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Kinetic studies of an aromatic iodination reaction using benzene or acetanilide, iodine, diiodine pentoxide and sulfuric acid in glacial acetic acid have been carried out. The reaction, followed using FT-Raman spectroscopy to monitor the disappearance of the aromatic over time, exhibits fractional order dependence in benzene but first order dependence in acetanilide. The difference in order between the two aromatics indicates that benzene participates in an equilibrium reaction before the rate limiting step of the reaction. This reversible step is proposed to be the reversible formation of a π-complex between adsorbed I2 and benzene as it adsorbs onto I2O5. Based on the calculated order, acetanilide most likely does not form a π-complex with adsorbed I2, rather it reacts from solution to form a σ-complex with activated I2 on the I2O5 surface. In both reactions, it is proposed that the rate limiting step is the formation of the σ-complex.

The purpose of this study was to determine whether cholesterol screening and nutritional counseling can reduce cholesterol concentrations in populations of otherwise unrecognized hypercholesterolemic children. A large pediatric practice in Parma Heights, Ohio, has conducted cholesterol surveillance of children over 2 years of age since 1986. The importance of cholesterol and other recognized risk factors for the progression of atherosclerosis is discussed with all families, and the American Heart Association's Step-One diet is recommended. The present study examines data from a cohort of 894 children (473 boys, 421 girls) who had cholesterol concentrations above 185 mg/dL (4.79 mmol/L) (the 90th percentile) at baseline and, after counseling, had a repeat measurement an average of 2.2 years later. Their mean ages were 7 years at the first testing and 9.2 years at the second. Children who had cholesterol concentrations above 200 mg/dL (5.18 mmol/L) (the 95th percentile) had lipoprotein profiles done, and if their LDL cholesterol exceeded 130 mg/dL (3.37 mmol/L) (the 95th percentile), they were referred to a nutritionist, and family members were advised to have their blood lipids analyzed.Mean cholesterol concentration for all 894 children over this time period decreased by 9.4% (19.5 mg/dL [0.51 mmol/L]; 95% CI = 17.5 mg/dL [0.45 mmol/L] to 21.5 mg/dL [0.56 mmol/L]; P

An adolescent boy returned home from a party and told his parents he may have taken some pills while there. He was given saltwater to drink, in an effort to induce emesis. He vomited numerous times, then seized. Hypernatremia (195 mmol/L) was diagnosed at the community hospital, and he was transferred to a pediatric intensive care facility. He suffered numerous complications and died from cerebral herniation. This case is presented to remind physicians of the dangers of this obsolete therapy.

Medical emergencies in children with rheumatic diseases require a different approach from their adult counterparts. Multiple factors may make it difficult to assess children in need of prompt medical treatment, including (1) an age-specific inability to communicate accurately (or at all), (2) a frequent underreporting of pain by the child, and exhibiting only short-term recall, (3) difficulty in performing physical examinations, diagnostic testing, and interventions due to the child's anxiety and (4) the physician's need to address parental issues, such as misperception of illness, anxiety, denial of severity, and parental fears that their delayed care-seeking contributed to a worsening situation. Medical emergencies are relatively infrequent in pediatric rheumatic diseases, but rapid diagnosis and treatment often can have significant positive impact on future growth and development of the child and may minimize morbidity and mortality. Whether involving one organ system or many, the spectrum of rheumatic disease in children ranges from limited and indolent to rapidly progressive and life-threatening and often benefits from a multidisciplinary approach. Often, only isolated reports or small case series regarding critical care in pediatric rheumatology are available, and thus, of necessity, diagnostic and treatment approaches are occasionally extrapolated from adult data. The purpose of this article is threefold: (1) to provide a guide for adult rheumatologists confronted with children with rheumatic disease emergencies, (2) to synthesize the relevant critical care literature for pediatric rheumatologists, and (3) to provide the pediatric critical care specialist and the general pediatrician with a concise resource regarding emergency rheumatic disease care. Topics are discussed by organ system, rather than disease, to minimize repetition.

We report a 6-week-old boy with meperidine neurotoxicity. What distinguished our patient from those previously reported was his minimal exposure to therapeutic doses of meperidine in the setting of normal renal function, and no history of sickle cell anemia, cancer, hepatitis, or cirrhosis. In addition, our patient had no abnormal changes in the electroencephalogram during the event. After only 2 doses of meperidine, he exhibited acute orofacial dyskinesias consisting of tongue thrusting, lip pursing, and facial grimacing combined with prominent flexion of the arms and stiffening of his legs. However, a normal sucking response remained. His symptoms resolved over the next 36 hours and did not respond to naloxone. We believe that this unique presentation of meperidine-induced neurotoxicity may be due to changes in the basal ganglia resulting from perinatal hypoxemia.