Staged reduction using a Silastic sac is the treatment of choice for large congenital abdominal wall defects.

Although the survival for infants with abdominal wall defects (AWD) has dramatically improved, agreement on the optimum surgical approach has not been reached. From October 1970 through March 1983, 31 neonates with gastroschisis and 14 neonates with omphalocele were treated. Reduction of the herniated viscera with primary fascial and skin closure was performed in 30% of the gastroschisis patients and 64% of the omphalocele patients. The remaining infants were managed by staged reduction of the herniated viscera using a Silastic sac. Overall, 27 of 45 patients (60%) were treated by staged reduction. Our procedure for staged reduction includes application of a Silastic sac as soon as the infant is stable. The herniated contents are reduced as rapidly as possible so that the prosthetic sacs can be removed within seven days. Abdominal wall stretching, "milking" of the intestinal contents into the stomach for decompression and a gastrostomy tube are avoided. The duration of hospitalization was not influenced by the method of abdominal wall closure in the gastroschisis infants. However, the hospitalization was approximately 10 days longer for those omphalocele patients managed by staged reduction. Complications which occurred in these patients include: respiratory distress (1); wound infection after removal of the Silastic sac (2); intestinal fistula (1); intestinal resection (3); intraabdominal sepsis (1); and incisional hernia (3). There was one death in the omphalocele group and three deaths in the gastroschisis group. Therefore, the overall survival for the 45 patients with AWD was 91%. Staged reduction of the herniated abdominal contents can be a safe, uncomplicated method of obtaining abdominal wall closure in neonates with AWD.

Disseminated Mycobacterium chelonei infection following cadaveric renal transplantation: favorable response to cefoxitin.

This article describes a case of disseminated Mycobacterium chelonei infection in a renal transplant recipient. This patient, who underwent thoracic duct drainage prior to cadaveric renal transplantation, developed M chelonei bacteremia and numerous subcutaneous nodules a few weeks after transplantation. The M chelonei initially responded to amikacin and tetracycline. Because of side effects and bacterial resistance, however, these drugs had to be discontinued. Subsequent treatment with cefoxitin led to reduction in size of subcutaneous nodules, but control of the infection was not achieved until an intravascular nidus of infection at the anastomotic site of an arteriovenous fistula was removed.

Fusobacterium nucleatum pericarditis.

A pericardial effusion was diagnosed by echocardiography in a 49 year old man who suffered acute cough, orthopnea, and chest pain. Because of a positive tuberculin skin test, mycobacteria were initially suspected as the cause of the pericarditis. The patient was therefore treated with antituberculosis drugs. The pericardial effusion failed to resolve, however, and pericardiectomy was performed. Culture of the pericardial fluid yielded pure Fusobacterium nucleatum growth. The patient responded to antibiotic therapy and was in good health 3 weeks after being discharged from the hospital. This represents the first report of F. nucleatum pericarditis.