attributed to the upper and in 21 cases to the lower urinary tract. Calcium oxalates are the most frequent constituents, followed by ammonium acid urate. The core of the stones in the upper tract was mostly composed of calcium oxalate. Ammonium acid urate was the second important core component, but occurred especially enriched in the lower urinary tract. On the basis of these and literature data, the lack of ammonium acid urate in juvenile stones in Europe and the USA seems surprising. Thus, it must be assumed therefore, that ammonium acid urate is a key to understanding the formation of endemic calculi. The cases studied support that with increasing standard of living, the incidence of bladder stones decreases.

From 1981-1982 we performed partial splenectomy in 6 children with beta-thalassaemia major as an alternative to splenectomy to reduce transfusion and to preserve some splenic immune function. In two of our young patients with transfusion requirements of 150 ml/kg/year, where more than 2/3 of the spleen was removed, the number of transfusions was significantly reduced with prolonged intervals, haemoglobin rose with a marked improvement in the general condition, nutrition and growth. There were no major post-operative complications. 2 years' follow-up revealed no infection without sepsis prophylaxis.

A newborn infant with a rare variety of combine anterior and posterior rachischisis in the lumbosacral spine is reported. The associated anomalies in this infant were meningomyelocele, communication of the colon with the spinal cleft, and anal atresia.

Subtotal splenectomy with omentopexy and partial splenic attachment is a good alternative to other operative procedures for the treatment of portal hypertension. With this method, the precipitation and increase in collateral circulation leads to rapid improvement.