Map Manager QTX, cross-platform software for genetic mapping.

Map Manager QTX (QTX) is software for analysis of genetic mapping experiments in experimental plants and animals. It includes functions for mapping both Mendelian and quantitative trait loci. QTX is an enhanced version of Map Manager QT, rewritten with the aid of cross-platform libraries (XVT, Boulder Software Foundry, Inc.), which allow it to be compiled for multiple computer platforms. It currently is distributed for Microsoft Windows and Mac OS and is available at http://mapmgr.roswellpark.org/mmQTX.html.

Ultrasound of the discharging umbilicus.

Ultrasound of a patent urachus has been well described. However, ultrasound of the other congenital abnormalities affecting the umbilicus has not. Two cases are described, one of a vitelline (omphalomesenteric) duct and one of an umbilical granuloma, in which the ultrasound findings guided the child's management, preventing a minilaparotomy.

Necrotizing enterocolitis complicating the management of posthemorrhagic hydrocephalus.

The case notes of all newborn infants with posthemorrhagic hydrocephalus (PHH) operated over the past 10 years at our institution were reviewed to establish the incidence and the effect of necrotizing enterocolitis (NEC) on morbidity and mortality following cerebrospinal fluid (CSF) shunting. Thirteen neonates had both PHH and NEC (group A); 7 of these patients were initially treated by ventriculoatrial (VA) shunt and six by ventriculoperitoneal (VP) shunt. Seventy-five patients had PHH alone (group B); all were treated by VP shunt. Eight patients in group A required an abdominal operation for NEC. The two groups were comparable for birth weight, gestational age, and other complications of prematurity. Episodes of shunt malfunction (infection and/or obstruction) and deaths occurring within 12 months from shunt insertion, in the two groups were compared. Shunt malfunction was more frequent in group A (72%) than in group B (27%) (P < .001). Shunt infection was observed in 39% of group A patients versus 14% in group B (P = .03). Distal shunt obstructions occurred in 28% of group A patients and only 3% of group B patients (P = .001). There were more deaths in group A (62% v 9%; P < .001). Thirty-one percent of group A patients and 4% of group B patients died following shunt complications (P = .006). In group A, there was no significant difference in mortality and shunt malfunction between patients with VA or VP shunts. The method of treatment and the stage of NEC did not influence morbidity and mortality after internal drainage for PHH.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopy-guided balloon dilatation of esophageal strictures and anastomotic strictures after esophageal replacement in children.

This study evaluates the safety, efficacy, and technical problems of the new technique of endoscopy-guided balloon dilation (EGBD) in the treatment of strictures of the esophagus and its replacement. Between 1986 and 1990, the authors treated 33 children (aged 3 weeks to 20 years) with EGBD; 18 had esophageal strictures (primary esophageal atresia repair, 13; reflux esophagitis, 5), 13 had anastomotic strictures after esophageal replacement (colon, 12; stomach, 1), and 2 had caustic strictures. The majority (23 of 33) had previously failed to respond to conventional bouginage (mean, 11.2 sessions; range, 1 to 32 sessions). EGBD was performed using flexible endoscopy and flouroscopic screening under general anesthesia. Endoscopy identified and resolved the errors or uncertainties of preoperative contrast studies in 7 patients, 5 of whom had colon interposition. EGBD was achieved in all 31 patients with esophageal or replacement strictures; the mean number of EGDB procedures per patient was 2.1 (range 1 to 7). Symptomatic relief was excellent in 24 and moderate in 7 patients. Both patients with caustic strictures had esophageal perforation from EGBD (excessive inflation, 1; false passage of guide wire, 1). Patients who had experienced both conventional bouginage and EGBD noticed less pain with EGBD and resumed eating sooner. The authors conclude that EGBD is safe and effective for treating esophageal and replacement strictures but not caustic strictures.

Scalp tumours mimicking encephaloceles.

Two neonates presented with benign scalp tumours that mimicked encephaloceles. In the more recent case ultrasonography confirmed that the tumour was extracranial.

Choledochal cyst and congenital hepatic fibrosis.

A case of choledochal cyst with congenital hepatic fibrosis is described. This association is known but insufficiently recognized, as is the association between Caroli disease and choledochal cyst. We urge that a specific search be made for these related disorders when patients present with manifestations of one of these disorders.

A prospective randomised controlled trial of antimicrobial prophylaxis in hydrocephalus shunt surgery.

Despite attempts to reduce their incidence, shunt infections remain a major complication of the treatment of hydrocephalus. Various forms of antimicrobial prophylaxis are in use, but no controlled, statistically valid trial has been conducted to assess their efficacy. Such a trial was therefore carried out and its design is described here. After a 1-year retrospective and prospective study by members of the United Kingdom Hydrocephalus Group to establish feasibility and infection rates, a statistical study showed that at least 712 patients would be required. Six centres were enrolled to fulfil these requirements, and ethical committee approval was obtained at each. The chosen prophylactic regimen was 10 mg vancomycin administered into the ventricular system during surgery. Adults and children undergoing insertion or revision of ventriculoperitoneal shunts were included unless they were receiving therapeutic antimicrobials. Randomisation was by computer-generated numbers. Controls received the antimicrobial regimen, if any, currently used in that centre, the only difference between the two groups being intraventricular vancomycin in the test group. Diagnosis of shunt infection included accepted clinical and microbiological criteria reinforced by measurement of serum C-reactive protein levels. Follow-up was for at least six months. After 2.5 years only 158 patients had been enrolled in the trial, 80 controls and 78 tests. There were 5 preventable infections in the control group and 2 in the test group. In view of the small total the planned statistical analysis was not possible. Therefore, while no problems were encountered with toxicity, the trial failed to enroll enough patients to answer the question of efficacy of antimicrobial prophylaxis in shunt surgery and the reasons for this are discussed.

Baby walkers . . . time to take a stand?

Experience in our hospital and figures from the Home Accident Surveillance System indicate that the number of accidents involving baby walkers is increasing. Safety specifications issued by the British Standards Institution are rarely, if ever, met in full by manufacturers. Home accident prevention measures have been shown to be of limited benefit. We advocate more stringent implementation of safety features in the design of baby walkers.

A new surgical approach to duplications of the intestine.

Two unusual intestinal duplications are described. In each case the mesenteric duplication had a separate muscular coat from the normal bowel permitting complete excision of the duplication without interference with the blood supply to the normal intestine.

Raised intracranial pressure not detected by ultrasound.

Two patients with raised intracranial pressure responding to ventriculoperitoneal shunting are described in whom ultrasound failed to show dilated ventricles. The importance of not equating absence of ventricular dilatation with normal pressure and ventricular dilatation with high pressure is emphasised.

Multiple benign mesenchymomata of the chest wall.

Chest wall mesenchymoma is a rare benign tumour arising from the ribs and occurring in infants, being usually present from birth. The few previously documented cases have been of solitary tumours. A 6-week-old infant presented with two separate lesions demonstrating specific radiological signs, and on isotope scanning with Technetium MDP a high uptake of the agent was demonstrated.

The use of intraventricular vancomycin in the treatment of CSF shunt-associated ventriculitis.

Ten cases of shunt-associated ventriculitis treated with intraventricular vancomycin are described. Eight were cured of their infection, one of these without shunt removal, though this failed in another instance. There were no toxic or untoward effects except in one case, where intravenous administration of vancomycin produced a histamine-like reaction. Intraventricular vancomycin, preferably combined with oral rifampicin, should be considered in cases of intractable or problematic shunt-associated ventriculitis due to Gram-positive organisms.

Inhalation injury to the respiratory tract of children.

Children with a history of exposure to smoke in a confined space or showing soot or burns, however minimal, on the face should be admitted to hospital. Respiratory distress may be delayed, but if it is progressive the patient should be curarized, intubated, and mechanically ventilated. Ventilation should be continued for a minimum of 48 hours, followed by 24 hours of spontaneous respiration against a positive airway pressure. It treatment is stopped sooner, a recurrence of stridor and pulmonary oedema is likely. It is mandatory to pass an endotracheal tube small enough to allow a leak between it and the oedematous mucosa, in order that laryngeal damage and subsequent subglottic stenosis may be avoided. It is important tu use high humidity of inspired gases to keep secretions fluid and the endotracheal tube patent. Dexamethasone should be given to minimise cerebral oedema and antibiotics to reduce the incidence of chest infections.

Management of leukaemic infiltration of the testis.

Of 95 boys treated for acute lymphoblastic leukaemia 25 have developed leukaemic infiltration of the testes. In 15 children relapse was apparently confined to the testes, and since treatment 7 of these boys remain in remission. The median duration of remission after testicular relapse was 72 weeks, considerably longer than that reported after other forms of leukaemic relapse.