bluuebunny/crossref_metadata_2025 huggingface dataset:
The Mandate Project: Institutionalizing a System of Patient Care Quality Assurance
Authors: Fleisher Daniel S. , Brown Clement R. , Zeleznik Carter , Escovitz Gerald H. , Omdal Charles
Published: December 2021

In 1970, prior to present-day requirements for quality assurance programs, a project was undertaken to institute such a program voluntarily in ten hospitals. Five hospitals succeeded in fully implementing the program which was based on the "Bi-Cycle Process" and each documented improvements in desired patient care behaviors. Two hospitals partially implemented the process and demonstrated no significant changes in desired patient care behaviors. Two hospitals failed to provide the data upon which assessments could be made and one hospital never got beyond preliminary efforts at instituting the process. The project demonstrates that a voluntary quality assurance program is feasible and has important implications for PSROs and continuing medical education. It also provides evidence that attention to psychosocial factors is essential in the institutionalization of programs designed to produce desired changes in patient care behaviors.
Skeletal and Splenic Hemangiomatosis With Consumption Coagulopathy: Response to Splenectomy
Authors: Dadash-Zadeh Mahboubeh , Czapek Emily E. , Schwartz Allen D.
Published: December 2021

Consumption coagulopathies commonly occur during the course of numerous pathologic conditions, including benign and malignant neoplasms. Occasionally the bleeding disorder may be the first manifestation of an illness, presenting the physician with a hemorrhaging patient and a diagnostic dilemma. The unusual case of a 9-year-old child with a two-month history of a hemorrhagic disorder is the subject of this report.

CASE REPORT

E. U., a 9-year-old white boy, was seen by his local physician because of a two-month history of easy bruising. A bone marrow aspiration was performed because the platelet count was found to be 37,000/cu mm. Because of uncontrolled bleeding from the site of the marrow aspiration, the patient was transferred to Children's Memorial Hospital.
Familial Mediterranean Fever With Temporomandibular Joint Arthritis
Authors: Simon Gilbert , Marbach Joseph J.
Published: December 2021

Familial Mediterranean fever (FMF) is a rare disorder of interest to pediatricians. In 70% of these patients, the onset of symptoms occurs prior to 10 years of age. Sephardic Jews and Armenians account for 85% of the prevalence. Abdominal pain and fever are the chief clinical manifestations, while the typical signs of joint inflammation are seen in about 80% of the cases. Usually, the joint symptoms are transitory and subside as soon as the fever and pain remit.1,2

This report describes a girl with FMF in whom temporomandibular joint (TMJ) arthritis was a prominent feature of her acute attacks, and in whom residual TMJ arthritic changes occurred.
In Reply: Commentson Breast-Feeding and Immunity
Authors: Gerrard J. W.
Published: December 2021

I am grateful to Mr. Du Busc for his letter and will do my best to answer the questions which he has raised. I am also glad that he has reviewed the material referred to in my review and thank him for challenging some of my statements.

As far as I can gather from their paper, Grulee et al.1 did not carry out their study to prove a point; they simply wanted to find out if there were differences in the morbidity and mortality rates in breast-fed, breast- and bottle-fed, and bottle-fed babies.
Elevated Nitroblue Tetrazolium Dye Reduction Test Response in Acute Viral Respiratory Disease
Authors: Sieber Otto F. , Wilska Maija L. , Riggin Rosella
Published: December 2021

Increased NBT dye reduction test responsiveness of neutrophil leukocytes has been observed in 14 of 17 infants with acute viral respiratory syndromes. Syndromes studied included croup, bronchiolitis, and pneumonia and were caused by parainfluenza virus types 1, 2, and 3, respiratory syncytial virus, influenza A virus, and adenovirus 1. NBT test elevation occurred early in every case of bronchiolitis and viral pneumonia and was associated with infections by all groups of viruses. On the other hand, NBT test results were normal or near-normal in a majority of cases of upper airway disease such as croup.
Dr. Swartz Comments
Authors: Swartz Donald R.
Published: December 2021

It was interesting to read the letter from Dr. Tolby regarding prevention of automobile accidents. Certainly the discussion of automobile accident risk and prevention is a major component of good well-child supervision (and of good parenting). Many may find the Consumer Reports article referred to in the letter a useful guide. The major problem, however, is the same as seen with smoking or obesity, i.e., patient motivation. I often point out the relative risk of severe injury on the ride to the office versus the risk of injury from diphtheria which we present by the diphtheria shot given on arrival here.
Comment on Teaching Interviewing
Authors: Scheff David
Published: December 2021

I was delighted to read "Teaching Interviewing" by Korsch."1 Most interesting was her query: "Why do certain well-trained physicians recoil from patients" expression of emotion and withdraw into technology whenever possible?" As a pediatric resident who teaches residents and medical students, I would like to suggest several possible answers.

First, medical school selection committees rarely pick candidates for their humanitarianism. Indeed, idealistic statements from candidates are often viewed as "unrealistic" and "immature."

Second, relating to patients is rarely discussed or encouraged in training medical students or residents. Medical students are imprinted with the technological.
Photodistribution of Viral Exanthems
Authors: Herman Peter S.
Published: December 2021

I was interested in the recent report1 regarding development of echovirus 9 and varicella exanthemata in photolocalized distribution in two patients. The authors point out the paucity of reports of photodistribution of viral eruptions. I should like to point out two references which add a number of cases and further information regarding the association of photosensitivity and viral exanthemata.

In 1947, a British report2 noted photosensitivity reactions occurring in Royal Air Force personnel who were routinely vaccinated and who were concurrently receiving prophylatic sulfanilamide during an epidemic of streptococcal tonsillitis and rheumatic fever.
Why Wasn't the Mother Skin Tested?
Authors: Abernathy Rosalind S.
Published: December 2021

I noted with interest the article on pulmonary hypersensitivity in the June 1975 issue1 because we had a similar case in a 28-year-old mother of a cystic fibrosis patient. The child was diagnosed as having cystic fibrosis at 5 months and started on pancrelipase granules* in July 1968. In January 1971, her mother began to have rhinitis and cough, which progressed to intermittent severe wheezing and dyspnea. Two months after onset, asthma was diagnosed. The bronchodilator tablet prescribed gave relief for a short time.
Chronic Illness in Childhood: A Regional Survey of Care
Authors: Pless I. Barry , Satterwhite Betty , Van Vechten Doris
Published: December 2021

Patterns of care provided by primary physicians for children with chronic physician illnesses are examied. Practices of pediatricians are compared with those of general practitioners in a ten-county region in Upstate New York. Data collected from 82 physicians surveyed in nine rural counties and one urban area indicate that, on the average, 7.4% of all children seen annually have one or more chronic conditions. Most such children are referred to subspecialists for part or all of their care; the frequency of referral, however, depends chiefly on the nature of the disorder. Primary responsiblity for the broader aspects of care is more often assumed by rural than urban physicians and more often by general practitioners than pediatricians. Nevertheless, mental health, social, and some technical services are generally underutilized by both groups of primary physicians.
Physical Signs in Childhood Asthma
Authors: Commey J. O. O. , Levison Henry
Published: December 2021

In 62 children with bronchial asthma, the presence of subjective dyspnea and wheeze, and some physical signs commonly associated with chronic obstructive airway disease in older patients, were compared with results of routine pulmonary function tests. Overall, airway resistance and the relationships of residual volume and functional residual capacity to total lung capacity were increased and other measurements of pulmonary function were moderately decreased. The time-honored subjective dyspnea, wheeze, rhonchi, and prolonged expiration were least useful as indices of severity of disease. Most of the patients, particularly those in whom laboratory testing revealed marked impairment, had notable rhonchi, prolonged expiration, scalene muscle and sternocleidomastoid contraction, and supraclavicular indrawing. Only sternocleidomastoid contraction and supraclavicular indrawing clearly correlated with the severity of airway obstruction. A call is made for a search for these useful signs, whose presence may be the only clue to moderately severe disease; however, their absence does not guarantee absence of severe airway obstruction.
Lactic Acidosis in Three Sibs Due to Defects in Both Pyruvate Dehydrogenase and α-Ketoglutarate Dehydrogenase Complexes
Authors: Haworth J. C. , Perry Thomas L. , Blass John P. , Hansen Shirley , Urquhart Nadine
Published: December 2021

A Canadian Indian family is described in which three of the children were mentally retarded, and had seizures and other neurological abnormalities. They had chronic metabolic acidosis associated with elevated blood levels of lactate, pyruvate, and alanine. Two of the children excreted large amounts of pyruvic and α-ketoglutaric acids in the urine and had elevated plasma levels of glutamic acid and proline. Hypoglycemia occurred with fasting in two of the children. Treatment with pharmacological doses of thiamine, lipoic acid, biotin, riboflavin, and various dietary regimes was without effect. One child died at 3½ months and another at 4½ months; the third is still alive at 23 months of age. Enzyme assays revealed a low level of activity of both the pyruvate and α-ketoglutarate dehydrogenase complexes in cultured fibroblasts of one of the sibs. These patients appeared to have partial defects in the oxidation of pyruvate, as well as of α-ketoglutarate within the tricarboxylic acid cycle.
Hepatitis Prevention
Authors: Cohen Stanley
Published: December 2021

The Task Force on Medical Care of the Vietnamese Child under the auspices of the American Academy of Pediatrics should be commended on the breadth and speed of the reporting. It is unfortunate that the terse statements required of the committee do not allow for an airing of controversy, as exemplified by the conclusion that γ-globulin for household contacts of patients with hepatitis B "is of no value."1 This long-established view was largely predicated on studies of individuals exposed to serum hepatitis by multiple transfusion, where the results2,3 may reflect the dose of γ-globulin used, the hepatitis B antibody (anti-HB8) titer, the large quantity of virus in the transfusion, or the variety types of hepatitis (A, B, C, drug, or postoperative) studied together as post-transfusion hepatitis.
Dr. Shannon et al. Reply
Authors: Shannon Daniel C. , Gotay Felicita , Stein Israel M. , Rogers Mark C. , Todres I. David , Moylan Fergus M.B.
Published: December 2021

We would like to respond to Dr. Brady's questions. First, we chose a heart rate exceeding 180 beats per minute as an arbitrary limit since it is likely that cardiac output falls at rates above that level due to inadequate filling time. As mentioned in our article, there were no other signs of toxicity except for sporadic vomiting. The toxic level of 20µg/ml cited by Dr. Brady seems to be reliable for older children and adults treated for bronchospasm but isn't necessarily applicable to preterm infants.
Concern Regarding Statement on Medications
Authors: Stein Martin
Published: December 2021

The Council on Child Health of the Academy may be commended for its attempt to outline a rational approach for the use of medication for hyperactive children.1 However, as a member of the pediatric community, I found myself becoming anxious when I read the statement.

Among physicians who work with children, there is a consensus that some children demonstrate a form of "hyperactivity" that suggests organic brain dysfunction–however "minimal" it may be; these children may diminish their overactivity, impulsiveness, and distractibility under the influence of central nervous system stimulants.
INFANT & CHILD IN THE CULTURE OF TODAY, reved. Edited by Arnold Gesell, M.D., et al. New York, Harper & Row, 1974, $9.95; 420 pp
Authors: Chamberlin Robert W.
Published: December 2021

This is a revision of the 1943 book by Gesell and Ilg. The purposes of this new edition, as stated in the introduction, were to rewrite the original in more modern language and to update some of the sections, particularly the one on culture. The authors have added more theoretical material on "cycles of development" and expressions of individuality, and one new descriptive stage of development for 3½ years of age. In addition, the nursery school data from each stage have been pulled together into a separate new section that discusses the behavior of children of different ages in nursery school settings.
Inunction and disease prevention
Authors: Barness Lewis A.
Published: December 2021

Burr and Burr1 showed that animals cannot survive without dietary fat. Supplementing a fat-free diet with certain fatty acids termed essential prevents the symptoms of fat deficiency.

Essential fatty acids consist mainly of linoleic (18:2), linolenic (18:3), arachidonic (20:4), and probably 20:5 and 22:6 acids.

Deficiency results in changes of cellular and cellular membrane permeability. Essential fatty acids are found in high concentration in phospholipids and in the lipoprotein complexes. Mitachondrial fractions are rich in polyunsaturated fatty acids and multiple enzyme activities are altered in their absence. Deficiency symptoms arise most rapidly in those animals undergoing rapid growth.

Clinical signs of dietary deficiency in humans has been limited largely to young rapidly growing infants.
Comparison of Mental Development in Individuals With Mosaic and Trisomy 21 Down's Syndrome
Authors: Fishler Karol , Koch Richard , Donnell George N.
Published: December 2021

During the past 15 years about 350 children with Down's syndrome have been seen at Children's Hospital of Los Angeles for psychological evaluation along with medical visits and other laboratory tests. Among this group there were 25 mosaic Down's syndrome children identified by chromosome analyses. They were matched for sex and chronological age with 25 trisomy 21 subjects and compared on psychological tests. The mosaic group demonstrated significantly higher intellectual potential, better verbal facility, and less visual perceptual difficulties than the trisomy 21 group. Their behavioral adjustment and personality characteristics were similar to those observed in other types of Down's syndrome. Since present psychological assessment techniques do not permit reaching valid conclusions about the ultimate intellectual status in very young infants with Down's syndrome, physicians and other professionals need to be careful when recommending early placement outside the home based merely upon the diagnosis.
Joint Pain and Rubella Vaccine
Authors: Tolchin Deborah
Published: December 2021

I was a little surprised to read that only two instances of recurrent joint pain in adult women receiving rubella vaccine have been reported.1 I submit the following case report.

A rubella seronegative female pediatrician (D.T.) in the child-bearing age range received Meruvax rubella vaccine and was converted to rubella seropositive. Over the next year there were five episodes of arthritis, mainly involving the joints of the hands, with sufficient swelling and pain to make fastening a safety pin extremely difficult, and sonic milder pain in the feet.
Drs. Soyka and Robinson Reply
Authors: Soyka Lester F. , Robinson Donald S.
Published: December 2021

We are honored that Dr. Lightwood would take time from his activities on Menorca to comment on our article.

We are in complete agreement that it is difficult at times on clinical grounds alone to differentiate between viral and bacterial infections. We feel there is an urgent need for development of rapid and precise diagnostic tests for this purpose, hopefully of such form that they could be carried out in the practitioners' office. Lacking this at present, one must rely on experience and whatever information can be gained from practical laboratory tests such as the throat culture for streptococci.
A "BILL OF RIGHTS" FOR CHILDREN (Publication 927 of the American Lecture Series). Edited by Henry H. Foster, Jr. Springfield, Illinois, Charles C Thomas Publisher, 1974, $7.50 cloth, $4.95 paper; 96 pp
Authors: Seidel Henry M.
Published: December 2021

This is the season for the "rights of children," and, consequently, the regrettable danger of faddism. Even so, it is important to stress that these are concerns which must consistently have our serious attention.

The questions are difficult. Children are, indeed, disenfranchised, poorly advocated, poorly served, and poorly judged in a society which gives lip service to their needs and primacy to the priorities and needs of adults.

Considering the current intensity of focus on the subject, is Henry Foster, Jr.'s book needed?
EARLY MALNUTRITION AND MENTAL DEVELOPMENT. Swedish Nutrition Foundation Symposium XII, Saltsjobaden, Sweden, August 20-22, 1973. Edited by J. Cravioto, et a!. Stockholm, Almqvist and Wiksell, 1974, $19.50; 332 pp
Authors: Chase H. Peter
Published: December 2021

The book consists of two parts, the first a collection of 23 invited papers or comments presented at the "Malnutrition and Mental Development" symposium held in Sweden in August 1973. The second and smaller part of the book consists of papers presented at the ensuing World Health Organization workshop on "Methodology in Studies of Early Malnutrition and Mental Development."

The initial conference resulted in a valuable collection of papers, the major emphasis of which was that environmental factors interact with malnutrition to result in the lowered mental development found in children of undernourished, socially deprived societies.
Birthweight of Children With Phenylketonuria
Authors: Rothman Kenneth J. , Pueschel Siegfried N.
Published: December 2021

The assumption that children with phenylketonuria (PKU) develop normally until birth was brought into question by the recent report that PKU children weigh several hundred grams less at birth than their unaffected siblings. We have examined intrafamily differences in birthweight in 40 sibships with at least one affected and one unaffected child. The difference in mean birthweights computed by taking a weighted average of the intrafamily differences was –69 gm, and the adjusted estimate of the birthweight difference between children with PKU and their siblings obtained from a fitted multiple regression function, is –51 gm. The findings are not consistent with the large difference in birthweight reported previously and are compatible with the assumption that the intrauterine physical growth of children with classical PKU is not adversely affected.
Questions Sampling Technique
Authors: Ferrara Angelo
Published: December 2021

What Pierson et al.1 described in their article in the September 1974 issue should be encouraged. Some modalities of asthma treatment (e.g., corticosteroid) traditionally have been carried out without the rigors of research.

There are a few observations that could be clarified.

(1) In their experimental design, the authors state that the 45 patients with status asthmaticus were randomly assigned either to a placebo (control) group or to one of the steroid-treated groups. If probability sampling2 was done, as I assume it was, then why were none of the previously treated steroid group (14 out of the 45 patients; see Fig. 2) represented in the control population?
NEONATAL AND PEDIATRIC VENTILATION. Edited by D. H. G. Keuskamp, M.D. Boston, Little Brown & Co, 1974, $12.50; 316 pp
Authors: Peabody Joyce L.
Published: December 2021

Dr. Keuskamp identifies the goals of this publication in his preface, that it is "to reflect current and past experience in the field of neonatal ventilation and display a diversity of opinions" and not to offer "conclusive advice as to how best to ventilate an infant with pulmonary complications." The content of this volume, contributed by 23 outstanding authors, lives up to this stated goal, and the result is refreshingly free from the shoulds and musts which frequently prevail in volumes on this subject.
TOILET TRAINING IN LESS THAN A DAY. Edited by Nathan H. Azrin, Ph.D., and Richard M. Foxx, Ph.D. New York, Simon & Schuster, 1974, $4.95
Authors: Young Paul C.
Published: December 2021

Parents and pediatricians will most likely respond to the title of this book with a cynical smirk. Written by two psychologists with extensive experience in teaching the mentally retarded, the book promises not only to train the child of approximately 20 months of age in four hours, but "to make the toilet training phase of a child's life the most pleasant experience he has had."

Beginning with an unnecessarily long chapter entitled "Current Concerns About Toilet Training: Letters From Mothers," which describes many cases of problems with toilet training, the authors then describe their method in general terms, followed by three chapters on specifics of the procedure, and followed by another (unnecessary) chapter describing in narrative fashion how "Mrs. James potty-trains Mickey."
Dr. Janeway's role in the IPA and his other contributions to the world scene
Authors: Vahlquist Bo
Published: December 2021

For the last two decades Dr. Janeway has been one of the foremost figures of international pediatrics. The same qualities which have served him so well at home have also brought him great respect and esteem in the world community of pediatricians. The following is a brief presentation of a few highlights from his activities on the world scene.

THE INTERNATIONAL PEDIATRIC ASSOCIATION (IPA)

During the long "reign" of Guido Fanconi as Secretary-General, from 1950 onwards, the vitality of the Association had increased considerably and the triennial international congresses progressively gained more prestige and attracted larger audiences.

At the Tenth IPA Congress in Lisbon, in 1962, a new constitution was endorsed.
Ampicillin-Associated Diarrhea: Effect of Dosage and Route of Administration
Authors: Phillips John A. , Lovejoy Frederick H. , Matsumiya Yoichi
Published: December 2021

There were two errors in the above report. In Table I, the mean number of stools per day in intravenously treated patients ≤ 12 months should have been 1.4, not 5.4. The mean number of stools per day in the control group ≤ 12 months should have been 1.6 instead of 4.6.
Projection of pediatric manpower requirements
Authors: Burnett Robert D. , Willian Mary Kaye , Olmsted Richard W.
Published: December 2021

In the 1960s, predictions were made that the United States faced a "physician shortage."1,2 On the basis of these predictions, federal legislation subsidized the establishment of new medical schools and the expansion of those in existence. From 1968 to 1974, the number of medical school graduates rose from 7,973 to 11,613.3 Nevertheless, problems of availability of, and access to, health services remain. Mere increase in number of physicians is not the solution to the problem of health care delivery in the United States; in fact, there is concern that we now face an oversupply of physicians.4 The recently published Carnegie report recommends that only "one" new medical school be established.5
Neonatal Circulatory Changes: An Echocardiographic Study
Authors: Riggs Thomas , Hirschfeld Stephen , Bormuth Connie , Fanaroff Avroy , Liebman Jerome
Published: December 2021

Serial echocardiograms were performed in the first three days of life on 38 normal full-term infants. Right ventricular systolic time intervals were measured from the pulmonic valve echogram and left ventricular systolic time intervals were determined from the aortic valve echogram. The heart rate, left ventricular pre-ejection period (LPEP), left ventricular ejection time (LVET), and LPEP/LVET ratio showed insignificant variation with increasing postnatal age. The right ventricular pre-ejection period (RPEP) shortened, the right ventricular ejection time (RVET) lengthened, and the RPEP/RVET ratio decreased with increasing age. The findings suggested that alterations in the RPEP/RVET ratio reflected the decreasing pulmonary artery diastolic pressure and pulmonary vascular resistance of the early neonatal period and may be valuable in the noninvasive evaluation of the newborn's pulmonary vascular bed.
Presentation of the C. Anderson Aldrich Award to Arthur H. Parmelee, Jr., and Sally A. Provence
Authors: Senn Milton J. E.
Published: December 2021

The Committee on Selection of the Aldrich Award this year has broken with tradition in honoring two leaders in child development.

This is fitting because both Arthur Parmelee, Jr., and Sally Provence have distinguished themselves in the field, and both do honor to C. Anderson Aldrich in emulating his serious studies of infants and children and his imaginative projects in pediatric education.

The nature of infant and early childhood development and behavior, the various processes (from the biological and physiological to the psychosocial) involved in development and personality formation, the complexities of interpersonal relationships, particularly within families, the opportunities, yes, the responsibilities of professional persons in ministering to children and parents have consumed the professional interest and personal passion of the colleagues we honor today, as they did of C. Anderson Aldrich.

I could add others, such as their manifold and creative efforts in behalf of children when they served as advisors to public services and childcare agencies.

Aldrich was a member of the Chicago School of Pediatrics whose constituents were distinguished in the 1920's, 1930's, and 1940's for their clinical competence and ingenuity, and their devotion to teaching colleagues in medicine about the burgeoning new specialty of pediatrics.

The list included Isaac Abt, Joseph Brennemann, Clifford Grulee, Julius Hess, Henry Helmholz (for a while), and Arthur H. Parmelee, Sr. This group, which influenced me in my training years, was friendly to, but wary of the "eastern pediatric establishment" whom they considered, with some justification, elitist.

I surmise that Arthur Parmelee, Jr., got his first inspiration and early direction towards developmental pediatrics from the Chicago group, especially his father.
Triglyceride Storage Disease: A Defect in Activation of Lipolysis in Adipose Tissue
Authors: Galton David J. , Gilbert Christine H. , Lucey James J. , Walker-Smith John A.
Published: December 2021

A child, aged 6 years 3 months, with a triglyceride storage disorder in peripheral adipose tissue, microcephaly, and gross emaciation has been studied at autopsy. The mean triglyceride content of adipocytes in hand and foot was 0.17 ± 0.02µg/cell and 0.18 ± 0.02µg/cell. Adipocytes from abdominal tissue were small, irregular, and difficult to measure accurately, reflecting the degree of cachexia. Basal tissue contents of cyclic AMP and release of glycerol and fatty acid from peripheral tissue of the child were in the same range as adult tissues. None of these measurements, however, were increased by incubation with isoprenaline (105 M), compared to a three- to seven-fold increment in adult subcutaneous tissues and to a four- to ten-fold increment of glycerol and cyclic AMP in peripheral adipose tissue of a control child aged 10 years. We postulate that the proband may have had a defect of adenyl cyclase or catecholamine receptor, which has a role in the abnormal storage of triglyceride in peripheral adipose tissue.
Comments on Blood Pressure I
Authors: Londe Sol , Goldring David
Published: December 2021

We read the statement "The Pediatrician and Hypertension"1 in the July 1975 issue with great interest and appreciation. In particular, we support the advice about caution in labeling a child "hypertensive."

We are concerned, however, about the values in Table I of the article, which are recommended as a guide, because they are based on averages of data arrived at in different manners in the three reports used.

The values published by Moss and Adams2 are based upon auscultatory systolic and diastolic pressure readings adjusted to arm circumference and height.
Orchitis and Cystic Fibrosis
Authors: Davis Jerry A.
Published: December 2021

I wish to report the case of J.J., a 17½-year-old white boy known to have cystic fibrosis since early infancy, who developed an acute left orchitis and epididymitis in May 1975. He also developed a less acute and less severe right orchitis and epididymitis. He was hospitalized from April 21 to May 7, 1975. I felt this case was of interest because the etiology of orchitis and epididymitis is apparently somewhat obscure in this group of patients.
Could the Umbilical Catheter Have Caused the Trouble?
Authors: Powers William F.
Published: December 2021

Makker and Lubahn's report1 of an infant with renovascular hypertension should have included more details of this low-birthweight infant's immediate neonatal management. In particular, was an umbilical artery catheter passed, where was its tip positioned, how long was it in place, etc.? Plumer et al.2 reported on ten infants with severe hypertension, eight of whom had a history of umbilical artery catheter placement as newborns. Can a catheter be implicated in the case of the infant reported by Makker and Lubahn?
DAY CARE: 3. SERVING PRESCHOOL CHILDREN. By Donald J. Cohen, M.D., and Ada S. Brandagee. U.S. Department of Health, Education and Welfare, Publication No. (OHD) 74-1057, U.S. Government Printing Office, Washington, D.C. 20402
Authors: Young Paul C.
Published: December 2021

This book is one of a series of handbooks being published by the Office of Child Development to "promote discussion and to improve the quality of day care in the United States," according to an introductory statement by Saul Rosoff, Acting Director, Office of Child Development. It was written by Donald J. Cohen, M.D., psychiatrist and pediatrician at Yale, in collaboration with Ada S. Brandagee, M.A. Dr. Cohen attempts "to provide a broad overview of the day care field, a basic state-of-the-art guidebook for those seriously concerned about preschool day care.
CORN-FLOUR AND INFANT LIFE
Authors: Philip A. G. S.
Published: December 2021

In the course of an inquest recently held at Plumstead on the body of a child aged four months, it transpired that the deceased, who had been put out to nurse, had been mainly fed on corn-flour and water. On such a diet any infant would sooner or later perish. Corn-flour contains little else than the granules of starch, and, although possessing a certain amount of heat-producing force, is in no sense a flesh-former. When employed, it should always be given with milk, as mixed with water only it is useless. When an infant is deprived of its natural supply of milk, its food should be assimulated as much as possible to that provided by the mother. Hence, on the excellent substitute found in cow's milk (always diluted with water, be it understood), the most delicate offspring can be successfully reared. Generally speaking, the diet should be exclusively a milk one until the age of one year is reached, and for some time after that broth or beef-tea should be very sparingly given. Meat and potatoes should be carefully eschewed, and we are convinced that the reckless use of these is responsible for many of the formidable evils which beset childhood.
Presidential Address—1976: Whither Pediatrics
Authors: Low Merritt B.
Published: December 2021

We had better plan for the future, and in participation with others. It just might come. We need humility and not arrogance in these endeavors, determination and not abrogation, firmness without preconceived notions, self-confidence without too much self-interest, self-advocacy in the sense that we speak for our silent, other selves—our children.

Even as we reflect in this bicentennial year on our illustrious past—and try to look into the future through our somewhat opalescent crystal balls—the present tends to overwhelm us. By the very nature and definition of our efforts, the practicing physician lives in the instant present—to the benefit of our patients, perhaps, but sometimes to the detriment of our own and our families' interests. Despite our deepest concerns and the nagging awareness of man's capability for his own destruction, we must take time to use the past's lessons and the present's problems to try to integrate a functional future. I speak for practical idealism. Even as independence was the rallying cry of Colonial times, so was interdependence the modus operandi within the Colonies themselves—constricted though it was by what we would now call "poor communications." Now our "poor communication" is autogenic rather than ecogenic!—the way we cope with the means they did not have. Try to think of pediatrics without the telephone!

If we think things are not going to change, let us ponder a bit on what has happened in pediatrics in the last 200 years, the last 100 years, the last 40 years, the last 10 years.
The Clinical, Biochemical, and Familial Presentation of Type V Hyperlipoproteinemia in Childhood
Authors: Kwiterovich Peter O. , Farah J. Ramsay , Brown W. Virgil , Bachorik Paul S. , Baylin Stephen B. , Neill Catherine A.
Published: December 2021

Primary type V hyperlipoproteinemia was identified in two preadolescent children. The propositus (kindred N) was a 10-year-old girl with severely creamy plasma, lipemia retinalis, hypertriglyceridemia (triglyceride level, 6,800 mg/100 ml), and hypercholesterolemia (cholesterol level, 490 mg/100 ml). Her parents and an 8-year-old sister all had endogenous hypertriglyceridemia (type IV hyperlipoproteinemia). In kindred A, an 11-year-old boy had triglyceride levels as high as 1,100 mg/100 ml and recurrent abdominal pain. His father had type V hyperlipoproteinemia; his mother was normal. All three of his older teenage siblings had type IV hyperlipoproteinemia. The enzymatic activities of lipoprotein lipase (LPL), hepatic triglyceride lipase (HTL), and histaminase (H) were studied in postheparin plasma. The LPL level was low in the children and both parents in kindred N. LPL level in kindred A was normal, except for one child with type IV hyperlipoproteinemia. HTL level was normal to above normal in both kindreds. Most patients had a normal H level, but one parent (kindred N) had no preheparin H and very low levels of postheparin H. There was a strong correlation (r = 0.58, significant at < 1% level) between the release of LPL and H but not between HTL and H (r = 0.22). The mean (± 1 S.D.) levels of the enzymes were as follows: LPL, 2.8 ± 0.7 µmol/ml/hr in kindred N and 5.4 ± 2.2 µmol/ml/hr in kindred A; H, 13.4 ± 6.8 units/ml in kindred N and 22.0 ± 11.9 units/ml in kindred A; and HTL, 18.0 ± 7.1 µmol/ml/hr in kindred N and 14.9 ± 6.3 µmol/ml/hr in kindred A. The enzymatic activities of kindreds N and A were significantly different for LPL (P < .001) and H (.025 < P < .05) but not for HTL. All but one child had at least one high insulin level, which was accompanied by hyperglycemia in two children. The hypertriglyceridemia in all but one child was ameliorated on therapeutic diets. These data suggest that the genetic basis of the hypertriglyceridemia in these two families is different and that hyperchylomicronemia in childhood is not confined to the rare type I hyperlipoproteinemia.
The determination of aspirin levels in the presence of hyperbilirubinemia
Authors: LJ Fenton
Published: December 2021

Fenton LJ, et al: The determination of aspirin levels in the presence of hyperbilirubinemia. Pediatrics 59:55, 1977

In the above article, the word "aspirin" should be substituted for "bilirubin" in the last sentence of the abstract.
Prepubertal XY Gonadal Dysgenesis
Authors: Isurugi Koichiro , Aso Yoshio , Ishida Hajime , Suzuki Toru , Kakizoe Tadao , Motegi Tomiko , Nishi Takeshi , Aoki Hiroko
Published: December 2021

Two children had prepubertal XY gonadal dysgenesis. A 7-year-old girl with clitoral enlargement had a left ovarian tumor that contained a dysgerminoma; the right gonad proved to be a gonadoblastoma. The second child (a 2-year-old girl) showed poor physical development and slight virilization of the genitalia. Her bilateral dysgenetic gonads were removed at exploratory laparotomy. The occurrence of gonadal tumors in XY gonadal dysgenesis is increased. It is probably related to the hypergonadotropinism existing from childhood as well as to genetic predisposition of the cryptorchid testis in the presence of a Y chromosome. Our first patient is one of the youngest who had XY gonadal dysgenesis with gonadoblastoma reported. The indication of prophylactic gonadectomy in XY gonadal dysgenesis is emphasized.
Damage to the Scrotal Testicle in Unilateral Cryptorchidism
Authors: Szalay Glenn C.
Published: December 2021

Among the several factors influencing the proper timing of surgery in cryptorchid children, the Section of Urology discusses two physiologic considerations: primary dysgenesis and thermal deterioration of germinal epithelium.1 Another physiologic factor that the committee did not discuss is damage done to the scrotal testicle in patients with unilateral cryptorchidism. For example, Mengel et al.2 found histologic damage to the unilaterally descended testicle in 67% of 237 cases. In addition, they refer to the work of Shirai et al.3 who demonstrated (in dogs) damage to both the retained and the scrotal testicle in experimentally induced unilateral cryptorchidism.
Caution About Preliminary Reports
Authors: Virdi Ranjeect , Wethers Doris L.
Published: December 2021

Preliminary reports are written to sound a warning, or to provide food for thought in the hope that the energy thus produced will propel other investigators to even greater heights of productivity. However, there is always the danger that the "preliminary" aspect will be overlooked or forgotten, and early results quoted as gospel. It was just such a contingency that concerned us when we read the report by McCormack et al., entitled "A Comparison of the Physical and Intellectual Development of Black Children With and Without Sickle-Cell Trait," in the December 1975 issue.
On the Physical and Intellectual Development of Black Children With and Without Sickle Cell Trait
Authors: Bowman James E. , Bernstein Shelly C.
Published: December 2021

The article by McCormack et al. in the December 1975 issue (p. 1,021) is another example of the apparent fascination of some investigators with the intellectual performance of blacks.

The abstract of this article is misleading. It contains none of the qualifications listed in the body of the article, such as "The intellectual performance of the sickle-cell carrier children does not allow us to make any [italics ours] conclusions at this time...." If no conclusions can be made, then what is the purpose of this report?
Perverse Pluralism
Authors:   Student
Published: December 2021

Comments in two unrelated news reports recently focused attention on the issue of "acceptance" of medical innovations in the United States. A prominent authority opined1 (in reference to antepartum glucocorticoid treatment to prevent hyaline membrane disease), "...there is no way to answer every conceivable question about possible [harmful] effects in 10-50 years.... At what point do we, as physicians, make the decision that data are adequate to move from experimental to clinical use?"

An apparent rejoinder2 appeared in comments on a completely different subject (the swine flu vaccination saga): "The experts say they are the only ones who can make the technical decisions and recommendations, but the emphasis on informed consent puts increased responsibility on the individual to accept or reject that advice....
OBSESSIVE CHILDREN: A SOCIOPSYCHIATRIC STUDY. By Paul L. Adams, M.D. New York, Brunner/Mazel, 1973, $12.50; 289 pp
Authors: Huessy Hans R.
Published: December 2021

The title is promising but the book is disappointing. The first chapters review all the theoretical formulations for obsessive-compulsive symptoms, with a detailed recital of all the psychoanalytic theories, their considerable disagreement, their arbitrariness, and their lack of relation to any data. The issue of whether obsessive-compulsive symptoms in childhood represent something different from adults symptoms is left unresolved and the discussion often moves between adults and children without clarity. Two types of diagnoses are included: obsessive-compulsive neurosis and obsessive-compulsive character or obsessive-compulsive personality.
LOSS OF CHILDREN
Authors: Anthony E. J.
Published: December 2021

With the children's development into puberty and adolescence, their impending loss is a threat to the system the parents have so arduously constructed. The children lose their parents, but parents also begin to lose their children (from early adolescence), and it is this depression that may evolve into a serious clinical melancholia. The parents experience a sense of emptiness about the home and an absence of goals that had motivated them so strongly and consistently throughout the childhood of their children. A solution to this threat of loss is the refusal to let go, albeit indirectly, and the attempt to lock the children further into an already carefully orchestrated double bind. The various major and minor revolutions-in-opposition express the desperate effort to break out of this bondage, with the effect that society gets the type of adolescent it expects and deserves. By further extension of the transactional process, the adolescent and young adult get (though not beget) and perpetuate the type of parent they expect and deserve.
Evaluation of Congenital Neutropenic Disorders by in Vitro Bone Marrow Culture
Authors: Falk Peter M. , Rich Kenneth , Feig Stephen , Stiehm E. Richard , Golde David W. , Cline Martin J.
Published: December 2021

The congenital neutropenias are a heterogeneous group of diseases whose etiology and pathogenesis are largely unknown. We studied nine neutropenic patients from seven families. Evaluation included peripheral blood cell and differential cell counts, epinephrine and typhoid vaccine stimulation studies, Rebuck skin windows, and bone marrow aspirations for morphological assessment and for in vitro culture in liquid suspension and in agar plates. Parallel cultures were set up with and without colony-stimulating activity (CSA), and peripheral leukocytes were assayed for cellular production of CSA.

Patients were initially classified on the basis of their clinical course: benign, mild, moderately severe, or severe disease. One patient in the moderately severe group had an immunoglobulin disorder.

Morphologically normal mature granulocytes were seen in bone marrow aspirates of two patients, and maturational defects of varying degree were seen in the remaining seven.

Colony formation in agar was markedly reduced below normal in three of seven, moderately reduced in two of seven, and greater than normal in two patients. Colonies in six of seven patients consisted exclusively of macrophages. Marrow from all but one of the nine patients demonstrated poor neutrophil development in suspension culture, and addition of CSA did not result in augmented granulocytic proliferation or maturation.

A scheme of normal neutrophil maturation is proposed, and the nine patients were categorized according to this scheme. Four patterns of congenital neutropenia emerged: type 1 was the most benign form of disease with essentially normal clinical and in vitro parameters, and a defect considered to be due to a small committed stem cell pool, abnormal release, or excessive utilization peripherally; type 2 had mild disease with presumed defective committed stem cell differentiation along the granulocyte line; type 3 included benign to severe clinical expression with an apparent defect at the level of the committed granulocyte precursor more severe than in type 2; type 4 disease had varied clinical expression but evidence for a defect at the level of the pluripotent stem cell.
Prenatal Diagnosis of the Congenital Nephrotic Syndrome
Authors: Mllunsky Aubrey , Alpert Elliot , Frigoletto Frederic D. , Driscoll Shirley G. , McCluskey Robert T. , Colvin Robert B.
Published: December 2021

Previously, diagnosis of the congenital nephrotic syndrome has been made prenatally on five occasions. The first was a diagnosis made in the third trimester.1 Five other diagnoses have been made before the 20th week of gestation.2-5

This report details the sixth case and the first case diagnosed prenatally, to our knowledge, in the United States. The possibility of this diagnosis was signaled initially by an elevated maternal serum α-fetoprotein (AFP) level and confirmed by electron microscopy.

CASE REPORT

A woman had had two sons who both died of congenital nephrosis in infancy. Certain diagnoses had been established in Boston on both children.
Polyhydramnios, congenital malformations, and intrauterine detection
Authors: Nadler Henry L.
Published: December 2021

Polyhydramnios is a common clinical problem occurring in approximately 1% to 2% of all pregnancies. In most instances, it presents as a chronic disorder with excessive amounts of amniotic fluid accumulating over many weeks; however, in some cases it may be of acute onset, resulting in severe abdominal pain and dyspnea. Acute polyhydramnios is frequently associated with uniovular multiple pregnancies.

Polyhydramnios may be associated with a number of maternal and fetal disorders, and in a significant percentage of cases is followed by fetal or neonatal death. Although the relative frequencies vary in reported series, polyhydramnios most commonly appears to be related to multiple pregnancies, maternal diabetes mellitus, or congenital malformations or is idiopathic, i.e., mother and fetus are presumably normal.