Kawasaki disease--atypical presentation.

Kawasaki disease, an acute systemic vasculitis of unknown etiology, is the leading cause of acquired heart disease in children in many parts of the world. It predominantly affects children under 5 years of age and is diagnosed clinically by the presence of characteristic clinical signs. Atypical patients, often younger than 1 year of age, manifest few early signs, usually have an incorrect admitting diagnosis and suffer from high morbidity and mortality. We report the presentation, clinical course and follow-up of a 3-month-old infant with atypical Kawasaki disease.

Respiratory function monitoring during mechanical ventilation in pediatric intensive care unit.

Noninvasive monitoring of lung function during mechanical ventilation has been used to study disease processes causing respiratory failure. Pediatric pulmonary function monitoring during mechanical ventilation in the pediatric intensive care unit in patient with respiratory failure is becoming more common in western countries. The article describes a review of principles and methods of respiratory function monitoring in the pediatric age group. It attempts to incorporate experience from original articles previously published as well as the experience in monitoring pulmonary mechanics at our institution. Routine monitoring of pulmonary mechanics in patients being mechanically ventilated may have significant impact on morbidity and/or mortality of pediatric patients with respiratory failure. Key articles pertaining to lung function testing in pediatric age group from past 15 years were used as well as clinical experience encountered by attending pediatric intensivists at Henrico Doctors' Hospital was incorporated. Over the past ten years the use of monitoring of gas exchange and bedside pulmonary mechanics monitoring as a part of respiratory function monitoring has become more common. With better clinical information to precisely document the status of lung function, it may lead to improved methods of ventilator management which may prevent complications and may significantly impact on morbidity and/or mortality of mechanically ventilated pediatric patients.

Differentiation of follicular adenoma and carcinoma of thyroid by immunohistochemical demonstration of ceruloplasmin.

In this study, and attempt was made to differentiate between follicular neoplasms of the thyroid using an immunoperoxidase staining technique for detection of ceruloplasmin. 54 histologically proved benign and malignant thyroidal lesions were selected. The staining for ceruloplasmin was consistently positive in follicular carcinoma and negative in follicular adenoma.

Establishing a new pediatric intensive care unit.

Pediatric intensive care is a collaborative practice of dedicated personnel, advanced technology and a diverse group of support services. Unit design must focus on current patient needs while envisioning the technological and clinical needs of the future. With insight and a cooperative effort, your design team can effectively transform ideas into a unit committed to the care of critically ill children.

Enhancement of colposcopic image by sulphosalicylic acid.

Acetic acid is used conventionally for enhancement of the colposcopic image. We used sulphosalicylic acid instead of acetic acid in 50 normal cases. The normal appearance was enhanced in all cases. The image was also enhanced in 70% cases of cervical intraepithelial neoplasia and 90% cases of cervical condyloma accuminata. The image was not inferior to that with acetic acid in any of the cases.

Conjunctival impression cytology--a study of normal conjunctiva.

Conjunctival impression cytology was used to study conjunctival ocular surface in 30 normal individuals in the age group of 20 to 60 years. The cytology was graded according to the classification of Nelson. Out of 30 subjects, 26 showed the features of Grade O (average age 28.33 years) and 4 showed grade 1 (average age 56.66 years). The method was very easy to perform, cheap and fast. The relationship of various cells to each other was maintained. This method can be used to study the conditions like trachoma, avitaminosis A and other disorders of conjunctival surface. It can be undertaken by a paramedical worker in an out patient clinic.

Detection of HSV-2 antigen in carcinoma cervix and premalignant conditions by immuno-cytochemistry.

One hundred and twelve cases of cervical pathology (58 paraffin sections and 54 cervical smears) were assessed by PAP technique and 30 cases by indirect immunofluorescent technique. Forty-two normal cervical smears from the age matched controls were stained by indirect immuno-fluorescent technique. HSV-2 antigen was detected by PAP method in 86 out of 112 cases (78.57%) i.e. 50/55 squamous cell carcinoma, 13/13 carcinoma in situ, 11/15 severe dysplasia, 3/4 moderate dysplasia and 9/16 mild dysplasia. The amount of antigen was maximum in squamous cell carcinoma and decreased in carcinoma in situ, severe, moderate and mild dysplasia in descending order. Three cases of adenocarcinoma cervix were negative. Only one case out of 42 controls was positive. HSV-2 antigen was detected by an indirect IF technique in 8/9 squamous cell carcinoma, 2/3 carcinoma in situ, 3/7 dysplasia, O/1 adenocarcinoma and 4/10 inflammatory cases. The above findings support the association between HSV-2 and squamous cell carcinoma cervix, as well as carcinoma in situ which is statistically significant.