bluuebunny/crossref_metadata_2025 huggingface dataset:
A Five-Year Chart Review of Children Biopsied to Rule Out Hirschsprung's Disease
Authors: Landman Gary B.
Published: November 2007

A 5-year chart review of all children biopsied to rule out Hirschsprung's disease was conducted at Johns Hopkins Hospital. A total of 150 (90%) charts of the 160 children who were biopsied were obtained and reviewed. Twenty-four children (16%) had aganglionosis by surgical pathology report. All had the onset of symptoms in the neonatal period. Ninety-seven percent of children without Hirschsprung's disease and who were biopsied after the neonatal period did not have symptoms during the first 4 weeks of life. Despite having severe symptoms from birth, nine (37.5%) of the children with Hirschsprung's disease were not biopsied until an average age of 15 months.

Data indicate that using the presence of bowel symptoms from the neonatal period as criteria for referral for biopsy would have missed none of the children with Hirschsprung's disease. Children with symptoms dating from the neonatal period should be considered for biopsy to avoid potential morbidity and mortality from the complication of enterocolitis.
Transient Primary Hypothyroidism in Prematures
Authors: Kulaylat N.A. , Najjar S.S.
Published: November 2007

Twelve sick neonates, ten of whom were prematures, were found to have transient primary hypothyroidism. Two months after cessation of treatment all those followed were found to be clinically and biochemically euthyroid. The possible etiologic factors in the pathogenesis of transient hypothyroidism of the sick prematures are discussed. Iodine deficiency is probably an important precipitating cause.
Symptomatic Hypothyroxinemia with Normal TSH Levels in Preterm Infants
Authors: Mercado Miguelito , Szymonowicz Wanda , Yu Victor Y. H. , Gold Hugo
Published: November 2007

The authors report eight preterm infants with hypothyroxinemia who developed clinical features similar to those described in congenital hypothyroidism: prolonged jaundice, hypoactivity, lethargy, constipation, edema, and hoarse cry. All had low serum thyroxine, normal thyroid stimulating hormone, and normal thyroid binding globulin levels. After exclusion of other causes for the symptoms, thyroid replacement therapy was started, resulting in rapid resolution of symptoms and return to euthyroid status. Follow-up of these infants after cessation of therapy revealed normal growth and development and normal thyroid function. The authors therefore recommend a prospective study to investigate the incidence of hypothyroxinemia, frequency of associated clinical features, and the benefits of thyroid replacement therapy based on a randomized controlled trial.
Proposed Guidelines for Screening of Metabolic and Endocrine Diseases of Dependent Neonates of the U.S. Armed Forces
Authors: Tiwary Chandra M.
Published: November 2007

State regulations for neonatal screening for metabolic diseases do not optimally serve the needs of the dependents of the U.S. Armed Forces. Guidelines are therefore proposed for the neonatal screening for metabolic disease based both on responses received across the United States and on the unique needs of the U.S. Armed Forces. The guidelines agree with the policies outlined by various national medical and scientific organizations. It is suggested that neonates be screened for phenylketonuria (PKU), hypothyroidism, galactosemia, and maple syrup urine disease (MSUD). The screening program is cost-effective and feasible. Prior to implementing the program throughout the U.S. military, a pilot program based at the Armed Forces Institute of Pathology should be started.
Infant Temperament, Childhood Accidents, and Hospitalization
Authors: Nyman Göte
Published: November 2007

The role of infant temperament in predicting the incidence of hospitalization and accidents of children under the age of 5 was studied in a prospective follow-up study. Temperament type and profile was originally measured for 1,855 infants (6 to 8 months of age). We obtained data for 270 who had later been hospitalized because of accidents or illnesses. Of these, the temperament of 35 who had suffered a contusion, poisoning, burns, or other accidents were more closely analyzed. The results show that a disproportionate number of all hospitalized children had earlier been characterized as "difficult" in their temperament. This was typical, however, for both the accident group and other hospitalized children. The hospitalized children had a significantly more negative mood and higher intensity of responses to normal everyday life situations. The accident group differed from other hospitalized children in being mainly more persistent but also showed a tendency to higher activity level and negative reactions to new situations. The results do not support a straightforward hypothesis of an early accident prone temperament but point out the significance of temperament in the processes of hospitalization and accidents.
Rapidly Filling Pleural Effusion Due To a Subarachnoid-Pleural Fistula
Authors: Singhi Pratibha , Nayak Uma S. , Ghai Sunita , Kumar Lata , Reddy K.S. , Suri R.K.
Published: November 2007

Only five cases of subarachnoid-pleural fistula in children have been reported previously. All had a history of trauma and associated neurologic deficit which gave clue to the diagnosis. The authors present a child who presented with a massive, rapidly filling, clear pleural effusion in whom there was no neurologic deficit. The history of an automobile accident in the past had almost been forgotten. A subarachnoid-pleural fistula was discovered on exploratory thoracotomy. The entity should be thought of, and actively investigated, in a child with a history of trauma and a pleural effusion of obscure etiology, even if there is no associated neurologic deficit.
Tension Pneumothorax Complicating Pulmonary Hydatid Disease in Childhood
Authors: Stewart M.P.M. , Cunningham M.S.
Published: November 2007

The case of a 3-year-old girl with bilateral pulmonary hydatid disease presenting as a tension pneumothorax is described. This is a rare but serious complication of hydatid disease in the pediatric age group which may arise as a result of rapid growth of the cyst in the lung and low resistance to its expansion. Prompt relief of the pneumothorax with intercostal drainage is advocated, followed by early surgical removal of any suspected cyst to avoid further complication.
Urinary Tract Infection in Sexually Abused Children
Authors: Reinhart Michael A.
Published: November 2007

Because urinary tract infections have been considered to be related to sexual abuse and proposed as an indicator of sexual abuse, a group of children reported as suspected victims of sexual abuse was studied. Clean-catch urine specimens were obtained at the time of their initial medical evaluations for sexual abuse. Results indicated that urinary tract infections were not present in this group of sexually abused children at rates substantially higher than the general population. The findings do not support routine screening of sexually abused children for urinary tract infection, and suggest that further study is indicated if urinary tract infection is to be considered an indicator of abuse.
Life-threatening Dysrhythmias in Varicella Myocarditis
Authors: Woolf Paul K. , Chung Tae-Sun , Stewart Julian , Lialios Minas , Davidian Marianna , Gewitz Michael H.
Published: November 2007

Varicella myocarditis is an unusual complication of a common childhood disease. Two patients with life-threatening dysrhythmias and circulatory failure are reported. One patient required permanent pacemaker implantation for acquired complete heart block, not previously described with varicella infection. Previously reported cases of varicella myocarditis are reviewed.
Peroxisomal Disorders
Authors: Talwar Dinesh , Swaiman Kenneth F.
Published: November 2007

The peroxisome is a small organelle present in almost all cells. The peroxisomal disorders are a newly recognized group of disease entities that share structural and/or functional abnormalities of the peroxisomes, are inherited, and may have profound neurologic and systemic effects. Some of the disorders lack peroxisomes in cells, while others have single or multiple peroxisomal enzymatic deficiencies despite the presence of normally appearing peroxisomes. The prototype of the peroxisomal disorders is Zellweger syndrome. X-linked adrenoleukodystrophy, neonatal adrenoleukodystrophy, infantile Refsum disease, hyperpipecolic acidemia and Refsum disease are some of the other disease entities presently classified as peroxisomal disorders. Accurate methods of pre- and postnatal diagnosis are available. Treatment strategies are being developed, but at this time prenatal diagnosis and appropriate genetic counseling is the best therapeutic intervention for those peroxisomal disorders characterized by profound neurologic handicap and early death.
The Natural History of Night Terrors
Authors: DiMario Francis J. , Emery E. Stanley
Published: November 2007

Night terrors are a sleep disorder, resulting from a partial arousal during slow-wave sleep. They usually occur within 2 hours of sleep onset and are characterized by agitation and unresponsiveness to external stimuli. Nineteen children (ten males, nine females) with onset of night terrors before age 7.5 years were studied by means of a questionnaire. Mean observation time (time from onset age to age at survey) was 8.5 years, but longer than 10 years in nine subjects. Seventy percent of the children had their initial frequency of night terrors as their peak frequency, with a tendency for shorter duration of the parasomnia in this group. Children with onset age less than 3.5 years may be expected to attain a peak frequency of at least one episode per week. Children with onset after 3.5 years, but before 7.5 years, may expect to attain a peak frequency of 1-2 episodes per month. There was a mean duration of 3.9 years, with a tendency for longer duration in children with positive family histories of sleep walking. Fifty percent stopped by age 8 years; 36 percent continued into adolescence.

No common abnormal behavioral profile or psychopathology was found. Common precipitants of attacks were not identified.
HCG Stimulation in Children With Cryptorchidism
Authors: Urban Maria D. , Lee Peter A. , Lanes Roberto , Migeon Claude J.
Published: November 2007

Fifty-eight children with cryptorchidism have been given hCG stimulation testing, 31 with bilateral cryptorchidism, 22 with unilateral, and 5 with prior unsuccessful orchiopexy. Hormonal studies were carried out prior to and following stimulation. In bilateral cryptorchidism, bilateral descent was observed in 32 percent of cases and in unilateral, the success rate was 55 percent. From their data, the authors concluded that hCG is not indicated if patients present elevated LH and FSH levels or if the basal T levels are in the pubertal range. In the other subjects, the hCG test will permit the determination of the presence or absence of testosterone production and in some cases it results in testicular descent. Finally, in cases of failure that require surgery, the hCG will stimulate tissue growth enhancing the success of orchiopexy.
Physician/School Teacher Collaboration
Authors: Marshall Richard M. , Wuori Donald F. , Hudler Mary , Cranston Christel S.
Published: November 2007

Physician/school teacher collaboration is crucial if exceptional students are to receive appropriate educational services mandated by Public Law 94-142 and Public Law 99-457. There is little in the professional literature to guide physicians who may be interested in working more closely with school personnel. The present article provides specific suggestions and recommendations to private practitioners for initiating and managing interprofessional collaboration with school personnel.
Proptosis, Skull Infarction, and Retro-orbital and Epidural Hematomas in a Child With Sickle Cell Disease
Authors: Mallouh Ahmad A. , Young Mark , Hamdan Jahed , Salamah Mohammad M.
Published: November 2007

A Saudi child with homozygous sickle cell discease (SS) presented with bilateral periorbital swelling, right-sided proptosis, skull bone infarcts, and retro-orbital and epidural hematomas. The findings of skull bone infarcts, retro-orbital and epidural hematomas are rare in patients with sickle cell disease.
Fatalities From Undetected Appendicitis in Early Childhood
Authors: Neuspiel Daniel R. , Kuller Lewis H.
Published: November 2007

A survey of unexpected death in children 1 to 5 years of age in a defined community over a 9-year period revealed three deaths, representing 4.5 deaths per million at risk per year. These cases were preceded by recognized prodromal symptoms, yet proper diagnosis did not occur and prompt therapy was not instituted. A higher index of suspicion, improved attention to early symptoms, and decreased therapeutic delay are suggested to prevent these deaths.
Escherichia coli Cellulitis in Children With Idiopathic Nephrotic Syndrome
Authors: Asmar Basim I. , Bashour Bassam N. , Fleischmann Larry E.
Published: November 2007

Although Streptococcus pneumoniae is traditionally considered the preponderant bacterial pathogen in children with nephrotic syndrome, recent data suggest an increase of infections with encapsulated gram-negative organisms. We report two children with idiopathic nephrotic syndrome in relapse who developed spontaneous Escherichia coli cellulitis. The organism was recovered from the cellulitis tissue aspirate of one, and from the blood of the other. Both patients responded to appropriate antibiotic therapy. Initial treatment of sepsis, peritonitis or spontaneous cellulitis in nephrotic patients should include broad spectrum antibiotic coverage pending results of appropriate cultures.
Schamberg's Purpura in Children: Case Study and Literature Review
Authors: Kececioglu Draelos Zoe , Hansen Ronald C.
Published: November 2007

Schamberg's purpura or progressive pigmentary dermatosis is uncommon in pediatric patients. A case study and literature review are presented to encourage the inclusion of Schamberg's purpura in the differential diagnosis of purpuric eruptions in childhood.
Intracranial Hemorrhage in Small-for-gestational-age Neonates: Comparison With Weight-matched Appropriate-for-gestational-age Infants
Authors: Dincsoy Mehmet Y. , Kim Young M. , Siddiq Foazia , Garcia Mamerto G. , Williams Howard
Published: November 2007

In a comparative study of 93 small-for-gestational-age (SGA) infants against 93 weight-matched, appropriate-for-gestational-age (AGA) neonates, the SGA group exhibited a significantly lower incidence of periventricular-intraventricular type intracranial hemorrhage (ICH) at the first ultrasound scan than did the AGA neonates (9/93 vs 21/93; p < 0.02). This apparent advantage was no longer maintained in later scans of the first week (16/93 vs 27/93; NS), despite the fact that the SGA group were 4 weeks advanced in gestational age and had fewer respiratory problems than the AGA controls. It is prudent, therefore, to follow SGA infants closely for ICH by repeat ultrasound examinations even if the first scan is negative. Evaluation of the subgroup of SGA infants with ICH against the total SGA population revealed lower admission body temperature and Apgar scores, and higher incidence of asphyxia, resuscitation, and mortality. The above observations in SGA infants with ICH and the lack of a similar trend between the AGA infants with ICH and the total AGA population suggest that SGA status, hypothermia, and ICH are interrelated. Hypothermia, therefore, can be used as a convenient marker for the possibility of ICH in low birth weight SGA infants. The authors' data is consistent with the view that hypothermia and ICH are both the consequences of perinatal asphyxia in SGA infants and probably reflect the magnitude of stormy perinatal events.
Multiple Sclerosis Presenting at 4 Years of Age: Clinical and MRI Correlations
Authors: DiMario Francis J. , Berman Peter H.
Published: November 2007

The authors present a patient with multiple sclerosis (MS) whose onset of illness was at 4 years of age. Three separate and distinct episodes of central nervous system (CNS) dysfunction associated with cerebrospinal fluid (CSF) pleocytosis, electroencephalographic (EEG) abnormalities, and extensive CNS white matter demyelination on both computerized tomography (CT) and magnetic resonance imaging (MRI) characterized her clinical course. Two episodes responded well to prednisone therapy.
Hallucinogenic Mushrooms
Authors: Schwartz Richard H. , Smith Deborah E.
Published: November 2007

Ingestion of mushrooms containing psilocybin produces hallucinogenic effects and has become a popular form of substance abuse among some adolescents and young adults. We have reviewed the medical literature on psilocybin mushrooms and describe current patterns of use, provide background material on the botony and pharmacology of these crude drugs, and report results of a small study on usage patterns among identified adolescent drug abusers. Among 174 adolescents already identified as substance abusers, 45 (26%) reported having used hallucinogenic mushrooms, frequently in conjunction with alcohol or other drugs. An average intake of 2-4 mushrooms was obtained for about $8, and led to intoxication for 5-6 hours. Mixing of intoxicants such as alcohol, marijuana, and psilocybin mushrooms was the rule. The acute adverse reactions may have been the result of drug synergy. Pediatricians should become aware of the specific patterns of the use of hallucinogenic drugs by adolescents and consider the possiblity of such use when evaluating a delerious or psychotic adolescent.
Intravascular Injuries from Intramuscular Penicillin
Authors: Weir Michael R.
Published: November 2007

Benzathine penicillin, procaine penicillin, and mixtures of both are opaque preparations for intramuscular injection. Visualization of aspirated blood, the fail-safe for avoiding intravascular injection, is predictably problematic. A spectrum of injuries, sometimes permanent, to the gluteal region, distal extremities, perineum, and spinal cord probably results from inadvertent intra-arterial injection, possibly due to vascular occlusion by large crystals of the penicillin salt(s). Since the arterial injuries disproportionately affect infants, use of these preparations in that age group should be minimized. The corresponding intravenous injection probably is Hoigne's syndrome, a procaine-induced central nervous system syndrome. Though usually brief and transient complications may be profound, including coma, convulsions, and death. Careful attention to details of anatomy and manufacturer's recommendations is critical.
Colorectal Carcinoma in the Young
Authors: Rose Richard H. , Axelrod Deborah M. , Aldea Peter A. , Beck A. Robert
Published: November 2007

A case of sigmoid carcinoma in a 16-year-old boy is presented and the topic of colonic carcinoma in the young is reviewed. Although colon carcinoma in the younger patient is uncommon, its prognosis is distinctly worse than in the adult population, because the preponderance of mucinous adenocarcinoma in children and young adults represents a more virulent type of colonic malignancy and because the delay in diagnosis contributes to a more advanced stage of the disease at the time of presentation. When dealing with symptoms potentially referrable to this disease, a thorough diagnostic work-up should ensue.
Breast Milk Jaundice in Preterm infants
Authors: Sirota L. , Nussinovitch M. , Landman J. , Dulitzky F.
Published: November 2007

A retrospective study was performed comparing bilirubin levels in 40 preterm newborns with uncomplicated courses fed a combination of premature breast milk and formula to those of 60 comparable preterm newborns fed formula only. A significantly higher bilirubin level was noted in the group fed the combined diet on the 6th day of life and on the day of discharge. Seventy-six and seven tenths percent of the preterm infants fed breast milk and formula met the criteria for phototherapy, whereas only 45 percent were treated in the group fed formula alone. Our findings indicate that premature breast milk might cause early and late increase in bilirubin levels in healthy preterm newborns.
Multidisciplinary Team Evaluation of School Dysfunction
Authors: Chessare John B. , Joost Jane , Smith Joel , Zinna Danielle , Pohorecki Sharon
Published: November 2007

Little is known of the characteristics of children experiencing school dysfunction who are evaluated by multidisciplinary teams. The records of 87 children seen during a calendar year were reviewed and information was gathered regarding their age, sex, and referral source. In addition, the chief concerns of the child's parents and educators, and the diagnostic outcome, were considered. Boys were more likely to have been referred for behavioral problems than for academic issues. Girls were seen at an earlier age. Younger children were more likely to have been referred by physicians. While there was a significant association between gender and reason for referral, we found no such relationship between gender and final diagnostic classification. Variables in the utilization of evaluation services are described. Cognizance of these issues should lead to improved provision of care to all children experiencing school dysfunction.
Hydrops Fetalis Due to ABO Incompatibility
Authors: Gilja Bal K. , Shah Vijay P.
Published: November 2007

Hemolytic disease of the newborn due to ABO incompatibility was first observed by Halbrecht in 1944. This entity has a spectrum ranging from minimal hemolysis requiring no therapy, as is the case in most instances, to severe hemolytic disease requiring aggressive managment including exchange transfusion in a small percentage of cases. An extreme degree of hemolytic disease of the newborn due to ABO incompatibility, i.e., hydrops fetalis, has not been well documented in the English literature. We present a case of hydrops fetalis due to ABO incompatibility. The severity of hemolytic disease due to ABO incompatibility can be forecast when indicated in selected cases.
Detection of Chlamydia Trachomatis in Adolescent Females Using Direct Immunofluorescence
Authors: Evans David L. , Demetriou Efstratios , Shalaby Hamed , Waner Joseph L.
Published: November 2007

Direct immunofluorescent slide tests for the detection of genital Chlamydia trachomatis have attracted considerable attention because of their speed and economy, but most evaluation trials have concentrated on adult, high-risk populations. Using 152 paired specimens, we compared the Syva MicroTrak® direct specimen test with culture in a population of adolescent females attending a general adolescent medicine clinic. The direct slide test was 90 percent sensitive and 95 percent specific overall, with positive and negative predictive values of 74 percent and 98 percent, respectively. Prevalence by culture was 13 percent. Six of our 23 positive slide tests could not be confirmed by culture. A positive chlamydia culture was significantly associated with nonwhite race, a positive Gram's stain, and the presence of mucopurulent endocervical discharge, but not with oral contraceptive pill use, obstetrical history, Pap smear results, multiple sexual partners, coexisting vaginitis or gonorrhea, or a history of prior sexually transmitted diseases. The direct test appears to be an acceptable substitute for culture in higher prevalence adolescent settings and a useful screening adjunct in lower prevalence groups.
Eczema Herpeticum
Authors: Novelli Valerio M. , Atherton David J. , Marshall William C.
Published: November 2007

Eczema herpeticum (EH) is a potentially life-threatening complication that may occur in children with atopic dermatitis. The clinical and laboratory features of EH as seen in 14 children are reported. The mean age of affected children was 34 months. A rapid viral diagnosis was made in 72 percent of patients. In one-third of patients there was a history of herpes labialis in one or other parent in the previous week. In 28 percent of the children, EH was initially thought to be an exacerbation or impetiginization of the underlying dermatitis. Eleven of 14 children were treated with acyclovir (intravenously in eight, orally in three). All patients recovered without sequelae.
Strategies for Reducing Inappropriate After-hours Telephone Calls
Authors: Caplan Steven E. , Straus John H.
Published: November 2007

It is essential for pediatricians to allow telephone access after office hours, but the volume and the nature of such calls is occasionally resented. This study tests the hypothesis that employment of two interventional strategies could reduce the number of after-hours calls without an increase in emergency room visits. The interventions were: 1) an educational program; and later, 2) a recorded message that revealed the phone number for a second call to reach the pediatrician. The call rate remained the same before and after the educational intervention alone, but after the recorded message was inaugurated, the rate declined 28 percent. After-hours emergency room visits were similar before and after each intervention. This study suggests a simple strategy to modestly reduce after-hours calls.
Application of Pharmacokinetics in the Diagnosis of Chemical Abuse in Münchausen Syndrome by Proxy
Authors: Mahesh Vinit K. , Stern H. Patrick , Kearns Gregory L. , Stroh Suzanne E.
Published: November 2007

The case of a preschooler who was chemically abused in Münchausen syndrome by proxy is presented. Though there were many clinical characteristics that raised suspicions of this syndrome, the definitive diagnosis was made by the application of pharmacokinetics during a hospital admission. This is the first reported use of this diagnostic approach to confirm this elusive disorder. Standard pharmacological equations can be used to provide this information from pharmacokinetic data which are readily available in most hospital settings.
Congenital Adrenal Hyperplasia Associated with Hyperphosphatemic Rickets
Authors: Dumas R. , Garabedian M. , Belon C. , Sultan C. , Garandeau P. , Naoumis A.
Published: November 2007

The authors describe a boy with precocious puberty due to adrenal hyperplasia associated with rickets, hypocalcemia, hyperphosphatemia, elevated PTH and alkaline phosphatase levels, and concentrations of 25-OH-D and 1,25-(OH)2D at the upper limit or above normal range. Treatment with hydrocortisone for 9 months did not normalize hypocalcemia and hyperphosphatemia. The addition of 1,25-(OH)2D3 (0.5-2 μg/day) to the corticoid treatment for 1 year was followed by a progressive normalization of plasma calcium, phosphorus, PTH and alkaline phosphatase concentrations with improvement of the osteomalacia on bone biopsy.
Early Onset of Childhood Pulmonary Lymphangiomyomatosis
Authors: Nussbaum Eliezer , Groncy Paula , Finklestein Jerry , Dickman Paul , Harrell James H.
Published: November 2007

The authors present the first case of lymphangiomyomatosis in a pediatric patient. Radiographic findings, biopsy, computerized tomography, and electron microscopy were useful in detailing the presentation of early onset of pulmonary lymphangiomyomatosis. The unusual presentation of this child includes a description of her disease prior to any pulmonary symptomatology and 4 years of follow-up.
Non-invasive Diagnosis of Pyomyositis
Authors: Yagupsky Pablo , Shahak Eliezer , Barki Yechiel
Published: November 2007

Two children, aged 6 and 8 years, were admitted to the hospital because of fever, pain, and tenderness over the muscular masses of the thigh and calf, respectively. The presumptive diagnosis of pyomyositis was confirmed by ultrasound studies. Antibiotic treatment was administered in both cases while one child also required surgical drainage of the muscular suppuration. Complete recovery was achieved in both cases.

Performance of ultrasound studies is indicated whenever pyomyositis is suspected.
Sweat Tests in Patients with Diabetes Insipidus
Authors: Doherty-Fuller Eileen , Copeland Kenneth C.
Published: November 2007

Increased sweat chloride concentrations have been reported in patients with nephrogenic (NDI) but not central diabetes insipidus (CDI).1-5 To determine whether false-positive sweat tests also occur in CDI, six subjects with CDI had plasma electrolytes, osmolalities, and sweat tests performed before and after water deprivation.

All subjects were hyperosmolar after dehydration (287 ± 2.0 and 296 ± 3.2 mosm/kg, plasma osmolality before and after dehydration, respectively; p = 0.02). Sweat chloride concentrations before and after dehydration were not different, and no positive sweat tests were observed. Sweat chloride concentrations after dehydration did not correlate with the degree of dehydration as assessed by either plasma sodium or plasma osmolality. We conclude that increased concentrations of chloride in sweat are not typically found in dehydrated subjects with CDI, although they have been reported in subjects with the nephrogenic form.
Sleep Apnea in Children Without Hypertrophy of the Tonsils
Authors: Hultcrantz E. , Svanholm H. , Ahlqvist-Rastad J.
Published: November 2007

Two 12-year-old boys with severe sleep apnea syndrome but normal-sized tonsils were satisfactorily corrected by tonsillectomy and uvulopalatopharyngoplasty. One of the boys had muscular hypotony as contributing cause of the condition. The other had mandibular hypoplasia in combination with a long soft palate. Thorough preoperative anamnesis and examination in a sleep laboratory are necessary to determine which cases will benefit from surgery in spite of normal-sized tonsils and which surgical procedure will be most helpful.
Management of Hypernatremic Dehydration due to Insufficient Lactation
Authors: Thullen James D.
Published: November 2007

Critical malnutrition and hypernatremic dehydration resulting from inadequate breast-feeding have previously been reported; the finding of elevated sodium concentration in expressed samples of mother's milk from these infants is found concurrently. This is the first case report describing successful relactation following management of hypernatremic dehydration in a breast-fed infant. Mother's milk was of inadequate volume and had a high sodium content. Treatment of the primary cause of this disorder, insufficient lactation, was effective in allowing successful relactation; a nursing supplementer is described.
Long-term, Small Dose Prednisone Therapy in Frequently Relapsing Nephrotic Syndrome of Childhood
Authors: Elzouki A.Y. , Jaiswal O.P.
Published: November 2007

A prospective study was performed to evaluate the effect of long-term small-dose prednisone therapy in frequently relapsing nephrotic syndrome (NS); 37 patients were included, with a relapse rate 4.6/patient/year (range, 3-8) (mean age, 6.7 years; range, 2-15 years). Prednisone was started 2 mg/kg/day once remission was induced. Prednisone was progressively reduced over weeks until 10 mg/day was reached, and then the daily dose was changed to 10 mg on alternate days. On follow-up (mean, 25.4 months; range, 10-58 months), only five had subsequent relapses and their relapse rate decreased significantly to 1.2/patient/year (p < 0.05). Forty-six episodes of infection were associated with exacerbation of NS; 41 of these excerbations remitted spontaneously without an increase in the dose of prednisone. Serial height and weight measurements revealed evidence of improved height velocity and obesity persisted in only two of 13 initially obese children.
Learning Disabilities Following CNS Irradiation
Authors: Fogarty Kathryn , Volonino Victoria , Caul Jefferies , Rongey Jan , Whitman Barbara , O'Connor Dennis , Accardo Pasquale
Published: November 2007

Thirteen elementary school age children with acute leukemia who had received cranial irradiation with dosages between 1,800 and 4,800 rads a mean of 6.3 years earlier were evaluated for the presence of learning disorders. The authors utilized both psychometric and educational tests. The results were analyzed according to a graduated regressed standard score procedure and yielded the following diagnoses: mental retardation, two (15%); learning disability in reading and mathematics, two (15%); learning disability in mathematics, five (39%); no psychoeducational diagnosis, four (31 %). Of the nine children (69%) who qualified for a specific psychoeducational diagnosis, only three were receiving any special educational services. The failure of a previous assessment of this same group of children at our center and of other research reports to uncover a similarly high incidence of neurodevelopmental pathology may be due to the specific tests employed or to the later onset of measurable difficulties in these patients.
Post-traumatic Cutaneous Mucormycosis in Diabetes Mellitus
Authors: Ryan-Poirier Kathleen , Eiseman Robert M. , Beaty James H. , Hunt Philip G. , Burghen George A. , Leggiadro Robert J.
Published: November 2007

Mucormycosis is infrequently encountered in the pediatric population in any of its forms (nasopharyngeal, disseminated, pulmonary, or cutaneous) and generally is associated with the immunocompromised host.

We present an adolescent with poorly controlled diabetes mellitus who developed a progressive skin lesion 3 weeks after a motor vehicle accident. Rhizopus species was isolated from the lesion, and the biopsy revealed a fungal vasculopathy. Control of her diabetes, aggressive surgical intervention and a 10-day course of antifungal therapy (amphotericin B) resulted in a favorable outcome.

This article illustrates the importance of considering cutaneous fungal infections, especially those in the class zygomycetes, in the diabetic patient with unusual, severe or persistent skin lesions. Early recognition is essential in order to avoid morbidity and mortality from this unusual opportunistic infection.
Group A Streptococcal Rapid Test
Authors: Beach Patricia S. , Balfour Lynda C. , Lucia Helen L.
Published: November 2007

We studied 29 children, aged 19 months to 16 years, prior to and after 18-24 hours of oral penicillin therapy to confirm the rapid disappearance of detectable pharyngeal antigen and to determine whether the antigen detectable by commercially available kits was excreted into the urine. Patients were recruited based on the presence of pharyngitis, no antibiotic therapy in the preceding 2 weeks, and a positive latex agglutination (LA) for group A beta hemolytic streptococci (GABHS) antigen on pharyngeal swab. Diagnosis was confirmed by positive GABHS culture on blood agar plates. Twenty-five of these children were also tested for GABHS antigen by enzyme-linked immunoassay (EIA).

After 18-24 hours of oral antibiotic therapy, only 10 patients had a positive test for GABHS on throat swab. Five of 29 subjects (17%) remained positive by blood agar plate (BAP) culture, eight of 29 (29%) by LA, and four of 23 (17%) by EIA. GABHS antigen was undetectable by LA or EIA in the urines of any of these patients, either prior to or after initiation of treatment, even in specimens concentrated as high as 100 fold.

Clinicians should routinely seek a history of prior antibiotic therapy in assessing pharyngitis. Neither of the kits tested are reasonably accurate for GABHS disease by detection of antigen in the pharynx after partial treatment or in the urine at any time.
Preventive Health Care Utilization
Authors: Gemperline Patrick , Brockert John , Osborn Lucy M.
Published: November 2007

The utilization of preventive health care services prenatally and for children up to 3 years old was determined by mailed questionnaire. The parents surveyed were randomly chosen from birth records provided by the Utah Bureau of Vital Records. "Adequate use of preventive services" was defined as six prenatal visits for a full-term pregnancy and as seven well-child visits during the first 3 years of life.

Responses, received from 219 (36.5%) parents, indicated only 1 percent did not utilize adequate prenatal care. Women made an average of 11.3 visits during their pregnancies; 83 percent saw their prenatal health care provider at least 10 times. Well-child visits were less adequately utilized, an average of 6.3 visits per child. Fifty-six percent made fewer than seven visits; only 23 percent made all of the nine visits recommended by the American Academy of Pediatrics. Patients who made seven or more well-child visits were more likely to have received their fourth diptheria, pertussis, tetanus (DTP) immunization and to have health insurance policies that paid for preventive health care services.

Results indicate that families use preventive services more consistently before the birth of their children than after. Use of preventive services is associated with adequate insurance coverage and results in more thorough immunization.
Ovarian Cysts in Precocious Puberty
Authors: Arisaka Osamu , Shimura Naoto , Nakayama Yuko , Yabuta Keijiro , Yoshizawa Yasuo , Hirai Yoshinori , Yoshimine Tsugio , Kuwabara Noriyuki
Published: November 2007

We describe a 7-year-old girl with precocious puberty in whom a single large cyst (5 cm) and several small cysts (8-10 mm) in the single remaining ovary were detected by the ultrasound examination. Endocrinological examinations confirmed the diagnosis of central precocious puberty. Pathologic findings after the removal of the cystic lesions revealed that the large cyst was derived from degenerated follicular cysts and the small cysts were identical to follicular cysts: all were considered to have been formed by gonadotropin stimulation.

In general, surgical removal of an ovarian follicular cyst in central precocious puberty is inappropriate. However, in this unusual patient who had a degenerated large cyst, surgery seemed to be appropriate because of a previously removed teratoma in the contralateral ovary.
Nursing Bottle Caries
Authors: Marino Ronald V. , Bomze Kurt , Scholl Theresa O. , Anhalt Henry
Published: November 2007

Nursing bottle caries is a pattern of extensive decay in newly erupted maxillary incisors. We examined nutritional, demographic, and behavioral characteristics of children with this condition and age/sex-matched controls, generating a profile of factors associated with increased risk for the development of this disease. Parents of 24 consecutive bottle caries patients seen in a private pediatric dental office completed a questionnaire. Controls were children receiving routine primary pediatric health services at a university based clinical office. Children with bottle caries were more likely to be living in a single parent household (p = 0.005). A higher incidence of sleep difficulties and strong temper also was reported (p = 0.05). Cases were more likely to take the bottle to bed and, to an older age than controls. They received less professional advice regarding weaning as well as less fluoride supplementation (p = 0.025). Clinical recognition of this profile may foster provision of specific anticipatory guidance resulting in primary prevention of this condition.
Recurrent Bacterial Meningitis
Authors: Hayashi Nobana , Kino Minoru , Nobori Urara , Yanagida Masahiro , Ushiro Kohichi , Kumazawa Tadami , Kobayashi Yohnosuke
Published: November 2007

A 5-year-old girl with congenital sensorial deafness experienced four episodes of bacterial meningitis in a 13-month period. On the fourth episode, an extensive search for the cause of recurrent meningitis was conducted.

Complete immunologic studies, humoral, cellular, and phagocytic, yielded negative results. Precise otological examination, i.e., skull roentgenograms, an inner ear target CT scan, and puncture of the eardrum, was attempted, which disclosed the inner ear malformation (Mondini's anomaly) and a cerebrospinal fluid (CSF) fistula. CSF discharge from the oval window was repaired surgically.

Extensive otologic evaluation should be conducted in patients with recurrent bacterial meningitis.
Is it Sexual Abuse?
Authors: Adams Joyce A. , Horton Mark
Published: November 2007

Because of the increasing number of reports of sexual abuse of children, pediatricians should become more familiar with the examination of the genitalia of prepubertal children and learn to recognize physical indicators of abuse. Although some physicians may not recognize abnormal findings on examination, in other cases, unusual physical findings may be reported erroneously as possible abuse. The authors report a case of an unusual genital finding in a child which was suspected initially as being caused by sexual abuse but was subsequently determined to be a congenital anomaly. An external examination using a colposcope was useful in delineating the normal appearance of the tissues in question.
Institutionalized Disabled Adolescents
Authors: Furman Lydia M.
Published: November 2007

Severely handicapped and institutionalized teenage girls have a variety of gynecologic problems that can be readily addressed by a physician with an interest in adolescent medicine who makes "home visits" to the institutions. Disabled teens are a unique group of adolescents whose needs intersect with those of normal teens. Educating and listening to the caretakers, who can then prepare the patients, is essential. Key topics include menses and menstrual calendars, adolescent development, the pelvic examination, and contraception.

The clinical problems most frequently encountered are vaginal discharge, menstrual cycle dysfunction, and oligomenorrhea. Basic on-site management is described. In this population, severe chronic illness and subnormal weights for age are not necessarily associated with secondary amenorrhea. Patients, parents, and staff are satisfied when gynecologic needs are met in an empathetic and thorough fashion. A list of educational resources is appended.
Benign Transient Hyperphosphatasia and HIV Infection
Authors: Fennoy Ilene , Laraque Danielle
Published: November 2007

The disorder, benign transient hyperphosphatasia, has been defined previously as a condition occurring in a normal child with spontaneous, transient elevation of alkaline phosphatase.

We report three cases of hyperphosphatasia in patients with congenital HIV infection and underlying liver disease which appear to satisfy the criteria for benign transient hyperphosphatasia despite the presence of chronic disease. These three children, when compared with three normal children with transient hyperphosphatasia exhibited similar patterns of change in serum alkaline phosphatase.

Extreme elevation of serum alkaline phosphatase in HIV infected patients does not of itself suggest alterations in clinical status nor indicate the need for extensive evaluation.
Listening Carefully
Authors: Triggs Elizabeth G. , Perrin Ellen C.
Published: November 2007

A simple checklist was developed for completion by parents prior to their regular meetings with their pediatricians for health supervision. Its efficacy in improving communication between pediatricians and parents about behavioral and developmental concerns was evaluated. Without the checklist, 30 percent of parents' concerns were discussed. More items overall, and more items that were concerns of the parent, were discussed with the use of the checklist than without it (p < 0.05). An intermediate but statistically significant effect was observed even when the pediatrician did not see the completed checklist (43% of concerns were discussed); this effect was increased when he did (53% of concerns discussed).

There were marked differences among pediatricians in the number of concerns that were discussed both with and without use of the checklist. Items regarding patterns of family life and child care, death or illness, siblings, and other stresses of modern families were frequently indicated as concerns on the checklist but were less frequently discussed.

The data demonstrate the effectiveness of a simple and efficient method to improve communication about childrens' behavior and development between their parents and their pediatricians.
Accuracy of Radiographic Differentiation of Bacterial from Nonbacterial Pneumonia
Authors: Courtoy Isabelle , Lande Arthur E. , Turner Ronald B.
Published: November 2007

The chest roentgenogram is an accepted tool for the diagnosis of pneumonia. Little information is available, however, addressing the ability of physicians to distinguish bacterial from nonbacterial pneumonias by examination of the chest roentgenogram. Five different observers evaluated 36 chest films from patients with pneumonia who had a laboratory proven etiologic diagnosis. The sensitivity of roentgenogram diagnosis of bacterial pneumonia ranged from 42-58 percent. When clinical and laboratory data were provided to the observers the sensitivity ranged from 42-92 percent.

This study indicates that chest film examination is too insensitive to be useful for the selection of patients who have bacterial pneumonia from those whose pneumonia is non-bacterial.
Acute Rheumatic Fever with Advanced Degree AV Block
Authors: Venu Reddy D. , Chun L.T. , Yamamoto Loren G.
Published: November 2007

Five cases are described of acute rheumatic fever meeting the modified Jones criteria with evidence of second or third degree atrioventricular block (AVB). One patient required a temporary transvenous pacemaker and two patients were treated with corticosteroids. One patient had an associated valvulitis. There was no long-term sequelae due to the AVB in any of the patients. The duration of the advanced degree AVB had a range of about 2 to 12 days. The cause of this advanced degree AVB is uncertain.

Advanced degree AVB with acute rheumatic fever appears to be self limited in most instances. Unlike rheumatic valvulitis, it is not associated with significant permanent morbidity.
Human Bite Marks
Authors: Gold Michael H. , Roenigk Henry H. , Smith E. Steven , Pierce Larry J.
Published: November 2007

Human bite marks are common findings in cases of fights among children, child abuse, sexual abuse, among institutionalized persons, and in a number of homicide cases. Human bites can mimic annular or arciform dermatoses. These are reviewed from both a clinical and histologic viewpoint. An example is presented of a 2 year-old girl with several annular lesions that were clinically mistaken for a dermatophyte infection. Antifungal medications were ineffective. After several days, a dermatologist identified the lesions as human bites. Physicians and other health care workers must be able to differentiate the clinical appearance of bite marks from other dermatologic diseases at an early stage so as to initiate proper therapy and counseling and, if indicated, a search for the perpetrator.
Spinal Epidural Abscess
Authors: Rockney Randy , Ryan Robert , Knuckey Neville
Published: November 2007

Spinal epidural abscess is an unusual disease in the pediatric age group, requires early diagnosis and prompt surgical drainage to insure a good clinical outcome. Back pain and fever are usually the only presenting symptoms occurring before precipitous neurologic deterioration. The causative organism is most often Staphylococcus aureus, which presumably is spread to the epidural space hematogenously. Diagnosis is facilitated by computed tomography (CT) scan, but the entire spine must be imaged by either myelography or magnetic resonance imaging (MRI) to assess for skip lesions.