Roger L.J. Kennedy

Peptic ulcer in children

Summary Duodenal ulcers occur at all ages of infancy and childhood. Ulcers of infants up to a year or two of age are usually acute and are most commonly suspected because of melena. In the six cases of chronic duodenal ulcer reported, the children were past the period of infancy. Two of these (Cases 1 and 2) are of particular interest because the histories and the roentgenologic appearance were typical at the early ages of four and six years, respectively. In childhood, and up to the age of puberty, the picture of ulcer may be so clear cut as to make diagnosis relatively simple, or so confused as to render diagnosis impossible except by operation. Roentgenologic examination is the most dependable single procedure in diagnosis of ulcers of children, but may lead to error by failing to give evidence of ulcer when present, or perhaps by indicating that ulcer is present when it is absent. Indications for medical and surgical treatment of ulcer and its complications in children are essentially the same as in adults. Duodenal ulcer should be sought in children of all ages who have chronic or recurring indefinite abdominal pain.

Blood sugar in newborn infants

Summary Blood sugar readings on fifty-one normal newborn infants were made onduplicate samples of blood by means of a modification of Somogyis method during the first six days of life. The technical error, measured as the standard deviation, estimated from the 306 differences between the duplicates, was 4.4 mg. per 100 c.c. (7.2 per cent of the mean). The average value for blood sugar as determined by the Folin-Wu method was significantly higher than the mean value for blood sugar as determined by the micromethod. For the entire group of 612 determinations the mean was 61.0±0.63 mg. per 100 c.c. and the standard deviation was 15.6 mg. The corrected intraindividual variability for these babies was 13.8 mg. per 100 c.c. (22.6 per cent of the mean) and the interindividual variability was from 7.0 mg. per 100 c.c. (11.5 per cent of the mean). The range of the determinations was 15.0 to 120.0 mg. per 100 c.c. When the low values were obtained no signs of hypoglycemia were observed. The blood sugar determinations made on samples of blood drawn in the morning were higher than those made on blood drawn in the evening, but not by an amount that is statistically significant, although perhaps a larger sample would have rendered it so. When the blood sugar was examined in relation to age, an average increase of 2.8 mg. per 100 c.c. per day during the first six days of life was found. There was no evidence of stabilization of the blood sugar during this period.

Oral and dental manifestations of histiocytosis X

Abstract This study of twenty-seven cases emphasizes the frequency and importance of the oral and dental manifestations of histiocytosis X. Suggestive clinical symptoms and signs or roentgenographic changes indicate biopsy for diagnosis and guidance to appropriate therapy.

Delayed transcaval renal penetration of a Greenfield filter presenting as symptomatic hydronephrosis.

In general, inferior vena caval filters are associated with low morbidity and mortality. Rarely, penetration of the inferior vena cava can occur, causing injury to adjacent structures. To our knowledge we report the first case of inferior vena caval filter penetration causing symptomatic hydronephrosis. CASE REPORT

Accidental vaccinia: Report of two cases in infants, with eczema vaccinatum in one case

Summary The two cases of accidental vaccinia presented in this paper consist of (1)a case of uncomplicated inoculation of the cheek of a child 18 months old and (2) a severe case of eczema vaccinatum in a child 6 1/2 months old. Both children recovered. The complications of vaccination are many but occur infrequently. Probably the most common are benign exanthems and multiform eruptions. Accidental vaccinia may result from vaccination. One of the most serious complications of this is the development of eczema vaccinatum in an eczematous child. The relationship between eczema vaccinatum and Kaposis varicelliform eruption is reviewed. The two cases reported indicate the dangers of accidental vaccinia and make clear the need for protection to prevent the accidental vaccination of nonimmunized individuals by a recently vaccinated person.

Illnesses within the first year of life

Summary Among 417 infants observed for attacks of illness within their first yearof life, the incidence of illness was not influenced by sex. The incidence of illness was 1.63 per infant per year. The frequency of illness increased as the infants approached 1 year of age.There was a definite seasonal fluctuation in the incidence of respiratory illnesses but not in the incidence of gastrointestinal illnesses. Respiratory illnesses comprised nearly 73 per cent of the illnesses during the first year of life. From a statistical standpoint the duration of breast feeding did not influence the rate of illnesses for the period studied. However, it must be remembered that many other factors predisposing to illness may have obliterated this single influence.