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Biomedical subjects

M T Stein

Publications and source records attributed to M T Stein.

At least 73 records · Page 4Linked to original sources
PubMed1999

A school-aged child with delayed reading skills.

During a health supervision visit, the father of a 7.5-year-old African American second-grader asked about his son's progress in reading. He was concerned when, at a recent teacher-parent conference to review Darren's progress, the teacher remarked that Darren was not keeping up with reading skills compared with others in his class. She said that he had difficulty sounding out some words correctly. In addition, he could not recall words he had read the day before. The teacher commented that Darren was a gregarious, friendly child with better-than-average verbal communication skills. His achievement at math was age-appropriate; spelling, however, was difficult for Darren, with many deleted letters and reversals of written letters. A focused history did not reveal any risk factors for a learning problem in the prenatal or perinatal periods. Early motor, language, and social milestones were achieved on time. Darren had not experienced any head injury, loss of consciousness, or chronic medical illness. He had several friends, and his father denied any behavioral problems at home or at school. His teacher completed a DSM-IV-specific behavioral survey for attention-deficit/hyperactivity disorder (ADHD). It did not show any evidence of ADHD. Darren's father completed 1 year of college and is currently the manager of a neighborhood convenience store. His mother had a high school education; she recalled that she found it difficult to complete assignments that required reading or writing. She is employed as a waitress. Darren does not have any siblings. The pediatrician performed a complete physical examination, the results of which were normal, including visual acuity, audiometry, and a neurological examination. It was noted that Darren seemed to pause several times in response to questions or commands. On two occasions, during finger-nose testing and a request to assess tandem gait, directions required repetition. Overall, he was pleasant and seemed to enjoy the visit. His pediatrician concluded that he had a learning problem but she was uncertain about the next step. She asked herself, "Is there anything else I can do in the office to evaluate Darren's problem with learning? Should I quickly refer him for educational testing or encourage a reading tutor? What questions can I ask his teacher that would be helpful? Am I missing a medical disorder?"

Child↗
PubMed1999

Persistent cough in an adolescent.

Jessica, a 14-year-old girl with a history of asthma, went to her pediatrician's office because of a persistent cough. She had been coughing for at least 3 months with occasional cough-free periods of less than a few days. The cough was nonproductive and was not accompanied by fever, rhinorrhea, or facial or chest pain. Jessica and her mother observed that the cough increased with exercise and typically was not present during sleep. She has used two metered-dose inhalers--albuterol and cromolyn--without any change in the cough pattern. For the past 5 years, Jessica has had mild asthma responsive to albuterol. She enjoys running on the cross-country team, soccer, and dancing. She is an average student and denies any change in academic performance. She has never been hospitalized or had an emergency department visit for asthma or pneumonia. There has been no recent travel or exposure to a person with a chronic productive cough, tobacco smoke, or a live-in pet. Jessica lives with her mother and younger sister in a 10-year-old, carpeted apartment without any evidence of mold or recent renovation. In the process of taking the history, the pediatrician noticed that Jessica coughed intermittently, with two or three coughs during each episode. At times, the cough was harsh; at other times, it was a quiet cough, as if she were clearing her throat. She was cooperative, without overt anxiety or respiratory distress. After a complete physical examination with normal findings, the pediatrician interviewed Jessica and her mother alone. Jessica's parents had been divorced for the past 6 years. She lived with her mother but visited her father, and his new family with two young children, every weekend. She spoke about this arrangement comfortably and said that she loved her father and mother but didn't like the tension she experienced at her father's home. "I don't like adults arguing when kids are around." When asked why she thought the cough persisted so long, she commented in a neutral tone, "I don't know. It's never been like this before." Jessica's pediatrician prescribed an inhaled steroid with the albuterol. When the cough did not respond after 1 week, he ordered a chest radiograph (normal) and a tuberculin skin test (purified protein derivative-negative), and he added montelukast (a leukotriene inhibitor) and monitored airway resistance with a peak flow meter. The cough persisted, and the peak flow recording showed normal airway resistance. At this time, Jessica's pediatrician suspected a conversion reaction and contemplated the next best therapeutic strategy.

Adolescent↗
PubMed1998

Diurnal and nocturnal enuresis in a 6 year old.

Justin is a 6-year-old boy diagnosed with attention-deficit/hyperactivity disorder who presented with daytime and night-time wetting. He had been toilet trained at the age of 3 years but was back in diapers as a result of the enuresis. His bowel movements were normal. The initial evaluation consisted of a urinalysis, urine culture, serum creatinine level, and renal/bladder ultrasound examination. The urine studies were normal. The serum creatinine level was elevated at 1.0 mg/dL. The ultrasound examination revealed bilateral mild hydronephrosis and a thickened bladder wall. A voiding cystourethrogram was ordered to evaluate anatomy, but Justin would not allow a Foley catheter to be inserted, so the procedure, along with cystoscopy, was performed under anesthesia. Cystoscopy revealed a highly trabeculated bladder, as is seen in either high-grade obstruction or a neurogenic bladder. The cystogram did not show any obstruction or vesicoureteral reflux. Meanwhile, Justin's symptoms continued to increase to the point at which he was constantly wet, and he no longer made any attempts to void on his own. A spinal magnetic resonance imaging study did not show any occult neurologic lesions. Urodynamic studies revealed a high-pressure bladder, poor emptying, and inappropriate voluntary contraction of the striated, urinary sphincter during micturition. Despite institution of anticholinergic medication, psychotherapy, and behavioral therapy, Justin continued to do poorly. He could not tolerate clean intermittent catheterization, and he eventually required a suprapubic tube for urinary drainage and preservation of his kidneys.

Child↗
PubMed1997

Cyclic vomiting.

Explore the source record for details and available documents.

Case Management↗
PubMed1996

Beyond infant colic.

Some of the most interesting cases in pediatric practice evolve through time. What may begin as a clear, well defined problem with a predictable natural history and an accepted intervention strategy may develop into a more complex, multi-faceted set of problems. It is these children who potentially provide clinicians with new insights into behaviors. This case of a colicky infant illustrates the wide spectrum of behavioral and physiological symptoms that emerge from a specific underlying behavioral phenomenon. It also emphasizes the significant benefit derived from a longitudinal perspective of developmental events.

Colic↗