SUMMARY Nutritional problems are very common in infants and young children of Asian immigrants; most arise as a result of inadequate weaning. An Asian infant should be weaned onto a diet which takes into consideration his parents' religious and cultural customs which affect diets.
Haemomediastinum is a very rare complication in haemophilia. Its occurrence after a minor chest injury in a boy aged 11 years is described. Complete recovery followed conservative treatment, which consisted of the correction of the coagulation defect with cryoprecipitate-AHG for 11 days, and a blood transfusion.Severe haemophilia is characterized by episodes of bleeding which may be spontaneous or traumatic in origin. This commonly results in haemarthroses and muscle haematomata, but occasionally serious internal bleeding (for example, retroperitoneal or subdural) occurs.We have recently encountered the very rare complication of haemomediastinum in a known haemophiliac. The occurrence of haemothorax has been reported (Barrett and Israels, 1965) and two examples of hae-mopericardium have been described (Anderson, 1964;Gaston, Mach, and Beck, 1961). However, haemomediastinum has been recorded previously only in association with bleeding in the neck, from which blood tracked into the mediastinum (Edmonds, 1951 ;Pochedly and Rosales, 1968). The purpose of this report is to describe the occurrence and treatment of haemomediastinum arising in a haemophiliac boy after a minor chest injury.
CASE REPORTAn 11-year-old boy was found to be a haemophiliac at the age of 15 months when excessive bruising after slight trauma was investigated. He has no detectable Factor VIII activity in the plasma and has suffered numerous bleeding episodes, including haemarthroses, haematuria and a retroperitoneal haematoma. On (Fig. 1). Initial treatment consisted of cryoprecipitate-AHG, 9 units intravenously (1 unit=yield of Factor VIII concentrate from 1 pint (0-57 litre) of blood), together with 3 pints (1'7 litres) of blood. Thereafter 12-hourly intravenous injections of cryoprecipitate-AHG were given for 7 days in doses adequate to maintain the plasma Factor VIII level above 10% ; 6-8 units 12-hourly was required. Daily doses were continued for a further 4 days. We tested for the presence of inhibitors of Factor VIII in our patient's plasma and none was found.Progress was satisfactory, with relief of the chest pain within 36 hours. The cervical swelling dis-372 on 11 May 2018 by guest. Protected by copyright.
Before 1975 in Blackburn in the Premature Baby Unit monitoring facilities were limited. Ambient oxygen monitoring, blood gas analysis, and ventilation were not being performed. Gradually, special care was introduced and from 1978-80 all babies requiring intensive care and long term ventilatory care were transferred to the Regional Neonatal Intensive Care Unit. Not all babies with incipient or established respiratory failure, however, could be accepted, and those declined had unfavourable outcomes. In 1981 local intensive and ventilatory care was begun, and since then the survival of all babies has improved considerably. Our early neonatal mortality and neonatal mortality have fallen below the regional levels. In a district general hospital it is possible to achieve survival figures comparable with those of a regional centre.
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