bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathology of the Heart in Kawasaki Disease
Authors: Fujiwara Hisayoshi , Hamashima Yoshihiro
Published: December 2021

Pathologic studies were done on 20 hearts of patients who had typical clinical signs and symptoms of Kawasaki disease. The cardiac lesions were classified according to the duration of illness at the time of death. Stage I (zero to nine days) was characterized by acute perivasculitis and vasculitis of the microvessels (arterioles, capillaries, and venules) and small arteries, and acute perivasculitis and endartenitis of the three major coronary arteries (MCAs). Penicarditis, myocarditis, inflammation of the atrioventricular conduction system, and endocarditis with valvulitis were also present. Stage II (12 to 25 days) was characterized by panvasculitis of the MCAs and aneurysm with thrombus in the stems. Myocarditis, coagulation necrosis, lesion of the conduction system, pericarditis, and endocarditis with valvulitis were also present. In stage III (28 to 31 days), granulation of the MCAs and disappearance of inflammation in the microvessels were noted. Patients in stage IV (40 days to 4 years) had scarring with severe stenosis in the MCAs. Fibrosis of the myocardium, coagulation necrosis, lesions of the conduction system, and endocardial fibroelastosis were also present.

The features observed revealed Kawasaki disease to be acute and inflammatory. The angiitis begins in the microvessels and fibrinoid necrosis of the media is rare. The disease is one with a pathologic pattern previously unknown.
Infant Radiant Warmers
Authors:   Committee on Environmental Hazards
Published: December 2021

Radiant warmers are frequently used in delivery rooms and neonatal care units when open access and external heat are simultaneously required.1 The sale of more than 13,000 units by U.S. manufacturers during the past ten years attests to the acceptance of these devices by pediatricians.2 However, some concern about the use of the warmers stems from potential hazards and the lack of information regarding possible effects of the devices. This concern was recently expressed by a panel of consultants to the Bureau of Medical Devices in the Food and Drug Administration (FDA) who recommended that the FDA obtain additional information to assist it in evaluating radiation warmer safety.3 If this recommendation is accepted by the FDA, current procedures require that additional information regarding the effects of radiant warmers on infants must be provided within a period of 30 months.4 Therefore, pediatricians should be aware of the issues involved.

The most serious complication of radiant warmers is extreme hyperthermia, which may occur from improper use or from dislodgement of the sensor probe. Hyperthermia may result in death or permanent neurological damage (T. Peebles, personal communication). Insensible water loss increases markedly when infants are placed in the warm, dry, open environment under radiant warmers, and may increase by 50% to 200% over that observed among infants in incubators, depending on the maturity of the infant and the type of warmer.5 First-degree burns have been attributed to radiant warmer heating of plastic-lined disposable diapers which were placed next to the skin for urine collection.6
A promising answer
Authors: Olmsted Richard W.
Published: December 2021

"A Tale of Two Doctors" is intended to document the weaknesses in the schema for medical education between the developed and the developing world countries. More importantly, the plight of the foreign physician returning home with no provision for his continuing education illustrates the fundamental problem of continuing education for all physicians in all countries. The problem, as stated by Dr. Fisher, is that "the commitment to postgraduate medical education overseas must continue beyond the provision of the core training experience." Modifying the statement by eliminating "overseas" more precisely defines the true dimensions of the problem.

It is no mere cliché to say that the half-life of a physician's knowledge is five or seven or ten years.
Seat Restraints Don't Fit
Authors: Hall Caroline Breese
Published: December 2021

Your articles on automobile safety for children1-6 are most heartening. Few, if any other, areas in pediatrics have such potential to produce a major and immediate improvement in the health of our children. However, such articles have neglected mentioning the older sibling, the school-aged child.

Children weighing 22 kg or more remain vulnerable orphans, not adopted by the presently available restraint systems. Adult lap belts are not adequate for these children with their different bulges, proportions, and pelvises.6
In Reply: Encopresis, Enemas, and Gold Stars
Authors: Levine M. D. , Bakow Harry
Published: December 2021

Dr. Fleisher's letter about our article on children with encopresis is certainly provocative and presents some alternative views about treatment.

We would certainly agree that pediatricians need to understand this symptom in depth in order to treat it adequately. Further knowledge of the physiology of defecation can be quite valuable in this respect. Dr. Fleisher's own review in Pediatric Annals is certainly helpful.

We agree that the distinction between nonretentive and retentive fecal soiling needs to be made.
Penicillin-Resistant Pneumococcal Meningitis
Authors: Iyer Prabhamani V. , Kahler John H. , Jacobs Norman M.
Published: December 2021

The problem of pneumococcal meningitis due to a relatively penicillin-insensitive organism was noted by Paredes et al. (Pediatrics 58:378, September 1976) and by others.1 We have recently had experience with a similar case.

The patient was an 8-month-old black boy with a one-week history of coryza and a one-day history of fever. Initial physical examination revealed a febrile (39.4 C), irritable, lethargic child with otherwise normal results of physical examination. Initial laboratory results showed a hemoglobin level of 10 gm/dl and a WBC count of 13,500/cu mm (56% polymorphonuclear leukocytes; 27% band forms; 15% lymphocytes; 1% monocytes; 1% eosinophils).
A Question on Failure-to-Thrive Study?
Authors: Kramer Michael S.
Published: December 2021

I applaud the good intentions of Drs. Hufton and Oates (Pediatrics 59:73, January 1977) in attempting to study long-term outcomes in children diagnosed as having nonorganic failure to thrive in infancy. Their careful analysis of physical growth, cognitive and emotional function, and familial and socioeconomic status provides a detailed documentation of the chronic nature of the disturbance both in the children and in their families. However, it seems to me that the applicability and general utility of such documentation for other pediatricians, health personnel, and social agencies involved in the care and management of these children and families is severely limited by the methodology and research architecture employed in this study.
Sex and Pediatricians
Authors: Shenker I. Ronald , Nussbaum Michael , Kaplan Eric
Published: December 2021

We read with enthusiasm the communication "Sex Education: Two Basic Questions" (Pediatrics 59:112, January 1977). We can attest to the universality of lack of information and misinformation regarding sexuality among the adolescents we see, most of whom have had basic health education courses in schools, since they are mandated in all districts in our community. We agree that pediatricians should become more actively involved in this area of health and preventive medicine than many have been.
A New Use for Adult Face Masks
Authors: Kopelman Arthur E. , Myers Gary J.
Published: December 2021

We would like to comment on the article by Pape et al. (Pediatrics 58:473, October 1976) in which the strap used to secure the face mask in mask-applied ventilatory support was noted to result in severe head molding with tower skull deformity in premature infants weighing less than 1,500 gm. The authors found an association between use of the face masks and significant intracerebellar hemorrhages, while in an accompanying commentary (p. 621), Shuman and Oliver refuted this association.
Time-Response Analysis of the Effect of Stimulant Medication on the Learning Ability of Children Referred for Hyperactivity
Authors: Swanson James , Kinsbourne Marcel , Roberts Wendy , Zucker Kenneth
Published: December 2021

This report introduces a method for obtaining behavioral time-response information for a short-acting psychotropic drug (methylphenidate [Ritalin]) that is widely used to treat behaviorally hyperactive children. We used a laboratory learning task to document that between one and two hours after the administration of a single dose of methylphenidate, the drug exerts its maximum effect on performance in a learning task in the laboratory. This effect on cognitive performance dissipates within the same day. This rapid and transient effect of methylphenidate makes it possible to classify patients in a single day into those who respond favorably and those who respond adversely to the drug in terms of its effect on cognitive behavior.
The Value of Pulsus Paradoxus in Assessing the Child With Status Asthmaticus
Authors: Galant Stanley P. , Groncy Charles E. , Shaw Kathryn C.
Published: December 2021

The presence of pulsus paradoxus (PP) in 13 episodes of status asthmaticus in 12 children, ages 13 months to 15 years, was compared sequentially to a clinical score, peak expiratory flow rate (PEFR), heart rate, arterialized capillary pH, carbon dioxide pressure (Pco2), and the ratio of inspired oxygen to oxygen pressure (FIo2)/Po2) during the first 48 hours following admission.

There was a significant correlation (P < .01) between the presence of a PP (≥ 5 mm Hg) and the clinical score (r = .79), PEFR (r = .55), and heart rate (r = .49). This was particularly striking when the PP was ≥ 20 mm Hg. There was no significant correlation between the mean PP and the Pco2 or FIo2/Po2, ratio. However, a mean Pco2, exceeding 40 mm Hg was associated with a highly significant (P < .005) difference in mean PP (22.2 mm Hg) compared to the mean PP (12.2 mm Hg) when the Pco2 was below 40 mm Hg. Although the PP technique can easily be learned by physician and nursing personnel, there are potential problems. The difficulties in children are compared to those in adults.

The PP is a valuable clinical tool in assessing the severity of airway obstruction in status asthmaticus. The presence of a PP, particularly greater than 20 mm Hg, is associated with moderate to severe airway obstruction. In conjunction with the overall clinical status of the patient and frequent blood gas determinations, the PP allows for better evaluation of the patient with status asthmaticus.
Idiopathic Atrial Flutter in Infancy: A Review of Eight Cases
Authors: Rowland Thomas W. , Mathew Rajamma , Chameides Leon , Keane John F.
Published: December 2021

The experience of three institutions in the management of atrial flutter in infants under 2 years of age without associated heart disease is reviewed. Five babies with neonatal onset were treated with digoxin and had uncomplicated resolution of their arrhythmia, although one continued to have episodes of paroxysmal supraventricular tachycardia for six years. Two of the three older infants required DC cardioversion for complications after quinidine was substituted for digoxin therapy. Digoxin continues to be the preferred initial therapy for non-acutely ill patients; those showing signs of cardiac decompensation should be converted with DC countershock.
Blood Glucose and Plasma Amino Acid Concentrations in Infants of Diabetic Mothers
Authors: Soltész Gyula , Schultz Károly , Mestyán Julius , Horváth Imre
Published: December 2021

Postnatal blood glucose and individual plasma free amino acid levels were measured in 14 newborn infants of diabetic mothers. All infants had a significantly lower blood glucose concentration than normal controls but no significant correlation was observed between the blood glucose values and any of the amino acids determined. As regards the quantitative and qualitative changes of the plasma aminogram, the total concentration of amino acids and the level of a few individual amino acids (glycine, alanine, taurine, and valine) were significantly elevated in full-term babies. However, no significant difference was found in the total plasma concentration of amino acids between premature infants of diabetic mothers and premature control infants, but the plasma alanine level was higher in the former. It is of interest that total plasma amino acid, alanine, and glycine levels were elevated in the asphyxiated babies.

This suggests that the postnatal hyperaminoacidemia observed in infants of diabetic mothers was due to birth asphyxia rather than to impaired gluconeogenesis. The possible role of a defective gluconeogenesis in the etiology of postnatal hypoglycemia in infants of diabetic mothers is not supported by these data.
Nephrogenic Diabetes Insipidus Due to Demethylchlortetracycline Hydrochloride in a Child
Authors: London Arnold L. , Siegel Norman J. , Zelson Joseph H. , Hayslett John P.
Published: December 2021

Nephrogenic diabetes insipidus occurred in a 7-year-old child who had received a high dose of demethylchlortetracycline hydrochloride (DMC). The patient had a relatively elevated urinary sodium concentration in addition to isosthenuria. The nephrogenic diabetes insipidus was completely reversible within one month after cessation of DMC administration.
Epidemic Neonatal Hyperbilirubinemia and Use of a Phenolic Disinfectant Detergent
Authors: Wysowski Diane K. , Flynt J. William , Goldfield Martin , Altman Ronald , Davis A Todd
Published: December 2021

Between March 28 and April 12, 1972, nine neonates in a New Jersey hospital received exchange transfusions for idiopathic hyperbilirubinemia. Five infants who had peak bilirubin concentrations from 23.9 to 42 mg/100 ml were treated within a 36-hour period. Affected infants had no other illnesses, and they and their mothers did not differ significantly from unaffected infants and their mothers regarding factors which could explain the epidemic. The increase in exchange transfusions began in January, which coincided with the time that the nursing staff increased the concentrations of a phenolic disinfectant detergent used for cleaning bassinets and mattresses. Preceding the cluster of cases in April they had vigorously cleaned the nursery with the disinfectant detergent. After use of the phenolic compound was discontinued, the epidemic of hyperbilirubinemia ceased.

These findings are similar to those of a subsequent outbreak in 1975 in a Wyoming hospital in which idiopathic hyperbilirubinemia developed in ten (18.5%) of 54 newborn infants; two received exchange transfusions. The same phenolic compound was used in excessive concentrations to clean incubators and bassinets. In addition, nursery ventilation was inadequate. When use of the cleaning compound was discontinued and the ventilation defects were corrected, the epidemic of hyperbilirubinemia ceased. These two episodes suggest a causal association between use of excessive concentrations of this phenolic disinfectant detergent and neonatal hyperbilirubinemia.
Amniotic Fluid Infections With Intact Membranes Leading to Perinatal Death: A Prospective Study
Authors: Naeye Richard L. , Peters Ellen C.
Published: December 2021

The pathogenesis of fatal amniotic fluid infections was analyzed in a large prospective study that included more than 1,000 medical, demographic, hereditary, and postmortem variables. The disorder was the most frequent cause of death in the study, with an overall perinatal mortality of 6.17 per 1,000 births. The mortality progressively declined after mid-gestation when antimicrobial activity normally appears in the amniotic fluid. A second peak of the fatal infections, after 37 weeks' gestation, was found mainly in the poor and undernourished. Maternal gestational weight gains were suboptimal and the involved neonates had a pattern of growth retardation characteristic of undernutrition. Maternal pregnancy weight gains were positively correlated with the number of prenatal clinic visits. Mother's race, socioeconomic status, age, short stature, and number of prior unsuccessful pregnancies lost their positive association with the fatal infections when mothers made more than nine clinic visits.
ME AND MY IV
Authors: Kohn Joshua
Published: December 2021

Through the IV medicine squirms,

If you don't change it, it will fill with germs.

And into your body the germs will flow,

Sometimes fast and sometimes slow.

Occasionally the IV will open.

Out pours the fluid and I'm hopin'

That I won't start whinin' and mopin'

Over the irrigation of my IV.

So I gotta start coping with the IV that broke open.
Hyperactive Children: A Ten-Year Study
Authors: Miller James S.
Published: December 2021

My experiences in practice during the past ten years lead me to believe that "hyperactivity" is primarily an emotional problem. Currently, however, the diagnosis is often made-and drugs administered-on the basis of fragmentary information about the child's behavior and with little attempt to explore the child's inner state or the family relationships.

These statements are based on observations made while following up 290 children whose diagnosis was hyperactivity. I was the family pediatrician in these cases and, as such, was eventually admitted to the interior of the families. Additionally, I gathered school records for the children and medical records for most of the adult family members. This broad data base, combined with my long personal relationship with the families, is the basis for the conclusions I present here. I submit that the data base is both more intensive and extensive than that which an academic institution or clinic can usually achieve; that is why a relatively apparent aspect of hyperactivity has been, until now, neglected.

THE SAMPLE

The period covered is from July 1965 through June 1975. My practice at that time was in Hayward, a suburb of the east San Francisco Bay. Omitting consultations, I followed up 1,016 families with 2,427 children for a mean of 61 months (SD, 29 months). I have matched my practice demographically to both the U.S. census and several regional surveys and have found the practice to be within 5% on occupational, marital, racial, and economic criteria. The diagnosis of hyperactivity for the 290 patients whose cases I will discuss had been made by either school personnel, parents, another physician, or, in some cases, all three.
Staphylococcus aureus Sepsis in Children With Cancer
Authors: Ladisch Stephan , Pizzo Philip A.
Published: December 2021

Seventy episodes of Staphylococcus aureus sepsis occurring over a nine-year period in pediatric cancer patients are reviewed. Prominent findings at the time of diagnosis included fever, granulocytopenia, and active malignancy. Probable or suspected sites of primary infection were present in 40 episodes (57%). Serious direct complications of staphylococcal sepsis included only three cases of pneumonia and one of myositis. However, second infections by other organisms developed in 16 episodes (24%), resulting in nine nonstaphylococcal infectious deaths during therapy. Endocarditis and osteomyelitis never occurred in this group of patients. The median duration of antistaphylococcal therapy was 15 days.
Newborn Screening for Maple Syrup Urine Disease (Branched-Chain Ketoaciduria)
Authors: Naylor Edwin W. , Guthrie Robert
Published: December 2021

Routine newborn screening for maple syrup urine disease (MSUD) has been conducted since 1964, and more than 9½ million newborns throughout the world have been tested with use of a bacterial inhibition assay (BIA) for leucine on dried filter paper blood specimens. Forty-three confirmed cases of the "classical" and the "intermediate" variant forms have been detected. The frequency of MSUD, based on these data, is approximately one in 224,000 newborns. The sensitivity and the specificity of the leucine BIA are demonstrated. There are several problems in routine screening for MSUD, including the fact that the "intermittent" variant form will be missed. A brief summary of the clinical course of the 13 cases detected by our collaborative laboratories is presented.
A Case of Generalized Wegener's Granulomatosis in Childhood: Successful Therapy With Cyclophosphamide
Authors: Baliga Radhakrishna , Chang Chung-Ho , Bidani Anil K. , Perrin Eugene V. D. , Fleischmann Larry E.
Published: December 2021

An 11-year-old white boy had Wegener's granulomatosis, a rare condition in the pediatric age group. The clinical course, pathological findings, and mode of treatment are outlined. The disease is in remission on a regimen of cyclophosphamide therapy as judged by both clinical and pathological criteria. This syndrome with protean manifestations should be considered in children with symptoms of repeated upper respiratory tract infections along with pulmonary and renal involvement. Early renal biopsy helps to establish the diagnosis of generalized involvement and to guide the course of treatment. Follow-up renal biopsies may serve as an indication for the continuation of treatment. Cytotoxic agents, especially cyclophosphamide, dramatically alter the course of the disease.
Acute Respiratory Distress in a Child After Steroid-Induced Pancreatitis
Authors: Goldberg Barry H. , Bergstein Jerry M.
Published: December 2021

Acute pancreatitis is a well-known but rare complication of corticosteroid therapy in both children1-3 and adu1ts.4,5 In adults, respiratory insufficiency may follow the onset of acute pancreatitis.6-8 This report describes a child with systemic lupus erythematosus (SLE) in whom acute respiratory distress developed after steroid-induced pancreatitis.

CASE REPORT

A 12-year-old girl with SLE in remission (maintenance therapy, 60 mg of prednisone on alternate days) was admitted to the University of California Los Angeles Hospital with a one-week history of fever, dysuria, facial rash, and joint pain. A urinary tract infection was detected and the patient was placed on a regimen of antibiotics.
Cholestyramine and Intestinal Obstruction
Authors: Poley J. R.
Published: December 2021

The report by J. D. Lloyd-Still (Pediatrics 59:626, April 1977) on two infants with intrahepatic cholestasis who developed symptoms of intestinal obstruction after having been fed cholestyramine is of significant interest. It serves as a reminder that, generally speaking, a physician should have an idea about potential side effects of drugs given to patients. However, prior to casting the "evil eye" on a potentially helpful drug, one should perhaps examine the reasons why this resin may have been the cause of problems.
Prolonged Prostaglandin E1 Infusion in an Infant With Cyanotic Congenital Heart Disease
Authors: Lewis Alan B. , Lurie Paul R.
Published: December 2021

A small-for-gestational-age premature infant with severe tetralogy of Fallot was treated with prostaglandin E1 to dialate the ductus arteriosus and increase pulmonary blood flow. The infusion was continued for 29 days without complication at which time surgery was performed.
Studies With Live Varicella Vaccine and Inactivated Skin Test Antigen: Protective Effect of the Vaccine and Clinical Application of the Skin Test
Authors: Baba Koichi , Yabuuchi Hyakuji , Okuni Hidekazu , Takahashi Michiaki
Published: December 2021

In December 1975, a patient with varicella was admitted to a ward for children less than 2 years of age. Among 76 children without a history of varicella, 33 children more than 1 year of age were immediately vaccinated with a small viral dose of 80 plaque-forming units per person. Forty-three children less than 1 year of age were left unvaccinated. Among the vaccinated children, only eight exhibited mild varicella, while typical varicella developed in all 43 unvaccinated children during the next ten weeks.

In July 1976, another patient with varicella was admitted to a ward with 49 children 3 to 5 years old. The children were immediately given the skin reaction test with mactivated varicella antigen. Seventeen of the 20 children with negative reactions were vaccinated, while the index patient and two children with fever were not vaccinated. Only one of the 17 vaccinated children showed mild varicella symptoms within two weeks after vaccination, while typical varicella developed in two unvaccinated children during the four weeks after appearance of the index case. Varicella developed in none of the 29 children who had positive skin tests. In the sequential skin test of seven vaccinated children, a positive skin reaction was observed as early as five days after vaccination, which preceded the appearance of neutralization antibody by seven to nine days.
EQUITY IN HEALTH SERVICES
Authors: Anderson O. W.
Published: December 2021

It is demonstrated that the increase in the use of physician and hospital services between 1963 and 1970 ... had no impact on health indicators as measured by disability days. It is often argued from results like these that a comprehensive national health insurance scheme would be a misallocation of resources in the public sector, if the objective is to improve health levels. Rather, it is argued, it would be a wiser policy to allocate fewer resources to a comprehensive curing system and more to programs designed to inculcate healthful life styles.

Life styles do not lend themselves easily to manipulated change, at least in the short haul. Public opinion will dictate that the health services delivery system will have to cope with the deleterious effects of prevailing life styles somehow. I do not believe there will ever be a puritanic majority who are so healthy and ascetic that they can legislate against a minority who are hedonistic and unhealthy.... Differentiating between life style saints and sinners is then not a tenable public policy. National health insurance will be designed therefore to serve both the prudent and the profligate, a policy I would regard as equitable.
Flow-Volume Relationship at Low Lung Volumes in Healthy Term Newborn Infants
Authors: Adler Saul M. , Wohl Mary Ellen B.
Published: December 2021

To describe the maximum expiratory flow-volume relationship in newborn infants, we simulated forced expiration by transiently applying positive pressure in a chamber surrounding the infant's body. Maximum expiratory flows were reached at any given lung volume when increases in chamber pressure failed to produce increases in flow. Maximum expiratory flows were achieved in seven of nine healthy newborn infants at lung volumes equal to functional residual capacity (FRC) and in all infants at lung volumes below FRC. The volume expired below FRC (6.4 ml/kg) was roughly equivalent to previously calculated values of expiratory reserve volume in newborn infants (7 ml/kg). The maximum expiratory flow volume curves showed that the infants were able to increase expiratory flow rates well above those achieved during tidal breathing. The convex shape of the curves at low lung volumes is compatible with flow limitation occurring in peripheral airways.
Prolonged Apnea
Authors:   Task Force on Prolonged Apnea
Published: December 2021

Prolonged apneic spells in infants may lead to morbidity and occasional mortality. Prolonged apnea is defined as cessation of breathing for 20 seconds or longer, or as a briefer episode associated with bradycardia, cyanosis, or pallor. Present etiological considerations in prolonged apnea include seizure disorders, severe infections, significant anemia (especially in infants who were preterm), gastroesophageal reflux, hypoglycemia and other metabolic disorders, and impaired regulation of breathing. It further seems likely that some victims of the sudden infant death syndrome (SIDS) have succumbed to unrelieved prolonged apnea.

Beyond specific treatment of any underlying disorder, 24-hour surveillance is critical to the management of prolonged apnea. Settings for intensive observation and care may include the appropriately staffed and equipped acute care hospital, and the infant's home. In addition, a long-term care facility or foster home may be considered.

Skilled care-givers are crucial to continuous observation and management of an infant in any setting. Care-givers should be trained in infant cardiopulmonary resuscitation and provided with continuing medical, technical, and psychosocial support. In the home setting, relief personnel should be available. Electronic or other monitors of the heart or respiratory rate may be useful adjuncts to 24-hour surveillance, but should be used only under medical supervision. There is presently no consensus concerning the relative advantages and disadvantages of cardiac and respiratory monitors-both present problems. Moreover, a successful outcome for every baby with prolonged apnea cannot be guaranteed, despite continuous surveillance (with or without monitors) and appropriate intervention.

Pediatricians must keep in mind that there is a significant psychological impact on all the members of the family of an infant with prolonged apneic spells, whether or not monitors are included in the management plan.
How Long Should a Foreign Body Stay in the Stomach?
Authors: Euler Arthur R.
Published: December 2021

Mandell et al. reported their experience with two children who swallowed foreign bodies (Pediatrics 60:460, October 1977). Both patients retained these objects in their stomachs for prolonged periods and had gastric surgery performed to remove the foreign bodies. I agree with the authors' recommendations that these children be followed up closely without any intervention for a four-week period. At that time I believe esophagogastroscopy should be performed to attempt to retrieve the object. With the foreign body forceps now available, most foreign bodies can be removed.
Revision of the Infant Temperament Questionnaire
Authors: Carey William B. , McDevitt Sean C.
Published: December 2021

The Infant Temperament Questionnaire, originally published in 1970, has been revised to improve its psychometric characteristics. The number of items was increased from 70 to 95, rating options were increased from three to six, more items have high-low reversals, and they are randomized as to content area. The new form was standardized on 203 4- to 8-month-old infants. Good test-retest reliability was maintained and internal consistency of the nine categories was raised to a higher level, thereby assuring a greater reliability of the instrument. These improvements should enhance the questionnaire's use in clinical and research applications.
Eustachian Tube Function and Allergy in Otitis Media
Authors: Bluestone Charles D.
Published: December 2021

Otitis media with effusion (OME) is one of the most common diseases of childhood. Acute OME is usually of the suppurative type, although it may be serous, while chronic OME has many synonyms, including "serous otitis media," "mucoid otitis," "nonsuppurative otitis media," "glue ear," and "allergic otitis media." The following discussion is a review of some of the factors that influence the etiology and pathogenesis of OME in general, and more specifically the role of Eustachian tube (ET) function and allergy in the disease process of OME.

The pathogenesis of OME appears to be related to abnormal function of the ET. Investigation into the exact nature of this dysfunction requires an understanding of the system constituted by the palate, nasal cavity, nasopharynx, ET, middle ear, and mastoid air cells. Within this system the ET has at least three physiologic functions with respect to the middle ear: protection from nasopharyngeal sound pressure and secretions, clearance into the nasopharynx of secretions produced within the middle ear, and ventilation of the middle ear to equilibrate air pressure in the middle ear with atmospheric pressure and to replenish oxygen which has been absorbed (Fig. 1).

ROENTGENOGRAPHIC STUDIES

The protective and clearance functions of the ET have been assessed by a radiographic technique.1,2 Radiopaque material was instilled through the nose of patients in order to observe the retrograde flow of the medium from the nasopharynx into the ET. Patients were considered to have normal protective function when radiopaque material entered only the nasopharyngeal or isthmic portion of the tube but did not enter the bony portion of the tube or middle ear cavity.
Advanced Techniques for Measuring Middle Ear Function
Authors: Northern Jerry L.
Published: December 2021

The use of acoustic impedance measurement as a means of evaluating the physiological function of the middle ear system is gaining wide interest by pediatricians.1-3 The impedance technique is extremely sensitive to differentiating between normal and pathological middle ears.

Children with middle ear effusions are typically identified by physicians through an otoscopic examination, or by audiologists when the child fails the traditional hearing screening test at school. Most physicians use otoscopy to visually examine the tympanic membrane, but with varying degrees of success.4 Otologists teach that pneumatic otoscopy is an absolute necessity to identify the presence of middle ear disease, yet only 25% of physicians use the pneumatic otoscope.5 In a recent study of the accuracy of otoscopic diagnoses, 15% to 20% of ears in children under 3 years of age with effusions were missed clinically. This high miss rate was noted in a group of examiners from a medical center who were aware that their diagnostic skill was being evaluated and thus should have been motivated to perform their most careful otoscopy.6 Accurate otoscopy and pneumotoscopy require skilled and experienced individuals. Our experience in training health professionals shows considerable variability in interpretation of otoscopic observations. Other problems in otoscopy include difficulty in visualizing the tympanic membrane, the removal of cerumen prior to examination, and the unwillingness of some children to cooperate with the examination.

TYMPANOMETRY

Tympanometry resolves many of the disadvantages of conventional audiology and otologic assessment. It requires only passive cooperation from children since no overt response is required.
Surgical Management of Eustachian Tube Dysfunction and Its Importance in Middle Ear Effusion
Authors: Donaldson James A.
Published: December 2021

One of otology's most significant advances in this century has been the reintroduction by Armstrong1 of the concept and the technique for restoration of middle ear ventilation. Previous attempts by such legendary otologists as Toynbee2 and Politzer3 had been ineffective and short-lived. The consequences of ineffective ventilation of the tympanum have plagued otologists for many years. In many instances, adequate ventilation of the tympanum can be accomplished by appropriate medical management. In others it is necessary to ventilate the tympanum by maintaining a tympanic membrane perforation with a ventilating tube.

Problem

Otologists are confronted daily with patients whose ears are not functioning optimally because of poor middle ear ventilation and/or middle ear fluid. The middle ear fluid may persist as the residual from a middle ear infection which has not yet been completely treated. (Complete treatment would necessarily require restoration of hearing and eradication of fluid.) It has been estimated that 10% of patients with acute suppurative otitis media treated with appropriate antibiotics and oral or topical nasal vasoconstrictors, with or without initial myringotomy, have residual middle ear fluid.4 Recent data suggest that children with persistent otoscopic, tympanometric, and audiologic changes have restricted development of some auditory processing skills as well as distortion of integrational patterns.5 This was found even when the hearing loss for speech frequencies averaged only 30 dB.

In addition to persistent middle ear fluid, otologists are concerned about middle ear vacuum associated with hearing loss or with middle ear atelectasis. The atelectasis is an especially disturbing problem because it is part of a continuum which may progress from asymptomatic middle ear vacuum through varying degrees of reversible atelectasis to irreversible atelectasis or adhesive otitis media (Figure).
Dysgerminoma Presenting as a Calcified Abdominal Mass With Hypercalcemia
Authors: Nelken Robert P. , Nieburg Phillip I. , Bergstrom William H. , Richman Robert A.
Published: December 2021

Ovarian neoplasms account for less than 2% of all pediatric malignant tumors. About one third of these tumors are pure dysgerminomas, which rarely present with abdominal calcification or hypercalcemia. This communication reports the unusual occurrence of both a calcified dysgerminoma and hypercalcemia in a 101/2-year-old girl.

CASE REPORT

A 101/2-year-old white girl was hospitalized for evaluation of anorexia of six months' duration, an 11-kg weight loss, polyuria, and polydipsia. On admission, she appeared weak and cachectic. Blood pressure was 110/80 mm Hg; pulse rate, 120 beats per minute; respirations, 28/mm; temperatare, 38.2 C; height, 130 cm; and weight, 25 kg. A left-lower-quadrant abdominal mass extended across the midline.
A LESSON ABOUT DRUNKARDS IN THE 1879 EDITION OF MCGUFFEY'S FIFTH ECLECTIC READER
Authors: C. T. E.
Published: December 2021

Many have hailed the McGuffey Eclectic Readers as major influences not only in American education but in American morals and culture as well. It is estimated that 122,000,000 copies were sold between 1836 and 1920.

A recurrent lesson in these Readers is the evils of drink. In the 1879 edition of the Fifth Reader, McGuffey chose this piece by John Greenleaf Whittier (1807-1892) to show the young reader the wretched effects of alcohol.

. . . One fine morning, not long ago, I strolled down the Merrimac, on the Tewksbury shore. . . . The path winds, green and flower-skirted, among beeches and oaks, through whose boughs you catch glimpses of waters sparkling and dashing below.

. . . Half fatigued with my walk, I threw myself down upon a rocky slope of the bank, where the panorama of earth, sky, and water lay clear and distinct about me. . . . Over all a warm but softened sunshine melted down from a slumberous autumnal sky.

My revery was disagreeably broken. A low, grunting sound, half bestial, half human attracted my attention. I was not alone. Close beside me, half hidden by a tuft of bushes, lay a human being, stretched out at full length, with his face literally rooted into the gravel. A little boy, five or six years of age, clean and healthful, with his fair brown locks and blue eyes, stood on the bank above, gazing down upon him with an expression of childhood's simple and unaffected pity.
Committee on School Health Health Education
Authors: Cook Donald E. , Andringa Conrad L. , Hess Karl W. , Kishner Leonard L. , Leavitt Samuel R. , Novak Stanley F. , Rogers Kenneth D. , Stackpole J. Ward , Wiggins Casper
Published: December 2021

The American Academy of Pediatrics believes that it is necessary to reaffirm its support for the concept of school health education, from kindergarten through grade 12, for all schoolchildren in the United States.

A basic concept of pediatrics is prevention, and health education is a basic element in the delivery of comprehensive health care. The public is continually bombarded by the media about the high cost of medical care and the overutilization and incorrect use of medical facilities. The media also writes about the problems of increasing promiscuity and illegitimacy; the money wasted on quackery; practices that are detrimental to the health of people in the United States; and the lag in the dissemination of new health information and facts to the public. The Committee on School Health believes that community health education programs, of which school health education programs from kindergarten through grade 12 are an integral part, are one of the most viable methods to help alleviate these and similar problems. Therefore, the Committee on School Health makes the following recommendations and urges action for them at state and local levels.

1. Health education is a basic education subject, and it should be taught as such. Health education is compatible with other traditional subjects and can enhance the contribution that other basic subjects make to general life experience, understanding, and skills.

2. Planned, integrated programs of comprehensive health education should be required for students from kindergarten through grade 12. Instruction should be given by teachers qualified to teach health education.
TOWARD CIVILIZED BEHAVIOR
Authors: Thomas Keith
Published: December 2021

. . .Changes in table manners are not mere curiosities. On the contrary, they reflect fundamental shifts in human relationships. The men who ceased to eat from the same dish and drink from the same cup were separated by a new wall of restraint and embarrassment at the bodily functions of others. This new sense of shame was visible in many areas. Originally people spat on the floor; then they were encouraged to put their foot over the spittle; later they used a spittoon; finally even that symbol of delicacy disappeared and they ceased to spit in polite society altogether. In the same way they progressed from blowing their noses on their sleeves to using their left hand, to using only two fingers, to adopting a handkerchief (Erasmus left only two forks, but he owned thirty-nine handkerchiefs). Instead of sleeping naked, several to a bed, they put on nightclothes and converted bedrooms into private, intimate areas. Nudity became shameful and an unmade bed was an embarrassing spectacle. Similar inhibitions grew up around the bodily functions. In the sixteenth century it was considered dangerous to hold one's wind; by the eighteenth century it was a major solecism to release it in company. Defecating and urinating became private activities, screened from public gaze. Language became more delicate. Prudery surrounded wedding ceremonies, prostitution, and the discussion of sexual matters. The aggressive impulses were inhibited. To express pleasure in violence, whether in mutilating one's opponents in battle or in burning cats alive (an animal ceremony in sixteenth century Paris) came to be regarded as "sick" or "infantile."
Diagnostic Dilemmas of Wilson's Disease: Diagnosis and Treatment
Authors: Werlin Steven L. , Grand Richard J. , Perman Jay A. , Watkins John B.
Published: December 2021

Wilson's disease, an autosomal recessive disorder of copper metabolism, may defy diagnosis in children The classical triad of Kayser-Fleischer rings, neurologic dysfunction, and hypoceruloplasminemia may be absent. Patients may be seen initially with acute or chronic hepatitis, hemolytic anemia, or neurologic dysfunction. Guidelines are presented for diagnosis of Wilson's disease based on a review of 25 pediatric and adolescent patients. A high index of suspicion is necessary so that therapy with penicillamine may be begun before irreversible liver or neurologic damage occurs. The prognosis is excellent when diagnosis and treatment are established early.
REPORT ON OBESITY AVAILABLE
Authors: H. R. J.
Published: December 2021

A workshop on Fetal and Infant Nutrition and Susceptibility to Obesity was held recently in Washington. A copy of the summary is available by writing to the Food and Nutrition Board, National Academy of Sciences, 2101 Constitution Avenue, Washington, DC 20418.
Clinical Usefulness of Polymorphonuclear Leukocyte Vacuolization in Predicting Septicemia in Febrile Children
Authors: Adams Richard C. , Dixon John H. , Eichner Edward R.
Published: December 2021

Vacuolization of the polymorphonuclear leukocyte (PMN) has generally been regarded as an indication of bacterial infection and has been particularly useful in diagnosing septicemia. In an effort to predict septicemia, peripheral blood smears from 69 febrile children were examined and systematically scored for severity of vacuolization. Thirteen children had remarkable vacuolization compared to the others. These 13 included only five children with bacterial illnesses and only one of the seven children with septicemia. Our finding that PMN vacuolization was neither diagnostic of septicemia nor predictive of bacterial infection suggests that the specificity of the link between vacuoles and bacteremia needs to be reassessed.
Heart Rate and Respiratory Rate Differences Between Preterm and Full-Term Infants During Quiet Sleep: Possible Implications for Sudden Infant Death Syndrome
Authors: Katona Peter G. , Egbert John R.
Published: December 2021

The heart rate and respiratory rate of eight preterm (average gestational age, 33.3 ± 2.2 weeks) and 13 full-term infants were determined during quiet sleep at home during the first year of life. Both heart rate and respiratory rate were greater in preterm infants throughout the first six months. The difference was maximum at age 10 weeks (21.1 beats per minute and 13.7 breaths per minute), with the difference being statistically significant, at least at the P < .01 level at ages 10, 12, and 14 weeks, while P ≥.01 at all other ages. The 10-to 14-week period is precisely the same period during which the incidence of sudden infant death syndrome (SIDS) has been reported to be maximum. These results support the concept that SIDS is linked to a vulnerable phase of cardiorespiratory maturation.
Evaluation of a Patterning Treatment for Retarded Children
Authors: Sparrow Sara , Zigler Edward
Published: December 2021

Three groups, each with 15 seriously retarded institutionalized children, were employed to evaluate a modification of the sensorimotor patterning treatment developed at the Institutes for the Achievement of Human Potential (IAHP). The treatment group received a program modeled after the IAHP methods for approximately two hours per day, five days per week, for one year. For the same length of time, a matched motivational control group participated in activities with foster grandparents designed to create positive, success-oriented interactions to improve self-esteem and feelings of efficacy. A no treatment group continued to receive the standard care of the institution, which was enlightened and resident-oriented. A wide variety of behavioral measures were employed, including the IAHP Developmental Profile, IQ, motor and language devlopment scales, and measures of affective, social, and maladaptive behaviors. On the majority of the measures there were no differences in posttest performance among any of the three groups. In no case did the pattern of change of the treatment group differ from that of its crucial comparison, the motivation group. However, all three groups showed some improvement in performance between the beginning and end of the study. It was concluded that the patterning treatment investigated in this study cannot be recommended for seriously retarded children.
Observations on Immediate Reactions of Families to Sudden Infant Death
Authors: Smialek Zoë
Published: December 2021

Many health professionals do not adequately support newly bereaved parents and may in fact ignore and abandon them at the time of bereavement. A possible reason for this lack of involvement may be the discomfort experienced by these individuals during such encounters and a misunderstanding of the normal grief reactions. From a two-year experience observing 351 families in whom an infant has died suddenly and unexpectedly, I have noted the most common immediate grief reactions. These reactions are discussed to increase the professional's awareness of the particular needs of these individuals.

These immediate reactions include shock, disbelief, and denial; negativism, hostility, and anger; self-reproach and guilt; demonstration of former unresolved grief; verbalization of previous fears of loss; and sometimes, even, relief. Families are entitled to assistance during this distressing time from a warm, caring professional who is able to allow free expression of grief however it is manifested and answer accurately the disturbing questions about the death of their infant.