Perinatally lethal short rib-polydactyly syndromes. 1. Variability in known syndromes

Thirteen newborns with lethal short rib-polydactyly (SRP) have been reviewed, 11 with SRP type III (Verma-Naumoff) and 2 with SRP type II (Majewski). In the former group there were three sets of siblings. The excess of males with SRP type III (Verma-Naumoff) is confirmed in this present study. A high frequency of phenotypic females including sex-reversed constitutional males with SRP type I (Saldino-Noonan) is in marked contrast to these findings in SRP type III. Possible hypotheses include variable expressivity in non-Majewski short rib-polydactyly syndromes with sex-reversed and constitutional female cases tending to show more severe phenotypic expression both in terms of major anomalies and skeletal dysplastic effects.

[Diagnosis and therapy of candidiasis in the premature infant]

Extension of intensive care seems to have increased the risk of systemic candida infection. We report the incidence of systemic candida infection in 8 low-birth-weight infants (gestational age 27-32 weeks, birth weight 710-1,550 g). All infants required respiratory treatment. Various silastic catheters were inserted. Antibiotic therapy was started on the first day of life, usually a combination of ampicillin and gentamycin. Candida septicaemia was diagnosed at the age of 8-69 days of life based on blood and urine cultures, in two children at autopsy. There were no specific clinical symptoms in regard to candida infection. Sonographic technique revealed hydronephrosis in 3 infants due to candida mycelium. Antimycotic therapy included amphotericin B (dosage 0.44-1.0 mg/kg X day) and 5-fluorocytosine (80-100 mg/kg X day) as well as a monotherapy of 5-fluorocytosine (100-200 mg/kg X day). Four children were treated successfully. We like to advice a regular search for candida in urine, blood, tracheal secretion, stool and skin in low-birth-weight infants under intensive care conditions. If antimycotic therapy is started in time, therapy can be successful.

Effect of nutrition on tissue carnitine concentrations in infants of different gestational ages

To investigate the effect of nutrition on tissue carnitine concentrations in infants of different gestational ages, specimens of muscle, heart, liver and kidney obtained at autopsy from 62 infants were analyzed for total acid-soluble carnitine content. Immature infants had smaller carnitine tissue reserves than term infants. Parenterally alimented premature infants (greater than 10 days old) had lower carnitine levels in heart, liver and kidney than those dying within 24 h after birth. Infants who received oral or intravenous carnitine had larger carnitine tissue reserves than those who did not. These data suggest that both gestational age and exogenous carnitine supply affect tissue carnitine reserves.

[Kimura' disease with localization at the neck (author's transl)]

This disease is discussed in the past mostly in the dermatological literature, the ENT specialist is little aware of its existence. The condition is characterized by subcutaneous, painless nodules occurring most frequently in the region of the ear, parotid gland, cheek and lateral neck. The lesion must be differentiated from disease of the lymph nodes, especially malignant tumours. The pathologic diagnosis is based upon a hyperplasia of angiolymphatic tissue and marked blood eosinophilia. The prognosis appears to be favourable. A case is presented together with the clinical picture and histopathological findings. The differential diagnosis and treatment are discussed.

[A case of olfactory neuroblastoma and Marcumar therapy (author's transl)]

Although nasal polypectomy is a frequently performed procedure in ENT Clinics, tissues taken may only seldom be histologically examined. We have recently uncovered an esthesioneuroblastoma during a routine polypectomy, and believe that even slightly changed "polyps" or fleshy or pinkish-gray appearing "polyps" seen with dicumarol therapy may mask tissue malignancy.

[Dissecting aneurysm of the splenic artery (author's transl)]

A case of a dissecting aneurysm of the splenic artery is presented. Although aneurysms of the splenic artery are common, a dissecting aneurysm has been mentioned infrequently in the available literature. Clinical aspects, confirmation of the diagnosis by celiac arteriography and surgical therapy are described. The pathogenesis is discussed briefly. The necessity of clinical awareness in cases of obscure abdominal pain is emphasized.

[Early diagnosis of carcinoma of the Fallopian tube by cervical smear (author's transl)]

A case of primary carcinoma of the Fallopian tube was discovered on routine mass screening of cervical smears. There were no symptoms and gynaecological findings were unremarkable. Atypical glandular epithelia in the smear may not, therefore, be adenocarcinoma of the cervix or body of the uterus, but could also be from an extrauterine carcinoma, especially if cervical scrapings are negative.

The Dandy-Walker syndrome associated with syringomyelia in a newborn infant

1. The association between a typical syringomyelia and the Dandy-Walker syndrome is reported in a newborn infant. 2. Morphologic studies of the pathologic lesions demonstrated that the development of the syringomyelic cavities depends directly upon hypertension of the CSF produced by obstruction of Magendie''s and Luschka''s foramina. Passage of the CSF from the 4th ventricle into the spinal medullary canal produced hydromyelia with a resultant syringomyelia. 3. The demonstration of this relationship between the cervicodorsal malformation and syringomyelia must be considered in diagnosis and treatment of syringomyelia particularly in the adult with a cervical malformation which may be asymptomatic.