bluuebunny/crossref_metadata_2025 huggingface dataset:
Is There an Unconscious National Conspiracy Against Children in the United States?
Authors: Rothenberg Michael B.
Published: July 2008

The author's thesis is that there is indeed an unconscious national conspiracy against children in our country. He presents data in relation to seven areas in which children function, to support his thesis. He then proposes an approach to understanding how this state of affairs has come about and makes specific recommendations that he feels will help us move toward a solution to this problem.
Developmental Aspects of Galactosemia from Infancy to Childhood
Authors: Fishier Karol , Koch Richard , Donnell George N. , Wenz Elizabeth
Published: July 2008

The developmental status of 60 galactosemic infants, their subsequent intellectual level, school status, visual-perceptual skills, and EEG results were analyzed. In addition, the intelligence of the parents and the unaffected siblings, as well as the educational and vocational status of the parents, were also investigated. The results reveal that the highest level of mental develop ment was in the preschool age group. The lowest level, and still within normal limits, was in the school-age children. The overall findings are consistent with earlier observations that better progress is found in those individuals whose dietary control is instituted at the youngest age level.
Fever in the First Six Months of Life
Authors: Pantell Robert H. , Naber Michael , Lamar Rebecca , Dias James K.
Published: July 2008

The age-specific rate of elevated temperature over 37.8 C was evaluated in all infants less than 6 months of age (n = 1341) seen from July 1, 1974 to June 30, 1978 in a family practice clinic. Mild elevations (37.8 C-38.3 C) were common even in the first few months of life, and accounted for 20.7 per cent of infant visits. Temperatures greater than 38.3 C are uncommon in the first months of life but are seen more frequently with each succeeding month. Temperature elevation over 38.3 C was associated with a significantly higher rate of meningi tis (p < .01), otitis media (p < .001) and lower respiratory infection (p < .05). Significantly higher laboratory usage was documented in infants less than 3 months and for infants with temperature more than 38.3 C. The high rate of mild temperature elevations in young infants suggests that a selective diag nostic strategy directed at high-risk infants is important. Infants less than three months of age with a fever exceeding 38.3 C are calculated to have 21.5 times the risk of a serious underlying infection as infants older than three months with a similar temperature elevation. Clinical evaluation must remain an important tool in determining which febrile infants should be evaluated by further laboratory and diagnostic tests.
Hemophilus influenzae Infections
Authors: Muñoz Aurea I.
Published: July 2008

Invasive disease due to Hemophilus influenzae constitutes a major pediatric problem. The present article summarizes current concepts regarding epidemio logic, diagnostic, preventive and therapeutic aspects of Hemophilus influenzae infections.
Urinary Tract Infections in Children
Authors: Fennell R.S. , Luengnaruemitchai M. , Iravani A. , Garin E.H. , Walker R.D. , Richard G.A.
Published: July 2008

Eighty-five girls, ages 3-16, with a past history of recurrent urinary tract infections were treated for 10 days with either trimethoprim/sulfamethoxazole, ampicillin or cephalexin. Patients with normal roentgenograms as well as those with reflux and cortical scarring were included. In the 12 weeks following completion of treatment, a significantly lower recurrence rate was noted in children who received trimethoprim/sulfamethoxazole. There was no differ ence in the recurrence rate whether or not radiographic abnormalities were present. No serious side effects were noted with any drug regimen.
The Hemolytic Uremic Syndrome Associated with ECHO 22 Infection
Authors: O'Regan S. , Robitaille P. , Mongeau J.-G. , McLaughlin B.
Published: July 2008

Serologic evidence for ECHO virus 22 was found in 8 of 10 patients with hemolytic uremic syndrome. The virus was isolated from the stools of two patients. All these patients also had gastroenteritis prior to the development of the syndrome. The results of this study indicate that ECHO 22 virus is an agent with a strong association with hemolytic uremic syndrome in pediatric patients.
Activation of Latent Graves' Disease in Children
Authors: Morillo Edgar , Gardner Lytt I.
Published: July 2008

In some children, psychological events have appeared to be important in the triggering of Graves' disease. This report examines the case histories of three children in whom the appearance of symptomatology of Graves' disease was associated with depression following the death of a loved one. An analysis of neuroendocrine and immunologic pathways suggests that depression, set off by bereavement, causes low levels of norepinephrine in the brain. The latter in turn may mediate an increase in ACTH and cortisol, leading to reductions in immune surveillance and resultant production of thyroid-stimulating immuno globulins, hence the development of Graves' disease.
Evaluation of Arthritis and Arthralgia in the Pediatric Patient
Authors: McCarthy Paul L. , Wasserman Diana , Spiesel Sydney Z. , Dolan Thomas F. , Jekel James F.
Published: July 2008

The records of 250 consecutive children presenting to a university pediatric service with joint complaints of unknown cause were reviewed to determine the frequency of diagnoses and the utility of laboratory data and physical examination findings. Eighteen per cent of children had orthopedic disorders (Group I), 17.6 per cent had autoimmune disorders (Group II), 19.6 per cent had joint complaints related to a bacterial infection (Group III), and 44 per cent had miscellaneous problems (Group IV). Autoimmune or infectious dis orders were eight times as likely if temperature was ≥38 C. and/or erythrocyte sedimentation rate was ≥30 mm/h was present than if absent (65% vs. 8% re spectively) ; the sensitivity of fever and/or elevated erythrocyte sedimentation rate was 93 per cent for Group II and III patients. The presence of rash was predictive of an autoimmune disorder in 67 per cent of the instances; a positive joint examination was seen disproportionately in Group I patients. A negative joint examination all but ruled out an infectious etiology. Other test results, such as diagnostic radiograms, WBC ≥ 15,000 per cu mm; or a positive ANA or rheumatoid factor were predictive but not sensitive indicators of selected groups. If the etiology of a child's joint complaints is unknown, the likelihood of an orthopedic, autoimmune or infectious disorder may be suggested by reviewing temperature and ESR data and skin and joint findings.
Multiple Nosocomial Infections
Authors: Leviten Daniel L. , Shulman Stanford T.
Published: July 2008

Many components of modern medical care greatly predispose subjects to nosocomial infection. These include cancer chemotherapy, organ transplanta tion, immunosuppression, and intensive supportive care, particularly in con junction with mechanical ventilatory support, invasive monitoring devices and prolonged central or peripheral intravenous therapy. The hazard of noso comial infection associated with residence in a modern intensive care unit is dramatized by the case history of a near-drowning victim whose hospital course was complicated by an unusually large number and variety of noso comial bacterial infections. Sixteen different bacterial organisms were iso lated from cultures of blood, purulent thoracostomy tube drainage, or purulent tracheal secretions during the patient's prolonged hospital course. Factors which predisposed this patient to nosocomial infections included prolonged positive pressure mechanical ventilation, long-term broad spectrum anti biotics, indwelling arterial and central venous lines, violation of anatomic barriers by foreign bodies such as multiple thoracostomy tubes, and resi dence in an intensive care unit. This patient's case demonstrates that effec tive means to prevent nosocomial colonization and infection are urgently needed.
Female Epispadias
Authors: Schey William L. , Kandel Gerald , Charles Allan G.
Published: July 2008

Female epispadias is a congenital anomaly representing a mild form of the spectrum of exstrophy of the bladder. Unrecognized and untreated, the handicap associated with the physical malformation can create overwhelming clinical and psychological problems for the affected female. Radiographic findings of spinal dysrhaphism with diastasis of the pubic bones are often associated with, and can afford the first clue to, the physical findings of absent clitoris, ununited labia and patulous and foreshortened urethra.
Familial Clustering of Tonsillectomies and Adenoidectomies
Authors: Katznelson D. , Gross S.
Published: July 2008

Eighty-one children undergoing tonsillectomies and adenoidectomies (T and A) were compared with a control group of 88 hospital patients. A significantly higher incidence of prior T and A was found to have been performed on the siblings and parents of the T and A group than the controls. Environmental, genetic or attitudinal factors could be responsible for this familial clustering.
Comparative Accuracy of Recent Abbreviated Methods of Gestational Age Determination
Authors: White Penny L. , Fomufod Antoine K. , Rao Mamidanna S.
Published: July 2008

Fifty healthy newborn infants were studied in an attempt to test the accuracy of several recently reported shortened methods of gestational age determina tion. The Finnstrom method with seven external characteristics was more accurate than those that contained only five or less criteria. In the statistical analysis it also yielded results that were very similar to those obtained using the original Dubowitz technique which has 21 criteria.
Prevention and Treatment of Serous Otitis Media with an Oral Antihistamine
Authors: Klein Suzanne W. , Olson Ardis L. , Perrin James , Cunningham David , Hengerer Arthur , Hoekelman Robert A. , Roghmann Klaus J.
Published: July 2008

Serous otitis media (SOM) is a common and troublesome disease in childhood. Although antihistamines are commonly prescribed to prevent or treat SOM, there have been no controlled clinical trials to determine the efficacy of such interventions. This study was designed to determine if antihistamines are of value in the prevention or treatment of SOM. Using a randomized double-blind method, 206 children with acute otitis media were treated with antibiotics and either brompheniramine maleate or placebo. The children were evaluated two weeks later by tympanometry and, independently, by combined pneumatoscopy and otoscopy. There were no significant differences overall between the treatment and control groups in terms of preventing SOM: 44% of those on antihistamine and 41 % of those on placebo had SOM after two weeks of therapy. However, children with a history of serous otitis media did signifi cantly better on placebo than did those on antihistamine, and children without a history of serous otitis media did significantly better on antihistamine than did those on placebo. One hundred children continued to use antihistamine or placebo for four more weeks. There were no significant differences between the treatment and control groups in terms of resolution of SOM (64% versus 68%).
Developmentally-Oriented Safety Surveys
Authors: Bass Joel L. , Mehta Kishor A.
Published: July 2008

A series of developmentally-oriented safety surveys has been utilized in both private practice and clinic settings in an effort to systematize safety counseling in a practical and meaningful manner, and to provide data com paring the educational needs of various socioeconomic and ethnic groups. Extraordinary deficiencies were identified in parental awareness and reported practice of basic accident prevention techniques at all levels and in all social and ethnic groups.
Maintenance of Ambulation in Duchenne Muscular Dystrophy
Authors: Siegel Irwin M.
Published: July 2008

As the processes of pseudohypertrophic muscular dystrophy advance, contractures about joints in the lower extremities progress until an unstable base of support secondary to equinovarus and weakened pelvic balance produced by hip flexion prohibit ambulation. Properly timed surgery and bracing have helped some patients to extend significantly their ability to ambulate. Because severe weakness can result from prolonged restraint, opera tive procedures must permit immediate mobilization without fear of excessive pain or wound dehiscence. The primary aims of surgery are to maintain standing balance and prolong independent ambulation. Conditions requiring surgical correction are lower extremity flexion contracture, metatarsus adductus, and rigid forefoot equinocavovarus. Techniques designed to improve these deformities and permit early postoperative mobilization include subcutaneous release of contracted tendons and percutaneous removal of cancellous bone with corrective manipulation of the feet. Postoperative plastic bracing enhances balance through mild knee flexion and ischial seating. Maintenance of the upright posture extends the ability of these patients to attend to their tasks of daily living. In addition, these techniques offer a method of prolonging ambulation in the patient with pseudohypertrophic muscular dystrophy. In so doing, confinement to a wheelchair with its inevitable downhill course may be significantly postponed.
Meningitis
Authors: Friedman Allan , Fleisher Gary
Published: July 2008

Our series of children with meningitis shows an increase in the frequency of isolation of Hemophilus influenzae type B. This increase is most marked among children between one and two months of age. Since H. influenzae was found in five of the seven children between thirty and sixty days of age, we recommend the use of chloramphenicol for the initial treatment of bacterial meningitis after the first month of life. Additionally, our mortality data suggest that early diagnosis and intensive supportive therapy can contribute to a further decrease in the fatality rate of this disease.
Neonatal Hypothermia in a Developing Country
Authors: Sahib El-Radhi A. , Al-Kafaji Nawal
Published: July 2008

Fifty newborn Iraqi children with hypothermia were studied to determine causes and incidence of the precipitating factors. The majority of infants more than three days old (late-onset) had evidence of infection, particularly septicemia. The overall mortality rate was 26 per cent-(42 per cent in low birth weight infants (LBW). Early-onset hypothermia in the first three days of life is due to exposure to cold without evidence of infection and has a good prognosis. The most common finding in our series was a high incidence of aspiration pneumonia in late-onset hypothermia. Antibiotics effective against Escherichia, coli, such as gentamicin, should be given from the outset to all patients with late-onset hypothermia without waiting for laboratory proof of infection.
Nasojejunal Feedings in Infants with Increased Intracranial Pressure
Authors: Benawra Raghbir , Kucera Paul , Mangurten Henry H.
Published: July 2008

A relatively common complication in preterm infants is intracranial hemor rhage, which is often followed by increased intracranial pressure and hydro cephalus. Shunt procedures must often be delayed because CSF protein and RBCs are increased. Since vomiting often precludes gastric feeding of these infants, we attempted nasojejunal feedings while awaiting the optimal time for shunt insertion. Favorable results were obtained in three infants in whom nasojejunal feedings were utilized.
Disseminated Infection Due to Adenovirus Type 4
Authors: Faden Howard , Gallagher Marie
Published: July 2008

This report describes the clinical and pathologic findings in a five-year-old child who died from a disseminated infection due to adenovirus type 4, a rare isolate in children.
Gastric Polyp of the Umbilicus in an 8-year-old Boy
Authors: Bambirra Eduardo A. , Miranda Dairton
Published: July 2008

A case of umbilical polyp composed of gastric mucosa is reported in an 8-year-old boy. This is an extremely rare lesion probably originating in remnants of the omphalo-enteric duct and mainly diagnosed in the newborn period. Clinically, this polyp should be differentiated from exhuberant proliferation of granulation tissue which represents the granuloma pyogenicum of the umbilical scar.
Endotracheal Foreign Bodies
Authors: Blumhagen Joel D. , Wesenberg Richard L. , Brooks John G. , Cotton Ernest K.
Published: July 2008

The diagnosis of foreign body aspiration into the lower airway depends primarily on the radiographic demonstration of partial bronchial obstruc tion causing localized air trapping or atelectasis, present in 95 per cent of the cases. Èndotracheal foreign bodies may often be visualized directly on high kilovoltage radiographs of the airway or by fluoroscopy. In three of the four cases presented in this report, radiologic evaluation was normal, but endo tracheal foreign bodies were subsequently demonstrated endoscopically. Foreign objects may remain in the trachea for prolonged periods of time, causing persistent coughing, wheezing, or stridor. When there is a clear history or strong suspicion of foreign body aspiration in a patient with persistent symptoms, bronchoscopy should be used for diagnosis and treatment.
Management of Infants with Roboin Anomaly
Authors: Lewis Michael B. , Pashayan Hermine M.
Published: July 2008

Congenital micrognathia and secondary glossoptosis, with or without cleft palate, constitute the Robin anomaly. Neonates with this condition are usually at great risk for life-threatening respiratory and feeding problems. The approach to the management of infants with this condition has included, in order of increasing complexity, positioning of the patient, surgical tongue- lip adhesion and tracheostomy. Because of dissatisfaction with the effective ness of surgical tongue-lip adhesion, and a desire to avoid performing a tracheostomy, a trial of intense non-surgical management was instituted. Ten consecutive patients admitted to the Boston Floating Hospital with Robin anomaly were treated successfully by positioning, without requiring tongue- lip adhesion or tracheostomy. Medical management procedures are outlined and discussed.
Benign Hypertrophic Gastropathy
Authors: Bloom R.A. , McQuaide J.R.
Published: July 2008

Ménétrier's disease (hypertrophic gastropathy) in patients under the age of 20 years is rare. A case is described and the features of the condition found in 11 young patients are discussed. The patients, when seen, are usually in acute abdominal pain and vomiting or edema due to hypoproteinemia is present. Eosinophilia was found in half of the recorded cases and the cause in these cases may be due to hypersensitivity. Anemia is common and hypoproteinemia usually found. There is a distinct male predominance and patients are usually Caucasians. Our patient is the second black male youth recorded with this disease. The distinction from adult Ménétrier's disease is its benign nature in this age group and complete clinical recovery is the rule. The term benign hypertrophic gastropathy is suggested.
The "Over-Anxious" Parent
Authors: Poole Steven R.
Published: July 2008

This study describes the sources of anxiety in parents who report being highly anxious at pediatric visits for minor problems, despite usual manage ment and reassurance. During a one-year period, 44 parents (0.8% of all visits; 3% of all families) were identified as "over-anxious" in a private pediatric practice. The most common sign of anxiety in these parents was the lack of satisfaction, or lack of closure, at the end of the visit. Each parent had from one to three underlying sources of anxiety in addition to the presenting complaint. The underlying sources of concern were uncovered in a brief inter view and they fell into six categories: hidden agenda (28%); vulnerable child (23%); inexperienced parents (23%); psychosocially stressed parents (14%); iatrogenic anxiety (7%); and the chronically anxious parent (4%). Reassurance alone did not relieve anxiety for these parents. However, their anxiety de creased when the physician recognized and treated their specific underlying concerns. Techniques are suggested for understanding and treating "over- anxious" parents in the practice setting.
The Role of Sonography in Evaluating Right Upper Quadrant Disease in Children
Authors: Friedman Anita P. , Slovis Thomas L. , Haller Jack O. , Lebensart D.P.
Published: July 2008

Since 1974, grey scale sonography has been used with increasing frequency in evaluating abdominal masses in children. Because sonography is nonin vasive and does not involve ionizing radiation, it is of particular value in the evaluation of pediatric patients. This paper focuses on right upper quadrant masses in children. The liver and gallbladder have been easy to image sonographically. It should be noted that sonography cannot accurately differ entiate between benign and malignant lesions. The pancreas, previously a difficult organ to appreciate radiographically, can be visualized with both ultrasound and computerized tomography. Both history and physical examina tion are important to the sonographic evaluation of masses in children.
Ambulatory Diabetes Management with Pulsed Subcutaneous Insulin Using a Portable Pump
Authors: Riley William J. , Silverstein Janet H. , Rosenbloom Arlan L. , Spillar Rebecca , McCallum Martha H.
Published: July 2008

A portable pump, programmed to administer intermittent pulses of insulin subcutaneously, supplemented by premeal boluses, was used by 8 patients for periods up to 12 months. Two boys, 11 and 16 years of age, sought improved growth; four young adults age 19 to 26 years desired normalization of metabo lism to forestall microvascular complications already manifest; a 14-year-old girl had been incapacitated by unstable diabetes and a 26-year-old woman had been unable to attain sufficient control to gain weight without developing hypoglycemia. Maximal possible control with conventional insulin administra tion was attempted prior to pump use and such control was measured by glycohemoglobin (HgbA1) percentage and urine and blood sugar levels during a 24-hour period and compared with control with pump use. All initially had marked reduction in 24-hour urine volume (mean 3.3 L ± 4 SEM to 1.4 ± 0.2), urine glucose (mean 198 g ± 81 to 14 ± 4) and glycemia (mean 258 mg/dl ± 29 to 133 ± 12). HgbA1% declined markedly in all but the 14-year-old girl over the first weeks and reached normal or near normal levels in three patients. Four patients continued to use the pump after 3.5 to 12 months because of improved sense of well being, weight control, and in one, marked reduction in proteinuria. Both boys had a doubling of growth pace. Four patients are no longer using the pump after 3 to 8 months because of incon venience, manipulation with intermittent usage, intolerance of normoglycemia, or overzealous control attempts with dangerous hypoglycemia. Pump use may permit the attainment of levels of control previously not possible, but is extremely demanding for patients and health personnel and must remain an experimental method in carefully selected and monitored patients.
Osteomyelitis and Bacteremia Caused by Bacteroides fragilis
Authors: Brook Itzhak
Published: July 2008

A neonate monitored with scalp electrodes during delivery presented with a scalp abscess, osteomyelitis and bacteremia. Bacteroides fragilis was recovered from the blood culture, and polymicrobial aerobic and anaerobic flora were isolated from the aspirated purulent material. Attention should be paid to the possibility of such complications in infants requiring fetal monitoring.
Allergic Rhinitis
Authors: Church Joseph A.
Published: July 2008

Allergic rhinitis affects up to 20 per cent of the pediatric population and occurs in children of all ages. Secondary infection, dental malocciusion and a variety of other sequelae may complicate the primary disorder. The diagnosis of allergic rhinitis is based on historic features, physical findings and selected laboratory investigations. Treatment may involve antigen avoidance programs and immunotherapy. However, pharmacotherapy with antihistamines, sym pathomimetics and, in severe cases, corticosteroids, is most frequently used.
Ondine's Curse and Neurocristopathy
Authors: Bower Richard J. , Adkins John C.
Published: July 2008

A newborn with congenital neuroblastomas, Ondine's curse (central hypo ventilation) and Hirschsprung's disease is presented. All lesions may be re lated embryologically and might fall under the general heading of neuro cristopathy.
Aerobic and Anaerobic Bacteriology of Cervical Adenitis in Children
Authors: Brook Itzhak
Published: July 2008

Needle aspirates from 53 inflamed cervical lymph glands were studied for aerobic and anaerobic bacteria and mycobacteria. Bacterial growth was achieved in 45 patients (85%). Sixty-six bacterial isolates were recovered, aver aging 1.5 isolates per specimen (0.8 aerobes and 0.7 anaerobes), with as many as 4 isolates in some specimens. Aerobic organisms alone were recovered in 27 aspirates (60%) of the 45 culture-positive aspirates, anaerobic bacteria alone in 8 (18%), and mixed aerobic and anaerobic bacteria in 9 specimens (20%). Mycobacterium scrofulaceum was recovered in one (2%). The predominant aerobic organisms were Staphylococcus aureus (14 isolates) and group A beta hemolytic streptococci (8). A total of 31 anaerobes were recovered, including gram-positive cocci (9, including 6 Peptococcus sp. and 3 Peptostreptococcus sp.), 8 Bacteroides sp. (including 3 B. melaninogenicus), 5 Propionibacterium acnes, and 4 Fusobacterium nucleatum. These data demonstrate the role of anaerobic organisms in cervical lymphadenitis and the need to culture aspirated, material for both aerobic and anaerobic microorganisms.
Bacteremia in Patients with Cystic Fibrosis
Authors: McCarthy Michael M. , Rourk Malcolm H. , Spock Alexander
Published: July 2008

Bacteremia in patients with cystic fibrosis (CF) has not been previously re ported, a fact probably attributable to activated systemic immunity in the pres ence of chronic bronchopulmonary infection. We have observed two CF pa tients under a year of age with documented bacteremia, and a teen-aged patient with autopsy evidence of premortem bacteremia. Organisms were Staphy lococcus aureus, Serratia marcescens, and Pseudomonas aeruginosa, having pre sumably spread from the lower respiratory tract in both patients. None of the patients had historical or laboratory evidence of immunodeficiency. The true incidence of bacteremia in CF patients is unknown, and the circumstances under which it occurs have not yet been defined.
Pneumoperitoneum
Authors: Gfeller-Varga Dorlinda A. , Felman Alvin H.
Published: July 2008

Children under intensive care for various illnesses are usually followed closely with radiographic examinations of the chest. The recognition of a pneu moperitoneum as a complicating feature of these illnesses depends on subtle radiographic signs that are frequently visible on the chest film studies. We have assembled and illustrated these findings in the hope that pediatricians will be better able to recognize this complication when it occurs.
Perthes' Disease after Poliomyelitis
Authors: Guillozet Noel
Published: July 2008

Aseptic necrosis of the capital femoral epiphysis occurred in a polio-wasted leg and was undiagnosed for over one year. The diagnosis was overlooked be cause of a pre-existent limp. Exacerbation of an existent limp or persistent knee or leg pain should always prompt a thorough search to exclude chronic and acute causes of hip disease in young children. Aggressive and individual ized care is indicated for Perthes' disease and may include non-surgical means such as recumbency and bracing in the very young or traction with abduc tion and various bracings in the older children. Surgical approaches may include femoral and/or pelvic osteotomies in a variety of approaches. Older children may refuse treatment and those with milder femoral head involvement may recover with minimal head asymmetry. Early and appropriate manage ment is generally successful in avoiding deformity.
Carotenemia
Authors: Lascari André D.
Published: July 2008

Awareness of carotenemia is important to avoid confusion with jaundice and unnecessary diagnostic studies. It is surprising how little information can be found about this relatively common condition in the standard pediatric textbooks. Ingestion of excessive amounts of carrots is the usual cause of carotenemia, but it can also be associated with ingestion of many other yellow vegetables, as well as some green vegetables. Mothers may unknowingly be giving their infants large amounts of carrots in the form of commercial infant food combinations. Carotenemia is a benign condition; vitamin A poisoning does not occur despite massive doses of carotene because the conversion of carotene to vitamin A is slow. Hypothyroidism, diabetes mellitus, hepatic and renal diseases may be associated with carotenemia, but are not caused by in gestion of carotene. The absence of yellow pigment in the sclera and oral cavities distinguishes carotenemia from jaundice. A similar disorder, lyco penemia, is associated with an orange-yellow skin pigmentation as a result of ingestion of large amounts of tomatoes.
A 16-Day-Old Breast-fed Infant with Metabolic Acidosis Caused by Salicylate
Authors: Clark Joseph H. , Wilson William G.
Published: July 2008

This is a report of a 16-day-old, breast-fed infant who presented with meta bolic acidosis and no history of drug ingestion. Salicylate intoxication was demonstrated as the probable cause of the acidosis.
Extrahepatic Biliary Atresia Associated with Cyanotic Congenital Heart Disease
Authors: Zukin D. Demetrios , Liberthson Richard R. , Lake Alan M.
Published: July 2008

Three patients with extrahepatic biliary atresia associated with cyanotic con genital heart disease are presented and their clinical courses reviewed. In these patients, the coincidence of cyanosis and jaundice caused an atypical green- appearing cutaneous discoloration which masked the early clinical detection of biliary atresia in one infant and cyanotic heart disease in the other two. In all infants, either partial or complete correction of the congenital cardiac lesion was possible. Two infants died from hepatic disease despite attempted surgical revision and one has satisfactory bile drainage one month following portoenterostomy. Awareness of the rare concurrence of cyanotic congenital heart disease and extrahepatic biliary atresia is helpful to the clinician when evaluating infants with atypical cutaneous discoloration. Early oversight of either underlying disease process can be avoided, and early evaluation and management of both entities can be possible.
Pneumococcal Arthritis and Osteomyelitis in Children
Authors: Chusid Michael J. , Sty John R.
Published: July 2008

Five children with pneumococcal bone and joint infections are described. Three of the children were less than one year of age and two had sickle cell disease. All but one had a primary or coincident focus of acute pneumococcal infection elsewhere. In the four children with septic arthritis, osteomyelitis was diagnosed subsequently in bones contiguous to the infected joint. All patients were successfully treated, although one developed permanent joint dysfunction. Although an unusual infection, pneumococcal infection of bones and joints should be sought in the appropriate clinical setting since such in fection requires specific surgical therapy and may be associated with signifi cant morbidity.
Aspiration Pneumonia in Institutionalized Children
Authors: Brook Itzhak
Published: July 2008

The antibiotic therapy of aspiration pneumonia was retrospectively reviewed in 74 institutionalized children with lung abscess (10), necrotizing pneumonia (12), and pneumonitis (52). Anaerobic bacteria were isolated in 69 patients (93%); and in 67 (90.5%), they were mixed with aerobic bacteria. Penicillin G was given to 20 patients, clindamycin to 20, and carbenicillin to 34. Genta micin was concurrently given to 35 of the patients. The mean duration of therapy in the three types of pulmonary infection was: lung abscess 30.2 days, necrotizing pneumonia 26.6 days, and pneumonitis 15.1 days. The mean dura tion of fever after initiation of therapy was 5.8 days, 8.1 days, and 3.4 days, respectively. The mean time for radiologic clearance was 35.6 days for lung abscess, 39.2 days for necrotizing pneumonia, and 13.5 days for pneumonitis. The three antibiotics were equally effective in all patients, including those from whom Bacteroides fragilis was recovered.
Successful Treatment of an Institutional Outbreak of Shigellosis
Authors: Bachrach Steven J.
Published: July 2008

An outbreak of shigellosis is described in an intermediate care hospital for children, where routine isolation procedures failed to halt the outbreak. Two weeks after the appearance of the first case, small numbers of patients be came symptomatic with fever and diarrhea, but remained culture-negative. One week later, two patients with positive cultures were identified, with many other symptomatic patients having negative cultures. Twenty-five days after identification of the first case, there were fourteen cases identified with shigellosis and many more symptomatic patients. It was at that time that hospital-wide measures of infection control were instituted, and treatment of all patients, infected and uninfected, was initiated with trimethoprim-sulfa methoxazole (TMP-SMX). No new cases of shigellosis were diagnosed after initiation of treatment, and symptoms abated within 72 hours.
Laboratory Identification of Inherited Hemoglobinopathies in Children
Authors: Kim Haewon C.
Published: July 2008

The early identification of some clinically significant hemoglobinopathies and the precise differentiation of hemoglobin variants are important to pro vide early comprehensive medical care to prevent some serious complica tions, assess prognosis, and offer genetic counseling. Laboratory approaches to screen for and confirm inherited hemoglobinopathies in children are presented. Methods include routine screening procedures as well as techniques available in research laboratories, with emphasis on readily available pro cedures. Since microcytic hypochromic anemia is the most common type of anemia in children under two years, attention is given to the differentiation of thalassemia trait from iron deficiency. The step-by-step work-up is also described for differentiating β-thalassemia from α-thalassemia.
Sodium and Water Content of Feedings for Use in Infants with Diarrhea
Authors: Walker Stuart H. , Gahol Victoria P. , Quintero Bernardo A.
Published: July 2008

The sodium and water intakes of a group of infants treated for diarrhea and dehydration in 1972-73, when hypernatremia was common, and a group of infants treated for diarrhea and dehydration in 1978-79, when hypernatremia was rare, were compared. Infants from both study periods whose intake was poor and who received feedings containing sodium in concentrations greater than 17 mEq/liter were more likely to develop elevated serum sodium con centrations. In a group of infants recovering from diarrhea, the effect upon the serum concentration of sodium of varying water and sodium intake was studied. Those treated with small amounts of a solution containing 30 mEq sodium per liter regularly demonstrated an elevation of serum sodium, whereas those treated with large amounts of the same solution regularly demonstrated a depression. It is concluded that infants with diarrhea should receive feed ings containing sodium in concentrations less than 17 mEq/liter unless a high fluid intake can be assured.
A Controlled Trial of Pyridoxine Supplementation in Children with Febrile Convulsions
Authors: McKiernan J. , Mellor D.H. , Court S.
Published: July 2008

A total of 107 children who had been hospitalized following a febrile con vulsion were enrolled into the trial. By random allocation, 55 children were treated with pyridoxine hydrochloride (20 mgs twice daily) and the remain ing 52 children were treated with a placebo until there had been either a fur ther convulsion or a year had passed without recurrence. Eighty children were adequately followed up and of these, 17 had a recurrent febrile convulsion while receiving medication. Recurrences occurrences occurred in 7 of the 38 children receiving pyriddxine and in 10 of the 42 childreh receiving placebo (χ2 = .346, p > 0.5). Initial tryptophan load tests had been abnormal in 34 children, and of these, recurrences occurred in 3 of the 17 who received pyridoxine and in 3 of the 17 who received placebo. It has yet to be shown that pyridoxine supplementation protects children from recurrent febrile convulsions.
Patient-Reported Compliance with Cystic Fibrosis Therapy
Authors: Passero Mary Ann , Remor Barbara , Salomon Janet
Published: July 2008

Parents and patients in the Rhode Island Cystic Fibrosis Center were inter viewed to determine the extent of compliance with various aspects of the thera peutic regimen. Current patterns of compliance were compared with retro spective clinic records of reported compliance up to 8 years prior to the time of study. Actual clinic attendance and reported compliance with medications were high. Patients reported significantly lower compliance with diet and chest physiotherapy. Most patients reported less compliance with chest physio therapy at the time of study than 3 to 8 years earlier, regardless of the severity of their lung disease. Patients frequently reported self-medication with non- prescribed vitamins, antibiotics, or other drugs. Patients' perceptions of the severity of their disease and the possible adverse consequences of discon tinuing therapy probably contribute to both good medication compliance and self-medication.
The Case for Mandatory Seat Restraint Laws
Authors: Paulson Jerome A.
Published: July 2008

Motor vehicle accidents are the leading cause of death and injury to chil dren over one year of age in the United States. About 800 motor vehicle occu pants less than four years old are killed each year and tens of thousands are injured severely enough to require emergency room treatment. Studies have demonstrated that the vast majority of children ride unprotected in motor vehicles. Restrained children are likely to have milder injuries or no injuries at all. One study intimates that seat belts or restraints could reduce injuries up to 70 per cent and deaths up to 90 per cent. Various educational efforts have been attempted to increase restraint and belt use. Most have not worked. Seat belt laws in other countries have been effective in increasing belt use by adults when the laws are enforced. In Tennessee, where a mandatory seat restraint law has been part of a large-scale educational effort, restraint use has increased from an average of 9 per cent prior to the law, to an average of 18.7 per cent in the fall of 1979. Because the problem of motor vehicle-related deaths and injuries is widespread and because legislation holds some promise for amelioration of this problem, pediatricians and public health professionals should work toward the passage of such laws.
Cerebrospinal Fluid White Blood Cell Counts and Lactic Acid Dehydrogenase in Enterovirus Type 71 Meningitis
Authors: Goldberg Frederick , Weiner Leonard B.
Published: July 2008

An outbreak of aseptic meningitis involving 36 children is described. Enterovirus type 71, a recently recognized cause of central nervous system and systemic illness in children, was found to be the responsible agent. On initial lumbar puncture, cerebrospinal fluid (CSF) polymorphonuclear (PMN) cell predominance was seen in 64%, and greater than 200 CSF white blood cells (WBC)/mm3 was seen in 25% of these patients. Fifty-four per cent of the pa tients subjected to repeat lumbar puncture had a significant rise in the number of CSF WBC/mm3, the majority with the maintenance of a PMN cell predomi nance. The CSF white blood cell findings of individual patients did not allow for differentiation from patients concurrently seen with bacterial meningitis. Both initial and serial measurements of CSF lactic acid dehydrogenase reliably distinguished these two groups of patients.
Pail Immersion Accidents
Authors: Walker Susannah , Middelkamp J. Neal
Published: July 2008

An unusual type of immersion accident is that involving a pail or bucket of water in the home. We describe four cases of drownings or near drownings in pails and summarize the literature. A review of this type of submersion resulted in a morbidity of 15.4% and mortality of 61.5%. Stable vital signs and normal neurologic examination initially are good prognostic indicators. A number of questions remain to be answered about the pathophysiological effect of these pail contents to the lungs. This hazard must now be included as a part of every discussion of poison prevention by pediatricians.
Red Blood Cell Survival in Patients with Ventricular Septal Defect and Patent Ductus Arteriosus
Authors: Khanna A. , Tandon R. , Basu A.K. , Shrivastava S.
Published: July 2008

Hemolysis of red blood cells (RBC) in stenotic or regurgitant cardiac val vular lesions has been felt to be due to mechanical trauma and shearing stress caused by turbulence of blood. RBC are also under a shearing stress from turbulence in high-pressure shunts, such as ventricular septal defect (VSD) and patent ductus arteriosus (PDA). The RBC survival time was measured in five patients with VSD and in 11 patients with PDA to determine if there was hemolysis of RBC. Six children without cardiac disease were also studied to obtain the control values for RBC survival times in the laboratory. Two patients with PDA were restudied one year postoperatively. Additional parameters studied were hemoglobin, packed cell volume, reticulocyte cell count, peripheral smear, and urinary hemosiderin. The hemoglobin values and the packed cell volumes were comparable in the two groups. The reticulocyte cell count was normal in all. Urinary hemosiderin was negative in all and the peripheral smear did not reveal abnormal red cell morphology. Mean red cell survival half-life in the two groups was identical. The red cell survival was abnormally low in two patients of PDA. Since one of these two patients had persistently low RBC survival postoperatively, the authors believe that the low red cell survival in this patient was unrelated to the presence of PDA. Based on findings in the small number of cases, the authors conclude that left to right shunt through a VSD or PDA is probably not associated with sig nificant red blood cell destruction.
Breast-feeding Patterns in a Nigerian Maternity Center
Authors: Ojofeitimi E.O.
Published: July 2008

The immediate postpartum feeding practices and the expected time of intro ducing infant formula to newborn infants at three maternity wards in Ile-Ife, Oyo State, Nigeria are described. Questionnaires and interview schedules were used to collect the data. Less than 3 per cent of the mothers introduced breast- milk to the infants within one hour after delivery, while the rest did not only feed the infants glucose water, but did so with feeding bottles. The time of initiating breast-feeding by the majority of the mothers ranged from 10 to 18 hours after delivery. The higher the level of education of the mothers, the earlier the expected time of introducing infant formula (p < 0.05). Essen tially, no mothers who had primary or greater education expected to nurse longer than 3 months.
Enteric Fevers in Children
Authors: Khuri-Bulos Najwa
Published: July 2008

The experience with enteric fevers in 71 children hospitalized at the Jordan University Hospital over a 4-year period is reviewed. Forty-one children were male and 30 female. Salmonella typhi was the causative organism in 26 and Salmonella paratyphi A and B, in the remaining 45 patients. Twenty-five children were less than two years of age, and the remaining 46, older than two. Gastroenteritis-like symptoms were seen more often in the younger age group, who also tended to lack splenomegaly and leukopenia. Further, the younger children were sicker at the time of admission and had a longer illness than the older ones. It is concluded that while enteric fevers lead to a mild illness in the older child, in infants and very young children the fevers were often character ized by a severe and protracted illness, the seriousness of which was complicated by delay in diagnosis.
A Self-Help Program for Childhood Asthma in a Residential Treatment Center
Authors: Richards Warren , Church Joseph A. , Roberts Michael J. , Newman Lawrence J. , Garon Mary Rose
Published: July 2008

A structured program designed to enhance self-treatment was successfully implemented in a residential center for asthmatic children. The ultimate objective of the program was to improve compliance with therapeutic regimens, which was felt to be a factor that had necessitated placement of many of the patients. The program was designed to educate the patient and the patient's family regarding the nature of asthma, its treatment and the importance of self-help. Efforts were also made to enhance the emotional maturity of the child. Patients remembered to take their medication over 90% of the time within 1 month of implementation of the program. A similar program was instituted for outpatient use.
The Role of the Physician in the Grief Process
Authors: Lorenzen Mark , Smith Leigh
Published: July 2008

A child's death is a particularly painful experience for the family. The grief process involves all family members, and although it is individualized many reactions and concerns are predictable. With knowledge of the grief process, the patient's physician may be of great assistance to the family during their time of need. A plan is suggested for helping the family to cope with their feelings.
Tracheal Atresia Associated with Congenital Absence of the Radii
Authors: Anderson Craig L. , Ahmed Gasudraz , Caldwell Candace C.
Published: July 2008

A case report of tracheal atresia with congenital absence of the radii is described. The authors suggest that this represents an addition to the VATER association.
Dystrophic Epidermolysis Bullosa
Authors: Burkhart Craig G. , Ruppert Elizabeth S.
Published: July 2008

The three forms of dystrophic epidermolysis bullosa include the autosomal recessive form and two autosomal dominant variants, the Cockayne-Touraine and Pasini forms. Whereas all three forms are clinically characterized by milia, nail dystrophy, and scarring, the autosomal recessive form tends to be the most mutilating .with frequent mucosal lesions. The Pasini variant often has generalized blistering commonly associated with mucosal involvement but to a lesser degree. The Cockayne-Touraine variant is usually localized to the extremities and tends to be the mildest form of dystrophic epidermolysis bullosa.

Ultrastructurally, the blister is located below the basal lamina in all three variants. The anchoring fibrils are either absent or hypoplastic in each condi tion. The autosomal recessive form alone also demonstrates dermal collageno lytic activity. The ultrastructural differentiation between the two forms of the dominant dystrophic epidermolysis bullosa depends on a quantitative rather than qualitative assessment of the anchoring fibrils.
Iron Sufficiency with Prolonged Exclusive Breast-feeding in Peruvian Infants
Authors: Pastel Robert A. , Howanitz Peter J. , Oski Frank A.
Published: July 2008

Serum ferritin and erythrocyte porphyrin concentrations were measured in seven Peruvian infants, who ranged in age from 7.5-12.0 months (mean: 9.3 months), who had been exclusively breast-fed all their lives. No infant had evidence of iron deficiency as reflected by a reduced serum ferritin, or an increased erythrocyte porphyrin. Mean serum ferritin and erythrocyte por phyrin values in these seven infants were similar to those of 40 nonanemic, noniron-deficient U.S. infants who ranged in age from 9 to 12 months, on a mixed diet. These findings illustrate that exclusively breast-feeding an infant for at least 9 months of life meets the iron requirements of the full-term infant.