Indian ,7. Pedlar., 26z 235, 1959.

ABSTRACTS OF THE CURRENT LITERATURE

THE NEWBORN

Neonatal omphatlt is and pyelonephritis: WILLIAM E. DELAN~Y III-- J. Pediat., 54: 36, 1959.

The recurrence of umbilical sepsis in the neonatal period is not un- common. Various complications of such an occurrence have long been recognised due to a spread of the infection from the umblicus to other parts of the body. The spread of the infection may extend via the umbilical veins or arteries, directly into the peritoneal cavity or subcutaneously, or via the lymphatic system, probably more so in subclinical cases or in those where much sepsis is not microscopically seen.

Out of the 2,210 live births that took place in the author's hospital ' during eleven months, postmortem examinations of three babies, dying in the neonatal period, revealed acute omphalitis associated with acute pyelone- phritis. The author presents these three cases.

Case No. 1 : A baby weighing five pounds and eight ounces was born to a late syphilitic, unmarried, Rh-positive, 29 year-old mother. The baby appeared normal at birth, and the serology and X-ray examination of the bones were negative for syphilis. On the second day, a moderate scleral and cutaneous icterus was noted, and on the third day, it appeared weak and the reflexes diminished. Green nasal discharge was seen and its culture showed growth of Streptococcus viridans, Staph. albus and E. coli. A direct Coomb's test was positive. No growth of bacteria resulted from the blood culture in forty-eight hours. The child died, in spite of treatment. An autopsy showed evidence of kernicterus and inflammatory and septic loci in the umbilical cord and the kidneys.

Case No. 2: A female child weighing seven pounds and eleven ounces was spontaneously delivered from a normal mother. Eight hours after birth, she appeared jaundiced. Serum bilirubin remained normal. The child de- teriorated in spite of treatment and died after ninety-six hours. Autopsy showed nothing "particular except kernieteric changes in the brain, and microscopically acute inflammation and sepsis in the kidneys and the um- blical cord area.

Case No. 3: Showed more or less a similar picture to the other two eases. Neonatal pyelonephritis has a grave prognosis and the author con- eluded tliat in that period, its association with omphalitis might be of great significance.

M. S. RAO.

Transplaeental transmiss ion o f pol iomyelit is antibodies to the newborn: F. MULLER and H. LENNARTZ--Gerrn. reed. Monthly, 3: 212, 1958 from Int. Med. Dig., 73: 359, 1959.

The authors set out to find out how long the passively acquired anti-

236 Indian Journal of Pediatrics

bodies against polio-virus persist in the blood of the newborn infants and children.

"One hundred and eighty-two samples of serum from healthy babies aged one to twelve months were examined for neutralizing antibodies to each of the three types of poliomyelitis virus.

"From the investigations carried out it was found that neutralizing antibodies to at least one type of the virus were present in all the babies during the first two months of life. Seventy-six per cent of the children had antibodies to all three types ofpoliomyeliti s virus, seventeen per cent against two types and seven per cent against one type only. With increase in age there was a fall in the number of cases with polio-antibody; only fifty per cent of cases showed the presence of the a nti-bodies against all three types at the fifth month, the minimum being between the ages often and eleven months. After twelve months the number of antibody carriers rose again."

Active immunization by feeding attenuated virus strains, according to the authors, renders further vaccination unnecessary. 'Exposure to natural poliomyelitis infection merely acts as a booster.'

" In this connection it is of importance to know for how long poliomyeli- tis-neutralizing antibodies derived from the mother persist in the baby. It is seen that all infants tested in their first two months of life possessed anti- bodies to at least one of the types of poliomyelitis. The proportional presence of each type is in accordance with previous serologic findings among German women of child-bearing age.

"The prolonged persistence of passively derived antibodies is surprising. I t has been found that the poliomyelitis-neutralizing antibody titre of the mother and, therefore, of the infant, is distributed along a gaussian curve with a mean titre of 1/32. If one now assumes that poliomyelitis-neutraliz- ing antibodies, as all other transplacentally transmitted antibodies and parenterally administered y-globulin have a half-life of thirty-five days, then it would be expected that in the fifth month all children starting with a titre at a serum dilution of 1-4, of 1/32 or less, i.e. fifty per cent, would react negatively.

"This is, in fact, the case. In the eleventh month all children should react negatively, but because active production of antibody in response to polio- myelitis virus will have commenced by then, this does not occur."

A. K. DEY.

INTERNAL MEDICINE

Fulminating bacillary dysentery: Clinical mainfestat|ons and management--Chin, reed. 3., 78:11 I, 1959.

This is a report on the clinical manifestations and management of fulminating bacillary dysentery from the Children's Hospital, Shanghai. The total number of cases treated was seventy-five. The characteristic features of the fulminating type were sudden onset, high fever of about 40~

Abstracts oj the Current Literature 237

repeated attacks of convulsion and coma, accompanied sometimes by circulatory failure and respiratory failure of central nervous system origin. Fulminating bacillary dysentery was different from the ordinary toxaemie type. The mortality in a series of seventy-five cases of fulminating type was 10.6 per cent while in a series of 188 mild toxaemic cases treated in the same hospital, the mortality was 4.4 per cent.

The incidence of the disease in the present series was 64.1 per cent in the age group 2 to 4 years. Boys were more affec,ted than girls. The onset was sudden in all the cases. Hyperpyrexia was the initial symptom in seventy- three cases, convulsions and coma in forty-seven cases, diarrhoea in twenty- six cases and vomiting in eight cases. At the onset, most of the cases showed conspicuous symptoms of generalised intoxication without dysenteric stools. Tachypnoea was noticed in all the cases. Pallor and irregular breathing often preceded the cessation of respiration. Of twenty-six cases with vomit- ing, six had coffee ground vomitus, and only two of them recovered. A slight

. degree of dehydration was found in only three cases and pain in abdomen was complained of in ten cases. Malnutrition was observed only in three cases. The foods suspected of transmitting the germ were chiefly fruits.

Stool cultures were positive in forty-three cases, fourteen for Flexner's bacilli and twenty-nine for Sonne's bacilli.

Macroscopic examination of stools revealed pus, blood or mucopus in most cases. A cold saline enema often helped in the diagnosis. However, the authors sound a note of caution, "diagnosis of the disease should not be based on stool examination alone". The pathogenesis of fulminating bacil- lary dysentery has been discussed. The character of onset and the patho- logic changes in these cases indicated the possible role of nonspecific ana- phylactoid reaction in this disease. "The bacteria or the products of bac- terial metabolism also participate in the intoxication process."

Results of animal experiments to study the mechanism of intoxication in this disease has also been described and it has been concluded that "i t was impossible to demonstrate that the bacterial endotoxin played a leading role in the mechanism of pathogenesis of the disease."

Treatment consisted of detoxication, antipyretic, anticonvulsive and shock relieving measures, regulation of respiration and antibiotic measures. A detailed description of the treatment has also been incorporated in this article.

S. P. GtIOSAL.

Ocular signs in gargoylism: CHOU YxcH~--Chin. reed. J., 78: 130, 1959. A case of gargoylism in a Chinese boy is reported. The patient, a boy of

4 years had all the typical features of gargoylism. He was mentally clear but dull in appearance. The bridge of the nose was depressed. The neck was short. He had a soft blowing systolic murmur in the precordial region. The abdomen was protuberant and there was an umbilical hernia. The liver and spleen were enlarged, each about four cm. below the costal margin. There was a large right-sided inguinal hernia. The hands were claw-shaped

4

238 Indian Journal o f Pediatrics

and the terminal phalangeal joints could not be fully extended. There was lumbar kyphosis. Vision was 0 .30 .U . The palpebral conjunctiva was slightly congested with papillary hypertrophy and follicles present. Both corneas were diffusely hazy and the opacities had a fine, gray-coloured and granular appearance involving the deeper corneal layers. Tension was 22 mm. of Hg. (Schoiotz) in each eye. The left eye showed a mild convergent strabismus. Both optic disks were normal. Due to corneal opacities no fundus details were available.

Roentgenographic examination showed elongation of the sella tureica. The twelfth thoracic vertebra and all the lumbar vertebrae were concave on their anterior surfaces. The second, third and fourth lumbar vertebrae were wedge-shaped. The ossification centres of the carpi appeared late and there were only four ossification centres. Both the ingunial and umbilical hernias were repaired, but the inguinal hernia recurred. Ocular examination done three years after the first examination showed visual acuity in the right eye 0-2 J. 5+1 and left eye 0.2, J.4-1. The haziness of the cornea had become denser than before.

The pathogenesis, symptoms and ocular signs of gargoylism have been briefly reviewed.

S. P. C.-HOSAL.

Kartagener's syndrome: S. S. MISRA, SATYA PRAKASH and S. N. PANDEYA --07. Indian med. Ass., 31: 285, 1958.

Two cases of Kartagener's syndrome of situs inversus, with bronchi- ectasis and sinusitis are reported.

Case 1--A 28-year old Hindu male, with productive cough of eight years' duration and fever for ten days, showed on examination dextrocardia, harsh vesicular breathing and coarse crepitations. Roentgenogram revealed obliteration of the frontal sinuses, dullness of left maxillary antrum and bilateral basal bronchiectasis with situs inversus.

Case 2---A 24-year old Muslim male came with the complaints of cough and breathlessness for three and a half years and expectoration for two years. Both eases presented the triad of situs inversus, bronchiectasis and sinu- sitis.

ADAMS and CHURCHILL estimated the incidence of bronchiectasis seventy-two times more in cases of situs inversus than in general hospital patients in Massachusetts.

At Mayo clinic during a twenty-two year period, bronchiectasis was thirty-three times more in patients with situs inversus than general patients. It is, therefore, quite clear that the association of dextrocardia, bronchiec- tasis and sinusitis is not a mere chance coincidence but is of definite signi- ficance.

~"~. AMRUTHAVALLL

Abstracts of the Current Literature 239

The myxoedema reflex in infants and children with hypothyroidism: C. Y. BOWERS, D. L. GORDON, and A. SEOALOFF, - - f t . Pediat., 54: 46, 1959.

The 'myxoedema reflex' is a peculiar tendon response consisting of a normal contraction but slow relaxation of the muscles, found in adult myx- oedema eases. The authors ventured to try it in eleven cases of infants and children, which they presented. The ages ranged from three months to thirteen years.

Out of the eleven, six were non-goitrous cretins, three goitrous cretins and two children with hypothyroidism after thyroidectomy. The respective diagnoses were confirmed by the usual tests employed viz., high cholesterol level, lowered alkaline phosphatase, serum protein-bound iodine and thy- rotrophin level, thyroidal I TM uptake in twenty-four hours, etc. The methods of the tests employed were described in the foot notes.

It was seen that in all the eleven cases, the 'myxoedema-reflex' was strongly present, and as in the adults, they tended to disappear with therapy sooner than most of the other clinical signs. It was stressed that while elicit- ing the reflex, whether in the upper or lower extremities, " the movement of the muscle bundle itself, not the movement of the forearm or the leg", should be noted. Also, that the tap should be a light one and not forceful.

The authors concluded that as it was hitherto untried in children it would be worthwhile performing it in suspected hypothyroidism cases among children and infants as well, and would serve a useful purpose in establish- ing a diagnosis, which the other complicated laboratory tests could later confirm.

M. S. RAO.

Exchange transfusion for acute poisoning in children: OGDEN C. BRUTON--U. S. armed Forces reed. J., 9: 1128, 1958 from Int. Med. Dig., 73: 351, 1959.

Three case reports are given, where exchange transfusions to combat poisoning in children were successfully employed.

The first case report deals with a two-year old male child who accident- ally ingested seventeen to twenty 100 mgm. capsules of nembutal. Half an hour later, he became comatose and was taken to the hospital. Gastric lavage having failed to bring out any improvement, exchange trans- fusion was started about two and a quarter hours after admission, and 2,290 ml. of whole blood were exchanged. The patient gradually improved. He finally regained consciousness. Pharyngeal suction was necessary for two to three hours. The patient had an uneventful recovery.

Case No. 2, a three-year old girl, was admitted in the hospital with the complaints of abdominal pain and she vomited orange-coloured fluid. Enquiry revealed that she had ingested pyridium. Gastric lavage was given and continued for forty-five minutes, when the return was found to be normal in colour. The child, however, became cyanotic and lethargic. Methaemo- globinaemia was diagnosed. Exchange transfusion was started about three hours after admission and 2,000 ml, of whole blood was transfused. The

240 Indian Journal of Pediatrics

patient recovered from cyanosis. Penicillin and streptomycin were adminis- tered prophylactically and the patient recovered without any sequelae.

Case No. 3, a twenty-month old girl, was admitted with the history of ingestion of a large quantity of aspirin. Gastric lavage did not cause any improvement. The blood salicylate levels were seventy-three, one hundred and twenty-one and one hundred and sixty mg. per cent two and a half hours, four hours and six hours after ingestion of aspirin. Signs of progressive intoxication were noted and exchanged transfusion was given eight hours after the ingestion. One thousand ml. of whole blood were exchanged. The blood salicylate level came down to 24.3 mg. per cent imme- diately after the transfusion. The patient recovered completely.

The author discussed the method of transfusion and suitability of ex- change transfusions in cases of poisoning. Use of prophylactic streptomycin and penicillin was advocated.

A. K. DEY.

Acute laryngo-traeheal bronchi t is : ANN M. PEACH and ELIZABETtI ZAIMAN----Br~/. Med. o7, Feb. 14, 416, 1959.

One hundred and twenty-two cases of acute laryngo-tracheo-bronchitis admitted to the Hospital for Sick Children, Toronto, were studied during two winter periods. Except thirty-eight, who required tracheotomy, the others were relieved by medical treatment. One died of post-operative pneumonia and empyema caused by pyogenic staphylococcus.

No typical weather pattern appeared to predispose to the onset of acute laryngo-tracheo-bronchitis, although symptoms appeared during condi- tions of falling temperature and humidity in more than half the cases. Be- cause of the thermostatically controlled heating equipment in Canadian homes this fall may produce drying up of secretions associated with an upper respiratory infection and mechanical obstruction of the respiratory tract.

Clinical features were coryza, hoarseness, croupy cough, stridor, dysp- noea and fever. The age range of the patients was four months to ten years, and the ratio of males to females was 3.5 to 1. Mortality was 0.8 per cent.

In the four years that have elapsed since this study was carried out, there has been l~ttle alteration in the principles of treatment. The effectiveness of observation, mild sedation, elective relief of obstruction and, in particular, a cool, humid atmosphere in the treatment of acute laryngo-tracheo-bron- chitis is shown by the low mortality amongst the children in the present study.

B. SARBADHIKARY.

A ease o f early yaws: JACK BARROW, H. J. WALLACE and C. S. NICOL-- Brit. Med. o7, Feb. 14, 420, 1959.

A Negro boy aged 10 years from Dominica developed an ulcer on his ankle during a voyage to the U. K. Later, crusted papules appeared on the

Abstracts of the Current L#eraiure 24i

scalp and trunk and 7". pertenue was demonstrated in the serum from one of these lesions. Price's precipitation test and Reiter's protein complement fixation test were positive in the blood. Both parents gave a history of yaws in childhood.

A diagnosis of early yaws was made. The lesions responded quickly to treatment with penicillin.

B. SARBADHIKARY.

Long survival in mitral s tenosis: A case report: H. R. N. JOHNSON --Brit. Med. J., Feb. 14, 421, 1959.

The long survival of occasional cases of mltral stenosis without aortic lesions has been emphasized by many. It is possible that atheroma accounts for some of these cases, though in many, a clear history of rheumatic fever is obtained.

A case is presented where a patient with an anatomically severe degree of mitral stenosis lived till 69 years of age and who, furthermore, had borne five children. It is, of course, impossible to say when the stenosis provided a a serious mechanical embarrassment to the heart, but it seems likely that the pathological process was initiated in her teens. Possibly a minor degree of stenosis may, in later years, become more severe by deposition of athero- matous material leading to further fibrosis and calcification.

B. SARBADHIKARY.

Indian chi ldhood cirrhosis: AMARJIT SINGH, S. S. JOLLY, M. BALASUBRAH- MANYAN--Brit. Med. J. , Jan 31,278, 1959.

Certain clinical and aetiological aspects of this disease as seen in the province of Punjab have been discussed in this paper. Thirty-three cases admitted over a period of one and half years were studied. Patients varied in age from 8 months to 7 years, the majority being between 1 to 3 years, and except three all were male children. Seven out of thirty-three patients were Sikhs while the rest were Hindus. Twenty of these children belonged to the Agarwal bania community who are strictly vegetarian.

History of familial incidence of this disease in siblings was found in thirty- three per cent of the cases. Two clinical types could be classified--acute and subacute. Patients of the acute type had a negative family history and invariably had an unfavourable prognosis; most of the patients died of liver failure.

The subacute groups consisted of older children and a history of similar illness in other siblings of the family was frequent. Though prognosis of this group was also grave, some recovered. The hlstopathological findings of the biopsy materials of the liver were similar to those described by the Indian Council of Medical Research Subcommittee on liver diseases.

The authors believe that the disease is inherited as a sex-linked condi- tion in most cases of the subacute group, while the acute variety probably has a different aetiology.

S. P. GHOSAL.

242 Indian ffournal of Pediatrics

Radioactive Vitamin Bx2 urinary excretion in anaemia: Normal values and their modif icat ion in disease: Ind. o7. Med. Sci., 13: 179, 1959.

Co 5s labelled vitamin B 12 was estimated in urine and stools of normal and diseased persons with the help of a scintillation counter and recorded in a scaling unit incorporating a pulse height discriminator circuit 0'8 /zg. of Co 5a labelled vitamin B n with a specific activity of 3"37 /~C per t~g. was ad- ministered orally in a fasting state. The samples of urine and faeces were collected at definite intervals up to a period of forty-eight hours.

The normal urinary excretion in 24 hours ranged from 12"3 to 24.2 per cent of the oral dose and 12.3 to 32"45 per cent in 48 hours.

In a ease of pernicious anaemia, addition of the intrinsic factor enhanced the absorption of vitamin B. It was otherwise absorbed in very small quantities compared to that of the normal as reflected in the renal excre- tion of vitamin B TM. Similarly, another case of megaloblastic anaemia follow- ing subtotal gastrectomy showed reduced absorption of vitamin B TM.

A case of nutritional megaloblastic anaemia, however, did not show any difference from the normals in the renal excretion of Co 5s labelled vita- min B 12, indicating absence of defective absorption of the vitamin in this condition.

J. NAG CHAUDHURI.

Haemoglobin H - tha lassaemia disease : JAMES A. WOLFF, RICHARD H. MICHAELS and FREDERICK H. VON HoFg--Blood, 13: 492, 1958.

The authors have presented a ten-year old male child of Italian par- entage who had been diagnosed as a case of Hb H-thalassaemia. Investiga- tion of his immediate family revealed that the parents and all four siblings were asymptomatic and did not have splenomegaly. The mother and the two sisters had significantly decreased red cell osmotic fragility, hypochromia, anisocytosis, poikilocytosis and ovalocytosis. There was no abnormal hae- moglobin in any member of the family. The authors have discussed genetic aspects of the association of Hb H with thalassaemia and have suggested that the father in this case may carry the gene for Hb H although it may not be expressed at all because of the absence of thalassaemia. They have also suggested that the ~tudy of other patients with the clinical picture resembling mild Cooley's anaemia may reveal the presence of haemoglobin variants.

U. S. SARKAR.

Investigation of megaloblast ic anaemias: M. McKELLAR--J~r ". Z" reed. O7., 58: 18, 1959.

In this paper laboratory procedures of use in the diagnosis and differen- tial diagnosis of megaloblastic anaemias have been discussed. The first suspicion of the presence of megaloblastic anaemia arises during routine examination of the peripheral blood of a patient with anaemia.

In severe uncomplicated pernicious anaemia the M.C.V. of red cells

Abstracts of the Gurrent Literatur~ 243

is increased while the M. C.H.C. remains noimal. The absolute reticulocyte count is low and the blood film shows anisocytosis and poikylocytosis of the red cells with many macrocytes. Polymorphonuclear leucocytes with nu- clear hyper-segmentation may be conspicuous. Nucleated red cells may be found and these cells may show megaloblastic maturation. Gaint platelets are invariably present and the plasma is icteric. The total leucocyte count is usually low with a relative lymphocytosis. Bone marrow aspirate is cellualr with numerous megaloblasts, giant myelocytes and metamyolocytes. In the mild megaloblastic anaemia there may only be a mild macrocytosis, mo- derate anisocytosis and poikylocytosis with almost a normal bone marrow picture.

When megaloblastic anaemia is complicated by severe iron deficiency the peripheral blood may show features of iron deficiency rather than those of megaloblastic anaemia. An intermediate type of peripheral blood picture may be seen in tropical nutritional macrocytic anaemia and in some anaemias

'associated with intestinal malabsorption. This is often called "dimorphic anaemia".

Confirmation of the diagnosis of pernicious anaemia may be provided by the absence of fi'ee acid in the gastric juice, even after an alcohol histamine

test meal. The method of tubeless gastric analysis using diagnex, a quinine ion-exchange resin complex dispenses with intubation. In this method the quinine ions, a proportion of which are absorbed and excreted in the urine as quinine, can be estimated fluorimetrically. Recent introduction of diag- nex blue has dispensed with the use of fluorescent light or other special equip- ments. The failure of gastric mucosa to secrete other compounds e.g., pepsin, has been used to infer the presence of achylia gastrica.

In recent years, pernicious anaemia has been recorded in children, even in the presence of acid secretion and without gastric atrophy.

Biopsy of gastric mucosa and cytological examination of gastric juice have been used recently in the investigation of megaloblastic anaemia, but they have their limitations. The demonstration of a very low vitamin B 12 level provide further objective evidence, though not proof of the presence of pernicious anaemia in the patient. The final proof of pernicious anaemia depends not only upon demonstrating an impaired secretion of intrinsic factor, but also upon the fact that oral vitamin B TM is absorbed normally not only in the presence of added intrinsic factor. A number of methods are available, all utilising vitamin B TM, labelled with radioactive cobalt, for demon- strating a defective absorption of vitamin B TM from the alimentary tract.

The two most important preliminary investigations in assessing the intestinal function in cases of megaloblastic anaemia are the fat balance and barium meal visualisation of the alimentary tract, especially the small intestine.

Recently introduced techniques now make it possible not only to detect systemic deficiency of Vitamin B TM and desaturation of the tissues for folic acid when present, but also to measure the absorption of vitamin B 12 and folic acid from the alimentary tract. Folio acid absorption can be estimated either by the differential folic acid excretion test of Girwood or by folic acid

244 Indian ffournal of Pediatrics

absorption test of Chanarin et al. In addition to vitamin B TM and folic acid, vitamin is also an antimegaloblastic substance. However, actual instances of megaloblastic anaemia due to dietary deficiency of vitamin C are very rare.

S. P. GHOSAL.

INFECTIOUS DISEASES

Tracheotomy in inf luen,a: JOHN H. DInGLE--Brit. Med. 07, Feb. 14- 419, 1959.

Obstructive tracheitis and laryngitis have not been noteworthy features in the many accounts of influenza epidemics. In 1957, RAWLINS described the case of a dyspnoeic, cyanosed patient who recovered following repeated bronchoscopy and a tracheotomy. He suggested that deaths in the recent influenza epidemic might have been prevented by drainage of the main air passages of the relatively few patients admitted with influenza to the Childrens' Hospital, Sheffield, in 1957. Of these, three required tracheotomy' and a fourth repeated laryngeal intubation and suction before admission. Two of these cases have been described in detail in this article. All these four patients made good recoveries.

Case 1 had subglottic oedema and probably oedema of the tracheal mucosa with copious outpouring of fluid into the trachea. Case 2 had obs- truction by dessicated mucus which adhered to the trachea in different layers. It seemed likely that these patients would not have survived if tracheotomy had been withheld, and the surgeons who performed the operations were of the same view.

Though tracheotomy had been indicated in cases of obstructive influenza in the past, these two cases seemed worth recording because of the paucity of previous reports in proved cases of influenza.

B. SARBADttlKARY.

Drugs in the treatment o f syphil is: Part II: A. J. KING--Brit. /~Ied. 07., Feb. 14, 431, 1959.

Penicillin is the drug of choice in the treatment of syphilis, but unfor- tunately there is evidence of an increasing incidence of hypersensitivity to the drug.

The author has discussed other antibiotics which have been tried in a patient sensitized to penicillin. Chlortetracycline and oxytetracycline by mouth gives immediate satisfactory effects in the treatment of cases of infec- tious syphilis. The organisms disappeared from surface lesions in from two to five days.

Chloramphenicol by mouth caused disappearance of 7". pallidum from the infectious lesions of early syphilis in twenty-four hours. This was followed by healing of lesions and later, negative serological test.

Carbomycin by mouth caused disappearance of 7-. pallidum from lesions in thirty-six to seventy-two hours after the initial dose. This is a preliminary report which has yet to be confilaned.

Abstracts of the Current Literature 245

I t has been suggested that a sensitized patient may be treated with penicillin by suppressing the reactions with the concurrent administration of of corticotrophin. Such a procedure is obviously fraught with danger, and, if attempted at all, should be done in hospital under close supervision.

B. SARBADHIKARY.

SURGERY

The acute surgical abdomen in the first year o f life: MARSHALL. L. MmHEL--Postgrad. Med., 24: 166, 1958 from Int. Med. Dig., 73: 354, 1959.

The author analysed the records of one hundred consecutive cases of acute abdomen in the first year of life from his hospital. In all the cases, an obstructive lesion was found. The author discussed the various causes and found that an inflammatory process had been common.ly found to be the cause of the acute abdominal surgical condition.

The analysis showed the following conditions as the responsible causes in the one hundred cases--(l) Incarcerated inguinal hernia in thirty cases, (2) incarcerated umbilical hernia in nineteen cases, (3) pyloric stenosis in ninety-four cases, (4) intussusception in nineteen cases. (5) intestinal atresia in four cases, (6) malrotation of the gut--extrinsic duodenal obstruction in one and midgut volvulus in one, (7) intestinal duplication in one and (8) post- operative adhesions in one case. The author has discussed in short, the etiology, pathology, clinical features and treatment of each of the conditions enumerated. Meckels' diverticulum, meconeum ileus and appendicitis were also discussed.

The author advocated prompt repair of inguinal hernias in infants by elective operation to prevent incarceration, which is very common in infants under one year. Pyloric stenosis, though not strictly an acute condition, was included in the list of causes because of its urgency. Fredet-Ramstedt operation was considered to be the method of choice. Operative treatment for intussusception was recommended. Immediate operation was considered necessary for midgut volvulus. Intestinal duplication was found to cause obstruction in three ways namely, obstruction, haemorrhage and ulceration. Excision of the involved area and an end-to-end anatomosis was found to be the treatment of choice when the ileum was involved, but could not be applicable where the stomach, doudenum or rectum was involved. The case reported was one of duodenal duplication in close proximity to the common bile duct. "The cystic cavity of the duplication was anastomosed to a loop of je junum to permit drainage. A side to side jejuno-jejunostomy was done below the first anastomosis."

Meckel's diverticulum was, according to the author, a rare cause of obstruction and so also appendicitis in infants under one year. Whereas meconeum ileus was found to be a "extremely severe form of intestinal obstruction that occurs most often in the first year of life."

A. K. DEv.