Irwin H. Krasna

Roentgen diagnosis of midgut malrotation: Value of upper gastrointestinal radiographic study

Abstract Thirty-two cases of malrotation of the bowel were reviewed and the radiographic findings analyzed in an attempt to correlate plain-film patterns with underlying surgical pathology, particularly the presence of volvulus. Although certain patterns were more common than others in various clinical and pathologic groups, no clearcut conclusions can be drawn from plain radiographs, with the exception of evidence of small-bowel obstruction that strongly suggests volvulus and possible intestinal ischemia. Barium studies are necessary for specific diagnosis in the majority of cases. An upper gastrointestinal examination is of greater diagnostic value than a barium enema, the former being a direct approach to the demonstration of obstruction located high in the gut, as well as being easier to interpret.

A mouse model for the study of necrotizing enterocolitis

A mouse model for the study of necrotizing enterocolitis is presented. It is a model of temporary intestinal ischemia and consists of occluding both superior mesenteric vessels with a bulldog clamp for varying periods of time. The resultant lesions resemble the intestinal lesions seen in necrotizing enterocolitis in respect to the gradual development of the necrotizing lesions and their patchy distribution. We also studied the effect of intravenous saline and low molecular weight dextran in preventing the development of these ischemic lesions. In moderate ischemia, saline and dextran show a similar protective effect, and in severe ischemia, both show a protective effect, with dextran being more effective than saline.

Malrotation, malnutrition, and ischemic bowel disease

Ischemic bowel disease (IBD) is the common denominator in determining the mortality and morbidity in children with malrotation and volvulus. Survival in such patients depends on the degree of ischemic intestinal damage. In all patients there is another common factor, namely, host nutritional status. To evaluate host nutritional status in patients with malrotation and volvulus, we reviewed our recent 5-yr experience with 50 patients diagnosed as having malrotation, excluding those with gastroschisis, omphalocele, and diaphragmatic hernia. This review revealed two important clinical findings. First, volvulus was found to be the most frequent complication of the malrotation anomaly; and second, the nutritional status of the patient at operation was extremely poor in the majority of instances. Seventy percent of our patients were classified as having acute protein calorie malnutrition (PCM) by the criteria of McLaren and Read. Mild PCM was present in 28% while 42% had moderate to severe PCM. Three patients had volvulus with gangrene and all were severely malnourished. Thirteen of the 50 patients presented with failure to thrive (FTT). To further examine the relationship between IBD and PCM, we developed a mouse model of midgut ischemia. Normally nourished animals demonstrated an incidence of IBD of 1/60 (1.6%), 2/70 (2.9%), and 14/40 (35%) when made ischemic for intervals of 10, 15, and 20 min, respectively. The malnourished mice developed IBD at an incidence of 13/37 (36%), 32/49 (66%), and 30/40 (75%) after respective ischemic intervals of 10, 15, and 20 minutes ( p

A simple purse string suture technique for treatment of colostomy prolapse and intussusception

A simple purse string technique for treatment of colostomy prolapse and intussusception is described. It is suggested as an alternative to more complicated procedures.

Massive gastric enlargement with delayed presentation of congenital diaphragmatic hernia: report of three cases and review of the literature.

In three cases of congenital diaphragmatic hernia presenting long after the newborn period, there was striking enlargement of the intraabdominal stomach. In each case there was herniation of the entire small bowel into the thorax and absence of a hernial sac. Despite the enormous capacity of the stomach, which was suggestive of obstruction preoperatively, no site of obstruction could be demonstrated at operation. This enlargement disappeared following surgical repair of the hernia.

Low molecular weight dextran and reexploration in the management of ischemic midgut-volvulus

Administration of low molecular weight dextran and reexploration in 36-48 hr, is recommended in cases of ischemic midgut volvulus. Five cases are presented utilizing this technique and many centimeters of small bowel were saved that would have been resected at time of the original exploration. One patient died as a result of sepsis due to central intravenous nutrition: the others are alive and well.

Pseudomonas septicemia; Necrotizing bowel lesions (NEC) and skin lesions in a 5-mo-old child

Necrotizing enterocolitis (NEC) that occurs in the high risk neonate is not usually associated with pathogenic organism. In older children the presence of NEC is often due to infection with a specific pathogen. A case of a five month old child with pseudomonas aeruginosa septicemia presented with typical NEC. in the course of two laparotomies, most of the small bowel was resected. Necrotizing skin lesions were also present, and the likely source of both of these lesions were septic embolic.

The surgical treatment of ulcerative colitis in childhood — a study of 38 cases

Abstract Ulcerative colitis in childhood has a prognosis even more serious than that in the adult and in recent years has been increasing in frequency. There may be a remarkable retardation of physical and sexual development with ulcerative colitis in childhood. Of 38 children operated on for ulcerative colitis at 16 years or younger, 22 were boys and 16 were girls. Fifteen were operated upon prior to the introduction of steroids and 23 after steroids were introduced. Steroids have not increased the interval between disease onset and surgery, but have changed the indications for surgery. Surgery for chronic invalidism is now a more common indication than acute exacerbation. Ileostomy and subtotal colectomy has been the most common operation. In the past 10 years there have been no deaths following subtotal colectomy or proctocolectomy.

Clinical management of malignant hyperpyrexia.

Experience with eight cases of malignant hyperpyrexia are presented. The different types are described and illustrated by clinical cases. Early recognition of this condition is the cornerstone in the successful management of the complication. Early diagnosis and methods of treatment are described.