bluuebunny/crossref_metadata_2025 huggingface dataset:
Cystic Renal Involvement in Tuberous Sclerosis
Authors: Yu Diana T. , Sheth Kumudchandra J.
Published: November 2007

We describe two cases of unusual presentation of tuberous sclerosis with cystic renal involvement. A 19-month-old white male who was initially misdiagnosed as having polycystic kidney disease of "adult-type" developed petit mal seizures and small "ash-leaf" depigmented areas, raising a suspicion of tuberous sclerosis. Computerized tomography (CT) of the brain revealed periventricular calcifications, confirming the diagnosis of tuberous sclerosis. A 15 3/4-year-old black female with tuberous sclerosis showed acceleration of renal failure. Computerized to mography scan of the abdomen showed cystic lesions of the kidneys. In young children with cystic renal involvement but a negative family history of tuberous sclerosis or polycystic kidney disease, a CT scan of the brain should assist in the diagnosis. A CT scan or ultrasound examination of the abdomen will differentiate cystic renal lesions from angiomyolipoma of the kidneys.
Incidence of Hyperbilirubinemia in Breast- vs. Formula-fed Infants
Authors: Adams Joyce A. , Hey Dennis J. , Hall Robert T.
Published: November 2007

A retrospective study of 233 consecutively born full-term infants was performed to determine the effect of several variables on the development of hyperbilirubinemia. Thirty-five (15%) of the infants developed peak bilirubin levels greater than 12 mg/dl in the first week of life. Step wise multiple regression analysis revealed that breast-feeding was the most predictive of a group of eight variables for the development of hyperbilirubinemia greater than 12 mg/dl. The correlation between type of feeding and hyperbilirubinemia was significant (p < 0.02). None of the other factors evaluated was significantly associated with hyperbilirubinemia.

Breast-fed infants also were found to have a significantly higher incidence of hyperbilirubinemia greater than 15 mg/dl; 12 of 101 (12%) infants compared with 2 of 117 (2%) formula-fed infants (p < 0.002). This group of infants accounted for the increased incidence of hyperbilirubinemia greater than 12 mg/dl in breast-fed infants.

There was no significant correlation between weight loss and development of hyperbilirubinemia in the breast-fed infants.
Management and Outcome of Necrotizing Enterocolitis
Authors: Kanto William P. , Wilson Rickey , Ricketts Richard R.
Published: November 2007

A survey of all cases of NEC in the State of Georgia during 1977 and 1978 identified 148 infants with NEC. Fifty-two of these infants were treated surgically, and the survival rate was 48 percent (26/54). The survival rate of medically treated patients was 68 percent (64/94) p < 0.02. Survival was inversely associated with birthweight, although the survival rate following surgery was similar regardless of size. Age of presentation did not influence frequency of surgery or survival, but if perforation at surgery was present in smaller infants (≤1500 g) the survival was less than if operation occurred prior to perforation (78% vs. 39%) p < 0.05. The type of surgical procedure required also was associated with survival. The survival rate was greatest (90%) if only large bowel was removed and least (27%) if small bowel was resected. These results indicate the influence of birthweight, surgical procedure required, and presence or absence of perforation on survival and particularly surgical survival in NEC. They suggest that reviews of outcome in surgical management must take into account the extent of the surgical procedure that it was necessary to employ.
A Human Umbilical Cord with Four Arteries
Authors: Beck Robert , Naulty Cheryl M.
Published: November 2007

An unusual case of a newborn infant with four umbilical arteries is presented. Multiple catheterizations revealed that triplication of the right umbilical artery was responsible. There were no associated malformations, and follow-up at 9 months of age revealed age-appropriate growth and development. This case extends the spectrum of observable umbilical artery anomalies.
Pneumococcal Osteomyelitis
Authors: Hadari I. , Dagan R. , Gedalia A. , Jeanine N. , Moses S.
Published: November 2007

Between 1979 and 1981, 22 children with osteomyelitis and/or septic arthritis were hospitalized at Soroka University Hospital. Streptococcus pneumoniae was cultured in five of the children, four of whom were under 2 years of age. In four other children under 2 years of age, Haemophilus influenzae was cultured. Staphylococcus aureus was identified less frequently in the younger age group. In deciding on initial antibiotic therapy, the possibility of such a bacteriological spectrum should be considered.
An Intervention to Improve Follow-up of Patients with Otitis Media
Authors: Casey Rosemary , Rosen Beth , Glowasky Albert , Ludwig Stephen
Published: November 2007

We evaluated the effects of an educational intervention and telephone reminders on compliance with medication-taking and appointment-keeping for children with otitis media. During an initial interview we examined parents' health beliefs and other factors associated with compliance in our outpatient setting. The children were then systematically assigned to one of five study groups (G1-5). Parents in G1 received an educational session with a nurse and two follow-up telephone reminders. Parents in G2 received only two telephone reminders. Parents in G 3 met with the nurse for an educational session only. Parents in G4 were exempted from interventions, while parents in G5 were exempted from the interventions and the initial interview. The telephone reminder significantly increased the return rate for follow-up appointments (p < 0.05). This effect was not enhanced by combining it with an educational intervention focusing more on medication compliance. Relatively simple and inexpensive interventions such as the ones described here improve follow-up appointment-keeping for children with otitis media. This enhanced compliance behavior is important in obtaining better health outcomes for children with acute illnesses.
Stridor Caused by Vocal Cord Malfunction Associated with Emotional Factors
Authors: Kattan Meyer , Ben-Zvi Zvi
Published: November 2007

We describe two adolescent patients in whom a disorder of the vocal cords associated with emotional factors resulted in acute episodes of stridor. Adduction of the vocal cords on inspiration and abduction on expiration was found on indirect laryngoscopy. The problem responded to either palcebo treatment or psychotherapy. The similarity between vocal cord dysfunction presenting as stridor and that presenting as asthma is discussed. The importance of diagnosing these functional problems in children is emphasized in order to avoid unnecessary diagnostic procedures and hazardous treatment.
An Analysis of Waiting Times in a Pediatric Emergency Department
Authors: Liptak Gregory S. , Super Dennis M. , Baker Nancy , Roghmann Klaus J.
Published: November 2007

Waiting times in a pediatric emergency department were studied using direct observations of patients and health providers on 14 separate days. The mean waiting time (from entry to first physician contact) of the 216 children studied was 49 minutes. Time spent in the waiting room was increased by both the nonavailability of a nurse and the nonavailability of an examining room, and was decreased by the severity of the patient's illness. Time spent in the examination room waiting for the physician was related to the availability of the physician and the number of patients concurrently registered in the emergency department as well as the severity of their complaint. Recommendations for decreasing waiting time, based on the observations, are made. Although each setting is unique, the study provides a model for the analysis of waiting patterns in similar facilities.
Fatal Aortic Rupture Presenting as Chest Pain in an Adolescent
Authors: Schaffer Michael S. , Nouri Soraya , Chen Su-chiung , Waggoner Alan D. , Pennington D. Glenn , Monteleone Patricia L.
Published: November 2007

An adolescent female with occult cystic medial necrosis died following spon taneous aortic rupture. A large saccular aortic aneurysm that had ruptured into the pericardial space was demonstrated by two-dimensional echocardiography and confirmed at surgery. Echocardiographic screening of the patient's family members revealed a 13-year-old brother with unsuspected aortic root dilatation. He is now being followed for possible progression of his disease. This case demonstrates the role of echocardiography in cystic medial necrosis. It can aid the acute management of patients with aortic dissection or aneurysm. It can also define patients with occult disease who require serial follow-up and genetic counseling.
A Comparative Analysis of Newborn Outcome in a Hospital-based Birthing Center
Authors: Waskerwitz Steven , Fournier Linda , Jones Phyllis , Meier Werner
Published: November 2007

Medical records of babies born in a hospital-based birthing center were reviewed to determine whether a birthing center alternative to traditional hospital care of the newborn is safe and cost- effective.

A cohort of 123 hospital-based birthing center low-risk deliveries was compared to 100 control low-risk deliveries born in the traditional setting at the medical center during the same time period. Morbidity was assessed using the Hollister Classification as reference and was based on treatment need.

The analysis of the babies' status at birth, 24 hours, and 72 hours revealed no difference in immediate morbidity. Cost of hospitalization was reduced by $340.00 per cohort baby. These data suggest that this alternative can be safe and cost-effective.

This study applies only to hospital-based birthing centers, because the safety of free-standing birthing centers has not been established and because screening for low risk can not eliminate morbidity.
Lead Encephalopathy
Authors: Selbst Steven M. , Henretig Fred M. , Pearce Jennifer
Published: November 2007

Acute lead encephalopathy has become a rare syndrome in the United States. Early recognition of the disease, with institution of specific chelation therapy, is critical in order to minimize mortality and morbidity. Lead intoxication, however, may mimic other more common diseases. We report an 8-year-old child with known sickle cell anemia who presented initially with findings suggestive of vaso occlusive crisis but who deteriorated rapidly and was found to have severe lead poisoning. We present her hospital course and review the management of lead encephalopathy in detail.
The Effects of Acute Viral Hepatitis on Theophylline Clearance
Authors: Feinstein Ronald A. , Miles Michael V.
Published: November 2007

The effects of acute viral hepatitis on theophylline clearance and maintenance dose requirements in a 12-year-old boy are described. Significant alterations in theophylline dosage may be required during the acute and recovery phases of viral hepatitis.
Gastrointestinal Malacoplakia in Children
Authors: Harfi Harb A. , Akhtar Mohamed , Subayti Yahya A. , Ashraf Ali Mohamed , Ferentzi Christian , Larkworthy William
Published: November 2007

Four children, whose ages ranged from 1 to 13 years, with malacoplakia of the gastrointestinal tract were treated at King Faisal Specialist Hospital between 1979 and 1983. All patients had either a preceding or a coexisting chronic illness. In one patient, malacoplakia was an incidental finding, while the remaining three patients presented with bloody diarrhea, abdominal pain, recurrent fever, and severe malnutrition. Colonoscopy in two patients revealed markedly inflamed and friable mucosa with focal ulceration alternating with patches of normal mucosa and pseudopolyposis. They were treated with antibiotics and cholinergic agonists. Three patients responded favorably, while one patient continued to have extensive active disease. Although the response to therapy is unpredictable, patients may respond if the treatment is continued on a long-term basis.
Cystinosis Presenting with Features Suggesting Bartter Syndrome
Authors: Whyte Michael P. , Shaheb Sudah , Schnaper H. William
Published: November 2007

Features suggestive of Bartter syndrome (hypokalemia, hypochloremic metabolic alkalosis, and normal blood pressure despite hyperreninemia and hyperaldoster onism) were found in a 5-year-old black child with cystinosis and Fanconi syndrome. Review of his medical records revealed that these abnormalities had probably been present when he first became clinically ill at 2 years of age. Sodium and potassium chloride supplementation lead to improved growth and strength, partial correction of his electrolyte abnormalities, and a decrease in markedly elevated plasma renin activity. Literature review disclosed a similar presentation in four Caucasian children with cystinosis.

Biochemical findings compatible with Bartter syndrome can occur together with evidence of generalized proximal renal tubular dysfunction (Fanconi syn drome) in nephropathic cystinosis.
Yogurt
Authors: Saal Howard M. , Ratzan Susan K. , Carey Dennis E.
Published: November 2007

Vitamin D deficient rickets occurred in a 15-month-old black girl for whom yogurt had been substituted for milk products. Investigation determined that commercially available yogurt contains no vitamin D, and that this fact is not generally recognized by lay persons and health professionals. Use of yogurt as a major source of nutritional intake in infants and young children may be a contributory factor in development of vitamin D deficiency rickets.
Respiratory Complications of Metatropic Dwarfism
Authors: Belik Jaques , Anday Endla K. , Kaplan Frederick , Zackai Elaine
Published: November 2007

Two infants with clinical and radiologic features of metatropic dwarfism presented in the neonatal period with episodes of cyanosis. Diagnostic studies to determine the etiology of these spells, including electrocardiogram, electroencephalogram, arterial blood gases, and metabolic and sepsis studies, were unremarkable. Chest roentgenograms revealed the characteristic long, narrow thoracic cage with no evidence of parenchymal disease.

Cervical spine stability evaluation, pulmonary function studies, and chest impedance monitoring with qualitative air flow thermistor studies and transcutaneous oxygen monitoring were carried out. Both patients demonstrated a significant increase in resistance of the respiratory system following passive maneuvering of the head from a neutral position, suggestive of hypopharyngeal air flow obstruction. Obstructive sleep apnea resulting in cyanosis was documented in both patients. All other studies failed to yield a cause for the episodes of cyanosis. Our investigation failed to alter the clinical course which resulted in respiratory arrest and death by 7 months of age. A table is presented for the differentiation of skeletal dysplasias presenting in the perinatal period.
Age-specific Patterns of Diagnosis of Acute Otitis Media
Authors: McFadden D.M. , Berwick D.M. , Feldstein M.L. , Marter S.S.
Published: November 2007

A retrospective review of clinical experience with the diagnosis of acute otitis media (AOM) in a large pediatric population (age, 0-12 years old) reveals two age-specific patterns of diagnosis: one in preschool children and one in schoolage children. In the population as a whole, AOM is diagnosed most frequently in the first 5 years of life; rates of diagnosis vary with gender (male: female ratio = 1.10) and season (fall/winter peak). In a linear regression model, age, gender, season, and interactions among these account for 52 percent of the variability in diagnostic rates.

In children less than 5 years of age, rates of diagnosis vary strikingly with gender and season; the regression model accounts for 55 percent of observed variability in diagnostic rates. In schoolage children (5-11 years old), however, males and females are equally likely to be diagnosed to have AOM, and seasonal variability is blunted; among these children, the regression model predicts only 22 percent of diagnostic rate variability.

These findings buttress existing knowledge of the epidemiology of AOM and have important implications for clinical practice, health planning, and pediatric research.
Persistent Pulmonary Hypertension in a Very Low Birthweight Preterm Infant
Authors: Watchko Jon F.
Published: November 2007

Persistent pulmonary hypertension of the neonate (PPHN) characteristically is seen in full-term or postterm infants. Occasionally, PPHN complicates the course of hyaline membrane disease in preterm infants. This report documents the unusual occurrence of PPHN in a preterm very low birthweight infant without apparent pulmonary parenchymal disease.
Acute Reversible Pulmonary Ischemia
Authors: Babiker Malik A. , Obeid Hussein AL , Ashong Emmanuel F.
Published: November 2007

A 6-year-old girl with sickle cell disease was admitted to the hospital with the diagnosis of the acute chest syndrome. The laboratory findings and the radionuclear lung scan supported a diagnosis of pulmonary infarction rather than pneumonia. She improved with intravenous fluids, oxygen, penicillin, and theophylline. The most likely explanation for the rapid resolution of the clinical syndrome, the chest x-ray, and lung scan abnormalities is that masses of sickled cells caused transient pulmonary vascular occlusion leading to perfusion defects and ischemia, and that the sickled cell thrombi were dislodged before the infarction occurred. To our knowledge, this phenomenon has not been described as a cause of the acute chest syndrome in sickle cell disease in children.
Premature Adrenarche
Authors: Kaplowitz Paul B. , Cockrell Janice L. , Young Reuben B.
Published: November 2007

Premature adrenarche (PA) or isolated growth of sexual hair in young children, is a benign condition that may initially be confused with true precocious puberty or pathologic virilizing disorders. The clinical findings, family history, and serum concentrations of dehydroepiandrosterone sulfate (DHEA-S) were compared in 24 children with PA (79% black females) seen in a 2-year period and in an age-matched control group of 17 black females. Twenty three of 24 patients, but none of the controls, had an adult-type axillary odor. There was a positive family history of PA in only three of 24 children with PA, and in one of 17 controls. The mean serum DHEA-S was significantly higher in the PA children than in the controls, but there was a broad range of concentrations (10-143 μg/dl), with values in 10 of 24 cases falling within the control range for age. We conclude that: (1) PA is a relatively common finding in black females between ages 3 and 8, (2) an axillary odor is almost always present in children with PA, and (3) determination of serum DHEA-S may be of some help in confirming the clinical impression of a modest increase in adrenal androgen secretion and in ruling out a more serious disorder. In most cases, however, the diagnosis of PA can be made on the basis of the history, physical examination, and lack of rapid progression over time; the use of laboratory tests to rule out a pathologic virilizing process may best be reserved for those children with very early onset, increased linear growth, or other signs of virilization.
Case Report of Two Children with Pseudohypoaldosteronism
Authors: Everist Jane , McVie Robert
Published: November 2007

Two black male siblings with pseudohypoaldosteronism are reported. They became ill in infancy with failure to thrive, renal salt wasting, and marked elevation of plasma aldosterone. These two patients illustrate many features of this uncommon disorder, as well as a severe metabolic acidosis. To our knowledge, this is the first report of pseudohypoaldosteronism in a black family.
Familial Juvenile Nephronophthisis
Authors: Cantani Arnaldo , Bamonte Gabriele , Ceccoli Daniel , Biribicchi Gianni , Farinella Francesco
Published: November 2007

Familial juvenile nephronophthisis (FJN) is a frequent cause of chronic renal failure in children and adolescents. Typically it presents after 6 years of age through adolescence, but may become apparent in early childhood. The clinical presentation is insidious, and the early symptoms of polyuria and polydipsia are often overlooked in the presence of a relatively normal urinalysis and in the absence of proteinuria, azotemia, and hypertension. Thus most patients are not diagnosed until after the onset of renal failure. These children are excellent candidates for properly selected transplantation.
Townes Syndrome
Authors: Hersh Joseph H. , Jaworski Margie , Solinger Robert E. , Weisskopf Bernard , Donat Jane
Published: November 2007

An 8-year-old male is presented with clinical findings of Townes syndrome in an otherwise unaffected family. Additional abnormalities possibly representing low frequency associations of this autosomal dominant multiple malformation syndrome included a cardiac defect and hypospadias. Similarities exist between Townes syndrome and VACTERL association, which is generally regarded to be sporadic in nature. Recognition of Townes syndrome as a distinct entity is critical for implementing appropriate management in early childhood, including amplification of hearing impairments. Variable expressivity may occur in this disorder. Careful evaluation must be made, therefore, of the parents of an affected infant with an apparent sporadic case, in order to provide the couple with an accurate recurrence risk at genetic counseling.
Evaluation and Management of Psychosomatic Symptoms in Adolescence
Authors: Smith Mark Scott
Published: November 2007

Adolescent patients commonly experience symptoms such as headache, chest pain, abdominal pain, or dizziness that are psychophysiologic responses to stress, anxiety, and depression. Because most symptomatic adolescents initially visit medical providers, and not mental health professionals, the clinician is faced with the challenge of providing a comprehensive evaluation that is not merely focused on the symptom. In addition to a careful medical assessment, this evaluation must include a review of psychosocial functioning in the family, school, peer group, and community. Appropriate management may include supportive counseling, instruction in relaxation techniques, anti-depressant medication, and referral for psychotherapy.
Progression of Orthostatic Proteinuria to Focal and Segmental Glomeruloscierosis
Authors: Berns Jeffrey S. , McDonald Bruce , Gaudio Karen M. , Siegel Norman J.
Published: November 2007

Focal glomerulosclerosis, with the nephrotic syndrome and progressive renal insufficiency, developed in a 15-year-old boy who presented initially 1 year earlier with orthostatic proteinuria. Although generally considered to be a benign disorder, this case suggests that on rare occasions, serious glomerular diseases may develop in patients with orthostatic proteinuria or that significant glomerular disease may occasionally present with postural proteinuria.
Caustic Ingestions
Authors: Moore William R.
Published: November 2007

More than 5,000 caustic ingestions are estimated to occur each year. Liquid lye is associated with the greatest morbidity. Endoscopy is the only method for evaluating the extent of the injury; clinical signs and symptoms (e.g., vomiting, dysphagia, abdominal pain, oral burns, leukocytosis) are not reliable. In less severe burns (involving only mucosal irritation or ulceration), current therapy with antibiotics and steroids results in a very favorable prognosis. Circumferential or very deep burns have a much poorer outcome, with a greatly increased risk of stricture formation and/ or perforation. The risk of developing esophageal carcinoma may be 1,000 times greater for individuals who have had a lye burn than in the general population. It cannot be overemphasized that prevention is still the key to decreasing this morbidity.
Infective Endocarditis Following Cardiac Catheterization in Infancy
Authors: Yu Luke C. , Greene Gerald , Sperling Donald , Morgan Beverly C.
Published: November 2007

A 4.5-month-old infant with transposition of great vessels and large ventricular septal defect developed acute infective endocarditis following cardiac catheterization. Beta-hemolytic streptococcus was recovered from three blood cultures. The infant survived after 6 weeks intravenous antibiotic therapy. The occurrence of infective endocarditis following cardiac catheterization during infancy is briefly reviewed and discussed. The importance of distinguishing febrile episodes of infancy from infective endocarditis and the use of two-dimensional echocardiography for diagnosis is re-emphasized.
Endoscopic Detection of Peptic Ulcer Disease in Cystic Fibrosis
Authors: Fiedorek Stephen C. , Shulman Robert J. , Klish William J.
Published: November 2007

Abdominal pain is common among cystic fibrosis (CF) patients and may be caused by a variety of conditions. Although peptic ulcer disease (PUD) has not been emphasized as a common cause of abdominal symptoms in CF, the risk for the development of PUD may be increased because of abnormal physiology. Contrast radiography appears to be an especially inaccurate method to document PUD in CF because the duodenal mucosa typically appears nodular and distorted with poor definition of the mucosal folds. These findings may obscure or mimic PUD. The first endoscopic diagnosis of PUD is reported in a CF patient. Based on this case and a review of the literature, endoscopy is the procedure of choice for evaluation of a CF patient who is suspected of having PUD.
Severe Cardiomyopathy Simulating Hepatitis in Adolescence
Authors: Treem William R. , Boyle John T.
Published: November 2007

Two adolescent patients referred for evaluation of severe "hepatitis" were found to have clinically unsuspected cardiac failure. Clinical profiles were characterized by anorexia, malaise, right upper quadrant pain, mild jaundice, initially predominantly indirect hyperbilirubinemia, profound elevations of transaminases, and prolonged prothrombin time. Left ventricular failure and low cardiac output were documented by clinical examination, echocardiography, and measurements of pulmonary capillary wedge pressure and cardiac index. Acute and chronic intrinsic liver disease was ruled out by appropriate tests. At autopsy, pathologic lesions of centrilobular necrosis characteristic of hepatic hypoxia were noted, and there was evidence of marked myocardial degeneration. These two cases emphasize the need for careful cardiac examination when evaluating acute hepatitis.
Gaffkya anaerobia Infection and Recurrent Parotitis
Authors: Sussman Sidney J.
Published: November 2007

This is a case report of a child with recurrent parotitis, distortion of Stensen's duct, and recovery of Gaffkya anaerobia on one occasion. Cause and effect relationships are discussed.
An Alternate Technique to Determine Umbilical Arterial Catheter Length
Authors: Rubin Bruce K. , McRobert Elizabeth , O'Neill Michael B.
Published: November 2007

Sick babies often have an umbilical artery catheter (UAC) inserted. To minimize risk to the baby, the catheter is inserted a distance calculated to place it either between the third and fifth lumbar vertebrae or between the sixth and 10th thoracic vertebrae when checked radiographically. The methods used to calculate this insertion distance require that length measurements of the baby be plotted on reference graphs. Directly measuring the distance from the baby's xiphoid process to his pubis and adding this to the distance from the pubis to mid-umbilicus yields an UAC insertion length that places the catheter between T6 and T10 as accurately as methods that require reference charts.
Group C and Group G Streptococci
Authors: Schwartz Richard H. , Shulman Stanford T.
Published: November 2007

The importance of non-group A streptococci as etiologic agents of acute pharyngitis in endemic circumstances is unclear. The authors attempted to clarify this issue in patients undergoing throat culture for acute pharyngitis in a suburban pediatric practice. Of 6,694 throat cultures, 2,243 (34%) yielded B-hemolytic streptococci, 83 percent (1,783) of which were bacitracin-sensitive and presumptive group A organisms. A random selection of 279 of the 460 bacitracin-resistant streptococci yielded 56 group C, 42 group G, 35 group F, 2 group A, and 3 mixed groups of streptococci.

Paired serologic specimens were obtained from 12 children with group C or G streptococci. Four of six group C subjects from whom paired serum specimens were obtained had a significant increase in anti-streptolysin O titer. However, no change in anti-C/G hyaluronidase or anti-C carbohydrate titer was observed. Similarly, two of six subjects with group G streptococci on throat culture in whom paired serum specimens were obtained showed an increase in ASO titer. No seroconversion to anti-C/G hyaluronidase, anti-C, or anti-G carbohydrates was demonstrated. Despite substantial clinical and circumstantial evidence, it could not be confirmed serologically that group C and G streptococci produced acute pharyngitis in this endemic setting.
Ethyl Alcohol Ingestion in Children
Authors: Leung Alexander K. C.
Published: November 2007

Information on ethyl alcohol intoxication in children is scarce. A retrospective study was conducted by chart reviews of 27 patients with documented ethanol ingestion admitted to the Alberta Children's Hospital, Foothills Provincial Hospital, Calgary General Hospital or Holy Cross Hospital from 1969 to 1984. Six patients had hypoglycemia and one experienced a convulsion. The rate of alcohol elimination was found to be greater than 6.2 mM/L/hr (28.4 mg/dl/hr), approximately twice the rate seen in adults. Six patients had hypokalemia, and two had severe metabolic acidosis.
Should the Mobile Intensive Care Unit Respond to Pediatric Emergencies?
Authors: Applebaum David , Slater Paul E.
Published: November 2007

Between October 1982 and October 1985, the Mobile Intensive Care Unit (MICU) in Jerusalem responded to 625 pediatric emergencies, representing 5% of the total MICU case load. The most common medical problem was seizures, diagnosed in 205 cases (33%). The second most frequent group related to trauma (175 cases; 28%). There were 71 cases (11.4%) of cardiac arrest. Resuscitation was attempted in 37, but there were no long-term survivors. Almost all cardiac arrest patients were found in asystole, and most had antecedent serious medical problems. Compared with the adult population, children were less likely to require or benefit from an advanced level of prehospital care. When resources for advanced care are limited, priority should be given to adult emergencies.
Normal Radiographic Findings After Foreign Body Aspiration
Authors: Musemeche Catherine A. , Kosloske Ann M.
Published: November 2007

Foreign body aspiration in children is frequently associated with unilateral emphysema or atelectasis on chest x-ray. Two cases are reported of tracheal or bilateral foreign bodies in which the original chest x-rays were read as normal, but the history was suggestive of the foreign body aspiration. Early bronchoscopy can prevent the long-term morbidity that results from unrecognized tracheobronchial foreign bodies.
Anaphylaxis to Cutaneous Exposure to Milk Protein in a Diaper Rash Ointment
Authors: Jarmoc Laura M. , Primack William A.
Published: November 2007

A 12-month-old boy, with a strong history of cow's milk allergy, developed two episodes of anaphylaxis following cutaneous application of a casein containing ointment to an inflamed diaper area. RAST testing showed a significant elevation in specific IgE antibodies to milk and milk proteins. This experience suggests that children who are highly sensitive to milk may have severe allergic reactions on cutaneous exposure to milk or milk products.
Term Abdominal Pregnancy, Meconium Aspiration, and Extracorporeal Membrane Oxygenation
Authors: Beck Robert , Killeen Vincent B. , Short Billie
Published: November 2007

This report describes a term gestation abdominal pregnancy resulting in meconium aspiration syndrome (MAS) complicated by pulmonary hypertension. These cases occur infrequently. In this instance, extracorporeal membrane oxygenation (ECMO) was successfully utilized to support the infant after conventional neonatal medical support failed to yield sufficient oxygenation.
Fibrous Histiocytoma of the Larynx in a Child
Authors: Wetmore Ralph F.
Published: November 2007

A 6-year-old child presented with a fibrous histiocytoma of the subglottic larynx. These tumors are rare in adults, and only one other case has been reported in a child. The current case is the youngest and best documented in the pediatric age group. The clinical presentation in this patient, along with controversies related to this class of neoplasms is discussed.
Relationship of Body Fat Distribution to Metabolic Complications in Obese Prepubertal Girls
Authors: Legido Agustín , Sarría Antonio , Bueno Manuel , Garagorri Jesús , Fleta Jesús , Abós Dolores , Pérez González José
Published: November 2007

The purpose of this study is to assess the relative effects of body fat distribution and obesity "per se" on serum glucose, insulin, and insulin resistance. Seventeen obese and nine nonobese control prepubertal girls were studied. Biceps, triceps, subscapular, and suprailiac skinfold thickness were measured. Percentage of body fat (% BF) and total body fat (TBF) were calculated. Body fat distribution was assessed by analyzing the central (suprailiac, subscapular)/peripheral (biceps, triceps) ratios. Oral glucose tolerance test was performed. Serum glucose and insulin were measured and insulinogenic index (insulin/glucose) was calculated. Body fat anthropometric data and body fat distribution indexes were significantly higher (p < 0.001) in the obese group. The obese population presented significantly elevated values of glucose, insulin, and insulinogenic indexes (p < 0.01-p < 0.001). In the obese group, insulin showed significant positive correlations (p < 0.05-p < 0.001) with biceps, subscapular, and suprailiac skinfolds, % BF and TBF, whereas the insulinogenic index had positive correlations with suprailiac skinfold and TBF (p < 0.05). Obese girls showed positive correlations between the body fat distribution indexes and insulin or insulinogenic indexes (p < 0.05-p < 0.001).

In prepubertal girls obesity is of the centripetal (central) type. This pattern has an important role in determining the alterations in the glucose-insulin homeostasis that characterize the childhood nutritional obesity.
Intrapartum Rupture of the Falciform Ligament and Umbilical Vein
Authors: Miller Barnett M. , Yoon Jing J. , Kim Mae H. , Gheewala Anup
Published: November 2007

Intra-abdominal hemorrhage in the newborn is uncommon, but it must be considered in the first 48 hours of life in the infant with pallor, anemia, abdominal distension, and shock. The injured liver is the most common source of bleeding, with the spleen and kidney less often involved. In the case presented, the hallmarks of intra-abdominal hemorrhage were evident. Exploratory laparotomy revealed intraperitoneal bleeding emanating from the disruption of the umbilical vein and its enveloping falciform ligament. There was no other site of intra-abdominal bleeding and there were no intrinsic abnormalities of the umbilical cord or the placenta. Disruption of the intra-abdominal umbilical vein represented the sole source of intra-abdominal bleeding in this patient. The case is reported to document disruption of the intra-abdominal umbilical vein as a rare cause of neonatal hemoperitoneum.
Renal Function in Full-Term Newborns Following Neonatal Asphyxia
Authors: Olavarría Fernando , Krause Sergio , Barranco Luis , Herrmann Fernando , Paez Viviana , Mezzano Sergio , Leal Nora , López María
Published: November 2007

A prospective study of full-term infants with neonatal asphyxia was performed to evaluate possible alterations in renal function. Twenty-one newborns with an Apgar score ≤ 3 at 1 minute after birth and a control group of 20 normal infants were included. Oliguria of 12 hours or more (less than 1 ml/Kg/h) during the first 24 hours after birth was considered indication for a volume challenge test and use of diuretic.

The study of renal function was effected between 24 and 48 hours after birth for asphyxiated and control infants (Period I), and was repeated between 48 and 72 hours (Period II) for the asphyxiated group only. Intrinsic acute renal failure was diagnosed in two patients, one of whom died. In 10 cases, prerenal oliguria responded promptly to volume expansion with improvement of biochemical indices in Period II. In nine cases, urine volume was not altered, and all functional parameters were comparable with those of control.
Clinical Characteristics and Serum Essential Fatty Acid Levels in Hyperactive Children
Authors: Mitchell E.A. , Aman Michael G. , Turbott Sarah H. , Manku Mehar
Published: November 2007

This study compared 48 hyperactive children with 49 age-and-sex-matched controls. Significantly more hyperactive children had auditory, visual, language, reading, and learning difficulties, and the birth weight of hyperactive children was significantly lower than that of controls (3,058 and 3,410 g, respectively; p < 0.01). In addition, significantly more hyperactive children had frequent coughs and colds, polydypsia, polyuria, and a serious illness or accident in the past year than controls, but there was no increase in asthma, eczema, or other allergies. Serum essential fatty acid (EFA) levels were measured in 44 hyperactive subjects and 45 controls. The levels of docasahexaenoic, dihomogammalinolenic, and arachidonic acids were significantly lower in hyperactive children than controls (docosahexaenoic: 41.6 and 49.5 μg/ml serum respectively, p = 0.045; dihomogammolinolenic: 34.9 and 41.3 μg/ml serum, p = 0.007; arachidonic : 127.1 and 147.0 μg/ml serum, p = 0.027). These findings have possible therapeutic and diagnostic implications, but further research is needed to attempt to replicate these differences.
Epidemiological Survey of 6 Years' Federal Health Service Experience of Pyloric Stenosis: Case Report of Presentation in a 26-month Male
Authors: Reyna Troy M. , Otero Carmelo , Weir Michael R.
Published: November 2007

Congenital hypertrophic pyloric stenosis (CHPS) is primarily a surgical process of the neonate and infant. Diagnosis and treatment of CHPS in a 26—month—old male prompted an inquiry of the military health service database for age of onset, sex, and birth position data. Data were analyzed on 604 cases found in a 71-month time period. The incidence for first-born males was .43 percent, for other than first-born males .34 percent, and for females .091 percent, the peak age being 3 weeks and 1 month old. Children diagnosed at age 6 months and older, as well as adults, were identified. Utilization of the Federal Health Care System data base allowed the study of a large number of patients with a broad spectrum of social, racial, and geographic backgrounds. We feel the study of this data provides a unique understanding of the epidemiology of this entity (CHPS).
Asymptomatic Toxocariasis in Children
Authors: Bass Joel L. , Mehta Kishor A. , Glickman Lawrence T. , Blocker Richard , Eppes Bonnie M.
Published: November 2007

Screening of 153 Hispanic children attending a Hospital-based primary care clinic revealed a 16 percent prevalence of Toxocara canis infection. Infections were found in other household occupants for half of these children. Follow-up of 20 children (for periods of up to 7 years) with asymptomatic T. canis infection failed to demonstrate any clinical sequelae. However, longer periods would be necessary to entirely discount the possibility of latent ocular disease. Treatment with thiabendazole did not appear to alter the course of the infection in a controlled 1-year evaluation as measured by eosinophil counts and specific T. canis antibody titers.
Rhabdomyolysis Complicating Doxylamine Overdose
Authors: Mendoza Fernando S. , Atiba Joshua O. , Krensky Alan M. , Scannell Lynne M.
Published: November 2007

A 16-year-old male presenting with anticholinergic symptoms was found to have hematuria and oliguria. Evaluation of the patient revealed a serum creatinine of 2.2 mg/d1, myoglobinuria, and a creatine phosphokinase (CPK) level of 78, 750 IU/1 with 99 percent fraction 3 isoenzyme. A toxic screen showed the presence of doxylamine, an antihistamine of the ethanolamine class, at a level of 75 times therapeutic. The patient did not have a history of trauma or seizures. The extremely high CPK level with the doxylamine overdose suggests that doxylamine may be associated with nontraumatic rhabdomyolysis. This is the first case report of rhabdomyolysis being associated with an antihistamine overdose.
Reversal of Central Nervous System Involvement in Hemolytic Uremic Syndrome by Use of Plasma Exchanges
Authors: Sheth Kumudchandra J. , Leichter Heinz E. , Gill Joan C. , Baumgardt Anne
Published: November 2007

A 12-year-old girl presented with weakness, diplopia, and lethargy after a prodrome of gastroenteritis. Laboratory studies were compatible with a diagnosis of hemolytic uremic syndrome. She developed seizures that were controlled by diphenylhydantoin and valium. In spite of peritoneal dialysis and fresh frozen plasma infusions, she progressed to a left hemiplegia associated with a brain scan finding of decreased blood flow in the right middle cerebral artery perfusion area. A 5 liter whole blood exchange transfusion did not improve the neurological status or low platelet count. Daily plasma exchanges with fresh frozen plasma replacement resulted in normal platelet count within 48 hours and was followed by progressive improvement in neurological status. Platelet agglutinating factor decreased to control levels. A repeat brain scan was normal.
Autologous Blood Transfusion in a Pediatric Population
Authors: Novak Robert W.
Published: November 2007

A program for both preoperative collection and intraoperative salvage of autologous blood was established for a pediatric population. Eighty two patients, 16 years old or younger, participated during a 2-year period. Thirty four had blood collected preoperatively and 48 utilized salvaged blood only. Only 5 percent of preoperative donations were associated with any adverse reaction and all reactions were mild. Salvaged blood provided an average of 48 percent of all blood needs in those patients in whom it was used alone; in only 10 percent of cases did it provide for all of the patient's blood needs. Preoperatively collected blood met an average of 74 percent of blood needs when it was used alone; in half of the cases it was the only blood the patient required. The combination of preoperatively collected and intraoperative salvaged blood was highly successful, meeting an average of 94 percent of blood needs and supplying all blood needs in 77 percent of these patients.
The Accuracy of Blood Glucose Testing by Children
Authors: Strumph Paul S. , Odoroff Charles L. , Amatruda John M.
Published: November 2007

While studies have evaluated the accuracy of adult patients and health personnel in reading various glucose oxidase impregnated strips to estimate blood glucose, there are no studies exclusively evaluating the accuracy of children with diabetes reading their own strips as compared to a staff member, and meter to meter variability in reading these strips. We evaluated the accuracy of reading chemstrip bG by children at a summer camp. The children's visual readings of their own strips were compared to the visual reading of a single staff member.

A total of 356 Chemstrip bG's were visually read by diabetic children and a single trained staff member at a summer camp for diabetics. The strips were then analyzed by two Accu-Chek bG meters. Intermachine variability was found to be negligible over the entire bG range. For the purposes of this study, we define accurate visual readings as those within ±15 percent of the meter reading of a given strip. At low bG values (40-79 mg/dl), accuracy by children and staff is low, with underestimating occurring in 39 percent of staff readings and 57 percent of children's readings. At intermediate bG values (120-239 mg/dl) readings are more accurate, especially when read by the staff, with misreadings occurring in only 16-19 percent of the strips. At high bG values (240-399 mg/dl), accuracy by children is decreased, with underestimation 500 percent more often than staff. We conclude that children are less accurate at reading Chemstrip bG than a trained staff member (51% versus 33% misreading), especially at the upper and lower ranges of bG values when visual readings are least accurate, and the need for therapeutic intervention is the greatest.
Measles in Zaire: 1987
Authors: Fischer Philip R.
Published: November 2007

Despite widespread efforts to prevent measles, a measles epidemic raged in Zaire during 1986 and early 1987. Hospitalized patients were studied with the goals of better understanding the weakness of the current efforts and of suggesting improvements in the local practice of primary health care. One hundred seventy five patients were hospitalized with measles or measles complications between October 1986 and February 1987 at the Evangelical Medical Center in north-eastern Zaire. Ten percent died. Most patients were young (but older than 15 months) and poorly nourished. All patients were incompletely vaccinated. A changed vaccine schedule is proposed, and more thorough application of primary health care measures is encouraged.
Infantile Vomiting Due to a Disappearing Hairy Polyp
Authors: Camacho Alfonso E. , Vonnegut Mark , Eavey Roland D.
Published: November 2007

Infantile vomiting can occur from many causes. A mass in the nasopharynx is an obscure reason for emesis. Maternal detection of an intermittently visible mass secured a diagnosis that had eluded observation, even after the patient had been hospitalized. "Hairy polyp" has received almost no attention in the Pediatrics literature. 1,2 This report is both for information about the unusual tumor and for reaffirmation of the value of parental observation.
AIDS Education in the Schools
Authors: Brown Larry K. , Fritz Gregory K.
Published: November 2007

As plans for massive public AIDS education grow, pediatricians will become increasingly involved with school systems as consultants and leaders. A review of relevant literature on students' current level of knowledge about AIDS and on educational efforts to date with high-risk groups (homosexuals and intravenous drug users) provides the rationale for school-based AIDS education. Literature describing the approaches used and the impact of programs for sex education, drug abuse prevention, and reduction of prejudice towards the disabled is reviewed to extrapolate that which applies to AIDS education. Important developmental characteristics of adolescents are discussed insofar as they have implications for the planning of AIDS curricula.