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1. A 4-year-old girl was brought to the emergency department by her parents on a Sunday afternoon. Because of a clinical history of right upper quadrant pain and trace hematuria, abdominal radiographs were obtained. What do they show?

The management of pediatricmigraine incorporates lifestyle strategieswith acute therapy and preventivemeasures. Lifestyle changes that candiminish the frequency and intensity ofmigraines include maintaining regularsleeping, eating, and exercise habits;staying well hydrated; dealing withstress; and avoiding dietary triggers ofmigraine. Acute treatment represents arace against the clock: the longer aheadache continues to smolder, the harderit is to treat. An over-the-counteragent may help in the very early stagesof headache: if it does not, however,it must be followed within an hour by atriptan. Patients with significantmigraine disability may need preventionmedications or alternative therapies.

A previously healthy 2-year-old boy was hospitalized after 2 weeks of persistent fever (temperature to a maximum of 38.9C [102F]) and a 2-day history of neck stiffness. There was no history of cough, rhinorrhea, or dysphagia. The oropharynx could not be examined because of neck stiffness. The patient had bilateral anterior cervical lymphadenopathy.

On examination, the left testicle was noted to be much smaller than the right. There was no change in color, and the testicle was firm and nontender. The physical findings were otherwise unremarkable.

For years, babies born between 32 and 36 weeks'gestation have been thought to have developmentaland neurological outcomes similar to those offull-term infants. Although studies have shownthat these infants are at greater risk for short-termmorbidities, such as respiratory distress, hyperbilirubinemia,hypoglycemia, and feeding problems,1 little researchhad been done regarding school outcomes for moderatepreterm(32 to 33 weeks) and late-preterm (34 to 36weeks) infants. Now a study in The Journal of Pediatricsby Chyi and colleagues2 has shown that these infantsmay also be at greater risk for difficulties in school laterin life.

Pregnant women with pregestational diabetes mellitus are more likely than pregnant women with gestational diabetes mellitus to have a child with birth defects, according to a report published online July 31 in the American Journal of Obstetrics & Gynecology.

Babies conceived spontaneously and as a result of assisted fertilization by the same woman have similar risks of adverse outcomes, meaning that adverse outcomes among assisted fertilization babies may be attributable to the underlying causes of infertility rather than the fertility treatment itself, according to a report published online July 31 in The Lancet.

Former US Surgeon General and pediatrician Julius B. Richmond, MD, has died of cancer at age 91, as reported by the American Academy of Pediatrics.

For 2 days, an 11-month-old girl had a progressively worsening rash and subjective fever (A). The rash began on the legs as bumps, which later became large violaceous lesions (B) and spread to the face, arms, and trunk.

Eating foods enriched with conjugated linoleic acid (CLA) may increase CLA levels in breast milk, which may confer health benefits to babies, according to Nutrition Research.

English childhood cancer survivors are significantly less likely to smoke than the general British population, according to an article published online July 29 in the Journal of the National Cancer Institute.

Twenty-two-month-old girl seen in the emergency department (ED) after several hours of abdominal pain associated with non-bloody, non-bilious emesis. Over past 2 months, has had 7 or 8 similar episodes of abdominal pain followed by emesis 1 to 2 hours later.

Annual per-capita government health expenditures are associated with survival of children with cancer in 10 low- and middle-income countries, and half of these countries offer very poor chances of survival for these children, according to research published in the August issue of The Lancet Oncology.

A gene linked to obesity may also have a hand in influencing appetite in children, according to the Journal of Clinical Endocrinology & Metabolism.

Increased consumption of fruits and vegetables may decrease the risk of diabetes mellitus, while increased consumption of fruit drinks may increase risk, and diets low in fat have no effect on development of diabetes, according to three articles published in the July 28 issue of the Archives of Internal Medicine.

Sustaining a 10 percent or more weight loss requires fairly high levels of physical activity in combination with reduced energy intake, according to an article published in the July 28 issue of the Archives of Internal Medicine.

After six months of a gluten-free diet, calcium metabolism defects returned to normal in a study of children with celiac disease, as reported in the August Journal of Pediatrics.

In HIV-infected mothers, risk of HIV transmission to their uninfected breast-feeding infants may be reduced by a prolonged postpartum course of nevirapine, according to an article published in the July 26 issue of The Lancet.

The age at which the protective effect of maternal measles antibodies wears off varies widely from region to region and should be taken into account when formulating optimum immunization strategies, according to an editorial published online July 24 in BMJ.

There were 43 cases of West Nile virus reported from 14 states this year up to July 22, according to a report published in the July 25 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

A school-based vaccination clinic was set up to control an outbreak of pertussis in a Cook County, Ill., high school after multiple recommendations to get vaccinated went unheeded, according to a report published in the July 25 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

ADHD diagnoses for children ages 6 to 17 have on average increased 3% per year from 1997 through 2006, according to the Centers for Disease Control and Prevention (CDC).

Investigators from the Centers for Disease Control and Prevention (CDC) report that the highest rates of tuberculosis come from immigrants and refugees from Africa, Asia, and South America, according to Reuters.

The emergence of a fourth tier of copayment for expensive drugs calls into question how Americans are going to handle the rising costs of health care, according to a perspective article in the July 24 issue of the New England Journal of Medicine.

The Genetic Information Non-discrimination Act (GINA), recently signed into U.S. law, creates a troublesome distinction between those at genetic risk for a disease and those with other characteristics that predispose them to a condition, according to a perspective article published in the July 24 issue of the New England Journal of Medicine.

Doctors using an electronic prescriptions system will be eligible for a bonus from Medicare from 2009 onwards for four years, according to U.S. health officials.

Prophylactic antibiotics administered to children an hour or less before spinal surgery may reduce the subsequent risk of infections, according to the online Pediatric Infectious Disease Journal.

The use of topiramate as monotherapy or as an adjunct to other treatment for epilepsy during pregnancy raises some concerns about the increased risk of congenital malformation, according to a report published in the July 22 issue of Neurology.

Many adolescent boys with a varicocele will have "catch-up" growth that reduces their testicular size discrepancy without requiring surgical repair, according to research published in the July issue of Urology.

A review of studies published in the International Journal of Adolescent Medicine and Health has found a link between bullying, being bullied, and suicide among children.