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Biomedical subjects

T Schonfeld

Publications and source records attributed to T Schonfeld.

At least 19 recordsLinked to original sources
PubMed2001

Acute diaphragmatic paralysis caused by chest-tube trauma to phrenic nerve.

A 3 1/2-year-old child developed unilateral diaphragmatic paralysis after chest drain insertion. Plain chest X-ray demonstrated paravertebral positioning of the chest-tube tip, and magnetic resonance imaging revealed hematomas in the region of the chest-tube tip and the phrenic nerve fibers. The trauma to the phrenic nerve was apparently secondary to malposition of the chest tube. This is a rare complication and has been reported mainly in neonates. Radiologists should notify the treating physicians that the correct position of a chest drain tip is at least 2 cm distant from the vertebrae.

Acute Disease↗
PubMed2001

Improvement of atypical acute disseminated encephalomyelitis with steroids and intravenous immunoglobulins.

Acute disseminated encephalomyelitis is a demyelinating syndrome that occurs infrequently in children. Various treatment modalities, such as plasmapheresis or steroids or intravenous immunoglobulins (IVIG), have been prescribed. The article describes the results of combined IVIG and high-dose steroids given for 3 days in the treatment of a patient with atypical encephalomyelitis. The results suggest that this approach may be more beneficial than the application of either drug alone.

Anti-Inflammatory Agents↗
PubMed2001

Yield of bronchoalveolar lavage in ventilated and non-ventilated children after bone marrow transplantation.

A study was undertaken to retrospectively evaluate the yield of bronchoalveolar lavage (BAL) in a single-institution series of children after bone marrow transplantation (BMT) and to compare the yield of BAL between the ventilated and nonventilated patients. We reviewed charts of 52 consecutive children after BMT who underwent BAL. Thirty patients (41 BALs) were nonventilated (group 1) and 33 patients (45 BALs) were ventilated for respiratory failure (group 2). Eleven patients were included in both groups. BAL was performed a median of 255 and 28.5 days after BMT in groups 1 and 2, respectively (P < 0.001). Group 1:17 pathogens were isolated from 13 BALs; a single pathogen from 10 BALs. Group 2:15 pathogens were isolated from 14 BALs (31.1% positive). Viruses were isolated from 13 BALs in group 2. A severe complication of BAL occurred in only one patient from group 1 (1.1%). Open lung biopsies were performed in one patient in group 1 and eight patients in group 2. The histological findings correlated with the BAL findings in 66.7%. In conclusion, there was no difference in the yield of BAL between the groups. Therapy was changed in one third of the patients dictated by the BAL findings. The risk of severe complications was relatively low. A good correlation between open lung biopsy (OLB) and BAL was found.

Bone Marrow Transplantation↗
PubMed2001

Benign occipital epilepsy mimicking a catastrophic intracranial event.

OBJECTIVE: To describe the rare, dramatic, presentation of benign occipital epilepsy. METHODS: We describe three children who presented to the pediatric emergency department from 1992 to 1996 with a clinical picture of catastrophic intracranial event. RESULTS: The main signs and symptoms were loss of consciousness in all patients, apnea in two, hemiclonus in two, general hypertonicity in two, eye deviation in two, fixed dilated pupils in one, and decorticate rigidity in two. All underwent emergency intubation, brain scan, and lumbar puncture, and all were treated with antibiotics, in addition to antiviral drugs in two. Two patients were also treated for suspected increased intracranial pressure. Two patients recovered within a few hours and one within 24 hours of admission without any residual neurologic deficit. Electroencephalograms, done within 48 hours after the event, revealed the classic pattern of occipital epilepsy in two patients and bilateral occipital slow wave in one. A 3- to 5-year clinical and electroencephalographic follow-up supported the diagnosis. CONCLUSION: Benign occipital epilepsy in children can mimic a catastrophic intracranial event. Electroencephalography, performed early in the Pediatric Intensive Care Unit, may avoid or shorten unnecessary and aggressive treatments such as hyperventilation, diuretic agents, and prolonged antiviral therapy.

Apnea↗
PubMed2000

Severe allergic bronchopulmonary aspergillosis in an infant with cystic fibrosis and her asthmatic father.

An infant with cystic fibrosis and her asthmatic father were diagnosed as suffering from allergic bronchopulmonary aspergillosis (ABPA). Cystic fibrosis was diagnosed in the infant at 6 weeks of age, and gene mutations were W1282X/G542X. She was diagnosed definitively as suffering from ABPA at age 3.5 years, but had suggestive symptoms from age 11 months. This may be the youngest age described to date for ABPA. The child responded well to systemic steroid therapy, but remained steroid-dependent over the next 4 years. Treatment with itraconazole enabled a marked reduction in steroid dosage. The father was an asthmatic, and a heterozygote for the cystic fibrosis transmembrane regulator (CFTR) mutation W1282X. He had a normal sweat test, atopy, and moderate reversible airway obstruction. There was no proven exposure to Aspergillus in the home environment. The importance of considering the diagnosis of ABPA even in infancy, the therapeutic dilemmas, and the possible role of abnormal CFTR function in the development of ABPA are discussed.

Adult↗
PubMed2000

Selected abstracts

Explore the source record for details and available documents.

Journal Article↗
PubMed1998

Prolonged croup due to herpes simplex virus infection.

UNLABELLED: Herpes simplex virus (HSV) is an uncommon cause of acute laryngitis in immunocompetent patients since it mostly occurs in immunocompromised subjects. We present two previously healthy children with prolonged gingivostomatitis and stridor (lasting 3 and 4 weeks) in whom HSV-1 was isolated from subglottal ulcers. CONCLUSION: HSV should be considered a possible pathogen in cases of prolonged or atypical croup not only in immunocompromised or elderly patients but also in otherwise healthy children.

Croup↗
PubMed1998

Open lung biopsy--successful diagnostic tool with therapeutic implication in the critically ill paediatric population.

Open lung biopsy (OLB) is an important diagnostic tool in children with immune deficiency and/or chronic lung disease with diffuse pulmonary compromise. These patients require a tailored therapeutic approach owing to their fragile status and the side effects of unnecessary or inadequate treatment. Twenty-six patients of mean age 5.6 y underwent 41 open lung biopsies in our centre between 1991 and 1995. Seventeen (65%) were immunocompromised (including 13 with malignancy) and 9 had other lung diseases. The biopsies were diagnostic in 25 patients (96%), and complete clinical-pathological correlation was found in 11 (42%). A specific infectious aetiology was detected in nine patients (35%), all of them immunocompromised. Therapeutic changes were instituted on the basis of the biopsy findings in 18 patients (69%). Two patients had postoperative complications (prolonged pleural leak). We conclude that OLB is a safe diagnostic procedure even in the critically ill child and should be employed without hesitation when conventional methods fail to provide a definitive diagnosis to help redirect therapy.

Adolescent↗
PubMed1998

Early emergence of ganciclovir-resistant human cytomegalovirus strains in children with primary combined immunodeficiency.

Children with primary combined immunodeficiency (CID) and human cytomegalovirus (HCMV) infection often deteriorate despite antiviral therapy. In this study, the emergence of ganciclovir-resistant strains was examined in 6 children with CID and HCMV infection, using sequence analysis of the HCMV UL97 gene and virus susceptibility assays. Mutations in the proposed ATP binding site associated with ganciclovir resistance were found in 4 of the 6 children. In 1 patient with B severe CID, an unusual multiplicity of mutations was found in the UL97 substrate binding domain between aa 590-606. All mutations were detected within 10 days to 3 weeks from initiation of therapy. The emergence of resistant strains in children with CID appears earlier than in other groups of HCMV-infected patients. These findings may have relevance to the cellular pathways involved in viral DNA repair and mutagenesis, and they indicate the need for early and frequent genotypic monitoring and prompt therapeutic modification in this patient population.

Bone Marrow Transplantation↗
PubMed1996

Screening obstructive sleep apnoea syndrome by home videotape recording in children.

Overnight polysomnography (PSG) has been used to diagnose and assess the severity of obstructive sleep apnoea syndrome (OSAS) in children. The aim of this study was to determine whether home video-recording of children during sleep may be used for screening OSAS. In 58 children suspected of having OSAS, PSG results were compared with the corresponding analyses of 30 min video-recordings of each child sleeping at home. The video-recordings were evaluated by: 1) overall investigator's clinical judgement; and 2) a scoring system based on noisy breathing, movements, walking episodes, apnoea, chest retractions and mouth breathing. PSG results were highly correlated with the video test results, with agreement in 49 out of 58 (84%). In 36 of the 58 children, the PSG was abnormal compared with 41 out of 58 abnormal video tests. The sensitivity of the overall investigator judgement of video test was 94% (34 out of 36) and the specificity 68% (15 out of 22). Video scores > 10 were highly predictive of OSAS, whilst scores < 5 were associated with normality. Using a stepwise logistic regression analysis, each of the scoring variables was tested against the PSG results and an equation was formulated for predicting PSG by the video test. The equation predicted PSG results in 49 out of 58 (84%) cases. Thirty minutes of home video-recordings during sleep is a reliable screening method for obstructive sleep apnoea syndrome in children. This technique may, thus, improve patient selection for polysomnography.

Algorithms↗
PubMed1992

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↗
PubMed1991

Outcome of oncology patients in the pediatric intensive care unit.

We evaluated the outcome of oncology patients in the Pediatric Intensive Care Unit (PICU) from a total of 72 consecutive admissions. Severity of illness and quantity of care were measured by the Physiologic Stability Index (PSI) and the Therapeutic Intervention Scoring System (TISS), respectively. The overall mortality was 51% and was especially high in patients admitted for acute organ system failure (OSF)-66%. Acute respiratory failure was the most frequent OSF (73%) and the most common cause for PICU admission. A poor outcome was associated with severe leucopenia (less than 1000 WBC/mm3, 91% mortality), acute renal failure (94% mortality) and central nervous system deterioration (83% mortality). When the outcome was predicted using a quantitative algorithm the observed mortality was significantly higher than the predicted for all admissions with a PSI higher than 5. Improved scoring systems are required to enable characterization of pediatric cancer patients admitted to the PICU.

Acute Kidney Injury↗
PubMed1989

Transient tachypnoea of the newborn and asthma.

A total of 58 children aged 4-5 years who were diagnosed as having transient tachypnoea of the newborn were studied. In contrast with the control group (n = 58), the infants with transient tachypnoea of the newborn had a significantly higher incidence of recurrent (more than two) episodes of wheezy breathlessness, symptoms consistent with asthma, and signs consistent with atopy.

Asthma↗
PubMed1988

Determination of blood gases in children with extreme leukocytosis.

The effect of extreme leukocytosis (greater than 300,000/mm3) on the PaO2 of blood stored at 22 degrees and 2 degrees C was studied in two children with leukemia. Arterial blood samples drawn from these patients at 1 and 10 min were compared to blood samples drawn from eight control patients with normal leukocyte counts and PaO2 levels in the same range. One minute after drawing the samples, the PaO2 values at 2 degrees C were significantly higher than those stored at 22 degrees C. Later, there was a rapid and progressive decline in PaO2 values in both samples stored at 2 degrees and 22 degrees C. Rapid consumption of O2 by leukocytes is liable to result in erroneous diagnosis of severe hypoxemia in patients with extreme leukocytosis. Immediate cooling of the samples is insufficient to eliminate this process.

Blood Gas Analysis↗