Temporal relationship modeling: DTP or DT immunizations and infantile spasms.

The time relationship between DTP immunization and infantile spasms (IS) onset was examined using three models--association, temporal shift, and no-effect--and the case/control data from the National Childhood Encephalopathy Study (NCES). Infantile spasms cases classified as being previously abnormal (e.g., tuberous sclerosis complex patients) showed a no-effect relationship, whereas those classified as previously normal suggested a fit to the temporal shift model, i.e. no increase in number of cases but a shortening of time to onset of seizure. No data fit the association model. Analyses for vaccine complications should examine for temporal changes (i.e. temporal shift) in addition to increased risks.

A developmental test based on the STYCAR sequences used in the National Childhood Encephalopathy Study.

During the National Childhood Encephalopathy Study, standard neurodevelopmental assessments had to be performed on a large number of children under 3 years of age scattered throughout Great Britain. Currently available tests were reviewed but were found to be impractical for this purpose. We describe a simple test procedure, based on the STYCAR sequences, suitable for use in a clinic or at home with the minimum of special equipment. Results were reliable and provided an informative record of a child's developmental progress. It may be possible to modify the scheme for general use.

Effects of the argon laser on anaesthetic gases and endotracheal tubes.

The effects of argon laser light on endotracheal tubes and gas mixtures have been studied. In recommended use accidental exposure to red rubber and PVC tubes caused minimal damage. Prolonged exposure of PVC tubing and a 2:1 nitrous oxide:oxygen mixture produced a minimal increase in temperature and no detectable increase in the concentration of higher oxides of nitrogen. Transparent endotracheal tubes are recommended if the argon laser is being used in the management of cutaneous lesions of the head and neck.

Infantile spasms and pertussis immunisation.

The possible roles of pertussis immunisation and of other factors in the aetiology of infantile spasms were investigated by analysis of 269 cases reported to the National Childhood Encephalopathy Study. In 34% of the cases an antecedent factor which may have caused infantile spasms was identified; the commonest of these were perinatal hypoxia (38 cases) and tuberous sclerosis (16 cases). Case-control analyses showed no significant association between infantile spasms and pertussis immunisation in the 28 days before onset. There was, however, some clustering of cases immunised with either diphtheria-tetanuspertussis or diphtheria-tetanus vaccines in the 7 days before onset. The excess compared with controls was compensated for by a corresponding deficit over the remaining period up to 28 days. It is suggested that these vaccines do not cause infantile spasms but may trigger their onset in those children in whom the disorder is destined to develop.

Paediatric manpower.

Two investigations of paediatric manpower in England, Wales, and Northern Ireland were carried out, each using a different method. The first survey located registrars and senior registrars and checked on their occupational status 3 years later in order to see which ones had been promoted. Loss factors--such as emigration, retirement for personal reasons, part-time training, or transfer to general practice, community paediatrics, or other medical specialties--were examined closely. The second survey was a cross-sectional analysis of the entire paediatric establishment. It examined in particular the distribution of consultants and registrars. Using figures from survey 2 and loss factors from survey 1, a model of the paediatric career structure could be constructed. This showed that the present career pyramid would be unable to absorb the current number of registrars in training. There is an urgent need for a comprehensive registration scheme for registrars, especially those with honorary contracts, who are not currently included in official records. Paediatrics is unique in having a high proportion of women for whom there is little opportunity of reconciling career aspirations with family commitments.

Joubert-Boltshauser syndrome with polydactyly in siblings.

Two siblings are described with clinical features of the Joubert-Boltshauser syndrome. Both had polydactyly and one had fleshy tumours of the tongue. Computed tomography of the brain showed hypoplasia of the cerebellar vermis, associated in one case with a cyst of the fourth ventricle.

Reye's syndrome in children under three years old.

The National Childhood Encephalopathy Study identified 37 cases of Reye's syndrome in children aged between 2 and 36 months in a 3-year period, giving an estimated incidence in Great Britain of 0.7/100 000 children a year. The diagnostic features were neither consistently positive in these cases, nor negative in 11 others later considered not to have Reye's syndrome. The prognosis was poor; the fatality rate was 46%, and 60% of the survivors were handicapped. A surveillance scheme to investigate pathological, clinical, and epidemiological factors in this rare condition is required. This has now been set up in the UK.

Pertussis immunisation and serious acute neurological illness in children.

The first 1000 cases notified to the National Childhood Encephalopathy Study were analysed. The diagnoses included encephalitis/encephalopathy, prolonged convulsions, infantile spasms, and Reye's syndrome. Eighty-eight of the children had had a recent infectious disease, including 19 with pertussis. Only 35 of the notified children (3.5%) had received pertussis antigen within seven days before becoming ill. Of 1955 control children matched for age, sex, and area of residence, 34 (1.7%) had been immunised with pertussis vaccine within the seven days before the date on which they became of the same age as the corresponding notified child. The relative risk of a notified child having had pertussis immunisation within that time interval was 2.4 (p less than 0.001). Of the 35 notified children, 32 had no previous neurological abnormality. A year later two had died, nine had developmental retardation, and 21 were normal. A significance association was shown between serious neurological illness and pertussis vaccine, though cases were few and most children recovered completely.

Comparison of the respiratory effects of ICI 35 868 and thiopentone in the rabbit.

The effects of thiopentone and ICI 35 868 on minute volume, respiratory frequency, tidal volume and arterialized venous PCO2, pH and standard bicarbonate have been compared in the rabbit. ICI 35 868 has two to three times the potency of thiopentone, but equivalent anaesthetic doses cause similar decreases in minute volume. ICI 35 868 decreased tidal volume to a greater extent than thiopentone. Whilst the time courses of the two drugs were similar in most respects, thiopentone produced a more prolonged increase in PCO2. This was accompanied by an increase in standard bicarbonate which was not seen in rabbits treated with ICI 35 868.

Subacute sclerosing panencephalitis.

Subacute sclerosing panencephalitis (SSPE) is now considered to be caused by measles virus. There are four diagnostic criteria, namely the clinical picture, a characteristic EEG, serology of serum and CSF and brain histology. A register of cases in the U.K. has been kept since 1971, and up to September 1977, ninety-six patients have been reported. The male/female ratio is 2 : 1. The disease most commonly affects children between the ages of nine and eleven years who usually have had measles at a very early age. The average delay between the measles infection and onset of SSPE was 6.8 years and of the thirty-four patients known to have died the average survival times was 1.2 years. There are still many questions about the pathogenesis and epidemiology of SSPE that have yet to be answered.