Neonatal malaria

Fifteen neonates were diagnosed to have malaria from July 1973 through October 1975. The mothers of these infants were young (mean age 25 years). Malarial parasites were demonstrated in the blood in ten of 15 mothers during pregnancy or puerperium. The age of onset of symptoms in the neonates varied from 6 to 24 days (mean 19 days). Clinical features charcteristic of malaria in early infancy were apathy and failure to suck, particularly marked during periods of high fever and later attended with progressive pallor and splenomegaly. One infant died and the rest 14 were cured wilh chloroquine.     

Effect of a pediatric trauma response team on emergency department treatment time and mortality of pediatric trauma victims

OBJECTIVE: Delay in the provision of definitive care for critically injured children may adversely effect outcome. We sought to speed care in the emergency department (ED) for trauma victims by organizing a formal trauma response system. DESIGN: A case-control study of severely injured children, comparing those who received treatment before and after the creation of a formal trauma response team. SETTING: A tertiary pediatric referral hospital that is a locally designated pediatric trauma center, and also receives trauma victims from a geographically large area of the Western United States. SUBJECTS: Pediatric trauma victims identified as critically injured (designated as "trauma one") and treated by a hospital trauma response team during the first year of its existence. Control patients were matched with subjects by probability of survival scores, and were chosen from pediatric trauma victims treated at the same hospital during the year preceding the creation of the trauma team. INTERVENTIONS: A trauma response team was organized to respond to pediatric trauma victims seen in the ED. The decision to activate the trauma team (designation of patient as "trauma one") is made by the pediatric emergency medicine (PEM) physician before patient arrival in the ED, based on data received from prehospital care providers. Activation results in the notification and immediate travel to the ED of a pediatric surgeon, neurosurgeon, emergency physician, intensivist, pharmacist, radiology technician, phlebotomist, and intensive care unit nurse, and mobilization of an operating room team. Most trauma one patients arrived by helicopter directly from accident scenes. OUTCOME MEASURES: Data recorded included identifying information, diagnosis, time to head computerized tomography, time required for ED treatment, admission Revised Trauma Score, discharge Injury Severity Score, surgical procedures performed, and mortality outcome. Trauma Injury Severity Score methodology was used to calculate the probability of survival and mortality compared with the reference patients of the Major Trauma Outcome Study, by calculation of z score. RESULTS: Patients treated in the ED after trauma team initiation had statistically shorter times from arrival to computerized tomography scanning (27 +/- 2 vs 21 +/- 4 minutes), operating room (63 +/- 16 vs 623 +/- 27 minutes) and total time in the ED (85 +/- 8 vs 821 +/- 9 minutes). Calculation of z score showed that survival for the control group was not different from the reference population (z = -0.8068), although survival for trauma-one patients was significantly better than the reference population (z = 2.102). CONCLUSION: Before creation of the trauma team, relevant specialists were individually called to the ED for patient evaluation. When a formal trauma response team was organized, time required for ED treatment of severe trauma was decreased, and survival was better than predicted compared with the reference Major Trauma Outcome Study population.     

Motion artifact reduction with fast spin-echo imaging

The influence of signal averaging (n), repetition time (TR), and echo delay (TE) on systematic noise (cardiac, vascular, respiratory, and peristaltic ghost artifacts) and statistical noise (thermal effects) was determined in eight healthy volunteers and 57 patients. Systematic noise was the dominant factor degrading abdominal magnetic resonance (MR) images. Signal averaging was the primary determinant of both statistical and systematic image noise, fitting a power function (n)b with b = 0.44 and -0.42, respectively, close to the expected b = -0.5 power function. All types of ghosting showed the same sensitivity to signal averaging. Normalized systematic noise increased slightly with TR (b = 0.16) and increased markedly with TE (b = 0.40). These data indicate that the short TR, short TE technique is a powerful method for reducing motion artifacts on breathhold images and can be combined with signal averaging to further suppress artifacts, improve signal-to-noise ratio, and maximize anatomic resolution.     

Tumor markers in patients with advanced breast cancer as prognosticators: A preliminary study

Summary A retrospective study was performed on 69 breast cancer patients (stage II, N=18; advanced disease, N=51) in order to assess the prognostic value of circulating prolactin (PRL), CEA, CA 15-3, insulin-like growth factor-1 (IGF-1), and epidermal growth factor (EGF) by RIA/IRMA. These markers were compared with short-term prognosis (two years). Significant difference was observed only for PRL (<20.0 ng/ml vs. >20.0 ng/ml), which provide an independent predictor of short-term prognosis in advanced breast cancer.     

Early rectal tube removal for improved patient tolerance during double- contrast barium enema examination

During a five year period, 62 patients each underwent two barium enema examinations. The length of time that the rectal tube remained in place varied in each subject. Early rectal-tube removal resulted in better patient acceptance of the double-contrast barium enema examination.     

Breast hamartomas: variable mammographic appearance

The mammograms of 17 women with pathologically proved breast hamartomas were reviewed. Abnormal masses were detected on 12. Nine women had masses with benign features. Two of these had findings considered classic for hamartoma. In three cases, the appearance of the mass was suggestive of carcinoma. The breasts were very dense in four of five women without detectable mass. The findings suggest that the classic mammographic appearance of breast hamartomas is less common than previously reported, which may be explained by earlier detection of small hamartomas.     

Inferior joint space arthrography of normal temporomandibular joints: reassessment of diagnostic criteria

Inferior joint space arthrograms of the temporomandibular joints of 31 healthy volunteers (62 joints) were obtained to determine normal arthrographic findings. The superior margin of the anterior recess was smooth and flat in 68% of the joints and concave in 32% with the subjects' mouths closed. The concavity was the result of the anterior ridge of the meniscus impinging on the contrast material. The concave impression could be distinguished easily from an anteriorly displaced meniscus on videotaped studies, which demonstrated a smooth transition of contrast material from the anterior to the posterior recess during opening of a subject's mouth. With the mouth open, the anterior recess decreased in size, appearing as a small, crescent-shaped collection of contrast material anterior to the head of the condyle in 52 joints (84%); it remained large in ten joints (16%) at maximal mouth opening. The configuration of the posterior recess was identical to that described previously; however, with the subjects' mouths closed, it was larger than the anterior recess, contrary to most previously reported results.