[Diagnostic image (281). A girl with fever, a sore throat and a rash].
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Biomedical subjects
Publications and source records attributed to D H Winterberg.
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In a 4-year-old boy with left-sided inguinal lymphadenopathy and a papule on his left lower leg situated at the end of a scar of a probable cat scratch, cat scratch disease was confirmed serologically.
In a 2-year-old girl, transverse furrows of the fingernails were noticed: Beau's lines associated with Kawasaki's syndrome.
A diagnosis of intracranial actinomycosis was made in a 9-year-old boy with headache, cranial nerve dysfunction and ataxia. Poor dental hygiene leading to caries and an inflammation in his right upper jaw probably was the cause of cervicofacial actinomycosis with intracranial extension. A full recovery was achieved by treatment with benzylpenicillin. Actinomyces is a gram-positive bacterium belonging to the endogenous flora of the mucous membranes of the oropharynx, gastrointestinal tract, and female genital tract. Disruption of the mucous membrane is the portal of entry for an extremely destructive infective process that is effectively treated with penicillin. Good orodental hygiene is important for the prevention of actinomycosis.
A 3-year-and-7-month-old girl with Down's syndrome had papules and vesicles on hands, feet and buttocks, and vesicular lesions in the oral cavity. A positive culture of enterovirus in vesicular fluid confirmed the clinical diagnosis 'hand-foot-mouth disease'.
In two neonate girls with vesicular skin lesions, incontinentia pigmenti (Bloch-Sulzberger syndrome) was diagnosed. This rare X-linked dominant ectodermal disease can cause abnormalities in several organ systems. Most prominent are the dermatological abnormalities, developing in 4 stages: the vesicular stage, the verrucous stage, the hyperpigmentation phase, and the atrophic phase. In addition to the cutaneous manifestations, many patients have anomalies of nails, hair and teeth. Serious related abnormalities of the eyes (intraocular vasculopathy) and central nervous system (convulsions, mental retardation) may occur. In 1989 the locus for the incontinentia pigmenti mutation was shown to be present on Xq28. Recently it was shown that the causative mutation is located on the NEMO ('NF-kappa B essential modulator') gene. A NEMO knock-out mouse model shows a dermatopathy of a transient nature, resembling the skin lesions in patients with incontinentia pigmenti.
A 4-year-old Indonesian girl was seen with streaky haematomas on back and chest. Because of fever, throat pain, cough and vomiting, her parents had rubbed her with balm and a coin. Coin rubbing is a harmless, traditional treatment for various illnesses which is regularly used in Southeast Asia. The cutaneous manifestations can be mistaken for battering or a bleeding disorder.
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Following a febrile illness with nasal discharge and vomiting a 1.5-year-old girl developed monomorphous erythematous papular lesions on the face, buttocks and extremities. A diagnosis of Gianotti-Crosti syndrome on the basis of an Epstein-Barr virus infection was made. The patient recovered in eight weeks without treatment. In the Netherlands the originally described relationship with a hepatitis B infection is very improbable in patients with the Gianotti-Crosti syndrome. Other viral agents like Epstein-Barr virus are much more likely.
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Explore the source record for details and available documents.
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The growing number of referrals to specialists is a matter of concern to the Government and the 'health insurance collective' (ziekenfonds). In spite of all kinds of measures this increase in referrals continues, also in pediatrics. An effective policy to reverse this trend depends on an understanding of its causes. This paper goes into the mechanisms of supply and demand in health care and the roles of both G.P. and patient in the decision to refer. Parents worry about their children's symptoms. These worries are not always understood by their general practitioner and may lead to referrals in which not medical questions but the worries of the parents take a central place. In treatment at the Out-Patient Clinic consideration should be given not only to the questions, worries and doubts of the G.P., but also to those of the patient and above all the patient's parents.