Pediatrics
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Drowning is the third most common cause of death in the pediatric age group in Florida. The clinical presentation, laboratory data, modes of therapy and outcome of 34 cases of near-drowning in children under the age of 14 years were reviewed. The most common clinical findings on admission were a history of cardiopulmonary resuscitation, tachypnea, pulmonary edema, and acidosis. ⋯ Twelve (35%) required mechanical ventilation. Of these only six survived, four of them with severe neurological sequelae. Modern management of respiratory failure is important for the ultimate survival of these patients; however, the final neurological outcome seems to be related to brain damage at the time of the asphyxia rather than to subsequent management.
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A total of 130 patients with uncomplicated short stature (4 to 17 years of age) were treated with oxandrolone, 0.25 mg/kg/day, for up to four years. Oxandrolone therapy resulted in a two-fold increase in mean growth velocity in the first six months of therapy and was an effective growth stimulant for the full four-year period. ⋯ Assessment of the contribution of oxandrolone therapy to the latter group is difficult because of inadequate methodology and the wide variation in individual growth patterns. Taken in their entirety, the data suggest that oxandrolone is useful in the prolonged treatment of uncomplicated short stature and is not associated with undesirable acceleration of skeletal maturation.
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Comparative Study
Management of tracheobronchial foreign bodies in children: a reevaluation of postural drainage and bronchoscopy.
The efficacy of the inhalation-postural drainage technique for removal of aspirated foreign bodies was compared with that of bronchoscopy in 76 children. Twelve of 49 children on postural drainage coughed out the foreign body (25%); the other 37 required bronchoscopy. The foreign body was successfully removed in 56 of 63 children who were bronchoscoped (89%). ⋯ If unsuccessful after several treatments, however, the technique should be abandoned, and bronchoscopy performed. Delay of foreign body removal beyond 24 hours may be associated with increased morbidity and prolonged hospital stay. With recent improvements in pediatric endoscopic instruments, the efficacy of bronchoscopy exceeds 90%.
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Lung volume, airway resistance, and compliance have been measured in 19 infants, 18 of whom suffered from the respiratory distress syndrome (RDS) at birth, while the remaining infant was ventilated for persistent apnea and a pneumothorax. Prior to discharge from the neonatal unit, and after recovery from RDS, most infants were found to have essentially normal lung function. When retested between 4 and 11 months of age, every infant who had received artificial ventilation during the acute illness was found to have developed a raised airway resistance, whereas the remaining infants, who had been treated with continuous positive airway pressure and/or oxygen were all entirely normal. The implications of these results for the management of RDS are discussed.
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Transillumination of the neonatal chest is described as an aid in the diagnosis of pneumothorax or pneumomediastinum. Sudden severe tension pneumothorax or pneumomediastinum can be localized for immediate treatment and the success of therapy can be immediately assessed using transillumination.