Acrodysostosis coinciding with pseudohypoparathyroidism and pseudo-pseudohypoparathyroidism.

The diagnosis of acrodysostosis has been differentiated from that of pseudohypoparathyroidism or pseudo-pseudohypoparathyroidism by the absence of endocrine abnormalities, more generalized osseous abnormalities, and a characteristic facial appearance. Two cases are presented which fulfill all of the major features of acrodysostosis: peripheral dysostosis, nasal hypoplasia (pug nose), and mental retardation. The first case had all the metabolic abnormalities of pseudohypoparathyroidism; the second case had urinary cyclic adenosine-3',5'-monophosphate findings suggestive of pseudo-pseudohypoparathyroidism. Therefore acrodysostosis cannot be differentiated from pseudohypoparathyroidism or pseudopseudohypoparathyroidism on clinical and radiologic features only.     

Transient hypertrophic gastropathy in childhood: a protein-losing gastropathy distinct from Menetrier's disease

Transient hypertrophic gastropathy in a child with similarity of radiographic and clinical features to Menetrier's disease is described. Distinction from Menetrier's disease is emphasized as the condition is characterized by abrupt onset, short duration, eosinophila and good prognosis. The association with hypersensitivity as a possible etiology is more suggestive in this condition. The radiographic changes will often provide the first clue to this condition and rapid reversal of the gastric changes is diagnostic.     

Ultrasonic detection of osteomyelitis. Pathologic correlation in an animal model.

The authors correlated sonographic findings with histologic findings in a rabbit model of osteomyelitis. Staphylococcus aureus osteomyelitis was induced in the femora of 11 New Zealand white rabbits. The opposite leg was used as a control. Sonographic findings showed fluid adjacent to the bone in 11 cases. The fluid was believed to be an inflammatory exudate, and its presence suggested osteomyelitis. Pathologic analysis showed extraperiosteal purulent fluid adjacent to the cortex as well as histopathologic changes of osteomyelitis in the 11 rabbits. There was one false-positive sonographic diagnosis of osteomyelitis in a rabbit that had a soft tissue abscess adjacent to the cortex.     

Premature fusion of the proximal humeral epiphyses in thalassemia

Premature fusion of the proximal humeral epiphyses with varus deformity is a common and characteristic radiologic finding in thalassemia anemia. A review of 17 cases with bilateral and one case with unilateral involvement, coupled with known anatomic and mechanical factors, suggested an explanation for this phenomenon. Hypertrophied marrow will thin the trabeculae and cortex, perforate the cortex through normal fenestrations, and proliferate subperiosteally. Normal force vectors result in medial humeral compression and ultimately premature fusion.     

Radiographic aspects of total parenteral nutrition during infancy.

In a retrospective radiographic study the authors reviewed the position of 82 central venous catheters in 57 consecutive infants receiving total parenteral nutrition between 1972 and 1976. Sixteen of the 82 catheters (19%) were initially not positioned within the superior vena cava and 11 (14%) migrated from a satisfactory position during therapy; peripheral edema, pleural effusion, and vascular thrombosis occurred more frequently in this group than in those infants with the catheter remaining in the superior vena cava. Unusual complications of intersititial pulmonary edema, hydrocephalus, and cardiac arrhythmia were noted in three different patients. An increased incidence of clinical complications is associated with catheter malposition or migration during total parenteral nutritional therapy. Radiographic monitoring with repositioning or removal of a malpositioned catheter may reduce the number of clinical complications.     

Radiographic findings and etiologic diagnosis in ambulatory childhood pneumonias

The chest roentgenograms of 128 consecutive ambulatory children with radiologic pneumonia were read independently and without clinical information by a faculty general pediatrician (Ped), a pediatric radiologist (R-P) and a general radiologist (R-G). The films were classified as normal, indicative of a viral or bacterial process, or indeterminate. Readings were compared with results of viral titers and bacterial cultures. Agreement between any two observers in classifying films, measured by unweighted Kappa, while statistically significant (p less than 0.001) for any pair, was low. There was no significant difference between the agreement scores of Ped/R-P, Ped/R-G, and R-P/R-G. Twenty-one patients had fourfold viral titer increases (N = 16) or positive bacterial cultures of blood or pulmonary aspirate (N = 5). The sensitivity of viral readings for titers increases varied from 19% to 68% depending on observer type; the sensitivity of bacterial readings for positive bacterial cultures varied from 60% to 80%. The three observers agreed on a correct reading in only three children with viral and three with bacterial pneumonia. Because of poor observer agreement and appreciable false-negative errors when viral and bacterial readings were compared to titer increases and positive bacterial cultures, respectively, we conclude that radiographic findings are poor indicators of etiology diagnosis in ambulatory childhood pneumonias and, of themselves, are an insufficient data base for making therapeutic decisions.     

Differential performance of the macarthur HBQ and DISC-IV in identifying DSM-IV internalizing psychopathology in young children

OBJECTIVE: Three sites collaborated to evaluate the differential performance of the MacArthur Health and Behavior Questionnaire (HBQ) and the Diagnostic Interview Schedule for Children Version IV (DISC-IV) in identifying DSM-IV psychopathology in young children. METHOD: A sample of 120 four- to eight-year-old nonreferred (community) (n = 67) and referred (clinical) (n = 53) children was examined. Mothers reported on their child's mental health symptoms using the HBQ (a dimensional measure with a clinical cutoff score) and the DISC-IV. Teachers independently reported on the child's symptoms and impairment in school using the teacher HBQ. Children self-reported on their symptoms using the companion Berkeley Puppet Interview. RESULTS: On the basis of its derived clinical cutoff scores, the HBQ identified significantly more children with clinical symptoms of DSM-IVinternalizing psychopathology than the DISC-IV in both referred and nonreferred groups. There was a high level of agreement between the two measures in the identification of externalizing psychopathology. Children identified as having internalizing psychopathology by the HBQ were also rated as highly symptomatic and impaired by teachers. CONCLUSION: The findings support the general validity of the parent HBQ for the assessment of young child psychopathology and the hypothesis that it captures more internalizing psychopathology than the DISC-IV in this population.