bluuebunny/crossref_metadata_2025 huggingface dataset:
A General Clinic for Adolescents
Authors: Gareis Frank J. , Yancy William S.
Published: November 2007

In a general clinic for adolescents within a large general hospital, the main problems were respiratory infections, sports injuries and similar minor trauma, and allergic disease. The experiences of this clinic afford a perspective to physicians who are currently in training concerning the types of medical problems exhibited by adolescents.
Subdural Hematoma in Infancy
Authors: Salmon James H.
Published: November 2007

Symptoms of subdural hematoma in infancy are nonspecific. This article suggests ways to make the diagnosis and details the technic for performing a subdural tap. The staff at the Cin cinnati Children's Hospital has had gratifying results with the conservative approach of repeating subdural taps as indicated.
Benign Essential Tremor in Childhood
Authors: Paulson George W.
Published: November 2007

Benign or essential tremor may occur in chil dren as well as adults. The prognosis is good, though the tremor tends to become worse with age. Reassurance and adjunctive pharmacologic management are the goals of therapy.
Report of Five Children with Hemophilus Influenzae Pneumonia
Authors: Soto Emilio , Silverio John
Published: November 2007

Five cases of Hemophilus influenzae pneumonia were observed in a 13- month period at Fairfax Hospital, Fairfax, Va. More aggressive diagnostic procedures may be required in order to diagnose this disease with greater frequency. This has become especially important in view of the growing recovery of ampicillin-resistant H. influenzae strains.
The Practical Management of Vesicoureteral Reflux in Children
Authors: Amar Arjan D. , Singer Bella , Chabra Kamla
Published: November 2007

Early recognition, adequate treatment, close observation, and systematic follow-up over a long period are essential to renal salvage in the child with vesicoureteral reflux. The decision whether and when to operate is made on a balance of factors by the pediatrician-urologist team. Among 236 patients with reflux diagnosed during childhood, reflux was stopped in 55 per cent of those treated medically and in 98 per cent of the more severe cases who were treated by ureteral reimplantation. Chronic pyelonephritis appeared or worsened during medical management in 12 per cent; no child showed new pyelonephritic scars or worsening of pyelonephritis after ureteral re implantation.
Deaths Due to Childhood Asthma
Authors: Wood David W. , Lecks Harold J.
Published: November 2007

Seven cases of death in patients with severe asthma are presented. The cause of death in asthmatic children is discussed under the following headings: mucus plugs, insufficient treatment, infection, aspiration, concomitant disease, oversedation, theophylline toxicity, overuse of metered dose pressurized aerosols, inadequate steroid therapy, and sudden cardiopulmonary arrest.

The authors conclude that asthmatic deaths are preventable.
Accidental Iron Poisoning in Childhood
Authors: Greenblatt David J. , Allen Marcia D. , Koch-Weser Jan
Published: November 2007

Between 1962 and 1973, six children were admitted to the Massachusetts General Hospital because of accidental iron poisoning. Intoxication was life- threatening in two children whose serum iron concentrations exceeded their iron binding capacities. One of these patients died despite intensive supportive care and desferoxamine therapy. Although iron poisoning appears to be relatively uncommon, it can produce life-threatening and fatal intoxication in children.
Cephalexin: Clinical and Laboratory Evaluation in Infants and Children
Authors: Rudoy R.C. , Riley Harris D.
Published: November 2007

Cephalexin appears to be a highly effective antibiotic. It possesses the qualities of rapid oral absorption, production of high drug levels in the blood and urine, and near absence of side effects. it is effective against infections due to gram-positive cocci infections, with the exception of Enterococcus, and for most infections caused by E. coli and Klebsiella. It is useful in the treatment of a wide variety of infections in infants and children, and particularly valuable with susceptible infections in patients who do not require parenteral antimicrobial therapy.
A Study of the Efficacy of the Feingold Diet on Hyperkinetic Children
Authors: Brenner Arnold
Published: November 2007

A study was conducted with 59 children, ages 6 to 14 years, hetero geneously grouped together under the diagnosis of the hyperkinetic, minimal brain dysfunction syndrome. Of 32 who were able to tolerate the Feingold salicylate-low and additive-free diet, 11 were markedly improved. A placebo effect could not definitely be ruled out, but the startling changes seen in patients who had been followed for years with other forms of therapy suggest strongly that this improvement was genuine.
Systemic Lupus Erythematosus in Children
Authors: Norris Donald G. , Colón Angel R. , Stickler Gunnar B.
Published: November 2007

Between 1945 and 1970, 101 children (86 girls and 15 boys) with systemic lupus erythematosus were evaluated at the Mayo Clinic. Only 9 children were less than 9 years old at the time of diagnosis. The most frequent presenting complaint was arthralgia; fever, fatigue, and a "butterfly" malar rash also were common. Renal involvement, found in more than 76 per cent of patients, was a prognostically poor sign. The overall survival of children with renal involvement is improved by the use of adequate steroid therapy.
Diarrhea, Red Diapers, and Child Abuse
Authors: Fleisher David , Ament Marvin E.
Published: November 2007

Three children were chronically given phenolphthalein in the form of laxatives by emotionally disturbed mothers. All children had repeated hos pitalizations and extensive diagnostic testing because of recurrent intractable unexplained diarrhea. One child died. Pink-red urine and stool were passed at some time during their illnesses. The presence of phenolphthalein was tested for by application of dilute acid or dilute alkali to the diapers causing respec tively disappearance or deepening of the pink-red color. Cases went un- diagnosed for prolonged intervals because mothers seemed exemplary. Evidence of their psychiatric illnesses was found once the possibility was considered.

Phenolphtalein poisoning should be tested for in any case of intractable diarrhea when objective evidence of intestinal mucosal damage cannot be found. The condition represents a heretofore unrecognized variant of child abuse or battering.
The Providing of Well-Baby Care within Parent-Infant Groups
Authors: Stein Martin T.
Published: November 2007

A model has been described for the practice of pediatrics using parent-infant groups. In a one year experience, three parent-infant groups met at monthly intervals. A one-hour parent discussion was followed by examination of the infants within the group setting. Among the benefits observed were much more attention to well-baby care and infant development, and the surfacing and alleviation of parental concerns and anxieties.
Diabetic Day
Authors: Kohler Elaine
Published: November 2007

The techniques of management by objective have been used to coordinate and evaluate the activities of a non-traditional program for the medical care and education of children with juvenile diabetes mellitus. "Diabetic Day" is an ambulatory child-directed clinic program in which health professionals work together to improve the child's ability to cope with diabetes.
Expenditures for Health Care of Children and Youth in the United States
Authors: Wallace Helen M.
Published: November 2007

This paper describes the expenditures for health care in the United States in fiscal year 1975. Proportionately, health expenditures for children and youth are lower than for other age groups. The average per capita expenditure for children and youth was $212.00. For children and youth public health care expenditures represented 24 per cent of the total; from public funds, Medicaid and the Department of Defense were the largest two programs; from the public sector, the federal government provided two thirds of the total health expendi tures. For children and youth, two thirds of all health expenditures were for hospital care and physicians' services.
Trichorhinophalangeal Dysplasia (Giedion Syndrome)
Authors: Kuna Gupta B. , Collipp P.J. , Balsam Dvorah
Published: November 2007

This rare syndrome is characterized by short stature, sparse, fine scalp hair, a pear-shaped nose, long philtrum, normal intelligence, and cone-shaped epi physes of the phalanges with deformities of the fingers.
Problems in the Care of the Infant Diabetic Patient
Authors: Grunt Jerome A. , Banion Carolyn M. , Ling Lyllis , Siegel Charles , Frost Michael
Published: November 2007

The unique problems of three infants who developed diabetes mellitus at 13 months of age or younger are discussed. These problems include: the administration of small doses of insulin; the difficulty in attaining control; and the evaluation of urinary sugar content. Suggestions for care are made.
A Study of the Inheritance Pattern of Romano-Ward Syndrome
Authors: Itoh S. , Munemura S. , Satoh H.
Published: November 2007

Romano-Ward syndrome consists of attacks of syncope, possible sudden death, accompanied by prolonged Q-T interval on ECG. We carried out HLA antigen typing of a family of 16 members having ten cases of Romano-Ward syndrome. All the ten cases had the common HLA haplotype of A9-Bw54, while the six not showing the symptoms did not have A9-Bw54 haplotype. The genes of this syndrome, considered to be inherited through the autosomal dominant patterns, are assumed to have a close linking to the major histo compatibility complex on the short arm of chromosome number 6.
A Comparison of Metaproterenol and Theophylline for Control of Childhood Asthma
Authors: Schuller Diane E. , Oppenheimer Philip J.
Published: November 2007

Twenty asthmatic children who had daily wheezing requiring constant medi cation as outpatients were given oral metaproterenol or oral theophylline in a randomized double-blind crossover study. Each medication was given for four weeks, after the theophylline dosage necessary to give a therapeutic level was established. Pulmonary function parameters, daily peak-flow measurements and diary symptom scores were statistically comparable in most patients during these four-week intervals. Metaproterenol may be used in place of oral theophylline for at least a four-week interval with no decrease in effectiveness.
Childhood Serous Otitis Media
Authors: O'Shea John S. , Langenbrunner David J. , McCloskey David E. , Pezzullo John C. , Regan J. Barry
Published: November 2007

Of 55 patients who had received, in a previously reported double-blind study, either an antihistamine-adrenergic combination or a placebo for three months for serous otitis media, 48 were followed without drug therapy for an additional year. During the follow-up period no differences were detected between the patients who had initially been treated with drugs and those who had received the placebo, as detected by audiometry, tympanometry, parental concern about hearing loss (as detected by the parents themselves or by their children's teachers or primary health care providers), school performance, or recurrences of serous otitis media.
Fluid, Electrolyte, and Glucose Maintenance in the Very Low Birth Weight Infant
Authors: Baumgart Stephen , Langman Craig B. , Sosulski Richard , Fox William W. , Polin Richard A.
Published: November 2007

The low birth weight premature newborn, less than 1000 gm, represents a dif ficult problem in the management of parenteral fluid, electrolyte, and glucose maintenance. To assess this problem, six infants (mean weight 720 gm, range 575- 835 gm; mean gestation 26.5 ± 0.4 SEM wk) nursed under radiant warmers were evaluated during the first three days of life to determine volume of fluid intake, sodium and dextrose intakes, and urine output. Insensible water loss (IWL) was measured on a metabolic scale. In accordance with current recommendations, infants received fluid volumes of 111 ± 10, 152 ± 16, and 191 ± 27 ml/kg/day on days 1, 2, and 3, respectively. Sodium intake (usually as 0.2% saline) ranged 0-8.5 mEq/kg/day. Dextrose infusions (as 10% solution) ran from 3.3 to 13.7 mg/kg/ min. Insensible water loss measured 159 ± 15 ml/kg/day. Despite increasing fluid intake, serum sodium concentration increased from 141 ± 3 mEq/l on day 1 to 155 ± 7 mEq/l on day 3 (p < 0.05). None of the infants became oliguric and only two urine specimens had specific gravity greater than 1.015. These data demon strate a larger insensible water loss than reported previously in small infants, but increasing the administration of standard 10% dextrose and 0.2% saline solution to balance insensible losses may result in sodium and glucose overload. Recom mendations are made for adjusting parenteral fluid therapy for birth weight groups 600-800, 801-1000, 1001-1500, and 1501-2000 grams and for environmental con ditions or radiant warmer or incubator, with or without plastic shielding or pho totherapy.
Bacterial Endocarditis with a Tolerant Staphylococcal Organism
Authors: McMillan Julia A. , Weiner Leonard B.
Published: November 2007

An eight-year-old boy developed staphylococcal endocarditis. He was treated initially with nafcillin and gentamicin, but he remained febrile. The minimum bactericidal concentration (MBC) of nafcillin was 130 times the minimum inhib itory concentration (MIC). Following the addition of rifampin to the antibiotic regimen, the patient became afebrile and recovered. The discrepancy between the MBC and MIC indicated tolerance to nafcillin. Tolerance is a mode of antibiotic resistance that must be considered in treating life-threatening illness.
Effect of Packaging and Appearance on Childhood Poisoning
Authors: Schum Timothy R. , Lachman Barry S.
Published: November 2007

Over a 13-month period, 14 patients were hospitalized at Milwaukee Children's Hospital for rodenticide ingestions. Ten of the 14 patients ingested Vacor Rat Poison (N-3-pyridylmethyl N'-p-nitrophenyl urea). Small children could easily mistake Vacor, which resembles corn meal, for breakfast cereal. To intervene for safer packaging of toxic substances, pediatricians need to be aware of the health hazard posed to children by attractive packaging.
The Role of the Chest Radiograph in the Management of Childhood Asthma
Authors: Rushton Alan R.
Published: November 2007

Emergency Room records were analyzed retrospectively for 1548 asthma patient visits over a 24-month period. Chest x-rays were obtained during 391 visits. Five per cent had focal atelec tasis, ten per cent had a pulmonary infiltrate. There was no difference between the x-ray results of those children successfully treated as outpatients and those requiring hospitalization. Physicians frequently ordered x-rays for asthmatic children under 5 years of age, for those with temperature greater than 38.3 C, symptoms longer than 2 days, respiratory rate greater than 40, a more severe attack with asthma score greater than 3, or pulmonary rales. Significantly abnormal chest radio graphs (focal atelectasis or pulmonary infiltrate) were found only in patients under 5 years old or in older patients with pulmonary rales. The other patient characteristics which appeared to indicate a more severe asthma attack did not correlate with abnormal radiograph reports. The routine chest x-ray does not appear to provide useful information for the design of treatment plans for children with asthma.
Hypoelectrolytemia as a Presentation and Complication of Cystic Fibrosis
Authors: Ruddy Richard , Anolik Robert , Scanlin Thomas F.
Published: November 2007

We describe three patients with cystic fibrosis (CF) with four episodes of hy poelectrolytemia, two of which were associated with documented metabolic al kalosis. CF should be included in the differential diagnosis of infants and children presenting with hypoelectrolytemia and metabolic alkalosis. Patients with CF are at risk of developing severe hypochloremia in hot weather and during intercurrent illness. An abrupt diminution of oral intake is an important suggestive sign, alerting the physician to look for the development of hypoelectrolytemia.
Comparison of Salivary Concentrations of Rifampin and Cefaclor
Authors: Ginsburg Charles M. , McCracken George H.
Published: November 2007

Cefaclor and rifampin were measured in the serum and saliva of healthy adult volunteers after ingestion of a liquid formulation and again after capsules of the drugs were given. Antimicrobially active drug was present in most salivary samples after ingestion of suspension of both drugs; however, only rifampin appeared in saliva after ingestion of the capsules. These data correlate with clinical studies of Hemophilus influenzae type b chemoprophylaxis and provide an expla nation of the efficacy of rifampin and the inability of cefacior to eradicate pharyngeal carriage of Hemophilus strains.
Evaluation of Cefaclor in Acute Otitis Media Caused by Ampicillin-resistant H. influenzae
Authors: Schwartz Richard H. , Rodriguez William J. , Khan Waheed N. , Brigham Lori , Ross Sydney
Published: November 2007

Cefaclor was used to treat 13 children with acute otitis media caused by ampicillin-resistant strains of Hemophilus influenzae. The children were re-examined on days 4, 10, and 28. Phar macologic compliance was assessed by means of a bioinhibition assay on a urine specimen obtained on days 4, 7, and 100 Nine of the 13 children had evidence by tympanogram of residual otitis media with effusion (secretory otitis media). Of these, three were noted to have a bulging, yellow or grey eardrum, which suggested an ongoing acute process. A second middle ear culture was obtained from two of the 3 children, but no pathogens were recovered. Two others had recurrence of otitis shortly after cessation of therapy. Cefaclor is an acceptable antibiotic for the treatment of ampicillin-resistant acute otitis media; but, after cefaclor therapy, some children continued to have a bulging eardrum and sterile pus in the middle ear or had recurrences of otitis soon after cessation of therapy.
Nephrotic Syndrome Associated with Non-Hodgkin's Lymphoma
Authors: Herskowitz Lee J. , Gottlieb Ruth P. , Travis Susan
Published: November 2007

The nephrotic syndrome (NS) in childhood is usually idiopathic with minimal change on renal histopathology, but can be secondary to other conditions. A case of NS associated with non-Hodgkin's lymphoma, which went into complete re mission with appropriate chemotherapy is presented.
Changes in Aerobic Pharyngeal Flora Related to Antibiotic Use and the Emergence of Gram-negative Bacilli
Authors: Yoshioka Hajime , Fujita Kozo , Maruyama Shizuo , Oka Ryuji
Published: November 2007

Pharyngeal flora were evaluated semi-quantitatively by counting and differentiating the colonies growing on blood agar plates into four major bacterial groups. In children they consisted mainly of α-streptococci, followed by smaller portions of Neisseria, and of gram-positive organisms other than α-streptococci. Gram-negative bacilli did not occur under normal conditions.

Oral ampicillin in a daily dose of 50 mg/kg caused suppression of the α-streptococci, and promoted emergence of gram-negative bacilli. Oral cephalexin in the same dose caused changes in the same direction, but less extensively than ampicillin. Parenteral aminoglycoside antibiotics in usual dosage did not change the pharyngeal flora.

Differential counting of the growth is a simple and useful tool to evaluate the ecology of pharyngeal flora. It serves to monitor overgrowth of resistant organisms in the respiratory tract.
Pediatric Screening of Southeast Asian Immigrants
Authors: Goldenring John M. , Davis Jeffrey , McChesney Margaret
Published: November 2007

Statistics from the first three months of operation of the Santa Clara County Indochinese Health Screening Clinic were analyzed for prevalence of anemia, parasitism, and exposure to tuberculosis in Southeast Asian children and young adults, ages 9 months to 24 years. Anemia was extremely common in infants up to 5 years of age (35.7%) and decreased to 4.8% in the 15- 24 year-old category. Parasitism was not age-dependent, with an average of 58.8 per cent of those screened exhibiting infestation. Positivity in tuberculin skin testing showed a pattern opposite to that of anemia, with a prevalence of 13 per cent in infants and children, rising to 34 per cent in young adults. Over 90 per cent of the target population was successfully screened. Health problems of Indochinese immigrants may be age-related and are very efficiently and effectively identified by an area-wide screening program.
Assessment of the Patient Suspect of Atopy
Authors: Hemstreet Mary Pat B. , Koors Patricia G.
Published: November 2007

A retrospective chart analysis of patients referred to the Allergy Service was undertaken to determine which historical and laboratory data most closely correlated with the presence of atopy. The serum IgE level was highly significant for all patients when analyzed as a group (p < 0.0001). Other factors assumed significance when the patients were analyzed by individual age groups. Guidelines for the logical assessment of the child suspect of atopy are proposed.
An Evaluation of Breast Pumps Currently Available on the American Market
Authors: Johnson Carmen Acosta
Published: November 2007

Eight breast pumps commonly seen in clinical practice were measured and ranked for de sirability in eight categories: pressure range, pressure control, size and shape of nipple cup, volume accommodation, visual feedback, ease of cleaning, ease of handling, and cost. Three scored relatively high (Egnell, Kaneson, and Loyd-B), three scored low (Gomco, Davol, and Bintner), and two appeared to be frequently ineffective (Evenflo and Ora'lac).
Tags and Bands of the Female External Genitalia in the Newborn Infant
Authors: Mor Naomi , Merlob Paul , Reisner Salomon H.
Published: November 2007

A high incidence of hymenal tags (5.75%) and hymenal bands (2.7%) was found during the routine physical examination of 974 female infants within the first 24 hours of life. Hymenal tags usually disappear spontaneously as the estrogen effect diminishes. If they do not, biopsy should be considered.

A simple test is proposed to demonstrate the superficial position of the hymenal band and its lack of connection with an internal structure.
Stress Management in Childhood
Authors: Yates Alayne
Published: November 2007

In general, physical and emotional problems are more likely to occur in adults and children who have been exposed to unusual environmental stress. The author reviews the research on children's reactions to environmental and intrafamilial trauma: all youngsters are symptomatic after severe trauma and certain symptoms are characteristic for a given developmental stage. However, some children are able to tolerate submaximal pressure without evident harm. These stress-resistant children are likely to exhibit optimism, ability, and a sense of control over their environment. These attributes can be consciously enhanced when children are taught problem- solving skills. The pediatrician is in an excellent position to prevent emotional morbidity by implementing interventions which would augment children's healthy defenses and enhance their sense of mastery.
Effect of Long-term Administration of Sodium Benzoate to a Patient with Partial Ornithine Carbamoyl Transferase Deficiency
Authors: Takeda Eiji , Kuroda Yasuhiro , Toshima Kenji , Watanabe Toshiyuki , Naito Etsuo , Miyao Masuhide
Published: November 2007

An 8-year-old girl with partial ornithine carbamoyl transferase deficiency was treated with sodium benzoate (200 mg/kg/day) for 13 months. Before administration of sodium benzoate, her protein intake was reduced to 1.0 to 1.5 g/kg/day and her caloric intake fluctuated. Hy perammonemic attacks were frequently observed in winter. After the start of administration of sodium benzoate, the severity and frequency of these attacks decreased, although her protein intake was increased to 1.5 to 2.0 g/kg/day. No adverse effect of sodium benzoate were detected by clinical and laboratory examinations. It is concluded that long-term oral administration of sodium benzoate was effective in reducing the frequency and severity of hyperammonemic attacks in this patient. Sodium benzoate therapy in combination with dietary manipulation may improve the growth and development of these patients by allowing reduced dietary protein restriction.
Inflammatory Constriction Following Complete Pericardiectomy in Tuberculous Constrictive Pericarditis
Authors: Kashani Iraj A. , Higgins Charles B. , Utley Joe R.
Published: November 2007

A 13-year-old boy with active tuberculous constrictive pericarditis underwent complete pericardiectomy together with antituberculous therapy and a short course of steroids. Six weeks following the surgery, he was seen with clinical and hemodynamic findings of recurrent pericardial constriction, presumably due to an inflammatory collection around the heart. Symptoms gradually resolved within six months with resumption of steroid therapy. Repeat hemodynamic study showed normal hemodynamics.

The case demonstrates the production of cardiac constriction by nonpericar dial inflammatory tissue and the possible benefits of steroid therapy in the treat ment of tuberculous constrictive pericarditis.
Jejunal Atresia Associated with Cafergot® Ingestion During Pregnancy
Authors: Graham John M. , Marin-Padilla Miguel , Hoefnagel Dick
Published: November 2007

Fetal vascular accidents have been suggested as one cause for jejunal atresia due to in utero interruption of the superior mesenteric arterial supply to the intestines. Experimental studies support this hypothesis, and ergotamine has been shown to be a teratogen in experimental animals as a consequence of its vasoconstrictive action. We report the occurrence of intrauterine growth retar dation and jejunal atresia in an offspring of a woman who also experienced four spontaneous abortions. During each of six pregnancies, the mother had taken as many as eight Cafergot® tablets daily. We raise the hypothesis that Cafergot (1 mg ergotamine tartrate and 100 mg caffeine) might represent a vascular dis ruptive teratogenic agent during pregnancy. This hypothesis is supported by the clinical association of nonduodenal intestinal atresia with other defects that have a disruptive vascular etiology.
The Prenatal Pediatric Visit Revisited
Authors: Berger Lawrence R. , Rose Edward
Published: November 2007

The potential value of prenatal interviews with pediatricians was explored through interviews with 20 low-income women in their last trimester of pregnancy. Major areas of attention in cluded prenatal concerns, psychosocial assessment, and anticipatory guidance. Important issues of relevance to pediatric care emerged, including gaps of parental knowledge, lack of financial and emotional support, and anxieties about the infant. Prenatal pediatric visits also served to encourage the involvement of fathers in pediatric care and to establish an ongoing professional relationship with the pediatrician. In health care settings where comprehensive, coordinated care is often lacking—such as teaching hospitals or county clinics—pediatric providers must take the initiative if families are to be reached prenatally.
Parapneumonic Pleural Effusion and Empyema in Children
Authors: Chonmaitree Tasnee , Powell Keith R.
Published: November 2007

Between 1962 and 1980, 50 children admitted to Strong Memorial Hospital had a pleural effusion or an empyema associated with pneumonia. Such parapneumonic effusion and em pyema accounted for 52 per cent of cases of pleural effusion and empyema of all etiologies admitted during those years. Review of cases of parapneumonic effusion and empyema suggested that clinical manifestations, laboratory, and roentgenographic findings did not separate these two groups of patients before thoracentesis was performed. Specific organisms were identified in 29 per cent of cases with parapneumonic effusion and 62 per cent with parapneumonic empyema. Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes were re sponsible for 35, 30, and 20 per cent of cases, respectively. Parapneumonic effusions were treated without closed-chest tube drainage in 76 per cent of the cases, while closed-chest drainage was necessary in virtually all cases of children with empyema.
Prevalence of Lymphadenopathy of the Head and Neck in Infants and Children
Authors: Herzog Lynn W.
Published: November 2007

This study demonstrates the widespread prevalence of "normal" adenopathy in children; i.e., not associated with infectious adenitis or serious system illness. The knowledge of this distri bution is helpful in determining when adenopathy may be pathologic. Occipital and postau ricular adenopathy is a common nonspecific finding in infancy; but, over the age of 2 years, it is sufficiently rare that it can be a useful diagnostic finding. Cervical and submandibular nodes are rare in infants under 12 months but are common in older children. Supraclavicular nodes are probably pathologic at any age.
The Asymmetric Tonic Neck Reflex
Authors: Marinelli Philip V.
Published: November 2007

Asymmetric tonic neck reflex (ATNR) is an easily elicited reflex in the immediate newborn period and should not be considered pathologic unless it is obligatory. Although bidirectional responses are normally encountered, unidirectional responses are not uncommon. The majority of infants display the complete reflex, however, the lower extremities are the most consistent participants.
Circumcision
Authors: Metcalf Thomas J. , Osborn Lucy M. , Mariani E. Mark
Published: November 2007

The purpose of this study was to investigate the current incidence of circumcision, the reasons governing parental decisions regarding circumcision, the immediate and later complications from the procedure, as well as genital problems occurring in uncircumcised boys. The incidence of circumcision was found not to have changed over the past five years despite the recommen dations of the American Academy of Pediatrics Task Force on Circumcision. The reasons given for circumcision reflected mostly the strength of tradition, rather than a medical approach. Four per cent of newborns experienced early complications from the procedure, whereas 13 per cent experienced later, minor complications. Problems reported in uncircumcised infants were probably variants of normal. While the results of this study add evidence for discontinuing neonatal circumcision, we strongly recommend that, if physicians dissuade parents from having their infants circumcised, they must give adequate information concerning hygiene and the slow, natural separation of the foreskin from the glans.
The Pre-participation Examination of the Young Athlete
Authors: Runyan Desmond K.
Published: November 2007

Examination of published reports and expert recommendations about appropriate pre-par ticipation examinations of young athletes reveals widespread disagreement about objectives, format, and content. This review and commentary examines current evidence and proposes a more modest routine athletic physical. Even without requiring evidence of careful science and methodologic rigor, few of the traditional parts of the physical for the athlete are found to have evidence of utility. Some newly suggested orthopedic maneuvers may ultimately prove useful. Definitive recommendations await evaluation, using appropriate and careful methodology.
Facilitating Patient Understanding in the Treatment of Growth Delay
Authors: Grew Robert S. , Stabler Brian , Williams Randall W. , Underwood Louis E.
Published: November 2007

Effective physician-patient communication is often critical to the success of therapy of an illness. It has been shown that childrens' understanding of their illness is related to their stage of cognitive development, emotional maturity, and the level of communication between doctor and patient. Using a simple visual technique, we have demonstrated that nearly 45 percent of growth delayed children and their families overestimated their height in relation to peers and nearly 80 percent have unrealistic expectations of hGH therapy. This could be corrected to a significant degree by using the same visual aid in combination with family conferences. The results of this study have implications for the nature of physician-patient communications in other disorders.
Pseudocyesis in an Adolescent Patient
Authors: Rosenberg Henrietta Kotlus , Coleman Beverly G. , Croop James , Granowetter Linda , Evans Audrey E.
Published: November 2007

The physical and psychological changes of pseudocyesis have bewaidered phy sicians since the time of Hippocrates. We present the case of a 14-year-old girl as a reminder that pseudocyesis needs to be considered in adolescents and that the diagnosis may not be obvious, even with current technologies. We document that gaseous distension and abdominal fat deposits can lead to dramatic abdom inal fullness and can mimic a term pregnancy.
Ocular Presentation of Sarcoidosis in Children
Authors: Kataria Sudesh , Trevathan G. Earl , Holland James E. , Kataria Yash P.
Published: November 2007

Ocular manifestations of sarcoidosis in children are the second most common occurrence after hilar adenopathy and pulmonary abnormalities. We present the case history of a 14-year-old black boy who presented with redness of the left eye, blurred vision, and decreased visual acuity. He was subsequently diagnosed as having sarcoidosis. All patients with uveitis or ocular findings suggestive of sarcoidosis should have a thorough medical examination and a chest x-ray. Those suspected of or proven to have sarcoidosis should have a complete ophthalmological examination. Sarcoidosis in children appears to be more frequent than previously estimated.
Pediatrics in the Marshall Islands
Authors: Dungy Claibourne I. , Morgan Beverly C. , Adams William H.
Published: November 2007

The delivery of health care to children living on isolated island communities presents unique challenges to health professionals. An evolved method of providing longitudinal services to infants and children residing on islands of the Marshall Island chain—a central Pacific portion of the Micronesian archipelago—is presented. The difficulties associated with provision of comprehensive health care in a vast ocean area are discussed.
Pediatric Cardiopulmonary Resuscitation
Authors: Ludwig Stephen , Kettrick Robert G. , Parker Margot
Published: November 2007

Cardiopulmonary resuscitation (CPR) records of 130 pediatric patients with cardiac arrest were reviewed. Ninety-six resuscitations were performed on patients hospitalized on the Medical and Surgical units of the Children's Hospital of Philadelphia (HP) and 34 on Emergency Department patients (EDPs).

In HP, initial survival was 90%. In 27% of HPs, airway and breathing techniques alone were life saving. A mean of 2.45 drugs per patient were used for HP. In EDP, initial survival was 56%. There had been advanced CPR during the prehospital transport phase for the EDPs. All but two EDPs required drug management. The mean was 4.25 drugs per patient.

Lidocaine and direct current defibrillation were used only rarely. Glucose was used frequently (33%) and should be considered in the list of essential resuscitation drugs. The necessity for resuscitation was most commonly associated with pulmonary diseases.

These findings reflect differences between pediatric CPR and adult CPR, and suggest limitations in applying adult standards to infants and children. It is suggested that the medical community develop separate pediatric CPR courses as independent modules for those who assume responsibility for resuscitating children.
Paregoric Intoxication with Pulmonary Edema in Infancy
Authors: Rice Thomas B.
Published: November 2007

This report describes a 3-week-old infant with paregoric intoxication and pul monary edema. The pulmonary edema associated with opiod use is treatable even though the precise mechanism of its formation remains undefined. The report emphasizes that the medical rationale involved in the use of paregoric is unclear. The use of this preparation in pediatric patients should be abandoned in view of such serious complications.
Hypercalciuria in Clinical Pediatrics
Authors: Langman C.B. , Moore E.S.
Published: November 2007

Idiopathic hypercalciuria is a cause of a variety of urinary tract complaints in clinical pediatrics. These include gross or microscopic hematuria, enuresis, urinary frequency or urgency, dysuria, sterile pyuria, and proteinuria in addition to renal calculi. A random urine calcium-creatinine concentration ratio can be used to initially screen for hypercalciuria. Patients with indeterminate results should have the test repeated, while those with abnormal values should receive a complete metabolic workup to determine the cause of hypercalciuria. Identifiable causes of hypercalciuria should be treated specifically, and thiazide diuretics are the preferred treatment for uncomplicated renal calculi. Pharmacotherapy in children with idiopathic hypercalciuria and symptomatology other than renal stones is controversial and should be limited to patients with severe clinical manifestations.
Pathogenesis and Prevention of Recurrent Infection After Haemophilus influenzae Bacteremia
Authors: Liston Thomas E.
Published: November 2007

Recurrence of disease after Haemophilus influenzae bacteremia is relatively uncommon and may often be preventable. Three previously unreported and 11 reported occurrences in ten patients were evaluated in regard to pathogenesis. Recrudescence can be prevented by adequate culturing prior to therapy, proper treatment based on complete sensitivity testing and pharmacologic prin ciples, and careful evaluation of clinical and microbiologic response. Relapse may be prevented in some instances by administering prophylactic rifampin to patients and close contacts who may be carriers of an infecting strain. Reinfections may be prevented through public health measures and the development of effective vaccines.
Excretory Urography and Cystourethrography in the Evaluation of Children with Urinary Tract Infection
Authors: Drachman Rephael , Valevici Melly , Adiel Vardy Peter
Published: November 2007

One hundred and ninety-one children with a first episode of urinary tract infection (UTI) underwent intravenous pyelography (IVP) and voiding cystourethrography (VCU). Only three children (1.5%) had positive findings in the IVP that were of prognostic significance and were confined to that particular investigation alone. In contrast, 97 (50.7%) of the VCUs showed an atomical abnormalities. Vesico-ureteral reflux (VUR) of varying grades was diagnosed in 77 children (40.3%). These findings stress the importance of radiological investigation of the urinary tract after the first incidence of UTI, but suggest that IVP will give information of therapeutic and/or prognostic value in a small number of cases.
Management of Children with Failure to Thrive in a Rural Ambulatory Setting
Authors: Casey Patrick H. , Wortham Betty , Nelson Joann Y.
Published: November 2007

To evaluate the growth course of children with failure to thrive (FTT) who receive aggressive management, we reviewed the 2-year experience of a secondary level ambulatory diagnostic and management clinic for children with FTT in a mostly rural state. We examined the children managed in this setting for cause of FTT, for growth outcomes after 1 year according to FTT clinical type, and for differentiating predisposing sociodemographic information.

Of 154 children referred to this clinic, 131 were diagnosed as suffering from FTT. Eighteen were admitted to the hospital after initial outpatient evaluation, and 93 were followed for at least 1 year. Twenty-two (17%) suffered from organic, 59 (45%) non-organic, and 46 (35%) mixed etiology FTT. After 1 year, 48 (52%) of the FTT children were improved, 37 (40%) were stable, and 8 (9%) were worse. Children placed in foster care were more likely to be improved (78%). FTT children considered improved after 1 year demonstrated the following at the time of initial diagnosis: lower maternal income, lower maternal education, and lower family socioeconomic status; higher birth order; more often black; and less likely for the father to be present in the home (all p ≤ .05). This experience offers several insights into the growth course and team management of FTT children.
Benign Elevation of Serum Alkaline Phosphatase, Transient and Persistent Variety
Authors: Abbassi Val , Colon A.R. , Schwartz Richard H.
Published: November 2007

Markedly increased serum concentration of alkaline phosphatase (AP) was discovered in seven children. Investigation showed the finding to be benign in each case. Family survey and follow- up studies revealed a familial pattern in four children and a transient, idiopathic origin in the other three. Awareness of these benign forms of hyperphosphatasemia will aid the physician in the interpretation of elevated AP.
An Approach to Management
Authors: Spitzer Alan R. , Fox William W.
Published: November 2007

Apnea of infancy represents a problem that is commonly encountered by the practicing pedia trician ; yet, few publications have outlined a practical approach to the care of such infants. In addition, the somewhat controversial aspects of infant apnea and sudden infant death syndrome (SIDS) have resulted in the belief on the part of many physicians that the care of children with apnea or "near-miss" SIDS is either very difficult or of little value. This article, which is based upon the program at The Children's Hospital of Philadelphia, describes an effective management plan for identifying children at risk, lists appropriate evaluation studies, and presents a series of protocols for treating infants with apnea. The initiation of this program has helped to demystify the care of children with apnea and has been very well received by both parents and physicians.
Problems in the Clinical and Roentgenographic Diagnosis of Pneumonia in Young Children
Authors: Stickler Gunnar B. , Hoffman Alan D. , Taylor William F.
Published: November 2007

The difficulty of diagnosing pneumonia by chest x-ray in children less than 4 years of age was studied by comparing the chest roentgenograms of 34 healthy children with the chest roentgen ograms of 34 children previously diagnosed as having pneumonia. Review of these films without knowledge of the previous interpretation and without clinical information disclosed variations regarding the roentgenographic confirmation of pneumonia in 24 percent of the cases and variations regarding the location of the lesion in about 50 percent of the cases.
Quantitative Reviewing of Medical Literature
Authors: Ottenbacher Kenneth J. , Petersen Paul
Published: November 2007

The quantitative literature review is presented as a unique type of research endeavor complete with formal stages that parallel those associated with primary or experimental research. This article provides a tutorial overview of the quantitative literature review procedure and, in con junction with the companion article published in this issue, serves to illustrate the application of this technique in the review process. The stages in quantitative review include: (1) problem formation; (2) data collection; (3) data evaluation; (4) analysis and interpretation; and (5) reporting results. It is argued that inferences made in the research review process are as central to the establishment of valid biomedical and clinical knowledge as inferences made in primary research.

Despite some limitations, quantitative reviewing procedures constitute a significant advance over the traditional narrative methods of integrating empirical research in an area of interest. The use of quantitative reviewing procedures represents a paradigm shift in which the literature review is conceptualized as a unique form of scientific inquiry complete with formal stages and methods. The adoption of these methods should assist researchers in the behavioral and biomedical sciences in establishing scientifically valid data bases to guide theory development and direct future clinical investigation.
Breast- vs. Bottle-Feeding
Authors: Eiger Marvin S. , Rausen Aaron R. , Silverio John
Published: November 2007

This study compares the morbidity of two groups of healthy, full-term infants (25 in each group) who were exclusively either bottle-fed or breast-fed for 5 months. There were no statistically significant differences in morbidity between the two groups except for a borderline greater frequency of upper respiratory infections in the bottle-fed group.

Although the study groups are limited in size, the results suggest that, when appropriate hygienic measures are taken and statistical biases eliminated, differences in morbidity between bottle-fed and breast-fed babies are relatively minor.

The data also show that modern infant formulas seem to be nutritionally complete in that there was no difference in the rate of growth or in hematological parameters measured in the bottle- fed and breast-fed group.
The Association of Spinal and Gastroesophageal Anomalies
Authors: Thurston Stephen E. , Lenn Nicholas J.
Published: November 2007

Severe cervical radiculopathy occurred in a child with gastroesophageal dupli cation who had a previously unrecognized vertebral malformation. We review the literature on the association of vertebral and gastroesophageal anomalies and discuss the recent studies in human embryology which detail the relations of notochord to endoderm and neural ectoderm at about 3 weeks of gestation. This case illustrates the opportunity of preventing nerve root or spinal cord compromise due to such vertebral anomalies when the possibility of their association with gastroesophageal duplication is considered.
Acquired Craniofacial Features Associated with Chronic Phenytoin Therapy
Authors: Johnson John P.
Published: November 2007

Although the teratogenic effect of phenytoin on the fetus has been well-documented, the effect on postnatal facial structure has not been emphasized. The evolution of such changes is illustrated with serial photographs and case histories of five mentally retarded individuals not known to have diagnoses that could account for these dysmorphic features. The intent of this report is to increase awareness of this serious consequence of phenytoin therapy and to stimulate interest in further studies of the phenomenon. The incidence and prevalence, mechanism of production, genetic predisposition, and critical age for development of this effect in patients treated with phenytoin needs to be determined.
Familial Growth Retardation with Isolated Thyroid-Stimulating Hormone Deficiency
Authors: Labbe A. , Dubray C. , Gaillard G. , Besse G. , Assali P. , Malpuech G.
Published: November 2007

Three brothers with isolated thyroid-stimulating hormone (TSH) deficiency were observed at ages 17, 15, and 10 years. They suffered from severely retarded growth, with a marked retardation in bone maturation. Their serum T4, T3, and TSH levels were low. Serum thyrotropin-releasing hormone (TRH) concentration was normal. No increases in TSH levels were elicited during the TRH test. The other pituitary hormones, adrenocorticotropic hormone, growth hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin hormone, responded normally to stimulation. Thyroxin treatment triggered a growth acceleration. Genetic investigation revealed several instances of small stature on the father's side.