A simple estimate of glomerular filtration rate in full-term infants during the first year of life

An estimate of glomerular filtration rate has been derived for children from body length (L, in centimeters) and plasma creatinine (Pcr, in milligrams per deciliter): GFR = 0.55 L/Pcr. The near universality of this estimate in children led us to seek a similar formula for estimating GFR in full-term infants during the first year of life. We measured Pcr in 137 healthy infants and performed creatinine clearance (Ccr) studies in 63 of them aged greater than or equal to 5 days. Beyond the first week, Pcr averaged 0.39 +/- 0.01 (0.10 SD) mg/dl. The estimate of GFR from 0.55 L/Pcr overestimated Ccr by 24% (P less than 0.001). Based on the calculation of a new constant from Ccr X Pcr/L, GFR was more accurately estimated from 0.45 L/Pcr (mean difference of Ccr - 0.45 L/Pcr = -0.4 +/- 3.7 (SE) ml/min X 1.73 m2) in full-term infants between 1 and 52 weeks of age. Because the constant 0.45 and Pcr do not change significantly during this period, GFR can be approximated at the bedside from body length of the healthy full-term infant (GFR = 0.45 L/0.39 = 1.1 L).     

Iron deficiency in infants: the influence of mild antecedent infection

In this study of 467 healthy term infants seen for routine 1-year health maintenance examination, we determined the influence of mild prior infection on the concentration of hemoglobin and other laboratory evidence of iron deficiency. In addition we studied the Hgb response in 261 infants randomized to receive a 3-month course of treatment with either iron or placebo. Infants who had had one or more clinic visits because of infection during the previous 3 months or who were reported as not being entirely well during the past month or who had an elevated sedimentation rate were more likely to have anemia or "low normal" Hgb, higher erythrocyte protoporphyrin and serum ferritin values, and lower serum iron concentration than infants who had been well. Hgb response greater than or equal to 1 gm/dl after iron treatment occurred more commonly in infants who had had prior visits because of infection. The results indicate that upper respiratory and other mild antecedent infections commonly predispose to iron deficiency (probably because of a decrease in iron absorption).     

Robotic-Assisted Laparoscopic Cervicovaginal Myomectomy

Study Objective

To illustrate a robotic-assisted laparoscopic resection for cervicovaginal myomectomy.

The effect of stimulus significance on relatively sustained (tonic-like) and relatively transient (phasic-like) aspects of electrodermal, heart rate, and eyeblink response

To examine the influence of stimulus significance on more sustained as well as transient aspects of electrodermal, cardiac (HR), and eyeblink response, a 21-sec tone was sounded in one ear or the other. A click occurred during many tones, and a light followed offset by 9 sec. Four groups were studied: one pressed a pedal immediately on hearing any click; another only on click during tone in a specified ear; a third also responded only to the specified ear, but withheld press until the light; a fourth listened without any response. Results confirmed the important role of stimulus significance in each system whether between- or within-subject comparisons were made. Sustained responses were seen only when a significant signal was sought, involving in each case sustained HR deceleration, slowed blink rate, and heightened electrodermal level. Transient response to click and light also appeared only when there were significant signals. Response to tone-onset gave more ambiguous results. ANOVAs of response magnitude suggested that onset of nonsignificant tones might have elicited ORs, while binomial tests indicated these were not elicited with better than random frequency anywhere but on those trials occurring more frequently at the experiment's onset. Interpretations consistent with both the significance hypothesis and with a distinction between automatic and voluntary ORs can be made only here. Motor response had no effect on electrodermal or eyeblink response, and on HR was associated only with increased acceleration 1-2 sec after pedal-press. Studies using small motor responses to establish stimulus significance are therefore not likely to be substantially biased by the response itself.     

The treatment of handwriting anxiety by an in-vivo desensitization procedure

A woman with a 50-year history of intense handwriting anxiety was treated wwith an in-vivo desensitization procedure. The technique was an adaptation of a method described by Janet in 1925. After only six sessions the subject was able to write in front of strangers without anxiety. Treatment effects were maintained at six month follow-up.     

Peritonitis in cirrhotic patients with LeVeen shunts

Six cirrhotic patients are described in whom peritonitis developed from 10 days to 15 months after the insertion of a LeVeen shunt. The presenting clinical features of fever, increasing ascites and deterioration in mental status resembled those previously reported for cirrhotic patients but with spontaneous peritonitis without shunts. Important differences were observed, however, in microbiology, incidence of bacteremia and therapy. Staphylococcus aureus, a rare cause of spontaneous peritonitis, was found in one half of our cases, suggesting that perioperative contamination during shunt placement was an important etiologic factor. All six had concomitant bacteremia which may be attributable to the direct peritoneal-venous connection. Appropriate systemic antimicrobial therapy without shunt removal failed to eradicate the infection irrespective of the patency of the shunt or absence of inflammation at the sites of insertion. Recommended treatment for suspected peritonitis in patients with shunts is systemic antimicrobial therapy with an agent active against staphylococci plus an aminoglycoside, followed by removal of the shunt if the diagnosis is confirmed.