Walter W. Tunnessen

Consequences of starting whole cow milk at 6 months of age

Two groups of infants, one fed whole cow milk commencing at 6 months of age (n = 69) and the other continuing to receive iron-fortified infant formula (n = 98), were closely observed over their second 6 months of life. At 12 months of age, infants fed cow milk had significantly lower mean serum ferritin levels and mean corpuscular volume, higher free erythrocyte protoporphyrin values, and greater incidence of hemoglobin values less than 11 g/dl than did formula-fed infants. There were no significant differences in frequency of otitis media, wheezing episodes, nasal discharge or congestion, diaper dermatitis, constipation, guaiac-positive stools, or hospital admissions between the two groups. These data suggest that, to avoid iron deficiency, infants should continue to receive iron-fortified formula throughout the first year of life or a daily iron supplement if they are fed whole cow milk before their first birthday.

The steroid-croup controversy: An analytic review of methodologic problems

The reasons for the controversy regarding the use of corticosteroids to treat croup were reviewed by evaluating nine studies for their adequacy in meeting eight methodologic standards essential for reducing bias and distortion in clinical trials. Five studies employed diagnostic criteria for croup but none stratified patients with croup into acute laryngotracheitis and spasmodic croup, the two forms which account for the large majority of cases of croup. Only four studies used adequate doses of steroids, defined as 100 mg of cortisone or an equivalent. Only two studies developed clinically relevant choices for the outcome event. Although steroids may be helpful in certain types of croup, it is impossible to reach a definite conclusion about the efficacy of steroids, since all of the studies have major inadequacies in clinical trial design.

Cutaneous lesions associated with cyclosporine therapy in pediatric renal transplant recipients

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Prepubescent Gonococcal Vulvovaginitis: A Call for Examination of All Household Members

Investigation of a five-year-old girl with gonor rheal vulvovaginitis revealed four other cases in the household. This illustrates the importance of investigation of all family members in such cases.

Is There an Optimal Time to Schedule Residency Interviews

The process of applying for a primary care residency position has become increasingly complicated in recent years. Some senior medical students seem to spend an inordinate amount of time and energy on this effort that may begin at the end of their junior year and extend up until the deadline for the National Resident Matching Program (NRMP) during the first week of January. The prospective applicant generally schedules interviews with five to ten programs that often vary in size, geographic location, and university or community affiliation. Larger residency programs may set up predetermined interview days, whereas smaller programs tend to schedule interviews at the convenience of the applicant. Does it matter when the prospective applicants schedule their interviews? Applicants say that they are told, usually by faculty advisors or fellow students, that interviews should not be scheduled too early in the course of the academic year for fear that they

IMPACT OF COMPUTER ASSISTED DIAGNOSIS ON HOSPITAL STAY

A previous study demonstrated the capacity of a computer (MEDITEL) to assist in the diagnosis of difficult pediatric problems. A study was undertaken to determine if the use of a computer diagnosis would hasten the time of initial diagnosis and reduce laboratory studies. A total of 67 pts. were studied. Pts. were selected if at the time of admission a diagnosis was not clearly evident. In 34 pts. the computer list of differential diagnoses was placed on the chart for the use of the house officer, while 33 pts. served as controls and the print-out retained by the chief resident. Review at discharge revealed that the time from admission to diagnosis was the same for both the computer (2.1 days) and control groups (2.8 days); the total number of laboratory studies ordered was similar (13.7 vs. 13.6); as was the number of irrelevant laboratory studies (1.3 vs. 2.3). When pts. in the control group, in whom a diagnosis had not been made within 48 hours, were contrasted with those in the computer group, it was found that the days to diagnosis was longer (4.48 vs. 3.40) and the number of irrelevant laboratory studies larger (3.57 vs. 1.50). Based on these observations, it would appear that in a univ. hospital setting, the routine use of computer assisted diagnosis will not decrease hospitalization costs but can be of benefit in those pts. in whom a diagnosis has not been established within 2 days of admission.