ABSTRACT
BACKGROUND: Low cerebrospinal fluid (CSF) glucose levels have been associated with sensorineural hearing loss (SNHL) in bacterial meningitis but systematic investigations are lacking. PATIENTS AND METHODS: A retrospective case control study was conducted comparing CSF glucose levels in 47 cases with and 145 controls without SNHL following bacterial meningitis. RESULTS: The mean CSF glucose level (standard deviation [SD]) was 1.3 mmol/l (1.2) in cases and 2.5 mmol/l (1.6) in controls (p < 0.001). The difference between the groups was significant for Streptococcus pneumoniae and Haemophilus influenzae but not for Neisseria meningitidis infection. It was independent of the delay of treatment if this was greater than 12 h. This delay was significantly longer in cases compared to controls. CONCLUSION: In bacterial meningitis other than that caused by N. meningitidis and independent of the duration of symptoms prior to diagnosis, CSF glucose levels were significantly lower in patients developing a SNHL compared to controls.
Subject(s)
Glucose/cerebrospinal fluid , Hearing Loss, Sensorineural/diagnosis , Meningitis, Bacterial/cerebrospinal fluid , Meningitis, Bacterial/microbiology , Biomarkers/analysis , Case-Control Studies , Child, Preschool , Female , Haemophilus influenzae/isolation & purification , Humans , Infant , Male , Neisseria meningitidis/isolation & purification , Probability , Prognosis , Reference Values , Retrospective Studies , Risk Assessment , Sensitivity and Specificity , Severity of Illness Index , Statistics, Nonparametric , Streptococcus pneumoniae/isolation & purificationABSTRACT
To investigate the integrity of sympathetic innervation in the hypomelanotic macules of tuberous sclerosis complex, we studied sudomotor function in nine patients with tuberous sclerosis complex. Postganglionic sudomotor function was assessed using the Silastic imprint test in nine patients with tuberous sclerosis complex who have at least one hypomelanotic macule greater than 2 cm in diameter. Sweating was induced by iontophoresis with 0.5% pilocarpine nitrate and sweat droplets were counted under a microscope using a 1 x 1 cm grid. Silastic imprint testing of an analogous skin area contralateral to the hypomelanotic macule was measured as a control. Sweat volume quantitation using sweat collectors was performed in five of the subjects. The sweat volume collected from the hypomelanotic macule was reduced compared to the control skin in four of the five subjects. Sweat droplet counts from the hypomelanotic macule were significantly reduced in only one of nine subjects. These data suggest that, although there is no difference in the number of functioning sweat glands in most hypomelanotic macules, the sweat glands produce less sweat (ie, decreased sweat volume) than in normal skin. We hypothesize that focal abnormalities of sympathetic innervation might be responsible for the hypomelanotic macules of tuberous sclerosis complex.
Subject(s)
Eccrine Glands/physiopathology , Hypopigmentation/etiology , Melanocytes/metabolism , Sweat/metabolism , Sympathetic Fibers, Postganglionic/physiopathology , Tuberous Sclerosis/physiopathology , Adolescent , Adult , Case-Control Studies , Child , Eccrine Glands/metabolism , Female , Humans , Hypopigmentation/physiopathology , Iontophoresis , Male , Muscarinic Agonists , Pilocarpine , Skin/pathology , Sympathetic Fibers, Postganglionic/pathology , Tuberous Sclerosis/complicationsABSTRACT
The ketogenic diet is becoming a more recognized method of treating seizures in some children with epilepsy. Texas Scottish Rite Hospital for Children (TSRHC) developed an interdisciplinary team that uses a comprehensive approach to implementing this innovative therapy. Anticipated outcomes of this unique approach are increased family satisfaction and improved dietary compliance, which maximizes the diet to its fullest potential. These outcomes are validated by anecdotal information by families' reports of satisfaction and successful diet maintenance for increased number of months (this population from 3-31 months). Of the 27 children ages 1-16 years, approximately 40% have experienced reduction of seizures of more than 50%, 25% are seizure free, and 35% have discontinued the diet for a variety of reasons including difficulty in consistently maintaining the diet. Originally introduced in the 1920s, the ketogenic diet has once again become cutting edge treatment for nonresponsive seizure activity.
Subject(s)
Dietary Fats , Patient Care Team , Seizures/diet therapy , Child , Humans , Ketone Bodies/biosynthesis , Parents/education , Patient Education as TopicABSTRACT
Records of 244 preschool medicals were studied retrospectively. The value of the examination to the children, their parents and teachers, and the use of clinical medical officer time was considered. Fifty-seven per cent had previously undetected problems deemed to require follow-up. This number was subsequently corrected to 50% in the light of current practice. Fourteen per cent warranted referral to other professionals and 4.5% received treatment. The high number of vision defects noted suggests further study. Fifteen per cent of the parents wished to discuss concerns about their children with the clinical medical officer. Clinical medical officer practice varied, but showed the incidence of follow-up to be inversely proportional to the referral rate. The number of previously undetected problems recorded in the survey supports medical examination of all children at this age. However, review of criteria and further study is indicated to make the best use of resources.
