The role of footwear in childhood injuries

To assess the influence of footwear on injury, we prospectively studied all injured children presenting to the Emergency Department of The Children's Hospital of Philadelphia during February, May, July, and October 1988. Information was collected concerning the type and characteristics of footwear worn and environmental factors. Comparisons were made between those involving and those not involving loss of footing (LOF) during injury. Of the 3015 children studied, LOF occurred in 1075 (35.8%). Overall, significantly more injuries involved LOF in children whose feet were covered (n = 946, 37.0%) than in those who were barefoot (n = 129, 29.1%) at the time of injury (P less than 0.001). However, children wearing low-top sneakers had the lowest rate of LOF (24.0%) of any group. Children wearing rough-sole footwear had LOF significantly less frequently (24.2%) than those wearing smooth-sole footwear (51.8%; P less than 0.001). Rubber-sole footwear was less frequently associated with LOF (n = 488, 28.6%) than were other sole materials (n = 457, 53.8%; P less than 0.001). Our data suggest a potential injury prevention strategy involving utilization of rough-sole footwear.

Is the endogenous antipyretic neuropeptide alpha-MSH responsible for reduced fever in aged rabbits?

The reduced febrile response in aged man has been noted since the beginning of clinical thermometry. Our previous research on aged rabbits and squirrel monkeys disclosed a similar reduced fever, presumably due to a decrease in central receptors for endogenous pyrogen. However, because central alpha-melanocyte stimulating hormone (MSH) appears to have a potent role in physiological control of fever, it may be that increased release of the peptide is responsible for the reduced febrile response in aged animals. To test this idea, antiserum specific to MSH was administered intracerebroventricularly to rabbits of known age. The antiserum given according to three schedules of treatment augmented fever caused by IV injections of interleukin-1 (IL-1) in young (less than 2 years) male and female rabbits. Aged female rabbits (3-5+ years) and females aged 2-3 years showed significant augmentation of fever only after pretreatment plus acute injection of antiserum. A single ICV injection of MSH (200 ng) reduced fever in all groups with the greatest antipyretic effect in the aged females. The results indicate that while aged rabbits have an increased antipyretic response to central MSH, binding of the endogenous peptide does not result in marked increases in fever in these animals. Thus, whereas a change in central MSH sensitivity may contribute to reduced fever in aged homeotherms, a reduction in central pyrogen receptors appears to be the most parsimonious explanation.

Pulmonary interstitial emphysema treated by high-frequency oscillatory ventilation

Twenty-seven low birth weight infants who developed pulmonary interstitial emphysema (PIE) and respiratory failure while on conventional ventilation were treated with high-frequency oscillatory ventilation (HFOV). The mean birth weight was 1.2 kg (range 0.55 to 2) with gestational age of 28 wk (range 25 to 34). Ten patients died, six of whom had documented sepsis with shock and were therefore excluded from analysis. All patients showed initial improvement on HFOV. Surviving patients showed continued improvement in oxygenation and ventilation at increasingly lower fraction of inspired oxygen and proximal airway pressure with resolution of PIE, while nonsurvivors progressively developed chronic respiratory insufficiency with continued PIE from which recovery was not possible. Overall survival in nonseptic patients was 80% (16 of 20). We found HFOV to be effective in the treatment of PIE and hypothesize that interstitial airleak is decreased during HFOV because adequate ventilation is provided at lower peak distal airway pressures.

A nonpulmonary complication of high-frequency oscillation

High-frequency ventilation (HFV) has been suggested as an alternative to standard positive-pressure ventilation with positive end-expiratory pressure (PPV/PEEP) in the treatment of infants with hyaline membrane disease. To assess the relative safety and efficacy of HFV, we compared standard PPV to HFV delivered by oscillation (HFO) and HFV delivered by a flow interrupter (HFFI) in a previously validated preterm baboon model of hyaline membrane disease. At necropsy, the livers of several animals were unexpectedly found to have severe fatty change and/or cytoplasmic vacuolization and edema. There was a strong correlation between use of HFO and the development of liver lesions. The hepatic lesion may reflect decreased cardiac output with a concomitant fall in splenic perfusion and/or alterations in normal intrathoracic pressure that increase resistance in the hepatic vasculature. Although the etiology cannot be determined precisely, these data suggest the potential for nonpulmonary complications of HFV in the immature newborn and mandate further investigation before its widespread clinical application.

Cardiac defects in a patient with congenital contractural arachnodactyly

Congenital contractural arachnodactyly (CCA) is a connective tissue disorder sharing many of the clinical manifestations of Marfan's syndrome. The case presented emphasizes that severe cardiac involvement may be manifested in the neonate with CCA, thus altering the more characteristic benign prognosis of CCA.

Survival and short-term morbidity of the premature neonate

Obstetric decisions regarding premature (23 to 32 weeks' gestation) infants must be based on gestational age. However, most reports of the survival of premature infants are based on birth weight. The present report relates the perinatal survival and morbidity of 105 newborns to the obstetric gestational dating criteria between 23 and 32 weeks' gestation. Gestational age was determined from at least four obstetric criteria including the first day of the last menstrual period, early pelvic examination, the earliest auscultation of fetal heart tones with a fetoscope, fundal height measurements in centimeters between 20 and 30 weeks' gestation, and sonographic gestational age measurements. At 23 to 26 weeks' gestational age, nine (39%) of 23 neonates survived. Five of nine survivors had moderate to severe intracranial hemorrhage, three had moderate to severe bronchopulmonary dysplasia, and three had moderate to severe retrolental fibroplasia. At 27 to 29 weeks' gestational age, 25 (93%) of 27 neonates survived. Of the 25 survivors, three had moderate to severe intracranial hemorrhage, one had moderate to severe bronchopulmonary dysplasia, and one had severe retrolental fibroplasia. At 30 to 32 weeks' gestational age, 52 (95%) of 55 neonates survived. Three of the 52 (6%) survivors had serious neonatal morbidity consisting of moderate to severe intracranial hemorrhage (three neonates) and moderate to severe bronchopulmonary dysplasia (one neonate). Thus, ten of 34 (29%) survivors between gestational ages of 24 to 29 weeks had a serious morbidity versus only three of 52 (6%) survivors between 30 to 32 weeks' gestation (P less than .01).

High-frequency ventilation compared to conventional positive-pressure ventilation in the treatment of hyaline membrane disease in primates

High-frequency ventilation (HFV) has been suggested as an alternative to conventional positive-pressure ventilation (PPV) in the treatment of infants with hyaline membrane disease (HMD). Using a previously validated primate model of HMD, 15 baboon fetuses were delivered at 75% of gestation and randomly assigned to 1 of 3 ventilator treatment groups: PPV, HFV delivered by an oscillator (HFO), or HFV delivered by a flow interrupter (HFFI). All animals had clinical and radiographic evidence of HMD. At 96 h of life, all animals were sacrificed and clinical and pathologic findings were analyzed. During the first 10 h of the experiment, the HFO animals required higher mean proximal airway pressures than either the HFFI or PPV groups. However, both the HFFI and HFO animals had higher PaO2/PAO2 ratios than the PPV controls, suggesting earlier saccular recruitment. Thus, HFV is as effective as PPV in the treatment of HMD in baboons. Whether it will decrease the risk of bronchopulmonary dysplasia is not known.

Differential pulmonary auscultation in neonates

Auscultation of neonates by means of conventional techniques is subject to many errors. Consequently, pediatricians rely on radiographs for much of their information regarding ventilation abnormalities. We report a method of simultaneous differential auscultation, using a double-headed stethoscope, which allows better auscultatory evaluation of neonates. The technique is simple and easily learned. The equipment used is inexpensive and easily constructed. The technique is most useful in emergency and transport situations when radiographs are not readily available.

Three cases of hemolytic anemia with erythrocyte pyruvate kinase deficiency in Alberta

Erythrocyte pyruvate kinase (PK) activity was determined by the lactate dehydrogenase-coupled spectrophotometric assay. The effects of modifications in the buffer and in substrate concentrations were studied. Three patients with congenital non-spherocytic hemolytic anemia were deficient in erythrocyte PK, and were evidently homozygous for this deficiency. The daughter of one patient and the parents of another had intermediate PK levels and were probably heterozygous. The erythrocyte adenosine triphosphate (ATP) level was low in one patient, high in another. Adenosine triphosphatase activity of the erythrocyte membranes of one patient was normal.

Early Man Site Found in Highland Ecuador

Field investigations in Ecuador have produced archeological evidence for the occupation of the northern Andes by early nomadic hunters. Surface collections and test excavations have demonstrated a complex of stone tools with typological relationships to level I at Fell's Cave in southern Chile, and technological relationships to the late Pleistocene "fluted point" complexes of North America. The date of these materials is estimated at 7000 to 8000 B.C.