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Clinical Therapeutics
Endoscopic Treatment of Primary Vesicoureteral Reflux
Foreword. This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are…
- March 29, 2012
- Diamond D.A. and Mattoo T.K.
- N Engl J Med 2012; 366:1218-1226
- CME
A 7-year-old girl with persistent, moderately severe vesicoureteral reflux has recurrent urinary tract infections while receiving prophylactic antibiotic therapy. Endoscopic correction of vesicoureteral reflux is recommended. The technique is described.
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Case Records of the Massachusetts General Hospital
Case 10-2012 — A 16-Year-Old Boy with Epigastric Pain and a Mediastinal Mass
Presentation of Case. Dr. Jennifer C. Hensley (Pediatrics): A 16-year-old boy was admitted to this hospital because of abdominal pain and a mediastinal mass. The patient had been well until 4 days before admission, when he began to feel vaguely ill. The next day, nonbloody emesis occurred. Two days…
- March 29, 2012
- Kelleher C.M., Forcione D.G., Gee M.S., Mino-Kenudson M.
- N Engl J Med 2012; 366:1241-1249
- Video
A 16-year-old boy was admitted to this hospital because of abdominal pain for 2 days. On examination, there was epigastric tenderness with guarding. Imaging revealed a posterior mediastinal cystic mass. Diagnostic procedures were performed.
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Editorial
Intramuscular versus Intravenous Benzodiazepines for Prehospital Treatment of Status Epilepticus
Acute seizures account for 1% of adult and 2% of pediatric emergency department visits, at an annual cost of $1 billion (in U.S. dollars). When seizures are prolonged or repetitive without recovery between episodes, the condition is termed status epilepticus, and it occurs in approximately 6% of…
- February 16, 2012
- Hirsch L.J.
- N Engl J Med 2012; 366:659-660
Acute seizures account for 1% of adult and 2% of pediatric emergency department visits, at an annual cost of $1 billion (in U.S. dollars).¹ When seizures are prolonged or repetitive without recovery between episodes, the condition is termed status ...
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Original Article
Intramuscular versus Intravenous Therapy for Prehospital Status Epilepticus
Early termination of prolonged epileptic seizures in response to intravenous administration of benzodiazepines by paramedics in the prehospital setting is associated with better patient outcomes. The randomized, controlled Prehospital Treatment of Status Epilepticus (PHTSE) trial (ClinicalTrials…
- February 16, 2012
- Silbergleit R., Durkalski V., Lowenstein D., et al.
- N Engl J Med 2012; 366:591-600
In this trial, subjects in status epilepticus were given either intramuscular midazolam or intravenous lorazepam by paramedics before arrival in the ER. Seizures were controlled in more subjects with midazolam, and midazolam was at least as safe and effective as lorazepam.
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Clinical Practice
Delayed Puberty
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 14-year-old…
- February 2, 2012
- Palmert M.R. and Dunkel L.
- N Engl J Med 2012; 366:443-453
- CME
- Full Text Audio
Puberty is considered delayed when it has not yet occurred at an age that is 2 to 2.5 SD later than average (traditionally, 14 years in boys and 13 years in girls). Constitutional delay of growth and puberty (CDGP) is the most common cause. Management of CDGP is discussed.
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Images in Clinical Medicine
Post-Traumatic Herniated Cervical Disk
Figure 1.
- February 2, 2012
- Diabira S. and Morandi X.
- N Engl J Med 2012; 366:462
- Free Full Text
An 18-year-old man with no notable medical history had sudden transient tetraplegia after heading a soccer ball. Ten minutes later, he had recovered normal strength. On examination, he had intense cervical pain, paresthesias on his shoulders and arms, and no other neurologic deficits.
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Original Article
GAD65 Antigen Therapy in Recently Diagnosed Type 1 Diabetes Mellitus
The clinical onset of type 1 diabetes is manifested by the effects of inadequate insulin secretion due to the immunologic destruction of pancreatic-islet beta cells. Despite replacement therapy with exogenous insulin, type 1 diabetes is associated with substantial morbidity and mortality. Even…
- February 2, 2012
- Ludvigsson J., Krisky D., Casas R., et al.
- N Engl J Med 2012; 366:433-442
This trial assessed alum-formulated glutamic acid decarboxylase, the 65-kD isoform (GAD65), a major autoantigen in type 1 diabetes. In patients with recent-onset disease; the compound did not significantly alter the loss of C peptide or improve clinical outcomes.
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Original Article
ADHD Drugs and Serious Cardiovascular Events in Children and Young Adults
Medications that are used to treat attention deficit–hyperactivity disorder (ADHD) are prescribed for more than 2.7 million children in the United States each year and have been considered to be relatively safe.– However, reports of adverse events from Canada and the United States that have…
- November 17, 2011
- Cooper W.O., Habel L.A., Sox C.M., et al.
- N Engl J Med 2011; 365:1896-1904
- Free Full Text
This large study found no increased risk of cardiovascular events in children and young adults using attention deficit–hyperactivity disorder (ADHD) drugs. Although the data are compatible with nearly a doubling of risk, the study was underpowered and the absolute event rate was quite low.
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Case Records of the Massachusetts General Hospital
Case 32-2011 — A 19-Year-Old Man with Recurrent Pancreatitis
Presentation of Case. Dr. Christopher J. Moran (Pediatric Gastroenterology): A 19-year-old man was admitted to this hospital because of recurrent pancreatitis. The patient had been well until approximately 6 months earlier, when lethargy and epigastric pain developed, associated with a dry throat,…
- October 20, 2011
- Shah U. and Shenoy-Bhangle A.S.
- N Engl J Med 2011; 365:1528-1536
A 19-year-old man was admitted to this hospital because of recurrent pancreatitis, associated with alcohol use, beginning 6 months earlier. On examination, he was obese and had upper abdominal tenderness. Imaging studies showed normal pancreatobiliary anatomy.
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Images in Clinical Medicine
Imperforate Hymen with Hematocolpometra
Figure 1.
- July 14, 2011
- Poll L.W. and Flake P.
- N Engl J Med 2011; 365:157
- Free Full Text
A 15-year-old premenarchal girl presented with a 4-day history of increasing abdominal pain. Her medical history was unremarkable. Physical examination revealed a palpable, nontender, nonpulsatile midline mass extending from the pelvis to the umbilicus.
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Correspondence
Propranolol for Intractable Diffuse Lymphangiomatosis
To the Editor: Diffuse lymphangiomatosis is a rare congenital disease with a usually poor prognosis, especially for children with thoracic lesions. Current therapies include surgery, interferon, radiotherapy, and glucocorticoids, but these therapies have side effects, and the treatment strategy…
- April 7, 2011
- N Engl J Med 2011; 364:1380-1382
- Free Full Text
Propranolol was effective in relieving respiratory distress in a child with diffuse lymphangiomatosis after the failure of other interventions. Response was associated with decreased serum levels of vascular endothelial growth factor.
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Editorial
Assessing the Value of Treatments to Increase Height
The use of growth hormone and estrogen has a long and often controversial history in the manipulation of growth. Pharmacologic interventions to increase growth in short children are increasingly common. We believe that the usefulness of growth-promoting treatments depends on well-designed studies…
- March 31, 2011
- Cuttler L. and Rosenfield R.L.
- N Engl J Med 2011; 364:1274-1276
The use of growth hormone and estrogen has a long and often controversial history in the manipulation of growth. Pharmacologic interventions to increase growth in short children are increasingly common. We believe that the usefulness of growth-promoting ...
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Original Article
Growth Hormone plus Childhood Low-Dose Estrogen in Turner's Syndrome
Turner's syndrome, which results from partial or complete X-chromosome monosomy, occurs in about 1 in 2000 live female births and encompasses diverse clinical features, including short stature, ovarian dysgenesis, and neurocognitive problems. The marked short stature in Turner's syndrome (an…
- March 31, 2011
- Ross J.L., Quigley C.A., Cao D., et al.
- N Engl J Med 2011; 364:1230-1242
- Free Full Text
This trial randomly assigned girls 5 to 12.5 years of age with Turner's syndrome to receive growth hormone, low-dose estrogen, neither, or both. Growth hormone increased adult height. Combining ultra-low-dose estrogen with growth hormone during childhood may optimize growth.
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Clinical Practice
Care of Transsexual Persons
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A healthy and…
- March 31, 2011
- Gooren L.J.
- N Engl J Med 2011; 364:1251-1257
- CME
- Full Text Audio
A healthy and successful 40-year-old man finds it increasingly difficult to live as a male. In childhood, he preferred playing with girls and felt that he should have been one. After much agonizing, he has concluded that only sex reassignment can offer the peace of mind he craves.
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Original Article
Efficacy of Quadrivalent HPV Vaccine against HPV Infection and Disease in Males
Human papillomavirus (HPV) infects the squamous epithelium in both sexes, leading to anogenital condylomata acuminata and, in males, to cancers of the penis, anus, and oropharynx. The rate of genital HPV infection among males is similar to that in females. In any 12-month period, the probability…
- February 3, 2011
- Giuliano A.R., Palefsky J.M., Goldstone S., et al.
- N Engl J Med 2011; 364:401-411
- Free Full Text
- CME
Limited data on the efficacy of the quadrivalent HPV vaccine are available for males. In this trial involving 4065 healthy boys and young men 16 to 26 years of age, the quadrivalent vaccine against HPV reduced the occurrence of external genital lesions by 60%.
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Perspective
Focus on Research: Weighing the Benefits and Costs of HPV Vaccination of Young Men
Sexually transmitted human papillomavirus (HPV) infections contribute to approximately 20,000 cases of invasive cancer in the United States each year; about 50% are cervical cancers, and the rest involve the vagina, vulva, penis, anus, or oral cavity or oropharynx. Less than 25% of HPV-related…
- February 3, 2011
- Kim J.J.
- N Engl J Med 2011; 364:393-395
New data suggest that a human papillomavirus (HPV) vaccine prevents anal intraepithelial neoplasia in men, particularly in men who have sex with men. As the FDA reviews this new evidence, the debate over routine HPV vaccination of boys and men is likely to be reignited.
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Case Records of the Massachusetts General Hospital
Case 37-2010 — A 16-Year-Old Girl with Confusion, Anemia, and Thrombocytopenia
Presentation of Case. Dr. Michele S. Duke (Pediatrics): A 16-year-old girl was seen in the emergency department of this hospital because of confusion, anemia, and thrombocytopenia. The patient had lupus nephritis but had been well until approximately 7 days before admission, when malaise developed,…
- December 9, 2010
- Binder W.D., Traum A.Z., Makar R.S., Colvin R.B.
- N Engl J Med 2010; 363:2352-2361
- CME
A 16-year-old girl with a history of lupus nephritis was seen in the emergency department because of altered mental status. She was somnolent and agitated and had no focal neurologic signs. Brain CT revealed no abnormalities. Laboratory studies revealed anemia and thrombocytopenia.
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Perspective
Screening Student Athletes for Sickle Cell Trait — A Social and Clinical Experiment
On April 13, 2010, the legislative council for Division I of the National Collegiate Athletic Association (NCAA) approved mandatory testing for sickle cell carrier status (sickle cell trait) for all student athletes participating in Division I sports. Students are to begin being tested for the…
- September 9, 2010
- Bonham V.L., Dover G.J., Brody L.C.
- N Engl J Med 2010; 363:997-999
On April 13, 2010, the legislative council for Division I of the National Collegiate Athletic Association (NCAA) approved mandatory testing for sickle cell carrier status (sickle cell trait) for all student athletes participating in Division I sports. ...
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Clinical Practice
Functional Hypothalamic Amenorrhea
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 16-year-old…
- July 22, 2010
- Gordon C.M.
- N Engl J Med 2010; 363:365-371
- CME
- Full Text Audio
A 16-year-old girl presents for evaluation of secondary amenorrhea. Her menarche was at the age of 12 years. Her last menstrual period was 6 months ago. She has lost 2.3 kg (5 lb) over the past 3 months and reports a 2-week history of unilateral foot pain. She typically runs 10 km (6 mi) per day, at least five times per week. Her body-mass index is 19. How should her case be evaluated and managed?
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Clinical Practice
Infectious Mononucleosis
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 16-year-old,…
- May 27, 2010
- Luzuriaga K. and Sullivan J.L.
- N Engl J Med 2010; 362:1993-2000
- CME
- Full Text Audio
A 16-year-old, previously healthy girl presents with a several-day history of fever, sore throat, and malaise. She appears very tired and has a temperature of 39°C. A physical examination is remarkable for diffuse pharyngeal erythema with moderately enlarged tonsils and the presence of several enlarged, tender anterior and posterior cervical lymph nodes. How should this case be managed?
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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