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Biomedical subjects

M E Rimsza

Publications and source records attributed to M E Rimsza.

18 recordsLinked to original sources
PubMed1994

Toluene embryopathy: delineation of the phenotype and comparison with fetal alcohol syndrome.

OBJECTIVE: To determine if maternal toluene abuse produces any structural or developmental disabilities in the developing fetus, a cohort of toluene-exposed infants was ascertained and examined. METHODOLOGY: Eighteen infants with a history of in utero toluene exposure were examined at birth. Nine of these infants were reexamined 3 to 36 months after their initial evaluations. The clinical findings in these patients were compared with those of similarly exposed children from the literature and with patients who had the fetal alcohol syndrome. RESULTS: Thirty-nine percent of all toluene-exposed infants described in this and other studies were born prematurely, and 9% died during the perinatal period. Fifty-four percent were small for gestational age, and 52% exhibited continued postnatal growth deficiency. A 33% incidence of prenatal microcephaly, a 67% incidence of postnatal microcephaly, and an 80% incidence of developmental delay were observed. Eighty-three percent of the patients had craniofacial features similar to the fetal alcohol syndrome, and 89% of these children had other minor anomalies. CONCLUSIONS: Data from the patients herein described and the available scientific literature suggest that the mechanism of alcohol craniofacial teratogenesis may be nonspecific, with a variety of teratogens, including toluene, giving rise to phenotypic facial abnormalities similar to those of the fetal alcohol syndrome. We propose a common mechanism of craniofacial teratogenesis for toluene and alcohol, namely a deficiency of craniofacial neuroepithelium and mesodermal components due to increased embryonic cell death.

Abnormalities, Drug-Induced↗
PubMed1992

Stun gun injury: a new presentation of the battered child syndrome.

Stun guns are self-protection devices that are increasingly available with few restrictions on their use and sale. We present a case of child abuse with a stun gun. The signs of such abuse are often subtle, and they may be underrecognized currently. The skin lesions that are often seen are hypopigmented circular macules, measuring approximately 0.5 cm in diameter. They may be raised slightly and erythematous if inflicted recently Most characteristic of stun gun assault is pairing of lesions approximately 5 cm apart. We discuss the design, operation, and effects of stun guns, and give an extensive differential of abusive and nonabusive circular lesions.

Battered Child Syndrome↗
PubMed1991

Practice management training for pediatric residents.

In 1986, a practice management training program was developed for pediatric house staff. In conjunction with this program, pediatric residents for the following 2 years completed questionnaires regarding their career goals, interests, and perceived competence in practice management. Postgraduate level-3 residents who completed the program felt more competent than postgraduate level-1 residents in all areas of practice management and were more likely to take an active role in managing their practice. There was a significant difference between postgraduate level-1 and level-3 residents who completed the program in several areas: feelings of overall competence in office management, choosing a practice location, office staff, appointment system, billing system, office computer, fee schedules, telephone management, and setting up an office laboratory. Exposure to a practice management program during residency training may better prepare future pediatricians for a successful practice.

Internship and Residency↗
PubMed1991

Child abuse or osteogenesis imperfecta: how can we tell?

Osteogenesis imperfecta may be difficult to differentiate from nonaccidental trauma. Social history may prejudice the physician in favor of or against considering the diagnosis of child abuse. Three cases of osteogenesis imperfecta that were initially diagnosed as nonaccidental trauma are presented. The availability of biochemical analysis of type I collagen was instrumental in confirming the diagnosis of osteogenesis imperfecta in all three cases.

Child↗
PubMed1989

An illustrated guide to adolescent gynecology.

The gynecologic examination should be considered an essential part of a complete physical examination in the adolescent girl. Many symptoms and signs which at first may seem to be unrelated to the reproductive tract are found to be due to gynecologic pathology after a careful gynecologic examination has been completed. Most of the diagnostic tests which are needed as part of the gynecologic examination can be easily performed in a pediatrician's office including wet preps, KOH preps, and Gram's stains of vaginal discharge. Other ancillary tests, including Pap smears and cultures for sexually transmitted diseases, can be obtained by the examining pediatrician and sent to local clinical laboratories. The pelvic ultrasound can be a helpful adjunct to the gynecologic examination when congenital anomalies, or adnexal masses, are suspected.

Adolescent↗
PubMed1988

Sexual abuse: somatic and emotional reactions.

A chart review and telephone interview of 72 sexual abuse victims was conducted to determine if children and adolescents who are victims of sexual abuse suffer from symptoms similar to the "rape trauma syndrome," which has been reported in adults. Symptoms similar to the rape trauma syndrome were found in 48 of the 72 abused children and only 26 of the matched control group, p less than .01. Common somatic complaints in the sexual abuse patients included dysuria, vaginal discharge and chronic abdominal pain. Some of the emotional and behavioral problems noted during the follow-up period among the sexual abuse patients included sleep problems, runaway behavior, and suicide attempts. The duration of abuse and age of the victim at the time of abuse significantly affected the frequency of reported somatic symptoms, but the type of abuse and type of assailant did not significantly affect the frequency of reported somatic and emotional reactions. There was no difference in the occurrence of school problems and early pregnancy between sexually abused patients and controls. Since 67% of all sexually abused patients suffered from emotional and somatic reactions, close follow-up of these patients is indicated.

Adaptation, Psychological↗
PubMed1987

Gardnerella vaginalis in prepubertal girls.

A prospective study was established to determine the significance of the isolation of Gardnerella vaginalis from the vagina in prepubertal children. Two hundred fifty-six children were enrolled. Group 1 consisted of 137 children who had been victims of sexual abuse; group 2, forty-eight children with genitourinary complaints and no history of sexual abuse; and group 3, seventy-one children with no genitourinary complaints and no history of sexual abuse. Gardnerella vaginalis was isolated from 20 patients (14.6%) in group 1 and five (4.2%) of 119 control patients from groups 2 and 3. Within group 1, G vaginalis was more likely to be isolated from children with a history of multiple episodes of sexual abuse than those with a single episode. Gardnerella vaginalis was not associated with any other historical, physical, or laboratory findings, including vaginal erythema or vaginal discharge.

Child↗
PubMed1983

Evaluation of a successful biosocial rotation.

Efficacy of an eight-week rotation in developmental and behavioral pediatrics for second-year pediatric residents was evaluated. Pretesting and posttesting disclosed that our residents felt more competent with biosocial problems, had more favorable attitudes toward patients with biosocial problems, and had increased factual knowledge in developmental and behavioral pediatrics. When reevaluated 12 to 24 months after rotation as third-year residents (PL-3), they performed better on a factual knowledge test than a PL-3 control group that had not had the rotation. They also felt more competent than the controls in the diagnosis and treatment of children with learning disabilities, hyperactivity, physical handicaps, depression, and gynecologic problems.

Arizona↗
PubMed1983

Cutaneous amebiasis.

An infant with cutaneous amebiasis of the vulva and amebic liver abscess is described. Epidemiologic investigations and serologic studies were crucial in establishing the diagnosis. The vulvar amebic ulcers responded dramatically to metronidazole therapy. Cutaneous amebiasis is a rare complication of Entamoeba histolytica infection which should be considered in the differential diagnosis of perineovulvar or penile ulcers. Cutaneous amebiasis may also occur on the abdominal wall surrounding a draining hepatic abscess, colostomy site, or laparotomy incision.

Amebiasis↗
PubMed1982

Medical evaluation of sexually abused children: a review of 311 cases.

The case records of 311 children and adolescents who were medically evaluated for sexual abuse are reviewed. Only 18% of these victims were assaulted by strangers; 131 of the assailants were relatives. Thirty percent of the victims reported multiple assaults over a time period of one week to nine years. Physical examination showed no abnormalities in only 23% of the patients. Twenty-one patients had gonorrhea and seven patients were pregnant. Guidelines for the medical evaluation of patients suspected to be victims of sexual abuse are discussed.

Adolescent↗
PubMed1980

Scorpion envenomation.

A potentially lethal neurotoxin-producing scorpion, Centruroides sculpturatus, exists in the southwestern United States. The most common symptoms of envenomation of 24 patients included local pain, restlessness, and roving eye movements. In this series 80% of cases were in children less than 10 years of age. Pain at the site of the sting was a predominant symptom in the patient more than 10 years of age; however, extreme and perpetual restlessness was the most common symptom in the younger patient. The diagnosis in children is usually made by clinical presentation alone since the site of the sting cannot be identified and children may not communicate the history of the sting. The most commonly used chemotherapeutic agent is phenobarbital. There is no evidence, however, that this drug decreases morbidity or mortality, and massive doses of phenobarbital were associated with two respiratory arrests in this series. The nature of scorpions and their venoms is discussed. Research is needed regarding the use of sympathetic blocking agents in scorpion envenomation.

Animals↗
PubMed1978

Complications of corticosteroid therapy.

The complications of corticosteroid therapy in children are protean. Perhaps the most important of these are adrenal insufficiency after withdrawal of steroids, immunosuppression, and growth failure. The physician who is caring for a child receiving corticosteroids must be aware of these common complications as well as the many less frequent side effects, such as cataracts, pseudotumor cerebri, pancreatitis, and steroid myopathy, to name a few. In all children, the risk of using corticosteroids should be weighed carefully before therapy with these agents is begun.

Adrenal Cortex Hormones↗
PubMed1978

Hemorrhagic retinopathy in a patient with cystic fibrosis.

A 21-year-old woman with a history of chronic lung disease secondary to cystic fibrosis (CF) developed an acute hemorrhagic retinopathy during exposure to moderately high altitude. Although retinal hemorrhages are known to occur in patients with CF, we speculate that the retinopathy in this case was partially related to altitudinal change and that patients with chronic hypoxemia may be predisposed to high-altitude retinopathy at much lower altitudes.

Acute Disease↗