Richard W. Kesler

Three-day therapy of lower urinary tract infectionswith nitrofurantoin macrocrystals: A randomized clinical trial

Forty-nine girls between the ages of 2 and 18 years with a symptomatic urinary tract infection documented by two clean-catch urine cultures completed a double-blind study comparing the effectiveness of three days versus ten days of nitrofurantoin macrocrystal therapy. Localization of the infection to the lower urinary tract was presumed on the basis of clinical presentation. All patients had sterile urine on day two or three of therapy. In the ten-day group, two of 23 patients (8.7%) experienced a single relapse, and seven patients (30%) had 12 episodes of reinfection during a six-month follow-up. In the three-day group, two of 26 patients (7.7%) had a single relapse, and six patients (23%) had 12 episodes of reinfection. The rates of relapse and reinfection in the compared groups were not statistically significantly different (P greater than 0.05). Three days of treatment with nitrofurantoin macrocrystals is an effective regimen for symptomatic girls presumed to have uncomplicated lower urinary tract infections.

Behavior of Children Undergoing Hypospadias Repair

We performed a prospective study on 10 boys between 2 and 6 years old undergoing repair for hypospadias. Clinical observation in the hospital ward rooms and play environment demonstrated a distinctive postoperative course of withdrawal and aggressive behavior with resultant increased parental anxiety, which results in strained staff-family relations. We speculate that this distinctive behavior may be owing to an interaction among parental attitudes, the pain and immobilization from operation and the level of the childs sexual development. Intervention was designed to give the boys behavioral outlets and to involve their family in preoperative and postoperative education.

Thrombocytosis in Henoch-Schönlein Purpura

The clinical and laboratory features of acute Henoch-Schönlein purpura in 18 patients are presented. Thrombocytosis was noted in 67 per cent of the patients and was significantly as sociated with the presence of abdominal pain and gastrointestinal bleeding. We found no cor relation between increased serum IgA concentrations or elevated sedimentation rates and any of the clinical features of Henoch-Schönlein purpura.

Intern ranking versus subsequent house officer performance

The rankings of candidates for pediatric internship by the Pediatric Intern Selection Committee (ISC) of the University of Virginia Medical Center were compared with subsequent performance rankings of house officers by faculty members and chief residents. Although a positive correlation was found between the rankings, the absolute magnitude of the correlation coefficients was relatively low and not statistically significant. We discuss factors responsible for the poor correlation and suggestions for ISCs.