Amniotic fluid cortisol after premature rupture of membranes.

Total amniotic fluid cortisol concentration was studied in 12 patients at 24 to 34 weeks of gestation after premature rupture of membranes of one to eight days duration. Rupture of the membranes of less than 24 hours duration was associated with normal amniotic fluid cortisol concentrations. Rupture of membranes for more than 24 hours was associated in 10 of 12 patients with higher than normal amniotic fluid cortisol levels. The rise in amniotic fluid cortisol concentrations following premature rupture of the membranes may reflect increased fetal or maternal cortisol production or both, and could explain enhanced lung maturation in such infants.     

The erythrocyte sedimentation rate in the newborn period.

Determination of the erythrocyte sedimentation rate in capillary blood can be of value in identifying neonates with infection. The normal values for the method described here range from 1 mm/l hour at 12 hours of age to 17 mm/l hour at 14 days of age. Most noninfected neonates with moderate to severe RDS or with other serious illness had values well within the normal range. Infected patients had marked elevations, and the majority of values returned to normal with clinical improvement. Coombs-positive ABO hemolytic disease was also responsible for elevated values. In about half of the infected patients the rise was not seen until 24 to 48 hours after clinical symptoms first appeared. The ESR can be useful in the nursery as a preliminary step in the laboratory evaluation of the sick neonate. Serial determinations may be of aid in identifying the infected infant when the results of bacteriologic cultures are obscured by antibiotic therapy.     

Childhood cancer in sibs.

Thirty-eight families with cancer in two or more children were identified from records of the Sidney Farber Cancer Center and the Children's Hospital, Boston. Neoplasms developed in one pair of identical twins and in 37 sets of sibs (2 with 4 affected sibs, 4 with 3, and 31 sib-pairs). Predisposition to cancer extended to their parents and other relatives, and subsequently to other sibs who were unaffected at the time of ascertainment of the cancer-prone families. Genetic susceptibility was suggested in individual families by parental consanguinity or by an inherited disorder predisposing to cancer, but in other instances no oncogenic factors were identified. Familial aggregates of childhood provide opportunities for etiologic study and cancer control.     

The acute and transient nature of idiopathic immune hemolytic anemia in childhood.

The records of 22 children with the diagnosis of idiopathic immune hemolytic anemia were reviewed. Fifty per cent of the children had a history of an antecedent infection and 32% had underlying immune deficiency or lymphoproliferative diseases. The majority (77%) of the patients had an acute self-limited disease which was frequently associated with a positive complement or nongamma Coombs test. The anemia was usually severe, and a number of the children had reticulocytopenia at the time of diagnosis. These children responded rapidly to transfusions and corticosteroids and generally remained well on follow-up. Immunosuppressive drugs did not prove useful in two patients refractory to prednisone, but splenectomy was apparently beneficial in three of four patients so treated. Mortality rate was 18%, with most of the deaths related to an underlying disease.     

Disaccharidase activities in small intestinal mucosa in patients with cystic fibrosis.

The disaccharidase activities in small intestinal biopsies were related to the morphology of the mucosa and the ages of 63 patients with cystic fibrosis and 177 healthy control subjects of Caucasian origin. In patients with CF and in the healthy control subjects under 5 years of age with normal intestinal mucosa, no low lactase activity was found. In those patients with CF who were over 5 years of age, one group had high and one group had low lactase activity, as occurs in healthy Caucasian control subjects of the same age. This finding supports the view that in patients with CF, lactase deficiency is not related to the disease entity. In patients with or without CF who had the same degree of mucosal atrophy, the decrease of disaccharidase activities followed the same pattern, indicating that enzyme activities are affected to the same extent by the damage of the mucosa. In patients with CF with pancreatic insufficiency, the disaccharidase activities were significantly (P less than 0.001) higher when compared to those in control subjects of the same age and ethnic group, although the increase was not uniform in all patients with cystic fibrosis.     

Brain abscess and cystic fibrosis.

Brain abscess has only recently been considered a complication of cystic fibrosis. Three patients are reported here and a fourth cited from the literature. All of our patients were young adults with advanced pulmonary disease. The bacteria involved were mouth organisms and were found in the sputum culture in only one of the patients. Resistance was present to previously given antibiotics. As patients with cystic fibrosis survive into adulthood, the risk of developing a brain abscess appears to increase.     

Detection of middle ear effusion by acoustic reflectometry

Existing diagnostic methods for otitis media with effusion are inadequate. We designed, built, and tested an acoustic reflectometer to overcome such inadequacies. The probe is placed at the entrance to the external auditory canal, whereupon a swept tone (1800 to 7000 Hz) is generated. The device records sound amplitude representing the sum of incident and reflected sound. This sum reaches a nadir at a frequency for which the quarter wave length corresponds to the distance from the microphone to the tympanic membrane; at this frequency reflected sound is maximally out of phase with incident sound. We measured this nadir (in decibels) and correlated the decrease in sound level at the nadir with the presence or absence of middle ear effusion. With a diagnosis confirmed by acoustic admittance and pneumatic otoscopy (n = 290), and using a breakpoint of 4.0 dB, the sensitivity was 94.4% and the specificity was 79.2%. Acoustic reflectometry can be portable, results are virtually instantaneous, and the method is reliable independent of age, crying, cerumen, and lack of cooperation from the child.