Irene M. Irving

Exomphalos with macroglossia: A study of eleven cases

Summary In 11 cases of exomphalos with macroglossia other features of the syndrome, which is sometimes familial, included high birth weight, accelerated postnatal growth and skeletal development, facial nevus flammeus, abnormal pinnae and other cranio-facial characteristics, a diaphragmatic anomaly, renal enlargement with abnormal histological features, adrenal cytomegaly and possibly pancreatic islet-cell hyperplasia. The reported occurrence of neo-natal hypoglycaemia in this syndrome is stressed.

Segmental dilatation of the ileum

Three new cases of congenital segmental dilatation of the ileum are presented and added to 12 cases of segmental dilatation found in the literature. The aspect of the condition which is of particular interest is the presence in 3 of the dilated segments of heteroplastic foregut derivatives of unusual varieties. The etiology of the condition is discussed; it does not appear to be a single distinct pathological entity.

Tissue reaction to pure and impregnated silastic

Abstract In experiments on rats, silver-impregnated silastic implants into muscle evoked the same degree of reaction as plain silastic and barium-impregnated silastic. Silver- and barium-silastic intracaval implants also produced comparable degrees of reaction and did not cause caval thrombosis. These findings, coupled with satisfactory clinical experience in the use of silver-silastic catheters, lead the authors to recommend the use of these catheters for caval intravenous alimentation and ventriculoatrial shunts, as their dense radioopacity facilitates radiographic monitoring.

Prune belly syndrome associated with exomphalos and anorectal agenesis

We have recently treated a child with prune belly syndrome in association with exomphalos and anorectal agenesis. This case raises the total incidence of exomphalos and anorectal agenesis to four and five, respectively, in our series of 13 cases of prune belly syndrome. Our case report lays emphasis on the severe respiratory problems that can complicate surgery in prune belly patients. We also attempt to relate the pattern of anomalies in our series to the controversy surrounding the embryogenesis of prune belly syndrome and suggest that our case material lends support to the concept of prune belly syndrome being due to an early disturbance of mesodermal development in both the abdominal wall and the urinary tract. We also suggest that the reported occurrence of gastroschisis in association with prune belly syndrome adds weight to the unifying theory of the embryogenesis of gastroschisis and exomphalos.

Annular pancreas in a fetus and its three-dimensional reconstruction

A three-dimensional 50-times scale reconstruction was made of an annular pancreas from an 18-week-old fetus. By the use of radio-opaque paint, the anatomy of the pancreaticobiliary system within the reconstructed duodenum was clearly revealed. The anatomical arrangement indicated that the annulus was formed from the ventral anlage of the pancreas and that part of the annulus intermingled with the duodenal wall. These findings are consistent with Lecco s theory of the embryogenesis of annular pancreas. The visualisation of internal structures in a reconstruction by the use of radio-opaque paint has not been described previously. This could be a useful technique in other embryological studies of the continuity of microscopic internal structures. Annular pancreas has been described previously by Weissberg in a 16-mm embryo. This report is the second case of a fetal annular pancreas in the literature.

A STUDY OF SPECIFIC E. COLI INFECTIONS OCCURRING IN A UNIT FOR SURGICAL NEONATES.

During a 2½ year period 14.6 % of 367 infants who had been subjected to surgery in the neo‐natal period excreted pathogenic E. eoli. Forty‐one per cent of the infected infants developed gastroenteritis; 59 % were symptomless excretors. The highest incidence of infection occurred in infants suffering from Hirschsprungs disease and high rectal atresia. Symptomless excretors were more liable to bacteriological relapse after antibiotic treatment than were infants with gastro‐enteritis.

Posture in the management of esophageal atresia: Variations on a theme by Dr. E. B. D. Neuhauser☆

Abstract Following a suggestion made by Dr. E. B. D. Neuhauser many years ago, an investigation was carried out to ascertain why infants with esophageal atresia tend to suffer from collapse of the right upper lobe after thoracotomy. It was found that the neonates bronchial tree does not differ anatomically to any marked degree from that of adults but that when the infant is lying flat on his back, contrast medium instilled into the trachea will invariably run first into the right upper lobe. Pathological considerations and clinical experience have shown that nursing these infants in the prone head-down position will prevent aspiration to a very marked degree and a special frame has been constructed to facilitate the nursing procedure.