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Abstract
We report a patient with pleuropulmonary blastoma who had a benign teratoma as a second primary tumor. The radiology, clinical course, and the biological importance of this rare neoplasm are discussed.
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Affiliation(s)
- T T Kiziltepe
- Egleston Children's Hospital, Emory University, Atlanta, GA 30322, USA
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2
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Reich JD, Sutherland J, Winn K, Pettignano R. Intramural anomalous left coronary artery from the right sinus of Valsalva supported with venoarterial extracorporeal membrane oxygenation. South Med J 1999; 92:714-6. [PMID: 10414482 DOI: 10.1097/00007611-199907000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the case of a 14-month-old girl with a wide complex dysrhythmia and cardiogenic shock due to abnormal coronary anatomy. She was kept alive for 20 days by full cardiocirculatory support, using venoarterial extracorporeal membrane oxygenation (VA ECMO). While she was on VA ECMO, a diagnosis was made of extensive myocardial infarction and an anomalous left main coronary artery. The patient was listed for heart transplantation and received a donor heart 20 days after beginning VA ECMO. We discuss the unusual presentation and course of the coronary arteries and the use of VA ECMO to support this patient before heart transplantation.
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Affiliation(s)
- J D Reich
- Egleston Children's Hospital, Atlanta, Ga, USA
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3
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Abstract
The etiology and prevention of sudden infant death syndrome (SIDS) are among the more frustrating topics in pediatrics. This article addresses several clinically relevant issues, including the relationships between apnea and SIDS, the nature of the "terminal event," effectiveness of home monitoring, the role of gastroesophageal reflux in apparent life-threatening events, and the association between the prone sleeping position and SIDS. This article is intended to provide the clinician with an awareness of the issues and the scientific basis needed to understand their contribution to SIDS.
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Affiliation(s)
- G E Freed
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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4
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Abstract
Solid ovarian masses in children are considered malignant unit proven otherwise. The authors report two cases of an unusual, benign, solid ovarian tumor found during ultrasound examination for evaluation of acute abdominal pain. Both patients were found to have a torsed nonviable ovary at the time of laparotomy. Patient 1 was a premenarcheal 10 year old who had undergone a lengthy evaluation for intermittent chronic abdominal pain. The ultrasound examination showed a 9- x 5-cm ovarian mass. Patient 2 was a virilized menarcheal 11 year old with a very large tumor (10 x 7 x 16 cm). The final pathology for both tumors was massive ovarian edema--a rare, stromal, virilizing tumor caused by chronic venous and lymphatic obstruction. Contralateral oophoropexy is a controversial treatment for the remaining ovary. A review of the literature regarding this uncommon tumor is provided.
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Affiliation(s)
- K F Heiss
- Department of General Surgery, Egleston Children's Hospital, Emory Univeristy, Atlanta, GA 30322
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5
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Abstract
The presence of juvenile polyps with resulting bleeding and abdominal pain has traditionally been considered a benign, self-limiting process which would resolve with age. The dictum that these polyps were usually solitary, were found predominantly in the rectosigmoid area, and were without malignant potential has been reconsidered in recent years with the increased use of colonoscopy. Several case reports in both adults and children have documented the presence of adenomatous changes in this syndrome. We report 3 cases of children, ages 3, 11, and 11 who were found to have adenomatous polyps in the midst of fields of juvenile polyps on evaluation for rectal bleeding. All three were treated definitively with endorectal pull-through. Two of these patients had atypia on histological evaluation, one of which was severe. We recommend a more aggressive approach to patients found to have multiple juvenile polyps on barium enema, including colonoscopic biopsies at several sites to determine the presence of adenomatous changes, with colectomy and endorectal pull-through should these be found.
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Affiliation(s)
- K F Heiss
- Department of General Surgery and Pathology, Egleston Children's Hospital, Atlanta, GA
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6
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McNeill MM, Gerber AR, McLaughlin DW, Vega RA, Winn K, Kaufmann L, Keyserling HL, Jarvis WR. Mannan antigenemia during invasive candidiasis caused by Candida tropicalis. Pediatr Infect Dis J 1992; 11:493-6. [PMID: 1608689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- M M McNeill
- Mycotic Diseases Branch, Centers for Disease Control, Atlanta, GA
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7
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Sarnthein M, Pflaumann U, Ross R, Tiedemann R, Winn K. Transfer functions to reconstruct ocean palaeoproductivity: a comparison. ACTA ACUST UNITED AC 1992. [DOI: 10.1144/gsl.sp.1992.064.01.27] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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8
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Abstract
In June, 1989, an outbreak of nosocomial listeriosis occurred in Costa Rica. Listeria monocytogenes was isolated from 9 ill infants 4 to 8 days old who were born after the delivery of an infant with early onset listeriosis. One nosocomial infection was fatal, 2 required mechanical ventilation and 1 resulted in hemiparesis. A higher proportion of cases than other infants born during the outbreak were delivered by cesarean section (55% vs. 24%, P = 0.04). Compared with the mothers of 36 random controls, case mothers were more often primiparous (odds ratio, 6.2, P = 0.03) or received general anesthesia before delivery (odds ratio, 4.4, P = 0.09). All infants were bathed with mineral oil from a multidose container. Culture of the oil by cold enrichment grew L. monocytogenes 4b with the same electrophoretic enzyme type as the outbreak strain. We hypothesize that aspiration of contaminated oil may have resulted in systemic listeriosis. General anesthesia may have increased the risk of aspiration. Lung tissue from the infant who died showed lipid-laden macrophages consistent with oil aspiration and had evidence of L. monocytogenes DNA detected by polymerase chain reaction. This is the first nosocomial outbreak of listeriosis in which a common source suggested epidemiologically was microbiologically confirmed. The high attack rate (greater than 200 times the United States rate of perinatal listeriosis) emphasizes the susceptibility of healthy neonates to L. monocytogenes. The results of our study led to the discontinuation of the use of mineral oil for bathing neonates in Costa Rica.
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Affiliation(s)
- A Schuchat
- Meningitis and Special Pathogens Branch, Centers for Disease Control, Atlanta, GA 30333
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9
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Zheng X, Shoffner JM, Lott MT, Voljavec AS, Krawiecki NS, Winn K, Wallace DC. Evidence in a lethal infantile mitochondrial disease for a nuclear mutation affecting respiratory complexes I and IV. Neurology 1989; 39:1203-9. [PMID: 2549452 DOI: 10.1212/wnl.39.9.1203] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A child died at 4 months of age of a lethal infantile mitochondrial disease associated with cardiomyopathy. Detailed pathologic evaluation of this patient revealed abnormalities in the striated muscle, smooth muscle, heart, and liver, but not the central nervous system. Biochemical analysis revealed a combined complex I and IV deficiency in skeletal muscle, heart, and liver, but not in kidney and brain. Analysis of mitochondrial translation products and mitochondrial DNA failed to detect any abnormality. Parallel studies on both parents were uniformly normal. These data support the hypothesis that this disease was the result of a nuclear DNA mutation in a developmental stage-specific and tissue-specific oxidative phosphorylation-gene.
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Affiliation(s)
- X Zheng
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA 30322
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10
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Abstract
Seven children with advanced nasopharyngeal carcinoma younger than 20 years of age diagnosed between 1975 and 1986 (inclusive) were treated with a uniform adjuvant chemotherapy regimen, which consisted of vincristine (1.5 mg/m2; day 1), doxorubicin (45 mg/m2; day 1), 5-fluorouracil (8 mg/kg; days 1 through 5), and cyclophosphamide (7 mg/kg; days 1 through 5). This combination chemotherapy was given for 12 to 24 months after completion of radiation therapy. The radiation doses to the primary sites ranged from 6000 cGy to a maximum of 6800 cGy. The radiation doses for neck prophylaxis ranged from 4500 cGy to a total of 5000 cGy. Involved sites were irradiated to at least an additional boost of 1000 cGy. One patient had an external dose 6000 cGy to the primary site boosted with brachytherapy of 3000 cGy at the surface of an ovoid. After chemotherapy myelosuppression occurred in all patients and was tolerable. All seven patients are surviving, six disease-free, for 22 months to 12 years (median, 4 years). This study suggests that the combination of radiation therapy and chemotherapy as used here has acceptable toxicity and is effective and further suggests that children with nasopharyngeal carcinoma, even in its advanced stage at diagnosis, may be curable.
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Affiliation(s)
- T H Kim
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322
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11
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Repke JT, Kuhajda F, Hochberg MC, Johnson TR, Winn K, Provost T. Fetal viral myocarditis and congenital complete heart block in a pregnancy complicated by systemic lupus erythematosus. A case report. J Reprod Med 1987; 32:217-20. [PMID: 3033234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Congenital complete heart block has been associated with collagen vascular disorders. Many etiologies have been proposed for the myocarditis that develops and results in the complete heart block. Transplacental antibody transfer--specifically, antibodies to tissue-soluble ribonuclear protein antigen-A--has been implicated as the etiology of the myocarditis. This case supports the association of this antibody while suggesting that viral infection may serve as an initiator of the autoimmune destruction. Also, fetal viral infection alone must be considered a possible cause of congenital complete heart block.
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12
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Abstract
The age-related decrease in asphyxia tolerance was examined in young rats under conditions that mimic prolonged apnea. A precise end point of asphyxia tolerance was determined by calculation of LD50 values for exposed groups. Daily exposure to episodes of sublethal asphyxia did not alter the age-related decrease in asphyxia tolerance. These results permitted further studies in which groups of 10-day-old rats were exposed to 10 min of asphyxia resulting in partial mortality of the group. The postmortem findings in these animals were compared to figures for unexposed littermates. The age-related changes in response to asphyxia and the postmortem findings in asphyxiated animals were compared to the age distribution of sudden infant death syndrome (SIDS) and the postmortem findings in these infants. The comparison showed that the terminal event in SIDS shares many features with lethal asphyxia.
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13
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Batson JL, Winn K, Dubin NH, Parmley TH. Placental immaturity associated with anencephaly. Obstet Gynecol 1985; 65:846-7. [PMID: 4000573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The placenta associated with anencephalic infants demonstrates striking histologic immaturity near term. This consists of large numbers of prominent cytotrophoblastic cells with frequent mitoses.
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14
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Lejeune P, Gunselmann W, Hennies L, Hess K, Rittgerodt K, Winn K, Gfrerer G, Schreiber U. Effects of BAY l 5240, a fixed combination of low dose nifedipine and acebutolol on hypertension: comparison with standard dose nifedipine. Eur J Clin Pharmacol 1985; 28:17-21. [PMID: 3886399 DOI: 10.1007/bf00635702] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
116 patients from 4 clinics participated in a double blind study to assess the efficacy of (BAY l 5240), a nifedipine-acebutolol fixed combination (10 mg + 100 mg), as compared to nifedipine 20 mg in essential hypertension. During the 10 week study, the mean recumbent blood pressure decreased 1 to 3 h after treatment from 175.5/105.2 to 148.3/88.0 mmHg in the BAY l 5240 group and from 174.3/102.9 to 150.3/86.5 mmHg in the nifedipine group. The results also showed a comparable decrease in the mean systolic (SBP) and diastolic (DBP) blood pressures before treatment (24 h after last tablet) and after physical exertion before and after either drug given for 4 weeks. Doubling of the dose for 4 additional weeks produced a moderate and similar additional decrease in blood pressure. The results show the possibility of treating essential hypertension with a low dose of a beta-adrenergic blocking agent in combination with 10 mg nifedipine. Both regimens were well tolerated. One patient in the BAY l 5240 group and 2 in the nifedipine group, all treated by the same investigator, were withdrawn from the study because of headache during the nifedipine pre-period.
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15
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Guzick DS, Winn K. The association of chorioamnionitis with preterm delivery. Obstet Gynecol 1985; 65:11-6. [PMID: 3966012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To ascertain what proportion of preterm deliveries are attributable to the association with chorioamnionitis, the authors examined prospectively the placentas from all 2774 women who delivered at the Johns Hopkins Hospital during 1980. The incidence of preterm delivery was 5.4% (110 of 2027) when neither chorioamnionitis nor premature rupture of membranes (PROM) was present, 11.9% (29 of 243) when chorioamnionitis was present without PROM, and 56.7% (51 of 90) when both chorioamnionitis and PROM were present (P less than .05). Only 27 of 333 cases of histopathologic chorioamnionitis or 8.1% had maternal antepartum fever, and only 11 of 333 or 3.3% had neonatal sepsis. Using logistic regression analysis to control for confounding variables, approximately 25% of the preterm deliveries were statistically attributable to histopathologic chorioamnionitis, occurring either alone or in association with PROM. In light of the infrequency with which histopathologic chorioamnionitis is clinically evident, the strong relationship between histopathologic chorioamnionitis and preterm delivery suggests that occult antepartum infection of the genital tract is an important cause of preterm delivery.
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16
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Abstract
Over an 11-year period, we encountered four cases in which an unexpected diagnosis of cystic fibrosis (CF) was first established on the basis of typical autopsy findings. Our experience suggests that the occurrence of such cases is more common than generally appreciated and emphasizes the often crucial role of the autopsy in medical practice.
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Graham D, Tracey J, Winn K, Corson V, Sanders RC. Early second trimester sonographic diagnosis of achondrogenesis. J Clin Ultrasound 1983; 11:336-338. [PMID: 6413546 DOI: 10.1002/jcu.1870110613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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18
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Abstract
Sonography has proved of great benefit in the diagnosis and management of certain fetal structural anomalies, including encephalocele. Active intervention may be guided by real-time sonography. It is considered that prenatal management will become increasingly common for a number of such anomalies.
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Affiliation(s)
- D Graham
- Department of Gynecology/Obstetrics, Johns Hopkins Medical Institutes, Baltimore, MD
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Johnson TR, Graham D, Sanders RC, Smith N, Simmons MA, Winn K. Ultrasound-directed paracentesis of massive fetal ascites. J Clin Ultrasound 1982; 10:140-142. [PMID: 6804518 DOI: 10.1002/jcu.1870100312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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20
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Abstract
We report the prenatal diagnosis of the Apert syndrome by fetoscopy. The patient was a 22-year-old college student with this autosomal dominant form of acrocephalosyndactyly whose first pregnancy had resulted in a stillborn, affected infant. Fetoscopy at 17 weeks showed that she was carrying another affected fetus, and the pregnancy was terminated.
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21
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Abstract
Cystic adenomatoid malformation of the lung (CAM) is an uncommon malformation in which normal tissue is replaced by cysts of various sizes. This malformation may be diagnosed prenatally with ultrasound by visualization of cystic masses in the fetal chest, which may occur in association with fetal hydrops. Three cases of fetal hydrops secondary to cystic adenomatoid malformation of the lung are described; in one case cystic lesions in the chest were clearly demonstrated.
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Affiliation(s)
- D Graham
- Department of Obstetrics and Gynecology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205
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22
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Shelby D, Winn K. Bug flash: a tool for expanding in-service education. Am J Infect Control 1980; 8:69A. [PMID: 10283772 DOI: 10.1016/s0196-6553(80)80067-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Thurman RG, Harden TK, Winn K. Cyclic AMP and beta-adrenergic receptors during the development of physical dependence on ethanol in the rat. Adv Exp Med Biol 1980; 126:145-55. [PMID: 6250327 DOI: 10.1007/978-1-4684-3632-7_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
1. The half-time for maximal withdrawal scores in the rat is 30 to 36 hours following around the clock intubation with ethanol. 2. Cyclic AMP levels in all brain areas decline with ethanol treatment and rise again to control levels during withdrawal. 3. Norepinephrine-stimulated adenylate cyclase activity is increased by chronic treatment with ethanol. However, it is unlikely that this change is related to physical dependence, as it occurs 50 to 60 hours following the development of half-maximal withdrawal scores. 4. Ethanol had no effect on the concentration of beta-receptors in the cerebral cortex.
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Thurman RG, Winn K, Urquhart B. Rat brain cyclic AMP levels and withdrawal behavior following treatment with t-butanol. Adv Exp Med Biol 1980; 126:271-81. [PMID: 6250328 DOI: 10.1007/978-1-4684-3632-7_22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
1. The time course development of physical dependence as assessed by the withdrawal reaction was identical for ethanol and t-butanol. 2. t-Butanol is most likely not metabolized by the liver and is eliminated from the rat 6 to 7% as rapidly as ethanol. 3. Blood and brain acetaldehyde could not be detected following treatment with t-butanol. 4. At the peak of withdrawal, cyclic AMP levels were indistinguishable from control values following treatment with either ethanol or t-butanol.
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27
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Parmley TH, Woodruff JD, Winn K, Johnson JW, Douglas PH. Histogenesis of leiomyomatosis peritonealis disseminata (disseminated fibrosing deciduosis). Obstet Gynecol 1975; 46:511-6. [PMID: 1207981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Leiomyomatosis peritonealis disseminata (LPD) is a rare clinical entity. Widespread subperitoneal nodules of apparent smooth muscle are found in patients who are pregnant or have recently been so. This clinical appearance together with mitotic figures found in frozen sections suggests malignancy. We believe, in contrast, that LPD is a benign reparative process in which fibroblasts replace subperitoneal decidua.
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Winn K, Becker LE, Herndon RM. Comparative studies of viral infections of the developing forebrain. II. Electron microscopic studies of rat virus and bluetongue vaccine virus infections. J Neuropathol Exp Neurol 1974; 33:530-40. [PMID: 4370666 DOI: 10.1097/00005072-197408000-00004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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