bluuebunny/crossref_metadata_2025 huggingface dataset:
Cockayne Syndrome: A Cellular Sensitivity to Ultraviolet Light
Authors: Schmickel R. D. , Chu E. H. Y. , Trosko J. E. , Chang C. C.
Published: December 2021

Two unrelated children, a boy 2½ years old and a girl 4 years old, were affected with the cachectic dwarfism of Cockayne syndrome. Fibroblast cultures derived from these patients exhibited increased sensitivity to ultraviolet (UV) light, but not to x-irradiation, as measured by colony-forming ability. In both Cockayne fibroblast cultures, the rate of removal of thymidine dimer from the irradiated cellular DNA was normal. This demonstration of a cellular defect in Cockayne cells suggests that there may be an enzymatic defect in the repair of UV light-induced damage.
Effects of Gravity on Tracheal Mucus Transport Rates in Normal Subjects and in Patients With Cystic Fibrosis
Authors: Wong John W. , Keens Thomas G. , Wannamaker Eleanor M. , Crozier Douglas N. , Levison Henry , Aspin Norman
Published: December 2021

A noninvasive, radionuclide imaging technique for measuring the rate of mucus clearance in the trachea (RT), was used to study gravitational effects on mucus clearance in 13 patients with cystic fibrosis (CF), average age 17 years; 7 normal, nonsmoking adults, average age 26 years; and a normal subject who was recovering from an acute upper respiratory tract infection (URTI). In the upright position, nine of the CF patients and the subject with URTI demonstrated abnormal tracheal mucus clearance which approached normal when they were placed in a 25° headdown position. The normal subjects and two of the CF patients showed no significant difference in the RT measured in the two positions. The results of the study indicate that the force of gravity can be a major influence on tracheal mucus clearance in CF and URTI subjects. This conclusion supports the use of postural drainage as an effective form of therapy in patients with cystic fibrosis.
Adolescent Health Concerns, Problems, and Patterns of Utilization in a Triethnic Urban Population
Authors: Parcel Guy S. , Nader Philip R. , Meyer Michael P.
Published: December 2021

All aspects of health (concerns, perceived adequacy of knowledge, problems, sources of care, and utilization of health care resources) were significantly influenced by the ethnic background, grade level, or sex of the 3,255 high school students surveyed in an urban triethnic community of 65,000. Variation in needs was not consistent for any one ethnic group, sex, or age group.

The highest ranked concerns and problems were school, drugs, sex, getting along with parents and adults, acne, depression, and overweight. Ninety-one percent reported they often or sometimes worry about their health. Sources of medical care were family physician (56.8%) and hospital emergency room (15.9%). Reported visits in the past year were none (27.5%); one (24.1%); two to three (32.2%); and four or more (14.7%).

In analyzing responses according to sex, grade, and ethnic background, several implications are apparent: (1) many of the concerns and problems identified require educational as well as health care services; (2) the diverse perceived health needs of an entire high school population indicate that the traditional one-semester general health course for all is grossly inadequate; and (3) students' concerns and problems are not limited to the areas of drugs, venereal disease, and unwanted pregnancy.

The study is presented as a model for the needs assessment phase of planning and delivering adolescent health care and health education services for a community.
Trimethoprim/Sulfamethoxazole and Ampicillin in the Treatment of Acute Urinary Tract Infections in Children: A Double-Blind Study
Authors: Ellerstein N. S. , Sullivan T. D. , Baliah T. , Neter E.
Published: December 2021

Trimethoprim/sulfamethoxazole and ampicillin therapy in children with acute urinary tract infection, whose microorganisms were susceptible to both drugs, proved to be of similar effectiveness. Side effects did not differ significantly between the two treatment groups.
Medical Team
Authors: Ranahan Margaret
Published: December 2021

I am writing to comment on the letter to the editor from Dr. Austin, which appeared in the October 1975 issue of Pediatrics (page 620). I am currently enrolled in the pediatric nurse associate program at the Mayo Clinic and am from Palo Alto, California. I feel that he made strong points and that his arguments still stood after Ms. McAtee and Dr. Silver's reply.

Before entering this program I was a pediatric staff nurse at a very busy community hospital; thus, I understand what Dr. Austin meant by the value of a trusted, medically competent person lighting the path of the child as he meets the various milestones-in sickness and in health-that life offers him.
Rickets Associated With Long-Term Anticonvulsant Therapy
Authors: Severi Francesca , Gasparoni Maria Clara , Martini Carla
Published: December 2021

The study presented by Crosley et al. in the July 1975 issue of Pediatrics (page 52) is the first dealing with noninstitutionalized children. A significantly higher value of serum alkaline phosphatase was observed in treated children than in the control population, while calcium and phosphorus abnormalities were minimal in both groups. We concluded a study on the serum alkaline phosphatase, calcium, and phosphorus levels in noninstitutionalized children, including 50 who were from 3 to 14 years old and who were receiving long-term anticonvulsant therapy (either diphenylhydantoin, phenobarbital, or both for more than 12 months) and 57 age-matched controls, all living at home.
Measurement of Intragastric Oxygen Concentration for the Diagnosis of H-Type Tracheoesophageal Fistula
Authors: Korones Sheldon B. , Evans Loraine J.
Published: December 2021

The demonstration of an H-type tracheoesophageal fistula before surgical correction is frequently difficult. Currently utilized procedures are so irregularly successful that surgical exploration is sometimes necessary without prior demonstration of the fistula. A case is reported in which the diagnosis was made by measurement of intragastric oxygen concentration, which increased and declined in response to the endotracheal insufflation of 100%oxygen and room air, respectively. The fistula was subsequently demonstrated by barium esophagram and was successfully treated surgically. In the presence of the classic clinical triad (choking during feedings, abdominal distention,and pneumonitis), a positive intragastric oxygen test may be sufficient indication for surgical exploration.
Accumulation of Carbon Dioxide in Oxygen Hoods, Infant Cots, and Incubators
Authors: Gale Rena , Redner-Carmi Rivka , Gale J.
Published: December 2021

The concentration of carbon dioxide in the air of oxygen hoods, infant cots, and incubators was found to be as high as 1% v/v (30 times the“fresh air” level of about 320 μl/liter). The physiological and clinical implications of the consequent long-term exposure of infants to atmospheres of such composition are discussed.
Intravenous Administration of Kanamycin and Gentamicin in Newborn Infants
Authors: McCracken George H. , Threlkeld Norma , Thomas Marion L.
Published: December 2021

The pharmacokinetics of kanamycin and gentamicin were studied after intramuscular (IM) and intravenous (IV) (constant infusion over 20 minutes)administration in newborn infants. The serum concentrations, halflives,area-under-the-curve values, and volumes of distribution were similar for each drug after both routes of administration. Based on these pharmacological similarities, it is likely that these aminoglycosides can be given safely and effectively as constant IV infusions to neonates in whom IM injections are not feasible.
Colonization With Group B Streptococci in Girls Under 16 Years of Age
Authors: Hammerschlag Margaret R. , Baker Carol J. , Alpert Susan , Kasper Dennis L. , Rosner Ingrid , Thurston Pauline , Webb Bette J. , McCormack William M.
Published: December 2021

Cultures from the vagina, pharynx, and anal canal of 100 healthy girls, 2 months through 15 years of age, were examined for the presence of group B streptococci. Of the 100 participants, 20% were colonized at one or more of these three sites. Pharyngeal colonization was detected in 15% of the girls under 11 years of age and in 5% of those over 11 years of age. Colonization at anogenital sites was observed in 19% of participants under 3 years of age, in 25% of those 11 years of age and older, and in only 4% of those between the ages of 3 and 10 years (P < .025). The concentration of serum antibody directed against the polysaccharide capsular antigen isolated from type III, group B Streptococcus appeared, in part, to be related to increasing age.
Effect of Cow's Milk on the Gastrointestinal Tract: A Persistent Dilemma for the Pediatrician
Authors: Eastham Edmund J. , Walker W. Allan
Published: December 2021

The confusing area of cow's milk intolerance is explored in an attempt to define the various mechanisms whereby milk affects gastrointestinal function,resulting in clinical symptoms (diarrhea, vomiting, gastrointestinal bleeding,etc.). The adverse reaction of infants to cow's milk ingestion may relate to lactose intolerance (enzymatic), a direct toxic reaction to the mucosal surface resulting in epithelial damage, or it may be immunologically mediated. Factors such as increased intestinal permeability to milk proteins during the newborn period may also contribute to susceptibility of young infants to milk sensitivity. The relative roles of systemic (milk agglutinins) and local immunity (SIgA antibodies) in milk intolerance are discussed and differential immunologic responses (IgE versus IgA/IgM) considered in the pathogenesis. It was concluded that new techniques such as organ culture of intestinal biopsy specimens are needed to establish the diagnosis of hypersensitivity and to begin to provide ways of adequately treating the condition.
Regional Services for Children and Youth With Diabetes
Authors: Giordano Beverly , Rosenbloom Arlan L. , Heller Debbie , Weber F. Thomas , Gonzalez Ronald , Grgic Ante
Published: December 2021

A regional diabetes program for children and youth comprising outreach clinics, frequent routine and emergency telephone contact, and a camping program was developed within the State Children's Medical Services (Crippled Children's) Program. The pediatric nurse specialist in diabetes served as the pivotal professional in the education and supervision of patients. Cost benefit was calculated from estimated hospital days prevented based on average length of admissions at diagnosis (14 days) and hospital days in the year prior to referral of those with established diabetes. During the first year 369 hospital days were prevented, for an estimated savings of $65,000; the second year 547 hospital days were avoided, a value of $96,000. Total annual program costs to the state and private patients (including camp fees) were$36,000. Although hospital costs are an apparent and useful reference to justify funding, the main value of the program must be in the prevention of secondary physical and emotional disability. This requires continuous commitment and availability of persons who know the patient and family, who can interpret information related to metabolic control of diabetes, and who are able to influence the family and community to respond appropriately to the youngster's needs.
Child-Initiated Care: The Use of School Nursing Services by Children in an “Adult-Free” System
Authors: Lewis Charles E. , Lewis Mary Ann , Lorimer Ann , Palmer Beverly B.
Published: December 2021

An experimental child-initiated care system was developed in an elementary school that permitted children, ages 5 to 12, to act independently of adults in seeking care from a nurse practitioner. Over 300 children were observed for two years. The patterns of use of services displayed by them were similar to those of adults. Seventeen percent did not make a visit to the nurse during the two-year period, and approximately 15% of the children accounted for over 50% of all of the visits. Rates of utilization were associated with those variables known to affect adult pattern of use: sex (female), social class(more affluent), ordinal position (only children or youngest children), and health orientations. The pattern of use was not associated with the presence of known medical problems.

Analysis of data on the utilization of pediatric services by these children indicated a significant association between the patterns of being taken to pediatricians and use of services in school. The mother's pattern of use of care was also significantly associated with her pattern of use of pediatric care for her children.

The children's health-related beliefs and expectations were examined before this child-initiated care system was initiated and at the end of the first and second years of operation. Significant treatment effects were observed in the predicted direction in several elements of the health-belief model, i.e.,perceived vulnerability and severity. In addition, children who had used the system placed greater emphasis on their own responsibilities for maintaining their health. Despite these changes in beliefs, utilization behaviors were not altered.
Nasopharyngitis and the Sudden Infant Death Syndrome
Authors: STEINSCHNEIDER ALFRED
Published: December 2021

Epidemiological studies repeatedly have demonstrated the importance of a number of variables in affecting the incidence of the sudden infant death syndrome (SIDS).1.2 Characteristically, the peak risk of SIDS is within the second to third month of life, with relatively few cases in the first month of life or after the first year. Another consistent observation is the association between minor upper respiratory tract inflammatory processes(nasopharyngitis) and SIDS: relatively more SIDS victims than controls have had clinical symptoms referable to the upper respiratory tract one to two weeks prior to death. Furthermore, histologic examinations have revealed upper respiratory tract
Unsuspected Hyperosmolality of Oral Solutions Contributing to Necrotizing Enterocolitis in Very-Low-Birth-Weight Infants
Authors: WILLIS DIANA M. , CHABOT JOANN , RADDE INGEBORG C. , CHANCE GRAHAM W.
Published: December 2021

In recent years necrotizing enterocolitis (NEC) has become a major problem in neonatal intensive care units. Recent incidences as high as 8% in all infants with a birth weight less than 2.5 kg and 14% in those with a birth weight less than 1.5 kg have been reported from one center.1Despite intensive searches for possible causative factors, no definite entity has been identified, but asphyxia,2 circulatory changes associated with exchange transfusion,3 umbilical vessel catheterization,4 immature immune status,5infection,6-8 and hypertonic feedings9 have all been implicated.

In the course of a series of nutritional studies involving thriving very-low-birth-weight infants we
Regional ambulatory care for children with diabetes
Authors: LESSER ARTHUR
Published: December 2021

The problem of the distribution of physicians in the United States continues to be a serious obstacle to access to medical care. Experiences with a variety of initiatives in recent years confirm that there are no simple solutions to complex problems and that continued efforts and experimental programs are needed. Among these are more imaginative and less insular uses of the resources that we have.

In this issue (p. 492), Giordano et al. describe a program designed to bring to diabetic children living in rural and urban areas of northern Florida the technical and professional services of a medical school
Results of an Immunization Audit
Authors: BLOOM JOHN E.
Published: December 2021

To the Editor:

The provocative article by McDaniel et al. (Pediatrics 56:504, October 1975) regarding private practice immunization stimulated me to carry out our own audit, following the authors' criteria as closely as possible. Ours is a three-pediatrician, urban group which utilizes three full-time pediatric nurse practitioners. We reviewed 400 “active” cases (at least one office contact in the past year). Forty-seven patients had incomplete immunizations,giving us an 87.3% completeness record according to the
Do Edicts Have Any Effect on Circumcision Rate?
Authors: SCHWARK THOMAS E.
Published: December 2021

To the Editor:

The literature continues to be replete with the continuing discussion(argument?) about the practice of routine neonatal circumcision. Although it is easy to find opinions, often emotionally stated, a search of the literature failed to reveal any current reference to the actual frequency of this procedure. For this reason it seems appropriate to report the incidence of neonatal circumcision in U.S. Air Force hospitals. During calendar year 1974 there were 16,400 male
Three Englishmen Favor Circumcision and Why They Do
Authors: JOHN-HUNT D. ST. , NEWILL R.G.D. , GIBSON O. B.
Published: December 2021

To the Editor:

In concluding that adequate penile hygiene is a viable alternative to neonatal circumcision (Pediatrics 56:610, October 1975), the Task Force seems unaware of our experience in England where circumcision is not general. Gairdnerl as far back as 1949 advocated education in penile hygiene but Burrowes,2 a school medical officer, observed in 1963 “among uncircumcised 17-year-old school-boys 70%-80% have never attempted to retract the prepuce though this was possible. Most suffered from balanitis.”
Safety Tops Can Be Unsafe
Authors: MARKS LEONARD J.
Published: December 2021

To the Editor:

The following case report describes a defect in the widely used “push down to open,” “child-proof” safety cap.

A 27-month-old boy ingested 50 ml of an antihistamine-decongestant mixture that his mother had diligently closed using its “push down to open safety top supplied by a local pharmacy. The bottle was purchased 28 days prior to ingestion, kept in a diaper bag, and used sporadically. It had last been opened one week prior
Paying for Pediatric Training and Care
Authors: North A. Frederick
Published: December 2021

In choosing the topic for this discussion I have deliberately ignored many of the issues which face the members of the Ambulatory Pediatric Association each day: how to be more effective teachers, how to run more effective and efficient ambulatory care programs, how to conduct research relevant to the needs of children and those who care for them. Each of these topics is important. Each of them has been thoughtfully addressed by past-presidents and speakers at meetings of this association. Each forms a substantial part of the agenda of its meeting.

I have chosen to address economic and, thereby, political issues which face ambulatory pediatrics because I am convinced that how pediatric care and training are paid for will determine its scope, its content, its distribution, and the way that its practitioners are prepared.

In this discussion I hope to persuade you of the following:

• That many of the teaching, patient care, and research issues that concern us are basically economic and thereby political issues;

• That the current methods of paying for the training of house officers is a major barrier to matching their training to the needs of the children, families, and communities they will serve;

• That current methods of paying for basic preventive services for children and their families are a major barrier to the achievement of better child health;

• That there are reasonable alternatives to our present methods of paying for pediatric care and training, and that these are economically and politically feasible.
Are We Missing Amblyopia? The Answer: Preschool Screening
Authors: Pollard Zane F.
Published: December 2021

Amblyopia is a reduced visual acuity in one eye that is not related to obvious structural or pathological anomalies.1 Most authors do not include organic causes of reduced vision such as cataract, retrolental masses, scarred cornea, chorioretinitis, and tumors in the group of patients having amblyopia. Visual acuity must be measured under monocular conditions. If a child is allowed to use his one normal eye while the visual acuity is measured, the amblyopia will go undetected. By carefully occluding one eye while the vision is measured in the fellow eye, an accurate evaluation is obtained. The diagnosis is made when there is at least a two-line difference in Snellen test types between the two eyes, e.g., 20/20 in one eye and 20/30 in the opposite eye. A conservative estimate has shown that at least 2% of the population has amblyopia.2 Amblyopia is a common finding in children with strabismus.3 If a child has strabismus, the parents and the pediatrician notice that something is wrong with the child's eyes. But, what about the child who has amblyopia and straight eyes? What percentage of children with amblyopia have straight eyes, and how can we be sure not to miss the diagnosis in these patients?

The answer is early preschool screening. The earlier the amblyopia is detected, the better the prognosis for successful treatment and the shorter the duration of intensive therapy.

A prospective study was carried out to determine what percentage of children with amblyopia have straight eyes. The results also show what percentage of patients with amblyopia might be missed if we check visual acuity only in children with strabismus.
Psychological Issues in Bone Marrow Transplantation
Authors: Gardner G. Gail , August Charles S. , Githens John
Published: December 2021

We studied the psychological and emotional problems experienced by seven children and their families who underwent bone marrow transplantation at the University of Colorado Medical Center from 1973 to 1975. These problems included (1) anxiety and depression relating to isolation, fear of death, and painful procedures; (2) an overdependence associated with a feeling of helplessness; (3) anger directed toward both the staff and the parents; (4) a reduced tolerance for medical procedures; and (5) periodic refusal to cooperate. Initially we had been concerned that patients might become agitated, psychotic, or even suicidal. These did not occur. Severe anxiety over bodily changes was not a problem. We did not encounter prolonged refusal to cooperate, refusal to remain in isolation, or drug addiction.

Important aspects in management included an honest, straightforward, and direct discussion of all aspects of transplantation, including the potential complications and the risks of death from the underlying disease or from complications of transplantation. A firm but understanding approach to the patients appeared to be the most effective method to develop their continuing cooperation. The opportunity for patients to express verbally their fears of procedures and of death was essential. The donors needed help in working through their feelings of guilt if a transplant was not successful. The parents needed continuing psychological support for the many personal, social, and psychological difficulties which they had to face.
Computerized Growth Record for Clinic Use
Authors: Robson J. R. K. , Braunstein H. M.
Published: December 2021

Since growth rate and growth achievement are related to the general health and welfare of the individual, routine measurement of height and weight is a necessity in the young. The procedures for surveillance require accuracy of measurement as well as accuracy in recording and retrieving data and comparison of these data with standards.

Although such a protocol is relatively simple, each one of the steps outlined involves the possibility of human mistakes. Thus, errors amounting to 10 lb in a total of 30 lb have been observed in a well-baby clinic, and variations in true weight amounting to 8 oz were usual unless the nurses were given special training in weighing techniques.1
Annual Summary of Vital Statistics—1976
Authors: Wegman Myron E.
Published: December 2021

Data for this article, as in previous reports,1 are drawn principally from the Monthly Vital Statistics Report,2-5 published by the National Center for Health Statistics. The international data come from the Demographic Yearbook6 and the quarterly Population and Vital Statistics Report,7 both published by the Statistical Office of the United Nations, and the World Health Statistics Report,8 published by the World Health Organization. All the United States data for 1976 are estimates by place of occurrence based upon a 10% sample of material received in state offices between two dates, one month apart, regardless of when the event occurred. Experience has shown that for the country as a whole the estimate is very close to the subsequent final figures.
Clinical and Serologic Testing of a Live Varicella Vaccine and Two-Year Follow-up for Immunity of the Vaccinated Children
Authors: Asano Yoshizo , Takahashi Michiaki
Published: December 2021

A live varicella vaccine derived from the Oka strain was given to 181 children who had no history of vanicella and were seronegative by complement fixation (CF) and neutralization (NT) tests; 125 children were hospitalized and 54 were receiving steroid therapy. Overall, senoconversion was achieved in 85.1% of the children by the CF test and in 97.8% by the NT test. Clinical reaction consisting of mild fever and rash appeared in only two children.

One hundred seventy-nine of the vaccinated children were followed up by questionnaire and 51 were followed up serologically approximately two years later, at which time 10 of 51 (19.6%) were seropositive by the CF test and 50 of 51 (98.0%) by the NT test. Only one out of 80 children who had postvaccinal contact with varicella contracted mild vanicella 16 months after vaccination. None of the vaccinees developed herpes zoster.

These results suggest that this live varicella vaccine may safely and effectively be used for children with or without underlying diseases, including those receiving steroid thenapy, and that immunity of at least two years' duration is conferred upon the vaccinated subjects.
DOUBTING
Authors: Rhodes P. ,   Student
Published: December 2021

When I was a House Officer and Registrar, my colleagues and I used to smile indulgently when we saw articles entitled "Whither Medicine", written by our elderly mentors. We were sure that we knew what medicine was about. We worked in world-famous hospitals, where excellent work was being done. Our place in the sun was certain and we had to get on with obtaining higher qualifications and increased experience to prove something to ourselves and for the benefit of our future patients.

This was done. A few "dropped off the ladder" of promotion, but some of us were lucky enough to be climbing nearer to the apex of the pyramid. We were still self-confident and without doubts. After some years as a consultant, or in charge of a university department, one felt reasonably master of the subject of one's choice. There were, of course, still things to be learned, but the clinical surprises became fewer. There was no need to practise one's skills just for the sake of boosting one's ego; they could be used as they were needed for the benefit of the patient. And it was then that the question arose of what exactly was the benefit of the patient. The doubts began to creep in.
Development of Auditory Function in Newborn Infants Revealed by Auditory Brainstem Potentials
Authors: Starr A. , Amlie R. N. , Martin W. H. , Sanders S.
Published: December 2021

Auditory brainstem potentials were recorded from scalp electrodes in 42 infants ranging in gestational age from 25 to 44 weeks. The latencies of the various potential components decreased with maturation. Wave V, evoked by 65-dB sensation level clicks, changed in latency from 9.9 msec at 26 weeks of gestation to 6.9 msec at 40 weeks of gestation. Central conduction times in the auditory pathway also decreased with maturation from 7.2 msec at 26 weeks to 5.2 msec at 40 weeks. The effects of brainstem and cochlear disorders on auditory brainstem potentials were noted in several abnormal infants. The application of all of these techniques could permit an objective definition of both normal and abnormal sensory processes in newborn infants.
CRITICISM'S EASY-TO BE RIGHT IS DIFFICULT
Authors: Bledstein Burton ,   Student
Published: December 2021

Perhaps never before within the last century have we as Americans been so aware of the arrogance, shallowness, and potential abuses of the vertical vision by venal individuals who justify their special treatment and betray society's trust by invoking professional privilege, confidence, and secrecy. The question for Americans is, How does society make professional behavior accountable to the public without curtailing the independence upon which creative skills and the imaginative use of knowledge depend? The culture of professionalism has allowed Americans to achieve educated expressions of freedom and self-realization, yet it has also allowed them to perfect educated techniques of fraudulence and deceit. In medicine, law, education, business, government, the ministry—all the proliferating services middle-class Americans thrive on—who shall draw the fine line between competent services and corruption?
Bone Mineral Status Measured by Direct Photon Absorptiometry in Childhood Renal Disease
Authors: Chesney Russell W. , Mazess Richard B. , Rose Philip G. , Jax Diane K.
Published: December 2021

Bone width (BW), bone mineral content (BMC), and their ratio (BMC/BW ratio) were measured in renal patients using direct photon absorptiometry.

Serial measurements were made on the radius and ulna in 74 children with renal diseases. Values were compared to age-, sex-, height-, and weight-matched controls. The SD from the mean in normal subjects is ± 10%. Significant demineralization (> -2 SD) was found in 42% of all patients and in 75% with tubulointerstitial disease. Twelve patients with nephrotic syndrome and two with systemic lupus erythematosus, all of whom were receiving prednisone therapy and had a serum creatinine level less than 1.0 mg/dl, and three treated with anticonvulsants had significant demineralization. Severe demineralization (> -3 SD) was found in four rachitic patients with tubulointerstitial disease. Normal mineralization was present in 32 patients with various primary glomerular diseases, seven of whom had a serum creatinine level greater than 1.5 mg/dl.

BMC declined with daily prednisone therapy but increased with alternate-day dosage in seven patients.

This study suggests that demineralization is more common in patients with tubulointerstitial disease and in patients with primary glomerular disease who are receiving prednisone (16 patients) or anticonvulsants. Photon absorptiometry appeared more useful than conventional radiographic evaluation in assessing skeletal involvement in childhood renal disease.
Hepatoportal Arteriovenous Fistula and Portal Hypertension in an Infant
Authors: Helikson M. A. , Shapiro D. L. , Seashore J. H.
Published: December 2021

Hepatic vascular lesions are rare, particularly in children. Hemangioendotheliomas frequently cause congestive heart failure secondary to systemic arteriovenous shunting of blood, whereas fistulas between the hepatic artery and portal vein usually produce portal hypertension and its complications. We report the fourth, and youngest, child with hepatoportal arteriovenous fistula (AVF). The clinical presentation of acute portal hypertension mimicking intestinal obstruction is unique.

CASE REPORT

A 5-week-old, 3.7-kg girl was admitted to Yale-New Haven Hospital with a one-week history of vomiting, diarrhea, and abdominal distention. Pregnancy and delivery had been uncomplicated. Findings of the physical examination were normal except for the abdomen which was distended and tympanitic, with high-pitched bowel sounds.
Cat-Scratch Skin Test Antigen: Purification by Heating
Authors: Carithers Hugh A.
Published: December 2021

Since the first use of a skin test for cat-scratch disease by Harry Rose, M.D., on Frankline Hanger, M.D., in 1946,1 there have been no reports of transmission of hepatitis or other disease through the use of hundreds of tests with the antigen on thousands of people. Use of the antigen has prevented countless surgical procedures, especially biopsy or removal of lymph nodes, and it has also helped relieve the anxiety of patients and parents of patients faced with an unexplained lymphadenopathy. Nevertheless, potential danger from the test has prevented its use in some locations, including important medical centers, and has caused some physicians to worry about safety.
CHILDHOOD IN CHINA
Authors: Kessen W.
Published: December 2021

If our observations were at all representative, the outstanding feature of childhood in China, and that which raises the lower basic problem, is the high level of concentration, orderliness, and competence of the children. The docility did not seem to us to be the docility of surrender and apathy; the Chinese children we saw were emotionally expressive, socially gracious, and adept. . . .

Over and over we asked ourselves how the very young Chinese child was brought competence, social grace, and restraint.

Put in its most simplifying form, Chinese children behave the way they do because that is the way children behave! The contrast with common American practice can be easily made. An American teacher (or parent) considers how he or she will effect a change in a child, what should be done with the child to make a difference. This attitude, which runs across many different theories of education, sees teaching as instrumental, as a set of procedures for the purpose of changing behavior. If the instruments of education, whether they are problem setting, positive reinforcement, or modeling, are ineffective, then change is difficult or distorted. Such a consciously instrumental attitude seems far less prevalent in Chinese schools. Rather, we formed the impression that Chinese teachers have uniform expectations of what children at one or another age can do and that they behave with the virtually certain knowledge that the children would come to behave in the expected way—and, critically, it did not much matter whether the children got there early or late.
Questions Chloramphenicol Recommendations
Authors: Marks Melvin I.
Published: December 2021

Jacobson et al. report the geographic distribution, minimum inhibitory concentrations, and a few clinical characteristics of childhood infections due to Haemophilus influenzae (Pediatrics 58:388, September 1976). These data are interesting and provide the reader with important epidemiologic information about the distribution of some of these resistant strains. The usefulness of this information is limited by the lack of a denominator to calculate the prevalence of such strains. Lacking prevalence figures and any evaluation of therapy, it is astounding that one half of the abstract of this article deals with therapy and comes to the conclusion that "chloramphenicol is recommended for the initial management of systemic illness definitely or probably due to H. influenzae type b."
CREATING PATIENTS
Authors: Spiro H. ,   Student
Published: December 2021

The trouble is, doctors trail a nimbus of disease like Typhoid Mary. Talk with doctors socially, and the talk often turns to disease. Let a stranger at a cocktail party find out what you do, and you are engulfed by his complaints. No wonder the physician tends to view life as a sequence of disorders requiring his attention, and his mission as bringing perfect health. Taught as a medical student to "see one, do one, teach one," no wonder he has the strongest faith in his technologic ministrations.

For example, if current controlled trials confirm that gallstones can be dissolved, even at the cost of continued monitoring, 20 million persons in the United States run the risk of having their lives revolve around a few stones, which they might have carried about to the grave with about as much ill-effect as a rabbit's foot. Some gallstones cause trouble, for many cholecystectomies are carried out each year; yet surely many gallstones must be innocent bystanders in persons who do not know that they have them, or else physicians would not still be finding them at autopsy. Even if all gallstones can be dissolved, physicians must still wonder whether they need to be and whether the large evangelical survey necessary to find the gallstones will create patients out of previously asymptomatic and functioning persons. Time and much money will tell, but I await the mobile vans in the streets reminding persons of their hidden gallstones with the same fervor as Jonathan Edwards might have urged repentance pressing Telpaque tablets and x-ray appointments upon the bystanders.
A 17TH CENTURY ENGLISH CURE FOR RICKETS
Authors: C. T. E.
Published: December 2021

Sir Thomas Browne (1605-1682) in an essay written probably in 1663 left the curious information that in Norwich, England, the livers of rooks were used for the cure of rickets:

Spermalegous rooks which by reason of the great quantity of cornfields and rook groves, are in great plenty. The young ones are commonly eaten; sometimes sold in Norwich market, and many are killed for their livers, in order to cure the Rickets.

This therapeutic note is of particular historical significance because it was written less than 20 years after Glisson's classic description of the disease (1650) and more than 150 years before the first report of the value of cod liver oil in the treatment of rickets (1824).
Neurodiagnostic Tests in Children With Brain Tumors: Changing Patterns of Use and Impact on Cost
Authors: Winston Ken R.
Published: December 2021

The utilization of neurodiagnostic tests in the initial work-up in children with brain tumors was relatively stable during the three years before computed tomography (CT) became available. After this test became available there was a significant (P < .05) reduction in the utilization of cerebral angiography, echoencephalography, electroencephalography, and ventriculography in children with tumors below the tentorium. In children with tumors above the tentorium, only a reduction in the use of cerebral angiography and radioisotopic scanning was demonstrated. These changes have resulted in a significant (P < .05) reduction in cost to the patient (or third party) for the initial neurodiagnostic work-up. Since CT became available, children with brain tumors undergo fewer tests, and the greatest reduction has been in tests that have the greatest cost.
Clinical Pharmacology and Efficacy of Ticarcillin in Infants and Children
Authors: Nelson John D. , Kusmiesz Helen , Shelton Sharon , Woodman Edythe
Published: December 2021

Ticarcillin was evaluated in 82 neonates and young infants with suspected sepsis and in 16 older children with chronic Pseudomonas infection of the mastoids. The infants also received kanamycin. Individual ticarcillin doses of 75 or 100 mg/kg were given every four, six, or eight hours by intramuscular injection or by a 30-minute intravenous infusion. Mean plasma concentrations one hour after a dose were from 125 to 189 µg/ml, depending on dosage, age, and maturity. Mean plasma half-lives were approximately 5 hours in the first week of life, 2 hours in infants from 1 to 8 weeks, and 0.9 hours in older children. Volume of distribution was approximately twice as great in infants as in children, and plasma clearance rates correlated inversely with age. Limited efficacy data suggest that ticarcillin is a suitable alternative to ampicillin or carbenicillin, when given concurrently with an aminoglycoside, for newborn infections. When given for several days before mastoidectomy and tympanoplasty, ticarcillin sterilized the mastoids in the majority of patients. A new dosage schedule for ticarcillin in pediatric patients is proposed.
DR. WILLIAM DOUGLASS' DESCRIPTION OF SCARLET FEVER IN 1736—AN AMERICAN MEDICAL CLASSIC
Authors: C. T. E.
Published: December 2021

Dr. William Douglass (1691-1752) was born in Scotland and received his medical education in Paris and Leyden. He came to Boston in 1716, and for a long time was the only physician in Boston with a medical degree. His description of a typical case of scarlet fever as he encountered it during the epidemic of "throat distemper" of 1735-1736 is the earliest description of scarlet fever in American medical literature and has been called "the first adequate clinical description of scarlet fever in English."1 It was vulgarly called the Throat Illness, or a Plague in the Throat.

The first attack is somewhat of a chill or shivering; soon after follows Head ake or some other versatile spasmodick pains, as pain in the back, joints, side etc; a vomiting or nausea, or in some constitutions, which are not easily provoked to vomit, only a certain uneasiness or sickness at Stomach; at the same time the Uvula, but chiefly the Tonsils, were tumified, inflamed and painful, with some white specks, then follows a flush in the Face and some miliary eruptions there with a benign mild fever, the same efflorescence soon after appears on the neck, chest and extremities; the 3d or 4th Day, Eruption is at the hight [sic] and well defined with fair intervals; the flushing goes off gradually with a general itching and in a Day or two more the cuticle scales or peels off, especially in the extremities: At the same time the cream coloured sloughs or specks in the Fauces become loose and cast off, and tumeffactions there do subside.
α2-Macroglobulin Deficiency in a Patient With Ehlers-Danlos Syndrome
Authors: Mahour G. Hossein , Song M. K. , Adham N. F. , Rinderknecht Heinrich
Published: December 2021

A new genetic defect, α2-macroglobulin deficiency, was found in a patient with Ehlers-Danlos syndrome (EDS). Other members of the family of five exhibiting this abnormality were the mother and one sister. All members, including the patient, had normal serum albumin and α1-antitrypsin levels. The deficiency, reported here for the first time, appears to be inherited by an autosomal co-dominant mode. Statistical evaluation of the dihybrid crosses for independent assortment between EDS and hypo-α2-macro-globulinemia showed a probability of 0.7 to 0.75. However, a possible link between EDS and hypo-a2-macroglobulinemia is suggested since the observed ratios of four siblings are exactly as expected, assuming that double gene defects are linked in the mother's genotype.
Cerebral Echinococcosis, a Pediatric Disease: Report of Two Cases With One Successful Five-Year Follow-up
Authors: Pearl Marilyn , Kotsilimbos Dimitrios G. , Lehrer Harold Z. , Rao Andavolu Hanumanth , Fink Harold , Zaiman Herman
Published: December 2021

Two cases of cerebral echinococcosis in children emphasize the need to consider the Echinococcus in the differential diagnosis of children with CNS signs and symptoms. One patient died because of delay in seeking medical attention. The other is now a 22-year-old college student with no evidence of recurrence more than five years after removal of Echinococcus cysts from both brain and liver.

The newer modalities available for diagnosis are discussed.

Therapy with mebendazole is reviewed; this relatively new, highly effective anthelmintic is well tolerated and has been apparently highly effective in a small number of cases.
Nonaccidental Trauma and Medical Folk Belief: A Case of Cupping
Authors: Sandler Alan P. , Haynes Vincent
Published: December 2021

Systems of medical folk belief exist today in the many diverse cultures represented in the United States.1 These beliefs and the remedies used in the traditional medical care system may be of clinical significance when families seek care from scientific health care systems. Recent reports have described the adverse effects of the administration of specific folk remedies to children. The Vietnamese practice of cao gio, coin rubbing over the skin of the back which has been oiled and massaged, was tried as a remedy for fever and chills.2 In the Mexican-American community, mollera caida, literally, "fallen fontanel," is the belief that the symptoms of vomiting, diarrhea, and lethargy are due to a downward displacement of the fontanel.
Baby Walker Injuries
Authors: Fazen Louis E. , Felizberto Pamela I.
Published: December 2021

In a study of 49 children between the ages of 8 and 14 months, parents were surveyed with a written questionnaire and a follow-up phone interview to determine the utilization of baby walkers and the frequency and severity of baby walker injuries. Most respondents (86%) placed their children in various types of baby walkers between 4 months and 1 year of age. Half of the 42 infants who used walkers experienced at least one accident involving a tip over, a fall down stairs, or finger entrapment. Two of those accidents resulted in injuries serious enough to require medical management. Both infants sustained head and neck injuries after falling down stairs in a walker. Whereas stairway and finger entrapment accidents occurred before the age of 7 months, tip overs were much more likely to occur after the age of 8 months. Injuries are more common but less severe than previously reported. Pediatricians and other child health advocates can inform parents about the health risks, encourage regulatory agencies to improve product labeling, and stimulate manufacturers to adjust the product to age and weight specifications of the growing infant.
PEDIATRIC COMMANDMENTS
Authors: Schnitzker William F.
Published: December 2021

1. REMEMBER THE GENES ARE ALL POWERFUL; in habitus, size, and often in drug reactions.

2. ALWAYS BE CONSIDERATE OF THE PARENTS; they are upset out of proportion to the magnitude of the problem.

3. NEVER USE THE WORD HURT; it creates more apprehension and fear.

4. PLEASE HOLD THE CHILD SECURELY; when necessary, it is much more considerate than to have to repeatedly restrain.

5. BE EXTREMELY CAREFUL ABOUT ADVICE FROM FRIENDS, RELATIVES OR NEIGHBORS.

6. NO ONE LIKES A SPOILED CHILD; what may be considered cute in a toddler usually becomes flip and nasty with age.

7. IT IS DANGEROUS TO HAVE CHEWING GUM AND CANDY IN THE MOUTH OF DISTURBED CHILDREN; please don't bring crackers, cookies or soda to the office.

8. PLEASE WATCH INFANTS AT ALL TIMES WHILE ON THE EXAMINING TABLE; no climbing on furniture, it is embarrassing and painful to sustain an injury.

9. KEEP APPOINTMENTS ON TIME; in consideration of others and the doctor.

10. DON'T ABUSE THE TELEPHONE; your doctor is available at all times, however, he appreciates receiving routine calls during office hours.
First Aid for Choking Children: Back Blows and Chest Thrusts Cause Complications and Death
Authors: Heimlich Henry J.
Published: December 2021

In the article "First Aid for the Choking Child" (Pediatrics 67:744, 1981), advice is given that is contrary to the vast majority of studies and reports in the medical literature. The methods recommended in the article not only have little scientific support, but also have led to serious complications and death as evidenced by numerous well-documented cases.

BACK BLOWS

The first treatment for the choking child according to the Pediatrics article is forceful administration of four back blows. No reference has been found to indicate why four back blows are better or worse than one or ten.

From the time of the study by Gross1 in 1854, to the present, there have been many published studies warning against the use of back blows.2-22
Reye Syndrome and Salicylates: A Spurious Association
Authors:   RS Working Group
Published: December 2021

The intent of this communication is to show that the potential for bias, confounding, and/or change in the reported case-control surveys of Reye syndrome (RS) was sufficiently great so as to make any and all inferences pertaining to associations or causality between aspirin and RS highly questionable—or worse—misleading. Further, five lines of recent clinical and scientific evidence question the biologic plausibility of the claimed association.