Sleeping position for infants and cot death in The Netherlands 1985-91

Until the early 1970s the traditional sleeping position for Dutch infants was not prone. After a much publicised lecture in October 1987 on the possible relation between sleeping prone and cot death, the fairly new habit of placing infants prone is being replaced by more traditional positions. The decrease in the prevalence of the prone sleeping position has been documented in six studies. Since 1987 the incidence of registered cot deaths has decreased from 1.04/1000 live births in 1986 to 0.44 in 1991; the real decrease of sudden unexpected death in infancy, however, is greater.     

A survey of basic resuscitation knowledge among resident paediatricians

A telephone questionnaire was undertaken to evaluate the knowledge of resident paediatricians on the subject of the basic resuscitation of the acutely sick child. The questionnaire was targeted at 88 resident paediatricians in hospitals accepting paediatric emergencies in four health regions. Outcome was measured as a correct response to questions based on several emergency scenarios and on the confidence expressed of basic resuscitation knowledge. The subject of emergency management of the child with a compromised upper airway was poorly answered with 40/73 (55%) resident paediatricians suggesting an incorrect endotracheal tube size for an 8 year old child. Fluid management was also deemed unsatisfactory with only 36/73 (49%) providing adequate transfusion secondary to haemorrhagic shock. In addition only 19/73 (26%) mentioned the intraosseous route as a means of obtaining vascular access in a child in extremis. Confidence of the knowledge of basic resuscitation of children was low among resident paediatricians with only 30/73 (41%) expressing confidence and 69/73 (94%) expressing a desire for more formal training in paediatric resuscitation. Resident paediatricians are usually the key personnel in the management of very sick children. This survey demonstrates a low level of basic resuscitation knowledge among resident paediatricians of all grades that must be remedied at a local and national level.     

Psychological response to growth hormone treatment in short normal children

Indian childhood cirrhosis (ICC) is an almost uniformly fatal disease whose outcome may be modified with penicillamine if given at a sufficiently early stage. Twenty nine children with ICC seen in Pune, India, in 1980-7, who had survived at least five years from onset of penicillamine treatment, were reviewed aged 6.3 to 13 years. They were assessed clinically, biochemically, histologically, and by duplex Doppler ultrasound examination. None had symptoms suggestive of liver disease. There were no toxic effects of penicillamine other than asymptomatic proteinuria. Hepatosplenomegaly reduced significantly and liver function tests returned to normal in all. In four children, significant hepatosplenomegaly was associated with an abnormal duplex Doppler hepatic vein flow pattern and micronodular cirrhosis on biopsy. Clinical findings, growth and development, and ultrasound examination were normal in the remainder. Review of serial liver biopsy specimens showed a sequence of recovery from ICC through inactive micronodular cirrhosis to virtually normal histological appearances. The four children who still have micronodular cirrhosis beyond four years from onset remain on penicillamine treatment. In the others penicillamine was stopped after 1-7 (mean 3.5) years without relapse, strong evidence that ICC is not due to an inborn error of copper metabolism.     

6Effect of a water load test on gastric myoelectrical activity and upper gastrointestinal symptoms in patients with nausea and vomiting of pregnancy

Nausea and vomiting of pregnancy (NVP) is a common syndrome in which symptoms predominate in the first trimester of pregnancy. Symptoms range from mild to severe and afflict up to 80% of pregnant women. The underlying mechanisms of NVP remain poorly understood. Provocative gastric function testing has not been performed in these patients. Aims: The aim of this study were to determine the effects of the water load test (WLT) on gastric myoelectrical activity, nausea, and other upper gastrointestinal symptoms in pregnant women. Method: 46 women with NVP were studied prospectively. Gastric myoelectrical activity was recorded throughout the study by electrogastrography (EGG). A 15 min baseline period was followed by a WLT during which patients ingested water until full over a 5 min period. After the WLT, an additional 30 min of EGG was recorded. EGG responses were categorized into four groups: normal (2.5–3.7 cpm), bradygastria (1.0–2.5 cpm), tachygastria (3.7–10.0 cpm), and mixed gastric dysrhythmia (tachygastria and bradygastria). Nausea, bloating, stomach fullness, and abdominal discomfort were recorded before, and 10, 20, and 30 minutes after the WLT on 100 mm visual analogue scales. Results: In response to the WLT, 14% of the women exhibited normal EGG responses, while significantly more (86%) exhibited gastric dysrhythmias (p < 0.01). Of the dysrhythmic EGG responses, 57% were tachygastria, 11% were bradygastria, and 18% were mixed gastric dysrhythmia. Patients with tachygastria ingested less water (338 ml) than patients with normal (371 ml), bradygastria (415 ml), or mixed gastric dysrhythmia (394 ml) patterns, but the differences were not statistically significant. 46% of the women reported nausea at baseline; significantly more women (72%) reported nausea after the WLT (p < 0.05). At 20 min after the WLT, a significant, direct relationship was observed between nausea severity and tachygastria (p < 0.05). The other upper gastrointestinal symptoms were not significantly increased by the WLT. Conclusions: (1) 86% of the pregnant women in this sample developed gastric dysrhythmias in response to the WLT. (2) Tachygastria was the most common dysrhythmia, and increased tachygastria was correlated with increased nausea. Gastric dysrhythmias are evoked by the WLT in women with NVP, suggesting these dysrhythmias have a pathophysiological role in the mechanism of NVP, and are a target for future therapies.     

经前方颈椎体切除入路切除椎管内肿瘤一例及文献复习

后方入路对某些位于脊髓腹侧肿瘤的显露与切除仍有困难,而前方入路可能更适宜这种病例。笔者经前路切除颈椎管内肿瘤1例,结合文献复习报告如下。     

‘Stalkitis’ in a pregnant 32-year-old woman: A rare cause of diabetes insipidus

A case of lymphocytic infundibulo-neurohypophysitis (LINH) or ‘stalkitis’ in a 32-year-old woman who presented with diabetes insipidus (DI) during pregnancy is reported here. The diagnosis was made with MR imaging. The clinical and radiological features of this rare disorder and the differential diagnosis of infundibular mass lesions are discussed. The differentiation from lymphocytic adenohypophysitis (LAH) is made. No improvement of the DI accompanying LINH is achieved with trans-sphenoidal surgery. Hence, recognition of typical cases with MR imaging and appropriate medical management avoids unnecessary neurosurgery. This is the second reported case of LINH associated with pregnancy and may suggest an association.     

Leber’s idiopathic stellate neuroretinitis: Differential diagnosis and approach to management

Background: Leber’s idiopathic stellate neuroretinitis (LISN) is a relatively uncommon clinical entity that is characterized by optic disc oedema and associated macular hard exudates. A broad range of causes can produce such a fundus appearance. Methods: The clinical experience of the authors is combined with a review of the pertinent literature to describe the features of LISN and its differential diagnosis. Conclusion: A knowledge of the potential causes of neuroretinitis is important in order to formulate an effective management strategy.