Biomedical subjects
Publications and source records attributed to J M Elser.
Complications from neonatal circumcision may result from inexperience or poor technique, but may also result from poor patient selection based on penile anatomy. The anatomic contraindications to neonatal circumcision are therefore presented in an effort to prevent complications.
Tuberous sclerosis complex (TSC) is an autosomal dominant disorder that can affect any organ of the body. We report the first case of advanced colonic adenocarcinoma in a patient with well-documented TSC, offer rationales for the association of this lesion with TSC, and review the literature pertaining to gastrointestinal involvement of this complex.
Migraine is a common clinical diagnosis, occurring in 4-10% of school age children. Migraine in the infant and preschool child has been infrequently described in retrospective studies. We report the prospective evaluation and therapy of six children (5-42 months) with migraine. In four of the children, Prensky's criteria were used for diagnosis, while the two youngest children presented with ophthalmoplegic migraine. All children had a strong family history of migraine and presented with headache and prominent features including facial pallor, irritability, sleep disturbance or mood changes. The oldest four children were successfully treated with either amitriptyline or imipramine in low doses. The infants with ophthalmoplegic migraine failed to completely respond to any therapy. At followup 2 to 18 months later, all children were well and without toxicity. The pediatrician should be aware that migraine may begin in infancy and can be effectively and safely treated.
During a 12-month period, four of the five infants with hemophilia known to have been born in Arkansas were examined for head bleeding. Three of the infants had had traumatic delivery, with use of low forceps in two and vacuum extraction in one. In the fourth patient, hemophilia was prenatally diagnosed, and vaginal delivery resulted in cephalohematoma. Diagnosis was delayed in three patients, including one with a family history of hemophilia. Central nervous system bleeding may be more common in hemophilic neonates than has been presumed. Pregnancy management should include consideration of family history of bleeding disorders and carrier testing in appropriate cases. In confirmed carriers, prenatal diagnosis is justified to allow choice of the least traumatic delivery method. Any term neonate with intracranial hemorrhage should be treated as being possibly hemophilic until proved otherwise.
From 1978 to 1988, microbiologically proven Pseudomonas osteochondritis and septic arthritis following nail puncture wound to the foot was diagnosed in 77 children aged 18 mo-19 y (77 and 17 cases, respectively). The syndromes were found in children with a history of wearing tennis shoes (70 cases), other shoes (5), and no shoes (2). All cases had surgical debridement of the infected cartilage or bone and drainage of infected joints. Pseudomonas aeruginosa was isolated in 38 cases and in conjunction with Staphylococcus aureus in 18. Anti-Pseudomonas antibiotics were initiated in all cases before surgical exploration; the average duration of treatment was 7.5 +/- 1.2 d postoperatively. Patient follow-up was 5.2 +/- 3.4 y (median, 4.8 y; range, 3 mo-10 y). Two relapses occurred; both patients had a previously undetected septic arthritis. These data suggest that with aggressive surgical management, Pseudomonas osteochondritis and septic arthritis can be treated effectively with postoperative antibiotics for 7 d.
Multicenter trials of ticarcillin/potassium clavulanate (Timentin) for bone, joint, skin and soft tissue infections in children were performed from 1983 to 1986. Fifty children with culture-confirmed Staphylococcus aureus infections were identified. Sixteen children (ages 6.2 +/- 3.9 years) with bone and joint infections received Timentin for 8.7 +/- 2.4 days with 11 of 16 cures, 5 of 16 improved, 11 of 11 bacteriologic cures and 3.9 +/- 3.5 days of fever. Thirty-two children (ages 5.7 +/- 3.5 years) with skin and soft tissue infections received Timentin for 5.3 +/- 1.6 days with 22 of 32 cures, 10 of 32 improved, 32 of 32 bacteriologic cures and 1.4 +/- 1.3 days of fever. Three patients had S. aureus bacteremia; all were clinical and bacteriologic cures. All S. aureus isolates were susceptible to Timentin, 18 of 23 isolates tested produced beta-lactamase and 21 of 44 isolates tested were resistant to ticarcillin. The purpose of this report is to describe the clinical efficacy of Timentin in treating these types of S. aureus infections in children.