bluuebunny/crossref_metadata_2025 huggingface dataset:
The X Isochromosome-X Syndrome [46,X,i(Xq)]
Authors: Santana Joao A. M. , Gardner Lytt I. , Neu Richard L.
Published: November 2007

It is important not to confuse the 46,X,i(Xq) syndrome with the 45,X classi cal Turner's syndrome. There are profound cytogenetic and clinical dif ferences between the two syndromes, which must be borne in mind in the differential diagnosis of amenorrhea and of infertility.
Continuous Intragastric Infusion of Elemental Diet
Authors: Hartline John V.
Published: November 2007

Five infants with gastrointestinal disease requiring neonatal surgery and two infants with nonsurgical disorders were nourished successfully using a constant intragastric infusion of an elemental diet. Two additional patients who developed persistent distention and gastric retention on IED had mechan ical obstruction requiring surgery and another died of NEC during treat ment. Use of IED avoided the risks of TPN and was followed by successful introduction of standard feeding techniques. IED provides a valuable alterna tive to TPN in selected infants and newborns. Caution with any enteral feeding method is required in infants at risk for NEC.
Who Should Accept Primary Responsibility for the Encopretic Child?
Authors: Hein Herman A. , Beerends Jerold J.
Published: November 2007

Such a program was used to treat 18 encopretic children; 17 improved and 14 became completely free of soiling. Most encopretic children can be man aged by pediatricians and only those children with severe emotional dis orders require psychiatric referral.
Do Stimulant Drugs Improve the Academic Performance of Hyperkinetic Children?
Authors: Barkley Russell A. , Cunningham Charles E.
Published: November 2007

Stimulant drug studies based primarily on measures of teacher opinion have frequently concluded that these drugs improve the achievement of hyperkinetic children. However, a review of those studies using more ob jective measures of academic performance revealed few positive short- term or long-term drug effects on these measures. What few improvements have been noted can be readily attributed to better attention during testing. The major effect of the stimulants appears to be an improvement in classroom manageability rather than academic performance.

It would seem that the stimulants are not able to influence those etiologic factors, other than overactivity and inattentiveness, which predispose hyperkinetic children toward school difficulties. Hence, since the goal of pediatric intervention with these children should be to enhance school per formance as well as reducing hyperactive behavior, the two should be independently and objectively monitored. Since stimulant medications fail to improve the academic performance of most of these children, additional educational assistance must be provided.
Recurrent Abdominal Pain in Children
Authors: Liebman William M.
Published: November 2007

The clinical pattern of 119 children with recurrent abdominal pain, located most commonly in the periumbilical region, revealed no distinct features. The most common associated symptoms were pallor, tiredness and anorexia. The most important socioenvironmental and behavioral factors were marital turmoil in 44 per cent, school activity in 32 per cent, and perfectionism in 30 per cent. Laboratory and radiologic and fiberoptic endoscopic studies were uniformly unremarkable. Counseling on a continuing basis helped 105 of these children.
Tick Paralysis in Three Children
Authors: Gorman Richard J. , Carter Snead O.
Published: November 2007

Reviewed are 3 cases of tick paralysis in children each with a different presentation. One child presented with an ascending flaccid weakness, an other with weakness and cerebellar signs, and a third with pure cerebellar signs. Ixodes scapularis, the black-legged deer tick, was the offending tick in Case 3 and apparently has not been previously reported to cause paralysis in humans. Because of the potential for a fatal outcome, it is imperative to consider tick paralysis in any child with an ascending flaccid weakness or acute ataxia.
Tuberous Sclerosis
Authors: Barakat Amin Y. , Cochran Winston E.
Published: November 2007

Tuberous sclerosis is characterized by epilepsy, mental retardation and adenoma sebaceum. Seizures and mental retardation were the presenting complaints in the nine cases presented here; however, a variety of clinical manifestations of the disease exist. Early diagnosis facilitates genetic counseling.
Sclerosing Cholangitis Associated with Inflammatory Bowel Disease
Authors: Freese D. , Latimer J.S. , Gilberstadt S. , Kane W. , Sharp H.L.
Published: November 2007

The asymptomatic course of two adolescents with hepatobiliary complica tions of inflammatory bowel disease are reported. As has previously been documented in adult patients, liver biopsy and cholangiography of the biliary tree are indicated procedures when the cholestatic enzymes are elevated in children with colonic involvement.
Noonan Syndrome
Authors: Traisman Edward S. , Traisman Howard S.
Published: November 2007

A report of three generations of Noonan syndrome, affecting one female and two males, is described. This is the ninth family in which male-to-male trans mission has been reported, suggesting an autosomal dominant trait.
Torticollis as the Presenting Sign in Cervical Spine Infection and Tumor
Authors: Visudhiphan Pongsakdi , Chiemchanya Surang , Somburanasin Racha , Dheandhanoo Dhanit
Published: November 2007

This report presents five patients with cervical-area infection and four with spinal cord tumors who presented with torticollis early in the course of their illnesses. Three children were found to have osteomyelitis of the cervical spine; two, retropharyngeal abscess; two, intramedullary astrocytoma; one, extradural neuroblastoma; and one, extradural sarcoma. Though torticollis is most frequently a benign condition, its persistence or its association with other objective findings should lead to a search for an etiologic basis.
Spontaneous Recovery of Selective IgA Deficiency
Authors: Blum Paul M. , Hong Richard , Stiehm E. Richard
Published: November 2007

Patients with selective IgA deficiency, the most common primary immuno deficiency, occasionally may undergo spontaneous recovery. In this paper we present three additional children whose IgA levels spontaneously returned to normal. All three presented with gastrointestinal symptoms, and one child also had frequent upper respiratory infections. We review other cases of spontaneous IgA deficiency, and the role of exogenous function in its etiology, and possible mechanisms of recovery.
Treatment of Group A Streptococcal Pharyngitis in Children
Authors: Ginsburg Charles M. , McCracken George H. , Steinberg Joel B. , Crow Stephen D. , Dildy Ben F. , Cope Francis , Zweighaft Teresa
Published: November 2007

Penicillin V, benzathine/procaine penicillin G, cefadroxil monohydrate, and erythromycin estolate were randomly assigned for therapy of group A streptococcal pharyngitis in 198 children. All patients improved within 24 hours of initiating therapy. Reinfection with a new group A streptococcal serotype occurred in 13 patients, 12 developing 7 to 12 days afrer stopping therapy and 11 becoming symptomatic. Relapse with the same organism oc curred in 16 patients, only 5 (31%) of whom were symptomatic. Antibody titer rises, antibiotic resistance of group A organisms, presence of penicillinase- producing staphylococci, and lack of compliance were not related to re current infections. There were no significant differences between the failure rates of the four test drugs: penicillin V, 12%; benzathine/procaine penicillin G, 12%; cefadroxil monohydrate, 5%; and erythromycin, 2%.
Cryptococcal Osteomyelitis
Authors: Hammerschlag Margaret R. , Domingo Javier , Haller Jack O. , Papayanopulos David
Published: November 2007

A case is reported of isolated cryptococcal osteomyelitis in an 11-year-old girl without any detectable underlying disease. The patient was successfully treated for six weeks with intravenous amphotericin B and oral 5-flucytosine. There is only one other case of cryptococcal osteomyelitis reported in the English medical literature in a child. Over 50 per cent of individuals with this infection will have an underlying condition which may have predisposed them to acquiring this disease.
Hepatic Benign Vascular Tumor in Infancy
Authors: Rosen P.R. , Mewborne E.B. , Macpherson R.I. , Nusynowitz M.L.
Published: November 2007

The use of multiple imaging modalities to diagnose hepatic hemangioendo thelioma in a neonate is demonstrated. This approach avoided operative inter vention to establish the diagnosis. Tc-99m sulfur colloid and Tc-99m PIPIDA scintigraphy was used to define the nature of sonographic hypoechoic struc tures in the liver, and angiography was employed to confirm the suspected diagnosis.
Neonatal Sepsis Resulting from Possible Amniotic Fluid Infection
Authors: Philip Alistair G. S.
Published: November 2007

Antibiotics are frequently prescribed "prophylactically" when the neonate is considered to be at risk for infection. The risk factors of prolonged rupture of membranes (>24 hours), maternal fever/infection, and/or unexplained preterm labor (suggesting possible amniotic fluid infection) were investigated in 276 babies. Only two of 150 babies investigated for a single factor proved to have sepsis, while of the 126 babies who had multiple factors, 13 had sepsis.

Several laboratory tests, used singly or in combination, were more helpful than clinical manifestations in predicting which babies were likely to be infected. Neo natal sepsis was present in 6 per cent of the total, in 10 per cent of neonates with clinical signs, in 21 per cent with an increased immature/total neutrophil ratio (I/T ratio ≥ 0.2), and in 36 per cent of infants with a positive "sepsis screen." The incidence of "infection" (sepsis and "very probable" infection) was 12 per cent overall, but was 14 per cent with neonatal signs, 44 per cent with I/T ratio ≥0.2, and 74 per cent in those with a positive sepsis screen. A leukocyte count < 5,000/ cu mm and/or an I/T ratio ≥ 0.2 was 100 per cent sensitive for sepsis, but the sepsis screen was most "efficient" at detecting "infection."

Starting antibiotics on the basis of risk factors alone does not seem appropriate. In situations where amniotic fluid infection is possible, evaluation with the leu kocyte count and differential (with or without other tests) could decrease the indiscriminate use of antibiotics, particularly when a single risk factor is the reason for suspecting infection.
Giant Ovarian Cyst
Authors: Westfall C.T. , Andrassy Richard J.
Published: November 2007

Ovarian cysts are relatively common in the adolescent, but cystic neoplasms of epithelial origin are seen infrequently. The case is presented of a 15-year-old female with an ovarian serous cystadenoma—the largest such ovarian cyst reported in this age group. The differential diagnosis of ovarian cysts in adolescents is reviewed.
Adolescent Suicide
Authors: McKenry Patrick C. , Tishler Carl L. , Kelley Coleen
Published: November 2007

Forty-six adolescent suicide attempters and their parents were compared with 46 adolescent nonattempters and their parents using various measures of family conflict, family cohesion, and parental maladaptive behavior. Data analysis in dicated several significant differences between these two family groups in these dependent measures of family functioning, suggesting that the family milieu plays an important role in the etiology of adolescent suicidal behavior.
Combined Fetal Alcohol and Hydantoin Syndromes
Authors: Wilker Richard , Nathenson Gerald
Published: November 2007

Two infants, born with extensive abnormalities probably resulting from maternal use of alcohol and hydantoin during pregnancy, are described. The findings suggest the speculation that con current exposure to these teratogens, in utero, may have synergistic or additive effects upon a fetus, producing serious malformations. The purpose of this report is to alert physicians to this combined syndrome. Its occurrence may be more common than anticipated.
Isolated Testicular Relapse Five Years After Cessation of Chemotherapy for Acute Lymphoblastic Leukemia
Authors: Chu Jen-Yih , O'Connor Dennis M. , Cradock Thomas V. , Gale Gordon B.
Published: November 2007

A 12-year-old boy was diagnosed as having acute lymphoblastic leukemia (ALL) at the age of 2 years 10 months. Chemotherapy was discontinued after 33 months of continuous remisson of ALL. Isolated testicular relapse occurred 5 years after . cessation of treatment. Isolated testicular infiltration if it occurs, usually does so within one year after discontinuing treatment. Late bone marrow or extramedul lary relapse usually does not occur after four years post therapy. Testicular relapse in this patient occurred five years after completing chemotherapy.
Ruptured Branchial Cleft Cyst Presenting As Acute Thyroid Infection
Authors: Montgomery Gary L. , Ballantine Thomas V. N. , Kleiman Martin B. , Wright James C. , Reynolds Janet
Published: November 2007

A case is presented of a child with signs of recurrent acute thyroid infection which was found to result from rupture of an infected branchial cleft cyst abscess. This association has not previously been reported. A review of the bacterial etiol ogies of suppurative thyroiditis in childhood is presented.
Emergency Intracranial Pressure Monitoring in Pediatrics
Authors: Mayer Thom , Walker Marion L.
Published: November 2007

Over an 18-month period, 56 pediatric patients who sustained severe neurologic insults under went intracranial pressure (ICP) monitoring. Indications for monitoring ICP were (1) a Glasgow Coma Scale (GCS) score of 7 or less or (2) loss of consciousness with inability to utter recognizable words or follow commands. Diagnoses were head trauma (n = 40), Reye's syndrome (n = 10), and hypoxic encephalopathy due to near-drowning (n = 6). Eighty per cent of patients had ICP el evations requiring treatment. The complication rate was 5.3 per cent, with no serious compli cations or infections noted. Overall mortality was 14 per cent, but patients with hypoxic en cephalopathy had significantly higher mortality (33%) when compared to patients with head trauma (12.5%) or Reye's syndrome (10%). Other factors associated with a poor outcome included presence of an intracranial mass lesion, GCS score, ICP elevations, hypoxemia, hypotension, hypercarbia, and the presence of multiple injuries (p < 0.01). Early diagnosis and aggressive treatment in these patients, including the use of ICP monitoring, has resulted in acceptable recovery in over 85 per cent of these patients.
Treatment of Giardiasis
Authors: Lerman Stephen J. , Walker Richard A.
Published: November 2007

Giardia lamblia has emerged as the most common intestinal parasite in the United States. This article presents a brief review of the clinically important aspects of giardiasis and evaluates the currently used therapeutic agents. Three drugs have been advocated for the treatment of giar diasis : furazolidone (Furoxone®), metronidazole (Flagyl®), and quinacrine (Atabrine®). None of them, however, is ideal. Metronidazole and quinacrine are more effective than furazolidone, but furazolidone has the advantage of a liquid formulation that makes administration to children easier. Quinacrine is much less expensive than the other two agents but has a somewhat higher rate of side effects and a bitter taste. There is concern about the carcinogenic potential of fur azolidone and metronidazole, but this has not been evaluated for quinacrine. In the balance, we conclude that quinacrine is probably the preferable drug to use in the pediatric age group because of proven effectiveness and lower cost.
Screening Small for Gestational Age Babies for Congenital Infection
Authors: Primhak R.A.
Published: November 2007

The widespread practice in newborn nurseries of screening asymptomatic small for gestational age (SGA) babies for TORCH infection has been evaluated. In a retrospective review, we found that, in 1979, in our nursery 23 (35%) of the sixty-six SGA babies were investigated for TORCH infection. No asymptomatic baby was investigated adequately to exclude infection. The two proven cases of congenital infection were both apparent on other clinical grounds, and neither would have been detected by our routine serologic screening. A review of published information on asymptomatic TORCH infections showed that, in the absence of other clinical signs of infection, intrauterine growth retardation is an unusual manifestation. Clinical investigation of TORCH infection should be confined to those babies with other clinical evidence of infection.
Lateral Cervical Meningocele
Authors: Shore Richard M. , Chun Raymond W. M. , Strother Charles M.
Published: November 2007

Although lateral meningoceles have been described in the thorax, they have not been previously reported in the neck. We describe an infant who was born with a lateral meningocele in the cervical posterior triangle that was felt clinically to be cystic hygroma. Surgical excision was complicated by a cerebral spinal fluid fistula and subsequent meningitis. Problems that this patient presented and po tential complications in management are discussed. Although the clinical mani festations of lateral meningoceles and extradural cysts are quite different, there are many anatomic similarities between these entities and other cervical masses that confuse diagnosis and nosology. Their differential diagnosis is reviewed.
Pleural Effusion and Ascites
Authors: Rosenberg Henrietta Kotlus , Berezin Stuart , Heyman Sydney , Witzleben Camillus , Watkins John B.
Published: November 2007

The usual presenting features of vitamin A intoxication are pseuotumor cerebri, skeletal pain, desquamative dermatitis, and hepatic inflammation. Our patient was a nine-year-old female who had increasing cough, dyspnea, and abdominal dis tention for a short time prior to admission. She was said to have been treated with 10,000 units vitamin A per day for skin rashes. Radiographic studies revealed a very large right sided pleural effusion, ascites, demineralized bones, and retarded skeletal maturation. The diagnosis of hypervitaminosis A was made. More detailed medical history confirmed that the child had, in actuality, received up to 300,000 units/day of vitamin A plus desiccated liver pills and carrot juice for the previous year. Clinical symptoms completely abated following acute medical treatment for ascites and cessation of vitamin A intake. Several months later, a sample of liver, obtained and preserved at the time of exploratory laparotomy, was homogenized and extracted with ethanol/hexane. The retinyl palmitate level was significantly elevated and consistent with vitamin A poisoning.
Gram Stain Interpretation of Blood Cultures
Authors: Wald Ellen R.
Published: November 2007

Bacteremia without an obvious focus of infection occurs relatively frequently in highly febrile children between the ages of six and 24 months. Management depends on the clinical situation and probable identity of the bacteria. A year-long study to determine the accuracy of differentiating gram-positive cocci morphologically on the Gram-stained smear of a blood culture demonstrated that streptococci and staphylococci can be distinguished when Gram staining is the procedure used by the laboratory. From such a preliminary report, the bacteremia can be evaluated in the context of the clinical situation and appropriate action can be taken.
Streptococcal Pharyngitis
Authors: Funamura Janwyn L. , Berkowitz Carol D.
Published: November 2007

Clinical prediction of streptococcal pharyngitis at the initial visit is often difficult. The applicability of the gram stain in the initial assessment of streptococcal pharyngitis was evaluated by comparing gram stain with ultimate culture results. Positive gram stains showed polymorphonuclear cells and typical gram-positive cocci. Thirty-one physicians rotating through the Acute Care Clinic of a county teaching hospital participated in the evaluation. The sensitivity, specificity, and predictive value of a positive test (PVP) were 62 per cent, 70 per cent, and 47 per cent, respectively. These results were compared to a clinical algorithm and to the results of a group with more expertise in the technique. It is concluded that the gram-stained smear of pharyngeal secretions does not appear to be a practical tool for the diagnosis of streptococcal pharyngitis in a busy pediatric emergency unit of a teaching hospital.
How do Hyperactive Children Feel About Taking Stimulants and Will They Tell the Doctor?
Authors: Sleator Esther K. , Ullmann Rina K. , von Neumann Alice
Published: November 2007

There are no systematic data on the attitudes of hyperactive children toward treatment with stimulant medication. Such knowledge would be of aid to the physician in understanding the child, structuring therapy, and improving compliance; therefore we interviewed 52 hyperactive children who had been so treated. The outstanding findings were that a large fraction of the children disliked the medication and often tried to avoid taking it. The physician interview provides valuable information with some children, but for assurance of accuracy the clinician needs to use other sources of information.
Legal Issues in Psychological Abuse of Children
Authors: Yates Alayne
Published: November 2007

The pediatrician must observe and assess a variety of emotional disorders in children, many of which seem related to adverse parental attitudes and actions. It is important for the pedia trician to appreciate the judicial system's constraints in defining psychological abuse so that, when appropriate, legal interventions can be actively encouraged. Cases most likely to be ad judicated are those in which the caretaker's harmful acts and attitudes can be causally related to measurable emotional damage in the child. Other cases which may be suitable are those in which the parent's actions are patently atrocious or the parents have consistently refused to obtain treatment for a seriously disturbed child. Cases which satisfy these criteria, and some which do not, are presented.
Clinical Estimation of Liver Size in the Normal Neonate
Authors: Weisman Leonard E. , Cagle Nancy , Mathis Richard , Merenstein Gerald B.
Published: November 2007

Clinical estimates of liver size and comparative analysis of the clinical techniques of esti mating liver size are not available for neonates. Liver span was determined by a pediatrician and pediatric nurse practitioner, in 100 consecutive normal term neonates at 1 and 3 days of life, using four methods. The most reproducible method in estimating liver size in neonates is either (1) percussion of the upper and lower borders or (2) percussion of the upper border and palpation of the lower border. The clinical estimate of liver size in a healthy term neonate is 5.65 cm, with a 95% confidence limit of 4.25 to 7.00 cm. These values provide a basis for comparison during routine examination.
The Motor Development of Fat Babies
Authors: Jaffe Michael , Kosakov C.
Published: November 2007

The motor development of a group of fat babies was compared with that of a group of normal weight babies. A significant correlation was found between excessive weight and gross motor delay. Over the ensuing year, both weight and development reverted to normal in the majority of infants. The possible relationship between observations is discussed, and a plea is made that a comprehensive evaluation of the motor-delayed overweight infant be performed before con cluding that the delay is due solely to the excessive weight.
Hemophilus influenzae Epiglottitis Occurring Concurrently in Two Siblings
Authors: Handler Steven D. , Plotkin Stanley A. , Potsic William P. , Downes John J.
Published: November 2007

Epiglottitis (more properly supraglottitis) is a potentially life-threatening infec tion of the supraglottic larynx that is most often caused by Hemophilus influenzae type B (HITB). Intrafamily spread of HITB disease has been described often for meningitis, but is rarely reported in epiglottitis. We describe two siblings seen concurrently with HITB epiglottitis and discuss prophylaxis of family members and close contacts.
Occult Bacteremia in Toxic-appearing, Febrile Infants
Authors: Schwartz Richard H. , Wientzen Raoul L.
Published: November 2007

The prevalence of occult bacteremia was evaluated prospectively in two groups of infants: those with a toxic appearance and temperature greater than 38.8 C and a comparison group with similar fever but without a toxic appearance. All patients were diagnosed by one physician employed in a suburban, middle-class, private ambulatory pediatric practice. Toxicity scores were assigned based on the results of history and physical examination. Peripheral white blood cell (WBC) counts and blood cultures were obtained for every child. Of 52 toxic infants involved in the study, an infectious source, commonly otitis media, was found in 26 (50%). Eighteen patients (35%) had WBC counts above 15,000. Bacteremia was documented in six patients (12%), due to Streptococcus pneumoniae in five and to group C Streptococcus in one. Five bacteremic infants had toxic, febrile illnesses for which no overt focus could be identified. None of 31 febrile infants without a toxic appearance had bacteremia. We conclude that highly febrile, toxic-appearing infants are at risk for occult bacteremia even when they are seen in the pedia trician's office. Toxicity diagnosed on the basis of clinical findings in a febrile infant warrants obtaining a white blood cell count and a blood culture.
Infant Apnea Syndrome
Authors: Camfield Peter , Camfield Carol , Bagnell Philip , Rees Elihu
Published: November 2007

The frequency of proposed causes for the infant apnea syndrome (IAS) or "near miss" sudden infant death is unknown. Using a protocol, we investigated a small series of 28 consecutive infants with IAS. This in-hospital evaluation included, for all patients, blood chemistries; x-rays of skull, lumbar puncture, chest, and barium swallow; electrocardiogram, echocardiogram, 24-hour Holter cardiac monitor; viral and bacterial cultures of blood, urine, stool, and CSF; EEG; and esophageal pH study for gastroesophageal reflux (GER). A probable cause was found in 17 of the 28 infants including GER 6, encephalitis 4, convulsive disorder 3, periventricular edema 1, Arnold-Chiari malformation 1, milk allergy 1, periodic breathing 1. Home apnea monitors were used only by three, all of whom had no diagnosis and only these three had repeat apneic episodes. There have been no deaths during follow-up of 12 to 24 months. It is our conclusion that detailed evaluation of IAS often yields a specific diagnosis. The most valuable investigations were lumbar puncture, EEG, and esophageal pH studies.
Influenza Vaccination in Asthmatic Children on Maintenance Theophylline Therapy
Authors: San Joaquin Venusto H. , Reyes Santiago , Marks Melvin I.
Published: November 2007

Reports of toxic serum theophylline concentrations in adults following influenza vaccination prompted this study. Peak and trough serum theophylline concentrations were measured in eight severely asthmatic children before and after vaccination against influenza. All eight chil dren had been treated with chronic theophylline therapy for at least one year prior to joining the study. No significant alteration of theophylline levels were seen up to 52 hours after vac cination. No clinical evidence of drug toxicity developed.
Clinical Predictors of Pneumonia As a Guide to Ordering Chest Roentgenograms
Authors: Leventhal John M.
Published: November 2007

To develop criteria for a more efficient approach to the ordering of chest roentgenograms, patients with fever or respiratory symptoms who were being evaluated with this diagnostic test were prospectively monitored. During a six-month period, residents working in a pediatric emergency room collected data on 136 children, 3 months to 15 years of age. Pneumonia, defined by appropriate abnormal chest roentgenographic findings, occurred in 19 per cent. Of the 29 single symptoms or signs examined, the variable which was the best predictor of pneu monia was tachypnea. In addition, a cluster of pulmonary findings was also a good index for pneumonia. If these clinical criteria had been applied to the patients under investigation, the number of chest roentgenograms obtained would have been reduced by 30 per cent.
Proteinuria in Children
Authors: Burke Edmund C. , Stickler Gunnar B.
Published: November 2007

Current information relating to the clinical significance of proteinuria in children through adolescence was reviewed. Proteinuria may be transient, orthostatic, or fixed. The data indicate that only fixed proteinuria—that is, proteinuria on multiple urine examinations without pos tural exaggeration—may indicate serious glomerular disease. The patient should be followed with periodic but infrequent examinations, avoiding unnecessary, complicated, and hazardous investigations.
Fournier's Syndrome in Infants
Authors: Adeyokunnu Adetunji A.
Published: November 2007

Six children aged between 3 and 12 weeks were treated for Fournier's syndrome in our hospital between 1972 and 1979. Circumcision, diaper rash, and perianal skin abscesses were suspected as portals of entry for pathogens initiating the lesions. In two cases Staphylococcus aureus was isolated. Medical treatment of the gangrenous area proved successful in all cases, and the children survived with no appreciable scrotal skin loss or adhesions. Our results confute the approach of previous workers, most of whom have advocated aggressive surgical manage ment in a devastating illness like Fournier's gangrene.
Juvenile Nephronophthisis with Blindness in a Three-month-old Infant
Authors: Gruppuso Philip A. , O'Shea Patricia A. , Orson Jay M. , Brem Andrew S.
Published: November 2007

Juvenile nephronophthisis is a slowly progressive renal disease with onset in infancy, char acterized by impaired renal concentrating ability. The combination of juvenile nephronophthisis and tapeto-retinal degeneration, renal-retinal dystrophy, may cause blindness in infancy, and renal failure in the first decade of life. This syndrome has not been previously described as a cause of renal failure in young infants. We report an infant who presented at three months of age with blindness and renal insufficiency. In addition, this infant had a disproportionate degree of hypocalcemia and hyperphosphatemia compatible with relative parathyroid gland insuffi ciency. We propose that this was due to an inability of this infant's parathyroid glands to undergo compensatory hypertrophy, rather than a specific defect in parathyroid function as sociated with renal-retinal dystrophy.
An Approach to Psychiatric Referrals in Pediatric Patients
Authors: Hodas Gordon R. , Honig Paul J.
Published: November 2007

Psychiatric referral is an important aspect of clinical pediatric practice. This paper discusses referral to a family-oriented psychiatrist of difficult families with children who have an acute or chronic psychosomatic complaint. It is the responsibility of primary care physicians to de velop facility in making psychiatric referrals. In this way the physician will be equipped to deal effectively with cases requiring attention beyond his time and expertise, as well as cases that he will manage alone. The paper considers five decision-points relevant for pediatricians making effective referrals of children with somatic complaints. (1) The pediatrician decides whether to conduct the evaluation on an outpatient or inpatient basis. In either case the work-up should be completed rapidly. A diagnostic hospitalization, whereby the parents agree to accept the results of a clearly defined evaluation as definitive, may be used with inpatient evaluations. The proposal of such a diagnostic hospitalization is considered. (2) After the medical evaluation is completed, the pediatrician decides whether to manage the case alone or to make a psychiatric referral. (3) A family conference can be used to initiate pediatric management or to make a psychiatric referral. A joint meeting, with both pediatrician and psychiatrist present, may be a crucial part of the management of difficult psychosomatic cases. The four stages of a typical joint meeting are described. (4) The utility of giving indirect rather than direct explanations of the meaning of a somatic symptom is described. By scapegoating the symptom rather than either the child or the parents, indirect explanations are often less threatening and more ac ceptable to the family. (5) Similarly, psychiatric involvement is often best proposed by rec ommending evaluation rather than treatment, since evaluation is less binding and takes into account the natural reluctance of many families to see the psychiatrist. After the referral has been made, ongoing contact between psychiatrist and pediatrician is important.
Nondyslexic Children with Combined Writing and Arithmetic Learning Disabilities
Authors: Siegel Linda S. , Feldman William
Published: November 2007

A common presenting problem of children in pediatric practice is the constellation of symp toms involving difficulty in completing assignments, trouble with written work, and organiza tional problems. Typically, these children do not have difficulty with reading but show problems with academic achievement. We have recently studied 29 children, aged 7 to 13, referred for learning problems. They were not dyslexic, that is their reading abilities were normal, but they had significant difficulty with written tests and assignments and problems with arithmetic. In addition to difficulty with eye-hand coordination as measured by a test of visual motor inte gration, these children showed poor performance on short-term memory tasks when compared with children who do not have writing or arithmetic problems. Suggested treatments include the use of tape recorders, typewriters, and calculators to help compensate for the writing and short-term memory difficulties associated with these learning problems. The pediatrician, acting as child advocate, can exert influence within the traditional school system to gain acceptance for use of learning aids by children with a developmental output disability.
Compliance with Pediatric Therapy
Authors: Jones Jerry G.
Published: November 2007

The problem of compliance with treatment is largely ignored in the major pediatric textbooks at the present time. However, the physician's responsibility should include a concern for the practicality of therapy and its acceptance by both parents and children. The subject of com pliance as related to pediatrics is selectively reviewed, and likely ways the physician can promote compliance are provided.
The Winnecott "Set Situation"
Authors: Taylor Toni , Osbom Lucy M.
Published: November 2007

D. W. Winnecott devised a short, simple test which he used to evaluate normal infants. In this study, we compared 9-month-old infants' behaviors elicited during the Winnecott Test (WSS), both with historical data and with their behavior during a structured separation from their mothers. We found significant correlations between the WSS, the structured separation, and historical data. This simple test can provide the practitioner with invaluable information regarding the infant, his temperamental style, and his relationship with others.
Immune Thrombocytopenia Associated with Tuberculosis
Authors: Jurak Stephen S. , Aster Richard , Sawaf Hadi
Published: November 2007

Thrombocytopenia associated with Mycobacterium tuberculosis infection de veloped concurrently in a mother and son. Antiplatelet antibodies were dem onstrated in the serum of both patients. It is suggested that this and possibly other hematologic complications associated with tuberculosis are immune me diated.
Sterilization of Infant Formula
Authors: Gerber Michael A. , Berliner Benjamin C. , Karolus John J.
Published: November 2007

A survey of 237 pediatricians currently practicing in Connecticut revealed that 97 (41%) recommend routine sterilization of infant formula for a mean of 4.4 months.

Eight bottles of proprietary formula were prepared in a controlled manner: four utilizing the "terminal heating method" of sterilization and four utilizing the "clean method" without sterilization. While the "terminal heating method" resulted in less bacterial contamination, three of the bottles prepared by the "clean method" had negative coliform counts and the other bottle had a minimal count.

Ten bottles prepared without sterilization were randomly selected from mothers who had brought their infants for well-child care. With the exception of a small inoculum of enterotoxin- producing Staphylococcus aureus in one bottle, no enteropathogens were identified.

The implications of this study for the routine preparation of infant formula are discussed.
Bacterial Tracheitis—An Old Disease Rediscovered
Authors: Sofer S. , Duncan P. , Chernick V.
Published: November 2007

During a 3-year period, seven children with bacterial tracheitis were admitted to the intensive care unit of the Winnipeg Children's Hospital. The illness was characterized by fever, toxicity, and stridor. Respiratory difficulty was secondary to copious thick purulent tracheal secretions. In the majority of patients the illness was caused by Staphylococcus aureus, and the rest had Hemophilus influenzae infection. Viral studies in five patients were negative. Most patients re quired endotracheal intubation and frequent tracheal toilet to prevent serious airway obstruc tion. In our ICU, bacterial tracheitis accounted for about 14 per cent of admissions with in fectious upper airway obstructive illness, while epiglottis and croup accounted for 55 per cent and 31 per cent, respectively. Only 5 per cent of children with croup admitted to the hospital were admitted to the ICU. Bacterial tracheitis has reappeared, at least in North America, as an important and serious cause of obstructive upper airway disease in children and must be rec ognized early in order to prevent catastrophic airway obstruction.
Pneumatocele in Infants and Children
Authors: Amitai Iona , Mogle Paul , Godfrey Simon , Aviad Ithamar
Published: November 2007

Pneumatoceles were found in 2.4 per cent of 493 infants and children with pneumonia. In all cases, attempts were made to establish the etiology by means of blood cultures and of deep tracheal aspirations or pleural punctures, when indicated. A definite cause was established in 9 of 12 cases. Seven were due to infection: in two Hemophilus influenzae was involved; two others were due to Pseudomonas aeruginosa; and Staphylococcus aureus, Klebsiella pneumoniae, and Streptococcus pneumoniae were each isolated in one case. Two pneumatoceles were seen following kerosene ingestion. A coagulase negative staphylococcus isolated only on blood culture in one other child may have been related to the illness. Two patients experienced spontaneous pneu mothorax and died of progressive respiratory failure due to enlargement of the pneumatocele, but all the other patients recovered without complication. Pneumatoceles in childhood can result from a variety of bacterologic infections as well as from kerosene ingestion.
Central Nervous System Manifestations of Sarcoidosis in Children
Authors: Weinberg Stuart , Bennett Harvey , Weinstock Irving
Published: November 2007

We report a case of central nervous system (CNS) sarcoidosis in a young girl and review the literature on the CNS manifestations of sarcoidosis in 23 cases occurring in children.
Behavior Modification in the Treatment of Rumination
Authors: Mestre Jose R. , Resnick Robert J. , Berman Wallace F.
Published: November 2007

Rumination is repeated regurgitation without nausea or associated gastrointestinal illness with concomitant weight loss and malnutrition. This paper describes a ruminating infant who was becoming severely malnourished. Hyperalimentation was used to provide necessary nutri tion, and a paradigm of aversive behavior modification was instituted. This form of therapy was successful after less than four weeks, with no harmful side effects and no recurrence of the disorder.
Manic-depressive Variant Syndrome of Childhood
Authors: Potter Rebecca L.
Published: November 2007

A case is described of manic-depressive variant syndrome of childhood in a ten-year-old boy. Children with manic-depressive variant syndrome frequently have signs and symptoms of hy peractivity and are often first seen by their pediatrician. The diagnoses of attention deficit disorder, organic mental disorder, borderline personality disorder, and childhood schizophre nia, are discussed with relation to their differentiation from the manic-depressive variant syn drome of childhood. The discussion further describes the early onset of symptoms in this boy and points out how a consideration of this diagnosis might be possible in early childhood, allowing for early inauguration of lithium therapy.
Hair Zinc Levels in Infants
Authors: Collipp P.J. , Kuo B. , Castro-Magana M. , Chen S.Y. , Salvatore Steven
Published: November 2007

Hair zinc concentration was determined by atomic absorption spectrophotometry in 308 normal neonates and in 119 normal infants aged 1 to 12 months. Hair zinc concentration declined from 204 μg/g at birth to 112 μg/g at age 8 months, and then rose to 144 μg/g at age 12 months. Breast-fed infants had higher hair zinc than formula-fed infants.
Successful Treatment of Supraventricular Tachycardia with Metoprolol, a Cardioselective Beta Blocker
Authors: Hepner Seymour I. , Davoli Enrico
Published: November 2007

Paroxysmal supraventricular tachycardia is a common problem in infancy and childhood. Past treatment has included digitalis and nonselective beta block ers (propranolol). We describe a new mode of therapy with a cardioselective beta blocker (metoprolol) that may be of use in patients resistant to standard therapy.
Direct Hyperbilirubinemia Complicating ABO Hemolytic Disease of the Newborn
Authors: Sivan Yakov , Merlob Paul , Nutman Jacob , Reisner Salomon H.
Published: November 2007

A retrospective study of the diagnostic implications of conjugated hyperbilirubinemia com plicating ABO hemolytic disease of the newborn (HDN) was done by studying the records of 264 infants with ABO-HDN. Direct hyperbilirubinemia was found to complicate ABO-HDN in 3 per cent of the infants, all being full term. Eighty-seven per cent were female and familial occurrence was noted in half of the cases. Most of the infants presented with anemia on the first day of life. Our data suggest that this is a benign complication of ABO-HDN which clears within a month.
The Effect of Early Feeding on Plasma Glucose Levels in SGA Infants
Authors: Wright Linda L. , Stanley Charles A. , Anday Endla K. , Baker Lester
Published: November 2007

Plasma glucose levels were measured during the first day of life in 24 small-for-gestational- age (SGA) infants who began formula feedings within two hours of birth. In contrast to the high incidence of low blood sugar seen previously in fasted SGA infants, no infant had a plasma glucose below 30 mg/dl; after the first feeding, no values below 40 mg/dl occurred. Mean plasma glucose levels were lower in infants born to mothers with preeclampsia (57.2 ± 2 vs 69.7 ± 2.3 mg/dl, p < .005). The results indicate that hypoglycemia (plasma glucose < 40 mg/dl) can be easily avoided in SGA infants simply by providing adequate calories without delay after delivery.
Myocarditis as a Complication of Infantile Chlamydia trachomatis Pneumonitis
Authors: Ringel Richard E. , Givner Laurence B. , Brenner Joel I. , Huang Shih-Wen , Wang San-pin , Grayston J. Thomas , Berman Michael A.
Published: November 2007

The case is presented of an infant with chlamydia pneumonitis who developed clinical and electrocardiographic signs of myocarditis. No significant antiviral antibodies developed. Elevated antichlamydial IgG titers were demonstrated during the initial phase. These declined during convalescence. This report provides further evidence associating C. trachomatis with infectious myocarditis.
Focal Convulsions Associated with Subclinical Measles Infection
Authors: Michener Robert C. , Henley Walter L.
Published: November 2007

A patient with focal convulsions of sudden onset had cerebrospinal pleocytosis and electroencephalographic evidence of a focal lesion in the right hemisphere. Except for fever, there was no clinical evidence of a viral infection. Measles antibodies were detected in the serum and CSF. The CSF abnormalities resolved, and the patient has been well for 4 years. This case is unusual because of the focal CNS involvement and the lack of any other clinical features of measles infection.
The Impact of Divorce on Teenagers
Authors: Westman Jack C.
Published: November 2007

Divorce is common in the contemporary way of life and deserves objective study. It may have redeeming features, but from the point of view of children, divorce is a stressful experience because of the disruption of the home and its financial, emotional, and social costs. The adverse impact, however, can be minimized by realistic and sensitive attention to its effects on children. Although divorce alters the living arrangements of affected families, it does not end family relationships. For this reason, marriage and divorce counseling should deal with the perspectives of both adults and children.

Most teenagers and their parents adjust to divorce and later regard it as having been a constructive action; but one-third do not. In those instances the turbulence of the post-divorce phase plays a crucial role in influencing pathological reactions in affected teenagers. The phy sician is in a strategic position to act as diagnostician, a clarifier of values, an educator in the facts of family life and divorce, a counselor in working through feelings about and attitudes toward divorce, and a source of support for teenagers.
Short Stature and Dysmorphism in the Child and Adolescent Female
Authors: Rohn Reuben D.
Published: November 2007

The clinician often encounters girls with varying combinations of short stature and subtle dysmorphic features that are compatible with either Turner or Noonan syndrome. A classic case of either syndrome with extensive unmistakable traits is the exception rather than the rule. Six cases are presented to help describe some of the difficulties in differential diagnosis and provide strategies to avert them.
Incidence of Acute Rheumatic Fever
Authors: Schwartz Richard H. , Hepner Seymour I. , Ziai Mohsen
Published: November 2007

The incidence of acute rheumatic fever has declined remarkably in the past three decades, but the disease has not been eradicated, as some physicians believe. This study documents the diagnosis of the disease in 23 middle-class children from Fairfax County, Virginia, during the 11-year- period from 1970 through 1980. This county has one of the highest median family incomes in the United States. The annual age-adjusted incidence rate of initial attacks of acute rheumatic fever per 100,000 Fairfax County children declined from 3.0 in 1970 to 0.5 in 1980.

In six of the 23 children, carditis accompanied by monarticular arthritis or arthralgia was present. Another seven children had carditis plus polyarthritis. Two patients had Sydenham's chorea. None of the children had erythema marginatum or rheumatoid nodules. In two children, symptoms of acute rheumatic fever developed two weeks after they finished a 10-day course of penicillin for Group A streptococcal pharyngitis. The remaining 21 children had not been considered ill enough to be brought to medical care prior to development of symptoms of acute rheumatic fever.
Near-fatal Kearns-Sayre Syndrome
Authors: Rheuban Karen S. , Ayres Nancy A. , Duncan Sellers T. , DiMarco John P.
Published: November 2007

The Kearns-Sayre syndrome is a relatively uncommon condition which occurs in childhood and is characterized by neurologic dysfunction and abnormalities in atrioventricular (AV) conduction. The high mortality rate is directly attrib utable to the cardiovascular manifestations of this syndrome. We report a case, with documentation of a "near-fatal" episode, and review the pertinent clinical features of the syndrome.