Manganese balance studies in infants after operations on the heart.

Manganese balance studies have been performed on 16 infants, aged 3 days to 8 months, in the period following operation for the correction of congenital heart defects. Samples were analyzed by flameless atomic absorption spectroscopy or by solvent extraction with 8-hydroxyquinoline followed by flame atomic absorption spectroscopy. A higher manganese content was found in either whole blood (710 +/- 320 nmole X litre-1) or purified plasma protein (1130 +/- 770 nmole X litre-1) compared with fresh frozen plasma (215 +/- 35 nmole X litre-1) used in intravenous drips. The manganese content of the milks used in oral feeding was 200-300 nmole X litre-1.

Experimental production of rectal stenosis and atresia in the rabbit.

Clinical reviews have suggested that there are different causes for the various types of anorectal atresia and stenosis. Such inferences have primarily been based upon the presence or absence of associated fistulas and other anogenital, urinary, and more remote congenital defects. Rectal stenosis and atresia of the middle and/or upper third of the rectum were produced in 27 of 38 rabbit feti subjected to partial to complete interruption of the blood supply to the rectosigmoid colon between the 24th and 26th day of gestation. Such experimental feti were located in the right tube, while a sham laparotomy was performed during the same maternal operation on 26 feti located in the left tube. An additional undisturbed 28 feti were available in both tubes to serve as controls. No other anomalies were produced in any group. These findings suggest that local ischemia, occurring late during fetal life, may well be the mechanism responsible for the creation of rectal stenosis and atresia of the middle and/or upper rectum.

The effects of starvation and surgical injury on the plasma levels of glucose, free fatty acids, and neutral lipids in newborn babies suffering from various congenital anomalies.

Blood glucose, plasma free fatty acids (FFA), cholesterol, phospholipids, and triglycerides were measured in blood obtained by heel prick from 32 neonatal surgical patients suffering from various cogenital malformations which prevented and adequate intake of milk. The result of almost complete starvation for up to 7 days was investigated and the effects of a surgical operation were studied in 12 of the babies. All the babies weighed more than 2 kg at birth. A surgical operation caused a rise in blood glucose concentration but a variable change in plasma concentration of FFA. Blood glucose returned to normal within 8 to 12 hr. The plasma concentrations of cholesterol and phospholipids did not change except in two babies in whom the concentration of both fell. Four to 24 hr after operation the plasma triglyceride level fell by an average of 25% but later rose. During starvation for 7 days the blood glucose concentration was maintained within normal limits. Plasma FFA concentration normally rose during the first 2 days of life and was very high between days 3 and 5. Plasma triglyceride, cholesterol, phospholipids, and total esterified fatty acids also increased after birth. The results suggest that during starvation in the neonate there is rapid mobilisation of fat from adipose tissue stores and a reduction in the peripheral utilisation of glucose. There was no evidence to suggest any impairment of fat mobilisation or metabolism even after starvation for 7 days. After surgical injury, these changes were accentuated because the rate of utilisation of fat was greater than that of mobilisation.

The urinary excretions of iron and chromium by children with burns and scalds.

There is a wide variation in the urinary output of chromium by children who have been burned or scalded. It seems possible that when the excretion of chromium is increased this may be related to an increased plasma concentration of glucose which may follow injury, and when the excretion of chromium is reduced this may be related to a low body content of chromium. During the first seven days after injury there is a significant increase in the excretion of iron. Likewise the iron/chromium ratio is also raised over the first seven days. The overall loss of iron during the first twelve days or thereabouts is probably not sufficient to require nutritional supplements over this period.

The excretion of alkaline ribonuclease by children undergoing surgery.

The excretion of alkaline ribonuclease has been measured in the urine of two groups of children after major operations. The excretion was significantly increased in all patients after open operations on the heart and in many of those who were operated on soon after birth for anomalies in the intestine. It is suggested that these elevations may indicate a disturbance of pancreatic function.

Metabolism of nicotinic acid in children with burns and scalds.

The excretions of two metabolites of nicotinic acid, N1-methylnicotinamide and N1-methyl-2-pyridone-5-carboxamide have been measured at varying times after injury in a group of 27 burned or scalded children. Compared with control patients the excretions of both of these metabolites were significantly raised after injury, which suggests that the utilisation of nicotinic acid is increased.

Wound infection in a children's hospital.

The operation wounds of 20 per cent of the children operated on in one surgical unit of a children's hospital became infected. Infection was commonest in the newly born operated on as emergencies, 50 per cent of whose wounds became infected. No connection was found between injection and nasal carriage of staphylococci. A possible source of infection in the young may be the umbilicus.

Why don't we prevent childhood accidents?

Accidental injury is the most important epidemic in the Western world today, and is especially important as a cause of death and disability in childhood. Many environmental factors are important causes of accidents, but there is no organisation within which doctors, official bodies, industry, and voluntary bodies can pool their experience and co-ordinate their efforts to reduce these environmental risks. A joint committee on childhood accident prevention should be formed in this country similar to that which exists in Sweden.

Splenogonadal fusion.

The fusion between splenic tissue and the left gonad or the derivatives of the left mesonephros is a rare congenital anomaly first described in detail by Pommer in 1887/9 and divided into two forms by Putschar and Manion in 1956. In the first or continuous type a cord of splenic or fibrous tissue connects the spleen and the gonadalmesonephric structures. In the second type the fused splenomesonephric structures have lost continuity with the main spleen. An example of the continuous form is presented and the previous reports are briefly reviewed.

Plasma biotin levels in children with burns and scalds.

The plasma concentrations of biotin were measured for up to 49 days after injury in nine children with burns and scalds which involved from 12% to 50% of the surface area of the body. Biotin levels below the minimum of the control range were observed in eight of the nine injured children at some stage during the episode.