RESUMEN
BACKGROUND/PURPOSE: Thomsen-Friedenreich cryptantigen activation (TCA) exposes neonates with necrotizing enterocolitis NEC to the risk of hemolysis after transfusion of blood products. The authors aimed to determine the prevalence of TCA in neonates with NEC and to correlate TCA with severity of disease and outcome. METHODS: One hundred four neonates with NEC were tested for TCA on admission. Patients with TCA requiring transfusion were given packed red cells, low-titer anti-T fresh frozen plasma, and washed platelets to avoid hemolysis. RESULTS: Twenty-three infants had TCA, and 96% of these had stage III disease. The incidence of TCA was significantly higher in infants with stage III disease compared with those with stage II (30% v 4%; P <.01). A total of 91% of infants with TCA required laparotomy compared with 81% of those with no activation. At laparotomy, widespread disease was more common in the TCA group (71% v 55%). TCA did not significantly increase mortality rate (TCA, 39% v no TCA, 28%); this may reflect the transfusion policy of our unit. CONCLUSIONS: Twenty-two percent of neonates with NEC referred to our unit had TCA. There is an association between TCA and advanced NEC. Screening of neonates with advanced NEC for TCA is advised to identify those at risk of hematologic complications.
Asunto(s)
Antígenos de Carbohidratos Asociados a Tumores/inmunología , Enterocolitis Necrotizante/inmunología , Enterocolitis Necrotizante/mortalidad , Enterocolitis Necrotizante/cirugía , Humanos , Recién Nacido , Isoantígenos/inmunología , Tasa de SupervivenciaRESUMEN
PURPOSE: The aim of this study was to evaluate the clinical significance of low platelet count in the surgical management of neonates with necrotizing enterocolitis (NEC). METHODS: The clinical course of 58 consecutive neonates with advanced NEC (Bell's stages II or III) treated in the authors' hospital between 1995 and 1998 was reviewed. NEC in neonates who required operation was classified as isolated, multifocal, or pan-intestinal. Severe thrombocytopenia was defined as platelet count less than 100 x 10(9)/L. Rapid fall in platelet count was defined as fall greater than 150 x 10(9)/L within 24 hours to a level less than 100 x 10(9)/L. RESULTS: Median birth weight was 1,564 g (range, 550 to 4,270) and gestational age was 31 weeks (range 23 to 41). Twenty-two neonates (38%) were below 1,000 g. Age at the onset of the disease was 13 days (range, 1 to 62). NEC was treated medically in 7 neonates (12%). Indications for operation included pneumoperitoneum in 23 neonates (45%), clinical deterioration in 19 (37%), and intestinal obstruction in 9 (18%). The nadir platelet count (lowest level during the course of disease) was lower in patients with stage III disease than in patients with stage II disease (P <.05). The greater the extent of the disease, the lower the platelet count (P =.012). The nadir platelet count was lower in infants who died than in survivors (P <.05). None of the patients with platelet count greater than 100 x 10(9)/L died. In predicting intestinal gangrene, severe thrombocytopenia has a sensitivity of 69%, specificity of 60%, and positive predictive value of 89%; rapid fall in platelet count has a sensitivity of 32%, specificity of 89%, and positive predictive value of 92%. CONCLUSIONS: (1) A platelet count less than 100 x 10(9)/L or a rapid fall in platelet count represent poor prognostic factors. (2) Monitoring the platelet count during the course of NEC is useful; however, it cannot be used in isolation to predict the extent of the disease or survival rate.
Asunto(s)
Enterocolitis Necrotizante/complicaciones , Recuento de Plaquetas/normas , Trombocitopenia/etiología , Peso al Nacer , Enterocolitis Necrotizante/clasificación , Enterocolitis Necrotizante/mortalidad , Enterocolitis Necrotizante/cirugía , Edad Gestacional , Humanos , Recién Nacido , Obstrucción Intestinal/etiología , Modelos Logísticos , Neumoperitoneo/etiología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Trombocitopenia/sangre , Trombocitopenia/clasificaciónRESUMEN
Duodenal duplications are rare congenital anomalies which can present with pancreatitis. A precise preoperative diagnosis is rarely possible. We present a 12-year-old girl with relapsing pancreatitis in whom the diagnostic survey was initially inconclusive. Two years later abdominal ultrasound revealed a cyst near the head of pancreas. At laparotomy a cysto-duodenostomy was performed. The histology of the cyst wall was diagnostic.