Fifty-four neonates transferred to the neonatal surgical unit because of acute necrotising enterocolitis (N.E.C.) are presented. Eleven died (20.4%), of whom seven were treated conservatively and four by operation. Ten patients required surgical exploration because of intestinal perforation, obstruction or suspected perforation. Another five neonates presented with intestinal perforation and were treated by percutaneous catheter drainage of the peritoneal cavity because of their extreme prematurity. Nine patients developed a colonic stricture diagnosed between six weeks and a year after the onset of the disease. Another six patients showed a segment of colonic narrowing detected on barium enema radiography without clinical evidence of bowel obstruction. They were treated conservatively and showed complete resolution at follow up studies.
Ten infants presented with choanal atresia. Four showed 4 or more components of CHARGE association, 3 of whom died before the age of 2 months while infants with choanal atresia but not having other features of CHARGE association survived. The combination of choanal atresia and heart disease carries a very high risk.
110 patients presenting to the Royal Hospital for Sick Children, Glasgow and the Paediatric Unit at Stobhill Hospital, Glasgow in the decade 1971 to 1980 were studied retrospectively. All patients had progressive hydrocephalus but excluded from consideration were patients with neural tube defects such as myelomeningocele and encephalocele. The aetiology, clinical course and outcome have been studied. The mortality was 17.2% in the first year of life and the overall mortality was 28.2%.
The results of treatment of 45 patients with nephroblastoma in the period 1953–1968 are presented. The overall three year survival rate is 27% while for those given radiotherapy and repeated courses of Actinomycin D following operation the three year survival rate is 40%. The results reported from other centres are discussed.
An animal model in which part of the pancreas was made diabetic due to almost total loss of insulin-secreting B cells, while the remainder of the gland remained normal, is described. In rabbits, a vascular clamp was placed across the junction of the body and tail of the pancreas, thus occluding the circulation to the tail. Alloxan (200 mg/kg) was injected i.v., and 4 min later dextrose (0.5 g/kg) was given by the same route. After a further 2 min the clamp was removed. Thirty-four animals were studied, 17 of which died in the first postoperative week of surgical complications or of alloxan-induced toxicity to the liver and kidneys. The survivors were killed between 4 and 12 weeks after surgery and were not metabolically diabetic. They had a virtually complete absence of B cells but a normal population of A, D, and PP cells in the head and body of the pancreas. The islets in the tail of the pancreas appeared entirely normal. This model appears suitable for studying the effects of locally produced insulin on pancreatic exocrine function in metabolically normal animals.
EI~OGH-SCI~(3i'~I,~Ii~1 disease is a well recognized pitfall in the differential diagnosis of acute abdominal emergencies. In reviewing the alimentary lesions in this disorder Balf (1951) concluded-&dquo; they appear to be of transitory importance only and there is no record of progression to chronic disease of the bowel.&dquo; The rarity of surgical complications has been confirmed by Phelan (1961). The following case appears to be the first full account in the English literature describing chronic small bowel obstruction after an attack of HenochSch6filein purpura. CASE .~'I~S ~'t~ ~R ~rA five-year-old boy was admitted April 14, 1962 with a history of pain in both knees for three days and pain in the abdomen and lumbar area commencing on the day of admission. Lumbar pain was the most striking symptom; any back movement caused the child to scream. He had no serious illness in the past. In the two months preceding admission he had intermittent attacks of abdominal pain and vomiting but on each occasion had completely recovered within 24 hours. At no time prior to admission had his abdomen been distended.On admission. He was a thin boy; temperature 99.4' F.; pulse rate 124/min.; respiration rate 2fiJ . min. He did not appear very ill yet resented any movement and all attempts at examination. Both knees and the right arm, especially in the elbow region, were swollen. There was a swelling over the dorsi-lumbar region of the spine with marked tenderness and rigidity.A clinical diagnosis of osteitis was made and penicillin therapy commenced. Investigations performed on admission wereHb.-10~~j~. 6V.B.C.-16,O~OJcu. mm. E.S.R.-5 mm. in 1st hour, 18 mm. in 2nd hour.Blood culture-----ne~ative. X-ray of right humerus and elbow and of spine -no abnormality noted other than soft tissue swelling around elbow joint. The following day he seemed a little better but his eyes were puffy and he passed a large, dark, loose stool. It was presumed to contain blood but was disposed of before this was confirmed. W.B.C.were now 13,000/cu. mm. E.S.R. 18 mm. in 1st hour, 45 mm. in 2nd hour.That night, i.e., 30 hours after admission, the child passed dark urine due to gross hematuria (prior to this there had been none). He also developed a purpuric rash over the buttocks, making the correct diagnosis obvioiis-Hefioch-Sch6nlein disease. During the next 12 hours he complained frequently of abdominal pain and had tenderness in the left side of the abdomen but no palpable mass. Radiography of abdomen showed fullness in the left flank (? extraperitoneal hematoma) but the distribution of gas in the abdomen was within normal limits.He was then transferred to the medical wards under the care of Dr. R. A. Shanks. He continued to have intermittent colicky abdominal pain and vomiting, occasional low grade fever, hematuria, proteinuria and positive tests for fecal occult blood at University of Manitoba Libraries on June 16, 2015 cpj.sagepub.com Downloaded from
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