Tertiary paediatric hospital admissions in children and young people with cerebral palsy.

BACKGROUND: Many previous studies that have investigated hospital admissions in children and young people with cerebral palsy lack information on cerebral palsy severity and complexity. Consequently, little is known about factors associated with the frequency and type of hospital admissions in this population. This study used hospital admission data available for all children and young people known to a population-based cerebral palsy register to describe the patterns of use of tertiary paediatric hospital services over a 5-year period. METHODS: This was a retrospective cohort analysis of routinely collected admission data from the two tertiary paediatric hospitals in the Australian state of Victoria. Data on admissions of individuals born between 1993 and 2008 registered on the Victorian Cerebral Palsy Register were analysed (n = 2183). RESULTS: Between 2008 and 2012, 53% of the cohort (n = 1160) had at least one same-day admission, and 46% (n = 996) had one or more multi-day admissions. Those with a moderate to severe motor impairment and those with a co-diagnosis of epilepsy had more admissions, and for multi-day admissions, longer lengths of stay, P < 0.05. Across all severity levels, respiratory and musculoskeletal diseases were the most frequently reported reasons for medical and surgical admissions, respectively. All-cause readmission rates for urgent multi-day stays within 7, 30 and 365 days of an index admission were 10%, 23% and 63%, respectively. CONCLUSIONS: The reasons for hospital admissions reported here reflect the range of comorbidities experienced by children and young people with cerebral palsy. This study highlights priority areas for prevention, early diagnosis and medical management in this group. Improved primary and secondary prevention measures may decrease non-elective hospital admissions and readmissions in this group and reduce paediatric inpatient resource use and healthcare expenditure attributable to cerebral palsy.

Splenic function in non-renal systemic lupus erythematosus.

The reticuloendothelial clearance of autologous heat-damaged red blood cells was assessed in 10 patients with systemic lupus erythematosus (SLE) but without clinical nephritis. Although in nine patients the disease was clinically active at the time of the test, only one patient had a prolonged half-clearance time (T 1/2). One patient who had persistently high titers of circulating immune complexes, but whose disease was clinically inactive, had a normal T 1/2. There was no correlation between the patients' age, duration of disease, disease activity, therapy or titer of circulating immune complexes and the T 1/2. It appears that a general defect in splenic function is not a universal feature of SLE and that high titers of circulating immune complexes may be found in the presence of efficient reticuloendothelial phagocytic ability.

Quantitative scintigraphy in diagnosis and management of plantar fasciitis (calcaneal periostitis): concise communication.

We have found that Tc-99m methylene diphosphonate imaging of the heel is of diagnostic value in the "painful heel syndrome," permitting positive identification of the site of inflammation in cases where radiography is unhelpful. With this technique, tracer uptake in the heel is susceptible to quantification, allowing a serial and objective assessment of response to therapy.

Nutrient digestion and performance by lambs and steers fed thermochemically treated crop residues.

Five studies were conducted to determine nutrient digestibility and performance of lambs and steers fed thermochemically treated crop residues and distillers dried grains with solubles (DDGS) as a corn replacement pellet (CRP; 75% residue:25% DDGS, DM basis). Fifteen Hampshire, Suffolk, or Dorset wethers (BW 33.3 +/- 5.0 kg) were utilized to evaluate nutrient digestibility of the unprocessed native (NAT) and CRP [Exp. 1: wheat straw (WS); Exp. 2: corn stover (CS); Exp. 3: switchgrass (SWG) and corn fiber:wheat chaff (CFWC)] when limit fed (Exp. 1 and 2: 1.8% of BW daily; Exp. 3: 2.5% of BW daily) compared with a 60% corn diet. In Exp. 4, 56 individually fed Dorset-cross wether lambs (BW 32.0 +/- 1.4 kg) were utilized to compare performance and digestibility of WS, wheat chaff (WC), corn fiber (CF), a 3:1 blend of corn fiber:wheat straw (CFWS), a 3:1 blend of CFWC, and SWG-CRP fed for ad libitum intake compared with a 45% corn diet. In Exp. 5, 32 individually fed Holstein steers (BW 185.2 +/- 0.9 kg) were used to evaluate performance and digestibility of diets containing corn, WS-CRP, CFWC-CRP, or NAT-WS fed for ad libitum intake. Crop residues were processed with 5% calcium oxide (DM basis) and 35% water in a double-shaft enclosed mixer (Readco Kurimoto Continuous Processor, York, PA) and subsequently pelleted with DDGS to form CRP. Feeding lambs WS-CRP (Exp. 1) or CS-CRP (Exp. 2) increased digestion of DM, NDF, and ADF compared with NAT (P < 0.05). In Exp. 3, feeding CFWC-CRP increased total tract NDF digestibility and ADF digestibility (P < 0.05). Experiment 4 final BW were greatest for control lambs and least for lambs fed CFWS-CRP or SWG-CRP. Body weight gains for lambs fed CRP averaged 15.9% less than control (P < 0.05). Lambs fed CRP diets had greater (P < 0.05) NDF and ADF intake and output. In Exp. 5, steers fed the corn or 2 CRP diets gained similarly and faster (P < 0.05) than those fed the NAT-WS diet. Steers fed the control corn diet were more efficient (P < 0.05) than steers fed other treatments. Steers fed the corn diet, CFWC-CRP, and WS-CRP had greater (P < 0.01) DM digestibility than NAT. The results confirm benefits for nutrient digestion and subsequent animal performance when crop residues are thermochemically processed. Processed crop residues may be fed in combination with DDGS to partially replace corn in ruminant diets.

Polymyalgia rheumatica.

Early diagnosis of polymyalgia rheumatica is often difficult. A missed diagnosis and inadequate treatment can result in severe and prolonged disability and expose the patient to the hazards of temporal arteritis. Treatment is effective and relatively straightforward provided that good doctor-patient communication is maintained.

Children in homeless families in Melbourne: health status and use of health services.

OBJECTIVE: To determine the prevalence of health and behaviour problems in a sample of children in homeless families and of psychological problems in their parents, and to assess the use of health services by homeless families. DESIGN: A cross-sectional, questionnaire-based prevalence survey. SETTING: Supported accommodation provided by a welfare service in Melbourne between May 1994 and June 1995. SUBJECTS: 51 children from 31 families soon after housing crises. RESULTS: More than one-third of all children had total behaviour problems scores in the "deviant" range (i.e., requiring mental health referral). Intellectual disability/developmental delay, skin problems, vision problems, recurrent headache, and asthma or other breathing problems were more prevalent in these homeless children than in a large Australian normative population. Their mothers scored higher than a large normative sample on the mental health questionnaire, most markedly for "anxiety-insomnia", "severe depression" and total score. Cost of treatment and transport difficulties were seen as barriers to using health care services. RECOMMENDATIONS: Australian health-care practitioners should be aware of the health and health service access problems of children in homeless families, and work to minimise their physical, emotional, developmental and academic disadvantages. Psychological support services should be available for homeless families, particularly for mothers.

Reticulum cell sarcoma in azathioprine-treated systemic lupus erythematosus.

The development of a reticulum cell sarcoma in the lung of a patient with systemic lupus erythematosus treated with azathioprine for 18 months is described. This possible hazard of immunosuppressive therapy is discussed in relation to patients with SLE.

Chloroquine-induced cytosomes with curvilinear profiles in muscle.

A patient with systemic lupus erythematosus (SLE) was treated with chloroquine therapy for four years after the onset of her illness. Nine years after cessation of chloroquine, muscle weakness developed as part of the SLE. Four muscle biopsies performed for diagnostic purposes revealed varying degrees of inflammatory change as well as distinctive cytosomes with curvilinear profiles (CCPs). These CCPs were identical to those reported in Batten disease, a degenerative disorder of children which has a clinical course different from SLE. The CCPs seen in this case of SLE are thought to result from the effect of chloroquine on membrane systems within muscle cells. This report calls attention to the fact that CCPs are not unique to Batten disease bu may also occur in muscle of SLE patients treated with chloroquine.

Combined temporal arteriography and selective biopsy in suspected giant cell arteritis.

Superficial temporal arteriography was studied by selective biopsy of abnormal arterial segments and random biopsy of the main stem in 33 patients with clinically supected giant cell arteritis. Of the total of 33 temporal arteriograms 9 showed definite abnormalities (7 in the periphery and 2 in the main stem). Selective biopsy of the 7 peripheral abnormal segments showed arteritis in only 2, narrowing of the vessels in the remainder being due to atheroma (3) and fibrointimal thickening (2)--that is, 5 'false positives' for temporal arteritis on arteriography. Histological evidence of arteritis was found in 9 patients, only 5 of whom had clearly abnormal arteriograms--that is, 4 'false negatives'. Thus temporal arteriography appears to have low sensitivity for identifying arteritic lesions and also frequently gives 'false positive' results. It is concluded that temporal arteriography is not a satisfactory alternative to biopsy, and that its value as an adjunct to selective biopsy is limited because of its frequent failure to detect lesions found histologically.