bluuebunny/crossref_metadata_2025 huggingface dataset:
Hyperthyroidism
Authors: Sills Irene N.
Published: December 2021

Hyperthyroidism in children and adolescents usually is due to Graves disease. The diagnosis may not be recognized promptly, and clinical findings initially may be attributed incorrectly to cardiac or psychological disorders. Once suspected, history and physical findings and measurements of TSH level, thyroid hormone levels, and thyroid antibodies make the diagnosis apparent. Treatment varies among endocrinologists and includes antithyroid medication, surgery, and radioactive iodine. Much is being learned about the autoimmune response that causes the disease, and the hope is that therapies directed at altering the autoimmune abnormalities ultimately will offer the best therapeutic alternatives.
INDEX OF SUSPICION
Authors: Dvorak Mary D. , Mazur Britta , Pascual A. George
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.

We invite readers to contribute case presentations and discussions.

Case 1 Presentation

A 6-day-old girl is brought into the clinic having a 12-hour history of fever to 101°F(38.3°C), irritability, and refusal to breastfeed. The child's mother is a bright, articulate woman who is very concerned about providing the best for this baby, her first, and is dedicated to breastfeeding. She notes that the child previously had been "a very good baby" - quiet, pleasant, and nondisruptive. Since birth, the child has slept for much of the day and night, awakening every 5 to 7 hours to feed. The baby usually wets her diapers after each feeding. However, her mother says that the last wet diaper was noted 6 hours ago, and it was barely wet.

Upon physical examination, the child appears quiet but awake.
Cat Scratch Disease
Authors: Klein Joel D.
Published: December 2021

Introduction

Cat scratch disease (CSD), a regional lymphadenitis affecting those lymph nodes draining dermal and/or conjunctival sites of inoculation, probably is the most common cause of chronic lymphadenopathy among children and adolescents. Adults account for only 10% to 20% of cases. It usually presents as a benign, self-limited disease involving tender regional lymphadenopathy that frequently has been present for 3 weeks or longer.

In most cases the infection is preceded by a cat scratch or other close contact with a cat (generally an immature one). This infection's association with cat scratches was described first by Robert Debre in 1931. Since then, the spectrum of CSD has been expanded to include the presence of various skin rashes, such as erythema nodosum and erythema multiforme, ocular involvement, and constitutional symptoms such as fatigue and fever. In addition, many case reports of CSD have included descriptions of atypical clinical manifestations such as central nervous system involvement, arthritis, osteomyelitis, and severe chronic systemic disease.

Most recently, two possible etiologic agents of CSD have been identified: a fastidious, pleomorphic gram-negative bacillus, Afipia felis, and a rickettsial pathogen named Rochalimaea henselae.

Epidemiology

CSD appears to occur worldwide and is seen in all regions of the United States. Cases may be seen sporadically all year long, but it appears to have a seasonal preference.
Acute Renal Failure: Diagnosis
Authors: Sehic Azra , Chesney Russell W.
Published: December 2021

Introduction

Although acute renal failure (ARF) is relatively uncommon, its mortality rate is potentially so high that it is important to recognize this condition in children. Rapid deterioration of renal function is caused by numerous insults and results in typical findings, including extracellular volume expansion, hyperkalemia, hypertension, metabolic acidosis, and azotemia. It usually is reversible, with the majority of patients recovering completely. However, ARF can lead to residual impairment of renal function and progress to end-stage renal disease and death. Conservative medical treatment often is life-saving.

Definition

ARF represents the rapidly progressive (within several hours or days) cessation of renal function, which results in the inability of the kidney to control body homeostasis, manifesting in retention of nitrogenous waste products (azotemia) and fluid and electrolyte imbalance. On the basis of pathophysiologic process, ARF has been divided broadly into three diagnostic categories: prerenal, intrarenal (organic-intrinsic), and postrenal failure (Table 1). Prerenal and early postrenal failures are renal functional disorders and responses of a structurally intact kidney to extrarenal processes. These forms of renal dysfunction recover rapidly as soon as the cause is reversed. However, if these two disorders are not recognized in time, persist too long, or are treated inadequately, they can result in intrinsic renal failure.
Formulas for the Healthy Term Infant
Authors: Greer Frank R.
Published: December 2021

Human milk remains the gold standard for infant nutrition. As a nutritional source, it shows a relatively large degree of both intra- and inter-individual variability in composition. It can be said that the more we learn about the unique compositional qualities of human milk, the more there is to learn. Although it is unreasonable to expect any artificial formula to duplicate this mammary gland secretion, this has remained an elusive goal of nutritionists and formula companies throughout the 20th century.

Infant formulas have changed substantially since the burgeoning of the modern formula industry in the 1950s. Many of these changes, such as the additions of iron, vitamin D, and perhaps vitamin K, addressed specific well-documented deficiencies and actually moved infant formula away from the composition of human milk. However, the majority of the changes made in recent years have been attempts to bring formulas closer in composition to human milk. The additions of taurine and carnitine, further reductions in sodium content, and increases in the percent of whey protein, though advantageous theoretically, have remained of questionable benefit when subjected to rigorous scientific methods. Much of the supporting research for formula modifications is sponsored by the formula industry, the results of which are then widely advertised in circulars aimed at practitioners involved in the care of infants.
Penicillin Update
Authors: Goldstein Stuart L. , Kaplan Sheldon L. , Feigin Ralph D.
Published: December 2021

Penicillin was discovered serendipitously by Alexander Fleming in 1928 while he was examining Staphylococcus variants. The first trials of penicillin in humans who had serious staphylococcal infections were undertaken more than I decade later and yielded impressive therapeutic results. Despite the introduction of numerous other antimicrobial agents and the emergence of many organisms resistant to penicillin, this agent remains a powerful and essential antibiotic 50 years after its first clinical application.

Pharmacology

The basic structure of the penicillins consists of the thiazolidine ring, a beta-lactam ring, and a side chain (Figure 1). The antimicrobial activity of all penicillins is produced by the thiazolidine/beta-lactam nucleus, and the organism-specific activity of a particular penicillin is determined by the side chain derivative. There are many naturally occurring side chain derivatives, but penicillin G is the most potent of these and, therefore, the only one used clinically. Semisynthetic penicillins are constructed from the basic penicillin nucleus with a side chain added. Each side chain alters the susceptibility of a particular penicillin to inactivating enzymes.

MECHANISM OF ACTION

All pencillins work by inhibiting bacterial cell wall synthesis, thereby affecting the stability of the cell wall and subsequent bacterial development. The cell wall is made of a peptidoglycan that is synthesized in three stages.

MECHANISM OF ACTION
Normal Speech and Language Development: An Overview
Authors: Coplan James
Published: December 2021

Normal Speech and Language Development

Language consists of any symbol system for the storage and exchange of information. It commonly is described in terms of auditory expressive and receptive ability (speech and listening comprehension, respectively). However, language also is conveyed visually. Normal infants attend to gestures and initiate various gestures to make their needs known; visual language development in deaf infants exposed to a formal sign system, such as American Sign Language (ASL), parallels the stages of oral language development in hearing infants;1 and reading and writing are obvious manifestations of visual language in older children and adults. Precursors to auditory and visual language are readily observable from earliest infancy. Because these precursors lack symbolic value, they are termed prelinguistic.

AUDITORY EXPRESSIVE LANGUAGE

Human infants produce a uniform sequence of prelinguistic utterances, regardless of the language spoken by their adult caretakers. The earliest of these utterances is cooing, which consists of musical, open vowel sounds. Cooing should be well established within the first 4 to 6 weeks of life. This is followed in the first few months of life by bilabial sounds: blowing bubbles or the "raspberry." By 5 months, laughing and a variety of monosyllables appear, such as "ba" or "ga." Between 6 and 8 months, infants produce polysyllabic babbling, which consists of the same syllable repeated over and over: "lalalalala," "mamamamama," "dadadadada," and so forth.
Behavioral Side Effects of Medications Used to Treat Asthma and Allergic Rhinitis
Authors: Milgrom Henry , Bender Bruce
Published: December 2021

Parents, teachers, and physicians are concerned that medicines may alter children's mood, behavior, and ability to learn. In clinical practice, adverse reactions to drugs and the perceptions associated with them influence prescribing patterns and undermine compliance. In the treatment of chronic disorders such as asthma, where successful management requires that patients take medications consistently over prolonged periods of time, factors affecting compliance become profoundly important.

Asthma medications have been associated with behavioral, affective, and neuropsychological changes in children. Oral corticosteroids exacerbate depression and impair verbal memory, and there are anecdotal reports of severe reactions to inhaled steroids among children, including psychotic behavior. Oral beta agonists have been reported to cause psychotic reactions in adult patients. In children, inhaled albuterol frequently induces a short-term hand tremor, but does not compromise more complex psychomotor functions. Theophylline improves concentration and results in slightly increased hand tremor and feelings of anxiety.

Medicines for allergic rhinitis and those used for cough and colds frequently are administered by parents without the supervision of physicians. Many of these preparations, given not only to children who have allergic disease but also to those who have self-limiting respiratory symptoms, are available over the counter (OTC). This confusing array of combination antihistamines, decongestants, expectorants, and anticholinergic agents constitutes the largest group of drugs taken by children.
Lice
Authors: Sonnenblick Howard C.
Published: December 2021

Three forms of pediculosis affect the human host, each with a predilection for certain parts of the body.

Pediculosis capitis. or head lice, is the most common type and is seen primarily in preschool and school-age children, especially girls. Transmission occurs by coming into direct contact with lice or by sharing infested brushes, combs, and hats. Adult lice and their eggs (nits) are found principally in the occipital region and behind the ears. Symptoms include severe itching, often resulting in excoriation and secondary bacterial infection.

Pediculosis pubis is seen most commonly in sexually active adolescents and young adults, although occasionally it may be found on the eyelashes of small children who come in contact with infected individuals.
Consultation with the Specialist
Authors: Tingelstad Jon
Published: December 2021

A 7-year-old boy complains of left upper quadrant pain following a fall from a tree 4 hours earlier. A 3-year-old girl has a spreading hemorrhagic rash and a temperature of 40.6°C (105.2°F). An 18-month-old boy returned to the pediatric intensive care unit 3 hours ago following prolonged open heart surgery for repair of a complex congenital heart defect. What do these three pediatric patients have in common? Each is a potential candidate for the development of shock.

Discussion

Shock is a complex pathophysiologic state that results from circulatory dysfunction and leads to failure to provide adequate quantities of oxygen and other nutrients to meet the metabolic requirements of the body's tissues. The etiologies of shock are numerous. Hypovolemic shock results from the loss of effective blood volume. For example, it may follow trauma to the spleen with unrecognized massive hemorrhage or it may be the result of severe dehydration caused by acute, explosive gastroenteritis. Septic shock, often the combination of multiple factors, follows the release of a series of mediators that cause peripheral vasodilation, myocardial depression, hypotension, ventilatory insufficiency, and anemia. Cardiogenic shock may occur after surgical repair of congenital heart defects, especially if the procedure is prolonged and difficult, or it may be associated with severe myocarditis, cardiomyopathy, or prolonged tachyarrhythmias. Decreased myocardial contractility leads to low cardiac output and hypotension.
Arbovirus Infections
Authors: Agha Rabia
Published: December 2021

Arbovirus infections are viral diseases transmitted by insect vectors—that is, they are arthropod borne. Clinically significant arboviruses in the United States include western equine encephalitis virus (WEE), eastern equine encephalitis virus (EEE), St. Louis encephalitis virus (SLE), the La Crosse (LAC) strain of the California encephalitis group, Powassan virus (POW), and Colorado tick fever virus (CTF). The four encephalitis viruses are spread by mosquitoes, whereas POW and CTF are tick borne. Not surprisingly, given that transmission depends on mosquito and tick vectors, arbovirus infections are most common in the US during the late spring and summer months. The geographic distribution of these viruses (see Table) is helpful to diagnosis because their clinical manifestations are not distinctive enough in individual patients to be diagnostic.
Hymenoptera Reactions
Authors: Mendez Elvin , Sicklick Marc J.
Published: December 2021

The order Hymenoptera comprises a group of insects that has a true stinger. Only the female of the species can sting because the stinger itself is a modified ovipositor.

Insect bites and stings are common and usually cause mild localized reactions. However, Hymenoptera stings are of greater concern, with reactions ranging from mild local irritation to fatal anaphylaxis. The incidence of systemic reactions to stings reported in the literature ranges from 0.4% to 0.8%. More recent studies have shown that up to 5% of the population is at risk of anaphylaxis laxis from insect stings. Fewer than 50 deaths from insect stings are necorded in the United States every year, but many more are unreported or undiagnosed.
Physiologic Anemia
Authors: Curtis Jane A.
Published: December 2021

The changes in levels of hemoglobin and hematocrit in the first weeks of life are dramatic. O'Brien and Pearson, in a classic article, demonstrated that these levels drop from an average hemoglobin of 17 g/dL and a hematocrit of 52% in cord blood to a hemoglobin of 11.4 g/dL and a hematocrit of 33% at 75 days of age. The reasons for this drop and the physiologic mechanisms involved in causing it have fascinated a number of researchers.

When considering the results of blood values, the first step is to be sure of the validity of the measurements. Early researchers in this area, such as Oettinger and Mills, noted a wide range of quoted normal values for hemoglobin and hematocrit of the newborn.
Vancomycin
Authors: Goldman David L.
Published: December 2021

Vancomycin, a glycopeptide antibiotic first isolated from the organism Amycolatopsis orientalis in 1956, was used initially to treat penicillin-resistant staphylococcal infections prior to the development of methicillin. It is selectively bactericidal against most gram-positive organisms, with almost no activity against gram-negative organisms. Several mechanisms of antimicrobial activity have been described for vancomycin, the primary one being interference with cell wall synthesis. Other mechanisms of action include alteration of bacterial cell membrane permeability and interference with messenger RNA synthesis. Because vancomycin and betalactam antibiotics act at different sites and stages of cell wall synthesis, no cross-resistance occurs.

Vancomycin is not absorbed well following oral administration and should be administered intravenously except for the treatment of Clostridium difficile colitis.
Vitamin A Supplementation and Measles
Authors: Fennelly Glenn J.
Published: December 2021

Vitamin A deficiency resulting from inadequate intake or induced by infection is associated with increased morbidity and mortality. Measles, the major single infectious cause of mortality in children worldwide, is more severe in children who have preexisting vitamin A deficiency. Several recent studies suggest that: 1) measles is associated with depressed serum levels of vitamin A; 2) hyporetinemia, defined as a serum retinol of less than 0.7 µmol/L, is associated with increased mortality from measles, especially in children younger than 2 years of age; and 3) vitamin A will decrease the risk of complications and death when administered during the acute phase of illness (within 5 days of the onset of rash).
Cold, Cough, and Allergy Medications: Uses and Abuses
Authors: Katcher Murray L.
Published: December 2021

Separately or in combination, antihistamines, decongestants, antitussives, and expectorants are used to treat the cough and rhinitis symptoms of the common cold and of allergies. Each year, Americans spend 1 to 2 billion dollars on cough and cold remedies and lose more than 26 million school days and 23 million work days because of rhinitis and associated symptoms. Studies have shown that antihistamines and decongestants are efficacious in the treatment of allergy symptoms, but the results of studies are mixed regarding their efficacy in the treatment of symptoms of the common cold, and studies show no effect in prevention or treatment of otitis media.

Some review articles and consensus opinions do not recommend the use of these drugs in the common cold (especially in preschool children), although some studies have demonstrated symptomatic relief, and physicians continue to prescribe or recommend these drugs for respiratory illness more than 36 million times annually.

The Common Cold

More than 200 million cases of acute upper respiratory infection (URI) occur each year in the United States, and more than 75 million are seen by physicians. URIs account for 23 million missed work days and 26 million missed school days. This is the second most common diagnosis made by office-based pediatricians, second only to otitis media.
Fluid Management of Diabetic Ketoacidosis
Authors: Finberg Laurence , Roberts Kenneth B.
Published: December 2021

In last August's issue (16:304, 1995), Roberts commented on recent recommendations for the fluid management of diabetic ketoacidosis (DKA). This issue has great importance because the older recommendations or "traditional" therapy begun in the 1960 to 1990 era was associated with occasional serious and sometimes fatal outcomes because of central nervous system (CNS) damage. One pedagogical problem results from calling the complication "cerebral edema"; a more accurate term is cerebral swelling because the excess water from therapy is largely in cells, not the interstitial fluids, as is true of edema. Imaging studies show the ventricles to be small, similar to the situation in lead poisoning or cerebral hypoxia. Understanding the mechanism for the swelling will make it easier for the therapist to monitor the administration of fluid.

The initial swelling may occur before therapy for reasons we can only surmise or that are unknown. We do know that osmoprotective molecules (myoinositol, taurine, and perhaps others) will enter or be produced in cells in a hyperosmolar state such as DKA. This increase in cellular solute will attract water by osmosis. When fluid that has a lower sodium chloride concentration than interstital fluid (Na, 150 mEq/L; Cl, 118 m/Eq/L) is administered rapidly, either intravenously or orally, the tight junctions of the CNS vasculature admit water molecules by diffusion more rapidly than sodium and chloride ions; there is about a 4-hour lag time in equilibrium.
The Spectrum of Erythema Multiforme
Authors: Rauch Daniel
Published: December 2021

Erythema multiforme (EM) is an acute hypersensitivity reaction characterized by distinctive skin lesions and mucous membrane involvement that has a spectrum of severity. It occurs in two forms: the more common "minor" type and the more severe "major" type, also called Stevens-Johnson syndrome (SJS). Sometimes EM includes toxic epidermal necrolysis (TEN) or Lyell disease. EM minor first was described completely by von Hebra in 1866; Stevens and Johnson described the major variant in 1922. EM occurs more often in males, and 20% to 50% of cases occur in the pediatric age group, although rarely in those younger than age 3 years.
INDEX OF SUSPICION
Authors: Toledo-Valido Martha , Neal M. Joyce , Duelge John T. , Kalyanaraman Meena , Patterson Maria
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.

We invite readers to contribute case presentations and discussions.

Case 1 Presentation

A 3-year-old girl is brought to the emergency department because of 24 hours of fever, nonproductive cough, and shortness of breath that has worsened progressively. She has no history of significant illness. She has been taking amoxicillin for 1 week to treat otitis media and pharyngitis.

On physical examination, the child appears in obvious respiratory distress. She has a temperature of 101°F (38.3°C), pulse of 150 beats/min, respiratory rate of 46 breaths/min, and blood pressure of 137/72 mm Hg. She is breathing with subcostal and intercostal retractions and nasal flaring. Her breath sounds are diminished in the area of the right upper lobe, and generalized inspiratory and expiratory wheezing is heard. Both tympanic membranes are red and distorted.
Beta2-Adrenergic Agents in Asthma
Authors: Turcios Nelson L.
Published: December 2021

For reasons not well understood, the prevalence of asthma, as well as its associated morbidity and mortality, has been increasing worldwide over the past 10 to 15 years. The pathophysiologic mechanism currently thought to underlie asthma involves both airway inflammation and bronchial hyperresponsiveness. Children who have asthma experience acute exacerbations of their disease, often precipitated by viral respiratory infections, by exposure to allergens or irritants, and by exercise. Wheezing, shortness of breath, chest tightness, and cough, all common symptoms that lead patients to seek relief, result at least in part from spasmodic contraction of bronchial smooth muscle. Drugs that relax bronchial smooth muscle produce the most immediate effect on airway caliber, even though edema and mucous secretions also contribute to airway obstruction.
Hypotonia in Infants
Authors: Stiefel Laurence
Published: December 2021

Neonatal hypotonia can have many different etiologies. Floppiness in an infant can be caused at various levels of the nervous system from disorders of the brain to spinal cord lesions, neuropathies, neuromuscular junction disorders, and myopathies. A variety of diagnostic tools are available for defining the source of the hypotonia, but before any serum values, muscle biopsies, electromyelograms (EMGs), or nerve conduction studies are ordered, a thorough neurologic examination is essential for determining the diagnosis.

The first goal in diagnosing the source of neonatal hypotonia is to ascertain if it is central on peripheral. Infants who have central hypotonia from a brain source usually have other central deficits.
Posthemorrhagic Anemia in the Newborn
Authors: Pearson Howard A.
Published: December 2021

Anemia in the newborn infant may result from many pathophysiologic processes. Because of the complex interrelations involving both mother and fetus, there is a broader list of causes of anemia in the neonatal period than is found at any other time of life. Anemia may be a consequence of three fundamental mechanisms: (1) loss of RBCs (hemorrhage); (2) rapid destruction of RBCs (hemolysis); or (3) underproduction of RBCs. The purpose of this review is to describe the mechanisms, clinical and laboratory features, and management of posthemorrhagic anemia in the newborn.1,2 Hemolytic and aregenerative anemias will be mentioned only briefly as differential diagnostic considerations.

CLASSIFICATION OF PERINATAL HEMORRHAGE

Although perinatal hemorrhage may occur in many ways, its causes can be conveniently divided into two general groups (Table 1). First: external hemorrhage, usually from the umbilical cord or placenta, in which an external bleeding site is obvious. Second: occult hemorrhage into closed compartments. In these cases bleeding is usually suspected because of clinical signs of blood loss such as pallor and shock.

EXTERNAL PERINATAL HEMORRHAGE

During uncontrolled or "precipitous" deliveries, a normal umbilical cord may rupture close to its attachment to the fetus. Rupture may also occur when the cord is abnormally short or excessively stretched by wrapping around the fetal neck or body.
Urogenital Tract Infections in Male Adolescents
Authors: Rosenfeld Walter D. , Litman Nathan
Published: December 2021

Urogenital tract infections in the pediatric and adolescent populations vary depending on both age and sex. Pediatricians are quite familiar with the infant with a bacterial urinary tract infection who had a congenital anatomic anomaly or the pre-school-aged or adolescent girl with cystitis. Similarly, adolescent boys who present with cystitis or pyelonephritis will almost always have one of several predisposing conditions such as a congenital anomaly, a neurogenic bladder, an obvious systemic disease such as diabetes mellitus, or an immunodeficiency disorder. The urinary tract infection that occurs under these circumstances is managed in the traditional manner by obtaining a specimen for culture and sensitivity testing and tailoring antibiotic and other appropriate therapy according to the patient's clinical status and the organism involved. The male adolescent with pyuria and/or dysuria without any of these predisposing conditions most likely has a sexually transmitted disease. If, however, a documented bacterial urinary tract infection is found, the patient should have a full urologic evaluation including an intravenous pyelogram, voiding cystourethrogram, and possibly cystoscopy, if these procedures have not been previously performed. Cystitis and pyelonephritis that occur without underlying problems in male adolescents are quite rare and will not be discussed further in this review.

Between 1971 and 1979 sexual activity among adolescent girls aged 15 to 19 years increased by 66%, with 38% having had a first sexual experience by age 16 years.1
Changes in Year Five
Authors: H. R. J.
Published: December 2021

With this issue of PIR, we begin year 5 of the Pediatrics Review and Education Program (PREP). Topics for special educational attention this year include endocrinology, metabolic disease, nutrition, genitourinary system disease, fluid and electrolyte metabolism, and gastrointestinal disease. There are 31 educational objectives relating to these topic areas. In addition, there are 163 educational objectives related to Recent Advances. Approximately 20% of these represent objectives that are repeats from one of the previous four years of the PREP cycle. Review articles in this year's PIR will address largely the topic areas, although when a Recent Advance objective seems particularly appropriate or timely for a review article, we will include these.
Self-Assessment Quizzes
Authors: MILBURN WILLIAM H.
Published: December 2021

Since the inception of Pediatrics in Review, readers have been invited to write comments on the back of their self-assessment quiz computer cards. These comments have been helpful in pointing out the strengths and weaknesses of both the articles and the questions. The self-assessment quizzes have been an area of concern and controversy. The questions have varied a great deal in quality and clarity.

The primary purpose of the quizzes is to encourage the readers to review the articles critically and thus enhance the learning experience. In addition, by answering the questions and returning the cards, PREP and AMA Category I credit can be received.
Practical Uses of Continuous Transcutaneous Oxygen Monitoring
Authors: Pasnick Marykay , Lucey Jerold F.
Published: December 2021

The comparison between intermittent Pao2 samples and a continuous transcutaneous PO2 recording can be compared to viewing a sports event by means of a single black and white photograph taken during the game versus a televised version complete with instant replays. Transcutaneous monitoring has made it possible to visualize the immediate effect of therapeutic maneuvers on PO2 as well as the physiologic response to a variety of routine procedures. In certain clinical situations with circulatory compromise, this measurement of tissue oxygenation may be a more pertinent clinical parameter than Pao2. The ability to monitor transcutaneous O2 tension continuously should enable researchers to further unravel the relationship of Po2 to various neonatal disorders such as retinopathy of prematurity, bronchopulmonary dysplasia, and intraventricular hemorrhage.

Other physiologic parameters may also be measured transcutaneously. A transcutaneous Pco2 monitor is now in use clinically, and a transcutaneous pH electrode, still in the developmental process, should be available in the near future. Like the transcutaneous Po2 monitor, these devices generate a continuous flow of clinical data enabling nurses and physicians to make rapid informed decisions based on the patient's current physiologic status.
Diagnostic Imaging in Gastrointestinal and Genitourinary Disease
Authors: Bickers Gayle H.
Published: December 2021

A wide choice of imaging techniques is available to visualize the GI and GU tracts. The use of imaging sequences for problems such as abdominal mass evaluation can minimize radiation exposure and decrease cost. However, physicians should not hesitate to tailor an imaging plan to the individual child's needs. Choosing the best single examination or series of studies for any particular child requires both knowledge of procedures locally available and frequent communication between the pediatrician and radiologist.
Early Intervention for the Biologically Handicapped Infant and Young Child: Is It of Value?
Authors: RUSSMAN Barry S.
Published: December 2021

Early intervention or infant stimulation programs have been developed for those children who are at risk for not achieving normal developmental milestones because of environmental or biologic problems. The high-risk children who have organic deficits can be identified by in utero, neonatal, or postnatal difficulties that have been correlated with specific diagnostic categories such as cerebral palsy, mental retardation, and learning disabilities. Whether early recognition and initiation of stimulation for this group of infants enhance neurologic development is unproven. On the other hand, there is no doubt that families of these children, and especially their mothers, have a much greater degree of stress compared with that experienced by families from the same socioeconomic backgrounds and whose children do not have such problems. Because of this observation, the programs must offer not only motoric, cognitive, and language stimulation, but also supportive psychological services.

The pediatrician should take a leadership role in helping families understand the purpose of infant stimulation programs in order to prevent disappointments when the infants involved with these programs make minimal gains. The pediatrician's ongoing support to the family is necessary, not only during the first few years of the child's life but even through the school-age years. It is also encumbent upon the pediatrician to develop a knowledge of programs available as well as a knowledge of the law as it pertains to the handicapped child.
The Role of the Practitioner in the Care of Children with Acute Leukemia
Authors: Dunn Nancy L. , Maurer Harold M.
Published: December 2021

The prognosis for a child with acute leukemia has improved dramatically over the past two decades. There are many factors that account for the improved survival rate including: better supportive care, especially for infectious and hematologic complications; sophisticated diagnostic techniques; and more effective multimodality treatment. The purpose of this article is to provide a guide for handling some of the more common questions and problems that may arise in the course of managing the care of a child with leukemia in practice.

The classification of leukemia, previously based simply on the morphology of the bone marrow elements, is now determined by a complex array of morphologic, cytochemical, and immunologic characteristics. The determination of cell surface and cytoplasmic markers by immunologic assays now permits the subclassification of acute lymphocytic leukemia, the most common form of childhood leukemia, into T, B, null, and pre-B subtypes (Table 1). The T and B cell subtypes are associated with a poorer prognosis than the null and pre-B cell subtypes and treatment is tailored accordingly.

Antileukemic therapy also has undergone change and refinement. The 1950s and 1960s brought many new cytotoxic drugs, first used singly and then in combinations. The end of this era was marked by the discovery of the value of prophylactic CNS treatment, using cranial irradiation and intrathecal methotrexate, in greatly reducing the incidence of meningeal leukemia.
Acquired Immune Deficiency Syndrome (AIDS)—A Pediatric Perspective
Authors: DESPOSITO FRANKLIN , MINNEFOR ANTHONY , OLESKE JAMES
Published: December 2021

The number of reported cases of adults with acquired immune deficiency syndrome (AIDS) is increasing and concern is growing regarding the potential impact of this epidemic on the pediatric population. Male homosexuals were the initial group afffected by AIDS. Soon thereafter, the disease was encountered among intravenous drug abusers, Haitians, and hemophiliacs. Major defects in cellular immune function develop and leave AIDS patients vulnerable to serious, often fatal opportunistic infections or malignancies.

In late 1982, the first evidence was provided to the Centers for Disease Control (CDC) indicating that infants and young children were victims of AIDS-like illness. Of five patients reported with otherwise unexplained immunodeficiency and opportunistic infection, one had received multiple blood transfusions for anemia and hyperbilirubinemia as a newborn.
Jimsonweed Abuse
Authors: Rumack Barry H.
Published: December 2021

Jimsonweed (Datura stramonium) is a plant found commonly throughout the United States. It is a member of the Solanum family to which other common plants, such as the potato, also belong. The genus Datura is found throughout the world under a variety of common names. All have similar pharmacologic activity. The botanical and common names for some of the Datura genus are shown in Table 1. Also listed are some examples of the Solanaceae family and others that have similar anticholinergic pharmacology and presentation.

Datura stramonium is a plant which grows to the height of three to six feet. Other members of the genus may be tree-like and grow to heights of more than 20 feet, especially in South America. D stramonium is an annual herb which grows from midspring to the first hard freeze; it reproduces primarily from seeds. It has dark green leaves similar to but larger than those seen on common tomato plants. It blooms approximately two months after it begins growth and develops long white flowers, lending the name "angel's trumpet" to members of this species. If the temperature condition at night does not fall below approximately 58°F, the fruit will set at the base of these flowers. A round fruit with spines will develop, thus the name "thron apple" (Figs 1 and 2).
Idiopathic (Immune) Thrombocytopenic Purpura in Children: Pathogenesis and Treatment
Authors: Schulman Irving
Published: December 2021

On the basis of available evidence it seems that "idiopathic" thrombocytopenic purpura, in children as in adults, should more properly be termed immune thrombocytopenic purpura. Although therapy is often employed because of the fear of CNS hemorrhage, the incidence of this dreaded complication is actually very low. New treatments may permit the physician to induce a safe platelet count while awaiting spontaneous remission. The indications for splenectomy in children may have to be reevaluated and here, too, new forms of therapy may permit the operation to be deferred and, in some cases, avoided entirely.
Genetic and Related Biomedical Aspects of Twinning
Authors: Hecht Frederick , Hecht Barbara K.
Published: December 2021

Twins are nothing new. They have been of interest for thousands of years.

The Song of Solomon sang in amorous tones: "Thy breasts are like two young roes that are twins, which feed among the lilies."

Genesis relates the story of Adam and Eve and their sons: Cain and Abel. According to Mohammedan tradition, Cain and Abel were born with twin sisters. Adam wished for Cain to marry Abel's twin and for Abel to marry Cain's twin. However, Cain was enamored of his own twin sister and so in jealousy slew his brother Abel.

Twins appear in many ancient writings beyond the Bible. Romulus and Remus, the mythic founders of Rome, were twins. Shakespeare wrote of "twinn'd lambs that did frisk; ' the sun, and bleat the one of the other" in The Winter's Tale.

GALTON: THE STUDY OF TWINS

Modern scientific interest in twins dates to Sir Francis Galton. In 1875, Galton emphasized the importance of studies of twins to distinguish heredity from environment or, as he put it, "nature from nurture." Galton, a cousin of Charles Darwin, made numerous other contributions, among them the study of fingerprints which are remarkably alike in identical twins. Fingerprints are today commonplace in law. In pediatrics, dermatoglyphic features assist in the rapid clinical diagnosis of trisomy 13, 18, and 21 (Down syndrome).
Assessment of Nutritional Status of Children
Authors: Suskind Robert M. , Varma Raj N.
Published: December 2021

Nutritional assessment is an integral part of optimal pediatric care. Undernutrition, which may be primarily due to inadequate food intake or secondary to infection, injury, or disease, is the most important cause of growth retardation in children. Comprehensive nutritional assessment involves evaluation by clinical, anthropometric, biochemical, and dietary methods. Nutritional parameters include those reflecting changes in body size, composition, and/or function. All patients should be nutritionally screened. If malnutrition is suspected, comprehensive nutritional assessment should be performed.
Urinary Incontinence in Children
Authors: Marshall Fray F.
Published: December 2021

A child aged 3 years or older with daytime as well as nighttime incontinence deserves a careful evaluation including an IVP, VCUG, possible urodynamic evaluation, and possible endoscopy. Although there are many possible causes for incontinence, an accurate diagnosis can usually be achieved with careful evaluation and structural abnormalities, if any, can then be corrected.
Lyme Disease
Authors: Doughty Robert A.
Published: December 2021

Lyme disease is an excellent example of successful medical pursuit of the cause of an idiopathic clinical syndrome. This pursuit led ultimately to a description of the bacterial source of the disease, the insect vector and its geographic distribution, the pathogenesis of the disease, and its treatment and complications.

The clinical syndrome, initially termed "Lyme arthritis," was first recognized in 1975 in Lyme, Connecticut by Dr Allen Steere and colleagues. They described a localized epidemic of a disease beginning with an unusual skin lesion followed by joint, neurologic, and cardiac manifestations. The "typical" patient was 5 to 15 years old, and the disease usually was seen in the summer with a distinct rash accompanied by chills, malaise, arthralgia and myalgia, head-ache and stiff neck, and occasionally pharyngitis.

CLINICAL PRESENTATION (Table 1)

The rash, erythema chronicum migrans (ECM), usually appears on a proximal extremity or the trunk, beginning as a red macule on papule which gradually enlarges to form a large plaque-like annular lesion averaging 16 cm in diameter (Fig 1). The lesions typically last about 3 weeks. Approximately half the patients have more than one skin lesion appearing within a few days of the initial lesion and sometimes merging with it. The outer border of the expanding lesion is usually intensely red and flat; the middle often shows some clearing.
Chronic Leukemia of Childhood
Authors: Weisman Steven J. , Berkow Roger L. , Baehner Robert L.
Published: December 2021

The chronic leukemias of childhood include chronic myelogenous leukemia (CML) and chronic lymphocytic leukemia. Chronic lymphocytic leukemia in childhood is a monoclonal B-cell neoplasm of great infrequency. CML occurs with enough frequency to warrant a review for the general pediatrician.

CML is a clonal (derived from a single cell line) myeloproliferative disorder that has two major forms in childhood, which, as a group, account for 2% to 5% of the childhood leukemias. "Adult" CML is a classic clonal myeloproliferative disease demonstrating the Philadelphia chromosome (Ph1). Its chronic phase lasts 2 to 3 years, then evolves into an acute phase which terminates in the blastic crisis. "Juvenile" CML is more often seen in infants and toddlers and is notable for the presence of rash, adenopathy, absence of the Ph1 chromosome, and elevated level of hemoglobin F. In fact, the two diseases have less in common than the similar names would imply. Approximately one third of CML in childhood is of the juvenile type.

A third type of myeloproliferative disorder resembling CML has been reported in two pairs of infant siblings. It clinically resembles juvenile CML, but does not appear to have the nearly universally fatal outcome. Finally, a familial myeloproliferative syndrome, which most closely resembles adult CML, has been reported in a large kindred.
Przełożony kościelny a notitia criminis w sprawie zastrzeżonego dla Kongregacji Nauki Wiary przestępstwa przeciwko VI przykazaniu Dekalogu
Authors: Majer Piotr
Published: December 2021

Autor w artykule przedstawił analizę odpowiedzialności ordynariusza, który otrzymuje informację o możliwym przestępstwie przeciwko VI przykazaniu Dekalogu, zastrzeżonym dla Kongregacji Nauki Wiary, w świetle Vademecum opublikowanego przez tę Kongregację 16 lipca 2020 roku. Prezentowane są następujące zagadnienia: notitia criminis jako źródło wiedzy o możliwym przestępstwie, problem właściwości ordynariusza oraz kryteria wstępnej weryfikacji otrzymanej informacji. W konkluzji autor dostrzega, że swoboda ordynariusza w dokonywaniu oceny wiadomości o przestępstwie oraz podjęciu decyzji o dochodzeniu wstępnym zostaje znacznie zmniejszona. Ograniczenie uznaniowości jest jednym z istotnych elementów niedawnej reformy kanonicznego prawa karnego przeprowadzonej przez papieża Franciszka.
Słowo i obraz. Homilia w transmisji audiowizualnej
Authors: Draguła Andrzej
Published: December 2021

Artykuł podejmuje problem wpływu czynnika technologicznego na percepcję homilii głoszonej podczas Mszy św. transmitowanej w radiu, telewizji czy też za pomocą streamingu internetowego. Przepowiadanie słowa Bożego jest poddane tym samym prawom, co inne transmisje live. Homilia słuchana w radiu pozbawiona jest warstwy wizualnej, a homilia transmitowana w telewizji oraz Internecie dociera do odbiorcy w wersji wizualnej zmontowanej przez reżysera obrazu. Obie formy różnią się od homilii wysłuchiwanej i oglądanej na żywo w kościele. Percepcja uwarunkowana medium, za pośrednictwem którego dokonuje się transmisja, warunkuje recepcję treści kazania. I choć skuteczność nadprzyrodzona słowa Bożego nie jest deterministycznie powiązana ze skutecznością komunikacyjną czy retoryczną, medialne pośredniczenie w odbiorze kazania nie pozostaje bez wpływu na jego skuteczność.
Między rygoryzmem a relatywizmem. Aspekty moralne współczesnych homilii
Authors: Swędrowski Jerzy
Published: December 2021

Orędzie Jezusa Chrystusa stoi w centrum nauczania kaznodziejskiego. Cały wymiar moralny w chrześcijaństwie realizuje się w perspektywie osobowej i przybiera praktyczny wymiar w postępowaniu. Religia i moralność pozwala ukazać nowość chrześcijaństwa i miejsce człowieka wobec Boga, wobec siebie i wobec wspólnoty. Na przestrzeni wieków kerygmat pozostaje centrum przepowiadania, a sytuacja życiowa człowieka staje się przestrzenią współpracy z Bożą łaską. Skrajne postawy rygoryzmu i relatywizmu wypływają najczęściej z braku jedności w ludzkich postawach i kulturze. Objawiają się one poprzez moralizowanie i budowanie wniosków oderwanych od rzeczywistości. Drogą rozwoju jest odkrywanie jedności w Bogu i jedności z Bogiem. Kaznodzieja spełnia rolę keryksa i mistagoga i czerpie ze źródeł na wzór ojców Kościoła. Moralne powinności pozostają tak długo odległe od człowieka, jak długo nie nawiązuje on relacji osobowych.
Model Story Brand w procesie przygotowania homilii
Authors: Kowalski Rafał
Published: December 2021

Tekst traktuje o możliwości i sposobach wykorzystania modelu Story Brand, stworzonego przez Donalda Millera, amerykańskiego pisarza, mówcę i biznesmana, jako pomocy w formułowaniu jasnego przekazu marketingowego dla przedstawicieli firm, przekonujących klientów do swoich produktów lub idei w procesie przygotowania homilii i kazań. Autor, zachowując kontekst nauk teologicznych, omawia poszczególne etapy, prowadzące do stworzenia atrakcyjnej i skutecznej mowy, która będzie oddziaływała na myślenie i działanie słuchaczy. Wydobywa przy tym te elementy, które mogą przyczynić się do poprawienia jakości homilii. Czytelnik zatrzymuje się przy siedmiu „przystankach” modelu SB7, które mają go doprowadzić do przygotowania skutecznego, a przede wszystkim ciekawego i trzymającego w napięciu komunikatu. Nie naruszając nauczania Kościoła na temat treści, która powinna znaleźć się w homilii, autor wskazuje jak wykorzystać osiągnięcia nauk o komunikacji dla celów homiletycznych, czego efektem będzie nadanie właściwej struktury komunikatowi, którym w tym przypadku jest jednostka przepowiadania.