Palisaded myofibroblastoma--an uncommon tumour of lymph nodes.

We report a case of palisaded myofibroblastoma of the groin in a woman aged 20 years who presented with a large groin swelling. It is an uncommon benign tumour mainly arising in a lymph node.

Neonatal primary hyperparathyroidism masked by vitamin D deficiency.

Neonatal primary hyperparathyroidism is a life threatening disorder that is associated with severe hypercalcaemia, hypotonia, bone demineralization, fractures and respiratory distress. Treatment consists of total parathyroidectomy and without this affected infants will usually die by the age of three months. We report a patient with neonatal primary hyperparathyroidism who survived without fractures or parathyroidectomy to an age of nine months, and in whom the hypercalcaemia became masked by vitamin D deficiency. At surgery, four-gland hyperplasia was demonstrated and total parathyroidectomy followed by oral calcitriol treatment has restored well-being and normocalcaemia. An absence of skeletal complications, a survival beyond three months of age without parathyroidectomy and the masking of the hypercalcaemia by vitamin D deficiency represents a unique combination of metabolic abnormalities in a patient with neonatal primary hyperparathyroidism.

Gestational age correction for height in preterm children to seven years of age.

Correction for gestational age continues to make a difference to the height SD score (SDS) to the age of seven years in very preterm babies. The height SDS for children born at 28 weeks' gestation increased by 0.25 SDS when postconceptual age was used instead of real age. Extrapolating from these results, the effect of correction would be an increase of approximately 0.32 SDS for a seven-year-old of 24 weeks' gestation. Unsatisfactory growth may be masked by a steady or increasing real age SDS in a few children. The risks of stopping using postconceptual age at two or three years include both false confidence in genuine cases of growth retardation and misinterpretation of a decrease in height SDS as evidence of growth retardation. As the number of very preterm babies who survive increases so does the importance of these observations.

Coordination of low birthweight seven-year-olds.

The coordination and laterality of a group of 171 seven-year-old children, free from major disability, with a birthweight of 2,000 g or less, were examined and compared with those of normal birthweight peers. More low birthweight children were left-handed and of mixed or undetermined hand, foot and eye dominance. Left-handedness may adversely affect some areas of performance of normal birthweight but not of low birthweight children. Low birthweight children performed significantly less well in tests of both fine and gross motor coordination. Girls tended to perform better than boys in fine motor tests. In the low birthweight group there was a correlation between IQ and coordination.

Outcome of preterm infants who suffered neonatal apnoeic attacks.

Thirty infants of less than 31 weeks post-menstrual age were monitored for apnoea using routine medical equipment and intermittent 24-h pneumocardiograms. These infants were examined again between 16 and 36 months of age. Full physical and ophthalmological examinations were carried out as well as audiometry and assessment using the Griffiths mental developmental scales. Twenty-five of these infants had suffered apnoeic attacks and two of these infants had an abnormal developmental quotient. Neither sensorineural deafness of retinopathy of prematurity were detected in the children who suffered apnoeic episodes. The poor prognosis which has been associated with neonatal apnoea may not apply to those infants without other serious neonatal problem.

Percutaneous absorption in preterm infants.

The skin of preterm infants varies considerably in its level of maturity. To understand skin absorption in premature infants better, we report a technique for the assessment of percutaneous absorption at various gestational and postnatal ages using stable, isotope-labeled (13C6) benzoic acid. Our results indicate that in the preterm infant, this method detects enhanced skin absorption in the first postnatal days, which declines over three weeks to that expected of a full-term infant. This approach also indicates an inverse relationship between gestational age and skin absorption, as well as postnatal age and skin absorption. The reported technique is a safe and noninvasive method using a model skin penetrant for the study of percutaneous absorption in preterm infants from which basic data may be derived to add to our understanding of skin barrier function.

Hyperphenylalaninemia with defective transamination.

Blood phenylalanine concentrations in a female neonate increased slowly to a level at which dietary phenylalanine restriction became necessary. At this point the patient's urinary aromatic acid excretion profile showed only minimal amounts of phenylpyruvic acid or related aromatic acids. Phenylalanine-tolerance tests, and a subsequent challenge with a normal diet for three days, revealed a progressive decline in the blood phenylalanine concentration at which transamination started to occur. This fits the classification of 'hyperphenylalaninemia with transamination defect'. Possible explanations for the defective metabolism are discussed in the light of the experimental findings.

Proctoscopy in infancy with reference to its use in necrotising enterocolitis.

Experience with the fairly simple and safe technique of proctoscopy in an infant using an ordinary auroscope is reported. The use of the auroscope showed the presence of a frank colitis in 13 of 14 consecutive cases of necrotising enterocolitis. A prospective study was made during a 6-month period of 51 infants with diarrhoea referred to a gastroenterology isolation unit; proctoscopic findings that suggested colitis were found in 10. Of these, 3 appeared to have necrotising enterocolitis; 3 had salmonella or shigella dysentery; in 3 of the remaining 4 the findings were localised to the anus, with normal mucosa above. This was attributed to a mild rectal prolapse on straining. There was no correlation between the severity of the diarrhoea and the presence of colitis. Proctoscopy is safe and valuable in the early diagnosis of necrotising enterocolitis. It is also helped in assessing the progress of the disease.

Vertical transmission of hepatitis B surface antigen in carrier mothers in two west London hospitals.

126 children of 102 hepatitis B surface antigen (HBsAg) carrier mothers were delivered at Hammersmith Hospital and Queen Charlotte's Maternity Hospital, between 1971 and mid-1978. Blood tests on 110 of these children showed that 8 out of the 18 with Chinese mothers, but only 6 out of the 92 other children, have become HBsAg positive. The presence of maternal hepatitis B e antigen (HBeAg) is also significantly correlated with transmission of HBsAg to the children. The management of children whose mothers are carriers is discussed.

Tuberculosis of the peritoneal cavity.

The clinical presentation and management of 30 consecutive patients with tuberculous peritonitis are reviewed. Seventy per cent of the patients were aged 40 years or less and 80 per cent were immigrants. The main clinical features of abdominal pain, loss of weight, vomiting and sweating at night had been present in a large number of patients for several months before presentation to hospital. The clinical diagnosis of tuberculous peritonitis was difficult in the absence of extraperitoneal tuberculosis. Laboratory investigations were of little value in establishing the diagnosis. An elevated ESR was found in 80 per cent of patients. At laparotomy omental biopsy was performed and was diagnostic in all cases. Laparotomy was a safe and fast method of obtaining tissue for confirmation of the diagnosis in suspected cases, particularly when presenting acutely. Ascitic fluid cultures and guinea-pig inoculations were positive in only 6 out of the 15 patients in whom they were performed. Only 1 patient died.

The importance of plasma lipid, glucose, insulin and fibrinogen in femoropopliteal surgery.

Fasting blood levels of cholesterol, triglyceride, glucose insulin and fibrinogen were measured preoperatively in 44 patients who had reconstructive operations for occlusive disease in the femoral and popliteal arteries. Comparison of these preoperative biochemical measurements with the results of surgery over a 4-year period indicated that failure was associated with significantly higher mean preoperative levels of both glucose (P less than 0.01) and fibrinogen (P less than 0.01). High fasting blood glucose was associated with early failure (occlusion between 3 and 12 months) and high plasma fibronogen was associated with late failure (occlusion between 1 and 4 years). The results of operation were not influenced significantly by preoperative blood levels of cholesterol, triglyceride or insulin.