Jerome T. Combs

New syndrome of neonatal hypoglycemia. Association with visceromegaly, macroglossia, microcephaly and abnormal umbilicus.

SYMPTOMATIC hypoglycemia in the newborn infant occurs approximately once in 500 live births.1 Over 80 per cent of these infants are small for their gestational age.2 The occurrence of symptomatic h...

Predictive value of the angle of acoustic reflectometry

Impedance tympanometry and acoustic reflectometry tracings were obtained on 406 ears of children between 4 and 16 years of age. The angle formed by the acoustic reflectometry tracing was measured. The reflectivity and the angle of the curve were compared with tympanometric results. Analysis of data on 182 normal ears and 224 abnormal ears revealed a sensitivity of 76.3% and a specificity of 89.6% when a reflectivity of 5.0 was used as the cut point. Utilizing a cut point of 90 degrees resulted in a sensitivity of 92.8% and a specificity of 93.9%. Using both a 5.0 reflectivity and a 90-degree angle as cut points improved sensitivity to 98.7% and specificity to 94.5%.

Hepatolenticular degeneration: The comparative effectiveness of D-penicillamine, potassium sulfide, and diethyldithiocarbamate as decoppering agents

Copper balance studies were performed on three patients with hepatolenticular degeneration to assess the relative values of D-penicillamine, of potassium sulfide, and of diethyldithiocarbamate therapy. The first produced a pronounced negative balance, whereas the latter two were essentially ineffective.

Precision of acoustic reflectometry with recorder in acute otitis media

There have been conflicting reports about the accuracy of the acoustic reflectometer in detecting middle ear fluid. A recording device connected to the reflectometer prints a graph showing the value of reflectivity to 0.1 unit. Twenty-four ears of children with suspected acute otitis media were studied. Ten reflectivity values were obtained for each patient. The mean standard deviation was 0.20 unit. Thus the imprecision of the instrument previously reported can be overcome by the recording device.

Acoustic reflectometry: spectral analysis and the conductive hearing loss of otitis media.

OBJECTIVE To test the hypothesis that the quality of sound reflected from the tympanic membrane with acoustic reflectometry is predictive of hearing loss caused by otitis media. METHODS A pediatrician in solo primary care practice examined 257 patients for middle ear disease using clinical criteria, tympanometry and an acoustic reflectometer with a recording device. Each ear was diagnosed as normal, acute otitis media or otitis media with effusion. Hearing testing with a select picture audiometer was performed by a technician who was blinded to the diagnosis. Paired data were obtained on some ears. RESULTS A spectrum of < 95 degrees identified 100% of the ears hearing at 30 dB or more because of otitis media. Paired data were obtained on 99 ears with otitis media that failed audiometry on the initial visit. On return 96 of the 99 showed a broader spectrum of reflected sound with improved hearing and clinical improvement of otitis media. CONCLUSIONS Measurement of the width of the spectrum of reflected sound is the basis for a new technology that shows initial promise for being able to provide objective information about the probability of conductive hearing loss caused by otitis media.

Perianal Streptococcal Disease

1. Kramer MS, Tange SM, Drummond KN, Mills EL. Urine testing in young febrile children. A risk-benefit analysis.JPediatr 1994;125:6-12. 2. Amir J, Ginzburg M, Straussberg R, Varsano I. The reliability of midstream urine culture from circumcised male infants. Am J Dis Child. 1993; 147:969-970. 3. Hardy JD, Furnell PM, Brumeitt W. Compression of sterile bag, clean catch and suprapubic aspiration in the diagnosis of urinary infection in early childhood. J Urol. 1976;48:279283. 4. Benito-Fernandez J, Sanchez-Echaniz J, Mintegui-Raso S, Montejo-Fernandez M. Urinary tract infection in infants: use ofurine specimens obtained by suprapubic bladder aspiration in order to determine the reliability of culture specimen of urine collected in perineal bag. An Esp Pediatr. 1996;45:149-152. 5. Gonzalez R. Urinary tract infection. In: Nelson WE, Beharman RE, Kliegman RM, Arvin AM, eds. Nelson Textbook ofPediatrics, ed. 15. Philadelphia: WB Saunders Company; 1996:15281531.

Single vs. double acoustic reflectometry tracings

Impedance tympanometry and acoustic reflectivity tests were obtained on 503 infants and children ranging from 3 months to 12 years of age during a 6-week period in a solo primary care practice. One hundred eighty-five of 1005 tracings from the acoustic otoscope with recorder demonstrated 2 reflectivities. This phenomenon occurred more commonly in infants than in older children and was not seen with reflectivities higher than 7 units. One hundred thirty-eight of the 185 double reflectivity tracings were associated with abnormal impedance tympanometry. The double reflectivity phenomenon may be important in helping to explain the false negative results occasionally seen with this technology in low and intermediate reflectometry scores. Future clinical research involving acoustic reflectometry should utilize the recording device and single and double reflectivity tracings should be handled separately in any analysis of data. Use of the recorder will also prevent false positive errors in the interpretation of some intermediate reflectivities.