This 580 gram female infant who was 29 weeks by obstetrical estimate was admitted to Colorado General Hospital on 7/17/74 having been transferred from Weld County Hospital in Greeley, Colorado, where she had been delivered at 7:00 P. M. on that day by cesarean section. Her mother is a 27-year-old gravida I, para 0 woman without previous medical illness. Her pregnancy had been uncomplicated until 25 weeks when she developed ankle swelling which was treated with hydroDIURIL. Despite the diuretic therapy, her edema persisted; and on 7/12/74 she was found to have elevated blood pressure which was treated with hydroDIURIL and Serpasil. On the day prior to delivery the mother was found to have increased edema, proteinuria, and hypertension and was, therefore, admitted to the hospital. During two days in the hospital she had increasing symptoms with hyperreflexia and jitteriness and blood pressure determinations to as high as 240/160. She was treated with Valium, phenobarbitol, Diazoxide, lasix, apresoline, Serpasil, and magnesium sulfate. By the evening of 7/17 it was elected to terminate the pregnancy for maternal indications, as she has not yet responded to medical management of her hypertensive disease. Essentially it was planned to do a hysterotomy termination of the pregnancy which was done under flouthane, nitrous oxide, vistaril, and atropine. The infant was resuscitated immediately after delivery by Dr. Robert Hartley and had Apgars of 3 at 1 minute and 8 at 5 minutes. She required positive pressure resuscitation via an endotracheal tube, was given oxygen from the first three to five minutes of life; and at this time the child breathed spontaneously and was able to be extubated. Initial gases in an F102 of 45% showed a p02 of 229, a pCO2 of 39, and a pH of 7.30. Her dextrostix was satisfactory ry and she was begun on an infusion via an umbilical artery catheter of D10W at 2 cc/hour. Arrangements for transfer to Colorado General Hospital were promptly made and the child arrived here at approximately 3 hours of age. On physical examination here the child's weight was 580 grams, her length was 34 cm, blood pressure was 62 systolic, temperature was 35.8 axillary, pulse was 160, respiratory rate was 54, and head circumference was 24 cm. The child was incredibly small, but pink, an active newborn without significant clinical respiratory distress. General physical examination was completely within normal limits. Gestational age Case Report assessment by physical criteria gave a gestational age of approximately 33 to 34 weeks, by neurological assessment the gestational age was estimated between 30 and 32 weeks; therefore, an overall clinical assessment of gestational age averaged 32 to 33 weeks. The child's entire hospital course was remarkably benign. She slowly tolerated the introduction to PM-60/40 feedings and had only mild to moderate apnea responding to stimulation over her first week in the hospital. She initially required feeding by constant intragastric drip but by the end of two weeks was able to move to intermittent gavage feeding schedule. She demonstrated steady weight gain so that at the end of two weeks in the hospital her weight was up to 840 grams. The remainder of her hospital course was completely benign with the only problems being that of caloric intake and weight gain which continued to go smoothly. At the time of discharge on 9/23/74, her weight was up to 1940 grams; her general physical This interesting child demonstrates not only viability at under 600 grams but also the fact that severe intrauterine growth retardation may occur in infants of this birth weight; thus, not all extremely low birth weight infants can be guaranteed to be immature. The valuation of this infant for other potential causes of intrauterine growth retardation including metabolic diseases and congenital infections was completely normal, and it is presumed that the etiology of her growth retardation was the maternal hypertensive disease. Case Report 5 A PREMATURE INFANT WEIGHING LESS THAN ONE POUND AT BIRTH Baby McG. was born about 10:30 p.m., on June 6, 1937, fifteen minutes after my arrival. The child was the third born to the mother, who was twenty-eight years of age at the time. The birth was approximately two months premature. The delivery was normal. The child was alive but so extremely small that I did not expect survival, since there was no incubator available. The nurse bathed the baby in warm olive oil, wrapped it in cotton, and placed it in a basket in a warm oven. No scales were at hand, so the actual birth weight was not obtained, but it was by far the smallest living baby I had ever seen. Shortly after birth the nurse gave the baby two drops of brandy in warm water from an eye dropper. Greatly to my surprise the nurse called me on the telephone the following morning to inform me that the infant was still alive and to request feeding instructions. About 11 a.m., June 7th, the day following birth, the nurse took the baby to a local grocery store, and weighed him on the grocery scales in the presence of the proprietor and another person. The weight of the baby at that time was fourteen ounces, as the accompanying affidavit confirms. For two days the child was given feedings of two drops of brandy and a few drops of corn syrup in warm water from a dropper. On the third day the child was given lactogen, in a dilution of one teaspoonful to one ounce of water, and since that time has been fed lactogen in the full strength dilution (1 part lactogen to 7 parts water), with progressive increases in volume as the baby grew older. For the first ten days of life the child took several droppers of formula each hour. At ten days on the infant was able to suck, and, therefore, was fed from a bottle on a two-hour schedule. During the first two weeks the baby was kept in a warm oven at night. 4 Case Report Sa The weight at 2 months was 3 pounds, at 4 months 6 pounds, at 7 months 9 3/4 pounds, at which time the body length was 24 1/4 inches. The child has been generally healthy and normal as to its physical and mental condition. Cereal, vegetable puree, and other usual additions were made to the diet at 6 months. At present the child is 12 months old, weighs 13 pounds 12 ounces, and measures 25 1/4 inches. - J. S. Monro, North Sydney, N. S. CAN. MED. ASSOC. J. 40: 69-70, 1939 Jan. 1939] 1 Case Report THE CANADIAN MEDICAL ASSOCIATION JOURNAL 40: 69-70, 1939 (Janua CASE REPORTS: PREMATURE INFANT WEIGHING 14 OUNCES those cases in which there is extensive renal damage. Whether or not nephropexy should be done depends on the case, In the two cases reported above it was not necessary. It is our personal view that any kidney, having been once disturbed from its bed and replaced, will do very little moving thereafter because of the formation of adhesions. Engle, Higgins and others believe that simple division and ligation of the vessel are quite sufficient. SUMMARY 1. Two cases of aberrant renal vessel arc reported. 69 2. Both occurred in males, and both on the left side. 3. Both caused marked symptoms, and in one there was sutlicient hematuria to suggest a renal neoplasım. 4. Neither case showed nephroptosis, and in neither case was there any marked hydronephrosis. 5. Both were cured by simple ligation and division of the aberrant vessel. 6. The condition of aberrant vessel is briefly described, with particular attention to the symptomatology, diagnosis and treatment. Case Reports A DERMOID CYST IN A CHILD BY A. T. GILLESPIE, M.D. O.M., aged 11 years. This girl came under my care on August 10, 1935, complaining of pain in the abdomen. The pain was intermittent, and while examining her she said it felt easier. The abdomen was greatly distended, and a large, firm mass was palpable in the lower part but extended above the umbalicus. In an older person one would consider pregnancy, but as she had had no menses and was only eleven years of age, this was at once ruled out. She gave a history of becoming larger in the abdomen for almost a year. At times it seemed to be more noticeable than at others. She was very sensitive about it, and refused to put on a bathing suit which her mother had given her. There was no dis. comfort until three days previous to my being called, when she commenced to have intermittent crampy pains. For the past two months she had had sone nausea and often vomited on getting up. She was removed to hospital, and an enema given, with a rather poor result. Catheterization did not reduce the size of the tumour. X-ray revealed a tumour with a slight opacity towards the right side, and the report suggested a dermoid cyst. On further palpation the mass was felt to rise out of the pelvis and extend two fingers' breadtlıs above the umbilicus. It was in the mid-line, oval in shape, firm, smooth and slightly movable from side to side; no fetal parts were palpable and there were no fetal heart sounds, The head and neck were negative. The respiratory movements were normal; no dullness found at the bases of the lung. No crepitations were heard. The heart was not enlarged; no murmurs. The kidneys were negative. The castro intestinal tract was negative, except for some constipation. She was operated on on August 12th through a lower median incision, under ether, and a large bluish mass exposed. Before this could be extricated from the abilomen a pint of dark reddish-coloured doid had to be aspirated. It was then removed from the ab. domen, and found to be twisted (one complete twist on its pedicle, which was attached to the right broad ligament beside the uterus). It was easily clamped, removed and sewed over. The child made a quick recovery, and convalescence was good except for a slight bronchitis and a small amount of infection in the lower end of the wound. The pathological report was as follows: "Gross specimen consists of a very large cystic structure measuring up to 13 cm. in diameter. It is found to he made up of several large cystic structures, some of which are filled with a greyish white grumous material. In others a few fine white hairs can be found scattered about in this grumous material. The walls of the cyst are intensely hæmorrhagic, suggesting a torsion of this cyst about its pedicle. No ovarian tissue could be found in the gross. "Microscopic report: Sections of the cyst confirm the diagnosis made in the gross, No evidence of malignancy. Diagnosis: Dermoid cyst." To summarize the main points: (1) one is struck with the youth of the patient; (2) the enormous size of the tumour as compared to her comparatively small abdomen; (3) it was a typical case of torsion of the tumour on its pedicle. A PREMATURE INFANT WEIGIIING LESS THAN ONE POUND AT BIRTH WIIO SURVIVED AND DEVELOPED NORMALLY BY J. S. MONRO North Sydney, N.S. The smallest infant to survive, as reported in the medical literature, weighed 600 grams (21.16 ozs.), at birth. I feel, therefore, that a brief report of the male infant which weighed 14 ozs. on the second day and 934 pounds at seven months will be of interest. This child was born in a country region, where the facilities for scientific care of a premature infant were contpletely lacking. In spite of this and. I feel, chiefly due to the interest and care given by the nurse on the case, this tiny infant lived, thrived, |