bluuebunny/crossref_metadata_2025 huggingface dataset:
Resolving Pediatric Preventive Care Gaps Through Hospital Inreach
Authors: Morehous John F. , White Cynthia , Brinkman William B. , DeBlasio Dominick J. , Reyner Allison , Kleiman Julie , Iyer Srikant B.
Published: December 2021

OBJECTIVES

Panel management processes have been used to help improve population-level care and outreach to patients outside the health care system. Opportunities to resolve gaps in preventive care are often missed when patients present outside of primary care settings but still within the larger health care system. We hypothesized that we could design a process of “inreach” capable of resolving care gaps traditionally addressed solely in primary care settings. Our aim was to identify and resolve gaps in vaccinations and screening for lead exposure for children within our primary care registry aged 2 to 66 months who were admitted to the hospital. We sought to increase care gaps closed from 12% to 50%.

METHODS

We formed a multidisciplinary team composed of primary care and hospital medicine physicians, nursing leadership, and quality improvement experts within the Division of General and Community Pediatrics. The team identified a smart aim, mapped the process, predicted failure modes, and developed a key driver diagram. We identified, tested, and implemented multiple interventions related to role assignment, identification of admitted patients with care gaps, and communication with the inpatient teams.

RESULTS

After increasing the reliability of our process to identify and contact the hospital medicine team caring for patients who needed action to 88%, we observed an increase in the preventive care gaps closed from 12% to 41%.

CONCLUSIONS

A process to help improve preventive care for children can be successfully implemented by using quality improvement methodologies outside of the traditional domains of primary care.
CHRONIC ILLNESS IN CHILDHOOD: PART I. EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS
Authors: Pless Ivan Barry , Douglas James W. B.
Published: December 2021

In 1946 a random sample (N = 5,362) of all children born in England, Wales, and Scotland during 1 week in March were selected for a longitudinal study of health and development. Educational, clinical, and psychological information were obtained from this national cohort at repeated intervals. At age 15, all children who had experienced a chronic physical disorder were identified. Their clinical profiles were defined and the social, psychological, and educational data on this group (N = 528) were compared with the remaining physically healthy children (N = 4,196).

A total prevalence rate of 111 chronically ill children per thousand under age 16 was found. This figure is of the same order as those reported for other studies of a similar kind. Most of the children (58%) suffered from a condition which primarily affected motor activities; 20% involved vision, speech or hearing, and 20% affected appearance.

Most disorders were mildly disabling and over 60% were still present at age 15. The composition of this population was compared with that of the remaining healthy children with respect to sex, social class, family size, and parents' health. These comparisons provide a background for subsequent reports describing the psychological, educational, and social consequences of chronic illness during childhood.
UTILIZATION OF SERVICES AT A NEIGHBORHOOD HEALTH CENTER
Authors: Salber Eva J. , Feldman Jacob J. , Rosenberg Lynn A. , Williams Shirley
Published: December 2021

Services received during 1968 by 1,989 children of 521 families registered over a 5-month period at a neighborhood health center have been examined. Eighty-seven percent received at least one professional service. Seventy percent of the children were seen by a pediatrician; most children received services from at least two types of personnel, the commonest combination being pediatrician and dentist.

Once families were registered, variables such as race, Aid to Families with Dependent Children status, residence, family size, and education of mother had only a minor effect on utilization of services at the health center. The child's age markedly influenced utilization rates, a greater proportion of preschool children than adolescents coming for attention and attending more often.

Visits to physicians and dentists were higher than national norms for corresponding ethnic and socioeconomic groups. We conclude that the response of residents to the health center has been favorable and that the easy accessibility, reachingout philosophy, and genuine concern of the staff has had its effect. Although many of our patients use a combination of resources to obtain medical care, the Martha Eliot Center appears to have become the primary unit for child care in a large section of the population served.
STUDIES OF THE SCHOOL AGE CHILD WITH MENINGOMYELOCELE: I. PHYSICAL AND INTELLECTUAL DEVELOPMENT
Authors: Scherzer Alfred L. , Gardner G. Gail
Published: December 2021

Fourteen meningomyelocele survivors in the beginning school years underwent physical and neurological examinations; 13 had re-evaluation of renal, orthopedic, and neurosurgical status. General physical status was satisfactory. Six showed eye abnormalities; nine had hydrocephalus to some degree; eight required an ileal conduit; 11 are fully ambulatory. Use of a Degree of Impairment rating system indicated eight with mild to moderate and six with severe physical involvement. This rating scale may be of benefit in studying future management of older children with this defect.

All children received psychological evaluation. Eight showed intelligence in the low to high average range. Three are mildly and three moderately retarded. The median I.Q. was 88. Social quotients paralleled I.Q. scores. I.Q. and S.Q. were not related to hydrocephalus, but correlated well with social class.

Six patients are in regular school programs while eight attend special classes for physically and /or mentally handicapped.

It is concluded that appropriate intervention can enable many children with meningomyelocele to develop satisfactorily and to have the intellectual capacity to master major cognitive and social tasks.
Psychosocial Study of Childhood Poisoning: A 5-Year Follow-up
Authors: Margolis James A.
Published: December 2021

Forty-two of 52 families that were participants in a retrospective study of childhood poisoning 5 years ago were included in this follow-up study. During the interim, none of the subjects or their siblings poisoned themselves and there was no shift from poisoning to other types of childhood accidents. Socioeconomic factors and school performance do not differentiate the groups. However, the poisoned children, especially the repeaters, have more behavior problems during latency than the control children and are characterized as hyperactive, "aggressive-impulsive," and "passive-anxious." The present study indicates that childhood poisoning is not only related to maladaptation in the child and family at the time of the poisoning, but predicts later problems in the child that are focused on difficulties in interpersonal relationships rather than exposing him to increased accident susceptibility. A parent-child relationship in the form of a "power struggle," misdirected anger, and developmental characteristics of oral explorative behavior, mimicry, and negativism predispose toddlers to ingest poisons.

Preventitive implications concentrate on the parent-child relationship rather than environmental risk. This approach includes education regarding developmental characteristics of the toddler, parent guidance to prevent power struggles and other inadequate methods of dealing with the child and ongoing intervention to help the child find more appropriate ways of handling aggression. These seem necessary both to reduce further poisonings and as primary prevention of serious characterologic problems later in the child's development.
Intraspinal Neurilemoma in Association with the Rubinstein-Taybi Syndrome
Authors: Russell N. A. , Hoffman H. J. , Bain H. W.
Published: December 2021

A case of intraspinal neurilemoma associated with typical Rubinstein-Taybi syndrome is presented. Although many patients with this syndrome have pyramidal tract signs, this is the first reported case of associated intraspinal tumour.

Possibly more patients with this syndrome will present with central nervous system tumours of the type associated with Von Recklinghausen's disease. Indeed the Rubinstein-Taybi syndrome possibly should be grouped with Von Recklinghausen's disease as one of the phakomatoses.
Brain Stem Glioma Causing Failure to Thrive
Authors: Sieben Robert L. , Ishii Nobuyoshi
Published: December 2021

A small fibrillary astrocytoma of the brain stem led to bulbar palsy, persistent regurgitation, and death from aspiration pneumonia in a 4-month-old boy. As no changes were produced in the external configuration of the brain stem, a pneumoencephalogram might not have revealed the presence of the tumor.
On Testing to Predict the Need for Eructation
Authors: Penchina Claude M.
Published: December 2021

Curiously enough, neither eructation, nor burping, nor belching, nor bubbling can be found in the indexes of the popular textbooks by Nelson1 and Holt,2 though air-swallowing in relation to colic, regurgitation, and vomiting is, of course, described. Furthermore, neither of these texts nor the popular book by Spock,3 describes any operational means (other than observation of pain and discomfort) to determine the existence of a trapped air bubble.

We have found a simple audio test to determine the presence of a large trapped air bubble in an infant's stomach before it becomes painful.
Bronchography Outmoded? A Radiologist Comments
Authors: Gyepes Michael T.
Published: December 2021

Dr. Mary Ellen Avery's very timely commentary, "Bronchography: Outmoded Procedure?" (Pediatrics, 46:333) deserves a few comments by a pediatric radiologist.

One of the problems with pediatric bronchography in the United States is that there is insufficient experience with the appropriate performance of this procedure and therefore there are only very small series available. Most of the large series are in the European literature and the perusal of that literature clearly indicates that this can be an excellent procedure and it can also be done safely.1-3
EXPERIMENTAL SALICYLATE POISONING: OBSERVATIONS ON THE EFFECTS OF ALTERING BLOOD pH ON TISSUE AND PLASMA SALICYLATE CONCENTRATIONS
Authors: Hill John B.
Published: December 2021

Sprague-Dawley rats were infused with sodium salicylate followed by saline, bicarbonate, or carbon dioxide inhalation. Bicarbonate raised the blood pH and lowered the muscle, brain and liver salicylate concentrations compared with the saline controls. Carbon dioxide inhalation produced the opposite effect.

Acetazolamide lowered the blood pH, raised the tissue salicylate levels, and increased the toxicity of sodium salicylate. If the systemic acidosis produced by acetazolamide was prevented with bicarbonate, the rise in tissue salicylate was also prevented.
DEVELOPMENT OF CHILDREN WHO HAD RECEIVED INTRA-UTERINE TRANSFUSIONS
Authors: Phibbs R. H. , Harvin D. , Jones G. , Talbot C. , Cohen M. , Crowther D. , Tooley W. H.
Published: December 2021

Sixty-six nonhydropic fetuses received intra-uterine transfusions for severe erythroblastosis fetalis; 24 survived the neonatal period–the youngest is now more than 1 year and the oldest 5 years of age. Serial evaluations of growth and development of the survivors were compared with their course in the perinatal period. Twenty-one were normal; one suffered severe central nervous system damage associated with severe cardiorespiratory failure, prolonged acidosis, and hypoxia during the neonatal period; one has a handicap due to hearing loss and one has a speech handicap. The results support the use of intra-uterine transfusion in appropriately selected fetuses when combined with aggressive treatment of cardiorespiratory distress and hyperbilirubinemia during the neonatal period.
MINIMAL CEREBRAL DYSFUNCTION IN CHILDREN WITH CHRONIC THROMBOCYTOPENIA
Authors: Matoth Yehuda , Zaizov Rina , Frankel Jacob J.
Published: December 2021

Chronic cases of idiopathic thrombocytopenic purpura (ITP) follow a relatively benign course in the majority of cases. A conservative attitude is, therefore, generally adopted in dealing with these cases.

A disproportionately high incidence of the syndrome of minimal cerebral dysfunction (MCD) has been observed in a series of 20 patients with chronic ITP closely followed over a period of years. Six patients had serious behavior problems and learning difficulties. Psychological testing revealed a visuomotor deficiency and an impaired capacity for abstraction. The clinical and psychological picture was consistent with the diagnosis of MCD. This diagnosis was supported by EEG findings, which showed abnormalities in all six patients. Psychological indicators of MCD and EEG abnormalities were prominent in the group of 20 patients as a whole.

These findings could be accounted for by multiple minute capillary bleeding. Considerations of prognosis in chronic ITP should be modified in view of this evidence for an organic brain lesion.
Fertility in a 45,X Female
Authors: Nakashima Ida , Robinson Arthur
Published: December 2021

We have reported the second case of a fertile female with a 45,X karyotype. The possibility of mosaicism cannot be dismissed, although in two different tissues the karyotype is consistently 45,X. Her normal daughter has a 46,XX karyotype.
Hyperlipidemia in the Hemolytic-Uremic Syndrome
Authors: Kaplan B. S. , Gale Diana , Ipp Tania
Published: December 2021

Campbell and Carré1 recorded the occurrence of hypertriglyceridemia in association with fatal hemolytic-uremic syndrome in a set of monozygotic twins and suggested that the hypertriglyceridemia was present as an inherited disease.

The purpose of this paper is to describe the finding of elevated triglyceride, cholesterol and phospholipid levels in six children with hemolytic-uremic syndrome.

Materials and Methods

Serum triglyceride, cholesterol, and phospholipid levels were measured in six out of seven consecutive patients with hemolyticuremic syndome admitted to the Transvaal Memorial Hospital for Children, Johannesburg. The criteria for diagnosis were hemolytic anemia with fragmentation of the red cells, a platelet count below 140,000 per cmm, and evidence of renal involvement.
Traumatic Amputation of the Glans Penis: A Follow-up Note
Authors: Mason James C.
Published: December 2021

This is a follow-up note in the case of amputation of the glans penis reported by Vincent and Rothenberg in the August, 1969 issue of Pediatrics.1

Recently, David, now aged 12, was admitted to the University Hospital, Seattle, Washington for removal of a bladder stone "the size of a hen's egg." As noted in the case reports, the boy, then 8, had accidentally amputated the glans penis when involved in a sadistic game proposed by an older boy.
Handbuch Der Algemeinen Pathologie: Prolegomena Einer Allgemeinen Pathologie, Erster Band, edited by H.-W. Altmann F. Büchner, H. Cottier, G. Holle, E. Letterer, W. Masshoff, H. Meessen, R. Roulet, G. Seifert, G. Seifert, and A. Studer. Berlin/Heidelberg/New York: Springer-verlag, 1969, 311 pp., no price given
Authors: Vawter Gordon W.
Published: December 2021

This prologue or introduction to a current German handbook of general pathology follows the previously published volumes of the series by as long as 15 years, but clearly includes material of current concern. The title of the series is usually interpreted as "General Pathology" but may be translated equally well here as the universal study of disease. This theme transcends the concept of general anatomic pathology as evidenced by the several contributors to the current volume who are not anatomic pathologists, but internists, anthropologists and so on.

The six articles composing the "prologema" range from 24 to 63 pages length in variably modern or simplified German, dealing in turn with:
ELEVATED SERUM IgA GLOBULIN IN ANAPHYLACTOID PURPURA
Authors: Trygstad Carl W. , Stiehm E. Richard
Published: December 2021

Serial determinations of serum levels of IgA, IgD, IgG, and IgM globulin were performed on 27 children with anaphylactoid purpura and two children with acute poststreptococcal glomerulonephritis. Ten of 20 children with anaphylactoid purpura seen within 3 months of the onset of the skin rash had significant elevations of their serum IgA globulin. The other immunoglobulin levels were normal in the remaining children and those with acute poststreptococcal glomerulonephritis.

The selective elevation of serum IgA globulin may be related to the pathogenesis of anaphylactoid purpura.
THE CRITICALLY ILL CHILD: CARE OF THE INFANT IN CARDIAC FAILURE
Authors: Goldring David , Hernandez Antonio , Hartmann Alexis F.
Published: December 2021

Heart failure may be defined simply as the inability of the heart to pump blood commensurate with the body needs. Although it is possible for the right or left ventricle to fail separately, it is much more common for infants to present with failure of both chambers. When a ventricle fails, the end-diastolic pressure in that chamber rises and the pressure in the atrium, central, and peripheral veins is increased. There is a decrease in blood flow to the kidney which is thought to be responsible for the renal retention of sodium and water which, in turn, increases blood volume. Thus, the elevations in pressures, the disturbances in blood flow, and abnormal distribution of water and electrolytes are homeostatic and compensatory mechanisms which help preserve cardiac output while they are recognized as the signs and symptoms of heart failure.

Infants under 1 year of age account for 90% of pediatric patients who develop congestive heart failure. The majority of these have congenital malformations, which are increasingly amenable to corrective surgery. The physician must, therefore, be able to make the diagnosis of heart failure with confidence and institute immediate therapy. The patient, ideally, should be transferred to a medical center with a well-equipped and well-staffed intensive care unit where therapy can be administered under 24-hour monitoring. Such an approach should steadily improve the salvage rate of infants in congestive heart failure.
Treatment of Cyanide Poisoning (Continued)
Authors: Mofenson Howard C. , Greensher Joseph , Horowitz Ray , Berlin Cheston M.
Published: December 2021

Dr. Berlin's schedule of treating cyanide poisoning by sodium nitrite and sodium thiosulfate should be in every emergency room and poison control center.1 It should also be included in Lilly's Cyanide Antidote Kit which contains these materials. (I have written the Eli Lilly Company concerning this.)

Since cyanide is a spectacular poison and evokes such a frightening response and vigorous treatment, it is important to emphasize that ferrocyanide and ferricyanide as found in Turndall's Blue and Prussian Blue are of low toxicity (potential single adult fatal dose 50 gm).
BODY IMAGE CHANGES IN TEEN-AGE DIABETICS
Authors: Kaufman Richard V. , Hersher Betsy
Published: December 2021

Fantasies of five diabetic teen-agers about their illness were collected in a study of the relationship between body illness and body image. All of the subjects revealed underlying distortions of their knowledge of the disease process bated on primitive notions about physical causality. The imagery employed was strongly visual and illness was seen as the result of external deprivation, or of various internal abnormalities and deficiencies, such as absence of part of the pancreas, blockage within the pancreas, or dilatation of the stomach. The influence of previous instruction and education by the medical staff was found to be superficial and in all cases the children's intellectual knowledge was incorporated into their own private thought systems.

The patients drew what the illness meant to them rather than what they knew about the pathophysiological processes, and in this way demonstrated the link between physical illness and body image. The patients described feeling seriously damaged by the diabetes, and were able to graphically symbolize their conceptions of this damage. Knowledge that the child's illness significantly alters a part of the self contributes to greater precision and effectiveness in communication.
Fixed Drug Combinations and the Displacement of Bilirubin from Albumin
Authors: Schiff D. , Chan C. , Stern L.
Published: December 2021

Silverman and associates,1 reported that the use of sulfisoxazole (Gantrisin) in premature infants resulted in the occurrence of kernicterus at low levels of serum bilirubin. Odell2 subsequently demonstrated that sulfisoxazole displaces bilirubin from its albumin binding sites in vitro, thereby making available lipid soluble free bilirubin capable of penetrating the central nervous system. This effect of sulfisoxazole in producing kernicterus has been confirmed experimentally in vivo in rats.3 Odell4 and Khanna, et al.5 have demonstrated a similar but quantitatively even greater bilirubin displacing effect of caffeine sodium benzoate, a drug still recommended by some as a respiratory stimulant for the newborn.
Cytomegalovirus Complement-Fixation Antibody Responses in Eskimo Families
Authors: Sinha Shyamal K. , Paul5 Frank P.
Published: December 2021

At the International Conference on Cytomegalovirus (CMV) Infections held at St. Gall, Switzerland in April, 1970, investigators from various countries reported the epidemiologic aspects of CMV infection and indicated its occurrence in many parts of the world.1

In the following data on CMV complement-fixation antibody responses in 44 Eskimo families located ill Wainwright Village, Alaska, 154 blood samples were collected during July, 1968. The complement-fixation (CF) test micromethod2 was adopted using the CF antigen (strain AD 169) prepared by Microbiological Associates, Bethesda, Maryland.
Pediatricians in Mental Health and Child Guidance Clinics
Authors: Gordon Albert M.
Published: December 2021

In reading "Utilization of a Pediatrician in a Mental Health Clinic"1 and "Utilization of a Pediatrician in a Community Child Guidance Clinic,"2 I am genuinely impressed by the reasons for calling a pediatrician to assist in the treatment of mental sickness. Unfortunately, pediatricians are trained to give physical sick and health care and not mental sick and health care.3 Therefore, a community pediatric mental health clinic should provide supervision and training for the pediatrician, as well as liaison with the agencies and organizations with which he is involved.
Throwing Stones (Continued)
Authors: Pittman Fred E. , Cone Thomas E.
Published: December 2021

Dr. Cone's comments on the piece, "Throwing Stones" strike me as coming from someone who has not observed at close hand boys of age 7 to 9 left to their own devices. To the terms wicked and malicious one can only add highly imaginative to describe the occasional behavior of perfectly normal children in this age group. In our own neighborhood where there are at least two dozen boys of this age (including my two 8-year-olds) the concerned parents turned the lads away from their wickedness and maliciousness (fortunately before serious hurting and maiming occurred) by the convincing threat of what Dr. Cone would probably consider unenlightened ancient child management –a sound thrashing.
A SYSTEM FOR COMPUTERIZED AUTOMATED BLOOD GAS ANALYSIS
Authors: Veasy L. George , Clark Justin S. , Jung A. Larry , Jenkins Jarrell L.
Published: December 2021

An automated system for on line, real time computerized determination of arterial blood pressure of oxygen and carbon dioxide, and pH has been developed at the Primary Children's Hospital. The determinations are made from a 0.3 ml sample of blood withdrawn automatically under computer control from an indwelling arterial catheter. The results are displayed nearly immediately in alpha-numeric terms on a memory scope at the cribside.

Laboratory evaluation and a limited clinical experience with six patients indicate the system to be a safe method for accurate and close monitoring of critically ill infants and is particularly applicable to use in the respiratory distress syndrome. The system is known as CABAS, a term coined from Computerized Automated Blood Analysis System.
INTUSSUSCEPTION IN PATIENTS WITH CYSTIC FIBROSIS
Authors: Holsclaw Douglas S. , Rocmans Claude , Shwachman Harry
Published: December 2021

Intussusception is one of the lesser known intestinal complications of cystic fibrosis and occurs in approximately 1% of patients. Clinical details are presented of 22 episodes of intussusception occurring in 19 patients over 4 years of age. The average age at onset was 9 9/12 years (Range 4 to 16 years). Most patients were in good or excellent clinical condition and all had pancreatic insufficiency. An operation was performed for 19 of the 22 episodes; resection was required twice. The etiology of the intussusception was felt to be the accumulation of thick putty-like inspissated material in the cecum. Reasons are given for urging the judicious use of the barium enema as a means of reducing the intussusception. Intussusception occurs more frequently than commonly thought and may even be the presenting complaint of the undiagnosed patient with cystic fibrosis.
ABETALIPOPROTEINEMIA: METABOLIC, ENDOCRINE, AND ELECTRON-MICROSCOPIC INVESTIGATIONS
Authors: Sperling Mark A. , Hengstenberg Fay , Yunis Eduardo , Kenny Frederick M. , Drash Allan L.
Published: December 2021

Two siblings presenting with short stature and severely retarded skeletal maturation were found to have steatorrhea, retinitis pigmentosa, night blindness, and loss of posterior column function. The finding of acanthocytosis in the peripheral blood smear, low levels of all serum lipid fractions, and complete absence of betalipoproteins on electrophoresis confirmed the diagnosis of abetalipoproteinemia. Vitamin A levels were low and free Vitamin E was absent in serum. Electron microscopic examination of duodenal biopsy did not clarify the site on mechanism of fat malabsorption.

Lipid studies in immediate relatives could not establish a heterozygous trait, though the majority of relatives had a prominent beta or pre-beta band on lipoprotein electrophoresis. The resemblance in physical appearance to hypopituitarism prompted an extensive endocrine evaluation. Thyroid indices and growth hormone responses to arginine and insulin stimulation were normal. Urinary 17 OHCS were in the low range of normal and the cortisol secretion rates were one and two standard deviations below the mean. These latter studies excluded endocrine abnormality as the cause of short stature which is best explained on the basis of prolonged malabsorption and malnutrition.
FACTORS INFLUENCING PREDISPOSITION TO SERIOUS ILLNESS IN LOW BIRTH WEIGHT INFANTS
Authors: Glass Leonard , Kolko Norma , Evans Hugh
Published: December 2021

Serious illness requiring rehospitalization of low birth weight infants following discharge from the nursery was related to four specific sociomedical factors.

These were failure of the mother to receive prenatal care, absence of the father from the home, receipt of public assistance, and presence of other children in the home. These factors formed the basis of a weighted prognostic index, permitting prospective assignment of a score to each low birth weight infant. Those at highest risk of inadequate follow-up care and rehospitalization were identified prior to discharge from the nursery. This may permit direction of intensive medical nursing and social services toward this high risk group.
TYROSINOSIS: A PATIENT WITHOUT LIVER OR RENAL DISEASE
Authors: Holston James L. , Levy Harvey L. , Tomlin Gary A. , Atkins Ruby J. , Patton T. H. , Hosty Thomas S.
Published: December 2021

A child institutionalized because of severe mental retardation was found to have biochemical evidence of tyrosinosis. He has had no evidence of hepatic disease. In addition, he has had no hyperaminoaciduria, glycosuria, or rickets. Plasma tyrosine concentrations while he was on a regular diet ranged from 16.0 to 25.6 mg per 100 ml. Urinary excretion of tyrosine and tyrosine metabolites, including p-hydroxyphenylpyruvic acid, p-hydroxyphenyllactic acid, and p-hydroxyphenyl-acetic acid, were markedly increased. This patient appears to have a primary defect in tyrosine metabolism and represents individuals with persisting tyrosinemia and tyrosyluria in whom no hepatorenal disease is found.
LORD CHESTERFIELD WRITES TO HIS SON ABOUT HOW ILL-BRED A THING IS LAUGHTER
Authors: C. T. E.
Published: December 2021

Affectations vary with the ever-changing rules for some of the petty aspects of so-called proper social comportment. Lord Chesterfield's affectation of hauteur and disdain about the indelicacy of laughter will strike those of us living in the 1970's as "laughable." In one of his many letters to his son, Chesterfield wrote:

Having mentioned laughter, I must particularly warn you against it: and I could heartily wish, that you may often be seen to smile but never heard to laugh while you live. . . . In my mind, there is nothing so illiberal, and so ill-bred, as audible laughter. . . . I am sure that since I have had the full use of my reason, nobody has ever heard me laugh.1

How dreary must have been Lord Chesterfield's son's childhood, or that of Lord Chesterfield's son's father!
CONSISTENCY AND CHANGE IN CHOICE OF MEDICAL CARE FOR PRESCHOOL CHILDREN
Authors: Mindlin Rowland L. , Lobach Katherine S.
Published: December 2021

Preschool children living in area probability samples of households in a slum and a middle class neighborhood were followed with bimonthly household interviews for 1 year. Their sources of medical care at the beginning and end of the year were compared. In both districts private physicians and clinics were used. Four-fifths of the middle class children and one-third of the slum children used private physicians. Greatest consistency in choice of the same provider at the beginning and end of the year was shown by middle class children using a private physician; least was shown by slum children using a clinic. With increasing income, middle class children were somewhat less consistent. Less than 1 year as a patient, and mother's complaint that she could not talk to the doctor enough were associated with change by the middle class but not the slum. A move of place of residence and a large number of illnesses in the child were associated with change in the slum but not in the middle class neighborhood.
Psychiatric Study of Parents of Children with Cyanotic Congenital Heart Disease
Authors: Rozansky Gerald I. , Linde Leonard M.
Published: December 2021

As a result of these sessions, the parents gained insight into their own psychological mechanisms. Knowledge of these reactions should be of help to the parents and to the pediatrician in handling families with children with cardiac disease. Parental adjustments, such as denial, have varied results in the doctor-patient relationship, from increased dependency and demandingness, to hostility and repeated inability to comprehend the efforts of the physician to give accurate diagnostic, prognostic, and therapeutic information. If the physician is unaware of these difficulties he may find it difficult in understanding some of the parent's behavior. With increased feelings of helplessness, the parents may either try to deny the illness or search for the omnipotent physician to care for their child and themselves. With this approach they can meet with only greater problems than they have in reality. Similar group sessions or individual discussion with the pediatrician might help parents become more conscious of their various defenses and feelings, even though painful, so that they might be fairer to themselves, their child, and the doctor.
Parental Expectations in Toilet Training
Authors: Stehbens James A. , Silber David L.
Published: December 2021

Seventy-one parents whose first-born child was between 6 and 10 months of age completed a questionnaire regarding their expectations in toilet training. Analysis of the data support the following conclusions: (1) Parental expectations in toilet training often are unrealistic and this is a preventable source of parent-child conflict; (2) Expectations regarding attainment of nighttime continence are more realistic than daytime; (3) There is a slight tendency for parents to expect girls to achieve daytime continence earlier than boys; (4) That physicians are looked upon as the most likely professional to whom mothers look to for help; (5) The physician or his aide should initiate discussions regarding toilet training before the child is 1-year-old.
Splenomegaly with Hypersplenism in Sickle Cell Anemia Treated by Radiation—Case Report
Authors: Sommer Annemarie , Kontras Stella B.
Published: December 2021

The incidence of splenomegaly in sickle cell anemia (defined as a spleen easily palpated below the costal margin in quiet respiration) appears to be around 10% after 10 years of age. Persistent splenomegaly in older children is rare and frequently is associated with hypersplenism. Splenectomy has been the treatment of choice in several reported cases based on red cell survival studies before and after splenectomy.1-3 Removal of the spleen has been found to be associated with marked improvement of previously very shortened red cell survival.

We want to report the case of a 12-year-old boy with sickle cell anemia, splenomegaly, and sickle cell heart disease who was treated by radiation therapy for his enlarged spleen because of hypersplenism.
PHYSIOLOGY FOR PEDIATRICIANS ASSESSMENT OF HYPOXIA IN THE NEWBORN SUGGESTIONS FOR A PRACTICAL APPROACH
Authors: Duc G.
Published: December 2021

Routine measurements of arterial Po2, Pco2, oxygen saturation of hemoglobin, P50, hemoglobin content allow a more accurate approach in the treatment of hypoxia in the neonate. Based upon these routinely available determinations and upon the clinical evaluation of the peripheral circulation, four types of hypoxia can be distinguished:

(1) Hypoxia with hypoxemia due to a decrease in arterial Po2.

(2) Hypoxia with hypoxemia due to a decrease in blood oxygen content without decrease in arterial Po2.

(3) Hypoxia with normoxemia due to a decrease in peripheral blood flow.

(4) Hypoxia with normoxemia due to an increase in the hemoglobin-oxygen affinity.

Hyaline membrane disease represents a possible combination of these four different mechanisms.
Foetal Autonomy: A Ciba Foundation Symposium, edited by G. E. W. Wolstenholme and Maeve O'Connor. London: J. & A. Churchill Ltd., 1969, 326 pp., $10.50
Authors: Smith Clement A.
Published: December 2021

When William Windle published his Physiology of the Fetus, in 1940, he referred to Preyer's Specielle Physiologie des Embryo, published 65 years before that, as "long the only source of summarized knowledge concerning the activities of embryos and fetuses of many species." Dr. Windle then noted how "within the last decade of two" or some 40 years after Preyer, "interest has revived and a new school of developmental physiology has come into being . . . (though) . . . few biologists are aware of all that has been accomplished."
The Nature of Childhood Autism, ed. 2, by Gerald O'Gorman, F.R.C.P., D.P.M. New York: Appleton-Century-Crofts, 1970, 163 pp., $7.75
Authors: Lucas Alexander R.
Published: December 2021

Several books on childhood psychosis have been published in the past decade bearing the encompassing titles Childhood Schizophrenia (Goldfarb), Infantile Autism (Rimland), and Childhood Autism (Kugelmass). Each title tantalizingly holds out the promise that this is the book we have been waiting for, but all fall short in one way or another of being the definitive volume on the subject. Until the cause is clarified and an effective treatment found, it may be premature to hope that such a work can be written.
RETROLENTAL FIBROPLASIA: THE PEDIATRICIAN'S DILEMMA
Authors: Patz A. , Kinsey V. Everett
Published: December 2021

Retrolental fibroplasia (RLF), which was unknown prior to the early 1940's, was first identified in premature infants by Terry in 1942.1 Within the short span of approximately 10 years, RLF had become one of the major causes of blindness in children throughout the world. The incrimination of oxygen in the early 1950's was demonstrated conclusively in a cooperative study performed in the United States in 1953-54 and published in 1956.2 The results of this study led to the general restriction of oxygen therapy, and the incidence of RLF subsequently decreased dramatically.

Avery and Oppenheimer3 in 1960 first reported that the mortality from hyaline membrane disease had increased in their nursery during the period of rigid curtailment of oxygen to prevent RLF.
DIAZEPAM IN THE MANAGEMENT OF THE NEONATAL NARCOTIC WITHDRAWAL SYNDROME
Authors: Nathenson Gerald , Golden Gerald S. , Litt Iris F.
Published: December 2021

Diazepam appears to be a safe and effective drug for the treatment of neonatal narcotic withdrawal symptoms. Control may be quickly achieved with a short course of therapy without serious side effects or the occurrence of rebound symptoms when the therapy is discontinued.
THE EFFECTS OF MATERNAL HYPOXIA AND HYPEROXIA UPON THE NEONATAL PULMONARY VASCULATURE
Authors: Goldberg Stanley J. , Levy Richard A. , Siassi Bijan , Betten Joanne
Published: December 2021

The fetal and newborn pulmonary artery has thickened media by comparison to that of the older infant. In this study we investigated the proposition that chronic maternal hypoxia during the latter part of gestation might induce further thickening of the neonatal pulmonary artery media. Relative medial thickness was determined by the ratio of the arterial media to external diameter. The mean ratio of small pulmonary arteries of progeny of hypoxic mothers was significantly thicker in each size group between 50 and 150 microns as compared to those born to mothers who spent their gestation in air or hyperoxic environments. Medial hypertrophy was most pronounced in the smaller arteries of the hypoxic group; no intersize variations were found between the control or hyperoxic groups. Medial thickness decreased in all arteries through 2 weeks of age; this decrease was greatest in control and hyperoxic arteries. The possible relationship of hypertrophied pulmonary arterial media and abnormally increased neonatal pulmonary vascular resistance is discussed.
HUMAN PLACENTAL TRANSFER OF HUMAN GROWTH HORMONE-I125
Authors: King Katherine C. , Adam Peter A. J. , Schwartz Robert , Teramo Kari
Published: December 2021

At term, human growth hormone (HGH) does not cross the human placenta: therefore, the source of HGH in the fetal plasma is the fetal pituitary. In order to determine whether the fetal pituitary is also the only source of HGH secretion early in gestation, the maternofetal transfer of HGH-I125 was evaluated in four pregnant women receiving legal therapeutic abortions by abdominal hysterotomy. The plasma concentration of HGH-I125 was maintained until fetal delivery by a continuous infusion of the labeled hormone at 20 µc/hr for 170 to 225 minutes; and the plasma HGH-I125 concentration was determined by a specific immunoprecipitation. Even with maternal plasma levels of radioactive HGH between 875 and 1287 cpm/ml, no HGH-I125 was detected in either umbilical venous or arterial plasma, or in the amniotic fluid.

As at term, no human placental transfer of HGH-I125 occurs early in gestation. Since the fetal hypophysis synthesizes, secretes, and stores HGH as early as 9 weeks in gestation, the fetal anterior pituitary apparently is the only source of HGH available to the human fetus.
THE ART OF TORMENTING CHILDREN ACCORDING TO MISS JANE COLLIER WRITING IN 1804
Authors: C. T. E.
Published: December 2021

Few women in English literature have distinguished themselves as satirists. But Miss Jane Collier, who is little known even to authorities on the history of English satire, could at times rise to Swiftian irony. An example of how to torment children from her little-known book entitled "An Essay on the Art of Ingeniously Tormenting" follows:

. . . That you pursue the method called INDULGENCE, which I have already marked out. This will infallibly make them miserable while infants; as common experience must shew (sic) you, that no children are so fretful, peevish, and uneasy, as those who are so indulged. And although you may, by this means, breed up a parcel of head-strong, hard-hearted cubs, who, when old enough, will defy your power; yet you may, in the mean time, amuse yourself with your servants, your acquaintance, and your friends, who may chance to be more fitted by nature, or education, for your purpose. You may go out of the world, also, with the pleasing reflection, that you have left behind you a set of wolves, cats, and foxes, of your own educating; who will help to plague and torment all the rest of mankind.
HYPERAMMONEMIA DUE TO A MUTANT ENZYME OF ORNITHINE TRANSCARBAMYLASE
Authors: Matsuda Ichiro , Arashima Shinichiro , Nambu Haruo , Takekoshi Yasuo , Anakura Michiya
Published: December 2021

In a case of congenital hyperammonemia described in an 8½-month-old girl, elevated blood ammonia was shown to result from a mutant enzyme of ornithine transcarbamylase. An in vitro study indicated a decrease in affinity of the enzyme for carbamyl phosphate but not for ornithine.
IgA: PRESENCE IN MECONIUM OBTAINED FROM PATIENTS WITH CYSTIC FIBROSIS
Authors: Rule Allyn H. , Lawrence David , Hager Hans J. , Hyslop Newton , Shwachman Harry
Published: December 2021

Meconiums obtained from patients with cystic fibrosis (CF) have been found to contain secretory and/or serum IgA.

Since IgA is believed to be synthesized after birth, its presence in the prenatal gut of patients with a hereditary disease involving dysfunction of the exocrine glands may be related to the basic disease lesion.
THE USE AND ABUSE OF VITAMIN A
Authors: Yaffe Sumner J. , Filer L. J.
Published: December 2021

The grave risks resulting from the unrestricted sale of high concentrations of vitamin A make it imperative that an active curb, by appropriate legislation if necessary, be placed on the over-the-counter marketing of high potency vitamin A preparations. Physicians should be aware of the vitamin A content in the preparations they prescribe for their patients. They also should caution parents regarding the dangers of overdosage of this vitamin.
THE TREATMENT OF ACNE WITH ANTIBIOTICS
Authors: Yaffe Sumner J. , Bierman Charles W. , Cann Howard M. , Gold Arnold P. , Kenny Frederic M. , Riley Harris D. , Schafer Irwin , Stern Leo , Weiss Charles F. , Shirkey Harry C. , Hayes Thomas H. , Bishop Jeffrey , Farchione Louis A. , Lockhart Jean D. , Sawchuk Steven
Published: December 2021

When broad-spectrum antibiotics were first introduced two decades ago for the treatment of acne, justification for such therapy seemed reasonably straightforward, e.g., the suppression of the suppurative inflammatory lesions commonly encountered in acne. As time went on, however, certain observations raised questions concerning the rationale for this form of treatment. First, it became apparent with cumulative clinical experience that the disease could ordinarily be controlled by doses of antibiotics lower than those required to treat bacterial infections. Second, bacteriologic studies disclosed that the only bacteria regularly recoverable from acne lesions were the anaerobic diphtheroid Corynebacterium acnes and aerobic coagulase-negative cocci, predominantly staphylococcus type II; both of these bacteria are known to be normal resident skin organisms.1 Thus, as no reports of controlled studies were then available for assessing the true efficacy of antibiotics used in the treatment of acne, the uneasy suspicion arose that such therapy might be inducing a primarily placebo response.

In 1965, Freinkel and her collaborators2 demonstrated that the oral administration of tetracycline, even in doses as small as 250 mg daily, resulted in a significant reduction of the free fatty acid concentration of the lipid (sebum) secreted to the skin surface by the sebaceous glands. This effect could be observed in normal subjects as well as in patients with acne and was entirely reversible on discontinuance of drug. The inflammatory lesions of acne are known to result from disorganization of the follicular epithelium, with consequent liberation of the intrafollicular contents, containing sebum, into the dermis.3
Tocopherol Therapy in Acanthocytosis
Authors: Wallis Kurt , Gross Meir , Zaidman Jacob L. , Julsary Angela , Szeinberg Aryeh , Kook Abraham I.
Published: December 2021

Acanthocytosis or a-beta-lipoproteinemia is a rare inborn error of metabolism known also as the "Bassen Kornzweig syndrome."1 We had

See Images in the PDF File

the opportunity to examine a Jewish girl, H.F., 11 years old, with a-beta-lipoproteinemia. The girl has healthy parents of Turkish origin who are first cousins, and a healthy brother and sister. At the age of 33½ months she was admitted to this hospital with a picture of malabsorption and from then on she was under our permanent observation.
Safety Measures and Accidental Poisoning
Authors: Sobel Raymond
Published: December 2021

The battle ground of accidental poisoning seems to be constantly active, at least in these columns,1 and I should like to add a note to the controversy between Dr. Scherz and Dr. Margolis about the relationship of environmental hazard to the incidence of accidental poisoning.

Dr. Scherz states that there are no published studies supporting the thesis that environmental hazard is not a significant variable. I wish to correct Dr. Scherz. In 19692 I published a paper in this Journal in which I demonstrated that home safety and the frequency of poisoning were unrelated in 397 children whose families were studied in depth.
Neonatal Enteric Infections Caused by Escherichia Coli (Annals of the New York Academy of Sciences, vol. 176), edited by Bud Tennant, D.V.M. New York: New York Academy of Sciences, 1971, 405 pp., $28.00
Authors: Nelson John D.
Published: December 2021

In May 1970 a conference was held which brought together investigators from varied fields to exchange ideas about pathogenetic mechanisms involved in neonatal enteric infections with Escherichia coli. This volume is a collection of the papers presented and the discussions. Appropriately, veterinarians were strongly represented since it has been largely through their research efforts in recent years that we have a somewhat better, though still woefully incomplete, understanding of the problem.

As is generally true of such conferences, the majority of papers were a re-hash of previously published work, but this volume does serve the useful purpose of collecting most of the relevant, investigational material into a convenient reference source.
RELATING MUCUS, CALCIUM, AND SWEAT IN A NEW CONCEPT OF CYSTIC FIBROSIS
Authors: Gibson Lewis E. , Matthews Wallace J. , Minihan Patrick T. , Patti John A.
Published: December 2021

Six experiments are described. A mucus-containing secretion from cystic fibrosis (CF) patients is shown to be hyperpermeable in vitro. Hyperpermeability is demonstrated in vivo after either mucus removal or the addition of CF serum. Calcitim is shown to elevate sweat chloride, and to cause hvperpermeability both in vitro and in vivo.

The implications of these experiments are discussed. The investigations of other workers are reviewed, and a unified theory concerning CF is presented. In this theory it is suggested that mucus has a biological function of inhibiting the passive flow of water and small ions, that CF is a disease in which mucus is hyperpermeable and fails to perform this function adequately, and that this failure is caused by an excess secretion of calcium from exocrine glands.