Results of treatment of gastroesophageal reflux with bethanechol

Thirty-seven infants and children with gastroesophageal reflux were studied with prolonged esophageal pH monitoring before and during treatment with bethanechol. Total reflux scores improved by 69% (P = 6.47 X 10(-7) during bethanechol therapy. This improvement resulted primarily from decreases in the frequency and the duration of reflux episodes occurring more than two hours after feeding. Our findings indicate that infants and children with gastroesophageal reflux may safely be treated with bethanechol; thus the need for surgery is avoided.

Serious air rifle injuries in children

Seven potentially lethal air gun injuries in children are reported. Multiple-pump action air rifles have penetration velocities far in excess of the classic Daisy "BB" guns. However, these lethal weapons are sold to be used by children. Lack of effective regulatory legislation coupled with parental ignorance will continue to allow for serious injuries and deaths in children. Physicians should be aware of the potential lethality of any air gun injuries.

Effects of acute administration of chlorinated water on liver lipids

An acute administration of chlorinated water to rats caused "fatty liver" and indicated a more than 2-fold increase in liver triacylglycerols at 2 days after administration. The acyl group composition of triacylglycerols and phospholipids in both liver mitochondria and liver whole homogenate were also altered by the chlorine treatment. Among the phospholipid acyl groups, there was an increase in the proportion of 20:4 but a decrease in most other polyunsaturated acyl groups. The acyl group changes were more obvious with phosphatidylcholines than with phosphatidylethanolamines. Other phospholipids, including cardiolipin in the mitochondrial membranes, were not greatly altered. Both morphological and biochemical changes were maximum at 2 days after the treatment and were fully recovered after 10 days. The disturbance of a number of enzymatic processes in the liver membranes may account for a large part of the changes observed.

The problem of "giant" omphalocele

"Giant" omphalocele implies an abdominal wall defect that is 5 cm or more in diameter with the liver in a central position. Giant omphalocele is often associated with other significant anomalies. Technically it is often difficult to close the abdominal wall defect and a staged repair utilizing prosthetic materials may be necessary. The morbidity and mortality associated with this entity remain significant despite advances in management techniques. Hospitalization is often prolonged and costly. For the best outcome in managing patients with giant omphalocele early attention to hypothermia and other metabolic requirements and long-term attention to nutritional needs are important. Techniques of closing the omphalocele should be adapted to the individual characteristics of the defect, but mobilization and stretching of the abdominal muscles should be begun as a newborn. The term hepatomphalocele implying "liver-containing omphalocele" is suggested to refer to this particular entity.

Obstruction of the suprahepatic inferior vena cava as a complication of giant omphalocele repair

Obstruction of the inferior vena cava with resultant Budd-Chiari syndrome after giant omphalocele repair has not previously been reported. Such a case is presented. We hypothesize the mechanism of this blockage to be posterior displacement of the inferior vena cava during reduction of the viscera and closure of the anterior abdominal wall, thereby creating angulation and mechanical blockage of the inferior vena cava at the diaphragmatic hiatus.

Acquired aganglionosis

A documented case of acquired aganglionosis is presented in which transrectal biopsies taken 4 mo apart first showed the presence then subsequently the absence of ganglion cells. Colostomy followed by a Soave procedure was curative.

Right-sided congenital diaphragmatic herniae presenting as pleural effusions in the newborn: dangers and pitfalls

Congenital diaphragmatic hernia presented with right-sided pleural effusion in two newborn infants.

Recognizing and referring neonatal surgical emergencies

Ultimate survival of the neonate with a surgical emergency depends upon early recognition by the family physician, who may refer the infant to a pediatric surgical center. The family physician must prevent infectious and metabolic insults to the critically ill neonate while preparing him for safe and rapid transport to a specialty institution. In many cases, the final outcome is as often determined by the initial care received at the referring hospital and during transport as it is by the surgical procedures and postoperative management.

Differentiation of mouse neuroblastoma cells in vitro and in vivo induced by cyclic adenosine monophosphate (cAMP)

The murine neuroblastoma appears to be a useful model for elucidating the mechanism of cellular differentiation. In tissue culture, MNB cells were induced to "irreversibly" differentiate into neuronal-like cells by DBcAMP alone or in combination with cAMP phosphodiesterase inhibitors: papaverine (Pap) and theophylline (Theo). Cells differentiated by DBcAMP, Pap, and Theo were no longer tumorgenic when reinoculated into animals of the host strain. In vivo, DBcAMP, Pap, and Theo caused a reduced tumor volume growth rate in animals with established tumors. Morphologically, this effect appears to be secondary to an arrest of cellular mitoses. Cells insensitive to these agents emerged after 3 to 4 days, and tumor growth accelerated to parallel the rate of the untreated tumors.