ABSTRACT
We present the case of a 7-month-old boy who presented with a history of bilious vomiting, abdominal distention with a mass, anorexia, and no urinary or stool output for 2 days. Air enema demonstrated a mass effect on the rectosigmoid area, with urinary contrast revealing a large Hutch diverticulum with a narrow neck of the urinary bladder. This patient illustrates a rare case of an infant with bilious vomiting.
Subject(s)
Bile , Diverticulum/diagnosis , Intestinal Obstruction/etiology , Rectal Diseases/etiology , Urinary Bladder Diseases/diagnosis , Vomiting/etiology , Child , Diagnosis, Differential , Diverticulum/complications , Humans , Male , Urinary Bladder Diseases/complicationsABSTRACT
This study was designed to determine whether end-tidal carbon dioxide (ETCO2) values obtained by noninvasive oral/nasal cannula circuit with side-stream capnometry correlate reliably with capillary PCO2 (CapCO2) in a pediatric population without cardiopulmonary problems. Each patient was monitored until a reliable 5-minute ETCO2 waveform was obtained. A capillary blood gas sample was drawn while, simultaneously, ETCO2 was recorded. The difference between CapCO2 and ETCO2 levels was tested with a paired t-test at P < .001. The limits of agreement were established with a 95% confidence level. The stability of the measured difference across the range of mean scores (CapCO2 + ETCO2/2), age, and respiratory rate was tested using simple linear regression. Fifty-eight children (23 girls and 35 boys) had mean ETCO2 readings of 33.96 mm Hg (SD 4.26), and mean CapCO2 readings of 35.93 (SD 4.04). A relative average bias of 1.96 with ETCO2 lower than CapCO2 was established with 95% limits of agreement of +/- 5.2 mm Hg (t = 5.71). Variability of difference scores was not related to range of mean scores (r = .08), age (r = .09), or respiratory rate (r = .25). End-tidal CO2 measured by an oral/nasal cannula capnometry circuit is a noninvasive method of assessing indirect measurements of PCO2 in a normal pediatric population.
Subject(s)
Carbon Dioxide/analysis , Respiration , Adolescent , Carbon Dioxide/blood , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , MaleABSTRACT
Although insulin has been proposed to mediate the dietary regulation of pancreatic amylase, its interaction with diet in the regulation of amylase and lipase is not well understood and was examined in diabetic rats fed diets high in carbohydrate (HC), protein (HP), or fat (HF) and treated with insulin. Diabetes, independent of diet, decreased amylase content (97%; P < 0.0001) and mRNA (90%; P < 0.0001), but insulin only restored amylase content and mRNA to respective dietary control values. Diabetes, independent of diet, also increased lipase mRNA 1.6-fold (P < 0.004) but interacted (P < 0.0003) with diet on lipase content, resulting in opposite effects in HC- (increased 202%) and HF-diabetic rats (decreased 40%). Insulin partially restored lipase content and mRNA to respective dietary control values. Diet, independent of diabetes, regulated amylase content (P < 0.0001) and mRNA (P < 0.0003), which were three- to fourfold greater in HC- than in HF-fed rats, and lipase content (P < 0.001) and mRNA [rat pancreatic lipase 1 (rPL-1), P < 0.04; rPL-3, P < 0.0001], which were 1.8-fold greater in HF- than in HC- or HP-fed rats. Insulin failed to stimulate maximal amylase gene expression in HP- or HF-fed diabetic rats, suggesting that it is necessary, but not sufficient, for this dietary regulation. Differential regulation of lipase activity and mRNA by diet and insulin raises the possibility that lipase gene expression is regulated by a complex interaction of diet and insulin.
Subject(s)
Amylases/genetics , Diabetes Mellitus, Experimental/enzymology , Diet , Gene Expression Regulation , Insulin/pharmacology , Lipase/genetics , Pancreas/enzymology , Amylases/metabolism , Animals , Blood Glucose/analysis , Body Weight/drug effects , Diabetes Mellitus, Experimental/genetics , Eating/drug effects , Insulin/blood , Lipase/metabolism , Male , RNA, Messenger/metabolism , Rats , Rats, Sprague-DawleyABSTRACT
STUDY OBJECTIVE: To alert practicing emergency physicians to an important and possibly increasing relationship between life-threatening group A beta-hemolytic streptococcal (GABHS) infections and children recovering from varicella. DESIGN: A case series of six patients managed from January through March 1993. SETTING: A university-affiliated pediatric specialty emergency department. TYPE OF PARTICIPANTS: Six previously healthy immunocompetent children between 1 and 5 years of age seen in our ED over a nine-week period. RESULTS: Six children had onset of varicella two days to two weeks before developing a serious life-threatening GABHS infection. Children presented with clinical symptoms of invasive GABHS infection with bacteremia (one patient); streptococcal toxic shock syndrome with negative blood culture (two), pneumonia with pleural effusion and streptococcal toxic shock syndrome (one), pneumonia with pleural effusion (one), and pyomyositis of the thigh (one). Four of six patients required intensive care admissions and aggressive support of vital signs. All six survived. CONCLUSION: Emergency physicians should be aware of the association between varicella and serious GABHS infections and be prepared to recognize and aggressively manage serious complications should they occur.
