bluuebunny/crossref_metadata_2025 huggingface dataset:
Failure to Demonstrate Beneficial Effect of Prostacyclin (PGI2) Infusion on Red Blood Cell Deformability in Patients with Peripheral Vascular Disease: A Possible Role of the Leukocytes
Authors: Parise Pasquale , Berrettini Mauro , Grasselli Serenella , de Cunto Maria , Nenci Giuseppe Giorgio
Published: November 2007

The effect of prostacyclin (PGI2) on red blood cell deformability is still con troversial. The authors have evaluated some hemorrheologic parameters during PGI2 infusion to patients with severe obstructive peripheral arterial disease not suitable for surgery and not responsive to other medical treatments. PGI2 infu sion resulted in a positive clinical effect in 12 of 16 patients, who experienced a significant improvement of their rest pain lasting from two days to more than seven months. Hematocrit, platelet count, and fibrinogen were not modified during PGI2 infusion whereas leukocyte count rose significantly.

The evaluation of red blood cell filterability (VRBC) (volume of RBC filtered in one minute) by a whole blood filtration technique showed no significant changes during PGI 2 treatment. However, since whole blood filterability is nega tively correlated to leukocyte count, a specific regression line was elaborated to remove the potential negative influence of the increased leukocyte counts. VRBC values adjusted to a standard leukocyte number significantly increased during PGI2 treatment.
Profuse Diaphoresis as the Presenting Symptom of Myocardial Ischemia with Normal Appearance of Coronary Arteriogram — A Case Report
Authors: Schwartz J. , Leibovitz A. , Habot B.
Published: November 2007

The authors present a case of a patient suffering from profuse diaphoresis as the sole manifestation of myocardial ischemia (syndrome x or coronary vasospasm). The diagnosis was established by positive exercise thallium 201 im aging and normal-appearing coronary arteriogram.
Intralobar Sequestration of the Lung Presenting as a Continuous Murmur—A Case Report
Authors: Vaidiyanathan D. , Meenakshi K. , Elangovan S. , Jeyachandran J. , Chockalingam V. , Tajamul Hussain A.
Published: November 2007

An eighteen-year-old asymptomatic woman with a continuous murmur, nor mal two-dimensional echocardiogram, and mild haziness of the left lower seg ment of the lung on chest x-ray was diagnosed to have sequestration based on the presence of a large anomalous systemic artery arising from the descending thoracic aorta supplying the lower lobe of the left lung. Normal bronchial con nections with the rest of the lung on bronchoscopy and delayed dye clearance from the left lower lobe bronchioles on bronchogram indicated its intralobar nature. The cause of the continuous murmur was thought to be the large flow through the anomalous systemic artery.
Spontaneous Idiopathic Subclavian Arteriovenous Fistula: A Case Report
Authors: Rossi GianPaolo , Miotto Diego , Bongiovi Stefano , Grego Franco , Nicolosi Gian Luigi , Pessina Achille C.
Published: November 2007

Systemic arteriovenous (AV) fistulas are a rare but correctable cause of hyperkinetic circulation and congestive heart failure. They are generally due to catheterization procedures, surgery, trauma, or aneurysms. A case of truly spontaneous AV fistula between left subclavian artery and left innominate vein is described. This patient presented with symptoms that might clinically be mistaken for a carpal tunnel syndrome. The discovery of a continuous to-and-fro murmur on her left upper sternal border led to the correct diagnosis. Surgical ligature of the fistula provided complete relief of the woman's symptoms.
Iron Chelation in Acute Iron Poisoning and Chronic Hypersiderosis
Authors: Walsh John R. , Gillick James B.
Published: November 2007

From the Radioisotope Laboratory and Department of Medicine, Veterans Administration Hospital and University of Oregon Medical School
Childhood Diabetes
Authors: O'Brien Donough
Published: November 2007

There is still much ignorance and un certainty as to the relative merits of strict vs. free diets, oral vs. injectable drugs, the basic physiologic faults, the useful ness of the sugar tolerance and related tests, etc. Here is a straightforward ex position of the newer insights into patho genesis which are pertinent to the best care of the child with diabetes.
Children with Communication Problems
Authors: Wolff Ernst , Horwood Carla
Published: November 2007

This study of 105 children with devel opmental handicaps and assorted com munication problems by a long-established group of specialists brings out the great importance of the team approach for establishing meaningful diagnoses and sensible treatments.
Castro-Intestinal Obstruction by Eyelash Adhesive in a Wooley Monkey (Lagothrix cance)
Authors: Koch Seth A. , Fidler Isaiah J.
Published: November 2007

Two veterinarians warn us of a poten tial hazard to the health of small children. They present a case of intestinal obstruc tion in a monkey following the accidental ingestion of eyelash adhesive.
Toward a Philosophy of Child-Rearing
Authors: Kay Robert E.
Published: November 2007

This article describes an approach which I have found useful when lecturing aver age parents of average chil dren. Some of these ideas may be helpful when coun selling parents of children with serious problems also, though in those circum stances the giving of advice alone, without some analysis of underlying feelings, may be largely ineffective.
The Exchange Transfusion
Authors: Pochedly Carl
Published: November 2007

The aims of an exchange transfusion— removal of sensitized red cells, removal of excessive bilirubin and Rh antibodies, and the correction of anemia—have not changed over the years. Morbidity and mortality rates are low, due primarily to better training of pediatricians and to advances in instrumen tation and technic.

This article reviews basic principles and current technics in exchange transfusion.
Concomitant Rheumatic Fever and Acute Glomerulonephritis
Authors: Chandrasekhara M.K. , Cornfeld D.
Published: November 2007

Concomitant rheumatic fever and acute post-streptococcal glomerulonephritis sometimes do occur simultaneously, with clinical features not notably different from those seen in children who have either disorder separately.

Differential recognition presents a neat clinical challenge.
Psychologic Sequelae of Early, Infancy Health Crises
Authors: Carey William B.
Published: November 2007

Evidence is accumulating that health threats or actual illness during early infancy may produce psychologic problems in some children, the result of a complex interaction of the mother, the child and the situation. Similar experiences arising later in childhood seem to have a less disruptive effect. Instead of speaking of a "vulnerable child syndrome" we might do better with the terms "neonatal crisis syndrome" or even the "ominous infant phenomenon," since these broader descriptions allow for the inclusion and expansion of the concepts discussed in this thoughtful set of reflections. Improved attention to these matters is justifiable on the basis of humane considerations alone, and need not await further studies. This may well be a most important area of activity for the pediatrician who seeks to prevent emotional disorders in his patients.
Poverty and Health in the United States
Authors: Brown Roy E.
Published: November 2007

It is bad enough that a man should be ignorant for it cuts him off from the commerce of other men's minds. It is perhaps worse that a man should be poor for this condemns him to a life of stint and scheming in which there is no time for dreams and no respite from weariness. But what is surely the worst is that a man should be ill for this prevents his doing anything much about either his poverty or his ignorance. (Nash, R. M., Amer. J. Public Health 58: 167, 1968, from George Kimble, Tropical Africa.)
Systemic Blastomycosis in Childhood
Authors: Hughes Walter T. , Franco Sophia , Myung Hi Kim Oh
Published: November 2007

In a 21-month-old infant with systemic blastomycosis blood and bone marrow specimens were found reliable sources for culture, whereas sputum cultures were negative. A clinical cure followed hydroxystilbamidine therapy. Family members and neighbors tested for serum precipitins had no evidence of infection, past or present. The true prevalence of blastomycosis in the pediatric population of the United States is not known.
Clinical Review : Changing Patterns of Gastrointestinal Manifestations of Cystic Fibrosis
Authors: Grand Richard J.
Published: November 2007

As advances in management continue to improve the chances of survival, older patients have more expressions of disturbed function within the gastrointestinal tract. These in turn call for new forms of treatment, physiologically derived.
Neonatal Hemophilus vaginalis (Corynebacterium vaginalis) Infection
Authors: Platt Marvin S.
Published: November 2007

Two cases of neonatal Hemophilus vagi nalis (Corynebacterium vaginalis) infection are presented. In addition, eight recent neonatal-maternal cases have been sum marized. The data obtained from these cases strongly suggest that the organism is a matemal, fetal and neonatal pathogen. Measures which promote successful isola tion and identification are outlined.
Clinical Review : Glossoptotic Hypoxia and Micrognathia— The Pierre Robin Syndrome Reviewed
Authors: Farnsworth Peter B. , Pacik Peter T.
Published: November 2007

A report on a congenital condition which is life-threatening from the mo ment of birth onward and must be managed accordingly with intelligence.
Hexachlorophene in the Newborn Nursery
Authors: Bressler R. , Walson P.D. , Fulginitti V.A.
Published: November 2007

A critical review of the available data on the risks and benefits of hexa chlorophene suggests that there is ample evidence for the toxic potential; whereas there is no substantial evidence of its benefit in life-threatening staph 80/81 epidemics, and effective less toxic alternatives are available. In view of its limited usefulness and definite toxicity, the routine use of hexachlorophene is unjustified.
The Clinical Presentations of Rocky Mountain Spotted Fever
Authors: Linnemann Calvin C. , Janson Paul J.
Published: November 2007

Rocky Mountain spotted fever continues to increase in the United States and the case-fatality ratio remains unchanged despite the availability of effective antibiotics. The apparent reason for the continuing deaths from this disease is the failure of physicians to consider the diagnosis in patients presenting with febrile exanthems in the late spring and summer months. A clinical diagnosis should be based on the history of tick exposure and the presence of fever and the typical exanthem. Serologic tests are useful mainly in retrospect. This article reviews the clinical experience with Rocky Mountain spotted fever in an endemic area in recent years and discusses problems in the diagnosis and management.
Fetal Growth Rates in Argentina—A National Collaborative Study
Authors: Halac Jacobo , Arias Marcelo E. , Numa Rigel Y. , Halac Eduardo
Published: November 2007

A sample of 7,520 pregnancies, representative of the national population of Argentina was used to construct intrauterine Growth Charts. These are applicable nationwide and since 1974, when first designed, have proved efficient and more reliable in evaluating Argentine neonates than the Colorado Growth Charts. We have now evaluated their usefulness and have shown that despite certain changes, the Charts remain accurate and valuable as they were when first elaborated. Argentine infants do not grow at the same rate as those in other countries and, as expected, social and geographic variations can influence fetal growth. This effort should encourage the undertaking of similar ones in other Latin American countries, as they represent unique populations in need of knowledge of their own growth patterns.
Gastrointestinal Symptoms in Rocky Mountain Spotted Fever
Authors: Jiminez Jorge , Byrne William J. , Seibert Joanna J. , Euler Arthur R.
Published: November 2007

Gastrointestinal symptoms are often present in patients with Rocky Mountain Spotted Fever (RMSF), particularly early in the course of the illness. However, pathologic changes in the gastrointestinal tract have not been reported in a child who has survived. We document vasculitis in the terminal ileum of a child with RMSF who also had radiographic findings consistent with involvement of the entire small bowel. An appreciation for the gastrointestinal manifestations should facilitate a rational approach to their management and prevent a delay in diagnosis.
Intrauterinely Acquired Pseudomonas Infection in the Neonate
Authors: Ruvalo Cecila , Bauer Charles R.
Published: November 2007

The case is presented of a premature infant with Pseudomonas aeruginosa infection, apparently acquired in utero. After a complicated postnatal course, the child was noted to have a profound hearing loss. The infection itself, was rapid and progressive, with the infant showing signs and symptoms characteristic of Pseudomonas infection, such as necrotizing skin vasculitis and "green" purulent discharge. Pseudomonas infection poses a virulent and life-threatening chal lenge to the immunologically immature infant. Infection with this organism, uncommon in the neonate, results in significant morbidity and mortality.
Role of Hepatobiliary Scintigraphy in Diagnosis of Caroli's Disease
Authors: Inciardi Marc , Leonard Joe C.
Published: November 2007

Caroli's disease is a relatively uncommon form of hepatic cystic disease which, in the past, was best diagnosed conclusively by surgical exploration. The present case is reported to illustrate the utility of technetium-labeled hepatobiliary agents in establishing the diagnosis.
Age-specific Presentation of Campylobacter Enteritis in Children
Authors: Naqvi Shehla H. , Dunkle Lisa M. , Clapper Monica A.
Published: November 2007

The presentation of Campylobacter enteritis varies with the age of the patient. Abdominal distention is common in infants less than 3 months of age. Fever remains uncommon up to 6 months of age, whereas abdominal pain and fever are common in children more than 1 year of age.
Clostridium difficile Toxin Associated with Chronic Diarrhea and Failure to Gain Weight
Authors: Liston Thomas E.
Published: November 2007

Two young children are described in whom chronic diarrhea associated with the presence of Clostridium difficile toxin responded to treatment with oral van comycin. C. difficile infection should be considered in the evaluation of young children with diarrhea who fail to gain weight, even in the absence of prior antibiotic treatment.
Pseudomonas Whirlpool Dermatitis
Authors: Feder Henry M. , Grant-Kels Jane M. , Tilton Richard C.
Published: November 2007

Pseudomonas aeruginosa skin infections developed in four children and their parents after use of a recreational whirlpool. These patients were carefully followed throughout the course of their illnesses. The incubation period was two to five days. The skin lesions included erythematous macules and papules, pustules, and nodules. The severity of the illness varied from a few scattered pustules in one patient to an extensive truncal rash, malaise, and fever in another patient. P. aeruginosa was recovered from skin lesions and the whirlpool water. Gram stains from two patients revealed polymorphonuclear leukocytes and gram-negative rods. In all patients, the rash improved within seven days and local application of povidone-iodine did not appear beneficial.
Isolated Menarche in Juvenile Hypothyroidism
Authors: Piziak Veronica K. , Hahn Henry B.
Published: November 2007

Isolated menarche is an unusual presentation of the advanced sexual development relative to bone age found in some patients with juvenile hypothyroidism. A case is presented, demonstrating that hypothyroidism should be considered in the eval uation of vaginal bleeding in childhood, particularly if skeletal maturation is delayed.
The "Empty Sella" in Childhood
Authors: Colm Costigan D. , Daneman Denis , Harwood-Nash Derek , Holland F. Jack
Published: November 2007

The "empty sella" (ES), a common entity in adults, is so named because a cerebrospinal fluid- filled arachnoid hernia fills the pituitary fossa and compresses the pituitary gland, creating the illusion of an "empty" sella. We report our experience of ES in childhood. Our four cases represent associations with ES that have not been previously described in childhood: case 1 was associated with central precocious pulserty; case 2 with secondary ES resulting from shrinkage of a prolactinoma during bromocriptine therapy; case 3 with pseudotumor cerebri; and case 4 with no significant pathology. Together, they account for approximately 1 percent of cases of radiographically enlarged sella tursica investigated here. This brings the number of cases of ES reported in children to 27. Review of these 27 cases reveals seven with local skull dysplasia and/or a familial inheritance. The remainder lacked clinical homogeneity or similarity to the common adult variety of ES. Children with ES did not exhibit the higher female preponderance reported in adults with ES. They showed a higher frequency of secondary cases (4/27), and of associated endocrine (10/15) and visual (8/17) abnormalities than is seen in adults with the "empty sella."
The Pediatric Population of Two Free-standing Emergency Clinics
Authors: Yunker Rose , Levine Martha , Sajid Abdul
Published: November 2007

We studied the pediatric patient population of two free-standing emergency clinics (FECs) through an audit of medical records for 20 days randomly selected throughout 1983. We recorded the age, sex, number of visits, patient diagnoses, laboratory work, and charges. This information was compared with earlier national studies of physician practice. Of the 1062 visits audited, 27.6 percent were by patients 21 years of age or younger. This number is comparable to the percentage of office visits made to a national sample of general and family practitioners but well below the same figure for pediatricians. The pattern of FEC visits by this age group emerged as quite different from the pattern of visits to a national sample of office-based physicians by the same age group. The most frequent diagnoses for pediatric patients visiting FECs were upper respiratory infection (31.9%) and trauma related problems (28.5%). The number of laboratory diagnostic procedures ordered in FECs was lower than similar statistics for a national sample of pediatricians. Mean charges for visits in the FECs studied were $40.23.
Sporadic Pharyngitis-associated Acute Poststreptococcal Nephritis
Authors: Khuffash Faisal A. , Sharda D.C. , Majeed Hassan A.
Published: November 2007

Between December 1980 and November 1984, the acute episode was studied prospectively in 187 children under 14 years presenting with acute poststreptococcal glomerulonephritis. The mean annual incidence was 19.5/105 children. The disease was mainly pharyngitis-associated and occurred throughout the year but peaked in the winter. The mean age was 5.4 years, and 71 percent of children were under the age of 8 years. Gross hematuria was the presenting feature in 93.6% of cases and was usually associated with edema. Hypertension was present in 45 percent, circulatory congestion in 27 percent, and heavy proteinuria in 22 percent of cases. The C3 level was low in 97 percent of the patients tested and returned to normal within 6-8 weeks. There were no deaths. Only one patient needed peritoneal dialysis. All except one patient were asymptomatic with normal creatinine within 8 weeks. The authors adopted a very optimistic attitude in the counseling of children with the disease and of their families.
Value of Rapid Diagnosis of Respiratory Syncytial Virus Infection on Management of Small Infants
Authors: Friedman Allan D. , Naqvi Shehla H. , Arens Max Q. , Eyler Margaret A.
Published: November 2007

Respiratory syncytial virus (RSV) is a common cause of infection in infancy and early childhood. A presumptive diagnosis of RSV infection can frequently be made on clinical grounds. Confirmation can be made by viral culture, which may take 3 to 7 days. Immunofluorescent assay (IFA) is a specific and sensitive test that can provide laboratory confirmation of RSV infection the same day. Rapid diagnosis of RSV infection may have implications regarding prevention of nosocomial spread of RSV, early initiation of anti-viral therapy, use of antibiotics, and duration of hospital stay. Data are presented regarding the use of RSV-IFA and its effect on patient management.
Anaerobic Pulmonary Abscesses
Authors: Shanks G. Dennis , Berman Jonathan D.
Published: November 2007

Multiple anaerobic pulmonary abscesses in previously healthy children are rare. Two cases are presented in which the discovery and adequate drainage of infectious foci in the head and neck were key to controlling the infection.
Sporadic Congenital Caffey's Disease
Authors: Marshall Gary S. , Edwards Kathryn M. , Wadlington William B.
Published: November 2007

Caffey's disease is an inflammatory skeletal disorder of infancy manifested clinically by fever, soft-tissue swelling, and constitutional signs with radiographic evidence of periosteal new bone formation. Although prevalent between 1940 and 1960, nonfamilial cases have become extraordinarily rare. The authors report the sporadic occurrence of congenital Caffey's disease in a premature infant and note an interesting association with maternal herpes zoster early during gestation. The etiology of this mysterious disease is likely to remain elusive as new cases become scarce.
Evaluation of Erythrocyte Disorders With Mean Corpuscular Volume (MCV) and Red Cell Distribution Width (RDW)
Authors: Monzon Carlos M. , Beaver B. Daniel , Dillon Timothy D.
Published: November 2007

The red cell distribution width (RDW), which provides a quantitative measure of heterogeneity of red cells in the peripheral blood, and the mean corpuscular volume (MCV) are part of the routine red cell indices reported by automated blood analyses. This study evaluated 193 pediatric patients with a wide range of erythrocyte disorders and determined the diagnostic utility of the RDW in relation to the MCV. Six different groups of erythrocyte disorders by MCV and RDW values are described: low MCV/normal RDW, low MCV/high RDW, normal MCV/normal RDW, normal MCV/high RDW, high MCV/normal RDW, high MCV/high RDW. This combination established a useful differential diagnosis of erythrocyte disorders. The data provided a baseline against which future studies of infants and children can be compared, though each laboratory has to verify its own normals. It should be cautioned that different electronic counters yield different RDW values, so there have to be qualifications when reporting reference values. The RDW may find its best use as a guide in the differential diagnosis of anemia, rather than as a definitive test per se.
Vulvar Hemangioma Simulating Child Abuse
Authors: Levin Alex V. , Selbst Steven M.
Published: November 2007

An infant with a vulvar hemangioma that had undergone extensive ulcerative changes was initially diagnosed as having a perineal burn secondary to child abuse. Although genital burns are a well-recognized manifestation of child abuse, knowledge of the natural course of untreated hemangiomas and the uncommon complication of ulceration as well as familiarity with the characteristic patterns of abusive burn injuries may allow the physician to avoid making this misdiagnosis. The confusion in diagnosis led to an extensive social service investigation that, in this case, had a positive outcome for the mother's ability to cope. There exists, however, the possibility of iatrogenic-induced emotional stress if child abuse is misdiagnosed.
Lyme Disease Presenting as Heart Block
Authors: Gregg Kishaba R. , Weinhouse Elliott , Chusid Michael J. , Nudel Dov B.
Published: November 2007

Lyme disease is now recognized as an infectious process capable of involving multiple organs including the cardiovascular system. We recently treated a boy whose complaints on admission related only to symptomatic heart block that was severe enough to require transvenous pacing. This boy was subsequently determined to have had Lyme Disease after his medical testing was reevaluated for possible tick exposure. In rare instances symptomatic heart block may be the sole presenting complaint of Lyme Disease in children.
Renal Toxicity
Authors: Lindsley Carol B. , Warady Bradley A.
Published: November 2007

Nonsteroidal antiinflammatory drugs (NSAIDs) are an important part of therapy for childhood rheumatic disease and for the symptomatic management of clinical problems such as fever, musculoskeletal pain, and dysmenorrhea. Overall, there is a low incidence of significant complications resulting from NSAID therapy in children, but serious adverse effects on renal function have occurred. The physician should be aware of the potential renal toxicity of these drugs and monitor patients accordingly.
Transient Lymphoblastosis and Thrombocytopenia in Gianotti-Crosti Syndrome
Authors: Weinerman Harry C. , Weisman Steven J. , Cates K. Lynn
Published: November 2007

Gianotti-Crosti Syndrome, or papular acrodermatitis of childhood, represents a characteristic rash that is irregularly associated with hepatitis B infection. The authors report papular acrodermatitis in a 10-month-old child with leukopenia, thrombocytopenia, circulating lymphoblasts, and acute anicteric hepatitis B. Physical examination revealed a densely distributed papular rash on the patient's extremities and face and neck, but not on his trunk, buttocks, palms, or soles. Laboratory investigation revealed a normal bone marrow and positive hepatitis B serology. This case reinforces the fact that hematologic findings should not dissuade the work-up of papular acrodermatitis for hepatitis B or other less commonly associated viruses.
Factor VIII Related Antigen (von Willebrand's Factor) In Kawasaki Disease
Authors: Irazuzta Jose E. , Elbl Francisco , Rees Allan R.
Published: November 2007

Kawasaki disease is a systemic vasculitis in which secondary development of coronary artery aneurysms can occur. Because Factor VIII related antigen has been found increased in other vasculiditides, VIII R:Ag was measured serially in patients with Kawasaki disease.

Factor VIII related antigen was prospectively evaluated in the acute phase of ten patients with Kawasaki disease, all of whom showed increased values at this stage (p > 0001). In six children a second sample was drawn at the convalescent phase, and all were normal. Of the original ten patients, two developed coronary artery aneurysms. Acute Factor VIII related antigen levels were not higher nor did Factor VIII related antigen fail to return to baseline in these two patients.

Based on our findings, Factor VIII related antigen is elevated in the acute phase of Kawasaki disease and returns to normal levels in the convalescent phase.
Antenatal Fetal Diagnosis and Maternal Transport Gastroschisis
Authors: Carlan Stephen J. , Knuppel Robert A. , Perez J. , Flasher Jackie
Published: November 2007

Gastroschisis is a rare congenital birth defect of the abdominal wall that invariably is fatal if not managed appropriately. Early in utero diagnosis is now possible using maternal serum alpha-fetoprotein and ultrasound. As with other serious congenital disorders, antenatal diagnosis allows therapeutic options and time for preparation. Even if the diagnosis is made late, however, efforts to achieve prenatal maternal transport are still reasonable. The neonatal outcome of an unplanned delivery of an anomalous child requiring immediate attention is likely to be better if the delivery occurs in a tertiary center. These facilities generally have specialized services and teams available for critical care around the clock.

The authors describe the maternal transport and delivery of a neonate with a serious disorder that required specialized attention at an hour when most hospitals are staffed with a skeleton crew. The necessary resources were available immediately, and the neonatal outcome was favorable. Although this report describes gastroschisis specifically, the concept of tertiary site delivery for potentially seriously ill neonates applies to any condition. With a late diagnosis, possible other anomalies, and a logistically unfavorable hour, the advantages of maternal transport are evident. This report also briefly reviews the area of antenatal ultrasound diagnosis and the newer mechanisms used to develop a perinatal care plan.
Wiskott-Aldrich Syndrome
Authors: Dubiel Andrzej , Szczerbinski Tomasz , Kurtyka Zuzanna , Kowalczyk Danuta
Published: November 2007

This paper presents a report on a child with Wiskott-Aldrich syndrome. The clinical picture and laboratory findings are characteristic of this disease. The prevailing symptoms have included recurrent respiratory and alimentary tract infections, seborrhic dermatitis-type skin lesions, and thrombocytopenia. Humoral and cellular immunological disturbances have been noted, and the pedigree pattern is very characteristic.
Effect of a Program to Facilitate Parent-Child Communication About Sex
Authors: Huston Rebecca L. , Martin Linda J. , Foulds D. Michael
Published: November 2007

U.S. teens have high rates of premarital sexual activity resulting in alarming rates of teenage pregnancy and sexually transmitted disease. One possible way to combat the problem of teenage sexual activity is to promote sexuality education within the family. The purpose of this study was to increase parent-child communication about sex through an educational program for parents. The effect of the educational program was evaluated by a nonrandomized, controlled trial. Volunteer parents were recruited from three middle schools (grade six through eight) located in middle to upper-middle socioeconomic class neighborhoods. The parents participated in four 2-hour sessions which included factual information about sexuality and exercises to improve communication skills. The experimental group (N=47) were requested to fill out questionnaires immediately before and one month after the program. The control group (N=17) were requested to fill out questionnaires one month before and again immediately before the program. Parents were asked to report the number of times they talked with their adolescents about 11 sex-related topics. The difference in reported frequency of communication before and after the program was compared using a two-tailed, matched pairs t-test. Twenty-four (51%) experimental group parents and eight (47%) control group parents completed both questionnaires. There was a significant increase in communication reported by the experimental group. The mean difference of the number of topics discussed was 10.9 (SD 7.3) for participants versus -2.5 (SD 5.9) for controls (p=.00053). This study shows that parent-child communication about sex can be facilitated by an educational program for parents.
Children of Battered Women: Developmental and Learning Profiles
Authors: Wildin Susan R. , Williamson W. Daniel , Wilson Geraldine S.
Published: November 2007

Children in battered women's shelters have been shown to have more behavior problems than their peers but limited information is available about their development. A pilot survey was undertaken to determine the prevalence of developmental or academic problems in children of residents of a battered women's shelter. Demographic data, medical and school histories and responses to standardized developmental or behavioral surveys were obtained from 39 mothers of 76 children. Two-thirds of the children were victims of abuse. On the Minnesota Child Development Inventory, the mean General Developmental Quotient (DQ) of 28 preschool children was 98; however, 39% had developmental delays by test criteria. Of 46 school-aged children, 21 (46%) had evidence of academic problems, including grade repetition, failing grades and need for special educational services. On the Louisville Behavior Checklist, 75% of 48 children had behavior problems. Children in a battered women's shelter are likely to experience academic and behavioral problems; however, further study is needed to elucidate etiological factors.
Parents' Worries About Children Compared to Actual Risks
Authors: Stickler Gunnar B. , Salter Margery , Broughton Daniel D. , Alario Anthony
Published: November 2007

To investigate the concerns of parents, questionnaires were given to the "first 100" parents waiting for their child's pediatric appointment in four different medical settings. They were asked to rate whether they worry "frequently," "occasionally," or "not at all" about 17 physical health issues, 16 psychosocial problems, 7 possible injuries, 4 instances of victimization, and 4 questions about parents' ability to provide discipline, affection, values and financial support. The response rate was 94% ; 89% were completed adequately for analysis. Parental concerns were compared to data from the National Center for Health Statistics about the statistical likelihood of the risks occurring. Ear infections (65%) were the most common health concern, followed by reaction to immunization (57%), common colds (51%), and cancer (50%). The greatest psychosocial concern was about children watching too much television (53%), followed by concerns about the quality of day care (50%). Three-quarters of parents worry about car accidents and 72% worry about abduction of their children. Parents worry significantly about their own contribution to their child's welfare: appropriate discipline (73%), affection (56%), values and being a role model (55%), and financial support (66%). Parents who had not completed high school worried more than parents who had more than a high school education (P < 0.03).
Pediatric Preventive Cardiology
Authors: Jennings Rufus B. , Leon Sandra Porter
Published: November 2007

The Division of Pediatric Cardiology began a preventive cardiology program in response to the American Academy of Pediatrics (AAP) Nutrition Committee recommendations on pediatric cholesterol screening. This program has consisted of both public and physician educational programs as well as the treatment of individual hyperlipidemic children. A survey of 67 local pediatricians has revealed that they have not followed the AAP directive for a "family history" approach to pediatric cholesterol screening, with most pediatricians screening all their patients for cholesterol abnormalities. Our dietary treatment program for hyperlipidemic children has given good short-term results, lowering mean total cholesterol concentrations by 10% (23 mg/dl) and mean low density lipoprotein cholesterol (LDL) concentrations by 9.3% (16 mg/dl), as well as decreasing the total cholesterol/high density lipoprotein cholesterol (HDL) ratio by 10% (0.6). The additional use of cholestyramine in nine selected patients has effected even greater mean value decreases of 45 mg/dl or 16% (total cholesterol), 44 mg/dl or 19% (LDL), and 1.3 or 19% (total cholesterol/HDL ratio). All these changes are statistically significant (p <0.05). These encouraging short-term results hopefully will promote the long-term goal of decreasing the incidence of coronary artery disease, which remains the leading cause of death in our country
Fiberoptic vs Conventional Home Phototherapy for Neonatal Hyperbilirubinemia
Authors: Schuman Andrew J. , Karush Gerald
Published: November 2007

Two methods of administering home phototherapy were compared. Twenty-two infants received home phototherapy with a fiberoptic cummerbund, and 26 infants received home phototherapy with a conventional four-bulb "bililight." The two treatment modalities proved equally effective in lowering bilirubin levels. The duration of treatment was a mean of 3.09 days in the fiberoptic group and 2.77 days in the bililight group, and the daily decline in bilirubin levels was a mean of 1.84 mg/dL/day in the fiberoptic group and 2.18 mg/dL/day in the bililight group. Differences were not statistically significant (Student's t-test, two-tailed). Upon completion of therapy, mothers responded to 15 statements intended to measure attitudes and perceptions regarding home phototherapy. In four of the 15 statements there was a statistically significant preference for fiberoptic therapy, as measured with the chi-square statistic (p <.05), while in the remaining statements there were no preferences expressed toward either treatment modality. Fiberoptic home phototherapy appears to be as effective as home phototherapy administered with conventional bililights and may be better accepted by parents.
Comparison of Self-Referred And Physician-Referred Patients To a Pediatric Diagnostic Center
Authors: Beebe Susan A. , Casey Rosemary , Magnusson Mark R. , Pasquariello Patrick S.
Published: November 2007

Self-referral of children by parents without the knowledge of the child's regular physician can lead to redundant or unnecessary testing and difficulty in arranging follow-up care. This study was designed to investigate reasons for self-referral in a hospital-based pediatric diagnostic center. During the study period, 59 patients were referred by their regular physicians and 51 were self-referred. In multiple-choice questionnaires completed by 85% of the parents, nearly half (18/39; 46%) of those who were self-referred but only 2/51 (4%) of physician-referred parents said the child's regular physician was unconcerned about the medical problem. Further study on the causes for this perception is needed before recommendations can be made to physicians about demonstrating their concern to families.
Atypical Extrapulmonary Presentations Of Severe Respiratory Syncytial Virus Infection Requiring Intensive Care
Authors: Njoku Dolores B. , Kliegman Robert M.
Published: November 2007

The patterns and nature of a four-month epidemic of severe respiratory syncytial virus (RSV)-associated disease were analyzed using presenting, demographic, clinical, and therapeutic data. Of 218 infants with RSV infection admitted to Rainbow Babies and Childrens Hospital, 49 (22.4%), most born prematurely, entered the pediatric intensive care unit (PICU). Fluorescent antibody and/or enzyme-linked immunosorbent assay documented RSV infection. PICU patients underwent airway stabilization; 53.5% were intubated and evaluated for sepsis. Patients with positive bacterial cultures received antibiotics; 18% were given ribavirin. Patterns of infection included hypothermia, septic shock appearance, apnea, pneumonia, and wheezing due to bronchiolitis. The average age difference between patients with hypothermia (23.3 days) and those with pneumonia (11.2 months) was statistically significant. There were no significant differences in average age, gestational age at birth, number intubated, worst pH and PCO2, duration of intensive care, or treatment modalities between infants with bronchopulmonary dysplasia who received ribavirin and those who did not.
Effect of Cotton-Tipped Swab Use on Earwax Occlusion
Authors: Macknin Michael L. , Talo Haitham , VanderBrug Medendorp Sharon
Published: November 2007

We studied parents' and patients' approach to earwax (cerumen) removal, patients' level of cerumen occlusion, and the association between the use of cotton-tipped swabs (CTS) and cerumen occlusion. Six hundred fifty-one consecutive patients from the general pediatric practice of the Cleveland Clinic aged 2 weeks to 20 years (57% males) answered a questionnaire with their parents' help. Of the 651, 401 (62%) had used CTS during the 2 months before the study. Examiners unaware of the questionnaire results found that 46 (7%) of both right and left ear canals were at least 75% occluded by cerumen. Cerumen occlusion of at least 75% was associated with CTS use on the left side ( P= .02), but not on the right side ( P= .27). We conclude that cotton-tipped swab use may be associated with cerumen accumulation.
The Clinical Characteristics and Infectious Outcomes of Febrile Infants Aged 8 to 12 Weeks
Authors: Bonadio William A. , Smith Douglas S. , Sabnis Svapna
Published: November 2007

We reviewed 356 consecutive cases of febrile infants aged 8 to 12 weeks who received outpatient evaluation for sepsis over 4 years. Thirty-three infants (9.3%) had a serious bacterial infection (SBI), including bacterial meningitis, bacteremia, urinary tract infection (UTI), and Salmonella enteritis. The SBI rate, which was directly proportional to fever height, was significantly greater for infants with hyperpyrexia (35%) than those with lesser degrees of fever (7.7%) and for infants with peripheral blood leukocytosis (total WBC count ≥ 15,000/mm3; 25%) than those with lesser total WBC counts (5.8%). An attending-level physician judged that 67% of infants with SBI appeared to be "well," including five of eight cases (63%) of bacteremia, 14 of 17 cases (82%) of UTI, and all three cases of Salmonella enteritis, whereas all five patients with bacterial meningitis appeared to be "ill." Urinalysis abnormalities indicative of UTI were present in 15 of 17 infants (88%) who had this infection. SBIs are not uncommon in febrile infants aged 8 to 12 weeks and occur significantly more often in those with either hyperpyrexia or peripheral blood leukocytosis.
Embolization of a Percutaneous Central Venous Catheter
Authors: Watkin S.L. , Stephenson T.J.
Published: November 2007

Percutaneous central venous catheters are widely used in both pediatric and neonatal practice. Complications previously reported with these lines include sepsis, occlusion, limb swelling, catheter retention, and rupture on attempted removal. 1-4 We describe a case in which the catheter ruptured during routine use, with embolization of the distal part into the child's central venous system.
Patient-Specific Reminder Letters and Pediatric Well-Child-Care Show Rates
Authors: Campbell James R. , Szilagyi Peter G. , Rodewald Lance E. , Doane Cynthia , Roghmann Klaus J.
Published: November 2007

The objective of this study was to determine whether patient-specific letters, which describe the content of an upcoming well-child appointment, improve the show rate of well-child appointments better than postcard reminders. In this prospective clinical trial conducted at a pediatric continuity clinic in a teaching hospital, 288 newborns were randomized to a letter, postcard, or control group. For every well-child appointment, families were sent either a letter pertaining to the particular well-child appointment or a postcard; the control group received no reminders. There were no differences in demographics among the groups. The show rates between the letter and postcard groups were not different, but were significantly higher than the show rate for the control group (75.0%, 73.7%, and 67.5%, respectively; P <.05) . A cost comparison between the use of postcards versus not using postcards revealed a benefit in the former. We concluded postcard reminders are effective in improving show rates for well-child-care visits, and that patient-specific letters have no additional benefit above that of postcard reminders.
Effective Utilization of Home-Video Recordings for the Evaluation of Paroxysmal Events in Pediatrics
Authors: Sheth Raj D. , Bodensteiner John B.
Published: November 2007

In young children, differentiating seizures from nonepileptic "spells" by history alone can be difficult, even for the specialist. Nonepileptic spells may be psychogenic (rare in the young child) or physiologic in origin. Physiologic spells misidentifed as epileptic may be treated with antiepileptic medication where none is needed. Recording spells on video provides a potentially valuable supplement to the clinical history in arriving at a correct diagnosis. In practice, however, most home-video recordings prove difficult to interpret. Simple instructions to parents on the manner in which spells should be recorded will greatly increase the usefulness of home-video recordings. A systematic analysis of precipitating factors and the evolution and resolution of the spell will very often exclude seizures. The widespread availability of home-video recordings provides the pediatrician with an opportunity to visually examine a child's spells, often avoiding unnecessary investigations and referrals and allowing the physician to more confidently offer reassurance to the parents.
Intraperitoneal Bladder Rupture: An Uncommon Manifestation of Child Abuse
Authors: Sirotnak Andrew P.
Published: November 2007

Abdominal injuries in the battered child are well described, and more than 10 % of blunt abdominal traumas in young children may be child-abuse related.1 Duodenal hematoma, liver laceration, superior mesenteric artery tear, and pancreatic damage are common nonaccidental injuries. Physical evidence of injury and clinical presentation are often inconsistent with the history. Child abuse is not often considered in the differential diagnosis of the acute abdomen. Because trauma to the kidneys or urinary system is an uncommon manifestation of child abuse, these injuries are more likely to go unrecognized. In this report, we review an unusual case of missed child abuse involving this system.
Bone Mineral Content in Nephrotic Children on Long-Term, Alternate-Day Prednisone Therapy
Authors: Polito Cesare , La Manna Angela , Todisco Nicola , Cimmaruta Ersilia , Sessa Giuseppa , Pirozzi Maria
Published: November 2007

Bone mineral content (BMC) was measured by single-photon absorptiometry in 24 children with steroid-dependent, minimal-lesion nephrotic syndrome after 1 to 6.3 years of alternate-day prednisone therapy and in a sex- and age-matched control group. Bone mineral content was -0.002 ± 1.2 standard deviation scores in patients and 0.3 ± 1.4 in controls ( t = 1.17; P = 0.25). No significant relation was found between BMC in patients and the amount of prednisone taken or the duration of therapy. Alternate-day prednisone therapy at doses usually needed to keep children with steroid-dependent nephrotic syndrome under control does not significantly affect BMC.
Insulin Secretion and Sensitivity in Healthy African-American vs American White Children
Authors: Arslanian Silva
Published: November 2007

Racial differences in insulin secretion and insulin sensitivity in healthy children were studied by administering a 2-hour hyperglycemic clamp (225 mg/dL) to 14 black and 16 white healthy adolescents (Tanner II-V), and 12 black and 11 white prepubertal children, matched for age, body mass index, and Tanner I pubertal development. In prepubertal children, fasting and first-phase insulin concentrations were higher in blacks compared with whites (14.7 ±1.3 vs 10.4 ±1.2, P=0.02, and 76.9 ±6.8 vs 52.1 ±6.4 μu/mL, P=0.016). There were no differences in second- phase insulin levels and insulin sensitivity index. In pubertal adolescents, first-phase and second- phase insulin concentrations were higher in blacks compared with whites (first-phase: 157.3 ±18.3 vs 77.0 ±8.7 μu/mL, P=0.0003; second-phase: 175.0 ±24.3 vs 108.7 ±8.8 μu/mL, P=0.012). Insulin sensitivity index was 35% lower in black adolescents compared with whites (P=0.02). These findings indicate that significant differences in insulin secretion and sensitivity are detectable early in childhood in healthy African-American vs American whites. However, genetic (race) vs environ mental factors (physical activity/fitness, energy balance) should be carefully scrutinized as potential factors responsible for such differences. Clin Pediatr. 1998;37:81-88
Discourse analysis of language intervention
Authors: Panagos John M. , Bobkoff Karyn , Scott Cheryl M.
Published: November 2007

Qualitative studies have produced new but fragmentary observations of the discourse of clinical lessons. This paper surveys these findings and integrates them around the principles of conversational discourse and discourse analysis. The picture which emerges is that training lessons are patterned within and across levels of conversational discourse. Social, verbal, and nonverbal components of clinician—child interaction are organized hierarchically for the purposes of eliciting correct linguistic responses. Clinical discourse research is discussed with reference to questions of clinical validity and practicality. Five learning hypotheses are also suggested.