bluuebunny/crossref_metadata_2025 huggingface dataset:
EVALUATION OF MIST TENT THERAPY IN CYSTIC FIBROSIS USING MAXIMUM EXPIRATORY FLOW VOLUME CURVE
Authors: Motoyama E. K. , Gibson L. E. , Zigas C. J.
Published: December 2021

The effect of home mist tent therapy in cystic fibrosis was reexamined using the measurement of maximum expiratory flow volume (MEFV) curves, forced expiratory volume (FEV1), and vital capacity (VC) in 16 patients every 2 weeks during a period of 4 to 5 months. In half of the patients the studies were made during an initial period of 8 to 12 weeks off and then a similar period on nocturnal mist tent therapy; in the other half the test conditions were reversed. No evidence of improvement in ventilatory function was found in these patients during the use of a mist tent; instead there was a small but significant decline in their ventilatory function. Home visits were made and bacterial contamination of mist tent equipment was noted in more than two-thirds of the tents in spite of careful cleaning instructions to the parents. The MEFV curve was found to be a simple yet sensitive test of evaluating lower airway obstruction in cystic fibrosis.
Excerpt II: Old Hound and his Master
Authors: Cone Thomas E.
Published: December 2021

A FABLE is defined by Samuel Johnson as "a narrative in which beings irrational and sometimes inanimate are, for the purpose of moral instruction, feigned to act and speak with human interests and passions." The fable below, read by many New England schoolboys more than a century and a half ago, aptly illustrates Dr. Johnson's definition.1
Maternal Guilt, Prenatal and Perinatal Insults, and Psychiatric Guidance
Authors: Thelander H. E.
Published: December 2021

The article "Indices of the Child's Earliest Attachment . . . etc." in the April 1972 issue of Pediatrics calls for comment. During 20 years of work with handicapped, retarded, and emotionally disturbed children at the Child Development Center, it was distressing to find how many of the mothers who had sought help from psychiatrists came in very depressed because the psychiatrist had made them feel that they were the cause of their child's abnormal condition.
Intravenous Insulin: Effect of Binding to the Infusion Set Upon the Dose Administered
Authors: Lamon Edward J.
Published: December 2021

Insulin has been known for many years to adsorb to laboratory glassware. This binding is thought to be a nonspecific surface phenomenon which also occurs when small doses of insulin are administered by slow intravenous infusion for therapeutic purposes. While only 8% of the administered insulin is adsorbed to the glass infusion bottle over two hours if 10 units of insulin is added to 500 ml of isotonic saline, when one includes the insulin adsorbed to the tubing, 30% of the insulin activity is lost in two hours.
Letter to the Editor
Authors: Brown R. E. , Madge G. E.
Published: December 2021

Quantitative studies to determine the exact amount of insulin received by a patient under the conditions of insulin-glucose therapy for Reye's syndrome would be academically desirable.

We admit that some insulin activity can be lost by nonspecific binding to the tubing and glassware. However, we cannot agree that the Reye's syndrome patients treated with "slow" intravenous infusion of hypertonic glucose and insulin may not have received any insulin. Thinner control films were less permeable than thicker control films.
PRENATAL NUTRITION OF LAMBS, BEARS—AND BABIES?
Authors: Cahill George F.
Published: December 2021

The two superbly documented papers from the Battaglia group by James et al. and Gresham et al. are most provocative, since they challenge current dogma that glucose is the primary fetal fuel. As evidence, they present several indisputable observations: measured transplacental glucose difference accounts for only 40% of measured fetal oxygen consumption or CO2 production, and a surprisingly high rate of fetal urea production attests to a high rate of amino acid oxidation. The following Table summarizes both their directly determined and their calculated data with several further extrapolations by this reviewer, must have been transferred from mother to fetus.
SOME UNSOLVED PROBLEMS IN CLINICAL ALLERGY: OBSERVATIONS ON MILK AND EGG HEMAGGLUTINATING ANTIBODY TITERS IN ALLERGIC CHILDREN
Authors: Dees Susan Coons
Published: December 2021

Bret Ratner's investigation of anaphylaxis, inheritance of allergy, intrauterine sensitization and allergy to foods are reviewed as a background to illustrate the unsolved problems still remaining in these areas. Immunologic methods developed subsequently have proven to be of little help in clinical food allergy. A discrepancy between levels of hemagglutinating antibody to milk and egg is observed in the sera of 543 allergic children. This bears no relationship to age, allergic disorder, diet or skin tests. There is an apparent correlation between absent IgA immunoglobulins and high titers of hemagglutinating antibody to milk. The significance of these antibodies to either milk or egg is not understood.
THE 1971 PRETEST OF THE AMERICAN BOARD OF PEDIATRICS
Authors: Burg Fredric D. , Wright F. Howell
Published: December 2021

In July 1971 the American Board of Pediatrics decided to offer pediatric residency program directors an opportunity to pretest individuals entering their training programs by making available to them an examination prepared by the American Board of Pediatrics. The 1971 written certifying examination was selected to serve as the pretest. This was a 500-item, multiple-choice question examination. Ninety-two pediatric residency programs participated. From these programs, 584 individuals were examined: 528 of these were first core year trainees. The mean standard score for the first core year trainees was 217 or about 1.4 standard deviations below the minimal pass level on the written certifying examination. This is nearby 3 standard deviations below the mean for the peer reference group which is defined as American and Canadian medical school graduates who are taking the written certifying examination of the American Board of Pediatrics for the first time and who have just completed their two core years of residency training. Fifteen percent of the first core year group scored 350 or better and, therefore, performed well enough to have passed the written certifying examination of the American Board of Pediatrics before beginning any formal training.
RESULTS OF TREATMENT OF 171 CONSECUTIVE MYELOMENINGOCELES—1963 TO 1968
Authors: Ames Mary D. , Schut Luis
Published: December 2021

Of the 171 children with myelomeningocele referred to the Children's Hospital of Philadelphia in a six-year period, 33 died, 23 were not available for follow-up, and 115 have been followed for three to eight years. In the 79 children whose hydrocephalus required shunt operation, 42% with thoracal lumbar lesion and 80% with lumbar and lumbosacral lesions are ambulatory and competitive with a Developmental or Intelligent Quotient of 80 or higher. In the 35 children not requiring such surgery, 90% are ambulatory and competitive. These results have been obtained by employing a simple but comprehensive and coordinated plan of treatment shared by the neurosurgeon and pediatrician with extensive use of paramedical personnel in the actual care of the child. Other doctors are used only as consultants and not in primary decision-making. Because no infallible criteria for determining potential at birth have evolved, all children are operated upon to close the defects and relieve the hydrocephalus.
Kala-Azar Imported into the USA
Authors: Zavoral James H. , Paloucek James T. , Yaeger Robert C.
Published: December 2021

Kala-azar, or visceral leishmaniasis, is not an indigenous disease in the United States. Prior to 1945, only nine cases had been reported in this country. Several reports following World War II, estimated that 50 to 75 cases had occurred in American servicemen who had been stationed overseas. Since World War II only three cases have been reported in the United States.

Two cases of Kala-azar which were diagnosed in the United States are presented. Leishmania donovani is discussed to alert physicians to the presence of this parasite as a cause of a potentially fatal disease. The children were probably infected with the organism in Spain.
COUNSELING OPPORTUNITIES IN HUMAN REPRODUCTION
Authors: Hazard Sprague W. , Allen V. Robert , Eisner Victor , Garell Dale C. , Hammar S. L. , Shaffer Thomas E. , Shen Jerome T. Y. , Tanner Natalia M. , Welty John Allen
Published: December 2021

Problems relating to human reproduction are among the critical issues of our time, and it is appropriate that pediatricians contribute to the solution of these problems. The changing dimensions of comprehensive pediatric care, more specifically the significant numbers of pregnancies being reported in young persons, support this position. For example, national statistics show that 44% of all pregnancies occur in persons under 20, and one out of four mothers on Aid to Families with Dependent Children in New York is pregnant before 16.

At least four roles can be identified for the pediatrician:

1. Genetic counseling: the pediatrician has already become proficient in giving knowledge to parents of the incidence of inborn errors of metabolism, chromosomal abnormalities, and other problems associated with genetic inheritance patterns.

2. Sex education: he often provides sex education to individual patients, families, and parents, in addition to teaching groups in his own practice and in schools, churches, or youth organizations.

3. Family planning and pregnancy counseling: he may provide assistance in these areas in behalf of the parents or adolescents. This assistance may involve a wide range of clinical advice and treatment, including the concept of spacing (rhythm method), contraceptive devices, or oral medication, whatever is considered most suitable for the individual. All alternatives for dealing with an unwanted pregnancy should be seriously discussed with the teenage girl and the other persons involved, including the parents if feasible. The pediatrician is in a unique position by the nature of his close association and relationship with the adolescent patient to provide this important personal service.
The Pediatrician and Atherosclerosis
Authors: Stare Frederick J.
Published: December 2021

The report of the Committee on Nutrition of the American Academy of Pediatrics on "Childhood Diet and Coronary Heart Disease" in your February 1972 issue of Pediatrics, and your commentary, "The Pediatrician and Atherosclerosis," both seem "typical" and a little old-fashioned. Perhaps one should expect this from pediatricians because they don't see the end results of coronary heart disease unless it be a fellow pediatrician in his 40s or 50s, or perhaps in their father in his early 60s, or they read of a celebrity like the late Gil Hodges.
Detergent Toxicity
Authors:   Subcommittee on Accidental Poisoning, Scherz Robert G.
Published: December 2021

Products of the soap and detergent industry find their way into every home in America. Fifteen percent of all inquiries to Poison Control Centers involve the ingestion of household detergents and polishing agents by children under 5 years of age. In 1970, these amounted to 10,810 reports, of which one-third involved soap, detergents, and cleaners. It is widely recognized that there are many more episodes than those actually reported. Poison Control Centers have learned that these ingestions have rarely led to clinically significant illness in the past.
A CONTROLLED TRIAL OF HYDROCORTISONE THERAPY IN INFANTS WITH RESPIRATORY DISTRESS SYNDROME
Authors: Baden Melvin , Bauer Charles R. , Colle Eleanor , Klein George , Taeusch H. William , Stern Leo
Published: December 2021

Forty-four infants were treated with hydrocortisone or a lactose placebo in a controlled study to evaluate the ability of postnatally administered hydrocortisone to alter the course or outcome in infants with the Respiratory Distress Syndrome (RDS). No significant effect on PaO2, PaCO2, [H+], percent ambient oxygen needed, A-aDO2 gradients, need for assisted ventilation, or survival was demonstrated. Plasma corticosteroids during the 72-hour period after administration showed significant differences between the hydrocortisone- and placebo-treated infants. Additional analysis of plasma corticosteroid levels in 24 RDS infants versus 10 control prematures failed to demonstrate any endogenous deficiency of corticosteroids in infants with RDS. Although no immediate detrimental effects of the therapy were seen, the postnatal use of corticosteroids did not appear to carry any obvious benefit for the infant with RDS.
The Interrelationship Between the Patient, His Family, the Referring Physician, and the Pediatric Allergist
Authors: Halpern Salmon R. , Vaughan Victor C. , Glaser Jerome
Published: December 2021

Dr. Howard Rapaport's attack on the report of the Committee on Allergy of the American Academy of Pediatrics is unrealistic; only by the most active cooperation between allergists and other health workers can the large number of allergic children receive needed attention.

His concern runs counter to the advances made in many areas of community medicine. Lay people are taught to administer injections, to take readings of temperature, pulse, and blood pressure. Pediatricians's assistants are increasingly involved in history taking, physical examinations, and prescribing medications.
Letter to the Editor
Authors: Cooper A. R.
Published: December 2021

The hypothesis by Dr. Smithwick et al. that altered cell-mediated immunity secondary to a vaccinia infection or hepatitis may have been a factor in the development of this child's disease is interesting. However, it should be noted that the reactions to atypical mycobacterial skin antigens were not suppressed during the period of active disease.
Letter to the Editor
Authors: S. C. A.
Published: December 2021

Nothing is.

The problem is not new and it is increasing. We think our readers, authors, and printers should be saved unnecessary words. But we don't like the looks or the sounds (when read literally) of the resultant prose any more than you do.
Continuous Antibiotic Therapy in Chronic Granulomatous Disease: Preliminary Communication
Authors: Philippart Arvin I. , Colodny Arnold H. , Baehner Robert L.
Published: December 2021

A series of nine patients with chronic granulomatous disease have been maintained on continuous nafcillin therapy for a period adequate to allow preliminary evaluation. Clinically significant hepatic sepsis has not occurred since initiation of this program. The effect on extra-hepatic sepsis is not yet clearly established.
Report of Severe Herpes Zoster in a 13½-Year-Old Boy Whose Chickenpox Infection May Have Been Acquired In Utero
Authors: Lyday Joseph H.
Published: December 2021

The onset of this present illness may have occurred 13½ years ago when D.L. was of about 7 months' gestation in the uterus of his mother who had contracted chickenpox from her then 4- and 7-year-old children.

Mrs. L. was severely affected with chickenpox and required hospitalization at Colorado General Hospital. She developed a confluent eruption over her entire body. She was febrile, delirious, and comatose for several days with chickenpox pneumonia, and was attended by Dr. C. Henry Kempe. Mrs. L. recalls that Dr. Kempe had requested that if her unborn child ever developed chickenpox he would like to hear about it.
DRUG INTERACTIONS—PART IV
Authors: Riley Harris D.
Published: December 2021

Activity of one drug may be modified by prior or simultaneous administration of another, and improved therapy is sometimes possible by concurrent medication. However, serious adverse effects may also arise from drug interaction.1 Interactions are caused by altered absorption, distribution, biotransformation or excretion of drugs, or from adjunctive action. In this communication certain known interactions affecting antimicrobial agents will be reviewed briefly and their mechanisms noted.

Preadministration Interactions

Besides chemical actions between drugs themselves before administration, as in infusion preparations, there may also be interaction between infusion vehicle and drug, and even between a drug and the container. Tetracyclines are photoxidized by the riboflavin in vitamin B complex and become inactive and change color in alkaline solutions. Kanamycin and methicilin inactivate each other, and bisulfite inactivates penicillin G.

Postadministration—Carrier Site Displacements

Interactions may take place after drugs have been absorbed and metabolized. Most antibiotics circulate in the blood reversibly bound to serum albumin. Each albumin molecule has several binding sites and the extent of binding varies from almost none with certain drugs, such as cephaloridine, kanamycin, vancomycin, polymyxin B and colistin, to 90% or more for oxacillin, cloxacillin, dicloxacillin, demeclocycline, novobiocin, and some of the long-acting sulfonamides.2,3 The protein-bound portion is metabolically inactive, but the free portion is active. When highly bound drugs compete for the same binding site, one or both may be displaced.4,5

Clinically significant responses may result when the bound fraction of one drug is displaced from its binding site by a second drug of greater affinity.6
VISION SCREENING OF PRESCHOOL CHILDREN
Authors: Kugel Robert B. , Bartram John B. , Bost Roger B. , Cavanaugh James J. A. , Hanson Virgil , Kennell John H. , Lorincz Andrew E. , McMahon Jean , Pearson Paul H. , Scott Roland B. , Scurletis Theodore D. , Browder J. Albert , Halpern Daniel , Martin Edwin W.
Published: December 2021

Ideally, an eye examination should be performed immediately after birth and periodically during the preschool years. These years are important because it is at this time that much of a child's relationship to his environment is being established through visual channels and treatment for visual disorders is most successful.

At present, this is an impossible goal due to the large reservoir of preschool children, limited trained personnel and financial support, and lack of understanding by the publie of the importance of early eye care.

As an interim measure, the most practical approach seems to be one of vision screening as part of the total health supervision of the preschool child. This would encompass children from 3 to 5 years of age and could be performed by trained paramedical personnel or volunteers with a minimum of equipment.

For a successful program there must be community cooperation, approval, organization, education, and financing. A real effort must be made to contact that large group of children who are unknown to any service (physician) or agency. The screening itself has little value unless it is accompanied by adequate follow-up and resources to accept the referral and supervise the provision of proper care.

CONDITIONS DETECTED BY SCREENING

1. Refractive errors.

2. Muscle imbalance.

3. Amblyopia.

4. Some eye diseases.

SCREENING PROCEDURES

A. Observation or history-applicable from birth.

1. Unusually large eyes, sensitivity to light, excessive tearing, cloudiness, inflammation, hemorrhage, abnormal eye movements, i.e., nystagmus.

2. Difficulty with focusing or persistent deviation of one eye after 6 months of age.
The Respiratory Distress Syndrome: Bronchial Arteries and Catecholamines
Authors: Holm William W.
Published: December 2021

Physiologically immature infants prone to the respiratory distress syndrome (RDS) have decreased endocrine reserve to cope with stresses of extrauterine life. Hormones beneficial in utero may possibly be detrimental to the newborn infant.

Historically, the heart and lungs were considered separate entities; eventually the "heartlung" concept evolved.

If we now consider the bronchial arteries and ductus arteriosus as a prenatal unit (with the former providing perfusion of the lung parenchyma) the "intrapulmonary shunting" and hypoperfusion found in RDS can be explained, and possibly the pathological findings of SIDS.
Letter to the Editor
Authors: Hazard Sprague W.
Published: December 2021

The plan of the Committee, as a follow-up to its statement on Venereal Disease and the Pediatrician, is to distribute to each member of the Academy the most recent recommendations of the Venereal Disease Branch of the Center for Disease Control. This will include the treatment of gonorrhea and syphilis, both congenital and acquired.
Diagnosis of Urinary Tract Infection
Authors: Todd James Kennedy
Published: December 2021

The recent paper by Cohen in the August issue of Pediatisics relies on the use of "one or more cultures of over 100,000 organisms per millimeter of urine" to make the diagnosis of urinary tract infections upon which the remainder of the study is dependent. Obviously, the colony count was intended to read "per milliliter," and yet the results of the study must be seriously questioned since the criterion for diagnosis of urinary tract infection was not rigid enough to exclude a large number of false-positives— patients who never really had urinary tract infections.
THE CHILD HEALTH ASSOCIATE: COMMENTS OF A PRACTICING PEDIATRICIAN
Authors: Ross Ralph A.
Published: December 2021

As one of the early practitioners of the "New Pediatrics," first talked about in the 1950s, I have been asked to give some of my reflections on recent developments in pediatric practice which Silver and Ott describe in the paper under review.

The satisfactions of long-term care of children and their families have been extolled frequently and are very real to those of us who have pursued this type of practice. The failures of too large a number of youngsters under our care to reach satisfactory adjustment in adult society offer frustrations equally real and even more poignant. The gnawing doubt that anything we have done is responsible for the good results is alleviated somewhat by our feeling that factors beyond our control are the cause of the failures.

Despite all the testimonials from patients and their families to our skill in helping, and the opposing and rather more vocal diatribes of others against the "permissiveness" allegedly fostered by Benjamin Spock, I sometimes ask myself: Has the output of 80% of my time in many years of pediatric practice really made use of the large input in time and effort by school, hospital, and individual? It is clear that the skills learned during training years have been a boon to the 20% of patients who required expert care in diagnoses, treatment, and preventive pediatrics. But what about that other 80%?

From comments in periodicals by dissatisfied pediatricians, from the large number of young and not so young practitioners who year by year give up the "New Pediatrics," and from annoyances expressed with the demands made by and material returns available from pediatric practice, I assume that many of my colleagues have found the balance of frustrations weighing heavily against the satisfactions.
Long Survival in a Male with 18-Trisomy Syndrome and Wilms' Tumor: A Subsequent Report
Authors: Geiser Clementina F.
Published: December 2021

It might be of interest to report that the oldest surviving male with the 18-Trisomy syndrome1 died recently, at the age of 15 years and 8 months, during a respiratory infection. Autopsy was not performed.
Vitamin K, Hepatic Fatty Infiltration, and Reye's Syndrome
Authors: Boon Donald J. , Eveloff A. Raymond , Pilapil Virgilio R.
Published: December 2021

A survivor of Reye's syndrome in whom vitamin K restored the prothrombin time to normal was previously reported.1 The use of vitamm K was suggested to be of value in prognosis, as well as indicating that the fatty liver was still functional. Recently, another case allowed evaluation of this question and in addition pointed to the importance of a liver biopsy for diagnosis.

The patient was a healthy 15-month-old white girl who developed an upper-respiratory tract infection five days before admission, with subsequent associated vomiting and lethargy.
Letters to the Editor
Authors: Bland Richard D.
Published: December 2021

To Dr. Ziering and Dr. Glaser, Dr. Bland comments as follows:

To begin, let me apologize to Dr. Ziening and to any of his colleagues who may have interpreted my previous comments as irreverent. Moreover, I regret that intellectual honesty has been mistaken as "intellectual pompousness," that unchallenged dogma in the literature has been read as scientific fact. My intent was not to deny the existence of allergy or the relationship between otitis media and dietary intolerance, but to emphasize our ignorance in this field, to encourage more meaningful investigation, and to discourage blind acceptance of the opinions of "fifty million Frenchmen."
Autistic Children: A Guide for Parents and Professionals, by Lorna Wing, M.D., D.P.M. New York: Brunner/Mazel, Inc., 1972, 157 pp., $7.50
Authors: Work Henry H.
Published: December 2021

While the subtitle of this book suggests that it is written for ‘parents and professionals,’ the writing would seem to be designed chiefly for the former. Since, however, it is not at all sinful for a physician to gain medical knowledge from a lay journal, this text on a 20-year-old but still cloudy subject, has much to recommend it.

Dr. Wing, experienced with this group of children, sets forth not only a clear picture of the symptomatology but equally a good exposition of the current controversies on etiology, with a well-supported bias towards the organic source.
Orthopaedics In Infancy And Childhood (Postgraduate Pediatrics Series, under the General Editorship of John Apley, C.B.E., M.D., B.S., F.R.C.P., J.P.), by G.C. Lloyd-Roberts, M. Chir. (Cantab.), F.R.C.S. New York: Appleton-Century-Crofts, 1971, 337 pp., $22.50
Authors: Hall John E.
Published: December 2021

In the words of the author, this book is intended as a guide for pediatricians and for orthopedic surgeons in training. It summarizes the personal experience of Mr. Lloyd Roberts during 15 years at the Hospital for Sick Children in London, England. He has tried to put pediatrics orthopedic conditions into perspective with regard to their frequency and significance. The concise references to the rarer entities will serve this purpose well as a starting point and as a guide to further study.
FAMILIAL DISEASE CHARACTERIZED BY NEONATAL JAUNDICE, AND PROBABLE HEPATOSTEATOSIS AND KERNICTERUS: A NEW SYNDROME?
Authors: Wadlington W. B. , Riley Harris D.
Published: December 2021

The findings in a male infant who died at 9 days of age of an illness characterized by jaundice, kernicterus, and evidence of hepatosteatosis are described. Chemical analyis of hepatic tissue obtained at autopsy showed the hepatosteatosis to be due to a striking increase in the concentration of total lipids and fatty acids. No known toxins, infections, blood group incompatibilities, or concurrent metabolic aberrations could be identified as playing an etiologic role. Four male siblings died previously within the first two weeks of life with clinical manifestations identical to those of the patient who underwent necropsy. Since all the patients were males, a sex-linked entity seems likely. It is believed that these patients may represent a previously undescribed genetic disorder of metabolism, the principal features of which are jaundice, kernicterus, and hepatosteatosis.
LEARNING EXPERIENCES DURING THE INTERNSHIP YEAR: AN EXPLORATORY STUDY OF PEDIATRIC GRADUATE EDUCATION
Authors: Alpert Joel J. , Youngerman Joseph , Breslow Jan , Kosa John
Published: December 2021

Two interns at two institutions studied their perception of learning internship, using the critical incident technique. The majority of these experiences were technical, and only a few were interpersonal. Full-time staff, including other residents and senior staff, made the greatest contribution to their learning. Most learning took place in the ward and relatively less in the ambulatory services. Patients were involved in most of the experiences usually because of their diseases. While there were differences between the two interns there were many similarities.

The conclusion of the study is that current training does not provide a basis for dealing with human problems because of the present orientation of the hospital, but also that further study is needed to determine the amount of hospital training needed to become a practicing physician.
THE COMPLEX OF CERVICAL AORTIC ARCH
Authors: Mullins Charles E. , Gillette Paul C. , McNamara Dan G.
Published: December 2021

This report presents the 14th published occurrence of cervical aortic arch and presumably the first to be recognized clinically. Based on a review of the pertinent features of these 14 cases, the criteria for cervical aortic arch "syndrome" are not only the cervical position of the apex of the arch but also the anomalous origin of arch branches as well as the anomalous course of descending thoracic aorta. The apex of an "unwound" aorta, or pseudocoarctation, may reach into the neck region but lacks the other criteria for cervical aortic arch complex. Obliteration or diminution in femoral pulses during brief compression of the pulsatile neck mass is specific for cervical aortic arch.
RENAL ABNORMALITIES IN THE RUSSELL-SILVER SYNDROME
Authors: Haslam Robert H. A. , Berman Wulfred , Heller Richard M.
Published: December 2021

There has been a recent report of five children with the Russell-Silver syndrome. It was suggested that the clinical features were well-established, and the only laboratory investigation necessary was a fasting blood glucose to exclude hypoglycemia.

This study is a review of the status of the genitourinary system in six patients with the Russell-Silver syndrome. Four had abnormal excretory urograms or cystograms. These abnormalities included bilateral chronic pyelonephritis, unilateral ureteralpelvic obstruction and severe reflux, and unilateral pyelonephritis.

The finding of significant potentially treatable anomalies in the genitourinary system of patients with Russell-Silver syndrome indicates that an intravenous pyelogram and cystogram be included in the investigation of these patients.
Choledochal Cyst Presenting as Recurrent Pancreatitis
Authors: Karjoo Manouchehr , Bishop Harry C. , Borns Patricia , Holtzapple Philip G.
Published: December 2021

Choledochal cyst, or congenital cystic dilatation of the common bile duct, is a rare anomaly usually presenting in the first decade with pain, jaundice, and an abdominal mass. The following is a report of a child with recurrent abdominal pain who showed clinical and biochemical evidence of recurrent pancreatitis. Investigation revealed a congenital choledochal cyst. The abdominal pain and biochemical abnormalities abated after choledochocystojejunostomy.

Case Report

J.J., a 4-year-old white girl, was admitted to the Children's Hospital of Philadelphia because of recurrent abdominal pain. This pain, located in the epigastrium, first started at the age of 1.5 years and was associated with fever, nausea, and vomiting.
A MODEL ACT PROVIDING FOR CONSENT OF MINORS FOR HEALTH SERVICES
Authors: Hazard Sprague W. , Allen V. Robert , Eisner Victor , Garell Dale C. , Hammar S. L. , Shaffer Thomas E. , Shen Jerome T. Y. , Tanner Natalia M. , Welty John Allen
Published: December 2021

Whereas, certain minors are not obtaining adequate medical, dental, or other health care due to current legal and medical obstacles,

Whereas, providers of medical, dental, and other health care are now vulnerable to legal action for giving care to minors,

Whereas, there is a need for coordination, stimulation, and support of access to medical, dental, and other health care for certain minors in need of such care without violating the rights of parents to protect and promote their minors' health,

Be It Enacted by the Legislature of the State of-----,as follows:

Section 1. For the purposes of this act:

(1) "Minor" means any person under the age of majority as defined by the State statute or under 18 years of age, whichever is lower;

(2) "Health Professional" means state licensed physician, psychologist, dentist, osteopathic physician, nurse, and other licensed health practitioner;

(3) "Health Services" means health services specified by the state, appropriately delivered by different health professionals including examination, preventive and curative treatment, operation, hospilization (admission or discharge), giving or receiving blood and blood derivatives, receiving organ transplantation, pledging donation of organs after death, the use of anesthetics, and receiving contraceptive advice and devices;

(4) The masculine shall include the feminine.

Section 2. Any person who reaches the age of majority or 18 years of age or is on active duty with or has served in any branch of the Armed Forces of the United States shall be considered an adult in so far as the consent for health services is concerned.
Cryptorchidism in the Newborn
Authors: Santesteban Alfredo
Published: December 2021

The incidence of cryptorchidism in newborn infants is stated to be 3% to 4% by Curran and Curran in a recent article.1 The reference cited is a report by Scorer published in 1957.2 However, a review of the literature shows that the incidence of cryptorchidism in the full-term new born infant is slightly lower and in the low birth weight infant (birth weight 2,500 gm or less), it is considerably higher.

Up until 1955 there was much confusion regarding the incidence of undescended testes in the newborn.
Package Inserts and Noncompliance With Doctor's Orders
Authors: Gorlich Gary M.
Published: December 2021

Noncompliance, i.e., patient refusal to take doctor-perscribed medication, is very important in pediatric practice. Recent literature in Pediatrics and other pediatric-oriented journals has addressed itself to the frequency and significance of this behavior.

In recent discussions with colleagues in dermatology I have learned of another "etiology" for noncompliance and wish to bring it to the attention of those in pediatrics not familiar with it, to wit: physician samples of medications usually contain a package insert which is intended for the physician's knowledge of the preparation in question.1
THE INCIDENCE OF INFECTIONS IN NURSERIES SINCE THE DISCONTINUATION OF HEXACHLOROPHENE BATHING
Authors: Campbell Alexander G.M. , Pitkewicz Janice S.
Published: December 2021

An increase in the number of infants with clinical staphylococcal infection (primarily Group II Staphylococcus aureus) was observed in a newborn nursery following discontinuation of daily hexachlorophene bathing of infants in December 1971. An increase was also apparent among infants seen at the hospital outpatient services. These infections were generally superficial, mild, and there were no deaths. A review of all nursery infections indicated that there was a slight overall increase in the infection rate which was entirely due to S. aureus.

Weekly colonization surveys were undertaken while hexachlorophene emulsion was reintroduced as a control measure in part of the nursery population. Hexachlorophene was effective in reducing the incidence of colonization even when rinsed off the skin at the end of each bath and when used to a maximum of five baths for each infant. The reintroduction of limited use of hexachlorophene was followed by a reduction in the number of staphylococcal infections.
COMMENT
Authors: Sutherland James M.
Published: December 2021

The first of these two papers (Dixon) describes an anlysis and study of nursery outbreaks. Thirty-one percent of the reports reached the CDC through the efforts of drug manufacturers. Some reports were solicited, others unsolicited and still others detected by means other than direct reports. Dr. Dixon and co-workers report statistical significance in the discontinuation of variable hexachlorophene bathing techniques between randomly selected hospitals and hospitals reporting staphylococcal nursery outbreaks.

In the second paper, Kaslow and co-workers (Kaslow) analyze results from a survey of 266 of 296 randomly selected hospitals. In this study, infants who developed the disease after discharge from the nursery were excluded. Relative to the Academy-FDA warning in December 1971, staphylococcal disease rates rose sixfold in nurseries in which hexachlorophene bathing was discontinued while disease rates were unchanged in hospitals continuing hexachlorophene bathing. However, disease rates rose in hospitals when hexachlorophene was not used for bathing infants either before or after the warning.

In neither of these papers, do the authors present data on the inverse relationship between hexachlorophene bathing in the nursery and disease caused by gram negative organisms. Authors of both papers address themselves to some of the uncontrolled variables inherent in these types of retrospective studies and caution against too firm conclusions based on their data alone. For example:

(1) In the first paper, the CDC authors note that at least 31% of the reports of epidemics received by them were facilitated in some fashion by the manufacturers. They suggest that the conclusions of the first study are also limited by the fact that hospitals continuing or discontinuing hexachlorophene without recognized problems were not studied.
TO TAP OR NOT TO TAP (Further Comments)
Authors: Byers Randolph K.
Published: December 2021

To my mind, the suspicion of a cerebral or cerebellar abscess is a contraindication to lumbar puncture until and unless technetium scan and electroencephalogram are both negative. In brain abscess, more than in any other lesion, severe and unpleasant lumbar puncture reactions have been particularly likely to occur. I suppose distortion of the brain rather than increased pressure alone may add to the risks. Two general situations seem to me also to contradicate lumbar puncture.

One is the suspicion of lead poisoning with encephalopathy. We have here for several years absolutely interdicted lumbar punctures when this diagnosis is under suspicion, pending estimations of blood lead or x-ray examinations of the gastrointestinal tract for lead chips.
Letters to the Editor
Authors: Holliday Malcolm A.
Published: December 2021

The thrust of the report entitled "Filled Milks, Imitation Milks, and Coffee Whiteners" by the Committee on Nutrition was to focus attention on the potential hazard for infants of imitation milks. In general, imitation milks are nutritionally inferior to milk with respect to protein, vitamin, and mineral contents. Coconut oil as a substitute for fat in milk is deficient in linoleic acid. Consequently, filled and imitation milks containing only coconut oil are unsuitable for this reason.
Hyperammonemia: Another Hazard in Parenteral Alimentation
Authors: DePaul Larkin Vincent
Published: December 2021

I have been struck by recent reports on the unduly high levels of ammonia in protein hydrolysatesl,2 and the occurrence of hyperammonemia (fatal at times) in certain patients treated by parenteral alimentation.3 In reading the statement titled, "Parenteral Feeding–A Note of Caution"4 by the Committee on Nutrition of the American Academy of Pediatrics I was greatly surprised that no mention was made of these problems, even though the report covers a list of ten other complications which have been reported to be associated with hyperalimentation.
Umbilical Artery Catheterization: Hyperosmolar Solutions as Cause of Thrombosis
Authors: Helwig Helmut
Published: December 2021

The examinations of Neal and co-workers1 are of great importance and interest, as are the studies of various other authors. It is certainly true that extreme caution with the indication for umbilical catheters–venous as well as arterial–is necessary. The study of Neal, however, does not reveal whether all or most of the thrombi were due to hyperosmolar solutions as 10% and 50% dextrose, THAM, or bicarbonate, were apparently administered to all infants. Ten percent dextrose–being hyperosmolar–was used as maintenance solution in all patients.
Hydrocephalus and the Cerebrospinal Fluid, by Thomas Herrick Milhorat, M.D. Baltimore: The Williams & Wilkins Co., 1972, 237 pp., $18.50
Authors: Welch Keasley
Published: December 2021

It is now almost 50 years since the publication of Harvey Cushing's Cameron Prize Lecture, The Third Circulation and its Disorders. The prodigious increase in knowledge of that circulation in the intervening years and the application of that knowledge to the treatment of hydrocephalus are reflected in Milhorat's book, while the limitations of our present position are not overlooked. The author, who is deeply involved with problems of hydrocephalus both as a clinician and an investigator, has provided an excellent appraisal of current understanding and practice.
THE PEDIATRICIAN AND IATRIC INFECTIOUS DISEASE
Authors: Weller Thomas H.
Published: December 2021

The privilege of presenting the second R. Cannon Eley Memorial Lecture permits acknowledgment of personal indebtedness to an individual who was a pediatrician's pediatrician.

In 1939, with a primary interest in infectious and parasitic disease, I was faced with the choice of an internship. The decision was not difficult for the superb teaching of communicable and infectious diseases by the group composed of Charles F. McKhann, R. Cannon Eley, Leroy Fothergill, and John Davies at the Children's had a magnetic quality and the diversified program of research on infectious agents then in progress was unique in Boston. In the McKhann-Eley laboratory, extraction of gamma-globulin from human placentas was to provide the first preparation for the prevention or modification of measles in the exposed child. From 1946 to 1963, when Cannon resigned his Children's and Harvard appointments to become Professor of Pediatrics at Brown University and Chairman of the Department of Pediatrics at Roger Williams Hospital in Providence, Rhode Island, he was our pediatrician. Thus our affection for Cannon and appreciation for his depth of clinical experience in the communicable disease field, stems from an association that transcended that customarily achieved between a senior staff man and his junior. As a consequence, we, perhaps more than others, had partial insight into Cannon's numerous unpublicized acts of kindness to generations of house staff and graduate students, as he assisted in the resolution of their personal crises, be they professional, economic or social.

From the foregoing remarks it is apparent that the request to present this Eley lecture has evoked memories of my own years at the Children's, and in turn reflection on changes that have occurred in the interim in the teaching and handling of infectious diseases.
FACTORS INFLUENCING THE SUPPRESSANT EFFECTS OF TWO STIMULANT DRUGS ON THE GROWTH OF HYPERACTIVE CHILDREN
Authors: Safer Daniel J. , Allen Richard P.
Published: December 2021

The effect of the regular intake of stimulant medication for two or more years on growth in weight and height was evaluated for 63 hyperactive children, 29 of whom received dextroamphetamine, 20 of whom received methylphenidate, and 14 of whom received no medication because of parental objection.

Major findings were: the long-term use of dextroamphetamine in hyperactive children causes a highly significant suppression of growth in weight and height; the long-term use of methylphenidate causes a less striking growth suppression only when daily doses over 20 mg are administered; tolerance develops to the weight suppressant effects of dextroamphetamine, but not to is inhibition of height growth; increasing the total degree of stimulant drug use over time generally increases the degree of growth suppression.
CONGENITAL CONCURRENCE OF ADRENAL CORTICAL TUMOR, GANGLIONEUROMA, AND TOXOPLASMOSIS
Authors: Gershanik Juan J. , Elmore Miles , Levkoff Abner H.
Published: December 2021

A neonate with hypertension, hyperglycemia, glycosuria, and an abdominal mass had, at postmortem examination, an adrenal cortical tumor, multiple microscopic ganglioneuromas of the contralateral adrenal gland, and toxoplasmosis. The possibility of a common linkage among these three entities is discussed.
Objective Early Criteria for Ventilatory Assistance in Hyaline Membrane Disease
Authors: O'Boyle Meade P. , Fletcher Anne B. , Avery Gordon B.
Published: December 2021

Ventilatory assistance utilizing a respirator and/or continuous positive airway pressure (CPAP) is commonly employed in the treatment of severe hyaline membrane disease (HMD).1 Artificial ventilation is indicated when the following classical blood gas criteria are met: (1) Pao2 [unknown] 40 mm Hg in an inspired oxygen concentration (Fio2) of 100%, (2) Paco2 [unknown] 70 mm Hg, (3) pH [unknown] 7.20, or (4) prolonged apnea.2,3 Typically, ventilation is postponed until the infant is moribund.4 Stern5 and Chernick and Vidyasagar6 suggest that earlier intervention might increase the survival of babies with HMD.

The classical blood gas criteria have been used at Children's Hospital of D.C. to indicate whether intervention is required.
Fetal Monitoring and Neonatal Blood Loss: Was Transfusion Indicated?
Authors: Merenstein Gerald B.
Published: December 2021

Scanlon and Walkley1 have clearly identified another cause of the iatrogenic neonatal anemia. It is difficult, however, to understand why this infant with symptomatic anemia (i.e., pallor, heart murmur, and cardiomegaly) was not transfused. Duc2 has described four types of hypoxia: type A, hypoxia with hypoxemia due to a decrease in Pao2; type B, hypoxia with hypoxemia due to a decrease in blood oxygen content without a decrease in Pao2; type C, hypoxia with normoxemia due to a decrease in peripheral blood flow; type D, hypoxia with normoxemia due to an increase in the hemoglobin oxygen affinity.
An Arc of Endocrinology, by K. J. Catt, M.D., Ph.D., F.R.A.C.P. Boston: Little, Brown & Company, 1971, 154 pp., $5.95
Authors: Gardner Lytt I.
Published: December 2021

This small volume reviews the rapid recent advances in endocrinology of the last few years. Much of the book was drawn from a series of articles in the Lancet, with the addition of two chapters; one on the endocrine changes in pregnancy, and the other a description of the tests utilized to determine endocrine function. Hormones in general are discussed and reviewed, with an all-too-brief treatment of the role of cyclic AMP as a mediator.
Malnutrition and the Retarded Human Development, by Sohan L. Monacha. Springfield, Illinois: Charles C Thomas, 1972, 382 pp., $19.75
Authors: McCance R. A.
Published: December 2021

It has been stated repeatedly that many people in this world are not nourished as well as they might be, but the writer of this book has gone to an immense amount of trouble to present the facts once more, particularly as they bear upon deficiencies of calories and protein. The vitamin deficiencies and mineral deficiencies, which create so much misery and eye disease in the Middle East and some of the townships of South Africa, are scarcely mentioned.