Does leucocytosis identify bacterial infections in febrile neonates presenting to the emergency department?

Objective: This study was undertaken to evaluate the discriminatory power of the peripheral white blood cell (WBC) count to identify bacterial infections in a cohort of febrile neonates (
Methods: Retrospective medical record review using descriptive statistics and a receiver operating characteristic (ROC) curve. Neonates who presented to a tertiary care paediatric emergency department between 1 January 1999 and 22 August 2002, had a temperature >or=38 degrees C, underwent lumbar puncture, and had a WBC count obtained were included.

Incidence and severity of recovery agitation after ketamine sedation in young adults.

Purposes: Psychic recovery reactions after ketamine administration are not uncommon in adults, but yet are rare in children 15 years old and younger. The nature of such reactions has not been previously described in young adults, and accordingly we wished to quantify the incidence and severity of recovery agitation after ketamine sedation in patients aged 16 to 21 years.

Basic Procedures: We prospectively collected data on 26 young adults aged 16 to 21 years who received ketamine for emergency department procedures, and treating physicians rated recovery "agitation," "crying," and "unpleasant hallucinations or nightmares" each on a 100-mm visual analog scale (0 mm="none," 100 mm="worst possible").

Ginkgo biloba and acetazolamide prophylaxis for acute mountain sickness: a randomized, placebo-controlled trial.

Background: Acute mountain sickness (AMS) commonly occurs when unacclimatized individuals ascend to altitudes above 2000 m. Acetazolamide and Ginkgo biloba have both been recommended for AMS prophylaxis; however, there is conflicting evidence regarding the efficacy of Ginkgo biloba use. We performed a randomized, placebo-controlled trial of acetazolamide vs Ginkgo biloba for AMS prophylaxis.

Clinical practice guideline for emergency department ketamine dissociative sedation in children.

We present an evidence-based clinical practice guideline for the administration of the dissociative agent ketamine for emergency department pediatric procedural sedation and analgesia. Substantial research in recent years has necessitated updates and revisions to the widely disseminated 1990 recommendations. We critically discuss indications, contraindications, personnel requirements, monitoring, dosing, coadministered medications, recovery issues, and future research questions for dissociative sedation.

Procedural sedation use in the ED: management of pediatric ear and nose foreign bodies.

This is the first report of which we are aware that describes the use of procedural sedation for the emergency department management of ear and nose foreign bodies in children < 18 years of age. During a 5.5-year period, we identified 312 cases of children with a foreign body in a single orifice (174 ear, 138 nose).

Yo-yo injuries.

Objective: This study was undertaken to describe pediatric yo-yo injuries as published in the English-language medical literature and in a large national database of emergency department visits in the United States.

Methods: Two search strategies of public data were used. All available materials from January 1993 through December 2002 including accident investigations, reported incidents, death certificates, and data from the National Electronic Injury Surveillance System involving yo-yos were requested from the United States Consumer Product Safety Commission.

Cardiac troponin I as a predictor of respiratory failure in children hospitalized with respiratory syncytial virus (RSV) infections: a pilot study.

This pilot study was performed to assess the use of cardiac troponin I to predict respiratory failure in children admitted to the hospital with respiratory syncytial virus (RSV) infections. We enrolled a prospective convenience sample of children under 5 years of age who were admitted to our university-based, tertiary care children's hospital from December 1, 2000, to February 1, 2002, with RSV infections. A cardiac troponin I was drawn at admission.

Blunt pediatric head trauma requiring neurosurgical intervention: how subtle can it be?

Recent literature on pediatric head injuries has suggested that important intracranial injuries might present to the ED without typical signs or symptoms. The objective of our study was to review our institutional experience with head-injured infants and young children to assess the subtlety of the ED presentation. We performed a retrospective medical record review of head-injured children View Article and Find Full Text PDF

Ventilatory response during dissociative sedation in children-a pilot study.

Objectives: It is unclear whether ketamine induces subclinical respiratory depression when administered in dissociative doses intravenously (IV). The authors report a pilot study of capnography in emergency department (ED) pediatric patients receiving ketamine alone for procedural sedation, and describe serial measures of ventilatory response [end-tidal carbon dioxide (EtCO(2)), respiratory rate, pulse oximetry].

Methods: The authors performed continuous capnography on a convenience sample of 20 ED pediatric patients who received ketamine 1.

Pediatric cardiac retransplantation: intermediate-term results.

Background: Cardiac retransplantation (re-CTx) in children is a controversial therapy, yet it remains the best treatment option to recipients with failing grafts. Our objective was to determine the incidence of re-CTx in a large pediatric population of recipients and evaluate the outcome of such therapy.

Methods: Between November 1985 and November 1999, 347 children underwent cardiac transplantation at the Loma Linda University Medical Center.

Asynchronous asymmetric form of heterogeneous osteopetrosis: initial case expanded and a new case.

We have discovered additional serial radiographs and clinical information on the initial case of "regional osteopetrosis tarda" that has been included in several editions of Caffey's Pediatric X-Ray Diagnosis. A definite second case was found after a search of radiology teaching files of other selected medical centers and the International Skeletal Dysplasia Registry. Analysis of the sequential unusual radiographic findings of the initial case and the equivalent compelling findings of the second case justifies renewed attention to an asynchronous asymmetric form of heterogeneous osteopetrosis.

Ketamine sedation for pediatric gastroenterology procedures.

Background: Although the dissociative sedative ketamine is used commonly for pediatric procedural sedation in other settings, the safety of this agent in pediatric gastroenterology is not well-studied. A 5-year experience with ketamine sedation for pediatric gastroenterology procedures was reviewed to document the safety profile of this agent and to identify predictors of laryngospasm during esophagogastroduodenoscopy (EGD).

Methods: The study was a retrospective consecutive case series of children receiving ketamine administered by pediatric gastroenterologists skilled in basic airway management to facilitate pediatric gastrointestinal procedures during a 5-year period.

Ethical challenges in infant heart transplantation: a clinical case presentation.

Although heart transplantation has become recognized as a viable option for the treatment of incorrectable heart disease in infants and children, its application becomes less clear in infants with potentially serious neurologic impairment. The following case study illustrates one transplant team's approach to decision making in the case of an infant born with a chromosomal deletion syndrome.

Successful myocardial volume reduction in a 9-month-old infant.

Left ventricular reduction has shown promise as a treatment for end-stage dilated cardiomyopathy, with restoration of the physiologic ratio between myocardial mass and left ventricular diameter. We present a case of successful partial left ventriculectomy utilizing both lateral and septal wall excision as treatment of dilated cardiomyopathy in a 9-month-old patient.

Ultra fast track in elective congenital cardiac surgery.

Background: Changes in healthcare delivery have affected the practice of congenital cardiac surgery. We recently developed a strategy of limited sternotomy, early extubation, and very early discharge, and reviewed the perioperative course of 198 pediatric patients undergoing elective cardiovascular surgical procedures, to assess the efficacy and safety of this approach.

Methods: One hundred ninety-eight patients aged 0 to 18 years (median 3.

Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures? A randomized, double-blind, placebo-controlled trial.

Study Objective: Despite widespread use of adjunctive benzodiazepines during ketamine sedation, their efficacy in reducing recovery agitation in children has never been studied. We wished to characterize the nature and severity of recovery agitation after ketamine sedation in children treated in the emergency department and to determine whether the addition of adjunctive midazolam reduces the magnitude of such recovery agitation.

Methods: The study was a randomized, double-blind, clinical trial of adjunctive midazolam versus placebo during ketamine sedation.

Inadvertent ketamine overdose in children: clinical manifestations and outcome.

Study Objective: We sought to characterize the clinical manifestations, outcome, and etiology of inadvertent ketamine overdose in the emergency department.

Methods: We investigated cases of inadvertent ketamine overdose in children seen in the ED solicited through electronic mail subscription lists or reported to the Institute for Safe Medication Practices. The clinical manifestations, outcome, and reported cause for each case are described.

What is the optimal dose of intramuscular ketamine for pediatric sedation?

Objective: The optimal dose of i.m. ketamine for ED procedural sedation in children is not known.

Heart transplantation for hypoplastic left heart syndrome: modified technique for reducing circulatory arrest time.

Background: The surgical technique of heart transplantation as therapy in infants with hypoplastic left heart syndrome was first reported over a decade ago. Since that time, incremental refinements have evolved that both facilitate the operation and potentially reduce the perceived neurologic hazards associated with the use of hypothermic circulatory arrest.

Methods: Minor technical adjustments have permitted infant heart transplantation to be accomplished with relative ease while markedly limiting the need for complete circulatory arrest.

Cardiac retransplantation for graft vasculopathy in children: should we continue to do it?

Background: Cardiac transplantation (CTx) has been established as an effective therapy for a variety of inoperable cardiac conditions in infants and children. However, graft vasculopathy (GV) has emerged as the main limiting factor to long-term survival of CTx recipients. The only treatment of severe GV is cardiac retransplantation (re-Tx).

Heart transplantation in infants and children with situs inversus.

Background: Recipient situs inversus has always represented a technical challenge during heart transplantation.

Objective: A simplified operative strategy for heart transplantation in a recipient with atrial situs inversus is described.

Methods: Fifteen pediatric recipients with situs inversus accompanying other complex congenital heart disease or dilated cardiomyopathy having "orthotopic" heart allotransplantation in one center, between 1985 and 1997, were reviewed retrospectively.

Percutaneous treatment of abdominal aortic aneurysm in a swine model: understanding the behavior of aortic aneurysm closure through a serial histopathological analysis.

Background: Previous studies used covered stent grafts to treat abdominal aortic aneurysms; however, such devices block flow into aortic side branches. We used uncovered stents with and without additional embolization coils to treat abdominal aortic aneurysm in a swine model and examined serial histological changes in the aneurysms over a 6-month period.

Methods And Results: We examined aneurysms in 9 control and 9 treated pigs (5 received stents alone and 4 received stents and coils).