VOX PAED
Some Personal Observations
on
Omphaloceles
Reference 1.
To the Editor: The article by James S. Simpson’ about the small omphalocele which was accidentally cut into was most interesting to me. Two years ago a newborn infant was referred to me because of jaundice. The jaundice was moderately high by the time he reached me, and I was considering the possibility of doing an exchange transfusion. This infant had a 2 cm bulge at the base of the cord which someone had wisely chosen to avoid when placing the clamp on the cord. This felt squishy (fluctuant if you wish), and caused some pain when squeezed. Since this hospital did not have a pediatric surgeon, I elected not to cut into the cord to do an exchange transfusion but transferred the child to Fresno. There, a small omphalocele was found and easily corrected. The jaundice was treated with the bilirubin light and did not lead to an
exchange. In contrast, I recently had a newborn whose cord was very large at the base. It was not fluctuant or tender. I gave a brief course of antibiotics when the skin around the cord got mildly red, but just left the cord alone otherwise. I worried a little, but the cord eventually dried up and fell off without evidence of any further problems.―EDWARD B. FEEHAN, M.D., Merced, Cal~ 05340.
S.: Misdiagnosis complicating umbilical vessel catheterization: a small omphalocele containing intestine is accidentally transected. Clin. Pediatr. 14: 727, 1975.
Simpsan, J.
Visualizing
the
Pupil
To the Editor: Examination of the eye and particularly the pupil is an important diagnostic step-both in an emergency and during a routine physical examination. But every clinician knows the difficulties which attend having a good look at the pupil of anyone with dark skin and a dark iris, particularly in daylight. Normally the pupil will be small and black and lie at the center of a brown-black circle of iris. Any light that we shine into the patient’s eye is reflected back, to make the pupil even less visible. After many years of trial, I have found that covering the lens of the examining flashlight with yellow cellophane paper (wrapped around the bulb) makes the pupil easily visible even when the patient is examined in bright sunlight. The yellow light will show the pupil most clearly when the illumination is projected from the temporal side.-B~aLtl H. ATHREYA, M.D., Children’s Seashore House, Atlantic City, NJ. 08401
634
Downloaded from cpj.sagepub.com at MOUNT ALLISON UNIV on July 4, 2015
Some Personal Observations
on
Omphaloceles
Reference 1.
To the Editor: The article by James S. Simpson’ about the small omphalocele which was accidentally cut into was most interesting to me. Two years ago a newborn infant was referred to me because of jaundice. The jaundice was moderately high by the time he reached me, and I was considering the possibility of doing an exchange transfusion. This infant had a 2 cm bulge at the base of the cord which someone had wisely chosen to avoid when placing the clamp on the cord. This felt squishy (fluctuant if you wish), and caused some pain when squeezed. Since this hospital did not have a pediatric surgeon, I elected not to cut into the cord to do an exchange transfusion but transferred the child to Fresno. There, a small omphalocele was found and easily corrected. The jaundice was treated with the bilirubin light and did not lead to an
exchange. In contrast, I recently had a newborn whose cord was very large at the base. It was not fluctuant or tender. I gave a brief course of antibiotics when the skin around the cord got mildly red, but just left the cord alone otherwise. I worried a little, but the cord eventually dried up and fell off without evidence of any further problems.―EDWARD B. FEEHAN, M.D., Merced, Cal~ 05340.
S.: Misdiagnosis complicating umbilical vessel catheterization: a small omphalocele containing intestine is accidentally transected. Clin. Pediatr. 14: 727, 1975.
Simpsan, J.
Visualizing
the
Pupil
To the Editor: Examination of the eye and particularly the pupil is an important diagnostic step-both in an emergency and during a routine physical examination. But every clinician knows the difficulties which attend having a good look at the pupil of anyone with dark skin and a dark iris, particularly in daylight. Normally the pupil will be small and black and lie at the center of a brown-black circle of iris. Any light that we shine into the patient’s eye is reflected back, to make the pupil even less visible. After many years of trial, I have found that covering the lens of the examining flashlight with yellow cellophane paper (wrapped around the bulb) makes the pupil easily visible even when the patient is examined in bright sunlight. The yellow light will show the pupil most clearly when the illumination is projected from the temporal side.-B~aLtl H. ATHREYA, M.D., Children’s Seashore House, Atlantic City, NJ. 08401
634
Downloaded from cpj.sagepub.com at MOUNT ALLISON UNIV on July 4, 2015
