Treatment and prevention of ophthalmia neonatorum

Question In my office I occasionally see neonates with conjunctivitis. What are the current recommendations for ocular prophylaxis at birth? Do topical antibiotics alone provide adequate treatment of neonatal conjunctivitis? When is systemic therapy indicated?Answer All infants should receive ocular prophylaxis at birth to prevent gonococcal ophthalmia. Neonates presenting with signs of conjunctivitis should have a conjunctival swab sent for Gram stain and culture. If Gram-negative diplococci are present on the Gram stain results, the infants and their parents should be treated immediately for presumed gonorrhea. Infants with chlamydial infection should be treated with oral antibiotics. Most of all other forms of bacterial conjunctivitis can be treated with topical antibiotics, with the exception of Pseudomonas infection. Infants should be followed during their treatment and upon completion of therapy to ensure resolution of symptoms. For cases in which sexually transmitted bacteria are implicated, the mothers and their sexual partners should be treated.     

三叶鼠尾草中小红参醌丙的结构

从三叶鼠尾草(Salvia trijuga Diels)的干燥根中分得9种结晶性成分,经鉴定为铁锈醇(ferruginol)、柳杉酚(sugiol)及系列高级脂肪酸三十四酸、三十酸、二十八酸、十六酸,另两种酸分别为对羟苯甲酸及氨基酸(dl-homoserine),晶Ⅰ为一新化合物,定名为小红参醌丙(trijuganone C),经光谱分析及化学反应推定其结构为15,16-二氢丹参酸甲酯。     

MR imaging of optic pathways in patients with neurofibromatosis

Twenty-one patients with documented neurofibromatosis had MR examinations to evaluate possible intracranial disease. In five cases the indication was a known or suspected optic glioma. Two patients were examined because of a history of seizures; the rest were examined as part of a baseline evaluation. Eighteen patients showed evidence of signal hyperintensity on T2-weighted images. Lesions involved the optic nerves, optic chiasm, optic tracts, lateral geniculate body, optic radiations, basal ganglia, periventricular white matter, cerebellar white matter, and dentate nucleus of the cerebellum. Comparison between MR and concurrent CT scans showed MR to be superior in demonstrating the posterior extent of optic-pathway gliomas. In addition, MR showed focal areas of hyperintensity in the basal ganglia, internal capsule, cerebellum, and/or white matter that were not detected on CT. Although we found MR to be superior to CT in detecting intracranial tumors in patients with neurofibromatosis, and in evaluating the extensive involvement of known lesions, the full clinical implications of our findings remain to be determined.     

Determining disability due to mental impairment: APA's evaluation of Social Security Administration guidelines

OBJECTIVE: APA evaluated the Social Security Administration's (SSA's) medical standards and guidelines for determining disability due to mental impairment to determine how well the standards and guidelines operationalize the statutory definition of disability in a manner consistent with current psychiatric practice. METHOD: Seventy-two psychiatrists were trained in one of two procedures: those in the sequential evaluation condition were trained in the process and forms used by the SSA's reviewing medical consultants, and those in the statutory definition condition were trained in the statutory definition of disability and application of clinical judgment according to this standard. Decisions regarding claimant's ability or inability to work were recorded on an instrument designed for the study. Each condition consisted of 12 panels of three members. They reviewed 732 actual claims for disability benefits. The panelists reviewed claims independently, then rendered panel judgments. Each claim was reviewed by one panel in each condition. RESULTS: The proportion of agreement between conditions for panel decisions (0.77) was higher than chance agreement (kappa = 0.46). The high level of agreement on claims judged to have good medical evidence and on which confident decisions were made (proportion of agreement = 0.96, kappa = 0.78) suggests that disagreements largely reflected ambiguities in application of the standards and guidelines to more complex cases or those with inadequate information. CONCLUSIONS: The SSA's revised medical standards and guidelines reflect clinical decisions about ability to work based on the statute and, with procedural modifications, should be retained. The SSA should be involved in further systematic studies to develop a field of scientific inquiry into disability and psychiatric disorders.     

Pericardial effusion and cardiac hemangioma in the neonate

In the absence of hydrops or sepsis, a pericardial effusion is a rare occurrence in the neonate. We report a case of a neonate with a pericardial effusion in which there was an associated intracardiac hemangioma. Our literature review found 32 cases of pericardial effusion with-out hydrops in infants under 3 months of age; twelve of these cases were associated with intracardiac and pericardial tumors; 20 others were discovered to be randomly associated with other problems.