Wm. Lane M. Robson

Hypocomplementemia and leukocytosis in diarrhea-associated hemolytic uremic syndrome.

Sixty-eight children with diarrhea-associated hemolytic uremic syndrome (D+HUS) were retrospectively examined to assess clinical variables associated with the combination of leukocytosis and hypocomplementemia. There was a statistically significant association between the white blood cell count (WBC) and the level of the third component of the complement system (C3). Children with both a low C3 and a high WBC were significantly younger and required hospitalization for a significantly longer period of time. Although there were also trends to increases in the presence of anuria and central nervous system complications and in the duration of anuria, elevated WBC, thrombocytopenia, dialysis, and hemorrhagic colitis in children with both an elevated WBC and a low C3, these changes did not achieve statistical significance. The presence of a low C3 and an elevated WBC may indicate a subset of children with D+HUS with a more severe episode.

Hemolytic-uremic syndrome

HUS is one of the most common causes of acute renal failure in childhood. D+ HUS is the most common form and usually follows an episode of hemorrhagic colitis due to VTEC or S. dysenteriae type 1. The SLT elaborated by these organisms is responsible for the endothelial damage that is the initial insult in the pathogenesis of the acute renal failure. Excellent supportive care is necessary to reduce the mortality and morbidity due to HUS.

Primary and Secondary Nocturnal Enuresis: Similarities in Presentation

Objective. To determine the differences or similarities in the clinical presentation between patients with primary and secondary nocturnal enuresis. Methods. A total of 170 patients with nocturnal enuresis were assessed at a busy tertiary care pediatric voiding dysfunction clinic at the University of Oklahoma Health Sciences Center. Patients with primary nocturnal enuresis (PNE) were compared with patients with secondary nocturnal enuresis (SNE) for a variety of clinical features, including gender, age when first voiding on their own, age on presentation, infrequent voiding, frequent voiding, urgency, daytime wetting, nocturia, urinary tract infection, constipation, vesicoureteral reflux, attention-deficit/hyperactivity disorder, uroflow results, and ultrasound evidence of a postvoid residual. Results. The only significant difference between the patients with PNE and those with SNE was in the prevalence of constipation. Constipation was significantly associated with PNE (74.59% vs 57.54%; odds ratio: 2.17; 95% confidence interval: 1.07–4.41). When adjusted for a history of constipation, the age at which a child began to void on his or her own became statistically significant. Patients with SNE started to void on their own at 2.13 years (SD: 0.61), an average of 0.22 years earlier than those with PNE, who started to void on their own at 2.35 years. Conclusions. PNE and SNE likely share a common pathogenesis. Symptoms of daytime voiding dysfunction are common in patients with PNE and SNE. Daytime voiding habits might influence how the central nervous system responds at night to a full or contracting bladder.

Acute gastroenteritis in children: role of anti-emetic medication for gastroenteritis-related vomiting.

Acute gastroenteritis is associated with significant morbidity in developed countries and each year is the cause of death of several million children in developing countries. Acute gastroenteritis is usually self-limiting. Oral rehydration therapy (ORT) is effective and successful in the majority of patients. Vomiting is common at the outset of viral gastroenteritis and can limit the effectiveness of ORT. Treatment with newer anti-emetic medications has been reported to facilitate ORT and to minimize the risk of dehydration and the need for intravenous hydration and hospitalization.The role of anti-emetic medications in the treatment of gastroenteritis-related vomiting is not clear. Some physicians agree with the use of anti-emetic medications because vomiting is unpleasant and distressing for the child and parents alike, and because vomiting can increase the likelihood of dehydration, electrolyte imbalance, and the need for intravenous hydration or hospitalization. Several surveys have shown that anti-emetic medications are commonly prescribed in the treatment of pediatric gastroenteritis and that adverse events are uncommon. Efficacy studies of the newer anti-emetic medications are now available and reveal that some are effective and help facilitate ORT. Other physicians disagree with the use of anti-emetic medications because acute gastroenteritis is a self-limiting condition, vomiting might help rid the body of toxic substances, there was previously a relative lack of published evidence of clinical benefit, and there are potential adverse events associated with the use of an anti-emetic medication.Anti-emetic medications that are currently available include ondansetron, granisetron, tropisetron, dolasetron, ramosetron, promethazine, dimenhydrinate, metoclopramide, domperidone, droperidol, prochlorperazine, and trimethobenzamide. Randomized, placebo-controlled trials suggest that ondansetron is efficacious and superior to other anti-emetic medications in the treatment of gastroenteritis-related vomiting. A recent double-blind clinical trial showed that a single oral dose of ondansetron reduces gastroenteritis-related vomiting and facilitates ORT without significant adverse events. Ondansetron shows promise as a first-line anti-emetic, and judicious use of this agent might increase the success of ORT, minimize the need for intravenous therapy and hospitalization, and reduce healthcare costs. Ondansetron should be considered in situations where vomiting hinders ORT, but a larger randomized, placebo-controlled trial is necessary before the medication can be routinely recommended for the treatment of gastroenteritis-related vomiting in children.

Hemorrhagic Bullous Lesions in a Child with Henoch‐Schönlein Purpura

Abstract:  An 8‐year‐old boy with Henoch–Schönlein purpura who developed hemorrhagic bullae is described. The occurrence of hemorrhagic bullae in children with Henoch–Schönlein purpura is rare. A perusal of the literature revealed but seven occurrences to which we add another one.

The circumcision question

Neonatal circumcision continues to be a controversial subject. The American Academy of Pediatrics has revised its earlier policy, stating that newborn circumcision has potential benefits as well as risks and emphasizing the need to explain these issues to parents considering the procedure so that an informed decision can be made. Compared with circumcised males, uncircumcised males are at greater risk for urinary tract infection, sexually transmitted disease, phimosis, paraphimosis, and balanoposthitis. Complications of circumcision include infection, hemorrhage, and meatal stenosis. Analgesia should be prescribed for the substantial pain associated with the procedure. Alternatives to circumcision include retraction of the foreskin with use of local or general anesthesia. Regular foreskin hygiene is important for all males, whether circumcised or not.

The Possible Role of Circumcision in Newborn Outbreaks of Community-Associated Methicillin-Resistant Staphylococcus aureus

Outbreaks of community-associated methicillin-resistant Staphylococcus aureus were recently reported in newborns at 3 major urban centers. Boys were disproportionately infected. A literature review and a statistical analysis confirmed that male newborns are significantly more likely to be infected with Staphylococcus aureus. Circumcision is a possible explanation for the recent outbreaks.

Attention-deficit hyperactivity disorder. Getting control of impulsive behavior.

Preview Children who fidget, chatter incessantly, interrupt, and hop from one activity to another may be very tiring to be around. Worse yet, their behavior limits their ability to learn and make friends and may have long-term consequences for themselves as well as their families. The authors review the features of attention-deficit hyperactivity disorder and summarize pharmacologic, educational, and behavioral intervention.

Xanthine calculi presenting at 1 month of age

Xanthinuria is a rare cause of nephrolithiasis and is usually due to an inherited abnormality in purine metabolism. A 5-year 6-month-old boy was assessed for a history of recurrent episodes of renal colic. The child first presented with symptoms due to xanthine calculi at 1 month of age, the youngest presentation we were able to identify. Xanthine calculi, although rare, should be considered in the differential diagnosis of nephrolithiasis and ureterovesical junction obstruction in children. Xanthine calculi should also be considered when symptoms suggestive of urinary tract infection are present but the urine culture is negative, and when an organe-brown sediment is noted in the urine or similar coloured stains are found in the nappy.

Haemolytic-uraemic syndrome associated with Aeromonas hydrophila enterocolitis

We read with interest the report by Bogdanovic et al. [1] on haemolytic-uraemic syndrome (HUS) associated with Aeromonas hydrophila enterocolitis. Since July 1987, we have assessed 82 children with typical HUS. Stool specimens from each child with HUS were tested for the presence of multiple pathogens including verotoxin-producing Escherichia coli, Salmonella, Shigella, CampyIobacter, Yersinia and A. hydrophila. Oxidase testing was routinely performed on all stool isolates. Forty-five (55%) children had E. coli 0157 : H7, 2 (2%) children had A. hydrophila, and 1 child (1%) had Campylobacter in the stool. We concur with Bogdanovic et al. [1] thatA, hydrophila should be added to the list of bacteria that may trigger an episode of typical (D+) HUS and that oxidase testing should be routinely performed on all stool isolates in patients with HUS. Wm. Lane M. Robson 1 Alexander K. C. Leung 1 Cynthia L. Trevenen 2 Departments of I Pediatrics and 2 Pathology University of Calgary Alberta Childrens Hospital 300, 10601 Southport Road SW Calgary, Alberta T2W 3M6 Canada