Right chest electrocardiographic patterns in normal subjects.

Right-sided chest lead ECGs (V3R to V6R) were recorded in 110 normal male subjects who were between the ages of 17 and 22 years old (mean, 17.9 years). The prevalence of the rS pattern decreased from V3R (89 percent) to V6R (37 percent). However, the opposite was the case for the rSr pattern (10 percent in V3R and 36 percent in V6R). The amplitudes of the r wave, S wave and secondary r wave all progressively decreased from V3R to V6R. The prevalence of the qr and qS patterns was 0 and 1 percent, respectively in V3R and 14 and 2 percent, respectively in V6R. A positive ST segment deviation of 0.5 to 1 mm was present in 13 percent of subjects in V3R and 5 percent in V4R. T wave inversion was common and the prevalence increased from V3R (60 percent) to V6R (79 percent).

Cockayne's syndrome--difficulties with early diagnosis.

The features of Cockayne's syndrome do not appear until 4 to 5 years of age. Early diagnosis is important for proper genetic counselling and antenatal screening. Despite various "diagnostic tests" offered by many authors, early diagnosis of the syndrome is still problematic. Four cases which were initially diagnosed as cerebral palsy are presented to illustrate this difficulty. Two cases were diagnosed as spastic cerebral palsy and the other two as familial spastic paraplegia. The features of Cockayne's syndrome appeared later.

ECG abnormalities in Kawasaki disease and their value in predicting coronary artery aneurysms.

ECG abnormalities suggestive of carditis were encountered in 20 of 25 patients (80%) with Kawasaki Disease. The commonest abnormalities were raised S-T segments (11 patients), increased Q/R ratio (11 patients) and prolonged corrected Q-T interval (7 patients). Six patients had coronary artery dilatation and all resolved on subsequent 2-D Echocardiography. These six patients all had ECG changes of carditis. Such changes were present in 74% of patients with normal coronary arteries. The differences were not significant. A similar comparison between the two groups using the modified Asai scoring system failed to show the usefulness of this scoring system in predicting the risk of coronary artery involvement in our patients.

Clinical features and haematological indices of bacterial infections in young infants.

The clinical features and haematologic indices of 100 young infants aged 3 months and below, admitted with suspected bacterial infections, were analysed. Fever, lethargy, hepatomegaly, poor feeding and irritability were the commonest features for suspecting a bacterial infection in these infants. However, the features significantly associated with bacterial infections were respiratory distress and cyanosis. Of the haematologic indices commonly associated with bacterial infections, only C-reactive protein and erythrocyte sedimentation rate were significantly predictive compared to leukocyte counts, absolute neutrophil counts and nitro-blue tetrazolium tests. When used in combination, a raised C-reactive protein with erythrocyte sedimentation rate, a raised erythrocyte sedimentation rate with abnormal leukocyte counts and a raised C-reactive protein with abnormal leukocyte counts were significantly associated with bacterial infections.

Unusual manifestations of Mycoplasma pneumoniae infection in children.

Mycoplasma pneumoniae infection is no longer a benign condition it was originally thought to be. Many extrapulmonary manifestations affecting major organ systems like the central nervous system, cardiovascular system, haematological system, gastrointestinal system, musculoskeletal system and renal system have been described. Early recognition of these manifestations is often difficult and serological diagnosis may not be helpful. Three patients with large pleural effusions, encephalitis, hemiplegia, hepatitis, autoimmune haemolytic anaemia and renal failure are discussed to highlight the many varied presentations associated with this infection.