bluuebunny/crossref_metadata_2025 huggingface dataset:
Mitral Valve Replacement in Infants and Children
Authors: Galioto Frank M. , Midgley Frank M. , Shapiro Stephen R. , Perry Lowell W. , Ciaravella James M. , Scott Lewis P.
Published: December 2021

Thirteen patients, ranging in age from 10 months to 19 years (mean 7.8 years) and in weight from 6.6 to 60 kg (average 29.5 kg) underwent 14 operations for mitral valve replacement with a heterograft prosthesis between January 1, 1976 and July 1, 1979 for a variety of congenital or acquired lesions. Preoperative indications included severe refractory congestive heart failure in each patient with growth retardation, which was especially prominent in the younger patients. Operative mortality was 14% (2/14) with both deaths occurring within 48 hours of operation in patients less than 6 years of age. All surgical survivors had clinical improvement as manifested by relief of symptoms, decrease in heart size, and significant growth. Routine postoperative catheterization in five patients revealed good initial postoperative results in those studied, with one patient having a second study 20 months after operation. He was found to have had degeneration of his bovine prosthesis and had subsequent successful reoperation with a porcine prosthesis. Further long-term serial catheterizations are needed to further document the history of heterograft prosthesis in children, but they are preferred to mechanical valves became of the lack of need for long-term anticoagulants and the absence of thromboembolism complications. This series suggests that mitral valve replacement, when indicated by refractory congestive heart failure and growth retardation, can be successfully performed even in infants and small children. Surgery should not be postponed to allow for subsequent patient growth if the natural history of the disease is of progression.
Hypersecretion of Gastric Inhibitory Polypeptide in Nondiabetic Children with Cystic Fibrosis
Authors: Ross Stuart A. , Morrison Diane , McArthur Robert C.
Published: December 2021

Failure of secretion of an insulinotropic enteric hormone has been postulated as a cause for the impaired insulin secretion observed following a glycemic stimulus in children with cystic fibrosis (CF). Gastric inhibitory polypeptide (GIP), a hormone located primarily in the duodenum, is the main hormonal stimulus to insulin release from the gastrointestinal tract. To determine whether hyposecretion of GIP was present in CF subjects, GIP secretion was measured in 15 control children and ten children with CF, following a standard oral glucose tolerance test. None of the subjects was diabetic but the CF children demonstrated significant insulinopenia compared to the normal control subjects. GIP secretion in the CF children was significantly greater than in the normal control subjects (normal, 38.8 ± 4.6 ng/ml · min; CF, 54.9 ± 6.1 ng/ml · min, P < .01). These findings indicate that there is increased production of GIP in CF children rather than impaired secretion as had been postulated. The demonstration of hypersecretion of GIP in nondiabetic insulinopenic individuals adds further support to the hypothesis that insulin exerts feedback control on GIP secretion.
Inverted Tandem Duplication of the Middle Segment of the Long Arm of Chromosome 14
Authors: Strain James E. , Smith Ann C. M. , Ward Brian E. , Robinson Arthur
Published: December 2021

Inverted tandem duplications in man are a rare form of structural rearrangements involving a single chromosome.1 We describe a patient with partial trisomy of chromosome 14 due to an inverted tandem duplication of the long arm.

CASE REPORT

The proband was a term product of a 24-year-old mother's second pregnancy. The first terminated in a miscarriage at six weeks. After the birth of the proband, the mother had two miscarriages at six weeks' gestation followed by two term pregnancies resulting in the delivery of normal female infants.

The proband was a male infant whose birth weight was 5 lb 0 oz.
Hydroxyzine Intoxication in a 13-Month-Old Child
Authors: Magera Barbara E. , Betlach Charles J. , Sweatt Alicia P. , Derrick C. Warren
Published: December 2021

A case of hydroxyzine toxicity following accidental ingestion in a 13-month old female infant has been presented. A plasma hydroxyzine concentration 8.5 hours after the acute ingestion was 102.7 µg/ml and toxicity was manifested primarily by generalized seizures and sinus tachycardia. General supportive care and seizure control with physostigmine resulted in complete recovery within 72 hours. This case represents the first documented report of hydroxyzine toxicity following acute ingestion in a child.
Pneumococcal Sepsis in Childhood Leukemia and Lymphoma
Authors: Allen Judith B. , Weiner Leonard B.
Published: December 2021

Forty episodes of sepsis in 28 patients with leukemia or lymphoma were reviewed. Streptococcus pneumoniae accounted for 14 episodes and was the most frequent etiologic agent isolated. Escherichia coli and Staphylococcus aureus accounted for an additional 16 episodes. No patients with pneumococcal sepsis died whereas the overall mortality was 25%. Five of the patients with pneumococcal sepsis had polymorphonuclear leukocyte counts less than 500/cu mm. All patients in remission who had pneumococcal sepsis had a leukocytosis in response to their infection. Foci in patients with pneumococcal sepsis were identified in 50% of the episodes and all were confined to the respiratory tract.
Psychoactive Medicinal and Nonmedicinal Drug Use Among High School Students
Authors: Roush George C. , Thompson W. Douglas , Berberian Rosalie M.
Published: December 2021

In the article "Psychoactive Medicinal and Nonmedicinal Drug Use Among High School Students" by Roush, Thompson, and Berberian (Pediatrics 66: 709-715, 1980) error has been noted in Table 4 (p 713). Under the heading Student Characteristics, the eighth line should read Being White.
Acetaminophen Assay
Authors: Segal Sydney , Anyan Walter R. , Hill Reba M. , Kauffman Ralph E. , Mofenson Howard C. , Pruitt Albert W. , Shinefield Henry B. , Singer Harvey S. , Weinberger Miles M. , Ballin John C. , Catz Charlotte , Farchione Louis , Freeman Martha M. , Frigoletto Fred , Penna Richard P. , Licata Sam A. , Oakley Godfrey , Sawchuk Steven , Soyka Lester F.
Published: December 2021

In its 1978 "Commentary on Acetaminophen,"1 the Committee on Drugs made reference to a colorimetric assay method in kit form (Kendal et al)2 which purportedly provided a reliable, quick, and practical method for identifying patients with potentially toxic concentrations of serum acetaminophen. Since publication of the commentary, the Committee has become aware of several reports of problems with the accuracy and specificity of this assay which limit its reliability and usefulness.3-7

Although the Kendal assay was mentioned in the commentary for informational purposes only, it has become apparent from subsequent comments in the literature that at least some individuals construed this mention as a tacit endorsement by the Academy of this specific assay method. It is not now and has never been the business or intent of the Committee or the Academy to recommend a specific analytic method for measuring acetaminophen. Numerous methods to measure acetaminophen in serum have been described during the past five years. The comparative advantages and disadvantages of the various methods were recently reviewed by Wiener,7 and this study should be used for specific information. Drugs other than acetaminophen—including salicylate, phenobarbital, and phenylbutazone—interfere with some of the colorimetric and spectrophotometric methods described in the literature. In addition, some methods measure inactive conjugates of acetaminophen as well as the active drug, thereby providing erroneously high results. The method used by a specific laboratory wifi depend, to a great extent, on the available analytic equipment and expertise. Therefore, it is important that the physician be aware of the method being used and the potential shortcomings and error inherent in that method when he/she interprets the results.
Rectal Mercury
Authors: Seidel James , MacMahon Mary
Published: December 2021

In the July issue (Pediatrics 66:130, 1980) we reported on acute mercury poisoning after polyvinyl alcohol (PVA) ingestion. We recently encountered another patient who was exposed to PVA in an unusual manner.

A 4-year-old girl was seen at a community health clinic with the complaint that there were small white worms in her stool. Her parents were given a kit containing three 10-ml bottles of PVA to collect stools for examination for ova and parasites with verbal and written instructions for stool collections.
Facial Cellulitis: An Early Indicator of Group B Streptococcal Bacteremia
Authors: Hauger Sarmistha Bhaduri
Published: December 2021

Epithelial manifestations as indicators of group B streptococcal (GBS) bacteremia have been infrequently reported in the literature. This report describes three infants, ranging in age from 2½ weeks to 7 weeks, who were seen with facial cellulitis as the only sign of GBS bacteremia. Only one of these infants had fever on presentation; otherwise, there were no signs of systemic illness. "Spontaneous cellulitis" should be viewed as an indicator of underlying bacteremia; in an infant less than 3 months of age, GBS should be considered a prime etiologic agent.
Adverse Reactions to Parenteral Lincomycin
Authors: Berry David D. , Brouhard Ben H. , Box Quellin T.
Published: December 2021

Lincomycin use has not been reported exclusively in children and inasmuch as it has been extensively used at our institution, a chart review of 265 patients who received parenteral lincomycin at a dose of 100 mg/kg/day in four divided doses for five days or longer was undertaken. The following conditions were diagnosed: cellulitis, 39%; septic arthritis, 21%; osteomyelitis, 16%; abscess, 13%; lymphadenitis, 9%; and pneumonia, 1%. Cures were achieved in all. The majority of organisms cultured were Staphylococcus aureus and Streptococcus pyogenes. Duration of therapy ranged from five to 63 days, with a mean of 15 days. The lincomycin dose ranged from 75 to 2,400 mg every six hours. The majority of patients received the drug intravenously, but 25.7% received it only intramuscularly. There were no adverse reactions at the administration sites. Only 3% of the patients developed diarrhea, which was not felt to be secondary to the drug. There were no cases of psuedomembranous colitis. Therefore parenteral lincomycin in children appears to be a safe and effective antibiotic when used for infections due to Gram-positive cocci.
Echocardiographic Mitral Valve Deformity in the Mucopolysaccharidoses
Authors: Johnson Gregory L. , Vine Donald L. , Cottrill Carol M. , Noonan Jacqueline A.
Published: December 2021

Previously reported echocardiographic abnormalities in patients with mucopolysaccaridosis and the Hunter-Hurler phenotype have stressed the similarity to calcific mitral stenosis despite the fact that mitral stenosis is a relatively uncommon manifestation of this disease. The purpose of this report is to describe the echocardiographic abnormalities in five patients with the Hunter-Hurler phenotype who had no clinical evidence of mitral stenosis. All had abnormal thickening of the mitral valve leaflets and one had echoes suggestive of calcification of the mitral annulus. All patients had normal electrocardiograms and roentgenographic cardiothoracic ratios, and two patients had no cardiac murmur. The high frequency of valvular deformity in this disease and the sensitivity of echocardiography in detecting these deformities suggest that echocardiography should be performed in the evaluation of patients with mucopolysaccharidosis. When echocardiographic evidence of valvular deformity is obtained, consideration should be given to bacterial endocarditis prophylaxis Pediatrics 67:401-406, 1981; mitral stenosis, Hunter-Hurler syndrome, echocardiography, mucopolysaccharidoses.
Hypokalemic Metabolic Alkalosis in Normotensive Infants with Elevated Plasma Renin Activity and Hyperaldosteronism: Role of Dietary Chloride Deficiency
Authors: Roy Shane , Arant Billy S.
Published: December 2021

The role of chloride deficiency in the generation of hypokalemic metabolic alkalosis with elevated plasma renin activity and plasma aldosterone levels, normal blood pressure, and a renal concentrating defect was studied in six infants given a soy formula that was deficient in chloride. A deceleration in linear growth, weight gain, and head circumference with age and delayed neurologic development were noted in every infant during the first six months of life. Microscopic hematuria and persistent elevation of plasma creatinine were noted in four of the infants. A renal biopsy in two infants revealed no juxtaglomerular hyperplasia, but interstitial tubular calcification was observed in one, and interstitial fibrosis was found in both. The generation of the hypokalemic metabolic alkalosis in these infants was explained by the reduced intake of chloride, and the addition of chloride alone to the diet resulted in a correction of the electrolyte abnormalities and the alkalosis.
Comment on Transcutaneous Bilirubin Device of Yamanouchi
Authors: Corchia Carlo , Vetrano Gennaro
Published: December 2021

Yamanouchi et al (Pediatrics 65:195, 1980) have reported a new simple noninvasive method for the transcutaneous measurement of bilirubin levels in newborn infants using a small instrument which measures the color intensity of the skin.

By using that method, we have estimated the number of serum bilirubin measurements on capillary samples which could be avoided in full-term infants without clinical problems other than jaundice.

In the last 12 months 2,555 newborns weighing 2,501 to 4,000 gm were admitted to our nursery; bilirubinemia was determined at least once in 2,011 (78.7%) of them, giving a total number of determinations of 11,301.
Hospital-Acquired Hepatitis A: Report of an Outbreak
Authors: Orenstein Walter A. , Wu Earnest , Wilkins Jeanette , Robinson Karen , Francis Donald P. , Timko Nikke , Wayne Ronald
Published: December 2021

A nosocomial outbreak of hepatitis A occurred after hospitalization of a 21-month-old girl with amebic liver abscess and unsuspected, anicteric hepatitis A. The index patient, who had an acute diarrheal illness prior to enzyme elevations, seroconverted from IgM hepatitis A antibody to IgG hepatitis A antibody. Of the 103 hospital personnel with known or potential exposure, three physicians (2.9%) contracted clinical hepatitis A, 27 to 29 days after their initial contact with the source patient. A fourth physician developed subclinical infection. Two of the three clinical cases occurred in two of the three primary care physicians of the source patient. Hepatitis A should be considered in any patient with acute, unexplained liver enzyme abnormalities. Diarrhea occurring in a fecally incontinent child incubating hepatitis A may increase the risk of transmission.
Glucose Polymer Tolerance in Premature Infants
Authors: Cicco Robert , Holzman Ian R. , Brown David R. , Becker Dorothy J.
Published: December 2021

Some formulas designed for premature infants contain glucose polymer (GP) as part of their carbohydrate content. GP tolerance tests and lactose tolerance tests were performed on 11 healthy premature infants at 2 to 3 weeks of age to compare their ability to digest and absorb GP and lactose. Total plasma reducing substances (TPRS), plasma insulin (PI), and plasma glucose were measured 10 minutes before and 30, 60, and 120 minutes after the oral carbohydrate test meal. Lactose and GP stimulated a significant increase in TPRS at 30 and 60 minutes and produced similar glycemic responses. However, GP stimulated a smaller PI response whether measured as the area under the PI response curve or as the PI/TPRS ratio. It was concluded that although GP and lactose evoke similar glycemic responses, they differ in their abilities to stimulate insulin secretion. The mechanism controlling this differential insulin response is unknown.
Skin Craters—A Complication of Transcutaneous Oxygen Monitoring
Authors: Golden Stephen M.
Published: December 2021

Continuous transcutaneous oxygen monitoring has become standard practice in the management of infants who require supplemental oxygen. Previously described complications of tcPo2 monitoring consist of prolonged intense skin erythema or first degree burns. Two cases of premature infants who developed numerous, hyperpigmented skin craters following prolonged tcPo2 monitoring are reported. Although these lesions appear to be harmless, they have not resolved with time and long-term cosmetic implications are unknown.
A Health Outreach to a Refugee Camp: Perspectives for Would-Be Volunteers
Authors: Olness Karen
Published: December 2021

In the short view, volunteers from western medicine can make substantial contributions to the health needs of refugees both in the camps and after resettlement to western countries. In the longer view, a well-planned exposure to health care delivery in very different cultural and economic environments tends to trigger a profound expansion of personal and professional awareness.
The Impending Pediatric ‘Surplus’: Causes, Implications, and Alternatives
Authors: Budetti Peter P.
Published: December 2021

The supply of pediatricians is increasing much more rapidly than the number of children in the United States. Between 1978 and 1990, the number of pediatricians will grow from approximately 26,000 to between 45,000 and 50,000, while the number of children will remain relatively constant. Although published standards vary widely, it appears certain that the forthcoming supply of pediatricians and family physicians will greatly exceed even the most generous estimates of the need for child health physicians. The recent work of the Graduate Medical Educational National Advisory Committee (GMENAC) has focused attention on the problem of physician oversupply. That panel estimates that by 1990 more than one of every eight pediatricians will be unnecessary and has recommended that even larger surpluses be allowed to develop. Determining whether the future supply will constitute a surplus raises issues for pediatrics that include not only the numbers, but also the proper balance of generalists, the role of family physicians and nurse practitioners, and trends in geographic preferences. Facing these issues will require a thorough analysis of child health needs to provide an adequate basis for making decisions about the number and appropriate training of child health care practitioners in the future.
MRS NATHANIEL HAWTHORNE'S INVALIDISM UNTIL HER MARRIAGE AT AGE 31 WAS ATTRIBUTED TO DIFFICULT TEETHING IN INFANCY
Authors: C. T. E.
Published: December 2021

Almost an article of faith among the laity until the beginning of this century was the belief that difficult teething could lead to ill health. The following quotation from Nathaniel Hawthorne's son's Hawthorne and His Wife1 points out his belief that his mother's invalidism up until she was married at age 31 was caused by difficult teething. It is of interest that Mrs Hawthorne's father, Dr Nathaniel Peabody, practiced dentistry in Salem and Boston, and also that she, like Elizabeth Barrett Browning, shed her invalidism shortly after her wedding day.

Sophia [Mrs Nathaniel Hawthorne] had been a very sick child on account of teething, and was made a life-long invalid by the heroic system of medicine which was then in vogue....She was incontinently dosed with drugs, from the harmful effects of which she never recovered, and which subjected her, among other things, to an acute nervous headache which lasted uninterruptedly from her twelfth to her thirty-first year, and of course, shortened her life by an unknown quantity [she lived to be 60 years old]...

The Boston physicians...tried their hands at curing her, and she went through courses of their poisons, each one bringing her to death's door, and leaving her less able to cope with the pain they did not reach. But the endurance of her physical constitution defied all the poisons of the materia medica—mercury, arsenic, opium, hyoscyamus, and all....In 1830 [she was then 19 years old]... she was living on hyoscyamus.

When Sophia Peabody became Sophia Hawthorne in 1842, she was, for the first time since infancy, in perfect health; nor did she ever afterwards relapse into her previous condition of invalidism.
Aortic Blood Pressure During the First 12 Hours of Life in Infants with Birth Weight 610 to 4,220 Grams
Authors: Versmold Hans T. , Kitterman Joseph A. , Phibbs Roderic H. , Gregory George A. , Tooley William H.
Published: December 2021

Systolic, diastolic, and mean aortic blood pressure measurements taken during the first 12 hours of life in 16 clinically stable, untransfused infants who weighed 610 to 980 gm at birth were analyzed. These infants were selected from 207 infants weighing <1,000 gm admitted to our hospital between 1965 and 1978. Selection criteria were pH ≥7.25, Paco2 <50 torr, Pao2 >50 torr, hematocrit >40%, inspired oxygen ≤40% at 6 hours of age. Blood pressures of appropriate for gestational age and small for gestational age infants of comparable weight were similar. From linear regressions of blood pressures on birth weight, average values and 95% confidence limits for two different birth weights were derived. For infants weighing 750 gm the mean aortic blood pressure, measured in torr, was 33 (range 24 to 42); systolic, 44 (range 34 to 54); diastolic, 24 (range 14 to 34). Mean blood pressures of infants weighing 1,000 gm were 34.5 (range 25 to 44); systolic, 49 (range 39 to 59); diastolic, 26 (range 16 to 36). These values are lower than those extrapolated from larger infants using a parabolic regression. Data from these 16 infants were combined with data from 45 larger infants to compute new nomograms for aortic blood pressures during the first 12 hours of life in infants weighing 610 to 4,220 gm. The relations between blood pressures and birth weights were best described by linear regressions. The lower limits of normal mean aortic blood pressure are 25 torr at 750 gm, 29 torr at 1,500 gm, and 37 torr at 3,000 gm; the lower limits of normal systolic blood pressure are 34 torr at 750 gm, 40 torr at 1,500 gm, and 51 torr at 3,000 gm. These extended nomograms should replace the parabolic regression of mean aortic blood pressure vs weight which may have inaccurately indicated hypotension in infants of very low birth weights.
Short Umbilical Cord: Its Origin and Relevance
Authors: Miller Marvin E. , Higginbottom Marilyn , Smith David W.
Published: December 2021

A short umbilical cord was found in newborns for whom there was evidence of early intrauterine constraint and in those with gross structural or functional limb defects that limited intrauterine movement. These findings were interpreted as showing that umbilical cord growth occurs in response to tensile forces relating to intrauterine space availability and fetal movement during early development. Thus, the finding of a short umbilical cord may indicate diminished fetal movement from either early intrauterine constraint or fetal limb dysfunction.
Further Definition of History and Observation Variables in Assessing Febrile Children
Authors: Mccarthy Paul L. , Jekel James F. , Stashwick Carole A. , Spiesel Sydney Z. , Dolan Thomas F. , Sharpe Michael R. , Forsyth Brian W. , Baron Michael A. , Fink Howard D. , Rosenbloom Marshall L. , Etkin Thomas , Zelson Joseph H.
Published: December 2021

The experienced clinician makes a judgment (hereafter called overall assessment [OA]) about the degree of illness of a febrile child prior to physical examination. In order to define the history and observation variables on which OA is based, 262 febrile children ≤24 months of age were evaluated simultaneously by multiple observers including attending pediatricians, practicing pediatricians, pediatric house officers, and nurses. The observer listed history and observation variables he/she thought most important in making an OA on a blank, lined form and then scored those variables and OA as normal, or mildly, moderately, or severely impaired. Scoring for observation rather than history variables was better correlated with scoring for OA and serious illness. The observation variables most frequently mentioned by all observers were the child's "looking at the observer" and "looking around the room." There were 20 observation variables frequently mentioned, the scoring of which significantly correlated with scoring for OA; four of these 20 variables related to eye function. The child's response to a stimulus was noted in 105/186 different observation variables listed; both the attending pediatrician and the house officer scored these stimulus-response variables significantly different in children with, vs those without, serious illnesses. For attending pediatricians, house officers, and nurses, serious illness was five to seven times as likely if an OA of moderate or severe impairment was made than if it were not made. OA is a key skill in evaluating febrile children; these data identify variables on which OA is based, document the importance of assessing eye function in young, febrile children, and demonstrate that eye function is one key type of stimulus-response behavior on which the pediatrician as clinician and developmentalist relies to make judgments about febrile children.
‘Stiff-Man Syndrome’ in an Adolescent
Authors: Daras Michael , Spiro Alfred J.
Published: December 2021

A 16-year- old boy with stiff-man syndrome is described because the condition rarely occurs in this age group. Diagnosis, by appropriate electrodiagnostic studies, is important because stiff-man syndrome is easily treated with high doses of diazepam.
Caloric Deprivation Questioned in Breast Milk Jaundice
Authors: Laws Harry F.
Published: December 2021

In reference to the data of Stevenson et al1 disputing the possibility that caloric deprivation during the first few days of life might contribute to hyperbilirubinemia, I take exception to the term "calorically deprived." It is implied that this is a pathologic condition and perhaps we should be supplementing the normal breast-fed baby. I would rather the bottle-fed baby be referred to as the "calorically supplemented" (overfed?). Two years ago we undertook a study to determine whether extra caloric supplementation of the breast-fed baby changed bilirubin values.
On Angiomas of Retina, Brain, and Skin
Authors: Sobel Louis I. , Odel Jeffrey G. , Friedman Alan H.
Published: December 2021

Recently Russell et al1 (Pediatrics 66: 306, 1980) described a child with a hemangioma of the right side of the forehead and right upper eyelid, an arteriovenous malformation of the basal ganglia and suprasellar region, and an ipsilateral angiomatous ocular lesion, who had an isolated growth hormone deficiency. They concluded that the vascular malformations were consistent with a variant of the Sturge-Weber syndrome. It is our opinion that their fundus and cerebral angiogram illustrations and the clinical description of the cutaneous vascular nevi represent a case of Wyburn-Mason syndnome.2-4
Effect of Parathyroid Hormone on Vitamin D Metabolism in Osteopetrosis
Authors: Aarskog Dagfinn , Aksnes Lage , Markestad Trond
Published: December 2021

Indices of vitamin D metabolism were studied before and after infusion of bovine parathyroid hormone extract in three children with osteopetrosis. Basal serum concentrations of calcium, alkaline phosphatase, and 25-hydroxyvitamin D tended to be low. Serum immunoreactive parathyroid hormone levels were in the upper normal range in two patients. A marked increase in urinary cyclic adenosine 3': 5'-monophosphate(cAMP) in all patients was solely due to an increase in the nephrogenous cAMP. The basal concentration of 1,25-dihydroxyvitamin D was clearly more than the upper limit of normal range in all three patients and increased after parathyroid extract infusion in one patient. The basal serum levels of 24,25-dihydroxyvitamin D were within normal limits and tended to decrease after parathyroid extract infusion in two of the patients. Parathyroid hormone and 1,25-dihydroxyvitamin D act in concert to increase calcium resorption from bone, and the increased serum levels of both these factors may reflect lack, or unresponsiveness, of target cells in bone.
New Rabies Vaccine
Authors: Plotkin Stanley A.
Published: December 2021

Four score and 16 years after Louis Pasteur brought forth the first rabies vaccine in 1884,1 a new vaccine was licensed in the United States. Pasteur's vaccine made protection of man against rabies possible, even after a victim had been bitten. However, there were failures of prevention and the presence of nerve tissue in the vaccine resulted in severe neurologic reactions, including encephalopathy.2

The introduction of animal antirabies serum by Koprowski and Black3 and the subsequent replacement of animal serum by human rabies immune globulin developed by Cabasso et al4 reduced the number of vaccine failures by providing passive rabies antibodies before the active immunity induced by vaccination.
Gastroesophageal Reflux and Pulmonary Disease
Authors: Herbst John J.
Published: December 2021

Chronic respiratory disease is a well-established complication of gastroesophageal reflux (GER).1-3 The elucidation of the relationship between the two events is hampered by the lack of a reliable test that indicates the presence or absence of GER and the lack of a test that consistently demonstrates that the pulmonary symptoms are directly caused by GER.4 In addition, GER may only contribute to the severity of the pulmonary disease, as in chronic asthma.5 In this issue of Pediatrics, Berquist et al describe their experience in evaluating 82 patients for GER who also had recurrent pneumonia or asthma.6 This article is of great value to clinicians who must care for these complex cases.
Spina Bifida: A New Disease
Authors: Leonard Claire O. , Freeman John M.
Published: December 2021

The paper by Wald entitled "Biofeedback in the Treatment of Fecal Incontinence in Patients with Myelomeningocele" (Pediatrics 68:45, 1981) represents an additional small, but significant step in the management of children with spina bifida.

In the 1950s most children with spina bifida were left to die. In the 1960s most were vigorously treated. In the early 1970s Dr John Lorber presented a retrospective analysis of his results, and published his criteria for selection.1 Over these three decades the approach to the newborn with spina bifida has swung like a pendulum. More recent series2,3 demonstrate that with early treatment more than 80% of children survive; in our experience more than 95% survive.
Letters to the Editor
Authors: Philip Alistair G. S.
Published: December 2021

Dr Murray is quite right to point out that some caution is required in interpreting a "sepsis screen," but it depends upon how one approaches the problem. Because the prevalence (strictly speaking, the incidence) of "proven sepsis" was 8%, an increase to 40% probability of infection is a fivefold increase. The incidence of "not having proven sepsis" was 92%, so that the increase to 99% (actually 99.5%) probability of not having infection implies only a slight improvement in our predictive capability.
Clinical and Serologic Evaluation of Measles, Mumps, and Rubella (HPV-77: DE-5 and RA 27/3) Virus Vaccines, Singly and in Combination
Authors: Lerman Stephen J. , Bollinger Mitzi , Brunken Jan M.
Published: December 2021

A double-blind, placebo-controlled comparison of single component and combination measles, mumps, and rubella (HPV-77: DE-5 and RA 27/3) virus vaccines involving 502 young children was conducted. The rubella antibody response was similar with RA 27/3 rubella and measles-mumps-rubella (RA 27/3) vaccines, but was diminished with the combination vaccine that incorporated HPV-77: DE-5 rubella. There was no evidence of enhanced clinical reactivity with either of the measles-mumps-rubella vaccines.
Recovery of Left Ventricular Function Following Discontinuation of Anthracycline Chemotherapy in Children
Authors: Lewis Alan B. , Crouse Vonda L. , Evans William , Takahashi Masato , Siegel Stuart E.
Published: December 2021

Echocardiographic evaluation of left ventricular (LV) performance was performed in 41 children during and following anthracycline chemotherapy. Prior to treatment LV function was normal in all patients; LV shortening fraction was 35.2 ± 0.7% and percent of predicted velocity of circumferential fiber shortening was 110 ± 2%. However, the indices measured concurrent with the final anthracycline dose (mean = 308 ± 16 mg/sq m) demonstrated a significant decline in LV function. The LV shortening fraction had decreased to 29.5 ± 0.8% and percent of predicted velocity of circumferential fiber shortening decreased to 94 ± 4% (P < .01). Four of the eight patients with evidence of significant LV dysfunction had received thoracic or upper abdominal irradiation. Following cessation of anthracycline therapy, LV function improved within one to six months and had returned to normal in all but two patients, both of whom received irradiation. Echocardiography is useful for the identification of anthracycline-induced LV dysfunction. With discontinuation of further anthracycline administration the functional decline in LV performance appears to be reversible.
Survival Following Myocarditis and Myocardial Calcification Associated with Infection by Coxsackie Virus B-4
Authors: Barson William J. , Craenen Josepha , Hosier Don M. , Brawley Robert L. , Hilty Milo D.
Published: December 2021

A Coxsackie virus B-4 was isolated from a neonate with clinical sepsis and clinical evidence of myocardial dysfunction. Radiographs demonstrated the presence and subsequent resolution of myocardial calcification. Electrocardiograms showed a left bundle branch block, presumably caused by calcification in the corresponding segment of the bundle of His. This case demonstrates an unusual complication of neonatal Coxsackie virus B infection.
WORLD VISION'S WORK IN REFUGEE CAMPS
Authors: Latta Robert W.
Published: December 2021

World Vision International, a Christian humanitarian organization working in 85 countries around the world, now has medical teams working in Kampuchea, Thailand, Somalia, and Ethiopia. In Kampuchea, WVI is running a pediatric hospital, and they have occasional needs there for French-speaking doctors, nurses, and laboratory technicians. In Thailand, WVI is looking for general practitioners and pediatricians, as well as nurses with similar backgrounds, to work with Khmer refugees along the Thai/Cambodia border and with Hmongs near the Thai/Laotian border in the vicinity of Vientiane. Most of WVI's Southeast Asia appointments are for a minimum of one year. WVI is also working with refugees in the northwest part of Somalia, near Hargeisa, and is seeking doctors, nurses, laboratory technicians, and a few supplemental logistical people for six-month terms in that area. In Ethiopia, WVI is maintaining a refugee effort in the southern provinces of Gamo-Gafa and Kefa. Their primary needs are for doctors and nurses. Some knowledge of the area is helpful, but not absolutely necessary. In Ethiopia, WVI is looking for people to sign on for one-year terms.
Pyruvate Carboxylase Deficiency: An Alleged Biochemical Cause of Leigh's Disease
Authors: Murphy Jerome V. , Isohashi Fumihide , Weinberg Mitchell B. , Utter Merton F.
Published: December 2021

Pyruvate carboxylase (PC) deficiency has been suggested as a biochemical cause of Leigh's disease (LD). To evaluate this hypothesis, PC activity was measured in liver, fibroblasts, and brain from patients with LD. In no patient was such a deficiency documented. Review of patients in whom LD and PC deficiency has been associated suggests that the tissues studied were frequently inadequately preserved. It is proposed that LD and PC deficiency are distinct entities.
Antenatal Diagnosis of Defects of Ureagenesis
Authors: Goodman S. I.
Published: December 2021

The approach usually taken to the intrauterine diagnosis of inborn errors of metabolism is to assay a particular enzyme in cultured amniotic cells, the rationale being that if the enzyme is normally present, its absence can be used to indicate fetal disease. Of the five inborn errors of ureagenesis, however, only two, ie citrullinemia and argininosuccinic aciduria, can be diagnosed in this manner because argininosuccinic acid synthetase and argininosuccinic acid lyase are the only urea cycle enzymes normally found in these cells. Both of these disorders have now been detected in utero,87,88 (S. D. Cederbaum and C. R. Scott, unpublished observations, 1980), and several other fetuses at risk have been correctly diagnosed as unaffected88-90 (S. I. Goodman, unpublished observations, 1980). Enzyme deficiency in cultured amniotic cells can be demonstrated directly21,22,91 or by examining the incorporation of 14C into arginine or cell protein.21,73,88,89,92 Further, fetuses with argininosuccinic aciduria have shown increased concentrations of argininosuccinic acid in amniotic fluid at amniocentesis87,88 (S. D. Cederbaum, unpublished observations, 1980) and delivery,93 with its amount remaining undetected when the fetus was not affected88 (S. I. Goodman, unpublished observations, 1980). Argininosuccinic acid is accumulated by the affected fetus, eg it is the most prominent free amino acid in its liver87,94 and, as it is poorly reabsorbed from the glomerular filtrate by cells of the proximal tubule,71 it probably enters the amniotic fluid in fetal urine.95 Thus, provided that a fetus has an intact urinary tract, whether or not it has argininosuccinic aciduria can probably be established within hours of amniocentesis merely by examining the fluid for the acid and/or its anhydrides by ion-exchange chromatography.
Dangers of Hydra-Lyte
Authors: Walker Stuart H.
Published: December 2021

Hypernatremia was frequent in the United States when oral electrolyte solutions containing 50 mEq of sodium per liter were utilized in the management of infantile diarrhea1,2; it has become less frequent in Great Britain since the introduction of low-solute milk (required to contain less than 20 mEq of sodium per liter).3 In underdeveloped communities, however, diarrhea has been successfully managed (without the development of hypernatremia) by the oral administration of solutions containing 80 to 90 mEq of sodium per liter.4,5
Letters to the Editor
Authors: Hoekelman Robert A.
Published: December 2021

Unfortunately, one always runs the risk, when asked to write a commentary, of being misunderstood. In my commentary on child health associate training programs, I offered only an explanation for the Colorado Child Health Associate Training Program not having been replicated elsewhere. I did not speak for or against the utilization of child health associates in the delivery of child health care. Perhaps, as Dr Jones suggests, there would be a large number of applicants to child health associate training programs.
Letters to the Editor
Authors: Naeye Richard L.
Published: December 2021

Dr McAnarney contends that data collected between 1959 to 1966 are no longer valid because prenatal services have changed and many adolescents now have abortions. Our paper did not deal with this broad issue but rather analyzed only the fetal-maternal competition for nutrients. If improved nutrition has now eliminated the consequences of this competition, it is up to those who claim that the problem has been eliminated to offer proof. Statistics show declining adolescent nutrition in Latin America and in many African nations where Pediatrics is widely read.
Mucosal Function and Breath Hydrogen Excretion: Comparative Studies in the Clinical Evaluation of Children with Nonspecific Abdominal Complaints
Authors: Barr Ronald G. , Watkins John B. , Perman Jay A.
Published: December 2021

To evaluate the role of the lactose breath hydrogen test for the detection of lactose malabsorption in children with chronic nonspecific abdominal complaints, breath hydrogen excretion was measured in 131 children with recurrent abdominal pain (n = 75) or chronic nonspecific diarrhea (n = 56) following a lactose load (2 gm/kg; maximum 50 gm). The data were compared to those obtained from lactose tolerance tests (n = 113) and symptom response following a lactose load (n = 109) performed simultaneously with the lactose breath hydrogen test, and with results from small bowel biopsies obtained in 31 children to determine dissacharidase activity and mucosal histology. The results indicate that an increase in breath hydrogen of greater than 10 ppm above base line values (Δppm) by 120 minutes ("early increase" response) completely discriminates between biopsyproven isolated lactase-insufficient and lactase-sufficient children. A similar increase after 120 minutes ("late increase" response) is consistent both with normal mucosal function and partial lactase insufficiency due to mucosal injury. Breath hydrogen responses predicted assayed lactase activity in all patients with isolated lactase insufficiency, but were "falsely negative" in four of ten children whose lactase insufficiency was secondary to mucosal injury. In both clinical groups, lactose malabsorbers report significantly more symptoms than absorbers (P < .001), but neither symptom reports nor tolerance tests are accurate methods for distinguishing lactose malabsorbers from absorbers. Although the lactose breath hydrogen test provides objective documentation of lactose malabsorption, it is not equally predictive of assayed lactase activity in all clinical groups.
Cefuroxime Therapy of Gonorrhea and Coinfection with Chlamydia trachomatis in Children
Authors: Patamasucon Pisespong , Rettig Philip J. , Nelson John D.
Published: December 2021

Twenty-seven episodes of gonorrhea occurring in children less than 15 years of age were treated with an intramuscular injection of cefuroxime, 25 mg/kg. Gonococci were eliminated from genital, pharyngeal, and anal sites in all cases. Cefuroxime was well tolerated and no side effects were observed. Coinfection with Chiamydia trachomatis was found in nine patients (33%). Among the seven patients with chiamydial genital infection, postgonococcal symptoms persisted in three children (43%). One patient ofthe five with chlamydial anal infection had symptoms. Chlamydial infections were successfully treated with trisulfapyrimidines.
Clinical and Metabolic Abnormalities in a Boy with Dietary Deficiency of Biotin
Authors: Sweetman Lawrence , Surh Linda , Baker Herman , Peterson Raymond M. , Nyhan William L.
Published: December 2021

Dietary deficiency of biotin was documented in an 11-year-old retarded boy as a consequence of a dietary prescription containing raw eggs. Clinical manifestations were alopecia totalis and an erythematous, exfoliative dermatosis. Metabolic characteristics included increased excretion of 3-methylcrotonylglycine, 3-hydroxyisovaleric acid, 3-hydroxypropionic acid, methylcitric acid, and lactic acid, as well as a propensity for the development of ketosis. The activities of propionyl coenzyme A carboxylase and 3-methyicrotonyl coenzyme A carboxylase in extracts of leukocytes were deficient. Treatment with biotin and the removal of raw eggs, which contain the biotin-binding protein, avidin, from the diet led to the reversal of all of the clinical and metabolic manifestations observed.
Effects of I ,25-Dihydroxyvitamin-D3 on Renal Function, Mineral Balance, and Growth in Children with Severe Chronic Renal Failure
Authors: Chan James C. M. , Kodroff Michael B. , Landwehr Douglas M.
Published: December 2021

To confirm and extend previous observations of enhanced linear growth in children with chronic renal disease being treated with 1,25-dihydroxyvitamin- D3 and to characterize further the calcium, phosphorus, magnesium, and zinc disorders in renal failure, 11 children (mean age 8 ± 5 years) with chronic renal insufficiency (glomerular filtration rate 18% ± 13% of normal) were evaluated on the basis of their reciprocal serum creatinine concentrations, height-velocity curves, mineral balances, and radiologic findings. Reciprocal serum creatinine concentrations analyzed retrospectively and prospectively during 32 months of 1,25-dihydroxyvitamin-D3 therapy showed progression of renal failure at rates linearly identical with those before treatment, thus suggesting that the treatment did not accelerate the rate of deterioration of glomerular filtration rate in chronic renal insufficiency. Indeed, one patient manifested a lesser decline in renal function (P sjlt .05). The height velocity of six of the children (75%) less than 12 years of age improved markedly over that expected for chronologic and bone ages after one year of treatment with orally administered 1,25-dihydroxyvitamin-D3, 15 to 35 ng/kg/day. All other medications except vitamin D2 were continued at their pretreatment dosage levels throughout the study. Growth velocity was unimproved in two of three children older than 12 years at the initiation of 1,25-dihydroxyvitamin- D3 therapy. Mineral balance data showed significant retention of calcium, phosphorus, magnesium, and zinc (357 ± 32 mg/sq m/day, 250 ± 82 mg/sq m/day, 38 ± 32 mg/sq m/day, and 1,157 ± 283 µ/sq m/day, respectively), after treatment for 12 months. In addition, serum calcium, alkaline phosphatase, and parathyroid hormone concentrations returned toward normal. Finally, healing of renal osteodystrophy was radiologically evident after six months of therapy.
Fatal Motor Vehicle Accidents of Child Passengers from Birth Through 4 Years of Age in Washington State
Authors: Scherz Robert G.
Published: December 2021

During the decade beginning Jan 1, 1970 and ending Dec 31, 1979, approximately 39,500 child passengers aged 0 to 4 years were in motor vehicle accidents reported and investigated in the State of Washington; 148 (0.4%) of the children were killed outright or subsequently died. Of the 39,500 children, approximately 6,300, or 16%, were wearing some type of safety restraint and only two, or 1:3,150, were killed. On the other hand, 33,200 were not wearing restraints and 146, or 1:227, were killed. If these ratios are extrapolated, one might conclude that if all the children had been wearing restraints, there would have been 93% fewer deaths. A d etailed analysis was performed on 39 fatalities for the years 1977, 1978, and 1979. Fatal accidents involving young children in Washington State usually occurred under ordinary circumstances on dry roads at low speeds during daylight hours and were unrelated to alcohol usage.
Letters to the Editor
Authors: Feldman Charles H. , Hutchinson Vincent E. , Pippenger Charles E. , Blumenfeld Thomas A. , Feldman Bernard R. , Davis William J.
Published: December 2021

We appreciate the comments of Weinberger et al and Spino et al. The equation utilized in our original report to calculate the apparent volume of distribution (V) was in error, as it was based on determinations for drugs that exhibit monoexponential elimination following a single intravenous dose. The correct formula for oral dosing at steady state with a drug obeying one-compartment model kinetics is: V = F.X0/AUCτ. K, where F is the total fraction of dose reaching systemic circulation, X0, is the dose, AUCτ is the area under the curve during a dosing interval; K is the elimination rate constant.1
Pharyngeal Gonorrhea
Authors: Silber Tomas Joce , Controni Guido
Published: December 2021

Farrell and co-workers1 make a strong case for the suspicion of sexual abuse in all children who have vaginal cultures that are positive for Neisseria gonorrhoeae. We want to add our support to their conclusions with an additional contribution: to extend their findings to include throat cultures positive for N gonorrhoeae. We have found this to be true in children of both sexes victimized by sexual abuse.

From January through December 1979 at our Children's Hospital National Medical Center we reviewed all cultures done on patients suspected of sex abuse.