The missing hazelnut.

This report describes a case of esophageal perforation caused by a hazelnut which became stuck in the upper esophagus but was not detected. We outline the pitfalls in diagnosis, complications and treatment in the pediatric population.

Neonatal gastric perforation: review of 23 years' experience.

PURPOSE: To review our experience of treating 13 neonates with gastric perforation (GP) over the past 23 years. METHODS: The records of all 13 patients were reviewed, noting gender, weight, gestational age, age at admission, associated anomalies, site of perforation, type of operation, and clinical outcome. RESULTS: There were 11 boys and 2 girls, with a mean body weight of 2 375 g, including 4 (45%) preterm infants. The mean age at admission was 3.2 days. Three (23%) infants had associated anomalies. Perforation occurred in the lesser curvature and anterior wall in 3 (23%) infants, at the greater curvature and anterior wall in 2 (15.4%), in necrosis of anterior wall in 1 (7.7%), at the esophageal junction and posterior wall in 2 (15.4%), at the lesser curvature and posterior wall in 1 (7.7%), at the lesser curvature and esophageal junction in 1 (7.7%), and the site was not specified in 3 (23%). Twelve patients were treated with gastrorrhaphy and drainage, and 1 was treated with gastrorrhaphy alone. Three patients required additional gastrostomy. Mortality was 53.8% (n = 7). Early diagnosis and management before clinical deterioration of the metabolic status improved the prognosis. CONCLUSION: The pattern of presentation and surgical findings should be investigated comparatively in premature and full-term neonates, as the etiology of this condition is likely to differ in these two gestational groups.

Pyloric atresia: 15-year review from a single institution.

BACKGROUND: Pyloric atresia (PA) is a rare pathology. Calder presented the first pyloric atresia case in 1749 and Touroff, Sussman, Meltz, and their colleagues presented the first successful operation in 1940. PA has 3 types of anatomic variations: (1) type A, pyloric membrane or web; (2) type B, the pyloric channel is a solid cord; and (3) type C, in which there is a gap between the stomach and duodenum. Associated anomalies also have been described. Epidermolysis bullosa (EB) and intestinal anomalies occur most often with this condition. METHODS: Charts of 16 cases of congenital PA, aged 1 to 30 days and admitted to our department between 1986 and 2001, were studied retrospectively in regard to sex, prenatal diagnosis, presence of polyhydramnios, time of admission, pathology, type of operation, associated anomalies, and mortality rate. RESULTS: In the study group, the male to female ratio was 5:3, the mean birth weight was 2,312 g and the mean age of admission was 6.5 days. The distribution of the anatomic variations was type A in 9 (56.3%) and type B in 7 (43.7%) of cases. Associated anomalies were present in 7 cases (43.8%). Familial occurrence was a prominent feature of our series. Seven of 16 cases occurred in 3 families. We performed 9 web excisions together with Heineke Mikulicz (H-M) pyloroplasty, 5 atresia excisions and gastro-duodenostomy, and 2 H-M pyloroplasties alone. Stamm gastrostomy was supplemented in 3 cases. The overall mortality rate (n = 9) was 56.3%. CONCLUSIONS: Pyloric atresia can be managed successfully if it is diagnosed early. In this group of patients, congenital anomalies or septicemia are the main causes of mortality.

Which patients are at risk? Evaluation of the morbility and mortality in newborn pneumothorax.

This study was conducted to evaluate the morbidity and mortality among the newborns hospitalized for pneumothorax. The data of 83 cases were analysed retrospectively according to gestational age, weight, underlying primary lung pathology, age of admittance, side of pneumothorax, drainage time, need for mechanical ventilation and mortality. Male: Female ratio was 1.6:1. Mean duration of admission was 63.8 hours (2 hours-20 days). 51 patients (61.4%) weighed les than 2500g and 41 patients (49.4%) were preterms. The mean weight was 2280 g (640-5170). Fifty one patients (61.4%) needed mechanical ventilation. The pnemothorax was on the right in 44 (53%), left in 21 (25.7%) and bilateral in 18 patients (21.7%). Overall 32 babies died. Among the non-survivors, 22 (68%) were preterm and there was a defined underlying lung pathology in 24 (75%). Twenty nine (90.6%) of them needed mechanical ventilation. The difference in mortality was significant in the presence of primary lung disease, low birth weight, prematurity and use of mechanical ventilation (P <005).