American journal of diseases of children (1911)
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We examined 11 children with infective endocarditis initially and serially by two-dimensional echocardiography. Nine (82%) of the 11 patients had echocardiographic findings at initial examination compatible with infective endocarditis. These results provided strong evidence in support of the diagnosis before bacteriologic confirmation was available. ⋯ Echocardiographic evidence of vegetations persisted during antibiotic therapy and resolved slowly during many months. Serial echocardiograms were useful in cases in which obvious valve destruction or marked increase in vegetation size imaged echocardiographically could be combined with clinical evidence of progressive heart failure to support a decision for early surgical intervention. Two-dimensional echocardiography can make important contributions to the diagnosis and management of children with infective endocarditis.
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Comparative Study
Respiratory status of children with epiglottitis with and without an artificial airway.
During a ten-year period, 22 children from our 170 cases of acute epiglottitis had reliable records of arterial blood gas data. The arterial/alveolar (a/A) oxygen tension ratios were calculated, with a value less than 0.75 representing abnormal gas exchange. ⋯ Thirty-three percent of initial chest roentgenograms were abnormal, with the major disorder being atelectasis and/or consolidation. We propose that the radiologic and gas exchange abnormalities result from the common pathophysiologic mechanism of increased lung water.
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Biography Historical Article
The first published report of an incubator for use in the care of the premature infant (1857).
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Seventeen children with sickle cell anemia received 40 partial exchange transfusions for serious complications of sickle cell anemia, and preoperatively to reduce the risk of anesthesia. Each patient received two partial exchange transfusions at 24-hour intervals and all patients tolerated the exchange transfusions well. ⋯ Patients with acute lung syndrome had remarkable improvement in clinical symptoms and PaO2 levels, and those with acute liver crisis had substantial reduction in serum bilirubin levels. All the other patients showed marked clinical improvement following the exchange transfusions.
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Gout is rarely noted as a clinical problem in secondary polycythemia-- even if profound polycythemia exists, as in cyanotic congenital heart disease. A retrospective study of 81 patients with congenital heart disease was done to assess the incidence of hyperuricemia. Twenty of 46 patients with cyanotic congenital heart disease had serum levels of uric acid greater than 8 mg/dl. ⋯ For cyanotic patients, serum levels of uric acid were related directly to the degree of polycythemia (r = .44; P less than .02). Impaired renal function or drug therapy did not seem to account for the hyperuricemia. Because levels of uric acid greater than 10 mg/dl probably are nephropathic, many of these patients may be incurring subclinical uric acid nephropathy.