American journal of diseases of children (1911)
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Temperatures were measured using an electronic thermometer in an emergency department to determine the relationship between oral or rectal and axillary measurements. A total of 164 data pairs were obtained--95 in afebrile children, and 69 in febrile children. The correlation coefficient was .74 for oral-axillary pairs, and .70 for rectal-axillary pairs. ⋯ The sensitivity was 46%; specificity, 99%; positive predictive value, 97%; and negative predictive value, 72% for combined oral-axillary and rectal-axillary data. It was concluded that axillary temperatures are not sensitive enough to determine a fever when measured with an electronic thermometer. Electronic thermometers should be used to determine oral or rectal temperatures; axillary temperatures may be misleading and should be abandoned in the outpatient setting.
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Coins are the most common esophageal foreign body in children. We prospectively evaluated 52 consecutive children who had swallowed coins to determine the incidence of asymptomatic esophageal coins and the rate of spontaneous passage. ⋯ The presence of symptoms was significantly associated with esophageal coins, but the absence of symptoms did not reliably exclude the possibility of an esophageal coin. All children who swallow coins should undergo roentgenographic evaluation.
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Few data are available on energy requirements of mechanically ventilated, critically ill children. We measured the resting energy expenditure in 18 mechanically ventilated patients between ages 2 and 18 years, using indirect calorimetry. All patients had fractional inspired oxygen concentration less than 0.6, no spontaneous respirations, hemodynamic stability, and no fever or active infection, and were receiving 5% dextrose. ⋯ In individual critically ill pediatric patients, energy requirements should be estimated by measuring their resting energy expenditure whenever possible and adding 5% for their activity. In the absence of the actual measurement of resting energy expenditure, the recommended energy requirement is 1.5 times basal energy expenditure. In this acute phase of injury, the daily nitrogen requirement is 250 mg per kilogram of body weight.
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During the past several years, we treated seven children with Kawasaki disease who developed a distinctive but rarely described perineal rash. This rash began three to four days from onset of the illness and desquamated in all instances by days 5 to 7. The presence of this rash may facilitate early diagnosis of Kawasaki disease and, hence, may influence the initiation of early treatment.
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Case Reports
Chlamydia trachomatis Fitz-Hugh-Curtis syndrome without salpingitis in female adolescents.
We encountered seven female adolescents with the Fitz-Hugh-Curtis syndrome and no signs or symptoms of salpingitis. Six of the patients had cervical cultures positive for Chlamydia trachomatis. The Fitz-Hugh-Curtis syndrome should be included in the differential diagnosis of right-sided abdominal pain in the sexually active female adolescent to avoid unnecessary diagnostic procedures and to reduce the prevalence of chlamydial infection and its complications.