B. Hellström

Plasma levels of diazepam after parenteral and rectal administration in children.

Plasma levels of diazepam and N‐des‐methyldiazepam were investigated in 19 children by a gas chromatographic method permitting the use of capillary samples. Intravenous administration was studied in 3 children and the plasma level curves showed a rapid decline during the first hour. Absorption and elimination after rectal administration of a solution in 16 children were similar to those after intramuscular administration. Diazepam given by suppository to 5 children gave much lower plasma levels and delayed time to peak levels. Recurrence of seizures in 2 children indicated that the anticonvulsant plasma level was of the order of 150 to 200 μg/liter. No significant side effects were observed. Thus rectal administration of a solution of diazepam is a practical method to arrest convulsions in children.

Electrode placement in EEG of infants and its anatomical relationship studied radiographically

Abstract A system of electrode placement is suggested for use in infants, with a smaller number of electrodes than in the 10–20 system. The anatomical relationship of the electrode placement was studied radiologically in 28 infants. From the positions of the electrodes as seen in plain skull X-ray films, their topographic relationship to the various parts of the brain was estimated.

The diagnosis and course of rheumatoid arthritis and benign aseptic arthritis in children.

Diagnostic criteria for rheumatoid arthritis adapted for the features of the disease in children have been suggested and used for a classification in a follow‐up examination. This study comprised 87 cases of aseptic arthritis of at least three weeks duration hospitalized in pediatric departments in Stockholm during 1952–1957. Those not fulfilling the criteria were labelled benign aseptic arthritis. They were compared with the rheumatoid arthritis cases as to the early clinical picture and the prognosis. The entirely different course in the two groups indicates that the suggested classification is of value in the prognostic prediction in cases of aseptic arthritis in children.

Excretion and anticonvulsant activity of steroid hormones in an infant with infantile spasm and hypsarrhytmia treated with excessive doses of ACTH

Abstract The excretion of steroids in urine and faeces was studied in an infant with infantile spasm with hypsarrhytmia. The analyses, which were carried out by gas-liquid chromatography and gas chromatography-mass spectrometry, were done before and after the infant was treated with excessive doses of ACTH. Prior to treatment the infant excreted less than 0.1 mg/24 h of individual steroids but after treatment the concentration in urine and faeces of several steroids increased 20–30 fold and the total excretion was about 12 mg/24 h both in urine and faeces. All the quantitatively predominant steroids excreted after ACTH treatment had a 3β-hydroxy-5-ene-structure: 3β,16α-dihydroxy-5-androsten-17-one, 3β,17β-dihydroxy-5-androsten-16-one, 5-pregnene-3β,20α-diol, 3β,16α-dihydroxy-5-pregnen-20-one, 3ξ,20ξ-dihydroxy-5-pregnen-16-one and 5-pregnene-3β,17α,20α-triol. 5-Pregnene-3β,20α-diol had an anticonvulsant activity when tested on newborn mice and the hypothesis is presented that the antiepileptic effects of ACTH in infants with hypsarrhytmia may be mediated via 3β-hydroxy-5-ene-steroids.

Late Prognosis in Asphyxia Neonatorum

Eightyfive children treated at a childrens hospital for asphyxia neonatorum were subjected to a follow‐up examination. Eighteen died during the newborn period. Sixtyfive of the 67 survivals were followed up. Among them 18 showed signs of a permanent cerebral injury (spasticity, mental retardation, convulsions). The late prognosis was correlated to different clinical symptoms during the newborn period. Children with convulsions, changed tonus, bulging fontanel, reduced sucking capacity have a conspicuously bad prognosis.

The Value of Urinary Sediment Examination as a Screening Method in Suspected Cases of c Leucodystrophy1

Among the various forms of diffuse cerebral sclerosis metachromatic leucodystrophy or leucoencephalopathy has been recognised by certain clinical, biochemical and pathological characteristics [l, 2, 7, 8, 9, 101. The disease has been found to be characterized by a pathologic accumulation of sulphatides (cerebroside sulphuric acid esters). This disease occurs in an infantile, a late infantile and an adult type [5 , 6, 81; the late infantile type is the one most commonly described.

Bronchial Changes in Children with Primary Tuberculosis of the Lungs

The authors examined bronchoscopically 23 cases of primary tuberculosis of the lungs in children with clinical or radiographic signs of bronchostenosis. Bronchial changes were observed in 18 cases. In 13 of these cases the changes were intrabron‐chial and associated with caseous necrosis and tuberculous granulations. The diagnostic and therapeutic role of bronchoscopy is emphasized.

The Lower Urinary Tract in Neonates with Myelomeningocele: Neurologic and Radiologic Correlative Study

A group of 27 infants with myelomeningoceles was investigated in the newborn period by neurologic examination and by micturating cystourethrography. An abnormal configuration of the bladder, trabeculation of the bladder wall, narrowing of the urethra at the external sphincter and alteration in the shape of the bladder neck were common findings. The incidences of trabeculation and a wide bladder neck were significantly related to neurologic lesions at a low thoracic and high lumbar level. Possible pathogenetic mechanisms presented in the literature are reviewed and the hypothesis is advanced that the alterations ate related to interruption of sympathetic innervation of the bladder.

Unilateral neurological defect in myelomeningocele with normal bladder function. Report on two cases.

Various clinical reviews concerning myelomeningocele give the incidence of normal urinary control as between 3 % (4) and 33 %, the latter figure originating from a somewhat selected series (3). With the cele in lumbosacral region the continence figures are generally low. The criteria of continence and particularly of normal bladder function vary. Sometimes the reports are based entirely on the history; sometimes bladder function is studied in a more detailed and objective manner. Only in recent years have conditions for the development of entirely intact bladder function begun to arise greater interest. Knowledge of these should constitute the basis of any clinical attempt to achieve continence. We shall here describe 2 cases of myelomeningocele which developed normal bladder function. These 2 cases were among the last 50 consecutive patients with myelomeningocele in the lower thoracic or the lumbosacral areas who were referred for urological evaluation. This group was examined by a team of a neurologist, a radiologist and a urologist.

Congenital Analgia: A Case Report

A case of congenital analgia in a 21/2 year old girl is described. In addition to the typical findings of a generalized indifference to potentially painful stimuli without any other significant neurological findings an EEG discloses a marked, bilateral epileptogenic abnormality. The girl has so far not had any signs of clinical epilepsy. The findings are discussed and a short review of the syndrome is presented.