bluuebunny/crossref_metadata_2025 huggingface dataset:
Should All Children With a Positive Blood Culture Have a Lumbar Puncture?
Authors: Vogel John
Published: December 2021

Dr. Rapkin's article1 makes an important contribution to the diagnostic approach to children with acute infectious illnesses. The findings of meningitis on repeat lumbar puncture point out the need for continued vigilance even after an initially negative LP. However, his suggestion that "a positive blood culture mandates a repeat LP" can perhaps be modified by a review of the child's clinical condition at the time a positive blood culture is reported. Patients 1 through 4 in his report all displayed central nervous system abnormalities—convulsions, lethargy, apnea—before the blood culture was reported as positive.
Fatal "Iron Heart" in an Adolescent: Biochemical and Ultrastructural Aspects of the Heart
Authors: Sanyal Shyamal K. , Johnson Warren , Jayalakshmamma B. , Green Alexander A.
Published: December 2021

Histochemical and ultrastructural aspects of the heart were investigated in an adolescent with fatal congestive heart failure resulting from exogenous hemochromatosis. Extensive iron deposits were found in all four chambers, papillary muscles, and the conduction system. These deposits were most prominent over the outer third of the left ventricular myocardium, with no significant difference between deposits in the middle and inner thirds. Quantitative analysis of iron from different chambers and all zones of the left ventricular myocardium confirmed the aforementioned pattern of iron distribution. Iron deposits in sinoauricular and atrioventricular nodes were similar to those in the right atrial myocardium. Degenerative changes and fibrosis were minimal.

Ultrastructural studies showed that intracytoplasmic iron deposition followed a perinuclear, paranuclear, or diffuse pattern. In addition, some iron was consistently present in the nucleus and mitochondria. It is postulated that the presence of iron in the mitochondria may adversely affect the cellular enzyme system; this could provide a biochemical basis for myocardial dysfunction in patients with acquired iron-storage disease.
Acute Necrotizing Enterocolitis in Infancy: A Review of 64 Cases
Authors: Santulli Thomas V. , Schullinger John N. , Heird William C. , Gongaware Robert D. , Wigger Joachim , Barlow Barbara , Blanc William A. , Berdon Walter E.
Published: December 2021

Sixty-four cases of necrotizing enterocolitis are reviewed. The diagnosis was based on tissue examination in 57 and on the clinical syndrome, including pneumatosis, in 7. Three factors are important in the development of the disease: injury to the intestinal mucosa, bacteria, and feedings. The indications for surgical intervention are pneumoperitoneum, signs of peritonitis, and intestinal obstruction. The importance of stress in the etiology of the disease is confirmed by the high incidence of perinatal complications, particularly hypoxia. The mortality was high, but results are improving with the institution of early aggressive treatment.
IF AT FIRST YOU DON'T SUCCEED, QUIT
Authors: Cahn Steven M.
Published: December 2021

American higher education stands on the brink of chaos. Never have so many spent so long learning so little.

The present crisis stems from the increasingly widespread acceptance among faculty and administrators of the fatal educational principle that a student should not be required to do any academic work that displeases him. If a student prefers not to study science or history or literature, he is allowed to attain his degree without studying any science, history, or literature.

If he prefers not to take examinations, he either makes special arrangementswith his instructor or else chooses his courses from among the evergrowing number that involve no examinations. If he prefers that his work not be graded, he arranges in most or all of his courses to receive an undifferentiated pass or fail. If he is concerned about obtaining high grades, he selects his teachers from among the many who have yielded to student pressure and now indiscriminately award A's to virtually everyone. As the dean of Yale's Morse College recently remarked of her students, "They get a B and they bawl. It takes a man or woman of real integrity to give a B."

Throughout the country the attempt is being made to provide students with what is advertised as a liberal education without requiring of them the necessary self-discipline and hard work. Students have been led to believe they can achieve without effort, that all they need do in order to obtain a good education is skip blithely down the merry road to learning.
Neonatal Paroxysmal Supraventricular Tachycardia With Hydrops
Authors: Cowan Richard H. , Waldo Albert L. , Harris Howard B. , Cassady George , Brans Yves W.
Published: December 2021

A critically ill infant with paroxysmal supraventricular tachycardia and hydrops fetalis responded well to aggressive management. Care must be taken to avoid digitalis toxicity. Procaine amide or quinidine are effective alternate therapies.
WILLIAM BUTLER YEATS WRITES ABOUT HIS BACKWARDNESS IN LEARNING TO READ
Authors: C. T. E.
Published: December 2021

That Yeats (1865-1939), the greatest poet to write in English in our time, had difficulty in learning to read may offer hope to parents and teachers faced with children for whom reading is not acquired with ease.

Writing in 1915, this is how Yeats described his slowness in learning how to read:

Because I had found it hard to attend to anything less interesting than my thoughts, I was difficult to teach. Several of my uncles and aunts had tried to teach me to read, and because they could not, and because I was much older than children who read easily, had come to think, as I have learnt since, that I had not all my faculties. But for an accident they might have thought it for a long time. My father was staying in the house and never went to church, and that gave me the courage to refuse to set out one Sunday morning. My father said if I would not go to church he would teach me to read. I think now that he wanted to make me go for my grandmother's sake and could think of no other way. He was an angry and impatient teacher and flung the readingbook at my head, and next Sunday I decided to go to church. My father had, however, got interested in teaching me, and only shifted the lesson to a weekday till he had conquered my wandering mind.
Long-Term Follow-up for Immunity After Monovalent or Combined Live Measles, Mumps, and Rubella Virus Vaccines
Authors: Weibel Robert E. , Buynak Eugene B. , McLean Arlene A. , Hilleman Maurice R.
Published: December 2021

Antibody in human subjects persisted without substantial decline for 8 years after mumps vaccine (Jeryl Lynn), for 6 years after measles (Attenuvax), for 5½ years after rubella vaccine (HPV-77 duck), for 5 years after measles-mumps-rubella and mumps-rubella combined vaccines, for 4 years after measles and rubella, and for 2 years after measles-mumps vaccines, the longest periods tested. Protective immunity against mumps illness persisted through the eighth year. The patterns for antibody following vaccination parallel those for natural infection and indicate that immunity will be lasting. Subclinical reinfection evidenced by antibody increase was commonly seen in persons who had been vaccinated, much as follows the natural infection.
Acquired Aganglionic Megacolon in a Premature Infant: Report of a Case
Authors: Touloukian Robert J. , Duncan Raymond
Published: December 2021

Hirschsprung's disease is presumably caused by intrauterine environmental or genetic factors which prevent the migration and formation of the intramural ganglion cell (IMG) in the distal colon. While the IMG is known to be particularly sensitive to anoxemia and other postnatal environmental factors, its selective loss following such stress has not been substantiated in an unoperated patient. The following report of a stressed premature newborn with the clinical and radiographic features of Hirschsprung's disease clearly documents the histologic disappearance of the IMG from the distal colon.

CASE REPORT

D.J. (#88-65-29), a 1,525-gm male infant, was born to a healthy 22-year-old abortus 0, gravida 1, para 0 mother following an uncomplicated 30-week gestation, ending in a spontaneous uncomplicated delivery.
Anterior Fontanelle Herniation
Authors: Gibson Noah F. , Ball Marshall M. , Kelsey Doris S. , Morrison Lemuel
Published: December 2021

Herniation of brain tissue through the anterior fontanelle is an extremely rare occurrence. Recently we treated a patient with anterior fontanelle brain herniation, most probably acquired secondary to meningitis.

CASE REPORT

A 2-week-old black male infant in previous good health was admitted to an outlying hospital with a one-day history of fever and irritability. Lumbar puncture revealed 238 WBC/cu mm with 90% neutrophils and a protein of 269 mg/ 100 ml. The infant was begun on parenteral therapy with methecillin, ampicillin, and kanamycin but was changed to penicillin G and kanamycin the following day when the cerebrospinal fluid culture grew β-hemolytic Streptococcus, non-group A or D. During the first two days of therapy, the infant had intermittent seizures and the anterior fontanelle began to bulge.
Psychological Problems of Vietnamese Orphans
Authors: Brazelton T. Berry
Published: December 2021

The recent statement by the American Academy of Pediatrics that, "Vietnamese orphans are no threat to U. S. health," is disturbing. The report focuses on the fact that orphans represent little risk of unusual communicable diseases requiring quarantine. It concerns itself with the physical health of these infants and provides a comprehensive list of infectious diseases that may affect them. However, there is little concern expressed for the children except as victims of a number of infectious diseases, poor immunizations, and nutritional deficiencies with the conclusion that the only problems they will face are "manageable or self-limiting."
Other Suggested Mechanisms for Hyperuricemia
Authors: Chesney Russell W.
Published: December 2021

The article by Mathew and Lifshitz on hyperuricemia calls attention to an important complication which might potentially result in uric acid nephropathy. Hyperuricemia has been noted in several other states of ketosis including ketogenic dietary therapy for convulsive disorders,2 hepatic fructose-i, 6-diphosphatase deficiency,3 and glygen storage disease, type I.4 Five of theents treated with a ketogenis diet developed renal stones.2 All of these entities have in common ketosis and elevated blo lactate and free fatty acid levels; the hyperuricemia is abolished by carbohydrate feeding in all.
Drs. Lifshitz and Mathew Reply
Authors: Lofshitz Fima , Mathew George
Published: December 2021

We appreciate Dr. Chesney's comments regarding our article. The review of pathologic states in which hyperuricemia occurs, as well as the several hypotheses for possible mechanisms of elevation of uric acid levels in blood, are of interest. However, the purpose of our paper was to caution those who institute low-carbohydrate therapy for obese, otherwise healthy, individuals, about this potentially harmful complication.
Co-editor moves
Authors: L. J. F.
Published: December 2021

On July 1, 1975, the Co-Editor of Pediatrics (R.J.H.) moved to Boston and the Harvard School of Public Health. There he will be the Roger I. Lee Professor of Public Health (Health Services and Child Health) and Head of a new department that combines the Departments of Health Services Administration, Maternal and Child Health, and Mental Health Services into the Department of Health Services Policy and Management. He will also be Professor of Pediatrics at the Harvard Medical School, working with the general pediatric and community programs at the Children's Hospital and with the primary care programs in other hospitals of the University.
Essential Amino Acids in the Treatment of Advanced Uremia: Twenty-Two Months' Experience in a 5-Year-Old Girl
Authors: Aronson A. Stefan , Fürst Peter , Kuylenstierna Bo , Nyberg Gunn
Published: December 2021

The value of conservative treatment in a case of chronic advanced renal failure was investigated in a 5-year-old girl with congenital hypoplastic kidneys. Before treatment the patient was severely anorexic and her plasma urea nitrogen was 180 mg/100 ml. Protein restriction alone was fruitless. After a transitional period on total parenteral therapy the patient was put on a maintenance oral diet, where an energy-rich diet was supplemented with essential amino acids including histidine. Plasma urea nitrogen dropped and stayed at about 50 mg/100 ml during the whole treatment in spite of a rising plasma creatinine from 10 to 24 mg/100 ml. The general condition of the patient normalized as she went into an anabolic state with weight gain and growth in height. The nitrogen balance studied in two different periods was positive. An acute attack of pancreatitis, secondary to hyperparathyroidism, ended the patient's life after 22 months of treatment.
"Streaking Leukocyte Factor," Arthritis, and Pyoderma Gangrenosum
Authors: Jacobs Jerry C. , Goetzl Edward J.
Published: December 2021

A 14-year-old boy with a 12-year history of episodes of sterile pyarthrosis and cutaneous inflammation and ulceration was found to possess a serum factor which enhanced the random migration of leukocytes in vitro. The serum factor was isolated by Sephadex G-200 gel filtration and found to have a molecular weight of approximately 160,000. This partially purified principle enhanced the random migration of purified normal human neutrophils or mononuclear leukocytes by up to 200% without influencing chemotaxis. Trauma or other stimuli may lead to an accumulation of this serum factor in some tissues of the patient with resultant excessive leukocyte influx and heightened local activity of the leukocytes in the inflammatory exudate.
Decreased Bactericidal Activity of Leukocytes of Stressed Newborn Infants
Authors: Wright William C. , Ank Bonnie J. , Herbert Jennifer , Stiehm E. Richard
Published: December 2021

Previous studies have established that leukocyte phagocytosis and intracellular killing are normal in term and low-birthweight newborns who are well. To determine the effect of stress or illness on newborn leukocyte function, the phagocytic and bactericidal activity of leukocytes from 40 sick newborns was compared with that of leukocytes from 12 newborns and 23 normal adults. To eliminate abnormal phagocytosis resulting from serum opsonic defects in newborn sera, pooled adult sera were used in all assays.

Twenty-five of the 40 stressed newborns (63%) had decreased in vitro activity against either Staphylococcus aureus 502A or Escherichia coli, or both, compared with decreased activity in two of 12 well infants (17%) and in four of 23 adult controls (17%). The mean bactericidal activity (percentage of organisms killed after two hours) of leukocytes from stressed newborns against S. aureus (83% ± 2 [SEM]) and E. coli (87% ± 4 [SEM]) was significantly less than in the combined well infant and adult control group (94% ± 1 for S. aureus and 97% ± .5 for E. coli). Although the more severely ill infants had an increased incidence of impaired antibacterial activity, the degree of impairment was not related to the severity of illness. No consistent relationship of decreased activity to birthweight, gestational age, age when studied, or specific diagnosis was seen. The leukocyte abnormality in stressed infants against S. aureus was principally a killing defect, while against E. coil both phagocytosis and killing were abnormal.

This study indicates that a wide variety of neonatal disorders may affect one or more of the steps required for normal bacterial killing. The lability of leukocytic antibacterial function under stress is an additional mechanism for the newborn's increased susceptibility to infection.
Parrot's Pseudoparalysis, Revisited
Authors: Rothner A. David , Klein Norma
Published: December 2021

Just over 100 years ago, Parrot described several children in whom pain in one or more extremities secondary to syphilitic involvement of bone resulted in lack of movement of those extremities. He called this pseudoparalysis. In recent years, the incidence of congenital syphilis has risen dramatically. Most physicians presently in training and many already in practice have had no personal experience with the signs and symptoms of this disorder. A recent case of congenital syphilis presenting with what appeared to be a right hemiparesis is illustrated in the following report.

CASE REPORT

A 2½-month-old black girl was evaluated for decreased movement of her right arm and right leg of three days' duration.
Observations on Dilute Hexachlorophene
Authors: Martin Gilbert I.
Published: December 2021

I read with great interest the article entitled "Neurotoxicity of hexachlorophene in the human. " The authors state that there was "no association between the vacuolar encephalopathy and recorded subtotal exposure to 3% hexachlorophene as specific localized cleansing preparations or to ‘diluted’ pHisoHex; only the number of baths actually recorded as baths in undiluted pHisoHex correlated with the lesion." The absence of lesions in the Children's Orthopedic Hospital group correlated well with the difference in bathing technique and dilution.
Infant Cereal Enrichment Controversy
Authors: Stewart Robert A.
Published: December 2021

The following comments are offered in criticism of certain conclusions drawn by Rios et al. in their article in Pediatrics. Although we can only agree with the authors that there is a need for definition of the many factors influencing iron absorption, including the precise effect of specific iron sources, we do vigorously protest the presentation of their 1971 studies as representative of current practices in infant cereal enrichment. Changes in the iron enrichment of infant cereals made five and three years ago have not been evaluated and, from their article, one can infer that baby food manufacturers have been derelict in utilizing iron with high bioavailability.
Questions Diagnosis of Single Ventricle
Authors: Shakibi Jami G.
Published: December 2021

I read with interest the paper by Tingelstad et al. which appeared in the July 1974 issue of Pediatrics. However, as far as the diagnosis of congenital heart disease is concerned, I am in the dark. After cardiac evaluation a diagnosis of mitral atresia, a single ventricle and corrected transposition was made.

A single ventricle by definition means the presence of only one ventricle receiving two atrioventricular valves. Mitral and tricuspid atresia are thus excluded.2, 4
Incubator Noise
Authors: Blennow Gōsta , Svenningsen Nils W. , Almquist Bengt
Published: December 2021

Recently we reported results from studies of incubator noise levels.1 It was found that in certain types of incubators the noise was considerable, and attention was called to the sound level in the construction of new incubators. Recently we had the opportunity to study an improved model of Isolette Infant Incubator Model C-86 where the mechanical noise from the electrically powered motor has been partially eliminated. With this modification it has been possible to lower the low-frequency sound levels to a certain degree in comparison to the levels registered in our study.
The Use of Xanthines in Treating Apnea of Prematurity
Authors: Morens David M.
Published: December 2021

The inclusion in the May 1975 issue of Pediatrics of two articles and a related commentary on the use of xanthines in the treatment of apnea of prematurity bring to mind some potential hazards of this sort of therapy to which none of the authors addressed themselves.

Xanthines are notorious gastrointestinal irritants. Presumably, many of the infant candidates for xanthine administration will also be at risk for the development of necrotizing enterocolitis. Prematurity, intestinal bacteria, enteral alimentation, and direct or indirect injury to the mucosa are frequently mentioned risk factors.
Dr. Shapiro Replies
Authors: Shapiro Donald L.
Published: December 2021

We appreciate the concerns expressed by Dr. Morens. Because of insufficient knowledge of the toxicity of theophylline in prematures, we are still restricting its use to severely apneic infants who fail to respond to all other therapies, including CPAP, and would otherwise require respirator ventilation.

We have continued to use the drug orally pending further studies on its pharmacokinetics in premature infants and have not noted serious gastrointestinal or electrolyte disturbance in our patients.
A Question on Tuberculin Testing
Authors: Lorin Martin I.
Published: December 2021

The practitioner seeking help and guidance in the use of tuberculin screening as a part of health care delivery will find little comfort in the pronouncements of the various pediatric pundits in the November issue of Pediatrics. Dr. Edwards and Dr. North both state in the section Pediatrics for the Clinician that the routine use of tuberculin skin testing can no longer be recommended and that it should be restricted to specific high-risk communities. Dr. Edwards1 provides some of the data and figures upon which this recommendation is based.
McAtee and Silver Reply
Authors: McAtee Patricia A. , Silver Henry K.
Published: December 2021

We appreciate the commentary of Dr. Austin regarding our article.

The nurse practitioner role was created because the needs of children for primary health care were not being adequately met through the existing health care delivery system.

Pediatricians who practice with nurse practitioners have found that the pediatrician and the nurse can provide more primary health services to children and can give more personalized care than they previously were able to do. Acceptance by patients and their parents has been excellent; more than one half of the parents indicated that joint care was better than that received from the same pediatrician alone.
Grading, Time Course, and Incidence of Exercise-Induced nduced Airway Obstruction and Hyperinflation in Asthmatic Children
Authors: Cropp Gerd J. A. , Schmultzler I. J.
Published: December 2021

We evaluated clinical status and pulmonary function in 60 perennially asthmatic and 11 normal children before and repeatedly after incrementally increasing bicycle ergometer exercise. The changes in clinical status and pulmonary function which were elicited by strenuous exercise were graded by an air exchange and a physiological grading system respectively. Normal children showed no significant clinical or physiological changes after exercise. Strenuous exercise elicited significant deteriorations in clinical and physiological measurements in 36% to 77% of asthmatic girls and 46% to 90% of asthmatic boys, the frequency depending on the test used to determine exercise-induced abnormalities. The incidence of exercise-induced asthma (EIA) was statistically significantly higher in asthmatic boys than girls. The higher incidence of EIA in boys was primarily due to a larger number of very severe attacks in boys than girls; mild and moderate EIA was about equally common in the two sexes. Most patients with EIA developed large and small airway obstruction, although large airway obstruction tended to be the predominant and the more severe abnormality. Clinical and physiological abnormalities, regardless of severity, were usually most marked during the first ten minutes after exercise and lessened thereafter. Mild EIA usually lasted for only 15 minutes or less; severe EIA improved, but usually did not resolve within 35 minutes of exercise. There were three patients in whom the severity of EIA got worse after exercise and an additional seven in whom the improvement was minimal. In these ten patients isoproterenol aerosol terminated EIA, indicating that exercise-induced large and small airway obstruction in asthmatic children is primarily. if not solely. due to bronchospasm.
The Use of the Treadmill for Assessing Exercise-Induiced Asthma and the Effect of Varying the Severity and Duration of Exercise
Authors: Godfrey Simon , Silverman Michael , Anderson Sandra D.
Published: December 2021

Running produces a greater amount of post-exercise bronchoconstriction than other forms of exercise Carried out at similar metabolic rates. The treadmill can be used to provide a standardized form of exercise when studying the asthmatic child. The severity of post-exercise bronchoconstriction depends upon the rate of working on the treadmill and the duration of exercise. A maximum response is obtained by six minutes of running at an uphill slope of 10% at a speed of 5 kmph (3 mph). Even with this type of test, there is still considerable variation in the resonse from time to time and greatest reproducibility is obtainde by repeating the test within one week. Treadmill exericise tests may be used in the diagnosis of asthma and in the assessment of its likely severity.
Comparative Aspects of Available Exercise Systems
Authors: Fitch Kenneth D.
Published: December 2021

Comparative studies have demonstrated that running is the greatest stimulus to exercise-induced asthma (EIA) and is the preferred laboratory test model to examine EIA and its modifications. Swimming provokes least EIA and is the exercise of choice for asthmatics. The frequency and magnitude of EIA produced by running is not altered by regular swimming training.
Suppression of Exercise-induced Asthma by Salbutamol, Theophylline, Atropine, Cromolyn, and Placebo in a Group of Asthmatic Children
Authors: Godfrey Simon , König Peter
Published: December 2021

A number of drugs are known to it exercise-induced asthma (EIA), but the results in some cases have been difficult to interpret due to the techniques employed. A comparative study was carried out in a group of children to investigate the effects of salbutamol, choline theophyllinate, cromolyn sodium, atropine, and placebo. The exercise test took the form of six minutes of standardized treadmill running. All the drugs, but not the placebo, were able to inhibit EIA to a significant degree, the effect being most marked with salbutamol. Cromolyn sodium caused no bronchodilatation at rest, while all the other drugs were bronchodilators, the effect being most marked with the aerosol atropine during exercise. It was impossible to distinguish the type of drug used for inhibition of EIA if it caused bronchodilatation at rest. The manner in which an exercise test can be used to investigate the duration of action or site of action of drugs is noted.
Application of Challenge Methods to the Evaluation of New Drugs
Authors: Oren Joseph
Published: December 2021

Exercise-induced bronchspasm (EIB), as opposed to asthma precipitated by exercise, is a valuable laboratory tool in the study of the newer pharmacologic agents being developed for asthma therapy. EIB is uniquely suited for the screening of agents with cromolyn-sodium-like activity prior to extended clinical drug studies in large patient populations. To be used meaningfully, the challenge technique must be subjected to rigorous controls, standardization, and evaluation in preselected patient populations. Because of the inherent variability of the method, careful study design and the use of double-blind statistical controls are necessary to minimize misleading placebo effects.
New Drug Evaluation Using Exercise-Induced Bronchospasm
Authors: Sprenkle Arthur C. , VanArsdel Paul P. , Bierman C. Warren
Published: December 2021

Exercise-induced asthma was used to demonstrate that a xanthone, a new orally active cromolynlike drug, has significant activity in man. The effect of a single oral dose of 8 mg/kg was studied in a double-blind cross-over fashion at two and five hours after administration, with significant inhibition of post-exercise bronchopasm being seen at five hours. Further study seems indicated to determine optimal dosage and clinical effectiveness.
The Asthmatic Child and His Participation in Sports and Physical Education
Authors: Kugel Robert B. , Barbero Giulio J. , Bartram John Bowman , Bost Roger B. , Dickinson David G. , Garrard Sterling D. , McMahon Jean L. , Scott Roland B. , Shard Austin R. , Weil William B. , Green William T. , Kennedy Charles , Koch Richars , Browder J. Albert , Gallagher James J. , Halpern Daniel
Published: December 2021

Bronchial asthma is a chronic pulmonary disorder, frequently allergic in nature, and characterized by paroxysms of dyspnea, wheezing, tightness in the chest, and bronchospasm. Asthmatic attacks may be minor and short in duration with little discomfort, or they may be very severe and of long duration, producing the characteristic picture of intractability. During symptomatic periods, it is usually possible to demonstrate changes in certain aspects of pulmonary function. With mild symptoms or between the episodes of severe asthma, the individual may be at little or no disadvantage in any or all activities. However, when the symptoms of pulmonary distress become severe or prolonged, this may lead to interruption of the child's daily routine, including school attendance. Occasionally, such children may become home or hospital bound for long periods of time.

Between the two extremes of no symptoms and severe asthma, there is a spectrum of respiratory or pulmonary disability—the nature and severity of which requires that each child receive individual consideration and evaluation in the matter of his daily activity. The outlooks for the control of asthma in children has been improving during the past several decades. However, with the increase in population, there is an increasing number of children who require medical management for this disorder. It is a leading medical cause for school absenteeism and probably contributes to inefficient school work because of chronic fatigue, irritability, decreased attention span, and secondary emotional disorders.

There is general agreement among physicians that most children with bronchial asthma should attend regular school since, when under proper control and with no residual pulmonary defect the child needs no special facilities.
Seroepidemiologic Survey of Varicella: Value of Specific Fluorescent Antibody Test
Authors: Gershon Anne A. , Krugman Saul
Published: December 2021

The sensitive varicella-zoster fluorescent antibody to membrane antigen (V-Z FAMA) test was used in a seroepidemiologic survey of two outbreaks of varicella involving 30 children. The attack rate of varicella based on clinical observations alone was 60%. The attack rate based on clinical and serological observations lay between 78% and 82%, after excluding those children who had detectable antibody at the time of exposure. No subclinical varicella infection was observed in this small series of patients. No boost in antibody response was observed in immunes who were exposed to varicella. No patients with detectable V-Z antibody by FAMA at the time of exposure developed clinical varicella. The V-Z FAMA test provided helpful information about the immune status of persons exposed to varicella.
DEATH RITUAL
Authors: Aries Philippe
Published: December 2021

Death in the hospital is no longer the occasion of ritual ceremony, over which the dying person presides amidst his assembled relatives and friends. Death is a technical phenomenon obtained by a cessation determined in a more or less avowed way by a decision of the doctor and the hospital team. Indeed, in the majority of cases the dying person has already lost consciousness. Death has been dissected, cut to bits by a series of little steps, which finally makes it impossible to know which step was the real death, the one in which consciousness was lost, or the one in which breathing stopped. All these little silent deaths have replaced and erased the great dramatic act of death, and no one any longer has the strength or patience to wait over a period of weeks for a moment which has lost a part of its meaning.

From the end of the eighteenth century [there has been] a sentimental landslide . . . causing the initiative to pass from the dying man himself to his family . . . Today the initiative has passed from the family, as much an outside person, to the hospital team. They are the masters of death—of the moment as well as the circumstances of death.
The RWT Method for the Prediction of Adult Stature
Authors: Roche Alex F. , Wainer Howard , Thissen David
Published: December 2021

The Roche-Wainer-Thissen (RWT) method estimates the adult stature of an individual from data recorded at a single childhood examination. The data required are recumbent length, nude weight, midparent stature, and hand-wrist skeletal age. If necessary, a measurement ent of the child's stature can be transformed to be approximately equivalent to recumbent length with little loss of accuracy. When applied to data from three longitudinal growth studies, the prediction errors with the RWT method were smaller than those with the method of Bayley and Pinneau.
Localized Necrosis of Scalp in Neonates Due to Calcium Gluconate Infusions: A Cautionary Note
Authors: Weiss Yochanan , Ackerman Chaim , Shmilovitz Lazar
Published: December 2021

Four cases of localized skin necrosis of the scalp in premature neonates are reported. Attention is drawn to this complication since its occurence is not emphasized sufficiently in literature. A three-fold pathogenetical mechanism is assumed to operate, namely, duration, slow leakage, and subsequent sudden extravasation. Suggested prophylactic measures are frequent changes of infusion sites and prevention of extravasation after needle removal.
A descriptive definition of the scope and content of primary health care
Authors: Silver Henry K. , McAtee Patricia Rooney
Published: December 2021

The subject of primary health care and the role of the primary health care provider have recently been receiving increasing recognition. Although there may be general understanding of the term, "primary health care," its exact meaning has been inadequately delineated, thus making it difficult to define its content and the scope of the role of the primary health care provider. Many think of primary health care only as initial care, the care resulting from first contact. Others consider it as dealing mainly with the acute medical aspects of health care and, in particular, those aspects having to do with illness and disease.
Nasopharyngitis and Prolonged Sleep Apnea
Authors: Steinschneider Alfred
Published: December 2021

The effect of nasopharyngitis on the simultaneous occurrence of prolonged sleep apnea (≥20 seconds in duration) was studied in 26 infants managed at home on an apnea monitor. During the observation period, these infants had a total of 69 illnesses which appeared to represent an upper respiratory tract inflammatory process. In general, the daily frequency of prolonged apneic episodes was significantly greater during nasopharyngitis when compared to comparable time intervals immediately prior to and following the illness. In addition, there was a decrease in the frequency of apneic episodes with increasing postnatal age until the episodes finally ceased to occur during the illnessreleted intervals. Apneic episodes ceased to occur at an earher age for the before- and after-illness intervals than for the time interval during which there were clinical symptoms. Thus, it would appear that infants go through an agerelated phase wherein prolonged apnea occurs during nasopharyngitis but not when free of illness.

The implications of these results for the management of infants having prolonged sleep apnea are discussed. In view of the hypothesis that prolonged sleep apnea is part of the physiological process resulting in the sudden infant death syndrome, these results also provide for the prediction that infants who suddenly die in association with nasopharynqitis would do so, in general, at a later age than those who succumb when free of an upper respiratory tract inflammatory tory process.
Parrot's Pseudoparalysis, Revisited
Authors: Rothner A. David , Klein Norma
Published: December 2021

Rothner AD, Klein N: Parrot's pseudoparalysis, revisited. Pediatrics 56:604, 1975.

Dr. Klein's name should be given as Nora J. (rather than Norma) Klein.
Adverse Reactions to Iodide Therapy of Asthma and Other Pulmonary Diseases
Authors: Yaffe Sumner J. , Bierman C. Warren , Cann Howard M. , Cohen Sanford N. , Freeman John , Segal Sydney , Soyka Lester F. , Weiss Charles F. , Ballin John C. , Done Allan K. , Del Prato Pierre S. , Farchione Louis , Kretchmer Norman , Oakley Godfrey , Sawchuk Steven , Scott C. P. , Simopoulos Artemis P. , Chudzik Gregory
Published: December 2021

Neonatal deaths from tracheal obstruction caused by congenital goiters have been reported from such widely scattered locales as Buffalo, New York, New York City, Philadelphia, Washington, D.C., Seattle, Tokyo, Japan, and Glasgow, Scotland. The mothers of these infants had asthma and were receiving conventional doses of iodides, either as potassium iodide or as mixtures of bronchodilators and iodides. Because of these deaths, the Committee on Drugs of the American Academy of Pediatrics has reviewed the use of iodides in the therapy of asthma and other chronic pulmonary diseases.

Five current textbooks advocate the use of iodides in chronic asthma.1-5 "Iodide compounds have a stimulating effect on bronchial secretions and represent expectorants of major importance in treating asthma and particularly status asthmaticus."2 The AMA Drug Evaluations6 recommends the use of iodides only for short-term medication. Current Pediatric Therapy7 emphasizes careful patient selection because only an occasional patient may benefit.

Dosage recommendations usually are 300 mg of potassium iodide every two hours in adults1 and 60 mg per year of age four times daily in children.4 These dosage recommendations are many times greater than the 65 mg of organic iodine (T4 and T3) which the average human thyroid gland delivers to the circulation per day, or the estimated daily adult iodide requirement of 200 mg of iodide.8 As a matter of fact, these recommended dosages for iodides represent 10 to 30 times the total body content of iodide!

Many preparations–some of which are available on an over-the-counter (nonprescription) basis–contain iodides, including antiasthmatic preparations, expectorants, and preparations whose trade names may not suggest the presence of iodides.
Heart Disease in Infancy. By Brian G. Barratt-Boyes, Ch. M., John M. Neutze, M.D., and Edward A. Harris, M.D. Baltimore, Maryland, Williams and Wilkins Co., 1973. $28.00; 339 pp
Authors: Noonan Jacqueline A.
Published: December 2021

The management of serious heart defects in infants remains a major challenge for both the pediatric cardiologist and the cardiac surgeon. With the refinement of profound hypothermia in Japan which permits prolonged circulatory arrest, surgeons in New Zealand, Australia, England, and the United States, as well as some European countries, began to perform primary corrective cardiac operations in infancy in preference to a palliative procedure. This book is a report of an International Symposium on Surgical Heart Disease held in New Zealand in February 1972.
Chronic Pulmonary Insufficiency of Prematurity
Authors: Ehrenkranz Richard A.
Published: December 2021

In the January 1975 issue of Pediatrics, Krauss et al.1 described "the pathophysiology and clinical course of a group of small premature infants, generally under 1,200 gm at birth, who develop a syndrome of delayed respiratory insufficiency." This syndrome, which they termed "chronic pulmonary insufficiency of prematurity" (CPIP) occurred after the first four to seven days of life, following an initial period of general well-being; was characterized by a 50% to 70% loss of lung volume, marked hypoxemia, and hypercapnia; and could be distinguished from respiratory distress syndrome (RDS), Wilson-Mikity syndrome, bronchopulmonary dysplasia, and pneumonia.
A Danger of Old Medications?
Authors: Lapin Joseph H.
Published: December 2021

The need for care in the administration of outdated drugs was forcibly brought home to me by a recent personal experience. A dietary indiscretion resulted in a flare-up of symptoms of an old duodenal ulcer and colitis. The next day severe abdominal pain followed by frequent, explosive, watery stools made me miserable. On a careful diet and antacids the pain was relieved. On the fifth day, in an effort to stop the diarrhea, I took two tablespoons of Kao-Con (Upjohn Company, Kalamazoo, Michigan) which was followed by explosive vomiting.
When Does Hydranencephaly Develop?
Authors: Bachman David S.
Published: December 2021

Koffier, et al.1 report a case of hydranencephaly following polycythemia in a newborn infant. In their report, the authors speculate that the elevated hematocrit level in the newborn period may have led to cerebral infarction and liquifaction, with the baby then presenting 54 days later with hydranencephaly.

There are a couple of problems with this speculation based on the information presented in the case report: (1) It is well recognized that a hydranencephalic baby can have a normal neurologic examination, as well as a normal head circumference and, thus, may be completely missed in the newborn nursery.
The Technique of Study Is Crucial
Authors: Swyer Paul A.
Published: December 2021

In the recent article by Darling and collaborators1 reference is made to the apparently exceptional nature of the diagnosis in North American centers. It is only made with significant frequency in certain hospitals, among which is the Hospital for Sick Children, Toronto. Our experience in this hospital as reported in 19552 and subsequently3 was analogous to that reported from the Boston Floating Hospital in 1974 in regard to the crucial importance of the diagnostic radiological technique as described by the workers in the Hospital for Sick Children, London.
Varicella Gangrenosa Due to Group A β-Hemolytic Streptococcus
Authors: Smith Edward W. P. , Garson Arthur , Boyleston James A. , Katz Samuel L. , Wilfert Catherine M.
Published: December 2021

Varicella is usually a well-tolerated disease in normal children. Pyogenic infections involving the skin are the commonest complications and their potential severity is emphasized by our recent experience with two children who suffered from gangrene as a result of cutaneous superinfection with group A β-hemolytic streptococci. We present the recognition and management of these patients in an effort to reacquaint physicians with this potentially fatal infection.
Staphylococcal Cervical Adenitis in Young Infants
Authors: Hieber J. Patrick , Davis A. Todd
Published: December 2021

Etiologic studies of cervical adenitis have rarely separated the cause of the infection in relation to the age of the patient. In older children, group A β-hemolytic Streptococcus has often been found to be the common offending organism and antibiotic therapy is frequently prescribed with this in mind.1,2 There are no comparable data for infants so that the most probable etiologic agent cannot be surmised from past experience. The two cases reported below emphasize the hazard of assuming that group A β-Streptococcus was the responsible agent, emphasize the necessity of considering other bacterial genera such as staphylococci, and indicate the need for needle aspiration of the node to establish a precise etiologic diagnosis.
Task Force on Pediatric Education
Authors: Olmsted Richard W.
Published: December 2021

A Task Force on Pediatric Education has been formed by the combined efforts of the major pediatric organizations. The mandate of this interorganizational Task Force is to examine in detail all issues pertaining to pediatric education from the undergraduate through the postgraduate and continuing education years. The Task Force will solicit and assess all available information concerning the future needs for pediatricians, the distribution of pediatricians and child patients, the range in the roles of pediatricians, and the most appropriate education for those roles. Most significantly the Task Force will consider the health needs of American children and how the educational process may better equip pediatricians and other child health care professionals to meet those needs.
Bacteremia in Children: An Outpatient Clinical Review
Authors: McCarthy Paul L. , Grundy Gordon W. , Spiesel Sydney Z. , Dolan Thomas F.
Published: December 2021

In a 20-month period, 1,783 children seen in the pediatric outpatient department had blood cultures performed and 117 (6.5%) of these children had bacteremia. Two thirds of the isolates were Diplococcus pneumoniae and Hemophilus influenzae b. Ninety-three percent of children with H. influenzae b bacteremia and 20% of children with pneumococcal bacteremia had soft tissue involvement at the initial visit. Most children with positive blood cultures (102) were previously well and beyond the newborn period and many (46) had seemingly trivial illnesses initially: upper respiratory tract infection, fever of unknown origin, otitis media, and diarrhea. In the absence of soft tissue infection, the latter three diagnoses correlated best with bloodstream invasion.

Nineteen children had persistent bacteremia and five developed soft tissue complications not noted initially.

Two factors, age between 7 and 24 months and temperature between 39.4 and 40.6 C, showed increased specificity for bacteremia but were sensitive only for pneumococcal disease. A temperature of ≥ 40.5 C showed more specificity for bacteremia than lesser fevers. A white blood cell count > 20,000/cu mm was poorly sensitive, and pulmonary infiltrates were neither specific nor sensitive for positive blood cultures.

Five bacteremic children had aseptic lymphocytosis in the cerebrospinal fluid.

Two days of intravenous antibiotic therapy and eight days of oral therapy were adequate for pneumococcal bacteremia without soft tissue involvement. This therapy may not be ideal, however, since other routes and duration of therapy were not evaluated.
Current Trends in Pediatric Urology
Authors: Woodard John R. , Belman A. Barry , Miller Harry C.
Published: December 2021

With 29 papers presented before the Urology Section (Washington, D. C., October 18 to 23, 1975), the annual meeting of the American Academy of Pediatrics is rapidly becoming the major forum for pediatric urology in this country. The content of this year's papers highlights much of what is current in this growing subspecialty. The topics discussed largely fell into three major categories, i.e., genitourinary anomalies, problems relating to or resulting from obstructive uropathy, and genitourinary neoplasms.

ANOMALIES OF THE GENITOURINARY TRACT

Hypospadias and cryptorchidism are two of the most common genital anomalies. Following his excellent movie on embryology of the male external genitalia, C. J. Devine presented a series of 200 consecutive patients with hypospadias surveyed for associated anomalies. Over one fourth of these patients had other birth defects, some multiple. Hernia, hydrocele, and cryptorchism were commonly associated anomalies. Of particular importance, he found that 16 of 160 (10%) of the patients so examined had abnormal excretory urograms (IVP). Over one half of the pyelographic abnormalities were surgical lesions such as hydronephrosis and vesicoureteral reflux. On the basis of this extensive experience Dr. Devine recommended that all patients with hypospadias undergo excretory urography.

In managing the child with no palpable testes, S. D. Levitt and his associates pointed out that bilateral cryptorchism is much more common than anorchia but that surgical exploration, unless extensive, has not proven completely reliable in making the differentiation. They proposed a test whereby the presence of a functioning testis might be determined prior to exploratory surgery, thereby possibly avoiding the need for such surgery.