Biomedical subjects
W L Robson
Publications and source records attributed to W L Robson.
Head banging.
Head banging is the rhythmic movement of the head against a solid object and is marked by an almost compulsive repetitiveness. The reported incidence in childhood varies from 5 to 15%. The male to female ratio is approximately 3 or 4 males to each female. While the exact etiology is unknown, the suggested etiologies include: an integral part of normal development, a kinesthetic drive, a tension releasing maneuver, an attention-seeking device, a response to restricted activity, a consequence of emotional deprivation, and a response to various acute illnesses. The onset is usually in the latter half of the first year of life and generally ends spontaneously by four years of age. Head banging generally occurs before normal sleep. The duration may vary from a few minutes to an hour. The frontal-parietal region of the head is the most frequently struck. Although head banging appears alarming, the child seldom inflicts significant damage to the head. The physical examination in children who are head bangers is usually normal. Laboratory investigations are generally not indicated. The appropriate treatment of head banging is to offer the parents a supportive and reassuring explanation that brain damage is unlikely and that the child will outgrow the problem.
Clinical signs of dehydration in children.
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Single umbilical artery. A report of 159 cases.
We retrospectively reviewed the records of 56,919 infants born from 1966 through 1986 to determine the incidence, significance, and possible associations of single umbilical artery (SUA). One hundred fifty-nine infants were affected. The sex distribution was approximately equal. Fourteen infants (8.8%) were twins who were discordant for SUA. The smallest twin was the one affected in all but two cases. Of the 159 infants, 16 were stillborn and 19 died neonatally. The mean birth weight of all infants with SUA was 2.47 kg, and the mean gestational age was 35.9 weeks. Young primipara and older multipara mothers were more commonly affected. There was an increased incidence of SUA associated with maternal diabetes, epilepsy, toxemia, antepartum hemorrhage, hydramnios, and oligohydramnios. Twenty-six (16.4%) of the associated placentas had anomalies. Seventy-one infants (44.7%) had other congenital malformations. The presence of these malformations was associated with increased mortality. Screening for renal anomalies with ultrasonography or intravenous pyelography was performed in 27 patients and yielded positive results in five (18.5%). We recommend that renal ultrasonography be performed on all infants with SUA.
Parent-child minimal change nephrotic syndrome.
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Acute diarrhea in children. What to do and what not to do.
Acute diarrhea is a leading cause of childhood morbidity and mortality. Primary care physicians and pediatricians should be familiar with its clinical features and management. Rehydration and maintenance of proper fluid and electrolyte balance are the most important aspects of treatment. While intravenous rehydration is the best form of treatment for children who are in shock or unable to drink, oral rehydration is the treatment of choice for the majority of children who have mild to moderate dehydration. Oral rehydration therapy is simple, practical, inexpensive, effective, and safe for children in developing as well as developed countries. We recommend the use of commercially available rather than homemade solutions. Antibiotic and antidiarrheal agents are usually not indicated. Early reintroduction of milk, formula, or solid food is important, as is instruction of parents in measures to minimize transmission of infectious agents.
Daytime urinary frequency in children.
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Nocturnal enuresis--a common frustration.
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Evaluation of the effect of pentobarbitone anaesthesia on the plasma potassium concentration in the rabbit and the dog.
The purpose of these studies was to determine the reasons for the hypokalaemia observed in rabbits studied in our laboratory. The rabbits consumed standard rabbit chow which is rich in potassium and remained in potassium balance. Hypokalaemia was only observed following anaesthesia. A number of additional investigations were undertaken to clarify the mechanisms involved. The hypokalaemia could not be attributed to technical factors, alkalaemia, hyperinsulinaemia or hyperaldosteronism, but seemed to be a function of anaesthesia. This effect of pentobarbitone anaesthesia was not unique to the rabbit, as similar changes also occurred in the anaesthetized dog. The findings reported in this paper have significant implications with respect to the interpretation of plasma potassium concentrations in anaesthetized subjects or animals.
Effect of mineralocorticoids on collecting duct hydrogen ion secretion in the rabbit.
The purpose of this study was to elucidate the mechanism whereby a potassium infusion led to an elevation in the urine minus blood (ohm-B) PCO2 difference in alkaline urine of the rabbit. Rabbits given 9alpha-fluorohydrocortisone 16 h prior to study had a significantly high olm-B PCO2 than control rabbits. However, the ohm-B PCO2 was increased further after potassium infusion. These results suggest that the increased collecting duct hydrogen ion secretion in the rabbit may in part have been induced by mineralocorticoids and in addition been influenced by increasing the potassium concentration.
Effect of extracellular fluid volume contraction on distal-nephron hydrogen ion secretion in vivo.
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Interpretation of the serum potassium concentration in metabolic acidosis.
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Bartter's syndrome. Differentiation into two clinical groups.
We were able to separate Bartter's syndrome patients into two groups: Group 1 patients are seen at a young age, with hyponatremia and episodes of extracellular volume contraction. Group 2 patients are older and most have tetany; plasma sodium values and renal sodium balances are normal. Plasma potassium values are lower and plasma renin activity and plasma magnesium levels are higher in group 1 than in group 2. It may be that all patients with Bartter's syndrome manifest the features of both groups, group 1 patients with time developing into group 2 patients. These observations have important implications in the treatment of patients with Bartter's syndrome.
Collecting duct hydrogen ion secretion in the rabbit: role of potassium.
The purpose of this study was to investigate distal nephron hydrogen ion secretion in the intact animal. The rabbit was chosen as the experimental model because it produces acid urine containing little ammonium. Upon replacement of the usual rabbit diet with milk, plus administration of an acid load (10 mEq/kg), the urine pH fell consistently from very alkaline values (PH greater than 7.4) to 4.8 +/- 0.2. Despite the ability to achieve high urine-to-blood hydrogen ion concentration gradients, the U-B PCO2, an index of collecting duct hydrogen ion secretion, was virtually zero. In these studies, the urine bicarbonate and buffer concentration were comparable to those observed in dog, rat, and man in which a high U-B PCO2 gradient was achieved. The rabbits studied had low plasma potassium concentrations (less than 3 mEq/L). Since potassium deficiency has been implicated in impaired urine acidification, potassium was administered, and it resulted in an increase in collecting duct hydrogen ion secretion as evidenced by a further fall in minimum urine pH during acidemia and a prompt rise in the U-B PCO2 during alkali administration. In summary, rabbits had a very low but not absent rate of collecting duct hydrogen ion secretion. Potassium administration increased the rate of hydrogen ion secretion in a segment of the collecting duct in which hydrogen ion secretion is reflected by an increase U-B PCO2.
Coexistence of distal renal tubular acidosis and nephrogenic diabetes insipidus in two patients: implications for the pathogenesis of distal renal tubular acidosis.
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Henoch-Schönlein purpura with thoraco-lumbar spine involvement precipitated by trampoline jumping.
A nine-year-old boy with Henoch-Schönlein Purpura (HSP) presented with an arthropathy of the thoraco-lumbar spine. The boy played on a trampoline for several days before the onset of the low-back pain. The vascultic rash of HSP is recognized to be pressure-dependent. The authors speculate that the arthropathy of HSP is also pressure-dependent and that the low back pain in this patient was consequent to the preceding trampoline jumping.