Filth, impurity, and threat

2021 ◽  
pp. 311-317
Author(s):  
Michael Obladen
Keyword(s):  
Cystic Fibrosis ◽  
Fetal Death ◽  
Severe Disease ◽  
Meconium Ileus ◽  
Fetal Life ◽  
Meconium Peritonitis ◽  
Meconium Aspiration ◽  
The Us

In many religions, body secretions have been regarded as impure or dangerous. Meconium, the pitch-like substance filling the gut at birth, was considered the embodiment of impurity and actively driven out from the newborn’s body. The custom was advantageous by breaking the taboo on colostrum consumption. Passing the meconium before birth was considered a bad omen. The claim that it indicated fetal death led to intense debates between the Parisian surgeons Viardel and Mauriceau. In 1798, Scheel described meconium aspiration into the airways, a severe disease still causing 1000 deaths annually in the US in 2008. Meconium ileus resulted from a hardened substance within the gut, linked to cystic fibrosis of the pancreas by Landsteiner in 1905. Meconium peritonitis, described by Morgagni in 1751, resulted when the dilated gut perforated during fetal life. A series of meconium occlusion and peritonitis were described in 1877 among infants admitted to the St. Petersburg Foundling Hospital. For centuries, ‘expelling’ the meconium was a postnatal routine with similarities to exorcism, freeing the child from evil.

scholarly journals Prenatal diagnosis of meconium ileus and meconium peritonitis: Indications for cystic fibrosis testing

2011 ◽  
Vol 139 (7-8) ◽  
pp. 527-530
Author(s):  
Amira Egic ◽  
Zeljko Mikovic ◽  
Vesna Mandic ◽  
Natasa Karadzov
Keyword(s):  
Cystic Fibrosis ◽  
Intestinal Obstruction ◽  
Cytomegalovirus Infection ◽  
Chromosomal Abnormalities ◽  
Disease Risk ◽  
Prenatal Testing ◽  
Anorectal Malformations ◽  
Meconium Ileus ◽  
Meconium Peritonitis ◽  
Foetal Blood

Introduction. More recently, the regions of increased abdominal echogenicity such as echogenic bowel, meconium ileus and meconium peritonitis have been associated with an increased prevalence of a variety of unfavourable outcomes including chromosomal abnormalities, cytomegalovirus infection, intestinal obstruction, anorectal malformations and cystic fibrosis. Earlier prenatal examinations of these severe autosomal recessive diseases had been suggested only to families with history of cystic fibrosis. Recently, systemic examination has been introduced by ultrasound with bowel hyperechogenicity where the fetus is the index case for genetic disease. Risk for cystic fibrosis with this ultrasonography findings ranges from 0-33%. Outline of Cases. Two patients are presented, aged 24 and 29 years, both primigravide. The first one had ultrasonography finding of meconium peritonitis revealed at the 37th week of gestation and the other meconium ileus revealed on ultrasonography at the 29th week of gestation. Both patients had prenatal testing of foetal blood obtained by cordocenthesis, both had normal kariotype and were negative for cytomegalovirus infection. Parental DNA testing for the 2nd patient showed that parents were not carriers for the 29 most frequent mutations. Both neonates had intestinal obstruction, underwent surgery and early postoperative course was normal. Hystopathological finding suggested a possibility of cystic fibrosis for the 1st patient, but parents did not want to be tested and for the 2nd one congenital bowel stenosis as a cause of intestinal obstruction. Conclusion. Ultrasonographic echogenic bowel is an indication for invasive procedures for foetal blood testing for chromosomal abnormalities, congenital infections and parental testing for cystic fibrosis. Only if parental heterozygosity is proven foetus should be tested.

scholarly journals Meconium Ileus Equivalent Complicating Cystic Fibrosis in Postneonatal Children and Young Adults

1977 ◽  
Vol 72 (4) ◽  
pp. 732-736 ◽  
Author(s):  
John W. Matseshe ◽  
Vay L.W. Go ◽  
Eugene P. DiMagno
Keyword(s):  
Cystic Fibrosis ◽  
Young Adults ◽  
Meconium Ileus ◽  
Children And Young Adults

Long‐term clinical outcome of cystic fibrosis paediatric patients presenting with meconium ileus

2020 ◽  
Vol 109 (12) ◽  
pp. 2738-2739
Author(s):  
Ioanna Loukou ◽  
Maria Moustaki ◽  
Marina Plyta ◽  
Konstantinos Douros
Keyword(s):  
Cystic Fibrosis ◽  
Clinical Outcome ◽  
Meconium Ileus ◽  
Paediatric Patients

scholarly journals Mifepristone as Bridge or Adjunct Therapy in the Management of Challenging Cushing Disease Cases

2021 ◽  
Vol 14 ◽  
pp. 117955142199410
Author(s):  
Alice Y Chang ◽  
Sasan Mirfakhraee ◽  
Elizabeth E King ◽  
Jennifer U Mercado ◽  
Diane M Donegan ◽  
...  
Keyword(s):  
Cushing Syndrome ◽  
Severe Disease ◽  
Disease Recurrence ◽  
Adjunctive Treatment ◽  
Therapeutic Trial ◽  
Cushing Disease ◽  
The Us ◽  
Clinical Benefits ◽  
Effects Of Radiation ◽  
Bridge Therapy

Establishing a definitive diagnosis of Cushing disease (CD), given its clinical and biochemical heterogeneity, initiating effective treatment to control the effects of hypercortisolism, and managing recurrence are challenging disease aspects to address. Mifepristone is a competitive glucocorticoid receptor antagonist that is approved in the US by the Food and Drug Administration to control hyperglycemia secondary to endogenous hypercortisolism (Cushing syndrome) in patients who have glucose intolerance or type 2 diabetes mellitus and have failed surgery or are not candidates for surgery. Herein, we describe 6 patients with CD who received mifepristone as adjunct/bridge therapy in the following clinical settings: to assess clinical benefits of treatment for suspected recurrent disease, to control hypercortisolism preoperatively for severe disease, to control hypercortisolism during the COVID-19 pandemic, and to provide adjunctive treatment to radiation therapy. The patients were treated at multiple medical practice settings. Mifepristone treatment in each of the described cases was associated with clinical improvements, including improvements in overall glycemia, hypertension, and weight loss. In addition, in one case where biochemical and radiological evidence of disease recurrence was uncertain, clinical improvement with mifepristone pointed toward likely disease recurrence. Adverse events associated with mifepristone reported in the 6 cases were consistent with those previously reported in the pivotal trial and included cortisol withdrawal symptoms, antiprogesterone effects (vaginal bleeding), hypothyroidism (treated with levothyroxine), and hypokalemia (treated with spironolactone). These cases show how mifepristone can potentially be utilized as a therapeutic trial in equivocal cases of CD recurrence; as a presurgical treatment strategy, particularly during the COVID-19 pandemic; and as bridge therapy, while awaiting the effects of radiation.

Newborn Screening for Cystic Fibrosis

PEDIATRICS ◽  
1991 ◽  
Vol 87 (6) ◽  
pp. 954-955
Author(s):  
IAN C. T. LYON ◽  
DIANNE R. WEBSTER
Keyword(s):  
Cystic Fibrosis ◽  
Newborn Screening ◽  
Elevated Level ◽  
Meconium Ileus ◽  
Screening Tests ◽  
Initial Screening ◽  
False Negatives ◽  
Immunoreactive Trypsinogen

To the Editor.— The report on newborn screening for cystic fibrosis1 illustrates the need for continued evaluation of such programs. The authors state that the identification of cases of cystic fibrosis (CF) by an elevated level of immunoreactive trypsinogen (IRT) in second (follow-up) samples from infants with positive initial screening tests could result in false negatives in 27% of cases of cystic fibrosis without meconium ileus (MI). We have screened 401 122 infants using the method originally reported.2

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