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Background/purpose: Ectopic cervical thymus (ECT) is a rare cause of neck swelling in children. Our aim was to evaluate the diagnostic and management challenges of this condition., Methods: Systematic review of the literature (1997-2020) using PRISMA guidelines., Results: A total of 192 cases of ECT were identified. Forty-two cases (4 studies) were excluded because of insufficient data resulting in 150 cases (7 bilateral) in a total of 143 patients. ECT presented as a solid mass in 71 cases (10 incidentally found at autopsy, 33 conservatively managed and 28 excised) and as a cystic mass in 79 cases (all excised). A total of 165 imaging studies in 123 patients were performed (65 ultrasound scans (USS), 51 magnetic resonance imaging (MRI) scans and 49 computer tomography (CT) scans). ECT was diagnosed by imaging in 18.7% (23/123) of patients. Fine needle aspiration cytology or incisional/needle biopsy were performed in 16% (23/140) cases; a correct diagnosis of ECT was obtained in 52% (12/23) of those cases. There were no reports of malignancy in 143 specimens analysed. A normal mediastinal thymus was absent in 2.5% (1/40) of patients investigated., Conclusions: ECT is a benign and relatively rare condition in children that is seldom diagnosed on imaging before tissue sampling or surgical excision. ECT might be the only active thymus in 2.5% of cases and careful consideration should be taken prior to its excision in young children. We recommend that ECT should be considered in the differential diagnosis of neck masses in children. Conservative management might be appropriate in selected cases and the presence of a normal mediastinal thymus in the thorax should be investigated before planning surgical excision., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021. Published by Elsevier Inc.)

The authors describe an unusual case of benign mesenchymoma of the groin in a 9-month-old boy.

Chronically instrumented fetal lambs were employed to test the hypothesis that the high voltage electrocortical activity phase is a state of low fetal oxygen consumption compared with the low voltage electrocortical activity phase. Measurements of umbilical flow (electromagnetic flowmeter) together with oxygen saturations and haemoglobin concentration of umbilical venous and arterial blood were used to calculate oxygen consumption. Significant depression of umbilical flow occurred at the transition from low voltage electrocortical activity to high voltage electrocortical activity; the maximum change averaged 14% 2 min after the onset of the high voltage phase. Significant depressions of oxygen saturation in umbilical venous and arterial blood were found within 5 min of the onset of high voltage electrocortical activity, averaging 2.2% and 5.2% respectively. No depression of oxygen consumption was found during these transient changes in early high voltage electrocortical activity, as the venous-arterial oxygen content difference widened significantly as a consequence of a greater fall in umbilical arterial oxygen content (0.7 ml/dl) than in umbilical venous oxygen content (0.3 ml/dl). Overall, we detected no significant depression of oxygen consumption in high voltage electrocortical activity. However a small but significant depression of oxygen consumption (6%) was found late in the high voltage electrocortical activity phase when the level of oxygen consumption in low voltage electrocortical activity was greater than 7 ml/min per kg. We conclude that the high voltage electrocortical activity in fetal lambs is not associated with a marked depression of oxygen consumption, despite significant transient depressions of umbilical flow and oxygen levels in umbilical venous and arterial blood.(ABSTRACT TRUNCATED AT 250 WORDS)

Six neonates are described with a gangrenous omphalitis, a disease not reported for many years. They had many features in common including previous good health. In two, the disease was preceded by the application of tobacco ash to the umbilical stump. Clinically there was gangrene of the umbilicus with a blood-stained discharge and extensive cellulitis radiating into the abdominal wall. Despite aggressive therapy including excision of the affected area, the systemic effects of the local disease progressed rapidly until all of the first five infants who presented, died. Microbiologically there was a polybacterial infection involving a wide variety of organisms particularly E coli and Clostridia species. There appeared to be an appropriate response by the infants to an acute bacterial infection, and two patients investigated showed no evidence of cellular or humoral immunodeficiency. The pathology was an infection causing local tissue necrosis with a vasculitis and microabscess formation, which involved adjacent structures by direct extension. The severe systemic symptoms were attributable to an endotoxemia or exotoxemia. The evolution of therapy for gangreneous omphalitis in the newborn, successful in the sixth patient, is discussed.

The management of 25 children with pseudocyst of the pancreas presenting over a 30-year period is reviewed. Nearly a third could be managed nonoperatively, monitoring clinical signs, serum amylase, and in recent years the findings of ultrasound and CT scan. Persistence of symptoms, signs, and hyperamylasemia for more than 4 weeks indicated failed resolution in all but one case. Endoscopic retrograde cholangiopancreatography (ERCP) done in those who did not improve spontaneously facilitated operative strategy. Early operation and internal drainage in selected cases was well tolerated. Individualization of treatment is emphasized.

Foregut drug receptors permit inotropic manipulation of the dysmotility pattern associated with gastroesophageal reflux (GER). Two prokinetic agents, ie, Metoclopramide and Cisapride were assessed in 18 infants with severe GER (mean age 6.5 months) by means of 18-hour continuous intraesophageal pH monitoring. Six parameters were recorded, and the results compared before and during pharmacologic stimulation. Both agents improved the parameters measured, but Cisapride was found to be more effective in enhancing lower esophageal sphincter competence and esophageal motor function. Long-term assessment of both agents in the management of GER in infants is indicated.