The first 10 years of the dialysis-transplantation program at The Hospital for Sick Children, Toronto. 1: Predialysis and dialysis.

Renal dialysis and transplantation have been used for many years for adults with kidney failure but only recently for children. In May 1967 a renal-dialysis-transplantation program was established at The Hospital for Sick Children, Toronto for patients aged 6 to 18 years living within 240 km of Toronto. In 1973, children aged 1 to 5 years began to be accepted into the program, and by August 1977, 90 children (mean age 11 years) from all parts of Canada had been admitted to the program. The creation of vascular access in very small patients is difficult; the most successful types of access have been central shunts (established above the knee or the elbow) and bovine grafts. Specially made dialysis equipment is necessary for young patients. Young children should only be accepted in a dialysis-transplantation program that has a medical staff expert in meeting the specific needs of such children.     

Malaria at the Hospital for Sick Children, Toronto.

The number of immigrants to Canada from countries where malaria is endemic increased sevenfold between 1964 and 1974. From January 1973 through July 1975, 15 cases of malaria were treated at the Hospital for Sick Children, Toronto. The only symptom common to all patients was fever, and it was not always cyclic. For any child with a fever of unknown cause who has been in a region where malaria is endemic within the previous 6 months, a blood smear should be examined for parasites. If the smear is negative even when stained with acridine orange, serologic testing should be performed. Acurrate species identification is important since therapy varies according to the causative organism.     

Acute Purulent Meningitis in Children: Experience at The Hospital for Sick Children, Toronto

Sixty-eight children with acute purulent meningitis were treated at The Hospital for Sick Children, Toronto, in 1962; nine deaths occurred. Hemophilus influenzae type B and meningitis in which no organism was cultured accounted for 35 and 17 cases, respectively. A number of other etiological agents caused six or fewer cases each.

The principal presenting complaints were fever and vomiting, the more familiar symptoms of meningeal irritation occurring in 20% or less. A short duration of onset suggested a more severe illness and graver prognosis. Seven of the nine fatal cases had a presenting history of less than 24 hours' duration. Persisting high fever, convulsions, cyanosis and abdominal distension were also associated more specifically with the fatal cases.

The laboratory examination of the initial spinal fluid sample, while of value in the identification of the causative organism, was not of prognostic value.

The value of general treatment measures, as well as specific therapy, was evident in all cases.

     

Neonatal Respiratory Distress: Experience at The Hospital for Sick Children, Toronto, 1960-1961

Four hundred and thirty infants selectively referred to the Newborn Unit of The Hospital for Sick Children, Toronto, with the symptom of respiratory distress, were reviewed. There were 142 cases of the “idiopathic respiratory distress syndrome” (IRDS), of which 67 were fatal. The remainder included 100 cardiac (76 deaths), 63 extra-pulmonary (28 deaths) and 109 other specific pulmonary conditions (54 deaths). Of the 109, half were due to massive aspiration. Serial observations and radiographs led to correct clinical diagnosis in 85% of necropsy-proved cases of IRDS and in a comparable proportion of all other conditions. The incidence and mortality rate of IRDS were twice as high in males as in females. A significant number of premature infants have transient respiratory distress after birth, and diagnostic criteria for inclusion in any study should be defined in detail. This study emphasized the large contribution of disorders of the respiratory and cardiac systems to neonatal mortality and led to the formation of a special department for intensive care and research in these conditions.     

'Epidemic neuromyasthenia' at the Hospital for Sick Children, Great Ormond Street, London.

An outbreak of an illness with features in common with ''epidemic neuromyasthenia'' affected the staff of the Hospital for Sick Children in London between August 1970 and January 1971. At least 145 cases were observed and the majority of these were nurses. Symptomatology was protean, clinical findings minimal and relapses frequent. Care was taken to minimize anxiety and fear in a vulnerable population, and laboratory investigations were purposefully limited in number for this reason. In general, laboratory findings, including virological investigations were negative. A high incidence of anti-complementary activity and the presence of ill defined aggregates in some acute sera on electron microscopy were interesting and possibly significant findings suggesting the presence of immune complexes. These findings, plus the ability of lymphocytes from some patients to proliferate in vitro, were thought to represent possible evidence of an infective process. Although no children were affected during the 1970 outbreak, it is interesting that seven children have recently been referred to the hospital with features compatible with ''epidemic neuromyasthenia''.     

Experience with Yersinia enterocolitica at The Hospital for Sick Children, 1972-74.

Thirty-six cases of Yersinia enterocolitica infection were detected in the years 1972-74. The form of the illness in young children was acute gastroenteritis and in older children "appendicular syndrome". Improved isolation and identification techniques have increased the laboratory recognition of this enteric pathogen.     

Natural History of Isolated Patent Ductus Arteriosus and the Effect of Surgical Correction: Twenty Years'' Experience at The Hospital for Sick Children, Toronto

Seven hundred and forty-four cases of patent ductus arteriosus were diagnosed at The Hospital for Sick Children, Toronto, in the 20-year period from 1947 to 1966. Of these 705 have been treated surgically. It is concluded that operation is best performed between 6 and 12 months of age. Isolated ductus arteriosus is rarely a cause of congestive heart failure, and is more likely to be so in the presence of the rubella syndrome. Failure associated with the anomaly in the neonatal period can usually be successfully managed by medical treatment. Spontaneous closure after one month of age is not to be expected. Surgical treatment at the appropriate time prevents the subsequent development of Eisenmenger's complex.