Milton L. Wagner

Typhlitis. An 18‐year experience and postmortem review

A review of pediatric autopsy results at the Texas Childrens Hospital, Baylor College of Medicine from 1970 through 1987 was conducted. Thirty‐three cases of typhlitis were identified in patients with acute leukemia and two cases each in patients with lymphoblastic lymphoma and aplastic anemia. Patients ranged in age from 10 months to 17 years. Fifty‐seven percent were male and 43% were female. All were myelosuppressed. A postmortem incidence rate of 24% was determined for patients with acute leukemia. Common symptoms included abdominal pain and distention in 78% of patients and acute lower gastrointestinal bleeding in 35%. Abdominal radiographs varied in spectrum from a nonspecific bowel gas pattern to frank right colonic pneumatosis intestinalis. Thirty‐three patients received chemotherapy within 30 days before onset of abdominal symptoms. All patients were febrile (> 38.5°C), and 33 received broadspectrum antibiotics. Three patients received amphotericin B. Premortem, 84% of organisms cultured from blood were bacterial whereas 16% were fungal. Fungal pathogens accounted for 53% of new microorganisms seen at autopsy. Postmortem examination showed typhlitis in the following anatomic distributions: (1) confined to the cecum; (2) involving the cecum and ileum; (3) involving the cecum, ileum, and ascending colon; or (4) involving the cecum, with sporadic ulcers throughout the intestine. This review includes clinical and postmortem features of typhlitis and current strategies for diagnosis and management.

An etiologic shift in infantile osteomyelitis: The emergence of the group B streptococcus

Twenty-one infants from six to 52 days of age (mean 23.3 days) with osteomyelitis were studied between 1965 and 1977. The etiologic agents were group B streptococcus (8), staphylococcus aureus (6), gramnegative bacilli (4), Streptococcus pneumoniae (1), and unknown (2). Patients with group B streptococcal osteomyelitis were characterized by an uncomplicated neonatal course, single bone involvement with a predilection for involvement of the proximal humerus, and lack of inflammatory signs. In contrast, patients with osteomyelitis due to other organisms frequently had had manipulative procedures predisposing to infection and were more likely to have multiple bone involvement, fever, and leukocytosis at the time of diagnosis. Functional impairment was detected in only one of 17 patients evaluated a mean of 36 months after diagnosis.

Complications of gastroesophageal reflux in patients with cystic fibrosis.

Seven patients with cystic fibrosis who had complications of gastroesophageal reflux including abdominal pain, peptic esophagitis, upper gastrointestinal hemorrhage, and esophageal stricture are described. We believe that these are gastrointestinal complications of CF and that they may be responsible for significant morbidity. The mechanical influence of a depressed diaphragm caused by hyperinflation, along with increased abdominal pressure with chronic coughing, may contribute to GER in CF. Early detection and treatment are important not only to prevent esophageal complications but also to increase the quality of life by relief of pain and by avoiding the resultant decrease in appetite, which can contribute to malnutrition.

Review of bronchopulmonary foregut malformations

The term bronchopulmonary foregut malformation (BFM) describes rare cases of pulmonary sequestrations that communicate with the upper gastrointestinal tract. An unusual type of BFM is described; it consisted of esophageal atresia, proximal and distal tracheoesophageal fistulae, and bilateral extralobar pulmonary sequestrations communicating with a common bronchial structure that replaced the distal esophagus. This case is related to other reported cases in the literature, and serves as the basis for a proposed theory of the embryonic development of BFM.

Cloacal Duplication: Genitourinary and Lower Intestinal Implications

Abstract Complete duplication of the bladder, urethra and hindgut is a rare congenital anomaly. We report a case of complete duplication of the genitourinary and lower intestinal tracts with a brief discussion of the pertinent embryogenesis and therapeutic options.

Disseminated Acanthamoeba infection in a human immunodeficiency virus-infected infant.

Infection with Acanthamoeba is difficult to diagnose and treat. We present the first case of disseminated Acanthamoeba infection in an HIV-infected infant. The infant survived 2 years with treatment with several agents having anti-Acanthamoeba activity in vitro.

Gastric leiomyoblastoma (epithelioid leiomyoma) occurring in a child: a case report.

Leiomyoblastomas are rare smooth muscle tumors occurring most commonly in the gastrointestinal tract of adults. We report the unusual occurrence of a gastric leiomyoblastoma in a child who presented with refractory iron deficiency anemia. The tumor had a superficial erosion which was apparently the source of intermittent hemorrhage resulting in anemia. Epithelioid cells, spindled cells, and cells arranged in a perithelial pattern were seen by microscopy, characteristic of a leiomyoblastoma. Immunohistochemical staining demonstrated muscle actin, vimentin, desmin, and alpha-1-antichymotrypsin, and electron microscopy showed focal densities alternating with thin filaments. All of these features help to differentiate the tumor from an inflammatory pseudotumor. Leiomyoblastomas are associated with paragangliomas and pulmonary chondromas in children, but these were not present in this child. The prognosis of leiomyoblastomas may be related to tumor size, mitotic rate, and cellular characteristics.

The evaluation of imperforate anus utilizing percutaneous injection of water-soluble iodide contrast meterial

The utilization of percutaneous injection of water-soluble iodide contrast media in evaluation of the position of the atretic rectal pouch in cases of imperforate anus is presented. This method demonstrates the exact site of atresia and often the origin of rectal fistulae. This method presents a more exact demonstration of an anatomic defect preparatory to surgery.

Umbilical metastasis (Sister Mary Joseph's nodule) in a child.

Abstract Metastatic malignancy to the umbilicus, also known as Sister Mary Josephs nodule, is a rare condition, which to our knowledge has not been reported in a child. We present a case of an umbilical metastasis from carcinoma of the colon in a boy who was also receiving chemotherapy for mediastinal lymphoblastic lymphoma.

The acute abdomen in the pediatric age group

T HE DEPENDENCE on radiographic information of the acute abdomen in the pediatric patient is frequently more important than in the older individual because of the inability of the young to describe his clinical problems. The single most important radiographic procedure is scout film study of the abdomen, in both supine and upright or decubitus positions. Subsequent upper or lower gastrointestinal tract studies are frequently indicated depending on the initial roentgen findings and clinical correlation. Although many of the same causes of acute abdomen in the adult are seen in the pediatric patient, only those conditions commonly found in the pediatric age group are included in this chapter. These are divided into congenital and acquired conditions.