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Pancreatitis, cholecystitis, and choledocholithiasis associated with infectious mononucleosis
ABSTRACTS
95
Pancreatitis, Cholecystitis, and Choledocholithiasis Associated W i t h Infectious Mononucleosis. C. Lifschitz and
Serial Liver Biopsies in Parenteral Nutrition-Associated Cholestasis of Early Infancy. Beverly Barrett Dahms and
S. LaSala. Clin Pediatr 20:131, (February), 1981.
Thomas C. Halpin, Jr. Gastroenterology 81:136 144, (July), 1981.
A 10-yr-old female presented with clinical and laboratory evidence of infectious mononucleosis. Resolution of liver function abuormalities occurred within 4 wk but 6 wk later she returned with abdominal pain and abnormal liver function tests with an elevated amylase. Work-up revealed cholelithiasis and choledocholithiasis. She underwent cholecystectomy and common duct exploration. In one series of 54 patients with pancreatitis only 5 (9%) had associated cholelithiasis and the incidence of choledocholithiasis in children with cholelithiasis is reported as 6 % . ~ a n d a l l IV. Powell
A Method of Assuring Stabilization of the Central Venous Line in Newborn Infants. L. F. Martin, C. R. Voyles, and
D. B. Groff. Surg Gynecol Obstet 153:93-94, (July), 1981. The authors report their experience with a silastic silicone rubber, gromet--a circular sleeve of silicon rubber bonded to a Dacron, polyester fiber, patch--to stabilize percutaneously placed central venous lines in infants. Nineteen catheters have been kept in place a total of 180 days without accidental removal. The technique has been dependable and it requires no unusual equipment. It is adaptable to a variety of catheters and can be utilized at different insertion sites.--George Holcomb, Jr.
Nutrition in the Severely Burned Child. J, R. So/oman.
Prog
Pediatr Surg 14:63 80, 1981. Adequate nutrition in the severely burned child often determines the morbidity and mortality and demands a high priority in the management of the burn injury. In the author's unit the requirement is calculated by combining the basic requirements for the age of child and additional requirements depending on the surface area of the burn. Limitation of metabolism, particularly at operation, also requires careful management. Parenteral nutrition commences as soon as the shock phase is controlled and progresses via tube feeding to full oral f e e d i n g . - - L Rangecroft
The clinical course and liver biopsy pathology of 11 infants with parenteral nutrition-associated cholestasis were reviewed. All infants except two were premature, and all had serious respiratory, gastrointestinal, and cardiovascular problems necessitating intensive care and the need for parenteral nutrition for an average of 6 wk (range 2-28 wk). Jaundice became apparent within 1.5-3 wk after beginning parenteral nutrition in all patients except two, who did not become icteric until after 8 wk of therapy. All infants except one had parenteral nutrition discontinued near the height of biochemical liver abnormalities, and most became anicteric within 2 wk after discontinuation of the infusion. One patient continued to receive parenteral nutrition in spite of severe liver disease, because of short-gut syndrome; he died at 5.5 mo of age from complications of chronic liver disease. Percutaneous liver biopsies were obtained in all patients at the height of their biochemical abnormalities, and follow-up biopsies were obtained in six of the infants between 9 and 11 mo of age. The initial biopsies showed cholestasis, hepatocellular ballooning and lobular disarray, Kupffer cell hyperplasia, extramedullary hematopoiesis and periportal inflammation in all patients. Ten patients also showed periportal fibrosis. The follow-up biopsies showed resolution of most of these abnormalities, except that all biopsies still showed hepatocellular cholestasis and hepatocyte ballooning. Sinusoidal fibrosis and portal fibrosis were also present in four of the six follow-up biopsies. These abnormalities suggest continuing liver damage, even though the infants are clinically well. The etiology of parenteral nutrition-associated liver disease remains unknown. Direct hepatotoxicity of the amino acid infusate and secondary metabolic effects of high glucose infusions have been incriminated. Since young infants seem to be particularly susceptible to this complication of parental nutrition, other factors, such as immaturity of the premature newborn liver, may apply.--Richard R. Rieketts
INTEGUMENT AND CONNECTIVE TISSUE Care and Needs of a Children's Burn's Unit. J. R. Soloman.
Prog Pediatr Surg 14:19-32, 1981. Nutritional Support of the Critically III Patient. E, L. Dunn,
E. E. Moore, and T. Jones. Surg Gynecol Obstet 153:46 48, (July), 1981. Utilization of elemental enteral feedings via catheter jejunostomy was studied prospectively in 23 patients requiring gastrointestinal operations. Nutritional assessment was performed within 24 hr of admission and repeated during the study. Vivonex HN was begun within 24 hr postop and advanced as tolerated. The study found that 16 of 21 patients were advanced to 100 cc/hr within 48 hr. No mechanical problems were encountered with maintenance or removal of the catheter and mild diarrhea occurred in 6 out of 21. In 9 of I 1 patients positive nitrogen balance was achieved and while total protein was increased, albumen remained constant. The study showed that immediate, postop, elemental feedings via jejunostomy are a feasible alternative method of nutritional support in selected critically ill patients.--Paul Gilliam
A comprehensive list of the requirements for a good children's burn unit is given here, based on the author's experience at The Royal Children's Hospital, Melbourne. Emphasis is placed on (a) the need to treat the child as an individual with differing needs according to age and (b) the need for a coordinated team approach involving various medical specialists, paramedical workers, local doctors and district nurses.--L. Rangecroft Burn Wound
Management.
M. R. Q. Davies, H. Rode,
S. Cywes, et al. Prog Pediatr Surg 14:33-62, 1981. A wide ranging article on the theoretical and practical aspects of burn wound management. A regime is described based on a four-stage classification of the wound according to age of injury, prior treatment and contamination/ infection, to help in the choice of local therapy.--L. Rangecroft
95
Pancreatitis, Cholecystitis, and Choledocholithiasis Associated W i t h Infectious Mononucleosis. C. Lifschitz and
Serial Liver Biopsies in Parenteral Nutrition-Associated Cholestasis of Early Infancy. Beverly Barrett Dahms and
S. LaSala. Clin Pediatr 20:131, (February), 1981.
Thomas C. Halpin, Jr. Gastroenterology 81:136 144, (July), 1981.
A 10-yr-old female presented with clinical and laboratory evidence of infectious mononucleosis. Resolution of liver function abuormalities occurred within 4 wk but 6 wk later she returned with abdominal pain and abnormal liver function tests with an elevated amylase. Work-up revealed cholelithiasis and choledocholithiasis. She underwent cholecystectomy and common duct exploration. In one series of 54 patients with pancreatitis only 5 (9%) had associated cholelithiasis and the incidence of choledocholithiasis in children with cholelithiasis is reported as 6 % . ~ a n d a l l IV. Powell
A Method of Assuring Stabilization of the Central Venous Line in Newborn Infants. L. F. Martin, C. R. Voyles, and
D. B. Groff. Surg Gynecol Obstet 153:93-94, (July), 1981. The authors report their experience with a silastic silicone rubber, gromet--a circular sleeve of silicon rubber bonded to a Dacron, polyester fiber, patch--to stabilize percutaneously placed central venous lines in infants. Nineteen catheters have been kept in place a total of 180 days without accidental removal. The technique has been dependable and it requires no unusual equipment. It is adaptable to a variety of catheters and can be utilized at different insertion sites.--George Holcomb, Jr.
Nutrition in the Severely Burned Child. J, R. So/oman.
Prog
Pediatr Surg 14:63 80, 1981. Adequate nutrition in the severely burned child often determines the morbidity and mortality and demands a high priority in the management of the burn injury. In the author's unit the requirement is calculated by combining the basic requirements for the age of child and additional requirements depending on the surface area of the burn. Limitation of metabolism, particularly at operation, also requires careful management. Parenteral nutrition commences as soon as the shock phase is controlled and progresses via tube feeding to full oral f e e d i n g . - - L Rangecroft
The clinical course and liver biopsy pathology of 11 infants with parenteral nutrition-associated cholestasis were reviewed. All infants except two were premature, and all had serious respiratory, gastrointestinal, and cardiovascular problems necessitating intensive care and the need for parenteral nutrition for an average of 6 wk (range 2-28 wk). Jaundice became apparent within 1.5-3 wk after beginning parenteral nutrition in all patients except two, who did not become icteric until after 8 wk of therapy. All infants except one had parenteral nutrition discontinued near the height of biochemical liver abnormalities, and most became anicteric within 2 wk after discontinuation of the infusion. One patient continued to receive parenteral nutrition in spite of severe liver disease, because of short-gut syndrome; he died at 5.5 mo of age from complications of chronic liver disease. Percutaneous liver biopsies were obtained in all patients at the height of their biochemical abnormalities, and follow-up biopsies were obtained in six of the infants between 9 and 11 mo of age. The initial biopsies showed cholestasis, hepatocellular ballooning and lobular disarray, Kupffer cell hyperplasia, extramedullary hematopoiesis and periportal inflammation in all patients. Ten patients also showed periportal fibrosis. The follow-up biopsies showed resolution of most of these abnormalities, except that all biopsies still showed hepatocellular cholestasis and hepatocyte ballooning. Sinusoidal fibrosis and portal fibrosis were also present in four of the six follow-up biopsies. These abnormalities suggest continuing liver damage, even though the infants are clinically well. The etiology of parenteral nutrition-associated liver disease remains unknown. Direct hepatotoxicity of the amino acid infusate and secondary metabolic effects of high glucose infusions have been incriminated. Since young infants seem to be particularly susceptible to this complication of parental nutrition, other factors, such as immaturity of the premature newborn liver, may apply.--Richard R. Rieketts
INTEGUMENT AND CONNECTIVE TISSUE Care and Needs of a Children's Burn's Unit. J. R. Soloman.
Prog Pediatr Surg 14:19-32, 1981. Nutritional Support of the Critically III Patient. E, L. Dunn,
E. E. Moore, and T. Jones. Surg Gynecol Obstet 153:46 48, (July), 1981. Utilization of elemental enteral feedings via catheter jejunostomy was studied prospectively in 23 patients requiring gastrointestinal operations. Nutritional assessment was performed within 24 hr of admission and repeated during the study. Vivonex HN was begun within 24 hr postop and advanced as tolerated. The study found that 16 of 21 patients were advanced to 100 cc/hr within 48 hr. No mechanical problems were encountered with maintenance or removal of the catheter and mild diarrhea occurred in 6 out of 21. In 9 of I 1 patients positive nitrogen balance was achieved and while total protein was increased, albumen remained constant. The study showed that immediate, postop, elemental feedings via jejunostomy are a feasible alternative method of nutritional support in selected critically ill patients.--Paul Gilliam
A comprehensive list of the requirements for a good children's burn unit is given here, based on the author's experience at The Royal Children's Hospital, Melbourne. Emphasis is placed on (a) the need to treat the child as an individual with differing needs according to age and (b) the need for a coordinated team approach involving various medical specialists, paramedical workers, local doctors and district nurses.--L. Rangecroft Burn Wound
Management.
M. R. Q. Davies, H. Rode,
S. Cywes, et al. Prog Pediatr Surg 14:33-62, 1981. A wide ranging article on the theoretical and practical aspects of burn wound management. A regime is described based on a four-stage classification of the wound according to age of injury, prior treatment and contamination/ infection, to help in the choice of local therapy.--L. Rangecroft