Urinary tract infection in adolescent boys.

Clinical and laboratory features of 21 adolescent males with urinary tract infections were studied. Sixty-seven percent were symptomatic and 80% revealed abnormalities on initial urinalysis. Forty-eight percent showed structural anomalies of the urinary tract. Recurrences were observed only in those having abnormalities of the urinary tract.

Pharmacokinetic evaluation of cefoperazone in infants.

The pharmacokinetics of cefoperazone were evaluated in 25 infants (mean age, 26 days) after intramuscular and intravenous routes of administration. The levels in blood that were achieved were severalfold higher than those required to inhibit common pathogens. The mean half-life of 240 min was one-half of that observed in 1- to 2-day-old infants but about twice that seen in adults. Further evaluation is needed to study the efficacy of the drug in infants and children.

Evaluation of cefotaxime in bacterial infections.

Cefotaxime, a third generation cephalosporin antibiotic, was evaluated in 26 infants and children for the treatment of documented or suspected bacterial infections, including pneumonia (10 cases), soft tissue skin infection (13 cases), and urinary tract infection (3 cases). An average daily dose of 60 mg/kg in 3 to 4 divided doses was administered parenterally for an average of 7 days. In 14 of the cases, primary pathogens, including Haemophilus influenzae b (resistant to ampicillin), Staphylococcus aureus, Staphylococcus pyogenes, Streptococcus pneumoniae and Escherichia coli, were eradicated. Clinical recovery occurred in each case. Blood levels at different time intervals and biological half-life were similar to those reported for adults. Mild and transient side effects observed were elevation of SGOT in two cases, alkaline phosphatase in one, and eosinophilia in one case.

Relationship of thyroid hormone levels to the severity of the narcotic withdrawal syndrome.

Serum T3, T4 and thyroid stimulating hormone (TSH) were evaluated in 24 neonates of mothers taking methadone and compared with 16 normal controls using cord serum and serum taken on days 1, 2, 3, 4, 7, and 14. Patients were divided into treated (Rx; n = 14) and not treated (No Rx; n = 10) groups based on withdrawal scores and correlated to thyroid hormone levels. T4 levels were greater in the Rx group when compared to controls on days 2, 4 and 7 (p less than 0.01) and when compared to the No Rx group on days 3 and 7 (p less than 0.005). No Rx patients had higher T4 levels when compared to controls on day 4 (p less than 0.05). In general T3 levels paralleled T4 results. TSH levels were decreased in the Rx group compared to No Rx and controls on day 2 (p less than 0.01). Lipsitz scores correlated with T4 levels on days 3, 4, and 7 in methadone patients (p less than 0.05) but did not correlate with T3 or TSH. These findings suggest a correlation between the severity of withdrawal symptoms and T4 and T3 levels.

Acute renal failure in battered child syndrome.

Battered child syndrome, a not uncommon problem, may involve deep structures including the liver, spleen, and brain. While involvement of kidneys is extremely rare, such an association is illustrated by the following case which presented with azotemia and hypertension. Management should depend on the degree of renal failure and hypertension as well as the extent of any electrolyte imbalance.

Analysis of the medical records in a pediatric emergency room.

A prospective evaluation of Pediatric Emergency Room records permitted analysis of major errors and of factors contributing to them. All records from July 1973 to June 1975 were reviewed daily by a board certified pediatrician using a previously established protocol. Patients had been seen by pediatric house staff from 4 PM to 8 AM on weekdays and from 8 AM to 8 AM on weekends and 25,907 records were reviewed. Errors were detected in 9.5 percent of these. The most common was an incomplete set of vital signs which accounts for 68 percent of all errors. Failure to arrange for appropriate follow-up care occurred in 16 percent of cases. Other errors ranged from two to four percent and included inadequate use of laboratory, incomplete physical examination, inappropriate diagnosis or therapy. Major omissions in the history were uncommon (1.3 percent). The frequency of errors was significantly greater at the start of each academic year (July to October), and at the start of each month (P<0.001). The errors occurred significantly more often at the first year level than the second year level (P<0.01). This study suggests a means of improving record keeping and house staff education, ie, attending-level supervision should be emphasized at the start of each month and academic year. Daily reviews of errors with the house staff as well as modification of chart design may bring about more complete patient evaluation and detailed recording of findings, diagnosis, and disposition.