Biomedical subjects
Publications and source records attributed to P A Vardy.
The incidence, clinical appearance and causative agent of tinea capitis among children of Ethiopian immigrants, was studied. Out of 124 children examined, 36 had scalp lesions and 32 cases were confirmed as scalp-ringworm on direct microscopy. Culture showed the dermatophyte to be Trichophyton violaceum. The clinical presentation, resembling seborrheic dermatitis, without clinically apparent hair invasion, was atypical.
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Two children aged 18 and 30 months presented with severe renovascular hypertension. Initially, surgical intervention was postponed because of the patients' young age. Adequate control of the hypertension and reversal of its sequelae were achieved with aggressive medical management. At present, both patients, aged 9 and 12 years respectively, have discontinued all medication, have achieved normal growth, are normotensive and have normal renal function.
One hundred and ninety-one children with a first episode of urinary tract infection (UTI) underwent intravenous pyelography (IVP) and voiding cystourethrography (VCU). Only three children (1.5%) had positive findings in the IVP that were of prognostic significance and were confined to that particular investigation alone. In contrast, 97 (50.7%) of the VCUs showed anatomical abnormalities. Vesico-ureteral reflux (VUR) of varying grades was diagnosed in 77 children (40.3%). These findings stress the importance of radiological investigation of the urinary tract after the first incidence of UTI, but suggest that IVP will give information of therapeutic and/or prognostic value in a small number of cases.
During an epidemic of poststreptococcal acute glomerulonephritis (PSAGN) in Israel during the second half of 1968, 155 children were hospitalized. All of them were initially followed up for 6 mo to 2 yr, during which period no evidence of continuing kidney damage was found. Fifty-five of the group were hospitalized over the next 2 to 10 yr for reasons unrelated to their original illness, at which time they also were found to be free of renal damage. Eighty children were examined 11 to 12 yr after the epidemic, and in them, too, urine examination, blood chemistry and blood pressure were within normal limits. It seems reasonable to conclude that the PSAGN of the 1968 epidemic was a benign disease with no lasting ill effects. Since most of the cases were associated with an M-55 skin Streptococcus and pyoderma, we suggest that glomerulonephritis due to pyoderma associated with this strain does not give rise to chronic renal disease.
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Congenital indifference to pain with anhydrosis (CIPA) is a well-defined entity among a group of sensory deficiency syndromes. Children with this genetic disease are insensitive to pain and temperature and do not sweat and suffer from psychomotor retardation. Self-inflicted trauma may be severe and lead to insoluble orthopedic problems. To date, 11 cases have been reported. We have reviewed the literature and are describing two girls with CIPA, born to consanguine Jewish parents of Moroccan origin. Immunoglobulin deficiency has been reported in CIPA but an immunologic investigation on one of our cases showed only an early and transient deficiency of IgA. The presence in the family of a brother with ataxia telangiectasia and complete absence of IgA would seem to be irrelevant and it seems probable that the parents are heterozygotic for two disparate autosomal recessive syndromes.
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Intestinal lymphangiectasia (IL) may vary widely in its manifestations and severity. Fifteen children seen between 1960 and 1974 with histologically proven IL are analyzed by clinical, laboratory, radiologic, and histologic criteria. Remissions occurred in most patients and none died. Exacerbations occurred in five children. Diarrhea was present in 14 patients and in 13 appeared before the age of 3 years. Vomiting occurred in nine patients and growth retardation in seven. Four children had associated peripheral lymphedema and two of these had a family history of lymphedema, both had affected fathers and one had affected siblings and paternal cousins. Seven had hypoproteinemic edema, and of these, four suffered from hypocalcemic seizures. Chylous effusions were present in five. Hypoproteinemia was present in 12 although five had no hypoalbuminemic edema. Six had lymphopenia which was related to the severity of the disease and was the last abnormality to disappear after clinical remission. Lymphopenia may first appear years after the protein loss begins. Upper gastrointestinal tract series were performed in 13 children and had diagnostic supportive value in seven. Six children had two or more small-intestinal biopsies done. They all showed great variation from one examination to the other, ranging from a normal appearance to severe changes. Lymphatic block may occur at different sites-in the lamina propria only, generalized (lamina propria, submucosa, serosa, and mesentery), or conversely in the mesentery alone with minimal changes in the lamina propria. In three patients intravenous hyperalimentation was necessary. Specific treatment with a high-protein, low-fat diet with added medium-chain triglyceride (MCT) is valuable. Surgical resection was of benefit in one patient, and anastomosis of mesenteric to para-aortic lymph nodes in another.
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