sucked the fingers of her left hand while petting an animal or &dquo;mak-

ing nice&dquo; to her infant brother. The finger-sucking was done in a characteristic manner, which was not reproduced except while petting. The maternal grandmother indicated that my patient’s mother had done exactly the same thing as a child. Although I recognize the limitations of retrospective anecdotal material, I can think of no reasonable explanation aside from heredity for the remarkable similarity between the behaviors of mother and child. Since this is a very unusual and highly specific behavior, neither coincidence nor copying is an acceptable explanation. If we permit ourselves to accept the possibility that behaviors like nail-biting, hair-twirling, and suckingpetting are genetic, we are faced with a number of fascinating questions for speculation. Can &dquo;one gene, one protein&dquo; explain the genetic mechanism? Is there a more efficient way to code for such complexity that would be less expensive in DNA? Perhaps there is a way to code for a set of iterative actions to create both structural and behavioral patterns the way a relatively simple fractal command can trace the outline of a complex fern. Meanwhile, I still have little success in helping people to stop biting their nails. WL. Lupatkin, M.D. Clinical Assistant Professor Columbia University College of Physicians and Surgeons New York, New York Attending Pediatrician Morristown Memorial Hospital

that monozygotic twins are concordant for the habit of nail-biting with approximately twice the frequency of dizygotic twins’ suggests some degree of hereditability. Actual estimation requires the

population incidence, monozygous and dizygous concordance rates, and a zygosity determination. It is estimated that 75% to 95% of infants2 and 30% to 45% of preschool children’ suck their thumbs.

sidered

1990:29;690-692.

The authors reply: We appreciate the opportunity to respond to the letter by Dr. Lupatkin. The fact

con-

a

To The Editor: The article &dquo;Varicella pneumonia as the presenting manifestation of immunodeficiency&dquo; is good and has clinical teaching value. But did I miss something? What were the HIV test results in the two cases presented? Please convey to Dr. Saulsbury how much I appreciated this well-presented paper. Gary Gorlick, M.D. Los Angeles, California

replies: I, in turn, apDr. Gorlick’s kind compreciate ments. Patient 1 was not tested for HIV before being lost to follow-up. Neither of her parents, however, had any risk factors for HIV infection. Patient 2 is HIV seronegative. Frank T. Saulsbury, M.D. The author

Associate Professor

Department of Pediatrics University of Virginia Health Sciences Center Children’s Medical Center

activities.’ Alexander K.C. Leung, M.B.B.S.,

typed movements

or

F.R. C.P. (C), F.R. C.P. (Edin) William Lane M. Robson, M.D., F.R. C.P. (C) D. Ross McLeod, M.D., F.R. C.P. (C)

Department of Pediatrics University of Calgary Alberta Children’s Hospital Calgary, Alberta, Canada 1.

Bakwin H, Bakwin RM. Behavior Disorders in Children. Philadelphia, PA:W.B. Saunders Co; 1972:510.

2.

Larsson EF, Dahlin KG. The prevalence and the etiology of the initial dummyand finger-sucking habit. Am J Orthod.

3.

Baalack IB, Frisk A. Finger-sucking in children: a study of incidence and occlusal condition. Acta Odontol Scand.

4.

Leung AK, Robson WL. Thumb-sucking. Am Fam Physician. In press. Comings DE, Comings BG. A controlled study of Tourette syndrome. IV. Obsessions, compulsions, and schizoid behaviors. Am J Hum Genet. 1987; 41:782-803.

1985;87:432-435.

1971;29:499-512.

Leung AKC, Robson WLM. Nail-biting. Clin Pediatr.

be

is

normal stage of development which, in some children, becomes a habit.4 Although there may be a genetic predisposition to thumb-sucking, the wide prevalence of this habit makes the study of its heredity difficult. Dr. Lupatkin’s observation of the 21/2-year-old child and her mother with coincidental finger-sucking and animal-petting is fascinating. Although a causal relationship cannot be established based on a single case report, genetic factors have been associated with other stereo-

Morristown, New Jersey 1.

Thumb-sucking to

HIV Status in Varicella Pneumonia

5.

Charlottesville, Virginia

Protein-Losing Enteropathy Associated with Rubella To The Editor: Dr. Belamarich and colleagues suggested that varicella infection can incite protein-losing enteropathy (PLE) .’ We would like to report a patient in whom there was a close association between the development of PLE and the onset of rubella. An 11-year-old female was referred to Sasebo Kyosai Hospital because of abdominal pain, vomiting, and diarrhea in May 1987, when rubella was epidemic in Sasebo, Japan.9 For the preceding few days, she had had fever and a morbilliform rash. There was no past medical history of rubella or

significant gastrointestinal problems.

Downloaded from cpj.sagepub.com at MICHIGAN STATE UNIV LIBRARIES on June 13, 2015

Her

initial

examination

703

showed only the morbilliform rash and enlarged postauricular and cervical lymph nodes. On the fourth hospital day, however, it was recognized that she had edema and ascites. Laboratory data revealed serum total protein and albumin concentrations of 4.5 g/dL and 2.7 g/dL, respectively. Stool studies for pathogenic bacteria and ova and parasites were all negative. Serial urinalyses and chemical tests of liver and kidney function were normal. The (xi-antitrypsin clearance was

elevated,

at

22.4

mL/day

(normal:

Protein-losing enteropathy associated with rubella.

sucked the fingers of her left hand while petting an animal or &dquo;mak- ing nice&dquo; to her infant brother. The finger-sucking was done in a char...
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