Irwin Gribetz

Pneumonitis in acute lymphatic leukemia during methotrexate therapy

Summary Four cases of an acute, self-limited respiratory illness in children who were receiving intermittent methotrexate therapy for the maintenance of remission of acute lymphatic leukemia are described; the description includes clinical and radiographic features, viral and serologic studies, and pulmonary biopsies in two of the patients. The clinical, radiographic, and histologic features were nonspecific. Changing complement fixation titers for respiratory syncytial virus in two patients and pleuropneumonia-like organisms in a third suggested that this syndrome may be caused by an infectious process, modified by the underlying illness or by the antimetabolite therapy.

NORMAL ELECTRICALLY INDUCED REFLEXES ("H REFLEXES") IN A 2-WEEK-OLD INFANT WITH ACRANIA AND CEREBRAL DYSGENESIS.

A patient with cerebral dysgenesis, who survived for 27 days after birth, had normal electrically induced reflexes (EIRs) at 2 weeks of age. Since neuropathological findings showed absence of pyramids, cortico-spinal tracts, and cerebellar vermis, it is obvious that these neural elements are not essential for the elicitation of the reflex, nor for the changes in reflex amplitude which occur when the infant goes from wakefulness to sleep, or vice versa.

Gangrene of the hand in a newborn child

Abstract A case of gangrene of the hand in a newborn offspring of a diabetic mother is presented. The child died on the twelfth day after birth and an autopsy was performed. The autopsy revealed the cause of the gangrene to be an occlusive calcified embolus in the right cubital artery. There was also occlusion of the inferior vena cava, left renal and adrenal veins. The adrenal vein was thought to be the most likely source of the embolus which apparently travelled through the foramen ovale to the right arm.

Acute parathion poisoning: Diagnosis and treatment

The increasing use of alkyl esters of phosphoric acid (parathion) as insecticides and therapeutic agents has resulted in a greater number of human poisonings. Parathion intoxication may result from absorption through skin, eyes, respiratory, and gastrointestinal tracts. The use of the new antidote 2-PAM (2-pyridine aldoxime methiodide), together with atropine and supportive measures in the treatment of an 18-month-old child with acute parathion poisoning is described. The first dose of 2-PAM was given 3 1/2 hours after ingestion of the poison. Cholinesterase determinations are discussed in relation to therapy, and a plan of treatment is recommended.

Recurrent pleural effusion: A complication of pancreatitis in childhood

While pleural effusion as a complication of pancreatitis has been described in adults, this entity has not been noted, in the English literature, in children. We have recently uncovered chronic pancreatitis as the cause of recurrent pleural effusions in an 8-year-old Puerto Rican male whose presenting complaint at another hospital was recurrent substernal and epigastic pain radiating to the left shoulder. Exhaustive investigation, including cultures of the pleural fluid, skin tests for typical and atypical mycobacteria and fungi, lupus preparations, bronchography and thoracotomy with pleural biopsy, failed to reveal the cause of the recurrent pleural effusions. Substernal pain recurred, and the initial complaint of epigastric pain was only then appreciated. Pleural fluid showed an amylase concentration of more than 1000 Somogyi units/100 ml at a time when the serum amylase content was 335 units/100 ml (normal = 30–180 units). Pancreatic stimulation with secretin (Boots) 1 unit/kg resulted in a 1 hour output of 25 ml or 1.4 ml/kg (normal = 2 ml/kg), and a maximal amylase concentration of 29 mEq/L (normal = 90 mEq/L), consistent with chronic pancreatitis. There was no family history of pancreatitis. Lipoprotein electrophoresis and urinary amino acid excretion were normal. Tests for mumps complement-fixing antibodies were negative. Pancreatitis should be considered as a possible cause of pleural effusion in childhood. Pleural-fluid amylase levels should be obtained in all children with unexplained pleural effusions.