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Neurofibroma and neuroblastoma both arise from the neural crest, and there has long been speculation regarding a pathogenetic relationship between them. Clinical characteristics do not necessarily distinguish these tumors, therefore the diagnosis of neuroblastoma should be considered in all children with neurofibromatosis 1 (NF-1) who have a rapidly growing or inaccessible mass. A careful physical examination, imaging studies, and urinary catecholamine measurement are indicated. In a child with NF-1 and malignancy, direct tissue examination may be necessary to differentiate malignant from nonmalignant tumor and guide therapy. Furthermore, with the significantly increased risk of certain types of childhood cancer in these patients, we recommend evaluation for this common heritable condition in all patients with malignancy.

The differential diagnosis of alopecia in the pediatric age group is simplified by the fact that 90% to 95% of the cases are caused by four major entities: alopecia areata, telogen effluvium, tinea capitis, and trichotillomania. Careful examination of the scalp, hair, and historical pattern of the loss will usually be rewarded by the correct diagnosis.

Bacterial skin infections are a common reason for children to be examined by a pediatrician. Streptococci and staphylococci are responsible for the great majority of the infections. Because of the variety of lesions produced by these bacteria, there is support for dividing impetigo into "traditional" crusted and bullous forms. Two important forms of cellulitis--facial and periorbital--have potential for serious systemic consequences. The bacterial etiology and treatment of cellulitis, animal bites, and puncture wounds of the foot require special attention for successful outcome.

Two groups of infants, one fed whole cow milk commencing at 6 months of age (n = 69) and the other continuing to receive iron-fortified infant formula (n = 98), were closely observed over their second 6 months of life. At 12 months of age, infants fed cow milk had significantly lower mean serum ferritin levels and mean corpuscular volume, higher free erythrocyte protoporphyrin values, and greater incidence of hemoglobin values less than 11 g/dl than did formula-fed infants. There were no significant differences in frequency of otitis media, wheezing episodes, nasal discharge or congestion, diaper dermatitis, constipation, guaiac-positive stools, or hospital admissions between the two groups. These data suggest that, to avoid iron deficiency, infants should continue to receive iron-fortified formula throughout the first year of life or a daily iron supplement if they are fed whole cow milk before their first birthday.

Computer assisted diagnosis was evaluated for its ability to hasten the time to initial diagnosis and reduce laboratory studies. The time to diagnosis averaged 2.8 days for a control group and 1.9 days for the group in which the computer printout was made available. In a small group in whom the diagnosis was not established until after 48 hours, there was a further trend to reduction in number of days to diagnosis and irrelevant laboratory studies. The ability of the computer to include the final diagnosis in the initial list of differential diagnoses remained unchanged for patients whose conditions were diagnosed before or after 48 hours, while the physicians' ability decreased. In a university hospital setting, computer-assisted diagnosis may be most beneficial for patients whose conditions have not been diagnosed within 48 hours of admission.

We present the sixth reported case of the Coffin-Siris syndrome. This disorder is characterized by the absence of the nails of the fifth fingers and toes, severe mental and developmental retardation, and postnatal growth deficiency. Feeding and respiratory problems are prominent features. The Dandy-Walker malformation was found at autopsy in our patient. This malformation was also present in the only other patient with this syndrome whose autopsy has been reported.

Patient, contact data, collected by two first year pediatric residents, separated in time by 25 years, were compared, and it is concluded that pediatric residency has undergone major changes throughout the past quarter century. Pediatric training has increased in length and includes more female residents. The overall intensity of patient care pediatric residents provide has increased. Children with chronic disorders that were often lethal conditions 25 years ago now make up a large portion of pediatric admissions to teaching hospitals.

The reasons for the controversy regarding the use of corticosteroids to treat croup were reviewed by evaluating nine studies for their adequacy in meeting eight methodologic standards essential for reducing bias and distortion in clinical trials. Five studies employed diagnostic criteria for croup but none stratified patients with croup into acute laryngotracheitis and spasmodic croup, the two forms which account for the large majority of cases of croup. Only four studies used adequate doses of steroids, defined as 100 mg of cortisone or an equivalent. Only two studies developed clinically relevant choices for the outcome event. Although steroids may be helpful in certain types of croup, it is impossible to reach a definite conclusion about the efficacy of steroids, since all of the studies have major inadequacies in clinical trial design.

One-week surveys of office visits to a general pediatric clinic were carried out at monthly intervals over a six-month period. Skin complaints accounted for 24% of the primary and secondary reasons for initiating clinic visits. Six categories of dermatologic conditions accounted for 81.5% of the pediatric clinic visits, with skin infections comprising 38.5%. A survey of new referrals to a pediatric dermatology clinic over a similar seasonal span revealed that the same six categories made up 51.8% of diagnoses. The surveys indicate that skin disorders are common reasons for pediatric office visits and suggest some areas that should be emphasized in the training of physicians in dermatologic diagnosis and management.

Two unrelated children, a girl and a boy, with alopecia, anomalous cutaneous pigmentation, abnormal thumbs, and endocrine disorders, including short stature and delayed bone age in one patient and juvenile onset diabetes mellitus in the other, are described. In one instance, the mother and the maternal grandmother had similar abnormalities, although of a less severe nature. Both children had normal nails and no unusual susceptibility to infections. We believe these two patients represent a previously undescribed syndrome of ectodermal dysplasia that may be inherited as an autosomal-dominant trait.

A 10 1/2-year-old girl had a ten-month history of spontaneous episodes of epistaxis and bleeding from the skin, eyes, and ears. The bizarre nature of the complaint, labeled as stigmata prior to referral, along with the altered family dynamics, led to the conclusion that the origin of the episodes was factitial. A mild case of gingivitis proved to be the source of blood for the bleeding episodes.

Medical attention was sought for a 23-month-old toddler because of anorexia, weight loss, irritability, profuse sweating, peeling and redness of his fingers and toes, and a miliarial rash. The diagnosis was mercury poisoning, and an investigation of his environment disclosed that he had been exposed to mercury from broken fluorescent light bulbs. Acrodynia resulting from fluorescent bulbs has not been previously reported.

Capillary (or strawberry) hemangiomas can present a difficult problem in management, and much controversy exists over whether it is better to watch and wait for natural involution, or to be more aggressive and attempt to prevent some of the negative potential sequelae. A case study of a neonate with a large, early macular capillary hemangioma of the head and neck successfully treated with the 585-nm pulsed dye laser is presented. In addition, a review of a number of treatments for more advanced lesions is presented. Modalities discussed include argon, carbon dioxide, and neodymium: YAG lasers; cryotherapy; local and systemic steroids; and surgical excision.