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Biomedical subjects

M Nitzan

Publications and source records attributed to M Nitzan.

At least 19 recordsLinked to original sources

[Transient hyperphosphatasemia of infancy].

Transient hyperphosphatasemia of infancy was diagnosed in 4 children hospitalized during a 6-month period (0.3% of all hospitalized children). The characteristic features of this disorder are: 1. elevation of serum alkaline phosphatase (of both liver and bone origin) up to 3-30 times the upper limit of normal for age (usually discovered during intercurrent infection); 2. return of the serum alkaline phosphatase to normal in a few weeks; 3. no residual clinical or laboratory evidence of bone or liver disease. The child is usually less than 5 years old. Recognition of the benign nature of this disorder prevents extensive laboratory workup and unnecessary anxiety.

Alkaline Phosphatase

ECG gated radionuclide plethysmography--a method for the assessment of pulmonary systolic blood volume increase.

During cardiac systole the stroke volume of blood which is ejected from the right ventricle increases the pulmonary blood volume. This systolic pulmonary blood volume increase is measured by using ECG gated chest scintigrams obtained with 99Tcm-labelled red blood cells. The total radiation counts in a region of interest that includes either the right or the left lung increases during systole. On the average, the increase of the total pulmonary systolic radiation was found to be 62% of the systolic radiation decrease in the left ventricle region of interest. The discrepancy between the value of the systolic pulmonary blood volume increase and that of stroke volume is attributed to blood flow from the lungs into the left atrium during the cardiac systole period.

Adult

Sudden infant death syndrome in the Tel Aviv and Petah Tikva districts.

We studied the epidemiology and incidence of the sudden infant death syndrome (SIDS) in the Tel Aviv and Petah Tikva districts during the period April 1980 to March 1983. Sixty-nine infants were diagnosed as SIDS and 38 of them had autopsies. Four cases were excluded because their autopsy revealed other diagnoses. When calculating for 24,183 live births per year during the study period, the rate of SIDS was found to be 0.47-0.90:1,000 live births. Other epidemiologic characteristics were: female:male [corrected] ratio 1:1.3; peak incidence at 2-4 months age, with 80% before age 6 months; increased incidence during the autumn and winter months (85% of SIDS cases); and highest incidence between midnight and 8:00 AM (84% of SIDS cases). None of the infants had a history of a previous apparent life-threatening event. Birthweight of infants who died of SIDS was not significantly different from that in the general population. No statistical relation to DTP (diphtheria, tetanus, pertussis) vaccination was found. Half the cases had mild respiratory illness during the week that preceded the sudden death. The incidence of parental cigarette smoking was higher than in the general population (56.5% vs. 36-53%; P less than 0.005) as well as the incidence of maternal smoking during pregnancy. We conclude that the incidence of SIDS in Israel is relatively low. The epidemiologic characteristics of SIDS in Israel are very similar to the presentation of the syndrome in other countries.

Age Factors

In-flight esophageal variceal bleeding en route for liver transplantation: a case report and review of the literature.

Esophageal variceal bleeding owing to portal hypertension is a potential threat in pediatric patients awaiting liver transplantation. We report a case of a three-year-old boy with severe congenital hepatic fibrosis, Caroli's disease, and portal hypertension who developed a life-threatening variceal hemorrhage for the first time in his life during commercial air transport to a liver transplantation center. Factors precipitating variceal bleeding are discussed, particularly those resulting from changes in altitude. It is recommended that prophylactic treatment for variceal bleeding be at least considered in children awaiting liver transplantation prior to prolonged air transportation. Because of differences in capabilities of treatment providers in various locales, and because there are as yet no conclusive data, the treatment of choice must be decided on an individual basis. Equipment for treating in-flight hemorrhage should be available.

Aerospace Medicine

The prognosis of convulsions during childhood shigellosis.

We examined the long-term outcome in 111 children who had convulsions during shigellosis and were followed for 3-18 years after the incident. No deaths or persistent motor deficits occurred as sequellae. Poor coordination of fine hand movements were noted in 3.3% of the 92 children who had no pre-existing neurological abnormality. Only 1 child developed epilepsy by the age of 8 years. Of the children 15.7% had recurrent febrile seizures. The only risk factor identified for febrile seizures following convulsions in shigellosis was a previous history (P less than 0.01). These observations suggest that convulsions in shigellosis have a favourable prognosis, and do not necessitate long-term follow up.

Child

Vestibular evoked potentials with short and middle latencies recorded in humans.

Following success in recording short latency vestibular evoked potentials in experimental animals, we have succeeded in our attempts to record such potentials in human subjects. The stimuli were repetitive, short steps of high intensity angular acceleration (10,000 degrees/sec2) with short rise times which would synchronously activate many neurons of the vestibular pathway. Stringent control procedures ensured that the recorded activity was not an artefact. Short latency vestibular evoked potentials were recorded in 10 normal subjects with peak latencies of 3.5, 6.0 and 8.4 msec and amplitudes of 0.5 microV. Middle latency potentials were also recorded with latencies of 8.8, 18.8 and 26.8 msec and amplitudes of 15 microV. These responses were absent in a cadaver and in patients with bilateral dead labyrinths. In normal subjects, these vestibular evoked potentials were not affected by white noise. In conclusion, short and middle latency vestibular evoked potentials were recorded in normal human subjects.

Adolescent

Transient renal acidification defect during acute infantile diarrhea: the role of urinary sodium.

We studied urinary acidification daily during the hospital course of 16 infants with acute gastroenteritis and metabolic acidosis. Urine pH value on admission was higher than 5.5 in 14 (87%) patients. We hypothesized that inappropriate urinary acidification was due to sodium deficiency and inadequate sodium delivery to the distal nephron. Forty-one urinary samples were collected during metabolic acidosis. The mean pH of 24 urine samples with sodium concentration less than 10 mmol/L was significantly higher than the pH of 17 samples with sodium concentration greater than 10 mmol/L (6.04 +/- 0.06 vs 5.19 +/- 0.1; p less than 0.001). The urine ratios of titratable acid to creatinine and of total acidity to creatinine were significantly higher in urine samples containing more sodium (p less than 0.02), whereas the ammonium/creatinine ratio was not. After administration of furosemide or correction of the sodium deficit, appropriate acidification was observed. We conclude that impaired urinary acidification is frequently found during metabolic acidosis in infants with acute gastroenteritis and results from a sodium deficit rather than from transient distal renal tubular acidosis.

Acidosis, Renal Tubular

Occult ocular damage as a leading sign in the battered child syndrome.

A three-month old, premature female infant is presented with severe bilateral occult ocular damage comprised of cataracts, lenses dislocation, retinal hemorrhages and total funnel-shaped retinal detachment without external signs such as bruises. This severe eye trauma is the result of child abuse. We would like to alert pediatricians as well as ophthalmologists that any ocular injury should raise the possible diagnosis of battered child syndrome even in the absence of other supportive evidence of external trauma.

Battered Child Syndrome

[Vestibular dysfunction and deafness complicating mumps parotitis].

A 9-year-old boy developed severe positional vertigo, unsteadiness, vomiting and nystagmus during active mumps parotitis. Audiometric examination showed complete right sensorineural hearing loss. Brain stem evoked response to audiometric stimulation of the left ear was normal, but was absent on stimulation of the right ear. CT scan of the brain was normal. While vestibular symptoms gradually improved during 1 week, the deafness on the right was permanent. Acute vestibulitis during mumps is very rare, but permanent unilateral deafness might be a much more common, severe, persistent complication than is generally believed. Such cases call for an urgent change in Israel's vaccination policy so that vaccination against mumps is included.

Audiometry

Recurrent ascites in an infant with perinatally acquired cytomegalovirus infection.

We describe an infant with symptomatic perinatally-acquired cytomegalovirus (CMV) infection manifested by fever, anaemia, thrombocytopenia and hepatosplenomegaly. This infant developed recurrent episodes of severe ascites during which the virus was isolated from his urine. This rare hepatic manifestation of neonatal CMV infection has, to the best of our knowledge, only been reported twice in aborted fetuses with intrauterine systemic CMV infection.

Ascites

Nutritional complications in an infant fed exclusively on homemade sesame seed emulsion.

A 3-month-old infant was exclusively fed a high calorie homemade sesame seed emulsion for 4 weeks. As a result of the milk content, the infant developed hypermagnesemia, hypokalemia, hyponatremia, and hypovitaminosis C. Although the mixture was highly caloric and the infant's intake was good, he showed profound failure to thrive. Analysis of the emulsion indicated that this complication was primarily due to the heterogeneity of the emulsion's caloric content resulting from a settling process which occurred after the emulsion was placed in the infant's bottle. This settling resulted in the portion containing the most calories being the last to reach the infant's mouth. These findings indicate that whenever a vegetarian diet is provided to a bottle-fed infant, the potential heterogeneity of the mixture's caloric content, as well as the contents themselves, should be considered.

Emulsions