Peter A.M. Raine

Kasabach-Merritt syndrome

Eight infants with hemangiomata associated with severe consumption coagulopathy are reviewed; three died. The presentations and method of management are discussed. The varied response to different modalities of therapy initiated this report and led to a search of the world literature in an attempt to identify the pattern of response, if any, to particular therapy. From our own experience with two cases and from the review of the literature, it appears that radiotherapy alone or in combination with steroids gives a superior overall treatment in terms of reducing the death rate.

A review of thermal injuries in young children

A group of 472 children under 3 yr of age were treated for thermal injuries in a 5-yr period; 65% were boys. Injuries were due mainly to scalding (82%) and involved predominantly the upper part of the body. Full thickness skin loss resulted in 30% of cases, and skin grafting was needed in 29%. Forty-two episodes of infection arose, and 50 patients (11%) developed other complications--hyperpyrexia, respiratory problems, fluid imbalance and convulsions were the commonest. The mortality rate was 1% (4 cases) and the mean duration of stay in hospital was 17 days. The plan of management is outlined with emphasis on the essential differences in treatment of young children, and the results are reported.

Colour of bile vomiting in intestinal obstruction in the newborn: questionnaire study.

Abstract Objectives To identify the colour that different groups of observers thought represented bile in a newborns vomit. Design Questionnaires displaying eight colours (pale yellow to dark green). Setting General practices in Glasgow, postnatal ward and level III special care baby unit in a university teaching hospital, and mother and toddler groups in Glasgow. Participants 47 general practitioners, 29 nurses on the baby unit, 48 midwives, and 41 mothers of babies and infants. Outcome measures Participants indicated which colour would represent bile in a babys vomit. More than one colour could be chosen. Respondents were also asked to indicate one colour that was the best match for bile. Results When any colour could be chosen, 12 (25%) general practitioners, 1 (3%) nurse on the baby unit, 5 (10%) postnatal midwives, and 23 (56%) parents did not consider green an appropriate colour for a babys vomit containing bile. Twenty three (49%) general practitioners, 7 (24%) neonatal nurses, 15 (31%) postnatal midwives, and 29 (71%) parents thought yellow was the best colour match. Conclusions There is little agreement about the colour of bile vomit in a newborn. It is more pertinent to ask parents about the colour of vomit rather than whether it contained bile. Many general practitioners and parents do not recognise green as an appropriate colour for bile in the vomit of newborns, which may delay surgical referral. Though yellow vomit does not exclude intestinal obstruction, the presence of green vomiting in a baby is a surgical emergency and requires expeditious referral.

Thoracic mesenchymoma of infancy

Mesenchymoma of the chest wall is rare in infancy and can be easily mistaken for a malignant tumor. It is a distinct pathological entity that presents at birth or during infancy as self-limiting expansile intraosseous lesions involving the body of one or more ribs. Histologically, it is a benign focal overgrowth of normal skeletal elements. Two such cases are presented.

Pneumatic dilatation in childhood cardio-achalasia

Abstract Three boys with achalasia of the cardia were treated with balloon dilatation, with relief of obstruction and weight gain in all cases. Symptoms recurred in one patient, who then underwent myotomy rather than further dilatation. We recommend dilatation as the primary procedure in childhood achalasia.

Cefotaxime Lavage in Children Undergoing Appendicectomy

SummaryIn an attempt to reduce postoperative sepsis, a series of randomised, double-blind studies was begun in 1982, using cefotaxime as backbone therapy. Up to 1985 (stages I and II), the best results were obtained using a combination of cefotaxime (75 mg/kg intravenously in 3 doses at 12-hourly intervals) plus metronidazole (10 mg/kg intravenously in 3 doses), both drugs administered 1 hour before surgery (preoperatively) or at anaesthetic induction (perioperatively). In 300 consecutive cases, the wound infection rates were 1% in uncomplicated acute appendicitis and 5% in perforated/gangrenous appendices.The present study (stage III) reports the findings in 401 consecutive patients: 215 treated with the above regimen, either pre-or perioperatively (group 1) and 186 who additionally had peritoneal lavage with cefotaxime 2 g/L during surgery (group 2). There were 16 wound infections overall, 2 among patients administered prophylaxis preoperatively and 14 in those administered prophylaxis perioperatively. All produced mixed cultures, with Escherichia coli, Streptococcus milleri and Bacteroides fragilis predominating. The overall figures for postoperative sepsis are 12/215 (5.6%) in the non-lavage group and 8/186 (4.3%) in the lavage group. Among patients with a perforated and/or gangrenous appendix, the wound infection rate was 8/72 (11.1% ) in the non-lavage group (group 1) and 4/66 (6.1%) in the lavage group (group 2). Each group had 2 cases of pelvic abscess.

Pseudomembranous enterocolitis—A potentially lethal disease

The cases of nine children with pseudomembranous enterocolitis, five of whom died, are reported here. Six had prior antibiotic therapy, and in eight there were other diseases present that were considered to contribute to the development of this disease. Awareness of this condition, which requires aggressive medical and surgical management, is discussed.

Gastrografin enema in meconium ileus: the persistent approach

This report describes the value of repeated use of gastrografin enema in uncomplicated meconium ileus. Fourteen of 21 neonates had successful intestinal decompression (66.6%) — 5 after a single enema and 9 after repeated attempts (up to 7 times in 1 case).

Cardiac tamponade: An unusual complication of ventriculo-atrial drainage of hydrocephalus

Abstract This is a report of a case of cardiac tamponade secondary to perforation of the myocardium by the introduction of a catheter on a stylet during revision of a ventriculo-atrial shunt.

Amir A F Azmy

Amir Azmy died after a serious illness borne stoically: even close friends and colleagues were unaware of the gravity of his situation. Many knew him as very friendly, open, and generous, but he was essentially a private man and always a gentleman, especially in his manners and dress. Amir exuded good humour and humanity, and on the rare occasion when his ire was raised he invariably suffered most. Amir was born near Alexandria in Egypt in 1939 and was one of a successful family of six brothers and a sister. He first came to the UK in 1970 to undertake training in surgery, working in Glasgow and London (including Westminster, Carshalton, and Great Ormond Street). Despite a short return to a lecturer post in Azhar University in Cairo, his future lay in Britain. In London, Amir worked with Herbert Eckstein, Duncan Forrest, and Jeremy Lawson, among others. Like all trainees of his day, …