Lillian P. Kravis

An analysis of fifteen childhood asthma fatalities

There is evidence from pediatric tertiary care centers in the United States that childhood deaths from asthma in hospitalized patients are becoming increasingly rare, while asthma mortality outside the hospital appears to be on the rise. When a young outpatient with asthma dies, the event is apt to be sudden and unanticipated and the victim is likely to be a preadolescent or adolescent who has suffered from asthma most of his or her life and who, despite ongoing bronchodilator therapy, requires hospitalizations for treatment of status asthmaticus. Patients in this age cohort have a strong tendency to underuse, overuse, or neglect to use prescribed medications, possibly as a gesture of emerging independence or because of the depression engendered by a chronic illness. In some instances serious psychosocial pathology accounts for noncompliance. For a patient with chronic asthma with a high-risk profile, any departure from an ongoing treatment regimen may result in respiratory failure. Pathologic complications of asthma may also act to upset the precarious physiologic equilibrium these patients have established. Unsuspected chronic pneumonia may lead to further increases in a chronically high degree of oxygen desaturation. Hypoxic seizures during an asthma attack may precipitate pulmonary edema. Tension pneumothorax has an even greater fatality potential for high-risk patients with asthma than it has for other patients with asthma, and pulmonary hypertension with cor pulmonale may develop because of chronic hypoxia. Some sudden deaths in children with chronic, severe asthma are unassociated with any of the above, making it necessary to entertain still other hypotheses.(ABSTRACT TRUNCATED AT 250 WORDS)

Eosinophilic Gastroenteritis in the Pediatric Patient

Eosinophilic gastroenteritis is a diagnosis to be entertained whenever a patient has abdominal complaints accompanied by striking peripheral eosinophilia. A definitive diagnosis is of great importance in this illness, since undiagnosed cases often undergo needless exploratory surgery. An infant seen at 2 years, 10 months of age with abdominal pain, nausea, and vomiting, was found to have a white blood cell count of 50,000/cu mm with 54% eosinophils and eosinophilic ascites. An antral tissue biopsy yielded a diagnosis of eosinophilic gastroenteritis after many studies had been made to exclude other diagnoses. Treatment with intermittent courses of prednisone kept the patient relatively asymptomatic over the period of 20 years during which she remained under our care. Immunologic studies shed no light on the etiology of this patients disorder. The literature dealing with diffuse, infiltrative eosinophilic gastroenteritis is reviewed.

Pulmonary Surfactants, Segmental Atelectasis, and Bronchial Asthma:

Address reprint requests to Harold I. Lecks, M.D., Children’s Hospital of Philadelphia, 1740 Bainbridge St., Philadelphia, Pa. 19146. ~-N-~ 1 0the medical mind, the term &dquo;bronchial asthma&dquo; tends to be associated exclusively with increased airway resistance caused by spasm, edema and secretions in the tracheobronchial tree, with little thought given to the dynamic changes which occur in the lung parenchyma during the acute attack. It is the purpose of this presentation to focus attention upon the area of the lung distal to the bron -

Asthma Mortality in Children: A 16-Years Experience at Children's Hospital of Philadelphia

Over the 16-year period from August 1969 to August 1985, 15 children aged 9 to 19 years, well-known to physicians in the Allergy Section of the Childrens Hospital of Philadelphia died unexpectedly of asthma outside the hospital. There were no deaths in hospitalized asthmatics during this time. Over half the deaths occurred since 1979, the same period in which significant increases in asthma deaths and hospitalizations were noted nationwide. The 15 children all had certain features in common and then subdivided into three subgroups. From analysis of the data five maxims for management of high-risk, chronic asthmatics were developed.

Serous Otitis Media Reflections on Pathogenesis and Treatment

From The Children’s Hospital of Philadelphia and The University of Pennsylvania School of Medicine. *Allergist, The Children’s Hospital of Philadelphia; , Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine. * Associate Allergist, The Children’s Hospital of Philadelphia; Instructor in Pediatrics, University of Pennsylvania School of Medicine. t Associate Allergist, The Children’s Hospital of Philadelphia; Instructor in Pediatrics, University of Pennsylvania School of Medicine. Mailing address: Children’s Hospital of Philadelphia, 1740 Bainbridge St., Philadelphia, Pa. 19146. SEROUS otitis media was defined initially EI~..C.~~J~

Management of Severe Atopic Dermatitis

Despite extensive investigations, no primary defect has been uncovered. For these patients the prognosis is usually poor. Perhaps the most severely affected group of infants is the one described by Hill 33 and designated by him as the atopic erythroderma group which comprises about 7 per cent of all children with atopic dermatitis, and having a distinct pattern of illness. Usually the eruption is evident in the immediate newborn period, and is characterized by a diffuse erythema of lobster red intensity affecting the entire integument. The skin may be somewhat thickened with a superimposed fine branny desquamation, and scratching may