bluuebunny/crossref_metadata_2025 huggingface dataset:
Tularemia Pneumonia in Urban Children
Authors: Halsted Crystie C. , Kulasinghe Hareen P.
Published: December 2021

Tularemia pneumonia occurred simultaneously in five children in urban Baltimore. The features of this outbreak are reported to document the mild nature of the pneumonic illness and thus to emphasize the variability of the pulmonary manifestations of Francisella tulareusis infection. These cases also serve as a reminder to physicians that tulareniia, an infrequently encountered illness, is endemic in the United States.

CASE REPORT

Three previously healthy brothers, T.W., J.W., and R.W., 8, 10, and 14 years of age, were seen at the Baltimore City Hospital Outpatient Clinic with a history of fever of ten days' duration. The temperatures, compulsively documented by their mother, ranged from 37.8 to 40.0 C (100 to 104 F) daily and did not abate with antipyretics or the oral administration of penicillin prescribed by the family physician at the onset of fever.
Close encounters with SIDS
Authors: Stark Ann R. , Mandell Frederick , Taeusch H. William
Published: December 2021

The use of apnea monitors at home to prevent sudden infant death syndrome (SIDS) in infants at risk is a debated issue. Several very difficult questions await answers: (1) Who should be monitored? (2) What kinds of monitors would be most effective? (3) Does monitoring work? (4) Are other approaches apt to be simpler and more efficacious, e.g., respiratory stimulants?

What is known about SIDS is mostly epidemiologic information. The incidence is 2 to 3 per 1,000 live births, with a peak age distribution between 2 and 4 months. Most deaths are silent and occur when the infant is supposedly asleep.
Primary Care Supplement
Authors: Rivara Frederick P.
Published: December 2021

I was very excited and pleased when I received my October 1977 issue of Pediatrics and found a supplement on primary care. However, with much disappointment I found that the articles included were, at best, focused on very narrow areas in pediatrics and, at worst, completely irrelevant to the current issues faced by primary care pediatricians in this country.

The precise definition of primary care has been a difficult problem. One operative definition is a system of health care that provides for unselected problem care; comprehensive care; entry point care; preventative care; ambulatory care; and majority care.1
Letter to the Editor
Authors: H. R. J.
Published: December 2021

While we agree with the definition of primary care articulated by Dr. Rivara, even it does not fully describe this important field. The recent Institute of Medicine definition of primary care1 adds to his points of accessible, comprehensive, and preventive services those of coordination, continuity, and accountability. To have addressed all of these in one small supplement of Pediatrics is a tall order. We clearly could not. In addition we believe that competency in managing the content of such services is also a responsibility of primary care physicians.
ODE TO THE HIPPIE
Authors: Bridges Thomas
Published: December 2021

Alas, former flower children are a social oddity. The threatening phenomenon known as the hippie is little more than a ghost of the 1960's-seldom thought about by the 60's generation and hardly known by 70's people. Ten years have scraped too many minds clean. Those optimistic child-people who danced through the streets of San Francisco have even faded out of the memories of their present selves. Metamorphosed into practical human beings? Or have they just grown up? Or do they remember too clearly?...

Most tried to rejoin the establishment. As if they could just walk back into their former selves. But the alienation was too complete.

The most sensitive and enthusiastic (intelligent?) minds of the 1960's will always be drop-outs or partly-ins—the most ambitious and durable working within the system to gather up whatever they need to get out of it again.

Our alienation has settled to the bone. Terminal. We walk around incognito. Up front is our get-along face. One must survive, you know. Inside, we still don't believe in any of it. Do you?
THE GREAT ELECTRONIC DICTATOR
Authors: Boorstin Daniel J. ,   Student
Published: December 2021

. . . television regulates not only our opinions on almost everything, but also: how, when, and what we eat; when we sleep; how we raise our children; what our children think of us; what we do or don't buy; what (and whether) we think of lawyers, doctors, policemen and lawbreakers; how we act in matters of sex and race; how we debate our national issues; what we believe (or imagine) to be our national issues. Most important, television has transformed our perception of what problems (an unhappy marriage, an upset stomach, catching a bank-robber or a mugger, preserving a near-extinct animal species) are soluble and how easily they can be solved.

We now lead a double life. The man-made experiences that we see on the tube have become more real than our everyday experiences. Television has brought an inversion of our consciousness. Nothing is really real unless it "happens" on television. When we take our eyes off the tube we see things that are not quite authentic—or, rather, which gain authenticity only by their resemblance to how things happen on television. Prosecuting attorneys, defense lawyers, jurors, criminals, potential criminals, witnesses are shaped by the "Perry Mason Syndrome." No crime remains unsolved (within the hour). The snail's pace of usual court procedure, like the long-term suffering of the victim or of the imprisioned criminal, goes unseen. Constitutional guarantees (which would bore viewers or slow the action) are depicted only perfunctorily, or as a nuisance in Kojak's way. Off the television screen most crimes are actually never solved, in fact most criminals are never even prosecuted and of those convicted only a small percentage go to jail.
Growth, Health, and Development After Neonatal Gut Surgery: A Long-term Follow-up
Authors: Tejani Amir , Dobias Bohdan , Nangia Bhim S. , Mahadevan R.
Published: December 2021

Growth and development data on 19 children who survived gut surgery in the immediate newborn period are presented. The follow-up period ranges from seven months to seven years six months, with a mean of three years eight months. Neonates who undergo gut resection are at a higher risk for delay in height and weight gain compared to those who have gut surgery without resection. Six of the 12 children who had gut resection showed delay in height gain and seven showed delay in weight gain. Of the seven children who had gut surgery but no resection, only one showed delay in height and weight gain after the age of 1 year. An individual approach and careful serial follow-ups are recommended for all children undergoing gut resection in the newborn period. Of the eight children who had psychometric testing in the gut-resected group, only two are normal. Three of the four older children in this group show signs of perceptuomotor defects, suggesting the need for subtesting such children at about 6 years of age so that remedial help, if necessary, may be provided when formal schooling begins.
Mucocutaneous Lymph Node Syndrome: Report of Two Cases Complicated by Gallbladder Hydrops and Diagnosed by Ultrasound
Authors: Magilavy Daniel B. , Speert David P. , Silver Terry M. , Sullivan Donita B.
Published: December 2021

Two patients with mucocutaneous lymph node syndrome are presented. During the course of their illnesses, they developed acute abdominal pain secondary to hydrops of the gallbladder. The diagnosis and management of each case was facilitated by ultrasonography.
THE 12-YEAR-OLD ANNA WINSLOW WRITES IN HER DIARY ON FEBRUARY 9, 1772, ABOUT HER PROBLEMS WITH A WHITLOW AND MULTIPLE BOILS
Authors: C. T. E.
Published: December 2021

In the year 1770, a bright little 10-year-old girl, Anna Green Winslow, was sent from her home in Nova Scotia to Boston, the birthplace of her parents, to be "finished" at Boston schools by Boston teachers. For a few years following her arrival in Boston, Anna kept a diary in which she recorded the daily events in her life. She was a sensitive and intelligent girl and her comments offer a vivid view of the life of a preadolescent girl in colonial Boston.

The entry below from her diary dated February 9, 1772, written when she was 12 years old, describes her problems with a whitlow and multiple boils. Her spelling has been retained.

Feb. 9th [1772]—My honored Mamma will be so good as to excuse my useing the pen of my old friend just here, because I am disabled by a whitloe on my fourth finger & something like one on my middle finger, from using my own pen; but altho' my right hand is in bondage, my left is free; & my aunt says, it will be a nice oppertunity if I do but improve it, to perfect myself in learning to spin flax. I am pleased with the proposal & am at this present, exerting myself for this purpose. I hope, when two, or at most three months are past, to give you occular demonstration of my proficiency in this art, as well as several others. My fingers are not the only part of me that has suffer'd with sores within this fortnight, for I have had an ugly great boil upon my right hip & about a dozen small ones—I am at present swath'd hip & thigh, as Samson smote the Philistines, but my soreness is near over.
FAMILY IMPACT ANALYSIS
Authors: Bane Mary Jo ,   Student
Published: December 2021

The idea of family impact statements came from participants in the 1973 Senate subcommittee hearings who recognized that government policies, or the lack of them, affect families in unintended and often harmful ways. Both the structure and the quality of family life are powerfully influenced by inflation, unemployment, health care, housing, and income security—all areas in which government makes policy without specifically considering its impact on families. The goal of an impact analysis would be to identify, document, and make public the effects of federal policies on families. The process of preparing and publicizing the statements would at best encourage legislation and programs that enhance family life. At the least, family values would be balanced against other goals as, for example, environmental impact analysis often balances environmental values against economic growth.
Antibody to Hepatitis A and B in Children in New York City
Authors: Cherubin Charles E. , Nair S. Ramachandran , Dienstag Jules L. , Purcell Robert H. , Szmuness Wolf
Published: December 2021

The rate at which the population of New York City acquires antibody to hepatitis B surface antigen (anti-HBs) has been shown to be related to socioeconomic factors,1-3 as is true for so many other infectious diseases. Similarly, antibody to hepatitis A virus (anti-HAV) has been demonstrated to be influenced in the same way in adults and children from New York City and in adults from other areas in this country.4,5 Unexpectedly it appears that both antibodies accumulate in the population very slowly, beginning in late childhood, and continue to increase in frequency up to middle age.

Because of discrepancies between two surveys of anti-HBs in New York City children,1,3 and because we wanted to define more accurately the rate at which children and young adults of different socioeconomic milieu were exposed to these two viral agents, we collected serum samples from a black population in Bedford Stuyvesant and a white population in Staten Island and tested them both for antibodies to HAV and HBsAg.
SWINE FLU FAILURE
Authors: Altman L. K. ,   Student
Published: December 2021

Mass preventive medicine programs clearly depend on public awareness. In an era when informed consent is not only a moral necessity but a legal right, preventive medicine proponents now recognize they cannot proceed unless they recognize the role of publicity in educating the public—not only about the merits but the necessary dangers in a public health program. Any measure that is taken to prevent an illness, or potential complication of an existing illness, involves risk which must be weighed against the threat of what is being prevented.

The experts say they are the only ones who can make the technical decisions and recommendations, but the emphasis on informed consent puts increased responsibility on the individual to accept or reject that advice. The swine flu immunization decision, like many other immunization policies, was made by a small group of selected "experts." Critics of the decision said they had little or no opportunity to voice opposition. Yet when decisions affecting the medical care of every person and every doctor's practice are made centrally, clearly the process needs modification to allow recognition of those with dissenting views or alternative plans. Otherwise, many suspect, there will be less support from those who are asked to take part in mass preventive medicine programs.
Fit for the Future: Lessons for the United States
Authors: H. R. J.
Published: December 2021

The United States has its tradition of White House Conferences; the United Kingdom has its Royal Commissions or Special Committees. The report of the Committee on Child Health Services,1 which took three years for a "far reaching inquiry" on how to improve child health services in the United Kingdom, is in this tradition of both countries. It is a report well worth the waiting and worth careful thought by pediatricians and policymakers in the United States. Volume 1, 448 pages long, is the body of the report. Volume 2 is a statistical appendix.

At the outset, any reviewer of this extensive work must limit his comments to only a few areas that seem most pertinent to our own scene.
α1-Antitrypsin Deficiency in Early Childhood
Authors: Sveger Tomas
Published: December 2021

Among 200,000 infants screened for α1-antitrypsin (α1-AT) deficiency, 125 Pi Z, 48 Pi SZ, 1 Pi S-, and 2 Pi Z- children were followed up prospectively. Eleven percent of the Pi Z infants had neonatal cholestasis, and at 2 years of age three of them had cirrhosis. About 50% of the asymptomatic Pi Z and Pi Z- subjects occasionally had serum alanine aminotransferase (ALAT) levels above normal, and in 15% of them the levels were probably permanently increased during the first two years of life. Two previously healthy Pi Z children had transient symptoms of liver disease at age 2 years in connection with severe infections. The Pi SZ children had no significant clinical liver disease and only two had abnormal serum ALAT levels. Among Pi Z children up to 2 years of age the following diseases were also encountered: eight had recurrent bronchitis with wheezing, two had persistant cough (both had cirrhosis), one had severe pneumonia one was mentally retarded, three had urinary tract infections, six had pronounced eczema, one had allergic shock, and three had congenital malformations. Among the Pi SZ children one had recurrent bronchitis, one had eczema, and one had juvenile rheumatoid arthritis. Three children, two Pi Z and one Pi SZ, have died. The Pi Z- and Pi S- subjects were healthy. In conclusion a variety of significant symptoms were observed in about 30% of the Pi Z children compared with 6% of the Pi SZ children during the first two years of life.
Studies of the Cause and Treatment of Hyperammonemia in Females With Ornithine Transcarbamylase Deficiency
Authors: Glasgow Allen M. , Kraegel John H. , Schulman Joseph D.
Published: December 2021

Assay of ornithine transcarbamylase (OTC) activity in multiple small bits of liver (approximately 5 mg) that were obtained from a single surgical biopsy in a patient with OTC deficiency revealed a 10- to 40-fold variation in enzyme activity. Similar studies with control autopsy liver specimens varied 2.5-fold at most. The greater variation in the patient with OTC deficiency probably is due to sampling of clusters of normal or abnormal hepatocytes that resulted from inactivation of either the abnormal or normal X chromosome. Enzyme activity assayed on small liver biopsy specimens may not be representative of the entire liver in female patients with OTC deficiency. The hyperammonemia in individuals heterozygous for OTC deficiency may be due in part to shunting of blood through multiple "metabolic portosystemic shunts." Treatment of a girl who has OTC deficiency with a low-protein diet, a low-protein diet supplemented with oral essential amino acids, and a low-protein diet plus oral ketoacids of essential amino acids was compared in short-term balance studies; on a separate occasion, a low-protein diet was compared to a low-protein diet plus lactulose. The low-protein diet plus oral ketoacid supplementation resulted in the best metabolic control of the patient's disease. On the other hand, paradoxical transient hyperammonemia was observed after the intravenous administration of ketoacids to two acutely ill female patients with OTC deficiency.
Computed Tomography in Child Abuse and Cerebral Contusion
Authors: Ellison Patricia H. , Tsai Fong Y. , Largent Jill A.
Published: December 2021

Cerebral contusion is considered to be the lesion leading to neurological sequelae of mental retardation and cerebral palsy in abused children. This has been difficult to document other than at autopsy or craniotomy by previously available techniques. Acute contusion or hemorrhage presumably secondary to contusion is readily documented by computed tomography (CT). We are reporting the cases of four children with alleged or suspected abuse and CT evidence of cerebral contusion. The contusion has been found both with and without external evidence of head injury.
SCIENTIFIC PUBLICATION
Authors: Relman A. S.
Published: December 2021

Dr. Kan of Ciba-Geigy [was quoted] as saying that the Anturane Research Team used The New England Journal of Medicine as a "court of last resort" in deciding whether to continue their clinical study of the drug after initial results appeared to be so favorable.... This seems to me to reflect a serious misunderstanding of the role of a scientific publication like The New England Journal of Medicine.... We make no claim to editorial omniscience, nor do we guarantee that everything we publish will stand the test of time. Indeed, we know that ideas are being continuously reshaped in the crucible of ongoing research and clinical experience.

Good journals try to facilitate this process by identifying noteworthy contributions from among the great mass of material that now overloads our scientific communications system. Everyone should understand, however, that this evaluative function is not quite the same thing as endorsement.
Decreased Heart Rate Variation in Decerebration Syndrome: Quantitative Clinical Criterion of Brain Death?
Authors: Kero Pentti , Antila Kari , Ylitalo Veli , Välimäki llkka
Published: December 2021

Heart rate variation (HRV) was measured in 12 children with brain death. Computer analysis demonstrated an overall heart rate variation (RMSM) of 3.5 to 9.6 msec (mean, 6.0 msec). The respective figures for beat-to-beat variation (RMSSD) were 4 to 16 msec (mean, 7.7 msec). Normal infants (RMSM, 20 to 30 msec) and children (RMSM, 50 to 90 msec) and infants with respiratory distress syndrome (RMSM, 10 to 20 msec) have a clearly higher HRV than those with brain death.

In all subjects a periodic component of the HRV with a cycle length of 5.9 ± 0.26 seconds was discovered. In five patients an additional periodic component was found that corresponded exactly to the rate of artificial respiration. This study demonstrated the value of accurate digital techniques in the characterization of fixed heart rate in decerebration. This phenomenon could be considered one clinical criterion of brain death.
Echographic Ventricular Systolic Time Intervals in Normal Term and Preterm Neonates
Authors: Halliday Henry , Hirschfeld Stephen , Riggs Thomas , Liebman Jerome , Fanaroff Avroy
Published: December 2021

Right ventricular and left ventricular systolic time intervals (RVSTIs and LVSTIs) were measured in normal term and preterm infants from 1 hour to 90 days of life. LVSTIs in both term and preterm infants were similar in the first five days of life. The ratio of left pre-ejection period (LPEP) to left ventricular ejection time (LVET) was lower in preterm infants older than age 5 days. Estimated gestational age had no influence on LVSTI. The ratio of right preejection period (RPEP) to right ventricular ejection time (RVET) was lower in preterm infants (0.32) than in term newborns (0.37). The preterm RPEP/RVET ratio decreased with age, but at a slower rate than in term babies. This was consistent with the lower pulmonary vascular resistance present in preterm infants.
BIRTH CONTROL AS VIEWED IN 1923 BY A HIGHLY RESPECTED AMERICAN PEDIATRICIAN
Authors: C. T. E.
Published: December 2021

Dr. Richard Arthur Bolt (1880-1959) was both a greatly respected American pediatrician and an acknowledged leader in the development of maternal and infant hygiene programs.

His chapter entitled "The Mortalities of Infancy" in Isaac Abt's (1867-1955) encyclopedic, nine-volume treatise on pediatrics, published between 1923 and 1926, contains this negative view of birth control.1

This terrific loss of life in utero or shortly after birth constitutes a serious problem from a biological as well as a social standpoint. Of recent years there has been an alarming increase in the frequency and actual number of induced abortions. This has gone hand in hand with the insidious propaganda for so-called "birth control" or "voluntary parenthood"—a movement which has gained momentum in France, Holland and New Zealand, and has gradually spread to England and the United States. While the birth control enthusiasts would indignantly disclaim any connection between the "contraceptive methods" of "voluntary parenthood" and induced abortions, it is very evident that the more "moral technique" of contraception must often break down and relief from the "accidents" which follow be frequently sought in induced abortion. Thus far contraceptive methods have been practiced largely by the elite and better educated classes. Those most able to bear children and meet their support have been the very ones to shirk the responsibility, while those for whom birth control is claimed to be a great boon still proceed to build up large families.

It has been estimated that at least four children to a family are necessary to keep up the stock.
EKG Effects of Imipramine Treatment in Children
Authors: Saraf Kishore R. , Klein Donald F. , Gittelman-Klein Rachel , Gootman Norman , Greenhill Philip
Published: December 2021

There are increasing reports of serious side effects in children with clinical use of imipramine in high doses. Our analysis of the EKG effects of imipramine in 25 hyperactive and 8 school phobic children suggests that children on a dose of imipramine of 3.5 mg/kg or more are likely to show an increase in PR interval of .02 seconds or more and that such increases are more likely to occur in patients with a small pretreatment PR interval. In 7 children the PR interval prolongation was above the rate-corrected norm. EKG monitoring seems desirable in children maintained on imipramine dose of 3.5 mg/kg or more.
Simplified Technique for Tympanocentesis
Authors: Kaplan Sheldon L. , Feigin Ralph D.
Published: December 2021

Needle tympanocentesis is a useful technique for elucidating the etiology of otitis media. The Senturia ear specimen collector has been designed specifically for tympanocentesis, but this instrument requires additional equipment, plus a source of negative pressure.1 Other investigators have used ap 18- to 20-gauge needle attached to a syringe in order to aspirate effusions behind the tympanic membrane.2 This technique requires that the operator direct the needle downward through the tympanic membrane while applying upward pressure to the syringe plunger. We have modified this technique so that double motion is no longer required; the operator can direct his attention toward perforating the tympanic membrane safely.
Federal program for indigent medically disabled children
Authors: Powers Hugh W. S.
Published: December 2021

In 1972, Congress made funds available for the support of disabled infants and children. The well-known Retirement Insurance Program of the Social Security Administration had its beginning in 1935. Title XVI was added in January 1974, in order that disability claims involving children up to 18 years of age could be investigated. This process was needed to establish the fact that the children in question were unable to grow, develop, learn, and attend school on a par with their peers. Furthermore, it was intended that if the child in question was proven to be unable to associate and compete with other children in their daily activities because of mental and physical impairments, such children and their families were to be provided with payments (supplementry security income) which would help with their support and maintenance.
Oxygen and Retrolental Fibroplasia: In Defense of Data
Authors: Kinsey V. Everett , Patz Arnall , Stern Leo
Published: December 2021

Accompanying the collaborative study report on PaO2 levels in retrolental fibroplasia (RLF) in the November 1977 issue of Pediatrics (60:655, 1977) were three editorial comments, two signed and one appearing under a somewhat confusing anonymous designation, commenting on the study, its outcome, and its implications. All three were critical of specific aspects of the report, some of which we, the authors, clearly realized not only when the study was being undertaken, but also when it was being analyzed and reported.
Absence of Kernicterus in Low-Birth-Weight Infants From 1971 Through 1976: Comparison With Findings in 1966 and 1967
Authors: Pearlman Mark A. , Gartner Lawrence M. , Lee Kwang-sun , Morecki Rachel , Horoupian Dikran S.
Published: December 2021

A review of 34 autopsied infants weighing 2,250 gm or less who died on the third to seventh days of life during the six-year period from 1971 through 1976 failed to reveal any cases of kernicterus. This contrasts with an incidence of 64% in low-birth-weight infants selected in the same manner from the same neonatal intensive care unit-premature center during the period 1966 and 1967. The 34 infants in the 1971-1976 series were not significantly different with regard to their birth weights, Apgar scores, perinatal complications, or pathologic findings, other than their lack of kernicterus, from the 14 infants in the 1966-1967 series. The only significant difference between these two groups of infants was a lower mean peak serum bilirubin concentration in the 1971-1976 series, corresponding with the establishment in 1970 of a more aggressive policy of exchange transfusion and phototherapy. The prevention of excessive hyperbilirubinemia along with the development of more sophisticated intensive care of the neonate in recent years may be responsible for the elimination of kernicterus in the 1971-1976 series of infants.
Hypercarbia at Birth: A Possible Role in the Pathogenesis of lntraventricular Hemorrhage
Authors: Kenny John D. , Garcia-Prats Joseph A. , Hilliard James L. , Corbet Anthony J. S. , Rudolph Arnold J.
Published: December 2021

To test the hypothesis that birth asphyxia has a role in the etiology of intraventricular hemorrhage (IVH), blood was collected from the umbilical artery (UA) at birth in 28 premature infants of 26 to 29 weeks' gestation and analyzed for hydrogen ion concentration [H · ], PCO2, standard bicarbonate level, and lactic acid level. The infants were followed up throughout their nursery stay until a diagnosis of IVH could be made or excluded, either by autopsy or clinical findings. Infants with IVH had lower Apgar scores. There were no differences in UA [H ·] or bicarbonate or lactic acid levels. However, infants with IVH had a significantly higher UA PCO2. Although the difference appeared relatively small, the increase in PCO2 during labor may have been relatively large. It is concluded that hypercarbia, possibly by increasing cerebral blood flow, may he one important factor in the genesis of IVH.
Maternal ABO Blood Group Type B: A Risk Factor in the Development of Neonatal Group B Streptococcal Disease
Authors: Regan Joan A. , Chao Solan , James L. Stanley
Published: December 2021

In a prospective study of maternal genital colonization with group B streptococci (GBS) at the time of delivery, epidemiological data, including blood type (ABO group), were recorded for the 1,062 patients studied. Blood type B was found in a statistically significant higher proportion of patients colonized with CBS (28%) compared with the total population (16.4%) (P < .005, x2 = 8.43). Women with blood type B were twice as likely to be colonized as those with types 0 or A. Hypotheses to explain this observation include the possibilities that GBS possess a B-like antigen, rendering parturients who lack anti-B antibody at increased risk for GBS colonization, or that GBS possess a receptor site for B surface antigens. One may speculate that a mutation toward an affinity for the human ABO blood group type B accounts for the advent of the group B Streptococcus as a significant perinatal pathogen.
Pediatric Aspects of Hyperlipidemia
Authors: Breslow Jan L.
Published: December 2021

Pediatricians and nutritionists are often asked about the type and amount of lipid that should be contained in the diet of an infant or a child. Interest is motivated by the high incidence of coronary artery disease in the American population, and the belief that diet is an important etiologic factor in atherosclerotic disease.1 Furthermore, since atherosclerosis is sometimes well advanced by the third decade of life, the true primary prevention of atherosclerotic disease is a pediatric problem and must begin in childhood.2.3 This report will review the relationship between diet, hyperlipidemia, and atherosclerotic disease, and will offer practical recommendations for intervention in the pediatric population.

It is estimated that 40% to 45% of the deaths in the United States are due to atherosclerosis and its complications. The majority of individuals with symptomatic atherosclerotic disease are 65 years or older.4 The disease is often associated with the aging process; however, there are individuals who age without signs of such disease. There also are individuals in the general population who develop symptomatic atherosclerotic disease at a young age. It is estimated that 3% of women and 10% of men will have some first event of coronary artery disease before 55 years of age.4 A large percentage of those in this group are predisposed to atherosclerotic disease because of metabolic or genetic factors such as the inherited forms of hyperlipidemia.5-8

Serum Lipids and Coronary Heart Disease

Atherosclerosis has existed for thousands of years, as evidenced by the autopsy performed on the embalmed body of an Egyptian pharaoh which showed an aorta affected with large calcified atheromatous lesions.9
Vertebral Osteomyelitis in Children: Report of Four Cases
Authors: Bolivar Ricardo , Kohl Steve , Pickering Larry K.
Published: December 2021

Four children had vertebral osteomyelitis due to Staphylococcus aureus. Abdominal signs and fever were frequent clinical manifestations. Back pain was an uncommon symptom except as a late manifestation in one patient. The portal of entry of the organism generally was not apparent. Location of infection was in the lower thoracic and lumbar spine. Diagnosis was based on roentgenographic changes, radionuclide imaging, and bacteriologic corroboration. We conclude that symptoms and signs of vertebral osteomyelitis in children can be atypical and that a diligent attempt to rapidly diagnose and promptly treat this condition will prevent orthopedic and neurotogic sequelae.
DR. S. JOSEPHINE BAKER AND THE TONSIL AND ADENOID RIOT AT A NEW YORK CITY PUBLIC SCHOOL ABOUT 1920
Authors: C. T. E.
Published: December 2021

Dr. S. Josephine Baker (1873-1945), Director of the Bureau of Child Hygiene of the New York City Department of Health from 1908 until 1923, described what must have been one of the most unusual riots in the history of American pediatrics.

I first heard of it when I got a ‘phone call that there was serious trouble at one of the public schools on the lower east side and went down to investigate. The school yard was clogged with a mob of six or seven hundred Jewish and Italian mothers wailing and screaming in a fine frenzy and apparently just on the point of storming the doors and wrecking the place. Every few minutes their hysteria would be whipped higher by the sight of a child ejected from the premises bleeding from mouth and nose and screaming with sheer panic. In view of what I saw when I had fought my way inside, I would not have blamed the mothers if they had burned the place down. For the doctors had coolly descended on the school, taken possession, lined the children up, marched them past, taken one look down each child's throat, and then two strong arms seized and held the child while the doctor used his instruments to reach down into the throat and rip out whatever came nearest to hand, leaving the boy or girl frightened out of a year's growth and bleeding savagely. No attempt at psychological preparation, no explanation to the child or warning to the parents.
Serum γ-Glutamyl Transpeptidase Activity: A Chemical Determinant of Alcohol Consumption During Adolescence
Authors: Westwood Michael , Cohen Michael I. , McNamara Helen
Published: December 2021

The drinking habits of 55 adolescents, aged 12 to 22 years, were evaluated in light of the current presumed upsurge in adolescent alcohol use. SGPT, SGOT, and alkaline phosphatase concentrations were essentially normal in all subjects. Serum γglutamyl transpeptidase (GGTP) concentrations were elevated in 12 of 15 adolescents who consumed six or more drinks per day. It is suggested that this test may warrant inclusion among other targeted screening procedures performed in teenage patients suspected of heavy alcohol consumption.
Telephone Assessment of lllness: What Is Being Taught and Learned?
Authors: Curry Thomas A. , Schwartz M. William
Published: December 2021

An important part of the educational program of house officers consists of teaching skills that are needed to practice medicine. There is great time and energy expended in the educational process, but rarely are these efforts subjected to critical evaluation. The following study points out the need for an evaluation program to determine if the teaching is effective.

Since pediatricians may spend one eighth of their time on the telephone,1 an important part of house officer training programs should be the development of telephone communication skills. Careful evaluations have demonstrated that pediatricians and house officers have not asked important questions during telephone consultations.
Take Care of Yourself: A Consumer's Guide to Medical Care, by D. M. Vickery and J.F. Fries (Addison-Wesley Publishing Co, 1976)
Authors: H. R. J.
Published: December 2021

"You can do more for your health than your doctor can." With this dramatic sentence the authors set the stage for a self-help book that should prove useful to families and their physicians. Many of us complain that patients contribute to their ill health by unhealthy habits and then use doctors inappropriately. This book seeks to correct both problems. Section I shows patients how to lead healthier lives, how to choose a physician, and how to use medical care most effectively.
Thumbs and anemia
Authors: Alter Blanche P.
Published: December 2021

There have been nine cases reported of children with triphalangeal thumbs and congenital RBC aplasia.1-8 The first such case was included in the review of 30 patients with congenital (erythroid) hypoplastic anemia in 1961 by Diamond et al.1 (This anemia had been described in 1938 in a brief report by Diamond and Blackfan.2 It was thereafter called the Diamond-Blackfan syndrome by some and congenital hypoplastic anemia by others.) The other cases of triphalangeal thumbs were reported individually, as if a new syndrome had been found, which recently was called the Aase syndrome.3 As a matter of fact, a review of 200 cases of congenital hypoplastic anemia in the literature has revealed 17 patients with associated thumb abnormalities.
Fouling one's own nest
Authors: Chisolm J. Julian
Published: December 2021

The occurrence of increased assimilation of chemicals by children who live near smelters and other industrial plants is well known. Lead,1-4 arsenic,5 and tetrachlorodibenzodioxin (TCDD),6 for example, have been implicated, and epidemiological data indicate airborne transport of these chemicals from the factory to nearby homes. Elsewhere in this issue (page 563), Dolcourt et al. present another route of transport of lead from factory to home, namely, via soiled work clothes. Although lead-bearing dust is implicated in this particular case, work clothing impregnated with organic chemicals and worn home7.8 and even human breast milk9 are implicated in other cases in which the children of workers have been affected.
Letter To The Editor
Authors: McCarthy Paul L. , Dolan Thomas F. , Jekel James F.
Published: December 2021

Dr. Todd has written a thoughtful commentary on our recent article.

All tests, alone or in combination, including the medical history and physical examination, have false-positive and false-negative errors. The balance between these errors is, as Dr. Todd mentions, determined by the cutoff points we choose. Although other cutoff points for WBC count and ESR were studied, a WBC count of 15,000/cu mm or more and an ESR of 30 mm/hr or more demonstrated the best balance of specificity and sensitivity for bacteremia or pneumonia in young children who had a temperature of 4°C or more.
Complication Using A Nasal Oxygen Catheter
Authors: Ackley Harry A. , Brewer M. Frederick
Published: December 2021

We would like to report a complication that resulted from using a nasal oxygen catheter in a manner similar to that described by Pinney and Cotton.

A 2-month-old boy with a large ventricular septal defect was admitted with fever, severe congestive failure, and hypoxemia. A feeding catheter was inserted 2 to 3 cm into one nare and nebulized oxygen was supplied at a flow rate of 0.5 liters/min. The catheter used was a No. 8 French Cutter Resiflex with a blind tip and two side holes. There was a p-off on the nebulizer.
Apnea, Hypoxemia, and Aborted Sudden Infant Death Syndrome
Authors: Brady June P. , Ariagno Ronald L. , Watts John L. , Goldman Steven L. , Dumpit Fe M.
Published: December 2021

To find out whether there is any relationship between the ventilatory response to hypoxia and the sudden infant death syndrome (SIDS), we studied the effects of mild induced hypoxia (PIO2, 120 mm Hg = 17% oxygen) in 16 infants aged 2 weeks to 6 months. Eight had recurrent apneic spells (apnea group) (five had aborted SIDS and three had recurrent apnea in the intensive care nursery) and eight were "well" preterm infants about to fly in a pressurized airplane (PIO2, 120 mm Hg) (control group). Mean birth weights were 2,245 and 1,400 gm and mean gestational ages were 35 and 30 weeks. Postconceptual ages (41.8 and 41.3 weeks) were almost identical.

Heart rate was obtained from an ECG, and respiratory rate and pattern were obtained from a pneumogram. In addition, end-tidal PCO2 and PN2 or PO2 were obtained with a nasal catheter and gas analyzers. In the apnea group with inhalation of 17% oxygen, we observed an increase in periodic breathing and an increase in both rate and total duration of respiratory pauses. In the control group there were no significant changes. Heart rate and PCO2 did not change in either group.

Our findings suggest that infants prone to apnea may have unique respiratory responses to mild induced hypoxia.
Comparison of Transcutaneous Oxygen Tension With Arterial Oxygen Tension in Newborn Infants With Severe Respiratory Illnesses
Authors: le Souëf Peter N. , Morgan Andrew K. , Soutter Linda P. , Reynolds E. Osmund R. , Parker Dawood
Published: December 2021

Transcutaneous oxygen tesion (tcPO2), measured by two skin electrodes of different design, and arterial oxygen tension (PaO2), measured by an intravascular oxygen electrode, were continuously recorded for periods of six hours in 15 newborn infants with serious respiratory illnesses. Ten of the infants needed mechanical ventilation and three needed continuous positive airway pressure. One skin electrode had three microcathodes surrounded by a heated ring-shaped anode, and the other had a large heated cathode. The temperature of both electrodes was set at 44°C and they were calibrated in vitro.

The tcPO2 recorded by the electrode with the microcathodes was found to estimate PaO2 reasonably accurately for the whole six-hour duration of the study. The tcPO2 recorded by the electrode with the large cathode gave a similar estimate of PaO2. for three hours, but then tcPO2. often fell relative to PaO2. This fall was probably caused by skin changes at the electrode site.

For a variety of reasons, our results suggest that measurement of tcPO2. is unlikely to replace continuous intravascular measurement of PaO2. in infants with severe respiratory illnesses.
Transcutaneous Oxygen Monitoring in Aminophylline-Treated Apneic Infants
Authors: Peabody Joyce L. , Neese Allen L. , Philip Alistair G. S. , Lucey Jerold F. , Soyka Lester F.
Published: December 2021

Transcutaneous PO2 (tcPO2) monitoring offers a new approach to the evaluation of drug effects. We investigated the effect of theophylline on ten premature infants with apnea. Theophylline was administered as aminophylline, 8 mg/kg per rectum every 12 hours for two doses and 4 mg/kg every 12 hours for a total of two or five days (short and long courses). The tcPO2, heart rate (beat-to-beat), and thoracic impedance were continuously monitored during each of three 4-hour study periods: 12 hours before theophylline administration, 12 hours after initiation of theophylline therapy, and 24 to 48 hours after discontinuing the drug's use. Plasma levels were measured by a radioimmunoassay developed in our laboratory. Polygraphic recordings were analyzed without knowledge of treatment for frequency of apneic spells, mean duration of apneas, total duration of hypoxemia (tcPO2 ≤40 torr), total duration of hyperoxemia (tcPO2 ≥100 torr), basal tcPO2, heart rate, and respiratory rate.

In each case during theophylline use, cardiorespiratory patterns were altered, respirations were more regular, apneic spells were reduced, PO2 was stabilized with less hypoxia and hyperoxia, and bradycardic episodes were decreased. There was considerable variation in the response of the ten infants and a significant difference in the frequency of return of symptoms between those receiving short-term therapy and those receiving the longer course.
Comparison of Acute-Phase Reactants in Pediatric Patients With Fever
Authors: McCarthy Paul L. , Jekel James F. , Dolan Thomas F.
Published: December 2021

We compared WBC count ≥ 15,000/cu mm (high WBC count), Wintrobe ESR ≥ 30 mm/hr (high ESR), temperature ≥ 40°C, and positive slide tests for C-reactive protein (CRP) at a serum dilution of 1:50 in febrile, ambulatory children. The CRP test was performed with and without heat inactivation of serum. An excellent correlation was found between noninactivated and inactivated CRP test results. Since the noninactivated CRP test can be done quickly, its results would be readily available in an outpatient setting. High ESR demonstrated the best balance of specificity and sensitivity for bacteremia, pneumonia, and other possible or proved bacterial illnesses. A positive CRP test was highly specific for these diagnoses but less sensitive than an ERS ≥ 30 mm/hr. Three combinations of acutephase reactants, high WBC count and/or high ESR, high ESR and/or positive CRP test, and high WBC count and/or high ESR and/or positive CRP test performed as well as high ESR alone. Each was less specific but more sensitive than high ESR for possible or proved bacterial illnesses. The evaluation of an ambulatory, febrile child with acute-phase reactants should include at least determination of ESR.
Pneumococcal Polysaccharide Immunization in Infants and Children
Authors: Cowan Morton J. , Ammann Arthur J. , Wara Diane W. , Howie Virgil M. , Schultz Linda , Doyle Nancy , Kaplan Michael
Published: December 2021

By using indirect hemagglutination antibody responses of normal infants and children to an octavalent pneumococcal vaccine that contained pneumococcal polysaccharide types 1, 3, 6, 7, 14, 18, 19, and 23 were evaluated. By 2 years of age, there was a significant rise in hemagglutination titers to all the polysaccharide types, except type 19. By 6 to 8 months of age, five of the eight types of pneumococcal polysaccharides tested resulted in up to 60% responders and, by 2 years, a significant number responded to all pneumococcal polysaccharide types in the vaccine. Pneumococcal polysaccharide type 3 resulted in a significant antibody response as early as 3 months of age, whereas type 19 never resulted in a significant antibody response. Except for type 3, it seemed that when the other pneumococcal polysaccharides tested produced an antibody response, the degree of response did not subsequently change significantly with increasing age.

The relationship of antibody response to age for pneumococcal polysaccharides is similar to that found for other polysaccharide vaccines. Based on the results of our study, we would recommend immunization with pneumococcal vaccine at 6 months of age with repeat immunization at 2 years of age, especially in high-risk children.
Enzymuria as a Marker of Renal Injury and Disease: Studies of N-Acetyl-βglucosaminidase in the General Population and in Patients with Renal Disease
Authors: Kunin Calvin M. , Chesney Russell W. , Craig William A. , England Albert C. , DeAngelis Catherine
Published: December 2021

Urinary excretion of N-acetyl-β-D-glucosaminidase (NAG) was shown to be reproducible in random urine specimens when expressed as the ratio of NAG to milligrams of urinary creatinine. The enzyme/creatinine ratio in 815 healthy people was relatively constant throughout childhood and adult life except for the first two years after birth and in individuals 56 years or greater. High ratios in the young children may be explained by low urinary creatinine excretion probably related to small body mass and reduced glomerular filtration rate at this age. The ratio was increased in adult uremic patients and children and adults with a variety of neurologic and obstructive lesions of the voiding mechanism. The presence of bacteriuria did not appear to increase the ratio.

Significant enzymuria (> 2 SD above the mean for age and sex) was detected in 38 of 81 children with well-characterized renal disease. Among patients with predominantly glomerular disorders there was a close relationship between activity of the disease and enzymuria. In patients with tubulointerstitial disease enzymuria was frequent even in the absence of proteinuria. One of the highest enzyme/creatinine ratios was observed in a child with cystinosis. These studies indicate that NAG enzymuria is a sensitive indicator of activity of renal disease and may prove to be a suitable screening test for significant renal disease or injury in childhood.