Oesophageal atresia

Oesophageal atresia (OA) encompasses a group of congenital anomalies comprising of an interruption of the continuity of the oesophagus with or without a persistent communication with the trachea. In 86% of cases there is a distal tracheooesophageal fistula, in 7% there is no fistulous connection, while in 4% there is a tracheooesophageal fistula without atresia. OA occurs in 1 in 2500 live births. Infants with OA are unable to swallow saliva and are noted to have excessive salivation requiring repeated suctioning. Associated anomalies occur in 50% of cases, the majority involving one or more of the VACTERL association (vertebral, anorectal, cardiac, tracheooesophageal, renal and limb defects). The aetiology is largely unknown and is likely to be multifactorial, however, various clues have been uncovered in animal experiments particularly defects in the expression of the gene Sonic hedgehog (Shh). The vast majority of cases are sporadic and the recurrence risk for siblings is 1%. The diagnosis may be suspected prenatally by a small or absent stomach bubble on antenatal ultrasound scan at around 18 weeks gestation. The likelihood of an atresia is increased by the presence of polyhydramnios. A nasogastric tube should be passed at birth in all infants born to a mother with polyhydramnios as well as to infants who are excessively mucusy soon after delivery to establish or refute the diagnosis. In OA the tube will not progress beyond 10 cm from the mouth (confirmation is by plain X-ray of the chest and abdomen). Definitive management comprises disconnection of the tracheooesophageal fistula, closure of the tracheal defect and primary anastomosis of the oesophagus. Where there is a "long gap" between the ends of the oesophagus, delayed primary repair should be attempted. Only very rarely will an oesophageal replacement be required. Survival is directly related to birth weight and to the presence of a major cardiac defect. Infants weighing over 1500 g and having no major cardiac problem should have a near 100% survival, while the presence of one of the risk factors reduces survival to 80% and further to 30–50% in the presence of both risk factors

Observations on the origin of congenital intestinal atresia

No Abstract. South African Medical Journal Vol. 96(9) (Part 2) 2006: 86

Book Review. - Literatur

Book Review. - Literatu

Book Review. - Literatur

Book Review. - Literatu

The Schism of the Eastern and the Western Churches

For a thousand years the church was regarded as a unit in spite of various sects and occasional violent disagreements among prominent churchmen. Nine hundred years ago it broke into a Greek and a Roman segment. Repeated efforts have been made to heal the breach, but only with passing success. It took a millennium to effect the schism; there is at present no indication that the two segments will ever reunite. The year 1054 has been accepted as the date of the schism. This date, however, merely serves the convenience of the historian. It is a handy road marker along the path of history. Actually the break between the East and the West had taken place in the hearts of many long before the dramatic incident of that year, when, on July 13, Cardinal Humbert desecrated the altar of the Hagia Sophia with his blasphemous pronouncement of the Patriarch\u27s excommunication

Book Review. - Literatur

Book Review. - Literatu

The Soteriolgical Aspect of the Doctrine of the Holy Trinity According to the Lutheran Confessions

The Lutheran Confessions are basically doxological in their treatment of the Holy Trinity, as they sound forth a hymn of praise to the grace and mercy of the Triune God. The theme of their exultant song is Soli deo gloria! But the God to whom alone shall be all glory is the Triune God: the Father and the Son and the Holy Ghost - three distinct Persons in one divine Essence. Measuring the space which the Confessions devote to the various doctrines which they profess, one might think otherwise

Book Review. - Literatur

Book Review. - Literatu

Luther\u27s Concept of the Atonement Before 1517

Recent years have seen a delightfully refreshing interest in Luther\u27s writings. One might almost speak of a Luther renaissance. Luther scholarship in Sweden immediately comes to one\u27s mind. But other countries as well have made their contributions, and other religious groups besides the Lutheran. We may think of such men as Werner Elert and Erich Seeberg in Germany, Philip S. Warson in England, and Roland H. Bainton in America. This number could easily be multiplied

Roman Catholic Child Welfare in the United States

Roman Catholic child welfare is concerned with the dependent child, including the delinquent child, which for one reason or another has gone wrong. Roman Catholic social workers recognize the change that has taken place from the days when education was the distinctive function of the home-first, on the mother\u27s knee, and then beside the father in the fields to the present time, when this function has largely been institutionalized and schools for the most part exercise this responsibility