Mitchell I. Rubin

Are We Overprescribing Antireflux Medications for Infants With Regurgitation

OBJECTIVE. Our goal was to evaluate the diagnosis and treatment of infants with persistent regurgitation who were referred to a pediatric gastroenterology service. METHODS. The records of 64 infants with persistent regurgitation and without any neurodevelopmental abnormalities, underlying illness, or cigarette smoke exposure were evaluated for diagnostic workup and treatment. Forty-four infants underwent extended esophageal pH monitoring. RESULTS. Only 8 of 44 pH studies showed abnormal acid reflux. Forty-two of these 44 infants were already on antireflux medications. Other etiologies included hypertrophic pyloric stenosis (4) and renal tubular acidosis (1). Discontinuation of medication did not result in worsening of symptoms in most infants with normal pH studies. CONCLUSIONS. The majority of infants who were prescribed antireflux drugs did not meet diagnostic criteria for gastroesophageal reflux disease.

A comparison of routine urinalysis, addis count, and blood sedimentation rate as criteria of activity in acute glomerulonephritis

Summary There is a close correlation between the return of the sedimentation rate to normal and recovery from acute glomerulonephritis. There is a correlation between the return of the sedimentation rateand the Addis count, the Addis count becoming normal about five weeks after the sedimentation rate. In those instances where there has been great disparity between the return of the sedimentation rate and the Addis count to normal, the sedimentation rate has been an equally if not a more reliable prognostic index than has the Addis count. However, of even greater prognostic significance is the return of both the Addis count and sedimentation rate to persistently normal levels for a period of several weeks. Finally, the simplicity of the blood sedimentation test, which seems tobe a valuable guide of the course of acute glomerulonephritis, recommends its use in this disease.

Arteriolosclerosis, hypertension, and cerebral atrophy in an infant

Summary The case record of a 20-month-old male infant with arteriolosclerosis is reported. As a complication of this disease an advanced degree of cerebral cortical atrophy occurred. It is emphasized that in the presence of cerebral cortical atrophy in childhood, arteriolosclerosis should be considered as one of the less common etiological possibilities. The possible causes of the hypertension and arteriolosclerosis in this child are discussed. In contrast to the adult, the child with chronic pyelonephritis and hypertension often has diffuse arteriolosclerosis.

An analysis of one hundred cases of acute poliomyelitis

Summary 1. An analysis is presented of the data taken from the records of 100 cases of acute poliomyelitis. 2.The maximum number of patients were hospitalized during the last week of August and the first week of September, 1932. With the ages of the patients varying from one to twelve years, 51 per cent of the patients were between one and one-half and five years of age. Males predominated over females in the ratio of 1.22 to 1. Color did not seem to confer any immunity. The majority of the patients in this series were well-nourished, well-developed children with normal hemoglobin concentration. The blood types of the patients had no influence on the incidence. Four patients who had received intramuscular whole blood as an attempted prophylactic measure did not develop paralysis but did develop the disease. 3. A discussion of the classification of the types of cases is presented. 4. Symptoms: A. Fever: Most patients exhibited fever on admission, ranging between 100° and 102° F. The dromedary type of temperature curve was not encountered. B. Gastrointestinal: Constipation, nausea, vomiting, and anorexia were frequent symptoms. Abdominal pain was not uncommon. Diarrhea of a mild type occurred occasionally. C. Cardiorespiratory: An initial upper respiratory infection occurred in a high percentage of cases. Respiratory phenomena incident to paralysis are discussed. Cardiovascular abnormalities were present. D. General: Deep pressure pain occurred in the majority of cases, as a transient symptom in nonparalytic cases and as a protracted symptom in those developing paralysis. Drowsiness appeared early in more than half the cases. Headache and backache occurred in 46.6 per cent and 26.6 per cent, respectively, of children able to give evidence of them. Irritability, weakness, and toxicity were rather frequent; restlessness and sweating were occasional occurrences; convulsions were rare. E. Nervous: Nuchal rigidity, stiffness of the back, and head drop were common early occurrences. Trophic and vasomotor disturbances were occasionally met. F. Genitourinary: Urinary retention occurred in less than 10 per cent of the patients as a transient symptom. G. Glandular: In no case was there generalized lymphadenopathy or splenic enlargement. H. Paralysis: A detailed analysis of the incidence, distribution, and relationship of reflexes to muscle paralysis is made. 5. Laboratory Data: A. Spinal Fluid: The fluid was usually clear and colorless. Pleocytosis was almost uniformly encountered. The relationship of the pleocytosis to paralysis and its variation during the course of the disease is outlined. Globulin was found increased in most of the fluids examined. An increase in the sugar content was found in but 23 per cent of the cases, the remaining patients exhibiting spinal fluid sugars within normal range. Chlorides were almost always normal. The Wassermann reaction carried out in twenty-five cases was negative. The fluids of nine patients showed slight pellicle formation. B. Urine: Urinary findings were those of any febrile disturbance. C. Serology: The blood Wassermann reaction determined in twentyfour patients was positive in one case—this a known case of syphilis. D. Hematology: The leucocytic response to the disease is analyzed. 6. The total mortality rate in this series was 7 per cent. However, in those children under eighteen months of age the mortality was 25 per cent. 7. The therapeutic measures employed in the early treatment of these cases are tabulated.