[Heavy metals in traditional Chinese medicine: ba-pao-neu-hwang-san].

Heavy metal intoxication of newborn infants fed with "Ba-Pao-Neu-Hwang-San" has been reported every year by many hospitals in Taiwan. About nine years ago, the National Laboratories of Foods and Drugs of the Department of Health, Executive Yuan, received one case report of a five month old female infant who died as a result of long term feeding with "Ba-Pao-Neu-Hwang-San". The drug was found to have contained lead 44,000 ppm. Although this unfortunate incident was propagated by most newspapers, the prescription of this ancient Chinese medicinal preparation is still widely accepted by ordinary people. Herbal medicine doctors prefer complex mineral drugs as did their ancestors thousands of years ago. In the last two years, we have collected 5 samples of "Ba-Pao-Neu-Hwang-San" from different manufacturers and measured the concentration of 16 heavy metals (including Cadmium, Mercury, Arsenic, Lead, Chromium, Manganese, Selenium, Germanium, Nickel, Calcium, Magnesium, Aluminum, Iron, Copper, Zinc, and Vanadium) in these drugs with Inductively-Coupled Plasma Atomic Emission Spectrometry and Graphite Furnace Atomic Absorption Spectrometry. The result of our survey revealed that the first sample (from Tainan) contained mercury 52,800 ppm, the fourth (from Ping-tung) contained mercury 34,500 ppm, and the fifth (from Sin-chu) contained mercury 65,700 ppm. The mercurial contents of these samples were apparently too high to be a safe drug.

[Survey of heavy metals in traditional Chinese medicinal preparations].

Traditional Chinese medicinal preparations are still widely used by natives in Taiwan. Some traditional Chinese medicine prepared with ancient formulas have been found to contain some heavy metals. There has been an occasional pediatric case admitted with heavy metal intoxication. In the last two years, we collected 11 ancient formula drug samples from the families of the patients. We detected the heavy metals with an inductively-coupled plasma atomic emission spectrometry and a graphite furnace atomic absorption spectrometry. The final result of our report reveals the problem of heavy metals in traditional Chinese medicinal preparations as being very serious.

[Neonatal bowel perforation successfully treated by conservative treatment: report of two cases].

Neonatal bowel perforation is a potentially lethal disease whose etiology and pathophysiology remain unclear. An aggressive approach with surgical intervention has been favored by some authors; otherwise, a high mortality rate was reported. In recent time, peritoneal drainage under local anesthesia for critically-ill premature infants with complicating perforation of necrotizing enterocolitis has had good results. Two cases of such perforation are reported. Case 1, a full-term baby was delivered by spontaneous delivery. Bowel perforation was found on the second day after birth. Case 2, a 27-week gestational age, premature baby, was delivered by emergent Cesarean section because of maternal placenta previa with massive vaginal bleeding. Bowel perforation was found, after feeding, on the seventh day after birth. Both sets of parents refused any surgical procedure, but the infants survived under medically conservative treatment, and the use of peritoneal drainage. This technique may be considered for neonates with bowel perforation if a surgical procedure is unsuitable or unacceptable.

Analysis of plasmid pattern in paediatric intensive care unit outbreaks of nosocomial infection due to Enterobacter cloacae.

Sequential outbreaks of nosocomial infection due to multiply-resistant Enterobacter cloacae occurred in September 1987, and between December 1988 and January 1989, in a paediatric intensive care unit. A total of eight neonates were affected and most had received ventilatory support. Initially, we were unable to determine whether the two outbreaks were caused by the same strain of E. cloacae. After applying plasmid profile analysis to identify epidemic strains, we established that the strain from the first outbreak was different from the second outbreak strain, as each had its own plasmid pattern. During the second outbreak, an environmental bacteriological survey was carried out. We found that the distilled water containers were contaminated with E. cloacae which had the same plasmid profile. After changing the distilled water containers and by reinforcement of aseptic techniques, the nosocomial outbreak was terminated.

[Neonatal chylous ascites: report of two cases].

Chylous ascites in neonates is an unusual and etiologically poor understood entity. Our first case was a female newborn who suffered from abdominal distension and recurrent vomiting after birth. The history, physical, laboratory, and radiologic evaluations were not diagnostic except the evidence of obvious ascites. Paracentesis was performed and ascitic fluid was obtained. She was later discharged on a strict low-fat medium-chain triglycerides formula. She was found to have continue increase in abdominal girth, poor growth and development, and respiratory distress in which led her to readmission at 8 months of age. Exploratory laparotomy was done in order to rule out an anatomical lesion in which may be obstructing the lymphatic flow; but no such lesion could be found. She expired at 1 year of age with chylothorax, chylopericardium and lobar pneumonia. The second case, a 37-day-old male baby, who was admitted because of right inguinal hernia. Milky ascitic fluid in the abdomen was incidentally found during herniorrhaphy. Analysis of the fluid revealed protein 1,616 mg/dl, glucose 487 mg/dl, and triglyceride 796 mg/dl. Culture of peritoneal fluid grew no bacteria. Other laboratory findings were: serum protein 4.8 mg/dl, and BUN 14 mg/dl. A plain film of abdomen and sonogram showed massive ascites. The infant was then put on Pregestimil with the hope that the medium-chain triglyceride formula would improve his condition. Since then the child's abdominal girth did not increase and he continued to growth and develop normally at 4 months follow up.

[Clinical analysis and study of hypospadias].

We did a retrospective survey on 117 patients with hypospadias to determine what other congenital anomalies were present. We confirm the increasing incidence of chordee with severity of hypospadias. There were many other systemic anomalies associated with hypospadias. We found nongenitourinary tract malformations as follows: neuromuscular 1.7%, gastrointestinal 4.3%, cardiovascular 3.4%, ENT 0.8%, eye 0.8%. The incidence of genitourinary tract anomalies associated with hypospadias was 24.8% (undescended testis 11.1% and hernia 6.0%). Intravenous pyelography should be reserved for a selected group of children with hypospadias with abnormal ultrasonograms or urologic symptomatology. The primary therapeutic approach is surgical. Urethra-cutaneous fistula requiring additional surgery may occur following hypospadias repair in about 29.0% of cases in this paper.

Intracranial malignant rhabdoid tumor: report of one case.

A 4-year-old boy presented with anorexia, headache, and poor spirits was found to have tumors in posterior fossa and suprasellar region which enclosed by CT scan of brain. Bilateral suboccipital craniotomy was performed by neurosurgeon. The pathological report revealed the tumor was malignant rhabdoid tumor. The patient died two and one half months after diagnosis in spite of surgical resection and radiotherapy of the tumor.

[Multiple intestinal hemangioma: report of two cases].

Hemangioma of the small intestine is a rare disease which is sometimes very difficult to diagnose because of its anatomical location. This report concerns two cases of multiple intestinal hemangiomas treated surgically. The first case was a four-year-old boy who suffered from recurrent abdominal pain and progressive hemorrhage from the gastrointestinal tract for four months. The character of his abdominal pain was non-specific. On physical examination, whole abdominal tenderness was evident. Serial laboratory and radiological examinations, including abdominal sonogram, barium enema, Tc-99m pertechnetate scan, upper gastrointestinal series failed to reveal abnormality. Multiple intestinal hemangiomas were found at exploratory laparotomy. The second case was a new-born suffering from fetal ascites. Abdominal sonogram, barium enema, voiding cystourethrography were performed without significant findings, and the diagnose of multiple intestinal hemangiomas was proved by laparotomy. In both, symptoms improved after segmental resection of the bowels. The purpose of this paper is to draw attention to the possibility of intestinal hemangioma as a source of recurrent abdominal pain, tarry stool or ascites in children.

[Child abuse: report of three cases].

Child abuse, a clinical condition in young children who have received serious physical abuse, is a frequent cause of permanent injury or death. The first case is a 7-year-old boy suffering from abdominal distension and pain for 3 days. He was beaten by his mother as a result of inadequately learning his lessons. Sonogram and CT of the abdomen showed massive ascites and a pseudocyst of the pancreatic body about 3 x 3 cm in diameter. The second case is a 4-year-old girl who developed a semicomatose state after her father impulsively struck her with a chair. CT of the brain revealed subdural hematoma over the left fronto-temporal region and midline shift to the right. She expired 5 days later. The third case, a 2-year-old girl, suffered from headache, seizure, vomiting and general malaise. CT of the brain showed severe brain swelling over the right side and midline shift to the left. She expired 1 month later. Psychiatric factors are probably of prime importance in the pathogenesis of the disorder, but our knowledge of these factors is limited. Parents who inflict abuse on children do not necessarily have psychopathic or sociopathic personalities or come from borderline socioeconomic groups, although most published cases fall into one of these categories. It is clearly the responsibility of all physicians serving children to be aware of, to recognize, and to properly manage any child who has been the victim of abuse.