Fourier phase analysis of first-pass data: noninvasive detection of pulmonary sequestration.

Nuclear medicine Fourier phase analysis of first-pass data was used to evaluate blood flow to cystic lung masses in two children suspected of having pulmonary sequestrations. In both cases, the Fourier images provided a rapid, noninvasive, inexpensive analysis of the blood supply to the masses and permitted identification of the masses as pulmonary sequestrations. The analysis does not depend on the location of the mass and demonstrates the location of systemic rather than pulmonic arterial blood supply to the mass. In one case, Fourier analysis identified a second source of systemic blood supply not visible with other imaging modalities. Preoperative assessment of a cystic lung mass using Fourier analysis enables noninvasive classification of the mass as a pulmonary sequestration with systemic blood supply and aids the surgeon in resection.

A technique for preservation of the ileocecal valve in the neonatal short intestine.

We report a technique, appendiceal interposition, which permitted preservation of the ileocecal valve in an infant with a congenitally short intestine (jejunum, 12 cm; ileum, 1 cm). The procedure was performed on the first day of life in conjunction with jejunal lengthening by the Bianchi technique. The result was a small intestine of 21 cm in length with an intact ileocecal valve.

Crucial bronchoscopic findings in esophageal atresia and tracheoesophageal fistula.

We performed a brief bronchoscopy in 42 newborn infants with esophageal atresia and tracheoesophageal fistula (TEF). The procedure was carried out in the operating room, usually just prior to thoracotomy for repair of the anomaly. Most infants had a gastrostomy tube placed initially. Observations included: (1) level of fistula, (2) presence of unusual variants, eg, double fistula, trifurcation fistula, (3) presence and severity of tracheobronchitis, and (4) position of the aortic arch. The endoscopic findings influenced the operative technique or management of 24 of the 42 infants (57%), including 13 infants (31%) with crucial findings which dictated a change in operative technique or management. Examples of the latter were an unsuspected cervical fistula associated with esophageal atresia, repaired by a cervical approach; other unusual variants of TEF (proximal fistula, trifurcation or quadrifurcation TEF), requiring specific dissection at thoracotomy; congenital stenosis of the right mainstem bronchus, requiring postoperative dilatation; or severe tracheobronchitis, which contraindicated thoracotomy. Observations at bronchoscopy accurately predicted the position of the aortic arch in ten recent infants, although the side of dominant pulsation was indeterminate in three other infants. Only one minor complication was attributable to the bronchoscopy. The procedure appeared to be safe and beneficial, and should be considered for all infants with esophageal atresia and TEF.

Balloon catheter dilatation of focal intestinal strictures following necrotizing enterocolitis.

Dilatation with a balloon catheter was successfully employed for 9 focal intestinal strictures which occurred in 5 infants following necrotizing enterocolitis. Eight of the 9 strictures were located in defunctionalized colon distal to an enterostomy; no infant had clinical intestinal obstruction. Because the dilatation achieved distal patency, subsequent closure of the enterostomy was accomplished without a formal laparotomy. The balloon dilatation technique may be valuable in the management of focal strictures that are not causing clinical intestinal obstruction.

Nonrefluxing central venous catheters in children.

A central venous catheter occasionally is necessary in infants to maintain adequate nutritional support. Our experience shows that routine dressing changes are not necessary. Clinical studies of a slit-valve central venous catheter in which intraluminal thrombosis is eliminated are described. The combination of minimal dressing manipulation, adequate dressing protection, and the nonrefluxing slit-valve catheter have markedly reduced sepsis rates.

Studies with a slit-valve catheter for parenteral nutrition.

A new catheter for central venous total parenteral nutrition has a blunt occluded distal end and a longitudinally oriented slit one centimeter proximal. Studies in rats show that this slit-valve prevents both reflux of blood and intracatheter thrombosis. This may be a factor in reducing sepsis associated with central venous total parenteral nutrition.