Greetings. Three questions for everyone: 1) I had a 7-week old female in today with a 5 day hx of projectile vomiting about every other feeding, gaining weight well (for now), constantly hungry, previous exams all wnl. (Also a slight cough and a self-resolving 101F rectal temp last night with mild diarrhea.) Physical exam was significant for the presence of an "olive" in the substernal region. The mother had also noticed this about two days ago and states that this is a new finding. Sounded like classic pyloric stenosis to me -- I sent the kid up to the hospital for an upper GI series and got myself ready to call Riley Children's Hospital in Indianapolis for the inevitable surgery. About two hours later, I got a call from radiology. _Negative_. I had the family come back down with the films. Yep, the emptying was apparently normal (confirmed by a gastroenterologist who looked at them for me as well.). The "olive" was still present when they returned. I spoke with my alternate supervising MD on the phone (my usual supervising is out of town for three weeks), who said that it sounded like pylorospasm and recommended 1 cc of Benadryl q6h, attempting to burp the child after every .5oz of formula, and having her sleep at a 45 degree angle. I relayed this to the parents and am having them come back Friday am for a weight check and to see how things are going. I'm still a bit concerned -- I looked in several texts, and all stated that the "olive" is virtually pathgnomonic for pyloric stenosis. Aside from the negative upper GI, the entire story is classic for pyloric stenosis. The emesis is non-bilious, and chest and plain abd films are negative as well. Does anyone have any thoughts on what could be going on here? 2) A five y.o. child came in for a school physical. The mom points out that she often will write names backwards "NHOJ" for "John". However, with time, she's been starting to write "correctly". In my presence she wrote her name correctly. Does this warrant a referral for dyslexia or some other form of learning disorder? (I've been unable to find anything definitive on this symptom, and I thought I'd wait until my supervising returns next week and run it by him then...) 3) One more point: A mother had seen the 20/20 piece on adverse reactions to the Hep B vaccine and doesn't want her twin boys to have the second shot in the series. Any points to "rebuttals" of those pieces or comparative data? I told her I'd try to put together some material and we could discuss it at the next visit, when they're due for the vaccinations. (I realize these shows are trying to educate the public, but one wonders why they don't also show us pictures of people suffering from HepB...I think this is why I gave up on US broadcast media years ago...) Thanks in advance -- I appreciate any help... Peace and Prosperity, Dipesh -<*>------------------------<*>- Dipesh Navsaria, MPH, PA-C Physician Assistant, Pediatrics Champaign & Danville, Illinois ()