Use of the telephone in paediatric general practice.
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Attitude of Health Personnel↗
Biomedical subjects
J C Vance
Publications and source records attributed to J C Vance.
Heat stress in motor vehicles: a problem in infancy.
Children have died from heat stress because they have been left in closed automobiles. Changes in the internal temperature of various sized automobiles left in the Brisbane summer sun were examined. With all windows and doors closed, this temperature rose from an ambient level of 36 C to a maximum of 67 C within 15 minutes and remained there until the doors were opened. Slightly lower temperatures were found for light colored sedans and station wagons. However, all readings were significantly above ambient and all produced an environment unacceptable for a child. Temperatures approaching ambient were only achieved with ventilation provided by windows at least 200 mm (half) open. A lesser gap (50 mm) resulted in interior temperatures exceeding 50 C, which is still too hot for children. Infants left in such an environment will lose fluid quickly from sweat and could become as much as 8% dehydrated in four hours. Subsequently the cerebral manifestations of heat stroke would ensue. Parents and pediatricians should be warned of the danger of heat stress if children are left in a closed automobile.
Australia↗
Effects of nephrotic syndrome on the family: a controlled study.
The hypothesis that the parents and siblings of children with nephrotic syndrome are more likely to develop psychosocial problems than those of healthy children was tested. Seventy-nine siblings from 36 such families were compared with 79 healthy children from closely matched families using interviews, parent rating scales, teachers' reports, and psychological tests. Although few striking differences were found between the two groups, the findings suggest several areas of increased vulnerability among the parents and siblings of children with nephrosis. Parents often denied the existence of apparently stressful events, but the personality profiles of the siblings suggested decreased social confidence and a lesser degree of self-acceptance. Evidence of inhibition, such as less aggression and poorer academic performance, were also described in response to questions in the interview. These results should prove useful to clinicians in the management of families of children with this or other chronic illnesses.
Achievement↗
Progress in community pediatric research.
This review examines three major facets of progress in community pediatric research. The number of publications with this orientation has increased substantially over a 10-year period, and abstracts submitted to the Ambulatory Pediatric Association meetings have doubled. New methodologies are identified and their application to ambulatory pediatric care is described. In particular, procedures and approaches are examined in the context of recognized criteria for sociomedical research.
Child↗
Antibiotics: their true place in the treatment of viral disease.
The use of antibiotics in viral diseases of childhood is discussed. If bacterial infection is likely, either as superinfection or as part of the differential diagnosis, then antibiotics should be given. The antibiotic of choice for each illness is considered. Respiratory infections are common. The diagnosis and treatment of streptococcal pharyngitis is compared with viral pharyngitis. Penicillin is indicated if the bacterial infection is possible. If there is difficulty in distinguishing between croup and epiglottitis, then chloramphenicol or ampicillin should be given. Otitis media and pneumonia caused by viruses are difficult to differentiate from their bacterial counterparts, and antibiotics are indicated. By contrast, antibiotics are not used in bronchiolitis or asthma. Antibiotics are contraindicated in gastroenteritis even if caused by bacteria. Prolongation of the carrier state or superinfection may then occur. Interpretation of the biochemical and bacteriological findings of the cerebrospinal fluid is important in distinguishing viral meningitis and encephalitis from bacterial meningitis. If bacterial meningitis is possible, then antibiotics should be used. The indications for antibiotics in viral diseases of the skin, eye, joints, heart and parotid are also discussed.
Anti-Bacterial Agents↗
Immunological and chromosomal studies in a patient with Sézary syndrome.
A patient with the small-cell variant of Sézary syndrome was studied before and during treatment with low-dose chlorambucil. He had depressed responses to phytohemagglutinin (PHA) and concanavalin A that returned to normal with clinical improvement. Spontaneously dividing cells were found in the peripheral blood by culturing lymphocytes without PHA for 24 hours. Seventy-two-hour PHA-stimulated lymphocyte cultures revealed predominantly hypodiploid chromosome numbers. Both abnormalities improved during treatment. Lymphocytes that were studied for sister chromatid exchanges had an increased number of exchanges per metaphase. Immunofluorescence studies revealed immunoglobulins and C at the dermoepidermal junction and in the dermal vessel walls. Our findings demonstrate that the depression of mitogen responsiveness that is sometimes seen in Sézary syndrome can be favorably affected by chemotherapy. Likewise, some chromosomal abnormalities may regress during successful therapy. These findings may provide a way of measuring the response to therapy.
Chlorambucil↗
Heterozygous alpha-1-antitrypsin deficiency and respiratory function in children.
We evaluated 224 children from Rochester, New York, families in which at least one parent was heterozygous for alpha-1-antitrypsin (AAT) deficiency by protease inhibitor (Pi) typing. The childhood population included, of the two major heterozygote Pi types, 75 Pi type MS children and 37 Pi type MZ children. This population was evaluated by means of a standardized respiratory questionnaire, physical examination, and pulmonary function tests. Maximal expiratory flow volume curves were obtained with subjects breathing both air and a helium-oxygen mixture. Total pulmonary resistance by the method of forced oscillations was measured at 3, 5, 7, and 9 cps. No differences in respiratory symptoms or physical findings were seen in Pi type MZ and MS children compared to Pi type MM children. However, when pulmonary function tests were evaluated by a matched-pair analysis designed to minimize other genetic and environmental risk factors, Pi type MZ subjects demonstrated statistically significant differences in forced expiratory flow rates and in increased frequency-dependent characteristics of total pulmonary resistance. These abnormalities are similar to those previously described in adult Pi type MZ subjects, and suggest that physiologic abnormalities associated with AAT deficiency are present early in life.
Adolescent↗
Depressed immune function in epidermodysplasia verruciformis.
Epidermodysplasia verruciformis (EV) is a rare disease characterized by the early onset and unremitting progression of wart-like lesions and frequent association of cutaneous carcinomas. We report two siblings with EV. Immunologic study of both patients demonstrated normal immunoglobulin levels, normal numbers of T-lymphocytes and B-lymphocytes, but markedly depressed in vitro blastogenic reactivity to mitogens and antigens. Cutaneous anergy to a variety of common skin test antigens was noted. These observations may reflect an inherited abnormality in immune function, or the depressed immune function may result from the viral infection of EV.
Adult↗
Day-transfusion centre for patients with thalassaemia major.
In August, 1973, the Royal Children's Hospital in Melbourne, Australia, established a day-transfusion centre for treatment of children with thalassemia major. The centre is described, and the results of the first 4 months of operation were compared with a similar period before the centre opened, for the same fifty children. A significant decrease in total number of nights spent in hospital, hours spent at hospital for each blood-transfusion, days lost from school or unusual activity, and travel cost was noted. The transfusion-rate rose, but this probably reflected a change of policy rather than an effect of the centre.
Adolescent↗
Phenytoin teratogenicity in man.
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Abnormalities, Drug-Induced↗