Methemoglobinemia in an infant.
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Biomedical subjects
Publications and source records attributed to M E Rimsza.
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An infant with cutaneous amebiasis of the vulva and amebic liver abscess is described. Epidemiologic investigations and serologic studies were crucial in establishing the diagnosis. The vulvar amebic ulcers responded dramatically to metronidazole therapy. Cutaneous amebiasis is a rare complication of Entamoeba histolytica infection which should be considered in the differential diagnosis of perineovulvar or penile ulcers. Cutaneous amebiasis may also occur on the abdominal wall surrounding a draining hepatic abscess, colostomy site, or laparotomy incision.
The case records of 311 children and adolescents who were medically evaluated for sexual abuse are reviewed. Only 18% of these victims were assaulted by strangers; 131 of the assailants were relatives. Thirty percent of the victims reported multiple assaults over a time period of one week to nine years. Physical examination showed no abnormalities in only 23% of the patients. Twenty-one patients had gonorrhea and seven patients were pregnant. Guidelines for the medical evaluation of patients suspected to be victims of sexual abuse are discussed.
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A potentially lethal neurotoxin-producing scorpion, Centruroides sculpturatus, exists in the southwestern United States. The most common symptoms of envenomation of 24 patients included local pain, restlessness, and roving eye movements. In this series 80% of cases were in children less than 10 years of age. Pain at the site of the sting was a predominant symptom in the patient more than 10 years of age; however, extreme and perpetual restlessness was the most common symptom in the younger patient. The diagnosis in children is usually made by clinical presentation alone since the site of the sting cannot be identified and children may not communicate the history of the sting. The most commonly used chemotherapeutic agent is phenobarbital. There is no evidence, however, that this drug decreases morbidity or mortality, and massive doses of phenobarbital were associated with two respiratory arrests in this series. The nature of scorpions and their venoms is discussed. Research is needed regarding the use of sympathetic blocking agents in scorpion envenomation.
The complications of corticosteroid therapy in children are protean. Perhaps the most important of these are adrenal insufficiency after withdrawal of steroids, immunosuppression, and growth failure. The physician who is caring for a child receiving corticosteroids must be aware of these common complications as well as the many less frequent side effects, such as cataracts, pseudotumor cerebri, pancreatitis, and steroid myopathy, to name a few. In all children, the risk of using corticosteroids should be weighed carefully before therapy with these agents is begun.
A 21-year-old woman with a history of chronic lung disease secondary to cystic fibrosis (CF) developed an acute hemorrhagic retinopathy during exposure to moderately high altitude. Although retinal hemorrhages are known to occur in patients with CF, we speculate that the retinopathy in this case was partially related to altitudinal change and that patients with chronic hypoxemia may be predisposed to high-altitude retinopathy at much lower altitudes.
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