bluuebunny/crossref_metadata_2025 huggingface dataset:
Acetylcholine-Mediated Vasodilatation and Tissue-type Plasminogen Activator Release in Normal and Hypertensive Men
Authors: Dell'Omo Giulia , Ferrini Laura , Morale Marco , De Negri Ferdinando , Melillo Elio , Carmassi Franco , Pedrinelli Roberto
Published: July 2008

Muscarinic agents release tissue plasminogen activator (t-PA) in the forearm circulation of normal subjects, but no information exists about their effect in those hypertensive patients in whom the response to endothelial-mediated vasodilators is blunted. Acetylcholine, an endothelium-dependent vasodilator and a muscarinic agonist that releases t-PA from in-vitro systems, and sodium nitroprusside, an endothelium-indepen dent vasodilator, were infused into the brachial artery at rates calculated to cause a similar degree of vasodilatation. The study was performed in five elderly, smoking hyper tensive patients in whom the clustering of detrimental factors for endothelial function permitted prediction of defective endothelial-mediated vasorelaxation, and five young, normotensive, nonsmoking male volunteers. Forearm blood flow was assessed by venous plethysmography; t-PA and plasminogen activator inhibitor 1 (PAI-1) antigen values were expressed as flow-dependent (net release, the product of venoarterial concentration gradient and forearm blood flow) or independent (absolute and fractional concentration gradients) indices. In patients, acetylcholine did not change flow and net release and concentration gradients of t-PA, suggesting that vasodilatation as such, possibly by increasing fluid shear stress, may induce t-PA release in human forearm. In normal subjects, acetylcholine and sodium nitroprusside increased t-PA antigen net release at the highest infusion rate, an effect attributable to forearm hyperperfusion, since absolute and fractional gradients did not change significantly. PAI-1 antigen did not change during either infusion in both controls and patients, indicating the absence of an endothelial pool to be mobilized acutely.
Prognostic Aspects of TcPO2 in Iloprost Treatment as an Alternative to Amputation
Authors: Chomard D. , Habault P. , Ledemeney M. , Haon C. , Chomard D.
Published: July 2008

To help in determining management strategy as an alternative to amputation by using a synthetic prostacycline, a preliminary study was undertaken in 12 patients (11 men and one woman), with a mean age of 71.08 years, ie, 13 limbs evaluated at the stage of amputation. All patients were treated with a combination of iloprost and physical therapy (massage, specific exercises, cardiorespiratory training). Static transcutaneous oxygen pressure (TcPO2) was measured, with a sensitization test by verticalization and inhalation of oxygen, on day (D) D0, D15, D28, D60, D180, and D365. Results were analyzed in absolute terms and by tissue oxygenation ratio (TOR) (ratio between absolute values of TcPO2 in the foot and those of a reference chest electrode). Supine TOR and vertical TOR, with values of 36.67 and 65.08, respectively, appeared to be significantly linked to the variable "preservation of limb." At 1 year, seven limbs were preserved (53.85%) while amputation had been scheduled for all the patients treated. Evidence was found in all patients who kept their limb of stability (7.69%) and a decrease in (30.77%) or disap pearance of pain (15.38%) at 1 year.
Detection of Coronary Artery Disease in Patients with Severe Aortic Stenosis with Noninvasive Methods
Authors: Patsilinakos Sotirios P. , Antonelis Ioannis P. , Filippatos Gerasimos , Houssianakou Irene K. , Zamanis Nikolaos I. , Sioras Elias , Tsiotika Theodora , Kardaras Fotios , Anthopoulos Lambros P. , Kranidis Athanasios
Published: July 2008

Exercise stress ECG testing is not generally recommended in patients with severe aortic stenosis. Analysis of the utility of exercise testing, both with and without the use of myocardial thallium-201 scintigraphy for the diagnosis of coronary artery disease (CAD), yielded low specificity. A noninvasive, safe, and accurate diagnostic modality to ascertain the presence of CAD is not available to date for patients with severe aortic stenosis. The aim of this study was to assess the safety and diagnostic accuracy of adenosine stress echocardiography (A-Stress-Echo) and of adenosine stress myocardial perfusion scintig raphy (A-SPECT), for the detection of CAD in patients with severe aortic stenosis. The study included 50 patients with severe aortic stenosis (maximal instantaneous aortic valve gradient > 80 mmHg, range 81 to 144 mmHg, and aortic valve area < 0.75 cm2). All patients were submitted to A-Stress-Echo, after a 6-minute infusion of adenosine (140 μg/kg body weight/min), and then (>3 days later) A-SPECT with the same dosage of adenosine as above. Coronary angiography was performed in all patients.

No major complications were observed. The unpleasant symptoms were brief and did not necessitate cessation of the test. Both modalities showed the same sensitivity (85% for A-SPECT and 85% for A-Stress-Echo) angiographically diagnosed CAD while A-Stress-Echo yielded much higher specificity (96.7% vs 76.7%). Concordance of the two methods was found in 40 cases and the specificity for those patients was 100%. A-Stress-Echo and A-SPECT, either separately or in combination, constitute excellent and safe noninvasive diagnostic methods in detecting CAD in patients with severe aortic stenosis.
Thalamic Hemorrhage Following Carotid Endarterectomy-Induced Labile Blood Pressure: Controlling the Lability with Clonidine
Authors: Ahsan Ejaz A. , Meschia James F.
Published: July 2008

Carotid endarterectomy can lead to alterations in baroreceptor sensitivity. Impairment of this sensitivity can in turn lead to volatility of blood pressure (baroreflex failure syndrome—BFS). Rapid elevations in blood pressure can cause hypertensive encephalopathy in a patient with BFS. A patient is presented with hypertensive intra cerebral hemorrhage associated with BFS.
Right Ventricular Myocardial Bridge in a Patient with Pulmonary Hypertension
Authors: Gurewitch Joseph , Gotsman Mervyn S. , Rozenman Yoseph , Rozenman Y.
Published: July 2008

Myocardial bridge is a not uncommon finding in routine diagnostic coronary angiog raphy or pathological examination of the heart. It is almost always confined to the left ventricle and the left anterior descending coronary artery. This report describes a patient with chronic lung disease, severe left ventricular dysfunction, and pulmonary hyperten sion in whom coronary angiography revealed bridging of the right ventricular branch of the right coronary artery.
The Exercise Pressor Reflex and Changes in Radial Arterial Pressure and Heart Rate During Walking in Patients with Arteriosclerosis Obliterans
Authors: Reggiani Paolo , Mattioli Alessandro , Corbellini Ezio , Garducci Stefano , Catalano Michele , Baccelli Giorgio
Published: July 2008

Little is known about the time course and extent of the changes in radial arterial pressure and heart rate taking place in patients with arteriosclerosis obliterans during walking, as well their subtending mechanisms. For this reason the authors measured these variables in 23 patients with arteriosclerosis obliterans and in nine normal subjects (control group), during treadmill walking and several tests. In the patients a rapid and marked increase in radial arterial pressure was recorded during walking, whereas the same parameter either fell abruptly or persisted at elevated levels during recovery. This pattern markedly differed from that recorded in normal subjects, and it was mainly brought about by the activation of the exercise pressor reflex. The following findings suggested that the exercise pressor reflex was activated: the conditions required for activation of the reflex were present in our patients; the pressure changes observed during walking tightly paral leled the changes due to this reflex activation; the hypertensive response to walking was enhanced by increases in severity of disease and in walking speed and duration; the reflex activity persisted during recovery; and the pressure pattern during walking was reproduced by walking with arrested blood circulation to a lower limb. On the contrary, the behavior of heart rate was similar in patients and normal subjects both during walking and recovery because it was not influenced by the exercise pressor reflex.
Concomitant Use of Intraaortic Balloon Counterpulsation and Streptokinase in Acute Anterior Myocardial Infarction
Authors: Deniz Kumbasar S. , Semiz Ender , Sancaktar Oktay , Yalçinkaya Selim , Ermiş Cengiz , Deger Necmi
Published: July 2008

Using a prospective, nonrandomized design, the authors sought to determine whether concomitant use of intraaortic balloon counterpulsation (IABP) and streptokinase in acute anterior myocardial infarction (MI) would improve the in-hospital mortality rate and angiographic findings. The study included 45 patients with an acute anterior MI. All patients received intravenous streptokinase. Among these, 25 patients had concomitant IABP while the remaining 20 patients had streptokinase alone. All patients underwent cardiac catheterization. Patients treated with concomitant IABP had a significantly higher frequency of thrombolysis in myocardial infarction (TIMI) grade 3 flow (n: 11; 44% vs n: 1; 5%, p<0.05), and there was a trend toward a lower in-hospital mortality rate in the IABP group (n: 0; 0% vs n: 3; 15%, p=0.08). The angiographic presence of thrombus image and grade ≥2 coronary collateral circulation to the infarct-related coronary artery for the IABP and non-IABP groups did not differ significantly. The preliminary results of this study suggest that concomitant use of IABP and streptokinase in acute anterior MI increases the incidence of TIMI grade 3 flow and may have decreased the in-hospital mortality rate without unacceptable rates of vascular or hemorrhagic complications.
Upper Extremity Vein Thrombosis: Etiologic Categories, Precipitating Causes, and Management
Authors: Sakakibara Yuzuru , Shigeta Osamu , Ishikawa Shigemi , Hiramatsu Yuji , Jikuya Tomoaki , Onizuka Masataka , Mitsui Toshio , Sakakibara Yuzuru
Published: July 2008

Although an increasing incidence of upper extremity venous thrombosis (U/E-DVT) has been reported, a relative paucity of information regarding the etiologic categories, precipitating causes, and proper management for this disorder is available. To settle on a strategy for the management of U/E-DVT, retrospective analyses were performed using records from the authors' hospital. In 12 patients (seven men, five women), 61 (mean) years of age, diagnosed as having symptomatic venography-proved U/E-DVT and followed up for 41 (mean) months, etiologic factors, precipitating causes, treatments, and outcomes were retrospectively analyzed. As etiologic factors, five of the patients had neoplastic disease, one had hemodialysis, and two had transvenous pacemaker implan tations. Among various precipitating causes of U/E-DVT, hypoproteinemia was most frequently noted (67%). Various types of therapeutic management were selected: from thrombolysis with urokinase in six, balloon angioplasty in two, thrombectomy in two, and venous bypass surgery in one patient. Pulmonary embolism did not occur in any of the patients and only three of them complained of mild intermittent arm swelling during the follow-up period. Four patients died of neoplastic disease or heart failure (three within the first 6 months).

This study, though limited, suggests that the rate of mortality depends on multiple underlying medical problems in U/E-DVT patients. Low incidences of late postthrom botic sequelae and pulmonary embolism were noted in this series. Symptomatic U/E- DVT patients could be managed conservatively with a revised supplementary therapy for their precipitating causes of U/E-DVT.
Effect of Magnesium Sulfate Pretreatment and Significance of Matrix Metalloproteinase-1 and Interleukin-6 Levels in Coronary Reperfusion Therapy for Patients with Acute Myocardial Infarction
Authors: Shibata Masashi , Ueshima Kenji , Harada Masako , Nakamura Moyoyuki , Hiramori Katsuhiko , Endo Shigeatsu , Sato Norio , Mukaida Harumi , Suzuki Tomomi , Suzuki Tomoyuki , Inada Katsuya , Shibata Masashi
Published: July 2008

Magnesium (Mg) inhibits the influx of calcium in vascular smooth muscle cells. The purposes of this study were to test the hypothesis that an intravenous administration of magnesium might effect the complement response and to determine the effects of a magnesium pretreatment of patients with acute myocardial infarction (AMI) on the incidence of reperfusion injuries. Thirty-eight AMI patients were treated with coronary reperfusion therapy within 6 hours of onset. They were randomly divided into two groups: group pretreated with intravenous magnesium sulfate (0.27 mmol/kg) (magnesium group, n=19), and nonpretreated controls (placebo group). The reperfu sion injuries observed within 1 hour after the coronary reperfusion included arrhyth mias, aggravated chest pain, and ST segment elevation in 12-lead electrocardiograms. Coronary recanalization was performed in 36 patients. The incidence of reperfusion arrhythmia was significantly lower in the magnesium group than in the placebo group (17% vs 78%, p<0.001). At the postreperfusion stage, there was a tendency for the degree of ST segment reelevation in the magnesium group lower than in the placebo group (2.5 ±2.3 mm vs 4.7 ±3.8 mm, p=0.07). No marked difference was observed in the incidence of chest pain aggravation between the two groups (67% vs 73%, ns). The peak serum levels of interleukin-6 (IL-6) were significantly lower in the magnesium group than those in the placebo group (38.9 ±25.0 vs 92.3 ±76.5 pg/mL, p=0.016). The peak serum levels of matrix metalloproteinase-1 (MMP-1) were lower than those in the placebo group (16.2 ±4.8 vs 19.7 ±9.0 ng/mL, p=0.09), but the difference was not significant. A positive correlation was observed between the peak MMP-1 values and the peak IL-6 values (r=0.57, p=0.001) in all patients. Increased serum ionized Mg2+ may inhibit arrhythmic recurrence and the production of IL-6 and MMP-1 after reperfusion and prevent the increase of myocardial lesions caused by calcium overload on myocytes. The increased IL-6 production may induce MMP-1, leading to tissue organ injury. Pretreatment with magnesium sulfate may protect the myocardium of AMI patients from reperfusion injuries.
Left Atrial Systolic Time Interval in Hyperthyroidism
Authors: Dazai Yasunobu , Dazai Yasunobu
Published: July 2008

The author noninvasively examined effects of thyroid hormone on left atrial function by using the left atrial systolic time intervals (LASTI) with its parameters as left atrial ejection time (LAET), left atrial preejection period (LAPEP), and LAET/LAPEP, as measured by pulsed Doppler echocardiography. The hyperthyroid (HTH) and normal control (NC) groups consisted of 21 and 25 subjects, respectively. He also considered serum triiodothyronine (T3) concentrations, age, heart rate, systolic blood pressure, left ventricular preload, afterload, contractility, diastolic function, P wave duration, PR interval, and left ventricular preejection period (LVPEP) as factors that might influence LASTI. LAET, LAET/LAPEP, and LVPEP in the HTH group were significantly shorter than in the NC group. LAET showed no significance with serum T3 concentration, but did with LVPEP in partial correlation analysis. These results demonstrated that a short LAET in the hyperthyroid state is controlled by a rapid rise in the left ventricular pressure.
Hyperhomocysteinemia, Aortic Thrombus, and Peripheral Arterial Emboli
Authors: Sindhav Jivantika B. , Comp Philip C. , Chandrasekaran Krishnaswamy , Chandrasekaran K.
Published: July 2008

A young Native American woman presented with ischemia of the left lower limb resulting from embolic occlusion of the left common iliac artery and left femoral artery. The source of her emboli was aortic thrombus. The only underlying abnormality responsible for her hypercoagulability appeared to be hyperhomocysteinemia.
Characteristics of Intracardiac Potentials at Successful Ablation Sites in Concealed Wolff-Parkinson-White Syndrome
Authors: Kawamura Yuichiro , Sato Nobuyuki , Sakamoto Naka , Yokoyama Ayumi , Kamada Shinsuke , Kakuchi Hiroyuki , Iida Yasuhito , Kikuchi Kenjiro
Published: July 2008

The authors investigated bipolar electrograms recorded from the catheter tip at the actual successful ablation sites in 22 consecutive patients with concealed Wolff-Parkinson-White syndrome to clarify the characteristics of the potentials indicating the optimal site for catheter ablation. In all patients the retrograde transaortic approach to their left-sided accessory pathways, and a temperature-controlled (60°C) energy delivery, were performed. The authors assumed that a shorter dissociation time (time from energy delivery to ventriculoatrial conduction dissociation) indicated more accurate catheter mapping. A significant negative correlation (r = 0.527, p < 0.05) between the AV ratio (ratio of the amplitudes of the atrial to ventricular potentials) recorded at the ablation catheter tip and the dissociation time was observed. When the AV ratio and the dissoci ation time were compared among the groups classified according to the corresponding Npeak (the number of positive potential peaks in the electrogram obtained from the ablation catheter tip during right ventricular apical pacing) value, they differed signifi cantly (p < 0.05 and p < 0.01, respectively), ie, a higher AV ratio and a shorter dissocia tion time related to a multipeak electrogram from the ablation catheter tip. The authors conclude that the atrial insertion site of the accessory pathway, exhibiting a multipeak complex electrogram that may represent nonuniform anisotropic characteristics, is an adequate ablation site.
Incidence and Clinical Significance of Interatrial Shunting in Patients with Atrial Septal Aneurysm Detected by Contrast Transesophageal Echocardiography
Authors: Zhao Bo-Wen , Xian Tang-Chao , Matsuo Hirohide , Mizushige Katsufumi
Published: July 2008

The prevalence of atrial septal aneurysm (ASA) in a general referral population of patients was investigated by use of transthoracic (TTE) and transesophageal echocar diographies (TEE). Contrast TEE was performed to detect interatrial shunting in patients with ASA. In this population, the prevalence of ASA as determined by TTE was 0.47% (24/5,079), and 0.78% (40/5,079) by TEE. Of these 40 patients 16 (40%) were judged to be normal by TTE. Of the forty patients who were positive for ASA, 50% demonstrated interatrial shunting (atrial septal defects, 10; patent foramen ovale, 10). The authors concluded that TEE is of significant value in detecting the presence of ASA and associated cardiac abnormalities. Contrast TEE further enhances the detection of interatrial shunting in patients with ASA.
Regression of Large Atrial Thrombi and Coronary Neovascularizations with Conventional Anticoagulation in Mitral Stenosis
Authors: Al-Bezem Rim , Clark Luther T. , Kwan Tak
Published: July 2008

The authors report a case of angiographically documented multiple coronary neovas cularizations originating from the left circumflex artery (LCX) and coursing toward multiple thrombi located in the left atrium in a patient with severe mitral stenosis. The thrombi as well as the neovascularizations underwent near-complete resolution with 4 weeks' anticoagulation therapy with warfarin maintaining an international normaliza tion ratio of 3.5. Percutaneous mitral balloon valvuloplasty was performed successfully without complications.
Accelerated Transplant Coronary Artery Disease and Massive Silent Acute Myocardial Infarction in a Heart Transplant Patient
Authors: Rossignol Daniel A. , Kipreos Barbara , Akosah Kwame , Mohanty Pramod K.
Published: July 2008

This case report describes an aggressive form of accelerated atherosclerosis predicted early after transplant by dobutamine stress echocardiography in a patient who died of massive myocardial infarction 32 months after transplantation. The main objective finding of this event was markedly increased cardiac filling pressures during an elective cardiac catheterization and coronary angiography. The literature is briefly reviewed.
A Retrospective Study of Late Outcome in Patients with Peripheral Arterial Occlusive Disease: An Association Between Prosthetic Vascular Graft and Cancer Death?
Authors: Yoshitomi Yuji , Kojima Shunichi , Umemoto Takuya , Hosoi Yasuo , Kuramochi Morio , Yoshitomi Yuji
Published: July 2008

The authors assessed the relationship between cause of death and treatment modality in patients with peripheral arterial occlusive disease. A total of 273 patients were treated with percutaneous transluminal angioplasty, surgical reconstruction, amputation, or medical therapy. We evaluated the outcome in various patient subgroups divided by treatments with a mean follow-up of 4.9 years. Most patients died because of cardio vascular or cerebrovascular events, and cancer was the second most frequent cause of death. Furthermore, there was a significant difference in cancer deaths between patients who received prosthetic vascular grafts and those with other types of treatment (9.3% vs. 2.8%, p < 0.01, odds ratio = 3.34). It is noteworthy that patients with peripheral arterial occlusive disease succumbed to cancer, especially the patients with prosthetic vascular grafts.
Office Screening for Asymptomatic Urinary Tract Infections
Authors: LaFave John B. , Engel John J. , French John D. , Richmond Marion D. , Rider Robert E.
Published: July 2008

The urines of 3,270 asymptomatic girls were screened at annual physical examinations. The urines were collected in Dixie Cups® without prior prepara tion of the perineum and cultured on 5% sheep cell agar. Less than 2 per cent of the specimens showed significant growth, thus requiring no follow-up visits by 98 per cent of the patients. Slightly less that ½ of one per cent were found to have asymptomatic urinary tract infections. The procedure was found to be practical, economically feasible and reliable, and was well accepted by both the parents and patients.
Outcome of Adopted Vietnamese Children
Authors: McBogg Pamela , Wouri Donald
Published: July 2008

Thirty-six adopted Vietnamese children were evaluated physically and developmentally from four months to ten years after their adoption. All of the children had experienced early months of malnutrition, disease and deprivation. Many of the children were adopted before their first birthdays and received continuous, adequate care from invested families. Only two children had intelligence quotients less than 85 on the Slosson Test. Though physical abnormalities such as residuals of poliomyelitis, ear infections, and soft neurologic signs existed, no child was incapacitated by these condi tions. From the data available in the study, developmental outcomes could not be adequately predicted on the basis of unknown genetics, early mal nutrition, or early deprivation.
Neonatal Subcapsular Hematoma of the Liver Presenting as an Abdominal Mass
Authors: Maze Aubrey , Lieber Marvin A. , Aballi Arturo J.
Published: July 2008

Two infants with hepatic subcapsular hemmorrhage presenting as abdominal masses at age 17 days and 49 days are reported. The first had a slowly progres sive course and the second had initial internal bleeding. Aortography assisted in the management of the second case.
Sudden Infant Death Syndrome
Authors: Krein Nicole
Published: July 2008

This paper provides guidelines for health professionals in dealing with the particular grief reactions experienced by families of babies who die of the sudden infant death syndrome (SIDS). Time and privacy are needed to work through the anguish of grief. However, the SIDS families who cope best are those who are also guided throughout their grieving process by a caring physician who is comfortable in his supportive role. It is hoped that through an increased understanding of acute loss, the medical community will be better able to help SIDS parents and their surviving children regain their psychologic energy.
Gonococcal Vulvovaginitis in Prepubertal Girls
Authors: Frewen Timothy C. , Bannatyne Robert M.
Published: July 2008

Eighteen bacteriologically proven cases of prepubertal gonococcal vulvo vaginitis in girls ages 2 to 10 years were treated. Problems of diagnosis and management are discussed.
Low-Dose Continuous Intravenous Insulin Infusion in Childhood Diabetic Ketoacidosis
Authors: Perkin Ronald M. , Marks James F.
Published: July 2008

We studied 58 children with diabetic ketoacidosis using a random, prospec tive protocol, with insulin administered either as a low-dose continuous in fusion or as high-dose intermittent subcutaneous injections. There were no statistically significant differences between admission pH and glucose deter minations or the time to metabolic correction. The incidence of hypoglycemia and hypokalemia was higher in patients receiving subcutaneous insulin. In sulin levels in the low-dose patients were 85-160 μU/ml. The insulin required to achieve metabolic recovery was 1.6 U/kg in the low-dose group and 4.5 U/kg in the high-dose group (p < 0.01). Glucose administered at a rate of 3 to 4 g per unit of insulin infused in the low-dose group maintained a serum glucose of 150 to 250 mg/dl. Our studies suggest that low-dose intravenous insulin therapy is safe, as effective as high-dose intermittent subcutaneous injections and avoids the risks of hypoglycemia and hypokalemia. Meticulous attention to individual patient care, however, must remain the most important single variable.
Cholestyramine Treatment of Chronic Diarrhea Associated with Immune Deficiency Syndrome
Authors: Bujanover Yoram , Sullivan Peter , Liebman William M. , Goodman Joseph , Thaler M. Michael
Published: July 2008

A 5-year-old boy with known severe combined immunodeficiency disease presented with chronic diarrhea, malabsorption and retarded growth. Candida albicans was found in distal duodenal fluid, and invading the intestinal mucosa. Chronic diarrhea persisted after antimycotic therapy, but responded to treat ment with cholestyramine. Repeated courses of cholestyramine resin over a 6-month period were required for complete resolution of the gastrointestinal symptomatology.
Effect of Position on Blood Pressure in Infants
Authors: Esserman Lisa , Levine Robert S. , Hennekens Charles H. , Jesse Mary Jane
Published: July 2008

In order to estimate the effect of position on blood pressure measurements during the first year of life, pressures were recorded for 71 infants at one, three, six and twelve months of age in both the propped and lying positions. The position of the infant appeared to have little effect on mean values or upon the correlation of measurements over time. These results favor the use of a position for blood pressure measurement during infancy which places primary import ance upon the comfort of the child.
Chronic and Occult Stool Retention
Authors: Barr Ronald G. , Levine Melvin D. , Wilkinson Robert H. , Mulvihill Denise
Published: July 2008

A scoring method was developed to assess severity of stool retention using plain abdominal radiographs. To determine whether the technique was clinically valid in identifying chronic stool retention, the method was used to evaluate films taken of children with known stool retention before and after therapy. The method showed significant statistical differences between symptomatic pre-therapy films and controls and between pre- and post-therapy films of treatment "successes." No significant differences were found between pre- and post-therapy "failures." Use of radiographs is not a substitute for careful history taking and examination, but this scoring method for evaluating stool retention can be recommended prior to more extensive, invasive investigations in children presenting with functional abdominal complaints.
Shwachman-Diamond Syndrome and Chronic Liver Disease
Authors: Liebman William M. , Rosental Eldad , Hirschberger Moshe , Thaler M. Michael
Published: July 2008

Clinically inapparent persistent chronic liver disease in a 15-month-old male patient with Shwachman-Diamond syndrome is presented. Cryptic hepatic involvement may be an unrecognized feature of the syndrome and should be evaluated in all cases.
EEG Abnormalities in Diabetic Children
Authors: Haumont D. , Dorchy H. , Pelc S.
Published: July 2008

The effect of diabetic control upon EEC has seldom been studied. In the present investigation, a significant positive correlation between EEC ab normalities and degree of diabetic control was found, but no definite increase was noted in relation to the duration of diabetes. Eighty per cent of our patients having more than 5 severe hypoglycemic attacks showed evidence of abnormal EEG, suggesting that hypoglycemic coma or convulsions are closely related to EEC abnormalities (minor hypoglycemic episodes had no effect on the EEG). With the sensitive technique of fluorescein angiography, we demonstrated a clear correlation between incipient retinal angiopathy and EEC abnormalities. The factors that most positively relate to pathologic electrocerebral (EEG) activity in diabetic children are frequent and severe hypoglycemic attacks, comas and/or convulsions, and vascular changes in the retina.
Congenital Cystic Adenomatoid Malformation
Authors: Nishibayashi Steven W. , Andrassy Richard J. , Woolley Morton M.
Published: July 2008

Cystic adenomatoid malformation is an uncommon but potentially curable cause of respiratory distress in the neonate. This report emphasizes the key diagnostic and therapeutic maneuvers involved in its proper management.
Physician-Adolescent Patient Relationship
Authors: Silber Tomas J.
Published: July 2008

Adolescents are very different from each other, but they all have a develop mental process in common: they are going through their second period of individuation and they are developing value systems. Doctors get in touch with their adolescent patients on many different levels and with varying degrees of intensity, but they too have something in common: an obligation to their patient. Although the nature of this obligation is open to debate, the fact is that any interpersonal experience contains a moral element virtually by definition: there is an ethical dimension to the physician-adolescent patient relationship. The nature of the doctor's obligation to the adolescent is defined as aiding the patient to achieve growth. The physician can do this through appropriate use of value clarification and often through personal example.
Congenital Neurosyphilis and Juvenile Paresis
Authors: Wiggelinkhuizen Jan , Mason Rosemary
Published: July 2008

Juvenile neurosyphilis is rare and may be arrested or modified in the early stage by antibiotic treatment for intercurrent infections. Inadequate treatment may weaken the signs and symptoms of neurosyphilis so much that a high index of clinical suspicion is required for early and correct diagnosis. It should be remembered, however, that benzathine penicillin does not constitute adequate treatment for neurosyphilis.
Illnesses Associated with Extreme Elevation of the Erythrocyte Sedimentation Rate in Children
Authors: Schimmelpfennig Robert W. , Chusid Michael J.
Published: July 2008

The laboratory and hospital records were reviewed for the 156 children seen at Milwaukee Children's Hospital over a thirty-one month period with erythrocyte sedimentation rates (ESR) greater than or equal to 100 mm/hr. Fifty-five per cent of the children had an underlying infectious disease, 25 per cent had a collagen or renal disease, 13 per cent had neoplasms, and 6 per cent had miscellaneous disease processes. Patients with infectious diseases and high ESRs were significantly younger, significantly more febrile, and had higher leukocyte and absolute band counts than did patients in the other groups. Patients with malignancy had significantly lower hemo globin levels, leukocyte and absolute PMN counts. Some patients did die during the 30-month study period but not during the particular hospitalization in which the ESR was obtained.
A Rachitic Infant Painted by Burgkmair 136 Years before Dr. Whistler Described Rickets
Authors: Cone Thomas E.
Published: July 2008

Rickets as a definite disease manifesting itself by a more or less constant association of symptoms was first described in 1645 by Daniel Whistler, an English physician. However, the disease must have existed years before Dr. Whistler's report, as is evident in the painting by Hans Burgkmair com pleted in 1509.
Recurrent Parotitis during Childhood
Authors: Wilson William R. , Eavey Roland D. , Lang Daniel W.
Published: July 2008

A case report of a child suffering from recurrent parotitis secondary to in advertant chewing on Stensen's duct orifice suggests that this cause may be common to other children plagued by this puzzling disorder.
Lead Poisoning
Authors: Cohen George J.
Published: July 2008

This report compares the clinical picture, diagnosis, treatment and outcome of children with lead poisoning in the 1950s1 and the 1970s. During this 20-year period, increasing attention has been given to lead poisoning both at the local and national level. This attention has produced legislation to fund screening programs and to reduce the allowable amount of lead in paint. Greater public awareness, more effective methods for screening both populations and en vironments, and a reduction in severe sequelae of lead poisoning have also been achieved.
Reye Syndrome Associated with Hemophilus influenzae Infection
Authors: Sundwall Dale A. , Bergeson Marvin E. , Ortiz Amil
Published: July 2008

A case of Reye syndrome in an infant associated with culture-proven Hemophilus influenzae type d infection and probable meningitis is presented. This represents the second such reported case and the first to be described in detail. The criteria for the clinical and chemical diagnosis of Reye syndrome are reviewed. Pertinent and abnormal features of this patient's presentation are discussed. The finding of a non-visualizing liver on technetium-99m sulfur colloid isotope scan and possible mechanisms are discussed.
A Comparative Study of the Old Tuberculin Tine Test and the PPD-Tine Test
Authors: Steiner Phillip , Rao Madu , Victoria Minerva , James Pushpom
Published: July 2008

Forty-one children suspected of having tuberculosis were simultaneously given an intermediate strength Mantoux test, an old tuberculin tine test (OT), and a purified protein derivative (PPD) tine test. Each test was read at 48 hours, and the largest diameter of induration was recorded. Twenty-nine patients had a positive reaction to the Mantoux test, 20 patients had a positive reaction to the OT tine test, and 16 patients had a positive reaction to the PPD-tine test. There were seven instances of a doubtful reaction to the OT tine test and nine to the PPD-tine test. Two children with positive Mantoux tests had negative OT tine tests, and four with positive Mantoux tests had negative PPD-tine test reactions. There was a significant difference between the number of positive reactors to the Mantoux test and both tine tests. If all tine test reactions of 2 mm or more were considered positive (doubtful plus positive reactors), there was no significant difference between any of the tuber culin tests. All suggestively positive tine reactors should, therefore, be retested with a Mantoux test to avoid false-negative interpretation of the tines.
Intussusception of the Appendiceal Stump
Authors: La Salle Andre J. , Andrassy Richard J. , Page Carey P. , Henry Daniel A. , Buckley Clifford J.
Published: July 2008

Intussusception of the appendiceal stump is a rare complication of appendec tomy. A patient is described in detail and the eighteen previously reported instances are reviewed. Symptoms associated with this entity were abdominal pain (95%), vomiting (47%), blood per rectum (26%), and a palpable abdominal mass (68%). The onset of symptoms occurred within two weeks following appendectomy in 84% of the patients. Barium enema examination was diagnostic in 87.5% of patients in whom it was performed. The diagnosis of intussusception of the appendiceal stump in the postoperative period is difficult because of the nonspecificity of symptoms, the paucity of physical findings, and the intermittent nature of the partial bowel obstruction. Early diagnosis and appropriate treatment are facilitated by a thorough knowledge of this rare complication of appendectomy.
Occult Pneumococcal Bacteremia and the Febrile Infant and Young Child
Authors: Feder Henry M.
Published: July 2008

Occult pneumonoccemia (OP) is unsuspected Streptococcus pneumoniae bac teremia occurring in a previously well child who presents with fever associated with either no focus or an upper respiratory focus of infection. In this report, four cases of OP are presented and the literature is reviewed. The risk of OP appears highest for children, seen in urban emergency rooms and clinics, who are 6 to 24 months of age with rectal temperatures ≥ 38.9 C (102 F) and who have white blood cell counts ≥ 15,000/mm3. Other symptoms associated with OP include irritability, rhinorrhea, and febrile seizures. When recalled because of positive blood cultures, 40 per cent of untreated patients with OP had had spontaneous resolution of their illness, 29 per cent had per sistent fever or symptoms and sterile blood cultures, 22 per cent had persistent fever or symptoms and positive blood cultures, while 10 per cent had a febrile course complicated by pneumococcal meningitis.
PCP Intoxication in Young Children and Infants
Authors: Welch Michael J. , Correa Gerald A.
Published: July 2008

Six cases of PCP intoxication in young children age 5 years and younger seen at UCLA Medical Center recently and 10 other cases from the literature are described and their clinical findings summarized. PCP intoxication should be suspected in young children and infants presenting with rapid onset of lethargy or coma, strange behavior, staring spells, ataxia, and nystagmus. Other findings less frequent but still suspect are opisthotonos, hypertension, tachypnea or hyperpnea, miosis, hyperreflexia, hypertonia, and rigidity. Once suspected, the diagnosis is most easily made by finding PCP in the urine. Proper diagnosis of PCP intoxication is important to ensure that rapid, appropriate treatment is given, costly diagnostic workups are avoided, and family evalua tions are instituted. One case strongly suggests that intoxication in infants may result from accidental inhalation when near individuals who are smoking PCP.
Neonatal Pneumonia Caused by Members of the Bacteroides fragilis Group
Authors: Brook Itzhak , Martin William J. , Finegoid Sydney M.
Published: July 2008

Three infants who presented with premature rupture of membranes and neonatal pneumonia caused by organisms belonging to members of the B. fragilis group are reported. In all 3 instances, the organisms were recovered from tracheal aspirates and in 2 from blood cultures as well. Two of the new borns, treated with ampicillin and gentamicin, succumbed to their infections. The third, treated with clindamycin, recovered. Appropriate antibiotic coverage taking into account the penicillin-resistant anaerobes seems warranted for infants with neonatal pneumonia.
One Boy-Girl Chart for Office Use From Eight NCHS Growth Charts
Authors: Jaworski Alexander A.
Published: July 2008

A revised single sheet height-weight growth form for boys and girls from 0-11 years is presented. Replacing the original growth chart published in 1968, this form includes the latest growth data from the National Center for Health Statistics.
Recurrent Cyanotic Attacks due to Unilateral Upper Airway Obstruction in Infants
Authors: Singh Amrik , Lingam S.
Published: July 2008

Two infants presented with recurrent brief cyanotic attacks and had uni lateral nasal discharge. Both were poor feeders. The triad—transient cyanotic attacks, poor feeding and unilateral nasal discharge—points to unilateral upper airway obstruction. When the obstruction was relieved, the symptoms disappeared.
Electrophysiologic Evaluation and Surgical Correction of Wolff-Parkinson-White Syndrome in Children
Authors: Benson D. Woodrow , Gallagher John J.
Published: July 2008

The Wolff-Parkinson-White syndrome is due to a congenital heart mal formation that is the result of one or more persistent anomalous atrioven tricular pathway(s). While supraventricular tachycardia is the most commonly associated arrhythmia, there is a wide spectrum of associated arrhythmias mending fatal ventricular fibrillation. It is now known that surgical ablation of the anomalous pathway(s) can result in complete cure of arrhythmias in some patients. The purpose of this report is to describe the current methods used for the preoperative and operative electrophysiologic evaluation and surgical treatment of children with the Wolff-Parkinson-White syndrome, as illustrated by the case presentation of a normal eight-year-old patient who had ventricular fibrillation.
Gluceptate Renal Imaging
Authors: Leonard Joe C. , Wenzl James E. , Allen E. William , Vanhoutte Jean J.
Published: July 2008

Gluceptate renal imaging was performed to evaluate renal function and morphology in 50 pediatric patients (27 males, 23 females). Retrospective categorization revealed that 49% (27) of the studies were for functional evalua tion, 27% (15) were for anatomic considerations and 23% (13) were of a miscel laneous nature. Thirty-one patients also underwent intravenous pyelograms (IVP) and in seven discordant cases gluceptate imaging provided correct information in five, compared with only one correct IVP. While both the IVP and gluceptate imaging provide clinical information concerning renal function and morphology, the ability to obtain blood flow data and to quantitate differ ential renal functional mass allows gluceptate imaging to define renal function more specifically than the IVP making it a more meaningful diagnostic procedure for the evaluation of patients with known or suspected renal abnormalities.
Management of Sexual Molestation in Preschoolers
Authors: Funk Jeanne B.
Published: July 2008

Guidelines are presented to aid in the management of single-incident, non- violent sexual exploitation of the preschool child. Objectives, include safe guarding the child, dealing with any physical trauma and facilitating a quick resolution of the acute emotional crisis for the child and the parents.
Unusual Aspects of Salmonella Meningitis
Authors: Geiseler P. Jan , Nelson Kenrad E. , Reddi K.T.
Published: July 2008

Two cases of salmonella meningitis that demonstrate unusual clinical and epidemiologic features are reported. The first case was a two-month-old infant with relapsing salmonella meningitis in whom ECHO 2 virus and S. enteritidis grew in mixed culture from cerebrospinal fluid. The second case was a five- month-old with typhoid meningitis. Although this patient eventually re sponded to chloramphenicol, repeated CSF cultures grew S. typhi despite his receiving high dose parenteral therapy with ampicillin and chloramphenicol. Stool cultures disclosed that the patient's mother was an asymptomatic carrier of S. typhi. Nine days after the positive stool culture, the mother developed S. typhi bacteremia.
Clean Intermittent Catheterization for Home Management in Children with Myelomeningocele
Authors: Enrile Benedicta G. , Crooks K. Kenney
Published: July 2008

Sixty-two children with myelomeningocele and neurogenic bladders have been managed with clean intermittent catheterization (CIC) at home for periods of 6 to 42 months. Abnormal upper urinary tracts improved or stabilized in 83 per cent of the children. There was no renal deterioration in children who began with normal upper tracts while on CIC. Bacteruria was common, but clinically not a problem, unless ureterovesical reflux was present. Urinary con trol was improved in 66 per cent of the children. CIC is an effective and safe method to regularly empty the urinary bladder and is an alternative to supra vesical urinary diversion in many children with neurogenic bladders.
Vaginal Discharge in Children and Adolescents
Authors: Singleton Alice Faye
Published: July 2008

Vaginal discharge is one of the most common gynecologic problems en countered in the pediatric and adolescent populations and may have many causes. A useful way of approaching the diagnosis of a discharge is by categoriz ing the patient as being prepubertal or postpubertal. In the prepubertal age group, discharge is generally associated with vulvovaginitis. In the post pubertal age group, discharge may be physiologic, or may associated with cervicitis or vaginitis. In each group, gonorrhea and sexual abuse must be ruled out. A practical approach to therapy is outlined.
Bacterial Epididymo-orchitis in Children and Adolescents
Authors: Hermansen Marcus C. , Chusid Michael J. , Sty John R.
Published: July 2008

Five cases of bacterial epididymo-orchitis are presented. These patients demonstrate three distinct mechanisms of bacterial infection of the intrascrotal structures: epididymo-orchitis as a presentation and a complication of urinary tract infection; epididymo-orchitis associated with sexually transmitted dis ease ; and epididymo-orchitis associated with systemic infection. We recom mend urine, urethral, and blood bacterial cultures, in addition to viral sero logic studies, as an appropriate evaluation for any patient with epididymo- orchitis.
Congenital Spherocytosis is Often Not Hereditary
Authors: Stevens Richard F. , Evans David I. K.
Published: July 2008

A retrospective study of 50 patients with hereditary spherocytosis (HS) from 41 families seen between 1967 and 1979 at the Royal Manchester Children's Hospital, and Booth Hall Children's Hospital, Manchester, England is de scribed. Nineteen patients (38%) had no family history of spherocytosis and in 12 patients (24%), tests on the family showed no evidence of disease. Various modes of inheritance are discussed in the light of these results. The traditional name for the condition (hereditary spherocytosis) is considered unsuitable as it is clearly inaccurate in many cases. The name congenital spherocytosis would be more appropriate.
Congenital Syphilis
Authors: Bryan Elizabeth M. , Nicholson Elizabeth
Published: July 2008

Twenty-three infants who had positive cord blood VDRL test results are described. Fourteen had clinical signs of congenital syphilis. All but one of the affected, and only one of the unaffected infants had high immunoglobulin M (IgM) levels. Several affected infants had low immunoglobulin G (IgG) levels suggesting poor placental transfer. Total protein, albumin and colloid osmotic pressure (COP) levels were generally within the normal range in the whole group, so these are unlikely to be responsible for the neonatal edema found in many of the affected infants.
Progression of Clinical Signs in Severe Infant Botulism
Authors: L'Hommedieu Charles , Polin Richard A.
Published: July 2008

The clinical evaluation of nine patients with severe infant botulism revealed an identifiable progression of signs due to blockade of the cholinergic synapse similar to that described for competitive blocking agents.7 This predictable se quence reflects different "margins of safety" for muscles involved in repetitive activities, diaphragmatic function and movement of the extremities. It is important for the clinician to realize that return of peripheral motor activity does not signify a completely recovered cholinergic synapse. Instead of having a four- to five-fold margin of safety, the infant remains close to the point of neuromuscular blockade. Added insults or stress to neuromuscular trans mission may precipitate respiratory failure. An understanding of the signs associated with progressive impairment of cholinergic synapses both during onset and during resolution of disease will allow safe care of the infant and will diminish the risk of iatrogenie complications. Evaluation of head control is the most sensitive physical fincling indicative of return of adequate neuromuscular function and signifies that oral feedings can be reinstituted.