A case of ectopia cordis abdominalis occurred in our service at St. Vincent's Infant and Maternity Hospital recently. REPORT OF CASEHistory and Course.\p=m-\Themother, S. F., a primipara aged 23 years, entered the hospital Sept. 15, 1941, in active labor. She came under observation for prenatal care May 23, 1941, and the course of the pregnancy was normal. Her blood pressure and urine were normal on repeated examination, and her Kahn reaction was negative. Her pelvic measurements were adequate and the estimated date of delivery was October 24. At the onset of labor, a diagnosis of placenta praevia marginalis was made, and Drs. J. X. Bremner and A. C. Wise after manual cervical dilation made a midforceps delivery.In the mother's family history there was no known instance of congenital defect. The father had a niece with a congenital cardiac lesion. At birth, P. F., a girl weighed 5 pounds 12\m=1/2\ounces (2,522 Gm.) The first recorded axillary temperature was 97.6 F. There was considerable mucus, which had to be aspirated with a trachéal catheter before the infant could breathe. The cry was weak. There were no abnormalities except those associated with the heart and the anterior abdominal wall. A ventral hernia ( fig. 1), approximately 6 by 6 cm., extended from the xiphoid process to a point caudad to and including the umbilicus. Its lateral borders were the rectus abdominis muscles. The sternum was normally fused. The skin overlying the hernia was darker than the sur¬ rounding skin, was thin and stretched and contained small distended blood vessels. The lower border of the darkened skin included the umbilicus. Immediately adjacent to the umbilical cord the skin was ecchymotic. The hernial sac included in its upper portion, a visible and palpable pulsating firm mass identified as a ventricle, probably the left. Loops of compressible bowel were visible and palpable through the thin hernial wall in the lower portion. Heart sounds were heard loudest over the pulsating mass but could also be heard in the usual precordial area. No murmur was detected at this time.The infant was placed in a heated crib, and the pulsating hernial mass was covered only lightly with sterile gauze. On September 26, the eleventh day of life, the cord came off and at its site a flat 5 cm. crust was left which in ten days healed, leaving a smooth scar.
CHICAGOPericarditis as the first clinical manifestation of active tuberculosis in childhood is rare. A careful review of the literature failed to reveal the report of such a case diagnosed during life.Waller 1 reported a case in which postmortem examination showed that the pericarditis was tuberculous ; tuberculous pericarditis as a postmortem observation is not a great rarity.2 Many cases of chronic phthisis reveal an adhesive pericarditis at autopsy, and in generalized miliary tuberculosis the pericardium is not infrequently involved along with other serous membranes. Norris 3 collected data on 1,780 cases of tuberculosis from various hospitals ; eighty-two cases of tuberculous pericarditis were found, thirty-two in which there were actual tubercles, and forty-nine in which tubercles or any other demonstrable etiology was not found. Machlachlan4 reviewed 975 autopsies in which 100 cases of pericardial involvement of one type or another were included; ten per cent of these were on a tuberculous basis. Wells 5 made a study of 1,048 autopsies made on adults with a view to determine the pathogenesis of healed fibrous adhesions of the pericardium. He found inflammatory changes in the pericardium in 128, while fifty-seven presented chronic inflammatory changes which had resulted in fibrous adhesions joining the two layers. The remaining seventy-one of the number examined had had an acute condition. In eight patients the condition had been of the chronic type on a rheumatic basis; in six.
There is a constant and striking difference in the bacteriologic findings in the stool of the breast-fed and the artificially fed infant. In the stool of the former gram-positive bacilli predominate, while in that of the latter 1 gram-negative, morphologically dissimilar organisms are in excess.To ascertain the significance of this variation and its importance in the problem of infant feeding were the objectives of this investigation. The introductory phase\p=m-\thestudy of lysozyme in human milk and its relation to the bacterial flora of the milk\p=m-\was begun in 1934 and is the subject of this paper.In 1931 Rosenthal and Lieberman 2 reported the influence of lysozyme in the development of the intestinal flora of infants. They found a lytic principle in the stools of nurslings which they tested against cultures of gram-positive sarcinas. It was inactivated by heating at 65 C. for one and a half hours or by boiling for three minutes. Rosenthal and Lieberman identified this substance as lysozyme. It was absent from the stools of artificially fed infants and from the meconium of nurslings for the first two days, but it was constantly present after the fourth day in the stools of breast-fed babies. Lysozyme was present in all samples of colostrum and breast milk but absent from cows' milk and from the modified milk commonly used in feeding infants. It inhibited growth of Bacillus coli at 37 C, and the organism was lvsed at 56 C. Bacillus bifidus was not disintegrated by lysozyme. Rosenthal and Lieberman concluded that lysozyme tends to stabilize the grampositive intestinal flora of nurslings. term "lysozyme" to this substance, which he found in all human tissues and secretions except in normal urine, cerebrospinal fluid and sweat. It was also present in animal tissues, egg white and turnips.Its characteristic quality was the dissolution of live bacteria in culture. It lysed 75 per cent of one hundred and four strains of bacteria obtained from the air, seven of eight pathogenic organisms, twelve of eighteen strains of intestinal streptococci, B. coli and typhoid bacilli.Fleming observed that lysozyme was soluble in water and in physio¬ logic solution of sodium chloride but insoluble in chloroform, ether and toluene. Lysozyme retained its potency at room temperature, remained active when dried in egg white and was precipitated from albuminous fluids by protein précipitants. Its activity was destroyed by a 5 per cent solution of sodium chloride. The lytic effect was most pronounced at a />h of 7. The thermostability of lysozyme differed somewhat, depend¬ ing on the source of the substance, only seven and a half minutes at 75 C. being necessary to destroy its action in saliva, while it took one hour of boiling to destroy its action in tears. Its optimum activation occurred at 60 C. It did not pass through a collodion membrane and was adsorbed by a porcelain filter, cotton wool, filter paper and charcoal.In a later observation, Fleming and Allison 4 stated that with Micrococcus lysodeikticus as an indicator suspensions ...
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