Mohsen Ziai

Unfamiliar Swelling After Head Trauma

* Professor of Pediatrics Tehran University, Medical Director Reza Pahlevi Medical Center, Tehran, Iran; Lecturer in Pediatrics, The Johns Hopkins University. † Assistant Professor of Neurology and Pediatrics, University of Miami, Miami, Fla. A6Y2-MONTH-OLD girl, previously well, fell, while strapped in her infant seat, from the kitchen table onto a tile floor some three feet below. She struck the side of her head, but there was no pallor or loss of consciousness. During the next few hours, she became increasingly fussy. She was taken to a pediatrician, and skull X-rays demonstrated a left parieto-occipital skull fracture. A neurologist concurred with the diagnosis. The child did well at home, was not lethargic

Anemia and Hemoptysis

* Professor of Pediatrics Tehran University, Lecturer in Pediatrics, Johns Hopkins University. A3-h’EAR-OLD GIRL, , ~.~. was brought to the hospital because of pallor. She had been investigated previously for her aneinia and the diagnosis of iron deficiency had been made. Her laboratory tests had revealed a low serum iron and increased iron-binding capacity, a microcytic anemia, and a poor response to iron therapy in spite of good reticulocytosis. Examination of stools

Hepatosplenomegaly of Unknown Etiology

the diagnosis of hepatosplenomegaly of unknown etiology. She had been worked up in another city where many investigations had been carried out without definite results. The problem, presented by the referring physician, was that of massive hepatosplenomegaly in a girl whose physical growth had been retarded but whose motor and mental development had been fairly normal, The family had noted enlargement of the abdomen since infancy, which physicians had attributed to hepatosplenomegaly. The patient had undergone many laboratory examinations including bone surveys, blood counts, bone mar-

Anemia, Shortness of Breath and Asthma in an Infant

* Professor of Pediatrics, Tehran University; Pediatrician, Ahari Children’s Hospital Medical Center; Dean, College of Health Sciences, Imperial Organization for Social Services, Teheran, Iran; Lecturer in Pediatrics, The Johns Hopkins University. AN I I-MONTH-OLD boy was brought for consultation because of dypsnea, pallor, and wheezing of several months’ duration. He had been hospitalized on several occasions for the investigation of these complaints, and the presence of~ bilateral pulmonary infiltrates had suggested the possibility of either aspiration or an infectious process. He had been treated with many antimicrobial agents as well as bron-

Fever and Hepatosplenomegaly of Three Month's Duration

* Professor of Pediatrics, Tehran University; Medical Director, Reza Pahlavi Medical Center, Tehran, Iran; Lecturer in Pediatrics, The Johns Hopkins University. ** Pediatric Department, Pahlavi University, Shiraz,. Iran. A FOURYEAR-OLD GiRL from Southern ~~ FOUR-YEAR-OLD GI Iran was admitted to the hospital because of a fever of three months’ duration, which was not associated with chills or . sweating. Twenty days later a dry cough was also noted. There were episodes of epistaxis and nonbloody diarrhea. Fever and cough persisted in spite of various medications. Her developmental milestones were slightly delayed. She was of a poor socioeconomic background and had poor nutrition. Physical examination on admission showed an underdeveloped, undernourished chronically illlooking child who had tachypnea and epistaxis. Her pulse rate was 120/min, respiratory rate 32/min, height 90.0 cm, weight 11.0 kg, blood pressure 90/50. Skin and mucous membranes were pale. There was puffiness of the face and bleeding from both nostrils. She had mild glossitis. Neck veins were engorged. Postauricular lymphadenopathy was present. Intercostal and substernal retractions were evident. Breath sounds were harsh and moist rales were audible all over the

Mysterious Iron Deficiency Anemia

* Professor of Pediatrics, Teheran University; Pediatrician, Ahari Children’s Hospital Medical Center; Dean, College of Health Sciences, Imperial Organization for Social Services, Teheran, Iran; Lecturer in Pediatrics, The Johns Hopkins University. t Director, The Central Blood Bank, Teheran University Medical Center, Teheran, Iran. . G., A 17-YEAR-OLD Iranian boy, was brought in because of weakness and pallor. He had been in fairly good condition until two years earlier, when he began to experience progressive weakness and was noted to be pale by a physician. He had been treated initially with medications containing iron, as well as with a number of other drugs, but in spite of this therapy, his improvement had not been satisfactory. There was no effort to identify the exact nature of his disease

An Unusual Cause of Failure To Thrive

not improve the weight curve. The vomiting, abnormal stools, and albuminuria persisted. Serologic test for syphilis and search for infections caused by cytomegalovirus, toxoplasmosis, and Listeria monocytogenes were all negative. His sweat Na and Cl levels were normal. Serum electrolytes and glucose were within the limits of normal; serum alkaline phosphatase and transaminases were slightly elevated. Two weeks later, at the age of 51/2 months, the infant was transferred to our hospital. His weight

Poor Breast Feeding in a Healthy Newborn

[sucrosej-free) was started. The infant improved remarkably and rapidly. Vomiting stopped, the stools looked normal, he gained 900 g in two weeks, and the icterus disappeared. The liver size decreased and the blood sugar remained at a higher level than previously. The infant left the hospital at this point, with a list of foodstuffs to be avoided, i.e., all fruits and fructoseor saccharosecontaining foods. Vitamin C and D supplements were prescribed.