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Gagueira induzida por teofilina - Relato de caso pioneiro (1981)


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Este arquivo pdf contém um relato pioneiro. Trata-se do primeiro caso documentado em literatura científica de gagueira induzida por medicação. O caso envolveu uma criança de 4 anos que apresentava uma única mudança comportamental ao receber o medicamento broncodilatador teofilina.

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Gagueira induzida por teofilina - Relato de caso pioneiro (1981)

  1. 1. 1981;68;749-750PediatricsMichael M. McCarthySpeech Effect of Theophyllinehttp://www.pediatrics.orgthe World Wide Web at:The online version of this article, along with updated information and services, is located onOnline ISSN: 1098-4275.Copyright © 1981 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005.American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007.has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by thePEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, itat BIN 8151 FMRP on March 10, 2008www.pediatrics.orgDownloaded from
  2. 2. LETTERS TO THE EDITOR 749at the age of 18 months, the children attend a nurseryschool part time for group activities. The maternal assist-ants receive continuing education on child rearing.This system, officialized in 1972, appears to conferbenefits on the children,8 their families, the health serviceof the Center for Maternal and Infant Protection, and thematernal assistants.Like family care, the environment thus offered to thechild is “natural” and open as opposed to the structured,closed environment of specialized centers, no matter howhigh their quality may be. The child grows in a familysetting, bonds to his/her caretaker, relates to varied real-life situations: meeting neighbors, shopping. . . . Further-more he/she gets the same health surveillance as his/herday care center counterpart and some group stimulation.The public health infrastructure offers medical compe-tence while families pay in proportion to their income.Flexibility of this type of care also reduces costs for thehealth service of the Center for Maternal and InfantProtection, eg, no building and furniture maintenanceand no operation of a kitchen responsible for up to 60daily meals of various compositions.Fringe benefits and employment security offered to thematernal assistants act positively in turn upon children’swell-being by contributing to the stability of care inas-much as inconsistency of care per se is a risk factor(Institut National de la Sante et de la Recherche M#{233}di-cale (INSERM, U. 185): Relations entre le developpe-ment de l’enfant et son mode de garde dans la premiereenfance, 1979).REFERENCESTHU HOANG, PHDUniversit#{233}Paris VUER Etudes M#{233}dicales et Biologigues andInstitut National de la Sante et dela Recherche M#{233}dicalea Villejuif: U 170 (statistiques)16 bis, avenue Paul-Vaillant-Couturier94800 Villejuif, Paris, France1. International Labor Office: Woman-power, the World’s Fe-male Labour Force in 1975 and the Outlook for 2XJO. ILO,Geneva, 19732. Organization for Economic Cooperation and Development:Women and Employment. OECD, Paris, 19803. Howell MC: Employed mothers and their families. Pediat-rics 52:252, 19734. Howell MC: Effects of maternal employment on the child.Pediatrics 52:327, 19735. Zambrana RE, Hurst M, Hite RL: The working mother incontemporary perspective: A review of the literature. Pedi-atrics 64:862, 19796. BeLsky J, Steinberg LD: The effects of day care: A criticalreview. Child Dev 49:929, 19787. Sibbison VH: The influence of maternal role perceptions onattitudes toward and utilization of early child care services,in Peters D (ed): A Summary ofthe Pennsylvania Day CareStudy. Pennsylvania State University, 19738. Caisse d’Ailocations Familiales: Cr#{232}chesfamiliales et travaild’#{233}quipe.Technical Actions Soc 12:9, 1973Questions Value of Name Change:RLF/ROP and IFTo the Editor.-I wish to disagree with the Second InternationalRetrolental Fibroplasia Conference. They wish, as theyhave written in a recent issue ofPediatrics (67:751, 1981),to “dislodge the established misnomer, RLF.” They wishto substitute two names, ROP and IF. I refrain frommentioning what ROP and IF, abominable acronyms,stand for, and go on to what is more important.The purpose of a name is to describe something sothat, in one brief word, a future scholar, investigator, orbookworm can quickly grasp what the writer has in mind.If, after every advance in our understanding of a disease,the name is changed, then the ignorant reader, who ispresumably the one to whom any written matter is ad-dressed, will be led on a wild goose chase, especially if heis looking up an historical subject. He will waste time, ashe searches through previous volumes of medical litera-ture, because every few years the name and all referencesto the disease he is pursuing will suddenly change.No disease has a perfectly appropriate name. It is luckythat no international conferences want to change thenames of measles, chickenpox, whooping cough, rheu-matic fever, etc, just because more is known about theseconditions; the confusion would be troublesome.Also, unfortunately, many modern medical writers andeditors of medical journals have become addicted toacronyms. Whose time do they save? Only the typist’s.The poor reader, who generally likes to skim many arti-des, can no longer do so. Acronyms with which he is notfamiliar have to be discovered by reading the openingparagraphs. There isn’t time to do that, if one wantsinteffigently to glean what is ofinterest in each thick issueof the many medical publications that now bombard us.I plead, therefore, to all writers and editors to avoidacronyms like the plague-excuse me, I meant to sayblack death. I can read black death just as fast as I canBD.RICHARD L. DAY, MDLakeview TerraceWestbrook, CT 06498Speech Eftect of TheophyllineTo the Editor.-Although symptoms of generalized central nervous sys-tem stimulation (eg, irritability, restlessness, and insom-nia) are recognized side effects of oral theophylline ther-apy,”2 I have recently encountered a patient who exhibitsa single, isolated behavioral change while receiving the-ophylline. Review of pertinent literature reveals no simi-lar reported cases.This 4-year-old white boy developed asthma at age 17months. Poor symptomatic control during the past sixmonths has necessitated two hospitalizations and threeat BIN 8151 FMRP on March 10, 2008www.pediatrics.orgDownloaded from
  3. 3. REFERENCES1. Vaucher Y, Lightner ES, Walson PD: Theophylline poison-ing. J Pediatr 90:827, 19772. Wyatt R, Weinberger M, Hendeles L: Oral theophyllinedosage for the management of chronic asthma. J Pediatr 92:125, 1978Circumcisions: Knowledge Isn’t EnoughYear No. of Term No. of Circum-Male Infants cisions1975 2,484 2,2881976 2,887 2,6871977 3,088 2,8511978 3,184 2,9501979 3,298 3,068% of InfantsCircumcised9293929293750 PEDIATRICS Vol. 68 No. 5 November 1981short courses of oral corticosteroids. Currently, the pa-tient’s condition is well controlled on inhaled beclometh-asone and oral Theo-dur, 200 mg every 12 hours (23 mg/kg/day). Serum theophylline level five hours after aTheo-dur dose is 12 gig/mi.The parents report that, every time the patient hastaken theophylline, both in the past and during thepresent regimen, he has begun to exhibit stammeringspeech. Although he can pronounce words without diffi-culty, he repeats some words eight to ten times beforeadvancing to the next word. The association between thespeech problem and medication may be coincidental, butboth parents adamantly maintain that the stammering isobserved only when the patient is on theophylline.I can find no data encouraging me to reassure theparents that this speech aberration is not a potentiallypermanent adverse effect of theophylline, nor have I beenof assistance regarding their concern that his speech willinvite teasing in school. Similar observations from otherpractitioners might therefore be ofbenefit in managementof this patient.MICHAEL M. MCCARTHY, MDPediatric Allergy Associates348 East VirginiaPhoenix, AZ 85004agreement with Osborn et al’ in that the 1975 policystatement by the American Academy of Pediatrics2 hasapparently had little impact on the incidence of circum-cision at our hospital.HOWARD J. BENNETT, MDMARK WEISSMAN, MDDepartment of Health Care SciencesThe George Washington UniversityMedical CenterWashington, DC 20037REFERENCES1. Osbom LM, Metcalf TJ, Mariani EM: Hygienic care inuncircumcised infants. Pediatrics 67:365, 19812. Committee on Fetus and Newborns: Report of the ad hoctask force on circumcision. Pediatrics 56:610, 1975In Reply.-Statistics concerning circumcision are not readily avail-able in the United States. During our study on hygiene,we polled Utah hospitals to ascertain the number ofmale births and the number of circumcisions performed.The percentage of infants circumcised varied from 0 to100%, with a statewide average of 87%. The majority ofphysicians responding to the questionnaire practiced inSalt Lake County. Our poll indicated that their estimatesof the incidence of circumcision were remarkably accu-rate.TABLE. Birth Record Data on Circumcision at LargestHospital in Salt Lake CountyTo the Editor.-In their article, Osborn et al’ discuss the results of astudy in which physicians were questioned about theirknowledge ofthe natural history ofthe foreskin and aboutthe advice they give parents concerning hygienic care ofuncircumcised infants. We agree completely with theirrecommendations and have routinely cautioned parentsagainst too vigorous retracting and cleansing of the fore-skin. We were surprised, however, that 80% of the physi-cians surveyed felt that only 10% or less of their maleinfants are uncircumcised. This prompted us to reviewthe birth records at our hospital for the last three years(Table). Although we found a higher percentage of uncir-cumcised infants at our institution, these data are inTABLE. Birth Record Data on Circumcision at TheGeorge Washington University Medical CenterYear No. of Term No. of Circum- % of InfantsMale Infants cisions Circumcised1978 1,500 1,190 791979 1,620 1,240 771980 1,590 1,290 81The Table reports the number of circumcisions per-formed in the county’s largest hospital.LUCY M. OSBORN, MDDivision of Ambulatory PediatricsUCLA Center for the Health SciencesLos Angeles, CA 90024Air in the Ductus?To the Editor.-The article “Paraplegia Due to Peripheral Venous AirEmbolus in a Neonate: A Case Report” (Pediatrics 67:472, 1981) needs further discussion.Although it is possible that the foramen ovale (FO)was the site of cross-over of air from venous to arterialcircuits, it is equally possible that the ductus was theshunt site in this 24-hour-old infant. The ductus is usuallyfunctionally closed by age 24 hours but is capable ofreopening in response to hypoxia. Anatomic closure, theat BIN 8151 FMRP on March 10, 2008www.pediatrics.orgDownloaded from
  4. 4. 1981;68;749-750PediatricsMichael M. McCarthySpeech Effect of Theophylline& ServicesUpdated Informationhttp://www.pediatrics.orgincluding high-resolution figures, can be found at:Permissions & Licensing entirety can be found online at:Information about reproducing this article in parts (figures, tables) or inReprints about ordering reprints can be found online:at BIN 8151 FMRP on March 10, 2008www.pediatrics.orgDownloaded from