No abstract

A patient with duplication of a short segment of 3q (3q21 leads to 26) without apparent deletion of 3 or of other chromosomes provided a further opportunity to study manifestations of this abnormality. The proposita had a broad nasal bridge, anteverted nostrils, webbed neck, and clinodactyly V in addition to congenital heart disease, limb abnormalities, cleft palate, and severe developmental delay. The infant did not have the hirsutism and synophrys present in other cases.

The pharmacokinetics of cefoperazone were evaluated in 28 newborn infants who were being treated for sepsis. A dose of 50 mg/kg was administered intravenously on days 0 to 2 in all, with a second dose administered on days 5 to 7 in 14 hifants. Cerebrospinal fluid penetration was also studied in seven neonates. The mean peak concentration of cefoperazone in the serum of premature infants <33 weeks of gestational age, 159 (standard deviation, ±22) ,ug/ml, was higher than concentrations in premature infants 33 to 36 weeks of age and full-term infants (110 ± 41 and 109 ± 29 jg/ml, respectively). The mean concentrations 24 h after dosage were similar in all three groups, 13 to 17 p.g/ml. The mean serum halflives were similar in the three subgroups and ranged from 7 to 9 h. After the dose at 5 to 7 days, mean blood levels in the subgroups at 0.5 h were 149, 112, and 112 1Lg/ml; 24-h levels ranged from 9 to 12~jg/ml. The mean serum half-lives ranged from 5 to 7 h. Cerebrospinal fluid levels in patients with meningitis ranged from 2.8 to 9.5 pLg/ml and in patients without meningitis from 1 to 7 ,ug/ml. Peak blood levels were 15 to 1,000 times higher than the 90% minimal inhibitory concentration of common pathogens found in newborns. These observations support the potential efficacy of cefoperazone in treatment of infections, including meningitis, in newborn infants.Cefoperazone (CPZ), a recently introduced broad-spectrum cephalosporin, is active in vitro against most gram-positive organisms, including group B streptococci, and gram-negative organisms, including Pseudomonas spp. (2-4). In adults, it has been effective in the treatment of various bacterial infections, including meningitis (2, 4). We have studied the pharmacokinetics, safety, and cerebrospinal fluid (CSF) penetration of CPZ in term and preterm neonates as a first step toward evaluating its protection against systemic infections in that age group.MATERIALS ANM METHODS Twenty-eight neonates admitted for evaluation and treatment of documented or suspected sepsis were enrolled after written, informed consent from their parents was obtained. All were receiving aqueous penicillin and gentamicin. Sepsis evaluation, including blood, urine, stool, and CSF cultures, was completed before conventional therapy.CPZ was administered in a single dose of 50 mg/kg of body weight as an intravenous infusion over a 3-min period. Of the 25 patients included in the pharmacokinetics study, 13 received the dose on day 1 and 12 received the dose on day 2 of life. Of these 25, 11 were full-term infants (gestational age, -37 weeks) with a mean birth weight of 3,068 g. Of the 25, 14 were preterm infants, including 9 infants 33 to 36 weeks old (mean weight, 1,896 g) and 5 infants 27 to 32 weeks old (mean weight, 1,220 g). A second dose of CPZ (50 mg/ kg) was administered intravenously between days 5 and 7 to 14 of 25 infants, including 5 full-term and 9 preterm infants. The remaining three infants (two premature and one full-term) with documented meningitis were given CPZ between 2 and...

Twenty two c h i l d r e n (age range :3-14 years, Sex:m:f: :12:lO) adm i t t e d t o Kings County H o s p i t a l o f Brooklyn w i t h s t a t u s asthmaticus were s t u d i e d t o determine t h e i r plasma ADH l e v e l s i n r e l a t i o n t o the s e v e r i t y o f the s t a t u s asthmaticus. Plasma ADH l e v e l s were measured b y RIA a t t h e time o f admission and again a t 1-2 weeks f o l l o w i n g recovery from s t a t u s . The r e s u l t s are shown i n t h e table.We conclude from t h e study t h a t 1. AOH r esponse increases w i t h s e v e r i t y o f s t a t u s asthmaticus 2. With h i g h sp. g r . o f u r i n e d u r i n g s t a t u s , i n add i t i o n t o dehydration increased ADH s e c r e t i o n should be k e p t i n mind and 3. I n a d d i t i o n t o o t h e r known f a c t o r s , increased ADH may p l a y a r o l e i n pulmonary edema w i t h s t a t u s asthmaticus.GROUP I GROUP I I n=14 n =8 W e s t u d i e d t h e v e n t i l a t o r y response t o hypoxia i n 7 newborn k i t t e n s (n=12), 2 t o 28 days o l d , K i t t e n s were s u r g i c a l l y instrumented t o record diaphragmatic EMG (EMGD~), eye movements (EOG), e l e c t r o c o r t i c a l a c t i v i t y (ECoG), and neck EMG, Ventilat i o n (OE) was measured with a mask and a flow-through system. K i t t e n s i n h a l e d 21% 02 f o r a c o n t r o l period of a t l e a s t 2 min, 10% 02 f o r 10 min, and 21% 02 f o r 2 min again. Measurements were made i n q u i e t s l e e p . With a decrease i n Fi02 t o lo%, t h e r e was an immediate i n c r e a s e i n OE (0,210+0.017 t o 0.30020,025 L/min/kg; p<0,005) which was n o t s u s t a i n e d , v e n t i l a t i o n decreasing t o 0,224 20,028 by 10 min of hypoxia. VT i n c r e a s e d from 3,820.2 mllkg t o 5.0'0,4 (p<0.005) and then decreased t o 3,9'0.2. Frequency in-c r e r s e d from 56'4.0 breathslmin t o 6323 (p<0.02) and then decreased t o 5525, The changes i n I E M G D~X~ followed those i n vE0 K i t t e n s s t u d i e d b e f o r e 7 days of l i f e had a more pronounced dec r e a s e i n v e n t i l a t o r y output a t 10 min of hypoxia than o l d e r k i tt e n s , Breathing p a t t e r n became i r r e g u l a r o r p e r i o d i c during hypoxia.On r e t u r n t o 21% 02 v e n t i l a t o r y output decreased a b r u p t l y due t o apnea. These r e s u l t s suggest; 1) t h e hyperventil a t o r y response t o hypoxia i n unanesthetized k i t t e n s i s not w e l l s u s t a i n e d with values a t end of hypoxia c l o s e t o c o n t r o l l e v e l s ;2) t h e b i p h a s i c response t o hypoxia i s p r i m a r i l y a f u n c t i o n of frequency; 3) younger k i t t e n s a r e l e s s a b l e t o s u s t a i n hypervent i l a t i o n than o l d e r k i t t e n s , W e s p e c u l a t e t h a t t h e l a t e f a l l i n v e n t i l a t i o n i s due t o a c e n t r a l mechanism a f f e c t i n g frequency. Arousal from q u i e t sleep (QS) i n response t o a hypoxic challenge (HC) does n o t occur i n many apnea o f infancy (AOI) p ...