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From 1993 through 1999, 26 children with retropharyngeal abscess and 2 children with acute epiglottitis were cared for by pediatric otolaryngologists in northern Virginia. Fever, sore throat, dysphagia, refusal to swallow, dysphonia, drooling, and neck extension are common presenting signs and symptoms in acute epiglottitis and in retropharyngeal abscess. Contrast-enhanced computed tomography of the oropharynx was performed in all cases and was the most helpful diagnostic test.

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OBJECTIVE: To determine the efficacy and safety of budesonide delivered by an inhalation-driven dry powder inhaler (Turbuhaler) in children with moderate to severe persistent asthma. STUDY DESIGN: In our randomized, double-blind, placebo-controlled, parallel-group, multicenter study, a total of 404 children with asthma, who were aged 6 to 18 years and who had been receiving inhaled glucocorticosteroid therapy, were randomly assigned to receive either 100, 200, or 400 micrograms of budesonide or placebo twice daily for 12 weeks. At baseline, mean forced expiratory volume in 1 second (FEV1) was 74.6% (range, 30.7% to 123.3%) of the predicted normal value. RESULTS: Patients in each of the three budesonide treatment groups showed significant dose-related improvements in lung function (morning peak expiratory flow and FEV1), in asthma symptoms, and with a significant decrease in inhaled beta 2-agonist use in comparison with placebo. Improvements were evident within 2 weeks and were maintained throughout the 12 weeks. Budesonide treatment had no significant effect on hypothalamic-pituitary-adrenal axis function, and the incidence of reported adverse events was similar in all treatment groups. CONCLUSION: Budesonide administered via a dry powder inhaler provided dose-related improvements in lung function and clinical status and was well tolerated by children (6 to 18 years of age) with moderate to severe persistent asthma.

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A 77-item questionnaire on cocaine and "crack" use patterns, and on the addictive, medical, and criminal consequences of such use, was completed by 464 largely white, middle-class, suburban, teenage drug abusers registered in seven geographically disparate outpatient treatment facilities. Of the 130 (28%) who smoked crack, 87 (67%) were designated as "experimenters" (use of crack 1 to 9 times); 20 (15%) were in an intermediate group (smoked crack 10 to 50 times); and 23 (18%) were heavy users (smoked crack more than 50 times). Sixty percent of heavy users progressed from initiation of crack use to its use at least once a week in less than 3 months. Almost 50% of the 87 experimenters and nearly all the 23 heavy users recalled preoccupation with thoughts of crack, rapid loss of the ability to modulate their use of the drug, and rapid development of pharmacologic tolerance. Suspiciousness, mistrust, and depressed mood were associated with the increasing use of crack. Seizures occurred in none of those who used cocaine by snorting it intranasally (without ever smoking crack), in contrast to 1% of the experimenters and 9% of the 43 respondents who had smoked crack at least 10 times. Seven percent of the 87 experimenters versus almost one fourth of the 43 who smoked crack more frequently had injected cocaine intravenously. The use of crack by middle-class adolescents is associated with rapid addiction and with serious behavioral and medical complications.

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During a 29-month period, we studied enteric infection in 70 families from a pediatric practice in suburban Washington, D.C. Fecal adenoviruses were detected in stools of 18 patients by tissue culture and electron microscopic procedures. From 6 through 11 months of age, the incidence of fecal adenoviruses associated with enteritis was seven per 100, and of confirmed enteric adenoviruses (EAds), three per 100 individuals per year. All EAds belonged to subgenus G (type 41). All three patients with EAds had diarrhea; two had vomiting and one had fever, but none required hospitalization. Ten of the 15 patients with non-EAds were younger than 2 years, and 60% had diarrhea, 40% had vomiting, and 20% had fever. Combined gastrointestinal and respiratory symptoms occurred more often in those who shed non-EAds (three of 11) than in matched controls (two of 48, P = 0.04). An adenovirus was detected in approximately 6% of gastroenteritis episodes, and confirmed EAds were present in approximately 2% of episodes of gastroenteritis in children younger than 2 years of age. None of the contacts of patients with non-EAds shed such virus in their stools. None of nine family contacts of those with EAd appeared to shed adenovirus in stool. In contrast, rotavirus spread readily to exposed adults (25% of 65) and children (56% of 62) when a child in similar families had rotavirus infection.

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This study was designed to corroborate previous observations of low serum concentrations of aminoglycosides after usual doses in patients with cystic fibrosis and to investigate possible mechanisms for this change. We studied gentamicin clearance after single and multiple intravenously administered doses in 10 non-acutely ill patients with mild to moderate CF. The data could best be described by a two-compartment model for drug elimination. The mean 1-hour serum concentration, mean volume of distribution, and mean total plasma clearance of gentamicin were not different from those reported for patients without CF. The similarity of the plasma and the renal gentamicin clearances, supported by the observations that greater than 80% of administered drug was excreted in the urine by 4 hours and that negligible amounts were detected in sweat, saliva, or sputum, implies that the kidney is the major route of elimination in patients with mild CF. The correlation of increased plasma gentamicin clearance as NIH score decreases supports the hypothesis that aminoglycoside pharmacokinetics are changed as the severity of disease increases. For patients with mild CF, standard doses of gentamicin (60 mg/m2) will give safe and therapeutic concentrations.

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