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Biomedical subjects

F Mandell

Publications and source records attributed to F Mandell.

9 recordsLinked to original sources

Delayed central nervous system myelination in the sudden infant death syndrome.

This study was designed to assess whether development of the central nervous system (CNS) is delayed in victims of the sudden infant death syndrome (SIDS). We selected the parameter of myelination because it is a continuously changing and readily accessible marker of CNS development in the SIDS age-range. We assessed myelination blindly in 61 SIDS and 89 autopsy controls. In 62 sites the degree of myelination was visually graded in myelin-stained histological sections on an ordinal scale of 0-4 using the inferior cerebellar peduncle as an internal standard of degree 3. Cases were stratified by postconceptional age at death and SIDS and controls were compared with respect to myelin degree at each site. Significantly delayed myelination (p less than 0.05) occurred in the SIDS group in 25 of the 62 sites examined. Hypomyelination affected fiber systems in which myelination is initiated before or after birth and which myelinate with different tempos and preferentially affect pyramidal and cerebellar (somatomotor) and prefrontal-temporal-limbic (visceromotor) systems. Hypomyelination was not associated with individual clinicopathologic variables in the SIDS group. Somatic growth and brain weight were significantly greater in SIDS than controls. Therefore, we suggest that SIDS is associated with a developmental CNS disorder. Although delayed CNS myelination most likely shares a common antecedent with sudden death and is not its cause, the role of somato- and viscero-motor systems in central cardiorespiratory control and arousal warrants further analysis in SIDS.

Birth Weight

Acute neonatal subdural hematoma following breech delivery.

We describe two term infants born by complicated breech deliveries, each of whom suffered an acute subdural hematoma. Both infants required repeated subdural taps; in one case a parietal burr hole was needed. Despite stormy neonatal courses, follow-up examination of the first infant at 26 months showed him to be normal, and in the other only a mild left esotropia was found at 22 months. Acute neonatal subdural hematoma is rare, but symptoms and signs are distinctive and the condition is remediable; immediate recognition and treatment is important.

Acute Disease

Sudden infant death syndrome. The disease and its survivors.

Sudden infant death syndrome (SIDS) is a peculiar entity in that the self-condemning reactions of the surviving family go far beyond the death itself. The parents should be helped to understand that SIDS is a disease, even though the mechanism of death is not known, and that it is neither preventable nor predictable. Surviving siblings should not be excluded from the mourning process and should be reassured about their good health and blamelessness in causing the death. If parents defer having another child until the grief process is complete, the psychologic environment for subsequent children will be healthier.

Child, Preschool

Erythromelalgia.

Erythromelalgia is an extraordinary disease which remains elusive in its pathophysiology and management. Victims suffer intense burning and redness of the hands and feet. In what appears to be the antithesis of Raynaud's disease, the pain is relieved by emersion in cold. A child with erythromelalgia is described whose symptoms began at age 3 years. Pharmacological management trials and thermography are incorporated in the report.

Child, Preschool

Sudden infant death syndrome and subsequent pregnancy.

In psychological conditions of mourning and guilt, women who have lost children often attempt to quickly conceive a "replacement" child. This study examines the subsequent pregnancies of 32 women whose children died of sudden infant death syndrom (SIDS). The expected rate of infertility in a normal population is 10%. Spontaneous abortion has an incidence of 12% to 15%. Among the 32 women attempting to conceive after the loss of their child, 10 (31%) had spontaneous abortions and 11 (34%) could not conceive after attempts for at least one year. This association between psychological and biological phenomena require special recognition by physicians who are advising parents who have lost children to SIDS. The management of these families includes compassion, understanding, and regard for the psychological environment of the subsequent pregnancy.

Abortion, Spontaneous

Treatment of atypical mycobacterial cervical adenitis with rifampin.

The clinical response of atypical mycobacterial cervical adenitis to standard antituberculous therapy has been disappointing. Surgical procedures in the anterior cervical triangle are difficult and often complete excision is impossible. In each of four children with atypical mycobacterial cervical adenitis in this study, the institution of rifampin therapy was followed by complete resolution. Previously rifampin, a well-tolerated, orally administered drug, had been used effectively with Mycobacterium tuberculosis. The place of this drug as a major alternative to surgical excision in cases of atypical mycobacterial cervical adentis is reviewed.

Antigens

Dermatoglyphics in sudden infant death syndrome.

An analysis of digital and palmar dermatoglyphic patterns was conducted in 173 victims of the sudden infant death syndrome (SIDS). The results expose four dermatoglyphic regions with pattern frequencies differing from those in a control population. These are an excess of Sydney creases, hypothenar patterns, open fields (with fewer vestiges) in interdigital region IV, and arches on all digits (females only). These findings indicate a genetic or early intrauterine environmental influence in SIDS infants. An increased incidence of dysmorphism and anomalies including recognition of specific syndromes support this contention. One could speculate that these dermatoglyphic deviations reflect specific genotypes and/or phenotypes particularly vulnerable to postnatal challenges. Differences in multiple dermatoglyphic categories support the concept of heterogeneity of the SIDS population and multicausality of SIDS.

Boston