RESUMEN
In recent years, because of prompt diagnosis and effective, aggressive resuscitation, the majority of infants and children with fulminant meningococcemia are surviving. From 1974 through 1984, 135 patients with this diagnosis were treated, and 126 of them survived. Although a purpuric skin rash developed in almost all of these patients initially, in eight of them it progressed to multiple confluent areas of cutaneous gangrene, usually associated with extensive necrosis of underlying subcutaneous fat, fascia, skeletal muscle, and even bone. Tissue necrosis seemed to be most extensive in regions of reduced blood flow, such as the extremities, but it almost never followed a pattern of anatomic vascular distribution. A most significant microscopic finding was the presence of multiple fibrin thrombi in vessels, often in close proximity with the foci of tissue necrosis. Five children who ranged in age from 6 months to 12 years required operation. Initially, all surface wounds were treated like full-thickness burns with silver sulfadiazene (Silvadene) dressings. Once the patient's condition had stabilized and the extent of tissue necrosis was apparent, all necrotic tissue was excised and the resulting wounds were temporarily covered with biologic dressings to assure a clean, viable base for skin grafting. Because the resulting quality of life postoperatively in all five surviving patients has been satisfactory, we recommend an aggressive surgical approach in patients with fulminating meningococcemia, despite what may initially appear to be devastating and even lethal complications of this disease.
Asunto(s)
Meningitis Meningocócica/cirugía , Púrpura/cirugía , Sepsis/cirugía , Tejido Adiposo/patología , Adolescente , Niño , Preescolar , Tejido Conectivo/patología , Femenino , Gangrena , Humanos , Lactante , Masculino , Meningitis Meningocócica/complicaciones , Meningitis Meningocócica/patología , Músculos/patología , Necrosis , Neisseria meningitidis , Púrpura/etiología , Sepsis/complicaciones , Trasplante de PielRESUMEN
From 1976 through 1982, 35 children with leukemia (27), aplastic anemia (4), and solid tumors (4), were evaluated for symptoms and signs of acute abdominal disease. Twenty-six patients required 34 operations, 14 of them for life-threatening events. Sixteen patients received a bone marrow transplant. The most common surgical emergencies were for acute massive Gl hemorrhage (10), biliary tract disease (4), and typhlitis (3). Thirteen (37%) of the children are alive and free of disease, 22 (63%) have died, 13 of them as a direct result of the abdominal complication which occurred. Alterations in the immune system and hematopoietic system caused by the malignant disease and its treatment with chemotherapy and irradiation appears to be responsible for a number of abdominal complications which the surgeon is asked to see. When symptoms and signs of an acute abdomen develop in patients with leukemia or solid tumors, prompt, thorough evaluation and early aggressive surgical treatment is needed if the patient is to survive. The surgeon should be aware of the unusual array of abdominal complications which can occur in this population of patients.
Asunto(s)
Abdomen Agudo/etiología , Anemia Aplásica/complicaciones , Terapia de Inmunosupresión , Leucemia/complicaciones , Neoplasias/complicaciones , Abdomen Agudo/cirugía , Adolescente , Adulto , Apendicitis/etiología , Enfermedades de las Vías Biliares/etiología , Trasplante de Médula Ósea , Niño , Preescolar , Femenino , Hemorragia Gastrointestinal/etiología , Enfermedad Injerto contra Huésped/etiología , Humanos , Lactante , MasculinoRESUMEN
During the past 2 years percutaneous fine-needle aspiration biopsy has been employed to help establish or confirm diagnosis in 32 infants and children. A 22-gauge needle is used to aspirate the site of suspected disease. For lesions inside the chest or abdomen, the needle is guided with the help of fluoroscopy, ultrasound, or computed tomography (CT) scan. Nineteen of the 32 patients had malignant disease, including lymphoma, neuroblastoma, rhabdomyosarcoma, Ewing's sarcoma, osteosarcoma, and leukemia. In all patients with solid tumors, tissue obtained at operation confirmed the accuracy of the diagnosis. In seven children with suspiciously enlarged lymph nodes, an open biopsy was avoided when the needle aspirate was clearly benign. In four children, the early appearance of metastatic or recurrent malignancy was confirmed without the need for open biopsy. In this small series, there were no false-negative or false-positive needle aspirates, and no complications directly related to the procedure. The skill and experience of the cytopathologist is essential to the success of this technique. Percutaneous fine-needle aspiration biopsy is a safe and reliable alternative method of establishing a diagnosis in infants and children with suspected malignant disease.