Sonographic presentation of Hirschsprung's disease. A case of an entirely aganglionic colon and ileum

Prenatal sonographic presentation of Hirschsprung's disease has been considered non-specific and uncommon. This report presents a second-trimester fetus with an aganglionic colon and ileum diagnosed by the sonographic presentation of dilated fetal bowel loops, increased abdominal circumference, and mild polyhydramnios. The prenatal sonographic diagnosis of Hirschsprung's disease helped to expedite early neonatal treatment.

The persisting mesonephric duct syndrome in a neonate with agenesis of the corpus callosum

Agenesis of the corpus callosum is a rare condition, often associated with craniofacial, skeletal and genitourinary abnormalities. We report on a male newborn in whom all of these organ systems were affected. The genitourinary anomaly consisted of vaso-ureteral fusion accompanied by renal, ureteral, vesical, ductal and genital malformations. The diagnostic approach and management of this unusual case are described and the literature is reviewed.

Transoesophageal echocardiography and the intraoperative diagnosis of left atrial invasion by carcinoid tumour

A 41-yr-old woman with pulmonary carcinoid tumour presented for thoracotomy and lung resection. However, intraoperative transoesophageal echocardiography (TEE) revealed that the tumour had invaded the left atrium, and the planned resection was aborted to allow resection under cardiopulmonary bypass at a later date. Although the incidence of cardiac involvement by lung cancer at the time of pulmonary resection is unknown, transoesophageal echocardiography can be useful in identifying the extension of hilar lung tumours. This should preferentially be done preoperatively, but can be done intraoperatively as described in this case report.

Presynaptic A1-purinoceptor-mediated inhibitory effects of adenosine and its stable analogues on the mouse hemidiaphragm preparation

1. The effect of adenosine or its stable analogues (2-chloroadenosine, CADO; 5'-N-ethylcarboxamidoadenosine, NECA; and N6-cyclopentyladenosine, CPA) on the release of [3H]-acetylcholine ([3H]-ACh), and on the development of force of contraction evoked by electrical stimulation of the nerve, were studied in the mouse phrenic nerve-hemidiaphragm preparation. Evidence was obtained that the release of ACh is subject to presynaptic modulation through presynaptic A1(P1)-purinoceptors. 2. Adenosine or its stable analogues (CADO, NECA, CPA) inhibited, in a concentration-dependent manner, both the release of ACh and the force of the indirectly elicited contraction of hemidiaphragm preparation, provided in the latter case that the margin of safety was reduced by (+)-tubocurarine or magnesium. The order of potency in reducing ACh release was CPA greater than NECA greater than CADO greater than adenosine with IC50 values of 0.08 +/- 0.01, 0.74 +/- 0.05, 9.05 +/- 0.20, and 410.2 +/- 42.5 mumol/l, respectively. The order of potency in reducing twitch tension was CPA greater than NECA greater than CADO greater than adenosine with IC50 values of 0.11 +/- 0.02, 0.48 +/- 0.03, 2.07 +/- 0.49, and 240.4 +/- 20.0 mumol/l, respectively. 3. 8-Phenyltheophylline (8-PT) antagonized the inhibitory effects of the adenosine receptor agonists on ACh release and twitch tension.(ABSTRACT TRUNCATED AT 250 WORDS)

Reusables win a battle over disposables

The time is right to market the environmental benefits of reusable textiles. Take it from Stan Wiener, director of sales for Unitex Textile Rental Services, Mount Vernon, N.Y. Wearing one of his company's reusable cloth examination gowns, Wiener made a sales call to a leading New York health services center. Persuaded by the environmental friendliness of reusables, the health center made the switch from paper gowns and has realized a 5,000-lb. reduction in disposable trash.

Laceration of the left pulmonary artery during removal of a bronchogenic cyst by right thoracotomy

Major vascular involvement by a bronchogenic cyst is rare; most large cysts cause respiratory symptoms. We present a case in which a large bronchogenic cyst was adherent to the left pulmonary artery. During removal of the cyst by right thoracotomy, the artery lacerated. Repair of the artery in such a situation taxes the surgeon's ingenuity and decision-making process.

Soft-tissue effects of biliary extracorporeal shockwave lithotripsy in swine

This study investigates the soft-tissue effects of biliary extracorporeal shockwave lithotripsy (BESWL) using a recently developed lithotripter, which consists of an electromagnetic shockwave generator and an integrated ultrasonic targeting system. Sixteen swine, evenly divided into four groups, underwent BESWL. One group had one BESWL session targeted on the gallbladder and another group had two BESWL sessions targeted on the gallbladder. The third group had one BESWL session targeted on implanted gallbladder stones and the fourth group had one BESWL session targeted on the region of the common bile duct (CBD). Half of each group were sacrificed on the day of lithotripsy and half 1 week later. Post-mortem examinations were performed. Each implanted gallstone had fragmented. There were no findings attributable to BESWL in 11 animals. Three animals had pulmonary haemorrhagic spots (the largest was 10 mm in diameter) and one had a submucosal CBD petechia; these findings were attributable to BESWL. In two animals, microscopic haemorrhage associated with bronchopneumonia (usually present in our pig population) was more prominent than usual. This was possibly attributable to BESWL. The swine's deep posterior costophrenic sulcus makes it difficult to avoid the lung base during BESWL in swine. We conclude that this BESWL device can fragment gallstones without causing clinically significant soft-tissue damage.

Human milk immunoglobulin A antibodies to Shigella virulence determinants

Because human milk is thought to protect infants from shigellosis, we evaluated milk for immunoglobulin A to Shigella virulence determinants. Milk was preincubated to remove antibodies unrelated to each locus of interest, using defined Shigella and E. coli hybrids containing known Shigella genetic segments prior to immunoblotting. The milk could not be shown to contain antibodies to chromosomally encoded virulence loci except for the expected antibodies to the products of the histidine locus. However, all the milk samples contained antibodies to antigens encoded by the large virulence plasmid. The finding of these antibodies suggests a possible mechanism by which human milk might protect infants.

The normal pericardium does not affect left ventricular function

Whether the normal pericardium exerts a constraining effect on left ventricular (LV) diastolic compliance and/or systolic function is controversial. Left ventricular filling and performance were studied in 15 patients by two-dimensional transesophageal echocardiography (2D-TEE) measuring end-diastolic area (EDa), end-systolic area (ESa), ejection fraction area (EFa), and hemodynamics immediately pre- and post-pericardiotomy. To diminish the influences of other variables such as surgical stimulation, chest wall constraint, and autoregulation, measurements were performed in deeply anesthetized patients with the chest fully opened immediately before and after pericardiotomy (PC). No significant echocardiographic or hemodynamic changes were observed after PC. Although alterations in compliance cannot be excluded, no significant changes in LV diastolic filling (EDa, pulmonary capillary wedge pressure [PCWP]) or systolic performance (EFa, cardiac output [CO]) were found. Therefore, it is concluded that the normal pericardium does not exert a measurable constraining effect on LV performance.

Chronic mesenteric vascular insufficiency with gastric ulceration

Four middle-aged women presented with long histories of severe progressive weight loss and chronic abdominal pain. Endoscopically atypical gastric ulcers were identified in all; the ulcers were multiple and antral in location, with irregular shapes, sloping edges, and whitish sclerotic bases, and were surrounded by mottled and erythematous mucosa containing numerous superficial erosions. They did not heal with conservative therapy. All 4 patients were found to be suffering from chronic mesenteric vascular insufficiency. Balloon dilatation of the superior mesenteric artery in one and surgical revascularization in the others resulted in progressive clinical improvement and healing of the ulcers. The striking feature in these patients with mesenteric ischemia was the finding of gastric ulcers with a morphology different from the ordinary gastric ulcer, which healed only with revascularization. Future observation of similar lesions should suggest the possible diagnosis and expedite early treatment of mesenteric insufficiency in patients with this disorder.

Clinical and biochemical study of a child with the non-neuronopathic-Type B form of Niemann-Pick disease

A child with Niemann-Pick disease type B, diagnosed at the age of two years and followed up for three years is described. Despite extensive visceral involvement--as deduced from marked hepatosplenomegaly and pulmonary infiltration--the child is in general good health and has no apparent neurologic abnormality. Biochemical studies revealed a tenfold increase of sphingomyelin content in his liver biopsy specimen and a markedly reduced sphingomyelinase activity in peripheral blood leukocytes. His parents were found to be heterozygous carriers of the disease, showing sphingomyelinase activity values intermediate between those of patient and healthy subjects. The relevant literature, concerning patients with the non-neuronopathic type B form, is reviewed.