Noonan syndrome associated with central giant cell granuloma

We report a case of Noonan syndrome associated with central giant cell granuloma. The patient was a 101/2-year-old boy with the chief complaint of proptosis of the right eye. He also had various malformations such as short stature, webbed neck, pectus excavatum, cubitus valgus, pulmonary valve stenosis and patent foramen ovale, a characteristic face appearance and cryptorchidism and so on. Chromosome analysis showed a 46, XY karyotype. A computed tomographic scan and magnetic resonance imaging showed a mass originated from the lateral wall of the right maxillary sinus. The patient underwent Caldwell-Luc operation. Histological examination of the mass showed the characteristics of central giant cell granuloma. This case report describes a patient with the features of the recently described Noonan-like/multiple giant cell lesion syndrome.     

自动化分析仪同时测定血清12项生化指标的正常值

本文将生化自动分析仪应用于健康检诊中,就其中1089名健康者的血清进行12项生化指标的检测,并对测得的结果进行分析整理,确定国人的正常值范围。同时又对自动分析仪的质量管理进行了探讨。     

MANIPULATION OF CHILDREN'S EATING PREFERENCES

Giving foods as rewards can enhance consumption of those foods, while giving rewards to induce consumption of foods can decrease subsequent consumption of those foods.     

Special issue: Group treatment after child and adolescent sexual abuse: Introduction

This introduction traces the increasing awareness of the prevalence of child sexual abuse over the last 20 years, examines the nature and consequences of such abuse and summarizes current information on the use of group treatment and its evaluation with sexually abused children and adolescents and their parents. Four examples of group treatment with different populations of abused children are described in this issue.     

A case of broken bones and systems: The threat of irresponsible testimony

A 2‐month‐old healthy baby presented to the emergency room with an arm that was not moving and was found to have multiple and extensive fractures of her long bones. An extensive medical work‐up was done, and the hospital's multidisciplinary child abuse team was consulted, including child protection, genetics, radiology, and general pediatrics. It was determined that the history, clinical findings, radiographic findings, and laboratory findings were consistent with child abuse. Child protection services removed the child from the home, and for the next 10 months, the infant was well, and did not sustain a single new fracture. At a civil proceeding to determine the infant's custody, an expert witness for the defense concluded that the child had hypermobile Ehlers‐Danlos syndrome and low vitamin D. He stated that because of these conditions, the baby was vulnerable to fractures with routine handling. This is a personal story of a clinical geneticist who explored fracture fact versus fracture fiction and learned about the difference between responsible and irresponsible testimony. This story gives insight into how physicians can prepare to transition from the clinic to the courtroom. It is also a story about how medical experts must and should remain unbiased, evidence‐based, and committed to accuracy and truth.     

Effect of submaximal exercise at low temperatures on pulmonary function in healthy young men

Summary In order to understand more fully the effect on pulmonary function of whole body exposure to cold during submaximal exercise, we measured pulmonary function indices in ten healthy male students and ten healthy male forestry workers of similar age following submaximal treadmill walking at different temperatures in a climatic chamber. After measuring the maximal aerobic capacity with a cycle ergometer test, the subjects had to walk on four separate occasions in the climatic chamber at an intensity of 70%–75% of their individual maximal heart rate; the first at normal room temperature and then randomly, either at 0°C or at −20°C, and vice versa. The duration of each walk was 8 min. Finally, each subject had to walk in the chamber at −20° C for 17 min. Flow volume spirometry was performed at room temperature 1, 5, 10, and 20 min after exercise and the values were compared to baseline values taken prior to the last walking test. There were only minor changes in pulmonary function indices following exercise at different temperatures. Only one student showed a reduction of over 15% in peak expiratory flow rate after an 8-min walk at −20° C. It seems that submaximal exercise of short duration, even at a temperature as low as −20° C, does not impair pulmonary function in healthy young men.     

Human papovavirus in a routine urine specimen of a four-year-old boy

Cellular changes produced by viruses can be readily identified using light microscopy and Papanicolaou stain of a fixed specimen. These findings can then be confirmed by viral culture and/or electron microscopy studies. Human polyomavirus, common in transplant recipients or otherwise immunocompromised patients, is one virus that can be identified using these methods. The following is a case study of a 4-yr-old boy with no known immune impairment who exhibited human papovavirus (polyomavirus) on a routine urine examination. The diagnosis was confirmed by electron microscopy.     

Infant Vocalization: An Index of Maternal Attitude Toward the Child

Brief observations of mother-stimulated infant vocalizationwere perform ed during pediatric clinic visits on 4- to 6-month-oldinfants to determine whether mothers with positive attitudestoward the pregnancy and/or the in fant would have infants whovocalized more during clinic visits. Mothers with more positiveattitudes toward the pregnancy, assessed prenatally, had infantswho showed significantly more vocalization during clinic visitsat 5 months, 6 months, and the combination of 5 and 6 months.Mothers with more positive attitudes toward the infant had infantswho showed signcantly more vocalization at 4 months and thecombination of observations at 4 months and 6 months. Resultssuggest that brief observations of vocalization during clinicvisits may be useful as a rough index of the quality of themother-child interaction.     

Environmental conditions and variation in levels of sun exposure among children in child care

Sun exposure in childhood is 1 of the risk factors for developing skin cancer, yet little is known about levels of exposure at this age. This is particularly important in countries with high levels of ultraviolet radiation (UVR) such as Australia. Among 49 children 3 to 5 years of age attending child care centers, UVR exposure was studied under 4 conditions in a repeated measures design; sunny days, cloudy days, teacher’s instruction to stay in the shade, and a health professionals instruction to apply sunscreen. Three different data collection methods were employed: (a) completion of questionnaire or diary by parents and researcher, (b) polysulphone dosimeter readings, and (c) observational audits (video recording). Results of this study indicated that more than half the children had been sunburnt (pink or red) and more than a third had experienced painful sunburn (sore or tender) in the last summer. Most wore short sleeve shirts, short skirts or shorts and cap, that do not provide optimal levels of skin protection. However, sunscreen was applied to all exposed parts before the children went out to the playground. Over the period of 1 hr (9–10 a.m.) the average amount of time children spent in full sun was 22 min. On sunny days there was more variation across children in the amount of sun exposure received. While the potential amount of UVR exposure for young children during the hour they were outside on a sunny day was 1.45 MED (Minimum Erythemal Dose), they received on average 0.35 MED, which is an insufficient amount to result in an erythemal response on fair skin even without the use of sunscreen.