Disseminated Bipolaris spicifera in a neonate.

We report a premature infant with disseminated fungal infection identified as Bipolaris spicifera. The infant was born at 23 4/7 weeks' gestation, weighing 780 g. At day of life (DOL) 7 erythematous areas on the back were noticed that progressed to black, necrotic skin lesions. A shave biopsy showed invasive fungal organisms that were identified by culture as B. spicifera. The lesions progressed despite aggressive surgical debridement and antifungal therapy. On autopsy, fungal organisms found throughout the internal organs confirmed disseminated disease with B. spicifera. This organism is now more often recognized as a human pathogen; however, this is the first reported case in a neonate.

Combination chemotherapy using vinblastine and methotrexate for the treatment of progressive desmoid tumor in children.

PURPOSE: We report the treatment of 10 children for progressive desmoid tumor not amenable to standard surgical or radiation therapy with the use of vinblastine (VBL) and methotrexate (MTX). PATIENTS AND METHODS: Ten patients aged 6.4 to 18 years with primary (two patients) or recurrent (eight patients) desmoid tumor were treated with VBL and MTX for 2 to 35 months. Patients with recurrent tumors had been previously treated with surgical resection with (two patients) or without (five patients) radiation therapy or with radiation therapy alone (one patient). No patient had previously received cytotoxic chemotherapy. The tumor response was assessed at routine intervals by physical examination and magnetic resonance imaging (MRI). RESULTS: Five patients had clinical evidence of response to therapy with complete resolution (three patients) or partial resolution (two patients) of physical examination and radiographic abnormalities. Three patients had stable disease during 10 to 35 months of treatment. Two of these patients had progressive disease 9 and 37 months after treatment stopped; one patient had no progression 16 months after therapy. Two additional patients with stable disease had chemotherapy discontinued after 2 and 3 months. Common side effects included mild alopecia and myelosuppression and moderate nausea and vomiting. In patients with responding tumors, MRI showed decreased tumor size and, in two patients, changes consistent with fibrosis and decreased cellularity of the tumor. CONCLUSION: Combination chemotherapy with VBL and MTX appears to control desmoid tumor without significant acute or long-term morbidity in most children. This may allow for further growth and development in these patients, which may decrease the morbidity of subsequent definitive therapy.

Incidence of IDDM in children living in Puerto Rico. Puerto Rican IDDM Coalition.

OBJECTIVE: To determine incidence, geographic distribution, and seasonal variation of IDDM in children 0-14 years of age living in Puerto Rico. Because these data have been collected through the infrastructure of the World Health Organization's DiaMond project, these results are directly comparable with incidence data from other population worldwide involved in this study. RESEARCH DESIGN AND METHODS: Beginning in 1990, new cases of IDDM were registered retrospectively from 1985 and prospectively to 1994 by review of medical records from island hospitals. Included in the hospital registry are 1,527 cases of IDDM. Validation of the primary source was by three secondary lists of cases obtained through diabetic camps, surveys of schools, and a government registry. Long linear modeling (capture-recapture) was used to correct incidence. RESULTS: Mean incidence of IDDM from 1985-1994 was 18.0 cases/100,000 children per year (95% CI 17.6-18.3). There was a slight female rather than male predominance: 51% of the cases were girls, and 49% were boys. Although Puerto Rico has marked variation in rainfall, altitude, and genetic markers, no significant differences are found in the incidence rates of different areas or seasons of the island. CONCLUSIONS: This registry of Puerto Rican children is the largest IDDM registry of minority children in the U.S. The results of this study indicate that the annual incidence of IDDM of children living in Puerto Rico is higher than the incidence of other multiracial ethnic groups living in the U.S.

Relation of lead and social factors to IQ of low-SES children: a partial replication.

An independent replication of a previous study (Schroeder et al., 1985) of the effects of interactive social environmental factors on the relationship of lead and Stanford-Binet IQ was performed on 75 of 80 low-SES black children screened by county health departments in North Carolina. Children's mean blood lead (PbB) level was 20.8 micrograms/dl (range, 6.3 to 47.4). Multivariate regression analyses showed no significant interactions between PbB and age, sex, maternal IQ, Caldwell home environment score, or SES (Hollingshead Two-Factor Index). There was a highly significant negative relationship between both mean and maximum PbB levels with IQ, p less than .002; that is, IQ decreased linearly as PbB increased. The most accurate and precise regression model included lead, maternal IQ, home environment, and gender.

Separating the effects of lead and social factors on IQ.

Initial evaluations of 104 low-socioeconomic status black children screened by the local community health departments in North Carolina showed significant effects of lead in the range 6-59 micrograms/dl on IQ after controlling for concomitant social factors, such as socioeconomic status, home environment, and maternal IQ. The main concomitant variable was socioeconomic status, which was multicolinear with other social factors. Five years later, when all blood lead levels were 30 micrograms/dl or less, lead effects on IQ were no longer significant. The correlation between maternal and child IQ, which had been suppressed initially in children with higher lead levels, returned to expected levels when decreases in blood lead level occurred, while concomitant variables remained stable over the 5-year period.

Environmental antecedents which affect management and maintenance of programs for self-injurious behavior.

This paper reports the effects of several environmental variables on the management and maintenance of a treatment program for self-injurious behavior (SIB) in residents in a state facility for retarded persons. Fifteen of the clients who participated in a developmental day-care program were compared across the final four months of the program and then at follow-up two years later. Twelve additional clients who were treated in the overall SIB program did not receive the day-care component, but were included in the follow-up study. Regarding program management, the effects of time, staff-initiated interactions, the presence of a newcomer or disruptive client, and medication changes on the behaviors of the 15 clients in the day-care program were assessed from an ecobehavioral approach. Participants in the follow-up study were compared with respect to the type of SIB program they received, the staff-patient ratio in their program, their visual impairment, use of self-protective devices, presence of stimulating material, and time-of-day observed. These issues are discussed in relation to program maintenance.