bluuebunny/crossref_metadata_2025 huggingface dataset:
Clonidine Poisoning
Authors: Pai G. S. , Lipsitz David J.
Published: December 2021

Clonidine (Catapres, Boehringer Ingelheim) is a relatively new hypotensive agent with complex pharmacologic actions on the autonomic nervous system. Little is known about its effects and side effects in children. An interesting combination of these were seen in a child who accidentally ingested an unknown quantity of this drug. Noteworthy was the lack of its main action and exaggeration of side effects in this child.

Experience with hypertensive adults has shown it to be an effective hypotensive agent with relatively mild side effects. Drowsiness and dryness of the mouth due to decreased salivation have been common. Transient sodium retention and weight gain occur.
Intussusception in Twins
Authors: Thomas Gareth G. , Zachary R. B.
Published: December 2021

The risk of intussusception occurring in the siblings of patients with intussusception is thought to be low, and there is no previous report of the condition occurring in twins.

In our case the second twin was affected within 36 hours of the onset in the first. Adenovirus was cultured from the one twin who was investigated.

See image in the PDF.file

CASE REPORT

The twins were identical boys of West Indian descent, 25 months of age, born and bred in England. They were perfectly well until the early hours of May 26, 1972, when twin A began to scream with acute abdominal pain.
A Search for Children With Possible MSG Intolerance
Authors: Reif-Lehrer Liane
Published: December 2021

Reif-Lehrer and Stemmermann1 recently reported on three children with a variety of neurological symptoms which were alleviated by the avoidance of foods containing exogenously added monosodium glutamate (MSG). We now have several additional children who are suspect. Most recently, I have obtained information about a child who was having increasing episodes of trembling, ringing in his ears, strange finger sensations, etc. Neither phenobarbital nor diphenylhydantoin had helped the child. In fact, the attacks increased in both severity and frequency after the child was given diphenylhydantoin.
Computerized Axial Tomography in Chronic Seizure Disorders of Childhood
Authors: Bachman David S. , Hodges Fred J. , Freeman John M.
Published: December 2021

Ninety-eight children with chronic seizure disorders were studied by computerized axial tomography (CAT). Structural abnormalities were identified in 30% of these children. The greatest incidence of abnormalities was in children with focal motor seizures (43%) and in those whose EEG demonstrated focal slowing together with focal spikes (38%). The most common abnormality was either focal or generalized atrophy (13%). Only about 2% of the abnormalities discovered by CAT were potentially of therapeutic significance. However, the demonstration of a static process, or the finding of a normal CAT, may be quite helpful to the family and physician in certain children with chronic seizure disorders.
Children With Encopresis: A Study of Treatment Outcome
Authors: Levine Melvin D. , Bakow Harry
Published: December 2021

A pediatric treatment program for encopresis was established in a large medical center. This consisted of counseling and education, initial bowel catharsis, a supportive maintenance program to potentiate optimum evacuation, retraining, and careful monitoring and follow-up. A group of 127 children received care for this problem. At the end of one year, outcome data were obtained on 110 patients. Of these, 51% had not had "accidents" for more than six months. Another 27% showed marked improvement and were having only rare episodes of incontinence. 14% of these children showed some improvement, but continued to have incontinence, while 8% showed no improvement whatsoever during the treatment year. These four outcome groups were compared with respect to a large number of demographic, developmental, psychosocial, and clinical variables.
Encephalitis in Infectious Mononucleosis: Diagnostic Considerations
Authors: Lange Beverly J. , Berman Peter H. , Bender Joseph , Henle Werner , Hewetson John F.
Published: December 2021

Four atypical cases of presumed infectious mononucleosis (IM) encephalitis are presented. To establish an etiologic diagnosis, Paul-Bunnell-Davidsohn heterophil titers (PBD), antibody titers to the antigens of the Epstein-Barr virus (EBV), and oropharyngeal excretion of EBV were determined. Criteria for a primary EBV infection are (1) an antiviral capsid antigen titer of 1:160 or greater, (2) the presence of antibody to the diffuse component of the early antigen, (3) absence of antibody to the nuclear antigen, and (4) excretion of the virus from the oropharynx. Three of the four cases met these criteria; of the three, one did not have a positive heterophil titer. The fourth case turned out not to be IM; there was a positive PBD heterophil, but there was no evidence of primary EBV infection.

Although the PBD heterophil is usually a reliable test to diagnosis IM, it is not always present in children, and it is sometimes nonspecifically elevated. Some EBV titers can be nonspecifically elevated as well; however, the above criteria are diagnostic of primary EBV infection.
The Clinical Course of Cardiac Disease in Down's Syndrome
Authors: Greenwood Ronald D. , Nadas Alexander S.
Published: December 2021

There were 230 patients with heart disease among 369 infants and children with Down's syndrome. The majority exhibited defects of the endocardial cushion variety and approximately one quarter had complete atrioventricular canals (CAVC). Pulmonary artery hypertension was uniform in catheterized patients in this latter group and frequent in all left-to-right shunts. Medical and surgical mortality was high (33%) in these 230 children and especially in those with CAVC and tetralogy of Fallot. Only 4% (76 of 1,916) of infants with critical heart disease in New England had Down's syndrome and the most frequent lesion encountered was complete atrioventricular canal.
Megavitamin Therapy for Childhood Psychoses and Learning Disabilities
Authors: Barness Lewis A. , Mauer Alvin M. , Anderson Arnold S. , Dallman Peter R. , Forbes Gilbert B. , Haworth James C. , Jesse Mary Jane , Scriver Charles R. , Winick Myron , Heird William C. , Kline O. L. , O'Brien Donough , Tomarelli Rudolph M. , Benton Duane A. , Celender Ivy M. , Purvis George A. , Saperstein Sidney , Smith Robert E. , Anderson Betty E. , Brown Myrtle L. , Cheney Margaret , Chopra Joginder , Darby William J. , Egan Mary C. , Lane J. Michael , McLean Harold T. , Read Merrill S. , Sarett Herbert P. , Teply L. J. , White Philip L.
Published: December 2021

Vitamins have long been recognized for their unique role in human nutrition. Most of these low-molecular weight, organic substances are precursors of coenzymes, and adequate amounts to meet the known nutritional needs of healthy persons of all ages have been defined by the Food and Nutrition Board of the National Academy of Sciences as the "Recommended Dietary Allowances" (RDA). The consistent opinion of the Committee on Nutrition of the American Academy of Pediatrics has been that normal children receiving a normal diet do not need vitamin supplementation1 over and above RDA levels.

However, there are a variety of clinical entities in which the daily intake of vitamins needs to be significantly increased. This is true, for example, with the fat-soluble vitamins A, D, E, and K in the steatorrhoeas2 and in the autosomally recessive selective malabsorption of vitamin B12.3 Rarely, children treated with isoniazid require increased pyridoxine; and, when treated with diphenylhydantoin sodium (Dilantin), they need increased folic acid and vitamin D.4 Finally, there are a number of rare inborn errors of metabolism affecting the apoenzyme at the cofactor binding site or involving the metabolism of the vitamin itself to its biologically active derivative.5 In these so-called dependency syndromes, the metabolic defect may completely or partially be overcome by greatly increasing vitamin or cofactor availability.

Set against a background of wide public belief in the benefits of vitamins, the accounts of dramatic amelioration of deficiency states, the easy and relatively inexpensive availability of these substances, and the occasional, remarkable benefit of large doses (both in the dependency syndromes and in certain other clinical situations), it is not surprising that a cult developed in the use of large doses of water-soluble vitamins to treat a wide spectrum of disease states.
Acetaminophen and Reye's Syndrome?
Authors: Little Joseph A.
Published: December 2021

I was most interested to read the article "Acetaminophen Poisoning and Toxicity" by Rumack and Matthew.1 This article is well worth reading by any pediatrician who prescribes acetaminophen.

I should like to call your attention particularly to the description of the clinical course of overdose reactions. I was struck with the similarity between this and the description of the findings in Reye's syndrome. Is it possible that many of the children seen with Reye's syndrome were actually reacting to this drug? I should think that this possibility would be well worth considering.
Acute Measles Encephalitis in Children With Immunosuppression
Authors: Aicardi Jean , Goutieres Francoise , Arsenio-Nunes Maria-Leonor , Lebon Pierre
Published: December 2021

Four cases of encephalitis occurring in children treated for lymphatic malignancies by immunosuppressive drugs are reported. Measles virus was isolated from the brain in one case and identified immunologically in another. Nucleocapsids identical to those seen in subacute sclerosing panencephalitis were demonstrated in three cases. Severe immunosuppression was evidenced in two patients by failure of rosette formation and low phytohemagglutinin tests. Pathologically, the inflammatory reaction was absent in one brain and moderate in two. Clinically, epilepsia partialis continua was a prominent feature in three patients. A history of measles or of contact was elicited in three cases, five weeks to three months before onset. All cases ran an acute fatal course. Measles virus can behave as an opportunistic invader of the central nervous system in children and the diagnosis of measles encephalitis should be considered in immunosuppressed patients.
Herpes Simplex: A Possible Cause of Brain-Stem Encephalitis
Authors: Ellison Patricia H. , Hanson Peggy A.
Published: December 2021

Herpes simplex virus was isolated from the tracheal aspirate of a 10-year-old boy presenting with acute onset of multiple cranial nerve palsies and a mild right hemiparesis. There was also an elevated herpes complement-fixation titer with decrease in the following weeks. Although the criteria for diagnosis of central nervous system infection by herpes virus have been debated, we propose that this represents a case of brain-stem encephalitis due to herpes simplex infection. The importance of early diagnosis and evaluation of therapy are emphasized by this case in which the patient recovered completely.
Tricyclic Antidepressant Overdoses in Adolescent Patients
Authors: Petit James M. , Biggs John T.
Published: December 2021

Tricyclic antidepressant plasma levels were measured in nine hospitalized adolescent overdose patients to define the medical seriousness of the drug ingestion. Seven out of nine of these patients ingested medication prescribed for treatment of their psychiatric symptoms. Indications for tricyclic therapy in adolescents are vague. The more frequent use of these drugs makes the potential for life-threatening ingestions relatively common. The amount of drug ngested is usually poorly documented. Plasma measurements are of value in assessing the efficacy of the various medical treatments of overdose patients. Two of these nine overdoses were medically serious as defined by plasma measurements. Supportive care with cardiac monitoring was adequate in one case; however, a fatality occurred in the other under what could be described as optimal patient management conditions.
PEDIATRIC PRIORITIES
Authors: Morley David ,   Student
Published: December 2021

Although three-quarters of the population in most developing countries live in rural areas, three-quarters of the spending on medical care is in urban areas, where three-quarters of the doctors live. Three-quarters of the deaths are caused by conditions that can be prevented at low cost, but three-quarters of the medical budget is spent on curative services, many of them provided for the elite at high cost.

I have suggested that teaching hospitals, or "disease palaces", and the specialist approach to health care that such institutions foster, have over the past 20 years hampered progress in health care in developing countries. Such teaching hospitals do not train the type of health personnel required; they do not act as referral centres; nor do they undertake the type of research that the community which supports them requires. Despite these deficiencies, a teaching hospital can absorb a quarter, a third, or even more of the total health budget of the country.
Syndrome of infant botulism
Authors: Berg Bruce O.
Published: December 2021

Since the initial recognition of infant botulism,1 seven additional patients have been identified in California and there are documented reports from other regions of the United States. The syndrome of infant botulism appears to be more common than is recognized, and the attention of physicians who attend patients should be directed to this syndrome of acute weakness.

Each of the first two cases reported was a product of a normal, full-term gestation, labor, and delivery. They were breast-fed and appeared normal until 6 and 11 weeks, respectively, when, over a period of one to two days, each became unable to suck and swallow and was generally weak.
Ductus Arteriosus Dilatation by Prostaglandin E1 in Infants With Pulmonary Atresia
Authors: Heymann Michael A. , Rudolph Abraham M.
Published: December 2021

Infants with pulmonary atresia depend on patency of the ductus arteriosus for survival in the immediate postnatal period. Despite continuing hypoxemia after birth the ductus arteriosus usually constricts, thus reducing pulmonary blood flow. This often occurs while awaiting surgical palliation or correction, leading either to marked deterioration in the infant's condition, or death. In ten infants with pulmonary atresia, we infused prostaglandin E1 (PGE1) at a rate of 0.1µg/kg/min in six and 0.05µg/kg/min in four into the descending aorta at the orifice of the ductus arteriosus. The ductus arteriosus was effectively dilated: at the narrowest point the diameter, measured in eight infants, almost doubled. In all ten infants arterial blood PO2 increased, averaging 24.6 mm Hg before and 43.7 mm Hg after the infusion was started. Infusion of PGE1 directly into the aorta adjacent to the ductus arteriosus avoided the complications of pyrexia, muscular twitching, and excitability which may be related to the effects of prostaglandins on the central nervous system.
Cyclic Vomiting in Children: Seen Through the Psychiatrist's Eye
Authors: Reinhart John B. , Evans Sue L. , McFadden David L.
Published: December 2021

Sixteen patients have been seen since 1956 at the Children's Hospital of Pittsburgh with a diagnosis of cyclic vomiting. Five of these patients were referred for psychiatric consultation or treatment. Four of the 16 had laparotomies and no specific pathological condition was found; seven of the patients did not have surgery or psychiatric intervention. Descriptive follow-up is given for all patients, as well as various methods of handling the problem. The psychological conflicts were found to be parental anxiety, a prolonged symbiotic relationship with the mother, and the failure of the child to separate and individuate.
GENETIC DIVERSITY
Authors: Lewontin R. C. ,   Student
Published: December 2021

Only about 7% of all human genetic diversity is between major races. It would appear then that the superficial characters of skin color, hair form, lip, nose, and eye shape that we use to distinguish human races are atypical and do not represent the mode of human genetic variation. The taxonomic division of the human species into races places a completely disproportionate emphasis on a very small fraction of total human genetic diversity.
Relation Between Quantities of Lead Ingested and Health Effects of Lead in Humans
Authors: Mahaffey Kathryn R.
Published: December 2021

Major metabolic effects of lead are briefly reviewed and available data on quantitative relationships between lead ingestion and development of toxicity in adults and children are discussed. Levels of lead ingestion producing clinical toxicity in adults are compared with normal levels of exposure. For children, comparison of levels of lead ingestion and quantities of lead producing toxic effects is not currently possible, as information on levels of lead producing clinical toxicity appears to be highly variable on the basis of the small amount of data available. However, recommendations on tolerable levels of lead exposure for children are proposed. based on estimates of lead exposure for children having normal and elevated body burdens of lead.
Allergy skin testing: Science or quackery?
Authors: Shapiro Gail G. , Bierman C. Warren , Furukawa Clifton T. , Pierson William E.
Published: December 2021

A commentary in Pediatrics in September 19751 condemned procedure-oriented fee schedules because they encouraged and rewarded the abuse of laboratory and elective surgical procedures. Allergy skin testing was included in this list. Letters to the American Academy of Pediatrics and telephone calls to the Chairman of the Section on Allergy of the Academy took issue with this inclusion. The commentary, however, was directed toward physicians and allergy laboratories who abuse skin testing rather than toward the procedure itself. It was directed to those who perform innumerable and casually selected skin tests as a substitute for an appropriate history, physical examination, and carefully selected tests based on that evaluation.
Frequency and Etiology of Gross Hematuria in a General Pediatric Setting
Authors: Ingelfinger Julie R. , Davis Alvin E. , Grupe Warren E.
Published: December 2021

Since the frequency of gross hematuria in general, unselected, pediatric outpatient settings has not been reported, we reviewed all patients with this symptom or sign at a pediatric emergency walk-in clinic during 24 consecutive months. Of a total of 128,395 patient visits, gross hematuria was proven in 158 (1.3/1,000 visits).

Fifty-six percent of all patients had readily apparent causes for their gross hematuria. Twenty-six percent of all hematuric patients had documented urinary tract infections, but only 9% had apparent glomerular disease.
The Early Childhood Development of 17 Boys With Sex Chromosome Anomalies: A Prospective Study
Authors: Tennes Katherine , Puck Mary , Orfanakis Dolores , Robinson Arthur
Published: December 2021

Seventeen boys with sex chromosome anomalies were identified at birth and followed up developmentally for two to five years. The 17 included 12 boys with 47,XXY, four with 47,XYY, and one with 46,XY/XXY mosaicism. None had major disabilities in physical, intellectual, or emotional growth. Some of the boys with 47,XXY were characterized as tall, inactive, poorly organized in motor functions, placid, and delayed in language; two of the four with 47,XYY were impulsive at 1 year of age. These deviations from normal were relatively mild; the boys were not found to be at high risk for grossly abnormal development in the early years.
Intracranial Pressure: Monitoring and Normalization Therapy in Children
Authors: Mickell John J. , Reigel Donald H. , Cook David Ryan , Binda Robert E. , Safar Peter
Published: December 2021

The clinical course of 42 children with intracranial pressure monitoring was reviewed. Intracranial hypertension was documented in a variety of diagnostic categories. Therapy was titrated to maintain a baseline intracranial pressure of less than 15 torr (mm Hg), and to decrease the frequency of spontaneous and reactive pressure waves. Ventricular drainage, controlled hyperventilation, intravenous glycerol osmotherapy, therapeutic hypothermia, and barbiturate loading were employed as needed to achieve those goals. Survival was significantly related to average and peak intracranial pressure levels and to the degree of serum hyperosmolality that developed during therapy.
Erythromycin Prophylaxis for Pertussis
Authors: Altemeier W. A. , Ayoub E. M.
Published: December 2021

A neonate admitted to the newborn nursery was found to have bacteriologically proven Bordetella pertussis whooping cough, and two of seven infants exposed to this child became infected. Erythromycin administration to the seven infants apparently prevented further infection as well as the appearance of clinical disease in the two infected infants. This limited experience supports previous reports of the efficacy of erythromycin in preventing B. pertussis infection and disease in susceptible children.
Cholestyramine Therapy and Intestinal Obstruction in Infants
Authors: Lloyd-Still John D.
Published: December 2021

Two infants are reported who developed partial intestinal obstruction following cholestyramine therapy for intrahepatic cholestatic syndromes. The hazards of this potential side effect of cholestyramine therapy are emphasized.
ANESTHESIA AND UNCOMMON DISEASES: PATHOPHYSIOLOGIC AND CLINICAL CORRELATIONS. Edited by Jordan Katz, M.D., and Leslie B. Kadis, M.D. Philadelphia, WB Saunders Co, 1973, $21; 543 pp
Authors: Smith Robert M.
Published: December 2021

The editors of this volume attempted a major feat in assembling fringe information on rare and unfamiliar diseases that might comfront the unsuspecting anesthetist. One could expect a hodgepodge of second-hand information in such a volume, but this is not the case. The exotic variety is there, but it is handled with considerable organization, and the topics, though multitudinous, are covered in enough depth to be interesting and meaningful. Fifteen sections prepared by 26 authors cover an extensive range of diseases.
SHORT FOLLOW-UP OF PREVIOUSLY REPORTED NEWBORN PERSON—1984 VERSION
Authors: C. T. E.
Published: December 2021

This short follow-up note was inspired by Edwin Newman's two books about the dreadful things all of us are doing to our language.1,2

Once again the reader will judge whether my contrived 1984 version, made up entirely of words and phrases found in recent professional journals, enriches or debases the English language.

The newborn person previously reported3 was included in a nonelitist, ongoing, low profile, broad programmatic and conceptualized interdisciplinary study, mounted as a double-barreled major research thrust to determine if body weight alterations are best parameterized by changes in caloric intake, and as a spin-off interface, whether the family unit is a microcluster of structured role expectations, or put in another way, whether the family is a bounded plurality of role-playing individuals. Hard questions and in depth dialogue by well-rounded, self-realized, self-composed, group-effective individuals with strong and proven track records characterized this project.

Resultwise the researched data base must wait for viable information inputs from the investigatees, thruputs between earlier studies and the researchers at this point in time, and outputs from the fundee to obviate possible politicization and inferiorization of the integrated results from utilization of nonfinalized computerized print-outs. Shifting paradigm analysis was also programmed into the investigation. Since new data inconsistent with operating images can challenge those images, it soon became perfectly clear that this research eventuated into a perpetual dynamic of re-imaging the "real."
The vulnerable small airway
Authors: Chernick V.
Published: December 2021

Fundamental physiological work in the late 1960s provided for the first time a clear understanding of (1) the role of the small airways (< 2 mm in diameter) in determining overall airway resistance to gas flow and (2) the relationship between central and peripheral airway resistance and lung growth.1,2 Involvement of the small airways early in the course of cystic fibrosis has been previously commented upon and documented in Pediatrics.3-5

After the age of about 5 years, the flow resistance of peripheral airways constitutes only about 10% to 20% of total pulmonary flow resistance,2 a fraction so small that conventional measurement of total resistance cannot detect small changes in the peripheral component.
The New Correct Answer to An Old Question on Kerosene Ingestion
Authors: Mofenson Howard C. , Greensher Joseph
Published: December 2021

The Personal Assessment for Continuing Education (PACE), part I, appears to be living up to its expectations of providing a guide for areas that need reinforcement, clarification, and updating.

See table in the PDFfile.

Since its distribution in our area we have had a number of calls from colleagues inquiring about question 75 of part I, multiple-choice questions: "Treatment of acute kerosene poisoning should include which of the following?" The correct answer (E) includes "(4) Administration of ipecac." It came as a surprise to many practicing pediatricians that emesis was now being advised for a petroleum distillate ingestion.
Is It Worth $50 Million?
Authors: North A. Frederick
Published: December 2021

Dr. Shiela Mitchell and her distinguished committee recommended in the July 1975 issue that blood pressure measurements should be a regular and routine part of every physical examination of every child over the age of 2. They recommended that any child with a blood pressure over the 95th percentile for age have a fundoscopic examination and at least one repeated blood pressure measurement and clinical evaluation within a few weeks. They stated that repeated examinations and further investigations are indicated if the blood pressure persists at or above the 95th percentile.
Postoperative Spinal Fluid Infections After Neurosurgical Shunting Procedures
Authors: McCarthy Maurice F. , Wenzel Richard P.
Published: December 2021

Although cerebrospinal fluid (CSF) shunt infections are recognized as a complication of central nervous system procedures, there are few data on the postoperative (30 days) risk of developing meningitis after neurosurgery and little epidemiologic information as to probable causes. Information provided by a continual nosocomial infection surveillance system1 identified the problem of CSF infections, and we wish to report a one-year study of the risk of developing meningitis in a postoperative period. A controlled retrospective study was performed to identify risk factors associated with hospital-acquired meningitis.
DUNCAN'S DISEASES OF METABOLISM: ENDOCRINOLOGY, ed 7. Edited by Philip K. Bondy and Leon E. Rosenberg. Philadelphia, WB Saunders Co, 1974, $26; 736 pp
Authors: Soyka Lester F.
Published: December 2021

The endocrinology section of Duncan's Diseases of Metabolism comprises 736 pages, or about 44% of the total text. The division of this seventh edition of a classic text in the field is perhaps a logical expression of the splitting of endocrinology from metabolism as each field has grown tremendously in the past decade. The endocrinology portion is compact and easy to use because of this division, aided by the employment of thin, though substantial paper and small, but easily readable type. These combine to avoid the feeling of consulting a big-city telephone directory, which is so common with use of many of the standard textbooks of today. The illustrations are generally excellent and the 54-page index, which covers both sections of the book, is unusually thorough.

As in all textbooks, many sections are outdated before they appear in print. Although the editors, Philip K. Bondy and Leon E. Rosenberg, propose to avoid this by means of a "last-minute" addendum, only two of the 13 chapters bear such, and one of these lists only three references, all dating to 1972. The other recent-developments section is longer and more helpful.

The content is essentially that of general clinical endocrinology, each chapter using the standard approach of considering normal structure and function and then diseases in a gland arrangement, starting with the hypothalamus and traveling downward to the testis and ovary. A small chapter on acid-base balance seems out of place, whereas those on nonendocrine-secreting tumors and serotonin and the carcinoid syndrome are useful extensions of the scope of endocrinology.
Traumatic Perforation of the Pharynx in the Newborn
Authors: Touloukian Robert J. , Beardsley George P. , Ablow Ronald C. , Effmann Eric L.
Published: December 2021

Two newborn, low-birth-weight infants with traumatic perforation of the pharynx and an additional 18 previously reported cases are presented. Injury produced by pharyngeal suction catheters and nasogastric and endotracheal tubes is generally unrecognized until the baby develops signs of esophageal obstruction or radiographic evidence of pharyngeal perforation, usually in the posterior mediastinum. The catheter may enter the pericardial space. Conservative management with intravenous antibiotics and a feeding gastrostomy is favored, except in instances that require mediastinal decompression. The key to prevention is the use of soft-tipped suction catheters and nasogastric tubes and careful visualization of the cords during endotracheal intubation. The use of metal stylets to direct the endotracheal tube is condemned.
Umbilical Artery Catheterization by a Cutdown Procedure
Authors: Clark J. Michael , Jung August L.
Published: December 2021

In severely ill newborns conventional methods of umbilical artery catheterization sometimes fail to achieve a functioning intravascular line. In 18 of 19 such newborns requiring umbilical artery catheters for optimal management, successful catheterization was attained using a cutdown procedure on the umbilical arteries. Vascular perforation within the anulus umbilicalis, tunica intima invagination ahead of an advancing catheter, and subintimal cannulation were defined as the causes of initial catheterization failure in all 19 newborns.
Topical Antibiotics
Authors:   Committee on Drugs, Segal Sydney , Cohen Sanford N. , Freeman John , Kagan Benjamin M. , Kauffman Ralph E. , Pruitt Albert W. , Soyka Lester F.
Published: December 2021

1. In most instances, gentle, thorough cleansing of minor wounds and burns, and protection of the area until healing occurs is sufficient treatnient. The literature available at the time this statement was prepared indicates that topical antibiotics may prevent infection after minor cuts, abrasions, and burns. Thus, their use in such conditions may be appropriate as an adjunct to cleansing.

2. Systemic antibiotics rather than topical antibiotics are recommended for the treatment of chronic pyodermas, such as impetigo.

3. Allergic reactions to topical antibiotics, including neomycin, are uncommon. However, when a patient is known to be sensitive to neomycin, the systemic use of any of the aminoglycoside antibiotics should be avoided if possible.

4. Topical aminoglycosides should not be used on large denuded skin surfaces (such as those that result from burns) because of possible absorption and systemic toxicity and because, when used topically, these agents encourage the growth of resistant organisms.
Oxygen Supplement During Endotracheal Intubation of the Infant
Authors: Wung Jen-Tien , Stark Raymond I. , Indyk Leonard , Driscoll John M.
Published: December 2021

Endotracheal intubation is indicated for maintaining an efficient airway, for preventing aspiration and permitting pulmonary toilet, and for prolonged administration of mechanical ventilation or general anesthesia for many types of operations.1,2 Laryngoscopy and intubation may result in injury to the lips, gums, tongue, nasal passage, larynx, or trachea. Additional complications include mediastinal and subcutaneous emphysema and pneumothorax.3 These complications can be minimized if hypoxia can be prevented and laryngoscopy is performed in an unhurried manner.

Patients who require a high ambient oxygen concentration in order to maintain an adequate PO2 usually react rapidly to an interruption of the oxygen supply by developing bradycardia and hypoxia.

See Image in the PDFfile
Staphylococcal Septicemia Resulting in Embolic Small Bowel Perforation
Authors: Heller Daniel , Keim Daniel E. , Todres I. David , Donahue Patricia
Published: December 2021

Intestinal perforation has not to our knowledge been reported as a complication of staphylococcal sepsis during infancy. We report a case in which staphylococcal bacteremia resulted in multiple metastatic abscesses of the small bowel with subsequent perforation.

CASE REPORT

A 4-month-old boy in previously good health was admitted to a local hospital with a two-day history of discharge from both ears. He had a temperature of 38.5 C (101.4 F), was lethargic, and had a distended abdomen. His pulse was 230 beats per minute and his respiratory rate 60 breaths per minute. A chest roentgenogram showed a right lower lobe pneumonia, and an abdominal film revealed dilated loops of small and large bowel.

See Image in the PDFfile
Persistent Interstitial Pulmonary Emphysema: Another Complication of the Respiratory Distress Syndrome
Authors: Stocker J. Thomas , Madewell John E.
Published: December 2021

Persistent interstitial pulmonary emphysema (PIPE) was observed in 22 infants during the neonatal period. All of the infants experienced respiratory distress during the first few days of life, and 21 of them were treated for the respiratory distress syndrome with artificial ventilation or oxygen or both. Ten infants developed a localized form of PIPE, with air-filled interstitial cysts measuring up to 3.0 cm in diameter confined to one or more lobes of lung. The involved segment of lung was resected in seven of these infants, all of whom survived. The remaining three died and autopsies were performed.

A diffuse form of PIPE was observed in the other 12 infants. Numerous cysts that were predominantly small (less than 0.3 cm) were seen in all lobes of both lungs. These infants received high concentrations of oxygen for prolonged periods, resulting in bronchopulmonary dysplasia in 11 of the infants. All 12 infants died. PIPE is characterized histologically by air-filled interstitial cysts partially lined by multi-nucleated giant cells.
PROMISING TREATMENT
Authors:   Boston Interhospital Virus Study Group
Published: December 2021

It is often suggested that controlled trials of promising treatments are unwarranted in conditions of very high mortality; severe respiratory distress syndrome has been used as an example. This is completely logical if the arguments are confined to the category of inevitably fatal conditions, but the situation is rarely this simple.

A Boston group wrote about this issue as follows:

"Patients with severe and fatal . . . disease merely represent the ‘tip of an iceberg’ for there are almost always many more with milder or even asymptomatic processes. Furthermore, the increased interest in diagnosis that accompanies the introduction of any new mode of therapy invariably results in the recognition of less severe cases that would previously have gone undiagnosed. Consequently, there is sure to be a lower morbidity and mortality in currently treated patients than in otherwise comparable historical controls, even when the treatment is without effect or actually deleterious."
Selective Erythroid Aplasia During Therapy for Acute Lymphoblastic Leukemia
Authors: Sallan Stephen E. , Buchanan George R.
Published: December 2021

Selective erythroid aplasia occurred in two children receiving chemotherapy for acute lymphoblastic leukemia. The aplasia was reversible on cessation of therapy in one patient, and the other child remains transfusion-dependent on chemotherapy. Possible causes of pure red cell aplasia are discussed.
Skateboard Accidents
Authors: Jacobs Robert A. , Keller Eugene L.
Published: December 2021

Skateboard-related trauma is causing significant morbidity and mortality that are rapidly increasing in frequency. The spectrum of injuries is predominantly fractures, contusions and abrasions, strains and sprains, and lacerations of the lower arm, lower leg, head, and face. Significant renal injuries are also a common cause of hospitalization.
Juvenile Dermatitis Herpetiformis: An Immunologically Proven Case
Authors: Hertz Kenneth C. , Katz Stephen I. , Aaronson Charles
Published: December 2021

Subepidermal blistering diseases of childhood have, in the past, been thought to represent cases of juvenile dermatitis herpetiformis, bullous pemphigoid, or benign chronic bullous dermatosis of childhood. While the small-blister variety closely resembles adult-type dermatitis herpetiformis, the large-blister, or bullous, variety has clinical and histologic resemblances to bullous pemphigoid. The patient presented in this report clearly fits previous descriptions of the large-blister type of juvenile dermatitis herpetiformis, bullous pemphigoid, or benign chronic bullous dermatosis of childhood both clinically and histologically, while his therapeutic response to dapsone and the presence of in vivo bound IgA at the basement membrane of normal and perilesional skin are highly characteristic of the adult type of dermatitis herpetiformis. Immunofluorescent studies of similar cases reported in the literature, however, have shown variable results, thus obscuring their classification. Though the proper place of all such cases in the nosology of blistering diseases is not yet clear, at least some of them closely resemble adult-type dermatitis herpetiformis by two important criteria-immunologic and therapeutic.
Posttraumatic Anterior Hypopituitarism—Revisited: The Role of TRH Provocative Release of Prolactin in the Confirmation of Anterior Pituitary Damage
Authors: Brown David R. , McMillin J. Michael
Published: December 2021

We have previously reported a case of anterior pituitary insufficiency in a 14-year-old girl following closed head trauma.1 Endocrine evaluation one year after her accident revealed hypopituitarism manifested by cachexia, hypothyroidism, hypogonadism, and hypoadrenocorticism. Laboratory studies demonstrated deficiencies of adrenocorticotropic hormone, thyroid-stimulating hormone (TSH), growth hormone, and gonadotropic hormones (follicle-stimulating hormone and luteinizing hormone). We postulated that her hypopituitarism was due to anterior pituitary gland destruction rather than stalk section or hypothalamic damage. We have recently measured her serum prolactin concentrations following provocative stimulation with thyrotropin-releasing hormone (TRH), and these results strengthen the evidence for direct anterior pituitary gland destruction and provide a more complete delineation of her endocrinologic function.
Loffler's Endomyocardial Fibrosis, Eosinophilia, and Acute Lymphoblastic Leukemia
Authors: Pereira Fabio , Moreno Hernan , Crist William , Ermocilla Rufino
Published: December 2021

Eosinophilia is a constant feature of Loffler's endomyocardial fibrosis.1,2 Three cases of this syndrome have been described in which acute lymphoblastic leukemia was concurrently present.3,4 Cytogenetic evidence in one of these cases suggested that the eosinophilia was "reactive" because the eosinophils had a normal karyotype while the lymphoblasts showed chromosomal aneuploidy.4 The subject of eosinophilia and eosinophilic syndromes has been extensively reviewed by others.5-8 The purpose of this report is to describe a boy with long-standing eosinophilia who presented with intractable heart failure, striking peripheral blood eosinophilia, and 38% lymphoblasts in the bone marrow. Current thoughts concerning the relationship of endomyocardial fibrosis, acute lymphoblastic leukemia, and eosinophilia are summarized.
Can We Identify a Group of Children at Age 2 Who Are at High Risk for the Development of Behavior or Emotional Problems in Kindergarten and First Grade?
Authors: Chamberlin Robert W.
Published: December 2021

A group of 198 children were followed from age 2 through first grade to see how consistent their behavior was across time and across settings. Measures of child behavior in the home were obtained when the children were ages 2, 4, and 5. Classroom behavior was ascertained when the children were in nursery school, kindergarten, and first grade. Correlations between early home and school behavior patterns were all quite low. Only when home and school measures were made close to the same point in time did relationships reach even a moderate level. Behavior within the same setting was more consistent over time than behavior across settings but even here relationships were not strong enough to be clinically useful for making predictions about individual children. It is concluded that early behavior in the home, as measured by these methods and for this population, is not by itself sufficiently predictive of later home or school behavior to warrant identifying the child or his family as being at "high risks’ for future problems.
Low-Dose Intravenous Insulin Infusion in Patients With Diabetic Ketoacidosis: Biochemical Effects in Children
Authors: Lightner Elmer S. , Kappy Michael S. , Revsin Betty
Published: December 2021

Twenty-five episodes of diabetic ketoacidosis in 20 children were treated with continuous low-dose intravenous insulin infusion. Stable serum immunoreactive insulin concentrations were produced, along with prompt falls in glucose, β-hydroxybutyrate, and glucagon levels, and a steadily increasing bicarbonate level. Neither hypokalemia nor hypophosphatemia developed. Elevated serum alanine concentrations were found during ketoacidosis in contrast to the lowered concentrations found in adults, and were correlated inversely with plasma glucagon concentrations. The treatment regimen described is safe, easy to use, efficacious, and resulted in prompt correction of the observed biochemical alterations in children with diabetic ketoacidosis.
Diagnostic Criteria for Influenza B-Associated Reye's Syndrome: Clinical vs. Pathologic Criteria
Authors: Corey Lawrence , Rubin Robert J. , Bregman Dennis , Gregg Michael B.
Published: December 2021

Between December 15, 1973, and June 30, 1974, a total of 379 cases of Reye's syndrome was reported to the Center for Disease Control. One hundred forty-seven (40%) were confirmed by either autopsy or biopsy, while 232 were diagnosed by clinical and laboratory parameters. Comparisons of the epidemiologic and demographic characteristics, the hospital course, the outcome, and the laboratory abnormalities of the clinically diagnosed and the pathologically confirmed cases revealed no significant differences. In the epidemiologic setting of influenza B outbreaks, children who have the acute onset of noninflammatory encephalopathy associated with elevated serum transaminase levels, hypoprothrombinemia, and elevated blood ammonia levels should be considered to have Reye's syndrome. Further evaluation of diagnostic criteria is needed, however, for sporadically occurring, nonepidemic cases of noninflammatory encephalopathy associated with hepatic dysfunction.
THE DREADFUL CONSEQUENCES OF NOT REMOVING THE CHILD'S HYPERTROPHIED TONSILS AND ADENOIDS—AS VIEWED IN 1915
Authors: C. T. E.
Published: December 2021

The editorial below published in 1915 in the now defunct Archives of Pediatrics is typical of the prevailing medical attitude at that time toward the putative calamitous effect of hypertrophied tonsils and adenoids.

It would seem that everyone must be aware of the deleterious effect of hypertrophied adenoids and tonsils....

It is, however, the fall of the year, the time when the first series of infectious colds runs through the community, when household after household finds one member after another succumbing to sneezing and coryza. The ruggedness gained from months in the country, whose bacteria-free air has permitted a loss of resistance to the germs of the common cold, seems in a day to give place to pallor and weakness. It is now, therefore, that the adenoid question comes bobbing up again after months of retirement, for it is the child with adenoids to whom the first cold of the year comes with greatest injury....

Again, it is the fall of the year, when the schools open. Coming to the schools are hundreds of children, who, through fault of their parents or their physicians, do not come physically fit to profit by the instruction which the schools afford. The school physical examination, which is now so general, detects, among other things, enlarged tonsils, mouth breathing, open mouths, malocclusion, narrow noses, high palatal arches, all bearing a relationship to faulty nasopharyngeal conditions, all lessening in some degree the child's keenness of intellect, retarding him, delaying his mates, and requiring a greater effort on the part of his teachers and a greater cost to the community....
The Fontogram: A Noninvasive Intracranial Pressure Monitor
Authors: Salmon James H. , Hajjar Waleed , Bada Henrietta S.
Published: December 2021

The applanation transducer was used to measure intracranial pressure (ICP) through the intact fontanel. The method is painless, rapid, and accurate. The pressures recorded with this fontogram were correlated with direct measurements of ICP. The correlation coefficient of the 21 paired determinations was .98—a very good correlation.

Fontanel pressure was determined in 35 normal newborn infants. The mean pressure was 7.37 mm Hg with an SD of ± 1.45 (range, 3.5 to 9.5 mm Hg). Three clinical cases are presented to illustrate the usefulness of this apparatus in the detection of increased ICP and in monitoring the effectiveness of treatment.
Neonatal Anterior Esophageal Perforation
Authors: Stein Robert T. , Wall Patrick M. , Kaufman Robert A. , Lamprecht Catherine , Roloff Dietrich W.
Published: December 2021

Traumatic esophageal perforation and/or formation of esophageal diverticula may occur during the intensive care of premature infants. Lee and Kuhn1 have reviewed this entity and have noted typical characteristics of location, suspected etiologic factors, incidence, etc. We would like to extend these observations by reporting an unusual complication of anterior esophageal perforation probably secondary to trauma from a laryngoscope blade.

CASE REPORT

The patient, a boy, was admitted to the University of Michigan Neonatal Intensive Care Unit at the age of 1 hour. Birth weight was 750 g; the estimated gestational age was 25 weeks. Membranes had ruptured just prior to delivery, and the amniotic fluid was cloudy and malodorous.
Varicella Hepatitis and Reye's Syndrome: An Interrelationship?
Authors: Landay Stephen E.
Published: December 2021

The host factors that may be important in the evolution of Reye's syndrome still need clarification. Thaler1,2 has raised the possibility that inborn errors in urea cycle enzymes may be instrumental in the development of the syndrome. He has postulated that such errors may lead to the hyperammonemia that is characteristic early in the illness. This elevated ammonia level may have a significant role in the pathogenesis of Reye's syndrome by virtue of its toxic effects on the brain, liver, and other organs. Cited below are three cases that occurred in one Florida community within one month. These may offer clinical support of the Thaler hypothesis, and they may illustrate an intimate relationship between Reye's syndrome and a less-discussed entity, varicella hepatitis.
Massive studies, minimal progress
Authors: L. J. F.
Published: December 2021

Large, expensive, multidisciplined, multicenter studies present special problems to journals. The study by Kinsey et al. in this issue (p. 655) is a good example. This study was designed by a distinguished peer group. It was carried out in five university centers by 27 investigators, written up for publication by ten authors, evaluated by statisticians, and was ready for publication nearly nine years after the research was first begun. The goal of the study was a very good one. The authors hoped to define the level of PaO2 and the duration of exposure which could result in retrolental fibroplasia. Nearly 10,000 blood gas studies were carried out on 589 low-birth-weight infants.