Hereditary multiple intestinal atresia: thirty years later

BACKGROUND

Hereditary multiple intestinal atresia (HMIA) is an unusual form of intestinal atresia with a presumed autosomal recessive mode of inheritance. The aim of this study was to review the authors' experience with this disease, 30 years after its first description.

METHODS

All cases of HMIA treated at the authors' institution were reviewed with a particular focus on presence of close consanguinity in the families, prenatal diagnosis, radiologic and surgical findings, pathology report, and outcome.

RESULTS

Sixteen cases were identified. Two patients were siblings (1 newborn and 1 aborted foetus) and close consanguinity was proven in 1 other case. Bowel obstruction was suspected on prenatal ultrasound scan in 6 patients, but HMIA could not be diagnosed specifically. Radiologic, surgical, and pathologic findings were compatible with the standard description of this disease in the literature. All the patients died. Mean survival time was 50 days.

CONCLUSIONS

Thirty years after its first description, HMIA remains a disease without reliable prenatal diagnosis nor effective surgical therapy. An autosomal recessive mode of inheritance is suspected. Until accurate in utero diagnosis becomes available, children with HMIA should be oriented toward palliative care.

Laparoscopic appendectomy in children: A favorable alternative in simple and complicated appendicitis

BACKGROUND/PURPOSE

The laparoscopic treatment of pediatric appendicitis remains controversial, particularly in complicated cases (gangrene and perforation). This study evaluates outcomes of open (OA) and laparoscopic appendectomy (LA).

METHODS

The 391 cases of pediatric appendectomy performed between January 1998 and January 2001 were reviewed for age, sex, weight, type and length of intervention, operative description, antimicrobial therapy, analgesia, complications, length of hospitalization, and histopathology.

RESULTS

A total of 126 patients were operated on by laparoscopy, 262 by laparotomy, and there were 3 conversions (LA + OA). LA patients were older (11.9 v 9.6 years; P <.001) and more frequently girls (57.1% v 38.2%; P =.0004). LA took longer to perform (45.7 v 40.6 minutes; P =.0014). Operatively, 24.6% of LAs were described as complicated compared with 22.5% in OA. Narcotic use was equivalent in both groups (1.16 v 1.29 days; P =.434), as was the incidence of complications, either operative (1.6% v 0.4%; P =.20) or postoperative (10.3% v 8.02%; P =.32). Hospitalization was shorter in LA (2.38 v 2.94 days; P =.0131). Histopathology was negative in 21.4% of LAs compared with 13% of OAs (P =.032).

CONCLUSIONS

Laparoscopic appendectomy does not increase the incidence of complications, even with gangrenous or perforated appendicitis. The length of intervention is prolonged by 5 minutes on average. This technique allows for a shorter hospitalization.

[Quality of life perception by women suffering from stage III or IV primary pulmonary hypertension and receiving prostacyclin treatment]

The goal of this study was to examine perception of quality of life in women suffering from stage III or IV primary pulmonary hypertension and being treated with prostacycline. This medication is a non-specific vasodilator with a short half-life. This was an explorative and descriptive multiple-case study (3 cases). The interview guides were elaborated according to Zhan's conceptual model of quality of life (1992). These helped in collecting qualitative data for content analysis. The results indicated that the 3 women were not satisfied with their quality of life, in terms of physical, psychological, social, and economic well-being, during the 12 weeks following the initiation of their treatment. Even though medical studies have shown a decrease in the mortality rate of individuals suffering from primary pulmonary hypertension within the first 12 weeks of prostacycline treatment, this case study cannot conclude that the quality of life of these 3 women had improved. A longer data collection period, with a larger sample size of patients, is recommended for future research.