Acute disseminated encephalomyelitis (ADEM) after pertussis infection.

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating disorder of the central nervous system which is usually precipitated by a viral infection or vaccination. A 3-month-old boy is reported who developed ADEM a week after full recovery from pertussis. MRI detected a high-intensity lesion extending from the pons to the mesencephalon, compatible with ADEM. Following the administration of intravenous immunoglobulins, the patient's clinical symptoms improved. This case report demonstrates that pertussis is capable of inducing an immune-mediated demyelinating disorder of the central nervous system.

The effect of prior BCG vaccination on the clinical and radiographic presentation of tuberculosis meningitis in children in Istanbul, Turkey.

SETTING: Department of Pediatrics, Istanbul University Faculty of Medicine, Istanbul, Turkey, between January 1984 and December 1996. OBJECTIVE: To explore whether neonatal BCG vaccination offers any protective effect on clinical and laboratory profiles of central nervous system (CNS) tuberculosis in children. DESIGN: A retrospective review of cases of CNS tuberculosis diagnosed and treated in one institution. RESULTS: Of the 145 patients identified with CNS tuberculosis, 9.6% were vaccinated during the neonatal period. The rate of close contact with contagious pulmonary tuberculosis in family, age distribution, clinical findings and laboratory investigations on admission were not significantly different in vaccinated and non-vaccinated children. Although mortality rate in the vaccinated patients (8.3%) was found to be nearly half of that in the non-vaccinated group (15.1%), severe sequelae were significantly more frequent (P < 0.02) among the vaccinated patients; CONCLUSION: This study shows that neonatal BCG vaccine has little effect on the clinical findings of subsequent CNS tuberculosis, and that these children have typical presentations of tuberculosis disease.

A survey of Belgian anesthesiologists.

From this national survey, it appears that anesthesiologists work on average 60 hours per week in a hospital; male anesthesiologists an average of 11 percent more than their female colleagues. Age had no major conflict on the average working hours: recently qualified anesthesiologist are fully integrated into the work schedule from the very start; weekly working hours remain virtually unchanged until the age of sixty and then gradually decrease. The average anesthesiologist devotes slightly more than half of his time (i.e. roughly 30 hours) to anesthesia in the operating room (OR); another important area of activity is intensive care, on average slightly over 8 hours per week or 15 percent of his overall time. About 90 percent of the anesthesiologists are involved in anesthesia in the OR and in continuing medical education, nearly half have educational duties and 20 percent undertake research. Based on financial considerations, 18 percent of the respondents believe there are too many anesthesiologists. In contrast, only 6 percent think this is the case when considering the quality of anesthesia only, and no less than 39 percent believe that there are too few anesthesiologists. According to nearly half of the respondents, the anesthesia workload is somehow too heavy; nevertheless, only 18 percent would be prepared to work less if this would mean a loss of income, and 25 percent is not willing at all to work less, irrespective of income loss. Over three quarters of respondents indicate a job satisfaction of 7 on a scale ranging from 0 to 10; this mark might be further increased by a higher salary and by an improved image of their profession. Pain management is the area of anesthesiology that needs to be developed first. The respondents considered professional insurance, medico-legal problems, and an excess of anesthesiologists, as main sensitive points for the future development of this specialty.

Can we predict the future evolution of anesthesiology workforce in Belgium?

Two models are proposed to predict the evolution of anesthesiology workforce over the next 20 years. Each model features various scenarios according to different assumptions related to future numbers of female anesthetists, working hours, or regulations for postgraduates' working for conditions. However the main uncertainties derive from the unknown evolution of demands. Despite their differences both models agree on several important conclusions: a 13 to 14% shortage of anesthesiologists currently exists to satisfy O.R. demands, this shortage will decrease over the next ten years, and after 2010 a new shortage could arise under the combined pressure of the numerus clausus, of the number of female anesthesiologists and of the aging of the still young population of anesthesiologists.

The phase-resolved photoacoustic method to indicate chemical assignments of paracetamol.

In this work, the phase-resolved photoacoustic method was applied to provide specific information on the chemical assignments of paracetamol in the near-infrared region. Two broad bands, centered at 1370 and 1130 nm, were well-resolved using this method, making it possible to assign the peaks centered at 1398, 1355 and 1295 nm to a C-H combination from a CH3 structure and the peak at 1305 nm to a C-H combination from the aromatic ring. This information represents a new finding in chemical studies regarding this medicament.

Predictive value of Doppler ultrasound in childhood pneumonia.

This study aimed to determine the predictive value of intercostal and pulmonary artery Doppler flow patterns in the outcome of childhood pneumonia. Pneumonia was classified according to type of pleural effusion and the ultrasound features of consolidations. Doppler flow patterns of intercostal and pulmonary arteries were analysed and correlated with pneumonia type and hospital stay. Of 83 pneumonia cases, 55 were uncomplicated and 28 were complicated. Pleural effusion was present in 54 cases, with 29 non-septated and 25 septated cases. Patients with uncomplicated pneumonia did not have abnormal Doppler flow patterns, compared with 64% (18 of 28) of patients with complicated pneumonia. Doppler ultrasound patterns in childhood pneumonia were correlated with pneumonia type and may be predictive of pneumonia outcome.

Inappropriate antimicrobial use in Turkish pediatric hospitals: a multicenter point prevalence survey.

OBJECTIVES: Although well-defined principles of rational antimicrobial use are available, inappropriate prescribing patterns are reported worldwide. Accurate information on the usage of antimicrobials, including factors associated with and influencing their use, is valuable for improving the quality of prescription practices. METHODS: In this cross-sectional point prevalence survey, data on patients hospitalized in 12 different children's hospitals were collected on a single day. Appropriateness of prescription was compared between the types of antimicrobials prescribed, indications, wards, and presence of/consultation with an infectious disease physician (IDP). RESULTS: A total 711 of 1302 (54.6%) patients evaluated were receiving one or more antimicrobial drugs. The antimicrobial prescription rate was highest in pediatric intensive care (75.7%) and lowest in the surgery wards (37.0%). Of the 711 patients receiving antimicrobials, 332 patients (46.7%) were found to be receiving at least one inappropriately prescribed drug. Inappropriate use was most frequent in surgery wards (80.2%), while it was less common in oncology wards (31.8%; p<0.001). Respiratory tract infection was the most common indication for antimicrobial use (29.4%). Inappropriate use was more common in deep-seated infections (54.7%) and respiratory infections (56.5%). Fluoroquinolones were used inappropriately more than any other drugs (81.8%, p=0.021). Consultation with an IDP appears to increase appropriate antimicrobial use (p=0.008). CONCLUSIONS: Inappropriate antimicrobial use remains a common problem in Turkish pediatric hospitals. Consultation with an IDP and prescribing antimicrobial drugs according to microbiological test results could decrease the inappropriate use of antimicrobials.

Comparison of evoked electromyography and mechanical activity during vecuronium-induced neuromuscular blockade.

The relationship of compound electromyography to mechanical myography was investigated in 20 patients given vecuronium in a dose of 0.1 mg kg-1. Mechanical response was affected less quickly and recovered faster than the electrical response. Although there was a good correlation between the two throughout the study, a shift towards mechanical responses was observed in all cases for the onset of blockade and recovery from blockade. Moreover, during recovery the mechanical responses became greater than the control value in all patients. This was also reflected in the statistically significant difference (P less than 0.05) of the regression lines relating tension and electromyography (TI as well as train-of-four ratio) between onset of, and recovery from, neuromuscular block.

Prevalence of childhood asthma in Istanbul, Turkey.

In order to determine the asthma prevalence in 6-12-year-old schoolchildren in Istanbul, we issued 2350 questionnaires, according to ISAAC criteria, in six randomly selected city primary schools to be completed at home by parents. A total of 2232 of the questionnaires were completed, an overall response rate of 94.9%, and 2216 questionnaires were taken into consideration. The prevalence of asthma was found to be 9.8% and wheezing 15.1%. To investigate the effect of socioeconomic status on the prevalence of asthma, we evaluated the heating system at home, the place of residence, the educational levels of the mother and father, the number of people living in the house, the sharing of bedrooms, and the annual family income. In conclusion, the prevalence of childhood asthma was not affected by any of these factors. Atopic family history, food allergy, eczema, and frequent otitis media and sinusitis attacks were evaluated and found to be significant in asthma prevalence.

Cardiovascular abnormalities in the Beckwith-Wiedemann syndrome.

Twelve of 13 patients with Beckwith-Wiedemann syndrome were found to have cardiovascular abnormalities: congenital heart disease in 7 of the 12 and isolated cardiomegaly in the others. No specific type of cardiac abnormality predominated.

Low immunoglobulin G3 levels in wheezy children.

This study aimed to investigate the prevalence of IgG subclass deficiency in wheezy children aged <3 y. Serum levels of IgA, IgE and IgG subclasses were measured in 310 children with recurrent wheezing and in 100 healthy controls. IgG3 levels were below the normal lower limit in 123 (39.6%) patients. This finding may reflect delayed maturation of the immune system, predisposing young children <3 y of age to wheezing.

Community-acquired severe staphylococcal septicemia in children: the relationship with blunt trauma.

BACKGROUND: With the aim of establishing the role of blunt trauma, a trauma without any fracture or obvious wound, as a risk factor in children who were admitted for community-acquired severe staphylococcal septicemia with various organ involvement, 63 patients were investigated during a seven-year study period. All children were previously healthy. RESULTS: Blunt trauma was present in 12 (46%) of 26 septicemic patients in whom skeletal infections were diagnosed and the relative risk of trauma was high (odds ratio 15.0; confidence interval 2.9-75.8, P < 0.001) in these children. Patients with multiple organ involvement and with multifocal skeletal infections were more frequent among traumatized patients. Children with skeletal involvement were significantly older than others (P < 0.001). The period between the first symptom of infection and the diagnosis was shorter in traumatized children (P < 0.001). None of the children with staphylococcal pulmonary or soft tissue infection had any history of trauma. We conclude that blunt trauma is one of the important risk factors for skeletal involvement in staphylococcal septicemia. Its immunosuppressive nature, especially in local damage of the skin barrier, may be the cause of seeding and multifocal infection.

Sonographic assessment of ceftriaxone-associated biliary pseudolithiasis in children.

PURPOSE: Ceftriaxone is a widely used third-generation cephalosporin. In this prospective study, we used sonography to investigate the incidence and outcome of biliary complications in children receiving ceftriaxone therapy. METHODS: Ceftriaxone was administered intravenously at a dosage of 100 mg/kg/day for 1-3 weeks to 118 children hospitalized for severe infection. Serial gallbladder sonograms were obtained on days 1, 5-7, and 10-14 of therapy and the day after therapy ended if it had lasted more than 2 weeks. When sonographic abnormalities were found, additional sonograms were obtained every 3 days until the abnormalities had completely resolved. RESULTS: Twenty patients (17%), all asymptomatic, demonstrated sonographic abnormalities: 8 had gallbladder sludge, defined as echogenic material without associated acoustic shadowing, and 12 had pseudolithiasis, defined as echogenic material with acoustic shadowing. These abnormalities spontaneously resolved within 2 weeks of stopping the ceftriaxone (mean time to disappearance, 8.2 +/- 3.4 days). No significant differences were found between patients with normal versus abnormal sonographic findings in sex, age, duration of treatment, or other risk factors for drug precipitation. CONCLUSIONS: Ceftriaxone-associated biliary pseudolithiasis is usually asymptomatic and was rapidly reversible after cessation of therapy in this group of Turkish children.

Influence of converting enzyme inhibition on isoflurane-induced hypotension for cerebral aneurysm surgery.

Twenty-five patients (aged 18 to 72 years), who recovered after the first bleed from a cerebral aneurysm, were operated on under neuroleptanaesthesia. Isoflurane was added to induce hypotension. It was found that the required hypotension (51 (SEM 1) mmHg) could be obtained and maintained at much lower isoflurane concentrations (less than 1%) after blockade of the angiotensin converting enzyme activity by enalaprilat (2.5 mg i.v.) than without such inhibition. During the hypotension which lasted 78 (SEM 10) min, only minor adjustments of the isoflurane concentration (0.70 (0.04%) were needed. The desired level of hypotension was obtained with preservation of the cardiac output and without tachycardia. No resistance to the blood pressure lowering effect of isoflurane was observed. On recovery from anaesthesia, a small increase of blood pressure above control values was seen in 16 patients and was easily reversed by small doses of clonidine (mean total dose: 220 (61) micrograms). The operative conditions were excellent and the postoperative recovery was uneventful and complete in 23 patients.

Clinical and neurophysiological correlations in patients with refractory partial epilepsy and intracranial structural lesions.

Twenty patients (13 males, 7 females), who presented with refractory partial epilepsy and a CT and/or MR detected intracranial intra-axial structural lesion were admitted to the University of Gent Epilepsy Monitoring Unit. Mean duration of the epilepsy was 17 years (2-47 years). All patients were enrolled in a comprehensive presurgical protocol including neurological examination, video-scalp-EEG monitoring with prolonged interictal and ictal recording, neuropsychological assessment and positron emission tomography (PET). Intracranial EEG monitoring was performed in 5 patients in whom discrepancies between different tests were found during the non-invasive evaluation. Clinical neurological examination was normal in 16 patients; 4 patients had a mild contralateral hemiparesis. Lesions were mainly located in the temporal lobe (55%). Most patients presented with complex partial seizures (90%). Clinical seizure characteristics correlated well with the lesion location in 55% of patients. Interictal EEG showed focal epileptic activity and focal slowing in respectively 85% and 30% of patients. Interictal EEG lateralization was congruent with the side of the lesion in 17 patients (85%). Interictal EEG localization was congruent with the lobe of the lesion in 13 patients (65%). Ictal EEG lateralized correctly in 14 patients (70%) and localized correctly in 10 patients (50%). Neuropsychological assessment lateralized and localized congruently in respectively 8/17 (47%) and 7/17 (41%) of patients. Interictal PET showed focal interictal hypometabolism, congruent with the lesion, in 13/16 (81%) of patients. Intracranial EEG was congruent with the lesion location in 3 patients but non-congruent in 2 patients. All patients underwent surgical procedures: average follow-up was 14 months (6-24 months). Complete surgical removal of the lesion with free margins resulted in a more than 90% reduction of seizures without postoperative neurological deficit in 12/13 patients.

In vitro chromosomal radiosensitivity in common variable immune deficiency.

Common variable immune deficiency (CVID) is characterized by low immunoglobulin levels and recurrent infections in patients with a period of normal immune function several years after birth. It is associated with diarrhea, malabsorption, bronchiectasis, and lymphoreticular malignancies. Radiation-induced chromosome instability may contribute to the high degree of susceptibility to neoplasia. Peripheral blood lymphocyte cultures were obtained from six patients with CVID and the healthy control group matched by age and sex. The groups did not differ in the frequency of spontaneous chromosome aberrations. After exposure to X-ray radiation, mitotic indices were found to be significantly low and incidence of chromosomal alterations were high in the CVID group. We conclude that chromosomes of cells from patients with CVID are significantly more radiosensitive than those of controls. Thus these patients must be protected from unnecessary X-ray examinations and in case of radiosensitive tumour, the dose of irradiation should be carefully monitored.