bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Undifferentiated Respiratory Infections in Infants
Authors: Ackerman Bruce D.
Published: November 2007

In this double-blind study of 60 infants with undifferentiated respiratory diseases, antibiotics seemed of no benefit in shorten ing the median duration of illness or in preventing secondary complications.

The conclusion is drawn that the danger of complications from the antibiotics them selves is greater than the good which many physicians believe that antibiotics produce in such diseases.
Cornelia de Lange Syndrome
Authors: Familant Joseph W.
Published: November 2007

This represents only the second case of the de Lange syndrome among Negroes in the Pediatric literature. This is, in addi tion, the first report to stress laboratory in vestigation of the syndrome. To date, the diagnosis has been made merely on morpho logic features, but this author cites a Beta globulin deficiency and hyposthenuria as possible "obligatory" or "coincidental" fea tures of this syndrome.
The Influence of Protein-Calorie Malnutrition on the Pattern of Pre-School Childhood Diseases
Authors: Ogbeide M.I.
Published: November 2007

Lagos, the Capital Territory of Nigeria, has an estimated 300,000 children under 15 years of age. With a total of only 140 hos pital beds available in two Pediatric Centers, the in-patient turnover is tremendous, and the size of the out-patient load unbelievable.

This account of pediatric observations in Nigeria, with its new and somewhat un orthodox conclusions, has great pertinence to Western Hemisphere problems of the re lationships between poverty and childhood diseases.
Achondroplasia
Authors: Langer Leonard O. , Baumann Paul A. , Gorlin Robert J.
Published: November 2007

"I have been associated with the Little People of America, a national organization of dwarfs, for five years, and have been running a registry for bone dysplasias at the University of Minnesota for two years. On the basis of this experience, I know that many individuals with other conditions are given the diagnosis of achondroplasia and that the implications of this diagnosis are often not recognized, or at least not trans mitted to the patient. 1 believe it is safe to say that a number of teachers of pediatrics consider achondroplasia as a broad category rather than a specific condition. I think this is wrong for the reasons stated in the pa per. Also, it seems to me, if this idea is abandoned more of an effort may be made to find out about conditions which are now considered 'atypical achondroplasia.'" —From the submission letter by the author.
Rubinstein-Taybi Syndrome
Authors: Sinnette C. , Odeku E.L.
Published: November 2007

The Rubinstein-Taybi syndrome of men tal retardation, broad thumbs and great toes, delayed linear growth, peculiar facies and other malformations is here described. The authors hypothesize that this newly de scribed syndrome and that of Smith-Lemli- Opitz represent the same genetic abnor mality.
Intravenous Pyelography in the Deferential Diagnosis of Renal Masses in the Neonatal Period
Authors: Emanuel B. , White H.
Published: November 2007

Intravenous pyelography was performed in 38 infants with palpable abdominal masses in the neonatal period. Accurate preopera tive diagnoses of a variety of renal lesions was achieved by this method in 28 of the infants. With eight of the others, retrograde pyelography proved useful. Two infants died before this procedure could be performed.
Unilateral Ichthyosiform Erythroderma
Authors: Carter Charles H. , Howard Fred H. , Connolly Josephine
Published: November 2007

Although rarely seen, unilateral congeni tal ichthyosiform erythroderma should be recognized by pediatricians. A little knowl edge of basic embryology may help to ex plain this startling condition to distraught parents.
Therapeutics Review: Psychotropic Drugs in Children
Authors: Willner Milton M. , Gordon Lee E.
Published: November 2007

Drug therapy in emotional disorders of children must be based on the experience of the therapist as well as the response desired in each individual patient. Psychopharmacotherapy is well within the range of the pediatrician—not limited exclusively to the child psychiatrist This up-to-date survey of the psychotropic drugs includes a summary of those most useful, with suggested dosages and possible toxic effects.
Developing Health Services for a Rural Head Start Program
Authors: Van Leeuwen G. , Blanton Joseph , Fogarty Rosemary
Published: November 2007

The purpose of the health services activities in a Head Start Program is to find and remedy a child's existing health defects, and thereby improve his present functioning. These preventive services not only support the child's future health, but improve that of family members and of the community in general. This paper describes how these comprehensive health goals were achieved in a poor rural area of southern Missouri.
In Cold Gas
Authors: Burg Fredric David , Douglass John M.
Published: November 2007

The U. S. Public Health Service desires to alert all physicians to the danger of carbon monoxide poisoning. This paper presents: (1) data on the known incidence of carbon monoxide poisoning; (2) some case histories to illustrate the subtle nature of the symptoms; (3) some comments on the symptoms as related to blood carboxyhemoglobin levels; (4) lists of preventive measures the interested physician can use to protect his patients and their children from the risk of this poisoning.
Bronchomalacia in Children
Authors: Lynch John I.
Published: November 2007

A congenitally soft bronchus may give rise to local atelectasis or emphysema and an en hanced susceptibility to pneumonia attacks.
Management of Intussusception
Authors: Levick Richard K.
Published: November 2007

Reducing intussusception by enema given under fluoroscopic control is being performed more often, in the U. S. A. as well as other countries. This report describes the technic, indications and contraindications in a busy British clinic.
Clinical Clues to Diagnosis of Metabolic Disorders
Authors: Barness Lewis A. , Morrow Grant
Published: November 2007

This practical paper is to be studied rather than read, memorized rather than skimmed. The contained information should be the "stock-in-trade" of every physician who takes care of infants and young children.
Broadening the Horizons of Pediatric Practice
Authors: Mendelsohn Robert S.
Published: November 2007

For best management of chronic diseases, one must use community or ganizations, political action and consumer representation along with more traditional tools of contemporary medicine. In this way the accomplish ments and opportunities of social medicine parallel those of biologic medicine. The farsighted physician must acquire expertise in both areas.
Retractile Sclerosing Mesenteritis
Authors: Spark Ronald B. , Yakovac William C. , Wagget John
Published: November 2007

The possibility of retractile sclerosing mesenteritis in childhood, even though a rarity, must be entertained in the differential diagnosis of children who have bizarre abdominal mass lesions.
Iron-deficiency Anemia at Birth
Authors: Miles Robert M. , Maurer Harold M. , Valdes Orestes S.
Published: November 2007

Iron-deficiency anemia in the newborn infant frequently is not recognized. This paper provides two illustrations of this disorder in the neonate, and out lines the pathogenesis as well as the laboratory tests necessary to establish the diagnosis. The discussion includes a differential diagnosis of anemia at birth.
Neonatal and Infant Auditory Screening Programs
Authors: Miller Maurice H.
Published: November 2007

The optimal age to recognize the existence of a hearing defect should be infancy, and preferably even the newborn period. For this reason many pediatricians are installing some form of audiometric testing in their offices. Here is a review of the present stage of development of methods for identifying hearing impairment early in life. The earlier a child's deafness is recognized, the faster and more successful will be medical rectification or the starting of essential rehabilitative approaches.
Is the Poisoning Accidental?
Authors: McIntire Matilda S. , Angle Carol R.
Published: November 2007

As this penetrating survey indicates, the need is for long term followup of self poisoning of children and adolescents. We must learn more about the incidence of repeated ingestions, drug abuse, suicide attempts, com pleted suicide and incapacitating disorders of personality and behavior.
Low Birth Weight Babies in the Hospital
Authors: Bauer Charles H. , Tinklepaugh Wendy
Published: November 2007

Fifty-seven low weight infants, averaging 1,879 g at birth, were sent home from the newborn nursery with an average weight of only 2,079 g. There was no unusual morbidity or mortality later on. Thus early discharge from modern hospital nurseries of thriving premature infants who are going to good homes to re ceive good care has many economic and psychologic advantages.
Renal Anomalies in Turner's Syndrome
Authors: Matthies Fred , Macdiarmid W.D. , Rallison Marvin L. , Tyler Frank H.
Published: November 2007

Of 15 patients with Turner's syndrome studied for renal anomalies by intravenous pyelogram, 11 had demonstrable abnormalities ; three had horseshoe kidney. None had evidence of impaired renal func tion. Four reported previous urinary tract infections. Similarities among the positional and structural abnormalities of the kidneys suggested a continuum of morphologic changes, with a possible re lationship of such changes to impaired positional information pro gramming by the developing abnormal gonad during embryogenesis.
Clinical Review : A Psyche and Soma Reunited
Authors: Johnson Frank K. , Baker Genevieve , Alexander A.A.
Published: November 2007

This report explores the dilemma presented by a life-threatening asthmatic condition, and describes how no therapeutic progress could be made un til after a team of medical and paramedical people were welded into a work ing unit and all the interrelated problems were attacked simultaneously.
Congenital Dislocation of the Hip—Diagnostic Screening and Treatment
Authors: Kadkhoda Mohamad , Chung Stanley M. K. , Adebonojo Festus O.
Published: November 2007

To understand why congenital dislocated hip (CDH) was diagnosed late (mean age: nine months) in children admitted to the Children's Hospital of Philadelphia (CHOP), 714 consecutive CHOP admissions, aged zero to two years, and 947 consecutive newborns delivered at the Hospital, Uni versity of Pennsylvania (HUP) were examined for CDH. The expected frequency of CDH was found at HUP. At CHOP, the children had a higher incidence of CDH, many with associated congenital anomalies, their hips were more difficult to examine, the hospital records contained few references to hip examinations. Had these children's hips been formally examined at birth, the delay in diagnosis might have been eliminated and treatment might have been easier and more successful.
Influenzavirus A2 Infections Presenting with Febrile Convulsions and Gastrointestinal Symptoms in Young Children
Authors: Price D.A. , Postlethwaite R.J. , Longson M.
Published: November 2007

We present the clinical features of Influenzavirus A2 infection in 75 young children admitted to a children's hospital. The most common presenting features were febrile convulsions, vomiting, coughing, diarrhea, and anorexia. At any age, the illness may present with respira tory tract symptoms and signs but in young babies gastrointestinal symp toms are often the presenting complaint. Children aged one to three years often present with febrile convulsions. Only in older children does the adult pattern begin to emerge. Evidence is put forward to suggest that encephalitis in association with influenza can be due to direct in vasion of the central nervous system by the virus.
Clinical Review : Renal Tubular Acidosis: Practical Guides to Diagnosis and Treatment
Authors: Hirschman Gladys H. , Rao David D. , Oyemade Olusola , Chan James C. M.
Published: November 2007

The syndrome of renal tubular acidosis in some one of its various forms should be suspected when an infant or child has failure to thrive, metabolic acidosis, constipation, diarrhea, vomiting, anorexia, polyuria, or dehydra tion in infancy. Confirmatory biochemical findings include an inappropriately high urinary pH, inadequate acid excretion and/or abnormal tubular reab sorption of filtered bicarbonate.

Growth can be normal when there is sustained correction of the metabolic acidosis through appropriate alkaline therapy.
Acute Hemiplegia in Children Complicating Upper Respiratory Infections
Authors: Zilkha Albert , Mendelsohn Frederic , Borofsky Leatrice G.
Published: November 2007

Three children presented with acute onset of hemiplegia following an upper respiratory infection. Angiography revealed irregularities, beading, and slow flow of a peripheral branch of a middle cerebral artery. In addition, one child had narrowing of the cervical segment of the internal carotid artery. An inflammatory arteritis of the cervical internal carotid artery is presumably the site of the formation of cerebral emboli.
Congenital Stridor in Infancy
Authors: Kahn A. , Baran D. , Spehl M. , Dab I. , Blum D.
Published: November 2007

Thirty-one cases of persistent stridor during infancy, which on study proved to be of congenital origin, were analyzed. The breakdown of these cases is as follows: 4 laryngotracheomalacia, 3 vascular anomalies, 4 angiomas, 1 mucous membrane, 1 laryngeal cyst. The remaining cases (18) belong to the so-called "benign" stridor group in that no specific etiology could be demonstrated and in that evolution was spontaneously favorable. In every case of stridor, the precise underlying cause should be looked for.

In addition to clinical assessment the investigation of an infant with stridor calls for the following methods of examination: chest x-ray; larynx x-ray (anterior and lateral view) during inspiration and expiration; esophago gram; direct and laryngotracheoscopy.

Angiopneumography should be confined to specific cases.
The "Chubby Puffer" Syndrome
Authors: Stool Sylvan E. , Eavey Roland D. , Stein Norman L. , Sharrar William G.
Published: November 2007

Upper airway obstruction and obesity can produce cardiopulmonary dis tress in susceptible children. Three such children with chronic airway ob struction due to hypertrophied tonsillar and adenoidal tissue developed pronounced obesity, which in turn helped to provoke sleep alternations, cardiac signs, and abnormal arterial blood gas values. After tonsillectomy and adenoidectomy the symptoms were relieved.
Neurology of Hard Times
Authors: Ellison Patricia H.
Published: November 2007

Many children and their families have experienced "hard times" because of the current economic conditions. Five cases are presented in which neurologic illness in children was related to changes in the family's economic circumstances. Pediatricians are encouraged to look carefully at the impact of changing economic conditions upon child health.
Diagnosis of Urinary Tract Infection
Authors: Slosky David A. , Todd James K.
Published: November 2007

The results of 787 consecutive suprapubic specimens in children were studied. Ninety-two patients with 128 positive cultures were reviewed. Sixty five children had documented urinary tract infection (UTI) proven by other cultures. Of these, 55 per cent had colony counts less than the traditional 100,000 colony forming units/ml., and 9 per cent had colony counts less than 10,000. Organisms usually regarded as "contaminants" (Staphylococcus epidermidis, mixed organisms) were occasionally proven to cause UTI.
Requesting the Autopsy: A Pediatric Perspective
Authors: Berger Lawrence R.
Published: November 2007

Many physicians find the request for autopsy to be one of the most difficult and unpleasant aspects of pediatrics. Lack of preparation, their own emotional reactions, and ambivalence about the necessity of autopsies contribute to this. This article offers an approach to the autopsy that emphasizes its importance to families and to pediatrics, and suggests a role for the physician at the time of the child's death that is both professionally and personally gratifying.
Linguistic and Auditory Milestones During the First Two Years of Life
Authors: Capute Arnold J. , Accardo Pasquale J.
Published: November 2007

Although language is recognized as one of the best predictors of develop ment, the lack of a simple evaluation tool has contributed to the general pediatrician's unfamiliarity with linguistic milestones. Here described is a 32-item instrument for the recording and assessment by the practicing pediatri cian of language milestones during the first two years of life.
Clinical Significance of Supernumerary Nipples in Black Neonates
Authors: Rahbar F.
Published: November 2007

The frequency of accessory nipples in black Americans is almost eight times greater than in white European patients. Association of a wide range of abnor malities with supernumerary nipples in whites has, thus far, not been our expe rience in black Americans.
Pyogenic Liver Abscesses in Children
Authors: Arya L.S. , Ghani Rashid , Abdali S. , Singh Meharban
Published: November 2007

Five children with pyogenic liver abscess were admitted to Institute of Child Health, Kabul during the period 1978 to 1980. All patients were males, and their ages ranged from 4 to 10 years. The clinical picture was characterized by fever, upper abdominal pain, enlarged tender liver with raised right dome of the dia phragm. The abscesses were located in the right lobe of liver in all cases, and they were solitary in three cases. Staphylococcus aureus was the etiologic agent in four cases and Escherichia coli in one. Open surgical drainage coupled with prompt parenteral antibiotic therapy in all cases seem to have favorably influenced the outcome. With a high index of suspicion pyogenic liver abscess in children can be diagnosed clinically without the aid of hepatic radionuclide scanning.
Campylobacter Enteritis Presenting with Convulsions
Authors: Solomon Nathaniel H. , Lavie Sal , Tenney Barbara L. , Blaser Martin J.
Published: November 2007

A 14-month old boy presented to the hospital having had a convulsion. Initial work-up was essentially negative except for the presence of a temperature of 40 C. On the second hospital day, the patient began to have diarrhea and Campylobacter jejuni was isolated. This case illustrates that Campylobacter infection may be associated with febrile convulsions, and that these may precede the diarrheal phase of the illness.
Pseudomonas aeruginosa Corneal Infections in Seriously Ill Children
Authors: Anderson Edwin L. , Stager David , Levin Daniel L.
Published: November 2007

Bacterial corneal ulcers can destroy vision if not treated early. Two seriously ill patients developed corneal infections with Pseudomonas aeruginosa while in the pediatric intensive care unit. In one patient the eye was destroyed. The other patient was treated successfully, but early intervention was crucial.
Successful Peritoneal Dialysis in an Infant Weighing Less Than 800 Grams
Authors: Kanarek Keith S. , Root Edward , Sidebottom Richard A. , Williams Paul R.
Published: November 2007

This paper describes the technical feasibility and successful outcome of peri toneal dialysis in the management of a 710-gram, 25-week-gestation infant.
A Microtechnique for Radioisotopic Determination of Glomerular Filtration Rate in Infants and Children
Authors: Braren Victor , Brill A. Bertrand , Touya Juan , Goddard John
Published: November 2007

Our experience with a microtechnique using 99mTc-DTPA for determination of glomerular filtration rate in 172 children is presented. It is a simple finger-stick method carried out in a four-hour time period by trained nuclear medical per sonnel. The procedure meets all criteria for precise measurement of glomerular filtration rate, and the radiation dose is low. Proof of accuracy was obtained by comparison of this technique with concomitant 24-hour urinary creatinine clear ance in a subset of children.
Concordant Optic Glioma in a Pair of Monozygotic Twins with Neurofibromatosis
Authors: Cartwright Sheila C.
Published: November 2007

The occurence is reported of optic chiasma gliomas in a pair of identical twins, both with neurofibromatosis. One twin developed precocious puberty in the sixth year of life and was shown by cisternal computerized tomography to have a su prasellar tumor, which proved to be a malignant glioma. The second twin had an abnormal growth spurt but not overt precocious puberty. Cisternal computerized tomography of the second twin revealed evidence of a similar, smaller tumor at the same site. The literature is reviewed and some possible genetic explanations discussed. This report also emphasises the importance of careful investigation of the second twin when a malignancy is found in one, irrespective of the site or type of the tumor.
Health Systems Agencies and Planning of Pediatric Hospital Services
Authors: McNamara John J.
Published: November 2007

Health Systems Agencies (HSA) are the official national health planning and regulatory agencies in the United States. This case study examines three HSA activities: determination of need, review and approval of federal grants, and ap propriateness review. The article raises questions about planning assumptions and suggests the need to simplify regulatory process and strengthen standards of pe diatric care in community hospitals.
Pediatric Accident Prevention
Authors: O'Shea John S. , Collins Edward W. , Butler Christine B.
Published: November 2007

Accidents remain a major health problem for children of all ages, in spite of attempts at prevention by industry, health workers, educators, and legislation. In order of decreasing frequency, serious pediatric accidents include moving- vehicle accidents, water-related accidents, burns, poisonings, and falls. Their cause, severity, and prevention will be considered, with future challenges emphasized.
Pediatrician-Parent Communication in a Continuity-of-care Setting
Authors: Arntson Paul H. , Philipsborn Herbert F.
Published: November 2007

This study investigated pediatrician-parent communication by content, analyz ing medical encounters in a setting providing continuity of care. Thirty-eight encounters between middle class families and three senior pediatricians were au dio-taped, transcribed, and analyzed for content. The categories of medical com munication coded from the interactions were related to each family's medical and demographic characteristics. Five patterns of results emerged: (1) There was a highly stylized active-passive role relationship, with doctors asking twice as many questions and making twice as many commands as the parents did. (2) A strong reciprocity norm existed between pediatricians and parents for the communication of affect. (3) The higher the experience, income, and educational levels of the parents, the shorter the encounters were, the less frequently symptoms were dis cussed, and the more frequently medication and professional treatment were men tioned. (4) Parents discussed health more in terms of organicity of causes than did pediatricians who, more frequently, raised environmental factors. (5) The more the family had a history of past illnesses, the more frequently the doctors made affect comments during the encounters. Comparing the results to findings drawn from an emergency clinic documented the importance of sustained relationships between practitioners and patients.
Management of Severe Feeding Dysfunction in Children with Fetal Alcohol Syndrome
Authors: Van Dyke Don C. , Mackay Linda , Ziaylek Evelyn N.
Published: November 2007

In the past three years, we have seen three children who required prolonged inpatient admissions for severe feeding dysfunction resulting in nutritional and growth problems. The pregnancies were significant for severe maternal alcohol abuse during the entire pregnancy. All of the subjects had multiple physical find ings and dysmorphic features seen in children with mild to severe fetal alcohol syndrome. Feeding evaluations showed significant delays in oral motor develop ment. Specific oral motor dysfunction was not a commonality and did not appear to be a major determinant in delays in feeding development. Continued assessment revealed that the babies had limited suck patterns and were consistently noted to tire easily. Each required feeding by either gastrostomy and/or nasogastric feeding for prolonged periods of time. They started initial feeding by mouth at about 8 to 10 months. The times for complete oral feeding were 14, 17, and 18 months.
Heterotopic Brain Tissue Simulating a Neonatal Tonsil
Authors: Feldman Bruce A. , Schwartz Richard H. , Chandra Roma , Anderson Kathryn
Published: November 2007

Heterotopic brain is a developmental anomaly in which isolated brain tissue is found outside the cranial cavity. A case of this rare anomaly, simulating a neonatal palatine tonsil, is presented.
A Reclamation of the Case Against Cow's Milk
Authors: Stickler Gunnar B.
Published: November 2007

The best nutrition for the full-term, healthy newborn remains breast milk, lovingly provided by the mother. Every effort should be made to educate, reemphasize, and reassure the mothers of our patients about this most natural way of infant feeding. Yet, when the situation demands it, properly adjusted cow's milk preparations are a very acceptable substitute. Cow's milk also becomes a part of the diet when the infant is weaned from the breast.
Incidence of Convulsions and Encephalopathy in Childhood Shigella Infections
Authors: Avital Avraham , Maayan Chani , Goitein Kalman J.
Published: November 2007

Of 117 children ill enough to be hospitalized with Shigella gastroenteritis, 53 per cent had neurologic symptoms, the majority during the onset of high fever: 11 per cent had convulsions alone, 22 per cent had encephalopathy alone, and 20 per cent had convulsions and encepha lopathy. The neurologic manifestations preceded the gastrointestinal symptoms in one fourth of the patients. Shigella sonnei was the predominant organism found in this study, especially in patients with neurologic symptoms.
Long-term Follow-up of Ambulatory Management of Osteomyelitis
Authors: Dunkle Lisa M. , Brock Norma
Published: November 2007

Over four years, 50 patients with osteomyelitis (32 classified as acute and 18 as subacute or chronic disease) were treated with oral antibiotics in an ambulatory setting. The profile of clinical and laboratory parameters, including etiologic agents, was similar to previous series. Forty-eight patients initially received parenteral drugs, mean duration 14 days (range 0-36). Oral agents administered at home included cephalosporins, clindamycin, dicloxacillin, peni cillin VK, amoxicillin, and sulfa-trimethoprim. Mean duration of total therapy was 53.2 days (range 16-365). In follow-up, ranging from 12 to 60 months (mean 35), relapses occurred in one patient with acute and one with chronic disease. Both responded to oral treatment. No residual infection has resulted, although clinical and radiographic sequelae remain in six more patients initially termed subacute or chronic.

Long-term follow-up of patients receiving high-dose oral antibiotic therapy for osteomyelitis due to sensitive organisms confirms the safety and efficacy of this mode of treatment and the feasibility of ambulatory management. The outcome after oral therapy is equivalent to that following parenteral therapy. Patients with subacute or chronic disease have a significantly poorer prognosis despite a milder initial illness and longer course of therapy.
Effect of Use of a Measured Dispensing Device on Oral Antibiotic Compliance
Authors: Ellison Robert S. , Altemeier William A.
Published: November 2007

The substitution of a syringe in place of a teaspoon for the delivery of oral medications has become routine in some pediatric practices for reasons that are not clear. Although a syringe would measure dosages more accurately, most oral medications have a broad acceptable dose range. A possible advantage of syringes is that parents who receive these may be more impressed with the importance of treatment than those prescribed medications by teaspoon. To test this hypothesis, 72 patients below 24 months of age with otitis media were randomly divided into a group that received a prescription indicating amoxicillin should be given by teaspoon and a group that received a labeled syringe for this purpose. The qualitative presence of the antibiotic in urine at seven-day follow-up visit was 56 per cent among the teaspoon users and 67 per cent among syringe users, while return rates for one week appointments were 51 per cent and 32 per cent, respectively. Neither difference was significant. Use of a measured oral dispensing syringe did not improve compliance in administration of medication or return for follow-up and, therefore, was judged not to be cost effective.
Eosinophilic Gastroenteritis in the Pediatric Patient
Authors: Kravis Lillian P. , South Mary Ann , Rosenlund Mary Loretta
Published: November 2007

Eosinophilic gastroenteritis is a diagnosis to be entertained whenever a patient has abdominal complaints accompanied by striking peripheral eosinophilia. A definitive diagnosis is of great importance in this illness, since undiagnosed cases often undergo needless exploratory surgery. An infant seen at 2 years, 10 months of age with abdominal pain, nausea, and vomiting, was found to have a white blood cell count of 50,000/cu mm with 54% eosinophils and eosinophilic ascites. An antral tissue biopsy yielded a diagnosis of eosinophilic gastroenteritis after many studies had been made to exclude other diagnoses. Treatment with intermittent courses of prednisone kept the patient relatively asymptomatic over the period of 20 years during which she remained under our care. Immunologic studies shed no light on the etiology of this patient's disorder. The literature dealing with diffuse, infiltrative eosinophilic gastroenteritis is reviewed.
Propoxyphene and Acetaminophen
Authors: Golden Nancy L. , King Katherine C. , Sokol Robert J.
Published: November 2007

Propoxyphene (Darvon®) and acetaminophen (Tylenol®) are widely prescribed analgesic agents. Both can cross the placenta, and propoxyphene can produce serious withdrawal symptoms in newborns. Neither propoxyphene nor acetam inophen is considered a teratogen, yet, three malformed infants who were an tenatally exposed to propoxyphene have previously been reported. We report a fourth case of an infant, with withdrawal symptoms and cranial-facial and digital malformations, born to a woman who used propoxyphene and acetaminophen throughout her pregnancy. We suggest the possibility that the antepartum use of propoxyphene and acetaminophen, in combination, may be teratogenic.
Policies Regarding Health and Social Care of Mothers and Children in the United States
Authors: Wallace Helen M.
Published: November 2007

Modifications in federal planning and budgeting for health care programs for mothers and children are reviewed. The potential effects on the affected populations are evaluated, and recommendations for response by the health care professions are presented.
Thrombocytosis in Henoch-Schönlein Purpura
Authors: Saulsbury Frank T. , Kesler Richard W.
Published: November 2007

The clinical and laboratory features of acute Henoch-Schönlein purpura in 18 patients are presented. Thrombocytosis was noted in 67 per cent of the patients and was significantly as sociated with the presence of abdominal pain and gastrointestinal bleeding. We found no cor relation between increased serum IgA concentrations or elevated sedimentation rates and any of the clinical features of Henoch-Schönlein purpura.
Age of Walking in the Cognitively Impaired
Authors: Hreidarsson Stefan J. , Shapiro Bruce K. , Capute Arnold J.
Published: November 2007

Age levels for independent walking were compared for groups of children with varying degrees of intellectual impairment, but without other neurologic handicaps. All walked inde pendently, save for 13.5 per cent of the profoundly retarded. Although mental retardation was associated with a delay in walking, subgroups existed at all levels that walked at a normal age. This suggests that the cognitive level is not the sole determinant for the achievement of this milestone.
A Pediatric Approach to Visual Handicap
Authors: Jaffe Michael , Rudolph Schnitzer Molly
Published: November 2007

When dealing with a visually handicapped child, the pediatrician's responsibility is consid erable. He or she plays a key role in establishing the pathologic diagnosis and in coordinating the subsequent medical therapy and genetic counseling if required. These responsibilities also include providing emotional support to the family, and advice regarding the various medical, developmental, and educational decisions that the family will face in the future. Basic knowledge regarding the effects of visual deprivation on the development of the child, and the use of appropriate compensatory stimuli utilizing the other sensory modalities, will be of great value as the pediatrician accompanies the patient through the trials that await him or her and the family.
Unusual Presentation of Medulloblastoma in Infancy
Authors: Fogelson M. Harold , Liwnicz Boleslaw H. , Schwankhaus John D.
Published: November 2007

The case is presented of an infant with a posterior fossa medulloblastoma who died at age 14 weeks without macrocephaly or signs of increased intracranial pressure. Infants with lower cranial nerve dysfunction and respiratory difficul ties in the neonatal period must be evaluated for posterior fossa tumors.
Review and Recommendations
Authors: Turetsky Rochelle A. , Strasburger Victor C.
Published: November 2007

In the light of the increase in teenage sexual activity over the past decade, the authors review current social, psychological, and educational attitudes. Together with a summary of the legal ramifications, they provide recommendations for treatment of this patient group.
A Follow-up Study of the Impact of Family Therapy in the Pediatric Office
Authors: Karofsky Peter S. , Keith David V. , Hoornstra Lois L. , Clune Constance S.
Published: November 2007

Fifteen families received family therapy from a pediatrician and nurse practitioner. Most families began therapy because of school problems or behavior problems with one of the chil dren. There was serious marital discord in nine families that resulted in divorce in two of them. At least one year after the families began therapy, they were recalled for interviews by a psy chologist who was unknown to them. Information was obtained during these interviews that indicates (1) pediatricians and nurse practitioners were accepted in their roles as therapists by 14 of the 15 families and (2) all families rated their family therapy experiences as useful.
Relative Hyperglucagonemia in L-Asparaginase-and Prednisone-induced Glucose Intolerance in Management of Acute Lymphocytic Leukemia
Authors: Turner Gary R. , Marks James F. , Buchanan George R.
Published: November 2007

Ten children with acute lymphocytic leukemia developed transient diabetes mellitus during treatment with L-asparaginase and prednisone. Serum glucose, plasma insulin, and plasma glucagon levels were measured when the patients were hyperglycemic. Six of the children were restudied several months later when there were no clinical or laboratory signs of glucose in tolerance. Hyperglycemia induced by L-asparaginase and prednisone was associated with depres sion of plasma insulin and, despite the inhibiting action of L-asparaginase on protein synthesis, a corresponding elevation of plasma glucagon. Thus patients with diabetes mellitus induced by L-asparaginase and prednisone have relative hyperglucagonemia similar to other patients with diabetes mellitus.
Sexual Abuse of Young Children
Authors: Khan Misbah , Sexton Mary
Published: November 2007

For an 18-month period, all sexual abuse cases were referred to a project social worker. From her initial interview and the medical records, data were analyzed for 113 children who were 12 years of age or younger. It was found that half were five years or younger and three-fourths of the cases were female children. Reasons were discussed as to why females are more likely to be identified as sexually abused cases. A higher than average rate of gonorrhea was found among the pediatric group studied. While only 44 per cent of abusers were relatives of the abused, almost all (93%) were known to the family. If a relative were the alleged abuser, there was a high probability that it was a father, stepfather, or uncle.
Scaling Scalp Diseases in Children
Authors: Allen Herbert B. , Honig Paul J.
Published: November 2007

Scaling scalp diseases in 142 children were evaluated. Included were seborrheic dermatitis, atopic dermatitis, tinea capitis, and psoriasis. Clinical signs were noted, and various treatments were then undertaken. Patients with seborrheic dermatitis responded well to treatment with antiseborrheic shampoo and topical corticosteroids. Atopic disease was more resistant to treat ment, but did improve with less frequent shampooing and twice daily topical corticosteroid application. Selenium shampoo was a useful adjunct in the treatment of tinea capitis (cultures became negative at two weeks compared to persistent positivity in other treatment groups).
Transient Solitary Diastolic Murmurs in the Newborn
Authors: Papadopoulos George S. , Folger Gordon M.
Published: November 2007

Three newborn infants were observed to have murmurs restricted to diastole. None was considered ill, and none has exhibited symptoms or findings of cardiopulmonary disease throughout follow-up. Localization of the diastolic timing and absence of a significant systolic component of the murmur were confirmed by phonocardiography. The transient nature of the finding was established by serial phonocardiography. Essentially normal cardiac anatomy was determined by routine chest radiograms, electrocardiograms, and echocardiography in both M and two-dimensional modes. Suggestive evidence for left-to-right shunting was present in each case. Invasive studies were not performed. An anatomic cause for the diastolic murmur was not discovered, suggesting it could be related to the ductus arteriosus or mild pulmonary in sufficiency.
Female Child Circumcision in Ilesha, Nigeria
Authors: Olamijulo Samuel K. , Joiner Kabba T. , Oyedeji Gabriel A.
Published: November 2007

In February 1981, the external genitalia of 578 female children were examined at the child welfare clinic, Wesley Guild Hospital, Hesha, Nigeria. Of these children 96.5 per cent were under five years of age, and 66.3 per cent were circumcised. Of the circumcisions, 75.5 per cent had been done in the first month of life. "Traditional" surgeons performed 68.7 per cent of the circumcisions, and private clinic personnel, 21.1 per cent. In 49.6 per cent, circumcision had been done to prevent the head of any future baby from touching the clitoris at parturition, an event believed to result in early death of the neonate. In 48 per cent, circumcision had been done just to conform with custom. Of 175 mothers questioned, 82 per cent believed that an uncircumcised lady was more likely to be promiscuous than a circumcised lady.
Treatment of Salmonella Gastroenteritis in Infants
Authors: Raucher Harold S. , Eichenfield Andrew H. , Hodes Horace L.
Published: November 2007

During 1981, we treated 20 infants, less than 24 months old, for nontyphoid Salmonella (NTSal) gastroenteritis (GE). Blood cultures were obtained in 17 cases, and Salmonella bacter emia was demonstrated in 8 (47%). Of the 13 children 3 to 24 months of age, 7 (54%) had positive blood cultures. One child (8 months old) appeared septic. The patients with bacteremia were treated with parenteral ampicillin. All 20 infants recovered, and no focal infectious com plications occurred. The incidence of bacteremia in NTSal GE is highest in children under 2 years of age. Previous reports have shown that the peak incidence occurs among infants less than 3 months of age. An infant with Salmonella bacteremia may be afebrile and show no symptoms of sepsis. In most cases, bacteremia is transient and does not alter the course of NTSal GE, but it may result in life-threatening complications such as septicemia and meningitis. Therefore we believe an infant with NTSal GE under 3 months old should have a blood culture and receive antibiotic treatment.
Significance of Neutrophils in Cerebrospinal Fluid Samples Processed by Cytocentrifugation
Authors: Naqvi Shehla H. , Dunkle Lisa M. , Naseer Shahida , Barth Charles
Published: November 2007

We reviewed medical records of 155 pediatric patients whose cerebrospinal fluid (CSF) sam ples contained an increased proportion of neutrophils when processed by cytocentrifugation, despite normal CSF total white blood cell count. It was determined that these CSF findings occurred more commonly in patients with bacteremia, peripheral leukocytosis, and increased numbers of red blood cells in the CSF. Pulmonary infiltrates in infants and otitis media in children were also significantly associated.

Cytocentrifugation allows the identification of neutrophils in the CSF, even in the absence of central nervous system infection. Infants and children with more than 10 per cent neutrophils in CSF require evaluations for focal and bacteremic infections.
Moxalactam-tobramycin-resistant Pseudomonas aeruginosa Isolates in Patients with Cystic Fibrosis
Authors: Brown Fitzpatrick Sherahe , Rosenstein Beryl J.
Published: November 2007

In vitro studies have shown synergistic killing activity against Pseudomonas aeruginosa (PA) with the combination of an aminoglycoside and moxalactam, a new beta-lactam agent. We describe three patients with cystic fibrosis (CF) with PA isolates that were resistant to all single-agent antibiotics, but sensitive to the combination of moxalactam-tobramycin. Initially, all patients had a good clinical response to this combination. However, during a second course of therapy, there was clinical deterioration coincident with the rapid emergence of moxalactam-tobramycin-resistant PA isolates.
Decisions to Withdraw Life Support in the Neonatal Intensive Care Unit
Authors: Ragatz Stephen C. , Ellison Patricia H.
Published: November 2007

Neonatal intensive care units may choose to selectively withdraw support in some neonates with severe brain damage. We offer suggestions for criteria for such withdrawal, and a review of 20 cases in which such a decision-making process occurred in our neonatal intensive care unit.
House Officer Management of the Febrile Child
Authors: Weiss Jeffrey , Herskowitz Lee
Published: November 2007

Questionnaires were used to survey 95 pediatric house officers in order to determine their reasons and methods for treating fever, as well as their knowledge of fever physiology. The reasons given for treating fever were to make the child comfortable (99%), to prevent seizures (63%), and to satisfy parents (44%). The average temperature at which antipyretic medication was started was 38.6 ± 0.3 C. Alternating doses of aspirin and acetaminophen were used by 53 per cent, and sponging was recommended by 76 per cent of the residents. The average tem perature at which sponging was started was 39.5 ± 0.6 C. The percentage of house officers who use sponging and/or alternating doses of antipyretics differed greatly from hospital to hospital.

Sixty-one per cent of the residents felt that fever is a defense mechanism which does not require treatment. Despite this belief, the majority of these residents use vigorous means to lower fever in children.
Regional Anesthesia During Newborn Circumcision
Authors: Holve Richard L. , Bromberger Patricia J. , Groveman Howard D. , Klauber Melville R. , Dixon Suzanne D. , Snyder Joel M.
Published: November 2007

A controlled, double-blind investigation was undertaken to determine whether regional anesthesia by dorsal penile nerve block (DPNB) could effectively minimize the pain and behavioral disruptions usually associated with newborn circumcision. Fifteen infants had DPNB with lidocaine, eight control infants had DPNB with saline, and eight additional control infants were circumcised without undergoing DPNB. Newborn distress was gauged by subjective observation, measurement of heart rate, and the percent of time spent crying in six sequential timed intervals during cir cumcision. Ninety-three percent of subjects who received lidocaine were observed to have a decrease in agitation after anesthetic administration. The mean increase in heart rate during circumcision was at least 50 percent less in the lidocaine injected group than in either control group (p < 0.01). Infants who had DPNB with lidocaine cried 50 percent less during circumcision compared to combined controls (p < 0.01). DPNB was easily administered, and there were no significant complications. Physicians who circumcise newborns have good reason to employ the technique of dorsal penile nerve block with lidocaine to minimize infant pain and distress.
Papular Acrodermatitis with Epstein-Barr Virus Infection
Authors: Iosub Silvia , Santos Connie , Gromisch Donald S.
Published: November 2007

A case of papular acrodermatitis (PAC) associated with Epstein-Barr virus in fection occurred in a 9-month-old child. Current knowledge of the possible role of various viral antigens in PAC is discussed.
Antishock Trousers in Pediatrics—A Case Management Report
Authors: Concannon John E. , Matre William M. , Verhagen Arie D.
Published: November 2007

A pediatric trauma patient whose initial management was assisted by antishock trousers is presented along with a discussion of the usage and cautions of this device.
Baby Walker-related Injuries
Authors: Wellman Scott , Paulson Jerome A.
Published: November 2007

A retrospective review of charts of patients with baby walker-related injuries presenting to a large urban emergency room over a 23-month period was undertaken. Ninety-seven percent of the children sustained injuries to their head or face. Sixty-eight percent of the injuries were the result of falling down steps. Twenty-two percent of the injuries required surgical or dental evaluation in addition to pediatric evaluation.
Purpura in Occult Pneumococcal Bacteremia
Authors: Stern H. Patrick , Engstrom Conley W.
Published: November 2007

An unusual case of occult pneumococcal bacteremia is reported. A 4-month-old female presented with ascending purpura on the lower extremities as the only abnormal physical finding. All initial laboratory studies were normal; however, Streptococcus pneumoniae serotype 6 was cultured from her blood within 18 hours and subsequently from the nasopharynx. This is the first reported case in humans of occult pneumococcal bacteremia presenting with the primary clinical finding of purpura. This entity has a well defined animal model in mice.
Neonatal Isoimmune Thrombocytopenia
Authors: Katz Jacob , Hodder Felicity S. , Aster Richard S. , Bennetts Geni A. , Cairo Mitchell S.
Published: November 2007

Isoimmune neonatal thrombocytopenia purpura (INTP) is a disease caused by platelet destruction by maternally derived antibody. Six patients were investigated. Maternal derived platelet trans fusions in two patients resulted in posttransfusion platelet counts of greater than 85,000/μl, a normal platelet survival of 7 to 10 days, and an early discharge from the hospital. In four patients, random donor platelet transfusions administered in the first week caused a transient rise of between 7 and 30,000 platelets per μl with a return to pretransfusion levels 24 to 48 hours later, confirming the ineffectiveness of this form of treatment. Corticosteroid therapy is not effective and because of its potential toxicity should not be recommended for use in INTP. Platelet antigen was identified in the parents, and maternal sensitization was proven by the presence of platelet specific antibody. Severity of the disorder was estimated by the initial platelet count and the duration in weeks for the platelet count to rise above 100,000/ μl. Lymphocytotoxicity and immune lysis, as measured by the 51Chromium release assay, did not show an obvious relationship with the severity of the disorder. In our patients, high scores in the platelet suspension immunofluo rescence test related to a more severe disorder, but a larger series would be necessary to confirm this finding.