bluuebunny/crossref_metadata_2025 huggingface dataset:
The Implications of Minor's Consent Legislation for Adolescent Health Care: A Commentary
Authors: Hazard Sprague W. , Eisner Victor , Garell Dale C. , Heald Felix P. , Hofmann Adele D. , James W. Scott , Shen Jerome T. Y. , Tanner Natalia M. , Thornton Melvin L. , Wasserman Martin P. , Wolfish Martin G.
Published: December 2021

The increasing emergence of legislation providing for minors' consent for health care furnishes a range of basic medical, legal, and social issues which require the thoughtful consideration of physicians caring for youth. The legislative provisions referred to account for a variety of consent situations ranging from the care of a specific illness or disorder to the dramatic lowering of the age for which consent for health care can be given.

The ultimate conflict in the matter of minor's consent is between the basic rights and responsibilities of parents concerning their children and the emergence of the concept that youths have the right to make decisions relating to their bodies and their care. When the preservation of privacy and confidentiality affects the utilization of health care by youth, the conflict must be resolved. Not only have state legislatures provided varying opportunities to resolve some of these issues, but also two major health organizations concerned with the health of youth have provided model acts which would serve as a basis for enabling young people to consent for confidential, comprehensive health care.

In recent years society has demonstrated a tendency to permit young people to determine a variety of aspects of their own affairs well before the traditional age of majority. In regard to health decisions, a number of situations have emerged in which the rights of youths deserve consideration. These include circumstances in which the person might avoid health care if the parents have to be informed, when a communication breakdown between the young person and the parents has taken place, if a need for emergency care occurs when parents cannot be reached, or when young people are living away from home in an adult life style.

Legislative responses to the sociohealth concerns affecting youth do not take a moral or judgmental position, nor do they infer a lessening of the importance of family integrity. They do respond to a number of reality health matters with high incidence which have emerged, particularly in the past decade. These laws do not require physicians to treat young people on their own consent, nor do they forbid physicians from informing parents if this is considered in the best interest of the patient. Furthermore, it is important for the physician to persuade youths to involve their parents and gain their support and understanding. Minors' consent can serve to restore interrupted communication between young people and their families.

The appearance and evolution of the "emancipated minor" and the "mature minor" concepts is recognition of the capacity of the adolescent to determine his own affairs and give an informed consent. The age at which human beings reach maturity is variable, and competent decision making is not assured by arrival at a certain chronological age.
Drs. Booth and Nadler's Reply
Authors: Booth Carol W. , Nadler Henry L.
Published: December 2021

We have read with interest the comments of Dr. Kelly regarding the theoretical usefulness of the techniques recently described for the demonstration of the heterozygous state in Hunter's syndrome. Dr. Kelly has suggested that this technique, which might permit certain females to be identified as carriers of Hunter's syndrome, would not significantly alter current genetic counseling concepts nor their application to amniocentesis for the prenatal detection of this disorder. Theoretical questions raised in his letten are certainly sound.
Leading Poisoning from Ingestion of Lead Shot
Authors: Greensher Joseph , Mofenson Howard C. , Balakrishnan C. , Aleem Anwer
Published: December 2021

A case of lead poisoning resulting from the ingestion of lead shot is reported. This unusual occurrence was discovered on x-ray of the abdomen, which should be a routine part of the investigation in all cases of suspected heavy metal poisoning. The lead shot came from the keel of a toy sailboat (specifically the 23-inch long "Classic" model produced in the past by Eldon Industries). Since many thousands of these sailboats may still be available for sale or have found their way into the toy collections of children, physicians should be alert to this potential source of lead poisoning. This case also illustrates the importance of thoroughly searching the entire environment to exclude causes other than paint and plaster when dealing with a case of lead poisoning.
Comment on Meningomyelocele Treatment
Authors: Sherman Sanford
Published: December 2021

Pediatrics has obviously placed Dr. Lorber's commentary (53:307, 1974) and Dr. Freeman's paper (53:311, 1974) in a prominent position in order to provoke response. I hereby rise to the "bait." At Children's Hospital Medical Center in Oakland, California, there is an active program for managing spina bifida. Our clinic, which meets weekly, has the regular attendance of a pediatrician, neurosurgeon, orthopedists, urologist, physical therapist, occupational therapist, social worker, Public Health nurse and brace maker.

Our ten-year experience is small compared with Dr. Lorber's and others, but it has had great continuity of professional personnel.
The Pathology of Neonatal Osteomyelitis
Authors: Ogden John A. , Lister George
Published: December 2021

The examination of multiple bones from a child who died of complications of septicemia and osteomyelitis elucidated the pathologic processes of infantile osteomyelitis. From a metaphyseal focus, there is spread in several directions. Most important, the infection can spread across the growth plate, along transphyseal vessels, to penetrate the epiphysis. Areas of direct destruction of growth plate were frequent findings, and allowed another route into the epiphysis.
DR. ABRAHAM JACOBI ON THERAPEUTICS OF INFANTS AND CHILDREN
Authors: C. T. E.
Published: December 2021

Abraham Jacobi (1830-1919), often called the Father of American Pediatrics, was the first to establish systematic and special clinics for the diseases of children. In 1896 when he wrote the practical note below, drug therapy for infants and children was far from a settled issue.

Therapeutics of infants and children have enjoyed, or suffered from, their fate like "books" and those of adults. They have had their stages between the era of dull and ignorant prescribing and that of impotent and conceited nihilism. But neither a deluge nor an absence of drugs make a physician, when by themselves alone, to the welfare of a single individual or the community. The ailments of children are but rarely complicated, and a single diagnosis tells the whole story. If it be not made, it is perhaps best for the practitioner not to attempt much doctoring and for the patient to be left alone. For, happily, most diseases have a tendency to get well, either completely or partially, and many will run a more favorable course when not meddled with.

This does not mean to say, however, that I discourage treatment even in such ailments as run a typical course extending over a number of days or weeks. On the contrary, I am opposed to the practice—much too common—of those who do not, for instance, wish to interfere with a whooping-cough because it finds its natural termination after several months. This is true, but many of the children find their natural termination also during these months.
Petechiae: Due to Adenovirus Type 7 Infection or to Acetylsalicylic Acid Therapy?
Authors: Casteels-Van Daele Maria
Published: December 2021

I read with great interest the article by Sahler and Wilfert on "Fever and Petechiae With Adenovirus Typ 7 Infection."1 The petechial rash presented by their patient might possibly be due to this infection, but it also corresponds quite well with the aspirin-induced purpura we reported in 1971.2 This purpura is believed to be due to the impaired platelet aggregation by an inhibition of ADP release following acetylsalicylic acid therapy. In these first observations I described some characteristics of these petechiae, namely the fact that they appear mainly on the face and neck, probably because of the interaction of the disturbed platelet function and a local increase of pressure in the capillaries, i.e., during coughing.
Lettrt To The Editor
Authors: Baker Carol J.
Published: December 2021

The two cases described by Dr. Brans, although clinically typical of fatal septicemia in neonates, are most unusual with respect to the concomitant infection in each patient with two distinct serogroups of hemolytic streptococci. In a 3½ year survey of group B streptococcal septicemia and/or meningitis cases in Houston, none of the isolates from sites in addition to blood or cerebrospinal fluid belonged to Lancefield groups other than B.1 As stated previously, groups B and G streptocci are typicaly β-hemolytic and bacitracinresistant on blood agar plates2; however, their colonial morphology is quite dissimilar.
CRAP DETECTION
Authors: Postman N. , Weingartner C.
Published: December 2021

". . . .it is the sign of a competent crap detector that he is not completely captivated by the arbitrary abstractions in which he happened to grow up."
Chronic Pulmonary Disease in Neonates With Assisted Ventilation
Authors: Rhodes Philip G. , Hall Robert T. , Leonidas John C.
Published: December 2021

Chronic lung disease in the form of stage III or IV bronchopulmonary dysplasia (BPD) was found to occur among nine of 188 infants receiving intermittent positive pressure ventilation for respiratory insufficiency. None occurred in infants ventilated with a mask alone. The duration of endotracheal intubation was not significantly longer in patients developing BPD; however, the duration of exposure to inspired oxygen > 60% was significantly longer in that group (mean, 141 hours.).

A previously undescribed form of chronic lung disease was found to occur among nine of 150 infants ventilated because of underlying idiopathic respiratory distress syndrome. A radiographic appearance of diffuse haziness with loss of identifiable lung markings occurred at 5 to 15 days of age and was not associated with clinical signs or symptoms or increased oxygen needs. These changes disappeared in one to five days.
100 YEARS ON, and STILL NO ANSWER
Authors: P. A. G.S.
Published: December 2021

The reader (researcher) who pursues a subject often discovers that "new" and "original" ideas may have been lying dormant for many years. The questions posed in the past were frequently left unanswered, until the development of more modern and sophisticated techniques. This year (1975) marks the 100th anniversary of the publication by Pierre Budin, in Paris, of an article posing the question, literally translated from the French, "At what moment ought one to practice ligating the umbilical cord?" (Progr. Med. [Paris] 3:765, 1875). He was asking the same question the following year, and obstetricians and pediatricians have been asking that question ever since. The last decade has witnessed a considerable number of investigations relating to the transfer of blood from the placenta to the infant at the time of delivery, much of it carried out at the Karolinski Institute in Stockholm. For the most part, the baby born at term who is appropriate for gestational age seems to be able to compensate for either excess or deprivation of blood (depending upon one's viewpoint). Despite widespread interest in the problem, the question with regard to the low-birthweight infant remains unresolved 100 years later.

Budin was a most inquisitive physician, and wrote on a wide variety of subjects, as evidenced by his book The Nursling published in 1907. One might thus attribute the question posed in 1875 to his fertile mind. However, he was preceded by almost 75 years by Erasmus Darwin who linked placental transfusion to onset of respiration in 1801.
SICK UNTIL PROVEN OTHERWISE
Authors: Thomas Lewis
Published: December 2021

. . . In the same sense that our judicial system presumes us to be innocent until proved guilty, a medical-care system may work best, if it starts with the presumption that most people are healthy. Left to themselves, computers may try to do it in the opposite way, taking it as given that some sort of direct, continual, professional intervention is required all the time to maintain the health of each citizen, and we will end up spending all our money on nothing but that. Meanwhile, there is a long list of other things to do if we are to change the way we live together, expecially in our cities, in time. Social health is another kind of problem, more complex and urgent, and there wll be other bills to pay...
Probable Neonatal Propoxyphene Withdrawal: A Case Report
Authors: Klein Robert B. , Blatman Saul , Little George A.
Published: December 2021

A baby with neonatal withdrawal from propoxyphene as evidenced by severe diarrhea, flapping tremors, shrill cry, diaphoresis, hypertonicity, and seizures is presented. Propoxyphene and its metabolites were identified in the patient's serum and urine. We express concern about the wide use of propoxyphene and its proposed use in substitution programs for detoxifying and maintaining heroin addicts in view of the possibility of neonatal complications.
Methylphenidate Reaction
Authors: Sleator Esther K.
Published: December 2021

Shader and DiMascio, in their book Psychotropic Drug Side Effects (1970), state "In spite of the fact that methylphenidate is one of the few psychotropic drugs that is widely available and recommended for use in the treatment of the hyperkinetic syndrome in children, remarkably few reports document adverse reactions to the drug." This is true of our experience at Children's Research Center. However, out of a total of 130 research subjects, one manifested a striking idiosyncratic reaction.
Infectious Mononucleosis in Children
Authors: Nakao Tooru , Chiba Shunzo , Ikeda Shugeru
Published: December 2021

We agree with the opinion of Tamir et al.1 that the Paul-Bunnell and mononucleosis tests are of little value in children.

In Japan, infectious mononucleosis is not common. Illness caused by Epstein-Barr virus (EBV) infection is rare after infancy because the positive antibody sera to EBV is 30% to 40% in the sera of infants between 1 and 24 months old. This increases rapidly to about 80% by 3 years of age.2 Primary EBV infection may occur before the age of 3 years.
Clinical Features of Renovascular Hypertension in Infancy: Report of a 9-Month-Old Infant
Authors: Makker Sudesh P. , Lubahn John D.
Published: December 2021

Certain common but seldom recognized clinical features of renovascular hypertension peculiar to infancy are emphasized in this communication from the observations made in a 9-month-old infant. Failure to thrive, extreme irritability, hypotonia, anorexia, vomiting, diarrhea, respiratory distress, and congestive heart failure are common clinical findings. Unless the physician is aware of this symptomatology or blood pressure is routinely obtained in all infants, the condition is likely to be missed. Renovascular hypertension is malignant and carries a high mortality but if diagnosed early may be cured by surgical intervention.
T System Immune-Deficiency in Down's Syndrome
Authors: Levin Stanley , Nir Erga , Mogilner Benjamin M.
Published: December 2021

Children with Down's syndrome (mongolism) are known to suffer frequent infections, particularly of the respiratory tract. This clinical observation has been confirmed in an epidemiological study in Denmark showing a 50-fold increased incidence of infectious diseases and a 123-fold increase of respiratory infections in mongols as compared to the normal population. In a clinicopathological study of all infants dying in our hospital over a period of ten years, we were impressed by the finding that all 13 cases of mongolism coming to autopsy showed marked lymphocyte depletion of thymus and lymph nodes.
SPORTS: INTRODUCING THE "HAPPY NON-HOOKER"
Authors: Maugh T. H.
Published: December 2021

Two scientists from California have used their technical ingenuity to make a significant improvement in the golf ball. They have invented a ball that resists hooking or slicing.

They used a principle from Newtonian physics that might be called "the spinning dumbbell rule." Two rigidly connected weights tend to spin around only one axis at a time-like a baton.

In this new ball the dimples cover 50% of the surface confined to a band around the equator with the poles smooth and with weight slightly concentrated in the poles.

In tests the "Happy Non-Hooker" achieved more than 90% of the distance of a conventional ball while reducing slicing by 75% to 80%.
Questions and Comments on Asthma Therapy
Authors: Sloan Earle R.
Published: December 2021

I would like to submit some questions and comments on Drs. Bierman and Pierson's protocol for the management of status asthmaticus published in the August issue of Pediatrics

(1) Is every child admitted to the hospital who does not respond to epinephrine injections (how many? frequency?)? Of the patients who are admitted, are all of them given intravenously administered corticosteroids as was suggested by the protocol? It would seem more desirable to try to break the asthma attack in the outpatient clinic by the use of aerosolized sympathomimetics, oxygen, and intravenously administered aminophylline in order to avoid frequent, costly hospitalizations and reliance on corticosteroids.
Comments on Asthma Therapy
Authors: Goldstein Nathan
Published: December 2021

For the most part, the approach of Drs. Bierman and Pierson to the pediatric patient with status asthmaticus appears sound; however, I feel the following comments are in order.

It has been my experience and that of others that it is seldom necessary to correct an arterial pH of 7.25 to 7.35; I would recommend bicarbonate therapy only if the arterial pH is less than 7.252, 3 Though the authors have indicated their desire for intravenously administered fluids containing 5% glucose, it is worthwhile to stress the importance of glucose administration to younger children since it has been found that patients with status asthmaticus under the age of 4 years have significant ketonemia.2
The Relationship Between Head Circumference and the Development of Communicating Hydrocephalus in Infants Following Intraventricular Hemorrhage
Authors: Korobkin Rowena
Published: December 2021

Rapidly enlarging head circumference is a standard clinical sign of progressive hydrocephalus in an infant. Six neonates 29 to 36 weeks gestational age, with intraventricular hemorrhage, confirmed by ventricular tap, had head circumferences measured at intervals from birth. The sudden appearance of rapidly expanding head size, not associated with changing clinical status, occurred 9 to 20 days after the estimated time of hemorrhage in all of the infants. Air ventriculography within three days of abnormal acceleration of head circumference growth demonstrated moderately to severely dilated ventricles. The ventricles were probably enlarging slowing from the time of hemorrhage because there was no associated clinical deterioration in the infants coincident with the rapid increase in head circumference. After intraventncular hemorrhage, enlarging head circumference appears to be an insensitive sign of hydrocephalus in premature infants.
Endotracheal Tube Placement in Infants Determined by Suprasternal Palpation: A New Technique
Authors: Bednarek Francis J. , Kuhns Lawrence R.
Published: December 2021

In order to decrease complications of improper endotracheal tube positioning, a method of placing the tube by palpation within the suprasternal notch was devised. The method proved to be simple and effective. The accuracy was verified by fluoroscopy and a clinical study comparing this technique with others is reported. No complications of the technique were noted.

Once palpation was reliable, the proper position of the tube tip was defined. From measurements taken from routine inspiratory chest radiographs on 142 infants, it was found that a point midway between the medial ends of the clavicle (IMP) was a good position because it approximates the true tracheal midpoint and, therefore, is a good landmark on a chest radiograph. This point allows for movement of the tube tip with head positioning and of carina with respiration. The tube tip can be placed near the IMP by the suprasternal palpation technique. This method, therefore, is useful in emergency situations or on initial intubations to avoid improper position of the tube tip prior to radiograph verification.
Comment on Mucocutaneous Lymph Node Syndrome: Could It Be a Heavy Metal Poisoning?
Authors: Cheek Donald B.
Published: December 2021

I have read with interest the information in your journal concerning the new disease mucocutaneous lymph node syndrome (MLNS) which seems to have almost reached epidemic proportions in Japan and is tentatively ascribed to a possible Rickettsia-like organism yielding a clinical picture not unlike periarteritis nodosa. While doubtless these assertions will prove to be correct in time and the evidence for infection would appear paramount, I would raise the question of possible background factors and in particular exposure to heavy metal.
Lettrt To The Editor
Authors: Maisels M. Jeffrey , Varano Lottie A.
Published: December 2021

The infants described in our report were ventilated with the Baby Bird ventilator. In addition to intermittent positive pressure, a continuous distending pressure of 5 to 10 cm H2O was used in all of the cases. Peak airway pressures ranged from 25 to 35 cm H20, and the rate of ventilation was usually 30 to 40 breaths per minute with an inspired/expired ratio of 1:1.

The idea that a decrease in diastolic filling may decrease intrapericardial pressure, and thus create a pressure gradient which encourages the development of pneumopericardium, is certainly intriguing.
Myelomeningocele: Suggested Minimal Urological Evaluation and Surveillance
Authors: Ridlon Herrick C. , Markland Colin , Govan Duncan E. , Leadbetter Guy , Price Stuart , Schoenberg Harry , Perlmutter Alan D.
Published: December 2021

A brief discussion has been' presented regarding minimal urological evaluation and surveillance of the child with myelomeningocele. At the present time enough experience has been collected throughout the country to establish recommendations for minimal evaluation and surveillance. It is recognized that there are some additional testing procedures presently being used of as yet unknown diagnostic or prognostic potential. It is also recognized that if treatment programs change and these children live into adulthood, changes in the program for surveillance may be necessary in later childhood and adult life.
Intolerance of Eight Ounces of Milk in Healthy Lactose-Intolerant Teen-Agers
Authors: Mitchell Keiffer J. , Bayless Theodore M. , Paige David M. , Goodgame Richard W. , Huang Shi-Shung
Published: December 2021

The ability of lactose-intolerant individuals to tolerate 8 ounces of milk was determined in healthy teenagers. Thirty-two blacks were studied with 50-gm lactose tolerance tests. Nineteen (59%) had a flat blood sugar curve and 13 (39%) also developed bloating, cramps, loose stools, or diarrhea with the test. These latter 13 were defined as lactose-intolerant.

Seven of the 13 lactose-intolerant teen-agers (54%) developed abdominal bloating and/or cramps after drinking 8 ounces of milk (half-pint). None had diarrhea. Eight were symptomatic with the equivalent amount of lactose (12 gm) while only one had symptoms with the monosaccharide components of lactose, glucose and galactose. The symptoms with milk and 12 gm of lactose were less severe than with the 50-gm tolerance test. A history of a prior awareness of milk intolerance was obtained from 11 of the 13 lactose-intolerant subjects.

At least one haLf of lactose intolerant teen-agers might be expected to be symptomatic after drinking 8 ounces of milk without other food.

Milk intolerance should be considered in the nutritional planning for teen-agers with special attention to members of population groups with a high prevalence of lactose intolerance.
The Iduronidase-Deficient Mucopolysaccharidoses: Clinical and Roentgenographic Features
Authors: Stevenson Roger E. , Howell R. Rodney , McKusick Victor A. , Suskind Robert , Hanson James W. , Elliott Dorothy E. , Neufeld Elizabeth F.
Published: December 2021

Hurler and Scheie syndromes, two of the six clinically distinct mucopolysaccharidoses, are deficient in the same lysosomal enzyme, α-L-iduronidase. A third group of iduronidase-deficient patients can now be identified during the pediatric years using clinical and radiographic criteria.

Based on inferential evidence for allelism between the Hurler and Scheie genes, the occurrence of genetic compounds which simultaneously carry both mutant alleles may be predicted to occur. This can be considered analogous to the structural gene mutations leading to hemoglobin SC disease. Four patients with phenotypes intermediate between Hurler and Scheie syndromes are felt to represent genetic compounds of this type. Both clinical and roentgenographic features are helpful in distinguishing these patients from those with Hurler syndrome or Scheie syndrome. Fibroblast correction characteristics identical to those of Hurler syndrome and Scheie syndrome and absence of consanguinity are additional features which favor classification as genetic compounds. The possibility of a third mutant allele at the Hurler-Scheie locus or of extreme phenotypic variation are not considered likely alternative explanations. Depending on the frequency of the Scheie syndrome and the Hurler syndrome, genetic compounds may occur with an intermediate frequency or may be more common than either homozygous condition.
Cyanosis, Cough, and Hypotension Following Intravenous Administration of Paraldehyde
Authors: Sinal Sara H. , Crowe James E.
Published: December 2021

Clinical and roentgenographic evidence of pulmonary edema developed following the intravenous administration of paraldehyde to a child. Experimental and clinical evidence indicate that administration of undiluted paraldehyde intravenously is hazardous.
Plasma and Dietary Phytosterols in Children
Authors: Mellies M. , Glueck C. J. , Sweeney C. , Fallat R. W. , Tsang R. C. , Ishikawa T. T.
Published: December 2021

Plasma phytosterol (plant sterol) levels were studied in 26 infants on various commercial formulas, in 36 infants on breast or cow's milk formulas, in 101 normal and 22 hypercholesterolemic children on a free diet, and in 32 hypercholesterolemic children on a low-cholesterol diet. Commercial formulas, poor in animal fats and enriched with vegetable oils, and low-cholesterol, phytosterol-rich diets generally elevated total plasma phytosterol levels in infants and hypercholesterolemic children from normal mean levels of 2 mg/100 ml to about 9 mg/100 ml. The implications of long-term three- to five-fold elevations of the plasma phytosterols (campesterol, stigmasterol, β-sitosterol) in infancy and childhood are unknown. Watchful prospective analysis of plasma phytosterol levels may be useful, particularly in regards to otherwise unanticipated long-term effects of cholesterol-poor, phytosterol rich diets.
Fatty acids, prostaglandins, and cystic fibrosis
Authors: Chase H. Peter
Published: December 2021

The papers by Elliott1 and by Campbell et al.2 in this issue of Pediatrics suggest a new approach toward etiology, pathophysiology, and therapy in patients with cystic fibrosis (CF). As in Elliott's original report of the effects of intravenous fatty acid therapy for CF,3 the patients in the present report fared remarkably well, particularly in regard to weight gain. As only 18 calories/kg of body weight were infused every three weeks, it is unlikely the increments in weight were due to calories. As noted in both papers1,2 previous investigators have also described essential fatty acid (EFA) deficiency in CF, and every experimental animal in which EFA deficiency has been produced has shown growth failure.
Alpha1-Antitrypsin Deficiency and Liver Disease in Children: Phenotypes, Manifestations, and Prognosis
Authors: Odièvre Michel , Martin Jean-Pierre , Hadchouel Michèle , Alagille Daniel , Thaler M. Michael
Published: December 2021

Odievre M, Martin J-P, Hadchouel M, Alagille D: Alpha1-Antitrypsin Deficiency and Liver Disease in Children: Phenotypes, Manifestations, and Prognosis. Pediatrics, 57:226, 1976.

Institutional affiliations of the authors should read: Unité de Recherche d'hépatologie infantile and Groupe de Recherche sur la génétique des protéines humaines, I.N.S.E.R.M., Bicêtre, France.

Reprints requests should be directed to: (M.O.) Unité de Recherche d'hépatologie infantile I.N.S.E.R.M. U 56, 78, rue du Général-Leclerc, 94270 Bicêtre, France.
The Effects of Methylphenidate on the Soft Neurological Signs of Hyperactive Children
Authors: Lerer Robert J. , Lerer M. Pamela
Published: December 2021

The neurological examination of many hyperactive children reveals the presence of abnormal neurological signs. Of 40 hyperactive children who had three or more neurological abnormalities on an initial neurological evaluation, 29 (72.5%) showed marked improvement or complete resolution of the neurological signs following treatment with methylphenidate hydrochloride (Ritalin) for 60 days. The administration of placebo did not change appreciably the neurological status of 20 hyperactive children. Improvement in behavior, which was ascertained by the use of Conners' Abbreviated Teacher Rating Scale, did not always correspond with resolution of the abnormal neurological signs. This finding suggests that methylphenidate affects behavioral and motoric functions separately and independently. Repeat neurological assessment, looking for resolution of abnormal neurological signs, should be included as part of the follow-up medical examination in treated hyperactive children. Coupled with other objective and subjective test information, improvement of the neurological status provides supportive evidence of overall improvement in the hyperactive child who is receiving drug therapy.
Benign Familial Macrocephaly: Report of a Family and Review of the Literature
Authors: Asch Alexander J. , Myers Gary J.
Published: December 2021

Five members in two generations of one family were found to have occipitofrontal head circumferences more than 2 SD above the mean. All five had normal intelligence and neurological examinations. Three of the five had ventricular dilatation by A-mode echoencephalography. The inheritance pattern of macrocephaly in this family appears to be autosomal dominant with incomplete penetrance. Possible causes of the macrocephaly in this family are discussed and the reported cases of macrocephaly with normal intelligence and no neurological deficits are reviewed.
Is the Academy Demolishing Private Practice?
Authors: Klein Arthur L.
Published: December 2021

As a pediatrician in private practice, I found the commentary on family intervention by Kempe1 in the November issue somewhat disturbing. It appears that Dr. Kempe does not feel that private pediatricians are able to adequately assess the psychosocial development of their patients and wants to interpose a nonprofessional "health visitor" from the state to do it for them. Most private practitioners see their newborns and mothers shortly after delivery and begin the continuing care of the child at that point.
LIPID METABOLISM AND ATHEROSCLEROSIS. Edited by D.W.K. Cotton. American Elsevier, $7.50; 116 pp
Authors: Glueck Charles J.
Published: December 2021

The brief volume Lipid Metabolism and Atherosclerosis edited by D.W.K. Cotton reflects the usual variability of submissions to an international symposium. The strengths of the volume are in the wide variety of areas covered, in the concise summary style of the authors, and in the more informal speculation which surfaces characteristically in the published free discussions. The weaknesses of the volume are more a reflection of the metier than the estimable authors, and are characterized by a considerable number of under-referenced sketches of topics with no real depth of reflection or reasonable balance of conflicting currents in the field.
Thymic cells and humoral factors as therapeutic agents
Authors: Wara Diane W. , Ammann Arthur J.
Published: December 2021

The experiments of Good et al.1 and Miller2 in 1962 established the thymus as an organ essential for the development and maintenance of cellular immunity. Further studies established that the immunologic functions of the thymus were mediated by both cellular and humoral components.

The importance of thymic cells in immunity was shown by the permanent restoration of cellular function in thymectomized animals following transplantation of intact thymus glands.3 Thymic-derived lymphocytes (T cells) have been identified as the population of cells which achieves maturation after migration through the thymus; their maturational stages are identified by various cellular characteristics and classified by nomenclature T0-T1-T2.4
Transcutaneous Po2 Monitoring in Routine Management of Infants and Children With Cardiorespiratory Problems
Authors: Huch R. , Huch A. , Albani M. , Gabriel M. , Schulte F. J. , Wolf H. , Rupprath G. , Emmrich P. , Stechele U. , Duc G. , Bucher H.
Published: December 2021

Results are reported concerning the clinical application of the transcutaneous Po2 method (tc Po2 method) according to Huch et al. for monitoring arterial Po2. Thirty long-term continuous tc Po2 recordings were made in 22 ventilated children and infants with cardiorespiratory problems in four different pediatric intensive care units (Zürich, Göttingen, Kassel, and Mainz). These recordings were compared with 132 arterial Po2 determinations made during the same period of time. There was a linear relationship and a close correspondence between arterial Po2 and tc Po2 (r = .94). The continuous recordings have shown that the variability of Po2 is much greater than assumed so far by single blood gas analysis. This fact restricts greatly the value of single samples. Continuous tc Po2 monitoring has proved to be a great help in optimal respirator setting.
A Multidisciplinary Approach to the Treatment of Child Abuse
Authors: Fontana Vincent J. , Robison Esther
Published: December 2021

A multidisciplinary team of professionals and paraprofessionals provides an innovative therapeutic approach for the treatment of child abuse and neglect among a deprived and disadvantaged population of abusing mothers. The therapeutic approach stresses residential care for mother and child, behavior modification through corrective child care experiences, personality modifications through individual and group therapy, and environmental and social changes through staff assistance and education.
Dealing With Unnecessary Medical Trauma To Children
Authors: Sibinga Maarten S. , Carey William B.
Published: December 2021

A sampling of the prescribing behavior of physicians from several areas of clinical practice suggests that children may be subjected to a substantial amount of unnecessary medical trauma. While some procedures are clearly necessary and others possibly so, still others appear to be performed as the result of parental pressures, specialty traditions, and external stresses or internal weaknesses of the physician. Reduction of unnecessary trauma is proposed through continuing scrutiny of all procedures, improved physician training, restructuring the practice situation, and consumer education.
The pediatrician and care of chronic illness
Authors: Jennison M. Harry
Published: December 2021

The prevalence of chronic illness in children in this country has been estimated to be 10% to 20%. (Chronicity, by definition, refers to any condition that persists for longer than three months.)1 Furthermore, the prevalence figures that identify at least one of every ten children as having chronic disease include only physical disorders and exclude mental or emotional handicaps and other conditions now classified as the "new morbidity." This group of problems, which encompasses preschool behavior and learning disorders as well as other school dysfunctions and adolescent adjustment problems, represents a significant additional class of chronic disabilities.

Primary physicians now find themselves with responsibility for (1) the earliest possible identification of any child with chronic disease; (2) assessment of various physical, emotional, and social needs including referral to specialty services such as consulting physician-specialists and other helping agencies and resources; and finally (3) provision of continuity and coordination of care for medical problems such as childhood cancer or a psycho-educational problem such as a severe learning disability.
Severe Staphylococcal Sepsis in Adolescents
Authors: Shulman Stanford T. , Ayoub Elia M.
Published: December 2021

During the three-year period beginning in early 1972, nine previously healthy children, ages 8 to 15 years, presented with manifestations of life-threatening septicemia due to coagulase-positive Staphylococcus aureus. In no patient was a predisposing cause for such infection, such as immunologic deficiency, drug abuse, or previous antibiotic or immunosuppressant therapy, discovered. Seven patients manifested evidence of bone and/or joint infection, while eight had pulmonary disease of varying degrees of severity, characterized initially by multiple small septic pulmonary emboli. One patient succumbed to the pulmonary complications of her disease. S. aureus was recovered from specimens of blood (seven patients), joint fluid (four), bone (four), pleural fluid (two), urine (one), sputum (one), and pericardial fluid (one). All organisms isolated were methicillin-sensitive; isolates from only one patient were penicillin-sensitive. In several instances, lack of clinical response was related to delay in adequate surgical drainage of infected material. Review of hospital records for the preceding five-year period failed to reveal similar cases of severe systemic staphylococcal infection in healthy adolescents. Although no direct evidence for a causal relationship is available, the occurrence of these cases corresponds temporally with implementation of restrictions upon the use of hexachlorophene.
Computerized Tomography in the Detection of Intracranial Metastases in Children
Authors: Dyment Paul G. , Rothner A. David , Duchesneau Paul M. , Weinstein Meredith A.
Published: December 2021

Computerized tomography brain scans produce sectional tomograms of the brain substance which demonstrate intracranial lesions. The procedure is safe and painless, and can be done on an outpatient basis. Three children with malignant disease had intracranial metastases demonstrated using this technique during a recent six-month period at the Cleveland Clinic.
Regional Obstetric Anesthesia and Newborn Behavior: Effect Over the First Ten Days of Life
Authors: Tronick Edward , Wise Susan , Als Heidelise , Adamson Lauren , Scanlon John , Brazelton T. Berry
Published: December 2021

This study examined the effects of carefully controlled amounts of analgesic premedications and anesthetics administered to mothers during delivery on the behavior of the newborn over the first ten days of life. The subjects were selected to minimize the synergistic effects of medication and other stress factors, such as abnormalities of pregnancy, labor, or delivery. The effects of these drugs on the behavior of these infants was small. The data provide a picture of the behavioral recovery of a group of minimally stressed newborns.
A Ten-Year Assessment of Methicillin-Associated Side Effects
Authors: Yow Martha D. , Taber Larry H. , Barrett Fred F. , Mintz A. Aaron , Blankinship G. Richard , Clark G. Edward , Clark Dorothy J.
Published: December 2021

The exact incidence and importance of side effects associated with methicillin therapy in children is unknown. During the ten-year period from 1964 to 1974 approximately 3,000 Houston children who received methicillin were observed for side effects. The great majority of these patients received the drug for less than ten days; however, side effects were more common in patients receiving long-term therapy. In order to assess these side effects, experiences with 124 children who received methicillin for ten days or longer were reviewed in depth. The average dose of methicillin was 200 mg/kg/day and the average duration was 22 days. In this highly selected group there were no adverse side effects in 54.8% and only eosinophilia in an additional 13%. Leukopenia occurred in 16%, microscopic hematuria in 8%, gross hematuria in 4%, skin rash in 6%, and "drug fever" in 6%. In many instances several of these side effects occurred within a single patient so that the total number of patients with definite side effects was 39 of 124 (31.5%). The true incidence figure of overall side effects is much lower than 31.5%. Corrected incidence rates based on a conservative figure of 3,000 methicillin-treated children are less than 1.5% for all side effects. In some patients the mechanism producing the adverse reactions seemed to be chemical irritation or toxicity and in others hypersensitivity. In nine of the 39 patients follow-up studies were not optimal. In the other 30 patients all side effects were reversible.
THE PRECOCIOUS THREE-YEAR-OLD LORD MACAULEY
Authors: C. T. E.
Published: December 2021

Thomas Babington Macaulay (1800-1859), historian, poet, essayist, and statesman, will most likely be remembered by American readers as the author of Lays of Ancient Rome. Macauley's precocity as a small child was vividly described in Sir George Trevelyan's The Life and Letters of Lord Macauley (1876) as follows:

From the time that he was three years old he read incessantly, for the most part lying on the rug before the fire, with his book on the ground, and a piece of bread and butter in his hand. A very clever woman who then lived in the house as a parlour-maid told how he used to sit in his nankeen frock, perched on the table by her as she was cleaning the plate, and expounding to her out of a volume as big as himself. He did not care for toys, but was very fond of taking his walk, when he would hold forth to his companion, whether nurse or mother, telling interminable stories out of his own head, or repeating what he had been reading in language far above his years. His memory retained without effort the phraseology of the book which he had been last engaged on, and he talked, as the maid said, ‘quite printed words’, which produced an effect that appeared formal, and often, no doubt, exceedingly droll.

About this period his father took him on a visit to Lady Waldegrave at Strawberry Hill, and was much pleased to exhibit to his old friend the fair bright boy, dressed in a green coat with red collar and cuffs, a frill at the throat, and white trousers.
Jansen's Metaphyseal Dysostosis
Authors: Gordon Stanley L. , Varano Lottie A. , Alandete Alvaro , Maisels M. Jeffrey
Published: December 2021

A case of Jansen's metaphyseal dysostosis, a rare disorder of endochondral ossification, is described. This is the first case in which the severe radiographic manifestations of this disease were detected at birth. Linear growth is significantly retarded at 2 years of age. Nevertheless, because full ossification with trabeculae is anticipated, early recognition and appropriate management during the phase of active growth should minimize deformities.
Tympanometry Controversy and Middle Ear Effusion: Too Much Concern or Too Little?
Authors: Paradise Jack L.
Published: December 2021

In his comments concerning our article on tympanometry,1 Mortimer expresses concern that the introduction of this test into widespread clinical use would unduly escalate health care costs–not only because of the purchase and operating costs of the testing instrument, but, more importantly, because "the results of tympanometric testing would be offered as justification for expensive, traumatic, therapeutic measures (tonsillo-adenoidectomy and/or tympanos-tomy tubes) of unproven need and dubious effectiveness."2 I share some of Mortimer's concerns3–any diagnostic instrument or technique is capable of being abused, or its results overinterpreted–but I disagree with the general thrust of his comments, chiefly because they present a limited view and in so doing may encourage diagnostic complacency and standpattism about a problem that I believe calls instead for increased attention to clinical observation and synthesis.
Dr. Krugman Replies
Authors: Krugman Saul
Published: December 2021

The decision to use immune serum globulin (ISG) for household contacts of symptomatic or asymptomatic carriers of hepatitis B virus should be dependent upon at least two factors: (1) the efficacy of the ISG preparation, and (2) the risk of acquiring disease following the exposure.

Efficacy of ISG. It is clear that conclusions based on studies which were conducted in the 1950's and 1960's are no longer valid today. At that time, specific tests for the identification of hepatitis B infection were not available.
Do We Really Need More Bureaucracy?
Authors: Arey Stuart Lane
Published: December 2021

I have just finished reading the proposed plan for recertification in Pediatrics. The aims of this document are laudable, and cannot be opposed by any pediatrician. However, I think a long look at the trends in education and certification is in order.

In the early 1920's a physician could take a three-week trip to Vienna and return as a pediatric specialist. By 1976 it had become necessary to complete a course of training and demonstrate competence by both written and oral examinations before being certified.
Reply to the "Apnea Monitor Business" Commentary
Authors: Beckwith J. Bruce
Published: December 2021

As co-author of the commentary1 to which Steinschneider took such umbrage in his rebuttal commentary,2 I gather I am supposed to feel wounded, or at least offended. However, despite the repeated implication that he disagrees with us on many points, I found Steinschneider's essay to be an eloquent reinforcement of the major points we wished to make.

His commentary was divided into four sections. The first, on "the use and misuse of monitors," says precisely what we were trying to say, but does it better.
Dr. Hoekelman Replies
Authors: Hoekelman Robert A.
Published: December 2021

I agree with Dr. Chamberlin that the maternal competence questionnaire used in my study as one of the endpoints of adequacy of well-baby care does not deal with those important aspects of well-baby care that he identifies. However, at the time the questionnaire was developed,1 these aspects were not considered important by the practicing pediatricians sampled to determine what knowledge a mother should have in order to be "judged" competent in rearing a child during the first year of life.
A Lethal Pacifier
Authors: Kravath Richard E.
Published: December 2021

A 5-month-old boy died of asphyxia from airway obstruction caused by his pacifier. It had been imported from Spain by La Cibeles Inc. of Union City, New Jersey, and had been marketed in New York, Massachusetts, New Jersey, Connecticut, Illinois, Maryland, Florida, and Puerto Rico under the brand names Fauna, Flower, Navy, and Texas. It sold for about 50 cents. It is attractive in design, but has characteristics that make it dangerous. Following our report to the United States Consumer Product Safety Commission,* the pacifier was recalled. We have been able to find only one similar case in the literature.1 The unnecessary tragedy was due to a preventable hazard and both individual and governmental action should avoid its recurrence.