Vipera palaestinae snake envenomations: experience in children.

In Israel, Vipera palaestinae (V. palaestinae) is the most common venomous snake, accounting for 100-300 reported cases of envenomation every year. However, V.

Epinephrine pharmacokinetics and pharmacodynamics following endotracheal administration in dogs: the role of volume of diluent.

Objective: to define the optimal volume of dilution for endotracheal(ET) administration of epinephrine (EPI).

Design: prospective, randomized, laboratory comparison of four different volumes of dilution of endotracheal epinephrine (1, 2, 5, and 10 ml of normal saline).

Setting: large animal research facility of a university medical center.

Extubation failure due to post-extubation stridor is better correlated with neurologic impairment than with upper airway lesions in critically ill pediatric patients.

The incidence of post-extubation stridor (PES) in a pediatric intensive care unit (PICU) and the need for reintubation is not known. Predictors of success on a subsequent extubation attempt and the efficacy of dexamethasone treatment prior to a subsequent extubation attempt are not established. In a prospective randomized double blind-controlled study in two PICU's in a university children's hospital setting, of 5,566 admissions over 35-months, we identified 32 patients who failed primary extubation and were reintubated for PES.

Urine samples from disposable diapers: an accurate method for urine cultures.

Background: The method of collection of the urine sample is of paramount importance in making a diagnosis of urinary tract infection in infants and children. Squeezing urine out of disposable diapers can provide a urine sample that can be used to detect chemical abnormalities as well as a specimen suitable for microscopic examination. To date there have been no reported studies on the use of this technique for urine culture as compared with samples collected by suprapubic aspiration and catheterization.

Pediatric craniocerebral wounds from plastic bullets: prognostic implications, course, and outcome.

Objective: To review our experience with craniocerebral injuries caused by plastic bullets, and to delineate prognostic factors for outcome.

Design: Retrospective case series of 29 patients presenting with plastic bullet-induced craniocerebral lesions.

Setting: Pediatric intensive care department of a tertiary care center.

Torticollis: an unusual presentation of spontaneous pneumomediastinum.

Torticollis is a common clinical sign encountered by pediatricians in a wide variety of childhood illnesses including those from traumatic, neurologic, infectious, inflammatory, and psychogenic causes. We describe a case of spontaneous pneumomediastinum (SPM) manifested as acute torticollis. To the best of our knowledge, torticollis as a result of spontaneous pneumomediastinum has not yet been described.

Spontaneous pneumomediastinum in children: clinical and natural history.

Unlabelled: Investigation of the clinical characteristics and natural history of nine children with spontaneous pneumomediastinum (SPM) was conducted at the Tel Aviv University Sheba Medical Centre between 1984 and 1994. Most cases occurred in the setting of a valsalva-type manoeuvre, while symptoms and signs on admission were mainly chest pain, dyspnoea, neck pain, subcutaneous emphysema, and Hamman's sign. Three clinical patterns concerning longterm sequelae were identified: patients without any long-term sequelae, patients with a tendency to airway hyperreactivity and subclinical asthma, and patients in whom SPM was the presenting feature of their asthma.

A controlled intervention in reduction of redundant hospital days.

Background: Inappropriate use of hospital services, in the form of unjustified hospital stay days (HSD), constitutes a major burden on a health budget. Reduction of unjustified HSD was achieved in a medical ward in a previous intervention study.

Methods: A controlled intervention aimed at reducing unjustified hospital stay was performed on 155 paediatric inpatients and 248 controls, by applying pre-set criteria for hospitalization and comparing to results in previous studies.

Intrathecal baclofen for severe torsion dystonia in a child.

The successful use of intrathecal baclofen, a structural analogue of gamma-aminobutyric acid, is described in the treatment of a 9-year-old boy with intractable torsion dystonia, not responding to conservative treatment. To our knowledge, this is the first reported case of continuous intrathecal baclofen for hereditary torsion dystonia. This case suggests that a continuous intrathecal infusion of baclofen may facilitate remission of intractable torsion dystonia, and provides a basis for further investigation of the treatment of intractable childhood dystonia.

Laceration of the phrenic artery. A life-threatening complication after repair of pectus excavatum.

We report a case of life-threatening hemothorax three months after surgical repair of pectus excavatum. Angiography revealed the hemorrhage to originate from a laceration of the phrenic artery secondary to dislodgment of the metal strut used for the repair. Awareness of this rare complication in patients after repair of pectus excavatum is required.

[Chloral hydrate--is it safe?].

Chloral hydrate is widely used as a sedative or hypnotic, especially in geriatric and pediatric patients. In therapeutic doses blood pressure and respiration are only minimally affected. We describe a 9-year-old boy in whom a life-threatening cardiac arrhythmia dominated the clinical presentation of chloral hydrate intoxication.

Plain radiography for diagnosis of gastrointestinal perforation in immune-compromised children--is it enough?

Gastrointestinal perforation is a surgical emergency in the pediatric patient and any delay in diagnosis might be hazardous. In immunocompromised children, the clinical signs of perforation may be blunted. We describe a child with acute lymphoblastic leukemia (ALL) and a perforated appendix and ileum in whom computerized tomography (CT) revealed extraluminal air that was not initially identified on plain abdominal film.

Rhabdomyolysis due to hereditary torsion dystonia.

Following an acute dystonic crisis, a 6-year-old boy with hereditary torsion dystonia developed rhabdomyolysis. To our knowledge, hereditary torsion dystonia has never been reported as a cause of rhabdomyolysis. Early diagnosis and treatment of rhabdomyolysis should be considered in children with severe dystonia in order to prevent renal failure.

Effect of extracorporeal membrane oxygenation flow on pulmonary capillary blood flow.

Objective: To validate a new application of the modified acetylene rebreathing method for pulmonary capillary blood flow in a swine extracorporeal membrane oxygenation (ECMO) model.

Design: Prospective, sequential measurements of pulmonary capillary blood flow, using a rebreathing technique, as affected by different flows through the ECMO circuit.

Setting: A cardiovascular hemodynamic research laboratory at a university medical center.

[Rubella encephalitis].

Morbidity in rubella is generally mild, and neurological complications are rare, varying from 1:6000-1:24,000. We describe an 11-year-old girl with severe manifestations of rubella encephalitis. The onset of encephalitis most often occurs within 1-6 days after development of the typical rash.

Nucellar callus of 'Femminello' lemon, selected for tolerance toPhoma tracheiphila toxin, shows enhanced release of chitinase and glucanase into the culture medium.

Phoma tracheiphila is the causative agent of the disease mal secco. Citrus cultivars differ substantially in respect to their sensitivity to the pathogenP. tracheiphila and its toxin.

Differential responses of citrus calli and protoplasts to culture filtrate and toxin of Phoma tracheiphila.

Nucellar calli from two citrus cultivars with known tolerance to mal secco disease were chosen as experimental material, to test the pathogen's response to culture filtrate (CF) and partially purified toxin (PPT). The response of the two calli to the CF was in reverse order to the known response of the two cultivars to natural and artificial inoculations with Phoma tracheiphila. HPLC analysis of P.

Suppression of somatic embryogenesis in Citrus cell cultures by extracellular proteins.

Nucellar-derived cell cultures of sour orange (Citrus aurantium L.) proliferate as proembryogenic masses. By a change in the carbon source of the medium from sucrose to glycerol they are induced to undergo synchronous embryogenesis forming embryo initials that develop into globular embryos.

Protoplast-fusion-mediated transfer of organelles from Microcitrus into Citrus and regeneration of novel alloplasmic trees.

Iodoacetate-treated Citrus protoplasts from embryogenic nucellar calli of Sour orange (C. aurantium) or from Rough lemon (C. jambhiri) were fused with γ-irradiated protoplasts from a related genus, Microcitrus.

Production of flavanone-neohesperidosides in Citrus embryos.

Grapefruit (Citrus paradisi) tissue cultures were examined for qualitative and quantitative changes in flavanone-neohesperidoside content during somatic embryogenesis. Embryos cultured in vitro contain naringin and a rhamnosyl-transferase activity which is capable of rhamnosylating position 2 on the flavanone glucosides. Rhamnosylation is carried out only in embryos cultivated on solid medium but not in embryos grown in suspension cell cultures.

A protoplast-to-tree system in Microcitrus based on protoplasts derived from a sustained embryogenic callus.

Adventitious embryos derived from a zygotic embryo in an in vitro cultured ovule of Microcitrus were transferred several times on solidified medium containing benzyladenine and 3-indoleacetyl-L-alanine to induce embryogenic callus. This callus was maintained for several years on medium devoid of growth regulators without losing its embryogenic capacity. Exposure of this callus to maceration enzymes led to protoplast suspensions.