Segmental intestinal transplantation can be an adequate therapy for short bowel syndrome in growing dogs.

This study was undertaken to investigate whether two-stage segmental small bowel allotransplantation can maintain growth and development of young dogs (16 weeks, 5 to 6 kg) with surgically created short bowel syndrome (SBS). After near-total small bowel resection (group 1; n = 3), irreversible weight loss was noted. After a sham operation (group 2; n = 3), no growth disturbances were found.

Prospective evaluation of the absorptive capacity of the bowel after major and minor resections in the neonate.

The outcome after major bowel resection in the neonatal period depends primarily on the time needed for bowel adaptation. A prospective study was begun in neonates after small bowel resection to evaluate the absorptive capacity of the bowel and growth parameters as a result of adaptation of the bowel. Twenty-four neonates who underwent bowel resection were included.

Islet cell cytoplasmic antibody reactivity in midgestational human fetal pancreas.

The reactivity of islet cell cytoplasmic antibodies (ICA)-positive and ICA-negative sera of recent onset type 1 diabetic patients was studied in human fetal pancreata of 12-18 weeks' gestation and compared with the reactivity of these sera in adult human control pancreata. The aims of the study were: (1) to observe the presence of ICA staining in human fetal islet cells; (2) to compare endpoint titres (in Juvenile Diabetes Foundation units) of ICA-positive patient sera in fetal pancreata and adult human control pancreata. Ten ICA-positive sera and eight ICA-negative sera from newly diagnosed diabetic patients and four sera from healthy controls were tested on three human adult and eight human fetal pancreata.

Alveolar epithelial composition and architecture of the late fetal pulmonary acinus: an immunocytochemical and morphometric study in a rat model of pulmonary hypoplasia and congenital diaphragmatic hernia.

The aim of the present study was to compare the architecture and alveolar epithelial cell composition of the pulmonary acinus in hypoplastic and normal fetal rat lungs. For this purpose, a rat model of pulmonary hypoplasia in association with congenital diaphragmatic hernia (CDH) induced by Nitrofen (100 mg on day 10 of pregnancy) was studied. Sections (5 microns) from lungs of control and Nitrofen-exposed fetal Sprague Dawley rats with or without CDH aged 18-22 days (vaginal plug on day 1, birth on day 23) were stained with hematoxylin and eosin.

Etiological aspects of congenital diaphragmatic hernia: results of a case comparison study.

We report the results of a parental questionnaire concerning possible etiological and teratological factors, such as exposure to herbicides, in the development of congenital diaphragmatic hernia (CDH). The herbicide Nitrofen interferes with lung development in rats, can induce diaphragmatic hernia and greatly resembles thyroid hormone. No association with the studied teratogens nor with maternal thyroid dysfunction was found.

Value of antibodies to GAD65 combined with islet cell cytoplasmic antibodies for predicting IDDM in a childhood population.

The value of a test for islet cell cytoplasmic antibodies together with a test for GAD65 antibodies to predict the subsequent development of diabetes over a period of 11.5 years was assessed in an open childhood population comprising 2,805 individuals. A single serum sample was obtained from each individual between 1975 and 1977 and screened for islet cell cytoplasmic antibodies for which eight individuals were positive (0.

Gas exchange across native lungs and extracorporeal membrane in neonates and pigs during extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) is a commonly used treatment modality for severe neonatal respiratory failure. The aim of the present study was to evaluate the relationship between ECMO blood flow and gas exchange across the native lungs and the extracorporeal membrane. In three healthy pigs, the ECMO flow correlated significantly with oxygen transfer (VO2) across the membrane (n = 12, r = .

Evaluation of lung function changes before and after surfactant application during artificial ventilation in newborn rats with congenital diaphragmatic hernia.

Patients with congenital diaphragmatic hernia (CDH) have unilateral or bilateral hypoplasia of the lungs including delayed maturation of the terminal air sacs. Because these lungs are highly susceptible to barotrauma and oxygen toxicity, even in full-term newborns, continued research into optimal ventilatory regimen is essential to improve survival rate and to prevent ongoing lung damage. Against this background, the effect of exogenous surfactant application is evaluated.

[3-week traction with 3-week spica-cast immobilization is as good as 6-week traction, and much cheaper].

Objective: To gain insight into the clinical en economic results of the treatment of femoral shaft fractures in children by means of traction for 3 weeks and spica immobilization for 3 weeks as an outpatient in comparison with traction for 6 weeks.

Design: Retrospective.

Setting: Sophia children's hospital in Rotterdam.

[Care and experiences of 20 set of parents concerning the death of children in a surgical intensive care unit].

Objective: To gain insight into the attitude and experiences of parents concerning the death of children in a paediatric surgical intensive care unit of a University Children's hospital.

Design: Retrospective evaluation of records from 1988-1992, supplemented with semistructured interviews in the second half of 1992.

Setting: Sophia Children's Hospital-University Hospital Rotterdam.

[Limitations to care; evaluation of decision making concerning the death of 104 children in a surgical intensive care unit].

Objective: To analyse the decision-making process concerning withholding and withdrawal of life-sustaining treatment in children who died in a paediatric surgical intensive care unit.

Design: Retrospective evaluation of medical and nursing records from the period 1988-1992.

Setting: Sophia Children's Hospital-University Hospital Rotterdam.

Short bowel syndrome: metabolic and surgical management.

The management of short bowel syndrome requires long-term nutritional support and monitoring, medication, and occasionally additional surgical procedures. Constant attention is required to ensure adequate adaptation of the gut. This article reviews the normal function of the small bowel, adaptation following resection, total parenteral and enteral nutrition, and the role of adjunctive surgical procedures in the management of short bowel syndrome.

Rectoperineal fistula in newborn boys.

Three newborn boys presented with features suggestive of classic low anorectal abnormality. However, during surgery they were found to have an intermediate anorectal abnormality and a rectoperineal fistula rather than an anocutaneous fistula. The surgical treatment of these infants is discussed.

Ultrasonography is accurate enough for the diagnosis of intussusception.

For more than 10 years the authors have been using ultrasonography to confirm clinically suspected intussusception without performing a contrast enema. The aim of this study is to review this diagnostic policy. Between 1980 and 1989, 163 children who, on clinical examination and plain abdominal radiographs were suspected of having intussusception, underwent ultrasonography to confirm the diagnosis.

Persistent pulmonary hypertension in high-risk congenital diaphragmatic hernia patients: incidence and vasodilator therapy.

Survival of congenital diaphragmatic hernia patients depends on the gravity of pulmonary hypoplasia and persistent pulmonary hypertension (PPH). Many vasoactive drugs have been used in the treatment of PPH, but often they also lower peripheral resistance, leading to a significant drop in arterial blood pressure. The incidence of PPH in 52 high-risk diaphragmatic hernia patients and the results of treatment with tolazoline and prostacyclin were evaluated in a study lasting 52 months and involving 52 patients.

Long-term survival of DLA-matched segmental small-bowel allografts in dogs.

The aim of this study was to investigate the combined effect of DLA matching and immunosuppressive therapy on the survival of segmental small-bowel allografts in dogs. Orthotopic segmental small-bowel transplantations (25 to 30% of total small bowel length) were performed in two stages: first a heterotopic segmental small bowel transplantation, followed after 5 to 8 weeks by a second-stage operation during which the heterotopic graft was placed in an orthotopic position and the native small bowel was resected. All dogs received cyclosporine immunosuppression.

Withholding and withdrawal of life support from surgical neonates with life-threatening congenital anomalies.

We evaluated why and how life support was withheld or withdrawn in surgical neonates. During the study period, January 1988 through December 1991, 529 neonates were admitted, 52 of whom died (10%). Twenty-eight deaths were due to the underlying disease.

Renal function up to 50 years after unilateral nephrectomy in childhood.

Removal of one kidney during childhood differs from removal of a kidney from an adult as the child's future depends on an adequate function of the remaining kidney during a longer period of time. We assessed the long-term effect of unilateral nephrectomy in childhood on renal function, protein excretion, and blood pressure. Data were obtained from 111 subjects undergoing uninephrectomy for unilateral renal disease before the age of 16 years who had no evidence of renal abnormalities in the contralateral kidney at the time of surgery.

Lyophylized dura patch repair of congenital diaphragmatic hernia: occurrence of relapses.

During an 8-year period, 71 neonates with congenital diaphragmatic hernia were admitted to the Sophia Children's Hospital. Seventeen patients died before surgery. The other 54 patients underwent either direct suture (18) or patch closure with lyophylized dura (36), depending on the size of the defect.