bluuebunny/crossref_metadata_2025 huggingface dataset:
Extracapillary Proliferative Glomerulonephritis in Children
Authors: Anand Sudhir K. , Trygstad Carl W. , Sharma Hari M. , Northway James D.
Published: December 2021

The clinical course and renal pathology of 17 children with acute extracapillary proliferative glomerulonephritis is reported. Patients with systemic ses associated with renal involvement were excluded. The onset followed streptococcal infection in ten; of these, four have died, one has been transplanted, and the remaining five have completely healed. The mean follow-up of the latter five patients was 32 months (range, 18 to 57 months). Of the other seven patients without evidence of preceding streptococcal infection, two have died, two have been transplanted, and the remaining three all have hypertension, proteinuria, and reduced creatinine clearance. The mean follow-up of the latter three patients was 29 months (range, 14 to 38 months). The initial renal histopathologic changes and their progress in later renal biopsies is described. The role of various therapeutic agents is discussed. The prognosis in acute extracapillary proliferative glomerulonephritis following streptococcal infection appears to be better than in ones without preceding streptococcal infection.
Congenital Heart Disease in 49, XXXXY Syndrome
Authors: Karsh Richard B. , Knapp Richard F. , Nora James J. , Wolfe Robert R. , Robinson Arthur
Published: December 2021

Since the initial report of the 49,XXXXY karyotype nearly 15 years ago, 86 cases have been reported in the world literature. The major features of the syndrome have been noted to be a triad of skeletal anomalies, hypogenitalism, and moderate-to-severe mental retardation. Among the less commonly associated abnormalities has been congenital heart disease, reported to have been seen in no more than 14 cases. The most frequently described lesion has been patent ductus arteriosus (PDA). We have recently seen two patients with the 49,XXXXY syndrome with associated congenital heart disease. This communication describes these two patients and reviews the literature to attempt to determine the actual frequency and types of congenital heart disease seen in this syndrome.
Another View of Data on Serum Thyroxine in RDS
Authors: Graham George G.
Published: December 2021

The article by Redding and Pereira reports that a group of premature infants with RDS had lower mean serum thyroxine levels than a group of prematures "comparable by gestational age" who did not develop RDS and implies a possible causative effect.

Table I of the article indicates that of the 40 prematures with RDS, 10 had a gestational age of less than 29 weeks, 10 had a gestational age of 30 to 33 weeks, and 20 had a gestational age of 34 to 37 weeks.
Drs. Redding and Pereira Reply
Authors: Redding Ralph A. , Pereira Celina
Published: December 2021

We thank Dr. Graham for his interest in our paper and for his constructive criticisms. However, there may be a problem in semantics in regard to his first criticism, for what we did "compare" were premature newborns with or without respiratory distress syndrome of similar gestational ages (30 to 33 weeks and 34 to 37 weeks respectively). Dubowitz et al. claim a 95% confidence limit of two weeks utilizing their total scoring system, which we also used.
Vaccination against herpes group viruses
Authors: Plotkin Stanley A.
Published: December 2021

The development of viral vaccines, like everything else, becomes more complicated with time. Success has been spectacular with vaccines against viral infections such as polio, measles, and rubella. The factor common to this success has been the protective effect of humoral antibody together with (in some cases) antibody secreted on mucosal surfaces. Now virologists are turning their attention towards the herpesvirus group, which presents problems not previously met.

The new problems may be summarized as follows:

(1)The possible oncogenicity of human herpesviruses. Several herpesviruses of animals have been shown beyond reasonable doubt to be oncogenic in homologous or heterologous species. These include the Lucké virus of frogs,1 the Herpesvirus saimiri of squirrel monkeys (oncogenic in other primates),2 and the Marek's virus of chickens.3
Histocompatibility locus antigen W27 and the rheumatic diseases
Authors: Rachelefsky Gary S. , Stiehm E. Richard
Published: December 2021

A new clue in the quest for an etiology of the rheumatic diseases may be the newfound association of certain of these disorders with the presence of the genetically inherited histocompatibility antigen, HL-A W27. The frequency of this antigen is 5% to 10% in the general population; by contrast, its frequency is 85% to 90% in adults with ankylosing spondylitis and Reiter's syndrome and 35% to 40% in children with juvenile rheumatoid arthritis.

Histocompatibility transplantation antigens are present on the surface of most cells (not erythrocytes) which are capable of inducing a cellular immune response in another of the same species and result in rejection of transplanted tissue or cells.
Effect of Food Supplementation During Pregnancy on Birthweight
Authors: Lechtig Aaron , Habicht Jean-Pierre , Delgado Hernán , Klein Robert E. , Yarbrough Charles , Martorell Reynaldo
Published: December 2021

The high prevalence of low-birtheight ( (≤ 2,500 gm) babies in many poor communities is a major public health problem. Studies in humans in situations of acute starvation suggest an effect of maternal nutrition on birth-weight, but less clear results appear under situations of moderate maternal malnutrition. We studied the effects of food supplementation during pregnancy on birthweight in four rural villages of Guatemala, in which two types of supplements were distributed: protein-caloric and caloric.

The caloric supplementation increased the total caloric intake during pregnancy. In both supplements, the amount of calories supplemented during pregnancy showed a consistent nt association with birthweight. In the combined sample the proportion of low-birthweight babies in the high-supplement group (G ≥ 20,000 supplemented calories during pregnancy) was 9% compared with 19% in the low-supplement ent gro≤ (< 20,000 supplemented calories during pregnancy). The relationship between caloric supplementation and birthweight (29 gm of birthweight per 10,000 supplemented ented calories) was basically unchanged after controlling for the maternal home diet, height, head circumference, parity, gestational age, duration of disease during pregnancy, socioeconomic status, and different rates of missing data. Moreover, a similar association was found in consecutive pregnancies of the same mother. We concluded that caloric supplementation during pregnancy produced the observed increase in birthweight.
The Interrelationship of Enterokinase and Trypsin Activities in Intractable Diarrhea of Infancy, Celiac Disease, and Intravenous Alimentation
Authors: Lebenthal Emanuel , Antonowicz Irena , Shwachman Harry
Published: December 2021

Enterokinase initiates digestion of protein by conversion of trypsinogen into trypsin. The interactions between enterokinase and trypsin were investigated in 6 patients with intractable diarrhea of infancy and 34 children with celiac disease. The six infants between 2 and 3 months with intractable diarrhea of infancy had reduced mucosal enterokinase activity (9.5 ± 4.8µM per gram of protein per minute) and reduced intraluminal trypsin activity (2.9 ± 0.7µM per gram of protein per minute) as compared with healthy controls (109 ± 34.2µM per gram of protein per minute and 14.3 ± 5.8µM per gram of protein per minute) respectively. The activities of all enzymes returned toward normal following treatment with intravenous alimentation. The mucosal morphology of all pretreatment biopsies in all cases showed Grade III atrophy which improved. These findings suggest that enterokinase deficiency and reduced intraluminal trypsin activity in intractable diarrhea of infancy may be one of the contributing factors to protein malabsorption and consequent malnutrition. Thirty-four children with celiac disease were between the age of 9 months and 13 years. The 11 newly diagnosed patients with celiac disease demonstrated Grade III to IV atrophy of the mucosa. The 23 patients with treated celiac disease on a gluten-free diet showed a normal to Grade II atrophy. In both treated and untreated celiac disease the enterokinase activities and the intraluminal trypsin activity were within normal limits.

The enterokinase activity in celiac disease is near normal in contrast to the marked reduction noted in intractable diarrhea of infancy even though the intestinal mucosa shows marked morphological alteration and the disaccharidase activities are greatly reduced in celiac disease. After a prolonged alimentary fast of up to 26 days on intravenous alimentation, two patients with intractable diarrhea of infancy showed improvement in the activities of enterokinase and trypsin. These findings demonstrate that enterokinase and trypsin activities in the gut were present and improved in the absence of oral feeding.
Some Implications of Declining Birth Rates for Pediatrics
Authors: Gorwitz Kurt , Smith Donald C.
Published: December 2021

Currently declining birth and fertility rates in the United States are having a significant impact upon both the absolute and relative size of the child population. The magnitude and extent of this impact are described and its implications for the practice of pediatrics are discussed. The timeliness of reexamining the role of the pediatrician in the delivery of health care services is emphasized.
Prolonged Cerebellar Dysfunction Associated With Paint-Sniffing
Authors: Kelly Col Thomas W.
Published: December 2021

This is the second reported case of cerebellar impairment attributed to chronic toluene inhalation. Sniffing of substances containing this solvent is not uncommon. Minimal cases might be detected if careful neurological observation is employed. Prevention of further damage by abstinence from the habit seems possible as judged by the course of the present patient. More importantly, potential abusers might be prevented from starting this pernicious practice with the knowledge that definite, persistent neurologic abnormalities can result.
Drs. Darling and Gellis Reply
Authors: Darling Donald B. , Gellis Sydney S.
Published: December 2021

Although our initial concern was to determine the true incidence of hiatal hernia in North American children relative to that reported from the United Kingdom and Europe, it became increasingly clear that the basic cause of symptoms in children (as well as in adults) was abnormal gastroesophageal reflux due to incompetence of the lower esophageal sphincter (LES) with or without demonstrable hernia, and Dr. Mones should have had no difficulty noting this in the paper.
Dr. Shannon Replies
Authors: Shannon Daniel C.
Published: December 2021

Dr. Morens raises questions of potential toxicity of theophylline in the gastrointestinal tract, kidney and ductus arteriosus. Except for vomiting, which has occurred in some infants when blood levels have been excessive (mainly 2Oµg/ml), we have not observed any of these side effects in treating 93 infants. In all infants, treatment was given through a nasogastric or nasojejunal tube until oral feeding was possible. Because acute severe toxicity in children and adults has been related to intravenous administration, we have used this route only when necessary. Because of erratic absorption, we have avoided the rectal route.
Dr. Edwards Replies
Authors: Edwards Phyllis Q.
Published: December 2021

It is apparent that routine tuberculin skin testing of youngsters has become a very low-yield activity. Although the expense of the skin test is minimal, it is well to review the purpose of using any diagnostic procedure, the likelihood that the results of the examination will lead to useful action, and the expense of the procedure. It has become evident that routine tuberculin tests throughout the child population of this country can no longer be recommended.
Nurse Practitioners and School Nurse Practitioners
Authors: Austin Glenn
Published: December 2021

In the November 1974 issue of Pediatrics McAtee and Silver discussed pediatric and school nurse practitioners, commenting that many in the nursing profession are dissatisfied with their role. The needs and desires of nurses and, in the commentaries, the needs of pediatricians were discussed but no one spoke for the needs of children and their families. None of the principals involved have ever really been in the primary practice of pediatrics. Few pediatric professors have had any successful long-term experience in private practice—the one place where they might learn the needs of parents and children and understand the effects of long-term health supervision.
Blood Gas in Exercise-Induced Bronchospasm: A Review
Authors: Katz Roger M. , Siegel Sheldon C. , Rachelefsky Gary S.
Published: December 2021

Exercise-induced bronchospasm (EIB) in some cases of asthma is related to hypocapnia, hypoxemia, and acidosis, but studies have shown that children do not develop as abnormal Pco2, Po2, or pH levels with the induction of EIB. Gradient changes of alveolar-arterial oxygen differences reveal ventilation perfusion abnormalities existing at the onset of exercise in those patients who do develop EIB.
Diagnosis of Neuroblastoma by Electron Microscopy of Bone Marrow Aspirates
Authors: Mackay Bruce , Masse Serge R. , King Oscar Y. , Butler James J.
Published: December 2021

Three patients are reported in whom the diagnosis of neuroblastoma was made following electron microscopy of a bone marrow aspirate. The ultrastructure of neuroblastoma cells is distinctive, and they can be distinguished by electron microscopy from cells of the other tumors with which neuroblastoma is often confused by light microscopy. The rapidity with which the diagnosis can be obtained through use of this procedure argues for its adoption in any patient in whom the diagnosis is suspected and who has tumor cells in bone marrow. Early initiation of appropriate therapy is made possible, and elaborate diagnostic procedures may be avoided.
Mortality From Tuberculous Meningitis Reduced by Steroid Therapy
Authors: Escobar Jorge A. , Belsey Mark A. , Dueñas Alvaro , Medina Pablo
Published: December 2021

In this study of 99 tuberculous meningitis patients from Cali, Colombia, treatment with steroids (in conjunction with antituberculous drugs) was shown to be more effective in reducing mortality than treatment with antibacterial drugs alone. Results further suggest that low dosages of steroids (1 mg/kg of prednisone daily for 30 days) are equally effective in treating the disease as high dosages (10 mg/kg of prednisone at the start of treatment, gradually reduced over a 30-day period). These results are based on sequential analysis of matched pairs, a statistical method particularly appropriate for clinical trials.
Rheumatic Pneumonia: The Need for a New Approach
Authors: Serlin Steven P. , Rimsza Mary Ellen , Gay John H.
Published: December 2021

Rheumatic pneumonia is a well-described, poorly understood, rare manifestation of rheumatic fever that is generally fatal. Until 1958, when Brown and his colleagues presented their comprehensive discussion, pediatric journals provided only five references. Since then, only one article has appeared in the pediatric literature. As illustrated by the following case report, pediatricians need to be aware of rheumatic pnuemonia in order to determine optimal therapy and management.

CASE REPORT

A.M., a 13-year-old Mexican-American boy, was in apparent good health until he developed fleeting arthralgia, abdominal pain, and low-grade fever. The day following the onset of symptoms acute appendicitis was suspected, and a laparotomy was performed at a community hospital.
Intravenous Injections and Infusions in Infants
Authors: Hanid Tessy K.
Published: December 2021

Classically the scalp vein and the antecubital veins are used for intravenous infusion in the neonate. For the former, the scalp has to be shaved and parents find this unaesthetic especially as the regrowth of hair may take several months; the latter has the disadvantage of difficult immobilization and the added risk of the infusion needle going into the surrounding tissue. The superficial veins on the back of the hands offer an excellent route for intravenous injection and infusion. This paper describes a constant vein which lends itself to this procedure.

Observation of the back of the hands of many adults reveals this constancy of the vein between the fourth and fifth metacarpals.
Developmental Effects of Seizures: Role of Malnutrition
Authors: Wasterlain Claude G.
Published: December 2021

Eighty-eight rats were paired at birth according to sex and weight. One member of each pair received two electroconvulsive seizures a day during the neonatal period (days 2 to 11). Access of its control littermate to the mother was restricted so that the body weights of any two paired rats never diverged by more than 2 gm on any day of life, and were usually within one half gram of each other. This guaranteed that the nutritional status of seizuretreated and control animals was similar throughout development.

On day 30 of life, seizure-treated rats had smaller brains (-56 mg, P < .05) and reduced numbers of brain cells (-13.106, P < .05) compared to their control littermates. It was concluded that the reduction of brain DNA brought about by neonatal seizures was not simply caused by malnutrition of seizure-treated animals.
Serum 25-Hydroxyvitamin D in Infantile Rickets
Authors: Arnaud Sara B. , Stickler Gunnar B. , Haworth James C.
Published: December 2021

In small children with nutritional vitamin D deficiency, the serum concentration of 25-hydroxyvitamin D (25-OH-D), the major circulating metabolite of vitamin D, was correlated with the stage of clinical disease. It was low (16 to 20 ng/ml) but within the normal range in the earliest (hypocalcemic) stage of the deficiency syndrome and decreased (< 15 ng/ml) in the more advanced stages. In patients with familial hypophosphatemia (X-linked dominant), mean serum 25-OH-D concentration was the same as in age-matched normal controls. Evidence is presented that endogenous parathyroid hormone may have a role in the depletion of serum 25-OH-D in deficiency states.
Frequency of Detection of Hemophilus influenzae Type b Capsular Polysaccharide in Infants and Children With Pneumonia
Authors: Wald Ellen R. , Levine Myron M.
Published: December 2021

Countercurrent immunoelectrophoresis was used to detect H. influenzae type b antigen in sera of 65 consecutive infants and children with clinical and radiographic evidence of pneumonia. Antigenemia was observed in only one patient who also had H. influenzae type b bacteremia. Blood cultures from four other children were positive for H. aphrophilus (one), Streptococcus pneumoniae (two), and an α-hemolytic Streptococcus (one). The frequency of pharyngeal colonization with H. influenzae type b was similar in children with or without pneumonia. If H. influenzae type b was the cause of pneumonitis in the children studied, it occurred without bacteremia or antigenemia.
Commentary on Breast-Feeding and Infant Formulas, Including Proposed Standards for Formulas
Authors: Barness Lewis A. , Mauer Alvin M. , Holliday Malcolm A. , Anderson Arnold S. , Dallman Peter R. , Forbes Gilbert B. , Goldbloom Richard B. , Haworth James C. , Jesse Mary Jane , Scriver Charles R. , Winick Myron , Kline O. L. , Miller Robert W. , O'Brien Donough
Published: December 2021

This statement proposes recommendations toward increasing the practice of breast feeding. Specific recommendations made for standards of infant formulas as to calorie, protein, fat, vitamin, and mineral levels apply to both milk-based and milk-substitute infant formulas. Such formulas, when used in place of breast-feeding, must supply most or all of the nutrients infants require during the first weeks or months of life.

The minimum levels of nutrients per 100 kcal recommended for formulas provide good growth and development in healthy, full-term infants; distinct hazards may be encountered at levels below these. However, no significant advantage is to be gained by providing levels in excess of these minima in normal infants. Recommendations for maximum levels are made only where quantities in excess lead to toxicity; generally, levels near the minima recommended are most desirable because they are the most likely to reflect the composition of human milk, and the least likely to result in any undesirable nutrient to nutrient interaction.

The recommendations also can be used as reference standards for formulas for special dietary uses of "medical" formulas. The Committee recommends that "medical" formulas be classified by FDA into a special group under the paragraph dealing with infant formulas.
Leukemia in Childhood. By Andre D. Lascari, M.D. Springfield, Illinois, Charles C. Thomas, 1973. $16.75; 486 pp
Authors: Fernbach Donald J.
Published: December 2021

The stated purpose of this text is to serve as a reference source of the significant literature in the English language for physicians treating children with leukemia. Dr. Lascari has accomplished this with a well-organized, lucid text which includes the author's admitted "bias" in a few controversial areas. The strength of the book is in several excellent chapters on uncommon manifestations and complications and unusual leukemia-like diseases.

In the early chapters there is an excellent discussion on etiology which includes a concise review of the possible role of viruses and the potential hazards of chemical leukemogens, among other factors.
Children and television
Authors: Feinbloom Richard I.
Published: December 2021

As a member of the generation which was raised on "The Lone Ranger," "Allen's Alley," and "The Shadow," as well as Wheaties, Ovaltine, and cereals "shot from guns," I confess to a bias against television which has interfered with my coming to honest grips with it. This bias has led me to discount the importance of television in my work with children and their families. The study of the relationship between viewing violence on television and apathy reported by Drabman and Thomas in the current issue of Pediatrics1 provides the stimulus to review the health-related aspects of this very important medium of communication.
Anaerobic Infections in Children: A Prospective Study
Authors: Dunkle Lisa M. , Brotherton Thomas J. , Feigin Ralph D.
Published: December 2021

The prevalence and significance of anaerobic infections in patients at St. Louis Children's Hospital were studied prospectively for a one-year period. Blood, selected body fluids, and aspirates obtained from abscesses or areas of cellulitis were cultured using special anaerobic collection and processing techniques.

Infected peritoneal fluid from patients with gastrointestinal disease yielded a large proportion of all anaerobic isolates. The types of organisms isolated were common inhabitants of the intestinal tract. Anaerobic organisms were recovered from only 0.75% of all blood cultures; anaerobic bacteremia accounted for 5.8% of all clinically significant bacteremic episodes (8.7% in the neonatal period and 4.8% in children over 1 month of age).

Serious anaerobic infections occurred more frequently in the compromised host or in newborn infants than in otherwise healthy children. Since anaerobic organisms cause a small proportion of infectious diseases in a general pediatric population, the cost of refined bacteriologic techniques for the isolation and identification of these organisms is not warranted in most community hospitals. However, such a program should be available in selected tertiary care centers to aid in the management of certain high-risk patients.
The Vulnerability of the Medical Student: Posthumous Presentation of L. L. Stephens' Ideas
Authors: Werner Edwenna R. , Korsch Barbara M.
Published: December 2021

L. L. Stephens described several critical issues in medical professionalization. The encounter with morbidity and mortality heightens the student's feelings of vulnerability. If he over-identifies with patients, he may suffer more and be unable to provide rational medical care. If he protects himself by dehumanizing patients, humane treatment suffers. Students have surreal perceptions of their responsibility for patients. Recognition of unconscious motivation may be troubling to students. Finally, there are emotional barriers to the recognition of psychosocial elements in disease. To optimize students' personal and professional functioning, medical training should deal with these concerns. Support can be provided by small continuing learning groups for students and clinical faculty, in which these issues, illustrated by videotapes of patient-student encounters and other clinical examples, are discussed in the context of providing comprehensive medical care. Support should continue during internship.
Does Watching Violence on Television Cause Apathy?
Authors: Drabman Ronald S. , Thomas Margaret Hanratty
Published: December 2021

The hypothesis that exposure to televised violence serves to increase children's toleration of real-life aggression was investigated. Fifth-grade boys and girls were exposed to either a violent television excerpt or a nonviolent, exciting control program. Immediately thereafter, each child was lead to believe that he had been given responsibility for monitoring the behavior of two younger children. Subjects who had witnessed the aggressive television program were found to be significantly slower to summon appropriate adult aid when the younger children began to argue and fight than were subjects who had viewed the control film.
Pinna Anomalies Associated With Congenital Conductive Hearing Loss
Authors: Jaffe Burton F.
Published: December 2021

This paper compares the normal pinna with the abnormal congenitally malformed pinna. Then the abnormal pinna is related to case histories where a hearing loss was found due to a congenital malformation of the middle ear ossicles. Careful examination of the pinna, therefore, may be a simple diagnostic sign of an underlying potentially surgically correctable hearing loss. An abnormal pinna is more often associated with a middle ear anomaly than with any other congenital malformation including a urinary tract anomaly.
Podophyllum–A Dangerous Laxative
Authors: Rosenstein Gladys , Rosenstein Herman , Freeman Martha , Weston Nathan
Published: December 2021

A physician asked the Food and Drug Administration (FDA) for information regarding podophyllum. He had under his care an infant born with phocomelia manifested by bilateral absence of the radii. During her pregnancy, the child's mother had occasionally taken a laxative which contained podophyllum as one of its active ingredients. This inquiry led to an intensive search for available information on this subject. The discussion below is a summary of this information. From the data it was determined that podophyllum is too toxic a drug to be used as a laxative, especially since much safer laxatives are available.

The FDA Advisory Review Panel on Over-the-Counter (OTC) Laxative, Antidiarrheal, Emetic and Antiemetic Drug Products, in a recently completed independent evaluation, similarly concluded that podophyllum resin is an unsafe laxative.
Mucocutaneous Lymph Node Syndrome (MLNS) in the Continental United States
Authors: Goldsmith Richard W. , Gribetz Donald , Strauss Lotte
Published: December 2021

This report details a case of mucocutaneous lymph node syndrome (MLNS) recognized in the continental United States. Reported originally by Kawasaki in 1967,1 the syndrome has since occurred widely in Japan.2 Except for Melish et al.'s report of nine cases in Hawaii, MLNS has thus far not been reported from any other area.3

CASE REPORT

T. S., a 2-year-old white boy, became ill with fever on August 19, 1974, and was examined on the third day of illness. His temperature had fluctuated between 38.9 and 39.4 C; when examined he had a markedly tender 2 x 4-cm single anterior cervical node accompanied by redness of the overlying skin.
Nosocomial Staphylococcal Cervical Lymphadenitis in Infants: Report of an Outbreak
Authors: Boyce John M. , Garner Julia S. , Twenge Jane A. , Shipley Janet M. , Dixon Richard E.
Published: December 2021

Staphylococcus aureus infections developed in 16 of 721 infants born at a general hospital during a six-month period (October 1972 to March 1973). Twelve of the 16 affected infants had cervical adenitis, which usually became manifest two to four months after they were discharged from the hospital. Although most infants with adenitis underwent incision and drainage procedures, physicians noted few constitutional symptoms. Staphylococcal phage types from infants with adenitis were identical to phage types commonly recovered from colonized newborns and nursery personnel at the hospital. Despite the long period between hospital discharge and onset of clinical symptoms, cases of cervical adenitis were probably nosocomial in origin.
Post-Traumatic Anterior Hypopituitarism
Authors: Paxson Charles L. , Brown David R.
Published: December 2021

Reports of anterior pituitary insufficiency following closed head trauma are unusual. In those cases reported, extensive endocrinologic evidence to support the clinical syndrome is often lacking. The present report documents a case of anterior pituitary insufficiency in a 14-year-old girl following a skull fracture. Endocrine evaluation one year after her automobile accident revealed hypopituitarism minifested by cachexia, hypothyroidism, hypoadrenocorticism, and hypogonadism with regression of secondary sex characteristics. Laboratory studies demonstrated deficiencies of both trophic and peripheral anterior pituitary hormones. The patient has responded to replacement therapy and is clinically well. A review of previously described cases is included.
Neonatal Pancreatic β-Cell Hyperplasia: Report of a Case With Failure of Diazoxide and Benefit of Early Subtotal Pancreatectomy
Authors: Crowder Wayne L. , Maclaren Noel K. , Gutberlet Ronald L. , Frost James L. , Mason G. Robert , Cornblath Marvin
Published: December 2021

A newborn infant with pancreatic β-cell hyperplasia had persistent hypoglycemia due to hyperinsulinism. After medical management, including the use of diazoxide and constant glucose infusions had proved ineffective, a subtotal pancreatectomy was curative. Cumulative experience seems to indicate that there should be little delay in performing a subtotal pancreatectomy when aggressive medical management cannot maintain normoglycemia in a neonate.
Variable Efficacy of Glucocorticoids in Congenital Adrenal Hyperplasia
Authors: Hansen James W. , Loriaux D. Lynn
Published: December 2021

We have examined the suppression of urinary pregnanetriol and 17-ketosteroids during treatment with cortisol, cortisone, prednisone, and dexamethasone in eight patients with congenital adrenal hyperplasia. A large individual variation in response to each agent was observed. In some individuals, cortisone is less effective than its generally accepted potency would indicate. At equivalent glucocorticoid dosage, dexamethasone was twice as effective as the other steroids in suppressing urinary 17-ketosteroids and pregnanetriol. The potency of dexamethasone in suppressing adrenal function was 80 times that of cortisol, about twice its generally accepted potency as a glucocorticoid or anti-inflammatory agent.
Under Scrutiny of Optometry
Authors: Seiderman Arthur S.
Published: December 2021

I am writing this letter in reference to Silver's article on learning disabilities which appeared in the March 1975 issue of Pediatrics.1 The article certainly was a much needed one, since pediatricians are frequently confronted with questions relating to children with learning disabilities. In general, I must commend the excellent representation and delivery.

The portion of the article which related to my own area of expertise, optometry, I felt was misleading and unfairly dealt with.
Impedance audiometry: Is it a wise investment?
Authors: Mortimer Edward A.
Published: December 2021

In this issue of Pediatrics there is a report1 of a method by which abnormalities of the middle ear that affect mobility of the drum, and therefore hearing, may be assessed quantitatively. In brief, the technique, called tympanometry, measures the compliance of the ear drum and, by ascertaining compliance at different external pressures, estimates pressures in the middle ear. The value to pediatricians and their patients of a means by which ear drum compliance and middle ear pressure can be measured lies primarily in the diagnosis and management of serous otitis media. Clearly, the data presented in this report indicate that this technique will usually discriminate between ears with middle ear effusions and normal ears.
Persistence of Fetal Cardiopulmonary Circulation: One Manifestation of Transient Tachypnea of the Newborn
Authors: Bucciarelli Richard L. , Egan Edmund A. , Gessner Ira H. , Eitzman Donald V.
Published: December 2021

Five cyanotic newborn infants underwent cardiac catheterization between 8 and 36 hours of age with a tentative diagnosis of cyanotic congenital heart disease. All had normal cardiovascular anatomy. Cyanosis was the result of persistence of fetal cardiopulmonary circulation with right-to-left shunting across the ductus arteriosus. In all infants, cyanosis resolved spontaneously and the infants survived without sequelae. Admission chest roentgenograms of all infants showed marked hyperinflation of the lungs. Except for severe hypoxemia, the clinical presentation, chest films, and course of illness of these infants were consistent with transient tachypnea of the newborn. It is proposed that an increase in pulmonary vascular resistance, due to hyperinflation of the lungs, was the mechanism which reopened the fetal cardiopulmonary circulatory channels and produced hypoxemia, and that these infants suffered from a rare manifestation of a usually benign newborn respiratory condition. Further, given these pathophysiologic mechanisms, the use of continuous transpulmonary pressure gradients in the management of such infants would be contraindicated.
Effects of Acutely Increasing Systemic Vascular Resistance on Oxygen Tension in Tetralogy of Fallot
Authors: Nudel Dov B. , Berman Michael A. , Talner Norman S.
Published: December 2021

Effects of phenylephrine hydrochloride on the degree of hypoxia were studied in six cyanotic patients with tetralogy of Fallot. Baseline aortic and right atrial oxygen saturations, blood gas tensions, pH, and indicator-dilution curves were obtained under stable conditions. Phenylephrine was infused while systemic arterial pressure was monitored continuously. Aortic and right atrial blood samples were measured at each 10 mm Hg systolic pressure increment and decrement and analyzed for pH, Po2, Pco2, and oxygen saturation. A 40 mm Hg peak systolic aortic pressure rise was the arbitrary end point for phenylephrine infusion and the indicator-dilution curve repeated. Aortic oxygen tensions rose in all from 4 to 28 mm Hg (mean, 14 mm Hg). The net right-to-left shunt decreased from 10% to 40% (mean, 25%) with phenylephrine infusion as compared to the shunt under basal conditions. The presumed mechanism related to the increase in systemic vascular resistance relative to right ventricular outflow obstruction with resultant augmentation of pulmonary blood flow. It is concluded that acutely raising systemic vascular resistance in patients with tetralogy of Fallot using phenylephrine infusion has a beneficial effect on systemic arterial oxygen level and might be the medical treatment of choice for protracted hypoxic spells.
An Unusual Case of Pelvic Appendicitis
Authors: LaCombe Michael A.
Published: December 2021

The atypical signs and symptoms, the misleading interpretation of symptoms by the patient's family, and the remarkable radiograph in the following case emphasize the difficulty in early diagnosis of pelvic appendicitis.

CASE REPORT

A 10-year-old boy came to the Emergency Department of Community Memorial Hospital, Toms River, New Jersey, complaining of pain in the pubic bone of four hours' duration. His mother thought he might have fallen on the cross-bar of his bike and was concerned about a possible fracture of the pelvis. The boy denied any nausea, vomiting, anorexia, or change in bowel habit and had no pain elsewhere. He had noticed no gross hematuria.
The Neglected Inguinal Hernia
Authors: Jona Juda Z.
Published: December 2021

The pediatric indirect inguinal hernia is by far the most common anomaly requiring surgical correction. Modern advances in pediatric surgical and anesthetic techniques and the improved preoperative and postoperative care of children have made the elective pediatric herniorrhaphy a remarkably safe procedure. Many centers in this country and abroad are treating the uncomplicated inguinal hernia in infants and children in the outpatient clinic. The safety of this practice is impressive even in the very young.
Environmental Autism
Authors: Zisman Alan S.
Published: December 2021

In their article on infantile autism and psychosis,1 Knobloch and Pasamanick present strong evidence to show that the children with autism seen in their developmental center all have organic brain disease, frequently have convulsions, and are mostly mentally deficient.

Certainly the view that autism derives from an organic disorder of the nervous system is the popular one. However, I think that the pediatrician among others should know that there is an "environmentalist" point of view.
T Cells and Age
Authors: Matsaniotis N.
Published: December 2021

In their interesting article, Dr. Fleisher and his colleagues1 stated that "data on T lymphocytes in young children have not been previously reported." We would like to point out that we have already reported in the British Medical Journal2 data on age dependence of T cells. We studied 171 healthy individuals of different ages; 50 of them were younger than 2 years. E rosettes were very low during the first month of life, both in percentages and absolute numbers.
Epidemiologic Characteristics of Infections Caused by Ampicillin-Resistant Hemophilus influenzae
Authors: Jacobson Jay A. , McCormick Joseph B. , Hayes Peggy , Thornsberry Clyde , Kirvin Linda
Published: December 2021

From February 1974 through May 1975, 58 isolates of ampicillin-resistant Hemohilus influenzae from patients were submitted to the Center for Disease Control from 23 states and the District of Columbia. The epidemiologic characteristics of these widely scattered cases were strikingly similar to those of cases previously reported from individual communities or institutions.

Because of the nationwide distribution of resistant isolates and the adverse consequences of ineffective therapy, the use of chloramphenicol is recommended for the initial management of systemic illness definitely or probably due to H. influenzae type b.
Infant Feeding and SIDS
Authors: Cunningham Allan S.
Published: December 2021

Is the role of infant feeding in SIDS really a dead issue, as Beckwith implies in his commentary on the article by Tonkin?1,2 Steele et al. found that 78% of SIDS infants had been exclusively bottle-fed, compared to 52% in a control group.3 Carpenter and Shaddick found that less than 6% of SIDS infants surviving to 3 months of age were exclusively breast-fed, compared to 22% of 3-month-old controls.4 Cameron and Asher found that 80% of their patients were receiving no breast milk at all by 1 month, compared to 39% of infants attending city clinics.3
Genetic screening: For better or for worse?
Authors: Holtzman Neil A.
Published: December 2021

Cystic fibrosis, sickle cell anemia, Tay-Sachs disease, and thalassemia are autosomal-recessive diseases that occur more frequently than once in 4,000 live births in subgroups of the American population. Tay-Sachs disease can be diagnosed by mid-trimester amniocentesis, a safe procedure.1 Early intrauterine detection of sickle cell anemia and thalassemia by placental aspiration has been reported2,3; the safety and accuracy of the techniques require confirmation. In the future, diagnosis of the 16-week fetus with cystic fibrosis will also be possible.

Prenatal diagnosis could drastically reduce the incidence of these disorders, but there are two prerequisites. First, couples in whom both mates are carriers must be identified before they have any children.
Errors in Insulin Dosage
Authors: Guthrie Richard A.
Published: December 2021

The problem reported by Shainfeld1 in the August 1975 issue regarding errors in insulin dosage with various syringes is well known and has been reviewed by the Committee on Therapeutics and by the Committee on Diabetes in Youth of the American Diabetes Association (ADA). I chaired the latter committee last year during these extensive discussions. Recommendations were made by the ADA to the Food and Drug Administration for the development of syringes with minimal dead space and will probably be a part of the specification to be forthcoming soon.
Intestinal Lymphangiectasia
Authors: de Sousa J. Salazar
Published: December 2021

In their excellent article on intestinal lymphangiectasia (IL), Vardy et al.1 are inclined to accept the thesis that "there are two types of intestinal lymphangiectasia-one genetic in origin and the other acquired and transitory." In the second type they include several different conditions, among them nephrosis,2 and they say that "It seems highly unlikely that such disparate conditions should have anything more than a coincidental relationship with intestinal lymphangiectasia. . . . This strengthens our supposition that intestinal lymphangiectasia may be relatively common and asymptomatic."
Dr. Lebenthal et al. Reply
Authors: Lebenthal Emanuel , Shwachman Harry , Vardy Peter A.
Published: December 2021

We appreciate the comments by Dr. Salazar de Sousa and agree with him on the association of nephrosis and intestinal lymphangiectasia. Since publication of our article,1 we have seen an infant who suffered from congenital nephrotic syndrome, mesangial proliferation and focal global glomerulosclerosis, and intestinal lymphangiectasia. It seems that a connection between the two entities is possible.

Secondary intestinal lymphangiectasia was found in five of 11 biopsy specimens taken from patients with intractable diarrhea of infancy.2
Erythromelalgia
Authors: Mandell Frederick , Folkman Judah , Matsumoto Shuzo
Published: December 2021

Erythromelalgia is an extraordinary disease which remains elusive in its pathophysiology and management. Victims suffer intense burning and redness of the hands and feet. In what appears to be the antithesis of Raynaud's disease, the pain is relieved by emersion in cold. A child with erythromelalgia is described whose symptoms began at age 3 years. Pharmacological management trials and thermography are incorporated in the report.
Counseling Parents of Children With Behavior Problems: The Use of Extinction and Time-Out Techniques
Authors: Drabman Ronald S. , Jarvie Greg
Published: December 2021

The pediatrician is the professional most frequently sought out for advice concerning disciplinary problems with children in the home. Behavioral psychologists have advocated the use of contingent ignoring and time-out procedures to help reduce problem behaviors; however, practicing pediatricians have found that these two procedures are often not successful. In fact, sometimes the two procedures seem to exacerbate inappropriate behavior. This paper documents the difficulties found in using the ignoring and/or time-out procedures in the home setting. Potential pitfalls in the use of ignoring, including not specifying the target behavior, not taking a baseline, inadvertently, intermittently reinforcing the inappropriate behavior, response bursts, spontaneous recovery, and not reinforcing an appropriate alternative behavior, are described. In addition, several pitfalls in the use of the time-out procedure, including selection of isolation area, inappropriate selection of time intervals, interference from others in the family, and escape attempts on the part of the child are discussed. For each potential problem a remedy is suggested.
THE QUALITY OF LIFE
Authors: Mahler H.
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 present ways are inadequate and other ways preferable-with a corresponding improvement in our willingness to learn.
Heterozygous Alpha-1-Antitrypsin Deficiency and Respiratory Function in Children
Authors: Vance J. C. , Hall W. J. , Schwartz R. H. , Hyde R. W. , Roghmann K. J. , Mudholkar G. C.
Published: December 2021

We evaluated 224 children from Rochester, New York, families in which at least one parent was heterozygous for alpha-1-antitrypsin (AAT) deficiency by protease inhibitor (Pi) typing. The childhood population included, of the two major heterozygote Pi types, 75 Pi type MS children and 37 Pi type MZ children. This population was evaluated by means of a standardized respiratory questionnaire, physical examination, and pulmonary function tests. Maximal expiratory flow volume curves were obtained with subjects breathing both air and a helium-oxygen mixture. Total pulmonary resistance by the method of forced oscillations was measured at 3, 5, 7, and 9 cps. No differences in respiratory symptoms or physical findings were seen in Pi type MZ and MS children compared to Pi type MM children. However, when pulmonary function tests were evaluated by a matched-pair analysis designed to minimize other genetic and environmental risk factors, Pi type MZ subjects demonstrated statistically significant differences in forced expiratory flow rates and in increased frequency-dependent characteristics of total pulmonary resistance. These abnormalities are similar to those previously described in adult Pi type MZ subjects, and suggest that physiologic abnormalities associated with AAT deficiency are present early in life.
IMPROPER ADVERTISING OF BABY FOODS CONDEMNED
Authors:   Student
Published: December 2021

Very strict rules should be adopted for the advertising of children's foods. Publicity for breast milk substitutes should in no case be aimed directly at the public or at families. Publicity for ready-made baby foods should make it quite clear that they are not intended for children of less than three months. The distribution of free samples and other means of sales promotion should be prohibited for everything relating to food for the young child. These are some of the conclusions reached by members of a WHO Working Group who met in Algiers from 26 to 30 October 1976 in order to study the problems of nutrition in relation to public health. The meeting was organized by the WHO Regional Office for Europe and in attendance were experts from 10 countries in the Region and representatives from FAO and WHO.

The necessity for better dietary education of the public and health workers and for emphasizing the value of breast-feeding was clearly stated, the themes to be stressed depending on the general socioeconomic status of the country or the area. For example, in industrialized countries where milk preparations for infants are easily available, stress should be laid primarily on the "immunological" advantages of breast milk and on the importance of infants being breastfed for at least six weeks. In developing countries the crucial nature of breast-feeding in the prevention of infections and malnutrition should be stressed.