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Toddler With a Clinical Diagnosis of Intussusception
BACKGROUND
A 2-year-old toddler presents with episodes of severe, intermittent, colicky abdominal pain, during which he draws up his legs. The boy has no past history of illness.
Physical examination reveals a palpable, tender, and ill-defined mass on the right side of his abdomen. The patient also has mild pyrexia, tachycardia, and mild leukocytosis. Laboratory tests reveal that levels of the inflammatory markers and bilirubin levels are mildly elevated. These findings suggest intussusception.
Imaging studies are performed. What is the diagnosis?
Hint
Why is the bilirubin level elevated? The sonographic findings establish the diagnosis.
Author:
Ali Nawaz Khan, MBBS, FRCP, FRCS, FRCR, Lecturer, Department of Diagnostic Radiology, Faculty of Medicine, University of Manchester, and Sri Priya Suresh, MBBS, MRCP, Specialist Registrar, Department of Radiology, North Manchester General Hospital NHS Trust, UK
North Manchester General Hospital, Crumpsall, Manchester M86RB, UK
eMedicine Editor:
Sat Sharma, MD
Associate Professor, University of Manitoba, Department of Medicine, Division of Pulmonary Medicine
A Call for Participation: Mobile Computing Usage Amongst Physicians
Please respond directly to Gregg.
Thank you,
My name is Gregg Malkary, Founder and Managing Director of the Spyglass Consulting Group, a leading market intelligence firm and consultancy focusing on the nexus of information technology and healthcare.
I am in the process of updating a market research study on mobile computing usage amongst physicians in the healthcare industry.To develop the subject matter I am conducting telephone interviews with over 100 physicians at healthcare organizations nationwide.
I would like to talk with you for approximately 30-35 minutes to discuss:
your daily workflow inefficiencies and bottlenecks
how you are using mobile computing solutions today
how you envision mobile computing solutions being used in the future
This market report is being targeted at:
·Software & hardware vendors, systems integrators and management consultants who are selling mobile computing devices, applications and services into the healthcare industry.
·Hospital administrators and IT executives who are making strategic decisions to fund clinical IT solutions including mobile computing.
·Investment banking and private equity investors
Spyglass’ current research, Healthcare without Bounds, focuses on the current and future potential of mobile computing and wireless technologies within the healthcare industry.
In November 2003, Spyglass published its first study, Trends in Mobile Computing that provided insights and perspectives on how Physicians are using mobile clinical solutions at the point of care.
In June 2004, Spyglass published its second study, Mobile Computing in Nursing that provided valuable insights and perspectives on how nurses are using mobile computing solutions at the bedside and how these solutions ca best be used to solve workflow inefficiencies.
Spyglass customers include leading high technology vendors such as McKesson, Cerner, Philips Medical, Cardinal Health, MercuryMD, ePocrates, IBM, NEC, Palm, Symantec, Citrix, Foundry Networks, Vocera Communications, PwC, and Cap Gemini.
For recent news coverage of our work, please visit:
Please let me know when it would be convenient for us to schedule a conference call.I would be more than happy to pick up the telephone charges.I can be reached at (650) 575-9682.
Regards,
Gregg
650 575-9682 (cell)
Gregg Malkary, Managing Director Spyglass Consulting Group Menlo Park, CA gmalkary@...
SETU Developmental Intervention Center - a not-for-profit enterprise, works with children between the age group of 0-5 years with Developmental Disorders like Mental Retardation, Cerebral Palsy, Autism, etc. and their parents.
Courtesy of the R.A.L.E. Repository, which offers digital recordings of respiratory sounds in health and disease.
R E F E R E N C E S
Friedman Y. Comparison of percutaneous and surgical tracheostomies. Chest 1996;110:480-5.
Gracey DR. Ventilator care beyond the intensive care unit. Mayo Clin Proc 1995;70:595-7.
Heffner JE. Tracheostomy in the intensive care unit. Part 1: Indications, technique, management. Chest 1986;90:269-73.
Heffner JE. Medical indications for tracheotomy. Chest 1989;96:186-90.
Heffner JE. Timing of tracheotomy in mechanically ventilated patients. Am Rev Respir Dis 1993;147:768-71.
Marx WH. Some important details in the technique of percutaneous dilatational tracheostomy via the modified Seldinger technique. Chest 1996;110:762-6.
Dr. Tarun Gera, Dr. Joseph L Mathew, Department of Pediatrics, LN Hospital, New Delhi, India
tracheostomy /indications
The indications for tracheostomy have gradually been usurped by the indications for endotracheal intubation. By and large, tracheostomy is now indicated only in those cases in which intubation is not feasible.
There are three broad groups of patients in which tracheostomy needs to be performed:
airway obstruction
Tracheostomy is needed in cases of upper airway obstruction when laryngeal intubation is not possible. Examples of such cases include patients with laryngeal or subglottic stenosis, physical trauma to the face, jaws, oral or pharyngeal cavities, and burns by corrosive chemicals or inhalation of smoke or gases.
dead space and secretions
Tracheostomy aids in conditions like chronic lung disease, bronchopulmonary dysplasia, and certain neonatal conditions by decreasing the dead space and easing pulmonary toilet.
ventilation
Tracheostomy may be indicated for the provision of positive pressure ventilation in patients with poliomyelitis, tetanus, brain damage, as an adjunct to cardiac surgery, in severe burns, and in the preterm neonate. Intubation may be employed for the short term (for periods up to 3 weeks) but for prolonged treatment the tracheostomy becomes easier to manage. Improvements in technique now permit intubation for periods of several months. Therefore some authors now argue that a tracheostomy becomes a necessity only when prolonged endotracheal intubation poses the threat of laryngotracheal injury.
Some specific indications for tracheostomy are given below:
An ideal clinical study, comparing the risks and benefits of tracheostomy with prolonged translaryngeal intubation has not been performed (Heffner 1989, Heffner 1993). Nevertheless, the use of a tracheostomy for providing access to the patient's airway has become commonplace in ICUs and other areas of the hospital for treating patients who are difficult to wean from mechanical ventilation (Gracey 1995). Additionally, the technique of percutaneous dilatational tracheostomy has added to the cost-effectiveness and ease with which this procedure can be performed at the bedside (Marx 1996, Friedman 1996). Taken together, these factors may explain the more frequent and earlier use of tracheostomy for patients in need of prolonged ventilatory support.
Benefits of a tracheostomy in long-term mechanical ventilation include improved airway suctioning, better patient comfort, absence of laryngeal complications, easier tube changes and capabilities for oral nutrition. Also, ventilator-dependent patients may tolerate weaning attempts better when spontaneously breathing through a tracheostomy that contributes less to airway resistance than an oral endotracheal tube.
Optimal timing, however, for conversion from endotracheal intubation to tracheostomy in most patients is controversial. A decision to continue endotracheal intubation for several weeks is encouraged by the avoidance of tracheostomy complications such as tracheal stenosis at the stoma site, the increased bacterial colonisation of the airway associated with tracheostomy, and the natural inclination to maintain the tracheal cannulation longer than needed once a tracheostomy has been placed.
Prolonged endotracheal intubation, however, is not risk free; there is potential for laryngeal stenosis, which progresses in severity with duration of intubation. Data from various prospective studies indicate that endotracheal intubation and tracheostomy both present inherent hazards for long term airway management. For the patient requiring chronic mechanical ventilation, however, endotracheal intubation is less comfortable, provides less efficient suctioning than through a tracheostomy tube, and risks laryngeal damage related to the duration of ventilation. Therefore, based on the available clinical data, most authors recommend endotracheal tube intubation for patients requiring assisted ventilation for less than 7 days (Heffner 1986). After 7 days of intubation the patient is re-evaluated; if extubation appears likely before the 11th day, then tracheostomy is not performed, but if extubation cannot be foreseen on the 7th day, conversion to tracheostomy should be strongly considered.
Realising that no general principle works for every patient, the decision to perform tracheostomy must often be individualized; the agitated difficult-to-sedate patient may benefit from earlier surgery, while the patient at higher risk for surgical complications may be allowed more time for possible extubation.
Tracheostomies for the management of obstructive sleep apnea have a number of disadvantages including aesthetic patient disfigurement, an imposed strict hygienic regime, occasional voice damage and the risk of tracheal stenosis. Therefore close adherence to indications for tracheostomy should be observed. If the patient is not a candidate for a uvulopalatopharyngoplasty because of morbid obesity, a small mandible or a nonvisible endolarynx by mirror examination due to excessive hypopharyngeal tissue, tracheostomy is considered in the following clinical situations:
considerable social and occupational disability from excessive daytime hypersomnolence,
sleep related cardiovascular complications,
polysomnographic documentation of numerous obstructive apneas with arterial oxygen desaturation,
confirmation of obstruction in the supraglottic region by fibreoptic endoscopy of the pharyngeal airway.
Why run to your office to consult medical references when a PDA is all you need? Download the convenient, helpful medical resources from Mobile MerckMedicus to your PDA to help you save time during your busy day. Explore MerckMedicus for more details.
Conclusion: on the basis of our midterm results, tricuspid valve replacement with a mitral homograft in children seems to be a valuable alternative surgical option...
Diastolic functions of the heart, measured by pulsed tissue Doppler echocardiography from 25 overweight and obese children, were compared with 91 children of normal weight who were 10 to 18 years old and had normal 2-dimensional echocardiographic examinations...
The Central Cardiac Audit Database (CCAD) was set up just over three years ago following the Kennedy Inquiry on infants’ deaths at the Bristol Royal Infirmary. Its aim is to meet the need for an accurate way of recording and monitoring cardiac care across the UK — not just as an early warning system of when things go wrong and not just for infants, but as a measure of long-term outcomes — to ensure that tragedies like Bristol can never happen again and that all heart-disease patients can be confident about the quality of their care, wherever they receive it...
Conclusions: Parental AF increases the future risk for offspring AF, an observation supporting a genetic susceptibility to developing this dysrhythmia. Further research into the genetic factors predisposing to AF is warranted...
Conclusion: A functional assay reveals significant variability in aprotinin concentration for pediatric patients using current weight-based aprotinin dosing. Additional investigation is necessary to determine target aprotinin concentration dosing regimens to provide better efficacy...
Conclusions: Bacteremia from these procedures occurs more often, from a wider variety of bacterial species, and for a longer duration after dental extractions than previously reported in any age group. Amoxicillin has a significant impact on the incidence, nature, and duration of bacteremia after nasal intubation, dental restorative and cleaning procedures, and dental extractions...
Conclusions: Reduced endothelial function, increased oxidative stress, and preclinical carotid atherosclerosis are independent determinants of impaired NMD in children. These data thus suggest that primary nitrate tolerance occurs in children at risk for atherosclerosis...
Tammy Delancey had never heard of "fifth disease." She was five months pregnant with her second child, a girl, in 1997, when she got sick. Her body hurt all over, she says. "You pull up the blinds in the morning and your eyes hurt from the sun. I knew it wasn't morning sickness," she says. Fifth disease is caused by a form of human parvovirus. It usually causes no symptoms or only mild ones, such as a rash on the cheeks in children. But in pregnant women, it can lead to potentially fatal anemia ...
The Ross-Konno procedure, applied to neonates with severe left ventricular outflow tract (LVOT) obstruction, offers a satisfactory solution in fully releasing the LVOT gradient, and in replacing the aortic valve with a pulmonary autograft with an excellent growth potential. We reported on three recent neonatal cases...
ADC -- Journal announcement
Dear Colleague
CALL FOR PAPERS
We would like to invite you to submit a paper to the 10th European Forum on
Quality Improvement in Health Care, to be held in London, 13-15 April 2005.
The Forum consists of one day minicourses, invited presenters, plenary
sessions, oral presentations and poster displays selected from submissions.
Authors are invited to submit abstracts for consideration for both oral
presentation and poster display.
Submit your abstract online at: http://www.quality.bmjpg.com
Themes of the Forum:
- Improving patient safety
- Partnership with patients
- Strengthening improvement in education and training
- Leadership, culture change and change management
- Achieving radical improvement in health care systems
- Health policy for lasting improvement in health care systems
- Measurement for improvement, learning and accountability
- People and improvement: individual professional quality
All abstracts must be submitted in English, and the deadline for receipt of
abstracts is Friday 1st October 2004. We hope that you will consider
contributing.
For further information on how to submit an abstract visit:
http://www.quality.bmjpg.com and click on the 10th European Forum link.
Please pass this email to any colleagues who may be interested in
attending.
Richard Smith and Don Berwick
Editor & CEO, BMJ; CEO, Institute for Healthcare Improvement
To unsubscribe from or edit your subscriptions to this service,
go to http://www.archdischild.com/cgi/alerts/etoc
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Treating running nose is no big deal... but treating its
complications and PNDrip is a headache for the practitioner. In fact,
I had seen pediatricians admitting and sedating for 3 days to get rid
off.
tricks:
Running nose:
A very common problem; watery or thick.. continuous or intermittent..
with fever or without fever
watery or thick.. :
Clean nostrils with ear buds, periodically, if its thicker.. use
saline drops : no of drops + no of months of age till 8 months.. then
10 drops for all, wait 2 secondsa fter each drop.. then clean with
ear buds once the drops are over. why more drops? - Bcos you want to
douche the whole nasopharynx and clean the nose; the sticly
secretions along nasopharynx will be dragged to oropharynx and then
swallowed.
If its running continuously, one may prefer putting decongestant
nasal drop like flucold drops.. or nasovion mini drops, use only 2 to
4 drops at any age.. nose will dry within 20 minutes provided drops
are put after drying the nose with ear buds.. small dose bcos we want
local action. Dont keep it TDS, can be used SOS. TDS use makes nose
dry.. and the worst nose block will happena nd child will be very
irritable crying refusla to feeds etc.
Treatment of noseblock: commonest cause; inadvertant or TDS use of
decongestant or sleeping in front of / facing fan..
Treatment: saline drops: I use nasoclear drops procedure as above.
But keep it TDS, keep nose wet, avoid drying by air/drugs. Stop
decongestant drops. If child is cranky, do a mechanical nasal suction
tiding over the crisis.. the thick secretions may be difficult to
suck by syringe. Give A soothing nebulisation following suction,
Clinical indicator: Irritability settles, child sleeps.
Treatment of Any of above with fever ; with or without PND:
Add a simple antipyretic, paracetamol: regular dose, round the clock
for 2 days. If running nose, give combination with decongestant TDS
orally, I find syp Sinarest more effective.
For PND: a good saline nebulisation with prior nasal suction and
saline drop wash of nose. continue oral PCM and decongestant drosp
combination for 3 days.
At times a short course chemotherapy with azithromycin may help.
I was hoping for a few ideas about a 6 year old boy I saw
recently, who has an extremely poor pencil grip.He is a bright little boy who is
managing all academic aspects of schooling well, except his writing which,
although neat and legible, is very slow. He is left handed and holds his pencil,
with his wrist supinated, thumb and three fingers on
the pencil shaft, with the fourth closest to the point.His teacher has apparently tried every readily
available pen grip, as well as a range of differing shaped pencils and pens.I plan to see him in school soon, but was
wondering if anyone has come across this or had any success with a similar
problem.
Course Director Philip A. Brunell, MD, invites you to attend this
comprehensive pediatric program. During this exciting educational
event, you’ll hear presentations from leading pediatricians on new
influenza vaccination recommendations, new AOM guidelines,
prescribing antibiotics and more.
New to the program this year, INFECTIOUS DISEASES IN CHILDREN columnist Edward A. Bell,
PharmD, BCPS, will expand on his Pharmacology Consult column with a
lecture on the management of ear pain.
This program is designed for pediatricians, family practitioners,
nurse practitioners and other health care providers to review new
information on pediatric diseases, diagnosis and
management.
At the conclusion of this
symposium, attendees should be able to:
Manage otitis media using new guidelines
Discuss the use of complementary and
alternative medicines in children
Recognize the cultural and medical issues of
underserved patient populations
Describe the prevalence of anaphylaxis and how
to treat and prevent this emergency
Apply current recommendations when vaccinating
children
Recognize the current issues in managing
mononucleosis
Identify clinical symptoms of influenza, and
review treatment and prophylaxis, including new guidelines for
vaccinating children
Identify the current issues concerning the use
of varicella vaccine
Recognize the use of antibiotics in a time of
increasing resistance
Explain the clinical epidemiology of preventing
pertussis today
From imagecase@... Thu May 27 18:53:20 2004 X-Apparently-To: drkondekar@... via 216.136.173.240; Thu, 27 May 2004 18:44:58 -0700 X-YahooFilteredBulk: 204.168.118.103 Return-Path: Received: from 204.168.118.103 (EHLO ESERVER02-2K) (204.168.118.103) by mta147.mail.dcn.yahoo.com with SMTP; Thu, 27 May 2004 18:44:58 -0700 Received: from ESERVER02-2K ([204.168.118.103]) by ESERVER02-2K with Microsoft SMTPSVC(5.0.2195.6713); Thu, 27 May 2004 21:53:20 -0400 From: imagecase@... To: drkondekar@... Message-Id: <20040527215320.372170@...> Subject: eMedicine Image Case 41 Date: Thu, 27 May 2004 21:53:20 -0400 MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="Boundary.11111111.11111111" Return-Path: imagecase@... X-OriginalArrivalTime: 28 May 2004
01:53:20.0015 (UTC) FILETIME=[8D34F1F0:01C44456] Content-Length: 3731
eMedicine's Case Studies program delivers unique and educational patient cases to healthcare professionals.
BACKGROUND The parents of this 3-day-old baby arrive in the emergency department stating that the newborn has been acting well since being discharged from the hospital yesterday. She is breastfeeding every 2-3 hours, moving her bowels multiple times daily, wetting her diapers after each feeding, and consoling appropriately. However, the parents report that, when they placed the baby on her side earlier today, she turned different colors—the side down was red, and the side up was white. On examination, the baby appears normal, but when laid on her right side, her skin changes colors, as demonstrated in the photograph. What is this phenomenon called? What causes the color change to occur?
Hint This is a benign condition of neonates.
Author:
Jennifer A. Jewell, MD, Clinical Assistant Professor of Pediatrics, University of Vermont School of Medicine, and Lorraine L. McElwain, MD, Assistant Professor of Pediatrics, University of Vermont School of Medicine
The Barbara Bush Children's Hospital at Maine Medical Center
eMedicine Editor:
John Leung, MD
Northwestern University, Northwestern Memorial Hospital
FYI,
Parents of children with chronic diseases report that health information
on the Web are helpful
>
> Parents of children with chronic diseases report that health information
Web
> sites are useful resources and don't undermine their trust in health
> professionals or their children's medications, according to a study by the
> University of York in England, BBC News reports
> (http://news.bbc.co.uk/2/hi/health/3703465.stm).
>
> The researchers found that most people were aware of the potential dangers
> of online health information and were confident they could distinguish
> between legitimate information and "rubbish," the BBC reports. The study
> stated that people are "sensible" about online resources and that there is
> "not necessarily" a need for quality guarantees for online health
> information. The study also found that people search the Internet in
> addition to other information sources, said Dr. Sarah Nettleton, the
study's
> lead researcher.
>
> The study also questioned some of the assumptions about the "digital
> divide." For example, the study found many low-income households "making
> highly productive use of e-health," while wealthier households make little
> or no use of such Internet resources. However, Internet access was greater
> among higher-income households, according to Nettleton.
>
> Dr. Paul Cundy, joint chair of the British Medical Association's IT
> committee, said the study supported the BMA's policy to encourage patients
> to seek health information online. "Doctors should not be fearful of
> patients carrying Internet printouts," he said.
>
> Study results are based on Web sites containing information on childhood
> eczema, asthma and diabetes, and a survey of 358 households with at least
> one child who had one or more of these conditions (BBC News, 5/12).
>
>
> Bob Pyke Jr.
> repyke@...
>
> "The best journeys are the ones that answer questions that at the outset
> you never even thought to ask."
> Rick Ridgeway
>
> "There are certain spots in the world where you can stand that will change
> the way that you look at things forever."
> Pete Whitaker
>
> Co administrator Telehealth List Serve and roving editor at large.
> http://www.telehealth.net/interviews/pykebio.html
>
> Editor, John Hopkins Pediatric Point of Interest
> http://derm.med.jhmi.edu/poi/
>
> Co moderator EurasiaHealth Medical Informatics Knowledge Network
> http://www.eurasiahealth.org
>
> ---------------------------------------------------
> To unsubscribe, go to http://www.acor.org/mwm.html
>
> For other information or problems contact:
> gfrydman@...
> ---------------------------------------------------
"GeneralPediatrics.com", the GeneralPediatrics.com logo, and "The GeneralPediatrician's View of the Internet" are all Trademarks of Donna M. D'Alessandro, M.D.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Resend: Links in the previous alert were incorrect.
We apologize for any inconvenience.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Fetal Neonatal Ed. -- Table of Contents Alert
A new issue of Archives of Disease in Childhood - Fetal and Neonatal
Edition
has been made available:
1 May 2004; Vol. 89, No. 3
URL: http://fn.bmjjournals.com/content/vol89/issue3/index.shtml?etoc
-----------------------------------------------------------------
Fantoms
-----------------------------------------------------------------
Fantoms
Ben Stenson
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 189
http://fn.bmjjournals.com/cgi/content/full/89/3/F189?etoc
-----------------------------------------------------------------
Reviews
-----------------------------------------------------------------
Neurocognitive outcome after very preterm birth
N Marlow
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 224-228
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F224?etoc
Diagnostic markers of infection in neonates
P C Ng
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 229-235
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F229?etoc
-----------------------------------------------------------------
Leading articles
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Injury and repair in developing brain
F M Vaccarino and L R Ment
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 190-192
http://fn.bmjjournals.com/cgi/content/full/89/3/F190?etoc
The magnetic resonance revolution in brain imaging: impact on neonatal
intensive care
N J Robertson and J S Wyatt
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 193-197
http://fn.bmjjournals.com/cgi/content/full/89/3/F193?etoc
-----------------------------------------------------------------
Perinatal pathology under the microscope
-----------------------------------------------------------------
The continuing decline of autopsies in clinical trials: is there any way
back?
M McDermott
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 198-199
http://fn.bmjjournals.com/cgi/content/full/89/3/F198?etoc
Perinatal pathology in the context of a clinical trial: a review of the
literature
C Snowdon, D R Elbourne, and J Garcia
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 200-203
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F200?etoc
Perinatal pathology in the context of a clinical trial: attitudes of
neonatologists and pathologists
C Snowdon, D R Elbourne, and J Garcia
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 204-207
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F204?etoc
Perinatal pathology in the context of a clinical trial: attitudes of
bereaved parents
C Snowdon, D R Elbourne, and J Garcia
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 208-211
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F208?etoc
-----------------------------------------------------------------
Neonatal transport services
-----------------------------------------------------------------
Contemporary neonatal transport: problems and solutions
L Cornette
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 212-214
http://fn.bmjjournals.com/cgi/content/full/89/3/F212?etoc
Optimising neonatal transfer
A C Fenton, A Leslie, and C H Skeoch
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 215-219
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F215?etoc
Perinatal transport: problems in neonatal intensive care capacity
A B Gill, L Bottomley, S Chatfield, and C Wood
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 220-223
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F220?etoc
-----------------------------------------------------------------
Original articles
-----------------------------------------------------------------
The potential impact on costs and staffing of introducing clinical networks
and British Association of Perinatal Medicine standards to the delivery of
neonatal care
E S Draper, B N Manktelow, C McCabe, and D J Field
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 236-240
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F236?etoc
Evaluation of advanced neonatal nurse practitioners: confidential enquiry
into the management of sentinel cases
M P Ward Platt and K Brown
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 241-244
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F241?etoc
Systematic review of transpyloric versus gastric tube feeding for preterm
infants
W McGuire and P McEwan
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 245-248
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F245?etoc
Ophthalmic impairment at 7 years of age in children born very preterm
R W I Cooke, L Foulder-Hughes, D Newsham, and D Clarke
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 249-253
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F249?etoc
Postnatal weight loss in term infants: what is "normal" and do growth
charts allow for it?
C M Wright and K N Parkinson
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 254-257
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F254?etoc
Visual function at school age in children with neonatal encephalopathy and
low Apgar scores
E Mercuri, S Anker, A Guzzetta, A L Barnett, L Haataja, M Rutherford,
F Cowan, L Dubowitz, O Braddick, and J Atkinson
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 258-262
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F258?etoc
Cost effectiveness analysis of neonatal extracorporeal membrane oxygenation
based on four year results from the UK Collaborative ECMO Trial
S Petrou and L Edwards
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 263-268
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F263?etoc
Responses to a fourth dose of Haemophilus influenzae type B conjugate
vaccine in early life
M H Slack, D Schapira, R J Thwaites, M Burrage, J Southern, D
Goldblatt, and E Miller
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 269-271
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F269?etoc
-----------------------------------------------------------------
Short reports
-----------------------------------------------------------------
Gestational age and the C reactive protein response
M A Turner, S Power, and A J B Emmerson
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 272-273
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F272?etoc
Extravasation injuries on regional neonatal units
C E Wilkins and A J B Emmerson
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 274-275
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F274?etoc
-----------------------------------------------------------------
Perinatal lessons from the past
-----------------------------------------------------------------
Dr Priscilla White (1900-1989) of Boston and pregnancy diabetes
P M Dunn
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 276-278
http://fn.bmjjournals.com/cgi/content/abstract/89/3/F276?etoc
-----------------------------------------------------------------
Letters
-----------------------------------------------------------------
Thickening milk feeds may cause necrotising enterocolitis
P Clarke and M J Robinson
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 280
http://fn.bmjjournals.com/cgi/content/full/89/3/F280?etoc
Linear IgA bullous dermatosis in a neonate
S Y R Lee, C Y Leung, C W Leung, C B Chow, K M Leung, and Q U Lee
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 280
http://fn.bmjjournals.com/cgi/content/full/89/3/F280-a?etoc
Vertical transmission of Citrobacter freundii
T J Malpas, J J Munoz, and I Muscat
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 280-281
http://fn.bmjjournals.com/cgi/content/full/89/3/F280-b?etoc
Recruitment failure in early neonatal research
S Nicklin and S A Spencer
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 281
http://fn.bmjjournals.com/cgi/content/full/89/3/F281?etoc
Gestational age in the literature
B V Pai and V A Pai
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 281-282
http://fn.bmjjournals.com/cgi/content/full/89/3/F281-a?etoc
Fever in the neonatal period
S Manzar
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 282
http://fn.bmjjournals.com/cgi/content/full/89/3/F282?etoc
Home phototherapy in the United Kingdom
M Walls, A Wright, P Fowlie, L Irvine, and R Hume
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 282
http://fn.bmjjournals.com/cgi/content/full/89/3/F282-a?etoc
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Book reviews
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A manual of neonatal intensive care, 4th edition
M P Ward Platt
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 279
http://fn.bmjjournals.com/cgi/content/full/89/3/F279?etoc
Neonatology & laboratory medicine
I A Laing
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 279
http://fn.bmjjournals.com/cgi/content/full/89/3/F279-a?etoc
Fetal and neonatal brain injury: mechanisms, management and the risks of
practice, 3rd edition
M Smith
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 279-280
http://fn.bmjjournals.com/cgi/content/full/89/3/F279-b?etoc
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eMedicine's Case Studies program delivers unique and educational patient cases to healthcare professionals. This case is brought to you by Merck.
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BACKGROUND
A young man presents to the hospital with an insidious onset of fatigue, chest tightness, and abdominal fullness. Chest radiographs and abdominal CT scans are obtained.
Hint
The patient has a chronic, systemic process.
Author:
D. Dean Thornton, MD, Clinical Assistant Professor, Department of Radiology, University of Alabama at Birmingham
Advanced Imaging Associates of Alabama, Inc., HealthSouth Medical Center, Birmingham
eMedicine Editor:
Sat Sharma, MD
Associate Professor, University of Manitoba, Department of Medicine, Division of Pulmonary Medicine
Hi,
I, Murthy, staying at USA. I have a question about bloodwork.
My son has Seizures problem which is undercontrol. Here doctors did
all kinds of tests and finally came to the conclusion use Tegretol
and Valporic acid till it goes way. But they alter dosages based on
the levels of these medicines in his blood. They are conducting the
bloodwork once in 3 months.
Doctors are doing the bloodwork for the following two items
Carbamaz / Tegretol
Valporate / Depakene.
As I am thinking to move to India permanantely, I am intersted to
know whether we can get the similar kind of tests in India also. I
know these medicines are very well available in India.
In general, for this kind of children on what basis medicine dosage
will be altered in India. Your answer will be great helpful to me.
Thank You
Murthy
Hello,
We are looking for articles to be freely published at
www.eMaxHealth.com
Please let us know if you know any sources, we will give the proper
attribution to the author and the source of article.
www.eMaxHealth.com offers free health related articles on various
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share your experience and knowledge on health. Maximize Your Health
by learning about it.
Thank you for your help guys.
Best wishes
eADC -- Table of Contents Alert
A new issue of Archives of Disease in Childhood - Fetal and Neonatal
Edition
has been made available:
1 March 2004; Vol. 89, No. 2
URL: http://www.archdischild.com/fn/content/vol89/issue2/
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Fantoms
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Fantoms
Ann Stark
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F96
http://www.archdischild.com/cgi/content/full/fetalneonatal%3b89/2/F96-a
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Reviews
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Postnatal steroid treatment and brain development
O Baud
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F96-F100
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F96
Neonatal transfusion practice
N A Murray and I A G Roberts
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F101-F107
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F101
Management of fluid balance in the very immature neonate
N Modi
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F108-F111
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F108
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Original articles
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Lateralisation of language function in young adults born very preterm
T M Rushe, C M Temple, L Rifkin, P W R Woodruff, E T Bullmore, A L
Stewart, A Simmons, T A Russell, and R M Murray
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F112-F118
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F112
Transient adrenocortical insufficiency of prematurity and systemic
hypotension in very low birthweight infants
P C Ng, C H Lee, C W K Lam, K C Ma, T F Fok, I H S Chan, and E Wong
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F119-F126
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F119
Early pituitary-adrenal response and respiratory outcomes in preterm
infants
P C Ng, C H Lee, C W K Lam, K C Ma, I H S Chan, E Wong, and T F Fok
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F127-F130
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F127
Maternal intravaginal prostaglandin E2 gel before elective caesarean
section at term to induce catecholamine surge in cord blood: randomised,
placebo controlled study
M Singh, S Patole, A Rane, D Naidoo, and P Buettner
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F131-F135
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F131
Suppressive effects of breast milk on oxidative DNA damage in very low
birthweight infants
H Shoji, T Shimizu, K Shinohara, S Oguchi, S Shiga, and Y Yamashiro
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F136-F138
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F136
Survival of very preterm infants: Epipage, a population based cohort study
B Larroque, G Breart, M Kaminski, M Dehan, M Andre, A Burguet, H
Grandjean, B Ledesert, C Leveque, F Maillard, J Matis, J C Roze, and P
Truffert
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F139-F144
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F139
Effect of birth order on neonatal morbidity and mortality among very low
birthweight twins: a population based study
E S Shinwell, I Blickstein, A Lusky, and B Reichman
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F145-F148
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F145
Prevalence of hypospadias and other genital anomalies among singleton
births, 1988-1997, in Scotland
S F Ahmed, R Dobbie, A R Finlayson, J Gilbert, G Youngson, J Chalmers,
and D Stone
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F149-F151
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F149
Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic
encephalopathy
P Shah, S Riphagen, J Beyene, and M Perlman
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F152-F155
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F152
Resuscitation with 100% O2 does not protect the myocardium in hypoxic
newborn piglets
W B Borke, B H Munkeby, L Morkrid, E Thaulow, and O D Saugstad
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F156-F160
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F156
Nosocomial cutaneous abscesses in septic infants
D Mandel, Y Littner, F B Mimouni, and S Dollberg
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F161-F162
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F161
Infection with Ureaplasma urealyticum: is there a specific clinical and
radiological course in the preterm infant?
U Theilen, A J Lyon, T Fitzgerald, G M A Hendry, and J W Keeling
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F163-F167
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F163
Clinical detection of low upper body blood flow in very premature infants
using blood pressure, capillary refill time, and central-peripheral
temperature difference
D A Osborn, N Evans, and M Kluckow
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F168-F173
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F168
Accuracy of the volume and pressure displays of high frequency oscillators
J A Leipala, S Iwasaki, A Milner, and A Greenough
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F174-F176
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F174
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Case reports
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Probable adverse reaction to a pharmaceutical excipient
C M Hall, D W A Milligan, and J Berrington
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F184
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F184
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Short reports
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Nutritional effects on auditory brainstem maturation in healthy term
infants
B Unay, S U Sarici, U H Ulas, R Akin, F Alpay, and E Gokcay
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F177-F179
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F177
Measurement of urine output by weighing nappies
S Oddie, R Adappa, and J Wyllie
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F180-F181
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F180
Cost effective use of satellite packs in neonates: importance of birth
weight
A Gupta, R Patel, and M Dyke
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F182-F183
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F182
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Images in neonatal medicine
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Gastric pneumatosis/interstitial emphysema of the stomach
M Bajaj and A L Ogilvy-Stuart
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F188
http://www.archdischild.com/cgi/content/full/fetalneonatal%3b89/2/F188
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Perinatal lessons from the past
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Louise Bourgeois (1563-1636): royal midwife of France
P M Dunn
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F185-F187
http://www.archdischild.com/cgi/content/abstract/fetalneonatal%3b89/2/F185
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Letters
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Neonatal necrotising enterocolitis and perinatal exposure to co-amoxyclav
A Al-Sabbagh, S Moss, and N Subhedar
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F187
http://www.archdischild.com/cgi/content/full/fetalneonatal%3b89/2/F187
Birth weight of Chinese babies born in Italy
F Festini, M F Reali, G Taccetti, T Repetto, and M de Martino
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F187
http://www.archdischild.com/cgi/content/full/fetalneonatal%3b89/2/F187-a
-----------------------------------------------------------------
Corrections
-----------------------------------------------------------------
CORRECTION Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F111
http://www.archdischild.com/cgi/content/full/fetalneonatal%3b89/2/F111
CORRECTION Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F187
http://www.archdischild.com/cgi/content/full/fetalneonatal%3b89/2/F187-b
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Electronic pages
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Author index Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F1
Subject index Arch. Dis. Child. Fetal Neonatal Ed. 2004;89 F2
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your browser at http://www.archdischild.com/cgi/etoc .
_______________________________________________________________________
Copyright (c) 2004 BMJ Publishing Group Ltd & Royal College of Paediatrics
and Child Health
ADC -- Journal announcement
9th European Forum on Quality Improvement in Health Care – have you
registered yet?
The 9th European Forum on Quality Improvement in Health Care takes place in
Copenhagen, 12-14 May 2004. To register online, or for further information
go to http://www.quality.bmjpg.com
The Forum involves a choice of one-day minicourses, various plenary
sessions, workshops, oral presentations and poster displays. The Forum
focuses on learning for all, and aims to provide the inspiration and
practical skills needed for those responsible for improving health care.
Speakers include: Don Berwick, Lars Lokke Rasmussen, Helen Bevan & Richard
Smith, covering topics including:-
- Basics of quality management in health care
- Organisational culture patterns that impact on change
- Bringing creativity and innovation to health services
- Applications of improvement methods in developing nations
- Six Sigma isn’t just about widgets: patients and staff can benefit too
- Implementing improvement on a large scale
- Interactive simulation based training course
- Comparison of national approaches to quality in the UK and Nordic
countries
You will also have the opportunity to attend a daily interactive simulation
based training course, training that can take place without endangering
patients.
For further information, or to access the online registration brochure,
please click here http://www.quality.bmjpg.com
Please pass this email on to any colleagues who may be interested in
attending.
BMJ Quality
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go to http://www.archdischild.com/cgi/alerts/etoc
_______________________________________________________________________
Copyright (c) 2004 BMJ Publishing Group Ltd. & Royal College of Paediatrics
and Child Health