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Biomedical subjects

R Ruddy

Publications and source records attributed to R Ruddy.

16 recordsLinked to original sources
PubMed1991

Infant botulism: a review of 12 years' experience at the Children's Hospital of Philadelphia.

Fifty-seven patients with infant botulism were cared for at The Children's Hospital of Philadelphia between 1976 and 1987. The ages of the children ranged from 18 days to slightly more than 7 months. The average duration of hospitalization was 44 +/- 34 days, with the average intensive care unit stay lasting 29 +/- 25 days (54 of 57 patients). The majority (77%) of the patients were ultimately intubated and mechanically ventilated (68%). The principal indication for intubation was loss of protective airway reflexes and not hypercarbia or hypoxemia. In those patients who required mechanical ventilation the average duration was 23 +/- 22 days, with the 10 most severely affected patients (greater than or equal to 28 days of mechanical ventilation) averaging 53 +/- 25 days. Excluding patients ventilated for more than a month, those who underwent tracheostomy were hospitalized nearly twice as long as those who were managed by nasotracheal intubation only (33.5 days vs 63.2 days). The use of continuous nasogastric feedings has supplied most infants with sufficient enteral feedings to avoid weight loss and the need for central intravenous alimentation.

Botulism↗
PubMed1990

Chest pain in children. Follow-up of patients previously reported.

During a 1-year period, 407 children with chest pain were seen in the Emergency Department of Children's Hospital of Philadelphia. Analysis of the clinical data of these children was reported previously. The authors successfully followed 149 of these children for 6 months or more, and 51 for 2 years or more. These patients returned for an average of 3.4 visits during the follow-up period. Thirty-four percent of the initial diagnoses were altered. Usually, during the follow-up period, the authors concluded that chest pain resulted from nonorganic causes. A new organic etiology was uncovered in only 12 of 149 cases. Only 1 child was found to have a heart abnormality (mitral valve prolapse), and 3 were found to have asthma. Chest pain did not resolve during the follow-up period in 43 percent of those followed. Children with chest pain should have follow-up care because of the persistence of symptoms, but serious disease is unlikely to be found over time.

Adolescent↗
PubMed1989

Knotting of a bladder catheter.

A case of knotting of a bladder catheter inserted to closely monitor a critically ill child is presented. The literature is reviewed, revealing knotting to be an unusual complication of this common pediatric procedure. Risk factors for knotting are discussed, and precautionary recommendations are presented.

Catheters, Indwelling↗
PubMed1987

Bicycle-related injuries.

To obtain epidemiologic data and information on the probable causes and severity of bicycle-related injuries, we interviewed all patients with such trauma. Between April 1 and Oct 1, 1983, 520 children presented to the Emergency Department of The Children's Hospital of Philadelphia with trauma related to two-wheeled nonmotorized bicycles. The ages of the patients ranged from 1 to 18 years (mean, 8.7 years), and most (72%) were males. Most accidents (84%) occurred less than five blocks from home, and 49% occurred in the street. Thirty-six percent of the patients admitted to stunt riding or going too fast when the accident occurred, and 36% claimed there was a problem with the surface on which they were riding. The accidents occurred when a patient lost control of the bike (45%), a patient on a bicycle was hit by a car (17%), or a pedestrian was hit by a bicyclist (10%). Only three patients were wearing protective equipment at the time of the accident. Most (54%) had received no specific safety instructions about bicycling. The extremities were injured in 53% of the accidents, but head and neck injuries accounted for 31%. Six percent required hospital admission. Males and children over 12 years of age were more likely to have multiple injuries. Accidents that occurred in the street or involved cars were associated with a greater number of serious and multiple injuries. The infrequent use of protective equipment and minimal safety instructions received by the patients in this study suggest that many bicycle-related injuries are preventable. Education of parents and children is recommended to improve bicycle safety.

Accident Prevention↗
PubMed1987

Metatropic dwarfism. Uncoupling of endochondral and perichondral growth.

Metatropic dwarfism is a rare heritable skeletal dysplasia that is thought to result from a defect in endochondral ossification. Histological studies have been few and have yielded inconsistent findings. In addition, no investigator has commented on the structure and function of the perichondral portion of the growth plate in patients who have metatropic dysplasia. To further characterize this disturbance, histological studies were carried out on autopsy specimens from the proximal part of the femur and the iliac crest of a patient who had this disorder. The major findings were: the absence of formation of normal primary spongiosa in the metaphysis; the presence of a thin seal of bone at the chondro-osseous junction, with abnormal metaphyseal vascular invasion and arrest of endochondral growth; and normal-appearing perichondral ring structures with persistence of circumferential growth. These findings suggest an uncoupling of endochondral and perichondral growth and offer an explanation for the dumbbell-shaped morphological structure of the osseous metaphysis that is seen in patients who have metatropic dysplasia. Other observations included prominence of the cartilaginous canals and vascular channels in the reserve zone; clumping of chondrocytes with enhanced staining of the pericellular matrix in the proliferative zone; a decreased ratio of cells to matrix in the hypertrophic zone, with intracellular metachromatic granules and incomplete evolution of chondrocytes; complete absence of an alcian-blue-positive zone of provisional calcification; and, finally, islands of dysplastic chondrocytes in the metaphysis. These abnormalities suggest that metatropic dysplasia is not simply a disorder of endochondral ossification. There appear to be associated defects in the longitudinal proliferation and maturation of chondrocytes and in the production of normal matrix.

Achondroplasia↗
PubMed1985

Methicillin-resistant Staphylococcus aureus in Dublin 1971-84.

Between 1971 and 1975, methicillin-resistant Staphylococcus aureus (MRSA) caused sporadic infection in eight Dublin hospitals although a case of bacteraemia was not recorded until 1976. From then on gentamicin-resistant MRSA rapidly became endemic in Dublin hospitals. The frequency of MRSA bacteraemia reached a peak in 1979-82 but MRSA infection remains an important problem. The most effective antimicrobial agent in treatment of invasive infection was vancomycin; little drug toxicity was seen. Where appropriate, concomitant surgical treatment such as debridement and drainage was usually necessary. Infection control measures directed at eliminating carriage proved effective in reducing spread. Molecular analysis showed two distinct MRSA phenotypes with similar phage-typing patterns. Gentamicin resistance was chromosomally encoded.

Gentamicins↗
PubMed1985

Temperature response to antipyretic therapy in children: relationship to occult bacteremia.

The response of rectal temperature to antipyretic therapy was studied in an attempt to identify a clinical characteristic that would distinguish children with occult bacteremia from those with sterile cultures of blood. Children 3-24 months of age with initial temperature recordings of 38.9 degrees C or greater had a blood culture drawn and received a standard dose (10mg/kg) of either aspirin or acetaminophen. Temperature was again recorded 60-120 minutes later. During the period of investigation, 255 patients were studied; 16 had bacteremia, and 239 had sterile blood cultures. There was no difference in the response to antipyretic therapy between the two groups. The mean decrease in temperature for each was similar (1.3 versus 1.05 degrees C, P = 0.14). The authors conclude that response to antipyretic therapy does not distinguish children who are bacteremic from those who are not.

Acetaminophen↗
PubMed1985

Injuries involving household furniture: spectrum and strategies for prevention.

We undertook a study to determine the incidence and spectrum of childhood injuries from accidents involving household furniture, using coffee tables as an example. Our review of data from the Consumer Product Safety Commission indicated approximately 250,000 furniture-related injuries in 1982 in the United States, 25 percent of them from coffee tables. Most of the injuries were lacerations of the head and face. In a review of injured children from our emergency department, we found that square or rectangular coffee tables with sharp edges were usually involved. A survey of pediatricians found that only 40 percent offered any advice to parents about hazardous types of household furniture. We conclude that furniture injuries are an important hazard for children and suggest strategies for prevention.

Accident Prevention↗
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↗
PubMed1982

Hypoelectrolytemia as a presentation and complication of cystic fibrosis.

We describe three patients with cystic fibrosis (CF) with four episodes of hypoelectrolytemia, two of which were associated with documented metabolic alkalosis. CF should be included in the differential diagnosis of infants and children presenting with hypoelectrolytemia and metabolic alkalosis. Patients with CF are at risk of developing severe hypochloremia in hot weather and during intercurrent illness. An abrupt diminution of oral intake is an important suggestive sign, alerting the physician to look for the development of hypoelectrolytemia.

Alkalosis↗
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↗