The Journal of pediatrics
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The Journal of pediatrics · Jun 1978
Neonatal circumcision and penile dorsal nerve block--a painless procedure.
Circumcision is the only surgical procedure, excluding cord-clamping and cutting, which is routinely performed on normal, healthy newborn infants, usually during the first two or three days of life. Apparently no analgesic technique has been described nor suggested in association with neonatal circumcision. This is the first description of a technique of penile dorsal nerve block in neonatal circumcision. In 52 instances using 0.5 ml of 1% lidocaine (Xylocaine) and a 1.2 cm number 27 gauge needle PDNB was successfully and safely introduced with consistent elimination of pain, rendering NC a painless surgical procedure.
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The Journal of pediatrics · Mar 1978
Respiratory obstruction and apnea in infants with bilateral abductor vocal cord paralysis, meningomyelocele, hydrocephalus, and Arnold-Chiari malformation.
This report describes 21 infants and children with bilateral abductor vocal cord paralysis and associated meningomyelocele, Arnold-Chiari malformation, and hydrocephalus. Two life-threatening forms of respiratory distress are distinguished: (1) upper airway obstruction due to bilateral abductor cord paralysis and (2) apnea. ⋯ Ten infants had evidence of aspiration and dysphagia. Vocal cord paralysis, apnea, aspiration, and dysphagia were frequently temporally related to increased intracranial pressure.
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The Journal of pediatrics · Jan 1978
Comparative StudyCardiac output measured by thermodilution in infants and children.
To determine the accuracy and reproducibility of cardiac output determination by thermodilution (COT) in children, simultaneous outputs were measured by the Fick technique (COF) (using measured oxygen consumption) and thermodilution in 26 children, ranging in age from 8 to 86 months, who were undergoing cardiac catheterization. There was excellent correlation between mean output by thermodilution and by the Fick technique: COT = 1.10 COF -- 0.2 l/minute, R = 0.91. ⋯ Serial values of thermodilution outputs were reproducible in each patient with a SD of 5.5%. Our observations indicate that COT is accurate, reproducible, and valuable in the care of critically ill infants and children.
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The Journal of pediatrics · Nov 1977
Randomized Controlled Trial Comparative Study Clinical TrialEffectiveness of low-dose continuous intravenous insulin infusion in diabetic ketoacidosis. A prospective comparative study.
Twenty pediatric patients with diabetic ketoacidosis were randomly assigned in equal numbers to receive insulin either as a low-dose continuous intravenous infusion or as high-dose intermittent subcutaneous injections. Blood was obtained hourly for determinations of total CO2, plasma glucose, and osmolality, and, in previously untreated patients, plasma insulin. Serum values of beta hydroxybutyrate, electrolytes, and acetone were monitored every two hours. ⋯ The incidence and the severity of hypokalemia were increased in the patients receiving subcutaneous insulin. There was less variation in the rate of reduction of plasma glucose in the infusion group. Low-dose continuous intravenous infusion of insulin is at least as effective in treating diabetic ketoacidosis as the traditional high-dose intermittent subcutaneous injection of insulin and offers some definite advantages.
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The Journal of pediatrics · Oct 1977
ReviewCurrent progress in the treatment of the child with cancer.
Treatment for the child with cancer has increasingly been on a rational rather than an empiric basis. An understanding has developed of the importance for determining clinical and laboratory features present at diagnosis as an aid not only to establish a prognosis but also to design specific treatment regimens. A system has been developed for bringing new chemotherapeutic agents into clinical trials as effectively as possible. ⋯ Physicians of different specialty interests have learned to work together to develop coordinated programs of treatment so important to optimal care. By far the most important lesson learned, however, is that cancer in children is not of necessity a fatal disease, even when dissemination has occurred. For the furture, it will be necessary to develop even more effective methods of treatment, and research must provide a better understanding of this disease that may offer the opportunity for prevention, which, after all, is the number one interest of the pediatrician.