bluuebunny/crossref_metadata_2025 huggingface dataset:
Venoruton® vs Daflon®: Evaluation of Effects on Quality of Life in Chronic Venous Insufficiency
Authors: Cesarone M. R. , Belcaro G. , Pellegrini L. , Ledda A. , Vinciguerra G. , Ricci A. , Di Renzo A. , Ruffini I. , Gizzi G. , Ippolito E. , Fano F. , Dugall M. , Acerbi G. , Cornelli U. , Hosoi M. , Cacchio M.
Published: June 2007

The aim of this independent study was to investigate differences in efficacy between oxerutins (Venoruton) and 500 mg micronized diosmin + hesperidin (D+H) (Daflon) in patients with chronic venous insufficiency (CVI), evaluating venous-related quality of life (Ve-QOL). A first group of 90 patients with severe venous hypertension (CVI, ankle swelling) was randomized to treatment with oxerutins or D+H. The oxerutins group received oral oxerutins (2 g/day); the D+H group received 3 (500 mg) tablets daily every 8 hours for 8 weeks. A second group of 122 comparable patients was included in a registry following the same study format. The 2 treatments were administered with the same methods and procedures. Clinical conditions were comparable. All patients completing 8 weeks of treatment were included in a registry. Specialists or general practitioners included patients when they considered that clinical conditions were compatible with treatment indications using 1 of the 2 treatments on the basis of their evaluation and experience. When cases were compatible with the registry, the prescribing physician communicated the case to our monitoring center. Patients were evaluated without interfering with their treatment. The main target of evaluation for this study was the change in Ve-QOL (range, 0-100) induced by treatment. A specific Ve-QOL questionnaire was used for this study. Ve-QOL score is a specific expression of the changes in QOL induced by CVI in patients between 35 and 75 years old (defined in our population studies) in which no other significant clinical disease is present (as a confounding factor affecting QOL). Two hundred twelve patients completed the 2 parts of the study. The 2 treatment groups were comparable for age and gender distribution. The mean age was 42 years (SD ±5.5) in the oxerutins group and 41.5 (SD ±6) in the D+H group. There were no differences in the severity of CVI between the treatment groups at inclusion. A significant decrease (46.8%, p<0.05) in Ve-QOL score; that is, improvement, was observed in the oxerutins group. The change in Ve-QOL was significantly less in the D+H group (15.5%). In conclusion, CVI, venous microangiopathy, and edema were significantly improved by the treatment with oxerutins; the improvement in QOL was significantly greater in the oxerutins group. The comparison with D+H indicates that oxerutins is comparatively more effective on Ve-QOL and on signs/symptoms of CVI
Accelerated Wound Healing: Multidisciplinary Advances in the Care of Venous Leg Ulcers
Authors: Bongiovanni Cheryl M. , Hughes Michael D. , Bomengen Robert W.
Published: June 2007

The etiologies of venous leg ulcers have been well known for millennia, and yet there remains no simple solution to this very common problem. Achieving closure of venous leg ulcers is often a lengthy process that is further complicated by the presence of significant comorbidities. The authors present data on healing venous leg ulcers in a cohort of 231 patients, most of whom had 1 or more complicating factors. Our multidisciplinary and aggressive approach to healing venous leg ulcers is described and has resulted in an average healing time of 29 days, a significantly shorter duration of treatment than the reported average of 6 months
Noninvasive Tissue Characterization of Coronary Arterial Plaque by 16-Slice Computed Tomography in Acute Coronary Syndrome
Authors: Sakakura Kenichi , Yasu Takanori , Kobayashi Yasuyuki , Katayama Takuji , Sugawara Yoshitaka , Funayama Hiroshi , Takagi Yousuke , Ikeda Nahoko , Ishida Takeshi , Tsuruya Yoshio , Kubo Norifumi , Saito Muneyasu
Published: June 2007

Noninvasive characterization of coronary plaques is challenging for cardiologists. The authors’ goal was to explore the clinical feasibility of newly developed 16-slice computed tomography (CT) in tissue characterization of coronary arterial plaques in patients with acute coronary syndrome. Sixteen patients with acute coronary syndrome underwent 16-slice CT (Aquillion, Toshiba) and coronary arteriography with intravascular ultrasound (IVUS) within 7 days. Twenty-three plaques were classified by IVUS according to plaque echogenicity: 6 soft plaques, 11 intermediate plaques, and 6 calcified plaques. Mean (±SD) CT numbers (Hounsfield units [HU]) of these 3 types of plaques were 50.6 ±14.8 HU, 131 ±21.0 HU, and 721 ±231 HU, respectively. Sixteen-slice CT facilitates noninvasive tissue characterization of coronary arterial plaques.
Cardiac Troponin I Increase After Successful Percutaneous Coronary Angioplasty: Predictors and Long-Term Prognostic Value
Authors: Okmen Ertan , Cam Nese , Sanli Arda , Unal Sennur , Tartan Zeynep , Vural Mutlu
Published: June 2007

After successful percutaneous coronary interventions (PCI), elevations of cardiac enzymes are not rare, but it is still not clear whether those elevations are associated with adverse late outcome. The purpose of the study was to investigate the relation between cardiac troponin I (cTn-I) increase after successful percutaneous intervention and late outcome. The study consisted of 100 consecutive patients (mean age 56 ±9.8, 84% male) who had successful elective coronary balloon angioplasty with or without stent implantation. Patients with stable angina (n=54) and unstable angina (n=46) were included in the study. Blood samples for measurement of cTn-I were taken before and immediately after the procedure, and every 6 hours for the first 24 hours. Patients with preprocedural cTn-I elevation were excluded from the study. Postprocedural cTn-I elevation was detected in 34 patients (34%, troponin (+) group) and cTn-I levels were normal in 66 patients (66%, troponin (-) group). Logistic regression analysis showed that intervention in patients with unstable angina, stent implantation following balloon dilation, and maximal inflation pressure were the predictors of cTn-I elevation (p=0.035, p=0.038, and p=0.014, respectively). During the prospective follow-up period for 21 ±7.5 months, the incidence of major cardiac events including recurrent angina, acute myocardial infarction, death, and revascularization were not different in patients with and without cTn-I elevation. Overall, major cardiac events occurred in 9 patients (26%) in the troponin (+) group and in 13 patients (20%) in the troponin (-) group. Kaplan-Meier survival analysis showed that cTn-I elevation was not an important correlate of overall cardiac events (log-rank: 1.66, p=0.19). The authors conclude that postprocedural cTn-I elevation is related to unstable angina, stent implantation following predilation, and inflation pressure, and there is no association with minor myocardial injury occurring after successful percutaneous coronary intervention and late adverse cardiac events.
Treatment of Essential Arterial Hypertension with Enalapril Does Not Result in Normalization of Endothelial Dysfunction of the Conduit Arteries
Authors: Eržen Barbara , Gradišek Primo , Poredoš Pavel , Šabovič Mišo
Published: June 2007

It is assumed that endothelial dysfunction due to arterial hypertension could be improved or even normalized by antihypertensive treatment. The present study was designed to explore that assumption in patients with essential hypertension treated with an angiotensin-converting enzyme (ACE) inhibitor-enalapril. Twenty-eight patients (mean age: 55.1 years) who fulfilled the following criteria were included: essential arterial hypertension present for more than 2 years, monotherapy with enalapril for at least 1 year, adequate treatment (blood pressure in the last year <140/90 mm Hg) and absence of other factors (smoking, hypercholesterolemia, diabetes, obesity), which could importantly influence endothelial function. The flow-mediated (endothelium-dependent) dilation (FMD) of the brachial artery was assessed by high-resolution ultrasound and compared with that of 22 age-matched healthy normotensive controls. The patients and controls did not differ in regard to body mass index, lipids, and plasma glucose and insulin; there were no smokers. FMD of the brachial artery was significantly decreased in patients in comparison to controls (7.9% vs 13.5%, p<0.01). FMD in patients was inversely correlated with the duration of hypertension ( r =-0.52, p<0.01) and with both systolic ( r =-0.72, p<0.01) and diastolic ( r =-0.43, p<0.05) blood pressure (measured after temporary withdrawal of treatment). This study showed that the adequate control of blood pressure achieved with enalapril is not followed by normalization of endothelial function, measured by FMD of the brachial artery.
Severe Coronary Artery Spasm with Anaphylactoid Shock Caused by Contrast Medium
Authors: Wang Charles Chao-Yung , Chang Shang-Hung , Chen Chun-Chi , Huang Hsuan-Li , Hsieh I-Chang
Published: June 2007

This study reports 2 cases of severe coronary artery spasm with anaphylactoid shock caused by contrast medium. The first patient had anaphylactoid shock in response to contrast medium and severe coronary spasms of both the left anterior descending coronary artery and the left circumflex coronary artery. The patient developed ventricular arrhythmia and complete atrioventricular block following the severe coronary spasm. The second patient had a totally occluded right coronary artery, owing to a spasm after anaphylactoid shock. Anaphylactoid shock should always be considered when persistent shock is noted after the coronary artery spasm has been relieved.
Angiosarcoma in a Pregnant Woman Presenting with Pericardial Tamponade
Authors: Azimi Nassir A. , Selter Jared G. , Abott J. Dawn , Cabin Henry S. , Hutner Anita , Copel Joshua , Setaro John F.
Published: June 2007

Although asymptomatic pericardial effusions are relatively common in pregnancy, their true incidence is not known. Symptomatic effusions are, however, rare in pregnancy. The authors present a rare case of pericardial tamponade complicating pregnancy with resulting diagnosis of angiosarcoma. They review the literature involving pericardial disease in pregnancy and discuss important issues in management and include a discussion of angiosarcoma.
Increased Serum Leptin Concentrations in Patients with Chronic Stable Angina Pectoris and ST-Elevated Myocardial Infarction
Authors: Taneli Fatma , Yegane Selma , Ulman Cevval , Tikiz Hakan , Bilge Ali Riza , Ari Zeki , Uyanik Bekir Sami
Published: June 2007

Leptin is an adipocytokine that is produced mainly by adipose tissue; it is also identified in atherosclerotic lesions in human coronary atherosclerosis. However, the relation of serum leptin concentrations to ischemic heart disease (IHD) is still obscure. The aims of the present study were to investigate serum leptin concentrations in patients with ST-elevated myocardial infarction (STEMI) and with chronic stable angina pectoris (CSAP) and to evaluate the possible correlations of leptin to other atherosclerotic risk factors; including serum high sensitive C-reactive protein (Hs-CRP), serum homocysteine, and fibrinogen concentrations. For this purpose, 35 patients with CSAP, 40 with acute STEMI, and 30 control subjects with normal findings from coronary angiography were taken into the study prospectively. Serum leptin concentrations were significantly higher in patients with CSAP and STEMI compared to the control group (7.74 ±1.34 vs 6.37 ±1.85 ng/mL, p=0.021 and 8.22 ±3.13 vs 6.37 ±1.85 ng/mL, p=0.023, respectively). In addition, serum homocysteine concentrations were significantly increased in patients with CSAP (15.23 ±5.96 vs 11.40 ±2.11 μmol/L, p=0.025) and patients with STEMI (15.90 ±5.02 vs 11.40 ±2.11 μmol/L, p=0.012) compared to the control group. Serum fibrinogen concentrations were significantly increased only in the CSAP group as compared to controls (4.15 ±1.39 vs 3.45 ±1.19 g/L, p=0.025). No significant correlation was found between leptin levels and selected risk factors. In conclusion, serum leptin concentrations were significantly higher in both the CSAP and STEMI groups. However, owing to the lack of correlation between the leptin levels and selected classical coronary risk factors, it may be considered that leptin can be evaluated as one of the independent risk factors for IHD. Further randomized and controlled studies will be required to determine the pathophysiological meaning of the increased leptin levels and the central role between adipocyte function and atherosclerosis.
Sarcomatous Pleural Mesothelioma Metastatic to Left Ventricular Endocardium
Authors: Senkottaiyan Neelavathi , Seacord Lynne M. , Fulling Keith H. , Birchem Jessica A. , Fraley Matthew A. , Alpert Martin A.
Published: June 2007

A 71-year-old man, a cigarette smoker with long-term asbestos exposure, developed multifocal malignant sarcomatous pleural mesothelioma that metastasized to the left ventricular endocardium without invading pericardium, myocardium, or the contiguous pulmonary vein. This is the first reported case of malignant pleural mesothelioma to metastasize in such a manner.
Systemic Versus Coronary Levels of Inflammation in Acute Coronary Syndromes
Authors: Suzuki Makoto , Saito Makoto , Nagai Takayuki , Saeki Hideyuki , Kazatani Yukio
Published: June 2007

To address a possible link between systemic and coronary inflammation in the setting of acute coronary syndromes, the authors examined both levels of 3 inflammatory mediators such as high sensitive C-reactive protein (hs-CRP), interleukin (IL)-6, and matrix metalloproteinase (MMP)-9 in patients with the early phase of acute myocardial infarction (AMI). In total, 20 patients with AMI showing minimal elevation of cardiac enzymes were studied. Before angioplasty, peripheral blood and culprit coronary thrombus were sampled to compare systemic and coronary levels of hs-CRP, IL-6, and MMP-9. Relation of systemic levels of hs-CRP and IL-6 to culprit coronary morphology was also evaluated by the use of intravascular ultrasound. Systemic and coronary levels of hs-CRP were nearly equivalent (4.3 ±5.0 vs 4.7 ±5.4 mg/L, p=0.279), whereas IL-6 and MMP-9 showed higher in coronary levels than in systemic levels (169 ±154 vs 93 ±107 pg/mL, p=0.002 and 164 ±116 vs 103 ±94 ng/mL, p=0.018, respectively). Systemic levels of hs-CRP were correlated with coronary levels of IL-6 (r =0.566, p=0.009). Culprit coronary plaque area demonstrated a positive relation with systemic levels of hs-CRP (r =0.466, p=0.038) and also IL-6 (r =0.707, p<0.001). The present study may provide an important insight into the link between systemic and coronary levels of inflammation, which is also associated with vulnerable coronary morphology in the setting of acute coronary syndromes.
Optimal Duration of Treatment in Surgical Patients With Calf Venous Thrombosis Involving One or More Veins
Authors: Ferrara Filippo , Meli Francesco , Amato Corrado , Cospite Valentina , Raimondi Francesco , Novo Giuseppe , Novo Salvatore
Published: June 2007

The aim of this study was to evaluate different durations of treatment in patients with calf venous thrombosis (CVT) involving 1 or more deep veins. The authors studied 2 groups of patients with postsurgical CVT diagnosed by echo-color Doppler. The first group consisted of 68 patients with CVT involving a single vein, and the second group consisted of 124 patients with CVT involving 2 or more veins. Immediately after diagnosis, all patients were treated with nadroparin calcium and sodium warfarin. Heparin treatment was withdrawn after 5–6 days of treatment, when the international normalized ratio (INR) was stabilized between 2 and 3. Each group was divided into 2 subgroups receiving anticoagulation treatment for 6 or 12 weeks, respectively. The endpoint was proximal extension of the thrombotic lesion, defined as the extension of the thrombus to the popliteal and/or femoral vein. In patients with single-vessel CVT there was no significant difference between the 2 subgroups, whereas in patients with CVT involving 2 or more vessels, a statistically significant difference was observed, the number of cases showing proximal extension of the thrombus being higher among patients treated for 6 weeks. Twelve weeks of anticoagulation treatment is better than 6 weeks only in patients with postsurgical CVT involving 2 or more veins.
The Effect of ACE Gene Polymorphisms on Doppler Blood Flow Parameters of Carotid and Brachial Arteries in Patients With Myocardial Infarction
Authors: Bilici Aslan , Ülgen Mehmet Sıddık , Nazaroğlu Hasan , Öztürk Önder , Ekici Faysal , Akgül Cihan , Alan Bircan
Published: June 2007

The authors investigated the relationship between the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and the blood flow characteristics of common carotid (CCA) and brachial arteries (BA) by color Doppler ultrasound (CDUS) in patients with acute anterior myocardial infarction (AAMI). Sixty four patients (11 women and 53 men), aged 25 to 77 years, with AAMI were studied. The ACE genotypes were established. Peak-systolic (PSV) and end-diastolic velocity (EDV) of right and left CCA, PSV of right BA, and intimal-medial thickness (IMT) of both CCAs were measured by CDUS. All results were evaluated statistically. The ACE genotypes were distributed as follows: 43.8% DD, 43.8% ID, and 12.5% II. PSVs of BA and both CCAs were lower in patients with DD and ID than with II (p<0.05). EDVs of both CCAs were also lower in the same groups, but statistically not significant (p>0.05). IMTs of both CCAs did not differ among patients with various ACE genotypes (p>0.05). These results suggest that ACE I/D polymorphism influences Doppler blood flow parameters of both BA and CCA, but does not affect IMT of CCA.
Serum NT-proBNP Concentrations in the Early Phase Do Not Predict the Severity of Systolic or Diastolic Left Ventricular Dysfunction Among Patients With ST-Elevation Acute Myocardial Infarction
Authors: Ben-Dor Itsik , Haim Moti , Rechavia Eldad , Murninkas Daniel , Harell Daniella , Porter Avital , Iakobishvili Zaza , Battler Alexander , Hasdai David
Published: June 2007

The cohort included 55 consecutive patients with first ST elevation acute myocardial infarction (STEAMI) who underwent reperfusion. Blood samples were drawn for N-terminal pro B-type natriuretic peptide (NT-proBNP), highly-sensitive C-reactive protein (hs-CRP), creatinine kinase (CK), cardiac troponin l (cTnl), and white blood cell (WBC) count within 24 hours of admission. Transthoracic echocardiography, performed within the same time frame, assessed left ventricular (LV) systolic function, as well as diastolic function. Variables significantly associated with poor systolic LV dysfunction were hs-CRP, peak CK, cTnl, and WBC. There was no significant correlation between NT-proBNP and systolic function early after STEAMI (p=0.49). Among patients with diastolic dysfunction, there was no significant correlation between NT-proBNP levels and peak mitral E-wave velocity to peak initial A-wave velocity (E/A ratio) (r =0.19, p=0.18) or E-wave deceleration time ( r =0.22, p=0.15). Thus, NT-proBNP levels in the early phase after STEAMI were not indicative of systolic or diastolic function.
Contribution of Plasma Lipid Disturbances to Vascular Endothelial Function in Patients With Slow Coronary Flow
Authors: Sezgin Alpay Turan , Barutcu Irfan , Sezgin Nurzen , Gullu Hakan , Esen Ali Metin , Acikgoz Nusret , Topal Ergun , Ozdemir Ramazan
Published: June 2007

Previous studies have suggested that microcirculatory abnormalities cause slow coronary flow (SCF). However, the underlying mechanism of this phenomenon has not yet been well documented. Therefore, the aim of this study was to determine the role of plasma lipid disturbances in pathogenesis of slow coronary flow (SCF). Forty patients with SCF (group I) and 37 subjects with normal coronary arteries (group II) were included in the study. In each subject plasma lipid concentrations (total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglyceride [TG]) and brachial artery flow-mediated dilatation (FMD) and nitroglycerin (NTG)-induced dilatation were measured. Total cholesterol level was found to be similar in the 2 groups. In group I, HDL-C level was lower than in group II (34 ±3 vs 40 ±4 mg/dL, p=0.0001). In group I, TG level was higher than in group II (213 ±29 vs 198 ±24 mg/dL p=0.002). In group I, FMD was smaller than that of group II (3.48 ±3.1% vs 10.4 ±5.6%, p=0.0001). The percent NTG-induced dilatation was not different between the groups (15.5 ±5.3% vs 17.3 ±6.9%, p=0.27). On regression analysis; there was a significant relationship between percent of FMD and HDL-C ( r =0.65, p=0.0001). When the 2 groups were analyzed separately, HDL-C was still related to percent of FMD in both groups ( r =0.47 p=0.002 and r =0.45 p=0.005, respectively). Multivariate regression analysis showed that only plasma HDL-C was independently related to FMD (F=7.5 p=0.0001). In patients with SCF, reduced flow-mediated dilatation was detected and was found to be associated with plasma lipid disturbances, principally low HDL and high TG levels.
Pulmonary Function Following Blastomycosis in Childhood
Authors: Alkrinawi S. , Pianosi P.
Published: June 2007

In order to determine the pulmonary outcome following blastomycosis during childhood, we compiled a case series of hospitalized patients from a retrospective review with later recall for pulmonary function testing, coupled with prospective measurements of pulmonary function in three patients, at a tertiary care children's hospital. A convenience sample of five of 17 patients hospitalized with pulmonary blastomycosis, whose mean age at the time of diagnosis was 10.6 +5.5 years, was recalled at a mean of 4.5 +3.5 years after diagnosis. Three patients more recently hospitalized underwent serial pulmonary function testing (PFT) prospectively from as soon after the acute infection as their condition permitted. All but two patients had normal PFT when last seen. The two patients with persistent pulmonary sequelae were among those followed up prospectively and had more severe clinical and radiographic pictures at the outset. Pulmonary function in children who suffered from pulmonary blastomycosis is normal in most patients at follow-up years later. Severe radiographic disease and slow recovery over months portend long-term sequelae.
Prolonged Morbidity Due to Delays in the Diagnosis and Treatment of Obstructive Sleep Apnea in Children
Authors: Richards Warren , Ferdman Ronald M.
Published: June 2007

The inclusion of a query concerning the presence of snoring in a questionnaire used by the Allergy Service of Childrens Hospital Los Angeles (CHLA) uncovered a significant number of patients who were experiencing prolonged and discomforting symptoms owing to previously undiagnosed obstructive sleep apnea (OSA) caused by adenotonsillar hypertrophy. Of 352 patients who were discharged with a diagnosis of OSA and tonsillectomy and/or adenoidectomy at CHLA in 1996-1997, a retrospective study of the first 45 randomly selected patients who agreed to participate in a telephone interview was performed. Analysis revealed that all patients experienced severe and discomforting symptoms with all describing severe or moderate snoring. Other symptoms included chronic mouth breathing (84%), frequent otitis media (64%), sinusitis (56%), sore throat (51%), choking (47%), and daytime drowsiness (42%). Other symptoms included poor school performnce, enuresis, poor appetite and/orxweight gain, dysphagia, and vomiting. Symptoms began at a mean age of approximately 2 years (”birth“-9 years), and the mean period of time between the development of significant symptoms and OSA was 3.3 years (6 months-1 3 years). Delay between onset of significant symptoms and surgery was>1 year in 82% of the patients,>2 years in 51% of the patients,>4 years in 31% of the patients, and>6 years in 13% of the patients. Forty percent of patients were self-referred to an otolaryngologist for treatment despite their primary care physician being aware of the symptoms. These results indicate that patient with OSA experienced prolonged morbidity and delays in treatment, which is probably widespread. Physican, parent, and third-party factors were found to have contributed to the delays in treatment.
Adolescents and Sports: Risk or Benefit?
Authors: Steiner Hans , McQuivey Ross W. , Pavelski Renee , Pitts Traci , Kraemer Helena
Published: June 2007

In order to begin to compensate for a lack of data on the effects of athletic participation in the development of adolescent mental health patterns, as well as to assess general health of the adolescent population, the Juvenile Wellness and Health Inventory (JWIHIS-76) was administered to 1,769 high school students. Our results indicate that sports participation is associated with self-reported lower total risk scores, mental and physical health benefits, and an increased risk of injury. This suggests a positive role for organized sports participation in youth populations. Prospective studies are needed to assess the impact of different sports, mounting performance pressure, and transition into collegiate levels of participation.
Prednisolone Plus Albuterol Versus Albuterol Alone in Mild to Moderate Bronchiolitis
Authors: Goebel Jens , Estrada Benjamin , Quinonez Jorge , Nagji Noorkarim , Sanford David , Boerth Robert C.
Published: June 2007

To evaluate combination therapy of mild to moderate bronchiolitis with bronchiodilators and corticosteroids, we treated 51 young children with first-time wheezing and symptoms of respiratory tract infection with albuterol plus either prednisolone or placebo for 5 days. Disease severity was scored on days 0, 2, 3, and 6. On day 2, prednisolone resulted in significantly lower scores (2.7 ±1.4 vs. 4.0 ±1.5 in all patients evaluated, p<0.05) than placebo, whereas there was no detectable difference on day 6, suggesting that addition of prednisolone to albuterol transiently accelerates recovery from bronchiolitis. The clinical significance of this effect needs to be evaluated in further studies.
Establishing a Pediatric Hospitalist Program at an Academic Medical Center
Authors: Ponitz Keith , Mortimer Joanne , Berman Brian
Published: June 2007

Academic medical centers have been challenged to respond to a rapidly changing and increasingly competitive health care environment. The Pediatric Consultation and Referral Service (PCRS) at Rainbow Babies & Childrens Hospital (RB&C)/University Hospitals of Cleveland was established in 1993 with the goal of providing rapid access to community-based physicians for the referral of patients requiring urgent hospitalization within the broad scope of general pediatrics. We describe our initial 3-year experience in the planning, implementation, and evaluation of a pediatric hospitalist program. PCRS provided care to 2,740 patients during the first 3 years of operation, 63% (1,716) of whom were under age 3 years. Leading primary diagnoses in order of decreasing frequency were asthma, pneumonia, bronchiolitis, febrile illness, gastroenteritis, seizures, croup, apnea, and cellulitis. Third-party payer mix was: Medicaid 42%, managed care 42%, indemnity insurance 10%, self-pay 6%, and Bureau for Children with Medical Handicaps 1%. From survey data, referring physicians and pediatric residents assessed perceptions of access, collegiality, and quality of care in a highly favorable manner. Subspecialty colleagues perceived access and collegiality very favorably but rated quality of care substantially lower than referring physicians and residents did. Our experience demonstrates that a pediatric hospitalist program is logistically and economically feasible and may contribute to the patient care, education, and research missions of academic medical centers. A well-structured program can provide community physicians with excellent access and support collegial relationships. Beyond increasing a medical center's patient referral base, a hospitalist program can potentially enhance the esteem of the discipline of general pediatrics and, it is hoped, promote general pediatrics as a viable career option for trainees.
Parental Attitudes Toward RB and Pellet Guns
Authors: Damore Dorothy T. , Ramundo Maria L. , Hanna Joseph P. , Dayan Peter S.
Published: June 2007

As well as describing our pediatric BB and pellet gun injuries and the circumstances surrounding these injuries, we also evaluated parental perceptions of the dangers of BB and pellet guns. A convenience sample of three groups of parents and their children presenting to a Midwest, urban, children's hospital emergency department was prospectively enrolled. The three groups of parents included the injured group, which consisted of the parents whose children had been injured by BB or pellet guns; the gun group, which consisted of the parents who allowed their children to possess BB or pellet guns but had not sustained injury from these guns; and the no gun group, which consisted of the parents who did not allow their children to have these guns. All parents completed a survey concerning their attitudes toward BB and pellet guns. Twenty-eight parents completed questionnaires in each of the three groups. Most BB and pellet gun injuries occurred in adolescent males at home without adult supervision and were inflicted by a friend or by themselves. The injured group and the no gun group viewed BB and pellet guns as significantly more dangerous than the gun group. Parents who allow their children to have BB or pellet guns appear to misperceive their potential for injury by allowing their children to use these guns in an unsafe manner. Clinicians must educate parents about the significant potential for injury of nonpowdered guns.
Prevalence of SIDS Risk Factors: Before and After the “Back to Sleep” Campaign in North Dakota Caucasian and American Indian Infants
Authors: McCulloch Kimberly , Dahl Stephanie , Johnson Sandra , Burd Larry , Klug Marilyn G. , Beal James R.
Published: June 2007

The objective of this study was to compare rates of infant sleeping position and other risk factors for sudden infant death syndrome from 1991 before the “Back to Sleep” campaign to rates in 1998 after the campaign. We used a cross-sectional risk factor prevalence study of risk factors for the years 1991 and 1998. In North Dakota the prevalence rates of prone sleeping declined 72% for American Indian infants and 62% for Caucasian infants. We were unable to identify a corresponding decline in SIDS in North Dakota for this time period. The relationship between sleeping position and SIDS may be more complex in rural and frontier settings and in American Indian populations than in urban and majority populations. The generalizability of this study is limited by the rural setting and small sample size. Longer term surveillance and additional reports from sites with pre “Back to Sleep” data as a baseline for both SIDS rates and sleeping position will be important to clarify the rate of prone sleeping position and SIDS.
Syndrome of Hypokalemic Metabolic Alkalosis and Hypomagnesemia Associated with Gentamicin Therapy: Case Reports
Authors: Shetty Avinash K. , Rogers N. Lynn , Mannick Elizabeth E. , Aviles Diego H.
Published: June 2007

Nephrotoxicity, as evidenced by renal insufficiency is a well-known consequence of gentamicin therapy. We report two patients with gentamicin-induced syndrome of hypokalemic metabolic alkalosis and hypomagnesemia. Both had complete recovery of renal tubular function after cessation of antibiotic therapy. These cases emphasize the need to routinely monitor patients receiving gentamicin therapy for electrolyte abnormalities to avoid potential morbidity.
The Value of Book Distribution in a Clinic-Based Literacy Intervention Program
Authors: Jones V. Faye , Franco Sofia M. , Metcalf Sharon C. , Popp Robert , Staggs Susan , Thomas Amy E.
Published: June 2007

The purpose of this study was to determine whether anticipatory guidance at well-child visits (WCV) that included early literacy development and the provision of books by the examining physician changed family literacy practices. It was conducted in an inner-city pediatric clinic that serves as the continuity practice site for pediatric and pediatric/internal medicine residents. There were 352 children (181 treatment: 171 control), aged 2 to 24 months, enrolled in this prospective, controlled study. The health care providers underwent training on literacy and on how to incorporate this information during WCV. Anticipatory guidance on safety, development, and early literacy was given to all parents. Additionally, the treatment group received an age-appropriate book at each WCV. There were 1,263 visits made (686 treatment, 577 control). Questionnaires were completed by parents on physician helpfulness and by physicians on parental receptiveness. Parental ratings on physician helpfulness were higher in the treatment group than in the control group (p<0.05). Physician's rating of parental receptiveness was also higher in the treatment group than in the control group (p<0.05). Two years after enrollment, mother-child pairs who received guidance and a book were two times more likely to report enjoyment in reading together than the controls who received guidance but no book. We conclude that anticipatory guidance that included early literacy development and distribution of books at WCV resulted in increased family literacy orientation, parental receptiveness, and perception of physician helpfulness.
Physician Reimbursement and the Medical Encounter: An Observational Study in Dutch Pediatrics
Authors: van Dulmen A. M.
Published: June 2007

Pediatrician reimbursement is shifting from fee-for-service to a fixed salary. In the Netherlands, as physicians working on a fee-for-service basis have a financial interest in talking less and in carrying out more diagnostic tests and investigations, it may be questioned whether this will influence the structure and content of medical visits. With use of 302 videotaped outpatient encounters with either salaried or fee-for-service pediatricians, differences were examined in visit length, number of requests for diagnostic tests and investigations (laboratory test, endoscopy, and radiography), pediatrician-parent communication behaviors, and patient satisfaction. This investigation was carried out by means of bivariate and multilevel analysis. The results showed that the visits with salaried pediatricians lasted almost 4 minutes longer. This surplus time was not spent on social talk or on a more elaborate history taking but was used to provide more information and advice. In addition, salaried pediatricians engaged in more empathic behavior toward the patient, thereby facilitating a therapeutic relationship. No differences were found in the number of diagnostic tests and investigations or in patient satisfaction. It may be concluded that history taking and social talk took place in a fixed part of the visit. Salaried pediatricians spent more time on exchanging information with their patients and paid more attention to patient concerns and emotions. As the reimbursement shift is not likely to diminish the number of diagnostic tests and investigations and will increase the length of the medical visits, overall financial benefits may be limited.
Effects of Lead Counseling for Children with Lead Levels &ge20 μg/dL:Impact on Parental Knowledge, Attitudes, and Behavior
Authors: Serwint Janet R. , Dias Magna , White Jeanette
Published: June 2007

The purpose of this study was to assess parental knowledge, attitudes, and behavior concerning lead reduction counseling. Of 108 children with confirmed venous lead levels &ge20 μg/dL, 75 (69%) of the parents were interviewed by telephone 6-9 months later. The majority of parents recalled being given specific lead reduction strategies. Knowledge of cleaning interventions was associated with parents who could state the lead level, who perceived a benefit from knowing it was elevated, and whose children were referred to a specialty lead clinic. Recall of nutritional interventions was associated with parents who could state the lead level and whose children were referred to a specialty lead clinic. Although 79% of parents thought that it was beneficial to know their child's lead level was elevated, only 65% reported implementing lead reduction strategies. The majority of parents recalled receiving lead reduction counseling but reported low compliance with lead reduction strategies. Further research is needed to determine the causes of the discrepancy between knowledge and making the behavior changes necessary to comply with lead reduction interventions.
Can Circumcision Prevent Recurrent Urinary Tract Infections in Hospitalized Infants?
Authors: Cason Dana L. , Carter Brian S. , Bhatia Jatinder
Published: June 2007

Urinary tract infection (UTI) is an uncommon but concerning condition for hospitalized premature infants. A retrospective chart review of all male infants admitted to the neonatal intensive care unit (NICU) from June 1996 through March 1999 was conducted at the Medical College of Georgia-a large academic medical center with a tertiary Level III NICU-to investigate the frequency and potential prevention of recurrent UTI in hospitalized infants. The effect of circumcision on recurrence of UTI was also investigated. There were 38 infants with 53 UTIs among 744 male infants admitted during the study period (5.1%). Infants were divided into two groups: Al <37 weeks with a single UTI and A2 <37 weeks with more than one UTI. In groups Al and A2, 57% of the first UTIs were due to Candida or E. coli, the remaining were due to other gram-negative organisms and Staphylococcus species. Mean gestational age (GA) in groups Al and A2 were similar (29 2 weeks, and 29 4 weeks); however, mean GA of infants with Candida UTI was 27 2 weeks, and for bacterial UT! 30 +3 weeks (p<0.01). None of the premature infants in the study had a recurrent UTI once a circumcision was performed. Premature uncircumcised males had an increased risk for UTI (Odds Ratio= 1.1, 95% CI, 3.3-28.9, p<0.001). Circumcision appears beneficial in reducing the risk for recurrent UTI in these infants.
Characteristics of Women Pediatricians
Authors: Frank Erica , Meacham Lillian
Published: June 2007

To contrast women pediatricians (n=807) with other U.S. women physicians, we used data from the Women Physicians' Health Study, a national, randomly sampled questionnaire survey (total n=4,501). Compared with other women physicians, women pediatricians worked less and reported lower incomes but also reported less work stress and less career dissatisfaction.

Pediatricians were less likely to counsel/perform screening regarding cholesterol, HIV, smoking, and alcohol but more likely regarding skin cancer or sunscreen use, nutrition, and weight. Given current emphases on trying to improve U.S. children's health practices, these findings are of concern.
A Double-Blind, Placebo-Controlled Crossover Study Investigating the Effect of Porcine Secretin in Children with Autism
Authors: Corbett B. , Khan K. , Czapansky-Beilman D. , Brady N. , Dropik P. , Goldman D. Zelinsky , Delaney K. , Sharp H. , Mueller I. , Shapiro E. , Ziegler R.
Published: June 2007

Objectives: A recent patient series reported the incidental findings of improved social and language skills in 3 children with autistic spectrum disorders after the administration of secretin, a peptide hormone. However, a subsequent study did not find evidence for a drug effect. Parents are seeking treatment with secretin despite the absence of empirical investigations demonstrating amelioration in autism symptomology. In order to more precisely measure the effects of secretin, this study investigated the effect of a single intravenous dose of porcine secretin on 12 autistic children through a randomized, double-blind, placebo-controlled, crossover study. Children were assessed on objective language and on social, neuropsychological, and gastrointestinal measures to evaluate drug effects. The study was conducted over a 16-week trial. The results indicated that significant differences were not observed on the majority of the dependent variables. Statistically significant differences were observed on measures of positive affect and activity level following secretin infusion. In general, the autistic children did not demonstrate the improvements described in the initial retrospective report.
A Randomized, Blinded Comparison of Chioral Hydrate and Midazolam Sedation in Children Undergoing Echocardiography
Authors: Wheeler Derek S. , Jensen Richard A. , Poss W. Bradley
Published: June 2007

The objective of this prospective, randomized, and blinded study was to compare the use of chloral hydrate versus oral midazolam sedation in children undergoing echocardiography. No adverse effects (nausea, vomiting, paradoxical agitation, or significant deviations from baseline vital signs) were noted with either medication. No differences were noted in onset of sedation between the 2 groups, however, the time to complete recovery was significantly shorter with midazolam than with chloral hydrate. The children in the chloral hydrate group had a significantly deeper level of sedation and were more likely to receive a more nearly comprehensive echocardiographic evaluation.
Self-Hypnosis for the Treatment of Functional Abdominal Pain in Childhood
Authors: Anbar Ran D.
Published: June 2007

Functional abdominal pain, defined as recurrent abdominal pain in the absence of an identifiable physiologic cause, can respond to psychological intervention in appropriate patients. In this patient series, functional abdominal pain of 4 of 5 pediatric patients resolved within 3 weeks after a single session of instruction in self-hypnosis. The potential impact of widespread application of such hypnotherapy may be large, because abdominal pain is thought to be the most common recurrent physical symptom attributable to psychological factors among children and adolescents.
Clinical Outcomes of Neonatal Meningitis in Very-Low-Birth-Weight Infants
Authors: Doctor Benedict A. , Newman Nancy , Minich Nori M. , Taylor H. Gerry , Fanaroff Avroy A. , Hack Maureen
Published: June 2007

We sought to describe the clinical presentation and consequences of meningitis among 64 very-low-birth-weight (VLBW <1.5 kg) infants who had 67 culture-proven episodes of meningitis over an 18-year period, 1977 through 1995. Demographic and neonatal descriptors of meningitis and later outcomes were retrospectively examined and neurodevelopmental outcomes of 39 of 45 (87%) meningitis survivors were compared to those of nonmeningitis survivors followed up to 20 months corrected age. Causes of meningitis included coagulase-negative Staphylococcus in 43% of episodes, other gram-positive bacteria in 19%, gram-negative bacteria in 17%, and Candida species in 20% of episodes. Spinal fluid abnormalities were sparse, regardless of etiologic organism. Of 38 nonbloody spinal fluid taps (<1,000 erythrocytes/mm3), 6 had >30 leukocytes/mm3, 5 protein >150 mg/dL%, and 6 glucose <30 mg/dL (1.67 mmol/L). Only 10 infants (26%) had 1 or more of these spinal fluid abnormalities. Meningitis survivors had a higher rate of major neurologic abnormality (41% vs 11%, p<0.001) and subnormal (<70) Mental Development Index (38% vs 14%, p<0.001) than nonmeningitis survivors. Impairment rates did not differ by etiologic organism. The effect of meningitis on neurologic outcome persisted even after controlling for birth weight, intraventricular hemorrhage, chronic lung disease, and social risk factors (odds ratio 2.27 [95% CI 1.02, 5.05]). We conclude that despite a sparsity of abnormal spinal fluid findings, culture-proven neonatal meningitis among VLBW infants has a detrimental effect on neurologic outcome, which persists even after controlling for other risk factors.
Developmental Screening of Children Diagnosed with Congenital Heart Defects
Authors: Weinberg Stacey , Kern Jeffrey , Weiss Kim , Ross Gail
Published: June 2007

Children with congenital heart disease (CHD) are more likely than normal children to have developmental delays. The development of 64 children with CHD less than 6 years old was screened with the Denver II. Thirty-five of the 64 children had CHD that required surgical or catheter intervention. These 35 children were significantly less likely than other children with CHD to be normal on developmental screening (46% vs 86%, respectively). Thirty-four percent of children with more severe CHD were referred for early intervention. As research shows the efficacy of early intervention, results indicate the need for early developmental evaluation of children with CHD of hemodynamic significance.
Thrush in the Breastfeeding Dyad: Results of a Survey on Diagnosis and Treatment
Authors: Brent Nancy B.
Published: June 2007

Infection with Candida albicans in the breastfeeding dyad has been associated with extreme pain in the breastfeeding mother and may lead to premature weaning. There is presently a dearth of information on diagnosis, natural history, and treatment of this condition in the literature. Therefore, before such a trial was conducted, a survey was sent to experts in the field of lactation, the members of The Academy of Breastfeeding Medicine, on the diagnosis and treatment of thrush in the breastfeeding mother and baby. Results showed that the majority of respondents relied primarily on history and physical examination of the baby, but not the mother, to make the diagnosis. Laboratory tests were ordered only rarely. The most common initial treatment was oral nystatin for the infant and cream for the mother's breasts. This was followed by oral nystatin for the infant and oral fluconazole for the mother. Treatment of recurrence or persistence was again most commonly nystatin for both mother and infant, followed by oral nystatin for the infant and oral fluconazole for the mother or oral fluconazole for both. In the absence of controlled trials of this condition, these results may serve as suggestions for the clinician, until definitive data are available.
Renal Tubular Acidosis: A New Look at an Old Problem
Authors: Roth Karl S. , Chan James C. M.
Published: June 2007

Although the definition of renal tubular acidosis (RTA) is simple, understanding the physiologic basis underlying the various types of this clinical entity is much more difficult. The pathophysiology of this disorder is reviewed using the normal acid-base functions of the involved segments of the nephron as a guide to understanding. Clinical and laboratory features of the subtypes of RTA are addressed, and diagnosis and treatment discussed. New developments in the knowledge and understanding of the associated growth disturbances, mineral metabolism, and molecular biology of RTA are also reviewed to provide the most current view of this relatively common pediatric entity.
Parental Expectations Regarding Discussions on Psychosocial Topics During Pediatric Office Visits
Authors: Burklow Kathleen A. , Vaughn Lisa M. , Valerius Kristin S. , Schultz Janet R.
Published: June 2007

Parents from urban (n=67) and suburban (n=76) primary care settings responded to a survey determining the extent to which 9 common psychosocial concerns have affected their children. Parents also reported their expectations of their pediatrician to discuss such topics during a health care visit. Within both settings, discipline was the most frequently experienced (41%), commonly discussed (34.3%), and frequently expected (75.4%) topic to be discussed. The frequency of discussions on psychosocial topics was less than half that of the actual reported occurrence of the psychosocial concern. When discussions on psychosocial topics did occur, however, most parents (87.3%) perceived pediatricians as helpful.