Enteral drug administration practices: report of a preliminary survey

This study was initiated to determine whether there is sufficient variation in enteral drug administration practices in hospitalized pediatric patients to result in adverse therapeutic consequences. A survey was developed and administered to nurses from three pediatric and six general hospitals. A total of 317 pediatric nurses responded. Results of the survey confirmed that the primary responsibility for administering enteral medications resides with the nurse. It also documented that many elements in the administration of enteral medications vary significantly among nurses, although nursing personnel expressed confidence in the efficacy of their individual drug administration techniques. Further quantitative evaluations of the efficacy of practices of enteral drug administration must be performed before meaningful standardization of drug administration techniques can be accomplished.     

Quantitative bacterial flora of acute appendicitis.

A quantitative bacteriological study of the appendix wall of 43 children admitted to this unit showed no significant differences between the flora of the histologically normal and acutely inflamed appendices. Bacteroides species, Escherichia coli, and streptococcal species were the commonest organisms isolated and were found in counts of 10(3) to 10(8) organisms per gram of tissue. Bacteroides species were most commonly the dominant flora in both normal and inflamed appendices. The lack of increased counts of organisms in acute inflammation of the appendix suggests an unfavourable environment to bacterial proliferation making primary bacterial infection an unlikely aetiological factor in the pathogenesis of appendicitis.     

Hormone study in a case of Klinefelter syndrome with an isochromosome Xq

We investigated the endocrine function of a patient with Klinefelter syndrome in which the extra chromosome was an isochromosome Xq. This man was azoospermic but with normal secondary sex characteristics; smallness of the testes was the only abnormal physical finding. High follicle-stimulating hormone (FSH, 70 mIU/mL) and moderately elevated luteinizing hormone (LH, 40 mIU/mL) were found; the FSH and LH response to LH-RH was exaggerated. Androgen and estrogen levels were normal. The insulin test (measure of glycemia, growth hormone, and corticol) and the test with TRH (measure of TSH and prolactin) gave normal results. We conclude that the presence of additional long arms of the X chromosome is sufficient to cause Klinefelter syndrome and that the presence of two extra Xq does not intensify the degree of androgenic insufficiency.     

Interposition of the gallbladder — or the absent common hepatic duct and cystic duct

Interposition of the gallbladder is a rare anomaly, but its diagnosis is important since it represents a surgically correctable cause of jaundice. The patients present with jaundice, abdominal pain and sometimes an enlarged gallbladder. Radiological diagnosis may be difficult since the condition may be mistaken for a choledochal cyst, hydrops of the gallbladder or Caroli's disease. The ultrasound, cholangiogram and surgical findings of dilated intrahepatic ducts adjacent to a normal or enlarged gallbladder with no dilatation of the common bile duct are presented in two children with this condition.     

Morbidity after percutaneous liver biopsy.

The safety of percutaneous liver biopsy with a 1.2 mm Menghini needle in infants aged one year or less was investigated. One hundred and eighty four procedures performed from 1975 to 1985 were reviewed. There were no deaths or major complications within 48 hours associated with the procedure. In five instances specific complications occurred: a drop in haemoglobin concentration (three), transient hypotension (one), and haematoma at the biopsy site (one). The result of liver biopsy was diagnostic in 83% of cases, compatible with unspecified metabolic disease in 8%, and normal or not diagnostic in 9%. This study suggests that percutaneous liver biopsy can be performed with relative safety in small infants if coagulation is normal and there are no major contraindications, and the results yield important diagnostic information which cannot be obtained using less invasive procedures.     

Acute peritonitis after minilaparotomy sterilization. A case report

The first reported case occurred of acute peritonitis secondary to a wound infection after minilaparotomy sterilization. The patient's dramatic presentation required a complete exploratory laparotomy.     

Airway management in Hallermann-Streiff syndrome

Hallermann-Streiff syndrome and other craniofacial anomalies predispose patients to airway emergencies. Anatomic abnormalities may render both intubation and tracheotomy unusually difficult. It is important for the otolaryngologist to be familiar with the special difficulties and hazards associated with these malformations in order to ensure optimal airway management.     

Urinary tract infection in infants with unexplained fever: a collaborative study

Nine centers collaborated to determine the rate of urinary tract infection in infants with unexplained fever, to determine whether the rate is higher in febrile infants than in asymptomatic infants, and whether the yield justifies urine cultures in febrile infants. Urine cultures were done in 501 infants 0 to 2 years of age. The rate of confirmed urinary tract infections in the 193 febrile infants was 4.1%. All infections were in girls, with a rate of 7.4%. The rate of confirmed urinary tract infections in the 312 asymptomatic infants was 0.3%; again, all infections were in girls, with a rate of 0.7%. The rate in febrile girls was significantly higher than the rate in asymptomatic girls (P less than 0.01). The data support the advisability of culturing the urine of infant girls with unexplained fever.