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'Microgastria--limb reduction' complex with congenital heart disease and twinning.

We report a newborn, the second of male twins, with multiple abnormalities, including microphthalmia, a complex cardiovascular malformation, asplenia, anomalous lobation of the lungs, oesophageal atresia, microgastria, intestinal malrotation, anal atresia, multicystic dysplastic kidneys, and reduction defects of the upper extremities. These defects fit into the so-called 'microgastria-limb reduction' complex. Two of twelve previously reported patients with this complex were from discordant twin pairs. The occurrence of twinning in three out of 13 cases suggests that the origin of the 'microgastria-limb reduction' complex may be related to the process of twinning itself.

Abnormalities, Multiple↗

An experimental animal model of intestinal obstruction to simulate in utero therapy for jejunoileal atresia.

OBJECTIVE: To obtain 'intestinal atresia-like' conditions in the fetal lamb model to subsequently allow in utero surgical repair. METHODS: Six time-dated pregnant sheep underwent general anesthesia at 75 days of gestation (term 145 +/- 5 days). After maternal laparotomy and hysterotomy, the fetal abdomen was opened. Once the jejunoileal intestinal loop was identified, the mesenteric vessels were isolated, ligated, and sectioned in 2 fetuses, and in the remaining 5 fetuses the bowel loop was ligated. Two further fetuses were used as controls and underwent sole laparotomy. Of the group of 7 fetuses 2 were reoperated at 100-105 days of gestational age and underwent intestinal recanalization. Eight fetuses were delivered at term by cesarean section and the remaining 1 by spontaneous delivery. One newborn underwent neonatal entero-enteric anastomosis. RESULTS: 4 out of 6 fetuses survived, in utero intestinal or vascular ligation having provoked an 'intestinal atresia-like' picture. The animal operated at birth died. The 2 control fetuses and the 2 fetuses with in utero intestinal recanalization survived until term. CONCLUSION: The present study shows that in utero treatment of intestinal obstruction is possible in an experimental model.

Animals↗

ILEAL ATRESIA.

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Humans↗

[Subtotal resection of the small intestine in newborn infants and infants. Results of an inquiry].

A circular was sent to eight clinics and 36 cases of children with extensive resections of the small intestine are reported. The reasons for the resections of the intestine were atresia and stenosis in the largest number of cases, then volvulus and lastly necrotizing enteritis. The residual intestine was measured with the measuring tape in only eight cases. The method of measurement in the other cases was not given. Surgery was unilateral in 26 cases and bilateral in ten. Surgical measures to slow passage were not used. The most frequent single causes of death were sepsis or pulmonary complications. The cause of death was a true malabsorption in only two cases. The main difficulties in the postoperative phase are ensuring adequate parenteral uptake of calories and the complications due to cava-catheter sepsis.

Age Factors↗

[Small bowel stenoses as a consequence of intrauterine transfusion (author's transl)].

An infant is reported who, because of Rhesus incompatibility, required 4 antenatal blood transfusions. At the last of these transfusions performed during the 30th week of pregnancy, the catheter could not be removed and was left in the foetus's abdomen. Two weeks later, spontaneous delivery of an 1820 gm. male infant resulted. He had to be operated on on the 2nd day of life because of small bowel atresia, which was caused by two severe intestinal strictures which had been produced by the catheter. Following removal of the catheter and resection of the strictures, the post-operative course was essentially uneventful.

Adult↗

180 Degrees rotated intestinal anastomosis for jejunoileal atresia in neonates - a preliminary study.

The authors report the results of a preliminary study of a new technique of 180 degrees rotated anastomosis carried out as a primary anastomosis for ten neonates with jejunoileal atresia. The details of the technique are illustrated. The advantages of this technique over the conventional end-to-back anastomosis are discussed. A comparative analysis shows improved results compared to the conventional anastomosis.

Anastomosis, Surgical↗