Cardiopulmonary resuscitation in hospitalized patients: continuing problems of decision-making

Disturbingly low survival rates after CPR prompted us to carry out a series of studies. Of 272 patients receiving CPR at our 600-bed community hospital in 1984, 102 (37.5%) patients survived initial resuscitation and 30 (11%) survived their hospitalization. Of the 102 initial survivors, only 15 patients had received full CPR including cardiac compression and/or defibrillation, endotracheal intubation, and cardiotonic drugs. These data were compared with those for 129 patients admitted to our critical care units in 1982 and 1983 in whom CPR was withheld. These patients had been designated "No CPR" primarily because of their poor response to therapy. There was an 11% survival rate for patients who had received CPR compared to a 16% survival rate for the "No CPR" group. These data suggest that criteria for administering CPR to hospitalized patients should be improved.     

India's needs and priorities in fertility regulation research

This article evaluates the needs and priorities of India in fertility regulation research. There are multivariate factors that affect the perceptions of people about fertility regulation in India. The socioeconomic status, level of education and religious beliefs have strong influences on their decision on the family size, spacing between children and also the sex of the children. Moreover, a large number of people are either quite ignorant of or cannot afford to avail with the technologies and services for controlling their fertility. These factors generally perpetuate high fertility, which strongly affect the infant and maternal mortality, and eventually the quality of life both for the present and the future generation. The International Conference on Population and Development Program of Action has provided India with an alternative to develop newer methods of fertility regulation so as to widen contraceptive choices. The objective of research in fertility regulation should ensure the fertility control of couples and ability to plan the number and spacing of children. Research in fertility regulation should be aimed at expanding contraceptive choices by improving the accessibility and acceptability of good quality contraceptive products and services. It would necessitate: improving the quality of care; increasing awareness about sexuality and fertility regulation; empowering women; and increasing male-female partnership in sharing responsibilities for family planning and parenthood.     

Management of ocular perforations resulting from peribulbar anaesthesia

PURPOSE: To analyze the clinical presentation and outcome of treatment for globe perforation secondary to peri-bulbar anaesthesia. METHODS: Eight patients (3 females and 5 males) aged 66-84 years were included in the study. Ocular perforations were suspected in 3 cases before or during surgery, in 4 cases diagnosis was established within one week and in one case at 3 weeks. Three patients underwent indirect argon laser photocoagulation to seal the retinal break, one patient had cryotherapy, 3 patients underwent a pars plana vitrectomy with fluid gas exchange and endo-laser; and one patient refused any further treatment. RESULTS: The final visual acuity after a mean follow up of 14 months was better than 6/9 in 2 patients, between 6/9-6/12 in 4 patients, and perception of light in 2 patients. CONCLUSION: If diagnosed early and treated adequately, a majority of patients with globe perforation during periocular anaesthetic could be saved.     

Hamartoma of the Face

Hamartomas are tumour like malformations which are due to a developmental anomaly. They are most commonly seen in the spleen, lungs, liver and kidney, they are rare in the head and neck region. A rare case of Hamartoma of the soft tissues of the face in a 13 year old boy is reported.     

15th International Symposium on Pediatric Surgical Research

Pediatric Surgery International -     

Glial-derived growth factor signaling pathway in infantile hypertrophic pyloric stenosis

BACKGROUND/PURPOSE: Glial-derived growth factor (GDNF), which is the ligand of RET is reported to be essential for the development of enteric nervous system. A GDNF knockout mouse model has shown that the gastric region is a critical passing site between GDNF-RET-independent neuroblasts (colonizing the esophagus) and GDNF-RET-dependent neuroblasts (colonizing the small and large bowel). The earliest GDNF site of production is the mesenchyme and the outer smooth muscle cell (SMC) layer of the developing bowel. In the mature gastrointestinal tract the presence of GDNF is restricted to enteric glial cells. The aim of this study was to investigate the expression of GDNF and RET in infantile hypertrophic pyloric stenosis (IHPS). METHODS: Full-thickness muscle biopsy specimens were obtained from 8 IHPS patients at pyloromyotomy and from 8 age-matched controls without gastrointestinal disease. Indirect immunohistochemistry was performed using avidin-biotin-peroxidase complex method with anti-GDNF and anti-RET antibodies. Quantitative analysis was performed using sandwich-type enzyme-linked immunosorbent assay (ELISA) for GDNF. RESULTS: GDNF- and RET-positive nerve fibers were absent or markedly reduced in IHPS compared with controls. GDNF was expressed strongly by smooth muscle cells of both muscular layers in IHPS, whereas no GDNF expression was detected in pyloric muscle of controls. The quantity of total GDNF in IHPS was significantly higher than in controls (P < .01). CONCLUSIONS: The lack or markedly decreased number of GDNF-positive nerve fibers in IHPS supports the hypothesis of a selective immaturity of the enteric glia in the muscular layers in IHPS. The strong expression of GDNF in smooth muscle cells in IHPS and the increased levels of GDNF in IHPS suggest a compensatory mechanism by which the smooth muscle cells continue to produce GDNF until maturation of the enteric glial cells occurs.     

Multiple gastrointestinal atresias result from disturbed morphogenesis

 Multiple gastrointestinal atresias (MGA) have been reported to account for 6% to 32% of all intestinal atresias. Controversy exists regarding the pathogenesis. Many investigators believe MGA to be the result of multiple ischemic infarctions of the intestinal tract. However, some have suggested that MGA results from a malformative process early in fetal life. Prenatal exposure to adriamycin in a rat model has been reported to lead to a spectrum of tracheoesophageal and associated malformations of the gastrointestinal tract, including intestinal atresias, identical to these observed in humans. The aim of this study was to determine the incidence and histopathologic findings of MGA in order to understand the pathogenesis. Timed-pregnant Sprague-Dawley rats were injected with adriamycin (1.75 mg/kg) in nine different gestational-day protocols. MGA was only seen in those rats who received adriamycin on gestational days 7, 8, and 9. The litters were recovered on day 21 by cesarean section. The digestive tracts (DT) of the fetuses were harvested for macroscopic and microscopic examination. Ten rats who received adriamycin on gestational days 7, 8, and 9 produced 87 newborns; 1 was damaged during dissection. DT anomalies occurred in 80 (93%) of the 86 newborns; 94% of these demonstrated MGA. There was a very high incidence of associated anomalies in newborns with MGA. Histologically, the blind-ending atresias showed different degrees of villous hyperplasia with or without intraluminal material. This is the first report demonstrating a high rate of occurrence of MGA in the adriamycin rat model. The injection of adriamycin early in gestation, the high incidence of associated malformations, and the anatomic and histologic findings in MGA indicate that MGA is a result of a malformative rather than an ischemic process. Accepted: 22 September 2000     

Neonatal intestinal perforation in Hirschsprung's disease

Over a period of 18 years, 77 of 135 patients treated for Hirschsprung's disease (HD) presented in the neonatal period. Of these 77 patients, 8 had gastrointestinal (GI) perforations. Seven patients were born at full term and 1 at 32 weeks of gestation. Three patients had associated trisomy 21. The site of perforation included rectum in 1 patient, sigmoid in 1, descending colon in 1, transverse colon in 2, caecum in 2, and jejunum in 1. Perforations occurred in ganglionic bowel in 7 patients and in the aganglionic segment in 1. One patient died in the newborn period of overwhelming sepsis secondary to enterocolitis, and histology of the bowel confirmed HD. In 6 patients HD was confirmed on barium enema and suction rectal biopsy, and they subsequently underwent a definitive pull-through operation. The 1 patient in whom the initial barium enema was normal continued to suffer from constipation until the age of 7 years, when the diagnosis of HD was established. He then underwent a pull-through procedure with no further problems. An association between neonatal intestinal perforation and HD must therefore be recognised to avoid delay in the management. Correspondence to: P. Puri