John L. Emery

Degenerative changes in the left lobe of the liver in the newborn.

BY JOHN L. EMERY Fronm the Deparltment of Pathology, Childrsenis Hospital, Shelfeld (RECEIVED FOR PUBLICATION MAY 2, 1952) The liver in a newborn child at necropsy of the liver toTthe tip of the gall bladder (Figs. 1, . occasionally shows a marked difference between the and 3). This communication is concerned with the left and right lobes. The left lobe is darker in incidence and possible cause of this condition. colour than the right and

Pulmonary thrombosis and its association with unexpected death in childhood.

Thrombosis of pulmonary vessels unassociated with local sepsis or cardiac deformity is rarely recognized in infancy and childhood. The condition is not usually considered by clinicians or by pathologists doing necropsies in this age period, and I have been unable to find a paper discussing this subject in the available literature. This communication is concened with pulmonary vascular thrombosis in 15 children seen in a series of approximately 200 consecutive necropsies.

The fat and water content of the left and right liver before and after birth.

Asymmetrical foamy-celled change in the right lobe of the liver in newborn infants was noted by Gruenwald (1949), and we have described (Emery, 1952) a rapid degeneration of the left physiological lobe of the liver following birth. These asymmetrical changes in the liver are associated with the different blood supply to the right and left physiological lobes in utero and are probably of great importance in metabolic changes in the newborn and in the study of later intra-uterine diseases. It is also obvious that the liver in the foetus and in the newborn should not be studied as a single organ but as two distinct but united organs, that is, a right and left liver. In order to investigate this problem further we have examined the fat and water content, both histologically and chemically, of the livers of children dying prematurely, at full term during the neonatal period and in some older children. Great differences between the contents of the right and left lobes were found in many cases, but before such findings could be assessed it was necessary to study the normal variation. Very little information is to be found in the literature on the amount of fat occurring normally in the human embryo in the neonatal period or concerning the lobe differences. Also examinations that have been reported have apparently not considered the pathological fatty changes now known to occur in the liver in utero and thus did not distinguish between normal and abnormal livers (Widdowson and Spray, 1951). Dorkin and Weinberg (1949) studied the histologically demonstrable fat in the livers of stillborn and newborn infants. They endeavoured to correlate fat content with maturity and concluded that the storage of fat reaches its maximum during the last month of gestation. Needham (1931) had also found an increase of fat in the human embryo as a whole from five to nine months but did not indicate if liver fat as such increased over this period. Rourke and Stewart (1942) examined the liver with regard to its uniformity with respect to the concentration of fat, water and vitamin A in different parts of the same liver and concluded that on the whole fats and water are uniformly distributed. Billing, Conlon, Hein and Schiff (1953) estimated the liver lipids in man in different parts of the liver by means of specimens taken by needle biopsy. They also found relative uniformity throughout the liver and that the histology and chemical estimation of fat content paralleled each other. Most of these investigations, however, were done on livers from adults. This communication records an attempt to establish the normal fat and water contents of the left and right livers in later foetal and early neonatal life. Materials and Methods For about a year the fat and water content of the left and right liver has been estimated on all (134) stillborn and neonatal infants coming to necropsy. The livers were divided into three parts by two cuts, one along the line of the anterior ligament and ductus venosus, that is, cutting off the anatomical left lobe. The second cut was taken from the tip of the gall bladder to the inferior vena cava through the base of the gall bladder to the hilum. This cut divides the liver into the physiological left and right lobes. The central part of the liver constituting the median part of the left physiological lobe was discarded after weighing. Blocks of distinctive shape were taken for histology from the left and right lobes, the remainder of which were then separately cut into thin slices by a very sharp knife and blotted to remove as much blood as possible. For chemical analysis the whole of the sliced lobes were weighed and dried on a hot plate at 95°-100° C. until a constant weight was obtained. From these values the water content was calculated. After grinding the tissue to a powder, duplicate samples were weighed,

Involution of the Left Liver in the Newborn and its Relationship to Physiological Icterus

It was recently shown (Emery, 1952) that in approximately a third of children dying within the first few days of birth there was microscopic evidence of degeneration of parenchymal cells in the left physiological lobe of the liver. This change was not seen in stillborn children and was seen with increasing rareness in older children. It was suggested then that the changes were due to cessation of the flow of placental blood through the left liver at birth. The importance of the microscopic changes in the liver should be reflected in gross changes in size of the different lobes of the liver at birth, and the present communication records a study of gross changes in the liver associated with birth.

Cardiac Concentric Hypertrophy in Children with Hydrocephalus due to Tuberculous Meningitis

During a necropsy on a child with internal hydrocephalus due to tuberculous meningitis, concentric hypertrophy of the left ventricle of the heart was noticed. Since that observation further cadavera were examined in greater detail for evidence of hypertension. In six out of a consecutive series of 16 deaths from tuberculous meningitis treated with streptomycin at the Sheffield Childrens Hospital evidence was found suggesting hypertension. Ca Se Case 1. The childs illness began with a cough at the age of 17 months, and he developed signs of tuberculous meningitis five months later. He had been undergoing streptomycin treatment for 18 months before death at the age of 3 years and 1 month. At necropsy, the body was seen to be emaciated. There was opisthotonos, and the limbs were in an extreme spastic posture. There was marked internal hydrocephalus with much exudate at the base of the brain and over the cisterna magna. There was dilatation of the fourth ventricle with thinning