Edward R. Graviss

Duodenogastric intussusception causing gastric outlet obstruction

Acquired gastric outlet obstruction occurred in an infant following surgery to correct congenital ileal atresia. Despite adequate decompression the gastric outlet obstruction persisted and required a second operation. A retrograde duodenogastric intussusception with an overlying pyloric stenosis proved to be the cause.

Congenital peritoneal mesothelioma

Only three primary peritoneal mesotheliomas in children have been previously reported. We describe a 6-wk-old girl with a papillary peritoneal mesothelioma of low grade malignancy. This is probably a congenital mesothelioma and is the youngest patient reported to date.

Jejunal intraluminal diverticular duplication with recurrent intussusception

Herein reported is a 2-yr-old child who presented with recurrent epigastric pain and occasional vomiting. Upper gastric intestinal series demonstrated an apparent intraluminal jejunal diverticulum with jejunojejunal intussusception. Operative reduction of the intussusception and removal of the diverticulum was curative.

Sonography of the Zellweger syndrome.

Case 1 A 6-day-old white infant girl was transferred to Cardinal Glennon Childrens Hospital for evaluation of dysmorphism. She was born to a G2, P2, AbO, mother by spontaneous vaginal delivery. The parents were not consanguineous and another sibling was normal and healthy. Her birth weight of 2050 g placed her below the 5th percentile. Her estimated gestational age was 36 weeks by Dubowitz, but 39 weeks by date. Head circumference was 325 em (50th percentile) with a wide and full anterior fontanelle (4 X 4 em) and separated sutures. She had narrow palpebral fissures and demonstrated hypertelorism. Her ears were low set and her skin was icteric, coarse, and wrinkled. There was no organomegaly. She had large labia minora, a prominent clitoris, and an imperforate anus with an anterior perineal-vagino-rectal fistula. Her extremities dem~ onstrated a left simian crease, bilateral clinodactyly and bilatA era] club feet. Neurological examination revealed hypotonia, absent Moro and gTasp reflexes, and a poor sucking reflex. A skeletal survey demonstrated irregular calcifications in and around both patellae, a small focus of calcification in both greater trochanters, in the left triradiate cartilage and in the left

Spina bifida and unilateral focal destruction of the distal femoral epiphysis

Focal destruction of the postero-lateral distal femoral epiphysis was present on radiographs in two children with spina bifida and objective lower limb sensory loss. Each patient presented with painless swelling of the knee. In one patient the epiphysis showed sclerosis and fragmentation associated with a defect. In the second patient the destructive change was the dominant radiographic abnormality and simulated bone tumor. Computed tomography in this patient showed a bone fragment occupying the defect suggesting epiphyseal fracture. The lesion in each patient was believed to be traumatic in origin and to represent a stage in the development toward neuropathic arthropathy.