bluuebunny/crossref_metadata_2025_split huggingface dataset:
LEFT CORONARY ARTERY FROM THE PULMONARY ARTERY
Authors: MCKINLEY HELEN I. , ANDREWS JEANNE , NEILL CATHERINE A. 
Published: December 2021

Three cases of left coronary artery arising from the pulmonary artery in infants are reported, making a total of 35 cases now reported.
One of these was apparently complicated by cardiac rupture, a sequence, to the authors' knowledge, not previously reported.
The symptom complex is again reviewed in order to stimulate interest in earlier diagnosis.
Since eight cases of this anomaly have been reported in adults, one of whom lived to 64 years, it is suggested that the life of the infant might be saved if diagnosed before irreversible myocardial changes have occurred.
The ideal treatment, if vasodilatory drugs fail, would seem to be a direct anastomosis of the left coronary with the aorta; however, since technically this is impossible at the present time, other methods of increasing the flow to the left coronary should be attempted. Gasul suggests the Pott's-Smith operation, which, by raising the pulmonary pressure, might increase the left coronary flow.
Questions About Task Force on Meningitis—Recommendations
Authors: KLEIN JEROME O. , FEIGIN RALPH D. , MCCRACKEN GEORGE H. 
Published: December 2021

To the Editor.—
We appreciate the many useful comments and suggestions about the Report of the Task Force on Diagnosis and Management of Meningitis (Pediatrics 1986;78 (suppl):959-982). We will respond to letters from Terry F. Cashmore (Bonita, CA), Alfred Florman (Albuquerque, NM), Robert J. Geller (Tuscaloosa, AL), Allen W. Mathies, Jr. (Pasadena, CA), Richard A. Moriarty and Gerald W. Fischer (Bethesda, MD), Kenneth B. Robbins (Honolulu, HI), Bradley Sullivan (Marshfield, WI), and M. C. Thirumoorthi.
Health Assessment and Screening During Adolescence
Authors: Marks Andrea , Fisher Martin 
Published: December 2021

The "medical checkup," like hot dogs and apple pie, has become an American tradition. Adolescents have checkups requested by schools, summer camps, sports teams, employers, parents, and, less frequently, themselves. At such times, a cursory chat between the teenager and health professional, followed by a quick physical examination, is unlikely to detect the most prevalent and significant health problems of young people today. The very nature of such an interaction may even serve to alienate the teenager from the health care system or provider. Alternatively, if properly focused and thorough, a checkup may not only uncover important areas of disease or dysfunction, but also should initiate a meaningful dialogue and relationship between the adolescent patient and health professional. A checkup generally occurs when an individual feels well and visits a medical professional without complaint or a checkup may be had in conjunction with medical attention to a specific problem. In either case, the primary purpose of a checkup is health assessment and screening.
Health screening has been defined by the World Health Organization as ". . . the presumptive identification of unrecognized disease or defect by the application of tests, examinations, or other procedures which can be applied rapidly." The purpose of health screening is to detect a problem (or problems) before it would usually become apparent or before medical attention is sought, with the intent of initiating treatment at an earlier and more optimal time, so as to prevent or favorably alter its course and consequences. Screening is not in itself diagnostic.
Cerebral Edema and Galactosemia
Authors: BELMAN ANITA L. , MOSHE SOLOMON L. , ZIMMERMAN ROBERT D. 
Published: December 2021

In Reply.—
We thank Drs Welch and Milligan for calling our attention to their interesting case. They describe a neonate who at four days of age had hyperbilirubinemia and neurologic dysfunction. At six days, cerebral edema was demonstrated by ultrasonographic examination. Galactosemia (transferance deficiency) was subsequently diagnosed. Neuroimaging procedures such as CT and ultrasound are invaluable diagnostic aids for the early identification of cerebral edema and may, as the authors suggest, provide evidence that cerebral edema occurs commonly in the acute phase of galactosemia.
Septic Arthritis
Authors: RAO SREEDHAR P. , MILLER SCOTT T. 
Published: December 2021

To the Editor.—
We read with interest the report by Syrogiannopoulos et al.1 The authors have reported six cases of isolated septic arthritis and eight cases of osteomyelitis, two with septic arthritis, in children with sickle cell disease. Whereas Salmonella was the commonest cause of osteomyelitis, Streptococcus pneumoniae was the commonest cause of septic arthritis. This appears to be the first report describing several cases of isolated septic arthritis in children with sickle cell disease.
Nephrolithiasis Following in Utero Diuretic Exposure: An Unusual Case
Authors: FISCHER ALLEN F. , PARKER BRUCE R. , STEVENSON DAVID K. 
Published: December 2021

Reports have appeared in the literature describing the relationship between diuretic therapy and nephrocalcinosis or nephrolithiasis in groups of preterm infants. Most of the affected infants were receiving furosemide for the treatment of bronchopulmonary dysplasia. Here, we report an unusual case of nephrolithiasis related to in utero diuretic exposure.
CASE REPORT
The patient was born prematurely at 33 weeks' gestation. The baby's mother was 33 years old, gravada 1, para 0, and had blood type O. She was a class FR diabetic (retinopathy, nephropathy, systemic hypertension), with a medication regimen that included captopril, 25 mg, twice daily; hydralazine, 25 mg, twice daily; and ethacrynic acid, 50 mg, twice daily.
Role of Pediatrician in Pediatric Emergency Medical Services
Authors: NARKEWICZ RICHARD M. 
Published: December 2021

The statement by the American Academy of Pediatrics' (AAP) Provisional Committee on Pediatric Emergency Medicine in this issue highlights the importance of pediatricians' involvement in emergency medical care for children. Pediatricians have responsibilities in advocating for children's unique needs in the emergency medical system at the state and regional levels and in individual practices as well. The AAP brings together many pediatric specialists in carrying out its role in this effort.
In the primary care setting, the pediatrician's role is to promote safety and injury prevention when counseling parents. This is a crucial part of health supervision, and the AAP has developed The Injury Prevention Program (TIPP) to assist pediatricians.
Salary or Fee-for-Service
Authors: HICKSON GERALD B. 
Published: December 2021

In Reply.—
Our study was directed at the big picture or more global concept of improving our basic understanding of physician reimbursement and how it impacts practice behavior. We hope that our controlled, prospective study will be the first of many such studies and literature reviews that will help to focus the pediatric community on finding ways of providing economically efficient high quality care to more people under circumstances of rapidly increasing medical inflation and community/governmental cost cutting. Asking patients who were chronically behind on their bills to obtain care at Metropolitan Nashville General Hospital (which was staffed by Vanderbilt residents and attending physicians) did not impact the health of such patients and was necessary for the study to serve as a model of the way the great majority of pediatrics is practiced in this country.
The Hastings Center Project on Imperiled Newborns: Supreme Court, Jury, or Greek Chorus?
Authors: LANTOS JOHN D. 
Published: December 2021

Ethics committees are many-splendored things and fulfill a variety of different functions. They can be educational resources, policy-making bodies, or consultants for particularly troubling cases. They can be legal watchdogs or instruments of institutional risk management. They can empower nurses or parents in conflicts with physicians or provide solace to physicians who face disturbing decisions. When ethics committees do so many things at once, there is a danger that they will do nothing well or will sabotage their central mission by getting embroiled in tangential or peripheral issues.
But how should ethics committees work? Should they merely reflect widely held opinions, or can they show us new and better ways to analyze and solve controversial problems?
FOR WHAT?
Authors: Student  
Published: December 2021

Her head looked shrivelled, somehow dessicated. She had electrodes fitted to her scalp, tubes and drips from every orifice, her eyes were bandaged against the light.
I wanted to drag everything away from her, every bit of machinery, to pick her up and hold her to my breast, even if it meant that she died in a few minutes. That would be better than having to suffer this—the pain, fear, noise, bewilderment, being surrounded and handled by strangers. At that moment, I did not see the medical staff as saviours, as people who were caring for my baby and trying to save her life; I saw them as aggressors, tormentors, people who had taken by baby away from me and were doing terrible things to her, who were keeping her from me. I was filled with anger and hurt on her behalf.
To a certain extent, I never got over that anger. It was an instinct, deep, irrational, passionate. She was being hurt, and for what? For the best? I wondered. I still do wonder.
HIDING BEHIND HORMONES IN MILK
Authors: L. J. F. 
Published: December 2021

Bovine growth hormone, synthesized in bacteria by the new techniques of genetic engineering, may make cows produce some 15 percent more milk. Such a spectacular productivity gain should delight consumers with lower prices and dairy farmers with higher profits. Then why are farmers from New York to Minnesota organizing to oppose the new technology?
The harsh fact is that there are too many dairy farmers. Less efficient producers—some of them family farmers—are kept in business by Federal subsidies that in recent years have reached $1 billion annually. Farmers fear that more milk at lower prices may reduce their incomes, forcing many off their farms. The National Farmers Union hopes to ban the hormone or force milk from treated cows to be so labeled, igniting public concern about "unnatural" milk.
The milk hormone has not yet been approved by the Food and Drug Administration, but so far there seems no serious safety issue. Milk now contains minute amounts of natural bovine growth hormone; the hormone is destroyed in digestion and is in any case inactive in humans. The dairy industry risks enormous damage if it raises needless safety doubts by insisting on labeling provisions for milk from hormone-treated cows.
Drug Screening
Authors: DUPONT ROBERT L. 
Published: December 2021

To the Editor.—
The joint report of the committee on Adolescence, the Committee on Bioethics, and the Provisional Committee on Substance Abuse (Pediatrics 1989;84:396-398) appears to miss the mark by a wide margin. Drugs and kids are a bad combination. Those of us concerned about children and youth need to work to help them grow up drug free. Screening for drug use is no more a violation of privacy than is screening for diabetes or tuberculosis.
Drug Screening
Authors: TOLMAS HYMAN C. 
Published: December 2021

To the Editor.—
I was dismayed and disappointed by the recommendations of the three committees responsible for the policy statement regarding drug screening, and I believe that they have failed to take into consideration the feelings of the general membership. The small print disclaimer on page 396 hardly equalizes the variations from stated policy for those who feel differently. Although I agree with many of the facts as stated, I believe the Committees have been remiss in not weighing some of the realistic aspects of this most important problem that plagues our youth and society in general.
Bone Marrow Transplants
Authors: FURMAN LYDIA 
Published: December 2021

In Reply.—
The first issue is whether or not bone marrow transplantation is, indeed, the most effective therapy available for children with leukemia. Drs Ogden and Steuber refer to "more than a decade of literature in which good responses after bone marrow transplantation have been reported." Likewise, Drs Weinblatt et al state that "the majority of patients currently receiving transplantation therapy for. . .leukemia in first remission are cured. . . ." However, Pinkel (Leukemia. 1989;3:242-244), in a recent editorial, carefully and succinctly reviewed the relevant data and concluded the exact opposite.
Fever and Petechiae in Children
Authors: KELLNER JAMES D. 
Published: December 2021

To the Editor.—
I read the article on "Fever and Petechiae in Children" by Baker et al1 with great interest. The results of Baker et al support the teaching I have received and my clinical impression that children having fever and petechiae most often do not have meningococcemia. Further, it appears that consideration of initial clinical features, peripheral white cell count, and examination of cerebrospinal fluid should allow a definitive assessment of whether invasive bacterial disease is present.
Persistent Pulmonary Hypertension and ECMO
Authors: GROSS IAN 
Published: December 2021

In Reply.—
Although it is difficult to compare the perinatal patient population in Israel directly with that in the US, the Jerusalem experience with persistent pulmonary hypertension (PPH) is encouraging and consistent with that of a number of centers here.
Definitive data on this subject are not currently available, but there is considerable indirect evidence, such as that of Bruckheimer and Eidelman, to support the view that babies born at large centers with comprehensive perinatal services are less likely to require ECMO and, therefore, that some of the need for ECMO may be preventable.
SUMMATION AND COMMENTARY
Authors: MILLER C. ARDEN 
Published: December 2021

The background papers and presentations document causes for concern about the health of children in the United States. Discussions at the conference affirm a zeal to improve supports and services on behalf of children. The international comparisons stimulate thinking on the approaches that are best suited for this country. Voices will be raised that the US must work out its own solutions and that we cannot learn from what other countries are doing. Understandings are firm that every nation's health care systems grow out of unique political, social, and economic traditions, but those systems are not immutable. A limited number of strategies are available to help children and young families. Insofar as the policies that enable those strategies can be clarified, the likelihood of developing the best approaches for this country is improved. We are grateful for the analysis of policies that prevail in other Western democracies.
One of the impressive aspects of health services for children in the five nations represented here is their differences. Health care financing and provider systems differ markedly; they are not cookie-cutter programs. Those differences present a responsibility to identify themes that are common to the nations with the best records of child health. Such themes deserve careful attention.
The first of the themes is the need for government action. The US has been through a decade of trying market systems featuring deregulation, individual responsibility, and volunteerism. The impression of most analysts is that these approaches have not worked. Important indicators of child health have worsened or previous favorable trends have slowed.
Epilogue
Authors: Harvey Birt 
Published: December 2021

This conference has clarified a number of basic issues. If we expect to improve the health of our children, we must change our philosophy about social welfare and about looking after children. We have always considered individualism our ideal, and the concept is rooted firmly in our frontier spirit and our system of free enterprise. European thought is oriented more toward interdependence, with greater emphasis on the well-being of the group. How we treat our children is influenced heavily by our philosophy, as the responsibility rests with each individual family.
Except in the event of what we define as child abuse, representing a tiny fraction of ineffective and damaging parental behavior, we place very few legal or social limitations on parents. Children are a national resource, and responsibility for their welfare is shared by every member of society. As Dr Verbrugge has observed, what we need in the United States is more solidarity and less solitariness, less individuality. This is the direction we must now pursue.
The United States needs a children's policy; our guests have made this clear. Health care cannot be separated from all the other factors that influence the well-being of children. We have learned about grants that families get at birth, subsidized day care available to all, lengthy parental leave after childbirth, and paid leave when children are sick. We have a long way to go, but rational child health policy is a good start.
Some feel that we must do everything at once to avoid further fragmentation. Barring a revolution in this country, this is simply not possible.
EFFORT TO RESCUE OTTERS AFTER SPILL IS IN DISPUTE
Authors: L. J. F. 
Published: December 2021

ANCHORAGE, April 20—Sea otters rescued from waters fouled by the Exxon Valdez oil spill fared poorly after their return to the wild last fall, and scientists working under Government contract say at least half may have perished over the winter.
Nearly 900 dead otters were found after the tanker spilled almost 11 million gallons of crude oil in March 1989. An additional 360 were netted alive and brought to rehabilitation centers at Valdez, Seward, Homer and Kodiak. About 200 were later returned to Prince William Sound but some scientists say that as many as half may have perished and that the rehabilitation effort has been largely futile...
The withholding of scientific information on the spill for legal reasons by all the parties is becoming a major source of controversy as research projects begin to generate at least preliminary data.
The "Companion Bottle": A Useful Predictor of Children at Risk for the Development of Nursing Bottle Caries
Authors: KOVESI THOMAS , LEVISON HENRY 
Published: December 2021

To the Editor.—
Bottle caries result from prolonged contact between sugar-containing fluids and the teeth of children put to bed with a nursing bottle,2 and can lead to serious dental morbidity. Although inquiry into children's nighttime use of bottles should be included in preventive health surveys,3 it may be omitted in the busy pediatric office or ward. We tested the hypothesis that children carrying a bottle in a clinic setting were also more likely to receive a bottle in the crib or bed at home.
Andrew Stinson Recalled
Authors: BACHRACH STEVEN 
Published: December 2021

To the Editor.—
It now has been nearly 15 years since Andrew Stinson was first admitted to the Intensive Care Nursery where I was working as a second year resident. Andrew was an 800-g premie, whose subsequent complicated course and eventual demise would not sound unfamiliar to anyone who has worked in an intensive care nursery. What made Andrew different was his family. While not medically sophisticated, they were well-educated people with very definite ideas about what they did or did not want done for their infant.
Diarrhea Care in Private Practice
Authors: TOCHEN MARK L. , TSUKAMAKI DON 
Published: December 2021

To the Editor.—
The article by Dr Snyder, "Use and Misuse of Oral Rehydration Therapy for Diarrhea,"1 led us to review our treatment of gastroenteritis, revise our telephone protocols, and seek out rehydration solutions. Our difficulty in obtaining adequate supplies mirrored that of Dr O'Banion.2 Expense to the patient is also an important factor: commercial premixed solutions sell for $4 to $6 per quart in our area, which many families cannot pay. Our solution was to obtain from the World Health Organization the name of the US supplier of oral rehydration solution (ORS) packets and order direct from the supplier (Jianas Bros Packaging Co, 2533 SW Blvd, Kansas City, MO 64108).
Talented Students
Authors: KIM DONTE , KWASMAN ALAN 
Published: December 2021

To the Editor.—
We read with great interest the commentary by Carol J. Mills, PhD.1 We have several concerns about her commentary.
Our first concern is that the phenomenon of frustration and disillusionment, which she describes, may not be isolated to "gifted" children. In her commentary, she states that there is, "a good deal of evidence to show that many gifted students . . . whose needs are not met adequately at an early age become frustrated and disillusioned with school."
The Normal Variation of Skin Creases
Authors: SLADEN ELSPETH M. 
Published: December 2021

To the Editor.—
I don't usually pay too much attention to the advertisements in Pediatrics, however, I was intrigued to see, in the October 1991 issue, the fine array of infant backsides in the ad for Genius Thermometers on pages A14 to A15. It is a good demonstration of the normal variation of skin creases. It should put to rest the myth that asymmetrical skin creases are a sign of congenital dislocation of the hips.
BLOOD SUGAR AND CITRIC ACID LEVELS IN NEWBORN INFANTS
Authors: GITTLEMAN ISAAC F. , PINCUS JOSEPH B. 
Published: December 2021

Citric acid levels were determined in 161 newborn infants varying in age from 2 hours to 8 days. The highest levels were found in the youngest individuals. The citric acid values varied between 0.5 and 5.5 mg./100 cc.
Glucose levels were also determined in 151 of the same infants and the authors found a tendency for the sugar levels to rise as the infants advanced in age.
A relationship between citric acid and glucose metabolism is again suggested by this study.
In the instances of neuromuscular hyperirritability which was studied, the citric acid levels cannot account for the convulsive state.
FDA Varicella Warning
Authors: TINKELMAN DAVID G. 
Published: December 2021

To the Editor.—
In a recent Food and Drug Administration (FDA) medical bulletin, letin,1 the FDA issued a warning that severe varicella infection may follow in individuals for whom corticosteroid therapy has been prescribed. Included in their warning was the use of all formulations of corticosteroids, without reference to dosage or demonstration of immunosuppression. In view of the fact that there are thousands of children receiving inhaled corticosteroids for the treatment of their asthma, and that this form of therapy recently has been not only condoned but recommended by the National Asthma Education Program Expert Panel Report,2 we feel that more research and education are required prior to issuing such a warning.
Presurgical Routine Screening
Authors: COHEN ALAN , BURK CAROL 
Published: December 2021

In Reply.—
Doctors Lackmann and Töllner provide additional data supporting our finding that the discovery of clinically important coagulation disorders during routine preoperative laboratory screening is infrequent. However, these investigators are troubled, as are we, by the problem of determining the appropriate use of screening tests when the disorder is rare and the tests are imperfect, but the consequence of failing to recognize the disorder may be grave. Even the most elaborate cost-benefit analysis may be of little comfort in approaching the individual patient and concerned parents.