bluuebunny/crossref_metadata_2025 huggingface dataset:
Spectrum of Salmonella-Associated Arthritis
Authors: Carroll William L. , Balistreri William F. , Brilli Richard , Parish Ruth Ann , Greenfield David J.
Published: December 2021

Arthritis is an uncommon extraintestinal manifestation of Salmonella infection. Three patients with Salmonella-associated arthritis with varying manifestations were seen at Children's Hospital Medical Center in an 11-month period: (1) a 12-year-old girl developed suppurative arthritis due to Salmonella typhimurium that required surgical drainage and prolonged parenteral antibiotic therapy; (2) a 12-year-old girl had migratory polyarthritis following gastrointestinal infection with S typhimurium; the acute synovitis subsided after a six-month period following anti-inflammatory medications; (3) a 14-year-old girl developed conjunctivitis, urethritis, and polyarthritis (Reiter's syndrome) in association with Salmonella gastroenteritis. These patients illustrate the distinct types of arthritis associated with Salmonella, and the association of this organism with both suppurative joint disease and reactive arthritis is reemphasized.
Adolescent Medicine: Subspecialty or Outcast?
Authors: Zack Brian G.
Published: December 2021

A subspecialty may be conceptualized as a relatively narrowly defined area of practice within a broader field, whose practitioners are expected to possess an expertise in that area significantly beyond that of the well trained generalist. In this sense adolescent medicine, as a subspecialty of pediatrics, has come of age.

In 1972 the American Academy of Pediatrics clearly included the adolescent age group within the boundaries of the responsibility of pediatrics.1 The American Medical Association officially recognized the field as a specialty in 1977.2 Shortly thereafter a Section on Adolescent Medicine was formed within the American Academy of Pediatrics.

In 1980 The Society for Adolescent Medicine published the inaugural issue of the Journal of Adolescent Health Care, the first scholarly journal devoted to the field.
Community Family Day Care: An Intermediate Solution Between Family Care and Institutional Care
Authors: Hoang Thu
Published: December 2021

In industrialized countries, the increasing participation in the work force of women during their childbearing years is now a well recognized fact.1,2 Choosing substitute care for her young child(ren) is a compelling question for a working mother to answer in relation to current knowledge of the effects of day care,3-6 the parents' feelings,7 the family finances, and the availability of facilities.6

In the United States the three popular forms of substitute care seem to be in-home, family, and institutional care.3-6
Letters to the Editor
Authors: Willis John
Published: December 2021

The suggestion by Dr Calmes that the ductus arteriosus could be an equally likely route for air to enter the systemic circulation from a peripheral vein seems well taken. I have no quarrel with Dr Calmes' interpretation and appreciate his insight.
A NATIONAL COLLECTION OF MATERIAL RELATED TO THE HISTORY OF PREMATURE INFANT CARE
Authors: Davis Audrey B.
Published: December 2021

An effort is under way to establish a collection of materials which will trace the development of perinatal-care technology in The National Museum of American History at Smithsonian Institution. Readers of Pediatrics are urged to cooperate in this national effort to locate materials of historical interest in back rooms of hospitals and in private collections.

The material of interest ranges from incubators (Lion-type used in incubatorbaby exhibits to the present-day models), resuscitation and ventilating devices (delivery-room apparatus, Bloxom Air-Lock, rocking bed, respirators ...), feeding items (gavage equipment, nasal spoons, indwelling tubes ...), photographs, hospital records (statistical reports, examples of patient records ...) and equipment used in landmark investigations (calorimetry, oxygen consumption ...).
Sustained Arterial Blood Pressure Elevation Associated with Pneumothoraces: Early Detection via Continuous Monitoring
Authors: Goldberg Ronald N.
Published: December 2021

The diagnosis of pneumothorax in the neonate is often heralded by such signs as deterioration of arterial blood gases, arterial hypotension, and cardiac arrest. An awareness of more subtle clinical signs of accumulating extra-alveolar gas may lead to earlier intervention and a decrease in morbidity. Fourteen episodes of pneumothorax developed in seven of 69 neonates who received ventilatory assistance (mean birth weight 1,828 ± 295 gm), of whom six were ventilated for hyaline membrane disease and one for pneumonia. Instantaneous heart rate and arterial blood pressure (ABP) were monitored continuously in all patients. Changes in vital signs were noted at a mean of 48 minutes (range 12 to 116 minutes) prior to thoracentesis. There was an increase in systolic ABP (7 to 26 mm Hg) associated with 70% of the episodes, and an increase in heart rate and pulse pressure associated with 57% of the episodes. By 20 minutes after thoracentesis there was a rapid decrease in ABP values toward levels not significantly different from base line. A sustained increase in ABP may be an early sign of accumulating extra-alveolar gas. Continuous monitoring and graphic representation of vital signs in the ventilated neonate may suggest the diagnosis of pneumothorax before clinical decompensation occurs.
An Animal Model for Airway Sensory Deprivation Producing Obstructive Apnea with Postmortem Findings of Sudden Infant Death Syndrome
Authors: Abu-Osba Yousef K. , Mathew Oommen P. , Thach Bradley T.
Published: December 2021

A series of experiments was performed in rabbits to investigate the effects of airway sensory stimuli on upper airway patency. Pharyngeal airway closure was observed in rabbits breathing through a tracheostomy tube; pharyngeal patency was rapidly restored either by closing the tracheostomy tube, which forced the animals to resume nasal breathing, or by creating cyclical pressure changes in the nose and pharynx to stimulate respiratory tidal airflow. This airway opening effect of pressure fluctuations was eliminated by topical anesthesia of the airway mucosa, an observation suggesting that sensory stimulation from pressure change is needed for airway patency. The observation that dead animals have a patent pharyngeal airway that is resistant to collapse from negative intraluminal pressure, whereas animals breathing via a tracheostomy have a readily collapsible airway that is closed at zero transmural pressure, suggests that airway-constricting muscles close the airway when the animals breathe via the tracheostomy. Loss of electromyographic activity from airway-dilating muscles (genioglossus) was observed during tracheostomal breathing and was restored by cyclical pressure changes applied to the upper airway lumen, an observation further supporting the concept that airway reflexes responding to pressure regulate the activity of airway-dilating and airway-constricting muscles. Topical anesthesia of the upper airway mucous membrane, which eliminated these responses to pressure, was associated with an obstructed pharynegal airway and death from apparent asphyxia in either pentobarbital-anesthetized adult animals or young animals without general anesthetic. Death resulting from airway obstruction in this manner was associated with postmortem findings of sudden infant death syndrome (pulmonary edema and pleural petechiae) in the majority of animals.
Postnatal Adjustment in Renal Function
Authors: Strauss Jose , Daniel Salha S. , James L. Stanley
Published: December 2021

Renal function was studied serially in 17 healthy term infants during the hours immediately following birth. Of 14 infants delivered vaginally eight received placental blood transfusion and six did not. The remaining three infants were delivered by cesarean section and received placental blood transfusion. Results indicate that the general pattern of change in urine output (V), clearance of inulin (CIN), and p-aminohippuric acid (CPAH), was similar in all infants despite a wide range in each of the functions measured. The pattern showed an initial increase in V, CIN, and CPAH followed by a decline to low values in all infants by 3 hours of age. Urine osmolality and output generally changed in opposite directions. During the first hour the values for V ranged from 0.02 to 0.47 ml/min; for CIN, from 0.5 to 9.1 ml/min; for CPAH, from 1.4 to 21.8 ml/min; and for osmolality, from 98 to 457 mOsm/kg. By 4 hours of age the values for V ranged from 0.01 to 0.15 ml/min; for CIN, from 0.8 to 3.7 ml/min; for CPAH, from 0.8 to 7.5 ml/min; and for osmolality, from 240 to 520 mOsm/kg. The initial values of V, CIN, and CPAH, as well as the changes, were greatest in those infants who received a placental transfusion; however, there were no statistical differences among the means of the various groups. By 4 hours of age, the range of values observed in the initial measurement was much less pronounced. This probably reflects the achievement of stability of renal circulation following adaptation to a variety of stresses during the intrapartum period.
Effect of Resident Peer Review on Charting Behavior
Authors: Greene John W. , Altemeir William A. , Moroney David M. , O'Connor Susan M.
Published: December 2021

Traditionally the medical profession and, more recently, federal agencies have promoted peer review to improve quality of health care, although its effectiveness is uncertain. To assess ability of peer review to increase recording of comprehensive care, the resident charting of growth, immunizations, and family, past medical, developmental, and birth history was monitored in randomly selected charts six months before (747 charts) and six months after institution of peer review (691 charts). Faculty emphasis for charting remained uniform throughout the study. During ten 1-hour sessions, pediatric residents reviewed the charts of their colleagues for comprehensive care and other measurements using a standard form. Although faculty were not present, residents reported by post-study interview that vigorous discussion and peer pressure occurred during the sessions, and subjectively they felt their charting had improved. An objective assessment indicated charting of past medical history worsened after peer review was initiated, and charting of family history improved slightly. All changes were marginal. Charting was not related to the volume of patients seen by individual residents or their level of training but was relatively consistent for individual residents over successive rotations.
Pediatricians Will Speak Up for Themselves!
Authors: Austin Glenn
Published: December 2021

The majority of us in pediatrics are primary care pediatricians who take care of children and young families on a day-to-day basis. All of us are proud that over the past decades we have managed to keep more and more children out of hospitals, that we have reduced infant mortality to an all-time low, and that we have managed to contribute in a very positive and meaningful way to the lives of the patients and parents we serve, as witnessed by the affection and esteem in which we are held by the individual families in our practices. They manifest their belief that we are the best equipped of all professionals to handle most of their children's health and psychosocial problems by the fact that 83% of reimbursements for care in pediatricians' offices are paid for "out of pocket" by young and generally nonaffluent families.1
Letters to the Editor
Authors: MacLean William C.
Published: December 2021

I was disappointed to see the recent commentary, "The Bowel Cocktail."1 A commentary in Pediatrics carries weight similar to that of an editorial and as such some degree of implied endorsement by the journal. It is Unfortunate to have Pediatrics seeming to endorse a shotgun approach to a common pediatric problem with many etiologies that deserves more thought than the mixing of a cocktail.

The article in the South African Medical Journal2 referenced by the authors in support of their cocktail is an anecdotal report of ten infants, far smaller than the 132 to 218 children referred to in the commentary.
Pediatric Manpower
Authors: Robertson William J.
Published: December 2021

The "Critique of the Final Report of the Graduate Medical Education National Advisory Committee by the Committee on Pediatric Manpower" (Pediatrics 67:585, 1981) and the special article by Dr Budetti, "The Impending Pediatric ‘Surplus’: Causes, Implications, and Alternatives" both fail, in my opinion, to address the principal dilemma that faces pediatricians and particularly pediatric educators. I refer to the paradox that while there is a projected surplus of 7,500 pediatricians by the year 1990, there are projected shortages in the five pediatric subspecialties of pediatric cardiology, endocrinology, hematology-oncology, nephrology, and neonatology.
Questions Controls
Authors: Garrison Stephen F.
Published: December 2021

In regard to the article, "Indomethacin Treatment for Symptomatic Patent Ductus Arteriorus: A Double-Blind Control Study" (Pediatrics 67:647, 1981), I feel that the study is invalidated because of poor controls. The authors state, "Despite randomization, however, in phase 2 the indomethacin-treated infants were significantly larger and more mature than the corrsponding control subjects, 1.39 ± 0.1 kg and 31.4 ± 0.5 weeks vs 1.1 ± 0.1 kg and 29 ± 0.4 weeks, respectively." A statistical difference of 2 weeks of gestational age could account for the increased morbidity and mortality of the control group.
Letters to the Editor
Authors: Stare Fredrick J.
Published: December 2021

After our review went to press, a brief report on the California study was published (Weiss B, Hicks Williams J, Margen S, et al: Behavioral responses to artificial food colors. Science 207:1487, 1980). However, such a short paper cannot do justice to the thoroughness and complexity of this study. A more complete discussion of this important experiment can be found in the investigators' report to the Food and Drug Administration (Margen S, Weiss B, Hicks Williams J, et al: Report on phase II—FDA contract 223-76-2040: A dietary challenge study of artificial food colors in children 1-7 years old with behavioral disturbances, 1978.
Expensive Burden?
Authors: Bonnet Gabrial A.
Published: December 2021

In response to the article "On Growing New Neurons: Are Early Intervention Programs Effective" (Pediatrics 67:38, 1981), it is no wonder that the practicing pediatrician continues to be confused in knowing what is "best" for the developmentally disabled individual. This subject continues to be clouded with many unanswered questions. What is most concerning to many of us is that a referral to the Developmental Disability Clinic often generates tremendous expense to the family which in most cases is already burdened with significant debts.
Plant Fiber Intake in the Pediatric Diet
Authors: Walker A. R. P. , Burkitt D. P.
Published: December 2021

The report of the Committee on Nutrition1 on the above topic, is to be commended for its balanced approach, deliberations, and conclusions.

High fiber diets were consumed ubiquitously by our ancestors of scarce a century ago, and are still consumed by many rural dwellers in Europe, and of course by the huge majority of Third World populations. It is therefore a stinging reflection on the poverty of our nutritional knowledge that uncertainty is still expressed over whether high fiber diets promote mineral deficiencies.
Role of Self-Esteem and Autonomy in Determining Medication Compliance Among Adolescents with Juvenile Rheumatoid Arthritis
Authors: Litt Iris F. , Cuskey Walter R. , Rosenberg Anne
Published: December 2021

This study was designed to improve understanding of adolescents' compliance with medical regimens. Compliance with salicylate therapy among adolescents with juvenile rheumatoid arthritis was examined in relationship to two of the most important issues of adolescent psychosocial development—self-image and autonomy. Standardized instruments that assessed these variables were administered to 38 adolescents with juvenile rheumatoid arthritis during the year in which compliance was determined, utilizing serum salicylate measurements. Patient and disease-related characteristics were also recorded, and interactions with personality variables were examined. The data show that adolescents with juvenile rheumatoid arthritis who comply with their medical regimen are those who have high self-esteem and are allowed more autonomy than the noncompliers. The longer the duration of the illness and the more symptoms present at onset, the poorer was self-concept, and hence compliance, at adolescence.
A Simple Method of Assessment of Gestational Age in Newborn Infants
Authors: Narayanan Indira , Dua Kavita , Gujral V. V. , Mehta D. K. , Mathew M. , Prabhakar A. K.
Published: December 2021

A simple method of assessment of gestational age based on only four characteristics, namely, the anterior vascular capsule of the lens, plantar creases, breast nodule, and ear firmness, is presented. Critical evaluation by appropriate statistical analyses has shown this to be a useful method of practical value with 95% confidence limits of 11 days. It is applicable to newborn infants, including sick babies, at any time within the first 2 days of life.
A Hospice Setting for Humane Neonatal Death
Authors: Silverman William A.
Published: December 2021

"To be told the meaning of your life by others, in terms which are not yours," sociologist Peter Marris has pointed out,1 "implies that your existence does not matter to them except as it is reflected in their own." This kind of life-defining authoritarianism has, in the past, been justified in the name of morality—and the dictatorial behavior of moral leaders has not abated in the present day. For example, a melodrama has recently been enacted in Danville, IL: parents and personal physician were indicted for attempted murder by starvation of malformed conjoined twins (Associated Press: Parents of Siamese twins charged. June 12, 1981).
Letters to the Editor
Authors: Barst Robyn J. , Prince Alice S. , Neu Harold C.
Published: December 2021

This case report is very encouraging in demonstrating that with recent advancements in echocardiographic technology and clinical perseverance, infective endocarditis (including Aspergillus endocarditis) can be diagnosed by noninvasive techniques. Echocardiography has been helpful in the diagnosis of infective endocarditis (Dillon T, et al: Management of infective endocarditis using echocardiography. J Pediatr 96:552, 1980), although no previous cases of Aspergillus endocarditis diagnosed by echocardiography have been reported. We are hopeful that with continued improvement in M-mode and two-dimensional echocardiographic technology that the necessity for angiocardiographic documentation of suspected vegetations will be eliminated.
Developmental and Neurologic Sequelae of Neonatal Hyperviscosity Syndrome
Authors: Black Virginia D. , Lubchenco Lula O. , Luckey Dennis W. , Koops Beverly L. , McGuinness Gail A. , Powell Douglas P. , Tomlinson Alan L.
Published: December 2021

One hundred eleven consecutive infants with neonatal hyperviscosity were identified by screening all newborns for polycythemia in an 18-month period. These polycythemic infants were matched with nonpolycythemic newborns for birth weight, gestational age, Apgar scores, and sex. Maternal, intrapartum, and neonatal data were analyzed for associated morbidity. Maternal preeclampsia was more common among the hyperviscous patients than among control subjects. Hypoglycemia was also significantly increased among the hyperviscous patients. Follow-up studies at 1 to 3 years of age revealed a significantly higher incidence (38% vs 11%) of motor and neurologic abnormalities in the infants with neonatal hyperviscosity. The data suggested that concurrent hypoglycemia increased the risk of a poor outcome in hyperviscous infants inasmuch as 55% of infants with both characteristics were abnormal at follow-up. This, however, was not significantly different from the outcome of infants with hyperviscosity alone (P > .05 but < .1). Further studies will be needed to confirm or deny this relationship.
THE BURROW INK TEST FOR SCABIES
Authors: Marcuse Edger K.
Published: December 2021

In France, the diagnosis of scabies rests upon finding le sillon (a well defined, zigzagged burrow) on an afflicted patient with the aid of a simple fountain pen. This so called Burrow Ink Test (BIT) consists of gently rubbing the scabietic papule with the underside of a fountain pen, covering it with ink. The excess ink is then wiped off with an alcoholsaturated gauze. If a burrow is present the ink will track down it and outline the limits of the canal....

In the United States, the diagnosis of scabies is made by the direct demonstration of the mite, the egg or the scybala (fecal pellets) in the skin....

Although the importance of le sillon ... was emphasized in 1835 by Simon Francois Renucci, the BIT has been passed along from generation to generation of French dermatologists by word of mouth without ... a definitive study.... We attempted to complete the work of Dr. Renucci by comparing the BIT with the superficial shave biopsy to establish its diagnostic validity....

Results. All ... 25 BIT-positive lesions provided material for superficial shave biopsy in which the mites, eggs, fecal pellets or any combination of the three were found.... Stated another way, if a lesion was BIT positive, it was also positive with the superficial shave biopsy.

By contrast, 11 of 30 BIT-negative lesions provided material for a positive superficial shave biopsy.

Discussion. The history of scabies seems to have evolved in a "two steps forward, one and one-half steps backward" fashion.... In 1657, Hauptman observed the mite under the microscope.... Thirty years later ... Bonomo and Cestoni extracted the mite from under the skin, observed it under the microscope and described it as a "small turtle".... Unfortunately, others could not repeat this work.... Lugol (of ... solution fame) ... offered 300 crowns ... to anyone who could demonstrate the mite.
Letters to the Editor
Authors: Ross Maurice
Published: December 2021

Berger does not appear to have an appropriate concept of how pediatricians manage private practices. I believe that all pediatricians are aware of the proper utilization of ancillary personnel to assist them in providing anticipatory guidance and preventive health care and that the vast majority employ such aides. I have trained and employed pediatric nurse associates. However, the original subject under discussion was the actual time spent by pediatricians and not by their staffs. The increasing cost of employing such personnel also adds to the expense of meadical care.
Pseudocholesterol Crystals in Urines of Newborns
Authors: Nanji Amin A.
Published: December 2021

Cholesterol crystals, which appear as irregularly or regularly notched transparent plates, are sometimes seen in urine and indicate severe urinary tract infection or rupture of lymphatic vessels into the renal pelvis. They have also been observed in synovial fluid and indicate a severe form of arthritis.1 On a number of occasions, I have observed in urine crystals whose shape resembles that of cholesterol crystals. These were found in the urines of healthy newborns. The crystals were not soluble in organic solvents such as ether and acetone.
Isopropyl Alcohol Burns
Authors: Weintraub Z. , Iancu T. C.
Published: December 2021

In their article "Burn Hazard of Isopropyl Alcohol in the Neonate" Schick and Milstein (Pediatrics 68:587, 1981) report two cases of second-degree and third-degree skin burns in premature infants. Both patients were of very low-birth-weight (756 gm at 22 weeks and 850 gm at 25 weeks) and isopropyl alcohol had been used either for conduction on ECG, or preparation of the umbilical stump for arterial catheterization.

We wish to report on four similar cases observed between 1977 and 1979.
Reducing Prescription Costs
Authors: Snodgrass Gary L.
Published: December 2021

The recent article by Chilton1 is an excellent attempt to increase physician awareness of prescription costs. However, the discussion of "quantity discounting" omits several important points. The following should be carefully considered before accepting the strategy of "prescribing a larger amount of a drug once" to effect cost savings.

1. Although increasing the prescription quantity reduces the cost per unit of medication, the overall prescription price is higher. A patient may call the pharmacy for a price quote and once hearing this larger amount may refuse to have the prescription filled altogether.
Dysmorphology and Adoptions
Authors: Wilkie Ormond L.
Published: December 2021

I read with interest the letter by Frank et al1 regarding the overrepresentation of adopted children in their dysmorphology clinic population.

The adolescent unit at College Hospital, Cerritos, CA is a treatment center for teenage patients with sociopathic behaviors, ie, truancy, running-away, incorrigibility, stealing, etc. Of the 131 teenagers admitted in 1980 to 1981, 25 (19%) were adopted, most shortly after birth. Of the 25 adopted children, 13 were male and 12 were female. Of the adopted children 20% had an abnormality of the birth process whereas this was noted in 27% of the children that were not adopted.
Letters to the Editor
Authors: Yogev Ram
Published: December 2021

Zaret raises an important issue—the interaction between chloramphenicol and other medications and more specifically, the interaction between chloramphenicol and acetaminophen, which has been reported to increase the t½ of chloramphenicol.1 However, the paper cited as evidence for such interaction has several faults, in our opinion. First, there was no control group—ie, patients receiving chloramphenicol alone. Second, acetaminophen was administered intravenously, and the levels achieved were not reported. Any competitive inhibition observed might relate to the high levels obtained by the intravenous administration, which might not be reached when the oral route is used.
Psychopharmacology of Attention Deficit Disorder: Pharmacokinetic, Neuroendocrine, and Behavioral Measures Following Acute and Chronic Treatment with Methylphenidate
Authors: Shaywitz Sally E. , Hunt Robert D. , Jatlow Peter , Cohen Donald J. , Young J. Gerald , Pierce Richard N. , Anderson George M. , Shaywitz Bennett A.
Published: December 2021

Despite the frequent use of methylphenidate (MPH) in school-aged children with disorders of attention, impulsivity, and activity regulation (attention deficit disorder, ADD), little is known of its clinical pharmacology. The pharmacokinetics of MPH as well as its effects on growth hormone and prolactin were examined after oral administration in 14 boys with ADD ranging in age from 7 to 12 years (mean 10.4 years). Peak concentrations determined in these acute studies were compared with concentrations obtained two hours after MPH administration in another group of children with ADD who were receiving MPH chronically. After a lag phase of approximately ½ to 1 hour, MPH reached a peak plasma concentration at 2.5 ± 0.65 hours after 0.34 mg/kg and 1.9 ± 0.82 hours after 0.65 mg/kg (mean ± SD). Terminal half-lives were 2.53 ± 0.59 and 2.61 ± 0.29 hours after administration of 0.34 and 0.65 mg/kg, respectively. Observed maximal concentrations ranged from 11.2 ± 2.7 ng/ml after administration of 0.34, and 20.2 ± 9.1 ng/ml after administration of 0.65 mg/kg. The mean area under the curve after administration of 0.65 mg/kg was approximately double that calculated at 0.34 mg/kg. Plasma growth hormone increased significantly from an initial (pre-MPH) mean concentration of 4.4 to peak at two hours at 10.5 ng/ml. Prolactin concentration declined significantly from a pre-MPH level of 9.5 to a nadir at 1½ hours of 3.80 ng/ml, supporting the notion that MPH is acting via central dopaminergic mechanisms. MPH concentrations in children receiving doses of 0.34 mg/kg chronically averaged 8.00 ± 0.91 at two hours, after medication, approximating the mean concentration at the same time observed in the acute study. The concentration of MPH in single "spot" samples obtained at two to three hours after administration of medication were significantly correlated with the percentage of improvement in the abbreviated Conners rating scale, indicating a relationship between plasma MPH concentration and clinical response.
FRIEDREICH'S ATAXIA
Authors: Copps Stephen C.
Published: December 2021

The clinical features of 115 patients from 90 families with Friedreich's ataxia are described. Onset of symptoms was before the age of 25 (mean 10.52) years in all the index cases. An analysis of early cases suggested that limb and truncal ataxia and absent tendon reflexes in the legs were the only consistent diagnostic criteria within five years of presentation. Dysarthria, signs of pyramidal tract dysfunction in the legs and loss of joint position and vibration sense are not necessarily present during the first five years of symptoms, but appear to develop eventually in all cases. Scoliosis and ECG evidence of cardiomyopathy were found in over two-thirds of the patients studied; pes cavus, distal amyotrophy, optic atrophy, nystagmus and deafness were all less frequent. The disorder was gradually progressive in all cases. The mean age of losing the ability to walk was 25 years; 95 per cent were chair-bound by the age of 44 years.

About 10 per cent of the patients had diabetes mellitus which was controlled by oral hypoglycaemic drugs in one quarter. Diabetes appeared to be associated with a higher incidence of optic atrophy and deafness. Diabetes also clustered within sibships; the risk of an individual with Friedreich's ataxia developing diabetes if an affected sib has it is over 40 per cent. Similarly, cardiomyopathy ran true within affected members of the same sibship, but there were instances of discordance which suggest that the development of the non-neurological features of Friedreich's ataxia may be controlled by modifying genes rather than heterogeneity of the main gene.
PHYSICIANS RATED HIGHLY IN NEW OPINION SURVEY
Authors:   Student
Published: December 2021

Clergymen and physicians provide more significant contributions to society than other professionals, most Americans believe.

The results of a recent Gallup Poll conducted by the American Institute of Public Opinion showed clergymen and physicians atop a list of 12 professionals rated by respondents to the poll.

The poll also showed that the public perceives that physicians work under the most stress or pressure, and that they enjoy the highest prestige of any of the professions.

Following are the results of the poll:

See table in the PDF file
Factitious Hypoglycemia
Authors: Mayefsky Jay H. , Sarnaik Ashok P. , Postellon Daniel C.
Published: December 2021

Insulin abuse resulting in hypoglycemia was originally reported in 1947.1,2 However, not until the 1970s was the serum C-peptide level recognized to be a reliable marker of pancreatic β-cell activity.3 Human C-peptide radioimmunoassay has been advocated recently as a useful test in diagnosing insulin-induced factitious hypoglycemia.4,5 This report describes a case of child abuse presenting as hypoglycemic coma secondary to insulin injection. The diagnosis was made by the presence of the pathognomonic triad: hypoglycemia, hyperinsulinemia, and low serum levels of C-peptide.

CASE REPORT

A 2-year-old black boy was brought to the emergency room in an unresponsive state. He was said to be unarousable after his regular afternoon nap.
A General Journal, High Prices, and New Journals
Authors: Lucey Jerold F.
Published: December 2021

There are now more than 40 pediatric subspecialty publications. Each season a new journal appears, promising to satisfy the needs of its specialized audience. These journals are expensive because they have very small circulations. Subscription fees are usually close to $100 a year.

Libraries are usually charged a double subscription fee and that is beginning to be a problem. The most expensive pediatric journal at this time is Biology of the Neonate at $248 per year! Our own university library spends more than $2,000 a year on subscriptions to 36 pediatric journals. Libraries are caught in the budget squeeze as each year subscription costs increase by 15% as do the total number of journals!
Prevention of Fetal Alcohol Effects
Authors: Rosett Henry L. , Weiner Lyn
Published: December 2021

The effects of alcohol on fetal development have gained renewed scientific attention during the decade following identification and description of the fetal alcohol syndrome (FAS). An association between maternal alcohol abuse and growth retardation, physical anomalies, and developmental delay in the fetus has been demonstrated through clinical, epidemiologic, and experimental evidence. The effects of various doses at different stages of gestation remain unclear. Is there a critical level of alcohol consumption that regularly produces the full FAS? Is there a lower threshold below which there is no danger of adverse effects? Is there one critical period during gestation or can adverse effects occur throughout pregnancy?
Help Wanted
Authors: Margolis Lewis H.
Published: December 2021

With a regularity reminiscent of the guillotine in revolutionary France, the monthly unemployment figures pronounce a sentence of hardship for an ever increasing number of American families. Because there are 100 million workers in the labor force, a 1% rise in the rate of unemployment translates into an additional 1 million jobless individuals, but this figure disguises the impact of unemployment on children and families.

How many children will experience the effects of parental unemployment in the coming months? The incidence of unemployment during a year exceeds the prevalence at the time of any given survey, the commonly reported figure.
In Reply: Skinfold Thickness
Authors: Sumners James , Heimler Ruth
Published: December 2021

We appreciate the critical eyes of Swyer and associates for the detection of our error in units of measurement. On review of our original data (Pediatrics 68:82, 1981), we found that rate of change in skinfold thickness should have been expressed in millimeters per week instead of millimeters per day. This change of units does not, of course, change the results of statistical analysis or conclusions derived.

We look forward to further studies to elucidate the etiology of the phenomenon reported.
Hyperalimentation Laboratory Support
Authors: Rutledge Joe , Miller Larry
Published: December 2021

The Committee on Nutrition, American Academy of Pediatrics has recently reported on the "Use of Intravenous Fat Emulsions in Pediatric Patients" (Pediatrics 68:738, 1981). The committee recommends restriction of the amount of fat emulsion given infants because of a lack of accurate and appropriate means of monitoring serum fatty acid and triglyceride concentrations. Such is not the case for triglycerides.

The pediatric clinical chemistry laboratory has the ability to measure serum triglyceride concentrations to support hyperalimentation therapeutic monitoring.
In Reply: Epileptics and School Personnel
Authors: Nader Philip R. , Brink Susan G.
Published: December 2021

Beringer, Biel, Ziegler, and Lai are quite correct in their calculations and conclusions about the low frequency of seizures compared with frequency of asthma attacks as a chronic condition in our population. One seizure episode occurred during the study period. In addition, two children were receiving antiseizure medication on a regular basis, thereby qualifying as maintenance episodes.

The purpose of our study was to identify types of health care problems rather than investigate in depth care issues for specific chronic conditions.
Atypical Measles Syndrome: Pathologic and Serologic Findings
Authors: Annunziato David , Kaplan Mark H. , Hall William W. , Ichinose Herbert , Lin Jen H. , Balsam Deborah , Paladino Vincent S.
Published: December 2021

The clinical course of measles occurring in 17 adolescents who had previously received killed measles vaccine is described. All adolescents had a peripheral dermatitis. Fifteen had characteristic pulmonary infiltrates. Serologic study in six adolescents using immunoprecipitation of 35S-methionine-labeled measles virus antigens revealed that 5/6 acute sera lacked antibody to the hemolysin antigen whereas 5/6 sera contained antibody to hemagglutinin antigen. Skin biopsies, obtained from three patients, demonstrate a combination of an Arthus reaction and delayed hypersensitivity. The typical measles histologic complex was absent. Measles virions were seen in the deep dermal blood vessels. The serologic and histopathologic presentation of this disease indicates that killed vaccine does not adequately induce antibody to the hemolysin (F) which is necessary to prevent cell-to-cell spread of paramyxoviruses. Killed vaccine does, however, produce hemagglutinin antibody and simultaneously incites later hypersensitivity to wild virus infection, producing the unusual dermatopathologic reaction seen.
DRIED SKIMMED MILK, BREAST-FEEDING, AND ILLNESS EPISODES
Authors: Haggerty Robert J.
Published: December 2021

In a controlled trial mothers and children attending urban maternal and child health clinics in Khartoum Province were given a fortnightly take-home food supplement of 1 kilogram of dried skimmed milk or an equivalent amount of local beans. There were approximately 300 children aged 6 to 26 months in each group and each child was followed for three to six months. A comparison of the two groups showed: (a) that the dried skimmed milk group mothers were more likely to continue breast-feeding; (b) there was no evidence to associate dried skim milk with an increased incidence of episodes of diarrhea, fever, or vomiting; (c) the utilization of health institutions was very similar in the two groups; and (d) there was no significant difference in the mothers' assessment of the proportion of children with a "poor" appetite in either group. This trial met with considerable methodological problems and the results should therefore be interpreted cautiously. There is a great need for more and better designed trials to assess the possible adverse effects of dried skim milk.
TEACHING STYLE
Authors:   Student
Published: December 2021

Conformity with authority, mastery of knowledge, specialization, adherence to a school of professional work, and emphasis on technique have all been identified . . . as means by which medical students control anxieties generated by the complexity of clinical practice. Therefore the right/wrong teaching attitude probably meets students' expectations more effectively than the attitude of instructors who present alternative views, dwell on controversies, and seem vague and indecisive.

Despite its popularity with students, we believe that authoritarian teaching not only may delay their cognitive development but also may affect their future attitudes towards student and patient education. A physician who has been trained to believe that there is only one legitimate approach to a given clinical situation may become insensitive to complexities in diagnosis, treatment, and patient relations. He may be less able to tolerate questions from his patients and students and may consider any inquiry into his decisions a threat to his authority. His response to criticism, whether real or imagined, may be "I disagree with you, and therefore you are wrong," rather than "I disagree, but you may be right." Indeed, some physicians show impatience and even hostility when patients do not comply with their orders, when they seek a second medical opinion, or even when they ask for further information about their diseases.
PARAMETER
Authors:   Student
Published: December 2021

Parameter is currently a very popular word, particularly among bureaucrats. I think it's generally used as a mispronunciation of "perimeter." A typical sentence from, say, a TV interview might go, "We've bent every effort to incorporate those subfunctions within the parameters of our organizational structure." As perimeter, that might make sense, perimeters being boundaries. I was puzzled as to why so many bureaucrats had decided to pronounce perimeter as parameter. I wondered if perhaps parameter meant nearly the same thing. Maybe a parameter was like a perimeter only better. I looked it up. Webster's New International, third edition:

pa·ram·e·ter. . . 1: the relative intercept made by a plane on a crystollographic axis, the ratio of the intercepts determining the position of the plane 2a: an arbitrary constant characterizing by each of its particular values some particular member of a system (as of expressions, curves, surfaces, functions) < a ∼ is a quantity which may have various values each fixed within the limits of a stated case or discussion—T. F. Weldon > specif: a quantity that describes a statistical population < a clear distinction should always be drawn between ∼s and estimates, i.e., between quantities which characterize the universe, and estimates of these quantities calculated from observations—Statistical Methods in Research & Production > < estimation of the values of the ∼s which enter into the equation representing the chosen relation—Frank Yates > b: an independent variable through functions of which other functions may be expressed < four ∼s are necessary to determine an event, namely the three which determine its position and the one which determines its time—P. W. Bridgman >
Malacoplakia of the Retroperitoneum in a Girl with Systemic Lupus Erythematosus
Authors: Hamdan Jahed A. , Ahmad Mohammed S. , Sa'adi Abdel Rahman
Published: December 2021

Malacoplakia is a rare chronic inflammatory disease, usually involving the bladder but occasionally affecting other organs. However, only two cases of malacoplakia of the retroperitoneum and ureter have been reported in the English language literature.1,2 Herein, we describe the third case of malacoplakia of the retroperitoneum and ureter in a patient with systemic lupus erythematosus who had been receiving prednisone therapy for two years. Modification by the steroid of phagocytosis and of the normal inflammatory response to bacterial infection, and the systemic lupus erythematosus, may have been of major importance in the genesis of malacoplakia in this patient.

CASE REPORT
Prenatal Alcohol Eftect Disputed
Authors: Miller Marvin
Published: December 2021

The conclusion of the article "Developmental language disability as a consequence of prenatal exposure to ethanol" by Shaywitz et al (Pediatrics 68:850, 1981), based on the two reported cases, is misleading and probably erroneous.

First, the authors have misinterpreted their raw, numerical, growth data. Using the same standard growth curves that they did,1 I find that the 118-cm height of S.E. (case 1) at 410/12 years of age is not 50th percentile as they state, but greater than the 97th percentile, and his weight of 20 kg is not 50th percentile as they state, but 75th percentile.
Valproic Acid: A Different View
Authors: Penry J. Kiffin
Published: December 2021

The Committee on Drugs of the American Academy of Pediatrics has prepared a statement on the benefits and risks of the antiepileptic drug valproic acid; this statement appears in this issue of Pediatrics (70:316, 1982). This report is extensive and objective in its review of published data on valproic acid, and is of great value to practicing pediatricians for that reason. However, the review fails to place vaiproic acid in perspective with other marketed antiepileptic drugs, which in many instances have equally serious side effects.
Improved Survival in the Suckling Rat Model of Group B Streptococcal Sepsis After Treatment with Nonsteroidal Anti-inflammatory Drugs
Authors: Short Billie Lou , Miller Marilea K. , Fletcher John R.
Published: December 2021

The nonsteroidal anti-inflammatory drugs, indomethacin and ibuprofen, have been shown to increase survival in various animal models of Gram-negative or endotoxin shock. To evaluate the use of these drugs in group B streptococcal sepsis, a clinically similar disease state, a newborn suckling rat model (4 to 5 days old) designed to simulate early-onset group B streptococcal sepsis was used. Sepsis was induced by a subcutaneous injection of group B streptococcal organisms (type III). A mortality ranging from 30% to 90% was used for the study. Indomethacin (3 mg/kg) or ibuprofen (4 mg/kg) treatment was administered by an intraperitoneal injection either at the time of the bacterial injection or after bacteremia (four hours) had occurred. Indomethacin clearly improved survival rates, even when given after bacteremia. Ibuprofen also clearly increased survival when given at the same time as the bacterial injection. Ibuprofen was more effective than indomethacin in the high mortality model (lethal dose for 90% survival of group). These drugs alter mechanisms that may be important in the irreversibility of sepsis and they may become useful adjuvants to our present treatment of early onset group B streptococcal sepsis.
THUNDER BREAKS THE GLUE
Authors:   Student
Published: December 2021

Graduate students, scientists and other researchers may find theory construction a rather complicated business. But first and second-graders seem to come up with explanatory answers to account for events with astonishing ease.

Some "instant theories" concocted by six and seven-year-olds to answer questions have been collected by Alice Morgan and appear in her book, If You Ask Me ...! (Troy University Press; Troy, Alabama, 1978). Here is a sample:

What are clouds?

"Soft cotton glued together."

Why are there clouds?

"Rain is in the middle."

How does it get out?

"Thunder breaks the glue."

We may wonder how long it will take this budding, young theorist to discover that giving answers is only part of the work? That an equally demanding or even greater task may involve arriving at the questions.

But let's not ask the fourth grade, San Francisco student who paused at his school's display of a sample barnyard—with a live cow, two calves, a pig, lamb and chickens—and asked, "How do pigs lay bacon?"
The Dimension of Inattention Among Children with School Problems
Authors: Levine Melvin D. , Busch Betsy , Aufseeser Cary
Published: December 2021

Within a population of children referred for school-related problems, youngsters with significant attention deficits were compared with children having other types of learning problems. Using data from parent and teacher questionnaires as well as results of multidisciplinary team assessments, each patient was assigned either to a group with significant attention deficits or to one with learning problems, but fewer, if any, problems with attention. Disagreement between observation sources was demonstrated. Children qualifying for the significant attention deficit group were characterized by a greater likelihood of having behavioral problems during the toddler and preschool years. They also had a higher prevalence of minor neurologic signs and difficulty on tests of language development. Their current behavioral and adjustment problems seemed to be more severe and widespread than those of the youngsters with whom they were compared. No major intergroup differences were observed with regard to age at referral, socioeconomic status, family history of learning and behavior problems, perinatal health risks, or psychosocial difficulties. There was considerable historic and symptomatic overlap between the two groups, suggesting that the clinical picture characteristic of significant attention deficits is relatively nonspecific and is either a primary or secondary finding in a large proportion of a heterogenous population of children experiencing difficulties in school.
PSYCHIATRIC INTERVENTION
Authors: Haggerty Robert J.
Published: December 2021

The present paper discusses the concept of infant psychiatry and assesses a variety of treatment approaches that have been used with psychologically disturbed infants. Despite these advances we have only made a beginning in communicating these principles to the families of infants in need. Whereas we may know how to assist children with disturbances in feeding, sleeping, or toilet training, we know little about breaking the vicious cycle of deprivation and the ensuing hopelessness and anger in disadvantaged families and those with physically atypical children.