1989 American Journal of Diseases of Children
doi: 10.1001/archpedi.1989.02150210008001
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
1989 American Journal of Diseases of Children
doi: 10.1001/archpedi.1989.02150210013003
Abstract In Reply.—In the conclusion of our article,1 we attempted to make a distinction between our recommendations and those of the AHA. As Dr Gill has correctly observed, the AHA does not list twice-daily penicillin therapy as an acceptable regimen for the treatment of streptococcal pharyngitis.2 However, based on our findings3 and those of several other investigators,4-8 we believe that twice-daily penicillin V therapy is an effective regimen. The Committee on Infectious Diseases of the American Academy of Pediatrics also notes that "with good compliance, two doses of oral pencillin totaling 800,000 U (500 mg) daily have been reported to be effective."9 References 1. Gerber MA, Randolph MF, DeMeo K, Feder HM Jr, Kaplan EL. Failure of once-daily penicillin V therapy for streptococcal pharyngitis . AJDC . 1989;143:153-155. 2. Dajani AS, Bisno AL, Chung KJ, et al. Prevention of rheumatic fever: a statement for health professionals by the Committee on Rheumatic Fever, Infective Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young . Circulation . 1988;78:1082-1086.Crossref 3. Gerber MA, Spadaccini LJ, Wright LL, Deutsch L, Kaplan EL. Twice-daily penicillin in the treatment of streptococcal pharyngitis . AJDC . 1985;110:125-130. 4. Breese BB, Disney FA, Talpey WB. Penicillin in streptococcal infections: total dose and frequency of administration . AJDC . 1965;110: 125-130. 5. Rosenstein RJ, Markowitz M, Goldstein E, et al. Factors involved in treatment failures following oral penicillin for streptococcal pharyngitis . J Pediatr . 1968;73:513-520.Crossref 6. Vann RL, Harris BA. Twice-a-day penicillin for streptococcal upper respiratory infections . South Med J . 1972;65:203-205.Crossref 7. Stillerman M, Isenberg HD, Facklam RR. Streptococcal pharyngitis therapy: comparison of clindamycin palmitate and potassium phenoxymethyl penicillin . Antimicrob Agents Chemother . 1973;4:514-520.Crossref 8. Spitzer TQ, Harris BA. Penicillin V therapy for streptococcal pharyngitis: comparison of dosage schedules . South Med J . 1977;70:41-42.Crossref 9. Peter G, Hall CB, Lepow ML, Phillips CF, eds: Report of the Committee on Infectious Diseases . 21st ed. Elk Grove, Ill: American Academy of Pediatrics; 1988:391.
1989 American Journal of Diseases of Children
doi: 10.1001/archpedi.1989.02150210013002pmid: 2505610
Abstract Sir.—I read with interest the article by Gerber et al1 in the February 1989 issue of AJDC. I was especially interested in his final paragraph. In his conclusion he states that his findings support other recommendations, specifically those of the American Heart Association (AHA), that oral penicillin V potassium can be given in two or three divided doses for 10 days for the treatment of group A streptococcal pharyngitis. I referred to the article cited and found that in fact they do not list twice-daily therapy as an acceptable treatment to prevent rheumatic heart disease.2 For those of us in private practice, it would certainly help to have this issue clarified. Does the AHA approve of twice-daily therapy with penicillin y or any medication other than a salt of erythromycin, as adequate treatment for group A streptococcal pharyngitis? References 1. Gerber MA, Randolph MF, DeMeo K, Feder HM Jr, Kaplan EL. Failure of once-daily penicillin V therapy for streptococcal pharyngitis . AJDC . 1989;143:153-155. 2. Dajani AS, Bisno AL, Chung KJ, et al. Prevention of rheumatic fever: a statement of health professionals by the Committee on Rheumatic Fever, Infective Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young . Circulation . 1988;78:1082-1086.Crossref
TONG, TIMOTHY;TEAFORD, PATRICIA A.
1989 American Journal of Diseases of Children
doi: 10.1001/archpedi.1989.02150210013004pmid: 2773891
Abstract Sir.—Infants and children who are ejected or who fall out of the rear beds of pickup trucks present a significant but underreported health care issue. Most legislation dealing with child restraint or seat belts issues do not adequately address this problem. We present two cases of children ejected from the rear bed of a pickup truck. Patient Reports.—Patient 1.—A 6-year-old right-handed Navajo boy fell from the back of a pickup truck that was traveling approximately 25 mph over a bumpy rural road. The child struck the frontal portion of his head and experienced a loss of consciousness for a few minutes. After initial evaluation and stabilization, he was transported to our institution. His vital signs on arrival included a heart rate of 70 beats per minute, a blood pressure of 120/65 mm Hg, and a respiratory rate of 20 breaths per minute. Neurologically, he had a References 1. Decker MD, Dewey MJ, Hutchinson RH. The use and efficiency of child restraint devices . JAMA . 1984;252:2571-2475.Crossref 2. Agran PF, Dunkle DE, Winn DJ. Motor vehicle accident trauma and restraint usage patterns in children less than 4 years of age . Pediatrics . 1985;76:382-386. 3. Meadows AT, Massari DJ, Fergusson J, Gordon J, Littman P, Moss K. Declines in IQ scores and cognitive dysfunctions in children with acute lymphocytic leukemia treated with cranial irradiation . Lancet . 1981;2:1015-1018.Crossref
WEIR, MICHAEL R.;DUNGAN, NEWTON O.
1989 American Journal of Diseases of Children
doi: 10.1001/archpedi.1989.02150210014005
Abstract Sir.—A case of isolated adenoiditis prompted a search of the literature for the condition. The results of the search were startling due to the virtual absence of characterization of what should be a distinctive, and not unusual, clinical entity. Patient Report.—A previously healthy 9-year-old girl presented with fever, rhinorrhea, pharyngeal pain, and hyponasal speech of 2 days' duration. She reportedly had had a tonsillectomy and adenoidectomy 3 years earlier for recurrent adenotonsillitis. Abnormalities on physical examination were limited to fever (temperature, 40°C), serous rhinorrhea that prompted nearly constant sniffling, total occlusion of the posterior nasal airway, and an exudative fullness just visible in the superior pharynx behind the uvula. Mild posterior cervical adenopathy was also present. A lateral soft-tissue roentgenogram of the head and neck was obtained (Figure). The postero-superior location and contour of the naso-pharyngeal mass seen on the roentgenogram suggested adenoid hypertrophy. Flexible fiberoptic nasopharyngoscopy revealed References 1. Ballenger JJ. Diseases of the Nose, Throat and Ear . Philadelphia, Pa: Lea and Febiger; 1977:276-279. 2. Birrell JI. Pediatric Otolaryngology . Chicago, Ill: Year Book Medical Publishers Inc; 1978;6:19-22. 3. Kornblut AD. Non-neoplastic diseases of the tonsils and adenoids . In: Paparella MM, Shumrick DA, eds: Otolaryngology . Philadelphia, Pa: WB Saunders Co; 1980:2263-2279. 4. Hibbert J. Tonsils and adenoids . In: Evans JNG, ed: Paediatric Otolaryngology (Scott-Brown's Otolaryngology) . London, England: Butterworths; 1987;6:369-383. 5. Sasaki H. Acute adenoiditis . Otolaryngology (Tokyo) . 1976;48:529-532.
1989 American Journal of Diseases of Children
doi: 10.1001/archpedi.1989.02150210014006
Abstract Sir.—To my knowledge, this instance of collagenous colitis in a 7-year-old boy is the first to be documented in a child. This condition is of unknown etiology and, in this case, appeared to respond to Stained sections from a rectal biopsy specimen showing the normal surface epithelium, the deposition of collagen as a band beneath the basement membrane, and the sparse chronic inflammatory infiltrate within the lamina propria (hematoxylin-eosin, original magnification × 140 [left] and ×320 [right]). sulfasalazine therapy. Since the original description by Lindstrom1 in 1976 of the clinicopathologic syndrome that was labeled collagenous colitis, about 50 patients2,3 with this condition have been described, all adults. Patient Report.—A 7-year-old boy had complained of large-volume watery diarrhea for several months; there were up to 10 bowel movements per day. Fasting and/or milk abstinence failed to improve the diarrhea. The feces contained no mucus or blood, and References 1. Lindstrom CG. 'Collagenous colitis' with watery diarrhoea: a new entity? Pathol Eur . 1976; 11:87-89. 2. Giardiello FM, Bayless TM, Jessurun J, Hamilton SR, Yardley JH. Collagenous colitis: physiologic and histopathologic studies in seven patients . Ann Intern Med . 1987;106:46-49.Crossref 3. Jessurun J, Yardley JH, Giardiello FM, Hamilton SR, Bayless TM. Chronic colitis with thickening of the subepithelial collagen layer (collagenous colitis): histopathologic findings in 15 patients . Hum Pathol . 1987;18:839-848.Crossref 4. Fausa O, Foerster A, Hovig T. Collagenous colitis: a clinical, histopathological and ultrastructural study . Scand J Gastroenterol Suppl . 1985; 107:8-23.Crossref 5. Palmer KR, Berr H, Wheeler PJ, et al. Collagenous colitis: a relapsing and remitting disease . Gut . 1986;27:578-580.Crossref 6. Wang KK, Perrault J, Carpenter HA, Schroeder KW, Tremaine WJ. Collagenous colitis: a clinicopathologic correlation . Mayo Clin Proc . 1987; 62:665-671.Crossref 7. Weidner N, Smith J, Pattee B. Sulfasalazine in the treatment of collagenous colitis: case report and review of the literature . Am J Med . 1984;77:162-166.Crossref 8. Rams H, Rogers AI, Ghandur-Mnaymneh L. Collagenous colitis . Am Intern Med . 1987;106: 108-113.Crossref 9. Hwang WS, Kelly JK, Shaffer EA, Hershfield NB. Collagenous colitis: a disease of pericrypt sheath? J Pathol . 1986;149:33-40.Crossref 10. Erlendsson J, Fenger C, Meinicke J. Arthritis and collagenous colitis: report of a case with concomitant polyarthritis and collagenous colitis . Scand JRheumatol . 1983;12:93-95.Crossref 11. Weinstein WM, Saunders DR, Tytgat GN, Rubin CE. Collagenous sprue: an unrecognized type of malabsorption . N Engl J Med . 1970; 283:1297-1301.Crossref 12. Baker AC, Rosenberg IH. Refractory sprue: recovery after removal of non-gluten proteins . Ann Intern Med . 1978;89:505-508.Crossref
BUSUTTIL, ANTHONY;FLETA, JESUS;SARRÍA, ANTONNIO;OLIVÁN, GONZALO;BUENO, MANUEL;BELLO, MARIA LUISA;CASTIELLA, TOMÁS
1989 American Journal of Diseases of Children
doi: 10.1001/archpedi.1989.02150210016007pmid: 2773875
Abstract Sir.—Osteoid osteoma is a benign bone tumor that principally affects men in the second decade of life. The clinical manifestations include a characteristic pain with nocturnal exacerbations that recedes or disappears after taking aspirin. In addition, muscular atrophy in the affected extremity and functional impairment are noted. If the tumor is located in the vertebrae, scoliosis can result. The most frequent locations are the femur, tibia, vertebrae, and humerus. A preliminary diagnosis can be made clinically, but confirmation is made by the visualization of the pathognomonic bone lesion, which is the "nidus" surrounded by an area of sclerosis. After surgical treatment, pathological study can confirm the diagnosis by examination of biopsy specimens. We present a series of patients with osteoid osteoma in whom computed tomography assisted in diagnosis of the lesions. Patient Reports.—Six children ranging in age from 3 years 5 months to 12 years 6 months References 1. Huguenin P, Bensakel H. Rèflexions á propos de l'ostèoma ostèoide chez l'enfant . Chir Pediatr . 1978;19:83-92. 2. Bello ML, Albareda A, Palanca A, Burillo B, Seral F. Osteoma osteoide de columna lumbar: estudio pre y postoperatorio con tomografía axial computarizada . Rev Esp Cir Ost . 1983;18:405-411. 3. Nelson OA, Greer RB. Localization of osteoma of the spine using computerized tomography: case report . J Bone Joint Surg Am . 1983;65:263-265.
1989 American Journal of Diseases of Children
doi: 10.1001/archpedi.1989.02150210016008pmid: 2773876
Abstract Sir.—Drs Halperin and Doyle, in their response to a recent letter,1 made an assertion that deserves clarification. They stated that"... diagnosing ITP [idiopathic thrombocytopenic purpura] on the basis of a positive serologic test would be as accurate as flipping a coin," given a positive predictive value of approximately 50%. The statement is accurate in this context, since they were referring to data gathered on a population of patients' sera that had a prevalence of ITP of approximately 50%.2 In general, however, using a coin flip as a screening test does not produce a fixed positive predictive value of 50%. Instead, it produces a positive predictive value equal to the prevalence of the disease in the population tested. The distinction is important. If we choose a disease, for example, with a 5% prevalence, then a coin flip will give a positive predictive value of 5%. If, however, another References 1. Halperin DS, Doyle JJ. High-dose intravenous methylprednisolone for childhood idiopathic thrombocytopenic purpura . AJDC . 1988; 142: 1273-1274. 2. von dem Borne AEGK, van der Lelie H, Vos JJE, et al. Antibodies against cryptantigens of platelets . Curr Stud Hematol Blood Transfus . 1986;52:33-46.
MAURO, ROBERT D.;HALPERIN, DANIEL S.
1989 American Journal of Diseases of Children
doi: 10.1001/archpedi.1989.02150210017009
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract In Reply.—Dr Mauro's remarks would be very pertinent if we had suggested in our reply that platelet antibodies should be detected as part of a screening program of ITP in the general population. This is not so, however. Such a screening test would be unjustifiable, not only because of its immense costs, but mainly because it would offer no therapeutic or preventive advantage to the patients detected in this manner, as compared with those whose thrombocytopenia has been discovered, as is usually the case, on clinical grounds. Thus, the controversy regarding the utility of platelet antibody testing is limited to the population of patients with thrombocytopenia and cannot be extrapolated to the general population. In this setting, our statement on "coin flipping" remains correct. Platelet antibody testing has a positive predictive value for ITP of 50%. In other words, the probability for a patient with thrombocytopenia of having ITP if the
1989 American Journal of Diseases of Children
doi: 10.1001/archpedi.1989.02150210017010
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract —Dr Mauro has pointed out a very interesting aspect of the algebra of calculating positive predictive values or PV +. PV+ is the probability that this subject has the disease tested for (D +) given that the test for the disease is positive (T +). PV+ can be written as prob(D + T +) = the probability of the disease given a positive test. This is a classic Bayes' formula issue and a subtle one that I have not seen discussed anywhere in my reading. For the record, I will go through the algebra in case someone challenges Dr Mauro's assertions. If you flip a coin instead of performing a test, you will get pr(T + D +) of.50; that is, the probability of a positive test T+ is the probability of, say, "heads." Also, the probability of a positive test among subjects without the disease, pr(T + D-), will also be
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