bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Prostacyclin Infusion on Blood Pressure and Plasma Renin Activity in Patients with Essential Hypertension
Authors: Kato Tadashi , Yoneda Syunki , Koketsu Masaaki , Fujinami Takao
Published: November 2007

The effects of prostacyclin infusion (6.7 ± 2.7 ng/kg/min, 3 to 10 ng/kg/min) on blood pressure, plasma renin activity (PRA), and 6-keto-prostaglandin F1α (6-keto-PGF1α) were studied in 7 patients with essential hypertension (4 men and 3 women) with a mean age of fifty-eight ± eleven years (forty-six to seventy- four years). The baseline value of 6-keto-PGF1αfor patients with essential hypertension was not lower than in healthy subjects. Blood pressure immediate ly dropped following prostacyclin infusion. Systolic blood pressure returned to the baseline value after prostacyclin infusion was discontinued. However, di astolic blood pressure and mean arterial blood pressure were still significantly decreased thirty minutes after termination of infusion. Heart rate did not change during prostacyclin infusion but decreased significantly when infusion was ter minated. PRA was not significantly affected by prostacyclin infusion. The 6-keto- PGF 1αlevel was about 8 times higher than the baseline value thirty minutes af ter initiation of prostacyclin infusion and approximately twice as high as the base line value thirty minutes after termination of infusion. The decrease in mean arterial blood pressure coincided with the increase in 6-keto-PGF1α. There was no correlation between mean arterial blood pressure and PRA, nor between PRA and 6-keto-PGF1α.

These results demonstrate that production of prostacyclin is not reduced in patients with essential hypertension, and heart rate and PRA are not changed by prostacyclin infusion, although prostacyclin decreases blood pressure.
Left Ventricular Blood Flow Analysis in Patients With and Without a Thrombus After First Q Wave Acute Anterior Myocardial Infarction: Two-Dimensional Doppler Echocardiographic Study
Authors: Bhatnagar Sudhir K. , Razzak Al-Yusuf Abdul
Published: November 2007

The authors studied 80 consecutive patients with a first Q wave anterior myocardial infarction (MI) by 2-dimensional and color Doppler echocardiog raphy (echo), on day 3 and day 10 after admission, to determine whether left ventricular (LV) blood flow dynamics differ between those who develop LV thrombus and those who do not. With pulsed Doppler echo, peak flow velocities were measured in diastole at the inflow tract, at the apex in diastole and systole, and at the outflow tract in systole. There were 11 patients (14%) who had LV thrombosis on day 3. On day 10, no other patient developed a thrombus.

There was no difference in the Doppler flow velocities, except for lower api cal diastolic velocities (0.23±0.04 m/s) (±SEM) in patients with thrombus as compared with those without it (0.33±0.01 m/s) (p<0.05). All patients with thrombus had apical dyskinesis and 8 (73%) had an anteroapical aneurysm, while 40 (58%) patients without thrombosis had dyskinesis and 11 (16%) had an aneurysm (p < 0.01). The ejection fraction was lower (25.4±3.2%), the wall motion score was higher (10.6±0.7), and mitral regurgitation was seen more frequently (45%) in those with LV thrombus (respective values in no thrombus group patients: 32.9±1.4%, 7.6±0.3, 7%).

The authors conclude that LV thrombus prediction is difficult by Doppler flow velocity study, whereas dyskinesis and aneurysmal dilatation of the LV apex is significantly associated with thrombus.
Chronic and Acute Effects of Cigarette Smoking on Skin Blood Flow
Authors: Tur Ethel , Yosipovitch Gil , Oren-Vulfs Sheila
Published: November 2007

A laser Doppler flowmeter was used to assess blood flow changes in habitu al smokers, as compared with nonsmokers, where members of both groups were young and healthy. Acute and chronic effects of cigarette smoking were meas ured by using the cutaneous postischemic reactive hyperemia test. Basic flow was recorded in four sites: forehead, postauricular, forearm, and finger.

Recovery time from reactive hyperemia was longer in habitual smokers than in nonsmokers. Peak flow during reactive hyperemia was significantly lower af ter smoking. Basic blood flow during smoking did not show significant varia tion in the sites tested. The authors conclude that skin microvasculature is influenced by acute and chronic effects of cigarette smoking in young subjects; they discuss some of the possible mechanisms and their implications.
Pacemaker Malfunction Due to Subcutaneous Emphysema — A Case Report
Authors: Santomauro Maurizio , Ferraro Sergio , Maddalena Giovanni , Fazio Serafino , Covino Elvio , Pappone Carlo , Spampinato Nicola , Chiariello Massimo
Published: November 2007

The authors describe a case of pacemaker malfunction due to a critical in crease of impedance resulting from air entrapment in the pacemaker pocket.
Microcirculation in Systemic Hypertension
Authors: Cesarone Maria Rosaria , Laurora Giuseppe , Belcaro Giovanni V.
Published: November 2007

In 40 patients with idiopathic systemic hypertension, skin blood flow was evaluated with laser-Doppler flowmetry, transcutaneous measurements of partial pressure of oxygen (PO 2) and partial pressure of carbon dioxide (PCO2), and determination of capillary permeability before and after treatment with nifedipine (10 mg tid for four weeks). Also 35 normal subjects matched for age and sex distribution were studied.

Before treatment, microcirculatory studies showed a significant decrease in skin flow and venoarteriolar response in hypertensive patients in comparison with normal subjects. Moreover, PO 2, PCO2, and capillary permeability were significantly lower in hypertensives. All these microcirculatory parameters significantly increased after nifedipine treatment while both systolic and diastolic pressures decreased.

In conclusion, laser-Doppler flowmetry used with other microcirculatory techniques was able to discriminate between normal subjects and hypertensive patients, and it was able to show the improvement in the microcirculation after nifedipine treatment.
Vascular Effects of Noise
Authors: Tomei Francesco , Tomao Enrico , Baccolo Tiziana Paola , Papaleo Bruno , Alfi Pasquale
Published: November 2007

The possible vascular effects of noise were studied. A study of the carotid vessels was made with Doppler ultrasonography in two groups of subjects exposed to various intensity of noise. The following data were studied: age, blood pressure, serum cholesterol, blood glucose, smoking habits, excess weight, electrocardiographic anomalies, family history of vascular disease, connection with duration of exposure and the type of noise and with audiometric deficits, and cerebrovascular modifications after postural changes and after a stress test. The control group comprised subjects not exposed to noise. The findings confirm that noise does play a role in causing vascular modifications that can be detected early by use of Doppler ultrasonography. This technique is predictive and could be useful in screening campaigns, following the method suggested here.
Microangiopathy of Ethylic Polyneuropathy
Authors: Bilancini Salvino , Lucchi Massimo , Curri Sergio B.
Published: November 2007

The authors have studied, by biopsy of the tip of the big toe, the histologic changes in microvessels of patients affected by ethylic polyneuropathy. Patients affected by diabetes, hypertension, peripheral arterial or venous diseases, or dermatologic diseases or vasculitides were excluded. The mean of daily drinks was 310 ± 105 g of alcohol, chiefly wine. Important pathologic modifications were noted; complete narrowing of the arteriovenous anastomosis, regressive changes of the Vater-Pacini corpuscles, and dilatation of the small veins and the capillaries. The findings were compared with those of a patient affected by ulcerans and mutilans acropathy of Bureau and Barriere, a typical disease of alcoholics. The same characteristics appeared: profound changes of the structure of the smallest vessels, with sclerosis, extended to the interstitium. In a previous study of the authors, 3 other patients affected by Bureau-Barriere disease showed the same pattern. These alterations can be explained as the effect of alcohol on the microvessels.
Non-Beta-Adrenergic-Mediated Peripheral Circulatory Hyperkinesia in Hyperthyroidism
Authors: Valensi Paul , Simon Alain , Pithois-Merli Isabelle , Levenson Jaime
Published: November 2007

Systolic time intervals and brachial circulation, evaluated by pulsed Doppler in terms of arterial diameter, blood velocity and flow, and vascular resistance, were studied in 12 hyperthyroid patients and in 12 normal controls. In patients, arterial circulation was studied before and during mechanical exclusion of the hand, and hemodynamic measurements were repeated after beta-blocker treat ment and after obtainment of euthyroid state. Compared with controls, patients had higher heart rate (P < 0.001), lower systolic time intervals (P < 0.05, P < 0.01), and higher blood velocity (P < 0.05). Beta blockade decreased heart rate (P < 0.05, P < 0.001) but did not change systolic time intervals and arterial circulation. Euthyroid state decreased heart rate (P < 0.01), preejection period (P < 0.01), and blood velocity (P < 0.01) and flow (P < 0.05). The decreases in velocity and flow before hand exclusion when euthyroid state was obtained were correlated with hyperthyroid values of velocity and flow respectively (r = 0.85, r = 0.90, P < 0.01, P < 0.001). Vascular resistance during hand exclusion was correlated negatively with serum T3level during hyperthyroid and euthyroid states. Thus, thyroid hormones but not beta-adrenoreceptors participate in the peripheral hyperkinesia of hyperthyroidism.
Screening for Domestic Violence in the Pediatric Office: A Multipractice Experience
Authors: Siegel Robert M. , Joseph Evelyn C. , Routh Susan A. , Mendel Sandra G. , Jones Evelyn , Ramesh Radhika B. , Hill Teresa D.
Published: November 2007

The purpose of our study was to screen for domestic violence (DV) in 4 different pediatric practice settings. Women who accompanied their children to well-child visits were eligible. The women were screened with a 6-question tool previously piloted by our group, which included questions on partner abuse, child abuse, and pet abuse. Over a 1-year period, 435 women were screened. Of these women, 95 (22%) described DV at some point in their lives. Sixty-nine (16%) reported abuse longer than 2 years before the screen and 26 (6%) reported more recent abuse. While 11 of 117 women screened in the more affluent private practice reported a history of past abuse, no women in that group reported DV occurring within 24 months. The proportion of women reporting violence did not differ significantly by site, but the proportion of patients reporting new violence was significantly lower at the private practice site by Chi-square analysis. In conclusion, women screened in a variety of pediatric settings will disclose DV. Recent abuse is more likely to be reported in settings with indigent patients. All pediatricians should be screening for DV and have protocols in place to offer women the services they need if DV is revealed. Clin Pediatr. 2003;42:599-602
Relationship of Oxygen Consumption to Body Build and Maturation
Authors: Pryor Helen B.
Published: November 2007

Healthy boys and girls show marked differ ences in their need for or use of oxygen, depend ing upon their body builds.

Slender children use more oxygen per kilogram body weight per minute than broad built ones when matched for age and sex. This raises the question of biochemical individuality with body build as the selective factor.
Kernicterus Associated with Perinatal Asphyxia and Drug Therapy
Authors: Behrman Richard E.
Published: November 2007

Experimental studies suggest that a variety of factors play a role in the pathogenesis of kemicterus—protein-binding, acidosis, anoxia, hypoglycemia, etc. Certain drugs probably play a role also. At present, none of these factors are clearly enough defined or capable of quan titation even to the limited degree that is ac knowledged for the bilirubin level. However, their expressions are definite enough at this time to be considered when reaching what is still fundamentally a clinical judgment as to therapy in patients with hyperbilirubinemia in whom exchange transfusion is not clearly indi cated by the level of bilirubin alone or in com bination with blood type, hemoglobin, reticulo cyte count and Coombs test.

It seems clear that judgments about the safety of a drug for the fetus cannot be based entirely on experience with newborns or on experiments with newborn animals. The dan gers to a newborn infant which are inherent in a particular drug may be multiple and may not be fully known.
The Obese Adolescent
Authors: Massengale Oliver N.
Published: November 2007

Few patients can be as frustrating to the physician as the overweight teenager. Obesity is common among adolescents and can be as incapacitating to them as cancer or coronary disease is to older in dividuals. In addition to its influence on physical health, excess weight may ad versely affect social acceptance, school success, athletic participation and fam ily relationships. Here is one approach to this problem.
Review : Familial Dysautonomia: The Riley-Day Syndrome
Authors: Ginsberg Stephen P.
Published: November 2007

Although individual case reports had already appeared, it remained for Riley in 1949 to recognize the common clinical features of these and his own patients as a definite disease entity.

This is a review of that disease—the Riley-Day syndrome, or familial dysau tonomia. This report includes a summary of the clinical pattern, laboratory aids to diagnosis, differential diagnosis, current therapy and prognosis.
Project Head Start and the Pediatrician
Authors: North A. Frederick
Published: November 2007

Project Head Start is a program to pro vide educational health, nutritional, psycho logic and social services to pre-school chil dren who live in conditions of economic deprivation. By providing these in a co ordinated way that allows each service to extend and enhance the value of the other services, it hopes to provide an environment in which each child can achieve his full potential. In the process of meeting these goals, Project Head Start can provide new knowledge, new procedures, and new mod els for organization that can have a revo lutionary impact on the health, education, and welfare of all children, and of our whole society.
Erythroblastosis Fetalis
Authors: Reiquam C.W. , Beatty E.C. , Connell John R.
Published: November 2007

This article is recommended both as a solid contribution to the understanding of severe erythroblastosis fetalis and as a demonstration of how stimulating to future research can be the thoughtful correlation of clinical with postmortem data when trying to unravel a knotty pediatric problem.
Review : The Parasitic Diseases of Childhood
Authors: Kagan Irving G. , Fox Howard A. , Walls Kenneth W. , Healy George R.
Published: November 2007

The ubiquitousness of certain protozoan and helminth parasites and the increasing geographic mobility of individuals point up the need for an awareness of the role of parasitic infections in pediatric prac tice.

This paper (a) surveys the advances in diagnosis and clinical understanding of those parasitic diseases of children which are the most common in Northern tem perate climates—amebiasis, giardiasis, pin worm infestation, visceral larva migrans, toxoplasmosis, pneumocystosis—and (b) surveys the usefulness, specificity, and limitations of the newer serologic tests in the diagnosis and management of these diseases. Therapy is not stressed.

Because of the recent recognition of the significance of Pneumocystis carinii infection, this is considered in somewhat greater detail than its rarity might other wise warrant.
Poor School Achievement: A Psychiatric Study and Classification
Authors: Ross Donald C.
Published: November 2007

Over the past few years, the au thor has developed a classification of children's emotional disorders4 and, in Part I, has presented and discussed the place of school achievement problems in this classi fication. 5 A recapitulation of Part I will be found in the summary. The categories of the classification sug gest a direction of management.

Part II continues the analysis of the case records of the 162 con secutively referred children who are the subjects of these papers. It de scribes the treatment methods ap plied as determined by the classifi cation categories, the case manage ment decisions made at the end of the evaluation period, and the re sults of a two-year follow up study.

Case Management Methods
Headaches and Abdominal Pains in the Adolescent
Authors: Schildkrout Mollie , Shenker I. Ronald
Published: November 2007

"The underlying dynamics should be understood by the clinician who treats the adolescent."
Measuring Success in the Reduction of Obesity in Childhood
Authors: Alley R.A. , Narduzzi J.V. , Robbins T.J. , Weir T.F. , Sabeh G. , Danowski T.S.
Published: November 2007

"This is an age of justified pessimism concerning the probability of success in treating obesity in adults. It is worth emphasizing, therefore, that judging by weight and by ponderal indices, some measure of success, major or minor ... can be anticipated in about one-half of obese children and adolescents."
Niemann-Pick Disease in Two Moslem Children
Authors: Fakatselli N.M. , Delta B.G. , Araboglu N.S. , Hudaverdi E.Y.
Published: November 2007

Some refresher comments on the clinical, histopathologic and biologic characteristics of this rare morbid entity.
Bilateral Wilms' Tumor
Authors: Anderson E. Everett , Herlong James H. , Harper John M. , Small Michael P. , Atwill William H.
Published: November 2007

Wilms' tumors occur bilaterally often enough to make it mandatory to study preoperatively, from this point of view, every child with clear signs of such a le sion in one kidney.
The Order of St. John and Its Role in Modern Medicine
Authors: Galea Joseph , Fenech Frederick F.
Published: November 2007

The Order of the Knights of St. John has changed during the course of six centuries from a military as well as a medical Order into a sovereign, effectual health agency of world-wide scope. Its interests encompass every field of medicine and human welfare; its care is always generous, almost always given free and is rendered solely pro utilitate hominum.

A survey of the past history of this selfless Order is given in Clinical Pediatrics 6: 728, 1967. Here is a brief summary of current activities.
Current Feeding Practices in Hospital Maternity Nurseries
Authors: Meyer Herman F.
Published: November 2007

The most significant change to come into the newborn nursery in the more than 50 years since the central nursery system evolved is the use of disposables and unit packaging, including ready-to-feed milk mixtures in one-use containers.
Parental Presence and Emotional State of Children Prior to Surgery
Authors: Lee Jeffrey S. , Greene Nicholas M.
Published: November 2007

Among 144 pediatric patients, the presence of parents prior to elective surgery had no demonstrable favorable effect on the preoperative emotional state of children. Indeed, there was more crying among children whose parents roomed-in than among whose who had no parental contact. Children between one and five years old were significantly more anxious than children five to eight years old.
Local Management of Atopic Dermatitis in Infants and Children
Authors: Jacobs Alvin H.
Published: November 2007

Successful management of the child with atopic eczema calls for careful attention to the many facets of this complex condition. The physician must evaluate psychologic, environmental and dietary factors, in addition to offering a plan for the local treatment of the skin. Forty-six children were treated by a modification of the Scholtz regime. Results were good to excellent in 85 per cent. The essentials of this treatment program consist of stopping all soap and water baths, cleansing and lubricating the skin with a nonlipid lotion, and applying fluocinolone acetonide in a nonlipid vehicle.
Character of Placentation in Twins, as Related to Hemoglobin Levels
Authors: Abraham J.M.
Published: November 2007

Capillary hemoglobin values estimated simultaneously in liveborn partners of 86 pairs of dichorionic twins during the first week of life were comparable in the two partners. In 20 pairs of liveborn twins with monochorionic placentas the values were different, with the second-born having the higher hemoglobin concentration. This difference, which was small in the first hours after delivery but became greater later (12 to 24 hours), indicates that shunting of blood occurs during delivery. Because of the abundant and easily recognizable anastomoses this placentofetal transfusion is greater in monochorionic twins. Ergometrine injection immediately after delivery of the second twin may enhance this process. Estimations of venous hemoglobin in 17 dichorionic twins showed slightly higher values in the second-born partners. The corresponding capillary blood levels were an average of 2.5 Gm./100 ml. higher than the venous values.
Scleredema Adultorum
Authors: Campbell John B. , Virtue Clarence M.
Published: November 2007

The clinical course, laboratory findings and histopathology of scleredema adultorum in a four-year-old boy were typical. Temporary elevation of urinary chondroitin sulfuric acid was observed. The urinary findings and histopathology suggest the possibility that scleredema may be an "acquired" and transitory mucopolysaccharidosis.
Severe Complications in an Infant Due to Sickle-cell Trait
Authors: Ragab Abdel-Salam H. , Stein Mervyn R. , Vietti Teresa J.
Published: November 2007

Intravascular sickling with secondary damaging complica tions can take place in children heterozygous for sickle-cell anemia when dehydrated, acidotic and ill with an infection.
Needs and Technics for Counseling Parents of Young Children
Authors: Browder J. Albert
Published: November 2007

Experiences in infancy and early childhood are important in the development of individual intelligence and personality. Is there a practicing pediatrician who has not observed serious behavioral abnormalities develop because of poor child-rearing practices?
Simplified Method for Mass Screening for Lead Poisoning Based on δ-Aminolevulinic Acid in Urine
Authors: Hankin Lester , Hanson Kenneth R. , Kornfeld Joseph M. , Ullmann William W.
Published: November 2007

This new dipstick test offers a practical way to screen children repeatedly for possible lead ingestion. Children with positive results by this screening method may be followed up with more specific diagnostic and laboratory approaches.
Cystinuria and Dermatomyositis
Authors: Fawcett Nancy P. , Nyhan William L.
Published: November 2007

A girl is described who had both cystinuria and dermatomyositis. This associa tion, not previously recorded, may or may not be pathogenetically related.
Clinical Review : Thirty Years of Ritual Circumcisions
Authors: Schlosberg Charles
Published: November 2007

Thirty years of surgical and pediatric experience with more than 10,000 cases of ritual circumcision.
Should Every Newborn Infant Be Given a Coombs Test?
Authors: Browdy Sol
Published: November 2007

This report from a community hospital compares the laboratory results with the clinical findings in 1,300 cord blood specimens tested because of potential Rh or ABO mother-child incompati bility, as determined before birth by blood typing of the parents.
Bradycardia Preceding Apneic Attacks in Low-Birthweight Infants
Authors: DuBrow Ira W. , Chen Jackson W. , Wong Paul W. K.
Published: November 2007

Two premature infants had frequent episodes of prolonged apnea. The apneic spells were not due to the more commonly known causes of apnea in infancy, but were consistently preceded by severe bradycardia. Atropine or ephedrine produced favorable therapeutic results.

Since severe bradycardia may be a cause of sudden death in infants, its recognition and treatment is important in the management of apneic infants.
Antibiotic Susceptibilities of 120 Strains of Staphylococcus Aureus Isolated from Patients at a Children's Hospital
Authors: Yoshioka Hajime , Rudoy Raul , Riley Harris D. , Yoshida Keiko
Published: November 2007

The antibiotic sensitivities of 120 strains of Staphylococcus aureus isolated from both hospitalized patients and outpatients at Children's Memorial Hospital, Oklahoma City were studied. The proportions of strains resistant to the commonly used antibiotics were considerably lower than that found by other workers in earlier years, except for penicillin G. Of the 120 strains, 98 (81.7%) were resistant to penicillin G, 13 (10.8%) to tetracycline, 9 (7.5%) to erythromycin, and 3 (2.5%) to clindamycin. No strains resistant against cephalothin, chloramphenicol, gentamicin, or oxacillin were found. Sixteen strains (13.3 %), of which 5 were inpatient strains and 11 were outpatient strains, were found to be resistant to more than one drug. Phage group 1 or type 80/81 staphylococci were not found among multiple resistant strains from hospitalized patients.
Hemolytic Anemia and Edema as the Initial Signs in Infants with Cystic Fibrosis
Authors: Dolan Thomas F.
Published: November 2007

This is a report of five infants eventually proven to have cystic fibrosis of the pancreas, who presented with hemolytic anemia and edema. Since the sweat test is often unreliable in edermatous states, the possibility of cystic fibrosis should be considered. Use of either a protein hydrolysate or addition of pancreatic enzymes will improve nutritional status, and when edema disappears, a definite sweat test can be performed. Evidence of vitamin E deficiency in some of the cases is presented, and the possibility of this as a cause of anemia is raised.
Exploring the Physically III Child's Self-Perceptions and the Mother's Perceptions of Her Child's Needs
Authors: Samaniego Lupe-Rebeka , Caldwell H. Stephen , Nitschke Ruprecht , Humphrey G. Bennett
Published: November 2007

When dealing with the management of the dying patient and his family, systematic research has been very limited. Understanding the dying child's needs, as well as his family's, is important for appropriate therapy programs. The present study investigated the mother's awareness of her child's expressed and wanted needs in three areas of interpersonal relationships. It also studied the dying child's self-perceived needs and desires as com pared with those of children with a non-life-threatening illness and with those of well children.
The Clinical Profile of the Newborn with Persistent Pulmonary Hypertension
Authors: Drummond Willa H. , Peckham George J. , Fox William W.
Published: November 2007

In 19 neonates with severe cyanosis, normal chest x-rays, anatomically normal hearts, and a high incidence of perinatal complications, the clinical course was characterized by variable sustained cyanosis. Cardiac catheteriza tion data showed high systemic or suprasystemic pulmonary artery pressure with right to left intracardiac shunting via the foramen ovale and ductus arteriosus. Arterial oxygen tension at an inspired oxygen concentration above 65 per cent was helpful in distinguishing these patients from those with congenital heart disease, and for predicting prognosis.
School: Child Advocate or Adversary?
Authors: Brown George W.
Published: November 2007

Pediatricians who see many children with learning problems are likely to encounter situations caused by school misunderstandings. This essay includes examples of frightening labeling of children, direct cruelty at school, confused academic goals, and administrative bungling. Some possible remedies and practical suggestions are presented.
Gonococcal Infections in Young Children
Authors: Low R.C. , Cho C.T. , Dudding B.A.
Published: November 2007

Of 43 youngsters with gonorrhea, 11 were under 10 years of age. These 11 had in common atypical clinical presentation, marital disharmony of the parents, crowded living conditions; some had been abused sexually. Manage ment of gonorrhea in such young children may require a concerted effort by a team of medical, social, and legal personnel to meet the needs of this unique entity.
The Design of a Training Program for Adolescent Medicine
Authors: Buchta Richard M. , MacKenzie Richard G.
Published: November 2007

Program design for training in Adolescent Medicine is still in an evolution ary state. Postgraduate fellows and program directors have different percep tions with regard to the importance of various components of the ideal training program. Fellows indicate a higher priority for problems associated with the female reproductive system than do their mentors. Inpatient experience received lesser emphasis by the Fellows. Adolescent Medicine as a subspecialty discipline is discouraged.
Anaerobic Bacteremia as Observed in a Children's Hospital
Authors: Echeverria Peter , Smith Arnold L.
Published: November 2007

To ascertain the significance of anaerobic bacteremia in a children's hospital, the records of all patients whose blood cultures grew anaerobes during a 24- month period were reviewed. Anaerobes were isolated from 144 out of 1,126 blood cultures yielding bacteria. Anaerobic diphtheroid grew in 122 out of 143 anaerobic cultures, but only 4 out of 122 were isolated from patients with anaerobic sepsis. Nine per cent of the total episodes of anaerobic bacteremia occurred in 13 children who met out criteria for anaerobic sepsis; two or more blood cultures obtained within a three-day period growing anaerobic bacteria, or an aerobe and an anaerobe, in a febrile child or one with an apparent in fectious focus. Bacteroides accounted for 7 out of 13 (64 per cent) of the relevant isolates, while anaerobic diphtheroids 4 out of 13 (26 per cent) and anaerobic gram-positive cocci accounted for the remainder 2 out of 13 (18 per cent).

Only one infant, with polymicrobial bacteremia, died, suggesting that an aerobic bacteremia is associated with less mortality in children than in adults. Anaerobic sepsis occurred in children who have had recent abdominal surgery, or who are immunosuppressed.
The Malleability of Infant Motor Development
Authors: Solomons Hope C.
Published: November 2007

Tests with the Bayley Motor Scale were given to 288 infants, equally divided by sex, in Yucatan, Mexico. These were 2 to 54 weeks in age and came from three sociocultural levels. In comparison to USA infants, early acceleration of motor development was followed by a marked downward trend. This phenomenon, if observed in a single child, may indicate progressive neurologic disease. Child-rearing practices would appear to account for the difference in pattern of test performance.
What Makes Adolescent Girls Flee From Their Homes?
Authors: Reilly Peter P.
Published: November 2007

Fifty girls who were arrested in Boston on a charge of running away and their parents were studied via psychiatric interviews, rating schedules and psychotherapeutic data. There was an absence of psychosis and mental retarda tion in this group. A diversity of factors leading to running away episodes were elicited. Sexual factors were common. Family disturbances were usually found, reflecting in part the urban areas from which this group came. The girls showed a remarkable uniformity of behavior while on the run. Treatment of the whole family was often necessary for success in dealing with the runaway problem. The importance of intervention promptly is demonstrated by the associated self-destructive behavior of the girls, the frequency of severe family disturbances and the later histories of these youngsters.
Breast Masses in Adolescent Females
Authors: Goldstein Donald P. , Miler Veronica
Published: November 2007

The clinical records of 51 female patients between the ages of 8 and 20 years who underwent excision of breast masses at Boston's Children's Hospital Medical Center were reviewed. In most instances excisional biopsy using local or general anesthesia was performed on an ambulatory basis. Fibroadenomas account for the majority of breast masses (81.4%). There were no malignancies. Breast tumors in pediatric and adolescent populations are best managed by careful physical examination, careful follow-up, needle aspiration when feasible, observation and surgical excision of persistent, enlarging or sympto matic masses. Patient education and breast self-examination teaching are highly recommended. Excisional biopsy of unilateral subareolar masses in the early pubertal female should be avoided, since these usually represent a physiologically enlarged breast bud.
Comparison of Infant Mortality in the United States and Sweden
Authors: Wallace Helen M. , Goldstein Hyman , Ericson Anders
Published: November 2007

This study summarizes differences between Sweden and the United States regarding certain aspects of infant mortality. Sweden has the lowest infant mortality rate (IMR) and the United States is number 16. Both the neonatal and postneonatal mortality rates of Sweden are considerably lower. Since 1960, the neonatal mortality rate of Sweden was reduced by a greater percentage. The incidence of low birth weight in Sweden is considerably lower. In the United States, no state has an IMR as low as that of Sweden. Nonwhite babies, babies born out of wedlock, and those of teenage or "old" mothers have a higher IMR. The article describes in some detail the organization and network of ser vices in Sweden that may be playing an important role in Sweden's low IMR.
Adrenal Cortical Carcinoma in a 4-Year-Old Child
Authors: Lanes Roberto , Gonzalez Saul , Obregon Oswaldo
Published: November 2007

A case is reported of a 4-year-old female with an adrenal cortical carcinoma that developed at the site of a previously removed adrenal gland. Initially, the tumor was only virilizing, but with time, it also became the source of a large secretion of glucocorticoids and, to a lesser degree, mineralocorticoids. It is one of the largest and most functional tumors described in a child.
Congenital Hepatic Fibrosis with Gastrointestinal Bleeding in Early Infancy
Authors: Fiorillo Amedeo , Migliorati Roberta , Vajro Pietro , Caldore Mariano , Vecchione Raffaella
Published: November 2007

We report a case of a 19-month-old infant with congenital hepatic fibrosis. The clinical features consisted of portal hypertension with massive gastrointestinal bleeding, recurrent cholangitis, and cystic dysplasia of the kidneys, without im pairment of renal function. The dramatic course of the disease required surgical treatment. Congenital hepatic fibrosis with life-threatening gastrointestinal bleed ing is extremely rare below three years of age. The purpose of the present report is to stress the need of looking for varices in all cases of congenital hepatic fibrosis, even when occurring in early infancy.
Parents' Conception of Their Use of Over-the-counter Medicines
Authors: Ames J. Tim , Hayden Gregory F. , Campbell Robert E. , Lohr Jacob A.
Published: November 2007

To explore their hypothetical responses to management of fever or nasal congestion in their children, 109 parents were interviewed in a clinic waiting-room area. Most parents said they would medicate their children in these situations without first consulting a health professional. Parents were more willing to administer a drug product for fever than for nasal congestion, especially to children under 2 years of age. Although most parents selected appropriate medi cations for these situations, many were poorly informed about these drugs and falsely attributed germicidal and decongestant properties to aspirin and Tylenol®. Younger, less educated, indigent parents in lower-status occupations were the least well informed. Pediatricians need to prepare parents for their role as health care providers.
Comparison of Breast, Cow, and Soy Feedings in the Prevention of Onset of Allergic Disease
Authors: Gruskay Frank L.
Published: November 2007

It has been reported that the feeding of cow's milk may enhance the development of atopy in predisposed infants. A prospective study following children from birth through 15 years of age in a private pediatric practice was designed to determine if the food ingested during the first months of life is related to the development of atopy in the offspring of allergic families. Each of 328 children with a positive family history of allergy was assigned to one of three groups. according to the feeding preference of the parents: 48 were fed breast milk; 79, soy-based formula; and 201, cow's milk formula. All groups had egg, citrus, tomato, and wheat restrictions as well as inhalant allergen avoidance. These were compared to a control group of 580 children with no family history of allergy.

Breast fed infants were found to have approximately one-half the incidence of atopy of cow's milk or soy formula fed infants from atopic families when followed for up to 15 years. Soy feeding produced no advantage over cow's milk in the prophylaxis of allergic disease. There was a threefold increase in clinically apparent atopic disease in offspring of allergic families when compared to controls but only a two-fold increase if the infant was breast fed. These results support the hypothesis that breast feeding and delay of exposure to known allergens may reduce the frequency of clinical allergic disease in the offspring of allergic families.
Pharmacotherapy for Behavior Disorders
Authors: Gadow Kenneth D.
Published: November 2007

The parents and teachers of 100 children receiving medications (primarily methylphenidate) for behavior disorders (primarily hyperactivity) were questioned about widely recommended treatment practices. The results showed that (a) in the majority of cases, pediatricians were responsible for supervising drug therapy; (b) most parents were satisfied with their current physician; and (c) approximately one half of the children had three or more office visits per year. However, teachers were rarely asked to use standardized procedures to evaluate drug response, and direct contact between teacher and physician was all but nonexistent. There was a considerable degree of disagreement between parents and teachers concerning drug efficacy, dosage, and the need for medication; and parents appeared to exert a considerable degree of control over treatment-related decisions. In general, drug-free periods were not scheduled on a regular basis, and evidence for an integrated multimodal treatment approach was lacking. The findings suggest that variables other than a clinically determined response to medication are often the salient elements of the treatment-related decision-making process.
Lidocaine Toxicity from Topical Mucosal Application
Authors: Mofenson Howard C. , Caraccio Thomas R. , Miller Harvey , Greensher Joseph
Published: November 2007

A case is reported of an infant who experienced seizures while being treated with a topical lidocaine 2% solution (Xylocaine® 2% Viscous) for teething. The pharmacology of lidocaine is reviewed to alert physicians to the potential dangers of topical mucosal application of these preparations.
Perinatal Management of Major Gastrointestinal Anomalies Diagnosed by Maternal Ultrasound
Authors: Stringel Gustavo , Gillieson Martin , Muram David , Mercer Stanley
Published: November 2007

Antenatal diagnosis of intestinal obstruction was made in four cases by ultrasound. We discuss the perinatal management of major gastrointestinal anomalies detected in utero in this way.
Residential Treatment Centers in Europe for Children and Youth with Diabetes Mellitus
Authors: Rosenbloom Arlan L.
Published: November 2007

Residential centers for children with diabetes in Germany, Netherlands, Scotland, and Den mark were visited during 1979 and 1980 to determine applicability of this approach to North American needs. Information was updated in 1982 and data from France added. Duration of patient stay was from one month to many years. All of the centers sought to involve the family in rehabilitation. Direction varied from full-time physician to nonmedical; and involvement of nurses, psychologists, and social workers ranged from nil to intense. Professional staffing ap peared to have no direct relationship to success of the houses; rather, good results depended upon a committed staff providing love and even-handed discipline. No comparative studies are available to evaluate the cost-effectiveness of these houses, which had a per diem cost, excluding capital investment, of $31 to $90 per patient.
Mitral Valve Prolapse
Authors: Greenwood Ronald D.
Published: November 2007

Mitral valve prolapse is a common finding in the pediatric population. Five percent (154/3100) of pediatric patients had clinical evidence of mitral valve prolapse. A positive family history and minor abnormalities on electrocardiograms were frequent. The vast majority of patients were asymptomatic and exhibited a benign clinical course.
A Study of Treatment Resistance Among Children Referred for Encopresis
Authors: Landman Gary B. , Levine Melvin D. , Rappaport Leonard
Published: November 2007

This study reports on some of the distinguishing characteristics of children with persistent encopresis who have proven, at long-term follow-up, to be resistant to intensive pediatric-based treatment at a referral outpatient clinic. Resistant children differed from responsive children primarily in two respects: they tended to have less stool retention at initial presentation, and their accidents occurred at all hours of the day. Additional information suggested that early success or failure did not presage long-term resistance and that parents' attributions of the cause of their child's soiling were related to outcome. Discussion centered on enumerating important high-risk factors that signal the need for more intensive intervention and follow-up.
Telephone Encounters in a University Pediatric Group Practice
Authors: Villarreal Sylvia F. , Berman Stephen , Groothuis Jessie R. , Strange Virginia , Schmitt Barton D.
Published: November 2007

The records of off-hours calls received by the University of Colorado Pediatric Group Practice from 4:30 p.m. throughout 8:00 a.m. weekdays and all day Saturday, Sunday, and holidays were audited. An answering service and pageboy system ensured 24-hour, 7-day-a-week accessibility through a single telephone number. The four practices received 2386 after-hours calls from No vember 1978 to October 1980. An average of 104 calls per month were received with approximately four calls per day on weekday evenings and six calls per day on Saturday, Sunday, and holidays. Five concerns accounted for 49 percent of all after hours calls: fever, vomiting and/or diarrhea, upper respiratory infection (URI), earache, and rash. While 75 percent of families made fewer than four calls per year, 4 percent made at least 12 calls per year, accounting for 18 percent of all calls. Families calling three or more times a month were defined as "frequent users" and accounted for 22 percent of a given month's calls. Most calls from the same families (55%) occurred within a 24-hour period and dealt chiefly with parental concerns about fever, vomiting and diarrhea, URIs, ear infection, accident, and rashes. The additional responsibility that residents assume in taking calls for the Pediatric Group Practice while on other off-hour assignments was not excessively demanding, and cost of the answering service was easily absorbed by group practice revenues.
Efficacy and Safety of the "Integral" Phototherapy for Neonatal Hyperbilirubinemia
Authors: Granati B. , Largajolli G. , Rubaltelli F.F. , Pollazzon P. , Bottos M. , Sartori E.
Published: November 2007

One hundred and ten full-term newborns were treated with integral phototherapy (IP) in the first week of life for hyperbilirubinemia (peak bilirubin concentration, 19.5 ± 2.8 mg/dl). IP was provided by an apparatus which irradiated the infants over the entire skin surface with four visible blue light lamps placed around the body at a mean distance of only 20 cm. The irradiance of the lamps at the skin surface was 0.350 mW/sq cm, in the wavelength range between 425 and 475 nm. The IP resulted in a 48-hour bilirubin decline rate of 0.163 mg/dl/h. After a mean exposure of 78 ± 32 h, the mean plasma bilirubin level was 8.4 ± 0.8 mg/dl. One hundred and ten comparable nonjaundiced infants were studied as controls.

At 6 years of age, both groups of subjects were called for a follow-up concerning growth, visual, and hearing functions, and neuro-developmental status. The follow-up was completed in 81 children of the IP group (73.6%) and in 89 of the controls (80.6%). There were no significant differences in the studied parameters between the two groups. The study concludes that IP appears to be an effective and safe treatment for jaundiced infants. IP employs less radiant energy from the lamp source than the traditional apparatus, but delivers this energy to a larger skin surface area.
Effectiveness of a Health Education Program in a Lower Socioeconomic Population
Authors: Dershewitz Robert A. , Paichel Walter
Published: November 2007

When teaching home safety, we selectively highlight those hazards most likely to injure children at various developmental stages. In one of the few studies evaluating this approach, we successfully taught a middle class population appropriate home use of ipecac syrup. The study reported herein replicated that study in a lower socioeconomic population. Although learning occurred, statistical significance was not quite achieved.

While this study does not refute the "targeted" approach, it does demonstrate that characteristics of the population are likely to affect the educational outcome. Impressive statistical improvement may not be demonstrated. Individual realistic goals must be established prior to implementation and evaluation of a program.
Follow-up of Families of Neonates in Whom Life Support Was Withdrawn
Authors: Walwork Edward , Ellison Patricia H.
Published: November 2007

Grieving patterns and psychosocial functioning were studied in 20 families who had participated in a decision-making conference regarding withdrawal of support of their newborn in the neonatal intensive care unit and for whom the life support had been withdrawn. Prolonged grieving was reported by one father and pathologic grieving by one grandmother. In the majority of families, grieving patterns and psychosocial functioning were similar to those of other families whose newborns have died.
Opsomyoclonus and Neuroblastoma
Authors: Warrier R.P. , Kini R. , Besser A. , Wiatrak B. , Raju U.
Published: November 2007

Three cases of neuroblastoma with opsomyoclonus are reported, reconfirming favorable prognostic significance of the association. In one case, computed tomography of the abdomen was the only confirmatry diagnostic study. Two of the cases also were unusual in that the patients had a concomitantly inherited genetic disorder not known to be associated with childhood cancer.
Neonatal Factor XIII Deficiency
Authors: Landman J. , Creter D. , Homburg R. , Sirota L. , Dulitzky F.
Published: November 2007

We describe a patient diagnosed in the neonatal period as having factor XIII deficiency who presented with persistent umbilical bleeding. Factor XIII deficiency is the only coagulation factor deficiency that cannot be detected by classical hemostatic tests, and a rapid diagnosis is vital during the first decade of life. A newborn presenting with persistent umbilical stump bleeding should be screened for factor XIII deficiency when routine coagulation tests prove normal.