bluuebunny/crossref_metadata_2025 huggingface dataset:
Erratic Absorption of a Slow-Release Theophylline Sprinkle Product
Authors: Pedersen Søren , Møller-Petersen Jens
Published: December 2021

The bioavailability and absorption pattern of theophylline from a slow-release theophylline sprinkle preparation were investigated in 12 asthmatic children both in fasting conditions and after a standardized meal. Theophylline given intravenously was used as a reference. Theophylline from the slow-release theophylline product was well absorbed under fasting conditions, but both absorption pattern and bioavailability were severely affected by concomitant food intake: a delay in absorption was found and the bioavailability was reduced from 91% (fasting) to 44% (P < .001). The erratic absorption of theophylline after food intake complicates safe therapy with the preparation and calls attention to the fact that it is not sufficient to investigate the absorption characteristics of slow-release theophylline preparations under fasting conditions only.
The Pediatrician's Guide to Computer Videodiscs
Authors: Blackman James A. , Huntley Joan Sustik
Published: December 2021

Computer-videodisc technology is currently redefining the uses and possibilities of media-assisted education. A specific videodisc program developed for use in pediatric education is described; the present state of videodisc technology is explained; possible future medical applications of this technology are suggested.
Intellectual Malnutrition: American Schools and the Pediatrician's Duty
Authors: STICKLER GUNNAR B.
Published: December 2021

"U.S. 6th-graders do poorly on math, science tests." That was the sober, accurate headline given by the Minneapolis Star and Tribune to an Associated Press story on Dec 12, 1983. The judgment "poorly" was based on comparison with students in seven other countries.

Prominent American scientists and academicians—Glenn Seaborg, Stephen Willoughby, Joseph Stoltman, and Gilbert White—developed the tests on mathematics, science, and geography. They were given to sixth-grade students in Australia, Canada, England, France, Japan, Sweden, Switzerland, and the United States in schools selected to represent the average in their countries.

In geography, the Swedes were first with 54.1 and Americans were fourth with 45.8.
Coronavirus?
Authors: YUNIS EDUARDO J. , AGOSTINI ROCCO M.
Published: December 2021

To the Editor.—

Rousset et al1 described particles within cytoplasmic vesicles in cells of intestinal mucosa and particles associated with the microvilli of these cells as coronavirus-like particles. Their conclusion is based on the morphology of the particles in section, and the fact that these particles were found in the intestinal mucosa of several patients with necrotizing enterocolitis who were shown by negative stain techniques to have coronavirus particles in their stools. Other authors2,3 have also proposed a viral nature for both types of particles.
Vitamin E Toxicity
Authors: HITTNER HELEN M.
Published: December 2021

In Reply.—

Sokol incorrectly asserts that we have extended our observations regarding pharmacologic vitamin E therapy. In all of our clinical studies, which include 418 high-risk preterm infants,1-3 the infants have consistently maintained mean plasma vitamin E levels below 3.5 mg/100 mL, which are within the adult physiologic range.

Sokol is concerned that our table 3 (reference 3, page 243) includes the clinical data (excluding Apgar scores) for only the 135 infants who survived ≥10 weeks. Data (including Apgar scores) for all 168 infants are presented in Table 1.
Trends in Breast-Feeding
Authors: Hendershot Gerry E.
Published: December 2021

Starting from very high levels in the 1940s, breast-feeding declined steadily to low levels in the early 1970s, and then began an upward trend which has apparently continued until the present (Fig. 1). In the 1940s, breast-feeding was more common among disadvantaged women. The subsequent decline was also more rapid among the disadvantaged, however, so that by the early 1970s, disadvantaged women were considerably less likely than others to breast-feed. Because the increase since the early 1970s has not been so pronounced among the disadvantaged, they continue to have relatively low levels of breast-feeding. The causes of these trends and differentials are not well understood.

These are the principal conclusions drawn from a review of statistical studies of trends and differentials in breast-feeding in the United States. The studies included national health surveys conducted by the federal government, market research surveys conducted by infant formula manufacturers, and infant feeding surveys conducted by medical researchers. The studies differed markedly in their methods—a fact that affects their validity, reliability, and comparability. The first section of this paper discusses these data sources and their limitations. The next two sections discuss the downward trend in breast-feeding from the 1940s to the early 1970s, and the upward trend since. Each of these sections examines demographic differences in these trends. A short section that addresses possible causes of the trends and differentials follows those two sections.

SOURCES AND LIMITATIONS OF THE DATA

The principal sources of data on trends and differentials in breast-feeding are national fertility surveys, market research surveys, and special purpose infant-feeding surveys.
Efficacy of Metolazone and Furosemide in Children with Furosemide-Resistant Edema
Authors: Arnold Watson C.
Published: December 2021

The effect of a combination of metolazone (0.2 to 0.4 mg/kg/d) and furosemide (2 to 4 mg/kg/d) in achieving a natriuresis and diuresis was measured in 14 children during 22 episodes of edema resistant to furosemide alone. Urinary volume increased from 24 ± 14 mL/kg/d for patients receiving furosemide to 51 mL/kg/d with combined diuretic therapy (P < .01), and sodium excretion increased from 34 ± 5 mEq/d to 155 ± 176 mEq/d (P < .01). Two children with severe hypoalbuminemia (serum albumin level <1.5 g/dL) and normal renal function, and five children with chronic renal insufficiency (71%) did not respond to combined diuretic therapy. The combination of furosemide and metolazone offers a useful and effective oral therapy in most children with edema resistant to furosemide. Children with chronic renal insufficiency and furosemide-resistant edema did not respond to combination diuretic therapy.
Effect of Sucrose on Hyperkinetic Children
Authors: Gross Mortimer D.
Published: December 2021

A hyperkinetic boy and his mother were found, by blind tests, to be hypersensitive to sucrose, with manifestations of irritability, hyperactivity, and headache. Neither glucose, lactose, or saccharin produced any behavioral changes. To ascertain whether this was common in those with hypersensitivity to sucrose, 50 hyperkinetic children, whose mothers had volunteered that they "knew" or were "sure" that their hyperactivity and general behavior were much worse when they had eaten foods containing sugar (sucrose), were tested in a blind experiment with a challenge dose of a glass of lemonade containing 75 g of sucrose compared with lemonade sweetened with saccharin; this was done three times. No differences could be found in their behavior after ingesting sucrose compared with saccharin. Hypersensitivity to sucrose can lead to adverse behavioral changes, but this hypersensitivity appears to be an uncommon condition. If suspected it can be tested for very simply.
Pathogenesis of Prune-Belly Syndrome
Authors: BARR MASON , BURDI ALPHONSE R.
Published: December 2021

To the Editor.—

In their recent report, Moerman et al1 argued that the prune-belly syndrome is caused by prostatic hypoplasia which produces a functional urethral obstruction. We would like to direct attention to a case we reported that casts some doubt on this hypothesis.2 Our report concerned an 11-week-old fetus with massive megacystis, ectasia of the nephrons, and attenuation of the abdominal muscle. The "prostatic" portion of the urethra was already largely dilated at a time when the prostatic buds are first appearing and well before these buds coalesce to form a gland.
Pathogenesis of Prune-Belly Syndrome
Authors: MOERMAN PHILIPPE
Published: December 2021

We thank Barr and Burdi for their comment on our paper.1 Since the reports of Pagon et al2 and Monie and Monie,3 it seems an established fact that the features of the prune-belly syndrome are caused by a urethral obstruction. However, an anatomic urethral obstruction is not found in most cases of prune-belly syndrome. In these patients, prostatic hypoplasia and cystic dilation of the prostatic urethra are constantly present. The most pertinent question is now indeed, whether the prostatic hypoplasia is the cause or the effect of the urethral dilation.
Thyroid Hormone Poisoning: Therapy Questioned
Authors: LEHRNER LAWRENCE M. , WIER MICHAEL
Published: December 2021

The letter from Kirkland et al points very clearly to the problem we addressed in our paper, and we appreciate the opportunity to restate it.

Prior to our report, the literature pertaining to thyroid ingestion can best be characterized as describing aggressive therapy, generally with a good outcome. Thus, the heroic treatment of our first case. However, after treating the first patient, we reviewed the mechanisms of thyroid hormone action and concluded that natural protective mechanisms exist and that aggressive therapy is rarely required.
Introduction to an Overview of Pediatric Patient Education
Authors: Fulginiti Vincent A.
Published: December 2021

Today's physicians must deal with a public that is both informed and misinformed on children's health care. Adult school and college courses, magazine articles, film and television documentaries, and a host of books offer parents readily available information on pediatric health care, but some of these sources are inaccurate or biased, or both. Erroneous information is also disseminated by a variety of nonmedical practitioners and special-interest groups. They publicize their theories and methods by using authoritative-sounding statements and impressive, if meaningless, letters after their names.

The profession of pediatrics is faced with the challenge of being the single most important source that parents can turn to for accurate information concerning their children's health. The challenge extends beyond that goal: pediatricians must also be willing to utilize educational methods and materials with which they may currently have little or no familiarity. Some of these techniques and tools will be presented in the following papers.

As a first step in achieving these goals, pediatricians must recognize that patient education is a critical function of their practices. Next, they must become sufficiently motivated to act on this recognition of responsibility for patient education.

Pediatricians must learn what patients need to know, what the best and most practical methods are to deliver that information, and what types of materials are available or need to be developed to assist in the educational process. Practices should be structured so as to enable sustained patient education while allowing for future innovations in either methods or materials.

The goal of this conference is to strengthen individual patient education efforts and to convince pediatricians and the American Academy of Pediatrics that an organized, chapter-centered program should be established.
Coughs and Colds
Authors: Walson Philip D.
Published: December 2021

Coughs and colds are seldom associated with serious diseases or complications, but they frequently cause patient discomfort, prompting many telephone calls and visits to hospitals and physicians' offices. Parents often harbor misconceptions regarding the etiology, diagnosis, and management of these conditions, leading to inappropriate treatment and home "remedies." The pitfalls associated with treating coughs and colds can be minimized when the physician takes time to educate patients and parents. Education should be anticipatory, reassuring, and unrushed. Adequate communication requires practice and thought. Good techniques include asking open-ended, nonthreaternng questions and avoiding the use of jargon. Parents must be asked about their understanding of and fears concerning coughs and colds. Education must include repetition, with feedback and rewards by someone who believes in the vlaue of education and transfers this belief to patients and parents. Effective patient education in the treatment of coughs and colds may be achieved by adopting the above common-sense techniques.
The Wheezing Child
Authors: Rachelefsky Gary S.
Published: December 2021

Asthma self-management is a new concept. Asthma Care Training for Kids (A.C.T.) was developed at the University of California at Los Angeles (UCLA); its concepts have been incorporated into the daily management of the asthmatic child. The child is allowed to be in the driver's seat, to have some control of his or her disease. Using the colors of the traffic signals—red, yellow, and green—pediatricians teach children about their symptoms, aggravators, and medications. The children keep daily diaries, which result in better control of disease, along with increased compliance. Causes of asthma are presented, pediatricians are advised to explain to their patients and the parents the concept of hyperreactive ("twitchy") airways; that is, asthma can be caused or aggravated by many things, including allergens, infection, and exercise. Proper home management is detailed, including environmental control. The use of antiasthmatic medications is stressed, especially the side effects.
Isolated Uvulitis Due to Haemophilus influenzae Type b
Authors: Li Karl I. , Kiernan Sharon , Wald Ellen R. , Reilly James S.
Published: December 2021

Infections of the uvula are infrequently recognized and have been previously described only in association with group A streptococcal pharyngitis or Haemophilus influenzae type b epiglottitis. Three cases of H influenzae type b bacteremic uvulitis are described. In suspected cases of H influenzae type b uvulitis, a lateral neck radiograph should be performed and parenteral antibiotics initiated.
Munchausen's Syndrome by Proxy (Child Abuse) Presenting as Apparent Autoerythrocyte Sensitization Syndrome: An Unusual Presentation of Polle Syndrome
Authors: Clark Gary D. , Key Janice D. , Rutherford Patricia , Bithoney William G.
Published: December 2021

Munchausen's syndrome was initially described in 1951. It has become increasingly recognized since that time. Recently, Munchausen's syndrome by proxy or Polle syndrome has been described. In this disease entity, a parent causes a factitious disease in a child. The disease may require extensive medical testing and the result may even be death. A wide variety of presentations of Polle syndrome have been reported including cardiac arrest, recurrent sepsis, and factitious bleeding. Autoerythrocyte sensitization, a syndrome of spontaneous purpura, was initially described in 1955. The diagnostic test described is intradermal injection of autologous blood which produces an area of painful purpura. The syndrome is therefore postulated to be due to hypersensitivity in the patient's own RBCs. The majority of patients with autoerythrocyte sensitization have had psychiatric disorders and the symptoms have improved only with psychotherapy. An infant who had a clinical picture of autoerythrocyte sensitization and who was later found to be a victim of Polle syndrome is reported.
Follow-up Studies on Children with Severe Dietary Chloride Deficiency During Infancy
Authors: Hellerstein Stanley , Duggan Eileen , Merveille Octave , Scarth Linda
Published: December 2021

Ten children who had severe dietary chloride deficiency during early infancy have grown normally during their first 4 to 5 years. With the exception of one child who did not get into the sitting position alone until he was 91/2 months of age, the patients reached the usual developmental milestones of the first 2 years during the expected age intervals. Developmental and psychological testing indicates that all of the children have at least average ability. However, three children have shown behavior patterns that may interfere with successful school performance. Serum creatinine and urea nitrogen concentrations appear to be normal as does renal concentrating capacity. During a 4-year follow-up, one child has shown persistent and a second intermittent microscopic hematuria.
Zinc Deficiency: Cause of Hypoproteinemia or Its Result?
Authors: WEIZMAN ZVI
Published: December 2021

To the Editor.—

I read with great interest the paper by Kumar and Anday.1 They suggest that hypoproteinemia in their patients is the direct result of zinc deficiency, which interferes with protein synthesis. However, in their discussion there is no mention of a different interpretation, namely that zinc deficiency might be the result of protein loss rather than a cause of poor synthesis.

Although liver disease and/or urinary protein loss have been ruled out, there are no data regarding a possible protein-losing enteropathy in these infants. Several disorders, such as cow milk intolerance (cases 1 and 3), congestive heart failure (case 2), gastrointestinal infections and infestations, immune deficiency states etc,2 are potential causes for abnormal enteric protein loss in these infants.
Family Life Events, Maternal Depression, and Maternal and Teacher Descriptions of Child Behavior
Authors: Fergusson D. M. , Horwood L. J. , Gretton M. E. , Shannon F. T.
Published: December 2021

The relationship between family life events, maternal depression, and teacher and maternal ratings of child behavior was studied in a birth cohort of New Zealand children. Analysis of variance and multiple regression analysis showed that for maternal ratings of child behavior, both maternal depression and family life events made significant independent contributions. For teacher ratings of child behavior, the only significant predictor was family life events. These results persisted when appropriate controls for family social, economic, and demographic characteristics were taken into account. The theoretical implications of these findings are discussed.
Infant Bioethics Committees
Authors: STRAIN JAMES E.
Published: December 2021

In Reply.—

Donovan raises important questions about the value of the committees. These same questions are being asked by physicians and hospital administrators throughout the country. Despite the uncertainty of the structure and function of the committees, the American Academy of Pediatrics has chosen to publish guidelines to assist hospitals and physicians in establishing local infant bioethics committees. Although the Academy has taken a leadership role in developing the guidelines, it should be emphasized that consultants from several other organizations have been included in discussions of the Academy's task force.
Morphologic Significance of Bifid Uvula
Authors: Shprintzen Robert J. , Schwartz Richard H. , Daniller Avron , Hoch Lynn
Published: December 2021

Bifid uvula is often regarded as a marker for submucous cleft palate although this relationship has not been fully confirmed. The reason for the tacitly assumed connection between these two anomalies has, in part, been perpetuated by the generally accepted definition of submucous cleft palate as the triad of bifid uvula, notching of the hard palate, and muscular diastasis of the soft palate. Recently, investigations have provided evidence of more subtle manifestations of submucous cleft palate by the use of nasopharyngoscopic examination of the palate and pharynx. It has been determined that submucous cleft palate can occur even when a peroral examination shows an intact uvula. This finding places the "marker" relationship in question. In order to determine the frequency of association between bifid uvula and submucous clefting, a total ascertainment of children with bifid uvula from a suburban pediatric practice was examined nasopharyngoscopically. It was determined that in all but two cases, children with bifid uvula had some or all of the landmarks of submucous cleft palate. Several of the children were found to have velopharyngeal insufficiency and mildly hypernasal speech. This finding prompts caution in the recommendation of adenoidectomy in the presence of bifid uvula.
Measles Outbreak in a Pediatric Practice: Airborne Transmission in an Office Setting
Authors: Bloch Alan B. , Orenstein Walter A. , Ewing William M. , Spain William H. , Mallison George F. , Herrmann Kenneth L. , Hinman Alan R.
Published: December 2021

In February 1981, a measles outbreak occurred in a pediatric practice in DeKalb County, GA. The source case, a 12-year-old boy vaccinated against measles at 111/2 months of age, was in the office for one hour on the second day of rash, primarily in a single examining room. On examination, he was noted to be coughing vigorously. Seven secondary cases of measles occurred due to exposure in the office. Four children had transient contact with the source patient as he entered or exited through the waiting room; only one of the four had face-to-face contact within 1 m of the source patient. The three other children who contracted measles were never in the same room with the source patient; one of the three arrived at the office one hour after the source patient had left. The risk of measles for unvaccinated infants (attack rate 80%, 4/5) was 10.8 times the risk for vaccinated children (attack rate 7%, 2/27) (P = .022, Fisher exact test, two-tailed). Airflow studies demonstrated that droplet nuclei generated in the examining room used by the source patient were dispersed throughout the entire office suite. Airborne spread of measles from a vigorously coughing child was the most likely mode of transmission. The outbreak supports the fact that measles virus when it becomes airborne can survive at least one hour. The rarity of reports of similar outbreaks suggests that airborne spread is unusual. Modern office design with tight insulation and a substantial proportion of recirculated ventilation may predispose to airborne transmission.
Evolution of Short-Course Antimicrobial Treatment of Tuberculosis in Children, 1951-1984
Authors: Kendig Edwin L.
Published: December 2021

Although the first unrecognized indication that short-course antimicrobial treatment of tuberculosis might be effective came in reports of tuberculous meningitis and miliary tuberculosis in children so treated by Lorber (1951 to 1956), the 1977 American Lung Association-American Thoracic Society recommendation for antimicrobial therapy of tuberculosis in adults still specified an 18-month course. The first prospective study on the short-course antimicrobial treatment of children in the United States was published in December 1983. The long delay before recognition of the practicability of short-course antimicrobial treatment of tuberculosis has probably been occasioned by ignorance of drug actions and the mechanisms involved.
Know Thyself—Adolescents' Self-Assessment of Compliance Behavior
Authors: Litt Iris F.
Published: December 2021

Noncompliance with contraception is a major cause of adolescent pregnancy. Studies of compliance predictors have produced conflicting results. The possibility that female adolescents' assessment of their own past compliance with other medications may be useful in predicting their future contraceptive compliance is explored. Accordingly, patients beginning an oral contraceptive regimen described their past compliance on a four-point scale, and a subset, in addition described themselves on the basis of a five-point scale ranging from "forgetful" to "well-organized." At 6-month follow-up, 75% of the patients were found to have described themselves accurately in terms of potential compliance behavior. Of patients who proved compliant, 64% had initially rated themselves as "well-organized" whereas none of the noncompliant patients had done so. These findings demonstrate the potential importance of the teenagers' self-assessment in determining those at risk for contraceptive noncompliance. The findings also suggest that compliance behavior among female adolescents may be generalizable across clinical situations, rather than being disease or medication specific.
Colloid Osmotic Pressure of Umbilical Cord Plasma in Healthy and Sick Newborn Infants
Authors: Ekblad Henrik , Kero Pentti , Korvenranta Heikki , Erkkola Risto , Välimäki Ilkka
Published: December 2021

Colloid osmotic pressure of umbilical cord plasma was measured in 242 healthy infants, in 34 infants with respiratory distress syndrome (RDS), in 18 infants with asphyxia, in 13 infants who were small for gestational age, in 15 infants born to mothers with diabetes mellitus, and in 18 infants born to mothers with pregnancy-induced hypertension. In healthy infants, colloid osmotic pressure correlated highly significantly with umbilical cord blood total protein level, gestational age, and birth weight. In infants with RDS, no correlation between colloid osmotic pressure and gestational age or birth weight was found. Infants with RDS and gestational age between 36 and 38 weeks had significantly lower colloid osmotic pressure than healthy infants, whereas colloid osmotic pressure of infants with RDS and gestational age between 32 and 35 weeks did not differ from that of healthy infants of corresponding gestational age. Healthy term infants delivered by cesarean section had significantly lower colloid osmotic pressure than infants delivered vaginally. Infants with asphyxia had significantly higher colloid osmotic pressure than healthy infants. Colloid osmotic pressure is related to the lung maturity of the near-term and term neonate. Infants with a colloid osmotic pressure greater than 16 mm Hg are unlikely to develop RDS.
Epidemiology of Neonatal Hyperbilirubinemia
Authors: Linn Shai , Schoenbaum Stephen C. , Monson Richard R. , Rosner Bernard , Stubblefield Phillip G. , Ryan Kenneth J.
Published: December 2021

Interview and record review data from 12,023 singleton deliveries were analyzed to determine the relationships between neonatal hyperbilirubinemia (10 mg/dL or greater) and maternal characteristics. Confounding variables were controlled by multiple logistic regression analysis. There was a statistically significant positive relationship between hyperbilirubinemia and low birth weight, Oriental race, premature rupture of membranes, breast-feeding, neonatal infection, use of the "pill" at time of conception, instrumental delivery, and history of first trimester bleeding. Maternal smoking and black race were negatively related to hyperbilirubinemia and statistically significant. In this study, other previously suspected etiologic factors such as epidural anesthesia, parity, use of oxytocin in labor, and white race were not associated with hyperbilirubinemia.
Inadvertent Intra-arterial Injection of Penicillin: An Unseen Danger
Authors: STOLLER KENNETH P. , LOSEY ROBERT
Published: December 2021

The inadvertent intra-arterial injection of penicillin has been reported in the buttock1-3 and in the thigh.4,5 The resulting lesion in the small arterioles leads to thrombosis and ischemic damage to tissues supplied by them.

Schanzer et al5 felt that accidental intra-arterial injections of penicillin were the result of a design flaw in the disposable, ready-to-use containers (Tubex) in which many of the penicillin preparations are supplied. This container consists of a glass tube with a 20-gauge, 3.2-cm needle at one end and a rubber disk (plunger head) with a threaded pin inserted in it at the other. The container is positioned in a metallic or plastic injector in which a plunger is screwed to the threaded pin permitting the contents to be ejected.
Do We Fatten Our Children at the Television Set? Obesity and Television Viewing in Children and Adolescents
Authors: Dietz William H. , Gortmaker Steven L.
Published: December 2021

The association of television viewing and obesity in data collected during cycles II and III of the National Health Examination Survey was examined. Cycle II examined 6,965 children aged 6 to 11 years and cycle III examined 6,671 children aged 12 to 17 years. Included in the cycle III sample were 2,153 subjects previously studied during cycle II. These surveys, therefore, provided two cross-sectional samples and one prospective sample. In all three samples, significant associations of the time spent watching television and the prevalence of obesity were observed. In 12- to 17-year-old adolescents, the prevalence of obesity increased by 2% for each additional hour of television viewed. The associations persisted when controlled for prior obesity, region, season, population density, race, socioeconomic class, and a variety of other family variables. The consistency, temporal sequence, strength, and specificity of the associations suggest that television viewing may cause obesity in at least some children and adolescents. The potential effects of obesity on activity and the consumption of calorically dense foods are consistent with this hypothesis.
Comparative Treatment Trial of Augmentin Versus Cefaclor for Acute Otitis Media with Effusion
Authors: Odio Carla M. , Kusmiesz Helen , Shelton Sharon , Nelson John D.
Published: December 2021

A total of 150 children with acute otitis media were randomly allocated to treatment with amoxicillin-potassium clavulanate (Augmentin) or with cefaclor. Each drug was given in a daily dosage of approximately 40 mg/kg in three divided doses for ten days. Tympanocentesis done before treatment yielded specimens that contained pneumococcus or Haemophilus sp or both in 67% of specimens. Viridans group streptococci were isolated from 10% of specimens and Branhamella catarrhalis from 6%. Patients were scheduled for followup examinations at midtreatment, end of therapy, and at 30, 60, and 90 days. Of the 150 children, 130 were evaluable. Five of 60 patients (8%) treated with cefaclor were considered therapeutic failures because of persistent purulent drainage and isolation of the original pathogen or suprainfection. There were no failures among patients treated with Augmentin (P = .019). Rates of relapse, recurrent acute otitis media with effusion, and persistent middle ear effusion were comparable in the two groups of patients. Diaper rash, or loose stools, or both were significantly more common in children treated with Augmentin (34%) than in those taking cefaclor (12%), but in no case was it necessary to discontinue medication because of these mild side effects (P = .002). Cefaclor therapy was discontinued in one patient because of severe abdominal pain and vomiting. In this study, treatment with Augmentin was superior to treatment with cefaclor in the acute phase of acute otitis media with effusion, but Augmentin produced more adverse effects. The rates of persistent middle ear effusion and recurrent acute otitis media with effusion were comparable with the two regimens.
Candy Flavoring as a Source of Salicylate Poisoning
Authors: Howrie Denise L. , Moriarty Richard , Breit Robert
Published: December 2021

Methyl salicylate (oil of wintergreen) in the form of candy flavoring was ingested by a 21-month-old male infant who subsequently developed vomiting, lethargy, and hyperpnea. A "swallow" of the solution resulted in a serum salicylate concentration of 8l mg/dL six hours after ingestion. The infant was treated with parenteral fluids and sodium bicarbonate and he recovered rapidly. Hazards associated with salicylate use in this form include lack of parental awareness of the substance's toxic potential, the attractiveness of the candy-like odor, and the availability of the liquid in non-child-resistant packaging containing potentially lethal quantities.
A Note on Interdisciplinary Research in Developmental/Behavioral Pediatrics/Psychology
Authors: Ellison Patricia H. , Kopp Claire B.
Published: December 2021

In sum, we have offered a few observations about the practice of interdisciplinary research. Now, in addition to our rather specific suggestions, we want to add a few general comments about the interactions of professionals who are actually involved in interdisciplinary research.

Collaboration between physicians and psychologists can be enriching, stimulating, and rewarding. But it can also be problematic, because the former do not have much exposure to research and the latter do not have much exposure to clinical issues. Bringing these skills together may require many hours of discussion and reading each other's publications.

Overall, physicians need to improve their research skills. Reading statistics texts, taking courses, handling data sets, reviewing other researchers' statistical designs are all reasonable strategies.

Psychologists also need to expand their knowledge base. Reading the clinical literature is a start, but this ought to be supplemented by consistent exposure to the clinical milieu. The physician, who has access to the clinical milieu, needs to be sensitive to the question of exposure.

Our final comments about collaboration are perhaps the most sensitive ones. The maintenance of a solid physician and psychologist research collaboration requires thoughtfulness, understanding, tact, and nurturance. Consider the status and responsiblities of the physician. He or she often outranks the psychologist, has access to the subject population, daily confronts ethical issues surrounding patient diagnoses, and controls communication of information to child and family. A sense of being in charge develops. Consequently, the psychologist may be perceived as being an adjunct to the research, responsible for day-to-day operations and committing ideas to paper. This is not a good formula for research.

There are no easy answers for resolving these difficult interpersonal situations. Some interdisciplinary teams have found that frequent communication helps, others have turned to interinstitution collaborations, and a few have established written guidelines for almost all aspects of the research (responsibility for decision making, day-to-day operations, first authorship on articles, etc). Addressing these delicate issues in the beginning, with intermittent reexamination, will generally lead to a successful endpoint.

These reflections are offered to our colleagues in the hope that interdisciplinary research will thrive and become a mainstay of both pediatrics and developmental psychology. After all, facilitating the growth of the child is a primary goal for each discipline.
Cerebral Blood Flow Measurement Techniques in Infants and Children
Authors: Kirsch Jeffrey R. , Traystman Richard J. , Rogers Mark C.
Published: December 2021

The tremendous growth of interest in neurologic intensive care and in the pathophysiology of the cerebral circulation in the past few years has resulted in increasing numbers of studies that document alterations in cerebral flow during the course of various diseases or as a response to treatment of them. Before pediatricians come to conclusions based on these studies, it is important to have an understanding of the techniques involved. The techniques are complex and difficult but are based on understandable principles. They also have limitations and are subject to misinterpretations.

Pediatricians should become knowledgeable about some of these techniques and their limitations because it is likely that they will be applied with increasing frequency in the next several years. We are on the threshold of exciting discoveries in abnormalities of cerebral blood flow and cerebral metabolism not only in critically ill children but also in children with congenital and learning disorders.
Single-Dose Versus Conventional Therapy of Urinary Tract Infections in Female Adolescents
Authors: Fine Joan S. , Jacobson Marc S.
Published: December 2021

A randomized, prospective study was done to assess the efficacy of single-dose v conventional treatment of acute urinary tract infection (UTI) in female adolescents. Thirty-one 12- to 18-year-old female adolescents with symptoms of an acute UTI and a urine culture with greater than 105 organisms were treated with amoxicillin, either as a 3.0-g single dose or 250-mg three times daily for ten days. Urine cultures obtained three days after completing therapy in each group, showed bacteriologic cure rate of 69% (11/16) with single-dose treatment compared with a cure rate of 87% (13/15) in the conventional treatment group (P = .23). When patients with resistant organisms were excluded, the cure rate was 85% in both groups. Complete symptom resolution in less than two days after commencing treatment occurred in 36% of single-dose group v none of the patients in the conventional-dose group. The finding has not been previously reported in single-dose trials. Candida vaginitis occurred in 20% of the conventional-dose group v none of the single-dose group. All patients in the single-dose group kept their first scheduled follow-up appointment, whereas 40% in the conventional group required reminders and rescheduling. Perfect compliance with the medication regimen was reported by 27% of the patients taking ten days of medicine. Although single-dose cure rates may not be superior to conventional-dose rates, the advantages of single-dose treatment include increased compliance with medication and follow-up, decreased side effects, and more rapid resolution of symptoms.
Recurrence of Rheumatic Fever
Authors: FEINSTEIN ALVAN R.
Published: December 2021

To the Editor.—

In a case report on prophylaxis for rheumatic fever, Nordin1 expressed dismayed surprise that monthly injections of 1.2 million units of benzathine penicillin G (BPG) had failed to prevent the recurrence of rheumatic fever in a 9-year-old girl. Although BPG was clearly the best of the various antistreptococcal prophylactic regimens tested in randomized clinical trials conducted by my colleagues and me at Irvington House during the late 1950s and 1960s, BPG was not perfect.
Neonatal Hyperviscosity: Randomized Study of Effect of Partial Plasma Exchange Transfusion on Long-Term Outcome
Authors: Black Virginia D. , Lubchenco Lula O. , Koops Beverly L. , Poland Ronald L. , Powell Douglas P.
Published: December 2021

The use of partial plasma exchange transfusion in newborns with polycythemia and hyperviscosity was evaluated. Ninety-three infants with polycythemia and hyperviscosity were randomly assigned to receive either partial plasma exchange transfusion or symptomatic treatment; the infants were matched with control infants without polycythemia. Neonatal course and outcome at 1 and 2 years were evaluated for each of the three groups. Polycythemic infants had more fine motor and speech problems at 1 year of age than did control infants. At 2 years of age, polycythemic infants had more gross motor delays, neurologic diagnoses, fine motor abnormalities, and speech delays than did the control infants. There was no significant difference at 1 year between the polycythemic infants who had received partial plasma exchange transfusion and those given only symptomatic care. At 2 years, the group receiving partial plasma exchange transfusion had fewer neurologic diagnoses and fine motor abnormalities.
Nonemetic Effects of Ipecac Syrup
Authors: Czajka Peter A. , Russell Steven L.
Published: December 2021

The aftereffects of home-induced emesis with ipecac syrup were determined by telephone interviews of callers to a poison center. During the 12-week study, the presence of any symptoms at follow-up in 146 patients was compared with findings in 99 callers to the poison center who did not receive ipecac. Within four hours after ipecac-induced emesis, 33.6% had no symptoms and 17.1% experienced protracted emesis. In the ipecac-treated group the incidences of one formed stool (4.1%) and lethargy during a typical sleeping time (42.5%) were not significantly different from the incidences in patients not receiving ipecac syrup. The incidences of diarrhea (13.0%) and atypical lethargy (11.6%) were higher (P < .025 and P < .05, respectively) after ipecac-induced emesis than in patients not receiving ipecac syrup. There was no significant statistical association between the propensity of the ingested toxin to produce diarrhea or lethargy and the occurrence of diarrhea or atypical lethargy. Because ipecac-induced emesis can produce diarrhea and lethargy, these side effects should be noted and differentiated from normal conditions when ipecac syrup is administered.
THE CHILDREN OF READING GAOL: A Letter from Oscar Wilde, 1897
Authors: Cone Thomas E.
Published: December 2021

A boy used to come and play in these streets.

Now he is alone.

Held by stone walls of a solitary cell.

Gray slits of life escape through bars immobilizing him with shadowy splints.

He sits on the floor wet with cold fear.

His face a white wedge of terror like a hunted animal.

He receives bread and water.

In burned out sockets there is wrath.

He has been crying all day.

He cannot understand prison.

He cannot realize what society is.

Darkness covers him with dreams of death.
Relative Rates of Fetal Hemoglobin and Adult Hemoglobin Synthesis in Cord Blood of Infants of Insulin-Dependent Diabetic Mothers
Authors: Bard Harry , Prosmanne Janie
Published: December 2021

Erythrocytosis, extramedullary erythropoiesis, and increased levels of plasma erythropoietin have been observed in newborn infants of diabetic mothers. Because there is evidence that there is a relationship between increased fetal hemoglobin production and acute erythropoietic expansion, it was considered important to study the proportion of fetal hemoglobin and adult hemoglobin synthesis in newborn infants of insulin-dependent diabetic mothers. Samples from nine newborn infants of diabetic mothers as well as nine control infants, ranging from 36 to 38 weeks of gestation, were incubated in an amino acid mixture containing [14C]leucine. The adult hemoglobin and fetal hemoglobin were then separated by column chromatography on DEAE [O-(diethylaminoethyl)] Sephadex. To confirm that the fetal hemoglobin obtained after Sephadex chromatography was not contaminated with other hemoglobins, several of the DEAE separations from each group were reconstituted and subjected to polypeptide chain elution using carboxyl-methyl cellulose chromatography. The data demonstrated that the newborn infants of diabetic mothers are synthesizing significantly more fetal hemoglobin than is expected for their period of development (82.2 ± 3.6 v 72.8 ± 4.2; P < .005). It is suggested that the in utero environment of the fetus of the diabetic mother causes an increase in fetal hemoglobin synthesis.
The Arms Race and Children in Fiscal Year 1985
Authors: STRAUSS ARTHUR
Published: December 2021

The current arms race harms all Americans. Children are most adversely affected by federal cutbacks in time-honored programs. By fueling an everexpanding arms race, we are mortgaging the nation's future. Health care professionals have a moral responsibility to alert the public regarding the consequences of recent federal policies for our most vulnerable citizens.
Vitamin E and Retinopathy of Prematurity Revisited
Authors: GOLE G. A. , SKINNER J. M. , HENDERSON D. W. , MUKHERJEE T. M.
Published: December 2021

The reply by Kretzer and Hittner to our letter questioning the efficacy of vitamin E in treating retinopathy of prematurity requires further comment. These authors claim that we are "incorrect" in asserting that gap junctions with their characteristic 2-to 4-nm gap are difficult to visualize in conventional ultrathin sections. Nevertheless, our experience in this area parallels that of other researchers in the field, including Staehelin and Ghadially, 4 who mention the difficulty of recognizing gap junctions in routine sections and in distinguishing them from tight junctions.
Relative Risk
Authors: SHEPS SAM
Published: December 2021

The article on injuries in a large, urban school district, provides valuable information regarding school accidents and injuries. Indeed the authors have carried out the most extensive analysis to date of the nature of school injuries and they have undertaken some interesting analyses in an attempt to understand the influence of a variety of school factors on accident rates.

However some of the data they report, specifically data in their tables 4, 5, and 6, may cause readers to misunderstand the concept of relative risk.
Reye Syndrome Associated with Aspirin Therapy for Systemic Lupus Erythematosus
Authors: Hansen James R. , McCray Paul B. , Bale James F. , Corbett Austin J. , Flanders David J.
Published: December 2021

A 14-year-old girl in whom Reye syndrome developed during aspirin therapy for an inflammatory disorder proven to be systemic lupus erthymatosus is reported. This case and similar cases of Reye syndrome in patients with juvenile rheumatoid arthritis suggest that an etiologic relationship exists between salicylate therapy and Reye syndrome in children with collagen vascular disorders.
National Institutes of Health Report on Causes of Mental Retardation and Cerebral Palsy
Authors:   From the Task Force on Joint Assessment of Prenatal and Perinatal Factors Associated with Brain Disorders
Published: December 2021

Neurologic and communicative disorders affect 42 million Americans. Mental retardation is present in 780,000 school-age children, cerebral palsy affects 750,000 Americans, and nearly 2 million individuals have epilepsy. Among these 42 million are countless individuals who suffer combinations of these neurologic disabilities. In an effort to define our current state of knowledge about the prenatal and perinatal factors associated with brain disordens, the National Institute of Neurologic and Communicative Disorders and Stroke (NINCDS) and the National Institute of Child Health and Human Development (NICHHD) appointed a group of experts to survey current data in order to identify pregnancy- and birth-related events that may account for the continued incidence of neurologic handicap among infants and children. Their results were published in a report entitled Prenatal and Perinatal Factors Associated with Brain Disorders.

Despite rapid advances in obstetric and neonatal medicine during the past several decades, physicians, patients, and attorneys still believe that the major causes of brain disorders are related to birth trauma and problems of labor. The Committee found that, although it was once simple to say that a specific event such as birth trauma or asphyxia caused brain disorders, it is not usually possible to pinpoint a single cause and its effect. The normal brain's ability to repair or compensate for even major developmental disruptions, combined with the gross and subtle interactions of biologic, social and environmental factors, confounds the task of assigning etiologies to brain disorders.

The causes of severe mental retardation are primarily genetic, biochemical, viral, and developmental and not related to birth events.
Epidemiology of Herpes Zoster in Children and Adolescents: A Population-Based Study
Authors: Guess H. A. , Broughton D. D. , Melton L. J. , Kurland L. T.
Published: December 2021

Medical records were reviewed for all 173 cases of herpes zoster diagnosed among residents of Rochester, Minnesota, less than 20 years of age during the period 1960 through 1981. The incidence of zoster increased with age from 20 cases per 100,000 person-years in those residents less than five years of age to 63 cases per 100,000 person-years in those aged 15 to 19. Morbidity was less than has been described in adults, as only two patients required hospitalization and no postherpetic neuralgia or other late complications were diagnosed. The single case of subsequent cancer found in 1,288 person-years of follow-up was not significantly different from the number expected based on cancer incidence in the general Rochester population. The incidence of childhood zoster in patients with acute lymphocytic leukemia was 122 times higher than in children without an underlying malignancy. Chickenpox in the first year of life was found to be a risk factor for childhood zoster, with a relative risk between 2.8 and 20.9. Neither chickenpox in the second year of life nor recent vaccinations were found to be risk factors for childhood zoster.