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Biomedical subjects

G Fleisher

Publications and source records attributed to G Fleisher.

At least 55 records · Page 3Linked to original sources
PubMed1983

Hemophilus influenzae cellulitis.

To define the clinical features of cellulitis due to Hemophilus influenzae type B, we reviewed the records of 78 children admitted to the hospital with cellulitis during a one-year period. Fifty-two children were afebrile (T less than 38 degrees C) and none had infections due to H. influenzae. Twenty-six children were febrile, 19 with facial and seven with extremity lesions. H. influenzae type B was recovered from seven of the febrile children with facial cellulitis, and one with extremity involvement. The mean WBC count of children with disease due to this organism was 17,500/mm3. Both fever and a leukocytosis (WBC count greater than 15,000/mm3) occurred more often in children with H. influenzae type B cellulitis than among those with infections due to other organisms.

Adolescent↗
PubMed1983

Interpretation of pediatric x-ray films by emergency department pediatricians.

This study compared the interpretation of pediatric roentgenograms by emergency department pediatricians and radiologists. Data were available from 532 of 600 children who had 564 radiographic studies during a six-week period: 217 examinations of the chest, 200 of the extremities, 74 of the skull, 35 of the abdomen, and 38 of miscellaneous structures. The emergency department pediatricians and the radiologists were in agreement in 91.1% of the cases. Among the 50 of 564 (8.9%) discordant studies, only seven (1.2%) required changes in therapy. The results attest to the accuracy of emergency department pediatricians in interpreting the usual types of films ordered in their department. However, this group specifically erred in the identification of subtle fractures and the detection of abnormalities incidental to the primary purpose for which the film was obtained. Future educational programs should address these areas of deficiency.

Adolescent↗
PubMed1983

Persistent Epstein-Barr virus infection and pregnancy.

Women seropositive for Epstein-Barr virus (EBV) were studied during pregnancy for reactivation of latent, persistent infection. Individual women usually (94%) maintained constant titers of antibodies to EBV-specific antigens, including viral capsid antigen, early antigen, and EBV-associated nuclear antigen. The geometric mean titer of the EBV-specific antibodies was constant throughout gestation. Pregnant women did, however, differ from control subjects in that they significantly more often had antibodies to early antigen (anti-EA) (55% vs. 22%-32%). Infants born to women with anti-EA had the same incidence of low birth weight, congenital anomalies, and neonatal jaundice as did the offspring of women without anti-EA. Within the limitations of the sample, our data suggest that reactivation of latent, persistent EBV infection occurs early during gestation but that this reactivation does not adversely affect the fetus.

Antibodies, Viral↗
PubMed1982

Fever in children with sickle cell hemoglobinopathies.

To estimate the frequency of bacteremia in children with sickle cell hemoglobinopathies (SCHs) and to evaluate the usefulness of various findings in predicting septicemia, we reviewed the charts of 153 patients with SCH who made 326 emergency department visits in a one-year period. Ninety children were febrile (greater than 38.0 degrees C). Four children, three of whom were 2 years old or younger, were bacteremic with Streptococcus pneumoniae. A temperature greater than 40 degrees C occurred in three of the four and was more common than in those who had sterile blood cultures. Two of the five patients who were 2 years old or younger and who had the combination of a WBC count of 20,000/cu mm or more and a temperature of 39.5 degrees C or higher were bacteremic. These children were significantly more likely to have bacteremia than those with lower temperatures and WBC counts.

Adolescent↗
PubMed1982

A non-x-linked syndrome with susceptibility to severe Epstein-Barr virus infections.

Three siblings developed severe (two) or fatal (one) infectious mononucleosis. This family differed from previously described kindreds with a susceptibility to overwhelming Epstein-Barr virus infections in that: (1) both males and females were affected; (2) they had a history of the recurrent bacterial infections; (3) they produced the full spectrum of antibodies to EBV in the expected range of titers; and (4) survivors recovered completely. Two of these youths, but not their parents or an unaffected sibling with mild IM, had a deficiency of natural killer activity that did not respond to preincubation of their peripheral blood mononuclear cells with interferon. NK activity may have an important role in controlling infections with EBV.

Adolescent↗
PubMed1982

Pediatric training in emergency medicine residency programs.

Endorsed emergency medicine (EM) residency programs were surveyed as to the nature and extent of training they provided in pediatric emergency care (PEC). In the surveys returned (82%) there were several important findings. The amount of time in PEC training was generally two months per year of training. This accounted for 16% of training time. However, the volume of pediatric patients was 25% of the overall patient population. There was wide variation in the sites of PEC training. Didactic sessions often did not cover even core topics. The training program directors were equally divided in their satisfaction with this aspect of their programs. Changes were recommended by 80% of the directors. Changes most often suggested were increasing pediatric patient exposure and obtaining PEC specialists as trainers.

Emergency Medicine↗
PubMed1981

Life-threatening complications of varicella.

We reviewed the records of 96 children hospitalized with varicella from July 1, 1975 to June 30, 1980. Eighty-one were immunologically normal and 15 were immunocompromised on the basis of neoplasia, immunosuppressive therapy, or genetic disease. These children experienced 106 complications including viral dissemination-encephalitis (44), bacterial infection (25), Reye's syndrome (17), unusual cutaneous lesions (eight), drug overdose (five), diabetic ketoacidosis (two), neonatal infection (two), dehydration (two), and exacerbation of preexisting nephrosis (one). The length of hospitalization varied from one to 38 days with a median of five days. There were ten varicella pneumonia (one), of neonatal varicella (one), and of a ruptured mycotic aneurysm secondary to septicemia (one). This review demonstrates (1) a substantial occurrence of life-threatening complications of varicella in childhood, and (2) a need for prospective epidemiologic data on the incidence of complications to determine the scope and extent of varicella vaccination.

Adolescent↗
PubMed1981

Cellulitis: initial management.

Although Staphylococcus aureus and Streptococcus pyogenes cause the majority of cellulitis, recent studies have shown a significant role for Hemophilus influenzae in facial, and less frequently, nonfacial infections. We devised an algorithm for the initial management of cellulitis based on our previous investigations showing a correlation of this organism with fever, leukocytosis, and facial involvement. Children were divided into four groups characterized as follows: Group I - extremity, temperature less than 38.5 C; Group II - extremity, temperature greater than 38.5 C, WBC less than 15,000/cu mm; Group III - extremity, temperature greater than 38.5 C, WBC greater than 15,000/cu mm; and Group IV - facial. Forty-five children were successfully followed. There were 34 in Group I, five in Group II, one in Group III, and five in Group IV. Two children in Group IV and the only child in Group III had H influenzae, recovered form the blood (3) or a direct aspirate (1). All three were febrile, with a range of 39.5 C to 40.1 C and has an elevated white blood cell count with a range of 19,200/cu mm to 26,000/cu mm. With one exception, children with cellulitis not due to H influenzae did not have both fever and leukocytosis. This algorithm allows the clinician to identify children with H influenzae cellulitis who are at risk for septic complications while minimizing unnecessary diagnostic or therapeutic interventions.

Adolescent↗
PubMed1981

Atypical lymphocytosis in children.

A complete blood count performed during the evaluation of a febrile or traumatized child may show the presence of atypical lymphocytosis. Although atypical lymphocytes occur in several conditions, they are most closely associated with infectious mononucleosis (IM). We initiated a study to determine if the presence in children of atypical lymphocytosis without the triad of splenomegaly, pharyngitis, and adenopathy is a manifestation of IM. Heterophil antibody (HA) and Epstein-Barr virus (EBV) titers were performed on 45 children with greater than or equal to 5% atypical lymphocytes. None had a significant HA titer. Thirty-three were seronegative for EBV, and 11 had titers indicative of past infection. One child had an antibody pattern suggesting a recent EBV infection; none had a titer consistent with acute IM. We conclude that isolated atypical lymphocytes does not point to infectious mononucleosis.

Adolescent↗
PubMed1980

Membrane dynamic alterations associated with activation of human platelets by thrombin.

Two fluorescent probes, N-carboxymethylisatoic anhydride, which binds to membrane proteins, and 1,6-diphenyl-1,3,5-hexatriene, a lipophilic label, have been used to follow membrane microenvironmental changes. Activation of human platelets by thrombin resulted in a simultaneous increase in values of fluorescence polarization (P) of both probes during the stages of shape change and secretion, which further increased during platelet aggregation. The similar pattern of changes in P for both probes indicates the interdependence of lipids and proteins in the activated platelet membrane.

Blood Platelets↗
PubMed1980

Penile edema in childhood gonorrhea.

A two-year-old boy with painless penile edema was seen in our emergency department. No discharge was present initially, but palpation of the urethra expressed a drop of material from the meatus. Neisseria gonorrhoeae was isolated, and the edema resolved rapidly following penicillin treatment. This report provides, to out knowledge, the first description of penile venereal edema in a child and discusses the diagnostic considerations in penile swelling.

Child, Preschool↗
PubMed1980

Cellulitis: a prospective study.

We prospectively studied 20 children, ages 2 to 12 years, seen with cellulitis. Each child had a complete blood count, a blood culture, and a culture of an aspirate from the lesion. The age of the child, the fever, and the extent of cellulitis determined whether the child was hospitalized. Outpatient antibiotic therapy was penicillin or dicloxacillin. Four children (20%) had an infection on the upper extremity: 14 (70%), the leg; 1 (5%), the forehead; and one (5%), the periorbital area. Three children (15%) had a white blood cell (WBC) count greater than or equal to 15,000 cu mm. Two were febrile. One child with a WBC count less than or equal to 15,000 cu mm was febrile. Two blood cultures (10%) were positive, both for Haemophilus influenzae. Twelve organisms were isolated from the aspirates: 8 Staphylococcus aureus (all penicillinase producing), 2 H influenzae, 1 Streptococcus pyogenes, and 1 Pseudomonas aeruginosa. Both children with H influenzae were febrile with WBC counts greater than or equal to 15,000 cu mm. Of the 17 children (85%) treated as outpatients, all but one responded. We recommend admission and cultures of the blood and an aspirate of the lesion for all facial cellulitis and treatment with oxacillin and chloramphenicol. In a truncal or extremity cellulitis, initial therapy should be directed against S aureus. If the child is febrile or the WBC count greater than or equal to 15,000 cu mm, H influenzae is a likely pathogen and thus intravenous chloramphenicol must be used after cultures are obtained.

Blood Cell Count↗
PubMed1980

Meningitis. Update of recommendations for the neonate.

Our series of children with meningitis shows an increase in the frequency of isolation of Hemophilus influenzae type B. This increase is most marked among children between one and two months of age. Since H. influenzae was found in five of the seven children between thirty and sixty days of age, we recommend the use of chloramphenicol for the initial treatment of bacterial meningitis after the first month of life. Additionally, our mortality data suggest that early diagnosis and intensive supportive therapy can contribute to a further decrease in the fatality rate of this disease.

Adolescent↗