bluuebunny/crossref_metadata_2025 huggingface dataset:
Corticosteroid Therapy-induced Obesity in Children
Authors: Merritt Russell J. , Hack Shirley L. , Kalsch Maryse , Olson David
Published: November 2007

The severity and persistence of corticosteroid-induced obesity were evaluated retrospectively in 23 children aged 1-14 yrs requiring more than 60 days of therapy with prednisone for idiopathic nephrotic syndrome. Mean relative weight (after clearing of proteinuria) at initiation of therapy was 107 ± 10 percent. Peak relative weight on therapy was 119 ± 15 percent following a mean total of 31 months of cumulative steroid therapy. The most recent available relative weight in remission at least 6 months following cessation of therapy was 107 ± 18 percent. The number of children whose relative weight exceeded 120 percent at initiation of, during and following therapy was 3, 10, and 4, respectively. In those with normal initial relative weight (<110%) there was no persistent obesity. Two of three initially obese patients (relative weight > 120%) remained obese. All patients with persistent obesity following therapy had initial relative weight of at least 110 percent and peak relative weight of more than 130 percent. The risk of persistent obesity as a result of chronic corticosteroid therapy in initially normal weight children who do not exceed 130 percent relative weight during therapy appears to be small.
Bart's Syndrome: A Mechanobullous Disease of the Newborn
Authors: Sirota Lea , Dulitzky Frederika , Metzker Aryeh
Published: November 2007

Bart's syndrome is one among the lesser known presentations of epidermolysis bullosa. It is characterized by congenital localized bullae of skin and mucous membranes sometimes associated with nail deformities, all of which disappear during the neonatal period. Early recognition allows for avoidance of inappropriate systemic or local therapy.
Prognostic Significance of Urinary Findings and Renal Biopsies in Children with Henoch-Schönlein Nephritis
Authors: Farine Michelle , Poucell Siria , Geary Denis L. , Baumal Reuben
Published: November 2007

Clinical course and renal biopsy were evaluated as predictors of renal outcome in 21 children with Henoch-Schönlein nephritis. Persisting heavy proteinuria and severe glomerular changes most accurately predicted those patients who were likely to develop renal failure. Renal biopsy is recommended only in patients with a nephrotic or nephritic/nephrotic picture.
Recurrence Rate of Febrile Convulsion Related to the Degree of Pyrexia During the First Attack
Authors: Sahib El-Radhi A. , Withana K. , Banajeh S.
Published: November 2007

Ninety-four children consecutively admitted to the hospital between January 1980 and December 1982 with their first febrile convulsion (FC) were studied to assess the influence of the degree of pyrexia on the recurrence rate of FC.

Thirty-eight of sixty-three children between 6 and 18 months of age (the peak incidence of FC) with fever above 40°C were almost seven times less likely to have subsequent convulsions with fever, than those whose initial febrile convulsion was associated with a lower degree of pyrexia.

It is suggested that the degree of pyrexia is a factor that influences the recurrence of FC. This may explain why some children have a reduced frequency of subsequent FC compared with others who appear to be at comparable risk.
Lack of Cardiac Effect from Repeated Doses of Albuterol Aerosol
Authors: Lee Haesoon , Evans Hugh E.
Published: November 2007

To simulate the pattern of use by some patients at home, we studied the effect of frequently repeated inhalation of albuterol aerosol on cardiac rhythm. Fifteen stable outpatient asthmatic children, ages 9-14 years were treated with two puffs of albuterol aerosol (180 mcg) followed either by hourly placebo or hourly albuterol aerosol for 5 hours (10 puffs = 900 mcg) in a randomized, double-blind crossover study. Cardiac rhythm was Holter monitored and pulmonary function was tested hourly for 5 hours. Heart rate (HR) was analyzed at hourly intervals. Pretreatment heart rate of 95.4 bpm ±1.9 SEM declined by 0.4-3 (bpm) after single dose and declined by 2.2-5.6 (bpm) from 99.2 (bpm) ± 2.3 SEM during multiple doses. No one developed arrhythmia, and side effects were infrequent on either day. Forced expiratory volume in 1 second (FEV1) increased similarly on both regimens. It remained stably elevated on the multiple doses, but it started to decline at 120 minutes after the single dose. Our study shows a substantial margin of safety in administration of albuterol aerosol to asthmatic children.
Systemic Hemophilus Influenzae Disease in Children
Authors: Nesheim Steven R. , Wilcox W. Dean
Published: November 2007

A 10-year retrospective study of age-frequency, sites of infection, and pre-existing conditions in 297 children with Hemophilus influenzae (HI) disease seen at Grady Memorial Hospital from 1974 through 1984 is described. The majority of the patients were black (73%) and of lower socio-economic status and were less than 2 years of age. Manifestations of HI disease were similar to those described in reports from other centers, with meningitis being the most common (56.7%). Epiglottitis was much less common in the present study than is generally reported. The death rate of all patients was 1.8 percent. The results of this study indicate that HI disease continues to be a significant risk in children less than 2 years of age.
Thrombocytosis in Children with Hemophilus Influenzae Meningitis
Authors: Thomas Gregory A. , O'Brien Richard T.
Published: November 2007

A retrospective study of thrombocytosis in children with Hemophilus influenzae meningitis was performed. Forty-five percent of patients had a platelet count greater than 500 X 109/l during hospitalization. The mean platelet count was 284 X 109/l on admission, and gradually increased to 648 X 10 9/l on day 11 of hospitalization. These results document that thrombocytosis is common among children with H. influenzae meningitis and suggest that it is probably a recovery phenomenon.
Gastroesophageal Reflux in Children
Authors: Shepherd R.W. , Wren J. , Evans S. , Lander M. , Ong T.H.
Published: November 2007

A clinical profile and the course and outcome with therapy of 126 infants and children with gastroesophageal reflux (GER), diagnosed at a median age of 2.5 months and followed for 1.5 to 3.5 years is presented. Features included repeated regurgitation or rumination (99%), signs suggesting esophageal pain (49%, excessive crying "colic," sleep disturbance, Sutcliffe-Sandifer syndrome, respiratory symptoms 42%), failure to thrive (18%), and minor hematemesis (18%). Feeding problems and maternal distress were common, associated with child abuse in four cases. Therapy was initially conservative (posture, thickening of feeds, antacids, bethanechol), augmented by cimetidine in those with proven esophagitis (n = 34, 0.27%). Most (81%) were symptom-free by 18 months of age (55% by 10 months of age); 17 percent had fundoplication with good results; 2 percent have persisting symptoms beyond 2 years of age (1% failed surgery). No deaths were recorded. Surgery was performed for recurrent apneas/aspiration (6%), refractory esophagitis or stricture (5%), and failed medical management (7%). Esophagitis was a significant determinant to outcome, and the importance of selective early endoscopy is emphasized. GER is a cause of considerable morbidity in infants but, with active therapy, is self-limiting in the majority. Certain distinctive clinical signs indicate those patients who require detailed investigation and to whom more aggressive therapeutic efforts should be directed.
Misdiagnosis of Cystic Fibrosis
Authors: Rosenstein Beryl J. , Langbaum Terry S.
Published: November 2007

A retrospective review was conducted of the charts of 271 patients with a diagnosis of cystic fibrosis (CF) who were evaluated over a 15-year period at the Johns Hopkins Hospital. Among these patients, eight were encountered in which the diagnosis of CF was made on the basis of a compatible clinical picture and at least two positive quantitative pilocarpine iontophoresis sweat tests but who were subsequently documented to have normal sweat electrolyte concentrations. Six of the eight patients had recurrent episodes of cough and wheezing without evidence of suppurative pulmonary disease. Our experience suggests that variability in sweat electrolyte concentrations may occur more commonly than is generally appreciated. In those patients who do not follow a typical course, it is crucial to repeat sweat tests, even if the initial diagnosis was based on two or more positive quantitative pilocarpine iontophoresis sweat tests performed in a CF referral center.
Providing Free Samples of Baby Items to Newly Delivered Parents
Authors: Hayden Gregory F. , Nowacek George A. , Koch William , Kattwinkel John
Published: November 2007

Recent studies have suggested that providing free sample packs of baby items to newly delivered parents may adversely influence parental health behavior. To determine the extent of this practice in Virginia, the head nurses of all 68 newborn nurseries and a random sample of 200 pediatricians were surveyed. Formula samples were being distributed at all hospitals. Formula packs were given to breast-feeding mothers at 65 (95%) hospitals although only 66 percent of the surveyed pediatricians approved of this practice. Samples of baby items other than formula (e.g., baby powder) were being distributed at 66 (97%) hospitals. Some physicians (18%) objected to the distribution of these non-formula samples, and others were not familiar with the content of these packs. In most instances, the hospital medical staff had not voted to approve the distribution of these packs. Parents were being informed only rarely about the source and intent of the packs.

The provision of sample packs to newly delivered parents affects approximately 3,000,000 babies each year in the United States. The short- and long-term effects of providing these packs have been inadequately explored. Physicians should make an active decision whether to distribute sample packs. Those physicians choosing to dispense these samples may wish to review and edit the content of the packs and to enclose in the pack a brief note explaining that the provision of the products does not constitute a medical endorsement.
Onset of Hemophilus influenzae Type-b Meningitis During Cefaclor Therapy for Preseptal Cellulitis
Authors: Brady Michael T. , Barson William J. , Cannon Harold J. , Grossman Lindsey K.
Published: November 2007

Second generation cephalosporins are frequently used for the treatment of bacteremic Hemophilus influenzae type b infections. "Breakthrough" meningitis during cefamandole therapy has documented the need for adequate cerebrospinal fluid penetration by these antibiotics if they are to be used in the therapy of Hemophilus infections.

A child with H. influenzae type b preseptal cellulitis is reported who initially responded to treatment with intravenous cefuroxime and oral cefaclor. However, while still receiving cefaclor, the child was readmitted with H. influenzae meningitis. Microtiter broth dilution susceptibility testing performed during the second admission showed the isolate to be relatively resistant to cefuroxime (minimum bactericidal concentration [MBC] = 4 μg/ml) and resistant to cefaclor (MBC > 16 μg/ml).

This experience documents the need to monitor the clinical response closely during therapy of H. influenzae bacteremic infections with these second generation cephalosporin treatment regimens. In addition, attention should be paid to minimum inhibitory concentrations of these cephalosporins, since variations in H. influenzae type b susceptibility to these agents may limit their efficacy.
The Physician's Role in Delivering Sensitive Information to Families with Handicapped Infants
Authors: Olson Jennifer , Edwards Marcia , Hunter Jay Allen
Published: November 2007

The critical nature of the physician's role in delivering sensitive information to families with handicapped infants is discussed. A review of research and teaching practices associated with conveying serious diagnoses is presented. Specific suggestions are described, to be followed when delivering disturbing diagnostic information.
A Follow-up Study of Preschool Children Evaluated for Developmental and Behavioral Problems
Authors: Blackman James A. , Levine Melvin D.
Published: November 2007

Parents and teachers of preschool children evaluated for developmental and behavioral problems in a tertiary pediatric clinic were surveyed an average of 15 months after the initial visit to determine whether they thought the original presenting problem(s) were still present. In 46 percent of cases in which there was an initial concern about behavior, parents continued to be concerned. In contrast, only 24 percent of responding parents continued to be concerned about developmental problems. In more than half of the cases in which parents were no longer concerned, especially about behavior, teachers indicated that there continued to be problems. Age and sex of children were not related to outcome. The higher the socioeconomic status of parents, the more likely the parents were to report persistent developmental problems. Children with persistent problems tended to have difficult temperament characteristics. This study suggests that it is difficult to predict which problems will persist and that there are varying viewpoints as to the nature and existence of these problems.
Behavioral, Psychosocial, and Academic Correlates of Marijuana Usage in Adolescence
Authors: Schwartz Richard H. , Hoffmann Norman G. , Jones Richard
Published: November 2007

In 1985 approximately 120,000 American high school seniors smoked marijuana daily. We interviewed 35 middle-class, cannabis-dependent adolescents with a mean age of 16 years who were patients in a drug treatment program. The patients also completed a lengthy self-assessment questionnaire designed to elicit information on drug-related problems. Our results show that family harmony, school attendance, and school achievement deteriorated once these young people began to use marijuana at least 4 days a week. The following behaviors were noted: remaining away from home without permission or parental knowledge for at least 7 consecutive days (29%), a D or F grade average on the last report card before they entered the drug treatment program (43%), involvement in a motor vehicle accident when the driver was under the influence of marijuana (26%), suicide attempts (20%), and convincing a "marijuana-naive" younger sibling to smoke the drug (20%). Despite such seemingly apparent signs of possible drug use by these 35 adolescents, a mean time of 12 months elapsed before parents suspected their children of marijuana abuse. In many cases mental health professionals consulted by a number of the children when they were using drugs were likewise unaware of the marijuana abuse.
Outpatient Radiographic Exposure in the First Five Years of Life
Authors: Fosarelli Patricia D. , DeAngelis Catherine
Published: November 2007

Young children receive a variety of diagnostic radiographs over time. In some cases the exposure to radiation may be unwarranted because the films may yield confusing results, or may also need to be repeated because of poor technical quality. Even when the results are clearly negative, the subsequent treatment may proceed as if the film had been positive because of the child's clinical condition. The cumulative effect of such low-dose radiation on infants and children over time is unknown.

The number and types of outpatient radiographs received by a cohort of poor children from a hospital-based continuity clinic during their first 5 years of life were reviewed. Also noted were the reason for obtaining the film, whether it was positive for that reason or another, whether the child had a chronic condition that prompted the use of radiograph, and the child's sex, race, and age when the film was obtained.

Of the 218 children, 132 (60.6%) received 349 sets of films in their first 5 years. There was no difference in the number of films by race or sex. Chest and posttrauma bone or joint films accounted for 315 sets of films or 90.3% of the total. Overall, 25.8% of the 267 chest films were positive; this varied by age. Only 15% of the chest films were positive in the first year compared with 29 to 49% in the second through fifth years (p < 0.001). Cough was the respiratory symptom most reliably associated with a positive chest film, both for the cohort (p < 0.0001) and for children in the first year of life (p < 0.01). Of the 132 children who had received a radiograph, 77 (58.3%) had some type of chronic condition, but only 33.5% of their films were directly related to those conditions. Of the children who received films, those with any chronic condition received more films in general (2.99 versus 2.10, p < 0.01) and chest films in particular (2.39 versus 1.44, p < 0.01) than did children without a chronic condition.
A Simulated "Acquired" Imperforate Hymen Following the Genital Trauma of Sexual Abuse
Authors: Berkowitz Carol D. , Elvik Sandra L. , Logan Nary
Published: November 2007

Imperforate hymen, a condition in which the hymen has no aperture, usually occurs congenitally, secondary to failure of development of a lumen. A case of a documented simulated "acquired" imperforate hymen is presented in this article. The patient, a 5-year-old girl, was the victim of sexual abuse. Initial examination showed tears, scars, and distortion of the hymen, laceration of the perineal body, and loss of normal anal tone. Follow-up evaluations over the next year showed progressive healing. By 7 months after the injury, the hymen was replaced by a thick, opaque scar with no orifice.

Patients with an apparent imperforate hymen require a sensitive interview and careful visual inspection of the genital and anal areas to delineate signs of injury. The finding of an apparent imperforate hymen on physical examination does not eliminate the possibility of antecedent vaginal penetration and sexual abuse.
Congenital Cytomegalovirus Infection With Osteolytic Lesions: Use of DNA Hybridization in Diagnosis
Authors: Jenson Hal B. , Robert Marie F.
Published: November 2007

A case of congenital cytomegalovirus (CMV) infection with long-bone lesions is presented. The bone lesions consisted of broad regions of generalized osteopenia with irregular fragmentation and spiculization at the zone of provisional calcification. Diagnosis of CMV infection was made by DNA spot hybridization of the urine sediment to DNA from the Towne strain of CMV, demonstrating the usefulness of DNA hybridization for identification of CMV in clinical specimens. Bone lesions associated with congenital CMV infection are useful early clues to diagnosis but can be indistinguishable from those of congenital rubella syndrome.
A Multicenterg Randomized, Single-blind Evaluation of Cefuroxime Axetil and Phenoxymethyl Penicillin in the Treatment of Streptococcal Pharyngitis
Authors: Pichichero Michael E. , Disney Frank A. , Aronovitz Gerson H. , Ginsburg Charles , Stillerman Maxwell
Published: November 2007

Ninety-three children from four pediatric practices, with clinical and bacteriologic evidence of acute Group A beta-hemolytic streptococcal pharyngitis (GABHS) randomly received cefuroxime axetil (60 cases) or phenoxymethyl penicillin (33 cases). Cefuroxime axetil was given twice daily (125 mg). Phenoxymethyl penicillin was given three times daily (250 mg). The treatment groups were similar. Throat cultures were routine 2 to 7 days after the start of therapy and 2 days and 14 days after the end of therapy. The bacterial cure rates were 85 percent (51/60) for cefuroxime axetil, and 88 percent (29/33) for phenoxymethyl penicillin treated patients. Clinical results were comparable in both treatment groups. It was concluded that cefuroxime axetil given twice daily is as effective as phenoxymethyl penicillin given three times daily in producing bacteriologic eradication and clinical symptomatic improvement in children with GABHS.
Mothers and Their Children Look at Baby Pictures: The NICU Experience in Retrospect
Authors: Wilson Ann L. , Munson David P. , Koel Deede , Hitterdahl Miriam
Published: November 2007

Photographs of Neonatal Intensive Care Unit (NICU) patients are frequently given to parents to promote bonding, but little attention has been paid to how families respond years later to viewing these special baby pictures. This study examines how 71 mothers of 3 to 7-year-old developmentally normal (DQ ≥ 80) children who weighed less than 1,500 g at birth describe this experience. Compared to a group of mothers whose children were full term at birth, the NICU mothers described personally feeling and perceiving their children as more fearful (p < .05), inquisitive (p < .0001), worried (p < .01), thoughtful (p < .0001), and tearful (p < .05). The responses of NICU mothers were significantly more highly correlated with their perceptions of their children's responses than were the mother-child correlations observed in a comparison group. The NICU children were reported by their mothers to ask about the NICU equipment, pain, being alone, their physical scars, and if their being "bad" caused their need for intensive neonatal care. Recommendations are provided on how pediatric care providers can assist NICU parents anticipate questions and respond to their children's concerns as they view these potentially distressing photographs.
Lacunar Infarction of the Basal Ganglia as a Complication of Hemolytic-uremic Syndrome
Authors: DiMario Francis J. , Brönte-Stewart Helen , Sherbotie Joseph , Turner Mary Ellen
Published: November 2007

Central nervous system (CNS) complications of hemolytic-uremic syndrome (HUS) commonly consist of alterations in mental status, seizures, and rarely hemiparesis.1,2 The authors report the clinical evolution of left hemiparesis and later choreo-athetoid movements in a patient who sustained a right lacunar infarction as a complication of HUS. The infarction is demonstrated on magnetic resonance imaging (MRI).
Use of Computed Tomography in Evaluation of Acute Respiratory Distress in a 4.5-month-old With Bronchogenic Cyst
Authors: Caudill John L. , Lloyd Thomas V.
Published: November 2007

A 4.5-month-old female presented with stridor and acute respiratory distress. Chest radiographs showed hyperinflation of the left lung. Computed tomography of the chest demonstrated a small bronchogenic cyst not clearly identified by other methods.
Totally Implantable System for Venous Access in Children With Cystic Fibrosis
Authors: Cassey J. , Ford W.D.A. , O'Brien L. , Martin A.J.
Published: November 2007

Thirteen children with cystic fibrosis had a totally implantable reservoir surgically inserted for repeated courses of intravenous antibiotics. The youngest patient was 17 months at the time of implantation. The catheters have been in place for an average of 463 ± 200 days. Forty seven courses of intravenous antibiotics have been given over a total of 832 treatment days. Three patients had complications. One experienced catheter separation from the portal, one catheter became occluded, and a third catheter fractured and migrated to the right atrium but was successfully retrieved percutaneously.

The catheters were accepted well by patients and parents. We conclude that implantable reservoir systems, although moderately expensive and not totally free of complications, offer another modality in the management of cystic fibrosis patients.
Severe Obstructive Sleep Apnea in a Child With Osteopetrosis
Authors: Carter Mary , Stokes Dennis , Wang Winfred
Published: November 2007

The clinical features of a 5-year-old patient with osteopetrosis and severe obstructive sleep apnea are presented. The patient responded to tonsillectomy, adenoidectomy, uvulectomy, and tracheostomy. The tracheostomy was later removed. Osteopetrosis, while rare, may be added to the list of causes of obstructive sleep apnea.
Half-strength TAC Topical Anesthetic
Authors: Bonadio William A. , Wagner Virginia
Published: November 2007

A prospective evaluation of 75 consecutive children with lacerations of the face, lip, and scalp who received TAC (tetracaine, epinephrine [adrenalin], cocaine) topical anesthetic for the repair of their wound was performed. The TAC preparation contained one-half the conventional concentration of cocaine (5.9%) and tetracaine (0.25%) previously used in other studies that have evaluated its anesthetic efficacy. A maximal dosage of 3 ml of TAC (containing 175 mg cocaine and 7.5 mg tetracaine) was applied to each laceration. The diluted TAC preparation provided complete anesthesia for approximately 95% of the more than 400 sutures placed. No adverse reactions were noted in any patient who received TAC, and in no instance did a complication of wound healing occur.

The original formulation of TAC was arbitrarily composed, and the maximum concentration per dosage of the potentially toxic component medications of TAC that can be "safely" applied to dermal lacerations in children remains to be defined. Utilization of this diluted preparation will diminish the risk of potential systemic toxicity from the absorbed component medications of TAC without compromising anesthetic efficacy.
C-reactive Protein as a Serial Index of Severity
Authors: Peltola Heikki , Jaakkola Maritta
Published: November 2007

The clinical course of 72 septicemic episodes or focal severe bacterial infections was monitored by daily measurements of serum C-reactive protein (CRP) in 59 children beyond the neonatal period, 19 of whom were immunocompromised. CRP was determined quantitatively by an immunoturbidimetric method from a finger prick sample until either clinical recovery occurred and antimicrobial therapy was discontinued or until the death of the patient. The primarily elevated CRP levels (≥20 mg/l) usually increased about for a day but then decreased rapidly, provided the patient recovered uneventfully. If not, CRP remained at a high level or reincreased after transient decrease. Behavior of CRP was not affected by the immunologic status of the patient. This property makes CRP especially useful in immunocompromised patients in whom other commonly used laboratory parameters may fail.
Trisomy 8 Mosaicism Syndrome
Authors: Kurtyka Zuzanna E. , Krzykwa Boguslawa , Piatkowska Edyta , Radwan Magdalena , Pietrzyk Jacek J.
Published: November 2007

The paper presents clinical manifestations and results of cytogenetic examination of two patients with trisomy 8 mosaicism syndrome. The findings confirm the extreme phenotype variability of this syndrome. Both the first patient, a mentally retarded child with multiple dysmorphic changes, and the second, a 31-year-old woman with normal IQ and hypogammaglobulinemia as a predominant sign, revealed osteoarticular anomalies. Dermatoglyphic studies in both patients were typical for trisomy 8, and correlated with deep skin furrows. The chromosomal analysis was based on two types of lymphocyte cultures: 3-day and 2-day. A decreased percentage of trisomic cells in 3-day cultures in comparison to 2-day cultures may suggest the influence of environmental factors on spontaneous elimination of trisomic cells in vitro.
Breastfeeding Among Low-Income, High-risk Women
Authors: Grossman Lindsey K. , Larsen-Alexander Janet B. , Fitzsimmons Sharon M. , Cordero Leandro
Published: November 2007

Data from a state supported project providing multidiscipline (clinical social work, nursing, nutrition, obstetrics, and pediatrics) assistance to low-income women judged to be at high perinatal risk by medical and social history were analyzed regarding infant feeding decisions. Data from 2,124 subjects delivered from 1976 to 1985 were available for analysis. The population tended to be single (77%), black (66%), poorly educated (63% less than a high school education), and young (mean age 21.8 years). Thirty-six percent were primiparas. The decision to breastfeed was associated with white race, older maternal age, higher educational level, marriage, and earlier utilization of prenatal care.

Prenatal infant feeding plans were compared with actual postpartum decisions for 1,168 women. Only 3 percent of those initially planning to bottle feed changed their minds postpartum and breastfed although 31 percent of those initially planning to nurse ultimately chose artificial feeding. Ten percent of women were initially undecided; one-third of this group ultimately breastfed, two-thirds bottle fed.

Overall the percentage of women in the project who were breastfeeding rose from 15 percent to 22 percent from the early to later years of the project (p < 0.0001).
Superior Vena Cava Syndrome in Infants
Authors: Raszka William V. , Smith Franklin R. , Pratt Stephan R.
Published: November 2007

Superior vena cava syndrome is uncommon in infants. With the increased use of central venous catheters, however, there has been an increased incidence of central venous occlusion. We report a case of superior vena cava syndrome occurring on two separate occasions in a premature infant with an indwelling central line. We discuss current concepts of prevention and management.
Recruitment of a Large Community of Pediatricians in a Collaborative Research Project
Authors: Nazarian Lawrence F. , Maiman Lois A. , Becker Marshall H.
Published: November 2007

To investigate the effects of an educational program on the compliance-enhancing behavior of pediatricians and the subsequent regimen adherence of their patients, it was necessary to enlist the participation of a large number of pediatric practitioners. The physicians had to be motivated to attend two evenings of tutorial training; to enroll their patients in the project; and to complete detailed study documents. Ultimately, 90 of the 97 pediatricians practicing in the community took part.

The following factors are felt to have contributed to the widespread participation of the pediatricians: 1) the subject was interesting and of relevance to clinical practice; 2) the study was designed so as not to interfere with office routine; 3) major demands were not made on the patients; 4) due consideration was given to the value of the physicians' participation; and 5) communication between the investigators and the practitioners was facilitated by a liaison pediatrician.
Surgically Curable Hypophosphatemic Rickets
Authors: Hanukoglu A. , Chalew S.A. , Sun C.J. , Dorfman H.D. , Bright R.W.
Published: November 2007

Childhood hypophosphatemic rickets (HR) is most often caused by a defect in renal tubular resorption of filtered phosphorus. However, HR can also be caused by secretion of a phosphaturetic factor from a tumor. The presentation of patients with the different HR syndromes may be identical. Distinguishing between the HR syndromes is essential, however, because HR caused by the renal defect requires life-long therapy with Vitamin D and phosphate replacement, but tumor-associated HR is cured by removal of the tumor. A case of hemangiopericytoma occurring in bone and causing HR is reported. Children with HR typically have normal levels of serum calcium and parathyroid hormone but very low levels of serum phosphorus. In a child with HR, the following features should prompt a thorough evaluation for a causative tumor: lack of other family members who have hypophosphatemia; presence of aminoaciduria, particularly glycinuria. Causative lesions are most commonly found in the bone or skin.
Excessive Water Drinking
Authors: Accardo Pasquale , Caul Jefferies , Whitman Barbara
Published: November 2007

In children examined at a child development clinic the incidence of excessive water drinking was almost exclusively confined to the foster care population. A series of 11 patients is compared with other reports of excessive water drinking as a marker for parent-child problems and inadequate nurturance. The parent-child interaction patterns were characterized as rejecting and both overprotective and overindulgent. The family adaptational styles tended to be chaotic and rigid, and the family cohesion styles disengaged or separated. Excessive water drinking can be considered a marker for problems in parenting.
Early Presentation with a Desmoid Tumor
Authors: Halata Michael S. , Miller Javier , Stone Richard K.
Published: November 2007

A 14-year-old patient who was eventually found to have Gardner syndrome initially presented at the age of 3 years with a desmoid tumor involving the scalp. A careful review of the family history revealed a high incidence of colonic cancer, which prompted endoscopic evaluation of the patient. The discovery of adenomatous polyps in the colon confirmed the diagnosis of Gardner syndrome.

In patients with hard or soft tissue tumors, the possibility of Gardner syndrome should be kept in mind, and a thorough family history taken. Early diagnosis may prevent malignant transformation of colonic polyps.
Nasal Glioma
Authors: Puppala Bhagya , Mangurten Henry H. , McFadden John , Lygizos Nicholas , Taxy Jerome , Pellettiere Edmund
Published: November 2007

Nasal gliomas are benign congenital midline tumors with the potential for intracranial extension. They are most commonly seen in neonates and children but rarely in adults. The treatment of choice is surgical excision. Inadequate primary excision results in a 4 to 10 percent recurrence. Hence, a thorough preoperative evaluation is essential to delineate the exact site and extension of the tumor and to plan the appropriate surgical approach. Computerized tomographic (CT) scans are useful in visualizing bony defects, but are not well suited for soft tissue imaging. Magnetic resonance imaging (MRI) offers superior soft tissue contrast, without ionizing radiation.

This is a report of a neonate with unexplained early respiratory distress. On day 5, a soft nasal mass became apparent. CT scans were inconclusive, so MRI scan was used to demonstrate intracranial extension. MRI is superior for imaging brain tissue, so it should be used preferentially to delineate intracranial extension and to help guide the surgical approach.
Nasal Continuous Positive Airway Pressure (CPAP) Therapy
Authors: Ryan C.F. , Lowe A.A. , Fleetham J.A.
Published: November 2007

An 8-year-old girl with Hallermann-Streiff syndrome (oculomandibulofacial syndrome) was examined. She had a history of severe snoring, reported nocturnal apnea, excessive daytime hypersomnolence, nocturnal enuresis, and failure to thrive. Overnight polysomnography confirmed severe obstructive sleep apnea. Long-term nasal continuous positive airway pressure (CPAP) therapy completely relieved the obstructive sleep apnea and was associated with improved weight gain and growth.
Varicella-associated Arthritis Occurring Before the Exanthem
Authors: Fierman Arthur H.
Published: November 2007

Varicella-associated arthritis represents an uncommon complication of varicella in children. In 20 previously reported cases, three were documented to be bacterial in origin. Viral isolation from synovial fluid was attempted in seven others, and varicella was isolated in just two. In all previous case reports, the arthritis occurred after or coincident with the onset of varicella. The current case is one in which joint involvement preceded the clinical onset of varicella. Clinicians should be alert to the possibility that varicella may manifest as an acute arthritis, even in the absence of the typical exanthem.
Comparison of Urine Dipstick, Microscopy, and Culture for the Detection of Bacteriuria in Children
Authors: Goldsmith Barbara M. , Campos Joseph M.
Published: November 2007

The authors compared dipstick tests for leukocyte esterase and nitrite and microscopic examination of urinary sediment with urine culture to assess whether the former tests could reliably rule out bacteriuria in specimens from children.

The authors studied urine specimens from 1010 infants and children younger than age 18. Compared with culture at ≥105 colony forming units (cfu)/ml, the sensitivities of leukocyte esterase, nitrite, and microscopic examination of white blood cells (≥5 wbc/hpf) or bacteria (in at least moderate numbers) were 76 percent, 29 percent, 82 percent, and 80 percent, respectively. The specificities of the same tests were 81 percent, 99 percent, 81 percent, and 83 percent, respectively. Compared with culture at ≥104 cfu/ml, the sensitivities of the tests were 64 percent, 21 percent, 64 percent, and 59 percent; the specificities were 82 percent, 99 percent, 81 percent, and 83 percent, respectively. The negative predictive values of leukocyte esterase and microscopic examinations of urinary sediment for white blood cells and bacteria were all 95 percent (≥104 cfu/ml) or 98 percent (≥105 cfu/ml).

The authors conclude that the leukocyte esterase test is as accurate as sediment microscopy in identifying urine specimens from infants and children harboring <10 4 or <105 cfu/ml.
Childhood Cancer Survivors: Attained Adult Heights
Authors: Holmes Grace E. , Holmes Frederick F. , Baker Ariel B. , Hassanein Ruth S.
Published: November 2007

As part of a large collaborative study, the authors administered a pretested questionnaire to 62 childhood and adolescent cancer survivors and 62 same-sex sibling controls. The authors requested information regarding attained adult height on the questionnaire. Mean adult height of survivors (172.2 cm) was less than that of controls (174.1 cm), at a borderline significant difference of p = 0.0757. Multivariate analysis examined four potential, independent variables as possible predictors of this difference. The presence of brain tumor (vs. nonbrain tumor) (p < .0001) and diagnosis at an early age (≤ 8 years vs. 9-15 years) (p = .05) were factors significantly related to the differential; sex of patient and type of therapy were not. Our findings thus identify malignancy site and age at diagnosis as important predictors of adult height in childhood and adolescent cancer survivors.
Viralization Due to Leydig Cell Tumor Diagnosis by Magnetic Resonance Imaging
Authors: Kaufman Ellen , Akiya Fred , Foucar Elliott , Grambort Frederick , Cartwright Karen C.
Published: November 2007

A 3-year-old boy who presented with signs of virilization had a Leydig cell tumor of the left testis that could not be detected by physical examination or by high resolution ultrasonography. His very small tumor was demonstrated by magnetic resonance imaging. The implications of adding this sensitive method of imaging to the evaluation of prepubertal virilization of presumed testicular etiology are discussed.
Toxic Psychosis Due to Chloroquine- Not Uncommon in Children
Authors: Garg Pukhraj , Mody Praveen , Lall K.B.
Published: November 2007

Toxic psychosis due to Chloroquine is a relatively uncommon occurrence in childhood. This entity must be kept in differential diagnosis in a case of unexplained psychosis, before resorting to a sophisticated array of detailed investigations. The purpose of this is to familiarize pediatricians with this relatively uncommon entity. The authors encountered four cases of psychosis with a wide variety of symptomatology over a period of the past 18 months.
The Correlation Between Low Birth Weight and Learning Traits in Senior School Pupils- A Retrospective Survey
Authors: Brook U. , Shemesh A. , Heim M.
Published: November 2007

The purpose of this study was to establish whether a correlation exists between childrens birth weight and their scholastic achievements in high school. This correlation has previously only been investigated only in primary school children and it was felt that it would be interesting to observe whether schooling changed the known status. The records of 718 children were reviewed and there appears to be a statistically significant disability for low birth weight children in the study of exact sciences and foreign languages whilst no significant differences were noted in the humanities and sport.
Early Identification of Hearing Loss: Listen to Parents
Authors: Thompson Marie D. , Thompson Gary
Published: November 2007

Families of 49 hearing-impaired children responded to a questionnaire requesting information about the identification of their child's hearing loss. Parents were the first to suspect the hearing loss in 48 cases but more often than not were told that the child would outgrow it or was too young to test. When professionals agreed with the parents and attended to their concerns, confirmation of the hearing loss occurred significantly more rapidly than when they disagreed with parents and ignored their concerns. A child whose hearing loss is not clearly identified and whose communication is inadequate or nonexistent, causes frustration and stress within the family and prevents the child from receiving the maximum benefit from early language input and amplification. It would benefit both the child and family if professionals would listen to parental concerns regarding their child and assist in the early identification process.
Psychosocial Screening in Pediatric Practice: A Survey of Interested Physicians
Authors: Bishop Sandra J. , Murphy J. Michael , Jellinek Michael S. , Dusseault Karen
Published: November 2007

This study followed up on 201 pediatricians and family practitioners who had requested information about the Pediatric Symptom Checklist (PSC), a parent-completed questionnaire which screens for psychosocial dysfunction in school-aged children. The physicians were sent a postcard survey asking whether they had used the PSC in their practices. Of the 157 (78%) who responded to the postcard survey, 36 (23%) reported that they had used the PSC. On a follow-up questionnaire, all of these physicians rated the PSC as useful, and nearly 80% reported that it led to increased case-finding and/or referrals. Ninety-six percent stated that they will continue to use the PSC; more than half of them routinely or frequently. The findings indicate a widespread interest in psychosocial screening, and suggest that additional educational efforts may be necessary to support the acceptance of the PSC in pediatric practice.
Endocardial Fibroelastosis With Coronary Artery Thromboembolus and Myocardial Infarction
Authors: Lane Kathryn L. , Herzberg Arlene J. , Reimer Keith A. , Bradford William D. , Schall Stewart A.
Published: November 2007

We report a case of an 18-month-old male, born to a woman with third trimester febrile illness, who had a history of congestive heart failure and respiratory distress, cardiomegaly, and electrocardiographic (ECG) findings suggestive of cardiomyopathy and myocarditis. After gradual improvement in heart size and function with pharmacologic therapy, he developed a terminal episode of respiratory distress and cardiogenic shock, with ECG findings of an anterolateral infarct. At autopsy it was found that endocardial fibroelastosis with mural thrombi in the left ventricle had been complicated by thromboembolism to the left anterior descending coronary artery, resulting in transmural infarction of the anteroseptal region of the left ventricle. Myocardial infarction is a potential but unusual thromboembolic complication of endocardial fibroelastosis. A high index of suspicion for coronary artery thromboemboli should be maintained in pediatric patients with cardiomyopathy and suspected myocardial infarction.
Bacterial Meningitis—An Update
Authors: Marks Melvin I.
Published: November 2007

This report emphasizes new clinical information about bacterial meningitis in infants and children. Important elements of diagnosis include examination for the presence of shock and increased intracranial pressure. In such cases, initial treatment should focus on appropriate fluid therapy, administration of oxygen, reduction of intracranial pressure and use of corticosteroids.

Currently, antibiotics of choice include ampicillin plus either cefotaxime or ceftriaxone in young infants, and one of these cephalosporins in older patients (beyond 3 months of age). Shorter durations of therapy (5 to 7 days for meningococcus, 7 days for haemophilus and 7-10 days for pneumococcus) are now commonly employed. In many centers, dexamethasone is started before the first dose of antibiotic and continued for 4 days to reduce neurologic and audiologic sequelae. Future trends will include studies of endotoxin neutralizers and non-steroidal anti-inflammatory drugs to reduce further tissue injury in meningitis. Prevention of meningitis is the ultimate goal. Since Haemophilus influenzae vaccination can now begin at 2 months, this approach may bring important results soon.
Temporal Bone Fractures in Children
Authors: McGuirt William Frederick , Stool Sylvan E.
Published: November 2007

A 10-year retrospective study of pediatric basilar skull fractures identified 120 patients with temporal bone fractures, of which 92 had otolaryngologic and audiologic evaluations. The otologic data provide documentation of the nature, common physical findings, complications, and management of these fractures. The prognosis of hearing impairment in children caused by temporal bone fractures is elucidated, as 76 of the 92 patients were available for long-term follow-up. Close interaction between involved services evaluating and treating pediatric trauma cases is mandatory for optimal patient outcome. A literature review of the presentation, complications, and management of pediatric temporal bone fractures is presented.
Drooling
Authors: Crysdale William S.
Published: November 2007

Troublesome and persistent drooling is not an uncommon problem in neurologically impaired children. For the past 15 years, a team approach has been utilized to assess and manage affected individuals. Programs intended to improve oral motor skills should be utilized initially. Surgery has proven necessary in over half of these patients; bilateral submandibular duct relocation and sublingual gland excisions are the current procedures of choice at our institution.
Sedation of Children for Technical Procedures
Authors: Cook Bruce A. , Bass James W. , Nomizu Simone , Alexander Mark E.
Published: November 2007

We sought to define the current standard of care for children undergoing sedation for painless diagnostic procedures by sending questionnaires to 284 pediatric residency program directors in North America. From the 89 responses, we determined that departments of pediatrics set sedation policies for children in most institutions, often with formal written guidelines for these procedures. Most require that children have some form of cardiorespiratory monitoring while under sedation and that they are attended by individuals trained in cardiorespiratory resuscitation until the child is fully recovered. The use of parents to transport and monitor the sedated child is uncommon, and total lack of monitoring is rare. Chloral hydrate in dosages of 25 mg/kg to 100 mg/kg is the most common drug used for sedation; DPT, a combination of parenteral Demerol(meperidine), Phenergan (promethazine), and Thorazine (chlorpromazine), at a maximum dose of 2 mg/lmg/lmg/kg is the second; and pentobarbital in a dosage of 5 mg/kg to 7 mg/kg is the third. These sedation regimens were associated with few serious side effects, except that two deaths were reported in infants with congenital heart disease who were sedated with DPT. We believe this survey may reflect the current standard of practice for sedation in North American infants and children undergoing diagnostic procedures.