Non-invasive respiratory monitoring in paediatric intensive care unit.

Monitoring respiratory function is important in a Paediatrics Intensive Care Unit (PICU), as majority of patients have cardio-respiratory problems. Non-invasive monitoring is convenient, accurate, and has minimal complications. Along with clinical monitoring, oxygen saturation using pulse oximetry, transcutaneous oxygenation (PtcO2) and transcutaneous PCO2 (PtcCO2) using transcutaneous monitors and end-tidal CO2 using capnography are important and routine measurements done in most PICUs. Considering the financial and maintenance constraints pulse oximetry with end tidal CO2 monitoring can be considered as most feasible.

Sacral chordoma--a case report.

Chordoma, a rare malignant tumour of early adulthood, rarely presents in children. We report such a case of rare malignant tumour which was diagnosed in the first decade of life.

Infantile mediastinal primary endodermal sinus tumour.

Primary extragonadal mediastinal endodermal sinus tumour is rare, and to date very few cases have been reported in the literature. We present here a case of rare extragonadal highly malignant commonest germ cell tumour in an infant who presented with a rapidly progressive mediastinal mass with dry non-productive cough, tachypnea without significant respiratory distress or toxicity.

Congenital nephrotic syndrome with clinical hypothyroidism.

A 15 month old boy with typical features of congenital nephrotic syndrome (CNS) is reported, who in addition to the renal pathology had an associated clinical hypothyroidism with low levels of total and free thyroxine and triiodothyronine and an elevated serum TSH. Improvement in the physical parameters and mental status from thyroid hormone replacement therapy is documented.

An analysis of children with typhoid fever admitted in 1991.

In 28 children, with bacteriologically and/or serologically diagnosed typhoid fever treated at KEM Hospital, Bombay in 1991, initially one of the three recommended drugs (viz. chloramphenicol, amoxycillin or co-trimoxazole) was given for 7 days for defervescence to occur. In those who failed to respond, a second trial of therapy with one of the other two drugs was initiated, after omitting the first drug. A second failure of therapy was taken as an indication to use ciprofloxacin singly. Eventually, 18 (64.3%) cases responded to chloramphenicol or amoxycillin or co-trimoxazole. Ciprofloxacin was used in 19(35.7%) cases. the failure rate of treatment with chloramphenicol was 50%, with amoxycillin 71.4%, with co-trimoxazole 75% and 0% with ciprofloxacin. An analysis of the 28 cases revealed that apart from fever (in 100%), splenomegaly (in 82.1%) was the most important clinical pointer to diagnosis, along with absolute eosinopenia (in 71.4%). There were no major complications, except 2 cases with typhoid hepatitis who responded to choramphenicol and co-trimoxazole, respectively. Blood culture grew Salmonella typhi in 7 cases, of which 5 (72%) were multidrug resistant S. typhi. There were no characteristic clinical features to identify multi-drug resistant typhoid fever.