ABSTRACT. Scurvy has been known since ancient times, but the discovery of the link between the dietary deficiency of ascorbic acid and scurvy has dramatically reduced its incidence over the past half-century. Sporadic reports of scurvy still occur, primarily in elderly, isolated individuals with alcoholism. The incidence of scurvy in the pediatric population is very uncommon, and it is usually seen in children with severely restricted diets attributable to psychiatric or developmental problems. The condition is characterized by perifollicular petechiae and bruising, gingival inflammation and bleeding, and, in children, bone disease. We describe a case of scurvy in a 9-year-old developmentally delayed girl who had a diet markedly deficient in vitamin C resulting from extremely limited food preferences. She presented with debilitating bone pain, inflammatory gingival disease, perifollicular hyperkeratosis, and purpura. Severe hypertension without another apparent secondary cause was also present, which has been previously undescribed. The signs of scurvy and hypertension resolved after treatment with vitamin C. The diagnosis of scurvy is made on clinical and radiographic grounds, and may be supported by finding reduced levels of vitamin C in serum or buffy-coat leukocytes. The response to vitamin C is dramatic. Clinicians should be aware of this potentially fatal but easily curable condition that is still occasionally encountered among children. Pediatrics 2001; 108(3). URL: http://www.pediatrics.org/cgi/content/full/ 108/3/e55; scurvy, hypertension, magnetic resonance imaging, bone pain. ABBREVIATION. MRI, magnetic resonance imaging.A 9-year-old girl with global developmental delay presented with signs of scurvy secondary to long-term ascorbic acid deficiency and was also discovered to have severe hypertension. This case highlights a rare disease that still exists in the pediatric population and points to a possible association between hypertension and vitamin C deficiency. Magnetic resonance imaging (MRI) findings of scurvy, which have been previously unreported, are described. CASE REPORTA 9-year-old girl was admitted to hospital because of musculoskeletal pain, inflammatory gingival disease, and hypertension.Her past medical history was remarkable for moderate global developmental delay, mild facial dysmorphism, and a seizure disorder managed with long-term phenytoin administration. She had 2 older sisters with a similar disorder, and a previous evaluation had not identified a known, inherited condition.She was admitted to a community hospital with a 2-month history of increasing bilateral knee pain and swollen, bleeding gums. There was no history of fever, weight loss, trauma, obviously swollen joints, petechiae, or bruising. At the time of her hospitalization, the child refused to walk. She previously ambulated with the aid of a walker.Investigations at that time revealed a hemoglobin of 79 g/L, white blood cell count of 8.9 ϫ 10 9 /L with a normal differential count and a platelet count of 470 ϫ 10 9 /L. A ...

Bladder exstrophy and cloacal exstrophy present challenging reconstructive problems. Traditionally, bilateral posterior iliac osteotomy has been performed in the majority of patients undergoing primary closure for these abnormalities. Recently, 2 anterior osteotomy approaches have been proposed: 1) incision of the ilium transversely above the acetabulum (transverse osteotomy) and 2) incision of the superior ramus of the pubis (superior ramus osteotomy). We devised a new anterior mid-iliac diagonal osteotomy that provides a more functional pelvic closure. To provide a fair comparison of the procedures we developed a pelvic exstrophy model based on data from a 3-dimensional computerized tomogram of a 3-year-old patient with classical bladder exstrophy. The different osteotomies were then performed on the model and the results were compared. Our new anterior mid-iliac diagonal osteotomy correction allowed the best surgical approach, provided the best correction of the flattened ilia bony deformities, was performed in the thinnest area of marrow bone and resulted in the best pelvic symmetry.

Three paediatric cases of blastomycosis, apparently acquired in or near Toronto, Ontario, a region not known to be endemic for this disease, are described. Blastomycosis was not suspected clinically in any of the three cases, and the diagnosis was established only when the diagnostic net was broadened to include fungal and mycobacterial cultures. All three patients were diagnosed after significant delays, which is consistent with the rarity of the disease in children and its acquisition outside previously accepted geographical boundaries. Pulmonary involvement was present in all three children, while one also had multifocal osteomyelitis. Drug therapy was successful in all three cases, either with amphotericin B followed by itraconazole, or itraconazole alone. Blastomycosis should be included in the differential diagnosis of a patient from the Toronto area who presents with a compatible history despite a negative travel history to known endemic zones.