Given the magnitude and seriousness of PICC complications, clinicians should reconsider the practice of treating otherwise healthy children with acute osteomyelitis with prolonged intravenous antibiotics after hospital discharge when an equally effective oral alternative exists.

Ten of the 14 patients with an abscess size > or =3 cm had an invasive intervention, but only 1 of these 10 had an initial 48-hour trial of antibiotics alone. In contrast, only 2 of the 22 patients who had an abscess size <3 cm received an invasive intervention (Fisher P= .0002). We conclude that conservative treatment with intravenous antibiotics may be a reasonable initial approach.

A 22-month-old African refugee male was referred to our emergency department by his pediatrician for prolonged fever. He was previously healthy and had just moved from Tanzania to Dallas, TX, 9 months before presentation. He had intermittent high fevers to 103°F, along with chills and night sweats for 7 days. Upper respiratory symptoms, including nasal congestion and cough, were noted for a few days. Review of systems was negative for localized pain, irritability, skin rash, conjunctivitis, dysuria, or choluria. He was still catching up with immunizations.His emergency department (ED) physical assessment revealed a febrile, well-nourished child who appeared non-toxic. Tympanic membranes and oropharynx were clear, and there was no conjunctivitis. Cardiovascular and pulmonary examinations were unremarkable.Abdomen was negative for hepatosplenomegaly or masses. No rashes or peripheral edema were present. Neurologic evaluation was normal.Initial ED diagnostic workup included a hemogram that showed marked leukocytosis with neutrophilia (WBC: 36,100/mm 3 and ANC: 20,700/mm 3 ) and normocytic, hypochromic anemia (hemoglobin 9.1 g/dL, MCV 64 and MCH 21). Urinalysis and chest X-ray were normal. He was admitted for further evaluation of his fever.As an inpatient, testing included a viral respiratory panel, malaria smear, urine culture, blood culture, PPD, and HIV, all of which were negative. Because of the patient's persistent high fevers, an abdominal ultrasound was obtained to rule out an occult abscess or malignant mass. The ultrasound revealed a 4.7 x 3.8 x 5.5 cm complex, hypovascular left renal mass.

Children with end-stage renal disease (ESRD) often remain hypertensive despite bilateral nephrectomy and aggressive fluid removal on hemodialysis. We speculated that an extrarenal source of renin might contribute to the release of "tissular" angiotensin-II (AT-II) generating hypertension in anephric patients. At the same time, experimental evidence supports that peripheral AT-II vasoconstrictive effect is likely mediated by endothelin-1 (ET-1). Thus, it is conceivable that hypertension in ESRD patients may be due, in part, to a cascade involving vascular production and secretion of AT-II and ET-1. In order to establish the relationship between AT-II, ET-1, and blood pressure we performed a pilot study to measure predialysis systolic and diastolic blood pressures (SBP and DBP, respectively) and serum AT-II and ET-1 levels in 12 anephric children receiving hemodialysis. Predialysis AT-II and ET-1 levels were similar in all patients, and neither value correlated with their mean SBP or DBP. In patients with postdialysis hypertension, there was no correlation between predialysis AT-II and ET-1 plasma levels. We therefore find no evidence to suggest that vascular-mediated AT-II and/or ET-1 contributes significantly to hypertension in anephric patients.