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We describe what we take to be the eighth case of miliary Crohn's disease since 1967 with a view to the possibility that miliary Crohn's disease is a disease different from Crohn's disease, and not just an early stage. Miliary Crohn's disease might be a different disease because (a) miliary tubercles are seen so rarely on the serosal surface of the bowel, (b) the 100 chance of finding crowded, typical granulomas in the bowel wall, and (c) the anatomic distribution of the lesion.

Chronic diffuse varioliform gastritis is an uncommon, subacute, inflammatory gastric musocal disease characterized by swollen congested rugae and disseminated mucosal erosions. The entity is exceptionally rare in children. The spectrum of reported symptoms is broad; frank hematemesis has never been reported in childhood. We present a child in whom the disease had a remarkably unusual clinical course. Because many caretakers were unaware of the existence of the disease in children, the patient had numerous hospitalizations and surgical procedures, until massive gastric bleeding resulted in unavoidable emergency total gastrectomy. Microscopical examination and immunofluorescent staining of the gastric mucosa confirmed the diagnosis of chronic diffuse varioliform gastritis.

To determine a reliable clinical approach to the problem of acute scrotum (AS) in children and identify patients who require emergent surgical intervention, 65 boys with the diagnosis of AS were studied. The mean age was 11 years. Acute orchitis/epididymitis was diagnosed in 42 (64.6%), torsion of the testis in 12 (18.5%), and torsion of the appendix testis in 5 (7.7%). A testicular radionuclide scan was the most reliable diagnostic tool, being positive in all 12 cases of torsion of the testis. Eighteen patients underwent scrotal exploration. Detorsion and bilateral orchidopexy was performed in 12, excision of a necrotic appendix testis in 5, and evacuation of a scrotal hematoma in 1. The outcome of the involved testis at follow-up examination was excellent, with only 1 child developing testicular atrophy. This study stresses the reliability of the selective approach for the treatment of the AS in children.To determine a reliable clinical approach to the problem of acute scrotum (AS) in children and identify patients who require emergent surgical intervention, 65 boys with the diagnosis of AS were studied. The mean age was 11 years. Acute orchitis/epididymitis was diagnosed in 42 (64.6%), torsion of the testis in 12 (18.5%), and torsion of the appendix testis in 5 (7.7%). A testicular radionuclide scan was the most reliable diagnostic tool, being positive in all 12 cases of torsion of the testis. Eighteen patients underwent scrotal exploration. Detorsion and bilateral orchidopexy was performed in 12, excision of a necrotic appendix testis in 5, and evacuation of a scrotal hematoma in 1. The outcome of the involved testis at follow-up examination was excellent, with only 1 child developing testicular atrophy. This study stresses the reliability of the selective approach for the treatment of the AS in children.

Acute intussusception has different clinical features in various parts of the world. The goal of this study was to determine the clinical presentation in different ethnic groups in Israel.

Acute intussusception has different clinical features in various parts of the world. The goal of this study was to determine the clinical presentation in different ethnic groups in Israel. A retrospective chart review of a 9‐year period (1985‐1995) was carried out at a university medical center. Data extracted included age, sex, ethnic origin, presenting symptoms and signs, the type of enema (barium or air), and the success rate of non‐surgical reduction of the intussusception. Ninety patients suffering from intestinal obstruction due to acute intussusception were admitted. The triad of intermittent screaming attacks, lethargy, and vomiting was observed in 37.5% of study subjects. The majority of patients were admitted during the warmer months of the year. The average age of the patients was 7.8 ± 3.7 months; 70% of them were between the ages of 4 and 9 months and 92.5% under 1 year of age. The female‐to‐male ratio was 1:2.1. Air enema was superior to the barium enema in achieving reduction (p < 0.01). The incidence in the Jewish population was similar to that observed in other surveys, and twice that found in the Arab population in our region (p < 0.05). The overall clinical presentation of acute intussusception found in our study does not differ from other studies. The lower incidence of acute intussusception found in the Arab population can be explained by ethnic, genetic, or nutritional factors.

Twenty-nine children with familial Mediterranean fever presented with 39 attacks of acute scrotal pain. Of these, 25 patients had an acute scrotum complicating familial Mediterranean fever and only four had testicular torsion. Scrotal pain was the only manifestation of a familial Mediterranean fever crisis in 36 episodes and in 15 boys scrotal involvement was the first manifestation of the condition. Fourteen patients were treated medically. Of 15 patients who underwent scrotal exploration there were no definite diagnostic findings in 11 and four had testicular torsion. Three cardinal features strongly suggest the diagnosis of acute scrotum in familial Mediterranean fever in a boy of Mediterranean origin with a relevant family history: recurrent scrotal pain or swelling; body temperature above 37·5°C; and gradual onset of pain, usually of more than 12 h duration. Conservative management can safely be undertaken in these boys without fear of losing a salvageable testis.

ABSTRACT: Adult respiratory distress syndrome (ARDS) is a critical medical problem in which severe arterial hypoxemia is often poorly responsive to conventional modes of mechanical ventilation. We studied the efficiency of mechanical ventilation of the peritoneal cavity in rabbits with experimental ARDS caused by lung lavage. The study shows that peritoneal ventilation is significantly effective in oxygenation of hypoxemic animals with ARDS and is also effective for carbon dioxide elimination. Peritoneal ventilation may be considered as an investigational method for extrapulmonary oxygenation in severe intractable hypoxemia caused by ARDS.

Adult respiratory distress syndrome (ARDS) is a critical medical problem in which severe arterial hypoxemia is often poorly responsive to conventional modes of mechanical ventilation. We studied the efficiency of mechanical ventilation of the peritoneal cavity in rabbits with experimental ARDS caused by lung lavage. The study shows that peritoneal ventilation is significantly effective in oxygenation of hypoxemic animals with ARDS and is also effective for carbon dioxide elimination. Peritoneal ventilation may be considered as an investigational method for extrapulmonary oxygenation in severe intractable hypoxemia caused by ARDS.

Torsion of a wandering spleen is a very rare entity that is usually unsuspected preoperatively. A case of acute colonic obstruction due to torsion of a wandering spleen in an adolescent is presented. The unusual clinical picture developed 4 years after a previous splenopexy. Fixation of the spleen to the left upper quadrant is considered the treatment of choice. Marlex mesh fixation of the spleen to the abdominal wall at the iliac crest level is suggested as an optional therapeutic approach in specific cases where classical splenopexy is not technically possible.

A 5-year-old girl with acute abdomen was diagnosed as suffering from hydrops of the gallbladder (HGB). She had typical clinical and laboratory characteristics of HGB including ultrasonography and radionuclide butylimidodiacetic acid (BIDA) scan.

Pyloric duplication is a rare anomaly of the gastrointestinal tract and an unusual cause of gastric outlet obstruction in infancy. Vomiting, weight loss, and a palpable mass are the main clinical findings. We present two cases successfully treated by different surgical approaches.

Infantile cholelithiasis is being diagnosed with increasing frequency. In infants, idiopathic cholelithiasis has rarely been diagnosed on abdominal ultrasound examination in the course of investigation for abdominal colic, but with no apparent biliary pathology. We report two infants, aged 1 and 2 months, in whom cholelithiasis was found during evaluation for vomiting and severe abdominal distress that was clinically suggestive of hypertrophic pyloric stenosis. Both infants, who remained symptomatic, underwent modified laparoscopic cholecystectomy (LC). This first presentation of LC in infants highlights the applicability of this novel technique in this very young age group.

A 4-year-old child suffering from both familial dysautonomia (FD) and congenital megacolon (CM) is described.

A 2-month-old premature infant was admitted to our pediatric intensive care unit because of severe Pseudomonas aeruginosa septicemia, in critical condition. A circular perianal lesion consistent with ecthyma gangrenosum developed and was treated conservatively. To our knowledge, the therapeutic dilemma between conservative and surgical management of this lesion has not been previously reported.

The dihydroxyfluorenones (I) react with the bromoacetic acid esters (II), yielding the bis(alkoxycarbonylmethoxy)fluorenones (III).