Morris J. Asch

Rectosigmoid perforation and intestinal evisceration from transanal suction.

Transanal suction injuries were sustained in 1981 by five children when they sat upon uncovered swimming area drain sites. Tears of the rectosigmoid areas occurred in each with associated evisceration and loss of substantial amounts of small intestine because of mesenteric separation. These cases are reviewed.

Jaundice, hypertrophic pyloric stenosis, and hepatic glucuronyl transferase

The true incidence of jaundice complicating hypertrophic pyloric stenosis has not been well documented. As jaundice associated with hypertrophic pyloric stenosis clears rapidly after pyloromyotomy, few clinical reports exist. Two previous retrospective studies showed clinical jaundice occurring in five of 227 patients (2.2%) and three of 157 patients (1.9%) 4 with hypertrophic pyloric stenosis. Between 1968 and 1973 there were 396 patients admitted to the Childrens Hospital of Los Angeles with hypertrophic pyloric stenosis. Thirty-two (8.1%) of these patients were recognized to have clinical jaundice as well as serum bilirubin levels of at least 2.0 mg/100 ml. This figure is undoubtedly low because it was derived from a retrospective chart review and the majority of infants did not have serum bilirubin levels determined.

Metabolic and hormonal studies comparing three parenteral nutrition regimens in infants.

Metabolic and hormonal studies were performed in 6 infants during the first 3 months of life while receiving 3 different types of parenteral nutrition: 1) 20% glucose and a nitrogen source (Dudricks method) 2) 12% glucose, a nitrogen source and soybean fat emulsion (Intralipid method) and 3) 12% glucose, a nitrogen source and 1% alcohol (Babsons method). All three regimens provided positive nitrogen balance of similar magnitude. The substrate-hormone relationships were appropriate. After parenteral fat free nutrition (primary caloric source glucose) the plasma glucagon levels were significantly lower and the growth hormone levels significantly higher than after the fat emulsion therapy period. The Dudrick and Intralipid methods resulted in a higher caloric intake and weight gain than the Babson method. The former two regimens cannot be completely endorsed, however, since septic and central vein complications are unavoidable with the Dudrick method particularly in the small infant; and the long term effects of intralipid, particularly on the liver are still unknown.

A triple duplication of the alimentary tract

Duplications of the alimentary tract occur infrequently, and are usually isolated anomalies. In the infant described below, a complex clinical picture was the result of three distinct duplication in widely separated portions of the alimentary tract (esophagus, duodenum, ileum). Details of the clinical course and technical management of an extremely long ileal duplication form the basis for this report.

Evaluation of different nitrogen sources in high-calorie parenteral therapy

Abstract Five infants and two children who required prolonged high-calorie parenteral therapy were placed on nitrogen-balance studies while receiving alternate courses of two nitrogen sources; i.e., a casein hydrolysate and a synthetic amino acid solution. Quantitative analyses of plasma and urine amino acid levels were carried out during the administration of both solutions. Administration of either synthetic amino acid or casein hydrolysate solutions in concentrations of 2.125% and 4.25% resulted in positive nitrogen balance and consistent apparently equal weight gain in both concentrations. The infusion of 6.7% synthetic amino acid solutions, in conjunction with a somewhat lower caloric intake than previously employed, resulted in a more positive nitrogen balance but a diminished rate of weight gain. Methionine was the only plasma amino acid component that was consistently elevated during these infusions. The solution of 2.125% synthetic amino acids produced the same rate of weight gain as the other solutions studied, with a constant significant positive nitrogen balance. When this nitrogen source is employed, potential complications in therapy appear to be minimal.

Surgery in Infancy and Childhood

This book admirably accomplishes its specified intention of covering basic knowledge of pediatric surgical problems for senior medical students, family physicians, and junior house officers. The first eight chapters include such general topics as preoperative and postoperative care, surgery in the newborn, trauma, and infection. The next 16 chapters cover the field of pediatric surgery in a regional anatomical fashion, including the gastrointestinal and genitourinary tracts, the thorax, and the musculoskeletal and central nervous systems. The last two chapters discuss the special areas of cancer and radiotherapy, and bacteriology. Mr Dennison and his contributing authors demonstrate an unusual ability to clearly and simply present a great deal of information, covering each subject in some detail without getting bogged down in theoretical aspects of problems or surgical technique. The table of contents is clear, orderly, and easy to read. The index seems comprehensive and quite usable. Although the number of contributors

An approach to acquired coagulation problems in the neonatal surgical patient

Summary Coagulation studies and case histories of five infants with surgical problems associated with acquired defects of coagulation are presented. The coagulopathies occurred during episodes of sepsis. Further study is necessary to differentiate hepatic dysfunction and diffuse intravascular coagulation secondary to sepsis.