Lawrence R. Kuhns

Gastric emptying using three different formulas in infants with gastroesophageal reflux.

Summary The role of delayed gastric emptying (GE) in the pathogenesis of gastroesophageal reflux (GER) in infants is controversial at present. GE has been shown to be altered by the composition and osmolality of the feedings. This prospective study was undertaken to assess the changes in the GE and the percentage of time GER was detected by scintigraphy using three different formulas on consecutive days in infants with GER. Twenty-eight infants under 1 year of age diagnosed to have GER by extended intraesophageal pH monitoring (pH being <4.0 for >5% of the duration of the test), underwent scintigraphy on three consecutive days using the same volume per single feeding of a casein-predominant, soy, or a wheyhydrolysate formula in a randomized order. The formulas were isocaloric. Gastric emptying and percentage of GER into the esophagus were estimated for 60 min following these feedings. Mean GER percent during the study was 20.39, 17.68, and 16.34 on casein-predominant, soy, and whey-hydrolysate formulas, respectively, and was not significantly different. Mean values of GE were 39.7%, 44.6%, and 48.5% on casein, soy, and whey formula, respectively. No significant difference in GE was also observed between casein-predominant and soy formula. However, a significant difference was observed (p < 0.05) on GE between casein-predominant and whey-hydrolysate feedings. Our data suggest that formula selection may be important in the treatment of conditions associated with delayed gastric emptying.

Endotracheal tube position in the infant

The locations of endotracheal tubes were assessed radiographically in 36 of 52 intubated infants during a 11/2 year period. In 18 of the 36 patients for whom there were radiographs, the endotrached tubes were in one of the bronchi. Eleven of these 18 patients developed atelectasis. The effects of head motion and respiration on the position of the tube were also evaluated. Suggestions are given to ensure proper placement of an endotracheal tube and for maintenance of the tube in the trachea.

Mechanism of endotracheal tube movement with change of head position in the neonate

The mechanism of alteration of endotracheal tube position with movement of the head and neck in the neonate was studied in a term newborn cadaver. The infant was intubated and serial radiographs were obtained with the head and neck in different positions. We propose that the skull acts as a lever arm from the anterior end of the maxilla to the first cervical vertebra. The fulcrum for movement of this lever arm is the upper cervical spine. Movement of the endotracheal tube in the trachea is directed by the maxillocervical lever arm when the skull and upper cervical spine are flexed, extended, or rotated.

Renal papillary necrosis in juvenile rheumatoid arthritis

Three patients who developed renal papillary necrosis while receiving long-term, high-dose aspirin therapy for juvenile rheumatoid arthritis are presented. It appears that aspirin alone or aspirin in combination with other drugs is the causative agent. The incidence and biologic significance of renal papillary necrosis are insufficient to alter the use of aspirin as the drug of choice in management of JRA. It is recommended that all children with JRA be encouraged to drink ample fluids and be followed with periodic urinalysis and blood pressure measurements. Those children who develop hematuria or hypertension should be evaluated by excretory urography.

New standards of ossification of the newborn.

Physical and neurological examinations of American and Swedish populations confirm that epiphyseal ossification of the newborn in the shoulder, knee, and foot is related to gestational age. The causes of accelerated, retarded, and dysharmonic osseous maturation of the neonate are reviewed.

Computed tomographic and angiographic demonstration of gastroduodenal artery pseudoaneurysm in a pancreatic pseudocyst.

The complementary use of computed tomography and angiography in two patients with bleeding gastroduodenal artery pseudoaneurysm associated with pancreatic pseudocyst is presented.

Intense Transillumination for Infant Venipuncture

Transillumination of an extremity during venipuncture in infants or obese children is described. Transillumination facilitates accurate placement of the needle tip within the vein.

Ultrasound examination of ankle injuries in children.

Fourteen children with ankle injuries, an open tibia and fibula physis, and negative radiographs had ultrasonography of their injured ankles. Five had an anterior talofibular ligament injury and five had an anterior tibiofibular ligament injury. Four had normal ultrasound examinations. Only two had a physeal injury, both of which were associated with a ligament injury. Eleven children had only lateral ankle tenderness. Ultrasound of these 11 revealed ligamentous injuries, normal examinations, and the two physeal injuries. Ligamentous injury was not associated with other tenderness patterns.

Ultrasound of the navicular during the simulated Ponseti maneuver.

Nonoperative treatment of the equinovarus foot has had a recent resurgence because of popularization of the Ponseti casting method. This method is based in part on reducing the talonavicular joint by moving the navicular laterally and the head of the talus medially. This study dynamically demonstrates the effect of a simulated Ponseti manipulation on the navicular.

The role of the septal area in the neuroendocrine control of growth in the adult golden hamster.

Somatic, endocrine and behavioral correlates of growth were measured in intact and hypophysectomized adult hamsters with or without electrolytic damage to the rostral septal area. Septal (SEP) lesions significantly increased somatic growth rate, food consumption and serum concentration of growth hormone (GH) and insulin. Pituitary GH content and concentration were reduced in lesioned hamsters. None of these changes were found in hypophysectomized hamsters with SEP lesions. SEP lesions did not affect the percentage of body fat. These data suggest that the septum or adjacent fibers of passage inhibit growth in adult hamsters.