bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolated Coronary Ostial Stenosis in Takayasu's Arteritis: Case Report and Review of the Literature
Authors: Noma Mitsuru , Sugihara Masayoshi , Kikuchi Yutaka
Published: June 2008

This report describes a rare clinical course of a young Japanese woman with Takayasu's arteritis and a review of the literature. Her first symptom was angina pectoris due to isolated left coronary ostial stenosis, which was relieved by aortocoronary bypass grafting surgery using a saphenous vein graft. At that time, the C-reactive protein was negative and the histopathologic findings of the specimens of the aorta could not confirm aortitis. Although she was free from any cardiovascular symptoms for about fifteen years,. syncopal attacks occurred owing to severe stenosis of the major branches of the aortic arch revealed by intravenous digital subtraction arteriograms.

Thus, Takayasu's arteritis could be a cause of coronary ostial stenosis in young women even if the inflammatory findings are negative and the major branches of the aortic arch are not involved at operation. In addition, revascularization using internal thoracic arteries might possess a potential risk of coronary insufficiency due to a later involvement of these proximal arteries.
Initiating Support Groups for Pediatric House Officers
Authors: Strahilevitz Aharona , Yunker Rose , Pichanick Adney Melvin , Smith Leigh , Richardson Joan
Published: June 2008

Several research studies document the stress of residency training and suggest that support groups may provide house officers with opportunities to release tension, and to attend to their feelings about their experiences. In planning such groups, consideration should be given to the need for this kind of program, its organization, and the means by which it can be evaluated.
Interaction of Health-care Professionals with Critically III Children and Their Parents
Authors: Marten George W. , Mauer Alvin M.
Published: June 2008

The stresses imposed on the emotional equilibrium of a team of health-care professionals by the serious illness of a child can disrupt communication among the team, the child, and the parents. Such stresses may be so severe as to interfere with the ability of the adults to meet the child's needs. Although the feelings and attitudes of critically ill children and their parents are well described in the medical literature, very little has been written about the psychosocial interaction among those responsible for the patient's care. Patterns of interaction which would be most beneficial to the child are still in doubt.

The purpose of this article is to review available information, as well as experience at St. Jude Children's Research Hospital, on the psychosocial interaction of the health-care team with crit ically ill children and their parents. An awareness of the difficulties of caring for such patients is essential in overcoming communication barriers, in reducing any interprofessional tensions that might arise during treatment, and in ensuring high-quality medical care.
Prophylaxis of Neonatal Conjunctivitis
Authors: Bernstein Gail A. , Davis Jeffrey P. , Katcher Murray L.
Published: June 2008

The recommendation by the Centers for Disease Control (CDC) that erythromycin and tetra cycline ointments, as well as topical silver nitrate solution, are acceptable regimens for prophylaxis of gonococcal ophthalmia neonatorum (GON) has resulted in widespread local review of policies for ocular prophylaxis. The data concerning the efficacy and side effects of these agents are somewhat confusing or nonexistent. We discuss the etiologies of neonatal conjunctivitis and the topical and systemic agents used for prophylaxis of GON. We also review all studies that have compared the efficacy of one prophylactic agent with that of another agent or with no prophylaxis. It is found that all three agents have similar efficacy in preventing GON, although silver nitrate has been used more extensively in populations at high risk for GON. However, since Chlamydia trachomatis is the most common infectious cause of neonatal conjunctivitis in the United States at this time, and erythromycin appears to be very effective in prevention of neonatal conjunctivitis due to C. trachomatis, it may have an advantage over the other two agents. In addition, eryth romycin use is associated with fewer ocular reactions than is silver nitrate.
Diagnosis of Adolescent Pregnancy—1965 vs 1980
Authors: Silber Tomas Jose , Saadat Manoochehr
Published: June 2008

This study compares changes in the accuracy of the diagnosis of pregnancy in adolescents between 1965 and 1980. We compared 44 records of adolescents evaluated in 1965 to those of 44 who were evaluated 15 years later in 1980. The following data were examined: (1) reason for consultation, (2) amount of time prior to making the correct diagnosis, and (3) the most common diagnostic errors. The results showed that (1) the initial diagnosis was correct only 75 per cent of the time in 1965 and 86 per cent in 1980, (2) both in 1965 and 1980 most patients initially consulted for "vague complaints," (3) in 1965 and 1980 the most common diagnostic errors were "gastrointestinal disorder" and "functional symptoms," and (4) pregnancy was diagnosed earlier in 1980 than in 1965.

Improvement in diagnostic accuracy should be possible if clinicians screen for pregnancy in adolescent girls consulting for vague symptoms such as nausea, weight gain, urticaria, and som nolence.
The Child with a Stiff Neck
Authors: Stein Martin T. , Trauner Doris
Published: June 2008

The child with a stiff neck can be a challenging diagnostic exercise. Four unusual examples of acute neck stiffness, not associated with meningitis, are presented to illustrate the various pathologic conditions which may produce this symptom. A differential diagnostic schema is sug gested on the basis of pathologic and physiologic alterations of cervical and paracervical anatomic structures.
Differential Pulmonary Auscultation in Neonates
Authors: Ackerman Neel B. , Bell Richard E. , deLemos Robert A.
Published: June 2008

Auscultation of neonates by means of conventional techniques is subject to many errors. Consequently, pediatricians rely on radiographs for much of their infor mation regarding ventilation abnormalities. We report a method of simultaneous differential auscultation, using a double-headed stethoscope, which allows better auscultatory evaluation of neonates. The technique is simple and easily learned. The equipment used is inexpensive and easily constructed. The technique is most useful in emergency and transport situations when radiographs are not readily available.
The Diagnostic Value of the Neurodevelopmental Examination
Authors: Farber Jon Matthew , Shapiro Bruce K. , Palmer Frederick B. , Capute Arnold J.
Published: June 2008

The neurodevelopmental examination is a pediatric approach to developmental diagnosis that relies on evaluation of multiple streams of development. The value of the neurodevelopmental examination for the early diagnosis of cerebral palsy and mental retardation was studied by a retrospective analysis of prospectively (longitudinally) collected data. Both conditions were found to be accurately diagnosed in the first year of life. For cerebral palsy, sensitivity was 0.81 and specificity 1.00; for mental retardation, sensitivity was 0.56 and specificity 0.96. The trained pediatrician can make early diagnoses of developmental disabilities.
Behavior and Feeling Changes in Siblings of Hospitalized Children
Authors: Craft Martha J. , Wyatt Nancy , Sandell Bonnie
Published: June 2008

The effects of hospitalization on ill children and their parents have been studied repeatedly, but effects on well siblings have received little attention. This investigation was designed to investigate sibling reactions when a brother or sister is hospitalized. The changes in feelings and behavior as reported by 123 siblings of hospitalized children and their parents from a large teaching hospital were studied. Young siblings were interviewed, while older siblings and parents were given a questionnaire. Siblings reported an average of four changes each. The number of changes reported by siblings was related significantly to several factors, such as sibling age, relationship of sibling with hospitalized child, explanation, fear of getting the illness, residence of sibling during hospitalization of the sick child, and perceived changes in parenting.

Even though siblings reported 519 changes, their patents reported only one-half that number. Parents of hospitalized children may not know how their well children are reacting. For this reason, health professionals need to interview siblings as well as parents to assess sibling welfare accurately. In addition, health professionals can help siblings by insuring that an adequate explanation is given to siblings and by encouraging parents to maintain siblings at home, either with a sitter or family members.
Pediatric Flexible Bronchoscopy and Its Application in Infantile Atelectasis
Authors: Nussbaum Eliezer
Published: June 2008

Forty-six pediatric flexible fiberoptic bronchoscopies were done on 29 infants under 1 year of age, including a 2.3-kg 1-week-old infant girl, and 17 small children between 1 and 2 years of age with persistent unilobar or multilobar atelectasis and declining PaO2 or rising PaCO2. Atelectasis resolved in all 29 infants (100%) and 10 of 17 (59%) small children after direct visualization, bronchial washing, and removal of mucous plugs and/or secretions using a flexible fiberoptic bronchoscope (FFB).

The procedure was not associated with any mortality or significant morbidity. Only one infant experienced minor epistaxis and another had transient minimal stridor. None of the 17 small children developed complications. The procedure resulted in resolution of respiratory distress and cough within 24 hours, as well as early hospital discharge in all patients regardless of complete or partial radiographic expansion.

Arterial blood gases were improved or normalized in 16 patients. When utilized for selective aspiration of mucous plugs or bronchial secretions, pediatric flexible bronchoscopy is particularly helpful in children with segmental or lobar atelectasis.
Rubella Seronegativity in a Low Socioeconomic Adolescent Female Population
Authors: Cohen Zori Beth , Rice Lynn I. , Felice Marianne E.
Published: June 2008

Ninety low socioeconomic adolescent females (aged 16-22 years, x 18.6 years) were screened for rubella immunity using a rubella IgG enzyme immunoassay. Data concerning past immuni zations (with documentation, if possible), prior rubella disease, and previous pregnancies were gathered through direct interviews. Results revealed 20 percent (18/90 girls) were seronegative. Fifty-eight percent (42/72) of the seropositive girls and 50 percent (9/18) of the seronegative girls gave verbal reports of previous rubella immunization, but only 11 subjects (12.2%) could provide documentation of previous vaccination, including one seronegative subject. Thirty-one percent (28/90) of the study population had a history of one or more previous pregnancies (22 therapeutic abortions, 10 live births, and 8 spontaneous abortions). A comparison of the seronegativity rate between the 28 girls who were pregnant previously and the 62 girls who were never pregnant demonstrated a significantly higher seronegativity rate among those who had been pregnant (29% vs. 16%; χ2 = 5.51; p < 0.05). The results of this study suggest that 1) the seronegativity rate in this age group is consistent with previous reports of rubella immunity, 2) few adolescents can provide documentation of rubella vaccination, and 3) presentation for abortion is an optimal time to vaccinate rubella susceptible females.
Newborn Screening for ABO Hemolytic Disease
Authors: Levine David H. , Meyer H. Belton P.
Published: June 2008

Confusion still exists regarding the true incidence of ABO hemolytic disease and the significance of the various laboratory investigations commonly employed in its evaluation. With such imprecision in diagnosis, early hospital discharge of newborns can be a potential problem. To evaluate the usefulness of more extensive screening than commonly employed and to identify possible indicators of severity, a pilot study of cord blood screening was undertaken. In the study, 1391 cord blood specimens were tested for type, Rh, direct antiglobulin test (DAT), indirect Coombs, and total and indirect bilirubin. Of the specimens, 53.3 percent were type A, B, or AB, and 19.3 percent of both A and B infants and 7 percent of AB infants had immune antibodies in their sera. DAT was neither diagnostic nor predictive of severity. DAT was negative in 48 percent of infants with serum antibody and did not correlate with cord blood or peak serum bilirubin levels. The cord blood bilirubin also was not diagnostic of hemolytic disease but was moderately predictive of peak bilirubin levels. The data do not support the use of any routine screening tests in the management of ABO hemolytic disease.
Philadelphia Chromosome-Positive Chronic Myelogenous Leukemia Following Apparent Acute Lymphoblastic Leukemia
Authors: Hajjar Katherine A.
Published: June 2008

The observation that Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL) may progress to chronic myelogenous leukemia (CML) has been well-documented among adult patients but reported only rarely in children. In this report, we describe a pediatric patient with atypical ALL, who subsequently went on to develop classical adult-type CML. This patient is unique and important because of the unusual clinical findings that she exhibited during the "ALL" phase, namely, extreme thrombocytosis, marrow fibrosis, and persistent spleno megaly, which heralded the onset of frank CML. It is suggested that the patient with presumed, but atypical, ALL by carefully evaluated for CML presenting in lymphoblastoid crisis, and that all patients with the morphologic diagnosis of ALL undergo complete cytogenetic and immunologic marker studies to confirm the diagnosis.
Monitoring the Resuscitation of Preterm Infants in the Delivery Room Using Pulse Oximetry
Authors: Maxwell Lynne G. , Harris Andrew P. , Sendak Michael J. , Donham Robert T.
Published: June 2008

The first few minutes after birth are a critical time of adaptation of the newborn infant to extrauterine life. The adequacy of that adaptation has been evaluated by means of the summed Apgar score. In preterm infants, Apgar score may correlate less with adequacy of cardiopulmonary function because of developmental immaturity. Measurement of arterial oxygen saturation by means of pulse oximetry offers a physiologic, real time method of monitoring the progress of cardiopulmonary adaptation by which the clinician can evaluate the need for and success of resuscitative efforts. Four preterm infants are reported in whom pulse oximetry was useful in assessing the changes in oxygen saturation during resuscitation.
Impact of the Diagnosis of AIDS on Hospital Care of an Infant
Authors: Krener Penelope G.
Published: June 2008

Detailed analysis of caretaker response to the first infant newly diagnosed with AIDS at a university hospital was done by review of nursing notes for three periods: before diagnosis of AIDS, after diagnosis, and after psychiatric consultation. Five consultation questions were posed, and the findings on investigation of these questions are discussed. It was found that the percentage of time that PRN medication was given dropped after diagnosis of AIDS but rose above the initial level after the consultation. The number of times per shift the nurse touched the baby (TLCs) was not found to be associated with use of PRN medication; rather it was explained by which nurse was caring for the child.

This study focuses on variations in nursing care of one infant to illustrate how variation in caretaker response can amplify the range of perturbations of the infant's behavioral response. It is speculated that caretakers of patients with AIDS may normally have feelings considered unacceptable in medical settings, including fear, blaming the patient, or a wish to avoid the patient. Such feelings are more difficult to tolerate in the care of children or infants and are superimposed upon the familiar stains associated with the care of chronically ill or dying pediatric patients.
Nonsurgical (Conservative) Treatment of Giant Omphalocele
Authors: Festen C. , Severijnen R.S.V.M. , Staak F. H. J. v. d.
Published: June 2008

Between January 1970 and December 1984, 65 patients with a congenital anterior abdominal wall defect were admitted to the Pediatric Surgical Center of the St. Radboud Hospital, Nijmegen, The Netherlands. There were 39 cases of omphalocele. Ten had giant omphalocele, defined as omphalocele that could not be closed primarily. In these cases, a conservative method of treatment was used.

The results are reported of these 10 cases of giant omphalocele with special emphasis on mortality, complications, and length of hospital stay. Mean hospital stay was 95 days. Local infection did not present serious problems. Sepsis occurred in half the patients but was managed with antibiotics. There was one case of late volvulus of the stomach.

All local applications, if used regularly, gave rise to complications. Two cases of hypothyroidism caused by the application of povidon-iodine and one case of alcohol intoxication were observed. In early years, one child was lost due to mercury poisoning. There was one early and one late death unrelated to the procedure.
Hypospadias and Urethral Abnormalities in Down Syndrome
Authors: Lang David J. , Van Dyke Don C. , Heide Fran , Lowe Phillip L.
Published: June 2008

In the course of general medical evaluations of 149 children and adolescents (younger than 21 years of age) and 11 adults with Down syndrome, five of the 77 males were noted to have dorsal urethral duplications. In all instances, there proved to be a single urethral meatus. The second opening led into a pit or blind channel, reflecting the presence of a distal hypospadias. In these five patients, laboratory studies were normal, nephrology histories were negative, and radiographic studies did not demonstrate any anatomic abnormalities of the urethra, ureters, or kidneys. These findings indicate that there is an increased occurrence of distal hypospadias in males with Down syndrome that may present with dorsal urethral duplications and/or glanular hypospadias.
Epispadias with Complete Prepuce and Phimosis in a Neonate
Authors: Merlob Paul , Mor Naomi , Reisner Salomon H.
Published: June 2008

A rare type of epispadias in a neonate is described in which a complete phimotic prepuce was present. In this situation, the accurate diagnosis is very difficult and may be easily overlooked in the neonatal period. The broad, spadelike glans, the dorsally directed prepucial opening, and the urinary stream are signs previously described. The special shape of the raphe penis and the depression between the corpora cavernosa felt by palpation of the glans are useful new clinical signs to suspect this type of epispadias.
Seizures in the Neonatal Intensive Care Unit of the 1980s
Authors: Calciolari Guido , Perlman Jeffrey M. , Volpe Joseph J.
Published: June 2008

A retrospective review was taken of 150 newborns with seizures evaluated at the same medical center and by the same investigator(s) from 1982 to 1987. The aims of the study were to determine in this current population the distribution of clinical seizure types, the distribution of causative etiologies, and the relation of etiology to the timing of onset of the seizures. Seizures were classified as subtle, multifocal clonic, generalized tonic, focal clonic, and myoclonic.

Subtle (65% of total) and multifocal clonic seizures (54% of total) were the most common seizure types. Subtle seizures usually occurred in combination with other seizure types. Only one seizure type was related to gestational age, i.e., focal clonic seizures in the term infant. Hypoxic-ischemic encephalopathy (65% of total) was by far the most common etiology in both preterm and term infants. Seizures with hypoxic-ischemic encephalopathy occurred characteristically early in the neonatal period, i.e., 90 percent in the first 2 days of life. Moreover, 80 percent of all seizures in the first 2 days of life were related to hypoxic-ischemic encephalopathy.
An Unusual Presentation of an Infected Urachal Cyst
Authors: Boyle Grace , Kotlus Rosenberg Henrietta , O'Neill James
Published: June 2008

An infected urachal cyst classically presents with a tender lower midline abdominal mass and systemic signs of infection, including fever, malaise, and leukocytosis. At times, the findings may be clinically confused with those of acute appendicitis, Meckel's diverticulitis, or peritonitis. Sonography aids in differentiating these entities by identifying the localized cystic mass containing debris, located anteriorly in the low mid-abdomen, extending from the region of the bladder to the umbilicus. We present an unusual case of an infected urachal cyst in a 6-year-old boy who presented with lower abdominal pain, fever, intermittent diarrhea, polyuria and dysuria, a firm, fixed left lower quadrant tender mass, and an elevated white blood cell count.
Determination of the Time of Closure of the Ductus Arteriosus in Severely III Premature Infants
Authors: McKone Robert C. , Weesner Kenneth M.
Published: June 2008

In order to investigate the time of ductal closure in the premature infant, we performed multiple echocardiographic examination in each of 42 premature infants. Twenty eight of these infants had spontaneous closure of the ductus arteriosus (median date of closure—3 days). Twelve required medical or surgical closure of the ductus arteriosus and two died of severe lung disease. There was a significant relationship of decreasing birth weight to prolonged patency of the ductus arteriosus.
Late Closure of the Ductus Arteriosus Using Indomethacin in the Preterm Infant
Authors: Kresch Mitchell J. , Moya Fernando R. , Ascuitto Robert J. , Ross-Ascuitto Nancy T. , Heusser Felipe
Published: June 2008

Several studies have shown a lack of effect of indomethacin therapy for the closure of a patent ductus arteriosus (PDA) in premature infants over 14 days of postnatal age. In this report we describe two cases in which a hemodynamically significant PDA was closed with indomethacin in preterm infants over 20 days of age. The response to indomethacin may be more related to postconceptual age than to actual postnatal age. We suggest that intravenous indomethacin therapy should be attempted before surgical ligation is performed in those premature infants under 34 weeks postconceptual age who have a hemodynamically significant patent ductus arteriosus.
Stool Water Loss in Very-low-birth-weight Neonates
Authors: Patrick Celeste H. , Pittard William B.
Published: June 2008

Fluid requirements in very-low-birth-weight (VLBW) infants include compensation for renal, insensible (skin and lung), and stool losses and provision for fluid retained for growth. Current estimates of stool water losses in VLBW infants are based on measurements established in term neonates. Therefore, the water content of 24-hour stool collections were determined in 11 healthy VLBW male infants on full enteral feeds and compared to the working norms. The neonates in this study were less than 2 weeks old with a mean ± SD birth weight and gestational age of 1,311 ± 112 g and 30.8 ± 1.5 weeks, respectively. They were receiving only enteral formula feedings of 100 ml/kg/day or more with no parenteral fluid supplementation. The mean ± SD number of stools and water content of the stools was 2.7 ± 2.0/day and 7.2 ± 4.0 ml/kg/day, respectively. There was a significant correlation (r = 0.696, p < 0.02) between gestational age at birth and number of stools per day, but the correlation between stool water loss per day, gestational age, volume of feedings per day, and birthweight was not significant. Based on this study, 7 ml/kg/day is a reasonable estimate of daily stool water loss in VLBW babies.
Alimentary Tract Duplications in Children
Authors: Bissler John J. , Klein Robert L.
Published: June 2008

This report reviews 11 alimentary tract duplications over a 25-year experience at Children's Hospital Medical Center of Akron, Ohio. The cases are compared and contrasted to the literature with respect to lesion, location, and patient presentation. There were no multiple duplications in this series. Clinical presentations were related to obstruction, abdominal pain, and/or hemorrhage. There were four foregut duplications, five midgut duplications, and two hindgut lesions. All patients were treated by surgical removal and all survived. One case was an incidental finding at appendectomy. Pooled data from five large series of duplications revealed the ileal region to be involved in 41 percent of all duplications, followed by esophageal (21 %), gastro-duodenal (12%), and jejunal (8%). Diverticular, recanalization, and split notochord theories of pathogenesis are discussed. The curious association between duplications and gastric mucosa is explored.
Down Syndrome
Authors: Van Dyke Don C. , Gahagan Cheryl A.
Published: June 2008

A review of the radiographs of 34 individuals with Down syndrome (DS), between 5 and 21 years of age, demonstrated subluxation of atlantoaxial instability (C1-C2) greater than 5 mm in three of the 34 individuals (9 percent). This is in general agreement with previously reported ranges of 10 to 20 percent. A review of the cervical spine radiographs of adults with DS, between 26 and 42 years of age, showed no subluxation but significant degenerative changes of the cervical spine with spur formation, narrowing of foramina, narrowing of the disc inner space, and osteophyte formation.

In both the DS child and the DS adult, the cervical spine may be an area of significant potential problems. In all cases any complaints of cervical pain or historical/clinical findings suggestive of neurologic involvement should initiate evaluation of the cervical spine. Baseline radiographic studies of the cervical spine are indicated in all DS children older than 5 years of age and should be considered in all DS adults, particularly those 30 years of age and older.
Home Nebulizers in Childhood Asthma
Authors: Ryan C. Anthony , Willan Andrew R. , Wherrett Brian A.
Published: June 2008

Seventy five percent of 91 parents of asthmatic children (aged 6 months to 15.4 years) with home nebulizers, responded to a questionnaire that sought to document parental experience with this form of therapy. The most common indications for acquiring a nebulizer were inability to use metered dose inhalers and poor response or intolerance to oral medications. When the children were classified into those who used the nebulizer daily (27/69) and those who used it less than daily (42/69), we found that the daily users were more likely to be in the severest category of asthma, by parental assessment, prior to the home nebulization program (p = 0.0035).

Retrospective, uncontrolled comparison before and after the acquisition of a home nebulizer showed significant decreases both in hospital admissions (1.7 vs 0.7; p < 0.001) and total in-patient days (4.1 vs 1.7; p < 0.0001). Home nebulizers are well tolerated by parents and children alike and may be associated with decreased morbidity.
Acute Bacterial Meningitis
Authors: Bonadio William A.
Published: June 2008

A retrospective analysis of 112 cases of pediatric bacterial meningitis over a 3-year period was performed to determine the rate of cerebrospinal fluid (CSF) lymphocytosis at initial evaluation. Of 14 neonates and 98 children older than 1 month of age not receiving preadmission antibiotic therapy, only one instance of CSF lymphocytosis occurred. This patient's CSF exhibited pleocytosis, hypoglycorrhachia, abnormally elevated protein content, and organisms visualized on gram stain smear. In children with bacterial meningitis not receiving antibiotic therapy at the time of evaluation, CSF differential cell count with relative lymphocytosis is rare.
Diaper Dermatitis
Authors: Bosch-Banyeras Josep Ma , Català Margarida , Mas Pilar , Simón Josep LI , Puig Artur
Published: June 2008

The role of vitamin A in preventing diaper dermatitis was evaluated in a double-blind, randomized, prospective study in which 114 newborns were enrolled over an 11-month period. Patients in Group A (58 infants) were treated with a cream that contained 1,000 IU/g of vitamin A, whereas patients in Group B (56 infants) were treated with a cream that had the same composition, but it did not contain vitamin A. Each participant returned once every 15 days for six follow-up visits.

The incidence and severity of diaper rash was not prevented by a vitamin A-containing cream.
Trisomy 22 Mosaicism with Normal Blood Chromosomes
Authors: Lessick Mira L. , Szego Katarina , Wong Paul W. K.
Published: June 2008

A female infant with growth failure, microcephaly, hypertelorism, epicanthal folds, preauricular pit, congenital heart defect, hypotonia, and delayed development is reported. Trisomy 22 mosaicism (46,XX/47,XX,+22) was found in cultured skin fibroblasts but not in blood lymphocytes. Trisomy restricted to skin fibroblasts is uncommon.

Cytogenetic evaluation of a second tissue (preferably skin) is suggested in patients with physical and mental abnormalities who have normal blood chromosome studies.
Chronic, Recurrent Multifocal Osteomyelitis
Authors: Van Howe Robert S. , Starshak Robert J. , Chusid Michael J.
Published: June 2008

Chronic recurrent multifocal osteomyelitis (CRMO) is an unusual inflammatory process involving multiple osseous sites, often recurrently. The authors recently diagnosed CRMO in an 8-year-old girl who had complained of toe pain for several weeks. A number of other involved, asymptomatic areas were discovered by bone scan. Biopsy of the lesions did not reveal any pathogens. Antibiotics and inflammatory agents were not used, and the patient recovered.

A review of previously reported cases of CRMO showed 1) that this entity affects children almost exclusively, 2) that from two to 18 sites, usually in the extremities, can be affected at one time, and 3) that about 20 percent of the patients develop a pustular rash on their palms and soles. Other than an elevated erythrocyte sedimentation rate, there are no consistent laboratory abnormalities, and cultures of affected bone are negative. Histopathology typically shows a chronic inflammatory response, sometimes with granulomas. Antiinflammatory agents and antibiotics offer little consistent beneficial effect. The disease is self-limited, and patients usually recover fully, although exacerbations may occur.

In the proper clinical setting, CRMO should be considered, since recognition of this entity avoids costly and potentially harmful diagnostic and therapeutic interventions.
Insurability of Pediatric Gastrointestinal Disorders
Authors: Bailey Mary Ann , Rosenthal Philip
Published: June 2008

To assess the insurability of children with gastrointestinal disorders, the authors surveyed by questionnaire 106 health-insurance companies concerning their handling of an application for health insurance for a child with a diagnosed gastrointestinal disorder. They received 24 responses (23%) of which only ten companies (42% of the respondents, 9% of the companies surveyed) completed the questionnaire. Insurance companies generally were not receptive to their inquiries.

The consensus of the responses was that ultimate insurability is dependent upon review of the medical record. For individual gastrointestinal diseases, responses were variable and often not easily categorized. Many companies encourage applicants previously denied coverage to reapply at a later date. Most pediatric gastrointestinal disorders are not insurable or insurable only at increased rates. Since insurability is dependent upon review of the medical record, the medical record must reflect the diagnosis and prognosis accurately.

Education of the insurance industry regarding pediatric gastrointestinal disorders is encouraged.
Extreme Hyperpyrexia in Childhood
Authors: Caspe William B. , Nucci Anne T. , Cho Sangho
Published: June 2008

The authors report the cases of five previously well children, aged 8 to 33 months, who were seen over a 14-year period, with admission temperatures in excess of 42.0°C (107.6°F). Four of the patients died. Each child had a similar clinical illness in which the hyperpyrexia played a critical role. Negative blood, cerebrospinal fluid, and stool cultures excluded bacterial sepsis as a possible etiology. This illness is similar, if not identical, to the newly described syndrome of hemorrhagic shock and encephalopathy (HSES) reported in European and American infants.
Valproic Acid Prenatal Exposure
Authors: Carter Brian S. , Stewart Janet M.
Published: June 2008

Valproic acid is an anticonvulsant that has been associated with open neural tube defects. We report a family in which the maternal use of valproic acid, and other anticonvulsants, during pregnancy resulted in different malformations in two siblings, one of which had a lipomyelomeningocele. The association of valproic acid and closed neural tube defects has not previously been reported.

A brief review of the teratogenic effects of valproic acid is included as well as the implications for early surgical management of lipomyelorneningocele.
Breast Feeding Preference of Hispanic and Anglo Women
Authors: Dungy Claibourne I.
Published: June 2008

Hispanic women of Mexican origin are one of the fastest growing minority groups in the United States, but little information is available regarding the rate of breast feeding among this group of women. The breast feeding preferences of Hispanic women delivering at a southern California university hospital were determined by retrospective analysis of birth log records from 1978 to 1985. Approximately 95 percent of the Hispanic women delivering at this institution were of Mexican origin. Hispanic women had a preference for breast feeding similar to the national average for the same time period. The rate of breast feeding among Hispanic women of Mexican descent was consistently higher than previous reports from other regions of the United States.
Purpura Fulminans
Authors: Chenaille Peter J. , Horowitz Marc E.
Published: June 2008

A 6.5-year-old boy developed purpura fulminans. He had no evidence of congenital protein C deficiency. He responded readily to heparin therapy with resolution of his coagulopathy. The coagulopathy resumed rapidly after heparin therapy was interrupted to allow for surgical procedures. Despite correction of his coagulopathy with heparin, surgical amputation of his leg was necessary because of inadequate perfussion.
Typhoid Fever
Authors: Kumar Ajay , Kapoor Ravi , Chopra Kamlesh , Sethi G.R. , Saha M.M.
Published: June 2008

Four cases of typhoid fever with unusual hepatic manifestations are described. Two cases had hepatitis and two had hepatic abscess. These complications are documented for the first time in the pediatric age group. Awareness of these rare manifestations may be helpful in avoiding unnecessary morbidity and mortality.
(Outpatient Management vs In-Hospital Management of Children with New-Onset Diabetes
Authors: Chase H. Peter , Crews Kent R. , Garg Satish , Crews Michael J. , Cruickshanks Karen J. , Klingensmith Georgeanna , Gay Elizabeth , Hamman Richard F.
Published: June 2008

The long-term results of outpatient management of subjects with newly diagnosed insulin-dependent diabetes mellitus (IDDM) are unknown. The longest follow-up described to date is for only one year, a time when most children with IDDM still make endogenous insulin. In this study, 41 young subjects with IDDM, treated and educated in the outpatient setting (1980 to 1984), were compared to a group of 80 similar subjects who received their initial education as hospital inpatients. Long-term glycemic control, as measured by longitudinal glycohemoglobin (HbAI) values was not different in the two groups (p >.05). We conclude that outpatient education and management of newly diagnosed subjects with IDDM is as safe and effective as inpatient treatment.
Brain-Death Criteria Currently Used by Pediatric Intensivists
Authors: Lynch Joan , Eldadah Maher K.
Published: June 2008

A survey was done to identify how pediatric intensivists determine brain death in children. Forty-nine pediatric intensive-care units (PICUS) were surveyed. The questionnaire explored the following areas: 1) clinical and confirmatory studies performed, 2) types of physicians involved, and 3) reevaluation intervals. Thirty-four centers responded to the questionnaire. Sixty-nine percent were children's hospitals, and 94% were university affiliates. The mean number of PICU beds was 17, with a mean admission rate of 890 patients per year, and the mean mortality rate for these units was 6%. There was general agreement on the sufficiency of clinical examination to determine cortical and brain-stem function. All the pediatric intensivists noted that a positive apnea test, absent cephalic reflexes, fixed and dilated pupils, and no motor response to pain were reliable signs of brain death. Radionuclide cerebral-flow scan and EEG were the confirmatory tests routinely used. Most physicians (77%) felt a second clinical examination was required within 12 to 24 hours. The opinion of more than one physician, one of whom was a neurospecialist, was required in 80% of the surveyed institutions.
Relation Between Maternal Characteristics and Child Behavior Ratings
Authors: Sanger Maureen S. , MacLean William E. , Van Slyke Deborah A.
Published: June 2008

The present study examined the extent to which mothers' ratings of their psychological distress, marital adjustment, and negative life events were related to maternal ratings of child behavior problems. Data were collected from mothers of 110 children (ages 2 to 12 years) who were referred to a pediatric clinic for a variety of common behavioral concerns. Maternal psychological distress and marital adjustment were significantly correlated with mothers' ratings on a child behavior checklist. Maternal psychological distress also accounted for a significant amount of the variance in maternal child behavior ratings over and above that accounted for by fathers' ratings of the same behaviors. Given that maternal characteristics co-vary significantly with reports of child behavior problems, pediatricians should interpret findings derived from child behavior rating scales within the overall family context.
Adolescent Medicine Practice In Urban Pittsburgh — 1990
Authors: Bradford Bradley J. , Lyons Charles W.
Published: June 2008

Adolescent medicine has emerged as a discipline in the present era with few key curricular or skill areas clarified and little consensus regarding the acceptance and interest generated in pediatricians by this area. This investigation was undertaken to ascertain present adolescent medicine practice patterns in Pittsburgh, Pennsylvania. The data generated are intended to serve as a basis for future comparisons. The methodology was a questionnaire design, with 178 (54%) of the questionnaires returned and subjected to analysis. The results indicated that 6% of pediatricians actually limit their practices to patients 16 years of age or younger, and 65% limit their practices to patients younger than 19 years of age. Most practices (64%) do not have a gynecological table. Only 20% of practices offer clinical services which would match the needs of adolescent patients, such as the prescription of oral contraceptives, counseling for homosexuality, or treatment of dysfunctional uterine bleeding. Most interestingly, pediatricians report seeing few adolescents with drug and alcohol problems or sexually transmitted diseases. These data provide the basis for future investigations.
Correlating CBC Profile and Infectious Outcome
Authors: Bonadio William A. , Smith Douglas , Carmody Julie
Published: June 2008

The cases of 1,009 febrile infants who were evaluated for sepsis as outpatients during a seven-year period were reviewed to correlate their complete blood count (CBC) profiles with the infectious outcomes. Eighty-one infants had serious bacterial infections (SBIs); the remainder (928) were culture-negative. The infants with SBIs had a significantly greater mean total white blood cell (WBC) count and absolute band count (ABC) than did those who were culture-negative, whereas the difference in mean percent of polymorphonuclear leukocytes was not significant. The sensitivity of the ABC was significantly superior to that of total WBC count in predicting the outcome of SBI. The diagnostic data provided by the ABC can aid physicians in determining the predictive value of CBC profiles for infectious outcome in febrile infants receiving outpatient sepsis evaluation.
The Perioperative Management of Pheochromocytoma in Children
Authors: Turner Miriam C. , Lieberman Ellin , DeQuattro Vincent
Published: June 2008

The perioperative experiences of 15 children and adolescents who underwent a total of 18 surgical procedures for resection of a pheochromocytoma were analyzed to determine clinical or hemodynamic events associated with intraoperative or postoperative complications. Of the pre- and intraoperative factors assessed, only preoperative resolution of symptoms and normalization of blood pressure were predictive of uncomplicated outcome. No intraoperative factors were statistically associated with outcome, but the four patients with complicated outcomes had had aggressively administered intraoperative fluids. Noninvasive measures of cardiac function did not help predict outcome; however, echocardiography results were available only for six patients. Two of the patients with complicated outcomes had cardiac dysfunction, suggesting undiagnosed catecholamine-induced cardiomyopathy in the other two with complicated outcomes. Intraoperative fluids should be given based on intraoperative blood pressures, the presence or absence of prior adrenergic blockade, and assessment of preoperative myocardial function. If preoperative myocardial dysfunction is revealed, intraoperative measurement of right atrial and pulmonary capillary wedge pressures may be indicated.
Do Adolescents Understand What Physicians Say About Sexuality and Health?
Authors: Ammerman Seth D. , Perelli Elizabeth , Adler Nancy , Irwin Charles E.
Published: June 2008

The high rates of adolescent sexual activity, often with adverse medical and social outcomes among minority females, prompted us to survey 160 girls between the ages of 13 and 18 concerning their knowledge of reproductive health terms, anatomy, and body functions. All were patients in a clinic in an inner-city hospital. We hypothesized that adolescents who were older, sexually active, and/or had received formal sex education would be better informed. We used a two-part, self-administered questionnaire. The first part focused on definitions of nine common medical and reproductive health terms; the second focused on definitions of unlabeled anatomic drawings of male and female genitourinary systems. The subjects' responses revealed their lack of information as well as a great deal of misinformation. No statistical differences in knowledge were found related to age, sexual activity status, or formal sex education. Many patients knew only nontechnical and slang terms and did not understand medical terms used by physicians in the clinic. Clinicians should not assume similar patients (minority and poor) know or understand their terminology and should use simple and, if necessary, explicit vocabulary.
Emergence of Invasive Group A Streptococcal Disease Among Young Children
Authors: Novotny William , Faden Howard , Mosovich Luis
Published: June 2008

Eight cases of invasive group A streptococcal disease in young children were reported over a three-month period, February to April 1990. The spectrum of clinical disease included: pneumonia with bacteremia (two patients), osteomyelitis/septic arthritis (three patients), epiglottitis/supraglottitis (two patients), and sepsis without a focus (one patient). Three cases followed chicken pox. Three children were in shock at the time of presentation, including one child who had a toxic shock-like appearance. Only four children had pharyngitis. Bacteremia was confirmed in three children and presumed in another three. All the subjects survived. Four isolates of group A streptococci were tested for exotoxin A, B, and C (A-0, B-4, C-1) production. These data confirm the reappearance of a highly invasive strain of group A streptococci capable of producing a variety of clinical diseases, including bacteremia and shock, in a significant proportion of victims.
Learning by Teaching
Authors: First Lewis R. , Lauerman Rosemary , Fenton Terry , Herzog Lynn , Snyder John D.
Published: June 2008

An educational program on oral rehydration therapy (ORT) for diarrhea was instituted in our residents' continuity clinics to evaluate the impact that residents teaching parents would have on the knowledge and practices of both groups. Sixty-one residents and 287 parents answered the initial written questionnaire before the teaching program began, and 48 residents and 147 parents completed a second questionnaire at the end of the program. Nineteen residents in two clinics were told to participate frequently in teaching the parents, while 29 residents in three other clinics were given no such instructions. The parents were divided into three groups: 58 received teaching and an instructional handout on the management of diarrhea; 73 received only the instructional handout; and 16 received neither intervention. The 19 "teaching" residents had a significantly improved overall score compared with the "nonteaching" residents (p <.03). No improvement was found in the scores of the 58 parents who received teaching compared with those of the 89 parents who received either a handout or no educational intervention. We conclude that active teaching of ORT may improve the knowledge and practices of residents, but that single teaching encounters, whether or not accompanied by written instructions, may have little impact on parents.
20/20 Hindsight: Effectiveness of Simulating the Impact of Federal Sentencing Legislation on the Future Prison Population
Authors: GAES GERALD G. , SIMON ERIC S. , RHODES WILLIAM M.
Published: June 2008

This article describes the results of a sentencing legislation and policy simulation conducted to project the federal inmate population. The simulation model was developed in response to a congressional mandate that the United States Sentencing Commission evaluate the impact of its sentencing guidelines on the future federal prison population. In mid-1987 the model was used to project changes in the use of probation and prison length of stay. The model accurately projected the impact of dramatic changes in sentencing structure that increased the federal prison population by 52% in the 4 years since the end of calendar year 1987. The article also discusses the interrelationships between sentencing legislation, sentencing practices, changes in criminal justice resource allocations, prison population “caps,” and the use of an impact model to inform the public policy debate surrounding the use of prison as a sanction.
Ideologies and Incarceration: Legislator Attitudes Toward Jail Overcrowding
Authors: WELSH WAYNE N.
Published: June 2008

Despite increasing legislative influence on criminal justice policy, research on the determinants and effects of lawmakers' attitudes toward specific criminal justice problems has been sparse. Combining interview and survey methods, this study examined punishment ideologies of California legislators and investigated linkages with attitudes about incarceration and jail overcrowding (perceived causes, effects, and solutions). Results suggested that legislators held beliefs supporting a mix of punishment ideologies, and ideology was only weakly related to support for specific punishment policies. Mixed ideologies and the lack of a clear distinction between liberal and conservative responses imply greater potential for bipartisan solutions to jail overcrowding and other criminal justice problems than has commonly been assumed. Support for initiatives such as juvenile prevention and intermediate sanctions was widespread and cut across party lines.