Southern medical journal
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Southern medical journal · Apr 1986
Comparative StudyCorrelation of the one-minute Apgar score and umbilical cord acid-base status.
The one-minute Apgar score has proven useful by ensuring rapid assessment of the neonate, but is often poorly correlated with other indicators of intrauterine well-being. Since fetal asphyxia is directly associated with neonatal acidosis, a low Apgar score in the face of normal pH and base deficit does not indicate an asphyxiated infant. In a study to ascertain the feasibility of combining umbilical artery pH with the one-minute Apgar score for neonatal assessment, umbilical artery pH and Apgar scores were obtained on 212 singleton pregnancies. ⋯ We recommend, therefore, that neonates with a one-minute Apgar score less than 7 have umbilical artery pH determinations to confirm the presence or absence of acidosis. We also recommend that when the pH is less than 7.20, a complete set of gas values be evaluated with that specimen. This information offers more precise confirmation of the diagnosis of fetal distress and neonatal asphyxia, both for treatment and more reliable follow-up data, as well as for medicolegal purposes.
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A patient receiving vancomycin for a serious staphylococcal infection had a lupus-like syndrome characterized by a malar rash, pain and erythema of the cartilage of both ears, and tender erythematous and hemorrhagic lesions of the finger tips. Biopsy and direct immunofluorescence study of the skin showed changes consistent with the diagnosis of lupus erythematosus. The possible development of a drug-induced vasculitis or lupus-like syndrome should be added to the list of rare toxic effects of vancomycin.
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Southern medical journal · Feb 1986
Case ReportsAortic pseudoaneurysm due to ingested foreign body.
We have described a child with pseudoaneurysm of the thoracic aorta caused by an ingested safety pin, who survived this life-threatening injury in which the diagnosis was elusive for four months. Esophageal foreign bodies, especially sharp, pointed ones, can cause such a cardiovascular complication. A high index of suspicion is imperative if the diagnosis is to be made early. Serial chest x-ray films showing an enlarging mediastinal mass should trigger aggressive radiologic evaluation.
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Southern medical journal · Jan 1986
Newborn metabolic screening: a search for "nature's experiments".
The rationale for metabolic screening includes discovery of new diseases, development of treatment methods, determination of the true incidence of disease in order to provide genetic counseling, and relief to the taxpayer when retardation is preventable. The number of diseases for which we can now screen is large and growing and must be periodically reviewed. Physical, cultural, and religious factors affect gene pool mixing, making it impossible to predict a priori what the incidence of a given disorder will be within the population screened. This paper reviews the rationale for establishing neonatal metabolic screening programs and the significance of the information gained.
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Nonaccidental or inflicted burns account for a significant subset of children hospitalized for the treatment of burns and are a form of child abuse. We review our experience with inpatient treatment of pediatric burns and examine the characteristics of patients with accidental and nonaccidental burns. ⋯ Unstable social factors and chronic medical problems were more common among those with inflicted burns. We suggest guidelines to differentiate between accidental and inflicted burn victims.