bluuebunny/crossref_metadata_2025 huggingface dataset:
AS OTHERS SEE US
Authors: C. T. E.
Published: December 2021

A tall, distinguished-looking, somewhat preoccupied man, Zuelzer, had been born in Germany, had trained in Berlin and in Prague, and had received postgraduate education in pediatrics, pathology, and blood in Boston before stopping off, on his career's course, in Detroit. There, some-what what to his own surprise, he had stayed. He had become a prominent member of a pediatric establishment in Michigan and in the United States. In Detroit he held the title of Director of the Child Research Center of Michigan, and he was professor of pediatric research at nearby Wayne State University. He was soon to join the editorial board of the powerful and conservative journal, Pediatrics.1
Pediatrics in the Sticks
Authors: Reeds Thomas O.
Published: December 2021

Many physicians feel that private pediatrics is primarily well-child care1 and envision a waiting room full of irate children and unreasonable parents waiting for a DPT. That this is not always the case is indicated by a summary of some of the problems I have been asked to evaluate during my first three months in a small Idaho community even though my practice is as yet anything but large. It has included:

It is apparent that my practice has included a significant number of hospitalized children with unusual illnesses.
Users and Nonusers of Hospitals
Authors: Moore Gordon T.
Published: December 2021

In their article examining the impact of the Rochester Neighborhood Health Center on hospitalization of children, Klein et al.1 demonstrated no overall change in hospital admission rates for the target population, but demonstrate a significant decrease in hospital utilization for the health center users. The fact that health center user rates fell while the nonuser rates rose during the study suggests a methodologic artifact as the cause of their findings. Two possible explanations can explain their observations.
Annual Progress in Child Psychiatry and Child Development, 1972, edited by Stella Chess, M.D., and Alexander Thomas, M.D. New York: Brunner/Mazel, Inc., 1972, 742 pp., $15.00
Authors: Aug Robert G.
Published: December 2021

For all those pediatricians and child psychiatrists who harbor lingering feelings of guilt about not getting around to reading as much of current professional journals as they'd like to, this book is a very effective remedy. In fact, this reviewer would prescribe it also for those who feel satisfied that they are keeping up well with the current literature, because of the remarkably wide array of different journals from which this book's articles have been selected; the reader is almost certain to come across valuable articles he would not otherwise have encountered.
Understanding Your Child From Birth To Three: A Guide To Your Child's Psychological Development, by Joseph Church. New York: Random House, 1973, 267 pp., $6.95
Authors: Howell Mary
Published: December 2021

More than 60% of the marriages contracted in the current year are expected to come to divorce or separation. Not only marriage but also parenthood is in a state of uncertainty; many young people are looking at the families they have known and wondering if the rewards of being parents outweigh the distress they believe they see. There is a growing body of social science literature that points to the isolated mother-father-child family–expecting to meet all of their needs behind the closed doors of their homes, and with responsibilities sharply divided between wage earner and housekeeper–as a family system that puts maximum stress on minimum strength.
PRIMARY MEDICAL CARE AND MEDICAL RESEARCH TRAINING
Authors: Nathan David G.
Published: December 2021

Dr. Cicely Williams delivered a challenging Blackfan Lecture, reproduced elsewhere in this issue of the Journal,1 at the Children's Hospital Medical Center on May 30, 1973. It should be carefully studied by all pediatricians, and particularly by pediatricians involved in academic programs. Dr. Williams speaks with the experience and wisdom gathered during more than 50 years of service to the field of maternal and child health and with unimpeachable academic credentials. She first described kwashiorkor in the Western medical literature in 1931.

Dr. Williams' message to academic pediatrics is loud and clear. It may be paraphrased in the following manner: "Be off," she states, "with your ultrascience, your superspecialists and your rapt attention to the few with so called interesting illnesses.
ALEXIS DE TOCQUEVILLE ON THE ADOLESCENT AMERICAN GIRL
Authors: C. T. E.
Published: December 2021

In May 1831, the 26-year-old French nobleman, Alexis de Tocqueville (1803-1859), arrived in the United States, and departed its shores in February 1832, only nine months late. His analysis of the American way of life which he wrote in 1835 as a result of his visit, remains, even today, one of the great classics in political literature. Tocqueville had this to say about the freedom of the adolescent American girl:

In the United States, the doctrines of Protestantism are combined with great political liberty and a most democratic state of society; and nowhere are young women surrendered so early so completely to their own guidance.

Long before an American girl arrives at the marriageable age, her emancipation from maternal control begins: she has scarcely ceased to be a child, when she already thinks for herself, speaks with freedom, and acts on her own impulse. The great scene of the world is constantly open to her view: far from seeking to conceal it from her, it is every day disclosed more completely, and she is taught to survey it with a firm and calm gaze. Thus the vices and dangers of society are early revealed to her; as she sees them clearly, she views them without illusion, and braves them without fear; for she is full of reliance on her own strength, and her confidence seems to be shared by all around her.

An American girl scarcely ever displays that virginal softness in the midst of young desires, or that innocent and ingenuous grace, which usually attend the European woman in the transistion from girlhood to youth.
ANNUAL SUMMARY OF VITAL STATISTICS–1972
Authors: Wegman Myron E.
Published: December 2021

This year I propose to depart somewhat from the usual format of these annual reports to include the results of some firsthand observations in the People's Republic of China. Beginning on June 15, 1973, I spent three weeks in China as a member of the medical delegation of the Committee on Scholarly Communication with the People's Republic of China. The delegation was multidisciplinary, including persons versed in anesthesiology, internal medicine, dentistry, psychiatry and neuroscience, hospital and medical care administration, nurse-midwifery, public health and pediatrics. The delegation visited medical schools, hospitals, industrial installations and communes in Kwangchow (Canton), Peking, Shenyang, Anshan, Fushun and Shanghai.
Explanation of Perinatal Mortality Rate in Collaborative Study
Authors: Goldstein Arnold S. , Mangurten Henry H.
Published: December 2021

The article by Froehlich and Fujikura1 on the prognosis of single umbilical artery is a much needed and highly informative addition to the literature. It presents a great deal of information and some important implications as to future management. We question the mortality rates quoted. They are given as percentages, and include stillbirths and neonatal deaths, i.e., perinatal mortality. The figure given as the general mortality rate is 3.8% or 38 per 1,000 births. Previous figures cited for perinatal mortality in the United States have varied from approximately 19 per 1,000 to approximately 26 per 1,000.2-4 We wonder how the figure of 38 per 1,000 was determined.
Gangrene of the Buttock: A Complication of Umbilical Artery Catheterization
Authors: Rudolph Nathan , Wang Hsinn-Hong , Dragutsky David
Published: December 2021

A case is described of necrosis of a portion of the buttock following on misdirection of an umbilical artery catheter into a distal division of the internal iliac artery. The need for radiologic localization of the position of the catheter is reaffirmed.
Aeromonas Hydrophila Infections
Authors: Phillips John A. , Bernhardt Harvey E. , Rosenthal Samuel C.
Published: December 2021

Five cases in which A. hydrophila was cultured are reported. The organism is found in natural water sources and most isolates have been from diarrheal stools. Our cases suggest that severe Aeromonas infections occur more often in water-associated wounds than previous reports indicate.

All isolates were sensitive to chloramphenicol, gentamicin, kanamycin, nalidixic acid, nitrofurantion, sulfonamides and tetracycline. Sensitivity to ampicillin and carbenicillin was absent and it was variable to cephalothin and colistin.
Biology of Brain Dysfunction, Vol. I, edited by Gerald E. Gaull. New York/London: Plenum Press, 1973, 403 pp., $35.00
Authors: Menkes John H.
Published: December 2021

One of the problems faced by the biomedical sciences is the time gap between new information obtained in the clinic and the laboratory and its dissemination. Presentations at national meetings usually do not provide a solution. At best, part of the data, as delivered from the podium, has not been subjected to prior rigorous scrutiny by peer groups, and the necessarily narrow view of the field renders them inadequate for teaching purposes.

Translation of information to the printed page requires a time gap which at its best runs to about six weeks, as is the case for some of the bimonthly research communications (Biochemical and Biophysical Research Communications and Life Sciences).
PROLONGED RUPTURE OF MEMBRANES ASSOCIATED WITH A DECREASED INCIDENCE OF RESPIRATORY DISTRESS SYNDROME
Authors: Bauer Charles R. , Stern Leo , Colle Eleanor
Published: December 2021

The finding of an increased occurrence of prolonged ruptured membranes (ROM) in a group of prematures without RDS led to a prospective study of the effect of prolonged rupture (defined as greater than 16-hour duration) on the subsequent course of premature infants. Seventeen mother-infant pairs were included in the study and steroid determinations (total blood corticosteroids, cortisol, and corticosterone) were performed on paired maternal plasma obtained prior to delivery and infant plasma obtained within the first hour of life.

There was a lower incidence of RDS in infants born after greater than 16 hours ROM (0/10), when compared to those who were born after membranes had been ruptured less than 16 hours (4/7). A correlation between steroid levels (both total blood corticosteroids and cortisol) in the infants and duration of ruptured membranes was seen. However, no correlations existed with the duration of labor.

It is postulated that the protective influence which prolonged rupture of membranes imparts on the premature fetus is mediated by elevated blood corticosteroids, which result in accelerated lung maturation and a subsequent decreased incidence of respiratory distress syndrome.
The Philosophy and Practice of Screening For Inherited Diseases
Authors: Komrower G. M.
Published: December 2021

In recent years there has been a decline both in morbidity and mortality attributable to infection, parasitic infestation, and malnutrition which has been coincidental with the development of promising approaches to the diagnosis, treatment, and prevention of genetic diseases. This has encouraged the consideration of genetically oriented screening programs as an exercise in preventive medicine, and considerable thought and effort have been expended in the development of suitable programs covering many inherited disorders, particularly those relating to mental retardation.

The World Health Organization in a recent publication, "Genetic Disorders—Prevention, Treatment and Rehabilitation,"has stated that the object of these endeavors is to improve the quality of life for individuals and society as a whole by permitting the control of disease in affected persons.

When one comes to plan a screening program it is important to keep the following criteria in mind. The incidence of the disorder(s) in question should be reasonably high. The program must be administratively feasible; the laboratory procedures used must be technically reliable with a very low (to absent) incidence of false-positive or negative results. (Better to have a false-positive than a false-negative.) The methods must be relatively unsophisticated and the cost of the whole scheme must not be great as there is little money available for this type of medical practice. Finally and most important, treatment must be available for the children detected. The family concerned should be given full guidance and encouragement and genetic counseling services should be available to them.
Total and Free Thyroid Hormone Concentrations in the Neonatal Period
Authors: Erenberg Allen , Phelps Dale L. , Lam Robert , Fisher Delbert A.
Published: December 2021

Radioimmunoassay measurements of serum concentrations of thyroxine (T4), triiodothyronine (T3), free T4 (FT4), free T3 (FT3), and thyroxine binding globulin (TBG) were conducted in full-term newborn infants between birth and 5 days of age. The mean concentrations of T4 and FT4 increased from cord blood levels of 11.9 µg/100 ml and 2.9 ng/100 ml to peak values of 16.2 µg/100 ml and 7 ng/100 ml by 24 to 48 hours of age. Mean serum total and free T3 concentrations increased from cord blood levels of 50.5 ng/100 ml and 146 pg/100 ml to peak values of 419 ng/100 ml and 1,260 pg/100 ml by 24 hours of age. Mean T3/T4 and FT3/FT4 ratios increased from 1/238 to 1/39 and from 1/20 to 1/6, respectively, during this period. By 72 to 126 hours, both the T4 and T3 concentrations had fallen somewhat. Mean serum TBG concentrations were unchanged and approximated 5.0 mg/100 ml during the first 5 days of life.

These data confirm earlier reports that the normal newborn infant rapidly becomes chemically hyperthyroid in the neonatal period due to increased thyroid hormone secretion; this neonatal hyperthyroid state is due more to T3 than to T4. The data also confirm earlier reports that the fetus is T3 deficient due to a decreased capacity to monodeiodinate T4 to T3 in extrathyroidal tissues. The rapid increase in serum T3 after delivery at a time when the capacity to convert T4 to T3 is reduced suggests that the increment in serum T3 is due, predominantly, to increased T3 secretion from the thyroid gland stimulated by the neonatal TSH surge. Thus with parturition, the newborn infant is transformed from a state of chemical T3 deficiency to a state of chemical T3 thyrotoxicosis.
Non-Thrombocytopenic Purpura Associated With Cat-Scratch Disease
Authors: Quillian Warren W. , Quillian Warren W. , Lancaster James W.
Published: December 2021

Carithers has summarized nicely the historical development of cat-scratch disease. He pays proper tribute to Drs. Debré, Foshay, Rose, Mollaret, Keefer, Greer, Daniel and others. The course of this illness, the theories of its etiology, its histopathology and details of the various complications of the disease, including thrombocytopenia, are well described in papers by Carithers, Warwick, Margileth and others.

The purpose of this report is to document the case of a patient with confirmed cat-scratch disease, who had a complication that has not been reported previously. This case report illustrates non-thrombocytopenic purpura in a 12-year-old boy with cat-scratch disease.

Case Report
Reduction of Plasma Propionate by Peritoneal Dialysis
Authors: Russell George , Thom Hazel , Tarlow Michael J. , Gompertz David
Published: December 2021

In a child with propionic acidemia, biochemical relapse associated with septicemia was successfully treated with peritoneal dialysis. It is suggested that this line of management is suitable for the management of biochemical crises in propionic acidemia.
A Teaching Model for Pediatric Intubation Utilizing Ketamine-Sedated Kittens
Authors: Jennings Paul B. , Alden Errol R. , Brenz Ronald W.
Published: December 2021

A teaching model for pediatric intubation, utilizing ketamine-sedated kittens, has been provided for physicians and ancillary medical personnel at Madigan Army Medical Center. A dosage of 22 mg/kg of ketamine, administered intramuscularly to weaned kittens, produces some sedation but maintains laryngeal reflexes comparable to the awake human neonate. Practice with this living model has fulfilled a needed requirement for medical personnel who may be called upon in pediatric emergencies.
Letter to the Editor
Authors: S. C. A.
Published: December 2021

A 2- to 3-month interval between receipt and printing of correspondence is a necessary nuisance. Evanston's silence, queried in Invaded Reader's reply above (which we received in November), was broken in December—Pediatrics, 52:767, 1973.
Letter to the Editor
Authors: Cherry James D. , Powell Keith R. , Gardner H. Garry , Roden Vernon J.
Published: December 2021

Thank you for the opportunity to reply to the stimulating letters of Dr. Dardick and Dr. Heisinger. Both of these observers have rightfully pointed out that acute epiglottitis and laryngotracheitis are different diseases and, therefore, should not have been lumped together in our comparative data. At the suggestion of Dr. Dardick, we have re-examined the 1970-1971, 1971-1972 comparative data, eliminating children with a diagnosis of epiglottitius (Table I). As noted, this has only tended to make racemic epinephrine look worse.
Disproportionate Short Stature: Diagnosis and Management, by Joseph A. Bailey, II, M.D., F.A.C.S. Philadelphia/London/Toronto: W. B. Saunders Co., 1973, 589 pp., $22.50
Authors: Spranger Jürgen W.
Published: December 2021

The orthopedic management of patients with inborn errors of skeletal development is unsatisfactory to both patient and physician. The results of major orthopedic procedures are frequently poor and the individual physician sees too few patients with a given condition to critically evaluate the results of his treatment.

In his book, Dr. Bailey reviews the operative and nonoperative procedures recommended in the management of various types of disproportionate dwarfism. His approach is particularly well shown in the chapter on diastrophic dwarfism: various orthopedic procedures are presented and their results are critically evaluated in 22 patients.
Some inferences from galactokinase deficiency
Authors: Sidbury James B.
Published: December 2021

The observations made by Olambiwonnu et al. in this issue on twins with galactokinase deficiency raise several issues of practical importance. The first point, which is not new but cannot be too often reemphasized, is the necessity to use a chemical reducing method, such as the Clinitest® tablet, for routine screening of urines for sugars. This, and the other copper-reducing methods, will detect all reducing sugars, whereas the methods utilizing glucose oxidase, such as Testape® or the Labstix,® will detect only glucose. If only the latter are used all melliturias except glucosuria will be missed. This is a matter of very acute practical concern in the neonatal period and early infancy when unsuspected cases of galactokinase deficiency, galactosemia, fructose intolerance and other melliturias should be detected for the best ultimate result.
The Shortsighted Treatment of Myelomeningocele: A Long-Term Case Report
Authors: Freeman John M.
Published: December 2021

Meningomyelocele is the most common severe congenital anomaly of the central nervous system (CNS), occurring in approximately 1/1,000 births. Until the late 1950s nothing was done for these children. Ingraham wrote that they should be given routine care until 18 months of age, when an accurate assessment of their neurologic function and intelligence could be made before closing the back. Many-most-died. The survivors who had severe hydrocephalus, hydronephrosis, and marked paraplegia, were left untreated at home or in institutions. The few survivors who did well were often children with meningoceles whose backs were then closed at 18 months.

Studies from England suggest that 10% to 16% of children with meningomyelocele who are untreated are alive at 1 to 2 years, and at least 7% of the most severely affected survive to one year. If a child lives two months, he has a 28% chance of being alive at 11 years-untreated. With vigorous, early treatment he has a 50% to 80% chance of survival and, depending on the series, has a poor chance for a useful, productive life or a good chance for being "competitive." How then should we approach the newborn with a meningomyelocele? What should be our approach to his or her management? This case report is intended to emphasize the disastrous potential results of one common form of management.

CASE REPORT

An 8-year-old white boy was recently brought to the Birth Defects Treatment Center for recommendations about future care. He was the third child of middle class parents and was born and treated elsewhere.
Physicians' Reactions to Training in a Pediatric Intensive Care Unit
Authors: Todres I. David , Howell Mary C. , Shannon Daniel C.
Published: December 2021

Physician trainees working in a pediatric intensive care unit (ICU) were interviewed early in their training experience, at the end of their training, and 1 to 12 months after their training had ended. Pediatricians responded significantly differently from anesthesiologists: they commented more often about their own feelings, and less often about procedural-intellectual-technical matters as contrasted with feelings and relationships. Pediatricians were also more likely than anesthesiologists to mention their own emotional reactions to ill children, their sense that patient death meant physician failure, and their dismay early in the training period about the stressful intensity of the work. Physicians who were parents differed from those who were not parents by commenting more frequently about their work with the parents of patients, and about the necessity for teamwork. Physician trainees interviewed early in the training period were less reflective about the experience, and less likely to comment on feelings and relationships, compared to those interviewed later. Analysis of the sources of satisfaction and discontent with work in the ICU, as stated by the physician trainees, has been useful in efforts to improve the climate of work and learning in the unit, and to provide optimal patient care.
Can the Number of Well Child Visits Be Reduced?
Authors: Chamberlin Robert W.
Published: December 2021

I am responding to Dr. Yankauer's commentary in the August 1973 issue of Pediatrics. Dr. Yankauer's questioning of the effectiveness of well child visits is provocative and timely. I would also agree with his suggestion that a study be done to determine if the number of well child visits can be reduced without compromising the observable benefits of health supervision. I suspect such a study will show no difference between experimental and control groups in such health indexes as immunization status, number of illness visits, number of treatable defects detected, and measures of weight, height, and hemoglobin.
Letter to the Editor
Authors: Lubin Bertram H. , Murphy Sharon B.
Published: December 2021

The article, Anesthetic Risks in Sickle Cell Trait, is disconcerting because its conclusions are unjustified and its implications unwarranted. For example, due to the paucity of preoperative information one might conclude that the patients were doubly heterozyous for a hemoglobinopathy such as sickle thalassemia.

The presence of generalized sickling at postmortem exam in the five patients reported does not constitute proof that intravascular sickling was pathogenic in the patient's death, for it is obvious that red cells from a patient with sickle trait will assume the sickled shape in the acidotic and hypoxic postmortem state.
Letter to the Editor
Authors: McGarry Paul , Duncan Caroline
Published: December 2021

To Dr. Abelson: The five cases reported were not the only ones found, all deaths were not investigated, and all anesthetics administered during this period of time were not reviewed. Incidence rates are, therefore, not known, and any figures implying that this was a statistical analysis would be misleading.

To Doctors Lubin and Murphy: We indicated those cases, three of five, on whom electrophoresis was done. The two not so tested had no clinical symptoms of hemoglobinopathy and were most likely cases of A-S hemoglobinopathy.
Efficacy of Zoster Immune Globulin
Authors: Judelsohn Richard G. , Meyers Joel D. , Ellis Robert J. , Thomas Elaine K.
Published: December 2021

Varicella may be a life-threatening infection in children who have immunodeficiency diseases or who are taking immunosuppressive medications. It was previously demonstrated that zoster immune globulin (ZIG) can prevent varicella in normal children if given within 72 hours of exposure, and its possible efficacy has been reported in high-risk immunodeficient children as well. A program for the distribution of ZIG to high-risk susceptibles was established at the Center for Disease Control in 1971. In 1972, 56 high-risk children were treated with ZIG after exposure. Forty-nine recipients had no clinical symptoms of varicella; at least 34 of these 49 had undetectable CF antibody before treatment, though their immune status by other serologic techniques was unknown. In the seven recipients who developed varicella, the disease was not life-threatening. ZIG may be preferable to other available therapeutic modalities in the prevention or modification of varicella.
Sudden Death in Young Patients With Congenital Aortic Stenosis
Authors: Doyle Eugenie F. , Arumugham Palaniappan , Lara Emilia , Rutkowski Monika R. , Kiely Brian
Published: December 2021

Four patients with congenital valvular and subvalvular aortic stenosis who died suddenly are presented in detail. Each had evidence of severe obstruction and left ventricular "strain" pattern on the electrocardiogram. Symptoms were present in three cases. Survey of the literature was done with particular reference to the usefulness of standard scalar electrocardiography and patient symptomatology in estimating the severity and the progression of the aortic obstruction. Of those who died suddenly with isolated aortic stenosis, 70% had left ventricular strain pattern, 21% had left ventricular hypertrophy alone, and 9% had an apparently normal electrocardiogram. Symptoms of exertional dyspnea, syncope, chest pain, and fatigue were present in almost all cases. Sudden death in the absence of severe ECG abnormalities and/or symptoms is very uncommon.
The Treatment of Status Epilepticus
Authors: Lombroso C. T.
Published: December 2021

Status epilepticus, though declining in frequency in recent years, is a medical emergency as well as a persistently difficult problem in balanced therapy. By its very nature it is likely to require the direct involvement of the family physician be he a pediatrician or a general practitioner.

It may be useful to begin by defining and considering special aspects in relation to causes and age. Most convulsive seizures are self-limiting events terminating on their own accord before specific medical treatment need or can be rendered. For these, positioning to prevent aspiration of excessive secretions and vomitus and prevention of self-injuries is generally sufficient. Prying open clenched teeth for the insertion of time-honored tongue blades, pencils, or fingers has no place in modern medicine. These maneuvers are useless in the prevention of tongue biting (that will have occurred at the onset of the initial tonic phase), but may actually be harmful by dislodging loose teeth, and by initiating nociceptive stimuli that reflexly can prolong the tonic phase. Likewise excessive restraining of convulsing patients may faciitate bone injuries. The administration of drugs postictally is unnecessary in the majority of isolated seizures. Exceptions of course are prolonged or serial convulsions, or status epilepticus as discussed below, and those instances in which the convulsion has occurred because of failure in taking prescribed antiepileptic medication. The recent availability for quick appraisal of serum levels of antiepileptic drugs is a useful guide in this respect.

Turning now to the definition of status epilepticus: official formulations such as "an attack which is so prolonged or so frequently repeated as to constitute a definite lasting condition" is open to some confusion.
Diagnosis and Treatment of Childhood Myoclonic Seizures
Authors: Livingston Samuel
Published: December 2021

Epileptic seizures in children occur in a variety of forms. While it may be difficult to classify some attacks, most seizures may be broadly divided into five groups: major motor (grand mal), petit mal, psychomotor (temporal lobe), myoclonic and autonomic. This writing is devoted to a discussion of the clinical manifestations, EEC findings, etiology, prognosis and treatment of myoclonic epilepsy of childhood. The data presented are based on approximately 1,500 children with myoclonic seizures who have been studied at The Johns Hopkins Hospital Epilepsy Clinic. In 1,150 patients, myoclonic seizures appeared during the first two years of life, most commonly between 3 and 9 months of age; and in the remaining 350 children, after the first two years of life, usually between 3 and 7 years of age. We classify myoclonic epilepsy into two types on this basis of age at onset.

1. Myoclonic epilepsy of infancy. In previous writings, we referred to this form of epilepsy as "minor motor epilepsy." Other terms currently in usage are "infantile spasms," "hypsarrhythmia" and "massive myoclonic seizures."

2. Myoclonic epilepsy of older children. This form of epilepsy is designated by many physicians as "petit mal variant," "head-dropping spells," "headbobbing spells," "akinetic seizures," "Lennox syndrome" and "Lennox-Gastaut syndrome."

CLINICAL MANIFESTATIONS

The predominant clinical feature of myoclonic epilepsy is a sudden flexor spasm of the body musculature, although extensor spasms are sometimes observed. The clinical manifestations vary, depending upon the posture of the patient.

Recumbent

Although this spell in the recumbent patient varies somewhat in clinical manifestations, it most commonly consists of a sudden flexion of the head with a simultaneous outward thrust of the upper extremities and flexion of the thighs on the abdomen. It is sometimes preceded by a short cry, laugh or giggle.
Letter to the Editor
Authors: Hall Robert T. , Rhodes Philip G.
Published: December 2021

We are very pleased to have received the comments of Doctors Barnett and Edelmann regarding the random selection of patients for placement in a study. We would heartily concur that random, rather than alternate or serial allocation, would avoid unconscious bias of a cyclic nature which might run in phase with the allocation cycle. It is also possible that if the investigators were aware of the treatment group to which the patient would be allocated, an additional bias would be introduced which could clearly affect selection of patients for study.
Interspersed Advertising
Authors: Palmisano Paul A.
Published: December 2021

I note, with great distress, that Pediatrics now intermingles advertising copy with scientific text. There must be a definite reason for this major departure from past policy. One possibility is that there has been a ground-swell of requests from fellows of the American Academy of Pediatrics to bring these urgent, shrill commercial messages to their attention. Another possibility is that the pharmaceutical industry and its Madison Avenue advertising agents have financially strong-armed the Academy brass to perpetrate this intrusion. Can the Editor tell me which of these reasons is true?
The Misuse of Statistics
Authors: Hoeffler Dennis F.
Published: December 2021

The increased utilization of probability analysis in medical publications has been accompanied by recurrent examples of the misapplication of biostatistical technique. A recent article in Pediatrics is a case in point. The authors support their premise that stimulant drugs have an adverse effect on the growth of hyperactive children with sophisticated statistical evaluations. They have, however, violated some basic assumptions that underlie their mathematical analyses.

The most evident error is the lack of randomness in the "treatment" groups.
Resuscitation of the Newborn Infant, ed. 3, edited by Harold Abramson, A.M., M.D. St. Louis: The C. V. Mosby Company, 1973, 461 pp., $26.95
Authors: Chernick Victor
Published: December 2021

There has been a seven-year hiatus since the second edition of this multi-authored book. The Editor has recognized the vast increase in knowledge since the previous edition and a number of new chapters have been added. To some, the title of the book might appear misleading; it is not limited to resuscitation, as the word is ordinarily used. In fact, the book is a general text of perinatology. The first five chapters deal with the problem of reproductive loss, fetal physiology and biochemistry, pathology, fetal anoxia and neonatal asphyxia, and congenital anomalies.
Behavior Disorders of Childhood and Adolescence, by Richard J. Jenkins, M.D. Springfield, Illinois: Charles C Thomas, 1973, 140 pp., $6.95
Authors: Harris Herbert I.
Published: December 2021

This monograph is written to describe and classify the disorders of childhood and adolescence that lie between the mild transient situational disturbances and the more severe pychoses, neuroses and personality disorders of this period.

After outlining the problem with which the monograph is concerned—behavior inappropriate to the situation—the author devotes a chapter to the statistical approach to child psychiatry, and then describes the types of disordered individuals encountered in a large clinic population of children and adolescents.
Principles of Immunology, edited by Noel R. Rose, M.D., Ph.D., Felix Milgrom, M.D., and Carel J. Van Oss, Ph.D. New York: Macmillan Publishing Company, Inc., 1973, 463 pp., $14.95 hardbound, $9.95 paperback
Authors: Quie Paul G.
Published: December 2021

This book will be a valuable addition to the practicing clinician's library. The editors assume that many physicians, while aware of immunologic breakthroughs and diagnostic laboratory techniques, only vaguely understand the basic principles of the science of immunology. Each of the first few chapters is beautifully elementary and simple in descriptions of the nature of antigens and antibodies and the specificity of their reactions. The application of these principles to newer assays for quantitation of immunoglobulins and measurements for cytotoxicity is clearly explained.
Indirect Plasma-Theophylline Monitoring in Asthmatic Children by Determination of Theophylline Concentration in Saliva
Authors: Levy Gerhard , Ellis Elliot F. , Koysooko Renu
Published: December 2021

The concentration of theophylline in mixed saliva and in plasma of 16 asthmatic children on regular theophylline therapy was obtained two and four hours after a maintenance dose. There is a strong and highly statistically significant correlation between the theophylline concentration in saliva and plasma. This correlation is not affected by the pH or flow rate of saliva. The concentration of theophylline in plasma could be predicted from the concentration in saliva within ± 10% in 20, and within ± 20% in all of the 32 samples. Determination of theophylline concentrations in saliva is an effective, convenient, noninvasive, and painless method for routine indirect monitoring of plasma-theophylline concentrations in asthmatic children on regular theophylline therapy.
The Electron Microscopic Appearance of Presecreted Gastric Mucus in Cystic Fibrosis
Authors: Lillibridge Clinton B. , Brown Marilyn R. , Hall Janet G.
Published: December 2021

Gastric mucosal biopsies from eight new untreated patients with cystic fibrosis (CF) and two normal subjects were studied by quantitative techniques of electron microscopy (EM) to determine whether presecreted gastric mucus was more compact (viscid) than normal. Analysis of variance techniques show no differences between means of all groups studied. These observations suggest that mucus may not be viscid prior to secretion. Electron microscopy of gastric mucus does not appear to be of diagnostic value in CF.
Letter to the Editor
Authors: Homan William E.
Published: December 2021

The arrogant and pompous tone of the "comments" of the Committee on Drugs in response to the Letter to the Editor by Drs. Livingston, Berman, and Pauli in the November 1973 issue of Pediatrics would be childish and ludicrous were it not all too typical. As a statement of an official Committee, printed in an official voice of the Academy, it proves merely embarrassing with its petulance. One may hope that the group signature, "Committee on Drugs," implies that at least not all the members of the Committee were willing to be signatories.
Urinary Tract Damage in Children Who Wet
Authors: Hinman Frank
Published: December 2021

A complex is described herein, consisting of the symptoms of urinary and often fecal incontinence, and the findings of disturbed structure and evacuating function of the urinary tract, with resultant infection. Emotional imbalance alters vesicourethral function both physiologically and pathologically, and results in poor coordination between contraction of the detrusor and relaxation of the external sphincter, similar to the effects of neurogenic disorders. We have named this condition nonneurogenic neurogenic bladder. If surgical correction of this structural damage is to succeed it must follow restoration of coordinated voiding, brought about by a program of anticholinergic drug administration, antibacterial therapy, correction of constipation, parental instruction, and finally strong suggestion often including hypnosis.
RADIATION-INDUCED HEAD AND NECK TUMORS
Authors: Miller Robert W.
Published: December 2021

Among about 11,000 children irradiated for tinea capitis in Israel, an excess of head and neck tumors was found after a follow-up of 12 to 23 years (Modan, B. et al., Lancet, 1:277, 1974). The numbers of neoplasms in cases vs. comparable controls were brain, malignant 8 vs 1, benign 8 vs 1; parotid gland, malignant 4 vs 0, benign 3 vs 1; and thyroid, malignant 12 vs 2. There was no excess of leukemia of lymphoma, and benign thyroid neoptasms were not studied. The excess of malignant thyroid tumors was puzzling because the dose absorbed should have only been 6.5 rad.
VAGINAL CANCER FROM INTRAUTERINE EXPOSURE TO SYNTHETIC ESTROGENS
Authors: Miller Robert W.
Published: December 2021

The risk of vaginal cancer among daughters of women who received estrogen during pregnancy has been calculated in the first prospective study reported to date (Lanier, A. P. et al., Mayo Clin. Proc., 48:793, 1973). Among nearly 24,000 children born at the Mayo Clinic obstetrics facilities, 1943 to 1959, no cancers were found among 404 females exposed to synthetic estrogens in the first trimester and traced to 13 to 29 years of age (median, 22 years). From this result it was estimated that the risk of developing vaginal or cervical clear-cell adenocarcinoma was no greater than seven per 1,000 by age 13, and was less than 13 per 1,000 by age 22. No such cancer was found among 400 females exposed in utero during other trimesters than the first. No excess of other cancers or of other diseases was found among the 804 live-born females or 877 males.
Relation of Serum Cholesterol to in vitro 7α-Dehydroxylation of Primary Bile Acids by Fecal Bacteria in Infants and Children
Authors: Samuel Paul , Schussheim Arnold , Lieberman Sidney , Don Eugene C.
Published: December 2021

Fresh feces from 104 infants and children (aged 3 days to 16 years) were homogenized and incubated with labeled cholic or chenodeoxycholic acid. After 2 and/or 24 hours' incubation, the percentage of converted (mostly 7α-dehydroxylated) primary bile acids was measured, and the degree of conversion was correlated with serum cholesterol levels. It was found that stool homogenates of patients with low levels of serum cholesterol (< 160 mg/100 ml) converted labeled primary bile acids poorly or not at all, whereas in patients with higher serum cholesterol levels (> l60 mg/100 ml) the conversion process was markedly increased. Thus, highly significant correlations were found between serum cholesterol levels and the capability of the fecal bacterial flora to convert both primary bile acids "in vitro."

The possibility is proposed that in man the relatively rapid progressive increase of serum cholesterol level following birth may be related to the colonization of the intestinal tract by 7α-dehydroxylating and/or bile acid degrading bacteria. It is suggested that the prevalence of these bacteria is subject to environmental effects, and it may be one of the important factors regulating cholesterol levels in man.
Myocardial Infarction Due to Coronary Thromboarteritis, Following Acute Febrile Mucocutaneous Lymph Node Syndrome (MLNS) in an Infant
Authors: Yanagisawa Masayoshi , Kobayashi Noboru , Matsuya Shoji
Published: December 2021

A previously healthy 6-month-old male infant was admitted to our clinic for persistent high fever and an erythematous skin rash. Hyperemia of conjunctivae, redness of oral mucosa, and swelling of several cervical lymph nodes were also observed. Soon after admission he developed jaundice which continued for one week. Results of laboratory examinations revealed leukocytosis, elevated ESR, mild proteinuria, leukocytes in urinary sediment, hyperbilirubinemia, increased serum alpha-2-globulin and positive CRP. Serum ASO titer was less than 100 Todd units and complement fixation reactions for various viruses were not significant. Cultures of blood, urine, stool and throat were negative. He was treated with antibiotics and steroids and improved gradually, but then developed signs and symptoms of congestive heart failure. An ECG showed a pattern of extensive myocardial infarction. He died of congestive heart failure at the age of 21 months. Autopsy findings revealed focal aneurysmal dilatation and obstruction of the bilateral coronary arteries. The myocardial infarction involved the septum of the anterolateral wall of the left ventricle. The coronary arteries, distal aorta, iliac arteries and pulmonary arteries were also involved, but very slightly. The symptoms, laboratory findings and the course of this patient were compatible with those of acute febrile mucocutaneous lymph node syndrome (MLNS), MLNS has been accepted as a new syndrome by most Japanese pediatricians in recent years. Its etiology is still unknown. Some of the patients with this syndrome had died suddenly of coronary thromboarteritis after recovering from the acute illness. Although autopsy findings of the fatal cases have been similar to those describing infantile polyarteritis nodosa, the relationship between MLNS and infantile polyarteritis is controversial.
The Clinical Picture of Sarcoidosis in Children
Authors: Kendig Edwin L.
Published: December 2021

Review of 33 patients 15 years of age and younger with a tissue-confirmed diagnosis of sarcoidosis is presented. The "typical" child with sarcoidosis is black (76%) and in the preadolescent or adolescent age group (100%). Chest roentgenogram shows bilateral hilar lymphadenopathy, with or without parenchymal infiltration or other involvement (97%). Eye lesions are relatively common (24%) and may be serious, with blindness occurring in two of the eight affected cases. Among the laboratory data, the most common abnormal finding is hyperglobulinemia (73%). The diagnosis of sarcoidosis should be strongly considered in any child with roentgenographic evidence of bilateral hilar lymphadenopathy.
Poisoning From Pesticides: Diagnosis and Treatment
Authors: Zavon Mitchell R.
Published: December 2021

Pesticides have been developed to kill living organisms. Insecticides in particular are likely to cause problems. Treatment can be very effective, but as with all poisons, prevention is far more efficient. Every family should be cautioned to minimize the availability of pesticides in the home and when needed to keep them in their original containers and in a place secured from inquisitive children.
The Unknown Poison
Authors: Mofenson Howard C. , Greensher Joseph
Published: December 2021

This article outlines a rational approach to management of an unknown poisoning.

See table in the PDF file.

If an unidentified material has been ingested, the safest course of action is to induce vomiting with ipecac if no contraindication exists (Table I).

If the product or ingredient is known but there is uncertainty regarding the quantity ingested, tables of toxicity rating (Tables II and III) are offered to help in deciding the necessity for treatment.

If signs and symptoms suggesting a potential poisoning are present, the most likely agents may be found in Table IV.

Definite toxicologic identification of ingested ingredients requires a great deal of time and special expertise. It is seldom available in time to aid in the treatment. Therapy should be directed toward support of vital functions (Table V).

A small number of rapid and easily performed presumptive tests are available and are offered to the practicing physician as an aid to making a more definitive diagnosis.
Salicylate Poisoning
Authors: Pierce Alexander W.
Published: December 2021

Medications are the most common substances accidentally ingested by children less than 5 years of age. In 1972, 62% of fatal ingestions reported to the National Clearinghouse for Poison Control Centers were due to drugs.1 The leading categories for fatal reported ingestions are drug combinations, analgesics, nonbarbiturate sedatives, and psychopharmacologic agents.

The effectiveness of child resistant containers (CRCs) in reducing the incidence of childhood accidental poisonings from medications has been demonstrated by the experience at Madigan General Hospital and in Essex County, Ontario. Scherz2 speculates a 75% reduction in childhood poisoning could be achieved by this measure alone. The Poison Prevention Packaging Act of 1970 (Public Law 91-601) permitted the Consumer Product Safety Commission to develop and administer safety packaging regulations for salicylates. Salicylates, generally considered the most important drug hazard for the preschool child,3 are currently available in both safety and non-safety containers. By law, each manufacturer can produce for retail use one size container with a noncomplying package. Therefore the risk of salicylate poisoning can be expected to continue from noncomplying packaging, the misuse of safety packaging by adults, and misuse of salicylates as therapeutic agents. The widespread use of safety packaging for children's aspirin has been accompanied by a steady decline in poisoning in preschool children from this source since 1970.

However, salicylates remain the single substance most frequently accidentally ingested by preschool children; and there were eight reported fatalities in 1972.1 Although accidental ingestion is a frequent problem, over one half of hospitalized cases of salicylism in children have been due to chronic ingestion associated with therapeutic misuse.
Hyperuricemia in a Child: A Complication of Treatment of Obesity
Authors: Mathew George , Lifshitz Fima
Published: December 2021

Childhood obesity has become an important management problem for the practicing pediatrician. Carbohydrate restrictive diets are being utilized in treatment with increasing frequency in recent years.1,2 Hyperuricemia during carbohydrate deprivation is a well-documented entity in adults,3,4 but has not been reported in children. In the following report we describe a child who developed severe hyperunicemia following a low-carbohydrate ketogenic regimen during the initial period of treatment of obesity.

CASE REPORT

R. F., a 10-year-old white girl, was admitted to North Shore University Hospital for management of severe exogenous obesity. She was the product of a normal pregnancy and uncomplicated delivery, and weighed 2,660 kg at birth.