Biomedical subjects
Publications and source records attributed to D G Marshall.
This is a report of a premature infant presenting with an esophageal atresia. At surgery it was realized that there was no posterior mediastinum and a single pleural cavity only. Other serious congenital anomalies were present. She died rather suddenly upon cessation of her prostaglandin E 1 at 34 days of life.
Here reported is an 11-week-old female infant with an incarcerated left direct inguinal hernia containing uterus, both ovaries, and fallopian tubes. An excision of the sac and back wall repair through the external ring was done.
Two teenage boys were treated at separate pediatric institutions for four separate pheochromocytomas over the last 15 years. The first operation in each boy was performed between 9 and 11 years of age, after they presented with severe hypertensive encephalopathy. One boy had separate adrenal tumors excised in 1968, and 3 and 11 years later, two more separate new left adrenal pheochromocytomas were again resected. They were not recurrent left adrenal tumors from residual pheochromocytoma-secreting tissue, because no visible tumor tissue was left behind at the completion of each previous operation, and he was clinically well for years between each tumor resection. The pathology was benign pheochromocytoma. He remains well since the last operation in 1979 but has a residual hemiplegia from the first tumor. The family history is negative. The second boy was first operated on in 1976 at age 11 years when two benign pheochromocytomas were removed from around the right renal artery and the left para-aortic area. He remained well for 6 years when he became hypertensive again (this time without encephalopathy), and had a right chest paravertebral pheochromocytoma removed and several weeks later a left adrenal tumor was also removed. He remains well and followed closely. His family history is negative.
Bile ascites is a rare cause of mild icterus and abdominal distension in the newborn. An indirect inguinal hernia may also occur. The authors report such a case in a 5-week-old infant. Proof was obtained by abdominal ultrasonography followed by scanning with N-(2,6-dimethyl phenyl carboxymethyl) iminodiacetic acid labelled with technetium 99m (99mTc HIDA) and paracentesis. Laparotomy was carried out at 7 weeks of age and the opening in the common bile duct was closed with excellent results.
Ten cases of primary peritonitis in children demonstrate that the usual presentation is one of rapid onset of lower abdominal pain in girls, clinically indistinguishable from acute appendicitis. Recovery after appendectomy is rapid. Fewer cases have positive peritoneal cultures or associated illnesses than in historical descriptions. Contemporary primary peritonitis follows a more benign course than in the past.
This is a report of a personal series of 10 children seen with femoral hernias over a 15-yr-period. Femoral hernia in this age group is rare and a correct preoperative diagnosis is often overlooked. In nine of the 10 patients the preoperative diagnosis was correct. We attribute this to an accurate clinical examination and the awareness of this entity in the differential diagnosis of a groin lump.
Intussusception in the newborn is a unique clinical entity, and one of the most unusual causes of intestinal obstruction in infants. Its cause can be idiopathic, secondary to a local lesion or a complication of disease. Early diagnosis and treatment are important, because survival depends on them. The authors report a case of jejunal atresia secondary to intrauterine intussusception, followed by a literature review. Less than 30 cases have been adequately documented in the world literature. Eight reports from the literature are selected to highlight clues for early diagnosis, such as vomiting, with or without bile, abdominal distension and bloody stools, because of their prognostic implications. Intussusception is rare under the age of 3 months; the incidence is 0.3% in the neonatal period. Previous reports indicate that a confusing clinical picture has led to a delay in operation and a high mortality. The ultimate outcome depends on an acute awareness of the condition in the presence of the diagnostic clues in a newborn.
Three children with testicular feminization syndrome have been seen in the past 4 yr. Each presented with at least one large inguinal hernia. The gonad was proven to be a testis by frozen section. Gonadectomy and herniorrhaphy were done. The plan is to remove the second gonad after puberty. The causation and genetics of this condition are briefly discussed.
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Direct inguinal hernias in otherwise well children are very infrequent. Two cases are reported in boys who previously had an indirect inguinal hernia repaired. In neither case had the cord been raised in the initial operation. A back wall repair in each has been satisfactory with no recurrence.
An unusual instance of a very large primary leimyosarcoma of the chest wall is presented. It was asymptomatic but a swelling had been noted between the left clavicle and nipple by the parents. Chest x-ray showed a massive tumor with mediastinal involvement. Preliminary biopsy indicated a leiomyosarcoma. Wide an bloc excision of the chest wall was done, including much of the 1, 2, and 3 ribs and a piece of lung. The defect was closed with Marlex mesh and covered with a U-shaped flap of pectoralis major muscle and skin. There were 4000 rads of radiotherapy plus 15 mo of chemotherapy added. To date, she remains clinically well and apparently tumor-free.
During 1974 and 1975, five newborn infants weighing between 760 and 1600 g developed severe intraabdominal complications of NEC due to necrotic bowel with perforation and peritonitis. Because these tiny neonates were very ill with sepsis and other severe medical problems, no attempt at laparotomy under general anesthesia was carried out. Instead, using local anesthesia, the contaminated peritoneal cavity was drained via a small incision, usually in the right lower quadrant. This permitted evacuation of air, pus, and stool. In all babies there was improvement evident in the abdomen within one wk, although two of the five newborns died from other causes. The three survivors are well and have normally functioning intestinal tracts 1-2 yr following surgery. One of these surviving babies developed a bowel stricture which subsequently required resection. We feel this method is preferable in the handling of the tiny sick neonate with a bowel perforation from NEC.
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BACKGROUND: A strain-variable transfer RNA-associated-locus (trl) was present in 50% of Irish Helicobacter pylori (H. pylori), isolates and did not correlate with the origin of the isolates. AIM: To associate a particular genotype or phenotype to trl status in H. pylori by further screening the isolates from the original study for the presence of known genotypic and phenotypic characteristics. METHODS: Forty two clinical isolates were screened for the presence of the cagA, vacA, iceA1 and vapD genes by Southern or DNA dot blot analysis. Western blot analysis was performed using antibodies to CagA, VacA, Lewis X (Le(x)) and Lewis Y (Le(y)). Plasmids were identified by the alkaline lysis method. RESULTS: The cagA gene was present in 29 (69%) of isolates screened and 21 (50%) produced the CagA protein. The vacA gene was detected in all of the isolates while VacA was expressed in 71.4%. The iceA1 and vapD loci were detected in 73.8% and 71.4% respectively. Le(x) was expressed in 42.9% and Le(y) in 38.1% of the isolates. Expression of both Lewis antigens was detected in 7.1% while in 30.9% neither antigen was detected. Plasmids were present in 47.6%. There was no association between the trl status of isolates and any of the above. There were no significant associations between the phenotypic and genotypic characteristics studied and peptic ulcer disease or non-ulcer dyspepsia. CONCLUSION: The strain-variable tRNA-associated locus is independent of the vacA/VacA, cagA/CagA, Lewis X, Lewis Y, iceA1, vapD and plasmid status in the population of Irish H. pylori isolates studied.