bluuebunny/crossref_metadata_2025 huggingface dataset:
Accuracy of the ICare rebound tonometer in glaucomatous eyes with topical ocular hypotensive medication
Authors: Diaz Alberto , Yebra‐Pimentel Eva , Resua Carlos García , Gilino Jorge , Giraldez Mª Jesus
Published: August 2010

Background:  The purpose of this study was to assess the accuracy of the ICare tonometer, using the Perkins applanation tonometer (AT) as the reference, in a sample population being treated with travaprost 0.004% for glaucoma.

Material and methods:  Twenty‐eight consecutive patients with open‐angle glaucoma or ocular hypertension who had been receiving travaprost 0.004% to control elevated intraocular pressure (IOP) were included in the study. IOP was measured in the entire sample with ICare and Perkins AT. The difference between the methods was plotted against the mean to compare the tonometers. The hypothesis of zero bias was examined by a paired t‐test. The 95% limits of agreement (LoA) were also calculated.

Results:  As previously found in young healthy subjects, ICare showed a tendency to overestimate Perkins IOP measurements by a mean of 3.57 mmHg. The agreement between the two methods is shown by the 95% LoA which was from −9.37 to +2.23 mmHg: 53% of the IOP differences fell within ±3 mmHg.

Conclusions:  The performance of the ICare tonometer in glaucomatous patients being treated with travaprost 0.004% to lower the IOP appears to be similar to that of young healthy patients. The tendency of ICare to overestimate the IOP readings should be considered when the instrument is used in the follow‐up of glaucomatous patients.
Focusing Children in Focus Groups
Authors: Khadka Jyoti , Woodhouse Margaret J. , Margrain Tom , Ryan Barbara , Davies Nathan
Published: August 2010

Purpose:  Focus groups are one of the widely used qualitative research methods. It is defined as a carefully planned discussion with a small group of people designed to obtain perception on a defined area of research interests in a permissive and non‐threatening environment. This technique is widely used in social sciences and marketing with adult participants but rarely used with children. We tried to assess how effective this technique could be to find out the daily living activities of children with and without low vision.

Methods:  A well‐structured script and a question route having questions on daily living activities were developed in best possible child friendly language. The children were approached through teachers. The children of a given age group were given information sheets and consent forms a week prior to focus groups. The teachers were asked to select 4–8 children randomly among those children who had parental consents. The focus groups were conducted in a quiet room by two moderators. The group discussions were audio recorded and the non verbal responses during the discussion of the children were noted down.

Results:  There were 81 participants (boys 57% and girls 43%) from seven schools, a centre for the visually‐impaired, and a leisure centre in Wales. The age range was between 5 to 17 years with mean age of 11 years. In total 13 focus groups were conducted, seven with visually impaired children and six with normally sighted children. The focus groups resulted in 15 h of recorded discussions demonstrating how readily the children talked. All the children actively participated and readily responded to all structured questions and openly discussed issues. In the groups with a wider age range, the older children tended to dominate. There was no difference between mixed gender and single gender groups in discussion. Younger children tired and lost interest after half‐an‐hour whereas older children were still participating up to 1 h. There was no obvious difference in quality of discussion between children with and without visual impairment. The children were found to be more comfortable to talk with friends than with strangers.

Conclusion:  A careful selection of the structured questions and a skilled moderator could make focus groups with children a very effective tool of qualitative data collection.
Pulfrich's phenonenon in a case of optic nerve hypoplasia
Authors: Heron Gordon
Published: August 2010

Introduction:  Optic nerve hypoplasia (ONH) is a congenital deficiency of retinal ganglion cells and their axons that form the optic nerve. This condition is associated with visual deficits ranging from no light perception in severe cases to vision within normal ranges in mild cases of ONH. In mild cases, deficits can be limited to sectoral anomalies in the visual field and normal vision with colour vision anomalies have been reported. We report here a case of mild ONH with visual symptoms relating to Pulfrich phenomenon (PP) occurring spontaneously.

Methods:  A 12 year girl presented with typical visual symptoms (bumping into objects when walking, poor object location at tennis) associated with the spontaneous PP. A simple pendulum revealed a perceived anticlockwise ellipse indicative of a left eye defect. This was neutralised by an 85% transmission filter placed before the right eye. The inter‐ocular latency difference was calculated to be 0.88 (S.D., 0.55) ms.

Results:  Fundus biometry showed an asymmetry in optic nerve size, the left being smaller than the right. Visual fields, anomaloscope and other colour vision tests, and both flash and pattern‐reversal stimuli Visually Evoked Potentials showed no difference in visual function between the right and left eyes.

Conclusions:  A case of very mild ONH gives inter‐ocular normal vision and visual function and yet a subtle inter‐ocular delay occurs resulting in visual symptoms associated with PP. These were completely removed with tinted spectacles.
The success rate of wearing bifocals in children with Down's syndrome
Authors: Al‐Bagdady Mohammad , Stewart RE , Woodhouse JM
Published: August 2010

Purpose:  Accommodation is reduced in approximately 75% of children with Down's syndrome (DS) compared to their peers (Woodhouse et al., 1993). A study by Stewart et al. (2005) showed that bifocals improve focusing on near targets and they are currently prescribed regularly. The study also showed that wearing bifocals improved the children's own accommodative ability over time. The aim of this study is to evaluate the success of wearing bifocals in improving accommodation.

Methods:  Clinical records of 37 children from the Cardiff University Down's Syndrome Vision Research Unit, who were prescribed bifocals, were reviewed. Their accommodation, using dynamic retinoscopy at 10, 16.7 and 25 cm, was noted before wearing the bifocals and during either their latest visit or when they stopped using bifocals. An accommodative lag of up to and including 0.75D at two or more testing distances is considered accurate (McClelland and Saunders, 2004).

Results:  The accommodative ability of 23 out of 37 (62.16%) of the children had improved (through the distance part of the lens) after using the bifocals for an average of 29.38 months. Thirteen out of those 23 had accurate accommodation, one third of the overall number of children, without the use of bifocals. These 13 children have returned, or will shortly return, to single vision spectacles.

Conclusions:  Using bifocals not only improves the children's accuracy of focusing on near objects through the bifocals, but also ‘trains’ their accommodative ability, with a success rate of 62.16% so far. For some children at least, bifocal wear can be a temporary management strategy.
The chromatic selectivity of visual crowding
Authors: Kennedy Graeme J. , Whitaker David
Published: August 2010

Purpose:  Precortical vision is mediated by three opponent mechanisms which linearly combine receptoral outputs to form a luminance channel (L + M) and two chromatic channels, red‐green (L/M) and blue‐yellow (S/L + M). These colour channels are known to undergo considerable cortical reorganisation in order to form multiple, ‘higher‐order’ mechanisms tuned to a variety of axes in colour space. Here we ask the extent to which the basic colour‐opponent mechanisms interact in the phenomenon of visual crowding, where nearby targets interfere with the spatial processing of a central test target.

Methods:  The task was to identify the orientation of a central Gabor patch whilst an annular plaid was positioned around the patch. The radius of the annulus was varied in order to produce different amounts of crowding. The chromatic content of the central patch and the annulus could be varied independently along the (L + M), (L/M) and (S/L + M) cardinal axes.

Results:  For all targets, when the target and crowding annulus were of the same chromaticity, the crowding effect increased with decreasing separation of the target and annulus. When the test and crowding stimuli had different chromatic properties, very little crowding was observed, even at the minimum separation of test target and crowding annulus.

Conclusions:  The crowding effect appears to be critically dependent on whether or not the target and crowding stimuli share a common chromatic axis. These results suggest a method by which performance in crowding‐limited tasks might be enhanced through appropriate selection of chromatic stimulus content.
Limbal and Bulbar Hyperaemia in Normal Eyes
Authors: Pult Heiko , Murphy Paul J. , Purslow Christine , Nyman Jeffrey , Woods Russell L.
Published: August 2010

Purpose:  To investigate the appearance of limbal and bulbar hyperaemia in normal eyes, their relationship and the inter‐observer agreement of clinical grading.

Methods:  The right eyes of 120 healthy, non‐contact lens‐wearing subjects (m = 57, f = 63, median age = 45 years, range 18–77 years) were examined by two trained observers. Limbal and bulbar hyperaemia were scored using the Cornea and Contact Lens Research Unit (CCLRU) redness grading scales interpolated into 0.1 increments. Redness of four quadrants, and overall, were assessed, and quadrant‐average redness was calculated. Inter‐observer agreement was assessed at the start and end of the study (20 subjects each).

Results:  For limbal redness, the overall (1.62 ± 0.46) (mean units ± S.D.) was not significantly different from the quadrant‐average (1.61 ± 0.40) score. For bulbar redness, the overall (2.02 ± 0.49) was higher than the quadrant‐average (1.82 ± 0.39) score (p < 0.0001). Significant correlations were found between bulbar and limbal quadrants (Pearson: r ≥ 0.43, p < 0.0001). Significant differences in redness were found between quadrants (p < 0.0001), with nasal and temporal redder than superior and inferior quadrants. Small effects of age and gender were found for limbal redness. The inter‐observer 95% limits of agreement were similar at the start and end of the study. They were larger for overall (0.57) compared with quadrant‐average (0.28) redness.

Conclusions:  For similar populations, a limbal redness above 2.5 or a bulbar redness above 2.6 (quadrant‐average) or 3.0 (overall) may be considered abnormal. Limbal and bulbar redness were correlated. Quadrant‐average scores are recommended instead of overall scores, as inter‐observer agreement was better.
Theoretical evaluation of the cataract extraction‐refraction‐implantation techniques for intraocular lens power calculation
Authors: Sheppard Amy L. , Dunne Mark C. M. , Wolffsohn James S. , Davies Leon N.
Published: August 2010

Purpose:  To evaluate theoretically three previously published formulae that use intra‐operative aphakic refractive error to calculate intraocular lens (IOL) power, not necessitating pre‐operative biometry. The formulae are as follows: IOL power (D) = Aphakic refraction × 2.01 [Ianchulev et al., J. Cataract Refract. Surg.31 (2005) 1530]; IOL power (D) = Aphakic refraction × 1.75 [Mackool et al., J. Cataract Refract. Surg.32 (2006) 435]; IOL power (D) = 0.07x 2 + 1.27x + 1.22, where x = aphakic refraction [Leccisotti, Graefes Arch. Clin. Exp. Ophthalmol.246 (2008) 729].

Methods:  Gaussian first order calculations were used to determine the relationship between intra‐operative aphakic refractive error and the IOL power required for emmetropia in a series of schematic eyes incorporating varying corneal powers, pre‐operative crystalline lens powers, axial lengths and post‐operative IOL positions. The three previously published formulae, based on empirical data, were then compared in terms of IOL power errors that arose in the same schematic eye variants.

Results:  An inverse relationship exists between theoretical ratio and axial length. Corneal power and initial lens power have little effect on calculated ratios, whilst final IOL position has a significant impact. None of the three empirically derived formulae are universally accurate but each is able to predict IOL power precisely in certain theoretical scenarios. The formulae derived by Ianchulev et al. and Leccisotti are most accurate for posterior IOL positions, whereas the Mackool et al. formula is most reliable when the IOL is located more anteriorly.

Conclusion:  Final IOL position was found to be the chief determinant of IOL power errors. Although the A‐constants of IOLs are known and may be accurate, a variety of factors can still influence the final IOL position and lead to undesirable refractive errors. Optimum results using these novel formulae would be achieved in myopic eyes.
Occupational colour vision requirements for police officers
Authors: Birch Jennifer , Chisholm Catharine M.
Published: August 2010

Inclusion of public service professions in the UK Disability Discrimination Act in 2004 prompted a review of occupational colour vision requirements for police officers. Changes in the regulations which existed prior to 2003 were proposed. The aim of this study was to obtain the views of serving police officers in Northern Ireland on the importance of good colour discrimination in everyday police work and on the recruitment regulations for patrol constables introduced in 2003 in mainland UK. These views were obtained by means of a questionnaire and informal discussions. More than 65% of police officers who responded to the questionnaire considered that good colour vision was very important for effective policing. Fewer than 2% considered that colour vision was unimportant. Experienced police officers agreed that the employment of colour‐deficient patrol constables, as permitted in the new regulations, would lead to reduced efficiency and organisational difficulties at the local level. A number of everyday activities were described which showed the need for accurate colour discrimination. The change in recruitment policy and the lack of clarity in the new regulations show inadequate appreciation of the needs of the occupation, of different types of colour vision anomalies and of the diagnostic function of colour vision tests. Failure to provide guidance on appropriate colour vision tests, examination procedures and counselling services is likely to result in inconsistent employment policies in different police forces. It is recommended that the colour vision standard in place prior to 2003 is reinstated at the recruitment stage. The Ishihara test should be used for screening, and colour‐deficient applicants further examined with the Farnsworth D15 test as a replacement for the City University Test 2nd edition.
Effect of Short Study Abroad Course on Student Openness to Diversity
Authors: Ismail Baraem , Morgan Mark , Hayes Kirby
Published: August 2010

ABSTRACT: An important contributing factor to students' willingness to work with diverse people is their “openness” to diversity. The objective of this study was to test the effect of a short (3‐wk) study abroad course to China on the openness to diversity/ challenge of the 23 students participating in the China study abroad course. Students were given the “openness to diversity” survey at the beginning of the course and at the end of the course. Statistical analysis concerning the change in openness to diversity between pre‐test and post‐test was conducted using the Mann‐Whitney non‐parametric test (P≤ 0.05). A significant increase (P= 0.007) in openness to diversity was observed as a result of the short study abroad course. The overall average change in openness to diversity found for this study (0.07) was consistent with that reported for semester‐long study abroad groups (0.074). Together these findings imply that short study abroad courses may have a significant effect on students' openness to diversity and may be as effective as longer study abroad programs. Overall, any study abroad course presents an opportunity to increase students' openness to diversity.
INVESTIGATIONS CONCERNING THE ORIGIN OF BLOOD‐PLATELETS
Authors: Petri Svend
Published: August 2010

Resumè:

In future experiments to elucidate the genesis of the blood‐platelets such methods must be employed as electively effect the blood‐platelet system.

Experimentally produced asphyxia (either owing to lack of O2 or after inhalation of illuminating gas) a) does not cause any noteworthy fluctuations in the number of blood‐platelets, b) is unsuitable for investigations into a numerical relation between megacaryocytes and blood‐platelets (Wright's theory). None of the corpuscular elements mentioned undergo the fluctuations described by Bianchini and others.
ÜBER VERSCHIEDENE NEUE SALMONELLA‐TYPEN
Authors: Kauffmann F.
Published: August 2010

Es wird über 4 neue Typen der Salmonella E‐Gruppe berichtet: S.amager = III.X.XXVI. y ? 1, 2 …, S.zanzibar = III.X.XXVI. k ? 1, 5 …, S.shangani = III.X.XXVI. d ? 1, 5 … und S.niloese = I.III.XIX. d ? z6 …

Bei dem von S. Gard beschriebenen »neuen Salmonellatypus (S.abortus canis)« handelt es sich nicht um einen neuen Typus, sondern um S.paratyphi B mit künstlich erzeugter 3.Phase (z5 …).

Es werden Untersuchungen über verschiedene Salmonella‐Typen mitgeteilt und zwar über S.budapest, S.mikawashima, S.narashino, S.worthington, S.minnesota, S.carrau, S.onderstepoort und S.kentucky.
Prophylaktische und therapeutische Wirksamkeit ver‐schiedener Präparate aus bestrahltem Ergosterin (Vigantol, Radiostol und Präformin).
Authors: SCHAFERSTEIN S. I.
Published: August 2010

Nach Befunden der Ukrainischen Kommission zum Studium der Rachitis. Die Arbeit wurde unter Mitbeteiligung der Proff. Rudneiv, Skloivsky, Jampolsky, Gerschenohn, Finkelstein und Golombo, des Dozenten Jachnis, der Ärzte Daiches, Sarche, Olewsky, Rodkin, Klimenko, Rosenblum, Mirer, Iwanitzkaja, Levina, Lubenskaja, Schingarewa, Heller u. a. ausgeführt.
The Weight of the Thyroid Gland in Children of 0–2 Years of Age
Authors: TÄHKÄ HILKKA
Published: August 2010

The thyroid glands of 244 infants of 0–2 years who had died of different diseases was examined and weighed.

The results show that the absolute weight of the thyroid gland is roughly constant, approximately 3 g for the whole of the first month of life. Subsequently, the weight begins to decrease reaching its minimum value (approximately 68 per cent of the newborn), at the age of 2–3 months. From that age the weight again begins to increase slowly.

The changes in weight are along the same lines in premature infants, the absolute weights only being considerably lower as, a fact evident from this series too, the size of the thyroid gland increases greatly towards the end of pregnancy.

No difference can be shown between the sexes in the size of the thyroid gland.

Congenital goitre was found in 10 patients of the material, i.e., in 6.25 per cent. In premature infants not a single case of goitre was encountered.

The duration and type of disease cannot be shown to affect the absolute weights of the thyroid gland. On the other hand, the size of the thyroid gland, calculated as a percentage of the average weight for the same age, seems to decrease the longer the duration of disease.
Linné as Pediatrician
Authors: FREDBÄRJ TELEMAK
Published: August 2010

From Carl von Linné's publications the author quotes and gives an account of Linné's concept and opinion of various matters regarding pediatrics and child health.
Collection of Urine in Infancy by Means of Plastic Colostomy Bandage
Authors: VESTERDAL JØRGEN
Published: August 2010

A simple method is described for collection of urine from infants of both sexes by means of a plastic colostomy bag.
The “Lente” Insulins in Juvenile Diabetes
Authors: ENGLESON GUNNAR , LEHMANN ORLA
Published: August 2010

The following is an account of investigations carried out at the Paediatric Department, University Hospital of Lund on the treatment of juvenile diabetes with the Lente Insulins.

The material comprises 42 patients, aged 2–17 years. In 37 cases (i.e. 88 per cent) a A blood sugar below 150 mg/100 ml was obtained. During establishment on the Lente Insulins we noted in some cases a substantial increase in height. Insulin reactions were rare and most patients felt better after changing to Lente Insulin.

L'insuline « lente » dans le traitement du diabète juvénile.

Résultats obtenus avec l'insuline « lente » dans le traitement de cas de diabète juvénile. Quarante‐deux patients âgées de 2 à 17 ans ont été traités. Dans 37 cas (soit 88%), le taux de la glycémie put être ramené en dessous de 150 mg/100 cm3. Une augmentation notable de la croissance en hauteur a été observée dans certains cas durant le traitement par l'insuline « lente ». Les réactions d.'intolérance à l'insuline furent rares et la plupart des malades se sentirent mieux après le passage à l'insuline « lente ».

“Lente”‐Insulinpräparate bei jugendlichem Diabetes.

Bericht über die Behandlung von jugendlichem Diabetes mellitus mit “Lente” Insulinpräparaten. 42 Kranke im Alter von 2–17 Jahren wurden auf diese Weise behandelt. In 37 Fällen, d.i. bei 88%, wurde ein Blutzuckerspiegel von unter 150 mg/100 ml erreicht. Während der Behandlung mit “Lente” Insulin kam es bei manchen Fallen zu einer wesentlichen Zunahme im Körperwuchs. Insulinreaktionen waren selten und die Mehrzahl der Patienten wies eine Besserung im Allgemeinbefinden auf, wenn sie auf “Lente” Insulinpräparate umgestellt wurden.

Insulinas «Lentet» en la diabetes infantil.

Se expone el tratamiento de la diabetes mellitus infantil con insulinas «Lente». Fueron tratados cuarenta y dos pacientes de 2 a 17 años de edad. En 37 easos (es decir el 88%) se obtuvo un delta de azúcar en la sangre inferior a 150 mg por 100 ml. Durante el tratamiento practicado con insulinas «Lente», se observó un aumento apreciable de la estatura en algunos casos. Se produjeron rara vez reacciones insulínicas y la mayoría de los pacientes se sintió mejor después de cambiar con las insulinas «Lente».
PHYSICAL GROWTH OF 5‐YEAR‐OLD CHILDREN WITH A LOW BIRTH WEIGHT
Authors: BJERRE INGRID
Published: August 2010

Abstract. Bjerre, I. (Department of Paediatrics, Malmö General Hospital, Malmö, Sweden). Physical growth of 5‐year‐old children with a low birth weight. Stature, weight, circumference of head and osseous development. Acta Paediatr Scand, 64: 33, 1975.–In a prospective investigation of the physical growth of children with a low birth weight, 143 unselected children who weighed less than 2500 g at birth were reviewed at 5 years of age. The children were grouped according to weight relative to gestational age.

Stature and weight were compared with normal curves for Swedish children and with a control series. The circumference of the head was compared with a normal curve. Osseous development was assessed by the method of Eklöf & Ringertz and was compared with their normal values.

Growth of the LBW‐children was slightly retarded in respect of stature, weight and osseous development, but not regarding head circumference. The values found for stature and osseous development were low in the group small for gestational age and for twins. Those LBW‐children who were appropriate for gestational age developed at a normal rate. This is true even for those with the lowest birth weight and those born long before term.

Osseous development was correlated with stature, which may be due to the measuring method used. Neither maternal disease nor feeding difficulties during the first few months of life had any demonstrable effect on the physical development of the children. Socio‐economic factors now surely play at most a subordinate role. Physical development of the children varied most with the mothers' stature and weight and probably with hereditary factors.
BLOOD GLUCOSE and PLASMA INSULIN and GLUCAGON RESPONSE DURING INTRAVENOUS GLUCOSE TOLERANCE TEST IN NEWBORN INFANTS AFFECTED BY ERYTHROBLASTOSIS FOETALIS
Authors: MASSI‐BENEDETTI FERDINANDO , MARINI ANTONIO , CACCAMO MARIA L. , FALORNI ADRIANO
Published: August 2010

Abstract. Massi‐Benedetti, F., Marini, A., Caccamo, M. L. and Falorni, A. (Paediatric Clinic of the University of Perugia and the Service of Neonatal Pathology of the University of ‐Milan, Italy). Blood glucose and plasma insulin and glucagon response during intravenous glucose tolerance test in newborn infants affected by erythroblastosis foetalis. Acta Paediatr Scand, 64:113, 1975.–Intravenous glucose injection (1 g/kg b.w.) was performed in eight newborn infants affected by erythroblastosis foetalis (IEF) and in seven controls during the first day of life in order to study insulin and glucagon response. The IEF infants were affected by mild or moderate hemolytic disease and their blood glucose values and plasma insulin concentrations before and throughout the test did not differ significantly from those of the controls. After the glucose injection the plasma glucagon concentrations showed great variations in both groups. The control infants did not show any significant changes; in the IEF infants, significant decreases were seen at 3 and 20 min of the test. These data seem to indicate that the alpha‐cell sensitivity to glucose is greater in IEF than in normal infants and is not dependent on the development of the glucose‐mediated insulin release mechanism.
Familial Aggregation of Blood Pressure in a Paediatric Population
Authors: FOSSALI E. , RUZZA M. L. , CODEGA C. , FRANCESCO C. DI , IURATO M. , MIGLIACCIO M. C. , MONTI M. C. , SANARICO M. , SERENI F.
Published: August 2010

ABSTRACT. Familial aggregation of blood pressure in childhood and the difference between males and females were studied in a random sample of a nursery and school‐age population in Milan. Age, sex, height, weight, skinfold thicknesses and heart rate were obtained. Blood pressure was measured in accordance with the recommendations of the Task Force of Blood Pressure Control in Children. After adjusting for age, significant correlation coefficients were found between mother and son (r=0.17 and r=0.11), mother and daughter (r=0.11 and r=0.15), and father and son (r=0.16 and r=0.17) for systolic and diastolic pressure, respectively; the father‐daughter correlations were not statistically different (r=0.08 and r=0.03). Multiple regression analysis underlined the difference between males and females; height was an important determinant in the males and body weight in the females. In conclusion, anthropometric measurements should be considered in evaluations of blood pressure status. Our results suggest important differences between males and females. The BP pattern of the parents also seems more important for sons, and there seems to be a lower correlation between fathers and daughters.
Plasma Dopamine, Norepinephrine, Epinephrine and DOPAC Levels in Preterm Infants Prior to and Immediately after a Sleep Ventilation Hypercarbia Test
Authors: DALMAZ Y. , ARIAGNO R. L. , BELLON G. , CHALLAMEL M. J. , PEYRIN L.
Published: August 2010

ABSTRACT. The postnatal maturation and the adaptational ability of the sympathoadrenal system has been investigated in preterm neonates (n=8), and in sick preterm neonates with respiratory disorders (n= 10). Plasma levels of dopamine (DA), norepinephrine (NE), epinephrine (E) and 3–4 dihydroxyphenylacetic acid (DOPAC) were evaluated at rest during the first month of life, and following an inhalation of a 5% carbon dioxide—21% oxygen mixture for 10 min. During the first month of life the sick preterm neonates exhibited similar NE, E, and DOPAC plasma levels but higher DA amounts than healthy infants. Plasma DA levels were inversely correlated with the transcutaneous oxygen tension (r= ‐0.636) indicating that hypoxemia was able to enhance the release of DA. Immediately following the hypercarbia test, there were no significant changes of plasma catecholamine levels in the sick preterms, but there was a significant increase of E plasma levels (+140%, p < 0.05) and a moderate elevation of NE and DA amounts in the healthy preterms. It is concluded that preterm neonates who have had respiratory disorders did not exhibit an immaturity of the sympathoadrenal system at rest, but had a defect in the release of E following hypercarbia exposure, which may be secondary to an alteration in chemoreceptor function and/or reduced catecholamine stores.
Temporal and individual variations in the dose of glucocorticoid used for the treatment of salt‐losing congenital virilizing adrenal hyperplasia due to 21‐hydroxylase deficiency
Authors: Sandrini R , Jospe N , Migeon CJ
Published: August 2010

The dose of glucocorticoid was evaluated in the treatment of 19 patients with salt‐losing congenital adrenal hyperplasia due to complete or nearly complete 21‐hydroxylase deficiency. In most cases, follow‐up was from infancy to puberty. The dose of steroid was expressed as oral cortisol (mg/m2 body surface area 124 hours); the equivalent doses of the various glucocorticoid preparations was as follows: 100 mg oral cortisol = 120 mg oral cortisone acetate = 25 mg oral prednisone = 50 mg intramuscular cortisol = 60 mg intramuscular cortisone acetate. The dose of glucocorticoid producing good laboratory and clinical control varied significantly with age. The dose fell from 26 mg/m2/24 hours in early infancy to 19 mg/m2/24 hours between 6 and 8 years of age, and then rose to 23–24 mglm2/hour in adolescence. In addition to these age‐related changes, there were large individual variations at each age. Indeed, the values from 4 of the 19 patients were not included in the calculation of the mean because they were more than 3 SD either above or below the mean. For the rest of the patients, the coefficient of variation ranged from 14.5% to 37.2%. It is concluded that glucocorticoid therapy must be adjusted carefully to the age and needs of each patient.
Screening for visual and ocular disorders in children, evaluation of the system in Sweden
Authors: Lennerstrand G , Kvarnström G , Jakobsson P
Published: August 2010

The aim of this study was to evaluate the visual screening system in Sweden. We have made a retrospective investigation of the results of screening for ocular disease and visual impairment of all children born in 1982 in three Swedish communities. The records from screening examinations from 0 to 10 y and from diagnostic follow‐up at the departments of ophthalmology that the children were referred to were inspected. The data were used to evaluate the efficiency of the Swedish visual screening system. The study included 3126 children. The attendance rate at the 4‐y examination was better than 99%. The sensitivity of the 4‐ and 5.5‐y screening examinations was on the average 92% and the specificity was 97%. The average number of false negative cases at 4 y was 5.6 in 1000 (0.56%). With this screening and subsequent diagnosis and treatment, the prevalence of amblyopia at different levels of visual acuity at the age of 10 y was: 0.06% with visual acuity <0.1,0.9% with visual acuity <0.5 and 1.7% with visual acuity < 0.7. In spite of largely unchanged pressure of amblyogenic factors in the population, the prevalence of deep and moderate amblyopia has been markedly reduced by screening and early treatment.
Low‐dose doxapram for treatment of apnoea following early weaning in very low birthweight infants: a randomized, double‐blind study
Authors: Rey E , Huon C , Mussat P , Parat S , Moriette G
Published: August 2010

The effects of low‐dose doxapram (0.5 mg kg−1 h−1) in combination with caffeine were evaluated on apnoea frequency following weaning from mechanical ventilation, and on blood pressure, in very low birthweight (BW) premature infants. Twenty‐nine infants with BW <1250 g, gestational age at birth (GA) <34 weeks and postnatal age <5 d, who required minimal respiratory support, were included. Following randomization, they received a loading dose of caffeine citrate and a continuous infusion of doxapram (doxapram, n= 14) or placebo (n= 15) was started. They were extubated 8 h after starting the infusion, which was continued for 5 d. During this period, weaning was well tolerated in both groups, apnoeas occurred less frequently and there was a greater increase in systolic blood pressure in infants treated with doxapram than in controls. Plasma doxapram levels were also higher than expected. It is therefore suggested that doxapram, even at low doses, should not be used during the first few days of life. Careful monitoring of blood pressure is required if doxapram is used later.
Dietary fibre, exercise and serum lipids and lipoprotein cholesterols in 12 to 15 year olds
Authors: Morley R , Baker BA , Greene LC , Livingstone MBE , Harland PSEG , Lucas A
Published: August 2010

Serum lipid and lipoprotein cholesterol levels track from childhood and are associated with risk of coronary heart disease. There is some evidence that these are influenced by dietary intake and exercise. Serum lipid and lipoprotein cholesterols were measured in a cohort of 119 British children aged 12–15 y who completed a dietary assessment and exercise questionnaire. The ratio of total‐ to high‐density lipoprotein cholesterol fell with increasing fibre intake, but after adjustment for age, body mass index, sex and other dietary factors, this was not statistically significant. Children exercising at least once a day had significantly lower serum total cholesterol and low density lipoprotein cholesterol levels than those exercising less frequently, even after adjustment for the above factors and dietary fibre intake. No dietary factor was significantly associated with any lipid measure after adjustment for the above factors. The challenge is how to optimize exercise level in adolescent children.
Sudden unexpected death in infancy: epidemiologically determined risk factors related to pathological classification
Authors: L'Hoir MP , Engelberts AC , van Well GThJ , Bajanowski T , Helweg‐Larsen K , Huber J
Published: August 2010

Infants that died suddenly and unexpectedly were studied as part of the European Concerted Action on sudden infant death syndrome (SIDS). Three paediatric pathologists, first independently of each other and later in a consensus meeting, classified 63 cases into 3 groups: SIDS (19 cases), borderline SIDS (30 cases) and non‐SIDS (14 cases). The interobserver agreement among the pathologists before the consensus meeting was moderate (Kappa = 0.41) and jointly it was higher (Kappa = 0.83). The distribution of epidemiologically determined risk factors was studied over these three groups. Maternal smoking after birth, low socioeconomic status and thumb sucking were found more often in SIDS than in the other cases. Inexperienced prone sleeping was a determinant for SIDS, but not for non‐SIDS. Previous hospital admission, low birthweight and/or short gestation were associated with borderline SIDS. Non‐SIDS cases received more breastfeeding, the parents hardly smoked during pregnancy and after birth, a firm mattress had been used, and more often signs of illness had been reported by the parents, compared with the SIDS and borderline SIDS cases. Bedding factors and both primary and secondary prone sleeping were equally distributed over the three groups which supports the hypothesis that, in SIDS and borderline SIDS, as well as in non‐SIDS cases, some similar external and preventable factors might influence the events leading to death. Research should therefore focus on all sudden unexpected deaths, after which subgroups such as SIDS cases can be separately analysed. The postmortem is an essential part of the whole work‐up of each case and the results should be interpreted with all other available data to arrive at a sound evaluation of cases and thus form the basis for the prevention of all sudden unexpected infant death.
Atrial fibrillation with neonatal pulmonary lymphangiectasia
Authors: Estlin EJ , Bennett MK , Skinner JR , Milligan DWA , Wren C
Published: August 2010

A female infant born at 28 weeks' gestation was found to have mild hydrops foetalis. Initial echocardiography showed a structurally normal heart. During the first week of life, episodic atrial tachycardia with 1:1 or 2:1 conduction was seen, requiring therapy with digoxin. The infant remained ventilator dependent, with a persistent, chylous pleural effusion which contained a preponderance of lymphocytes. Congenital pulmonary lymphangiectasia (CPL) was confirmed histologically. Worsening episodes of atrial tachycardia, including episodes of atrial fibrillation, were further investigated and a repeat echocardiogram revealed thickening of the entire right atrial wall. The cardiac findings of a thickened right atrial wall with the histological signs of myocarditis were thought to be the cause of paroxysms of atrial fibrillation, an extremely rare arrhythmia in the neonatal period. To the authors' knowledge there have been no previous reports of CPL in association with the cardiac abnormalities described herein.
Hydrops foetalis caused by hepatic haemangioma
Authors: Albano G , Pugliese A , Stabile M , Sirimarco F , Arsieri R
Published: August 2010

The authors report a moderately premature baby with Down's syndrome and hydrops, the latter probably caused by a large hepatic haemangioma which was diagnosed only after birth. At birth the baby was affected by massive right hydrothorax, ascites, hypoalbuminaemia and severe respiratory distress. With the use of modern neonatal intensive care, the baby survived. Corticosteroid treatment (prednisolone 2 mg kg−1 d−1 i.v. in divided doses) was associated with a very rapid resolution of the haemangioma and the baby was healthy at follow‐up. Although hepatic angiomas are not uncommon in the neonatal period, the association with hydrops is a rare finding.
Young female survivors of childhood leukaemia do not have increased somatic concerns
Authors: Puukko L‐RM , Sammallahti P , Hovi L , Aalberg V , Siimes MA
Published: August 2010

Objective: This study examined whether experience of cancer in childhood leaves a hypersensitivity to various somatic symptoms. Further, are self‐reported somatic symptoms explained by medical late‐effects or a worry of recurrence of the cancer?Methods: Of the total of 44 female survivors of leukaemia, 42 were compared with 69 age‐matched healthy controls. We used a questionnaire to study self reported somatic symptoms and a face‐to‐face interview to explore worries about recurrence of the illness. Health status and medical late effects were evaluated by a paediatric haematologist. Results: In contrast to our assumptions, young survivors of leukaemia reported fewer somatic symptoms than healthy age‐matched comparison subjects (p < 0.001). Late physical sequelae were uncommon except in the survivors of allogeneic bone marrow transplantation. Of the survivors, 52% were afraid of recurrence of the illness. The presence of physical or visible impairment and worry of recurrence were unrelated to frequency of somatic symptoms. Conclusions: The results suggest that experience of childhood leukaemia and its treatment does not result in increased somatic concerns or hypochondriacal tendencies.
Diabetic microangiopathy
Authors: Dahl‐Jørgensen K
Published: August 2010

Microvascular complications of diabetes include retinopathy, nephropathy and neuropathy. The first signs of these complications may develop in children and adolescents, particularly if insulin treatment has been inadequate. The mechanisms by which diabetic microangiopathy develop are not known, but probably include genetic influences. Several biochemical changes may interact, one important change being increased protein glycation. Important functional changes are increased organ blood flow, increased vascular permeability, abnormal blood viscosity and abnormal platelet and endothelial function. The structural hallmark of diabetic microangiopathy is the thickening of the capillary basement membrane. These changes may lead to occlusive angiopathy and to tissue hypoxia and damage. Screening for microangiopathy should start in children and adolescents after 5‐y duration of the disease and 10 y of age. The screening should include retinal examination through a dilated pupil or fundus photography, urinary albumin excretion rate, blood pressure measurement and neurological examination. Several intervention trials have shown that near normoglycaemia may reduce the risk of microangiopathy. There is a curvilinear association between the risk of development and progression of microangiopathy and mean blood glucose. Therefore, optimal insulin treatment is important in children and adolescents.
Monitoring for retinopathy in children and adolescents with type 1 diabetes
Authors: Danne T , Kordonouri O , Enders I , Hövener G
Published: August 2010

In children with an average diabetes onset at 11 y of age, the first retinal changes can be expected after a median diabetes duration of 9y, while the median time until clinically relevant background retinopathy is 14 y. Periodic examinations of the retinal status become necessary with the onset of puberty or after 5y of diabetes duration. Only sensitive methods should be used for retinopathy screening; the minimum recommended standard is a stereoscopic slit‐lamp biomicroscopic examination in mydriasis. The degree of glycaemic control, both before and after puberty, appears to be of outstanding importance for the development of retinopathy, but the contribution of other factors (arterial blood pressure, lipid abnormalities, sex steroids, smoking and genetic factors) may be of varying relevance in the individual patient. Thus, to improve the long‐term prognosis for children with diabetes appropriate screening for retinopathy and associated risk factors is mandatory.
Hypoxia‐induced free iron release in the red cells of newborn infants*
Authors: Buonocore G , Zani S , Sargentini I , Gioia D , Signorini C , Bracci R
Published: August 2010

Heparinized blood samples were obtained at birth from 164 newborn infants (101 full term; 63 preterm). Intra‐erythrocyte free iron concentration and hypoxanthine plasma levels were determined by high‐pressure liquid chromatography. Intra‐erythrocyte free iron concentration was higher in preterm than in full term babies (p < 0:0001) and adults (p < 0:0001). Statistically significant correlations were observed between intra‐erythrocyte free iron concentration and hypoxanthine levels (r = 0:66; p= 0:0001), pH (r = ‐ 0:76; p = 0:0001), base excess (r = ‐ 0:79; p= 0:0001), and gestational age (r = ‐ 0:44; p= 0:0001) in both infant populations. Multiple regression analysis between intra‐erythrocyte free iron concentration in cord blood, as an independent variable, and Apgar score at 1 min, pH, base excess, hypoxanthine values, FiO2 needed for resuscitation immediately after delivery, and gestational age, as dependent variables, identified hypoxanthine levels (p= 0:0003; partial F‐test = 15.4) as the best single predictor of intra‐erythrocyte free iron concentration. In conclusion, hypoxia induces intra‐erythrocyte free iron release, and therefore enhances the risk of oxidative injury due to hydroxyl radical generation.
Neonatal tracheal obstruction caused by aspiration of decidual tissue
Authors: van Wylick RC , Fletcher WA , MacRae BB , Dow KE
Published: August 2010

We report a newborn female born at 29 weeks’gestation who was unable to be resuscitated following a vaginal breech delivery. At autopsy the larynx and trachea contained a 1.2 × 0.2 cm fragment of tissue. Microscopic sections of this tissue revealed it to consist of decidua. This is the first report in the literature of tracheal obstruction secondary to aspiration of decidua. The mechanism by which this tissue may have resulted in completed obstruction of the trachea is discussed.
Effects of early postnatal dexamethasone therapy on calcium homeostasis and bone growth in preterm infants with respiratory distress syndrome
Authors: Lin YJ , Yeh TF , Lin HC , Wu JM , Lin CH , Yu CY
Published: August 2010

The effects of dexamethasone therapy on calcium homeostasis and bone growth were evaluated in 49 infants (24 placebo and 25 dexamethasone) who participated in a double‐blind trial of early dexamethasone therapy for the prevention of chronic lung disease. Dexamethasone (0.25 mg kg‐1 b.i.d. on d 1–7; 0.12 mg kg‐1 b.i.d. on d 8‐14; 0.05mg kg‐1 b.i.d. on d 15‐21; 0.02mg kg‐1 b.i.d. on d 22‐28) or saline placebo was given i.v. Serum calcium (Ca), phosphorus (P) and parathyroid hormone (PTH), and the corresponding urinary excretion of calcium (FECa) and phosphorus (FEP) were measured on d 2, 3, 7, 10, 14, 21 and 28 after starting the study. Radiographic evaluations of bone growth were also evaluated. Infants in the dexamethasone group had significantly higher PTH on d 2 (p < 0:01), 7 and 14 (p < 0:05) than infants in the placebo group. The dexamethasone‐treated infants also had significantly higher FEP on d 2,7 and 14 (p < 0:05) and lower FECa on d 7 and 14 (p < 0:05) than control infants. There was no significant difference between the groups in bone growth during the study. It was concluded that early dexamethasone therapy causes a transient elevation in PTH without apparent change in bone growth. The long‐term effect remains to be evaluated further.
Clinical relevance of Ureaplasma urealyticum colonization in preterm infants
Authors: Ollikainen J , Heiskanen‐Kosma T , Korppi M , Katila M‐L , Heinonen K
Published: August 2010

A cohort of 78 infants of gestational age less than 34 weeks was examined for Ureaplasma urealyticum colonization and neonatal morbidity. Ureaplasma urealyticum was cultured from nasopharyngeal, endotracheal and blood‐culture samples. A child was considered as being colonized if any sample was positive. The children with perinatal U. urealyticum colonization (n= 11; 14%) differed from those with no colonization (n= 67) in two important aspects: (i) they had higher leucocyte counts on the first (18.6 vs 12.4 109) and the second (29.0 vs 15.4 109) days of life (p= 0:01, both days); and (ii) they more often needed high‐frequency oscillatory ventilation (45% vs 13%, p= 0:02). This study showed that U. urealyticum colonization is associated with signs of the host defence response together with symptoms of respiratory tract involvement suggesting the pathogenicity of U. urealyticum in premature infants.
Survival of a preterm neonate with late onset hydrops fetalis due to parvovirus B19 infection
Authors: McNamara PJ , Ramanan R
Published: August 2010

This paper presents a case of non‐immune hydrops (NIH) which presented late at 28 weeks’gestation during an otherwise asymptomatic pregnancy. A severely hydropic female infant was born with significant cardiorespiratory compromise; however, aggressive resuscitation and postnatal treatment resulted in a favourable outcome. Parvovirus B19 DNA was subsequently detected in postnatal blood samples by nested polymerase chain reaction. This case emphasizes that survival is achievable even in those cases where intrauterine transfusion is not performed. It highlights the importance of prompt delivery and intensive neonatal support in such situations.
Coexistence of acquired protein S and protein C deficiency and the Arg506Gln mutation in factor Va in a child with severe thromboembolic disease
Authors: Shavit I , Brenner B , Lanir N , Kassis I , Lorber A , Shehadeh N
Published: August 2010

An 11‐y‐old girl who presented with cellulitis and clinical signs of deep vein thrombosis (DVT) is reported here. She developed staphylococcal sepsis, recurrent septic emboli and a large vegetation on the tricuspid valve. The patient was found to be heterozygous for the Arg506Gln mutation in factor Va and had low levels of protein C and protein S during the sepsis. The coexistence of the two thrombophilic states may explain the severe thromboembolic manifestations.