bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduced Power in Fronto-Parietal Theta EEG Linked to Impaired Attention-Sampling in Adult ADHD
Authors: Cowley Benjamin Ultan , Juurmaa Kristiina , Palomäki Jussi
Published: December 2021

Attention-deficit/hyperactivity disorder (ADHD) in adults is understudied, especially regarding neural mechanisms such as oscillatory control of attention sampling. We report an electroencephalography (EEG) study of such cortical mechanisms, in ADHD-diagnosed adults during administration of Test of Variables of Attention (TOVA), a gold-standard continuous performance test for ADHD that measures the ability to sustain attention and inhibit impulsivity. We recorded 53 adults (28 female, 25 male, aged 18–60), and 18 matched healthy controls, using 128-channel EEG. We analyzed sensor-space features established as neural correlates of attention: timing-sensitivity and phase-synchrony of response activations, and event-related (de)synchronization (ERS/D) of α and θ frequency band activity; in frontal and parietal scalp regions. TOVA test performance significantly distinguished ADHD adults from neurotypical controls, in commission errors, response time variability (RTV) and d′ (response sensitivity). The ADHD group showed significantly weaker target-locked and response-locked amplitudes, that were strongly right-lateralized at the N2 wave, and weaker phase synchrony (longer reset poststimulus). They also manifested significantly less parietal prestimulus 8-Hz θ ERS, less frontal and parietal poststimulus 4-Hz θ ERS, and more frontal and parietal prestimulus α ERS during correct trials. These differences may reflect excessive modulation of endogenous activity by strong entrainment to stimulus (α), combined with deficient modulation by neural entrainment to task (θ), which in TOVA involves monitoring stimulus spatial location (not predicted occurrence onset which is regular and task-irrelevant). Building on the hypotheses of θ coding for relational structure and rhythmic attention sampling, our results suggest that ADHD adults have impaired attention sampling in relational categorization tasks.
A rare case of macroprolactinoma in a patient with Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome
Authors: Zainordin Nur Aisyah , Mohd Shah Fatimah Zaherah , Eddy Warman Nur Aini , Wan Muhammad Hatta Sharifah Faradila , Mohamad Aimi Fadilah , Abdul Ghani Rohana
Published: December 2021

A 17-year-old lady presented with primary amenorrhoea, headache, nausea and lethargy. She had delayed pubertal development that also includes under-developed breast (Tanner Stage 2). Hormonal investigations showed a high serum prolactin level of 1 680 000 mIU/L (normal value: 45–375 mIU/L), with low oestradiol, progesterone, follicular-stimulating hormone and luteinizing hormone. Early morning cortisol level was 206 nmol/L (normal value: >450 nmol/L), thyroxine was 7.5 pmol/L (normal value: 9.0–24.0 pmol/L) with TSH 5.091 mIU/L (normal value: 0.4–4.5 mlU/L). A pituitary MRI showed a 2.7 (AP) × 3.7 (W) × 4.6 cm (CC) macroadenoma, with invasion into the left cavernous sinus and encasement of cavernous portion of the left internal carotid artery. MRI pelvis showed absent uterus, cervix and 2/3 upper vagina confirming Mullerian hypoplasia. Cytogenetics showed 46XX. These findings were suggestive of Mayer–Rokitansky–Kauser–Hauser (MRKH) syndrome with the presence of a pituitary macroprolactinoma and panhypopituitarism. She was treated with hydrocortisone, levothyroxine and cabergoline. Repeated MRI showed a reduction in tumour size by approximately 50%. This case illustrated a rare coexistence of these two conditions, being only the third reported case in the world. In addition, this would be the first case of a functioning pituitary adenoma in a patient with MRKH syndrome.

Learning points

Comprehensive hormonal and radiological investigations are important in the management of a young patient with primary amenorrhoea.

Coexistence pathology of two separate pathologies should be considered in patient presenting with primary amenorrhoea.

Early diagnosis of MRKH or any disorders of sex development should be treated early, providing pharmacological, surgical, psychological and emotional support to the patient and reducing risk of associated complications.

Abnormal pituitary hormones, particularly panhypopituitarism, would impose greater impact not only psychologically but also metabolically leading to cardiovascular, morbidity and mortality risks in this patient if not treated early.

A multidisciplinary approach is necessary for patients presenting with MRKH to ensure appropriate treatments and follow-up across the lifespan of the patient.
ПРОФЕСІЙНА РОБОТА ТА МАТЕРІАЛЬНІ УМОВИ ДІЯЛЬНОСТІ УКРАЇНСЬКИХ ПОВІТОВИХ АДВОКАТІВ ГАЛИЧИНИ НА РУБЕЖІ ХІХ–ХХ СТОЛІТЬ
Authors: Кобута Степан
Published: December 2021

Стаття присвячена аналізу професійної діяльності українських галицьких повітових адвокатів на рубежі ХІХ–ХХ століть. Географічними рамками визначено територію сучасної Івано-Франківщини (Станиславівщини). Проаналізовано географію та розвиток адвокатського стану на повітовому рівні, специфіку професійної діяльності, суспільний статус та рівень матеріальних умов життя українських правозахисників.

Українські адвокати свою професійну діяльність спрямовували на захист прав співвітчизників, провадили діловодство і правовий захист українською мовою, зрозумілою для їхніх клієнтів. Цей аспект був важливим для малограмотних українських селян, які вбачали у “своїх” адвокатах захисників не тіль­ки майнових чи соціальних, але й національних прав.

За спеціалізацією участі в судових процесах адвокати поділялися на карних оборонців і циві­ліс­тів. До визначних карних оборонців серед станиславівських адвокатів належали Л. Бачинський, В. Дуди­кевич, Т. Окуневський, К. Трильовський, А. Чайковський. Висококласними захисниками цивільного права вважалися І. Мандичевський, І. Макух, Ю. Олесницький, Й. Партицький, І. Ганкевич. Значний обсяг робо­ти припадав на адвокатів невеличких повітових містечок, які вели різноманітні справи на рівні повітових судів першої інстанції.

Своєю професійною працею та громадською діяльністю українські адвокати формували новий соціальний тип українського галицького інтелігента – освіченого, заможного, успішного. Їх ділова рес­пек­табельність, матеріальний достаток ставали взірцем фаховості і статусності, прикладом для наслідування. Це був поступовий шлях модернізації української нації, де правнича адвокатська верства зайняла місце провідника у національному русі Галичини, продемонструвала приклад станової і соціальної самореалізації.

Ключові слова: адвокати, Галичина, захисник у цивільних справах, канцелярія адвокатська, кар­ний оборонець, правник
ПАРЛАМЕНТСЬКА ДІЯЛЬНІСТЬ ВАСИЛЯ КОВАЛЬСЬКОГО (1873–1891 рр.)
Authors: Кавацюк Дмитро
Published: December 2021

Стаття присвячена діяльності галицького політика Василя Ковальського в австрійському парламенті в 1873–1891 рр. під час V–VII каденцій. Автор дав оцінку виступам депутата на засіданнях Палати послів рейхсрату, здійснив підрахунок поданих ним петицій, інтерпеляцій і виголошених промов у порівнянні з іншими тогочасними депутатами: Іваном Озаркевичем, Едуардом Гербстом, Францом Короніні та Евзебіусом Черкавським. Політик лобіював інтереси українського шкільництва, сприяв мо­дернізації законодавства у сфері судівництва, вирішував питання фінансової дотації Греко-католицькій церкві. З’ясовано відносини В. Ковальського з іншими депутатами парламенту, насамперед Едуардом Гербстом і Францом Короніні, та основні напрями його багатогранної діяльності. Особливу увагу при­ді­лено виборчим кампаніям в округах, де політик виступав кандидатом і завдяки яким потрапив до пар­ла­менту. Висвітлено участь В. Ковальського у виборах до Палати послів у Галицькому сеймі 1867–1871 рр. Основним джерелом для написання статті стали протоколи засідань австрій­ського пар­ла­мен­ту та Галицького крайового сейму, де міститься інформація про обрання В. Ковальського до Палати послів, повний зміст його виступів, а також періодичні видання, спогади сучасників подій тощо.

Ключові слова: В. Ковальський, Палата депутатів (послів), парламент, вибори, Галицький сейм, інтерпеляція, петиція.
Solid Tumors in the Neonatal Period
Authors: Fernández Karen S.
Published: December 2021

Solid tumors discovered at birth or during the first month after delivery are rare. Neonatal tumors are often benign. Malignant tumors in neonates represent only 2% of all malignancies in childhood. Some tumors that appear histologically malignant may show benign behavior, whereas apparently benign tumors may be fatal by virtue of their site of origin, which makes neonatal tumors one of the most difficult diagnostic and therapeutic challenges in the neonatal units. Planning the diagnostic evaluation and therapeutic interventions necessitates a multidisciplinary approach that involves the neonatology, radiology, surgery, pathology, hematology, and oncology services. Here we provide a general overview of the most common tumors seen in the newborn period.
EDITORIAL
Authors: HUBBARD JOHN P.
Published: December 2021

THE first step of the Committee for Improvement of Child Health has been a big one. The Committee has drawn up a recommendation for federal support of pediatric education.

This recommendation arises directly out of the Academy's nation-wide two-year Study of Child Health Services and is the first specific action taken by the ICH Committee. It is a step which has not been undertaken lightly. The proposal was drawn up after consideration in two meetings and consultation with deans of medical schools and heads of pediatric departments, officials of the Federal Security Administration and others particularly concerned. The recommendation was then submitted to the Executive Board and received the unanimous approval of the Board at a special meeting in Chicago on February 8, 1948.
MULTIPLE CYSTIC TUBERCULOSIS OF THE BONES
Authors: BIRDSONG MCLEMORE , L'ENGLE CAMILLUS S.
Published: December 2021

MULTIPLE cystic tuberculous cranial lesions are uncommon. Meng and Wu have reported 40 cases involving the skull, and Gibson has described 32 cases involving multiple lesions over the skeletal system. These two reports point out that in countries where tuberculosis is prevalent, multiple tuberculous lesions of other bones are common.

Jungling called attention to multiple cystic lesions in the bones in nine cases and chose to refer to the condition as osteitis tuberculosa multiplex cystica. The lesions he described were in the small bones of the hands and feet almost entirely, and occurred in adults. A large majority of the cases mentioned were not confirmed by recovery of the tubercle bacillus from the lesions.

In recent years Lyford, Hsieh, et al, Stalmann, Kelly and Sailer, Law and Perham, Martin, Fox, Frost, and Martin and Fogel, have all reported cases of multiple tuberculous bone lesions. Most of these cases have sufficient information to confirm the diagnosis. However, since proven cases of multiple cystic tuberculosis are uncommon in pediatric literature, this being the fourteenth case reported, it seem worth while to record it.

History: No. 222,524, T.B.E., a 13 months old white male child, was admitted with a complaint of subcutaneous swellings and fever for eight months' duration.

Except for several episodes of diarrhea the child was well until he was five months of age. At that time it was noticed that he had swellings on both sides of the neck. During the eight months prior to admission swellings appeared in the axilla, in the groin, on the anterior surface of the right upper leg, on the fourth finger of the right hand, and on the right side of the head. Some of the swellings attained the size of 1.5 cm. They did not increase or decrease in size. They never suppurated nor drained. The swellings were quite tender. At times the nodes softened, only to harden again. After the eighth month of life the child neither gained nor lost weight though he ate fairly well. He ran an intermittent fever, and, for one month prior to admission here, he ran a daily fever as high as 38.8°C.

The child had been treated elsewhere with penicillin and X-ray therapy. A biopsy specimen taken from a node on the right side of the neck was sent to this hospital, and was reported as tuberculous adenitis.

Past history revealed no exposure to tuberculosis. The mother and father had had negative chest X-rays elsewhere. The child had always received raw cow's milk.
Diagnostik der Kinderkrankheiten mit besonderer Berücksichtigung des Säuglings
Authors: GOOD R. A.
Published: December 2021

In the fifth edition of "Diagnostik der Kinderkrankheiten" Dr. Feer has once again attempted to present the elements of pediatric diagnosis in the form of a timely practical handbook for medical students and busy practitioners. Following the semeiotic arrangement employed in previous editions the author draws on his extensive pediatric experience to provide a wealth of accurate diagnostic detail in a refreshingly familiar style. Although the spectrum of pediatric diagnosis is, in general, covered admirably, certain important aspects are neglected. Problems peculiar to the diagnosis of virus and parasitic infections in childhood receive little attention; only the bare elements in the diagnosis of deficiency diseases and endocrine disturbances are discussed; and the fields of acute and chronic poisoning, as well as the subject of malignancy in childhood, are incompletely elucidated.
THE PEDIATRICIAN AND THE PUBLIC
Authors: PARK EDWARDS A. , LONDON ARTHUR H.
Published: December 2021

In the fall of 1943, a group of members of the State Medical Society began a study of medical needs of North Carolina. It was obvious that citizens of many sections were not receiving adequate medical care. While this condition was accentuated by the war, it was known to have existed for many years and that the requirements would likely increase after the war. These doctors were of the opinion that organized medicine within the state has a very definite responsibility in furnishing leadership for a movement that would bring improved medical attention to larger groups of citizens.

While North Carolina has made much progress economically in the past two decades, it, nevertheless, has a comparatively low per capita income—this, of course, is true of most southern states. It ranks third from last in the nation in the ratio of doctors to the population, and is almost as low with regard to hospital beds. Thirty-four of its 100 counties have no hospital beds, and 55 counties have no beds for Negroes. Seventy-three per cent of its population lives in rural areas—towns of 2,500 or less. Roughly, 70% of its doctors live in 10 of the more populous counties.

After many discussions, the group agreed that the following factors were of importance in the overall problems:

1) Shortage of medical personnel, hospitals and their unequal distribution.

2) Inability of a large number of persons to pay for good medical service.

3) Lack of information or initiative on how to use facilities
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: BAUMGARTNER LEONA
Published: December 2021

The accompanying table summarizes the incidence of nine important communicable diseases, based on weekly telegraphic reports from State health departments. The reports from each State for each week are published in Public Health Reports under the section “Incidence of Disease.”

Diseases Above Median Incidence

Influenza.—A total of 8,963 cases in influenza was reported for the 4 weeks ended November 29. The 1942-46 median for the corresponding period was 8,662 cases which was represented by the 1946 incidence. A slight excess over the 5-year median was reported in the South Atlantic and South Central sections, but in all other sections the incidence was below the median seasonal expectancy. Of the total cases Texas reported 4,199, South Carolina 1,754 and Virginia 1,056, those States being mostly responsible for the relatively high incidence in the sections in which they are located.

Whooping cough.—While this disease has dropped from the high level reached earlier in the season, the current incidence was 1.4 times the 1946 incidence during the same 4 weeks, and about 11% above the med
SPECIAL REVIEWS
Authors: STOKES JOSEPH , WARD ROBERT
Published: December 2021

Francis bacon made the suggestion that in gathering scientific data we ought to be neither like spiders, which spin things out of themselves,nor like ants which merely collect, but like bees which both collect and arrange.

With Bacon's advice in mind, I would like to arrange the facts brought out by certain studies which bear on the following questions: (1) How does poliomyelitis virus enter the human body? (2) How is it eliminated? (3) Where is it found outside of man? (4) What are the modes of spread? (5) Why do we have epidemics?

Until recently, the portal of entry in man was considered by many to be by way of the nose. This concept was based on the following: (1) Virus was reportedly detected in human nasal mucosa in one out of three attempts;1 (2) Virus had been recovered from human nasopharyngeal washings collected in such fashion that it was impossible to tell which component, nasal or pharyngeal, contributed the virus; (3) the only extra neural site by which rhesus monkeys could be infected had been by nasal instillation. It should be noted that when monkeys are so infected, typical lesions are always found in the olfactory bulbs.2 Moreover,infection by this route in monkeys can be prevented by spraying the nose with certain chemicals such as zinc sulfate.3

What evidence stands against the nose? First, it should be stressed that in the temperate zones most epidemics of poliomyelitis strike during the warm months—not the common season for
AMERICAN ACADEMY OF PEDIATRICS, INC. PROCEEDINGS AND REPORTS
Authors: TOOMEY JOHN A.
Published: December 2021

Today begins an epoch in the history of the Academy; for it marks the advent of the first issue of the Academy's own journal-Pediatrics. The journal's title is striking, as are its style and format. All of which have been given much thought and study in order to make them outstanding and meaningful.

The contents includes original articles, proceedings and reports from the Academy as well as an informative division composed of feature sections—surely enough to pique the interest of every reader.

The birth of pediatrics was not precipitous, but was a result of long and diligent study by a special committee which concluded that the progress made by our organization in the past few years had been so rapid as to require a journal of its own to help record its many activities and to publish reports thereof. Also, so much is happening in the field of pediatrics that a special journal is needed mainly to coordinate the many developments suggested by the various active committees and to transmit these suggestions to the membership. We have long needed a place for reports, exposition and discussion; no longer will mimeographed bulletins satisfy.

From time to time, voluminous progress reports have been circulated from Dr. John P. Hubbard on the recent Study of Child Health Services. Here, now,is adequate and proper place for their publication. We are gratified in having been able to persuade Dr. Hubbard to direct a fact finding bureau to be called Trends in Health Legislation and
THE USE OF COMPLEMENT-FIXATION TECHNIC IN THE ANALYSIS OF TWO INSTITUTIONAL OUTBREAKS OF MUMPS
Authors: HENLE GERTRUDE , HENLE WERNER , HARRIS SUSANNA
Published: December 2021

Two institutional outbreaks of mumps have been analyzed with the aid of the complement-fixation reaction. The data indicate that mumps occurred only in children who failed to react significantly with the V-antigen at the onset of the epidemic. About 30% to 40% of all infections remained inapparent according to the clinical data of the outbreaks studied, or the records of past mumps. A few children with low antibody levels to both V- and S-antigens developed an increase in anti-V but not in anti-S, a type of response noted not infrequently following skin tests or subcutaneous vaccination. In one of the schools (M) no children were left at the end of the epidemic period who failed to react with the V-antigen. At School D at least eight of the children showed no serologic evidence of recent or past infection. Possible explanations for these various data are discussed.
Child Offenders
Authors: SENN MILTON J. E.
Published: December 2021

In this book juvenile delinquency is appraised by a lawyer not in legal terms nor in concepts of criminal nor moral codes, but in terms of illness, and physical and psychologic symptoms of dysfunction are described. Individual chapters of the book are given over to descriptions of character types, with numerous case reports about the mentally retarded, emotionally unstable, neurotic, physically ill and socially handicapped child. The development of deviant behavior in these individuals is illustrated. Habitual truancy from school is listed as an important early manifestation, and it is emphasized that this should serve as a danger signal to teachers and other school personnel including physicians and nurses.
EXPERIMENTAL USE OF METHYL TESTOSTERONE AND TESTOSTERONE IN PREMATURE INFANTS
Authors: AGERTY HORST A. , SEITCHIK JOSEPH N.
Published: December 2021

One hundred premature infants weighing between 1.8 and 2.3 kg. were studied in respect to time to regain birth weight, time to gain to 2.5 kg., rate of weight gain and protein-nitrogen intake. Fifty-five received an androgen either orally or parenterally. The infants received a diet of varying protein content.

While the results suggested a minimal protein-anabolic effect in all the treated infants, this was associated with a decreased nitrogen intake. Thus no clinical benefit resulted.

Neither the method of administration of the androgen nor the protein content of the diet offered influenced the results.
RETROLENTAL FIBROPLASIA: CLINICAL OBSERVATIONS
Authors: HEPNER W. R. , KRAUSE ARLINGTON C.
Published: December 2021

Retrolental fibroplasia is a postnatally acquired disease. The basic pattern for the disease is present in the majority of premature infants born weighing less than 1500 gm.

A relationship between the electrolyte content of the diet, and fluid retention can be established in small premature infants. A relationship between large blood transfusions and an increased incidence of RLF is presented. Exclusively human milk diets, fed until a weight of 1800 gm. is achieved, do not prevent RLF developing later in infants born weighing less than 1500 gm. ACTH may exert its temporary influence on RLF by its diuretic effect on water and salt metabolism in the premature infant.

Two factors, formulae of high electrolyte concentration and blood transfusion, may overload the capacities for physiologic adjustment of the smaller premature infant, and lead to RLF. A direct relationship between the development of RLF and blood transfusion during a period of water and electrolyte retention is reported.

The practice of feeding high electrolyte formulae, and excessively large blood transfusion for anemia may be responsible for the remarkable variation in incidence from hospital to hospital, the variation in incidence even in the same hospital, and the increasing incidence of RLF in premature infants following the introduction of these practices.
SHORT TERM MANAGEMENT OF A CHILD BEHAVIOR DISORDER
Authors: ROSEN VICTOR H. , LANDSBERG EVA
Published: December 2021

A seemingly obstinate case of refusal to be toilet trained in a four year old boy was treated by brief counselling of the mother. The interpretation of her own conflict was the major factor in the reversal of the child's problem. The rather striking results are discussed in terms of the parent-pediatrician relationship and the pediatrician-psychiatrist team work. The effect of bringing a psychodynamic point of view to bear in the elucidation of intrafamilial tensions is evaluated.
ALTERATIONS IN BLOOD CHEMISTRY CAUSED BY DIARRHEA DURING INFANCY AS DETERMINED BY DIRECT ANALYSIS OF PLASMA AND ERYTHROCYTES
Authors: ETTELDORF JAMES N. , HILL FONTAINE S. , TUTTLE A. H. , PINHEIRO DACIO , BASS ANNE C. , OVERMAN R. R.
Published: December 2021

By direct chemical and physical-chemical analyses, plasma and erythrocyte sodium, potassium and chloride concentrations, plasma calcium, bicarbonate and protein concentrations, and the blood NPN have been determined on infants between the ages of 2 and 15 months with severe diarrhea.

Considerable range and inconsistent changes serve to demonstrate that it is impossible to predict with certainty any definite relationship between the alterations in the various ions in individual cases.

A significant or near-significant reduction in the mean plasma Na occurred in infants with diarrhea under 11 months of age; the plasma K and Cl and the erythrocyte K definitely tend to be reduced, whereas the erythrocyte Na tends with few exceptions to show only a slight increase during diarrhea.

The plasma HCO3 was always reduced and usually significantly so. The degree of acidosis and to a somewhat less extent the decrease in erythrocyte K were related to the severity of the diarrhea.

Significant increases in the blood NPN and plasma protein were usually observed.

The value of the erythrocyte as a practical medium for gauging intracellular ionic alterations which occur during diarrhea is discussed briefly.
SPECIAL ARTICLE
Authors:   THE EXAMINATIONS COMMITTEE
Published: December 2021

The written examination of January 11, 1952 was taken by 462 candidates, a larger number of candidates than on any previous occasion. A sample of the total number was selected for statistical analysis, the sample being made up of the grades earned by 284 candidates who by July 1, 1952 had stood the oral examination and could therefore be classified as having passed or failed the over-all examination. Two additional candidates who appeared for oral examination were given a "condition" in "Growth and Development"; the grades earned by these candidates are not included in the analysis. Of the total of 286 candidates the final results show: passed, 238; failed, 46; conditioned, 2.

The examination was divided into five sections, designated as A, B, C, D and E. Section A was composed of 100 false and true statements. All of these questions had been asked in previous Board examinations and all had been answered correctly by from two-thirds to three-fourths of the candidates. They were so selected to conform with the opinion of the Committee that the purpose of its examination is to discover the poorly qualified candidates and not to assign rank-order preference to the best qualified candidates.

Section B was designed to test the candidate's knowledge of infant feeding. Twenty questions, answerable by "yes" or "no," were presented in connection with three feeding formulas to be assessed by the candidate. The questions of both sections, A and B, offered the candidate only two choices (false or true; yes or no); a correct answer to any question was therefore assigned one-half of a grading point and a perfect score on Sections A and B would have been 60.
Combined Use of Growth Hormone and Gonadotropin-releasing Hormone Analogues: The National Cooperative Growth Study Experience
Authors: Kohn Brenda , Julius Joanne R. , Blethen Sandra L.
Published: December 2021

Gonadotropin-releasing hormone ana-logues (GnRHa) are used to treat central precocious puberty. They also are used to delay puberty in short children with a prognosis for impaired adult height. In both cases, growth hormone (GH) treatment is sometimes added. To determine how North American pediatric endocrinologists are using the combination of GH and GnRHa, we searched the National Cooperative Growth Study (NCGS) database and identified 509 patients who were treated with both. Among them were 139 patients with a diagnosis of precocious puberty. Most of these (82%) also had GH deficiency (GHD). Of the 370 patients who did not have precocious puberty, 71% had GHD. There were 200 patients with precocious puberty who were treated with GH but not with GnRHa. The children who were given GH alone (77% of whom had GHD) were much younger than the children who were given both GH and GnRHa (5.7 ± 2.9 years for those who were not treated with GnRHa vs 9.1 ± 2.7 years for those who were).

Data on both predicted adult height before GH treatment and near- adult height were available for 141 of the patients who were given both GH and GnRHa. There was a statistically significant increase in near-adult height over pre-GH predicted adult height in girls with precocious puberty (5.4 ± 4.3 cm) and without precocious puberty (3.0 ± 6.1 cm). There was no statistically significant gain in height for boys who did not have precocious puberty (1.3 ± 6.8 cm). There were too few boys with precocious puberty (n = 7) to enable meaningful conclusions. In a multiple regression analysis of data on girls who did not have precocious puberty, duration of GH treatment was the most important variable predictive of height gain.gonadotropin-releasing hormone, growth hormone, precocious puberty, idiopathic growth hormone deficiency, organic growth deficiency, idiopathic short stature.
The Insulin-like Growth Factor Binding Protein Superfamily: New Perspectives
Authors: Rosenfeld Ron G. , Hwa Vivian , Wilson Lisa , Lopez-Bermejo Abel , Buckway Caroline , Burren Christine , Choi Won Kyu , Devi Gayathri , Ingermann Angela , Graham Donna , Minniti Giuseppi , Spagnoli Anna , Oh Youngman
Published: December 2021

The insulin-like growth factor (IGF) binding proteins (IGFBPs) were initially identified as carrier proteins for IGF-I and IGF-II in a variety of biologic fluids. Their presumed function was to protect IGF peptides from degradation and clearance, increase the half-life of the IGFs, and deliver them to appropriate tissue receptors. The concept of IGFBPs as simple carrier proteins has been complicated, however, by a number of observations: 1) the six IGFBPs vary in their tissue expression and their regulation by other hormones and growth factors; 2) the IGFBPs are subjected to proteolytic degradation, thereby altering their affinities for the IGFs; 3) IGFBP-3 and IGFBP-5, in addition to binding IGFs, also can associate with an acid-labile subunit, thereby increasing further the half-life of the IGFs; 4) in addition to modifying the access of IGF peptides to IGF and insulin receptors, several of the IGFBPs may be capable of increasing IGF action; 5) some of the IGFBPs may be capable of IGF-independent regulation of cell growth; 6) some of the IGFBPs are associated with cell membranes or possibly with membrane receptors; and 7) some of the IGFBPs have nuclear recognition sites and may be found within the nucleus. Additionally, a number of cDNAs identified recently have been found to encode proteins that bind IGFs, but with substantially lower affinities than is the case with IGFBPs. The N-terminal regions of the predicted proteins are structurally homologous to the classic IGFBPs, with conservation of the cysteine-rich region. These observations suggest that these low-affinity binders are members of an IGFBP superfamily, capable of regulating cell growth by both IGF-dependent and IGF-independent mechanisms. insulin-like growth factor, insulin-like growth factor binding proteins.
A Comparison of Suburban and Urban Daytime Telephone Triage Calls
Authors: Philipp Barbara L. , Wilson Claire , Kastner Beth , Pearson Colleen , Bauchner Howard
Published: December 2021

Objective.

To compare daytime nurse telephone triage calls received by a suburban practice with those received by a hospital-based, inner-city pediatric practice.

Methods.

A research assistant, listening simultaneously with triage personnel, prospectively coded all calls received by the nurse triage telephone offices in 2 pediatric practices. Calls were coded the first full, nonholiday week of 3 consecutive summer and 3 consecutive winter months, alternating morning and afternoon sessions. One practice was suburban and had almost all commercially insured patients; the other was hospital-based, in an inner-city, and consisted mostly of patients with Medicaid coverage or no health insurance.

Results.

A total of 901 calls were triaged in the suburban practice (SP) and 768 in the urban practice (UP). The chief complaints of calls regarding medical problems were similar at both sites. Difficulties with language were noted less often in SP compared with UP (1% vs 17%). The reason for the calls differed by site: medical problem relating to illness or injury (SP 55% vs UP 40%); social issue (SP 1% vs UP 9%); documentation request (SP 2% vs UP 7%); request for laboratory work (SP .3% vs UP 4%); and well child advice (SP 9% vs UP 5%). The disposition of calls also differed by site: telephone advice was offered significantly more in SP than in UP (32% vs 20%); fewer calls required the need for the medical record in SP than in UP (2% vs 12%).

Conclusions.

Calls received by a daytime nurse telephone triage office in an affluent SP and a UP are similar in regard to medical problems. Training programs can feasibly prepare physicians and nurses for both kinds of practice settings. The urban site received more calls affected by language and social issues. This could have administrative implications for staffing ratios, language skills of staff and knowledge of available support services.
Risk Assessment for Gonococcal and Chlamydial Infections in Young Children Undergoing Evaluation for Sexual Abuse
Authors: Ingram Daniel M. , Miller William C. , Schoenbach Victor J. , Everett V. Denise , Ingram David L.
Published: December 2021

Objective.

Testing for gonorrhea (GC) and chlamydial (Ct) infection in children who are being evaluated for sexual abuse is invasive and costly. We developed selective criteria to limit unnecessary testing for these infections.

Methods.

Over a 10-year period (May 1988 to May 1998), clinical information was collected in a prospectively designed database for all children ages 0 to 12 years by the WakeMed Child Sexual Abuse Team in Raleigh, North Carolina. The study population comprised 3040 (2414 girls and 626 boys) of the 3064 children evaluated for sexual abuse. Children were interviewed, examined, and tested by culture for GC and Ct orally, rectally, and genitally. Information from referral sources, accompanying guardians, and previous recent physical examinations was recorded. Bivariate analyses and logistic regression were used to develop 2 sets of screening criteria to predict children at greatest risk of infection with: 1) GC and/or Ct (GC/Ct) and 2) GC alone.

Results.

Fifty-eight children were identified with GC/Ct infections (37 with GC, 25 with Ct; 4 children were coinfected). The proposed algorithm for GC/Ct infections would have identified all children with these infections, while avoiding testing 56% of children without infection. Using genital cultures only, the proposed risk score for GC/Ct infections would have identified 100% of GC/Ct cases with 85% fewer cultures compared with testing all children with oral, rectal, and genital cultures.

Conclusion.

The use of a risk assessment algorithm for GC and Ct infections may reduce the cost and trauma of testing young children who are being evaluated for sexual abuse. sexual abuse, gonorrhea, Neisseria gonorrhoeae, chlamydia, Chlamydia trachomatis, sexually transmitted diseases, children.
SPECIAL REVIEWS
Authors: MILLER ROBERT W.
Published: December 2021

Life in the atomic era has brought with it increased exposure to ionizing radiation. Radiobiology is concerned with the study of the effects of this physical agent. The clinical application of the facts derived experimentally may apply not only to atomic bomb catastrophes, but also to exposures to x-rays in daily medical practice.

Ionizing radiation may alter a key physiologic process thus producing an aberrant cellular differentiation. An undetectable acute change may set the stage for the appearance after a long latent period of (a) congenital anomalies or infertility; (b) carcinogenesis; (c) premature aging and degenerative changes.

Minimal dose levels for producing these changes in humans is not known. However, experimental work to date indicates that the young recipient of x-rays is more apt to develop late sequelae than is the adult. In addition, his longer life span makes him a more likely subject for such changes. Because of unavoidable exposure to irradiation in industry, medicine and warfare, it is suggested that elective pediatric roentgen procedures be limited as much as possible. Roentgen exposure diaries for patients are recommended.
TREATMENT OF ENTEROBIASIS (PINWORM INFESTATION) WITH DIPHENAN®, EGRESSIN® AND GENTIAN VIOLET
Authors: JUNG RODNEY C. , BEAVER PAUL C.
Published: December 2021

Pinworm infestations in children were diagnosed and followed for various periods by means of the cellulose-adhesive-tape technic, after which they were treated with diphenan®, egressin® or gentian violet and again followed for six days or longer. Twenty-four children were likewise tested but not treated.

Diphenan® was found to have no detectable anthelmintic effect when given in high dosage to 53 children.

Judged on the basis of cure-rate on 16 children, egressin® in relatively high dosage was of no value. It did, however, apparently decrease slightly the frequency of egg-deposition.

A standard seven day course of gentian violet produced cures in at least 80% of 33 heavily infested children.

The rate of spontaneous apparent cure was found to be related to the frequency of positive tests during the initial period of observation.

Investigations of remedies for pinworm infestation yield more conclusive results if conducted on selected patients whose rate of spontaneous apparent cure is more or less predictably low.
INCIDENCE OF HYPERTENSION IN POLIOMYELITIS
Authors: PERLSTEIN MEYER A. , ANDELMAN MORTON B. , ROSNER, DAVID C. , WEHRLE PAUL
Published: December 2021

Hypertension is a frequent occurrence in poliomyelitis. In a 1950 epidemic in Chicago it occurred in about one-third of all cases.

Hypertension was generally of transitory nature, although in two instances it was prolonged.

Hypertension was three times more frequent in patients with paralysis than in nonparalytic patients. It was most common in respirator cases.

The incidence of hypertension was not related to the localization of paralysis, emotional factors, anoxia, sympathetic system involvement or kidney involvement. Therefore, it is inferred that it is probably of central origin.
Pesticides
Authors: Weiss Bernard , Amler Sherlita , Amler Robert W.
Published: December 2021

Pesticides are a broad group of heterogeneous chemicals that have a significant public health benefit by increasing food production productivity and decreasing food-borne and vector-borne diseases. However, depending on the agent and the exposure, they may pose health risks. Because of their behavior, acute accidental toxic exposures occur more commonly in children. Because of the dietary habits and greater intake of foods per kilogram in children and because some infants are breastfed, there is also concern about the effects on them of low-level environmental exposures. In the absence of direct conclusive evidence, consistent and relevant observations have led some investigators to infer that chronic low-dose exposure to certain pesticides might pose a potential hazard to the health and development of infants and children. Other investigators have concluded that such inferences can be neither supported nor refuted at the present time. The pediatrician has a role to play in recognizing the symptoms of acute exposure and to be able to provide appropriate treatment. It is essential to study whether there are subtle neurologic effects that may result from low-level pesticide exposures in individual patients.
Hematopoietic Stem Cells
Authors: Trigg Michael E.
Published: December 2021

The hematopoietic system of the young child acquires, through time, the ability to cope with exposure to a number of environmental toxins and infectious agents. Occasionally, severe aplastic anemia occurs secondary to exposure to some of these toxins or infectious agents. The occurrence of severe aplastic anemia provides an opportunity to study the maturation of the hematopoietic system because often the immune system is partially intact. Hematopoietic stem cell transplants permit the study of the complete reconstitution of the hematopoietic and immunologic system. Stem cell transplants are often used to treat severe aplastic anemia or, alternatively, may be part of the treatment for an underlying malignant disease or a genetic disease. Sources of stem cells and the age of the recipient and donor have an impact on the success of the stem cell transplant. A stem cell transplantation provides a window of opportunity to study and observe the normal maturation of the immune system and the sensitivity. Very clearly, children recover from severe aplastic anemia and stem cell transplantations more readily with fewer problems and complications than adults. The environmental risks that a child who received a stem cell transplantation faces are related primarily to the deficiencies of the hematopoietic system and immune system during the recovery phase. Therefore, diminished resistance to infectious agents, primarily viruses and other opportunistic organisms, are the primary risk that children who are recovering from these transplantations face. There are few data on the susceptibility of these children to the toxic effects of other environmental toxicants during the recovery period, which may take years before complete recovery.
Liver
Authors: Piñeiro-Carrero Víctor M. , Piñeiro Eric O.
Published: December 2021

The liver’s unique metabolism and relationship to the gastrointestinal tract make it an important target of the toxicity of drugs and xenobiotics. The developmental changes that occur in the liver’s metabolic activity from birth to adolescence contribute to the varied sensitivity to toxins seen in the pediatric population. Hepatic drug metabolism, often with an imbalance between the generation of toxic metabolites and detoxification processes, can influence the degree of hepatotoxicity. The decreased capacity of the neonatal liver to metabolize, detoxify, and excrete xenobiotics explains the prolonged action of drugs such as phenobarbital, theophyline, and phenytoin. The reduced capacity of glucuronide conjugation in the neonate not only predisposes them to physiologic jaundice but also is probably responsible for the chloramphenicol-induced gray infant syndrome. Age-related sensitivity to drugs is attributable in part to differences in metabolic activity. For example, young children are more resistant to acetaminophen hepatotoxicity when compared with adults, whereas children are more susceptible to valproic acid–induced toxicity. The resistance to acetaminophen toxicity is attributable to biochemical differences in young children. In children, sulfation predominates over glucuronidation, leading to decreased formation of toxic intermediates. In addition, infants have a greater capacity to synthesize glutathione, thereby inactivating toxic metabolites of acetaminophen more effectively. Hepatic toxicity as a result of drugs and environmental toxins presents a wide spectrum of clinical disease. Hepatitis is the most common presentation, but every major type of liver pathology can occur. Most drug reactions are attributable to idiosyncratic hepatotoxins; therefore, liver injury occurs rarely. The diagnosis of toxin-induced liver disease requires a high index of suspicion and often entails the exclusion of other causes of liver disease in children. Drug or environmental xenobiotic-induced hepatotoxicity should be considered in the setting of identified exposure or when other causes of childhood liver disease are excluded. Children who take medications that are known to be hepatotoxic, such as anticonvulsants and antineoplastic drugs, need frequent monitoring for evidence of hepatic toxicity. The treatment is often nonspecific; the most important intervention is the prompt discontinuation of the drug or removal of the environmental toxin. A specific antidote is available only for acetaminophen intoxication. In cases of severe toxicity, the patient may develop liver failure. Liver transplantation may be necessary for patients whose liver failure does not resolve.
ON THE POSSIBLE INFLUENCE OF GREAT ALTITUDES ON THE DETERMINATION OF CERTAIN CARDIOVASCULAR ANOMALIES
Authors: ALZAMORA VICTOR , ROTTA ANDRÉS , BATTILANA GUIDO , ABUGATTAS RICARDO , RUBIO CARLOS , BOURONCLE JOSÉ , ZAPATA CÉSAR , SANTA-MARÍA E. , BINDER TODORO , SUBIRIA RICARDO , PAREDES DAVID , PANDO BENJAMÍN , GRAHAM GEORGE G.
Published: December 2021

Over a period of 8 years, 176 cases of cardiac anomalies have been found in over 10,000 consecutive admissions. The place of birth and its altitude have been recorded for each one of these causes.

Patent ductus arteriosus and persistent interatrial communications are more likely to be found in patients born at high altitudes.

It is suggested, but remains to be shown, that this is true for defects of the pulmonary artery. No apparent relation could be found in this series for other malformations.

It is presumed that mechanical factors tied to the pulmonary circulation and the lower oxygen tension both have a decisive influence.
SPIROMETRIC ANALYSIS OF LUNG FUNCTION FOLLOWING PULMONARY RESECTION IN CHILDHOOD
Authors: TURNER J. A.
Published: December 2021

A group of 40 individuals who underwent pulmonary resection in childhood were studied by means of spirometric tracings. The time interval between operation and testing varied from 3 months to 19 years. The ages at operation ranged from 3 years to 15 years.

No significant disturbance of resting ventilation, oxygen consumption or average tidal air was found. Reduction in vital capacity corresponded to the extent of resection performed and was more marked in those instances in which bilateral resection was necessary. It was noted that reduction in vital capacity was more evident in the inspiratory phase in all instances except those suspected of having continuing pulmonary disease. In these individuals the reduction in vital capacity was more marked in the expiratory reserve phase.

Maximum voluntary ventilatory capacity reduction was likewise compared to extent of surgical resection and showed a correlation similar to that of vital capacity. Evidences of pulmonary emphysema were more apparent in those cases whose maximum breathing capacity was markedly reduced. In all but one instance breathing reserve figures were within the normal range.

Although children tolerate pulmonary surgery extremely well, the age at operation is not the significant factor in the degree of resultant pulmonary function. The important factors are those of extent of pulmonary resection and consequent pulmonary emphysema.
HEREDITARY NONSPHEROCYTIC HEMOLYTIC ANEMIA PRESENTING AS HEMOLYTIC DISEASE OF THE NEWBORN INFANT
Authors: BRUTON OGDEN C. , CROSBY WILLIAM H. , MOTULSKY ARNO G.
Published: December 2021

A case of hereditary nonspherocytic hemolytic disease is reported. The patient presented the clinical picture of hemolytic disease of the newborn infant at birth; however, laboratory studies confirmed the correct diagnosis. Family study revealed the mother to have a similar but milder hemolytic anemia. Splenectomy in the patient at 10 months of age was not beneficial. Differential diagnosis is briefly discussed. The nature of the red cell defect responsible for the condition is unknown. This study points out that hereditary nonspherocytic hemolytic anemia should be considered in patients with the clinical picture of erythroblastosis fetalis who fail to have the expected laboratory findings of that disease.