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Images in Clinical Medicine
Nevus Sebaceous
Figure 1.
- May 17, 2012
- Cifuentes L. and Ziai M.
- N Engl J Med 2012; 366:1923
- Free Full Text
A 6-year-old girl who was born with a plaque on her forehead presented to the clinic. The plaque was smooth, elevated, and arranged in a linear pattern on the forehead.
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Original Article
Reproductive Technologies and the Risk of Birth Defects
Consistent evidence from individual studies, including registry-based cohort studies, and meta-analyses, has linked assisted conception involving in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) with an increased risk of birth defects.– The associations between the use of…
- May 10, 2012
- Davies M.J., Moore V.M., Willson K.J., et al.
- N Engl J Med 2012; 366:1803-1813
In this study, the risk of birth defects was increased with IVF but was no longer significant after adjustment for maternal factors. The risk of birth defects associated with intracytoplasmic sperm injection remained higher after multivariate adjustment. Residual confounding cannot be ruled out.
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Case Records of the Massachusetts General Hospital
Case 12-2012 — A 10-Month-Old Girl with Vomiting and Episodes of Unresponsiveness
Presentation of Case. Dr. Helen H. Yeung (Pediatrics): A 10-month-old girl was seen in the emergency department at this hospital because of vomiting and episodes of unresponsiveness. The patient had been well until 2 a.m. on the day of admission, when she awoke with vomiting that was associated…
- April 19, 2012
- Sassower K.C., Allister L.M., Westra S.J.
- N Engl J Med 2012; 366:1527-1536
- CME
A 10-month-old girl was seen in the emergency department because of vomiting and episodes of unresponsiveness, which had begun suddenly 7 hours earlier. She gradually became somnolent. Vital signs, a physical examination, and brain imaging were normal.
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Review Article
200th Anniversary Article: What We Don't See
Sixty-eight years after the inaugural issue of The New England Journal of Medicine and Surgery, Sir William Osler introduced the term "pediatrics." Although "diseases peculiar to children" had figured in Benjamin Rush's lectures at the University of Pennsylvania since 1789, most physicians in the…
- April 5, 2012
- Hostetter M.K.
- N Engl J Med 2012; 366:1328-1334
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- Interactive/Multimedia
This article reviews the evolution of child health in four eras — the recognition of children as a specific population (1812–1880), the rise of public health as remedy (1881–1930), the development of vaccines (1931–1980), and the global era (1981–2012).
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Images in Clinical Medicine
Kerion Celsi
Figure 1.
- March 22, 2012
- Proudfoot L.E. and Morris-Jones R.
- N Engl J Med 2012; 366:1142
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A healthy 5-year-old boy presented with a 3-month history of an inflammatory mass on the scalp that had not responded to antibiotics. The physical examination revealed a boggy occipital swelling studded with pustules, as well as postauricular lymphadenopathy.
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Original Article
Enzyme-Replacement Therapy in Life-Threatening Hypophosphatasia
Hypophosphatasia is the inborn error of metabolism that is characterized by low serum alkaline-phosphatase activity from loss-of-function mutations, typically missense, within the gene for the tissue-nonspecific isozyme of alkaline phosphatase (TNSALP). Natural substrates of TNSALP that accumulate…
- March 8, 2012
- Whyte M.P., Greenberg C.R., Salman N.J., et al.
- N Engl J Med 2012; 366:904-913
- Video
In this study of perinatal and infantile hypophosphatasia, patients received ENB-0040, a bone-targeted, recombinant, human tissue-nonspecific isozyme of alkaline phosphatase that is lacking in this disease. Rickets healed, and developmental milestones and pulmonary function improved.
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Original Article
Brief Report: A Mutation in the Thyroid Hormone Receptor Alpha Gene
Thyroid hormones have diverse actions, which include regulation of skeletal growth, maturation of the central nervous system, cardiac and gastrointestinal function, and energy homeostasis. In addition, thyroid hormones control their own production by feedback inhibition of hypothalamic thyrotropin…
- January 19, 2012
- Bochukova E., Schoenmakers N., Agostini M., et al.
- N Engl J Med 2012; 366:243-249
On whole-exome sequencing, a child with clinical hypothyroidism but borderline-abnormal thyroid hormone levels was found to have a heterozygous nonsense mutation in THRα, encoding a mutant protein inhibiting wild-type receptor action in a dominant negative manner.
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Perspective
Bariatric Surgery in Adolescents
In this electronic age, we have become increasingly sedentary, while food, much of it prepackaged and of high nutrient density, is available in abundance. That overweight and obesity rates have reached epidemic proportions among children and adolescents in industrialized society is no longer news,…
- October 13, 2011
- Ingelfinger J.R.
- N Engl J Med 2011; 365:1365-1367
Is the possibility that a minimally invasive surgical procedure might cure a child's obesity and its complications an appealing solution? Or does a surgical approach to this complex problem constitute a misguided application of technology to a societal disorder?
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Images in Clinical Medicine
Traumatic Diaphragmatic Hernia
Figure 1.
- October 6, 2011
- Picetti E. and Mergoni M.
- N Engl J Med 2011; 365:e30
- Free Full Text
A 6-year-old boy presented to the hospital after several hours of vomiting and dyspnea. He had been in a motor-vehicle accident 6 months earlier and had sustained a seatbelt injury that necessitated surgical repair of a right diaphragmatic hernia.
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Images in Clinical Medicine
Ectopic Tooth in the Maxillary Sinus
Figure 1.
- September 29, 2011
- Nisa L. and Giger R.
- N Engl J Med 2011; 365:1232
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A 15-year-old boy was referred for evaluation of recurrent episodes of maxillary and dental pain accompanied by a purulent oral discharge. Examination revealed purulent material draining from a small opening in the gum next to the upper right maxillary first molar.
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Images in Clinical Medicine
Orbital and Cerebral Arteriovenous Malformations
Figure 1.
- September 29, 2011
- Choudhri O. and Chang S.D.
- N Engl J Med 2011; 365:e28
- Free Full Text
An 8-year-old girl had a 3-month history of progressively impaired vision in the right eye, with paresthesias and spastic paresis of the left arm and leg. Examination of the right eye revealed the tortuous blood vessels of a complex intraorbital arteriovenous malformation.
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Case Records of the Massachusetts General Hospital
Case 27-2011 — A 17-Year-Old Boy with Abdominal Pain and Weight Loss
Presentation of Case. Dr. Nina Mayer (Medicine–Pediatrics): A 17-year-old boy was seen in the pediatric gastroenterology clinic of this hospital because of abdominal pain and weight loss. The patient had been well until approximately 6 weeks earlier, when intermittent crampy abdominal pain…
- September 8, 2011
- Winter H.S., Gervais D.A., Branda J.A.
- N Engl J Med 2011; 365:940-950
- CME
A 17-year-old boy was admitted to the hospital because of a 6-week history of abdominal pain, constipation, and weight loss. Gastrointestinal radiographs showed narrowing of the cecum. CT scans showed peritoneal implants and a mediastinal mass.
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Special Article
Malpractice Risk According to Physician Specialty
Despite tremendous interest in medical malpractice and its reform,– data are lacking on the proportion of physicians who face malpractice claims according to physician specialty, the size of payments according to specialty, and the cumulative incidence of being sued during the course of a…
- August 18, 2011
- Jena A.B., Seabury S., Lakdawalla D., Chandra A.
- N Engl J Med 2011; 365:629-636
- Free Full Text
- CME
In this analysis of data from a national liability insurer, 7.4% of physicians faced a malpractice claim each year, although 78% of claims did not result in payments to claimants. The authors estimate that 75 to 99% of physicians will face a malpractice claim by the age of 65.
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Images in Clinical Medicine
Tongue Mucocele
Figure 1.
- July 28, 2011
- Lypka M. and Hammoudeh J.
- N Engl J Med 2011; 365:e9
- Free Full Text
An 8-year-old boy was referred for evaluation of a mass in the tongue. The lesion had fluctuated in size since being first noted 4 months earlier. He was otherwise asymptomatic, and his medical history revealed that he habitually bit his tongue.
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Correspondence
In Vivo Biomechanical Measurements of a Football Player's C6 Spine Fracture
To the Editor: During an investigation of concussion in American football players, we captured in vivo biomechanical data on a cervical spine fracture as it occurred in a male athlete (age, 18 years; height, 189.0 cm; weight, 79.4 kg) who was performing a head-down tackling maneuver. The…
- July 21, 2011
- N Engl J Med 2011; 365:279-281
- Free Full Text
- Video
Sports are a common cause of spine injuries. Video footage documented an 18-year-old football player who sustained a cervical spine fracture during a head-down tackling maneuver. A telemetry system in the player's helmet measured the location and magnitude of the impact that caused the injury.
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Clinical Implications of Basic Research
SHANK3, the Synapse, and Autism
Autism spectrum disorders present a paradox of great heterogeneity and great specificity. Well over 100 genetic disorders yield an autism phenotype, most through specific but distinct mechanisms, and many of which affect the synapse. SHANK3 (SH3 and multiple ankyrin repeat domains 3) is known to be…
- July 14, 2011
- Herbert M.R.
- N Engl J Med 2011; 365:173-175
Variants of SHANK3, a gene encoding a structural component of the postsynaptic density, have been associated with autism. Mice engineered to carry mutant genes showed autism-like behavioral features that included repetitive grooming and disinclination to socialize.
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Editorial
Fluid Resuscitation in Acute Illness — Time to Reappraise the Basics
Fluid resuscitation is a fundamental intervention in the treatment of critically ill patients. However, there is little conclusive evidence to guide clinicians about the best type of resuscitation fluid; the appropriate timing, volume, and rate of fluid administration; and the optimal way to…
- June 30, 2011
- Myburgh J.A.
- N Engl J Med 2011; 364:2543-2544
Fluid resuscitation is a fundamental intervention in the treatment of critically ill patients. However, there is little conclusive evidence to guide clinicians about the best type of resuscitation fluid; the appropriate timing, volume, and rate of fluid ...
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Correspondence
Eculizumab in Severe Shiga-Toxin–Associated HUS
To the Editor: The hemolytic–uremic syndrome (HUS), a thrombotic microangiopathy, most commonly occurs secondary to infection with Shiga-toxin–producing Escherichia coli (STEC-HUS), although rare, atypical forms are associated with abnormalities in complement-regulating proteins. The inhibition…
- June 30, 2011
- N Engl J Med 2011; 364:2561-2563
- Free Full Text
This letter reports treatment of three children with severe, dialysis-requiring Shiga-toxin–induced hemolytic–uremic syndrome (HUS) with eculizumab, a monoclonal anti-C5 antibody. The condition of all three children improved rapidly.
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Original Article
Mortality after Fluid Bolus in African Children with Severe Infection
Rapid, early fluid resuscitation in patients with shock, a therapy that is aimed at the correction of hemodynamic abnormalities, is one component of goal-driven emergency care guidelines. This approach is widely endorsed by pediatric life-support training programs, which recommend the…
- June 30, 2011
- Maitland K., Kiguli S., Opoka R.O., et al.
- N Engl J Med 2011; 364:2483-2495
- Free Full Text
In this study from sub-Saharan Africa, children with severe febrile illness and impaired perfusion were randomly assigned to fluid-bolus therapy or no bolus. Albumin or saline boluses significantly increased 48-hour mortality in critically ill children with impaired perfusion.
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Case Records of the Massachusetts General Hospital
Case 19-2011 — A 4-Year-Old Haitian Boy with Vomiting and Diarrhea
Presentation of Case. Dr. Ana A. Weil (Medicine): A 4-year-old Haitian boy was admitted to a hospital in Haiti affiliated with this hospital because of vomiting and diarrhea of 10 hours' duration. The patient had been well until approximately midnight the night before admission, when vomiting and…
- June 23, 2011
- Harris J.B., Ivers L.C., Ferraro M.J.
- N Engl J Med 2011; 364:2452-2461
A 4-year-old Haitian boy was admitted to a hospital because of vomiting and diarrhea. On examination, he was hypovolemic and lethargic. Episodes of diarrhea became too numerous to count. Rehydration was initiated, and a diagnostic test result was received.
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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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