The management of infants and children for painless imaging.

The ability of a child to remain sufficiently immobile for painless imaging depends upon their behaviour and the imaging itself. Anaesthesia allows imaging to be optimised but it is expensive, scarce and inappropriate for many situations. Fortunately, sedation and behavioural techniques are sufficiently successful for the majority of scanning, and success rates are high provided that suitable children are selected. Sedation, however, administered by non-anaesthetists, may have catastrophic complications such as airway obstruction. Current UK recommendations demand that any sedation technique has a 'wide margin of safety', but in addition to this, safety is dependent on trained, skillful and experienced staff. Magnetic resonance imaging frightens many children and special planning is necessary for sedation and anaesthesia. When planning an imaging service for children, all the management techniques should be considered in order to achieve maximum efficiency, quality and safety.

An assessment by nurses and mothers of a 'Road-to-Health' Book in the Western Cape.

OBJECTIVES: To evaluate English, Afrikaans, and Xhosa mother-retained 'Road-to-Health Book' (RTH book) for children, and an electronic calculator. DESIGN: Researchers D Harrison (DH) and H Harker (HH) informed clinic staff about the contents and significance of the RTH book. They requested nurses to use this book in conjunction with the Road-to-Health Card and to issue and explain its use to every visiting client. The use of an electronic calculator that plotted horizontal centile and Z-score charts was demonstrated and explained. To determine the relevance of the book and the electronic calculator, nurses involved in the study for 6 months were given three standardised descriptive questionnaires with 'yes', 'no' and 'don't know' responses. Clients were traced and interviewed by the researchers after 6 - 12 months to obtain their views on the book. SETTING: Clinics that provided children with healthcare in 24 locations in the Western Cape Province participated in the study. The children lived in informal settlements, in low-, middle- and high-income residential areas, and on farms in the Cape Town, Stellenbosch, and Paarl regions. SUBJECTS: One hundred and fourteen nurses were enrolled in the study as well as 581 clients to whom the RTH book was issued. OUTCOME MEASURES: The use of and comments on the RTH book by nurses and clients were based on analysis of the questionnaires. RESULTS: The majority of nurses (81.6%) and clients (96%) found the RTH book useful. The horizontal and Z-score growth charts and electronic calculator were less acceptable because their use was time-consuming and less well understood. CONCLUSION: The RTH book with appropriate modifications should be issued to clients in place of the current Road-to-Health card and educational material.

Assessing bupivacaine 10 mg/fentanyl 20 microg as an intrathecal test dose.

After ethics committee approval and verbal consent, women undergoing elective caesarean section given spinal anaesthesia with hyperbaric 0.5% bupivacaine 10 mg (2 mL) plus fentanyl 20 microg (spinal group, n = 20) and women requesting epidural analgesia in labour given the same drugs and doses epidurally, either in the same concentration (epidural small volume group, n = 10) or as 10 mL of 0.1% bupivacaine plus fentanyl 20 microg (epidural large volume group, n = 12) were recruited. The temperature of the great toes, sensory block on the outer ankle (S1 dermatome), motor block at the ankle and haemodynamic changes were recorded every 2 min for 10 min. There was a significant rise in foot temperature only in the spinal group. At four minutes a combination of warm toes and motor or sensory block, usually both, were seen only in the spinal groups. Haemodynamic changes were non-specific. We conclude that bupivacaine 10 mg with fentanyl 20 microg is a reliable agent to detect intrathecal placement by 4 min by which time a combination of motor and sensory block at the ankle and toe warming should be present.

Complete characterization of the (D2O)2 ground state: high Ka rotation-tunneling levels.

We report the observation of extensive a- and c-type rotation-tunneling (RT) spectra of (D2O)2 for Ka = 0-4. These data allow quantification of molecular constants and tunneling splittings for a number of previously unobserved RT states of (D2O)2. The vibrational ground state has thus been characterized to energies as high as those of some of the intermolecular vibrations, and we present the first test of the VRT(ASP-W) potential at these high Ka states.

Errors in anthropometric measurements in neonates and infants.

The accuracy of methods used in Cape Town hospitals and clinics for the measurement of weight, length and age in neonates and infants became suspect during a survey of 12 local authority and 5 private sector clinics in 1994-1995 (Harrison et al. 1998). A descriptive prospective study to determine the accuracy of these methods in neonates at four maternity hospitals [2 public and 2 private] and infants at four child health clinics of the Cape Town City Council was carried out. The main outcome measures were an assessment of three currently used methods namely to measure crown-heel length with a measuring board, a mat and a tape measure; a comparison of weight differences when an infant is fully clothed, naked and in napkin only; and the differences in age estimated by calendar dates and by a specially designed electronic calculator. The results showed that the current methods which are used to measure infants in Cape Town vary widely from one institution to another. Many measurements are inaccurate and there is a real need for uniformity and accuracy. This can only be implemented by an effective education program so as to ensure that accurate measurements are used in monitoring the health of young children in Cape Town and elsewhere.

Hypermagnesemia in a pediatric patient.

IMPLICATIONS: A high blood magnesium level is a rare but life-threatening event. This case report describes an accidental overdose of magnesium that occurred in an 18-month-old girl during a routine operation. The effects of high magnesium levels and its treatment are explained in detail.

Propionic acidemia in a four-month-old male: a case study and anesthetic implications.

Propionic acidemia is a rare genetic disease associated with significant medical problems. When patients with this disease present for surgery, their anesthetic must be tailored to meet their special needs. This case report provides information regarding propionic acidemia and its anesthetic management.

An assessment of the 'road-to-health' card based on perceptions of clinic staff and mothers.

OBJECTIVES: To describe the opinions of health personnel and parents at child health clinics in Cape Town; to determine the accuracy and completeness of data recorded on the present 'Road-to-Health' (RTH) card; and to ascertain the views of clinic staff and mothers regarding what information they would like to record. DESIGN: Descriptive prospective study. SETTING AND SUBJECTS: Qualitative interviews of 35 health personnel and 150 mothers/caregivers were conducted at 17 child health clinics. The clinic practices of 32 health personnel were monitored and details of 150 RTH cards were examined. MAIN OUTCOME MEASURES: Responses of health personnel at public and private child health clinics and of mothers were analysed. Data recorded on the card were extracted under the headings: neonatal data, immunisation schedules, measurements, and weight-for-age chart. RESULTS: Most nurses supported the concept of an RTH card but a large majority recommended that it be replaced with a notebook retained by the mother. A significant proportion of health personnel did not know how to use the weight-for-age chart. Most mothers attending clinics carried the card, but this number dropped for hospital visits and consultations with private doctors. Mothers' understanding of the card was limited. For mothers the weight-for-age chart, immunisation schedule and milestone section are obscure. CONCLUSION: Health personnel and mothers would like to replace the RTH card with a notebook in the parents' home language. It should contain more information on health matters, adequate space to record weight and infectious diseases, an illustrated milestone chart and an improved schedule for immunisations. Mothers perceived the RTH card as belonging to the clinic and wanted a 'baby's own' document.

Carcinoma de estirpe tiroidea en quistes tiroglosos: presentación de 3 casos / Thyroid carcinoma in thyroglossal cyst: presentation of three cases

La aparicion de carcinomas de estirpe tiroidea en quistes tiroglosos, que representan un remanente embriologico anormal del tracto tirogloso y a su vez la lesion congenita más comun en el cuello, es un fenomeno raro, aunque no sorprendente en virtud de la relacion embrionaria con la glandula tiroides. Además, algunos estudios demuestran una alta frecuencia de tejido tiroideo funcionante en quistes tiroglosos libres de neoplasia. Los autores presentan 3 nuevos casos de carcinoma de estirpe tiroidea en quistes tiroglosos y hacen una revision de la literatura. Se piensa que hasta 1993 aparecian menos de 150 casos en la literatura mundial.