Congenital Syphilis in Newborn

In six cases of congenital syphilis in newborn at Los Angeles County-USC Medical Center over a seven-month period the clinical findings fell into two categories related to the time of onset of symptoms. Infants ill in the nursery presented evidence of transplacental infection; infants who became ill later showed the “classic” findings of rash, rhinorrhea and pseudoparalysis.No single clinical symptom was present in all cases but all symptomatic infants had radiographic evidence of bone disease. Respiratory distress was present at the onset of symptoms in three of four infants with neonatal disease, and all three had evidence of interstitial pneumonia in chest radiographs.Serologic testing may be difficult to evaluate in the newborn period, but more recent and specific tests are helpful in diagnosis. Penicillin remains the drug of choice. The only death occurred at five hours of life in a premature infant. Growth and development in surviving infants appeared normal.     

Neonatal Respiratory Distress: Experience at The Hospital for Sick Children,Toronto, 1960-1961

Four hundred and thirty infants selectively referred to the Newborn Unit of The Hospital for Sick Children, Toronto, with the symptom of respiratory distress, were reviewed. There were 142 cases of the “idiopathic respiratory distress syndrome” (IRDS), of which 67 were fatal. The remainder included 100 cardiac (76 deaths), 63 extra-pulmonary (28 deaths) and 109 other specific pulmonary conditions (54 deaths). Of the 109, half were due to massive aspiration. Serial observations and radiographs led to correct clinical diagnosis in 85% of necropsy-proved cases of IRDS and in a comparable proportion of all other conditions. The incidence and mortality rate of IRDS were twice as high in males as in females. A significant number of premature infants have transient respiratory distress after birth, and diagnostic criteria for inclusion in any study should be defined in detail. This study emphasized the large contribution of disorders of the respiratory and cardiac systems to neonatal mortality and led to the formation of a special department for intensive care and research in these conditions.     

CHOLEDOCHOLITHIASIS—Correlation of Preoperative with Operative and Postoperative Data to Enhance Diagnostic Insight

One hundred cases of common bile duct explorations were reviewed in an attempt to obtain information that might give insight into the diagnosis and definitive treatment of choledocholithiasis. Fifty of the hundred patients had common duct stones. Correlations were made between the incidence of choledocholithiasis as proved at operation, and the following factors: Kind and number of choledochal exploratory criteria used, the clinical diagnosis of common duct stones, and the pathologic features of gallbladders removed.The incidence of stones was statistically related to aging.The most frequent choledochal exploratory criteria were common duct dilatation or thickening (63 cases) and history of jaundice (50 cases).The most reliable single criterion in “diagnosing” common duct stones was palpable common or hepatic duct stones, the diagnosis having been correct in 15 of 17 such cases.The most reliable combination of criteria was a history of jaundice, plus palpable stones, with correct diagnosis in all such cases.The clinical diagnosis of choledocholithiasis was correct in only 17 per cent of cases.The correlation of the incidence of common duct stones with the degree of gallbladder disease—that is, acute or chronic—did not provide information that might be helpful in diagnosing choledocholithiasis.The incidence of proven retained common duct stones was 3 per cent, the non-fatal postoperative complication rate was 21 per cent and operative mortality was 1 per cent.     

301例早产儿视网膜病变筛查结果及其高危因素分析

目的:调查早产儿视网膜病变(ROP)的发生情况并分析其高危因素。方法:选取2017年6月至2018年6月在我院进行眼底检查的301例早产儿,依据《早产儿治疗用氧和视网膜病变防治指南》和《中国早产儿视网膜病变筛查指南》对早产儿进行筛查和随诊,同时收集早产儿及其母亲的相应病历信息,采用多因素Logistic回归分析分析ROP的高危因素。结果:301例早产儿中,共检出ROP患儿43例,其中须接受治疗的患儿13例,所有患儿经过2-6个月的治疗和随诊后均好转。围产因素中,胎龄小、出生体重低、吸氧、输血、有急性呼吸窘迫综合征(ARDS)的早产儿ROP检出率更高(均P0.05);母体因素中,多胎分娩的早产儿ROP检出率高于单胎分娩的早产儿(P0.05)。Logistic回归分析显示,胎龄小、出生体重低、吸氧、输血和有ARDS为早产儿ROP的高危因素(P0.05)。结论:早产儿ROP发病率较高,胎龄小、出生体重低、吸氧、输血和有ARDS是其高危因素,在临床实践中应给予重视,及早发现ROP并规范治疗,以降低早产儿ROP的发病率。     

婴幼儿先天性心脏病术后床边胸片的临床应用评价

评价床边胸片在婴幼儿先天性心脏病术后的临床应用价值,总结其常见并发症以提高阅片正确率。方法:55例先天性心脏病术后婴幼儿患者,男34例,女24例,年龄1月至36月(平均12．8月),其术后均使用移动X线机摄取床边胸片,总结分析术后胸片新出现的异常表现。结果:55例先天性心脏病惠儿术后床边胸片中,发现31例新出现异常X线表现,发生率为56．4%。其中胸腔积液12例;气胸9例,其中4例合并皮下气肿;肺不张5例;左下肺炎3例;肺水肿1例;膈肌抬高1例。婴幼儿先天性心脏病术后最常见的并发症中前三位的依次为:胸腔积液、气胸和肺不张,分别占38．7%、29．0%、16．1%。结论:床边胸片是及时全面了解先天性心脏病患儿术后胸部出现新异常的重要和有效的检查手段,且简便易行,能将婴幼儿不能主诉的影响减至最低,从而为临床提供及时的诊疗依据。     

RETROLENTAL FIBROPLASIA—Blindness in Infants of Low Weight at Birth

Retrolental fibroplasia is today the principal cause of blindness in children of preschool age, exceeding all other causes combined. The disease occurs in infants of low weight at birth, commonly those born prematurely. The incidence of the disease is rising at an alarming rate. Vitamin E deficiency, corticotropin (ACTH) deficiency, the use of cow''s milk in place of mother''s milk, and improper oxygenation have been suggested as etiologic factors but the cause remains a mystery. Often the incidence is high in institutions in which maximal care is given premature infants.Clinically, the disease advances through an “active” phase during which regression is possible, and a “subsiding” or “cicatricial” phase which terminates with the formation of a disorganized opaque mass behind the lens. The earliest manifestations are noted in the fundi. Hemorrhages, neovascularization, transudation commencing in the periphery, and retinal separation contribute to the formation of the characteristic retrolental membrane. The diagnosis may be made when the retrolental membrane is observed in the eye of an infant whose weight at birth was low. Differential diagnosis is required occasionally.Thus far, no form of therapy has prevented or reversed the pathologic changes successfully. Use of vitamin E, corticotropin and mother''s milk has not influenced the incidence of the disease. Avoidance of premature delivery if possible is indicated.     

Skeletal Scintigraphy: The Use of Technetium 99M-Labeled Complexes in the Detection of Early Osseous Involvement by Metastatic Tumors

Skeletal scintigraphy using Technetium-99m (^99mTc) complexes was carried out in a series of 332 cancer patients. The results of scintigraphy were compared with the results of roentgenography and with the diagnostic usefulness of serum alkaline and acid phosphatase levels and the presence or absence of bone pain. In 25 percent of cases, lesions were first identified with scintigraphs. When metastastic lesions were present on both scintigraphs and roentgenograms, the number was greater on scintigraphs in 72 percent of cases. Six false negative studies were recorded (1 percent). Sixty percent of patients with early metastasis—that is, those with abnormal scintigraphs and negative roentgenograms—were asymptomatic. Serum alkaline and acid phosphatase levels were normal in 40 percent and 42 percent respectively of those with early skeletal involvement. Skeletal scintigraphy with ^99mTc complexes is superior to other commonly employed techniques used to assess bone metastasis.     

The erect abdominal radiograph in the acute abdomen: should its routine use be abandoned?

The value of erect and supine abdominal radiographs and erect chest radiographs was analysed prospectively in 102 consecutive patients admitted to hospital with acute abdominal symptoms. The radiographs were reported on initially by junior surgeons of the admitting team, special note being made of the value of the erect abdominal radiograph over the combination of the supine abdominal radiograph and erect chest radiograph. On the basis of information obtained from the erect abdominal radiograph alone no changes in patient management were recorded. A consultant radiologist reported on the same radiographs at a later date. In five cases the erect abdominal radiograph was thought to have contributed useful or additional information, although in four of these cases abnormal features were visible in the supine film. In three of the five cases important but subtle information was missed by junior surgeons. In five of the 102 patients information obtained from the erect abdominal radiograph was potentially misleading. The small yield of positive information, potentially misleading features, and lack of effect on surgical management suggest that the routine use of the erect abdominal radiograph in the acute abdomen should be abandoned.     

Severe Metabolic Acidemia in Infants: Clinical and Therapeutic Aspects

A study of 10 infants in severe metabolic acidemia (pH below 7) led to the conclusion that the clinical signs—hyperventilation, coma or lethargy, peripheral vascular collapse, a significantly palpable liver, and abdominal distension—may all be directly related to the metabolic acidemia. In five of 10 infants, an initial erroneous diagnosis of congestive heart failure or pneumonia was made. Dramatic clinical improvement followed correction of the acidemia with rapid intravenous administration of sodium bicarbonate. This rapid administration of sodium bicarbonate was safe, provided hypocalcemia was recognized and treated in its early stages. In severe metabolic acidemia the measurement of blood bicarbonate alone does not reflect adequately the magnitude of the acid-base derangement and repeated measurements of hydrogen ion concentration, Pco₂ and bicarbonates are needed to evaluate and treat such infants correctly.     

Abnormalities of the Urinary Tract in Association with Congenital Cardiovascular Disease

The incidence of urinary tract abnormalities in a group of infants and children with congenital cardiovascular disease was determined by assessing roentgenograms of the abdomen taken following angiocardiographic studies. The urinary tracts of 400 of these patients were so outlined, but in 50 others the tracts could not be outlined. In 21 of the latter the urinary tracts were assessed at autopsy.Of these 421 children, nine (approximately 2%) had serious urinary tract disease, and 15 (approximately 3.5%) had anomalies which were of no clinical significance.The incidence of four renal anomalies—bifid collecting system, rotated kidney, horsehoe kidney and ectopic kidney—was compared with that in another group of patients without cardiovascular disease. No significant difference was found in the incidence of these four anomalies in the two groups.     

Computer-Assisted Diagnosis of Abdominal Pain using “Estimates” Provided by Clinicians

This paper reports a comparison between two modes of computer-aided diagnosis in a real-time prospective trial involving 472 patients with acute abdominal pain. In the first mode the computer-aided system analysed each of the 472 patients by referring to data previously collated from a large series of 600 real-life patients. In the second mode the system used as a basis for its analysis “estimates” of probability provided by a group of six clinicians. The accuracy and reliability of both modes were compared with the performance of unaided clinicians.Using “real-life” data the computer system was significantly more effective than the unaided clinician. By contrast, when using the clinicians'' own estimates the computer-aided system was often less effective than the unaided clinician—especially when diagnosing less common disorders. It seems, firstly, that future systems for computer-aided diagnosis should employ data from real-life and not clinicians'' estimates, and, secondly, that clinicians themselves cannot analyse cases in a probabilistic fashion, since often they have little idea of what the “true” probabilities are.     

COMMON LESIONS OF THE URETHRA IN WOMEN

Urethral disease in women and girls often is overlooked. As the urine may seem to be normal as determined by repeated urinalysis, the symptoms—urinary frequency and burning—may be attributed entirely to other pelvic disease or to functional disorder. Since erroneous diagnosis may lead to unnecessary procedures or to neglect of treatment with consequent development of severe disease in the kidneys or ureters, it is important to consider urethral lesions as a possible cause in any case of abdominal discomfort in women.The most common lesions of the urethra in women are urethritis, stricture, caruncle, inflammatory polyps and cysts, prolapse of the urethra, and diverticulum. In some cases diagnosis can be made simply on the basis of inspection and palpation. In others more extensive diagnostic procedures must be carried out in order that treatment may be definitive.The methods of treatment, varying with the nature of the lesion, are outlined herein.     

Genitourinary Presentation of Tuberculosis

Tuberculosis (TB) is less common in developed countries; however, the incidence of TB—especially resistant strains—is on the rise worldwide. Cases of TB manifesting as urologic complications are rare in the United States. Urologists should be aware of this potential manifestation, especially in patients who have recently immigrated to the United States or have traveled abroad for prolonged periods. Two cases are presented here to illustrate this entity.Key words: Tuberculosis, Genitourinary complications, Mycobacterium tuberculosisTuberculosis (TB) is a disease dating back to antiquity and has continued to thrive to the present time. Signs of TB have been found in Egyptian mummies dating back to 3000 to 2400 BCE,¹ and scholars have postulated that TB may have led to the deaths of Egyptian pharaoh Akhenaton (1353-1336 BCE) and his wife Nefertiti. TB, then known as “the consumption,” reached epidemic proportion in Europe in the 1700s, and was responsible for one in four deaths in England. The causative bacillus, Mycobacterium tuberculosis, and the mode of transmission were described by Robert Koch on March 24, 1882, which is now designated annually as World Tuberculosis Day.²In 2013, the World Health Organization estimated an annual rate of 9 million new TB cases, and it is second only to human immunodeficiency virus (HIV) and AIDS as a single infectious agent killer. TB is also a major cause of death in HIV-related mortalities. Globally, the incidence is declining, albeit slowly.³In the United States, the incidence of TB showed a resurgent increase, peaking in 1992 after decades of steady decline due to the emergence of HIV/AIDS; subsequently, the incidence of TB has continuously declined at the rate of 3% to 4% per year, with 9588 new cases reported in 2013. The majority of cases represent reactivation of latent TB acquired previously in foreign-born individuals, and reflects TB incidence in their countries of origin.⁴Extrapulmonary sites account for 10% of all TB cases; genitourinary TB accounts for 30% to 40% of all extrapulmonary cases, second to lymph nodal affection. Peak occurrence for urogenital TB is between the ages of 20 and 40 years, with a 2:1 ratio of men to women; it is more prevalent in developing countries.⁵Urogenital TB arises from hematogenous dissemination from the lungs; the kidney, epididymis, and prostate are the primary landing sites. The bacillus then gains access to other organs via direct or lymphatic means. Affected individuals are often free of any pulmonary symptoms or involvement.Signs and symptoms for urogenital TB are typically nonspecific and usually mimic a wide range of more commonly occurring urologic conditions. Lower urinary tract symptoms (LUTS), pyuria, hematuria, and pain are among the usual presenting symptoms; they are usually refractory to standard treatment regimens and are easily missed unless a high index of suspicion is exercised.     

Obesity and Respiratory Infection in Infants and Young Children

A controlled trial has been carried out to test the widely held “clinical impression” that overweight infants have a greater liability to respiratory infections than those of normal weight. Two matched groups of children aged between 3 months and 2 years were studied, containing children whose weight was above the 90th percentile, or was between the 25th and 75th percentiles, at the start of the trial.Data from 120 children of the overweight group were available for analysis, of whom 47 experienced at least one respiratory infection during the trial and 73 did not. Of children remaining over the 90th percentile at the end of the trial 19 had suffered respiratory infections and 28 had not. One baby in the overweight group suffered a “cot death” from acute bronchiolitis. In the control group, 103 cases were analysed—23 had suffered a respiratory infection and 80 had remained free of respiratory infection throughout the trial. These figures are statistically significant and suggest that obesity in infants and young children is associated with an increased incidence of acute respiratory infections.     

Roentgenographic observation of gas-fluid levels in the colon of children with abdominal pain and malabsorption of lactose

Gas-fluid levels in the colon observed in radiographs are abnormal and usually indicate serious gastrointestinal disease. Colonic gas-fluid levels associated with concurrent abdominal pain and malabsorption of lactose, documented by lactose breath hydrogen testing, were observed in five children. Incomplete lactose absorption is a relatively benign condition that can be added to the differential diagnosis of gas-fluid levels in the colon and may account for some cases of spontaneous resolution of clinical and radiologic signs in children presenting with acute recurrent abdominal pain.     

Tuberculosis: A Challenge to the General Practitioner

Of 157 patients dying of tuberculosis in Ontario (1960) 132 (87.4%) suffered from the pulmonary form of the disease (incidence 2.6 per 100,000). In the same year, 1632 of 1847, or 88.3%, active new cases reported had the pulmonary type and 183 additional cases were reported without details as to type of disease. Thus, in 1960, a total of 2030 new cases of tuberculosis were reported in Ontario.Of 1367 patients with pulmonary tuberculosis (reinfection type), 357 (26.1%) had “far advanced” disease and 613 (44.8%) had “moderately advanced” disease.This high percentage of patients with “moderately advanced” to “far advanced” disease at the time of diagnosis constitutes the real challenge to physicians in private practice, who made the diagnosis in 45% of cases.Emergence of resistant strains of bacteria increases the urgency of prompt diagnosis and treatment. The most vulnerable population segment is the 15-30 year age-group, many of whom are negative intracutaneous reactors. A high index of suspicion is necessary, particularly in certain segments of the population with a high incidence of infection, combined with a careful history, meticulous physical examination, intracutaneous tests, chest and other radiographs, and appropriate bacteriological studies.     

Body temperature in premature infants during the first week of life: Exploration using infrared thermal imaging

BackgroundHypothermia is a problem for very premature infants after birth and leads to increased morbidity and mortality. Previously we found very premature infants exhibit abnormal thermal patterns, keeping foot temperatures warmer than abdominal temperatures for their first 12 h of life.PurposeWe explored the utility of infrared thermography as a non-invasive method for measuring body temperature in premature infants in an attempt to regionally examine differential temperatures.ResultsOur use of infrared imaging to measure abdominal and foot temperature for extremely premature infants in heated, humid incubators was successful and in close agreement using Bland and Altman technique with temperatures measured by skin thermistors.ConclusionsOur study methods demonstrated that it was feasible to capture full body temperatures of extremely premature infants while they were resting in a heated, humid incubator using a Flir SC640 infrared camera. This technology offers researchers and clinicians a method to examine acute changes in perfusion differentials in premature infants which may lead to morbidity.     

SYSTEMIC LUPUS ERYTHEMATOSUS—Early Cytologic Diagnosis

The diagnosis of systemic lupus erythematosus—a relatively common disease—is difficult because of the variable nature of the symptoms, which resemble those of many other conditions. The finding of the characteristic cells is pathognomonic, although failure to find them does not rule out the diagnosis.If the diagnosis is suspected the “L.E.” cell test should be performed on two samples of blood from the veins and one from the bone marrow. After separation of a haparinized sample by centrifuge, a drop from the buffy coat is Wright-stained on a slide and examined for rouleaux formation and for a hematoxylinstaining material sometimes seen in intercellular bodies (which may be surrounded by a rosette of leukocytes) and sometimes seen as ingested by a leukocyte. Only the last finding is positively diagnostic of lupus erythematosus.A statistical analysis of 62 cases treated at the Los Angeles County General Hospital is given. Because of the frequency of rheumatoidlike arthritic changes in the disease, all patients with this form of arthritis should be given the test. Spontaneous remission and then relapse after a long asymptomatic interval occurred in many cases. With early diagnosis and vigorous treatment with cortisone and corticotropin, many patients can be relieved of symptoms.     

APPENDICITIS AND PREGNANCY

In 74,000 obstetrical patients at Los Angeles County Hospital the incidence of acute appendicitis in pregnancy was 0.05 per cent. In a study of 36 cases of clinically diagnosed appendicitis in pregnancy between 1956 and 1960, it was shown that the fetal and maternal morbidity and mortality were decreased when a definite operative procedure was done early. The difficulty in diagnosis is increased by the necessary consideration of pyelonephritis and twisted ovarian cyst. Rupture of the appendix increased hazards to maternal and fetal survival. It was noted also that threatened premature labor may indicate a ruptured appendix. Emergency operation with the use of antibiotics in such cases was effective therapy. The incidence of premature delivery was proportionate to the delay in operating. If operation was performed in less than eight hours after admission to the hospital, there was no maternal or fetal loss. A delay greater than eight hours resulted in a 17 per cent fetal loss in premature delivery and 4 per cent fetal loss of infants at term.     

Nephrotic Syndrome Due to Primary Renal Disease in Adults: I. Survey of Incidence in South-east England

In a prospective survey of the nephritic syndrome due to primary renal disease in adult patients in the South-east Metropolitan Region of England 50 patients were seen in a two-year period—a minimum annual incidence of 9·0 new cases per million adult population. The frequency distribution of the three main histological groups was “minimal change” 30%, membranous nephropathy 12%, and proliferative glomerulonephritis 58%. The higher proportion of patients with minimal histological change compared with that found in most previously published series may be explained by the avoidance of selection of patients for inclusion. The much lower incidence of membranous nephropathy probably reflects the use of stricter histological criteria for this diagnosis.