The “E.M.G.” syndrome (exomphalos, macroglossia, gigantism)

182

ABSTRACTS

tion at the time of venipuncture, and occlusion of the needle hub with sterile gloved PROPHYLACTICAN~m~o-rrcs IN INTENSIVE finger while preparing to insert the catheter. THERAPY: EXPERIENCE IN A CARDIAC To prevent superior vena caval obstruction the authors stress the importance of radiolSURGICALUNIT. I. A. Sallam, W. A. ogical proof of the position of the catheter Mackey, and W. H. Bain. Brit. J, Surg. and to reposition or remove a coiled or 57:722-724 (October), 1970. kinked catheter.-M. GilberC. Postoperative wound or respiratory infecESTIMATIONOF ARTERIALpH AND pC0, tion in 469 patients undergoing cardiac FROM CENTRALVENOUSSAMPLES.A. T. surgery was studied. The patients were Marty, E. M. Barsamian, and B. Smith. divided into 3 groups: Ann. Thorac. Surg. 10:248-256 (SeptemGroup 1 (149 patients): No antibiotics ber ) , 1970. were given until an infection was clinically manifest. Group 2 (266 patients): prophyThe authors correlated pH, p0, and lactic penicillin, 1 MU 6 hourly, or ampicilpC0, obtained from the radial or femoral lin 0.5 g 6 hourly for one week. Group 3 artery in 36 consecutive patients after open (54 patients) : prophylactic ampicillin. 0.5 g heart surgery and in 5 mongrel dogs during 6 hourly, plus methicillin, 2.0 g 6 hourly, hemorrhagic shock with the same “blood given intravenously for 48 hr. gases” obtained from the superior vena cava. Incidence of infection in group one was 7; They found that good correlation existed in about two-thirds the infective organism between arterial and venous pH and pC0, was staphylococcus aureus and one-third of the organisms were resistant to ampicillin. when the central venous p0, was above 25 mm Hg. In the face of lower venous p0, In the groups who had prophylactic antithan 25 mm Hg (which usually was a reflecbiotic the rate of infection was doubled and tion of low cardiac output) the correlations there was a preponderance of gram-negative were not acceptable. The authors conclude organisms, almost two-thirds of which were that, in the face of adequate tissue perfusion resistant to ampicillin. and adequate venous PO,, changes in central In patients who had no antibiotics postvenous pH and pC0, reflect changes in the operative pyrexia lasted for about 3 days. In corresponding arterial gases quite well and the antibiotic group this period was promay be used to monitor a patient’s respiralonged to about 6 days. This response was tory and acid base status.-]. G. Rosenkrantz difficult to explain; it may reflect disturbance of the normal bacterial population in TECHNIQUE FORHUMANMARROW GRAFTING. the body or occult infection. As a general E. D. Thomas and R. Storb. Blood 36:507rule the use of prophylactic antibiotic is not 515 (October), 1970. recommended in patients undergoing cardiac The technique of obtaining from living surgery.-_]. Lari. human donors, preparing and administering SUBCLAVIANVENIPUNCTURE:PREVENTABLE marrow is described in detail.-M. Gilbert COMPLICATIONS. BEPORT OF Two CASES. THE “E.M.G.” SYNDROME( EXOMPHALOS, C. L. Johnson, J. Lazarchick, and H. B. MACROGLOSSIA, GIGANTISM).I. M. 1roing. Lynn. Mayo Clin. Proc. 45:712-719 (OcProg. Pediat. Surg. l:l-61, 1970. tober), 1970. GENERAL CONSIDERATIONS

The authors report on two major complications in 120 percutaneous subclavian catheterizations via the infraclavicular route. One 60-year-old patient recovered from air embolism, and a i7-year-old patient whose catheter was coiled in the superior cava vein developed a superior vena caval obstruction and thrombosis. To prevent air embolism the authors advise the Trendelenburg posi-

This syndrome, usually sporadic, but sometimes familial is described in detail in 12 cases who showed in addition to the three title features, marked nevus flammeus, ear lobe anomalies, other craniofacial dysplasias, visceromegaly of many organs, cytomegaly of the adrenal fetal cortex, renal medullary dysplasia, and polycythemia. One of the cases developed a hepatoblastoma. Hemi-

183

ABSTFtACl’S

hypertrophy, though not seen in these, is often a feature of the syndrome. The six survivors ( aged 6-10X yr ) were of normal intelligence but had advanced physical development. Their facial appearante is made characteristic by a relative underdevelopment of the maxilla. Infants with this syndrom require recognition and careful follow-up because of the frequency of neonatal hypoglycemia and the possibility of intra-abdominal neoplasia.R. C. M. Cook

THORAX A REVIEW OF 23 HUMAN LUNG TRANSPLANTATIONS BY 20 SURGEONS.C. R. H. Wildeuuur and 1. R. Benfeld. Ann. Thorac. Surg. 9:489-513 (June), 1970. An up-to-date review of the present perience.-_]. G. Rosenkrantz

ex-

PULMONARY VASCULAR RESISTANCEFOLLOWING LUNG REIMPLANTATION AND TRANSPLANTATION. G. R. Daicog, P. D. Allen, and C. J. Streck. Ann. Thorac. Surg. 9: 569-579 (June), 1970. This is a series of canine experiments and discussion of the development of acute pulmonary hypertension following pulmonary implantation. The authors show that it is the distensibility and size of the arterial anastomosis which is most important in the development of pulmonary hypertension in the immediate postoperative period. They clearly distinguish immediate postoperative pulmonary hypertension from late chronic pulmonary hypertension, and clearly state that their experiments were not designed to shed light on the latter.-J. G. Rosenkrantz TENSION PNEUMOPERITONEUMAND PNEUMOTHORAXIN THE NEWBORN. B. 3. Leininger, W. L. Barker, and H. T. Langston. Ann. Thorac, Surg: 9:359-363 (April), 1970. This is a report of a newborn who, immediately following birth, developed a right tension pneumothorax. Following drainage with an intercostal catheter, he improved, but was noted on X-ray to have air under the right hemidiaphragm. This air resolved spontaneously, the child was fed cautiously, and

he recovered. Cause for the pneumoperitoneum was not discovered, and it is assumed to be secondary to the tension pneumothorax. -.I. G. Rosenkrantz SPONTANEOUS HEMOTHORAX IN THE NEWBORN. B. L. Aaron and D. J. Doohen. Ann. Thorac. Surg. 9:258-262 (March), 1970. This is a report of a full-term infant with respiratory distress who developed a spontaneous left hemothorax with hypoprothrombinemia. He was explored with a presumptive diagnosis of left diaphragmatic hernia, the diaphragm found intact and the hemothorax drained with an intercostal catheter. He recovered with restoration of his prothrombin time. The presumption is that no specific vascular anomaly was present to account for the bleeding, but since the thorax was not explored, this presumption cannot be proved. -1. G. Rosenkrantz PLEURAL EMPYEMA IN CHILDREN. Q. R. Stiles, G. G. Lindesmith, B. L. Tucker, B. W. Meyer, and 1. C. Jones. Ann. Thorac. Surg 10:37-43 (July), 1970. The principles and results of management of empyema have undergone changes over the past 20 years, partly due to changes in the disease, the virulence of its causative organism and antibiotic therapy, and partly following realization that the child with empyema behaves differently than the adult and is frequently able to resolve chronic empyema without aggressive surgery. This is clearly shown in this review of 152 patients with pneumonia and empyema. In the years 19551961, 88 patients (of whom 46 were in the first year of life) were managed by tube drainage (41 patients), and subsequent open drainage ( 23 ) or pulmonary decortication (12 of the 23); from 19621969, 64 patients (of whom only 7 were in the first year of life) were different& managed: tube drainage in 9 with subsequent open drainage in 4 and decortication in 2 of these 4. The predominant organisms were staphylococcus (78 cases) and diplococcus pneumoniae ( 6 cases). Eight patients died during the years 19551961; only one since. Pneumatoceles were frequently present, but the incidence of pneumothorax has dropped markedly (24 cases in 1955-1961; 1 since 1961). At the moment, with better antibiotic con-