Ian T. Cohen

MR imaging of benign fatty tumors in children: report of four cases and review of the literature

This study correlates the magnetic resonance imaging characteristics with the pathologic findings in rare benign fatty soft tissue tumors in four children. A review of the literature is presented. Two cases of infiltrating lipoma displayed bright signal on both T1- and T2-weighted images, similar to that observed in subcutaneous fat. Histological study revealed extensive muscle infiltration by mature fat, with some areas of total fatty replacement. The case of facial lipomatosis revealed an extensive process of fatty invasion of adjacent soft tissue and osseous deformity by mass effect of the tumor. This lesion was bright on T1- and T2-weighted images. Histopathologic examination showed widespread invasion of squamous mucosa and skeletal muscle. The single case of lipoblastoma involved the presacral region and right buttock. This lesion, although bright on both T1 and T2 weighting, was relatively hypointense to subcutaneous fat on T1. Microscopic examination revealed a well-encapsulated fatty mass made up of cells ranging from lipoblasts to mature lipocytes. In childhood, when fatty lesions are almost always benign, a morphologic characterization by magnetic resonance may be sufficient basis on which to make critical therapeutic judgements.

Necrotizing enterocolitis in a neonatal piglet model

The aim of this study was to develop an animal model for necrotizing enterocolitis (NEC). Twenty-five neonatal Hanford minipigs had carotid artery and external jugular vein catheters and rectal Clinical Tonomitors placed under anesthesia. Experimental animals were subjected to a hypoxic insult (50% reduction in baseline PaO2 for 30 minutes) and hypothermic stress (core temperature reduced to 35 degrees C for 30 minutes). Regular oral diet was resumed and the survivors were euthanized 3 to 4 days later. All animals underwent necropsy with gross and histopathological evaluation of the entire bowel. Of 22 experimental animals, 14 survived (64%) and 8 (36%) died of pulmonary hemorrhage. Of the 14 survivors, 8 (57%) had gross and microscopic evidence of NEC. Six of the total 25 animals (24%) sustained rectal perforations from the tonometer. Of 3 control animals, one died of pulmonary hemorrhage and the two survivors had normal intestine. This model successfully produced gross and histological evidence of NEC. The tonometer shows promise as a predictor of NEC provided technical modifications can reduce the complication rate.

The effects of enteral stimulation on gallbladder bile during total parenteral nutrition in the neonatal piglet

The neonatal piglet is a satisfactory model for the human neonate requiring total parenteral nutrition (TPN). Bile status and subsequent liver and gallbladder dysfunction have long been documented as serious complications of long-term TPN. The purpose of this study was to determine whether small amounts of enteral formula during TPN will maintain normal bile appearance and composition. Thirty-one Hanford miniswine, 3 to 6 days old underwent surgery for the placement of central venous catheters. Two days postoperatively, the animals were separated into three groups, according to dietary regimens. Group 1 (n = 10), the control group, received pig formula (SPF-lac) orally (200 cal/kg/d); group 2 (n = 11), was maintained on TPN (180 cal/kg/d) with an enteral supplement of SPF-lac (20 cal/kg/d); group 3 (n = 10), was maintained on TPN only (200 cal/kg/d). The TPN formula consisted of 35 g/kg/d of glucose, 10 g/kg/d of protein, and 3 g/kg/d of lipid. The animals were maintained on these diets for 6 weeks. At necropsy, gallbladder with bile was weighed and bile volume and appearance was recorded. Chemical analyses was performed on 26 bile samples. Gallbladder weight was significantly decreased in groups 2 and 3 compared with group 1 (P less than .0003, P less than .033, respectively, using Students t test with Bonferoni adjustment). Volume was significantly decreased only in group 2 (P less than .003). Group differentiation in relation to bile appearance was determined by the presence or absence of either bile sludge or crystals.(ABSTRACT TRUNCATED AT 250 WORDS)

Accessory diaphragm in an infant

Accessory diaphragm is a rare congenital abnormality that almost always occurs on the right side and is often associated with cardiovascular anomalies. This paper describes the clinical presentation, radiologic diagnosis, and surgical treatment of the condition. Early recognition and prompt surgical treatment will prevent the chronic pulmonary complications reported in the literature.

Nutritional status following surgical correction of congenital gastrointestinal anomalies

A review of the literature reveals scanty data on the nutritional status of children following surgical correction of congenital intestinal anomalies in the neonatal period. Therefore, as part of the routine follow-up of 108 children who had undergone neonatal surgery, a simple nutritional assessment was performed. The diagnosis in these 108 children included: esophageal atresia; upper gastrointestinal obstruction; bowel resection; Hirschsprungs disease; imperforate anus; anterior abdominal wall defects; and miscellaneous. The follow-up period ranged from 2 wk to 9 yr after surgery. For each child the weight and height was plotted on a growth chart (National Center for Health Statistics). Seventy-six percent (82) of the children had weights and heights above the fifth percentile. The emphasis of this paper is on the 24% (26) of children whose weights and heights fell below the fifth percentile. The factors contributing to the retardation in growth were grouped as follows: (1) Undiagnosed, correctable surgical problems; (2) Undiagnosed correctable nonsurgical problems; (3) latrogenic complications; (4) Associated untreatable conditions; (5) Complications of the disease. Eleven (10% of the total) children had factors that were preventable or remediable. It is proposed that every neonate undergoing surgical correction of a congenital intestinal anomaly should be assessed and followed by a nutritional team consisting of a physician, nutritionist, and nurse. Nutritional parameters should be used in the assessment of long-term results following such surgery. In this way earlier recognition or prevention of factors contributing to growth retardation may be achieved.

Survey of Nutritional Problems Encountered in Children with Neuromotor Disorders

A survey of 200 patients ranging in age from 5-21 yr was undertaken in 3 facilities in central Pennsylvania: state- (100), county- (13), and privately-operated (66), together with 21 children being cared for at home. Their diagnoses included chromosomal, metabolic, and anatomic abnormalities, and other encephalopathies. The following nutritional problems were identified: 1) inadequate nutrient intake due to feeding technique, swallowing difficulties, or regurgitation; 2) obesity and low activity level; 3) constipation; 4) nutrient-drug interactions and allergies; and 5) inadequate standards with which to compare growth and adequacy of nutrient intake. The nutritional problems encountered in these pediatric patients with neuromotor disorders warrant management by a physician-nutritionist team skilled in nutritional assessment and techniques of providing nutritional support.

The role of the nutritional team in the management of the child with cancer

Nutritional problems are not usually high in the priorities of those caring for the child with cancer and managed separately by the parent, nurse, and physician. The purpose of this paper is to describe the important role of a nutritional team, consisting of a physician, nutritionist, and nurse in the total care of such patients. The advice of such a team was sought in the management of 51 pediatric cancer patients representing a cross-section of those seen in a pediatric cancer center. The nutritional problems arose from the disease and/or the therapy and included psychologic and organic brain problems; oral and pharyngeal problems; intestinal obstruction, ileus, or malabsorption; and anorexia, nausea, or vomiting. The personnel involved functioned more efficiently as a team than separately. It is concluded that the nutritional team has a role in the overall management of the child with cancer, and that it would be advantageous for such a team to function in the early management of all these children. The longrange benefits of this approach will be the more effective management of demonstrated nutritional problems, the prediction of preventable problems, and the recognition of the vital role of nutritional education for all personnel involved in the management of these children.