bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Management Issues in Males with Sex Chromosomal Mosaicism and Discordant Phenotype/Sex Chromosomal Patterns
Authors: Van Dyke Don C. , Hanson James W. , Moore Jay W. , Patil Shivanand R. , Hawtrey Charles E. , Hansen James R.
Published: November 2007

The recent availability of Y DNA probes has made it possible to identify two forms of 46,XX male syndrome: Y DNA positive and Y DNA negative. The Y DNA positive male results from a X;Y translocation with a low recurrence risk; the Y DNA negative males are due to a mutation with a high recurrence risk. 46,XX males and mosaic forms are phenotypically indistinguishable. A review of the case histories for 11 individuals indicates that affected males have highly variable genital and nongenital phenotypes. Physical findings may be clearly apparent or nonexistent. With the exception of external genitalia, the basis for this variability is unknown. It may be related to differences in Y chromatin expression as the result of variable inactivation of the X chromosomes, or to the existence of minor deletions or point mutations secondary to an exchange of genetic material. Common and uncommon clinical problems in these individuals require evaluation and follow-up care that is provided through a cooperative, interdisciplinary approach.
Hypersensitivity to Carbamazepine Mimicking Infection
Authors: Cochran Frederick B.
Published: November 2007

Carbamazepine may produce a wide range of side effects including blood dyscrasias, liver damage, lethargy, skin eruptions, psychoses and extrapyramidal symptoms.1 Hypersensitivity reactions to carbamazepine are uncommon but have included generalized lymphadenopathy, pulmonary eosinophilia, asthma, pseudolymphoma, thrombocytopenia, leukocytosis, agranulocytosis, aplastic anemia, inappropriate antiduresis, erythroderma and renal failure.1-9 Such reactions are rare in children. One child recently presented with symptoms and physical signs suggestive of a viral infection, after having shown an allergic response to phenobarbital.
Klinefelter Syndrome: The Need for Early Identification and Treatment
Authors: Mandoki Miguel W. , Sumner Gayla S.
Published: November 2007

A 14-year-old boy presented with severe academic difficulties, emotional disturbance, borderline mental retardation, tall stature, delayed sexual development, small testes, and gynecomastia. Chromosomal analysis revealed an additional X chromosome compatible with the diagnosis of 47, XXY Klinefelter Syndrome. This case retrospectively follows the progression of learning and behavioral problems occurring in the primary grades prior to the diagnosis of Klinefelter Syndrome and reports the effects of psychiatric treatment, modified educational placement, testosterone supplementation, and corrective surgery in adolescence. The early identification of Klinefelter Syndrome is vital to the XXY male in that many of the developmental, behavioral and emotional problems associated with an additional X chromosome are amenable to treatment.
Neonatology in the 1990's: Surfactant Replacement Therapy Becomes a Reality
Authors: Berry David D.
Published: November 2007

It has been more than 35 years since the lung was discovered to be lined with a layer of surface-active material that is important in lung stability and mechanics of respiration. 1-4 The absence of this "anti-atelectasis" factor2,3 was proposed by Avery and Mead in 1959 to be the cause of hyaline membrane disease of premature infants.5 An indepth historical review of pulmonary surfactant by Tierney 6 was recently published. In the years since 1959, there has been an exhaustive amount of research aimed at elucidating the structure and function of pulmonary surfactant, the ultimate goal being a safe and effective exogenous surfactant for the treatment of the Respiratory Distress Syndrome (RDS). The days of surfactant research are far from over, but the era of surfactant replacement therapy is now upon us. The practitioner needs to be knowledgeable about surfactant and aware of his or her role in surfactant therapy for premature infants. The following is intended to clarify some of the important issues of surfactant replacement.
Colic Medication and Apparent Life-Threatening Events
Authors: Hardoin Richard A. , Henslee Judith A. , Christenson Christopher P. , Christenson Patricia J. , White Mitchell
Published: November 2007

Eight infants with histories of apnea and cyanosis were referred to the Southwest SIDS Research Institute for evaluation of apparent life threatening events (ALTE). All of the infants had been treated for colic with a 1:1 concentration of dimenhydrinate (Dramamine) and phenobarbital, hyoscyamine sulfate, atropine sulfate and scopolamine hydrobromide (Donnatal). The medication was pre-mixed by local pharmacists. A comprehensive work-up failed to reveal a cause for the ALTE in any infant. The Dramamine/Donnatal mixture was withdrawn and polygraphic evaluation was conducted. Cardiorespiratory abnormalities were identified in all eight infants and significant gastroesophageal reflux (GER) was documented in four. The possibility that colic medication contributes to cardiorespiratory instability and GER in vulnerable infants requires serious consideration and further evaluation.
Newborn Chemical Exposure from Over-the-Counter Skin Care Products
Authors: Cetta Frank , Lambert George H. , Ros Simon P.
Published: November 2007

Human exposure to potentially toxic environmental chemicals is major concern to our society. Over-the-counter (OTC) skin care products are a potential source of environmental chemical exposure to newborns. A prospective study was undertaken to define existing newborn bathing practices and quantitate environmental chemical exposure from OTC skin care products. One hundred-ninety six mothers of infants discharged from our newborn nursery were asked to respond to a questionnaire concerning newborn bathing practices and OTC skin care product usage. Complete questionnaires were returned by 23% of the mothers. The average newborn had 8 ± 3 (± SEM) skin care products applied with the resultant exposure to 48 ± 18 different environmental chemicals. Forty-seven percent of our respondents used a baby powder. The average one month old was bathed 4 times a week and was shampooed 3 times weekly. Seventy-eight percent of the respondents reported that their newborn had a rash but only 45% of those reporting a rash sought professional medical advice. Thirty-seven percent of the mothers reporting a rash made a change in bathing practice or product selection. In view of our findings, the human newborn is exposed to a large number of environmental chemicals thorough topical OTC preparations. The efficacy, transcutaneous absorption and potential toxicity of these products should be investigated.
The Long Term Benefits of a Comprehensive Teenage Pregnancy Program
Authors: Rabin Jill M. , Seltzer Vicki , Pollack Simcha
Published: November 2007

A comprehensive program was founded in 1982 to provide adolescents with prenatal and family planning care. The program's impact through its first five years of operation on medical aspects of pregnancy course and fetal outcome will be the subject of a separate report. This study examines subsequent maternal and infant health of the patients attending the program compared to a control group. Four hundred ninety-eight adolescents and their newborns attending the program's mother-baby family planning clinic from 1982 to 1989 (subject group) were compared to ninety-one adolescents and their newborns receiving postpartum family planning and pediatrics clinics from 1980 through 1989 (control group). Seventy-five percent of the subject group regularly attended mother-baby clinic, compared to 18% of the control group attending family planning and pediatric clinics (P≤.0001). The subject group experienced less maternal and infant morbidity, greater school attendance, graduation, employment, and contraceptive use than the control group (P<.0001). Many parameters improved with each program year indicating continued wide acceptance of our program by area adolescents.
Sibling Rivalry
Authors: Leung Alexander K.D. , Robson Wm. Lane M.
Published: November 2007

Rivalry occurs between most, if not all, siblings to a varying degree. Rivalry may be manifested as a verbal or physical attack, frustration, persistent demands for attention, or as regressive phenomena. When handled properly, healthy competition among siblings will lead to the acquisition of social, interpersonal and cognitive skills that are important to the development of the child. Mismanagement of the competition may lead to psychological problems later in life. The appropriate spacing of children and the preparation of existing children for a new sibling help to reduce sibling rivalry. Family situations that will potentially lead to jealousy should be avoided. Parents should not make comparisons between siblings and favoritism should be avoided. When episodes of sibling rivalry develop, the cause rather than the manifestation of the rivalry should be treated. Patience, love, understanding, common sense, and humor are important parental skills necessary to minimize sibling rivalry.
Genitourinary Gonorrhea Presenting as Mild Arthritis
Authors: Kerr Josephine M. , LeBlanc Weiner , Heagarty Margaret C.
Published: November 2007

It has long been recognized that post-gonococcal arthritis may take one of two forms: disseminated gonococcemia with acute septic arthritis and a milder self limited disease with few systemic symptoms. The findings in this patient suggest that occult genitourinary gonococcal infection is a meaningful differential diagnosis in patients with unexplained mild arthritic symptoms.
The Value of the Autopsy in Congenital Heart Disease
Authors: Kay Marsha H. , Moodie Douglas S. , Sterba Richard , Murphy Daniel J. , Rosenkranz Eliot , Ratliff Norman , Homa Andrea
Published: November 2007

We reviewed autopsies in 50 consecutive cases of congenital heart disease between 1980 and 1988. Autopsy results were compared to premortem clinical diagnosis. The patients ranged in age from two days to 66.5 years with a mean age of 6.42 years; 68% were less than one year of age. The most common diagnoses were hypoplastic left heart syndrome in 16 (32%) and ventricular septal defect in five (10%). Other common diagnoses included coarctation of the aorta, hypoplastic right heart syndrome, tetralogy of Fallot, transposition of the great vessels and tricuspid atresia. No patient had a missed diagnosis that would have changed survival (Class 1). Four (8%) of the patients had one missed major diagnosis that did not change their survival because they were already being symptomatically treated or because no clinical treatment was available (Class 2). The majority of autopsy derived data were missed minor diagnoses that were related [14 (28%) - Class 3] or unrelated [12 (24%) - Class 4] to the terminal disease process. However, despite the small percentage of autopsy findings that would have directly affected survival, the autopsy provided important additional clinical information in 30 (60%) patients. This information could be used to correct management errors and to develop protocols for prophylaxis against known complications. The pediatric autopsy can provide useful clinical data that may be a guide to altering clinical therapy and is essential in providing genetic counseling.
Preventing Parental Child Abduction: Analysis of a National Project
Authors: Long Nicholas , Forehand Rex , Zogg Carolyn
Published: November 2007

Recent data from a study indicate that child abduction by a parent is up to six times more frequent than previous estimates had suggested. Relative to parental child abductions, stranger abductions occur on a very infrequent basis. While much attention has been placed on prevention programs for stranger abductions, prevention programs for parental child abduction have been nonexistent. The present study analyzes data from a national hotline program that targeted prevention of parental child abduction. Data were collected on 86 consecutive telephone calls from parents contemplating abduction of their child(ren). These data provide information on demographic variables, level of interparental conflict/violence, reasons for contemplating abduction, and abduction plans. Data are also presented that indicate a mediation program may be effective in preventing some cases of parental child abduction. However, such a mediation program is a very difficult course of action and impacts only a small percentage of parental child abduction cases.
A Treatment Protocol of the Acute Asthma Patient in a Pediatric Emergency Department
Authors: Press Shirley , Lipkind Reina S.
Published: November 2007

A treatment protocol for pediatric patients with acute asthma from 8 months to 15 years of age was utilized in an urban pediatric emergency department. In a three month period, 682 children were evaluated with acute asthma with 566 (83.0%) initially discharged and 116 (17.0%) admitted. There were no deaths. Treatment included aerosol inhalation in 682 patients (100%) and both intravenous steroids and aminophylline in 247 (36.2%) patients. Medical care was rendered by housestaff physicians supervised by full-time attending physicians. Of the 566 patients discharged, 131 (21.1%) patients had received intravenous aminophylline and steroids. Of those discharged 14 (2.5%) were admitted during the subsequent 48 hours for status asthmaticus. Of the 247 patients who received intravenous medications, chest radiographs consistent with pneumonia were noted in 15 (6.2%). The routine use of this protocol has been effective in the short term emergency department management of pediatric patients with acute asthma and had been accepted by the housestaff and attending physicians.
Polyuria in Childhood
Authors: Leung Alexander K.C. , Robson Wm. Lane M. , Halperin Mitchell L.
Published: November 2007

Polyuria may result from either a water or a solute diuresis. Although the history and physical examination may provide clues to the cause of the polyuria, the definitive diagnosis requires laboratory tests which focus on the osmolality of the urine and serum in combination with the urine volume and the rate of excretion of osmoles. An isoosmolar or hyperosmolar urine is found in children with a solute diuresis or in normal children, whereas a hypoosmolar urine is found in children with a water diuresis. In the latter case, a low serum osmolality suggests primary polydipsia whereas a high serum osmolality suggests antidiuretic hormone (ADH) deficiency or insensitivity. A water deprivation test is necessary when the initial evaluation fails to establish the cause of polyuria. A vasopressin test enables the differentiation between neurogenic and nephrogenic diabetes insipidus (DI).
The Role of Computed Tomography in the Diagnosis of Subperiosteal Abscess of the Orbit
Authors: Andrews Thomas M. , Myer Charles M.
Published: November 2007

Periorbital cellulitis is a frequent complication of sinusitis in children. Subperiosteal abscess (SPA), however, is an uncommon sequela and may lead to serious complications if not promptly and adequately treated. A series of 13 consecutive patients who underwent orbital computed tomographic (CT) scans from January 1, 1986, to June 30, 1989, to investigate the possibility of SPA were reviewed. As demonstrated in this series, the diagnosis of subperiosteal abscess remains a clinical one that may be supported, but not determined, by an orbital CT scan. Cautious interpretation of these studies is advocated. Aggressive surgical therapy in appropriate clinical situations will lead to more rapid resolution of the disease process and fewer complications.
Neonatal Respiratory Distress Secondary to an Obstructing Nasopharyngeal Dermoid
Authors: Thomsen James R. , Clayton James , Baker Robin , Nowlin John
Published: November 2007

A case presentation of a newborn infant with intermittent, complete airway obstruction secondary to a pedunculated nasopharyngeal dermoid is presented. The differential diagnosis of obstructing nasopharyngeal lesions of the neonatal period is discussed, and an organized management strategy is proposed.
Pediatric Head and Neck Rhabdomyosarcoma
Authors: MacArthur Carol J. , McGill Trevor J.I. , Healy Gerald B.
Published: November 2007

Rhabdomyosarcoma (RMS), the most common malignant soft-tissue tumor in the pediatric population, occurs most often in the head and neck region. Major advancements in the management of these aggressive tumors have been achieved in the last 20 years on three fronts: chemotherapy, radiation therapy, and surgery. Surgery, with the advent of skull-base, craniofacial, and free-tissue-transfer reconstructive techniques, has once again become part of the primary management of these tumors. Prior to 1960, RMS was uniformly fatal; now, with the introduction of multimodality treatment regimens, two thirds of patients can expect long-term survival.
Pathophysiology of Neonatal Subconjunctival Hemorrhage
Authors: Katzman Gerald H.
Published: November 2007

Of 111 newborns examined, 33 had subconjunctival hemorrhage (SCHN). Three of 19 patients delivered by cesarean section and 30 of 92 newborns delivered by the vaginal route had SCHN. Perinatal factors including duration of membrane rupture, length of second stage of labor, maternal weight and weight/length ratio, maternal ingestion of anti-inflammatory drugs, gravidity, birth weight, and Apgar score did not differ significantly in the groups with and without SCHN. It is proposed that in the majority of cases SCHN is a consequence of elevated venous pressure in the head and neck produced by compression of the fetal thorax and/or abdomen by uterine contractions. Tight umbilical cord around the neck probably represents an additional mechanism for SCHN.
Toe Walking and Language Development
Authors: Accardo Pasquale , Morrow Jill , Heaney M. Susan , Whitman Barbara , Tomazic Terry
Published: November 2007

Neurodevelopmental markers that are present early in childhood may identify children at risk for later developmental disabilities. This paper attempts to clarify the relationship between one such proposed marker, toe walking, and language development in a general pediatric population. One hundred sixty-three children being seen for well-child visits were included in the study. Information from each child's caretaker was obtained for language development and a history of toe walking; observation of toe walking during the visit was also included. The frequency of toe walking was 24%. Language quotients were calculated and compared for toe walkers (n=39) and non-toe walkers (n=127). The mean language quotient for toe walkers tended to be consistently lower than that for non-toe walkers. The specificity of toe walking for low language scores was 85% but had a sensitivity of only 32%. Although an association between toe walking and language delay is supported by the present data, the association does not appear to be clinically significant.
Neonatal Campylobacter Fetus Meningitis: A Report of an Unusual Case
Authors: Bingham William T. , Chan Anthony , Rennie Robert , Williams Kurt E. , Sankaran Koravangattu
Published: November 2007

Campylobacter fetus is a rare cause of meningitis in the pediatric age group and, in particular, among neonates. The clinical presentation of campylobacter meningitis in high-risk neonates is not well-described. A review of campylobacter meningitis by Lee et al1 in 1985 reported nine cases occurring in neonates, of which only one case was caused by C. fetus. In the ensuing six years only three more confirmed cases of neonatal meningitis caused by C. fetus have been reported.2,3 We here report another confirmed case of C. fetus meningitis in a neonate.
Noninvasive Methods for Estimating In Vivo Oxygenation
Authors: Benaron David A. , Benitz William E. , Ariagno Ronald L. , Stevenson David K.
Published: November 2007

Clinical signs of hypoxia and hyperoxia are nonspecific and unreliable, yet both are potentially injurious. Noninvasive methods of oxygen assessment fill the gap between clinical observation and invasive tests, helping physicians deliver sufficient oxygen with minimum toxicity. Potential sites for oxygen measurement vary between the blood and the mitochondria; each method measures at a different site and detects different types of hypoxia and hyperoxia. Thus, values obtained by two different methods are not equivalent, giving each method unique strengths and weaknesses. We review two clinical methods (pulse oximetry and transcutaneous oximetry), as well as four experimental methods (near-infrared spectrophotometry, magnetic resonance spectroscopy, magnetic resonance saturation imaging, and time-of-flight absorbance spectrophotometry). The principles of each method and the clinical situations in which each succeeds or fails are discussed. A fundamental understanding of each method can help in deciding which methods, if any, are appropriate for a given patient and how best to correct observed oxygenation problems once they are discovered.
Pediatric Wandering Spleen
Authors: Rodkey Mark L. , Macknin Michael L.
Published: November 2007

Wandering spleen is a rare diagnosis, especially in the pediatric population. We reviewed the English literature from 1900 through April 1991 for all cases of wandering spleen in patients from birth through age 10. There are 50 case reports prior to the one presented here. The goals of this article are to summarize the histories, findings, and treatment of the 51 patients, describe diagnostic and treatment modalities, and increase the clinician's suspicion for wandering spleen. This condition is probably underdiagnosed and potentially treatable by splenopexy if suspected and diagnosed early in the course of disease.
A Treatment Program for Adolescents With Phenylketonuria
Authors: Gleason Linda A. , Michals Kimberlee , Matalon Reuben , Langenberg Patricia , Kamath Savitri
Published: November 2007

A treatment program for adolescents with phenylketonuria (PKU) , incorporating education, goal-setting, self-monitoring, contracts, and rewards, was evaluated by measuring knowledge of PKU, blood phenylalanine concentrations, and health locus of control (LOC) before and after participation in the program. Of the 16 subjects, seven subjects successfully completed the program by achieving behavioral goals. These subjects increased their knowledge of PKU and decreased their blood phenylalanine concentrations, but the nine nonsuccessful subjects did not. There was no significant change in LOC scores for either group. There was a significant relationship between baseline blood phenylalanine levels and success with the program. Therefore, this pilot study demonstrates that adolescents who have already achieved some measure of metabolic control can be expected to be most successful with this program and realize the greatest benefits from it in the form of increased knowledge of PKU and even better metabolic control.
Dietary Practices, Physical Activity, and Body-Mass Index in a Selected Population of Down Syndrome Children and Their Siblings
Authors: Sharav Teresa , Bowman Thomas
Published: November 2007

Thirty sibling pairs, each with one Down syndrome child between the ages of 2 and 14, were selected from families who had participated in an infant-stimulation program. The maternal and paternal educational levels were 14.9 and 16.9 years, respectively. The Down syndrome patients and their siblings were compared in terms of body-mass index, that is, weight/stature2 (w/s 2); activity as measured on a questionnaire; and weekly caloric intake. There were no significant differences between the Down syndrome children and their siblings in terms of w/s2. The Down syndrome patients were less active than their siblings and spent significantly more time indoors, showing a preference for indoor activities. Caloric intake calculated as percentage of recommended allowance for height was somewhat less in the Down syndrome children—88.7%, compared with 95% in the siblings—but not significantly so. It is postulated that even though Down syndrome patients have been shown to be at risk for obesity, familial and other environmental factors, such as dietary control and involvement in physical activity, have an influence.
Case of Primary Erythromelalgia in a Child
Authors: Strozik Krzysztof , Lis Grzegorz
Published: November 2007

Erythromelalgia is a rare syndrome occurring in adults and characterized by increased local skin temperature, redness, edema, and burning pain in the feet and, less often, the hands.1-4 Primary erythromelalgia has been referred to as "burning feet syndrome. "5 This article describes a boy suffering from a primary type of erythromelalgia.
CaEDTA vs CaEDTA Plus BAL to Treat Children with Elevated Blood Lead Levels
Authors: O'Connor Mary E.
Published: November 2007

The effectiveness of CaEDTA alone vs CaEDTA plus BAL was compared retrospectively in a group of 72 children with lead levels between 2.41 μmol/L (50 μg/dL) and 2.90 μmol/L (60 μg/dL). The children who received both drugs had higher median zinc protoporphyrin (ZnP) concentrations at the initiation of therapy than children who received CaEDTA alone (160 μg/dL vs 96 μg/dL, p <.01). There was a significantly increased incidence of vomiting and abnormal liver-function test results in the children who received both drugs. The children who received CaEDTA alone had a greater percent mean fall in lead level at one to three weeks postchelation (30.5 % vs 18.1 %, p <.05). Children who received both CaEDTA and BAL had a greater percent decrease in ZnP at four to eight months postchelation, but there was no difference in percent decrease in lead levels. Children who received both drugs also had a greater number of repeat courses of chelation by six months. The addition of BAL to CaEDTA for treatment of children with lead levels of 2.41 μmol/L (50 μg/dL) to 2.90 μmol/L (60 μg/dL) produced greater toxicity and does not seem to prevent repeat chelations within six months.
Anisometropic Amblyopia: An Easily Overlooked Cause of Visual Loss in Children
Authors: Lehman Sharon S. . , Kubacki Joseph J.
Published: November 2007

Anisometropic amblyopia is a unilateral visual-acuity reduction secondary to suppression of a constantly blurred image in the eye with the greater uncorrected refractive error. The refractive error may be farsightedness (hyperopia), nearsightedness (myopia), and/or irregular curvature of the cornea (astigmatism). Children with anisometropic amblyopia have good visual acuity in one eye and usually have straight eyes. These factors, combined with peekingfrom under the occluder by the child during visual screening, may allow monocular reduced visual acuity to go undetected. Delay in diagnosis and treatment may result in an irreversible decrease in visual acuity. Other types of amblyopia will be discussed. Two cases are presented to illustrate these points. Suggestions for refining and improving basic screening technique will be made.
Seizures and Fever: Can We Rule Out Meningitis on Clinical Grounds Alone?
Authors: Offringa Martin , Beishuizen Auke , Derksen-Lubsen Gerarda , Lubsen Jacobus
Published: November 2007

A study was done of 309 children seen in two ERs with a first seizure and fever to assess whether meningitis could be recognized using readily available clinical information. Among these children, 23 (7%) cases of meningitis were diagnosed. A group of 69 children with seizures and fever but no meningitis served as controls. Signs from ER examinations that discriminated between children with and those without meningitis were: petechiae, nuchal rigidity, coma, persistent drowsiness, ongoing convulsions, and paresis or paralysis; 21 cases were thus identified. Two children with a suspicious history but none of these signs proved to have meningitis. Children whose seizures showed no complex features and whose febrile illness revealed no suspicious features did not have meningitis. Our results indicate that based on available clinical data, meningitis can be ruled out in children presenting with seizures and fever; thus, there is no need for routine investigation of cerebrospinal fluid.
A Changing Pattern of Epiglottitis
Authors: Ryan Michael , Hunt Michael , Snowberger Tina
Published: November 2007

Address correspondence to: Michael Ryan, D.O., Department of Pediatric Subspecialties, Geisinger Medical Center, Danville, PA 17822-1339 Summary: A case review of epiglottitis at Geisinger Medical Center over the past 12 years demonstrates a decrease in the number of pediatric patients with epiglottitis and an increase in the number of adults with epiglottitis. In the last five years, the number of epiglottitis patients younger than 10 years has fallen (0 cases), while the number of patients over 10 years of age has increased (6 cases). The cause of epiglottitis, Hemophilus influenzae type b, remains constant in the pediatric as well as in the adult population. There appears to be an increasing frequency of epiglottitis in adults and a decreasing frequency of epiglottitis in children.
Cholelithiasis in Infants with Down Syndrome
Authors: Aughton David J. , Gibson Peter , Cacciarelli Alexander
Published: November 2007

Only four cases of cholelithiasis have been reported in patients with Down syndrome and none in Down syndrome infants. The cases of three Down syndrome infants (all males) with cholelithiasis are reported. Each exhibited different fetal complications, and in each, Down syndrome was diagnosed at birth. Gallstones apparently were congenital (a rarity) in one infant, since they were detected on the first day of life. Cholelithiasis was an incidental finding in another of the infants when, at 12 weeks old, he had renal ultrasonography because of a urinary tract infection. The third infant was 4 months old when sonographic studies revealed a gallstone. Despite the confirmation of cholelithiasis in all three infants, none has since had any signs or symptoms that suggest the need for intervention. Cholelithiasis is probably more common in Down syndrome infants than has been supposed, but whether Down syndrome infants with gastrointestinal (GI) malformations are more likely to have gallstones than are children with similar GI malformations but with normal karyotypes is unknown.
Screening for Psychosocial Dysfunction In Pediatric Practice
Authors: Murphy J. Michael , Arnett Hayley L. , Bishop Sandra J. , Jellinek Michael S. , Reede Joan Y.
Published: November 2007

This study examined the routine implementation of the Pediatric Symptom Checklist (PSC), a brief questionnaire which screens for psychosocial dysfunction in school-aged children in an outpatient pediatric practice. Results indicated that the PSC was well-accepted by parents and adequately tolerated by busy clinic staff. When the PSC was included as part of the standard procedure for well-child visits, the referral rate for psychosocial problems due to positive PSC scores rose to 12% from the clinic baseline referral rate of 1.5%, a significant increase ( P<.01). Half of the children who screened positive on the PSC had not been previously identified by their pediatricians as having psychosocial problems, and more than half had never received any psychological treatment. When implementation of the PSC was discontinued, the referral rate fell to 2%, a rate similar to baseline. The findings suggest that it is possible to incorporate the PSC into routine pediatric practice and that the PSC can help pediatricians identify and better serve children experiencing psychosocial difficulties. The study also suggests that further work is needed to understand the barriers to ongoing implementation.
Human Growth Hormone: A New Substance Of Abuse Among Adolescents?
Authors: Rickert Vaughn I. , Pawlak-Morello Claire , Sheppard Vicki , Jay M. Susan
Published: November 2007

It has been estimated that as many as 250,000 adolescents are using anabolic steroids (AS). Recently, anecdotal reports suggest that athletes may also be using human growth hormone (HGH). The purpose of the present study was to determine the following: 1) if adolescents in two suburban midwestern high schools (83% white, 14% Asian, and 3% black) were using HGH; 2) knowledge of its effects; 3) reasons for use; and 4) concurrent AS use. After we obtained informed written consent, 224 male and 208 female 10th-grade students were surveyed using a 15-item questionnaire. Of male students surveyed, 5% (n = 11) reported past or present use of HGH, and one female student reported use. Our data suggest that among male adolescents surveyed, a majority had heard of this substance, and 31 % of males reported knowing someone who was using HGH. Chi-square analysis found a significant association between AS and HGH use where seven AS users reported past or present use of HGH. Most HGH users were unaware of its side effects and reported first use between 14 and 15 years of age. No differences in sports activity, ethnicity, or age were found between users and nonusers of HGH.
Perceptions of Vaccine Efficacy, Illness, And Health Among Inner-City Parents
Authors: Keane Virginia , Stanton Bonita , Horton Lisa , Aronson Robert , Galbraith Jennifer , Hughart Nancy
Published: November 2007

A resurgence of measles in the past decade has focused attention on the limitations of current immunization programs, particularly for inner-city, low-income populations. As part of a larger study of immunization rates, we discussed perceptions of disease severity and vaccine efficacy, as well as the prioritization of the tasks of parenthood, with 40 parents of infants living in inner-city Baltimore to discover their beliefs about immunization. Vaccines were considered only partly successful; susceptibility to chickenpox after vaccination was repeatedly cited as evidence of vaccine failure. Fever was seen as a primary indicator of illness; thus, vaccines were believed to cause, rather than prevent, illness. Immunization was not considered a high-priority parental responsibility. These findings suggest future interventions be aimed at changing parental perceptions of vaccines as ineffective and of fever after immunization as an indicator of illness. Finally, immunizations should be made easily available, even during clinic visits for a child's illness.
What, Me Worry?
Authors: Kaufman Keith L. , Brown Robert T. , Graves Karen , Henderson Patricia , Revolinski Mary
Published: November 2007

Adolescence is generally regarded as a time of transition demanding considerable adaptation. Failing to successfully negotiate the developmental hurdles associated with this period can have serious physical and psychosocial consequences (e.g., teenage pregnancy, suicide, disruption of social relationships, poor school performance). Efforts to identify problems that adolescents typically experience have been useful in facilitating a better understanding of this developmental phase. However, the perceived concerns or worries of adolescents themselves have been neglected as an additional source of useful information. This study assessed the worries of 622 adolescents between the ages of 12 and 20 years on an 80-item self-report measure, the "Things That Worry Me" scale. Findings indicated consistent concerns related to terrorism, adolescents' self-esteem, parents' physical and mental health, and adolescents' dating and sexual relationships. Gender- and race-specific differences are discussed and implications for future research and clinical applications are offered.
Physicians' Attitudes Toward the Diagnosis And Management of Fever in Children 3 Months to 2 Years of Age
Authors: Ipp Moshe , Jaffe David
Published: November 2007

Ninety-seven primary-care physicians, including 73 family physicians and 24 pediatricians, were surveyed in order to ascertain their knowledge and attitudes regarding fever in children 3 months to 2 years of age. A rectal temperature between 37.0°C and 37.9°C was considered to indicate fever by 35% of physicians. Only 17% believed there was no danger from fever, while 12% believed that fever could cause brain damage. Seizures were considered a principal danger of fever by 49% of physicians, and 22% believed that brain damage could result from typical febrile seizures. While 70% chose relief of discomfort as the main purpose of antipyretic treatment, 30% would use temperature alone as an indication for antipyretics. It is concluded that although many physicians have an acceptable attitude toward the diagnosis and management of fever, a significant number still have exaggerated concerns.
Evaluation of Cavernous Transformation Of the Portal Vein by Magnetic Resonance Imaging
Authors: Glassman Mark S. , Klein Susan A. , Spivak William
Published: November 2007

We describe two children who underwent magnetic resonance imaging (MRI) as part of the evaluation of isolated splenomegaly after Doppler ultrasound was unable to identify the portal vein. The diagnosis of cavernous transformation of the portal vein and the normalcy of the biliary tract and hepatic architecture were confirmed by MRI. Because of the risks associated with computed tomography (CT) and angiographic evaluation of such patients, the use of MRI, a noninvasive modality, in the evaluation of pediatric patients requires further consideration.
Reevaluating the Impact of Video Games
Authors: Funk Jeanne B.
Published: November 2007

The evolution of the video game phenomenon is reviewed and contemporary data are presented. A survey assessing frequency and location of play and game preference was completed by 357 seventh- and eighth-grade students. In this middle-class sample, about two thirds of girls played video games at least one to two hours per week at home, but only 20% played in arcades. About 90% of boys played in the home and about 50% in arcades. Approximately half of preferred games were from one of two categories of violent games, while 2% of preferred games were educational. Parent education about the influence of the media should include recommendations to monitor game playing and influence game selection.
Prevalence and Characteristics of Blastocystis horninis Infection in Children
Authors: O'Gorman Molly A. , Orenstein Susan R. , Proujansky Roy , Wadowsky Robert M. , Putnam Philip E. , Kocoshis Samuel A.
Published: November 2007

Blastocystis hominis, a protozoan whose pathogenicity has been questioned, is sometimes found in the human gastrointestinal tract. We sought to determine the prevalence of Blastocystis in stool and to characterize clinical features of infection with Blastocystis in children. Forty-six (3%) of 1,736 patients undergoing fecal microscopy at Children's Hospital of Pittsburgh between January 1, 1985, and December 31, 1988, harbored Blastocystis. Of these 46 children, 75% had exposure to well water or had been in developing countries. Thirty-nine of the 46 (85%) experienced gastrointestinal symptoms, such as abdominal pain, diarrhea, vomiting, and weight loss. Blastocystis was the only parasite found in 35 of those 39 symptomatic children. Symptoms resolved within one month in 90% of patients receiving antiparasitic pharmacotherapy, but in only 58% (P <.04) of those receiving no therapy. We conclude that children infected with Blastocystis often experience gastrointestinal symptoms and that treatment increases the rate of symptomatic improvement. We speculate that Blastocystis is a human pathogen.
Status of Immunization and Iron Nutrition in New York City Homeless Children
Authors: Fierman Arthur H. , Dreyer Benard P. , Acker Peter J. , Legano Lori
Published: November 2007

A retrospective review of the hospital records of New York City children aged 6 months through 6 years showed that 63 homeless children had a higher rate of immunization delay than an age- and sex-stratified sample of 63 domiciled children living at the same federal poverty level. In a logistic regression model, this difference persisted after controlling for sex, age, ethnicity, presence of chronic illness, and reason for referral. In a 6-month- to 2-year-old subgroup, homeless and domiciled children had equal rates of anemia, but homeless children were more likely to have elevated erythrocyte protoporphyrin (EP) levels consistent with iron deficiency. This difference, too, persisted after controlling for the same confounding factors. Elevated EP levels and immunization delay were likely to coexist in the homeless children. The higher rate of immunization delay is compatible with the occurrence of measles outbreaks in some New York City shelters. The higher rates of iron deficiency may reflect overall poor nutrition. All these findings have significant implications for the design of health-care programs for homeless children.
The Association of Chiari Type I Malformation and Neurofibromatosis Type 1
Authors: Dooley Joseph , Vaughan Daniel , Riding Michael , Camfield Peter
Published: November 2007

The association of neurofibromatosis type 1 (NF1) with Chiari malformations of the cerebellum and brain stem has been reported on only two previous occasions.1,2 The pathogenesis of both conditions has remained unclear, although the Chiari type I malformation is most likely due to hypoplasia of the posterior fossa with subsequent extension of the cerebellum through the foramen magnum.3 NF1 is also associated with a variety of cerebral dysplasias.4 We present a patient with both of these dysplastic lesions whose Chiari malformation was asymptomatic.
Cadaver Renal Transplantation in Children
Authors: Tejani Amir , Fine Richard N.
Published: November 2007

In North America, about 50% of all renal transplants done in children are from a living-related donor source — a figure two and a half times greater than the comparative figure for Europe. Graft survival in children is lower for cadaveric donor (CD) than for living-related donor (LRD) kidneys. Four of 10 children with a CD kidney lose their graft within four years. Since it is unlikely that the availability of LRD kidneys will increase, attention must be focused on improving outcome of cadaver renal transplants in children. This review analyzes factors that affect graft outcome. Young recipient age, utilization of kidneys from very young donors, and cold ischemia time are detrimental to prolonged graft survival. Additional factors that impact adversely on cadaver graft survival are a history of previous transplantation, absence of a DR match, and black ethnic origin of the recipient. An understanding of risk factors to graft survival should enable physicians to optimize cadaver renal transplantation in children.
A Survey of Quebec Pediatricians' Attitudes Toward Donor Insemination
Authors: Sanschagrin Mary Lisa , Humber Elaine B. , Cumming Speirs Carol , Duder Sydney
Published: November 2007

Inspired by a study done in France, Quebec pediatricians were surveyed regarding their knowledge of children conceived by donor insemination (DI) and their families, as well as their attitudes and opinions about DI. A two-part questionnaire was mailed to all 487 members of the Quebec Association of Pediatricians. One hundred and ninety-seven (40%) responded. Findings indicate that Quebec pediatricians have treated few children conceived by DI and know little about how their families are handling the issue of DI. Most pediatricians favored telling DI offspring about their mode of conception, and almost half stated that such children, at maturity, should have the right to know their biological fathers. Their opinions reflect the growing trend toward openness in adoption and DI.
Rectal-Axillary Temperature Difference in Febrile and Afebrile Infants and Children
Authors: Anagnostakis Dimitris , Matsaniotis Nicholas , Grafakos Stelios , Sarafidou Emy
Published: November 2007

The rectal-axillary temperature difference (R-A) was measured in the morning, at midday, and in the afternoon on 1,519 occasions in 1,149 children from birth to 5 years old. Of these, 302 children were febrile (rectal temperature ≥38°C) and 847 were afebrile. A wide range in R-A was found for each individual in both groups. The magnitude of this difference was not associated with sex or age. In febrile children, the R-A was significantly greater ( P<.0001) at the apparent onset of fever (1.04 ± 0.25°C) than later, when fever had been present for at least two hours (0.53 ± 0.22°C). These findings indicate that it is impossible to find a standard number by which to convert axillary to rectal temperature or vice versa. Furthermore axillary temperature may be relatively low or even “normal” despite an elevated rectal temperature at the onset of fever.
Congenital Syphilitic Skeletal Manifestations in a Premature Infant Revisited
Authors: Ilagan Nestor B. , Weyhing Burt , Liang Keh-Chyang , Womack Sophie J. , Shankaran Seetha
Published: November 2007

Increasing rates of congenital syphilis have been reported in recent years despite the availability of adequate therapy. In our perinatal-neonatal center, approximately 1.5 % of newborns have reactive serologic tests for syphilis.1 Untreated or partly treated maternal syphilis can adversely affect neonatal outcome since the treponeme can cross the placenta at any time during pregnancy. 2 As a result of hematogenous placental transmission, neonatal manifestations are usually systemic and similar to the secondary stage of syphilis, and include hepatosplenomegaly, jaundice, neuro-syphilis, and skeletal changes. A case of early congenital syphilis in an extremely premature infant with primary skeletal involvement is presented.
All Children Are Special: The Child with PKU
Authors: Weaver Anna R. , Berlin Cheston A. , Roth Karl S.
Published: November 2007

The following is a letter written by Anna Weaver about her family, and especially about her children. The Weavers live in a rural part of Lancaster County, Pennsylvania, and have a long Mennonite heritage.
Correlating Changes in Body Temperature With Infectious Outcome in Febrile Children Who Receive Acetaminophen
Authors: Bonadio William A. , Bellomo Thomas , Brady William , Smith Douglas
Published: November 2007

We reviewed the body-temperature patterns of 140 children ages 2 to 24 months who had fever >39.0°C, received acetaminophen 10 to 15 mg/kg, and had their temperatures remeasured 60 to 90 min later. The children comprised three groups: 22 had bacterial meningitis; 59, isolated bacteremia; and 59, nonbacterial febrile illness. Percentages of patients who became afebrile (temperature < 38.0°C) after receiving acetaminophen were not significantly different among the three groups. Differences in mean temperature decrease after antipyretic was given were significant within each group but not between groups. An inverse relation (P < .004) between patient age and magnitude of temperature was revealed by the following formula: °C of defervescence = 1.66 -(0.028 x patient age in months). Thus, highly febrile young children with and without invasive bacterial infections who receive a therapeutic dose of acetaminophen experience a significant temperature drop after 60 to 90 min but do not commonly defervesce to an afebrile state. The degree of defervescence is age-dependent and does not distinguish between infectious outcomes.