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Brainstem auditory evoked potentials (BAEPs) were performed on 114 children with attention deficit disorder (ADD). Prolonged latencies of waves III and V and longer brainstem transmission time interval of waves I-III and I-V were observed in the study group compared with normal controls. A significant asymmetry of wave III latency between the ears was found in children with ADD, but not observed in the control group. The authors conclude that children with ADD have brainstem dysfunction. BAEPs, an objective electrophysiological test, may contribute to the diagnosis of ADD, distinguishing these children from the normal population.

The brainstem function of eight children with familial dysautonomia was investigated by brainstem auditory evoked potentials and compared with that of age-matched healthy control children. All median latencies of waves III and V in the study group were significantly higher than those of the control children. Brain transmission times of waves I-III and I-V were significantly prolonged in the study group compared with the control group. These results provide additional objective support for the assumption that the brainstem function of children with familial dysautonomia is affected by this disease.

The objective of this study was to assess the frequency of symptomatic urinary tract infections (UTIs) following voiding cystourethrography (VCUG) while using prophylactic antibiotics. Medical records of 421 patients who underwent a VCUG during a period of 4 years were reviewed. Three hundred forty-nine had a VCUG following a febrile UTI, and 72 had the test for evaluation of hydronephrosis. All received prophylactic antibiotics and were evaluated within 7-10 days following the VCUG. One hundred seventy-two children (41%) had an abnormal VCUG. Seven of 421 children (1.7%) had symptoms suggestive of UTI. Two had culture negative pyuria; one had Escherichia Coli UTI, and four had Pseudomonas aeruginosa UTI. On multivariate logistic regression analysis, the risk factors contributing to the development of UTI following VCUG were the presence of vesicoureteral reflux (VUR) and its severity (odds ratio [OR] 2.52; 95% confidence interval [CI] 2.24, 2.83, p =0.001; and OR 2.32; 95% CI 2.05,2.62, p =0.04, respectively). The incidence of VCUG-induced UTI in children receiving prophylactic antibiotic therapy is low. There is a relatively high rate of Pseudomonas UTI, especially in children with moderate to severe reflux. We recommend that children with symptoms suggesting a UTI following a VCUG should be treated for Pseudomonas aeruginosa pending culture results.

Objective.To assess the frequency of urinary tract anomalies in male neonates Design.During a period of 4.5 years, from July 1994 through December 1998, 45 male neonates A dimercaptosuccinic acid (DMSA) scan was recommended to all patients but was performed only in 30 of 45, most of them with an abnormal VCUG. The renal scan was performed at least 4 months after the UTI.Results.Urinary tract abnormalities were observed in 22 of 45 male neonates. Nineteen had vesicoureteral reflux (VUR), 1 had VUR and a double collecting system, 1 had VUR and a posterior urethral valve, and 1 had an ureteropelvic junction stricture. Renal atrophy or scars, as demonstrated by DMSA scan, were detected almost exclusively in neonates with VUR grade 3 and above. Only 1 neonate with VUR grade 1 had a pathologic DMSA, and the US of this male also demonstrated renal atrophy. Escherichia coli was the pathogen in 62% (28 of 45), and 9 boys had bacteremia.Conclusion.We suggest that US and VCUG should be performed routinely after the initial UTI in male neonates. Renal scan should be reserved for those cases in which the US suggests renal parenchymal damage or when VCUG detects VUR grade 3 and above.

Background. In previous studies, the oral calcium loading and deprivation test has been used to distinguish between children with renal (fasting) hypercalciuria (RH) and absorptive hypercalciuria (AH). Objective. We evaluated the long-term clinical course of 30 children with idiopathic hypercalciuria and investigated the influence of urinary sodium excretion, as a reflection of its intake, on urinary calcium excretion. Methods. Thirty normocalcemic, normophosphatemic children (21 boys and 9 girls) with urinary calcium to creatinine ratios greater than 0.57 mmol/L/ mmol/L (> 0.21 mg/dL/mg/dL) on three consecutive examinations participated in this study. They were divided according to their responses to calcium deprivation and loading into AH (16 patients) and RH (14 patients). Results. When restudied 3 to 7 years later, 6 of the 16 children with AH were normocalciuric and three demonstrated characteristics compatible with RH. The remaining seven patients maintained their initial AH pattern. Of the 14 children with RH, four were normocalciuric and four demonstrated AH. The remaining six children maintained their initial RH pattern. A significant positive correlation was observed between urine sodium and calcium excretion in children with AH or RH. Children who were normocalciuric at the second study had significantly lower values of urine sodium excretion when compared with those in whom hypercalciuria persisted. Conclusions. We suggest that AH and RH constitute a continuum. The change in characteristics observed during the second study suggests that any attempt to divide these patients into two physiologically distinct subtypes may be artificial. The main factor influencing urinary excretion of calcium in our patients seemed to be sodium intake.

Hydrocephalus due to bilateral obstruction of the foramen of Munro in a 9-year-old girl was diagnosed 4 years after mumps meningoencephalitis, and is presented in this case report suggesting a possible association with late complication of mumps virus, providing further circumstantial evidence of the role mumps virus may play in the pathogenesis of hydrocephalus.

A controlled clinical study compared the antipyretic effectiveness of acetaminophen administered at regular 4h intervals (group 1, n = 53) versus sporadic usage contingent upon a body temperature above 37.9 degrees C (group 2, n = 51) in 104 children presenting with simple febrile convulsions. The incidence of febrile episodes or temperature values were similar in spite of significantly larger amounts of acetaminophen administered to patients in group 1. Four and 4 children in groups 1 and 2, respectively, had a second episode of febrile seizures, in all of them within the first 24h of admission. We conclude that the prophylactic administration of acetaminophen in children with febrile seizures is not effective in the prevention of fever, the reduction of its degree, or in preventing the early recurrence of febrile seizures.

We aimed to investigate, by means of dimercaptosuccinic acid (DMSA) scan, the relations between vesicoureteral reflux (VUR) and its degree, pyelonephritis during infancy, and renal parenchymal findings. Seventy-four infants with pyelonephritis, 44 girls and 30 boys (mean age at their first pyelonephritic episode 4.12 months, median 3 months), were enrolled in the study. Voiding cystourethrography (VCU) and ultrasonography (US) were performed within 6 weeks following the infection. DMSA was performed at least 4 months after the urinary tract infection (UTI). The renal parenchymal pathology was defined as focal or multifocal defects or as a split renal uptake of less than 45%. DMSA scintigraphy revealed that 19% (14/74) of the children had renal damage. Renal parenchymal findings were observed only when VUR was present, and its grade was above 3/5. No abnormality was found in 51 renal units without reflux, 9 with VUR grade 1/5, and 54 with grade 2/5. Renal pathology was observed in 9/24 renal units with VUR grade 3, 3/8 with grade 4, and 2/2 with grade 5. No correlation was found between renal parenchymal defects and clinical presentation of the pyelonephritis, type of the microorganism, presence of bacteremia, or the number of recurrent infections. In adequately treated infants, renal damage is probably due to a reflux-associated, preexisting, congenital renal parenchymal pathology and not to the inflammatory process. We suggest that DMSA scintigraphy should not be performed routinely in every infant with UTI and should be reserved primarily for children with VUR grade 3 and above.

AIM—To investigate sodium (NA+) potassium (K+) adenosine triphosphatase (ATPase) activity in newborn infants at different gestational ages, to elucidate the mechanism underlying poor renal sodium conservation in preterm infants. METHODS—Fifty three healthy newborn infants, gestational age 30-42 weeks, were studied. Umbilical cord red blood cell Na+ K+ATPase activity, plasma renin activity, and plasma aldosterone activities were measured in all of them. Red blood cell Na+ K+ATPase activity was re-examined in eight preterm infants, one and two weeks after birth. Total and ouabain sensitive ATPase activity was measured spectrophotometrically using a method that couples ATP hydrolysis with NADH oxidation. RESULTS—Red blood cell Na+ K+ATPase activity was significantly lower (p

Circumcision seems to reduce the overall incidence of urinary tract infections (UTI), although a few studies have suggested that ritual circumcision may be a predisposing factor for UTI within the first 2 weeks following the procedure. The aim of this study was to investigate a possible causal relationship between ritual circumcision and UTI. The study comprised 82 infants with UTI, 55 females and 27 males under the age of 1 year. All males were circumcised on the eighth day of life. The median age of infection was 0.75 and 7.0 months for males and females, respectively. Fifty-two percent (14/27) of UTI episodes were diagnosed within the 2 weeks following circumcision. A significantly lower incidence in Escherichia coli-induced UTI was observed in males compared to females, 67% and 93%, respectively. Similarly, the incidence of E. coli-induced UTI was also significantly lower in males presenting within 2 weeks following circumcision (57%) compared to infants presenting prior or more than 2 weeks following the procedure (92%). Positive blood cultures of an identical microorganism were observed in 6/27 males compared to 2/55 females. The incidence of urinary tract malformations and their severity were similar in both sexes. We conclude that the high incidence of UTI following a ritual Jewish circumcision, as well as the relatively high preponderance of bacteria other than E. coli, may suggest a causal relationship between circumcision and UTI.

Screening of children and adolescents for hyperlipidemia is controversial. We performed a cholesterol surveillance study of 806 children aged between 6 and 14 years. The initial cholesterol screening test was done by finger stick in the non-fasting state. Children with cholesterol values exceeding 4.55 mmol/l ("borderline" risk) and their parents had their lipid profiles measured following a 12 h fast by venipuncture. The incidence of coronary risk factors in the families of children with hypercholesterolemia was estimated. Of the initial group, 71 children had total capillary cholesterol levelsor = 4.55 mmol/l, and in 65 of these children serum lipid profile was reexamined after an overnight fast. Fifty-five children were found to have total venous cholesterol (TVC) levels4.55 mmol/l, and 27 of the 55 had a low density lipoprotein (LDL) cholesterol level3.4 mmol/l ("borderline" risk). A positive correlation was found between TVC and LDL-cholesterol levels. Of the hypercholesterolemic children 49% had a parent with hyperlipidemia and 13% had a family history of premature myocardial infarction (before 55 years of age). We conclude that screening of children based on the presence of hypercholesterolemia or its possible complications in other family members may fail to identify many of the children with hypercholesterolemia. Thus, if thorough identification of young children with hypercholesterolemia is desired, inclusive population screening would be the most effective approach.

A pair of non-identical twins with severe pseudohypoaldosteronism (PHA) were followed over a period of 4 years. The diagnosis was based on dehydration, hyponatremia, hyperkalemia, high urine sodium/potassium ratios, and high serum concentrations of aldosterone and renin. Sweat and saliva electrolyte concentrations were high, suggesting multifocal target-organ unresponsiveness to mineralocorticoids. No hydramnios was observed during pregnancy. Despite continuous treatment with sodium chloride and sodium bicarbonate (or = 20 g/day) and cation exchange resin (Kayexalate, sodium polystyrene sulfonate,or = 4 g/kg per day), the children had repeated episodes of dehydration, hyponatremia, and hyperkalemia. Growth velocity was normal in both twins. Catch-up growth was observed following infancy in the first twin. Normalization of plasma aldosterone, electrolytes, and renin concentrations was achieved at the age of 9 months.

L'abces primitif du psoas est une maladie relativement rare avec toutefois une incidence plus elevee chez l'enfant et l'adolescent. La symptomatologie clinique habituelle comporte: la temperature, des douleurs abdominales et une claudication. La claudication a tendance a faire incriminer un probleme musculo-squelettique en dessous du pelvis mais en fait les mouvements de la hanche interessent le psoas qui est en grande partie retroperitoneal et en relation intime avec les organes intraperitoneaux. Quoique la tendance actuelle est d'utiliser l'echographie abdominale, l'examen par toucher rectal est certainement aussi une etape valable dans le bilan clinique et peut aider beaucoup a preciser l'existence d'une masse ou d'un abces pelvien

A 16-year-old girl, presenting initially with pericarditis and life threatening pericardial tamponade, developed clinical episodes characteristic of FMF few months later. This case report and several others reported previously, suggest that FMF should be considered in patients from certain ethnic groups presenting with pericardial effusion.

Sydenham chorea, a major manifestation of acute rheumatic fever, has been the most common form of acquired chorea during childhood. Despite the recent dramatic decline in both incidence and severity of rheumatic fever in our area, the frequency of carditis was unchanged. This study investigated retrospectively the incidence of chorea in the last three decades (1960–1990) in our area. During the 30 years of the survey, 28 patients with Sydenham chorea were treated in our centre of whom 10 were seen between 1960–1970, 17 between 1970–1980, and only one patient between 1980–1990.

Two enteric bacterial pathogens were concomitantly isolated from the feces of 18 infants less than 6 months of age admitted to the Assaf Harofeh Medical Center over a 7-year period. In all but two patients stool cultures grew enteropathogenic Escherichia coli, six of serogroup 0119. The other organisms cultured were Shigella, Salmonella, Campylobacter jejuni and Aeromonas hydrophila. The usual clinical presentation was diarrhea, dehydration and vomiting of acute onset, and low grade fever. Patients with gastroenteritis due to a single agent compared with multiple pathogens had a milder course of disease, a milder degree of dehydration and acidosis, a lesser need for i.v. fluid treatment and shorter hospitalization.

The aim of this study was to determine whether using air enema for acute intussusception is related to a higher rate of recurrence than other methods of treatment. A 10-y (1986-95) retrospective study was performed in a university-affiliated paediatric division. The overall recurrence rate for 97 patients with acute intussusception was 7.8% (10% of whom were treated non-surgically). There were no recurrences following the surgical treatment. In matched groups of patients, no risk factors were found for recurrence following air vs barium enema.

We describe an 8-year-old boy with fatal herpes simplex encephalitis in whom CT performed 2 days following the onset of symptoms apparently demonstrated an extensive infarct.

Idiopathic hypercalciuria: A familial generalized renal hyperexcretory state. Twenty-two children with idiopathic hypercalciuria (IH) as well as their parents and siblings were compared to 29 control children and their parents and siblings. Urinary calcium excretion following calcium deprivation or calcium loading was significantly higher in parents and siblings of the IH children than in the corresponding controls. Significantly higher rates of glomerular filtration and increased urinary excretion of sodium potassium and phosphate were found in all family members in the IH group as compared to controls. Significant positive correlations of the five variables studied (glomerular filtration and urinary excretion of calcium, phosphate, sodium, and potassium) were noted within individuals and also within families, both in the IH and the control groups, notwithstanding the lower mean levels in the latter. Serum concentrations of calcium, phosphate, potassium, and sodium were similar in the IH and controls. The distributions of all urinary variables in both the IH and control groups were unimodal with considerable overlap of the two groups, suggesting that IH may be a single entity, possibly representing the upper end of normality. Our data seem to indicate that IH is more likely to be due to nutritional than to genetic factors, since maintenance of sodium potassium homeostatis in the face of increased excretion necessitates increased ingestion of these electrolytes, while increased sodium ingestion is known to be associated with increased urinary excretion of calcium, potassium, and phosphate. Hypercalciurie idiopathique: Un etat d'hyperexcretion renale generalisee familiale. Vingt-deux enfants avec une hypercalciurie idiopathique (IH) ainsi que leurs parents et fratrie ont ete compares a 29 enfants controles et leurs parents et fratrie. L'excretion urinaire de calcium apres restriction calcique ou charge calcique etait significativement plus elevee chez les parents et la fratrie des enfants IH que chez les controles correspondants. Des debits de filtration glomerulaire significativement plus eleves, et des elevations de l'excretion urinaire de sodium, de potassium, et de phosphate ont ete trouves chez tous les membres des familles du groupe IH par rapport au controle. Des correlations positives significatives des cinq variables etudiees (filtration glomerulaire et excretion urinaire de calcium, phosphate, sodium, et potassium) ont ete notees chez les individus, et aussi dans les familles chez les groupes IH et controle, malgre des concentrations moyennes plus faibles chez le dernier. Les concentrations seriques de calcium, phosphate, potassium, et sodium etaient identiques chez les IH et les controles. Les distributions de toutes les variables urinaires chez les groupes IH et controles etaient unimodales, avec un chevauchement considerable entre les deux groupes, suggerant que l'IH pourrait etre une entite unique, representant peut-etre la partie superieure de la normale. Nos donnees semblent indiquer que l'IH est probablement due a des facteurs plus nutritionnels que genetiques, puisque le maintien de l'homeostasie du sodium et du potassium en presence d'une augmentation de l'excretion necessite l'augmentation de l'ingestion de ces electrolytes, tandis que l'augmentation accrue de sodium est connue pour etre associee avec l'augmentation de l'excretion urinaire de calcium, de potassium, et de phosphate.

Previous data have suggested an age-related increase in renal clearance of gentamicin. This phenomenon could be the result of an increase in glomerular filtration rate (GFR) and/or of an augmentation in its transtubular influx. To investigate this question, four groups of rats, 2, 4, 6 and 8 weeks old, were sacrificed. 125I-labeled gentamicin uptake was measured in renal cortical slices as the cpm/mg wet tissue slice/medium (S/M) ratio. There was a significant age-related increment in gentamicin uptake. S/M ratios at 2, 4, 6 and 8 weeks were 3.49 +/- 0.46 (n = 7), 3.52 +/- 0.37 (n = 10), 4.23 +/- 0.42 (n = 10), 4.81 +/- 0.45 (n = 17), respectively (mean +/- SD; r = 0.78; p less than 0.01). Intraperitoneal injections of gentamicin were administered to another group of rats for 10 consecutive days from age 2 weeks and more. Gentamicin uptake of their renal cortical slices at 6 weeks of age was similar to that observed in the parallel age group of the nonstimulated rats (S/M ratio 4.18 +/- 0.41).

Hypospadias in a congenital anomaly which in most cases has to be corrected surgically. We include micturition cystourethrography (MCU) in the preoperative workup of all these children as well as three months postoperatively. Meatal stenosis and müllerian duct remnants are known to occur in this condition, but vesicoureteral reflux (VUR) was an unexpected finding in many boys who were asymptomatic and had no evidence of urinary tract infection. Fifty-eight of 305 hypospadiacs, examined by MCU, proved to have reflux, most of them grade II. In 37, VUR was found before surgery and in the remaining 21 after surgical correction, many of them with meatal stenosis. In 10 patients reflux appeared in the postoperative period where there had been none in the preoperative study; 8 of the 10 had a postoperative stricture of the distal urethra, and VUR subsided in 4 after adequate dilatation. We conclude that vesicoureteral reflux is not uncommonly found in patients with hypospadias, even in those who are completely asymptomatic. We believe this is an additional incentive to include an MCU in the pre- and postoperative evaluation of patients with this anomaly.

One hundred and thirty four ambulatory children with bronchial asthma were investigated in the Pediatric Pulmonary-Allergic Service. In 95 patients an interval characterised by prodromal respiratory symptoms (cough, rhinorrhoea, and wheezing), behavioural changes (irritability, apathy, anxiety, and sleep disorders), gastrointestinal symptoms (abdominal pain and anorexia), fever, itching, skin eruptions, and toothache preceded the onset of the attack of asthma. Each child had his own constant set of prodromal findings. A significant age related increase in serum IgE concentrations was observed in these patients. No such relation was observed in children with an acute onset of attack of asthma without any preceding symptoms. We suggest that awareness of these prodromal symptoms may lead to an early introduction of treatment, thus avoiding or abbreviating some of the acute attacks of asthma.

Renal effects of the administration of contrast media during cardiac catheterisation were compared in two groups of patients with congenital heart diseases. Group A consisted of 21 patients with cardiac malformations, characterised primarily by left ventricular volume overload and known to be associated occasionally with left heart failure, such as: left to right shunts and left ventricular valvular defects. Group B consisted of 23 patients with lesions affecting the right ventricle which are rarely associated with left heart failure, such as: Tetralogy of Fallot and Pulmonic stenosis. Patients in Group A showed a significant increment in both plasma creatinine and uric acid levels in the 24 h following heart catheterisation. This observation was significantly more prominent in the older age group (above the age of 5 years). In Group B no changes in these parameters were encountered. Plasma renin activity and fractional sodium excretion increased and decreased respectively, by a similar degree in both groups in the 24 h following contrast media administration. No difference in renal tubular handling of uric acid was observed between both groups, nor did any of the patients studied demonstrate any degree of proteinuria or abnormality in the urine sediment, prior to or following heart catheterisation. We suggest that chronic pre-existing left ventricular overload should be considered a risk factor among the other known risk factors which promote the incidence of acute renal failure after contrast media administration.(ABSTRACT TRUNCATED AT 250 WORDS)

The mean serum aldosterone concentration of 37 infants with acute gastroenteritis and dehydration was markedly elevated on admission (mean +/- SE 94.3 +/- 12.1 ng/ml) and approximated to normal values (18.2 +/- 3.7 ng/ml) following recovery from the acute disease (t=3.56 p less than 0.005). Serum aldosterone levels were significantly positively correlated with the percent weight loss (r=0.41, p less than 0.05) and with the blood urea nitrogen levels (r=0.55, p less than 0.001). There was no correlation between either serum sodium levels or blood osmolarity and aldosterone concentrations. Serum potassium levels were positively correlated with aldosterone levels (r=0.53, p less than 0.001). These findings indicate that small infants when dehydrated respond appropriately with elevated aldosterone levels. The amount of body fluid depletion and hyperkalemia are the major factors determining the amount of aldosterone response.

A 4½-year-old boy with macrocephaly, pseudopapilledema, lipoangiomatosis, macropenia, and spotted pigmentations of the glans is reported. Lipoid masses were found in the subcutaneous tissue, tonsils, and probably the left lung. Some of these findings are consistent with features already reported by Riley and Smith, later by Bannayan, and recently by Ruvalcaba et al. We propose to unify the features of this syndrome and name it macrocephaly, mamartomas, and papilledema syndrome. The inheritance in our described case seems to be autosomal dominant.

A significant reduction in the urinary calcium-creatinine ratio, was found in thirty-four ambulatory epileptic children on long term anticonvulsant therapy, studied during wintertime. No significant difference in the urinary excretion of cyclic AMP, phosphate or amino-acids was observed when the study-group was compared to an age-matched control group. Serum calcium and phosphate values were normal, but a significant increment in alkaline phosphatase was noted. Since there was no evidence of hyperactivity of the parathormone, it is suggested that the enhanced renal tubular calcium reabsorption in children on long term anticonvulsant therapy is a nonparathormone mediated phenomenon, possibly compensating for reduced calcium absorption in the gastrointestinal tract.

KN: Zinc in total parenteral nutrition: Requirements and metabolic effects, Gastroenterology 76:458, 1979. 6. McClain CJ, Soutor C, and Zieve L: Zinc deficiency: A complication of Crohn's disease, Gastroenterology 78:272, 1980. 7. McClain CJ, Van Thiel DH, Parker S, Badzin LK, and Gilbert H: Alterations in zinc, vitamin A and retinolbinding protein in chronic alcoholics: A possible mechanism for night blindness and hypogonadism, Alcoholism Clin Exp Res 3:135, 1979. 8. O'Leary M J, McClain CJ, and Hegarty PVJ: Effect of zinc deficiency on the weight, cellularity, and zinc concentration of different skeletal muscles in the post-weaning rat, Br J Nutr 42:487, 1979. 9. Wilson ID, McClain CJ, and Erlandsen SL: Ileal paneth cells and IgA system in rats With severe zinc deficiency: An immunohistochemical and morphology study, Histochem J (in press). 10. Shenkin A, and Wretlind A: Parenteral nutrition, World Rev Nutr Diet, 1976. 11. Widdowson EM: Trace elements in human development, in Barltrop D, and Burland WL, editors: Mineral metabolism in pediatrics, Oxford, 1969, Blackwell Scientific Publications, p 85. 12. Halsted JA, Ronaghy HA, Abadi P, Haghshenass M, Amirhakemi GH, Barakat RM, and Reinhold JG: Zinc deficiency in man, Am J Med 53:117, 1972. 13. Hsu JM, Anthony WL, and Buchanan PJ: Zinc deficiency and incorporation of 14C-labelled methionine into tissue proteins in rats, J Nutr 99:425, 1969. 14. Walravens PA, and Hambidge KM: Growth of infants fed a zinc supplemented formula, Am J Clin Nutr 29:1114, 1976.

Sixty-eight children (ages ranging from 5 months to 16 years) with urolithiasis were treated between 1966 and 1979. There were 36 females (53%) and 32 males (47%). Sixteen children (24%) had associated urinary tract infection; 4 out of these (6%) presented with urinary tract malformation. Fifty-five calculi (89%) were found in the upper urinary tract (kidney and ureter); 24 of the chemically studied calculi (80%) were made of calcium salts. In 30 children, metabolic investigations were carried out, leading to the discovery of hypercalciuria in 17 (57%). In one patient, important vesico-ureteral reflux associated with urolithiasis led to renal failure.

A two-year-old boy of Arabic extraction presented with progressive jaundice and prolonged pyrexia. Both IgM and IgG immunofluorescent antibody titers for Q fever were 1:1280. Two goats and one cow of the domestic animals owned by the family also had positive antibody titers against Q fever. In spite of antibiotic treatment with tetracyclines and chloramphenicol, the hepatic involvement progressed gradually. On the twentieth day of admission the child succumbed from hepatic failure. This child presents a rare case of fatal hepatic failure due to Q fever.

During an epidemic of poststreptococcal acute glomerulonephritis (PSAGN) in Israel during the second half of 1968, 155 children were hospitalized. All of them were initially followed up for 6 mo to 2 yr, during which period no evidence of continuing kidney damage was found. Fifty-five of the group were hospitalized over the next 2 to 10 yr for reasons unrelated to their original illness, at which time they also were found to be free of renal damage. Eighty children were examined 11 to 12 yr after the epidemic, and in them, too, urine examination, blood chemistry and blood pressure were within normal limits. It seems reasonable to conclude that the PSAGN of the 1968 epidemic was a benign disease with no lasting ill effects. Since most of the cases were associated with an M-55 skin Streptococcus and pyoderma, we suggest that glomerulonephritis due to pyoderma associated with this strain does not give rise to chronic renal disease.

One hundred and ninety-three children with bacillary dysentery were admitted to the "Assaf Harofeh Hospital" during the years 1975-1980. Generalized convulsions were observed in 37 (19.2%) children. The incidence of seizures was significantly higher in children whose age ranged between 1 and 6 years when compared to those below or above this age range. Convulsions were not observed when fever was below 38 degrees C, however, higher fever was not associated with a parallel increase in their incidence. Temperature above 38 degrees C was less common in infants compared to older children. These findings suggest that convulsions in shigellosis do not differ from simple febrile convulsions in respect to age, sex, presence and degree of fever. The incidence of resistance to either ampicillin or trimethoprim-sulfamethoxazole was similar in all the various shigella strains isolated in our population.

The urinary calcium/creatinine ratio, during a low-calcium diet and after an oral calcium load, was determined in 128 members of 29 families. No differences were observed between subjects of different sexes, ages and ethnic origins. Our data allow characterization of hypercalciuria in Israeli patients with urolithiasis.

Augmentation du taux d'insuline dans le sang du cordon chez les prematures atteints de detresse respiratoire par rapport aux temoins

The effect of digitalis and diuretic therapy on sweat fluid composition was investigated. Patients treated for congestive heart failure with a combination of digoxin and diuretics demonstrated a higher concentration of sodium and chloride in their sweat fluid when compared to age-matched controls. The administration of diuretics alone did not affect sweat fluid composition. The digoxin-induced increase in sodium concentration was significantly higher than that observed for chloride. These data suggest that digoxin markedly inhibits sodium reabsorption along the sweat gland tubule, whereas chloride transport is affected to a lesser degree. A significant correlation between sweat fluid sodium and serum digoxin concentrations was observed. We conclude that the increased digoxin-induced sweat sodium and chloride losses may affect sodium homeostasis in patients with congestive heart failure.

Four newborn babies developed acute heart failure a few hours after circumcision at 8 days. During this procedure, a sponge soaked in epinephrine was applied to the circumcision site and left there for several hours. Treatment was with digoxin and diuretics and signs of heart failure disappeared within 24-72 hours.

Serum creatine kinase (CK) was determined in 52 children admitted following an episode of febrile convulsions. Enzyme levels correlated with the estimated duration of the seizure. Twenty-four hour values were significantly higher than those observed 1 hour after the convulsive episode. Serum CK levels are frequently used for diagnostic purposes, so the questionable validity of this test when drawn after a convulsive episode must be considered.

A 6-year and 8-month-old boy on chronic intermittent peritoneal dialysis for end stage kidney disease presented with severe diarrhea, abdominal distension, cramps, tenesmus and vomiting. Barium enema showed rigidity and irregularity of the mucosa of the sigmoid and distal descending colon, with ‘thumb print like’ appearance, findings compatible with ischemic colitis. The institution of hemodialysis and discontinuation of the peritoneal dialysis resulted in a marked clinical and radiological improvement. Kidney transplantation performed a month later was associated with a complete cure of his intestinal disease.

Five cases of partial or complete agenesis of the sacrum (also called the caudal regression syndrome) diagnosed at the Chaim Sheba Medical :Center are reported. Neurological dysfunction of the bladder was present in all. Two patients were diagnosed at the ages of four months and three years, and had dilated collecting systems and neurological deficits of the upper motor neuron type. In three of the patients, the malformation was recognized later, at the ages of 7 1/2, 11 and 22 years. All three had a normal urinary tract, on examination by intravenous urography, and neurological deficits of the lower motor neuron type. Although no overt reduction of renal function was noted in those of our patients in whom diagnosis was delayed, it appears that early diagnosis and treatment of the neurogenic bladder associated with the caudal regression syndrome may reduce both morbidity and discomfort.

The response of desamino-D-arginine vasopressin (DDAVP) was investigated in 32 enuretic children in a double-blind clinical study. The 15 children treated with DDAVP showed a significant reduction in the incidence of bed wetting--from 18.7 +/- 6.5 to 6.5 +/- 9.2 wet nights per 30 days. In 6 children bed wetting stopped entirely, in 6 there was a satisfactory response, and in 3 the response was marginal or there was none. When DDAVP was stopped most children reverted to their earlier bedwetting habits (15.7 +/- 8.9 nights a month). Response to DDAVP was significantly better in children aged more than 10 years (mean age for the entire group). The administration of DDAVP was not associated with any appreciable change in morning urine osmolalities. No adverse effects were noted. It is concluded that DDAVP is effective in nocturnal enuresis, particularly in older children. It is suggested that the cessation of bed wetting may, in part, reflect functional properties of DDAVP rather than antidiuresis.