Biörn Ivemark

Implications of Agenesis of the Spleen on the Pathogenesis of Conotruncus Anomalies in Childhood

Six embryos measuring 9–12 mm in greatest length have been shown by the writer to contain early splenic primordia in the left aspect of the dorsal mesogastrium. Their ovulation age is estimated to be 31–36 days. Temporal relations of splenic formation to conotruncus septation and division of the A‐V canal have been discussed. This last is divided before septation of the conotruncus is completed. The author has shown that early splenic primordia exist at the time of fusion of the A‐V canal cushions. At the same time there is initiation of pulmonary lobation, and there is a primitive gut mesentery.

Juvenile Nephronophthisis. Part II A Histologic and Microangiographic Study

The renal changes in fatal cases of familial juvenile nephronophthisis have been described previously (Fanconi et al., 1951, Hackzell & Lundmark, 1958, and Hooft et al., 1959). The changes were regarded as being due to a diffuse renal contraction. No morphologic evidence of congenital defects in the kidney was given by any of these authors. I n the present paper, the renal pathology of two fatal cases of this disease will be described. The clinical features have been presented in the report by Broberger, Winberg & Zetterstrom in this issue (Cases 2 and 3). Evidence will be presented to show that there is a characteristic lesion of the descending and ascending limbs of the loop of Henle. This defect is associated with a cortical atrophy which is considered t o be secondary to the tubular lesions. I n view of the tendency of this disease to occur as a familial trait, it seems probable that the tubular defect has a congenital basis.

Generalized Arterial Calcification Associated with Hydramnios in Two Stillborn Infants

Histologic, microradiographic and X‐ray crystallographic findings are recorded in two stillborn infants with idiopathic generalized arterial calcification, in one of which there was also nephrocalcinosis. The mineral salt deposits consisted solely of hydroxyapatite and was regarded as metastatic. In both cases there was hydramnios. Since 5 out of 7 known cases of neonatal idiopathic arterial calcification had hydramnios the possibility of a causal connection cannot be ruled out.

Obscure cardiomyopathies with coronary artery changes

Abstract A series of patients with suspected cardiomyopathy were investigated by coronary angiography. Thirteen of them had coronary arteriograms suggesting more or less extensive coronary involvement of the type demonstrated by markedly straight and narrow branches of both main coronary arteries. One of these patients had established Friedreichs disease and another had three sisters affected by this neurologic disease. The coronary angiographie findings in these 2 patients were indistinguishable from those of the remaining 11. A special histopathologic examination in 1 of the 5 deceased patients (all from the group of 11) disclosed widely distributed medial changes in the medium-sized and small coronary arteries and fibrotic involvement of the myocardium of the same appearance as described in cases of Friedreichs disease or other heritable diseases. Thus a possibility exists that a similar coronary arteriopathy is responsible for the angiographie pattern of all patients in the present series. Various types of cardiac arrhythmias, occurring paroxysmally or persistently, conduction disturbances, and in a few cases cardiac failure as well as chest pain, were the main causes of symptoms, except in 3 patients who were free of symptoms. No conclusive correlation could be established between electrocardiographic abnormalities (including ST-T changes in a few patients) and the extent and distribution of the coronary involvement on the arteriograms. The arrhythmias were, with one exception, resistant to the usual therapy. Hemodynamic (in 4 patients) and other laboratory investigations were unrewarding concerning the pathogenesis. Five of the 13 patients died (4 in ventricular fibrillation and 1 in congestive heart failure) during a relatively short follow-up period.

The Vasculature of the Developing and Mature Human Adrenal Gland

As was shown by Kolliker in 1854 [6], the adrenal gland in man is supplied by arteries that divide outside the capsule into a number of branches which pass through the capsule and ramify centripetally in the cortex and medulla. The complexity of the vascular supply of the adrenal glands [lo] is manifested in the difficulty of diagnosing pathologic conditions in the glands by angiography. From an article by Lever [8] i t is evident that the vascular pattern of the fully developed gland is similar in most mammals. No study seems to have been made, however, of the development of the vascular architecture during the preand postnatal growth of the adrenals. In the course of a study of the neoplastic changes in the adrenal glands the need for comparison with the normal microangiographic vascular pattern was recognized [3]. The investigation was accordingly extended to cover the development of the adrenal glands.

Generalized herpes simplex infection associated with staphylococcal septicemia in a newborn infant.

The clinical and autopsy findings in a female newborn infant who expired at an age of 15 days from a generalized herpes simplex infection associated with septicemia due to Staphylococcus aureus have been reported. The source of the herpetic infection which probably started as an ulcerative esophagitis remains unknown. The diagnosis of generalized viral infection was established from virologic studies of liver and brain tissue and from the demonstration of intranuclear inclusion bodies in the esophagus, myocardium, liver, spleen, adrenal glands and brain.

ASCENDING INFECTION IN LABOUR. ITS EFFECT ON MOTHER AND CHILD

The risk of intra-uterine infection in the newborn child was pointed out at the end of last century (Kiistner, 1877; Geyl, 1880). In 1915, Slemons reported bacteria in the subamniotic space at the attachment of the umbilical cord after prolonged labour. Douglas and Stander (1943) showed that mortality and morbidity among infants are higher the longer the course of labour. They stressed the significance of infections in this connection. The therapeutic and prophylactic use of chemotherapy and antibiotics during labour has been recommended by many authors (FihrCus, 1946; Keettel and Plass, 1950; Siddal, 1950; von Friesen, 1951; and others). The studies reported by these authors, however, were based on comparisons of treated and untreated cases and were incomplete from the bacteriological aspect. A leading article in The Lancet in 1955 stated that insufficient attention has been paid to the role of intra-uterine infection in perinatal mortality. In histological studies of stillborn infants and neonatal deaths Labate (1947) found signs of infection in 8 per cent of 868 cases and Corner et al. (1951) in 6.6 per cent of 1,233 cases. Penner and McInnis (1955) were able to cultivate bacteria from the lungs of infants dying as a result of prolonged labour. The most commonly encountered bacteria ac

Infection of the foetus during labour.

S. Jaykka, Finland. I would like to contribute to our knowledge of circulation conditions in the lungs with a few anatomical data: According t o v. Hayek, there is a ))short circuit)) past the capillaries. I t travels via pulmobronchial anastomosis and flows into the venous plexus of the bronchus under the mucosa. If Indian ink is injected into the pulmonary artery in a ))respiratory distress)) lung i t can be seen to travel via w. Hayek’s short circuit)) in the atelectatic parts of the lung. I t seems to me tha t theoretically artificial respiration is hardly beneficial for impaired diffusion when the capillaries are not perfused. Ventilation may be justified when the child has apnoea. I would, however, prefer for theoretical reasons Ylppo’s old method of applying oxygen via the digestive tract.

Diffuse Interstitial Pulmonary Fibrosis (Hamman–Rich Syndrome) in Infancy: Report of a Case with Histologic and Respiratory Studies

The case of a 7‐month‐old girl with diffuse interstitial pulmonary fibrosis is reported. Signs of progressive respiratory distress with cough and cyanosis started at 1 month of age. Respiratory studies revealed a markedly decreased lung‐compliance, normal or slightly elevated residual lung volume and hyperventilation. There was marked arterial desaturation and this finding together with the respiratory dysfunction is considered typical of interstitial pulmonary fibrosis and is well explained by the biopsy picture of marked collagenous thickening of the alveolo‐capillary septa.

Arterial Bronchopulmonary Anastomoses

Publisher Summary This chapter discusses the arterial bronchopulmonary anastomoses. The basic arterial pattern of the lung is that of two essentially separate arterial systems with their respective areas of supply. Thus, the pulmonary arteries supply the terminal air-spaces, while the bronchial arteries supply the bronchi and the bronchial adnexa. The bronchial arteries further supply the interlobar septa, contribute to the supply of the interlobular septa, and form the vasae vasorum of the major pulmonary arteries and veins. The bronchial arteries of the fetus and newborn constantly supply small areas of the pulmonary parenchyma proper, particularly in the medullary zone of the lung, and the pulmonary arteries may contribute to the arterial supply of the bronchi by the pulmobronchial arteries. The arterial supply of the visceral pleura is shared between the bronchial and pulmonary arteries. The pleura of the mediastinal aspect and that of the interlobar fissures are largely supplied by bronchial arteries, which also supply a small part of the diaphragmatic aspect and the margin of the coastal area. The rest of the visceral pleura is supplied by the pulmonary artery.