Treatment of snake, insect, scorpion, and spider bites in the pediatric emergency department

Obtaining an adequate depth of anesthesia is a continuous challenge to the anesthetist. With the introduction of muscle-relaxing agents the traditional signs of awareness are often obscured, or difficult to interpret. These signs include blood pressure, heart rate, pupil size, etc. However, these factors do not describe the depth of anesthesia (DA) in a cerebral activity sense. Hence, a better measure of the DA is required. It has been suggested that Auditory-Evoked Potentials (AEP) can provide additional information about the DA. The general method of extracting AEP is by use of a Moving Time Average (MTA). However, the MTA is time consuming because a large number of repetitions is needed to produce an estimate of the AEP. Hence, changes occurring over a small number of sweeps will not be detected by the MTA average. We describe a system-identification method, an autoregressive model with exogeneous input (ARX) model, to produce a sweep-by-sweep estimate of the AEP. The method was clinically evaluated in 10 patients anesthetized with alfentanil and propofol. The time interval between propofol induction and the time when the Na-Pa amplitude was decreased to 25% of the initial amplitude was measured. These measurements showed that ARX-estimated compared to MTA-estimated AEP was significantly faster in tracing transition from consciousness to unconsciousness during propofol induction (p < 0.05).     

Dog bites in children admitted to Pennsylvania trauma centers

Dog bites are a major public health problem in the pediatric population, requiring emergency treatment for wound repair and possible hospitalization in a trauma center. Data from the Pennsylvania Trauma Outcome Study were analyzed, and the records of 183 pediatric dog bite patients from 1990 to 1995 were evaluated. Dog bites were found to constitute a very small proportion of the total pediatric admissions to Pennsylvania trauma centers; however, the findings were similar to other reported studies.     

Estimates of fatal child abuse and neglect, United States, 1979 through 1988

The results of recent surveys in the United States have suggested a rising tide of fatalities due to child abuse or neglect (CAN). Because these surveys lack consistency in case definition and are incomplete in coverage, the use of death certificate data to estimate the number of CAN deaths was explored. To estimate these deaths among children 0 through 17 years old for 1979 through 1988, three models were formulated, each comprising six coding categories: (1) deaths coded explicitly as due to CAN, (2) homicides, (3) injury deaths of undetermined intentionality, (4) accidental injury deaths, (5) sudden infant death syndrome fatalities, and (6) natural-cause deaths. Research studies and crime data were relied on to estimate the proportions of deaths in categories 2 through 6 that were actually due to CAN, and other assumptions were varied to create a range of estimates. For the 10-year period, the estimated mean annual CAN fatalities ranged from 861 to 1814 for ages 0 through 4, and from 949 to 2022 for ages 0 through 17. Child abuse and neglect death rates did not increase over the period; in fact, they were relatively stable for ages 0 through 17 and showed a modest decline for 0 through 4. Ninety percent of fatal CAN occurs among children younger than 5 years old, and 41% occurs among infants. About 85% of CAN deaths are recorded as due to other causes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Nursing health assessment of preschool children in Perth County

With a view to simplifying the separation of haemopoietic stem cell concentrates from human peripheral blood, in preparation for their clinical use, the production of lymphocyte concentrates by cotton wool filtration has been investigated. Using the method which is described in detail, highly purified suspensions may be prepared without the selective loss of thymus-independent lymphocytes. Optimal operating conditions are defined. Haemopoietic stem cell concentrates may thereby be harvested, and are shown to be capable of proliferation and differentiation on subsequent culture in vivo.     

Fournier''s gangrene: historic (1764-1978) versus contemporary (1979-1988) differences in etiology and clinical importance

Little objective data exist regarding the effect of the Aircast Air-Stirrup on motor performance. Thus, the effect of the Aircast on the amplitude and frequency of postural sway during unilateral stance was evaluated for 15 uninjured male subjects. Postural sway during static and dynamic tests was measured using the Chattecx Balance System. Use of the Aircast improved unilateral postural control as evidenced by decreases in some of the components of postural sway. Previously, a link was made between a large amplitude of unilateral sway and a high probability of ankle injury (14). Thus, since Aircast use was found to decrease the amplitude of unilateral sway, it may also be beneficial in reducing the probability of injury. Although the scope of this study did not allow for differentiation among the complex systems involved in postural control, the possibility of the Aircast enhancing afferent feedback was proposed. The restricted inversion-eversion range of motion associated with the Aircast, in conjunction with the present observation that unilateral stability was enhanced with its use, suggests that the Aircast may provide a valuable prophylactic role in helping to reduce the incidence of ankle injuries.     

Licensed Psychologists on the Increase, 1974-1979.

Tracking the licensed psychologists in 10 target states revealed a 12% increase from 1974 to 1976 and a further 27% increase in the next three years, or a 42% growth over this five-year (1974-1979) period. Given an unduplicated count of 25,510 licensed psychologists nationally in 1976, these trends suggest a national projection, as of 1980, of 35,100 licensed psychologists residing in the United States, of whom 24,300 are clinically active doctoral-level, health service providers. Policy implications and variations among the states are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Jurisdictional trends in opioid overdose deaths, 1988-96

Management factors in 36 Pacific Northwest dairy herds were evaluated for their association with the prevalence of Shiga toxin-positive Escherichia coli O157 (E. coli O157) in dairy cattle. The within-herd prevalence of E. coli O157 was estimated by bacteriological culture of fecal pat samples, collected monthly for 6 months (approximately 60 per visit), from heifer cattle. During the first visit to each farm, a management questionnaire was administered that covered a broad range of animal husbandry practices. On each subsequent visit, a brief questionnaire was administered to detect changes in management practices. A significantly higher prevalence of E. coli O157 was noted in herds that fed corn silage to heifers compared to herds that did not feed corn silage. More tentative associations of E. coli O157 prevalence were observed for weaning method, protein level of calf starter, feeding of ionophores in heifer rations, feeding of grain screens to heifers, and feeding of animal by-products to cows.     

The prevalence of breast feeding in Calgary, 1979-1980

The breastfeeding practices of infants in Calgary, Alberta in 1979 and 1980 were studied using annual cohorts. Approximately 63% of infants were breastfed during the 1st week and the proportion did not change significantly during the 1st month. This proportion is higher than in an earlier study in Calgary and surveys in Canada several years ago. Most infants not breastfed during the 1st month were given commercially available infants' formula, and only a small percentage of infants were given cow's milk. The proportion of breastfed infants fell significantly after 3 months, suggesting that encouragement of breast feeding should continue for several months after delivery.     

Trends in United States ovarian cancer mortality, 1979-1995

The authors have compared the results of scalp reductions with extenders with their earlier results of scalp reductions without extenders. The extenders seem to prevent "stretch-back" and provide 30 to 86% more effectiveness when a second reduction is performed 4 weeks later.     

Childhood cancer incidence and trends in Minnesota, 1988-1994

Childhood cancer incidence patterns for Minnesota, obtained from the Minnesota Cancer Surveillance System, were compared with national rates as well as with historic data from eight Minnesota counties. In total, 1,140 neoplasms were diagnosed in children (ages 0 to 14) between 1988 and 1994. Leukemias were the most common diagnosis for boys (30.3%) and girls (29.6%), followed by central nervous system tumors. The average annual age-adjusted incidence rates for all cancer sites were 167.2 and 136.2 per million for boys and girls, respectively. These rates were somewhat higher than national rates. In particular, the incidence rate for astrocytoma in boys was significantly elevated. Childhood cancer incidence, particularly brain tumors, has increased in the eight-county region from 1969 to 1994. This analysis demonstrated the Minnesota's childhood cancer incidence patterns are similar to national patterns.     

Response to Schmidt's (1988) comments on Faust, Hart, Guilmette, and Arkes (1988).

Responds to the comments by J. P. Schmidt (see record 2010-03278-001) on the current authors' original article, Neuropsychologists' capacity to detect adolescent malingerers (see record 1989-09946-001). In the latter study, the neuropsychologists were presented with actual test results, a fabricated history, but neither collateral reports nor direct client contact during the assessment. Schmidt (1989) asserted that this represented insufficient data on which to base a neuropsychological diagnosis; therefore, it was not surprising to him that neuropsychologists experienced great difficulty in detecting malingering. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Socioeconomic correlates of infant mortality in Hong Kong, 1979-93

Contractions change the configuration of the lesser curvature of the stomach while they indent the greater curvature. We studied these lesser curvature changes by measuring the position and angle of the gastric incisura on still frames captured from videotapes of isolated cat stomachs suspended in physiologic solution. In response to filling with 100 mL Krebs' solution stomachs generated a tonic contraction of the fundus/body segment and gave rise to a peristaltic contraction that spread from the body and through the antrum to the pylorus. In preparations where we left the duodenal cannula open we found that the incisura moves toward the gastro-oesophageal (GO) junction and the angle of the incisura widens as the contraction passes through the stomach and empties its contents. Furthermore, the angle of the incisura is most acute when the full stomach starts contracting in its fundic segment and again when the contraction involves the gastric sinus (the wedge-shaped segment adjacent to the incisura which forms the transition between the body and the antrum of the stomach). In preparations where the duodenal cannula was kept closed, the angle of the incisura becomes most acute when the contraction involves the gastric body and when the luminal pressure peaks. We conclude that changes in the position and angulation of the incisura are part of the mechanical response of the stomach to filling and emptying; unlike the peristaltic contraction along the greater curvature the net movement of the incisura goes in the orad direction. Movements of the incisura profoundly affect the configuration of the stomach and hence the distribution of luminal contents between various gastric segments. The gastric sling muscles are responsible for the formation of the gastric incisura but their role in any movements of the incisura remains to be defined.     

Temporal trends in Canadian birth defects birth prevalences, 1979-1993

Syrian hamsters of the APA strain (APA hamsters) develop spontaneous mesangial thickening in the renal glomeruli from an early age. They also develop focal and segmental glomerulosclerosis (FSG) at and after 6 months of age. In this study, histopathological, immunohistochemical and lectin histochemical examinations were conducted to clarify the modification of the spontaneous renal lesions of APA hamsters by streptozotocin(SZ)-induced diabetes. Histopathological analysis revealed that the expansion of the mesangial region was more prominent and the thickening of the glomerular basement membrane (GBM) was weaker in SZ-treated animals than in non-treated ones. Immunohistochemical analysis suggested that type IV collagen and laminin were involved in the expansion of the mesangial region and thickening of the GBM. In lectin histochemical analysis, podocytes, capillary endothelial cells, GBM and a part of mesangial region of SZ-treated animals were positive for RCA120 and GSL-I with neuraminidase-pretreatment although they were negative for these lectins in non-treated animals. These results suggest that the spontaneous glomerular lesion of APA hamsters is modified qualitatively and quantitatively by SZ-induced diabetes.     

Presentation, diagnosis and treatment of renal abscesses: 1972-1988

We reviewed 61 consecutive patients with renal abscesses who were treated between 1972 and 1988 to determine whether the patient characteristics and mortality differed from those of patients treated during the preceding 2 decades. The results demonstrate that the predisposing conditions, symptomatology, abnormal physical findings, abnormal laboratory results, abnormal radiographic findings and infecting organisms of patients with renal abscesses have not changed during the last 40 years. Ultrasonography and computerized tomography, which became available in the 1970s, identified 35 of 38 (92%) and 23 of 24 (96%) abscesses, respectively. In 57 cases (97%) the abscess was drained and the patients survived. In 4 cases the abscess escaped clinical detection and contributed to patient death. The marked improvement of survival among patients with renal abscesses during the last 2 decades is attributable to improved diagnostic precision and, probably, improved antimicrobial therapy and supportive care.     

Epidemiologic characteristics of conotruncal heart defects in California, 1987-1988

In this population-based case-control study, we explored the association of selected parental and infant characteristics from the birth certificates of children with conotruncal heart defects. We compared 252 cases to a random sample of 5,000 nonmalformed infants from a cohort of 341,839 California live births for 1987-1988. The prevalence of conotruncal defects was 0.732 per 1,000 total births. A decreased risk (OR = 0.55, 95% CI0.33-0.89) for delivering infants with conotruncal defects was found among mothers born in Mexico compared to mothers born in California. An increased risk was observed for Native American mothers compared to non-Hispanic whites (OR = 2.6, 95% CI 1.1-6.0). We also compared risks associated with the individual diagnoses that comprise the group of conotruncal defects. Only minor differences in risk estimates between the anatomic diagnoses were observed, lending support to the methodologic approach of using conotruncal defects as a single category of heart defects in etiologic investigations.     

Decrease and inequalities of infant mortality in Salvador, 1980-1988

This study sought to describe the changes in mortality among infants under one year of age in different areas of the city of Salvador, Bahia, during the period 1980-1988. This was done using estimates of variation in two indicators: proportional infant mortality and the coefficient of infant mortality. Values for the first indicator were separated into low, intermediate, high, and very high quartiles for 1980 and then calculated again using 1988 data. The second indicator was derived from the estimated number of live births using the rate of 33.4/1,000 inhabitants for 1980 and 31.4/1,000 for the years thereafter. The results showed that infant mortality in that age group had declined over the period, but that at the end of the period inequalities persisted in the distribution of infant deaths, which confirmed that conditions remained adverse for certain segments of the population.     

The underreporting of deaths of American Indian children in California, 1979 through 1993

OBJECTIVES: This study linked birth and death certificates to determine misclassification of deaths of American Indian children in California. METHODS: Birth records for 1979 to 1993 were matched with mortality records through a computerized system. RESULTS: The number of deaths to American Indians was estimated to be three to four times greater than that reported on death certificates. Children in urban counties and those who died before 1987 were more likely to be misclassified. CONCLUSIONS: California death certificates identify less than one third of the deaths among American Indian children. Adjusting for racial misclassification provides a more accurate accounting of child mortality among American Indians.