Biomedical subjects
Publications and source records attributed to R D Feigin.
Fecal samples from sixty patients were utilized to evaluate a method for the preservation of anaerobic organisms. Comparison was made with a method commonly employed in the collection of specimens from the operating room and bedside. Analysis of the numbers ae preservation of anaerobic fecal flora in a reliable manner during a 24 hour delay between specimen collection and plating.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Plasma concentrations of arginine vasopressin were determined by radioimmunoassay in 13 normal children, 21 patients with febrile illnesses (not bacterial meningitis), and 17 patients with bacterial meningitis. The mean +/- 1 SD concentrations of AVP in the normal children and patients with various febrile illnesses were 0.7 +/- 0.6 and 1.0 +/- 1.2 muU/ml, respectively. The mean +/- 1 SD concentration of AVP in patients with bacterial meningitis was 3.3 +/- 2.3 muU/ml. The concentrations of AVP in the patients with bacterial meningitis were significantly greater (P less than 0.001) than those noted in the normal children or children with other febrile diseases.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A method of clinical staging for infants with necrotizing enterocolitis (NEC) is proposed. On the basis of assigned stage at the time of diagnosis, 48 infants were treated with graded intervention. For Stage I infants, vigorous diagnostic and supportive measures are appropriate. Stage II infants are treated medically, including parenteral and gavage aminoglycoside antibiotic, and Stage III patients require operation. All Stage I patients survived, and 32 of 38 Stage II and III patients (85%) survived the acute episode of NEC. Bacteriologic evaluation of the gastrointestinal microflora in these neonates has revealed a wide range of enteric organisms including anaerobes. Enteric organisms were cultured from the blood of four infants dying of NEC. Sequential cultures of enteric organisms reveal an alteration of flora during gavage antibiotic therapy. These studies support the use of combination antimicrobial therapy in the treatment of infants with NEC.
Explore the source record for details and available documents.
A diagnosis of leptospirosis was confirmed in nine children who were admitted to St. Louis Children's Hospital during the past 54 months. Epidemiologic, clinical, cultural, and serologic data which were obtained emphasize (1) the high incidence of urban cases; (2) contact with dogs as the most likely source of infection; and (3) that serotypes other than Leptospira icterohaemorrhagiae may produce severe clinical disease. Unusual or previously unreported manifestations of leptospirosis including acalculous cholecystitis, pancreatitis, abdominal causalgia, desquamating skin rashes, and infarction of the extremities which were noted in these children are discussed.
A prospective study of bacterial meningitis in children was initiated two years ago. Serum sodium concentrations below 135 MEQ/liter were noted on admission in 72 of 124 (58.1 %) of patients enrolled in the study protocol. Low initial serum sodium concentration and prolonged depression in serum sodium despite fluid restriction correlated significanly (P less than 0.001 to 0.01) with the presence of neurologic sequelae of the disease. Inappropriate secretion of antidiuretic hormone as the cause of these electrolyte changes could be inferred by indirect measurement of serum and urine solute and volume data and was specifically documented, in patients enrolled most recently, by specific radioimmunoassay of antidiuretic hormone.
Future research concerning the interactions between infectious disease and nutritional status must extend our available knowledge concerning these two major problem areas. Critical studies must be designed in animal models as well as in man. The effects of malnutrition on immune responsiveness must be studied. Key information is lacking with respect to the utilization of host energy and protein during infection. Alterations in body chemistry are especially important in protracted diarrheal and respiratory diseases of children. A concensus has not yet been reached concerning the optimal approach to iron nutritional needs during infection or to those of other trace nutrients including the vitamins. Research needs in each of these areas are listed.
The factors underlying acute infantile hemiplegia are seldom identified. Coxsackie A9 focal encephalitis was documented for the first time in a 3-month-old infant with fever, hemiconvulsions, and hemiplegia followed by a static motor deficit and epilepsy. It has been suggested that the acute infantile hemiplegia associated with encephalitis results from an arteritis or venous sinus thrombosis with subsequent cerebral infarction. However, this was not observed in our patient. Rather, a series of brain scans, computerized tomograms, and a cerebral angiogram clearly documented the evolution of a focal necrotizing encephaloclastic process resulting in a porencephalic cyst. Serial cerebrospinal fluid viral cultures were necessary to isolate the etiologic agent (tcoxsackie A9). The infant did not have a neutralizing antibody response to the infecting viral agent despite an apparently intact immune system, which possibly may be explained by the developed of immune tolerance or an insufficient amount of infecting viral antigen. This emphasizes that serologic studies alone may not be adequate to document an acute central nervous system viral infection. This patient also typifies the poor prognosis in infants presenting with acute hemiplegia, fever, and convulsions in the absence of cerebrovascular occlusion.
Explore the source record for details and available documents.
Twenty hospitalized children between 1 and 11 years of age were enrolled in a comparative randomized evaluation of trimethoprim-sulfamethoxazole (TM-SM) and ampicillin for the treatment of shigellosis. Each drug was provided for five days. The group treated with ampicillin had significantly more stools per day (mean 21.25) compared to the TM-SM group (8.64). Treatment with TM-SM appeared to be associated with a more rapid reversion of stool cultures to normal, but these differences compared to ampicillin were not statistically significant. Review of all isolates of Shigella from our hospital revealed a marked decrease in sensitivity to ampicillin over the last six years. This pattern has been observed in other centers. TM-SM may be the best drug for the treatment of shigellosis in areas where multiple antibiotic-resistant organisms are common.
Explore the source record for details and available documents.
Hartnup disease is a rare genetic disorder of amino acid transport associated with variable and intermittent clinical abnormalities. A family is described in which three siblings had an intermittently progressive neurological disease and two of the affected siblings had the Hartnup-pattern aminoaciduria. Neuropathological examination of one case showed severe diffuse atrophy, generalized neuronal loss in the cortex, and Purkinje cell loss in the cerebellum. In vivo and in vitro studies of intestinal amino acid transport in the surviving sibling indicated a partial defect in the transport of several neutral amino acids (tryptophan, alanine, serine, and methionine) with normal transport of other neutral amino acids (threonine, phenylalanine, histidine, tyrosine, and isoleucine). Transport of glycine, proline, hydroxyproline, and the basic amino acids appeared normal.