Predicting low birth weight delivery using maternal nutritional and uterine parameters

At the Institute of Medical Sciences, Banaras Hindu University in Varanasi, India, health workers took anthropometric measurements and hemoglobin level of 196 pregnant women at gestation of 37-41 weeks and of their singleton newborns to detect a combination of maternal nutritional and uterine parameters which could be used to screen mothers at high risk of delivering a low birth weight (LBW) infant ( 2500 g). The maternal anthropometric measurements included pre- and post-delivery weight, height, head and midarm circumference, fundal height, and abdominal girth. Weight, height, head and midarm circumference, and hemoglobin were significantly correlated with birth weight. Pre-delivery weight was better correlated than post-delivery weight with birth weight (r value = 0.4966 vs. 0.3494). The correlation between pre-delivery weight and birth weight remained, even when hemoglobin and one of the uterine parameters were controlled simultaneously. Hemoglobin was an independent significant predictor of birth weight, when all other variables were controlled simultaneously. Both fundal height and abdominal girth were significantly associated with birth weight, when all other variables were controlled simultaneously. Fundal height had a greater difference in means of birth weight than did abdominal girth (960 vs. 871 g). If the fundal height was less than 25 cm, all infants had a LBW. If the fundal height was greater than 35 cm, only one infant had a LBW. The multiple regression equation using pre-delivery weight, hemoglobin, fundal height, and abdominal girth (all independent significant parameters) to estimate birth weight accounted for 70.5% variation. Researchers tested the equation on 118 consecutive full-term singleton newborns. The equation predicted LBW in 32 of the 36 actual LBW deliveries. The estimated birth weights in the 4 actual but missed cases were 2620, 2600, 2566, and 2826 g. This equation can be successfully used to screen pregnant women for LBW.     

Infrared thermometry of newborn infants

An infrared thermometer, the FirstTemp, was tested among newborn infants by comparing tympanic membrane temperature measurements in three operating modes, "Cal-tympanic," "Cal-surface," and "Cor-tympanic," with nearly simultaneous tympanic membrane, rectal, and axillary temperature measurements using other standard methods. The FirstTemp underestimated other measurements of body temperature in the "Cal-tympanic" mode and overestimated them in the "Cor-tympanic" mode. In the "Cal-surface" mode, the First-Temp readings were significantly lower than tympanic membrane temperatures measured with a thermistor probe and electronic thermometer (mean difference 0.2 degrees C) but not significantly different from rectal or axillary temperatures. According to these results, the FirstTemp can be used reliably in the "Cal-surface" mode but not in the "Cal-tympanic" or "Cor-tympanic" mode. Its speed and ease of operation offer significant advantages over traditional clinical methods of temperature measurement.     

Family history of cancer and autoimmune disease and risk of leukemia in infancy: a report from the Children's Cancer Group (United States and Canada)

Objectives: As there are some suggestions that a family history of cancer or autoimmune disease might be associated with an increased risk of leukemia in children, we explored this possibility using data from a matched case-control study conducted by the Children's Cancer Group. Methods: We compared the family history of cancer and autoimmune diseases of 302 infant leukemia cases (diagnosed within the first 18 months of life) with that of 668 individually matched controls in the United States and Canada. Results: Although not significant, cancer history in parents was found to be associated with an elevated risk of infant leukemia (odds ratio [OR] = 1.4, 95 percent confidence interval [CI] = 0.6-3.6), predominantly acute myeloid leukemia (AML) (OR = 2.2, CI = 0.6-9.0). Cancer history among second-degree relatives was also related to a non-significantly elevated risk of AML. Family history of autoimmune diseases, on the other hand, was generally not found to be related to the risk of infant leukemia. Conclusion: This study provided no strong evidence that family history of cancer or autoimmune disease is a major risk factor for infant leukemia.     

Surgical complications and their management in a series of 300 consecutive pediatric cochlear implantations.

OBJECTIVE: To report the short- and long-term complications encountered in a large number of consecutive children undergoing implantation in a single center. The current study also describes the management and sequelae of each complication. STUDY DESIGN: Prospective study assessing the surgical findings and complications of deaf children undergoing implantation. SETTING: Pediatric tertiary referral center for cochlear implantation. PATIENTS: The present study includes 300 consecutive children undergoing implantation, with a mean age at implantation of 5.1 years, ranging from 1.3 to 16.9 years. Of these children, 196 (65%) had congenital deafness of unknown cause. The commonest known cause was meningitis (73 of 300 [24%]) followed by congenital cytomegalovirus infection (17 of 300 [6%]). Children have been followed up regularly after implantation, typically at yearly intervals after the first year. The mean duration of follow-up at the time of the study was 4 years (range, 0.1-14 yr). RESULTS: There were no major perioperative (within 1 d after surgery) or major early postoperative (within 1 wk after surgery) complications. In the same periods, there were 19 and 15 minor complications, respectively. These complications (e.g., eardrum perforation, hematoma, flap swelling, wound infection, temporary facial weakness) settled with conservative treatment or minor intervention. With regard to the late surgical complications (>1 wk after surgery), there were 7 major (e.g., severe flap infection requiring explantation, cholesteatoma, persistent eardrum perforation) and 14 minor complications (e.g., mild flap infection, flap swelling, hematoma). A number of complications were encountered even 14 years after the original operation, and some of them needed repeated interventions, highlighting the importance of long-term follow-up. However, most of the complications occurred very close to the surgical procedure (<1 yr). CONCLUSION: An overall rate of 2.3% for major surgical complications and an overall rate of 16% for minor surgical complications suggest that cochlear implantation is a relatively safe surgical operation in experienced centers. Most surgical complications are minor and can be managed with conservative treatment or minor surgical intervention. However, meticulous attention to surgical detail, especially handling soft tissues and leaving the posterior canal wall intact, and long-term follow-up are of paramount importance in minimizing the incidence of surgical complications.     

Computed tomography diagnosis of tracheobronchopathia osteochondroplastica

Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease characterized by the presence of osseous and cartilaginous submucosal nodules projecting into the tracheobronchial tree. Most cases are asymptomatic and discovered incidentally at post‐mortem. We identified a case of TO on thoracic spiral CT and confirmed the diagnosis on bronchoscopy. This article reviews the imaging characteristics of TO, and shows the 3‐D virtual bronchoscopic and multiplanar reconstruction appearances of TO.     

Diagnosis of pulmonary embolism: Ventilation perfusion scintigraphy versus helical computed tomography pulmonary angiography

The present study compared the accuracy of ventilation perfusion scintigraphy (VQS) and CT pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism. This was a prospective observational study of 112 patients with suspected pulmonary embolism (PE) who could be studied with both investigations within 24 h. Results were compared to final diagnosis at completion of 6-month follow up, using receiver operating characteristic (ROC) analysis. Pulmonary embolism was diagnosed in 27 referred patients (24%). The sensitivity and specificity of VQS and CTPA were similar to that reported from the literature. A normal VQ scan had the highest negative predictive value (100%), while a high-probability VQ scan had the highest positive predictive value (92%). There was no overall difference (area under the ROC curve (AUC)) between VQS (AUC (95% CI) = 0.82 (0.75,0.89)) and CTPA (AUC = 0.88 (0.81,0.94)) for the diagnosis of PE. Among patients with abnormal chest X-rays, CTPA (AUC 0.90 (0.83,0.97)) appeared somewhat better than VQS (AUC 0.78 (0.68,0.88)) but this difference did not reach statistical significance. In this instance, CTPA is at least as accurate as VQS and may provide an opportunity to make alternative diagnoses.