Tuberous Sclerosis Complex and Type 1 Neurofibromatosis
September 1st 2007The diagnostic test is a Wood light examination. An example of another child with these lesions as they appear under Wood light is shown in Figure B. The Wood light is ultraviolet; it exploits the fact that melanin will preferentially absorb the light and appear darker. Those areas that contain less melanin thus will be highlighted.
Atypical Tuberculin Skin Test Responses
September 1st 2007Twenty-four hours after receiving a standard 5-unit purified protein derivative of tuberculin (PPD) skin test, a young African American presented with a slightly pink, raised, firm plaque at the site of the injection (A). His previous PPD test results were negative. He denied any constitutional symptoms and rashes. He was otherwise healthy, was not taking any medication, and was HIV-negative.
Eczema Herpeticum: A Manifestation of Hyperimmunoglobulin E Syndrome
September 1st 2007A 4-year-old girl presented with a sore throat, dysphagia, fever (temperature up to 40°C [104°F]), and a pruritic vesicular rash. On the first day of the illness, 4 days earlier, she was evaluated by her pediatrician who prescribed azithromycin for a presumed upper respiratory tract infection. About 2 days later, a papular rash developed on the abdomen and perioral skin; the fever had persisted, and the child's oral intake had decreased. The next day, the rash continued to spread, and the patient refused to take anything orally, including fluids. The mother thought that the rash was a hypersensitivity reaction to the antibiotic.
Middle School and College Vaccination
September 1st 2007By the pre-middle school visit, the child should have already received 3 or 4 doses of IPV (only 3 are required if the last dose was given after the age of 4 years); 3 doses of hepatitis B vaccine; 2 doses of MMR vaccine; 2 doses of varicella vaccine; and 2 doses of hepatitis A vaccine.
Middle School: A Time for Maturation-and Vaccination
September 1st 2007ABSTRACT: The pre-middle school well child visit is now an important landmark on the vaccine schedule. The pre-kindergarten visit no longer has the distinction of being the last of the visits for "school shots." Pediatricians should emphasize this point at the 4- to 6-year-old well child visit so that parents are aware of the need for another series of vaccines in about 5 years.
Adolescent Scoliosis: REFERENCES:
September 1st 2007ABSTRACT: Patient compliance is a significant problem in exercise therapy and bracing for adolescent scoliosis, and exercise has been considered to have no therapeutic benefit. According to recent studies, however, muscle function asymmetry is a consistent finding in patients with this condition and is correctable with progressive resistance exercises. Patients' baseline and progress can be quantified accurately with exercise by performing precise measurements of torso rotation and lumbar strengthening. Strengthening is associated with control of scoliotic curves, if they are below the operative level. Because even some decrease in the amount of curve may be expected, this form of therapy may be as beneficial as bracing. The treatment also may be used for controlling pain in older patients with scoliosis.
Immunizing the College Student: REFERENCES:
September 1st 2007ABSTRACT: College is a time of new exposures, risk-taking, and adventure. Thus, protection with proper immunization is paramount. Pediatricians should offer the recommended vaccines whether required for college entry or not. When the young adult comes to the office to have the college health form completed and signed, seize the opportunity to tout the benefits of pre-college vaccination.
Hypersensitivity to Vaccine Stabilizer
September 1st 2007A 5-year-old boy with seizure disorder and developmental delay presented to our allergy and immunology clinic for a severe reaction that developed after he had received multiple vaccines. One month before our evaluation, the patient had been vaccinated against varicella, hepatitis A, and influenza at his pediatrician's office. Latex gloves were not used for vaccine administration.
UTI Prophylaxis-Beneficial or Harmful?
September 1st 2007For years we have been prescribing prophylactic antibiotic therapy for children with a first-time urinary tract infection (UTI) before obtaining imaging studies-as is recommended in the 1999 American Academy of Pediatrics' practice parameter1-and for those with vesiculoureteral reflux (VUR). Although many pediatricians have raised questions about the efficacy and safety of this practice, the risks and benefits of antibiotic prophylaxis have not been well studied.
Elementary School: REFERENCES:
September 1st 2007ABSTRACT: Vaccination must be promoted before and on entry into elementary school. Not only does vaccination provide substantial health benefits to society, it is the law. The recommended childhood vaccination schedule changes on a yearly basis. Similarly, state vaccination requirements for school entry also may change yearly to accommodate these recommendations. Pediatricians need to remain abreast of the most recent vaccine information and to offer all vaccines at the appropriate well child visits. The goal is to limit the number or eliminate altogether the need for catch-up vaccines when the time comes for entry into elementary school.
"HEADDS" Up on Talking With Teenagers
September 1st 2007Perhaps some aspects of this scenario sound familiar? Many pediatricians feel ill-equipped to meet the often complex needs of adolescents. Some physicians have a challenging time convincing teenagers to talk to them about anything. Others worry about opening a Pandora's box of issues that cannot fully be addressed. Given the time and reimbursement constraints facing primary care providers, the wish to avoid time-intensive patients is understandable.