Morris W. Levinsohn

Intelligence and hypoxemia in children with congenital heart disease: fact or artifact?

Previous studies have reported lower intelligence for cyanotic than for acyanotic children with congenital heart disorders, a finding attributed to the degree of hypoxemia present. Several important variables have not been examined consistently, however, including coexisting neurologic or genetic disorders, definitive surgery, degree of sickness, age at testing sex and social class. The present study examined the relation of these variables to obtained intelligence measures for 82 consecutively admitted children, excluding children with abnormal neurologic examinations and those having received definitive surgery. Consistent with earlier reports, intelligence quotients for the acyanotic children (112.81 +/- 14.52 mean +/- SD) were significantly higher (t = 2.60; p = 0.006) than for the cyanotic group (103.50 +/- 15.81). Although sex, race and social class were not significantly different between the 28 cyanotic and the 54 acyanotic children, the cyanotic children were significantly sicker (x2 = 9.12; p = 0.005) and younger (t = 4.10; p = 0.001). However, when young and old children and the degree of sickness within cyanotic and acyanotic groups were compared, no significant differences were found. These findings demonstrate that intelligence differences between cyanotic and acyanotic children persist when the effect of neurologic abnormalities and definitive surgery is removed and remain despite the severity of sickness or childs age at testing.

Accidental chlorpromazine ingestion as a cause of neuroleptic malignant syndrome in children

arrhythmias in children: one hundred thirty-five cases. Am Heart J 1980;100:1063-1069. 4. Shahar E, Barzilay Z, Frand M, Feigl A. Amiodarone in control of sustained tachyarrhythmias in children with WolffParkinson-White syndrome. Pediatrics 1983;72:813-816. 5. Waxman HL, Groh WB, Marchinski FE, et al. Amiodarone for control of sustained ventricular tachyarrhythmia: clinical and electrophysiologic effects in 51 patients. Am J Cardiol 1982;50:1066-1074. 6. Simon JB, Manley PN, Brien JF, et al. Amiodarone hepatotoxicity simulating alcoholic liver disease. N. Engl J Med 1984;311:167-172. 7. Dreifus LS, Ogawa S. Quality of the ideal antiarrhythmic drug. Am J Cardiol 1977;39:466-468. 8. Hesslein PS. Amiodarone therapy in children: a cautionary comment. Pediatrics 1983;72:817-818. 9. Plomteux G, Heusghem C, Ernould H, et al. Long-term hepatic tolerance of amiodarone in the clinic. Eur J Pharmacol 1969;8:369-376. 10. Harris L, McKenna WJ, Rowland E,. et al. Side effects of long-term amiodarone therapy. Circulation 1983;67:45-51. 11. Fogoros RN, Anderson KP, Winkle RA, et al. Amiodarone efficacy and toxicity in 96 patients with recurrent, drug refractory arrhythmias. Circulation 1983;68:88-94. 12. Poucell S, Ireton J, Valencia Mayoral P, et al. Amiodarone associated phospholipidosis and fibrosis of the liver: light, immunohistochemical and electron microscopic studies. Gastroenterology 1984;86:926-936.

Intellectual and emotional sequelae of Reye's Syndrome.

Previous reports on survivors of Reyes syndrome have indicated a high proportion of significant neurological and intellectual sequelae. However, increasingly sophisticated monitoring and therapeutic techniques have diminished both the mortality and morbidity of this disease. Our present study documented the relatively good intellectual and neurological prognosis for recent survivors of Reyes at our institution and explored the emotional impact of this illness on survivors families.The significant emotional problems of the children and their families were in striking contrast to the relatively good intellectual and academic recovery. Nine of the 16 survivors showed emotional disruption (primarily somatic complaints, anxiety, and depression). Fourteen of 16 mothers interviewed continued to suffer from anxiety, depression, and overprotective behavior as long as 5 years after their childs illness. In many respects, the parents endured more prolonged and profound suffering than did the children. These findings have implications for the delivery of follow-up care to families of survivors.

Intracranial volume pressure response in infants and children: preliminary report of a predictive marker in metabolic coma.

Intracranial volume-pressure response was assessed in 6 children suffering from metabolic coma and ranging in age 2 months-13 years. No untoward pressure or infectious complications occurred. The relationship between baseline mean intracranial pressure (MICP) and volume-pressure response assessment (VPRA) in these patients seems to be exponential rather than linear. By itself, the test is no better than baseline MICP at identifying patients at greatest risk of developing significantly increased intracranial pressure (ICP). When used in conjunction with baseline MICP, this method of VPRA identifies a population with an 80% risk of developing serious ICP elevations within a 4 h time period. Patients with the best overall prognosis had significantly lower mean VPRA values than those with poorest overall prognosis.

Small-droplet steatosis and intracranial hypertensionin arginosuccinic lyase deficiency

or plasma zinc concentrations, to provide an earlier and more reliable warning of inadequate zinc nutr i t ional status than would be the case by measur ing serum alkaline phosphatase activity. Theoretically, the ra te and degree of recovery of mucosal integrity af ter t r ea tment of these patients with gluten-free diet could be influenced by zinc deficiency that had developed before inst i tut ion of thera-

Facilitation of exchange transfusions with Scribner shunts in Reye's syndrome.

Scribner shunts were placed in nine patients, who had clinical and laboratory evidence of Reyes syndrome and ranged in age from four to fifteen years, to facilitate repeated, rapid exchanges of large volumes of blood. A method of inserting the Scribner shunt is described. Over a period of 30 to 90 minutes, 3 to 8 units of blood were easily exchanged without hemodynamic or mechanical difficulties. There were no infections; all shunts were removed from survivors after four to eight days without permanent sequelae.