Biomedical subjects
Publications and source records attributed to L Spitz.
A child who developed apneic spells during feeding, following repair of oesophageal atresia is reported. Symptoms were relieved by suspending the aortic arch to the undersurface of the sternum. Tracheomalacia, its diagnostic and management is discussed.
Thirteen infants with haematemesis associated with hypertrophic pyloric stenosis were investigated in order to elucidate the source of bleeding. All 13 patients showed endoscopic evidence of oesophagitis, moderate in 4 and severe in 9. No significant gastric mucosal lesion was found. It was concluded that the site of the haemorrhage was the oesophageal mucosa in all 13 infants. Eleven of the patients experienced troublesome postoperative vomiting.
The number of glands at a constant level within the wall of the common bile duct was measured in the foetus, infant, child and adult. The number of glandular acini increases from foetal life to reach a maximum within the 1st year of life. Thereafter it remains remarkably constant. This is in contrast to the lumen and wall of the common bile duct which only reaches adult proportions in adult life. Conversely, the density of acini within the wall of the common bile duct is at a peak in early foetal life and decreases progressively throughout infancy and childhood.
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An analysis of the factors which may predispose towards postoperative vomiting after pyloromyotomy for hypertrophic pyloric stenosis was carried out in 72 infants at this hospital. 26 (36%) infants experienced moderate to severe postoperative vomiting of sufficient intensity to cause the postoperative feeding regimen to be modified or interrupted. Only two parameters were found to be of statistical significance. These were the state of the oesophageal mucous membrane on endoscopical examination and the presence of haematemesis in the preoperative period. No evidence for a gastric mucosal lesion could be found. An advanced oesophageal mucosal lesion was found in 30% of patients, and this was the source of the haemorrhage in all 11 in whom haematemesis was noted postoperatively. The stay in hospital was prolonged (8 days) in those infants with troublesome vomiting postoperatively compared with those with lesser problems (3 days).
Gastric biopsies from 35 infants with hypertrophic pyloric stenosis have been assessed for histological features of gastritis. No erosions were found, and there was no excess cellular infiltration of the lamina propria compared with a control group. Fresh haemorrhage into the lamina propria was frequent in both pyloric stenosis and control sections.
Another example of neonatal appendicitis is presented, and the clinical details of 33 cases previously documented in the literature are reviewed. This rare condition is characterized by an inordinate delay in diagnosis, a high incidence of perforation of the appendix and a high mortality.
We report on experience gained in the treatment of 158 cases of oesophageal atresia presenting during a period of 10 years. The factors influencing mortality were analysed. During the period studied there was a slight improvement in survival, and this was probably due mainly to improved preoperative preparation of those babies undergoing primary repair. At best, 'staging' was thought to have had little influence on the survival of poor risk cases. Midwives, obstetricians, paediatricians, surgeons, and general practitioners did not do all that they could have done to prevent morbidity and mortality in these babies. At least one-third of the 79 deaths could have been prevented, and several deaths were caused solely by lack of awareness of the possible complications and associated abnormalities.
From the review of the literature it would seem that excision as the most appropriate method of treatment is generally preferred to the internal drainage procedures. Despite the strong arguments in favor of primary excision, approximately two-thirds of patients undergoing Rouxen-Y choledochocystojejunostomy experience excellent results in both the short and long term follow-up periods. There is much to be said for recommending the Roux-en-Y choledochocystojejunostomy as the primary method of treatment of choledochal cysts, especially when the procedure is undertaken by inexperienced surgeons, and to reserve excision for those patients who have complications.
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The ultimobranchial gland (UBG) is an endocrine gland which contributes C cells to the thyroid gland in mammals. Dysembryonic tissues derived from the UBG have been described as cystic bodies. The following case illustrates the criteria which characterize dysembryogenesis of the UBG.
A reliable experimental model for the study of cystic dilatation of the extrahepatic biliary system has been produced purely by ligation of the distal end of the common bile duct in the newborn lamb. Six of nine experimental lambs surviving the immediate postoperative period lived for periods ranging from 27 to 40 days. All six developed cystic dilatation of the common bile duct.
In a series of 241 amniograms, there were two cases of fetal tissue damage resulting from the subcutaneous injection of contrast material. Details of these two cases are given and the damage sustained illustrated. Measures designed to prevent such complications are outlined, together with recommendations for its management, should such a complication occur.
The hazard of ingestion of a beverage can top in a child is presented. These can tops are susprisingly low radio density and their presence can be overlooked on a conventional P.A. X ray of the chest. In such cases a lateral radiograph of the chest should be included in the routine investigation of the child.
Twelve infants with necrotizing enterocolitis were treated surgically in the 2 year period from 1973 to 1974. Resection of gangrenous intestine and proximal enterostomy was preferred in 11 patients. There were four deaths: two were grossly premature infants, one died from electrolyte disturbances related to the proximal enterostomy, and one was an apparent cot death. Intravenous nutrition was used routinely in all cases in the postoperative period. The problems of recommencement of enteral feeding and ileostomy dysfunction are discussed briefly.
Ninety-six cases of exomphalos or gastroschisis managed at The children's Hospital, Sheffield, during the period 1964-74 are analysed. There were 306 cases with minor lesions, 30 with major lesions, 27 with a ruptured exomphalos and only 3 with gastroschisis. The overall mortality rate was 46-9 percent. Survival could be closely correlated with the birth weight, the nature of the primary lesion, the presence or absence of liver within the sac and the presence and severity of associated congenital anomalies. A "scoring system" based on these criteria is proposed to predict the prognosis of an infant with an exomphalos.
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The Cincinnati General Hospital Emergency Department has a training program for emergency medicine residents on a multidisciplinary emergency psychiatry team. This essential training should occur in the emergency department setting rather than in psychiatric inpatient units of state hospital settings. There are advantages and disadvantages to this arrangement. Nonmedical members of the emergency psychiatry team train and support emergency medicine residents in a multidisciplinary approach to treatment. Some observations are made about how the emergency medicine residents deal with emotionally disturbed patients. Finally, 80% of emergency medicine residents responded to questionnaire on their reactions to the multidisciplinary emergency psychiatry team.