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has confirmed the usefulness of glyceryl trinitrate ointment in children with anal fissure. A total of 102 children aged between 2 months and 15 years were randomised to one of four treatments: placebo (vaseline), 10% lidocaine, EMLA (eutectic mixture of 5% prilocaine and 5% lidocaine), and 0.2% glyceryl trinitrate ointment (GTN) each applied locally twice daily. After 10 days complete relief of symptoms was achieved in 0, 4%, 20%, and 45% of the respective groups, and at 8 weeks in 10%, 42%, 76%, and 91%. Complete healing was seen at 10 days in none of the first three groups and in only one (4%) of the GTN group. At 8 weeks the rates of complete healing were 5%, 29%, 64%, and 82%. These authors suggest using GTN ointment for fast relief and either GTN or EMLA until fully healed.
A cross-sectional study of 1532 13–16 year olds in 10 British towns (
) has shown no effect of infant feeding (breast or bottle) on adolescent serum concentrations of total- (TC) and low-density-lipoprotein –cholesterol (LDLC). A systematic review of published studies included in the same article, however, showed that breastfeeding is associated with higher concentrations of TC and LDLC in infancy but lower concentrations in adult life. The reduction of cholesterol concentrations in adults is modest (0.18 mmol/L for TC) but might be associated with a reduction in coronary risk of about 10%. It is calculated that on this basis about 3% of the population risk for coronary disease in the UK might be attributed to bottle feeding.
Research on adult patients in Denver, Colorado (
) has shown a deficiency of locally produced antimicrobial peptides in skin biopsy specimens from patients with eczema compared with patients with psoriasis. These peptides (cathelicidins and β-defensins) are produced in response to skin inflammation and are active against bacteria, fungi, and viruses. The particular peptides measured in this study (the cathelicidin LL-37 and human β-defensin -2) had synergistic bactericidal activity against Staphylococcus aureus. This may go some way to explaining why 30% of patients with eczema, but only 7% of patients with psoriasis, have skin infection.
Every paediatrician must have experienced a sense of unease about the fate of children with chronic illness or disability when they grow too old for paediatric services. Young adult teams (YATs), typically including a specialist in rehabilitation medicine, a psychologist, therapists, and a social worker, have been set up to provide a service for disabled adolescents and young adults. A study in Leeds and Stoke on Trent (with YAT), and Birmingham and Leicester (without YAT) (
) has shown that young disabled people with access to a YAT were 2.5 times more likely to participate in society when compared with similarly disabled young people without access to a YAT. Pain, fatigue, and stress were the main factors restricting participation.
Non-capsulate Haemophilus influenzae (strains not typable as a, b, c, d, e, or f) is second only to group A β haemolytic streptococcus as a bacterial cause of vulvovaginitis in children. In Kettering (
) over a period of 3 years between 1997 and 2000 a total of 1016 vulval and vaginal swabs from 814 girls aged 14 years or under presenting with vaginal discharge or itching produced 38 isolates of H influenzae (all non-capsulate) from 32 girls aged 1.5–11 years (mean 4.9 years). The most common biotype of H influenzae was biotype II (15 of 25 tested). No other pathogens were isolated together with H influenzae. Fourteen children had recurrent vulvovaginitis of whom six had more than one episode of H influenzae vulvovaginitis. Resistance of isolates to amoxicillin, trimethoprim, or clarithromycin was fairly common but did not present a problem in clinical management.
The ventricular pre-excitation pattern (VPE) is the characteristic ECG pattern associated with Wolff-Parkinson-White syndrome. The management of asymptomatic (no history of tachycardia attacks) patients found to have VPE is controversial. In Naples (
) 57 such children were followed up for a mean of 4 years. Eleven had congenital heart disease. One patient died suddenly at the age of 8 years. Five patients developed symptomatic supraventricular tachycardia (SVT) and were treated with either drugs or radiofrequency catheter ablation. Sustained SVT was induced in 17 of 35 patients who underwent electrophysiological studies including atrial stimulation. Seven patients had intermittent VPE on follow up and three lost the VPE pattern altogether. The risk of ventricular tachycardia and sudden death in asymptomatic patients with VPE remains uncertain even for those in whom supraventricular tachycardia can be induced by atrial stimulation. The balance of risks and benefits from treatment is therefore also uncertain but these Italian cardiologists offer treatment as “the only way to prevent those “rare” cases of sudden death”.
Some children with autism have lymphoid nodular hyperplasia and colitis when investigated some years after measles immunisation but the relationship between colitis, autism, and immunisation is hotly debated. A study in Iceland (
) has provided evidence that measles immunisation does not commonly cause intestinal inflammation. Using faecal calprotectin concentrations as a measure of intestinal inflammation they aimed to study 109 infants before Pentavac (diphtheria, tetanus, pertussis, polio, and Hib) immunisation at 12 months and 2 and 4 weeks later and before MMR at 18 months and 2 and 4 weeks after that. Fifty-eight infants completed the study. There were no significant differences between faecal calprotectin levels at any of the six time points. These researchers conclude that neither Pentavac nor MMR provoked intestinal inflammation within 4 weeks but they can’t rule out the possibility that MMR might do so in a few susceptible infants (which, of course, is exactly what the anti-MMR lobby would propose).
Full term newborn babies are commonly hypermetropic and astigmatic and these gradually correct spontaneously during the first year, a process known as emmetropisation. A study of 59 preterm infants without retinopathy of prematurity in Glasgow (
) has shown that prematurity is associated with myopia, anisometropia, astigmatism, and variation in astigmatic axis. The emmetropisation process meant that by the time these infants reached term their astigmatism and anisometropia was of the same order as in full term infants at birth but the preterm infants remained less hypermetropic. Anisometropia persisted to 6 months in infants <1500 g at birth. Abnormal cranial ultrasound findings were associated with greater hypermetropia. At 4 years nearly 20% of the preterm infants had significant refractive errors.