Subvisceral pleural air in neonates with respiratory distress.

We reviewed our cases of persistent extrapulmonary air following chest tube placement and decided to test the hypothesis that this entity may represent collections of air beneath the visceral pleura. We describe ten patients who had this entity despite one or more chest tubes per pleural cavity, and described the creation of subvisceral pleural blebs in preterm lambs with respiratory distress requiring mechanical ventilation. We conclude that (1) subvisceral pleural air may occur in infants with respiratory distress and, thus, may be inaccessible to chest-tube drainage, and (2) centrifugal dissection of air, though poorly appreciated previously, may play an important role in the pathogenesis of extrapulmonary air.

New fine structural features of cardiac rhabdomyoma: report of a case.

Electron microscopy of a cardiac rhabdomyoma revealed two varieties of cells: (1) typical "spider cells' characterized by few myofibrils and large aggregates of glycogen particles free in the cytoplasm; and (2) cells with more myofibrils, less glycogen, and glycogen within membrane-limited vacuoles. These differences in myofibril development and glycogen content represent two succeeding stages in the early maturation of normal cardiocytes. The vacuoles containing glycogen were interpreted as autophagic and, consequently, active in the glycogen decrease typical of normal maturing cardiocytes. Rhabdomyoma cells did not show the structures, e.g., T system, characteristic of the late normal heart development. This study supports the theory that arrested cardiocyte maturation is a factor in the pathogenesis of cardiac rhabdomyoma.

Failure of indomethacin to close persistent ductus arteriosus in infants weighing under 1000 grams.

Six preterm infants with a persistent ductus arteriosus, who failed to improve with conventional medical management, received indomethacin in an attempt to close the duct pharmacologically. All infants weighed less than 1000 g when the drug was administered. All showed a transient response to indomethacin; however, no infant demonstrated a permanent response, even though 5 of the 6 received multiple doses. One of the patients developed a severe episode of anuria, uraemia, and gastrointestinal bleeding. Of the 6 infants, 3 underwent subsequent successful surgical ligation of the ductus. It is suggested that the extremely preterm infant may be a 'poor responder' to indomethacin. Since the side effects of indomethacin may be life-threatening, it may be wise to consider surgical ligation in lieu of indomethacin administration in these infants.

The asphyxiated bladder as a cause of delayed micturition in the newborn.

Although delayed micturition in the immediate newborn period is ofter a normal physiologic variation it may be associated with pathological states leading to a decrease in urine formation or reduction of urine flow. Recently, 5 newborns subjected to severe perinatal stress were seen, who exhibited delayed micturition despite adequate urine formation and no evidence of gross anatomic abnormalities. These patients presented with distended bladders that could be maneuvered easily by Credé's method. We believe that these cases represent a heretofore undescribed asphyxiated bladder syndrome and suggest consideration of such a diagnosis when bladder distension occurs subsequent to an asphyxial event. In male newborns it is important to differentiate this syndrome from posterior urethral valves and if urine is not expressed easily one should consider early intervention with diagnostic studies and, perhaps, suprapubic drainage.