A retrospective review was done on the medical records (March 1986 through December 1989) of patients referred to Pittsburgh Children's Hospital with the presumptive diagnosis of epiglottitis. Data obtained included age, final diagnosis, referring physician's radiographic evaluation/interpretation, procedures (intubation, IV administered, aerosol, cultures obtained), transport times, and long-term morbidity and mortality. The diagnostic value of lateral neck radiographs was analyzed. Lateral neck radiographs were found to be of little value in the primary evaluation of epiglottitis. Rather, skilled personnel, using an established protocol, did limit morbidity and mortality in patients with symptoms consistent with epiglottitis. All medical centers should develop a protocol for management of patients presenting with symptoms suggestive of epiglottitis.
The neonatal Bartter syndrome (NBS) is associated with a complex disorder of mineral metabolism in children, including hypercalciuria, nephrocalcinosis, and diminished bone mineral density. Although cyclooxygenase inhibition usually brings about improvement in these findings, there is a variable component which is resistant to such therapy in many children. The factor mediating this disorder has not been identified. Blood and urine from 12 children with NBS were examined. When compared with samples from normal children and adults, all (NBS) sera reduced bone calcium uptake in a bone disc bioassay. This effect persisted in the presence of parathyroid hormone (PTH) antibody and PTH receptor blockade, indicating that neither PTH nor PTH related peptide was responsible. It was eliminated by indomethacin, suggesting that prostanoid generation was essential. Protamine was also inhibitory, as was the addition of ecteola, an anion binder. Activity could be recovered from ecteola by elution with hypertonic buffer. Urine samples from children with NBS had the same calcitropic effect. The agent was removed by ecteola and recovered by hypertonic elution. Activity was eliminated by protamine and by heparinase, but not by trypsin digestion. Size exclusion centrifugation showed that the activity was associated with a material between 10 and 30 kilodaltons. Finally, urine ecteola eluates from NBS patients raised serum concentrations of calcium after intraperitoneal injection in rats. These data suggest that children with NBS have a calcitropic substance in their serum and urine which is not found in normal individuals. The substance is heparin like, and mediates its effects through prostanoid production. These studies provide additional evidence against a direct renal cause of the urinary calcium disturbance characteristic of the disorder.
Increasing mean airway pressure by pressure control ventilation and positive end-expiratory pressure should be considered as a therapeutic intervention in patients with persistent chylous effusions.
We present an unusual pediatric patient with severe allergic bronchopulmonary aspergillosis that masqueraded as pulmonary tuberculosis. After antituberculous therapy, the patient's pulmonary disease flared, prompting an aggressive diagnostic evaluation. Radiographic findings included nodular pulmonary densities with superimposed infiltrates. Lung biopsy showed evidence of acute and chronic inflammation with necrotizing granulomas, giant cells, tissue eosinophilia and rare hyphal elements.
An elevated INR in a child with cerebral palsy was evidently related to long-term therapy with azithromycin. The abnormal INR normalized after discontinuation of azithromycin and administration of one dose of phytonadione.
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