Surgical experience with necrotizing enterocolitis in the infant

Touloukian, Robert J.; Berdon, Walter E.; Amoury, Raymond A.; Santulli, Thomas V.

doi:10.1016/s0022-3468(67)80078-2

Cited by 113 publications

(34 citation statements)

References 14 publications

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“…Virtually all previous reports of this syndrome (Sealy, 1953;Lober and Lillehei, 1954;Ring and Lewis, 1950) have demonstrated a marked predilection for bowel ischemia to occur in the terminal ileum and cecum. Furthermore, clinical experience with a newborn form of ischemic bowel disease has also noted a strong tendency for the terminal ileum and cecum to suffer ischemic damage (Touloukian et al, 1967;Stevenson et al, 1969;Briski et al, 1982). Is there is a discernible physiological basis for this known predisposition of the terminal ileum to suffer ischemic damage?…”

Section: Discussionmentioning

confidence: 99%

“…The predilection of the gut on either side of the ileocecal value to suffer ischemic damage is well known to the surgeon, neonatologist, and cardiologist (Sealy, 1953;Lober and Lillehei, 1954;Ring and Lewis, 1956;Touloukian et al, 1967;Stevenson et al, 1969;Briski et al, 1982). To date, there have been no studies directed at identifying the cause of this peculiar distribution of ischemic lesions, although ill-defined anatomic considerations have been invoked in the past (Ring and Lewis, 1956).…”

Section: Regulation Of Terminal Deal and Cecal Blood Flowmentioning

confidence: 99%

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Resting and exercise renal blood flows in immature ovine aortic coarctation. Impact of gradient relief.

Lock

Kulik

Green

et al. 1983

Circulation Research

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SUMMARY. The primary purpose of this study was to determine whether a neonatally induced thoracic aortic coarctation reduces renal blood flow dunng physiological stress (treadmill exercise), and whether relief of the gradient returned renal blood flow during exercise to normal. Two ancillary questions were also addressed: does a coarctahon alter the responses of enteric and other visceral vascular beds to treadmill exercise? Eight newborn lambs that underwent sham thoracotomy with placement of left atrial lines served as controls; in seven Iambs we also created a recently described form of dilatable juxtaductal coarctation. This preparation is unique in that, like human coarctation, the obstruction does not get worse as the animal grows. Rest and exercise vascular pressures and regional blood flows were detemined 2-2V2 months after surgery. Coarctations were relieved with balloon dilation angioplasty catheters, inserted percutaneously. Postdilation rest and exercise hemodynamic studies were performed, at the same level of exercise, 24 hours after dilation. Renal blood flow did not change with exercise in the control animals. In lambs with coarctation, renal blood flow fell (-22%, P < 0.01) during exercise. Unexpectedly, an exercise-induced fall in renal blood flow (-22%, P < 0.001) persisted even after effective relief of the coarctation (descending aortic blood pressure fell 25% with exercise predilarion, but remained unchanged with exercise postdilation). Blood flow to the terminal ileum and cecum followed a qualitatively similar pattern to that of renal blood flow in control, predilation, and postdilation lambs, and this pattern was distinct from that of other enteric and visceral organ flows. These results demonstrate an expected abnormality in the regulation of exercise renal blood flow in lambs with coarctation of the aorta; however, the persistence of this abnormality after effective gradient relief does not support the previously advanced theory that postcoarctarion hypertension is largely nonrenal in origin. The apparent similarity between ileocecal and renal blood flow control under these circumstances may provide a clue to the known predilection of the terminal ileum to suffer ischemic injury. (Circ Res 53: 644-654, 1983) EARLIER in this century, the hyptertension above an aortic coarctation was attributed to abnormal aortic wall compliances (Blumgart et al., 1931;Bing et al., 1948). Subsequently, however, renal autotransplantation experiments indicated an important role of the kidney in producing this hypertension (Scott and Bahnson, 1951), presumably on the basis of impaired renal blood flow (RBF) (Parker et al., 1982). Despite this, previous attempts to document a coarctation-associated decrease in renal perfusion have either been unsuccessful (Harris et al., 1950;Fallo et al., 1978), or have required the unphysiological stresses of marked sodium restriction and/or general anesthesia (Bagby et al., 1975;Alpert et al., 1979). Thus, the mechanism by which a coarctation produces hypertension remai...

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Section: Discussionmentioning

confidence: 99%

Section: Regulation Of Terminal Deal and Cecal Blood Flowmentioning

confidence: 99%

Resting and exercise renal blood flows in immature ovine aortic coarctation. Impact of gradient relief.

Lock

Kulik

Green

et al. 1983

Circulation Research

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“…(25) in an elegant study demonstrated in a rat model that Klebsiella-induced necrotizing enterocolitis could be prevented by feeding rat colostral macrophages but not by feeding the soluble colostral factors. Similar experiments have not been performed in human neonates but epidemiologic studies have suggested that necrotizing enterocolitis is less common among infants fed with untreated breast milk (20,33). There seem little doubt that there is a defmite biologic significance in the living functional phagocytes of the human colostrum, however further studies are needed to clarify the magnitude and importance of their contribution to the infants host defence mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Antibody Dependent Cytotoxicity of Human Colostrum Phagocytes

et al. 1982

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Summaryhave given contradicting results. Robinson et al. (30) found macrophages and neutrophils to phagocytose and kill Staph aureus MOnOc~tes and ~~~~~o~~~o~u c~~a~ neutro~hils of human ~010s-and E, co[i in vi[ro very efficiently after opsonization by the trum were identified using cytochemical staining procedures. The aqueous phase of milk. On the other hand Ho and Lawton (12) cO1Ostral phagocytes in antibody dependent found good phagocytic power of colostral cells but poor killing cellular cytotoxicity was found to be satisfactory at high effector/ activity of E, coli, target cells ratio (20:l) Colostral monocytes showed a diminishedThe aim of the present work was to further study the function cytotoxicity when 'Ompared mOnOcytes of Or of colostral phagocytes (monocytes and polymorphonuclear neuperipheral blood at low effector/target cells ratio (1:l). This could trophils). We tested their ability to elicit antibody-dependent be due to the extensive fat ingestion by these Or other cellular cytotoxicity i.e., their ability to kill anitbody-coated target inhibitory factors found in colostrum.cells in vitro.We also tested the ability of peripheral blood monocytes who Speculation had phagocytosed lipid to elicit antibody-dependent cytotoxicity.The demonstration of antibody dependent cellular cytotoxicity of colostral phagocytes gives further support to the biological MATERIALS AND METHODS importance of the cellular components of human milk.Collection of colostrum. Colostrum was obtained from 16 women within the first 5 days following delivery. Mothers manually There is now growing information documenting that human expressed their milk into sterile plastic containers. The samples breast milk is superior to cow's milk in minimizing both the were brought to the laboratory within one hour of collection. morbidity and mortality of infants (3,4,29,35). The immunologic Preparation of colostal cells. Because of the high fat content of factors in human milk that offer resistance against infection to the colostrum, the usual procedures for identification of the white neonates are summarized in several review articles (26,28,34). In cells in the peripheral blood could not be applied. Consequently contrast the functions of the cellular components of human milk alternate methods were devised. Samples were centrifused at 200 have received relatively little attention till recently. The white cells x g for 25 min. During centrifugation the milk separated into of human colostrum were first observed in 1839 by Alexander three layers: a cell pellet, middle layer and fat layer. The cell pellet Donne (6). These cells were rediscovered in 1966 by Smith work-was washed twice in Eagle's basal medium (BME) and resusing in Goldman's laboratory (31). They were found to be present pended in the same medium plus 10% foetal calf serum (FCS) at concentrations of 0.5-10 million cells/ml in colostrum and Subsequently the cells were counted in a haemocytometer. The comprise 30-85% macrophages, 1-80% polymorphonuclears and viability of cells...

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“…Neonail:al Necrotizing Enterocolitis (NEC) is a highly lethal disease of the gastrointestinal tract in the .newborn, primarily in low-birth-weight infant, and is characterized by ischemic necrosis of the bowel wall frequently leading to perforation and death (Mizrahi et al, 1965;Touloukian et al, 1967). It was Generisch (1891) who firs•t reported on this entity, followed by Thelander This paper tries to present a brief review on tthis highly lethal yet salvageable disease of the newborn infant.…”

Section: Introductionmentioning

confidence: 99%

Neonatal Necrotizing Enterocolitis

Tjandra

2017

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Neonatal Necrotizing Enterocolitis (NEC) is a highly lethal disease of the newborn infant, which has aroused great interest in the past decades. It is characterized by ischemic necrosis of th'e intestinal wall, frequ®tly /'{fading to perforation and death. Unlike most neonatal emergencies, it is acquired and can be wccessfully treated without op,eration in most cas(!S.The etiology is still obscure and is considered to be multifactorial. Intesti11al ischemi.a, infections, cow's milk, and hyperosmolar

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Surgical experience with necrotizing enterocolitis in the infant

Cited by 113 publications

References 14 publications

Resting and exercise renal blood flows in immature ovine aortic coarctation. Impact of gradient relief.

Resting and exercise renal blood flows in immature ovine aortic coarctation. Impact of gradient relief.

Antibody Dependent Cytotoxicity of Human Colostrum Phagocytes

Neonatal Necrotizing Enterocolitis

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