Surgical necrotizing enterocolitis and intraventricular hemorrhage in premature infants below 1000 g.

BACKGROUND/PURPOSE: Infants with very low birth weight are at increased risk for both intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC). IVH often progresses in severity after initial diagnosis and causes severe neurological morbidity and mortality. The authors examined the role of NEC in the progression of IVH in these infants. METHODS: The authors conducted a retrospective case-control study using data from the University of Maryland neonatal intensive care unit database between 1991 and 2003. From a cohort of 957 infants with very low birth weight, 53 pairs of infants labeled as IVH progression versus controls were selected and closely matched in respect to their gestational age and birth weight. Charts from these infants were reviewed to identify risk factors contributing to IVH progression. RESULTS: Infants with IVH progression were significantly more likely to suffer from NEC (odds ratio, 3.6), whereas infants with surgical NEC showed a greater association with IVH progression (odds ratio, 5.33). Association with thrombocytopenia was also seen (odds ratio, 3.33). Sepsis showed trend toward significance (odds ratio, 1.9; P = .095) for progression of IVH. CONCLUSION: Surgical NEC showed the greatest risk for IVH progression. NEC and thrombocytopenia also appear to be risk factors for IVH progression.

Gangrenous intestine in a hernia can be reduced.

A 3-month-old former 31-week premature triplet presented with a perforated terminal ileum 36 hours after complete reduction of an incarcerated inguinal hernia. Classic pediatric surgery teaching asserts that gangrenous bowel in an inguinal hernia will not reduce. In this case, gangrenous bowel was reduced and proceeded to perforate after reduction. Though extremely rare, it is possible to reduce gangrenous bowel, and disposition requires reliable observation at home or hospitalization, if circumstances warrant.

Translocation (11;15;19): a highly specific chromosome rearrangement associated with poorly differentiated thymic carcinoma in young patients.

Thymic carcinoma is a rare epithelial neoplasm of the thymus. The presence of a specific chromosomal abnormality may augment diagnosis and therapeutic stratification. We report a 15-year-old boy diagnosed with thymic carcinoma who presented with a large anterior mediastinal mass, pleural effusion, and bone metastasis. The pleural fluid, cytology, bony lesions, and bone marrow were examined and chromosomal studies were performed. Histologic and immunohistochemical studies confirmed a poorly differentiated squamous cell type of thymic carcinoma. The karyotype of the pleural fluid at the time of diagnosis revealed a complex three-way translocation t(11;15;19)(p15;q12;p13.3). The constitutional karyotype was 46,XY. Five months after diagnosis, a bone marrow aspirate demonstrated tetraploidy with all translocation chromosomes in duplicate, as well as an unbalanced rearrangement involving chromosome 1: 92,XXYY,t(11;15;19)(p15;q12;p13.3)x2[15]/92,XXYY,idem,add(1)(qter)[5]. Despite aggressive multiagent chemotherapy, the patient's condition progressed with bone marrow disease and he died 6 months after diagnosis. Several case reports of a similar chromosomal abnormality have been reported for thymic carcinoma in young patients with poor outcome. This karyotypic abnormality appears to mark a cohort of patients with thymic carcinoma who have a poor prognosis despite aggressive chemotherapy.