American journal of diseases of children (1960)
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A 13-year-old boy with a three-year history of an illness characterized by stiff hands, arthralgias in the metacarpophalangeal joints, flexion contractures in all fingers, and thickened skin over his hands, arms, and thighs had an initial diagnosis of juvenile rheumatoid arthritis with dry synovitis. Eosinophilia and a deep-fascial biopsy led to a diagnosis of eosinophilic fasciitis. Prednisone therapy resulted in sustained subjective and objective improvement.
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We retrospectively surveyed records of 153 patients with croup or epiglottitis. Thirty-four children required intubation of the trachea to relieve upper airway obstruction. ⋯ A PaO2 below 50 mm Hg is observed in 38% and pneumothorax in 24% of all reported cases. Supplemental oxygen, positive end-expiratory pressure, mechanical ventilation, and chest tube drainage have prevented death despite these life-threatening complications.
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Coagulation studies were performed on 16 children with gram-negative septicemia without the complications of septic shock, liver disease, malnutrition, or laboratory evidence of classic disseminated intravascular coagulation (DIC). Ten (63%) of the 16 cases were found to have abnormal partial thromboplastin and/or prothrombin times. ⋯ The mechanism that produced this coagulopathy was not known, but evidence was found that suggested that endotoxin may interfere with the vitamin K-carboxylation reaction. The data indicated that abnormal coagulation screening test results in children with gram-negative septicemia were not specific for DIC and that a significant number of patients had a coagulopathy not related to DIC.
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Comparative Study
Preventive care and overall use of services. Are they related?
The relationship between the use of services of children constantly enrolled in a prepaid group practice medical plan for six years and the completeness of their preventive care were examined. Children who were consistently low users of services were more likely to be lacking one or more components of standard preventive care, particularly general health assessments in older children and vision, hearing, and tuberculosis screening in younger children. ⋯ The relationship between low use of services and incomplete preventive care persisted after controlling for the severity of morbidity, although children with more severe morbidity were somewhat less likely to be missing preventive care. Health facilities and practitioners should pay special attention to assessing the need for standard preventive care in children who are infrequent users of services.
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Clinical deterioration has been observed in sick neonates during lumbar puncture. This study was done to determine if hypoxemia occurred during lumbar puncture, if hypoxemia was position dependent, if transcutaneous PO2 (TcPO2) monitoring effected hypoxemia, and what possible mechanisms were involved. Twenty-six neonates received lumbar punctures in either a standard lateral knee-chest position, sitting position, or modified lateral without knee-chest position. ⋯ The time TcPO2 was under 50 mm Hg was greater for standard lateral positions than sitting or modified lateral positions. Increased intraesophageal pressure, in the standard lateral position, suggests extrathoracic compression of the chest by the abdominal contents. We recommend lumbar punctures be done in the sitting or modified lateral position.