Clinical pediatrics
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Clinical pediatrics · Dec 1989
Case ReportsPeripheral limb gangrene following rectal biopsy. Treatment with prostacyclin and exchange transfusion.
After a rectal biopsy, a 3-week-old boy developed centripetally progressive distal limb gangrene. This was accompanied by transient hypertension and high levels of circulating immune complexes. The ischemia was reversed by prostacyclin infusion, oral corticosteroids and multiple exchange transfusions.
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Clinical pediatrics · Nov 1989
Infants with apparent life threatening events. Cardiac rhythm and conduction.
The role of cardiac dysrhythmias in the pathogenesis of Sudden Infant Death Syndrome (SIDS) is uncertain, but there have been several reports of infants with Apparent Life Threatening Events (ALTE) due to significant dysrhythmias. To further characterize the cardiac rhythm and conduction of these "at-risk for SIDS" infants, we performed 24-hour continuous (Holter) electrocardiograms on 100 full term, healthy infants with ALTE. Sixty-two patients (62%) had one or more dysrhythmias on Holter monitor. ⋯ The incidence of ventricular dysrhythmias and long QTc are consistent with previously advanced theories of cardiac electrical instability in some of these patients, but no patient with ventricular dysrhythmias required therapy. The incidence of sinus node dysfunction requiring therapy was 2 percent. Although Holter monitoring of infants with ALTE only infrequently determines therapy, it may provide data linking theories of cardiac etiology of SIDS with actual clinical events.
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Clinical pediatrics · Sep 1989
Toxic epidermal necrolysis. A comprehensive approach. Multidisciplinary management in a burn center.
Toxic Epidermal Necrolysis (TEN) is a life-threatening disorder with reported mortality rates of 25-60 percent in pediatric patients. The authors report on their experience in managing six children using a standardized treatment protocol in the intensive care unit of a regional burn center. ⋯ There was one death in the series, and one child had ophthalmologic complications. Treatment in a multidisciplinary burn center is recommended for children with TEN.
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Clinical pediatrics · Aug 1989
Case ReportsMassive levothyroxine ingestion. Conservative management.
The clinical course of a 29-month-old girl who was referred for evaluation after ingesting ninety 0.2-mg tablets of levothyroxine is reported. Despite an initial thyroxine (T4) level of 282 micrograms/dl and a triiodothyronine (T3) level of 1,837 ng/dl at 48 hours postingestion, her symptoms were mild and included irritability, vomiting, tremor, and tachycardia. Treatment was limited to activated charcoal and propranolol. ⋯ The child's clinical course was benign. Even after massive acute ingestions of levothyroxine, children's symptoms are usually mild and may be controlled with propranolol. This conservative approach should be considered before expensive and potentially dangerous therapies are undertaken.
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Clinical pediatrics · Jun 1989
Case ReportsTherapy of acute bronchospasm. Complicated by lactic acidosis and hypokalemia.
Hypokalemia and lactic acidosis developed following correction of respiratory acidosis in a 5-year-old child who presented with respiratory failure secondary to severe asthma and treated with theophylline, inhaled albuterol, and parenteral methylprednisolone. Calculation of the "anion gap" that provided the clue to presence of lactic acidosis was confirmed by the measurement of serum lactate level.