Antimicrobial prophylaxis for fractured base of skull in children

The details are reviewed of 50 children who were treated over a 10-year period with clinical signs of fractured base of skull. Two patients died early without signs of sepsis-due to the severity of their head injuries. Of the remainder, 23 received antibiotic prophylaxis and 25 did not. One patient from each of these groups developed pneumococcal meningitis, and they were successfully treated. Our results correlate well with those previously published, confirming the low incidence of infective complications with or without prophylaxis. The need to assemble a large enough series to make statistically significant conclusions regarding this infrequent condition is highlighted throughout the literature, which is reviewed here.     

Surgical Management of Marfan Syndrome in Children

Between August 1983 and January 1991, seven patients with Marfan syndrome underwent surgery for severe cardiovascular complications. The mean age at presentation was 5.7 months (range 4 to 9 months) in the infant group (n = 3), and 13.3 years (range 10 to 16 years) in a group of older children (n = 4). The primary indications for surgery in the infant group (performed at a mean of 3 years after diagnosis) were ascending aortic aneurysm with valvar regurgitation in one patient, and severe mitral valve prolapse with regurgitation in two. In the older group, surgical indications (performed at a mean of 2.8 years after diagnosis) were ascending aortic aneurysm with valvar regurgitation in three patients and acute aortic dissection in one. For aortic surgery, a composite valved conduit was used in four patients, and an aortic homograft in one. For mitral valve surgery, mechanical prostheses were used. Ail patients survived the primary operation. Over a mean follow-up of 17.5 patient-years (range 1 to 9 years), two patients in the infant Marfan group went on to further successful surgery (prosthetic mitral valve replacement and aortic root repair with aortic homograft) at a mean interval of 4.3 years after the Initial surgery. Our results suggest that the major cardiovascular risk factors of Marfan syndrome in the young, even in those diagnosed during infancy, have been favorably changed by surgery with an encouraging medium-term outlook. The correct timing of surgery is aided by echocardiography. (J Card Surg 1994;9:50–54)     

石杉碱甲类似物的研究II.N-甲基吡啶酮石杉碱甲类似物的合成

石杉碱甲(1)是从中草药石杉属植物千层塔(Lycopodium serratum Thunb.)中分得的一种高效可逆的乙酰胆碱酯酶抑制剂,临床试验证实它对早老性痴呆症有显著疗效。本文报道N-甲基吡啶酮石杉碱甲类似物2和3的合成。2-甲氧基-5-甲氧羰基-11-亚甲基-5,9-甲撑环辛-7-烯并吡啶(9)在乙腈中用三甲基氯硅烷和碘化钠选择性脱保护以定量的产率得吡啶酮10,再用甲醇钠和碘甲烷甲基化得N-甲基吡啶酮11,11经碱性水解,Curtius重排和氨基的脱保护得N-甲基吡啶酮石杉碱甲类似物2。通过类似的途径从中间体2-甲氧基-5-甲氧羰基-7-甲基-11-酮-5,9-甲撑环辛-7-烯并吡啶(14)合成了类似物3。类似物2和3的乙酰胆碱酯酶抑制活性均低于天然石杉碱甲。     

Using 16O35Cl to correct for chloride interference improves accuracy of urine arsenic determinations by inductively coupled plasma mass spectrometry.

We have observed inaccurate urine arsenic values with the method of isobaric fractionation, which was designed to correct for the 40Ar35Cl interference with 75As quantitation by inductively coupled plasma mass spectrometry. Isobaric fractionation, which is based on ion intensities at m/z 77 and 82, consistently underestimates the 40Ar35Cl interference and overestimates urine arsenic. We present an improved method for identifying the argon-chloride interference. We observed that signal intensities for the species 16O35Cl and 40Ar35Cl are proportional (I75 = 0.0295 x I51 - 14.7, r2 = 0.998; where Ix is the normalized ion intensity at m/z X) in water and urine, over a broad range of chloride concentrations (0-800 mmol/L). The proportionality constant is remarkably stable within a run (mean and SD, 0.0295 +/- 0.0023, based on 10 replicates of five chloride calibrators, 0, 100, 200, 400, and 800 mmol/L). Increased sensitivity (50-fold) for detecting the 40Ar35Cl interference provides improved accuracy for urine arsenic quantitation as demonstrated by a split-sample comparison with graphite-furnace atomic absorption spectrophotometry.     

Preventing child abuse: An experimental evaluation of the child parent enrichment project

Perinatal child abuse prevention projects are increasingly favored but rarely evaluated. The paper describes an experimental evaluation of the Child Parent Enrichment Project (CPEP). Women were referred to the project during or just after pregnancy if identified as at-risk of engaging in child abuse by community professionals. Clients were randomly assigned to CPEP services (n=24) or traditional community services (n=26). CPEP services involved six months of home visiting by paraprofessional women and linkage to other formal and informal community resources. Multivariate Analysis of Covariance on posttest scores, controlling for pretest scores, show advantage for the CPEP group in prenatal care, birth outcomes, better reports of child temperament, and better indicators of child welfare. CPEP mothers tended to report better well-being. No significant differences were demonstrated for levels of formal and informal support. Reports of child abuse were similar for both groups. Consumer satisfaction indicates that clients valued the program. The preliminary results argue for further use and evaluation of perinatal child abuse prevention services.The authors thank Sharon Ikami and CPEP staff and volunteers. Richard P. Barth, D.S.W. is Associated Professor at the School of Social Welfare, University of California, Berkeley. Susan Hacking, Ph.D. was Project Director and Jordana Ash, M.S.W. is Child Welfare Worker, Alameda County Department of Social Services. Funding was provided by Bio-Medical Research Support Grant 2-507-RR07006 Resources from the Division of Research National Institute of Health, the State of California Office of Child Abuse Prevention, and the Office of Human Development Services ACYF, DHHS (Grant #90-CA-0998).