Intra-specific host sharing in the manipulative parasite Acanthocephalus dirus: does conflict occur over host modification?

The acanthocephalan parasite Acanthocephalus dirus induces a colour change in the intermediate host, the aquatic isopod Caecidotea intermedius, which increases transmission to definitive hosts (creek chub, sunfish). We examined the potential for conflict to occur between infective (cystacanth) and non-infective (acanthor, acanthella) stages of A. dirus over the level of colour modification that should be induced when these stages share a host. Using a field survey, we showed that host sharing by infective and non-infective stages was relatively common and that infective and non-infective stages differed in their effects on colour modification. Non-infective stages induced a colour change over 40% of the body, whereas infective stages induced a colour change over 80%. Thus, conflict could occur between stages over the level of modification that should be induced. We then showed that mixed-stage infections induced a colour change in the host that was consistent with the level of modification induced by the infective stage. We discuss the potential significance of these results to patterns of host modification and their effects on stage-related survival in nature.

Segmental infarction of the omentum: a difficult diagnosis.

Segmental infarction of the greater omentum is a rare diagnosis. This report describes a case of omental torsion in an eight-year-old boy. The report assesses the predisposing factors, the classification and the place of ultrasonography.

Meconium ileus secondary to cystic fibrosis. The East London experience.

Meconium ileus (MI) affects 15% of neonates with cystic fibrosis (CF). The authors reviewed the management and outcome of 51 neonates presenting to a single institution between 1976 and 1995 with MI secondary to CF. Clinical presentation included abdominal distension (96%), bilious vomiting (49%), and delayed passage of meconium (36%). A family history of CF was present in 4 cases (8%). Twenty-three neonates presented with MI and evidence of volvulus, atresia, or perforation (complicated MI). Of these, 16 underwent stoma formation, 1 appendicectomy, and 6 resection with primary anastomosis. Twenty-eight neonates presented with uncomplicated MI. Of these, 11 were managed non-operatively by Gastrografin enema (10) or enteral N-acetylcysteine (1). The remainder required stoma formation (15) or bowel resection with primary anastomosis (2). Early postoperative complications occurred in 2 neonates (4%). In this hospital the 1-year survival for this condition has increased from 49% (1953-1970) to 98% (1976-1995) irrespective of the surgical procedure performed or the presence of volvulus, atresia, or perforation. In our experience, bowel resection with primary anastomosis is as safe as stoma formation and is associated with a reduced length of initial hospital stay.

Pneumatic intussusception reduction via a colostomy: case report.

Intussusception is uncommon in infants with a colostomy. The authors present the first documented case of intussusception in an infant with a colostomy in which pneumatic reduction was achieved via the stomal opening. The inflated balloon of a Foley catheter was plugged against the stoma at skin level and a tight seal was obtained. Successful reduction was achieved without any adverse effects to the patient.

Association of ambiguous genitalia with VATER anomalies and its significance in management.

Tracheo-oesophageal fistula, oesophageal atresia, and imperforate anus are known to be associated with renal anomalies - the VATER complex. The occurrence of ambiguous genitalia with this collection of anomalies has not previously been highlighted. We report two cases occurring 15 years apart; both had renal agenesis and neither was salvagealble from a renal or pulmonary viewpoint. Preoperative ultrasound examination of the renal tract should be performed in all babies born with the VATER complex and ambiguous genitalia; this will prevent unnecessary surgery.

An easy method for adjusting a silo for delayed closure of gastroschisis.

A method is described permitting rapid and safe tucks and adjustments to be made to a silo in staged reduction of an anterior abdominal wall defect.

The importance of serial biophysical assessment of fetal wellbeing in gastroschisis.

OBJECTIVE: To review antenatal and intrapartum assessment of pregnancies complicated by gastroschisis. DESIGN: Retrospective descriptive study. SETTING: University College Hospital, London. SUBJECTS: 24 consecutive cases of gastroschisis between 1986 and 1991. RESULTS: The gestational age at sonographic diagnosis was 20.3 weeks (SD 6.77) and at birth was 36.5 weeks (SD 2.06). There were 21 live births, all with good surgical outcome. There were 16 vaginal deliveries and eight caesarean sections. The elective sections were for oligohydramnios and dilated bowel (1) and clinically suspected growth retardation (1); the intrapartum caesarean sections were for fetal distress (4) and premature breech presentation (2). There were six with dilated gut on ultrasound; one of these ended in a stillbirth. There was a significant association between gut dilatation and caesarean section for fetal distress (P = 0.004). There was also a significant association between meconium staining and fetal distress (P = 0.021). Of these babies, 46% were < or = third centile for corrected birth weight. CONCLUSIONS: While half of the babies with gastroschisis were small for gestational age at birth, reliable antenatal prediction of birth weight is difficult. Gut dilatation may be an indicator of either antenatal or intrapartum fetal distress, but does not correlate with poor neonatal surgical outcome. We suggest close antenatal surveillance of fetal wellbeing in all cases of gastroschisis because, in addition to growth retardation, many show some evidence of fetal distress and 12.5% end in stillbirth, even when appropriately grown.

Double duodenal atresia/stenosis: a report of four cases.

Four neonates with double duodenal atresia/stenosis are described. Preoperative plain radiographs in two patients demonstrated atypical appearances suggestive of complex pathology. Cystic dilatation of the second part of the duodenum was observed at laparotomy in two patients and in one of these the "cyst" was palpable preoperatively, causing diagnostic confusion. All four patients underwent successful surgery but one infant with Down's syndrome subsequently died of congenital heart disease.

Acute leukemia in an infant with Marfan's syndrome: a case report.

We describe a familial case of Marfan's syndrome with associated intrathoracic stomach detected during the neonatal period. The patient developed a primitive leukemia at 3 months of age. Acute leukemia in a patient with Marfan's syndrome has not previously been reported.

Complications of endorectal pull-through for Hirschsprung's disease.

In 10 years, 57 infants with Hirschsprung's disease underwent endorectal pull-through (ERPT). Postoperatively, 3 patients died. Of the 44 survivors with an intact endorectal anastomosis aged more than 3 years, 23 (52%) had an excellent result, and of the 28 children more than 5 years old, 23 (82%) had a satisfactory result. Of the 53 known survivors of all ages, 18% suffered from diarrhea with intermittent incontinence and 5 (9.4%) had undergone a Duhamel procedure within 4 years of ERPT.

Controversies in the management of gastroschisis: a study of 40 patients.

Forty infants with gastroschisis were referred to two paediatric surgeons during a 13 year period. Overall survival was 90%. Nine patients were transferred in utero and 31 were referred postnatally. Birth weights, gestational ages, and Apgar scores were similar for both groups. Primary closure of the defect was successfully achieved in seven (78%) patients in the prenatally transferred group compared with 17 (55%) in the postnatal group. Significantly less postoperative assisted ventilation, and a trend in favour of early discharge home, were noted after prenatal transfer. Problems arising during postnatal transfer may have contributed to these differences. No major differences resulting from the mode of delivery were identified. Patients treated by primary closure fared significantly better than those undergoing staged repairs with prosthetic material. Prospective randomised studies are required to confirm these findings.

Results of surgical treatment of neonatal necrotizing enterocolitis.

In 6 years, 74 neonates were treated for necrotizing enterocolitis, 40 (54 per cent) of whom underwent operation. The early postoperative mortality rate was 23 per cent and there was one late death. Of the 30 postoperative survivors, two have short bowel syndrome, two have chronic respiratory disease, two are partially sighted, and five (17 per cent) have severe developmental delay. Only 15 (50 per cent) survivors enjoy good health.

Oesophageal atresia.

Fifty years ago this congenital anomaly was incompatible with survival. Advances in neonatal intensive care, anaesthesia and surgical techniques permit successful correction in the vast majority of patients. Death in a patient with oesophageal atresia is now rarely attributable to that anomaly, but occurs in the very premature and those babies with other associated major anomalies.

Fetal diaphragmatic hernia: the value of fetal echocardiography in the prediction of postnatal outcome.

Nineteen pregnancies complicated by fetal congenital diaphragmatic hernia (CDH) referred for fetal echocardiography have been reviewed. Congenital heart disease was diagnosed prenatally in three fetuses; in one of these the pregnancy was terminated, the two other infants died in the neonatal period. The presence of the fetal stomach within the thorax or a hernia/heart area ratio greater than 1.7 was associated with a large diaphragmatic defect. Polyhydramnios was not associated with a poor postnatal outcome. Evidence of cardiac ventricular disproportion before 24 weeks gestation in isolated CDH was associated with 100% mortality. Development of ventricular disproportion during the third trimester was associated with a survival rate of 75%. In three fetuses, all of whom survived, no ventricular disproportion was detected during the third trimester examination.

Infantile colitis: a manifestation of intestinal Behcet's syndrome.

A brother and sister of first cousin Pakistani parents presented with recurrent mouth ulcers and chronic diarrhoea in the neonatal period. Diarrhoea persisted in spite of treatment with oral prednisolone and sulphasalazine. Both children required subtotal colectomy with ileostomy. Histopathology of the resected colons was virtually identical and showed multiple deep "flask"-shaped ulcers, often penetrating to the serosa, in the presence of chronic inflammation, but without any of the characteristic histological features of Crohn's disease. The appearance closely resembled the colitis of Beh,cet's syndrome. Both children (aged 6 and 3.5 years, respectively) have continued to have recurrent perianal disease with intermittent bloody diarrhoea since the operation. Apart from the initial symptoms of oral aphthous ulcerations in both children, no other major criteria have developed so far. Intestinal Behçet's syndrome should be considered in the differential diagnosis of chronic inflammatory bowel disease in childhood.

Clostridium difficile and acute enterocolitis.

Clostridium difficile belonging to groups not normally detected in infancy was the only potential pathogen detected in the stools of two infants with severe enterocolitis. Further information regarding the virulence of this organism was obtained by use of a recently introduced typing scheme.

Surgical emergencies after prenatal treatment for intra-abdominal abnormality.

Emergency surgery was required in three babies who had been treated prenatally after ultrasonic detection of gastrointestinal abnormality. There are at present no indications for prenatal intervention in such babies.

A new surgical approach to duplications of the intestine.

Two unusual intestinal duplications are described. In each case the mesenteric duplication had a separate muscular coat from the normal bowel permitting complete excision of the duplication without interference with the blood supply to the normal intestine.