bluuebunny/crossref_metadata_2025 huggingface dataset:
Animal Tests to Screen for Human Teratogens
Authors: Sullivan Frank M.
Published: December 2021

Despite Dr. Brent's statement earlier that animal models are not good for teratologic testing, they are all that we have at the moment. It is not reasonable to use new compounds without some preliminary experimental teratology, and it is not reasonable to think we can use human beings for toxicological screening of new compounds. Therefore, I should like to describe briefly, especially for the clinicians present, several aspects of teratologic testing in animals. First the question, "Is a given drug teratogenic?" To my mind that is the same type of question as, "Is a given drug toxic?" because teratogenesis is just one aspect of toxicology. For almost any compound someone could devise a system to show that it is teratogenic.

When a drug or chemical is administered to a pregnant animal, it can affect either the mother first or the fetus first. If the fetus is more sensitive, low doses may produce malformations. At higher doses more severe effects occur, namely lethality. At still higher doses, the mothers themselves become ill.

If the mother is more sensitive, no effects are observed on the fetus until the mother receives near-lethal doses, at which time one begins to see abnormal or defective fetuses. We have found that, generally, drugs which are teratogenic for the fetus at almost toxic levels for the mother are rather safe. Drugs that are teratogenic at doses much lower than the toxic levels for the mother are, on the whole, unsafe. The judgment is made without regard to the therapeutic dose of the drug.
Industrial and Agricultural Chemicals
Authors: Sandifer S. Hope
Published: December 2021

The alert practitioner should know the types of pollution created by agriculture and industry in his area. In agriculture, two important pollutants are nitrates and pesticides (which include insecticides, herbicides, fungicides, rodenticides, and defoliants). Pediatricians are well aware of methemoglobmnemia due to excessive nitrates in water. Nitrates in water supplies are of increasing concern because of runoff from feed lots and incremental use of fertilizers. Tolerance levels of nitrate in municipal water supplies are established, and pediatricians should insist that these standards be enforced in their community.

With regard to pesticides, the Environmental Protection Agency has funded 13 community studies throughout the United States. The purpose is to monitor the health of pesticide workers compared with suitable controls. To date no significant health effects have been demonstrated. Most studies have been made on adult males because of their occupational exposure to pesticides. The groups under surveillance include workers who manufacture pesticides, pest-control operators who spray daily, and farmers who have intermittent exposure to high concentrations of pesticides. We are seeking the effects, if any, in the most heavily exposed persons before trying to determine the effects of smaller doses. This approach suffers the problem of small sample size (several thousand instead of hundreds of thousands of exposed persons).

Our studies and those of others have shown that DDT in the sera of blacks is about two to three times that of whites.1-3 We had assumed that this difference was due to environmental exposure, but recent studies in Charleston, South Carolina, have suggested a genetic factor.
Overview: The Effects of Chemical Pollutants on the Fetus and Child
Authors: Robbins Frederick C.
Published: December 2021

What I have to say in my summary will be very personal. It concerns information that has filtered through those remaining neurones, and perhaps reflects certain prejudices which result from a good many years of association with a rather comparable field, the prevention of infectious diseases and the development and introduction of vaccines. This work has many problems similar to those pertaining to chemical pollutants. Throughout this Conference we have emphasized repeatedly the peculiar susceptibility of the fetus and young child to environmental chemical pollutants. It has been pointed out that, in addition to the periods of special vulnerability (particularly evident in early fetal life), the infant and child are more subject to certain environmental risks at different stages of development (e.g., the high incidence of poisonings in toddlers). Our special concern for the fetus and the young child is not based on these considerations alone. Clearly, any adverse happening to an individual early in life, particularly if it affects intellectual achievement, provides a great burden on the social system; and, the longer the period this person must be supported by society, the greater the burden and the greater the cost-not just in money but in many other ways. Death from the socioeconomic point of view is relatively unimportant, compared to a chronic disability.

Behavioral psychologists have taught us about imprinting, which is particularly evident in some animals but has not been demonstrated in children. Dr. Holland's comments about the effect of air pollution in the first year of life, and its sequelae in later life are of great importance, and certainly need to be subjected to further study.
Familial Congenital Duodenal Atresia
Authors: Der Kaloustian Vazken M. , Slim Michel S. , Mishalany Henry G.
Published: December 2021

More evidence for the genetic etiology of a form of duodenal atresia has been coming our way since the publication of our report in Pediatrics,1 followed by a Letter to the Editor.2

The original paper and the follow-up letter reported three patients with congenital duodenal atresia in two families closely related. All four parents were first cousins of each other and an autosomal recessive type of inheritance was suggested. The source of the proposed gene for both families was traced to a single individual.
Evaluation of Neck Masses: The Soft-Tissue Roentgenogram
Authors: Schmitt Barton
Published: December 2021

Jaffe and Jaffe in their recent excellent article1 have reminded us that one out of six malignant neck tumors has its origin in the nasopharynx. They recommend examination of this relatively inaccessible site by means of direct viewing through the nose, indirect viewing via a nasopharynx mirror, or palpation. Since all of these techniques are difficult for the physician who does not use them frequently, I would appreciate their comments on the reliability of a lateral soft-tissue film of the neck for detection of nasopharyngeal masses.
Infectious Diseases of Children and Adults, ed. 5, by Saul Krugman, M.D., and Robert Ward, M.D. Saint Louis: The C. V. Mosby Company, 1973, 494 pp., $21.50
Authors: Karzon David T.
Published: December 2021

Among the many books in the pediatric armamentarium there are some that emerge as "classics" in their time. Such is the stature of Krugman and Ward's Infectious Diseases of Children and Adults which has recently appeared in its fifth edition. This time the title is expanded to "of Children and Adults." The book retains the virtues of earlier editions. It remains a readable "slim volume" despite significant additions. It bears the homogeneity, individuality and wholeness attainable in a volume written not by a collection of editors but by two very close colleagues.
EPSDT
Authors: Foltz Anne-Marie , Silver George A.
Published: December 2021

Dr. Dixon makes a well-balanced, mildly critical presentation of EPSDT elsewhere in this issue. We are more hopeful of the eventual impact of EPSDT and less sanguine about its present success than the author. For a long time there has been no real concern with the desperate, even scandalous neglect of child health by government. This was, of course, at the same time that we were exposed to the pious cant about "heritage of the future" and "a nation's most precious possession." Consequently, for Secretary Gardner to have achieved the Congressional approval for as wide-ranging a proposal as the mandated examination and treatment of every eligible child was an historic success.
Rectal Absorption From Aspirin Suppositories in Children and Adults
Authors: Nowak Margaret M. , Brundhofer Barbara , Gibaldi Milo
Published: December 2021

Absorption of salicylate was determined by means of urinary excretion techniques after rectal administration of a commercial aspirin suppository to eight children and four adults. The absorption of drug from the suppository was exceedingly slow; perhaps an order of magnitude slower than that observed after oral administration of conventional tablets. The amount of drug absorbed was highly dependent on the time between insertion and the first defecation (retention time ). Retention times as long as four to five hours resulted in only about 60% of the dose being absorbed. In our judgment the use of aspirin in the form of rectal suppositories provides the clinician with little control over drug therapy.
Leukocyte Lactate Dehydrogenase in Bacterial Meningitis
Authors: Powers David W. , Ayoub Elia M.
Published: December 2021

Lactate dehydrogenase (LDH) was assayed in peripheral leukocytes of 32 children with bacterial meningitis, nine children with nonbacterial meningitis, and 24 age-matched, healthy controls. Leukocyte LDH activity in patients with bacterial meningitis was significantly higher than in patients with nonbacterial meningitis (p < 0.01) and normal controls (p < 0.001). Eighty-eight percent of the patients with bacterial meningitis had leukocyte LDH values exceeding, 150 units/106 WBC, the upper limit of normal value for controls. Nitroblue tetrazolium (NBT) dye tests performed on 23 patients with bacterial meningitis were elevated in ten patients (43%). The elevation of leukocyte LDH activity in patients with bacterial meningitis appears to be independent of the number of circulating granulocytes or the presence of bacteremia. A major factor which appeared to influence the leukocyte LDH activity was the duration of adequate antibiotic therapy. Sequential determinations showed a return of the LDH values to normal approximately ten days after the initiation of therapy. A rise in leukocyte LDH was encountered in two patients with subdural effusion. The finding of significantly elevated leukocyte LDH values in three newborn infants with neonatal meningitis and sepsis suggests that this test may be of value in the diagnosis of neonatal sepsis.
Atresia of the Common Pulmonary Vein: Report of One Case
Authors: Mody Gita T. , Folger Gordon M.
Published: December 2021

Common pulmonary vein atresia is a rare cause of pulmonary venous obstruction which leads to the early development of hypoxemia and acidemia with death in the neonatal period. The characteristic radiographic appearance of the lungs is due to extreme dilatation of the subpleural lymphatic channels. This entity may be differentiated from the other lesions causing pulmonary venous obstruction by selective angiography. Total surgical correction with an anastomosis between the common pulmonary vein and left atrium is feasible but has not been successful thus far.
EPSDT (Early and Periodic Screening, Diagnosis and Treatment Programs)
Authors: Dixon Morris S.
Published: December 2021

EPSDT is the means the federal government has selected to force the states to seek out poor children who are out of the mainstream of medical care and to offer them preventive services. The use of periodic screening exams (as defined in the Program Regulations Guide) is an untried method of providing health care and may be unsuccessful, but fortunately the states have been given much freedom in program design and future modification.

Major obstacles at present are the absence of specific goals at the state level, and a lack of commitment by state governments and administrators to provide adequate funds and direction for a successful program. Inadequate health resources in inner cities and rural areas, the lack of outreach workers, and a low priority for health care on the part of the consumer all add to the problem.

If EPSDT is successfnl in screening out children with problems and then providing diagnosis and treatment for them, it will be a major achievement. If it takes the next step and places children in a continuing primary care facility, it will be a significant advance in achieving the Academy's goal-the attainment by all children of their full potential for physical, emotional, and social health.
Quality Assurance The Road to PSRO and Beyond
Authors: Haggerty Robert J.
Published: December 2021

Assuring the quality of medical care is now mandated by law. The method to be used initially of peer review through organizations built to review hospital care paid for by Medicare and Medicaid is one step along a long road to guarantee or to improve the quality of care. It would seem wise to begin with simple and uniform data that can yield some idea of what is going on in the process of delivering care. The use of the uniform hospital discharge abstract is one place to begin. I believe we should not ignore nor condemn this public mandate because it will be so rudimentary at the beginning. It is necessary to have limited expectations of what these new organizations can be expected to accomplish. The negative comments should not reduce the importance of this national experiment. We can begin with an active program of applied research to define the goals of health care better, to develop better methods to measure these goals, to document some of what now happens in practice, and to remember that the purpose of the exercise is not to police health care but to stimulate better care and better health for the public. We are embarking on a major social experiment, one that no nation has even before attempted. With initial limited goals and willing participation of physicians in the program my judgment is that more good than harm will result.
Searching the cause for seizures
Authors: Menkes John H.
Published: December 2021

As in other neurological disorders, the diagnostic process in a child with epileptic seizures attempts to answer two questions: (1) the ascertainment of the type of seizure that the child has experienced, and its focus, if any; and (2) the cause for the attacks.

The paper by Yalaz and Treves,1 published in the current issue of Pediatrics, raises the point as to how extensively one should search for an answer to these questions. A thorough history, taken not only from the parent, but also from the child who may prove to be a surprisingly reliable informant, is undoubtedly the single most important prerequisite for diagnosing the seizure type.
Identification of Streptococcus pyogenes in a Pediatric Outpatient Department: A Practical System Designed for Rapid Results and Resident Teaching
Authors: Sprunt Katherine , Vail Dorothea , Asnes Russell S.
Published: December 2021

A rapid screening method for identification of clinic patients with pharyngitis who are carrying group A beta-hemolytic streptococci and for teaching residents the values and limitations of the culture-disk approach to identification has been reviewed as developed for a busy clinic and a busy hospital laboratory. Identification of positive cultures in less than 24 hours, using Taxos A disk and specific fluorescent antibody uptake, resulted in 12% apparent false-positive and 3.6% false-negative reports. However, when viewed in the light of the techniques used for verifying results, there were probably 3% false-positive and 3% false-negative reports. The screening method is considered acceptably reliable and practical as a laboratory tool and a resident teaching device.
Intracranial Pressure During Compressive Head Wrapping in Treatment of Neonatal Hydrocephalus
Authors: Epstein Fred , Wald Alvin , Hochwald Gerald M.
Published: December 2021

Cranial compression has been advocated as a rational treatment technique for select cases of neonatal hydrocephalus. In this report the effect of iatrogenically elevated intracranial pressure on underlying spinal fluid hydrodynamics is documented. It was noted that prior to "treatment" intracranial pressure was in the range of 200 to 250 mm H2O. During cranial compression it was elevated to 500 to 700 mm H2O. When treatment was temporarily suspended after three to four hours, pressure abruptly dropped below the pretreatment baseline value and gradually increased over one to two hours. It is concluded that the latter changes were secondary to accelerated CSF absorption during cranial compression and gradual reaccumulation when treatment was terminated.
Fond memories of Virginia Apgar
Authors: James L. Stanley
Published: December 2021

Virginia Apgar died in her sleep on August 7, 1974, but the example of her life, her enthusiastic spirit, her optimism, her generosity, and her fearlessness are still very much alive. She was 65 years old. In her lifetime she had at least five careers: anesthesiology, public health, genetics, aviation, and research. In addition, there were her many hobbies. And she excelled in all.

She was one of the most remarkable people I have ever known. With her, life was exciting; her youthful enthusiasm and energy were boundless. She was warm and compassionate, and at the same time had a great sense of humor, sometimes earthy.
The Japanese Operation for Biliary Atresia: Remedy or Mischief?
Authors: Lilly John R.
Published: December 2021

A case illustration is given of an infant with biliary atresia who had the Kasai operation more than 1½ years ago and is now, by all biochemical and histiological criteria, cured. The early results with this operation in 14 patients are similar to those reported by the Japanese, that is, 25% have had sustained postoperative bile drainage. Success has never been achieved in infants older than 4 months. A long-held notion in this country to withhold operation in infants with jaundice until after 4 months has thus far militated against a critical and impartial evaluation of the Kasai operation. A plea is made to complete diagnostic work-up for jaundice during the first months of life so that the operation, if elected, may have a genuine chance for legitimate long-term analysis.
WHO INVENTED THE POPSICLE?
Authors: Dickson Paul
Published: December 2021

Frank Epperson was the inventor who made lemonade from a specially prepared powder that he sold at an Oakland, California, amusement park. While visiting friends in New Jersey, he prepared a batch of special lemonade and inadvertently left a glass of it on a windowsill with a spoon in it. The temperature went down below zero during the night and in the morning Epperson saw the glass. He picked it up by the spoon handle and ran hot water over the glass freezing the frozen mass. In his hand was the first Epsicle, later to be known as the Popsicle. Epperson saw immediately the potential of what he held in his hand and applied for a patent, which was granted in 1924. He was fortunate, because research conducted by The Ice Cream Review in 1925 revealed that a major ice cream company was experimenting with "frozen suckers" at the time of the windowsill incident, and as far back as 1872 two men doing business as Ross and Robbins sold a frozen-fruit confection on a stick, which they called the Hokey-Pokey.
WISDOM OF A NOBEL PRIZE WINNER
Authors: Timbergen N.
Published: December 2021

"What is the upshot of these remarks?"

First of all they stress the importance for medical science of open minded observation—of "watching and wondering." This basic scientific method is still too often looked down upon by those blinded by the glamor of apparatus, by the prestige of tests, and by the temptation to turn to drugs . . ."

Medical science and practice meet with a growing sense of unease and lack of confidence from the side of the general public. The causes are complex, but at least in one respect the situation could be improved: a little more open mindedness, a little more collaboration with other biologic sciences and a little more attention to the body as a whole and the unity of body and mind could substantially enrich the field of medical research.
Recurrent Acute Pancreatitis in Patients With Cystic Fibrosis With Normal Pancreatic Enzymes
Authors: Shwachman H. , Lebenthal E. , Khaw K.-T.
Published: December 2021

Ten adolescent and young adults with cystic fibrosis (CF) have had well-documented recurrent attacks of acute pancreatitis. The diagnosis of CF in each patient was delayed because they did not have pancreatic insufficiency. The diagnosis of CF was documented by the typical pulmonary involvement and elevated sweat sodium and chloride levels in all cases and a positive family history in six of the ten patients. Two patients were diagnosed as having acute pancreatitis before the diagnosis of CF was made, thus indicating that acute pancreatitis may be the presenting complaint in the young adult with CF. The diagnosis of acute pancreatitis was based on the presence of severe abdominal pain, usually with vomiting, tenderness in the mid-epigastrium, elevated serum and urinary amylase and serum lipase. Attacks were precipitated by fatty meals, alcohol ingestion, postcholecystectomy and tetracycline administration. In some patients no precipitating event could be elicited. Intravenous secretin-pancreozymin stimulation tests revealed a diminished bicarbonate secretion with little effect on the secretion of the zymogen enzymes. A mild attack of pancreatitis occurred after secretin-pancreozymin stimulation. The endocrine pancreatic function tested in four patients was normal as revealed by the glucose tolerance tests and determinations of serum insulin, growth hormone and free fatty acid. Transduodenal pancreatograms were performed in three patients; one showed a normal pancreatic duct, one showed duct obstruction and in the third patient a beady type of narrowing was found. The selenomethionine Se 75 uptake of the pancreas was noted only in the head of the pancreas. This suggests that loss of function occurs initially to a greater extent in the tail and body of the pancreas. Three patients died and showed characteristic lesions of CF.
Separation Protest in Day-Care and Home-Reared Infants
Authors: Kearsley Richard B. , Hartmann Rebecca , Zelazo Philip R. , Kagan Jerome
Published: December 2021

Separation protest was measured by the onset and duration of fretting or crying in 24 day-care and 28 home-reared infants during a two-minute period of isolated separation from their mothers in an unfamiliar room. Separation episodes were repeated under similarly controlled circumstances at two-month intervals from 3½ through 13½ months and at 20 months of age. The composition of the daycare and home-reared groups was similar for sex, ordinal position, and family background. Day-care and home-reared infants showed similar patterns in the manifestation of separation protest over age, with sharp reductions in latency to crying and marked increases in the occurrence of crying at 9½ and 13½ months. These results suggest that the psychological processes underlying separation protest are not meterially altered by the continuing presence of the young infant in a day-care program designed to meet both his physical and psychological requirements.
Metastatic Malignant Melanoma in Prepubertal Children
Authors: Trozak Daniel J. , Rowland Willard D. , Hu Funan
Published: December 2021

Medical literature is full of involved and Confusing reports on the genesis, incidence, and development of metastatic melanoma in children. The reason for this confusion can be found in the early uncertainties that surrounded the real nature and correct diagnosis of metastatic melanoma in the prepubertal child. Before 1950, reports of melanomas with metastases in children were rare, poorly documented, and in many cases erroneous.1-4 In particular, benign nevi (now known as benign juvenile melanoma) went unrecognized and because of their alarming microscopic features were often diagnosed as malignant melanomas. For example, deceived by the predilection of this nevus for childhood, its frightening appearance, and failure to metastasize, Pack and Anglem wrote: ". . . . although malignant melanomas are found in infancy and childhood, they are of low grade malignancy and seldom metastasize" In a later paper, Pack6 coined the term "prepubertal melanoma" for those nonmetastasizing pigmented tumors of children which were microscopically indistinguishable from melanoma. He suggested removal before puberty when endocrinologic stimulation rendered certain of them capable of metastasis. Other investigators also noted this seeming disparity between microscopic appearance and clinical behavior.7 In 1948, Spitz8 provided the criteria for separating this unusual-looking nevus from malignant melanoma and termed it "juvenile melanoma." Later she and Allen9 showed that although these lesions are not restricted to children, they are much more common before puberty.* Subsequent authors10-13 have also classified juvenile melanoma among the benign nevi and the term spindle or epithelioid cell nevus10,12,13 is now preferred. McWhorter and Woolner13 in 1954 reviewed the subject of malignant melanoma in children and suggested that the favorable prognosis was spurious and due to the erroneous classification of spindle and epithelioid cell nevi under the former agnosis.
Clindamycin Treatment of Osteomyelitis and Septic Arthritis in Children
Authors: Feigin Ralph D. , Pickering Larry K. , Anderson Donald , Keeney Ronald E. , Shackleford Penelope G.
Published: December 2021

Forty-eight children, 1 month to 14 years of age, including 11 patients with untreated acute osteomyelitis, 8 with pretreated acute osteomyelitis, 12 with septic arthritis, and 11 with cellulitis or soft tissue abscess, were treated with clindamycin. Staphylococcus aureus was isolated from the blood, synovial fluid, bone, or soft tissues of 27 of these individuals while group A, beta-hemolytic streptococci or Clostridia were isolated from 9 patients. Clindamycin was provided intravenously until patients were afebrile for three days followed by orally administered clindamycin for one week in patients with cellulitis to as long as six months in patients with chronic osteomyelitis. Clinical and bacteriologic responses to treatment generally were excellent, most likely reflecting the excellent serum and tissue concentrations of clindamycin which were achieved. Serum concentrations of clindamycin following intravenous infusion at 20 to 30 mg/kg/day in three divided doses were 8-to 32-fold in excess of the minimal inhibitory concentrations of all organisms isolated in this study. Bone and synovial fluid concentrations of clindamycin were 60% to 85% of the serum concentrations measured concomitantly. Clindamycin provides an effective alternative treatment of osteomyelitis and septic arthritis in children who are sensitive to penicillin.
Osteomyelitis and Sepsis: Severe Complications of Fetal Monitoring
Authors: Overturf Gary D. , Balfour George
Published: December 2021

Sophisticated modern methods of fetal monitoring during labor have improved the prognosis for highrisk infants, but the possible adverse side effects have not yet been fully documented. One infant with osteomyelitis and one with streptococcal sepsis are reported. In the future, greater attention should be paid to such potential complications and new noninvasive techniques of fetal monitoring should be developed.
Is There Evidence That Antibiotics Prevent Oral Infections?
Authors: Speck William T.
Published: December 2021

Dr. Alan M. Polson's article on gingival and periodontal problems in children was most informative.1 However, I found the last sentence somewhat puzzling, i.e., "Antibiotics are a help in preventing secondary infection." I wonder if the author could (1) provide evidence to substantiate his suggestion that secondary bacterial infection occur with acute herpetic gingivostomatitis and (2) substantiate his claim that antibiotics prevent such a complication?
Questions Regarding Neonatal Hepatitis
Authors: Thaler M. Michael
Published: December 2021

Lawson and Boggs1 reported the results of long-term follow-up of 23 patients with "neonatal hepatitis." The authors state that "familial neonatal hepatitis had significantly more serious morbidity and mortality than the sporadic disease, whether or not surgically treated." It is difficult to see how this conclusion was reached on the basis of a total of five cases from two families, without a control group of unoperated familial cases. Moreover, the two families are put forward as examples of familial neonatal hepatitis, whereas they appear to represent two distinct types of liver disease: family S is subject to a chronic hepatocellular process characterized by relatively elevated bilirubin, transaminase, and prothrombin values and normal alkaline phosphatase values, which terminates fatally in biliary cirrhosis; in family McK, hepatic excretory function appears primarily affected, resulting in pruritus, elevated alkaline phosphatase values, hypercholesterolemia, and progression to chronic cholestasis, presumably reflecting paucity of intrahepatic bile ducts.
Diiodohydroxyquin and Optic Atrophy
Authors: Idriss Ziad H. , Derkaloustian Vazken M.
Published: December 2021

In the July 1974 issue of Pediatrics, several articles appeared concerning acrodermatitis enteropathica, the use of diiodohydroxyquin as a therapeutic agent, and the risk of developing optic atrophy secondary to that drug. We have reported three cases of acrodermatitis enteropathica of childhood; two of these patients were successfully treated with diiodohydroxyquin.1 One developed optic atrophy during the course of treatment (1,500 mg/day), while the other did not. It would be interesting to know how many patients have been treated by Drs. Pittman et al, Rayhamzadeh et al, and Fleisher et al, and how many have suffered from optic atrophy.
Surveillance of pediatric adverse drug reactions: A neglected health care program
Authors: Bleyer W. Archie
Published: December 2021

Dr. Alan K. Done, Director of Pediatric Pharmacology for the Food and Drug Administration, has recently secured a commitment from the pharmaceutical industry to complete preclinical studies of the many drugs which have not as yet been tested in young animals and are therefore not currently available for use in children. Once accomplished, this action and others already taken by the agency should help solve the problem of "therapeutic orphans."1 On the other hand, young children continue to be exposed to a large number of drugs which are already on the market and which are being given without adequate medical supervision or monitoring for adverse reactions.
Smallpox Vaccination Reactions, Prophylaxis, and Therapy of Complications
Authors: Goldstein Joel A. , Neff John M. , Lane J. Michael , Koplan Jeffrey P.
Published: December 2021

Smallpox vaccination in the United States is a routine public health measure which has been under intensive review during the last decade. The most frequently occurring adverse reactions to vaccination are benign and require little or no systemic therapy. These reactions include accidental infection, erythematous and urticarial rash, and generalized vaccinia. Chickenpox occurring concurrently with vaccination presents no problem unless vaccinia has widely superinfected the chickenpox lesions. There is no risk to the pregnant woman who is vaccinated, but there is a slight risk that the fetus will develop fetal vaccinia. The vaccinia does not cause congenital malformations. Vaccinia hyperimmune globulin (VIG) in prophylactic dosage may be given to a pregnant woman who is traveling to a smallpox infected or endemic area in order to prevent fetal vaccinia.

Vaccinia necrosum and eczema vaccinatum require vigorous systemic therapy with VIG, and often thiosemicarbazone. Post-vaccinial encephalitis, while frequently serious, has not been shown to be ameliorated by VIG therapy, although there are data which suggest VIG has some value in prophylaxis for encephalitis. Prophylaxis, prompt recognition, and proper therapy may reduce the fatality rates of these complications.

Revaccination of patients who have suffered a complication is a frequent clinical problem. Revaccination of an individual who has had post-vaccinial encephalitis or vaccinia necrosum is contraindicated unless the risk of contracting smallpox outweighs the risk of the above two diseases. Revaccination of children who have had eczema vaccinatum is not contraindicated. Revaccination of children with a history of accidental infection or erythematous or urticarial rash presents no known or theoretically increased risk.
THOMAS RAYNALDE ON GOGGLE EYES (1552)
Authors: C. T. E.
Published: December 2021

Thomas Raynalde (fl. 1540-1551), an English physician, is best known as the translator of Eucharius Roesslin's Rosegarten which is known in English as the Byrth of Mankynde. This, the first English printed book on midwifery, recommends that goggle eyes be treated as follows:

If the child have goggle eyes, or that it look a squint, then first set the cradle in such a place, that the light may come directly and right in the child's face, neither in the one side, neither in the other, neither above the head, lest it turn the sight after the light. Also mark, on which side the eyes do goggle, and let the light come unto it on the contrary side, so that by this means the goggling of the eyes may be returned to the right place. And farther, it shall be good to hang clothes of divers and fresh colours on the contrary side, and specially of the colour of light green or yellow, for the child shall have pleasure to behold these strange colours, and in returning the eyesight towards such things, it shall be occasion to rectify the sight again.1
The Timing of Tuberculin Tests in Relation to Immunization With Live Viral Vaccines
Authors: Brickman Helen F. , Beaudry Pierre H. , Marks Melvin I.
Published: December 2021

The validity of the recommendation that routine screening for tuberculosis precede the administration of live viral vaccines was tested in a field study. One hundred and ten children already known to be tuberculin-positive, mostly on the basis of prior vaccination with BCG, were immunized with live viral vaccine and retested with tuberculin at the same time. Reversion to a negative tine test occurred in 3% of children given measles, mumps, or rubella vaccine, and 3.6% of controls who received no vaccine but had the tuberculin test repeated at the same intercal. Very few Mantoux reactions (two of 68) reverted to negative in children given one of the three vaccines, singly or in combination; some became smaller, but there was no significant difference in the changes in the size of the Mantoux reaction between the vaccinated group and the control group, with the exception of an unexplained increase in the size of the reaction in many of those who received rubella vaccine. Screening for tuberculosis by tine or Mantoux test is not invalidated by simultaneous administration of vaccines against measles, mumps, or rubella, given singly or in combination, as part of preventive care programs.
Aspects of Communication Between Patients and Doctors: An Analysis of the Discourse in Medical Interviews
Authors: Raimbault Ginette , Cachin Olga , Limal Jean-Marie , Eliacheff Caroline , Rappaport Raphaël
Published: December 2021

The transcripts of tape-recorded interviews of pediatric endocrinologists and patients with Turner's syndrome and their parents were reviewed in consultation with child psychoanalysts in order to evaluate certain aspects of communication between patients and doctors. The transcripts showed that the doctors often talked at cross purposes with the parents and their patients, evading emotional issues in favor of quasi-scientific explanations which the patients and parents did not understand. Parts of the discourse, at times unconscious, have been shown to be of great importance as means of communication. Reviewing the transcripts of the doctor-patients discourse is an excellent way of improving one's therapeutic communication with the patient. The same material can be used for teaching purposes.
Dr. Pierce Replies
Authors: Pierce Alexander W.
Published: December 2021

Dr. Manoguerra is correct in noting discordance between the two articles included in the symposium on poisoning in childhood.

It is generally accepted that the combined use of syrup of ipecac and activated charcoal requires deferring the administration of the activated charcoal until emesis has been induced. Since activated charcoal should be administered within 30 minutes of ingestion to achieve significant inhibition of drug absorption and since syrup of ipecac frequently requires 30 minutes to induce emesis, combined use of the two therapeutic modalities has been precluded.
The lost art of consultation—a plea for the return of striped trousers
Authors: Goldbloom Richard B.
Published: December 2021

Having grown up in a medical household, I remember vividly my late father's reminiscences about the accepted protocol for medical consultation during his early years as a practicing pediatrician in Montreal more than half a century ago. In those days, whenever a second opinion was requested by the patient's family or physician, the family physician made a personal approach to the consultant, preliminary discussion of the problem was held, and a time was established when physician and consultant would convene at the bedside, whether at the home or in hospital.

The details of the consultation rite were formal and unvarying.
Diagnosis of Pneumothorax or Pneumomediastinum in the Neonate by Transillumination
Authors: Kuhns Lawrence R. , Bednarek Francis J. , Wyman Michael L. , Roloff Dietrich W. , Borer Robert C.
Published: December 2021

Transillurmination of the neonatal chest is described as an aid in the diagnosis of pneumothorax or pneumomediastinum. Sudden severe tension pneumothorax or pneumomediastinum can be localized for immediate treatment and the success of therapy can be immediately assessed using transillumination.
Successful Treatment of Wilms' Tumor With Intracranial Metastases
Authors: Traggis Demetrius , Jaffe Norman , Tefft Melvin , Vawter Gordon
Published: December 2021

A patient with Wilms' tumor and pulmonary metastases (successfully treated with radiotherapy and chemotherapy) subsequently developed a cerebral metastasis. This was treated by surgical excision, radiotherapy, and the continued use of chemotherapy. The patient is living and free of disease five years after craniotomy. Cerebral metastases from Wilms' tumor should not be considered incurable.
Drs. Goldberg and Spierto Reply
Authors: Goldberg Samuel D. , Spierto F. W.
Published: December 2021

In a previous publication from this laboratory, we acknowledged the variatioplasma renin activity (PRA) with posture, diurnal variation, and salt intake. Dr. John Laragh's group has related PRA to 24-hour urinary sodium excret. However, we felt and continue to feel this method is iractical in any setting other than a metabolic ward and, therefore, developed the method relating PRA and sodium/creatinine ratio in a urine specimen collected immediatelyafter venipuncture in adults. Admittedly, in dealindiately ividuals not of adult size, as is the case in our studies of adolescents, relationship of PRA to sodium/creatinine ratio per unit surface area would be of great interest.
Use of Sound and Stethoscope in Esophageal Atresia
Authors: Van Leeuwen Gerry , Lozier Cheryl Ann
Published: December 2021

Some years ago we conducted a congenital anomaly survey which included passage of a nasogastric tube bilaterally with one attempt to enter the stomach. Today we continue to see infants with esophageal atresia undiagnosed because the catheter when passed curls up in the esophageal sac. Thus, when air is injected it can be heard in the stomach. We therefore urge that people performing this congenital anomaly survey practice listening to the difference between the sound of air entering the stomach and the sound of air entering the esophageal pouch.
Further speculation about numbers of pediatricians
Authors: Rogers Kenneth D.
Published: December 2021

In their article, "Some Implications Of Declining ng Birth Rates for Pediatricians," Gorwitz and Smith make three predictions and propose responses to these. The predictions are that births in the United States will remain at about three million or less per year for several decades, hospital beds for children will remain excessive, and the number of pediatricians will increase to a point of oversupply. The recommended action includes a moratorium on construction of new hospital beds for children and reevaluation of the role of the pediatrician with appropriate modification of size and content of training programs. These predictions and recommendations ions deserve examination.
Immunization Action Month, October 1975
Authors: Katz Samuel l.
Published: December 2021

For the third consecutive year October has been designated as Immunization Action Month (IAM). This is the effort of a coalition of governmental, professional, and private groups to highlight the need for continued attention to the immunization programs of all American children, particularly the pre-school group. The American Academy of Pediatrics since the inception of IAM has been among the leaders in its activities. Once again this year, the members of the Academy are urged to participate actively on the local scene in generating information about the goals of IAM and in implementing them. The justification for continued efforts of this sort must be found in the data on the utilization of vaccines and on the reported cases of those diseases which can be prevented.
Surfactant in the Lung and Tracheal Fluid of the Fetal Lamb and Acceleration of Its Appearance by Dexamethasone
Authors: Platzker Arnold C. G. , Kitterman Joseph A. , Mescher E. Joseph , Clements John A. , Tooley William H.
Published: December 2021

We measured tracheal fluid production rate and pulmonary surfactant flux in 12 sets of twin fetal lambs of 102 to 135 days' gestation. In nine of these sets we also measured surfactant flux and the concentration of saturated lecithin in the lungs before and during dexamethasone infusion into one of the twins. The average tracheal fluid flow rate was 3.25 ml/kg/hr (SD 1.6) and, relative to body weight, did not change between 103 and 135 days' gestation or during the infusion of dexamethasone. In untreated fetuses, surfactant was detected between 108 and 130 days and its flux gradually increased but remained less than 150µg/kg/hr at 135 days' gestation; the amount of disaturated lecithin in the lung relative to body weight increased 13-fold from 108 to 134 days. From these data we calculated that the minimal rate of synthesis of disaturated lecithin was increased about 4-fold by dexamethasone from 108 to 120 days; this enhancement fell to about 1.8-fold by 135 days. The rate of secretion of disaturated lecithin, as estimated by surfactant flux in tracheal fluid, was increased by dexamethasone throughout the interval of the study.
Another Idea Regarding SIDS
Authors: Shaw Edward B.
Published: December 2021

The large number of pediatricians and investigators who have a great interest in the sudden infant death syndrome (SIDS) should read the recent paper by Kadlub and Kadlub. They propose a theory that adds a new concept to the many theories which have been proposed, many of which have been already discarded. They state "this is a disease which does not make sense" and "the very first symptom of this condition is death." True.

They believe that the infant who swallows large amounts of air along with his food, who has not been allowed to belch, and who lies flat in his crib, perhaps right after feeding, may expel an enormous amount of air in his sleep from the position in which he sleeps and with which his epiglottis, nasopharynx, and nasal passage are inadequate to deal.
Question Regarding Need for Treatment
Authors: Kaemmer Arthur W. , Johnson Byron R.
Published: December 2021

Dr. Greensher and his colleagues are to be congratulated for bringing to the readers' attention a most unusual source of lead poisoning. Inasmuch as many localities are initiating city-wide lead screening programs, it is obvious that pediatricians in this country will be seeing many children with abnormally elevated blood lead levels, and in many cases diligent efforts such as this will have to be undertaken to determine the exact source of the environmental lead. biggest problems with mass screening programs for lead poisoning are well outlined by Moriarty's article.2
Exercise-Induced Bronchial Lability in Wheezy Children and Their Families
Authors: Godfrey Simon , König Peter
Published: December 2021

Studies have been carried out to investigate bronchial lability as assessed by means of standardized running exercise tests. It was found that children who had been wheezy as infants still had an abnormal degree of bronchial lability, even if they were asymptomatic, and closely resembled children who had continued to wheeze. The relatives of asthmatic children displayed a high incidence of bronchial lability. atopic diseases, and positive skin tests, and a similar incidence was found in the relatives of babies with wheezy bronchitis. The difference from a control population was particularly noticeable in the healthy relatives of wheezy children. Studies in monozygotic and dizygotic twins have shown a very high incidence of concordance for asthma, particularly when bronchial lability is taken into account. These studies suggest a common genetic basis for wheezing in childhood, based on the inheritance of bronchial lability. The difference in response of the actively asthmatic subject from that of other labile subjects suggests that additional environmental factors are necessary to interact with the inherited bronchial lability.
Relative Sensitivity of Different Pulmonary Function Tests in the Evaluation of Exercise-Induced Asthma
Authors: Cropp Gerd J. A. , Schmultzler I. J.
Published: December 2021

Sixty asthmatic children were exercised on a bicycle ergometer and had pulmonary function tests performed before and repeatedly after exercise. Pulmonary function measurements included airway resistance (Raw), specific airway conductance (SGaw) functional residual capacity (FRC), peak expiratory flow rate (PEFR), maximum mid-expiratory flow (MMEF), forced expiratory volume during first second of expiration (FEV1), and forced vital capacity (FVC). At any one time during the post-exercise observation period decreases in SGaw were greater than changes in any other pulmonary function test, making SGaw the most sensitive test for the detection. of exercise-induced airway obstruction in asthmatics. Beyond five minutes after exercise PEFR and MMEF were reduced by exercise approximately equally, but somewhat less often and less markedly than SGaw. Exercise-induced reductions in FEV1 were less marked and less frequent than decreases in PEFR and MMEF, and reductions in FVC were the least severe and least often observed abnormality. Decreases in SGaw were significantly, but not linearly correlated with decreases in PEFR, MMEF, FEV1,, FVC, and FEV1/FVC. There were statistically significant linear correlations between exercise-induced increases in FRC and decreases in FVC and between increases in Raw and FRC. If we accept that increases in Raw and FRC indicate increases in large and small airway obstruction respectively, exercise-induced decreases in FVC may indirectly suggest acute hyperinflation and thus small airway obstruction. Although the positive correlation between Raw and FRC indicated that both large and small airway obstruction developed after exercise in many of our asthmatics, increases in Raw were usually greater than increases in FRC, suggesting that large airway obstruction tends to be greater than small airway obstruction in exercise-induced asthma.