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Biomedical subjects

J L Jacob

Publications and source records attributed to J L Jacob.

At least 73 records · Page 4Linked to original sources

[Prospective study of 64 cases of Kawasaki's disease].

We prospectively studied 64 children with Kawasaki disease. The well recognized signs were seen, but we also found hyperemia of the tympanic membrane in 27%, uveitis in 17%, syndrome of inappropriate secretion of anti-diuretic hormone in 9%, hydrops of the gallbladder in 8%, pulmonary infiltrations in 5% and one death. One patient presented with acute kidney failure, another one presented with stenosis of the renal artery, and 8 presented white blood cells (WBC) in the urinary sediment. Sedimentation was accelerated and there was an important decrease in hemoglobin blood level around the 5th day of illness. The WBC count rose around the 10th day; thereafter, all these results returned to normal while platelets counts rose. Albumin blood level was low, and all the following data were higher than normal: alpha-1-globulin, alpha-2-globulin, IgA, IgM, SGOT, SGPT, bilirubin and CRP. Viral studies were performed in 37 patients; 12 showed positive results.

Blood Cell Count↗

Trilateral retinoblastoma: bilateral retinoblastoma with pinealoblastoma.

Bilateral retinoblastoma was diagnosed in a 12-month-old boy. The left eye was enucleated; the choroid and the optic nerve were not invaded by the tumour. The right eye had three lesions: one was photocoagulated, and the other two were irradiated. Two years later, symptoms and signs of intracranial hypertension prompted computerized tomography, which demonstrated a mass in the pineal region and secondary hydrocephalus. The right eye showed papilledema but no evidence of tumour activity in the three retinal scars. Radiation therapy and chemotherapy had only a transient effect, and the child died at 42 months of age. At autopsy the pineal region and the third ventricle were found to be replaced by a pinealoblastoma with retinomatous differentiation. Only 11 other cases of pinealoblastoma associated with bilateral (heritable) retinoblastoma have been reported. The embryologic relationship between the pineal gland and the retina has given rise to the concept of trilateral retinoblastoma, a concept important in the investigation and follow-up of patients with bilateral retinoblastoma.

Brain Neoplasms↗

The oculocardiac reflex: a graphic and statistical analysis in infants and children.

A new method for the detection and recording of the oculocardiac reflex (OCR) is described and applied to 49 healthy infants and children (six months to nine years old) undergoing strabismus surgery under halothane anaesthesia with spontaneous ventilation. Eighty-one extraocular muscles were studied. Square wave stimuli (abrupt and sustained tractions) were definitely more reflexogenic than slow slope stimuli (very gradual, progressive and gentle tractions). Vagal escape, as well as fatigue of the OCR, are graphically documented and analysed. In this series, using well-defined and controlled tractions, the medial rectus was not more reflexogenic than the other extraocular muscles. Hypercapnia was an important adjuvant factor of the OCR. Controlled ventilation is recommended. The routine use of intravenous anticholinergic drugs is briefly discussed. Prevention of the OCR, and prophylaxis of cardiac arrhythmias during strabismus surgery, now seem to be placed on a more rational basis.

Age Factors↗

The oculocardiac reflex in strabismus surgery.

During strabismus surgery on 81 extraocular muscles in 49 children the cardiac response to calibrated traction on each of the muscles operated on was studied through the use of a microdisplacement transducer and the tachometer of a cardiac monitor. There was no significant difference in the frequency of induction of the oculocardiac reflex between the medial rectus and the other muscles or between the two eyes. However, quick traction provoked a reflex in 87% of instances, whereas progressive traction did so in only 51% of instances, a significant difference (p less than 0.05). Thus, because the oculocardiac reflex is frequent during strabismus surgery, cardiac monitoring during the operation and minimal, gentle manipulation of the extraocular muscles are important.

Child↗

Ocular manifestations of Kawasaki disease (mucocutaneous lymph node syndrome).

This paper describes nine patients, five girls and four boys aged 4 months to 7 years (mean 3 3/4 years), who had the clinical and laboratory features of Kawasaki disease (mucocutaneous lymph node syndrome). Eight of them had mild to moderate anterior uveitis, and one child showed choroidal, retinal and vitreous changes in one eye that caused a severe visual loss. Recognition of this disease is important, particularly since 1% to 2% of patients under 2 years of age die suddenly from coronary arteritis.

Child↗

Progressive-addition lenses in the management of esotropia with a high accommodation/convergence ratio.

In 25 children esotropia due to abnormal synkinesis between accommodation and accommodative convergence was corrected with progressive-addition lenses. Twelve of the children had been wearing conventional bifocals; the other 13 were given progressive lenses for the first time. The near esodeviation was satisfactorily neutralized in most cases, and nearly all the children had some stereopsis. All adapted well and without difficulty to the progressive lenses.

Accommodation, Ocular↗