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The purpose of this paper is to review three cultural concepts (acculturation, ethnic identity, bicultural self-efficacy) and their relationship to the known risk and protective factors associated with youth violence. We conducted a review of the relevant literature that addresses these three cultural concepts and the relationship among culture, violent behavior, and associated cognition. The available literature suggests that ethnic identity and bicultural self-efficacy can be best thought of as protective factors, whereas acculturation can be a potential risk factor for youth violence. We examine the connection between these cultural concepts and the risk and protective factors described in the 2001 Surgeon General's Report on Youth Violence, and present a summary table with cultural risk and protective factors for violence prevention. These concepts can assist physicians in identifying risk and protective factors for youth violence when working with multicultural adolescents and their families. Physicians are more effective at providing appropriate referrals if they are aware that navigating among different cultures influences adolescent behavior.

In Reply.— We read with interest the comments made by Drs Weinberg et al concerning our management of the infant reported in Pediatrics.1 We agree with their conclusion that arterial catheters in critically ill neonates are potentially dangerous and should be monitored closely. We disagree with Dr Weinberg's contention that thrombolytic therapy was not indicated in this case. Our patient demonstrated deteriorating renal function due to the thrombus. In view of progression of renal failure on hepanin therapy, thrombolytic therapy was clearly appropriate in this case.

CASE REPORT The patient was a 2800-g black girl delivered by primary cesarean section because of fetal distress and meconium aspiration after 42 weeks' gestation. Her mother's pregnancy had been complicated by cocaine use. The baby's Apgar score was 5 at 1 minute and 7 at 5 minutes. Maternal and neonatal urine toxicology screens were positive for cocaine, and the infant was treated with phenobarbital because of withdrawal symptoms. She was transferred to Children's Hospital and Health Center for treatment of CO2 retention and probable meconium aspiration syndrome. She was mechanically ventilated, and an umbilical artery catheter was inserted. The infant improved and was extubated after 4 days; the umbilical catheter was removed on day 8 of life. She did well until 11 days of life when she became tachypneic and acidotic with a systemic blood pressure of 130/106 mm Hg.

In Reply.— As we mentioned in the discussion section of our paper,1 parathyroidectomy may have been deleterious to this patient. The experience of Hodsman et al2 with the inappropriateness of parathyroidectomy in nondialyzed uremic patients with osteomalacia could not be applied to our patient because that literature was not in print at the time our patient was treated. Evidence for toxicity of aluminum has, until recently, been controversial. The literature of the past year clearly shows that aluminum can be toxic to bone.

Seven children with nephrotic syndrome resistant to 8 weeks of oral prednisone at a doses of 2 mg/kg/day and biopsyproven FGS were treated with intravenous MP (30 mg/kg/dose) and alternate day prednisone. MP was given three times a week for two weeks and then at increasing intervals. All seven patients had a marked decrease in edema and urinary protein excretion and an increase in serum albumin concentration. Three patients were treated with an alkylating agent in addition to the high dose MP to produce a sustained remission. The clinical remissions lasted from one to twenty months. Six out of seven patients are in remission and edema free after a mean of 10.5 months on therapy. One patient developed a cataract shortly after being started on MP and immediately after a prolonged course of high-dose daily prednisone. Another patient developed hypertension early in the course of MP therapy which resolved as the interval between MP infusions was increased. No other adverse reactions were observed. It would appear that intravenous MP in high doses causes a significant improvement in the short-term morbidity of FGS. The long-term effects of this treatment remain to be determined.