Traumatic deaths from dog attacks in the United States.

A newspaper survey and search of the medical literature identified 74 deaths from dog attacks, 51 of which occurred in a designated five-year study period. Most attacks were by single pet dogs without a preceding history of viciousness and without known provocation by the victim. The highest number of deaths (23) occurred in infants less than 1 year of age. Most of the remaining victims were children aged 1 through 8 years, and elderly women.

A "new" lethal multiple congenital anomaly syndrome: joint contractures, cerebellar hypoplasia, renal hypoplasia, urogenital anomalies, tongue cysts, shortness of limbs, eye abnormalities, defects of the heart, gallbladder agenesis, and ear malformations.

Three cases of a lethal malformation syndrome with severe visceral anomalies were seen in two families and include one pair of sibs. The predominating external manifestations are mesomelic dwarfism, micrognathia, V-shaped upper lip, microglossia, thick alveolar ridges, ambiguous genitalia, webbed neck, highly arched palate, clubfeet, fused fontanelles, inclusion cysts of the tongue, four-finger creases, digital anomalies, apparently low-set ears, widely spaced nipples, and dislocated thighs and forearms. The internal findings include oligopapillary renal hypoplasia, severe congenital heart defect, cerebellar hypoplasia, pulmonary hypoplasia, hypoplastic larynx, and hypoplastic gallbladder. Other findings from the two autopsies and one clinical investigation not documented in all three patients include unilobar lungs, hydrocephalus, cataracts, microphthalmia, polydactyly, islet cell hyperplasia, suprapubic skin crease, urethral anomalies, and a decreased number of turns of the cochlea. The hypoplasia seen in the several affected organs is similar to the disordered development seen in experimental models of branching epithelial morphogenesis in which mesenchymal-epithelial interaction has been disrupted.

Facilitation and inhibition of the human startle blink reflexes by stimulus anticipation.

The cutaneous eyeblink has 2 electromyographic components, 1 unilateral and early (R1) and 1 bilateral and late (R2), which are served by different neural pathways. These 2 reactions were measured when the eliciting stimulus was expected or relatively surprising. Forewarning was varied in 3 ways: Subjects received notice that the stimulus was about to occur on some trials (Experiment 1); delivered the stimulus to themselves on some trials (Experiments 2 & 3); or experienced a series of trials in which a tone was paired with the eliciting stimulus, followed by tone-alone trials interspersed with test trials (Experiment 4). In each case, forewarning enhanced R1 amplitudes while depressing R2 but reduced the latency of both components. This mixed pattern of effects reveals that the preparatory state provoked by forewarning focuses excitatory and inhibitory processes simultaneously on different reflex pathways: inhibition central and excitation peripheral.

Predictors of intussusception in young children.

OBJECTIVE: To identify predictors of intussusception in young children. DESIGN: A retrospective cross-sectional study. SETTING AND PATIENTS: A consecutive sample of children younger than 5 years on whom contrast enemas were performed because of suspected intussusception seen at an urban children's hospital from 1990 to 1995. METHODS: We evaluated historical, clinical, and radiographic variables. Variables documented in 75% or more of the medical records and associated with intussusception (P< or =.20) in the univariate analysis were evaluated in a multiple logistic regression analysis. Variables retaining significance (P< or =.05) in the multivariate analysis were considered independent predictors of intussusception. We used bootstrap resampling techniques to validate the multivariate model. RESULTS: Sixty-eight (59%) of the 115 patients had intussusception. Univariate predictors of intussusception included male sex, age younger than 2 years, history of emesis, rectal bleeding, lethargy, abdominal mass, and a highly suggestive abdominal radiograph. In the multivariate analysis, we identified only 4 independent predictors (adjusted odds ratio; 95% confidence interval): a highly suggestive abdominal radiograph (18.3; 4.0-83.1), rectal bleeding (17.3; 2.9-104.0), male sex (6.2; 1.2-32.3), and a history of emesis (13.4; 1.4-126.0). We identified 3 of these 4 variables (all but emesis) as independent predictors in more than 50% of 1000 bootstrap data samples. CONCLUSIONS: Rectal bleeding, a highly suggestive abdominal radiograph, and male sex are variables independently associated with intussusception in a cohort of children suspected of having this diagnosis. Knowledge of these variables may assist in clinical decision making regarding diagnostic and therapeutic interventions.

Operative intervention for pediatric liver injuries: avoiding delay in treatment.

To identify the physiological and anatomic factors that characterize the need for operative management of blunt pediatric liver injuries, the case records of 106 pediatric trauma victims with liver injuries over a 6-year period were reviewed. Sixty-nine patients were managed without operation (nonoperative) and 37 underwent operation, 7 with penetrating and 30 with blunt liver injuries. Of these 30 patients, 21 underwent laparotomy due to blunt liver injuries (operative); the remaining 9 patients required operation due to associated intraabdominal injuries. Nine (45%) of the 21 operative patients had major hepatic vein or retrohepatic vena caval injuries, 7 of whom died. Overall mortality was 9.4% (10/106). When nonoperative and operative groups were compared, those who underwent laparotomy due to blunt liver injuries: (1) had significantly lower Champion and Pediatric Trauma Scores due to multisystem injury; (2) had 25% or greater lobar disruption with pelvic blood collections on computed tomography scan; (3) underwent early transfusion within 2 hours of admission (18/21); and (4) were frequently found to have a major hepatic vein or retrohepatic vena caval injury at the time of operation. Only one patient successfully managed without operation received greater than 30 mL/kg of blood products within 24 hours of admission. As selective nonoperative management of pediatric liver injuries gains widespread acceptance, the identification of factors that predict the need for operative intervention will limit the potential risks of delay in treatment.

Pediatric HIV Long-Term Nonprogressors.

Patients infected with HIV are best categorized along a continuum from rapid progressors to HIV long-term nonprogressors. Long-term nonprogressors (LTNPs) are those in which AIDS develop many years after being infected with HIV, often beyond the 10-year mark, and represent 15-20% of the HIV infected patients. Many of these patients are able to control their infection and maintain undetectable viral loads for long periods of time without antiretroviral therapy. After a comprehensive literature search, we found extensive data related to HIV LTNPs in the adult population; however, very limited data was available related to LTNPs within the pediatric population. We present a case of pediatric HIV LTNPs, perinatally infected patient with undetectable viral loads, despite never receiving ART. Although there are not many instances of LTNPs among children, this child may be one, though she had intermittent viremia. She has continued to manifest serologic evidence of infection, with yearly ELISA and western blot positive tests. Based on the viral fitness studies that were performed, this case exemplifies an adolescent LTNP.

Excretory urography with glucagon.

Glucagon administered to ten children during excretory urography showed only a transient dilution of contrast material without any other change in the appearance of the urinary tract. No beneficial role for glucagon in routine excretory urography was demonstrated.

Reflux of barium into the middle ear during upper gastrointestinal series.

In four children, barium was refluxed into the nasopharynx, eustachian tubes, and middle ears during routine upper gastrointestinal series. Three children had gastroesophageal reflux and one had incoordination of swallowing. The possible significance of such reflux with regard to middle ear disease is not known.

Genu valgum after proximal tibial fractures in children.

Eight children with fractures of the proximal tibial metaphysis developed a significant genu valgum on the injured side. A study of the radiographs showed that the deformity was primarily due to bowing of the tibia below the site of fracture. The deformity may be the result of plastic bowing of the tibia accentuated by weight bearing during healing.

Primary coccidioidomycosis in children presenting with massive pleural effusion.

Large pleural effusion as the presenting feature of coccidioidomycosis in childhood has not previously been reported and may cause significant diagnostic difficulty. Three children are described who required prolonged hospitalization and therapy with amphotericin B. Primary coccidioidomycosis should be included in the differential diagnosis of large pleural effusions in pediatric patients who have been in the endemic area. Such effusions suggest a severe form of the disease and may represent evidence of acute dissemination.

Renal displacement caused by a supradiaphragmatic, paraspinal Ewing-like sarcoma and simulating an adrenal mass.

Two cases of children with paravertebral soft-tissue masses that histologically resembled Ewing sarcoma of bone are reported. In both cases the mass was located immediately above the diaphragm. It depressed the posterior segment of the diaphragm and indirectly caused displacement of the ipsilateral kidney, thus simulating an adrenal mass on excretory urography. The anatomic reasons for this phenomenon and the main features of the tumor are discussed.

Inhibition of the cutaneous eyeblink reflex by unilateral and bilateral acoustic input: the persistence of contralateral antagonism in auditory processing.

The eyeblink reflex elicited by a cutaneous stimulus is inhibited by weak auditory stimuli that are heard just before the blink. It has been shown that monaural prestimuli produce more reflex depression than binaural prestimuli do, suggesting that reflex modification is sensitive to the outcome of antagonistic connections between contralateral auditory inputs. We examined the time course of this antagonism by giving unilateral versus bilateral pairs of noise pips 100 msec before the reflex eyeblink, with the noise pips separated by 0, 1, 4, or 8 msec. Unilateral stimuli were more effective in every condition, but their advantage diminished with increased delay between the two components. The extended bilateral and unilateral trends of increasing reflex depression with increased delay meet at about 15 msec; if this extrapolation is valid, 15 msec represents the upper limit on this system's retention of the location of a brief noise impulse. The rate of convergence of the two temporal functions reflects the decay of the antagonistic effect of one noise on its contralateral counterpart.

Osteomyelitis of the cervical spine following dental extraction.

Osteomyelitis of the cervical spine developed in two children following dental extraction. A significant delay in diagnosis and treatment in both cases may have contributed to subsequent permanent spinal deformities. The possibility of cervical osteomyelitis must be considered in a child when severe neck pain develops following dental extraction.

Parenchymal reflux in renal dysplasia.

Primitive ducts, tubules, and cysts often communicate with the pelvoccalyceal systems of dysplastic kidneys, and may sometimes be filled in retrograde fashion with radiographic contrast material. Their size, shape, and distribution provide a variable radiographic appearance that must be distinguished from other causes of intrarenal reflux. When reflux filling of dysplastic structures is incomplete, the radiographic findings do not fully represent the severity of anatomic abnormality.

The stubbed great toe: a cause of occult compound fracture and infection.

Six children suffered Salter I fractures of the distal phalanx of a great toe caused by stubbing. The first four children presented with cellulitis and osteomyelitis. The last two were treated promptly with antibiotics, and no infection developed. Analysis of the anatomic relationship of the distal phalanx and nail indicates that these fractures were compound despite the absence of usual clinical signs. Recognition of these occult compound fractures and treatment with antibiotics should prevent infectious complications.

Relative efficacy of radiographic and radionuclide bone surveys in the detection of the skeletal lesions of histiocytosis X.

Radionuclide studies have been considered a more sensitive indicator of the presence of the bony lesions of histiocytosis X in children than have radiographic bone surveys. Our results suggest that the opposite is true. Although positive correlation between bone scans and radiographs was found in eight of nine patients, only 35% of the individual lesions visible on radiographs were seen on radionuclide studies. Results of radionuclide studies did not correlate with age or sex of the patient, presence or duration of symptoms, radiographic appearance, or anatomic location of lesions. Our results suggest that the radiographic skeletal survey is more sensitive than radionuclide studies in detecting the skeletal lesions of histiocytosis X.

Antemortem diagnosis of massive air embolism in the newborn.

A case is presented of massive air embolism complicating respiratory distress syndrome of the newborn. This uncommon complication of respiratory therapy has occurred only with high inflation pressures and has been uniformly fatal in this and all reported cases. Antemortem radiographs are necessary for accurate diagnosis.

Nickel-doped nanocrystalline glass-ceramic fiber.

The spectroscopic properties of Ni(2+)- doped nanocrystalline glass-ceramic fibers are reported. The cerammed fibers show strong fluorescence with peak wavelength at 1250 nm, 3-dB bandwidth at ~250nm, measured lifetimes at >1ms, and low-fluorescence saturation powers (~35mW) for 980-nm diode pumping. Current diode-pumped output powers are ~100microW .

Renal malposition associated with omphalocele.

Nine patients with omphalocele had abnormally positioned kidneys; in 8, the kidneys were more cephalad than normal, immediately subdiaphragmatic in position. In one patient the kidneys were more caudal than normal. This renal malposition should be recognized in order to avoid unnecessary imaging procedures in patients with omphalocele.