A case of adrenal tuberculosis with acute Addison's disease is presented. The case showed diagnostic and therapeutic problems, the latter concerning the untoward effects due to metabolic interferences and pharmacologic interactions among antitubercular drugs, substitutive corticosteroid therapy and hepatic metabolism. The side-effects, interactions and metabolism of drugs used during the course of disease are discussed.

Acute Disease↗

PubMedDate not supplied

Behavioural and physiological reactivity to noise in the newborn.

OBJECTIVE: To assess the electromyographic (EMG) and behavioural reactivity of a group of newborn infants exposed to noisy stimulation of various intensity recorded in the Paediatric intensive care Unit (PICU). METHODS: The study was performed at the nursery of the Paediatrics Department (University of Padova) on a group of 21 healthy newborns (mean 39 weeks of gestation), assessed between 24 and 72 h after birth. The study involved taking EMG recordings of the corrugator supercilii muscle and assessing the infant's behaviour at the baseline (15 seconds before stimulation), during noisy stimulation (for 1-2 seconds) and during recovery (15 seconds in three subphases). The noises, previously recorded in PICU, had four different intensities and were administered in random order to all infants. Descriptive analysis and repeated-measures analysis of variance (anova) were performed on the EMG and behavioural data. RESULTS: The infants demonstrated a significant reaction to the noises both in the EMG recordings and in behavioural changes, especially during intense noisy stimulation. The reaction lasted longer than the stimulation period, preventing the infants from returning to the baseline condition. CONCLUSIONS: Exposure to high-intensity noise produced in PICU causes evident behavioural and physiological effects (EMG). This is a field of study that could have important repercussions, given the medium- and long-term effects of repeated noise stimulation.

Electromyography↗

PubMedDate not supplied

Self-report assessment of recurrent abdominal pain.

UNLABELLED: Pain is the principal, and often the only symptom in cases of recurrent abdominal pain (RAP). The purpose of this study was to analyze the clinical background behind the pain symptom and the pain's capacity for differentiation in the diagnostic assessment of a group of 86 children suffering from RAP and observed at a pediatric gastroenterology service. The self-rating methods applied to the children included a verbal scale and a Visual Analogue Scale (VAS) for scoring the pain, and the Eland method, which is based on a graphic representation of the pain to enable its quantification and localization. Regardless of the pain assessment emerging from this study, the children were divided into 3 groups on the basis of a standardized diagnostic procedure, i.e. G1--upper gastrointestinal tract disease; G2--RAP with no apparent organic cause; G3--intestinal disease. RESULTS: The intensity of the pain fails to distinguish between the three groups, while other features seem more useful, e.g. variability in the pain's intensity, the number and location of painful sites, and the how the pain is graphically represented. Drawings typical of RAP with no apparent organic cause characteristically represent the pain more accurately and in greater detail, using more colors and a certain refinement in the performance of the drawing, with varying types of pain in subsequent episodes, and involving several abdominal and even extra-abdominal sites. In our experience, this method might contribute towards the completion and standardization of the child's clinical history and clinical evaluation. Such methods would have to be validated by further clinical studies, however.

Abdominal Pain↗

PubMedDate not supplied

[Changes in plasma nonesterified fatty acids and blood glucose in the newborn infant in therapy with aminophylline].

We investigated the effect of intravenous infusions of aminophylline on plasma glucose and nonesterified fatty acid (NEFA) levels in 14 newborns with apnea (mean birthweight: 2.514 +/- 866 g; mean gestational age: 34.8 +/- 3.94 weeks). Theophylline apparent volume of distribution was 0.55 liters per Kilogram and the half-life was major than 12 hours. It was found that theophylline caused pronounced and prolonged lipid mobilization, as measured by the plasma NEFA. The ability of theophylline to induce a rapid rise in blood glucose was confirmed. Elevation in plasma NEFA might be an important factor in facilitating the competition with bilirubin for binding sites of albumin and the development of arrythmias in newborns with acute myocardial injury.

Aminophylline↗

PubMedDate not supplied

[Neonatal cystic lymphangioma].

The A.A. reports a case of cystic congenital linphangioma of the face and neck, recently observed on the Neonatal Intensive Care Unit. The therapeutic approach was very difficult and required three times a surgical menagement because of successively relapses. The control and normalization of the compressive and infective complications due to the massa and its removal were hard too. In spite of some aesthetical problems, the results may be considered satisfactory. Our case enphasizes the intrinsec, complex, therapeutical difficulties of the cystic linphangiomas.

Esthetics↗

PubMedDate not supplied

[Noise exposure in neonatal intensive care units].

This study evaluates the exposure of newborn babies in neonatal intensive care units (NICU) to noise which can cause hearing lesions directly (acoustic trauma) as well as indirectly (hypoxia). Moreover, noise can have an aggravating effect when combined with other potentially harmful factors in the NICU, such as ototoxic medication or stress due to other external stimuli, such as excessively bright light, lack of a day/night rhythm or pain. Sound pressure levels were measured in the NICU and inside the cribs in various experimental conditions, classified under 3 different types of sound events: constant background noise, variations in background noise and impulsive events. The main sources of noise detected were crib noise generated by ventilation and temperature control systems, ambient noise in the room, noise caused by the staff in the NICU, noise generated by crib alarm systems and NICU apparatus and noise caused by activity on the crib cover or on its plexiglas top. Findings revealed that the influence of ambient noise is fairly irrelevant. Background noise and its variations concerned with activities in the department never exceeded the limits considered potentially harmful to adults (DRC), whereas the impulsive noise generated by staff on the cribs or on the plexiglas tops was considerable and potentially harmful. These findings demonstrate that it is feasible and relatively easy to control noise in the NICU and significantly reduce the impulsive noise component by training staff to be more careful and avoid any unnecessary jolting and rough handling on and near the cribs.

Environmental Exposure↗

PubMedDate not supplied

[Transportation of the critical newborn infant and child].

Advance in the science and technology of neonatal and pediatric critical care have resulted in improved outcome for high risk newborn and children. Effective interhospital transport programmes are necessary for the appropriate use of resources and has become an integral component of regionalized perinatal care. It is now well established that use of an organized neonatal and pediatric transport team results in a fall in mortality and morbidity of infant. The American College of Obstetrician and Gynecologist and, recently, American Academy of Pediatrics published guidelines and recommendations for safe interhospital transfer of neonates, infants and children. Training of personnel, selection of equipment, organization and communication between hospitals are critical elements of a successful transport system. We present an overview of the role, principles and operating procedures of such neonatal-pediatric transport team and the basis of clinical stabilization before and during transfer. We also discuss data of the first 17 month experience of the Neonatal-Pediatric Transport Service of the Department of Pediatrics, University of Padua.

Ambulances↗