bluuebunny/crossref_metadata_2025 huggingface dataset:
Anticonvulsants and Rickets–A Different View
Authors: Livingston Samuel , Pauli Lydia L.
Published: December 2021

We are writing in regard to the article on anticonvulsant therapy and rickets by Crosley et al.1 Their investigation was apparently stimulated by our reports of the absence of chemical, clinical, and radiographic evidence of rickets in a large series of ambulatory patients receiving antiepileptic drug therapy over a protracted period of time.2-5 These authors utilized a study group consisting of 74 patients attending a pediatric neurologic outpatient clinic and receiving chronic anticonvulsant drug treatment, and a control group composed of 95 children selected from both the pediatric neurology and the general pediatric outpatient populations.
Dr. Holliday Replies
Authors: Holliday Malcolm A.
Published: December 2021

The only valid grounds for concern about fluoride intake in early infancy is the low fluoride content of human milk, which is cited in my letter and presented as clearly as possible.

Obviously, a number of infants have been fed water with fluoride and no discernible harm has resulted. The evidence favoring the fluoride intake after six months is compelling and a reference has been cited.

I hope this information is helpful.
Serum Cholesterol Levels in American (Pima) Indian Children and Adolescents
Authors: Savage Peter J. , Hamman Richard F. , Bartha Gregory , Dippe Stephen E. , Miller Max , Bennett Peter H.
Published: December 2021

Serum cholesterol levels from birth to adulthood in a population of North American (Pima) Indians are described and compared to those of Caucasian populations.

Cholesterol levels at birth (mean ± SEM, 87 ± 2.6 mg/100 ml) were similar in Pimas and Caucasians, but levels in Pimas from 5 to 16 years (148 ± 4.6 mg/100 ml) were 20 to 30 mg/100 ml lower than among most white populations. The levels showed little rise with age from 5 to 16, then rose significantly in both sexes from ages 17 to 25. Cholesterol levels in adult Pimas (190 ± 1.5 mg/100 ml) were up to 50 to 60 mg/100 ml lower than in American whites, and showed little increase after age 25. Two cohorts of children followed prospectively for six years indicated that the prevalence data reflect sequential changes in the population. Cholesterol levels of those subjects were significantly correlated at the first and last examinations.

The Pima, in contrast to Caucasian American populations, have relatively low levels of serum cholesterol and low rates of coronary heart disease, but evidence of a causal relationship with the latter remains to be established.
Heart Rate and Blood Pressure in Black Newborns and in White Newborns
Authors: Schachter Joseph , Lachin John M. , Kerr Joyce L. , Wimberly Francis C. , Ratey John J.
Published: December 2021

Sixty-one full-term, appropriate-weight black newborns had higher heart rates, replicating a racial heart rate difference, but did not differ significantly in systolic blood pressure from 71 white newborns. Systolic blood pressure in the newborn is related both to the total number of feedings from birth and to the total fluid intake.
Comments on Urology Section on Myelomeningocele
Authors: Lebowitz Robert L. , Colodny Arnold H.
Published: December 2021

We are delighted that the Section on Urology of the American Academy of Pediatrics has formed the Action Committee on Minimum Necessary Surveillance of the Child with Myelomeningocele and that guidelines have been formulated and are being publicized.1 In our experience this emphasis is long overdue and we heartily endorse the committee's recommendations.

However several clarifications of the committee's guidelines are in order.

(1) The committee recommends that baseline blood urea nitrogen and serum creatinine determinations be done shortly after birth.
Dr. Silver Replies
Authors: Silver Larry B.
Published: December 2021

It is difficult to reply to Dr. Browder's comments for he suggests that I said certain things in my paper that I did not say and he suggests that I should have said other things which I did state in the paper.

I do not feel that the field of learning disorders is outside the expertise of the physician. I refer to the physician as key to the coordinated efforts to help these children. My purpose in reviewing the literature was to assist the family physician.
Comment on Medication for Hyperkinetic Children
Authors: Oettinger Leon
Published: December 2021

The article of the Council on Child Health referring to medication for hyperactive children1 contains several misleading or confusing statements:

(1) The hyperkinetic behavior syndrome (minimal brain dysfunction) appears in children of below-average intelligence as well as in children of average or above-average intelligence. This was generally agreed on at a recent meeting in Alta, Utah, where a number of investigators, including Paul Wender and C. K. Conners, were present. In an article presented for the Workshop on Evaluating Long-Term Effects of Stimulant Drug Therapy, I presented data showing that minimal brain dysfunction occurred at essentially all levels of intellect.2
Evaluation of the Child With a Learning Disorder
Authors: Hogan Gwendolyn R. , Ryan Nell J.
Published: December 2021

In order to appreciate our approach to the evaluation of a child with a learning disorder it is necessary to provide some background material. The total population of the state of Mississippi consists of 2.2 million people of which 900,000 did not complete high school and 400,000 did not complete grade school. There are no publicly financed kindergartens and no compulsory school attendance laws in this state. Eighty-eight percent of the children who attend school are, however, educated in the public school system. The state is divided into 150 separate school districts and 1,140 special education teachers are provided for the entire state. Of these special education teachers, 1,000 are assigned to classes for the mentally retarded and the remaining 140 teachers provide instruction for children with specific learning disorders. In the Jackson Separate School District which includes the largest metropolitan area in the state there are 27,496 students enrolled in the public school system and of that number 852 students are in special education classes. Of these 852 students in special education, 644 are classified as educable mentally retarded, 100 are classified as trainable mentally retarded, and 108 are classified as having specific learning disabilities. This figure for children with specific learning disabilities is well below the estimated figure of 15% which has been determined by other surveys.

The vast majority of children entering the first grade have been exposed to no structured learning situation. Routine testing for school readiness is not done in the public school system. Firstgrade students do receive vision and hearing screening tests which are administered by volunteers through the PTA.
Inferior Vena Cava Obstruction Secondary to Indwelling Venous Catheters: Two Cases
Authors: Riggs Thomas , Hirschfeld Stephen , Borkat Gordon , Liebman Jerome
Published: December 2021

It has been common practice to leave an indwelling venous catheter with its tip in the inferior vena cava (IVC) following cardiac catheterization in ill infants who are to subsequently undergo corrective or palliative surgery. A polyvinyl chloride catheter may be conveniently inserted into the same vein employed for the diagnostic catheterization in order to monitor central venous pressures and deliver intravenous fluids.

Two instances of thrombosis of the IVC which occurred following the use of indwelling femoral venous catheters, placed after cardiac catheterization, are reported. Not only is this complication particularly serious from the standpoint of potential thromboembolism, but it also eliminates the use of the IVC approach in a group of patients who require repeated cardiac catheterizations.
Drs. Soyka and Robinson Reply
Authors: Soyka Lester F. , Robinson Donald S.
Published: December 2021

The letter of Dr. Wineberg makes four points and then deteriorates to a diatribe. While not wishing to participate in a town-gown quarrel, it might be pointed out that Dr. Wineberg would not qualify as an academic because not even 50% of what he has said is true.

First, the children seen in the emergency room at the Boston City Hospital are in no way comparable to those seen in a routine office visit. The presence of bacteremia in these children is an indication for appropriate intensive antibacterial therapy, and treatment with the usual antibiotics in the usual doses that are all too routinely employed for upper respiratory tract infections would be inadequate.
Are You Seeing Enlarged Breasts in Infants?
Authors: Dreyfus Norma , Lipper Evelyn
Published: December 2021

We have observed a high incidence of enlarged breast tissue in a small group of well female infants followed since birth for health care maintenance in a pediatric program.

Of 64 infants followed for one year, ten between the ages of 8½ and 12 months were noted to have enlarged breast tissue. The size of the tissue ranged from 1 x 1 cm to 4.5 x 4 cm. Since breast measurements were not recorded in these infants throughout infancy, it cannot be said with certainty whether this was de novo breast development or continuation of neonatal hypertrophy.
Dr. Beckwith Replies
Authors: Beckwith J. Bruce
Published: December 2021

Dr. Cunningham's well-researched and carefully worded statement is not one with which I can quibble. To do so would be to label myself as being both antimammary and unscientific. Our misgivings, as I tried to express in the commentary to which he refers, relate to those zealots who, unlike Dr. Cunningham, in effect blame the bottle-feeding mother for the death of her baby.

Obviously, until the final answer is in, all clues, however fragmentary, must be carefully milked.
You Can Lead a Fellow to PACE, But Can You Make Him Think?
Authors:   Student
Published: December 2021

Few would argue that the half-life of medical "truths" is not shrinking at an accelerating rate.1 Under these circumstances, it would seem prudent to encourage physicians to question answers; instead, the AAP has now launched a campaign to supply Fellows with answers to questions!

Leaving aside a call for evidence concerning the efficiency of the slick, gimmicky, PACE package in accomplishing the avowed purpose of inculcating "the answers," a heretical ("Thank God there are no free schools or printing . . . for learning has brought disobedience and heresy into the world, and printing has divulged them...."
The Hidden Cost Dilemma
Authors: Sparling David
Published: December 2021

The commentary by Steigman amid Kendig1 on frequency of tuberculin testing, found in the August 1975 issue, presents a basic dilemma common to all preventive health procedures incorporated into office pediatrics. The cost of tuberculin testing is not in the material, but in the personnel time to administer and explain. If the patient is to return to the office for measurement and documentation, there are additional requirements of personnel time and office space.

In our own office, where around 2,500 tuberculin tests are done each year, we have continued tuberculin testing at each annual health examination.
Dr. Feig Replies
Authors: Feig Stephen A.
Published: December 2021

Thank you for the opportunity to reply to the letter of Drs. McWilliams and Maurer. We were truly perplexed by the presentation of the meningeal metastases in the reported patient. Lacking convincing evidence of central nervous system metastatic disease or bony erosion of the skull, we were loath to apply chemotherapy, which might have aggravated his clinical course and would have been of doubtful efficacy in any event. Additional radiation therapy was felt to be inadvisable because, in the opinion of our radiotherapists, the patient had been treated originally with a dose that closely approached the tolerance of the brain stem.
FAULTY THINKING
Authors: Scott A. J.
Published: December 2021

Postgraduate educators in the past have assumed that lack of information underlies physician failures. It seems likely that faulty thinking is as commonly at fault and often due to biases that are part of us all. The correctives for these biases lie partly in the use of the controlled trial and the formal analysis of the decision matrix among other techniques. If as a profession we insist on analyzing and formalizing our beliefs in these ways, we can avoid major and expensive new fashions, and we may have shown to us more convincingly where persent ways are inadequate and other ways preferable-with a corresponding improvement in our willingness to learn.
THE DECADENCE OF THE AMERICAN FAMILY AS VIEWED IN 1884
Authors: C. T. E.
Published: December 2021

Almost a century ago editorials such as the one below expressed the fear that the American family was in serious trouble.

We do not like to be doleful, but it is impossible to ignore some of the facts that have been presented with the last year or two [1882] by Dr. Goodell, Dr. Nathan Allen, and others. These facts relate to...the decadence of family life among Americans. Dr. Allen, who has been studying this subject for many years, presents the case very directly in an article entitled "The New England Family" (The New Englander). It is asserted that the objects of the institution of the family are three: the propagation of children, the preservation of chastity, mutual help and company. In each of these respects the American family, especially the New England family, shows a marked and progressive deterioration, since one hundred years ago.

As regards the propagation of children, it is shown that the average native New England family is very much less productive than formerly.... The birthrate in New England families has been steadily declining until now it is lower than that of any European country except France. One additional element in this, no doubt, is the habit of delaying marriages-a habit made almost necessary by the more expensive style of living which is demanded, and by what some consider the selfishness of young men who prefer not to sacrifice their liberty to the responsibility and expense of domestic life.

Another indication of family deterioration is the increase of divorces.
INDIVIDUAL ACTION
Authors: Hirsen F. ,   Student
Published: December 2021

Considered in isolation, the individual's demand for education . . . , for an auto, for a country cottage, can be taken as genuinely individual wants. . . . Acting alone, each individual seeks to make the best of his or her position. But satisfaction of these individual preferences itself alters the situation that faces others seeking to satisfy similar wants . . . there is an "adding up" problem. . . . What each of us achieve, all cannot.

A break between individual and social opportunities may occur for a number of reasons; excessive pollution and congestion are the most commonly recognized results. A neglected general condition that produces this break is competition for performance. Advance in society is possible only by moving to a higher place among one's fellows, that is, by improving one's performance in relation to other people's performances. If everyone stands on tiptoe, no one sees better. Where social interaction of this kind is present, individual action is no longer a sure means fulfilling individual choice. . . .
Controlled Study of Child Health Supervision: Behavioral Results
Authors: Gutelius Margaret Frances , Kirsch Arthur David , MacDonald Sally , Brooks Marion Riddick , McErlean Toby
Published: December 2021

Extensive child health supervision, with emphasis on counseling and anticipatory guidance, was provided for the first three years of life to an experimental series of 47 normal first-born black infants from low-income families living in the environs of Children's Hospital in Washington, D.C. The mothers were unmarried schoolgirls in normal physical and mental health. A control series consisted of 48 similar mother-child dyads from the same area. Data were collected, in part by an outside evaluator, at yearly intervals on both experimental and control series in a form suitable for coding on computer cards. Comparison of differences in behavioral results between the two series showed statistically significant findings in favor of the experimental children, as well as numerous favorable trends during the first six years of life. Positive effects became evident in diet and eating habits, in some developmental problems of growing up (such as toilet training), and in certain abstract qualities including self-confidence. Significant differences were also noted between the experimental and control mothers for various child rearing practices and personality characteristics. No significant difference or trend favored the control series. We believe that a causal relationship existed between the intervention amid at least some of the significant findings.
Light Filtration During Transillumination of the Neonate: A Method To Reduce Heat Buildup in the Skin
Authors: Uy Joaquin , Kuhns Lawrence R. , Wall Patrick M. , Stein Robert T. , Heidelberger Kathleen
Published: December 2021

Filtration of the light used for transillumination of neonates is employed to reduce heat buildup in the skin during transillumination. Clinical and experimental evaluation of the effects of filtration are presented.
The Electroencephalogram in Pediatric Practice: Its Use and Abuse
Authors: Lewis Darrell V. , Freeman John M.
Published: December 2021

Utilized appropriately, the EEG is a helpful diagnostic tool; however, it is currently much abused and much overutilized. Understanding its limitations and its usefulness may lead to less frequent but more appropriate requests for EEGs. Realization that the EEG alone neither diagnoses nor rules out epilepsy and that it is not crucial in the diagnosis or management of "minimal brain damage" should decrease the utilization and abuse of the procedure.
DID THE Rh FACTOR CHANGE THE COURSE OF ENGLISH HISTORY?
Authors: C. T. E.
Published: December 2021

Sir Hector Maclennan, a Scottish gynecologist, has come tip with an intriguing theory about the failure of the marriage of Henry VIII to his first wife, Catherine of Aragon, and its effect on the religious and political history of England.

Henry was married to Catherine for 19 years; happily married, according to Sir Hector, to begin with and, had she been able to bear him a son, there seems little doubt and general agreement on the part of the historians of the period that he would have remained married to hen for the rest of his life. But by the time Catherine was 40 she had had a number of miscarriages and premature labors; she had produced five babies who died within days and weeks of delivery, amongst them three sons. The sole survivor was a girl, Many, born in 1518 and upon her the safety of Tudor throne and the tranquility of the country depended. It was not enough and Catherine had not been pregnant for seven years. Her failure to produce a son jeopardized the succession and so Henry looked for an excuse to get rid of her.

Sir Hector's hypothesis to explain Catherine's bad obstetric history is this:

If Queen Katherine [sic] was Rh negative and either of her two husbands [Katherine had first married Henry's brother Arthur who died within a year of his marriage] Rh positive, antibodies might have been set up which prejudiced her future deliveries. If we admit such a possibility, and it's not very far-fetched, then of course this would explain the neonatal deaths which followed.
Hospital-Acquired Viral Respiratory Illness on a Pediatric Ward
Authors: Wenzel Richard P. , Deal E. Chandler , Hendley J. Owen
Published: December 2021

All 171 patients admitted to four study rooms containing cribs were under surveillance during the winter and spring for development of nosocomial respiratory viral infection. One sixth of the 90 children at risk acquired respiratory illness while in the hospital. Viruses were isolated from two thirds of the patients with nosocomial infections: rhinovirus, respiratory syncytial virus, parainfluenza, and influenza A and B.

Serial viral cultures of the children under surveillance suggested that nine of 11 virus-positive nosocomial infections were not acquired from a roommate. Furthermore, the risk to a patient of becoming infected with a virus being shed by a roommate was only 3%. The need for isolation of all children with a respiratory illness in a single room with a separate air exhaust system is not suggested by these data.
We Should Stop Misuse of P Value
Authors: Cook David
Published: December 2021

Dr. Jekel's commentary "Should We Stop Using the P Value in Descriptive Studies? (Pediatrics 60:124, July 1977) is a gentle jeremiad about misuses of statistics in medicine. His intentions are laudable. However, he may persuade physicians who are uncomfortable with statistical manipulations that these should be abandoned, rather than that misusage should be abandoned.

The main points made by the commentary are three. The first notes that mindless data-dredging can result in large number of spurious, supposedly "significant" results.
Pathophysiology of Aspirin Overdosage Toxicity, With Implications for Management
Authors: Temple Anthony R.
Published: December 2021

The principal pathophysiologic effects of toxic doses of salicylates are characterized by (1) stimulation of the respiratory center of the brain, leading to hyperpnea and respiratory alkalosis; (2) uncoupling of oxidative phosphorylation, leading to increased oxygen utilization and glucose demand, increased glyconeogenesis, and increased heat production; (3) inhibition of Krebs cycle enzymes, leading to decreased glucose availability and increased organic acids; (4) alterations in lipid metabolism and amino acid metabolism, enhancing metabolic acidosis; and (5) increased fluid and electrolyte losses, leading to dehydration, sodium depletion, potassium depletion, and loss of buffer capacity. The principal toxic manifestations of respiratory alkalosis and metabolic acidosis, altered glucose availability and depletion, fluid and electrolyte losses, and hypermetabolism result in serious morbidity and are potentially fatal. Therapy of salicylate intoxication should be aimed principally at replacement of fluid and electrolytes, correction of acidemia, administration of glucose, and prevention of further salicylate absorption and enhancement of salicylate elimination.
Pharmacokinetics of Acetaminophen in Children
Authors: Peterson Robert G. , Rumack Barry H.
Published: December 2021

Acetaminophen absorption may occur at a somewhat greater rate in children if the syrup form is utilized. The overall plasma elimination of acetaminophen is somewhat slow in the neonate, but is comparable to that of adults in both children and adolescents, as judged by half-life determinations. This would suggest that the frequency of acetaminophen administration in children should be similar to the schedule recommended for adults and that a dosing interval of four hours should not result in drug accumulation. The question of a toxic quantity of acetaminophen for young children must remain open until adequate metabolic or retrospective toxicologic data become known. Since the volumes of distribution appear to be the same in both adults and children, the same dose should apply in both groups; currently, 10 mg/kg is considered to be both safe and effective for antipyresis
Chest Physiotherapy in the Newborn: Effect on Secretions Removed
Authors: Etches P. C. , Scott Bridget
Published: December 2021

In the article "Chest Physiotherapy in the Newborn: Effect on Secretions Removed" by Etches and Scott (Pediatrics 62:713, November 1978), there was an error on page 713 regarding the amount of negative pressure generated by the Air Shields Diapump. The sentence should read, "The suction source was the routine apparatus in our unit—an Air Shields Diapump generating a negative pressure of less than 150 mm Hg."
CONTRASTS IN HMO AND FEE-FOR-SERVICE PERFORMANCE
Authors: H. R. J.
Published: December 2021

This study compares various aspects of HMO performance in 10 plans with that of the fee-for-service system for the Medicaid population. Additionally, it examines utilization differences between several types of HMO's, grouped according to organization and provider payment. Four areas of behavior were studied—enrollment selectivity, utilization of services, accessibility of care, and satisfaction.

The only significant difference between the two systems was in hospital utilization. Group-practice HMO's had significantly lower hospital utilization than the fee-for-service groups; foundation HMO's did not. This difference seems to indicate that capitation payment to an HMO alone is not significant enough to produce major changes in utilization and that the organized multispecialty group-practice arrangement with largely salaried physicians may be more significant. For the other variables—previous health status, ambulatory-care use (including preventive care), accessibility, and satisfaction-the two groups were remarkably similar.
Acute Suppurative Parotitis Caused by Anaerobic Bacteria: Report of Two Cases
Authors: Brook I. , Finegold S. M.
Published: December 2021

Staphylococcus aureus is the predominant pathogen in acute suppurative parotitis. Although anaerobic bacteria are prevalent in the normal oral and upper respiratory tract flora and frequently are involved in oral and facial infections, they have seldom been isolated from patients with suppurative parotitis. It may be that a role for anaerobes in parotitis has not been documented because of inadequate specimen transport or anaerobic culture techniques. We describe two cases of acute suppurative parotitis in which cultures yielded anaerobic bacteria. In one case, no aerobes were isolated; in the other, the anaerobe was the predominant organism numerically.
Meningitis Due to Haemophilus influenzae Other Than Type b: Case Report and Review
Authors: Greene Gerald R.
Published: December 2021

A 4-month-old female infant with meningitis caused by Haeinophilus influenzae type f had a hospital course complicated by sterile subclural effusions and persistent neurologic normalities. One year later she was normal in all respects. The infant's mother had serum bactericidal antibodies to H. influenzae type b but not to type f. During recovery the patient had no bactericidal antibodies to type b, and the type f organism could not be maintained in her serum. Review of the literature identified 40 cases of meningitis reported as caused by H. influenzae other than type b. An evaluation of the ten cases described as due to encapsulated strains (a, e, and f) shows that the age distribution and clinical features are similar to those of meningitis caused by type b. Only five cases of meningitis caused by unencapsulated H. influenzae have been described. Four of the patients were older than the usual age range for type b meningitis and two had prior head trauma. A large clinical trial in Finland with a two-year observation period has denionstrated no untoward increase in non-b H. influenzae meningitis in recipients of a type b vaccine. Serious infections caused by other H. influenzae types will continue to occur sporadically and may increase in frequency when an effective vaccine against type b is widely used in infants.
Modern motor milestones
Authors: Berger Lawrence R.
Published: December 2021

In child development circles, a motor milestone is a discrete event in a person's progressive mastery of control over the body's movements. To most parents, each milestone-sitting up without support, grasping a raisin between thumb and forefinger, holding a cup, taking the first step all by herself—is a joyous occasion in their child's life. Children of the seventies, however, exhibit a new set of motor milestones made possible by our affluent society. None of these is cause for celebration. The modern milestones are discrete events marking the child's progressive involvement with engine-driven vehicles.

As early as 4 years of age, children may ride their first minibike.
Asthma and allergists: A modern perspective
Authors: Bergner Renee K.
Published: December 2021

In the current issue of Pediatrics (page 1061), Leffert elegantly reviews the theories of asthma pathogenesis, while identifying areas of our continued ignorance. He also calls for pediatricians to assume a more central role in the management of this condition rather than resort to the traditional, often near automatic practice of referring and deferring to allergists. It would be a pity to obscure the important theme of Leffert's article by an intramural fight for "turf" between pediatricians and allergists.

The noteworthy points of Leffert's article are: (1) Not all asthma is due to allergy. (2) Dramatic developments in asthma therapy have taken place in recent years.1-4
Asthma: A Modern Perspective
Authors: Leffert Fred
Published: December 2021

When viewed in the broad modern perspective, there is nothing about asthma that should mystify or depress the pediatrician. Although sometimes a difficult clinical problem, it is one for which rational approaches are available. The pediatrician who is willing to acquire the basic knowledge necessary for a modern understanding of asthma will find management of the asthmatic child to be one of the most intellectually appealing and emotionally gratifying aspects of his practice. Pediatricians who demand more from the allergist than the traditional rituals can be a major force in raising the standards of the practice of allergy.
Complications of Prenatal Therapy With Diethyistilbestrol
Authors: Herbst Arthur L. , Scully Robert E. , Robboy Stanley J. , Welch William R.
Published: December 2021

Cancer of the vagina is a rare type of genital malignancy that usually occurs as squamous cell carcinoma in postmenopausal women. Vaginal clear cell adenocarcinoma (Fig. 1), which used to be termed "mesonephroma," is an extremely rare type of genital cancer and was almost never encountered in younger patients until recently. In 1970, a clinical and pathologic study of seven cases of clear cell adenocarcinoma of the vagina in females between the ages of 14 and 22 years was published; all of them had been seen or treated in the late 1960s. These seven cases exceeded the total number of this type of cancer that had been previously reported in this age group.1 The next year, a retrospective epidemiologic study was conducted that included an additional case, and this cohort of eight was compared to 32 controls. It was found that the risk of development of these carcinomas was significantly associated with intrauterine exposure to diethylstilbestrol.2

Diethylstilbestrol therapy for high-risk pregnancy to reduce fetal wastage had been very popular in the late 1940s and 1950s. However, its use was stated to be contraindicated in 1971 by the Food and Drug Administration after the results of the initial epidemiological studies were confirmed.3 Clear cell adenocarcinoma of the cervix has also been associated with intrauterine exposure to diethylstilbestrol.4,5 In addition, other similar nonsteroidal synthetic estrogens such as dienestrol and hexestrol have also been implicated in the association.

Studies of the clinical, epidemiological, and pathologic aspects of these neoplasms have been centralized in the Registry for Research on Hormonal Transplacental Carcinogenesis (formerly the Registry of Clear Cell Adenocarcinoma of the Genital Tract in Young Females).
Treatment of Excessively Tall Girls and Boys With Sex Hormones
Authors: Prader Andrea , Zachmann Milo
Published: December 2021

Sex hormones in high doses administered over a period of one to two years are today the only effective medical way to decrease future adult height in excessively tall adolescents. Such treatment is not physiological and should be considered only if a careful growth prediction gives an excessive adult height that is a severe psychological or physical handicap to the patient. The most effective and safest way of treatment is not yet fully worked out, but the principles are simple: The hormone preparations used should be as natural as possible, the dosage as low as possible for producing the desired effect, and treatment should start only after the spontaneous onset of puberty and be discontinued at a bone age of about 15 years in girls and 17 years in boys. The risks are probably similar to those of the contraceptive pill and of pregnancy. The short-term risks are small in the adolescent age period. Fertility does not seem to be impaired. The long-term risks are not yet completely known.
Desmopressin in the Management of Nocturnal Enuresis in Children: A Double-Blind Study
Authors: Sová Marie Birká , Birkás Otto , Flynn Michael J. , Cort Joseph H.
Published: December 2021

Desmopressin (1-desamino-[8-D-Arg]-vasopressin) (DDAVP) was given by nose drops to 22 children with persistent nocturnal enuresis (mean age, 6.6 ± 2.9 years; range. 4 to 12 years) the evening before sleep. With saline alone as placebo and with comparison to enuretic frequency before the onset of the trial, fortnightly periods were compared under double-blind conditions with the children at home. Pretreatment and placebo fortnights showed wetting frequencies (nights per fortnight) of 10.6 ± 4.9 and 11.0 ± 4.4, respectively. The value of the fortnight during desmopressin therapy was 4.2 ± 4.5, which was significantly different from either of the previous means (P .01 ). Of the 22 subjects, four failed to react to therapy at all. There was decreased enuretic frequency in the remaining 18, of whom 12 decreased markedly or ceased wetting. One month after the trial, seven of the respondents were dry with desmopressin therapy. There was clear evidence of a large nocturnal volume of dilute urine before treatment in six of the respondents in whom such measurements could be reliably made. These children responded to dehydration with urine concentration. however, so that the suggestion can be made that a failure to develop a normal diurnal pattern of urine volume and concentration may underly some cases of enuresis.
Familial Spontaneous Pneumothorax
Authors: Wilson William G. , Aylsworth Arthur S.
Published: December 2021

A family is described in which four persons in three generations suffered spontaneous pneumothoraces: a newborn, an infant, an adolescent, and an adult. Review of the literature reveals 61 reports of familial spontaneous pneumothorax in 22 families. The ratio of male to female cases is approximately 1.8. Affected parents and affected children (including affected fathers and sons) are seen in ten families, while affected siblings with unaffected parents are noted in 13 families. Consanguinity has not been reported. Although autosomal dominant inheritance has been suggested as an explanation of familial spontaneous pneumothorax, available pedigree data are not adequate for statistical analysis. Physicians should be aware of the familial occurrence of spontaneous pneumothorax so that members of such families may be appropriately managed when problems arise.
Host Defense in Infantile Osteopetrosis
Authors: Reeves Jerry D. , August Charles S. , Humbert James R. , Weston William L.
Published: December 2021

Since infants with malignant osteopetrosis often die from infection at an early age, we studied several aspects of host defense in five such infants. No consistent abnormality was found in cellular or humoral immunity. Monocyte cellular chemotaxis and phagocytosis were normal in four tested infants. However, all four of these infants had decreased intracellular bacterial killing by monocytes. Neutrophil function tests in five infants showed that two had defective bacterial phagocytosis and four had reduced cellular chemotaxis, decreased nitroblue tetrazolium reduction, and decreased intracellular bacterial killing. The severity of the decreased bactericidal capacity of granulocytes did not correlate with the number of circulating immature granulocytes. Our data suggest that abnormal function of circulating monocytes and granulocytes may contribute to impaired host resistance to infection. We postulate that this defect may reflect a more generalized inherited abnormality of phagocytic cells and perhaps osteoclasts that plays a role in the pathogenesis of infantile osteopetrosis.
Meningococcal Group Y Pneumonia in an Adolescent Female
Authors: Hersh Joseph H. , Gold Ronald , Lepow Martha L.
Published: December 2021

Neisseria meningitidis group Y has been considered to be an uncommon pathogen. Meningococcal group Y disease has recently been reported with increased frequency in military training camps coincident with the routine use of meningococcal group C vaccine. Pneumonia produced by the group Y organism may mimic disease caused by common respiratory tract pathogens, and isolation by routine methods may be difficult. A 16-year-old asthmatic female developed lobar pneumonia secondary to N meningitidis group Y while on alternate day steroids. We speculate that neither steroid therapy nor an isolated serum IgA deficiency in the presence of secretory IgA discovered after her recovery predisposed her to sinopulmonary disease. The true incidence of group Y disease is unknown. Awareness of its potential pathogenicity may have clinical significance with the availability of a group Y vaccine.
PRINCESS ELIZABETH, SECOND DAUGHTER OF KING CHARLES I, AND RICKETS
Authors: C. T. E.
Published: December 2021

In 1856 the coffin of Princess Elizabeth (1635-1650) was discovered during the demolition of old St. Thomas's Church at Newport, Isle of Wight, England.

Mr. Ernest P. Wilkins, MRCS, examined the remains of the Princess and noted:1

The bones of the upper arm were slightly curved outwards—more particularly the right humerous—while those of the forearm were somewhat twisted and considerably curved outwards. The spinal column, retaining the relative position of the vertebrae during life, presented an extremely curved condition constituting the double lateral or S curvature of pathologists, which must have caused considerable projection of the right shoulder-blade and its attendant deformity ....

The condyles of the lower extremities were very large in relative proportion. The femur or thigh bone of the left side was curved forwards and inwards, that of the right side was more distorted than any other long bone. It was very much curved forwards and inwards. This bone was much flattened, its greatest diameter being from before, obliquely outwards and backwards; the concavity of the curve was somewhat filled in, and the bone thus strengthened by additional osseous deposit in accordance with the natural reparative tendency of Nature's laws. The bones of the leg, the tibia and fibula, were much curved outwards.

The bones of the skeleton indicate the great deformity which existed during life—there was evidently considerable "growing out" of the right shoulder-blade and corresponding flattening of the left side of the back. The lower extremities were contorted and of unequal length, the knees were what is termed "knocked"; below the knees the legs were bowed, the heels thrown outwards and the toes inverted.
Survival after Massive Aminophylline Overdose in a Premature Infant
Authors: Wells David H. , Ferlauto Jerry J.
Published: December 2021

The use of theophylline preparations for treating apnea in premature infants has gained popularity in many neonatal intensive care units.1,2 Toxocity of aminophylline in premature infants is not well studied. We present a case of severe aminophylline intoxication in a premature infant secondary to a pharmacy error. We call attention to the massive overdose tolerated by this infant and relate how the error was made so that other hospitals might avoid such incidents.

CASE REPORT

Baby girl C.E. was a 1.2 kg 30 weeks gestation, second born twin of a 23-year-old gravida 1, para 0, abortus 0 Rh negative mother.
Infections with Chlamydia trachomatis
Authors: Nichols Roger L.
Published: December 2021

Chlamydia trachomatis is a highly successful parasite of man which is to say that while some disease conditions produced are severe or fatal the majority are relatively minor. Worldwide in distribution, this organism remains the leading cause of blindness, due to trachoma; fully 15% of the world's population may be infected, prompting Sir Macfarlane Burnet to term trachoma one of the three most serious diseases of mankind.1 With the dwindling after World War II of the trachoma problem in the border states (Mason-Dixon line) of the United States, seven hospitals of the US Public Health Service devoted to this disease were closed and interest in chlamydial infections, save for an occasional outbreak of psittacosis, shifted to underdeveloped countries where trachoma remained a problem.
Countercurrent Immunoelectrophoresis in Group B Streptococcal Disease
Authors: Stechenberg Barbara W. , Schreiner Richard L. , Grass Susan M. , Shackelford Penelope G.
Published: December 2021

Countercurrent immunoelectrophoresis was used for the detection of group- and type-specific antigens in the body fluids of 61 infants from St. Louis and Indiana with group B streptococcal infections. Urine concentrated using an Amicon filter yielded the highest percentage of positive results; 81% were positive in the St Louis group. When three body fluids (urine, CSF, and blood) were available, at least one was positive for group B streptococcus in 95% of the cases. This study demonstrates the applicability of this test in a tertiary care facility (St Louis) and in smaller hospitals (Indiana) with access to central laboratory.
Mercury Vapor Contamination of Infant Incubators: A Potential Hazard
Authors: Waffarn Feizal , Hodgman Joan E.
Published: December 2021

In a survey of 42 infant incubators 18 showed detectable concentrations of mercury vapor. In 12 instances the concentrations of mercury vapor in the thermometer holder exceeded industrial safety standards. In 16 incubators the contamination was traced to broken mercury-in-glass thermometers used to monitor incubator ambient temperatures. Use of alcohol thermometers or thermistors in place of mercury-in-glass thermometers would eliminate this potential hazard.
Comparison of Urinary Lactic Dehydrogenase with Antibody-Coated Bacteria in the Urine Sediment as Means of Localizing the Site of Urinary Tract Infection
Authors: Lorentz William B. , Resnick Martin I.
Published: December 2021

Two noninvasive methods of localizing the site of urinary tract infection, urinary lactic dehydrogenase (LDH) isoenzymes and antibody coating of bacteria in the urinary sediment, have been prospectively compared with the bladder washout technique in a series of children with urinary tract infection.

Fifteen children had infection localized in the upper tract. Urinary LDH isoenzymes correctly localized the infection in 14 children; however, the infection was correctly localized by the antibody coating of bacteria in only eight patients (P < .02). Fourteen children had lower tract infection by the bladder washout technique. Urinary LDH isoenzymes localized the infection in all 14 children, whereas the antibody coating correctly localized the infection in ten children (P < .05). This study shows the urinary LDH isoenzyme pattern to be a more accurate technique than the detection of antibody-coated bacteria for localizing the site of urinary tract infection.
In Reply: Type Haemophilus influenzae Infections
Authors: Greene Gerald R.
Published: December 2021

In my recent article in Pediatrics,1 which reviewed meningitis due to Haemophilus influenzae other than type b, the statement is made that no cases of meningitis due to type c or d had been reported until that time. There have been two reports of type d meningitis published subsequent to that article, and a previously mentioned case has been brought to my attention. The above report by Drs Bromberg and Peter represents the first described case of meningitis in a child due to H influenzae type d.
Night Breast-Feeding and Dental Caries
Authors: Abbey Louis M.
Published: December 2021

It is of concern to some dentists and pediatricians lately that at-will nocturnal infant breast-feeding has been implicated as a cause of a dental caries pattern1,2 similar to "nursing bottle" caries.3

I submit that not a shred of valid scientific evidence exists supporting the contention that the practice of nighttime, at-will breast-feeding promotes dental caries in young children. Studies examining the incidence of dental caries in primitive cultures, where demand breast-feeding including at-will nighttime nursing is the norm4 and children are not usually weaned until 18 months to 3 years, continually report extremely low caries rates among the children.5-7
Ontogeny of the Local Immune System
Authors: Ogra Pearay L.
Published: December 2021

The classic studies of Tomasi and his colleagues' in early 1960s demonstrated that the predominant class of immunoglobulin in various external fluids was of IgA class, although it is a relatively minor immunoglobulin in serum. These observations represent the foundations of the earlier concept of the secretory immune system. Subsequent studies conducted during the last decade have made it clear that in addition to IgA, other immunoglobulin (IgM, IgE, IgG), components of T-cell-mediated immunity and other nonimmunologic factors are also present in significant amounts in the external mucosal secretions.2,3 Thus, the current concept of the local (secretory) immune system includes the secretory IgA, other immunoglobulins and cell-mediated immune reactivity. The local immune system is referred to the complex mechanisms of specific immunity existing on the external mucosal surfaces and which appear to operate somewhat independent of the immune function in other systemic sites in man and most other mammalian species. The local immune system includes the bronchus associated lymphoid tissue (BALT), gut associated lymphoid tissue (GALT), and the immunocompetent cell or organized lymphoid follicles in the conjunctiva, salivary glands, and upper respiratory tract, genitourinary tract and mammary glands.4-6 A number of publications3,4 have extensively reviewed the development and function of the secretory immune system. In this report, an attempt will be made to provide an overview of the more recent developments in the mechanisms of local immunity.

SECRETORY IMMUNOGLOBULINS

Structure of Secretory IgA

The bulk of the IgA immunoglobulin in external secretions exist as a complex molecule which consist of three immunologically distinct components: (1) a dimer of two 7 S IgA molecules, (2) the J (joining) chain, and (3) the secretory component (SC).
Cellular (T Cell) Immunity in the Human Newborn
Authors: Stiehm E. Richard , Winter Harland S. , Bryson Yvonne J.
Published: December 2021

The cellular immune system of the human newborn, like the rest of the immunologic apparatus, is anatomically intact, antigenically inexperienced, and functionally deficient. The latter is suggested by the newborns' enhanced susceptibility to infection, diminished delayed cutaneous hypersensitivity reactions, and selective abnormalities (when compared to adults) of measures of cellular immunity in vitro. These include impaired proliferative response to ubiquitous antigens, depressed lymphotoxin, migration inhibition factor, and immune interferon production, and diminished cytotoxic reactions including cell-mediated lympholysis. By contrast, other aspects of neonatal T cell function, such as to mitogens or allogeneic lymphocytes, natural interferon and leukocyte inhibition factor production, and number and percentage of E-rosette-forming cells are generally normal.

These decreased functional properties may provide an explanation for the newborns' susceptibility to infection and for the occasional occurrence of engraftment of foreign cells from either the mother or from prenatal or neonatal blood transfusion.