No abstract

A program for early selection and treatment of the infant with myelomeningocele was developed at the University of Oklahoma Health Sciences Center in 1977. Over a 5-year period, 69 babies were evaluated, 36 babies were recommended for early vigorous treatment. Of the 33 babies for whom only supportive care was recommended, five were initially treated at the parents' request, two underwent delayed vigorous treatment, one was subsequently treated by "crisis management," one moved and did not return for follow-up, and 24 received only supportive care. All 24 babies died between 1 to 189 days of age (mean 37 days). The involvement of several physicians and paramedical support personnel is considered essential for this approach of early selection and treatment. Continued support and regular follow-up is necessary for any baby who receives only supportive care. Parents retain legal custody. Although ethical concerns make any approach difficult, the method presented is considered to be the best alternative available at this time.

Atopic dermatitis, one of the common dermatologic abnormalities encountered by pediatricians in clinical practice, is a chronic pruritic skin disorder occurring in individuals with a personal or family history of atopic disease such as asthma or allergic rhinitis. Atopic dermatitis appears to be an inherited disease, although the mode of inheritance has not been established. Clinically, its course can be divided into stages: infantile, childhood, and adult. Recognition of atopic dermatitis in any of these stages should facilitate appropriate treatment. This general overview examines several aspects of the disease, including current concepts of clinical manifestations, differential diagnosis, pathogenesis, and treatment.