Treatment of croup. Sending home an improved child and relieved parents.

Croup is the most common cause of upper airway obstruction in children between the ages of 6 months and 6 years. Most children can be effectively treated in the office or emergency department with nebulized saline solution and oral or intramuscular dexamethasone (Decadron, Hexadrol) in a dose of 0.6 mg/kg. Occasionally, nebulized racemic epinephrine must be given; a dose of 0.5 mL of 2.25% solution diluted in 2.5 mL of saline solution is safe for all ages. Children requiring two epinephrine treatments should be hospitalized. Home care consists of adequate hydration and humidification and fever control. Antihistamines, decongestants, and antibiotics have no proven effect on uncomplicated viral croup.

Home phototherapy treatment of neonatal jaundice.

A home phototherapy program for healthy, term newborns with hyperbilirubinemia (n = 62) was implemented, and results were compared prospectively with a group of term neonates who met enrollment criteria but were treated in-hospital (n = 55). The purpose of the study was to prospectively assess the feasibility, safety, and effectiveness of home phototherapy in treating uncomplicated neonatal jaundice. Infants were required to be greater than 24 hours old and to weigh at least 2,270 g (5 lb). Enrolling physicians were instructed to select infants whose clinical diagnoses and bilirubin levels allowed an adequate margin of error for a trial of home phototherapy and whose parents were capable of managing the added responsibilities of home therapy. At the time the phototherapy equipment was delivered and set up in their home, parents received extensive instruction, including how to record pertinent ongoing data on a home flow sheet. Serum bilirubin levels were measured at least daily. The preponderant diagnosis listed by enrolling physicians was "physiologic jaundice." No parent reported significant complications, and no infant required rehospitalization. Bilirubin levels decreased as rapidly in the home group as in the hospitalized control group, and duration of treatment averaged 2.8 days. About $18,000 was saved by treating these 62 infants at home compared with in-hospital costs in our community. We found home phototherapy to be a feasible, safe, and effective alternative to in-hospital phototherapy for otherwise healthy, jaundiced infants with motivated and capable parents.

Occupational lead poisoning in the United States: clinical and biochemical findings related to blood lead levels.

Dose-response relationships between blood lead levels and toxic effects have been evaluated in 160 lead workers in two smelters and a chemicals plant. Blood lead levels ranged from 0.77 to 13.51 mumol/litre (16-280 microgram/dl). Clinical evidence of toxic exposure was found in 70 workers (44%), including colic in 33, wrist or ankle extensor muscle weakness in 12, anaemia (Hgb less than 8.69 mumol/litre (Hb/4) or 14.0 gm/dl) in 27, elevated blood urea nitrogen (greater than or equal to 7.14 mmol/litre or 20 mg/dl) in 28, and possible encephalopathy in two. No toxicity was detected at blood lead levels below 1.93 mumol/litre (40 microgram/dl). However, 13% of workers with blood lead levels of 1.93 to 3.81 mumol/litre (40-79 microgram/dl) had extensor muscle weakness or gastrointestinal symptoms. Anaemia was found in 5% of workers with lead levels of 1.93-2.85 mumol/litre (40-59 microgram/dl), in 14% with levels of 2.90 to 3.81 mumol/litre (60-79 microgram/dl), and in 36% with levels greater than or equal to 3.86 mumol/litre (80 microgram/dl). Elevated blood urea nitrogen occurred in long-term lead workers. All but three workers with increased blood urea nitrogen had at least four years occupational lead exposure, and nine had received oral chelation; eight of this group had reduced creatinine clearance, and eight had decreased renal concentrating ability. These data support the establishment of a permissible biological limit for blood lead at a level between 1.93 and 2.90 mumol/litre (40-60 microgram/dl).

Leptospirosis: a common-source outbreak due to leptospires of the grippotyphosa serogroup.

In the period August 1-10, 1975, seven cases of leptospirosis occurred in residents of Stewart County, Tennessee. Based on serologic evidence, the infection was caused by leptospires of the Grippotyphosa serogroup. Epidemiologic study showed that the patients apparently acquired their infection while swimming in Cub Creek, a small local stream. Stagnation of the stream resulting from subnormal rainfall may have contributed to the timing of the outbreak. The source of leptospiral contamination for the stream could not be determined.

Acute hemorrhagic cystitis. Industrial exposure to the pesticide chlordimeform.

An outbreak of hematuria occurred from May 20 to May 23, 1975, among employees of a chemical packaging plant. Nine of 22 workers who packaged the insecticide chlordimeform in a separate shed became severely ill with abdominal pain, dysuria, urgency to void, or hematuria. None of 18 persons who worked in other areas of the plant were affected. Four additional workers who had packaged the chemical during the previous year had a history of similar symptoms. Bladder biopsy specimens from three affected persons showed severe hemorrhagic cystitis; chlordimeform and 2-methyl-4-chloroaniline, a metabolite of chlordimeform, were present in urine specimens collected three days after exposure. The illness lasted from one week to two months; the workers recovered completely. Chlordimeform that was injected subcutaneously into three cats produced similar, though less severe, changes in the bladders of two animals.

Trials of influenza A/New Jersey/76 virus vaccine in normal children: an overview of age-related antigenicity and reactogenicity.

The total multicenter data from trials with inactivated monovalent influenza A/New Jersey/76 virus vaccine in 2,326 normal children were collected and summarized at Vanderbilt University (Nashville, Tenn.). These combined data provided the best measure of the relative antigenicity and reactogenicity of each manufacturer's vaccine. Children younger than 10 years of age were shown to have vaccine-associated reactions to doses of whole-virus vaccine containing as little as 50 chick cell-agglutinating units. Split-virus vaccines were well tolerated in doses eight times as high. No vaccine was satisfactorily antigenic in a single dose. A two-dose regimen of split-virus vaccine was antigenic, and this regimen was not associated with acute reactions.

Gonorrhea in preadolescent children: an inquiry into source of infection and mode of transmission.

From November 1974 through December 1975 a study was made of all reported cases of gonorrhea in children under 10 years of age in Tennessee. Clinical manifestations of the 73 subjects identified included vaginal infection (48), urethritis (11), conjunctivitis (8), and ophthalmia neonatorum (6). A total of 203 relatives and associates of 54 subjects was cultured. Fifty-four (27%) had gonorrhea; 43 of these were relatives. A history of sexual contact was found in 18 children, including seven where the contact had a positive culture for Neisseria gonorrhoeae. Sexual transmission was common in children with vaginitis or urethritis. In nine cases, sexual abuse or child neglect was suspected. The recognition of a child with gonococcal infection identifies a cluster of family members and associates who are at increased risk of having gonorrhea.

Carbon tetrachloride toxicity potentiated by isopropyl alcohol. Investigation of an industrial outbreak.

Fourteen workers in an isopropyl alcohol packaging plant became ill after accidental exposure to carbon tetrachloride. In four, renal failure or hepatitis developed. Isopropyl alcohol potentiation of carbon tetrachloride toxicity has been shown previously only in rats. Acetone, a product of isopropyl alcohol metabolism, is a major potentiator of carbon tetrachloride toxicity. Workers had elevated levels of acetone in samples of expired alveolar gas and thus were metabolically predisposed to carbon tetrachloride injury. Stricter limits for industrial carbon tetrachloride exposure should be established where concomitant isopropyl alcohol use occurs.