Considering suffocatory abuse and Munchausen by proxy in the evaluation of children experiencing apparent life-threatening events and sudden infant death syndrome.

This study describes 138 young children admitted to the hospital over a 23 year period for recurrent apparent life threatening events (ALTEs), unexplained deaths, or with Sudden Infant Death Syndrome (SIDS)-related diagnoses. In examining the potential for suffocatory abuse in living children, we utilized characteristics in the literature that distinguish SIDS or ALTEs due to natural disease states from abuse. Findings demonstrate a co-occurrence of risk factors that raise suspicions of suffocatory abuse or Munchausen by Proxy.

Life-threatening Pyridium Plus intoxication: a case report.

A 16-month-old male presents with an overdose of Pyridium Plus, a combination anticholinergic, azo dye, and barbiturate, resulting in seizures, coma, and methemoglobinemia. This case report reviews the treatment of methemoglobinemia with methylene blue, activated charcoal, and exchange transfusion. Additionally, the role of the pulse oximeter is addressed when methemoglobinemia exists and is treated with methylene blue.

Life-threatening Pyridium Plus intoxication: a case report.

A 16-month-old male presented with an overdose of Pyridium Plus--a combination anticholinergic, azo dye, and barbiturate--resulting in seizures, coma, and methemoglobinemia. This case report reviews the treatment of methemoglobinemia with methylene blue, activated charcoal, and exchange transfusion. Additionally, the role of the pulse oximeter is addressed when methemoglobinemia exists and is treated with methylene blue.

Cardiac malformations in trisomy-18: a study of 41 postmortem cases.

The cardiac malformations in 41 karyotyped and autopsy cases of trisomy-18 are presented in detail. The salient findings were a ventricular septal defect in all cases; tricuspid valve anomalies in 33 cases (80%); pulmonary valve anomalies in 30 (70%); aortic valve malformations in 28 (68%); mitral valve anomalies in 27 (66%); polyvalvular disease (that is, malformations of more than one valve) in 38 (93%); a subpulmonary infundibulum (conus) in 40 (98%); a bilateral conus with a short subaortic infundibulum in 1 case with double outlet right ventricle (this being the only documented case of bilateral infundibulum in trisomy-18); double outlet right ventricle in 4 cases (10%), three having a subpulmonary infundibulum only and all 4 having mitral atresia; tetralogy of Fallot in 6 cases (15%), 2 having pulmonary atresia; and a striking absence of transposition of the great arteries and inversion at any level (visceral or cardiac), findings that appear to be characteristic of all trisomies. These data suggest that excessive chromosomal material (as in trisomies) may result in situs solitus at all levels.