[Separation of Siamese twins. Neither child was given preference].
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Decision Making↗
Biomedical subjects
S Haugstvedt
Publications and source records attributed to S Haugstvedt.
Plasma concentrations of lidocaine and prilocaine and analgesic effect after dermal application of EMLA cream 5% for surgical removal of mollusca in children.
The plasma concentrations of lidocaine and prilocaine after dermal application of EMLA cream 5% were determined in two clinical studies. The cream (10-16 g) was applied to a total surface area of 100-160 cm2. Each area was covered by a Tegaderm dressing (3M) in order to obtain occlusion. An application time of 2 hours was used. Two age groups of ten children were studied: 2-3 years and 6-8 years. In both groups venous blood samples were drawn prior to application and at 2, 3, 4 and 5 hours. In addition, in one of the studies, the cream was used during the surgical removal of mollusca in order to study the analgesic effect of the cream. The absorption of the local anaesthetics as indicated by plasma concentrations was far below toxic levels. The highest individual concentration of lidocaine was 315 ng/ml and of prilocaine 215 ng/ml. The analgesic effect was sufficient--eight out of ten patients experienced no or slight pain. Transient local reactions (paleness, redness) were frequently observed. In one patient with eczema present at the application site prior to the application, a reaction persisted for one week. Dermal analgesia provided by EMLA is a safe and effective method for alleviation of pain from removal of mollusca and the plasma concentrations are innocuous.
Analgesia↗
[Bicycle heel--an unnecessary injury which is easy to prevent].
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Adolescent↗
Disseminated aspergillosis treated with amphotericin B and surgery in a boy with chronic granulomatous disease.
A case of systemic infection caused by Aspergillus fumigatus in a seven-year-old boy suffering from chronic granulomatous disease is described. The fungus had infiltrated his lungs, his left foot and the popliteal and inguinal lymph nodes. Amphotericin B, 1 mg/kg daily, was given for three months via a central venous catheter, Progressive anaemia made amputation of his left leg necessary. The bone tissue was heavily infiltrated with fungal elements. The regional lymph nodes were also resected because of fungal growth. After six months no fungi were found in liver aspirates taken on account of liver abscesses due to Staphylococcus aureus. The combined medical and surgical approach resulted in complete eradication of the Aspergillus infection, as verified by the disappearance of Aspergillus precipitins.
Amphotericin B↗
Methodological aspects of renography in children.
Kidney function in children by renography has been evaluated. For reproducible results a high degree of standardization with respect to position, hydration and dosage was necessary. The wide range of kidney size and depth in children requires age-adapted collimators. For practical use for different size have been constructed for the age-groups: less 1 year, 1-5 years, 6-9 years and 10-15 years. A reduction in the surrounding activity of the kidneys is thereby obtained and disturbing influence from the bladder or contralateral kidney is prevented. Kidney function variables from the renogram are presented in terms of uptake and excretion ratios. The correlation between sum of uptake ratios and clearance measurements is good in cases with slight or moderate difference in kidney size. The standardized renographic technique has many advantages for kidney function measurements in children. The method is applicable in all ages, it is simple and reliable without extensive preparations and requires a low radiation dose. Also in children we can confirm the previous opinion obtained in adults that renography is a clinical valuable method of measuring kidney function.
Adolescent↗
Kidney size in normal children measured by sonography.
Kidney length and depth were measured by sonography in 46 normal children fro 0 to 16 years of age. Sonography was used to obtain kidney measurements without the known magnification caused by factors of chemical and photographic nature seen by urography. The results of our study were used to control the age-adapted equipment for renography in children. There was a good correlation between kidney length and depth and variables like age, weight, height and body surface area. The best values were found in the correlations to body surface area. We could confirm the previous findings by other methods of kidney size measurements in children that there is no significant difference in kidney length between boys and girls. The left kidney is slightly longer than the right one and the kidney centre distance is slightly but significantly larger on the left side. No such difference was present in the distance skin to kidney surface.
Adolescent↗
A simple method of background subtraction in two-detector renography.
To increase the accuracy in the routine measurement of the side distribution of kidney function from 131I-Hippuran renograms, a simple method of background subtraction has been developed. Principally a background curve was adapted to the renogram on each side, assuming an initial amplitude corresponding to the amplitude of phase I of the renogram. The amplitudes of the renogram over background after 2 min is recognized as a measured of kidney function and a background quotient was calculated by dividing the background curve amplitude at 2 min with its initial amplitude. Mean values of the background quotient recorder over thorax was 0.62 and over an empty kidney region 0.73. It was found that a quotient of 0.70 could be used generally, thus omitting the need for a background curve registration at each renographic examination.
Adolescent↗
Evaluation of unilateral kidney function in children. A comparison between renography and separate clearance.
Unilateral kidney function in children was evaluated by determination of 51Cr-EDTA-clearance combined with estimation of side distribution of kidney function by renography. As reference, separate clearance of 51Cr-EDTA, determined by sequential external ureteral occlusions on both sides, was used. A comparison between these two methods was made in 28 patients with varying degrees of unilateral kidney function impairment. A significant correlation was found when the renograms were corrected for extrarenal background activity. Thus, renography in combination with determination of the glomerular filtration rate with 51Cr-EDTA is a valuable method for evaluating separate kidney function in children, both methods being easily performed and requiring small radiation doses.
Adolescent↗
Kidney split function in children. A comparative study between renography and planimetry from urography.
The suitability of the background-subtracted renogram as a method for separate kidney function in children was evaluated by comparison with planimetry of the individual renal parenchymal area measured from urography. In different groups of renal disorders the total kidney function as reflected by the glomerular filtration rate has been compared with the sum of right and left renal parenchymal areas. The percentage side distribution of kidney function estimated from the renogram combined with measurements of total glomerular filtration rate has been correlated to individual renal parenchymal area. A good correlation was found for both total and separate measurements. A moderate scatter around the regression lines has to be taken into consideration when kidney function is judged from planimetry. A highly significant correlation was observed between renography and planimetry for the percentage distribution of kidney function, indicating that both methods are well suited for determining the side distribution of kidney function. For calculation of individual kidney function, combination of renography and 51Cr-EDTA-clearance offers a reliable method with a modest dose of irradiation.
Adolescent↗
Asymptomatic bacteriuria in schoolgirls. III. Relation between residual urine volume and recurrence.
Residual urine volume (RUV) has been measured in 70 schoolgirls with asymptomatic bacteriuria using 121I-hippuran. The mean volume of residual urine was 23.7 ml. More than 5 ml RUV, the highest value found in 14 girls without bacteriuria or a history of urinary tract infection, was found in 47% of the patients. The mean volume for residual urine in the control girls was 1-1 ml. Among the 44 girls cured for their bacteriuria be a bladder wash out test or antibiotic treatment, recurrence was significantly more common (p less than 0.001) in those greater than 5 ml in RUV (45/20, 75%) than in those with less than or equal to 5 ml (4/24, 17%). In 5 of 22 patients not treated, the bacteriuria disappeared spontaneously during a one year observation period. The RUV was less than 3 ml in 4 of these 5 girls. While the presence of residual urine per se may not be the primary event leading to bacteriuria, it may increase the risk of recurrences, by facilitating bacterial growth and impairing the wash out of bacteria from the bladder on micturition.
Adolescent↗