The Journal of pediatrics
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The Journal of pediatrics · Nov 1994
Comparative StudyAnti-neutrophil cytoplasmic antibodies in children with ulcerative colitis.
Tests that positively identify individuals with ulcerative colitis, distinguishing them from patients with Crohn disease or other causes of colitis, have not been reliable. Genetic predisposition to inflammatory bowel diseases and genetic influence on immune regulation resulted in the clinical evaluation of potential serologic markers. In adults the presence of anti-neutrophil cytoplasmic antibody (ANCA) in serum identifies patients with ulcerative colitis. ⋯ Furthermore, the majority of patients with ulcerative colitis had a perinuclear pattern of these antibodies by indirect immunofluorescence. The combination of a positive ANCA and perinuclear indirect immunofluorescence pattern was 97% specific for ulcerative colitis. We conclude that determination of ANCA is a sensitive and specific clinical test for identification of children and adolescents with ulcerative colitis.
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The Journal of pediatrics · Nov 1994
Case ReportsBronchospasm after intravenous administration of adenosine in a patient with asthma.
We describe a 13-year-old patient with asthma in whom severe bronchospasm developed immediately after the intravenous administration of 12 mg of adenosine. The risk of bronchospasm in patients with reactive airway disease may favor the use of alternative methods for the termination of supraventricular tachycardia.
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The Journal of pediatrics · Nov 1994
Plasma lactate concentration as a predictor of death in neonates with severe hypoxemia requiring extracorporeal membrane oxygenation.
Plasma lactate concentrations have been used as an indicator of tissue hypoxia and as a predictor of the outcome of critical illness in adults. We evaluated the value of plasma lactate levels in predicting death in neonates with severe hypoxemia requiring extracorporeal membrane oxygenation (ECMO). We retrospectively reviewed the medical records in regard to plasma lactate levels and other clinical and biochemical measurements in 28 consecutive neonates requiring ECMO from July 1992 to December 1993. ⋯ An admission plasma lactate concentration of < 25 mmol/L predicted survival with a sensitivity 100%, a specificity 71.4%, and positive and negative predictive values of 91.3% and 100%, respectively. We conclude that plasma lactate levels could be useful in predicting death in neonates with severe hypoxemia requiring ECMO. Further prospective evaluations of the predictive value of plasma lactate levels in sick neonates are required to confirm these initial observations.
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The Journal of pediatrics · Nov 1994
Assessment of ductus arteriosus shunt in preterm infants supported by mechanical ventilation: effect of interatrial shunting.
We studied 51 preterm infants (< 1500 gm) with serial color Doppler echocardiography to determine the impact of incompetence of the foramen ovale on the hemodynamic implications of shunting through a patent ductus arteriosus. Doppler and two-dimensional echocardiographic measures included left atrial/aortic root ratio, right (RVSV) and left ventricular stroke volumes (LVSV), and outputs to determine relative ventricular outputs (RVSV/LVSV) and to calculate the pulmonary/systemic flow ratio (Qp/Qs), the diameter of the color flow Doppler mapping of interatrial and ductal shunts, pulsed Doppler pattern, and velocity of those shunts. The dominant direction of shunting at the ductal and atrial levels was left to right. ⋯ We conclude that atrial shunting has a significant impact on the hemodynamic implications of ductal shunting in many very preterm infants. This renders use of the relative ventricular outputs to calculate Qp/Qs inaccurate as a single measure of shunt size in patent ductus arteriosus. If the shunt is predominantly left to right, the most accurate assessment is provided by color flow ductal shunt diameter.