bluuebunny/crossref_metadata_2025 huggingface dataset:
The pediatrician and hypertension
Authors: Mitchell Shiea C. , Blount S. Gilbert , Blumenthal Sidney , Hoffman Jullien I. E. , Jesse Mary Jane , Lauer Ronald M. , Weidman William H.
Published: December 2021

Hypertension is one of the more common diseases affecting American adults. It is the cause of at least one fourth, and perhaps as many as one half, of all cardiovascular deaths. In spite of its importance, only about one half of those with the disease ordinarily are detected, only one half of those found to be hypertensive are being treated, and, of those who are receiving treatment, only one half, that is one eighth of the total hypertensive population, are receiving adequate treatment.

Essential hypertension has been considered to be a disease of adults. The information available to physicians about its mechanisms, its endpoints, and its therapy has been developed from data collected in adult populations.
CHALLENGE AND PURPOSE
Authors: Mumford Lewis
Published: December 2021

Yet: there is an Ahab in every man, and the meanest member of the crew can be awakened to the values that Ahab prizes: given a storm and a stove boat, and the worse rascal on shipboard may be as magnificent as Odysseus. All men live most intensely when they are moulded by such a purpose-or even, wanting that, by an enterprise that counterfeits it. Art, religion, culture in general, all those intangible triumphs of the spirit that are embodied in forms and symbols, all that spells purpose as opposed to senseless energy, and significance as opposed to routine-these efforts develop human life to its fullest, even when they work contrary to the ordinary standards of the world.
Osteomalacia Associated With Anticonvulsant Drug Therapy in Mentally Retarded Children
Authors: Tolman Keith G. , Jubiz William , Sannella Joseph J. , Madsen Jack A. , Belsey Richard E. , Goldsmith Ralph S. , Freston James W.
Published: December 2021

A survey of 289 severely retarded inpatients at a school for retarded children in American Fork, Utah revealed 67 patients with osteomalacia as defined by hypocalcemia, hypophosphatemia, elevated serum alkaline phosphatase levels, and appropriate bone changes. Investigation of the variables which might influence bone mineralization revealed no differences in age, sex, physical activity, sunshine exposure, or dietary intake of vitamin D between the osteomalacia and nonosteomalacia groups. However, all of the patients with osteomalacia were receiving anticonvulsant medications, either phenobarbital, diphenylhydantoin, or both. Duration of anticonvulsant therapy was the most important contributing factor to the development of osteomalacia. Seventy-five percent of patients who had received anticonvulsants for more than ten years had osteomalacia. The single most costly medical problem at the school is the treatment of pathologic bone fractures due to demineralized bone.
The Therapy of Hyperammonemia Due to Ornithine Transcarbamylase Defiency in a Male Neonate
Authors: Snyderman Selma E. , Sansaricq Claude , Phansalkar Sadashiv V. , Schacht Robert G. , Norton Patricia M.
Published: December 2021

Ornithine transcarbamylase deficiency in the male neonate has been considered to be invariably fatal because of the severity of the hyperammonemia. An extreme degree of hyperammonemia in a male neonate was brought under control by a series of exchange transfusions, prolonged peritoneal dialysis, adequate caloric intake, and a mixture of essential amino acids with an excess of aspartic acid and arginine. After the initial phase, it was possible to maintain the plasma ammonia level with dietary therapy alone, in spite of a number of complications that might be expected to cause tissue damage and increase the hyperammonemia.
Perinatal outcome and referral age
Authors: Cassady George
Published: December 2021

During the past decade, prompt application of new knowledge of perinatal pathophysiology has dramatically improved the quality of life for surviving tiny premature infants. The results of prompt correction and, when possible, prevention of such potent interrelated insults as hypoglycemia, asphyxia, hyperoxia, jaundice, shock, thirsting, and starvation have led the more optimistic of us to expect the virtual disappearance of neurologic residua, previously considered the unavoidable legacy of surviving premature infants. In contrast, the data reported by Fitzhardinge in this issue1 serve as an important warning that all may not be well with these babies. Certain flaws in this report—the 16% attrition rate (no follow-up), the inadequate description of the control group (no control DQ's), and the failure to objectively document such measureable influences on outcome as serum unconjugated bilirubin, serum osmolality, blood sugar, and Po2 and Pco2—should caution the reader to accept these findings only with liberal "grains of salt."
THE SCIENTIFIC METHOD
Authors: Card W. I.
Published: December 2021

In the history of science, it is difficult to think of any activity that was traditionally carried out by empirical methods, an activity such as agriculture on weather forecasting, in which when it was introduced, the scientific method has not proved far superior. It is difficult to believe that it will not prove equally so in medicine. The most immediate benefit might result from test reduction, as there is much evidence that all of us tend to ask for unnecessary numbers of tests.
Hyaline Membrane Disease Treated With Early Nasal End-Expiratory Pressure: One Year's Experience
Authors: Boros Stephen J. , Reynolds John W.
Published: December 2021

This report describes one year's experience treating hyaline membrane disease (HMD) with nasal endexpiratory pressure (NEEP). During the 12 months from July 1, 1973 through June 30, 1974, 119 children with HMD were admitted to the Intensive Care Unit of St. Paul Children's Hospital. Sixty-nine infants were treated early in the course of their disease with NEEP. The survival, incidence of complications, and the number of endotracheal intubations are reported and compared to our experience during a similar time period prior to the use of NEEP (1971-1972). Since the advent of the early application of modest amounts of end-expiratory pressure by nasopharyngeal tube, there has been an increase in the survival of all admissions with HMD, but the increase was statistically significant (P<.01) only in those weighing 1,501 to 2,000 gm. There was a significant decrease (P<.025) in the total number of children with HMD requiring endotracheal intubation. There was no change in the incidence of pneumothoraces or bronchopulmonary dysplasia. NEEP is a simple and effective technique for creating continuous airway distending pressure. Its effectiveness and ready availability make the routine endotracheal intubation of infants requiring only continuous airway distending pressure no longer justifiable.
Editorial Comment
Authors: H. R. J.
Published: December 2021

This report stimulated enthusiastic comment from one reviewer who noted that it "presents an innovative approach to a problem troubling all academic departments and their part-time clinical faculty." While many pediatric departments are doing many of the things noted in this paper to improve communications between town and gown, the "new" feature is the formal organization of the clinical faculty. In many ways the report is a promisory note, and we still need an evaluation of its effectiveness on both part-time faculty and students. However, the communication should stimulate other departments to try methods of melding town and gown relations. Hopefully, such projects will include a careful evaluation of how well they work.
Group Practice in a University-Based General Pediatric Clinic: A Preliminary Report
Authors: Berkelhamer Jay E.
Published: December 2021

The format for health-care delivery has changed from a solo to a group model at the General Pediatric Clinic of Chicago Wyler Children's Hospital. Evaluation of the new model after the first year has demonstrated a significant improvement in the attitudes of house staff toward their experience in primary-care delivery.
Photodistribution of Viral Exanthems
Authors: Reken D. Van
Published: December 2021

This letter is in regards to the lead article in the August 1974 issue of Pediatrics entitled "Photodistribution of Viral Exanthems."1

The contribution of the authors is the dissemination of the knowledge that common viral exanthems can have a marked photodistribution for reasons which are unclear. However, there are several points which detract from the general worth of the paper.

First, although the authors criticize the primary care physician for delay of diagnosis, they cannot diagnose case I as an echovirus 9 infection by standed cirteria.
Urologist's Views Challenged
Authors: Philip Alistair G. S.
Published: December 2021

It is not clear to me why the commentary by Burger and Guthrie1 entitled "Why Circumcision?" appeared in the Experience and Reason section. They did not provide their experience and, unfortunately, their reasoning raised some dubious arguments. The question of the relationship between uncircumcised males and carcinoma of the cervix has been debated for many years, but the authors should be reasonable and present the facts accurately. They quote Aitken-Swan and Baird2 as supporting the concept that carcinoma of the cervix has an increased incidence in women whose husbands were not circumcised.
Still More Criticism
Authors: Sorrells Morris L.
Published: December 2021

On reading the article "Why Circumcision"1 I found many of the statements used to support recommendations for neonatal circumcision open to question.

Recent studies do not show the relationship of cervical cancer to circumcision that the authors imply. The article by Aitken-Swan and Baird2 actually reaches the opposite conclusion. I know of no controlled study that supports this contention. The level of hygiene in both male and female indeed seems to be a factor in the etiology of cervical cancer, but that circumcision increases hygenic standards is patently not true.
Studies in Meconium: Disaccharidase Activities in Meconium From Cystic Fibrosis Patients and Controls
Authors: Antonowicz I. , Ishida S. , Shwachman H.
Published: December 2021

Meconium ileus represents the earliest clinical manifestation of cystic fibrosis. The differences found in the composition and amount of protein, mucoprotein, mucopolysaccharides, and reducing sugars in meconium from newborns with cystic fibrosis might be of significance relative to the pathogenesis and early diagnosis of this disease. We studied the enzymatic activity of disaccharidases (lactase, sucrase, maltase, and palatinase) in meconium of infants with cystic fibrosis and controls. We found an increase in the specific activity of these enzymes in the meconium from infants with cystic fibrosis as compared to the specific activity in meconium from normal infants. The increase in the activities, expressed as micromols per gram of protein per minute was: lactase, 100 times higher; sucrase, 18 times; maltase, 4.8 times; and palatinase, 8.9 times.
Lymphocyte Surface Receptors in Childhood Acute Lymphocytic Leukemia
Authors: Esber Elaine , DiNicola William , Movassaghi Nasser , Leikin Sanford
Published: December 2021

B and T cell lymphocyte surface receptors were studied in the bone marrow and peripheral blood of 16 patients with childhood acute lymphocytic leukemia. T cell surface receptors were identified on the blasts of one patient. Increased percentages of T or B cell surface receptors were not found in the bone marrow of the other 15 patients. There was a negative correlation between the percentage of pathologic cells in the peripheral blood and the percentage of cells with T and B surface receptors. The results of this study indicate that childhood acute lymphocytic leukemia is a heterogeneous disease in terms of lymphcyte surface receptors and that the pathologic cells of the majority of patients with this disease cannot be identified as being of thymic or non-thymic origin.
Trisomy 8 Syndrome
Authors: Cassidy Suzanne B. , McGee Barbara J. , Van Eys Jan , Nance Walter E. , Engel Eric
Published: December 2021

In 1970 we reported the case of a 2-month-old boy with a C autosomal trisomy and euploid mosaicism, and suggested, by comparison with other cases, that this chromosome imbalance might result in a definite syndrome. It has now been determined by Giemsa banding studies that the trisomy which is present involves a number 8 member, and a follow-up of this case is presented. In addition, a review of all published cases of authenticated trisomy 8 suggests that this specific anomaly leads to a distinct clinical syndrome involving mild psychomotor retardation, bone and joint anomalies, and other visceral defects. The condition is benign in comparison with other autosomal trisomies.
Letter to the Editor
Authors: L. J. F.
Published: December 2021

Pediatrics is certainly not trying to "cut off family practitioners." We hope our journal is read by all and useful to many who are interested in the care of children, whatever their formal training base may have been.
The Word From the Mint
Authors: Brooks Mary
Published: December 2021

An article in the December 1974 issue of Pediatrics states that "The United States Mint may begin producing an aluminum alloy one-cent coin." Although it is true that over a year ago consideration was given to producing an aluminum coin, that plan has been abandoned.

An inordinate increase in the price of copper was the prime factor in our 1973 decision to move toward an aluminum um one-cent coin. However, the price of copper has decreased from a peak of approximately $1.40 per pound in May 1974 to the present price of 40¢ to 554¢ per pound.
Letters to the Editor
Authors: H. R. J.
Published: December 2021

We think it is important for pediatricians to realize that there are several screening tests for developmental abnormalities. What is the best test is not determined as yet. It seems to us that the issue is important, for many states are now mandating compulsory screening prior to school entry and pediatricians responsible for implementing these programs will be faced with the decision as to what screening procedures to use. In the absence of comparative data, one will have to rely on his own judgment.
Are T-Cell Malignancies More Frequent in Younger Children?
Authors: Borella Luis , Sen Luisa
Published: December 2021

Seeger and Stiehm should be congratulated on their recent careful review of a complex subject, T and B lymphocyte subpopulations.1 They correctly point out the technical problems in the identification of these cell types as well as their significance in the evaluation of certain immunological disorders. In their discussion of T-cell leukemia, however, the authors make the point that T-cell malignancies may be more frequent in younger children, on the basis of a review of lymphoid cell subpopulations by Kersey et al.2
Watch Out for Combinations
Authors: Smith David L.
Published: December 2021

Iodochlorhydroxyquin, in combination with hydrocortisone (Vioform-Hydrocortisone [CIBA]) is widely available and widely used for a variety of skin disorders because of its anti-inflammatory and broad chemotherapeutic efficacy against bacterial, fungal, and monilial agents. Its application to other-than-normal skin could conceivably result in optic atrophy.1 In view of this fact, its continued presence on the market should be brought into question. I plan to try to sharpen my dermatologic acumen and prescribe more specific therapy for the dermatoses I see.
Where Are the Pediatricians?
Authors: Smith John
Published: December 2021

I read many articles about the decline of your specialty. The most recent article decries the nurse practitioner who this author-prophet claims will bring about the doom of medical pediatricians.

Yet our community of Sandy, Utah, is desperate for a pediatrician. Our 30,000 population could easily support two or three pediatricians now. Ours is a young, large, family-oriented, growing community. The economics are excellent, the air is clean, a class A medical school and childrens' hospital are 30 minutes away.
Corticosteroids and Brain Growth
Authors: Price H. V.
Published: December 2021

While reviewing recent articles on neonatal hypoglycemia we were intrigued by the findings of Dr. Pildes and her colleagues. Particularly interesting was the finding that 26 of their 39 children had also been treated with corticosteroids in an effort to correct neonatal hypoglycemia. Animal research suggests that neonatal corticosteroid therapy may interfere with brain function and we were surprised to find that possible effects of these drugs were not mentioned or indeed apparently analyzed in the above paper.
Dr. Dietzsch Replies
Authors: Dietzsch Hans-Joachim
Published: December 2021

In answer to the questions of Solonions and Cotton concerning our recent study on the use of arginine hydrochloride inhalations in cystic fibrosis patients,1 we wonder whether these authors misunderstood us. The fate of these children with cystic fibrosis depends on the quality of the inhalation treatment. This means if you replace a good mucolytic drug with a better one you step by step approach the ideal mucolytic solution. As a result of many years' experience we have learned that N-acetylcysteine is an effective and well tolerated mucolytic drug (Dietzsch, H-J, et al: Dtsch Gesundheitsw 28:842, 1973).
Generalized Lymphadenopathy and Nephrotic Syndrome as a Manifestation of Mephenytoin (Mesantoin) Toxicity
Authors: Snead Carter , Siegel Norman , Hayslett John
Published: December 2021

This report describes a patient who developed marked generalized adenopathy and nephrotic syndrome while receiving mephenytoin (mesantoin) for a seizure disorder. Renal biopsy showed a diffuse proliferative glomerulonephritis. Lymph node histopathology revealed replacement of parenchyma with lymphocytes, eosinophils, and reticuloendothelial cells. A hypersensitivity reaction is postulated as the etiology of both these processes.
Hyperdynamic Heart Failure Due to A-V Fistula Associated With Wilms' Tumor
Authors: Sanyal Shyamal K. , Saldivar Victor , Coburn Thomas P. , Wrenn E. L. , Kumar Mahesh
Published: December 2021

Intrarenal arteriovenous (A-V) fistula associated with Wilms' tumor is extremely rare and is an unusual cause of congestive heart failure in infancy and childhood. In a recent review of 440 children with Wilms' tumor, Miller et al.1 did not find a single case of A-V fistula; nor did Gomes and Bernatz2 find any Wilms' tumors in 139 patients with various forms of A-V fistula. Results of angiographic studies in children with Wilms' tumor are at marked variance as to the occurrence of A-V fistula. Whereas Hidai et al.3 and others4-6 did not find a single patient in whom Wilms' tumor was associated with intrarenal A-V fistula, Cremin et al.7 and Meng and Elkin8 reported such an association in two of 13 and one of 6 children, respectively.
Dr. Kempe Replies
Authors: Kempe C. Henry
Published: December 2021

I welcome the opportunity to respond to Dr. Klein's thoughtful comments.

My suggestion for the widespread utilization of a health visitor to see every child and to establish a means whereby the child will be able to obtain comprehensive health care is not meant to interfere with the outstanding performance of private physicians in providing health care to their patients. If the health visitor ascertains that provision has been made for adequate health care, she then functions mainly as a resource for the physician in seeing that his services are utilized.
The Academy Replies
Authors: Frazier Robert G.
Published: December 2021

The Academy owns and manages the publication of the journal Pediatrics for the purpose of publishing scientific information and ideas about matters affecting child health. The papers for publication are contributory and are selected by the Editors and Editorial Board on the basis of relevance and excellence. The interpretation of data and experience is the prerogative and responsibility of the authors and does not represent the action or policy of the Academy, except as in the case of Committee statements where this is specifically indicated.
A Comment on Arterial Po2–A Clinically Irrelevant Value
Authors: Wittig Heinz J. , Leifer Kent N.
Published: December 2021

The December 1974 issue of Pediatrics contained an article1 and an editorial comment2 which we find disturbing, misleading in their implications, and all too reminiscent of much in the recent literature regarding the possible adverse effects of bronchodilator aerosols on the arterial oxygen (Po2) levels of asthmatic patients.

We feel that thoughtful analysis of virtually all papers dealing with this blood gas problem will reveal very little data suggesting that arterial Po2 alterations from aerosols are statistically significant, much less clinically relevant.
Concern Over Day Care
Authors: Palmeri R.
Published: December 2021

I strongly disagree with the speculations made by Kearsley et al. in their article.1

The authors found that the emergence of separation protest in infants was not affected by their attendance, throughout the major portion of the first 20 months, in a day-care center. Obviously, the babies' experience in that day-care center did not interfere with the maturation and emergence of that important developmental landmark, separation anxiety and protest.

The authors' speculations, however, should not go unchallenged.
INFANT NUTRITION, ed 2. By Samuel J. Fomon, et al. Philadelphia, WB Saunders Co., 1974, $22.50; 556 pp
Authors: Goldbloom Richard B.
Published: December 2021

The significance of nutritional knowledge for pediatrics and pediatricians has undergone some dramatic fluctuations in the last 50 years. Early in the 20th century, during the immediate postnatal period of modern pediatrics, nutrition was a major preoccupation for the physician who cared for infants and children. Many of his working hours were spent manipulating formulas and diets and looking for elusive diagnostic clues in the stool characteristics of infants. These practices were looked upon with bewilderment and suspicion by other members of the medical profession and, in the light of newer knowledge, some of them may well have involved an element of witchcraft.
Use of a Tape-Recorder To Enhance Physician-Mother Communication in the Newborn Period
Authors: Zlotnick David A.
Published: December 2021

Editors' Note: The following description of an aid in practice is presented because it may be useful to other practitioners, and as a stimulus for readers to write short descriptions of methods they have found useful in practice. While it would be ideal if such innovations were thoroughly evaluated, our purpose in publishing them is to stimulate others to try out such new ideas, and to evaluate their effectiveness.

The use of small tape-recorders has proved an invaluable aid in solving the dilemma of providing the mother of a newborn infant with meaningful information concerning the care of her baby, in a personal manner and in the shortest possible time.
Neurological Impairment Induced by Hyperventilation in Children With Sickle Cell Anemia
Authors: Allen John P. , Imbus Charles E. , Powars Darleen R. , Haywood L. Julian
Published: December 2021

This experience with strokes induced by hyperventilation during repose in patients with SS is presented to caution against its use in patients with SS. We have discontinued hyperventilation during EEC in all of our patients with SS. Cheatham and Brackett12 and Richards and Nulsen13 state that the risks of angiography in patients with SS are significant. However, Stockman et al. have recently demonstrated that with repeated exchange transfusion preparation, angiography can be carried out without incident. Even so, we did not feel these patients were surgical candidates; therefore, angiography was not performed.

If further experience with hypertransfusion should prove effective in producing clinical and functional neurological improvement, angiography would be a useful tool in following the course of the vascular disease. Certainly, the angiographic reversal of the vascular disease would suggest that hypertransfusion may be helpful in patients with SS who have had transient cerebral episodes.
Would PNPs Be More Efficient?
Authors: Hudgens Carolyn
Published: December 2021

As a student in the pediatric nurse practitioner (PNP) program at the University of Iowa, I was delighted to see the article by Hoekelman1 which presented an experimental study to compare the adequacy of well-baby care given by physicians alone vs. a combination of physicians and PNPs. The review of previous experimental studies2-3 and suggestions for further studies recognizes the need to determine the most efficient use of health personnel.

One question that this study leaves in my mind concerns the well-baby visits that the R.N. conducted in both of the reduced-frequency groups.
Treatment of Nocardia
Authors: Ahronheim Gerald A. , Idriss Ziad H.
Published: December 2021

One aspect of Drs. Cox and Hughes' timely report on nocardiosis1 merits additional inquiry and comment. What was the time relationship between the appearance of nocardial disease and treatment of the Pneumocystis carinii pneumonitis in patients 2 and 4? Were these patients on antipneumocystis therapy at the time of recognition of nocardial infection and, if so, for how long and with what agents? If they were being treated with a combination of a sulfonamide and a folic acid antagonist (e.g., pyrimethamine or trimethoprim), do these cases represent the development of nocardiosis while on "specific therapy" (i.e., sulfonamides)?
Committee's Recommendations Challenged!
Authors: North A. Frederick
Published: December 2021

Dr. Shiela Mitchell and her distinguished committee1 recommend that blood pressure measurements should be a regular and routine part of every physical examination of every child over the age of 2. They recommend that any child with a blood pressure over the 95th percentile for age have a fundoscopic examination and have at least one repeat blood pressure measurement and clinical evaluation within a few weeks. They state that repeated examinations and further investigations are indicated if the blood pressure persists at or above the 95th percentile.
Dr. Hoekelman Replies
Authors: Hoekelman Robert A.
Published: December 2021

The 2- and 4-month visits on the reduced-frequency schedule for babies assigned to both pediatricians and pediatric nurse practitioners (PNPs) were conducted by private office or clinic nurses (non-PNPs). Those visits were scheduled for the purpose of administration of immunizations and screening tests only. The provision of counseling and anticipatory guidance by those nurses was not planned, but was given if requested by the nurse or if deemed necessary by the pediatrician or the PNP. The nurses conducting these visits did not have any formal training in these areas.
Screening for psychosocial problems
Authors: Korsch Barbara
Published: December 2021

The work on screening for psychosocial problems reported in this issue of Pediatrics1 is a careful, clinical study allowing valid inferences to be drawn. This is particularly welcome in a complex field in which most solo or group practices are in no position to organize this kind of venture and keep the appropriate records for analysis. Obviously, one of the fringe benefits of a prepaid medical care program is the possibility of large-scale clinical studies of health care delivery. Through the years, the work emanating from Kaiser, and specifically from this group, has born ample witness to this. Similarly, some of the prepaid national health programs in other countries have yielded data which would be difficult to obtain under any other system of health care.
Plasma Renin Activity in Familial Dysautonomia: Unresponsiveness to a β-Adrenergic Blocker
Authors: Hochberg Z. , Kahana L. , Spindel A. , Diengott D.
Published: December 2021

In familial dysautonomia (FD) the autonomous nervous system, reflex control, superficial sensation, and motor coordination are all affected.1 Postural hypotension with periods of hypertension are common findings.

Rabinowitz et al.2 showed abnormal release of renin in seven patients with FD, six of them having high plasma renin activity (PRA). Abnormal values of PRA were observed in the upright position and on a low-salt diet.

Propranolol, a β-adrenergic receptor blocker, inhibits PRA in man regardless of the previous PRA values.3

The effect of propranolol on PRA and blood pressure of children with FD was studied, since it was hoped that propranolol, by suppressing renin release, might stabilize their blood pressure.
PNP Care Is More Expensive!
Authors: Weinberger Howard L.
Published: December 2021

We would like to comment on the article by Hockelman on well-baby care.1

Although conceptually in support of the role of the pediatric nurse practitioner in the future delivery of well-child supervision, we feel obligated to question the conclusion presented in the article. Hoekelman states that three visits to a PNP for well-child supervision are equivalent to six visits to a PNP and to three or six visits to a pediatrician, and a number of measures of effectiveness are presented to support his conclusion.
A Plea for Care and Clarity
Authors: Bolduan Nils W.
Published: December 2021

An egregious example of less than adequate proof-reading appears in both the title and the substance of the article by Powers and Swyer. It seems that "umbilical arterial catheterization" in the title is not really what is meant. The abstract of the article begins with the umbilical artery and proceeds to the iliac artery to end again with the umbilical artery.

I am still not sure what was studied and reported on. Was the catheter in an umbilical artery, or in an iliac artery?
The Use of Histamine Questioned
Authors: Sanyal Shyamal K.
Published: December 2021

The pathogenetic mechanism proposed by Levin et al.1 to explain the persistence of fetal cardiopulmonary circulatory pathway (PFCCP) during infancy if of interest. However, their suggestion that use of histamine injected directly into the pulmonary artery may be beneficial in such patients raises some questions.

The initial cardiac catheterization data in their patient at the age of 33 days show hypoxia and hypercarbia. The authors have indicated in Table II that both of these factors could produce a decrease in pulmonary blood flow as well as an increase in pulmonary artery pressure and pulmonary vascular resistance.
Drs. Levin and Paul Reply
Authors: Levin Daniel L. , Paul Milton H.
Published: December 2021

We agree with Dr. Sanyal's point that histamine should not be used in patients with persistent pulmonary hypertension, especially newborns in whom there are no data to support its effectiveness or safety. Our suggestion in the article1 was merely intended to stimulate interest for the possible use of this agent and, therefore, sound investigation into its efficacy. We had hoped that it would be clear from the article that we provided no evidence for the efficacy of any mode of therapy in this condition.
PROBLEM-ORIENTED MEDICAL CONCEPTS. Edited by Richard E. Easton. New York, Appleton-Century-Crofts, 1974, 150 pp
Authors: Margolis Carmi Z.
Published: December 2021

"This book attempts to define problem-oriented medical record concepts . . . from a pragmatic point of view . . . with such clarity that any member of the health care team will be able to understand them, and adapt them to his or her discipline."

Clarity is attempted through the use of the following STYLISTIC DEVICES that the author feels will assist the reader to LEARN problem-oriented concepts:

(1) Printing KEY WORDS in upper case.
CDP: A major breakthrough!
Authors: Wung J. T. , Stark R. I. , Hegyi T. , Driscoll J. M. , James L. Stanley
Published: December 2021

It is now over 15 years since infants suffering from the respiratory distress syndrome (RDS) were first treated with artificial ventilation.1-4 The principles on which this treatment was based were sound, but the difficulties in implementation great. Institution of artificial ventilation was commenced late in the disease when the infant was approaching a state of respiratory and circulatory failure. This was in part because of the problem in identifying which infant might recover spontaneously and in part because of the hazards of therapy. However, as knowledge and experience increased, pediatricians gradually learned of the intricacies not only of the machines but also of the disease and began to manage patients with varying degrees of success.5
Annual Summary of Vital Statistics–1975
Authors: Wegman Myron E.
Published: December 2021

During 1975, continuing the recent general year-to-year trend, there were fewer births, deaths, and marriages and more divorces than in the previous year. Infant mortality again reached an all-time low for the country, 16.1 per 1,000 live births (Table I).

BIRTHS

Previous articles have pointed out that census bureau projections, influenced largely by the "baby boom" after the Second World War, predicted a steady increase in the number of women in the child-bearing ages (assumed to be 15 to 44 years) through 1980. In 1975 the number of women in this age group did indeed increase, by about 2%. Yet a fall in the fertility rate (Fig. 1) resulted in an actual decrease in the number of births to a projected total of 3,149,000.
Atrioventricular Block Complicating Meningitis: Treatment With Emergency Cardiac Pacing
Authors: Morriss Jill H. , Gillette Paul C. , Barrett Fred F.
Published: December 2021

Percutaneous insertion of a transthoracic pacing wire is described in a child who developed complete A-V block during hospitalization for treatment of meningitis. This is a simple method and the necessary material can be easily included on emergency carts.
View of China Questioned
Authors: Davis Edward G.
Published: December 2021

In the article "Child Care in the People's Republic of China–1973: Part II." by Joe D. Wray.1 I am very curious as to the repeated references to "China in preliberation days," "preliberation China." "Fighting, scuffling, rough-housing, or disputes seemed to occur rarely." "There is no doubt however, that the message they receive from society is that the competence they develop is to be used to ‘serve the people,’ and not for personal benefit or gain."
Dr. Wray Replies
Authors: Wray Joe D.
Published: December 2021

When William Buckley interviewed Theodore H. White on "Firing Line," and the subject of contemporary China came up. Buckley accused White of "dripping with praise" in his accounts of China, and went on to imply his contempt for other well-known figures who have "raved" about China; Buckley himself was apparently unimpressed by what he saw in China. What we see in China depends, as it tends to do everywhere, on the biases we take with us; what we think of what we see is even more dependent on our biases.
A Reminder About Otitis Media
Authors: Shelley J. H.
Published: December 2021

Dr. Rowe's article1 on the treatment of acute suppurative otitis media was a thorough review but he failed to include a medication for the relief of pain. Younger pediatricians should never forget that symptomatic relief is important in the treatment of various diseases.
Male Pseudohermaphroditism With Partial Androgen Insensitivity
Authors: Keenan Bruce S. , Kirkland John L. , Kirkland Rebecca T. , Clayton George W.
Published: December 2021

Androgen insensitivity was demonstrated in two male siblings with partial masculinization of the external genitalia. They had a previously undescribed defect characterized postpubertally by high plasma testosterone and luteinizing hormone concentrations with low serum folliclestimulating hormone levels. Studies in skin fibroblasts showed normal androgen receptor affinity and capacity for 5α-dihydrotestosterone (DHT), normal nuclear retention of the receptor-DHT complex, and normal conversion of testosterone to DHT.
Meningococcal Disease in Day-Care Centers
Authors: Jacobson Jay A. , Filice Gregory A. , Holloway J. Ted
Published: December 2021

Household contacts exposed to patients with meningococcal disease are at demonstrably higher risk of that disease than the general population.1,2 Less intimate and less prolonged contact such as that involving hospital personnel3 or school classmates4 is not clearly associated with increased risk. This may well be due to the fact that older children and adults commonly have protective antibodies.5 Preschoolers, on the other hand, are more often susceptible as shown by their higher age-specific primary6 and secondary7 attack rates. When a child who attends a day-care center nursery develops meningococcal disease the presumed exposure of numerous susceptibles is a theoretically dangerous situation.
Dietary Essential Fatty Acids in Cystic Fibrosis
Authors: Rosenlund Mary Loretta , Selekman Janice A. , Kim Hong K. , Kritchevsky David
Published: December 2021

Analyses of serum lipids of children with cystic fibrosis (CF) have indicated a deficiency in essential fatty acids (EFA). In view of a report that intravenous administration of soybean oil emulsions normalized sweat sodium values in CF children, we studied the effects of orally administered essential fatty acids (as corn oil) for one year. Some improvement was noted in all patients, but no one consistent factor predominated. However, arachidonic acid, which was found only in trace amounts or was absent in sera of all children with CF before the clinical trial, was increased significantly in the sera after the oral administration of EFA for one year. Other findings included a significant decrease in sweat sodium and T3 in most patients.
Nutritional Aspects of Vegetarianism, Health Foods, and Fad Diets
Authors:   Committee on Nutrition
Published: December 2021

Most individuals who adhere to unusual nutritional practices, except for balanced vegetarianism, are aware that their ideas run counter to the mainstream of medical and nutritional opinion. Some adopt such diets as an expression of disillusion with medicine or the "establishment" Physicians and other health professionals should be prepared to encounter strong resistance if they attempt to reverse such practices. Parents are likely to resist the suggestion of major dietary changes, and it is best to focus on those features of the diet that are of greatest potential harm to their children. However, even with the more extreme dietary practices, it is usually possible to prevent serious harm by striving for dietary variety and balance and working within the value system or philosophy of the group or individual.
Hypercalciuria With Nephrolithiasis: A Complication of Total Parenteral Nutrition
Authors: Adelman Raymond D. , Abern Steven B. , Merten David , Halsted Charles H.
Published: December 2021

Total parenteral nutrition (TPN) is a proven adjunct to the management of severely debilitated patients in whom oral or tube feeding is ineffective or contraindicated.1-4 Several studies have shown that the use of TPN in inflammatory bowel disease has led to better nutritional preparation for surgery, amelioration of symptoms and radiographic findings, and possibly even remission.5-7 Reported complications of the use of TPN include hypophosphatemia, acidosis, hyperglycemia, and hyperosmolar coma.1-4 The present report concerns a child with severe Crohn's disease who developed marked hypercalciuria associated with renal calculi while receiving TPN. After removal of calcium from the TPN solution, there was rapid disappearance of hypercalciuria followed by passage and dissolution of calculi.
Drugs in South America
Authors: Fisher Julian H.
Published: December 2021

Having just arrived to spend some time here in nutrition and health care studies, I realize that there are many cultural adjustments to be made. One which I find difficult to accept is the seemingly unbridled license which pharmaceutical houses (some of which number among our better-known ethical firms in the United States) take in manufacturing and promoting drugs in South America. Whether the parent companies lack control or lack concern, I am hard-pressed to pass judgment from this vantage point.
Anguish Over Contradictory Articles
Authors: Costich Timothy D.
Published: December 2021

As a sufferer from fairly severe hay fever, I read with great interest the article by Johnstone et al.,1 hypothesizing a connection between general anesthesia and respiratory allergy. My interest was heightened because I underwent a hernia repair at Strong Memorial Hospital at age 16 months. The article by Ballantine et al.2 in the same issue leads me to believe that I should have had my operation in Boston.

The two articles are absolutely contradictory.
In Reply: Could the Umbilical Catheter Have Caused the Trouble?
Authors: Makker S. P.
Published: December 2021

Limitation on space made by the journal necessitated the brevity of the case report, and, therefore, a detailed account of the neonatal hospital course was not included in our article. At birth, the Apgar score was 8, and the baby required bagging with oxygen for three minutes. Initial blood gas determinations in 40% oxygen showed a PaO2 of > 100 mm Hg. At 20 hours of age, moderate respiratory distress developed, requiring nasal continuous positive airway pressure (CPAP).
In Reply: On the Physical and Intellectual Development of Black Children With and Without Sickle Cell Trait
Authors: McCormack Michael K. , Scarr Sandra , Katz Solomon H.
Published: December 2021

Many of the concerns expressed in the letters of Drs. Virdi and Wethers and Dr. Bowman and Ms. Bernstein are indeed legitimate social issues. We are all aware of the gross injustices associated with screening clinics for sickle cell trait and with the misuse of information regarding sickle cell trait. It was never our intention to have the information presented in our article misused by insurance companies, teachers, guidance counselors, etc., as a method for further stigmatizing black people in the United States.
Value of Simultaneous T3, T4, and TSH Measurements for Management of Graves' Disease in Children
Authors: Golden Michael P. , Kaplan Solomon A. , Lippe Barbara M. , Lee W. N. Paul
Published: December 2021

One hundred simultaneous determinations of serum T4 and T3 were performed during the course of treatment of 23 children and adolescents with Graves' disease. Five patients were previously untreated and six were experiencing relapse after treatment was discontinued. During relapse, increased T3 concentration is frequently present when serum T4 concentration is normal, and T3 measurement is therefore more reliable for early detection of relapse. During therapy with thionamides, T4 measurement alone is often misleading in assessing adequacy of control achieved by therapy. Commonly, patients who clinically have hyperthyroidism have serum T4 concentrations within the normal range but continue to have elevated T3 concentrations (T3 toxicosis). Similarly, T4 can be suppressed into the hypothyroid range in the clinically euthyroid patient with either a normal or high T3 concentration. In these patients, determination of serum T3 often prevents premature reduction of thionamide dosage. When T4 and T3 concentrations do not clearly demonstrate presence or absence of hypothyroidism, measurement of serum thyroid stimulating hormone can be of value.
Prenatal Diagnosis of Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency
Authors: Milunsky Aubrey , Tulchinsky Dan
Published: December 2021

There is a paucity of data concerning the feasibility of the early antenatal diagnosis of congenital adrenal hyperplasia (CAH). Jeffcoate et al.1 reported elevated amniotic fluid 17-keto-steroid and pregnanetriol levels in a patient at term carrying a fetus with CAH. Nichols2 and Nichols and Gibson3 reported high amniotic fluid pregnanetriol levels in two other patients in term pregnancies. In contrast, Merkatz et al.4 found normal amniotic fluid 17-ketosteroid and pregna-netriol levels in two other patients carrying fetuses with CAH who had repeated amniocenteses at 26, 30, 35, 38, and 33 and 37 weeks gestation. New5 also noted that in his experience, 17-ketosteroid or pregnanetriol levels in amniotic fluid were not useful for the antenatal diagnosis of CAH.
Comment on Nasotracheal Intubation and Croup
Authors: Phelan Peter D.
Published: December 2021

I was interested to read the report by Rapkin in the July 1975 issue on nasotracheal intubation in epiglottitis. We have used this technique for patients with epiglottitis and acute laryngotracheobronchitis for the last five years and have recently reviewed our experience with intubation in 40 patients with epiglottitis and 47 patients with laryngotra-cheobronchitis.

I agree with Dr. Rapkin that nasotracheal intubation is a very satisfactory procedure in epiglottitis and is virtually complication-free in skilled hands.
Audit Defended
Authors: Thorpe James H. , Thorpe Helene S.
Published: December 2021

Beset as our medical profession is today with malpractice insurance costly or unavailable, with federal reimbursement not covering even the paperwork, and with politicians threatening more legislative encumbrances, it is no wonder that Dr. Bergman views audit with alarm (Pediatrics 56:345, 1975). The mandates of Professional Standards Review Organization for medical care evaluation seem to be just another governmental snare and delusion.

Yet, in fact, were PSRO to be repealed or die unfunded tomorrow, audit would still be the best evaluative tool established so far.
Dr. Bergman Replies
Authors: Bergman Abraham B.
Published: December 2021

I couldn't agree more that various methods designed to assess the quality of medical care should be subjected to scientific scrutiny. My point was that hospitals and physicians have been propelled into an orgy of frenetic, expensive busywork without evidence that these activities will indeed improve quality or even save money.

The most frequent type of audit in our (teaching) hospital is house staff and attending physicians asking each other several hundred times a day, "why did you do this?"
CLINICAL PERINATOLOGY. Edited by Silvio Aladjem, M.D., and Audrey K. Brown, M.D. St. Louis, CV Mosby Co. 1974, $39.50; 492 pp
Authors: Philip Alistair G. S.
Published: December 2021

The field of neonatology may safely be considered to have blossomed during the sixties. With increasing knowledge came the realization that study of the neonate could not be considered in the isolation of extrauterine existence. Both pediatricians and obstetricians gave more attention to the fetus. Thus, perinatology has emerged in the seventies.

This is attested to by the appearance of the Journal of Perinatal Medicine in 1973, Clinics in Perinatology in 1974, and two books (reviews) on perinatology at the end of 1974. Both of these books have multiple contributors. One of the books is Modern Perinatal Medicine, edited by L. Gluck, and Clinical Perinatology is the other.

Clinical Perinatology is directed toward obstetricians and pediatricians and provides a useful basic text on the subject. (Modern Perinatal Medicine, on the other hand, seems to be directed more toward those working exclusively in this field.) The content is arranged logically, ranging from the opening chapter, "Physiology and Pathophysiology of Maternal Adjustments to Pregnancy," to the closing chapter, "Impact of Neonatal Intensive Care on Quality of Life." Most of it is eminently readable, though I labored a bit over "Perinatology: Legal and Ethical Considerations."

There are some statements with which one may argue, e.g., "the cause of increased size in infants of diabetic mothers is not known" (chapter 1) and "hepatitis appears not to be transmitted to the fetus" (chapter 2). Other statements may be untrue, e.g., "severe neonatal jaundice can be precipitated by the competitive binding of sulfonamides" (p. 51). The author is correct in drawing attention to the danger of sulfonamides, but displacement of bilirubin (leading to kernicterus) is the problem, sometimes without significant jaundice.