Prevention and therapy of serous otitis media by oral decongestant: a double-blind study in pediatric practice.

We studied the efficacy of (1) preventing the development of serous otitis media (SOM) by using an oral decongestant in children with acute otitis media and (2) treating SOM with an oral decongestant. In a randomized double-blind study, 190 children were treated for acute otitis media with antibiotics and either pseudoephedrine hydrochloride (Sudafed) or placebo. They were evaluated two weeks later by tympanometry and (independently) by clinical evaluation and pneumotoscopy. There were no significant differences between the two groups, except that males developed SOM significantly more often than did females. Use of decongestant and placebo was continued in 78 patients with SOM for up to four more weeks. Again, there were no siginificant differences between the treatment groups except that patients with an allergic history did significantly worse using a decongestant. Overall there was no benefit from pseudoephedrine in either the prevention or treatment of SOM.

Selenium in premature infants.

Premature infants have a lower selenium concentration in serum than full-term infants and children. The selenium concentration goes down quickly in infants treated for respiratory distress syndrome without supplementation. One premature infant with bronchopulmonary dysplasia had persistently low concentrations of selenium. Vitamin E supplements did not affect the serum selenium concentration in healthy premature infants. Supplementation with 3 microgram/kg of selenium in parenteral fluids prevented the fall in the concentration seen in other infants not supplemented. Premature infants and especially those treated with oxygen may warrant selenium supplementation to the parenteral nutrition solution. Vitamin E supplements alone are apparently not sufficient to prevent selenium deficiency and potential oxygen toxicity.

Epidemiologic, clinical, and laboratory features of Coxsackie B1-B5 infections in the United States, 1970-79.

In the period 1970 through 1979, the Coxsackie B1, B2, B3, B4, and B5 viruses constituted 24 percent of more than 18,000 enteroviruses isolated and reported through national surveillance. Young children, especially males, were most frequently affected: 48 percent of the national surveillance population were less than 5 years of age, including 30 percent who were less than 1 year old. Among the most frequently reported clinical syndromes associated with B infection were meningitis (in 56 percent of patients with B1-B5 infections), encephalitis (in 15 percent), and respiratory tract disease (in 14 percent). Carditis, a well-known B syndrome, was reported with only 2 percent of B1-B5 infections. Like most enteroviral agents, Group B viruses were isolated primarily during the summer: 87 percent of all these isolations were made during the 5 months from June through October. Although B2, B3, and B4 viruses were isolated at relatively uniform levels each year, B1 and B5 viral illnesses occurred nationwide as explosive epidemics only in certain years. A separate population of B-infected patients, identified by the Nassau County Medical Center (NCMC) Virus Laboratory, East Meadow, N.Y., during the same 10-year period, was studied to compare epidemiologic characteristics and to evaluate in greater detail clinical and laboratory features of B infections. Because of more active solicitation of specimens for testing, ascertainment in the NCMC system was more complete. The most frequently reported clinical findings at NCMC included fever (97 percent of cases), which was biphasic in 27 percent; pharyngitis (85 percent); vomiting (56 percent); headache (49 percent); other respiratory signs and symptoms (44 percent); diarrhea (40 percent); abdominal pain (33 percent); rash (31 percent); and otitis (28 percent). Rash was more frequently associated with younger than with older age groups (P < .01) for all B agents. Overall, throat (T) and rectal (R) swabs had the highest B-positivity rates among known infected patients(83 percent for T and 78 percent for R). Only for T was the positivity rate correlated with the interval between onset of illness and obtaining the specimen (P < .05). B agents grew most quickly from T specimens, but most reliably from R specimens. On the basis of these data,the authors recommend that both T and R specimens be obtained from every patient for whom prompt and reliable laboratory diagnosis of B infection is sought.To the authors' knowledge, these results from 10 years of national surveillance represent the largest surveillance summary of Coxsackie B viruses to date in the literature. Comparison of these results with those reported over the same 10 years by NCMC reflects differences that arise mostly because of differences in ascertainment systems.

Collaborative research between a Department of Pediatrics and its clinical faculty.

Collaborative research involving members of the full-time and clinical faculties of a Department of Pediatrics increases our knowledge of problems encountered in primary care practice by bringing the practitioner's perspective on the nature of such problems and the population of patients he serves to the investigative arena. For the practitioner, active involvement in collaborative research is rewarding because he or she formulates the questions to be addressed and takes part in planning and implementing the research and reporting results. Through such collaboration, the academician gains immeasurably by being able to study common clinical problems in primary care settings, where they are encountered most often. To be successful, collaborative research must be a joint effort with ongoing communication and sharing of responsibilities between academicians and practitioners.

Prevention and treatment of serous otitis media with an oral antihistamine. A double-blind study in pediatric practice.

Serous otitis media (SOM) is a common and troublesome disease in childhood. Although antihistamines are commonly prescribed to prevent or treat SOM, there have been no controlled clinical trials to determine the efficacy of such interventions. This study was designed to determine if antihistamines are of value in the prevention or treatment of SOM. Using a randomized double-blind method, 206 children with acute otitis media were treated with antibiotics and either brompheniramine maleate or placebo. The children were evaluated two weeks later by tympanometry and, independently, by combined pneumatoscopy and otoscopy. There were no significant differences overall between the treatment and control groups in terms of preventing SOM: 44% of those on antihistamine and 41% of those on placebo had SOM after two weeks of therapy. However, children with a history of serous otitis media did significantly better on placebo than did those on antihistamine, and children without a history of serous otitis media did significantly better on antihistamine than did those on placebo. One hundred children continued to use antihistamine or placebo for four more weeks. There were no significant differences between the treatment and control groups in terms of resolution of SOM (64% versus 68%).

A new and improved gas chromatographic method for the determination of fluoride in plasma and faeces.

A method is described that extracts fluoride selectively as trimethylfluorosilane using carbon tetrachloride and trimethylchlorosilane . Drawbacks of other methods as well as advantages of the proposed method are discussed. The method is directly applicable to plasma and faeces samples, has a short gas chromatographic run time due to the use of a backflush technique and is suitable for automation. Its lowest quantifiable limit for plasma and faeces is 10 micrograms/l and 1 microgram/g fluoride respectively, using 1.0 ml or 1.0 g samples. Preliminary pharmacokinetic parameters of fluoride obtained in two subjects are reported.

Group B coxsackievirus infections in infants younger than three months of age: a serious childhood illness.

From 1970 to 1979 the viral laboratory at the Nassau County Medical Center (NCMC) tested 602 culture specimens that were positive for group B coxsackievirus. Eighty-one of the specimens were from hospitalized infants younger than three months of age with nonfatal infection. The case histories of 77 of these infants, whose medical records were available for study, are reviewed here. Aseptic meningitis was the clinical syndrome seen most frequently (48 of 77 patients). Protein levels in cerebrospinal fluid (CSF) did not rise above 170 mg/dl, and in only three infants did the glucose concentration in CSF fall below 30 mg/dl. Infants were febrile for an average of 3.1 days, and no infant had fever of longer than six days' duration. During 1970-1981, eight newborns whose culture specimens were examined at NCMC died of overwhelming group B coxsackievirus disease. The clinical histories of these eight patients and 33 other fatal cases reported in the literature are reviewed. Three patterns of death were observed. Rapid death occurred in 12 patients aged 2-17 days. In 11 patients a diphasic illness led to death at age 8-24 days. In 18 patients a progressive illness was described. Myocarditis was present in all infants. Pulmonary hemorrhage and liver necrosis occurred in 30 and 18 patients, respectively. Jaundice was more frequently observed in fatal cases. Bleeding diatheses were also reported and probably reflect hepatic necrosis. Twenty-four mothers had evidence of a viral-like infection occurring between 10 days antepartum and five days postpartum. Group B coxsackievirus infection must be considered a serious disease of the newborn, which in our community occurred in 77 of 153,250 live births and accounted for six deaths between 1970 and 1979.

A general system for the automation of a backflush equipped gas chromatograph and its application in the determination of fluoride in plasma and faeces.

A fully automated system is described in which a gas chromatograph equipped with a backflush valve is automatically operated under the control of a specially designed timer unit. The system requires minimum data acquisition due to the selection of the signals to be integrated while waste of recorder paper is also avoided. It has the capability of unattended operation of fifty samples which--in the case of fluoride determination--are chromatographed in about four hours.

Massive theophylline intoxication: effects of charcoal haemoperfusion on plasma and erythrocyte theophylline concentrations.

The results of a charcoal haemoperfusion on plasma and erythrocyte theophylline concentrations are described in a patient, intentionally intoxicated with a sustained-release theophylline formulation. It is demonstrated that the charcoal-filled Gambro Adsorba 300-C column is effective in removing theophylline. This effectiveness is based on pharmacokinetic parameters, which are presented. The necessity of measuring plasma and erythrocyte theophylline concentrations is outlined. Calculations based on plasma theophylline concentrations only can lead to an underestimation of the effectiveness.