Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units

Context  

If delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required.     

Schlieren photography study of energy absorption by uric acid nuclei

Previous studies using microfocus x-ray radiography on concentric laminated uric acid calculi following in vitro extracorporeal shock-wave lithotripsy (ESWL) has demonstrated the enlargement of the matrix layers. The Schlieren technique was used to verify the hypothesis that the incident energy would be concentrated in the matrix layers by total internal reflection. Because of the rough surface of the stone, the ultrasonic beam (4 MHz) was incident at various angles. At the critical Rayleigh angle (45.9 degrees +/- 0.5 degrees ), the reflected beam consisted of a spectacularly reflected lobe and a reradiated leaky Rayleigh wave. Different critical Lamb angles, theta(L), of 30.8 degrees, 38.1 degrees and 50.8 degrees (experimental uncertainty 0.5 degrees ) were also determined. Depending on the angle of incidence on the stone surface, a Rayleigh wave can be produced and/or one or more layers, as a whole, are set into vibration (Lamb excitation), with the result that shell-like fragments consisting of one or more layers, break off the stones at sites of weaker bonding, as has been noted in previous in vitro lithotripsy experiments by our group.     

Problems stemming from pregnancy in a woman with phenylketonuria

A normal infant was born to a 25 year-old mother with phenylketonuria who had never been treated. The mother had been fed a phenylalanine restricted diet for 3 months before the beginning of the pregnancy. Dietary control was maintained throughout the whole gestation. The problems of dietary control in a mentally retarded woman are analysed.     

Use of buserelin acetate in an in vitro fertilization program: a comparison with classical clomiphene citrate-human menopausal gonadotropin treatment

A comparison has been established retrospectively between clomiphene citrate-human menopausal gonadotropin (CC-hMG) and buserelin acetate-hMG treatments in in vitro fertilization trials performed over a 3-year period. The analysis of 466 CC-hMG and 319 buserelin acetate-hMG trials shows that buserelin acetate-hMG stimulation generates a greater ovarian response resulting in higher numbers of oocytes being retrieved (6.2 + 3.8 versus 9.3 + 5.2) and fertilized (2.8 + 2.7 versus 4.3 + 3.8). More embryos are thus obtained, allowing a wider choice for intrauterine replacement and cryopreservation. Mean embryonic vitality scores do not differ (4.33 + 1.51 versus 4.44 + 1.54), implying that the embryonic quality remains similar in both treatments. A premature demise of the corpus luteum occurs in a large proportion of buserelin acetate-hMG cycles. However, when suppletive progesterone treatment is given, there is a trend toward a better implantation rate per embryo, and a significantly higher ongoing pregnancy rate is observed in relation to buserelin acetate-hMG treatment (20%) as compared with CC-hMG cycles (14%).     

Oligo-elements of the amniotic fluid from normal, hypotrophic and trisomy 21 fetuses

Oligo-elements concentrations were measured between 16-18 weeks of normal pregnancy in the amniotic fluid of 84 women who delivered children with a normal weight, 16 women who had term delivery of hypotrophic children, and 7 women who delivered trisomic children (5 trisomy 21, one trisomy 18 and one trisomy 10p). Copper, zinc, bromine, lead, rubidium assays were carried out using fluorescence X spectrophotometry with dispersion of energy. The oligo-elements levels are not different in the three groups of amniotic fluid: hypotrophic, trisomic or normal fetuses. These results are compared with those previously reported.     

Prevention of mother-to-child transmission of HIV in developing countries: recommendations for practice. The Ghent International Working Group on Mother-To-Child Transmission of HIV

OBJECTIVES: Different approaches to prevent mother-to-child transmission of HIV are being evaluated in developing countries. The first trials using a short regimen of zidovudine have been successful in Thailand, C?te d'Ivoire and Burkina Faso. International and local strategies are now being considered. The Ghent International Working Group on Mother-to-Child Transmission of HIV developed public health policy options to integrate these interventions into basic and maternal and child health (MCH) services. METHODS: The following tasks were undertaken: a critical review of randomized trials; an international pooled analysis of late postnatal transmission of HIV through breastfeeding; a review of the cost-effectiveness and cost-benefit of antiretroviral prophylaxis; a feasibility assessment of preventive strategies, including a postal survey on HIV voluntary counselling and testing (VCT) of pregnant women; the identification of requirements and research priorities for prenatal, obstetric and paediatric care. These projects provided the background for a three-day workshop in Ghent, Belgium, in November 1997. Conclusions were further refined, based on 1998 research findings. RESULTS: A summary of relevant evidence and ten public health recommendations are reported. VCT for pregnant women, a short regimen of zidovudine together with alternatives to breastfeeding currently represent the best option to reduce vertical transmission in most developing countries. The primary goal of the integrated package supporting these interventions is to alleviate overall maternal and infant morbidity and mortality. CONCLUSION: Prevention of mother-to-child transmission of HIV should now be considered for integration into basic health and MCH services of selected countries, with the involvement of governments and donor agencies.     

Congenital toxoplasmosis presenting as massive neonatal ascites

A preterm infant with isolated transudative ascites caused by Toxoplasma gondii is described. In the absence of obvious congenital malformations, toxoplasmosis should be considered in the differential diagnosis of fetal and neonatal non-immune ascites.     

Endometrial morphology in stimulated in vitro fertilization cycles and after steroid replacement therapy in cases of primary ovarian failure

Endometrial morphology and ultrastructure are studied in 17 spontaneous, 23 stimulated, and 18 artificial cycles in cases of primary ovarian failure. Normal light-microscopic aspect was found, but impaired development of nucleolar channel system and stronger intercellular junction have been observed by electron-microscopic studies in stimulated cycles with relative excess of luteal estrogen. Normal glandular maturation can be obtained in patients with premature menopause, given adequate steroid replacement, but an abnormally dense fibrocytic aspect of the stroma is characteristic of the first treatment cycles.