Neonatal alloimmune thrombocytopenia (NAIT) is the most common cause of severe thrombocytopenia in an otherwise healthy newborn. The most serious complication is intracranial hemorrhage, which can occur either in the fetus or the newborn. Despite the known serious sequelae, both antenatal management and neonatal treatment modalities are plagued by the ...

OBJECTIVE: To compare maternal and neonatal outcomes in deliveries managed by a policy of expectant management and active management of women with preterm prelabor rupture of membranes (pPROM), at 34-36 completed weeks of gestation. DESIGN: Retrospective multicenter cohort study. SETTING: Three tertiary care teaching hospitals in France. POPULATION: Women with ...

Given the vast and growing volume of medical literature, it is essential to develop reliable strategies for identifying articles of importance and relevance. Here, we summarize 5 notable articles for general internal medicine published in 2008 and 2009. Clinical vignettes are presented to illustrate situations in which each study might ...

Background: Neonatal hypoglycaemia is a common problem linked to both brain damage and death. There is controversy regarding both the definition of and best treatment for neonatal hypoglycaemia. Aim: To determine current management of neonatal hypoglycaemia within the Australian and New Zealand Neonatal Network (ANZNN). Methods: Four questionnaires were sent ...

The updated Dutch guidelines on Neonatal Resuscitation assimilate the latest evidence in neonatal resuscitation. Important changes with regard to the 2004 guidelines and controversial issues concerning neonatal resuscitation are reviewed, and recommendations for daily practice are provided and argued in the context of the ILCOR 2005 consensus.

The importance of vascular access in neonatal clinical practice is increasing, because of the survival of a larger number of premature babies, who require administration of long-term intravenous fluids and medications than in the past. In these newborn central venous lines are preferred to peripheral lines, particularly Peripherally Inserted Central ...

Rosai-Dorfman disease (RDD) is a rare entity of non-Langerhans cell histiocytoses (non-LCH) which usually presents with bilateral painless cervical lymphadenopathy. We describe a neonate with RDD who presented with anemia, thrombocytopenia and hepatomegaly. He recovered spontaneously with conservative management. This represents an atypical presentation of RDD. Conservative management with close ...

Fetal and neonatal alloimmune thrombocytopenia is not a well-known disease, except among specialists in maternal-fetal medicine, neonatologists, and certain pediatricians (ie, hematologists). However, this is by far the most common cause of early severe thrombocytopenia in neonates and of intracranial hemorrhage in term neonates. In addition, if a newborn is ...

As a hand therapist, we don't really treat a lacerated tendon. The physician is the one that handles the repair. We actually are treating all the secondary problems that occur as a result of the injury and the repair. To quote Ken Flowers (JHT past editor), " Scar Wars" can ...

Omphalocele is one of the most common abdominal wall defects seen in the prenatal period. Once this diagnosis is confirmed, it is important to check the fetal karyotype and thoroughly assess the fetus for other malformations. Prenatal management involves serial assessment of fetal growth and prenatal testing to ensure fetal ...

There is a pressing need for consistent, evidence-based guidelines in the management of neonatal seizures by pediatric neurologists and neonatologists. Israeli pediatric neurologists and neonatologists completed a 20-item, self-administered questionnaire on choices of antiepileptic drugs, treatment of intractable neonatal seizures (unremitting seizures after 3 medications), treatment duration, and recommended workup. ...

The existence of dual inner ear pathology such as unilateral Meniere's disease (MD) with a contralateral vestibular schwannoma (VS) is very rare, but provides the otologist with a significant management dilemma. In this study, we present 5 cases of unilateral disabling MD with a contralateral VS in the better hearing ...

A bilobed Zenker's diverticulum is an uncommon finding. Given the rarity of these bilobed pharyngeal pouches, their management can pose a clinical dilemma. We advocate transoral endoscopic division and stapling of the larger lobe as the management of choice for this clinical finding. We present 2 patients, each with a ...

Traumatic pulmonary herniation involves the protrusion of lung parenchyma beyond the normal borders of the thoracic cage through a defect in the musculoskeletal wall. Anesthetic management involves airway protection, lung isolation, and avoidance of distension of the herniated segment. We report the successful anesthetic management during surgical management of pulmonary ...

Cystic hematomas were diagnosed in 3 neonatal foals. In all 3 foals, cystic hematomas resulted from umbilical trauma or thrombocytopenia. Findings in these foals suggest that cystic hematoma should be included in the differential diagnosis of hematuria in neonatal foals. Management of cystic hematomas includes both medical and surgical options.

Premature rupture of the membranes (PROM) complicates 10% of all gestations and 2-4% of preterm pregnancy. Our success in preventing preterm PROM and preterm birth is hampered by our limited knowledge of its etiology. PROM remains the single most identifiable cause of preterm delivery and the major contributor to perinatal ...

OBJECTIVE: To determine whether hand hygiene practices differ between levels of contact with neonates; to characterize the hand hygiene practices of different types of personnel; and to compare hand hygiene practices in neonatal intensive care units (NICUs) using different products. METHODS: Research assistants observed staff hand hygiene practices during 38 ...

Constrictive pericarditis and restrictive cardiomyopathy, two relatively uncommon clinical conditions, create a diagnostic dilemma primarily because of the many similarities in both their clinical and hemodynamic presentations. However, considerable differences exist in the pathophysiology, management, and prognosis between these two syndromes. Furthermore, the precise diagnosis of constrictive pericarditis and restrictive ...

Attempts at human resuscitation date back to ancient times. Most strategies for resuscitation focused on adults until the early 1800s, when newborn resuscitation captured the interest of noted practitioners. The most promising techniques and strategies for neonatal resuscitation were developed during the latter part of the twentieth century. This article ...

Emery-Dreifuss muscular dystrophy is a rare form of muscular dystrophy associated with cardiac implications such as cardiomyopathy and arrhythmias leading to sudden death. We describe the anesthetic management of a patient with Emery-Dreifuss muscular dystrophy who presented for orthopaedic surgery and discuss the disorder and its potential anaesthetic implications.

We report on the use of methohexital during elective neonatal direct current cardioversion. In contrast with the available data on cardiac management in neonates with supraventricular tachycardia and the guidelines on anaesthetic management during cardioversion in adults, data on anaesthetic management in neonates are still lacking. Methohexital might be an ...

We report a neonate with a duodenal web demonstrating the windsock appearance on US. In neonates, duodenal web is rare and its windsock appearance is also rarely seen. The windsock sign of duodenal web has been a well-known finding on upper gastrointestinal series. The corresponding windsock appearance may be demonstrated ...

While major maxillofacial pathology in the young patient is relatively uncommon, non-malignant conditions may pose a significant treatment dilemma due to their aggressive or unpredictable behaviour. Several such diseases managed by the Oral and Maxillofacial Surgery Unit at the Royal Children's Hospital of Melbourne have been selected for review. Illustrative ...

Advances in the surfactant era have resulted in a dramatic rise in the survival of 23-26 week old neonates. For the group as a whole, survival is 50% with a 50% morbidity in survivors. Current literature includes a few 'small baby protocols' suggesting guidelines for management based on institutional experiences. ...

The discovery of monoclonal antibodies (mAbs) produced by "hybridoma technology" by George Köhler and Cesar Milstein in 1975 has had a great impact both on basic biological research and on clinical medicine. However, this impact was not immediately recognized. It took around 10 years to appreciate the importance of using ...

Prospects for the Application of Antibodies in Medicine.

There is a dilemma in the management of ingested intact button batteries in the gastrointestinal (GI) tract distal to the oesophagus: whether to do an emergency laparotomy or to adopt a wait-and-watch policy. In this case report an effective, safe, and quick method of GI lavage was used and a ...

Maintenance of normal intracranial pressure is crucial to the development of the neonatal brain. Certainly, neonatal hydrocephalus will perturb cerebral development and calls for careful and timely intervention. Many competing factors must be taken into account when evaluating the neonate with hydrocephalus. A neurosurgical approach to the management of neonatal ...

STUDY OBJECTIVE: To study how different anesthetic practices during the transition from anesthetic delivery by mask to endotracheal intubation affect end-tidal postintubation anesthetic concentration and operating room (OR) pollution. DESIGN: Prospective study. SETTING: Anesthesia research laboratory. MEASUREMENTS AND MAIN RESULTS: We studied four gas flow management practices: practice vaporizer off, ...

A visual model of general practice as a field of medicine is presented. Definitions of terminology and concepts to be used are discussed. By the application of this terminology a model of health, including the concept of disability, is constructed. This model is used to define and describe dilemmas occurring ...

A CMA-sponsored Internet discussion group, Clinical Q&A, has become a popular feature of CMA Online. About 150 physicians from around the world have participated in discussions and question-answer interaction, usually about diagnostic or patient-management dilemmas. Based on the success of the venture, CMA Online plans to expand the Internet forums ...

Do today's students have any second thoughts about their decision to pursue a career in medicine? Gabriel Leung, who graduates in June from the University of Western Ontario, considers the problems and dilemmas that have confronted him and his classmates during their short careers and muses on the uncertain future ...

Preeclampsia affects two patients, the mother and the fetus. Traditionally, women with severe preeclampsia have been delivered without delay, regardless of fetal considerations. Although delivery is appropriate therapy for the mother, aggressive management with immediate delivery of a fetus remote from term leads to high neonatal mortality and morbidity resulting ...

Clinical dilemmas that frequently challenge intraoperative neurosurgical anesthetic management include the use of the sitting position, and the application of monitoring strategies for the detection of venous air embolism. Familiarity with the physiological consequences of anesthetic administration and patient positioning, and the physiological consequences of VAE will enable the anesthetist ...

Middle mediastinal pheochromocytomas are exceedingly rare. Because so few cases have been reported, consensus has not been reached regarding the anesthetic management of patients with these tumors. The use of cardiopulmonary bypass (CPB) for the resection of intrapericardial pheochromocytomas has met with varied success. We report the first documented case ...

This paper outlines the basic principles of Doppler ultrasound as used in neonatal medicine. In explains the method's limitations and the extraneous variables which must be taken into account when interpreting Doppler velocity data. Not with standing the methods limitations the use of Doppler ultrasound in various neonatal conditions will ...

This is a report of a five-year-old girl with phenylketonuria (PKU) and hereditary fructose intolerance (HFI) who underwent elective strabismus surgery. PKU and HFI are two inborn errors of metabolism which have an autosomal recessive mode of inheritance. This case report describes the anesthetic features of a patient with PKU ...

Infantile fibromatosis is a process that is difficult to distinguish from fibrosarcoma. It is found in neonates and infants but only rarely has it been reported to involve the external genitalia or scrotum. A 10-month-old boy is described with histologically proved infantile fibromatosis of the scrotum. Characteristics distinguishing infantile fibromatosis ...

The U.S. Supreme Court's most recent pronouncement on abortion rights [Planned Parenthood of Southeastern Pennsylvania v. Casey] resembles the dieter's dilemma: one knows exactly how to get where one is going but lacks the willpower to follow through. In an opinion filled with exceptionally progressive, equality-based arguments for reproductive freedom, ...

New developments in pharmacologic management of cerebral ischemia and hemorrhage are reviewed. A number of agents with diverse modes of action have now been shown to be neuroprotective in adult and neonatal animal models when administered either before or after a hypoxic-ischemic insult. As experience improves with these agents in ...

In Quebec, the elderly receive 4.5 prescriptions per year for sedative-hypnotic medications, most of which are benzodiazepines. Similar rates have been documented in the rest of Canada and other Western countries. Physician prescribing practices must be moderated, as the incidence of cognitive dysfunction, injury, and hidden disorders associated with benzodiazepine ...

This article describes the critical incident technique and offers practical guidance on how the technique can be used to investigate dilemmas in medicine. It extols the particular virtue of this research method for general practice that it can be used to exploit the natural tendency of doctors to tell anecdotes. ...

Preeclampsia is a disease of unknown etiology and a major contributor to maternal and neonatal morbidity and mortality. With severe preeclampsia, numerous factors including intravascular volume depletion and susceptibility of developing pulmonary edema complicate anesthetic management. Invasive monitors such as CVP or PA pressure measurements are often required for guiding ...

A newborn infant who had an uncomplicated repair of gastroschisis with modified Ladd's procedure developed chylous ascites when fed. After 7 weeks of nonoperative management with total parenteral nutrition, the ascites resolved. Widening the mesentery may have damaged the lymphatics, and is not necessary for malrotation associated with gastroschisis. Prolonged ...

Posterior canal wall reconstruction using porous hydroxylapatite (HA), Grote canal wall prosthesis (Richards), has been recommended for obliteration of troublesome "canal-wall-down" procedures. The same method has been utilized during the management of diverse otologic problems. The results obtained encourage the further utilization of this technique in the management of various ...

When we first thought of this series we agreed that there was one man who could do justice to the main theme of the series - the actual dilemma many new graduates face immediately on going into general practice. So we approached Colin Dexter and asked him if he would ...

The growth of alternative medicine poses particular problems for general practitioners working in the National Health Service. This paper reviews the subject and presents preliminary results of a two-stage study of the prevalence of use of alternative medicine in a south London practice. Extended interviews with users explored motivations for ...

This article deals with management of acute sports injuries on the field or on the ice and in the dressing room or in the arena's first-aid room. Its most vital message is "Be prepared". A team approach and suitable ambulance and hospital back-up are mandatory. Individual management of a specific ...

Forty-six neonates with omphaloceles seen at the Children's Hospital and Medical Center in Seattle from 1975 to 1985 were reviewed. There was an 87 percent survival rate in those surgically managed. The 23 neonates who underwent primary closure all survived. The 13 neonates with giant omphaloceles with the liver in ...

Desmoid tumors are rare nonencapsulated benign lesions that invade the musculoaponeurotic tissues of the body. Such tumors infiltrate insidiously, and attempts to remove them frequently fail, usually leaving residual tumor. The use of adjuvant radiotherapy to decrease the recurrence rate in partially resected extra-abdominal desmoids has been reported by several ...