Introduction: Small bowel atresia (SBA) is one of the most common causes of congenital intestinal obstruction. However, the accuracy of prenatal ultrasound in diagnosing this condition has not been entirely ascertained. The aim of this study was to analyse the predictive accuracy of ultrasound in detecting SBA prenatally. Methodology: Retrospective study of all cases with prenatal suspicion or postnatal confirmed SBA seen in a tertiary fetal medicine and pediatric surgery units from 2007 to 2013. Cases with duodenal atresia were excluded from the study. The predictive accuracy of ultrasound and different ultrasound signs, alone and in combination, was calculated. Results: 65 fetuses with prenatal suspicion or postnatal confirmed SBA were enrolled. 58 cases had full data and were included in the analysis. Predictive accuracy of ultrasound in detecting the presence of SBA was poor, with a sensitivity of 50% (95% CI 26.0-74.0) and a specificity of 70.59% (95% CI 52.5-84.9). The presence of both bowel dilatation ≥17 mm and polyhydramnios after 32 weeks of gestation slightly increased sensitivity (66.67%, 95% CI 34.9-90.1) and specificity (80.00%, 95% CI 44.4-97.5). Conclusions: In case of suspicion of SBA before the 3rd trimester, an ultrasound after 32 weeks should be performed to confirm the presence of both polyhydramnios and bowel dilatation >17 mm.
A herd of cattle which produces calves with generalised glycogenosis type II has been established. Seven affected animals have been born and their disease status as indicated by a decreased acid alpha-glucosidase activity and excessive glycogen deposition in muscle, can be detected on the day of birth. Two animals have died of heart failure aged 3 and 5 months and have shown cardiomegally. Five animals were clinically normal until 9 months of age when they failed to maintain weight gain, showed muscle weakness and four were killed aged between 12 and 16 months after showing difficulty in rising. All affected animals had abnormal ECG tracings and had elevated levels of CK, LDH and HBDH in serum. Excessive amounts of glycogen were deposited in voluntary, cardiac and smooth muscle, and in cells of the nervous system. The muscles showed a vacuolar myopathy. Both the infantile and late onset forms of generalised glycogenosis type II are present in this herd of cattle. The condition appears to be controlled by a recessive allele at a single autosomal locus.
The screen-detected incidences of IRA and acute midgut volvulus were significantly greater in heterotaxy than the normal population. Prophylactic Ladd procedure was associated with less morbidity and mortality compared with emergency surgery. A long-term prospective randomized trial is needed to define the indication for screening and prophylactic treatment of IRA in heterotaxy.
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