Assessing the outcomes of cancer patients in a home nursing program.
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Biomedical subjects
Publications and source records attributed to B J Reilly.
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To investigate whether hepatobiliary rickets is caused by defective intestinal absorption of vitamin D or by impaired hepatic hydroxylation of the vitamin, we studied three children who developed severe rickets, hypocalcemia, and hypophosphatemia, two despite having received 400 to 800 IU vitamin D per day by mouth, and one despite prolonged treatment with 10,000 IU daily. On oral vitamin D therapy, plasma vitamin D and 25-hydroxyvitamin D levels were low. When two children were treated with weekly intravenous doses of 3,000 IU vitamin D to approximate the recommended prophylactic allowance, their plasma calcium and phosphate values improved promptly, the radiographic lesions healed, and the plasma concentrations of vitamin D and 25-hydroxyvitamin D became normal. Our studies indicate that the primary cause of hepatobiliary rickets is intestinal malabsorption of vitamin D, not impairment of the hepatic metabolism of the vitamin.
A case of Schwartz-Jampel syndrome with electrical, radiographic, biopsy, and pharmacological studies is presented along with a summary of the 12 other reported cases. Radiological study showed nonspecific but definite abnormalities. The muscle biopsy revealed myopathic and neurogenic features. No drug was effective in reducing our patient's stiffness.
The clinical and radiographic appearances of four children with cardiac extension of Wilms' tumor and four cases from the literature are described. Four of the eight children were seen for "cardiac problems" and four for "routine" Wilms' tumor. In those "routine" cases, there were no clinical suggestions of inferior vena cava or cardiac extension. Preoperative screening for tumor extension may be crucial. However, because of the rarity of cardiac extension, it would be appropriate to screen patients by noninvasive methods such as gray scale ultrasound of the abdomen, echocardiography, or computed tomography before any invasive procedure is considered.
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A prospective study comparing the radionuclide skeletal survey with the radiographic survey was performed for 159 children with known primary neoplasm. Forty-four showed radionuclide evidence of metastases, while only 14 had radiographic evidence. Thus, 68% of metastases were discovered by bone imaging alone. No false negative images for metastases were obtained, though there was one false negative image for primary tumor. Radionuclide skeletal survey is recommended as the primary evaluation for bony metastases in all children with neoplasms. Suspect areas should then receive complete radiographic examination.
Use of a Delta scanner has resulted in delineation of neoplastic, obstructive and inflammatory renal diseases, hepatic tumors, and other abdominopelvic mass lesions. Of 47 patients examined, 32 had proved mass lesions. Computed tomography provided unique information about the complete delineation and nature of lesions and detected unrecognized lesions. Technical problems and solutions are discussed.
Twelve cases of neonatal intussusception are presented and another 25 taken from the literature are reviewed. Intussusception in the first month of life is a distinct clinical and pathological entity, presenting as bowel obstruction in the first days and usually led by a tumor. In the past, a high mortality rate has been related to late diagnosis. The barium-enema examination is diagnostic.
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Twenty-three children less than 18 months old who had clinical and radiological evidence of bronchiolitis and remained symptom-free thereafter were studied to determine pulmonary function ten years later. Abnormal Pao2, Viso V and RV/TLC ratio were found in the majority of subjects, and 31.3% had abnormalities in all three tests; four and one-half percent had exercise-induced bronchospasm. These changes indicate a residual parenchymal or airways lesion following bronchiolitis.
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Cranial computed tomography has been performed in adults for the past 2 years but relatively few children have undergone this procedure. The specific uses in children are in detecting intracranial mass lesions and identifying the character of the lesion, and evaluating congenital cranial diseases such as cerebral dysplasia, tuberous sclerosis and leukodystrophies. This safe, rapid, noninvasive technique will soon replace or supplement standard neuroradiologic techniques in infants and children.
Infants of two groups, one of 16, one of 14 infants, who weighed less than 1.3 kg at birth (mean 1.01 +/- 0.05 kg), were studied from age 14 days until they reached 1.8 kg body weight. Infants were pair-matched for gestational age and birth weight and one member was randomly allocated to two treatment groups. Infants in group A received no calcium supplement and those in group B received calcium lactate, 800 mg/kg/24 hr hr, in divided doses with each feed. All were fed "Improved" SMA, 200 ml/kg/24 hr, 160 cal/kg/24 hr, and were given a multivitamin preparation containing 500 IU vitamin D2/dose. The infants' weekly length gain did not differ between groups (1.08 +/- 0.04 cm/week vs 1.11 +/- 0.04 cm/week; mean +/- SEM). Mean weight and head cercumference increments also were similar (group A, 163 +/- 6 g/week; 1.12 +/- 0.03 cm/week; group B, 170 +/- 6 g/week and 1.18 +/- 0.03 cm/week). An increase in blood pH from 7.33 +/- 0.01 to 7.41 +/- 0.01 (P less than 0.01) in group A babies was associated with a decrease in PCO2 from 44.2 +/- 1.0 to 38.9 +/- 1.4 mm Hg. Values remained unchanged with age in group B babies...
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