bluuebunny/crossref_metadata_2025 huggingface dataset:
Lymphoblastic Conversion in Chronic Myelogenous Leukemia
Authors: Crist William M. , Ragab Abdelsalam H. , Ducos Rafael
Published: December 2021

The following acknowledgment was omitted from the article "Lymphoblastic Conversion in Chronic Myelogenous Leukemia" by Crist et al. (Pediatrics 61:560, April 1978): "We are indebted to Dr. Gurbax Sekhan for performing cytogenetic studies, to Drs. William T. Shearer and Alexander R. Lawton III for performing lymphocyte marker studies, and to Dr. Phillip Holland and co-workers for performing terminal transferase assay."
Angina Pectoris in a Child With Sickle Cell Anemia
Authors: Hamilton Wade , Rosenthal Amnon , Berwick Donald , Nadas Alexander S.
Published: December 2021

A 7-year-old black boy with sickle cell disease, Wolff-Parkinson-White syndrome, mild left ventricular dysfunction, and normal coronary arteries developed angina pectoris five months after cessation of hypertransfusion therapy. Exercise-induced ECG ST segment depression associated with angina disappeared following transfusion therapy.
COST-BENEFIT RATIO OF RAISING CHILDREN
Authors: Harris Martin
Published: December 2021

"...the motivation to restrict fertility is essentially a question of the balance between the benefits and costs of parenthood. With industrialization, the cost of rearing children increases—especially after the introduction of child labor laws and compulsory education statutes—because the skills which a child must acquire in order to earn a living and be of benefit to its parents take longer to learn. At the same time, the whole context and manner in which people earn their livings becomes transformed. The family ceases to be the locus of any significant form of production activity (other than that of cooking meals and begetting children). Work is no longer something done by family members in or near the family or business. Rather, it is something done at an office, store, or factory in the company of other people's family members. Hence the return flow of benefits from rearing children hinges more and more on their economic success as wage earners and their willingness to help out in the medical and financial crises that parents can expect in their waning years.

The availability of painless contraception and the altered structure of economic tasks—the contraception revolution and the job revolution—provide the key to many puzzling aspects of contemporary social life. Longer life spans and spiraling medical costs make it increasingly unrealistic to expect children to give comfort and security to their aging parents. Thus we are in the process of substituting old-age and medical insurance programs for the preindustrial system in which children took care of their aged parents.
Bacterial Vaccines and Infectious Asthma
Authors: Mueller Harry Louis
Published: December 2021

In the article that reviewed the rational management of allergic disease (Pediatrics 60:320, September 1977), Twarog and Colten's statements, made as though factual, are in reality opinions; they also attempted by innuendo to turn a simple fact into a questionable state. I refer to the use of the label "so-called" as an adjective describing bacterial vaccines. These vaccines are in fact bacterial vaccines. I believe their bias is showing.

An article that reviews the work of others, in a field where the reviewers have done no investigative studies themselves, should certainly quote accurately and then indicate that their conclusions are opinions.
Letter to the Editor
Authors: Camfield Peter , Camfield Carol
Published: December 2021

The riddle of febrile seizures is that despite their high risk of recurrence (35% to 50%), the natural history of the disorder is benign for the vast majority of children.1 If daily phenobarbital administration for several years is to be recommended after the first febrile seizure, it must be shown to be exceedingly effective and safe. The commendable study of Woff et al. is the second2 prospective randomized trial with concurrent controls of the efficacy of phenobarbital to prevent recurrent febrile seizures.
Insulin Allergy in a 19-Month-Old Boy with Newly Diagnosed Diabetes Mellitus
Authors: Wishner Kathleen L. , Fisher Lynda K. , Kumar Dinesh
Published: December 2021

Systemic insulin allergy is rare and usually occurs in adults with diabetes mellitus following reinstitution of insulin therapy.1,2 The present case is unusual in that the systemic symptoms appeared 23 days after initial continuous treatment with insulin in a very young child.

CASE REPORT

An 18-month-old boy was seen by his pediatrician six weeks after a severe episode of varicella, with a monilial diaper rash and a three-week history of polyuria, polydipsia, polyphagia, and weight loss. The blood glucose concentration was 534 mg/100 ml and serum ketones were present. Diabetes mellitus was diagnosed. He was hospitalized and insulin therapy was instituted without incident; the patient was discharged on a daily mixed dose of regular and isophane (NPH) insulins (single-peak, beef-pork mixture, Eli Lilly & Co).
Cardiac Tamponade from Central Venous Catheterization: Two Cases in Premature Infants with Survival
Authors: Opitz James C. , Toyama William
Published: December 2021

Cardiac tamponade is a well-recognized complication of cardiac catheterization. It is also a known complication of central venous catheters that have been inserted for nutritional as well as other purposes.1-8 Dudrick et al9 first documented the clinical application of total parenteral nutrition and, since that description, hyperalimentation has been used with increasing frequency.

This paper describes two infants of very low birth weight who survived after developing pericardial tamponade caused by perforation by a central venous catheter. To our knowledge, only two premature infants are reported to have survived this complication. When rapid deterioration is noted in any infant with a central venous catheter in place, this perforation must be rapidly considered in the differential diagnosis.
Development of Haemophilus influenzae Type b Meningitis in a Household Contact Treated with Rifampin
Authors: Boies Eyla G. , Granoff Dan M. , Squires Janet E. , Barenkamp Stephen J.
Published: December 2021

Household contacts less than 48 months of age who are exposed to cases of invasive Haemophilus influenzae disease are at increased risk of developing secondary disease.1 Prophylaxis ofcontacts with rifampin has been proposed.1 The effectiveness of rifampin prophylaxis in prevention of secondary cases remains controversial, but to date there have been no reported cases of disease in family members who received prophylaxis. The purpose of this communication is to describe the occurrence of Haemophilus meningitis in a household contact who had been treated with rifampin using a dose and regimen currently considered to be optimal.1 We also explored the complex epidemiology of transmission of Haemophilus in this family by use of a recently described technique for subtyping of isolates by outer membrane protein profiles.2
Letter to the Editor
Authors: Ramamurthy Rajam S. , Brans Yves W.
Published: December 2021

The comments of Shohat and colleagues are well taken. The change in peripheral venous hematocrit with postnatal age observed by them is a well known phenomenon that has been reported previously.1 The changes in viscosity should be expected in the newborn as the blood viscosity determination parallels the hematocrit. The assumption that the umbilical venous hematocrit level would parallel these changes is not entirely correct.

In a preliminary investigation involving 32 infants we determined the correlation between mixed cord blood hematocrit, peripheral venous (PVHct), and umbilical venous hematocrit (UVHct).
Blood from All Newborns
Authors: Therrell Bradford L.
Published: December 2021

The recent National Symposium on Laboratory Aspects of Newborn Screening addressed many of the issues reflected in the recently published recommendations regarding newborn screening.1 These guidelines are extremely important and represent a great deal of thought and effort on the part of the Committee on Genetics.

All of the published recommendations were whole-heartedly endorsed by the Symposium participants and unanimous support was given to a resolution concerning the importance of Recommendation 2 (a recommendation concerning the importance of testing).
Phenothiazines and Sudden Infant Death Syndrome
Authors: Kahn André , Blum Denise
Published: December 2021

A relationship between sudden infant death syndrome (SIDS), sleep apnea, and upper airway infections has been reported. The present observation stresses the possible influence of phenothiazine-containing medications and the occurrence of SIDS. The drug is commonly used for the treatment of infants with nasopharyngitis in Belgium and in some other European countries. In a prospective study, 52 SIDS victims, 36 near miss infants, and 175 control infants were compared for the coexistence of nasopharyngitis and phenothiazine treatment in the days preceding death or hospitalization. The incidence of nasopharyngitis was comparable in the three groups (approximately 31%), but phenothiazines were used significantly more frequently in SIDS victims (23%) and near miss infants (22%) than in control subjects (2%). It is postulated that phenothiazines, as CNS depressors, may contribute to the occurrence of SIDS.
Tracheobronchial Foreign Bodies: The Impact of a Postgraduate Educational Program on Diagnosis, Morbidity, and Treatment
Authors: Puterman Marc , Gorodischer Rafael , Leiberman Alberto
Published: December 2021

Aspirated foreign bodies (FBs) may remain undetected and cause serious complications. As part of a postgraduate educational program, results of a local survey were presented to the local medical staff in order to increase its awareness of this diagnostic possibility. The present study was carried out in order to evaluate the management of children with tracheobronchial FBs during two 2-year periods, before and after teaching sessions held in December 1976. In comparison with the previous two years during the 1977-1978 period, the percentage of cases in which a positive history of aspiration was obtained increased from 47.6% to 84.0%; the mean number of hospitalizations due to tracheobronchial FBs decreased from 1.9 to 1.04 per infant, and the mean number of hospital days required for final diagnosis decreased from 17.6 to 5.3. The postgraduate educational program had a positive effect on physician performance and patient care.
ANOREXIA NERVOSA
Authors: Haggerty Robert J.
Published: December 2021

Anorexia nervosa is a serious psychosomatic disorder which most typically begins between 16 and 18 years of age. Clinicians have often held that early onset (eg, ages 11 to 15) is associated with a better outcome. This paper reviews the long-term outcome studies on anorexia nervosa and concludes that this contention is not supported by available data. The methodologies of seven outcome studies that focus on an early onset population are critiqued, and it is concluded that two methodologies are strong. Because of the increasing prevalence of anorexia nervosa, this once rare disorder can now be more easily investigated, and consequently better follow-up studies, which examine potential prognostic factors including age of onset, should be forthcoming.
INFORMED CONSENT
Authors:   Student
Published: December 2021

Let us address ourselves to the problem of informed consent. I believe, as a physician who has had prior contact with the family, that I can persuade 99% of parents to my way of thinking if I really work at it, even if I am 100% wrong. If I tell them in such a way that I appear concerned and that I am knowledgeable and that I have their interests at heart and the interest of their foetus or their newborn baby, there is no question they will be totally agreeable to my suggestion. I think informed consent is an absolute farce, legalistically, morally and ethically. The information is what I want it to be. Certainly, the physician must try to involve the parents in decision making. He should do so to the maximum extent feasible, but we are fooling ourselves if we believe that the parent or the physician can make all the decisions.—Director of a Neonatal Intensive Care Unit.
OUR AMERICAN DAUGHTERS (1856)
Authors: C. T. E.
Published: December 2021

The following editorial published in 1856 in Hall's Journal of Health, a well- read publication of the 1850s, will vividly demonstrate how much our attitude toward rearing our daughters has changed since 1856.

OUR DAUGHTERS

Are the hope of our country's future. Their physical, moral and domestic education, are of an importance which no array of figures can express, which multitudes of ponderous tomes could not adequately portray.

As is the mother, so is the man. If she be a woman of physical vigor, a high guaranty is given of healthy children. If her moral character is pure, formed in the mould of Bible piety, we may anticipate for her offspring, lives of the self same piety, with its benevolent influences spreading far and wide, from all their habitations.

If the mother in her domestic relations, be a pattern for all that is cleanly and systematic, and punctual and prompt and persevering, with womanly dignity and lovingness pervading all, then may we look for every son of such a woman to be a man of mark for his time, and for every daughter, to become a wife well worthy of a king.

When such destinies hang upon the future of our daughters, ought they to be hurried from a loving mother's side at seventeen, at fifteen, at twelve, to be purchased care of a governess? To the herded tuition of fashionable boarding schools, where glitter and superficiality and empty show predominate; where nothing that is radically useful and good is thorough; where associations are inevitable, with the children of the parvenue, as well as with the scion of the decayed aristocrat, thus exposing the pure heart to the withering and corrupting examples of mere pretence and of baseless pride?
AN APPEAL TO THE PRESIDENT OF THE UNITED STATES OF AMERICA AND THE CHAIRMAN OF THE PRESIDIUM OF THE U.S.S.R. SUPREME SOVIET
Authors:   Student
Published: December 2021

The growing threat of thermonuclear war and the continued development and proliferation of nuclear weapons have compelled us as physicians to examine in detail the consequences such a war would have on the people of our nations and of the world, whose health and survival are our professional commitment.

During the past several days, physicians and scientists from 31 countries have gathered to consider relevant data on the immediate and long term effects of a nuclear conflict. We were unanimous in concluding that:

. . . The growth in sheer numbers of nuclear weapons and the increasing complexity and sophistication of delivery systems increase the possibility that a nuclear conflict may be triggered by tragic accident.

Physicians are aware from their daily work that technologic systems are liable to malfunction and that human performance may fail because of mental derangement or even simple error. Whereas such failures in medicine may jeopardise a single life, the malfunctioning of military systems may now endanger the existence of humanity....
BIRTH RATE IS THE KEY
Authors:   Student
Published: December 2021

The best current estimates suggest that the population ef the Third World is likely to triple in the next century and thereafter remain stable. Even if life expectancy were to rise at what appears to be the fastest rate possible, the effect on the ultimate, stable population of the Third World would be small. The reason is that the rate of population growth in the developing countries has become increasingly insensitive to changes in the death rate. The most important influences on growth are future trends in fertility and the large numbers of young people now reaching childbearing age, mainly as a result of high fertility in the recent past. If population growth is to be kept to a minimum, attention to reducing the birth rate will be most important. No substantial demographic consideration need stand in the way of the industrialized countries' carrying out their responsibility to help increase life expectancy in the developing countries....reductions in mortality have a diminishing influence on population growth as higher levels of life expectancy are achieved. The reduced effect is due to a shift in the age distribution of deaths. An infant saved from death from smallpox is enabled to live 50 or 60 years before dying of some other cause. A mother who would have died in childbirth gains another 30 or 40 years. A person 70 years old suffering from coronary insufficiency is granted another five years. As a result of such delays the average age at death and the proportion of deaths occurring among older people rise.
Paroxysmal Atrial Tachycardia in Infancy: Long-Term Follow-up Study of 49 Subjects
Authors: Lundberg Åke
Published: December 2021

A follow-up study of 49 individuals with paroxysmal atrial tachycardia in infancy is reported. Forty subjects had supraventricular tachycardia and nine had atrial flutter/fibrillation. The mean follow-up period was 24 years. Males whose ECGs showed preexcitation displayed the highest rate of recurrences (approximately 60%) in the long-term follow-up. Approximately 30% of the subjects without preexcitation in the ECG displayed episodes of supraventricular tachycardia in their third decade. Eighty-six percent of the children of the subjects in the present series were males. The prognosis is good in the absence of congenital heart disease.
Letter to the Editor
Authors: Zimmerman Andrew W.
Published: December 2021

Tasic and colleagues are correct in pointing out the potential hazards of zinc toxicity in treating infants with acrodermatitis due to low zinc in their mothers' milk. Infants, especially premature infants, who have symptoms of acrodermatitis enteropathica while being breast-fed should be assumed to have normal capacity for uptake of zinc in the gut. If breast-feeding is continued during administration of zinc, the plasma zinc level can be expected to rise rapidly. This is due in part to the positive effect of human breast milk on zinc absorption as well as normal absorptive capacity.
ARE THE MENTAL PECULIARITIES OF A NURSE PARTAKEN BY HER NURSLING?
Authors: C. T. E.
Published: December 2021

Most of the writers on infant feeding until the late eighteenth century repeated the time-worn stories of character in humans, as well as in the lower animals, being transmitted by breast milk. However, as late as 1830, the highly respected Boston Medical and Surgical Journal was still perpetuating this belief, as is evident in the following quotation.1

We read, in the Spectator, of a certain very worthy man, who, having been bred with the milk of a goat, was extremely shy and timid in public, but that, nevertheless, he had frequently an hour in private, when, giving loose to his goatish propensities, he would enjoy a few frisks and capers. It is reported of Caligula, that he did not inherit his cruel and murderous disposition from either father or mother, but that his nurse was of a barbarous savage temper. Tiberius' nurse was unhappily a little too fond of tippling, and the Emperor proved a notorious drunkard. A bitch suckled a pig, which, when grown, would hunt as well as an ordinary hound; and the philosophical Phavorinus observes that, if a lamb be reared with goat's milk, or a kid with that of an ewe, the wool of the one will become hard, and the hair of the other soft. Further we may state, that, in the purest ages of Greece and Rome, this influence of the nurse in instilling her own good and bad qualities into the infant she suckled, was no less known than guarded against; and we find it particularly remarked, that, when Rome flourished as a commonwealth, "children were not suckled by mercenary nurses, but by the chaste mothers that bore them; thus were the Gracchi reared by their mother Cornelia, and Augustus by his mother Attia.
Current Distribution and Trends in the Location Pattern of Pediatricians, Family Physicians, and General Practitioners Between 1976 and 1979
Authors: Budetti Peter P. , Kletke Phillip R. , Connelly John P.
Published: December 2021

The literature suggests that pediatricians in the United States are concentrated in the more densely populated regions and states, whereas family physicians and general practitioners are more likely to settle in rural areas. The rapidly increasing supply of all child health physicians had led many to hypothesize that the traditional geographic preferences of pediatricians would expand to include smaller communities. Data for 1976 to 1979 confirm the urban concentration of pediatricians and the more even distribution of family physicians and general practitioners. These data also demonstrate a marked imbalance of pediatricians within county groups, resulting in some areas of shortage even within highly metropolitan communities. Evidence of a trend toward increased dispersion of pediatricians into urban shortage areas is presented, but there is no indication that enough pediatricians will settle in rural areas to meet the needs of children in those small communities.
Increasing the Protection of Newborn Infants in Cars
Authors: Christophersen Edward R. , Sullivan Margaret A.
Published: December 2021

Please note the following errata in the 1982 Red Book, and correct your copy:

Pages 26-27. The bottom line of page 26 and the top two lines of page 27 are duplications. Cross them out.
Letter to the Editor
Authors: Sokoloff Burton
Published: December 2021

I appreciate Neff's comments concerning my statement that "foster families should be encouraged to incorporate the foster child into their own health care system." It became obvious during his commentary that I should have expanded slightly on this subject, rather than "generalizing" in one sentence. It is true that for any "special needs" medical or psychosocial problem, continuous medical care is essential. The responsible social agency should be urged to keep the child with special needs close to his present medical care facility even if his foster care is transferred to another home.
Adverse Reactions Associated with DTP Immunizations
Authors: Johnstone T. , Arcand T. A.
Published: December 2021

We were very interested in the article by Cody and colleagues1 and the documentation of the lack of neurologic sequelae and death associated with DTP immunization. When considering this study, and the British National Childhood Encephalopathy Study,2 it appears that the risk-benefit ratio of pertussis vaccine favors routine pediatric DTP immunization. However, it is important to remember the contraindications to pertussis vaccine. Apart from individual histories of seizures, convulsions, or cerebral irritation in the neonatal period, the development of a "screaming syndrome," or shock, convulsions, or encephalopathy following any dose of DTP vaccine is an absolute contraindication to further administration of vaccine containing the pertussis component.
Through the Looking Glass—Or, Look Before You Leap
Authors: CASSADY GEORGE
Published: December 2021

Nurses are now so active in newborn intensive care units that exchange transfusions, lumbar punctures, vascular catheterizations, placement of chest tubes, and many other complex and complicated but time-consuming procedures need no longer burden the busy physician. According to the neonatologists in charge, specially educated nurses are independently performing these and many other tasks in most neonatal intensive care units (NICUs). Assuming that similar practices exist in those units not assessed and that nurses are in fact doing what the neonatologists say they are, these amazing observations deserve careful study and deep thought by all who care for newborn infants.
Digoxin and Low-Birth-Weight Infants
Authors: OLANDER DAVID S. , MAURER MICHAEL
Published: December 2021

In their recent communication, Johnson et al suggested that conventional digoxin use may be sufficiently toxic forlow-birth-weight infants to prompt consideration of alternative therapies. This conclusion was supported by their detection of digitalis associated illness in 9/18 small premature infants receiving digoxin in doses of 0.003 to 0.005 mg/kg twice per day. The documentation of abnormally elevated serum digoxin concentrations in 7/9 patients further supports the possibility of clinically significant digoxin toxicity.

Akin to the findings of Berman et al and Pinsky et al, this investigation only confirms the observation that overdosage of infants with digoxin may result in digitoxicity.
Does Mr Yuk Work?
Authors: KRENZELOK EDWARD P.
Published: December 2021

Fergusson et al stated that the use of Mr Yuk labels was not a deterrent to childhood poisoning incidents. Based upon their methodology the results of the study are not surprising. Mr Yuk labels and other poison warning labels such as the skull and crossbones and Officer Ugg represent a small aspect of a total poison prevention education and information system. The labels have two primary functions—to create awareness of a particular poison center and to serve as a deterrent.
Cerebral Blood Flow
Authors: BAYLEN BARRY G. , EMMANOUILIDES GEORGE C.
Published: December 2021

In the commentary, "Pulsatility Index, Patent Ductus Arteriosus, and Brain Damage," It was stated that we have shown that "blood flow" to the brain was not reduced in premature lambs with left-right ductal shunting. The abstracted data referred primarily to alteration of the percent distribution of blood flow and not to changes of absolute blood flow to systemic organs before and after patent ductus arteriosus (PDA) occlusion in preterm lambs. We subsequently demonstrated that absolute cerebral blood flow (milliliters per gram per minute) in fact was significantly reduced in preterm lambs with PDA.
Effects of Obstructive Sleep Apneas on Transcutaneous Oxygen Pressure in Control Infants, Siblings of Sudden Infant Death Syndrome Victims, and Near Miss Infants: Comparison with the Effects of Central Sleep Apneas
Authors: Kahn Andre , Blum Denise , Waterschoot P. , Engelman E. , Smets P.
Published: December 2021

In order to investigate the effects of obstructive sleep apneas upon transcutaneous Po2 75 polysomnograms, recorded during night sessions in 25 control infants, 25 siblings, and 25 near miss for sudden infant death syndrome (SIDS) infants were studied. These observations were compared with the decreases in transcutaneous Po2 measured during central sleep apneas in the same infants. During a total of 707.6 hours of sleep, 33 obstructive apneas and 1,650 central apneas were recorded. Obstructive apneas were seen in three control infants (three episodes), one sibling (five episodes), and six near miss for SIDS infants (25 episodes). The obstructive apneas tended to be short (less than 10 seconds). Comparatively, the central apneas were equally distributed in the three groups of infants, and only the near miss children presented apneas that lasted as long as 19 seconds. The decrease in transcutaneous Po2 was proportional to the duration of both types of apnea, but for a given duration the decrease in transcutaneous Po2 was significantly greater for the obstructive apneas than for the central apneas (with a mean difference of 7.59 ± 0.53% Po2. It is concluded that the hypoxic effects of the obstructive apneas might have important clinical implications in infants, such as the near miss for SIDS.
Oral Penicillin Prophylaxis in Children with Impaired Splenic Function: A Study of Compliance
Authors: Buchanan George R. , Siegel Jane D. , Smith Susan J. , DePasse Bonnie M.
Published: December 2021

One measure used to prevent overwhelming sepsis due to Streptococcus pneumoniae in children with defective splenic function is oral penicillin prophylaxis. However, a frequently cited argument against this approach is the likelihood of poor compliance. Compliance was studied by examining urine specimens for penicillin by the Sarcina lutea disc diffusion technique in 22 surgically asplenic children, two patients following bone marrow transplantation, and 38 infants and young children with sickle cell disease. Multiple specimens (mean 3.5 per patient) were examined in 43 of the children. Overall, 125/188 (66%) of the urine samples contained penicillin, indicating compliance within the previous 12 to 24 hours. Compliance tended to improve on subsequent clinic visits. These relatively good results were attributed to an intensive educational program in which repetitive efforts are made to counsel patients and parents about the risks of life-threatening infection. Poor compliance should no longer be invoked as a reason not to study the efficacy of prophylactic penicillin in functionally or surgically asplenic subjects.
Urea Nitrogen Excretion in Critically Ill Children
Authors: Mickell John J.
Published: December 2021

Urinary urea nitrogen (UUN) excretion as an index of both total nitrogen excretion and protein catabolism was assayed in 32 children (aged 2 months to 15 years, median 6 years) (50% mechanically ventilated) during an intensive care unit course of one to ten days (median three days). The daily UUN excretion was 4.38 ± 2.22 gm/sq m (171 ± 89 mg/kg) (N = 121 patient days). The average daily UUN excretion (N = 32 children) was well described by a linear regression equation for square meters of body surface area (BSA) (milligrams of UUN = 4,421.5 x BSA; r2 = .903). This linear relationship permitted the valid comparison of both individuals and subgroups despite wide age differences. Excretion data in the mechanically ventilated vs the spontaneously breathing children, and in four diagnostic subgroups (Reye syndrome, seven; sepsis, six; elective surgery, seven; and miscellaneous, 12) were evenly distributed about the regression line for body surface area. Variability in average daily UUN excretion was on an individual basis, and was independent of diagnostic or therapeutic subgroup.
Systolic Time Interval Characteristics in Children with Duchenne's Progressive Muscular Dystrophy
Authors: Sanyal Shyamal K. , Tierney Ralph C. , Rao P. Syamasundar , Pitner Samuel E. , George Stephen L. , Givins Dennis R.
Published: December 2021

Systolic time interval (STI) characteristics of 17 boys with Duchenne's muscular dystrophy (DMD) were compared with those of 80 normal boys who served as control subjects. The heart rate decreased linearly with age in normal control subjects (r = -.47, P < .01). By contrast, heart rate was significantly higher in patients with DMD (P <.001) and tended to increase further with age. Each STI variable for normal control subjects increased significantly with age (P ≤ .01); QII, left ventricular ejection time (LVET), and pre-ejection period (PEP), in addition, decreased with increasing heart rate (P ≤ .05). In dystrophic patients QII and LVET decreased with increasing heart rate (P < .001) but were not influenced by age. None of the other STI values in dystrophic patients was significantly influenced by either age or heart rate. Mean QII, LVET, and QI were shorter and PEP, isometric contraction time (ICT), and PEP/LVET ratio were longer (P < .001) for DMD patients than for normal control subjects. In 13/17 patients, QII and LVET were below the 95% confidence interval of the normal mean, whereas PEP, ICT, and PEP/LVET exceeded the upper limits of normal in 8, 9, and 11 patients, respectively. For dystrophic patients, the difference (Δ) between the observed values and those predicted from regression equations for normal control subjects was lower for QII, LVET, and QI (P < .01) but higher for PEP (P < .04), ICT, and PEP/LVET ratio (P < .001). Δ QII and Δ LVET increased with age (P = .001 and .032, respectively). Duchenne's muscular dystrophy is thus documented to be associated with substantial alterations in STI characteristics that suggest a compromise of global left ventricular performance. Some of these abnormalities increase with age, probably reflecting the progressive cardiomyopathy characteristic of this disease.
Potential for Single High-Dose Influenza Immunization in Unprimed Children
Authors: Gross Peter A. , Quinnan Gerald V. , Gaerlan Pureza F. , Denning Carolyn R. , Davis Anne , Lazicki Mabel , Bernius Maureen
Published: December 2021

High concentrations of split-product vaccine (SPV) are more immunogenic than lower concentrations. These studies were verified with another influenza strain, B/Singapore/22/79. Two ether-treated SPVs were compared in 80 children and young adults. The vaccine strains were influenza A/Bangkok/79, A/Brazil/78, and B/Singapore /79; 44 patients received a high-dose SPV containing 7, 7, and 60 µg each of the respective hemagglutinins (HA) and 36 received a standard dose SPV containing 7, 7, and 7 µg of HA, respectively. Among persons initially seronegative by hemagglutination inhibition (HAI) tests, the geometric mean titer (GMT) in 15 recipients of one high dose was 97 vs GMT of 37 in 18 recipients of one standard dose (P < .05). Furthermore, 87% of high-dose recipients had HAI titer ≥ 40 vs 44% of standard dose recipients. In initially seropositive persons, GMT in 29 recipients of one high dose was 170 vs GMT of 84 in 18 recipients of one standard dose (P < .05). Immune response to the other two virus strains was comparable for the two vaccines. The reaction index for the high dose vaccine was 0.70 vs 0.45 for the standard dose (P = NS). An A/Bangkok epidemic struck the New York metropolitan area. The attack rate in unvaccinated matched sibling control subjects was 35% (15/43). There were no vaccine failures. In conclusion, in the small number of patients studied, a 60-µg HA dose of B/Singapore/79 was significantly more immunogenic than a standard 7-µg HA dose without an increase in reactogenicity.
The Prognostic Significance of Peak Ammonia Levels in Reye Syndrome
Authors: FITZGERALD JOSEPH F. , CLARK JOSEPH H. , ANGELIDES ANASTASIOS G. , WYLLIE ROBERT
Published: December 2021

Reye syndrome is currently viewed as a specific disease entity distinguished from other causes of hepatic failure and encephalopathy on clinical and histologic grounds. A variety of therapeutic approaches, ranging from supportive management to invasive intracranial pressure monitoring and barbiturate-induced coma, have been used because of the wide spectrum of disease progression and severity. Early identification of factors predictive of a poor outcome would be of value in assessing the need for aggressive management. Based on a ten-year experience with 95 patients with Reye syndrome, we suggest that peak plasma ammonia levels are predictive of disease severity and patient survival.
Hazards of Battery Ingestion
Authors: Temple David M. , McNeese Margaret C.
Published: December 2021

A 12-year-old boy ingested a mercury battery from a watch as a part of an alleged poisoning attempt by an uncle. The battery apparently ruptured spontaneously in the child's stomach less than 36 hours after ingestion. At surgery one battery terminal was found embedded in gastric mucosa thought to be progressing toward gastric perforation. The unique complications of battery ingestion, such as gastrointestinal perforation and possible mercury poisoning, are reviewed. A strong recommendation for immediate endoscopic or surgical removal of ingested batteries is made. Parental education along with preventive measures by manufacturers such as package warnings, specific labeling of battery contents on each package, and "childproofing" of battery-containing products is stressed.
Parent Acceptance of Routine Use of the Carey and McDevitt Infant Temperament Ouestionnaire
Authors: Little David L.
Published: December 2021

Anticipatory guidance can be more effective if constellations of temperament characteristics that make children difficult to parent are recognized. The Carey and McDevitt Infant Temperament Questionnaire can be used to screen for such children. Parents of children who were not difficult to parent also found the temperament evaluation useful. A total of 120 questionnaires were completed, and 79 families completed the author's survey. Nearly 90% of parents responding gained a better understanding of their child, 87% thought the time involved was worthwhile, and 57% thought it changed their approach to parenting.
Creatinine Excretion
Authors: SUTPHEN JAMES L.
Published: December 2021

In Reply.—

The questions posed by Harkavy allow me to expand on the initial presentation of the data in my previous report.1 As documented by numerous previous reports, urinary creatinine excretion does, in fact, reflect body muscle mass.2 Furthermore, it has been documented in older infants that creatinine excretion per kilogram increases with the age, weight, and length of the infant.3 The regression data in my report are not expressed in terms of creatinine per kilogram as the dependent variable as this multiplies the error of creatinine measurement by including the error in weight measurement (hydration states etc).
Asymmetric Crying Facies: Which Is the `Right-Wrong' Side?
Authors: EVERS KARL-GEORG , GRONECK PETER
Published: December 2021

To the Editor.—

Congenital asymmetric crying facies is generally considered to be due to unilateral agenesis or hypoplasia of the anguli oris depressor muscle (HAODM). Electromyographic (EMG) examinations of the affected sides have revealed absent spontaneous activity or diminished motor unit activity.1-3 Association of HAODM syndrome with congenital heart disease, the "cardiofacial syndrome," has been described.4 Major defects of other organ systems and minor congenital defects may be associated with asymmetric crying facies as well.5

Monreal6 reported five patients with asymmetric congenital crying facies syndroms who besides this anomaly displayed juxtaoral defects, egm atresia of one side of the jaw and soft palate, cleft lip, hypoplasis of mandible and ear.
Dimethyl Sulfoxide (DMSO)
Authors:   Committee on Drugs,   Committee on Sports Medicine
Published: December 2021

Dimethyl sulfoxide (DMSO) is an industrial solvent that has become a legend in its own time. In 1963, Dr Stanley Jacob introduced DMSO to reduse the swelling and pain of arthritis. Quickly, a wide variety of unsubstantited claims were made, and enthusiasm apprently precluded careful studies.

In fact, the compound has a number of interesting pharmacologic properties that may be beneficial to patients. Its ability to penetrate intact skin, carrying a variety of chemicals, offers hope for eliminating many painful injections; its inhibition of certain prostaglandins offers hope that various inflammatory diseases may be suppressed; its local analgesic properties may reduce cutaneous pain from burns and injuries; its ability to dissolve compounds such as amyloid and collagen might be harnessed; and DMSO's ability to reduce increased intracranial pressure in head injuries could reduce morbidity if not mortality.

But research has not yet demonstrated that the potential of DMSO can be safely fulfilled. Clinical research was suspended in 1965 when injury to the lens was found in animals, but inasmuch as no human injury was detected, limited studies were permitted again in 1968. Asked for an opinion in 1972, the National Academy of Sciences stated that the compound should remain an investigational drug. During this period many papers detailed anecdotal results of cutaneous, intravenous, or oral use, and in 1978 the FDA approved Rimso (50% solution of DMSO) for the treatment of interstitial cystitis, the only approved use of the drug today. In the same year the Arthritis Advisory Committee to the Food and Drug Administration rejected the new drug application approval of DMSO based on the submitted studies.
Toward a Prudent Diet for Children
Authors:   Committee on Nutrition
Published: December 2021

Nutritional manipulation has been suggested as a mode of decreasing atherosclerosis. Atherosclerosis is a disease process that begins with fatty streaks during infancy and childhood and progresses at a variable rate to the formation of atheromatous plaques and subsequent obstruction of arteries, which may result in coronary and cerebral thrombosis.

Hypercholesterolemia, hypertension, smoking, obesity, abnormal glucose tolerance, lack of physical activity, and psychosocial tension have been identified as risk factors of arteriosclerosis in adults. Attention has been directed to advisable diets of infants and children, although arteriosclerosis and coronary artery disease are rare in these age groups. Dietary recommendations for adults, including low-fat and low-cholesterol diets, have been made to limit some of the risk factors and thus help prevent atherosclerosis. Evidence supporting and denying the importance of each of the risk factors has been reported extensively and is not reviewed here. The application of some of these dietary recommendations to children has been questioned.

Dietary factors in children must be considered simultaneously with physical activity, life-style, and genetic influences. Limiting fat and cholesterol intake has been questioned because, during the first years of life, breast milk (a cholesterol-containing food) is considered the ideal food for infants. In teenagers, serum cholesterol consistently decreases from preteen levels. In addition, formation of bile acids, hormones, and special tissues may indicate a continuing need for cholesterol during the entire growth period. Furthermore, limitation of total caloric intake to maintain ideal weight and dietary variability, including vegetables, will result in a lowering of fat intake.

There is controversial evidence concerning the relationship between dietary and serum lipids in infants.
Membranoproliferative Glomerulonephritis and α1-Antitrypsin Deficiency in Children
Authors: Strife C. Frederic , Hug George , Chuck Gail , McAdams A. James , Davis Charles A. , Kline Jeffrey J.
Published: December 2021

Two white girls had reduced serum concentration of α1-antitrypsin (α-AT), phenotype ZZ, and liver disease. Hepatocytes exhibited the microscopic criteria of α-AT deficiency. Hypocomplementemia, elevated circulating immune complexes (patient 1), clinical signs of renal disease, and the histologic findings of membranoproliferative glomerulonephritis (MPGN) type I developed. Immunoglobulin A (but not α-AT) was demonstrable immunologically as a component of glomerular deposits in patient 1. Among 53 patients with MPGN but without clinical signs of liver disease, none had Pi type Z. Among 23 patients with phenotype ZZ but without clinical signs of kidney disease, six had abnormal complement protein levels, but the pattern did not resemble that of idiopathic MPGN type I. These results are consistent with the conclusion that MPGN in the two patients reported here is a consequence of their chronic liver disease and is not directly related to the presence of the allelic α-AT variant PiZ.
1981 Milk Feeding Patterns in the United States During the First 12 Months of Life
Authors: Martinez Gilbert A. , Dodd David A.
Published: December 2021

From 1955 to 1981, questionnaires were mailed to a nationally representative sample of mothers to determine the use of various milks for feeding infants during the first 6 months of life. Data from these surveys demonstrated the resurgence of breast-feeding both in incidence and duration, and this increase has occurred across all levels of income and education. Statistical analysis indicated that the trends were significant (P < .01) for all demographic categories surveyed. In 1981, as in 1980, a bimonthly telephone survey of mothers of infants 8, 10, and 12 months of age determined milk use during later infancy. A combination of data from the mail and telephone surveys for 1981 provided information on milk feeding patterns and demographic characteristics for the first 12 months of life. Maternal employment was shown to reduce the incidence and duration of breast-feeding.
Cyclacillin Versus Amoxicillin as Treatment for Acute Otitis Media
Authors: McLinn Samuel E. , Serlin Steven
Published: December 2021

A double-blind study of 240 pediatric outpatients with acute otitis media demonstrated that cyclacillin administered three times a day for ten days, is as effective as and better tolerated than a similar regimen of amoxicillin. Clinical success was achieved in 96% of the children treated with each drug, and the bacteriologic cure rate was 98% in each treatment group. Only three of the 119 children (2.5%) treated with cyclacillin had drug-related diarrhea, in contrast to 17/121 children (14%) treated with amoxicllin (P <.01). This greater tolerance for cyclacillin may be due to its more effective and rapid absorption in the upper gastrointestinal tract. The results are discussed in terms of the low incidence of resistant strains of Haemophilus influenzae and the advantages of cyclacillin as the first-line treatment for acute otitis media.
Congenital Leukemia: Two Transient Regressions Without Treatment in One Patient
Authors: CHU JEN-YIH , O'CONNOR DENNIS M. , GALE GORDON B. , SILBERSTEIN MICHAEL J.
Published: December 2021

Congenital leukemia is a rare disorder that presents many interesting clinical features.1-4 The clinical course is generally believed to be that of rapid deterioration.2-4 We present a case report of a patient with congenital leukemia and a normal karyotype who had two spontaneous regressions of the disease. The patient later responded to treatment with the acute lymphocytic leukemia regimen and is currently in remission at the age of 48 months despite CNS relapse at the age of 22 months.

CASE REPORT

A white female infant was born to a healthy 32-year old gravida 2 para 2 in December 1978. Pregnancy and delivery were unremarkable.
Treatment of Choking
Authors: EIGEN HOWARD
Published: December 2021

To the Editor.—

The controversy over which method provides the best relief of central airway obstruction has been marked by the publishing of a myriad of "Special Comments," editorials, and statements, and a dearth of scientific studies. The interesting study by Day and co-workers1 brings a new point of view to this problem by looking at ballistic forces. The question remains as to whether the model of a ball rolling free in a rigid tube is a valid model for soft food lodged in a distensible airway.
Use of Microcomputers in the Division of General Pediatrics
Authors: Schwartz William , Hammer Larry
Published: December 2021

Uses of a microcomputer in a division of general pediatrics are described. Various software systems for word processing (APPLE WRITER and APPLE PIE), data base management (DB MASTER), electronic worksheets (VISICALC), statistics (MICROSTAT), and medical education (CAMPS, PILOT) are described and evaluated. The important first step in developing a program for microcomputers is to determine the department's needs and then match these requirements with appropriate commercial programs. Programming a system is complex, time consuming, and beyond the skills of most physicians. It is better to have equipment that can be expanded than to purchase equipment with greater than necessary capacity (and cost).