Demographics, management, and outcome of peripartum cardiomyopathy in a community hospital.

OBJECTIVE: The purpose of this study was to describe the outcome of peripartum cardiomyopathy in patients cared for in a community hospital. STUDY DESIGN: The cases of peripartum cardiomyopathy treated at Central Baptist Hospital in Lexington, Kentucky, from January 1, 1992, to December 31, 1998, were reviewed. RESULTS: Eleven patients with peripartum cardiomyopathy were identified. The patient population was 91% white and 9% African American. Seventy-two percent of patients were nulliparous, and the prevalence of chronic hypertension was 27%. All patients were examined with echocardiography and met diagnostic criteria for the disease when this modality was used. The mean ejection fraction was 32% +/- 10%. Invasive techniques used to assist in diagnosis included left ventricular catheterization (63%), right ventricular catheterization (54%), and cardiac biopsy (54%). One patient required cardiac transplantation. This patient also had an embolic stroke from a confirmed mural thrombus. No study patient died of the disease, and no other major complications were observed. CONCLUSIONS: The patient profile of peripartum cardiomyopathy in this study differed remarkably from profiles in published reports. Nulliparous white women have better outcomes than indicated by previous reports, probably because of the low frequency of coexisting chronic disease and a younger age at diagnosis.

Neonatal alloimmune thrombocytopenia due to anti-HPA-1b (PLA2)(Zwb). A case report and review.

BACKGROUND: Neonatal alloimmune thrombocytopenia is a rare condition due to passively acquired maternal antibodies directed against paternal platelet antigens inherited by the infant. Only 5 cases have been reported due to antibodies against HPA-1b (PLA2) (Zwb). CASE REPORT: We report a case of neonatal alloimmune thrombocytopenia due to anti-HPA-1b in the second pregnancy of a 26-year-old Caucasian female. The male infant was treated with a 5-day course of intravenous immunoglobulin without complications. We report the HLA phenotype of the infant's mother and summarize the previous case reports due to anti-HPA-1b. CONCLUSION: Based on this case and a review of the literature, intravenous immunoglobulin as well as random donor exchange transfusion and random donor platelet transfusions are effective in the treatment of neonatal alloimmune thrombocytopenia due to anti-HPA-1b. Obvious associations between HLA alleles and sensitization to HPA-1b have not been elucidated.

Normative data of hemoglobin concentration and free erythrocyte protoporphyrin in a private pediatric practice: a 1990 update.

Free erythrocyte protoporphyrin (FEP) and hemoglobin (Hgb) concentrations were tested in 790 children in a private pediatric office; results were compared to those obtained in 1984. Only 16 children (2%) had abnormal FEPs in 1990 compared to 76 children (9.6%) in the earlier study. The mean FEP in the normal group also decreased significantly in each age group studied. The hemoglobin concentrations were not significantly different in most of the age groups studied. Screening for iron deficiency in our pediatric practice by determining hemoglobin and FEP concentrations had a much lower yield in 1990 than in 1984.

New medical standards for Virginia's high school athletes.

Virginia physicians administering preparticipation physicals to high school athletes this fall are using the new, expanded examination form that appears in this issue. Representing multidisciplinary input and incorporating current sports medicine information, the form is designed to identify the student at high risk for injury and to evaluate for a specific sport. After a two-year pilot program conducted by the authors the new form was officially adopted by the Virginia High School League.

Normative data of hemoglobin concentration and free erythrocyte protoporphyrin in a private pediatric practice.

Free erythrocyte protoporphyrin (FEP) and hemoglobin concentrations in 788 children were investigated during routine check-ups in a private pediatric practice. FEPs greater than 3.0 ZPP/gm hemoglobin were found in 29.8 percent of 9-month-olds and in 9.6 percent of the total group tested. Correlations between FEP levels and hemoglobin concentrations are presented.

Three-day therapy of lower urinary tract infections with nitrofurantoin macrocrystals: a randomized clinical trial.

Forty-nine girls between the ages of 2 and 18 years with a symptomatic urinary tract infection documented by two clean-catch urine cultures completed a double-blind study comparing the effectiveness of three days versus ten days of nitrofurantoin macrocrystal therapy. Localization of the infection to the lower urinary tract was presumed on the basis of clinical presentation. All patients had sterile urine on day two or three of therapy. In the ten-day group, two of 23 patients (8.7%) experienced a single relapse, and seven patients (30%) had 12 episodes of reinfection during a six-month follow-up. In the three-day group, two of 26 patients (7.7%) had a single relapse, and six patients (23%) had 12 episodes of reinfection. The rates of relapse and reinfection in the compared groups were not statistically significantly different (P greater than 0.05). Three days of treatment with nitrofurantoin macrocrystals is an effective regimen for symptomatic girls presumed to have uncomplicated lower urinary tract infections.

Otitis media: a review.

We have presented recommendations for diagnosis and management of otitis media in children based on a comprehensive review of the pertinent medical literature. For an entity that is so common, there still remain amazingly large numbers of areas of controversy. We have also attempted to stress the importance of appropriate therapy and adequate followup as being very important in the management of otitis media. Newer concepts, particularly the use of the impedance bridge tympanogram, have been mentioned. With all the above background information in mind and with considerations for what is practical for the patient and the medical community, we would recommend the following as the acceptable minimal care for patients with otitis media. When the diagnosis of the acute otitis media is made on the basis of physical findings of myringitis, and/or middle ear fluid, and/or rupture of the tympanic membrane, the following treatment course is advisable: Neonates Culture of middle ear fluid if possible. Ampicillin 200 mg/kg/day intramuscularly. Gentamicin 3/5mg/kg/day intramuscularly. Hospitalize and treat until well and for minimum of seven days. Observe closely for meningitis and other infections and drug toxicity. These should be handled only by physicians experienced in dealing with patients in this age range. Appropriate work-up for septicemia should precede treatment. Switch to specific antibiotic when cultures and sensitivity available. Children. From 2 months to 6 years of age: Ampicillin 50mg/kg/day. Decongestant (if desired). Administer for ten days. Every patient with otorrhea, severe otitis and those not clinically well should be seen for followup ten to 14 days later. They should have a minimum of otologic evaluation including drum mobility. In persistent cases, audiometry and otologic referral are necessary. If patient is allergic to penicillin, erythromycin at 20mg/lb/day may be used. Trimethoprim sulfa may hold promise in the future. Tetracycline is never indicated in this age range because of side effects and high relapse rate secondary to resistant organisms. Patients above 6 years of age: Penicillin pheyoxymethyl 250 mg every six hours for ten days. Decongestant (if desired). Followup and penicillin allergy as above.

Prevention of recurrent urinary tract infections in girls.

Eighteen girls between the ages of 3 and 13 years--with a history of at least three culture-documented episodes of bacteriuria in the previous year, but without radiologic evidence of major urinary tract abnormality--were placed on a double-blind, crossover study comparing the effectiveness of nitrofurantoin macrocrystals against a placebo in preventing the recurrence of bacteriuria. Each child was placed on a daily low dose of nitrofurantoin (1.2 to 2.4 mg/kg/day) or an identical-appearing placebo for six months. Each child was then placed on the opposite capsule for a similar period. There were 35 episodes of bacteriuria (4.2 episodes/patient/yr) in the patients taking the placebo, which compared with a rate of 3.8 episodes/patient/yr during the year prior to the study. Only two episodes (0.2 episodes/patient/yr) occurred in the patients taking the drug. The difference in the rate of recurrent bacteriuria between the girls on placebo and on medication is significant at the 0.01 level using the Wilcoxin matched-pairs test. There were no adverse reactions to the drug. Nitrofurantoin macrocrystals in a single daily low dose appear to be a safe, effective method of preventing recurrent bacteriuria in girls at high risk.