Biomedical subjects
Jeffrey P Louie
Publications and source records attributed to Jeffrey P Louie.
Witnessed and unwitnessed esophageal foreign bodies in children.
OBJECTIVE: The purpose of this study was to describe the clinical presentation of children with either an unwitnessed or witnessed esophageal foreign body. METHODS: Retrospective chart review was performed. Patients were identified using ICD-9 code for esophageal foreign body. Clinical data and management techniques, along with complications were abstracted. RESULTS: For the 5-year period of review, 255 patients were identified with an esophageal foreign body. 214 children had a witnessed ingestion. The mean age of the unwitnessed ingestion group was 2.3 years, compared to 4.6 years for a witnessed ingestion. In both groups, males and females were distributed equally and the most common ingested object was a coin. Bivariate, unadjusted analysis revealed that history of wheeze (OR, 4.35) and fever (OR, 11.15) had the largest association with patients who had an unwitnessed ingestion. Multivariate analysis indicated that any physical findings of wheeze, rhonchi, stridor, or retractions were associated significantly with a diagnosis of an unwitnessed foreign body. Children less than 2 years of age and with a documented fever are also predictive of an unwitnessed ingestion. Eleven children (4.3%) with esophageal abnormalities were also noted to have foreign bodies. CONCLUSIONS: Children who present to the emergency department two years old and younger, who have a documented fever and with respiratory findings should be considered at risk for having a retained esophageal foreign body. Children with esophageal abnormalities may also be at risk for retained esophageal foreign bodies.
Appropriate use of antibiotics for common infections in an era of increasing resistance.
In many respects, antibiotics have changed medicine forever. Countless lives have been enhanced and saved with antibiotic use. Unfortunately, the medical community has opened Pandora's box through the casual distribution of outpatient antibiotics. Society will indeed suffer, as well as the medical profession, if antibiotics are not used judiciously. To date, the rate of penicillin resistance has steadily risen in North America and in many other areas of the world. Much of the increase in resistance has been caused by the distribution of antibiotics for viral infections (e.g., bronchitis, colds, or purulent nasal discharge) as well as nonstreptococcal throat infections. Parental pressure for physicians to prescribe antibiotics also has contributed to the rise in antibiotic resistance. The authors have discussed many common pediatric ED infections and have illustrated the key points for making the diagnosis of each. In addition, the authors also recommend the appropriate choice of antibiotics for each disease process, with an emphasis on narrow-spectrum, first-line antimicrobials. Physicians, as the "holders of the prescription pad," should be aware of the problems with increasing bacterial resistance especially ED practitioners who work on the front line. In addition, families and patients should be educated about the harm of inappropriate antibiotic use. The AAP publishes pamphlets for parents that discuss these issues. It is believed, as was seen in Finland and Japan, that judicious use of antibiotics leads to a decrease in resistant bacteria and prolong antibiotic usefulness. This is an issue of great importance to the long-term health of patients. What Benjamin Rush stated in 1789 is true today: "Do not condemn, or oppose, unnecessarily, the simple, prescriptions of your patients. Yield to them in matters of little consequence but maintain an inflexible authority over matters that are essential to life."
Cecal volvulus in childhood.
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Rational use of antibiotics in the outpatient setting.
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