Facts and fallacies about varicella and the varicella vaccine.

Varicella is a nearly ubiquitous infection that results in significant morbidity and occasional mortality. The varicella vaccine has been licensed in the United States for the past five years. While varicella vaccination rates are slowly growing nationally, the immunization rate for South Dakota remains abysmally low. The legislature has recently mandated this vaccine for school entry in South Dakota, to promote its increased use. There are many fallacies about varicella and the varicella vaccine and questions about how new requirements of varicella vaccination before school entry will be met. This article identifies these common misconceptions and can serve as a resource for answers to questions commonly asked of vaccine providers.

Treatment of croup with glucocorticoids.

Croup is a common upper airway disease in children that can range from mild and self-limiting to severe and fulminating. Typical treatment in the past has been mist therapy, although its effectiveness is still being debated. Studies have been published evaluating the efficacy of oral, nebulized, and intramuscular dexamethasone and nebulized budesonide, in a number of combinations and concentrations, in patients ranging in age from 3 to 72 months. The majority of the subjects in the studies were males and more than one-third of the patients in one study previously had croup. The studies have consistently pointed out that the use of oral, intramuscular, and nebulized steroids have been beneficial in patients with varying severity of croup. Nebulized budesonide has been shown to be effective, but is not currently available in the US. Based on this information, intramuscular or oral dexamethasone has been shown to be effective and, in some studies, safe and could be administered to patients presenting with moderate-to-severe croup.

Effectiveness of methylphenidate in Native American children with fetal alcohol syndrome and attention deficit/hyperactivity disorder: a controlled pilot study.

This pilot study was designed to assess the short-term effectiveness and side effects of methylphenidate in treating symptoms of attention deficit hyperactivity disorder (ADHD) in Native American children (5 to 12 years old) with documented fetal alcohol syndrome (FAS) or partial fetal alcohol syndrome. Using strict criteria for the diagnosis of FAS and ADHD, a randomized double-blind cross-over study of two placebos and a fixed dose of methylphenidate was completed in 4 Native American children in a residential school. Each treatment condition lasted 5 days, and daily observational outcome measures, the Conners Parent Rating Scale (CPRS-48), and the Conners Teacher Rating Scale (CTRS-39), were employed. Methylphenidate significantly improved scores of the Hyperactivity Index Scale on the CPRS-48 and the CTRS-39 but not the Daydreaming-Attention score on the CTRS-39. Side effects were similar to those traditionally found in other populations. The promising preliminary results suggest that a more definitive study of methylphenidate in Native and non-Native children with FAS and ADHD is warranted.

Color-coded Doppler sonography in the diagnosis of abdominal masses.

A man in his forties was operated on for testicular cancer on the right-side with subsequent radiotherapy. Two years later, another tumor was found on the opposite side and surgically removed, followed by polychemotherapy. In the follow-up period, CT scanning and ultrasound showed large abdominal masses which were suspected to be metastases. Before initiating four cycles of chemotherapy, we checked their nature by Doppler sonography and found them to be recently developed abdominal varices due to an alcoholic liver cirrhosis. We were able to demonstrate that Doppler sonography can provide further information and is easy to use.

Myocardial and circulatory effects of inosine.

The action of inosine (2.5, 5, or 10 mg.kg-1.min-1 iv) was investigated in open chest rats (n = 46) and guinea pigs (n = 16). Left ventricular and aortic pressures, dP/dtmax, and stroke volume were measured. Additionally, isovolumic peak pressure and peak dP/dtmax were measured during short occlusions of the aorta for assessing myocardial performance independent of circulatory changes. In rats inosine caused a dose dependent decrease in dP/dtmax (-5%, -21%, -40% of preinfusion values), heart rate (-7%, -23%, -55%), and mean aortic pressure. Additionally, a subgroup of seven rats was paced at their initial preinfusion heart rate, but independently from the heart rate there was a reduction in dP/dtmax (-15%). The isovolumic measurements confirmed the negative inotropic effect of inosine in rats. Peak dP/dtmax was reduced to 85% of preinfusion values with a dose of 2.5 mg.kg-1 min-1 (to 70% of preinfusion values with 10 mg.kg-1.min-1). Similarly, the maximum isovolumic pressure for a defined filling volume was decreased by 30 mmHg (at 350 microliter; 5 mg.kg-1.min-1; p less than 0.05). The mean aortic pressure decreased with 2.5 mg.kg-1.min-1 inosine indicating vasodilative properties. In contrast to the significant effects in rats even 10 mg.kg-1.min-1 inosine did not have an effect on heart rate, mean aortic pressure, or dP/dtmax in guinea pigs. The isovolumic peak left ventricular pressure in guinea pigs was also unchanged after inosine infusion. Thus the haemodynamic effects of inosine were species dependent.