Kawasaki disease--atypical presentation.

Kawasaki disease, an acute systemic vasculitis of unknown etiology, is the leading cause of acquired heart disease in children in many parts of the world. It predominantly affects children under 5 years of age and is diagnosed clinically by the presence of characteristic clinical signs. Atypical patients, often younger than 1 year of age, manifest few early signs, usually have an incorrect admitting diagnosis and suffer from high morbidity and mortality. We report the presentation, clinical course and follow-up of a 3-month-old infant with atypical Kawasaki disease.

Respiratory function monitoring during mechanical ventilation in pediatric intensive care unit.

Noninvasive monitoring of lung function during mechanical ventilation has been used to study disease processes causing respiratory failure. Pediatric pulmonary function monitoring during mechanical ventilation in the pediatric intensive care unit in patient with respiratory failure is becoming more common in western countries. The article describes a review of principles and methods of respiratory function monitoring in the pediatric age group. It attempts to incorporate experience from original articles previously published as well as the experience in monitoring pulmonary mechanics at our institution. Routine monitoring of pulmonary mechanics in patients being mechanically ventilated may have significant impact on morbidity and/or mortality of pediatric patients with respiratory failure. Key articles pertaining to lung function testing in pediatric age group from past 15 years were used as well as clinical experience encountered by attending pediatric intensivists at Henrico Doctors' Hospital was incorporated. Over the past ten years the use of monitoring of gas exchange and bedside pulmonary mechanics monitoring as a part of respiratory function monitoring has become more common. With better clinical information to precisely document the status of lung function, it may lead to improved methods of ventilator management which may prevent complications and may significantly impact on morbidity and/or mortality of mechanically ventilated pediatric patients.

Tuberculous lymphadenitis: extended cytomorphologic features.

In tuberculous lymphadenitis, FNAC smears sometimes reveal only caseous necrosis without epithelioid cell granuloma. They pose a diagnostic problem, if AFB staining is negative. The diagnostic clue noticed in these cases was presence of multiple pink, homogenous structures with irregular shape and well-defined margins: "eosinophilic structures" (ES). The purpose of the present study is to find out the nature of ES and their role in the diagnosis of tuberculosis. Seventy FNAC smears from documented cases of tuberculous lymphadenitis were classified according to their cytomorphological features. The association and relation of ES with other morphological criteria was noted. Immunoperoxidase staining was performed to find out the reactivity of ES to tuberculous antigen. Its intensity of positivity was compared with epithelioid cell granuloma and degenerating granuloma. It was concluded that ES are degenerated granuloma and thus form an extended diagnostic criterion.

Ultrafilterable hypomagnesemia in neonates admitted to the neonatal intensive care unit.

OBJECTIVE: To evaluate the frequency and clinical correlates of ultrafilterable hypomagnesemia in neonates admitted to the neonatal intensive care unit (ICU). DESIGN: Prospective, observational study. SETTING: Massachusetts General Hospital and Mount Auburn Hospital. PATIENTS: A total of 117 patients (84 neonatal ICU patients and 33 normal newborns) studied over a 2-yr period of time. MEASUREMENTS: Blood samples were collected during the first 48 hrs after admission. The concentrations of magnesium (total and ultrafilterable), ionized calcium, parathyroid hormone, electrolytes, glucose and arterial blood gases were determined. RESULTS: Ultrafilterable circulating magnesium concentrations were determined in 74 of 84 neonatal ICU patients. On admission to the neonatal ICU, 23 (31.1%) of 74 neonates had ultrafilterable hypomagnesemia; two (2.7%) of 74 patients had ultrafilterable hypermagnesemia. Neonatal ICU patients had significantly lower (p < .001) ultrafilterable magnesium concentrations compared with normal neonates. Hypomagnesemic ICU patients required mechanical ventilatory support more frequently than did normomagnesemic ICU neonates (p < .05). Ionized hypocalcemia was a common finding in our patients (34 [42%] of 81). However, ultrafilterable hypomagnesemia was not statistically associated with ionized hypocalcemia (p > .05). Despite the below normal serum concentrations of ultrafilterable magnesium observed in our study, there was no impairment in parathyroid hormone secretion. CONCLUSIONS: Ultrafilterable hypomagnesemia is a common finding in neonates admitted to the ICU. Ultrafilterable hypomagnesemia is associated with the need for mechanical ventilation. To our knowledge, this is the first report of ultrafilterable magnesium concentrations in normal and sick neonates.

Differentiation of follicular adenoma and carcinoma of thyroid by immunohistochemical demonstration of ceruloplasmin.

In this study, and attempt was made to differentiate between follicular neoplasms of the thyroid using an immunoperoxidase staining technique for detection of ceruloplasmin. 54 histologically proved benign and malignant thyroidal lesions were selected. The staining for ceruloplasmin was consistently positive in follicular carcinoma and negative in follicular adenoma.

Establishing a new pediatric intensive care unit.

Pediatric intensive care is a collaborative practice of dedicated personnel, advanced technology and a diverse group of support services. Unit design must focus on current patient needs while envisioning the technological and clinical needs of the future. With insight and a cooperative effort, your design team can effectively transform ideas into a unit committed to the care of critically ill children.

Enhancement of colposcopic image by sulphosalicylic acid.

Acetic acid is used conventionally for enhancement of the colposcopic image. We used sulphosalicylic acid instead of acetic acid in 50 normal cases. The normal appearance was enhanced in all cases. The image was also enhanced in 70% cases of cervical intraepithelial neoplasia and 90% cases of cervical condyloma accuminata. The image was not inferior to that with acetic acid in any of the cases.

Hormonal responses to surgical stress in children.

The hormonal responses to surgical stress in adults are well characterized. We hypothesized that children have age-related differences in the "stress responses" to surgery. To test this hypothesis we prospectively studied 98 children (aged 2 to 20 years) undergoing elective surgical procedures under general anesthesia. Preoperative and postoperative (1 hour postoperation) blood samples were obtained and serum prolactin and cortisol concentrations were measured. Patient data were stratified by patient age and length of operation. All patients had significant (P < .05) increases in serum cortisol and prolactin concentrations 1 hour postoperatively as compared with preoperative values. However, there were no significant differences in prolactin and cortisol responses to surgery based on the age, anesthetic technique, or length of operation. Females had higher mean (+/- SD) serum prolactin concentrations (78.41 +/- 62.23 micrograms/L) as compared with males postoperatively (39.8 +/- 21.75 micrograms/L) (P < .05). We conclude the following: (1) children have significant increases in circulating prolactin and cortisol concentrations following surgery and anesthesia, and that those increases are not affected by age, length of surgery, or anesthetic technique; and (2) females have greater prolactin responses to surgery and anesthesia than males.

Electrolyte abnormalities in critically ill children.

OBJECTIVE: To provide a brief overview of the causes, diagnosis, and therapies of electrolyte abnormalities frequently seen in critically ill children. DATA SOURCE: Published articles and bibliographies identified from pertinent review articles and books published in the past 20 yrs on fluid and electrolyte therapy in children. CONSTRAINT: The review includes only human studies and articles published in the English language. STUDY SELECTION: Human studies pertaining to abnormalities of water homeostasis, sodium, potassium, calcium, and magnesium homeostasis in children were selected. Prospective randomized studies were selected as much as possible. DATA EXTRACTION: Pertinent data abstracted from multiple, independent clinical studies were used to develop an approach to electrolyte abnormalities in critically ill children. DATA SYNTHESIS: An approach to diagnosis and therapies of common electrolyte abnormalities in critically ill children. CONCLUSIONS: Electrolyte abnormalities are common in critically ill children and can be easily treated once recognized. Further studies are needed to better understand the role of ionized calcium and magnesium in neonatal and pediatric critical illness.

Conjunctival impression cytology--a study of normal conjunctiva.

Conjunctival impression cytology was used to study conjunctival ocular surface in 30 normal individuals in the age group of 20 to 60 years. The cytology was graded according to the classification of Nelson. Out of 30 subjects, 26 showed the features of Grade O (average age 28.33 years) and 4 showed grade 1 (average age 56.66 years). The method was very easy to perform, cheap and fast. The relationship of various cells to each other was maintained. This method can be used to study the conditions like trachoma, avitaminosis A and other disorders of conjunctival surface. It can be undertaken by a paramedical worker in an out patient clinic.

Double lumen umbilical venous catheters in critically ill neonates: a randomized prospective study.

OBJECTIVES: To compare relative efficacies and complications associated with the use of double lumen vs. single lumen umbilical venous catheters in critically ill neonates. DESIGN: Prospective randomized control trial. SETTING: Neonatal ICU. PATIENTS: Forty-three critically ill neonates. INTERVENTIONS: Group 1 patients (n = 20) received single lumen umbilical venous catheters and group 2 patients (n = 23) received double lumen catheters. A record of the following information was kept: demographic data including diagnosis and indication for umbilical venous catheter insertion, catheter tip location, length of catheterization (days), number of additional iv catheters and complications (sepsis, hepatic necrosis, thrombosis, or mechanical complications). MEASUREMENTS AND MAIN RESULTS: Double lumen umbilical venous catheters were well tolerated and were associated with no significant increased risk of mechanical complications when compared with single lumen umbilical venous catheters. The number of additional iv catheters required (0.8 +/- 0.1 [SD]) was significantly (p less than .05) less in the double lumen umbilical venous catheter group as compared with additional iv catheters required (2.3 +/- 0.8) in the single lumen umbilical venous catheter group. CONCLUSION: Double lumen umbilical venous catheters are well tolerated for short-term use, decrease the need for additional venous catheters in critically ill neonates, and may not significantly increase the risk of mechanical complications when compared with single lumen umbilical venous catheters.

Detection of HSV-2 antigen in carcinoma cervix and premalignant conditions by immuno-cytochemistry.

One hundred and twelve cases of cervical pathology (58 paraffin sections and 54 cervical smears) were assessed by PAP technique and 30 cases by indirect immunofluorescent technique. Forty-two normal cervical smears from the age matched controls were stained by indirect immuno-fluorescent technique. HSV-2 antigen was detected by PAP method in 86 out of 112 cases (78.57%) i.e. 50/55 squamous cell carcinoma, 13/13 carcinoma in situ, 11/15 severe dysplasia, 3/4 moderate dysplasia and 9/16 mild dysplasia. The amount of antigen was maximum in squamous cell carcinoma and decreased in carcinoma in situ, severe, moderate and mild dysplasia in descending order. Three cases of adenocarcinoma cervix were negative. Only one case out of 42 controls was positive. HSV-2 antigen was detected by an indirect IF technique in 8/9 squamous cell carcinoma, 2/3 carcinoma in situ, 3/7 dysplasia, O/1 adenocarcinoma and 4/10 inflammatory cases. The above findings support the association between HSV-2 and squamous cell carcinoma cervix, as well as carcinoma in situ which is statistically significant.