Post on 25-Aug-2018
transcript
CONTENTS
Printed in USA.
COMMENTARY
263 Extending the Boundaries of MedicineRobert J. Haggertv
ARTICLES
265 Strokes in ChildrenMichael J. Rivkin and Joseph J. Volpe
279 Separation or Synthesis: A Holistic Approach toTherapeuticsKat/ii J. Kemper
284 Developmental Learning Disorders: Clues to TheirDiagnosis and ManagementDonna M. C’apiii
291 Index of SuspicionJ. Peter Harris, Carol J. Buzzard, Liliana D. Gutierrez,
Franz E. Babi, Susan K. Ratzan
IN BRIEF
263 Pressures: Impact on Health of Adolescents
294 Rifampin
DEPARTMENT OF CORRECTIONS
264 Erratum
COVER
Each of our 1996 issues of Pediatrics in Review will feature a work of art
submitted to our cover art contest this past year. We received more than200 entries and have chosen 12 to appear on our covers-four from eachof three age groups: 5 to 7 years, 8 to 10 years, and 11 to 15 years. The
entrants were asked to submit a drawing of what they like to do best.Most entries will be displayed by the American Academy of Pediatrics at
various sites.
This month’s work, by 9/i-year-old Alexander Alemar, is of himswimming. Alexander lives in Las Vegas, NV; his pediatrician is Kim M.
LaMotte, MD.
ANSWER KEY
1. D; 2. B; 3. D; 4. B; 5. E; 6. D; 7. C; 8. D; 9. D; 10. A; 11. A; 12. B; 13. D; 14. A;
15.D
Pediatrics in ReviewVol.17 No.8
August 1996
EDITORRobert J. HaggertyUniversity of RochesterSchool of Medicine and DentistryRochester. NY
Editorial Office:Department of PediatricsUniversity of RochesterSchool of Medicine and Dentistry601 Elmwood Ave. Box 777Rochester, NY 14642
ASSOCIATE EDITORLawrence F. NazarianPanorama Pediatric GroupRochester, NY
CONSULTING EDITOREvan Charney, Worcester, MA
EDITOR, IN BRIEFHenry M. Adam, Bronx. NY
ASSOCIATE EDITOR, IN BRIEFTina L. Cheng, Washington, DC
MANAGING EDtTOR
Martha H. Sallzman, Elk Grove Village, IL
EDITORIAL CONSULTANT
Victor C. Vaughan, III, Stanford. CA
EDITORIAL BOARDHoover Adger, Jr. Baltimore, MDRussell W. Chesney, Memphis, TNPeggy Copple, Tucson, AZJames J. Corrigan, Jr. New Orleans, LABrahm Goldstein, Portland. ORJohn L. Green, Rochester, NYWalter Huurman, Omaha, NEJohn Kattwinkle, Charlottesville, VAKathi Kemper, Seattle, WAJohn T. McBride, Rochester, NYLawrence C. Pakula, Timonium, MDKenneth B. Roberts, Worcester, MABradley M. Rodgers, Charlottesville, VAAllen W. Root, Tampa, FLLawrence Schachner, Miami, FLGail G. Shapiro, Seattle, WAFrank R. Sinatra, Los Angeles, CAMartin T. Stein, LaJolla, CAJon Tingelstad, Greenville, NCTerry Yamauchi, Little Rock, AR
EDITORIAL ASSISTANTSydney Sutherland
PUBLISHERAmencan Academy of PediatricsOlle Jane Z. Sahler, MD, Director
Department of EducationJo A. Largent, Director
Division of Medical JournalsDeborah Kuhlman, Copy Editor
PEDIATRICS IN REVIEW(ISSN 0191-9601) is ownedand controlled by the Amencan Academy of Pediatrics.It is published monthly by the American Academy ofPediatrics, 141 Northwest Point Blvd. P0 Box 927, ElkGrove Village, IL 60009-0927.
Statements and opinions expressed in Pediatrics inReview are those of the authors and not necessarilythose of the American Academy of Pediatrics or itsCommittees. Recommendations included in this pub-lication do not indicate an exclusive course of treat-ment or serve as a standard of medical care.
Subscription price for 1996: AAP Fellow $110: AAPCandidate Fellow $85; AAFP $135; Allied Health orResident $85; Nonmember or Institution $145. Currentsingle price is $10. Subscription claims will be honoredup to 12 months from the publication date.
Second-class postage paid at ARLINGTONHEIGHTS, ILLINOIS 60009-0927 and at additionalmailing offices.
© AMERICAN ACADEMY OF PEDIATRICS, 1996.All rights reserved. Printed in USA. No part may beduplicated or reproduced without permission of theAmerican Academy of Pediatrics. POSTMASTER:Send address changes to PEDIATRICS IN REVIEW,American Academy of Pediatrics, P0 Box 927, ElkGrove Village, IL 60009-0927.
The printing and production of Pediatncs in Review ismade possible, in part, by an educational grant fromRoss Products Division, _____________Abbott Laboratories. r��i
IROSSII SUPPOR�NG II PEDiATRIC I1.EDUCAT1ONJ
278 Pediatrics iii Review Vol. 17 No. 8 August 1996
�:�c.‘ ; .:
with human immunodeficiency virus. Arch
PediatrAdolesc Med. 1994:148:965-970
‘�‘‘ ‘ � ‘‘‘ “ � ‘� �‘ “ � � �
Pihko H, Tyni T, Virkola K, et al. Transient PIR QUIZ A. Albuterol.
ischemic cerebral lesions during induction B. Aspirin.
chemotherapy for acute lymphoblastic I . The most common clinical mani- C. Nifedipine.
leukemia. J Pediatr 1993;l23:7l8-724 festation of stroke in a full-term D. Oral contraceptives.
Ravelli A, Martini A, Burgio 0. Antiphospho- newborn is: E. Theophylline.
lipid antibodies in paediatrics. EurJ A. Anisocoria.Pediatr 1994; 153:472-479
Rivkin M, Anderson M, Kaye E. Neonatal idio-B. Bulging fontanalle.
C. Decerebrate posturing.
4. Which one of the following disor-
ders of amino acid metabolism
pathic cerebral venous thrombosis: an unrec- D. Focal seizures. carries the greatest risk of cere-ognized cause of transient seizures or lethar-
gy. Amimi Neural. 1992:32:51-57
E. Hemiparesis. brovascular occlusion?
A. Hartnup disorder.
Scott M, Barnes P. Kupsky W, Adelman L. 2. Which one of the following thera- B. Homocystinuria.
Cavernous angiomas of the central nervous
system in children. J Neurosurg.
pies is most useful in the manage-
ment of cerebrovascular occlusion
C. Maple syrup urine disease.D. Phenylketonuria.
1992:76:38-46 in a child who has sickle cell dis- E. Tyrosinosis.Sigal L. The neurologic presentation of vas- ease?
culitic and rheumatologic syndromes.Medicine. l987;66: 157-180
Siegler R. Spectrum of extrarenal involvement
in postdiarrheal hemolytic-uremic syn-
drome. J Pediatr l994;125:Sll-5l8
Simioni P. Battistella P. Drigo P. et al.
Childhood stroke associated with familial
protein S deficiency. Brain Devel.
1994:16:241-245
Warach 5, Chien D, Li W, et al. Fast magnetic
resonance diffusion-weighted imaging of
acute human stroke. Neurolog�� ‘
1992:42:1717-1723
A. Co�ticosteroids.
B. Exchange transfusion.
c. Heparinization.D. Strepto�tinase infusion.
E. Surgical thrombectomy.
3. Which one of the following med-
ications is most likely to predis-
pose to cerebrovascular thrombo-sis
5. Deficiency of which of the follow-
ing is associated with an increased
risk of thrombotic/embolic cere-
brovascular disease?
A. Factor V.
B. Fibrinogen.
C. Plasminogen.D. Platelet activating factor.
E. Proteins C and S.
‘ ‘ � � . -� . � � . � � . � ‘ � � � ‘ � . .‘
Pm Quiz-CME CreditA short quiz can be found at theend of each article in Pediatrics in
Review. Use the Quiz Card (boundinto the January issue) to recordyour answers. Each question has a
SINGLE BEST ANSWER. Theanswers to the questions appear onthe inside front cover of each issue.Three AMA Category 1 continuingmedical education (CME) credits are
awarded per completed issue for ayearly total of 36 CME credits.
To obtain credit, record youranswers on the Pediatrics in Re-
view Quiz Card and send it to theAmerican Academy of Pediatrics,PREP Office, P0 Box 927, Elk
Grove Village, IL 60009-0927. Toreceive CME credit on the 1996annual credit transcript, Quiz Cardsmust be received by February 28,1997. Quiz Cards received after this
deadline will be recorded in the yearthey are received. Quiz Cards fromthe 1996 volume of Pediatrics in
Review will be accepted throughDecember 31, 1998. A special note
to PREP gmup subscribers: Youwill receive the PIR Quiz Card and
the Self-Assessment Credit ReplySheet under separate cover.
The American Academy of Pedi-attics (AAP) is accredited by the
Accreditation Council for Continu-ing Medical Education to sponsorcontinuing medical education forphysicians. The American Acad-emy of Pediatrics designates thePediatrics Review and Education
Program (PREP) for 56 credithours in Category 1 of the Physi-cian’s Recognition Award of theAmerican Medical Association.
PREP meets the criteria for 56hours of credit toward the AAPPREP Education Award.
PREP has been reviewed and isacceptable for 56 prescribed hoursby the American Academy ofFamily Physicians. (Term of ap-proval: beginning date January 1996.Enduring materials are approved for1 year with option to request renew-al.) For specific information, pleaseconsult the AAFP Office ofContinuing Medical Education.
PREP has been reviewed and isacceptable for 32 AOA Category2-B CME hours by the AmericanOsteopathic Association. For spe-cific information, please consult theAOA Department of Education.
PREP has been approved for 56NAPNAP contact hours. An individ-
ual requesting contact hours shouldsubmit proof of participation and
verification of PREP accreditation tothe NAPNAP National Office.
In addition, the Canadian Paedi-atric Society has approved PREP
as one method for pediatricians to
demonstrate maintenance of com-petence (MOCOMP). For specificinformation, please consult theCPS directly.
PREP EDUCATION AWARD:
The AAP PREP Education Awardrecognizes Academy Fellows andCandidate Fellows who earn a mm-imum of 150 AAP-approved CME
credits over 3 consecutive years.The Award will be mailed auto-
matically in July 1997 to all mdi-
viduals who qualify.To qualify for the PREP Educa-
tion Award, a Fellow or Candidate
Fellow must:
. Earn a minimum of 75 credithours through participation inPREP or PREP: The Course, and
. Earn the remaining credit hours(75 hours) through other Acade-my-sponsored or -approved CME
activities. This may include: AAPSpring Session or Annual Meet-ing; AAP CME courses; ACQIP;Pediatric UPDATE Audiocasseue
Tape Program; or other AAPapproved courses.
ThERAPEUTiCSHolistic Medicine
PIR QUIZ
6. Of the following conditions, the onethat can be treated most appropri-ately primarily by lifestyle therapyis:
A. Acute otitis media.B. Crohn disease
C. Pulmonary hypertension.D. Systemic hypertension.
E. Urolithiasis.
7. Of the following conditions, the one
that can be treated most effectively
with biomechanical therapy is:
A. Acne.
B. Autoimmune thyroiditis.
C. Depression
D. Primary enuresis.
E. Retinitis pigmentosa.
8. Of the following conditions, the one
that can be treated most effectivelywith bioenergetic therapy is:
A. Acne.B. Conduct disorder.
C. Inflammatory bowel disease.D. Migraine headache.
E. Schizophrenia.
9. Of the following conditions, the one
that can be treated most effectively
with biochemical therapy alone is:
A. Attention deficit hyperactivitydisorder.
B. Chronic recurrent abdominalpain.
C. Intussusception.
D. Streptococcal tonsillo-
pharyngitis.
E. Tension headache.
Pediatrics in Review Vol. 17 No. 8 August 1996 283
REFERENCES1 . Eisenberg DM, Kessler RC, Foster C, et al.
Unconventional medicine in the United
States. N Engl J Med. l993;328:246-252
2. Spigelblatt L, Laine-Ammara 0, Pless lB.
Guyver A. The use of alternative medicine
by children. Pediatrics. 1994:94:8 1 1-8 14
3. Stern RC, Canda ER, Doershuk CF. Use of
nonmedical treatment by cystic fibrosis
patients. JAdolesc Health. 1992:13:
612-6154. Weizman Z, Alkrinawai 5, Goldfarb D, et
al. Efficacy of herbal tea preparation in
infantile colic. JPediatr. 1993:122:
650-6525. Johnson ES, Kadam NP, Hylands DM, et
al. Efficacy of feverfew as prophylactic
treatment of migraine. Br Mcdi. 1985:
291:569-573
6. Lindahl 0, Lindwall L. Double-blind study
of a valerian preparation. Pharmacol
Biochem Behav. 1989:32:1065-10667. Berkowitz CD. Homeopathy: keeping an
open mind. Lancet. 1994:344:701-702
8. Rieder MJ. Prevention of neural tube
defects with periconceptional folic acid.
Clin Perinatol. 1994:21:483-503
9. Kleijnen J. Ter Riet G, Knipschild P.
Vitamin B6 in the treatment of premenstru-
al syndrome-a review. Br J Obstet
Gvnecol. 1990;97:847-852
10. Warshafsky 5, Kamer RS, Sivak SL. Effect
of garlic on total serum cholesterol. A
meta-analysis. Ann Intern Med. 1993:119:
599-60511. Nagarathna R, Nagendra HR. Yoga for
bronchial asthma: a controlled study. Br
MedJ. 1985:291:1077-1079
12. Spiegel D, Bloom J, Kraemer AC. Gottheil
E. Effect of psychosocial treatment on sur-
vival of patients with metastatic breast can-
cer. Lancet. 1989:2:888-891
13. Wheeden A, Scafidi FA, Field T, et al.
Massage effects on cocaine-exposed
preterm neonates. J Dev Behav Pediatr.
1993: 14:3 18-322
14. Field T, Morrow C, Valdeon C, et al.
Massage reduces anxiety in child and ado-
lescent psychiatric patients. J Am Acad
ChildAdolesc Psvchiatr. 1992:31:125-131
15. Lu DP, Lu OP. Acupuncture
anesthesia/analgesia for pain and anxiety
control in dental practice. Compendium.1993; 14:464-468, 470-472
16. Klide AM. Acupuncture analgesia. Vet Clin
North Am SmallAnim Pract. 1992:22:
374-37917. Hesse J. Mogelvang B, Simonsen H.
Acupuncture versus metoprolol in migraine
prophylaxis: a randomized trial of trigger
point inactivation. J Intern Med.
1994:235:451-45618. Bellumomini J, Litt RC, Lee KA, Katz M.
Acupressure for nausea and vomiting of
pregnancy: a randomized, blinded study.
Obstet Gvnecol. l994;84:245-248
19. Brewington V. Smith M, Lipton D.
Acupuncture as a detoxification treatment:
an analysis of controlled research. J Subst
Abuse Treat. 1994:11:289-307
20. Gagne D, Toye RC. The effects of thera-
peutic touch and relaxation therapy in
reducing anxiety. Arch Psychiatr Nurs.
l994;8: 184-189
21. Kramer NA. Comparison of therapeutic
touch and casual touch in stress reduction
in hospitalized children. Pediatr Nurs.
1990:16:483-485
22. Byrd RC. Positive therapeutic effects of
intercessory prayer in a coronary care unit
population. South MedJ. 1988:81:
826-82923. Dossey L. Healing Words: The Power of
Prayer and the Practice of Medicine. New
York, NY: Harper Collins; 1993
24. Reilly D, Taylor MA, Beattie NO. et at. Is
evidence for homeopathy reproducible?
Lancet. 1994:344:1601-160625. Jacobs J, Jimenez LM, Oloyd SS, et al.
Treatment of acute childhood diarrhea with
homeopathic medicine: a randomized clini-
cal trial in Nicaragua. Pediatrics.1994:93:719-725
290 Pediatrics in Review Vol. 17 No. 8 August 1996
DEVELOPMENTLearning Disorders
language therapists, neunopsycholo-gists, education specialists, and occu-pational therapists. This multidisci-
plinany approach will help prevent
the secondary conditions that causeso much acute distress and associatedmorbidity. Early diagnosis and inter-vention can have a momentous effecton some of the most significantaspects of a child’s life.
SUGGESTED READINGAmerican Psychiatric Association. Diagnostic
(hid Statistical Manual. 4th ed. Washington
DC: American Psychiatric Association:1994
Denckla MB. The child with developmental dis-
abilities grown up: adult residua of child-
hod disorders in behavioral neurology.
Neural Clin. 1993:11:105-125
Filipek PA. Neurobiologic correlates of devel-
opmental dyslexia: how do dyslexics� brains
differ from those of normal readers? J Child
Neurol. I 995: 10:S62-S69
Galahurda AM. The pathogenesis of childhood
dyslexia. In: Plus F. ed. Language
Comniunication an(l tilt’ Brain. New York.
NY: Raven Press: 1988:127-138
Interagency Committee on Learning
Disabilities. A Report to the US Congress.
Washington. DC: US Government Printing
Office: 1987
National Joint Committee on Learning
Disabilities (1990). Learning Disabilities:
Issues on Definition. A Position Paper of the
National Joint Co,n,nittee on Learning
Disabilities. Austin. Tex: Pro-ED: 1994
Osterrieth PA. Le test de copie d’une figure
complexe. Arc/i de Psvcho!ogie. 1944:30:
206-356Pennington BF. Diagnosing Learning
Disorders: A Neuropsvchological Frame-
work. New York. NY: Guilford Press: 1991
Rourke BP. ed. Syndrome of Non verbal
Learning Disabilities. New York. NY:
Guilford Press: 1995US Department of Education. Sixteenth Annual
Report to c’ongress 00 the Implementation
oft/ic Individual.s with Disabilities
Education Act. Washington, DC: 1994
PIR QUIZ
10. As currently defined, learning
disabilities comprise difficulties
in reading. writing, or arithmetic
that occur in children who have:
A. Otherwise normalintelligence.
B. Residual effects of central
nervous system trauma.C. Residual effects of fetal alco-
hol syndrome.
D. Residual effects of lead poi-
soning.
11. As currently defined, learning
disorders comprise each of the
following except:
A. Elective mutism.B. Specific mathematical
disability.
C. Specific reading disability.
D. Posttraumatic learning
disability.
12. In the evaluation of a child sus-
pected of having a learning dis-ability, the most helpful examina-
tion among the following is:
A. Electroencephalography.
B. History.
C. Metabolic studies.D. Magnetic resonance imaging.
E. Physical examination.
13. Which of the following disorders
is least likely to be comorbid
with a learning disability?
A. Anxiety disorder.B. Bipolar disorder.
C. Depression.
D. Psychosis.
E. Substance abuse.
14. For which of the following is
there least evidence of specific
location of function in the brain?A. Executive function.
B. Long-term memory.
C. Phonologic processing.
D. Social cognition.
15. Academically, the grade level atwhich the transition from learn-ing to read to reading to learntakes place is:A. Kindergarten.B. First grade.
C. Second grade.
D. Fourth grade.E. Sixth grade.