Thyroid abscess associated with Eikenella corrodens in a 7-year-old child.
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Biomedical subjects
Publications and source records attributed to I T Cohen.
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Accessory diaphragm is a rare congenital abnormality that almost always occurs on the right side and is often associated with cardiovascular anomalies. This paper describes the clinical presentation, radiologic diagnosis, and surgical treatment of the condition. Early recognition and prompt surgical treatment will prevent the chronic pulmonary complications reported in the literature.
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The evaluation of a technique of laparotomy for the staging of Hodgkin's disease in childhood, including 52 operative procedures, is reviewed. A standard protocol, including splenectomy, multiple hepatic and bone marrow biopsies, and the routine sampling of at least six designated lymph node groups, was employed. It was demonstrated that the surgeon is unable to identify Hodgkin's disease by gross inspection and that the biopsy of node groups previously not included in routine laparotomy studies, ie, mesenteric and porta hepatis nodes is essential to staging in childhood. Stage was altered from stages I and II to stages III and IV in 35% of the patients. The incidence of abdominal recurrence following a negative laparotomy was 7%, and the incidence of post-splenectomy hyperacute infection was 4.5%. This study included minimal use of the lymphangiogram (33%), which accounted for the relatively larger group of patients in clinical stages I and II.
The clinical records of 180 pediatric patients who received Intralipid via peripheral veins at a single institution (1964-1977) were retrospectively analyzed, with particular reference to the complications of this form of therapy. Intralipid was used in a dose range of 2--4 g/kg/day in order to supply 40% of the daily calorie requirements. The patients were neonates, infants, children, and adolescents with a wide range of clinical diagnoses. Local complications associated with Intralipid therapy were minimal. Transient elevations in serum enzyme levels (SGOT, SGPT, and LDH) were observed in 4% of patients, but all of these returned to the normal range after cessation of therapy. Ten patients had histologic evidence of cholestasis, the significance of which is discussed. The lipid emulsion was employed in patients with preexisting hyperbilirubinemia with concomitant resolution of jaundice. Intralipid was administered to patients with known severe thrombocytopenia (secondary to sepsis or myelosuppression) with return of the platelet counts to normal levels during the course of infusion therapy. The use of Intralipid in patients with established sepsis did not delay its response to conventional surgical or antibiotic therapy. There were no instances of the "overloading" syndrome observed.
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A survey of 200 patients ranging in age from 5-21 yr was undertaken in 3 facilities in central Pennsylvania: state- (100), county- (13), and privately-operated (66), together with 21 children being cared for at home. Their diagnoses included chromosomal, metabolic, and anatomic abnormalities, and other encephalopathies. The following nutritional problems were identified: 1) inadequate nutrient intake due to feeding technique, swallowing difficulties, or regurgitation; 2) obesity and low activity level; 3) constipation; 4) nutrient-drug interactions and allergies; and 5) inadequate standards with which to compare growth and adequacy of nutrient intake. The nutritional problems encountered in these pediatric patients with neuromotor disorders warrant management by a physician-nutritionist team skilled in nutritional assessment and techniques of providing nutritional support.