bluuebunny/crossref_metadata_2025 huggingface dataset:
HEAD AND NECK TUMORS IN CHILDREN
Authors: Jaffe Burton F. , Jaffe Norman
Published: December 2021

This report is a review of 178 children with malignant head and neck tumors seen during a ten-year period at the Children's Hospital Medical Center and the Children's Cancer Research Foundation in Boston, Massachusetts. Each tumor type is analyzed to display its unique features. When a neck mass occurs, a complete ENT examination is needed to identify an occult primary in the nasopharynx, in the nose, or in some other site that is difficult to see. A total physical examination is needed to detect a systemic disease or a primary below the clavicle.

Many of the tumors of the head, unfortunately, are internal and present with common symptoms, like an earache, a stuffy nose, or a headache. They only become identified when the tumor greatly enlarges or metastasizes.

Treatment with surgery, cryosurgery, radiation therapy, and chemotherapy may be used alone or in various combinations of them.
WHY DO SICKLE SCREENING IN CHILDREN?
Authors: Fost Norman , Kaback Michael M.
Published: December 2021

An approximate desire to "do something" about sickle cell disease has produced a plethora of sickle screening programs. While the advantages of early identification of individuals with sickle cell disease is apparent, the purpose of identifying children with sickle trait is less clear. There is uncertainty about the clinical significance of sickle trait, and there are ethical and legal hazards in being so identified. The demonstrated failure of genetic counseling to successfully transmit information in other population groups also dictates a reexamination of the presumed benefits of sickle screening programs.

Screening programs should be initiated after pilot studies have resolved these issues, not before.
Cytomegalovirus Infections of Man, by Dr. Ulrich H. Krech, Dr. Mirko Jung, and Dr. Franciska Jung. Basel/München/Paris/London/New York/Sydney: S. Karger, 1971, 124 pp., $7.70
Authors: Nankervis George A. , Gold Eli
Published: December 2021

Krech, Jung, and Jung review the current knowledge of infection with cytomegalovirus, (CMV), particularly emphasizing the role of this agent in birth defects and in post-transfusion and transplantation syndromes. Although a large portion of the content of the volume is based on presentations at the first International Conference on Cytomegalovirus Infections, held in St. Gall, Switzerland, in the spring of 1970, the authors blend this material with selected reports from the literature and their own work.
MANPOWER AND TRAINING REQUIREMENTS IN PEDIATRIC CARDIOLOGY
Authors: Adams Forrest H. , Blumenthal Sidney , DuShane James W. , Lurie Paul R. , McNamara Dan G. , Rudolph Abraham M. , Abrahamson Stephen , Foster Judilynn T.
Published: December 2021

A comprehensive assessment of professional activities, training programs, testing procedures, and manpower needs in pediatric cardiology was made by the Sub-board of Pediatric Cardiology of the American Board of Pediatrics from 1967 to 1971. Examination content is the subject of a separate report. Professional activities were determined by questionnaires, diaries, direct observations, and workshops, which revealed that 63% of professional time was devoted to patient care, 6% to research, 6% to teaching, 7% to administration, and 18% to self-education. Ninety percent of the pediatric cardiologists worked full time in hospitals and seventy percent in university medical centers. Training programs should include experience in clinical practice, research, and teaching methods in an environment having adequate facilities for comprehensive care of children with diseases of the cardiovascular system, sufficient numbers of patients, and appropriate staff supervision. The numbers of pediatric cardiologists in cardiac centers and private practice were determined and current professional manpower shortages identified. Opinions also were obtained from pediatric cardiologists in existing training programs and pediatric department chairmen in medical schools concerning the needs anticipated by 1980. Continued support of superior training programs is recommended.
SOME PEDIATRIC PATIENTS OF MORE THAN PASSING INTEREST—WHO WERE THEY?
Authors: C. T. E.
Published: December 2021

Each of the eight children below played an important role in the history of pediatrics. Who were they?
Pneumoperitoneum Associated With Chronic Respiratory Disease in the Newborn
Authors: Leonidas John C. , Hall Robert T. , Holder Thomas M. , Amoury Raymond A.
Published: December 2021

Pneumoperitoneum in the neonate is an alarming roentgen sign in the overwhelming majority of cases indicative of perforation of the gastrointestinal tract, for which immediate laparotomy is indicated.1,2 In a small number of cases intraperitoneal air has been described to occur with pneumomediastinum and/or pneumothorax.3,4 It is thought that air dissects from the mediastinum into the retroperitoneal tissues through the diaphragmatic foramina, and then descends between the leaves of the mesentery with final rupture into the free peritoneal space.3-5 The clue to the benign nature of free intraperitoneal air in these cases is the simultaneous radiographic evidence of pneumomedisatinum and/or pneumothorax.3,4
Letters to the Editor
Authors: Liggins G. C.
Published: December 2021

Although we try to limit Letters to 300 words, the writers were allowed more space in view of the importance of their subject. Comments by Drs. Liggins and Howie, and Drs. Baden and Stern follow:

The observation of Drs. Farrell and Zachman that corticosteroid treatment of fetal rabbits enhances lecithin biosynthesis by induction of the enzyme PCGT should not obscure the possibility that other effects of steroids share in the accelerated maturation of treated lungs.
ANTIBIOTIC STABILITY IN SOLUTIONS USED FOR INTRAVENOUS NUTRITION AND FLUID THERAPY
Authors: Feigin Ralph D. , Moss Kanneth S. , Shackelford Penelope G.
Published: December 2021

The present study was designed to assess the stability of ampicillin, carbenicillin, clindamycin, kanamycin, cephalothin, methicillin, and penicillin in three parenteral hyperalimentation mixtures as reconstituted for delivery to the patient in the clinical setting.

Stability at 4C, 25C, and 37C was tested in parenteral hyperalimentation mixtures containing either crystalline amino acids or a protein hydrolysate. In two series of experiments the stability at 4C, 25C, and 37C of ampicillin, cephalothin, and kanamycin also was assessed in Isolyte M (ISO M), Isolyte P (ISO P), Ringer's lactate (LR), 5% dextrose in water, (D5W), 10% dextrose in water (D1OW), dextrose in normal saline (D5S), and normal saline (NS) to which hydrocortisone or heparin had been added. All antibiotics retained their effectiveness at an acceptable level in the hyperalimentation solutions at 4C. At 25C and 37C, all antibiotics except clindamycin lost activity by 24 hours. Kanamycin was least stable in these solutions and ampicillin also lost a significant degree of antimicrobial activity. Addition of heparin or hydrocortisone imparted stability to ampicillin in the seven parenteral solutions although significant loss of activity was noted at 37C in D5W, D1OW, D5S, and LR. Most solutions containing heparin or hydrocortisone and cephalothin turned yellow by 24 hours. A precipitate appeared in solutions containing heparin and kanamycin but there was minimal loss of antimicrobial activity. Kanamycin was stable in all solutions containing hydrocortisone except in D5W and D10W at 37C.
EPIDEMIOLOGY OF SLIPPED CAPITAL FEMORAL EPIPHYSIS: A REVIEW OF THE LITERATURE
Authors: Kelsey Jennifer L.
Published: December 2021

From a review of the literature on the epidemiology of slipped capital femoral epiphysis it is concluded that the incidence is greatest in males around the ages of 12 to 15 years and in the females at about the ages of 10 to 13 years, that males are more susceptible than females, that the incidence is greater in Blacks than in whites, that in many localities symptoms are more likely to begin in spring and summer than in fall and winter, that familial aggregation of cases occurs more often than would be expected by chance, that the left hip is affected more frequently than the right in males but not in females, that children with slipped epiphysis are usually overweight, that there is a slight tendency for them to be tall for their age, and that they tend to have undergone slower-than-average skeletal maturation. There is some suggestion that members of low socioeconomic classes are more likely to be affected than those in higher classes, and that incidence is highest in the Midwestern, Middle Atlantic, and Southeastern states, and lowest in the Mountain and Great Plains states.

Most of these risk factors have been found to play a role in either decreasing the strength of the epiphyseal plate or in increasing the amount of shearing stress to which the plate is subjected at the time it is most vulnerable.
Evaluation of the American Board of Pediatrics Oral Examination by Candidates After Completing It
Authors: Burg Fredric D. , Wright F. Howell
Published: December 2021

Because there has been debate over the validity and reliability of the oral examination1-4 the American Board of Pediatrics has undertaken a critical assessment of this aspect of its examination process. Candidates taking the oral examination since October 1970 have received a questionnaire at its conclusion. These were completed and returned to the Board office by 677 of 1,170 candidates (58%) after seven oral examination sessions administered during 1¼ years. The answers may interest readers of Pediatrics.
Management of the Decision to Die
Authors: Menzer Lawrence L.
Published: December 2021

I was quite moved and impressed by the thought-provoking article, "The Adolescent Patient's Decision to Die" by Schowalter et al.1 In the face of great medical advances we are still far behind in solving the great emotional, religious, and ethical problem of passive and active euthanasia.

I sincerely hope that the author's suggestion to "gather a body of medical literature of individual cases" will be heeded and that your journal will aid by offering its pages as a means of communication.
Letters to the Editor
Authors: Kafka H. L.
Published: December 2021

From time to time, teachers become unhappy with their way of teaching. This was expressed in the publications of Barbara M. Korsch, M.D.,1-3 and Raymond S. Duff, M.D.4 From time to time, some progress is made, but generally student teaching has remained the same for the past decades. It is not surprising that results are what they are because our teaching is traditionally disease oriented rather than patient oriented. Our students learn about pathology, etiology, and symptomatobogy of various diseases as if these were existing independently of a human being.
Rheumatic Fever, ed. 2 (vol. II in the series Major Problems in Clinical Pediatrics), by Milton Markowitz, M.D., and Leon Gordis, M.D., Dr.P.H. Philadelphia/London/Toronto: W. B. Saunders, 1972, 309 pp., $11.50
Authors: Massell Benedict F.
Published: December 2021

Although a number of texts devoted to special aspects of rheumatic fever have appeared within the past half century, Milton Markowitz, first in the 1965 edition with Ann Kuttner and now in an updated and amplified edition with Leon Gordis, has provided the first objective and comprehensive monograph on this disease since 1924, when Carey Coombs's Rheumatic Heart Disease was published. In view of the advances in our knowledge of the etiology and control of rheumatic fever that have been made since the days of Carey Coombs, this monograph by Markowitz and Gordis answers a long felt need.
Play And Development (A Symposium with contributions by Jean Piaget, Peter H. Wolff, René A. Spitz, Konrad Lorenz, Lois Barclay Murphy and Erik H. Erickson), edited by Maria W. Piers. New York: W. W. Norton & Company, 1972, 176 pp., $5.95
Authors: Friedman David Belais
Published: December 2021

The title Play and Development describes the unifying theme of this book but may mislead the unwary and the unsophisticated. The list of contributors should provide clues to the fact that Play and Development is not a simple exposition of children's play and developmental patterns. Actually, a background in developmental theory and practice is essential if one is to appreciate the subtleties of this excellent volume.

In the opening paper, Jean Piaget discusses the origins and development of "operations" in children and defines "operations" as internalized, reversible actions.
Neurology Of Childhood Learning Disorders, by Richard J. Schain, M.D. Baltimore: The Williams & Wilkins Co., 1972, 144 pp., $9.25
Authors: Gascon Generoso G.
Published: December 2021

This publication is a landmark because it is the first systematic exposure of an approach to diagnosis and management of learning problems in children written by a pediatric neurologist. It, therefore, deserves careful critical attention.

The author details his neurological examination techniques, discusses the concept of a brain damage behavioral syndrome, examines hyperactivity, minimal brain dysfunction, and developmental dyslexia, discusses other etiological conditions, then ends with chapters on general management and a diagnostic classification system.
Herbert Birch
Authors: Barnett Henry L. , Belmont Ira , Eisenberg Leon
Published: December 2021

Pediatrics suffered a grievous loss in the sudden death of Dr. Herbert G. Birch, Research Professor at the Albert Einstein College of Medicine, on February 4, 1973, at the age of 54. For us, the loss was personal as well as professional; we will miss a friend whose like will not be found soon again and a champion of the best traditions of American pediatrics.

Herb was simply head and shoulders above just about anyone we knew, his knowledge was encyclopedic, his intelligence prodigious, his productivity unmatched.
Letters to the Editor
Authors: Steinschneider Alfred
Published: December 2021

Dr. Steinschneider comments as follows. We are particularly impressed by his second, third, and fourth sentences:

The possibility of child abuse should be considered in every case of sudden infant death. However, extreme restraint must be exercised that this diagnosis not become one of exclusion. Failure to define the cause of a sudden death can never be used as support for the diagnosis of child abuse. Humanity as well as logic dictates the need for positive evidence as well as extreme sensitivity in the collection of such information.
Genetic Counseling. New York: The National Foundation–March of Dimes (Box 2000, White Plains, New York 10602), 22 pp., no cost
Authors: Nadler Henry L.
Published: December 2021

The pamphlet entitled "Genetic Counseling" briefly introduces the general concepts of genetic counseling. This publication, prepared by The National Foundation–March of Dimes, provides useful information which should be made available to parents and potential parents for purposes of family planning. Available free-of-charge, it could well be distributed in physicians' offices, outpatient departments, and family counseling units. Hopefully, it will generate greater awareness of the potential benefits of genetic counseling for the prevention of genetic disorders.
RECOVERY FROM THE RESPIRATORY DISTRESS SYNDROME
Authors: Stahlman Mildred
Published: December 2021

Few diseases of a noninfectious origin have undergone such a marked change in prognosis in recent years as clinical hyaline membrane disease (CHMD or IRDS). With the advent of newborn intensive care units and all that they currently imply in the management of acutely ill infants with severe CHMD, little wonder that the prognosis and natural history of this disease have been markedly altered. This altered outlook and the documentation of the physiological alterations in lung function is well illustrated in the article of Bryan et al.2 entitled "Pulmonary Function Studies During the First Year of Life in Infants Recovering from the Respiratory Distress Syndrome" which appears in this issue of Pediatrics.
Gonococcal Arthritis In A Newborn Infant
Authors: Kleiman Martin B. , Lamb George A.
Published: December 2021

A case of gonococcal arthritis in a 28-day-old infant is reported along with a brief review of the literature. Pediatricians should be reminded of this entity especially in view of the rising incidence of gonorrhea in the United States.
Screening for Lead Poisoning: Measurements and Methodology
Authors: McLaren Gordon D. , Barthel William F. , Landrigan Philip
Published: December 2021

Piomelli et al.1 have presented an extensive experience in comparison of free erythrocyte porphyrin (FEP) levels with blood lead concentrations. Their finding that an FEP ≥ 250µg/100 ml RBC was invariably associated with a blood lead concentration ≥ 6Oµg/100 ml is consistent with data obtained in our laboratory2 using a somewhat different microfluorometric method for FEP determination.3

We must, however, take issue with the conclusion of Piomelli et al.1 that only FEP levels above 250µg/100 ml RBC should be considered "positive."
Acute Suppurative Thyroiditis
Authors: Cosmas Adolfo Pérez , Rodríguez Carmen A. Saenz
Published: December 2021

In a recent article in Pediatrics, by Kirkland et al.,1 reference is made to only 36 cases of acute suppurative thyroiditis in children. Two years ago we made a review of the literature due to two unusual cases evaluated by us, one is a 1½-year-old Negro Dominican boy2 who presented two recurrent episodes of acute suppurative thyroiditis and a 7-year-old Puerto Rican girl who presented acute suppurative strumitis, for she suffered from chronic lymphocytic thyroiditis with superimposed suppuration.
CARDIAC DISEASE IN CHILDREN
Authors: Ferencz Charlotte , Craft Joan , Sultz Harry
Published: December 2021

Evaluation of patients newly referred to a pediatric cardiology clinic revealed that approximately twothirds of the children did not have heart disease. Of the other third, those with significant heart disease, 77% had congenital malformations and most were in the first year of life when diagnosed. Those in the first month of life had the highest mortality rate. Among newly referred school-aged children rheumatic heart disease was the major diagnosis.

Screening constituted a high proportion of the service's work load. Pediatricians did not differ significantly from other referral sources in the preselection for referral of cardiac cases.

The annual incidence of pediatric heart disease was comparable for different geographic areas surrounding the medical center and for racial groups. However, significant differences were found in the circumstances leading to referral. In disadvantaged black children, referral depended principally on hospital clinics visited for noncardiac illness. White children were predominantly referred in the course of routine examinations performed by pediatricians.

The findings reveal a need to plan specialty services in relation to the population base and with consideration of the accessibility and performance of the professionals who will select the patients for referral.
RAYNAUD'S DISEASE PRESENTING IN A 5-MONTH-OLD-MALE INFANT
Authors: Sayre James W.
Published: December 2021

Raynaud's disease appears to be an unusual disorder in early childhood. The manifestations in a 5-month-old infant described here seem to be in keeping with the accepted criteria of Raynaud's disease. It is unusual in that the toes were the earliest areas involved and presented severe, sustained vasoconstriction. Other cases reported in childhood also involved the toes more prominently than the fingers, the reverse of the usual observation in adults. Improvement while on reserpine therapy may be only coincidental.
KILLED SUBUNIT INFLUENZA VACCINE IN CHILDREN
Authors: Phillips Carol F. , Phillips Charles A. , Hodgkin William E. , Forsyth Ben R. , Rubin Ben A. , Geraghty Margaret E.
Published: December 2021

Thirty-three children ranging in age from 5 to 9 years were immunized with varying doses of bivalent A2 (Hong Kong variant) B subunit influenza vaccine. The immunization was given intramuscularly. There were no local or systemic reactions. Thirty-one of 33 children (94%) demonstrated four-fold or greater rises in antibody titer to type A antigen. Twenty-one of 33 (64%) showed four-fold or greater rises to type B antigen. A booster four weeks after immunization produced no significant increase in antibody titer. The subunit influenza vaccine, which is antigenic and well tolerated in children, should be considered for use if routine immunization of children against influenza is deemed desirable.
A NEW RETROGRADE METHOD FOR ADMINISTERING DRUGS INTRAVENOUSLY
Authors: Benzing George , Loggie Jennifer
Published: December 2021

A new technique for administering drugs, especially antibiotics, intravenously to pediatric patients is described. By insertion of a segment of tubing between two three-way stopcocks in the patient's intravenous line, drugs diluted for intravenous administration may be pushed retrograde.

After turning both stopcocks for infusion, diluted drugs are administered intravenously and automatically followed by maintenance fluids. If two or more drugs are given, their separation is accomplished by introducing a barrier volume of 5% glucose water. Nursing time and effort for intravenous drug administration are reduced to one-fifth to one-third of that required by the piggyback method. Preparation of diluted antibiotics in capped syringes by the hospital pharmacy additionally decreases time consumed by the registered nurse for drug administration. The I.V. Retrograde system has been used successfully for more than one year in a two hundred and thirty bed children's hospital.
COOLING IN THE EMERGENCY TREATMENT OF BURNS
Authors: Epstein Michael F. , Crawford John D.
Published: December 2021

Recent correspondence in the Lancet1-3 has called attention to the benefit of immediate cooling in the treatment of thermal injuries. This simple form of first aid can be provided as well by the layman as by the health professional and, more importantly, sooner. Given the same thermal stimulus, prompt cooling can mean the difference between extensive deep burns and more limited superficial injuries.

What is the evidence to back this claim? The studies of Henriques and Moritz4 and Ofeigsson5 indicate that after hot water or flame exposure the temperature of skin and of the deeper tissue layers remains high enough to result in a period of extension of coagulation necrosis.
Thyroid Abscess in Childhood
Authors: Olambiwonnu N. Olatunji , Penny Robert , Frasier S. Douglas
Published: December 2021

In a recent article by Kirkland et al.1 describing the nature of solitary thyroid nodules in 30 children, one child with thyroid abscess was reported. The authors reviewed 35 cases of abscesses in childhood, four of which were reported after 1950. We recently studied a child with thyroid abscess in whom the clinical course was characterized by multiple recurrences.

The patient was a 5 4/12 year-old-girl who developed progressive swelling in the anterior portion of the neck two weeks after the onset of intermittent low grade fever, rhinorrhea, and cough.
Stimulant Drugs and Growth of Hyperactive Children
Authors: Bates Talcott
Published: December 2021

The excellent and timely study by Drs. Safer and Allen,1 indicating suppression of longitudinal growth with dextroamphetamine, does not mention dosage.

Would the authors comment on this? Do all doses of dextroamphetamine sulphate suppress longitudinal growth in children or may there be a dose level which is nonsuppressive?
Letters to the Editor
Authors: Safer Daniel , Allen Richard P.
Published: December 2021

You are quite correct; the dose of dextroamphetamine was not included in the paper.1 The daily dose range for dextroamphetamine was 5 to 40 mg. The average daily dose was 12.4 mg. Fifty-four percent of the children received this medication during the summer, and 10% received the medication three times daily.

There was no significant relationship between the dose of dextroamphetamine and growth suppression, a finding presented in Table IV of the paper. We do not know if doses less than 5 mg daily are nonsuppressive of growth.
Causes of Pyloric Atresia
Authors: Szalay Glenn C.
Published: December 2021

Saw et al.1 refer to two reports of familial pyloric atresia; another example was recently reported by Keramidas and Voyatzis.2 Saw and co-authors state that 30 cases of pyloric atresia have been reported in the literature; Keramidas and Voyatzis mention a report in the German literature3 that "refers to 47 reported cases, and adds two reports."

Another rare cause of nonbilious emesis is pyloric duplication, which may more closely mimic pyloric stenosis.4 Saw et al. bring up the "vascular" theory, i.e., intrauterine ischemic infarction, to explain pyloric atresia but I questioti5 whether this theory can be used to explain either pyloric atresia, pyloric duplicalions, or gastric duplications.
POTENTIAL THERAPEUTIC PITFALLS IN REYE'S SYNDROME
Authors: Brown R. E. , Mullick F. G. , Madge G. E.
Published: December 2021

Reye's syndrome1 is no longer considered to be a rare disease, even though it was not described in medical school to those who graduated more than 10 years ago. This is probably the result of several factors, including the education of the pediatrician and pathologist to recognize the cardinal manifestations of the syndrome and their better appreciation of the spectrum of this disease process.

The essential features of this disease process which affects children are easily recognized. These include, in many instances, an antecedent, viral-type illness followed by protracted vomiting; the development of an encephalopathy without a concomitant encephalitis or meningitis; some evidence of hepatic dysfunction, usually in the absence of jaundice; and biopsy or autopsy evidence of fatty accumulation in the viscera, primarily the liver.
LONG-TERM EFFECTS OF OTITIS MEDIA A TEN-YEAR COHORT STUDY OF ALASKAN ESKIMO CHILDREN
Authors: Kaplan Gary J. , Fleshman J. Kenneth , Bender Thomas R. , Baum Carol , Clark Paul S.
Published: December 2021

Histories of ear disease, otoscopic examinations, and audiologic, intelligence, and achievement tests were obtained from a cohort of 489 Alaskan Eskimo children who have been followed through the first ten years of life. Seventy-six per cent had experienced one or more episodes of otitis media since birth. Of these, 78% had their first attack during their first two years of life. Perforations and scars were present in 41%. A hearing loss of 26 decibels or greater was present in 16%, and an additional 25% were in the normal range but had a measurable air-bone gap. Children with a history of otitis media prior to 2 years of age and a hearing loss of 26 decibels or greater had a statistically significant loss of verbal ability and were behind in total reading, total math, and language. In addition, children who had an early onset of otitis media but now had normal hearing with a conductive component were also adversely affected in verbal areas. The number of otitis media episodes was related to tympanic membrane abnormalities, hearing loss, and low verbal and achievement scores.

These findings indicate that otitis media has been a significant cause of morbidity in Alaskan Eskimo children, and its onset during the critical years of language development as well as the number of episodes play an important role in impairing verbal development.
In Reply: A New Syndrome? Or Galactosemia?
Authors: Wadlington W. B. , Riley Harris D.
Published: December 2021

We appreciate and agree with many of the comments of Dr. Ruth Harris. As pointed out in the article,1 the first patient was seen in 1950 and the second in 1954. We believe that galactosemia was ruled out by the negative Benedict's test of the urine of both siblings–the most practical technique available at that time. The Clinistix reagent strips were not introduced until 1956. In regard to her point about measuring galastose-1-phosphate uridyl transferase, it was pointed out in the article that there are now many other measurements which would be desirable in these patients which were not available at the time the patients were seen.
Phenergan® Is No Longer Available for Topical Use
Authors: Silverio John
Published: December 2021

I have read in a recent issue of Pedistrics (February 1973) the review of the Committee on Drugs entitled "Antihistamines in Topical Preparations."

I was surprised to see that the Committee mentions that Phenergan® (promethazine hydrochloride) "is available as a topical preparation."

For your information (and the information of the Committee on Drugs), I would like to state that the marketing of Phenergan Cream was discontinued over one year ago (January 13, 1972).

I am sure that the Committee on Drugs is willing to make the appropriate acknowledment so that the the readers of Pediatrics would not be mislead.
In Reply: Criteria for Ventilatory Assistance in Hyaline Membrane Disease
Authors: Avery Gordon B. , Fletcher Anne B. , O'Boyle Meade P.
Published: December 2021

We agree, in the main, with the commentary of Vidyasagar and Pildes concerning our objectively derived criteria1 for early intervention with ventilatory assistance in hyaline membrane disease (HMD). Accumulating experience supports the efficacy and relative freedom from complications of both continuous positive and negative expiratory pressure in the management of HMD. Some infants whose right to left shunts are not large enough to demand assistance by arterial oxygen criteria do seem to have markedly noncompliant lungs and have a tendency to tire on the second to fourth day of their illness.
Meningococcal Meningitis Presenting As Acute Cerebellar Ataxia
Authors: Yabek Steven M.
Published: December 2021

Acute cerebellar ataxia is a well-described, benign syndrome characterized by an acute dramatic onset of truncal ataxia, hypotonia, nystagmus, intention tremor, irritability and vomiting. The patients, generally under 5 years of age, usually have a preceding viral infection and undergo spontaneous cure without specific treatment within weeks or months of the onset. They remain afebrile and the cerebrospinal fluid shows only a mild pleocytosis and protein elevation later in the course of the disease.1-4

Although purulent meningitis can present with a wide variety of central nervous system manifestations, there have been no reports of bacterial meningitis manifesting as cerebellar ataxia until recently. This report will describe such a case.
PEDIATRICIANS' ROLE IN DAY CARE OF CHILDREN
Authors: Everist Bruce W. , Bloom David , Fink Donald L. , Green Frederick C. , Hass Gerald , James Grace , Martinez Waldo M. , Pisani Albert , Schoen Edgar J. , Sutliff Willis , Wheelock Seymour E.
Published: December 2021

This statement by the American Academy of Pediatrics on day care services for children points to desirable goals for physicians who are involved in day care programs.

Day care of children refers to the wide variety of arrangements which parents, for various reasons, choose for the care of their children of whatever age. This concept includes such facilities as family day care homes and group care-day care in child development centers, nursery schools, day nurseries, kindergartens, programs planned for hours before and after school and week- days when school is not in session-regardless of name, purpose, or auspices. Good day care provides educational experiences and guidance, health services, and social services as needed by the child and his family. It safeguards children, helps parents to maintain the values of family life, and helps prevent family breakdown.

Pediatricians should understand the implications of day care for children and their families. They should be familiar with quality standards for health and for general day care programs. They should know the potential of day care for promoting health and learning. They should also know the problems of day care and its potential dangers when services are poor in quality. In all cases, the pediatrician is encouraged to assume an active role in day care.

PEDIATRICIANS' CONTRIBUTIONS

Pediatricians can contribute to the experience of children in day care in a number of ways:

1. They may speak up as informed advocates on the quality of day care services in their community.

2. They may comment on day care educational materials, concepts, and programs.
Letters to the Editor
Authors: Hughes Gerald E.
Published: December 2021

Dr. Gerald E. Hughes comments as follows:

It is apparent that there is a lack of agreement about "the role" that various pharmaceutical manufacturers play at a scientific meeting. If the only role were providing samples and discounts and entertainment to the registrants, it is quite likely that medical organizalions and pharmaceutical manufacturers would have become equally disenchanted and the practice would have withered away. However, medical organizations generally expect scientific meetings to be self-supporting and would not be unhappy to have some margin of profit to support other educational activities.
Letters to the Editor
Authors:   Commitee on Drugs
Published: December 2021

The Committee offers the following comments:

The Committee on Drugs of the American Academy of Pediatrics appreciates the communication from Drs. Livingston, Berman, and Pauli concerning the use of amphetamines in the management of epilepsy. The Committee has carefully considered the two indications which Drs. Livingston et al. have raised in their letter. A thorough search of the medical literature by the Committee has failed to reveal any data documenting the efficacy of amphetamines in counteracting the side effects of usual anticonvulsant agents.
Letters to the Editor
Authors: Kane Robert L.
Published: December 2021

Dr. Kane commented as follows:

Dr. Browder's letter suggests an interesting explanation for our data. Certainly the working Navajo mother is likely to be more acculturated and thus less "at risk" than her nonworking counterpart. He has correctly suggested an explanation for the relationship between the small number of siblings and a large number of unmarried mothers in the neglect group. However, before one leaps to a causal association, it should be recognized that the neglect cases have fewer instances of no siblings than did the controls.
High-Dosage Intravenous Calcium Therapy for Osteoporosis and Osteomalacia in Anticonvulsant Therapy With Hypomobilization
Authors: Latorre Humberto , Kenny Frederic M.
Published: December 2021

Approximately 25% of those receiving the anticonvulsants diphenylhydantoin and phenobarbital have low serum calcium and elevated alkaline phosphatase levels which may be secondary to hepatic hydroxylase induction and inactivation of principal vitamin D metabolites. We found hypocalcemia, hypophosphatemia, and x-ray evidence of rickets in three children undergoing such therapy. Healing occurred in two patients who were maintained on anticonvulsants during two and four months of therapy with vitamin D, calcium and phosphorus supplement. Thereafter, vitamin D alone maintained the healing. A third patient with spastic quadriplegia, immobilized from infancy, had seizures treated with diphenylhydantoin and phenobarbital. At 9 years of age she had osteoporosis, osteomalacia, and spontaneous fracture. Rickets and secondary hyperparathyroidism were characterized by hypocalcemia, hypophosphatemia, elevated alkaline phosphatase, elevated phosphate clearance and low percent tubular reabsorption of phosphorus. Intravenous calcium gluconate (270 mg of elemental calcium/24 hours; total, 15 gm) over several two- to three-week periods resulted in healing of rickets and osteoporosis without deleterious side effects. Intravenous calcium therapy probably suppresses endogenous parathormone and may stimulate thyrocalcitonin. It deserves trial use in juvenile osteoporosis when rapid correction is necessary.

See figure in the PDF file
Loss of Limb Following Intravenous Diazepam
Authors: Schneider Sanford , Mace John W.
Published: December 2021

Since its introduction for the control of status epilepticus in 1965, parenterally administered diazepam has proven to be extremely effective in halting prolonged seizure activity. Reported side effects have been minimal and usually not associated with significant morbidity. However, apnea, bradycardia, hypotension, cardiac arrest, and conversion of atypical spike and wave status epilepticus to graudmal status have been reported. Additionally, thrombophlebitis following intravenous administration has been associated with diazepam. Langdon et al. recently stated that 3.5% of patients receiving diazepam intravenously Prior to esophagogastroscopy developed thrombophlebitis. In several patients venous thrombosis was marked and tender cords were palpable many months after injection.
A HUMOROUS ENGLISH CHILDREN'S POEM OF 1757
Authors: C. T. E.
Published: December 2021

The poem below was included in a little book published in 1757 with the tile Fables in Verse, for the Improvement of the Young and Old. The author is unknown.

THE BALD CAVALIER

WHEN periwigs came first in wear, Their use was to supply And cover the bald pate with hair, To keep it warm and dry.

For this good end, our Cavalier Determined one to buy, Which did so natural appear That it deceived the eye.

But riding out one windy day, Behold! a sudden squall Soon blew his feathered hat away, And periweg and all.

He joined the laugh with noddle bare, And sang in concert tone, ‘How should I save another's hair, Who could not keep my own?’

Moral

To take upon oneself a joke, Good humour shows and wit, Which may a second laugh provoke, And leave the biter bit.1
Counseling and Synthetic Steroids in Short Stature Without Organic Disease
Authors: Yaffe Sumner J. , Bierman C. Warren , Cann Howard M. , Cohen Sanford , Freeman John , Gold Arnold P. , Kenny Frederick M. , Riley Harris Dewitt , Schafer Irwin A. , Soyka Lester F. , Weiss Charles F. , Chudzik Gregory , Kenny Frederic M. , Schafer Irwin , Ballin John C. , Done Alan K. , Farchione Louis , Scott C. P. , Sawchuk Steven , Simopoulos Artemis P.
Published: December 2021

The common problem of short stature in children who are growing at a normal rate is best managed by clarification of, and attention to, the psychological issues. This may require referral for expert psychological counseling. In a few instances, the physician, parents, and patient may agree that carefully supervised use of one of the synthetic will be made on a short-term basis in an attempt to accelerate growth rate.
Continued Care of Urinary Tract Infections
Authors: Browning Robert W.
Published: December 2021

Dolan and Meyers do not mention one of the more important factors in the treatment of urinary tract infections in childhood. I refer to the practice of obtaining follow-up cultures at regular periods of time following the child's infection. It is common knowledge that infection may recur without symptoms; by obtaining serial follow-up cultures, reinfection can be discovered and treatment restarted. I would consider this to be as important as urologic referral, pyelography, etc.
A Method of Prediction of Age of Menarche From Height and Weight at Ages 9 Through 13 Years
Authors: Frisch Rose E.
Published: December 2021

A method of prediction of age of menarche from the height and weight of a girl at each age from 9 through 13 years using quartiles of total body water as percent of body weight, an indicator of body composition, particularly fatness, at each age is presented. A similar method to predict age of initiation of the adolescent growth spurt from the height and weight of a girl at age 8 years is also given. Comparison of the results with prediction by other methods supports the idea that the ratio of lean body weight to fat and the metabolic rate per kilogram are important for the determination of sexual maturation. The time difference between actual and predicted age of menarche was six months or less for 59% of the subjects at age 12, 53% at age 11, 48% at age 10, and 47% at age 9.
The Psychoanalytic Study of the Child, vol. 27, edited by Ruth S. Eissler, M.D., Anne Freud, L.L.D., D.Sc., M.D., Marianne Kris, M.D., and Albert J. Solnit, M.D. Quadrangle Books, Inc., A New York Times Company, 1973, 770 pp., $12.50
Authors: Aug Robert G.
Published: December 2021

As most readers probably know, The Psychonanalytic Study of the Child is a series of annual volumes which are collections of original articles written within a psychoanalytic frame of reference. Year after year, these articles are of uniformly high quality, and the current volume (1972) is no exception; however, there is great variation in the usefulness and relevance of these articles for the practicing pediatrician.

The articles in the current volume are grouped into five sections.
Neurological Sequelae of Group B Streptococcal Neonatal Infection
Authors: Horn Kenneth A. , Zimmerman Robert A. , Knostman James D. , Meyer W. Terrence
Published: December 2021

Eighteen survivors from a series of 44 infants with neonatal group B streptococcal infection were examined from eight weeks to four years later for possible long-term neurological sequelae. Of six infants with laboratory-validated group B streptococcal meningitis, one died at 11 months of age as a result of complications of hydrocephalus, and another infant was found to have minor neurological sequelae. Of the remaining 12 infants with documented or probable group B sepsis, two were found to have neurological residua. The combined morbidity and mortality rate in the group of 44 infants was 50% (18 deaths and four sequelae).
Psychological Problems of Children With Chronic Juvenile Arthritis
Authors: McAnarney Elizabeth R. , Pless I. Barry , Satterwhite Betty , Friedman Stanford B.
Published: December 2021

Adjustment of 42 children with chronic arthritis and an equal number of healthy children selected as matched controls were studied by three methods—parental, school, and individual psychological ratings. Children with arthritis were identified as having more psychological problems than the control group. It is suggested from this study that children with arthritis, but with no disability, may have more emotional problems than the disabled child with arthritis and more than a control group. Psychosocial evaluation and support are suggested as a routine part of outpatient services for arthritic children and their families, and some methods from this study may be applicable for this purpose.
Simplified Feeder for Infants With Cleft Palate
Authors: Paradise Jack L. , McWilliams Betty Jane
Published: December 2021

Standard pediatric texts accord scant attention to feeding problems in infants with cleft palate, dismissing them as mild and easily managed. Quite a different impression, however, is conveyed by retrospective accounts of parents' experience, which characterize the feeding process in such infants as laborious, time consuming, and anxiety provoking, with ingested volume often inadequate. Since actual studies of feeding and weight gain in infants with cleft palate have not been reported, the dimensions and implications of the problem remain uncertain.

When first seen at this Center, most infants under 1 year of age with cleft palate are undergrown. Weight gain has often averaged less than 500 gm monthly during the first few months of life, and histories of difficult feedings—often prolonged to an hour or more in duration—are the rule.

See image in the PDF file

See image in the PDF file

See image in the PDF file
Possible Remedy For Stuttering
Authors: Healy C. E.
Published: December 2021

I recently had an unusual patient whose management presented a very interesting possibility. This 14½-year-old girl was first seen by me a year ago for a regular examination for school, but had stuttering so severe as almost to preclude normal communication. She could start no word without stuttering. The more pressure applied to her, the worse the stuttering became, so that a simple yes or no would take as much as 30 seconds to speak.
A New Method of Providing Continuous Positive Pressure Breathing in Infants
Authors: Carden Edward , Levin Kenneth , Fisk Graham , Vidyasagar Dharmapuri
Published: December 2021

A simpler device for the production of CPPB has been described which is smaller, lighter, but functions as well as most conventional apparatus.
Primary Child Health Care by Family Nurse Practitioners
Authors: Greenberg Robert A. , Loda Frank A. , Pickard C. Glenn , Collins Phoebe , Compton Betty S. , Hargraves Glenda O. , Wilkman Margaret J.
Published: December 2021

This study analyzes the child health care role of four family nurse practitioners (FNPs) serving 990 families with 1,300 children in a rural clinic 30 miles from a hospital base. In a 12-month program they were trained to give primary care, using standing orders, to all family members. Respiratory infections, well child care, psychogenic problems, allergic conditions and injuries comprised 75.5% of pediatric cases. The FNPs managed 70.3% of all cases without physician consultation. Respiratory infections, well child care and gastrointestinal problems which comprised 57% of all cases were managed with a combined consultation rate of 14.3%. The physician maintained primary responsibility for the management of 3% of all cases. Review of medical records revealed that 93% of the cases were managed properly by the FNPs. The positive experience reported in this study indicates that the FNP role should be developed as one method of providing primary health care.
Human Growth After Birth (2nd Ed.), by David Sinclair, M.A., M.D., D.Sc., F.R.C.S.E. London: Oxford University Press, 1973, 212 pp., $7.95
Authors: Garn Stanley M.
Published: December 2021

This is a little paperback about growth and aging, extended in scope, and increased in price ($7.50), though the per-page cost (3.75£ per page) is not so horrendous as at first it may seem. For the price it provides an overview of the subject, 66 figures and 8 tipped-in plates, and a logical approach to the subject, with a distinctly British or U.K. flavor. It is intended "for preclinical medical students, but with the needs of paramedical workers and of students and teachers of human biology also in mind."
Neonatal Emergencies and Other Problems, by John Black, M.D., F.R.C.P. New York: Appleton-Century-Crofts, 1973, 282 pp., $14.45
Authors: Chernick Victor
Published: December 2021

Although not implicit in the title, this book presents a synopsis of perinatology. The publisher indicates it will be of interest to the house officer, general practitioner and midwife but the author states "the book is intended primarily for those who have the responsibility of the day-to-day care of the newborn infant." The former objective may have been realized but not the latter.

There are twenty-two chapters, beginning with prenatal factors which may influence the newborn infant such as maternal disease, drugs, the infant at risk because of previous abnormal pregnancies, metabolic disorders, and congenital malformations.
Letter to the Editor
Authors: Dobbing John
Published: December 2021

Dr. Littman's letter demonstrates the extent to which I have obviously failed to make myself clear to him (and perhaps to some others); and for this I apologize. I believe that a re-reading of my Commentary will convince him that I am entirely with him in his misgivings.

In particular, (1) I did try to stress my own misgivings about the unreasonable and unscientific extrapolation from rat to man which is prevalent in the literature;
Destined for fame—But one would not think it
Authors: Illingworth Ronald S.
Published: December 2021

Retrospective studies are often unsatisfactory because of the absence of important data. This is certainly true of biographies. For a pediatrician the study of the early life of persons destined for world fame is fascinating—though often disappointing because so often facts which one would particularly like to know about a person's childhood are unknown and unrecorded. Often, one feels biographical details are more anecdotal than factual; yet there is much to be learned from a study of the more useful biographies—and what one learns is not just a matter of interest. It is of much value in counselling distraught parents and teachers who are dismayed by the behavior, appearance, backwardness or poor progress of their charges.