Adjusted Troponin I for Improved Evaluation of Patients with Chest Pain.

The use of cardiac troponins (cTn) is the gold standard for diagnosing myocardial infarction. Independent of myocardial infarction (MI), however, sex, age and kidney function affect cTn levels. Here we developed a method to adjust cTnI levels for age, sex, and renal function, maintaining a unified cut-off value such as the 99 percentile.

Laparoscopic excision of a gastric diverticulum in a child.

Gastric diverticulum is a rare entity; the patient usually presents with vague abdominal pain, nausea, vomiting, and weight loss. Diverticulectomy is required for patients with intractable symptoms or complications. We report the laparoscopic excision of a gastric diverticulum in a 15-year-old girl who had been symptomatic for 5 years.

Possible new syndrome of microcephaly with cortical migration defects, Peters anomaly and multiple intestinal atresias: a multiple vascular disruption syndrome.

A possible new multiple vascular disruption symdrome is described. The male patient had microcephaly with cortical migration defects, Peters anomaly and multiple inestinal atresias.

Microscopic analysis and significance of vascular architectural complexity in renal cell carcinoma.

The objective of this study was to evaluate the utility of measuring microvessel fractal dimension (MFD) as a parameter of architectural microvascular complexity in localized renal cell carcinoma (RCC). Forty-nine patients with low-stage clear cell RCC were assessed in a 9-year follow-up retrospective study. Tumor vessels were visualized with the endothelial marker CD34.

Laparoscopic accessory splenectomy in recurrent chronic immune thrombocytopenic purpura.

Splenectomy is the definitive treatment for most cases of idiopathic thrombocytopenic purpura (ITP). We present the case of a patient who was discovered to have ITP at age 5 and was treated medically for 3 years with decreasing response to medication. At age 8, he underwent splenectomy, after which the platelet count stabilized at approximately 200,000/mm3.

Horner's syndrome and bilateral esophageal duplications.

Bilateral esophageal duplications are exceptionally rare. A 3-month-old male presented with a left-sided Horner's syndrome. Upon further investigation, bilateral upper thoracic masses with an air-fluid level within the right-sided mass were found.

Management of an abdominal cerebrospinal fluid pseudocyst using laparoscopic techniques.

Abdominal cerebrospinal fluid (CSF) pseudocysts are reported to occur in < 1% of ventriculoperitoneal shunts. Management options include various types of shunt revisions with or without aspiration or excision of the pseudocyst. We report a case in which laparoscopy was utilized in a 12-year-old boy to excise a portion of the pseudocyst, remove the shunt catheter tip from the residual pseudocyst, and reposition it in the peritoneal cavity.

m-Acetylanilido-GTP, a novel photoaffinity label for GTP-binding proteins: synthesis and application.

A novel photoaffinity label, m-acetylanilido-GTP (m-AcAGTP), was synthesized and used to identify GTP-binding proteins (G-proteins). This GTP analogue is easily prepared and can be used for photoaffinity labelling of G-proteins without chromatographic purification. In the presence of the beta-adrenergic agonist isoprenaline, it activates turkey erythrocyte adenylate cyclase.

Digitally assisted laparoscopic drainage of multiple intraabdominal abscesses.

Laparoscopic drainage of multiple walled off intraabdominal abscesses may be difficult to perform safely due to a lack of tactile sensation. A single finger introduced through a small abdominal incision can be used to aid in the dissection and may obviate the need for open laparotomy in some cases. Digitally-assisted laparoscopic exploration and dissection utilizes the superior visualization of laparoscopy without completely sacrificing the benefits of tactile sensation.

Aerocele, an unusual complication of anterior cricoid split.

Since its introduction, the anterior cricoid split has proven to be a safe and effective procedure for the management of infants with acquired subglottic stenosis. In this article we report an unusual complication--an aerocele, which occurred on the 14th day following an anterior cricoid split on a 9-month-old child. The possible etiology and successful management of the aerocele are reviewed.

Laparoscopic cholecystectomy in teenagers.

The positive experience with laparoscopic cholecystectomy (LC) in the adult surgical community encouraged us to perform LC in our last nine adolescent patients requiring cholecystectomy. There were no operative or postoperative complications, and the average hospital stay was less than 3 days. All the teenagers resumed their normal activities 1 week after surgery and were pleased with the small operative scars.

Necrotizing enterocolitis in infancy.

The most common gastrointestinal emergency in the newborn is necrotizing enterocolitis. Premature babies are the most likely victims, but it also occurs in full-term infants. Although great strides have been made in elucidating some of the factors responsible for necrotizing enterocolitis, such as intestinal ischemia, bacterial overgrowth, and feeding dysfunction, the exact etiology is as yet unclear.

The irreducible ovary: a true emergency.

The management of a child with an irreducible ovary remains inconsistent in pediatric surgical centers. An informal survey of senior pediatric surgeons and an extensive review of the literature showed a prevailing view that the trapped ovary is not at significant risk of vascular compromise. Two recent cases prompted a review of our experience from 1984 to 1989, during which 1,699 children with inguinal hernias underwent operation, 386 (23%) of whom were girls.

Utero-vaginal hypoplasia. Sonographic, embryologic and clinical considerations.

Congenital absence of hypoplasia of the uterus is a cause of primary amenorrhea in approximately 15% of cases. Ultrasound is often employed as an early imaging modality in the evaluation of patients with primary amenorrhea. Demonstration of total absence or marked hypoplasia of the uterus in the presence of normal ovaries during pelvic ultrasound examination, suggests the diagnosis of congenital uterine aplasia or hypoplasia.

Idiopathic intestinal perforations in the newborn: an increasingly common entity.

Between 1982 and 1987 seven neonates ranging in age from 24 hours to 1 week were treated for idiopathic intestinal perforations at the Montefiore Medical Center, Albert Einstein College of Medicine. Four of the infants were born prematurely; three were full term. Five were being treated in an intensive care nursery when the perforation was diagnosed.

Characterization of human papilloma virus types in condylomata acuminata in children by in situ hybridization.

The presence of human papilloma virus (HPV) DNA sequences of types 6, 11, 16, and 18 was determined by in situ hybridization under stringent conditions on archival paraffin-embedded tissue sections in eight condylomata acuminata observed in children below the age of 12 years. Viral sequences were detected in seven of eight cases: all of them contained HPV 6, four contained also HPV 11, and one contained HPV 16 and 18. Papilloma virus common antigen was detected in only three of eight cases, all of them being positive also by in situ hybridization.

The management of surgery in infants and children with the acquired immune deficiency syndrome.

Between January of 1981 and June of 1984, 53 infants and children with the diagnosis of AIDS were seen at our institution. Twenty-one of these patients have required 35 operations to determine or administer the proper therapy. We have taken every precaution to minimize the risks of exposure of all health care personnel.

A role for endoscopy in the placement of ventriculoperitoneal shunts.

Compartmentalization of the lateral ventricle may prevent adequate functioning of ventriculoperitoneal shunts. We recently treated a patient with postinfectious hydrocephalus who required bilateral shunts. In addition, the left ventricle was shown to contain a large noncommunicating cyst.

Regulation of brain temperature in pigeons: effects of corneal convection.

The effect of direct ventilation of the eyes on cooling in the brain was investigated in domestic pigeons (Columba livia, mean mass 0.27 kg) with thermocouples chronically implanted in the hypothalamus and anterior eye chamber. During conductive heating in still air body-brain temperature difference (delta T) was 2.

Occult bleeding from a perforated gastric duplication in an infant.

We report what we believe is the first case of a perforated gastric duplication with occult intraperitoneal hemorrhage and massive abdominal distention in the neonatal period. At operation, a perforated ulcer on the free anterior surface of the duplication was identified and the entire cyst excised by submucosal dissection.

Laparoscopy for presumed nonacute salpingitis: a new look at an old problem.

The increased prevalence of venereal disease among adolescents has resulted in a rise in nonacute salpingitis. Laparoscopy was evaluated as an aid in the diagnosis and treatment of presumed nonacute salpingitis in 29 adolescents. The patients had a mean duration of symptoms of 5.