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Biomedical subjects

S R Poole

Publications and source records attributed to S R Poole.

At least 19 recordsLinked to original sources
PubMed1995

Grunting respirations in infants and children.

Grunting respirations are recognized as a sign of serious illness in infants and children, but have not been well studied beyond the newborn period. We present three illustrative cases and the results of a descriptive study which elucidates the causes of grunting in infants and children and suggests guidelines for assessing pediatric patients with this symptom. All patients between one month and 18 years of age who presented to the Emergency Department (ED) of The Children's Hospital of Denver during the last five months of 1992 with grunting respirations were prospectively identified, and their charts were retrospectively reviewed. The 51 pediatric patients with grunting respirations (0.3% of all patients seen in the ED) fell into three groups based upon mode of presentation: 1) 55% presented with predominantly respiratory signs and symptoms, and each one had a respiratory or cardiac condition; 2) 25% presented with high fever (greater than 38.5 degrees C) but without respiratory signs and symptoms, and all had an infectious cause (three fourths of them had an invasive bacterial disease); 3) 20% presented with neither fever nor respiratory signs or symptoms and had one of a variety of conditions which appeared to cause pain. Presenting symptoms can guide the selection of tests used to evaluate the infant or child with grunting respirations. Guidelines for evaluation are provided in this report.

Adolescent↗
PubMed1992

Monozygotic twin girls with congenital malformations resembling fanconi anemia.

Monozygotic (MZ) twin girls, diagnosed at birth to have Fanconi anemia (FA) on the basis of multiple anomalies and an apparently increased baseline chromosomal breakage frequency in one twin, have been followed prospectively for 13 years. They have not developed aplastic anemia or other hematologic manifestations of FA. There was no evidence for increased baseline or diepoxybutane (DEB)-induced chromosomal breakage in either twin when the studies were repeated in Denver as well as in New York. Since the cellular phenotype must be considered in establishing the diagnosis of FA, these MZ twins should not be classified as affected with FA. Using the scoring system for FA diagnosis developed by Auerbach et al. [1989], the probability coefficients of their having FA based solely on clinical findings, prior to DEB testing, were .75 and .92, respectively. When the combination of their anomalies are taken together, their FA probability coefficient is .98. Through the International FA Registry, 15 additional patients have been identified with an FA probability score of .75 or greater, but who have not developed aplastic anemia and who are DEB negative. These patients, as well as the twins described in this report, are most likely a heterogeneous group and may represent other syndromes like Holt-Oram, VATER, VACTERL and IVIC, with genetic as well as nongenetic etiologies. These cases demonstrate the importance of testing with DEB or other DNA crosslinking agent in order to discriminate between FA and other syndromes with a similar phenotype.

Abnormalities, Multiple↗
PubMed1991

The infant with acute, unexplained, excessive crying.

This study describes 56 infants who presented to the Emergency Department of The Children's Hospital of Denver during a 1-year period with an episode of excessive, prolonged crying, without fever and without a cause that was apparent to the parents. The final diagnoses included a broad array of conditions, of which 61% were considered serious. The history provided clues to the final diagnosis in 20% of cases. Physical examination revealed the final diagnosis in 41% and provided clues to the diagnosis in another 13%. Accurate diagnosis requires a thorough physical examination, which should include careful skin inspection underneath all clothing, palpation of all large bones, fluorescein staining of the cornea, eversion of eyelids, rectal examination, retinal examination, and thorough neurologic examination. "Screening" laboratory tests, except for urinalysis and urine culture, were of little help. This study indicates that for those patients in whom the physical examination is not diagnostic, the persistence of excessive crying after the initial examination predicts the presence of a serious cause. Those infants who cease crying before or during the initial assessment are unlikely to have a serious cause. Recommendations for a stepwise assessment are offered.

Child, Preschool↗
PubMed1991

The role of the pediatrician in abolishing corporal punishment in schools. Committee on School Health, American Academy of Pediatrics.

Corporal punishment in school is allowed in 30 states in the United States. The American Academy of Pediatrics, together with numerous other child-advocacy groups, has reaffirmed its position that corporal punishment in schools should be prohibited by state statute in all states. This article provides background information and recommendations regarding the potential role for pediatricians in attaining this goal.

Academies and Institutes↗
PubMed1990

The child with simultaneous stridor and wheezing.

We describe 25 patients with simultaneous stridor and wheezing. Twelve patients presented to the emergency department of The Children's Hospital of Denver over a two-year period; we found an additional 13 in a review of the literature. A combination of two disorders produced stridor and wheezing in six patients, with one condition in the extrathoracic airway and one in the intrathoracic airway. The remaining 19 patients had single lesions, nine with obstruction of the extrathoracic airway and 10 with obstruction of the intrathoracic airway. The causes of stridor and wheezing in these 19 patients fell into three general categories: (1) congenital lesion affecting the airway (eight patients); (2) foreign body in the airway or esophagus (nine patients); and (3) acquired lesion affecting the airway (two patients). All eight patients with congenital lesions developed symptoms by four months of age. All nine patients with an airway or esophageal foreign body were between five and 30 months of age. The history may be misleading, and the physical examination often cannot discriminate among the various likely diagnoses. However, the addition of four plain x-ray views (lateral neck, posteroanterior and lateral chest, and forced expiratory chest) located the site of obstruction in 18 of 25 patients. Barium swallow identified the two patients with vascular rings. Four patients underwent endoscopy to determine the site of obstruction. We make recommendations for evaluation of these patients.

Adolescent↗
PubMed1988

Differentiation of epiglottitis from laryngotracheitis in the child with stridor.

To identify which clinical findings serve to differentiate acute epiglottitis from laryngotracheitis and also to evaluate the role of direct inspection of the epiglottis in the evaluation of children initially thought to have laryngotracheitis, we prospectively evaluated 155 children presenting to the emergency room with acute stridor. Three of the findings on physical examination were associated with epiglottitis: absence of spontaneous cough, drooling, and agitation. The diagnosis assigned prior to inspection of the epiglottis was incorrect in two of six patients with epiglottitis and in three of 149 patients with laryngotracheitis. The diagnosis made after inspection was correct in all 155 patients. Minor complications of inspection were seen in seven patients with laryngotracheitis. No complications were seen in the children with epiglottitis. We conclude that drooling, agitation, and absence of cough are predictors of epiglottitis, but clinical findings alone cannot exclude epiglottitis in every child who appears to have laryngotracheitis. When laryngotracheitis is the suspected diagnosis, inspection of the epiglottis by a pediatrician in a hospital emergency room is an effective aid to the evaluation of the child with acute stridor.

Acute Disease↗
PubMed1985

Persistent lower respiratory disease in children.

Recurrent or persistent lower respiratory disease in children may present in various ways. The differential diagnosis includes reactive airways disease (asthma), prolonged viral pneumonia (in the young infant) and foreign body aspiration-the most common causes of persistent respiratory symptoms. The differential diagnosis also includes a long list of rare conditions. Because of the many diagnostic possibilities, the evaluation of a child with persistent lower respiratory disease should be carried out in a systematic, stepwise fashion.

Asthma↗
PubMed1984

Recurrent abdominal pain in childhood and adolescence.

Most children and adolescents with recurrent abdominal pain (three or more episodes over three months) have psychophysiologic pain. This diagnosis can be based on specific criteria. Features include periumbilical or epigastric pain that occurs in the context of stressful events; a review of systems that does not point to organic disease; a family history of psychophysiologic gastrointestinal symptoms; a physical examination that reveals only abdominal tenderness, and negative laboratory tests.

Abdomen↗
PubMed1984

Hyperactivity.

Overactivity and poor attention span are symptoms for which there are several possible causes. The physician's role is to assist the family and school in recognizing the specific cause of the hyperactivity, institute appropriate treatment, and document and evaluate that treatment is effective.

Amphetamines↗
PubMed1984

Patients with delusional and bizarre thinking.

Patients with delusional or other types of bizarre thinking are often incorrectly labeled as schizophrenic. This error has significant medical and social implications to the patient. Delusional thinking has been linked with a variety of nonschizophrenic problems including the use of licit and illicit drugs, a wide variety of medical diseases, and nonschizophrenic psychiatric disturbances. A series of case studies in which the diagnosis of schizophrenia was incorrectly made elucidates the problem and helps the physician consider the alternatives.

Adolescent↗
PubMed1983

Bibliotherapy: an adjunct to care of patients with problems of living.

Bibliotherapy, or the selected use of reading as an adjunct to the treatment of medical and psychological problems, has a long history in the library science literature. However, the use of bibliotherapy by practicing physicians has not been significant. Many patients who see family physicians are candidates for bibliotherapy as adjunctive treatment. In the past five years numerous well-written books that address various patient problems of living have been made available. The authors surveyed a variety of health care specialists in the Denver area to develop a reading list for people with life problems. These problems have been categorized under the following headings: dealing with life crises and transitions, parents and children, parenting, coping with illness and disability, death and dying, lifestyle modification, sexuality, and coping with feelings. The resulting annotated bibliography may be used as a guide for practicing physicians who feel that appropriate reading material may be beneficial to their patients with such problems.

Adjustment Disorders↗
PubMed1983

The nurse practitioner's role in adolescent health care.

This study describes the 12,414 health care problems of 3,657 adolescent patients visiting 12 family practices over a one-year period. Age-sex distribution, visiting patterns and all categories of morbidity are described for patients between 13 and 20 years of age. Significant sex differences and differences among early, middle and late adolescents are also described. The results of this study have important implications for the training of nurse practitioners. Traditionally, nurse adolescent patients in their clinical setting to determine what conditions they learn about. This paper proposes the need for a competency-based curriculum and offers a list of topics to form the core of such a curriculum.

Adolescent↗
PubMed1983

Pediatric behavioral science in family practice.

Behavioral science is a well-accepted component of family practice, but official guidelines and proposed curricula have a predominantly adult focus. This paper describes a pediatric behavioral science curriculum for family practice residents that has been successfully integrated into the three-year family practice residency curriculum at the University of Colorado. Details of development and implementation are presented: the requisite knowledge base, skills, and attitudes; the core pediatric behavioral science topics and diagnoses; the family physician's role in handling each core diagnosis; guidelines for making management decisions; suggested approaches to teaching the curriculum; and a reference list for behavioral science faculty.

Attitude of Health Personnel↗