[Gastroesophageal reflux in children].
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Biomedical subjects
Publications and source records attributed to M Nitzan.
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We studied 158 children with culture-proven shigellosis, 37 (23.4%) of whom had convulsions. Historical, clinical, and laboratory data were compared between patients with and without convulsions to define risk factors for the development of seizures. Age was the most important predisposing factor. The highest incidence of shigellosis associated with convulsions was found in children between 6 months and 4 years of age. Peak body temperature and a family history of convulsions also independently affected the development of seizures. Sex and Shigella strain showed differences between the groups but failed to reach statistical significance.
In view of the role of immunoglobulin A (IgA) in the local host defenses of the gut and biliary tract, and the association of IgA deficiency with various intestinal disorders, an ultrasonographic study was performed to determine the prevalence of gallstones in selective IgA deficiency. Eight of 13 children (three girls and five boys) with selective IgA deficiency had abnormal biliary sonograms. Four had cholelithiasis, and four had biliary sludge only. IgA deficiency may predispose to gallbladder infection, and thus to the development of gallstones. Decreased bile acid pool due to intestinal losses, and biliary stasis due to reduced hormonal gallbladder stimulation may also play a role in some cases, but further studies are needed. This association adds a new gastrointestinal abnormality to those known to be associated with selective IgA deficiency.
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The total and differential leukocyte counts of 238 infants with acute gastroenteritis were evaluated as an aid in differentiating between nonbacterial and bacterial infection. In contrast to the total leukocyte count, which was noncontributory, the absolute band count and the ratio between band and total neutrophil count (B/N ratio) were helpful, with the highest values seen in patients with Shigellosis. A B/N ratio greater than 0.10 can help differentiate Shigella, Salmonella, and Campylobacter infections from E. coli and nonbacterial gastroenteritis with a sensitivity of 84.3 per cent and a specificity of 74.5 per cent.
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Unilateral hydrocephalus due to foramen of Monro-obstruction was diagnosed in a newborn who presented with macrocephaly at birth. The mother had mumps in the second trimester of pregnancy and immunological studies indicated possible intrauterine infection of the baby with mumps virus. His condition deteriorated rapidly, and he developed myoclonic seizures. The possible relationship of intrauterine mumps infection to neonatal neurological complications is discussed.
A giant pigmented nevus (GPN) was present in only one of identical twins. Proof of the identical twinship was based on blood group and HLA system findings. The time of appearance of GPN malformation is assumed to be during early embryologic life. Despite previous opinions to the contrary, we suggest that there is no genetic transmission in GPN.
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One of two children admitted with septicemia due to group A beta-hemolytic streptococcus died following a very fulminant course. This organism may cause overwhelming disease in newborn infants, as well as in children with diseases which compromise the immune system. Group A streptococcus, though very sensitive to penicillin, can cause severe and rapidly progressive illness even in previously normal children, unless recognized and treated promptly.
The major complication in the acute form of infantile spinal muscular atrophy is the aspiration phenomenon, due to the pharyngo-laryngeal deficit. The radiographic findings of this deficit are characterized by epipharyngeal regurgitation, hypopharyngeal distention, good function of the cricopharyngeal sphincter and absence of epiglottic closure during the act of deglutition. The differential diagnosis of other neuromuscular entities is discussed in view of two documented radiographic cases.