Intussusception in Children: A Clinical Review.

Intussusception is the most common cause of small bowel obstruction in young infants. Therefore a high index of suspicion and thorough knowledge of this condition is of major importance to be able to diagnose and treat this potentially life threatening condition. In this review we describe epdidemiology, etiology and clinical symptoms of intussuception. Furthermore, we describe diagnostic modalties, especially ultrasonography as the primary choice for diagnosis. In addition, non-operative treatment with different types of enema reduction techniques, and operative treatment by laparotomy and laparoscopy, and outcomes have been reviewed.

Perinatal changes in myocardial metabolism in lambs.

BACKGROUND: Lactate accounts for a third of myocardial oxygen consumption before and in the first 2 weeks after birth. It is unknown how the remainder of myocardial oxygen is consumed. Glucose is thought to be important before birth, whereas long-chain fatty acids (LC-FA) are the prime substrate for the adult. However, the ability of the myocardium of the newborn to use LC-FA has been doubted. METHODS AND RESULTS: We measured the myocardial metabolism of glucose and LC-FA with [U-(13)C]glucose and [1-(13)C]palmitate in chronically instrumented fetal and newborn lambs. In fetal lambs, myocardial oxidation of glucose was high and that of LC-FA was low. Glucose and LC-FA accounted for 48+/-4% and 2+/-2% of myocardial oxygen consumption, respectively. In newborn lambs, oxidation of glucose decreased, whereas oxidation of LC-FA increased. Glucose and LC-FA accounted for 12+/-3% and 83+/-19% of myocardial oxygen consumption. To test whether near-term fetal lambs could use LC-FA, we increased the supply of LC-FA with a fat infusion. In fetal lambs during fat infusion, the oxidation of LC-FA increased 15-fold. Although the oxidation of LC-FA was still lower than in newborn lambs, the contribution to myocardial oxygen consumption (70+/-13%) was the same as in newborn lambs. CONCLUSIONS: These data show that glucose and lactate account for the majority of myocardial oxygen consumption in fetal lambs, whereas in newborn lambs, LC-FA and lactate account for the majority of myocardial oxygen consumption. Moreover, we showed that the fetal myocardium can use LC-FA as an energy substrate.

Ovine placentome morphology: effect of high altitude, long-term hypoxia.

The effect of high altitude, long-term hypoxaemia on placentome morphology in the sheep was examined using singleton and twin pregnant ewes. Normoxic twins had lower fetal and placental weights (3.7+/-0.2 kg and 215+/-26 g, respectively) than normoxic singleton fetuses (4.3+/-0.2 kg and 336+/-17 g, respectively). Fetal and placental weights were similar in normoxic singleton and high altitude (3820 m) hypoxic singleton fetuses (4.3+/-0.2 and 4.4+/-0.4 kg, 336+/-17 and 342+/-62 g, respectively). The distribution of placentome types was classified into four major categories (A-D) and for normoxic singletons was as follows: A=76+/-4, B=22+/-3, C=1+/-2, and D=1+/-1. Normoxic twins tended to have more type B (type A=63+/-10, B=33+/-8, C=2+/-1, and D=2+/-1). High altitude hypoxic singletons had significantly fewer type A (33+/-4) and more type B (50+/-3), C (10+/-7), D (7+/-1) placentomes than normoxic singletons. In addition, in the sea-level control group, five animals were found to be spontaneously hypoxic with a placentome distribution similar to that of the high altitude hypoxic fetuses. In conclusion, both high altitude, long-term hypoxia and low altitude spontaneous hypoxia lead to a significant change in placentome distribution with less type A and increases in types B, C and D. Physiologically, the change in the several placentome types with high altitude hypoxia suggests an acclimatization response to optimize transplacental exchange efficiency.

Aortic-left ventricular discontinuity of noninfectious origin.

The existence of a cavity of noninfectious origin between the annulus of the ascending aorta and the left ventricle is described. Aortic-left ventricular discontinuity occurred as a late complication of aortic valve replacement in an octogenarian. A patient with severe symptomatic aortic valve stenosis underwent aortic valve replacement and aortic root enlargement into the noncoronary sinus with pericardial tissue. Four months after her valve surgery the patient presented with shortness of breath. Angiocardiography and transoesophageal echocardiography revealed a complex, irregular pouch at the right coronary cusp side of the valve with paravalvular leakage back into the left ventricular outflow tract. Reoperation was performed, the disconnection between the aortic annulus and the left ventricle was repaired and the valve was replaced. The aortic-left ventricular discontinuity did not involve the area where aortic root enlargement was performed. No evidence of infection was found and the most likely cause of the reported complication is mechanical in nature.

Successful aortic valve replacement in a patient with AIDS.

In trying to assess the benefit of cardiac surgery in AIDS patients, the question arises whether a patient with a deficient immune system can tolerate open heart surgery well enough to make the operation worthwhile. Surgical procedures and cardiopulmonary bypass have been noted to alter immune function (Diettrich et al., Ide et al.). Therefore, the presence of clinical AIDS is often still regarded as a contraindication to cardiac surgery. In this report we describe an AIDS patient who developed endocarditis of the native aortic valve. The endocarditis was successfully treated with antibiotic drugs, but the patient was left with damaged valves. Over the months he developed a massive aortic insufficiency and underwent aortic valve replacement. The patient did well after surgery, and is alive and well 18 months after the operation, suggesting that cardiac surgery might be a good and valuable treatment option in AIDS patients.