Accidental exposure to drugs and household products in young children and self-poisoning by adolescents are common clinical problems of important concern to the general pediatrician. This article reviews new developments in the field of pediatric toxicology including 1) epidemiologic data collected from poison centers and hospital admissions that illustrate the changing spectrum of pediatric poisonings; 2) progress in identifying clinical features or laboratory tests predictive of outcome in specific poisoning; 3) advances in and limitations involving decontamination methods and antidote therapy in different toxic ingestions; and 4) recent investigations toward prevention of pediatric poisoning with an emphasis on barriers to compliance.

Adolescent↗

PubMed1993

A 2-year-old girl with hematemesis, melena, and splenomegaly.

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Child, Preschool↗

PubMed1993

A 7-month-old boy with poor growth, hypercalcemia, and unusual facies.

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Abnormalities, Multiple↗

PubMed1991

Characterization of in vivo expression of the human papillomavirus type 16 E4 protein in cervical biopsy tissues.

The role of human papillomavirus (HPV) proteins in the pathogenesis of cervical intra-epithelial neoplasia (CIN) and invasive cervical cancer is poorly understood. To characterize E4 protein expression in 49 paraffin-embedded cervical biopsies representing different histopathologic grades of disease, antibodies were elicited to a synthetic peptide corresponding to amino acids 20-34 of a protein predicted to be encoded by the HPV 16 E4 open reading frame. The E4 protein was detected throughout the spectrum of CIN, from CIN1 to CIN3. Expression was localized to the cell nucleus, primarily in the superficial layers of the squamous cervical epithelium. Ultrastructural studies showed that the E4 protein was organized into compact, intranuclear arrays 25-35 nm in diameter. E4 protein expression was also demonstrated in some histologically normal tissues containing HPV 16 DNA, but not in any of five cervical cancers containing HPV 16 DNA. These results suggest that E4 protein expression may precede development of light microscopic tissue abnormalities, that it may continue through the spectrum of CIN, and that expression of this protein may be reduced or terminated in invasive cancer. The function of this protein remains unknown, but its nuclear localization may be consistent with a role in viral maturation.

Amino Acid Sequence↗

PubMedDate not supplied

Orthopaedic manifestations of invasive group A streptococcal infections complicating primary varicella.

The incidence of invasive group A streptococcal (GAS) infections in primary varicella appears to be increasing. GAS infections complicating varicella range from cellulitis, abscess, and septic arthritis to life-threatening necrotizing fasciitis and pyomyositis in association with GAS toxic shock syndrome (TSS). Four patients admitted in 1 year to the Children's Hospital and Medical Center in Seattle, whose care included evaluation and treatment by the Orthopaedic service, are presented to illustrate this spectrum. Three had a delay in diagnosis, including discharge from previous emergency department visits. One patient with polyarticular septic arthritis was treated with diagnostic aspiration and intravenous antibiotics. The remainder required urgent surgical debridement for treatment of deep infection. Patients with necrotizing fasciitis or pyomyositis had life-threatening complications of TSS, including hypotension, adult respiratory distress syndrome (ARDS), coagulopathy, and acute renal failure. These patients required aggressive fluid resuscitation and prolonged intensive care unit support. Diagnostic imaging studies were obtained in one patient with necrotizing pyomyositis but may have served only to delay definitive treatment. Recognition of the potential for secondary GAS infections and a high index of suspicion for the presence of necrotizing soft-tissue infection are essential in the evaluation of any child with fever and localized extremity pain with varicella.

Arthritis, Infectious↗