The inconspicuous penis.

OBJECTIVE: To describe the etiology and management of the group of abnormalities referred to as the inconspicuous penis. DESIGN: Analysis of 19 cases seen over a period of 2 years by chart review. SETTING: Children's hospital in a major metropolitan area. PATIENTS: Nineteen boys referred to two pediatric urologists over a period of 2 years with penises that appeared abnormally small, but on palpation and measurement, were found to have a normal shaft with a normal stretched length. Diagnoses included were buried penis, webbed penis, and trapped penis. Patients ages ranged from 1 week to 13 years. FINDINGS: There were eight patients (42%) with trapped penis, and all were complications of circumcision (age 1 week to 7 months). Of nine (47%) patients with buried penis, two had been circumcised prior to diagnosis. One (5%) patient had webbed penis and one (5%) had combined buried and webbed penis. INTERVENTION: Six trapped penises were surgically repaired, and two resolved spontaneously. Five patients with buried penis had surgical repair, and two are being followed up for probable repair at age 9 to 12 months. Two were not repaired because of medical conditions or parental concerns. The webbed penis was surgically repaired as was the combined buried and webbed penis. The repair were all successful and had no complications. CONCLUSIONS: Inconspicuous penis encompasses a group of conditions in which the penis appears small but the shaft can be normal or abnormal in size. Circumcision is contraindicated in these patients until they have been evaluated by a urologist. Further study is needed to determine the natural history of these disorders and to better define which patients will benefit from surgical intervention and at what age.

National trends in pediatric resident recruitment.

Primary care residency programs throughout the nation are having increasing difficulty recruiting sufficient residents. Only 65% of pediatric residency positions are filled with medical graduates from the United States. We sent a questionnaire to pediatric residency program directors throughout the country to assess what changes pediatric programs had implemented in response to matching concerns. Forty-one percent had recruited non-house officer professionals to perform resident-type work. Such professionals included osteopathic and/or foreign-trained physicians (55%) and moonlighters (49%). House staff work hours had been reduced in 35% of programs and on-call frequency in 33%. Sixty-one percent had made significant changes in their recruiting practices in the past 5 years that are described herein. Annual recruiting budgets varied from nothing to over $75,000. This survey reveals widespread reduction in resident work load and increased intensity in the recruiting process throughout the country.

Practice management training for pediatric residents.

In 1986, a practice management training program was developed for pediatric house staff. In conjunction with this program, pediatric residents for the following 2 years completed questionnaires regarding their career goals, interests, and perceived competence in practice management. Postgraduate level-3 residents who completed the program felt more competent than postgraduate level-1 residents in all areas of practice management and were more likely to take an active role in managing their practice. There was a significant difference between postgraduate level-1 and level-3 residents who completed the program in several areas: feelings of overall competence in office management, choosing a practice location, office staff, appointment system, billing system, office computer, fee schedules, telephone management, and setting up an office laboratory. Exposure to a practice management program during residency training may better prepare future pediatricians for a successful practice.

Occult carbon monoxide poisoning in an infant.

The diagnosis of occult carbon monoxide poisoning in children is a difficult problem and may be frequently overlooked. An infant with recurrent episodes of unrecognized CO exposure and subsequent neurologic deterioration is presented. A clue to the diagnosis in this case was the finding of basal ganglia abnormalities on computed tomography. Clinical findings, etiology, and treatment of CO poisoning are reviewed. We suggest that CO toxicity should be suspected in any child with acute or recurrent neurologic deterioration.