bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of an Anaerobic Culture Jar in Processing Pediatric Throat Cultures
Authors: Hayden Gregory F. , Dudley Sharon , Hendley J. Owen
Published: November 2007

Two hundred consecutive throat cultures from a Pediatric Walk-in Clinic were processed, using both aerobic and anaerobic culture techniques. The 35 aerobic isolates of group A beta-hemolytic streptococci (BHS) were all confirmed anaerobically as well, and there were two additional isolates detected only by the anaerobic technique. Of these 37 bacitracin-sensitive isolates, only 24 (65%) could be identified at 24 hours using the aerobic technique, compared to 29 (78%) using the anaerobic technique.

In contrast to this relatively small effect upon the isolation of group A BHS, the yield of BHS from groups B, C, F, and G was more than doubled by the anaerobic technique. The confusion engendered by the improved detection of these bacitracin-resistant BHS using the anaerobic tech nique offset the small advantage in thoroughness and speed of detection of group A organisms. On this account, until more is known about the possible signaficance of isolating nongroup A BHS in the pharynx, the advisability of using an anaerobic culture jar to process pediatric throat cultures remains uncertain.
Fetal-neonatal Uremia in Advanced Maternal Diabetes
Authors: Moya Fernando R. , Reece E. Albert , Hobbins John C.
Published: November 2007

A symmetrically growth retarded premature infant was born to a mother with advanced diabetic nephropathy, chronic renal failure, and hypertension, and man aged with aggressive medical therapy without the use of dialysis. The neonatal course was uncomplicated, except for cord blood creatinine and BUN concentrations of 4.7 mg/dl and 116 mg/dl, respectively, that fell to 1.1 mg/dl and 44 mg/dl by 2 days of age. Strict glucose control, careful management of the metabolic abnor malities of uremia, and periodic surveillance of fetal well-being led to a successful pregnancy.
Idiopathic Torsion Dystonia Associated with Lesions of the Basal Ganglia
Authors: PeBenito Rhandy , Farretti Chantal , Chaudary Riffat R. , Woodrow Paul K.
Published: November 2007

We report two siblings who are suffering from a dystonic syndrome, clinically indistinguishable from idiopathic torsion dystonia (dystonia musculorum defor mans) but with cranial computerized tomographic scan findings of basal ganglia lesions, similar to that reported in Wilson's disease.

The occurrence of the disorder in the same sibship suggests an autosomal recessive mode of inheritance and may represent another variety of the syndrome of idiopathic torsion dystonia.
Early Initiation of Weaning Foods and Proliferation of Bacteria in Nigerian Infants
Authors: Elegbe I.A. , Ojofeitimi E.O.
Published: November 2007

Ninety-five children, age range from 1 to 18 months, were followed for the types of weaning foods. Forty-five of the 95 children were evaluated for intestinal bacteria colonization. The most frequently isolated pathogens were enteropathogenic Escherichia coli (EPEC) and Staphylococcus aureus. Children who were not subjected to early initiation of weaning and supplementary foods had lower bacteria counts than their counterparts.
Holoprosencephalic Disorders
Authors: Iannetti Paola , Chessa Luciana , Brattoli Lucilla , Fantozzi Luigi M. , Bozzao Luigi , Colloridi Vincenzo , Guardalà Clelia
Published: November 2007

A child with microcephaly, facial dysmorphisms, seizures, and congenital car diopathy is presented. On the basis of skull x-rays, electroencephalogram, trans- illumination of the head, and computed tomography (CT) scan, the diagnosis of semilobar holoprosencephaly was made. The heterogeneous etiology of the disorder is discussed in order to evaluate the recurrence risk. The usefulness of CT scan for the classification in the different types of holoprosencephaly is stressed.
Comparison Between Cephalexin Two- and Four-Time Per Day Regimens in Group A Streptococcal Pharyngitis
Authors: Stillerman Maxwell , Aronovitz Gerson H. , Durnell Monty D. , Rosenberg Raymond
Published: November 2007

In previous studies, twice daily (bid) and four times daily (qid) administration of most antibiotics approved for group A streptococcus (GAS) pharyngitis therapy have been demonstrated to be equally effective. In this study, four investigators collaborated in a double-blind, randomized multicenter study assessing the efficacy of cephalexin given in doses of 1.0 g or 0.5 g daily on a bid or qid regimen for 10 to 14 days to 157 patients with GAS pharyngitis. The mean daily doses for patients on the bid and qid regimens were 30 mg/kg and 29 mg/kg, respectively. Pretreatment and two follow-up cultures, usually 2 to 6 and 12 to 16 days after the end of treatment, were taken on all patients. Failure, defined as recurrence of the original GAS M-precipitin and T-agglutination types on follow-up culture, occurred in 7.3 percent of 82 patients on the bid and 5.3 percent of 75 patients on the qid regimen. We conclude that cephalexin bid and qid regimens are equally effective, and that the bid regimen can be recommended for all antibiotics approved for GAS pharyngitis therapy.
Ocular Involvement in Varicella
Authors: Jordan David R. , Noel Léon-Paul , Clarke William N.
Published: November 2007

Twenty-four children with classical chickenpox were referred for ophthalmic assessment because of lesions on the lids and in the eye. The appearance of these lesions, their treatment, and their complications are discussed. Twenty-five percent of these children were documented to have an anterior uveitis.
Familial Congenital Short Small Bowel with Associated Defects
Authors: Sansaricq Claude , Chen Wen Jer , Manka Maya , Davis Donald , Snyderman Selma
Published: November 2007

In 1974, Royer et al. described a familial syndrome consisting of a short and sluggish small bowel, malrotation of the gut, and pyloric stenosis. These authors stressed the uniformly fatal outcome of their four cases, as well as other possibly unrecognized cases previously described in the literature. The present report deals with two more familial cases, of which one represents a long-term survivor of the syndrome. The intensive work of maintaining nutrition, controlling infection, and managing the complications of associated defects are described.
Profound Shock Following Intervention for Chronic Untreated Stool Retention
Authors: McGuire Tona , Rothenberg Michael B. , Tyler Donald C.
Published: November 2007

Chronic stool retention with soiling is a common and distressing condition in children. Diagnosis and treatment generally involve both medical and psychological aspects. This case addresses a potentially life-threatening complication of shock occurring during treatment of chronic stool retention with castor oil, and also explores the psychosocial factors felt to be contributory.
The Adverse Effects of High Oral Osmolal Mixtures in Neonates
Authors: Atakent Yucel , Ferrara Angelo , Bhogal Madhu , Klupsteen Mathilda
Published: November 2007

In both animals and humans, there are numerous clinical, physiologic, and morphologic al terations that occur when hypertonic solutions are introduced into the alimentary tract. The most serious adverse effect observed in the human infant is necrotizing enterocolitis. A short in vitro study analyzing osmolalities of drug-formula mixtures at various dilutions, conducted by the authors, showed that an unacceptable degree of high osmolality may be achieved in the preparation of common medications used in newborn nurseries. Although review of the literature confirms that, in general, the osmolalities of mixtures fed to newborns should not exceed 460 mOsm/kg H2O, lower levels would be preferable in ill and low birth weight newborns. When possible, consideration should be given to the use of parenteral medication for the critically ill neonate. Ideally, the osmolalities of mixtures fed to newborns should be measured if they are not known or cannot be calculated.
Congestive Heart Failure Due to Giant Cutaneous Cavernous Hemangioma
Authors: Howell David M. , Gumbiner Carl H. , Martin Gladys E. O.
Published: November 2007

A female infant is presented with isolated giant cutaneous cavernous hemangioma with secondary severe congestive heart failure. Studies to identify other major arteriovenous malformations were negative. An attempt to treat the patient with a corticosteroid was not successful in reducing the size of the hemangioma. She required an aggressive anticongestive medical regimen for 2 years. Though not previously described, high output congestive heart failure can occur secondary to isolated cutaneous hemangioma. Aggressive medical management may alleviate the need for the increased risk of surgical or other therapeutic approaches in this often self-limited condition.
Peregrination in the Problem Pediatric Patient
Authors: Fialkov M. Jerome
Published: November 2007

Peregrinating pediatric patients are those who go from physician to physician either within hospitals or from clinic to clinic within a community. They are often the symptom bearers of dysfunctional multiproblem families requiring an interdisciplinary approach to diagnosis and management. Because of the obscure nature of the child's pediatric problems, such children are often shunned by the medical profession and other social agencies, setting in motion a sequence of events that can prove detrimental to the child, his family, the community, and the state. This article illustrates the need for an anticipatory, coordinated approach in the management of this complex psychosocial condition.
Hepatocellular Carcinoma in an Infant Presenting with Calcified Soft Tissue Mass
Authors: Fletman Donna , Rosenberg Henrietta Kotlus , Evans Audrey E.
Published: November 2007

We recently encountered an 8-week-old male with hepatocellular carcinoma, whose presenting feature was a calcified soft tissue mass. This manifestation has not been reported previously in the literature and was not observed in our review of the 31 patients with primary hepatic neoplasms seen during the past 25 years at the Children's Hospital of Philadelphia.
Association of Temperature Greater Than 41.1°C (106°F) With Serious Illness
Authors: Press Shirley , Fawcett Nancy P.
Published: November 2007

In a 9-month prospective study conducted in an urban emergency room, 15 children with rectal temperature greater than 41.1°C (106°F) were evaluated. Seven of the 15 patients were admitted to the hospital. Two children who were discharged home required subsequent admission, and six were managed on an ambulatory basis. Eight (53.3%) children had serious disease: two bacterial meningitis, two bacteremia without meningitis, two pneumonia, one pericarditis with effusion, and one Kawasaki disease. In four, the final diagnosis indicated a much more serious illness than was considered initially. The laboratory studies did not correlate reliably with the final diagnosis or need for admission. Children with a rectal temperature greater than 41.1°C are at high risk for a life-threatening illness and should be evaluated for sepsis and meningitis.
Subdural Collection of Intravenous Fat Emulsion in a Neonate
Authors: Stine Mary Jo , Harris Howard
Published: November 2007

An infected subdural collection of intravenous fat emulsion (Intralipid) was diagnosed in a 5-week-old premature infant who was receiving total parental nutrition (TPN) through a facial vein cutdown. This fluid was successfully drained and the infection, due to Staphylococcus epidermidis, was treated with vancomycin. We postulate that the subdural collection occurred as a result of septic thrombosis of the internal jugular vein with subsequent retrograde flow and infiltration of Intralipid from the bridging veins into the subdural space. This complication of central TPN has not been reported previously.
Serum Immunoglobulins in the First Year of Life
Authors: Fosarelli Patricia , Winkelstein Jerry , DeAngelis Catherine , Mellits E. David
Published: November 2007

Serum IgG, IgM, and IgA were measured in 316 infants younger than 12 months of age. Information including the child's race, sex, age, and past history of infections or atopy was collected. Birth records were also reviewed to ascertain the child's birthweight and gesta tional age.

Serum IgG levels were higher in black infants than in white infants after the age of 4 months. Serum IgM levels were higher in black females than in black males for infants older than 1 month. For infants younger than 4 months of age, those weighing less than 2500 g at birth had lower IgG levels than those weighing more than 2500 g. Infants younger than 1 month whose gestational age had been less than 36 weeks had lower IgG levels than those greater than 36 weeks. Infants aged 1 to 4 months whose gestational age had been less than 36 weeks had lower IgG levels than did those 40 or more weeks. Infants with a positive history for atopy had lower IgG levels than similarly aged infants with a negative history.
Cystic Fibrosis Mistaken for Idiopathic Biliary Atresia
Authors: Perkins William G. , Klein Gordon L. , Beckerman Robert C.
Published: November 2007

Previous reports of prolonged jaundice in cystic fibrosis have not described operative and histopathological findings in the liver and biliary tree. In the two cases reported here, obstructive jaundice in the neonatal period was associated with anatomical evidence of intra- or extrahepatic biliary obstruction. Hepato portoenterostomy, a surgical procedure that is not without complications, was performed on one of the patients for biliary atresia before the diagnosis of cystic fibrosis was suspected. Prolonged obstructive jaundice may be an early manifes tation of cystic fibrosis and may resolve without operative management. A sweat test should be performed on all patients with prolonged obstructive neonatal jaundice to rule out cystic fibrosis.
Ultrasonic Systolic Blood Pressure Gradient Between Upper and Lower Limbs in Normal Term Chinese Neonates
Authors: Ho T.F. , Yip W.C.L. , Tay J.S.H. , Wong H.B.
Published: November 2007

The determination of a normal pattern of systolic blood pressure (SBP) gradient between upper limbs (UL) and lower limbs (LL) in neonates is important in the diagnosis of the coarctation syndrome. The scarcity of studies of normal neonates and the conflict of opinion prompted us to evaluate this problem. The UL and LL systolic blood pressures of 100 normal term Chinese neonates were measured by the Doppler Ultrasonic method (Roche Arterio sonde 1020).

Under resting condition, the majority (89%) of our neonates had a negative SBP gradient (LL > UL). The mean LL SBP (70.1 mmHg) was significantly higher than that of the UL (59.5 mmHg), p < 0.001. Eleven out of 100 of our neonates had a positive (UL > LL) SBP gradient. Eight of these were less than 1 week old. None had a positive gradient of more than 20 mmHg. According to the results of our study, during the first week of life, normal neonates may have upper limb pressure greater than lower limb of up to 20 mmHg.
Benign Recurrent Isolated VI Nerve Palsy of Childhood
Authors: Sullivan Shona C.
Published: November 2007

Benign recurrent isolated VI nerve palsy of childhood is a rare condition. The diagnosis is essentially one of exclusion. The following case report is of a child with 11 recurrences between age 10 months and 11 years. The literature is reviewed.
Mycobacterium marinum Infection in a 4-year-old Child
Authors: Fragoso Michael A. , Murray Dennis L.
Published: November 2007

Infections with Mycobacterium marinum are uncommon in children but should be considered by a physician confronted with chronic, poorly healing skin lesions. A case of such an infection in a 4-year-old child is presented. Presenting signs and symptoms, differential diagnosis, and treatment of these infections are discussed.
Guide to Early Diagnosis of Biliary Obstruction in Infancy
Authors: Ferry George D. , Selby Maija L. , Udall John , Finegold Milton , Nichols Buford
Published: November 2007

Presenting characteristics, long-term outcome, and techniques used in the diagnosis of 143 infants with suspected biliary obstruction are reviewed. Sixty-nine patients had surgically confirmed extrahepatic disease and 74 had intrahepatic disorders. A disproportionate number of infants with intraphepatic disease were boys (p = 0.013), low birthweight (p = 0.001), or had siblings with liver disease (p = 0.017). An initial total bilirubin of 20 mg/dl or greater was rare except in the intrahepatic disease category of neonatal hepatitis of known cause (p = 0.006). The initial percutaneous liver biopsy correctly predicted the ultimate diagnosis in 94 percent of all 143 patients. A methodological outline to diagnosis is presented, emphasizing early recognition of symptoms and careful follow-up with hepatobiliary imaging, liver biopsy, and surgical exploration, if required, until definitive diagnosis is made. This approach has aided us in reducing the age of diagnosis of biliary atresia from 12.8 ± SD 7.3 weeks during the period 1971 through 1979 to 6.8 ± SD 2.6 weeks from 1980 to 1982 (p = 0.0015). Eighteen-month survival has improved from 25 to 60 percent.
Primary Hyperparathyroidism
Authors: Arisaka Osamu , Arisaka Madoka , Toyono Keiko , Shimizu Toshiaki , Yabuta Keijiro , Hayashi Hirotoshi , Sugiyama Yoshiki , Tanaka Toru , Kitagawa Ryuichi
Published: November 2007

A 13-year-old girl presenting with abdominal pain, polyuria, polydipsia, and radiologically confirmed renal calculi was diagnosed as having primary hyper parathyroidism. Laboratory data revealed markedly elevated serum calcium, low phosphorus, and elevated parathyroid hormone. Other parathyroid function tests also confirmed the diagnosis of primary hyperparathyroidism. Ultrasound ex amination showed a small echogenic nodule in the parathyroid gland. Following a single gland resection, the extremely high serum calcium level promptly decreased to normal range, and it has remained normal.
Reinstituting Oral Feedings in Children Fed by Gastrostomy Tube
Authors: Blackman James A. , Nelson Christy L. A.
Published: November 2007

Children with gastrostomies may return to oral feedings provided the health problem which led to its placement has resolved, stabilized, or been corrected. However, attempts to accomplish this are likely to be met with resistance from the child, including gagging, choking, biting, and vomiting. Aspiration and even fatal airway obstruction are possible. Seventeen children with gastrostomies were evaluated to determine appropriateness for oral feedings. Only 10 of this group were deemed acceptable candidates. Five were managed successfully as outpatients and four as inpatients. One patient with dysphagia aspirated, and oral feedings were discontinued. Selection criteria and management methods are described.
Familial Meconium lleus with Normal Sweat Electrolytes
Authors: Tal Asher , Carmi Rivka , Chai-Am Eitan , Zirkin Howard , Bar-Ziv Jacob , Freud Enrique
Published: November 2007

Meconium ileus (MeI) is the presenting symptom in 10 to 15 percent of infants with cystic fibrosis (CF), but it is a rare phenomenon in patients who do not have this disease. We report four Bedouin siblings who had Mel with no laboratory evidence of CF.
Acute Valproic Acid Toxicity at Therapeutic Concentrations
Authors: Wason Suman , Savitt Daniel
Published: November 2007

A previously healthy nonepileptic 11-year-old girl presented with confusion and disorientation after an acute ingestion of valproic acid. Her serum concen tration of valproic acid was 39.6 mcg/ml, a range normally considered "thera peutic" in the control of seizures. She recovered without sequelae despite the subsequent attainment of higher valproic acid concentrations.
Self-inflicted Injuries in Childhood
Authors: Putnam Nicholas , Stein Martin
Published: November 2007

Eleven clinical and behavioral syndromes that can result in self-inflicted injury in childhood and adolescence are reviewed and classified. The causes and remedies of such injuries vary both among and within these 11 classes. Pediatricians should be alert to the possible presence and meaning of self-injury.
Daily Calorie and Fluid Calculations in the Intensive Care Nursery Using a Pocket Computer
Authors: Yamamoto Loren G.
Published: November 2007

A computer program, run on a hand-held printing pocket computer, that simplifies routine calorie and fluid calculations on high-risk neonates in the intensive care nursery is described. It is useful in performing these calculations on patients with parenteral nutrition, diluted feedings, other intravenous fluids, and medium-chain triglyceride oil supplements, all of which make calorie and fluid calculations by hand very difficult. Both physician and nonphysician personnel can be taught to use this program, allowing them to quickly and easily perform the otherwise laborious fluid and calorie calculations, even on complicated patients.
Seven Hereditary Syndromes with Pigmentary Retinopathy
Authors: Cantani Arnaldo , Bellioni Paolo , Bamonte Gabriele , Salvinelli Fabrizio , Bamonte Marina Tucci
Published: November 2007

This article reviews several autosomal recessive syndromes characterized by pigmentary retinopathy and, in many, combined with deafness, hypogonadism, and/or mental retardation. These syndromes are manifested in infancy and childhood. Although no specific treatment is available, an early diagnosis can be the first step in initiating symptomative management and preventive measures for the patient and family.
Use of a Child Behavior Checklist in the Psychosocial Assessment of Children with Epilepsy
Authors: Dorenbaum David , Cappelli Mario , Keene Daniel , McGrath Patrick J.
Published: November 2007

Children with epilepsy are faced with many of the same psychosocial stressors as other chronically ill children, and a proper assessment is vital. The purpose of this study was to determine whether the Child Behavior Checklist of Achenbach and Edelbrock could be used as a practical and objective tool for evaluating the psychosocial needs of children with epilepsy. Thirty-eight children were randomly selected from the Neurology outpatient clinic at the Children's Hospital of Eastern Ontario. Questionnaires were completed by the mothers during their waiting period. Results dem onstrated the highest risk of maladjustment was within social functioning. As children reach ad olescence, adjustment problems are mostly related to school. Although as a group, our sample did not differ from norms for behavior problems, there was evidence to suggest behavioral malad justment for individual children. The checklist appears to be a good screening tool for maladjustment that could be included as part of the pediatrician's comprehensive assessment of children with epilepsy.
Techniques for Warming Red Blood Cells Packaged in Different Containers for Neonatal Use
Authors: Luban Naomi L. C. , Mikesell Gerald , Sacher Ronald A.
Published: November 2007

Essential to the management of the sick, low birth weight infant is maintenance of a neutral thermal environment by use of convection incubators and radiant warmers. Manipulation of the infant in preparation for transfusion and the transfusion of cold blood could theoretically lower the infant's body temperature, subsequently contribute to cold stress, and concomitantly increase metabolic demands and oxygen requirements. The authors evaluated different pretransfusion ma nipulations of syringe aliquots and bags of blood in an effort to provide a clinically acceptable product for transfusion to sick, very low birth weight infants.
Severe RSV Bronchiolitis in an Immunocompromised Child
Authors: Padman Raj , Bye Michael R. , Schidlow Daniel V. , Zaeri Nayereh
Published: November 2007

A 9-year-old with immunodeficiency developed a severe, diffuse respiratory illness that necessitated mechanical ventilation. Open lung biopsy revealed Respiratory Syncytial Virus (RSV) as the sole pathogen. RSV detection should be included in the differential diagnosis of diffuse lung disease in an immunocompromised child.
Primary Liver Abscesses in Children and Adolescents
Authors: Goldenring John M. , Flores Mitchell
Published: November 2007

Twelve cases of liver abscess in children and adolescents presenting at Children's Hospital at Los Angeles from 1974 to 1983 were reviewed. Most occurred in children younger than 5 years of age. The time from onset of symptoms to presentation did not differ over the 10-year period examined. However, diagnosis was made more rapidly in the latter half of the decade due to the development of advanced noninvasive imaging techniques and serologic methods. A constellation of fever, abdominal pain (whether or not localized in the right upper abdomen), vomiting or anorexia, hepatomegaly, elevated white blood cell count and sedimentation rate, and an unexplained anemia should prompt the clinician to include occult liver abscess in the differential diagnosis and proceed to early use of ultrasound or isotopic liver-spleen scan. History of travel or immigration or exposure to food handlers harboring the infection is important to differentiate amebic abscess from bacterial abscess. This suspicion may greatly alter the course of treatment.
Children Less Than Three-Years-Old With Pharyngitis
Authors: Schwartz Richard H. , Hayden Gregory F. , Wientzen Raoul
Published: November 2007

During a 15-month period, 148 infants and children less than 3-years-old who presented with signs and/or symptoms of pharyngitis were monitored in a private pediatric practice. Clinical signs included fever (95 or 64%), tonsillar exudate (16 or 11%), and cervical adenopathy (5 or 3%). Beta-hemolytic streptococci (BHS) from group A were isolated from throat swabs in 37 (25%) instances. These isolations were more common among children 25-35 months old than among children less than 2 years old (35% vs. 19%, p < 0.05), and were significantly more likely when overnight anaerobic culture techniques were used rather than conventional aerobic methods (23 % vs. 11%, p < 0.01).

Group A BHS may be isolated relatively frequently from symptomatic children under 3-years-old. Whether these isolations reflect invasive infection or asymptomatic carriage is uncertain.
Salivary Gland Disease in Children: A Review
Authors: Myer Charles , Cotton Robin T.
Published: November 2007

The early recognition of salivary gland disease depends upon a high index of suspicion by the clinician. A systematic approach to salivary gland disease in children is presented by a group of algorithms, which is supplemented by a discussion of the historical, physical, and diagnostic test findings characteristic of salivary gland pathology. Therapeutic alternatives are discussed for both neoplastic and non-neoplastic disorders.
Fibrodysplasia Ossificans Progressiva Presenting as Osteomyelitis-Like Syndrome
Authors: Voynow Judith A. , Charney Edward B.
Published: November 2007

An 8-year-old boy presenting with fever, neck pain, and torticollis was eventually diagnosed as having fibrodysplasia ossificans progressiva (FOP). The initial bone scan was interpreted as being suggestive of vertebral osteomyelitis. Subsequent computerized tomographic studies (CT scan), however, demonstrated paravertebral soft-tissue calcification adjacent to, but not involving, intact cervical vertebrae. The acute process of FOP was thereby distinguished from that of osteomyelitis by use of CT scan.
Neonatal Aspergillosis
Authors: Rhine William D. , Arvin Ann M. , Stevenson David K.
Published: November 2007

Neonatal aspergillosis is a rare, usually overwhelming multisystem infection diagnosed postmortem. We present a neonate who had a brain abscess diagnosed by CT scan that was found at surgical exploration to contain aspergillus. Treatment included prolonged antifungal medication and several surgical interventions. The child has neurologic sequelae, including a seizure disorder and hemiplegia. There are no previously reported survivors of neonatal aspergillosis.
Pancreatic Heterotopia as a Cause of an Acute Abdomen
Authors: Curran John P. , Anderson Virginia
Published: November 2007

A 6-year-old boy with fever, vomiting, abdominal pain, and leucocytosis was found to have a small nodule of heterotopic pancreatic tissue in the wall of the jejunum. Leakage of pancreatic enzymes caused inflammation and hemorrhagic necrosis of adjacent smooth muscle. Excision of the lesion was followed by prompt and permanent relief of all signs and symptoms. Small intestinal pancreatic rests can cause acute and chronic abdominal complaints and should be carefully sought at laparotomy when no other etiology is encountered.
Mitral Valve Prolapse in a Patient with Frontometaphyseal Dysplasia
Authors: Park Joon M. , Contreras Edwing A. , Garcia Rafael R.
Published: November 2007

Frontometaphyseal dysplasia (FMD) was described by Gorlin and Cohen 1969.1 Since then, 20 cases have been reported.2 The common findings include a characteristic face with particularly prominent supraorbital ridges, defective vision, hearing and dentition, micrognathia, high arched palate, winged scapulae, limited joint motion, and poorly developed musculature.3 Despite the presence of a heart murmur described in several patients,1,2,4,5 a specific cardiac lesion has not been diagnosed. This report describes a patient with mitral valve prolapse (MVP) and FMD.
The Incubation Period Necessary for Detection of Bacteremia in Immunocompetent Children with Fever
Authors: Rowley Anne Heitzman , Wald Ellen R.
Published: November 2007

The authors determined the time required for blood cultures to be detected as positive for the common bacterial pathogens in immunocompetent infants and children with fever who had no apparent source of infection. Records of the bacteriology laboratory were reviewed retrospectively from 1981 to 1984 for blood cultures that were positive for Haemophilus influenzae type b, Streptococcus pneumoniae, Neisseria meningitidis, Salmonella species, and group B streptococcus. Blood culturing by a conventional technique and a radiometric method were compared sequentially. Only four (1.5%) of 268 specimens were detected as positive after the second day of incubation; in each case that detection of bacteremia was delayed there was an identified source of infection. For H. influenzae, but not S. pneumoniae, significantly more bacteremias were detected earlier by the radiometric method. Discontinuation of empiric antibiotic therapy in immunocompetent children with suspected bacteremia and without focal infection appears warranted when blood cultures have been sterile for at least 48 hours.
Interpretation of Traumatic Lumbar Puncture
Authors: Mehl Albert L.
Published: November 2007

Contamination of cerebrospinal fluid (CSF) with blood at the time of collection interferes with the interpretation of laboratory studies. Twenty-four children with normal CSF were studied prospectively using an experimental model. Blood was added to clear CSF, producing red cell counts from 1,000 to 600,000 cells per cubic millimeter. The expected values for white blood cell count, protein, percent neutrophils, and glucose were calculated, using the results from uncontaminated CSF, peripheral blood cell counts, blood protein, and the red blood cell count of the contaminated specimen. The ratio of observed values to expected values ranged from 0.13 to 3.00 for CSF white blood cell count (mean 0.96, standard deviation 0.56), from 0.55 to 1.63 for CSF protein (mean 0.97, standard deviation 0.23), and from 0.10 to 2.25 for percent neutrophils in the CSF (mean 1.17, standard deviation 0.41). CSF glucose was unchanged by the addition of blood. Guidelines for interpretation of laboratory studies following traumatic lumbar puncture are suggested.
Failure to Thrive Due to Obstructive Sleep Apnea
Authors: Everett Allen D. , Koch William C. , Saulsbury Frank T.
Published: November 2007

The clinical features of two children with failure to thrive due to obstructive sleep apnea are presented. Both patients had subnormal growth velocities for height and weight for many months before diagnosis; both were underweight for height. Relief of their airway obstruction by adenotonsillectomy was promptly followed by catch-up growth and subsequent normal growth velocities. Obstructive sleep apnea should be considered in the differential diagnosis of failure to thrive in children.
Psychiatric Liaison to Liver Transplant Recipients
Authors: Krener Penelope G.
Published: November 2007

Child psychiatric consultants perform psychiatric assessment and liaison among various clinical services. Execution of these familiar roles for pediatric liver transplantation recipients exposes unfamiliar and difficult bioethical problems. Administrative problems arise if the recipient's suitability is too narrowly evaluated. Assessment may be time-limited. The intensive care unit environment and the VIP characteristics of child transplantation patients may distort observations and constrain opportunities for preventive preoperative psychologic management. Unnecessary psychiatric complications may ensue, which imperil the transplantation surgery. The primary caretakers may have an extraordinary emotional investment, so liaison is pressured. Three cases are presented to illustrate these points. Medical ethical perspectives and the limitations of medical training to prepare physicians to perceive them are indicated. That these limitations also affect the psychiatrist is acknowledged, and a clinical research approach is suggested.
Initial Fluid Therapy for Children with Meningitis with Consideration of the Syndrome of Inappropriate Anti-diuretic Hormone
Authors: Kanakriyeh Mohammed , Carvajal Hugo F. , Vallone Ambrose M.
Published: November 2007

A review of 85 children with meningitis admitted to the University Children's Hospital at Hermann Hospital revealed that only six patients (7%) had sufficient clinical and laboratory evidence to be compatible with the diagnosis of inappropriate secretion of antidiuretic hormone (SIADH). This is in contrast with various communications in the pediatric literature that have reported an association between the two conditions of as high as 85%. Hyponatremia (serum sodium 135 mEq/ L) was observed in 27 (32%), but neither the initial laboratory data nor the subsequent follow-up data supported the diagnosis of SIADH. Moderate to severe dehydration was documented in 16 patients (19%) and suspected in more than 50% of the cases (serial weight determinations indicating an increase in weight from admission to discharge). Although the incidence of neurologic sequelae in this series was not influenced significantly by the presence or absence of hyponatremia, SIADH, or fluid restriction, the numbers are still small. Based on these data, routine fluid restriction cannot be recommended unless there is confirmatory evidence of SIADH.
Non-Hodgkin's Lymphoma in Childhood Presenting as Thyroid Enlargement
Authors: Fiorillo Amedeo , Migliorati Roberta , Fiore Michele , Caldore Mariano , Menna Giuseppe , Celentano Luigi
Published: November 2007

The authors report a case of a 10-year-old girl with early involvement of the thyroid gland by non-Hodgkin's lymphoma, an uncommon site of presentation of childhood lymphomas. In pediatrics, thyroid enlargement is more often caused by lymphocytic thyroiditis. The good response to therapy, in spite of the advanced stage of the disease, is noted.
Neonatal Intussusception Associated with Neonatal Small Left Colon Syndrome
Authors: Hall Sue L. , Murphy J. Patrick , Holder Thomas M. , Segal Arlene E.
Published: November 2007

A newborn infant with intestinal obstruction resulting from intussusception associated with neonatal small left colon syndrome is described. Differences between neonatal and infantile intussusception are detailed. Chronic loose intussusception in utero is proposed as one cause of the neonatal small left colon syndrome. Consideration should be given to doing a rectal biopsy and a sweat chloride test to differentiate neonatal small left colon syndrome from Hirschsprung's disease and cystic fibrosis, respectively, when the clinical diagnosis is not readily apparent.
Hypertension and Intussusception
Authors: Prichard John G. , Pakula Anita S.
Published: November 2007

Two unusual cases of intussusception in children less than a year old are presented. Each patient was brought to the author's attention because of altered level of activity, and both were found to be hypertensive. The hypertension resolved after the intussusception was reduced. Diagnosis of hypertension in children, when associated with gastrointestinal dysfunction, is discussed.
Pneumonia Associated with Acute Rheumatic Fever
Authors: Yamamoto Loren G. , Seto Dexter S. Y. , Venu Reddy D.
Published: November 2007

Pulmonary involvement in acute rheumatic fever is rare. Clinical and laboratory findings in rheumatic pneumonia are non-specific. Most of the cases of rheumatic pneumonia described in recent years have had a fulminant course often resulting in death. Autopsy findings are suggestive of but not specific for rheumatic pneumonia. In this article a case of pneumonia associated with acute rheumatic fever is described. Pneumonia and carditis occurred simultaneously in a 10-year-old boy treated without steroids, which resulted in recovery. The clinical spectrum of rheumatic pneumonia can range from mild to fulminant.
Pseudodementia in the Mentally Retarded
Authors: Myers Beverly A. , Pueschel Siegfried M.
Published: November 2007

Intellectual and behavioral deterioration in an individual who is mentally retarded presents a diagnostic challenge to the clinician, since the deterioration may be the result of the primary disorder or a new process. The mentally retarded individual's limitations in communication make the diagnostic assessment more difficult. The authors report the case of pseudodementia in a mentally retarded teenager presumed to have been caused by impacted otic cerumen and corrected by removal of the cerumen. The discussion includes a review of medical, neurologic, psychiatric, and environmental causes of intellectual and behavioral deterioration.
Hazards of Splenic Embolization
Authors: Back Lyle M. , Bagwell Charles E. , Greenbaum Barbara H. , Marchildon Michael B.
Published: November 2007

Perceived high operative risk for splenectomy in children with hematologic disorders and hypersplenism has led to attempts at transcatheter splenic embolization (TSE) as a possibly safer alternative. A recent experience with a child who presented with an apparent acute subcapsular hematoma after TSE and who underwent complicated emergency splenectomy prompted review of the risks and complications of TSE. Although theoretically attractive in many respects, TSE is associated with significant morbidity. The resultant diagnostic and therapeutic difficulties of this procedure can potentially complicate patient management, and the often life-threatening sequelae warrant considerable restraint in its use. In addition, TSE often fails to produce the desired, long-term hematologic response. Because of the morbidity and risk associated with TSE, primary operative intervention is advised for most children in whom splenectomy is indicated. Morbidity associated with the direct operative approach may be minimized by judicious use of blood components and by meticulous surgical technique.
Digital Swelling Following Long-term Administration of Prostaglandin E1 in an Infant
Authors: Sharp Cecil , Robertson Alex
Published: November 2007

A premature infant with hypoplasia of the right heart and pulmonary arteries required treatment with prostaglandin E1 (PGEI) for 107 days prior to surgical intervention. Digital swelling was noted at 40 days of age. Swelling was measured by determining the ratio of the distal phalangeal depth to interphalangeal depth. The ratio declined from 1.16 to 0.94 in the first 64 days after treatment. We believe digital swelling is a reversible complication of PG therapy.
The Incidence of Symptomatic Intracranial Hemorrhage in Term Appropriate-for-gestation-age Infants
Authors: Sachs B.P. , Acker D. , Tuomala R. , Brown E.
Published: November 2007

Symptomatic intracranial hemorrhage in term infants is rare. In over 23,000 deliveries the authors were only able to find 12 diagnosed cases for an incidence of 5.9/10,000 livebirths (≥2,500 g and ≥37 weeks' gestation). No consistent clinical patterns were identified. However, the obstetrical risk factors were a precipitate delivery, a second stage of more than 2 hours, the use of pitocin, and a forceps delivery. The number of cases of asymptomatic ICH was unknown because routine surveillance was not done. Furthermore, some infants may have become symptomatic following discharge, which may have resulted in an undercounting of the incidence of ICH. Most infants, however, became symptomatic by the second day.
Congenital Absence of Lacrimal Puncta and of All Major Salivary Glands: Case Report and Literature Review
Authors: Higashino Hirohiko , Horii Tsuguo , Ohkusa Yoshiaki , Ohkuma Hiroshi , Ino Chiyonori , Nakazawa Midori , Izumi Haruaki , Kobayashi Yohnosuke
Published: November 2007

A 7-year-old girl had dry mouth and recurrent infections of the lacrimal fistulae with decreased lacrimal secretion. All four puncta were absent, and a Schirmer test showed decreased lacrimal secretion. Salivary gland imaging with sodium pertechnetate 99mTcO4 showed absence of all major salivary glands. Lower lip biopsy disclosed normal structure of the salivary gland. No evidence of abnormal inheritance patterns could be demonstrated.
Neonatal Posterior Fossa Subdural Hematoma
Authors: Coker Steven , Beltran Rebecca , Fine Michael
Published: November 2007

Hemorrhage into the posterior fossa is a rare neurosurgical emergency in neonates. CT scanning is diagnostic. Blood layering under the apex of the tentorium cerebelli, however, may resemble a dilated vascular structure, and the rigidity of the pressured tentorium may prevent upward transmission of increased intracranial pressure, resulting in a soft fontanelle.
Communication and Special Health Care Needs of a Profoundly Hearing Impaired Adolescent
Authors: Chacko Mariam R. , Buttler John T. , Kirkland Rebecca T.
Published: November 2007

This report describes the authors' experience in providing medical and contraceptive care to a profoundly hearing impaired adolescent in a hospital setting. Ways to communicate effectively with the hearing impaired are described.
Acquired Coagulation Inhibitor in Association With Rocky Mountain Spotted Fever
Authors: Scimeca Philip G. , Weinblatt Mark E. , Kochen Joseph A.
Published: November 2007

An acutely ill 4-year-old girl with Rocky Mountain spotted fever (RMSF) was found to have a coagulation inhibitor. This child had no serious bleeding manifestations and minimal hemorrhagic skin manifestations despite severe RMSF, concurrent thrombocytopenia, as well as the coagulation inhibitor. Hemostatic abnormalities that occur with RMSF as well as other infectious illnesses associated with coagulation inhibitors are reviewed.
May Children With Otitis Media With Effusion Safely Fly?
Authors: Weiss Michael H. , Ormond Frost J.
Published: November 2007

This study addresses the question of whether patients who fly with otitis media with effusion (OME) are at risk for the development of barotitis. Fourteen patients with otitis media with effusion were followed before and after air travel. No ear with OME became symptomatic, though two contralateral, previously "normal" ears did become symptomatic. An analysis of the physiology of this phenomenon is presented.
Combined Iron Deficiency and Lead Poisoning in Children
Authors: Carraccio Carol L. , Bergman Garrett E. , Daley Barbara P.
Published: November 2007

Concern for the concomitant occurrence of iron deficiency and elevated blood lead in children is raised by animal studies documenting increased gastrointestinal lead absorption in the presence of iron deficiency. An elevation in free erythrocyte protoporphyrin (FEP) above 35 mg/dl is seen with both iron deficiency and lead toxicity.

To determine whether the degree of elevation in FEP is useful in predicting which children with elevated blood lead levels have concomitant iron deficiency, 109 children suspected of having an elevated lead burden were studied. A complete blood count, reticulocyte count, FEP, lead, and ferritin were measured on each child.

The effect of the independent variables, lead and iron status, both alone and in combination, on the dependent variable, FEP, was analyzed through a linear regression model. Lead status alone accounted for 42 percent of the explained variance in FEP, and the lead-iron interaction increased the explained variance by only an additional 1 percent.

Screening for iron deficiency in children with elevated blood lead should continue to be based on dietary and socioeconomic risk factors and not on degree of elevation in FEP.
Autism and Plumbism
Authors: Accardo Pasquale , Whitman Barbara , Caul Jefferies , Rolfe Ursula
Published: November 2007

Six cases of inner city black children with both infantile autism and lead poisoning are reviewed. In three cases, developmental deviance seems to have been present before the possible impact of lead toxicity. In two cases the lead poisoning may have contributed to the onset or acceleration of developmental symptomatology. In one case the temporal sequence remains unclear. Possible patterns of interaction and the implications for clinical practice are discussed.
Skull Erosion and Bony Changes in a Child With Endocardial Cushion Defect
Authors: Hegde Hardally R. , Tyrrell Michael J. , Wilson Diana R. G. , Leung Alexander K. C.
Published: November 2007

A 9-year-old boy with an endocardial cushion defect who had skull erosion as well as widening of the diploe is described. This was accompanied by thickening of the tables, "hair-on-end" striations in the skull, and cortical thinning and medullary cavity expansion in the femora. The skull erosion is attributed to venous distension and increased blood volume. The finding of skull erosion in cyanotic congenital heart disease has not been reported before.
A Controlled Trial of Methylphenidate in Black Adolescents
Authors: Brown Ronald T. , Sexson Sandra B.
Published: November 2007

The short-term effects of methylphenidate were examined on behavioral, laboratory, academic, and physiological measures in 11 black male adolescents diagnosed as having attention deficit disorder (ADD). In a double-blind, crossover design with randomized order, the subjects received placebo and each of three methylphenidate doses (0.15 mg/kg, 0.30 mg/kg, and 0.50 mg/kg) for a period of 2 weeks per medication dosage. Significant drug effects were found for the majority of measures. In general, the higher doses resulted in the most beneficial response in behavioral, academic, and laboratory measures of attention and impulsivity. However, a significant linear increase occurred in diastolic blood pressure. The results suggest that methylphenidate is an effective adjunct to the treatment of ADD in adolescents.
The Reliability of Calculated Bicarbonate in Clinical Practice
Authors: Rivkees Scott A. , Fine Burton P.
Published: November 2007

Current clinical laboratory methods utilize the Henderson-Hasselbalch equation to calculate plasma bicarbonate from measured pH and pCO2. This practice assumes that the apparent first dissociation constant for carbon dioxide in serum, pK'1, is invariable in clinical situations. This assumption has been questioned recently. Our study examined arterial blood samples from 50 acutely ill patients who were routinely sent for blood gas analysis. The pH and PCO2 were measured on a blood gas analyzer and the total CO2 was determined on the same blood sample using a microgasometer. The calculated pK' 1 from these parameters was 6.10 ± 0.018 (m ± SD) with a range of 6.06 to 6.15. This amount of variability could be explained by the error in the methods. The correlation for calculated to measured total CO2 was y = 094x + 1.81, r = 0.98, p < 0.001. These findings indicate that pK'1 is functionally fixed in clinical practice and that the methods used to calculate serum bicarbonate are acceptable.