David Cornfeld

Nephrosis: A long-term study of children treated with corticosteroids

When adrenocortical steroids were first used in the treatment of childhood nephrosis in the early 1950s, the prompt and impressive diuretic response led to enthusiastic claims regarding the effects of such treatment on the morbidity and mortality of the disease. Toward the end of the decade, however, more cautious reports began to appear. In the present study a case fatality rate of fifteen per cent was noted at the time of the five year evaluation, a marked improvement over that recorded in the precorticosteroid and preantibiotic eras. However, deaths from the disease have continued to occur in subsequent years and, at the time of the eight to ten year follow-up, the case fatality rate approached twenty-five per cent.

Management of urinary tract infections in children

Urinary tract infection is common in children. The presentation varies with age. Younger children exhibit protean signs. Diagnosis is dependent on the demonstration of significant bacteriuria in a properly collected and handled urine sample. The approach to treatment depends on the degree of illness at presentation, the presence of structural urinary tract abnormalities, and the age of the patient. Pathophysiology of urinary tract infection is dependent on interactive factors of the host and of the invading microorganism. Urinary tract abnormalities have significant impact on the management of children with urinary tract infections, both medically and surgically. Of particular importance is the observation that renal damage usually occurs within the first 5 years of life, and treatment delay in some young patients may have significant consequences. The overall prognosis in children with urinary tract infection is favorable.

British pediatrics—a specialty in transition?

A SABBATICAL TENURE in Great Britain has provided this writer with the opportunity to observe at close hand current pediatric thinking on the other side of the Atlantic. Many of the issues have their parallel in our country, but at the very time that some spokesmen have declared the future of pediatrics bleak in the United States/ a renewal of interest in the specialty is evident in our mother country. There, pediatrics may well be following a path which will lead it in a direction very similar to that which we currently have in the United States. The National Health Service, initiated in 1948, perpetuated a division between preventive services, based largely On local health authorities, and acute child health care services, which are provided by the general practitioner. Until very recently there was no requirement that the general practitioner, who provided all of the primary care for children, have specialty training in pediatrics. As a result, pediatrics has developed in Great Britain as a hospital specialty, providing the setting for the emergence and development of the Consultant pediatrician. The original National Health Service Act set up a tripartite scheme consisting of the general practitioner, hospital specialist, and local health authority service. By this Act the local health authorities were obligated to provide preventive care to expectant and nursing mothers and young children, and all immunization programs. The general practitioners contract did not cover preventive services explicitly a n d the local health authority was barred from providing treatment services. The Act was amended in 1974 in an effort to provide a more integrated service. In recent years, voluntary training programs have been introduced for the general practitioner and a threeyear vocational program which general!y provides six months of training in the care of sick children has been

Research in General Academic Pediatrics

The evolution of the academic generalist can be viewed either as a relatively recent phenomenon or as reincarnation of an older clinical model.1 The latter individuals can still be found in most medical schools as a small number of faculty whose status derives from extensive clinical experience and who are respected for their clinical expertise in diagnosing or managing the individual patient. Their contribution to the intellectual content of medicine evolves from thoughtful, questioning observation more often than for formal research endeavors.