bluuebunny/crossref_metadata_2025 huggingface dataset:
Rational Management of Allergic Disease: The Role of Immunotherapy
Authors: Twarog F. J. , Colten H. R.
Published: December 2021

Objective support for the use of immunotherapy in the management of allergic disease has been obtained in several well-designed clinical studies. From these results, one should not expect total "desensitization," but rather an increased ability to tolerate antigen exposure and a corresponding decrease in the need for other therapeutic measures.

Immunotherapy is only a part of the total care of allergic patients. It should not be a substitute for appropriate environmental controls and pharmacologic management.

The rapid advances of the past few years in understanding of the biochemical basis of allergic disease should lead to more effective management of these frequent clinical problems.
Defects of Neutrophil Chemotaxis and Random Migration in Thalassemia Major
Authors: Khan Abdul J. , Lee Chuck-Kwan , Wolff James A. , Chang Hsin , Khan Parvin , Evans Hugh E.
Published: December 2021

Chemotactic and random migrations in a group of 11 patients with thalassemia major were found to be defective. This may be partially the basis for the predilection to infection occasionally observed in these patients. These findings may reflect a primary defect of polymorphonuclear leukocytes or may be secondary to associated liver disease and/or diabetes mellitus. Further studies are required to define the mechanisms involved.
TOYS FOR CHILDREN IN 1898
Authors: C. T. E.
Published: December 2021

The Archives of Pediatrics, established in 1884, was the first American journal devoted exclusively to diseases of children. Each issue for a span of many years usually contained an editorial or two. The one below is a good example of an editorial published toward the end of the 19th century.

The amusement of young children is largely derived from toys and playthings. The character, therefore, of their toys becomes of importance even in the case of healthy children.

One of the most noticeable peculiarities of childhood is a tendency to become attached to certain things and to cling to them most persistently. The young child loves certain nursery songs, and never tires of hearing the mother sing them over and over. He loves certain stories, and listens with minute attention to their hundredth repetition. He becomes attached to certain toys and persistently goes back to them in preference to the new and more handsome ones, and clings to the old dilapidated doll in preference to the most gorgeous new one. All this is common knowledge to every observer of children.

An explanation, or a partial explanation at least, is not difficult to reach. A child's mental capacity is yet undeveloped and his comprehension is very small. He knows and appreciates the old familiar doll and its few clothes. The new one, with its closing eyes and jointed limbs and its colnplex and elaborate dress, is beyond his small comprehension. It tires him as much to investigate and unravel all its mysteries as it does his lawyer father to master an intricate case.
Epstein-Barr Virus Is Not Synonymous With Infectious Mononucleosis
Authors: Steigman Alex J.
Published: December 2021

Infectious mononucleosis (IM) is a defined clinical syndrome, until recently regarded as of uncertain etiology affecting only a limited number of persons. The etiology of IM can now be ascribed correctly to primary infection with Epstein-Barr virus (EBV), a member of the herpesvirus family.

It is increasingly evident that primary infection with EBV may also induce a range of clinical responses from no detectable illness1 to a variety of disorders without the clinical or hematologic hallmarks of the IM syndrome.
Clinical Pharmacokinetics of Aspirin
Authors: Levy Gerhard
Published: December 2021

Aspirin is very rapidly absorbed from the gastrointestinal tract when administered as a solution, and somewhat more slowly when administered in tablets. It is rapidly hydrolyzed in the body to salicylic acid; the plasma concentration of the latter must be maintained within a relatively narrow range to obtain an adequate anti-inflammatory effect and to minimize systemic adverse effects. The two major pathways of salicylate elimination, i.e., formation of salicyluric acid and salicyl phenolic glucurocide, become saturated at relatively low body levels of the drug. Consequently, steady-state ("plateau") salicylate levels increase more than proportionately with increasing daily dose, and the time required to reach steady state increases with increasing daily dose. The renal clearance of salicylic acid increases markedly with increasing urine pH; antacids capable of increasing urine pH can therefore cause a pronounced lowering of steady-state salicylate concentrations under clinical conditions. There are pronounced intersubject differences in salicylate elimination kinetics; dosage must be individualized on the basis of plasma concentration and clinical response. The drug is readily transferred across the placenta and is only slowly eliminated by the newborn infant. The drug is also transferred from mother to nursing infant through the breast milk.
Chronic Salicylate Administration in Juvenile Rheumatoid Arthritis: Aspirin "Hepatitis" and Its Clinical Significance
Authors: Schaller Jane G.
Published: December 2021

In the article "Chronic Salicylate Administration in Juvenile Rheumatoid Arthritis: Aspirin ‘Hepatitis’ and Its Clinical Significance" by Schaller (Pediatrics 62: 916, November 1978 suppi), there were two errors in Table IV on page 920. The report of Russell et al. was published in 1971, not 1961, and Rich and Johnson's report was published in 1973, not 1963.
Growth of Escherichia coli and Concentration of Iron in an Infant Feeding Formula
Authors: Baltimore Robert S. , Vecchitto John S. , Pearson Howard A.
Published: December 2021

Iron deficiency reaches epidemic proportions in infants, particularly those of low socioeconomic status.1 In an attempt to decrease the frequency of this deficiency, iron fortification of infant cereals and cow's milk formulas has been advocated.2

Although the prevention of iron deficiency is a valid nutritional goal, concern has recently been voiced about possible detrimental effects of iron supplementation.3,1 This concern has been based on studies indicating an association between hyperferremia and serious infection,3,6 and also by denionstrations that the bacteriostatic properties of serum and milk can be abolished by the addition of iron.7,8 These findings have been extrapolated into suggestions that the iron supplementation of cow's milk formulas might predispose the infants consuming them to an increased risk of bacterial infection and even that ironcontaining formulas might be contraindicated.4
Estrogen Receptor Binding and Growth of the Reproductive Tract
Authors: Clark James H. , Hardin James W. , McCormack Shirley A.
Published: December 2021

It is well known that normal growth and development of the reproductive tract depends on the proper stimulation by estrogen and other sex hormones. Likewise, it has been recognized for years that estrogenic stimulation provides an environment that is conducive to the development of neoplasia.1 The interrelationships between normal and abnormal estrogenic stimulation are not well understood. However, because of recent developments in biochemical and molecular biology, the mechanism of action of estrogen is beginning to be understood. In this article, we present some of these findings and relate them to normal and abnormal estrogeninduced growth.

At physiological temperatures, estrogen readily enters all cells (Fig. 1). In hormone-sensitive cells, estrogen is retained by binding to soluble macromolecules in the cytoplasm. These macromolecules are called cytosol receptors (Rc); while their exact nature in vivo is not known, they appear to be large proteins made up of two or more subunits. The binding reaction is specific for estrogens and results in the formation of receptor estrogen complexes (RcE) that undergo translocation to nuclear sites (RnE). The translocation process depletes the cytosol of Rc sites and these are subsequently replenished by mechanisms discussed below. Nuclear binding of the RnE complexes can be classified as either acceptor (A) or nonacceptor (NA) sites. Acceptor sites are generally visualized as a specific complex of chromosomal proteins, probably nonhistone proteins, that the RnE complex recognizes and binds to with a very high affinity. Nonacceptor sites are considered to be secondary sites on chromatin where the RnE complex can bind with a lower affinity.
Endogenous Estrogen Production in the Young
Authors: Siiteri Pentti K.
Published: December 2021

Only in human pregnancy is the fetus exposed to high concentrations of estrogens throughout gestation, owing to the unique interplay of steroidogenesis between fetus, placenta, and mother. It is well recognized that both the fetal and maternal adrenal glands contribute to placental estrogen synthesis by secretion of steroidal precursor androgens.1 The principal estrogen of human pregnancy, estriol, is produced in disproportionately large quantities because of the extensive 16α-hydroxylation of fetal dehydroepiandrosterone sulfate (DHEAS) in fetal liver and other tissues. 16α-Hydroxy DHEAS is directly converted to estriol within the placenta by the abundant sulfatase, 3β-hydroxysteroid dehydrogenase-isomerase, and aromatase enzymes contained therein. Thus, the fetus is the source of most of the estriol precursor during pregnancy. Fetal and maternal DHEAS secretion contribute roughly one half of the precursor for placental estradiol synthesis late in pregnancy. Although most of the placental estrogen is secreted into the maternal circulation, a large quantity is delivered to the fetus via the umbilical vein. Table I lists the approximate concentrations of free estrone, estradiol, and estriol, as well as progesterone, in umbilical venous and arterial plasma as compared with the concentrations found in the maternal circulation at term of normal pregnancy. It can be seen that the concentration of estriol is approximately ten times that of estradiol and five times greater than that of estrone entering the fetus. The level of estradiol in the fetal circulation (5 to 6 ng/ml at term) is 10 to 20 times higher than that found in the normal adult female just prior to the midcycle gonadotropin surge.
A Review of the Evidence Linking Estrogens and Cancer in Animals
Authors: Hertz Roy
Published: December 2021

This Conference has involved a very highly qualified treatment of the biochemical, clinical, and epidemiological aspects of the estrogen-cancer problem. Accordingly, I have assumed that it is my assignment to cover the experimental biological facets of this problem. This I shall endeavor to do with a major emphasis on the historical development of our knowledge in this field.

It is instructive to examine the very early experimental observations that initially raised the question of the role of steroid hormones in the etiology and pathogenesis of cancer in the recognized target organs.

Almost at the very beginning of modern endocrinology, Allen and Doisy1 reported the cornification of the vaginal epithelium of the mouse following administration of ovarian extracts. They appreciated that this represented a remarkably active tissue proliferation requiring a degree of mitotic activity seldom seen in normal tissues. Thus, Allen et al.2 actually used colchicine to arrest the mitotic activity induced by estrogen in the vaginal mucosa and in the myometrium of the rat. They reported that a transverse section of the vagina at 37 hours after a single injection of estrogen contained as many as 1,585 mitoses. Equal mitotic activity was also reported for the estrogen-treated uterus.3 These observations provided the experimentalist with a potent growth-stimulating agent that profoundly affected the female genital tract, so commonly the site of cancer in women.

These findings arose against a background of both experimental and clinical knowledge of the relationships of ovarian function to the pathogenesis of breast cancer, for Beatson4 had shown as early as 1898 that ovariectomy ameliorated the clinical course of breast cancer in women.
Effect of Prenatal Estrogen Exposure on Male Genitalia
Authors: Mills James L. , Bongiovanni Alfred M.
Published: December 2021

The discovery of adenocarcinoma of the vagina in young women exposed to exogenous estrogens in utero led to a search for similar effects in men. Such studies were difficult because of ascertainment problems and the low incidence of the disorders being investigated. Numerous examinations of cancer registries have demonstrated an increased incidence of cancer of the testis. Secular trends suggest that this increase is not attributable to prenatal estrogen exposure. No history of exposure has been obtained in any patients with genital malignancy in the group at risk. Evaluation of relative risk for congenital malformations in a prospectively ascertained cohort disclosed increased risk for diethylstilbestrol (1.56) and ethinyl estradiol (1.89). The association of estrogen with the broad category of malformations used in this study was minimal. A relative risk of 1.60 for hypospadias was found. However, the numbers were too small to be statistically significant (and no increased risk was found by another investigator). The risk of cardiovascular disease was significantly greater in those exposed to estrogens in utero. This finding was confirmed by a study of congenital heart disease following sex hormone exposure. Four case reports of children exposed to estrogens in utero described external genitalia ranging from normal female to male with hypogonadism. The four cases seemed to have abnormal testes as a common feature. This was also noted in a fetus aborted after exposure to diethylstilbestrol. Responses to a questionnaire led one group to suggest that urethral stenosis is more common following prenatal diethylstilbestrol exposure. Long-term follow-up of men exposed in utero to diethylstilbestrol showed increased incidence of epididymal cysts, hypotrophic testis, and hypoplastic penis. Morphologically abnormal sperm, low ejaculate volume, and low sperm counts were also more common in those exposed to diethylstilbestrol.
Behavioral Effects of Estrogen Treatment in Human Males
Authors: Meyer-Bahlburg Heino F. L.
Published: December 2021

Human males are exposed to exogenous estrogens in various treatment regimens: (1) Prenatally, (a) if the pregnant mother continues to ingest certain contraceptive steroids, or (b) if she is administered estrogens for pregnancy maintenance; (2) in adolescence and adulthood, when treated (a) for the control of deviant sexual behavior or (b) for demasculinization and feminization in the case of transsexualism; and (3) in midlife or later, when treated for androgen-dependent cancer, especially of the prostate. In spite of the diversity of treatment goals, each regimen provides an experimental model for the investigation of the effects of exogenous hormones on behavior—some of which may be considered undesirable side effects in a risk-benefit analysis of estrogen treatment.

In this report, I will briefly review the current status of knowledge with respect to regimens 1, 2, and, to a minor degree, 3. The discussion will focus on sex-dimorphic behavior (i.e., behavior in which males and females typically differ), intelligence, and general psychopathology. In the section on prenatal effects, progestogens will be discussed along with estrogens because both are frequently administered in combination.

EFFECTS OF PRENATAL EXPOSURE TO ESTROGENS AND/OR PROGESTOGENS

As outlined in another Conference article by Ehrhardt (page 1166), animal research has shown prenatal exogenous estrogens to masculinize sex-dimorphic behavior in the female and to interfere with normal masculinization in the male. This is in contrast to progesterone, which is assumed to have demasculinizing effects in both males and females.1,2 With regard to mental abilities and general psychopathology, I am not aware of any animal models that would allow us to predict effects of prenatal estrogens and/or progestogens in man.
DAVID HOSACK OF NEW YORK DESCRIBES AN EPIDEMIC OF GERMAN MEASLES IN 1813
Authors: C. T. E.
Published: December 2021

Physicians of the seventeenth and eighteenth centuries probably observed cases of rubella, but it was not until 1829 that it was finally separated from measles and scarlet fever and considered as a distinct entity.1

David Hosack (1769-1835)2 observed an epidemic of an eruptive disease in New York in 1813 resembling measles. His description fits that of rubella and was far better one than any other report of this disease until Henry R. Veale's (1832-1908)3 in 1866. Hosack wrote:

An eruptive disease in many respects resembling the measles, has prevailed to a considerable extent during the last three months [1813]. Such was the resemblance it bore to the measles in its invasion, the character and extent of the eruption, that by many it was called the French measles. It, however, differed from the measles (rubeola vulgaris) in several particulars. The fever preceding the eruption, was very inconsiderable in degree, and of short duration, not more than twenty-four hours; and in some few cases the eruption appeared without any preceding fever; the eruption itself generally disappeared at the end of the second or beginning of the third day; the eyes were rarely affected with it as in measles, and in no cases as in the latter disease, was it attended with cough or oppression, excepting such as are attendant upon most febrile complaints.

In several cases this disease occurred in children, who some time afterwards, were attacked with the measles, attended with all its characteristic symptoms, and in other instances, adults who were certainly known to have had the measles in early life, were the subjects of this eruptive complaint.
Nosocomial Respiratory Syncytial Virus Infections in an Intensive Care Nursery: Rapid Diagnosis by Direct Immunofluorescence
Authors: Mintz Lawrence , Ballard Roberta A. , Sniderman Susan H. , Roth Robert S. , Drew W. Lawrence
Published: December 2021

A nosocomial outbreak of respiratory syncytial virus infections involved 8 of 17 infants in an Intensive Care Nursery and one additional infant in the adjoining Newborn Nursery. Immunofluorescent staining of nasopharyngeal specimens was positive in six of seven virologically confirmed cases (86%). One additional case with negative viral cultures was also identified by this technique. Viral isolation in tissue cultures required an average of 4.9 days, whereas results of immunofluorescent studies were available in two to four hours. Rapid identification of infected infants by immunofluorescence permitted prompt institution of infection control measures.
Increased Work of Breathing Associated with Nasal Prongs
Authors: Goldman Steven L. , Brady June P. , Dumpit Fe M.
Published: December 2021

To see if continuous distending pressure (CDP) given by nasal prongs increases work of breathing, we measured the mechanics of breathing, minute ventilation, and blood gases in nine infants with both nasal prong and face mask CDP. Minute ventilation was 16% larger (P < .02), work of breathing was 94% higher (P < .01), and the mean PaO2 was 8 mm Hg lower (P < .03) with the nasal prongs. There was no difference in pH or PaCO2. We speculate that CDP given by nasal prongs may increase the risk of respiratory failure in the premature infant already compromised with hyaline membrane disease.
Caffeine Toxicity in a Neonate
Authors: Kulkarni Prakash B. , Dorand Rodney D.
Published: December 2021

Caffeine poisoning in children is extremely rare. So far only four cases have been reported.1-4 Two children expired and two others survived. Review of the literature fails to show any reports of caffeine poisoning in a neonate. The purpose of this report is to present such a case and review the literature.

CASE REPORT

Patient T.B. was a full-term infant delivered to a 28-year-old gravida 1, para 0, black woman by emergency cesarean section for eclampsia and cephalopelvic disproportion. Apgar scores were 3 and 4 at one and five minutes, respectively. The infant was resuscitated with bag and mask. At 20 minutes of age, the infant was given 125 mg of caffeine (1,3,7-trimethyl xanthine) and sodium benzoate intramuscularly followed by 0.2 ml of Nalline for poor respiratory effort.
Congenital Absence of the Pancreas and Intrauterine Growth Retardation
Authors: Lemons James A. , Ridenour Robert , Orsini Edmund N.
Published: December 2021

Recent investigations support the concept that insulin is a primary growth hormone during fetal life. The importance of insulin in fetal development is illustrated by the following case presentation, a severely growth-retarded infant who possessed no detectable pancreatic tissue at postmortem examination.

CASE REPORT

Patient B.G.C. was born following an uncomplicated pregnancy to a 19-year-old gravida 1, para 0, abortus 1 mother by emergency Cesarean section for fetal distress. The baby weighed 1,350 gm with Apgar scores of 2 at one minute, 2 at five minutes, and 4 at ten minutes, requiring immediate intubation and ventilation. Gestational age was 41 weeks by dates, 36 to 37 weeks by clinical examination, and greater than 36 weeks by radiologic evidence of teeth calcification.1
Controlled Clinical Trial of Pediatric Telephone Protocols
Authors: Strasser Patricia Hartge , Levy Janice C. , Lamb George A. , Rosekrans Julia
Published: December 2021

A randomized clinical trial of pediatric protocols administered by health assistants demonstrated an alternate method of handling telephone complaints in a large emergency room. The new system advised a higher medical examination rate than the current system in the emergency room probably because the current system has deficits with respect to collecting necessary information and making explicit decisions. This higher rate of recommended visits demonstrated in the emergency room was not confirmed in the two pediatric primary-care settings in which the protocol system was also tested. In addition to this use, the telephone protocols may also be useful in training medical and nursing students, in handling telephone complaints similar to a poison control center, in triaging problems in a rural or emergency medical service, and in providing a record of the telephone call.
Use of Antimicrobial Drugs in General Hospitals: IV. Infants and Children
Authors: Townsend T. R. , Shapiro M. , Rosner B. , Kass E. H.
Published: December 2021

The use of antimicrobial drugs was studied among 933 randomly selected infants and children who were hospitalized in 20 short-stay general hospitals in Pennsylvania. Twenty-two percent of pediatric patients received antimicrobial drugs: 5% of neonates and 57% of patients aged 12 to 18 months. Sixty-eight percent of the 265 antimicrobial courses administered to these children consisted of a penicillin or a penicillin analogue. Ampicillin was the single drug most frequently administered and was given in 32% of all courses. In contrast to the findings in older children, penicillin or penicillin analogues and aminoglycosides were the only antimicrobial drug groups administered to neonates. Seventy-nine percent of courses were initiated for proved or suspected infections and 17% were initiated to prevent infections associated with surgical or nonsurgical invasive procedures. Cultures were associated with the initiation of 84% of courses among neonates and 39% of courses among children 6 to 9 years of age. This study provides the initial information, from data derived from randomly selected general hospitals, to permit a statement of norms of practice with respect to use of antimicrobial drugs in pediatric populations.
Response of Hypertensive Adolescents to Dynamic and Isometric Exercise Stress
Authors: Fixler David E. , Laird W. Pennock , Browne Richard , Fitzgerald Victoria , Wilson Susan , Vance Ruth
Published: December 2021

Isometric handgrip and dynamic exercise stress tests were performed on 109 hypertensive and 74 normotensive subjects 14 to 17 years old. The hypertensive subjects had resting systolic or diastolic pressures persistently above the 95th percentile on four consecutive examinations. Blood pressures and ECGs were recorded during isometric handgrip (25% maximum effort for four minutes) and bicycle ergometry until the subject was exhausted. The hypertensive subjects increased systolic pressure by an average 16 mm Hg with isometric exercise and 53 mm Hg with dynamic exercise. Control subjects had similar pressure changes, averaging 18 and 54 mm Hg, respectively. During isometric handgrip stress, diastolic pressures increased 12 mm Hg in hypertensive subjects and 18 mm Hg in control subjects. Only two hypertensive adolescents developed systolic pressures exceeding 220 mm Hg during dynamic exercise stress, and none developed systolic pressures above 200 mm Hg during isometric exercise stress. None of the normotensive or hypertensive subjects developed cardiac arrhythmias and the prevalence of ST segment depression during maximal stress was less than 2% in both groups. Therefore, in adolescents with mild to moderate hypertension the risk of developing significant ECG or hemodynamic abnormalities during mild isometric or heavy dynamic exercise is small. We believe the decision to restrict physical activity of an adolescent with elevated pressures should be based on the development of abnormal ST segment depression, cardiac arrhythmias, or excessive blood pressures at the time of exercise stress testing.
Metabolic Fuel and Hormone Responses to Fasting in Newborn Infants
Authors: Stanley Charles A. , Anday Endla K. , Baker Lester , Delivoria-Papadopolous Maria
Published: December 2021

To examine why newborn infants frequently cannot maintain adequate levels of plasma glucose in the interval between delivery and the time they are first fed, circulating metabolic fuel and regulatory hormone concentrations were determined in 44 healthy infants at the end of an eight-hour postnatal fast. Plasma glucose fell below 40 mg/100 ml prior to eight hours in four of 24 term-appropriate-for-gestational-age (AGA), two of nine preterm-AGA, five of six term-small-for-gestational-age (SGA), and three of five preterm-SGA infants. Fuel and hormone patterns in the premature and SGA infants were not different from those found in term-AGA infants. Results in these neonates differed in two areas from the response to fasting seen later in life. In fasted term-AGA infants, ketones were low (β-hydroxybutyrate 0.29 ± 0.04 mM/liter) despite elevated concentrations of fatty acid precursors (1.4 ± 0.07 mM/liter), and the group of infants studied failed to demonstrate the increase in plasma ketones with lower glucose levels (r = +.23, P = .07) which is found in older children. Levels of glucose precursors were two to three times higher in term-AGA infants (lactate 2.9 ± 0.2 mM/liter; alanine 0.48 ± 0.02 mM/liter) than levels found beyond the neonatal period and, in contrast to older children and adults, were not diminished in infants with lower plasma glucose (lactate, r = -.28, P = .035; alanine, r = -.33, P = .02). These differences between the responses to postnatal fasting and those seen beyond the neonatal period suggest that the capacity for both hepatic ketone synthesis and gluconeogenesis is not fully developed at birth.
Comparative Pharmacokinetics of Amoxicillin and Ampicillin in Infants and Children
Authors: Ginsburg Charles M. , McCracken George H. , Thomas Marion L. , Clahsen Joan
Published: December 2021

The pharmacokinetics of amoxicillin and ampicillin were studied in 24 infants and children. Mean peak serum concentrations of 5.4 µg/ml in fasting and 3.2 µg/ml in nonfasting patients were observed after 15 mg/kg amoxicillin doses. Area under the curve values and serum half-life values were similar in fasting and nonfasting patients. The pharmacokinetics of amoxicillin (15 mg/kg) were compared to those of ampicillin (25 mg/kg). Peak serum concentrations, area under the curve values and half-life times were comparable for the two drugs. Amoxicillin (25 mg/kg) and ampicillin (25 mg/kg) were compared in cross-over fashion in 11 children. Serum concentrations of amoxicillin were consistently larger than those of ampicillin; the differences were of borderline significance at one and two hours and statistically significant at four and six hours after the dosage. The bioavailability of amoxicillin was twice that of ampicillin. Amoxicillin was detected in approximately half of the saliva samples studied. Although the salivary concentrations in many children exceeded the inhibitory level for most pneumococci and group A streptococci and for many non-β lactamase-producing Haemophilus influenzae type b strains, the clinical relevance of these observations is unknown.
EARLY NEONATAL MORTALITY
Authors: R. R. H.
Published: December 2021

The United States has had a substantial decline in infant mortality rates. Mortality rates for low birth weight infants remained fairly stable prior to 1965, but have "decreased sharply" since then. The decrease in mortality among these infants accounted for more than half of the overall fall. The most likely explanation is the development and proliferation of medical technology for management of the low birth weight infant.

Comment: Nice to hear some good news of what we are doing well. Regionalization and intensive care do make a difference.
Nephritis in Children and Young Adults with Systemic Lupus Erythematosus and Normal Urinary Sediment
Authors: Woolf Alan , Croker Byron , Osofsky Stephen G. , Kredich Deborah W.
Published: December 2021

One male and seven female patients (aged 6 to 26 years) with systemic lupus erythematosus (SLE), normal urinalyses, and normal biochemical tests of renal function, had renal biopsies to determine if significant nephropathy existed. Several had active SLE in other body systems at the time, either clinically or as evidenced by low serum complement and high native DNA antibody levels. The renal biopsy specimens were studied by light, fluorescent antibody, and electron microscopy. Three patients had a generalized segmental, two had a focal segmental, and one had a generalized diffuse proliferative glomerulonephritis. In addition, one patient had minimal glomerular findings with interstitial inflammation. All eight patients were found to have moderate immune complex deposition by immunofluorescence and/or electron microscopy studies. The absence of clinical renal involvement in patients with SLE does not preclude ongoing active and "silent" glomerular damage with moderately severe proliferative changes.
Hypertension and Sports
Authors: Strong William B.
Published: December 2021

The article "Response of Hypertensive Adolescents to Dynamic and Isometric Exercise Stress" which appears in this issue of Pediatrics (p 579) raises a number of interesting and practical questions for pediatricians. For example, What is hypertension? What does hypertension mean to the child or youth? Should the youth with hypertension be allowed to participate in competitive athletics? What is the role of exercise testing in the evaluation of hypertension? What additional information does it provide?

WHAT IS HYPERTENSION?

Blood pressure (BP) is the resultant of cardiac output (CO), and systemic vascular resistance (SVR). Because CO and SVR vary from one person to another, it is not surprising that there is a wide range of normal BP values.
Excessive Sweating in an Apparently Normal Teenager
Authors: Fan Warner J-W. , Cohen Nathaniel M.
Published: December 2021

Excessive sweating is a common complaint in pediatrics. In most cases it is normal, but may occasionally be a manifestation of an underlying disorder. We recently encountered an apparently normal teenager who sweated most dramatically.

S.M., a 12-year-old girl, presented with the complaint of excessive sweating. This had started three years previously in Virginia, but had worsened in Hawaii. The sweating was constant, independent of activity or anxiety level, and was sufficient to form a small puddle around the feet after some 30 minutes.
Milk and Peculiar Behavior
Authors: Murray John J.
Published: December 2021

I am writing this letter to inquire whether any of the pediatricians in the Academy around the country have encountered behavioral problems associated with ingestion of dairy products. In my practice I have run into several patients who undergo marked alterations in behavior patterns when ingesting dairy products, and whose behavior is totally changed by the withholding of dairy products from the diet or in some instances the addition of Lactobacillus acidophilus to the milk that they drink.
Intelligence in Dysautonomia
Authors: Day Richard L.
Published: December 2021

The study of 53 patients with dysautonomia by Welton et al (Pediatrics 63:708, 1979) is the most extensive survey of mental ability in this condition yet published. The conclusion is drawn "that the same proportion of the dysautonomic population scored within the average range of intelligence as if found in the general population."

The unwary reader might conclude that the brain in dysautonomia has escaped the otherwise widespread damage to more easily assessed parts of the nervous system.
INTRODUCTION
Authors: Miller Michael E. , Stiehm E. Richard
Published: December 2021

Interest in the mechanisms by which the human neonate derives protection against microorganisms has become a major consideration in the prevention and management of neonatal infections. As such, a conference on Host Defenses in the Fetus and Neonate was co-sponsored by the Kroc Foundation and the National Foundation/March of Dimes at the Kroc Foundation's headquarters in the Santa Ynez Valley, California, October 16-19, 1978. This supplement contains the proceedings of the conference.

Extensive discussions followed each presentation, and these have been summarized by the rapporteur for that session. The rapporteurs were: Richard B. Johnston, Jr, MD, Robert C. Seeger, MD, Jane Pitt, MD, Harvey R. Colten, MD, R. Michael Blaese, MD, Rebecca H. Buckley, MD, and Diane Wara, MD.

On behalf of all the participants, we express our profound gratitude to Dr Peter Amacher of the Kroc Foundation for his efforts in ensuring a successful meeting.
Neonatal Cellular and Humoral Immunity to Group B Streptococci
Authors: Hill Harry R. , Shigeoka Ann O. , Hall Robert T. , Hemming Val G.
Published: December 2021

The mechanisms of host resistance to group B streptococci have not been defined precisely. In the studies reported here we have assessed the contributions of both humoral and cellular factors in protection against strains of this group. With assays of specific opsonic activity based upon the production of polymorphonuclear leukocyte chemiluminescence and radiolabeled bacterial uptake, we have demonstrated that specific heat-stable antibody and the classic complement pathway are major factors in opsonization of these organisms. In the absence of specific antibody, fresh serum resulted in markedly reduced bacterial uptake indicating, at best, a minor role for the alternative complement pathway. Additional studies have indicated that strain-specific antiphagocytic factors as well as type-specific ones may play a role in the virulence of these organisms. Neonates who developed group B streptococcal sepsis usually lacked opsonic activity in their infecting strain. In addition, polymorphonuclear leukocytes from normal term and stressed neonates showed impaired metabolic activation as measured in the chemiluminescence assay following exposure to opsonized group B streptococci. These results suggest that neonates who develop group B streptococcal disease may have defects in both the humoral and cellular aspects of their acute inflammatory response which may contribute to the high mortality observed in this most fulminant of bacterial infections.
Behavior Modification Protocols on a Pediatric Adolescent Unit
Authors: Woolston Joseph L. , Schowalter John E.
Published: December 2021

The use of operant conditioning protocols for the management of behavioral disturbances of hospitalized adolescents with serious chronic medical illnesses is discussed in this paper. The use of the protocol from the point of view of changing hospital staff interaction is emphasized. Three cases are used to illustrate the process by which the protocol is created and its therapeutic effect on the patient and staff.
Candida Esophagitis and Laryngitis in Chronic Mucocutaneous Candidiasis
Authors: Kobayashi Roger H. , Rosenblatt Howard M. , Carney Jean M. , Byrne William J. , Ament Marvin E. , Mendoza Guillermo R. , Dudley James P. , Stiehm E. Richard
Published: December 2021

Five children (aged 11 to 19 years) with lifelong chronic mucocutaneous candidiasis had 12 episodes of esophageal and/or laryngeal candidiasis documented by endoscopy. Symptoms included hoarseness (8/12), dysphagia (6/12), and hemoptysis (1/12). There was poor correlation between oral lesions and esophageal or laryngeal involvement. On fiberoptic endoscopy, the esophagus was involved alone in four episodes (33%), the larynx in two episodes (17%), and both structures in six episodes (50%). In six of eight instances, the esophagram was nondiagnostic or markedly underestimated the extent of inflammation. Intravenous amphotericin B or miconazole resulted in the resolution of these infections for variable periods of time. Repeat endoscopy was used to follow the course of the disease. Aerosolized amphotericin B was effective on one occasion in clearing candidal lesions of the larynx and one small area of the left mainstem bronchus. Oral topical therapy was not beneficial. Since the signs and symptoms of laryngitis or esophagitis are often minimal or absent and complications, including strictures, may arise from chronic inflammation, periodic endoscopy and systemic therapy may be necessary.
Erythrocyte Insulin Binding in Insulin-Dependent Diabetes Mellitus: Lack of Relationship to Duration and Control of Diabetes in Children and Adolescents
Authors: Kappy Michael S. , Plotnick Leslie P. , Findlay Joann C. , Kayne Richard D.
Published: December 2021

Insulin binding was measured in the erythrocytes (RBCs) of four children and 12 adolescents with insulin-dependent diabetes mellitus in the basal (fasting, nonketotic) state. Children and adolescents with insulin-dependent diabetes mellitus showed normal binding of insulin to their RBCs when expressed as the total insulin bound over the physiologic range of insulin concentrations. The insulin receptor concentration and receptor binding affinity for insulin were also normal. These parameters of insulin binding were not correlated with either the duration of diabetes or the degree of diabetic control in the patients. Since insulin binding by erythrocytes has been shown to reflect binding by traditional target tissues (liver, fat), the data suggest that alterations in binding of insulin to cells in children and adolescents with insulin-dependent diabetes mellitus probably play little, if any, role in the response of these patients to exogenous insulin or in the control of their glucose metabolism in the basal state.
In Vitro Cell-Mediated Immunologic Assay for Cow's Milk Allergy
Authors: Ashkenazi Azaria , Levin Stanley , Idar Dalia , Or Ayala , Rosenberg Ian , Handzel Zeev T.
Published: December 2021

The production of a lymphokine, the leukocyte-migration-inhibition factor (LIF), by peripheral blood lymphocytes in response to an in vitro challenge with bovine β-lactoglobulin was assayed in infants and children suspected of having allergy to cow's milk protein. of the patients studied, 24 had cow's milk allergy, 24 were normal control subjects, 18 had recovered from milk allergy, 10 were newborns, and 10 were babies suffering from acute gastroenteritis. All patients with milk allergy demonstrated significant LIF production in response to β-lactoglobulin (23.5% ± 6.4%). In the normal control subjects, LIF was 3.1% ± 4.3% (P < .0005). Only two of the 24 control subjects and two of the ten newborns had high-normal values bordering on the positive. None of the ten babies with acute gastroenteritis gave a positive response. Most of the children who had recovered from milk allergy and were ingesting cow's milk had negative assays. This cell-mediated immune assay is shown to be a reliable test for the diagnosis of sensitivity to milk protein in infants and children, and for determining dietary treatment and when this treatment can be safely terminated. In most cases, its use should eliminate the need for the potentially dangerous and ethically questionable provocation test, as well as the need for repeated intestinal biopsies.
Astrocytoma in an Infant with Prolonged Apnea
Authors: Kelly Dorothy H. , Krishnamoorthy Kalpathy S. , Shannon Daniel C.
Published: December 2021

A 4-week-old infant experienced prolonged central sleep apnea requiring resuscitation. At 6 months of age he developed episodic obstructive apnea (diagnosed as laryngospasm by direct laryngoscopy) with an abnormal EEG and a normal computed tomography (CT) scan, and at 14 months of age he developed hemiparesis due to a gemistocytic astrocytoma grade III-IV. Following removal of the mass, he has had occasional seizure activity, but no further episodes of obstructive apnea.
Follow-up Studies of Very Low Birth Weight Infants (1,250 Grams or Less) Born and Treated Within a Perinatal Center
Authors: Kumar Savitri P. , Anday Endla K. , Sacks Linda M. , Ting Rosalind V. , Delivoria-Papadopoulos Maria
Published: December 2021

The growth and development of inborn very low birth weight infants was evaluated in 50 of 60 survivors from 132 babies weighing ≤1,250 gm born July 1974 to December 1977. Mean ± SE birth weight and gestation was 1,066 ± 19.3 gm and 29.5 ± 0.3 weeks, respectively, with 13 infants small-for-gestational age. Of the survivors, 26% weighed ≤1,000 gm. Male to female ratio was 1:1.4. Apgar scores ≤5 at five minutes occurred in 16% of the infants. Respiratory distress syndrome occurred in 56%, but only 10% (5/50) required mechanical ventilation. At 1 year, 46% small for gestational age (SGA) and 8% appropriate for gestational age (AGA) infants were less than the third percentile for weight. Major neurologic abnormality occurred in three infants (6%), one of whom is also blind. Grade V retrolental fibroplasia occurred in two others. Severe developmental delay (development quotient <80, Gesell) occurred in these five infants and two other neurologically normal babies. Of 15 infants weighing ≤1,000 gm, two had major handicaps. Eight percent of the AGA infants and 30% of the SGA infants had major handicaps. These data indicate that infants born and treated in a perinatal center have a decreased incidence of asphyxia and severe respiratory distress syndrome and that the incidence of major handicaps is reduced, especially in the appropriate for gestational age baby.
Contemporary Plagues and Social Progress
Authors: Weller Thomas H.
Published: December 2021

For this address at the opening session of the First Mexican National Congress of Infectious Diseases in Children (ler, Congreso National de Infectologia Pediatrica), I have chosen as my title "Contemporary Plagues and Social Progress." While in medicine the term plague usually refers to diseases caused by Pasteurella pestis, the word has broader meanings and usages. It describes that which smites or troubles, can refer to an afflictive evil or anything troublesome or vexatious, or can be applied to any malignant disease, especially those that are contagious. It can be used as an expression of annoyance, as a mild oath, or with the implication of harassment. Thus, today we are concerned with the plague of plagues, the afflictive evils of the cumulative insults of infectious disease. Additionally, we might be tempted to cast a plague on the system of medical education and on the political process that neither conveys the continuing importance of infectious diseases nor funds the mechanisms for their containment. Or, should the shoe be on the other foot? Should not society cast a plague on us?

As experts in the field of infectious disease, have we not failed to publicize that, on a global basis, the combination of diarrheal disease and malnutrition is the leading cause of death in infants and children? Has not our successful use of antibiotics induced unjustified public complacency regarding the problems of infectious disease? Why have our low-keyed reports of resistant typhoid bacilli, or pneumococci or of gonococci failed to dispel the prevalent mystique that science has controlled infectious agents, leaving cancer and heart disease in the public eye as the major unconquered problems in the health field?
Pediatric Examination of Educational Readiness
Authors: Conners C. Keith
Published: December 2021

For many years pediatricians have carried out both informal and systematic assessments of behavior in children, with the early motor assessments of Ilg and Ames perhaps being the most well-known. Levine et al (p 341) have responded to the need for a structured assessment of more complex behavioral functions of the school age child with the PEER (Pediatric Examination of Educational Readiness). This instrument will no doubt be welcomed for several reasons: it is brief, systematic, covers a wide range of functions, and fits readily into the pediatrician's repertoire. One can only applaud this effort to provide a systematic, quantitative framework for assessing functions of critical importance to child adaptation and development.
Letters to the Editor
Authors: Zambrana Ruth B. , Hurst Marsha , Hite Rodney
Published: December 2021

We feel that a number of important issues are raised by the letters in response to our literature review on working mothers. First, we would agree with Dr Katcher that the phrase "working mothers" is indeed a misnomer. Certainly women who work in the home as full-time mothers and homemakers work hard and make a significant and necessary contribution to society as well as to their own families, a contribution that public policy does not appropriately recognize and reward. In our review, however, we were dealing with the particular concerns and conflicts that arise when a mother is working or is deciding to return to work as a paid employee outside the home.
Value of Tracheal Aspirates Questioned
Authors: Goldman Steven L.
Published: December 2021

The extensive study recently reported by Sherman and co-workers attempts to evaluate the use of early tracheal aspiration in diagnosing congenital pneumonia.1 Their findings are of interest and confirm some previous studies and clinical impressions.

However, the authors' conclusion that "early direct tracheal aspiration ... appears to be a specific ... procedure for the early diagnosis of congenital pneumonia" does not seem to be supported by the data they present.

Specifically, for their conclusion to be valid, a definite correlation of positive tracheal aspirates with presence of pneumonia must be made.
Letters to the Editor
Authors: Wennberg Richard , Sherman Michael
Published: December 2021

We agree that a positive tracheal aspirate may represent colonization without infection especially after 12 hours of age or if more than one organism is isolated. Dr Goldman suggests that our observations are merely confirmatory of the study by Harris et at,1 but the experimental designs were in fact quite different. Harris et al1 cultured organisms from the nasal pharynx or tracheal aspirate of only four of 29 patients evaluated before 12 hours of age, but did not state whether these four patients also had evidence of systemic infections.