Fairer pay for consultants?--Clinical-judgment battle--Oriental service.
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Biomedical subjects
Publications and source records attributed to J Lister.
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In a neonate with exsanguinating intraperitoneal bleeding admitted with a provisional diagnosis of ruptured liver due to birth trauma, laparotomy revealed the source of hemorrhage to be an adrenal neuroblastoma. This case prompted a review of cases of abdominal neuroblastoma admitted to the Neonatal Surgical Unit in Alder Hey Children's Hospital from 1953 to 1976. The features of 10 cases are presented: in three of them there was hemorrhage into the tumor. Of the 10 cases, six survived tumor free from 2 to 12 yr and there is one short-term survivor. The purpose of this presentation is to emphasize the possibility of an underlying neuroblastoma in cases of neonatal adrenal hemorrhage and also the relatively good prognosis in neuroblastoma presenting in the neonatal period.
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Identical male twins are described, one of whom presented with clinical symptoms of Addison's disease whereas the other was shown to have a deficient adrenal cortical response to stimulation tests. Both had positive adrenal cortex antibodies.
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Forty-six cases of neonatal necrotizing enterocolitis are reported, with a 46% mortality rate. Unlike most other series, low birth weight children accounted for only half the cases. The recognized initiating factors of hypoxia and hemodynamic changes were not always present. A high index of suspicion in the child with non-specific malaise and earlier positive diagnosis provide the most likely means of improving results.
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