In utero defecation of the nondistressed fetus: a roentgen study in the goat.

An experimental study was performed to investigate gastrointestinal motility and meconium passage, with simultaneous blood gas measurements, in the fetuses of eight pregnant goats at 110 to 114 days' gestation (full term, 147 to 155 days). With the goats under halothane anesthesia, a nasogastric tube and a heparinized central venous catheter were inserted into the fetuses. 24 hours after surgery, 10 mL of gastric juice from the fetus was replaced with a nonhydrosoluble contrast medium, and serial roentgenograms and blood samples (for pH, PO2, and PCO2 measurement) were taken every 4 hours. All fetuses began to pass the contrast medium into the amniotic cavity within 16 to 22 hours, and central venous blood gas values were normal. The results of this study suggest that the fetus, which urinates routinely, also defecates routinely into the amniotic cavity, even in the absence of distress. The increased incidence of meconium staining in fetal distress conditions may be indicative of impaired clearance of amniotic fluid.

Complications of typhoid fever requiring laparotomy during childhood.

All the complications requiring laparotomy among 680 children who were diagnosed as having typhoid fever between 1981 and 1990, at Hacettepe University Children's Hospital, were retrospectively analyzed. Four patients developed intestinal perforation, two gastrointestinal bleeding, and two splenic abscess, with frequencies of 0.58%, 0.29%, and 0.29%, respectively. The overall frequency was 1.17%. While the risk was 1.58% among males, it was 0.42% among females with no statistically significant difference (P > .05). The risk was higher among patients above 6 years of age (P < .05). While perforation and hemorrhagic complications developed within 10 days of initial symptoms and splenic abscess required 10 and 30 days for development, there were no clinical signs and laboratory findings predicting the occurrence of complications in the course of typhoid fever. Two patients, one with intestinal perforation and the other with gastrointestinal hemorrhage, died within 2 days following the septic postoperative courses. On the other hand, 12 patients, among those without complications requiring laparotomy, died of unremitting septic course of the disease. The mortality rate rose from 1.78% to 25% when complications occurred. The findings in this series demonstrate that typhoid fever presents a challenge to the pediatric surgeons not only because of the complications requiring laparotomy with high mortality rates, but also the absence of criteria predicting the occurrence of complications in the course of typhoid fever.

The long-term results of diaphragmatic plication.

Twelve patients who had undergone diaphragmatic plication with the diagnosis of congenital diaphragmatic eventration between 1975 to 1989 were evaluated for the long-term results of plication. Assessment of the long-term functions of the plicated diaphragms 1.5 to 11 years postoperatively was achieved by fluoroscopic, ultrasonographic, and spirometric studies. The absence of paradoxical motion with normal localization of the diaphragms in all patients, and satisfactory motions of diaphragms in 9 patients were documented by fluoroscopy. Measurements of diaphragmatic thicknesses showed that plicated diaphragms of all patients maintained their growths in proportion to the contralateral sides. Additionally, normal values of pulmonary function tests in five of six patients of suitable age for spirometry were obtained. All the clinical studies demonstrated that diaphragmatic plication did not interfere with further development of diaphragms, and late functional results of the plication were acceptable. This supports the choice of surgery in the treatment of diaphragmatic eventration.

The necessity of prophylactic antibiotics in uncomplicated appendicitis during childhood.

A prospective, randomized, clinical study was done to evaluate the place of prophylactic antibiotics in uncomplicated childhood appendicitis. One hundred patients with uncomplicated appendicitis were randomly assigned to one of four groups, each consisting of 25 cases. Group 1 patients did not receive prophylactic antibiotic. Group 2, group 3, and group 4 patients received ornidazole, penicillin plus tobramycin, and piperacillin, respectively. The use of prophylactic antibiotics did not yield better results than the use of placebos. The rarity of infectious complications after uncomplicated appendicectomy may be unique for children. Although the need for antibiotic prophylaxis is well documented in adults, the rarity of infectious complications makes it highly questionable in the treatment of uncomplicated appendicitis in children.

The effect of intrauterine vascular compromise on further development of corpus spongiosum and urethra.

An in-utero experimental study was performed to evaluate the effects of intrauterine vascular compromise on further development of corpus spongiosum and male urethra. Thirty time-mated pregnant New Zealand white rabbits on their twenty-third day of gestation were used. Deterioration of the blood supply of the corpus spongiosum and urethra was attempted by electrocauterizing the perineum adjacent to the root of the phallus without damaging the corpus spongiosum and urethra, under the operating microscope. A bipolar cautery was carried out using a specially designed forceps having 100 microns interspaced fixed tips. Five experimental and seven control live male litters were delivered at term by Cesarean sections. Their anogenital regions were examined histopathologically. While the corpus spongiosum extended as long as the corpus cavernosum to the tip of phallus in control litters, the corpus spongiosum ended under the skin in one of the experimental group and in the other four was shorter than the corpus cavernosum. In the latter group, no histopathological evidence of tissue destruction which might be related to electrocauterization, was found. Similar to the pathogenesis encountered in intestinal atresia, a vascular insult which might occur even after the completion of organogenesis, may affect the fate of the corpus spongiosum and urethra. Localized ischemia resulting from local vascular insults may explain, at least in theory, the pathogenesis of some congenital anomalies of corpus spongiosum and urethra such as hypospadias.

Is fetal thoracic compression really the underlying mechanism of lung hypoplasia in oligohydramnios? An experimental study in a rabbit model.

Compression of the fetal thorax by the uterine wall is one of the theories proposed to explain the mechanism of lung hypoplasia in association with oligohydramnios. However, the reduction in the intrathoracic space and the evidence of compression on the fetal thorax have not been demonstrated in detail. Therefore an experimental study was planned to determine the effects of oligohydramnios on available intrathoracic space and lung volume in the rabbit fetus. Amniotic fluid was shunted into the peritoneal cavity between 23 and 31 days of gestation. Intrathoracic space and lung volumes (TV and LV), and lung and body weight (LW and BW) values were measured in our study and control fetuses at term. Lung weight/body weight, lung volume/thorax volume, thorax volume/body weight ratios were calculated and the values of the fetuses with shunting and controls were compared. The difference between TV/BW ratios was not significant. LW/BW and LV/TV ratios were significantly reduced in experimental fetuses compared to the controls. Chronic drainage of amniotic fluid into the peritoneal cavity resulted in reduced LW/BW and LV/TV ratio, but did not effect TV/BW ratio. The low LV/TV ratio in the fetuses with shunting despite similar TV/BW ratio suggested that the diaphragm had been elevated. This is also an explanation for the observation of reduced chest circumference and chest circumference/abdominal circumference ratio in prolonged premature rupture of the membranes in vivo. The developing fetal lungs would undergo not only transthoracic but also trans-abdomino-diaphragmatic compression. However, it is unlikely in the tubular shaped rabbit uterus. In oligohydramnios amniotic fluid dynamics or physical characteristics with its contents should be disturbed. A previous experimental study with herniation of the amniotic sac causing lung hypoplasia through reduced intraamniotic pressure without oligohydramnios also questioned the role of fetal compression. Although fetal lung development was significantly impaired, the thoracic cage was not affected by amniono-peritoneal shunting. Therefore, we suggest that lung hypoplasia resulted from another mechanism rather than thoracic compression.

An unusual association: fibroepithelial polyp and contralateral nephrolithiasis in a child.

A 12-year-old boy presented with fever and flank pain bilaterally. Intravenous pyelogram revealed multiple stones and hydronephrosis in the right kidney and an obstructive filling defect at the left upper ureter. Exploration of the left ureter revealed a fibroepithelial polyp. The presented case was an example of the unreported association between fibroepithelial polyp and contralateral nephrolithiasis.

Hydatid disease presenting as an intrascrotal mass in a child.

A thirteen-year-old boy with the preliminary diagnosis of hydrocele of the cord who underwent surgery is presented. Ultimate diagnosis of hydatid disease was established by surgical exploration and histopathologic examination of the specimen. Although it is a rare occurrence, hydatid disease should be considered as a diagnostic possibility in endemic areas.

Duplication of the rectum resembling a juvenile polyp.

A five-year-old boy with a rectal mass mimicking a rectal polyp, which proved to be a cystic duplication of the rectum, is presented. In a child with painless rectal bleeding, a mass palpated during rectal examination is usually diagnosed initially as being a rectal polyp. However, the case presented revealed the possibility of rectal duplication.

Ipsilateral and contralateral testicular blood flows during unilateral testicular torsion by 133Xe clearance technique.

Testicular blood flows during unilateral testicular torsion were measured by Xenon-133 clearance technique. Xenon-133 was injected via the left carotid artery into the heart. Measurements were performed in control and left-sided testicular torsion groups, each consisting of ten rats. Left and right testicular blood flows, which were 29.157 +/- 2.272 ml/100 g/min and 29.773 +/- 2.934 ml/100 g/min in the controls, were 11.983 +/- 3.655 ml/100 g/min and 16.098 +/- 3.757 ml/100 g/min in the experimental group and differed significantly. The decrease in contralateral testicular blood flow may play an important role in the contralateral testicular damage encountered following unilateral testicular torsion.

Fetal survival after in utero experimentation in the rabbit.

Fifty time-mated pregnant rabbits were used to evaluate the factors influencing fetal survival rate (FSR) after in utero experimentation. Only one of the following variables--number of manipulated fetuses per rabbit, gestational age during experimental procedure, method of hysterotomy, and amount of amniotic fluid loss--was respectively modified in the five consecutive groups. Each group consisted of 10 rabbits and identical procedures were performed in each group. The FSR among groups was compared. Although comparison of FSR between two succeeding groups did not reveal a significant difference, comparison of the FSR of the latter two groups with the former two groups revealed a significant difference. While the most substantial improvement in FSR was achieved by modification of the hysterotomy method, all of the factors, cumulatively if not individually, established a significant difference.

Superior vesical fissure: an exstrophy variant or a distinct clinical entity.

A case of superior vesical fissure is presented to discuss the embryologic origin of the anomaly. In view of the simplicity of the anomaly and the discrepancies between the characteristics of superior vesical fissure and bladder exstrophy, superior vesical fissure is suggested to be a distinct clinical entity with an embryological origin different from bladder exstrophy.

Fetal penile and urethral development subsequent to vascular insult in the last trimester of gestation: an experimental study in goat fetuses.

OBJECTIVE: To investigate a possible mechanism (the vascular theory) in the development of congenital anomalies of the penis and urethra in the fetus of the goat. MATERIALS AND METHODS: Fifteen male Angora goat fetuses underwent an operation at 110-114 days of gestation whereby branches of the internal pudendal artery within the superficial compartment of the perineum were ligated. Five male fetuses served as controls in which the perineum was explored with no ligation. RESULTS: Five treated and three control live offspring were delivered spontaneously. Although no genitourinary anomalies were observed on gross examination, histopathological examination of the penises of treated animals revealed smaller penises with increased fibrosis. CONCLUSION: A defective vascular supply can partly explain the morphogenesis of some aspects of the congenital anomalies of the penis and urethra.

The effect of low amniotic pressure without oligohydramnios on fetal lung development in a rabbit model.

OBJECTIVE: Our purpose was to examine fetal lung development in reduced intraamniotic pressure without amniotic fluid loss. STUDY DESIGN: A circular portion of uterine wall measuring 1 cm in diameter was excised while the chorionic and amniotic membranes were left intact at the twenty-third day of gestation in New Zealand White rabbits. The chorionic and amniotic membranes herniated spontaneously through the defect. RESULTS: Amniotic pressure was significantly reduced after herniation. Lung weight/body weight ratios at term were significantly reduced in experimental fetuses compared with controls. Residual amniotic fluid volumes at term did not differ. Histopathologic examination of lung specimens showed that fetal lungs had not matured in the experimental group as fully as in the control group. CONCLUSION: This experimental study demonstrated that low amniotic pressure impaired fetal lung development, even without oligohydramnios.

Does hepatic subcapsular calcification in a premature baby reflect disease?

We followed a premature baby with hepatic subcapsular calcification of unknown etiology. Results of clinical and laboratory investigations and growth of the patient were normal. The causes of this condition are discussed and we suggest that it does not necessarily reflect disease.