a review and update of pediatrics and various topics related to child health
click below for the detailed article
http://geocities.com/anticoagulationinchildren
Saturday, December 23, 2006
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
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
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)
<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 |
 | 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] | |
| 2: | Brown L, Shaw T, Wittlake WA. | Related Articles, Links |
| Does leucocytosis identify bacterial infections in febrile neonates presenting to the emergency department? Emerg Med J. 2005 Apr;22(4):256-9. PMID: 15788823 [PubMed - indexed for MEDLINE] | |
| 3: | Butler KL, Best IM, Oster RA, Katon-Benitez I, Lynn Weaver W, Bumpers HL. | Related Articles, Links |
| Is bilateral protected specimen brush sampling necessary for the accurate diagnosis of ventilator-associated pneumonia? J Trauma. 2004 Aug;57(2):316-22. PMID: 15345979 [PubMed - indexed for MEDLINE] | |
| 4: | Sawalha W, Ahmad M. | Related Articles, Links |
 | Bilateral pleural empyema following periodontal abscess. East Mediterr Health J. 2001 Jul-Sep;7(4-5):852-4. No abstract available. PMID: 15332792 [PubMed - indexed for MEDLINE] | |
| 5: | Heininger U. | Related Articles, Links |
| Comment on findings of Hodge et al. Respirology. 2004 Mar;9(1):141; author reply 142. No abstract available. PMID: 14982618 [PubMed - indexed for MEDLINE] | |
| 6: | Binstadt BA, Caldas AM, Turvey SE, Stone KD, Weinstein HJ, Jackson J, Fuhlbrigge RC, Sundel RP. | Related Articles, Links |
| Rituximab therapy for multisystem autoimmune diseases in pediatric patients. J Pediatr. 2003 Nov;143(5):598-604. Erratum in: J Pediatr. 2004 Apr;144(4):558. PMID: 14615729 [PubMed - indexed for MEDLINE] | |
| 7: | Sit SC, Yau EK, Lam YY, Ng DK, Fong NC, Hui YW, Cheng WF, Leung CW, Chiu MC. | Related Articles, Links |
 | A young infant with severe acute respiratory syndrome. Pediatrics. 2003 Oct;112(4):e257. PMID: 14523208 [PubMed - indexed for MEDLINE] | |
| 8: | Goedvolk CA, von Rosenstiel IA, Bos AP. | Related Articles, Links |
| Immune complex associated complications in the subacute phase of meningococcal disease: incidence and literature review. Arch Dis Child. 2003 Oct;88(10):927-30. Review. PMID: 14500317 [PubMed - indexed for MEDLINE] | |
| 9: | Pilorget H, Montbrun A, Attali T, Tiran-Rajaofera I, Bony C, Brayer C, Samperiz S, Alessandri JL. | Related Articles, Links |
| [Malignant pertussis in the young infant] Arch Pediatr. 2003 Sep;10(9):787-90. French. PMID: 12972206 [PubMed - indexed for MEDLINE] | |
| 10: | Hodge G, Hodge S, Markus C, Lawrence A, Han P. | Related Articles, Links |
| 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] | |
| 11: | Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ. | Related Articles, Links |
| The evolution of Lemierre syndrome: report of 2 cases and review of the literature. Medicine (Baltimore). 2002 Nov;81(6):458-65. Review. PMID: 12441902 [PubMed - indexed for MEDLINE] | |
| 12: | Smith C, Taylor D. | Related Articles, Links |
| Quieting the '100-day cough'. A primer on pertussis. Adv Nurse Pract. 2000 Oct;8(10):60-2. No abstract available. PMID: 11761540 [PubMed - indexed for MEDLINE] | |
| 13: | Pierce C, Klein N, Peters M. | Related Articles, Links |
| Is leukocytosis a predictor of mortality in severe pertussis infection? Intensive Care Med. 2000 Oct;26(10):1512-4. PMID: 11126265 [PubMed - indexed for MEDLINE] | |
| 14: | Garcia-Perez A, Espino M, Barrio A, Echavarri F, Bonet B, Bueno M, Yanguela J. | Related Articles, Links |
| [Pseudotumor cerebri associated with maxillary sinusitis: clinico-pathological study] Rev Neurol. 2000 Jul 1-15;31(1):45-8. Spanish. PMID: 10948583 [PubMed - indexed for MEDLINE] | |
| 15: | Hudnall SD, Molina CP. | Related Articles, Links |
| Marked increase in L-selectin-negative T cells in neonatal pertussis. The lymphocytosis explained? Am J Clin Pathol. 2000 Jul;114(1):35-40. PMID: 10884797 [PubMed - indexed for MEDLINE] | |
| 16: | Lee B. | Related Articles, Links |
| 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 |
| ECLS in pertussis: does it have a role? Intensive Care Med. 1999 Nov;25(11):1341-2. No abstract available. PMID: 10654231 [PubMed - indexed for MEDLINE] | |
| 18: | Panacek EA. | Related Articles, Links |
| Occult pneumonias in febrile children with leukocytosis. Ann Emerg Med. 1999 Nov;34(5):683-4. No abstract available. PMID: 10533022 [PubMed - indexed for MEDLINE] | |
| 19: | Baraff LJ. | Related Articles, Links |
| Empiric chest radiographs in febrile children with leukocytosis. Ann Emerg Med. 1999 Apr;33(4):480. No abstract available. PMID: 10092739 [PubMed - indexed for MEDLINE] | |
| 20: | Bobrov VM, Shishkin SA. | Related Articles, Links |
| [Middle mass molecules as an indicator of intoxication in the purulent inflammatory ENT diseases] Vestn Otorinolaringol. 1999;(1):33-4. Russian. PMID: 10081416 [PubMed - indexed for MEDLINE] | |
| 21: | Bachur R, Perry H, Harper MB. | Related Articles, Links |
| Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis. Ann Emerg Med. 1999 Feb;33(2):166-73. PMID: 9922412 [PubMed - indexed for MEDLINE] | |
| 22: | Green SM, Rothrock SG. | Related Articles, Links |
| 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. PMID: 9922418 [PubMed - indexed for MEDLINE] | |
| 23: | Heininger U, Klich K, Stehr K, Cherry JD. | Related Articles, Links |
| Clinical findings in Bordetella pertussis infections: results of a prospective multicenter surveillance study. Pediatrics. 1997 Dec;100(6):E10. PMID: 9382911 [PubMed - indexed for MEDLINE] | |
| 24: | Fishback N, Koss M. | Related Articles, Links |
| Update on lymphoid interstitial pneumonitis. Curr Opin Pulm Med. 1996 Sep;2(5):429-33. Review. PMID: 9363179 [PubMed - indexed for MEDLINE] | |
| 25: | McCarthy VP, Carlile JR. | Related Articles, Links |
| Hyperleukocytosis with pertussis. J Assoc Acad Minor Phys. 1997;8(3):52-4. PMID: 9271891 [PubMed - indexed for MEDLINE] | |
| 26: | Solomon KS, Levin TL, Berdon WE, Romney B, Ruzal-Shapiro C, Bye MR. | Related Articles, Links |
| Pneumothorax as the presenting sign of Pneumocystis carinii infection in an HIV-positive child with prior lymphocytic interstitial pneumonitis. Pediatr Radiol. 1996;26(8):559-62. PMID: 8753672 [PubMed - indexed for MEDLINE] | |
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| Leucocyte count, platelet count and erythrocyte sedimentation rate in pulmonary tuberculosis. Afr J Med Med Sci. 1995 Jun;24(2):131-4. PMID: 8669390 [PubMed - indexed for MEDLINE] | |
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| In vivo/ex vivo T cell depletion for GVHD prophylaxis influences onset and course of active cytomegalovirus infection and disease after BMT. Bone Marrow Transplant. 1995 Mar;15(3):387-93. PMID: 7599563 [PubMed - indexed for MEDLINE] | |
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| [Lymphocyte subpopulations in bronchoalveolar lavage fluid in AIDS] Dtsch Med Wochenschr. 1994 Mar 4;119(9):289-95. German. PMID: 8119108 [PubMed - indexed for MEDLINE] | |
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| Kostmann's syndrome with chronic pneumonia and lymphocytosis: effect of recombinant human G-CSF. Turk J Pediatr. 1994 Jan-Mar;36(1):87-91. PMID: 7514821 [PubMed - indexed for MEDLINE] | |
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| Measles without rash in an infant with pertussis. Acta Paediatr Jpn. 1993 Dec;35(6):541. No abstract available. PMID: 8109236 [PubMed - indexed for MEDLINE] | |
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| [Diffuse alveolar pertussis with major hyperleukocytosis with "pseudocentrocytic" contingent] Pediatrie. 1992;47(2):117-20. French. PMID: 1319026 [PubMed - indexed for MEDLINE] | |
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| Fatal varicella in a healthy girl. J Med Assoc Thai. 1990 Nov;73(11):648-51. PMID: 2283495 [PubMed - indexed for MEDLINE] | |
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| Bacteremia in febrile children with lobar pneumonia and leukocytosis. Pediatr Emerg Care. 1988 Dec;4(4):241-2. PMID: 3231554 [PubMed - indexed for MEDLINE] | |
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| Syndrome of periodic fever, pharyngitis, and aphthous stomatitis. J Pediatr. 1987 Jan;110(1):43-6. PMID: 3794885 [PubMed - indexed for MEDLINE] | |
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| Ten-year course of early-onset Weber-Christian syndrome with recurrent pneumonia: a suggestion for pathogenesis. Pediatrics. 1986 Jul;78(1):115-20. PMID: 3725481 [PubMed - indexed for MEDLINE] | |
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| Oncologic emergencies II. Hematologic and infectious complications of cancer and cancer treatment. Pediatr Clin North Am. 1985 Jun;32(3):613-24. PMID: 3873638 [PubMed - indexed for MEDLINE] | |
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| 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 |
| 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] | |
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| [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 |
| 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 |
| Heterophil antibody in adults with sore throat: frequency and clinical presentation. Ann Intern Med. 1982 Apr;96(4):505-8. PMID: 6895981 [PubMed - indexed for MEDLINE] | |
| 49: | Krylov AA, Dmitriev VI. | Related Articles, Links |
| [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 |
| 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 |
| [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 |
| 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 |
| Some aspects of humoral and cellular immunity in children suffering from spastic bronchitis. Arch Immunol Ther Exp (Warsz). 1980;28(1):53-9. PMID: 6968194 [PubMed - indexed for MEDLINE] | |
| 54: | Shann F, Germer S. | Related Articles, Links |
| 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 |
| Legionnaires' disease: clinical features of the epidemic in Philadelphia. Ann Intern Med. 1979 Apr;90(4):509-17. PMID: 434627 [PubMed - indexed for MEDLINE] | |
| 56: | Buchs S. | Related Articles, Links |
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| 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] | |
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| 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] | |
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| 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] | |
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| [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] | |
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| [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] | |
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| Dissection tonsillectomy--complications and follow-up. J Laryngol Otol. 1969 Jun;83(6):601-8. No abstract available. PMID: 5254391 [PubMed - indexed for MEDLINE] | |
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| 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] | |
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| [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] | |
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| [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] | |
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| 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] | |
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| An evaluation of the treatment of subglottic hemangioma. Laryngoscope. 1968 Nov;78(11):1956-64. No abstract available. PMID: 5755027 [PubMed - indexed for MEDLINE] | |
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| [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 |
| [Acute infectious lymphocytosis] Kinderarztl Prax. 1968 Mar;36(3):105-8. German. No abstract available. PMID: 5715780 [PubMed - indexed for MEDLINE] | |
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| [Infectious lymphocytosis in children with tuberculosis] Probl Tuberk. 1968;46(5):82-3. Russian. No abstract available. PMID: 5708505 [PubMed - indexed for MEDLINE] | |
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| 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] | |
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| 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] | |
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| 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] | |
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| Leukaemia, leukaemoid reaction and tuberculosis. Acta Med Scand. 1967 Oct;182(4):427-32. No abstract available. PMID: 5234000 [PubMed - indexed for MEDLINE] | |
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| 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] | |
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| [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] | |
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| [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] | |
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| [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] | |
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| [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] | |
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| [Febrile, lymphocytic and hypergammaglobulin syndrome] Prensa Med Argent. 1966;53(1):361-3. Spanish. No abstract available. PMID: 4168487 [PubMed - indexed for MEDLINE] | |
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| [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] | |
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| 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] | |
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PaediatricsYahoogroups Dr Kondekar <drdoctor@hotmail.com> wrote:
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 countson 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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