bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of the Twin Transfusion Syndrome
Authors: Shorland Jean
Published: November 2007

A pair of monochorial twins showing marked features of the twin trans fusion syndrome is described. The hemoglobin differences between them at birth was 19.8 Gm./100 ml. The management of hyperbilirubinemia and polycythemia in the recipient, and of anemia, heart failure, respiratory distress, hypothermia and hypoglycemia in the donor is discussed.
Serum Immunoglobulins in Edematous Protein—Calorie Malnourished Children
Authors: Alvarado Jorge , Luthringer David G.
Published: November 2007

Serum levels of IgG, IgA and IgM were found to be either normal or elevated in PCM patients, with no relation to the degree of protein-calorie depletion, the percentage of white cells and plasmocytoid lymphocytes in peripheral blood, or the prognosis. The IgG rose in a child developing mumps even though his diet was only sufficient for nitrogen equilibrium. These results still do not elucidate the discrepancy that exists between elevated immunoglobulin fractions and the high mortality rate asso ciated with the presence of infection in protein-calorie malnutrition.
Newborn Intensive Care in the United States, East and West
Authors: Indyk Leonard , Cohen Shep
Published: November 2007

This report describes informally yet penetratingly the current "state of the art" in some of this country's best Newborn Intensive Care Units. With it the authors present a scheme or "scale" for evaluation which should prove very helpful in all hospitals attempting to care for sick newborns.
Lung Puncture-Aspiration as a Bacteriologic Diagnostic Procedure in Acute Pneumonias of Infants and Children
Authors: de Olarte Diana García , Trujillo S. Hugo , Uribe P. Alvaro , Agudelo O. Nancy
Published: November 2007

Lung puncture-aspiration is simple and generally innocuous. For the study of acute pneumonia it is superior to examination of naso pharyngeal, throat or laryngeal cultures and gives more positive re sults than does blood culture. It can be extremely useful in investi gational studies and with selected patients in whom identification of the precise pathogen is necessary for optimal antibiotic therapy.
The Variable Pattern of Mental Development of Rural Black Children
Authors: Brown Roy E. , Halpern Florence
Published: November 2007

This preliminary report of an infant population, de prived both nutritionally and environmentally, shows that poor environment is as relevant as malnutrition for mental development in the first three years of life.
Children and Youth Projects and Related Comprehensive Health Care Programs
Authors: Wallace Helen M.
Published: November 2007

The 56 Children and Youth Projects, 53 Maternity and Infant Care Proj ects, 54 official State Crippled Children's Programs, 55 Neighborhood Health Centers, many centers for handicapped children, and a small num ber of organized group practices, together represent the major reservoirs of experience in comprehensive health care in the U. S. A. today. Criti cally and farsightedly, this important essay explores the practical aspects of offering comprehensive care to the millions of "high priority" children.
Monitors as Medical Tools
Authors: Indyk Leonard
Published: November 2007

Correspondence to: 107 Bennett Rd., Teaneck, New Jersey 07666. Monitors are a relatively recent development and as such are often not uti lized as fully as possible. It is the purpose of this series of solicited articles to remove whatever mystery still surrounds monitors for those without the appropriate technical training. Dr. Indyk will discuss the scope and man ner of functioning of monitors, their applications and limitations, the use ful ranges of measurement, and the trustworthiness of particular readings.
Disseminated Intravascular Coagulation Complicating Propylthiouracil Therapy
Authors: Sammon T. James , Peden Virginia H. , Witzleben Camillus , King James P.
Published: November 2007

A 16-year-old girl with thyrotoxicosis, treated successfully for two years with propylthiouracil, developed a purpuric rash, prolonged pro- thrombin time, increased split fibrin products, elevated antinuclear anti body titer and glomerular changes. The symptoms abated after ther apy with heparin and prednisone, although the ANA titer remained elevated. This is presented as the first reported instance of dissem inated intravascular clotting resulting from propylthiouracil therapy.
The Growth and Development of Low Birth Weight Infants Receiving Intensive Neonatal Care
Authors: Grassy Richard G. , Hubbard Connie , Graven Stanley N. , Zachman Richard D.
Published: November 2007

This study reports the growth and development of 28 survivors who had a birth weight of ≤1,000 g and were cared for at a Regional Neonatal In tensive Care Unit. Only eight (30%) had neurologic abnormalities including spastic hemiparesis, retrolental fibroplasia, hydrocephalus, motor retarda tion, and some delay in language skills. The other survivors had normal physical examinations and developmental progress judged by a variety of screening examinations up to age four years, three months. The average caloric intake during the first week was 61 kg/da, although over half never reached that level until day 4. Nearly all the infants have had standard growth patterns thus far.
Biological and Clinical Significance of the Gut as a Barrier to Penetration of Macromolecules
Authors: Galant Stanley P.
Published: November 2007

This review stresses the importance of the gut as an immunologic organ, and describes those factors in the gut which impede penetration of potentially harmful macromolecules, particularly the secretory IgA system. Because of the immaturity of this gut function in the young infant, breast feeding should be encouraged for the first six to nine months of life whenever possible.
Hereditary Aplasia Cutis Congenita and Associated Defects
Authors: McMurray Brian R. , Martin Lester W. , Dignan Peter St. John , Fogelson M. Harold
Published: November 2007

Hereditary aplasia cutis congenita (ACC) is a rare, dominantly inherited syndrome of scalp aplasia associated with defects of the underlying skull and absent distal phalanges of the feet. The scalp lesions are generally benign, but the increased risk of bleeding or meningitis may require skin grafting.
Bacteremia in 28 Ambulatory Children
Authors: Hamrick Harvey J. , Murphy Captain Thomas F.
Published: November 2007

Bacteremia with known pathogens was documented in 28 acutely ill, febrile outpatients during a 29-month period. All of the children were previously healthy and were initially managed as outpatients. Eight patients presented with no identifiable focus of infection. Twenty patients had either otitis media or pneumonitis. An association between otitis media and bacteremia with H. influenzae type b was noted in 5 patients. Bacterial meningitis occurred subsequently in 7 patients (25 per cent); 1 death occurred in this group. The blood culture, as an outpatient procedure, was helpful in establishing a bacterial etiology in selected chidren with either high fever (with or without otitis media), febrile seizures, or pneumonia. In addition, the positive blood culture was a vital aid in identifying the young child at risk for meningitis.
Coping with Disability and the Surgical Experience
Authors: Nathan Susan W.
Published: November 2007

Twenty-five adolescent girls undergoing surgery for correction of idiopathic scoliosis (curvature of the spine) were administered the Rorschach Ink Blot Test preoperatively, and the House-Tree-Person Test preoperatively, post operatively, and at one year follow-up. In the figure drawing test younger girls scored significantly higher than older girls in both the preoperative and postoperative periods. The older adolescent's sensitivity of issues of physical attractiveness and bodily functioning increased her painful awareness of the deformity. With other measures, girls who denied their deformity significantly differed from nondenyers in their ability to cope with the stress of surgery; they had greater feelings of vulnerability and perception of the self as the object of an aggressive attack. Such denying, highly anxious patients need greater psychologic preparation prior to surgery. The limited motility of the postoperative scoliotic patient distorts body image perception and promotes feelings of passivity and helplessness.
Intentional Poisoning of Two Siblings by Prescription Drugs
Authors: Hvizdala Eva V. , Gellady Andrew M.
Published: November 2007

The two cases described in this report are examples of a bizarre form of child abuse. Intentional poisoning with prescription drugs was used by the mother to simulate an underlying disease in her two children. Combined with mis leading history and interference with laboratory procedures, she confounded physicians for years, and led to unnecessary hospitalizations, treatment and multiple laboratory procedures for these children. This report may alert physicians to earlier recognition of this form of child abuse.
Children with Psychogenic Abdominal Pain and Their Families
Authors: Hughes Michael C. , Zimin Robert
Published: November 2007

Children hospitalized with psychogenic abdominal pain and the children's families are discussed from the perspective of a child psychiatrist working within the pediatric hospital. Psychosocial and emotional difficulties for the child and parents are noted as families use somatic symptoms to deal with psychic distress. Principles for management are emphasized, utilizing a comprehensive team approach by physicians, nurses, and other health professionals. Through constructive use of hospitalization and informed fol low-up, these children and their parents can be helped toward symptomatic improvement and a more meaningful understanding and resolution of their underlying emotional difficulties.
Prevalence of Childhood Allergy in a Subtropical Environment
Authors: Marks Meyer B. , Caputo Leonard , Mirmelli Philip , Zaragoza Jose
Published: November 2007

Other prevalence studies of allergy in school children have been limited to temperate zones only. The aims of this computerized investigation were wholly focused on South Florida, located in a subtropical climate. The occurrence of allergy in relation to marked geographic variations was surveyed to evaluate the prevalence of allergy in connection with these topographic differences.
225 Skateboard Injuries in Children
Authors: Illingworth Cynthia M. , Jay Ann , Noble Dilys , Collick Mary
Published: November 2007

Among 225 skateboard accidents treated at the Children's Hospital, Sheffield, in 8 months from August 1977, there were 92 fractures (40.9 per cent), of which 19 required manipulation under general anesthetic. Most involved the upper limb. Next most frequent were lacerations, bruises, abrasions, and injuries of joints and soft tissues. Four children had concussions (one with a fractured skull), 8 others had minor head injury, and 23 had soft tissue injuries of the head and neck.

As for the reasons for the accidents, 20 per cent were due to hitting a stone, 10 per cent to a hole or bump in the pavement, 8 per cent to collisions, and three accidents to faults in the skateboards. Sixteen of the children were injured on the first day of their skateboarding. The role of protective clothing was uncertain. The city has no skateboard parks. Injuries due to skateboards were compared to injuries due to playground equipment.
Acute Transverse Myelopathy in Childhood
Authors: Novak Robert W. , Jones Gilbert , Ch'ien Lawrence T.
Published: November 2007

Four cases and a literature survey show acute transverse myelopathy to be a dramatic but rare pediatric problem. Neurologic deficits can be significant but generally improve with the passage of time. The prognosis for complete recovery, however, is poor.
The Effect of Early Initiation of Colostrum Feeding on Proliferation of Intestinal Bacteria in Neonates
Authors: Ojofeitimi E.O. , Elegbe I.A.
Published: November 2007

One hundred eighty normal neonates with an average weight above 2.50 kg and having no feeding difficulties were divided into two groups and randomly assigned to either colostrum or to glucose water feeding regimens during the 3-day stay at the maternity ward. The effects of the feeding regimens on intestinal colonization were studied by examining the stools of the neonates. All bacteria recovered were identified quantitatively and biochemically. Of the 180 mothers, 105 complied with the instructions on feeding regimens. The majority of the neonates receiving colostrum had significantly lower bacterial counts than those on glucose water (p < 0.001). The results of the preliminary study indicated that early initiation of colostrum feeding to neonates where potable water is not readily available will supress the proliferation of bacteria in the neonates.
Steps Toward Resolving Cultural Conflict in a Pediatric Hospital
Authors: Korbin Jill E. , Johnston Maxene
Published: November 2007

A serious and potentially life-threatening disease in a young child was identified and resolved through medical intervention. However, in the course of hospitalization, a conflict arose between the mother and the health care providers that required legal constraints on the mother. A ret rospective account of this conflict between Western health care providers and a family from a Caribbean culture lends itself to an examination of the role of cultural considerations in pediatric hospital care. Suggestions for resolving cultural conflict in clinical practice are discussed.
Scimitar Syndrome
Authors: Mardini M.K. , Sakati N.A. , Lewall D.B. , Christie R. , Nyhan W.L.
Published: November 2007

Three patients with the scimitar syndrome represented an incidence at the King Faisal Specialist Hospital and Research Centre of one per cent of patients who underwent cardiac catheterization. In one of the patients the anomalous pulmonary venous return and the pulmonary hypoplasia was on the left. The syndrome is usually benign. Its recognition may save the patient from unnecessary additional diagnostic procedures.
Fever in Acute Myelogenous Leukemia
Authors: Sadowitz P. David , Stockman James A.
Published: November 2007

Twenty patients with acute myelocytic leukemia were observed over a period of 16.5 patient years in an attempt to identify any relationship between fever, granulocytopenia (<1000 gran ulocytes/μl), infection, and disease status. An infectious origin for fever in association with gran ulocytopenia could be established in the majority of instances during the induction of remission and during relapse. This finding differs from what has been previously noted in children with the more common form of leukemia, acute lymphocytic leukemia.
Systemic Hemophilus influenzae Infection
Authors: Lerman Stephen J.
Published: November 2007

In Omaha, from 1974 to 79, 30 (12.5%) of 240 patients with Haemophilus influenzae bacteremia or meningitis had a wide variety of conditions known to be associated with increased susceptibility to bacterial infection. Neonates and adults accounted for 47 per cent of the infections. Non-type b and non-typable strains caused 41 per cent of the episodes. Forty-one per cent of patients had bacteremia with no detectable focus of infection. The incidence of meningitis was low. Mortality was 28 per cent, considerably higher than in patients who were previously healthy.

A review of the medical literature indicated that low-birth weight infants and patients with leukemia and other malignancies undergoing chemotherapy, splenectomy, congenital asplenia, sickle cell anemia, immunoglobulin deficiency diseases, cerebrospinal fluid shunts, and skull de fects are at greater risk for systemic H. influenzae disease than the general population.
Neonatal Seizures
Authors: Boer Henry R. , Gal Peter
Published: November 2007

A nationwide survey of neonatologists and pediatric neurologists was conducted to ascertain their methods of evaluating and managing neonatal seizures. Of the sampled 750 physicians, 284 (38%) responded to the single mailing. Most respondents use a routine for seizure workup which includes glucose, calcium and electrolyte determinations, and a lumbar puncture. On the other hand, there was a great variation in the use of an EEG, CT scan, skull x-ray, and a drug and metabolic screen.

Phenobarbital was the initial drug of choice and phenytoin usually the second drug. Neurologists used higher loading doses for phenobarbital and phenytoin. Most physicians monitored blood levels to adjust maintenance doses. Drug therapy was usually continued for two months to one year after seizure control. Criteria for discontinuation were often arbitrary but included a normal electroencephalogram and the absence of seizures. The results demonstrate a lack of consensus in the evaluation and management of neonates with seizures.
Efficacy of Phototherapy and/or Exchange Transfusions in Neonatal Jaundice
Authors: Kalpoyiannis Nicholas , Androulakis Nicholas , Hadjigeorgiou Emmanuel , Papadatos John , Oeconomidou Ourania , Nicolopoulos Demetre
Published: November 2007

In a review of treatment of neonatal jaundice, the authors studied the impact of phototherapy on outcome. From comparing exchange transfusion treatment over a 39-month period prior to the availability of phototherapy to a 39-month period incorporating phototherapy in the treatment regimen, the authors conclude that phototherapy (1) acts slowly but constantly to reduce bilirubin levels and (2) is effective even in severe hemolytic jaundice, but its effectiveness is inversely related to the degree of hemolysis. While phototherapy can never totally replace exchange trans fusion, it can certainly reduce the number of transfusions needed.
Should Inferior Venacavography be Performed in Management of Children with Wilms' Tumor?
Authors: Mahboubi Soroosh , Rosenberg Henrietta Kotlus , D'Angio Giulio J.
Published: November 2007

Our retrospective study showed that a routine inferior venacavogram by foot injection is not helpful in the initial workup for a patient with Wilms' tumor since incomplete or misleading information can result from such an evaluation. The use of ultrasound and computed tomography yields more accurate information regarding the status of the inferior vena cava.
Use of a Seminar as an Aid in Helping Interns Care for Dying Children and Their Families
Authors: Berman Stephen , Villarreal Sylvia
Published: November 2007

An annual seminar held by the University of Colorado, Department of Pediatrics, is designed to assist interns to cope more effectively with the emotional strains of caring for dying patients and their families. In the seminar, interns are randomly divided into four small groups con sisting of six interns, a chief resident, two pediatric faculty members, and a nurse or social worker from an intensive care unit. This paper reviews the resident evaluations of the seminar, as well as the results of a questionnaire which explored attitude formation toward death. Interns felt that the opportunity to discuss death and dying early in their training program helped them gain an understanding of their own feelings about death, which enabled them to cope better with the stress involved in caring for dying children. Additional benefits from the seminar included more effective interpersonal communication, the establishment of deeper and more meaningful friendships, and a stronger esprit de corps.
Pityriasis Rosea in Children
Authors: Cavanaugh Robert Michael
Published: November 2007

Pityriasis rosea is a common disorder of unknown etiology that may simulate a number of other dermatologic entities. Secondary syphilis should always be ruled out, particularly in ad olescents. Pruritus occurs more frequently than is generally appreciated. The herald patch may not always be present. Secondary lesions occasionally occur distal to the elbows and knees and on the face. Over the more proximal parts of the body the secondary lesions will characteris tically align themselves with the long axis following the skin lines of cleavage. The natural course is that of spontaneous resolution within 6 to 8 weeks. Sequelae are rare and usually medically insignificant. Management with oral antipruritics and/or topical steroids may be necessary to relieve the itching.
The Telephone in Pediatric Medicine
Authors: Fosarelli Patricia D.
Published: November 2007

From a review of numerous studies and reports of management of pediatric illness by tele phone, it is concluded that innovative methods of teaching effective diagnosis and management by telephone still need to be explored. More research should be done on patient outcomes to assess the adequacy of the initial decision-making process, rather than relying solely on the number of questions asked. This will necessitate studies using actual patient telephone vignettes rather than simulated ones.

Finally, research needs to be done on the efficacy of the "telephone hour" used by many physicians to manage their day more efficiently. Such studies could compare patient outcome and parent and physician satisfaction, in practices where the "telephone hour" is standard, to those practices where patient calls are managed as they occur.
Differential Leukocyte Count in Acute Gastroenteritis
Authors: Ashkenazi Shai , Amir Yaakov , Dinari Gabriel , Schonfeld Tommy , Nitzan Menachem
Published: November 2007

The total and differential leukocyte counts of 238 infants with acute gastroenteritis were evaluated as an aid in differentiating between nonbacterial and bacterial infection. In contrast to the total leukocyte count, which was noncontributory, the absolute band count and the ratio between band and total neutrophil count (B/N ratio) were helpful, with the highest values seen in patients with Shigellosis. A B/N ratio greater than 0.10 can help differentiate Shigella, Salmonella, and Campylobacter infections from E. coli and nonbacterial gastroenteritis with a sensitivity of 84.3 per cent and a specificity of 74.5 per cent.
Adult-type Respiratory Distress Syndrome in Children
Authors: Nussbaum Eliezer
Published: November 2007

Adult respiratory distress syndrome (ARDS) is not well recognized in children. We report seven individuals, ranging in age from 1.5 to 16 years. The clinical picture of ARDS reached a peak in 72 hours from admission and was associated with a 28.5 per cent death rate (2/7). In no case was an organism isolated, either from bronchial washings via a flexible bronchoscope or from open lung biopsy specimen. ARDS is characterized by severe damage to the alveolar- capillary unit and probably inadequate production of lung surfactant, resulting in severe hy poxia, hypoxemia, intrapulmonary shunting, and marked decline in pulmonary compliance. The prognosis remains poor in the pediatric age group. The pathophysiology of this entity is outlined, with guidance for monitoring and therapy.
Atopic Dermatitis
Authors: Oakes Raymond C. , Cox Alan D. , Burgdorf Walter H. C.
Published: November 2007

Atopic dermatitis, one of the common dermatologic abnormalities encountered by pediatri cians in clinical practice, is a chronic pruritic skin disorder occurring in individuals with a personal or family history of atopic disease such as asthma or allergic rhinitis. Atopic dermatitis appears to be an inherited disease, although the mode of inheritance has not been sestablished. Clinically, its course can be divided into stages: infantile, childhood, and adult. Recognition of atopic dermatitis in any of these stages should facilitate appropriate treatment.

This general overview examines several aspects of the disease, including current concepts of clinical manifestations, differential diagnosis, pathogenesis, and treatment.
Teaching Well Child Care
Authors: Osborn Lucy M. , Reiff Michael I.
Published: November 2007

Despite recommendations that the emphasis of the well child visit be on behavior and de velopment, some studies indicate that pediatricians continue to spend a relatively small per centage of each well baby visit on these subjects. One factor contributing to the discrepancy between current recommendations and practice may be the way we teach residents to perform this task. In this study, we investigated and evaluated current methods for teaching well child care. Our data indicate that the content of well child care is being taught, but that problems with teaching setting, methods and frequency of supervision, and lack of formal evaluation may be among the factors which contribute to our continued inability to change the focus of well child visits.
Pseudo-toxic-shock Syndrome Due to a Drug Reaction
Authors: Bernstein David I. , Carney Jean , Cherry James D.
Published: November 2007

A case is reported of a 13-year-old girl who had an illness initially thought to be toxic shock syndrome but subsequently noted to be a toxic reaction to the anticonvulsant, carbamazepine. The patient was never hypotensive but she was febrile and had a desquamative rash and involvement of three organ systeans. Staphylococcus aureus was recovered from the patient's blood and vagina.
Pitfalls in Diagnosis of Osteomyelitis in Children with Sickle Cell Disease
Authors: Wethers Doris L. , Grover Ranjeet
Published: November 2007

The cases of three children with unusual features of osteomyelitis and sickle cell disease are presented. Two children had salmonella osteomyelitis, one with a recurrence 1.5 years after adequate intravenous therapy. In the second, the bone scan was negative despite verified disease. The causative organism in the third case was Staphylococcus aureus, and there was extensive bone involvement of the radius without symptoms, but with a positive bone scan. It is recom mended that the possibility of osteomyelitis be entertained in a child with sickle cell disease whenever there are symptoms and/or objective findings referrable to bone. Radionuclide scans, when used in timely fashion, can assist in the diagnosis, but confirmation can best be achieved by the recovery of microorganisms through blood culture and/or bone aspirate. The choice, dosage, and duration of antibiotic therapy should be determined by causative organisms and by serologic titers.
Applicability of a Scoring System in the Diagnosis of Streptococcal Pharyngitis
Authors: Funamura Janwyn L. , Berkowitz Carol D.
Published: November 2007

The usefulness of a scoring system, developed in a private pediatric practice, for the early diagnosis of streptococcal pharyngitis has been evaluated in a teaching hospital. The system, evaluated in 892 patients, appears most useful in predicting culture-negative patients (80%). A false positive rate of 20 per cent precludes the use of the scoring system in the decision to initiate antibiotic therapy at our institution.
Computed Tomography of Neuroblastic Tumors in Children
Authors: Faerber Eric N. , Carter Barbara L. , Sarno Robert C. , Leonidas John C.
Published: November 2007

Computed tomography (CT) was performed in 16 children with neuroblastic tumors. CT aided significantly in the accurate preoperative delineation of tumor extent and in the demonstration of tumor features not visualized by conventional radiography. CT provided excellent postoperative follow-up, particularly in assessing the effects of chemotherapy and radiation therapy. The results of CT, ultrasound, radionuclide imaging, and conventional radiography have been compared.
Oral Rehydration Therapy of Severe Diarrheal Dehydration
Authors: Sharifi Jalaladdin , Ghavami Fakhraddin
Published: November 2007

In 1980, 104 infants with seven to 15 percent dehydration due to severe diarrhea and vomiting were hospitalized in Tehran and treated in two separate phases, deficit therapy and maintenance therapy, using two isotonic oral solutions. For deficit therapy, solution A (sodium 80, potassium 20 mmol/1) was administered at a rate of 40 ml/kg per hour until all signs of dehydration dis appeared. For maintenance therapy, solution B (sodium 40, potassium 30 mmol/l) was given sip by sip at a rate of about 250 ml/kg per 24 hours until diarrhea stopped. Intravenous fluids were not used, even in severe dehydration and shock. The efficacy and safety of this regimen were confirmed by rapid and successful rehydration and correction of electrolyte abnormalities present on admission.
A Case of Yersinia pseudotuberculosis Septicemia Accompanied by a Large Abdominal Tumor
Authors: Nakamura Michiru , Shikano Takaaki , Ueno Norihiro , Matsumoto Takahide , Ohkawa Masato , Tono-oka Tatsuhito
Published: November 2007

A 2-year-old girl with Yersinia pseudotuberculosis septicemia had a large abdominal mass that had to be differentiated from malignant tumor. The mass disappeared rapidly with antibiotic therapy and was defined to be a cluster of enlarged ileocecal lymph nodes by the clinical course and the findings at ultrasonic examination and Gallium scintigraphy.
Transtelephonic Monitoring in Pediatric Patients with Clinically Suspected Arrhythmias
Authors: Fyfe Derek A. , Holmes David R. , Neubauer Sharon A. , Feldt Robert H.
Published: November 2007

Evaluation of patients with symptoms suggestive of cardiac arrhythmias is difficult using standard studies if the episodes are infrequent and have a short duration. Transtelephonic electrocardio graphic recorders were provided for 41 patients with suspected arrhythmic episodes. None had previously documented arrhythmia. There were 18 males and 23 females (age range 14 months to 19 years; mean 10.9 years). The interval prior to a diagnostic transmission was 0.5 to 8 months (mean 2.5 months). Twenty-one of 41 patients (51%) provided transmissions during a typical episode, nine of which were abnormal. Paroxysmal supraventricular tachycardia was found in eight patients and unsuspected intermittent complete heart block in one patient. The remaining 12 patients had normal sinus rhythm. Twenty patients did not transmit because episodes either were too brief or did not recur. Transtelephonic monitoring was effective in the diagnosis of certain arrhythmias that are infrequent and short in duration. Normal transmitted electrocar diograms during a typical symptomatic episode excluded cardiac arrhythmias.
Understanding Autism
Authors: Farber Jon Matthew , Capute Arnold J.
Published: November 2007

Although much is known about autism, misconceptions persist. A case report is presented and used as a framework for dispelling some common myths about the condition. A simple, practical model for understanding autism is proposed and recommendations are provided for the practitioner managing a child with autistic-like features.
An Overview of the Etiology, Diagnosis, and Management of Anorexia Nervosa
Authors: Golden Neville
Published: November 2007

The incidence of anorexia nervosa is increasing in adolescents. The pediatrician caring for teenagers is often the first professional confronted with the early signs and symptoms of this disorder. Clinical features and available literature on the psychological, nutritional, and family disorganization found in patients with anorexia nervosa are reviewed. Different therapeutic ap proaches are discussed, and current data on outcome are presented.
Hypernatremic Dehydration in Infants with Gastroenteritis
Authors: Khuffash Faisal A. , Majeed Hassan A.
Published: November 2007

Of 1045 children admitted with gastroenteritis over a 12-month period and studied retrospectively, serum sodium level was tested in 802. Sixty patients (7.5%) had hypernatremic dehydration (HD). The peak incidence of HD, the highest serum sodium levels, and the worst outcome were all encountered in infants under the age of 3 months. An association with pre-admission high solute feeding was less obvious. Pre-admission volume intake could not be evaluated. There was no association of HD with the etiological pathogen or climatic conditions. The weight-for-age was below the fifth percentile in 21 patients (35%). One patient (1.7%) died, another (1.7%) developed peripheral gangrene, and four (6.7%) were left with significant neurologic complications. All of these patients were under the age of 4 months.

In this subtropical country, the most important risk factor for the development of hypernatremia in the course of gastroenteritis is the young age. Environmental risk factors do not seem to play a significant role.
Umbilical Cord Care
Authors: Andrich Mary P. , Golden Stephen M.
Published: November 2007

Umbilical cord colonization rates were examined over a 4-year period following topical ap plication of bacitracin (1978-1980) or triple dye (1980-1982). A total of 2402 cords were cultured: 1229 following bacitracin cord care and 1173 after triple dye application. Cords treated with bacitracin had significantly higher colonization rates when compared to triple dye prophylaxis. Bacterial colonization with Staphylococcus epidermidis and group B β-hemolytic streptococcus was found only after bacitracin prophylaxis. Our data support the use of triple dye for routine cord care and suggest that bacitracin application may increase the rate of group B streptococcal col onization.
Valproic Acid and Congenital Malformations
Authors: Bantz Maj Eric W.
Published: November 2007

An infant exposed in utero to valproic acid was born with multiple congenital malformations, including duodenal atresia, lumbar vertebral fusion, thoracolumbar scoliosis, renal abnormalities, diastasis recti abdominis, depigmentation of the eye brows, and a large hemangioma. The child had neonatal hyperbilirubinemia and postnatal growth deficiency. This case report is an addition to the literature im plicating valproic acid as a human teratogen.
Neonatal Herpes Simplex Virus Death Manifested as Rapidly Progressive Pneumonia
Authors: Mascola Laurene , Cable Douglas C. , Walsh Patrick , Guinan Mary E.
Published: November 2007

This report describes a case of probable herpes simplex virus (HSV) pneumonia in a neonate with no other localized signs of HSV infection. A 37-week-old infant became ill on the fourth day of life and died 6 days later of overwhelming pneumonia and ensuing complications. After the infant's death, viral cultures from the trachea, nasopharynx, and gastric aspirate grew herpes simplex virus. The mother had no history or signs of HSV infection at delivery. She developed a postpartum fever, and 8 days later herpetic lesions were noticed on the vulva and buttocks. The source of this infant's infection was most likely the maternal birth canal. Nosocomial acquisition could not be ruled out, but no history of HSV infection was found in either involved hospital personnel or in 38 infants defined to be at risk for nosocomial acquisition of the disease. Neonatal HSV can present as a rapidly progressive pneumonia without other clues to etiology.
Fatal Lower Respiratory Tract Infection due to Herpes Simplex Virus in a Previously Healthy Child
Authors: Sofer Shaul , Pagtakhan Reynaldo D. , Hoogstratten Jan
Published: November 2007

A well-nourished, previously healthy, 9-month-old baby died of herpes simplex virus infection of the lower respiratory tract, without apparent dissemination. The herpetic disease followed bacterial pneumonitis for which the patient had had tracheal intubation.
The Efficacy of Vestibular Stimulation as a Form of Specific Sensory Enrichment
Authors: Ottenbacher Kenneth J. , Petersen Paul
Published: November 2007

The application of recently developed, quantitative literature reviewing methods (meta-analysis), detailed in the companion article in this issue,1 is illustrated by examining the results of studies that explored the effectiveness of vestibular stimulation as a form of sensory stimulation. Sixty- seven studies were located that employed some form of vestibular stimulation as the independent variable. Fourteen of these studies met criteria consistent with traditionally accepted standards of empirical inquiry in the behavioral and biomedical sciences and were included in the review. The 14 studies contained 31 hypothesis tests that evaluated the efficacy of vestibular stimulation as a form of sensory enrichment designed to facilitate various developmental parameters. An analysis of the results of these tests, using quantitative reviewing methods, revealed that subjects receiving vestibular stimulation performed significantly better than members of control or com parison groups who did not receive such stimulation. We can begin to answer questions of efficacy using research reports which currently exist when that research is properly synthesized by the quantitative review method. The use of quantitative reviewing procedures is recommended to help establish a consensus when synthesizing conflicting research literature in the behavioral and biomedical sciences.
Neonatal Total Gastrectomy
Authors: Quak S.H. , Joseph V.T. , Wong H.B.
Published: November 2007

A 2-day-old, female infant underwent total gastrectomy for spontaneous gastric gangrene and perforation. She developed the following complications: growth re tardation, vitamin B12 deficiency, post-gastrectomy dumping syndrome, and oc casional bile regurgitation. Nutritional management is described. The two previously reported survivors of total gastrectomy in the neonatal period are reviewed.
Five-year Follow-up of Vietnamese Refugee Children in the United States
Authors: Sokoloff Burton , Carlin Jean , Pham Hien
Published: November 2007

The purpose of this study was to investigate the present physical, mental, and psycho-social health of Vietnamese refugee children. Questionnaires were sent or given to adoptive families, foster families, and Vietnamese children living in the United States with their family units. Otitis media, respiratory ailments, and varicella constituted a large number of their initial medical problems. Severe nightmares and temper tantrums occurred frequently during their first year. It was found that the children's health and emotional problems improved markedly after the first year. Despite stormy pasts, present social and school problems are minimal, and some children appear to be high achievers. Most of the Vietnamese children, especially those who were adopted, are doing much better than we anticipated. Advance preparation and guidance given by the involved agencies appear to be of significance in achieving these excellent results.
Evaluation of a Paper-patch Test for Sweat Chloride Determination
Authors: Yeung William H. , Palmer Judy , Schidlow Daniel , Bye Michael R. , Huang Nancy N.
Published: November 2007

This article evaluates a recently developed qualitative sweat patch test (SPT). A battery- powered stimulator with polymer pad electrodes is used to stimulate sweating, followed by the application of a paper patch which collects the sweat and shows color change on sweat chloride levels above 40 to 50 mEq/l. Our data consist of 66 patients with cystic fibrosis, 75 control subjects, and 37 relatives of patients with cystic fibrosis, excluding 22 subjects (11%) with insuffacient sweat. There were no false-negative results among 66 patients with cystic fibrosis, and in the control group, 71 of 75 subjects gave negative results and the other four gave positive results. Of the 37 relatives, eight gave positive results; all of the eight subjects are parents of patients with cystic fibrosis. Our results indicate that SPT is useful and reliable when there is sufficient sweat. This portable and simple patch test may serve as an excellent screening test for cystic fibrosis.
The Endocrine Spectrum of Septo-optic Dysplasia
Authors: Izenberg Neil , Rosenbtum Mindy , Parks John S.
Published: November 2007

Six children with septo-optic dysplasia were evaluated at the Children's Hospital of Philadelphia. There was a common history of young, nulliparous mothers. The clinical presentation of these children differed according to age of presentation and was a function of the degree and type of hypctthalamic-prituitary and ophthalmologic impairment.

Endocrine evaluation revealed four of six children to be growth hormone deficient, four of six to have hypothalamic hypothyroidism, and two of four to have elevated prolactin levels. One of the patients demonstrated adrenocorticotropic hormone deficiency, and one had diabetes insipidus. Neuroanatomic findings in the children were variable, but, in general, the rare syndrome did not carry as grave a morbidity as had been reported previously. Our data support a high degree of hypothalamic impairment in septo-optic dysplasia.
Cystic Fibrosis in Pueblo Indian Children
Authors: Gerdes Jeffrey S. , Murphy Shirley
Published: November 2007

Three Pueblo American Indian children with cystic fibrosis are described. The three cases constitute a higher incidence of cystic fibrosis in Pueblo Indians than would be expected from the known rarity of this disease in American Indian populations. This report discusses the possible genetic implications and emphasizes the need to consider the diagnosis of cystic fibrosis in American Indians with appropriate symptoms.
Palpable Spleens in Newborn Term Infants
Authors: Mimouni Francis , Merlob Paul , Ashkenazi Shai , Litmanovitz Ita , Reisner Salomon H.
Published: November 2007

Spleen tip size was determined in 470 full-term appropriate-for-gestational-age infants within the first 24 hours of life. The spleen was palpable in 17.9 percent of them. It was palpated less than 1 cm below the costal margin in 11.7 percent, between 1 and 2 cm in 3.6 percent, and 2 cm or more in 2.6 percent. No cause for spleen enlargement was found except in two infants with ABO hemolytic disease.
Maximal Work Capacity in Prepubescent Obese and Nonobese Females
Authors: DeMeersman Ronald E. , Stone Stephen , Schaefer David C. , Miller William W.
Published: November 2007

Measurements of cardiorespiratory function during an incremental treadmill test were compared in 15 obese (OB) prepubescent girls, 7 to 12 years old, and in 15 age-matched, nonobese (NOB) controls. Open circuit calorimetry was used for data collection during the progressive work test. Maximal oxygen consumption indexed for weight was significantly lower in the obese group of girls (23.0 ± 3.9 ml/kg/min) than in the nonobese controls (36.7 ± 0.9 ml/kg/min). In addition, exercise tolerance was longer in the nonobese group, albeit not statistically significant. In conclusion, diminished cardiopulmonary performance and attenuated exercise tolerance in prepubescent obese females in the current investigation seemed to be influenced by excess body weight.
Total Parenteral Nutrition in the Management of Traumatic Chylous Ascites in Infancy
Authors: Dillard Robert P. , Stewart Angela G.
Published: November 2007

Chylous ascites is rare in the pediatric age group and usually of unknown etiology or due to congenital abnormalities of the lymphatic system. This report describes an infant with posttraumatic chylous ascites, unable to tolerate dietary therapy, in whom total parenteral nutrition allowed successful management. The experience gained in this case clarifies the management of chylous ascites from all causes. Specific recommendations for a treatment protocol are made.
Intracranial Pressure Monitoring by Subarachnoid Bolt in Comatose Children
Authors: Nussbaum Eliezer , Maggi J. Carlos
Published: November 2007

The safety of intracranial pressure (ICP) monitoring by the subarachnoid bolt was studied in 124 comatose children with global (103 patients) and focal (21 patients) cerebral lesions. None of the children developed cerebral hematoma, diffuse bleeding, epileptical focus, or local or systemic infection. Based on our experience, we advocate the use of the subarachnoid bolt for the purpose of ICP monitoring as a simple and safe modality.
Spontaneous Remission of Cryptosporidiosis in a Child with Acute Lymphocytic Leukemia
Authors: Stine Kimo C. , Harris Jo-Ann S. , Lindsey Norma J. , Cho Cheng T.
Published: November 2007

Cryptosporidiosis has been documented in pediatric patients with various forms of congenital and acquired immunodeficiency. This is a report of crypto sporidiosis in a child with acute lymphocytic leukemia. Cryptosporidiosis, an un common cause of diarrhea, may produce severe diarrhea in children with acute lymphocytic leukemia.
Sex Chromosome Fragment in a Phenotypically Normal Female
Authors: Wilson Darrell M. , Hintz Raymond L. , Ross Jon C. , Rosenfeld Ron G.
Published: November 2007

The authors report a 15-year-old short, nonvirilized, prepubertal female whose peripheral karyotype revealed a mosaicism in which 62 percent of the cells had a karyotype of 45X, and the other 38 percent had a karyotype of 46X plus a small unidentified marker chromosome. Since the authors were unable to determine from the karyotype whether this marker was derived from an X or a Y chromosome and because of the high risk for neoplasia in abnormal gonads containing Y material, she underwent surgical exploration, with removal of gonadal tissue. Microscopic examination of the streak gonads revealed a mixture of dysgenetic ovarian and testicular type tissues. The presence of testicular-like tubules strongly implied the presence of Y material in the genotype. Review of the literature reveals at least 19 similar cases in which presumed sex chromosomal markers or fragments were found in phenotypically normal females. Because of the risk of gonadal neoplasia in patients with occult Y chromosomal material, gonadectomy is indicated when the origin of the marker chromosome is uncertain.
Pharmacologic Treatment of Psychiatric and Neurodevelopmental Disorders in Children and Adolescents (Part 1)
Authors: McDaniel Keith D.
Published: November 2007

A review is presented of the diagnosis and drug treatment of the more common psychiatric and developmental disorders in the pediatric population. Where applicable, DSM III (Diagnostic and Statistical Manual of Psychiatric Disorders, III) criteria are utilized to describe the behavioral syndromes. The indications for usage and appropriate dosages of antipsychotics, antidepressants, anxiolytics, stimulants, and lithium are described. Those disorders discussed are attention deficit disorder, conduct disorders, anxiety disorders, sleep disorders, schizophrenia, autism, Tourette's syndrome, mental retardation, depressive illness, manic depressive illness, eating disorders, and enuresis.
Correlation of Nasopharyngeal and Conjunctival Cultures with Middle Ear Fluid Cultures in Otitis Media
Authors: Groothuis Jessie R. , Thompson Juliette , Wright Peter F.
Published: November 2007

Eighty children with acute otitis media (AOM) were prospectively studied to determine the correlation and clinical usefulness of nasopharyngeal (NP), conjunctival (CONJ), and middle ear fluid (MEF) cultures. NP cultures correlated more accurately with MEF (p < 0.01) than did CONJ cultures (p < 0.05) for both Streptococcus pneumoniae and Haemophilus influenzae (H. flu).

The positive predictive value of NP cultures for positive MEF was only 47%, but the negative predictive value was 87 percent. NP cultures, therefore, appear to have significant predictive clinical value only when negative in identifying children likely to have sterile MEF.

High correlation of NP, CONJ, and MEF in children with H. flu conjunctivitis (p < 0.01) suggests that early systemic rather than topical antibiotic treatment for H. flu conjunctivitis in small children may avert subsequent occurrence of the "conjunctivitis-otitis" syndrome.