bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic Pulmonary Disease in Neonates After Artificial Ventilation: Distribution of Ventilation and Pulmonary Interstitial Emphysema
Authors: Watts John L. , Ariagno Ronald L. , Brady June P.
Published: December 2021

To determine pulmonary function abnormalities in patients with neonatal bronchopulmonary dysplasia (BPD), we measured distribution of ventilation by nitrogen washout, minute and tidal volume, and arterial and alveolar gases in three groups of ten preterm infants with similar birth weights (mean = 1,340 g) and gestational ages (mean = 30.3 weeks). Infants in group A were never artificially ventilated, those in group B were ventilated but had no subsequent BPD, and those in group C were ventilated and developed BPD. Infants with BPD had severe maldistribution of ventilation (pulmonary clearance delay 223% versus 47% and 60% for groups A and B). They had decreased tidal volumes (5.3 ml versus 7.0 and 6.2 ml) and higher respiratory rates (60/min versus 47 and 48) but similar minute volumes. They also had increased Paco2 (53.6 torr versus 41.9 and 43.4 torr) and increased arterial-alveolar carbon dioxide gradients (6.8 torr versus 3.1 and 1.8 torr).

There was no statistically significant difference between groups B and C for the time spent in fractional inspired oxygen > 0.40 and > 0.60, or the time ventilated or intubated, or the incidence of patent ductus arteriosus. Early pulmonary interstitial emphysema was much more common in the infants who subsequently developed BPD (eight of ten versus two of ten, P < .01).
Adrenocortical Insufficiency and Relapsing in the Idiopathic Nephrotic Syndrome of Childhood
Authors: Leisti Seppo , Vilska Jussi , Hallman Niilo
Published: December 2021

Twenty-five children with "minimal change" idiopathic nephrotic syndrome (INS) were given ACTH tests before, during, and after prednisone medication (total of 55 medication episodes). Most had insulin tests, too. Continuous medication caused a significant decrease in the responses of all children. A significant recovery was universally evident already at the end of intermittent medication. No further consistent change was observed during remission six months later. Both before and at the end of the medication, one third of the children had subnormal responses.

The children were grouped according to the length of the ensuing remission: group I, < 0.5 year; group II, 0.5 to 1.0 year; group III, > 1.0 year. Both before and after medication the basal plasma cortisol concentration and the responses to ACTH and insulin were significantly higher in group III than in group I. At the end of the medication the responses were also significantly higher in group II than in group I.

A normal response predicted a > 0.5-year remission and a subnormal response a < 0.5-year remission. This was true for 20 of 27 responses to ACTH before medication, and for 23 of 27 responses at the end of the medication. For the insulin test, only the response at the end of the medication was significantly predictive (16 of 18).

An analysis with the ACTH test of two to six consecutive relapses in 14 children confirmed the value of the adrenocortical state in predicting the length of remission. The postmedication tests were superior to the premedication tests in predictive value.

Children with postmedication adrenocortical suppression should be detected and given an appropriate cortisol substitution until their adrenocortical function has normalized. Other schedules of glucocorticoid medication of INS should be evaluated for lesser adrenocortical suppression.
Effect of Systemic Antibiotics on the Microbial Flora of the External Ear Canal in Hospitalized Children
Authors: Ostfeld Ervin , Rubinstein Ethan , Gazit Ephraim , Smetana Zehava
Published: December 2021

The effect of antibiotic therapy and hospitalization on the external ear canal flora was investigated in 131 children. Fifty-eight percent of the patients receiving antibiotic therapy had Gram-negative bacilli or yeasts in their external ear canal, compared with 17% of the patients who were hospitalized for ten days or longer and only 3% of the patients who were hospitalized for short periods. Antibiotic therapy is the major factor in determining the colonization rate of the external ear canal with potentially pathogenic flora. Children under 1 year of age seem to be the most susceptible group to this shift of flora.
Amikacin Therapy of Exacerbations of Pseudomonas aeruginosa Infections in Patients With Cystic Fibrosis
Authors: Lau William K. , Young Lowell S. , Osher Alan B. , Dooley Richard R.
Published: December 2021

Amikacin, a new semisynthetic aminoglycoside antibiotic with activity against Pseudomonas aeruginosa, was used to treat 22 acute exacerbations of chronic pulmonary infections in 18 patients with cystic fibrosis. Patients ranged from 5 to 32 years of age and had mucoid P. aeruginosa isolated from sputum. The amikacin dose was usually 7.5 mg/kg every eight hours but was increased to 10 mg/kg and/or carbenicillin was added in selected cases depending on clinical course. Although P. aeruginosa was not eliminated from our patients' sputum except in two cases, there was a good clinical response in 19 of 22 courses. Significant improvement in chest x-ray films, spirometry, or arterial oxygen tension was documented in 11 of 17 courses. One instance of serum creatinine level elevation could not be attributed to this antibiotic. Two patients showed minimal (15 dB) unilateral high-frequency hearing loss on serial audiograms. Activity against many gentamicin-resistant strains and high blood levels are among the attractive properties of amikacin. Amikacin is clinically effective in treating Pseudomonas-associated pulmonary infections complicating cystic fibrosis.
Varieties of Varicella Gangrenosa
Authors: John T. Jacob
Published: December 2021

Gangrene of the skin and deeper tissues, a rare complication of varicella, has been reported several times during the last 20 years.1-7 A review of these and older reports has led me to believe that varicella gangrenosa is a descriptive term for a variety of conditions. This is not a new concept, but one propounded in 1959,1 or possibly even earlier.

One of these conditions is moist gangrene, believed to be an infectious complication of varicella caused mostly by hemolytic Streptococcus or Staphylococcus aureus.1,2,6
Screening for Congenital Metabolic Disorders in the Newborn Infant: Congenital Deficiency of Thyroid Hormone and Hyperphenylalaninemia
Authors: Scriver Charles R. , Feingold Murray , Mamunes Peter , Nadler Henry L.
Published: December 2021

The Committee on Genetics of the American Academy of Pediatrics was formed in 1976. The initial reports from the Committee are published in this supplement to Pediatrics: one on guidelines for screening the newborn infant for hyperphenylalaninemia (including phenylketonuria [PKU]) and the other on screening for congenital hypothyroidism.

The first statement describes guidelines for screening for thyroid hormone deficiency in newborn infants; it concerns a traditional problem in pediatrics, the prevention of cretinism. A statement on "T4 screening" has already been issued by the American Thyroid Association.1 Why is there need for another (and longer) statement from the Academy? The Task Force on Genetic Screening recommended a special review of T4 screening, and that recommendation has been acted on quickly in the hope that most of the mistakes made in PKU screening will not be repeated in T4 screening. The American Thyroid Association statement adequately describes the status of testing for T4 deficiency; it does not cover other essential components of an effective screening program, namely, provision for serving patient retrieval, diagnosis, and treatment. The Committee urges pediatricians and endocrinologists who elect to push ahead with T4 testing to pause and examine the many issues of mass newborn infant screening before they act too hastily, perhaps to the detriment of their patients and newborn infant screening programs.

Dr. Jean Dussault served as consultant to the Committee when it examined T4 screening; his personal experience extends to ¼ million screened subjects and emanates from a model program which has largely avoided many pitfalls of newborn infant screening.
Comment on Soy Protein Intolerance
Authors: Kuitunen Pekka
Published: December 2021

With great interest I read the report by Whitington and Gibson on soy protein intolerance (Pediatrics 59:730, May 1977). In the Archives of Diseases in Childhood of May 1975, the study group for gastrointestinal disorders at the Children's Hospital, University of Helsinki, Finland, presented 54 infants with the malabsorption syndrome with cow's milk intolerance.1 Thirty-five of these 54 infants received soy protein as a substitute for cow's milk. Four of these 35 infants had concomitant soy protein intolerance.
Questions About Complications of H. influenzae Meningitis
Authors: Beam Thomas R.
Published: December 2021

The article, "Long-Term Outcome of Hemophilus influenzae Meningitis Related to Antibiotic Treatment" (Pediatrics 60:1, July 1977), attempts to establish several points regarding antibiotic efficacy without clear documentation. First, diagnostic criteria included demonstration of the organism in "cerebrospinal fluid or blood, or both." However, it is unclear how many patients had positive blood cultures with negative CSF cultures; it is also unclear how the diagnosis of meningitis was made under these circumstances. Similarly, no mention is made of how many children received antibiotics prior to hospitalization or whether these antibiotics were appropriately chosen by subsequently available sensitivity data.
Comment on Renal Anomalies and Pneumothorax
Authors: Rucker Ralph W.
Published: December 2021

Drs. Bashour and Balfe (Pediatrics 59(suppl):1048, June 1977) claim to have demonstrated a 19% incidence of renal anomalies in patients in the newborn period with spontaneous lung rupture. Before this figure can be accepted as fact and before decisions of investigation and/or therapy based on this incidence are initiated, certain details about their study should be noted. This retrospective study suffers primarily from the lack of information as to why the infants with spontaneous pneumothorax or pneumomediastinum were brought to the attention of the neonatal intensive care unit.
Acetaminophen Overdose: Incidence, Diagnosis, and Management in 416 Patients
Authors: Rumack Barry H. , Peterson Robert G.
Published: December 2021

Acetaminophen overdose was studied in 416 patients as part of a nationwide multiclinic open study. Twenty-seven percent of the patients were toxic by plasma acetaminophen level. The 12- to 21-year-old age group had the highest incidence of toxic blood levels (47%). Children under age 5 had the mildest toxicity of any age group; only two of 16 patients had toxic blood levels. No relationship to subsequent Reye's syndrome could be demonstrated. Acetylcysteine is a safe, effective treatment if administered within the first ten hours; it has some efficacy with no toxicity if used after ten hours. Acetylcysteine has advantages over both cysteamine and methionine. All patients in this study recovered with no sequelae.
γ-Globulin Level and Dietary Protein Intake During the First Year of Life
Authors: Zoppi Giuseppe , Zamboni Giorgio , Siviero Marcello , Bellini Pierantonio , Cancellieri Maria Lanzoni
Published: December 2021

To investigate the possible causes of relatively low blood γ-globulin levels (≤0.5 gm/dl) during the first year of life, 287 patients less than 1 year of age who were suffering from mild diseases were studied retrospectively. They were divided into two groups, those with a γ-globulin level less than 0.5 gm/dl and those with a γ-globulin level greater than 0.5 gm/dl. By reconstructing the diets given, it was found that they had been receiving isocaloric diets that differed only in protein supply: patients with lower γ-globulin levels received 2.9 gm/kg/day of protein and patients with higher γ-globulin levels received 4.0 gm/ kg/day. Fifty-five healthy subjects were studied prospectively during the first year of life on two isocaloric diets that differed only in their protein content: the first one supplied 2.5 gm/kg/day of protein and the second supplied 4.0 gm/kg/day. At approximately 5, 7, and 10 months of age, hemoglobin, total protein, albumin, globulins, immunoglobulins, and other common blood parameters were measured. Patients on the lower protein diet had a γ-globulin concentration of less than or equal to 0.5 gm/dl and those on the higher protein diet had a γ-globulin concentration of greater than or equal to 0.8 gm/dl. Immunoglobulin levels, particularly IgG, were lower in patients on the lower protein diet. The subjects with lower protein intake and lower levels of γ-globulin and immunoglobulins showed significantly higher morbidity.
An Outbreak of Pneumocystis carinii Pneumonia at a Pediatric Hospital
Authors: Chusid Michael J. , Heyrman Kurt A.
Published: December 2021

Eleven cases of Pneumocystis carinii Pneumonia were diagnosed during a 3½-year period at a pediatric hospital where this infection had never been identified previously despite appropriate studies. The incidence of infection was 3.0, 7.4, and 4.2 cases per 1,000 patient months in children being treated for acute leukemia, neuroblastoma, and rhabdomyosarcoma, respectively. The outbreak coincided with increased intensity of chemotherapy for these malignancies. Ten of the patients had received four or more chemotherapeutic agents within three months of the onset of infection. Because no exogenous source of the epidemic was found, latent endogenous infection activated by immunosuppression was presumed to be the ultimate cause of the outbreak. Increased intensity of chemotherapy may result in P carinii outbreaks and may be an indication for anti-Pneumocystis prophylaxis with trimethoprim/sulfamethoxazole in patients at risk.
A BARGAIN WITH NATURE
Authors: H. R. J.
Published: December 2021

Humans have a longer childhood relative to our lifespan than any other species. This provides immense plasticity-ability to learn from their environment and their culture. Most organisms on Earth depend on their genetic information which is prewired into their nervous system. While our behavior is still significantly controlled by our genetic inheritance, we have, through our brains, a much richer opportunity to blaze new behavioral and cultural pathways on short time scales. We have made a bargain with nature; our children will be difficult to raise, but their capacity for new learning will greatly enhance the chances of survival of the human species.
Acne: Current Concepts
Authors: Esterly Nancy B. , Furey Nancy L.
Published: December 2021

At the patient's initial visit an assessment of general medical health and degree, type, and extent of acne is made. A careful history is obtained to determine possible aggravating factors, such as the ingestion of hormones or drugs, or the use of moisturizing or corticosteroid creams.

If the patient has a few comedones and papules, benzoyl peroxide alone may be adequate. If comedones are large and numerous, retinoic acid plus benzoyl peroxide is useful. If there are a significant number of deep pustules and nodules, tetracycline or erythromycin orally can be prescribed. The dosage of antibiotic should be tapered and the drug discontinued as soon as the inflamniatory lesions subside. The patient should be informed that topical medications must be used indefinitely even when the eruption improves because the medications will prevent formation of new lesions. The patient should also be told that acne responds over a period of weeks, not days, and that improvement may not be noticed for four to eight weeks. Provision of a realistic time frame helps the adolescent to maintain confidence in the peeling medications which, at times, will cause irritation and redness of the face.

Frequency of cleansing and appropriate cleansing agents and shampoos should be discussed. Dietary facts and fictions should also be mentioned, and, in some instances, parents should be included to preveiit confrontations at home. Girls who feel the need to cover blemishes should be advised to avoid greasy foundations and substitute one of the many cosmetically acceptable water-based formulations now available.

Patient compliance will increase if a brief explanation of the pathogenesis of acne lesions and the effects of therapeutic agents is provided. Above all, the teenager should be told that the outlook for improvement is good, that acne can be treated successfully, and that for most patients, excellent control can be achieved if there is cooperation and interest on the part of both physician and patient.
Rare Diseases, Common Problems: Recognition and Management
Authors: Holtzman Neil A.
Published: December 2021

Although a growing number of inherited metaboic diseases can be treated effectively, diagnosis often comes too late to benefit the patient. There are at least two ways, however, in which diagnosis can be made before irreversible damage occurs. First, physicians whose services are sought when a patient becomes ill could be attuned to the possibility of metabolic conditions. This is difficult when the initial symptoms, for example, vomiting or poor feeding, resemble those of common, self-limited illnesses, or when they suggest, as with respiratory distress, other categories of serious illness. Second, all infants could be screened for indicators of some of these conditions. Then the primary physician has a responsibility to determine the significance of both positive and negative results and to decide whether follow-up is needed.

This study had three objectives: (1) to determine whether physicians are aware of the common problems with which inherited metabolic conditions often present; (2) to determine whether their management of common problems facilitates the early diagnosis of such conditions; and (3) to assess their evaluation of screening test results.

METHODS

Physicians who were participating in three continuing education programs were asked to answer, anonymously, several questions dealing with recognition and in management of geneticmetaboic diseases before they were given any instruction on the subject. The same questionnaire was distributed to the pediatric house staff at The Johns Hopkins Hospital. The tabulated results were discussed with the respondents collectively during hour-long conferences.

RESULTS AND COMMENTS

Classification of Respondents

One hundred fifty-six physicians returned the questionnaire: 67 pediatricians (in practice, 56; full-time faculty, 6: unknown, 5), 30 general or family practitioners, and 59 pediatric house officers.
Postmenopausal Carcinoma as a Result of Estrogen Treatment: Survey of Evidence
Authors: Mack Thomas M.
Published: December 2021

Recent studies concerning the relationship of exogenous estrogens and endometrial cancer have been reviewed and the objections to their conclusions discussed. Even considering the most serious of these reservations, it is difficult to avoid the tentative conclusion that estrogens are causally linked to endometrial cancer and that the attributable risk is numerically sizable. Whether the medical costs will be ultimately shown to outweigh the benefits of estrogen replacement therapy will depend largely on whether or not a relationship to breast cancer is shown and on the magnitude of the effect of estrogens in preventing serious complications of ovarian failure. For the time being, treatment of menopausal symptoms with estrogens should be as brief as possible, should use the lowest dose possible, and should probably be given in cyclic fashion, particularly to women with intact uteruses. Every attempt should be made to give patients a quantitative understanding of both potential risks and benefits before they decide in favor of or against estrogen therapy.
Estrogen Treatment of Girls With Constitutional Tall Stature
Authors: Bierich Jürgen R.
Published: December 2021

We define "tall stature" as a body height 2 SD or more above the mean of the population. The mean height for adult women in our country is 166 cm; the 97th percentile is 179 cm.

Up to 1976, we treated tall girls if their expected definite height surpassed 180 cm. Under the impression of the publications of Ziel and Finkle1 and Smith and co-workers,2 at the end of last year we decided to restrict the indication for estrogen treatment to girls with a growth prognosis above 183 cm. The prognosis has been made with the Greulich-Pyle Atlas and the tables of Bayley and Pinneau. Bone age was always determined independently by two experts.

This report is based on the therapeutic results in 41 girls aged 10 to 15 years whose treatment now is finished. At the start, their average age was 13 years and 2 months. In half of the girls, menarche had already occurred; their mean age was 13½ years. In the other half, this had not been the case; their mean age was 12 years and 9 months. Mean midparents' height was 177 cm for the whole series. This is considerably higher than the average for the population, which in Great Britain is 168 cm, according to Tanner et al.3

METHODS

Therapy was performed with conjugated natural estrogens (Presomnen [Germany]; Premarin, comparable US product). The daily dose was six 1.25-mg tablets, ie, 7.5 mg/day. The estrogens were given continuously without any interruption. To obtain menstruation-like bleedings, the girls took an oral estrogen for five days in the fourth week, at first megestrol, later dydrogesterone.
Contraceptives and the Young: Present Status and Future Prospects
Authors: Segal Sheldon J.
Published: December 2021

Although today's couples have access to a greater array of relatively safe and effective methods of fertility regulation than ever before, these methods are neither safe enough nor effective enough. The need for improvement in contraception is clear from the frequent resort to termination of unwanted pregnancies through induced abortion and from the rise in the incidence of sterilization, a surgical and generally irreversible method often chosen simply because of the unavailability of a suitable nonsurgical and reversible method.

Reproductive behavior is shaped by many dimensions of human experience, including sexuality and the social and economic roles of women and men. It is important that fertility regulation technology take these other dimensions into account for different cultures and for different age groups. It is important also, in different circumstances, that the risks of fertility regulation methods be balanced against the risks of pregnancy.
Annual Summary of Vital Statistics—1977
Authors: Wegman Myron E.
Published: December 2021

Data for this article, as in previous reports1, are drawn principally from the Monthly Vital Statistics Report2,6, published by the National Center for Health Statistics. The international data come from the Demographic Yearbook7 and the quarterly Population and Vital Statistics Report8, both published by the Statistical Office of the United Nations. All the U.S. data for 1977 are estimates by place of occurrence based on a 10% sample of material received in state offices between two dates, one month apart, regardless of when the event occurred. Experience has shown that for the country as a whole the estimate is very close to the subsequent final figures.
Persistent Localized Pulmonary Interstitial Emphysema and Lymphangiectasia: A Causal Relationship?
Authors: Leonidas John C. , Bhan Ina , McCauley Roy G. K.
Published: December 2021

The mechanism responsible for persistent regional pulmonary interstitial emphysema under tension, which occasionally complicates assisted ventilation, has not been explained. It is difficult to comprehend how interstitial air may cause lobar hyperinflation and not escape to the mediastinum or pleura. Histologic examination of resected emphysematous lung in two neonates with this type of interstitial emphysema revealed air dissecting from the interstitial connective tissue into markedly dilated lymphatics. It is proposed that intralymphatic air dissection causing emphysematous lymphangiectasia may be responsible for fixation of the lung in the emphysematous state.
Occult Fractures in the Production of Gait Disturbance in Childhood
Authors: Singer Jonathan , Towbin Richard
Published: December 2021

Trauma to the lower extremities is the principal cause of gait disturbance in early childhood. Three cases are presented to emphasize the relative frequency of children hospitalized for diagnostic evaluation of altered gait who have occult fractures. The cases may refresh the primary physician of the variables that serve as obstacles to accurate diagnosis.
Intravenous Linoleic Acid Supplementation in Children with Cystic Fibrosis
Authors: Chase H. Peter , Cotton Ernest K. , Elliott Robert B.
Published: December 2021

Ten children with cystic fibrosis were given infusions of either Intralipid or a similar number of calories from 10% glucose every other week for one year. The children who received Intralipid gained significantly more in height and weight than during their previous year and on cumulative data analysis showed greater improvement (23 of a possible 45 points) than did the control group (-2 points). Both groups appeared to benefit from the increased medical attention.
JOHN LOCKE ON THE CARE OF THE NEWBORN INFANT (1684)
Authors: C. T. E.
Published: December 2021

John Locke (1632-1704), physician and philosopher, is best known for his Essay Concerning Human Understanding (1690). His reputation as a philosopher has overshadowed the extent of his medical interests. Locke's journals between 1678 and 1698 contain thousands of items of medical interest.

An entry in his journal for September 1684 contained the following recommendations for the care of the newborn infant.1

1. Soon after birth the baby can be given 1 or 2 spoonfuls of syrup of violets with almond oil, to loosen the bowels and keep it from convulsive colic. Or else distilled olive oil can be mixed with sugar.

2. If the newborn baby is in a weak condition you can blow on it the smell of chewed onions and cloves; smear its nostrils and lips with Cinnamon water; press warm slices of meat on its head and anus; wrap in bandages soaked in red wine and place in a bath composed of water or beer and fresh butter. If the baby is lively give a little after a mixture of 1 spoonful of distilled almond oil and syrup of Cowslip flowers and ½ spoonful of wine tempered with sugar, so that it can purge itself properly.

3. As soon as it begins to feed on pap, give it for the first few days a little powder of Marchion.

4. If it is weak apply to the region of the heart a cloth coaked with warm Embryon. The best ways to stimulate its strength are baths, putting warm wine on its head, placing hot meat on its chest, smearing its nose and lips with cinnamon water, putting onions near its nostrils, etc.
Testosterone and Estradiol Concentrations in Paired Maternal and Cord Sera and Their Correlation with the Concentration of Chorionic Gonadotropin
Authors: Penny Robert , Parlow Albert F. , Frasier S. Douglas
Published: December 2021

Testosterone (T) and estradiol (E2) concentrations were determined and correlated with beta human chorionic gonadotropin (β-HCG) concentrations in 43 paired maternal and cord sera (22 female and 21 male infants). Mean (± SD) maternal E2 concentrations were significantly (P < .005) higher when the sex of the fetus was male than when the sex of the fetus was female (20.6 ± 3.9 vs 13.5 ± 3.2 ng/ml). Maternal T concentrations were not significantly different when related to the sex of the fetus (males, 114.8 ± 60.7 vs females, 113.8 ± 54.5 ng/100 ml, P > .1). Regression analysis did not show a significant correlation between maternal T or E2 concentrations and maternal β-HCG concentrations. Mean cord serum T and E2 concentrations of male infants were significantly greater than that of female infants (T, 38.8 ± 8.5 vs 25.8 ± 7.1 ng/100 ml, P < .005; E2, 9.1 ± 3.3 vs 6.6 ± 2.0 ng/ml, P < .005). Regression analysis showed a significant (P < .005) correlation between cord β-HCG concentrations and E2 concentrations for male infants (r = .7) and female infants (r = .6). A significant correlation between cord β-HCG concentrations and T concentrations was found for male infants (r = .5; P < .01) but not for female infants (r = .3; P > .05). There was no correlation between maternal and infant E2 concentrations (males, r = .3, P > .05; females, r = .3, P > .2) or T concentrations (males, r = .02, P > 0.4; females, r = .06, P > .3). These data (1) confirm the sex difference in cord serum T and E2 concentrations, (2) indicate that the lower β-HCG concentrations in mothers of male infants are associated with E2 concentrations which are greater than those in mothers of female infants, and (3) are consistent with an influence of β-HCG on fetal T and E2 secretion.
In Reply: Obese-Writing
Authors: Barness Lewis A.
Published: December 2021

On reading your letter, the first question that comes to mind is, how come your wife is so smart. Apparently she is the one who makes up the new words and develops the hypotheses about physicians and their lab tests.

Secondly, it is my firm belief that treatment of obese-writing is about as effective as treatment of any other kind of obesity. If the patient isn't very interested in reducing, no type of behavior modification or any other treatment is likely to be effective.
Bactericidal and Metabolic Function of Polymorphonuclear Leukocytes
Authors: Quie Paul G. , Mills Elaine L.
Published: December 2021

The bactericidal and metabolic function of the phagocytic system requires integration of several complex humoral and cellular factors responding to different regulators. Polymorphonuclear leukocytes are highly mobile cells, capable of phagocytosis of bacteria or fungi with formation of a "cellular digestive system" containing reactive oxygen radicals, hydrogen ions, and digestive enzymes. The unique metabolism of oxygen in neutrophils results in release of energy as light (chemiluminescence), a response closely associated with microbial killing. Neonatal neutrophils cope with normal bacterial challenges in vitro as efficiently as adult neutrophils; however, these cells have decreased capacity for locomotion, decreased deformabiity, decreased phagocytosis in low serum concentrations, and decreased chemiluminescence. These subtle defects in function can be amplified by exaggerated challenge which may be related to a higher incidence of sepsis during the neonatal period.
B Cell Ontogeny: Immunoglobulin Genes and Their Expression
Authors: Lawton Alexander R. , Cooper Max D.
Published: December 2021

B cell development occurs in a series of discrete stages which can be distinguished on the basis of morphologic and functional criteria. Genesis of B cells begins within the fetal liver as early as eight weeks gestation, and is later maintained in bone marrow. The first recognizable developmental stage is the rapidly-dividing pre-B cell which synthesizes cytoplasmic IgM but lacks surface receptors for antigen. Immature B lymphocytes emerging from pre-B cells express surface IgM, but are uniquely susceptible to inactivation as a consequence of specific antigen binding. Progeny of these cells express different classes of cell surface immunoglobulin and become committed to differentiate into plasma cells synthesizing IgM, IgD, IgG, IgA, or IgE immunoglobulins, respectively.

By the beginning of the second trimester, the human fetus has an adult proportion of B lymphocytes expressing different immunoglobulin classes and capable of recognizing an extensive variety of antigens. The qualitative and quantitative deficiencies in antibody responses of newborns, as compared to adults, appear to reflect regulatory interactions with T cells and macrophages rather than absence of B lymphocytes capable of generating a response.

Recent research with recombinant DNA technology has provided remarkable new knowledge of the structure and organization of immunoglobulin genes. This developing information, in concert with more detailed studies of the cellular expression of these genes during ontogeny, holds the promise of generating insights into the molecular mechanisms regulating gene expression during differentation.
Ontogeny of Serum Complement Proteins
Authors: Colten Harvey R. , Goldberger Gabriel
Published: December 2021

The capacity for complement biosynthesis appears early in gestation. In most species, functional complement and properdin systems are intact by the end of the first trimester. An increase in fetal serum complement concentration (several components) occurs early in the third trimester reaching 30 to 50% of adult levels. The mechanisms for initiation of fetal biosynthesis of complement and the apparent change in rate of synthesis are knknown. The role of complement, if any, in utero is also not known. These will most certainly be subjectics of further investigations.
Complement in the Newborn Infant
Authors: Johnston Richard B. , Altenburger Karl M. , Atkinson Alva W. , Curry Robert H.
Published: December 2021

Classical pathway activities and component concentrations in sera from newborns can be compared more realistically to normal adult values than to maternal values since activities and components are increased in maternal sera. Whole complement hemolytic activity appears to be subnormal in approximately half of term infants, with mean activity being about 70% to 90% of normal. Concentrations of Clq, C4, C2, C3, and C7 have been 60% to 100% of adult concentrations in term infants and somewhat less in preterm infants. Younger gestational age has been correlated with lower levels of total hemolytic activity, Clq, C4, and C3.

Activity of the alternative pathway appears to be more frequently subnormal in newborn sera than does activity of the classical pathway. Factor B and properdin concentrations have varied from about 35% to 60% and 35% to 70% of adult values, respectively. Opsonization and hemolysis mediated by the alternative pathway have been subnormal in 15% to 75% of term infants, depending upon the assay. Gestational age appears to correlate with alternative pathway hernobytic activity and properdin concentration but not with concentration of factor B.

Reductions such as these in single complement components and functions probably would not predispose an otherwise normal individual to infection. However, it seems likely that the multicomponent and dual pathway deficiencies found in neonates, especially in conjunction with the decreased phagocyte function known to exist in that population, could increase the likelihood of serious infection. Predicted infections with this configuration of abnormalities would be extracellular bacterial. Whether the newborn infant is actually predisposed to infection because of the complement deficiencies summarized here remains to be proved. This and other unanswered questions lead us to conclude that understanding of the complement system in the newborn is, pardon the expression, still in its infancy.
Pyogenic Arthritis of the Sacroiliac Joint in Pediatric Patients
Authors: Schaad Urs B. , McCracken George H. , Nelson John D.
Published: December 2021

Clinical manifestations, diagnostic studies, and management of pyogenic sacroiliitis were reviewed in 77 pediatric patients. This infection occurs primarily in late childhood, is more common in boys, and has a subacute onset in about two thirds of cases. Recognition of the characteristic signs and symptoms of sacroiliac involvement coupled with radioisotope bone scanning substantially reduces the delay in correct diagnosis that averaged 3.9 weeks in all patients (4.8 weeks in those without and 1.7 weeks in those with bone scans performed). Joint aspiration under biplane fluoroscopic control and culture of the aspirated material is indicated in establishing the specific etiologic agent which is Staphylococcus aureus in most cases. Adequate management of pyogenic sacroiliitis consists of appropriately monitored antibiotic treatment and, if present, evacuation of pus. The use of spica cast immobilization offers no apparent beneficial effect. Indications for surgery include drainage of pus and removal of sequestered bone. With adequate management the prognosis of suppurative sacroiliitis in pediatric patients is excellent, despite persistent abnormal radiographic findings in most patients.
Nephropathy in the Wiskott-Aldrich Syndrome
Authors: Spitler Lynn E. , Wray Betty B. , Mogerman Stanley , Miller John J. , O'Reilly Richard J. , Lagios Michael
Published: December 2021

Nephropathy was detected in five of 32 patients with the Wiskott-Aldrich syndrome who were participating in a study of transfer factor (TF) therapy. In two patients, nephropathy was present before TF and did not appear changed by TF therapy. One of these patients subsequently developed progressive renal failure requiring dialysis beginning 5½ years after TF therapy. In two patients, decreased renal function appeared very soon after the administration of TF. One patient showed gradually decreasing renal function beginning after two years of TF therapy. An additional patient was identified who died with renal failure without having received TF. The results suggest that renal failure occurs in the Wiskott-Aldrich syndrome more frequently than generally recognized and that administration of TF may precipitate or accelerate the renal disease in patients with this syndrome.
Immunosuppressive Activity of Cord Blood Leukocytes
Authors: Abedin Mehnur , Kirkpatrick Charles H.
Published: December 2021

The in vitro effects of cord blood cells from term and preterm infants on cell-mediated immune responses by adult lymphocytes were studied. The experiments showed that cord blood cells were potent suppressors of antigen- and mitogen-induced proliferation of adult T cells. In contrast to the previously reported observations with adult suppressor cells, the cord blood cells did not require mitogenic activation to exert their suppressive activity. It was also found that a similar, if not identical, suppressive activity was released into the fluid phase when cord blood cells were placed in tissue culture for three to five days. Studies with subpopulations of cord blood cells showed that the suppressive factor was released from rosette-forming T lymphocytes, but not from cell populations that were depleted of T cells. In addition, the production of and the action of the soluble suppressive factor was inhibited by indomethacin.
Rapid Fluorometric Assay of Bilirubin and Bilirubin Binding Capacity in Blood of Jaundiced Neonates: Comparisons with Other Methods
Authors: Cashore William J. , Oh William , Blumberg William E. , Eisinger Josef , Lamola Angelo A.
Published: December 2021

The concentrations of total blood bilirubin, albumin-bound bilirubin, and the reserve and total bilirubin binding capacities of 35 neonatal blood samples (28 patients) were determined by automated front-face fluorometry (hematofluorometer). These values were compared to results of diazo determinations, Sephadex gel filtration, and peroxidase-oxidation methods. Total blood bilirubin level by fluorometry agreed well with the total plasma bilirubin level by diazotization (r = .96, σ = 1.7 mg/100 ml). Albumin-bound bilirubin concentrations by fluorometry also correlated well with diazo values (r = .95, σ = 1.9 mg/100 ml) and were slightly lower than the total blood bilirubin concentrations. Values for total bilirubin binding capacity determined by fluorometry agreed well with results obtained for the same specimens by Sephadex gel filtration (n = 28, r = .97, σ = 1.8 mg/100 ml) and by peroxidase-catalyzed oxidation (n = 25, r = .97, σ = 1.7 mg/100 ml). The agreement among the results obtained by the three methods indicates a well-defined in vitro end point at which available primary or "tight" binding sites on albumin are saturated with bilirubin. In this clinical experience the coefficient of variation of results with the hematofluorometer was 8.4% for total blood bilirubin and 6.5% for total binding capacity. A comparison of "sick" with "well" infants revealed that the fraction of bilirubin not bound to albumin was significantly different for these two groups. The assays made with the hematofluorometer are quick (10 to 15 minutes) and require only a small quantity (∼150 µl) of blood.
Paratesticular Mass as a Presenting Sign of Sarcoidosis
Authors: Schaeffer Janis , Nussbaum Michael , Meyersfield Sandy
Published: December 2021

Sarcoidosis is a chronic granulomatous process of obscure origin. Although the disorder is characterized by multisystem disease, involvement of the genital tract is uncommon. The purpose of this paper is to record a patient with a scrotal mass as a presenting symptom of sarcoid. Sarcoidosis should be considered when the differential diagnosis of scrotal masses is under consideration.

CASE REPORT

An 18-year-old black man was admitted to the Adolescent Service of Long Island Jewish-Hillside Medical Center with the chief complaint of a right scrotal mass. His past medical history and review of symptoms were entirely negative except for a 14-lb weight loss in four months.
Neonatal Posterior Fossa Subdural Hematoma
Authors: Barton Leslie L.
Published: December 2021

I have followed with great interest the recent surge of literature relating to the diagnosis and treatment of neonatal intracranial hemorrhage. I do feel, however, that the conclusions drawn by Serfontein and Stein regarding the diagnosis of neonatal posterior fossa subdural orrhage need emphasis as well as clarification. These authors state that "should CT not be available, either subdural taps or ventriculography, or both, should be performed."1 The anatomy of the infants' skull,2 as well as the cases reported by these and other authors,3,4 serve to illustrate the importance of recognizing the infratentorial location of posterior fossa hemorrhage.
Postscript to Incubator-Baby Side Shows
Authors: Silverman William A.
Published: December 2021

When my article about premature infant "shows" appeared in Pediatrics1 it caught the eye of Felix Marx, of Bonn, Germany. He called attention2 to an 1896 popular-magazine story3 in which the identity of the man named "Lion" was revealed (see citation 7 in reference 1).

According to the profusely illustrated piece, Doctor Alexandre Lion, of Nice, was a philanthropic physician who established "The Baby Infant Charity" (Oeuvre Maternelle des Couveuses D'Enfants, located at 26, Boulevard Poissonière, Paris) for the saving of infant life.
Mothers Who Work—Differing Views
Authors: Bell Reed
Published: December 2021

I question your judgment in publishing the special article "The Working Mother in Contemporary Perspective" (Pediatrics 64:862, 1979). Certainly all of us should be aware of the special needs of working parents, single or married, especially with young children, and provide support services to meet their needs.

However, the thinly veiled liberationist-feminist propaganda is out of order in a professional scientific publication. Jingoist phrases such as "anachronistic societal values," political "changers," "change-oriented activities,", "familial egalitarianism," etc reveal the bias of the writers sponsored by the Business and Professional Women's Foundation of Washington, DC.
Ototoxicity in Premature Infants Treated with Kanamycin
Authors: Davidson S. , Brish M. , Rein N. , Rubinstein M. , Rubinstein E.
Published: December 2021

Among the untoward side effects of kanamycin, ototoxicity is particularly frequent. Premature infants may be at increased risk because of their low glomerular filtration rate. Previous studies have revealed decreased sensory neural hearing in 0% to 19% of term and premature infants who received kanamycin. Because only one study specifically investigated this question in premature infants,1 we have performed an audiometric survey in children aged 4 to 10 years (mean 7.5 years) who received kanamycin while premature and in age-matched controls.
Questions on the Use of Vitamin D3
Authors: Balsan Sonia , Steendijk Robert
Published: December 2021

From their observations in a boy with hypophosphatemic rickets Chan and Bartter1 conclude that administration of 1α,25-dihydroxyvitamin D3 (1,25-(OH)2D3) is the treatment of choice for this disease. Since this point of view is not shared by everybody, it demands careful scrutiny. The conclusion rests on the increased growth velocity, the radiologic healing of the rachitic lesions, and the increase in serum phosphorus which occurred when treatment was changed from vitamin D2 to 1,25-(OH)2D3. From the growth curve of this boy it appears that the increase in growth velocity could represent the pubertal growth spurt in a late maturer.
Letters to the Editor
Authors: Chan James C. M. , Bartter Frederic C.
Published: December 2021

In the treatment of renal hypophosphatemic rickets, the risks of hypercalcemia and vitamin D toxicity are always imminent. The use of 1,25-dihydroxyvitamin D with its shorter half-life offers a distinct advantage in conjunction with the continuous phosphate supplementation.1-3

The accelerated growth velocity secondary to the use of 1,25-dihydroxyvitamin D has now been extended to five patients. The initial report in a 3-year-old girl2 showed acceleration of growth velocity from the 25th to the 78th percentile.
Systematic Study of Four Years of Internship
Authors: Adler Robert , Werner Edwenna R. , Korsch Barbara
Published: December 2021

As part of the continuing effort to study perceived attitudes, stresses, and coping mechanisms of pediatric interns in a hospital-based training program, this paper focuses in depth on how attitudes toward patients and toward the internship experience become more negative in the course of the internship year. Sources of stress and changes in coping mechanisms are documented. There were no significant effects of gender or marital status on interns' attitudes. Gender and marital status were not correlated with performance during the year, and attitudes were not consistently correlated with performance. Discussion of the significance of these findings in pediatric training and suggestions for redirection of pediatric training programs are made.
Got a Minute?
Authors: Hoekelman Robert A.
Published: December 2021

Once or twice during each of the past three decades we have been presented with the results of studies concerning the content of well child visits.1-6 These studies have analyzed the amount of time physicians spend in the several components of such visits and have shown that very little attention is given to discussion of child behavior and development or to the provision of anticipatory guidance and assurance to the mother.

The most recent of these studies, by Reisinger and Bires in this issue of Pediatrics (p 889),6 is perhaps the most discouraging to those who advocate periodic well child visits as a mechanism for providing support and guidance to mothers in child rearing and as a means for preventing emotional, behavioral, and developmental problems.
Cimetidine and Pulmonary Hypertension
Authors: Goldenring John , Franklin Lawrence C.
Published: December 2021

Recently Chhattriwalla et al1 reported the use of cimetidine, a competitive antagonist to H2 histamine receptors, for treatment of reflux esophagitis and gastroduodenal ulcer disease in neonates. The authors correctly point out that the only common major side effect to this drug in adults, seen primarily with chronic administration, is a state of mental confusion.2 However, we feel it is important to point out that there is one major contraindication to cimetidine in neonates which we would not expect to find in adults or children.
Letters to the Editor
Authors: Scanlon John W.
Published: December 2021

We thank Drs Goldenring and Franklin for their interest in our case report. Their theoretical concerns seem well founded and should be considered. The cases reported were infants without pulmonary hypertension or the need for tolazoline.

It is of interest that a paper by Adams and colleagues in the very same issue of Pediatrics (62:298, 1980) reports on the use of cimetidine to treat gastric hypersecretion from chronic tolazoline administration in the syndrome of persistent fetal circulation.