Treatment of pediatric localized scleroderma with methotrexate.

Objective: To analyze the effectiveness of methotrexate (MTX) for the therapy of pediatric localized scleroderma (LS).

Methods: A retrospective chart review was performed for 17 pediatric patients with LS who failed topical therapy and were subsequently treated with MTX (12.5-25 mg weekly) with or without oral corticosteroids.

Sjögren syndrome in a child: favorable response of the arthritis to TNFalpha blockade.

Tumor necrosis factor alpha (TNFalpha) blockade has recently been found to be ineffective in treating glandular and extraglandular manifestations of adult Sjögren syndrome (SS), including arthralgia and arthritis. We report a girl who developed purpura, polyarthritis, uveitis, and severe dental caries in the first year of life and optic neuritis by age three. SS was diagnosed at 11 years of age, when severe hypokalemic renal tubular acidosis developed during infliximab treatment for arthritis.

Methotrexate used as a steroid-sparing agent in non-renal chronic Henoch-Schönlein purpura.

Henoch-Schönlein purpura (HSP) is the most common form of systemic vasculitis in childhood and a small percentage of children develop a chronic form of the disease that often requires prolonged corticosteroid therapy. A detailed case description of a child with non-renal chronic HSP treated with methotrexate to allow for tapering of corticosteroids is presented. This represents the first report of methotrexate use in the treatment of chronic HSP.

Hypophyseal-pituitary-adrenal axis in autoimmune and rheumatic diseases.

This article discusses the effects of sex steroids and anterior pituitary hormones on the immune system. Data from clinical and experimental studies on the effects of CRH, FSH, LH, and prolactin are reviewed. This is followed by a summary of results from our studies on the effects of FSH, LH, and prolactin on PBMC, CD4+ cells, and CD8+ cells in vitro.

Double-Blind Placebo-Controlled Treatment Trial of Chlamydia trachomatis Endocervical Infections in Pregnant Women.

Objective: The purpose of this study was to determine if treatment of pregnant women with Chlamydia trachomatis infection would lower the incidence of preterm delivery and/or low birth weight.

Methods: Pregnant women between the 23rd and 29th weeks of gestation were randomized in double-blind fashion to receive either erythromycin 333 mg three times daily or an identical placebo. The trial continued until the end of the 35th week of gestation.

Colonization with group B streptococci in pregnancy and adverse outcome. VIP Study Group.

Objective: Our purpose was to study the association of cervicovaginal colonization with group B streptococci with pregnancy and neonatal outcome.

Study Design: A prospective study was conducted at seven medical centers between 1984 and 1989. Genital tract cultures were obtained at 23 to 26 weeks' gestation and at delivery.

Adolescents with chronic disease. Transition to adult health care.

Older adolescents are in the midst of many life changes related to physical and emotional development, education and career choices, family and peer relationships. The presence of a chronic disease adds an additional burden. At this stage of development, transfer of care to an adult facility becomes a major challenge for the adolescent, parents, and pediatric and adult care providers.

A randomized placebo-controlled trial of erythromycin for the treatment of Ureaplasma urealyticum to prevent premature delivery. The Vaginal Infections and Prematurity Study Group.

Ureaplasma urealyticum has been associated with low birth weight and histologic chorioamnionitis and it is a frequent isolate from the chorioamnion of patients who are delivered prematurely. In prior clinical trials using antibiotics active against U. urealyticum, antibiotic treatment was associated with reduced prematurity and increased mean birth weight.

Antepartum cultures for Ureaplasma urealyticum are not useful in predicting pregnancy outcome. The Vaginal Infections and Prematurity Study Group.

To test the hypothesis that genital colonization with Ureaplasma urealyticum would predict adverse pregnancy outcome, 4934 women from five medical centers were evaluated for vaginal colonization with U. urealyticum between 23 and 26 weeks' gestation and followed up to delivery. U.

A sexually transmitted diseases curriculum in adolescent medicine.

We conducted a needs assessment and developed and evaluated a model curriculum on sexually transmitted diseases (STDs) for house officers on an adolescent medicine rotation. Residents thought it important for physicians to acquire skill in treating STDs during residency (mean rating, 4.4 on a five-point scale) and were willing to provide medical care for adolescents likely to have an STD (mean rating, 4.

Perinatal infections with Chlamydia trachomatis.

Much has been relearned and learned anew about perinatal chlamydial infections during the past 10 to 15 years. The adverse effects of infection on pregnancy outcome have been suggested but not fully documented or explained. Epidemiologic, biologic, and immunologic correlates of risk for infection and complications of pregnancy due to C.

False positive results with the use of chlamydial antigen detection tests in the evaluation of suspected sexual abuse in children.

The presence of rectal or genital infection with Chlamydia trachomatis in children is frequently considered an indicator of sexual abuse. The diagnosis of chlamydial infection in these children has been complicated by the use of antigen detection methods instead of culture. We report five cases in which the use of chlamydial antigen detection tests in the evaluation of suspected child abuse gave false positive results.

An outbreak of necrotizing enterocolitis. Association with transfusions of packed red blood cells.

Of 187 newborns admitted to a 33-bed, level III neonatal intensive care unit between January 1, 1985 and June 23, 1985, 33 developed necrotizing enterocolitis during their hospital stay. Twenty of the 33 newborns (61%) had onset of symptoms between April 1 and June 23, suggesting clustering during this period. A case-control study, with matching on birth weight class, approximate date of admission to the unit and approximate duration of stay, failed to reveal any association of the syndrome with type or timing of feeding, perinatal hypoxic events, as determined by apgar scores and labor history, or specific microbial organisms.