Russell S. Asnes

Psychogenic Chest Pain in Children

Thirty-six children with psychogenic chest pain were studied. A specific stressful situation causally related to the onset of symptoms could be identified in most patients with psychogenic chest pain. Fifty-five per cent of children with psychogenic chest pain had a history of other recurrent somatic com plaints and 30% had a history of significant sleep disturbances.

The first febrile seizure: A study of current pediatric practice

A natonwide survey of pediatricians was conducted to ascertain their methods of evaluation and ofmanagement of a child who had had a “first” febrile seizure. Two hundred and sixty (58%) of the sample of 445 pediatricians responded to the single mailing. Nearly one-quarter (24%) routinely hospitalized the child. A wide variation in utilization of diagnostic studies for this condition was reported. Those procedures for which the highest proportion of respondents indicated routine performance were: lumbar puncture (41%); measurements of concentrations of serum calcium (38%) and of blood sugar (43%); and electroencephologram (36%). Of the 260 respondents, only 15% prescribed phenobarbital therapy for a defined period of time after the occurrence of the first febrile seizures. Fifty-four percent of pediatricians advised parents to administer phenobarbital only when the child had a febrile illness. The results demonstrate that practicing pediatricians vary widely in the evaluation and management of children with an initial febrile seizure. Lack of consensus among pediatric practitioners concerning the management of this and other conditions will seriously hamper future peer review efforts.

Chronic Neurotic Encopresis As A Paradigm Of A Multifactorial Psychiatric Disorder

Chronic neurotic encopresis (CNE), a childhood psychiatric disorder characterized by inappropriate fecal soiling, necessitates the formation of the following specific etiological factors: a) a neurologically immature developmental musculature, an organic condition which may complicate toilet training; b) premature or harsh toilet training; c) a family constellation in which the father is frequently absent and the mother erratic, emotionally inappropriate, and distant; d) the childs formation of a noncommunicative, passive, dependent personality. All of these factors are helpful in explaining the occurrence of CNE, which is thus seen as the result of a synergistic interaction among them. The complexity of etiological agents dictates a multifactorial rather than unicausal model of mental illness. Future research and tactics of psychother-apeutic intervention should focus on the interplay among these factors rather than attempting to single out one primary predisposing factor.

Chinese Restaurant Syndrome in an Infant

or post-Sino-Cibal syn’droli-ne .2 Subsequent journal correspondence verified the existence of this entity and expanded upon the sy~n-~ptcan~zatca~c~~y to include: dizziness, Hushin~, sweating, bitempora!, constricting headaclie,-int’i-aot-bital tightness, lightheadedness, weakness, palpitation, nausea and vomiting.3-s Affected individuals experienced symptoms within 15 to 45 minutes of commencing a Chinese dinner, and the illness lasted for

Maternal expectations and attitudes toward toilet training: A comparison between clinic mothers and private practice mothers

Mothers at inner city clinics differ from middle-class suburban mothers with private pediatricians in their attitudes and expectations regarding toilet training, such as the ideal age to initiate bladder and bowel training, ideal age for completion of toilet training, response to the child who soils after a program of toilet training has been initiated, and source of information to guide in toilet training. Possible explanations to account for these differences are explored; the implications for training health personnel are discussed.

Massive Hematuria in a Young Adolescent with Sickle Cell Trait

Fam Physician 1979:20:104-8. 2. Cohen SR, Herbert WI, Lewis GB et al. Foreign bodies in the airway. Five-year retrospective study with special reference to management. Ann Otol Rhinol Laryngol 1980;89:437-42. 3. Moussalli H. How to remove a foreign body from the trachea and bronchial tree. Br J Hosp Med 1981;25:300-4. 4. Aytac A, Yurdakul Y, Ikizler C, et al. Inhalation of foreign bodies in children. Report of 500 cases. J Thorac Cardiovasc Surg 1977;74:145-51. 5. Logvinoff MM, Taussig L. Foreign body aspiration in childhood. Ariz Med 1980;37:77-9. 6. Abdulmajid OA, Ebeid AM, Motaweh MM et al. Aspirated foreign bodies in the tracheobronchial tree: report of 250 cases. Thorax 1976;31:635-40. 7. Tucker JA. Obstruction of the major pediatric airway. Otolaryngol Clin North Am 1979;12:329-41. 8. Kim IG, Brummitt WM, Humphrey A, et al. Foreign body in the airway: a review of 202 cases. Laryngoscope 1973;83:347-54. 9. Dudgeon DL, Parker FB, Frittelli G, et al. Bronchiectasis in pediatric patients resulting from aspirated grass inflorescences. Arch Surg 1980;115:979-83. 10. Banks W, Potsic WP. Elusive unsuspected foreign bodies in the tracheobronchial tree. A nidus for infections that may be quiet for long periods of time. Clin Pediatr 1977;16:31-5. 11. Blumhagen JD, Wesenberg RL, Brooks JG, et al. Endotracheal foreign bodies. Difficulties in diagnosis. Clin Pediatr 1980;19:480-4. 12. Reed MH. Radiology of airway foreign bodies in children. J Can Assoc Radiol 1977;28:111-8. 13. Burrington JD, Cotton EK. Removal of foreign bodies from the tracheobronchial tree. J Pediatr Surg 1972;7:119-22. 14. Leonidas JC, Stuber JL, Rudavsky AZ, et al. Radionuclide lung scanning in the diagnosis of endobronchial foreign bodies in children. J Pediatr 1973;83:628-31. 15. Berger PE, Kuhn JP, Kuhns LR. Computed tomography and the occult tracheobronchial foreign body. Radiology 1980;134:133-5. 16. Hight DW, Philippart AI, Hertzler JH. The treatment of retained peripheral foreign bodies in the pediatric airway. J Pediatr Surg 1981;16:694-9. 17. Cotton EK, Abrams G, Vanhoutte J, et al. Removal of aspirated foreign bodies by inhalation and postural drainage. A survey of 24 cases. Clin Pediatr 1973;12:270-6. 18. Law D, Kosloske AM. Management of tracheobronchial foreign bodies in children: a reevaluation of postural drainage and bronchoscopy. Pediatrics 1976;58:362-7. 19. Keith FM, Charrette EJP, Lynn RB, et al. Inhalation of foreign bodies by children: a continuing challenge in management. Can Med Assoc J 1980;122:52-7.

Treatment of Encopresis

Since the term “encopresis” was established by Weissenberg in 1926, numerous articles have appeared, sometimes offering conflicting views of etiology, diagnosis, and treatment. The major reason for this disagreement may be that all encopresis is not one single disease entity and that the symptom of fecal soiling may be observed in different types of children. Therefore, by way of introduction, it might be useful to differentiate the various types of fecal soiling and their respective causes.

Pharmacotherapeutics: A Rational Approach

The decision of a physician to prescribe a pharmacotherapeutic agent, the selection of a particular agent, and the efficacy of that agent are influenced by factors which may be grouped into three major areas: attitudes and compliance of patients and parents, factors influencing the prescribing habits of physicians, and drug pharmacology, manufacture, and distribution factors.

The inaccuracy of paper medicine cups: A warning

A N u M B E R of -decisions are involved in the selection and administration of a pharmacologic agent to a patient: (1) establishing diagnosis, (2) determination of the necessity for treating with a pharmacologic agent, (3) selection of an appropriate agent, (4) selection of the safest and most efficient route of drug administration, (5) determination of the dosage to be administered, and (6) selection of the appropriate time intervals for administration. An additional and occasionaliy overlooked factor is the accuracy of the measuring deyice used for administration of liquid medications. Teaspoons, the most commonly utilized measuring devices in the home, have been shown to vary greatly in capacity? In addition, there can be significant variation in the amount of medication administered by dif ferent individuals using the same teaspoon. 2, Shirkey 3 has commented on the use of medicine glasses and paper and plastic medicine cups. He states that disposable cups are used widely in the hos-

CLINDAMYCIN EFFECTIVE IN THERAPY OF STREPTOCOCCAL PHARYNGITIS

Benzathine penicillin (BP) is considered to be the most effective therapy for removal of Streptococcus (S.) pyogenes from the pharynx. The following study was undertaken to determine whether oral clindamycin (CL) was equally effective for this purpose. This possibility was suggested by published observations made in private practice in which CL was compared with other oral antibiotics.939 clinic patients with throat cultures positive for S. pyogenes were randomly selected for treatment with intramuscular BP, oral CL or oral phenoxymethyl penicillin (PMP). 621 returned for a follow-up culture and brief history on at least one scheduled visit. 307 returned for all scheduled visits at 1, 2, and 4 weeks after initiation of therapy.Data from the first 2 follow-up cultures indicate that CL and BP had similar failure rates (8% and 9% resp.) and that PMP was less efficacious than either of the other 2 antibiotics (p<.01). Late cultures indicate that CL is not as efficient as BP or PMP in preventing recurrences. This latter finding differs from all others in the literature, is not due to age, sex, weight, quantity of S. pyogenes in original culture or dosage of CL, and is unexplained.Oral CL is effective in removing S. pyogenes from the pharynx and may be as effective as BP.