bluuebunny/crossref_metadata_2025 huggingface dataset:
Noma in a Full-term Neonate
Authors: Alkalay A. , Mogilner B.M. , Nissim F. , Barak Y. , Handzel Z.T. , Ostfeld E.
Published: November 2007

Noma is an uncommon gangrenous process usually affecting malnourished children. A full-term neonate with orofacial noma, bilateral choanal atresia, and transient neutropenia with B cell deficiency is reported. This unusual appearance of noma in a well-nourished newborn might be related to the combination of choanal atresia and transient immune deficiency.
Attention Deficit Disorder Children with or without Hyperactivity
Authors: Ullmann Rina K. , Sleator Esther K.
Published: November 2007

Each patient with Attention Deficit Disorder (ADD), with or without hyperactivity, is unique in the variety and severity of the handicapping conditions associated with ADD. The use of a well- designed teacher rating scale can provide the clinician with a behavioral prafile of each patient. The importance of knowing the child's specific problems is emphasized by the results of this research, which show that methylphenidate has a major effect in improving attention, is helpful in decreasing activity level, but often has only a minor effect on deficient social skills and oppositional (aggressive) behavior.
Clinical Presentation and Management of Pseudomonas Osteomyelitis
Authors: Elliott Stephen J. , Aronoff Stephen C.
Published: November 2007

To determine the incidence and clinical characteristics of Pseudomonas aeruginosa osteomyelitis in children, the records of 144 hospitalized patients under 19 years of age were reviewed; 104 fulfilled the study criteria for the diagnosis of acute or chronic osteonxyelitis. Pseudomonas aeruginosa was recovered from 10.6 percent of the children and was the second most common pathogen isolated. In comparison to children with staphylococcal infections, patients with pseudomonal osteomyelitis were significantly older, gave an antecedent history of penetrating trauma, and lacked clinical and laboratory evidence of systemic illness. The data collected in this study suggest that osteomyelitis due to Pseudomonas aeruginosa is a distinct entity with clinical features differing from those of Staphylococcus aureus. Management should be directed at adequate surgical debridement followed by 10 to 21 days of antimicrobial therapy.
Clinical Features of Mild Systemic Meningococcal Disease with Characterization of Bacterial Isolates
Authors: Edwards Kathryn M. , Jones Lawrence M. , Stephens David S.
Published: November 2007

Neisseria meningitidis is an important cause of fulminant septicemia and meningitis in children. Only limited reports of mild disease associated with this organism exist. In this study, we describe eight children, ages 2.5-19 months, with mild meningococcal disease and characterize the menin gococcal isolates from some of these patients. Children with mild meningococcal disease presented with a mean fever of 40.1°C, but without purpura or petechiae. Five were diagnosed as having otitis media and were not thought to be seriously ill when initially observed. Six of the eight children had complete resolution of their clinical symptoms as outpatients. One had apparent meningococcal meningitis that sterilized without antibiotic therapy, and one had persistent low grade bacteremia that cleared within 48 hours after institution of parenteral antibiotics. Charac terization of the meningococcal isolates from three of the patients revealed that the organisms were encapsulated, piliated, and contained similar outer membrane proteins. This report confirms that blood stream invasion by N. meningitidis organisms may result in clinically mild disease.
Thoracic Actinomycosis in Childhood
Authors: Golden Neville , Cohen Harris , Weissbrot Jay , Silverman Stuart
Published: November 2007

A 14-year-old boy presenting with a chest wall mass, pulmonary infiltrate, and scoliosis was found to have thoracic actinomycosis with distal vertebral involve ment. Review of the medical literature for the past 25 years revealed only 23 other pediatric cases of thoracic actinomycosis. Clinical, standard radiological, and microbiological findings can be nonspecific. The diagnosis is dependent on a high index of suspicion. A long course of penicillin is the treatment of choice. Body computed tomography is a useful diagnostic aid and is helpful also in evaluating response to therapy.
Intrauterine Intracranial Hemorrhage in an Infant with lsoimmune Thrombocytopenia
Authors: Sadowitz P. David , Balcom Robert
Published: November 2007

An infant with isoimmune thrombocytopenia and presumed intrauterine intra cranial hemorrhage is presented. This infant developed focal seizures on day 6 of life which were controlled with phenobarbital. Presently, the infant is growing and developing normally. Previous cases have been described and are summarized in this paper. There is no known method for predicting or preventing this particular complication.
Cognitive-Motor Interactions
Authors: Capute Arnold J. , Shapiro Bruce K. , Palmer Frederick B. , Ross Alan , Wachtel Renee C.
Published: November 2007

The relationship of gross motor development to later cognitive status was assessed by comparing the ages of attainment of four early milestones to later performance on the Stanford Binet. The ages of rolling supine to prone, sitting alone, crawling, and walking were collected in a prospective fashion via parental report for 213 Caucasian children. Stanford Binet IQ was measured at 3 years. Significant but low-order correlations were noted for age of milestone and Stanford Binet IQ. Stratifying the sample by IQ standard deviation groups revealed significant relationships, but this was largely the result of the difference between the extreme groups (117 vs. 85). Children with earlier ages of milestone attainment did not have higher IQs on average. The association of gross motor development and cognition is not strong enough to allow the use of one to predict the other.
Gastrointestinal Dialysis with Activated Charcoal and Cathartic in the Treatment of Adolescent Intoxications
Authors: Mofenson Howard C. , Caraccio Thomas R. , Greensher Joseph , D'Agostino Ronald , Rossi Anthony
Published: November 2007

This article reports five patients who had taken a substantial medication overdose and presented in coma. Two had taken a salicylate overdose and three a phenobarbital overdose (one of these ingested a combination of phenobarbital and phenytoin). The cases were treated by our standard protocol of supportive therapy and alkaline diuresis plus repetitive oral doses of activated charcoal (gastrointestinal dialysis). All patients were alert and oriented within 24 hours. Toxicokinetic analysis of the blood levels is discussed. Gastrointestinal dialysis represents a relatively noninvasive method that may benefit certain intoxicated patients even after systemic absorption has occurred. The technique and recommendations for its use are discussed and described in detail.
Intensity and Frequency of Sound Levels from Cordless Telephones
Authors: Orchik Daniel J. , Schumaier Daniel R. , Shea John J. , Moretz William H.
Published: November 2007

Recent reports have established that the ring of a cordless telephone is sufficient to produce hearing loss. In the present study, the intensity and frequency spectrum of the ring signal for three cordless telephones known to be involved in reported cases of acoustic trauma are presented. The potential hazard to hearing is reviewed, the implications for the pediatric community discussed, and the recommendation made that unmodified cordless telephones be kept out of the reach of children.
Polymorphic Light Eruption in Childhood
Authors: Draelos Zoe Kececioglu , Hansen Ronald C.
Published: November 2007

The purpose of this article is to acquaint the pediatrician with polymorphic light eruption (PMLE) a light-induced, eczematous, cutaneous reaction that frequently begins in childhood. This sun- induced eruption is frequently misdiagnosed because of its similarity to atopic dermatitis.
Psychogenic Purpura in Adolescent Patients
Authors: Sorensen Ricardo U. , Newman Arthur J. , Gordon Erlinda M.
Published: November 2007

The occurrence of psychogenic purpura has been documented in adults. The authors present their experience with nine adolescent and young adult patients observed since 1981. The age of eight of these patients ranged from 13 to 18 years. One patient with cystic fibrosis was 23-years- old. All patients presented with painful inflammatory lesions followed by bruising. There was no evidence of an infectious process or a hematologic, immunologic, or renal abnormality. Integral to the diagnosis was the existence of an underlying emotional disorder. In all patients, bruising decreased after diagnosis was explained to the patient and family. Four patients required psycho therapy. Results of 2-year follow-up suggest that early intervention may produce a favorable outcome in this age group.
Indomethacin in the Treatment of Proximal Tubular Acidosis
Authors: Garin Eduardo H. , Scott David I.
Published: November 2007

Treatment of a 7-week-old black male who had proximal tubular acidosis with large doses of bicarbonate did not achieve correction of the acidosis and was accompanied by diarrhea. Addition of indomethacin therapy (2 mg/kg/day) was followed by correction of the acidosis and allowed a decrease in the dosage of alkali.
Effect of Anorexia Nervosa on Linear Growth
Authors: Pfeiffer Roxane Javid , Lucas Alexander R. , Ilstrup Duane M.
Published: November 2007

To study the effect of severe undernutrition on linear growth during adolescence, a report was obtained on the ultimate adult height of 71 patients who had had anorexia nervosa at or before age 16 years. At time of diagnosis (ages 9-16 years) median height percentile was 49; at adult follow-up (ages 18-29 years) the median height percentile was 55. This change favoring growth was statistically significant (p < 0.01). Height percentile was maintained or increased in 45 patients and decreased in 26 patients. In only four patients did it change by more than 20 percentile points downward; in 12 patients height percentile increased by more than 20 points. We conclude that, despite weight loss of up to 45 percent at or before age 16 years, most patients with anorexia nervosa continue to grow in stature according to expected norms.
Vitamin D2 Therapy of Pseudohypoparathyroidism
Authors: Mimouni Francis , Neumann Victoria A. , Tsang Reginald C. , Hollis Bruce W.
Published: November 2007

A patient treated with massive doses of vitamin D for pseudohypoparathyroidism who had a convulsive episode due to hypocalcemia is reported. Evaluation of the patient's vitamin D status led us to conclude that the patient was non-compliant with vitamin D treatment.
Chronic Illness, Psychosocial Problems, and School Absences
Authors: Weitzman Michael , Walker Deborah Klein , Gortmaker Steven
Published: November 2007

The number of days absent from school during the 1979-80 school year for 573 children aged 6-17 years in Berkshire County, Massachusetts was ascertained by parent reporting in a random household survey. Children with a wide range of chronic health impairments were reported as missing more school than their healthy peers (8.7 days vs. 5.8, p < .001). Although there was a trend for children reported as having functional impairments to miss more school than those with chronic conditions without functional impairments (11.0 vs. 8.1), the difference was not statistically significant. Children with a variety of reported psychosocial difficulties missed more school than those without psychosocial difficulties for the sample as a whole and for those with reported chronic conditions. These findings document support for the assumption that children with a wide range of physical and psychological problems miss more school than their healthy peers and illustrate that the etiology of school absences is multifactoral and reflects behavioral as well as purely physical phenomena.
Neisseria gonorrhoeae in Asymptomatic Prepubertal Household Contacts of Children with Gonococcal Infection
Authors: Nair Prasanna , Glazer-Semmel Esta , Gould Carolyn , Ruff Elizabeth
Published: November 2007

This report describes the occurrence of gonococcal infection among prepubertal household contacts of children younger than 12 years of age. The records of 14 index cases (12 females and 2 males) reported during the period January 1979 and June 1983 were reviewed. Among 31 asymptomatic contacts of 10 index cases, nine (29%) had positive cultures (5 females and 4 males). Three were siblings of the index cases, and six were other children in the index households. The predominant site of positive cultures was the throat (7/9). This high recovery rate of gonococci among young asymptomatic household contacts makes clear the need for aggressive surveillance of prepubertal household contacts of children with gonococcal infection, and the importance of culturing all three sites, e.g., vagina/urethra, rectum, and throat.
Thrombotic Lesions of the Tricuspid Valve in the Newborn
Authors: Sussmane Jeffrey B.
Published: November 2007

Two cases of nonbacterial endocardial thrombi (NBET) on the atrial surface of the tricuspid valve in the full-term infant are presented. The pathophysiology and the events peculiar to the full-term infant that suggest susceptibility to this rare pathological phenomenon are reviewed. The difficulties in diagnosis and treatment are discussed.
The Efficacy of Computer-Assisted Instruction (CAI) in an Outpatient Pediatrics Clinic
Authors: Parish Ruth Ann
Published: November 2007

This prospective study was done to measure the effectiveness of a CAI program in teaching outpatient pediatrics to third-year medical students, as measured by their scores on the mandatory pediatrics examination taken at the end of their pediatrics rotation. A significant difference was found between the number of students receiving Honors vs. Satisfactory scores on their examinations between those who worked at our hospital before vs. after the CAI program became available; there was also a statistically significant difference between the number of students who received Honors on their pediatrics examinations when comparing the Harborview-after-computer group to the Other-locations-after-computer group. Such a CAI program appears to be an effective learning aid for medical students doing their outpatient pediatrics rotations. It affords information about costs to the patient, is omnipresent and is an effective alternative to either lecture or reading as a method of learning.
Home Phototherapy
Authors: Grabert Brian E. , Wardwell Charlotte , Harburg Susan K.
Published: November 2007

Hyperbilirubinemia in the healthy, term neonate is the most common reason for prolonged hospitalization. Expense, separation from a nursing mother, imparting a sense of illness to the infant, and disrupting such processes as "bonding" are all drawbacks to in-hospital phototherapy. Home Phototherapy Associates in Colorado Springs, Colorado has treated 260 newborns from April 1982 to February 1985.

The infants treated by home phototherapy averaged 0.81 days of hospital phototherapy before being discharged to home phototherapy for an average of 2.44 days. Average bilirubin on entry into home phototherapy was 14.19 mg/dl and 10.97 mg/dl when discontinued. The average age upon entering home phototherapy was 3.97 days. Home phototherapy was ordered at the discretion of the private physician. Parents were given verbal and written instructions on care of the jaundiced newborn, kept a record of their baby's progress and signed a consent form.

There have been no complications in 260 newborns treated at home. There were 17 rehospitalizations.

Home phototherapy is an effective and safe alternative to prolonged hospitalization for the healthy, full-term newborn with jaundice. Parental satisfaction has been nearly 100 percent. The average daily decrement in bilirubin is comparable with that reported by others for in-hospital phototherapy. The cost savings, uninterrupted "bonding" process, and the ability to keep mother and child united are some of the observable benefits.
14 Years of Experience with Home Phototherapy
Authors: Rogerson Alexander G. , Grossman Elmer R. , Gruber Howard S. , Boynton Ragna C. , Cuthbertson James G.
Published: November 2007

This report describes a group of patients with hyperbilirubinemia treated with phototherapy at home. An account is made of methods used, advice given, problems encountered, and results obtained. It is suggested that home phototherapy can and should be carried out by pediatricians as part of routine outpatient pediatric care.
Rapid Strabismus Screening for the Pediatrician
Authors: Cibis Gerhard W. , Waeltermann Joanne M.
Published: November 2007

"I thought I saw my child's eyes turning" is a frequent observation of parents. The Brueckner test is a simple method, easily learned, to determine the presence or absence of true strabismus. With some practice, an observer can uncover strabismus and amblyopia. This test makes use of a direct ophthalmoscope and the same corneal reflexes one is familiar with in pen light testing. The position of the corneal light reflex is an important portion of the Brueckner test, but the additional, definitive information is derived from the red reflex that fills the entire pupil and gives an excellent backdrop to the bright white dot that is the corneal light reflex. The eye that is turned in or out will have a brighter, more orange-red reflex and the appearance of increased pupil size. Even with pseudostrabismus or unusual angle kappas, the equality or inequality of the red reflex determines the absence or presence of true strabismus. With practice, the Brueckner test can yield the doctor an answer to one of the most common parental concerns.
Abuse of Isobutyl Nitrite Inhalation (Rush®) by Adolescents
Authors: Schwartz Richard H. , Peary Page
Published: November 2007

Isobutyl nitrite is a volatile liquid sold without a prescription as a "room odorizer" but is widely used as an inhalant to produce feelings of euphoria. Of the 173 13-22-year-olds (mean age, 16 years) clients of a long-term drug treatment facility who completed a questionnaire related to drug use, 74 (43%) admitted to having used isobutyl nitrite at least once, 22 (13%) had used the substance ten or more times, and eight (4% ) used the substance 50 or more times. Inhalation of this malodorous substance leads almost universally to dizziness and lightheadedness and usually to severe symptoms of vasodilatation such as "pounding of the heart," blurred vision, and a "warm feeling." The feeling was unpleasant to 44 percent of the users in this study, and most also experienced pulsatile headache. In addition, contact dermatitis and irritation of the tracheobronchial tree and eyes occurred in some users. The primary use of this substance as an euphoric agent warrants consideration of banning its sale altogether.
The Investigation of Atypical Psychosomatic Illness
Authors: Dunger D.B. , Pritchard J. , Hensman S. , Leonard J.V. , Lask B. , Wolff O.H.
Published: November 2007

The experience of 12 children with atypical psychosomatic illness who presented considerable diagnostic difficulties is described. All patients were admitted to the hospital, and using a team approach, it was possible to make a confident diagnosis. No organic disease was identified, and a psychosomatic diagnosis was made. In general, atypical symptoms and signs, false-positive investigations, and differing medical opinion had compounded the diagnostic difficulties. The value of the observations made by ward staff of the childrens' symptoms and behavior is stressed.
Evaluating Oral Health Needs in Preschool Children
Authors: Nirschl Ronald F. , Kronmiller Jan E.
Published: November 2007

Pediatricians and family physicians can play a significant role in the initiation of dental care for preschool children because they are seen more often by a physician than a dentist. The Committee on Standards for Child Health Care of the American Academy of Pediatrics recommends inspection of the mouth, teeth, and gums at every pediatric visit. This article describes the oral tissues in health and in disease as well as the role physicians can play in preventive dental care.
Lethargy as a Presenting Symptom in Patients with Intussusception
Authors: Heldrich Fred J.
Published: November 2007

The author's experience with lethargy in pediatric patients with intussusception was reviewed retrospectively over a 10-year period and proved to be a symptom elicited on admission in half of the patients. The results indicate that lethargy is an important symptom in patients with intussusception when occurring in association with vomiting, melena, or a palpable abdominal mass, or all three.
Improved Survival and Short-term Outcome of Inborn "Micropremies"
Authors: Gerdes Jeffrey S. , Abbasi Soraya , Bhutani Vinod K. , Bowen Frank W.
Published: November 2007

Survival and significant chronic morbidity were determined by retrospective chart review for 107 inborn "micropremies." "Micropremies" are defined as appropriate-for-gestational age neonates of <1,001 grams and ≤28 weeks gestation. The overall survival rate for "micropremies" was 64 percent, ranging from 20 percent at 24 weeks to 83 percent at 27 weeks gestation. Race and sex are important determinants of survival in these infants. The incidence of severe, chronic morbidity in "micropremies" is relatively low. The acceptable outcome for "micropremies" supports aggressive perinatal management for fetuses as low as 24 to 25 weeks gestation. However, it is important for physicians to use current statistics from their own institutions when counseling parents and making management decisions.
Neonatal Mastitis
Authors: Walsh Margaret , McIntosh Kenneth
Published: November 2007

Forty-one cases of neonatal mastitis seen at Children's Hospital, Boston since 1947 have been analyzed and the literature since 1950 reviewed. All 41, like those in the literature, occurred in full-term infants 1-5 weeks of age, with a sex ratio of 2:1 (females:males). Bilaterality was rare (3 cases in this series, one in the literature review) and systemic spread or extramammary foci even rarer. The incidence has changed little in the past 35 years except for the larger number of cases in the 1950s. In the present series, all but a few cases have been caused by Staphylococcus aureas, and gram-negative enteric bacilli have not been seen. Therapy is surgical incision and drainage when fluctuance is present, but early treatment with appropriate intravenous antibiotics has apparently obviated the need for surgery in many recent cases. The prognosis for cure of the infection is excellent.
Neonatal Cortisol Response to Circumcision with Anesthesia
Authors: Williamson Paul S. , Donovan Evans Nolan
Published: November 2007

Eleven male newborns were circumcised with a local dorsal penile nerve block, and 13 controls were circumcised without anesthetic. Matched pairs of pre- and postcircumcision cortisol levels in the two groups were compared. The adrenal cortisol response to surgery was not significantly reduced by the administration of lidocaine. Blood sampling and anesthetic injection of venipuncture alone did not evoke the adrenal response in uncircumcised control infants. Cortical input or secondary epinephrine elevation may be producing the cortisol elevation in infants despite regional blockage of the afferent nerve pathways.
Diagnosis of Tourette Syndrome in Childhood
Authors: Lacey Daniel J.
Published: November 2007

Acquired movement disorders in children can present a diagnostic dilemma. Chorea, dystonia, and atypical seizures must be distinguished from simple or complex tics. The combination of chronic motor and vocal tics, Tourette syndrome, may in some children be associated with thought and behavioral disorders, sleep disturbances, headaches, and school difficulties (e.g., attention deficit disorder). The increasing numbers of children recognized as having Tourette syndrome, its broadening clinical spectrum and frequent familial nature are detailed in this review.
Two Uncommon Radiographic Signs of an Anterior Neonatal Pneumothorax
Authors: Grim Paul F. , Keenan William J.
Published: November 2007

An anterior pneumothorax in a supine neonate is difficult to diagnose. A correlation was sought between radiographic signs of an anterior pneumothorax and clinical data to facilitate the radiographic diagnosis. A total of 817 consecutive admissions to two regional nurseries were reviewed, and infants with pneumothoraces were identified. Nineteen percent of these neonates had anterior pneumothoraces with Medial Stripe and Large Hyperlucent Hemithorax signs observed on the chest radiographs. The Medial Stripe sign was not associated with any distinguishing clinical features that would assist the physician in the interpretation of the radiograph. The Large Hyperlucent Hemithorax sign was noted predominantly on the left side in near-term infants who were breathing spontaneously. It was concluded that there are specific clinical variables associated with a Large Hyperlucent Hemithorax sign of an anterior pneumothorax in a supine neonate.
The Evaluation of Minor Cervical Blunt Trauma in the Pediatric Patient
Authors: Lusk Rodney P.
Published: November 2007

Blunt trauma delivered directly to the neck of the pediatric patient may be associated with significant airway compromise. The external signs are not indicative of the extent or site of the trauma. A high index of suspicion is warranted in all patients with this type of injury. A patient with apparently minor direct trauma to the neck is presented to illustrate the principles of evaluation and treatment of these injuries.
Virilization of a Female Infant due to an Adrenal Tumor
Authors: Pardo Julio M.
Published: November 2007

We report here the case of a 22-month-old girl with virilization due to a potentially malignant adrenal tumor. She presented with clitoromegaly and growth of pubic hair, first noticed at birth. The clinical picture, hormonal profile, and pathologic findings are described. The practical aspects of the differential diagnosis and treatment are illustrated.
Gowers' Sign in Discitis in Childhood
Authors: Amir Naomi , Hurvitz Haggit , Korn-Lubetzki Isabelle , Shalev Ruth S.
Published: November 2007

Three cases of discitis in early childhood presented with acute refusal to walk or change in gait pattern without neurologic deficits. In all three, a Gowers' sign was observed, although none had muscular weakness. The diagnosis of discitis was confirmed by the characteristic radiographic findings on survey lumbosacral films and/or by a hot spot at the L3 level on technetium bone scan.
A Study of Brucellosis in Childhood
Authors: Sharda Dinesh C. , Lubani Mahmoud
Published: November 2007

Two hundred children with brucellosis are described. The clinical characteristics on presentation included prolonged fever, arthralgia, weight loss, and malaise in the majority of the patients. Biochemical characteristics included a relative lymphocytosis in 92.9 percent of the patients and elevated liver enzymes in 83.5 percent. The Brucella agglutination titer was 1:320 or more in all the cases studied, but repeated blood cultures yielded growth of Brucella organisms in only 42 percent of the patients. Brucellosis is an important cause of fever in children living in areas where Brucella-infected animals are raised.

Consumption of raw milk or dairy products made from raw milk are the main sources of infection. Education of the public and governmental control are necessary to eradicate the disease.
Acute Bacterial Conjunctivitis
Authors: Vichyanond Pakit , Brown Quinzetta , Jackson Doug
Published: November 2007

We report the results of eye culture specimens, obtained from patients under 20 years of age, submitted to the Bacteriology Department of our institution from January 1 through April 30, 1983. A total of 72 specimens were positive for one or more strains of bacteria. The most commonly isolated bacteria was Hemophilus influenzae (34 strains, 42%), followed by Staphylococcus epidermidis (11 strains, 13.75%) and Streptococcus pneumoniae (9 strains, 11.25%). Mean age of patients with H. influenzae (excluding a 20-year-old patient) was 15 months with standard deviation of 13 months. Chloramphenicol and tetracycline showed excellent in vitro activity against bacteria of all age groups. Tetracycline may prove to be the drug of choice for the treatment of acute conjunctivitis if comparative clinical data support its in vitro superiority.
Erythromycin Prophylaxis for Recurrent Otitis Media
Authors: Lampe Richard M. , Weir Michael R.
Published: November 2007

Patients with recurrent otitis media without persistent middle ear effusion were studied for antibiotic prophylaxis efficacy. In the first phase, erythromycin ethylsuccinate was used as prophylaxis for otitis media in 45 patients in a dose of 10 mg/kg twice daily. Acute otitis media occurred in eight of 45 (18%) while receiving erythromycin, and in 22 of 41 (54%) following prophylaxis termination. The attack rate (episodes of otitis media per 2-month period) was 0.86 before prophylaxis, 0.20 during prophylaxis, and 0.79 following prophylaxis.

In a second phase of the study, erythromycin was compared with sulfisoxazole for otitis media prophylaxis in a group of 42 children. Sulfisoxazole (500 mg per dose) was administered twice daily. Acute otitis media occurred in five of 28 (18%) children while receiving erythromycin and in nine of 21 (43%) children while receiving no prophylaxis. The attack rate (episodes of otitis media per 2-month period) was 0.81 before erythromycin prophylaxis, 0.18 while receiving erythromycin, and 0.50 after erythromycin prophylaxis. Acute otitis media occurred in eight of 14 (51 %) children while receiving sulfisoxazole, and in two of five (40%) children while receiving no prophylaxis. The attack rate (episodes of otitis media per 2-month period) was 0.78 before sulfisoxazole, 0.72 while receiving sulfisoxazole, and 0.56 after sulfisoxazole prophylaxis.

Erythromycin antimicrobial prophylaxis for children with recurrent otitis media was superior to no prophylaxis and to sulfisoxazole prophylaxis in this study of patients with recurrent otitis media without persistent middle ear effusion.
Pulmonary Function in Older Children and Young Adults with Gastroesophageal Reflux
Authors: Allen Julian L. , Wohl Mary Ellen B.
Published: November 2007

A wide variety of types of pulmonary diseases and respiratory symptoms have been associated with gastroesophageal reflux (GER). Asthma, chronic bronchitis, bronchiectasis, and pulmonary fibrosis have all been linked to GER, but causal mechanisms have been difficult to establish. To characterize pulmonary function abnormalities in older children and young adults (age 7-23 years) with GER, lung function was evaluated in 22 patients being treated for reflux. The patients were divided into two groups: nine subjects (Group 1) had no history of pulmonary symptoms. Thirteen subjects (Group 2) had known pulmonary disease; all had diagnosed asthma, and five had a history of recurrent pneumonia. Lung volumes and spirometry were measured. Airway reactivity was assessed by measuring change in flows following isocapneic hyperventilation of subfreezing air. The presence of "small airway" disease was assessed by air-helium flow volume curves and the single breath oxygen test. Lung size, as indicated by measurement of total lung capacity, was normal in all patients. Flow rates, density dependence of maximal expiratory flow, single breath oxygen test, and tests of airway reactivity were abnormal only in Group 2 patients and were normal in the Group 1 patients. That not all children with GER have abnormal pulmonary function suggests that, if there is a causal relationship between GER and lung disease, it is multi-factorial in nature. Children with GER who do have lung disease have evidence of airway obstruction, maldistribution of ventilation, and increased airway reactivity, but do not have restricted lung volumes.
Interpretation of Traumatic Lumbar Puncture
Authors: Mehl Albert L.
Published: November 2007

Contamination of cerebrospinal fluid (CSF) with blood was studied prospectively in nine children with aseptic meningitis as the second phase of a study reported in this volume last month. Using criteria defined in the first phase, four of nine patients had recognizably abnormal CSF after experimental contamination with blood. As a third phase of the study, 53 children with bacterial meningitis were reviewed retrospectively to assess if hypothetical contamination of CSF with blood would have disguised their abnormal CSF studies. All but one of these 53 patients had either an abnormal CSF glucose or a positive gram stain (indicators independent of contamination with blood), and none would have gone undiagnosed with hypothetical contamination of up to 200,000 red cells per cubic millimeter. Guidelines for interpretation of laboratory studies following traumatic lumbar puncture are reviewed.
Pediatric Management of Nonpervasively "Hyperactive" Children
Authors: Landman Gary B. , McCrindle Brian
Published: November 2007

Sixty-five children viewed by their teachers as hyperactive were evaluated as to whether they would benefit from stimulant medication. All underwent extensive neurodevelopmental and educational testing. Additional information was obtained from school and parent questionnaires and interviews. Children were not placed on medication unless they demonstrated characteristic impulsive, inattentive, and/or overactive behavior in two of three environments (home, school, clinic). Fifty-two children (80%) were not placed on medication. Follow-up was completed in 80 percent, and 93 percent of these children were doing well with nonpharmacologic interventions.

Initial comparison of children not placed and placed on medication revealed that age, race, SES, amount of resource help and retention could not distinguish groups. Children placed on medication had difficulties earlier in school (X2 = 4.88, p < 0.05), weren't as delayed academically (X2 = 6.30, p < 0.05) and had less neurodevelopmental disorders (X2 = 9.01, p < 0.01).

If a careful psychosocial history does not reveal impulsive, inattentive, and/or hyperactive behavior outside of school, a child should be evaluated to rule out neurodevelopmental and educational problems.
The Natural History of Idiopathic Chest Pain in Children
Authors: Rowland Thomas W. , Richards Marilyn M.
Published: November 2007

Repetitive chest pain of obscure origin is commonly encountered in older children and adolescents. A questionnaire study was conducted to determine the long-term outcome in 31 patients diagnosed as having idiopathic recurrent chest pain after an average 4.1-year follow-up period. Although 45 percent reported having had persistent symptoms, chest pain had disappeared in 81 percent of those followed more than 3 years. Equally reassuring is the fact that in no case did occult disease subsequently appear to account for the initial symptoms. This study supports the current clinical approach of limited diagnostic evaluation and reassurance in the management of these patients.
Milk-Thickening Agents as a Treatment for Gastroesophageal Reflux
Authors: Vandenplas Yvan , Sacré Liliane
Published: November 2007

Milk thickening agents are believed to reduce episodes of gastroesophageal reflux, but their use has not been evaluated thoroughly.

We studied the effect of these agents in 30 bottle-fed babies, 6-8 weeks old, with clinical gastroesophageal reflux pathology. Continuous 24-hour esophageal pH monitoring revealed gastroesophageal reflux pathology for all parameters studied: reflux index (18.4%), duration of the longest reflux episode (23.3 min), number of reflux episodes in 24 h (34.5), number of reflux episodes > 5 min (6.8). All investigations were performed in prone-anti-Trendelenburg position.

The infants were treated with milk thickening agents (1 g to 115 ml, as recommended by Carre). Most (n = 25) showed clinical improvement of their symptoms. A second pH monitoring was performed under treatment conditions after 7-14 days, and showed in 24 infants a decrease of the number of reflux episodes (15.1 in 24 h) (p < 0.001), but a comparable reflux index (17.8%) (NS) and number of long lasting (>5 min) reflux episodes (7.8) (NS). The duration of the longest reflux episode, however, increased significantly (56.6 min) (p < 0.001). In six infants all parameters were within normal ranges at follow-up.

Milk thickening agents seem clinically effective as a treatment for gastroesophageal reflux in individual cases, but can lead to occult gastroesophageal reflux episodes of long duration, possibly increasing the risk for esophagitis or respiratory dysfunction.
Infant Colic, Distress, and Crying
Authors: Hewson Peter , Oberklaid Frank , Menahem Samuel
Published: November 2007

The literature regarding infant colic is critically reviewed. Although there have been a number of theories proposed as to etiology of colic, the literature is characterized by difficulties in definition, methodologic problems, and numerous claims as to both etiology and management that are anecdotal. Infant colic is best conceptualized as the end result of a complex transaction between the infant and his environment, with multiple factors responsible for the crying and distress of an infant. The most important factors in appropriate intervention are a physician's receptivity and sensitivity toward the stressed mother, together with an interested and practical approach to providing adequate support while delineating the individual stresses acting on both mother and baby. Future research is needed to delineate markers for those subgroups of infants who may present with crying as a manifestation of specific clinical situations.
Hemorrhagic Pancreatitis in a Young Child Following Valproic Acid Therapy
Authors: Kotlus Rosenberg Henrietta , Ortega William
Published: November 2007

Hemorrhagic pancreatitis was diagnosed with portable realtime ultrasound in a critically ill 4-year-old child. The ultrasonic features were diffuse pancreatic enlargement, generally and focally increased pancreatic echogenicity, and ascites. Ultrasound was indispensable as a portable noninvasive imaging modality that allowed for rapid and accurate diagnosis.
Erythromycin-induced Drug Interactions
Authors: Zitelli Basil J. , Howrie Denise L. , Altman Harold , Maroon Thomas J.
Published: November 2007

The authors report a case of erythromycin-induced carbamazepine toxicity in a 6-year-old child following use of erythromycin ethylsuccinate (50 mg/kg/day). Within 5 days of erythromycin use, vomiting, weakness, lethargy, ataxia, nystagmus, and cogwheeling movements developed. A serum carbamazepine concentration had increased from 11.9 mg/L (measured 1 week prior to antibiotic use) to 25.8 mg/L. Following erythromycin withdrawal, serum concentrations returned toward baseline, and symptoms resolved.

Erythromycin has known effects on hepatic enzyme function, with altered cytochrome P-450 function. The dramatic reduction in carbamazepine clearance observed in this patient is similar to that reported when erythromycin is used concurrently with other drugs. A brief review of potentially significant erythromycin drug interactions is presented.
Idiosyncratic Reactions to Phenytoin
Authors: Powers Nancy G. , Carson Stephen H.
Published: November 2007

We present a detailed case report of an idiosyncratic reaction to phenytoin and review the manifestations in 16 additional pediatric patients (2.5-21 years of age) described in the literature. These cases illustrate the frequency of fever (82%), rash (94%), lymphadenopathy (94%), hepatitis (94%), and eosinophilia (76%). This constellation of signs and symptoms will frequently mimic common pediatric illnesses so the pediatrician responsible for the care of the seizure patient being treated with phenotoin should be aware of the possibility of an idiosyncratic reaction. Delay in discontinuation of the drug may be life-threatening.
Thumb Polydactyly as a Part of the Range of Genetic Expression for Thenar Hypoplasia
Authors: Graham John M. , Brown Forst E. , Hall Bryan D.
Published: November 2007

Attempts to study the genetics of human thumb polydactyly have been hampered by lack of awareness of the extremely varied expression of upper limb preaxial anomalies. It has been appreciated that thumb polydactyly could range from a broadened distal phalanx to complete duplication of the entire thumb. Most cases are sporadic and unilateral, but rare familial cases with wide variability and occasional nonpenetrance have been described. Four unrelated families are described who have thumb polydactyly as part of the range of expression for a dominant gene that is frequently associated with absence of thenar intrinsic muscles and flexor pollicis longus with inability to flex the thumb across the palm (the Fromont anomaly). These families and previous literature reports suggest that expression of the gene can range from thumb hypoplasia (most commonly the Fromont anomaly) to triphalangeal thumb or thumb polydactyly. As a consequence of this experience, we urge that parents, siblings, and other close relatives of patients born with thumb polydactyly be carefully examined for mild degrees of thumb hypoplasia or any other thumb anomaly, and that these findings be considered when providing recurrence risk counseling.
Hypersensitivity Pneumonitis Due to Dove Antigens in an Adolescent
Authors: Balasubramaniam Susheela K. , O'Connell Edward J. , Yunginger John W. , McDougall John C. , Sachs Martin I.
Published: November 2007

Hypersensitivity pneumonitis is infrequently reported in children. This article describes a 15-year-old girl who presented with insidious onset of dyspnea and weight loss. A hamster and doves were housed in her bedroom. Chest radiographs showed bilateral nodular infiltrates. Pulmonary function tests showed a restrictive pattern with O2 desaturation at rest. The diagnosis was substantiated by the presence of precipitating antibody to dove serum and droppings and by clinical improvement, along with marked improvement in pulmonary function test, after the doves were removed from her environment. The importance of making an early diagnosis to prevent debilitating fibrotic lung disease is emphasized. A detailed environmental history is essential.
Umbilical Artery Catheterization: A Potential cause of Refractory Hypoglycemia
Authors: Malik Munir , Wilson Don P.
Published: November 2007

Two infants with persistent, symptomatic hypoglycemia are reported. Both were thought to have iatrogenic hyperinsulinism due to a malpositioned umbilical artery catheter. Repositioning of the catheter to avoid direct infusion into the arterial blood supply to the pancreas resulted in prompt cessation of hypoglycemia.
Acute Renal Failure in the Neonate
Authors: Turner Miriam C. , Naumburg Eric G.
Published: November 2007

Two cases of fatal group B streptococcal disease complicated by rhabdomyolysis in the neonate are described. They were identified by blood and cerebrospinal fluid cultures positive for group B streptococcus and by a combination of hyperkalemia, urine dipstick positive for blood without microscopic hematuria, and elevated serum muscle enzymes.
Small Bowel Obstruction as a Complication of Kawasaki Disease
Authors: Murphy Daniel J. , Morrow W. Robert , Harberg Franklin J. , Hawkins Edith P.
Published: November 2007

A case of small bowel obstruction in an 8-month-old infant with Kawasaki disease is described. At laparotomy a discrete area of jejunal stricture with adhesions was noted. Microscopic examination revealed evidence of small artery thrombosis. Kawasaki disease results in a diffuse vasculitis, which may produce significant abnormalities in multiple organ systems. Serious abdominal complications can occur and should be considered when gastrointestinal symptoms develop in a patient with Kawasaki disease.
Epidermoid Cyst of the Spleen Successfully Treated by Marsupialization
Authors: Sullivan Cornelius A. , Konefal Stanley H.
Published: November 2007

Nonparasitic splenic cysts, although rare, should be considered in the differential diagnosis of persistent vague upper abdominal pain in children and young adults. These cysts, which are less common than traumatic pseudocysts, include hemangiomas, dermoids, lymphangiomas, and, as in the present case, epidermoid variants. Ultrasound is diagnostic. The pathogenesis of these lesions remains obscure. While some continue to advocate splenectomy as definitive treatment, an operation with splenic salvage should be possible, even in centrally located lesions.
A Community Model for Physician, Educator, and Parent Collaboration for Management of Children with Developmental and Behavioral Disorders
Authors: Ulrey Gordon , Hudler Mary , Marshall Richard , Wuori Donald , Cranston Christel
Published: November 2007

This article describes a model for physician, educator, and parent collaboration in the management of children with developmental and behavioral disorders. The results of implementing the model with 256 professionals and parents of developmentally disabled children are described and discussed. The benefits of using the model in school districts and/or communities seeking to improve interprofessional collaboration and work with families are presented. The model has been demonstrated to be effective in producing practical solutions for improving collaboration that is relevant to local community barriers and based on input from physicians, educators, and parents.
An Association Between Recurrent Otitis Media in Infancy and Later Hyperactivity
Authors: Hagerman Randi J. , Falkenstein Alice R.
Published: November 2007

An association between the frequency of otitis media in early childhood and later hyperactivity is reported in this study. The subjects were 67 children referred to a child development clinic for evaluation of school failure. Ranging from 6 to 13 years old, all the children demonstrated specific school learning problems, and 27 were also considered hyperactive by two or more raters. Sixteen of the hyperactive children were treated with central nervous system stimulant medication. In retrospect, there was positive correlation between an increasing number of otitis media infections in early childhood and the presence and severity of hyperactive behavior. Ninety-four percent of children medicated for hyperactivity had three or more otitis infections, and 69 percent had greater than 10 infections. In comparison, 50 percent of non-hyperactive school-failure patients had three or more infections and 20 percent had greater than 10 infections. Twenty-two of 28 children (79%) known to have more than 10 infections experienced recurrent otitis before 1 year of age.
An Evaluation of the Effects of Being Regarded as "Unmotivated"
Authors: Landman Gary B.
Published: November 2007

To designate someone as unmotivated or lazy has consistently been shown to affect behavior towards that person. A prospective study evaluated the relationship between such a designation and events at school. The subjects included 164 school-aged children who presented to the Johns Hopkins School Problems Clinic and, prior to their evaluation, had extensive forms completed by their teachers and parents. Lack of motivation was seen as the primary cause of school difficulties in 80 children (49%). Testing revealed that 69 percent were more than one year behind academically; 48 percent were more than two years behind. Fifty-one percent had been retained in grade, and 8 percent of those had been retained twice. Only 16 percent were receiving remedial help.

A comparison between children seen as unmotivated and those not perceived as such showed that sex, race, and socioeconomic status (SES) were not distinguishing factors. Children seen as unmotivated were further behind academically (Chi2 = 7.02 p < 0.05), had been retained more often (51% versus 25%, Chi2 = 11.6 p < 0.001), and were receiving less intensive remedial help at school (Chi2 = 6.14 p < 0.05). There was a trend for children seen as unmotivated to be older (mean = 129m SD = 38m versus mean = 103m SD = 33m, t = 1.47 p = 0.1).