Decreased thymus size on chest radiography: a sign of pediatric human immunodeficiency virus infection?
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Child, Preschool↗
Biomedical subjects
A Meyers
Publications and source records attributed to A Meyers.
Economic barriers to the use of oral rehydration therapy. A case report.
Diarrheal dehydration is a highly prevalent condition among young children and is readily prevented and treated with oral rehydration therapy. We report a death due to hypernatremic dehydration caused by rotavirus diarrhea of a 9-month-old infant whose mother attempted to purchase oral glucose-electrolyte solution in a pharmacy but was unable to afford it. While efforts such as the National ORT Project should help to promote the proper at-home treatment of this condition, we conclude that oral rehydration therapy will not be used optimally by the parents of children living in poverty until the economic barriers to its use are removed.
Dehydration↗
Pediatric HIV disease. The newest chronic illness of childhood.
HIV disease has emerged as a major chronic illness of childhood. Children with HIV infection and children with other chronic health impairments have much in common, including the need for comprehensive, multidisciplinary, coordinated care that includes special attention to the psychosocial effects on the child and family. However, because the mother and often the father and siblings share this lethal viral infection, the impact of HIV disease upon the family surpasses that of virtually all other chronic conditions. This is compounded by the association of the disease with drug use, its preponderance among the most disenfranchised populations in the United States, and the persistent public fear and discrimination surrounding AIDS. We have made substantial progress already in the medical management of this infection, and while we await the development of more effective therapies, we already have the tools and knowledge in hand to help these families.
Acquired Immunodeficiency Syndrome↗
Delayed onset of cardiac arrhythmias from sustained-release verapamil.
Sustained-release products in overdose are known to produce prolonged effects as well as delayed onset. The availability of sustained-release calcium channel blockers may produce an initial misleading picture for patients who are at risk for serious toxicity. We report the cases of two adults who had delayed onset of arrhythmias after ingestion of sustained-release verapamil. In both cases, a single dose of activated charcoal was administered, but the patients still developed toxicity. Some of the unique problems encountered with sustained-release formulations are discussed, and 24-hour cardiac monitoring for sustained-release calcium channel blocker overdoses, despite a possible early asymptomatic period, is suggested.
Adult↗
Malignant melanoma arising in a congenital nevus.
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Aged↗
A need in special operations medicine for lightweight x-ray equipment.
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Equipment Design↗
Bottle-feeding and malocclusion: is there an association?
To determine whether there is an association between bottle-feeding and malocclusion, a case control study was conducted by means of a questionnaire sent to the parents of 737 patients aged 10 to 12 years from a large private pediatric dental practice. Questions included method and duration of infant feeding, type of nipple used, pacifier use, sucking habits, history of orthodontic treatment, and parental orthodontic history. Analysis of valid responses (N = 454) showed need for treatment to be associated only with history of parental orthodontic treatment (P less than 0.05). A trend toward association of bottle-feeding with need for orthodontic treatment was found in the increasing need for treatment with increasing exposure to bottle, but was of marginal significance (P = 0.058).
Bottle Feeding↗
Poverty and child health.
Poverty is now more heavily concentrated in children than at any other time in U.S. history. Poverty's influence on child health is pervasive and creates a variety of clinical challenges. This discussion reviews the clinical expression of poverty in childhood and assesses our clinical and political capacity to reduce its tragic impact.
Child↗
Effects of Maine's 1981 and Massachusetts' 1982 driving-under-the-influence legislation.
In 1981, Maine passed a drunk driving law with mandatory penalties and a new civil charge to increase the conviction rate. One year later, Massachusetts increased drunk driving penalties, particularly for repeat offenders and intoxicated drivers involved in fatal crashes. In Maine, single-vehicle nighttime fatal crashes declined 22 per cent the year before passage of the law, and 33 per cent the year after. Maine's rates returned to pre-law levels by the third post-law year. Prior to Massachusetts' new law, single-vehicle nighttime and overall fatal crashes there also declined 20% and 22%, whereas after this law fatal crash rates did not decline further compared with the pre-law year or other New England states. Pre- and post-law surveys indicate that both laws were followed by some increases in public perceptions that drunk drivers stopped by police would be arrested, convicted, and receive automatic penalties. But, few believed it was very likely that drunk drivers would be stopped. For only two of three years studied after Maine's law did more people there report decisions not to drive because they had drunk too much. In Massachusetts, reported driving after heavy drinking declined as much the year before as the three years after its law.
Accidents, Traffic↗
Rapid method for the measurement of differential renal function: validation.
The precise measurement of glomerular filtration rate (GFR) and renal plasma flow (ERPF) usually requires continuous intravenous administration of adequate substances, with multiple blood and urine analysis, and does not allow measurement of separate renal function. Schlegel et al. and Gates described isotopic methods for the measurement of global and unilateral GFR and ERPF based on the determination by scintillation camera of the fraction of the injected dose ([99mTc]DTPA-[131I]hippuran) present in the kidneys 1-3 min after its administration. These methods require counting of the injected dose and correction for attenuation, but no blood or urine sampling. We have validated these techniques by simultaneous infusion of inulin and PAH in patients with various levels of global renal function (anuric to normal). To better define unilateral renal function we have also studied nine kidneys in patients either nephrectomized or with a nephrostomy enabling unilateral function measurement. A good correlation between inulin or PAH clearances and fractional uptake of [99mTc]DTPA or [131I]hippuran by the kidney was observed. Very good reproducibility of both isotopic techniques was shown. We conclude that determination of the fractional uptake of [99mTc]DTPA and [131I]hippuran between 1 and 3 min allows good and reproducible prediction of global and especially of unilateral kidney function with great rapidity and simplicity, rendering this technique suitable for clinical practice.
Adult↗
Severe deficiency of alpha 1-antitrypsin associated with cutaneous vasculitis, rapidly progressive glomerulonephritis, and colitis.
The association of vasculitis with severe deficiency of alpha 1-antitrypsin is rare. This report describes a 44-year-old man with severe deficiency of alpha 1-antitrypsin associated with diffuse vasculitis involving skin, kidney (rapidly progressive glomerulonephritis), and colon (colitis). Colitis has not previously been reported in association with deficiency of alpha 1-antitrypsin. Other reported cases are reviewed and the possible immunologic mechanisms underlying the association are discussed.
Adult↗
Membrane modulation in a methylotrophic bacterium Methylococcus capsulatus (Texas) as a function of growth substrate.
Methylococcus capsulatus (Texas), when grown on methane, undergoes with age a progressive degeneration of internal membrane structure with a simultaneous accumulation of intracellular inclusions. When M. capsulatus is grown on methanol, virtually no internal membranes are present but, instead, cells contain many intracellular droplets morphologically similar to inclusions in old methane-grown cells. Membranes are regenerated by the cells when a methanol-grown culture is transferred back to methane. The oxidative ability of methane- and methanol-grown cells was compared.
Intracellular Membranes↗
A detailed analysis of the 1-hour posttransplant renal biopsy. Its value in predicting future outcome of kidney transplants.
A detailed histological assessment of the 1-hour posttransplant biopsy has been made in 65 cadaver and related renal transplants. There was a lack of correlation between the numbers of polymorphonoclear leucocytes per glomerulus, the prescence and severity of thrombi, vascular changes, interstitial scars, the presence of absence of immune deposits, and the renal function of the patients at 90, 180 and 365 days. The only positive findings was a statistically significant correlation between the glomerular tamponade at 90 days and the renal function. This was not borne out at 180 and 365 days.
Biopsy↗
Telephone-skills training for retarded adults: group and individual demonstrations with and without verbal instruction.
Effects of telephone-skills training delivered to institutionalized retarded adults in group and individual demonstrations, both with and without verbal instructions, were examined. The trials effect was significant for four telephone tasks and for the sum of the four tasks. Persons in all conditions, including the practice control condition, significantly improved skill performance. These findings indicate that, for skill development tasks with retarded adults, demonstration and verbal summaries may add little to the practice experience and that group delivery of training procedures appears to be cost-effective.
Adult↗
Hydrops fetalis: a review of seven cases.
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Edema↗
Bilateral choristomas of the external auditory canals.
To our knowledge, we report the first case of external auditory canal choristomas in the American literature. The pathologic condition of each side was serous salivary tissue, and at surgery, there was no connection with the parotid gland.
Child↗
A technique for analyzing clinical data to provide patient management guidelines.
This article describes a technique for analyzing clinical data in order to guide patient management decisions. The technique is illustrated by considering a specific decision problem encountered in the management of possible meningitis, namely, whether or not to administer antibiotics while awaiting the results of a CSF bacterial culture. Data from 303 patients with meningitis are analyzed in order to determine which combination of clinical variables best discriminates between bacterial and aseptic cases. From these variables, a probability tree is constructed that indicates the probability of bacterial meningitis, depending on a patient's clinical characteristics. In addition to identifying the most important variables, the analysis reveals that a number of tests performed routinely on patients with meningitis are of questionable diagnostic value.
Bacterial Infections↗