bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community Outreach: An expanding role for hospitals
Authors: SEWELL J. , OBERKLAID F. , DEBELLE G. , CULLEN J. , CARMICHAEL A. , FINNOCCHIARO C. 
Published: March 2008

Abstract Pressures for paediatric institutions to expand their traditional roles have come from changes in morbidity patterns, training requirements and community needs. Planning for new models of health care delivery has led to the development of the Community Outreach Program (COP), a hospital‐based model which utilizes existing community resources to provide early intervention services, training in community paediatrics and integtration of hospital and community based health care.A process evaluation of the COP was performed after 18 months operation. Eighty‐eight children were seen in a 7 week period, 20% with complex problems requiring further assessment and community consultation. Staff at the community agencies serviced considered the COP to be a major contributor to health care in their areas. Medical trainees developed new assessment techniques and management strategies for children with problems not previously encountered. It appears that the COP is a useful model for the delivery of health care, in particular to disadvantaged communities.
An evaluation of cell therapy in Down syndrome
Authors: FOREMAN P. J. , WARD J. 
Published: March 2008

AbstractA group of children with Down syndrome who were being treated with cell therapy was matched for age and sex with an untreated control group. Comparisons were made between the groups with respect to a number of developmental and physical variables which have been reported to be influenced by cell therapy. Of 55 comparisons made between treated and control groups, two differences were statistically significant. This study failed to show sufficient significant results for the treatment to be regarded as effective.
Comparison of a positive expiratory pressure (PEP) mask with postural drainage in patients with cystic fibrosis
Authors: ASPEREN P. P. VAN , JACKSON L. , HENNESSY P. , BROWN J. 
Published: March 2008

AbstractThe use of a positive expiratory pressure (PEP) mask was compared with postural drainage in the treatment of 10 patients with cystic fibrosis. The patients were allocated randomly in a crossover fashion to the two regimens and evaluated initially by a physiotherapist and over a 4 week treatment period by use of a diary card. There was no significant difference in sputum production or change in lung function between each technique as assessed by the physiotherapist. Diary card evaluation also failed to demonstrate a difference in sputum production, symptom score or peak expiratory flow rate between the 4 week treatment periods. It was concluded that PEP mask therapy is an acceptable and effective alternative to postural drainage in interval therapy of patients with cystic fibrosis, although the patients have tended to revert to postural drainage during acute exacerbations.
Spontaneous resolution of extrahepatic biliary obstruction in a neonate
Authors: EVANS J. E. , VANCE J. C. 
Published: March 2008

AbstractA patient with spontaneous resolution of complete extrahepatic biliary obstruction shortly after the neonatal period is described. Liver biopsy prior to resolution revealed widened portal tracts and extensive fibrosis; these changes normalized following resolution. The aetiology was not established but possibilities included a choledochal cyst, localized inflammation; for example, pancreatitis, a calculus of the common bile duct or a congenital membrane. Management of this patient would have been advanced if there were a paediatric size side‐viewing duodenoscope which would have diagnostic and therapeutic potentials.
Recent advances in bone marrow transplantation
Authors: VOWELS M. R. 
Published: March 2008

AbstractThe major barriers to successful bone marrow transplantation (BMT) are graft‐versus‐host disease (GVHD), infection, rejection and relapse. The combination of methotrexate and cyclosporin is significantly better than either alone in controlling GVHD. Removal of T cells from donor marrow prior to BMT has also decreased GVHD significantly, but a 5–10% rejection rate occurs and an increased relapse risk is being reported by some centres. Cyclosporin is valuable in the treatment of both acute and chronic GVHD. Interstitial pneumonitis due to cytomegalovirus (CMV) Is a major cause of mortality. Protection can be provided with CMV hyperimmune globulin and also by the avoidance of blood donors who are CMV antibody positive. Fractionated total body irradiation is associated with decreased toxicity compared to single dose. There is a 75% 4 year disease‐free survival following BMT for acute non‐lymphoblastic leukaemia in first remission, a 50% survival for acute lymphoblastic leukaemia in second remission and an 88% survival for chronic myeloid leukaemia in chronic phase. BMT for β‐thalassaemia major in young patients without organ dysfunction cures 80% of patients and identical results are achieved for severe aplastic anaemia when BMT is undertaken prior to blood product transfusion.
The mucopolysaccharidoses
Authors: WRAITH J. E. , ROGERS J. G. , DANKS D. M. 
Published: March 2008

AbstractThe experience of the Royal Children's Hospital in managing patients with mucopolysaccharidosis is discussed. All share the common feature of abnormal storage, within lysosomes, of partially degraded glycosaminoglycans, but different diseases within the group as a whole present different problems. The presentation, diagnosis and clinical outcome of 69 affected children are described.
Longitudinal study of very low birthweight infants: Impairments, health and distance growth to 14 years of age
Authors: KITCHEN W. H. , RYAN M. M. , RICKARDS A. L. 
Published: March 2008

AbstractOf 456 consecutive infants born in a tertiary maternity centre in 1966–70 and of birthweight under 1501 g, 171 (37.5%) survived their primary hospitalization. Subsequently three children died and the outcome of 142 (90.5%) of the remaining children presumably still alive were reviewed at a mean age of 14.5 years. Four children had cerebral palsy although only one child was legally blind, 31.6% (48/152) had an existing or corrected visual impairment; visual impairments occurred significantly more frequently in those of birthweight under 1251 g or those born before 29 weeks gestation. Six children required hearing aids and three others were still epileptic. Four children were chronic asthmatics and one had rheumatoid arthritis. None had disabling malformations and there was no delay in pubertal changes. The distributions of weight, height and head circumference percentiles were not significantly different from a standard Australian population. For children in the cohort, weights and heights were under the 10th percentile in 13.4% and 14.1%, respectively. Of the 30 children with birthweights under the 10th percentile and who were reviewed as teenagers, only eight (26.7%) were still in this weight category.
Acute viral encephalitis in children
Authors: WONG V. , YEUNG C. Y. 
Published: March 2008

AbstractFifty‐seven cases satisfying criteria of the diagnosis of acute viral encephalitis were studied. They were divided into two groups: Group 1 (presumed), 48 eases; Group 2 (postinfectious), nine cases. A possible association of viral aetiology was found in 26%. Viruses isolated were: influenza (3 cases), Coxsackie virus (2), adenovirus (2), mixed cytomegalovirus and adenovirus and herpes simplex viruses (1 case each). The mortality rate was 28%. Among the 41 survivors, 76% were completely normal and 24% had neurological sequelae with focal neurological deficit in 29%; personality changes in 6%; moderate mental retardation in 2%; severe mental retardation in 4%; hyperactivity in 4% and epilepsy in 4%. The best predictors to unfavourable outcome were the rapid rate of deterioration in conscious level after admission and the age of the patients.
Observations on diagnostic skills in paediatric medicine* and their perceived learning†
Authors: MENAHEM S. 
Published: March 2008

Abstract An attempt was made to review the diagnostic or problem‐solving skills of a group of four students as they interviewed children and their parents, who presented with common paediatric problems. The students were instructed to complete a pro forma stating the most likely diagnosis with their reasons; their answers to be given as the interview proceeded and after completion of the patient encounter. The students entertained up to six diagnoses and despite considering the correct diagnosis early in the interview, often arrived at an incorrect final diagnosis. Some improvement was noted in the students' performance when the exercise was repeated at the end of their 10 week paediatric term. The students tended to follow a disengaged enquiry, in part related to an inadequate knowledge base. By way of comparison, four consultants were put through the same exercise and arrived at the correct diagnosis after considering only one or two diagnoses.The students were also asked how they considered they had acquired those skills. As part of their answers, all included “formal learning”. The majority also suggested the observation of a suitable clinical model. When the consultants were asked the same questions all included “independent learning”. All subjects came from traditional medical schools.The relevance of these findings is discussed in terms of patient management and the teaching of problem‐solving skills to undergraduate and postgraduate students.
Systemic candidiasis and pneumonia in preterm infants
Authors: LOKE H. L. , VERBER I. , SZYMONOWICZ W. , YU V. Y. H. 
Published: March 2008

AbstractTwenty‐two preterm infants with systemic candidiasis are reported, of which seven cases were presumed to be antenatally acquired and 15 postnatally acquired. All except one were of very low birthweight. Fifteen infants had positive cultures of blood, cerebrospinal fluid or urine and seven had candida pneumonia only. Clinical features included general instability, respiratory deterioration and a necrotizing enterocolitis‐like presentation. The incidence of leukocytosis, shift to the left, eosinophilia and thrombocytopenia were not different from those with bacterial infection. The diagnosis was made after death in two infants. In the remaining 20 infants, treatment was initiated between 5 and 97 days of age, with a median delay of 4 days after the first positive cultures were taken. Complications of amphotericin and 5‐flucytosine therapy which developed in five infants resolved on cessation of treatment. The mortality rate was 18% and impairment rate among the 17 very low birthweight survivors was 18%. A high index of suspicion is required for systemic candidiasis, especially in infants of less than 1000 g birthweight. If recognized early, effective and safe antifungal therapy is possible with favourable short‐ and long‐term outcome.
Congenital hypothyroidism in Singapore: Prescreening era
Authors: TAN S‐H. , WONG H‐B. 
Published: March 2008

AbstractEarly diagnosis and treatment is extremely important in patients with congenital hypothyroidism to prevent mental retardation. Late diagnosis in children with congenital hypothyroidism results in a poor developmental outcome with low IQ and poor educational and occupational abilities. General practitioners and paediatricians should try to diagnose congenital hypothyroidism early, so that treatment can be initiated as soon as possible. The importance of a neonatal screening programme for congenital hypothyroidism is emphasized.
Sweat testing by capillary collection and osmometry: Suitability of the Wescor Macroduct System for screening suspected cystic fibrosis patients
Authors: BARNES G. L. , VAELIOJA L. , McSHANE S. 
Published: March 2008

AbstractA new method of collecting and analysing sweat (Wescor Macroduct) has advantages of simplicity of collection and direct reading of results by osmometry. Forty‐seven children with cystic fibrosis and 47 normal children had sweat tests performed simultaneously by the Gibson and Cooke method and by the Wescor Macroduct method. The new method had a higher rate of inadequate collection (19% vs 6%) which was more marked in children under 5 years of age. This was due partly to the difficulty of fitting a 2.5 cm pilocarpine gel disc to small arms. When an adequate collection was obtained, results were reliable with no false negatives occurring during this study. The Wescor Macroduct sweat test is a reliable method for use in peripheral centres to screen patients suspected of having cystic fibrosis. All children with an inadequate collection or a positive result should be referred to a reference centre for confirmation of the diagnosis. However, the majority will be saved the expense and disruption of travel.
Three patients with carbon monoxide poisoning treated with hyperbaric oxygen therapy
Authors: EKERT P. , TIBBALLS J. , GORMAN D. 
Published: March 2008

AbstractThe clinical management of three patients (two children, one adult) with carbon monoxide poisoning is presented. Treatment included hyperbaric oxygen therapy with a good outcome in two of the three patients. The pathophysiology of carbon monoxide poisoning and the benefits of treatment with hyperbaric oxygen therapy are reviewed.
Diagnosis of 21‐hydroxylase deficiency in newborn infants by GC‐MS of urinary steroids
Authors: YONG A. B. W. , PITT J. J. , MONTALTO J. , DAVIES H. E. , WARNE G. L. , CONNELLY J. F. 
Published: March 2008

Abstract In a study using gas chromatography‐mass spectrometry (GC‐MS) on urine specimens from 16 normal infants and 16 infants with congenital adrenal hyperplasia (CAH) due to 21‐hydroxylase deficiency (aged 1 day to 4 weeks), the major steroids recognized in all infants were: 16α‐hydroxy‐dehydroepiandrosterone, 16β‐hydroxy‐dehydroepiandrosterone, 16‐oxo‐androstenediol, androstenetriol, 15β, 17α‐dihydroxy‐pregnenolone and 16α‐hydroxy‐pregnenolone.Pregnanetriol was detectable in three normal infants (aged 3, 6 and 15 days) but the levels seen in 15 CAH patients were in a higher range. Pregnanetriolone, 5β‐17‐hydroxy‐pregnanolone and 15β, 17α‐dihydroxy‐pregnanolone were present in the urine of 15 CAH patients, but were not detectable in any of the normal infants. The older the patient, the higher the level was of each of these four steroids.The results indicate that, even on day 1, patients with CAH due to 21‐hydroxylase deficiency may be positively identified using GC‐MS of urine specimens. This does not preclude the possibility that a minority of patients with CAH, most likely those with mild 21‐hydroxylase deficiency, may not exhibit the characteristic GC‐MS findings on day 1, as seen in one of the 18 CAH patients.
Recurrent and non‐recurrent croup: An epidemiological study
Authors: COHEN B. , DUNT D. 
Published: March 2008

Abstract A community‐based study investigating the natural history of recurrent and non‐recurrent croup is described. Daily temperature data were collected during 1977–83, in order to analyse seasonal variation and the effect of atmospheric temperature on the number of croup episodes per calendar month. A case‐control study of 137 cases—consisting of 75 children with recurrent croup and 45 children with non‐recurrent croup—and 236 controls matched by age and sex was also conducted. It aimed to study associations between croup and other selected diseases in the patients and their families.Recurrent croup differed from non‐recurrent croup in its natural history in a number of ways. There was a winter and autumn peak in the number of episodes per month. These episodes occurred on days with significantly lower maximum and minimum temperatures. Recurrent croup was significantly associated with a patient history of asthma and wheezy bronchitis and a family history of croup.In contrast, non‐recurrent croup showed an autumn peak only, as well as no association with atmospheric temperature or other disease in the patients and their families. This study confirms and extends observations indicating that recurrent croup involves a persistent and inherited airways hyper‐reactivity that is triggered by viral and other stimuli, including those related to temperature.
Distribution of plasma Vitamin E levels in supplemented very low birthweight infants
Authors: ARNOLD J. D. , LESLIE G. I. , EARL J. W. , O'HALLORAN M. 
Published: March 2008

Abstract The distribution of plasma Vitamin E (VE) was determined in 25 very low birthweight (VLBW) infants who were supplemented with 100 mg/kg per day of α‐tocopherol acetate, given intragastrically. Their mean birthweight was 917 g and mean gestational age was 28 weeks. Mean plasma VE levels after 1 and 6 weeks' supplementation were 2.7 mg/dL (s.e.m. = 1.0) and 6.4 mg/dL (s.e.m. = 1.4), respectively (the difference was not significant). There was wide variability in plasma VE levels in these infants despite being on an identical dose of tocopherol. Plasma VE was < 0.5 mg/dL in 12% of samples, 0.5–3.0 mg/dL in 32%, 3.1–5.0 mg/dL in 18%, and 5.1–20 mg/dL in 38%. Fifteen of the 25 infants had at least one level in the range which has been associated with an increased incidence of septicaemia and necrotizing enterocolitis (> 5.0 mg/dL).These data suggest that if a policy of VE supplementation for VLBW infants is chosen, monitoring of plasma VE levels appears necessary so that the dosage can be adjusted in order to maintain plasma VE within the optimal range. This study's dosage regimen of supplementing infants with 100 mg/kg per day of VE was associated with a high incidence of elevated plasma VE levels and it is concluded that it is not advisable to use such large doses of VE in the premature newborn.
Ganglion cells in colonic mucosa
Authors: SCURRY J. 
Published: March 2008

AbstractIntramucosal ganglion cells are commonly believed not to occur in normal colon and to be found only in the chronic bowel motility disorder, neuronal intestinal dysplasia. After chance observations of two intramucosal ganglion cells in endoscopic biopsies in two patients without neuronal intestinal dysplasia, a retrospective study was undertaken to determine how frequently ganglion cells are present in colonic mucosa. Excluding the index cases, three intramucosal ganglion cells were found in 169 consecutive colonic biopsies. The nature of the ganglion cells was confirmed by positive neurone specific enolase staining by the peroxidase‐antiperoxidase technique in all cases. None of the patients had neuronal intestinal dysplasia. The diagnosis of neuronal intestinal dysplasia should rely on a constellation of clinicopathological features. Rare intramucosal ganglion cells are a normal histological finding.
Aluminium concentrations in infant formulae
Authors: SIMMER K. , FUDGE A. , TEUBNER J. , JAMES S.L. 
Published: March 2008

Abstract The aluminium concentrations in breast milk and in 25 commercially available infant formulae were measured. The mean concentration in breast milk was 49 μg/L while concentrations in most of the humanized formulae were less than 500 μ/L. Higher concentrations were found in Nan, Prem Enfamil and the three soya formulae.We suggest that all formulae have the potential to be contaminated with aluminium, and to varying degrees in different batches. Until it is known whether aluminium toxicity occurs in normal infants fed these formulae, it seems reasonable to expect manufacturers to routinely measure aluminium and keep aluminium contamination to a minimum. This may be especially important for formula fed to infants with compromised gastrointestinal and renal systems.
Paediatric post‐injury management: A hospital‐based review of deaths
Authors: WHEATLEY J. , CASS D. 
Published: March 2008

Abstract In order to begin to evaluate the need for an integrated trauma management service for injured children, a retrospective review of deaths following admission to a suburban teaching hospital was conducted. The medical records and coroners' reports for 64 consecutive cases over 68 months were reviewed, looking for errors in care which may have contributed to fatal outcomes.There was a male predominance (64%). The main causes of death were pedestrian injuries (42%), drownings (20%), injuries to vehicular passengers (17%) and injuries to cyclists (13%).Errors, often multiple, occurred in 29 cases (45%). Errors most frequently involved airway control and ventilatory support (25%), volume replacement (19%) and delays in performing essential investigations (13%). Errors were most frequent at the referring hospitals (49% [17 of/35 referred cases], compared with 14% at the teaching hospital), and principally involved multiply injured victims of blunt trauma (81%, 13 of 16 patients).In only three cases (5%) would better management have salvaged the patient. This can be explained partly by the predominance of what were judged to be irretrievable intracranial injuries (90%) in patients suffering blunt injuries. In contrast, an analysis of the same patient group revealed that in 30–50% the fatality could have been prevented by the full application of well recognised safety strategies. While strategies such as triage and trauma teams should reduce the error rate, it is yet to be proven that optimal post‐injury care will significantly reduce mortality.
Early neonatal hyperkalaemia in the extremely premature newborn infant
Authors: LESLIE G.I. , CARMAN G. , ARNOLD J.D. 
Published: March 2008

Abstract The incidence of hyperkalaemia in 43 consecutive infants born at less than 28 weeks gestation and cared for in our neonatal intensive care unit was documented. Plasma K levels were related to indices of renal function as well as to the degree of illness in the infants. The mean gestational age was 26.0 weeks (range 24–27 weeks) and the mean birthweight was 815 g (range 395–1170 g).Twenty‐six of the infants (60%) had at least one plasma K >5.5 mmol/L and 13 (30%) had a maximum plasma K >7 mmol/L. The mean postnatal age at which the plasma K exceeded 7 mmol/L was 25 h (range 10–39 h). Five infants with plasma K >7 mmol/L developed cardiac arrhythmias and four died of this complication. Only one infant had a targe intraventricular haemorrhage.Only two of 16 infants with an initial plasma K <5 mmol/L had a maximum plasma K >7 mmol/L, compared with eight of 10 with an initial plasma K >6 mmol/L (P <0.005). Plasma K also correlated directly with plasma urea (P <0.001) and plasma creatinine (P < 0.025), and inversely with urine volume (P < 0.05). Plasma K did not correlate with K intake, arterial pH, presence of asphyxia, severity of respiratory illness, gestation or birthweight.The rapidity with which the plasma K concentration reached potentially hazardous levels in some infants makes it imperative to measure plasma K within 6 h of birth and to continue to monitor levels at least every 6 h for the first 48 h in all infants born at less than 28 weeks gestation.
The gut, motility and manometry
Authors: CATTO‐SMITH A. G. 
Published: March 2008

ABSTRACTMany diseases in childhood present with symptoms resulting from the effects of those diseases on gut motility, including vomiting, colicky abdominal pain, ileus, constipation or diarrhoea. The control of gastrointestinal motility has been the subject of intensive research. It is now recognized that motility in the gastrointestinal tract is influenced by a complex range of factors, not only involving intestinal musculature, but also neural and humoral control. The development of techniques to measure motor activity in the gastrointestinal tract has increased our understanding of the pathophysiology of motor disorders. Manometric techniques are now available to study motility in pharynx, oesophagus, stomach, the biliary tract small and large intestine, and anorectum.The following discussion provides a background to the use of manometry in the study of motor disorders affecting the gut and will focus on the oesophagus and anorectum.