Search

Treatment of small postoperative interloop abscesses (ILA) can be challenging. In children, these collections have usually been drained surgically at a second operation. This article describes three children with small postoperative ILAs who were treated by percutaneous needle aspiration and parenteral antibiotics, with good outcomes. The advantages of this technique and its utilization in the management of children with ILAs are discussed.

We describe a case of a full-term infant with severe respiratory failure and pulmonary insufficiency caused by an anomaly consisting of a single, unilobar lung arising from the trachea and situated in the middle mediastinum. Plain film, echocardiogram, and surgical aspects will be described and correlated with the post mortem findings and embryologic considerations. We were unable to find a similar case reported in the literature and conclude that this rare lesion represent an intermediate form between total and unilateral pulmonary agenesis.

The urinary excretion of the unique amino acid, 3-methylhistidine (3MH), has been proposed as a marker of endogenous protein catabolism and an index of a patient's metabolic state. Yet, the mechanisms of the renal handling of 3MH remain unclear. Consequently, we determined the simultaneous clearance of 3MH (C3MH) and inulin (Cin) in rats. Net reabsorption of 3MH was a consistent finding. In ten euvolemic animals, C3MH (313.2 ± 37.5 μl/min/100g BW) was less than Cin (1017.1 ± 21.2) and the percent 3MH reabsorbed was 72.6 ± 3.7%. In five volume expanded animals, the percent 3MH reabsorbed was not significantly altered (80 ± 5.0%). To confirm net reabsorption, 3MH combined with inulin was microinjected into proximal tubules of surface nephror Inulin recovery from the microinjected kidney averaged 102 ± 5% while the recovery of 3MH was only 74 ± 6% (P < 0.01). The percent of 3MH reabsorbed had no relationship to the quantity of 3MH injected, suggesting that there is no Tm for 3MH. This study clearly demonstrates that: 1) the renal clearance of 3MH is less than that of inulin, 2) net tubular reabsorption occurs over a wide range of filtered loads of 3MH and 3) a Tm for reabsorption of this amino acid metabolite could not be documented. These factors must be considered in using urinary excretion of 3MH as a marker of nutritional status.

The unusual amino acid 3-methylhistidine (3MH) is present only in muscle (the major protein mass in the body). Urinary 3MH is an ideal indicator of protein catabolism because the one mole of 3MH released upon breakdown of each mole of actin and myosin heavy chain is excreted from the body without reutilization. We are presently investigating the effects of parenteral nutrition on the protein metabolic state of neonates whose oral nutrient intake for various clinical conditions is inadequate. In a preliminary study 17 3MH/creatinine ratio measurements were performed on spot urines in 6 premature and 5 term infants. The newborns who were healthy and growing were found to have a ratio of 0.222± 0.016 (mean and S.D.) which value is about two times higher than that of normal adults in our population. The 3MH/creatinine ratio was significantly elevated (range 0.270 - 0.690; mean 0.377 ± 143 S.D.) in infants who were losing weight and had low nutrient intake because of prematurity, sepsis or postoperative condition. The relatively high 3MH/creatinine ratio in normal growing infants is consistent with the elevated metabolic rate and protein turn-over in neonates. The rise in the ratios of stressed infants reflects increased muscle protein catabolism which is apparently secondary to malnutrition. (Supported by HD-10235)