Biomedical subjects
W L Robson
Publications and source records attributed to W L Robson.
A perspective on controversies about neonatal circumcision.
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Evaluating tall children.
The causes of tall stature are numerous; genetic tall stature and constitutional tall stature are the most common. Diagnosis can usually be established from the history and physical examination. An estimation of bone age can help to confirm diagnosis and to determine the child's growth potential. No treatment is usually necessary. Hormonal therapy can be considered for individuals for whom the predicted height is excessive if the psychosocial and medical advantages outweigh the risks of treatment.
Post-streptococcal glomerulonephritis.
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Ectopic thyroid gland simulating a thyroglossal duct cyst: a case report.
There have been many reports of the inadvertent removal of an ectopic thyroid gland that was mistaken for a thyroglossal duct cyst. The differentiation of these two conditions is extremely important, because inadvertent removal of an ectopic thyroid gland may result in profound hypothyroidism. The authors report the case of a 5-year-old girl with an ectopic thyroid gland in whom the preliminary diagnosis was a thyroglossal duct cyst. They review the embryologic features in the development of an ectopic thyroid gland and discuss an approach to the management of this congenital anomaly.
Unilateral renal agenesis.
Unilateral renal agenesis is a relatively common congenital urinary malformation that is usually diagnosed during fetal ultrasonography. Some cases of URA may represent involution of a previous MCDK. Unilateral renal agenesis may be an isolated congenital malformation or may be associated with chromosomal abnormalities or a variety of nonchromosomal syndromes including the VACTERL and MURCS associations. Congenital cardiac malformations are the most common malformations associated with URA. Girls with URA should have a pelvic ultrasound to look for abnormalities in the müllerian structures. Vesicoureteral reflux is the most common abnormality noted in the contralateral kidney. The prognosis of individuals with isolated URA is good. There are reports of hypertension and renal insufficiency in long-term studies of patients with a single kidney, and lifetime follow-up is recommended.
Renal agenesis, multicystic dysplasia, and uretero-pelvic junction obstruction--a common pathogenesis?
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Attention-deficit hyperactivity disorder. Getting control of impulsive behavior.
A sizable number of school-aged children, more often boys, may have attention-deficit hyperactivity disorder (ADHD). Its cause is unknown. Some investigators implicate food additives or lead poisoning. These theories are not supported by study results, however. Physicians are dependent on reports of parents and teachers to diagnose ADHD, since the children may not show signs at an office visit. The presence of criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, third revised edition, and descriptions by parents and teachers of significant and pervasive impairment at home or school are diagnostic. Treatment is essential to minimize the academic failure, rejection, and loss of self-esteem that can result from the behaviors that typify ADHD. Use of stimulant medication is the most effective intervention and should be continued as long as it provides benefits without adverse effects. Concomitant behavioral therapy may be useful, and the entire family may benefit from psychotherapy.
Picture of the month. Fragile X syndrome.
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The absence of anti-neutrophil cytoplasmic antibodies in patients with Henoch-Schönlein purpura.
Sera from 14 patients with acute Henoch-Schönlein purpura (HSP) and 5 patients with a past history of HSP were assessed using a immunofluorescence technique for the presence of IgG, IgA, and IgM anti-neutrophil cytoplasmic antibodies (ANCA). There was no evidence of IgG, IgA, or IgM ANCA in the sera of these patients. These results suggest that ANCA are not involved in the pathogenesis of HSP.
Kegel exercises and squatting behavior.
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Side effects and complications of treatment with desmopressin for enuresis.
A literature search revealed 23 studies that have reported on the type or frequency of side effects or complications associated with the use of desmopressin (DDAVP, Rhône-Poulenc Rorer Pharmaceuticals Inc, Collegeville, Pennsylvania) for the treatment of enuresis. Thirty-one (4.3%) side effects were reported in 717 patients. Seizure secondary to water intoxication is a potential complication of treatment with desmopressin and was reported in six patients, usually in association with excess fluid intake during the evening or day preceding the use of desmopressin. Desmopressin appears to have a favorable safety profile. Patients should be specifically instructed not to ingest excess fluids during the evening prior to administration of desmopressin.
The P1 blood group and the severity of diarrhea-associated hemolytic uremic syndrome.
Thirty-one children with diarrhea-associated hemolytic uremic syndrome were retrospectively studied to determine if expression of the P1 blood type was related to the severity of the acute illness or to the prognosis. No differences were found in the clinical variables studied in the patients who were P1 positive compared to the patients who were P1 negative. The clinical variables studied included the age, hemoglobin, white blood cell count (WBC), and presence of central nervous system involvement at presentation, the duration of elevated WBC, thrombocytopenia, hemorrhagic colitis, and anuria, and the follow-up incidence of proteinuria, hypertension and decreased GFR. Expression of the P1 phenotype does not appear to exert a protective influence in patients with D+ HUS.
Renal colic due to Henoch-Schönlein purpura.
A six-year-old boy with Henoch-Schönlein purpura (HSP) presented with renal colic and the passage of tubular-shaped blood clots in the urine. The authors suggest that the renal colic was due to a ureteritis. Ureteritis in patients with HSP may be more common than is generally appreciated.
Henoch-Schönlein purpura.
Henoch-Schönlein purpura is a fairly common pediatric disorder. The role of immunosuppression in the treatment of HSP continues to be controversial and awaits a multicenter controlled trial. The prognosis for the majority of patients is very good. Less than 2% of patients develop a serious complication associated with long-term morbidity. The most common serious complication is end-stage kidney disease, which may develop late in the disease after the symptoms from other organ systems have resolved. Patients with HSP should be carefully followed for several years to look for evidence of late renal involvement, and those patients who develop renal involvement should be followed regularly throughout their lifetime.
Sneezing.
Sneezing is a common symptom with numerous causes. Allergic rhinitis is the most common cause of persistent or frequent sneezing. The evaluation of a patient with sneezing should be individualized according to the duration and severity of the symptom. Laboratory tests are not necessary in the majority of patients, since the diagnosis is usually obvious from the history and physical examination. The treatment of persistent or recurring sneezing should be directed at the cause whenever possible. Firm pressure on the nose or lip may be helpful to abort an attack of sneezing.
Benign lymphoepithelial lesion (Mikulicz's syndrome) of the submandibular glands in a four-year-old boy.
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Chronic cough in children.
The two most common causes of chronic cough among children are asthma and recurrent viral upper respiratory infection. Awareness of other potential causes of chronic cough is important. A specific diagnosis can usually be made with a thorough history, physical examination, and simple laboratory investigations.