Pub Date : 1991-07-01DOI: 10.1001/ARCHPEDI.1991.02160070030017
M. Kimura, H. Kuno-sakai, Y. Sato, H. Kamiya, R. Nii, S. Isomura, K. Horiuchi, T. Kato, M. Deguchi, H. Saikusa
The reactogenicity and immunogenicity of the Takeda acellular pertussis vaccine combined with tetanus and diphtheria toxoids were compared in 139 infants aged 3 to 8 months, 60 infants and children aged 9 to 23 months, and 99 children aged 24 to 30 months. Good antibody responses to pertussis toxin (PT), filamentous hemagglutinin (FHA), and agglutinogens occurred in all age groups after both the third and fourth doses. After the fourth (booster) dose, the mean antibody values in initially seronegative infants vaccinated at 3 to 8 months of age were as follows: anti-PT, 67.8 enzyme-linked immunosorbent assay units (EU) per milliliter; anti-FHA, 149.5 EU/mL; the agglutinin titer was 125.6. The values in initially seronegative children vaccinated at 24 to 30 months of age were as follows: anti-PT, 92.9 EU/mL; anti-FHA, 251.7 EU/mL; the agglutinin titer was 275.8. Reactions following immunization were minimal. Except for drowsiness after the first dose in infants, there were no clinically significant differences in reactions between infants and older children. The findings in this study coupled with the recent demonstration of efficacy of this vaccine in 2-year-old children supports the recent Japanese recommendation to lower the age of immunization with acellular pertussis vaccine combined with tetanus and diphtheria toxoids to 3 months.
{"title":"A comparative trial of the reactogenicity and immunogenicity of Takeda acellular pertussis vaccine combined with tetanus and diphtheria toxoids. Outcome in 3- to 8-month-old infants, 9- to 23-month-old infants and children, and 24- to 30-month-old children.","authors":"M. Kimura, H. Kuno-sakai, Y. Sato, H. Kamiya, R. Nii, S. Isomura, K. Horiuchi, T. Kato, M. Deguchi, H. Saikusa","doi":"10.1001/ARCHPEDI.1991.02160070030017","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1991.02160070030017","url":null,"abstract":"The reactogenicity and immunogenicity of the Takeda acellular pertussis vaccine combined with tetanus and diphtheria toxoids were compared in 139 infants aged 3 to 8 months, 60 infants and children aged 9 to 23 months, and 99 children aged 24 to 30 months. Good antibody responses to pertussis toxin (PT), filamentous hemagglutinin (FHA), and agglutinogens occurred in all age groups after both the third and fourth doses. After the fourth (booster) dose, the mean antibody values in initially seronegative infants vaccinated at 3 to 8 months of age were as follows: anti-PT, 67.8 enzyme-linked immunosorbent assay units (EU) per milliliter; anti-FHA, 149.5 EU/mL; the agglutinin titer was 125.6. The values in initially seronegative children vaccinated at 24 to 30 months of age were as follows: anti-PT, 92.9 EU/mL; anti-FHA, 251.7 EU/mL; the agglutinin titer was 275.8. Reactions following immunization were minimal. Except for drowsiness after the first dose in infants, there were no clinically significant differences in reactions between infants and older children. The findings in this study coupled with the recent demonstration of efficacy of this vaccine in 2-year-old children supports the recent Japanese recommendation to lower the age of immunization with acellular pertussis vaccine combined with tetanus and diphtheria toxoids to 3 months.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"2 1","pages":"734-41"},"PeriodicalIF":0.0,"publicationDate":"1991-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76185009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-07-01DOI: 10.1001/ARCHPEDI.1991.02160070065023
M. Rudolf, Z. Zadik, S. Linn, Z. Hochberg
Seasonal variation in growth of normal children has been well described, although the mechanism by which it occurs has not been elucidated. The growth of 52 growth hormone-deficient children treated with synthetic human growth hormone was analyzed. A similar seasonal variation was observed, with mean (+/- SEM) peak growth occurring in the summer (8.2 +/- 0.3 cm/y) and winter (7.7 +/- 0.2 cm/y), and trough growth occurring in the autumn (6.9 +/- 0.3 cm/y). Forty-seven percent of subjects grew minimally during the autumn, and only two children showed peak growth in that season. Individual variations between maximal and minimal growth seasons amounted to 3.5 +/- 0.3 cm/y. The seasonal pattern was statistically significant for the group as a whole, for the prepubertal subgroup, and for the boys. The variation persisted when the first year of treatment was excluded to avoid bias of the initial growth spurt. The season of onset of therapy did not affect total growth during the first year. The demonstration of a seasonal pattern in growth of these children suggests that the seasonal variation may be mediated by peripheral rather than central factors. Paired clonidine-provoked growth hormone levels and an integrated concentration of 24-hour growth hormone levels and serum levels of insulinlike growth hormone I measured in a control group of normally growing children were also analyzed and showed no seasonal variation. This further suggests that peripheral rather than central factors are responsible for the seasonal variation in children's growth.
{"title":"Seasonal variation in growth during growth hormone therapy.","authors":"M. Rudolf, Z. Zadik, S. Linn, Z. Hochberg","doi":"10.1001/ARCHPEDI.1991.02160070065023","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1991.02160070065023","url":null,"abstract":"Seasonal variation in growth of normal children has been well described, although the mechanism by which it occurs has not been elucidated. The growth of 52 growth hormone-deficient children treated with synthetic human growth hormone was analyzed. A similar seasonal variation was observed, with mean (+/- SEM) peak growth occurring in the summer (8.2 +/- 0.3 cm/y) and winter (7.7 +/- 0.2 cm/y), and trough growth occurring in the autumn (6.9 +/- 0.3 cm/y). Forty-seven percent of subjects grew minimally during the autumn, and only two children showed peak growth in that season. Individual variations between maximal and minimal growth seasons amounted to 3.5 +/- 0.3 cm/y. The seasonal pattern was statistically significant for the group as a whole, for the prepubertal subgroup, and for the boys. The variation persisted when the first year of treatment was excluded to avoid bias of the initial growth spurt. The season of onset of therapy did not affect total growth during the first year. The demonstration of a seasonal pattern in growth of these children suggests that the seasonal variation may be mediated by peripheral rather than central factors. Paired clonidine-provoked growth hormone levels and an integrated concentration of 24-hour growth hormone levels and serum levels of insulinlike growth hormone I measured in a control group of normally growing children were also analyzed and showed no seasonal variation. This further suggests that peripheral rather than central factors are responsible for the seasonal variation in children's growth.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"31 1","pages":"769-72"},"PeriodicalIF":0.0,"publicationDate":"1991-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88716937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-07-01DOI: 10.1001/ARCHPEDI.1991.02160070100029
Susan M. Scott, Cathy Rogers, Pamela Angelus, Conra Backstrom
The pattern of urinary epidermal growth factor/creatinine levels in necrotizing enterocolitis was examined in 75 infants (in 28 infants the diagnosis of necrotizing enterocolitis was considered; 47 infants were studied for effect of surgery or nutrition on epidermal growth factor levels). There was a consistent and significant increase in epidermal growth factor/creatinine values at the time of diagnosis of necrotizing enterocolitis compared with baseline values. Epidermal growth factor levels in infants without necrotizing enterocolitis and in early nutrition remained unchanged. These results suggested that urinary epidermal growth factor/creatinine levels may differentiate stage II and III necrotizing enterocolitis from stage I disease. The increased epidermal growth factor/creatinine levels may be related to the absorption into the circulation of preexisting gastrointestinal tract epidermal growth factor through damaged tissue or to increased synthesis by the gastrointestinal tract in response to the injury caused by necrotizing enterocolitis.
{"title":"Effect of necrotizing enterocolitis on urinary epidermal growth factor levels.","authors":"Susan M. Scott, Cathy Rogers, Pamela Angelus, Conra Backstrom","doi":"10.1001/ARCHPEDI.1991.02160070100029","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1991.02160070100029","url":null,"abstract":"The pattern of urinary epidermal growth factor/creatinine levels in necrotizing enterocolitis was examined in 75 infants (in 28 infants the diagnosis of necrotizing enterocolitis was considered; 47 infants were studied for effect of surgery or nutrition on epidermal growth factor levels). There was a consistent and significant increase in epidermal growth factor/creatinine values at the time of diagnosis of necrotizing enterocolitis compared with baseline values. Epidermal growth factor levels in infants without necrotizing enterocolitis and in early nutrition remained unchanged. These results suggested that urinary epidermal growth factor/creatinine levels may differentiate stage II and III necrotizing enterocolitis from stage I disease. The increased epidermal growth factor/creatinine levels may be related to the absorption into the circulation of preexisting gastrointestinal tract epidermal growth factor through damaged tissue or to increased synthesis by the gastrointestinal tract in response to the injury caused by necrotizing enterocolitis.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"9 1","pages":"804-7"},"PeriodicalIF":0.0,"publicationDate":"1991-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78461788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-07-01DOI: 10.1001/ARCHPEDI.1991.02160070053021
B. Joorabchi
This report describes and evaluates a 42-station objective structured clinical examination (OSCE) administered to 29 pediatric residents and six medical students. In half of the stations, residents spent 5 minutes performing a clearly defined clinical task while being rated by an observer. In the other half of the stations, they answered questions based on the data just gathered. There were six interviews with real or simulated patients, four physical examinations, six laboratory tests or procedures, and one chart review. Eight rest stops were provided. The results of the OSCE were compared with those of resident performance ratings and the Pediatric Board's in-training examination. The OSCE scores could clearly separate the students from the residents and each class of residents from all others (construct validity). The in-training examination could not separate first-year post-graduate level and second-year postgraduate level residents. Resident performance ratings could distinguish only first-year postgraduate level from third-year postgraduate level residents. Residents uniformly agreed that the OSCE measured important clinical objectives attesting to its content validity. Reliability for the OSCE was calculated at the 0.8 to 0.83 range. It is concluded that valid and reliable clinical examinations in pediatrics are feasible, practical, and highly desirable.
{"title":"Objective structured clinical examination in a pediatric residency program.","authors":"B. Joorabchi","doi":"10.1001/ARCHPEDI.1991.02160070053021","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1991.02160070053021","url":null,"abstract":"This report describes and evaluates a 42-station objective structured clinical examination (OSCE) administered to 29 pediatric residents and six medical students. In half of the stations, residents spent 5 minutes performing a clearly defined clinical task while being rated by an observer. In the other half of the stations, they answered questions based on the data just gathered. There were six interviews with real or simulated patients, four physical examinations, six laboratory tests or procedures, and one chart review. Eight rest stops were provided. The results of the OSCE were compared with those of resident performance ratings and the Pediatric Board's in-training examination. The OSCE scores could clearly separate the students from the residents and each class of residents from all others (construct validity). The in-training examination could not separate first-year post-graduate level and second-year postgraduate level residents. Resident performance ratings could distinguish only first-year postgraduate level from third-year postgraduate level residents. Residents uniformly agreed that the OSCE measured important clinical objectives attesting to its content validity. Reliability for the OSCE was calculated at the 0.8 to 0.83 range. It is concluded that valid and reliable clinical examinations in pediatrics are feasible, practical, and highly desirable.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"172 1","pages":"757-62"},"PeriodicalIF":0.0,"publicationDate":"1991-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77524566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-07-01DOI: 10.1001/ARCHPEDI.1991.02160070060022
T. Rowland
Obesity impairs performance in most athletic events, but the influence of increased body fat on cardiopulmonary function has not been clearly delineated. An understanding of the fatness-fitness relationship is important in the optimal design of exercise programs for obese subjects. In this study, 27 adolescent females with body fat levels ranging from normal to gross obesity were evaluated to determine the impact of adiposity on physiologic factors during maximal and submaximal treadmill walking. Increased skinfold measures correlated significantly with absolute maximal oxygen uptake throughout the range of body fat levels (r = .72), and oxygen consumption per kilogram of body weight and treadmill endurance time both declined as fatness increased (r = -.49 and -.42, respectively). Obesity did not affect submaximal walking economy. These findings indicate that increased fat levels are associated with increased cardiopulmonary exercise capacity, but that functional fitness declines because of the inert load created by excess body fat. Therefore, therapeutic exercise programs for obese adolescents are best designed to increase caloric expenditure and decrease body fat rather than to improve aerobic fitness.
{"title":"Effects of obesity on aerobic fitness in adolescent females.","authors":"T. Rowland","doi":"10.1001/ARCHPEDI.1991.02160070060022","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1991.02160070060022","url":null,"abstract":"Obesity impairs performance in most athletic events, but the influence of increased body fat on cardiopulmonary function has not been clearly delineated. An understanding of the fatness-fitness relationship is important in the optimal design of exercise programs for obese subjects. In this study, 27 adolescent females with body fat levels ranging from normal to gross obesity were evaluated to determine the impact of adiposity on physiologic factors during maximal and submaximal treadmill walking. Increased skinfold measures correlated significantly with absolute maximal oxygen uptake throughout the range of body fat levels (r = .72), and oxygen consumption per kilogram of body weight and treadmill endurance time both declined as fatness increased (r = -.49 and -.42, respectively). Obesity did not affect submaximal walking economy. These findings indicate that increased fat levels are associated with increased cardiopulmonary exercise capacity, but that functional fitness declines because of the inert load created by excess body fat. Therefore, therapeutic exercise programs for obese adolescents are best designed to increase caloric expenditure and decrease body fat rather than to improve aerobic fitness.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"32 1","pages":"764-8"},"PeriodicalIF":0.0,"publicationDate":"1991-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84236703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-07-01DOI: 10.1001/ARCHPEDI.1991.02160070109031
Jean M. Luchi, Forrest C. Bennett, J. C. Jackson
In infants with bronchopulmonary dysplasia, the influence of the severity of their pulmonary disease on neurodevelopmental outcome is unknown. Neurodevelopmental outcomes at a mean age of 36 months were assessed in 27 premature subjects who had bronchopulmonary dysplasia. Subjects had a mean birth weight of 940 g (range, 540 to 1690 g) and a mean gestational age of 27 weeks (range, 25 to 31 weeks). The duration of mechanical ventilation ranged from 22 to 128 days, and the duration of requirement of supplemental oxygen ranged from 34 to 1033 days. No significant correlations were found between duration of mechanical ventilation or oxygen therapy and overall neurodevelopmental outcome. In contrast, cranial ultrasound findings of intracranial hemorrhage and/or periventricular echodensity related specifically to poorer cognitive outcome. By age 3 years, severity of bronchopulmonary dysplasia is not a sufficient predictor of neurodevelopmental outcome. Intracranial hemorrhage and periventricular echodensity continue to be important predictors.
{"title":"Predictors of neurodevelopmental outcome following bronchopulmonary dysplasia.","authors":"Jean M. Luchi, Forrest C. Bennett, J. C. Jackson","doi":"10.1001/ARCHPEDI.1991.02160070109031","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1991.02160070109031","url":null,"abstract":"In infants with bronchopulmonary dysplasia, the influence of the severity of their pulmonary disease on neurodevelopmental outcome is unknown. Neurodevelopmental outcomes at a mean age of 36 months were assessed in 27 premature subjects who had bronchopulmonary dysplasia. Subjects had a mean birth weight of 940 g (range, 540 to 1690 g) and a mean gestational age of 27 weeks (range, 25 to 31 weeks). The duration of mechanical ventilation ranged from 22 to 128 days, and the duration of requirement of supplemental oxygen ranged from 34 to 1033 days. No significant correlations were found between duration of mechanical ventilation or oxygen therapy and overall neurodevelopmental outcome. In contrast, cranial ultrasound findings of intracranial hemorrhage and/or periventricular echodensity related specifically to poorer cognitive outcome. By age 3 years, severity of bronchopulmonary dysplasia is not a sufficient predictor of neurodevelopmental outcome. Intracranial hemorrhage and periventricular echodensity continue to be important predictors.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"347 1","pages":"813-7"},"PeriodicalIF":0.0,"publicationDate":"1991-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79696583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-07-01DOI: 10.1001/ARCHPEDI.1991.02160070021014
R. Schoumacher
Home care for children dependent on ventilators or other equipment is increasingly common. Until recently, such children remained in acute-care hospitals, using vast amounts of resources, even when they required less-than-acute care. Less than a decade ago, only a few demonstration projects in this country routinely attempted to return ventilator-dependent children to their homes and back into the community. 1 Today, an expanding home-care industry assists many established centers, pediatricians, and specialists in this transfer. The trend toward home care has been stimulated by rising societal expectations, awareness of the needs of the disabled, the increasing number of children rescued from formerly lethal conditions but sustaining disability in the process, and the high cost of inpatient care in acute-care facilities. Clearly, the foremost pressure is financial. Third-party payers, both public and private, do not believe they can sustain the high costs of maintaining such children in
{"title":"Saving money with home care.","authors":"R. Schoumacher","doi":"10.1001/ARCHPEDI.1991.02160070021014","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1991.02160070021014","url":null,"abstract":"Home care for children dependent on ventilators or other equipment is increasingly common. Until recently, such children remained in acute-care hospitals, using vast amounts of resources, even when they required less-than-acute care. Less than a decade ago, only a few demonstration projects in this country routinely attempted to return ventilator-dependent children to their homes and back into the community. 1 Today, an expanding home-care industry assists many established centers, pediatricians, and specialists in this transfer. The trend toward home care has been stimulated by rising societal expectations, awareness of the needs of the disabled, the increasing number of children rescued from formerly lethal conditions but sustaining disability in the process, and the high cost of inpatient care in acute-care facilities. Clearly, the foremost pressure is financial. Third-party payers, both public and private, do not believe they can sustain the high costs of maintaining such children in","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"1 1","pages":"725"},"PeriodicalIF":0.0,"publicationDate":"1991-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83140231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-07-01DOI: 10.1001/ARCHPEDI.1991.02160070025016
A. I. Fields, A. Rosenblatt, M. Pollack, J. Kaufman
We evaluated home care costs and the cost-effectiveness of home care vs alternative institutional care for respiratory technology-dependent children in a Medicaid Model Waiver Program. "Cost-savings" was measured as the difference between the established Medicaid reimbursable charges to enact an individualized care plan at a long-term care institution and the actual Medicaid reimbursements for home care. Ten patients--six dependent on mechanical ventilation and four with a tracheostomy who were receiving oxygen--were included in the analysis. The mean (+/- SD) annual home care costs were $109,836 +/- $20,781 for ventilator-dependent children and $63,650 +/- $12,350 for oxygen-dependent patients with a tracheostomy, representing annual savings of approximately $79,000 per patient and $83,000 per patient, respectively. The largest portion of home care reimbursements was for nursing care, accounting for 69.0% and 59.0% of the two patient groups. The full program (50 patients) has the potential for a savings of $4 million per year.
{"title":"Home care cost-effectiveness for respiratory technology-dependent children.","authors":"A. I. Fields, A. Rosenblatt, M. Pollack, J. Kaufman","doi":"10.1001/ARCHPEDI.1991.02160070025016","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1991.02160070025016","url":null,"abstract":"We evaluated home care costs and the cost-effectiveness of home care vs alternative institutional care for respiratory technology-dependent children in a Medicaid Model Waiver Program. \"Cost-savings\" was measured as the difference between the established Medicaid reimbursable charges to enact an individualized care plan at a long-term care institution and the actual Medicaid reimbursements for home care. Ten patients--six dependent on mechanical ventilation and four with a tracheostomy who were receiving oxygen--were included in the analysis. The mean (+/- SD) annual home care costs were $109,836 +/- $20,781 for ventilator-dependent children and $63,650 +/- $12,350 for oxygen-dependent patients with a tracheostomy, representing annual savings of approximately $79,000 per patient and $83,000 per patient, respectively. The largest portion of home care reimbursements was for nursing care, accounting for 69.0% and 59.0% of the two patient groups. The full program (50 patients) has the potential for a savings of $4 million per year.","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"36 1","pages":"729-33"},"PeriodicalIF":0.0,"publicationDate":"1991-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79334715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-07-01DOI: 10.1001/ARCHPEDI.1991.02160070012003
M. Bass
Sir. —Chaves-Carballo et al 1 described nine infants with clinical features similar to heatstroke that they diagnosed as hemorrhagic shock and encephalopathy (HSE). An editorial in the same issue focuses on the inconsistencies and perplexities of the mysterious HSE syndrome. 2 During the past 15 years, I recall seeing several fatal cases that were presumptively diagnosed as either HSE or sudden infant death syndrome, but after an investigation of the home, could be diagnosed as heatstroke, exposure to toxic fumes, or both. 3,4 In the cases diagnosed as heatstroke, based on on-site investigations, there was a lack of awareness by some pathologists that exposure of a young infant, like other small mammals, to high environmental temperatures may lead to cardiogenic shock and sudden death. 5 Chaves-Carballo and coworkers 1 discussed the catastrophic clinical features and sparse laboratory data of HSE but failed to mention anything about the home environment of
{"title":"The fallacy of the hemorrhagic shock and encephalopathy syndrome.","authors":"M. Bass","doi":"10.1001/ARCHPEDI.1991.02160070012003","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1991.02160070012003","url":null,"abstract":"Sir. —Chaves-Carballo et al 1 described nine infants with clinical features similar to heatstroke that they diagnosed as hemorrhagic shock and encephalopathy (HSE). An editorial in the same issue focuses on the inconsistencies and perplexities of the mysterious HSE syndrome. 2 During the past 15 years, I recall seeing several fatal cases that were presumptively diagnosed as either HSE or sudden infant death syndrome, but after an investigation of the home, could be diagnosed as heatstroke, exposure to toxic fumes, or both. 3,4 In the cases diagnosed as heatstroke, based on on-site investigations, there was a lack of awareness by some pathologists that exposure of a young infant, like other small mammals, to high environmental temperatures may lead to cardiogenic shock and sudden death. 5 Chaves-Carballo and coworkers 1 discussed the catastrophic clinical features and sparse laboratory data of HSE but failed to mention anything about the home environment of","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"24 1","pages":"718"},"PeriodicalIF":0.0,"publicationDate":"1991-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84567932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1991-07-01DOI: 10.1001/ARCHPEDI.1991.02160070018011
E. Secord, S. Claude, C. Newton
Sir. —We recently had an alarming case of accidental atropine sulfate poisoning in a 4-year-old boy who was brought to the emergency department after injecting himself with 2 mg of atropine from a vacuum-loaded syringe. Why was such an article within reach of a young child? The boy's uncle had recently returned home from military service. He was stationed in Saudi Arabia and issued the syringe to use as an antidote in chemical warfare, ie, in case he suffered symptoms of cholinergic poisoning. The child was observed for 24 hours after receiving two consecutive doses of activated charcoal. 1 He suffered only minor symptoms of tachycardia, mydriasis, and drying of the mucous membranes, and was released the following day. We were relieved that he had no complications, since, according to reports, people have died of anticholinergic poisoning. 2 In this case, the circumstances of the accident were more alarming
{"title":"War souvenir poisoning.","authors":"E. Secord, S. Claude, C. Newton","doi":"10.1001/ARCHPEDI.1991.02160070018011","DOIUrl":"https://doi.org/10.1001/ARCHPEDI.1991.02160070018011","url":null,"abstract":"Sir. —We recently had an alarming case of accidental atropine sulfate poisoning in a 4-year-old boy who was brought to the emergency department after injecting himself with 2 mg of atropine from a vacuum-loaded syringe. Why was such an article within reach of a young child? The boy's uncle had recently returned home from military service. He was stationed in Saudi Arabia and issued the syringe to use as an antidote in chemical warfare, ie, in case he suffered symptoms of cholinergic poisoning. The child was observed for 24 hours after receiving two consecutive doses of activated charcoal. 1 He suffered only minor symptoms of tachycardia, mydriasis, and drying of the mucous membranes, and was released the following day. We were relieved that he had no complications, since, according to reports, people have died of anticholinergic poisoning. 2 In this case, the circumstances of the accident were more alarming","PeriodicalId":7654,"journal":{"name":"American journal of diseases of children","volume":"149 1","pages":"724"},"PeriodicalIF":0.0,"publicationDate":"1991-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73645397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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