Yersiniosis in children

Sixty-five strains of Yersinia enterocolitica were isolated from stool specimens obtained from 35 patients over a 12-month period. The microbiologic characteristics and drug sensitivities are reported and the clinical patterns of disease associated with the organism are described. Gastroenteritis affecting infants and young children is the most frequent manifestation. The data for 1972 show the same epidemiological trend as in preceding years.     

AIDS in children

The application of medical quality assurance principles to ambulatory patient care using the traditional methods of medical chart audit, process review, and physician education has yielded generally disappointing results in improving patient care and physician performance. Newer methods assist physicians by providing patient and medical reference data at the time of a patient''s visit. Techniques for tracking treatment outcomes and patients'' test results and for providing instructions to patients may improve both care and patients'' and physicians'' satisfaction.This feature appears regularly in THE WESTERN JOURNAL OF MEDICINE. It is intended to cover recent developments in a broad range of issues that will have an impact—either directly or indirectly—on clinical practice. Occasionally the seminars may include informed speculation about likely future developments.     

Muscle function in children

Electrically evoked mechanical and contractile properties of the triceps surae have been measured in 52 children aged 11 and 14 years, and results compared with previously reported data for adults (Davies and White 1982). The results show that the time to peak tension (TPT), half relaxation time (1/2RT) and supramaximal tension (Pt) of the twitch were not significantly (P greater than 0.1) different in girls and boys and independent of age. The 14-year-old girls and boys were stronger in terms of their supramaximal 10, 20, and 50 Hz tetanic tensions and maximal voluntary contraction (MVC) than their younger counterparts, and both groups of children were significantly (P less than 0.001) weaker than the young adults. However, if standardisation was made for an anthropometric estimate of calf muscle (plus bone) cross-sectional area (CSA), the differences in strength disappeared. Electrically stimulated and voluntary maximal force per unit CSA measured at the knee were 17.1 and 20.5 N X cm2 respectively and independent of sex and age. The loss of force during a 2-min stimulated fatigue test was the same in the children as the adults. The average fatigue indices ranged from 0.52 to 0.72 in the children, compared with 0.68 in the adults. It is concluded that absolute differences in muscle strength in children are a function of muscle mass. The force generating capacity expressed in N X cm2, fatiguability, contraction and relaxation times of the triceps surae would appear to remain unchanged through adolescence and early adulthood.     

Orbital tumors in children

Unilateral proptosis in a young child can often be the presenting sign of an orbital mass. Appropriate management of these lesions requires a thorough knowledge of the types of orbital tumors which may present in the pediatric age group, as well as knowing the most appropriate work-up necessary to obtain an accurate diagnosis. This paper will describe a case of a 13-year-old African-American female who presented with uniocular proptosis, blackouts of her vision, dull aching pains in certain positions of gaze, resistance to retropulsion, and mild disc edema. An orbital mass was confirmed following a work-up which included an ultrasound of the orbit and a CT scan. The differential diagnoses included an orbital hemangioma or schwannoma. A diagnosis of a schwannoma involving the orbit was made following surgical removal of the lesion. A review of common orbital tumors seen in children will be presented in addition to the appropriate work-up and management of these lesions.