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Vol 3, No 3
Vol 3, No 3 August 2007 ISSN 1708-8569
 
Special communication
Review articles
Original articles
Clinical summary
Case reports
   
Special communication:
An innovative strategy for reinvigorating clinical research and training
  Karl S. Roth, James C. M. Chan, Bruce Buehler
  Karl S. Roth, James C. M. Chan, Bruce Buehler

Omaha and Portland, USA

Author Affiliations: Department of Pediatrics, Creighton University School of Medicine, Omaha, Nebraska, USA (Roth KS); Department of Pediatrics, University of Vermont, Barbara Bush Children's Hospital, Maine Medical Center, Portland, Maine, USA (Chan JCM); Department of Pediatrics, University of Nebraska, Omaha, Nebraska, USA (Buehler B)

Corresponding Author: James C Chan, MD, Maine Medical Center, Department of Pediatrics, 22 Bramhall St, Portland, Maine 04102-3175, USA (Tel: +1-207-662-2439; Fax: +1-207-662-6272; Email: chanj@mmc.org)

Over the past two decades, it has become apparent that diminishing numbers of young American medical graduates engage in clinical research activities. Many publications have analyzed the causes for and addressed the means by which this trend can be reversed. The National Institutes of Health have put into place several mechanisms to encourage young physicians to become physician-scientists. However, virtually no attention has been given to older physicians who might be so inclined. In this paper we suggest two innovative means by which to enable senior faculty to retrain and actively engage in fruitful clinical research and mentoring of medical students and young physicians. In addition, we suggest a more modest option by which senior faculty may obtain career stimulus when department and/or institutional resources are extremely limited.

Key words: faculty development; clinical research; training

                                    World J Pediatr 2007;3(3):165-169

  [Abstract] [Full Text] [PDF]  
Review articles:
Chronic lung disease in preterm neonates
  Victor Yu, Jeanie-Beth Tan
  Victor Yu, Jeanie-Beth Tan

Melbourne, Australia

Author Affiliations: Department of Pediatrics, Ritchie Centre for Baby Health Research, Monash University, Monash Medical Centre, Australia (Yu V); Newborn Services, Monash Medical Centre, Australia (Tan JB)

Corresponding Author: Victor Yu, MD MSc (Oxon) FRACP FRCP (Lond Edin & Glasg) FRCPCH, Professor of Neonatology, Department of Paediatrics, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia (Tel: 61 3 9595 5191; Fax: 61 3 9594 6115; Email: victor.yu@med.monash.edu.au)

Background:  With advances in neonatal intensive care, increasing numbers of preterm neonates are now surviving. In the past they would have died before there was time to develop chronic lung disease (CLD). Based on the definition of a neonate requiring any form of respiratory therapy (oxygen or assisted ventilation) at 36 weeks' post-menstrual age, the CLD rate in Australia is 52% in those <28 weeks and 12% in those 28-32 weeks gestation. The high CLD rate in the former group is due to their improved survival rates (one-year survival rate of infants born in the State of Victoria is 41% at 23 and 24 weeks, 73% at 25 weeks, and 88% at 26 weeks).

Data sources:  Randomized controlled trials (RCTs), including meta-analyses and Cochrane reviews on the prevention and treatment of CLD were identified in the published literature.

Results: The following perinatal strategies were found to be effective in preventing or minimizing CLD: antenatal corticosteroids, postnatal surfactant, reduced oxygen saturation targeting at 89%-94%, early use of continuous positive airway pressure, synchronized ventilation, permissive hypercapnia ventilation strategy, high frequency oscillatory ventilation, closure of symptomatic patent ductus arteriosus with indomethacin, reduced fluid intake, and inhaled nitric oxide. Several anti-inflammatory and anti-oxidant agents have been found in RCTs to be effective, including vitamin A and recombinant human superoxide dismutase. Clinical management after the development of CLD includes appropriate oxygen and ventilation strategies, fluid restriction, and diuretic and bronchodilator therapy. Postnatal corticosteroid therapy is efficacious but its side-effect is increasing. The risk of cerebral palsy outweighs the benefit of therapy. Only in severe CLD, low-dose and short-course dexamethasone should be used.

Conclusion: Ongoing basic and clinical research is required to identify perinatal and neonatal interventions that are effective in either preventing or treating CLD in preterm neonates.

Key words: chronic lung disease; bronchopulmonary dysplasia; respiratory failure; prematurity; neonatal intensive care 

                                                                                                                World J Pediatr 2007;3(3):170-186
  [Abstract] [Full Text] [PDF]  
Current perspectives on Guillain-Barré syndrome
  Min Zhong, Fang-Cheng Cai
   

Min Zhong, Fang-Cheng Cai

Chongqing, China

Author Affiliations: Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China (Zhong M, Cai FC)

Corresponding Author: Fang-Cheng Cai, MD, Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China (Tel: 86-23-63622544; Fax: 86-23-63622874; Email: caifangc@126.com)

Background: This article aims to review recent advances in the etiology, typing, pathogenesis and treatment of Guillain-Barré syndrome (GBS).

Data sources:  Articles were searched in PubMed with the searching items related with Guillain-Barré syndrome.

Results and Conclusion: The commonly identified preceding pathogens have been identified such as Campylobacter jejuni, cytomegalovirus and others. Immunomodulating treatment has been proven to alleviate nerve damage and shorten the progression of the disease. GBS remains a serious disorder with a relatively high disability rate and a mortality, which definitely requires more effective treatment.

Key words: Guillain-Barré syndrome; infection; neuropathy; Immunomodulating treatment

                                                                                                                      World J Pediatr 2007;3(3):187-194
  [Abstract] [Full Text] [PDF]  
Original articles:
Intravenous immunoglobulin 1 g/kg as the initial treatment for Kawasaki disease
  Hirohiko Shiraishi, Mayu Iino, Masaru Hoshina, Kou Ichihashi, Mariko Y Momoi
  Hirohiko Shiraishi, Mayu Iino, Masaru Hoshina, Kou Ichihashi, Mariko Y Momoi

Tochigi, Japan

Author Affiliations: Department of Pediatrics, Jichi Medical University, Tochigi, 329-0498, Japan (Shiraishi H, Iino M, Hoshina M, Ichihashi K, Momoi MY)

Corresponding Author: Hirohiko Shiraishi, MD, Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan (Tel: +81-285-58-7366; Fax: +81-285-44-6123; Email: shiraish@jichi.ac.jp)

Background: Coronary artery lesion (CAL) in Kawasaki disease (KD) is prevented by intravenous immunoglobulin (IVIG); however, the total amount of IVIG should be reduced if the outcome is the same. Our aim was to determine whether the treatment with IVIG at an initial dose of 1 g/kg on the 5th  to 7th day of illness with additional IVIG for refractory patients is effective for preventing CAL.

Methods: A total of 107 KD patients were treated according to the days of illness and the Harada score within 7 days of illness. All the patients with Harada score 4 or more were treated with IVIG at an initial dose of 1 g/kg, and the patients who were refractory to the initial dose, additional IVIG at a dose of 1 g/kg up to 3 g/kg was infused. Echocardiography was performed to detect the incidence of CAL.

Results: Seventy-eight patients (73%) were treated with IVIG at an initial dose of 1 g/kg according to the Harada score and the duration of illness; IVIG was started when their Harada score became 4 or more and basically on the 5th day or later. Six critically ill patients were treated with IVIG at a dose of 1 g/kg starting from the 2nd or 4th day, and all of them were refractory to the initial dose of 1 g/kg and further treated with additional doses of 1 to 3 g/kg (CAL was not observed); whereas the other 72 patients (of whom 42 were admitted by the 4th day and waited until the 5th day) were treated on the 5th to 7th day with IVIG at an initial dose of 1 g/kg. Of the 78 patients, 57 responded to the initial dose of 1 g/kg, but the remaining 21 refractory patients required additional IVIG (a total dose of IVIG up to 4 g/kg). Twenty-nine patients (27%) were treated without IVIG because their Harada score was less than 4, and CAL was not observed. In 4 (3.7%) of the 107 patients who had IVIG at 1 g/kg (n=1) or additional IVIG up to 3 g/kg (n=3), CAL appeared but regressed within 6 months after the onset.

Conclusion: Treatment of KD with IVIG at an initial dose of 1 g/kg on the 5th to 7th day with additional IVIG for refractory patients can have the same effect as the standard protocol (IVIG of 2 g/kg).

Key words: coronary artery; echocardiography; immunoglobulin; Kawasaki disease

World J Pediatr 2007;3(3):195-199

  [Abstract] [Full Text] [PDF]  
Pneumocystis jiroveci pneumonia in non-HIV immunocompromised Taiwanese children
  Kin-Sun Wong, Ngern sae-lom S, Iou-Jih Hung, Chao-Ping Yang
   

Kin-Sun Wong, Ngern sae-lom S, Iou-Jih Hung, Chao-Ping Yang

Taoyuan, Taiwan, China

Author Affiliations: Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan, China (Wong KS, Hung IJ, Yang CP); Department of Pediatrics, Provincial Hospital, Taoyuan, Taiwan, China (Ngern sae-lom S)

Corresponding Author: Kin-Sun Wong, MD, Department of Pediatrics, Chang Gung Children's Hospital, 5 Fu Hsin Street, Taoyuan, Taiwan, China (Tel: 886-3-3281200 ext 8202; Fax: 886-3-3288957; Email: pchest@adm.cgmh.org.tw)

Background: Pneumocystis pneumonia (PCP) has been a common opportunistic infection in patients infected with human immunodeficiency virus (HIV). Up to the present, the burden of HIV infections predisposing to PCP is not a major concern in Taiwanese children. This paper describes our experience in dealing with 5 children with PCP in a tertiary children's center in northern Taiwan.

Methods: We retrospectively reviewed cases by computer search of our hospital records with a diagnosis of PCP by microbiological or histological evidence of Pneumocystis jiroveci infection in patients younger than 18 years of age between January 1996 and December 2005 in the Chang Gung Children's Hospital.

Results: A total of 5 patients with PCP were identified. Their ages ranged from 2 months to 14 years. The major underlying diseases were acute lymphoblastic leukemia (1 patient), severe combined immunodeficiency (SCID) (2), Langerhans cell histiocytosis (1), and systemic lupus erythematosis (1). None of the patients received regular chemoprophylaxis, 4 patients survived but 1 died from respiratory failure.

Conclusions: From 1996 to 2005, PCP infections in Taiwanese children were commonly seen in primary immunodeficiency diseases, leukemia, or malignancies receiving cytotoxic and corticosteroid therapy. PCP in susceptible patients suggests non-compliance or under-prescription of PCP chemoprophylaxis by the patients or in-charge physicians respectively.

Key words: Pneumocystis jiroveci pneumonia; non-HIV immunocompromised; immunodeficiency                 

                                                                                                                    World J Pediatr 2007;3(3):200-202
  [Abstract] [Full Text] [PDF]  
Taste development in Chinese newborns
  Lan Zhang, Hai-Qi Li
  Lan Zhang, Hai-Qi Li

Chongqing, China

Author Affiliations: Department of Primary Child Care, Children's Hospital of Chongqing University of Medical Sciences, Chongqing 400014, China (Zhang L, Li HQ)

Corresponding Author: Lan Zhang, MD, Department of Primary Child Care, Children's Hospital of Chongqing University of Medical Sciences, Chongqing 400014, China (Tel: 86-13982156971; Email: zlan7487@126.com)

Background: Baby facial action coding system (FACS) is a standard instrument created by Oster and Rosenstein. Many researchers used it to study the taste development in infants of different countries. This study was undertaken to investigate the facial responses of newborns to four basic tastes as well as the gender-related taste sensitivity.

Methods: Sixty-two newborns (31 females and 31 males) were tested at 90 minutes after birth in response to four tastes including 25% sucrose (sweet), 5% sodium chloride (salt), 1.43% citric acid (sour), and 0.025% berberine (bitter). The mothers of the newborns had normal pregnancy and spontaneous delivery. The newborns were full-term with Apgar scores ≥8 at 1 and 5 minutes. The facial responses to the four tastes were classified into nine facial action units and expressions from A1 to C3, which also represented as the 1-9 grades of intensity. Cry was defined as intensity of grade 9 and nausea as grade 10. The expressions of the newborns were recorded by video. The chi-square test and the Wilcoxon's rank-sum test were used for statistical analyses.

Results: Most of the newborns showed absence of mouth action or sucking while the sucrose solution was given (P<0.01). No special expressions were seen when the salt solution was fed (P>0.01). The lip pursing with brow and middle face actions was a major response to the sour solution (citric acid) (P<0.01). The expressions responding to the bitter solution were mouth gaping with brow and middle face actions (P<0.01). Male newborns were more sensitive to the sweet and bitter solutions than female ones (P<0.01). There were no sex differences in the intensities of facial responses to the salt and sour solutions (P>0.05).

Conclusions: Newborns can present distinct responses to the four basic tastes (sweet, salt, sour, and bitter). Male newborns are more sensitive to sweet and bitter solutions than female newborns.

Key words: neonates; taste; development

                World J Pediatr 2007;3(3):203-208

  [Abstract] [Full Text] [PDF]  
Expression of Fas and FasL in human neuroblastoma and its clinical significance
  Qiang-Song Tong, Li-Duan Zheng, Shao-Tao Tang, Shi-Wang Li, Guo-Song Jiang, Jia-Bin Cai, Yuan Liu, Qing-Lan Ruan
  Qiang-Song Tong, Li-Duan Zheng, Shao-Tao Tang, Shi-Wang Li, Guo-Song Jiang, Jia-Bin Cai, Yuan Liu, Qing-Lan Ruan

Wuhan, China

Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China (Tong QS, Tang ST, Li SW, Jiang GS, Cai JB, Liu Y, Ruan QL); Department of Pathology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China (Zheng LD)

Corresponding Author: Qiang-Song Tong, PhD, MD, Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China (Tel: 86-27-85991567; Email: qstong@mails.tjmu.edu.cn)

Background: Recent evidences indicated that tumor cells could induce apoptosis of T cells by combining Fas on active T cells' surface with self-expressed FasL to escape immune surveillance. This study was undertaken to detect the expression of the Fas/FasL system in neuroblastoma (NB) tissues and its clinical significance in clinical practice.

Methods: Immunohistochemical staining was performed to detect the expression of Fas and FasL in 40 cases of NB. The relations among Fas and FasL expression, clinical stages, pathological types, and postoperative survival time of patients were analyzed.

Results: The positive expression rates of Fas in I-II, III-IV and IV-S stages were 64.3%, 22.2% and 50.0% respectively (P<0.05). The positive expression rate of FasL in III-IV stage was 33.3%, which was significantly higher than that in I-II (21.4%) and IV-S stages (12.5%). FasL expression rates in patients with NB (28.1%) and unfavorable histology (UFH) (33.3%) were higher than those of patients with ganglioneuroblastoma (GNB) (12.5%) and favorable histology (FH) (15.8%). However, Fas expression rates in patients with GNB (50%) and FH (63.2%) were higher than those of patients with NB (40.6%) and UFH (23.8%). A positive correlation was observed between Fas expression and postoperative survival time (n=25, r=0.354), but no obvious correlation between FasL expression and postoperative survival time.

Conclusions: Abnormalities of the Fas/FasL system are related to the development of NB. Detection of the expression of Fas/FasL system may be useful to evaluate the clinical prognosis of NB.

Key words: neuroblastoma; Fas; FasL; gene expression; immune escape

World J Pediatr 2007;3(3):209-213

  [Abstract] [Full Text] [PDF]  
Asymptomatic urinary abnormalities among primary school children in Egypt
  Ashraf Bakr, Amr Sarhan, Ayman Hammad, Mohamed Ragab, Osama S Salama, Fatma Al-Husseni, Mohamed Azmy
   

Ashraf Bakr, Amr Sarhan, Ayman Hammad, Mohamed Ragab, Osama S Salama, Fatma Al-Husseni, Mohamed Azmy

Mansoura, Egypt

Author Affiliations: Department of Pediatric Nephrology (Bakr A, Sarhan A, Hammad A, Ragab M); Department of Clinical Pathology (Salama OS); Department of Pathology (Al-Husseni F); Department of Community Medicine (Azmy M), Mansoura University Children's Hospital, Mansoura University, Mansoura, Egypt

Corresponding Author: Ashraf Bakr, MD, PhD, Mansoura Faculty of Medicine, Mansoura, Egypt; Mansoura University Children's Hospital, Mansoura, Egypt (Tel: 00 2050 2230376; Fax: 00 2050 2234092; Email: ashbakr@mans.edu.eg)

Background: Mass urinary screening is a useful way to detect the prevalence of renal diseases and to improve its outcome. This study was undertaken to detect the prevalence of asymptomatic urinary abnormalities among primary school children  in Egypt.

Methods: A total of 1670 healthy children were included in this study. Urinary screening was performed with the dipstick method.

Results: Twenty-two children (1.3%) had urinary abnormalities at the first screening and only 12 (0.72%) had urinary abnormalities at the second screening. Of the children who had urinary abnormalities, 6 (0.36%) had isolated hematuria (IH), 2 (0.12%) had isolated proteinuria (IP) and 4 (0.24%) had combined hematuria and proteinuria (CHP). Renal biopsy was performed on 4 children (2 with CHP, 1 with IH and 1 with IP). Post streptococcal acute glomerulonephritis (PSAGN) was identified in 3 of the 6 IH children, hypercalciuria and renal stone in 2, and no abnormality in 1. One of the IP children had orthostatic proteinuria and the other had focal segmental glomerulosclerosis. The pattern of renal diseases in CHP children was PSAGN in 2, diffuse mesangial proliferation in 1 and IgA nephropathy in 1.

Conclusions: Asymptomatic urinary abnormalities were detected in a small number of primary school children in Egypt and PSAGN was the leading cause for these abnormalities. Only 3 children had evidence of chronic kidney disease. The study raises question about the cost-benefit ratio for the national implementation of the urine screening program.

Key words: urine screening; hematuria; proteinuria; primary school children 

                                                                                                                     World J Pediatr 2007;3(3):214-217
  [Abstract] [Full Text] [PDF]  
Effect of S-adenosylmethionine on total parenteral nutrition-associated cholestasis
  Yi-Sheng Liu, Wei Cai, Sheng-Mei Wu, Long-Hua Qian
  Yi-Sheng Liu, Wei Cai, Sheng-Mei Wu, Long-Hua Qian

Shanghai, China

Author Affiliations: Xinhua Hospital Affiliated to Medical School, Shanghai Jiaotong University, Shanghai Institute for Pediatric Research, Shanghai 200092, China (Liu YS, Cai W, Wu SM, Qian LH)

Corresponding Author: Yi-Sheng Liu, MD, PhD, Xinhua Hospital Affiliated to Medical School, Shanghai Jiaotong University, Shanghai Institute for Pediatric Research, Shanghai 200092, China (Tel: 86-21-65790000 ext 3426; Fax: 86-21-65791316; Email: liuyisheng2002@yahoo.com.cn)

Background: Total parenteral nutrition (TPN) has been used clinically for more than 30 years, but hepatobiliary complications associated with TPN remain to be solved. The aim of this study was to investigate the effect of S-adenosylmethionine (SAMe) on TPN-induced cholestasis and hepatocytic apoptosis.

Methods: Twenty-four newborn rabbits were randomly divided into 3 groups: normal control group receiving breast milk, TPN group receiving TPN at a dose of 200 kcal/kg per day, and SAMe group receiving TPN plus SAMe at an intravenous dose of 100 mg/kg per day. Blood and liver samples were collected one week later. The levels of serum bile acid, alanine aminotransferase (ALT), alkaline phosphatase (AKP), total bilirubin, direct reaction bilirubin, albumin and globulin levels were detected by an automatic biochemical analyzer. Hepatic pathological changes were observed under the light microscope, and apoptosis of hepatocytes was determined with the TUNEL method.

Results: There were no significant differences in the levels of serum bile acid, ALT, AKP, total bilirubin, albumin and globulin between the SAMe group and control group (P>0.05). The level of direct reaction bilirubin in the SAMe group was obviously higher than that in the control group (P<0.01), but significantly lower than that in the TPN group (P<0.01). Cholestatic changes and mild hepatic steatosis were observed in the TPN group, while no such changes were found in the SAMe and control groups. The apoptotic cell counts were 0.263%±0.041% in the control group, 1.060%±0.217% in the TPN group, and 0.467%±0.182% in the SAMe group. The apoptotic cells were much more in the TPN group than in the control (P<0.01) and SAMe groups (P<0.05).

Conclusions: TPN can cause cholestasis and increase apoptosis of hepatocytes in newborn rabbits. SAMe can prevent TPN-induced cholestasis effectively, and the inhibition of hepatocytic apoptosis may be one of its mechanisms.

Key words: S-adenosylmethionine; total parenteral nutrition; apoptosis; cholestasis; steatosis; newborn

                                                                                                                World J Pediatr 2007;3(3):218-221
  [Abstract] [Full Text] [PDF]  
Clinical summary:
Eosinophilic cystitis in nine children
  Ming Liu, Yu-Zhen Zhang, Yu-Hua Li, Hua Xie
 

Ming Liu, Yu-Zhen Zhang, Yu-Hua Li, Hua Xie

Shanghai, China

Author Affiliations: Department of Radiology, Xin Hua Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200092, China (Liu M, Zhang YZ, Li YH); Department of Radiology, Xin Hua Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200092, China (Xie H)

Corresponding Author: Ming Liu, MD, Xin Hua Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200092, China (Tel: 86-21- 65790000 ext 5003; Email: lesserniuniu@126.com)

Background: We described the clinical and imaging manifestations of eosinophilic cystitis and eosinophilic granulomatous cystitis in children.

Methods: The clinical and imaging (mainly CT) manifestations of 7 patients with pathologically proved eosinophilic cystitis and 2 patients with eosinophilic granulomatous cystitis were analyzed retrospectively after cystoscopic tissue biopsy or surgery.

Results: Six boys and three girls, aged 3-13 years (mean 8.3 years), complained of hematuria, irritative voiding, dysuria and abdominal pain. CT scans showed localized or nodular lesions in 4 patients, 2 of them had proved eosinophilic granulomatous cystitis, and others had diffused lesions. All patients were subjected to  bladder autoaugmentation, mass resection or medication with corticosteroids and antibiotics.

Conclusions: The clinical and imaging (mainly CT) manifestations of eosinophilic cystitis and eosinophilic granulomatous cystitis in children are apt to be confused with other bladder tumors. Biopsy is necessary for confirming the diagnosis of the lesion and to select the proper management.

Key words: bladder; tumor; cystitis; eosinophils; biopsy; computed tomography

                    World J Pediatr 2007;3(3):222-225

  [Abstract] [Full Text] [PDF]  
Case reports:
Unusual presentation of posterior urethral valve
  Vijay D Upadhyaya, Anand Pandey, AN Gangopadhyaya, DK Gupta
  Background: Posterior urethral valve (PUV) may present with different symptoms, starting from abdominal distension, respiratory distress, and severe septicemia to failure to thrive.

Methods: A 5-year-old child presented with acute abdominal pain and was suspected to have complete intestinal obstruction. Exploratory laparotomy revealed that the bowel was severely adhered to inflamed bladder but no other abnormalities. After laparotomy the patient responded well, but had difficulty in urination. The patient was then confirmed with PUV by voiding cystourethrography, and underwent hook fulguration.

Results: The catheter was removed on the 4th day after fulguration. The patient was discharged in satisfactory conditions.

Conclusion: PUV has a wide range of clinical presen-tations and a proper collection of case history is essential to reach a correct diagnosis.

Key words: posterior urethral valve; intestinal obstruction; clinical presentation

                    World J Pediatr 2007;3(3):226-227

  [Abstract] [Full Text] [PDF]  
Successful separation of ischiopagus tetrapus conjoined twins
  Xi-Sheng Zhang, Zhi-Gang Feng, Qi-Xin Xiong, Min-Ju Li, Da-Xing Tang
  Background: A pair of female ischiopagus tetrapus conjoined twins were transferred to our hospital when they were 3 days old and with a total weight of 3850 g. They were fused face to face from the umbilicus to the pelvis at an angle of 60 degrees. There was a single umbilicus ventrally. The twins shared an anus, and each infant exhibited a urethral and two vaginal orifices.

Methods: A series of radiological examinations showed two separate normal upper tracts, two small intestines joined at the common terminal ileum, a single cecum, and a common colon connected with an anus in twin A. They had two retropubic bladders close together as a large bladder with a very thin midst membrane, two sacrums faced each other and division of pubic symphysis. Separation surgery was performed on the twins at the age of 3 months.

Results: The surgery lasted for 4.5 hours. Both infants were transferred to the Neonatal Intensive Care Unit (NICU) after the operation. Twin A died 6 hours after the operation for unknown reasons. Twin B survived and the follow up showed that she became a normal and healthy girl.

Conclusions: Ischiopagus conjoined twins are rare and their separation is more difficult for the variable anatomy. Careful preoperative evaluation and planning are very important. The connecting bridge should be enlarged sufficiently before operation so as to repair the abdominal wall.

Key words: conjoined twins; ischiopagus; tetrapus; separation; surgery

World J Pediatr 2007;3(3):228-231

  [Abstract] [Full Text] [PDF]  
Neonatal severe anemia caused by parvovirus B19 infection
  Fu-Gen Wu, Yuan-Hai Zhang, Hong Chen, Feng Lin, Jian-Min Zhang
 

Background: Human parvovirus B19 may cross the placenta and result in fetal infection, morbidity and death. We present here a case of newborn infant with severe anemia who died from human parvovirus B19 infection.

Methods: Analysis was made based on the clinical presentations. According to the case history, physical and laboratory findings, neonatal severe anemia induced by parvovirus B19 infection was suggested; autopsy and pathological examination were performed on the infant subsequently.

Results: The hemoglobin level was significantly low at 19 g/L. The infant died after emergency treatment and was subjected to autopsy. The diagnostic nuclear inclusion for parvovirus B19 infection were observed in the marrow, liver, spleen, and placenta under the light microscope.

Conclusion: Clinical presentation and pathological studies all indicated that the infant was infected with parvovirus B19.

Key words: human parvovirus B19; neonate; infection; anemia

                 World J Pediatr 2007;3(3):232-235

  [Abstract] [Full Text] [PDF]  
   
 
 
 
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