bluuebunny/crossref_metadata_2025 huggingface dataset:
Intestinal Lymphangiectasia: A Reappraisal
Authors: Vardy Peter A. , Lebenthal Emanuel , Shwachman Harry
Published: December 2021

Intestinal lymphangiectasia (IL) may vary widely in its manifestations and severity. Fifteen children seen between 1960 and 1974 with histologically proven IL are analyzed by clinical, laboratory, radiologic, and histologic criteria. Remissions occurred in most patients and none died. Exacerbations occurred in five children.

Diarrhea was present in 14 patients and in 13 appeared before the age of 3 years. Vomiting occurred in nine patients and growth retardation in seven. Four children had associated peripheral lymphedema and two of these had a family history of lymphedema, both had affected fathers and one had affected siblings and paternal cousins. Seven had hypoproteinemic edema, and, of these, four suffered from hypocalcemic seizures. Chylous effusions were present in five. Hypoproteinemia was present in 12 although five had no hypoalbuminemic edema. Six had lymphopenia which was related to the severity of the disease and was the last abnormality to disappear after clinical remission. Lymphopenia may first appear years after the protein loss begins. Upper gastrointestinal tract series were performed in 13 children and had diagnostic supportive value in seven. Six children had two or more small-intestinal biopsies done. They all showed great variation from one examination to the other, ranging from a normal appearance to severe changes.

Lymphatic block may occur at different sites-in the lamina propria only, generalized (lamina propria, submucosa, serosa, and mesentery), or conversely in the mesentery alone with minimal changes in the lamina propria. In three patients intravenous hyperalimentation was necessary.

Specific treatment with a high-protein, low-fat diet with added medium-chain triglyceride (MCT) is valuable. Surgical resection was of benefit in one patient, and anastomosis of mesenteric to para-aortic lymph nodes in another.
Recurrent Caffey's Cortical Hyperostosis and Persistent Deformity
Authors: Blank Eugene
Published: December 2021

A boy, age 12 years, who had infantile cortical hyperostosis has continued to have occasional aches and new cortical thickenings in his arms and legs. His mandible is undergrown and his ribs have an abnormal slope.

Recurrence of Caffey's cortical hyperostosis and persistent deformity have been observed in other children and young adults. Some unexplained cases of late cortical thickening and pain may be due to Caffey's disease.
Clinical Manifestations of Crohn's Disease in Children and Adolescents
Authors: Burbige Eugene J. , Huang Shi-Shung , Bayless Theodore M.
Published: December 2021

Crohn's disease (regional enteritis) is a chronic disorder which usually appears in adolescence or early adulthood.1-8 The average age of onset reported in the adult literature is 27 years.9 Although it has not been reported frequently in children, Van Patter et al., found that 14% of 600 patients observed at the Mayo Clinic had an onset of symptoms occurring before the age of 15.10 Rogers et al.,11 utilizing a computerized analysis of their files, found that 21% of 489 patients with the diagnosis of Crohn's disease had the onset before age 15. In fact, the first patient that attracted Dr. Crohn's attention to this entity was a 16-year-old boy.12 Among the patients in the 7 to 15-year-age range at the Mount Sinai Hospital in New York, the maximum incidence was at 10 to 14 years of age.5 The current communication summarizes the clinical features of 58 patients with Crohn's disease of the small intestine and/or of the colon whose disease appeared before they were 15 years of age and emphasizes the prominence of the extra-intestinal manifestations. The mode of presentation of these younger patients was often such that the clinician's attention was diverted from the gastrointestinal tract.

PATIENTS STUDIED

During a 20-year period (1952 to 1972) at the Johns Hopkins Hospital, 376 patients were discharged with the diagnosis of regional enteritis or Crohn's disease. Forty-eight of them, or 12.7%, were under the age of 15. The diagnosis was based on pathological and/or roentgenographic cnteria.

The study group included these 48 patients plus 10 others seen in the outpatient department or at other Baltimore hospitals (Sinai Hospital and the Greater Baltimore Medical Center).
Significance of Mediastinal Mass in Acute Lymphoblastic Leukemia
Authors: Ravindranath Yaddanapudi , Kaplan Joseph , Zuelzer W. W.
Published: December 2021

A mediastinal mass (MM) is found at the time of diagnosis in 10% to 15% of children with acute lymphoblastic leukemia (ALL).1 In view of the frequent progression of childhood mediastinal lymphoblastic lymphoma (MLL) to leukemia,2,3 ALL + MM may be MLL with early bone marrow involvement. We have found that MLL is a T cell tumor, while ALL is a tumor of cells with neither T nor B cell characteristics.4 Therefore, if ALL + MM is a leukemic stage of MLL, patients with ALL + MM and ALL may differ in their clinical characteristics and responses to therapy. To test this hypothesis, we conducted a retrospective study to compare children with ALL + MM and ALL followed in this clinic over the last seven years.
A review of Antihistamines and the Common Cold
Authors: West Sheila , Brandon Brenda , Stolley Paul , Rumnll Richard
Published: December 2021

Antihistamines, used alone and in combination with other drugs, were initially promoted for the treatment of a viral upper respiratory infection (URI) during the late 1940's. Their popularity grew with the claim that these drugs aborted further development of a cold if taken shortly after the onset of symptoms. Increasing use of antihistamines resulted from subsequent claims that they appeared to shorten the duration of a cold and, at present, antihistamines and combination cold preparations containing these agents are promoted for the symptomatic relief of colds.

Current use and expenditure reflects the general acceptance of these drugs by both patients and physicians for use in treating a cold. National marketing research data estimate that approximately 94% of office visits for a cold result in prescriptions for the patient, of which one third are prescriptions for antihistamimc combination preparations. Other data estimate that 3.5 million prescriptions were written for cough and cold preparations containing antihistamines in 1972. Consumer expenditures were over $600 million a year for nonprescription cough and cold remedies in 1972. Despite their apparent popularity, many cough and cold remedies contaming antihistamines have been deemed less than effective by the National Academy of Science, and the Food and Drug Administration has begun an inquiry which may result in action to require manufacturers of these agents to comply with limitations on components and advertising claims.

Although there are a number of reports in the literature regarding the effectiveness of antihistamines for the treatment of the common cold, the conflicting nature of the results has led to considerable confusion over the merits of these drugs.
Occult Recurrence of Nasopharyngeal Rhabdomyosarcoma Manifesting as Isolated Increased Intracranial Pressure
Authors: Brown Michael R. , Sherry William E. , Menkes John H. , Feig Stephen A.
Published: December 2021

In this paper we report a child who had extensive neoplastic infiltration of the meninges which defied clinical detection. We believe that any patient with a past or present history of tumor who presents with increased intracranial pressure should be presumed to have intracranial neoplastic involvement, even in the face of negative diagnostic studies. As in this case, other causes of increased pressure should be systematically intracranial excluded.
Caring for Children and Working: Dilemmas of Contemporary Womanhood
Authors: Eisenberg Leon
Published: December 2021

American women are entering the labor force in increasing numbers; currently 53% of women in intact families are in paid employment as are 41% of those with children under 18; this despite the fact that women earn less than 60% of the wages paid men in similar occupations. Women are responding to the pressures of an inflationary economy, to the costs of higher education for their children, to opportunities for personal fulfillment, and to a growing market for service occupations. Yet married women continue to carry 70% to 80% of child care and household duties when both parents work. Conventional stereotypes of feminine passivity, formalized in the last century, grossly misperceive women's roles and abilities and constitute a psychological barrier to self-realization for both men and women. Social innovations in child care will be necessary if we are to provide optimal conditions for child development at a time when family roles are in sharp transition. The pediatrician, as family counselor, can help to support mothers and fathers seeking to fulfill parental, occupational and personal needs in a rapidly changing society.
Chronic Vulvovaginitis in Children Due to Shigella flexneri
Authors: Davis Thomas C.
Published: December 2021

Although previous reports have implicated Shigella flexneri in resistant or chronic cases of vulvovaginitis in children, no authors have described the clinical findings of this condition. The report presents four cases of persistent vulvovaginitis in prepubertal Indian girls from different reservation communities in Arizona. S. flexneri was isolated in pure culture from the vaginal discharge of each patient. All four cases were characterized by a prolonged vaginitis with a bloody, punilent discharge which responded poorly or not at all to various topical modes of therapy for nonspecific vaginitis. Three cases cleared completely when treated with orally given ampicillin for one week. The striking similarity of these cases suggests that chronic Shigella vulvovaginitis is a recognizable clinical entity and should be considered in the differential diagnosis of persistent vaginitis in children, especially in those from communities where Shigella is endemic.
Rickets Associated With Long-Term Anticonvulsant Therapy in a Pediatric Outpatient Population
Authors: Crosley Carl J. , Chee Claire , Berman Peter H.
Published: December 2021

Over a 12-month period, an ambulatory pediatric population receiving long-term anticonvulsants was surveyed for the presence of biochemical and radiologic rickets. There were 74 treated children and 95 matched controls. Elevations of serum alkaline phosphatase activity occurred in 31 of the 74 (42%) treated children (23 of 47 children between 2 and 10 years and 8 of 21 children between 10 and 16 years). This frequency of abnormal values was significantly greater than that which occurred in our control population. Calcium and phosphorus abnormalities were minimal in both treated and control populations. Radiologic rickets occurred in 6 of the 74 (8%) of the treated children and in none of the control population. Neither the severity of the rickets nor the degree of hyperalkaline phosphatasemia were correlated with age of the patient, duration, and/or dose of anticonvulsant therapy.
Immunization "dyspractice": The need for "no fault" insurance
Authors: Krugman Richard D.
Published: December 2021

We are on a collision course in many areas of the United States. A number of states have passed compulsory immunization laws for school children, yet the majority of the vaccines required in fulfillment of these laws have a specific incidence of adverse reactions. These range from mild fever or irritability to encephalitis or paralysis. True, the incidence is small, but it is real. For live oral trivalent poliovirus vaccine, for example, the package insert cautions that "the possible low level of risk to the vaccinated subject or to close contacts [should] be considered at all times."

Yet what recourse does the one person in tens of thousands suffering an adverse reaction have?
Early Growth and Development in Low-Birthweight Infants Following Treatment in an Intensive Care Nursery
Authors: Fitzhardinge P. M.
Published: December 2021

Sixty-seven appropriate-for-date infants with gestations less than 33 weeks were followed for 12 months after their term dates. All had been born after September 1970. None received hypercaloric alimentation as neonates. Growth from the expected date of delivery was compared with that of 24 normal full-term infants and with accepted growth standards. The boys did not differ from the controls or the standard in mean weight, length, and head circumference, in weight and height indices, or in velocity of weight and linear growth. The girls had a slower velocity of weight growth for the first six months and had significantly lower weight indices at 12 months than did their controls. Velocity of linear growth, height indices, and mean length and head circumference for the girls were similar to those of the control standards.

Gross central nervous system defects occurred in 22.5% of the boys but in none of the girls. More than one half of the abnormalities were hydrocephaly. The mean post-conceptional developmental quotient was 110 for the girls and 108 for the boys.
Assisted Ventilation in Infants With Meconium Aspiration Syndrome
Authors: Vidyasagar Dharmapuri , Yeh T. F. , Harris V. , Pildes Rosita S.
Published: December 2021

In a retrospective analysis of infants born with meconium staining over an 18-month period at Cook County Hospital, 32 infants met two of the three criteria for the diagnosis of meconium aspiration syndrome: (1) history of meconium in the oropharynx or trachea; (2) clinical evidence of respiratory distress; and (3) x-ray evidence of aspiration pneumonia. Seventeen infants developed respiratory failure; nine of these infants died. One infant without respiratory failure died of sepsis. Analysis of sequential arterial blood pH and gas tension showed that nonsurviving infants had persistently high PCO2 and A-a gradient in spite of initiation of assisted ventilation. These changes seem to be related to severe right-to-left shunting and ventilation perfusion abnormalities. The data further suggest that asphyxia and acidosis occur well before the infant is born and that intrapartum monitoring to recognize fetal asphyxia may help in improving morbidity and mortality from meconium aspiration syndrome.
Pediatric Clinical Faculty Structure and Teaching Hospital Function
Authors: Leslie Hugh J. , Reeb Kenneth G. , Rome Leonard P. , Strassman Selig S.
Published: December 2021

An organization of clinical faculty has been formed at Rainbow Babies and Childrens Hospital, Cleveland, Ohio, to help coordinate the mutual goals but sometimes conflicting needs of practicing pediatricians and a teaching hospital. The organization has been active in developing and conducting educational experiences for students, house officers, and practitioners. It has contributed to efforts to improve ambulatory and impatient care. Collaborative clinical research projects involving practitioners and academicians are planned. We know of no other existing similar organization. We propose that other institutions with similar needs consider this mechanism to help improve their academic and patient care programs.
THE DIAGNOSIS DERBY
Authors: Coll J R
Published: December 2021

Picking a Derby winner and making a diagnosis have much in common. The inspirational punter relies on "having a feeling" or a pin stabbed at a race card. Some doctors use similar methods for diagnosis. They and the punters are overgenerous in remembrance of success; there is always a good excuse for the horse or diagnosis that was left at the start. But the racing form of a horse can be calibrated, and random choice be transmuted to calculated probability. The handicapper, like the doctor, seeks discriminative information to predict the order in which the runners should pass the winning post. Unlike the doctor, the handicapper then proceeds to eliminate discrimination to attempt a dead heat for the field. We are said to be a nation of gamblers, and if mathematical methods can be invoked for games of chance there is no reason why the nation's doctors should not readily apply mathematics to the serious business of the nation's diseases.
Medex: A Time-Motion Study
Authors: Sells Clifford J. , Herdener Richard S.
Published: December 2021

Six Medex working with family practitioners were followed by an observer for a total of 18 days to gain an objective profile of how Medex spent their workday.

Medex on the average spent 30% of their time with office patients and saw 38% of all office patients. Medex saw between 25% and 100% of all pediatric office patients and spent on the average 37% of their office patient time with pediatric patients. On the average, Medex saw 8 pediatric and 11 adult office patients per day.

Well-child examinations, the largest pediatric diagnostic category, accounted for 30% of Medex pediatric office patient time. Minor surgery accounted for the second largest portion of pediatric office patient time (21%) while respiratory illness ranked third (11%).

In view of the increasing role family practitioners and their assistants will undoubtedly play in the provision of child health care, pediatricians are urged to work closely with family physicians in developing and implementing health care services for children.
Nutrition, Growth, Development, and Maturation: Findings From the Ten-State Nutrition Survey of 1968-1970
Authors: Garn Stanley M. , Clark Diane C. , Lowe Charles U. , Forbes Gilbert , Garn Stanley , Owen George M. , Smith Nathan J. , Weil William B. , Nichaman Milton Z. , Johansen Erling , Rowe Nathaniel
Published: December 2021

The Ten-State Nutrition Survey of 1968-1970 contributed far more information on nutrition and growth than was originally anticipated. In addition to quantification of the relationship between economic level and size and growth progress and demonstrating the concomitants of obesity and the effects of leanness, the results pointed out major gaps in our knowledge and provided a new body of substantive important information.

The survey did not find pot-bellied, spiderlimbed malnutrition of the starvation level. It did not suggest the prevalence of "hunger" of a kind widely advertised in a 1967 television spectacular. What it did show was that the dimensions of poverty could be spelled out in smaller size and lesser growth. It also showed interactions between economic level and size and growth performance in blacks and whites.

Among the novel and serendipitous findings were those showing dimensional, developmental, and temporal differences between black and white children who were carefully matched for economic level. The study showed the simple effect of level of fatness on both tempo and amount of growth. It demonstrated the antecedents of obesity in socioeconomic context. And it showed the differing participation of different organ systems and measures of somatic and skeletal development.

The Ten-State Nutrition Survey has been criticized first for directing attention to the poor, and second because it was not exclusively a survey of the poor. Yet, we now have data that never before existed. These data show the exact dimensional and developmental comparisons, both of the children of the poor and those of median incomes.
Lettrt To The Editor
Authors: Kawasaki Tomisaku
Published: December 2021

On behalf of the authors of our paper, I appreciate a very interesting and important comment raised by Dr. Cheek.

Although acrodynia was in our mind as a disease to be differentiated from mucocutaneous lymph node syndrome, a difference in clinical pictures (Table I) and measurement of mercury concentration in the hair of the patients with the syndrome (Table II) lead us to exclude acrodynia.

It is also worthwhile to note that acrodynia has been very rare in Japan up to the present, probably due to the fact that mercury-containing products such as teething powders and lotions have never been habitually used in this country.
Sudden Infant Death Syndrome and Subsequent Pregnancy
Authors: Mandell Frederick , Wolfe Lawrence C.
Published: December 2021

In psychological conditions of mourning and guilt, women who have lost children often attempt to quickly conceive a "replacement" child. This study examines the subsequent pregnancies of 32 women whose children died of sudden infant death syndrome (SIDS). The expected rate of infertility in a normal population is 10%. Spontaneous abortion has an incidence of 12% to 15%. Among the 32 women attempting to conceive after the loss of their child, 10 (31%) had spontaneous abortions and 11 (34%) could not conceive after attempts for at least one year. This association betWeen psychological and biological phenomena require special recognition by physicians who are advising parents who have lost children to SIDS. The management of these families includes compassion, understanding, and regard for the psychological environment of the subsequent pregnancy.
Welcome to our new Spanish language edition
Authors: Lucey Jerold F.
Published: December 2021

Beginning with this month's issue, Pediatrics will be translated into Spanish. Angel Ballabriga, M.D., Professor of Pediatrics in the Autonomous University and Chairman of the Children's Hospital of the Seguridad Social, Barcelona, Spain, will be the guest editor. Our Spanish edition will be published and distributed by Ediciones Doyma in Spain to approximately 15,000 physicians caring for children.

We hope that our new readers in Spain will find Pediatrics useful in their practices. Professor Ballabriga will select, for highlighting, those articles he believes to be of particular interest to Spanish physicians.

If this venture is judged to be mutually successful, we hope that it will be but the first of several steps planned to bring Pediatrics to a wider international audience.
Diagnosis of Meckel's Diverticulum by Radioisotope Scanning
Authors: Martin Gilbert I. , Kutner Fredric R. , Moser Lawrence
Published: December 2021

The clinical illness observed in a 5-month-old infant with Meckel's diverticulum is described. A sodium pertechnetate radioisotope scan was employed to confirm the clinical impression. The technical procedure, evaluation, and importance of the radioisotope study is discussed.
Diet and Growth in Congenital Heart Disease
Authors: Strangway Alice , Fowler Rodney , Cunningham Kathrine , Hamilton J. Richard
Published: December 2021

To assess the relationship between diet and growth in congenital heart disease we studied nutrient intake, body measurements, and cardiac status in 568 affected ambulatory patients less than 11 years of age. Most had mild heart disease, 104 were cyanotic, and only 10 were in congestive heart failure. Major disturbances of growth were uncommon. For the entire group body weight was below normal but only in those studied before 2 years of age; rates of growth and weight gain were normal over the period preceding the dietary study. There was no statistically significant relationship between intake of calories, protein, or other nutrients and growth or gain, analyzing the entire group, or analyzing patients subgrouped according to age, severity of heart disease, or severity of growth retardation. Body size and growth were diminished in cyanosed compared with noncyanosed children but cardiac status had no effect on nutrient intake. We conclude that in children with growth failure associated with congenital heart disease, nutrient intake is not an important factor limiting their growth.
Birthweight Doubling Time: A Fresh Look
Authors: Neumann Charlotte G. , Alpaugh Melinda
Published: December 2021

Infant birthweight doubling time is widely quoted as being achieved between 5 and 6 months. The purpose of this study was to determine the time of birthweight doubling and to identify important related variables. A total of 357 normal infants with birthweights between 2,500 and 4,100 gm were studied. Mean age of birthweight doubling for the entire group was 119 days (3.8 months). Bottle-fed infants doubled their birthweights earlier than breast-fed infants: 113 days vs. 124 days (P < .05). Boys doubled their birthweights earlier than girls: 111 days vs. 129 days (P < .0001). Solids were introduced earlier in bottle-fed infants (mean, 1.9 months) than in breast-fed infants (mean, 3.9 months). Harvard percentiles for mean group weight and length at the time of birthweight doubling were: for bottle-fed infants, 75th and 55th percentiles respectively; for breast-fed infants, 55th and 60th percentiles respectively; for boys, 75th percentile for both weight and length; for girls, 50th percentile for both weight and length. Thus, bottle-fed infants appear to have weight gains in excess of length gain and may be developing early obesity. In light of the poor prognosis in treating obesity, closer supervision of early infant feeding practices is indicated.
A Therapeutic Trial of Fatty Acid Supplementation in Cystic Fibrosis
Authors: Elliott Robert B.
Published: December 2021

Seven children with cystic fibrosis (CF) have been treated for at least one year with intravenously administered soya oil emulsion. In all, an improvement of at least one biochemical abnormality in character with the disease appeared. The children's clinical course remains benign. This course is remarkably better than that of other children with CF treated without Intralipid in Auckland in the same period, though a placebo effect cannot be discounted.

It is postulated that intravenous supplementation with essential fatty acid in CF may in turn partially correct an error of metabolism of prostaglandins present in the disease.
Theophylline Secretion Into Breast Milk
Authors: Yurchak Anthony M. , Jusko William J.
Published: December 2021

The infant of an asthmatic patient showed irritability associated with ingestion of breast milk only on days when the mother was taking theophylline. Pharmacokinetic studies in this woman and in four other subjects revealed that theophylline distributes well into breast milk. The average milk to serum concentration ratio of the drug was about 0.7 and milk concentrations paralleled the time-course of serum and saliva concentrations. On a relative body weight basis, a nursing infant would usually receive less than 10% of the mother's dose of theophylline which is normally an inconsequential amount.
Relationship of Allergy, Enuresis, and Urinary Infection in Children 4 to 7 Years of Age
Authors: Siegel Sharon , Rawitt Leslie , Sokoloff Burton , Siegel Bernard
Published: December 2021

A group of 234 children, 4 to 7 years old, in a middle- to upper-middle-class Caucasian population, were divided into four groups and matched for age and sex. Group 1 consisted of 50 children previously treated for urinary infection; control group 1 contained 55 well children; group 2 consisted of 69 children treated for respiratory allergy; and control group 2 contained 60 well children.

There was no statistical difference in persistent enuresis (night wetting every week), persistent day wetting (every week), allergy, or family history of enuresis, when group 1 and control group 1 were compared. A family history of urinary infection was higher (P < .05) in group 1.

There was no statistical difference in persistent enuresis, persistent day wetting, previous urinary infection, or family history of enuresis or urinary infection when group 2 and control group 2 were compared.

This study suggests that there is no relationship between respiratory allergy, enuresis, and urinary infection.
Persistent Mullerian Structures in a Male Neonate
Authors: Stallings Martin W. , Rose A. Hewitt , Auman George L. , Cunningham Russell D.
Published: December 2021

A 2-week-old male infant was diagnosed as having persistent Mullerian structures. Microscopically normal testes were found, as well as a uterus, cervix, and fallopian tubes. Plasma testosterone values responded normally to human chorionic gonadotrophin stimulation. This condition at times is familial, and genetic counseling is indicated.

CASE REPORT

A 2-week-old white boy presented with a history of a mass in the left groin. This mass was not present at birth. There is no family history of inguinal mass and the patient has no siblings. Physical examination revealed a normal male infant with a 2-cm to 3-cm hard mass in the left inguinal area.
Septic Arthritis in an Infant Due to Clostridium ghoni and Hemophilus parainfluenzae
Authors: Renne James W. , Tanowitz Herbert B. , Chulay Jeffrey D.
Published: December 2021

Clostridium ghoni and Hemophilus parainfluenzae are uncommon causes of human infection. Both of these agents were isolated from joint fluid in a child with septic arthritis.

CASE REPORT

An 8-month-old white girl was admitted with a three-day history of irritability, fever, and inability to lie on her right side. Ten days prior to admission bilateral otitis media was treated with 600,000 units of benzathine penicillin intramuscularly and sulfisoxazole suspension (1 gm daily until admission). Fever and irritability from otitis abated by the fifth day of therapy.

On admission the infant appeared acutely ill and had a temperature of 39.7 C.
A Question on Chart Audits
Authors: Thorpe Helene S. , Thorpe James H.
Published: December 2021

Outpatient chart audit, as performed by Russo et al.'s faculty,1 demonstrates the problems of measurement as much as that which is measured.

By now, with national emphasis on inpatient audit,2 it is evident that medical education and practice have neglected documentation of care given–this despite a long-time need for accurate, concise, legible record-keeping to assist in care by multiple professionals, to support disability evaluations, to avoid malpractice claims, to effect third-party reimbursement, and to enhance clinical investigation, among others.
The Food Additive Hypothesis, Lead, and Hyperactivity
Authors: David Oliver
Published: December 2021

The observations of Dr. Feingold1 concerning hyperactivity and its association with food additives raises the possibility of an interesting coincidence. In our work, we have been concerned with the relationship that the heavy metal lead has with hyperactivity. In studying this association we have been treating certain hyperactive children (approximately 50% to 60% of our hyperactive population) with lead chelating agents. We have been struck by the fact that at the start of this regimen many of our patients experience a worsening of the behavioral disturbance.
Designing a Child's Safety Seat
Authors: Meyer Robert P. , Lavenson Jack I. , deCastro Fernando J.
Published: December 2021

There is an increasing need for understanding human elements in the development of commercially successful products for children.1-4 We have generated and utilized human factors data in the design of a child's safety seat.

Thirty-five children, aged 6 to 42 months, were randomly selected from a Midwestern population. Anthropometric data were obtained by recording age, height, head width, shoulder width, buttock width, arm length, and leg length. Each child was photographed standing and sitting against a grid.
Abdominal Distension Following Ritual Circumcision
Authors: Horwitz Jonathan , Schussheim Arnold , Scalettar Howard E.
Published: December 2021

The report of the Ad Hoc Task Force on Circumcision1 and the letter by Dr. W. Berman2 appearing in the same issue presented us with an unusual diagnostic and therapeutic problem.

An 18-day-old infant was brought to us with a ten-hour history of mild, green, watery diarrhea and refusal to eat. There was no fever or vomiting, and on close questioning it was learned that he had been voiding normally. Over this period of time he refused to take any milk or liquids and it was this feature that had the parents particularly concerned.
Management Criteria, Documentation, and Peer Review of Initial Urinary Tract Infection
Authors: Margileth Andrew M. , Thompson Hugh C. , Osborne Charles E. ,   Joint Committee on Quality Assurance
Published: December 2021

During part of a national study to formulate criteria for chart audit of quality assurance of child health care, criteria were developed for diagnosis and management of urinary tract infections. These criteria were validated by pediatricians and family physicians in academic medicine and in practice. They were judged relevant to the medical care process and patient outcome by both. The selected criteria were also recommended by the majority of two large physician groups for use in peer review.

An important aspect of the study assessed the frequency of performing and recording indicated procedures or tests. In the first three phases of the study these criteria were said to be performed and recorded by a large majority of physicians. However, in the fourth (community) phase, when charts of 166 primary care physicians were actually audited, documentation was so poor that peer review by chart audit would be impractical at present.

Assuming proper documentation of the medical care process, similar criteria could be used for chart audit, clinical research, and educational purposes. Since the diagnostic and management process of initial urinary tract infection is established, development of structured health care forms and education in proper record-keeping are two important challenges for those interested in the evaluation of ambulatory care.
The Hazards of Skateboard-Riding
Authors:   Hawaii Chapter, American Academy of Pediatrics, Atienza Fernando , Sia Calvin
Published: December 2021

Skateboard-riding has become increasingly popular among Hawaii's children. The thrill of the ride and the challenge of keeping one's balance and working intricate maneuvers while speeding down a hill captures the fancy of many of our young.

This sport, however, has produced an alarmingly high toll of injury and illness. Pediatricians and emergency departments of our major hospitals have seen and taken care of large numbers of patients (aged between 3 years and 35 years, but with a distribution overwhelmingly pediatric) with significant injuries which include cerebral concussion, fractures, soft tissue injuries of varying degrees of severity and complications, and injury to internal organs.

During a three-month period at the Kauikeolani Children's Hospital, July to August 1975, there were 16 patients admitted with the following: seven cerebral concussions, one skull fracture, five assorted bone fractures, one soft tissue injury and infection, one retroperitoneal hemorrhage, and one instance of major surgery for removal of the spleen.

During the months of August and September 1975 the Emergency Department of Straub Clinic reported the following skateboard injuries: 14 fractures, 14 soft tissue injuries, 5 lacerations, and 2 cerebral concussions. Of the 35 patients seen, three were admitted—one with an open fracture, one with cerebral concussion, and one with a skull fracture.

During a four-week period (two weeks in June and July and two weeks in August and September) at the Emergency Department of Kaiser Medical Center, 66 cases of skateboard injuries were seen with six patients requiring admission for fractures and brain concussion.
The Pediatric Nurse Associate
Authors: Burnett Robert D. ,   Committee on Pediatric Manpower
Published: December 2021

During the past several years as Chairman of the American Academy of Pediatrics' Committee on Pediatric Manpower I have witnessed the development of the concept of the pediatric nurse associate (PNA) within the specialty of pediatrics. In addition, I have also been aware of the controversies within the AAP membership regarding the role of the PNA in child health care delivery.

Many of you will recall the concern of the mid-1960's which widely publicized an impending catastrophic shortage of pediatricians.
What Makes a Good Growth Chart?
Authors: North A. Frederick
Published: December 2021

Owen and Garn, in their recent editorial,1 extensively discuss the nature of the data used to derive the norms or standards used on the growth chart, but they dismiss the format of the chart with only a few words. I would argue that for usefulness in the health care of children the format of the chart is much more important than the data used to derive the standards.

What is it that the clinician expects, or should expect, to learn from measurements plotted on a chart?
Pneumocystis carinii Pneumonia in Two Vietnamese Refugee Infants
Authors: Giebink G. Scott , Sholler Larry , Keenan Thomas P. , Franciosi Ralph A. , Quie Paul G.
Published: December 2021

Two refugee Vietnamese infants developed pneumonia unresponsive to antibiotics. Clinical signs included malnutrition, a history of recent bacterial infection, and the acute development of fever, cough, and increasing respiratory distress with hypoxia. Lungs were clear on auscultation. Diagnosis of P. carinii in both was made by lung biopsy, and the infants recovered after pentamidine isethionate therapy. Laboratory evidence suggesting cell-mediated immune deficiency was present in both patients. Physicians caring for infants with pneumonia unresponsiveness to antibiotics, especially if the neonatal history is unknown, should proceed immediately with diagnostic studies for P. carinii.
Mercury Poisoning and MLNS
Authors: Nishida Goro
Published: December 2021

The course and symptoms of MLNS which Dr. Kawasaki et al. described in the September 1974 issue of Pediatrics1 are similar to those described by Dr. Currie.2 Lymph node enlargement can occur in acrodynia.3 Sudden death due to cardiac failure is also reported.4-6

I suggest that MLNS is the "acute febrile form" of infantile acrodynia. Mercury sources in the disease could be inactivated vaccines, in addition to polluted food and old mercury-containing preparations (such as diphtheria vaccine, Japanese encephalitis vaccine, influenza vaccine and globulin) which contain .05 mg of mercury per milliliter if thiomersal is the preservative.
Sleep Apnea in Eight Children
Authors: Guilleminault Christian , Eldridge Frederic L. , Simmons F. Blair , Dement William C.
Published: December 2021

Eight children, 5 to 14 years of age, were diagnosed by means of nocturnal polygraphic monitoring with a sleep apnea syndrome similar to that seen in adults. Excessive daytime sleepiness, decrease in school performance, abnormal daytime behavior, recent enuresis, morning headache, abnormal weight, and progressive development of hypertension should suggest the possibility of a sleep apnea syndrome when any of these symptoms is associated with loud snoring interrupted by pauses during sleep. Surgery may eliminate the clinical symptomatology.
Chemoreceptor Function and Sleep State in Apnea
Authors: Fagenholz S. Allen , O'Connell Kathleen , Shannon Daniel C.
Published: December 2021

Resting ventilation and ventilatory responses to 100% oxygen and to 5% carbon dioxide in air were measured in REM and non-REM sleep in post-neonatal infants. Normal controls were compared to infants with prolonged apnea and to siblings of sudden infant death victims. No significant differences in ventilatory responses were found between the groups. We conclude that apnea may occur in infants whose central and peripheral chemoreceptor activity is normal while they are breathing.
Intellectual Performance of 36 Phenylketonuria Patients and Their Nonaffected Siblings
Authors: Dobson James C. , Kushida Emily , Williamson Malcolm , Friedman Eva G.
Published: December 2021

Thirty-six patients with a confirmed diagnosis of phenylketonuria (PKU) were identified and placed on dietary therapy before reaching 121 days of age. These children are currently between 4 and 6 years old, and have been given the Stanford-Binet Intelligence Scale. Subsequently, their normal siblings of closest age were selected as matched-pair controls and were also tested with the Staford-Binet. The mean age of the PKU sample when tested was 50.0 months, and 50.9 months for the normal controls. The 36 index patients scored a mean IQ of 94 and their nonaffected siblings obtained a mean IQ of 99. This five-point mean difference was significant at the .02 level, and suggests the presence of a minimal intellectual impairment associated with PKU, even when treatment begins early and is rigorously monitored.
Home Urine Cultures by the Dip-Strip Method: Results in 289 Cultures
Authors: Gillenwater Jay Y. , Gleason Charles H. , Lohr Jacob A. , Marion Donald
Published: December 2021

Bacteriuria screening on 289 children was performed by their parents by means of a self-administered dip-strip culture which was inoculated, incubated, and interpreted in the home. Simultaneous pour-plate quantitative cultures and laboratory-tested dip-strip cultures were done on the same urine specimen which had been tested at home. The dip-strip culture was reliable (89%) in detecting significant bacteriuria with home administration and interpretation. Only 1.6% false-positive results occurred in the home testing. The dip-strip home cultures are an effective way for screening or follow-up of patients with bacteriuria.
Epiglottitis: Incidence of Extraepiglottic Infection: Report of 72 Cases and Review of the Literature
Authors: Molteni Richard A.
Published: December 2021

A review of 72 cases of epiglottitis seen at the Children's Hospital of Denver was undertaken to determine the incidence of extraepiglottic and septic foci in this disease. A parallel review of the literature was also undertaken. The clinical, bacteriologic, laboratory, and radiologic findings of this patient population are described.

A 25% incidence of both pneumonia and cervical lymphadenitis was found to be associated with this illness. Exudative tonsillitis and otitis media were the only other complications, although they were infrequently noted. No cases of septic arthritis or meningitis were encountered, although 50% of these patients were recognized as bacteremic. A low incidence of septic complications (eight cases of meningitis and one case of periarticular abscess) is noted in a review of the literature. Recommendations for antibiotic management and definition of the population at risk for septic complications are given.
Near-Drowning in Children: Clinical Aspects
Authors: Fandel Ivar , Bancalari Eduardo
Published: December 2021

Drowning is the third most common cause of death in the pediatric age group in Florida. The clinical presentation, laboratory data, modes of therapy and outcome of 34 cases of near-drowning in children under the age of 14 years were reviewed. The most common clinical findings on admission were a history of cardiopulmonary resuscitation, tachypnea, pulmonary edema, and acidosis.

Twenty-eight (82%) patients survived. Twelve (35%) required mechanical ventilation. Of these only six survived, four of them with severe neurological sequelae. Modern management of respiratory failure is important for the ultimate survival of these patients; however, the final neurological outcome seems to be related to brain damage at the time of the asphyxia rather than to subsequent management.
Pseudobattering in Vietnamese Children
Authors: Yeatman Gentry W. , Shaw Constance , Barlow Matthew J. , Bartlett Glenn
Published: December 2021

Until recently the presence of linear bruising on children in America was synonymous with child abuse.1 With the large influx of Vietnamese children, physicians should be aware of the practice of coin-rubbing.2

While providing medical care for Vietnamese children at Fort Indiantown Gap, Pennsylvania, we commonly saw petechiae and frank purpura of the chest and back. These lesions were often linear and resembled trauma. Indeed, we received one report of alleged trauma from an outside physician who was not familiar with the condition.

The lay practice of Cäo Gió is quite commonly used among the Vietnamese for several symptoms including fever, chills, and headaches.
Face Masks Defended
Authors: Shuman Robert M. , Oliver Thomas K.
Published: December 2021

Pediatricians caring for the newborn are particularly aware of unexpected deleterious outcomes of well-intentioned therapy. Oxygen, chloramphenicol, sulfadiazine, and continuous positive airway pressure are examples. Elsewhere in this issue Pape et al.1 suggest that intermittent positive-pressure ventilation provided by a tight-fitting face mask in low-birthweight infants is yet another example. They observed a 30% incidence of significant intracerebellar hemorrhages in infants so treated (groups A and D). Such hemorrhages were seen in 10% of babies who were ventilated by an endotracheal tube rather than by mask (groups B and C), and were not seen in their 13 nonventilated babies (group E).
An Evaluation of the Safety of a Low-Saturated-Fat, Low-Cholesterol Diet Beginning in Infancy
Authors: Friedman Glenn , Goldberg Stanley J.
Published: December 2021

This study was designed to detect developmental, body chemistry, or somatic differences that might be present in children who had been on a low-saturated-fat, low-cholesterol (LSFLC) diet since birth. Comparison to a matched control group at age 3 years failed to demonstrate significant differences in percentile height, percentile weight, head circumference, age, skinfold thickness, total serum protein, hemoglobin, number of failures on a Denver Developmental Screening test, or number of sick visits. Experimental children did have significantly lower serum cholesterol than a large group of children of similar age. It is concluded that at age 3 years, no significant adverse findings were present in the group who had been nourished on a LSFLC diet since birth as compared to a control group.
Municipal Child Health Services: A Ten-Year Reorganization
Authors: Porter Philip J. , Leibel Rudolph L. , Gilbert Cynthia K. , Fellows Judith A.
Published: December 2021

There has been increasing interest within the medical community in developing primary care programs in teaching hospitals that meet the medical needs of a community.19,20 The Cambridge Hospital system provides a working model for such a mutually beneficial interaction. Based on principles of administrative centralization and utilization of the pediatric nurse practitioner, the neighborhood health centers operate as part of a cost-effective series of concentric circles. Administrative centralization within the Department of Pediatrics at the Cambridge Hospital has permitted the elimination of duplicate medical services and the development of a responsive community health service. The pediatric nurse practitioner, under close senior staff supervision, serves as the primary caretaker in the neighborhood centers. In addition to her role as the provider of a protocol determined, age-related series of physical, psychometric, and laboratory examinations, the pediatric nurse practitioner also cares for minor injuries and illnesses of childhood. Any child deviating from a clearly established range of norms for any physical, developmental, or laboratory parameter is immediately referred to the senior staff pediatrician for further evaluation. Finally, any patient requiring subspecialized inpatient care is referred to the Massachusetts General Hospital. The senior pediatric staff of the Cambridge Hospital serves the function of coordinating and supporting the rapid interlevel communication which must occur between community service, primary hospital, and a tertiary care facility.

This neighborhood health care system is, we feel, a medically sound, educationally exciting, and fiscally responsible solution to a problem facing many urban areas and their academic medical institutions.
Ketonic Diet in the Management of Pyruvate Dehydrogenase Deficiency
Authors: Falk Rena E. , Cederbaum Stephen D. , Blass John P. , Gibson Gary E. , Kark R. A. Pieter , Carrel Robert E.
Published: December 2021

Two brothers, aged 11 years 6 months and 2 years 3 months, with psychomotor and growth retardation, episodes of weakness, ataxia, ophthalmoplegia, and elevated levels of blood pyruvate were shown to have a deficiency in the pyruvate dehydrogenase complex (PDH). When they ate a diet high enough in fats to cause ketonemia but not acidosis, there was a fall in blood pyruvate levels, a decrease in the frequency and severity of the episodes of neurological deterioration, an increased rate of growth and development in the younger brother, and increased strength and endurance in the older one. The possibility of dietary treatment makes the early diagnosis of PDH deficiency more important. Determination of blood pyruvate and lactate levels following a standard glucose meal (glucose-pyruvate test) appears to be the most reliable screening test for this condition.