The hazards of using a child as an interpreter.
When a language barrier prevents communication with immigrant parents, there may be a temptation to use a bilingual child as an interpreter. We report a possible hazard.
Anorexia↗
Biomedical subjects
T J David
Publications and source records attributed to T J David.
Clinical management of children and adults with cystic fibrosis.
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Adult↗
Migration of fine bore Silastic catheter to pulmonary artery.
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Catheterization, Central Venous↗
Management of anaphylactic reactions to food.
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Aerosols↗
Recapturing a five-month-old bite mark by means of reflective ultraviolet photography.
After a brutal rape, which the victim survived, a bite mark was photographed and other evidence was collected. It was not until several months later when the bite mark became a critical piece of evidence, that the problem with its collection became apparent to the prosecutor. The photograph of the bite mark taken by law-enforcement officials at the time of the crime did not include a reference scale. Therefore the bite mark was of little evidentiary value. The authors subsequently examined the victim (five months later) and "recaptured" the bite mark pattern with a proper reference scale by means of reflective ultraviolet photography.
Bites, Human↗
Growth in atopic eczema.
Growth was studied in 68 children aged 2-12 years with atopic eczema. Height SD scores were significantly correlated with the surface area of skin affected by eczema. The mean height of 41 patients with less than 50% of their skin surface affected (group I) was normal (mean SD score -0.11). The 27 children with more than 50% of their skin affected (group II) were significantly shorter (SD score -0.83) and were also short allowing for their parental target height. The predicted heights were also normal in group I but were lower than expected in group II. Regression analysis suggested that height was most dependent on parental height. The extent of the disease had a significant additional effect, whereas dietary treatment and treatment with topical steroids had only marginal additional effects. The growth of children with eczema affecting less than 50% of the skin surface area appears to be normal, and impaired growth is confined to those with more extensive disease.
Age Determination by Skeleton↗
Psychosocial adjustment in preschool children with atopic eczema.
Atopic eczema is a chronic skin disorder that is most common in early childhood, an important stage in the child's social and emotional development. The psychiatric adjustment and mother-child attachment in 30 preschool children with severe atopic eczema was compared with 20 matched controls. Patients with eczema had a significant increase in behaviour symptoms, 7/30 (23%) v 1/20 (5%); with significant excess of dependency/clinginess, 15/30 (50%) v 2/20 (10%); fearfulness, 12/30 (40%) v 2/20 (10%); and sleep difficulty, 19/30 (63%) v 9/20 (45%), but there was no significant difference between the two groups in the security of attachments, 25/29 (86%) v 14/20 (70%). Significantly fewer mothers of children with atopic eczema were in outside employment, 8/29 (27%) v 13/20 (65%), or felt supported socially, 10/29 (34%) v 13/20 (65%). Significantly more of them, 9/30 (30%) v 1/20 (5%), felt particularly stressed in relation to their parenting and less efficient in their disciplining of the affected child. In spite of this and at variance with earlier reports in the literature, they did not display negative attitudes towards their child. On the contrary mothers had a positive empathic attitude towards the child, 7/14 (50%) v 2/16 (12%). Child behaviour problems, 7/14 (50%) v 2/16 (12%), and maternal distress, 12/14 (85%) v 5/16 (31%), were significantly more common in the more severely affected children. Minor behaviour problems and parenting distress are important features of severe atopic eczema in early childhood but atopic eczema does not lead to insecurity of the mother-child attachment.
Adaptation, Psychological↗
Poland anomaly with contralateral ulnar ray defect.
We report an atypical case of the Poland anomaly. Unreported features are that the hand abnormality is on the contralateral side to the chest wall defect, there is an ulnar ray predominance, and lack of syndactyly.
Fingers↗
Controlled study of Pseudomonas cepacia and Pseudomonas maltophilia in cystic fibrosis.
In a retrospective study, children with cystic fibrosis who were colonised with Pseudomonas cepacia were compared with a control group who were colonised with Pseudomonas maltophilia. Out of 216 children with cystic fibrosis seen between 1983 and 1990, P cepacia was recovered from 13 (median age at colonisation 12.2 years) and P maltophilia from 23 (median age at first colonisation 6.1 years), and both organisms were recovered in five cases. With the exception of two patients with P cepacia in whom no other pathogens were found, all the patients with P cepacia or P maltophilia had co-colonisation with Pseudomonas aeruginosa. The lack of spread of P cepacia to siblings with cystic fibrosis, and the relative lack of inpatient contact between colonised and uncolonised patients suggest that cross infection is not the sole route whereby patients with cystic fibrosis become infected, but the possibility of cross infection cannot be excluded from our data. Three patients with P cepacia died, but two of these had shown appreciable respiratory deterioration before colonisation with P cepacia; there was no evidence of unexpected deterioration in the remainder or in the controls with P maltophilia. By 1990, the prevalence of P cepacia was 9/133 (7%) and that of P maltophilia was 13/133 (10%), but it was impossible to determine to what extent this increase was due to the introduction of the routine use of selective media. Further studies are required to establish whether patients with and without P cepacia should be segregated.
Adolescent↗
Tartrazine in atopic eczema.
Multiple double blind placebo controlled challenges with tartrazine 50 mg (three challenges) and glucose placebo (three challenges) were performed in 12 children with atopic eczema aged 1 to 6 years. The children were selected on the basis of severity (regular clinic attenders) and a parental history that tartrazine provoked worsening of the eczema. In only one patient did the three tartrazine challenge periods correspond with the highest symptom scores or the highest physician observer scores, and the probability of this occurring by chance in one or more patients out of 12 was 0.46. In this sample we were unable to confirm intolerance to tartrazine in 11 out of 12 patients.
Child↗
Extreme dietary measures in the management of atopic dermatitis in childhood.
Of 63 children with severe atopic dermatitis who were treated with a diet eliminating all but 6 foods for a 6-week period, 9 (14%) abandoned the diet, 21 (33%) completed the diet but did not benefit, and in 33 (52%) there was significant benefit. However, the outcome at 12 months was the same regardless of the response to the diet because of the tendency for dermatitis to markedly improve in all three groups. Of 37 children with exceptionally severe atopic dermatitis treated with an antigen avoidance regimen comprising hospitalization, exclusive feeding with an elemental formula for a median duration of 30 days, and measures to reduce exposure to pet animal and dust mite antigens at home, 10 (27%) either failed to respond to the regimen or relapsed within 12 months, and sustained improvement was seen in 27 (73%) patients. A few-food diet or a strict anti avoidance regimen may be associated with improvement of atopic eczema where conventional treatments have failed.
Adolescent↗
Elemental diet for refractory atopic eczema.
A total of 37 children with refractory wide-spread atopic eczema were treated with an antigen avoidance regimen comprising hospitalisation, exclusive feeding with an elemental formula for a median duration of 30 days, and measures to reduce exposure to pet and dust mite antigens at home. After the initial period of food exclusion, food challenges were performed at intervals of seven days, and the patients followed up for at least 12 months. Ten of the children (27%) either failed to respond to the regimen or relapsed within 12 months. Improvement in the eczema was seen in 27/37 (73%) patients, by discharge from hospital their disease severity score had fallen to a median of 27% of the pretreatment figure, and only 3/27 required topical corticosteroids. There were no clinical or laboratory findings which could be used to predict the outcome. Drawbacks to the regimen were prolonged hospitalisation (median 70 days), a fall in body weight and serum albumin concentration, and a risk of anaphylactic shock (4/37 cases). A strict antigen avoidance regimen may be associated with improvement of atopic eczema where conventional treatments have failed.
Animals↗
Holidays and atopic eczema.
Information was collected by telephone about 300 holidays taken over a three year period by 126 children with severe atopic eczema. During the holidays, improvement in eczema occurred more frequently (112/300, 37%) than deterioration (63/300, 21%). There was a significant correlation between improvement and a more southerly holiday location: improvement was common in holidays taken in the Mediterranean or further south (63/92, 69%), but holidays in northern Britain were more likely to be associated with deterioration (27/100, 27%) than improvement (13/100, 13%). Changes in eczema were correlated with changes in asthma in 231 holidays taken by children with both conditions, but improvement was not significantly associated with pet ownership. All patients returned to their preholiday state, usually within two weeks of return home. The causes of changes in eczema while on holiday have not been identified.
Adolescent↗
Six food diet for childhood atopic dermatitis.
Sixty-three children with severe atopic dermatitis aged 0.4 to 14.8 years, were treated with a diet eliminating all but six foods for a 6-week period. Nine (14%) abandoned the diet before 6 weeks had elapsed. Twenty-one (33%) completed the diet but did not benefit. Thirty-three (52%) patients obtained greater than or equal to 20% improvement in the disease severity score at 6 weeks, and for these patients, foods were reintroduced singly at weekly intervals. The outcome at 12 months was the same for the group who responded to the diet, the group who failed to respond, and the group who failed to comply, because of the tendency for dermatitis to improve markedly in all three groups. Although dietary elimination of this type may be associated with immediate improvement, the long term outcome appears to be unaffected by dietary success or failure.
Adolescent↗
Nocturnal growth hormone release in children with short stature and atopic dermatitis.
This study was designed to test the hypothesis that children with atopic dermatitis and short stature fail to release growth hormone after falling asleep. Peak serum growth hormone response to arginine was compared with peak growth hormone concentration during sleep in 6 children with atopic dermatitis and short stature (greater than 3 SD below the mean) aged 7 to 12 years, and 5 control children aged 9 to 12 years without atopic dermatitis or asthma but with unexplained short stature (greater than 3 SD below the mean). All 5 control children achieved normal levels of growth hormone after falling asleep, whereas 3 of the 6 children with dermatitis did not. All patients with dermatitis were capable of releasing growth hormone after arginine stimulation. The results suggest that in some prepubertal children with atopic dermatitis and short stature there may be an impairment of growth hormone release during stage 4 sleep.
Arginine↗
Failure of oral zinc supplementation in atopic eczema.
An eight week double-blind placebo-controlled trial of oral zinc sulphate 185.4 mg per day was undertaken in 50 children with atopic eczema aged 1-16 years. In those receiving zinc there was no significant improvement in disease severity as assessed by surface area affected and degree of erythema, symptom scores of itch, sleep disturbance and redness of skin, or weight of emollient or topical steroid use.
Administration, Oral↗