bluuebunny/crossref_metadata_2025 huggingface dataset:
ANAPHYLAXIS
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. , Chudzik Gregory , Shirkey Harry C. , Soyka Lester F.
Published: December 2021

Anaphylaxis* is an acute reaction, which may range from mild self-limited symptoms to a grave medical emergency. It is caused by a variety of agents, usually occurs unexpectedly, frequently is iatrogenic, and can be fatal if not treated promptly and appropriately. Every physician's and dentist's office, pediatric outpatient clinic, hospital emergency room, allergy clinic or allergy testing laboratory, and radiology department should be equipped to treat this potential disaster.1

The Committee on Drugs of the American Academy of Pediatrics has reviewed the equipment and procedures necessary to treat this emergency, and offers this guide to physicians.

CLINICAL PICTURE

Anaphylaxis is usually characterized by the following sequence of signs and symptoms: generalized flush, urticaria, paroxysmal coughing, severe anxiety, dyspnea, wheezing, orthopnea, vomiting, cyanosis, and shock. The sooner symptoms develop after the initiating stimulus the more intense the reaction. Symptoms beginning within 15 minutes after administration of the inciting agent require the most expedient management.

The primary cause of death in the child is laryngeal edema. In the adult, cardiac arrhythmais may be superimposed on acute upper airway edema.2

MAJOR CAUSES OF ANAPHYLAXIS

Table I lists the most common agents associated with anaphylaxis in children. The severity and acuteness of onset will depend upon both the type of agent and the route of administration. Generally, agents administered parenterally are more apt to result in severe life-threatening or fatal anaphylactic reactions than those ingested orally or administered topically to mucus membranes. Medications administered orally, such as aspirin or penicillin, however, have been associated with fatal reactions so that the oral route cannot be utilized with impunity.
PAROXYSMAL TACHYCARDIA IN INFANCY: FOLLOW-UP STUDY OF 47 SUBJECTS RANGING IN AGE FROM 10 TO 26 YEARS
Authors: Lundberg Åke
Published: December 2021

A follow-up study of 47 individuals with paroxysmal tachycardia in infancy is reported. The incidence of recurrence decreases from 55% during infancy to 17% up to 10 years of age; a slight increase to 23% is then observed in adolescence. There is a higher incidence of paroxysm in cases with preexcitation in the ECG. Physical overexertion may be a triggering factor in recurrences, but exemption from school physical education and sports should only be granted exceptionally. No signs of reduced physical working capacity were found in this group. The results of maintenance therapy do not appear to have improved in the past decade.
HEREDITARY PANCREATITIS: THREE NEW KINDREDS AND A CRITICAL REVIEW OF THE LITERATURE
Authors: Kattwinkel John , Lapey Allen , di Sant'Agnese Paul A. , Edwards William A. , Hufty Mary P.
Published: December 2021

Hereditary pancreatitis (HP) is a recently described autosomal dominant disorder of unkown etiology. Symptoms usually begin in childhood, but generally are diagnosed only when pancreatic insufficiency and calcifications appear in the young adult age group. Clinical manifestations include recurrent acute attacks of excruciatingly severe abdominal pain with intercurrent symptomfree periods. In addition to the positive family history there are definite differences in sex incidence, age of onset, occurrence of etiologic factors (e.g., alcoholism, gallstones), and pancreatic pathology between HP and chronic relapsing pancreatitis of adults. In the course of the disease various complications (e.g., glucose intolerance, pseudocysts, etc.) may occur in HP, but less commonly than in classical adult pancreatitis.

Three new kindreds with 30 definite and 51 suspected cases of HP, representing more than one-third of all previously reported cases, are presented with detailed investigations of pancreatic and parathyroid function, serum lipids, pathologic specimens, and urinary amino acids. These studies clearly separate HP from diseases otherwise associated with pancreatitis. With these three and the 18 previously reported kindreds, it is evident that HP is not a rare disease and is the most common cause of recurrent pancreatitis in childhood. It should be included in the differential diagnosis of recurrent abdominal pain and pancreatic calcifications in the pediatric age group.
PEDIATRIC PERCEPTIONS: THE PUBLIC HEALTH NURSE—A NEGLECTED RESOURCE
Authors: Wilson James L.
Published: December 2021

I Write to emphasize the very great assistance, particularly the kind of assistance, that I find dedicated nurses especially trained in pediatrics and Public Health can give to pediatricians. My emphasis is not on the number of patients who can be seen but the quality of service that can be given.

For many years my academic environment and concentration on teaching and consultation protected me from the pressures present in a busy practitioner's office. During these years, I was often impressed by the great gratitude from parents of patients because, as they would say, "You have answered a lot of our questions." Often they would also say: "We like our own pediatrician very much, but his office is so crowded and he is so busy that we feel guilty in asking him all the questions we have about our children. What we really like about this visit is the way you have so generously given us of your time to answer all those questions that bother us."So, when I recently saw the new offices of a pair of pediatricians starting into practice, I was frankly upset to notice that in the many small examining rooms it was evident that chairs were kept at a minimum. Still more upsetting was the explanation that this arrangement made it easier for the physician to walk out of the room because he would be standing. Not only would there be less awkwardness in interrupting a conversation but the mothers would be less likely to sit down and ask questions if there were not enough chairs for everyone to be seated.
THE FEP (FREE ERYTHROCYTE PORPHYRINS) TEST: A SCREENING MICROMETHOD FOR LEAD POISONING
Authors: Piomelli Sergio , Davidow Bernard , Guinee Vincent F. , Young Patricia , Gay Giselle
Published: December 2021

The FEP test is a micromethod that measures rapidly and reliably free erythrocyte porphyrins in a blood sample of 20µl. The results of the FEP test increase exponentially with the blood Pb level.

The FEP test was performed in 1,038 blood specimens submitted to the New York City Department of Health Bureau of Laboratories for Pb analysis. Of these, 568 had Pb levels ≥ 40µg/100 ml. The concentration of FEP was higher than 250µg/100 ml RBC (positive FEP test) in all the samples with greatly increased blood Pb level (≥ 60µg/100 ml), in 55.1% of those with ambiguous blood Pb level (40 to 59µg/100 ml), and in 5.1% of those with low Pb level (< 40µg/100 ml).

The FEP test provides a biological indicator of undue lead absorption, suitable for rapid screening of children for lead poisoning. The test can easily be performed by any clinical laboratory.
GONADOTROPINS DURING CHILDHOOD AND ADOLESCENCE: A REVIEW
Authors: Kulin Howard E. , Reiter Edward O.
Published: December 2021

FSH and LH have been detected in the blood and urine of prepubertal individuals by bioassay as well as the newer immunologic methods. Despite considerable improvement in the understanding of puberty in man the process still remains a mysterious one. The mechanisms which initiate this period of growth and the time of their onset are still not known; cellular and biochemical changes involved in puberty have not been studied in man or lower animals. The physiology of the releasing factors which are stored in the median eminence of the hypothalamus and stimulate FSH and LH may contribute to an understanding of sexual maturation. Similarly, the function of the neuroactive amines in regulating gonadotropins is a subject of a great deal of current investigation and also may further such knowledge.

Methodologic problems have been only partially solved in the area of gonadotropin research. For studies in children a need exists for improved assay sensitivity or new means of concentrating biological specimens. Similarly, many of the normal patterns as well as the abnormalities of gonadotropic function during the first two decades of life have not yet been well characterized. Hypergonadotropic states such as gonadal dysgenesis may be detected frequently in the prepubertal child by the measurement of serum FSH, but hypogonadotropism is much more difficult to identify in the young boy or girl.

One of the most pressing needs–which should be realized soon–is for longitudinal rather than cross-sectional studies. The normal levels of FSH and LH during childhood and pubescence may be quite different for a given individual than the somewhat blurred picture which cross-sectional investigations present.
ABO System Incompatibility: Relationship Between Direct Coombs Test Positivity and Neonatal Jaundice
Authors: Orzalesi Marcello , Gloria Fulvia , Lucarelli Paola , Bottini Egidio
Published: December 2021

Recent evidence indicates that neonatal serum bilirubin levels much lower than 20 mg/100 ml may produce minor or even severe damage of the central nervous system, particularly when they are associated with other pathological situations.1-3 This information has prompted a more aggressive approach to neonatal jaundice aimed at the prevention rather than the therapy of severe hyperbilirubinemia. However, most of the proposed methods of treatment, including phenobarbital and phototherapy, present potential hazards for the infant and should, therefore, be used only in infants with a high risk of jaundice.4,5 Newborn infants incompatible with their mothers in the ABO system present a potentially higher risk of severe hyperbilirubinemia particularly in the presence of a positive direct Coombs test.
HEXACHLOROPHENE TOXICITY—HUMAN EXPERIENCE AT THE ARMED FORCES INSTITUTE OF PATHOLOGY
Authors: Mullick Florabel G.
Published: December 2021

Six patients exposed to 3% hexachlorophene were studied. Two were adults that had accidentaly ingested a large amount of the substance. The remaining were children, two of which were being treated with 3% hexachlorophene baths for burns and two for severe congenital ichthyosis.

The two adults developed symptoms shortly after ingestion and died in less than 48 hours. The interval between exposure and symptoms in the children ranged from six hours to ten days. All the children showed severe vacuolation of the white matter in different areas of the cerebrum as well as the cerebellum. In the two adults no vacuolation of the white matter was evident.
STAPHYLOCOCCAL DISEASE OUTBREAKS IN HOSPITAL NURSERIES IN THE UNITED STATES—DECEMBER 1971 THROUGH MARCH 1972
Authors: Dixon Richard E. , Kaslow Richard A. , Mallison George F. , Bennett John V.
Published: December 2021

Following the Food and Drug Administration's release of recommendations on limiting the use of products containing hexachlorophene (HCP) for bathing newborn infants, 142 hospitals spontaneously reported outbreaks of neonatal staphybococcal disease. Epidemiologic investigations were carried out in 73 of these hospitals; 66 had confirmed outbreaks of neonatal staphylococcal disease. In 60 of the 66, discontinuation of HCP bathing of newborn infants preceded the epidemic. Alterations in handwashing policies did not appear implicated in any outbreak investigated. These findings suggested that discontinuation of HCP bathing of newborn infants was associated with increased incidence of neonatal staphylococcal disease.
ANESTHETIC RISKS IN SICKLE CELL TRAIT
Authors: McGarry Paul , Duncan Caroline
Published: December 2021

Five Negro children with sickle cell trait died during or shortly after general anesthesia. Their ages were 18 months to 13 years. In four of the five cases sickle cell trait was undiagnosed and asymptomatic. In one, S-C hemoglobinopathy had been diagnosed previously. Four of the deaths were sudden, unexpected, and attributed to cardiac arrest of unknown cause. One was associated with massive hemorrhage and respiratory tract obstruction during surgery. Generalized sickling, widespread vascular occlusions by conglutinated erythrocytes and early parenchymal changes of hypoxia were found at autopsy, suggesting that massive intravascular sickling of red blood cells was present at the time of death and may have been the immediate cause. Circumstances known to promote sickling prevailed. Preoperative screening for sickle cell hemoglobin might have led to different management.
THE DUTY OF PARENTS TOWARD THEIR DEPRAVED CHILDREN—
Authors: C. T. E.
Published: December 2021

Complete rejection of the belief in depravity or innate tendencies to wickedness of children did not appear generally in popular American literature until just before The Civil War.1 The following passage, written in 1810 by Cyrus Comstock of Hartford, Connecticut, typifies the generally accepted Calvinist belief of the early 1800s in the innate depravity of children:

It is a consideration truly to be deplored that children have depraved hearts. This depravity, if unrestrained, will certainly lead them in the road to eternal ruin. And when parents out of excessive fondness, indulge their children in every thing, and resign their own judgments, and suffer themselves to be governed by them, they strengthen this depravity, and bind their children stronger and stronger, under these chains of moral darkness, and it would be just with God, if he should reserve such children under these chains of darkness to the judgment day. There parents must meet their children and give an account how they train them up. 2
RESPIRATORY CONTRIBUTION TO THE THERMAL BALANCE OF THE NEWBORN INFANT UNDER VARIOUS AMBIENT CONDITIONS
Authors: Sulyok E. , Jéquier E. , Prod'hom L. S.
Published: December 2021

The influence of environmental humidity and temperature on the thermal balance of 45 full-term newborn infants was studied by direct calorimetry within 24 hours after birth. The respiratory heat loss measured at 32C and 20% relative humidity (RH) represented 9.5% of the total heat production, and it decreased to 2.9% when RH was 80%. In neutral thermal environment (32C, 50% RH), the mean respiratory heat loss was lower than that measured during a warm exposure (36C, 50% RH), in spite of a higher absolute humidity in the latter condition. This suggests that respiration might have a thermoregulatory function during heat exposure in the newborn. Evaporative heat loss from the skin was more elevated than that from the respiratory tract, but it was less sensitive to change in ambient humidity. Convective and radiative heat losses from the skin were inversely related to ambient temperature; similarly, the metabolic rate decreased with increasing ambient temperature up to 36C. This work provides further data on the varying energy exchange between the newborn infant and his environment; it should lead to a more rational planning of infant care and caloric requirements and demonstrates the important effects of different environmental conditions on the newborn infant.
ACCELERATED PULMONARY SURFACTANT AFTER INTRAUTERINE INFECTION IN THE FETAL RABBIT
Authors: Kotas Robert V.
Published: December 2021

Intrauterine inoculation of Staphylococcus aureus into 24-day rabbit fetuses resulted in changes in lung maturation at 27 days comparable to those seen after glucocorticoid injection. The lungs of infected litters had increased low pressure stability and distensibility with decreased surface tension upon compression, and resembled 29- to 30-day control lungs.

Although intrauterine infection is found to be harmful to the fetus, it may have a secondary effect of preparing a fetus for premature air breathing.
Excerpt X: Shepherd's Boy and Husbandmen
Authors: Cone Thomas E.
Published: December 2021

Moral precepts have been taught by way of fables ever since Aesop (c.620-c.560 B.C.) introduced this literary form into Western literature. But the pithy style of an Aesopian moral often became the protracted moral lesson read by our children in their readers of the early 1800s. The fable below is a good example of this prolixity.1
Special Problems of Anesthesia in Infants, by Zdzislaw Rondio, M.D. Warsaw: Polish Medical Publishers, 1971, 147 pp., $4.75
Authors: Smith Robert M.
Published: December 2021

This is a carefully prepared small text, published in Poland but written in English, which covers well the physiologic peculiarities of the neonate, and the relation of these to anesthesia. Growth of the trachea, and other early changes in the respiratory tract are succinctly described, as is the child's characteristic response to drugs. Polish anesthetic technics currently employed in infants are nicely outlined with clearly drawn sketches to fill in descriptive explanations. All areas of the book are exhaustively documented with 390 references listed at the end of the volume.
The Biochemical and Immunological Basis of Bronchial Asthma, by Kjell Aas, M.D. Springfield, Illinois: Charles C Thomas, 1972, 238 pp., $11.50
Authors: Dees Susan C.
Published: December 2021

This monograph by Kjell Aas of the Pediatric Department, and Pediatric Research Institute of the Rikshospitalet of University of Oslo, Norway, is an excellent concise summary of current information on the fundamental processes underlying the pathophysiology of asthma presented from the aspect of host, allergen, and effects of their interaction. Certain chapters are outstandingly well written, among these are chapter 15 on allergens of asthma in which Dr. Aas's own work on the allergens of cod fish is discussed, and chapter 16 summarizing current information on the biochemical mediators.
THE DIAGNOSIS OF THE MALTREATMENT SYNDROME IN CHILDREN
Authors: Fontana Vincent J.
Published: December 2021

The maltreatment of children is a disease affecting the child and the parents. It is difficult to accept the fact that in our society today inhuman cruelty to children appears to be rapidly increasing. The perpetrators of these crimes are, for the most part, not strangers but the parents themselves. In 1968, in New York City, there were 956 cases of abuse reported. In 1969, there were 1,600 and in 1970, the incidence rose to approximately 3,000 cases. The number of neglected children during this time has been noted to be approximately 35,000. Within the period 1966 to 1970, there has been a total percent increase of 549 in reported cases of child abuse to New York's Central Registry.

It is most important for all of mandated sources under the present child abuse law–especially the physician in the hospital–to be able to recognize situations in which abuse or neglect may exist. It is not necessary for a physician to be absolutely sure about any abuse or neglect, as the law clearly states that cases of suspicion must also be reported. This disease, if not properly managed, leads to critical consequences. It is estimated that one out of every two battered children dies after being returned to his parents. Many of these battered children, if they survive amid approach adolescence, begin to show signs of pyschological and emotional disturbances reported as irreversible in most cases. There has been expressed concern that the probable future tendency of abused children is to become the future battering Parent or the hard-core criminal responsible for crimes and violence in our society.
THE IMPACT OF THE ROCHESTER NEIGHBORHOOD HEALTH CENTER ON HOSPITALIZATION OF CHILDREN, 1968 TO 1970
Authors: Klein Michael , Roghmann Klaus , Woodward Kenneth , Charney Evan
Published: December 2021

The admission patterns of children to area hospitals was studied. The study design allowed for comparisons between actual users of the health center, nonusers who lived in the target area and a comparison group. During the second year of operation, the admission rate of health center users was only 33 versus 67 per thousand for nonusers and 39 per thousand for the comparison group. Comparing the first two years, hospital days per thousand among users dropped by approximately half. Due to higher admission rates and longer average stays, nonusers had a rate of 2.5 times that of the users for hospital days per thousand. The rate for the comparison group remained constant. Users had fewer admissions for respiratory infectious diseases and more admissions for surgical restorative procedures. These trends were not present for the nonusers or for the comparison group. Despite extensive outreach, physician availability, and the team approach, the health center continued to have a large number of child admissions who reached the hospital without referral (the "leakers").
TREATMENT OF APNEA IN NEONATES WITH AN AUTOMATED MONITOR-ACTUATED APNEA ARRESTOR
Authors: Frank Ulrich A. , Bordiuk Joseph M. , Borromeo-McGrail Virginia , Saltzman Marcus B. , Keitel Hans G.
Published: December 2021

A rapidly inflated and deflated balloon placed under the neck elicited a startle response in 94.2% of a series of tests in neonatal subjects, proving more effective than ten other stimuli tested. The balloon stimulus was incorporated into an automatic monitor-actuated apnea arrestor which successfully terminated 99 of 105 apneic episodes in low birth weight neonates. To the extent that anoxia resulting from delayed recognition and treatment of apneic episodes causes neurologic damage, the use of monitoring and automatically actuated mechanical stimulation should improve prognoses in infants of low birth weight.
Sjögren's Syndrome and Achalasia of the Cardia in Two Siblings
Authors: Koivukangas Timo , Similä Seppo , Heikkinen Erkki , Räsänen Olavi , Wasz-Höckert Ole
Published: December 2021

This report documents a rare occurrence of Sjögren's syndrome and achalasia of the cardia in two siblings (Table I). Sjögren's syndrome manifested itself at the ages of 4 and 8 years, and achalasia of the cardia at the age of 10 years in both girls. The familial occurrence of both these conditions is reviewed, and the genetic factors in their pathogenesis are discussed.
Cushing's Syndrome, Therapy or Remission?
Authors: Mosier H. David
Published: December 2021

Putnam et al.1 argue that therapy for Cushing's syndrome will have little effect on ultimate growth of the patient with Cushing's syndrome. They do not consider the possibility that growth impairment in hyperadrenocorticism may be the result of the severity and duration of the disease and the age at which the patient is exposed to high levels of glucocorticoids.
CONGENITAL MICROGASTRIA, A CASE REPORT WITH A 26-YEAR FOLLOW-UP
Authors: Blank Eugene , Chisolm Alvin
Published: December 2021

A 27-year-old woman had congenital microgastria, which was apparent in roentgenographic examination when she was 1 year of age. Despite inability to eat anything but pureed foods for the first 13 years and despite persistent vomiting during that time, she has reached normal adult size and has three healthy children. This report represents two firsts: the first case of congenital microgastria in an English language journal of pediatrics and the first with a long follow-up.
PSYCHOLOGICAL IMPACT OF CARDIAC CATHETERIZATION
Authors: Aisenberg Ruth B. , Wolff Peter H. , Rosenthal Amnon , Nadas Alexander S.
Published: December 2021

Fifty children between 4 and 15 years of age were subdivided into three age groups and studied before, during, and after cardiac catheterization. Nearly all of the youngest, but less than half of the oldest patients manifested negative behavioral and intrapsychic changes after catheterization. The behavior patterns of the youngest children were affected specifically in the domains of regression, aggression, affectivity, and attitude. The increase of general and somatic anxiety was equally distributed among older and younger children. Among boys the increase of aggression was typically expressed in physical modes, whereas girls more often responded by verbal aggression.

Since children do not perceive cardiac catheterization as an innocuous procedure, and the catheterization experience may, in selected cases, interact with previously existing conditions to produce long-term adverse effect, intervention to protect very young cardiac patients may be advisable. Prophylactic play therapy could be utilized; or where medically feasible, cardiac catheterization could be postponed until later childhood.
PROPRANOLOL PALLIATION OF TETRALOGY OF FALLOT: EXPERIENCE WITH LONG-TERM DRUG TREATMENT IN PEDIATRIC PATIENTS
Authors: Ponce Florentina E. , Williams Luther C. , Webb Hazel M. , Riopel Donald A. , Hohn Arno R.
Published: December 2021

Propranolol therapy was given to 22 patients with tetralogy of Fallot (1 mg/kg/6 hr orally). In 13 infants (3 to 20 months of age), the medication was used in effort to postpone surgery to a more optimum size. In nine children (2 to 11 years of age), the drug was used while awaiting surgery, or when parents refused the proposed surgery or when surgery was not recommended because of associated defects.

Parameters observed during follow-up evaluations included electrocardiograms, chest x-rays, and pH and blood gas determinations. Serum propranolol values were obtained in 15 patients. The acute hemodynamic response to 0.2 mg/kg given intravenously was observed in eight patients at cardiac catheterization. The frequency and severity of hypoxic spells was evaluated utilizing historical information. Eighteen patients were noted to have spells prior to therapy. Propranolol was observed to abolish or to lessen the hypoxic spells in all but one patient. A satisfactory response, without complications, was observed in 17 patients. Refractoriness to propranolol occurred in five patients. Surgery, either by total correction (seven patients) or by shunt operation (five patients) was performed 3 to 27 months after therapy was begun. Postoperative complications attributable to propranolol were not observed. While the mechanism of propranolol action is open to speculation, the success of propranolol therapy in this series leads us to encourage its use for palliation of patient with tetralogy of Fallot, especially in infants.
Simple Device for Producing Continuous Negative Pressure in Infants With IRDS
Authors: Bancalari Eduardo , Gerhardt Tilo , Monkus Ellen
Published: December 2021

Increasing experience with the use of continuous transpulmonary pressure, either positive or negative, during the last years has clearly demonstrated the success of this mode of therapy in IRDS.1-3

Forty newborn infants with this disease have been treated with continuous negative pressure (CNP) in the Newborn Intensive Care Unit, Department of Pediatrics, University of Miami School of Medicine, using a modified incubator-respirator.*

Twenty-one required only CNP, three of whom died (14%). Among the 19 who needed CNP plus intermittent positive pressure ventilation, nine died (47%). All required more than 70% oxygen to maintain a Pao2 over 50 mm Hg before using CNP.
Letters to the Editor
Authors: Smith Clement A.
Published: December 2021

To Drs. Poley and Bhatia:

I don't know why the argument over the place of allergy among causes of abdominal pain and other vague recurrent problems continues to create correspondence, but I suspect the failure of letter writers to look far enough back into the literature may be one reason. Since June of 1970 we have aired the argument twice in our pages (1, 2), remarking about the first of these epistolary explosions (1, C, D) that perhaps the old arguments are still the best.
A SURVEY OF OFFICE MANAGEMENT OF URINARY TRACT INFECTIONS IN CHILDHOOD
Authors: Dolan Thomas F. , Meyers Alan
Published: December 2021

Responses to a written questionnaire by family physicians and pediatricians in private practice concerning their evaluation and management of suspected childhood urinary tract infections have been compared to the standards employed by a university pediatric department, which include documentation by culture, radiographic evaluation, and treatment. The survey reveals that 50% of physicians who responded made this diagnosis without cultures in the office setting. Criteria for ordering radiographic studies, choice of antibiotics, and indications for referral to a urologist differed from the standards. The implications of failure to discover correctable genitourinary abnormalities and of unnecessary drug or hospital utilization, and the place of peer review and continuing medical education in the private practice setting are discussed.
INTERMITTENT PREDNISONE THERAPY IN CHILDREN AND ADOLESCENTS AFTER RENAL TRANSPLANTATION
Authors: Reimold Ekkehard W.
Published: December 2021

Retardation of growth and maturation is a frequently observed complication after renal transplantation in children. It is attributed predominantly to the presently used immunosuppressive therapy.

In four girls who were followed up to 28 months after transplantation the dose of prednisone was reduced to 1 mg/kg/day within six weeks. Between three and one-half and five months it was further changed to an alternate-day treatment schedule provided no signs of rejection were found and a stable renal function was present.

With this treatment the incidence of rejection was not increased, all steroid side effects gradually subsided and the renal function remained normal. All four patients were growth retarded before operation. They continued or started to grow after transplantation; two girls reached the 50th height percentile within 12 months; the other two have shown considerable growth. Alternate-day prednisone therapy is an important modification of the presently used immunosuppressive treatment, facilitating medical and social rehabilitation and reducing the number of complications in children and adolescents.
EMPLOYED MOTHERS AND THEIR FAMILIES (I.)*
Authors: Howell Mary C.
Published: December 2021

More than 40% of all U.S. mothers of children of 18 years of age or younger are employed. The prevailing notion that employed mothers are deviant is examined with regard to published research literature. No uniformly harmful effects on family life, nor on the growth and development of children, have been demonstrated. It is concluded that conditions of employment, and the attitudes of other family members, probably influence the employed mother's relationship to her family by affecting her self-esteem and energy sources.

Maternal employment may jeopardize family life when the conditions of her employment are demeaning to her self-esteem, when other family members are strongly disapproving of her work away from home, or when mutually agreeable arrangements for children and housework cannot be made. Otherwise, maternal employment seems to offer many advantages to family relations and for the lives of children.
PHENOTYPE OF MALIGNANCY: THE MUCOSAL NEUROMA SYNDROME
Authors: Schimke R. Neil
Published: December 2021

Nearly 15 years have passed since Hazard et al.1 delineated medullary carcinoma of the thyroid gland (MCT) as a distinct pathologic entity. Since the initial description more than 250 cases have been reported, a number far out of proportion to the frequency of the tumor among thyroid carcinomas, as it comprises less than 10% of all malignancies of this gland.2 Much of this seemingly excessive interest in MCT has arisen because of the unusual features of the tumor itself. It is pleomorphic in appearance, generally presenting as a spindle- or small-cell carcinoma occurring in solid sheets, rosettes, and even a papillary or pseudofollicular pattern.
Acute Dextropropoxyphene Hydrochloride (Darvon) Poisoning
Authors: Zavelson Thomas M. , Debusk Franklin L.
Published: December 2021

This case illustrates the devastating effects of Darvon overdose on cardiorespiratory physiology and cerebral function. The case report and discussion emphasize the relative futility of treatment and the nature of the pathophysiologic disturbances.
Gonococcal Ophthalmia Neonatorum and Routine Screening of Pregnant Women for Gonorrheal Infection
Authors: Ris Hania W.
Published: December 2021

Drs. Snowe and Wilfert's1 timely paper on epidemic reappearance of gonococcal ophthalmia neonatorum calls attention to a very serious problem. Recently in Wisconsin a case of gonococcal ophthalmia was reported2 in a 3-day-old infant who received silver nitrate prophylactic treatment. The prenatal care consisted of 14 visits to an obstetrician, which did not include screening for gonorrhea.

The author's statement in the summary "gonorrhea occurs with significant frequency in obstetrical groups to merit attempts at therapy of the gravid mother" could be misinterpreted as advocating treatment without establishing a diagnosis.
A New Role for the School Physician: Approval by Those Concerned
Authors: Asbed Ruth-Alice , Fox Mary Alice , Wender Esther
Published: December 2021

We, too, would like to add our comments to Dr. Menkes' editorial "A New Role for the School Physician" (Pediatrics, 49:803, 1972). In our county, school physician services are provided by the County Health Department. These physicians (called School Medical Advisors in our system) have usually had some pediatric training and most are fully board qualified. They are based in area health centers whose broad-spectrum public health pediatric assignment includes a cluster of schools. The school services they provide are primarily of three kinds:
CONTEMPORARY COMMUNAL CHILD REARING
Authors: Johnston Charley M. , Deisher Robert W.
Published: December 2021

For children, the environment of the intentional community can provide important advantages that few nuclear families are in a position to give. With the dissolution of the extended family and with increasing personal and interpersonal alienation, these advantages are amplified. In the 20 communal groups visited, the observer found significant variation in the degree to which these potential advantages have come to be realized. In each, difficulties–personal, interpersonal and physical–have presented themselves. In the few instances where neither the biological parents nor the extended family of the commune has provided the necessary environment of basic trust, the children have evidenced this lack. Where major difficulties have been overcome and the commune members have been able to realize some of the potential advantages of communal child rearing, the reward has been children who demonstrate self-confidence, openness, warmth, independence and maturity.
TRACHEOSTOMY IN EPIGLOTTITIS
Authors: Rapkin Richard H.
Published: December 2021

Mortality in epiglottitis was compared in two groups of patients. There was no mortality in a small group of patients who were tracheotomized electively, whereas patients who were observed and tracheotomized on clinical indication had a 25% mortality or near mortality. It is suggested that elective tracheostomy, performed in patients with the confirmed diagnosis of epiglottitis, may protect them from the unpredictability of this disease.
IMMUNIZATION ACTION MONTH, OCTOBER 1973
Authors: Katz Samuel L.
Published: December 2021

The pediatrician has always been among those physicians most sensitive and attentive to the principles and practice of preventive medicine. For the past three decades immunization against infectious diseases has constituted a major aspect of his activities. Many of the vaccines utilized today are the products of research and of investigators fostered by pediatric institutions. The success of these immunizing agents has had profound, beneficial effects on childhood morbidity and mortality. This same success has enabled the pediatrician in his practice and in his research to focus greater energies on many of the other challenges to the health of infants and children.
WHY WE SHOULD REGIONALIZE PERINATAL CARE
Authors: Lucey Jerold F.
Published: December 2021

Considerable evidence now exists supporting the concept that the regionalization of perinatal or newborn intensive care centers is highly desirable.1-45 It is my hope that a brief review of data not summarized previously will provide interested physicians with support for the argument in favor of regionalization.

There is general agreement that such programs are worthwhile; although, because of their several different approaches, no specific therapy available in such centers can be singled out as the prime reason for their success in reducing perinatal mortality. Nevertheless, this success can presumably be attributed to increased cooperation with obstetrical departments, and to the constant availability of a larger number of trained personnel devoting full-time attention to the infant, newborn, and unborn.
PARENT-SPECIFIC HEIGHT STANDARDS FOR PREADOLESCENT CHILDREN OF THREE RACIAL GROUPS, WITH METHOD FOR RAPID DETERMINATION
Authors: Wingerd John , Solomon Irene L. , Schoen Edgar J.
Published: December 2021

Since parent-specific height standards are important in evaluating abnormalities of childhood growth, such standards have been determined from 59,000 height measurements of 11,233 California children aged 1 to 9 years, of white, black, and other racial groups.

Mean heights for the three groups diverged increasingly with age after 1 year: blacks were tallest, the mixed group shortest. Positive correlation between midparent height and child height increased with age. Nonwhite children, especially blacks, were taller for parent height than were whites. The discrepancy may reflect differing growth patterns; or the nonwhite children may become taller than their parents. A convenient "slide rule" is presented, which makes clinically feasible the determination of the parent-specific height centile for any child of either sex in each racial group.
T3 TOXICOSIS IN ADOLESCENCE: PRESENTATION AS RECURRENT HYPERTHYROIDISM
Authors: AvRuskin T. W. , Tang S. , Shenkman L. , Hollander C. S.
Published: December 2021

The second adolescent patient with recurrent hyperthyroidism caused by isolated hypersecretion of T3 (T3 toxicosis) has been discovered.

In 1969, this 17-year-old female patient initially presented with conventional Graves' disease was treated with propylthiouracil, but discontinued her medication after three months. Two and one-half half years later, she developed clinical and laboratory tory features of recurrent Graves' disease, save for a normal total and free thyroxine (T4). Serum T3 by radioimmunoassay was elevated (210 ng/100 ml) and thyroid binding globulin capacity for T4 was normal. Serum TSH was not detectable and failed to rise after intravenous infusion of 400 mg thyrotropin-releasing hormone. Other parameters of T3 toxicosis, as noted in adults with this syndrome, were confirmed. T3 toxicosis presenting as recurrent hyperthyroidism may be more common than previously recognized in the pediatric population.
CENTRAL NERVOUS SYSTEM DISEASE ASSOCIATED WITH MYCOPLASMA PNEUMONIAE INFECTION:
Authors: Lerer Robert J. , Kalavsky Steven M.
Published: December 2021

CNS disease associated with Mycoplasma pneumoniae infection is being recognized with increasing frequency. This report documents the occurrence of encephalitis and/or polyradiculitis in five children who had M. pneumoniae infections diagnosed on the basis of fourfold or greater changes in complement fixation titers to M. pneumoniae. A review of 50 reported cases indicates that cerebrum, cerebellum, spinal cord, and nerve roots can be affected singly or in combination. More than half of the patients have been under 21 years of age, and there is a striking male preponderence in this younger age group. Fifty-eight percent of patients had antecedent bronchitis and/or pneumonia, and 21% had antecedent URI; 21% had no antecedent respiratory symptoms. Patients under 14 years of age, patients with encephalitis or polyradiculitis, and patients with higher CSF cell count and protein concentration seemed to have a worse prognosis for full neurological recovery. The pathogenesis of this complication of M. pneumoniae infection is unclear. Therapy is supportive; tetracycline and corticosteroids have been used in the past, but a clearly beneficial effect has not been shown. In patients with aseptic meningitis, encephalitis, acute cerebellar ataxia, and polyradiculitis, diagnostic laboratory studies should include cultures and serologic tests for M. pneumoniae.
Pneumatosis Intestinalis In Childhood Dermatomyositis
Authors: Oliveros Miguel A. , Herbst John J. , Lester Patrick D. , Ziter Fred A.
Published: December 2021

The gastrointestinal complications of dermatomyositis are well known. Reviews, however, do not mention pneumatosis intestinalis in this disorder).1-3 Although noted in progressive systemic sclerosis,4-7 its association with dermatomyositis has been documented in only one case,5 unreported in the pediatric literature. It is important to distinguish this apparently benign condition from pneumoperitoneum secondary to intestinal perforation, which is a grave complication of dermatomyositis.1

CASE REPORT

W. W., an 8-8/12-year-old girl with a three-year history of dermatomyositis with prominent skin rash, disseminated subcutaneous calcification, muscle wasting and induration, also complained of occasional abdominal pain, recently localized to the right hypochondriurn and right shoulder. Inspite of continuous prednisone treatment and intermittent trials of azathioprine, methotrexate, and cyclophosphamide the patient's disease failed to remit.
Camphorated Oil Intoxication During Pregnancy
Authors: Weiss Jeffrey , Catalano Philip
Published: December 2021

A fourth case of intoxication with camphorated oil during pregnancy is presented. The baby is apparently healthy. Camphor has been shown to cross the placenta, and is a potential toxin for the fetus in utero as well as the gravid female. Since no therapeutic effects have been attributed to camphorated oil, a ban on its sale is requested.
Neonatal Withdrawal Following Maternal Ingestion of Ethchlorvynol (Placidyl)
Authors: Rumack Barry H. , Walravens Phillip A.
Published: December 2021

Intrauterine exposure to many drugs and chemicals is known to result in adverse effects on the fetus or neonate.1 A withdrawal syndrome in the newborn has been described for only a few agents the most prominent of which are in the narcotic group.2 Maternal barbiturate exposure also causes a syndrome with somewhat different features in the neonate.3 Adult withdrawal after discontinuation of drugs has been demonstrated with several additional medications including diazepam (Valium), chlordiazepoxide (Librium), meprobamate (Milltown), and ethchlorvynol (Placidyl).4,5 There is little reason to believe that a neonate would be spared from withdrawal of these drugs after maternal use. We report a case of withdrawal in a neonate from ethchlorvinyl documented by laboratory confirmation.6
Depressed Whole Blood Serotonin Levels Associated With Behavioral Abnormalities in the de Lange Syndrome
Authors: Greenberg Alan , Coleman Mary
Published: December 2021

In 1933 Cornelia de Lange first described two infants with a striking appearance and a pattern of congenital anomalies which she named "typus degenerativus amstelodamensis."1 Subsequently, other cases of this syndrome were reported in the European literature, but it was not until 1963 that the syndrome attracted attention in this country with the publication of case reports in the American and English literature.2-6

The patients have a distinctive appearance (Fig. 1) which becomes more apparent as they grow older. However, the diagnosis can be difficult during infancy. In a recent monograph, Berg et al.7 suggested that a useful criteria for diagnosis is eight or more of the following clinical findings:
HEALTH OF DAUGHTERS-AN 1842 VIEW
Authors: C. T. E.
Published: December 2021

Mrs. Lydia H. Sigourney (1791-1865), a popular and prolific contributor to the American lay literature during the first half of the 19th century, had this to say about what mothers might do to give their daughters a good constitution.

Mothers, is there any thing we can do, to acquire for our daughters a good constitution? Is there truth in the sentiment sometimes repeated, that our sex is becoming more and more effeminate? Are we as capable of enduring hardship as our grandmothers were? Are we as well versed in the details of housekeeping, as able to, bear them without fatigue, as our mothers? Have our daughters as much stamina of constitution, as much aptitude for domestic duty, as we ourselves possess? These questions are not interesting to us simply as individuals. They affect the welfare of the community. For the ability or inability of woman to discharge what the Almighty has committed to her, touches the equilibrium of society, and the hidden springs of existence.

Tenderly interested as we are for the health of our offspring, let us devote peculiar attention to that of our daughters. Their delicate frames require more care, in order to become vigorous, and are in more danger through the prevalence of fashion. Frequent and thorough ablutions, a simple and nutritious diet, we should secure for all our children.

But I plead for the little girl, that she may have air and exercise, as well as her brother, and that she may not be too much blamed, if in her earnest play, she happen to tear or soil her apron.
Childhood Illness: A Common Sense Approach, by Jack G. Shiller, M.D., F.A.A.P. New York: Stein and Day, 1972, 320 pp., $7.95
Authors: Webb Clarence H.
Published: December 2021

This book by a practicing pediatrician of Westport, Connecticut, is aimed at the parent, more specifically the mother, with the hope of shifting emphasis from "panic pediatrics" to "do-it-yourself pediatrics." The author states that his purpose is threefold: to indicate when simple disease can be treated at home; to alert parents as to when medical help should be sought; and to encourage young mothers to take better care of their sick children.

Dubious of solving the discrepancy between the volume of demands and the available medical manpower by the expedient of pediatric assistants, Dr. Shiller seeks to reduce visits to the pediatrician by teaching mothers to evaluate their children's illnesses in a conscientious and confident manner.
CLINICAL PHARMACOLOGY OF CARBENICILLIN AND GENTAMICIN IN THE NEONATE AND COMPARATIVE EFFICACY WITH AMPICILLIN AND GENTAMICIN
Authors: Nelson John D. , McCracken George H.
Published: December 2021

Because of its greater activity against Pseudomonas and Proteus and comparable activity against other bacteria, carbenicillin has theoretical advantages over ampicillin or penicillin as initial therapy, along with an aminoglycoside antibiotic, for suspected infections in the neonate. From a previous study of carbenicillin pharmacokinetics, mathematical predictions of dosage and intervals of administration were made and tested in 55 infants from 1 to 45 days of age treated with carbenicillin and gentamicin. Clinical efficacy was compared with a randomly selected group of 55 babies treated with ampicillin and gentamicin. No deaths directly attributable to infection occurred in either group. In bacteriologically documented infections follow-up cultures indicated eradication of the pathogen. All serum specimens tested for bactericidal power against Escherichia coli or Pseudomonas had bacterial titers of 1:2 or greater.

Dose response curves and daily serum specimens during subsequent days of treatment were assayed for antibiotic content. Peak serum level and serum half-life were correlated with dosage, interval, age, and weight. The proposed dosage schedule of carbenicillin for neonates is (1) 100 mg/kg initial dose; (2) 75 mg/kg subsequent doses at eight hourly intervals through 7 days of age for infants under 2,000 gm and at six hourly intervals until 4 days of age for babies weighing over 2,000 gm; (3) thereafter, 100 mg/kg every six hours for both weight groups. These dosages should assure therapeutic serum concentrations or carbenicillin when its use is desired or indicated for the neonate. Therapeutic results with carbenicillin and gentamicin were satisfactory in this study, but a larger experience is needed before the relative efficacy of this combination vis-à-vis other antibiotics commonly used for neonatal infections can be assessed.