bluuebunny/crossref_metadata_2025 huggingface dataset:
A Shadchin in Academe
Authors: PLESS I. B.
Published: December 2021

The Yiddish word shadchin is best translated as marriage broker. In the old days, in the small communities or shtetls where many Eastern European families lived, such an individual emerged, probably self-appointed, to help arrange marriages. One assumes that both parties were eager to get married, but either were unaware of the other's intentions or simply required the help of a third party to sort out some of the obstacles that lay in the path of eternal bliss.

Academia today bears some semblance to the shtetl of the past. The communities of the Ivory Tower consist, more or less, of like-minded individuals with similar backgrounds, goals, and aspirations.
Use of Bacterial Antigen Detection in the Diagnosis of Pediatric Lower Respiratory Tract Infections
Authors: Ramsey Bonnie W. , Marcuse Edgar K. , Foy Hjordis M. , Cooney Marion K. , Allan Inez , Brewer David , Smith Arnold L.
Published: December 2021

Two immunochemical methods were used to identify Haemophilus influenzae and Streptococcus pneumoniae capsular antigens in the urine and serum of 162 children with acute lower respiratory tract infection. These methods were compared with standard bacterial blood culture. Viral and mycoplasma cultures of respiratory secretions were obtained simultaneously to determine the frequency of antigenuria at the time of nonbacterial acute lower respiratory tract infection. Urine from groups of well children and children with acute otitis media was tested for capsular antigens to determine the incidence of antigenuria. Antigenuria was found in 24% of children 2 months to 18 years of age with acute lower respiratory tract infection compared with a 2% incidence of bacteremia. Antigenuria was found in 4% of asymptomatic children and 16% of children with acute otitis media. One third of children with symptoms of acute lower respiratory tract infection and viral isolates from the oropharynx had bacterial antigenuria. The sixfold increase in frequency of bacterial antigenuria in children at the time of lower respiratory symptoms suggests that bacterial acute lower respiratory tract infection may be more common than identified by traditional culture techniques. Because bacterial antigen may come from other sites such as the middle ear, further studies are needed to determine the role of antigen detection in the diagnosis of pediatric acute lower respiratory tract infection.
Seat Restraint Contamination and Cleaning
Authors: Paulson Jerome A.
Published: December 2021

This study was undertaken to demonstrate that seat restraints are unlikely vehicles for the transmission of pathogenic bacteria from infant to infant in seat restraint loaner programs. Simple surface cleaning with antibacterial solutions is sufficient to prepare seats for reloaning.
Prepubertal Growth and Skeletal Maturation in Children With Sickle Cell Disease
Authors: Stevens Michael C. G. , Maude Gillian H. , Cupidore Lena , Jackson Helen , Hayes Richard J. , Serjeant Graham R.
Published: December 2021

In a longitudinal study of 298 children with homozygous sickle cell (SS) disease and 157 children with hemoglobin SC disease, between birth and 9 years of age, observations of weight and height were made. These were compared with similar data derived from an age- and sex-matched group of 231 children with a normal hemoglobin (AA) genotype. Growth in children with SC disease was not significantly different from that in normal children, but children with SS disease had statistically significant, and progressive, deficits in both weight and height before 2 years of age. The average deficit approached 1 SD below the normal mean for age by 9 years. Observations of skeletal maturity, based on radiologic assessment of bone age at the wrist, were made on a proportion of these children at 5 and 8 years of age. Children with SS disease were significantly retarded at 8 years but not 5 years, which is consistent with increasing deficit in height. These observations confirm the early impact of SS disease on physical development and provide standards from which clinical expectations of growth may be derived. The relevance of these findings and their relationship to the characteristic delay in pubertal development is discussed together with a review of possible etiologic factors. The benign nature of SC disease is endorsed by the absence of an effect on growth in the prepubertal child.
Secular Changes in Rehospitalization of Very Low Birth Weight Infants
Authors: Mutch Lesley , Newdick Malcolm , Lodwick Alan , Chalmers lain
Published: December 2021

Neonatal survival among very low birth weight infants (<1,500 g) has improved dramatically during the last decade. Concern about the quality of life among these survivors has focused mainly on the prevalence of severe motor, sensorineural, and intellectual impairment. This study examined the possible effects of increasing survival on less serious morbidity as evidenced by hospital readmission patterns. The experience of VLBW survivors in a geographically defined population has been compared with that of a randomly selected group of heavier infants. As VLBW infant survival rates improved from 35% to 48% between 1968 to 1972 and 1974 to 1978, the rehospitalization rate before 2 years of age increased from 22% to 27%. In contrast, among heavier infants, rehospitalization rates decreased from 9.8% to 8.9%. The relative risk of readmission associated with VLBW thus increased from 2.2 to 3.0. Although this increase in the overall relative risk of rehospitalization in VLBW infants was not statistically significant, there was a dramatic and statistically significant increase in the relative risk of being readmitted because of structural defects (particularly hernias). Overall, there was a marked decline in the number of days spent in the hospital in both birth weight groups.
Junctional Epidermolysis Bullosa of the Larynx
Authors: KENNA MARGARET A. , STOOL SYLVAN E. , MALLORY SUSAN B.
Published: December 2021

Epidermolysis bullosa is a rare genetically determined, dermatologic disease in which minor trauma causes blister formation.1 A new variant of hereditary epidermolysis bullosa, generalized atrophic benign epidermolysis bullosa, junctional form, has been recently reported.2 Airway involvement has not been a notable feature of this disease. We report the first case of an infant having benign junctional epidermolysis bullosa with laryngeal involvement.

CASE REPORT

An 11-month-old white boy with known junctional epidermolysis bullosa and mild stridor since birth was referred by his dermatologist for increasing stridor of 24 hours duration. He was initially thought to have croup; however, conservative treatment with mist and racemic epinephrine did not improve his symptoms.
Steroid Abuse by Adolescents
Authors: KWASMAN ALAN
Published: December 2021

To the Editor.—

I would like to call attention to my suspicion that there is significant steroid abuse among adolescents and offer a short case report. I have been surprised at the number of adolescent boys who come in for physical examinations and ask about steroids. None of these patients have asked for steroids, but they openly state that they can get them from "friends." All of them appear concerned about the side effects.

I would like to present the salient features of one case of steroid abuse.
Fungal Colonization in the Very Low Birth Weight Infant
Authors: Baley Jill E. , Kliegman Robert M. , Boxerbaum Bernard , Fanaroft Avroy A.
Published: December 2021

In the neonate, fungal infections result in significant morbidity and mortality. For very low birth weight (<1,500 g) infants, we prospectively determined the fungal colonization rate to be 26.7%. In one third of infants with fungal colonies, mucocutaneous candidiasis developed, and in 7.7%, systemic disease developed. Two thirds of the infants had colonies in the first week of life. This colonization was probably acquired during labor and delivery, because those infants who had colonization were more often delivered vaginally than by cesarian section. Early colonization, commonly from the gastrointestinal or respiratory tract, featured Candida albicans and Candida tropicalis. Late colonization, occurring after 2 weeks of life (15.0% of patients), was more likely to be cutaneous and was associated with either Candida parapsilosis or such poor growth that the organism could not be identifled. Infants with colonization only rarely had budding yeasts (6.1%), whereas more than half of the infants with either a urinalysis showing budding yeasts or a urine culture growing fungi had invasive disease. Fungal contamination was not found on either thoracotomy tubes or catheter tips. In the low birth weight infant, fungal colonization represents a significant risk factor for cutaneous or systemic candidiasis in these infants.
Cerebrospinal Fluid Endorphins and the Infant Apnea Syndrome
Authors: Orlowski James P.
Published: December 2021

Cerebrospinal fluid (CSF) β-endorphin levels were determined in 16 patients with infant apnea syndrome and 34 control patients. A statistically significant difference (P ≤ .0001) was found with the infant apnea syndrome patients having β-endorphin levels of 14.7 ± 1.2 pmol/L (mean ± SE) and the controls having levels of 6.9 ± 0.6 pmol/L (mean ± SE). To test whether these elevated CSF β-endorphin levels were the result or the possible cause of the apneas, three patients with infant apnea syndrome and abnormal CSF β-endorphin levels participated in a study to determine whether a continuous low-dose infusion (10 ug/kg/h) of the narcotic antagonist naloxone would reduce the occurrence of apneas and respiratory pauses during all-night polysomnogram recordings. A fourth patient with documented apneas but normal CSF β-endorphin levels was also studied while on a regimen of naloxone. In the patients with infant apnea syndrome and abnormal CSF (β-endorphin levels, a significant (P ≤ .05) reduction in apneas and respiratory pauses occurred during naloxone infusion. There was no change in the occurrence of apneas or respiratory pauses during naloxone infusion in the patient with normal CSF endorphin levels. Abnormal CSF levels of endorphins may play a role in apneas of infancy and may be amenable to therapy with narcotic antagonists.
Blood Lead Levels and Dietary Calcium Intake in 1- to 11-Year-Old Children: The Second National Health and Nutrition Examination Survey, 1976 to 1980
Authors: Mahaffey Kathyrn R. , Gartside Peter S. , Glueck Charles J.
Published: December 2021

Whether, and to what degree, dietary calcium is inversely associated with blood lead levels was examined in 2,926 black and white children, 1 to 11 years of age, from the Second National Health and Nutrition Examination Survey (NHANES II). Blood lead levels were significantly higher in black than in white children, whereas white children had significantly higher dietary calcium intake (P < .0001). Using covariance analysis and multiple regression analysis, determinants of blood lead levels were assessed as follows. The dependent variable was log10 lead, with independent variables age, sex, race, height, Quetelet index, dietary intake of calcium, phosphorous, fat, carbohydrate, and calories, community size index, poverty index ratio, geographic region, urbanization index, and all two-way interactions of the preceding. In the multiple regression analysis, the following independent variables were significant, P < .05. Race (black) and sex (male) were positively associated with blood lead level (P < .0001 for both). The lower the family income and the more urban the family residence, the higher were the blood lead levels (P < .0001, < .008, respectively). A significant independent inverse association of blood lead levels with year of examination was noted, reflecting a downward secular trend in blood lead levels. Height was inversely associated with blood lead level (P < .0001). Dietary calcium intake was also inversely associated with blood lead level (P = .028). Dietary intake of phosphorous, fat, carbohydrate, and total calories were not significantly associated with blood lead levels. The most direct strategy for prevention of childhood lead poisoning involves primary prevention to reduce exposure. However, increasing calcium intake mihgt have value in secondary prevention of relative and absolute lead intoxication. We speculate that the NHANES II findings may be useful in identifying an avenue for secondary prevention of the effects of lead exposure by highlighting improved public health measures aimed at increasing intake of calcium and dairy products (when well tolerated), particularly in low-income black and white urban dwellers.
Variation on Tick Removal
Authors: KAMMHOLZ LARRY P.
Published: December 2021

To the Editor.—

Recently, Needham described a method of tick removal involving grasping the head of the tick with a blunt curved forceps or tweezers and applying steady traction (Pediatrics 1985;75:997-1002). In a letter (Pediatrics 1986;77:261), Cochran mentioned pulling the tick out vigorously, skin and all, to the accompaniment of an "eech" sound.

Some of us might prefer not to elicit such sounds from our smaller subjects. During the past few years, I have removed ticks relatively easily in the following way. The point of a suture needle (FS-2 cutting) is positioned in the face of the tick just above the attachment to the skin.
Variation on Tick Removal
Authors: WUNG JEN-TIEN , JAMES L. STANLEY , KILCHEVSKY EITAN , JAMES EDWARD
Published: December 2021

In Reply.—

We would like to respond to Dr Levin's letter which questions the appropriateness of publishing our article on the management of infants with severe respiratory failure and persistence of the fetal circulation (PFC), without hyperventilation (Pediatrics 1985;76:488-494). Dr Levin may take exception to the opinions expressed as to how we manage severe respiratory failure, but he cannot take exception to the results.

Induction of profound hypercarbia using both a high ventilator rate and a high inspiratory pressure for the treatment of PFC has resulted in a survival rate of less than 60%, an incidence of air leak in excess of 50%, and the development of bronchopulmonary dysplasia in 25% of the patients.
Use of Otoscope for Cranial Transillumination of the Infant Skull
Authors: KARNIK DILIP J. , KARNIK SHUBA D.
Published: December 2021

To the Editor.—

Transillumination of the head is a simple and useful technique for evaluating intracranial content in very young children. For detecting suspected hydrocephalus, subdural effusions, and large intracranial cysts, this procedure remains inexpensive and very easy to perform.1 High intensity transilluminators have been used for this procedure; however, they are not readily available at the bedside in the office. Therefore, in such situations an otoscope can be used for such a purpose.

A Welch Allen wall model was used for this purpose with good success.
Swallowing Syncope in a Child
Authors: WOODY ROBERT C. , KIEL ERNEST A.
Published: December 2021

Sudden loss of consciousness in children may be caused by either cardiac or neurologic dysfunction. Generalized seizure activity, breath-holding spells, and vasovagal syncope precipitated by a variety of factors frequently occur.1,2 The following case illustrates an unusual cause of repeated loss of consciousness in a child.

CASE REPORT

A 4-year-old white girl was in excellent health until 18 months of age when she first appeared to faint. During following 3 months, she was asymptomatic but then began having similar fainting episodes several times a day. For the next 2 years, the mother sought medical attention from pediatricians, cardiologists, neurologists, and otolaryngologists and began keeping detailed daily records of all spells.
Transcutaneous Carbon Dioxide Tension in Newborn Infants: Reliability and Safety of Continuous 24-Hour Measurement at 42°C
Authors: Bucher Hans U. , Fanconi Sergio , Fallenstein Falk , Duc Gabriel
Published: December 2021

In 58 newborn infants a new iridium oxide sensor was evaluated for transcutaneous carbon dioxide (tcPco2) monitoring at 42°C with a prolonged fixation time of 24 hours. The correlation of tcPco2 (y; mm Hg) v Paco2 (x; mm Hg) for 586 paired values was: y = 4.6 + 1.45x; r = .89; syx = 6.1 mm Hg. The correlation was not influenced by the duration of fixation. The transcutaneous sensor detected hypocapnia (Paco2 < 35 mm Hg) in 74% and hypercapnia (Pco2 > 45 mm Hg) in 74% of all cases. After 24 hours, calibration shifts were less than 4 mm Hg in 90% of the measuring periods. In 86% of the infants, no skin changes were observed; in 12% of infants, there were transitional skin erythemas and in 2% a blister which disappeared without scarring. In newborn infants with normal BPs, continuous tcPco2 monitoring at 42°C can be extended for as many as 24 hours without loss of reliability or increased risk for skin burns.
Reduced Incidence of Hyaline Membrane Disease in Extremely Premature Infants Following Delay of Delivery in Mother With Preterm Labor: Use of Ritodrine and Betamethasone
Authors: Kwong Melinda S. , Egan Edmund A.
Published: December 2021

Data from two groups of infants (24 to 28 weeks' gestational age) excluded from a controlled trial of the use of calf lung surfactant extract for the prevention of hyaline membrane disease are reported. The two groups were excluded from the trial because the mothers had received betamethasone for greater than 24 hours prior to delivery or because, on admission to the hospital, labor was too far advanced for proper informed consent to enter the trial. Attempts were made to delay delivery of threatened premature labor by the use of ritodrine in all mothers without evidence of infection, heavy vaginal bleeding, or severe preeclampsia and to induce surfactant production by maternal injection of betamethasone. A prospective scoring system and respiratory support variables were used to compare the groups. Infants born to mothers who successfully completed this regimen had a 28% incidence of hyaline membrane disease v a 68% incidence in infants in whose mothers it was unsuccessful due to inability to stop advanced labor (P = .001). Inspired oxygen, mean airway pressure, and ventilator rate were lower and the ventilator efficiency index was higher in the treated group during the first 48 hours of life. An aggressive approach to postpone premature delivery and to induce surfactant production by using tocolysis and a regimen of glucocorticoids reduces the incidence of hyaline membrane disease in very premature infants, 24 to 28 weeks' gestation.
Lactational Capacity of Marginally Nourished Mothers: Relationships Between Maternal Nutritional Status and Quantity and Proximate Composition of Milk
Authors: Brown Kenneth H. , Akhtar Naheed Ahmed , Robertson Alastair D. , Ahmed M. Giashuddin
Published: December 2021

Longitudinal studies of the nutritional status of 60 lactating Bangladeshi mothers from an underprivileged, periurban community and of the quantity and composition of their milk were completed to determine the relationships between maternal nutritional status and lactational capacity. Daily milk production was estimated by 24-hour test-weighing; the nitrogen, fat, lactose, and total energy concentrations of extracted milk samples were analyzed at various stages of lactation to estimate total milk nutrient production. Although the mothers were poorly nourished compared with international reference populations, their lactational capacity was not severely impaired. Average milk production peaked at 750 g/d when the infants were between 5 and 7 months of age. Nitrogen and fat concentrations declined with (log) infant age; lactose concentration increased with (log) infant age (P < .001). Average concentrations of milk nutrients when the infants were 3 months of age were: nitrogen, 0.161 g/dL; fat, 2.804 g/dL; lactose, 7.92 g/dL; energy, 61.0 kcal/dL. Fat and energy concentrations were significantly greater, and fat and energy amounts tended to be greater, for mothers with larger triceps skinfold thickness or arm circumference. Changes in nutritional status within individual women were also significantly related to the amount and composition of their milk: within-woman increases in triceps skinfold thickness were associated with increases in fat and energy concentrations (P < .01) and within-woman increases in body weight were associated with increases in the amounts of milk and all major nutrients (P < .01). Milk production declined significantly during certain months of the year, just before the major harvest period. The findings suggest that, despite their remarkably good lactational capacity, the mothers' milk production was limited to some extent by their nutritional status and may, therefore, be further increased with nutritional improvment.
Polymicrobial Bacterial Sepsis and Defective Neutrophil Chemotaxis in an Infant With Cystic Fibrosis
Authors: Kurland Geoffrey , Mark John D. , Halsted Crystie C. , Miller Michael E.
Published: December 2021

A 4½-month-old, white girl was admitted to the hospital with respiratory distress and persistent polymicrobial bacteremia. Cystic fibrosis associated with malnutrition and a transient defect in peripheral neutrophil chemotaxis was diagnosed. This remarkable combination of presenting features in a patient with cystic fibrosis is the focus of this case report.
Familial Partial Peripheral and Pituitary Resistance to Thyroid Hormone: A Frequently Missed Diagnosis?
Authors: Hopwood Nancy J. , Sauder Sue Ellyn , Shapiro Brahm , Sisson James C.
Published: December 2021

The diagnosis of partial peripheral and pituitary resistance to thyroid hormone was ultimately made in two boys, 7 and 9 years of age, and a 10-year-old girl who had goiters and hyperthyroxinemia. The boys were treated with propythiouracil and/or thyroidectomy or iodine 131 for suspected thyrotoxicosis but had poorly suppressible serum thyroid-stimulating hormone (TSH) post treatment in spite of the usual L-thyroxine replacement. The girl had increasing goiter size while receiving propylthiouracil, 100 mg every eight hours. These findings led to reevaluation of thyroid hormone dynamics in these children and their families. Twelve additional family members, 3 to 38 years of age, compatible with an autosomal dominant inheritance, were also found to have peripheral and pituitary resistance to thyroid hormone. All affected individuals had elevated serum thyroxine and triiodothyronine levels, normal to slightly elevated triiodothyronine resin uptakes, and a nonsuppressed serum TSH. The five individuals who were given thyrotropin-releasing hormone showed exaggerated TSH responses, which normalized on L-thyroxine therapy. Misdiagnosis in six of 15 family members led to significant morbidity (hypothyroidism, delayed growth, and therapy risk). A nonsuppressed serum TSH in a patient with suspected thyrotoxicosis should lead to suspicion of this disorder. Appropriate management for this condition includes L-thyroxine therapy to decrease goiter size and normalize TSH responses to thyrotropin-releasing hormone.
Idiopathic Hypoparathyroidism: A Case Study on the Interactions Between Exogenous, Parathyroid Hormone Infusion and 1,25-Dihydroxyvitamin D
Authors: SANTOS FERNANDO , CHAN JAMES C. M.
Published: December 2021

Idiopathic hypoparathyroidism is a rare entity which is clinically characterized by episodes of hypocalcemia and hyperphosphatemia with deficient endogenous parathyroid hormone secretion.1,2 Exogenous parathyroid hormone administration elicits the appropriate renal phosphaturic response,3,4 and no associated endocrinopathies have been reported.1,2 Treatment with 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) is currently recommended.1,2,5

Responses to exogenous parathyroid hormone infusion consist not only of an increase in urine phosphate excretion but, more definitively, an increase in nephrogenous cyclic adenosine monophosphate (cAMP) production.6 Studies of these parameters in pediatric patients have been reported,3 but little is known about the influence of parathyroid hormone administration on the urine calcium excretion of hypoparathyroidism in children and how the renal response to parathyroid hormone may be modified by the 1,25-(OH)2D3 therapy.
Infant Mortality and the American Academy of Pediatrics
Authors: SMITH MARTIN H.
Published: December 2021

In recent years, there has been a surge of renewed interest on the part of numerous groups in the subject of infant mortality, a source of continued concern to pediatricians for many years. The constancy of concern of the American Academy of Pediatrics about infant mortality is evident in the fact that Pediatrics has published a summary of national statistics on the subject annually since 1950. That yearly analysis by Dr Myron Wegman appears in this issue.1

In addition, a statement of the Academy's current position on infant mortality also appears in this issue.2 As this position paper makes clear, there are several reasons for a renewed concern about infant mortality.
Nuclear Accident at Chernobyl: Implications for Pediatricians
Authors: BALK SOPHIE J. , NEUSPIEL DANIEL R. , BERGER DAVID K.
Published: December 2021

To the Editor.—

The accident at the Chernobyl nuclear reactor on April 26, 1986, was the worst nuclear accident of this sort to date. This accident and its implications raise great concern among many individuals and groups. As pediatrcians, we are anxious to place the issue of nuclear energy on the agendas of all health care professionals, especially those who care for children.

As of late spring, 26 people had died and 187 of 299 previously reported were still hospitalized with radiation sickness (The New York Times, June 6, 1986, p A11).
Alcohol, Drugs, and Head Injury
Authors: JACOBSON MARC S. , RUBENSTEIN ELAINE M. , HEALD FELIX P.
Published: December 2021

In Reply.—

Dr Schwarz has brought out an interesting point in the etiology of adolescent closed head injury, but our study showed a predictable pattern of difficulties after injury regardless of prior substance abuse. In fact, the blood alcohol level was elevated in half of a sample of closed head-injured adolescents admitted to our unit; other substances of abuse were not systematically studied, but our experience suggests that they are also frequently involved. We routinely prescribe abstinence from alcohol and other drugs in our posttraumatic care.
Interventions in Preschools to Increase the Use of Safety Restraints by Preschool Children
Authors: Bowman Jennifer A. , Sanson-Fisher Robert W. , Webb Gloria R.
Published: December 2021

Despite the proven safety value of wearing vehicle safety restraints, people continue to travel without this protection. Legislation requiring the use of safety restraints has been implemented in several countries, including Australia, in an attempt to improve rates of restraint use. In Australia, legislation dramatically increased rates of adult restraint use, yet the rate of restraint use by children remains comparatively low. One of the main reasons for parents not restraining their child is the child's dislike of wearing a restraint, with resultant disruptive behavior. This study compared two interventions implemented within preschools: a coercive intervention aimed at parents and an educational intervention aimed at preschool children. Measures of restraint use were made by direct observation at preschools prior to intervention and again immediately following the 2-week interventions. The safety restraint use of children in the control and coercive intervention groups did not change significantly as a result of intervention. Restraint use of children in the educational intervention group increased 15 percentage points from 60.6% to 75.0%: a significant increase of 25%. This novel intervention approach holds promise as a means of increasing preschool children's use of safety restraints.
Transfusion-Associated Acquired Immunodeficiency Syndrome—What Is the Risk?
Authors: FISHER MARGARET C.
Published: December 2021

Relatively few pediatricians will ever care for a child with the acquired immunodeficiency syndrome (AIDS); yet, all will be asked questions about this disease. Parents want to know the risk of their children acquiring AIDS. The fear and even panic surrounding AIDS continues to escalate. To educate our patients and control panic, we must understand the disease and the routes of transmission.

It is now clear that AIDS is one end of the spectrum of illness caused by the human immunodeficiency virus (HIV, formerly called HTLV-III/LAV). The virus is present in blood and body fluids. It is transmitted from person to person by sexual contact and by exchange of blood.
High-Frequency Ventilation and Tracheal Injuries
Authors: MAMMEL MARK C. , OPHOVEN JAN , GORDON MARGARET J. , BOROS STEPHEN J. , LEWALLEN PATRICK
Published: December 2021

In Reply.—

Dr Wiswell and colleagues raise a number of questions about our recent report of tracheal injury following high-frequency ventilation.1 We appreciate their concerns but disagree with their conclusions.

We think the title of the paper is a good one. It is true that an individual perusing only the title of this report might assume that we studied all types of high-frequency ventilation currently available and conclude that all produce tracheal damage. Would a longer, more detailed title have been better? We think not for a number of reasons.
Aspiration of Makeshift Pacifier
Authors: MILLUNCHICK E. W.
Published: December 2021

In Reply.—

The limitation of pacifiers to one piece is indeed not necessary. Any suitable, safe pacifier is preferable to a makeshift pacifier.
Lack of Statistical Power
Authors: PASCOE JOHN M.
Published: December 2021

To the Editor.—

Dr Donowitz described an interesting research project in which the efficacy of overgown use in the prevention of pediatric intensive care unit nosocomial infection was examined.1 He concludes that "overgowns were an expensive and ineffective method of preventing or decreasing nosocomial infections."1 Although Dr Donowitz may be correct, his inattention to sample size and statistical power in this negative trial makes his argument less than compelling.

Given the nosocomial "base rate" of about 10% without gowns, the detection of an infection rate difference of 50% between the nongown and gown subgroups (α = .05, β = .2) would require a sample size of about 500 in each subgroup.2
IN DEFENSE OF TECH SPEAK
Authors: Student
Published: December 2021

Tech Speak is jargon, but it's more than just jargon. Rather than separating people, as ordinary jargon does, it unifies them.... Tech Speak replaces the jargon of Indo-European herdsmen with a rigorous and logical language.... The expressions correspond as closely as possible to the workings of things they signify: barbers are keratin management professionals, a cemetery is a biolysis center, an egg is an avian embryo nutrient cartridge, a happy face is the oral curve of the hedonic affect icon.
Propylene Glycol: Increased Incidence of Seizures in Low Birth Weight Infants
Authors: MACDONALD MHAIRI G. , GETSON PAMELA R. , GLASGOW ALLEN M. , MILLER MARILEA K. , BOECKX ROGER L. , JOHNSON EMILY L.
Published: December 2021

Propylene glycol is a solvent commonly used in drug preparation. Although generally considered nontoxic, there are reports of toxic effects in animals and humans. Noted toxic effects have included seizures, sudden collapse, cardiac arrythmia and asystole, hepatic damage, renal damage, hemolysis, and serum hyperosmolality with a marked osmolar gap. We have previously reported serum hyperosmolality in small premature infants receiving a large dose of propylene glycol during IV nutrition. The major source of propylene glycol for these infants was an IV multivitamin solution, MVI-12 (Armour Pharmaceutical Co). Other drugs used in the newborn nursery were also found to contain significant amounts of propylene glycol (Table 1).
The Circumcision Debate
Authors: HARKAVY KENNETH L.
Published: December 2021

The article by Drs Wiswell and Roscelli (Pediatrics 1986;78:96-99) was an attention grabber, because it suggested a "medical" justification for circumcision. There are, however, several unanswered issues in the paper. Because circumcision was not randomly applied to the male babies, the reader needs to be reassured that the two groups (circumcised and uncircumcised boys) are indeed comparable. Variables that relate to circumcision, such as ethnic preferences, socioeconomic status (or military rank), race, prematurity, or hypospadias, may also relate to the risk of infection.
SOURCE OF ERROR IN TEST FOR STOOL TRYPSIN
Authors: GAFFNEY PAUL C.
Published: December 2021

A source of error in the gelatin film test for stool trypsin is reported. Identical results are obtained with Kodak and DuPont film when incubation at room temperature for two hours is used.

The gelatin on DuPont film incubated at 37° C. for one hour is digested by stools from infants with mucoviscidosis and also by distilled water as well as by stools from healthy infants. Stools from some infants with mucoviscidosis will digest the gelatin on Kodak film when incubated at 37° C. for two hours.

Kodak film should be used if the preparations are to be incubated at 37° C. for one hour, as recommended in the original description of the technic.
POLIOMYELITIS AND COXSACKIE VIRUSES IN PARALYTIC POLIOMYELITIS
Authors: CURNEN EDWARD C. , MELNICK JOSEPH L.
Published: December 2021

Tests for the presence of Coxsackie virus were carried out with specimens of feces and swabbings of the nasopharynx from 20 infants and children suspected of having poliomyelitis who were admitted to a hospital during the summer of 1949 in New York City.

Both Coxsackie virus and poliomyelitis virus were recovered from feces collected during the course of illness from each of two children with paralysis.

The strains of Coxsackie virus which were isolated from both of these patients were found to be serologically related to Dalldorf's Type 1 Coxsackie virus.

The Coxsackie and poliomyelitis viruses which were isolated from one of these patients were found not to be immunologically related to each other.

Tests with specimens of serum from both patients showed that one but not the other developed, during convalescence, an increase in the capacity to neutralize the strains of Coxsackie virus which were isolated from them.
SPECIAL ARTICLE
Authors: WASHBURN ALFRED H.
Published: December 2021

EVER since accepting the kind invitation of your President I have known what I wanted to talk to you about tonight. However, when it came to giving my talk a title—a label which would suggest my main theme—then I was stumped. I want to talk a bit about a number of things—about the Child Research Council, about human growth, about education, about pediatric research, and about the responsibilities of the pediatrician in the half century ahead of us. I might then call the talk a "Pediatric Potpourri." The only difficulty with this title is that Mr. Webster, in his fourth definition of the term, says, "a literary production composed of parts brought together without order or bond of connection." While it may be that some of you will decide by the end of this talk that it has been a veritable potpourri yet I hope to succeed in welding a definite "bond of connection" between the various topics discussed. Perhaps the growth, the development, and the adaptation of the human organism is the cementing substance which should run as a golden thread of continuity from the beginning to the end of my discourse.

I have used the term "human development" rather than "child development" because my talk tonight is as much concerned with the development of mature and thoughtful pediatricians as it is with the sound and happy development of children who may some day become physicians, lawyers, engineers, businessmen or senators. In fact I'm going to start talking about the Child Research Council not merely as a particular sort of research approach to child development but also as an educational experience for the investigators involved in the venture.
ANEURYSMS OF THE SINUSES OF VALSALVA
Authors: FOWLER RICHARD E. L. , BEVIL HAROLD H.
Published: December 2021

A case of aneurysm of a sinus of Valsalva, with rupture, in a four year old female child is presented. This is believed to be the youngest patient with rupture as yet reported.

Studies on the case undertaken in an attempt to verify the diagnosis in vivo included cardiac catheterization, which yielded results compatible with a stream of arterial blood entering the venous circulation at the level of the right ventricle; arterial oxygen analyses; and oxygen uptake determination. From figures obtained by these procedures the extent of the left-to-right shunt was calculated to be about 18% of the systemic blood flow. An attempt was made to correlate the unusually benign clinical course with the results obtained from these procedures.
THE PRESIDENT PAGE
Authors: BEAVEN PAUL W.
Published: December 2021

THE report of the Committee on Medical Education will appear in full in the minutes of the Executive Board. Your earnest attention to this summary is desired. I shall refer to it only briefly here.

I wish to emphasize that here we have a committee with a problem and they have solved it well. The goal they sought was the continuation of the work begun by the Educators' Conferences under the sponsorship of the ICH Committee. Not only have they carried on these conferences, but they have enlarged and improved them.

As I have pointed out before, other committees have done equally well with their assignments, but the significance of the work of the Committee on Medical Education is that it was assigned one of the great projects of the ICH Committee. We have not let that committee down nor have we let ourselves down. The Committee on Medical Education has underscored the great object of our society "to establish and maintain the highest possible standard for pediatric education in medical schools and hospitals, pediatric practice and research."

This committee made two innovations. Prior to last year the United States and Canada were divided into 10 regions, so that there were 6 to 11 medical schools in each region. Last year it was divided into 8 regions and the Canadian schools met with the United States representatives. This year the Canadian medical school representatives met as Canadians and the conference was held in Toronto. This was done because they have problems individual to themselves and it turned out to be a wise move.
PROTEIN AND AMINO ACID REQUIREMENTS OF INFANTS
Authors: ALBANESE ANTHONY A.
Published: December 2021

Evidence has been presented which supports the view that the nutritional inadequacy of unsupplemented breast feeding of infants beyond the third month of life arises primarily from quantitative rather than qualitative limitations of certain amino acids. On the basis of amino acid composition data and the biologic value of a number of proteins tested in infants, it appears that to overcome the defects of this feeding practice which still prevails in larger areas of the world the necessary diet supplements should be derived principally from animal protein sources, milk and meat, rather than cereal proteins. In the lack of animal foods, soybean milk may be employed to advantage.
CLINICAL SURVEY OF VASCULAR COMPLICATIONS IN "JUVENILE DIABETES MELLITUS"
Authors: GRAYZEL HAROLD G. , WARSHALL HYMAN B.
Published: December 2021

In diabetes mellitus we are dealing primarily with a profound carbohydrate disturbance in which a state of hypoinsulinism plus imbalance of the anterior pituitary and adrenal cortical hormones are present. This extensive disturbance affects metabolic functions of many organs and tissues. Because of the interrelationship between carbohydrate, protein and fat and even mineral and water metabolism, there must be varying degrees of change both normal and abnormal, in all of these metabolic processes. The aberrations may be transitory or more prolonged, depending upon the persistence and severity of the metabolic derangement. Since no juvenile diabetic patient, even with the assistance of present-day insulin and prescribed diet, can respond in a completely physiologic manner to his food intake, activity, etc., we must expect metabolic deviations from the normal. It is logical to assume that the closer the approximation of the diabetic patient to a normal physiologic state, the more desirable it is and the less likely is he to suffer qualitatively and quantitatively from the results of his metabolic disorder.

In this small series to date none of the patients whose control was considered good developed detectable vascular lesions even though they had the disease for 10 to 28 years.

This survey adds to the slowly accumulating clinical data indicating decided benefits of a well controlled diabetic state in humans.
ASPHYXIAL ATTACKS IN THE NEWBORN INFANT DUE TO CONGENITAL OCCLUSION OF THE POSTERIOR NARES
Authors: MEDOVY HARRY , BECKMAN I. H.
Published: December 2021

Asphyxial attacks in newborn infants may occasionally be due to congenital occlusion of the posterior nares. The diagnosis may be made by observation of the infant during feeding, by inability to pass a catheter or probe through the nares into the nasopharynx and by roentgenographic studies with lipiodol in the nasal passages.

Treatment is surgical and may be carried out successfully in early infancy if the condition is bilateral, Treatment of the unilateral cases may be deferred to later childhood. Autopsy on a case of sudden asphyxial death in an infant should not be considered complete until the nasal openings are examined.
SEXUAL PRECOCITY IN FEMALES
Authors: PRAY L. G.
Published: December 2021

Two cases of sexual precocity in female children are reported. One child with the McCune-Albright syndrome had her onset of menses at 3 years of age. Surgical removal of an ovary containing luteinized follicular cysts and primordial follicles has resulted in arrest of her sexual precocity over a period of almost four years, giving her a more normal childhood than would otherwise have been possible.

The other child has findings diagnostic of the constitutional type of precocity, by far the most common type. Vaginal bleeding in her case began at 4 years of age. In view of the favorable effect of finding and removing a cystic ovary in the child with McCune-Albright disease, this child was explored surgically. There were early adolescent changes in the uterus, tubes and ovaries, but no other abnormalities were found.
THE TESTIS
Authors: SOBEL EDNA H. , SNIFFEN RONALD C. , TALBOT NATHAN B.
Published: December 2021

The history, physical appearance and laboratory studies performed on eight boys with premature masculinization are presented. The histologic appearance of their testicular tissue is described. Four of the patients had true precocious puberty, which was complete in one and incomplete in three of them. Four had pseudoprecocious puberty, due to adrenal hyperplasia in three of the patients; two of these had associated metabolic disturbances; in the fourth child pseudoprecocity resulted from an adrenal cortical carcinoma.

Comparison of the two groups of patients shows that physically they are similar, although bilateral enlargement of the testes or metabolic disturbances in some instances may indicate the source of the precocity. The children with adrenal virilism excreted large amounts of 17-ketosteroids, possibly arising from abnormal precursors, while the patients with true precocity excreted only small amounts of 17-ketosteroids. The observations further suggest that testicular biopsy may be a simple additional means of distinguishing between true precocity and adrenal precocity. In the former the stimulation seems to be all inclusive with respect to the gonads, leading to the development of large interstitial cells and to tubular maturation and spermatogenic activity of varying degree. In precocity of adrenal origin the interstitial cells do not develop. The appearance of the interstitial cells is apparently the essential feature which differentiates the histology of the testis in these two conditions.
HEPATITIS AND NEPHROSIS DUE TO SOLUBLE BISMUTH
Authors: KARELITZ SAMUEL , FREEDMAN AARON D.
Published: December 2021

An instance of jaundice, abdominal pain and anuria due to administration of sodium bismuth thioglycolate (thiobismol®) with liver and kidney damage is reported.

The great toxicity of the water soluble preparation of this heavy metal in this and other similiar cases is stressed.

Attention is drawn to the use of BAL therapy in the early or first phase, to the need for caution in fluid administration in cases of lower nephron nephrosis caused by bismuth during the anuric and oliguric phases, and to the need for covering the loss of fluid and electrolytes in the subsequent diuretic phase.

The use of soluble bismuth preparations should be limited to specific conditions and only to those cases which fail to respond to less toxic drugs.
INFLUENCE OF DIET ON THE OCCURRENCE OF HYPERPHOSPHATEMIA AND HYPOCALCEMIA IN THE NEWBORN INFANT
Authors: GITTLEMAN ISAAC F. , PINCUS JOSEPH B.
Published: December 2021

Studies on the effect of diets on the serum calcium and phosphorus levels in the newborn infant have been made. Human milk has been found to be the most effective in maintaining a normal calcium and phosphorus level. Evaporated milk has been found to be the least satisfactory because it tends to produce the largest number of instances of hyperphosphatemia and hypocalcemia. The desirability of adding vitamin D to the diets of infants in the neonatal period is questionable. In the infants studied, the hyperphosphatemia and hypocalcemia was more marked than in those who did not receive this supplement.
School Performance and Theophylline
Authors: RACHELEFSKY GARY S.
Published: December 2021

In Reply.—

In regard to your comments:

1. The parents' and teachers' check lists were indeed not the same because they were each evaluating different settings/behaviors.

2. The check lists have been standardized and are published (Melvin Levine, MD). The mood items and hyperactivity items are presented in different forms to allow for more complete evaluation.

3. School performance, as evaluated by the children's individual teachers, was adversely affected as determined by the parameters presented in the table.
School Performance and Theophylline
Authors: RACHELEFSKY GARY S. , WO JULIE , ADELSON JUDIH , MICKEY M. RAY , SPECTOR SHELDON L. , KATZ ROGER M. , SIEGEL SHELDON C. , ROHR ALBERT S.
Published: December 2021

In Reply.—

Dr Twarog and colleagues raise a number of questions about our report of the adverse effects of theophylline. We appreciate their concerns and we hope the following satisfies them.

The study was double blinded and randomized; the investigators, the children, the teachers, and the parents had no way of knowing which child was receiving theophylline or placebo, and there was no prior experience with theophylline titration. A "designated'tant' physician monitored the theophylline levels.
1α-Hydroxyvitamin D3 Treatment of Three Patients With 1,25-Dihydroxyvitamin D-Receptor-Defect Rickets and Alopecia
Authors: Takeda E. , Kuroda Y. , Saijo T. , Naito E. , Kobashi H. , Yokota I. , Miyao M.
Published: December 2021

Three patients with clinically different severities of vitamin D-dependent rickets, type II, with alopecia, which is 1,25-dihydroxyvitamin D-receptor-defect rickets and is particularly resistant to treatment with calciferol analogues, were treated with large doses of lα-hydroxyvitamin D3 (1α-(OH)D3) and 2 g of calcium lactate. Except for the alopecia, all of the abnormalities of patients 1 and 2 were reversed by treatment with 3 µg/kg/d of 1α-(OH)D3, and those of patient 3, who had the severest manifestations, were reversed by treatment with 6 µg/kg/d. The serum 24,25-dihydroxyvitamin D concentrations of the three patients were low before treatment and those of patients 1 and 2 increased during treatment. These findings suggest that in patients 1 and 2, 25-hydroxyvitamin D-24-hydroxylase was stimulated via a 1,25-dihydroxyvitamin D-receptor-mediated system by treatment with 1α-(OH)D3.