Harris D. Riley

Complications of tetracycline therapy

S I N c E the introduction of chlortetracycline in 1948, tetracycline and its derivatives have been used extensively in medical practice and accepted as safe and effective drugs. In fact, considering the incidence of allergic reactions to penicillin and certain other antibacterial agents, the tetracyclines have been thought by many to be the least toxic of the commonly used antimicrobial drugs. In recent years, however, increasing evidence has accumulated from various complications associated with therapy with these agents. I t is the purpose of this paper to review some of the actions of the tetracyclines and to describe the known and suspected complications associated with their use.

Congenital Intracranial Vascular Malformations in Children

The clinical, laboratory, and other features of 16 children with congenital intracranial vascular malformations seen over a period of 15 years are presented. 13 patients had an arteriovenous (AV) malformation, 2 patients an aneurysm of the vein of Galen, and 1 a congenital internal carotid/internal jugular fistula. Based on onset of symptoms the patients ranged in age from 3 months to 16 years with an average age of 7½ years; however, 5 patients had their first clinical manifestation before 6 years of age. Unfortunately, definitive diagnosis could not be made until an average of 15½ years. The most important clinical manifestations were focal or generalized seizures and spontaneous intracranial bleeding, each occurring in 6 patients. Of 2 patients who presented with hydrocephalus, 1 had had an unexplained episode of cardiac failure during infancy. Inequality in the size of the legs, and periodic headaches were the initial manifestations in 2 other patients. Analysis of this series of patients with intracranial AV malformations suggests the following diagnostic recommendations: careful auscultation of the skull for bruits should be performed in all infants and children with cardiac failure of unknown aetiology; patients with focal seizures refractory to anticonvulsant therapy should be re-examined at frequent intervals to detect focal neurological deficit which otherwise may go unnoticed; and, finally, patients with a seizure disorder who develop focal signs of neurological deficit deserve a complete diagnostic investigation, including contrast studies.

Pericarditis with effusion in infants and children

Seventeen cases of pericarditis with effusion in infants and children seen at the Childrens Memorial Hospital, University of Oklahoma Medical Center, during a 3 1/2 year period are reviewed. The etiology of the cases was as follows: rheumatic fever, 4; purulent infections, 3; rheumatoid disease, 1; idiopathic origin (presumably viral), 1; metastatic tumor, 1; uremia, 1; fibrocystic disease, 1; and 5 cases of the postpericardiotomy syndrome. In addition to the major clinical findings of pericarditis in infants and children, special diagnostic techniques including pericardiocentesis, roentgenography at cardiac catheterization, serial angiocardiography, image intensifier fluoroscopy, kymography, and radioisotope scanning are reviewed. Four representative cases of the disease are presented.

Clinical Review : The Guillain-Barré Syndrome in Childhood A Comprehensive Review, Including Observations on 19 Additional Cases

From the Department of Pediatrics and the Children’s Memorial Hospital, University of Oklahoma Medical Center, Oklahoma City, Oklahoma. Supported in part by Pediatric Neurology Training Grant, No. 8TI HD-64-03 from the National Institute of Neurological Diseases and Blindness and by a Grant from the National Foundation to the Clinical Study Center for Birth Defects at Children’s Memorial Hospital. * Formerly Special Fellow in Pediatric Neurology, Children’s Manorial Hospital, University of Oklahoma Medical Center, Oklahoma City, Oklahoma. ~~ Professor of Pediatrics, University of Oklahoma

NEEDLE BIOPSY OF THE LIVER IN INFANTS AND CHILDREN.

Forty consecutive percutaneous Menghini needle biopsies of the liver in 36 children were reviewed. Biopsy findings were the most useful in children with chronic hepatomegaly without jaundice. Of the 16 children in this category, the biopsy findings established the basis for the hepatomegaly in 11 (56 per cent). These were almost uniformly children in whom extensive diagnostic procedures had failed to yield a diagnosis.

THE INFLUENCE OF PROPHYLACTIC METHICILLIN AND OXACILLIN IN THE PREVENTION OF STAPHYLOCOCCAL COLONIZATION AND SUBSEQUENT CLINICAL INFECTION IN NEWBORN INFANTS.

Two hundred randomly selected newborn infants were studied to determine the natural history of staphylococcal nasal colonization patterns. Methicillin and oxacillin were given prophylactically to 81 patients; rthe control group was of equal size. The effect of this treatment on infection and carrier rates after the infants had been discharged to the home environment was also studied. It teas found that prophylactic administration of Ithe synthetic penicillins significantly reduced the nasal staphylococcal colonization rates of newborns but was ineffectual in eradicating the carrier state once it was established. The regimen did not have any apparent long‐term effect on subsequent colonization rates or on the incidence of infection once the infant left the hospital nursery and was exposed to the environment of its home.

Congenital internal carotid-internal jugular fistula

Summary A 7-year-old Mexican boy with a congenital internal carotid artery-internal jugular vein fistula is presented. The child was in good health until one month prior to admission when he developed right-sided motor seizures. Three days following admission he suddenly died following an apneic spell. To our knowledge this congenital vascular anomaly has not been previously described.

Twitching in a neonate with normal laboratory findings.

* Professor of Pediatrics Tehran University, Lecturer in Pediatrics Johns Hopkins University. t Children’s Memorial Hospital. ‡ University of Oklahoma Medical Center, Oklahoma City, Okla. ÄCAUCASIAN MALE infant weighing 3.7 kg was delivered at the University of Oklahoma Medical Center after 37 weeks gestation. The pregnancy, labor and delivery were uncomplicated and the baby had an Apgar score of 9 at one minute. Fifteen minutes after delivery the baby developed spontaneous twitching of all extremities. The patient appeared alert and these tremors could be provoked by merely handling him. The head circumference measured 36 cm and