Maurice N. Srouji

Neonatal appendicitis: Ischemic infarction in incarcerated inguinal hernia

A premature 12-day-old infant with ischemic infarction of the appendix due to hernial incarceration is presented. Literature review (1901-1975) of 106 cases of acute appendicitis in the first 30 days of life permitted tabulation of some clinical aspects in 94 cases. Overt manifestations mandating surgical intervention and isolation of the inflammatory process in the inguinoscrotal region are important factors responsible for the significantly better prognosis for neonatal hernial versus intraabdominal appendicitis.

Congenital diaphragmatic hernia: Deleterious effects of pulmonary interstitial emphysema and tension extrapulmonary air

Survival after repair of congenital diaphragmatic hernia (CDH) is limited by adequacy of prenatal pulmonary development. Ventilatory function may be compromised further by multiple adverse perinatal factors that necessitate intermittent pressure ventilation (IPPV). Barotrauma frequently complicates IPPV, and is observed in several forms. These complications lead to ventilatory and hemodynamic dysfunctions. Of 50 infants with CDH repaired in the first 24 hr of life, 36% survived. Infants operated in the first 8 hr had a lower survival rate (28%) than those operated between 8 and 24 hr (50%). Tension extrapulmonary air (TEPA) was observed in 30 infants (60%), was significantly higher in dying infants ( p p

Zinc deficiency during parental nutrition: Skin manifestations and immune incompetence in a premature infant

Deficiency of trace elements during total parenteral nutrition (TPN) has emerged with the transition from use of crude hydolysates to the use of purified mixtures of crystalline L-amino acids unsupplemented with trace elements. A 1.4-kg neonate had an ischemic segmental ileal volvulus with diffuse peritonitis that necessitated bowel resection (13 cm) and temporary ileostomy. Prolonged total (including plasma and intralipid) and supplemental parental nutrition induced a good anabolic response. After 3 mo, excessive ileostomy drainage developed and failed to respond to cessation of enteral feedings, but at 3.5 mo birth weight had almost doubled. At that time, skin lesions consistent with acrodermatitis enteropathica appeared and spread quickly. Topical and systemic treatment for secondary skin infection did not ameliorate or halt spread of the lesion. Immune deficiency (IgG 107 mg/dl) was treated with fresh frozen plasma, without improvement. Plasma zinc (40 μg/dl) and alkaline phosphatase (27 IU) were below normal range. Zinc sulfate oral therapy produced a dramatic improvement in 36 hr and complete disappearance of the skin lesions within 1 wk. Concurrently, ileostomy drainage decreased, irritability subsided, and appetite improved, with elevation of IgG, zinc, and alkaline phosphatase to normal levels. Zinc is a structural and functional component of various enzyme systems essential for metabolism. Zinc deficiency, in this case, developed as a result of inadequate intake, excessice loss of zinc-containing enzymes in pancreatic and intestinal fluids, and utilization of available zinc in the anabolic tissue growth response to TPN. Fast repletion of immune mechanisms enhanced control of skin infections and healing.

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

Pneumothorax and pneumomediastinum in the first three days of life

Summario in Interlingua Vinti infantes con pneumothorace e/o pneumomediastino durante le prime tres dies del vita esseva studiate in relation al problems de resuscitation a pression positive e de therapeutica in general. Le mortalitate depende del associate morbos, sed le methodos empleate in le therapia es etiam importante. Pneumothorace in resuscitate infantes es probabilemente plus frequente que lo que es generalmente recognoscite e require intervention chirurgic plus sovente e plus promptemente que pneumothorace de occurrentia spontanee.

Neonatal sigmoid volvulus with absence of mesocolon

Abstract Volvulus of the sigmoid colon is exceptionally rare in infancy and childhood. In this report volvulus of the sigmoid colon in a neonate was found associated with maldevelopment of the mesocolon.

Isolated gastric pneumatosis

Summary Four patients with gastric pneumatosis are presented. All had increased intragastric pressure and gastric outlet obstruction. They all had a favorable clinical course and prompt resolution of the gastric intramural air after gastric decompression.

The effect of cardiac catheterization on the acid-base status of infants with congenital heart disease.

The arterial acid-base status was determined on 34 infants in the first year of life before and after cardiac catheterization and angiographic studies. At the start of the procedure 47 per cent of these infants had an uncompensated acid-base abnormality. At the end of the procedure 91 per cent were uncompensated. Metabolic acidosis was the predominant type of imbalance before and after the catheterization studies. Acid-base abnormalities were more pronounced in the younger cyanotic infants with pulmonary congestion. Monitoring of the acid-base status and prompt correction of any abnormalities are recommended before, during, and after catheterization studies.