bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Detection of Adenomatous Polyposis Coli in Gardner's Syndrome
Authors: Naylor Edwin W. , Lebenthal Emanuel
Published: December 2021

Gardner's syndrome, an autosomal dominant disorder, consists of multiple polyposis of the colon associated with various soft-and hard-tissue tumors. The appearance of adenomatous hyperplasia and polyposis in at-risk patients before adolescence has not been fully appreciated. Four preadolescent children from a kindred with Gardner's syndrome were examined by use of colonoscopy and mucosal biopsy. In three children (18 months, 6 years, and 9 years old) adenomatous hyperplasia or polyposis was found. The colon of the fourth child (3 years old) was normal. The three affected children were asymptomatic. The youngest had a barium enema and results were normal. The oldest child had polyps. Biopsies revealed focal atypical hyperplasia of the glands with pseudostratification of the epithelial cells, frequent mitotic figures, and the absence of goblet cells. More severe manifestations were noted in the splenic flexure than in the sigmoid flexure or rectum. The youngest patient showed early adenomatous hyperplasia characterized by a marked reduction of the goblet cells, especially in the surface epithelium. Colonoscopy and mucosal biopsies are mandatory in at-risk children. By deferring colonic examination until adolescence, a patient is placed at risk for malignant degeneration of the adenomatous tumor.
Diphtheria-Pertussis-Tetanus Vaccine: Reactogenicity of Commercial Products
Authors: Barkin Roger M. , Pichichero Michael E
Published: December 2021

Parents from four practices were surveyed to ascertain reactions of children to diphtheria-pertussis-tetanus (DPT) vaccine in the 48 hours after immunization. Vaccines were administered according to current recommendations. Responses were scored in three categories: temperature, behavioral changes, and local reactions. Questionnaires were returned by 1,232 (84.9%) patients. Only 7.0% reported no reaction, while 336 (27.3%) reported mild, 722 (58.6%) moderate, and 88 (7.1%) severe reactions. Over 50% experienced temperatures of at least 100 F, and 80% noted behavioral changes; 72.2% had local reactions. No encephalitis, seizures, or hospitalizations were reported. Reactogenicity was similar for the five immunizations of the recommended series and the two manufacturers evaluated. Reported reactions in the control group were significantly lower than in the study group. These reaction rates underline the need to reevaluate present DPT vaccines.
Standard and Special Human Immune Serum Globulins as Therapeutic Agents
Authors: Stiehm E. Richard
Published: December 2021

Human γ-globulin is a valuable and frequently prescribed biological used to provide passive immunity against microbial agents, toxins, or cells. γ-Globulin is most widely used for the short-term prevention of certain bacterial or viral diseases when active immunization is unavailable (eg, hepatitis A) or when active immunization has not been given before exposure (eg, tetanus, rabies). γ-Globulin is also indicated on a continuous basis in replacement therapy for persons with antibody immunodeficiency. It is also (mis)used by many physicians for colds, allergies, and recurrent infection despite lack of proved efficacy.

Two types of γ-globulin preparations are available: standard human immune serum globulin (HISG) for general use, and special human immune serum globulins with a known antibody content for specific illnesses (Table I).

In addition, certain animal sera and antitoxins are available for passive immunity (Table I). Although a discussion of these agents is beyond the scope of this review, it is important to emphasize that their use is associated with considerable risk of adverse side reactions (anaphylaxis and serum sickness). Accordingly, the physician should know the exact indications for their use, always institute sensitivity testing, and be ready to treat side reactions immediately.1

SOME PROPERTIES OF IgG GLOBULIN

The immunoglobulins or "γ-globulins" are the proteins of the plasma and tissue made in lymphoreticular tissues which have antibody activity.2 Although there are six classes of immunoglobulin—IgG, IgM, IgA, IgD, IgE, and secretory IgA—only IgG is present in significant quantities in HISG.

IgG is a glycoprotein with a molecular weight of 150,000 daltons distributed equally between the serum and the tissues.
Respiratory Disease Associated With Gastroesophageal Reflux
Authors: Christie Dennis L.
Published: December 2021

Several recent reports have emphasized the association between gastroesophageal reflux with tracheobronchial aspiration and recurrent episodes of bronchitis, asthma, pneumonitis, bronchiolitis, apnea, and even aborted sudden infant death syndrome.1-4 The majority of these papers have stressed the fact that infants and children with recurrent pulmonary symptoms, such as wheezing, tachypnea, fever, cough, and chest roentgenographic evidence of pneumonitis or pneumonia, may be aspirating gastric contents into the lungs during periods of recumbency or after feeding.

There has been enthusiasm for an antireflux surgical procedure to stop these suspected repeated episodes of aspiration.5 Investigators have relied on an indirect diagnosis of aspiration by demonstrating abnormalities in esophageal function associated with recurrent respiratory disease.
Continuing Medical Education: The Other Side of the Coin
Authors: Sumer Timur
Published: December 2021

It is hard to disagree with Dr. Fisher about the problem of continuing medical education for foreign medical graduates (FMG) after they return to their countries (Pediatrics 61:133, January 1978). However, the other side of the coin should be exposed before expecting any action from the government on this matter.

As it looks from the FMG's point of view, the new immigration rule that limits the FMG's stay in the United States to two years is a reflection of the government's self-serving attitude.
Upper Gastrointestinal Bleeding in Children and Adolescents
Authors: Cox Kenneth , Ament Marvin E.
Published: December 2021

This is a retrospective study of upper gastrointestinal testinal hemorrhage in 68 children and adolescents who were less than 19 years old. In descending order of frequency, the five most common causes were duodenal ulcers, gastric ulcers, esophagitis, gastritis, and esophageal varices. There was male predominance in all diagnoses except gastric ulcers and gastritis. Signs and symptoms correlated poorly with the source of bleeding. Endoscopy was the most reliable method of identifying the bleeding site. Mortality correlated with the following: (1) initial hematocrit or hemoglobin level of <20% or <7 gm/100 ml, respectively, (2) transfusion requirements of >85 ml/kg of blood without surgical intervention, (3) failure to identify the source of bleeding, (4) presence of a coagulation disorder, and (5) coexistence of another life-threatening disease.
Pediatricians' Immunization Consent Practice, Washington State
Authors: Marcuse Edgar K.
Published: December 2021

The new requirement for obtaining written informed consent for routine childhood immunization in many publicly funded immunization programs prompted us to look at current immunization consent practices of pediatricians in Washington state.

We mailed a questionnaire (pp 420-421) to 338 pediatricians and allied health professionals on the mailing list of the Washington Chapter of the American Academy of Pediatrics. One hundred seventy-six (52%) responded. The results are summarized in the accompanying Table. Although each question was asked for each routine immunization-diphtheria-pertussis-tetanus (DPT), tetanus diphtheria toxoid (Td), oral polio vaccine (OPV), measles-mumps-rubella (MMR)—there was almost no difference in consent procedure by type of vaccine.
Otitis Media in Infancy: Tympanometric Findings
Authors: Groothuis Jessie R. , Sell Sarah H. W. , Wright Peter F. , Thompson Judith M. , Altemeier William A.
Published: December 2021

Ninety-one normal infants were followed longitudinally for varying periods from November 1975 to April 1977 to assess the correlation between tympanometry and pneumatic otoscopy and to study the pathogenesis of acute and chronic otitis media early in life. Type A (normal) tympanograms correlated with normal otoscopic findings in 92% of instances. Type B tympanograms, indicating reduced drum compliance with a relatively flat pressure curve, were associated with abnormal otoscopic findings in 93% of cases. The A8 (reduced compliance, normal pressure) and C (normal compliance, negative pressure) tympanograms were less consistent predictors of otoscopic findings. The correlation of tympanometric and otoscopic findings were similar in infants above and below 7 months of age. Tympanometry provided some insight into the natural history of otitis in 71 infants followed 12 to 17 months. Infants who failed to develop otitis had type B curves in only one of 240 determinations (0.4%). This pattern did not appear in those who developed acute otitis media (AOM) until the month preceding the first attack; nine of 29 tests (31%) made under these circumstances were type B. When a type B curve appeared in an asymptomatic study infant who had not previously had otitis, AOM developed within a month in nine of ten instances. At the time of diagnosis of first AOM, 87% of tympanograms were type B with the remainder type A8 or C. Sixty-three percent of tympanograms obtained from 25 infants during the six months following first AOM were type B, indicating that abnormal middle ear function was often prolonged. Fifteen of these 25 developed recurrent otitis during follow-up.
Aerobic and Anaerobic Bacterial Flora of the Maternal Cervix and Newborn Gastric Fluid and Conjunctiva: A Prospective Study
Authors: Brook Itzhak , Barrett Cynthia T. , Brinkman Charles R. , Martin William J. , Finegold Sydney M.
Published: December 2021

Aerobic and anaerobic cultures were performed on cervical swabs from 35 mothers and their newborn infants' gastric aspirates and conjunctival sacs. Four hundred seventy-nine isolates were obtained; 287 were aerobes and 192 were anaerobes. The cervical and gastric cultures overall yielded a similar flora, but this was not always the case when one compared mothers with their own newborn infants. The conjunctival cultures yielded about half of the number of bacteria per specimen that the gastric contents yielded, and a repeat conjunctival culture done 48 hours later showed a marked reduction in the number of potentially pathogenic bacteria isolated. The predominant aerobes isolated were Staphylococcus epidermidis, diphtheroids, viridans streptococci and Haemophilus vaginalis. The predominant anaerohes were the Bacteroides fragilis group, Propionihacterium acnes, Peptococcus, other Bacteroides and Peptostreptococcus organisms. Statistical analysis revealed significant positive correlation between the isolation of certain groups of organisms and increased duration of pregnancy, increased baby's weight, and prolonged duration of labor.
Total Fluoride Intake of Infants
Authors: Singer Leon , Ophaug Robert
Published: December 2021

The fluoride content of commercially prepared infant foods processed in fluoridated and nonfluoridated plants has been determined. The use of fluoridated water during processing has been shown to increase significantly the fluoride content of certain infant foods. The data obtained have been employed to calculate the minimum and maximum total daily fluoride intake for infants up to 6 months of age. The maximum total daily fluoride intake for infants tip to 6 months of age is 0.127 mg of fluoride per kilogram of body weight. An infant consuming human milk or cow's milk and living in a community that does have fluoridated water has a substantially lower total daily fluoride intake.
TASKS OF THE CHILD HEALTH SERVICE
Authors: H. R. J.
Published: December 2021

The major tasks of the new Child Health Service [in the United Kingdom] are identified as the promotion of good health in the child population, which is basically healthy, well nourished, and subject to comparatively few serious diseases, and the care of the minority of children who are abnormal from birth or early life. The treatment of disease in infancy and childhood will still be important, and the aim will be to concentrate pediatric hospital facilities into larger and more efficient units, if possible of 100 or more beds and seldom less than 60, with supportive day care and outpatient services. The widespread establishment of special care units for newborn infants is already helping to raise the standard of neonatal pediatrics and this trend will be intensified. . . . Acute hospital pediatrics will form a relatively small part of the total commitment of the Child Health Service, which will be based on prevention at least as much as on the treatment of disease. The essential unity of pediatrics is emphasized, school health and the care of the handicapped being integral components just as much as pediatric cardiology or neonatology and in no way to be regarded as lesser forms of practice.
THE RISE OF PROFESSIONALISM
Authors: Larson M. L.
Published: December 2021

Professional work conditions (and not only the general ideology) foster individualism. The professional's sense of power and authority flows not only from his actual command over special knowledge but also from his control over interpersonal situations. The first established professions—medicine, law, the ministry, and architecture—were typically concerned with the problems of individuals. Only indirectly did they define society as their client. Today, individualized service becomes an ideological remedy for the ills of a social situation, a screen for the social problems caused by the bureaucratic systems through which services are delivered—most notably in the medical and teaching professions.

The ideological insistence on individual aspects, the neglect of the whole, merges with specialization to confine the professional in an ideological conception of his role: the importance of narrow responsibilities is consciously and unconsciously emphasized, exaggerating the "dignity" of the functions. The dominant ideology attributes to professionals and experts special prestige as well as "moral and intellectual superiority": sharing in this ideology, professionals can easily mystify to themselves their actual power. Moreover, they are locked into conformity with the role society offers them to play—locked in by their vocational choice, by the particular mystique of each profession, and by their whole sense of social identity.

Finally, the technocratic ideology of science and objectivity excludes from the specialist's concern the social and political consequences of his acts. Nowhere is this truer than in the technical and scientific fields.
Attitudes and Interpersonal Skills During Pediatric Internship
Authors: Werner Edwenna R. , Adler Robert , Robinson Ricki , Korsch Barbara M.
Published: December 2021

The initial phases of a program for analyzing interpersonal skills and attitudes and personal adaptation of pediatric interns at a high-pressure tertiary care hospital are described. Interns found internship stressful and less satisfying in many regards than they expected. They were often unable to cope adaptively with the stresses encountered. There were indications of worsening attitudes toward aspects of patient care. However, interns' confidence increased during the year. A videotape vignette test of interpersonal sensitivity showed no change in sensitivity from beginning to end of the year. Videotapes of interns' visits with clinic outpatients made at three points during the year also showed no improvement in interpersonal or communication skills or attention to psychosocial issues. While parents were generally satisfied with the visit, interns lacked skills in some of these areas. None of the data collected, including sex, marital status, and pre-admission rank by the selection committee, predicted end-of-year performance rating by the chief residents. Sex and marital status were also uncorrelated with measured skills and attitudes.
Shigella Vaginitis: Report of 38 Patients and Review of the Literature
Authors: Murphy Trudy V. , Nelson John D.
Published: December 2021

Thirty-eight cases of Shigella vaginitis were identified in a retrospective review of records kept over the past 14 years. The cases of vaginitis were due to three subgroups of Shigella. Vaginitis varied in severity and duration, persisting for several months in some instances. In 47% of the cases, there was associated bloody vaginal discharge. Only two children had diarrhea temporally associated with vaginitis, but six others had had diarrhea. Many treatment modalities were used. Systemic antibiotic therapy appeared more effective than topical antimicrobials in the few patients who could be evaluated. Review of the literature revealed 32 additional cases, including four in adult women.
Accidental Childhood Iron Poisoning: A Problem of Marketing and Labeling
Authors: Krenzelok Edward P. , Hoff Julie V.
Published: December 2021

Accidental iron poisoning still represents a significant hazard in children less than 5 years of age. The problem is compounded by the attractiveness of dosage forms, their high availability, and ambiguities in product labeling. Manufacturers accentuate label ambiguity by not specifically designating the iron as being total elemental iron or iron compound. A list of products that contain iron has been prepared to help clarify this issue.
Effect of Storage Processes on the Bacterial Growth-Inhibiting Activity of Human Breast Milk
Authors: Hernandez Jacinto , Lemons Pamela , Lemons James , Todd James
Published: December 2021

Human breast milk samples were collected from lactating mothers, and aliquots were maintained at room temperature, frozen, and pasteurized. Samples were inoculated with 10 to 5O colony-forming units per milliliter (cfu/ml) of Escherichia coli or group B streptococcus, and incubated at 37 C. Quantitative growth was measured at eight and 24 hours. No inhibitory activity was demonstrated by control broth, commercial formula, and pasteurized breast milk, which had a rapid logarithmic growth to a maximum of 108 to 109 cfu/ml at 24 hours. Compared with these controls, fresh breast milk, fresh frozen breast milk, and breast milk frozen for 21 days demonstrated a significant inhibition of bacteria growth. A trend toward gradual loss of inhibiting activity was noted with prolonged freezing of breast milk. Although freezing may quantitatively decrease the amount of some breast milk host-defense factors, it cannot be assumed that cotuparable functional reductions will necessarily result.
Psychologic Adjustment of Siblings of Children With Chronic Illness
Authors: Lavigne John V. , Ryan Michael
Published: December 2021

Although numerous references are made to the stressful, deleterious effects of chronic or terminal illnesses and handicaps on the siblings of pediatric patients, very few studies have been conducted using comparison groups. The present study compares the adjustment of 3-to 13-year-old siblings of pediatric hematology (N = 62), cardiology (N = 57), and plastic surgery patients (N = 37) with healthy siblings (N = 46). The adjusttuent measure was an objective, paper-and-pencil measure of children's emotional and behavioral problems, the Louisville Behavior Checklist. On analyses of covariance, the patient groups were more likely to show symptoms of irritability and social withdrawal, and the differences between illness groups approached significance on measures of fear and inhibition. Among the younger children, ages 3 to 6, there were significant group differences, with the siblings of patients undergoing plastic surgery showing the highest level of general psychopathology. Among children ages 7 to 13, male siblings of patients with blood disorders were more likely to show signs of emotional disturbance than female siblings. No group differences were noted on measures of aggression or learning problems. Significant interactions between sex and age relationship to the child were noted on scales of social withdrawal, inhibition, immaturity, and irritability.
Relationship of Blood Pressure to Blood Lead Concentrations in Small Children
Authors: Jhaveri Ramesh C. , Lavorgna Lorenzo , Dube Shiv K. , Glass Leonard , Khan Farida , Evans Hugh E.
Published: December 2021

Elevated blood lead concentrations are associated with a variety of pathophysiologic changes in both children and adults, even in the absence of clinical symptoms. Although hypertension has been described in adults with elevated blood lead concentrations,1 there have been no systematic studies in infants and children in which lead levels were correlated with blood pressure measurements. In the present study, blood lead concentrations of greater than 40 µg/dl were associated with blood pressure elevations in infants and young children.

SUBJECTS AND METHODS

Thirty-four patients, age 1 to 3 years, who were referred to the Special Lead Clinic of the Jewish Hospital and Medical Center of Brooklyn because of blood lead levels of more than 40 µg/dl were subjects of the study.
Steroid-Associated Catatonia: Report of a Case
Authors: Sullivan Bradley J. , Dickerman Joseph D.
Published: December 2021

Psychosis in a child is a problem that demands urgent diagnosis and, when appropriate, treatment Steroid therapy is an unusual cause of such a disturbance. There are few reports in the adult literature and none in the pediatric literature concerning steroid-associated personality disturbances We describe a child receiving steroid therapy who had an organic psychosis that progressed to catatonia.

CASE REPORT

A previously healthy 11-year-old boy, who was examined initially at another institution, had a facial rash and reported weakness of the proximal limb muscles. A clinical diagnosis of dermatomyositis was made by a dermatologist, although no electromyogram (EMG), muscle biopsy, or lupus erythematosus (LE) preparation was obtained.
Effect of Safety Packaging on Aspirin Ingestion by Children
Authors: Clarke Alisone , Walton William W.
Published: December 2021

The effectiveness of child-resistant closures, required under the Poison Prevention Packaging Act of 1970, in reducing the incidence of accidental ingestion of aspirin and aspirin-containing products among children less than 5 years of age has been investigated. Data from Poison Control Centers and the National Center for Health Statistics were analyzed to determine the ingestion level before and two to three years after safety closures were required. Baby aspirin and nonbaby aspirin products were analyzed separately. For baby aspirin, it is estimated that safety packaging has reduced the incidence of ingestions 45% to 55%. For nonbaby aspirin products, the reduction has been 40% to 45%.
Physical Growth in Phenylketonuria: II. Growth of Treated Children in the PKU Collaborative Study From Birth to 4 Years of Age
Authors: Holm Vanja A. , Kronmal Richard A. , Williamson Malcolm , Roche Alex F.
Published: December 2021

Height, weight, and head circumference data up to age 4 years are reported for 124 children with phenylketonuria (PKU) who had been started on diet management before 4 months (121 days) of age and who were participating in the Collaborative Study of Children Treated for Phenylketonuria. Growth measurements of both the children and their parents corresponded with national and international standards. The growth of children with PKU was compared also with that of a group of normal children in the United States in whom corresponding longitudinal growth data had been obtained at the Fels Research Institute (FRI). Statistically significant differences between the groups were not noted at any age. However, when these groups were compared on coefficients using curve fitting, a trend toward a greater increase in weight as they became older, noted in both sexes in the PKU study group, was significantly higher (P ≤ .005) in the PKU study girls compared with the FRI sample. Height growth was identical in both groups, and comparison with family data showed that the children with PKU grew as expected for their genetic endowment.
THE INTERGENERATIONAL CHASM
Authors: Howard Maureen
Published: December 2021

In these modern times, when neither economic advantage non the nation's good is well-served by fecundity, we reproduce mainly to project ourselves, in some form, into the future not via time machine but by the transmission of our own values, culture, and traditions. If the next generation rejects these in toto, we lose that rickety bridge to a kind of immortality that makes the often dreary business of child-rearing worthwhile.

What had turned the recent past into a nightmare for many middle-class parents was the loss of their future in just such terms. Here was the legend given flesh in which their own fine children were stolen from the hearth by the elf thieves of the counterculture who left in their place changelings—bewitched mystics, madmen, bombers and junkies—none of whom would take a place in the continuum of the traditional community....

The children of those changelings... [are being reared in] urban and rural communes, and institutes of the new religions (those of Lamas and Hare Knishnas). [In one] a 10-year-old girl managed to keep an immaculately conventional bedroom—gingham bedspread, curtains, mirror and hairbrushes carefully placed on a dressing table. "If you want to have a straight kid, then be a freaky mother," her mother everlastingly spaced, complained one day.
Submandibular Adenitis in a Newborn Caused by Mycoplasma hominis
Authors: Powell Dwight A. , Miller Karen , Clyde Wallace A.
Published: December 2021

Despite frequent colonization of the newborn infant with genital mycoplasmas, morbidity due to these organisms has been cited on few occasions. This report describes an infant with suppurative submandibular lymphadenitis from whom Mycoplasma hominis was isolated in pure culture.

CASE REPORT

A 2,580-gm, firstborn, black, female twin was the product of a 36-week pregnancy in a 15-year-old primigravida in whom mild preeclampsia and fever developed one day prior to delivery. After spontaneous rupture of the membranes and a 12-hour labor, the infant was delivered without complication by low forceps and vacuum extraction. Apgar scores were 7 and 9 at one and five minutes, respectively; findings on routine newborn examination were unremarkable.
Impact of Safety Packaging on Accidental Poisoning
Authors: Scherz Robert G.
Published: December 2021

During the past 20 years (1957-1977), the accidental death rates in the United States from poisoning by solids and liquids have changed greatly. The death rate per 100,000 population rose steadily from 0.8 in 1957 to 2.2 in 1975 and then decreased to 1.9 in 1976 and an estimated 1.8 in 1977. The increase in death rates since 1957 was due mostly to changes in the age group 15 to 44 years. There were smaller increases in the groups 5 to 14 years and the 45 years and older. The only age group that has shown a consistent decline has been the one younger than age 5 years.
Neonatal Hyperviscosity: I. Incidence
Authors: Wirth Frederick H. , Goldberg Karen E. , Lubchenco Lula O.
Published: December 2021

Capillary hematocrits were performed on 790 infants during the first four hours after birth. These infants were delivered between August 8 and December 7, 1974, at the University of Colorado Medical Center, which is at an altitude of 1,061 m above sea level. When the capillary hematocrit was 7% or greater, venous hematocrit and blood viscosity were determined. Capillary hematocrits obtained from warmed heels in the first hour after birth were spuriously high and not consistently related to venous hematocrit. Venous polycythemia, defined as a hematocrit of 65% or greater, occurred in 4% of the newborn population. Hyperviscosity (2 SD above the mean for newborns) occurred in 5% of the newborn infants. At a venous hematocrit of 65% or greater, hyperviscosity was predictable, but some infants with venous hematocrits between 60% and 64% also had hyperviscosity of the blood. The incidence of polycythemia and hyperviscosity was further related to birth weight and gestational age. The infants who were small for gestational age were at highest risk of polycythemia and hyperviscosity, followed by infants who were large for gestational age. However, the greatest number of infants with hvperviscosity were term appropriate for gestational age. Preterm infants with gestational ages of less than 34 weeks were not affected.
The Effects of Stimulant Medication on the Growth of Hyperkinetic Children
Authors: Roche Alex F. , Lipman Ronald S. , Overall John E. , Hung Wellington
Published: December 2021

This article reviews the literature on possible growth-suppressing effects of stimulant medications in the long-term treatment of children with the hyperkinetic behavior syndrome. The evidence clearly indicates a temporary retardation in the rate of growth in weight and suggests a temporary slowing of growth in stature, but no effect on adult stature or weight. This temporary effect on growth is present during the first few years of treatent and seems related to drug dosage and to the presence or absence of drug holidays. These conclusions relate specifically to treatment during the prepubertal period; little is known of the growthrelated effects of treatment extending through pubescence.
TESTING THE TEACHERS - THE DALLAS EXPERIMENT
Authors: Mitchell Richard
Published: December 2021

Here is an excerpt from what may prove to be one of the more important unpublished works of 1978. It's something we'd all like to know more about these days, the credo of a teacher:

"I believe a role of a classroom teacher is to a leader of her class. She should be a leader in teaching her class knowledge to its full potentials. She should make sure that the children maximize in their subjects by having materials available for them at all times and that it is appropriate for them (the subject matter.) She should be patient and understanding with the children and know that all the children have different capabilities."

These words were written by a young woman looking for a job in the Dallas Independent School District (DISD). She was not hired, although she has probably taken a job someplace else by now. Maybe she's teaching your children to maximize in their subjects.

The schoolteacher's increasingly strident claim to be a professional is much less convincing than it used to be when teachers were more obviously intellectuals. Certainty teachers are the least trained of all the so-called professionals, and their training is the least likely to be scrutinized by anyone other than those who claim to provide it. Its effectiveness cannot be tested in the marketplace; the pay scale is the same for the best and the worst teachers. To be certified as a teacher in Texas, as in almost any state, all one needs to do is to graduate from college with passing grades in a certain number of education courses.
Manometry and Histochemistry in the Diagnosis of Hirschsprung's Disease
Authors: Morikawa Yasuhide , Donahoe Patricia K. , Hendren W. Hardy
Published: December 2021

Acetylcholine esterase histochemistry and rectal manometrv have been used sequentially to evaluate constipated children and to make the diagnosis of Hirschsprung's disease. When applied together, these modalities give a reliable diagnosis of Hirschsprung's disease, restricting the use of deep rectal biopsy to those patients in whom symptoms are niost suggestive of Hirschsprung's disease. Acetylcholine esterase histochemistry may be more reliable than rectal manometry in the newborn and premature periods. It is hoped that the combined use of these techniques may make deep rectal biopsy obsolete except in patients with hvpoganglionosis.
Future Events: Pediatrics in Review
Authors: H. R. J.
Published: December 2021

Beginning in subsequent volumes of Pediatrics, readers will find a new section, Pediatrics in Review, a major activity in continuing education of the American Academy of Pediatrics. This 32-page supplement will be included with all copies of Pediatrics for the next two issues. After that, only those readers who subscribe to PREP (Pediatric Review and Education Program), or who elect to subscribe to Pediatrics in Review alone, will receive this within their copies of Pediatrics. This "introductory" offer is designed to acquaint all readers with the continuing education program in the hopes that they will be interested in subscribing. Each issue will contain four to six review articles and several abstracts, together with questions that will allow the reader to determine whether he or she has retained the main points of the article.
Correlations Between Appointment Keeping and Reorganization of Hospital Ambulatory Pediatric Services
Authors: Pearce Tola , O'Shea John S. , Wessen Albert F.
Published: December 2021

Over a period of 13 months before and after a university-affiliated hospital's daytime ambulatory pediatric facility was upgraded from an episodic care clinic to a primary care unit, 260 subjects were interviewed in an attempt to predict compliance with return appointment scheduling. The parents of patients more than 10 years of age were the least compliant, but most of the differences in compliance appeared due to the subject's evaluation of the diagnostic ability, thoroughness, and sympathy of the physician at the initial visit. Although no changes were noted in the subjects' demographic characteristics or in their general opinions of ambulatory health care delivery or of attitudes desired of physicians, their evaluations of recent visits improved and the missed appointment rate declined by 46% in the course of the study. Moreover, the pediatric house officers, who evaluated the patients, demonstrated an increased ability to assess the characteristics the subjects found important in physicians.

Improvements are still needed, especially in the amount of communication between house officers, patients, and parents, but heeding clients' opinions about the provision of primary health care may help to make missed appointment rates negligible.
Vitamin E and Neonatal Bilirubinemia
Authors: Gross Steven J.
Published: December 2021

A study was designed to determine the effect of vitamin E on bilirubinemia in the preterm infant. Twenty infants with birth weights between 1,000 and 1,500 gm and 20 infants with birth weights between 1,501 and 2,000 gm were studied. Half the infants in each birth weight group received vitamin E administered intramuscularly in a total dose of 50 mg/kg during days 1 to 3 of life; the remaining infants served as controls. The administration of vitamin E produced significantly increased plasma tocopherol concentrations and normal hydrogen peroxide hemolysis tests by the end of the first week of life. Infants with birthweights ≤1500 gm who received vitamin E demonstrated a significant decrease in serum bilirubin on day 3 of life (6.5 ± 2.2 vs 8.8 ± 2.2 mg/dl) as well as a significant decrease in peak serum bilirubin during the first week of life (8.3 ± 2.2 vs 10.6 ± 2.6 mg/dl). The duration of phototherapy also was significantly less in the vitamin E-supplemented group (48 ± 18 vs 107 ± 31 hours). These differences were less pronounced in infants with birth weights more than 1,500 gm.
Folic Acid Supplementation in Low Birth Weight Infants
Authors: Stevens David , Burman David , Strelling M. Keith , Morris Audrey
Published: December 2021

Low birth weight infants(246) entered a trial of folic acid supplementation from 3 weeks to 12 months of age. The folic acid group had significantly higher mean hemoglobin levels at 6 and 9 months of age but the differences were only about 0.5 gm/dl, there was no significant difference in hematocrit, and in both groups of infants the mean hemoglobin levels were higher than those of normal birth weight infants. The differences in hemoglobin, although statistically significant, are of uncertain clinical significance. Median red cell folate levels remained within the normal adult range in both groups of infants. A minority of infants in the untreated group had low red cell folate levels but this was usually temporary, corrected by dietary folate, and not associated with low hemoglobin. Weight gain was not affected by folic acid supplementation. The infants in this trial were fed with a milk preparation containing 3.5 µg/100 ml of folic acid which is a similar concentration to that of human milk and we recommend that the folate content of milks fed to low birth weight infants should not fall below this level. We do not have sufficient grounds to recommend routine folic acid supplements for all low birth weight infants throughout the first year of life but there is a possibility that their folate intake may sometimes be suboptimal.
Hyperammonemia Associated with Perinatal Asphyxia
Authors: Goldberg Ronald N. , Cabal Luis A. , Sinatra Frank R. , Plajstek Carolyn E. , Hodgman Joan E.
Published: December 2021

Twelve infants with severe perinatal asphyxia were found to have elevated blood ammonia levels (302 to 960 µg/100 ml). In the seven survivors, hyperammonemia was associated with CNS irritability, hyperthermia, hypertension, and wide neonatal heart rate oscillations. Follow-up examinations revealed severe neurologic dysfunction in five of seven infants. CNS depression, hyperthermia, hypertension, and a nonreactive, fixed heart rate characterized the infants that died. These findings suggest a clinical entity secondary to perinatal asphyxia whose signs and symptoms may be related to hyperammonemia.
Metabolic Alkalosis in Infants with Cystic Fibrosis
Authors: Beckerman Robert C.
Published: December 2021

Since submission of the article, "Hypoelectrolytemia and metabolic alkalosis in infants with cystic fibrosis," and, during the first eight months of academic practice, I have diagnosed six cystic fibrosis infants under 1 year of age, four of whom had documented episodes of hypoelectrolytemia and severe metabolic alkalosis. The data are included in the Table.

Cases 1 and 2 had recurrent episodes of metabolic alkalosis before the diagnosis of cystic fibrosis was made. Cases 2 and 4 are black infants, in whom the diagnosis of cystic fibrosis would not have been suspected, had not the association between cystic fibrosis and metabolic alkalosis of infancy been recognized.
Recurrent Meningococcal Meningitis with Absence of the Sixth Component of Complement: An Evaluation of Underlying Immunologic Mechanisms
Authors: Vogler Larry B. , Newman Simon L. , Stroud Robert M. , Johnston Richard B.
Published: December 2021

A 5½-year-old black girl with recurrent meningococcal meningitis and absence of the sixth component of complement (C6) is reported. To explore the pathogenesis of recurrent neisserial infections in C6 deficiency, a detailed analysis of her immune competence was conducted. Her serum had normal chemotactic, opsonic, alternative complement pathway, and specific antibody activity, but lacked complement-mediated bacteriolytic activity. In addition, her C6-deficient serum was indistinguishable from normal serum in a complement-dependent assay of phagocyte bactericidal activity. Absent bacteriolysis remains the only consistent defect associated with recurrent neisserial infections and absence of one of the late-acting complement components.
Clinical Hepatotoxicity of Isoniazid in Children
Authors: Stein Martin T. , Liang Dora
Published: December 2021

A patient is presented with reversible clinical and biochemical hepatocellular injury secondary to isoniazid (INH). This apparently rare drug reaction in children is compared with the more common transient hypertransaminasemia induced by isomazid. A review of the clinical literature and basic pharmacologic mechanisms of isoniazid-induced hepatotoxicity has led to a rational plan for monitoring and managing children who are treated with INH.
Pancreatitis Associated with Valproic Acid Therapy
Authors: Batalden Paul B. , Van Dyne Bruce J. , Cloyd James
Published: December 2021

The development of acute pancreatitis in an 8-year-old boy being treated with valproic acid for simple absence spells is documented. A brief discussion of the other previously reported complications with valproic acid is included.
Blood Lead Levels in a Rural Population: Relative Elevations Among Migrant Farmworker Children
Authors: Perrin James M. , Merkens Mark J.
Published: December 2021

Most reports of lead poisoning or exposure to lead hazards have been from urban settings, with the epidemiology of elevated blood leads in rural populations remaining unclear. When urban and suburban populations are compared, higher levels are consistently found in urban settings. A study of smaller illinois cities (10,000 to 150,000 population) found blood lead elevations in 10% to 30% of the children evaluated, with no apparent correlation between community size and mean levels.1 Cohen and her colleagues2 reported that, although the mean blood level in a rural group was lower than in an urban group, 9% of children in their rural group had blood lead levels of 40 µg/100 ml or higher.
Value of the Neonatal Neurologic Examination
Authors: Volpe Joseph J.
Published: December 2021

The value of performing a careful neonatal neurologic examination frequently is questioned on the basis of two major contentions. The first is that the usual examination evaluates only function of subcortical structures, and the second, related in large part to the first, is that abnormal neurologic findings are poor indicators of subsequent neurologic abnormality. We consider neither of these contentions to be supported by available data and discuss each briefly below.

The usual support raised for the contention that the neonatal neurologic examination evaluates only function of subcortical structures relates to findings with hydranencephalic and anencephalic infants. Such infants often exhibit sleep-wake cycles, blink to light and sound, normal pupillary responses, and reflex extraocular movements.1,2
Prevention of Child Abuse: Pediatrician's Role
Authors: Magnus Peter D.
Published: December 2021

"Precious few pediatric disorders lend themselves as readily to prevention as child abuse,"1 for society can no longer support the escalating costs of crisis care. Child abuse does cross all socioeconomic levels of our society, but it is the poor who have more malnutrition, overcrowded living conditions, and less accessibility to medical care, including prenatal and well-child care. Thus, there are more cesarean sections, premature and small-for-gestational-age babies, and those with developmental disabilities among the economically disadvantaged.
Motor Vehicle Occupant Deaths in Young Children
Authors: Baker Susan P.
Published: December 2021

Motor vehicle occupant deaths of US children aged 0 to 12 years were analyzed. Surprisingly, the death rate is highest for children less than 6 months old: 9.0/100,000, dropping to 4.5/100,000 for 1-year-olds and about 3/100,000 for children aged 6 to 12. The second and third months of age are a period of especially high risk. More attention should therefore be focused on protecting infants from injury and death resulting from motor vehicle crashes.
Mixed and Obstructive Sleep Apnea and Near Miss for Sudden Infant Death Syndrome: 2. Comparison of Near Miss and Normal Control Infants by Age
Authors: Guilleminault Christian , Ariagno Ronald , Korobkin Rowena , Nagel Lynn , Baldwin Roger , Coons Susan , Owen Margaret
Published: December 2021

Twenty-nine full-term near miss for sudden infant death syndrome (SIDS) and 30 normal control infants underwent 24-hour polygraphic monitoring. Several types of respiratory events during sleep (eg, central, mixed, and obstructive apnea, periodic breathing) were defined and tabulated. Analysis of these respiratory variables and comparison of groups of near miss and control infants indicated that between 3 weeks and 4½ months of age only one variable was consistently different at a statistically significant level: the number of mixed and obstructive apnea 3 seconds during total sleep time. This study also showed an increase in mixed and obstructive respiratory events during sleep at 6 weeks of age in control as well as in near miss infants.
A Circulating Inhibitor of Platelet Aggregation in Bartter's Syndrome
Authors: O'Regan S. , Rivard G. E. , Mongeau J.-G. , Robitaille P. O.
Published: December 2021

Aggregation studies were performed on platelets from five patients with Bartter's syndrome. Epinephrine failed to induce aggregation in all five patients. Adenosine 5'-diphosphate (ADP) produced a single reversible phase of aggregation, and there was depressed sensitivity to collagen. Response to ristocetin was normal. There was a dose-related inhibition of ADP-induced platelet aggregation when plasma from the patients was added to normal platelet-rich plasma. This inhibition was diminished or absent when patients were receiving aspirin. Washed platelets from two patients who were no longer undergoing aspirin therapy, showed a normal response to epinephrine in normal platelet-poor plasma. Bleeding time was reduced from 23 minutes to 12 minutes in one patient while on aspirin therapy. These studies suggest that a circulating inhibitor of platelet aggregation, probably of prostaglandin origin, is present in the plasma of patients with Bartter's syndrome.
Skin Surface Carbon Dioxide Tension in Sick Infants
Authors: Hansen Thomas N. , Tooley William H.
Published: December 2021

Skin surface Pco2 (Psco2) was measured at 44 C in 17 sick infants using a Radiometer surface Pco2 electrode. Values obtained for Psco2 were compared with simultaneous values for arterial Pco2 (Paco2). Psco2 was found to be linearly related to Paco2 by a regression line with a slope 1.37. Paco2 could be predicted from Psco2 to within 6 torr in all instances. The relationship was not affected by the patient's gestational age, postnatal age, weight, or blood pressure. This electrode is a valuable clinical tool in the management of sick infants.
Legionnaires' Disease in a Child with Cancer
Authors: Ryan Michael E. , Feldman Sandor , Pruitt Bonnie , Fraser David W.
Published: December 2021

Although Legionnaires' disease has only recently been recognized as a distinct clinical entity, serologic surveys of localized outbreaks of respiratory illnesses have indicated that its geographic distribution is wide.1-5 Most cases have occurred in clusters, but reports of sporadic cases are increasing.6 The disease appears to be most prevalent among elderly persons or adults undergoing immunosuppressive therapy; it has seldom been documented in children.1,7,8 We report a previously undetected case of Legionnaires' disease in a child with acute lymphocytic leukemia in remission.

MATERIALS AND METHODS

To determine whether Legionnaires' disease had occurred in a childhood cancer population with pneumonia, we reviewed the records of patients between 1 and 18 years of age for whom percutaneous transthoracic lung aspirates had been obtained between April 1970 and December 1977.
X-Rated Playgrounds?
Authors: Sweeney Theodora Briggs
Published: December 2021

Safeguarding the primacy of the person in a technologic society will probably always be a challenge, especially in relation to its weaker members. Despite sincere efforts to anticipate and avoid it, chances are that a "humanization lag" will continue to exist between our devices and the modifications that make it possible to live comfortably with them. From aerosols to zeppelins, improvements are made in response to a felt human need.

Whether because children can't vote or because adults tend to view anything remembered from their own childhoods as sacrosanct, playgrounds and the equipment installed on them have for too long gone unexamined in terms of their suitability for human use.