Ophthalmic manifestations of primary oxalosis.

The clinical and pathological findings of a 6-month-old infant with primary oxalosis, who died in renal failure, are presented. The oxalate crystalline deposition in the retinal pigment epithelium corresponded to the flecked retinopathy observed ophthalmoscopically. The difficulties in establishing a precise biochemical diagnosis are discussed and the relevant ophthalmic literature is reviewed.

Routine examination in the neonatal period.

OBJECTIVE: To assess the value of the second neonatal examination as a medical surveillance procedure. DESIGN: Prospective survey of routine neonatal examinations and the abnormalities identified during 8 March-30 June 1988. SETTING: Maternity unit with an annual birth rate of 5700. SUBJECTS: For first neonatal examination: 1795 babies born in the unit during the 115 day observation period. For second routine examination: 1747 babies (97.3%) discharged from postnatal ward. MAIN OUTCOME MEASURES: Missed abnormalities (present but not previously noted); minor abnormalities (superficial infection or trivial or transient abnormalities not requiring intervention); and important abnormalities (unlikely to have been present at first examination but requiring intervention). RESULTS: An abnormality was detected in 158 (8.8%) infants on first neonatal examination. 1428 (79.6%) babies had a routine second examination, which disclosed 63 previously undetected abnormalities. Of these, seven (11%) would have been present on first examination, 49 (78%) were considered minor, and seven (11%) important--the most consequential being dislocatable hips (four infants). Thus an important finding was detected by only 0.5% of second examinations. CONCLUSIONS: A second thorough examination in the early neonatal period cannot be justified as a screening procedure. A repeat examination of the hips alone in the first week of life is necessary.

Modification of the AOAC gas-liquid chromatographic method for indole in shrimp: collaborative study.

Several changes were suggested for standardization of the AOAC official final action gas chromatographic method for the determination of indole in shrimp. In a collaborative study, 3 FDA laboratories compared the modified method with the current method. At a 95% confidence level, the same results were obtained for each respective sample by the AOAC or the modified method, which had the following changes. The cleanup column was standardized by drying the silica gel for 2 h at 125 degrees C and equilibrating with 3 g of water/25 g of silica gel. Concentrated ethyl acetate shrimp extracts were treated with anhydrous sodium sulfate before column cleanup and indole was eluted from the column with 15% ethyl ether/hexane. A reduced amount of the internal standard, 2-methylindole, was used to improve peak height measurements at the 25 microgram% indole level. The modified method has been adopted official first action to replace method 18.075.

Postgraduate education for part-time doctors.

A course of evening lectures was held for doctors working part-time and who found attending hospital postgraduate activities difficult. The results of a questionnaire suggested that this was a welcome venture and that there will be a larger number of women doctors who may have special postgraduate educational needs.

Semeiology--a well established and challenging paediatric speciality.

"This week's mystery comes from seven-year-old Callum from Middlesex who, when walking a variable distance, develops an ache around the knees and down his calf of such severity that he has to stop, when it disappears immediately. He also used to wake at night complaining of 'pains in the leg' when younger. This has now improved. This is a most puzzling case, as the relationship to exercise is strongly suggestive of interruption of the blood supply or claudication, though this would not explain the nocturnal pain. Callum has been investigated from top to toe by paediatric specialists, who have been unable to reach a diagnosis. So he, and his mum, will be more than grateful if anyone out there has any suggestions." (Dr James Le Fanu, Doctor's Diary, Daily Telegraph, 2 April 2002)

Parental attitudes to a clinical examination in paediatrics.

A selected group of parents, whose children were patients in a recent clinical examination, declared, with one exception that this experience was not disturbing to them or their child. The overall impression given was of interest in the proceedings and of satisfaction that this was a tangible method of expressing their gratitude for the care their children had received. Complaints were few and related to organization rather than to the examiners or candidates.

The relationship between European paediatricians and commerce: ethical principles in paediatrics working group recommendations. Confederation of European Societies of Paediatrics (CESP).

UNLABELLED: It is important that doctors have an ethically proper relationship with commercial interests. The relationship between paediatricians, paediatric societies and industry is probably healthy. To further the interests of patients it is important that it remains so. CONCLUSION: This mentionship would be undermined if: there was a perceived conflict of interests between paediatricians, their patients and industry; paediatricians were seen to endorse companies whose marketing and other practices were unethical. It will be enhanced if: paediatricians did not receive individual gain from industry; industrial support for educational and research activities, whether to individuals or institutions, is open, proportionate and accountable.

Ultraviolet detection procedure for liquid chromatographic determination of indole in shrimp.

In an ultraviolet detection procedure, indole was extracted from shrimp by blending with carbonate buffer and then partitioned into ethyl acetate. Before quantitation by high pressure liquid chromatography (HPLC), interferences were removed by the use of a polyamide cleanup column. Concentrated column effluent was injected into the chromatograph. Indole was detected by monitoring absorbance at 217 nm and quantitated by comparison of indole peak height to that of an internal standard, 2-methylindole. Recoveries of indole ranged from 72 to 117%. Results agreed well with those by the official AOAC gas-liquid chromatographic (GLC) method.

Should we follow up children with Henoch-Schönlein syndrome?

We reviewed 31 children who had had Henoch-Schönlein syndrome without nephritis at least 5 years before. None was found to have progressive renal disease and these patients do not require the same long-term follow-up as those with clinical renal involvement.

Fluorometric determination of histamine in cheese.

Thirty-one samples of cheese obtained from retail outlets were analyzed for histamine, using an official AOAC fluorometric method. The types of cheese analyzed and the ranges of histamine found were: colby, 0.3--2.8; camembert, 0.4--4.2; cheddar, 1.2--5.8; gouda, 1.3--2.4; provolone, 2.0--23.5; roquefort, 1.0--16.8; mozzarella 1.6--5.0; and swiss, 0.4--250 mg histamine/100 g. Ten of the 12 samples of swiss cheese contained less than 16 mg histamine/100 g. The remaining 2 samples which contained 116 and 250 mg histamine/100 g were judged organoleptically to be of poor quality. An investigation of one processing facility showed that the production of histamine in swiss cheese may have been a result of a hydrogen peroxide/low temperature treatment of the milk supply. Recovery of histamine added to methanol extracts of cheese ranged from 93 to 105%. Histamine content was confirmed by high pressure liquid chromatographic analysis of the methanol extracts.

Concentrated milk feeds and their relation to hypernatraemic dehydration in infants.

The composition of milks usually fed to 25 infants admitted to hospital with a dehydrating illness was studied. 15 hypernatraemic babies had been given feeds of greater sodium concentration and osmolality than those fed to the 10 infants whose plasma sodium was below 150 mEq/l. Hypernatraemic dehydration may be followed by death or permanent brain damage. Most infants in the survey were receiving milk with a sodium content greater than that advised by the manufacturers. Suggestions are made for reducing the sources of error commonly made in the reconstitution of dried milk formulae.

Renal transplantation in children with occult neurogenic bladders drained by intermittent self catheterisation.

Children with neurogenic bladders have usually not been considered for renal transplantation because of the potential complications caused by chronic infections of the urinary tract. Two girls with occult neurogenic bladders who were practising intermittent self catheterisation were given renal transplants. Both took prophylactic antibacterial agents after transplantation, and both experienced infections at some stage, but none of these infections produced a deterioration in renal function. In one patient creatinine clearance fell and signs of obstruction appeared, but this was because the patient had been catheterising herself only two or three times a week. When she resumed catheterisation four times a day creatinine clearance rose and the urographic and renographic appearances returned to normal. These results suggest that, with adequate catheterisation and urinary chemoprophylaxis, infection is not a particular problem in children with bladder dysfunction who undergo renal transplantation.

The diet composition and nutritional knowledge of patients with anorexia nervosa.

A retrospective study of typical 24-h food intake was undertaken of the diets of 17 anorexia nervosa patients during the initial and the most severe phases of their illness. Patients completed a nutritional knowledge questionnaire. Patients' diets were significantly lower in energy and in all major nutrients than those of control subjects. The proportion of energy derived from protein was significantly higher, from fats significantly lower and from carbohydrates not significantly different from that of controls. The mean intake of all nutrients in the more severe phase of illness was lower in the initial phase. Intakes of calcium, retinol activity and ascorbic acid were below RDA levels in the majority of patients, but only a few reported intakes of thiamin, riboflavin and niacin equivalent below RDA values. Most patients scored higher on the nutritional knowledge questionnaire than matched controls, particularly in respect to questions concerning caloric content of food, dieting and roughage. Not all patients obtained high nutritional knowledge scores however, and 25 per cent performed less well than selected controls.