In the second sampling stage, intact classes from either a required subject e. The traditional method of diagnosing and managing ileo-colic intussusception is barium enema contrast reduction. Iatrogenic death is a term defining patient death as a direct result of treatments by a physician, whether from misdiagnosis of the ailment, or adverse drug reactions used to treat the illness. We do our best to make certain that; "Every vital nutrient must be available within the body— for the support of the cell — All of the time. Many drugs manufactured are originally derived from a natural compound found in nature. Osteoid present in tumors after chemotx may represent an inherent ability of the tumor to maturate and differentiate.
Herein lies the modern-age dilemma; if the mineral or nutrient is no longer in the soil, it cannot be in the plant, and those plant constituents or phytonutrients normally made from the inorganic soil matter, such as vitamins, enzymes, and co-factors, subsequently cannot be produced within the plant either. The difference between the two numbers, 87 and 94, in our simple analogy does not seem vast; however, the difference between a nutrient poor food supply and adequate nutrition is the difference between prolonged cellular life and pre-mature cellular death.
Currently within the U. However, history has shown us that millions die while waiting for official recognition, often of the scientifically obvious. Aside from man-made synthetic, radioactive, and inert elements, the universe is composed of approximately 77 naturally occurring atomic elements found within the Periodic Table of Elements used in chemistry.
All of these elements are naturally present within the human body, and utilized if made available. They exist within all plant and animal life. They are found in the waters of the oceans, the soils of the land, and within the atmosphere we breathe. They are the components of life on this planet. There are quite possibly thousands of naturally occurring phytonutrients found within an organic natural food supply, many yet to be discovered.
These miraculous compounds include complex carbohydrates, amino acids, fatty acids, enzymes, vitamins, minerals, and an entire array of co-factors. Co-factors are substances that need to be present in addition to an enzyme for a certain physiologic reaction to take place.
Our choices boil down to a stark simplicity. As you will learn, there exists an entire multitude of nutrients scientifically shown to be beneficial to health and longevity. Therefore, the term essential should not be the guideline or goal, but rather the provision of an optimum supply of nutrients.
The intelligent course of action to obtain optimum health, is clearly the consumption of the widest possible spectrum of naturally occurring, side-effect-free nutrients and phytonutrients available, in their purest bio-available form. This is the mentality which infers that drugs are more beneficial than consistent, diverse, and quality nutrition. There exist many other damaging terms as well, curiously inserted within the common health vocabulary which are clearly counter productive to public well being.
This is true, yet government agencies currently list approximately forty, while scientists have discovered and continue to discover hundreds, if not thousands of natural occurring life enhancing nutrients. They persist to perpetuate arbitrary, inadequate, misleading, and damaging concepts. The fact is, we are not receiving them in significant quantities.
The current Plague of degenerative disease is firm confirmation of this. Without adequate amounts of proline and vitamin C, the production of collagen from pro-collagen is inhibited. Proline, lysine, green tea extract, and vitamin C inhibited the spread of cancer cells in an experimental study. All nutrients required by the human cell are essential, and we can no longer afford to rely on the body to synthesize nutrients where co-factor components may no longer exist.
Missing nutrients during childhood development potentially provide an open door for the manifestation of diseases in childhood and the later appearance in adulthood. It is all economics. The term semi-essential should be eliminated as well in regard to nutrients. Under optimum conditions, your body can manufacture the other fatty acids required for health if you have adequate amounts present of these two essential fatty acids. The reality is that most Americans consume a dietary ratio estimated to be 1: We are falling considerably short on Omega III.
Furthermore, due to the nutrient and trace nutrient poor diet that is consumed by most, it is highly likely that the conversion of the inadequate levels of essential fatty acids will not likely be converted to the other necessary fatty acids, and therefore, we are deficient in them as well! We would all prefer optimum health and a disease-free existence. Interestingly, this surviving but suffering public certainly creates an endless demand for expensive pharmaceuticals and medical procedures.
Perfect nutritional cellular support, over time, also minimizes or prevents the need for expensive drugs and invasive surgical procedures. Thus, Prevention eliminates the need for the bulk of pharmaceuticals. Would Big Pharma like to hinder or even eliminate Prevention? I will leave this question open for you.
Should we attend a magic show at the local fair, a magician may entertain us with illusions. Illusions are tricks designed to cause us to believe something is, or has occurred, that in reality is not or has not. The basis of a good trick or illusion is to distract the viewer while the reality of the situation goes unnoticed. Humans are designed with two eyes situated in the front of their skulls. We look forward when we think and focus.
We usually focus on what is being presented directly in front of us. We are easily distracted, sometimes with the use of props. We cannot focus clearly on any subject using our peripheral vision. When something is off to the side and not emphasized, we tend to miss it.
Things we miss or do not see clearly, we cannot focus on. Sometimes, things we do not see, we may not believe really exist. Way back when aspiring masters of illusion, the pharmaceutical marketeers , first realized their products carried harmful and sometimes lethal effects, they were presented with a daunting dilemma.
As they do today, they desired desperately to peddle their synthetic concoctions in the largest possible volume, regardless of consequence to the public. Their self-serving, profit-driven desire was to minimize the focus on the harmful properties within their synthetic products. Certainly, they must have initially wished they could just push these marketing dilemmas off the table, or at least, off to the side.
Resorting to psychology, they soon discovered that inference is often a master of problem solving. The power of suggestion! The stark reality is ; the biological monkey wrench is causing damage to the pristine cellular machine from the moment we swallow the synthetic substance. Ninety-nine percent of all drugs marketed only mask cover-up symptoms of underlying problems. These are The Masters of Distraction. Diverting public attention away from the reality of prevention and healing is the crux of their illusion.
Obviously, prevention and healing should be intelligently addressed through cellular support by the natural means for which we are designed. Apparently, we are not supposed to be paying close attention. Ironically, the vast majority of medications treat only symptoms and possess no curative powers. This is one important fact the pharmaceutical industry does not want emphasized; namely that given the proper natural resources, barring overwhelming trauma, intoxification, or infection, the body can and will heal itself!
Many volumes could be written on this subject and the financial conflicts of interest existing within a bureaucracy intended to protect the public. The result of decades of manufactured public blind faith in this approval system, in addition to the blind faith in practitioners who have forcibly become little more than Cartel sales persons, has rendered the masses perfect clients of Mr. Then he dramatically raised the price! The television ads at present are no less than hilarious.
Currently, they are telling us to take a pill rather than be annoyed with the prospect of having to urinate between baseball innings. Unfortunately, this pill may at the very least induce uncontrollable gambling urges, in conjunction with extremely vivid, horrifically violent and brutal nightmares all documented side-effects.
If you suffer from osteoporosis low bone mineral density , do not concern yourself with calcium and mineral supplementation - certainly not. Just pop the latest synthetic masterpiece, linked to osteonecrosis of the jaw, causing bone tissue to die and never regenerate, and be done with it!
If you would like to quit smoking, never mind will-power, your flavor-of-the-month awaits in a doosie that is likely, according to their winking tortoise, to send you into fits of chronic vomiting. Take all five together and you could sit in your chair for hours, feeling no tingles, passing no fluids, unable to rise, unable to speak, and vomiting on yourself in the name of modern medicine.
Maybe it is among those that do not reveal themselves right away. Could it be one of those the FDA does not require announcing to the silly unassuming consumer? Losing this dangerous game of health roulette is not always immediately apparent. Many times, the cellular damage caused by these synthetic concoctions may not surface for months or even years.
Our health care system, if properly restructured, would profit enormously, not by being a self-preserving drain on the patient, but by providing true heath care with the main focus on prevention. The Tricks of the Trade. How do they frighten us away from what is good for us — what was designed for us, and lure us towards harmful synthetic products-for-profit?
The key tool used is misinformation. The tactics are profitable and the result over time on public perception, and consequently public health, is a manufactured disaster. Organic aluminum is present in many common fruits and vegetables such as bananas, cucumbers, and tomatoes. Inorganic aluminum is a toxic and potentially harmful metal.
The plant has processed the inorganic mineral because we need the organic mineral. You can not die eating organically grown bananas, cucumbers, and tomatoes. You can only become healthier! Another classic example is the attack on natural Vitamin E and other naturally derived vitamins. None of the other seven naturally occurring components of vitamin E were added. They conveniently failed to inform the public that they were using synthetically produced vitamin E.
They did not go as far as to warn against almonds, avocado, olives, and spinach - all wonderful sources of natural Vitamin E. These types of covert and diabolical side shows are a flagrant abuse of the public trust and inevitably culminate in the deterioration of public health! Nowhere was it mentioned that dehydrated powered eggs contain oxidized cholesterol, which was the cause of the elevation in abnormal lipids.
Who would eat rotten eggs containing rancid fat, except unsuspecting pawns in a misguided experiment designed to perpetuate misinformation to confuse and frighten the public? Typically, eggs do not raise cholesterol levels. They are a wonderful source of protein and other beneficial nutrients. They are indirectly one of the leading causes of the rising rates of degenerative diseases. The wonderful and positive news which I am about to share with you can and will change your life.
In all probability it will also extend your life if you take it to heart and take simple action. According to the U. Iatrogenic death is a term defining patient death as a direct result of treatments by a physician, whether from misdiagnosis of the ailment, or adverse drug reactions used to treat the illness. Drug reactions are the most common cause of iatrogenic death.
Although an argument seems to exist as to who rightfully receives credit for the show position, 3 , concerning hundreds of thousands of needless deaths, the diseases or the doctors , one thing is curious for certain: As of the printing of this publication, the public is unable to access this information on the American Medical Association web-site.
For this reason, they argue, The Establishment is responsible, directly or indirectly, for every death involving disease which may have been prevented or cured, had the patient been properly informed. Most doctors are not aware of, or perpetrating any conspiracy, they are simply being misled. As you read the information to follow, it may become more than apparent that if the American Medical Association AMA would allow doctors to PROPERLY instruct patients in regard to health, over time we would see no diseases outranking accidents, drastic reductions in all disease figures across the board, and very little deaths if any caused by doctors.
To give credit where credit is due, probably the greatest technological advance in modern medicine is the treatment for crisis situations. Surgical procedures have been developed that accomplish miraculous results. Where would we be, for example, without the skilled emergency room doctor, surgeon, and staff when we are burned, poisoned, or injured by accident? Emergency surgery can be life saving in the case of heart attack, stroke, or the removal of a tumor to name just a few.
Unfortunately, we have been conditioned to rely on drugs and surgery to correct the majority of our ills. The need for most surgeries could certainly be avoided in the first place if the patient was not permitted to deteriorate for decades due to misinformation and a complete lack of prevention.
Most doctors practicing today, regardless of their specific field, are wonderful caring individuals. It is the entrenched profit-based policies of The Establishment system which are to blame for the miserable track record of modern medicine … not the doctors.
The word standard no longer refers to the qualities of high or low, excellent or poor. It now means that you do what everybody else is doing; even though no vote on the matter has been taken.
The neuroses of arrogance and dogma have made medicine self-destructive and severely impaired its capacity for creative or dissident thinking. It has always been the dissident thinker which has caused the art and the science of medicine to advance and flourish.
The pharmaceutical complex provides research grants, contracts and advertising support responsible for the existence for the many thousands of journals published each year.
This guarantees virtual control over scientific and medical direction and thought. The result has been highly profitable. The great majority of physicians are honest, dedicated, and sincere scientists.
Such treatment destroys the sound sentiments, the sincerity and the self-confidence of pupils and produces a subservient subject. The doctors today are working with the tools they are permitted to utilize by establishment policy , primarily drugs.
The majority of these brilliant, well-intentioned practitioners have become the subservient subjects. This will be further discussed, but for now it is most important to understand the current epidemic of disease upon our society and the solution.
Currently, one in three Americans are expected to contract some type of cancer in their lifetime. Over million Americans suffer from some form of digestive disease, 80 million Americans suffer from arthritis, 61 million Americans almost one-fourth of the adult population live with active cardiovascular disease, 21 million suffer from diabetes, 18 million from obstructive sleep apnea OSA , and 50 million Americans are afflicted with tinnitus, to mention the tip of the iceberg.
The young are developing diseases which will be diagnosed in their later years. Diseases are out of control in America and they are fueled by the allopathic philosophy of the main-stream medical establishment, which focuses on symptoms rather than prevention and the causes of disease.
This philosophy is the imposed will of Big Pharma. More and more people do not have the energy they need to get through the day while millions of others are suffering with degenerative disease.
Millions more await diagnosis due to the fact that the overwhelming majority of the population are experiencing cellular starvation and premature aging, - no matter how much food they consume. As previously defined; the term phytonutrient is derived from the Greek word phyto meaning plant, and nutrient ; a constituent of food, vital for physiological function.
Phytonutrients are biologically active compounds in plant-derived foods that elicit biological activity in the body. Phytonutrients are necessary for optimum health due to their vast array of cellular functions. Phytonutrients stimulate our immune and natural detoxification systems. According to United States Department of Agriculture USDA , phytonutrients may serve as antioxidants, enhance immune response, enhance cell to cell communication, cause cancer cells to die, and repair DNA damage.
As we will be discussing, many of the benefits mentioned here are just the tip of the iceberg. Now let us ponder that statement for a moment. It was the bolded words; they apparently. It is as if they are distressed in having to announce this. Hundreds, if not thousands of reputable scientific studies confirm it, and they are using the words they apparently.
Apparently, it would have been a very good idea to send every citizen a notice in the mail! If they were worried about the postage costs, they could have coordinated with the IRS and slipped the notice in with the tax correspondence.
The USDA goes on to state that isoflavones may reduce the risk of heart disease, osteoporosis, and several types of cancer, and certain flavonoids in blueberries may actually reverse nerve cell aging and a wide array of compounds in fruits and vegetables may protect cell components against oxidative damage as well as vitamins C or E. Yes, you read correctly. Flavonoids reverse cell aging. Keep in mind that all these wonderful benefits stated are isolated to only what they currently understand, or choose to disclose concerning these majestic bio-active living constituents.
Upon reading this, an intelligent person may surmise that these are just a few minor points that make the difference between disease, suffering, and pre-mature death, verses a long and healthy life.
Throughout this book I will periodically prompt you to ask yourself a question such as: Why has this information been kept on the sidelines? As mildly indicated here by these two government bodies, and confirmed by hundreds of research studies conducted worldwide, the cures are clearly designed into the plants and subsequently the foods, in the form of these disease fighting bioactive substances.
Provided that the necessary minerals and nutrients are found in the soil, the vital phytonutrients will be produced in the plant, but again, herein lies the problem. The food we eat today is far removed from what our grandparents or great-grandparents ate.
Most food was grown locally and was consumed within a few days of being picked or caught. It was not sprayed with preservatives, mold inhibitors, or waxes. The soil was rich with nutrients and essential minerals, yielding crops high in the same. The healthy soil had a living environment containing nitrogen-fixing bacteria, minerals, and was alive with rich organic matter. This is no longer the case. The overwhelming majority of the modern day food supply is grown in depleted soils void of the necessary components needed to produce sufficient vital life-saving phytonutrients.
The prevention of, and the cure for the majority of degenerative diseases and conditions alike, is already known , and for the main part due to the synergistic effect that these disease fighting bioactive living substances possess when combined, the prevention or cure is basically the same for most.
The cure, and preferably the prevention of the majority of degenerative diseases and conditions, is the consistent daily ingestion of a comprehensive, full spectrum of disease fighting plant-derived bioactive substances, in sufficient amounts, while avoiding harmful substances both on the market and in many cases, approved by the FDA.
Many have been known by scientists and doctors who have been threatened with research funds being cut-off, jobs terminated, and licenses to practice revoked. Today, many a good practicing doctor would love nothing more than to be granted permission to treat their patients effectively.
We are asking them to take medicines we will not take and to submit to operations which we will not permit on ourselves. Imagine living in a prison environment in a foreign country where you receive your news and information from one source. Your television has only one channel and the prison staff, in particular the warden, controls everything you view. If the warden does not want the prison population to view a particular telecast, it will not be broadcast on The Channel. If the warden did not want a particular piece of information to be known, he would sensor that as well.
You would not know if the information you were viewing was accurate, incomplete, or altogether false. If the news looked real on The Channel, you may not even suspect that it was false, incomplete, or slanted in any manner. What the warden decided to broadcast would be all the information you would receive. Sounds like a horrible situation to be in, does it not? It will be no shock to anyone to learn that one of the top purchasers of advertising medium in all the media sources listed above is Big Pharma.
One of the richest industries in the world, the pharmaceutical industry, commands a top position in advertising dollars spent. They certainly do want us to receive their message. Equally as important to them, are messages which they do not want us to receive. This means that they are a very important client of the media in general. News stations owned by networks, as well as independent stations both rely on advertising dollars to survive. It is the same with print and other forms of media as well.
It is simply how they make their money. For the most part we view what has been approved to be released for us to view. Few have more gold than Big Pharma. No business wants to lose one of their largest sources of advertising dollars, especially when the competing media is raking in those Pharma dollars.
Currently, the national media is addicted to the advertising dollars of pharmaceutical companies. The networks and independents alike are heavily dependant upon drug advertising. In most cases, upon review, findings or information contrary to the drug agenda will simply be left out or buried, rather than risk the potential upset of the big client.
Henceforth in many cases, as with any other industry, the mere presence of money and power influences action or inaction. Income represents the quality of content a media outlet can produce. If they cannot match the competition in desirable content, viewer ratings will drop, and in time, they are out of the game. This gives Big Pharma, Big Clout , placing the drug industry in the position of unwritten censorship control.
The Cartel holds the cards. They have the power to influence what is printed, broadcast, and what remains unseen. Profits from drug sales are King. This is their system. We can be wise or blind to these facts - the choice is ours. This is the state of the world we live in. The harsh reality is the world and what we see is controlled by money and greed, not compassion, and thus the The Plague proliferates. Oh, those beautifully choreographed, softly-lit, just out-of-focus Big Pharma ads.
Who else is capable of such masterful displays of heartfelt emotion? Who else has an unlimited production and advertising budget? Oh the way they feel and flow, with just the right touch of slow-mo. The happy, healthy participants portray the vision of the way a splendid life should be. They are against the human design and thus produce one hundred thousand plus annual deaths, and approximately 2. Some say the number of unreported deaths and maiming is incalculable. Did you know that in recent years the Pharma Cartel has been charged with registered complaints of crimes against humanity for systematically obstructing and even fighting the prevention and the eradication of diseases?
Big Pharma invests millions in campaign contributions designed to benefit their interests and promote their agendas. Not only will some candidates promise to support certain policies and bills prior to being elected, but after gaining office, they will then be obligated to repay the favors in the form of passing various legislations which benefit their big contributor and hinder natural manufacturers.
The corruption does not stop with politicians. These corrupt systems of influence are outrageous conflicts-ofinterest, literally killing the American public.
We are deteriorating and dying while being misled, robbed, and taken for fools. The latest variety of drug propaganda ads utilize cartoons in an attempt to appeal to a paying public whom they perceive as mindless.
Ask your doctor about…XYZ. Thousands of scientists, researchers, and even the USDA have conceded that phytonutrients enhance cell-to-cell communication and immune response, detoxify carcinogens, repair DNA damage, and cause cancer cells to die, as the tip of the iceberg.
Can you imagine if a synthetic drug were created which would accomplish just a fraction of all this? Why, it would be the largest selling pharmaceutical of all time, despite the inevitable side effects. I really liked everything about the book. In her book, Ms. I found the similarity fascinating as to how both our topics, unrelated in subject matter, were identical in regard to big business withholding life-empowering information from the public.
I personally know of two people whose emotional lives have been saved by the information in that little book, but that is not my point here. Indeed, it is those who are in control, in general, who do not want certain secrets revealed. We must first understand that which has been hidden from us; The Keys to Health, Youth, and Longevity.
Adequate and quality cellular nutrition in relation to cell health, longevity, and disease prevention is a proven and undisputed scientific fact recognized for decades by the scientific community.
These components enable cells to communicate with other cells and with the immune system to perform an entire array of health functions including; the elimination of foreign invaders such as viruses, harmful bacteria, and diseased cells. This fascinating discovery has become more fully studied and understood within the last decade.
Numerous multi-functional nutritional components of The Code of Life also play an array of cellular support, detoxification, and nourishment roles within The Universal Spectrum of Life, as many of the components of The Spectrum equally help promote optimal communication within The Code. The healthy or optimum orchestration of The Symphony of Life within us is entirely dependant upon the quality and quantity of nutritional components including The Code within The Universal Spectrum of Life.
The full spectrum of age and disease fighting nutrients and bio-active phytonutrients. The complete, harmonious, and synergistic bio-chemical activity orchestrating every physiological function occurring throughout the entire human body. All are critical to our health and survival, and in essence,. These are the basic concepts of health which have been obscured by the pharmaceutical drug establishment.
They are factually the hidden keys to health, healing, disease prevention, youth, beauty, anti-aging, and longevity. This is what humans are designed to receive. They are the intended fuel and medicine by design. If a scientist knows the chemical pathway, and he is not so much concerned with what he does not understand or will inevitably create, then it is possible for him to produce almost anything in an inexpensive, synthetic manner in a laboratory.
Through mirror imaging, synthetic vitamins and minerals are synthesized by the pharmaceutical and chemical industries from many of the same starting materials that drugs are made from, primarily; coal tar, petroleum products, animal by-products, waste, shells, and inorganic minerals.
Synthetic vitamins possess limited, laboratory created mirror-image components isolated synthetic parts. Everyone just assumes a vitamin is a vitamin. Those known are limited in number, in contrast to the Grand Natural Design, for certainly there will be many more discoveries of additional components found within the entire plant complex. A prime example of this is Aloe vera. Another example would be some of the co-factors found to accompany plant-derived Vitamin C, which are various bioflavonoids.
These micro-nutrient co-factors are indispensable for proper Vitamin C absorption and maximum utilization. As stated, synthetic vitamins possess a laboratory created mirror-image component, out of an entire complex or family of micronutrients or co-factors that accompany the vitamin in its natural phytonutrient state.
The term fractionated refers to an isolated portion or just a part of the original natural molecular complex. They are the living cellular fuel of rejuvenation.
But what may be more important is the fact that synthetic vitamins, prepared from chemicals instead of nature, are frequently less active biologically than their natural counterparts, thereby reducing any beneficial effect they may have. For example, Vitamin E is a fat-soluble vitamin that exists in eight different forms. Each form has its own biological activity. Antioxidants such as vitamin E in their natural state act to protect your cells against the effects of free radicals, play a role in immune function, in DNA repair, and other metabolic processes.
The synthetic form of Vitamin E displays only one third to one half the biological activity as the natural form. Furthermore, the synthetic form interferes with the utilization of the natural one.
Some health problems have been associated with the synthetic form. This is true of vitamins A, beta-carotene, C, D, and E. Purposely using the synthetic and isolated vitamins in these experiments paints a fraudulent picture of vitamins in general for the public. The small loss in vitamin revenue is re-captured many fold with increased pharmaceutical sales. They are hedged and positioned to profit either way. Under the heavy influence of Big Pharma, the mainstream medical establishment views the human body as more or less a machine-like mechanism made up of individual, and at times, replaceable parts.
If an organ malfunctions, they administer a drug to alter its function, or if need be, remove it or attempt to replace it with a new organ. The human body is in fact much greater than simply the sum of its parts. We are vastly multi-dimensional, composed of matter and interacting energy. Our parts work in synergy, each cell, each organ dependant upon the welfare and health of the other. Life has been created for life, and life sustains life. The Body is comprised of many systems, for example; the digestive, nervous, cardiovascular, respiratory, eliminatory, immune, cutaneous skin , musculoskeletal, energy, or glandular systems.
The optimal function of all these areas of the body are dependent upon and synergistic with one another, beginning with the digestive tract. The digestive tract must be operating at optimum health and efficiency in order to provide all areas of the body simultaneously with adequate nutrition. The degree to which our cells are effectively supported and communicating is the degree of protection we possess against aging and disease. For this reason, it would be preferable to consistently ingest more of the vital components than our bodies actually need, than to starve the cell to any degree.
Scientific review supports the use of a wide variety of phytonutrients and it appears that the more antioxidant and phytonutrient protection we provide to our bodies …the better. The perfect anti-aging, anti-disease philosophy becomes; "Every vital nutrient must be available within the body — for the support of the cell.
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Investigation of the effect of silicon powder on the performance of Pericarp of mangosteen controls clinical microbes. Meconium in urine shows the pt has a fistula between the rectum and the urinary tract. Flat "bottom" or perineum lack of intergluteal fold , and absence of anal dimple indicates poor muscles and a rather high malformation needing a colostomy. Patients with no clinical signs at 24 hours of birth will need a invertogram or cross-table lateral film in prone position to decide rectal pouch position.
Those cases with high defect are initially managed with a totally diverting colostomy. Diverting the fecal stream reduces the chances of genito-urinary tract contamination and future damage. These infants require a colostomy before final corrective surgery.
The colostomy can be done electively before discharge from the nursery while the GI tract is decompressed by dilatation of the fistulous tract. A single orifice is diagnostic of a persistent cloacal defect usually accompany with a small-looking genitalia. Cloacas are associated to distended vaginas hydrocolpos and urologic malformations. This makes a sonogram of abdomen very important in the initial management of these babies for screening of obstructive uropathy hydronephrosis and hydroureter.
Hydrocolpos can cause compressive obstruction of the bladder trigone and interfere with ureteral drainage. Failure to gain weight and frequents episodes of urinary tract infections shows a poorly drained urologic system. A colostomy in cloacas is indicated.
Radiological evaluation will be of help along with a diverting colostomy in this cases. Perineal fistulas can be managed with cutback without colostomy during the neonatal period. The most important prognostic characteristic is the severity of the IA. Patients with low IA have a good probability of having normal stool patterns.
Patients with high IA report more problems such as fecal incontinence and constipation. For patients who cannot maintain normal bowel function, the use of a special diet, underpants liners, enemas and drugs have ameliorated their lives. Long-term follow up with both qualitative and quantitative quality of life considerations of these patients is very important.
References 1- Chen CJ: The treatment of imperforate anus: J Pediatr Surg 34 Inheritance of familial congenital isolated anorectal malformations: Am J Med Genetics Do children with repaired low anorectal malformations have normal bowel function?
J Pediatr Surg 32 6: Semin Pediatr Surg 4 1: Management of anorectal malformations during the newborn period. World J Surg 17 3: Posterior sagittal approach for the correction of anorectal malformations.
Surgical treatment of high imperforate anus. World J Surg 9 2: J Pediatr Surg 17 5: Although intussusception can occur at any age, the greatest incidence occurs in infants between months of age. Over half of the cases are in the first year of life. Frequently occurs after a recent upper respiratory infection, by Adenovirus type 3 that causes a reactive lymphoid hyperplasia that act as lead point of Peyer's patch.
Meckel's diverticulum, polyps, Henoch's Schonlein purpura, hematoma, lymphoma, foreign bodies, and duplications. Most children have no lead point and it is felt that enlarged mesenteric nodes or swollen Peyer's patches may be the cause. The baby has intermittent periods of severe discomfort with screaming, stiffening and drawing up of the legs, followed by periods of rest.
Vomiting may occur and bloody, mucoid currant jelly stool may be passed. The baby may become dehydrated and appear acutely ill. Frequently, lethargy may be an early sign. To be successful, the barium must reflux into the terminal ileum. The surgeon should be notified before an attempt at barium reduction, and should be present at the time of study. Recently the use of gas enema reduction has been successful in patients with: Ultrasonography can be used as a rapid sensitive screening procedure in the initial diagnosis of intussusception.
Previous adverse clinical features that precluded barium reduction can be replaced during gas reduction. Predictors of failure of reduction are: Air reduction pneumocolon is a very effective alternative method since it brings less radiation shorter flouroscopy time , less costs and less morbidity in cases of perforations.
Failure of hydrostatic reduction requires urgent operation through a right lower quadrant horizontal incision. The intussusception is reduced by pushing on the distal bowel like a tube of toothpaste rather than pulling the proximal bowel.
Most cases are ileo-colic intussusception, and a few are jejuno-jejunal or ileo-ileal intussusception. The traditional method of diagnosing and managing ileo-colic intussusception is barium enema contrast reduction. In China where this is the most common surgical emergency in childhood, pneumatic reduction has been used for more than 25 years. A recent tendency toward this approach is seen in recent years in Occident.
Small bowel aeration is a sign of complete reduction. Gas enema reduction is very successful in patients with: The condition can occur in an isolated form either localized to colon or disseminated throughout the bowel , or associated to other diseases such as Hirschsprung's HD , neurofibromatosis, MEN type IIB, and anorectal malformations. Clinically two different types of isolated IND have been described: Type A shows symptoms of abdominal distension, enterocolitis, bloody stools, intestinal spasticity in imaging studies Ba Enema since birth, is less common and associated with hypoplasia of sympathetic nerves.
Type B is more frequent, symptoms are indistinguishable from that of HD, with chronic constipation, megacolon, and repeated episodes of bowel obstruction. Management depends on clinical situation; conservative for minor symptoms until neuronal maturation occurs around the 4th year of life, colostomy and resectional therapy for life threatening situations.
The most common congenital diaphragmatic hernia CDH is that which occurs through the postero-lateral defect of Bochdalek. It is caused by failure of the pleuroperitoneal membrane to develop adequately and close before the intestines returning to the abdomen at the tenth week of gestation.
The intestines then enter the pleural cavity and cause poor lung development leading to pulmonary hypoplasia a reduced number of alveoli per area of lung tissue. This defect is postero-lateral in the diaphragm and may vary in size. Stomach, liver or spleen may be partly in chest as well.
The clinical presentation is that the newborn becomes rapidly cyanotic, acidotic, and has poor ventilation. Major findings relate to the degree of pulmonary maldevelopment. Chest films will show intestines in the chest. Placement of a radiopaque nasogastric tube may show the tube coiled in the lower left chest.
Higher risk factors are: Treatment consist of rapid intubation and ventilation with use of muscle relaxants, placement of a nasogastric tube to prevent gaseous distension of the intestines and preoperative stabilization of arterial blood gases and acid-base status. Surgery can be undertaken when one of the following objectives are met: Operative management consist of abdominal approach, closure of hernia by primary repair or use of mesh, and correction of malrotation. Postoperative management is very difficult.
Due to hypoplastic lungs, there is frequently pulmonary hypertension leading to right-to-left shunting and progressive hypoxemia, hypercarbia, and acidosis that worsens the pulmonary hypertension. The use of chest tubes may cause overstretching of the already hypoplastic alveoli causing: Postoperatively, the infant should be kept paralyzed and ventilated and only very slowly weaned from the ventilator. The severity of pulmonary hypoplasia, both ipsilaterally and contralaterally, is the main determinant of outcome.
ECMO extracorporeal membrane oxygenator has come to reduce somewhat the mortality of this condition. The mortality of CDH is directly related to the degree of lung hypoplasia associated. Death is caused by persistent pulmonary hypertension and right ventricular failure. Prospective studies of prenatally diagnosed fetus prior to 25 wk.
This unsolved problem has prompted investigators to develop new treatment options such as preoperative stabilization, jet-frequency ventilation, and ECMO. Another area of development is intrauterine fetal surgical repair. To achieve success fetal surgery should: Intrauterine repair has meet with limited success due to herniation of the fetal liver into the chest through the defect. Disturbance of the umbilical circulation during or after liver reduction causes fetal death.
Positive-pressure ventilation after birth reduces the liver before the baby comes for surgical repair. Harrison USFC Fetal Treatment Center has devised separate fetal thoraco-abdominal incisions to deal with this problem "two-step dance" , reducing or amputating the left lateral segment of the liver.
Another less invasive approach is enlarging the hypoplastic lungs by reducing the normal egress of fetal lung fluid with controlled tracheal obstruction called PLUGS Plug Lung Until it Grows. Infants and children will present with either respiratory or gastrointestinal symptoms such as: Occasionally the child is asymptomatic. A rise intrabdominal pressure by coughing or vomiting transmitted to any defect of the diaphragm makes visceral herniation more likely.
Diagnosis is confirmed by chest or gastrointestinal contrast imaging. Management consists of immediate surgery after preop stabilization.
Most defects can be closed primarily through an abdominal approach. Chest-tube placement in the non-hypoplastic lung is of help. Surgical results are generally excellent. A few deaths have resulted from cardiovascular and respiratory compromise due to visceral herniation causing mediastinal and pulmonary compression.
First described in , Morgagni Hernias MH are rare congenital diaphragmatic defects close to the anterior midline between the costal and sternal origin of the diaphragm. Almost always asymptomatic, typically present in older children or adults with minimal gastrointestinal symptoms or as incidental finding during routine chest radiography mass or air-fluid levels. Infants may develop respiratory symptoms tachypnea, dyspnea and cyanosis with distress. Cardiac tamponade due to protrusion into the pericardial cavity has been reported.
US and CT-Scan can demonstrate the defect. Trans-abdominal subcostal approach is preferred with reduction of the defect and suturing of the diaphragm to undersurface of sternum and posterior rectus sheath. Large defects with phrenic nerve displacement may need a thoracic approach.
Results after surgery rely on associated conditions. Two types of esophageal hernia recognized are the hiatal and paraesophageal hernia. Diagnosis is made radiologically always and in a number of patients endoscopically. The hiatal hernia HH refers to herniation of the stomach to the chest through the esophageal hiatus. The lower esophageal sphincter also moves. It can consist of a small transitory epiphrenic loculation minor up to an upside-down intrathoracic stomach major.
HH generally develops due to a congenital, traumatic or iatrogenic factor. Most disappear by the age of two years, but all forms of HH can lead to peptic esophagitis from Gastroesophageal reflux.
Repair of HH is determined by the pathology of its associated reflux causing failure to thrive, esophagitis, stricture, respiratory symptoms or the presence of the stomach in the thoracic cavity. In the paraesophageal hernia PH variety the stomach migrates to the chest and the lower esophageal sphincter stays in its normal anatomic position.
PH is a frequent problem after antireflux operations in patients without posterior crural repair. Small PH can be observed. With an increase in size or appearance of symptoms reflux, gastric obstruction, bleeding, infarction or perforation the PH should be repaired. The incidence of PH has increased with the advent of the laparoscopic fundoplication.
A hernia is defined as a protrusion of a portion of an organ or tissue through an abnormal opening. For groin inguinal or femoral hernias, this protrusion is into a hernial sac. Whether or not the mere presence of a hernial sac or processus vaginalis constitutes a hernia is debated. Inguinal hernias in children are almost exclusively indirect type. Those rare instances of direct inguinal hernia are caused by previous surgery and floor disruption.
An indirect inguinal hernia protrudes through the internal inguinal ring, within the cremaster fascia, extending down the spermatic cord for varying distances. The direct hernia protrudes through the posterior wall of the inguinal canal, i. The embryology of indirect inguinal hernia is as follows: During the third month of gestation, the processus vaginalis extends down toward the scrotum and follows the chorda gubernaculum that extends from the testicle or the retroperitoneum to the scrotum.
During the seventh month, the testicle descend into the scrotum, where the processus vaginalis forms a covering for the testicle and the serous sac in which it resides. At about the time of birth, the portion of the processus vaginalis between the testicle and the abdominal cavity obliterates, leaving a peritoneal cavity separate from the tunica vaginalis that surrounds the testicle.
The typical patient with an inguinal hernia has an intermittent lump or bulge in the groin, scrotum, or labia noted at times of increased intra-abdominal pressure. A communicating hydrocele is always associated with a hernia. This hydrocele fluctuates in size and is usually larger in ambulatory patients at the end of the day. If a loop of bowel becomes entrapped incarcerated in a hernia, the patient develops pain followed by signs of intestinal obstruction.
If not reduced, compromised blood supply strangulation leads to perforation and peritonitis. Most incarcerated hernias in children can be reduced.
Associated to these episodes of incarceration are chances of: Symptomatic hernia can complicate the clinical course of babies at NICU ill with hyaline membrane, sepsis, NEC and other conditions needing ventilatory support.
Repair should be undertaken before hospital discharge to avoid complications. Postconceptual age sum of intra- and extrauterine life has been cited as the factor having greatest impact on post-op complications. These observation makes imperative that preemies with post conceptual age of less than 45 weeks be carefully monitored in-hospital for at least 24 hours after surgical repair of their hernias.
Outpatient repair is safer for those prematures above the 60 wk. The very low birth weight infant with symptomatic hernia can benefit from epidural anesthesia.
At times, the indirect inguinal hernia will extend into the scrotum and can be reduced by external, gentle pressure. Occasionally, the hernia will present as a bulge in the soft tissue overlying the internal ring. It is sometimes difficult to demonstrate and the physician must rely on the patient's history of an intermittent bulge in the groin seen with crying, coughing or straining. Elective herniorrhaphy at a near convenient time is treatment of choice. Since risk of incarceration is high in children, repair should be undertaken shortly after diagnosis.
Simple high ligation of the sac is all that is required. Pediatric patients are allowed to return to full activity immediately after hernia repair. Bilateral exploration is done routinely by most experienced pediatric surgeons. Recently the use of groin laparoscopy through the hernial sac permits visualization of the contralateral side. Testicular feminization syndrome TFS is a genetic form of male pseudohermaphroditism patient who is genetically 46 XY but has deficient masculinization of external genitalia caused by complete or partial resistance of end organs to the peripheral effects of androgens.
This androgenic insensitivity is caused by a mutation of the gene for androgenic receptor inherited as an X-linked recessive trait. In the complete form the external genitalia appear to be female with a rudimentary vagina, absent uterus and ovaries.
The incomplete form may represent undervirilized infertile men. This patients will never menstruate or bear children. Early gonadectomy is advised to: Vaginal reconstruction is planned when the patient wishes to be sexually active.
These children develop into very normal appearing females that are sterile since no female organs are present. A hydrocele is a collection of fluid in the space surrounding the testicle between the layers of the tunica vaginalis.
Hydroceles can be scrotal, of the cord, abdominal, or a combination of the above. A hydrocele of the cord is the fluid-filled remnant of the processus vaginalis separated from the tunica vaginalis. A communicating hydrocele is one that communicates with the peritoneal cavity by way of a narrow opening into a hernial sac.
Hydroceles are common in infants. Some are associated with an inguinal hernia. They are often bilateral, and like hernias, are more common on the right than the left. Most hydroceles will resolved spontaneously by years of age. After this time, elective repair can be performed at any time.
Operation is done through the groin and search made for an associated hernia. Aspiration of a hydrocele should never be attempted. As a therapeutic measure it is ineffective, and as a diagnostic tool it is a catastrophe if a loop of bowel is entrapped. A possible exception to this is the postoperative recurrent hydrocele. The undescended testis is a term we use to describe all instances in which the testis cannot be manually manipulated into the scrotum.
The testes form from the medial portion of the urogenital ridge extending from the diaphragm into the pelvis. In arrested descent, they may be found from the kidneys to the internal inguinal ring. Rapid descent through the internal inguinal ring commences at approximately week 28, the left testis preceding the right. Adequate amounts of male hormones are necessary for descent.
The highest levels of male hormones in the maternal circulation have been demonstrated at week Thus, it appears that failure of descent may be related to inadequate male hormone levels or to failure of the end-organ to respond.
The undescended testes may be found from the hilum of the kidney to the external inguinal ring. The undescended testis found in 0. Testes that can be manually brought to the scrotum are retractile and need no further treatment. Parents should know the objectives, indications and limitations of an orchiopexy: To improve spermatogenesis producing an adequate number of spermatozoids surgery should be done before the age of two. Electron microscopy has confirmed an arrest in spermatogenesis reduced number of spermatogonias and tubular diameter in undescended testis after the first two years of life.
Other reasons to pex are: The management is surgical; hormonal Human Chorionic Gonadotropin treatment has brought conflicting results except bilateral cases. Surgery is limited by the length of the testicular artery.
Palpable testes have a better prognosis than non-palpable. Laparoscopy can be of help in non-palpable testis avoiding exploration of the absent testis. Viens, MS University of Toronto. An umbilical hernia is a small defect in the abdominal fascial wall in which fluid or abdominal contents protrude through the umbilical ring.
The presence of a bulge within the umbilicus is readily palpable and becomes more apparent when the infant cries or during defecation.
The actual size of the umbilical hernia is measured by physical examination of the defect in the rectus abdominis muscle, and not by the size of the umbilical bulge. The size of the fascial defect can vary from the width of a fingertip to several centimetres.
Embryologically, the cause of an umbilical hernia is related to the incomplete contraction of the umbilical ring. The herniation of the umbilicus is a result of the growing alimentary tract that is unable to fit within the abdominal cavity. Umbilical hernias are more prevalent in females than in males and are more often seen in patients with African heritage.
The increased frequency of umbilical hernias has also been attributed to premature babies, twins and infants with long umbilical cords. There is also a frequent association with disorders of mucopolysaccharide metabolism, especially Hurler's Syndrome gargoylism. Most umbilical hernias are asymptomatic; the decision to repair the umbilical hernia in the first years of life is largely cosmetic and is often performed because of parental request, not because of pain or dysfunction.
In the past, some parents use to tape a coin over the umbilical bulge, however, manual compression does not have an effect on the fascial defect. Treatment of umbilical hernia is observation. However, surgical repair is recommended if the hernia has not closed by the age of five. The incidence of incarceration trapped intestinal loop is rare, even in larger defects.
Females should especially have their umbilical hernia corrected before pregnancy because of the associated increased intra-abdominal pressure that could lead to complications. The procedure is simple and incidence of complication such as infection is extremely rare. The repair is usually done as outpatient surgery under general anesthetic.
Inguinal and umbilical hernia repair in infants and children. Surg Clinics of North Am 73 3: Swenson's Pediatric Surgery - 5th edition. The developing human - 4th edition.
Philadelphia, WB Saunders, pp. Some observations on umbilical hernias in infants. The comparative incidence of umbilical hernias in colored and white infants. J Natl Med Assoc The three most common abdominal wall defect in newborns are umbilical hernia, gastroschisis and omphalocele.
Omphalocele is a milder form of primary abdominoschisis since during the embryonic folding process the outgrowth at the umbilical ring is insufficient shortage in apoptotic cell death. Defect may have liver, spleen, stomach, and bowel in the sac while the abdominal cavity remains underdeveloped in size. The sac is composed of chorium, Wharton's jelly and peritoneum. The defect is centrally localized and measures cm in diameter.
A small defect of less than 2 cm with bowel inside is referred as a hernia of the umbilical cord. Epigastric localized omphalocele are associated with sternal and intracardiac defects i. Cardiac, neurogenic, genitourinary, skeletal and chromosomal changes and syndromes are the cornerstones of mortality. Cesarean section is warranted in large omphaloceles to avoid liver damage and dystocia.
After initial stabilization management requires consideration of the size of defect, prematurity and associated anomalies. Primary closure with correction of the malrotation should be attempted whenever possible.
Antibiotics and nutritional support are mandatory. Manage control centers around sepsis, respiratory status, liver and bowel dysfunction from increased intraabdominal pressure. The protruding gut is foreshortened, matted, thickened and covered with a peel. The IA might be the result of pressure on the bowel from the edge of the defect pinching effect or an intrauterine vascular accident.
Rarely, the orifice may be extremely narrow leading to gangrene or complete midgut atresia. In either case the morbidity and mortality of the child is duplicated with the presence of an IA. Alternatives depend on the type of closure of the abdominal defect and the severity of the affected bowel. With primary fascial closure and good-looking bowel primary anastomosis is justified. Angry looking dilated bowel prompts for proximal diversion, but the higher the enterostomy the greater the problems of fluid losses, electrolyte imbalances, skin excoriation, sepsis and malnutrition.
Closure of the defect and resection with anastomosis two to four weeks later brings good results. Success or failure is related to the length of remaining bowel more than the specific method used. Initially do an Apt test to determine if blood comes from fetal origin or maternal origin blood swallowed by the fetus. If this coagulation profile is normal the possibilities are either stress gastritis or ulcer disease.
If the coagulation profile is abnormal then consider hematologic disease of the newborn and manage with vitamin K. The apt test is performed by mixing 1 part of vomitus with 5 part H2O, centrifuge the mixture and remove 5 ml pink. If the coagulation profile is abnormal give Vit K for hematologic disorder of newborn.
If it's normal do a rectal exam. A fissure could be the cause, if negative then consider either malrotation or Necrotizing enterocolitis. The stress includes prematurity, sepsis, hypoxia, hypothermia, and jaundice. These babies frequently have umbilical artery, vein catheters, have received exchange transfusions or early feeds with hyperosmolar formulas.
The intestinal mucosal cells are highly sensitive to ischemia and mucosal damage leads to bacterial invasion of the intestinal wall. Gas-forming organisms produce pneumatosis intestinalis air in the bowel wall readily seen on abdominal films. Full-thickness necrosis leads to perforation, free air and abscess formation. These usually premature infants develop increased gastric residuals, abdominal distension, bloody stools, acidosis and dropping platelet count.
The abdominal wall becomes reddened and edematous. There may be persistent masses and signs of peritonitis. Perforation leads to further hypoxia, acidosis and temperature instability. The acid-base status is monitored for worsening acidosis and hypoxia.
The white blood cell count may be high, low or normal and is not generally of help. Serial abdominal films are obtained to look for evidence of free abdominal air, a worsening picture of pneumatosis intestinalis, or free portal air.