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Individual Episodes (individual + episode)
Selected AbstractsA clinical review of 105 patients with PFAPA (a periodic fever syndrome)ACTA PAEDIATRICA, Issue 2 2010HM Feder Abstract Aims:, We describe the presentations and clinical outcomes of pediatric patients diagnosed with PFAPA (Periodic Fever, Aphthous lesions, Pharyngitis, and cervical Adenitis). Materials and methods:, The medical records of children with recurrent fever and referred between 1998 and 2007 to a tertiary pediatric care hospital were reviewed. Children who met clinical criteria for PFAPA were then asked to participate in a follow-up study. Results:, One hundred and five children met study criteria for PFAPA which included at least six episodes of periodic fever. Most (62%) were males, the mean age at onset of PFAPA was 39.6 months (80% were <5 years at onset), the mean duration of individual fever episodes was 4.1 days, and the mean interval between episodes was 29.8 days. Accompanying signs and symptoms included aphthous stomatitis (38%), pharyngitis (85%), cervical adenitis (62%), headache (44%), vomiting with fever spikes (27%) and mild abdominal pain (41%). A prodrome (usually fatigue) preceded the fever in 62% of patients. Parents noted that when their child with PFAPA had fever, other family members remained well. Laboratory tests in patients with PFAPA were nonspecific. Individual episodes of fever usually resolved with a single oral dose (,1 mg/kg) of prednisilone. The interval between fever episodes shortened in 50% of patients who used prednisilone. PFAPA resolved spontaneously (mean length 33.2 months) in 211105 (20%) patients. PFAF'A episodes continued (mean length 23 months) at the end of this study in 661105 (63%) patients. Cimetidine therapy was associated with the resolution of the fevers in 7/26 (27%) patients; tonsillectomy was associated with the resolution of the fevers in 11/11 (100%) patients. Conclusion:, PFAPA can usually be defined by its clinical characteristics. Individual febrile episodes usually resolve dramatically with oral prednisilone. The cause of PFAPA is unknown and research is needed to define its etiology. The overall prognosis for children with PFAPA is excellent. [source] A small dose of droperidol decreases postoperative nausea and vomiting in adults but cannot improve an already excellent patient satisfactionACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2001A. Hechler Background: We evaluated whether or not 1) a routine prophylaxis with 20 ,g ,· ,kg,1 body weight of droperidol would efficiently prevent postoperative nausea and vomiting (PONV) after elective surgery in adults and 2) an efficient prophylaxis would improve patient satisfaction. Methods: With approval of the local ethics committe and after having obtained informed written consent, 1334 patients in a randomised, single-blinded fashion either received droperidol (group 1, n=665) or saline intravenously (group 2, n=669) 20 min before the end of a standard O2/N2O/fentanyl/isoflurane anaesthesia of at least 30 min duration. End points: incidence of PONV during the first 24 h; individual episodes of nausea or vomiting, overall patient satisfaction with the procedure. Results: Compared to saline, intravenous injection of droperidol substantially and significantly reduced the incidence of PONV from 30% to 20% (P<0.0001). Women suffered three times more frequently from PONV (10.5% vs. 30%, P<0.0001). Droperidol significantly reduced the incidence of PONV from 35.4% to 24.4% in women (relative risk reduction: 31%, P=0.0002), but not in men (13.1% vs. 8.2%, relative risk reduction: 37%, P=0.159) , without impact on overall patient satisfaction (98.8% vs. 97.1%, P=0.439). Distribution of surgical procedures, sex, age, height, weight and anaesthetic duration were not different between groups. To prevent one woman from suffering PONV, nine had to be treated prophylactically at an individual drug cost (German prices) of about 0.80 per woman. Conclusion: Routine PONV prophylaxis with 20 ,g ,· ,kg,1 body weight of droperidol is cost-efficient and appropriate in women but not in men. [source] Serious Bacterial Infections in Febrile Outpatient Pediatric Heart Transplant RecipientsACADEMIC EMERGENCY MEDICINE, Issue 10 2009Shan Yin MD Abstract Objectives:, The purpose of this study was to describe the incidence of serious bacterial infections (SBIs) in febrile outpatient pediatric heart transplant recipients and to assess the utility of using white blood cell (WBC) indices to identify patients at low risk for bacteremia. Methods:, A retrospective study was conducted on all heart transplant recipients followed at a single children's hospital. All outpatient visits from January 1, 1995, to June 1, 2007, in which fever was evaluated were reviewed. Patients with history of a primary immunodeficiency, receiving concurrent chemotherapy, or having had a stem cell or small bowel transplant were excluded. Demographic, historical, physical examination, laboratory, and radiographic data were then recorded. Results:, Sixty-nine patients had 238 individual episodes of fever evaluation; of these, 217 (91.2%) had blood cultures drawn with results available in their initial evaluation. There were six (2.8%) true-positive blood cultures and eight (3.7%) false-positive cultures. Chest radiography was done in 185 evaluations (77.8%), and 44 episodes of pneumonia (23.8%) were diagnosed. Of 112 urine cultures done, one (0.9%) was positive. Neither of two lumbar punctures performed were positive. In non,ill-appearing children without indwelling central lines or focal bacterial infections (pneumonia, cellulitis), the incidence of bacteremia was 1.2%. In children with a focal bacterial infection, the rate of bacteremia was 6.3%. WBC indices were not significantly different between bacteremic and nonbacteremic patients. A band-to-neutrophil ratio (BNR) of ,0.25 and a published guideline for identifying low-risk infants using WBC indices identified all bacteremic patients, each with a sensitivity of 100% (95% confidence interval [CI] = 48% to 100% and 54% to 100%, respectively). Conclusions:, The incidence of bacteremia was low in febrile, outpatient pediatric heart transplant patients, especially in those who were not ill-appearing and did not have a focus of serious infection. Two different low-risk criteria performed well in identifying the bacteremic patients, although given the low number of true-positive cultures, the CIs for the sensitivities of these tests were extremely wide, and neither test could be reliably used at present. A prospective multicenter study is required to confirm the low incidence of bacteremia and low-risk criteria in this population. [source] Clinoform nucleation and growth in coarse-grained deltas, Loreto basin, Baja California Sur, Mexico: a response to episodic accelerations in fault displacementBASIN RESEARCH, Issue 3 2005Estelle Mortimer We investigate the controls on the architecture of coarse-grained delta progradational units (PUs) in the Pliocene Loreto basin (Baja California Sur, Mexico), a half-graben located on the western margin of the Gulf of California. Dorsey et al. (1997b) argued that delta progradation and transgression cycles in the basin were driven by episodic fault-controlled subsidence along the basin-bounding Loreto fault. Here we test this hypothesis by a detailed analysis of the sedimentary architecture of 11 exceptionally well-exposed, vertically arranged fluvio-deltaic PUs, each of which shows lateral facies transition from proximal alluvial facies palaeo-seaward into distal pro-delta facies. Of these 11 PUs, seven exhibit a lateral transition from a shoal water to Gilbert-delta facies associations as they are traced palaeo-seaward. This transition is characterised by down-transport development of foresets, which grow in height up to 35 m. Foreset units thicken in a basinward direction, with initially an oblique topset,foreset geometry that becomes increasingly sigmoidal. Each delta is capped by a shell bed that records drowning of the delta top. This systematic transition in delta architecture records increasing water depth through time during individual episodes of progradation. A mechanism that explains this transition is an accelerating rate of fault-controlled subsidence during each PU. During episodes of low slip rate, shoal-water deltas prograde across the submerged topography of the underlying delta unit. As displacement rate accelerates, increasing bathymetry at the delta front leads to steepening of foresets and initiation of Gilbert deltas. Subsequent delta drowning results from sediment starvation at the shoreline at high slip rates because of sediment trapping upstream. The observed delta architecture suggests that the long-term (>100 kyr) history of slip on the Loreto fault was characterised by repetitive episodes of accelerating displacement accumulation. Such episodic fault behaviour is most likely to be because of variations in temporal and spatial strain partitioning between the Loreto fault and other faults in the Gulf of California. A physical explanation for the acceleration phenomenon involves evolving frictional properties on the episodically active Loreto fault. [source] | ||||||||||