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Biomedical subjects

E Tirosh

Publications and source records attributed to E Tirosh.

At least 73 records · Page 4Linked to original sources
PubMed1990

Practical approach to the diagnosis and treatment of apnea of infancy.

Twenty-three infants aged 6 days to 9 months, sequentially referred for apnea or apparent life-threatening events (ALTE), were studied. A selective approach consisting of hospitalization, prolonged cardiorespiratory monitoring, and a graduated investigative protocol yielded positive findings in 75% of the subjects. Polysomnographic study and continuous esophageal pH monitoring were found to be the most informative. In addition to other appropriate therapeutic interventions, cardiorespiratory home monitoring was prescribed for four patients. In three nonmonitored subjects apnea recurred. Two infants died, one with homocystinuria complicated by brain hemorrhage and another with a fulminant viral infection. These investigative results and their outcome indicate that in cases of apnea or ALTE in apparently healthy infants, in-patient monitoring and evaluation is of much value. Home monitors should only be recommended in a selected group of patients, and an adequate follow-up and support system is essential.

Female↗
PubMed1989

Physiotherapy for children with cerebral palsy. Evidence for its efficacy.

Physiotherapy is currently the most popular therapeutic intervention for cerebral palsy. This therapy requires highly trained personnel, diverse equipment, and parental cooperation. Notwithstanding the expense and commitment required for the implementation of a therapeutic program, a computer search of the literature published in English during the past 15 years revealed only nine studies pertaining to the efficacy and no study addressing the effectiveness of this intervention. A critical review of this literature, employing 14 methodological and reporting criteria, revealed that only three studies adequately fulfilled nine of the criteria; the remaining studies used a less rigorous design. Of those three articles, two used statistical analysis and concluded that the results were negative, while the third utilized clinical analysis only and demonstrated positive results. Evidence for the usefulness of this therapy has yet to be demonstrated; with the presently available methodologies it is ethically imperative to institute a properly designed, collaborative, multicenter, randomized, controlled trial.

Cerebral Palsy↗
PubMed1989

The ameliorating effect of lumbar puncture in viral meningitis.

To test the hypothesis that lumbar puncture in viral meningitis results in symptomatic improvement, a group of 48 children was studied. Twenty-six patients had proved aseptic meningitis, and 22 had infections outside the central nervous system. Before and after lumbar puncture each subject was repeatedly scored for symptoms independently by the attending pediatrician and a parent. Marked symptomatic improvement in children with meningitis was demonstrated following lumbar puncture, while no significant change was demonstrated in the control group. The mechanism underlying this improvement is not clear; however, we consider a number of possible explanations.

Age Factors↗
PubMed1989

Sandifer syndrome reconsidered.

Three children with Sandifer syndrome are described. One patient was at first erroneously diagnosed as having neurological disease; the two others had true neurological damage, which led initially to misinterpretation of their bizarre dystonic features. Awareness of this entity will spare such children needless investigations and suffering, while giving them the benefit of proper treatment.

Antacids↗
PubMed1989

Short-term efficacy of thyroid hormone supplementation for patients with Down syndrome and low-borderline thyroid function.

The thyroid function of 44 subjects with Down syndrome who were between 2 and 51 years of age was assessed. Three patients (7%) had hypothyroidism, and in 2 of them high titers of antimicrosomal antibody were detected. Seven additional subjects (16%) had low-borderline thyroid function, 6 with elevated thyroid stimulating hormone. These 7 subjects constituted the cohort for an evaluation of the short-term benefits of thyroid hormone supplementation in the low-borderline thyroid functional state. A double-blind crossover drug placebo trial failed to document any cognitive, social, response time, or physical changes attributable to the 8- to 14-week drug treatment period compared to an untreated matched control group. Results provided no evidence for the efficacy of short-term thyroid hormone therapy for this population.

Adolescent↗
PubMed1988

Joint mobility and motor development.

The association of joint hypermobility and motor development was sequentially investigated in 715 infants from the ages of 8 to 14 months. Seven joints were evaluated for mobility, and each infant underwent a physical and neurological examination. Parents were given a Denver Developmental Parents' Questionnaire. All subjects with a general developmental delay, systemic illness or syndrome were excluded. The infants were classified as having normal or delayed motor development with normal or delayed joint mobility. They were re-examined six months later. Multivariate statistical techniques was used for categorical analysis, and three joints were found to be significantly associated with motor delay at the first examination--hip abduction, elbow hyperextension, and foot dorsiflexion. Of the 715 infants, 126 had joint hypermobility and of these 38 (30.2%) had motor delay. Sixty four of 589 (10.9%) with normal joints had delayed motor development. Six months later 23 out of 35 of the group with joint hypermobility and 42 out of 53 of the group with normal joints had normal motor function. Joint hypermobility is associated with an increased incidence of motor delay in infancy. Over the ensuing six months most of the subjects will catch up. These findings, indicating a favourable prognosis, have implications regarding clinical assessment and parental counselling.

Child Development↗
PubMed1988

Hyperventilation in the awake state: potentially treatable component of Rett syndrome.

Hyperventilation, which occurs in some patients with severe mental handicap, is a prominent feature in the histories of most girls with Rett syndrome but its mechanism and effects have not been established. Respiratory function was therefore studied in 18 patients with Rett syndrome and 23 healthy controls. Ten of the patients (56%), but none of the controls, hyperventilated only when awake, and began doing so after a period of normal breathing without hypoxaemia. After hyperventilation was established it was interspersed with prolonged periods of apnoea (over 19 seconds) accompanied by Valsalva manoeuvres. Hypoxaemia (less than 90%) occurred in 47% of these periods of apnoea and five (50%) of the patients had oxygen saturation values of under 50%. During hyperventilation severe hypocapnia developed in every patient, and recorded arterial pH measurements ranged from 7.47 to 7.60. A further four patients (22%) did not hyperventilate, but had clear histories of hyperventilation when younger. All had frequent apnoeic pauses accompanied by Valsalva manoeuvres. The remaining four girls (22%) neither hyperventilated nor gave a clear history of doing so. Three had occasional apnoeic pauses associated with the Valsalva manoeuvres. All but one of the 18 patients had increased quantities of periodic apnoea compared with the control subjects. The hypocapnic alkalaemia and hypoxaemia resulting from hyperventilation may contribute to the cerebral impairment in Rett syndrome. Since the hyperventilation is 'primary', and not secondary to preceding apnoea, it is potentially treatable. Further studies will determine if treatment is practical and of benefit.

Adolescent↗
PubMed1988

Comparison of early neonatal behavior in two Israeli ethnic groups.

A review of the literature on differences between Israeli children born to parents of North African and of European descent revealed only a few studies concerning child development. Two trends emerged: a) these developmental differences seemed to resolve gradually over time; and b) there appeared to be an early general developmental precocity in the infants of North African descent, while in later childhood, European children generally performed better in all developmental areas. The present study compared the early behavior of 40 second-generation Israeli neonates from these two ethnic groups. The results indicated a few statistically significant behavioral differences between the groups, all in favor of the North African group. The auditory habituation item was dependent on maternal education, a result which may be attributed to genetic and/or intrauterine environmental factors fostering the development of a protective mechanism in a potentially over-stimulatory future environment. The small-scale differences between the neonates of the two ethnic groups may represent the already documented tendency and gradual resolution of interethnic variations and the early North African precocity during infancy.

Africa, Northern↗
PubMed1988

Relationship between head dimensions and body length in the context of mental retardation.

The relationship and possible disproportion between different cranial dimensions--head length, head circumference and biparietal diameter--body length and developmental status in normocephalic children were studied in 166 mentally retarded and 471 normal control subjects, between the ages of 3 months and 6 years. When the total cohort was analyzed, all dimensions, particularly head length, were found to be significantly reduced in the study group compared with the controls. Stratification into three age-groups revealed that in the 3- to 15-month-old subjects, head length was the most significantly reduced dimension, while in the older children body length was more significant, followed by head length. Further discriminant analysis resulted in a formula consisting of only three factors--body length, head length and age. Head circumference and biparietal diameter were noncontributory. This investigation did not support the concept of a disproportionately small head compared with height in normocephalic mentally retarded children, but rather a general growth failure mostly affecting height and head length.

Body Height↗
PubMed1987

The clinical significance of multiple hair whorls and their association with unusual dermatoglyphics and dysmorphic features in mentally retarded Israeli children.

The prevalence of multiple hair whorls in a group of mentally retarded patients was 8% as opposed to 3.6% in a group of healthy children. A statistically significant relationship was demonstrated between mental retardation, multiple hair whorls, more than two dysmorphic features, and unusual dermatoglyphics. The results confirm the importance of multiple hair whorls as a genuine dysmorphic feature. The significance of these markers in the evaluation of mentally retarded subjects is discussed, with special reference to the timing of the fetal insult.

Abnormalities, Multiple↗
PubMed1987

The dilemma in prenatal diagnosis of idiopathic microcephaly.

It is estimated that 20 to 35 per cent of idiopathic microcephaly is hereditary. Common practice dictates that after the birth of such a case, subsequent pregnancies should be monitored ultrasonographically in order to facilitate early antenatal diagnosis, and thus genetic counselling. Two cases are reported to indicate the difficulties encountered. In case 1 head growth appeared to be normal until the 20th week of gestation and then slowed down to 31 cm at birth. In case 2 head growth proceeded normally until the 28th week of gestation; at birth it was 32 cm and over the succeeding months became markedly microcephalic. The accuracy of various ultrasonographic techniques is reviewed, and the limitations are discussed. In the light of these findings it is concluded that reliable prenatal diagnosis of hereditary microcephaly is not available as yet.

Cephalometry↗
PubMed1986

Immature sound localisation and abnormal development.

This investigation tested the hypothesis that high risk infants showing immaturity in localisation of a sound stimulus would be more likely to have appreciable neurodevelopmental dysfunction. The cohort comprised 112 infants, 66 of whom were classified as 'high risk'. Every infant underwent a neurological and developmental assessment, a sound localisation response test, and an audiological examination when necessary. The first examination was performed at age 8-9 months and was repeated between six and eight months later. It was found that if the sound localisation response was mature at the first examination normal development could be anticipated at the second examination. If an immature sound localisation response was shown then considerable dysfunction could be anticipated in about half of the infants. It is suggested that special attention be paid to the maturity of the sound localisation response in infants during auditory screening procedures, and an immature response should alert the examiner to the possibility of appreciable abnormality in development.

Auditory Perception↗