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WITHIN THE CURRENT ERA of educational reform, greater numbers of early childhood teachers have become engaged in teaching mathematics curricula that require teachers to have a deep understanding of children's mathematical thinking. The purpose of this study is to examine how pre-kindergarten teachers in the United States (US) notice and interpret children's mathematical thinking. To address teacher knowledge of children's mathematical thinking, a qualitative case study was conducted. The sources of data include classroom observation and post-observation interviews with each teacher. The results indicate that these teachers varied in their level of noticing and attending to students' mathematical thinking. Although some teachers could successfully engage their students' mathematical thinking, the extent to which they interpreted that thinking was different., Introduction An educational reform movement focused on teaching and learning mathematics and based on curricular and instructional recommendations such as Principles and Standards for School Mathematics (NCTM, 2002) is currently [...]

A MULTIPLE-CASE STUDY INVESTIGATION of the experiences of eight Chinese immigrant children in New Zealand early childhood centres suggested that the immigrant children's learning experiences in their first centre can be understood as a process of negotiating and creating intercultural relations. The children's use of family cultural tools, such as the Chinese language, was a distinctive feature of their learning experiences, simultaneously revealing and extending their exploration of the intercultural practices and their establishment of a sense of belonging. In the presence of Chinese-speaking peers who acted as 'bridges' and 'boundary objects', the Chinese language was actively used by the immigrant children in English-speaking early childhood centres and, as a result, they created intercultural relations which: (i) bridged the two cultures; (ii) brought the cultures into convergence; (iii) enabled the children to claim group identity; and (iv) battled intercultural constraints. The absence of Chinese speakers, on the other hand, constrained possibilities for intercultural relations. The focus on intercultural relations in this study is expected to lead to educational initiatives to support the incorporation of diverse cultures in early childhood services., Introduction This paper explores particular forms of intercultural relations that occurred for a group of Chinese immigrant children attending their first early childhood centre in New Zealand. We define intercultural [...]

Objective To examine the relation of dietary and physical activity (PA) patterns with the body mass index (BMI), and the associations between these patterns among children. Methods A representative sample of 21 111 school students aged 6-18 years was selected by multistage random cluster sampling from 23 provinces in the Islamic Republic of Iran. PA and dietary pattern were assessed by self-administered validated questionnaires. Findings Fruit and vegetables, dairy products and snacks (salty, fatty or sweet) had a similar consumption frequency of approximately twice a day. The type of fat most frequently consumed was hydrogenated solid fat (consumed by 73.8% of families). The PA level was significantly higher among boys than girls, in rural than in urban residents, and in intermediate students than high-school students. Among boys, the frequency of consumption of vegetables and plant proteins ([R.sup.2] = 0.46); and among girls, the frequency of consumption of dairy products and fruits, as well as high PA level had a significant inverse association with BMI ([R.sup.2] = 0.57). Among boys, the low frequency of consumption of fruits, the time spent on PA and the energy expenditure; and among girls, the time spent on PA and the energy expenditure, had significant relationships with overweight. When controlling for covariates, PA levels had significant relationships with the frequency of consumption of all food groups. Conclusion Unhealthy lifestyles make Iranian young people prone to chronic diseases later in life. When examining their health benefits, the interrelationship of dietary and PA behaviours should be considered. Relation entre l'indice de masse corporelle et l'association activite physique/comportements alimentaires dans un echantillon national d'enfants et d'adolescents iraniens : Etude CASPIAN/Asociacion de la actividad fisica y los habitos alimentarios en relacion con el indice de masa corporal en una muestra nacional de ninos y adolescentes iranies: estudio CASPIAN Objectif Etudier la relation entre les pratiques en matiere alimentation et d'activite physique et l'indice de masse corporelle (IMC), ainsi que les associations de ces pratiques parmi les enfants. Methodes Un echantillon representatif randomise, compose de 21 111 eleves ages de 6 a 18 ans, a ete selectionne par une procedure de sondage en grappe a plusieurs degres dans 23 provinces de la Republique Islamique d'lran. Les pratiques en matiere d'activite physique et d'alimentation ont ete evaluees par des questionnaires valides auto-administres. Resultats Les frequences de consommation de fruits et legumes, de produits laitiers et d'en-cas (sales, gras ou sucres) etaient similaires et de deux fois par jour environ. Les matieres grasses les plus frequemment consommees etaient des matieres grasses solides hydrogenees (consommees par 73,8 % des familles). Le niveau d'activite physique etait nettement plus eleve chez les garcons que chez les filles, chez les ruraux que chez les urbains et chez les etudiants de cycle intermediaire que chez les etudiants de l'enseignement superieur. Chez les garcons, la frequence de consommation de legumes et de proteines vegetales ([R.sup.2] = 0,46); et chez les filles, la frequence de consommation de produits laitiers et de fruits, ainsi que la pratique d'une activite physique intensive, presentaient une correlation inverse significative avec l'indice de masse corporelle ([R.sup.2] = 0,57). Chez les garcons, la frequence de consommation de fruits, le temps consacre a I'activite physique et les depenses energetiques; et chez les filles, le temps consacre a I'activite physique et les depenses energetiques, etaient significativement corrales avec le poids. Les autres cofacteurs etant maintenus constants, les niveaux d'activite physique etaient significativement correles avec la frequence de consommation de I'ensemble des groupes d'aliments. Conclusion La pratique de modes de vie nuisibles a la sante a augmente la predisposition des jeunes Iraniens aux maladies chroniques a un stade ulterieur de la vie. Lorsqu'on examine les benefices pour la sante de I'activite physique et de comportements alimentaires sains, les interactions entre ces deux facteurs doivent etre prises en compte. Objetivo Examinar la relacion entre los habitos alimentarios y el grado de actividad fisica (AF) por un lado y el indice de masa corporal por el otro, asi como las asociaciones entre esas variables en la poblacion infantil. Metodos Se selecciono una muestra representativa de 21 111 escolares de 6-18 anos mediante tecnicas de muestreo aleatorio multietapico por conglomerados en 23 provincias de la Republica Islamica del Iran. La AF y los habitos alimentarios se evaluaron mediante cuestionarios validados autoadministrados. Resultados La frecuencia de consumo de frutas y verduras, productos lacteos y refrigerios (salados, grasos o dulces) fue similar, de aproximadamente dos veces al dia. El tipo de grasa consumido con mas frecuencia eran las grasas solidas hidrogenadas (73,8% de las familias). El nivel de AF fue significativamente mayor entre los varones que entre las muchachas, en los residentes en zonas rurales queen los de zonas urbanas, yen los alumnos de nivel medio queen los alumnos de instituto. Entre los chicos, la frecuencia de consumo de verduras y proteinas vegetales ([R.sup.2]= 0,46), y entre las chicas la frecuencia de consumo de productos lacteos y fruta, asi como un nivel alto de AF, estaban inversamente relacionados, de forma significativa, con el IMC ([R.sup.2]=0,57). Entre los chicos, la baja frecuencia de consumo de fruta, el tiempo invertido en alguna AF y el gasto energetico estaban relacionados sensiblemente con el exceso de peso. AI controlar las covariables, se observo que los niveles de AF estaban relacionados de forma significativa con la frecuencia de consumo de todos los grupos de alimentos. Conclusion Los modos de vida poco saludables predisponen a los jovenes iranies a sufrir enfermedades cronicas mas adelante en la vida. La relacion entre los habitos alimentarios y el nivel de AF es un aspecto a considerar a la hora de estudiar los beneficios para la salud asociados a esos factores. [TEXT NOT REPRODUCIBLE IN ASCII.], Introduction According to WHO estimates, by 2020, noncommunicable diseases (NCD) will account for approximately three quarters of all deaths in the developing world. (1) Interest in childhood precursors to chronic [...]

Pilocytic astrocytomas are among the most common intramedullary spinal cord tumors in the pediatric age group. The presence of contrast enhancement is a major factor used to distinguish these tumors from other spinal cord lesions. We present a case of histologically proved non-enhancing intramedullary spinal cord pilocytic astrocytoma in a 12-year-old girl. This case represents an exception to the conventional wisdom that pediatric spinal neoplasms enhance with administration of intravenous contrast material. Keywords Pilocytic astrocytoma * Spinal cord tumor * Pediatric

Scrotal abscess in infancy is rare and, in an otherwise healthy infant, an unexpected pathology. We present a 2-week-old boy with a unilateral scrotal swelling, imaged by high-resolution sonography. Sonography with colour Doppler demonstrated an encapsulated heterogeneous mass in the left scrotum with surrounding hyperaemia and a hypervascular spermatic cord. The testis was not demonstrable with full certainty and surgical exploration was undertaken. A scrotal abscess, indistinguishable from the testis and epididymis, had to be resected and on histology was found to have originated from the tunica vaginalis. Urogenital investigations did not reveal any associated abnormality and the final diagnosis was idiopathic scrotal abscess. High-resolution sonographic features with colour Doppler of a scrotal swelling can suggest an abscess and help determine appropriate therapy. Keywords Scrotum * Abscess * Sonography * Infant

Phytate, a salt of phytic acid (myo-inositol 1,2,3,4,5,6-hexakisphosphate), is found in certain plant-based foods. It strongly chelates minerals, forming insoluble complexes in the small intestine that cannot be digested or absorbed. Information on the phytate content of rice-based diets of children in Northeast Thailand is limited. In this study 1-day weighed duplicate diet composites were collected from 40 Northeast Thai children (age 6-13 years) randomly selected from participants (n =567) of an efficacy trial in Ubon Ratchathani province. Diet composites were analyzed for zinc, iron, and calcium by atomic absorption spectrophotometry, and for phytate (as inositol penta-phosphate and hexa-phosphate) by high-performance liquid chromatography; the accuracy and precision were established using a certified reference material for the minerals and an inter-laboratory comparison for phytate. The median (1st, 3rd quartiles) zinc, iron, and calcium contents of the diet composites were 4.3 (3.7, 6.1), 4.3 (3.2, 6.5) and 130 (82, 216) mg/day, respectively. The inositol penta-phosphate and hexaphosphate levels were so low they were below the detection limit, attributed in part to leaching of water-soluble potassium and magnesium phytate from glutinous rice after soaking overnight before cooking. Clearly, phytate will not compromise mineral absorption from these diets. Instead, low zinc intakes are probably primarily responsible for the low zinc status of these children. In contrast, although intakes of dietary iron appear low, the prevalence of biochemical iron deficiency was also low, suggesting that iron absorption may have been higher than previously assumed. Whether the low calcium intakes compromise optimal bone health in these growing Northeast Thai school children is unknown. Keywords: Food, minerals, micronutrients, bioavailability, phytate, rice, Thailand, deficiency

Background: Adamantinoma is a rare slow-growing malignant bone tumour. Objective: To describe the imaging appearances of six childhood cases and review the published literature. Materials and methods: The database of the Working Group on Paediatric Oncology, Academic Medical Centre/Emma Children's Hospital Amsterdam, was searched for cases of adamantinoma. Additionally a literature study was performed to identify cases of adamantinoma in childhood. Results: We identified six local cases of adamantinoma of the long bones, two boys (age 3 and 8 years) and four girls (mean age 8.8 years, range 3.0-14.0 years). The location of the tumour was the tibia in five and the tibia and fibula in one patient. In two patients initially a different diagnosis was made, which led to a delay in appropriate treatment. None of the children showed pulmonary metastases and all underwent total gross resection. On follow-up (mean 6.1 years, range 1.6-12.0 years) all children remained disease-free. Besides a discussion of our six patients, imaging features, histopathology, surgical approach and a literature review of childhood adamantinomas is presented. Conclusion: Although the incidence of adamantinoma is low, it is important to recognize this rare bone tumour, since in the early stages of the disease adequate treatment will result in an excellent prognosis. Keywords Bone * Tumour * Adamantinoma * Radiography * CT * MRI * Children

Cherubism is a paediatric disease affecting the jaws. It is a close radiological mimic of giant cell lesions of the mandible. The radiographic features of this condition are well known; however, the MR imaging features have not been well described. We describe the radiographic, CT and MR imaging features of cherubism in a 5-year-old girl. We highlight the MR appearances of cherubic lesions and the ability of MRI to not only accurately depict the anatomical extent of the lesions, but also to reveal signal intensity changes in those areas that are apparently normal on radiographs and CT images. Keywords Cherubism * Mandible * Radiography * CT * MRI * Child

Objectives. We assessed child care facilities' proximity to heavily traveled roadways in an attempt to estimate the extent of potential exposure of young children to vehicle-related pollution in this understudied microenvironment. Methods. We examined approximately 24000 licensed child care facilities in California located within 200 m of heavily traveled roadways. Results. Approximately 57 000 of the available slots in California child care centers (7% of the overall capacity) are in facilities located within 200 m (650 ft) of roadways averaging 50000 or more vehicles per day, and another 172000 (21%) are in facilities located within 200 m of roadways averaging 25000 to 49000 vehicles per day. Facilities providing care to infants or preschool-aged children and facilities located in disadvantaged areas were more often situated in medium- or high-traffic areas. Conclusions. Additional research is needed to further clarify the significance of the child care microenvironment in terms of potential childhood exposures to vehicle-related pollutants. Design strategies, notification standards, and distance-based siting restrictions should be considered in the facility licensing process and in land use and transportation planning. doi: 10.2105/AJPH.2005.077727

Objectives. We examined the relation between parents' level of English proficiency and their children's access to health care. Methods. Using the 2001 California Health Interview Survey, we conducted bivariate and multivariate analyses of several measures of children's access to health care (current health insurance status, usual source of care, emergency room visits, delayed or forgone care, traveling to another country for health care, and perceived discrimination in health care) and their association with parents' English proficiency. Results. Compared with English-speaking households, children in non-English-speaking households were more likely to lack health insurance, to not have doctor contact, and to go to other countries for health care and were less likely to use emergency rooms. Their parents were less likely to report their children's experiencing delayed or forgone care or discrimination in health care. Conclusion. English proficiency is a strong predictor of access to health insurance for children, and children in non-English-speaking families are especially likely to rely on other countries for their health care. English proficiency may mitigate the effects of race/ethnicity commonly observed in health care access and utilization studies.

ABBREVIATIONS. CHI, child health index; MAUP, modifiable areal unit problem. In their article "The Health Status of Southern Children: A Neglected Regional Disparity" (in this month's Pediatrics electronic pages), Goldhagen [...]

The Sukuma ethnic group appears to be expanding across Tanzania at a rate far greater than other ethnic groups in the area. In this paper, the household-level dynamics that may be fueling this expansion are explored by comparing measures of infant mortality and child health with another Tanzanian ethnic group, the Pimbwe. Consistent with expectations, the Sukuma appear to have comparable levels of fertility but lower child mortality. As predicted, compared to the Pimbwe, Sukuma children are also heavier and taller for their age, suggesting better nutritional status. Four hypotheses about why the Sukuma are so successful in this area are addressed. Surprisingly, the results show that household food security and wealth are not related to children's nutritional status, nor can maternal effects account for the observed health differences. Several lines of evidence suggest that different patterns of infant feeding practices may underlie the differences in children's nutritional status. KEY WORDS Africa; Sukuma; Pimbwe; seasonality; household food security; undernutrition; stunting

Abstract This article is a case study investigating the maintenance of Finnish in the language of two young Finnish-American bilinguals. The main source of data is a 90 mins audio-taped [...]

Byline: Todd Sheridan (1), Frederic B. Askin (1), Hongxiu Ji (1) Keywords: foreign body; giant cell; placental membrane; amniotic fluid leakage; intrauterine transfusion; immunostaining Abstract: We report the pathologic finding of a multinucleated foreign body giant cell reaction to squames and fetal hair in the placental membranes in a 37-week 1-day intrauterine gestation. This reaction appeared to have developed in association with repeated intrauterine procedures performed in the third trimester, including cordocentesis for fetal blood sampling, intrauterine blood transfusion, and amnioreduction for polyhydramnios. This type of reaction most likely was directed to prolonged amniotic fluid leakage that occurred spontaneously or after intrauterine procedures in the second half of the second trimester and the third trimester. Careful examination of the placental membranes and recognition of the foreign body giant cell reaction may provide etiologic insight in cases of unexplained oligohydramnios. Author Affiliation: (1) Department of Pathology, The Johns Hopkins Hospital, 401 North Broadway, Baltimore, Maryland, 21231, USA Article History: Registration Date: 01/01/2005 Received Date: 20/04/2005 Accepted Date: 04/06/2005 Online Date: 05/10/2005

Objectives. We examined socioeconomic inequalities in self-rated health by analyzing indicators of childhood socioeconomic circumstances, adult socioeconomic position, and current material resources. Methods. We collected data on middle-aged adults employed by the City of Helsinki (n = 8970; 67% response rate). Associations between 7 socioeconomic indicators and health self-ratings of less than 'good' were examined with sequential logistic regression models. Results. After adjustment for age, each socioeconomic indicator was inversely associated with self-rated health. Childhood economic difficulties, but not parental education, were associated with health independently of all other socioeconomic indicators. The associations of respondents' own education and occupational class with health remained when adjusted for other socioeconomic indicators. Home ownership and economic difficulties, but not household income, were the material indicators associated with health after full adjustment. Conclusions. Own education and occupational class showed consistent associations with health, but the association with income disappeared after adjustment for other socioeconomic indicators. The effect of parental education on health was mediated by the respondent's own education. Both childhood and adulthood economic difficulties showed clear associations with health and with conventional socioeconomic indicators. (doi:10.2105/AJPH.2004.047969)

Abstract Classic polyarteritis nodosa (c-PAN) is a rare disease in adults and extremely rare in children. We report a 3-year-old girl with c-PAN who presented with disturbances of consciousness and [...]

Invasive group A Streptococcus (GAS) infections can be fatal and can occur in healthy children. A case-control study identified factors associated with pediatric disease. Case-patients were identified when Streptococcus pyogenes [...]

A study of children's help-seeking behavior in 5 Cleveland, Ohio (USA) neighborhoods revealed the important role played by particular members of neighborhood institutions and establishments not commonly considered in research on children's social networks: the school crossing guard, the librarian at the local public library branch, and the store owner/clerk at the neighborhood convenience store. These roles--above and beyond their 'position descriptions'--ranged from provisioner of winter clothing in the case of crossing guards to mediator of child disputes in the case of public librarians. Moreover, crossing guards, librarians, and store owners/clerks were identified by some children as resources for dealing with bullies. The implications of these unrecognized supportive roles are discussed. Key words: social support, children, help-seeking, neighborhoods

Breakfast has been labeled the most important meal of the day, but are there data to support this claim? We summarized the results of 47 studies examining the association of breakfast consumption with nutritional adequacy (nine studies), body weight (16 studies), and academic performance (22 studies) in children and adolescents. Breakfast skipping is highly prevalent in the United States and Europe (10% to 30%), depending on age group, population, and definition. Although the quality of breakfast was variable within and between studies, children who reported eating breakfast on a consistent basis tended to have superior nutritional profiles than their breakfast-skipping peers. Breakfast eaters generally consumed more daily calories yet were less likely to be overweight, although not all studies associated breakfast skipping with overweight. Evidence suggests that breakfast consumption may improve cognitive function related to memory, test grades, and school attendance. Breakfast as part of a healthful diet and lifestyle can positively impact children's health and well-being. Parents should be encouraged to provide breakfast for their children or explore the availability of a school breakfast program. We advocate consumption of a healthful breakfast on a daily basis consisting of a variety of foods, especially high-fiber and nutrient-rich whole grains, fruits, and dairy products. J Am Diet Assoc. 2005;105:743-760.

The purpose of this study was to compare the dietary intakes of children who attend child-care centers with the recommendations of the Food Guide Pyramid for Young Children. Three-day dietary records were obtained for 50 children ages 3 to 5 years old who attended nine childcare centers in central Texas. Dietary intakes during child care were measured by a researcher, and dietary intakes at home were recorded by a parent. During child care, the 3-year-old children consumed sufficient fruits and meat/alternates, but not sufficient grains, vegetables, or dairy to meet two thirds of Food Guide Pyramid for Young Children recommendations. The 4- and 5-year-old children only consumed sufficient dairy. Ninety-one percent (20 of 22) of the 3-year-old children met two thirds of their estimated energy requirements during child care, compared with 5% (1 of 20) of 4-year-old children and 25% (2 of 8) of 5-year-old children. Intakes at home did not compensate for lack of grain and vegetable consumption during child care. J Am Diet Assoc. 2005;105:790-793.

Objective To develop and validate a food frequency questionnaire (FFQ) for low-income, 1- to 3-year-old Hispanic, African-American, and white children. Design A convenience sample of low-income mothers provided dietary data for their child via FFQs and 3-day diet records. Subjects/setting Participants (N=77) were recruited from Special Supplemental Program for Women, Infants, and Children clinics and public health clinics. All subjects were Hispanic, African-American, or white mothers of children 1 to 3 years old, 18 years of age or older, income less than 200% of the federal poverty level, and were literate in English. Statistical analyses performed Wilcoxon signed-ranks tests were used for comparisons of food group servings on time 1 and time 2 FFQs and to examine differences in food group servings between the FFQ and diet records. Spearman correlations were calculated to assess test-retest reliability and the relative validity. Contingency tables were used to determine the degree of association between the FFQ and diet records. Results Reliability correlations were significant for all nine food categories ([bar.x]=0.69), ranging from 0.53 (soups) to 0.84 (nonstarchy vegetables). Validity correlations were significant for all food groups ([bar.x]=0.41) except starchy vegetables. Thirty-six percent of children were classified into the same quartile of food group intake and 78% into the same or within one quartile. Conclusions The FFQ yielded excellent reliability and acceptable validity and can be used to assess food choices in a triethnic sample of low-income 1- to 3-year-old children. J Am Diet Assoc. 2005;105:727-734.

Objective To identify factors related to children's bone mineral indexes at age 8 years, and to assess bone mineral indexes in the same children at ages 6 and 8 years. Design Bone mineral content (BMC [g]) and bone mineral density (BMD; calculated as g/[cm.sup.2]) were measured by dual-energy x-ray absorptiometry (DEXA) in children and their mothers when the children were 8 years of age. A subset of children had an earlier DEXA assessment at age 6 years. Children's dietary intake, height, weight, and level of sedentary activity were assessed as part of a longitudinal study from ages 2 months to 8 years. Subjects/setting Fifty-two healthy white children (25 male, 27 female) and their mothers. Main outcome measures Children's total BMC and BMD at age 8 years. Statistical analyses performed Correlations and stepwise multiple regression analyses. Results Factors positively related to children's BMC at age 8 years included longitudinal intakes (ages 2 to 8 years) of protein, phosphorus, vitamin K, magnesium, zinc, energy, and iron; height; weight; and age (P[less than or equal to].05). Factors positively related to children's BMD at age 8 years included longitudinal intakes of protein and magnesium (P[less than or equal to].05). Female sex was negatively associated with BMC and BMD at age 8 years (P[less than or equal to].05). Children's bone mineral indexes at ages 6 and 8 years were strongly correlated (r=0.86, P<.0001 for BMC; r=0.92, P<.0001 for BMD). Conclusions Because many nutrients are related to bone health, children should consume a varied and nutrient-dense diet. J Am Diet Assoc. 2005;105:735-741.

This study examined packing (pocketing or holding accepted food in the mouth) in 3 children who were failing to thrive or had inadequate weight gain due to insufficient caloric intake. The results of an analysis of texture indicated that total grams consumed were higher when lower textured foods were presented than when higher textured foods were presented. The gram intake was related directly to levels of packing. That is, high levels of packing were associated with higher textured foods and low gram intake, and low levels of packing were associated with lower textured foods and high gram intake. All participants gained weight when texture of foods was decreased. Packing remained low during follow-up for 2 participants even when the texture of food was increased gradually over time. These data are discussed in relation to avoidance, response effort, and skill deficit. DESCRIPTORS: avoidance, packing, pediatric feeding disorders, texture assessment

Byline: Yi-Ju Chen (1), Chih-Sung Hsieh (2), Hock-Liew Eng (1), Chao-Cheng Huang (1) Keywords: Ovarian fibroma; Ovarian tumour; Infancy; Gorlin's syndrome Abstract: Ovarian fibroma rarely occurs in prepubertal girls. We report an ovarian fibroma in a 7-month-old female infant presenting as a right abdominal mass. The tumour was composed of oval-to-spindle cells forming interlacing fascicles and intermingling with collagen fibres. Immunohistochemically, the tumour cells were weakly positive for estrogen receptor and progesterone receptor but negative for inhibin. To the best of our knowledge, this is the youngest case of ovarian fibroma up-to-date in the English literature. Because Gorlin's syndrome was not present in the patient's family, other factors such as germline or somatic mutations may predispose the occurrence of this ovarian fibroma in infancy. Author Affiliation: (1) Department of Pathology, Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung , County 833, Taiwan (2) Department of Pediatric Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan Article History: Registration Date: 13/08/2004 Accepted Date: 25/07/2003 Online Date: 30/09/2004

Byline: J. Kosutic (1,2) Keywords: Acute myocarditis; Transient left ventricular hypertrophy Abstract: A case of rare acute myocarditis with heart failure and transient left ventricular hypertrophy in a 4.5-month-old male infant is described. Initial echocardiogram demonstrated severe concentric left ventricular hypertrophy with depressed left ventricular systolic function and reduced left ventricular cavity. Left ventricular hypertrophy was transient it decreased significantly within a couple of weeks concomitantly with the improvement of ejection fraction. The myocarditis resolved without sequelae. The natural course of this rare mode of presentation of myocarditis and its relationship to immunosuppressive and immunomodulatory treatment are discussed. Author Affiliation: (1) Mother and Child Health Institute, Radoja Dakica 8, 11070, Novi Beograd, Serbia and Montenegro (2) Narodnih heroja 13, 11070, Novi Beograd, Serbia and Montenegro Article History: Registration Date: 01/01/2003 Online Date: 08/06/2004

Byline: Maria S. Correa-Rivas (1), Isabel Matos-Llovet (1), Lourdes Garcia-Fragoso (2) Keywords: ectopia cordis; pentalogy; Cantrell; thoracoabdominal schisis; cleft lip/palate; midline defects Abstract: We present the case of a 28-h-old female infant born at 37 weeks of gestation with a rare congenital malformation consisting of a pentad of findings: ectopia cordis, a midline supraumbilical wall defect, a defect of the lower sternum, absent pericardium, and an anterior diaphragmatic defect. This constellation of defects is known as the pentalogy of Cantrell. Additional autopsy findings included a bilateral cleft lip and palate, bilateral pulmonary hypoplasia, an atrial septal defect, and a patent ductus arteriosus. We present this case because of its rarity and discuss the pathologic findings. Author Affiliation: (1) Department of Pathology and Laboratory Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, 00936-5067, USA (2) Department of Pediatrics, Neonatology Division, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, 00936-5067, USA Article History: Registration Date: 01/01/2004 Received Date: 20/09/2002 Accepted Date: 17/06/2004 Online Date: 06/12/2004

Byline: Laurentia Nodit (1), Noriko Murase (2), Jorge D. Reyes (2), George V. Mazariegos (2), Rakesh Sindhi (2), Ronald Jaffe (1) Keywords: small bowel transplantation; liver transplantation; transient posttransplant lymphadenopathy; graft-versus-host reaction; lymphocyte trafficking; mixed lymphocyte reaction Abstract: There is sparse information in humans on graft-versus-host (GVH) lymphadenopathy. A 15-month-old male received a liver and small bowel transplant for short bowel after gastroschisis. At 21 days he developed a GVH-like skin rash. Flow cytometry demonstrated 16.1% circulating donor cells. Polymerase chain reaction for Epstein-Barr virus was negative. Two months later, the rash recurred with diffuse lymphadenopathy. Lymph node biopsy showed effaced architecture without visible follicles, large numbers of CD79a.sup.+ immunoblasts interspersed with smaller CD3.sup.+ and CD8.sup.+ cells, and prominent dendritic cell hyperplasia. Human herpes virus 8, cytomegalovirus, and EBER-1 probes were negative, as was polymerase chain reaction for human herpes virus 6. Allograft intestinal biopsies on days 10 and 24 had a similar infiltrate. The features appeared to be those of lymphocytes trafficking between the graft and host with a mixed lymphocyte reaction in situ, a GVH-type reaction without tissue damage. The reaction was self-limiting in the intestinal graft, and the lymphadenopathy resolved with some decrease in immunosupression. Circulating donor cells fell to 2.5% by day 62, and the child has been rejection free on low-dose immunosuppression. Author Affiliation: (1) Department of Pathology, Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine, 3705 Fifth Avenue, Pittsburgh, PA, 15213, USA (2) Division of Transplant Surgery, Children's Hospital of Pittsburgh and Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, 3705 Fifth Avenue, Pittsburgh, PA, 15213, USA Article History: Registration Date: 01/01/2004 Received Date: 03/03/2004 Accepted Date: 03/06/2004 Online Date: 06/10/2004 Article note: Presented in abstract form at the Society for Pediatric Pathology Vancouver, British Columbia, Canada March 6, 2004 (Mod Pathol 2004 17 270)

Byline: Rathi M. Sabaratnam (1), Anunathan Reddi (2), Dhirendra Govender (1) Keywords: acinic cell carcinoma; bronchus; lung; obstruction; pediatric Abstract: Primary acinic cell carcinomas of the lung are rare tumors, usually presenting in adulthood as parenchymal or endobronchial masses. These lesions are generally recognized by their morphological pattern and the presence of periodic acid-Schiff (PAS)-positive, diastase-resistant cytoplasmic granules. We describe a case of primary acinic cell carcinoma of the bronchus in a 4-year-old girl. The tumor has the typical acinar structures: weakly PAS-positive, diastase-resistant cytoplasmic granules and intra-acinar laminated calcific structures. A lobectomy was done with a clear bronchial resection margin. The child is well with no evidence of recurrence or metastasis 2 years postresection. Author Affiliation: (1) Department of Anatomical Pathology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, South Africa (2) Department of Cardiothoracic Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, South Africa Article History: Registration Date: 01/01/2004 Received Date: 23/01/2004 Accepted Date: 20/04/2004 Online Date: 30/07/2004

Byline: Elizabeth S. Norman (1), Simon Bergman (1), Jacqueline K. Trupiano (1) Keywords: Key words: chondromesenchymal hamartoma; hamartoma; sinonasal Abstract: The sinonasal region is the site of several hamartomatous lesions, the majority of which are mesenchymal, with vascular hamartomas predominating. The occurrence of hamartomas in the nasal cavity of infants and children is especially rare. Nasal chondromesenchymal hamartoma (NCMH) is a rare lesion of the intranasal sinuses generally diagnosed in the newborn period, with the eldest reported patient presenting at 16 years of age. This neoplasm is composed of mesenchymal-stromal and chondroid tissue in varying proportions. It is felt to be analogous to the mesenchymal hamartoma of the chest wall, a lesion of similar histology generally involving the ribs and chest wall of neonates. To the best of our knowledge, only 14 cases of NCMH have been reported to date. We report a case of NCMH in an 11-year-old boy. Author Affiliation: (1) Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA Article History: Registration Date: 01/01/2004 Received Date: 05/01/2004 Accepted Date: 24/03/2004 Online Date: 30/07/2004

Byline: Monica Bhatia (1), Kanwal Kher (2,3), Caterina P. Minniti (1,3,4) Keywords: Acute lymphoblastic leukemia; Nephrotic syndrome; Immunosuppression; Focal segmental glomerulosclerosis; Cyclosporin A; Tacrolimus Abstract: A 5-year-old African-American male was diagnosed with nephrotic syndrome (NS). Because of concomitant leukopenia, bone marrow aspiration was performed, which did not demonstrate a hematological malignancy. The patient received standard daily steroid therapy for treatment of NS. Steroid resistance at 5 weeks of therapy led to a renal biopsy, which documented focal segmental glomerulosclerosis (FSGS). He was begun on cyclosporin A (CsA) and later switched to tacrolimus because of side-effects of CsA. Seven months after the initial diagnosis of NS, the patient was diagnosed with acute lymphoblastic leukemia (ALL). The patient is in complete remission of ALL and partial remission of NS with continued nephrotic-range proteinuria. Review of the literature shows four other cases of pediatric ALL after NS. No particular immunosuppressive agent seemed to be causative in the evolution of ALL. Although the exact mechanism for development of ALL after NS is unknown, the incidence of leukemia may be increased after immunosuppressive therapy when used in this context. Author Affiliation: (1) Division of Pediatric Hematology/Oncology, Children&apos;s National Medical Center, Washington, D.C., USA (2) Division of Pediatric Nephrology, Children&apos;s National Medical Center, Washington, D.C., USA (3) Department of Pediatrics, George Washington University School of Medicine, Washington, D.C., USA (4) Center for Cancer and Blood Disorders, Children&apos;s National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010, USA Article History: Registration Date: 14/07/2004 Received Date: 30/04/2004 Accepted Date: 14/07/2004 Online Date: 14/09/2004

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