bluuebunny/crossref_metadata_2025 huggingface dataset:
Phlebotomy with Iron Therapy to Correct the Microcytic Polycythemia of Chronic Hypoxia
Authors: Sondel P. M. , Tripp M. E. , Ganick D. J. , Levy J. M. , Shahidi N. T.
Published: December 2021

Patients with chronic hypoxia develop a physiologically appropriate "secondary" polycythemia that improves oxygen carrying capacity. Supplemental iron is often required to maintain this. In severe cases when hematocrit levels approach 70%, iron is withheld in order to avoid dangerously high hematocrit levels and the risks of vascular sludging due to "hyperviscosity." Some patients even require reduction of viscosity by exchange of their polycythemic blood for plasma when symptoms develop. Iron deficiency with microcytic polycythemia can then develop. Management of such patients is unclear. Continued blood withdrawal will worsen the iron deficiency; iron supplementation will increase the hematocrit level and the risks of hyperviscosity. The combination of frequent phlebotomy with oral iron therapy should improve iron stores while safely maintaining a stable hematocrit level in patients with microcytic polycythemia. This combination should also have multipie beneficial effects on tissue oxygen delivery and utilization. This approach has been discussed and used for a patient with microcytic polycythemia due to Eisenmenger syndrome. While on therapy the patient's clinical symptoms decreased, and his serum iron level, hematologic indices, and treadmill tolerance tests all improved.
Balloon Embolization of a Bleeding Gastroduodenal Artery in a 1-Year-Old Child
Authors: Janik Joseph S. , Gordon Culham J. A. , Filler Robert M. , Shandling Barry , Stringel Gustavo
Published: December 2021

Severe stress can produce ulceration and uncontrollable hemorrhage in the pediatric age group. Modern angiographic techniques, using embolization of a Silastic balloon to occlude a visualized bleeding vessel, can successfully control hemorrhage and avoid surgical intervention and its resultant disordered gastric physiology. Recently this technique was used to control hemorrhage from the gastroduodenal artery in a 1-year-old child with severe respiratory sepsis. This is the youngest reported child in whom the technique has been used to control bleeding from this vessel.
Esophageal Web: A Previously Unrecognized Complication of Epidermolysis Bullosa
Authors: Hillemeier Craig , Touloukian Robert , Mccallum Richard , Gryboski Joyce
Published: December 2021

The course of the esophageal disease in four patients with epidermolysis bullosa dystrophica recessive is examined. Three of four patients experienced web formation, a previously unrecognized finding, and the significance of this lesion in the evaluation and management of these patients is emphasized. One offour patients underwent a successful colonic interposition for severe esophageal disease and the role of this potentially life-saving procedure is discussed.
Measurement of Intracranial Pressure
Authors: Myerberg David Z.
Published: December 2021

I read with interest the timely article by Horbar et al entitled "Effect of Application Force on Noninvasive Measurements of Intracranial Pressure" (Pediatrics 66: 455, 1980). Many are impressed with the correlation that the Ladd sensor displays in comparison to directly measured intracranial pressure (ICP). However, I share the concern of Horbar et al that there may be problems with the constancy of application force of the sensor.

I was surprised when I increased application force over the sensor in the monkey model.1
Some Observations on Pediatrics: Its Past, Present, and Future
Authors: Rogers David E. , Blendon Robert J. , Hearn Ruby P.
Published: December 2021

I am honored to be with you today. I am particularly flattered that the American Academy of pediatrics-an institution with such a proud history of single-minded advocacy of the health and welfare of children-would permit an internist-turned-philanthropist to make this keynote address.

I have long admired the Academy. I tend to believe that the secret of your remarkable success and the respect you have been accorded by American society derives from your unswerving devotion to your original mission. Many of our professional societies, while initially spawned to help address the needs of those who are their special concern, have come to be more preoccupied with the special needs and problems of their membership.

Not so with this organization. Better health and better opportunities for children have remained your rallying points, and the needs of pediatricians as such have been distinctly secondary. This has not been lost on your admirers. I hope you can keep this refreshing idealism intact in our current cynical world. Your 1980 ten-point agenda for American children has a magnificent Jeffersonian ring to it.1 It is a bill of rights for children that deserves wide attention and circulation, and I congratulate you.

So this is a historic and significant occasion.

It is historic because it represents your 50th Anniversary.2

It is historic because we have just completed a decade in which many of the programs designed to improve the health and welfare of children launched with your help in the 1960s have borne fruit.

It is significant because you are launching your lofty ten-point agenda.
Method for Predicting When Children with Progressive Renal Disease May Reach High Serum Creatinine Levels
Authors: Arbus Gerald S. , Bacheyie Godfrey S.
Published: December 2021

Optimal planning of therapy for children with progressive renal failure requires accurate prediction of the age at which the serum creatinine (SC) level of the patient will be sufficiently high to warrant dialysis or renal transplantation. In a retrospective study of 29 children with progressive renal disease, linear regressions for each child were developed from the reciprocal of serum creatinine (1/SC) on time. It was found that in children, as in adults, the rate of deterioration of renal function expressed as 1/SC described a linear regression. From the regressions developed, it was determined that predictions using at least six 1/SC values on time would have given acceptable estimates of the age at which dialysis treatment became necessary. With the more precise measurement of SC now available it is likely that even more accurate predictions will be possible in the future.
Accumulation of Ganglioside GM2 in Cerebrospinal Fluid of a Patient with the Variant AB of Infantile GM2 Gangliosidosis
Authors: Pullarkat Raju K. , Reha Henry , Beratis Nicholas G.
Published: December 2021

Brain biopsy has been used for the diagnosis of the variant AB of infantile GM2 gangliosidosis. Accumulation of ganglioside GM2 (300 ng of neuraminic acid per milliliter) was observed in the CSF of a patient with this disorder. GM2 was found also in the CSF of a patient with classic Tay-Sachs disease. Normal CSF did not contain any measurable amounts of GM2. In addition, a glycolipid with a mobility, by thin-layer chromatography, similar to that of paragloboside was observed in the CSF of the patient with the variant AB of GM2 gangliosidosis. These findings indicate that the variant AB can be diagnosed by demonstrating accumulation of GM2 in the CSF of patients with normal hexosaminidase activity.
Advice from Breast-feeding Mothers
Authors: Christoffel Katherine K. , Clark Aleta V. , Esterly Nancy , Koval Janice , Ruiz Bruni , Chandler Alma Buckner , Doane Brenda , Chacko Donna , Elson Sally
Published: December 2021

We are working mothers who are writing to bring to the attention of practicing pediatricians some practical aspects of combining breast-feeding with employment outside the home. Several of us are physicians, mainly pediatricians, yet we feel that we and our pediatricians have not always been sufficiently aware of the special needs of working mothers who breast-feed, and so we have been less helpful to the mothers of some patients than we might have been. We have learned that the nursing problems encountered by mothers who work outside the home include all those encountered by mothers who remain at home, and several more.
Was It a Type II Error?
Authors: Pascoe John M.
Published: December 2021

Dr Oski's controlled study (Pediatrics 66:168, 1980) comparing the gastrointestinal (GI) symptoms of a group (N = 44) of infants receiving formula with iron and a group (N = 49) receiving formula with no iron was well conceived and practical. However, his concluding statement "...our study failed to provide any evidence for the commonly held belief that iron-fortified formulas produce gastrointestinal side effects in infants," was not supported conclusively by his data.

A recent review article emphasizes the importance of type II errors in clinical controlled trials.1
Letters to the Editor
Authors: Shearer Madeleine H.
Published: December 2021

On the basis of 13 premature births to mothers who were given cans of protein-rich supplement, Rush et al (Pediatrics 65:683, 1980) conclude that "... the supplement produced growth retardation." The data do not support this conclusion.

The authors calculate that women on the protein sypplement actually increased their mean daily caloric intakes by only 261 calories to 2,326—still below the Recommended Daily Allowances (RDA) for the average pregnant women (AND the malnourished one).
Use of Biofeedback in Treatment of Fecal Incontinence in Patients with Meningomyelocele
Authors: Wald Arnold
Published: December 2021

Fourteen children (aged 5 to 17 years) with meningomyelocele and significant fecal soiling underwent anorectal manometry using a three-balloon system connected to a physiograph. On the basis of manometric criteria demonstrating some rectal sensation, eight patients were treated with biofeedback conditioning. Patients were taught to contract the external anal sphincter or nearby gluteal muscles in response to various volumes of rectal distention. Four of the eight patients who were treated with biofeedback had a good clinical response with disappearance of soiling or a greater than 75% improvement in the frequency of soiling. Follow-up periods ranged from three to 12 months. The minimum criteria for successful treatment appeared to be normal threshold of rectal sensation and ability to contract gluteal or related muscles. Anorectal manometry is a rapid, easily obtained test that can identify those children with meningomyelocele and fecal incontinence who may benefit from biofeedback conditioning. Biofeedback is a simple, safe, and effective technique in the treatment of certain children with fecal soiling due to neurogenic anal sphincter dysfunction.
Multiple Cases of Cyanide Poisoning by Apricot Kernels in Children from Gaza
Authors: Lasch Eli E. , Shawa Raghda El
Published: December 2021

Two episodes of cyanide poisoning occurred in children after ingestion of apricot kernels. The first episode involved eight children who exhibited typical signs and symptoms of cyanide poisoning two hours after having ingested a large amount of apricot kernels. Seven children recovered. One died soon after admission. The second episode involved 16 children who had eaten a sweet prepared from such kernels. The symptoms and signs were identical with those in the first group but appeared one-half hour after the ingestion and were much more severe. Thirteen children recovered, two died shortly after admission, and a third child died two hours later. Apricot kernels contain a cyanogenetic substance called amygdalin, which after hydrolysis, liberates hydrocyanic acid. This activation usually occurs only after ingestion. In the second instance hydrolysis probably occurred during the preparation of the sweet, explaining the short interval between the ingestion and the appearance of the signs of poisoning.
Potentiation of Clostridium botulinum Toxin by Aminoglycoside Antibiotics: Clinical and Laboratory Observations
Authors: Santos José Ignacio , Swensen Paul , Glasgow Lowell A.
Published: December 2021

A child with infant botulism became apneic and died while receiving ampicillin and gentamicin therapy. As aminoglycosides have been implicated in the induction and/or exacerbation of neuromuscular blockade, we used an animal model to test the hypothesis that aminoglycosides potentiate neuromuscular blockade of botulinum toxin. In the range of aminoglycoside doses utilized in these experiments, both gentamicin and tobramycin enhance neuromuscular impairment and death of botulinum toxin-exposed mice. These results support recently published clinical observations that aminoglycosides may potentiate neuromuscular weakness caused by botulinum toxin, and suggest that these antibiotics should be used with caution in suspected cases of infant botulism.
The Final Unfounded Claims?
Authors: Campbell Ralph K.
Published: December 2021

I was disillusioned by the article by Stare et al (Pediatrics 66:521, 1980) in that there seemed to be an attempt to have this article be the final word on the ineffectiveness of the Feingold diet. It upsets me when a "scientific" report from their institution (Harvard University School of Public Health), aided by the work of the food industry's own Nutrition Foundation, is given more prestige than the results of the studies of a clinician such as Feingold.
Early Development of Infants of Birth Weight Less Than 1,000 Grams with Reference to Mechanical Ventilation in Newborn Period
Authors: Ruiz Maria Paz D. , LeFever Judith A. , Hakanson David O. , Clark David A. , Williams Margaret L.
Published: December 2021

Growth, development, and neurologic status were assessed at 1 year of age in 38 infants of birth weight less than 1,000 gm who were born in 1976 through 1978. Twenty had received mechanical ventilation as newborns, and this group had a significantly higher incidence of respiratory distress syndrome, seizures, cardiac arrest, bronchopulmonary dysplasia, and retrolental fibroplasia than those not ventilated. The ventilated infants had a high incidence (70%) of bronchopulmonary dysplasia and of retrolental fibroplasia (20% grade III or IV). Seven of eight infants with severe developmental delay (>2 SD), six of nine with moderate delay (>1 SD), and seven of eight with neurologic disability had received ventilation. There was no difference in growth between the ventilated and nonventilated children. Of the total group, 53% showed no problems.
Be Prepared!
Authors: Schowalter John E.
Published: December 2021

The survey of hospitals' preparation practices for children by Azarnoff and Woody in this issue of Pediatrics1 raises a number of important questions, again. I say again, because the discrepancy between what is known about the usefulness of preparation and the status it is given in most hospitals has long been present.

The survey shows that most pediatric preparation in acute care hospitals is done by nurses. The characteristics of hospitals that tend to offer preparation are that they are larger than average, have staff trained in psychosocial care, and primarily serve Anglo-American patients. One third of the hospitals that responded to the survey stated that they had some sort of regular preparation program.
Committee on Nutrition and the WHO Code of Marketing Breastmilk Substitutes
Authors: Barness Lewis A.
Published: December 2021

Many have questioned the decision of the American Academy of Pediatrics not to support all of the provisions of the International Code of Marketing of Breastmilk Substitutes of the World Health Organization. Some have attributed the AAP stance to allegiances other than to children, but the AAP has long been known for its support of breast-feeding. The AAP has already expressed its concern for the adequacy of the WHO code in a press release and elsewhere. Some of the deliberations of the AAP Committee on Nutrition (CON), while I was its chairman, may be of interest.

The AAP Committee on Nutrition has unofficially considered the various drafts of the Code during the past three years and has voiced its suggestions for further revisions, without notable effect.
THE PUBLISHING GAME
Authors: M. E. K.
Published: December 2021

In 1958, when James D. Watson worked his way up to the rank of Associate Professor at Harvard, the young biochemist had on his curriculum vitae eighteen papers ... today the bibliography of a candidate ... often lists 50 or even a hundred papers.

... Paper inflation has become a fact of academic life during the past two decades.... The increases stem not from a sharp rise in productivity but rather from changes in the way people publish. Co-authorship is on the rise, as is multiple publication of the same data. The length of papers, meanwhile, has been decreasing.

A researcher publishes four short papers rather than one long one. This fragmentation contributes to a host of problems not the least being the sheer growth of the literature. One estimate holds that the Index Medicus for 1985 will weigh more than one ton.
Arteriohepatic Dysplasia
Authors: Riely Caroline A. , Rosenfield Nancy S. , Cotlier Edward
Published: December 2021

Drs Levin and colleagues1 report five well documented cases of arteriohepatic dysplasia. In addition, they report the results of laboratory tests and physical examination in family members of two of their patients. Their report omits mention of findings related to the eye (posterior embryotoxon and retinal pigmentary changes) or of the additional skeletal findings (decrease in interpedicular distance in the lumbar spine as well as changes in the servical spine and hands) which we have reported to be associated with this syndrome.2,3
Letters to the Editor
Authors: Clark Joseph H. , Fitzgerald Joseph F.
Published: December 2021

The resurgence of interest in the role of salicylates in Reye's syndrome during the past year is exemplified by the recent article of Starko et al.1 This and other epidemiologic studies2 suggest that subjects with Reye's syndrome consume significantly greater quantities of salicylate- containing compounds than control subjects, even when matched for the variable of fever. The relationship of salicylates to Reye's syndrome has been pondered for 15 years; yet, a cause-effect relationship remains to be established.
Are Lateral Neck X-rays a Waste of Time?
Authors: Margolis Carmi Z.
Published: December 2021

I fear that the management of epiglottitis is again headed in a dangerously conservative direction. In 1972, we demonstrated that routine tracheotomy could reduce the mortality of epiglottitis from between 4% and 50% to 0.1 This approach was subsequently strongly supported in the literature.2-4 However, one gets the impression from recent articles that the appropriate management for a child with suspected epiglottitis includes first a lateral neck film,5 then an attempt at mask and bag,6 and finally, if nothing else works, nasotracheal intubation. Tracheotomy is no longer mentioned.
Developmental Follow-up of Hyperventilated Neonates: Preliminary Observations
Authors: Brett Claire , Dekle Maggie , Leonard Carol H. , Clark Christine , Sniderman Susan , Roth Robert , Ballard Roberta , Clyman Ronald
Published: December 2021

A group of 13 newborn infants greater than 37 weeks' gestation were selected to be hyperventilated because of severe hypoxemia refractory to conventional mechanical ventilation, ie, failure to maintain Pao2 > 50 torr with an FIO2 of 1.0, despite Paco2 ≤40 torr and pH ≥7.40. Eleven survived; nine were available for follow-up evaluations. As a group, the nine infants were exposed to a Paco2 ≤20 torr for 51.8 ± 11.8 ( mean ± SEM) hours, to Paco2 ≤15 torr for 11.8 ± 3.3 hours, to a pH ≥7.50 for 64.4 ± 18.6 hours, and to a pH ≥7.60 for 6.1 ± 2.9 hours. One infant was lost to follow-up after a normal assessment at nine months. The other eight infants (seven AGA, one markedly SGA) were at least 1¼ years old at the time of evaluation. The seven AGA infants had a normal developmental quotient (mean 110 [range 96-130] by Stanford-Binet or Bayley assessment); the one SGA infant had a Bayley score of 89. All eight had normal neurologic examinations. These preliminary findings are reassuring with respect to neurologic and developmental outcome following prolonged hyperventilation.
Diet and Theophylline
Authors: Weinberger Miles , Smith Gary , Milavetz Gary
Published: December 2021

The recent article by Feldman et al1 demonstrating the effect of diet on theophylline elimination is qualitatively consistent with a previous report in adults2 but contains quantitative inaccuracies that distort the clinical relevance of the data. Specifically, the apparent volumes of distribution and the half-life of elimination were inappropriately determined, resulting in specious values that are not consistent with the more appropriately calculated clearance values.

The authors state that the apparent volume of distribution was calculated by dividing the serum concentration extrapolated to zero time into the dose of the drug.
Letters to the Editor
Authors: Spino M. , Thiessen J. J. , Isles A. , Levison H. , MacLeod S. M.
Published: December 2021

We found the report by Feldman et al1 interesting with potential clinical application. However, we would like to point out an error in their determination of the apparent volume of distribution (V) and comment on both their methodology and results.

They state that V was calculated by dividing the dose of the drug by the extrapolated y intercept for drug concentration at time 0. This method is correct for a drug which exhibits monoexponential elimination following a single intravenous dose.
Infant Botulism
Authors: Shaw Edward B.
Published: December 2021

The work of Thompson et al1 presents findings in nine Utah patients with infant botulism. In contrast to several other authorities who failed to demonstrate Botulobacillas botulinus in infants of the same age without evidence of clinical disease, Thompson et al1 report a significant number of positive stool cultures in infants who showed no evidence of botulism. They comment that positive stool cultures alone cannot be relied on to establish the diagnosis in the absence of characteristic muscle weakness, and support the proposal that the organism, so ubiquitous in nature, may be distributed by dust, especially during drought conditions.
Epidemiology of Adolescent Dysmenorrhea
Authors: Klein Jerry R. , Litt Iris F.
Published: December 2021

Dysmenorrhea is the leading cause of recurrent short-term school absenteeism among adolescent girls. Controversy surrounds the relative role of psychologic and biologic variables in the pathogenesis of dysmenorrhea. Therefore, data from 2,699 menarcheal adolescents, drawn from a national probability sample of 12- to 17-year-old girls (the National Health Examination Survey), were analyzed by bivariate and multivariate analytic techniques for biologic, psychologic, and demographic correlates of dysmenorrhea. Of 1,611 adolescents (59.7%) who report dysmenorrhea, 14% frequently miss school because of cramps. The greatest proportion of variation of independent variables in a stepwise multiple regression analysis in this study was predicted by gynecologic or postmenarcheal age. Preparation for menarche, a psychologic variable, did not predict either dysmenorrhea or subsequent school absence. Socioeconomic status was positively correlated with dysmenorrhea although race was not. However, black students (23.6%) miss more school because of dysmenorrhea than white students (12.3%) even when socioeconomic status is held constant. Data in this study suggest that biologic variables play a substantial role in the pathogenesis of dysmenorrhea.
OUR FIRST JOURNAL DEVOTED EXCLUSIVELY TO PEDIATRICS (1884)
Authors: C. T. E.
Published: December 2021

By the 1880s American articles pertaining to diseases of children had become so numerous and so scattered through the medical literature that a group of five rather young New York physicians, whose practices leaned heavily toward pediatrics, became convinced of the need for a special American journal devoted exclusively to pediatric topics. In 1883 a publisher was found and in January 1884 the Archives of Pediatrics made its debut with William Perry Watson (1854-1925) as the editor. (Figure shows title page.) The Archives of Pediatrics continued until September 1962, when it merged with the American Practitioner and the Quarterly Review of Pediatrics to appear under the new name of Clinical Pediatrics.

See Images in the PDF File

The first paper published in the first issue was on convulsions in children. The paper was filled with practical hints about how the young physician should evoke order from chaos when he made a house call to see a convulsing child. The secret was to keep everyone busy in preparing a warm bath, moving the patient to a larger bedroom, removing his clothing, wrapping him in a flannel blanket, and looking for mustard to put in the hot bathwater. By the time all these had been done the convulsion would probably have abated.
We Spoke Up for Children and Were Heard!
Authors: McKay R. J.
Published: December 2021

Fellows of the American Academy of Pediatrics should be proud of the effective way their organization has recently "spoken up for children." Thanks to the well-coordinated team efforts of our elected officers, especially our immediate Past-President, Don Blim; of our Washington office led by Jackie Noyes; and of the Government Affairs Committee, chaired by Birt Harvey, the chance has greatly diminished that children will be forgotten or shortchanged by the block-grant approach to reducing federal expenditures for health care. Although support was given by such organizations as the Association of Maternal and Child Health-Crippled Children (MCH-CC) Directors, the Children's Defense Fund, and the American Medical Association, it was AAP initiative, strategy, and implementation from start to finish that carried the day.
Let's Speak Up for Pediatricians
Authors: St Geme Joseph W.
Published: December 2021

I am concerned about the self-image of pediatricians. I am concerned that those physicians whose professional careers surround the consummate health and welfare of our children consider themselves to be leveled among their professional colleagues with the same perspective as their patient populations, that is, second-rate, less important, and less distinguished in their capabilities and professional objectives than the classic "adult" physicians, the internists and surgeons. The obstetrician-gynecologist shares some of the same perceptual problems, a mind-set of subliminal second-class professional citizenship, consistent with the still attenuated role of women, their professional clientele.

Oh, there are exceptions! There are pediatricians who take charge of their professional practice groups, hospital staffs, national societal organizations, teaching hospitals, and medical schools.
Letters to the Editor
Authors: Osborn Lucy M.
Published: December 2021

Statistics concerning circumcision are not readily available in the United States. During our study on hygiene, we polled Utah hospitals to ascertain the number of male births and the number of circumcisions performed. The percentage of infants circumcised varied from 0 to 100%, with a statewide average of 87%. The majority of physicians responding to the questionnaire practiced in Salt Lake County. Our poll indicated that their estimates of the incidence of circumcision were remarkably accurate.
Lung Surfactant in an Era of Replacement Therapy
Authors: Notter Robert H. , Shapiro Donald L.
Published: December 2021

In this paper current knowledge of the palmonary surfactant system with particular emphasis on aspects that relate to exogenous surfactant replacement therapy for the neonatal respiratory distress syndrome (RDS) is considered. The work provides an overview, but concentrates on several facets of lung surfactant research that help to elucidate and evaluate past and present attempts toward such therapy. Subjects addressed include the functional need for specific lung surfactant components to obtain optimal surface activity and some of the required surface property measurements to characterize such activity. Also discussed is current knowledge of lung surfactant synthesis and secretion and the potential effect of exogenous surfactant on the endogenous pulmonary surfactant sytem. A primary theme throughout is that an analysis of previous clinical trials involving surfactant replacement shows the necessity for strong interactions with related basic science investigations. It is suggested that future human infant surfactant replacement trials proceed deliberately, and include maximal correlations with basic in vitro research on lung surfactant biophysics and biochemistry and with experiments in animal models.
Colloid Osmotic Pressure in Newborn Infants: Variations with Birth Weight, Gestational Age, Total Serum Solids, and Mean Arterial Pressure
Authors: Wu Paul Y. K. , Rockwell Gary , Chan Linda , Wang Shu-Mei , Udani Vikram
Published: December 2021

Colloid osmotic pressure (COP) of blood was measured directly at birth with the Wescor membrane colloid osmometer (model 4100) in 91 appropriately grown, 11 large, and nine small for gestational age "well" newborn infants. COP correlated directly with birth weight (r = .726, P < .00001) and gestational age (r = .753, P < .00001). COP values for small for gestational age (SGA) and large for gestational age (LGA) infants were found to fall within the 95% prediction interval with regard to birth weight and gestational age for appropriate for gestational age (AGA) infants. Simultaneous measurements of COP, total serum solids, and central arterial mean blood pressure were made. The results showed that COP correlated directly with total serum solids (r = .89, P < .0001) and mean arterial blood pressure (r = .660, P < .001). Among the factors evaluated, total serum solids was the best predictor of COP.
DISADVANTAGES OF HAVING DIABETES–AND ADVANTAGES
Authors: Keltner Robert William
Published: December 2021

About three years ago I became a diabetic, and since then I have been very interested in learning all I can about the disease. I am interested in the medical profession and am considering going into diabetes research.

As with other diseases, there are disadvantages to having diabetes. I have found that I must maintain a delicate balance between insulin injections, diet, and exercise in order to keep my blood sugar at a normal level. The maintenance of this balance requires a great deal of my attention, so occasionally I am unable to concentrate completely on some activity. I must always be conscious of my sugar level and be ready to make adjustments if my level is too high or too low. Another problem I have experienced is that other people do not understand diabetes. I have encountered people who think diabetics are sick and cannot lead normal lives. Other disadvantages of diabetes are the daily insulin injections I must take and the complications that can occur if proper control is not maintained. Although I have not experienced complications, some diabetics experience slow healing of wounds and impairments of eyesight and circulation.

Despite the disadvantages of diabetes, I have found that having it is advantageous in some aspects. My healthy diet and regular exercise have allowed me to stay in good shape. Some doctors consider diabetes "the healthiest disease." Another advantage of diabetes actually stems from the disadvantages of the disease. In some ways the problems involved with diabetes have made me more determined to excel at whatever I do.
A VICTORIAN CHILD AND THE CHILDREN'S HOSPITAL (1881)
Authors: C. T. E.
Published: December 2021

The following description of life in a children's hospital appeared in The Children's Sunday Album, published in London in 1881.1 The wide difference between the rich and the poor child was usually accepted in the Victorian era as part of the Divine order of things.

Look at this picture well, you little, bright, happy children, who are well and strong, or even any afflicted like these, and be grateful for the cheerful homes, the loving friends, the comforts which surround you! Good generous people, pitying and loving little children, have sent enough money to support them, and have them taught trades to enable them to lead useful lives, though they are cripples.

See how busily at work this big girl is at the end of the form; but her crutches lying beside her tell only too plainly of her misfortune. Bad nursing in their babyhood, joyless unchildlike lives in crowded dirty streets, cause the children of the London poor to be wretched sufferers; and it is a piteous, touching sight to visit the hospitals which have been built for these poor little creatures. Everything is done for them that skill and kindness can do; but it is not like you at home in your beautiful nurseries, with your toys and books, your loving mother, and healthy little brothers and sisters making merry round. In each little bed is some poor, suffering child, tended by kind nurses certainly, but no mothers. Think of this, little ones, when inclined to be fractious and cross, and troublesome, and bless God who has made your lot so bright.
Diet and Hyperactivity: Is There a Relationship?
Authors: Hindle R. C.
Published: December 2021

The article under this title written by Dr F. J. Stare and colleagues1 gives rise to considerable concern. The root cause of my concern being the use of unpublished data to support an argument that is more destructive than constructive in its criticism. They quote this unpublished data as "the most important study to date on the relationship between diet and hyperactivity," indicating that this study was completed in California three years ago—which surely should be time enough for a study on such an emotive topic to have been published if it was, in fact, "the most important study to date."
Transcutaneous Bilirubinometry: A New Light on an Old Subject
Authors: Hegyi Thomas
Published: December 2021

The role of bilirubin as a cause of central nervous system morbidity in the newborn infant has been well recognized for several decades. The specific serum concentration that leads to cellular injury, as well as the precise mechanism of damage, are as yet unclear but general principles of therapy have been established. Early detection of hyperbilirubinemia is based on the clinical assessment of dermal icterus followed by appropriate serum tests to determine the degree of serum bilirubin elevation.

The relationship of dermal icterus and serum bilirubin concentration has intrigued clinicians for more than a century.1 In an attempt to utilize skin color as an index of hyperbilirubinemia many techniques have been investigated.
Lead Study Questioned
Authors: Spector Steven , Brown Kevin E.
Published: December 2021

The recent article by Drs Ernhart, Landa, and Schell1 regarding developmental deficits resulting from subclinical levels of lead displays serious inaccuracies of data interpretation and measurement. Although their rigorous attempt to improve the methodology in this area of research is commendable, there are major shortcomings in their research.

These investigators "question reports of positive findings" and conclude that the effects of subclinical lead levels "are minimal." They dismiss the few significant results and would have us believe that it was mere coincidence or artifact that these few significant results were obtained on the "critical intelligence test set."
ARMAND TROUSSEAU ON THE TREATMENT OF ENURESIS (c1850)
Authors: C. T. E.
Published: December 2021

Armand Trousseau (1801-1867), in his time considered the foremost clinician of the Hôtel-Dieu (the oldest hospital in Paris), made many significant advances in the treatment of diphtheria, scarlet fever, typhoid fever, and rickets.

In one of his clinical lectures at the Hôpital des Enfants-Malades, Trousseau gave the following suggestions for the treatment of enuresis.

This infirmity [enuresis] I consider a neuralgia or névrose, and it is much more common than is generally believed. It has been thought nearly incurable, but with belladonna, is one of the most easily cured of all diseases.

Those children who are troubled in the daytime are not cured by belladonna.

A child going to bed with an empty bladder will pass his water during the first two hours, sometimes during the first hour; placed in bed at 9 o'clock, the bladder will throw off its contents at 10 o'clock, and then retain them until 8 o'clock the following morning, being full at that time. The accident generally happens once only during the night, but sometimes twice. During the first hours of sleep, you generally find in young men and children an erection. The question may be asked, whether something of the same kind may not take place in the bladder. This complaint is most common among young girls, and is generally cured spontaneously at the age of puberty; but when this is not the case, do what chance has shown to be efficacious.

Treatment—The first precaution is to break up the bad habit of the organs. Wake the child at the end of an hour, and make him pass his water; after several days, make him at the end of an hour and a half. This is only accessory.
Quinacrine Hydrochloride-Induced Yellow Discoloration of the Skin in Children
Authors: Sokol Ronald J. , Lichtenstein Philip K. , Farrell Michael K.
Published: December 2021

The drug of choice for treatment of giardiasis in children has changed over the past several years. Metronidazole (Flagyl) has been found to be carcinogenic in mice and mutagenic in bacteria,1 and is, therefore, no longer approved by the Food and Drug Administration for the treatment of giardiasis. Thus, quinacrine hydrochloride (Atabrine) is the recommended alternative drug for the treatment of giardiasis in children. The purpose of this report is to remind physicians of a common side effect of quinacrine hydrochloride and to call attention to a simple clinical method for its confirmation.

CASE REPORT

S.W., a 3-year-old white boy, had a three-week history of three to six loose, watery bowel movements per day.
Echocardiography in Aspergillus Endocarditis
Authors: Kleiman Martin B.
Published: December 2021

In an extensive review1 of endocarditis caused by Aspergillus in children, Barst et al found no cases in which the presence of vegetations was proven by echocardiography. We present the case report of a child in whom the two-dimensional echocardiogram first established the presence of a mycotic aneurysm and associated intracardiac and intra-aortic vegetations.

Case Report. An 11-year-old girl with severe congenital aortic stenosis underwent aortic valvulotomy on Dec 17, 1977. Fever developed on the 11th day after surgery and daily spikes to 38.8 C (102 F) continued for the ensuing several weeks.
Suprapubic Aspiration Associated with Hematoma
Authors: Morrell Rose Ellen , Duritz Gilbert , Oltorf Charles
Published: December 2021

A newborn female infant who experienced an intramural bladder hematoma with upper tract obstruction secondary to a suprapubic aspiration is described. The literature is reviewed and the conservative management of this child is discussed.
Aspirin Fatalities—The New Taxonomy
Authors: McIntire Matilda S. , Angle Carol R.
Published: December 2021

In the letter "Aspirin Fatalities—The New Taxonomy" by McIntire and Angle (Pediatrics 69:249, 1982), in the second paragraph, the last sentence should read: Eight of the 11 deaths occurred at the victim's residence, implying delayed recognition and underutilization of poison control center facilities.
Neural Tube Defects: Prevention by Vitamin Supplements
Authors: Smithells R. W.
Published: December 2021

Neural tube defects (NTD) have been the object of more intense epidemiologic study than any other kind of birth defect. This is in part because of their ready recognition at birth (and, in recent years, before birth) and in part because their consequences are usually catastrophic: they kill or they cripple.

Regarding their cause, no single genetic or environmental agent has been identified (or is likely to be) and a multifactorial basis is assumed. If failure of neural tube closure results from the additive effects of several adverse factors, removal or correction of any one might shift the developmental balance across the threshold from NTD to normality.
Eagle-Barrett Syndrome
Authors: Dorst John P. , Seidel Henry M.
Published: December 2021

Eponyms may at times have an unexpected value when they are used to designate syndromes or specific diseases. We would suggest, for example, that Eagle-Barrett1 syndrome is a kinder and more appropriate designation than "prune belly syndrome."

Our experience tells us that the latter designation is disturbing to parents of children who have the problem. Unfortunately, these children are sometimes referred to as "prune bellies." The designation does lend itself at times to an unintended but nevertheless demeaning overtone.
Letters to the Editor
Authors: Todd James K.
Published: December 2021

The above letter suggests that some women are prompted to change their tampon use practices based upon knowledge of toxic shock syndrome. The general trends recited here are commensurate with other observations across the country. Others have observed that over time some of these women will revert back to the use of tampons as publicity about toxic shock syndrome wanes. Although the Center for Disease Control (CDC) has claimed that the incidence of toxic shock syndrome has decreased,1 they have a passive surveillance system and data from other, more complete, active surveillance programs (Michael Osterholm, personal communication) suggest that no decrease has occurred.
OLIVER WENDELL HOLMES ON TELLING THE PATIENT THE WHOLE TRUTH
Authors: C. T. E.
Published: December 2021

Oliver Wendell Holmes (1809-1894), in an address delivered to the graduating class of the Bellevue Hospital Medical College on March 2, 1871, had this to say about telling all the truth to patients1:

Your patient has no more right to all the truth than he has to all the medicine in your saddle-bags, if you carry that kind of cartridge-box for the ammunition that slays disease. He should get only just so much as is good for him. I have seen a physician examining a patient's chest stop all at once, as he brought out a particular sound with a tap on the collar-bone, in the attitude of a pointer who has just come on the scent or sight of a woodcock. You remember the Spartan boy, who, with unmoved countenance, hid the fox that was tearing his vitals beneath his mantle. What he could do in his own suffering you must learn to do for others on whose vital organs disease has fastened its devouring teeth. It is a terrible thing to take away hope, even earthly hope from a fellow-creature. Be very careful what names you let fall before your patient.
Temporomandibular Joint Dysfunction with Facial Pain in Children
Authors: Belfer Myron L. , Kaban Leonard B.
Published: December 2021

Temporomandibular joint dysfunction with myofascial pain, a well-known clinical disorder in adults, is reported in children. In a series of 400 patients, 40 children less than 16 years of age were seen. Of these pediatric patients, 35% had a reactive depression as primary psychopathology. The multifactorial nature of the disorder is described. The need to differentiate this syndrome from recurrent otitis media and other pain syndromes is emphasized. A combined medical, oral surgical, and psychiatric management program is outlined.
Symptomatic Atlantoaxial Dislocation in Down Syndrome
Authors: Hreidarsson Stefan , Magram Gary , Singer Harvey
Published: December 2021

Spinal cord compression secondary to atlantoaxial dislocation in Down syndrome is relatively uncommon. This case emphasizes the importance of early diagnosis and appropriate radiologic procedures.
Favorable Results of Neonatal Intensive Care for Very Low-Birth-Weight Infants
Authors: Cohen Ronald S. , Stevenson David K. , Malachowski Natalie , Ariagno Ronald L. , Kimble Keith J. , Hopper Andrew O. , Johnson John D. , Ueland Kent , Sunshine Philip
Published: December 2021

From 1961 to 1976, 229 infants with birth weights ranging from 751 to 1,000 gm were admitted to the Stanford University Hospital Intensive Care Nursery. The overall neonatal mortality for these infants was 63% (144/229), and there were ten late deaths. Before 1967, no infant in this group who required mechanical ventilation survived; therafter, 30% (34/114) of the ventilated patients survived. Of the 75 long-term survivors 60 participated in a high-risk infant follow-up program; these included 23 infants who had received mechanical ventilation. The mean birth weight of these infants was 928 ± 67 (SD) gm. Seventeen children (28%) had significant morbidity: seven (12%) with severe handicaps and ten (17%) with moderate handicaps. During this same period, seven infants weighing less than 750 gm at birth were also observed. The three infants who had not required ventilatory support thrived; the other four infants had required respirators and were significantly handicapped. More recently, neonatal mortality for infants with birth weights from 751 to 1,000 gm has improved: for 1977 to 1980, it was 28% (33/118). Furthermore, neonatal mortality for ventilated infants in this weight group was 27% (26/95). These data indicate an improved prognosis for very low-birth-weight infants, even with ventilatory support.
Mental Retardation in the Bannayan Syndrome
Authors: Saul Robert A. , Stevenson Roger E. , Bley ROGER
Published: December 2021

Bannayan syndrome, first reported in 1971, is characterized by macrocephaly and multiple softtissue and visceral hamartomas.1 Two reports have documented autosomal dominant inheritance and an altered rate of linear growth.2,3 An intracranial tumor occurred in one patient.3 We report a third family with Bannayan syndrome with a significant additional feature, mental retardation.

CASE REPORT

The proband, a 1710½-year-old white male adolescent, was noted shortly after a normal birth to have a large head, diagnosed as "hydrocephalus." No specific intervention was initiated. Skin tumors developed within the first year, and a 5x6x7-cm lipoma (confirmed by histologic examination) was removed from the right axilla at 2 years of age.
Letters to the Editor
Authors: Versmold Hans T.
Published: December 2021

No infant with a birth weight less than 1,000 gm is normal. Therefore, there will be a continuing controversy about the criteria for electing infants as a "normal" reference group.

The crucial difference between infants in the study of Feldman et al1 and our "well babies" is that we systematically excluded transfused infants, because we usually transfuse infants for suspected hypovolemia, hypotension, or anemia, conditions excluding them from our analysis to eliminate the bias of blood pressures artificially elevated by volume expansion.
Chloramphenicol Interactions
Authors: Zaret Gary M.
Published: December 2021

In a recent report describing chloramphenicol pharmacokinetics1 it was stated that patients changing from intravenous to oral administration of the antibiotic exhibited prolonged half-life (t½ = 6.5 ± 2.5 [SD] hours) compared with values obtained during intravenous administration ( t½ = 4.0 ± 1.4 [SD] hours). These findings, consistent with an earlier study,2 are said to indicate that oral administration of chloramphenicol may be at least as effective as administration via the intravenous route.

One aspect not considered in this report concerns the concurrent use of other (nonantibiotic) medications.
Letters to the Editor
Authors: Winter William D.
Published: December 2021

Joseph W. St. Geme, Jr, has written of the pediatrician's self-image and sense of "worth" (Pediatrics 68:734, 1981). I quite agree with his sense that we should not feel that we are small doctors because we treat small patients. And I quite agree that the newly graduated resident should not allow his special skills to fade in deference to those of other specialists.

But when his emphasis on the "worth" of a pediatrician focuses ultimately on the monetary, I take issue: