76
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Balagin VM, Mel'nikova NI. [Acute kidney failure in newborn infants with congenital abnormalities]. ANESTEZIOLOGIIA I REANIMATOLOGIIA 1996:61-62. [PMID: 9045588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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77
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Abstract
We are reporting two cases of segmental dilatation of small intestine presenting as neonatal intestinal obstruction. Clinco-pathological features, etiology and management are discussed in brief.
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78
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Kays DW. Surgical conditions of the neonatal intestinal tract. Clin Perinatol 1996; 23:353-75. [PMID: 8780909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Many different pathophysiologic conditions can affect the neonatal intestinal tract and ultimately require surgical intervention. The symptomatology is primarily that of bowel dysfunction and obstruction. A thorough understanding of these disease processes is necessary of the managing physician. With this knowledge, a systematic course of resuscitation, evaluation, and treatment can be instituted, usually with predictably gratifying results for patient, family, and physician alike.
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79
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Arcellana RC, Robinson TW, Tyson RW, Joyce MR. Neonatal fellowship. McKusick-Kaufman syndrome with legal complications of hydrometrocolpos and congenital endometriosis. J Perinatol 1996; 16:220-3. [PMID: 8817436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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80
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Huang SF, Vacanti J, Kozakewich H. Segmental defect of the intestinal musculature of a newborn: evidence of acquired pathogenesis. J Pediatr Surg 1996; 31:721-5. [PMID: 8861493 DOI: 10.1016/s0022-3468(96)90687-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Two cases of premature newborns with a segmental defect of the intestinal musculature are presented. The clinical diagnoses were intestinal obstruction and perforation, respectively. Emergency laparotomy was performed. In the first case, this showed a dilated loop of ileum and proximally dilated small bowel. The second case had ileal perforation with marked pneumoperitoneum. Pathological examination showed multifocal partial or complete absence of the muscularis propria, with relative preservation of the remaining components of the bowel wall in both cases. In addition, foci of recent muscular necrosis was noted in case 1, and early replacement fibrosis in case 2. These findings suggest that the muscle defect was secondary to muscle injury rather than a primary absence of muscle. The different theories of pathogenesis are discussed.
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MESH Headings
- Anastomosis, Surgical
- Diagnosis, Differential
- Diseases in Twins
- Female
- Humans
- Ileum/abnormalities
- Ileum/pathology
- Ileum/surgery
- Infant, Newborn
- Infant, Premature, Diseases/pathology
- Infant, Premature, Diseases/surgery
- Intestinal Obstruction/congenital
- Intestinal Obstruction/pathology
- Intestinal Obstruction/surgery
- Intestinal Perforation/congenital
- Intestinal Perforation/pathology
- Intestinal Perforation/surgery
- Muscle, Smooth/abnormalities
- Muscle, Smooth/pathology
- Muscle, Smooth/surgery
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81
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Abstract
Two cases of caecal duplication are presented, one in a neonate and one in an infant. The diagnosis was made at laparotomy, which had been undertaken for the presumptive diagnosis of intestinal atresia and torsion of an ovarian cyst respectively. Also the literature on alimentary tract duplications is reviewed, referring to the incidence, presenting symptoms, and location of the duplication, in particular that of the caecum.
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82
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Govani RV. Congenital proximal jejunal diaphragm. JOURNAL OF THE INDIAN MEDICAL ASSOCIATION 1996; 94:115, 121. [PMID: 8810212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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83
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Pierro A, van Saene HK, Donnell SC, Hughes J, Ewan C, Nunn AJ, Lloyd DA. Microbial translocation in neonates and infants receiving long-term parenteral nutrition. ARCHIVES OF SURGERY (CHICAGO, ILL. : 1960) 1996; 131:176-9. [PMID: 8611075 DOI: 10.1001/archsurg.1996.01430140066018] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To explore whether episodes of endogenous septicemias due to microbial translocation are clinically relevant in neonates and infants who are receiving long-term parenteral nutrition (PN). DESIGN Prospective observational cohort study of 2 years. SETTING Neonates and infants who underwent surgical procedures and required PN because of gastrointestinal abnormalities. MEASUREMENTS Surveillance cultures of the oropharynx and gut were obtained at the first of PN and thereafter twice each week. These cultures were processed for all microorganisms, except for coagulase-negative staphylococci, in a semiquantitative manner to detect overgrowth. A blood sample was taken for culture from both the central venous line and peripheral vein on clinical indication only. Microbial translocation was diagnosed when the microorganisms that were isolated from the blood sample were also carried in the throat and/or rectum within the 2 weeks preceding the episode of septicemia. MAIN RESULTS Of 94 infants, 10 (11%) experienced 24 episodes of septicemia (ie, 7.3 septicemic episodes per 1000 days of PN). Six infants experienced 15 episodes of microbial translocation due to enteric microorganisms, including Escherichia coli, Klebsiella, Candida species, and enterococci. Microbial translocation occurred after a median of 58 days of PN (range, 32 to 286 days). The enteric organisms that caused septicemia were always present in the throat and/or rectum and in high concentrations ( > 10(5) colony-forming units per gram [ie, overgrowth]) in 60% of the translocation episodes. All but one episode occurred in infants with an abnormal serum bilirubin level ( > 17 mumol/L [0.99 mg/dl]). CONCLUSIONS In neonates and infants who are receiving PN, septicemia may be a gut-related phenomenon.
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84
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Abstract
Rectal atresia and stenosis are rare and peculiar anorectal malformations for which many and varied surgical procedures have been described, ranging from simple perforation of the atresia to extensive sacro-abdomino-perineal pull-through operations. The results of the operations have been generally unsatisfactory, chronic constipation being a common postoperative feature. In the authors' experience, the Duhamel pull-through is the operation of choice for this problem.
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85
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Chiu HH, Chang MH, Chen CL, Hsu HY, Ni YH. The association of syndromic paucity of the interlobular bile ducts and congenital mechanical obstruction of the small intestine. J Pediatr Gastroenterol Nutr 1995; 21:304-7. [PMID: 8523214 DOI: 10.1097/00005176-199510000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Three patients with congenital mechanical intestinal obstruction and features of syndromic paucity of the interlobular bile ducts (SPILBD) are presented. Two of them have siblings with syndromic paucity of the interlobular bile ducts. Two patients had jejunoileal atresia, while the other had a meconium plug with intestinal perforation. All subjects underwent surgery for intestinal obstruction within the first 24 h of life. Progressive disappearance of the bile ductules was observed in one case. We believe that an insult such as vascular insufficiency to both bile ductal epithelium and the small intestine may be the cause of this congenital disorder.
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86
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Tillig E, Robel R, Vogtmann C, Viehweg B, Möckel A. [Severe protracted intrauterine impaired perfusion--a cause of enteral motility disorder in the premature infant]. Z Geburtshilfe Neonatol 1995; 199:190-4. [PMID: 8528954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The importance of measurement of blood flow in the fetal and uteroplacental circulations for the assessment of fetal wellbeing has been undisputed since some years. The present study is designed to prove if any relationship exists between severe hemodynamic disturbance in fetal as well as uteroplacental vessels and the occurrence of postnatal impairment of intestinal motility. The progress of 130 children, born in the University Women's Hospital Leipzig between 1991-1993 and with birth weights below 1500 g, has been analyzed. Doppler ultrasound examinations for detection of impairment in fetal and uteroplacental circulation were performed in all cases during pregnancy. A severe impairment of blood flow in the above mentioned circulations was defined by the presence of pathological pulsatility or resistance indices in both fetal and uteroplacental vessels as well as absent end diastolic flow in the umbilical artery and signs of centralization in the fetus. A severe hemodynamic impairment was found in 27 children and 26 of these were classified as severe hypotrophic after birth. The progress of these children was compared with this of other hypotrophic and euthrophic premature babies who had not revealed hemodynamic abnormalities. The incidence of disturbed postnatal intestinal motility (delayed meconium excretion, abdominal distention, retrograde peristalsis, subileus) was significantly higher in hypotrophic neonates with hemodynamic abnormalities in the course of pregnancy. Four of these newborns underwent surgery and surgical findings did not correlate with enterocolitis. The resumption of oral food intake for neonates who had hemodynamic impairments during pregnancy was delayed compared with the control groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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MESH Headings
- Birth Weight/physiology
- Enterocolitis, Pseudomembranous/congenital
- Enterocolitis, Pseudomembranous/diagnostic imaging
- Enterocolitis, Pseudomembranous/physiopathology
- Female
- Fetal Growth Retardation/diagnostic imaging
- Fetal Growth Retardation/physiopathology
- Fetus/blood supply
- Gastric Emptying/physiology
- Gastrointestinal Motility/physiology
- Gastrointestinal Transit/physiology
- Gestational Age
- Hemodynamics/physiology
- Humans
- Infant, Newborn
- Infant, Premature, Diseases/diagnostic imaging
- Infant, Premature, Diseases/physiopathology
- Intestinal Obstruction/congenital
- Intestinal Obstruction/diagnostic imaging
- Intestinal Obstruction/physiopathology
- Intestines/blood supply
- Ischemia/congenital
- Ischemia/diagnostic imaging
- Ischemia/physiopathology
- Maternal-Fetal Exchange/physiology
- Pregnancy
- Risk Factors
- Ultrasonography, Doppler
- Ultrasonography, Prenatal
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87
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88
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Konje JC, de Chazal R, MacFadyen U, Taylor DJ. Antenatal diagnosis and management of meconium peritonitis: a case report and review of the literature. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 1995; 6:66-69. [PMID: 8528807 DOI: 10.1046/j.1469-0705.1995.06010066.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We present a case of meconium peritonitis which was associated with a short bowel and complicated by progressive bowel distension and difficulty in making a definitive diagnosis of cystic fibrosis. Treatment was by bowel resection and an ileostomy (and later bowel anastomosis), followed by parenteral nutrition which was complicated by hepatitis. The literature is reviewed and management dilemmas and options are discussed.
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89
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Poenaru D, Uroz-Tristán J, Leclerc S, Murphy S, Bensoussan AL. Imperforate anus, malrotation and Hirschsprung's disease: a rare association. Eur J Pediatr Surg 1995; 5:187-9. [PMID: 7547811 DOI: 10.1055/s-2008-1066202] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The association of imperforate anus with anomalies of rectal innervation is very rare. Moreover, malrotation only rarely accompanies these malformations. We report 2 patients with this unusual triple association and its impact on their management. Retrospectively both patients presented at birth with the same radiological picture of distended distal colon and right-sided small bowel location. We discuss the importance of a systematic search for associated intestinal malformations in cases of imperforate anus in order to avoid serious complications and to choose the optimal operative strategy.
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90
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Yoshizato T, Koyanagi T, Nagata S, Takashima T, Fukushima S, Nakano H. Three-dimensional ultrasound image of the fetal stomach: congenital duodenal obstruction in utero. Early Hum Dev 1995; 41:39-47. [PMID: 7781568 DOI: 10.1016/0378-3782(94)01607-q] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To quantitatively characterize the stereographic stomach configuration in utero, 11 fetuses (subject-group) with congenital duodenal obstruction, diagnosed antenatally, between 29 and 37 weeks' gestation were studied. Also included were 879 uncomplicated fetuses between 20 and 40 weeks' gestation as a control-group. Applying the algorithm which we devised: "Modeling a three-dimensional shape from a silhouette by detecting symmetry", we reconstructed the three-dimensional stomach configuration from a two-dimensional ultrasound image for each case. The statistical differences in two parameters, stomach volume and sphericity, between subject- and control-group fetuses, were analyzed using the Grubbs-Smirnoff's test at corresponding gestational ages. From 29 to 37 weeks' gestation, the stomach volume in the subject-group fetuses was found to increase greatly with advancing gestation, having significantly higher values than the control-group fetuses, whereas the stomach sphericity remained unchanged with no significant differences from the control-group fetuses. These findings indicate that the fetal stomach with duodenal obstruction maintains almost the same three-dimensional portrayal in utero as that seen in uncomplicated fetuses, although the stomach becomes extremely enlarged.
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91
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Niemann H, Schmidt KH, Wintzer G. [Duplication of the colon. An incidental finding in segmental rectal stenosis]. Chirurg 1995; 66:226-9. [PMID: 7750396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Colonic duplication is a rare, congenital anomaly. A case is presented in order to show the etiology, pathology and clinical importance of colonic duplication.
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92
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Nakada K, Fujioka T, Kawaguchi F, Yamate N. [Congenital intestinal atresia and stenosis]. NIHON RINSHO. JAPANESE JOURNAL OF CLINICAL MEDICINE 1994; Suppl 6:267-70. [PMID: 7837467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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93
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Heydanus R, Spaargaren MC, Wladimiroff JW. Prenatal ultrasonic diagnosis of obstructive bowel disease: a retrospective analysis. Prenat Diagn 1994; 14:1035-41. [PMID: 7877951 DOI: 10.1002/pd.1970141105] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Fetal obstructive bowel disease was diagnosed in 29 patients at 22-37 weeks (median 32 weeks) of gestation, seven (24 per cent) of whom also displayed other anomalies. Polyhydramnios was present in 20/29 cases (69 per cent). An abnormal karyotype existed in 7/29 cases (24 per cent), of which six were diagnosed prenatally (trisomy 21, n = 5; 69,XXX, n = 1) and one postnatally (trisomy 21). There was always an association with the ultrasonic 'double bubble' sign. Obstructive bowel disease was confirmed postnatally in 20/29 (69 per cent) cases, i.e., oesophageal atresia (n = 1), duodenal obstruction (n = 12), and small bowel obstruction (n = 7). Other anomalies existed in 6/29 (21 per cent) cases, i.e., multicystic kidney (n = 1) and multiple congenital anomalies (n = 5). The perinatal mortality rate was 35 per cent (7/20).
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94
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Muller F, Dommergues M, Ville Y, Lewin F, Delvalez-Morichon N, Nihoul-Fekete C, Bargy F, Dumez Y, Boue A. Amniotic fluid digestive enzymes: diagnostic value in fetal gastrointestinal obstructions. Prenat Diagn 1994; 14:973-9. [PMID: 7899271 DOI: 10.1002/pd.1970141013] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The diagnostic value of amniotic fluid gamma-glutamyl-transpeptidase (GGTP) and intestinal alkaline phosphatase (iALP) was evaluated in 55 patients who underwent amniocentesis for karyotyping because fetal gastric or small bowel dilatation had been detected by ultrasound. Gastrointestinal malformation was confirmed in 46 cases and there was no gastrointestinal anomaly in nine cases. Prenatal ultrasound was suggestive of gastroduodenal dilatation in 34 cases (group I) and small bowel dilatation in 21 cases (group II). In group I, amniotic fluid GGTP above the 99th percentile was 71 per cent sensitive and 100 per cent specific for a true anatomical defect of the digestive tract (mainly duodenal atresia). In group II, high levels of GGTP and/or iALP were 69 per cent sensitive and 83 per cent specific for a fetal digestive tract anomaly. In other words, when digestive tract dilatations were diagnosed by prenatal sonography, abnormal amniotic fluid enzyme activities were strongly suggestive of such an anomaly, the possibility of which was not precluded by normal amniotic fluid iALP and GGTP activities. But amniotic fluid digestive enzyme activities do not help in defining the prognosis.
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95
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Schultz LR. Volvulus, the deadly twist. THE NEBRASKA MEDICAL JOURNAL 1994; 79:326. [PMID: 7991001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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96
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Abstract
The morbidity and mortality in short bowel syndrome are directly related to the length of the remaining small bowel and to the duration of total parenteral nutrition. We describe the successful salvage of an infant with extensive small bowel infarction for whom a new technique was used to preserve all viable mucosal surfaces. The infant, with gastroschisis, was found to have a tight volvulus of the extruded bowel and extensive small bowel ischemia at the time of delivery. Forty-eight hours after reduction of the volvulus and abdominal decompression, a second-look laparotomy was performed. Although only the terminal 13 cm of ileum was completely viable, 25% of the circumference of a further 23 cm of proximal jejunum/ileum was considered salvageable. After debridement of the dead tissue, the remaining gutter of jejunum was divided at its midpoint, and the two halves were anastomosed longitudinally to provide a "neojejunum" of 12 cm in length, which was anastomosed between the duodenum and terminal ileum. Full enteral feeding was tolerated from day 47. Although the neojejunum was excised on day 149, after becoming dilated and atonic, by that time the remaining small bowel had elongated to 30 cm. Because of the early institution of full enteral feeding, there were no long-term complications related to total parenteral nutrition.
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97
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Tabata T, Matsumoto Y, Myojin T, Komatsu K. [Identical twins with different types of jejunal atresia]. NIHON GEKA GAKKAI ZASSHI 1994; 95:709-11. [PMID: 7838113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This is a report of identical twins who were associated with different types of jejunal atresia, whose mother had no problems during her gestation. One was associated with a membranous atresia, and the another multiple jejunal atresia. Identical twins, both of whom are associated with intestinal atresia are very rare. The anomalies of these infants might be resulted from congenital factor and secondary circulatory disturbance.
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98
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Shapkin VV, Shumov ND, Braev AT. [Long-term results of treatment of children with severe congenital intestinal obstruction]. VESTNIK ROSSIISKOI AKADEMII MEDITSINSKIKH NAUK 1994:17-20. [PMID: 7516760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A total of 295 children were operated on for severe ileus. The late outcomes of treating 88 children were studied for some months to 18 years. The assessment of the therapy results, the detection of causes of complications and the determination of the functional status were made by using a complex of study methods. Thirty-one children required surgical correction of complications. Five groups of children were identified and complications and reconstructive surgical techniques were determined and characterized.
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99
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Gürgan T, Zeyneloglu HY, Develioglu O, Urman B. Megacystis microcolon intestinal hypoperistalsis syndrome: antenatal ultrasound appearance. A case report. ASIA-OCEANIA JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1993; 19:383-6. [PMID: 8135670 DOI: 10.1111/j.1447-0756.1993.tb00397.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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100
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Merten DF. Practical approaches to pediatric gastrointestinal radiology. Radiol Clin North Am 1993; 31:1395-407. [PMID: 8210357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Radiologic evaluation of the pediatric gastrointestinal tract requires knowledge of the specific problems acutely afflicting the gastrointestinal tract in children and the specialized approaches required for accurate radiologic diagnosis. Efficacious radiologic evaluation and accurate diagnosis are possible only when the radiologist is aware of the presence and significance of clinical findings. The radiologist must take an active role in formulating a presumptive diagnosis and determining the best course of radiologic examination. Careful correlation of clinical and radiologic findings is necessary to assure accurate diagnosis and appropriate treatment.
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