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Objective To study the differences in blood pressure readings between the auscultatory and oscillometric (Dinamap model 8100; Critikon, Tampa, Fla) methods. Design Survey of 2 blood pressure instruments. Setting Public schools. Participants Seven thousand two hundred eight schoolchildren aged 5 through 17 years. Main Outcome Measure Blood pressure levels. Results For all children combined , Dinamap systolic pressure readings were 10 mm Hg higher (95% confidence interval, −4 to 24 mm Hg) than the auscultatory systolic pressure readings. Dinamap diastolic pressure readings were 5 mm Hg higher (95% confidence interval, −14 to 23 mm Hg) than the auscultatory Korotkoff phase V diastolic pressure readings. Conclusion These findings preclude the interchange of readings by the 2 methods. Caution must be exercised in the diagnosis of hypertension when an automated device is used.

Acquired hemidiaphragmatic paralysis from phrenic nerve injury has been described in a variety of traumatic and surgical conditions, including birth trauma, neoplasms, and complications of thoracic surgery1and jugular venous cannulation.2,3We observed the case of an 8-year-old child in whom a temporary paralysis of the left hemidiaphragm developed from an empyema, with eventual resolution in 16 months. To our knowledge, empyema has not been reported as a cause for paralysis of the ipsilateral hemidiaphragm. Report of a Case.An 8-year-old boy presented to the emergency department with a traumatic puncture wound, 2 cm in length, to the left subscapular region after falling on a tree root earlier that evening. The initial evaluation revealed no foreign body in the chest wall, and the chest roentgenogram was without abnormalities. The patient's wound was treated by primary closure in the emergency department, without surgical exploration. The child returned to the

We report a case of recurrence of the ventricular shunt as a result of bacterial endocarditis more than seven years after the surgical correction of tetralogy of Fallot (TOF) that was treated successfully with an intravenous antimicrobial alone. Report of a Case .—This 13-year-old boy had corrective surgery for TOF at the age of 6. The ventricular septal defect (VSD) was closed with a Teflon patch and the right ventricular outflow tract was resected. A widely split second heart sound and a grade 2/6 pulmonary ejection murmur were present. A regurgitant murmur of a VSD was not described on five clinic visits postoperatively. Complete right bundle branch block was present on the ECG and roentgenograms demonstrated a normal heart size and vascularity. The patient was admitted to a local hospital with history of fever and shaking chills of ten days' duration. Five consecutive blood cultures were positive for Staphylococcus aureus

Sir .—A recent article in the October 1987 issue of AJDC by Wareham et al 1 demonstrated wide 95% prediction intervals (17 to 21 mm Hg) for systolic, diastolic, and mean blood pressures (BPs) as recorded by an oscillometric BP monitoring system (Dinamap 1846) in premature newborns and advised cautious interpretation of the Dinamap BP readings in this age group. It is an interesting finding in the presence of a number of articles confirming the accuracy of Dinamap BP measurements in full-term neonates (references 2 through 7) 1 and in infants and children aged 1 month through 16 years. 2 In fact, we have found the Dinamap method to be a better predictor of intra-arterial BP than the conventional auscultatory readings obtained by research nurses. 2 However, on close inspection of our data, we find a trend of diminished accuracy of the Dinamap readings when arterial pressures were in the