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PubMedDate not supplied

[Diagnostic limitations of the physical examination in the identification of children with anemia].

A total of 143 children was randomly selected from a Pediatric out-patients clinic in order to evaluate the accuracy and reproductibility of the clinical signs of anemia. The patients, who ranged from 6 to 68 months old, were assessed on the basis of 2 clinical examinations performed independently by 2 physicians. Clinical diagnosis of anemia relied upon the examination for the presence of pallor through an inspection of the skin, conjunctivaes, lips, tongue and palms. The reference standard taken into consideration was hemoglobin in venous blood samples. The prevalence of anemia (hemoglobin < 11.0 g/dL) consisted of 41.3%, predominating among patients who ranged from 6 to 24 months old (59.3%). The sensitivity of the different clinical signs for the 2 examinations was low ranged from 28.8% to 52.5%. Almost all the children with hemoglobin concentration lower than 9.0 g/dL presented at least one suggestive clinical sign of anemia. The Kappa coefficient (K) demonstrated a mild agreement between the 2 examinations for the assessment of cutaneous pallor (K = +0.32) and moderate agreement for the evaluation of the conjunctivaes, lips-tongue and palms (K from +0.55 to +0.59). In view of limitation of the accuracy and reproductibility of the clinical signs of anemia, we may state that the determination of hemoglobin concentration should be introduced as a routine procedure of major importance in health care services.

Anemia↗
PubMed1997

Astrocytic adhesion molecules are increased in HIV-1-associated cognitive/motor complex.

Half of AIDS dementia cases are associated with HIV-encephalitis or myelin pallor. Another half die with no HIV-related neuropathological changes. Previous observations suggest that cerebral dysfunction may result from more subtle cellular interactions. and that some of them may be mediated by cell adhesion molecules. In the present study the expression by astrocytes and endothelial cells of intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) was analysed as a function of the neuropathological diagnosis, the density of astrogliosis and of HIV-1 positive cells, and of the mental status. Twelve AIDS cases, without focal brain lesion, eight of whom were demented, were selected from a prospective study. They were compared with six control cases with multiple sclerosis, and with six control patients without neurological disease. ICAM-1 and VCAM-1 expression was localized by immunofluorescence and confocal microscopy. HIV protein gp41 was detected by immunohistochemistry on adjacent sections. Endothelial expression of ICAM-1 and VCAM-1 was significantly up-regulated in all AIDS patients. VCAM-1 only was related to myelin pallor. The density of VCAM-1 or ICAM-1 positive astrocytes increased in demented AIDS patients, independently of the neuropathological findings or the density of gp41 positive cells. Expression of cell adhesion molecules, together with other secondary mechanisms such as secretion of cytokines may play a role in the pathogenesis of white matter lesions leading to HIV-1-associated cognitive changes.

AIDS Dementia Complex↗
PubMed1976

Symptoms of pheochromocytoma, with particular reference to headache, correlated with catecholamine production.

In a series of 27 patients with proved pheochromocytoma, differential analysis of catecholamines in blood, urine, and tumor specimens of 19 patients enabled grouping of subjects into those whose tumors produced predominantly norepinephrine (NE) (11 patients), predominantly epinephrine (E [Two patients]) and approximately equal amounts of both (six patients). Sustained hypertension was more common in the first group and pallor and tremor in the latter two groups, but no distinctive syndrome could be recognized as signifying the secretion of NE or E. Headache was a symptom in 20 of 27 patients and was related to sudden, transient elevation of the blood pressure, rather than sustained hypertension. The variable duration and intensity of the headache in different patients can be explained by the pressor and cranial vasoconstrictor effects of the secreted amines, which respectively enhance and diminish vascular headache.

Adolescent↗
PubMed2003

Clinical presentation of severe anemia in pediatric patients with sickle cell anemia seen in Enugu, Nigeria.

Anemia is a major cause of morbidity and mortality among patients with sickle cell anemia. In this study, 108 episodes of severe anemia were prospectively evaluated in 108 patients with hemoglobin SS disease attending the pediatric sickle cell clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria. Young children between the ages of 2 and 4 years were found to be at the greatest risk of developing anemic crises (severe anemia). There was a gradual but progressive decline in the incidence of severe anemia in the age range 8-16 years old. Upper respiratory tract infections are the most commonly associated infections in patients with severe anemia. Others included malaria, septicemia, urinary tract infection, acute chest syndrome, and osteomyelitis. Their role in precipitating episodes of severe anemia among the patients studied could not be fully evaluated. Pallor, jaundice, and fever were the most commonly encountered symptoms in patients with severe anemia on admission. About half of the parents/guardians failed to notice severe anemia among the patients studied, perhaps due to the dark color of the African skin. Caregivers need to be educated on how to recognize anemia among patients with sickle cell anemia when they develop febrile episodes.

Adolescent↗
PubMed2006

Two fatal cases of selenium toxicity.

Two patients, a 36-year-old female and a 36-year-old male, separately experienced new onset nausea, vomiting, diarrhea, abdominal pain, muscle weakness and pallor. Over a period of 14-16 h these symptoms continue and progress to include hypotension refractory to therapy, pulmonary edema and cardiovascular collapse. Autopsies show hemorrhagic pulmonary edema, splenomegaly and lack of anatomical cause for sudden death. Postmortem analysis, in one case post-embalming and exhumation, revealed elevated selenium concentrations and a determination of the cause of death. These two cases present several important features associated with selenium toxicity, two of which are previously unreported: (1) selenium as a potential homicidal agent, (2) the toxidrome and time frame of selenium toxicity, (3) selenium determination in exhumed, embalmed tissues, (4) postmortem urinary selenium concentration, and (5) decrease in tissue concentrations over time.

Abdominal Pain↗
PubMed1998

Familial lipoprotein lipase deficiency in infancy: clinical, biochemical, and molecular study.

OBJECTIVES: To describe the characteristics of lipoprotein lipase (LPL)-deficient patients seen in infancy and to evaluate the safety and efficacy of severe fat restriction. METHODS: Children <1 year old presenting with chylomicronemia between 1972 and 1995 were identified, and their clinical courses were reviewed retrospectively. RESULTS: LPL deficiency was demonstrated in 16 infants who presented with irritability (n = 7), lower intestinal bleeding (n = 2), pallor, anemia, or splenomegaly (n = 5), and a family history or fortuitous discovery (n = 2). All plasma samples were lactescent at presentation. Chylomicronemia responded rapidly to dietary fat restriction, and it was possible to maintain satisfactory metabolic control for a prolonged period of time. Only 1 adolescent girl had an episode of pancreatitis associated with the use of oral contraceptives. No persistent adverse effects on growth were seen. We obtained abnormal values for serum iron, alkaline phosphatase, and total calcium. CONCLUSIONS: The presentation of LPL deficiency is heterogeneous during infancy. Close dietary monitoring is required to avoid nutritional deficiencies. Estrogen therapy should be avoided in LPL-deficient patients.

Adolescent↗
PubMed1984

Symptoms after primary immunisation with DTP and with DT vaccine.

Symptoms after routine primary immunisation of 6004 infants with diphtheria/tetanus/pertussis (DTP) vaccine and 4024 infants with diphtheria/tetanus (DT) vaccine have been compared. After each dose, crying, screaming, and feverishness were more frequent with adsorbed DTP than adsorbed DT, but the difference was small. Attacks of high-pitched screaming, episodes of pallor or cyanosis with limpness, convulsions, and local reactions occurred with similar frequency after both vaccines. There was a considerable increase in local reactions after the 3rd dose with both vaccines. Over 1000 doses of plain DTP (with no aluminium hydroxide adjuvant) were given during the study. Post-vaccination symptoms were more common after the plain than after the 2 adsorbed preparations.

Crying↗
PubMed1986

The differential effect of arginine vasopressin on skin blood flow in man.

Physiological elevation of plasma vasopressin in man results in a small reduction in skeletal muscle blood flow but the action on skin blood flow has not been reported. We have studied eight male subjects during infusion of arginine vasopressin (AVP) at 2 units/h for 90 min. Plasma levels of AVP, measured by radioimmunoassay, rose to 68.5 (7.0) pg/ml, mean (SEM). Forearm and finger blood flow was measured with an electronic plethysmograph, hand interdigital skin-fold blood flow with a laser-Doppler blood flow meter and facial temperature with a thermocouple. All subjects developed marked facial pallor during infusion of AVP, facial temperature falling from 34.2 (0.2) to 32.7 (0.1) degrees C (P less than 0.001) then rising to 33.7 (0.1) degrees C (P less than 0.01) after AVP was stopped. Hand interdigital skin-fold blood flow also fell from 2.6 (0.02) to 2.3 (0.02) V (P less than 0.001) and rose sharply to 3.6 (0.2) V (P less than 0.001) on stopping the infusion. There were small changes in forearm and finger blood flow: both rose, from 6.3 (0.1) to 6.9 (0.1) (P less than 0.001) and 46.1 (1.0) to 54.3 (0.7) ml min-1 100 ml-1 (P less than 0.001) respectively. Neither fell when AVP was stopped. Heart rate remained unchanged throughout. These results indicate that high physiological levels of AVP, comparable with those attained during physical stress, produced a fall in blood flow in the face and interdigital skin-fold of the hand consistent with a fall in nutritional blood flow to skin.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Visceral leishmaniasis in Pakistani children.

Visceral leishmaniasis is endemic in Pakistan. No studies of visceral leishmaniasis in childhood have been reported from Pakistan. We prospectively studied clinical and laboratory features in 58 Pakistani children with visceral leishmaniasis. Mean age of the children was 2.9 years. Fever, pallor, and abdominal distention were the most common clinical manifestations, and hematologic abnormalities were the most common laboratory findings. All children recovered after antimicrobial therapy. Pakistani children with visceral leishmaniasis tended to be younger than affected children from Africa and were less likely to have lymphadenopathy.

Abdomen↗
PubMedDate not supplied

Prevalence of cyclic vomiting syndrome in a sample of Turkish school children in an urban area.

OBJECTIVES: Cyclic vomiting syndrome (CVS) is characterized by recurrent, explosive bouts of vomiting punctuating periods of normal health. Its prevalence is unclear in the world, and is unknown in Turkey. This study was designed to investigate its prevalence in Turkish school children. METHODS: The study was performed on 1263 children, aged 6 to 17 years old, who were selected by systematic sampling method before, for the celiac disease prevalence study. The population was asked the questions relating to CVS. Children whose answers fulfilled CVS criteria were invited for clinical interview and physical examination at the hospital. RESULTS: Of 1263 children, 24 (1.9%) fulfilled the criteria of CVS. Of them, 33.3% were male, 66.6% were female; the age ranged from 7 to 14 years old (mean age 10.5). The mean onset age was 7+/-3.4 years (5 to 12 years). The duration of attack ranged from 3 to 10 days (median: 5 days). Prodromal symptoms were reported in 25% of children with CVS. The episodes were accompanied by pallor, anorexia, feeling unwell, headache, abdominal pain, and photophobia in 100%, 100%, 83.3%, 66.7%, 58.3%, and 16.6%, respectively. Precipitating factors were reported by 20.8% of the children. Six children (25%) had migraine. A positive family history for migraine was noted in 7 (29.2%). Seven children (29.2%) suffered from travel sickness. CONCLUSIONS: In this first CVS prevalence study in Turkey, we found that CVS is highly prevalent in school children. For this reason, we emphasize that clinicians should be aware of this syndrome and consider it in the differential diagnosis of recurrent vomiting.

Abdominal Pain↗
PubMed1978

Reflex anoxic seizures ('white breath-holding'): nonepileptic vagal attacks.

From clinical history 58 children were diagnosed as having reflex anoxic seizures secondary to provoked cardioinhibition (also known as white breath-holding attacks). Before referral, these seizures were commonly misdiagnosed as epileptic either because the provocation was ignored, not recognised, or was a febrile illness, or because there was no crying, no obvious breath-holding, little cyanosis, and often no pallor to suggest syncope and cerebral ischaemia. The duration of cardiac asystole after ocular compression was measured in these children and in 60 additional children with other paroxysmal disorders. In 45 (78%) of the 58 with reflex anoxic seizures asystole was 2 seconds or over, and in 32 (55%) it was 4 seconds or greater, an abnormal response. Review of the literature supports the concept that these seizures result from vagal-mediated reflex cardiac arrest which can if necessary be prevented by atropine. The simple name 'vagal attack' is proposed. Ocular compression under EEG and ECG control supports the clinical diagnosis if asystole and/or an anoxic seizure is induced; the procedure described is safe and should be routine in seizure or syncope evaluation, when a meticulous history still leaves room for doubt.

Adolescent↗
PubMed1969

Evaluation of diagnostic significance of certain symptoms and physical signs in anaemic patients.

In a study of 133 anaemic and 111 non-anaemic hospital patients pallor of recent onset was the only symptom which was significantly associated with the severity of the anaemia. Dizziness in acute blood loss anaemia, and anorexia and painful tongue in vitamin-B(12) deficiency, were the only symptoms which might be helpful in diagnosing the type of anaemia. The frequency of glossitis in patients with megaloblastosis was confirmed, but neither glossitis nor nail changes were significantly more common in patients with iron-deficiency anaemia than in the control patients.

Aged↗
PubMed1988

Toward earlier diagnosis of splenic injury?

A series of patients who were found at operation to have sustained splenic rupture is described and their immediate presenting features are detailed. Signs of peritoneal irritation were not always present and patients were not often 'shocked' when first seen. Helpful early signs included a low haemoglobin and pallor. There is a tendency to underestimate the significance of left quadrant pain in the presence of rib fractures. Peritoneal lavage and ultrasound should be more readily employed. Text book features should not be expected early and this must be taught to junior doctors who work in accident and emergency medicine.

Adolescent↗
PubMed1985

Viscerally induced cutaneous vasospasm.

Superficial vasomotor tone in the forearm has been thought to be dependent mostly on vasodilatation rather than vasoconstriction. Despite this view we report now that a mechanism for profound vasoconstriction exists in the forearm surface. This phenomenon was observed in normal subjects undergoing elective radial artery catheterization and the stimulus for the vasoconstriction consisted of the intra-arterial infusion of normal saline (rate of 0.5 - 6.0 ml/min). Two components to this reaction were observed. A stable pericatheter zone of pallor varied in extent proportional to the rate of infusion. The second component consisted of distal patches of vasoconstriction over the whole anterior forearm surface which first appeared 5 to 10 seconds after the infusion rate was increased. These satellite areas tended to coalesce with sustained infusion but they were unstable over time. Local changes in vascular intrinsic regulation can account for the pericatheter vasoconstriction but this does not readily explain the observed distal changes. The time latency, distribution and evolution of the distal vasoconstriction suggests the operation of an autonomic vasomotor reflex arc.

Adult↗
PubMed1978

Recurrent abdominal pain in children: a retrospective survey of 119 patients.

The clinical pattern of 119 children with recurrent abdominal pain, located most commonly in the periumbilical region, revealed no distinct features. The most common associated symptoms were pallor, tiredness and anorexia. The most important socioenvironmental and behavioral factors were marital turmoil in 44%, school activity in 32%, and perfectionism in 30%. Laboratory and radiologic and fiberoptic endoscopic studies were uniformly unremarkable. Counseling on a continuing basis helped 105 of these children.

Abdomen↗
PubMed1995

Autonomic measures associated with chemotherapy-related nausea: techniques and issues.

Advances in antiemetic therapy for cancer patients have been hindered by a lack of understanding of the physiological mechanisms associated with nausea and their corresponding measurement techniques. Here we review conceptual and methodological issues involved in developing an autonomic frame of reference for nausea and outline two strategies for assessing autonomic function. A primarily research-oriented strategy uses heart rate, blood volume pulse, pallor, and skin temperature to assess autonomic activity and reactivity over 24 hr. Peak values of these measures relative to time of emesis, heart rate spectral analyses of autonomic activity, and analyses of the standard deviation of successive differences of beat-to-beat intervals were all associated with subsequent nausea. A primarily clinically oriented strategy assesses normal and abnormal results on eight common bedside clinical tests of autonomic function. The total number of abnormal tests was associated with subsequent nausea. A better understanding of chemotherapy side effect mechanisms is likely to result in less polypharmacy and more effective individualized treatment for cancer patients.

Arrhythmia, Sinus↗
PubMed1976

Occlusive arterial disease in the lower leg and foot.

In approaching a patient suspected of peripheral vascular disease the following signs and symptoms are of key importance (16): 1) Pain in the extremity which is induced by exercise and relieved by rest; pain which is influenced by posture is localized to one digit, is unilateral or is paroxysmal. 2) Impaired pulsations of peripheral arteries. 3) Abnormal color of the skin, particularly when affected by raising or lowering the part. 4) Gangrene, ulceration, impaired nail and hair growth, excessive calluses, or paronychial infections. 5) Unusual warmth or coldness. 7) Swelling, atrophy, or difference in length of extremity. 8) Ausculatory evidence of arteriovenous fistula. 9) Cyanosis or unusual pallor of digits when immersed in cold water. 10) Peripheral neuritis.

Age Factors↗
PubMed1999

Presenting features and treatment outcome of 78 Malaysian children with neuroblastoma.

To study the distribution of presenting features and their prognostic significance in neuroblastoma treated in a single institution in Malaysia. A retrospective study was made of 78 neuroblastoma cases diagnosed and treated in the University Hospital, Kuala Lumpur, Malaysia between June 1982 and February 1997. Diagnosis was established by standard histological criteria. The presenting features were evaluated for their distribution and prognostic influence. Disease-free survival from diagnosis was the outcome variable of interest. The ages ranged from 0.1 to 11 years old (median: 3 years old). The tumor originated from the adrenal glands in 83% and the majority of cases presented in advanced stage (stage III 22%, stage IV 66%). Bone marrow was the commonest site of distant metastasis occurring in 45% of patients. The main presenting signs and symptoms in decreasing order were pallor, fever, abdominal mass, weight loss, and bone/joint pain. Univariate analysis conferred age, initial stage and Hb level as significant prognostic factors. No influence in disease-free survival was found for sex, race, primary site, urinary vanillylmandelic acid level, white cell count and platelet count. Overall 2-year disease-free survival was achieved in 27 (39%) patients. Four patients underwent bone marrow transplant, three of whom achieved 2-year disease-free survival. The results suggest that age, initial stage and hemoglobin level are significant prognostic factors based on univariate analysis. In addition, more Malaysian children presented with adrenal primary site and advanced disease compared to previous reported studies.

Adrenal Gland Neoplasms↗