bluuebunny/crossref_metadata_2025 huggingface dataset:
ANTIHISTAMINES IN TOPICAL PREPARATIONS
Authors: Yaffe Sumner J. , Bierman Charles W. , Cann Howard M. , Gold Arnold P. , Kenny Frederic M. , Riley Harris D. , Schafer Irwin , Stern Leo
Published: December 2021

Antihistamines were introduced in France by Halpern in 1942 and in the United States at the end of World War II; they had been investigated extensively during the war for therapy of motion sickness. By the late 1940s, a mass of information on the structure activity relationship had accumulated and most major drug manufacturens had introduced antihistamines into the market for oral, parenteral, and topical administration. Topical use was efficacious in acute dermatitis because the local anesthetic activity of the drugs diminished pruritus.

The first reports of sensitization to the topical antihistamines, which began to appear in 1947, incriminated tnipelennamine (Pyribenzamine), diphenhydramine (Benadryl), antazoline (Antistine), and pheniramine (Trimeton).1-4 In the ensuing 25 years, though thousands of instances of antihistamine contact dermatitis have occurred, many topical antihistamines remain on the market. The Committee is concerned about the use of topical antihistamines which are sold over the counter for use in such conditions as chickenpox and poison ivy. Table I lists most of the preparations currently available for topical use.

CLASSES OF ANTIHISTAMINES

The antihistamines are classified according to their chemical structure into five primary groups as shown in Table II. Each drug carries its own index of sensitization and other adverse effects when employed topically. The ethylenediamine derivatives include the following: antazoline phosphate (Antistine), promethazine hydrochloride (Phenergan*), and tripelennamine (Pyribenzamine). They are particularly active in inducing contact dermatitis and were responsible for the cases first reported.5,6 Ethylenediamine, because of its dibasic structure, is widely used in various organic syntheses for the preparation of dyes, inhibitors, rubber accelerators, fungicides, synthetic waxes, resins, insecticides, and asphalt-wetting agents.
Recurrent Abdominal Pain: Recurrent Controversy
Authors: Deamer William C.
Published: December 2021

The article on recurrent abdominal pain, headache and limb pains by Dr. Øster1 in the September issue of Pediatrics will, I am sure, bring almost as much reader comment as was generated by Dr. Barbero's2 May 1970 article on recurrent abdominal pain.

In one series of 96 children with the allergic tension-fatigue syndrome seen in our Pediatric Allergy Clinic and privately, the six most common complaints–other than respiratory tract symptoms which usually motivated their referral–were in order: headache, 61%; recurrent abdominal pain, 58%; nervous tension or irritability, 52%; pallor, 52%; fatigue or tiredness, 47%; and limb pains, 36%.
Wilson-Mikity or Meconium Aspiration Syndrome?
Authors: Cohen Morton L.
Published: December 2021

In reporting the third case of Wilson-Mikity syndrome in a full-term neonate, Drs. Keidel and Feingold1 appear instead to have described a classic case of meconium aspiration syndrome. Their patient, delivered with difficulty at 41 weeks' gestation, aspirated meconium at the time of delivery and was severely asphyxiated at birth. Respiratory distress developed after resuscitation and the baby was noted to have "diffuse granularity of both lung fields and hyperinflation indicating meconium aspiration." Later, when the chest film showed "hyperexpanded lungs with depressed diaphragms and cyst-like foci alternating with coarse infiltrates" their diagnostic impression apparently changed to Mikity-Wilson syndrome.
Review of Recent Evidence of Toxic Effects of Hexachlorophene
Authors: Kimbrough Renate D.
Published: December 2021

The published data on the toxicity of hexachlorophene in animals and man are discussed. Studies performed in the author's laboratory including hexachlorophene blood level determinations in animals and man are also reviewed. Hexachlorophene can produce paralysis in rats, rabbits, cats, and pigs and blindness in sheep. Microscopic examination of the brains of rats and monkeys given repeated doses of hexachlorophene shows status spongiosus of the white matter and normal gray matter. Small amounts of hexachlorophene are absorbed through the skin of animals as well as man. Aside from the neurological effects of hexachlorophene, the chemical uncouples oxidative phosphorylation which may cause body temperature elevation.
A PERSPECTIVE ON HEXACHLOROPHENE
Authors: Gluck Louis
Published: December 2021

Hexachlorophene is highly effective in the control of colonization and disease with Staphylococcus aureus in both normal and high risk nurseries, when properly used, including correct cord and skin care.

However, much more about this compound needs to be known, particularly more about the metabolism in the human, absorption, excretion, body storage, tissue distribution, and so forth.
COMMENTS ON FDA HEXACHLOROPHENE POSITION PAPER
Authors: Trout Monroe E.
Published: December 2021

I would like to comment on several points made in the FDA position paper.

It is our understanding that the death from staphylococcal disease which occurred in Florida was that of an infant who was not bathed with hexachlorophene. As a matter of fact, in that hospital there was marked conflict among the staff. Some had their babies bathed with hexachlorophene and others did not. The staff members themselves did not know which infants were or were not bathed with hexachlorophene in that particular nursery nor the manner in which they were bathed. However, I think that one thing is quite obvious and that is that there was a definite break in the nursery routine from a position of having all the babies bathed with hexachlorophene to a haphazard bathing with a resultant rise in staphylococcal disease.

I think the FDA's allusion to neuropathological changes in autopsy material from California have been adequately answered by Dr. Davis' studies which were presented at this meeting. I do think that a false impression is left with the reader if he only reads FDA's comments about this study in California. It is interesting to note that there were two representatives from the University of Cincinnati present at the conference and neither one of them mentioned any study about neuropathological changes in infants at the University of Cincinnati. However, obviously something was communicated to the FDA but I find it strange that no mention was made of the study during the discussion of neuropathology at the conference
THE ASSESSMENT AND RECORDING OF MEASUREMENTS OF GROWTH OF CHILDREN: REPORT OF A SMALL CONFERENCE
Authors: Owen George M.
Published: December 2021

The most widely used standards for height and weight, those of Stuart and Meredith, are still appropriate references, although they do not accurately represent the U.S. child population. New standards based on current measurements of more representative population samples should be substituted and their use promoted. The American Academy of Pediatrics and the Maternal and Child Health Service are currently exploring arrangements to accomplish this goal. Studies should be undertaken to ascertain the effectiveness of routine physical measures for detecting disorders of growth as indicators of significant disease.

If measures other than length-height, weight, and head circumference prove meaningful for evaluating physical growth and if more productive interpretations of traditional physical growth data become possible, the American Academy of Pediatrics should disseminate this information and encourage its application through educational programs. Included in such an effort should be development of recording instruments which would increase accuracy, encourage and facilitate use of these measures, and enhance their interpretation.
TRANSIENT BACTEREMIA DURING DENTAL MANIPULATION IN CHILDREN
Authors: Berry Frederic A. , Yarbrough Sandra , Yarbrough Nelson , Russell Catherine M. , Carpenter Martha A. , Hendley J. Owen
Published: December 2021

Pediatric patients with moderate to severe dental abnormalities were screened for bacteremia during restoration and/or extraction of carious teeth under general anesthesia. Blood cultures were obtained before nasotracheal intubation, after intubation, after restoration of carious teeth but before extraction, following extraction of teeth, and in the immediate postoperative period. All cultures before intubation were negative in the 34 children studied. Twelve percent were positive after nasotracheal intubation (p < .05), 16% were positive after restoration of carious teeth (p < 0.025), 65% were positive after extraction of carious teeth (p < .0005), and 14% were positive in the recovery room (p < .025).

Although the incidence of bacteremia in these pediatric patients was lower than the incidence reported in adults following dental procedures, the need for the prophylactic administration of antibiotics in children with heart disease who are to undergo dental manipulations is clear.
EFFECTS OF CONTINUOUS NEGATIVE PRESSURE ON LUNG MECHANICS IN IDIOPATHIC RESPIRATORY DISTRESS SYNDROME
Authors: Bancalari Eduardo , Garcia Otto L. , Jesse Mary Jane
Published: December 2021

Changes in lung mechanics produced by continuous thoracic negative pressure, (CNP) were determined in twelve newborn infants with idiopathic respiratory distress syndrome (IRDS).

CNP produced a significant increase in arterial oxygen tension, with no change in pH, and HCO-3.

Minute ventilation decreased with CNP but Paco2 did not change significantly, suggesting a reduction in physiologic dead space while CNP was applied.

Functional residual capacity increased to 127% of its initial value, after the institution of CNP.

Dynamic lung compliance decreased to approximately 56% of its previous value with CNP. This change in compliance may be explained if the increase in FRC was not only due to expansion of collapsed alveoli, but also to overdistention of the functioning units.
CAPILLARY BLOOD SAMPLING IN THE INFANT: USEFULNESS AND LIMITATIONS OF TWO METHODS OF SAMPLING, COMPARED WITH ARTERIAL BLOOD
Authors: Hunt Carl E.
Published: December 2021

Measurements of simultaneous arterial, histamine capillary (HC), and plain capillary (PC) pH, Pco2 and Po2 in 46 infants have indicated the clinical usefulness and limitations of blood so obtained.

Arterial, HC, and PC pH can be used interchangeably for calculation of base deficit (BD). HC and PC Pco2 are identical, but average 10 mm Hg more than Paco2 within the usual clinical range. The resultant error in capillary BD as compared to arterial or venous BD can be minimized by the regression equation: arterial BD = 1.3 (PC BD) + 3.9.

For Po2, the two capillary methods are comparable when the Pao2 is less than 60 to 70 mm Hg. By either capillary method, a Po2 of 30 represented an average Pao2 of 30, 50 represented 60 and a capillary Po2 of 60 indicated a Pao2 of approximately 90 mm Hg. A PC or HC Po2 greater than 60 to 70 mm Hg did not allow for an accurate and reliable estimation of Pao2. When concerned with a precise quantitation of cardiopulmonary status in any critically ill infant, therefore, there is still no substitute for arterial sampling.
RESPONSE TO DIETARY THERAPY IN B12 UNRESPONSIVE METHYLMALONIC ACIDEMIA
Authors: Nyhan William L. , Fawcett Nancy , Ando Toshiyuki , Rennert Owen M. , Julius Richard L.
Published: December 2021

A 14-month-old girl with a virtual arrest in development at a 3-month stage was found to have methylmalonic acidemia. She was unresponsive to large doses of B12 or of dimethylbenzimadazole cobamide. Dietary therapy was devised to restrict protein containing isoleucine, threonine, valine, and methionine to the amounts required for growth. She had a dramatic response both clinically and chemically. Catch-up somatic growth was matched by growth in head size and intellectual development. These observations indicate that marked improvement in brain function may occur during the treatment of metabolic disease, even well after a year of age.
TO TAP OR NOT TO TAP
Authors: Menkes John H.
Published: December 2021

In a paper, published in the current issue of Pediatrics, Margolis and Cook1 stress the risk of a so-cabled routine lumbar puncture performed on infants with primary pulmonary or cardiac disease. Their experience, that in such instances a lumbar puncture may induce respiratory or cardiac arrest, prompts one to reexamine indications for this procedure. As a rule, we should have a specific question or questions which we hope can be answered by examination of the CSF. The more relevant this question to the diagnosis and treatment of a patient, the greater the risk that can be taken in obtaining spinal fluid.
The Response of Leukocytes in the Peripheral Blood During and Following Exchange Transfusion in the Newborn
Authors: Xanthou M. , Nicolopoulos D. , Gizas A. , Matsaniotis N.
Published: December 2021

Serial leukocyte counts were done on 12 full-term and eight premature jaundiced babies during exchange transfusions and daily thereafter until the ninth day, in order to study changes in each cell type. The main changes were found to be (1) a marked reduction in all cell types during the procedure with a statistically significant difference in absolute values before and after; (2) significantly lower values of the polymorphonuclear neutrophils and eosinophils in the baby's blood at the end of the transfusion compared with those of the donor's blood, with the monocytes and lymphocytes showing no statistically significant change; and (3) a remarkable rise in each cell type starting soon after the procedure and reaching a peak within the week following the transfusions. Comparison of absolute values during the post-transfusion days with those found in normal babies of corresponding postnatal age showed that the polymorphonuclear neutrophils and eosinophils were significantly increased, the lymphocytes unchanged, and the absolute values of monocytes decreased compared to those of normal babies.
THE EFFECTS OF RAPID INFUSION OF HYPERTONIC SODIUM BICARBONATE IN INFANTS WITH RESPIRATORY DISTRESS
Authors: Siegel Sharon R. , Phelps Dale L. , Leake Rosemary D. , Oh William
Published: December 2021

The effects of rapid intravascular infusion of 0.9 M sodium bicarbonate were evaluated in 18 full-term and premature newborn infants who had predominant metabolic acidosis associated with respiratory distress. During the 30-minute postinfusion period, the hematocrit fell at three minutes from 50% to 45% (p = < .001), and returned to 46.5% at 30 minutes (p = < .02); the serum sodium rose from 135 mEq/liter to 141 mEq/liter (p = < .05) at three minutes and then returned to 136 mEq/liter at 30 minutes; the osmolality increased from 278 mOsm/liter to 287 mOsm/liter at three minutes (p = < .001) and returned to 281 mOsm/liter at 30 minutes; and the arterial blood pressure rose from a baseline of 46.8 mm Hg to 48 mm Hg at One minute (p = < .05), dropped below the baseline at 15 minutes (p = < .05), and rose almost to the baseline at 30 minutes. These results suggest that rapid intravascular infusion of hypertonic sodium bicarbonate may lead to an increase in intravascular volume. No significant clinical symptoms related to central nervous system insults were observed.
ABNORMAL THYROXINE METABOLISM IN HYPOSOMATOTROPHIC DWARFISM AND INHIBITION OF RESPONSIVENESS TO TRH DURING GH THERAPY
Authors: Porter Basil A. , Refetoff Samuel , Rosenfield Robert L. , De Groot Leslie J. , Fang Victor S. , Stark V.
Published: December 2021

Thyrotropin (TSH) release and thyroxine metabolism have been studied in order to determine whether human growth hormone (GH) administration is causally related to the occasional development of secondary hypothyroidism in GH-deficient dwarfs. Five hyposomatotrophic dwarfs and one normal child were studied. The TSH response to synthetic thyrotropin-releasing hormone (TRH) was normal in all, regardless of thyroid functional status. Before GH administration, two of the three clinically euthyroid dwarfs were found to have daily thyroxine degradation rates in the hypothyroid range although serum total and free thyroxine levels were normal. Following six to ten days of GH treatment, TSH levels fell slightly and the TSH response to TRH was blunted. During long-term GH treatment of four dwarfs no significant change in thyroid function was observed. In addition, TSH responsiveness to TRH recovered in three of these four chronically treated patients, including one who was frankly hypothyroid. The growth rate of the three clinically euthyroid dwarfs improved during long-term GH therapy; nevertheless, the addition of 50µg triiodothyronine to the treatment regimen of the dwarf in whom the thyroxine degradation rate was lowest resulted in a markedly improved growth rate.

These studies indicate that a state of hypothyroidism that is undetectable by measurement of total serum thyroxine and free thyroxine exists in some GH-deficient patients. GH may be necessary for normal thryoxine metabolism and action. Such a GH effect might explain the observed influence of GH on TSH release. On the other hand, the demonstrated abnormality in thyroxine metabolism may result from mild, preexisting TSH deficiency.
SUBACUTE NECROTIZING ENCEPHALOMYELOPATHY (LEIGH'S DISEASE): DETECTION OF THE HETEROZYGOUS CARRIER STATE
Authors: Murphy Jerome V.
Published: December 2021

Urines from the seven parents of patients with subacute necrotizing encephalomyelopathy (Leigh's disease) clearly inhibit the synthesis of thiamine triphosphate. The incidence of this urinary inhibitor in other relatives indicates that the heterozygous carrier state of Leigh's disease can be detected by utilizing this assay. Analysis of urine for this inhibitor should be valuable in the accurate genetic counseling of relatives of patients with this disease.
VELOCITY GROWTH
Authors: Falkner Frank
Published: December 2021

The concept of velocity, or incremental, growth is difficult for some to grasp, perhaps because of a deeply embedded misconception that a baby starts to grow and does so steadily through the seven ages of man. But the rate or speed of growth is clearly not constant, nor are its inconstancies themselves constant in all individuals. The changes that occur in any growing child can only be revealed if growth is seen as a varying continuum. Therefore, we must not only study growth velocity and show how much this varies at various ages, what patterns of growth are being revealed by this approach, and what they can tell us about the growth of pediatric patients.
Pediatric Nursing, ed. 2, by Helen C. Latham, R.N., M.L., M.S., and Robert V. Heckel, B.S., M.S., Ph.D., with the collaboration of Joyce A. Vermeersch, B.S., M.P.H. St. Louis: The C. V. Mosby Company, 1972, 490 pp., $9.75
Authors: Stevens A. Denise
Published: December 2021

The major emphasis in the book appears to be on normal growth and development, the child in society, and psychological reaction to hospitalization. Yet it does not discuss stage theories of personality development, such as those of Erik Erikson, which are now commonly used in laying the foundation for principles of growth and development with students in pediatric nursing.

Its treatment of disease conditions is general and written in very simple terms. (Example: in discussing rheumatic fever, there is no mention of major and minor manifestations, and only the major symptoms of carditis, polyarthritis, and chorea are discussed, and briefly, at that.)
Pediatric Therapy, ed. 4, edited by Harry C. Shirkey, B.S. (Pharm.), M.D., F.A.A.P. St. Louis: The C. V. Mosby Company, 1972, 1221 pp., $34.50
Authors: Lovejoy Frederick H.
Published: December 2021

The fourth edition of Pediatric Therapy is impressive for its completeness and its wealth of practical information. Included in its 120 chapters are the contributions of some 96 writers. The price is high but the reader will obtain his money's worth for a book that serves superbly both as a manual for the management of pediatric disease and as a resource text on therapeutics. The book is clearly written, concise, well organized, and carefully indexed.
ROLE OF THE COURTS
Authors: Kelley Florence M.
Published: December 2021

It is important to know what the courts can do and cannot do in the area of abused and neglected children.

Often the Family Court is listed as an agency. It is not an agency. It is part of the court system. Its operation is circumscribed by the concept of being a real court. For a long time there was a theory that the Family Court or Juvenile Court could be a kind of social work oriented operation, not quite a real court, not truly a social work agency. This concept has been abandoned.

The Family Court is a court of record and is in all aspects a court. It is dependent in the action it takes on evidence which must conform to strict rules that are laid down. It is an adversary proceeding. It is not enough to produce a child that looks as if it has been beaten. A judge in the Family Court also has before him the person who may be charged with having beaten the child. That person, be it a parent or guardian, is entitled to counsel, to help in his defense. The adversary process then takes place. Persons bring forth evidence to show that the parent did abuse the child. The parent is enabled under the court system to bring forth before the judge evidence that he or she did not do it. It is then up to the judge to give this evidence due weight and make a decision as to whether or not the allegations have been proven.
ENVIRONMENTAL INTERACTION AND MEMORY DURING PETIT MAL (ABSENCE) SEIZURES
Authors: Freemon Frank R. , Douglas Eustace F. O. , Penry J. Kiffin
Published: December 2021

The authors reviewed videotape records of petit mal or absence seizures in order to examine psychologic components of the petit mal attack. Four patients are reported in detail and specific seizures from four other patients are mentioned. Many seizures were associated with the retention of visuomotor coordination. Some patients attended to an auditory cue and produced a verbal response during a seizure. The degree of memory loss for events occurring during a seizure varied from complete amnesia to total retention of memory. The authors conclude that most neurology textbooks oversimplify the complex mental changes which accompany a petit mal attack.
DIAGNOSTIC USE OF IODINE 131 IN CHILDREN
Authors: Treves S. , Crigler J. F.
Published: December 2021

An interesting case report of thyroid carcinoma in this issue1 reflects the concern of many pediatricians regarding the use of iodine 131 (131I) for diagnostic purposes in children. Perhaps it is time to review the role of the use and the safety of iodine 131 thyroid uptake and scan in evaluation of disorders of the thyroid gland in children.

With today's technology, thyroid uptake determinations can be performed with extremely low amounts of iodine 131. Large sodium iodine crystals of high sensitivity and long counting time allow doses of a fraction of 1 microcurie (i.e., = 0.1 to 0.5µCi), with a resulting thyroid absorbed dose varying with age but always much lower than that in the case report.1
Complete Heart Block After Cardiac Catheterization: A Rare Complication
Authors: Freed Michael D. , Rosenthal Amnon
Published: December 2021

A case report of a 4-year-old girl with tetralogy of Fallot who developed A-V dissociation during cardiac catheterization is presented. His bundle electrograms performed six days later localized the block proximal to the recorded His potential. The child has been followed for six months and is well with alternating Wenckebach and first degree heart block.
DAY CARE FOR HANDICAPPED CHILDREN
Authors: Kugel Robert B. , McMahon Jean L. , Bartram John B. , Berenberg William , Cavanaugh James J. A. , Hansen Virgil , Kennell John H. , Lorincz Andrew E. , Pearson Paul H. , Scott Roland B. , Scurletis Theodore D. , Taft Lawrence T. , Browner J. Albert , Halpern Daniel , Whelan Richard J.
Published: December 2021

Day care programs oriented to the developmental needs of infants and young children should be established throughout the United States and should be available to all parents who wish to enroll their children. Excellent day care programs with a well-trained, child care staff, progressive educational programs, and comprehensive child health care services can benefit many children of this country, including those who are handicapped.

Whenever possible, handicapped children should be integrated into the same groups and programs as other children. The physical, emotional, social, and intellectual characteristics children share are greater than the differences caused by any handicap. No children should be isolated, segregated, or excluded. Day care facilities should be planned to include the needs of handicapped children. They should be free of physical barriers that would limit their use by a handicapped child; they should also contain provisions for the use of wheel chairs, grab bars, and other locomotive devices. The staff for programs with provisions for the handicapped will generally need additional training and be larger than that for programs for normal children; and the class size will often be smaller.

Even when day care programs are available for all children, the need for special programs for the handicapped will be great. Some special programs can be provided as a supplement to the day care program, for example, physical therapy and speech training for a child with cerebral palsy. Some infants and preschool children with handicaps may require separate programs in centers with a specially trained staff for a few months or years, for example, those who are blind, deaf and blind, autistic, and severely mentally retarded.
Corticosteroids as Primary Therapeutic Agents in Respiratory Distress Syndrome (RDS)
Authors: Farrell Philip M. , Zachman Richard D.
Published: December 2021

The long awaited article by Liggins and Howie1 was received with great enthusiasm. Although one must remain cautiously optimistic, it would appear that for the first time an agent is available which transcends the previous methods of supportive management and provides at least a primary approach to prophylactic therapy for RDS. Their data for steroid-treated infants of 26 to 32 weeks' gestation are impressive statistically and the incidence of RDS in the control group (69.6%) is a credible figure based on current estimates.2
Treatment and Prolonged Observation of Urinary Tract Infections
Authors: Strauss José , Askin John , Mitnik Mario , Lynne Charles
Published: December 2021

The report by Matthew Cohen,1 which appeared last August in Pediatrics, encompasses many aspects of diseases of the genitourinary tract which should be of interest to pediatricians in general and pediatric nephrologists and urologists in particular. One of the most important clinical observations stressed by Dr. Cohen is that a child with a properly documented urinary tract infection should be kept under prolonged observation. His arbitrary recommendation of six years coincides with our own teaching that the overall care and observation of these patients should be similar to that for rheumatic fever or tuberculosis.
Letters to the Editor
Authors: Cohen Matthew
Published: December 2021

I wish to thank Dr. Strauss and associates for their pertinent letter. Their remarks and the previous correspondence with Dr. Todd1 are of practical importance in the treatment of urinary tract infections.

I agree that x-rays should be performed early in the course of urinary tract disease but I did not state that radiologic evaluation of a girl's urinary tract infection is unnecessary if her urinary tract infection responds to an antibiotic.

I can only reinforce Dr. Strauss' statement that the goal of treatment is to conserve renal tissue.
PNEUMATOCELES ASSOCIATED WITH ESCHERICHIA COLI PNEUMONIAS IN THE NEWBORN
Authors: Kuhn Jerald P. , Lee B.
Published: December 2021

The radiological and clinical findings in three cases of neonatal Escherichia coli pneumonia complicated by pneumatocele formation are discussed.

In all three of the cases the pneumatoceles occurred as the pneumonia was resolving. Radiologically, the pneumatoceles were indistinguishable from the pneumatocele formation associated with staphylococcal pneumonia. Resolution of the pneumatoceles was slow but uncomplicated.
INDIAN HEALTH: AN UNMET PROBLEM
Authors: Mortimer Edward A.
Published: December 2021

This issue of Pediatrics contains (on page 1060) an article by Dr. Arthur Kaufman entitled "Gasoline Sniffing Among Children in a Pueblo Indian Village." Many readers may not appreciate one significant aspect of this study; it is an attempt to go beyond the problems of episodic or chronic organic diseases so much more pressing among Indians than in non-Indian children. For the facts are that physicians in the Indian Health Service have little time for this kind of study and reflection; they can do little more than the equivalent of putting out fires. At a time when most American children have adequate health care–and many perhaps suffer from too much–and when pediatricians are turning their attention to such problems as education, learning disorders, emotional development, and improving the quality of life for children, Indian children display too many health problems that have long ago been solved for most other children in this country.
THE INDIAN HEALTH SERVICE: COMMENTARY ON A COMMENTARY
Authors: Kemberling Sidney R.
Published: December 2021

As Chairman of the Committee on Indian Health of the American Academy of Pediatrics, I would like to comment on Dr. Mortimer's provocative commentary: "Indian Health: An Unmet Problem." In the main I agree with its content, but I would modify some of his statements and offer additional or alternative solutions.

Dr. Mortimer sees problems in the Albuquerque area, and he is inclined to generalize from them to the entire Indian Health Service. Although problems exist everywhere, they differ from area to area in their nature and severity. For example, in his first paragraph he refers to the fact that Indian Health Service physicians have little time for study, research, and reflection.
PSYCHOSOCIAL ASPECTS OF THE MANAGEMENT OF SEIZURES IN CHILDREN
Authors: Voeller Kytia K. S. , Rothenberg Michael B.
Published: December 2021

The authors present the impressions gained from their experiences with 266 patients in the pediatric seizure clinic of a general hospital. They conclude that the systematic inclusion of psychosocial dynamics and attention to personality development in the management of children with a variety of seizure disorders have both therapeutic and prophylactic value.

To utilize this approach, they outline specific techniques and principles which can be applied by the physician with little additional time commitment and with no special psychological or psychiatric skills.
Hypoglycemia Associated With Propranolol
Authors: McBride John T. , McBride Margaret C. , Viles Peter H.
Published: December 2021

The beta-adrenergic blocking agent, propranolol, has been recommended for both immediate treatment and long-term control of cyanotic spells in children with tetralogy of Fallot.1 It has also been suggested as the second drug of choice, after digitalis, in the management of paroxysmal supraventricular tachycardia.2 The use of propranolol in children with heart disease thus is increasing. We would like to call attention to the possible occurrence of hypoglycemia during periods of restricted oral intake in children receiving propranolol.

The most frequently cited side effects of propranolol are bronchospasm, bradycardia, hypotension, and congestive heart failure.3 Although not usually considered a side effect, hypoglycemia has been reported.4,5
THE PHYSICIAN AND THE DEAF CHILD
Authors: McMahon Jean , Kugel Robert B. , Bartram John B. , Berenberg William , Cavanaugh James J. A. , Hanson Virgil , Kennell John H. , Lorincz Andrew E. , Pearson Paul H. , Scott Roland B. , Scurletis Theodore D. , Taft Lawrence T. , Browder J. Albert , Halpern Daniel , Martin Edwin W.
Published: December 2021

Deafness is a handicap which seriously impairs a child's ability to develop his potential and usually precludes a normal relationship between him and society. Hearing impairments developed in thousands of children during the rubella epidemic of the mid-sixties. The present struggle of these youngsters to acquire language highlights the impact of deafness. Therefore, the Committee's attention is focused on this disability, and the need to cite the physician's responsibility to the deaf child becomes paramount.

One child in 1,500 is born deaf. Many more acquire deafness after birth, and 3 children in 100 have impaired hearing. The normal acquisition of language depends on the auditory system; and the relationship between normal language development and one's capability to function in society is obvious.

There is some disagreement about when a hearing impairment should be classed as deafness; and many resort to a functional description based on the need of the child to be educated in a school for the deaf. For the purposes of this statement, a child can be considered deaf if his threshold of hearing across the speech frequencies (i.e., from 500 through 2,000 cycles per second) is depressed 80 db (ANSI) in the better ear.

The importance of documenting the presence of hearing in the growing infant cannot be stressed too strongly. It is equally important to recognize the implications of the absence of normal hearing in a child. The physician who renders primary health care to the child and cares for him from the bassinet1 to adulthood should assume this task (the type, the extent, and the cause of hearing loss should be determined by otolaryngologists and audiologists).
On What Basis Are Decisions Made About Infants' Shoes?
Authors: Goldsmith Richard
Published: December 2021

I read with some interest your recent article on the question of infant shoes and pediatric prejudice by Dyment and Bogan.1 I probably would have given a hedging affirmative answer to "question 8." But I would wonder on what scientific basis this answer would be based.

It would be interesting to question the pediatricians on their own choice of personal footwear in relationship to foot and leg fatigue at the end of the long day.
Symposium On Myelomeningocele, by the American Academy of Orthopaedic Surgeons. St. Louis: The C. V. Mosby Company, 1972, 317 pp., $24
Authors: Welch Keasley
Published: December 2021

The American Academy of Orthopaedic Surgery is the representative society for that specialty in this country and the vehicle by which orthopaedics has taken a position of leadership in the area of continuing education. This symposium was held under the auspices of the Academy at Hartford and Newington, Connecticut, in November 1970.

Intended, according to the preface, "to bring an up-to-date overview of the philosophy, treatment methods, techniques, and general understanding of problems encountered in the management of patients with myelomeningocele and related disorders," the volume does just that and does so in an interesting, attractively prepared and well-illustrated format.
EFFECTS OF PHENOBARBITAL ON BILE SALT METABOLISM IN CHOLESTASIS DUE TO INTRAHEPATIC BILE DUCT HYPOPLASIA
Authors: Stiehl Adolf , Thaler M. , Admirand William H.
Published: December 2021

The effects of phenobarbital (PB) on bile salt metabolism in a patient with severe cholestasis due to congenital paucity of perilobular bile ducts were studied with 14C-cholate and 3H-chenodeoxycholate.

During the control period (without PB) cholate was the predominant bile salt in the peripheral blood, whereas chenodeoxycholate was predominant in the total bile salt pool. This difference in the distribution of the two primary bile salts appeared to be caused by relatively greater impairment of excretion of cholate from the liver cell into the bile.

PB administration caused a decrease in the total serum bile salt concentration (from 132 to 62µg/ml), in the total bile salt pool (from 412 to 304 mg) and in the biologic half-life (cholate from 106 to 34 hours; chenodeoxycholate from 77 to 42 hours). The proportion of the total bile salt pool present in the peripheral blood decreased from 16.8% to 11.7%. In addition, PB markedly increased the fecal bile salt excretion.

These data suggest the PB improves pruritus in this type of intrahepatic cholestasis by reducing serum bile salt concentrations. This is accomplished by a shift in bile salts from the peripheral blood into the enterohepatic circulation and by enhancing fecal bile salt excretion.
Letters to the Editor
Authors: Paradise Jack L. , Lewis Kathryn H. , Saitz Edward W. , Moriarty Richard W.
Published: December 2021

Most of the important and familiar problems in ambulatory pediatric teaching identified by Duff et al.1 must ultimately depend for their solution, as they and Green2 agree, on the success of efforts to achieve adequate financing of this aspect of medical education. Plainly, teaching problems are fewer and patient care is better when ambulatory faculties include full-time, pediatric generalists, and when supporting social and psychiatric services are available. Meanwhile, it seems important to consider low- or no-cost, alternative approaches in the quest for more effective teaching.
Letters to the Editor
Authors: Green Morris
Published: December 2021

While recognizing that the magnitude of the patient population who come to many of the ambulatory services in metropolitan centers makes personalized care difficult, it is clear that many individuals and institutions are actively exploring arrangements that attempt this.

The care of the person in health services, a practice championed by Blackfan, Schick, and Powers in the past and by Senn, Richmond, Solnit, Korsch, and others in the present, is a relatively new phenomenon in large ambulatory services.1
Recurrent Abdominal Pain: Recurrent Controversy
Authors: Poley J. Rainer , Bhatia Mira
Published: December 2021

We agree wholeheartedly with the comments made by Drs. Deamer and Sandberg1 referring to the article by Dr. Øster.2 Recurrent abdominal pain with and without chronic or intermittent diarrhea is a very common manifestation of intolerance to dietary proteins or "food allergy." In our experience, the most frequent offending proteins are milk proteins, soy proteins (various soy-protein formulas, also present in candy bars), and related leguminous proteins, as well as corn and the citrus family.
Early Recognition of Childhood Deafness
Authors: Austin Glenn
Published: December 2021

Some parents of deaf and hard of hearing children are impatient with American medical care and not without justification. The enclosed "Hearing Checklist"1 was put together by a parent, working for the volunteer organization "Foundation for Hearing Research Inc." She gathered the material from several sources after hearing that deaf infants are routinely picked up in New Zealand by observation in their clinics at 6 months of age. It is evidently rare to pick them up this early in the United States.
Practical Guidance for Office Pediatric and Adolescent Practice, by Byron B. Oberst, M.D., F.A.A.P., S.A.M. Springfield, Illinois: Charles C Thomas, 1972, 258 pp. $13.50 cloth, $9.75 paper
Authors: Teree Thomas M.
Published: December 2021

Although this book provides the reader with helpful hints about practice routines such as scheduling, charges, consultations, and the use of the telephone, it is rather a statement of the conventional wisdom which is supposed to transpire between the well patient-family complex and the pediatrician. Dr. Oberst and his colleagues have sharpened the blade of anticipatory guidance to a razor's edge and their methods should be known to all practicing child health specialists. Their system includes a mountain of literature, evening lectures, periodic questionnaires, frequent visits, and community involvement.
The Maltreated Child: The Maltreatment Syndrome in Children, ed. 2, by Vincent J. Fontana, M.D., F.A.A.P., with a foreword by Mother Loretto Bernard. Springfield, Illinois: Charles C Thomas, 1971, 96 pp., $7
Authors: Newberger Eli H.
Published: December 2021

"Today . . . the important battle continues between the child murderer and the child saver" (p. 8).

"There must be an acknowledgment by society, immediately, that the problem of child abuse and neglect does exist and is on the increase. Recognition of this syndrome as an index of social and parental delinquency should stimulate community cooperation through the establishment, if not already in existence, of organizations, protective agencies, and courts for better child protection." (p. 38)
THE RELATIONSHIP OF INTELLIGENCE AND CEREBRAL MANTLE IN TREATED INFANTILE HYDROCEPHALUS (IQ Potential in Hydrocephalic Children)
Authors: Young Harold F. , Nulsen Frank E. , Weiss Martin H. , Thomas Paula
Published: December 2021

Hydrocephalus in early life can often be so successfully treated as to allow children to live and grow with normal intelligence. Whereas untreated hydrocephalus allows only unpredictable intelligence when arrested, a far better prognosis holds for treated hydrocephalus. In an analysis of 147 patients with hydrocephalus treated by valveregulated ventriculovenous shunt, IQ can be related to ultimate frontal cerebral mantle. We have sought to correlate late IQ with the nature of the presenting abnormality, the age at which treatment was instituted, and the adequacy of control of the hydrocephalus as reflected in growth of cerebral mantle.

This analysis indicates that in certain specific situations, prognosis for good IQ is predictable. At the same time, the study suggests guidelines for adequacy of shunting and the urgency for early shunting to allow for maximum benefits.
FOLLOW-UP OF INFANTS WITH SINGLE UMBILICAL ARTERY
Authors: Froehlich Luz A. , Fujikura Toshio
Published: December 2021

Of 39,773 white and black consecutive single births, 344 (0.9%) had single umbilical artery (SUA). The incidence was higher in whites (1.2%) than in blacks (0.5%). Despite high mortality in infants with SUA (14.0%) the incidence was still 0.7% among surviving infants. Associated malformations were present in 19 of 36 dead infants with SUA, or 52.8%, and in 11 of 266 SUA survivors, or 4.1%. Cardiovascular and genitourinary anomalies were not higher in dead infants with SUA compared to all dead malformed infants.

A follow-up study of infants up to 4 years of age was undertaken, comparing 266 SUA survivors with 798 matched controls. Among malformations found in survivors, only inguinal hernia was significantly higher in SUA children compared to controls. The incidences of other specific abnormal conditions were not significantly different in the two groups. The mean values of body weight, body length, and head circumference at 4 months, 1 year, and 4 years of age, were almost equal in the two groups, as were the mental and motor scores at 8 months and the I.Q. at 4 years of age.
CONSTIPATION AND URINARY TRACT INFECTION
Authors: Neumann P. Z. , deDomenico I. J. , Nogrady M. B.
Published: December 2021

From our experience with 45 children with urinary tract infection and constipation, the improvement or cure of 80% by correcting abnormal bowel habits suggests that constipation may be an etiological factor in urinary tract infections. While successful regulation of bowel habits was accompanied by termination of the infection, failure to correct constipation was associated with recurrence.
CHILD HEALTH SUPERVISION–IS IT WORTH IT?
Authors: Yankauer Alfred
Published: December 2021

It is something of a paradox that pediatricians should question the worth of child health supervision, "the foundation of pediatrics," as a recent statement of the American Academy of Pediatrics has asserted.1 It was the concepts of prevention, education, and counsel rather than the peculiarities of children's disease which set Cadogan, Armstrong and John Bunnell Davis apart from other English physicians in the Age of Enlightenment. It was the linkage of child health supervision to the swell of social reform at the turn of the present century which sowed the seeds of pediatrics as a specialty in the United States.
The Newborn Child, ed. 3, by David Vulliamy, M.D., F.R.C.P., D.C.H. Baltimore: The Williams & Wilkins Company, 1972, 189 pp., $11.75
Authors: Avery Mary Ellen
Published: December 2021

The third edition of this well-known primer has been revised and updated to become a timely and useful guide. Among its attributes are its small size (it fits a lab coat pocket beautifully), frequent subject headings, clarity of style, and emphasis on common problems. The illustrations are relatively few in number but pertinent.

The book is recommended for students, residents, and nurses who first become associated with a nursery service. It serves as a readable and useful introduction.
BECKWITH'S SYNDROME WITH EXTREME ORGAN HYPERPLASIA
Authors: Roe Thomas F. , Kershnar Ann K. , Weitzman Jordan J. , Madrigal Luis Salinas
Published: December 2021

A large newborn infant with hemihypertrophy, omphalocele, hepatomegaly, left upper quadrant abdominal mass, and zoster-like skin rash had severe hypoglycemia at 4 hours of age. Serum immunoreactive insulin levels were markedly elevated. Hypoglycemia was not controlled by vigorous medical therapy but blood glucose levels returned toward normal following subtotal excision of the markedly hyperplastic pancreas at 24 days of age. At 4½ months of age, a right upper quadrant abdominal mass was noted and urinary adrenal steroid levels were elevated. The right adrenal gland was found to be markedly hyperplastic and it was removed; the left adrenal gland was slightly hyperplastic. Between the ages of 5 and 8 months the umbilical stump enlarged progressively forming a large pedunculated tumor which was removed. This patient presents an unusually severe example of Beckwith's syndrome with both prenatal and postnatal organ overgrowth, severe hypoglycemia and hyperinsulinism.
THE SAD OUTCOME OF AN INFANT WITH ST. ANTHONY'S FIRE IN 1828
Authors: C. T. E.
Published: December 2021

Erysipelas, or St. Anthony's fire, formerly very common, is rarely seen today. It is a distinctive type of acute cellulitis of the skin and subcutaneous tissues caused by group A betahemolytic streptococci. The case history below, written in 1828 by Sir Arthur Clarke, a member of the Royal College of Surgeons, London, is a vivid reminder of the gravity of paraumbilical infections in the preantibiotic era:

A lady in the country sent for me, while writing these pages, to visit her infant the tenth day after its birth. She informed me that she had just discovered an inflammation round the navel, which the midwife had concealed from her. Upon examination I found its entire belly covered with cloths, wetted with some cold solution of sugar of lead in water, on removing which the navel appeared in a sloughy gangrenous state, surrounded by a most extensive erysipelatous inflammation, which spread almost over the whole abdomen. About the navel, was hard, swelled and painful. The screems of the infant were piercing and incessant, and increasing the inflammation and pain by the action produced in the surrounding muscles. I directed its bowels to be kept open, twice or three times a day, with castor oil, and occasionally with rhubarb and calomel: the navel to be covered with an emollient poultice every eight hours, and the surrounding inflammation to be dusted with fine powdered starch. The appearances were so changeable as to compel me to alter the applications almost daily, from the simple bread and milk, to the carrot and fermenting poultices, camphorated spirits, etc.
Anal Carrier Rate of Group A Beta-Hemolytic Streptococci in Children With Streptococcal Pharyngitis
Authors: Asnes Russell S. , Vail Dorothea , Grebin Burton , Sprunt Katherine
Published: December 2021

A study was carried out to determine the frequency of anal cultures positive for group A beta-hemolytic streptococci in children with acute pharyngitis whose throat cultures were positive for group A beta-hemolytic streptococci. Only 6% of the patients screened had positive anal cultures and none of these children had a history of recurrent streptococcal pharyngitis. This rate does not warrant routinely obtaining anal cultures from children with group A beta-hemolytic streptococcal pharyngitis.