American Journal of Diseases of Children

ROBERTSON, WILLIAM O.

1978 American Journal of Diseases of Children

doi: 10.1001/archpedi.1978.02120300019001pmid: 645670

Abstract In this issue of the Journal (p 466), Wilson and his colleagues report a fatality as a result of acetaminophen overdose, compounded as it was by simultaneous phenobarbital ingestion and phenacetin treatment. The issues addressed highlight lessons for each of us who deal either with accidental or with purposeful poisonings. In addition to emphasizing the toxic potential of acetaminophen, the report stresses the potentiating effect of other drugs on the toxic process. At the same time, it serves to document the therapeutic implications of our understanding of the pharmacokinetics involved. Viewing the current scene against the past may serve to clarify the importance of their observations. Paralleling the Poison Control Movement of the 50s and 60s were numerous reports documenting the severe effects of aspirin overdoses. Whether the result of an "accidental" ingestion by a toddler ("purposeful" in his or her eyes), an inadvertently prescribed, excessive dosage regimen, or a References 1. Treatment of acute paracetamol poisoning . Br Med J 2:481-482, 1977.Crossref 2. Gazzard BG, Davis M, Spooner J, et al: Why do people use paracetamol for suicide? Br Med J 1:212-213, 1976.Crossref 3. Mitchell JR, Jollow DJ, Potter WZ, et al: Acetaminophen-induced hepatic necrosis: Part 1. Role of drug metabolism . J Pharmacol Exp Ther 187:185-194, 1973. 4. Mitchell JR, Thorgeirsson SS, Potter WZ, et al: Acetaminophen-induced hepatic injury: Protective role of glutathione in man and rationale for therapy . Clin Pharmacol Ther 16:676-684, 1974. 5. Prescott LF, Ballantyne A, Park J, et al: Treatment of paracetamol (acetaminophen) poisoning with N-acetylcysteine . Lancet 2:432-434, 1977.Crossref 6. Crome P, Volans GN, Vale JA, et al: Oral methionine in the treatment of severe paracetamol (acetaminophen) overdose . Lancet 2:829-850, 1976.Crossref 7. Rumack BH, Matthew H: Acetaminophen poisoning and toxicity . Pediatrics 55:871-876, 1975. 8. Peterson RG, Rumack BH: Treating acute acetaminophen poisoning with acetylcysteine . JAMA 237:2406-2407, 1977.Crossref 9. Koch-Weser J: Acetaminophen . N Engl J Med 295:1297-1300, 1976.Crossref

KOPELMAN, ARTHUR E.

1978 American Journal of Diseases of Children

doi: 10.1001/archpedi.1978.02120300021002pmid: 645671

Abstract Recent medical advances have resulted in improved care of the mother and fetus during preterm labor and delivery, and of the preterm infant after delivery. As a consequence, the odds for survival and of survival without serious neurological residue appear to be much better than even a few years ago. Despite the recent advances in medical care, preterm delivery remains the major contributor to perinatal mortality and morbidity. In an excellent study of the contribution made by preterm delivery to perinatal mortality at the John Radcliffe Hospital, Oxford, England, in 1973 and 1974, Rush et al1 found that only 5.1% of pregnancies resulted in preterm delivery, and that these infants resulted in 85% of all early neonatal deaths excluding those due to lethal malformations. Tables 1 and 2 show the actual neonatal survival rates by gestational age and by birth weight in Oxford in 1973-1974 and in Rochester, NY, References 1. Rush RW, Keirse JJMC, Howat P, et al: Contributions of preterm delivery to perinatal mortality . Br Med J 2:965-968, 1976.Crossref 2. Drillien CM: The incidence of mental and physical handicaps in school-age children of very low birth weight . Pediatrics 27:452-464, 1961. 3. Lubchenco LO, Delivoria-Papadopoulos M, Butterfield LJ, et al: Long-term follow-up studies of prematurely born infants: I. Relationship of handicaps to nursery routines . J Pediatr 80:501-508, 1972.Crossref 4. Lubchenco LO, Delivoria-Papadopoulos M, Searls D: Long-term follow-up studies of prematurely born infants: II. Influence of birth weight and gestational age on sequelae . J Pediatr 80:509-512, 1972.Crossref 5. Stewart AL, Turcan DM, Rawlings G, et al: Prognosis for infants weighing 1,000 grams or less at birth . Arch Dis Child 52:97-104, 1977.Crossref 6. Alden ER, Mandelkorn T, Woodrum DE, et al: Morbidity and mortality of infants less than 1,000 grams in an intensive care nursery . Pediatrics 50:40-49, 1972. 7. Rawlings G, Stewart A, Reynolds EOR: Changing prognosis for infants of very low birth weight . Lancet 1:516-519, 1971.Crossref 8. Dweck HS, Saxon SA, Benton JW, et al: Early development of the tiny premature infant . Am J Dis Child 126:28-34, 1973. 9. Hagberg B, Olow I, Hagberg G: Decreasing incidence of low birth weight diplegia: An achievement of modern neonatal care? Acta Paediatr Scand 62:199-200, 1973.Crossref 10. Goldenberg RL, Nelson KG: The premature breech . Am J Obstet Gynecol 127:240-244, 1977. 11. Pomerance J, Ukrainski C, Ukra T: The cost of living for infants 1,000 grams at birth, abstracted . Pediatr Res 11:381, 1977.Crossref

LOGGIE, JENNIFER M. H.

1978 American Journal of Diseases of Children

doi: 10.1001/archpedi.1978.02120300023003pmid: 645672

Abstract In the past decade, there has been an increasing awareness of hypertension as it affects both children and teenagers. It is of particular note that essential or primary hypertension, once considered rare in the young, is being diagnosed with increasing frequency, particularly in adolescence. As a result of this new awareness, there has been a recent proliferation in the number of reports in the pediatric literature that are related to systemic hypertension. In addition, three symposia in the last two years have been devoted to juvenile hypertension.1.2 The most recent of these, held in October 1977, was cosponsored by the Medical College of Pennsylvania and the Medical Horizons program of the Ciba Pharmaceutical Co. This article is a synthesis of the 22 papers presented in Philadelphia and it attempts to summarize some of the current thinking relative to this new area. In his overview of the problem, Dr Sidney References 1. Medical Horizons Symposium: Hypertension in Childhood and Adolescence . Pittsburgh, Medical Horizons Program, Ciba Pharmaceutical Co, 1976. 2. New MI, Levine, LS (eds): Juvenile Hypertension , 8. New York, Raven Press, 1977. 3. Report of the task force on blood pressure control in children . Pediatrics 59( (suppl) ):797-820, 1977. 4. Voors AW, Webber LS, Berenson GS: Epidemiology of essential hypertension in youth: Implications for clinical practice . Pediatr Clin North Am 25:15-27, 1978. 5. Zinner SH, Levy PS, Kass EH: Familial aggregation of blood pressure in childhood . N Engl J Med 284:401-404, 1971.Crossref 6. New MI, Levine LS: Adrenocortical hypertension . Pediatr Clin North Am 25:67-81, 1978. 7. Finnerty FA Jr: Contraception and pregnancy in the young female hypertensive . Pediatr Clin North Am 25:119-126, 1978. 8. Kilcoyne MM: Adolescent hypertension , in New MI, Levine LS (eds): Juvenile Hypertension . New York, Raven Press, 1977, pp 25-35. 9. Frohlich ED: The adrenergic nervous system and hypertension: State of the art . Mayo Clin Proc 52:361-368, 1977. 10. Dahl LK: Salt and hypertension . Am J Clin Nutr 25:231-244, 1972.

Wilson, John T.;Kasantikul, Vira;Harbison, Raymond;Martin, Dan

1978 American Journal of Diseases of Children

doi: 10.1001/archpedi.1978.02120300026004pmid: 347920

Abstract • A 13-year-old epileptic girl took an overdose of acetaminophen (Tylenol) and phenobarbital. Hepatic encephalopathy developed and the patient died eight days later. Necropsy revealed extensive centrilobular necrosis of the liver, degeneration of the renal distal tubules, and infarcted and demyelinated foci throughout the white matter of the cerebral cortex. Electron microscopy of intact hepatocytes showed a proliferation of both smooth and rough endoplasmic reticulum consistent with enzyme induction from phenobarbital. To our knowledge, this is the first reported death in a child in the United States as a result of acetaminophen and should alert physicians to an expected increase in acetaminophen toxicity as the drug becomes more widely available. (Am J Dis Child 132:466-473, 1978) References 1. Prescott LF, Swainson CP, Forrest ARW, et al: Successful treatment of severe paracetamol overdosage with cysteamine . Lancet 1:588-592, 1974.Crossref 2. Clark R, Thompson RPH, Borirakchanyavat V, et al: Hepatic damage and death from overdose of paracetamol . Lancet 1:66-69, 1973a.Crossref 3. Maclean D, Peters TJ, Brown RAG, et al: Lancet 2:849-852, 1968.Crossref 4. Sanerkin NG: Acute myocardial necrosis in paracetamol poisoining . Br Med J 2:478, 1971.Crossref 5. Rumack BH, Matthew H: Acetaminophen poisoning and toxicity . Pediatrics 56:871, 1975. 6. Dunlop D: Discussion of papers presented in session I . J Int Med Res 4:29-31, 1976. 7. Gazzard BG, Davis N, Spooner J, et al: Why do people use paracetamol for suicide? Br Med J 1:121-123, 1976a.Crossref 8. Gazzard BG, Spooner JB, Williams RS: Why paracetamol? J Int Med Res 4:24-28, 1976b. 9. Volans GN: Self-poisoning and suicide due to paracetamol . J Int Med Res 4:7-14, 1976. 10. Chambers DR: Fatal drug overdosage . J Int Med Res 4:14-24, 1976. 11. McJunkin B, Barwick KW, Little WC, et al: Fatal massive hepatic necrosis following acetaminophen overdose . JAMA 236:1874-1875, 1976.Crossref 12. Boyer TD, Rouff SL: Acetaminophen-induced hepatic necrosis and renal failure . JAMA 218:440-441, 1971.Crossref 13. Wright N, Prescott LF: Potentiation by previous drug therapy of hepatotoxicity following paracetamol overdosage . Scott Med J 18:56-58, 1973. 14. Prescott LF, Wright N, Roscoe P, et al: Plasma-paracetamol half-life and hepatic necrosis in patients with paracetamol overdosage . Lancet 1:519-522, 1971a.Crossref 15. Sutton E, Soyka LF: How safe is acetaminophen? Clin Pediatr 12:692, 1973.Crossref 16. Kauffman R: Commentary on acetaminophen . Pediatrics 61:108, 1978. 17. Koch-Weser J: Medical intelligence, drug therapy: Acetaminophen . N Engl J Med 295:1297-1300, 1976.Crossref 18. Booker HE, Darcey BA: Enzymatic immunoassay vs gas/liquid chromatography for determination of phenobarbital and diphenylhydantoin in serum . Clin Chem 21:1766-1768, 1975. 19. Legaz M, Raisys VA: Correlation of the EMIT® antiepileptic drug assay with a gas liquid chromatographic method . Clin Biochem 9:35-38, 1976.Crossref 20. Evans MA, Harbison RD: Microanalysis by gas-liquid chromatography for phenacetin and paracetamol in plasma . J Pharm Sci , to be published. 21. Prescott LF, Park J, Sutherland GR, et al: Cysteamine, methionine, and penicilliamine in the treatment of paracetamol poisoining . Lancet 2:109-113, 1976a.Crossref 22. Prescott LF, Park J, Proudfoot AT: Cysteamine, L-Methionine and D-Penicillamine in paracetamol poisoning . J Int Med Res 4:112-118, 1976b. 23. James O, Lesna M, Roberts SH, et al: Liver damage after paracetamol overdose: Comparison of liver-function tests, fasting serum bile acids, and liver histology . Lancet 2:597-581, 1975. 24. James O: A controlled trial of cysteamine in the treatment of acute paracetamol poisoning.

Lawson, Edward E.;Grand, Richard J.;Neff, Raymond K.;Cohen, Lawrence F.

1978 American Journal of Diseases of Children

doi: 10.1001/archpedi.1978.02120300034005pmid: 645673

Abstract • The liver span in 350 infants and children was determined by percussion of the upper and lower borders in the midclavicular line. Mean liver span was found to be related to age curvilinearly and ranged from a minimum of 1.9 cm at 1 week of age to a maximum of 7.7 cm in males and 6.3 cm in females at 20 years of age. In children with normal growth patterns, age and sex were found to be the major factors influencing liver size. Though height and weight also correlated with liver span, these variables did not add substantially to the correlation using age and sex alone. The presence of minor systemic illnesses, eg, otitis and gastroenteritis, did not affect liver span. The expected normal values for liver span at different ages for male and female children have been established and provide the basis for comparison during routine physical examination. (Am J Dis Child 132:474-476, 1978) References 1. Naftalis J, Leevy CM: Clinical estimation of liver size . Am J Dig Dis 8:236-239, 1963.Crossref 2. Peternel WW, Schaefer JW, Schiff L: Clinical evaluation of liver size and hepatic scintiscan . Am J Dig Dis 11:346-350, 1966.Crossref 3. Castell DO, O'Brien KD, Muench H, et al: Estimation of liver size by percussion in normal individuals . Ann Intern Med 70:1183-1189, 1969.Crossref 4. McNicholl B: Palpability of the liver and spleen in infants and children . Arch Dis Child 32:438-440, 1957.Crossref 5. Deligeorgis D, Yannakos D, Panayofou P, et al: The normal borders of the liver in infancy and childhood: Clinical and x-ray study . Arch Dis Child 45:702-704, 1970.Crossref 6. Younoszai MK, Mueller S: Clinical assessment of liver size in normal children . Clin Pediatr 14:378-380, 1975.Crossref 7. Deligeorgis D, Yannakos D, Doxiadis S: Normal size of liver in infancy and childhood . Arch Dis Child 48:790-793, 1973.Crossref 8. Abraham S: Preliminary Findings of the First Health and Nutrition Examination Survey, United States, 1971-1972: Anthropomorphic and Clinical Findings , No. (75) -1229. US Department of Health, Education, and Welfare, Health Resources Administration, 1975. 9. Bliss CI: Statistics in Biology . New York, McGraw-Hill Book Co, Inc, 1970, vol 2. 10. Snedecor GW, Cochran WG: Statistical Methods , ed. Ames, Iowa, Iowa State University Press, 1967. 11. Coppoletta JM, Wolbach SB: Body length and organ weights of infants and children: A study of the body length and normal weights of the more important vital organs of the body between birth and 12 years of age . Am J Pathol 9:55, 1933.

Carlson, Jacqueline A. K.;Middleton, Peter J.;Szymanski, Maria T.;Huber, Johannes;Petric, Martin

1978 American Journal of Diseases of Children

doi: 10.1001/archpedi.1978.02120300037006pmid: 206132

Abstract • During the period of May 1972 to March 1977, twenty-one fatal cases of rotavirus acute gastroenteritis were recorded in the city of Toronto. The mean age of these subjects was approximately 1 year. Boys outnumbered girls by 12 to 9. Death occurred within three days of onset of symptoms in all cases. Sixteen of the subjects were profoundly dehydrated and had sodium levels (serum or vitreous humor) in excess of 150 mEq/liter. In 11 subjects, sodium values were greater than 160 mEq/liter. Although a physician was contacted in 16 instances, these infants still perished. We suggest that both language difficulties and the rapid rate of fluid depletion contributed significantly to the fatal outcome. At autopsy the bowel was often dilated and filled with fluid. Postmortem autolysis precluded an accurate histological assessment of the small bowel mucosa. (Am J Dis Child 132:477-479, 1978) References 1. Rotavirus of man and animals . Lancet 1:257-259, 1975. 2. Davidson GP, Bishop RF, Townley RRW, et al: Importance of a new virus in acute sporadic enteritis in children . Lancet 1:242-246, 1975.Crossref 3. Middleton PJ, Szymanski MT, Abbott GD, et al: Orbivirus acute gastroenteritis of infancy . Lancet 1:1241-1244, 1974.Crossref 4. Some winter viruses: Public Health Laboratory Report, United Kingdom and Republic of Ireland . Br Med J 1:1347, 1976.Crossref 5. Palmer E, Martin M, Foster S: Reo-like virus epidemic enteritis in 1964 , abstracted. American Society for Microbiology, 1977, p 53, C110. 6. Moffett HL, Shulenberger HK, Burkholder ER: Epidemiology and etiology of severe infantile diarrhea . J Pediatr 72:1-14, 1968.Crossref 7. Whitlaw A, Davies H, Perry J: Electron microscopy of fatal adenovirus gastroenteritis . Lancet 1:361, 1977.Crossref 8. Sainte-Marie G: A paraffin embedding technique for studies employing immunofluorescence . J Histochem Cytochem 10:250-256, 1962.Crossref 9. Swift PGF, Worthy E, Emery JL: Biochemical state of the vitreous humour of infants at necropsy . Arch Dis Child 49:680-685, 1974.Crossref 10. Catalogue 92-723 , vol 1, pt 3. 1971 Census of Canada . Ottawa, Public Statistics of Canada, (October) 1973, pp 7-8. 11. Middleton PJ, Szymanski MT, Petric M: Viruses associated with acute gastroenteritis in young children . Am J Dis Child 131:733-737, 1977.

Pickering, Larry K.;Ericsson, Charles D.;Ruiz-Palacios, Guillermo;Blevins, John;Miner, Michael E.

1978 American Journal of Diseases of Children

doi: 10.1001/archpedi.1978.02120300040007pmid: 645674

Abstract • Five children with intraventricular shunts developed ventriculitis due to organisms resistant to multiple antimicrobial agents but sensitive to gentamicin sulfate. No gentamicin was detected in ventricular CSF of four patients at a time when gentamicin was being administered only intravenously. The intraventricular administration of 1 mg of gentamicin resulted in ventricular CSF concentrations greater than 20 μg/ml one hour and 5 to 14 μg/ml 36 hours after administration. Patients were treated with intraventricularly given gentamicin for an average of 16 days, with no apparent complications or relapses during the 12- to 24-month follow-up period. Intraventricularly administered gentamicin sulfate (1 mg every 24 to 36 hours) in conjunction with complete shunt removal was an effective means of therapy of ventriculitis caused by bacteria resistant to antibiotics that readily penetrate the blood-brain barrier. (Am J Dis Child 132:480-483, 1978) References 1. Schoenbaum SC, Gardner P, Shillito J: Infections of cerebrospinal fluid shunts: Epidemiology, clinical manifestations and therapy . J Infect Dis 131:543-552, 1975.Crossref 2. Shurtleff DB, Flotz EL, Weeks RD, et al: Therapy of Staphylococcus epidermidis: Infections associated with cerebrospinal fluid shunts . Pediatrics 53:55-62, 1974. 3. Salmon JH: Ventriculitis complicating meningitis . Am J Dis Child 124:35-40, 1972. 4. Smith AL, Smith DH: Gentamicin: Adenine mononucleotide transferase: Partial purification, characterization and use in the clinical quantitation of gentamicin . J Infect Dis 129:391-401, 1974.Crossref 5. Broughton A, Strong JE, Pickering LK, et al: Radioimmunoassay of iodinated tobramycin . Antimicrob Agents Chemother 10:652-656, 1976.Crossref 6. Moellering RC Jr, Fischer EG: Relationship of intraventricular gentamicin levels to cure of meningitis . J Pediatr 81:534-536, 1972.Crossref 7. Kaiser AB, McGee ZA: Aminoglycoside therapy of Gram-negative bacillary meningitis . N Engl J Med 293:1215-1220, 1975.Crossref 8. Rahal JJ Jr, Hyams PJ, Simberkoff MS, et al: Combined intrathecal and intramuscular gentamicin for Gram-negative meningitis: Pharmacologic study of 21 patients . N Engl J Med 290:1394-1398, 1974.Crossref 9. Lorber J, Kalhan SC, Mahgrefte B: Treatment of ventriculitis with gentamicin and cloxacillin in infants born with spina bifida . Arch Dis Child 45:178-185, 1970.Crossref 10. Newman RL, Hold RJ: Intrathecal gentamicin in treatment of ventriculitis in children . Br Med J 2:539-542, 1967.Crossref 11. Whang CJ, Cauthen JC, Garcia-Bengochae F: Successful treatment of ventriculitis by continuous intraventricular irrigation with gentamicin solution . Surg Neurol 2:91-94, 1974. 12. Sabath LD, Garner C, Wilcox C, et al: Susceptibility of Staphylococcus aureus and Staphylococcus epidermidis to 65 antibiotics . Antimicrob Agents Chemother 9:962-969, 1976.Crossref 13. Rahal JJ Jr: Treatment of Gram negative bacillary meningitis in adults . Ann Intern Med 77:295-302, 1972.Crossref

Westley, C. Ross;Cotton, Ernest K.;Brooks, John G.

1978 American Journal of Diseases of Children

doi: 10.1001/archpedi.1978.02120300044008pmid: 347921

Abstract • Racemic epinephrine has been advocated for the treatment of croup, but controlled studies have not proved it more effective than saline. Twenty patients (aged 4 months to 5 years) hospitalized with acute croup and persistent inspiratory stridor at rest were randomly assigned to one of two treatment groups: saline or racemic epinephrine, both nebulized and delivered by intermittent positive pressure breathing. Clinical scores were significantly improved (P <.01) at ten and 30 minutes following the treatment with racemic epinephrine but not at 120 minutes. Racemic epinephrine was significantly more effective than saline at 10 (P <.01) and 30 minutes (P <.05) but not at 120 minutes after the treatment. We conclude that nebulized racemic epinephrine is effective treatment for the acute signs of croup. (Am J Dis Child 132:484-487, 1978) References 1. Adair JC, Ring WH, Jordan WS: Ten-year experience with IPPB in the treatment of acute laryngotracheobronchitis . Anesth Analg 50:649-655, 1971.Crossref 2. Melnick A, Berger R, Green G: Spasmodic croup in children: Personal experiences with intermittent positive pressure breathing in therapy . Clin Pediatr 11:615-617, 1972.Crossref 3. Breivik H: Behandling av akutt laryngitt med forstøvet racemisk adrenalin . Tidsskr Nor Laegeforen 95:441-443, 1975. 4. Jordan WS, Graves CL, Elwyn RA: New therapy for postintubation laryngeal edema and tracheitis in children . JAMA 212:585-588, 1970.Crossref 5. Singer OP, Wilson WJ: Laryngotracheobronchitis: two years' experience with racemic epinephrine . Can Med Assoc J 115:132-134, 1976. 6. Taussig LM, Castro O, Beaudry PH: Treatment of laryngotracheobronchitis (croup): Use of intermittent positive pressure breathing and racemic epinephrine . Am J Dis Child 129:790-793, 1975. 7. Gardner HG, Powell KR, Roden VJ, et al: The evaluation of racemic epinephrine in the treatment of infectious croup . Pediatrics 52:52-55, 1973. 8. Dunnett CW: New tables for multiple comparisons with a control . Biometrics 20:482, 1964.Crossref 9. Ellis EF, Taylor JC Jr, Lefkowitz MS: Letter to the editor . Pediatrics 53:291-292, 1974. 10. Glezen WP, Denny FW: Epidemiology of acute lower respiratory disease in children . N Engl J Med 288:498-505, 1973.Crossref

Granoff, Dan M.;Sargent, Edward;Jolivette, Dan

1978 American Journal of Diseases of Children

doi: 10.1001/archpedi.1978.02120300048009pmid: 306193

Abstract • Three children had osteomyelitis due to Haemophilus influenzae type b. They were seen with signs and symptoms indistinguishable from infection caused by other organisms. One child was initially misdiagnosed as having septic arthritis because of failure to appreciate that Hemophilus may also cause bone infection. In the second patient osteomyelitis and arthritis developed during ampicillin sodium therapy for treatment of Hemophilus meningitis. His initial infection was caused by an ampicillin-sensitive isolate but his orthopedic infection subsequently responded to therapy only after changing to a regimen of chloramphenicol. In the third patient, bone scintigraphy was helpful in diagnosis since serial roentgenograms were not diagnostic of osteomyelitis. The anticapsular antibody responses of these patients were measured by radioimmune assay. The levels found were low but comparable to age-matched control children with H influenzae type b meningitis. (Am J Dis Child 132:488-490, 1978) References 1. Nelson JD: The bacterial etiology and antibiotic management of septic arthritis in infants and children . Pediatrics 50:437-440, 1972. 2. Ravn H: Acute haematogenous osteomyelitis due to type-b Haemophilus influenzae . Lancet 1:517-518, 1966.Crossref 3. Taylor JC, Fallon RJ: Osteomyelitis due to Haemophilus influenzae . Lancet 1:715, 1966. 4. Busfield PI, Finlay HVL: Osteomyelitis due to Haemophilus influenzae . Lancet 1:715, 1966.Crossref 5. Farrand RJ, Johnstone JMS, Maccabe AF: Haemophilus osteomyelitis and arthritis . Br Med J 2:334-336, 1968.Crossref 6. Todd JK, Bruhn FW: Severe Haemophilus influenzae infections: Spectrum of disease . Am J Dis Child 129:607-611, 1975. 7. Granoff DM, Nankervis GA: Infectious arthritis in the neonate caused by Hemophilus influenzae . Am J Dis Child 129:730-733, 1975. 8. Granoff DM, Nankervis GA: Cellulitis due to Haemophilus influenzae type b . Am J Dis Child 130:1211-1214, 1976. 9. Escamilla J: Susceptibility of Haemophilus influenzae to ampicillin as determined by use of a modified, one-minute beta-lactamase test . Antimicrob Agents Chemother 9:196-198, 1976.Crossref 10. Thornsberry C, Kirven LA: Antimicrobial susceptibility of Haemophilus influenzae . Antimicrob Agents Chemother 6:620-624, 1974.Crossref 11. Granoff DM, Congeni B, Baker R Jr, Ogra P, Nankervis GA: CIE in the diagnosis of Hemophilus influenzae b infection: Relationship of detection of capsular antigen to age, antibody response and therapy . Am J Dis Child 131:1357-1362, 1977. 12. Robbins JB, Parke JC Jr, Schneerson R, et al: Quantitative measurement of "natural" and immunization-induced Haemophilus influenzae type b capsular polysaccharide antibodies . Pediatr Res 7:103-110, 1973.Crossref 13. Waldvogel FA, Medoff G, Swartz MN: Osteomyelitis: A review of clinical features, therapeutic considerations and unusual aspects (first of three parts) . N Engl J Med 282:198-206, 1970.Crossref 14. Dich VQ, Nelson JD, Haltalin KC: Osteomyelitis in infants and children . Am J Dis Child 129:1273-1278, 1975. 15. McHenry MC, Alfidi RG, Wilde AH: Hematogenous osteomyelitis: A changing disease . Cleve Clin Q 42:125-153, 1975. 16. Hemborg A, Kempi V, van der Linden W: Scintigraphy with 99mTc-tripolyphosphate in the early diagnosis of osteomyelitis . Nucl Med 15:53-55, 1976. 17. Treves S, Khettry J, Broker FH, et al: Osteomyelitis: Early scintigraphic detection in children . Pediatrics 57:173-186, 1976. 18. Majd M, Frankel RS: Radionuclide imaging in skeletal inflammatory and ischemic disease in children . J Nucl Med 126:832-841, 1976. 19. Gilday DL, Paul DJ, Peterson J: Diagnosis of osteomyelitis in children by combined blood pool and bone imaging . Radiology 117:331-335, 1975.

Friday, Gilbert A.;Hiles, David A.

1978 American Journal of Diseases of Children

doi: 10.1001/archpedi.1978.02120300051010pmid: 645675

Abstract • Three patients had four lid distichiasis and signs and symptoms of allergic rhinoconjunctivitis. The findings consisted of ocular irritation with tearing, photophobia, periodic lid swelling, rhinorrhea, and boggy nasal mucosa. Treatment of the allergic rhinoconjunctivitis was unsuccessful until the distichiasis was relieved. Exacerbations of signs and symptoms recurred when lashes regrew. A neural reflex relationship exists to explain most of the symptom complex resulting from ocular irritation. In the evaluation of patients with rhinoconjunctivitis, trichiasis should be looked for, especially if there is noticeable photophobia present. (Am J Dis Child 132:491-493, 1978) References 1. Walsh FB, Hoyt WF: Clinical Neuro-ophthalmology , ed 3. Baltimore, Williams & Wilkins, 1969, pp 551-555. 2. Duke-Elder S: Normal and abnormal development: Congenital deformities: Part 2, in System of Ophthalmology . St Louis, CV Mosby Co, 1963, pp 873-876. 3. Pico G: Congenital ectropion and distichiasis . Trans Am Ophthalmol Soc 55:663-700, 1957. 4. Falls HF, Kertesz ED: A new syndrome combining pterygium colli with developmental anomalies of the eyelids and lymphatics of the lower extremities . Trans Am Ophthalmol Soc 62:248-275, 1964. 5. Scheie HG, Albert DM: Distichiasis and trichiasis: Origin and management . Am J Ophthalmol 61:718-720, 1966. 6. Fox SA: Distichiasis . Am J Ophthalmol 53:14-18, 1962. 7. Mustonen E: Congenital distichiasis . Acta Ophthalmol 50:598-607, 1972. 8. Deutsch AR: Distichiasis and epicanthus . Am J Ophthalmol 3:168-173, 1971. 9. Robinow M, Johnson GF, Verhagen AD: Distichiasis: Lymphedema . Am J Dis Child 119:343-347, 1970. 10. Chynn KY: Congenital spinal extradural cyst in two siblings . Am J Roentgenol 101:204-215, 1967.Crossref