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Gonorrhea in Prepubertal Children
PEDIATRIC UROLOGY
K. B.
WAITES, M. B. BROWN, S. STAGNO, J. SCHACHTER, S. GREENBERG, G. P. HEMSTREET AND G. H. CASSELL, De-
partments of Microbiology, Biology, Surgery and Pediatrics, University of Alabama at Birmingham, University Station, Birmingham, Alabama, Department of Epidemiology, University of California at San Francisco, San Francisco, California and Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi Pediatrics, 71: 250-252 (Feb.) 1983 The authors report on a 10-year-old girl with a 1-year history of dysuria, frequency, occasional incontinence and nocturnal enuresis, who was referred after having negative urine cultures, excretory urography, cystoscopy and failure to respond to a variety of antibiotics. A repeat full evaluation was negative except for severe erythema and induration of the vaginal vault, with an exudative vaginitis noted at examination under anesthesia. Mycoplasma hominis and Ureaplasma urealyticum were present in high numbers in cultures of the vagina, cervix and urethra. Urine culture was negative. It subsequently was discovered that the child had been sexually molested by a 70-yearold male neighbor shortly before the initial onset of symptoms. She was treated with oral tetracycline with complete resolution of the symptoms and physical findings. This case illustrates the advisability of considering mycoplasma infection in the child with persistent lower urinary tract symptoms but no obvious bacterial pathogen. If mycoplasma infection is found a careful sexual history should be obtained. H. McC. S. 12 references
Editorial comment. The authors describe a 10-year-old girl whose urinary symptoms of dysuria, frequency, and day and night wetting were not resolved after a normal routine urologic investigation. The authors emphasized that internal examination of the introitus disclosed an exudative inflammatory process. On culture the exudate demonstrated ureaplasma and mycoplasma. When lower urinary tract symptoms persist despite routine care consideration should be given to mycoplasma as a causative agent. M. M.
Gonorrhea in Prepubertal Children
s. R. DEITCH, D. L.
CHADWICK, T. COLEMAN, D. O'HARE, B. SOKOLOFF, G. G. STERNE, V. WAGNER, M. SGROI, E. SCHWARTZ, H. FELITTO AND K. GRUNDFAST, Committee on
s.
Early Childhood, Adoption, and Dependent Care
1257
also reported that "Chassas Moir gave a personal account of a case to Patterson (1961) of a woman with a deep ring about the abdomen, but no records are available". Of the 4 documented cases published to date some points might be stressed. There were 2 male and 2 female patients. Two patients were white, 1 was Filipino and 1 was black. There were low abdominal ring constrictions just above the pubis in 2 patients and higher bands below the umbilicus in 2. However, the histologic structure of all bands seemed identical as well as their orientation, being higher posteriorly as mentioned by Schneider, following a specific somite. Two patients presented with other congenital anomalies: bands around 2 toes and a clubfoot in 1, and a pilonidal sinus with a cleft of the soft palate in 1. One patient's mother had a shallow band around the base of 1 toe. The other patient had an identical twin with no congenital defects. Of the 4 patients 3 underwent Z-plasty at young ages to expand the constrictive band and not to alter the growth of the pelvis. One of these operated patients had an uneventful pregnancy and gave birth to a son without any congenital anomaly. Finally, no mention is made about abnormalities of the amnion or placenta in all 4 cases. The author's patient, who appears to represent the fifth case of congenital band about the pelvis in the medical literature, has shown some points in common with the 4 previous cases plus some new interesting features about this pathological condition. A case of congenital ring constriction about the pelvis is reported in a 28-year-old pregnant woman. The pregnancy evolved uneventfully and the patient gave birth to a perfectly normal son. The 4 previously published cases are reviewed in search of potential etiologic factors. Author's abstract 3 figures, 1 table, 9 references
Editorial comment. The author describes a band encircling the pelvis with a segmental distribution. The etiology of such bands is controversial but one likely possibility is that they are a manifestation of congenital deformation by the amniotic sac. M.M.
A New Simplified Technique for Pediatric Anorectal Manometry
A. J. ROSENBERG AND A. R. VELA, Departments of Pediatrics and Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana
Pediatrics, 71: 553 (Apr.) 1983
Pediatrics, 71: 240-245 (Feb.) 1983
Physicians should assume that children with gonorrhea have acquired it by sexual contact and most such contacts are abusive. The diagnosis of gonorrhea in a prepubertal child will dictate reports to protective agencies and the public health department. It should not be assumed that the agencies will communicate with each other. P.R.R.
In 86 children with constipation and fecal incontinence the authors have performed anorectal manometry using rectal distension (5 cm. above mucocutaneous margin) with a balloon made from a rubber glove and sized appropriately for the child, and a pressure microtransducer placed in the high pressure zone of the internal anal sphincter. The rectal balloon was distended by a syringe until the resistance of pressure against the rectal wall was felt. The pressure transducer recorded the response of the internal sphincter. The normal response is relaxation and a pressure decrease. In patients with aganglionic megacolon (Hirschsprung's disease) there is no pressure drop. Of the 86 patients studied 17 were diagnosed to have Hirschsprung's disease, which was confirmed by rectal biopsy. There were no false positive or false negative studies. The technical details that the authors believe are important in
Congenital Band About the Pelvis J.-N. CASAUBON, Division of Plastic Surgery at St. Joseph and Ste-Marie Hospitals, Trois-Rivieres, Quebec, Canada
Plast. Reconstr. Surg., 71: 120-122 (Jan.) 1983 Congenital bands about the pelvis are rare, with only 4 such cases documented in the medical literature. However, Evans
K. B.
WAITES, M. B. BROWN, S. STAGNO, J. SCHACHTER, S. GREENBERG, G. P. HEMSTREET AND G. H. CASSELL, De-
partments of Microbiology, Biology, Surgery and Pediatrics, University of Alabama at Birmingham, University Station, Birmingham, Alabama, Department of Epidemiology, University of California at San Francisco, San Francisco, California and Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi Pediatrics, 71: 250-252 (Feb.) 1983 The authors report on a 10-year-old girl with a 1-year history of dysuria, frequency, occasional incontinence and nocturnal enuresis, who was referred after having negative urine cultures, excretory urography, cystoscopy and failure to respond to a variety of antibiotics. A repeat full evaluation was negative except for severe erythema and induration of the vaginal vault, with an exudative vaginitis noted at examination under anesthesia. Mycoplasma hominis and Ureaplasma urealyticum were present in high numbers in cultures of the vagina, cervix and urethra. Urine culture was negative. It subsequently was discovered that the child had been sexually molested by a 70-yearold male neighbor shortly before the initial onset of symptoms. She was treated with oral tetracycline with complete resolution of the symptoms and physical findings. This case illustrates the advisability of considering mycoplasma infection in the child with persistent lower urinary tract symptoms but no obvious bacterial pathogen. If mycoplasma infection is found a careful sexual history should be obtained. H. McC. S. 12 references
Editorial comment. The authors describe a 10-year-old girl whose urinary symptoms of dysuria, frequency, and day and night wetting were not resolved after a normal routine urologic investigation. The authors emphasized that internal examination of the introitus disclosed an exudative inflammatory process. On culture the exudate demonstrated ureaplasma and mycoplasma. When lower urinary tract symptoms persist despite routine care consideration should be given to mycoplasma as a causative agent. M. M.
Gonorrhea in Prepubertal Children
s. R. DEITCH, D. L.
CHADWICK, T. COLEMAN, D. O'HARE, B. SOKOLOFF, G. G. STERNE, V. WAGNER, M. SGROI, E. SCHWARTZ, H. FELITTO AND K. GRUNDFAST, Committee on
s.
Early Childhood, Adoption, and Dependent Care
1257
also reported that "Chassas Moir gave a personal account of a case to Patterson (1961) of a woman with a deep ring about the abdomen, but no records are available". Of the 4 documented cases published to date some points might be stressed. There were 2 male and 2 female patients. Two patients were white, 1 was Filipino and 1 was black. There were low abdominal ring constrictions just above the pubis in 2 patients and higher bands below the umbilicus in 2. However, the histologic structure of all bands seemed identical as well as their orientation, being higher posteriorly as mentioned by Schneider, following a specific somite. Two patients presented with other congenital anomalies: bands around 2 toes and a clubfoot in 1, and a pilonidal sinus with a cleft of the soft palate in 1. One patient's mother had a shallow band around the base of 1 toe. The other patient had an identical twin with no congenital defects. Of the 4 patients 3 underwent Z-plasty at young ages to expand the constrictive band and not to alter the growth of the pelvis. One of these operated patients had an uneventful pregnancy and gave birth to a son without any congenital anomaly. Finally, no mention is made about abnormalities of the amnion or placenta in all 4 cases. The author's patient, who appears to represent the fifth case of congenital band about the pelvis in the medical literature, has shown some points in common with the 4 previous cases plus some new interesting features about this pathological condition. A case of congenital ring constriction about the pelvis is reported in a 28-year-old pregnant woman. The pregnancy evolved uneventfully and the patient gave birth to a perfectly normal son. The 4 previously published cases are reviewed in search of potential etiologic factors. Author's abstract 3 figures, 1 table, 9 references
Editorial comment. The author describes a band encircling the pelvis with a segmental distribution. The etiology of such bands is controversial but one likely possibility is that they are a manifestation of congenital deformation by the amniotic sac. M.M.
A New Simplified Technique for Pediatric Anorectal Manometry
A. J. ROSENBERG AND A. R. VELA, Departments of Pediatrics and Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana
Pediatrics, 71: 553 (Apr.) 1983
Pediatrics, 71: 240-245 (Feb.) 1983
Physicians should assume that children with gonorrhea have acquired it by sexual contact and most such contacts are abusive. The diagnosis of gonorrhea in a prepubertal child will dictate reports to protective agencies and the public health department. It should not be assumed that the agencies will communicate with each other. P.R.R.
In 86 children with constipation and fecal incontinence the authors have performed anorectal manometry using rectal distension (5 cm. above mucocutaneous margin) with a balloon made from a rubber glove and sized appropriately for the child, and a pressure microtransducer placed in the high pressure zone of the internal anal sphincter. The rectal balloon was distended by a syringe until the resistance of pressure against the rectal wall was felt. The pressure transducer recorded the response of the internal sphincter. The normal response is relaxation and a pressure decrease. In patients with aganglionic megacolon (Hirschsprung's disease) there is no pressure drop. Of the 86 patients studied 17 were diagnosed to have Hirschsprung's disease, which was confirmed by rectal biopsy. There were no false positive or false negative studies. The technical details that the authors believe are important in
Congenital Band About the Pelvis J.-N. CASAUBON, Division of Plastic Surgery at St. Joseph and Ste-Marie Hospitals, Trois-Rivieres, Quebec, Canada
Plast. Reconstr. Surg., 71: 120-122 (Jan.) 1983 Congenital bands about the pelvis are rare, with only 4 such cases documented in the medical literature. However, Evans