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Examination of eyes of infants
960
Editorial correspondence
occurs in several other conditions associated with hypokalemia. Nevertheless, following correction of hypokalemja, studies of erythrocyte 2~Na influx appear to be useful for laboratory confirmation of Liddle syndrome in patients presenting with hypertension and hypokalemia without demonstrable renal or adrenal pathology.
Paul E. Hyman, M.D. Fellow, Pediatric Gastroenterology University of California, Los Angeles Room 22-340 Marion Davies Children's Clinic Los Angeles, CA 90024
The Journal of Pediatrics May 1980
This is best done two to three hours after a meal in a setting where the lighting is not harsh.
James H. Moller, M.D. Professor of Pediatrics University of Minnesota Pediatric Cardiology Box 94 Mayo Memorial Bldg. 420 Delaware St, S.E. Minneapolis, M N 55455 REFERENCE
1. Appel TC: Laryngoseopic ophthalmoscopy, J PEDIATR 94:847, 1979.
Repty Examination of eyes of infants To the Editor: This concerns the letter by Dr. Ted C. Appel in the May, 1979, issue of THE JOURNAL, entitled, "Laryngoscopic ophthalmoscopy." Dr. Appel describes a problem many pediatricians have in examining the eyes of a neonate or infant. He attempts to solve this problem by slipping the blade of a laryngoscope under the upper eyelid and retracting it, thereby exposing the cornea. This is a risky procedure. Despite his admonition to care not to damage the cornea and sclera, this could easily happen, particularly in a vigorous infant. An alternative method of examining an eye of a newborn is not to attempt to open the eyelids forcefully with the fingers or the laryngoscope, but to hold the infant upright; more often than not the eyelids open on their own, allowing you to view the cornea.
To the Editors: I appreciate Dr. Moller's appropriate concern attending the use of a laryngoscope, or any other instrument, for the purpose of retracting the eyelids. Indeed, I would encourage the use of his, or a similar, technique for assessing pupfllary responses when voluntary, or even random, cooperation can be ellicited. The patients described in my letter had significant eyelid edema, as associated with refractory congestive failure, hypoxic renal failure, or head trauma. Voluntary opening of the eyes was either not observed or was severely limited. Laryngoscopic ophthalmoscopy is best used in such instances of lid edema, when more conventional approaches have failed.
Ted C. Appel, M.D. Department of Pediatrics Eastern Maine Medical Center 489 State St. Bangor, ME 04401
Erratum. In the February, 1980, issue to THE JOURNALOF PEDIATRICS(96:259, 1980), in the article by Ann B. Bjornson, Jeffrey S. L0bel, and Beatrice C. Lampkin, "Humoral Components of Host Defense in Sickle Cell Disease During Painful Crisis and Asymptomatic Periods," the following information should have been included in the table: Determination (mean _+ SEM) % of normal IgM
IgA Patient Asymptomatic 60.9 _+ 5.5 164.2 _+ 30.1 Crisis 83.3 + 11.3 163.6 _+ 27.6 Control 119.2 _+ 8.7 179.9 _+ 18.5 In addition, the title of the table should have read: Concentrations and functional activity of components of the classical and alternative complement pathways and concentrations of IgG, IgA, and IgM in the sera of 18 patients with sickle cell disease during crisis and asymptomatic periods. Also, the activating substance used for the measurement of C3 conversion was inulin not insulin.
Editorial correspondence
occurs in several other conditions associated with hypokalemia. Nevertheless, following correction of hypokalemja, studies of erythrocyte 2~Na influx appear to be useful for laboratory confirmation of Liddle syndrome in patients presenting with hypertension and hypokalemia without demonstrable renal or adrenal pathology.
Paul E. Hyman, M.D. Fellow, Pediatric Gastroenterology University of California, Los Angeles Room 22-340 Marion Davies Children's Clinic Los Angeles, CA 90024
The Journal of Pediatrics May 1980
This is best done two to three hours after a meal in a setting where the lighting is not harsh.
James H. Moller, M.D. Professor of Pediatrics University of Minnesota Pediatric Cardiology Box 94 Mayo Memorial Bldg. 420 Delaware St, S.E. Minneapolis, M N 55455 REFERENCE
1. Appel TC: Laryngoseopic ophthalmoscopy, J PEDIATR 94:847, 1979.
Repty Examination of eyes of infants To the Editor: This concerns the letter by Dr. Ted C. Appel in the May, 1979, issue of THE JOURNAL, entitled, "Laryngoscopic ophthalmoscopy." Dr. Appel describes a problem many pediatricians have in examining the eyes of a neonate or infant. He attempts to solve this problem by slipping the blade of a laryngoscope under the upper eyelid and retracting it, thereby exposing the cornea. This is a risky procedure. Despite his admonition to care not to damage the cornea and sclera, this could easily happen, particularly in a vigorous infant. An alternative method of examining an eye of a newborn is not to attempt to open the eyelids forcefully with the fingers or the laryngoscope, but to hold the infant upright; more often than not the eyelids open on their own, allowing you to view the cornea.
To the Editors: I appreciate Dr. Moller's appropriate concern attending the use of a laryngoscope, or any other instrument, for the purpose of retracting the eyelids. Indeed, I would encourage the use of his, or a similar, technique for assessing pupfllary responses when voluntary, or even random, cooperation can be ellicited. The patients described in my letter had significant eyelid edema, as associated with refractory congestive failure, hypoxic renal failure, or head trauma. Voluntary opening of the eyes was either not observed or was severely limited. Laryngoscopic ophthalmoscopy is best used in such instances of lid edema, when more conventional approaches have failed.
Ted C. Appel, M.D. Department of Pediatrics Eastern Maine Medical Center 489 State St. Bangor, ME 04401
Erratum. In the February, 1980, issue to THE JOURNALOF PEDIATRICS(96:259, 1980), in the article by Ann B. Bjornson, Jeffrey S. L0bel, and Beatrice C. Lampkin, "Humoral Components of Host Defense in Sickle Cell Disease During Painful Crisis and Asymptomatic Periods," the following information should have been included in the table: Determination (mean _+ SEM) % of normal IgM
IgA Patient Asymptomatic 60.9 _+ 5.5 164.2 _+ 30.1 Crisis 83.3 + 11.3 163.6 _+ 27.6 Control 119.2 _+ 8.7 179.9 _+ 18.5 In addition, the title of the table should have read: Concentrations and functional activity of components of the classical and alternative complement pathways and concentrations of IgG, IgA, and IgM in the sera of 18 patients with sickle cell disease during crisis and asymptomatic periods. Also, the activating substance used for the measurement of C3 conversion was inulin not insulin.