Biomedical subjects
Publications and source records attributed to B Muhlbauer.
Each of tri-zygotic female triplets was found to have a right-sided sliding inguinal hernia. Although inguinal hernia has been previously diagnosed in twins, as well as in relatives of patients with hernias, a genetic basis for the condition has not been established.
A 2200 g male infant was found to have esophageal atresia and esophageal fistula in addition to truncus arteriosus and oculo-auriculo-vertebral dysplasia. The presence of facial asymmetry in an infant with esophageal atresia should prompt a search for additional anomalies before surgery is contemplated.
A case is presented of a newborn with a large abdominal wall defect of aplasia cutis conservatively treated with a new skin substitute (Omiderm). Omiderm is a thin, transparent membrane that is relatively inelastic when dry and capable of absorbing water. This provides an optimal environment for wound healing by preventing microbial invasion. It is simple to apply and easily removed, and it adheres without glue or staples. It is transparent, permitting direct vision of the defect. By enhancing the epithelialization process, shorter hospitalization is required. The large area of aplasia cutis healed completely under the Omiderm within 6 weeks.
The prevalence and time trends of spina bifida and anencephaly in the central area of Israel have been studied using data derived from four hospitals affiliated with the International Clearinghouse for Birth Defects Monitoring Systems. Spina bifida rates show a continuous increase from 1978 (1.1/10,000) to 1986 (7.4/10,000) with a peak in 1984 (7-fold increase compared with 1978). The logistic regression analysis of proportion of cases revealed a significant linear trend over time (P less than 0.005). Anencephaly rates increased from 1978 to 1981 but later decreased continuously until 1986 when the prevalence returned to the initial level of 1978. This time trend of spina bifida may represent a real alarm; the implications of this observation are discussed.
During the period between October 1984 and January 1985, an outbreak of Serratia marcescens took place in the Serlin Maternity Hospital in Tel-Aviv. Four major and six minor infections were noted in newborn and preterm infants. An additional group of 24 neonates were asymptomatic carriers of S. marcescens. Extensive control measures were undertaken, including closing the SCBU to further admissions and the opening of a new SCBU. Other measures included maintaining babies in cohort groups, strict handwashing, and use of gloves and gowns. There was also intensified encouragement of breast feeding and thorough cleansing and disinfection of the SCBU and nurseries. After 3 months, the outbreak was controlled. No identified source for the outbreak was detected. We feel that the extensive measures employed were responsible for controlling the outbreak within a relatively short time.
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A peculiar odour in an infant may raise the possibility of several important syndromes. Four cases of newborn infants with peculiar smells are described. In two, the sharp odour was identified as cumin, one smelled of fenu-greek and one of curry. All these babies were born to mothers who ingested spicy food prior to delivery. In one case, the foul smelling amniotic fluid led to a spurious suspicion of amniotitis.
Two fatal cases of Serratia marcescens sepsis and meningitis are reported here. The first case, a 1,420-g male infant born after 35 weeks of gestation, developed abdominal distension, hypotension and acidosis on the 3rd day after birth. Cerebrospinal fluid (CSF) was cloudy; blood and CSF cultures were positive for S. marcescens. He died within 24 hours after the appearance of symptoms, and purulent meningitis was found at autopsy. The second case, a 1,100-g boy born after 29 weeks of gestation, developed Escherichia coli sepsis at 14 days of age, from which he recovered. At 26 days of age he developed convulsions. Blood and CSF cultures grew S. marcescens. He was given gentamicin, chloramphenicol and supportive treatment, but expired 48 hours after the onset of symptoms. Both cases appeared within a 2-day period.
Measles acquired in utero has a broad spectrum of illness, ranging from mild to rapidly fatal disease. We encountered two case of perinatal measles during the 1982 epidemic. In both cases the mother became febrile 4 to 5 days before admission, and a typical morbilliform rash appeared a few hours prior to delivery. Physical examination of both infants was within normal limits. They were each treated with human serum globulin (0.25 ml/kg body weight). In one of them, a maculopapular rash appeared on the neck after 5 days, which rapidly spread to all the body. No catarrhal or constitutional signs were noted. Hyperbilirubinemia occurred in both infants, requiring an exchange transfusion in one. Both were discharged in excellent condition. Viral cultures were negative in both infants, while serological studies revealed hemagglutination inhibition antibodies in rising titers.
A fetal tachyarrhythmia was discovered at the thirty-second week of gestation of a 22-year old woman. Fetal echocardiography revealed atrial fibrillation with rapid ventricular rate, without any other demonstrable cardiac abnormality. In spite of therapeutic maternal blood levels of digoxin, the fetal ventricular rate and cardiac size increased, which prompted us to perform cesarean section at the thirty-fourth week of gestation. A baby with a Wolff-Parkinson-White syndrome but no other cardiac anomaly was delivered. Recurrent episodes of nonsustained atrial fibrillation with conduction over the accessory pathway occurred in the first hours of life. The Wolff-Parkinson-White pattern was not present on subsequent ECG recordings. The use of echocardiography in the diagnosis and management of this rare fetal tachyarrhythmia is emphasized.