bluuebunny/crossref_metadata_2025 huggingface dataset:
Care of the Child With a Colostomy
Authors: Cooney Diane E. , Grosfeld Jay L.
Published: December 2021

Colostomy in infancy and childhood is usually performed for benign disease and is of a temporary nature. The colostomy often may be functional for 12 to 18 months, however, and therefore requires skilled care by the patient and/or his parents. The purpose of this report is to describe a combined inpatient-outpatient program of colostomy care that has resulted in improved management of infants and children with colostomies. The physician, parent, nurse, and enterostomal therapist are all intimately involved in the program. It is further intended to acquaint the pediatric physician with complicating factors related to the procedure.

Colostomies in children are frequently performed to relieve colonic obstructions resulting from congenital anomalies such as Hirschsprung's disease, colon atresia, and imperforate anus, and occasionally for pelvic and perineal tumors, Crohn's disease of the colon, and instances of rectal perforation.1,2
The Prevention of Recurrent Otitis Media
Authors: Rako Jules
Published: December 2021

Dr. Rowe's review1 of acute suppurative otitis media was excellent, but I am concerned over the lack of pursuing the problem of preventing recurrent otitis media with long-term antibiotic therapy. Perrin et al.2 did a very short study using sulfisoxazole and found very encouraging results. Why haven't more centers studied this problem? Otitis media is one of the most frequent problems seen in general pediatric practice today. The vogue of tympanostomy tubes emerged with very little control study, and now even our ear, nose, and throat colleagues are less satisfied with the tubes than they were seven years ago.
In Reply: The Prevention of Recurrent Otitis Media
Authors: Rowe D. Stewart
Published: December 2021

I agree with Dr. Rako that long-term anitibiotic treatment of recurrent suppurative otitis media appears promising and deserves further study. Such study seems necessary to me for several reasons.

Only two controlled studies of long-term antibiotic treatment have been reported. The results of the study1 of Alaskan Eskimo children cannot be assumed to be valid for most childhood populations in the United States. Confirmation of the Rochester group's encouraging results2 of sulfonamide treatment will be necessary.
Host defense in malnutrition
Authors: Katz Michael , Stiehm E. Richard
Published: December 2021

It has not been possible to relate a particular immune failure or deficiency to absence of a specific nutrient. All of these studies have viewed the totality of malnutrition and, yet, it would seem reasonable to expect that specific nutrient deficiencies would affect the response differently and that the almost infinite number of possible interactions among nutrients may have their particular effect. Furthermore, it has not been possible to evaluate any of these studies in terms of the influences that infections themselves have brought to bear. These considerations have led us to conclude that studies of man cannot be carried out with a precision required for the definitive answers. This is not a defeatist notion, but rather a value judgment that prompts us to recommend a more intensive series of investigations in animal model systems, the conclusions of which could then be applied selectively to clinical studies of man.

The important question that must be considered is possible nutritional interventions in severely infected patients, such as those undergoing major surgery or immunosuppressive therapy. Potential dangers of using live attenuated viral vaccines in malnourished populations must be evaluated. It is necessary to assess the possibility that such vaccine viruses unchecked by normal immune response in malnourished individuals may lead to the establishment of states of latency and, ultimately, slow infections.

The need for further studies has been given recognition by a workshop conference held in May 1975 under the title "Malnutrition and the Immune Response"; the proceedings are soon to be published in book form.57 The question of the influences of infection upon the state of nutrition has also been considered in a recent workshop, the proceedings of which will also be published.58 We believe that the current critical approach to this important health problem will generate answers long wanting. When these answers do become available, they will guide us into better care not only of the malnourished in the developing world, but also of those in the industrialized countries.
Techniques for Analysis of Micturition Reflex Disturbances in Childhood
Authors: Bradley William E. , Andersen Jens T.
Published: December 2021

During the past two decades, improvements in technology and changes in conceptualization have contributed to greater objectivity in the assessment of micturition reflex disturbances.1,2 These changes have been applied principally to analysis of adult dysfunction and have recently been implemented in evaluation of neuromuscular dysfunction of the urinary bladder in infancy and childhood.

These newer methods include gas cystometry,3 integrated sphincter electromyography (EMG),4 measurement of reflex-evoked potentials in micturition reflex pathways,5 and electroencephalography (EEG).6 Complementary urodynamic methods include uroflowmetry,7 measurement of urethral pressure profiles,8,9 and observation of pressure-flow relationships during voiding.10

These studies, when appropriately selected and individualized to the patient as a result of the history and examination, provide valuable information. They delineate the site and nature of the impairment of the nervous mechanisms used in the neural and muscular infrastructure in micturition during infancy and childhood. Finally, they provide a rational basis for selection of pharmacologic agents11 and surgical techniques12 to restore urinary continence.

Gas cystometry technique

Gas cystometry has replaced water cystometry in the evaluation of patients for detrusor reflex instability. The patients are catheterized, and the bladder is inflated with carbon dioxide at room temperature at a constant flow rate of up to a maximum of 200 ml/min. Intravesical pressure is recorded by an isovolumetric strain gauge and transducer amplifier calibrated in centimeters of water.4 Because of the high perfusion rate and brief test interval, additional testing for reflex instability is facilitated. These additional procedures include (1) change in posture from supine to upright, (2) determination of response to subcutaneous injection of bethanechol, and (3) sleep cystometry.
Inguinal Hernia in Premature Infants
Authors: Walsh S. Zoe
Published: December 2021

I was interested to read the article by Harper et al. in the July 1975 issue on the incidence of hernias in premature infants weighing 1,000 gm or less at birth. According to these authors, no one thus far has recognized the remarkably high incidence of inguinal hernias (30%) in premature infants weighing less than 1,000 gm.

I should like to point out, however, that a high incidence of such hernias in very-low-birth-weight premature infants was reported by Knox1 in 1959 and Walsh2 1962.
NEUROPATHOLOGY OF VISION: AN ATLAS. By Richard Lindenberg, et al. Philadelphia, Lea & Febiger, 1973, $35; 500 pp
Authors: Robb R. M.
Published: December 2021

However extensive this atlas is, it is probably important to note at the outset what it is not. It is not an account of ocular or retinal pathology affecting vision. Rather, the book starts with the optic disc and proceeds back through the optic nerve, tracts, and radiations to the visual cortex. It does not include ultrastructural details of pathological processes, but deals with gross and light microscopic descriptions correlated in most instances with clinical observations on individual patients.
Pulmonary Function Abnormalities in Symptom-free Children After Bronchiolitis
Authors: Kattan Meyer , Keens Thomas G. , Lapierre Jean-Guy , Levison Henry , Bryan A. Charles , Reilly Bernard J.
Published: December 2021

Twenty-three children less than 18 months old who had clinical and radiological evidence of bronchiolitis and remained symptom-free thereafter were studied to determine pulmonary function ten years later. Abnormal PaO2, Viso V and RV/TLC ratio were found in the majority of subjects, and 31.3% had abnormalities in all three tests; four and one-half percent had exercise-induced bronchospasm. These changes indicate a residual parenchymal or airways lesion following bronchiolitis.
Folic Acid Nonresponsive Homocystinuria Due to Methylenetetrahydrofolate Reductase Deficiency
Authors: Wong Paul W. K. , Justice Parvin , Hruby Marilyn , Weiss Edra B. , Diamond Eugene
Published: December 2021

Four siblings from a family with 11 children of Irish ancestry were observed to suffer from an essentially identical clinical illness, consisting of delayed psychomotor development in infancy and childhood, severe mental retardation, and upper motor neuron dysfunction. Death occurred at an early age in three siblings. In cases in which detailed physical examinations were performed, ectopia lentis, marfanoid features, and severe bony deformities were absent. Homocystinuria, homocystinemia, relatively normal concentrations of methionine and cystine in tissue fluids, and absence of methylmalonic aciduria were found. A deficiency of methylenetetrahydrofolate reductase was demonstrated in cultured skin fibroblasts from two siblings. Postmortem examination of two of the three patients who died showed extensive vascular thrombosis. No biochemical improvement was observed in the surviving child following treatment with large doses of folic acid.
Maintenance of Protection in Patients Treated for Stinging Insect Hypersensitivity: A Booster Injection Program
Authors: Mueller Harry Louis
Published: December 2021

A program of annual booster injections of mixed stinging insect whole body extract was given to 133 patients who had previously had three years or more of immunological treatment for systemic reactions to Hymenoptera stings. Two patients who were restung had mild symptoms that were evidenced by a few scattered hives with itching. No patient on a dose of 0.2 ml of 1:10 dilution extract had any reaction when they were restung. It is believed, therefore, that this program merits continuation with that dosage for a period long enough to determine its true effectiveness. There is some indication that this is an improvement over the program which stops treatment after three years. There is further support for the belief that this condition and the treatment are dose related. There is also evidence for my belief that this sensitivity, and the treatment, differ from the usual atopic sensitivity in antibody-antigen response.
Blind justice
Authors: S. W. A.
Published: December 2021

On November 18, 1976, a jury in New York City decided in favor of the defense's argument that a retrolental fibroplasia (RLF)-blinded 22-year-old woman had been treated with oxygen according to the accepted standard of care at the time of her birth in the summer of 1954. This notable event was ignored by the news media. Several days earlier there had been prominent news coverage of a $400,000 out-of-court settlement in a similar (summer of 1954 birth) RLF-suit brought against another New York hospital. Apart from what this says about the fourth estate, these events point up some curious facets of the mindset in both the legal and the medical communities concerning the great epidemic of infantile blindness that began in 1942 and ended dramatically in 1954 to 1955.
Prenatal detection of neural tube defects: False positive and negative results
Authors: Milunsky Aubrey
Published: December 2021

An estimated 6,000 to 8,000 babies with neural tube defects (NTDs) are born each year in the United States. The suffering of both child and family has been well documented.1-3 Prenatal detection early in the second trimester of pregnancy became possible in 1972 when elevated α-fetoprotein (AFP) concentrations in amniotic fluid in association with open NTDs were demonstrated in Edinburgh.4 These results have been amply confirmed.5-10 The AFP test is best used and most reliable between 14 to 16 weeks of gestation.8 With such prenatal diagnosis, termination of the abnormal pregnancy can be offered to the family.

AFP is synthesized by the yolk sac and fetal liver and normally passes from the fetal serum into fetal urine and then into the amniotic fluid.
Dr. Rapkin Replies
Authors: Rapkin Richard H.
Published: December 2021

I agree with most of the points made by Dr. Phelan in his letter, especially those related to the need for skill in performing nasotracheal intubation. It is unreasonable to assume that this degree of skill will be available in most hospitals, and, therefore, tracheostomy will continue to be an important procedure for securing the airway of a child with epiglottitis.

Since the submission of my article, which indicated possible dangers of nasotracheal intubation in viral croup, there have been two articles published that support Dr. Phelan's contention that such intubation is safe and effective in the treatment of this disease.1,2
Can Vitamin E Deficiency Occur in an Infant Receiving Total Parenteral Nutrition?
Authors: Johnson A. Myron , Morris Mary Ann Williams
Published: December 2021

Reports in the July 1975 issue of Pediatrics of total parenteral nutrition (TPN) in newborn infants, with and without lipid supplementation,1,2 have prompted a brief report of our experience with a small premature infant given TPN because of upper gastrointestinal obstruction and postoperative intolerance of enteral nutrition. Although cause-and-effect relationships are far from clear, this infant's course raises a question about the adequacy of vitamin E supplementation for premature infants receiving TPN.

Case Report. F.I. (No. 31-10-62) was the first born in a pair of dizygotic black twins, weighed 1,370 gm, and was the product of a 30-week gestation terminated by spontaneous rupture of membranes.
Questions Need for Prophylaxis With Silver Nitrate
Authors: Shaw Edward B.
Published: December 2021

Why should Credé prophylaxis with silver nitrate be continued? Nishida and Risemberg still recommend this (Pediatrics 56:368, 1975) but admit that it often provokes chemical conjunctivitis (which is benign and clears in 24 hours, before gonococcal infection usually occurs). Because of chemical conjunctivitis, it is not used in 20% of the nation's hospitals.

Introduction of silver nitrate drops is definitely traumatic-just opening the lids is frequently a struggle. (Obstetrical services that are most meticulous about introducing the silver nitrate solution have the most severe reactions from it.)
Urinary Tract Anomalies in Neonates With Spontaneous Pneumothorax and/or Pneumomediastinum
Authors: Bashour Bassam N. , Balfe J. Williamson
Published: December 2021

Spontaneous pneumothorax is reportedly occurring in 0.05% to 1% of all live births.1,2 Pediatricians have long been aware of the apparent association between spontaneous pneumothorax, with or without pneumomediastinum, and congenital anomalies of the urinary tract. However, reports of the incidence of this relationship have been inconclusive, based on small numbers of infants.3-5 We therefore sought to determine this incidence in a large clinical population.

METHODS

We reviewed the records of all 6,236 infants admitted to the neonatology unit during 1961-1967 and selected all cases of spontaneous pneumothorax or pneumomediastinum or both (lung rupture) and of congenital urinary tract anomalies.
Brunell's Brush-off
Authors: Brunell Philip A.
Published: December 2021

As is usually the case, Dr. Plotkin and I are generally in agreement. Our major difference is with respect to timing. In the last sentence of my commentary, I clearly qualified my own feelings that no additional clinical vaccine trials appear to be indicated with the phrase "at this time." If at some time in the future it is shown that (1) varicella produces more morbidity than is now generally appreciated or (2) we might achieve greater success in immunizing or reimmunizing adults or (3) additional basic or clinical research provides new information, I would certainly encourage reexamination of the problem.
Implications of Pathologic Findings in the Treatment of Neonatal Necrotizing Enterocolitis
Authors: Joshi Vijay V.
Published: December 2021

The pathologic findings in neonatal necrotizing enterocolitis (NNE) have been well described,1-3 but the following features need emphasis because of their implications in the treatment of the disease.

1. A common misconception is that the dark-red dull-appearing affected portion of the intestine in NNE is indicative of infarction of the intestine, i.e., necrosis of total thickness of the bowel. But, in fact, the necrosis seen in the affected portion of the intestine is almost exclusively confined to the mucosa1-3 and is transmural only in a focal area or areas in cases in which a perforation or perforations occur.
DEMYSTIFICATION OF MEDICAL TECHNOLOGY
Authors: Mahler H. ,   Student
Published: December 2021

. . . I would say that making rehydration salts for babies available to mothers in every home is likely to be more useful in the short, medium, and long term than expecting the mother to take the baby to a special centre and have this service done for her. There should be no secret either in the way in which diarrhoeal disease occurs or in its treatment. There appears to be no possible reason why the knowledge and the skills of dealing with it should not go down the professional tree to every household at risk. This is what I mean by "demystification" of medical technology.
LIFE SUPPORT
Authors:   Student
Published: December 2021

The staff have got to start realizing that they are dealing with live people, not just products on an assembly line to be tested for their newest "component"....Let's have more people hired for...supportive roles to patients. Otherwise, I am forced to come to a radical conclusion: it is very cruel to develop the machines and transplants to save lives and not be concerned enough about supporting these people and their families through all the problems they will meet. Part of me is forced to believe that it would have been kinder to let some people with chronic illnesses die. There should be a bill of rights for kidney patients stating, "Unless you can provide me with people who will try to listen, understand and support me and my family in the many adjustments ahead, think twice before you put me on a kidney machine or give me a transplant."
Haemophilus influenzae Type b Capsular Polysaccharide Vaccine in Children: A Double-Blind Field Study of 100,000 Vaccinees 3 Months to 5 Years of Age in Finland
Authors: Peltola Heikki , Käythy Helena , Sivonen Aulikki , Mäkelä P. Helena
Published: December 2021

A recently developed Haemophilus influenzae type b capsular polysaccharide vaccine was given to 48,977 children 3 months to 5 years of age; an equal number of children receiving group A meningococcal vaccine served as controls. The protection as well as serum antibody response was strongly age-dependent. Among children who had received the H. influenzae type b vaccine when 18 months of age or older, there were no cases of bacteremic disease caused by H. influenzae type b in the first year after vaccination. At the same time 11 such cases were seen in the control group of the same age, a highly significant difference. In the second year after vaccination two cases occurred in the H. influenzae type b-vaccinated group, five in the meningococcal-group A vaccinated group. No protection was seen among children who had been younger than 18 months when vaccinated, even if they received a booster dose of the vaccine.

The serum antibody response to the H. influenzae type b polysaccharide, measured by radioimmunoassay, was poor in children below 18 months of age and good in those above it. No effect of the vaccine could be seen on the nasopharyngeal carriage of H. influenzae type b, which was approximately 6% in this age group. Adverse effects of the vaccine were mild.
Estimation of the Age of Cutaneous Contusions in Child Abuse
Authors: Wilson E. F.
Published: December 2021

Estimation of the age of a cutaneous contusion on an abused child is probably more often requested of pediatricians and family practitioners than of pathologists. Guidelines for this estimation are not easily found and are not available in a standard textbook on child abuse.1 Some previously reported guidelines are presented below, modified only by being placed in tabular form (Table).2-6

A contusion of the skin follows the application of blunt force sufficient to disrupt vessels, usually capillaries, from which blood escapes and accumulates in the corium and/or subcutis, without loss of the integrity of the surface of the skin. The bleeding usually starts immediately following disruption of the vessel wall and may continue only briefly or persist for hours.
Television and Children
Authors: Frankel Herman M.
Published: December 2021

Pediatricians at The Permanente Clinic are becoming increasingly concerned about the effects of television on the health of our patients, including the children hospitalized in the 32-bed pediatric unit of Bess Kaiser Hospital. Prompted in part by the appearance of our new color television sets, and in part by articles and accompanying editorials in Pediatrics, The New England Journal of Medicine, and The Journal of the American Medical Association, we have been discussing both our responsibility to our young patients and our responsibility to help their parents examine the impact of television viewing on children's health and daily lives.
Dr. Miller Replies
Authors: Miller Robert W.
Published: December 2021

Pediatricians are well aware of the special susceptibility of the fetus and child to chemical pollutants.1 Methemoglobinemia may occur in infants exposed to nitrates from well water2; congenital Minamata disease (cerebral palsy) has occurred from intrauterine exposure to methylmercury in fish from contaminated seawater.3 There is no doubt about the need for safe water.

In its statement, the Committee on Environmental Hazards considered the evidence then available on the carcinogenicity in man of chemical contaminants of water.
Drs. Shanis and Moshang Reply
Authors: Shanis Bonnie S. , Moshang Thomas
Published: December 2021

We appreciate the interest and attention of Dr. Pombo et al. to the use of propranolol and exercise as a provocative test of growth hormone (GH) release. Since publication of our article, we have studied an additional 24 normal short children and three Gil-deficient children. Twenty-two of the 24 normal children had GH levels greater than 10 ng/ml. Therefore, among the total 56 normal children evaluated, the incidence of false-negative responses was 3.6%, slightly lower than the one in 15 reported by Maclaren et al. and the one in 17 reported by the above authors.

See table in the PDF file
Dr. Frankenburg Replies
Authors: Frankenburg William K.
Published: December 2021

Dr. Perrin has written a thoughtful response to our article. There are problems with dichotomizing screening results into positive and negative, for the more deviant the screening finding, the higher the predictive value of a positive screen. For instance, initial positive phenylketonuria screening results of 4 mg/100 ml and one of 20 mg/100 ml have predictive values of positive tests of 5% and 95%, respectively.1,2 DDST findings are not dichotomized into positive and negative. Instead, they are classified as "abnormal" (highly suspect), "questionable" (borderline suspect), and "normal" (none suspect).
Dr. Moroz Replies
Authors: Moroz S. P.
Published: December 2021

Drs. Roy and Webster suggest that the association between α1-antitrypsin (α1AT) deficiency and membrano-proliferative glomerulonephritis (MPGN) is that of chance. This certainly may well be the case. We did not see other liver diseases. We did not suggest that α1AT deficiency was necessarily associated with idiopathic MPGN, and, in fact, showed that four patients with MPGN and no liver disease were not α1AT-deficient and did not show deposits of α1AT by immunofluorescent stains within their glomeruli.
Accepted Standards?
Authors: Johnson Donald F.
Published: December 2021

I read with interest the article entitled "Treatment of Acute Sore Throats: A Comparison of Pediatricians and General Physicians" by Dr. Gordis et al. (Pediatrics 57:422, March 1976), but was distressed to find that my style of management may have been considered "below generally accepted standards."

Past experience has shown that a single throat culture may yield a false-negative result in 10% to 15% of otherwise documented streptococcal sore throats. This false-negative percentage can be improved by careful adherence to technique, but points up the necessity for the clinician to rely on his judgment as well as the culture result.
Commentary on Acetaminophen
Authors:   Committee on Drugs
Published: December 2021

Acetaminophen is being promoted as the preferred analgesic-antipyretic, particularly for pediatric use, with suggestions that it is safer and perhaps more efficacious than aspirin. The claim that acetaminophen is less toxic than aspirin is based on a lower incidence of certain side effects and toxic manifestations observed with acetaminophen than with aspirin. Although in therapeutic doses acetaminophen does not share the adverse gastrointestinal, hemorrhagic, and acid-base side effects of aspirin, it does have its own unique toxicity. When ingested in excessive quantities, it may be more lethal than aspirin, and considerably more difficult to treat.

Available studies indicate that acetaminophen and aspirin given in equal milligram doses are equally effective in relieving pain and fever.1,2 In contrast to aspirin, acetaminophen has little anti-inflammatory effect.

Animal toxicity studies, although helpful in elucidating mechanisms of toxicity, have failed to provide conclusive answers to the question of relative toxicity of acetaminophen and aspirin. Acute toxicity studies in several animal species have produced widely varying results. The degree of acetaminophen toxicity varies not only among different species3 but also among different strains within the same species.4 Additional determinants of acetaminophen toxicity are the nutritional status5 of the animals and pretreatment with microsomal enzyme inducers or inhibitors6 Furthermore, it is unknown which animal species, if any, best reflect toxicity in humans.

A large number of serious acetaminophen poisonings, including fatalities, have been reported from Great Britain during the past decade.7-9 Reports of acetaminophen toxicity have been less common in the United States. However, one major poison control center in the United States recently reported 156 acetaminophen ingestions, with four fatalities, during a one-year period.10
Radiation of Pregnant Women
Authors:   Committee on Radiology
Published: December 2021

If a patient is to be examined even if pregnant, scheduling serves no useful purpose and may be counterproductive. If an examination can be postponed to the end of pregnancy, the need for that examination is questionable, even if the patient is not pregnant.

Two alternatives to the foregoing procedure for these situations, which require special consideration, are offered.

1. The examination can be postponed until after the pregnancy, or it can be conducted at the next menstrual period when the patient is known not to be pregnant.

2. Modification of an examination to reduce the radiation dose can be considered without necessarily compromising the thoroughness of the study. This option can be exercised for any patient when indicated by the judgment of the attending physician who, in consultation with the radiologist, can determine the examination protocol.

All physicians who request and conduct radiologic examinations should familiarize themselves with the pertinent radiologic information. The attending physician should carefully consider the need for the examination and record the decision in the patient's record. And, the x-ray consultation request should carry a notation that the matter of potential or actual pregnancy has been taken into account in the decision to request the examination.
Tracking Correlations of Blood Pressure Levels in Infancy
Authors: Levine Robert S. , Hennekens C. H. , Klein B. , Gourley J. , Briese F. W. , Hokanson J. , Gelband Henry , Jesse Mary Jane
Published: December 2021

The association between elevated blood pressure levels in adults and increased risk of coronary and cerebrovascular disease has been well documented.1,2 Prospective studies of blood pressure in both adults and children have also shown strongly positive tracking correlations,3-5 tracking correlations being defined as the relationship between blood pressure measurements obtained at two points in time from the same individuals.

In adults 35 to 70 years of age, tracking correlations of 0.6 for systolic pressure3,4 and 0.5 for diastolic pressure4 have been reported over four-year follow-up intervals. In children, Zinner et al.5 reported correlations of 0.25 for systolic pressure and 0.14 for diastolic pressure over a four-year follow-up interval.
In Reply: Suggests More Tests for Chest Pain Diagnosis
Authors: Driscoll David J.
Published: December 2021

I am grateful for your comments regarding our article "Chest Pain in Children: A Prospective Study."

Two of the 43 children in that study had a history suggestive of gastrointestinal dysfunction and appropriate studies, including upper gastrointestinal contrast series and screening for occult blood in the stool, were done. Evidence for ulcers, esophagitis, or gastric reflux was not found in either patient.

We did not intend to imply a psychogenic origin for idiopathic chest pain.
Questions Car Safety Statistics
Authors: Vimpani Graham V.
Published: December 2021

I was disappointed at the editorial decision to publish the paper by Dr. Kanthr, "Car Safety for Infants: Effectiveness of Prenatal Counseling" (Pediatrics 58:320, September 1976). Dr. Kanthor himself must have realized that the differences between his counseled and noncounseled group in the proportion of children being adequately restrained in their family automobile at the six-week well-child visit did not reach statistical significance (df = 1, χ2 = 1.527, .2 < P < .3). He justifiably claimed that the results suggested only a trend, but he did claim that the differences observed in the two groups resulted from the single counseling session.
In Reply: Dry Myringotomies and Impedance Testing
Authors: Paradise Jack L. , Smith Clyde C. , Bluestone Charles D.
Published: December 2021

The first issue raised by Gordon—the "problem of the [unexpectedly] dry myringotomy" suggests a misreading of the stated conditions of our study. The subjects were not our patients, but were patients whose cases were being managed by other physicians who allowed us to study them. And the diagnostic assessments—both otoscopic and tympanometric—were carried out immediately preoperatively. Thus few of the "dry taps" were unexpected: rightly or wrongly, most of them were performed knowingly in order to insert tympanostomy tubes in an effort to prevent recurrence of acute otitis media1 rather than to remove middle ear effusion.
In Reply: Were Infants in the Control Group Sicker?
Authors: Belenky David A. , Woodrum David E. , Hodson W. Alan
Published: December 2021

Dr. Vollman's comments are thoughtful and pertinent. As he no doubt realizes, we cannot completely resolve the question of comparability of the patient groups. The mortality figures for those infants breathing spontaneously on entry to the study are presented in the accompanying Table. Since this represents a group of patients selected out of the study population in retrospect, it is meaningless to apply any test of statistical significance to these figures. To complicate matters further, six of the control patients in the Table required mechanical ventilation immediately after qualifying for the study (before the next blood gas sample was drawn); all six died.
Factors Leading to Delay in the Diagnosis and Affecting Survival of Children With Head and Neck Rhabdomyosarcoma
Authors: Pratt Charles B. , Smith John W. , Woerner Sarah , Mauer Alvin M. , Hustu H. Omar , Johnson Warren W. , Shanks Ellen C.
Published: December 2021

Rhabdomyosarcoma of the head and neck often presents with vague symptoms which mimic other disease conditions. These factors lead to undue delay in the establishment of the correct diagnosis and the delivery of acceptable therapy, including surgery, radiation therapy, and chemotherapy. There is, however, evidence of improved results of treatment of these tumors since the addition of multiple drug chemotherapy to surgery and radiotherapy.
Pneumocystis carinii Infection: Evidence for High Prevalence in Normal and Immunosuppressed Children
Authors: Pifer Linda L. , Hughes Walter T. , Stagno Sergio , Woods Diane
Published: December 2021

Using Pneumocystis carinii organisms propagated through three passages in embryonic chick epithelial lung cultures, specific antigens and antisera were prepared for use in counterimmunoelectrophoresis and indirect immunofluorescent antibody techniques. These methods proved to be specific and sensitive for the detection of P. carinii antigen and antibody, respectively, in sera, and were applied to the study of cancer patients with P. carinii pneumonitis (PCP), cancer patients without pneumonitis, and normal children. Antigenemia was detected in 95% of patients with PCP, in 15% of cancer patients without pneumonitis, and in none of the normal children tested.

In cross-sectional and longitudinal studies of normal infants and children, acquisition of serum antibody to P. carinii was demonstrated to occur progressively with increase in age. By 4 years of age two thirds of the normal children were found to have antibody to P. carinii in titers of 1:16 or greater. These studies indicate that subclinical P. carinii infection is highly prevalent in normal children, analogous to other opportunistic infections where active disease is manifest predominantly in the compromised host.
Longitudinal Evaluation of Neonatal Nosocomial Infections: Association of Infection With a Blood Pressure Cuff
Authors: Myers Martin G.
Published: December 2021

Nosocomial infections acquired in a special care nursery were surveyed longitudinally. The rates of acquired infection were determined, allowing the evaluation of specific infection control measures. A blood pressure cuff, utilized for all infants in the nursery, was associated with an increased rate of infection.
Candida albicans Meningitis in a Premature Neonate Successfully Treated With 5-Fluorocytosine and Amphotericin B: A Case Report and Review of the Literature
Authors: Lilien Lawrence D. , Ramamurthy Rajam S. , Pildes Rosita S.
Published: December 2021

Candida albicans meningitis was diagnosed in a 45-day-old premature infant whose birth weight was 1,616 gm. Symptoms consisted of poor weight gain and poor sucking. The combined use of amphotericin B and 5-fluorocytosine (5-FC) resulted in negative CSF cultures after 12 days of therapy. Amphotericin B was given for 45 days (total 83 mg) and 5-FC for 60 days (total 19 mg). Only one other premature infant has been reported in the literature who had similar treatment. A review of Candida meningitis diagnosed before death in 11 other infants less than 1 year of age is presented.
A NIGHTMARE
Authors: Lilienthal David ,   Student
Published: December 2021

We are entering a whole new era of life . . . there are two sides to technological knowledge—good and evil . . . I'm concerned about the extraordinary power of [atomic] weapons and the strain they impose on humanity . . . when it comes to this deadly technology, we follow people who are mad, because people who are sane and understand the democratic process haven't taken charge. . . . The first part of the "Atoms for Peace" was great . . . there was an exchange of information about the medical use of isotopes, the agricultural use of tracers, the physical properties of matter . . . then they started sending things—devices, fuels—instead of ideas, and these became a major export . . .—it's a nightmare.
SPECIAL CONSIDERATION FOR HUMANS
Authors: Dawkins R. ,   Student
Published: December 2021

Recently there has been a reaction against racialism and patriotism, and a tendency to substitute the whole human species as the object of our fellow feeling. This humanist broadening of the target of our altruism has an interesting corollary....

The feeling that members of one's own species deserve special moral consideration as compared with members of other species is old and deep. Killing people outside war is the most seriously regarded crime ordinarily committed. The only thing more strongly forbidden by our culture is eating people (even if they are already dead). We enjoy eating members of other species, however. Many of us shrink from judicial execution of even the most horrible human criminals, while we cheerfully countenance the shooting of other harmless species as a means of recreation and amusement. A human foetus, with no more human feeling than an amoeba, enjoys a reverence and legal protection far in excess of those granted to an adult chimpanzee. Yet the chimp feels and thinks and-according to recent experimental evidence-may even be capable of learning a form of human language. The foetus belongs to our own species, and is instantly accorded special privileges and rights because of it....

The muddle in human ethics [is] over the level at which altruism is desirable-family, nation, race, species, or all living things....
The Role of Antibiotics, Immunizations, and Adenoviruses in Pertussis
Authors: Baraff Larry J. , Wilkins Jeanette , Wehrle Paul F.
Published: December 2021

Sixty-five patients with pertussis were identified by a clinical criterion, and Bordetella pertussis was isolated from 75% of these patients or their symptomatic household contacts. Negative nasopharyngeal cultures were usually associated with either a history of antibiotic therapy with erythromycin or tetracycline (two of three patients), two or more diphtheria and tetanus toxoids with pertussis (DTP) vaccines (six of eight patients), or both (two of three patients). Erythromycin therapy resulted in the elimination of B. pertussis from the nasopharynx in 2 to 7 days (mean, 3.6 days) compared with 7 to 17 or more days (mean, > 12 days) in patients treated with no antibiotics, but had no effect on the duration or severity of illness as judged by length of hospitalization. Adenoviruses were recovered from five of 44 patients cultured. Four of these isolates were from throat swabs obtained early in the illness and the remaining isolate was from one of 33 repeated viral cultures obtained two to three weeks later; B. pertussis was also isolated from these five patients. Paired serum samples were obtained from only two of these patients. Neither demonstrated a fourfold rise in adenoviral complement-fixing antibodies. Therefore, in these patients, adenoviral isolation may have been secondary to reactivation of a latent viral infection by infection with B. pertussis.
Conservative Surgery for Splenic Injuries
Authors: Sherman Neil J. , Asch Morris J.
Published: December 2021

Splenectomy for traumatic injury of the spleen has recently been questioned, due to the occurrence of postsplenectomy sepsis. During the past year we have operated on six children with splenic injuries and, by utilizing different surgical manuevers, have successfully preserved all or part of the spleen. The following report describes the management of these children and the operative techniques that allow the injured spleen to be salvaged.
The Williams Elfin Facies Syndrome: The Psychological Profile as an Aid in Syndrome Identification
Authors: Bennett Forrest C. , LaVeck Beverly , Sells Clifford J.
Published: December 2021

The Williams syndrome is a sporadic disorder generally characterized by a peculiar pattern of craniofacial abnormalities (elfin facies), prenatal and postnatal growth deficiency, mental retardation, variable congenital heart disease (including supravalvular aortic stenosis), and occasionally infantile hypercalcemia.1 Its etiology, pathogenesis, and possible relationship to vitamin D and calcium metabolism have not as yet been determined.2

Previous reports of children with this syndrome make reference to their overall mental retardation as determined by IQ as measured by various psychological tests.1,3 Frequent mention is also made of these children's tendency to an unusual, outgoing personality.1,3 Other observers describe a unique type of mental deficiency with poor motor coordination but an unusual command of language, often resulting in a superficial overestimation of cognitive abilities.3
Anti-D Globulin-Induced Hemolysis in Agammaglobulinemia and Arthritis
Authors: Pabst Henry F. , Gelpke Paul M.
Published: December 2021

A major advance in pediatric preventive medicine has been the administration of anti-D globulin to D-negative mothers after delivery to inhibit development of antibodies to the D antigen in the rhesus blood group. This globulin is prepared commercially from pooled plasma of individuals with a high anti-D antibody titer. The indirect Coombs' titer of anti-D of acceptable preparations is usually 1:3,200 or higher.1 Injections of twice the usual therapeutic amounts of anti-D globulin into a D-positive volunteer have caused only minimal reductions in hemoglobin level and hematocrit value and no ill effects.1 Our observations in an agammaglobulinemic 4-year-old D-positive girl who received 1,800 µg of anti-D globulin with resulting hemolysis are therefore pertinent.
Dr. Kozak et al. Reply
Authors: Kozak Peter P. , Cummins Leo H. , Gillman Sherwin A.
Published: December 2021

Based on a very limited study, we have been able to demonstrate significant changes in theophylline levels in patients receiving three different types of erythromycin preparations. Elevated theophylline levels were associated with administering erythromycin ethylsuccinate, erythromycin stearate, and erythromycin estolate.

We were not able to detect any pattern of alterations in theophylline levels associated with either temperature elevations or other medications being administered concomitantly.
Why Wasn't It Aspiration of Gastric Contents?
Authors: Hall Caroline B. , Hall William J.
Published: December 2021

The article by Travis and colleagues (Pediatrics 59:695, May 1977) focuses on yet another possible complication of treating the child with croup and epiglottitis, noncardiogenic pulmonary edema. Although the mechanisms proposed by the authors for this phenomenon are intriguing, we wonder why a more common mechanism, that of aspiration of gastric contents, was not also considered. The level of consciousness in both of these patients was depressed, and both required intubation under general anesthesia in emergent circumstances.
KNOWLEDGE AND WISDOM
Authors: Cowper William
Published: December 2021

Knowledge and Wisdom, far from being one, Have oft-times no connexion. Knowledge dwells In heads replete with thoughts of other men; Wisdom in minds attentive to their own. Knowledge is proud that he has learned so much; Wisdom is humble that he knows no more.
Predicting Adult Stature Without Skeletal Age and Without Paternal Data
Authors: Wainer Howard , Roche A. F. , Bell Susan
Published: December 2021

The RWT method for predicting adult stature from childhood variables uses the current recumbent length and weight of the child, the stature of each parent, and the skeletal age of the child as predictor variables. There is only a small increase in the errors of prediction if population mean values are substituted in the prediction equations when the father's stature, the skeletal age of the child, or both these variables are unknown. This modified method is more generally applicable than the original RWT method.
Encephalocraniocutaneous Lipomatosis
Authors: Fishman Marvin A. , Chang Charles S. C. , Miller James E.
Published: December 2021

Two patients with encephalocraniocutaneous lipomatosis have been studied. The main features of the syndrome are unilateral cutaneous and ophthalmologic lesions with ipsilateral cerebral malformations. Seizures beginning in infancy and varying degrees of mental retardation are present in affected patients. The involved tissues are derived from the embryonic ectodermal and mesodermal layers.
Tricuspid Insufficiency Associated With Aneurysm of the Ventricular Septum
Authors: Eshaghpour Eshagh , Kawai Nobuyoshi , Linhart Joseph W.
Published: December 2021

Because of the anatomic relation of an aneurysm of the membranous ventricular septum (AMVS) to the tricuspid septal leaflet or because of the tricuspid septal leaflet involvement in the aneurysm formation, dysfunction of the tricuspid valve is likely to occur in patients with AMVS. The auscultatory manifestations of the resultant tricuspid insufficiency (TI) could be masked by the systolic murmur of the ventricular septal defect (VSD), which is often present in these patients.

The presence of TI is suggested by phonocardiographic findings in five patients with AMVS and is further supported by intracardiac phonocardiography and angiocardiography. After inhalation of amyl nitrite, a pansystolic murmur appeared in three patients, and the intensity of the pansystolic murmur increased significantly in two patients. Inhalation of amyl nitrite reduces the systemic resistance, resulting in decreased systemic pressure and diminished intensity of the murmur of a small VSD. Augmentation of the systemic venous return is reponsible for increased intensity of TI murmur.
Chromosome 3 Duplication q/Deletion p Syndrome
Authors: Fineman Robert M. , Hecht Frederick , Ablow Ronald C. , Howard Rufus O. , Breg W. Roy
Published: December 2021

This report describes the clinical, chromosomal, and radiological findings in four unrelated families with different recombinant chromosome 3 abnormalities. On the basis of the phenotypic and cytogenetic findings seen in our six patients and those noted in two recent reports, we concur with Allderdice et al. that the syndrome in which the long arm (q) of chromosome 3 is duplicated and the short arm (p) is deleted is a distinct clinical entity. The psychomotor retardation found in this syndrome appears to be caused mostly by monosomy of the region 3pter→3p25, while severity of the physical malformations (and hence the lethality) is apparently proportional to the amount of extra chromosome 3q material present. That is, patients who are trisomic for larger segments are physically more affected than patients who are trisomic for smaller amounts of the long arm of chromosome 3. Features common to the chromosome 3 duplication q/deletion p syndrome are mental and growth retardation, microcephaly, seizures, prominent and/or asymmetric frontal bossing, ocular hypertelorism, ptosis, upward-slanting palpebral fissures, and low-set and/or malformed ears. Other anomalies frequently seen are short webbed neck, various types of congenital cardiovascular disorders, omphalocele, cryptorchidism, spina bifida, short digits, hypotonia, and digital impressions on skull x-ray examination which are presumably caused by trisomy for the distal band (3q28) of the long arm of chromosome 3.

In addition, the importance of doing chromosome studies in persons who are mildly affected, both mentally and physically, is illustrated by the study of one of these families.