Saturday, September 30, 2006

pediatric hypotension. Low blood pressure in children

Its ironic to believe that there are no standards set / studied or developed to diagnose pediatric hypotension. Low blood pressure in children is defined and taken as different pediatricians and hence are the maximum confusions and unnecessary use of inotropes and development of complications.

In most developing countries, low normal blood pressure is very common, its mainly related to poor nutrition including decreased intake. More so in children when any illness in children predominantly results in decreased intake and thus subclinical hypovolemia.
I had personally attended many deaths in children in intensive care settings in tertiary care settings, they aere associated mainly with hypovolemia whatever the diagnosis be.
Sometimes it was fluid restriction, sometimes inadequate correction of fluid deficit and sometimes excess diuretic administration with fluid restriction.All these surely worsen hemodynamics in
situations like nephrotic syndrome, shock sepsis, meningitis, congestive geart failure etc.

here are simple rules that help us in avoiding unnecessary use of inotropes in children especially dopamine , dobutamine and adrenaline.

following are the levels of systolic blood pressure lower normal limits below which inotrope support may be warranted provided a failur to fluid resucitation is documented with at least 60 ml/kg fluid infusion in 2 hours.
weight of child blood pressure lower normal systolic
1-2 kg 50 mm Hg
3-10 kg 60 mm Hg
10 kg and above 70 mm Hg (plus double the age in years, when age is 10 or more)

( according to standard guidelines the inotropes need to be started below 60 mmHg systolic BP in newborn, below 70mm Hg in infants and below 80 mm Hg in children upto 10 years, and above 10 years below 90 mmHg.

Most books give guidelines to maintain systolic BP to 50th centile, and give guidelines as when it drops below 50th centile, start inotropes. But this is unjustified in clinical settings when there is a significant chance of the blood pressure being normal even at 10-50th centile. So considering the normal Gaussian variation, every blood pressure cant be treated with inotropes when it starts falling below 50th centile.
Lets just give a thought, why is blood pressure needed for? to perfuse the distal most part of extremeties to maintain oxygen distribution and saturation to 96%. If the same is maintained, which can be easily assessed and monitored in children due to tehir thin skin; why is there a cry to maintain systolic BP even if saturation and perfusion is stable and normal.

Blood pressure being regulated by various mechanisms and can change with childs activity, movement of cuff tube and cuff size and also proper size BP cuffs in children is a known rarity often, its impractical to trust the readings of BP just to define hypotension. And since ist last thing to change, may be you have to wait to see the effect of ongoing therapy?
(the arguments made by many are that if BP is at 50th centile or just below it, that means body has given an indication of failing BP regulation and needs inotropes; but friends, thats not so; as if body regulatory mechanisms fail, it should immediately drop below 10th centile.



To summarise, for all practical purposes, fluid resuscitation is warranted as life saving measure, when
newborn systolic blood pressure falls below 50 mm Hg
infant systolic blood pressure falls below 60 mm Hg
and systolic child blood pressure falls below 70 mm Hg

REMEMBER DONOT THINK OF INOTROPES UNLESS YOU HAVE MADE SURE THAT BODY HAS ENOUGH BLOOD VOLUME (40-80cc per kg) IN BLOOD VESSELS, THIS CAN BE CONFIRMED BY CHECKING CVP, IT SHOULD BE MORE THAN 5 TO START INOTROPES (or at least 60-80 cc/kg fluid has to be pushed in), SO BUILD UP VENOUS VOLUME BEFORE GETTING INOTROPE SUPPORT.









Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA

Tuesday, May 23, 2006

methods of recording BP

Infants

Older children

Auscultation

Auscultation

Flush method

Palpation method

Ultrasonic (Doppler) and oscillometric (Dinamp) devices

Blood pressure should be measured after 3-5 minutes of rest in the seated position with the cubital fossa at heart level. Infants and toddlers may be supine. The cuff should be inflated to a pressure of 20-30 mmHg above systolic blood pressure with a cuff deflation rate of 2-3 mmHg/sec. It should be recorded at least twice on each occasion.

Systolic blood pressure is determined by the onset of the ‘tapping’ Kortokoff sounds. The definition of the diastolic blood pressure is changed from muffling of the K sounds (the 4th Kortokoff sound) in children under 13 years old to the disappearance of the sounds (the 5th Kortokoff sound) in children of all ages.



Dr kondekar santosh venketraman
child health specialist at HIS best!
9869405747
Pediatrician; seth G S Medical colllege
KEM Hospital - Parel/Bhabha Hospital - Bandra
Mumbai
for parents*more about me* Caring for kids*Yahoogroups Paediatrics*

Friday, April 28, 2006

for pediatricians : clinical tips

for pediatricians
for pediatricians

06/08/2003

There is nothing called an emergency intubation?: TIP:not resistance but lack of some precaution on your part.; YES!! Just be confident in AMBU BMV, infact you should never hurry for intubation, unless you achieve a good chest rise and good color/spo2 on AMBU. BMV is the standard safest and most effective mode of mechanical ventilation. If you hurry for intubation, I am sure you will land up in complications. You always have enough time to plan an emergency intubation, give atropine and sedation and to chose the proper tube size.

--------------------------------------------------------------------------------

06/07/2003

Most of my patients with fever chills, who I send home on chloroquine; they come back within 24 hrs saying no effext! Is it chloroquine resistance?: TIP:not resistance but lack of some precaution on your part.; See it takes at least 26 hrs to get control over fever after starting chloroquine. If you had taken time to tell pt that fever may recur in 36 hrs, he wouldnt come to you at the next spike of fever. Also some other imp points which you need to tell him are: Shivering/sweating is nothing to worry (!), blankets may aggrevate temp.; Vomitting may be common following tablets. (Why dont you habituate yourself to give the first dose of chloroquine in hospital itself?. Its prefered that it should be given with food but even glucon D suffices; also countering the hypoglycemia effect)
Delete It Cancel

Tuesday, March 14, 2006

how to inject medicines to babies?

funny


<3 yrs: I recommend child in mothers arm, immobilised... while one injects in thigh or butts.

3yr and above : no amount of counselling helps. Just inform that he may be given an injection which may not pain if he cooperates. Then apply restrain and finish the procedure in shortest time without the kid realising most of it.

===============================================

The maximum pain occurs when the chemical brushes with cut nerve endings.

SO:

use a separate needle to inject.

and when you withdraw needle out, let it be in shortest time span ( preferably with a jerk... rather than slow removal that pains alot).

injecting medicine in... slow or fast usually doesnt much affect duration or intensity of pain...( u r in painless intermuscular or fascial plain)


avoiding bony sites and periosteal injury will be preferable. ( so prefer bulk of muscle... dont hurry to inject)

Monday, March 13, 2006

oral/RT rehydration is almost as efficacious as parenteral, provided the feeding is supervised despit vomitting and sepsis is ruled out.

for pediatriciansoral/RT rehydration is almost as efficacious as parenteral, provided the feeding is supervised despit vomitting and sepsis is ruled out.

Sunday, February 19, 2006

Re: paediatrics yahoo case discussion: query

Dear collegue:
 
My first impression after read this was an infection due to pertussis in an unvaccinated children or an inmunosupression secondary to acute leukemia, but these entities had some details in the clinical exam, labs o history hardly to hide, so I did a fast search on pubmed and these are my results: Pneumonia AND Leucocytosis
 
-Its more linked to pertussis, after mycoplasma or EBV 
-Leukemoid reaction is a bad prognostic finding, independent of the causal agent.
 
Juan Pablo Chalco O MD
Pediatrician
 
Items 1 - 127 of 127
One page.
1: De Berry BB, Lynch JE, Chung DH, Zwischenberger JB. Related Articles, Links
Abstract Pertussis with severe pulmonary hypertension and leukocytosis treated with extracorporeal membrane oxygenation.
Pediatr Surg Int. 2005 Aug;21(8):692-4. Epub 2005 Oct 13.
PMID: 15937656 [PubMed - indexed for MEDLINE]
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Abstract Does leucocytosis identify bacterial infections in febrile neonates presenting to the emergency department?
Emerg Med J. 2005 Apr;22(4):256-9.
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Free Full Text A young infant with severe acute respiratory syndrome.
Pediatrics. 2003 Oct;112(4):e257.
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8: Goedvolk CA, von Rosenstiel IA, Bos AP. Related Articles, Links
Free Full Text Immune complex associated complications in the subacute phase of meningococcal disease: incidence and literature review.
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9: Pilorget H, Montbrun A, Attali T, Tiran-Rajaofera I, Bony C, Brayer C, Samperiz S, Alessandri JL. Related Articles, Links
Abstract [Malignant pertussis in the young infant]
Arch Pediatr. 2003 Sep;10(9):787-90. French.
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10: Hodge G, Hodge S, Markus C, Lawrence A, Han P. Related Articles, Links
Abstract A marked decrease in L-selectin expression by leucocytes in infants with Bordetella pertussis infection: leucocytosis explained?
Respirology. 2003 Jun;8(2):157-62.
PMID: 12753529 [PubMed - indexed for MEDLINE]
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Abstract The evolution of Lemierre syndrome: report of 2 cases and review of the literature.
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12: Smith C, Taylor D. Related Articles, Links
No abstract Quieting the '100-day cough'. A primer on pertussis.
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13: Pierce C, Klein N, Peters M. Related Articles, Links
Abstract Is leukocytosis a predictor of mortality in severe pertussis infection?
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14: Garcia-Perez A, Espino M, Barrio A, Echavarri F, Bonet B, Bueno M, Yanguela J. Related Articles, Links
Abstract [Pseudotumor cerebri associated with maxillary sinusitis: clinico-pathological study]
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15: Hudnall SD, Molina CP. Related Articles, Links
Abstract Marked increase in L-selectin-negative T cells in neonatal pertussis. The lymphocytosis explained?
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16: Lee B. Related Articles, Links
No abstract Progressive respiratory distress in an infant treated for presumed pertussis.
Pediatr Infect Dis J. 2000 May;19(5):475, 492-3. No abstract available.
PMID: 10819348 [PubMed - indexed for MEDLINE]
17: von Rosenstiel IA, Plotz FB. Related Articles, Links
No abstract ECLS in pertussis: does it have a role?
Intensive Care Med. 1999 Nov;25(11):1341-2. No abstract available.
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18: Panacek EA. Related Articles, Links
No abstract Occult pneumonias in febrile children with leukocytosis.
Ann Emerg Med. 1999 Nov;34(5):683-4. No abstract available.
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19: Baraff LJ. Related Articles, Links
No abstract Empiric chest radiographs in febrile children with leukocytosis.
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20: Bobrov VM, Shishkin SA. Related Articles, Links
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Abstract Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis.
Ann Emerg Med. 1999 Feb;33(2):166-73.
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22: Green SM, Rothrock SG. Related Articles, Links
No abstract Evaluation styles for well-appearing febrile children: are you a "risk-minimizer" or a "test-minimizer"?
Ann Emerg Med. 1999 Feb;33(2):211-4. No abstract available.
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23: Heininger U, Klich K, Stehr K, Cherry JD. Related Articles, Links
Free Full Text Clinical findings in Bordetella pertussis infections: results of a prospective multicenter surveillance study.
Pediatrics. 1997 Dec;100(6):E10.
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24: Fishback N, Koss M. Related Articles, Links
Abstract Update on lymphoid interstitial pneumonitis.
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25: McCarthy VP, Carlile JR. Related Articles, Links
Abstract Hyperleukocytosis with pertussis.
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Abstract Pneumothorax as the presenting sign of Pneumocystis carinii infection in an HIV-positive child with prior lymphocytic interstitial pneumonitis.
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29: Hotz P, Loos U, Luderitz B. Related Articles, Links
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30: Yetgin S, Ozbek N, Tuncer M, Gocmen A, Ozcelik U. Related Articles, Links
Abstract Kostmann's syndrome with chronic pneumonia and lymphocytosis: effect of recombinant human G-CSF.
Turk J Pediatr. 1994 Jan-Mar;36(1):87-91.
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31: Matsuo M, Hara T, Ura Y, Motoyama K, Miyazaki S. Related Articles, Links
No abstract Measles without rash in an infant with pertussis.
Acta Paediatr Jpn. 1993 Dec;35(6):541. No abstract available.
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32: Constans J, Ladner J, Dabis F, Brossard G, Commenges D, Leng B, Conri C. Related Articles, Links
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Abstract [Diffuse alveolar pertussis with major hyperleukocytosis with "pseudocentrocytic" contingent]
Pediatrie. 1992;47(2):117-20. French.
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Aktuelle Traumatol. 1988 Feb;18(1):51-4. German.
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Arch Fr Pediatr. 1986 Mar;43(3):175-8. French.
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42: Shenderova RI, Osina NA. Related Articles, Links
No abstract [Types of group-specific proteins, ceruloplasmin and transferrin in pulmonary tuberculosis patients]
Probl Tuberk. 1986;(9):50-3. Russian. No abstract available.
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43: Allegretta GJ, Weisman SJ, Altman AJ. Related Articles, Links
Abstract Oncologic emergencies II. Hematologic and infectious complications of cancer and cancer treatment.
Pediatr Clin North Am. 1985 Jun;32(3):613-24.
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44: Bertotto A, Forenza N, Peirone AP, Mazzarino I, Vaccaro R. Related Articles, Links
No abstract T-cell subsets in children with pertussis.
Haematologica. 1984 May-Jun;69(3):342-5. No abstract available.
PMID: 6432647 [PubMed - indexed for MEDLINE]
45: De Martino M, Rossi ME, Muccioli AT, Ulivelli A, Vierucci A. Related Articles, Links
Abstract Preferential increase of a T-cell subset as a cause of lymphocytosis in children with whooping cough.
Boll Ist Sieroter Milan. 1984;63(5):479-82.
PMID: 6335661 [PubMed - indexed for MEDLINE]
46: Lafitte JJ, Steenhouwer F, Roussel M, Courcol R, Voisin C, Caillaux M, Debosker Y, Geslin P. Related Articles, Links
Abstract [Kinetics of the local immune response in lobar pneumonia]
Bull Eur Physiopathol Respir. 1983 Mar-Apr;19(2):209-13. French.
PMID: 6871500 [PubMed - indexed for MEDLINE]
47: Saumur JH. Related Articles, Links
No abstract Hematology problem: pertussis.
Am J Med Technol. 1983 Mar;49(3):169-70. No abstract available.
PMID: 6340501 [PubMed - indexed for MEDLINE]
48: Aronson MD, Komaroff AL, Pass TM, Ervin CT, Branch WT. Related Articles, Links
Abstract Heterophil antibody in adults with sore throat: frequency and clinical presentation.
Ann Intern Med. 1982 Apr;96(4):505-8.
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49: Krylov AA, Dmitriev VI. Related Articles, Links
No abstract [Tonsillogenic reactive polyadenitis and leukemoid reactions in young people]
Voen Med Zh. 1982 Jan;(1):62-4. Russian. No abstract available.
PMID: 7058657 [PubMed - indexed for MEDLINE]
50: McGeady SJ, Murphey SA. Related Articles, Links
No abstract Disseminated Mycobacterium kansasii infection.
Clin Immunol Immunopathol. 1981 Jul;20(1):87-98. No abstract available.
PMID: 6455228 [PubMed - indexed for MEDLINE]
51: Matsuhashi Y. Related Articles, Links
No abstract [Studies on lymphocytes associated with pertussis infection and vaccination. Analysis of lymphocyte subpopulation (author's transl)]
Kansenshogaku Zasshi. 1980 Aug;54(8):383-95. Japanese. No abstract available.
PMID: 6782177 [PubMed - indexed for MEDLINE]
52: Ward PC. Related Articles, Links
Abstract The lymphoid leukocytoses.
Postgrad Med. 1980 Feb;67(2):217-23.
PMID: 7352124 [PubMed - indexed for MEDLINE]
53: Prusek W, Jankowski A. Related Articles, Links
Abstract Some aspects of humoral and cellular immunity in children suffering from spastic bronchitis.
Arch Immunol Ther Exp (Warsz). 1980;28(1):53-9.
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54: Shann F, Germer S. Related Articles, Links
Abstract Leukaemoid reaction in Eastern Highlands children.
P N G Med J. 1979 Dec;22(4):55-7.
PMID: 299330 [PubMed - indexed for MEDLINE]
55: Tsai TF, Finn DR, Plikaytis BD, McCauley W, Martin SM, Fraser DW. Related Articles, Links
Abstract Legionnaires' disease: clinical features of the epidemic in Philadelphia.
Ann Intern Med. 1979 Apr;90(4):509-17.
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56: Buchs S. Related Articles, Links
No abstract [Significance of blood sedimentation for diagnosis of pertussis]
Dtsch Med Wochenschr. 1978 Mar 10;103(10):399-400. German. No abstract available.
PMID: 639652 [PubMed - indexed for MEDLINE]
57: Botvin'ev VV, Baranova NF, Sterligov LA. Related Articles, Links
No abstract [T- and B-immunity systems in acute respiratory and allergic diseases of the respiratory organs in children]
Vestn Akad Med Nauk SSSR. 1978;(7):24-9. Russian. No abstract available.
PMID: 307880 [PubMed - indexed for MEDLINE]
58: Handzel ZT, Levin S, Ashkenazi A, Hahn T, Altman Y, Czernobilsky B, Shechter B, Trainin N. Related Articles, Links
Abstract Immune deficiency of T system with possible T cell regulatory activity defect.
Isr J Med Sci. 1977 Apr;13(4):347-53.
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59: Weintraub MI. Related Articles, Links
Abstract External ophthalmoplegia, ataxia, and areflexia complicating acute infectious polyneuritis.
Am J Ophthalmol. 1977 Mar;83(3):355-7.
PMID: 848540 [PubMed - indexed for MEDLINE]
60: Malleson PN, Bennett JC. Related Articles, Links
Abstract Whooping-cough admissions to a paediatric hospital over ten years. The protective value of immunisation.
Lancet. 1977 Jan 29;1(8005):237-9.
PMID: 64762 [PubMed - indexed for MEDLINE]
61: Erben W, Ebert H. Related Articles, Links
Abstract [Relationship between age and inflammatory reaction following mitral commissurotomy]
ZFA. 1977;32(2):41-5. German.
PMID: 919582 [PubMed - indexed for MEDLINE]
62: Tacu V, Cdun-Tarabutta G, Dascalu M, Nastasa V, Alexa M. Related Articles, Links
No abstract [Biological changes in the course of acute microbial bronchopneumopathies. II.]
Rev Med Chir Soc Med Nat Iasi. 1977 Jan-Mar;81(1):23-7. Romanian. No abstract available.
PMID: 866833 [PubMed - indexed for MEDLINE]
63: Bernales R, Eastman J, Kaplan J. Related Articles, Links
Abstract Quantitation of circulating T and B lymphocytes in children with whooping cough.
Pediatr Res. 1976 Dec;10(12):965-7.
PMID: 1087001 [PubMed - indexed for MEDLINE]
64: Begue P, Lasfargues G, Omanga U. Related Articles, Links
No abstract [Respiratory infections due to Mycoplasma pneumoniae]
Ann Pediatr (Paris). 1976 Jan 2;23(1):43-6. French. No abstract available.
PMID: 16104250 [PubMed - indexed for MEDLINE]
65: Morse SI. Related Articles, Links
No abstract Biologically active components and properties of Bordetella pertussis.
Adv Appl Microbiol. 1976;20:9-26. No abstract available.
PMID: 11644 [PubMed - indexed for MEDLINE]
66: Bachi C, Jona E, Botta G. Related Articles, Links
No abstract [Some cases of lymphomonocytosis and atypical immunological syndromes]
Minerva Med. 1975 Jun 20;66(45):2212-6. Italian. No abstract available.
PMID: 1143704 [PubMed - indexed for MEDLINE]
67: Hoagland RJ. Related Articles, Links
Abstract Infectious mononucleosis.
Prim Care. 1975 Jun;2(2):295-307.
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68: Vietti TJ, Ragab AH. Related Articles, Links
Abstract Complications and total care of a child with acute leukemia.
Cancer. 1975 Mar;35(3 suppl):1007-14.
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69: Chervenick PA. Related Articles, Links
No abstract Infectious mononucleosis.
Dis Mon. 1974 Dec;:1-29. Review. No abstract available.
PMID: 4373218 [PubMed - indexed for MEDLINE]
70: Eule H, Werner E, Winsel K, Iwainsky H. Related Articles, Links
No abstract Intermittent chemotherapy of pulmonary tuberculosis using rifampicin and isoniazid for primary treatment: the influence of various factors on the frequency of side-effects.
Tubercle. 1974 Mar;55(1):81-9. Review. No abstract available.
PMID: 4620295 [PubMed - indexed for MEDLINE]
71: Behan PO, Moore MJ, Lamarche JB. Related Articles, Links
No abstract Acute necrotizing hemorrhagic encephalopathy.
Postgrad Med. 1973 Oct;54(4):154-60. No abstract available.
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72: Andriushchenko TM. Related Articles, Links
No abstract [Significance of leukocytosis, antihistamine factor and tuberculin hemolysis in the diagnosis of tuberculosis]
Vrach Delo. 1973 Aug;8:8-12. Russian. No abstract available.
PMID: 4149202 [PubMed - indexed for MEDLINE]
73: Nimis R. Related Articles, Links
No abstract [Presence of unusual cellular elements in the circulating blood (in some cases of acute diseases of various etiology)]
Minerva Med. 1973 May 27;64(38):2035-47. Italian. No abstract available.
PMID: 4737076 [PubMed - indexed for MEDLINE]
74: Novis BH, Bank S, Marks IN. Related Articles, Links
No abstract Gastro-intestinal and peritoneal tuberculosis. A study of cases at Groote Schuur Hospital 1962-1971.
S Afr Med J. 1973 Mar 3;47(9):365-72. No abstract available.
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75: Steinitz H. Related Articles, Links
No abstract [Results of clinical trials with cephadrine in children]
Infection. 1973;1(3):163-9. German. No abstract available.
PMID: 4597099 [PubMed - indexed for MEDLINE]
76: Fernbach DJ, Starling KA. Related Articles, Links
No abstract Infectious mononucleosis.
Pediatr Clin North Am. 1972 Nov;19(4):957-68. Review. No abstract available.
PMID: 4343069 [PubMed - indexed for MEDLINE]
77: Ishchenko IK, Orlov OV. Related Articles, Links
No abstract [Characteristics of the course of acute pneumonia in young persons]
Voen Med Zh. 1972 Oct;10:77-8. Russian. No abstract available.
PMID: 4669169 [PubMed - indexed for MEDLINE]
78: Dietzsch HJ, Wunderlich P, Potschick G, Frey G. Related Articles, Links
No abstract [Abscessed (staphylococcal) pneumonia in childhood]
Z Arztl Fortbild (Jena). 1972 Sep 1;66(17):863-8. German. No abstract available.
PMID: 4118084 [PubMed - indexed for MEDLINE]
79: Park S, Giammona ST. Related Articles, Links
No abstract Toxic effects of tear gas on an infant following prolonged exposure.
Am J Dis Child. 1972 Mar;123(3):245-6. No abstract available.
PMID: 4554617 [PubMed - indexed for MEDLINE]
80: Zinov'ev IP, Dibeeva LM. Related Articles, Links
No abstract [Hyperleukocytosis in fibro-cavitary pulmonary tuberculosis]
Probl Tuberk. 1972;50(1):60-3. Russian. No abstract available.
PMID: 5010784 [PubMed - indexed for MEDLINE]
81: Kaluza P. Related Articles, Links
No abstract [Slowly-resolving and persistent pneumonias--differentiation of non-contagious tuberculosis and bronchial carcinoma]
Z Erkr Atmungsorgane Folia Bronchol. 1972;137(1):17-33. German. No abstract available.
PMID: 4486577 [PubMed - indexed for MEDLINE]
82: Justus J, Heyne K. Related Articles, Links
No abstract [Pathological-anatomical and clinical findings in progressive septic granulomatous disease in infants]
Acta Paediatr Acad Sci Hung. 1972;13(4):377-86. German. No abstract available.
PMID: 4268903 [PubMed - indexed for MEDLINE]
83: Naeye RL, Dellinger WS, Blanc WA. Related Articles, Links
No abstract Fetal and maternal features of antenatal bacterial infections.
J Pediatr. 1971 Nov;79(5):733-9. No abstract available.
PMID: 5000610 [PubMed - indexed for MEDLINE]
84: Caul EO, Mott MG, Clarke SK, Perham TG, Wilson RS. Related Articles, Links
No abstract Cytomegalovirus infections after open heart surgery. A prospective study.
Lancet. 1971 Apr 17;1(7703):777-80. No abstract available.
PMID: 4101275 [PubMed - indexed for MEDLINE]
85: Arndt HJ. Related Articles, Links
No abstract [Fulminating epiglottitis in children. Report on 50 cases]
Dtsch Med Wochenschr. 1971 Apr 2;96(14):569-77. German. No abstract available.
PMID: 5548854 [PubMed - indexed for MEDLINE]
86: Burke JP, Klein JO, Gezon HM, Finland M. Related Articles, Links
No abstract Pneumococcal bacteremia. Review of 111 cases, 1957--1969, with special reference to cases with undetermined focus.
Am J Dis Child. 1971 Apr;121(4):353-9. Review. No abstract available.
PMID: 4396753 [PubMed - indexed for MEDLINE]
87: Lampkin BC, Mauer AM. Related Articles, Links
No abstract Clinical manifestations of visceral larva migrans. Variability as related to duration of ingestion.
Clin Pediatr (Phila). 1970 Nov;9(11):683-5. No abstract available.
PMID: 5477280 [PubMed - indexed for MEDLINE]
88: Verin P. Related Articles, Links
No abstract [Infectious pathology. II. Viral pathology]
Arch Ophtalmol Rev Gen Ophtalmol. 1970 May;30(5):437-52. Review. French. No abstract available.
PMID: 4316940 [PubMed - indexed for MEDLINE]
89: Goudemand M, Bauters F, Leduc M, Tacquet A, Devulder B, Debruyne J. Related Articles, Links
No abstract [Generalized mycobacteriosis with hematologic manifestations (fatal infection with Mycobacterium kansasii with myeloid type, leukemoid reaction)]
Rev Tuberc Pneumol (Paris). 1970 Mar;34(2):225-46. French. No abstract available.
PMID: 5510313 [PubMed - indexed for MEDLINE]
90: Kostyshin AT. Related Articles, Links
No abstract [Migration of leukocytes to the surface of the palatine tonsils in tonsillitis]
Zh Ushn Nos Gorl Bolezn. 1970 Mar-Apr;30(2):76-80. Russian. No abstract available.
PMID: 5496049 [PubMed - indexed for MEDLINE]
91: Breson K, Diepeveen J. Related Articles, Links
No abstract Dissection tonsillectomy--complications and follow-up.
J Laryngol Otol. 1969 Jun;83(6):601-8. No abstract available.
PMID: 5254391 [PubMed - indexed for MEDLINE]
92: Leigh PG. Related Articles, Links
No abstract Appendicitis--still a considerable problem.
S Afr Med J. 1969 May 31;43(22):700-5. No abstract available.
PMID: 5786237 [PubMed - indexed for MEDLINE]
93: Guignard J, Rousseau L, Le Gouas JJ. Related Articles, Links
No abstract [Pneumopathies in children due to ingestion of petroleum]
Ann Pediatr (Paris). 1969 Apr 2;16(4):284-9. French. No abstract available.
PMID: 5800640 [PubMed - indexed for MEDLINE]
94: Kowal-Gierczak B, Kuczynska-Sekieta K, Dolinska G, Falowska-Adamczyk W, Szott M. Related Articles, Links
No abstract [Some biochemical changes in patients with post-influenzal complications]
Przegl Lek. 1969;25(12):793-6. Polish. No abstract available.
PMID: 5367980 [PubMed - indexed for MEDLINE]
95: Fujii K. Related Articles, Links
No abstract Studies on lymphocytosis induced by Hemophilus pertussis. 3. Clinical studies: observations of peripheral blood and cultured lymphocytes in vitro.
Hiroshima J Med Sci. 1968 Dec;17(4):261-83. No abstract available.
PMID: 4307309 [PubMed - indexed for MEDLINE]
96: Calcaterra TC. Related Articles, Links
No abstract An evaluation of the treatment of subglottic hemangioma.
Laryngoscope. 1968 Nov;78(11):1956-64. No abstract available.
PMID: 5755027 [PubMed - indexed for MEDLINE]
97: Al'tman EM, Katkova LS. Related Articles, Links
No abstract [On the interrelation between chronic tonsillitis and acute appendicitis in children]
Pediatriia. 1968 May;47(5):62-4. Russian. No abstract available.
PMID: 5713344 [PubMed - indexed for MEDLINE]
98: Kocoglu V. Related Articles, Links
No abstract [Acute infectious lymphocytosis]
Kinderarztl Prax. 1968 Mar;36(3):105-8. German. No abstract available.
PMID: 5715780 [PubMed - indexed for MEDLINE]
99: Men'shikova NL, Sintosova GG. Related Articles, Links
No abstract [Infectious lymphocytosis in children with tuberculosis]
Probl Tuberk. 1968;46(5):82-3. Russian. No abstract available.
PMID: 5708505 [PubMed - indexed for MEDLINE]
100: Shakhnovich LA. Related Articles, Links
No abstract [On the reaction of local (comparative) leukocytosis]
Lab Delo. 1968;9:573-4. Russian. No abstract available.
PMID: 4184969 [PubMed - indexed for MEDLINE]
101: Collins JO, Rosenberg HA, Warren P. Related Articles, Links
No abstract Disseminated pathergic granulomatosis in a 4-month-old infant: a case report.
Pediatrics. 1967 Dec;40(6):975-9. No abstract available.
PMID: 6074137 [PubMed - indexed for MEDLINE]
102: Kjellman B. Related Articles, Links
No abstract Bronchial asthma and recurrent pneumonia in children. Clinical evaluation of 14 children.
Acta Paediatr Scand. 1967 Nov;56(6):651-9. No abstract available.
PMID: 4169523 [PubMed - indexed for MEDLINE]
103: Brooksaler F, Nelson JD. Related Articles, Links
No abstract Pertussis. A reappraisal and report of 190 confirmed cases.
Am J Dis Child. 1967 Oct;114(4):389-96. No abstract available.
PMID: 6047238 [PubMed - indexed for MEDLINE]
104: Skarberg KO, Lagerlof B, Reizenstein P. Related Articles, Links
No abstract Leukaemia, leukaemoid reaction and tuberculosis.
Acta Med Scand. 1967 Oct;182(4):427-32. No abstract available.
PMID: 5234000 [PubMed - indexed for MEDLINE]
105: Johnston RB Jr, McMurry JS. Related Articles, Links
No abstract Chronic familial granulomatosis. Report of five cases and review of the literature.
Am J Dis Child. 1967 Oct;114(4):370-8. No abstract available.
PMID: 4167307 [PubMed - indexed for MEDLINE]
106: Ambs E, Koch WR. Related Articles, Links
No abstract [On the diagnostic value of the white blood count in the convulsive stage of whooping cough]
Z Kinderheilkd. 1967;100(4):331-42. German. No abstract available.
PMID: 5596638 [PubMed - indexed for MEDLINE]
107: Shengeliia AA. Related Articles, Links
No abstract [Comparative evaluation of Wunderlich's triad, ESR indexes and leukocytosis in children with pneumonia]
Pediatriia. 1966 Apr;45(4):66-7. Russian. No abstract available.
PMID: 5985085 [PubMed - indexed for MEDLINE]
108: Shnaider LA, Dzhikiia NI. Related Articles, Links
No abstract [The blood picture in chronic and recurrent forms of pneumonia in young children]
Pediatriia. 1966 Mar;45(3):44-8. Russian. No abstract available.
PMID: 5974304 [PubMed - indexed for MEDLINE]
109: Liebscher S, Wunderlich P. Related Articles, Links
No abstract [A case of facial paralysis caused by adenovirus type 5 infection]
Dtsch Med Wochenschr. 1966 Feb 11;91(6):256-9. German. No abstract available.
PMID: 4285741 [PubMed - indexed for MEDLINE]
110: Ambs E. Related Articles, Links
No abstract [On the characterization of pertussis lymphocytes in the peripheral blood]
Ann Paediatr. 1966;206(2):120-34. German. No abstract available.
PMID: 5953109 [PubMed - indexed for MEDLINE]
111: Ferrari M. Related Articles, Links
No abstract [Febrile, lymphocytic and hypergammaglobulin syndrome]
Prensa Med Argent. 1966;53(1):361-3. Spanish. No abstract available.
PMID: 4168487 [PubMed - indexed for MEDLINE]
112: PEDOYA C, GIRIER L, MICHALLET M, DISCAMPS C. Related Articles, Links
No abstract [VALUE OF THE ORAL ADMINISTRATION OF CLOMETHOCILLIN IN THE TREATMENT OF INFECTIONS DUE TO PENICILLIN-SENSITIVE BACTERIA.]
Presse Med. 1965 Apr 24;73:1219-20. French. No abstract available.
PMID: 14273899 [PubMed - OLDMEDLINE for Pre1966]
113: GREWE HE, MARTINI-PAPE M. Related Articles, Links
No abstract [PURULENT MEDIASTINITIS IN EARLY INFANCY.]
Kinderarztl Prax. 1964 Jul;32:305-14. German. No abstract available.
PMID: 14252840 [PubMed - OLDMEDLINE for Pre1966]
114: DREYFUS B. Related Articles, Links
No abstract [PRACTICAL INTERPRETATION OF BLOOD LYMPHOCYTOSIS.]
Rev Prat. 1964 May 1;14:1673-81. French. No abstract available.
PMID: 14147342 [PubMed - OLDMEDLINE for Pre1966]
115: FLEISCHHACKER H, STACHER A. Related Articles, Links
No abstract [REACTIONS OF BLOOD LYMPHOCYTES.]
Med Klin. 1964 Mar 6;59:382-5. German. No abstract available.
PMID: 14176487 [PubMed - OLDMEDLINE for Pre1966]
116: OLSON LC, MILLER G, HANSHAW JB. Related Articles, Links
No abstract ACUTE INFECTIOUS LYMPHOCYTOSIS PRESENTING AS A PERTUSSIS-LIKE ILLNESS: ITS ASSOCIATION WITH ADENOVIRUS TYPE 12.
Lancet. 1964 Jan 25;39:200-1. No abstract available.
PMID: 14074503 [PubMed - OLDMEDLINE for Pre1966]
117: MATTELAER PM, RILEY HD Jr. Related Articles, Links
No abstract LEUKEMIA IN THE PERINATAL PERIOD.
Ann Paediatr. 1964;203:124-36. No abstract available.
PMID: 14206837 [PubMed - OLDMEDLINE for Pre1966]
118: DUBOIS J. Related Articles, Links
No abstract [PREVENTION BY PENICILLIN OF THE BACTERIAL COMPLICATIONS OF MEASLES IN CHILDREN.]
Rev Med Liege. 1964 Jan 1;19:19-24. French. No abstract available.
PMID: 14135986 [PubMed - OLDMEDLINE for Pre1966]
119: WULFF H, KIDD P, WENNER HA. Related Articles, Links
No abstract ETIOLOGY OF RESPIRATORY INFECTIONS. FURTHER STUDIES DURING INFANCY AND CHILDHOOD.
Pediatrics. 1964 Jan;33:30-44. No abstract available.
PMID: 14115225 [PubMed - OLDMEDLINE for Pre1966]
120: SHVALKO AD, MUKHINA TL. Related Articles, Links
No abstract [HEMATOLOGICAL CHANGES IN WHOOPING COUGH IN CHILDREN DURING THE FIRST MONTHS OF LIFE.]
Vopr Okhr Materin Det. 1963 Oct;27:55-9. Russian. No abstract available.
PMID: 14123225 [PubMed - OLDMEDLINE for Pre1966]
121: KAPLAN AS, GAEVA LL, MAKARENKO GA. Related Articles, Links
No abstract [ANALYSIS OF AN OUTBRAKE OF ADENOVIRVUS DISEASES IN THE PEDIATRIC SECTION OF A TUBERCULOSIS SANATORIUM.]
Pediatriia. 1963 Sep;42:23-7. Russian. No abstract available.
PMID: 14088498 [PubMed - OLDMEDLINE for Pre1966]
122: KRIUKOVA OF, KECHKINA ZS. Related Articles, Links
No abstract [ON ADENOVIRUS INFECTION IN CHILDREN.]
Vopr Okhr Materin Det. 1963 Jul;90:81-2. Russian. No abstract available.
PMID: 14069411 [PubMed - OLDMEDLINE for Pre1966]
123: GOTTI D, GRAZIA G. Related Articles, Links
No abstract [INFECTIOUS MONONUCLEOSIS IN CHILDHOOD. FINDINGS OF A CLINICAL NATURE.]
Clin Pediatr (Bologna). 1963 Apr;45:229-32. Italian. No abstract available.
PMID: 14075309 [PubMed - OLDMEDLINE for Pre1966]
124: SORENSEN H. Related Articles, Links
No abstract [Lymphocytic angina complicated by facial paralysis.]
HNO. 1962 Mar;10:74-6. German. No abstract available.
PMID: 13915267 [PubMed - OLDMEDLINE for Pre1966]
125: HOFMEIER K. Related Articles, Links
No abstract [On the effects of long-term vitamin C administration on susceptible children and those with a lymphatic diathesis.]
Med Nov. 1959 Nov 28;48:2351-5. German. No abstract available.
PMID: 14402451 [PubMed - OLDMEDLINE for Pre1966]
126: BINDER L, GOBEL Z. Related Articles, Links
No abstract [Lymphocytosis caused by pertussis.]
Orv Hetil. 1958 Mar 30;99(13):442-4. Hungarian. No abstract available.
PMID: 13553425 [PubMed - OLDMEDLINE for Pre1966]
127: SZWALKIEWICZ O. Related Articles, Links
No abstract [Epidemic infectious lymphocytosis in Rabka.]
Pediatr Pol. 1957 Apr;32(4):377-85. Polish. No abstract available.
PMID: 13504927 [PubMed - OLDMEDLINE for Pre1966]


PaediatricsYahoogroups Dr Kondekar <drdoctor@hotmail.com> wrote:
hi all
I have a case to share, and would be glad to have expert opinion.
 
8 month baby presented on 26 feb with history of measles 10 days prior, and respiratory distress since then, xray after admission showed bilateral parahilar opacities closely resembling bronchopneumonia, counts were near normal, child was given supportive care, was discharged on oral amox-clav as a so called prophylaxis for preventing secondary bacterial infection ( I disagree). Complete XRC resolution was documented within 3 days of admission, child was discahrged on oral antibiotics. There was no fever documented since admission.
 
After 3-4 days, child had fever again.. she couldnt come to hospital over weekend, when she followed up on 6 th March with fever of almost 3 days high grade; there was no refusal to feeds, she refused admission for some reasons, she was sent home after changing antibiotics to oral cefixime as monitoring wasnt possible.
 
There was no relief with same medicines, she was readmitted on around feb 10, on admission... the same patch on Xrchest was obvious, child was having significant distress and there were bilateral crepts, with high fever, again responded to conservative therapy, fever responded to cefotaxim IV after 3 days of therapy, distress settled.
The interesting thing in this course was that... the counts
 
on admission 26 feb TC 12000 poly 62  Lympho33
on readmission on 10 march TC 55000 P73  L 25, rest atypical L cytes
after 8 days of antibiotic therapy.. TC 99000 P 60 L 37, rest attypical L cytes.
 
Can we discuss what exactly we were dealing with?

Dr kondekar santosh venketraman
child health specialist at HIS best!
9869803343
pediatrician; seth G S Medical colllege
KEM Hospital - Parel/Bhabha Hospital - Bandra
Mumbai


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