Donald H. Altman

Management of gastroschisis and short bowel: Report of 17 cases☆

Abstract An 8-yr experience with 17 cases of gastroschisis is presented. Survival has increased with refinements of surgical techniques and availability of intravenous hyperalimentation during the period of bowel malfunction. Primary closure is attempted if possible, without causing undue increase of intraabdominal pressure. Where this is not possible, a staged closure is used. A method of staged closure with dacron-reinforced silastic sheets is described. Of the 17 patients, 16 were operated on, 11 survived the repair, and nine are now alive. It was possible to distinguish antenatal from perinatal evisceration from the degree of serosal and mesenteric reaction. Short bowel, megasigmoid, embryonic appendix, and cecum were common observations. In the neonatal period, the radiological pattern of the sigmoid colon resembled that of the jejunum. With time, all changes reverted to normal except the incomplete rotation, which persisted.

Experience with Hemophilus Influenzae Pneumonia

Hemophilus Influenzae is a gramnegative pleomorphic rod most commonly encountered as normal flora from throat cultures in all age groups, but as a pathogen, its role has been established in cases of meningitis, pyogenic arthritis, softtissue abscess, and pulmonary infections. The incidence of primary Hemophilus infiuenzae pneumonia and empyema diminished markedly after the introduction of the sulfonamides. The recent occurrence of two cases of unusually severe Hemophilus infiuenzae pulmonary infection in infants prompted the following review of our experience with this entity during the past five years. Selection of Cases The records of all patients discharged from two hospitals5 with the diagnosis of Hemophilus infiuenzae pneumonia during the period 1960–1965 were reviewed. In the majority of these cases, the etiologic diagnosis was established by nasopharyngeal culture. Only those cases with a positive blood or pleural effusion culture were included and evaluated further. Of 10 such patients, 3 were hos...

Congenital malignant tumors

Nine cases of congenital malignant tumors are reported with special attention to significant histories, diagnosis and pathologic documentation. The cases include fibrosarcoma, neuroblastoma, reticulum cell sarcoma, undifferentiated sarcoma and malignant histiocytosis. The authors believe that congenital malignant tumors occur more frequently than the number of previously reported cases would suggest and allude to the scientific value in considering them as a group. Among the reported cases are an 11‐year cure of neuroblastoma, death of a 6‐month fetus due to undifferentiated sarcoma and the sixth reported case of orbital sarcoma. Diagnostic considerations of juvenile fibrosarcoma are discussed. A brief comment concerning each tumor is included, offering the physician pertinent clinical background and relative frequency of occurrence.

A New Radiographic Finding in Mongolism

The radiographic manifestations of Downs syndrome have been described by many authors. Recently, several new stigmata have been published (3–5). The pelvic characteristics in this syndrome, as described by Caffey and Ross (1, 2), remain the most constant radiologic abnormalities; but in a small percentage of infants the pelvis is normal. The roentgen diagnosis of mongolism, therefore, must be substantiated by other findings, and finally by chromosomal analysis. The purpose of this paper is to present a new radiologic finding and to show its relatively high incidence in this chromosomal abnormality. Figure 1 is the chest radiograph of a newborn girl first seen because of duodenal atresia. Although the infant was clinically mongoloid, the pelvic radiograph disclosed normal iliac and acetabular contours. However, accessory sternal ossification centers (4) and congenital heart disease were present. In addition, only 11 pairs of ribs were counted. Genetic studies revealed a trisomy of the No. 21 chromosome. B...

Cystic Enlargement of the Kidney in Infancy

There is a group of cystic renal lesions occurring during infancy, 4 of which can be accurately diagnosed by the radiologist. The first group, manifested by unilateral renal enlargement, includes two entities: multicystic kidney and unilateral hydronephrosis. The second group, manifested by bilateral renal enlargement, also includes two entities: polycystic disease and bilateral hydronephrosis. Unilateral Renal Enlargement Multicystic kidney may be secondary to an intrauterine vascular accident similar to that described in bowel atresia (10). Plain film radiography demonstrates a unilateral mass in the renal area without calcification. The intravenous urogram (Fig. 1) shows no function on the affected side. The gross specimen (Fig. 2) is a grape-like cluster of cysts varying in size from a few millimeters to several centimeters in diameter. There is no recognizable renal tissue, and there is atresia of part or all of the ureter. The renal artery is markedly hypoplastic. Postoperative radiography of the sp...

The Roentgen Evaluation of the Urinary Tract Following Treatment for Vesicoureteral Reflux

urinary tract infection accounted for 6.7 per cent of all hospital admissions to Variety Childrens Hospital during the year of 1967. In order to properly evaluate this common cause of disease in the child, a thorough review of the radiographs of children undergoing urinary tract investigation has been correlated with clinical findings and medical and surgical management. Two thousand five hundred and seventy-four roentgen examinations of the urinary tract have been performed on 2,246 pediatric patients during the past five years. Two hundred and sixty-two patients (11 per cent) had vesicoureteral reflux. In 782 patients with proved urinary tract infection, the occurrence of vesicoureteral reflux has been 19 per cent. Material and Method Each of the patients referred to our radiology department for investigation of the urinary tract had both cystourethrography and excretory urography performed by the method previously reported by the authors (1). Both of these procedures are carried out without sedation. ...