Stress at three‐month immunization: Parents’ and infants’ salivary cortisol response in relation to the use of pacifier and oral glucose

The aims of the present study were to investigate (1) whether the salivary cortisol response could be dampened during a routine three‐month immunization if the infant received sweet‐tasting solution in combination with a pacifier and (2) stress experienced by parents during immunization of the infant. Ninety‐eight infants were included into one of four intervention groups: ‘glucose and pacifier’, ‘water and pacifier’, ‘glucose’, or ‘water’. Saliva was collected before and 30min after the immunization. Infants’ crying‐time and parents’ self‐reported stress (VAS) were measured before and after immunization. Infants in the ‘pacifier and glucose’ group had a significantly smaller change in salivary cortisol than infants in the other groups (F_3,72=3.1, p<0.05). In the ‘glucose and pacifier’ group the median salivary cortisol levels decreased 33% after the immunization. In the ‘water and pacifier’, ‘glucose’, and ‘water’ group median cortisol increased with 50%, 42%, and 8%, respectively. No significant differences in crying‐time were observed between the intervention groups. If the infant cried before the immunization, the crying‐time during the immunization was longer (p<0.01) and cortisol increased more (p<0.05). Median cortisol levels for parents decreased after the immunization (p<0.01). Median VAS increased 50% (p<0.0001) after immunization. First time parents rated higher stress on VAS before immunization (p<0.01). Parents’ change in cortisol and VAS were significantly related to infants’ crying time. In conclusion, the combination of oral glucose and pacifier dampen infants’ salivary cortisol in response to the three‐month immunization.     

Hemobilia in childhood

During a 10-year period we have encountered three cases of hemobilia among children after blunt abdominal trauma. All patients had the classical symptoms with varying degrees of severity. One of the patients, a 5-year-old boy, had several episodes of severe gastrointestinal bleeding, abdominal pain, and jaundice during a 2-month period. He was treated with selective arterial embolization of the left hepatic artery. The symptoms ceased instantly, and the patient has remained healthy during an observation period of more than 2 years. In cases of hemobilia, selective arterial embolization is a safe method with no serious complications. Arterial collaterals develop very quickly and the risk of liver dysfunction is small. We suggest that embolization of hepatic arteries may be the treatment of choice even in small children with hemobilia.     

Arterial segmental vasoconstriction in hypercholesterolaemic patients

Regular, wave-like constriction in medium-sized arteries, arterial segmental vasoconstriction (ASV), has been observed at arteriography and described by many authors. We found ASV in arteriograms of the superficial femoral artery in 13 of 107 hypercholesterolaemic patients, enrolled in the Probucol Quantitative Regression Swedish Trial (PQRST). The arteriograms were digitized and studied with a quantitative computer-assisted technique. The frequency of ASV was higher than has been reported earlier in clinical materials, possibly because of an increased vasoreactivity in hypercholesterolaemia, as recently observed experimentally. The ASV patients were, on average, younger, had lower blood pressure and less atherosclerosis, than the non-ASV patients. ASV was not found in any of the 19 patients in the material who either had symptoms of peripheral vascular disease or arteriographically verified arterial occlusions. No significant correlations with smoking habits or serum cholesterol levels were found. A computer-based index of ASV and measurement of ASV wavelength are discussed.     

Assessment of lung water content by roentgen videodensitometry

In 17 anesthetized and mechanically ventilated pigs, different degrees of lung injury were induced by iv infusion of oleic acid (mean dose 0.1 ml/kg). The change in radiologic density of the chest was measured by a videodensitometer before and 4 h after oleic acid infusion. The lungs were then removed for determination of the wet/dry weight ratio (WW/DW). The change in radiologic density was significantly correlated to WW/DW (r = .87) and to the changes in end-inspiratory pressure (r = .80), mean pulmonary arterial pressure (r = .77) and venous admixture (r = .79), but not to changes in the oncotic-hydrostatic pressure gradient of the lungs (r = .46). Roentgen videodensitometry appears to be a useful method for assessing changes in extravascular lung water content.     

Renal haemodynamics before and after splanchnic block in patients with hypertension

In eighteen patients with hypertension of presumed renal origin the haemodynamics of the kidney were studied by arterial pressure recording, blood flow measurement and selective arteriography before and after a splanchnic block. The material was divided into kidneys with and kidneys without arterial stenosis. In these patients with hypertension a positive correlation was found between mean arterial pressure and renal vascular resistance both before and after the splanchnic block. In patients with renal arterial stenosis the change in relative renal vascular resistance was negatively correlated to the initial resistance, implying that in kidneys with a high initial vascular resistance the resistance decreased to a relatively greater extent than in kidneys with a low initial resistance. At high blood pressures ischaemic areas in the kidney were found. The volume of these areas is dependent upon sympathetic tone, such that a high sympathetic tone results in ischaemia of a larger volume of the kidney. This applies both to kidneys with and to those without arterial stenosis. The results of this investigation thus support the assumption that in the presence of hypertension a kidney is under the control of a sympathetic tone that may form a part of the pathogenetic process in hypertension.     

Multiple endocrine neoplasia type 1: a 10-year prospective screening study in four kindreds.

A total of 80 individuals in 4 kindreds with multiple endocrine neoplasia type 1 (MEN 1) have been subjected to repeated biochemical screening during a 10-yr period with the principal aim being to analyze characteristics of the developing pancreatic lesion. Age at presentation of the MEN 1 trait averaged 18 yr in 7 previously unaffected individuals, and this effect of the screening procedure represented a lowering by almost 2 decades. Pancreatic endocrine involvement was recognized at a mean age of 25 yr and constituted the presenting lesion in a majority of the patients. A standardized meal test and basal values of serum pancreatic polypeptide, insulin, proinsulin, and gastrin were the most efficient markers for the pancreatic lesion and preceded signs of pancreatic tumors upon radiological examinations by a mean of 3.5 yr. A 75% penetrance of the islet cell disease and 90% for primary hyperparathyroidism within the affected individuals equalled the prevalences reported in autopsy studies. Two of the kindreds showed signs of intrafamilial homogeneity with respect to the profile of peptide excess (P less than 0.05) and considerable discrepancy in the malignant potential of the pancreatic lesions. The results of early detection and surgical intervention of the pancreatic tumors in MEN 1 suggested an impact on morbidity, while any effect on the mortality of these individuals remains to be clarified.     

Phlebographic evaluation of nonthrombotic deep venous incompetence: new anatomic and functional aspects

The anatomy, valvular function, and reflux patterns in the deep veins of the lower extremities were studied by ascending and descending phlebography in 126 limbs with nonthrombotic deep venous incompetence. The most common patterns were isolated reflux in the superficial femoral vein (51%), and combined reflux in the superficial femoral and the deep femoral veins (44%). Isolated deep femoral vein reflux occurred in 5%. As the degree of reflux in this vein varied considerably, a grading system for classification of deep femoral vein reflux was proposed. Depending on variations in the deep femoral vein anatomy, four different patterns could be distinguished. This study demonstrated that contrast filling of the deep femoral vein during ascending phlebography may indicate the presence of reflux in this vein. Complete visualization of the deep femoral vein is a new diagnostic sign that strongly correlates (p less than 0.001) with reflux in the deep femoral vein. The mean number of valves in the superficial femoral vein was reduced with increasing degree of reflux compared with a reference group consisting of 41 extremities without reflux. The diameter of the popliteal vein was significantly increased in the presence of pathologic reflux, which may indicate that vein wall dilation is a major cause of primary nonthrombotic deep venous incompetence.