Diagnosing hypertrophic pyloric stenosis: does size matter?

This retrospective study examines the size of the pyloric tumour at the time of surgery in 100 patients (76 boys, 24 girls) operated over a 2.75 years period from June 1993 to March 1996. The size of the pyloric tumour was classified into one of three categories (short, moderate or large) by the operating consultant and documented in the operation note.

Persistent nocturnal cough: randomised controlled trial of high dose inhaled corticosteroid.

Objective: To investigate the effect of a short course of inhaled corticosteroid in the treatment of isolated and persistent nocturnal cough in children.

Design: Randomised double blind placebo controlled study.

Setting: Subjects' homes in east London, England.

Monitoring and complications of parenteral nutrition.

A knowledge of the complications of parenteral nutrition is inherent in the design of any monitoring system. In the initial stages of therapy, the complications are usually of electrolyte imbalance. It must also be appreciated that the provision of nutrition to severely malnourished patients will expose underlying deficiencies, particularly of phosphates and trace elements.

Cough and sleep in inner-city children.

This study aimed to determine whether cough at night keeps children awake, to describe the relationship between children's cough and sleep and to report parents' perceptions of their children's cough and sleep. Thirty-nine children with reported persistent cough at night (>3 weeks) were recruited and studied for 6 nights by video-recording. Coughs were counted and sleep state was coded for awake, restless sleep and quiet sleep.

Prescribing for persistent cough in children.

To identify the medications general practitioners consider for the treatment of persistent isolated cough, we undertook a postal questionnaire survey of a sample of general practitioners in east London. Fewer than 10% indicated that they never prescribed for such cough. About 70% sometimes considered antibiotics and/or bronchodilators in all age groups.

Meconium ileus secondary to cystic fibrosis. The East London experience.

Meconium ileus (MI) affects 15% of neonates with cystic fibrosis (CF). The authors reviewed the management and outcome of 51 neonates presenting to a single institution between 1976 and 1995 with MI secondary to CF. Clinical presentation included abdominal distension (96%), bilious vomiting (49%), and delayed passage of meconium (36%).

Surface umbilical pyloromyotomy.

Background: Despite much initial enthusiasm, umbilical pyloromyotomy has failed to achieve widespread popularity. This mostly relates to difficulty with delivering the pyloric tumour through the relatively small incision.

Method: A new technique for umbilical pyloromyotomy is described in which a circumumbilical skin incision with a right lateral extension is combined with transverse division of the linea alba and part of the right rectus muscle.

Pre-operative fasting for paediatric anaesthesia. A survey of current practice.

There has recently been much debate about pre-operative fasting for paediatric anaesthesia. There is no consensus about the optimum fasting times for children undergoing elective surgery. In order to establish a standard for paediatric pre-operative fasting times, we undertook a postal survey, targeting members of the Association of Paediatric Anaesthetists resident in the United Kingdom and Ireland in 1995.

An evaluation of the role of suction rectal biopsy in the diagnosis of intestinal neuronal dysplasia.

Background: German pathologists have developed a consensus for histological features of intestinal neuronal dysplasia.

Methods: A blind reevaluation of ganglionic suction rectal biopsies from infants and children who initially presented with symptoms of intestinal dysmotility was made.

Results: 84 of 411 specimens had sufficient depth of submucosa for adequate assessment.

Association of ambiguous genitalia with VATER anomalies and its significance in management.

Tracheo-oesophageal fistula, oesophageal atresia, and imperforate anus are known to be associated with renal anomalies - the VATER complex. The occurrence of ambiguous genitalia with this collection of anomalies has not previously been highlighted. We report two cases occurring 15 years apart; both had renal agenesis and neither was salvagealble from a renal or pulmonary viewpoint.

Pneumatic intussusception reduction via a colostomy: case report.

Intussusception is uncommon in infants with a colostomy. The authors present the first documented case of intussusception in an infant with a colostomy in which pneumatic reduction was achieved via the stomal opening. The inflated balloon of a Foley catheter was plugged against the stoma at skin level and a tight seal was obtained.

Oral antibiotics for common infections in children: for and against.

There are very real fears that the antibiotic era may soon be over. Increased use of antibiotics is a major factor in the widespread emergence of antibiotic resistance, which now exists in most of the common bacterial pathogens affecting children. Health-care workers must become aware that the implications are very serious and learn to use these valuable drugs with care.

Epithelial cell proliferation in childhood enteropathies.

Background/aim: The aim of this study was to investigate epithelial cell turnover in childhood enteropathy to establish whether common disease related mechanisms operate. Levels of epithelial cell proliferation were measured in children with food intolerance (cows' milk protein intolerance and coeliac disease), and after infection with Giardia lamblia, Cryptosporidium, and enteropathogenic Escherichia coli.

Methods: Comparative measures of epithelial cell proliferation were performed by recording mitotic activity and MIB-1 immunoreactivity in proximal small intestinal biopsy specimens.

An easy method for adjusting a silo for delayed closure of gastroschisis.

A method is described permitting rapid and safe tucks and adjustments to be made to a silo in staged reduction of an anterior abdominal wall defect.

Effect of neck rotation on the timing and pattern of infant tidal breathing.

While neck flexion and extension are known to influence the patency of the upper airway, far less information is available regarding the effects of neck rotation. The effect of neck rotation on respiratory rate (RR), expiratory time (tE), and phase angle (phi) was assessed in 17 healthy infants aged between 1 and 4 months. An inclinometer was used to measure neck rotation and uncalibrated Respiratory inductive Plethysmography to measure the dependent variables while the infants were in natural, quiet sleep.

Erythrocyte cupric/zinc superoxide dismutase exhibits reduced activity in preterm and low-birthweight infants at birth.

In a comparative study in term, preterm and low-birthweight infants, the mean activity and standard error of the mean for copper/zinc superoxide dismutase (Cu/Zn SOD) in cord erythrocytes from five term small for gestational age infants was 0.94 +/- 0.10 SOD units (mg protein)-1.

Intractable diarrhea of infancy.

The current concept of intractable diarrhea of infancy is that of a heterogeneous syndrome with diverse etiologies. The purpose of this review is to provide an update on this group of dis-eases. As modern diagnostic techniques become available, new disorders will continue to be recognized.