bluuebunny/crossref_metadata_2025 huggingface dataset:
Telford's Operation for Primary Palmar Hyperhidrosis
Authors: Gyftokostas Dimitrios , Koutsoumbelis Christos , Daskalakis Emmanuel , Bouhoutsos John
Published: November 2007

Bilateral upper dorsal sympathectomy via the supraclavicular approach was performed in 42 patients for palmar hyperhidrosis. In 16 patients (32 extremi ties) the effect of sympathectomy on digital circulation was evaluated objec tively, in comparison with that of 15 control subjects. Mean values of finger temperature and of digital systolic pressure increased by 6.9°C and 36 mmHg respectively after operation, whereas an increase of digital blood flow and a decrease of the time of the clearance of 99mTc by approximately 60% were re corded. Differences between preoperative and postoperative values and those of controls were statistically significant. Clinical results of treatment remain satis factory after a mean follow-up period of thirty-two months with no case of recurrence. Permanent decrease of plantar hyperhidrosis was recorded by 14 patients. The advantages of Telford's operation over other methods of upper extremity sympathetic denervation are discussed.
Hemostatic Abnormalities in Sneddon's Syndrome
Authors: Mayou Susan C. , Kovacs Iren B. , Ridler Colin D. , Kirby John D.
Published: November 2007

Sneddon's syndrome is a rare condition comprising widespread livedo retucularis and multiple episodes of transient cerebral ischemia. Treatment to date has been empirical. The hemostatic/thrombotic status of 4 patients with Sneddon's syndrome was studied by a unique technique, hemostatometry, which measures primary hemostasis (shear-induced platelet plug formation), the over all coagulation, and thrombolysis (dislodgment of the hemostatic plugs) from nonanticoagulated blood.

In all 4 patients, platelet reactivity, which shows itself in the initial phase of the hemostatic reaction, was enhanced. The overall hemostasis, in which the generation of thrombin by activated platelets plays the decisive role, was enhanced in 3 patients. Three of the 4 patients had hypercoagulation, and in 3, spontane ous thrombolysis was inhibited.

Treatment was commenced with aspirin and nifedipine, and patients were monitored both clinically and by serial hemostatometry over two years. One patient had one further transient ischemic episode; the other 3 remained asymptomatic. Thus, the observed clinical improvement correlated with im provement of the hemostatic profile.
The Antihypertensive and Cardiac Hemodynamic Effects of Nebivolol
Authors: DeCrée J. , Van Rooy P. , Geukens H. , Haeverans K. , Verhaegen H.
Published: November 2007

Acute, subacute, and chronic treatment with nebivolol, a novel β1-selective adrenergic antagonist, significantly lowered systolic and diastolic blood pressure and heart rate in patients with essential hypertension. No orthostatism and bradycardia were reported. A comparison between a normal control group and 23 hypertensive patients revealed that the ratio between the preejection period (PEP) and the left ventricular ejection time (LVET) of the systolic time inter vals (STI) was significantly increased in the hypertensive patients, owing to a prolongation of the PEPc (PEP corrected for heart rate). Treatment with ne bivolol 5 mg once a day significantly improved the PEP/LVET, in acute condi tions from 0.42 ± 0.023 to 0.39±0.018, after one month of treatment from 0.40 ± 0.013 to 0.36 ± 0.013 and after one year of treatment from 0.41 ± 0.012 to 0.36 ± 0.010, owing to a significant shortening of the PEP c. There was no correlation between changes of blood pressure and changes of STI.

Diastolic dysfunction is an early finding in hypertension and may well be reflected in the prolongation of the PEPc. The improvement of left ventricu lar performance, as measured with STI, suggests that treatment with nebivolol may favorably influence the underlying diastolic dysfunction and be of therapeutic value for hypertensive patients with left ventricular damage.
Diagnosis of Pulmonary Arteriovenous Malformation by Ultrafast Chest Computed Tomography in Rendu-Osler-Weber Syndrome with Cerebral Ischemia—
Authors: Love Betsy B. , Biller José , Landas Steve K. , Hoover William W.
Published: November 2007

Pulmonary arteriovenous malformations occur in 15-20% of patients with Rendu-Osler-Weber syndrome and can be the source of paradoxical emboli caus ing cerebral ischemia, septic emboli leading to brain abscesses, or polycythemia causing hyperviscosity and cerebral ischemia. The diagnosis of these malforma tions may be elusive, since classic clinical or radiologic findings may be absent in some patients. The authors report a patient with Rendu-Osler-Weber syndrome with cerebral ischemia who had normal findings from a pulmonary examina tion and chest roentgenogram. An ultrafast computed tomography scan of the chest demonstrated, however, a pulmonary arteriovenous malformation in the right upper lobe that was successfully resected. Ultrafast computed tomography of the chest is a relatively noninvasive method of screening for a pulmonary ar teriovenous malformation in a patient with Rendu-Osler-Weber syndrome and otherwise unexplained neurologic symptoms.
Short- and Long-Term Comparative Study of Anistreplase Versus Streptokinase in Acute Myocardial Infarction
Authors: Silber Haim , Hausmann Michael J. , Katz Amos , Gilutz Harel , Zucker Nili , Ovsyshcher Ilya
Published: November 2007

Streptokinase is well established as an effective thrombolytic. Anistreplase, a new thrombolytic drug, is a complex of streptokinase and acylated human plas minogen that can be administered by intravenous bolus and activates plasmino gen at the clot site. Although both streptokinase and anistreplase are effected in treating myocardial infarction (MI), they have different pharmacologic proper ties. This study was designed to identify short- and long-term differences in their clinical effectiveness, safety in use, and survival rates in patients with acute MI.

One hundred ten successive patients under seventy years of age admitted within three hours after onset of sustained chest pain suggestive of acute MI were randomized to receive either 30 units of anistreplase intravenously over five minutes or intravenous injection of 750,000 units of streptokinase over thirty to sixty minutes.

Reperfusion was achieved in 34 of the 52 (65%) patients treated with anis treplase and in 41 of the 58 (71%) patients treated with streptokinase (p = NS). The two drugs were equally effective in preserving left ventricular ejection frac tion, which was found to be significantly better in patients with anterior wall MI who had achieved reperfusion than it was in those who did not (p < 0.02). One-month, twelve-month, and thirty-six-month survival rates were high (96% to 88%) with no significant difference between the two treatment groups.

The authors conclude that the two drugs are equally effective thrombolytic agents but that anistreplase has the advantage that it can be administered as a bolus injection.
Effect of Cardiac Dysfunction Upon Diastolic Cerebral Blood Flow
Authors: Gomez Camilo R. , McLaughlin James R. , Njemanze Philip C. , Nashed Ashraf
Published: November 2007

The transcranial Doppler (TCD) studies performed in 54 patients with various forms of cardiac dysfunction were reviewed and the results compared with those of normal individuals. There were 4 patients with aortic insufficiency, 5 being treated by intra-aortic balloon pumps, 12 patients with atrial fibrillation, 11 with syncope, and 22 undergoing cardiopulmonary resuscitation. In all instances, significantly low or even absent diastolic cerebral perfusion was found. The importance of this parameter, in the future evaluation and management of similar patients, is discussed.
Coronary Angioplasty in Patients with Previous Coronary Artery Bypass Grafting
Authors: Unterberg Christina , Buchwald Arnd , Wiegand Volker , Kreuzer Heinrich
Published: November 2007

Between 1982 and 1990, in 134 patients with prior coronary artery bypass grafting and recurrent angina, repeat coronary angiography and balloon angioplasty of stenoses in grafts or native arteries were attempted. Mean age of grafts was 45.6 months, range three days to twelve years. At the time of angioplasty, 6 patients had one-vessel-disease, 33 had two-vessel-disease, and 95 had three-vessel-disease. A total of 182 lesions were dilated: 55 venous grafts, 3 internal mammary artery grafts, and 124 native vessels. Forty-nine of 55 (89%) venous grafts could be successfully dilated, and in 3 internal mammary artery grafts, a stenosis reduction > 50% was achieved. In 65 of 88 (74%) grafted native arteries, dilation success was achieved. Twenty-seven of 36 (75%) patients with prior bypass surgery to other arteries had successful angioplasty of nongrafted native arteries. Three patients underwent emergency bypass surgery after dissection and acute occlusion: one of them died in cardiogenic shock secondary to acute myocardial infarction. The angiographic success rate in grafts was slightly higher than in native arteries (90% vs 74%).

These data indicate that percutaneous transluminal coronary angioplasty in patients after bypass surgery is possible at a low risk (3%) and constitutes an effective therapy in symptomatic patients.
Effects of Alternately Aligned Static Micromagnetic Fields on Intravascular Endothelial Lining
Authors: Matsumoto Hiroshi , Kira Kazuaki , Kondoh Kensuke , Hiramatsu Ken
Published: November 2007

Effect of alternately aligned static micromagnetic fields on intravascular en dothelial linings were investigated in 32 common carotid arteries of mongrel dogs. Endothelia of bilateral carotid arteries were mechanically denuded 5 cm in length, and as a general rule, 1 denuded artery was wrapped by a 1- or 5-cm-long film of alternately aligned static micromagnetic fields with 250 gauss/cm 2 and the artery on other side (control) was not wrapped. The arteries were excised at weeks 1, 2, 3, 4, 5, 6, and 8 after endothelial denudation in order to examine the in traluminal surfaces of the distal, intermediate, and proximal portions of the speci men by light and scanning electron microscopy. Histopathologically, all the distal and proximal portions in each group were well lined with endothelium. There was, however, a significant difference between the experimental and control groups in the endothelial regeneration of the intermediate portion. Endothelial coverage of the serial specimens of the experimental group was found to occur earlier than that of the control group. Alternately aligned static micromagnetic fields accelerated the intravascular endothelial linings.
Digoxin-Like Immunoreactive Substance in Urine of Patients with Mucocutaneous Lymph Node Syndrome (MCLS)
Authors: Tamura Hiroshi , Shimoyama Sadatoshi , Sunaga Yasuo , Sakaguchi Masao , Kuroume Takayoshi
Published: November 2007

Levels of digoxin-like immunoreactive substance (DLIS) and dehydroepian drosterone sulfate (DHEA) in urine from patients with mucocutaneous lymph node syndrome (MCLS) were measured by radioimmunoassay. Because DLIS of stored samples was often below the level of detection by conventional immu noassay, the authors used 80% ammonium sulfate and extraction with phos phate buffer and then 80% hot ethanol. To study the origin of raised levels of DLIS in urine, the synthesis of DLIS by cultured human umbilical vein endothe lial cells (HUVEC) was tested in vitro. The correlation between DLIS and DHEA levels was not significant. Mean levels of urinary DLIS corrected for creatinine in the patients with MCLS were significantly higher than in both normal and diseased controls. The culture medium of HUVEC was found to contain DLIS activity. These results show that MCLS should be added to the clinical states associated with an increased urinary concentration of DLIS and that the endothelial cells are one source of DLIS in man.
Role of the Captopril Test in Renovascular Hypertension: A Case Report
Authors: Nortier J. , Wautrecht J.C. , Delcour C. , Schoutens A. , Dereume J.P.
Published: November 2007

This article reports the case of a rapidly severe stenosis of the right renal artery, causing uncontrolled hypertension. After failure of a percutaneous transluminal renal angioplasty, which provoked the thrombosis of the vessel, a surgical revascularization was performed after ± eighteen hours of renal ischemia. Blood pressure, blood urea nitrogen and serum creatinine returned to normal values. A dramatic improvement of the right renal function was attested at the hippuran scintigraphy after a dose test of captopril. The results of renographic studies obtained in this clinical case underline the role of the captopril radionuclide test in detection and follow-up after treatment of renovascular hypertension.
Pulmonary Artery Catheterization: The Right Heart Should not be Left Out—A Case Report
Authors: Cook Deborah J. , Davis Stacy F. , Barr Juliana A. , Pearl Ronald G.
Published: November 2007

Tricuspid valve stenosis in the setting of endocarditis is associated with a high morbidity. Diagnostic approaches incorporate a high clinical index of suspicion, echocardiographic evidence, and inferences about hemodynamic data derived from pulmonary artery catheterization. As demonstrated by the case presented herein, inadequate initial evaluation of right-sided pressures delayed the diagnosis and treatment of prosthetic tricuspid valve stenosis.
Preventive Services: Blood Pressure Checks at Well Child Visits
Authors: Moran Colleen M. , Panzarino Valerie M. , Darden Paul M. , Routt Reigart J.
Published: November 2007

The objective of this study was to determine rates of blood pressure (BP) screening at well-child visits as recommended by the Task Force on Blood Pressure Control in Children. The 1985 and 1996 National Ambulatory Medical Care Surveys were analyzed for changes in proportion of well visits for children aged 3-18 years at which BP was checked. Patient and physician demo-graphics are described. BP screening increased from 50% in 1985 to 61 % in 1996. For pediatricians, the estimates were 50% (95% CI, 43-57) and 60% (95% CI, 53-68). For family/general medicine the estimates were 51% (95% CI, 34-69) and 58% (95% CI, 43-74). Age, geographic location, and length of a visit were significant in predicting BP screening. Gender, race, ethnicity, or urban location were not. A stepwise logistic regression confirmed these results. Rates of screening BP at well-child visits have increased but fall short of current recommendations. High-risk children are not screened at a rate different from their lower risk peers. Clin Pediatr. 2003;42:627-634
Infantile Scurvy
Authors: Grewar David
Published: November 2007

Though easily recognized clinically, infantile scurvy is often missed.
Abnormalities of the Urinary Tract
Authors: Quillian Warren W.
Published: November 2007

This communication deals primarily with clinical problems of the urinary tract familiar to those engaged in the general practice of pediatrics. The observations and comments represent experiences ob tained through repetitive cases encoun tered by the author over a period of many years.
Childhood Status Asthmaticus
Authors: Lecks Harold I. , Wood David , Kravis Lillian P.
Published: November 2007

The complications of bronchial asthma are increasing. This paper presents clini cal and laboratory data obtained from a group of children admitted in status asthmaticus to Children's Hospital of Philadelphia and describes in detail the program of management which emerged from study of these data. Speculations are also made regarding the pathophysi ology of this illness.
Homosexuality and the Pediatrician
Authors: Shearer Marshall
Published: November 2007

Homosexuality is a psychiatric syn drome which begins in childhood. By rec ognizing some of the predisposing factors early, and then using his influence and knowledge to work towards their correc tion, the pediatrician can often play a ma jor role in preventing its development.

Homosexuality must be looked upon as the illness which it is. It is not just a "different way of life."
Martha May Eliot, M. D
Authors: Bierman Jessie M.
Published: November 2007

My introduction to Martha Eliot came early in my career in Public Health. It was in the summer of 1936, shortly after I had joined the staff of the Montana State Board of Health as Maternal and Child Health Director. The effects of the depression were still being felt, multiplied by eastern Montana's eighth year of drouth. There were no crops, cattle were dying for lack of feed, and the temperatures soared in the 100's. A telephone call soon came from Washington. It was Dr. Eliot of the Children's Bureau asking how the children were far ing in the eastern counties. She informed me that Dr. Doris Murray of the Children's Bureau staff would arrive the following week to help me do a survey.
Wheezing Associated With Respiratory Tract Infections In Children
Authors: Freeman Geraldine L.
Published: November 2007

This paper reviews the known relation ships of common acute bacterial and viral respiratory infections to the asth matic state and to wheezing attacks in children. Implications for treatment are discussed in view of what has already been learned and what we need to know.
The Kurdistani Cradle Story
Authors: Bloch Aaron
Published: November 2007

Israeli immigrants from Iraq tie their infants into the Kurdistani cradle, a low wooden rocking bed, from birth until they are ready to walk. Movement is impossible. Is this a danger to children? What are the public health aspects of this custom?

A pediatrician tells the fascinating story of his search for an swers to these and related questions. It is a classic example of the impact of modern preventive medicine upon traditional child-rear ing customs.
Medical Counseling of Parents of the Retarded
Authors: Solomons Gerald , Menolascino Frank J.
Published: November 2007

Expansion in comprehensive programs for the chronically handicapped, and the multidisciplinary approach to evaluation, have produced problems in communica tion, not only among the professional dis ciplines concerned, but between the pro fessionals and the families seeking help. The time, expense and effort involved in the evaluation of a mentally retarded child can be largely wasted if the explanation to the parents is either inadequate or not understood. The initial interpretation in terview is particularly crucial to all fur ther treatment and habilitation attempts, and in this regard the "primary physician" is probably the most important individual the family will meet.

Guidelines for counseling the parents of the retarded are outlined.
Chronic Paronychia in Children
Authors: Stone Orville J. , Mullins J. Fred
Published: November 2007

Thumb-sucking is the most frequent predisposing factor of chronic paronychia in children.

There are two basic components in chronic paronychia. One is a pocket which holds moisture and allows the sur vival of many different organisms. The other is an anatomic deformity of round ing out and retraction of the posterior nail fold because of foreign material in the dermis. The dermal change with the subsequent rounding out and retraction assures the continuing presence of the pocket.

Chronic monilial disease usually local izes at sites of pre-existing defects. Mo nilia contribute to the disease process by irritation on the surface and by penetra tion of debris into the dermis. This debris stimulates chronic inflammation which in turn often aggravates the original defect.
Pseudo-intestinal Obstruction
Authors: Ramanathan K. , Grossman A.
Published: November 2007

Intestinal paralysis in the newborn without any demonstrable anatomic ab normality of the gastro-intestinal tract 1-3 is a disorder which closely resembles symptomatic aganglionosis, but the pres ence of normal ganglion cells and its association with low birth weight dis tinguishes one from the other. No satis factory explanation for the syndrome is available.

This paper describes such a case.
Postrubella Thrombocytopenic Purpura
Authors: Staub Henry P.
Published: November 2007

Just as after measles and chickenpox, ru bella in children may be followed by acute transitory thrombocytopenic purpura from bone marrow injury. All eight children here described made uneventful recoveries, and this is the usual pattern.

Specific epidemiologic inquiries and per haps even serologic studies for rubella should be done when a child experiences an attack of acute thrombocytopenic pur pura with no obvious inciting cause.
The "Thumb Sign" in Children
Authors: Feingold Murray
Published: November 2007

Protrusion of the thumb beyond the clenched fist is almost always found in chil dren with Marfan's syndrome.

In a random pediatric population studied, 1.1 per cent of the whites and 2.7 per cent of the Negroes had this finding but not the syndrome. Hence the sign has limited value as a screening test.

Because the sign is not present in homo cystinuria it may be clinically useful in dis tinguishing between this condition and Mar- fan's syndrome.
Office Examination of Palatopharyngeal Function
Authors: Bloomer H. Harlan , Wolski William
Published: November 2007

A functional palatopharyngeal valve is es sential for the production of normal speech. Any malfunctioning of this valve, as indi cated by hypernasality, hyponasality, or im paired speech intelligibility, warrants careful examination and diagnosis.

For a complete study of the palate and its associated tissues one needs a specialist, but simple procedures for identification of palatopharyngeal dysfunction can be car ried out by the physician in general practice. These procedures include evaluation of speech, visual examination of the palate and nasopharynx, digital palpation of the hard and soft palate, soft tissue x-ray films of the head, and the use of readily obtainable in struments such as a steel mirror, stethoscope, and spirometer. Patients who have inade quate palatopharyngeal function and abnor mal speech should be referred for special examination and treatment.

This paper identifies some of the causes of palatopharyngeal dysfunction, describes the procedures which can be used in its detection, and suggests referral sources avail able for special consultation.
Calcium and Phosphorus Levels in Submaxillary Saliva
Authors: Mandel Irwin D. , Eriv Alfred , Kutscher Austin , Denning Carolyn , Thompson Robert H. , Kessler Walter , Zegarelli Edward
Published: November 2007

The provocative finding of higher than normal levels of submaxillary calcium and phosphorus in asthmatic children, and the repeated demonstration of abnormally elevated levels in cystic fibrosis, suggest a potentiany important line of investigation into the basic pathogenesis of these diseases.
Encopresis
Authors: Silber David L.
Published: November 2007

The child with fecal incontinence tends to be resented by his parents, ostracized by his peers, condemned by his teacher, and is frustrating to his physician. There have been numerous studies of this subject in recent years, but information and practical suggestions on therapy are not readily available to the practitioner.
Congenital Cystic Adenomatoid Malformation of the Lung
Authors: Parodi-Hueck Luis , Densler James F. , Reed Richard C. , Poulos Peter , Shulman Murray W.
Published: November 2007

A newborn infant with congenital cystic adenomatoid malformation of the lung was treated successfully by resection of the affected lobe. This case plus 39 others reported in the English literature are reviewed here.

Early diagnosis and early resection of the involved lobe or lobes are important.
The Sexually-Molested Child
Authors: Parisi Eaton Antoinette , Vastbinder Earl
Published: November 2007

Here is a modern, pediatrically-oriented approach to this touchy medical-legal-social problem. Included is a valuable checklist of what the physician should do when an alleged sexually-assaulted child is presented to him.
Our American Educational System
Authors: Kay Robert E.
Published: November 2007

"The main thing they teach us in school is how to be good niggers, obey rules, dress in our uniforms, play the game, and 'NO, Don't be UPPITY!' Oh, we're trained for participating in 'the democratic process'-we have our student governments, but they can only legislate about basketball games and other such meaningful topics. Don't mention the curriculum—they'll tell us what to learn! Oh, we can express our complaints in the school newspaper, but the principal says what gets printed. 'Don't embarrass the school's reputation!' Not only are we forced to attend school in the first place, but we have to carry I.D. cards all the time, walk on the right side of the hall, and if the teacher doesn't want us to, we can't even take a leaks!"—From a high school underground newspaper.
Rapid Detection and Identification of Mucopolysaccharides in Urine
Authors: McDonald T.P. , Lozzio Carmen , Lotkin Pauline
Published: November 2007

This technic decreases the time required for MPS (mucopolysaccharide) testing, and per mits quantitative measurement of urinary MPS without the need for elaborate electrophoretic and chromato graphic equipment. The method, if supplemented by a differential chromato graphic study, helps identify specific fractions of the MPS components. These two screening methods are useful for confirmation of clinical diagnosis of various mucopolysaccharidoses.
Syndrome of the Abandoned Small Child
Authors: Kushnick Theodore , Pietrucha Dorothy M. , Kushnick Judith B.
Published: November 2007

The demographic, social and clinical phe nomena which attend the medical care of abandoned children in a municipal hos pital are sufficiently distinctive and repeti tive to warrant the pattern being viewed as a medico-social entity or syndrome.
Clinical Review : Milk Allergy in Infants and Young Children
Authors: Freier S. , Kletter B.
Published: November 2007

Milk allergy can be overcome easily if one develops a high index of suspicion which leads to early diagnosis. Avail able treatments make the outcome uniformly successful.
Parental Attitudes and Their Influence on the Medical Management of Diabetic Adolescents
Authors: Lahood Barbara J.
Published: November 2007

Competent professional assistance can meet the challenges of keeping parents and patients on a stable and sound emotional course as the diabetic adolescent grows up.
What the Pediatrician Should Know About Children's Teeth
Authors: Emergencies I. Dental , Bernick Sheldon M.
Published: November 2007

At the request of the editors of CLINICAL PEDIATRICS, Dr. Bernick is writing a series of articles on pediatric dentistry, de signed to inform pediatricians about current dental technics use ful in children. We hope that through this series, the ties be tween pedodontists and pediatricians will become stronger and more fruitful from the standpoint of good patient care.— Editor
Epidemic and Endemic Pattern of Childhood Nephritis
Authors: McDowall M.F. , Ramkissoon R. , Bassett D.C.J.
Published: November 2007

More than 800 children with acute glomerulonephritis were ad mitted to one hospital in Trinidad during three and one-half years. In the first 15 months the disease was epidemic. The illness af fected chiefly the children of the rural poor, with most cases at tributable to streptococcal infection of the skin rather than of the respiratory tract. In signs, symptoms and clinical course, the dis ease in Trinidad resembled closely the acute glomerulonephritis which follows streptococcal pharyngitis in temperate climates.
Bilateral Femoral Dysgenesis
Authors: Bailey Joseph A. , Beighton Peter
Published: November 2007

Three patients with bilateral femoral dysgenesis are described, and the pathogenesis and clinical significance discussed. Af fected patients are often surprisingly agile, but surgery may be required for painful hips or to remove portions of poste riorly projecting femurs if these cause discomfort on sitting.
Sleep and Sleep Disturbances in Young Children
Authors: Battle Constance U.
Published: November 2007

A pragmatic survey of what goes on during normal sleep, as related to sleep disturbances and sleep problems.
Medullary Carcinoma of the Thyroid
Authors: Sturtz George S. , Brown Robert B.
Published: November 2007

Medullary carcinoma of the thyroid occurred in a young girl with an unusual facies, neuromas of the lips and tongue, bilateral pes cavus and a slipped capital femoral epiphysis. These abnormalities may rep resent the phenotypic manifestations of a single gene. Patients with this type of face and lips or any of the other findings should be followed carefully for the presence of thyroid and adrenal tumors.
Cerebral Arteriovenous Fistula Producing Tem porary Heart Failure in a Newborn Infant
Authors: Sunderland Cecille O. , Morgan Clarence L. , Lees Martin H.
Published: November 2007

Cerebral arteriovenous malformations producing heart failure in in fancy with or without neurologic manifestations are usually fatal. This infant with a large cerebral arteriovenous fistula exhibited severe heart failure at 12 hours of age, yet never had any neurologic abnormality. His heart failure regressed with medical management. At 20 months of age the only abnormality on physical examination was a cranial bruit. An arteriovenous fistula anywhere in the body can cause conges tive heart failure in infancy, even in the absence of localizing symptoms.
Problems with Contraception in Adolescents
Authors: Johnson Lois B. , Burket Robert L. , Rauh Joseph L.
Published: November 2007

Contraceptive methods of all types have their highest failure rates in young or nulliparous females. This paper describes ex periences with intrauterine contraceptive devices in adolescents.
Acute Hematogenous Osteomyelitis in Infancy and Childhood
Authors: Ek Johan
Published: November 2007

An analysis of the clinical and laboratory expressions of this dis ease, based on observations of 85 affected infants and children.
Epidemic Glomerulonephritis in Hawaii
Authors: Bell Thomas D.
Published: November 2007

In this epidemic of acute glomerulonephritis in Hawaii 71 per cent of the children had a preceding streptococcal infection. While this precursor was pharyngitis in the majority, impetigo seemed an equally important source. Early antibiotic administration attenuated ASO titers and seemed to be beneficial. Many of the clinical findings resembled those of pre viously reported glomerulonephritis epidemics associated with impetigo.
Renal Cysts in Childhood
Authors: Hoeffel J.C. , Jacottin G. , Bourgeois J.M.
Published: November 2007

Primary renal cysts in children are extremely vari able. Each entity has a distinctive radiologic pattern.
Several Examples of Mysterious Fevers
Authors: Ziai Mohsen
Published: November 2007

The child with persistent or recurrent fever can present a great diag nostic challenge. Being thorough when taking the history, carrying out the physical examination and then evaluating all the findings includ ing those of the indicated laboratory tests will usually throw sufficient light on the situation to facilitate the formulation of a diagnosis. Fol lowing are some examples:
Cardiology Review : The Medical and Surgical Management of Patients with Congenital Heart Disease
Authors: Friedberg David Z. , Litwin S. Bert
Published: November 2007

Today, techniques for diagnosis, medical preparation, and definitive surgical repair are available for most cardiac anomalies, if needed. These permit successful treatment and carry a low mortality. Such children can now be expected to lead normal and meaningful lives as contributors to society.

When serious symptoms occur in infancy, as discussed herein, an emer gency exists and prompt diagnosis and treatment are mandatory for survival.
The Problem of Trisomy 22
Authors: Zellweger Hans , Ionasescu Victor , Simpson Jane , Burmeister Leon
Published: November 2007

A case of trisomy 22 with partial long arm deletion (47, +22 q—) studied by G-banding is presented. The patient, a five-month-old male, showed failure to thrive, delayed psychomotor development, large, low-set ears, mild micrognathia, atrial septal defect, and marked muscular hypotonia. The father's karyotype was normal. The mother's karyotype was 46 XX, but one of the #22 chromosomes showed a deletion of the long arm as seen in the proband's karyotype. A comparison with previously reported cases in the literature indicates a great variability of clinical features of trisomy 22: "classical form," cat eye syndrome, and abortive cases (as this reported case).
Cervical Adenitis in Infancy
Authors: Wald Ellen R. , Sivasubramanian K.
Published: November 2007

Four cases of cervical adenitis occurring in infants under four months of age are presented. Coagulase positive staphylococci were recovered in pure culture from the involved lymph node in each instance. Staphylococcal aureus as a cause of lymphadenitis should be suspected in patients who present with acute lymph node swelling and no obvious focus of infection. Antibiotic management of this clinical problem should include therapy specific for the staphylococcus.
Lower Airway Foreign Body Aspiration in Children
Authors: Shirazy Majd N. , Mofenson Howard C. , Greensher Joseph
Published: November 2007

This analysis of thirteen cases of lower airway foreign body aspiration in children reveals a high incidence of aspiration into the left main bronchus, and an increased incidence in older children. Early identification of non- radio opaque foreign bodies such as food and plastic toys is difficult in the absence of a positive history. Suggestions are offered for prevention, early detection, and treatment.
The Comparative Efficacy of Cephalexin and Sulfisoxazole in Acute Urinary Tract Infection in Children
Authors: Russo Raymond M. , Gururaj Vymutt J. , Laude Teresita A. , Rajkumar Solomon V. , Allen John E.
Published: November 2007

A double blind, comparative study of the efficacy of cephalexin versus sulfis oxazole was conducted on 100 children with initial episodes of urinary tract infections.

The overall bacteriologic and clinical cure rates were comparable for both antimicrobials. Children treated with cephalexin had a clinical cure rate of 86 per cent and a bacterial cure rate of 84 per cent, while those given sulfisoxazole were found to have rates of 82 and 92 per cent respectively.

However, cephalexin was noted to have a rather high rate of failure in the therapy of Proteus mirabilis infections (4/8), casting some doubt on its use in urinary infections caused by this organism.

Untoward effects associated with either medication were minimal.
The ABCs of Educating the Patient with Chronic Bronchial Asthma
Authors: Ghory Joseph E.
Published: November 2007

Total rehabilitation of the chronic asthmatic child needs 1) a philosophy, 2) an objective, and 3) a method. The philosophy is to help the child lead as normal a life as possible. The objective is to accomplish this in his home, in his play and in his school. The method to accomplish this must include education and understanding of the disease by the patient and his family.
In Memoriam
Authors: Koblenzer Peter J.
Published: November 2007

Since the deaths of Dr. Irving J. Wolman, Editor-in-Chief of Clinical Pediatrics, and his wife Roslyn, the Journal's office has received many tributes. The following are a few brief excerpts:
Alveolar Hypoventilation and Cor Pulmonale Associated with Chronic Airway Obstruction in Infants with Down Syndrome
Authors: Levine O. Robert , Simpser Moises
Published: November 2007

Four infants with Down syndrome developed cor pulmonale and heart failure in association with chronic upper airway obstruction. Features of the sleep apnea syndrome were conspicuous; namely, noisy breathing with retraction, cyanosis and frequent apnea during sleep, and daytime lethargy and somnolence. The clinical picture masqueraded as cyanotic congenital heart disease. Arterial blood gas anal yses revealed alveolar hypoventilation, especially during sleep. The nature of the obstructive element was variable. Adenoidectomy provided partial relief in one patient, and tonsillectomy and adenoidectomy resulted in temporary improvement in two others. Three patients were markedly benefitted by tracheostomy. Func tional inspiratory pharyngeal closure was demonstrated fluorographically in one patient.

Infants with Down syndrome may be predisposed to upper airway obstruction by virtue of hypoplasia of facial and oropharyngeal structures and generalized hypotonia. Additional obstructive elements may be contributed by hypertrophied lymphoid tissue, excessive secretions, and glossoptosis. Removal of the obstructive element is helpful, but functional obstruction may only be relieved by tracheos tomy.
Intrarenal Arterial Stenosis
Authors: Doody Patrick T. , Wombolt Duane G. , Tynes William V. , Goldberg Marvin
Published: November 2007

This report documents a case of hypertension caused by an intrarenal arterial stenosis in a ten-year-old girl. The renovascular origin of her hypertension was suggested by a positive saralasin acetate infusion test, and the lesion was identified by use of the subtraction technique in renal arteriography. Partial nephrectomy resulted in resolution of the pa tient's hypertension with good function in the remaining portion of the kidney.
Trimethoprim-Sulfamethoxazole Treatment of Multiantibiotic-Resistant Staphylococcal Endocarditis and Meningitis
Authors: Tamer M. Akram , Bray John D.
Published: November 2007

The successful treatment of a multiantibiotic-resistant Staphylococcus aureus endocarditis and meningitis with oral trimethoprim-sulfamethoxazole is reported.
Indomethacin for Closure of Patent Ductus Arteriosus in Prematures
Authors: Mullett Martha D. , Croghan Thomas W. , Myerberg David Z. , Krall John M. , Neal William A.
Published: November 2007

A controlled, double blind trial of indomethacin versus placebo was conducted in prematures of birth weight <1750 g, with a murmur of patent ductus arteriosus (PDA). The dose of indomethacin was 0.2 mg/kg for 2 doses, orally, 24 hours apart. Forty-seven patients entered the trial. Twenty-four received indomethacin and 12 of these met the criteria for response; 23 received the placebo and two met the criteria for response (p < 0.01). Subsequent surgical ligation for symptomatic PDA was required in 13 of 23 in the placebo group and 4 of 24 in the indomethacin group (p < 0.01). When administered early, indomethacin is moderately effective in closing PDA in premature infants.
Congenital Ingrown Toenails
Authors: Honig Paul J. , Spitzer Alan , Bernstein Robert , Leyden James J.
Published: November 2007

The great toenails of 302 newborn infants were evaluated to identify a specific conformation which might predispose these children to chronic paronychia. Forty-one infants who appeared to have great toenails impeded by tissue distally were followed for 12 months. All had essentially normal appearing nails by six months of age. None developed chronic paronychia. The results suggest that. the changes originally noted were variations in the normal development of the great toenail.
Limited Diagnostic Value of Routine Cord Blood Bilirubin Determinations
Authors: Jacobson Mark P. , Bernstein Henry H.
Published: November 2007

In a retrospective study, cord blood bilirubin levels of 87 neonates who received standard phototherapy for neonatal hyperbilirubinemia were compared with the cord bilirubin levels of 95 neonates without neonatal hyperbilirubinemia, none of whom received phototherapy. There were no significant differences in the cord bilirubin levels between the two groups. These results suggest that routine determination of cord blood bilirubin levels is neither necessary nor cost effective.
Salmonella Gastroenteritis in the First Three Months of Life
Authors: Nelson Susan J. , Granoff Dan
Published: November 2007

Salmonellosis in older children and adults is usually a self-limited disease, but the risk of complications in infants is not well-defined. We performed a retrospective review of 52 patients, 90 days of age or less, seen at the St. Louis Children's Hospital between 1975 and 1981. with stool cultures positive for Salmonella. Sixteen were 30 days old or less (neonates), 21 were 31- 60 days of age, and 15 were 61-90 days old. Among patients in whom blood cultures were done initially, bacteremia was most frequent in neonates: 5/11 (45%), compared to 2/18 (11%) in older infants. All seven infants presenting with bacteremia received 10 or more days of antibiotic therapy; yet complications (osteomyelitis, fatal meningitis or chronic diarrhea) developed in three of five neonates and one of two older infants. Complications also developed in seven of 22 patients who initially had negative blood cultures, including two infants in whom sepsis later developed and two infants who required intravenous hyperalimentation because of chronic diarrhea and malnutrition. The group of 23 patients who did not have blood cultures all did well. Salmonellosis is not necessarily a self-limited infection in young infants. Even in the absence of bacteremia, clinicians would appear to be justified in using antimicrobial therapy in infants 3 months of age or less with salmonella gastroenteritis, particularly neonates or older infants with symptoms of dysentery or failure to thrive.
Cholestasis in Infancy
Authors: Watson Susan , Giacoia George P.
Published: November 2007

The natural history of cholestatic syndromes in infancy remains largely unclarified for lack of sufficient data. Newborn and premature infants are particularly vulnerable to cholestasis because of immaturities in bile-forming mechanisms. Until recently, two broad categories of etiologic factors have been thought to be associated with cholestasis in early infancy: mechanical obstruction (almost always extrahepatic), and hepatocellular damage (the "neonatal hepatitis" group). Although in both groups specific etiologic factors have been identified, the majority of cases are currently of unknown etiology.

Problems in differential diagnosis are reviewed. In the neonatal period, laboratory screening procedures usually do not uncover cholestatic liver disease until the infants become icteric. It is important to note that patients with liver dysfunction may remain anicteric or become anicteric while cholestasis persists. It is, therefore, important that biochemical markers of cholestasis other than conjugated bilirubin be found.
The Effectiveness of Health Education on Home Use of Ipecac
Authors: Dershewitz Robert A. , Posner Michael K. , Paichel Walter
Published: November 2007

It is widely recommended by pediatricians that syrup of ipecac for secondary prevention of poisoning be kept in homes where there are young children. To evaluate the efficacy of this recommendation we measured mother's gain in knowledge of how to use ipecac safely at home.

The study population (n = 78) were primarily middle class mothers bringing their 9-month- old infants to one pediatrician at a health maintenance organization for a well-baby visit. The pediatrician delivered health education on poisonings. A before-after study design was used. The highly significant (p < 0.001) gain in knowledge demonstrates that parents can learn to use ipecac safely at home. The practitioner should limit safety counseling to selected areas most problematic at each age level, and within each topic, should concentrate on the most salient points.
Reliability of Transcutaneous Oxygen Monitoring of Critically III Children in a General Pediatric Unit
Authors: Yip William C. L. , Tay John S. H. , Wong H.B. , Ho T.F.
Published: November 2007

While transcutaneous continuous monitoring of partial pressure of oxygen (TcPO2) is a proven valuable diagnostic tool in intensive care of sick neonates, its use in older children is less well defined. The purpose of this study is to establish the accuracy and reliability of TcPo2 as a reflection of arterial partial pressure of oxygen (Pao2) in critically ill pediatric patients. Twenty-six children, age ranging from 4 days to 13 years, were studied. The main diagnostic categories were cardiac 54 per cent, respiratory 27 per cent, gastrointestinal 15 per cent, and neurologic 4 per cent. Forty three estimations of Pa o2 (by radial arterial sampling) and TcPO2 (by cutaneous monitor) were obtained simultaneously. Their correlation coefficient, regression equation, and confidence limits were calculated by standard statistical methods with the aid of a microcomputer. Our data show that the high degree of correlation between TcPO2 and Pao2 is highly significant (r = 0.90, p < 0.001) for the full range of Pa o2 between 0 to 200 mm Hg. At the lower range of Pao2 (0-79 mm Hg), the degree of correlation (r = 0.91, p < 0.001) is better than that (r = 0.77, p < 0.001) at the higher range (80-200 mm Hg), although the difference between the two correlation coefficients is not significant (p > 0.05). It is important to note that TcPo 2 consistently underestimates the Pao2 and the 95% confidence limits are rather wide. We conclude that TcPO2 is a reasonably accurate reflection of Pao2 in critically ill pediatric patients. Its main advantage is in predicting and showing trends in tissue oxygenation by noninvasive means. However, when critical assessment of the degree of hypoxemia is required, TcPO2 is no substitute for Pao2.
Proper Aerosol Inhalation Technique for Delivery of Asthma Medications
Authors: Hae Soon Lee
Published: November 2007

Forty-two (42) children with asthma, 7 to 15 years old, who had been taking aerosol medi cations from canister nebulizers for longer than 6 months were evaluated for adequacy of aerosol inhalation technique. The mouthpiece of a canister nebulizer was modified so that actuation of the canister and inhalation through the mouthpiece could be recorded. Of 42 patients, 24 had correct inhalation technique (they synchronized the actuation of canister and inhalation); 18 (43%) did not. The most frequent mistake (11 patients) was releasing the aerosol into the mouth without inhaling. Those who inhaled incorrectly were taught the correct tech nique by repeated instructions and demonstrations; 1I learned it within 5 minutes, but 7 required a longer instruction period. Most had retained the technique when retested later. The physician should teach each patient the correct technique when aerosol therapy is started and should check again on follow-up examinations to assure that the patient obtains maximum benefit from aerosol therapy.
Predicting the Need for Exchange Transfusion in Newborn Infants
Authors: Robertson Alex F. , Karp Warren B. , Davis Harry C. , Zack Catterton W. , Bunyapen Chantrapa
Published: November 2007

The need for exchange transfusion was analyzed retrospectively using several different meth ods (total bilirubin binding capacity, birth weight, plasma protein level, and two published charts). These predictive methods were applied to 175 jaundiced infants for whom all the data were available and to 19 infants who were actually exchanged. Most of the patients were sick, premature infants. This study demonstrates the lack of agreement among the predictive methods.
Peptic Ulcer Disease in Children and Adolescents
Authors: Tolia Vasundhara , Dubois Reuben S.
Published: November 2007

We report a retrospective review of peptic ulcer disease (PUD) in children seen at Children's Hospital of Michigan, over 10 years (1971-1980). Of the 61 included, 31 had primary ulcers and 30 had stress ulcers. The diagnosis was made by either barium meal or endoscopy, at surgery, or at autopsy. Stress ulcers were commoner in children less than 4 years of age and were precipitated by various conditions leading to shock. The majority of these patients required surgery for perforation or bleeding. Primary ulcers were more common in children older than 4 years. The most common presenting symptoms in this group were abdominal pain and gas trointestinal bleeding. The majority of patients with primary PUD received medical therapy in the form of antacids and/or cimetidine. In one-third of these patients, surgery was necessary for complications such as intractable pain, perforation, or massive recurrent hemorrhage.