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Biomedical subjects

A Shanon

Publications and source records attributed to A Shanon.

16 recordsLinked to original sources
PubMed1997

The role of a secondary pediatric ambulatory care service within the community.

OBJECTIVE: To describe the establishment and function of a secondary pediatric ambulatory care service within the community, to assess the utilization of a pediatric community service ("The Center"), and to assess parents' degree of satisfaction with the quality of care in the center. DESIGN: Personal information and information regarding all visits was recorded and analyzed. A structured telephone interview was used to evaluate parents' satisfaction with the quality of care in the center. SETTING: A pediatric community centre managed by board certified pediatricians. The clinic offers primary and secondary care. PARTICIPANTS: A random sampling of parents of children who visited the center (n = 615). RESULTS: The number of children treated in the center increased five-fold within three years. Most visits took place during evening hours and over the weekends. The most common presenting symptoms were fever, respiratory and gastrointestinal complaints, earache, and trauma. Eighty-nine percent of parents were satisfied or very satisfied with the quality of care in the center; 95% were satisfied or very satisfied with the attitudes of physicians and nurses providing treatment. CONCLUSION: The center is widely utilized by parents with a great degree of satisfaction. The availability and extended working hours of the center provided medical care for a large number of children seeking "after hours" medical attention, as well as a backup for the primary care physicians. The center, therefore, provides a model for improved quality of medical care within the community.

Ambulatory Care↗
PubMed1994

Management of moderate head injury in childhood: degree of consensus among Canadian pediatric emergency physicians.

The purpose of this study was to assess the degree of consensus among Canadian pediatric emergency physicians regarding the management of moderate head injury in children. A questionnaire regarding the management of moderate head injury in a child was developed, and it concentrated on indications for admission and policies regarding skull radiograph. The questionnaire was given to all pediatricians who are members of the Emergency Section of the Canadian Pediatric Society (n = 33) and who represent 15 Canadian pediatric emergency departments. The outcome was measured by the degree of consensus regarding management of children with moderate head injury. Twenty-three of 33 (70%) questionnaires, representing 14 of 15 (93%) emergency departments, were returned. Only five of 23 (22%) questionnaires report routinely admitting otherwise well children with short (three minutes or less) loss of consciousness; five (22%) routinely order a skull radiograph - three (13%) routinely do both. Certain clinical indicators led to 70 to 80% agreement regarding admission: severe headache, seizures, depressed skull fracture, and persistent vomiting. Agreement of more than 70% regarding indications for ordering a skull radiograph was achieved only for clinical suspicion of a depressed skull fracture. In conclusion, for the average child who is well after a loss of consciousness after a head injury lasting three minutes or less, the majority of respondents do not routinely admit the child or order a routine skull radiograph. A reasonable degree of consensus (70-80%) regarding ordering of skull radiographs and admission is based on clinical criteria.

Canada↗
PubMed1993

Prevalence of hypertension in children with primary vesicoureteral reflux.

This study was undertaken to determine the prevalence of hypertension in children with primary, uncomplicated vesicoureteral reflux (VUR) and to evaluate the relationship between blood pressure (BP), grade and duration of reflux, and renal scarring. Subjects were identified retrospectively during a 17-year period; of 146 subjects who agreed to participate, 129 (88.4%) were female. Mean age at diagnosis was 5.0 years (range, 1 month to 16 years), and at follow-up was 14.4 years (range, 5 months to 21 years). Mean duration of follow-up was 9.6 years. Renal scarring was detected in 34.3% of patients by intravenous pyelogram, ultrasonography, or both. The BP at diagnosis was linearly related to the grade of reflux, but values were not higher than expected norms for age. At follow-up, mean systolic and diastolic BP were at the 41.6 percentile and the 18.7 percentile, respectively. No patient's BP was above the 55th percentile. After a mean follow-up period of 10 years, we conclude that primary, uncomplicated VUR, regardless of the number of documented urinary tract infections, duration and severity of reflux, modality of therapy, presence of renal scarring, and duration of follow-up, is not associated with the development of hypertension. Hypertension does not appear to be a complication of VUR and urinary tract infection unless there is preexisting dysplasia.

Adolescent↗
PubMed1993

Comparison of CNS adverse effects between astemizole and chlorpheniramine in children: a randomized, double-blind study.

OBJECTIVE: To assess the central nervous system side effects of chlorpheniramine and astemizole in children. DESIGN: Prospective, randomized, double-blind cross-over study. SETTING: Children were recruited from the out-patient allergy clinic and from respondents to an advertisement in a local newspaper. The study was conducted in the outpatient clinics of the ambulatory care services of the Children's Hospital of Eastern Ontario. PATIENTS, PARTICIPANTS: Children 8-16 years of age, with isolated allergic rhinitis or hay fever, were eligible for the study. We excluded children with: (1) chronic conditions (specifically asthma, atopic dermatitis, learning disabilities, or current treatment with oral corticosteroid medication); (2) known allergy to the study medications; (3) recent use of any antihistamine medication. One hundred and three children entered the study and 92 completed it. INTERVENTIONS: Children were stratified by age and randomly allocated to treatment with one of the two medication sequences. Over a period of 13 weeks both groups had 1 week of baseline studies, 3 weeks of one study medication, either chlorpheniramine or astemizole, a 6-week wash-out period and then 3 weeks of the other study medication for a second treatment period. MAIN OUTCOME MEASURES: Attention span (continuous performance test), short-term auditory and visual memory (visual aural digit span test), visual memory for geometric shapes (Benton visual retention test), motor coordination and visual-motor integration (grooved pegboard test), tapping speed and fine motor coordination (finger tapping test), physical side effects (such as sleepiness and dizziness), and compliance. RESULTS: One hundred and three patients were enrolled in the study, 92 (89%) completed the study. There were no significant drug effects on the visual retention test and the continuous performance test. On the visual aural digit span test, patients treated with astemizole scored higher than at baseline. There were no clinical or statistical differences in adverse effects between the two medications or between each medication and baseline. CONCLUSIONS: The two antihistamines studied had no adverse effects on the performance of children.

Adolescent↗
PubMed1992

Nonfatal childhood injuries: a survey at the Children's Hospital of eastern Ontario.

OBJECTIVE: To examine the types and severity of injuries seen in the Emergency Department of the Children's Hospital of Eastern Ontario and the circumstances surrounding the events. DESIGN: Chart review. SETTING: A tertiary care hospital that serves a child population of 600,000 in eastern Ontario and western Quebec. PARTICIPANTS: Every sixth day's charts of children up to 17 years of age who visited the Emergency Department because of injuries between Sept. 1, 1984, and Aug. 31, 1985, were examined retrospectively. RESULTS: A total of 2886 charts were reviewed. There were more boys than girls. Most (1354 [46.9%]) of the accidents had occurred at home. Falls and sports-related accidents were the leading causes of injury (in 1088 [37.7%] and 560 [19.4%] of the cases respectively). Most of the visits were for minor injuries (bumps, swellings, cuts, bruises and scrapes), and only 114 (4.0%) of the children were admitted to the hospital. Injuries from motor vehicle accidents accounted for the highest admission rate (17.4%). Important information regarding the circumstances surrounding the events (e.g., whether a seat belt or car seat was used) was frequently missing from the charts. CONCLUSIONS: Nonfatal injuries are common, especially in or around the home, and remain a significant problem in our society in terms of radiographic and consulting fees, time off from school or work and pain. Given the difficulties in obtaining information on the circumstances surrounding the events prospective studies are needed. Factors related to the occurrence and severity of childhood injury and whether these factors can be altered remain a high priority for research.

Accidental Falls↗
PubMed1992

Evaluation of renal scars by technetium-labeled dimercaptosuccinic acid scan, intravenous urography, and ultrasonography: a comparative study.

The objective of our prospective study was to compare the sensitivity and specificity of ultrasonography, intravenous pyelography, and dimercaptosuccinic acid scan in detecting scarred kidneys. Twenty-seven consecutive subjects with recurrent urinary tract infections, vesicoureteral reflux, scarred kidneys, or a combination of these problems had all three imaging procedures performed. With the total number of scars serving as the gold standard, the sensitivity (94%) and specificity (100%) in identifying renal scars in children were highest for the DMSA scan. Intraobserver (95%) and interobserver (90%) reliability were also high for the DMSA scan. However, the clinical interpretation of the increased sensitivity of the DMSA scan is unknown. Changes on the scan not identified by intravenous urography may not represent true scars. Research into the long-term significance of these scars is indicated.

Adolescent↗
PubMed1992

Central nervous system side-effects of antihistamines in schoolchildren.

There are no studies available in the literature on the effects of classical antihistamines on the central nervous system (CNS) in children. Clinical studies indicate that somnolence occurs more often with classical antihistamines than with placebo. There is no difference in inducing somnolence in children between placebo and astemizole or terfenadine, two new antihistamines that have thoroughly been shown to have no sedative effect greater than placebo in adults. A double-blind, cross-over trial investigating the CNS-effects of astemizole and chlorpheniramine in schoolchildren failed to show a negative effect of either of these drugs on performance.

Astemizole↗
PubMed1991

Serious childhood injuries caused by air guns.

OBJECTIVE: To determine the severity of nonfatal injuries to children caused by air guns and pellet guns. DESIGN: Case series (hospital chart review). SETTING: Inpatient wards of the Children's Hospital of Eastern Ontario. PATIENTS: All children under 18 years of age admitted to the hospital from Jan. 1, 1979, to Dec. 31, 1989, under ICD code E917, E922, E955, E965, E970 or E985 who had suffered air gun injuries. MAIN OUTCOME MEASURES: Personal data, circumstances of event and clinical data. RESULTS: The 43 children (37 boys) had a median age of 12 years. The circumstances of the accident were known in 20 cases: 17 children were playing and 3 were cleaning the gun when it went off. Four children thought the gun was unloaded. In five cases the bullet ricocheted into the eye. Nine injuries were self-inflicted. Injury was to the extremities in 21 (49%), the eyes in 15 (35%) and the head and neck in 7 (16%). The median length of hospital stay was 4 days. Six children had long-term disabilities, all the result of eye injuries; two had cataract surgery, and four required enucleation of the eye. CONCLUSIONS: Air guns can cause serious injury to children. Their sale needs to be banned or at least carefully regulated.

Adolescent↗
PubMed1990

Methodologic limitations in the literature on vesicoureteral reflux: a critical review.

We analyzed studies concerned with four important aspects of vesicoureteral reflux in infancy and childhood: the imaging procedures for the evaluation of vesicoureteral reflux, the treatment of reflux, and the correlation between reflux and later development of hypertension and end-stage kidney disease. The objectives of the study were to evaluate the validity and reliability of the current literature, to draw conclusions, and to recommend future studies for unresolved issues. We reached the following conclusions: (1) Retrograde cystography should be the gold standard for diagnosing vesicoureteral reflux. When ultrasonography and cystography are performed together, all clinically important abnormalities in the urinary system are detected. Intravenous pyelography is needed only when either or both of these studies are abnormal. (2) Other than abolishing reflux, surgery offers no short-term advantages (in terms of preventing breakthrough urinary tract infections, improving renal function, or preventing the development of new scars, hypertension, or end-stage kidney disease) over medical management. (3) The short periods of follow-up and methodologic flaws encountered in the reviewed studies make determination of the incidence of hypertension in children with vesicoureteral reflux impossible. (4) Although indications for an association between vesicoureteral reflux and end-stage kidney disease exist, the strength of this association has not been determined.

Child↗
PubMed1990

Ultrasonographic studies in the management of recurrent abdominal pain.

The medical records of 65 children and adolescents who had abdominal ultrasonography for the evaluation of recurrent abdominal pain were reviewed. Fifty-three subjects (81%) had normal results; in 12 cases (19%) an abnormality was detected. In no case could the pain be attributed to the abnormal finding. Furthermore, in 3 subjects, disclosure of the abnormal findings could have caused more harm than good. The role of the abdominal ultrasonographic study in the management of recurrent abdominal pain in children and adolescents is discussed.

Abdomen↗
PubMed1988

Combined familial adenosine deaminase and purine nucleoside phosphorylase deficiencies.

We studied an Arab family in which two infants died of severe combined immunodeficiency caused by adenosine deaminase (ADA) deficiency. One infant had purine nucleoside phosphorylase (PNP) activity in the leucocytes only half that of normal. Four other infant siblings had previously died from infections before the age of 2 months. Hyperpigmented skin lesions preceded death in three cases. The healthy parents and three healthy siblings aged 4-9 years had varying degrees of both ADA and PNP deficiencies in both white and red cells. ADA deficiency was pronounced in two siblings, and mild in the third and in the parents, and PNP activity was severely deficient in one sibling, and moderately deficient in the parents and other two siblings, who were all well. Complete absence of ADA from white cells lead to the development of severe combined immunodeficiency, but even minimal residual ADA and PNP activity allowed maturation of the immune system with normal immune function.

Adenosine Deaminase↗
PubMed1987

Diffuse, progressive hyperpigmentation: an unusual skin manifestation of mycosis fungoides.

Pigmentary changes in mycosis fungoides usually occur in association with poikiloderma atrophicans vasculare or following therapy and regression of lesions. Several cases of hypopigmented mycosis fungoides have also been reported. We present the case report of a patient who developed pruritic, diffuse macular hyperpigmentation of the skin. Biopsy specimens from hyperpigmented skin revealed histologic and ultrastructural features typical of mycosis fungoides. Giant melanin granules were found in the tumor cells, as well as in keratinocytes and Langerhans cells. As far as we know, this is the first report of cutaneous hyperpigmentation as a single presenting sign of mycosis fungoides.

Aged↗
PubMed1983

Necrotizing enterocolitis--a 5-year experience.

With the increased survival of very-low-birth-weight neonates, necrotizing enterocolitis (NEC) represents one of the most frequent life-threatening conditions for this population. NEC was diagnosed on 24 occasions during a 5-year period (1977-81) at the Neonatal Intensive Care Unit, Kaplan Hospital, Rehovot. These 24 NEC cases, confirmed by radiological, surgical or pathological findings, were analyzed in a retrospective study. The mean weight was 1,450 g and the mean gestational age 32 weeks. Only one of the affected infants was a full-term newborn. The mean age at onset of symptoms was 9.8 days. In one case, NEC developed before feedings were started. The infectious agents--most frequently gram-negative rods--were isolated from the most seriously ill babies. Cultures from blood and gastric aspirate were positive in 10 of the 12 fatal cases. No bacteria were isolated from the blood among the survivors. Rotavirus, the only viral particle detected, was diagnosed in the bloody stools of two of the infants who recovered completely. Prophylactic therapy with oral kanamycin, administered to all premature infants weighing less than 1,500 g born over a 3-year period, did not appear to have a preventive influence. The overall mortality was 50%, with no sequelae observed among survivors. The high incidence of positive cultures among fatal cases suggests that overwhelming infection played a fundamental role in the outcome.

Enterocolitis, Pseudomembranous↗
PubMedDate not supplied

Nephropathy in arteriohepatic dysplasia (Alagille's syndrome).

A 15-year-old girl evaluated for short stature and delayed puberty was found to have features of syndromatic arteriohepatic dysplasia or Alagille's syndrome. The characteristic triangular face, stubby nose, peripheral pulmonic stenosis, a history of prolonged neonatal jaundice and evidence of hepatic parenchymal disease were present as well as bilateral small kidneys and delayed puberty. The recognition of kidney involvement in this syndrome and the characterization of the frequency and nature of the renal disorder are of great prognostic significance and could influence the morbidity and mortality of these patients.

Abnormalities, Multiple↗
PubMedDate not supplied

Childhood gunshot injuries in the Ottawa area.

To determine the incidence of non-fatal firearm injuries in the Ottawa area, we retrospectively reviewed the charts of all children admitted to the Children's Hospital of Eastern Ontario for firearm injuries in the last 15 years. The Children's Hospital is the only pediatric tertiary care care centre in the Eastern Ontario and Western Quebec areas, serving a child population of 600,000. Eighteen children were admitted to our hospital for firearm injuries during this period; six suffered long-term disabilities. The low number of non-fatal firearm injuries at our institution reflects national trends in the incidence of fatal firearm injuries in Canadian children and adolescents.

Adolescent↗