bluuebunny/crossref_metadata_2025 huggingface dataset:
TENNIS ELBOW
Authors: Yirka M.
Published: December 2021

The injury leading to the disability is not uncommon in those who take much physical exercise, particularly lawn-tennis, whence the name TENNIS ELBOW. However, athletic sports in which strenuous and exact movements of the arm play an important part, are not the only causes of the trouble. The history of the affliction in those in whom it occurs in the course of their favorite exercise is almost invariably as follows: Immediately after a stroke, or occasionally some few hours or days afterwards, pain is noted in the elbow, usually the right, in the neighborhood of the external condyle. This pain may be so severe and sudden as to seem to paralyze the arm temporarily, so that all movements are performed with the greatest difficulty or not at all. This pain is usually markedly increased by extension of the forearm, not so much by flexion and may be intermittent or constant, and returns immediately the exercise is taken up again. Lesser degrees of pain or disability are noted in many cases. The pain is most sharply limited limited to the neighborhood of the external epicondyle of the humerus.
Pediatricians and Child Day Care Programs
Authors: Chang Albert , O'Neill Richard
Published: December 2021

In 1966, Scurletis et al1 surveyed the attitudes of North Carolina pediatricians toward child day care and found a concentration of interest in the individual child's health rather than on the community health needs and problems in day care. It seemed to us opportune, in 1976, to determine (1) the extent of involvement of pediatricians in day care, (2) their attitudes toward day care placement of infants and children, and (3) their recommendations for the improvement of the health components in day care.
Reader Points Out Error
Authors: Fraser David W.
Published: December 2021

Speck et al1 purport to show that Staphylococcus aureus, S epidermidis, and Escherichia coli interfere with colonization of neonates with group B streptococcus. Unfortunately, their documentation is defective. They indicate that, of the sites (nasopharynx or umbilicus) of group B streptococcus. Unfortunately, their documentation is defective. They indicate that, of the sites (nasopharynx or umbilicus) of group B colonization in 268 3-day-old infants, S aureus was found in only 15% (6/40), S epidermidis in only 29% (12/41), and E coli in only 24% (10/41).
Chronic Nonspecific Diarrhea: Dietary Relationships
Authors: Cohen Stanley A. , Hendricks Kristy M. , Mathis Richard K. , Laramee Susan , Walker W. Allan
Published: December 2021

Chronic nonspecific diarrhea (CNSD) is the most common cause of prolonged diarrhea without failure to thrive. Although it is most commonly seen from ages 6 to 36 months, CNSD may persist until 54 months of age. Forty-four patients with this syndrome had complete dietary histories, and were divided into four groups on the basis of their intakes and responses to its modification. Each of the four groups had significantly less fat in their diet at the time of presentation than did ten non-CNSD patients (P < .005) presenting similarly. In three of the groups, daily fat consumption was increased, irrespective of the adequacy of their initial intakes. In all 38 patients in these groups, this dietary modification was associated with the resolution of symptoms. The fourth group, with initially normal dietary fat ingestion, did not respond to dietary therapy. The overall success rate of the regimen in this patient population was 82%. Carbohydrate, fiber, and caloric contents of the diets did not appear to play as significant a role as fat intake.
Effects of Methylphenidate on Hyperactive Children's Ability to Sustain Attention
Authors: Charles Linda , Schain Richard J. , Zelniker Tamar , Guthrie Donald
Published: December 2021

The purposes of this study were to investigate the attentional characteristics of hyperactive children, the relationship of subjective and objective measures of these characteristics, and the effects of methylphenidate on these measures of attention. Forty-five hyperactive children, ages 6 to 10 years, were entered into an 18-week study of the effects of methylphenidate (Ritalin) on attention. Measures included rating scales completed by teachers and parents and a vigilance task. All measures reflected significant changes during the period of investigation. Attention and behavior were significantly improved under drug conditions and significantly worsened when methylphenidate was discontinued. However, only performance on the objective measure returned to predrug levels; final off-drug parent and teacher ratings remained improved over initial reports. Parent ratings of behavior, and specifically of children's ability to attend, were unrelated to equivalent teacher ratings. Teachers' ratings of attention correlated significantly with performance on the vigilance task, discriminated between on-drug and off-drug conditions, and discriminated between children who obtained normal or near normal predrug scores on the objective measure and those who performed poorly on this measure. Methylphenidate improved attentional performance for children who had poor predrug scores on the vigilance task, but did not produce a statistically significant change on the scores of children with normal predrug performance.
The Effects of Abdominal Loading on Rib Cage Distortion in Premature Infants
Authors: Fleming Peter J. , Muller Nestor L. , Bryan M. Heather , Bryan A. Charles
Published: December 2021

The action of the diaphragm in inspiration is to decrease intrathoracic pressure and raise abdominal pressure, which elevates the rib cage. In the supine position, the rise in abdominal pressure is smaller because of the lack of abdominal muscle tone. In premature infants the inward pull of the diaphragm on the very compliant ribs causes inward movement on inspiration (ie, distortion) which is exacerbated by the lack of intercostal muscle activity during rapid eye movement (REM) sleep, their predominant state.

We raised abdominal pressure by means of an inflatable cuff in 12 newborn infants (gestation 28 to 40 weeks) to try to improve inspiratory coupling of the rib cage and diaphragm. There was no significant change in minute ventilation, indicating no ventilatory impairment. In all studies in which there was distortion, abdominal loading produced a reduction or abolition of distortion (P <.01). Abdominal loading may be useful in reducing diaphragmatic activity in premature infants.
Asymptomatic Bacteriuria in Adolescent Girls: II. Screening Methods
Authors: Emans S. Jean , Grace Estherann , Masland Robert P.
Published: December 2021

Of 500 asymptomatic adolescent girls who were screened for bacteriuria by three methods—dipslide (Uricult), dipstrip (Microstix-3 reagent strips), and home nitrite test (Microstix-Nitrite reagent strips)—eight cases (1.6%) were detected: 6/8 by dipslide and dipstrip; 5/8 by nitrite testing. The false-positive-rate (> 104 colonies/ml) of the dipslide test was 6.4%, and the dipstrip test, 2.8%. A history of vaginal discharge was not associated with "contaminated" specimens. False-positive nitrite tests were reported by 0.6% of the patients who returned the postcards.

Overall, 70.4% of the patients returned the postcards for the home nitrite test. The patients were divided by method of payment (Medicaid vs non-Medicaid) in order to provide an approximation of socioeconomic status; non-Medicaid patients were significantly more likely to return postcards than Medicaid patients (75.8% vs 63.7%). Of the group reporting previous urinary tract infection, 79% of both Medicaid and non-Medicaid patients returned postcards, suggesting that a prior experience with the diagnosis increased compliance with a home test.
Evaluation of Breast Milk and Breast Milk Substitutes on Growing Rats
Authors: Forsum Elisabet , Lönnerdal Bo
Published: December 2021

Breast milk substitutes are used extensively in many countries of the world. They are generally based on milk protein, but formulas containing other protein sources are also marketed. The protein and amino acid adequacy of such formulas are ascertained by comparison with breast milk. Furthermore, the pediatric Committee on Nutrition1 recommends that the protein level of a breast milk substitute should not fall below 1.8 gm/100 kcal if the protein has a PER of at least 100% of casein. If the PER is below that of casein, the protein content of the formula should be increased accordingly, although proteins with PER below 70% of casein should not be used.
The Working Mother in Contemporary Perspective: A Review of the Literature
Authors: Zambrana Ruth E. , Hurst Marsha , Hite Rodney L.
Published: December 2021

The purpose of this article is to provide a perspective on the dilemmas working mothers face due to the contradictory messages that emanate from both popular child-rearing books and clinical studies. A review of the working mothers' sections of popular child-rearing books, and an interdisciplinary review of research in the area of maternal employment over the last decade was conducted in order to assess current knowledge in the field. Both popular child-rearing books and books for the working mother tend to reflect the cultural norms of appropriate maternal behavior, but rarely include evidence from empirical research. Findings from a review of literature in medicine, psychology, sociology, and education are discussed in relation to effects of maternal employment on children and families. An understanding of recent research regarding maternal employment will enable the pediatrician to better respond to the needs of the working mothers and their families.
Significance of Quantitative Salivary Cultures for Group A and Non-group A β-Hemolytic Streptococci in Patients with Pharyngitis and in Their Family Contacts
Authors: Kaplan Edward L. , Couser Robert , Huwe Barbara Ballard , Mckay Carolyn , Wannamaker Lewis W.
Published: December 2021

One hundred ninety-six individuals, 86 with clinically overt pharyngotonsillitis and 110 of their clinically negative contacts were studied to evaluate the sensitivity and the specificity of quantitative saliva cultures for group A β-hemolytic streptococci. We also compared this technique with semiquantitative throat cultures as a means of isolating group A streptococci and of differentiating the streptococcal carrier state from patients with bona fide streptococcal upper respiratory tract infection as defmed by the presence of an antibody response. The data indicate that the throat culture is a more reliable means of identifying group A β-hemolytic streptococci in the upper respiratory tract than is the saliva culture. The converse is true for non-group A β-hemolytic streptococci; the saliva culture is a much better means for isolating these organisms. In individuals positive by both techniques we found good correlation between the degree of positivity of the saliva culture and the degree of positivity of the throat culture. Furthermore, while there was a definite trend for individuals with strongly positive cultures to demonstrate more often an antibody rise in either antistreptolysin O and/or antideoxynibonuclease B—indicating bona fide infection—this relationship was not sufficiently constant to provide a clear differentiation. This study also indicates that discordance (one positive, one negative) of simultaneous duplicate semiquantitative throat cultures is much more common among individuals who do not show an antibody response ("carriers") than among those with an antibody response (bona fide infection). This study confirms our previous observations suggesting that the presence of C-reactive protein in the serum of patients with a positive culture for group A streptococci and clinical signs and symptoms of pharyngitis is often an indication of true streptococcal upper respiratory tract infection, and that even with a positive saliva culture at the initial visit, a negative C-reactive protein is only infrequently (25%) associated with an antibody response.
Unsafe Playgrounds
Authors: Reichelderfer Thomas E. , Overbach Avrin , Greensher Joseph
Published: December 2021

Pediatricians generally may not be aware that playgrounds and playground equipment present an unsuspected hazard to children. Swings, slides, and playground equipment are ranked fifth in the Consumer Product Hazard Index based on data from the National Electronic Injury Surveillance System (NEISS) of the Consumer Product Safety Commision (CPSC), with an Age Adjusted Frequency-Severity Index of 12,498,000 for 1976 to 1977.1 Last year the CPSC's NEISS estimated that 167,000 persons were administered hospital emergency room treatment on a nationwide basis for injuries associated with public (75,000), home (41,000), and unspecified (51,000) playground equipment. The majority of those injured were between 5 and 10 years of age.
Tuberculin Testing in the Pediatric Office and Clinic
Authors: Kendig Edwin L.
Published: December 2021

Another article in this issue of Pediatrics, "Assessment of Tuberculin Screening in an Urban Pediatric Clinic," (p 856) again focuses attention on a weighty question: Is routine use of the tuberculin test important? The authors have pointed out the difference in philosophy of the Center for Disease Control, and the American Academy of Pediatrics. The Center for Disease Control recommends that routine tuberculin testing for school children and other similar programs be abandoned if the yield of

positive tuberculin reactions is less than 1%1; this recommendation is based on the assumption that discovery of cases at this low rate will not have epidemiologic impact (italics added).
Letters to the Editor
Authors: Christie Dennis L.
Published: December 2021

I disagree with several points stated by Dr Leape.

1. The acid reflux test is still the standard for significant gastroesophageal reflux as has been documented by numerous reports.1-2 Dr Leape states that monitoring of the esophageal pH under physiologic conditions is more reliable and relevant in the pediatric patient. I would like him to tell us how he would do 24-hour pH monitoring in infants and children and make it physiologic without the need for restraints, etc.
Dysautonomia in an Infant with Secondary Hyperammonemia Due to Propionyl Coenzyme A Carboxylase Deficiency
Authors: Harris David J. , Yang Bob I. Y. , Wolf Barry , Snodgrass Phillip J.
Published: December 2021

A male infant who had vomiting and coma in the absence of ketoacidosis was initially thought to have dysautonomia because of abnormal responses to methacholine and histamine, as well as abnormal urinary catecholamine excretion. Following an episode of hyperammonemia, a liver biopsy was performed which revealed a partial deficiency of carbamyl phosphate synthetase activity. The patient was treated with a protein-restricted diet supplemented with a mixture of ketoacid analogues of the essential amino acids, which precipitated ketosis and acidosis. A primary deficiency of propionyl coenzyme A (CoA) carboxylase was subsequently demonstrated. Because disorders of propionate metabolism may not initially present with ketoacidosis, we recommend examination of both plasma and urine for metabolites of this pathway, as well as direct measurement of propionyl CoA carboxylase activity in peripheral blood leukocytes, before performing a liver biopsy to evaluate urea cycle enzyme activities, and particularly before adding keto acid/amino acid mixtures to a protein-restricted diet.
Major Complication Secondary to Percutaneous Radial Artery Catheterization in the Neonate
Authors: Cartwright Glen W. , Schreiner Richard L.
Published: December 2021

Severe respiratory distress in the newborn requires frequent monitoring of arterial pH, Po2, and Pco2. Indwelling arterial catheters are frequently used in most severely ill infants for arterial blood sampling. Suggested sites for these lines have included the umbilical artery, temporal artery, radial artery, posterior tibial artery, dorsalis pedis artery, and the ulnar artery. It is well appreciated that there are serious and sometimes fatal complications from umbilical artery catheterization.1,2 A recent report suggests the possibility of cerebral vascular complications with temporal artery catheterization.3 Recently, a number of investigators have advocated the use of percutaneous radial artery catheterization.4-6 To our knowledge, there has been only one reported case in a neonate of a significant complication with radial arterial catheterization.
Cor Pulmonale in Severe Pierre Robin Syndrome
Authors: Johnson George M. , Todd David W.
Published: December 2021

Pulmonary hypertension or cor pulmonale, cardiomegaly, and pulmonary edema have been rarely reported in association with the upper airway obstruction found in severe Pierre Robin syndrome.1,2 The case presented herein supports Jersaty's1 contention that cor pulmonale and heart failure with pulmonary edema may be more common in severe cases of this syndrome than heretofore recognized. In this case tracheostomy resulted in dramatic regression of these life-threatening cardiorespiratory complications.

CASE REPORT

A white male infant was born on Dec 20, 1974 with Apgar scores of 5 and 7. His birth weight was 3.61 kg. The child had the classical features of a severe Pierre Robin syndrome with a wide cleft palate, micrognathia, and glossoptosis (Fig 1).
Delayed Cardiopulmonary Arrest After Lomotil Ingestion
Authors: Cutler Edward A. , Barrett Gregory A. , Craven Paul W. , Cramblett Henry G.
Published: December 2021

A 2-year-old boy had cardiopulmonary arrest 12 hours after ingestion of an unknown amount of a diphenoxylate hydrochloride and atropine sulfate compound (Lomotil). This history was obtained retrospectively after repeated denials of possible drug ingestion. We conclude that Lomotil toxicity, in particular, should be considered whenever a patient has respiratory depression many hours after suspected ingestion of a drug and that in general, drug ingestion should he excluded when unexplained coma or cardiopulmonary arrest occurs.

REPORT OF A CASE

A 2-year-old boy had cardiopulmonary arrest at six o'clock in the morning at home and was resuscitated by the emergency squad.
Bacterial Cholangitis in a 10-Week-Old Infant with Fever of Undetermined Origin
Authors: Wyllie Robert , Fitzgerald Joseph F.
Published: December 2021

We report a 10-week-old infant with fever and hepatosplenomegaly who had bacterial and histologic evidence of cholangitis. Our patient was found to have a structurally normal biliary tract and intact immune system.

CASE REPORT

A 10-week-old white female infant was admitted to the James Whitcomb Riley Hospital for Children with fever and hepatosplenomegaly in February 1978. The patient was the product of an uneventful pregnancy, labor, and delivery; her birth weight was 3.07 kg. The infant was reportedly well until three weeks prior to admission when fever was initially documented. Increasing irritability and persistent fever prompted her transfer to our facility. There was no history of vomiting or diarrhea nor were there any changes in feeding habits.
National Committee for Clinical Laboratory Standards
Authors: Bruck Erika
Published: December 2021

Many members of the Academy of Pediatrics seem to be generally unaware of the fact that your Academy has participated for ten years in a very interesting and valuable organization, the National Committee for Clinical Laboratory Standards (NCCLS).

The NCCLS has only three kinds of members: professional organizations, industrial (clinical laboratory instruments and supplies), and government agencies (CDC, FDA, NBS, NIH). Each member is represented by one delegate and one alternate. At present there are close to 110 members, of which 20 are professional societies.
Letters to the Editor
Authors: Rothman Kenneth J. , Pueschel Siegfried M.
Published: December 2021

Saugstad1 studied the difference in birth weight between 53 Norwegian children with phenylketonuria and their 86 siblings. The mean birth weight of the propositi was 356 gm, less than that of siblings; this difference was more than 500 gm after adjustment for parity. To evaluate this finding, we studied the birth weights of 52 children with phenylketonuria and their 79 siblings (Pediatrics 58:842, 1976). Because birth weight varies considerably between families, we compared affected subjects with their siblings within families rather than pooling all subjects as Saugstad did.
Factors Affecting Heart Rate Variability in Preterm Infants
Authors: Cabal Luis A. , Siassi Bijan , Zanini Bernardino , Hodgman Joan E. , Hon Edward E.
Published: December 2021

Neonatal heart rate variability (NHRV) was studied in 92 preterm infants (birth weight, 750 to 2,500 gm; gestational age, 28 to 36 weeks). Each infant was monitored continuously during the first 6 hours and for one hour at 24, 48, and 168 hours of life. During each hour NHRV was quantified and related to the following parameters: sex, gestational age, postnatal age, heart rate, and the presence and severity of respiratory distress syndrome (RDS). NHRV in healthy preterm infants was inversely related to heart rate level and directly related to the infant's postnatal age. In healthy babies with gestations of 30 to 36 weeks there was no significant correlation between NHRV and gestation. Decrease in NHRV was significantly related to the severity of RDS, and the reappearance of NHRV in infants with RDS was associated with a good prognosis. Decreased NHRV significantly differentiated the infants with RDS who survived after the fifth hour of life. The data reveal that NHRV (1) should be corrected for heart rate level and postnatal age; (2) is decreased in RDS; and (3) can be used as an indicator of morbidity and mortality in preterm infants with RDS.
Comparison Radiographs of Extremities in Childhood: Recommended Usage
Authors: Merten David F. , Felman Alvin H. , Glaser Norman , McSweeney William J. , Northway William , Goldman Harold S. , Grossman Herman
Published: December 2021

Extremity injuries, a common problem in pediatric practice, are responsible for a significant number of radiographic examinations performed on children each year. Radiologic diagnosis in these injuries may be complicated by the variable appearance of the growing skeleton, especially around the epiphyses and the physeal plate. In the past, it has been a common and accepted practice for pediatricians, generalists, orthopedic surgeons, and radiologists to obtain routinely radiographs of the uninjured limb1-3 for comparison with those of the injured extremity to rule out subtle fractures or dislocations.

Recently, increasing concern about potential dangers of ionizing radiation, coupled with agitation from insurance carriers and governmental agencies to reduce escalating medical costs, has resulted in mounting pressure to limit diagnostic radiographic examinations. At the same time, however, rising malpractice litigation has, in many instances, forced physicians to obtain additional radiographic studies to "protect" themselves, especially in trauma cases. Radiographs of traumatized extremities contribute significant numbers of medicolegally oriented radiologic examinations each year. Although comparison views are no doubt helpful in some instances, until recently there has not been any effort to document the extent of use or diagnostic value of comparison views, especially those routinely obtained.

Within the past two years there have been two studies on this problem. In 1977, a survey4 of pediatric radiologists throughout the United States and Canada sought to determine individual application of comparison views, whether selective or routine; factors that influence this use; extent of comparison views, whether single or multiple; and cost of the additional radiographic studies.
Noninvasive Assessment of Left Ventricular Function Related to Serum Digoxin Levels in Neonates
Authors: Sandor George G. S. , Bloom Kenneth R. , Izukawa Teruo , Patterson Michael W. H. , Rowe Richard D.
Published: December 2021

Eighteen neonates in heart failure were investigated to assess whether high or low serum digoxin levels had differing effects on left ventricular function as determined by systolic time intervals obtained by echocardiography. Nine patients had digoxin levels of 1.99 ± 0.35 ng/ml (group 1). Nine others had levels of 3.62 ± 0.95 ng/ml (group 2). Systolic time intervals were obtained by echocardiography before and at 5 days after digoxin and correlated with serum levels. The heart rate, preejection period (PEP), left ventricular ejection time (LVET), electromechanical systole (QS2) and the PEP/LVET ratio were measured. LVET and electromechanical systole were indexed. These measurements were analyzed, and the two groups were compared using Student's t test.

The clinical improvement in both groups was similar and no difference in ECG changes were noted. Therapy with digoxin produced changes in heart rate and systolic time intervals in both groups. Both showed significant shortening of electromechanical systole index; group 1 significantly shortened the LVET index and PEP/LVET ratio, whereas group 2 significantly shortened the PEP. Statistical analysis comparing the two groups showed no difference between them.

Digoxin produces measurable changes in the indices of left ventricular function. The magnitude of these changes suggests no therapeutic advantage to the higher levels.
Familial Asplenia, Other Malformations, and Sudden Death
Authors: Katcher Avrum L.
Published: December 2021

Two families have been presented. In one, asplenia occurred with and without gastrointestinal malformations. In the other, cardiovascular malformations occurred in one member and Ivemark syndrome in the other. All three children with asplenia died in infancy, two with evidence of sepsis. Sudden death in infancy may be due to sepsis in a child with isolated asplenia syndrome and impaired resistance to infection. Both isolated asplenia and some cases of congenital heart disease without asplenia may be related to Ivemark syndrome.

New infants born in families with a history of congenital cardiovascular malformations, visceral heterotaxy, or other malformations associated with Ivemark syndrome should be tested for asplenia, primarily by searching for Howell-Jolly bodies. infants with asplenia should be protected with prophylactic antibiotics. Pneumococcal polysaccharide vaccine is indicated at the age of 2 years.

It would appear worthwhile for pediatric surgical or pediatric cardiologic services to perform a screening program for Howell-Jolly bodies.
Injuries to Young Athletes
Authors: Flynn Thomas G. , Kennell John H. , McLeod Robert N. , Shaffer Thomas E. , Strong William B. , Thornton Melvin L. , Van Rooy Clemens W. , Wilkins Kaye E. , Baker Fred W. , Malacrea Richard F.
Published: December 2021

Numerous factors must be considered in protecting the health of athletes. Of fundamental importance to physicians are (1) the prepaticipation medical examination for authorization to enter a sports program, and (2) the prevention, recognition, and treatment of injuries incurred in sports. The purpose of this statement is to call attention to the subject of sports injuries so that pediatricians can take measures to protect their young patients and set up a system for diagnosing and treating athletic injuries.

Young athletes present special problems that are perhaps more familiar to pediatricians than to other physicians and supervisors of sports programs:

1. Their strength is not proportional to their size, resulting in wide differences in physical performance of individuals of the same age.

2. Young athletes are impatient about restrictions on activities, even when restrictions are necessay for the diagnosis and the healing of injuries.

3. Flexible ligamentous structures and open epiphyses result in susceptibility to musculoskeletal injuries that should have prompt evaluation and treatment.

4. Some children and adolescents have unrecognized congenital conditions that make them more susceptible to athletic injuries.

5. Young athletes usually lack motivation to work hard to condition their bodies for endurance, strength, and acclimatization to heat.

6. Many young athletes are disinterested and indifferent about the fitting, adjustment, and care of their protective equipment.

7. Young athletes in sports programs sponsored by schools or community agencies rarely have the benefit of supervision and advice from a qualified athletic trainer. The duties of an athletic trainer are usually assumed by a coach or parents, or by a physician who at times may be available only by telephone.
Encouraging Breast-Feeding
Authors: Barness Lewis A. , Dallman Peter R. , Anderson Homer , Collipp Platon Jack , Nichols Buford L. , Walker W. Allan , Woodruff Calvin W.
Published: December 2021

Physicians, nurses, nursing personnel, and hospitals need to examine their practices and procedures that encourage or discourage breast-feeding. The cultural attitudes and life-styles of today's world tend to mitigate against breast-feeding. Yet, the benefits of breast-feeding to the neonate and the mother are so numerous that pediatricians must strongly encourage the practice.
Comment on Committee on Drugs Report
Authors: Lantner Ingrid L.
Published: December 2021

It is sad, and in my opinion, unfortunate that, after having evaluated the multiple harmful effects due to marijuana, the Committee decided to be concerned only with the heaty use of this intoxicant. Are we, as the experts of the health of our youth, going to compromise with a drug causing long range consequences to practically all systems of our body? This drug is accumulative, and therefore will sooner or later give some deleterious effect to any user.
Breast Pumps
Authors: Hervada Arturo R.
Published: December 2021

I would like to recommend two breast pumps that we have found to be very useful to nursing mothers. From correspondence with pediatricians in various parts of the country, I have gotten the impression that many of them are not aware of these useful adjuncts to human lactation.

The first one, the "Loyd-B-Pump" (Fig 1) is a simple, hand-triggered pump that we have found very helpful for the working, nulsing mother who needs to pump her breasts once or twice daily to collect her own milk.
A Randomized Controlled Trial of Prenatal Nutritional Supplementation in New York City
Authors: Rush David , Stein Zena , Susser Mervyn
Published: December 2021

This randomized controlled trial of nutritional supplementation in pregnancy, in a poor black urban population in the United States, aimed to increase the birth weight and influence the postnatal development of the offspring of mothers at high risk of having low birth weight infants. The execution of the research design and adherence to the treatment regimen among the experimental population appeared adequate for a reasonable test of the treatments. At birth, the only significant favorable effect of supplementation observed was the prevention of depressed birth weight among the offspring of mothers who smoked heavily. With balanced protein-calorie supplementation, length of gestation was increased, the proportion of low-birth-weight infants reduced, and mean birth weight raised by 41 gm (not statistically significant). With high protein supplementation, there was an excess of very early premature births and associated neonatal deaths, and there was significant growth retardation up to 37 weeks of gestation. At 1 year of age, significant effects of high protein supplement were found on three psychological measures: visual habituation, visual dishabituation, and mean length of free play episodes. These measures were unrelated to measures of growth at birth and at 1 year of age. There were no detectable residual adverse effects of high protein supplementation at 1 year of age.
ON AIR INSUFFLATION FOR THE TREATMENT OF INTUSSUSCEPTION– AS REPORTED IN 1864
Authors: C. T. E.
Published: December 2021

The first successful surgical operation for intussusception in an infant was reported in 1874.1 Prior to this date, infants with intussusception were occasionally treated by introducing air into the rectum by means of a tube attached to a common pair of bellows.

In 1864 David Grieg2 of Dundee, Scotland published the first detailed report of the successful treatment by insuffiation of several infants with intussusception. This is how he described his first case.

Case I.—M.S.G., a stout, healthy, female child, 6 months old, always enjoyed good health, never having had a day's sickness; never had any food except breast milk; never troubled with diarrhoea or bowel complaint. Was in her usual good health on Monday, 13th October 1862, up to 6 o'clock in the evening, when, without any obvious cause, she suddenly became fretful, kicking with her feet, bending the body backwards, and screaming. In about ten minutes she became very sick and vomited severely. The skin became cold and clammy, the countenance pale, and the lips livid.... She seemed to have great pain in the abdomen, which came on in paroxysms, and to increase in intensity until she vomited, when she would seem relieved a little, or at least so faint and sick as not to scream. When given the breast, she would take it readily; but as the sickness and vomiting, with a paroxysm of pain, immediately came on, she latterly refused it. Immediately when she was seized a spoonful of castor oil was given, and hot fomentations were applied to the abdomen.
HYDROPATHY, OR THE WATER-CURE, AS AN ESCAPE FROM THE PITFALLS OF ALLOPATHIC PRACTICE, AS VIEWED IN 1851
Authors: C. T. E.
Published: December 2021

During the nineteenth century many medical sectarians arose to challenge the heroic treatment of the allopaths with their insistence on bleeding, blistering, purging, and dosing with calomel. The hydropaths, one of the most influential of these sects, rejected all drugs and placed their faith solely in natural cures such as fresh air, sunshine, exercise, natural diet (often vegetarian), and above all, water, which they used in every conceivable way.

Mrs Mary Gove Nichols, a nonphysician health reformer, opened a water-cure establishment in New York City about 1848. She believed that the spread of hydropathy would eventually make physicians obsolete.

Mrs Nichols1 described how a friend's child was "murdered by the ignorance, and the time-honored death-dealing system of Allopathy." This event led her to embrace the "water-cure" method which she forcefully popularized during the middle part of the last century. She wrote:

A mother...mourned all the time for a child of four years, who had been seized with croup. The mother was thrust out of the room, and the door locked by her family physician, because she was averse to bleeding, and then the child was bled into a dead fainting fit, and revived to take dose after dose of calomel, till the doctor gave her up to die, and another distinguished allopathic physician was sent for. He decided that the only chance of saving the child was to compel it to breathe the fumes of burning calomel. This was done five times; the child struggled so as to escape from the father, who held her with all his force, and ran across the room.
Professional Courtesy
Authors: Bass Lee W. , Wolfson Jerome H.
Published: December 2021

Professional courtesy is a practice that has outlived its usefulness. Today it stands in the way of a physician and his family getting the best care available. It is an anachronism which in the modern medical milieu defeats the noble purpose it was originally intended to serve. Physician attitudes toward each other and their patients should be an integral part of the ongoing ethical discussion, starting at the beginning of medical school and continuing on throughout one's medical career. The concept and implications of professional courtesy should be included in these discussions because they go to the heart of getting and giving the best care available.

Major criticisms against doing away with professional courtesy are that this somehow denigrates the medical profession, removes the aura of medicine, casts a shadow on its nobility, and somehow translates itself into the idea that money is what is good about medical care. We feel the central concept of the doctor-patient relationship (no matter who the patient is) should be a special sense of caring. However, not charging for care makes it different for the patient and the physician. Both may feel compromised. Both may feel the loss of freedom to react. Charging for care says that the patient's needs are significant, deserve attention, and that the doctor's services have value.

Pediatrics, perhaps more than any other specialty, requires frequent communication and visits between physician and patient and entails extensive use of the telephone. We feel that because of professional courtesy many physician-parents and their spouses are deterred from using pediatric services appropriately by timely office visits or telephone calls. They therefore do not receive optimal care.35

In starting practice, the young physician must make a decision when he sees his first doctor-patient. Although he may have never been taught about the concept, somewhere in the back of his mind is a thought that Hippocrates said physicians should not charge other physicians for care, and so he establishes a precedent of professional courtesy that usually remains through a lifetime of practice and is very difficult to change or abandon. It is therefore at the start of practice that the disadvantages of professional courtesy should be most carefully considered. We recommend not starting the custom. But even if it has already been started, we recommend that this anachronism be abandoned.
Moyamoya and Fanconi's Anemia
Authors: Cohen Nathan , Berant Moshe , Simon Joshua
Published: December 2021

We report a 10-year-old boy who has Fanconi's anemia and was admitted because of acute hemiplegia of the left side. Internal carotid arteriography disclosed a moyamoya cerebrovascular pattern on the right side. Although this condition may be acquired, it is suggested that in this case the moyamoya might pertain to the array of congenital malformations associated with Fanconi's anemia. Intracranial accidents occurring in Fanconi's anemia are generally ascribed to the bleeding tendency; however, the possibility of an underlying vascular anomaly should also be considered.
Hyperphenylalaninemia Due to Dihydropteridine Reductase Deficiency: Diagnosis by Measurement of Oxidized and Reduced Pterins in Urine
Authors: Milstien Sheldon , Kaufman Seymour , Summer George K.
Published: December 2021

Hyperphenylalaninemia due to dihydropteridine reductase deficiency results from the inability to maintain the aromatic amino acid hydroxylase cofactor, tetrahydrobiopterin, in its reduced or active form. Diagnosis of the disease is usually made by direct enzymatic assay on liver biopsies or in cultured skin fibroblasts. Evidence is presented that normal children and classic phenylketonuric children excrete mainly tetrahy-drobiopterin in their urmnes, whereas children with dihydropteridine reductase deficiency excrete only oxidized forms of biopterin. Details of a rapid high performance liquid chromatographic assay for the measurement of the various forms of biopterin in urine are presented. This assay can be used to screen for suspected dihydropteridine reductase mutants.
Pulmonary Edema and Croup
Authors: Hurley R. Morrison , Kearns J. R.
Published: December 2021

There have been two reports of children1 and adults2 developing acute pulmonary edema secondary to acute upper airway obstruction. We are reporting a similar case which demonstrates the same association.

A 5-year-old girl had a mild upper respiratory tract infection and harsh cough two days prior to admission in April 1975. She awakened suddenly the evening of admission unable to breathe. She improved slightly in the cold outside air en route to hospital, but on arrival she developed acute distress with laryngeal stridor suprasternal and intercostal indrawing.
Overconcern and Overtreatment
Authors: Volpe Frank J.
Published: December 2021

Recently I received the pamphlet "Age 3 - Age 7" from the American Association of Orthodontists. It strikes me as a not-so-subtle marketing effort to increase the business of orthodontists. Could it be that pediatricians are being asked to do their marketing for them?

At a time when health care professionals should be doing their utmost to decrease costs and unnecessary utilization of health services, this pamphlet encourages increased utilization of services of questionable worth.
Training in School Health
Authors: Nader Philip R. , Vanderpool Nathalie A.
Published: December 2021

In a recent commentary (Pediatrics 63:681, 1979) we questioned how many programs existed for training in school health. To answer this question we sent a copy of our commentary, a letter requesting a response, and a survey card (card and data tables available on request from authors) to 143 Pediatric Department Chairs in the United States (127) and Canada (16). A substantial number, 109 of the 143 (76.2%) returned the anonymous card following the single mailing.
Metopic Craniostenosis as a Consequence of Fetal Head Constraint: Two Interesting Experiments of Nature
Authors: Graham John M. , Smith David W.
Published: December 2021

Two instances of metopic craniosynostosis provide dramatic experiments of nature which implicate fetal head constraint as one cause of early sutural fusion. The presumed restriction of growth stretch at the metopic suture in one instance was due to a bicornuate uterus in which the fetal head was markedly constrained. The second instance was in one of monozygotic triplets reared in a small mother in which the affected fetal head had been wedged between the hips of the two unaffected siblings.
The Pancytopenia of Isovaleric Acidemia
Authors: Kelleher John F. , Yudkoff Marc , Hutchinson Raymond , August Charles S. , Cohn Robert M.
Published: December 2021

Severe pancytopenia developed in two infants with isovaleric acidemia. Previous reports indicate these hematologic abnormalities are a leading cause of death in affected infants. Our findings suggest that the pancytopenia may be due to arrested maturation of hematopoietic precursors. Prompt transfusion of appropriate blood components prevented complications due to the hematologic abnormalities.
Early History of Heart Surgery
Authors: Mayer Thom
Published: December 2021

It was with great interest that I read Moss' excellent summary of data concerning congenital heart disease.1 Of particular interest were the well-taken references concerning Gross' "atrial well" and Lillehei's use of crosscirculation. In that vein, however, there is one inaccuracy in the article. In speaking of repair of patent ductus arteriosus, Moss states that it represents "the oldest of all heart operations." Although the 1939 report by Gross2 did signal the onset of surgical therapy of congenital heart disease, the first successful heart operation was performed by Ludwig Rehn of Frankfurt, Germany in 1896,3 only seven years after Theodor Billroth had declared that, "A surgeon who would attempt such an operation should lose the respect of his colleagues."
Other Effects of Bilirubin
Authors: Thong Y. H.
Published: December 2021

Two articles1,2 in a recent issue of Pediatrics draw attention to the urgent need for further research into mechanisms of bilirubin toxicity. My own theory of bilirubin encephalopathy,3 which may be of interest to your readers, was unfortunately published too late to be included in Dr Karp's excellent review.2 This theory ties together disparate observations: (1) the importance of the hexose-monophosphate shunt (HMP-shunt) in brain metabolism,4 and (2) the ability of unconjugated bilirubin to inhibit the HMP-shunt of phagocytosing neutrophils.5
‘Knocked Out’—An Early Sign of Intussusception
Authors: Thurston Don L. , Thurston Jean Holowach , McCoy Ernest E.
Published: December 2021

In the July 1979 issue of Pediatrics, Singer reported two cases of intussusception in which altered consciousness was an early manifestation. Singer considered that such findings were atypical except in the case of moribund children with prolonged intussusception, fluid and electrolyte imbalance, blood loss, and/or strangulation of the bowel.

Actually it has long been known that neurologic signs and symptoms are commonly seen early in this disorder. More than 30 years ago, in a study of acute intussusception in 95 infants and children, Oberhelman and Condon reported that "shock or impending shock as an early (the italics are ours) symptom is not adequately stressed in the literature" (Surg Clin North Am 27:3-22, 1947).
Neonatal Transport Nurses: An Analysis of Their Role in the Transport of Newborn Infants
Authors: Thompson Theodore R.
Published: December 2021

From September 1976 to March 1979, nurses selected from the newborn intensive care unit (NICU) assumed the transport team leadership role for 443 newborns. Each nurse had successfully completed an eight-week didactic and practical educational program in the assessment, management, stabilization, and transport of ill newborns including premature infants, those with various medical and surgical disorders, and those requiring assisted ventilation. Physician supervision and consultation was always available. The overall survival rate for these infants was 81%, a rate similar to that for newborns transported by physicians. The transport nurses consistently demonstrated the ability to effectively assess, manage, stabilize, and transport ill newborns. In addition, their utilization has alleviated a physician shortage on the NICU, has improved the response time to transport requests, and has enhanced educational opportunities for physicians and nurses.
Acute Fluoride Poisoning in a New Mexico Elementary School
Authors: Hoffman Richard , Mann Jonathan , Calderone James , Trumbull Jon , Burkhart Michael
Published: December 2021

Thirty-four persons became ill with acute fluoride poisoning shortly after drinking water in an elementary school in Los Lunas, NM. The water supply of the school was supplemented with a concentrated sodium fluoride solution designed to raise fluoride levels in drinking water to 1 to 5 ppm. Two water samples taken after the incident was reported showed elevated fluoride levels of 375 and 93.5 ppm. Malfunction of a relay switch controlling dilution of the fluoride solution produced toxic fluoride levels in the water. The symptoms of all patients were mild and generally of short duration, with two thirds of patients reporting complete resolution within 24 hours. The bitter, salty taste of the water deterred consumption of large amounts and prevented serious intoxication.
Regional Neonatal Transport: Impact of an Integrated Community/Center System
Authors: Sumners James , Harris Howard B. , Jones Bobbetta , Cassady George , Wirtschafter David D.
Published: December 2021

In the face of increasing neonatal referrals from a large geographic region, community hospital resources were recruited and coordinated with regional center resources to facilitate "community-based" neonatal transport. All transport requests were first "triaged" by an attending neonatologist. Discriminant analysis was used to assess the impact of resource allocation decisions. Decisions regarding allocation of resources to an individual transport generally reflected geographic distance to be traveled, size of delivery service at referring hospital, and apparent degree of illness. Physicians participation in transports was reduced from 95% to 15% of the trips. The incorporation of community-based transport resources and nonphysician transport teams into a coordinated triage and transport process with existing center-based resources did not adversely affect neonatal survival. Capacity of the transport system was enhanced with these reallocations.