bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Human Immune Serum Globulins
Authors: Stiehm E. Richard 
Published: December 2021

Pediatric practitioners administer γ-globulin frequently, usually following hepatitis exposure or prior to foreign travel. Administration of γ-globulin, or human immune serum globulin (HISG), its official name, is also indicated in several other situations.
HISG is used intermittently to prevent a specific infection in normal subjects, and it is continuously to prevent recurrent infections in immunocompromised subjects. Two types of HISG preparations are available: standard human immune serum globulin for general use and special human immune serum globulin with a known antibody content for specific illnesses (Table 1). In addition, some animal sera and antitoxins are still used for certain infections (eg, diphtheria), poisonings (eg, snake bites or botulism), or immunosuppression (eg, antilymphocyte globulin). Recently (September 81), human immune serum globulin for intravenous use has been licensed.
SOME PROPERTIES OF IMMUNOGLOBULIN G
The immunoglobulins or "γ-globulins" are the proteins of the plasma and tissue made in lymphoreticular tissues that have antibody activity.1 Although there are six classes of immunoglobulin—IgG, IgM, IgA, IgD, IgE, and secretory IgA—only IgG is present in significant quantities in HISG.
IgG is a glycoprotein with a molecular weight of 150,000 distributed equally between the serum and the tissues. The IgG molecule is Y-shaped with two combining sites, one at the end of each arm.
Breast-Feeding and Herpes
Authors: Fulginiti Vincent A. 
Published: December 2021

Dr McNiel of Fort Dodge, Iowa writes: "Our infection committee noticed that in the new edition of the report of the Committee on Infectious Disease (Red Book) that mothers with active genital herpes may now breast-feed infants. Recent articles in Pediatric Infectious Diseases (1:81, 1982)and in Pediatrics in Review (2:259, 1981) show that herpes is still a devastating illness to most newborns who get it. Roughly 90% of babies who get neonatal herpes are either dead or damaged and with treatment the outlook is for better survival, but still a large percent of the survivors are damaged. If they consider it such a devastating infection in the newborn, I do not understand this change in recommendation from strict isolation to allowing infants to breast-feed. It seems a pretty big risk to consider that the mother will keep her hands off of her lesions while breast-feeding her infant and not touch her infant with contaminated hands.
Do you have any data or are you aware of any data on why the American Academy changed their recommendations?"
Reply: Dr McNiel's infection committee spotted one of the controversial areas of infectious diseases practice. The issue the committee faced was broader than just breast-feeding; it concerned the degree of contact permissible between an infected person and a newborn infant. Herpes in the newborn generally is a disease transmitted just prior to or at the time of delivery, following direct contact of the infant with herpes virus-rich lesions in the genital tract. There are exceptions, of course, in which caretakers appear to have been the source for infants after birth. Even in these circumstances direct contact appeared necessary (kissing an infant, etc).
Given this background, we were faced with the dilemma of what to do for the maternal-infant pair postdelivery. On the one hand, direct contact with lesions or with fingers contaminated with herpes carried a small but significant risk. On the other hand, as pediatricians we wished to encourage appropriate mother-infant contact, including breast-feeding.
Our experts advised us that: (1) The risk postdelivery was very low; some claimed there was no risk at all, that infants were infected during birth or not at all. (2) If the nipple and surrounding skin were unaffected, breast-feeding was not contraindicated. (3) To further reduce the minimal (if any) risk, primary lesions should be covered and thorough handwashing taught and practiced. Hence, our recommendation in the Red Book.
Menstrual Problems During Adolescence
Authors: Litt Iris F. 
Published: December 2021

Medical interest in menstrual absence is antedated by that of the philosophers and theologians (Aristotle, Plato). The importance of menses induction in early medical teaching is underscored by the observation that 14% of all drugs listed by Dioscovides of Ana Zarbos in the first half of the second century AD were supposedly capable of inducing menses. It was, even in antiquity, recognized that cessation of menses was an early sign of pregnancy, yet amenorrhea was regarded as a systemic disease that required immediate intervention. Although there have been sizable gains in our understanding of amenorrhea, modernday physicians often face a comparable dilemma in approaching its differential diagnosis and determining a course of action. This article is written in order to simplify this process and, in so doing, to assist the pediatrician in dealing with the adolescent patient with amenorrhea, as well as other common menstrually related problems, such as menometrorrhagia and dysmenorrhea.
AMENORRHEA
In order to understand absence of menses, it is first necessary to visualize the mechanisms responsible for its presence. The first prerequisite for normal menses is presence of a functionally and anatomically intact cerebral-hypothalamic-pituitary-ovarian-uterine axis. This system is apparently capable of cyclic menses from birth, the reasons for its quiescence until puberty remaining an intriguing mystery.
Approach to the Febrile Patient with No Obvious Focus of Infection
Authors: Long Sarah S. 
Published: December 2021

The summary in Table 1 could be used as a mental checklist for the pediatrician who examines a child with fever. Whether the pediatrician opts to "keep the rules" or appropriately decides to "break the rules," knowledge of the guidelines will help him to focus his approach and to adopt attitudes of caution in certain circumstances. The body of knowledge of infectious agents chemotherapeutic agents has burgeoned over the past 40 years; the rules have changed very little. Thus, the rules might also serve as standards against which "new discoveries" that dictate departure from an established mode of clinical practice would have to be weighed.
The adage, "Name the bug before you choose a drug," is especially germaine to pediatrics. Potential pathogens or "bugs" continually change as the patient's age, exposure, and immunity change. The serious diseases they cause mandate that initial treatment be given with the best "drugs." The age-related causes of bacterial meningitis presented in Table 2 could serve as a primer for age-related causes of other invasive disease as well. For bone, joint, and soft tissue infection as well as for septicemia without a focus the age line for group B Streptococcus and H influenzae would be extended upward and S aureus would be added for all ages. Although the relative importance of each pathogen for each clinical entity might vary, therapeutic considerations would be appropriately served by a schema such as this.
Unfortunately, the susceptibility of pathogens to antimicrobial agents will continue to change. Fortunately, new and potentially better therapeutic agents will continue to be discovered or invented. When new problems of antibiotic resistance emerge or when superior therapeutic modalities are proved, the pediatrician must be knowledgeable of such events and be prepared for change.
Conjunctivitis in Infancy and Childhood
Authors: Hammerschlag Margaret R. 
Published: December 2021

Conjunctivitis is one of the most common afflictions affecting the eyes. Practically every microorganism, from viruses to bacteria have been implicated as causes of conjunctivitis. Depending upon the etiologic agent, conjunctivitis may range from a mild self-limited infection to one that can destroy vision and even be life-threatening.
This review will be divided into two sections covering conjunctivitis in older infants and children and ophthalmia neonatorum, which has a different epidemiology.
CONJUNCTIVITIS BEYOND THE NEONATAL PERIOD
Epidemiology and Etiology
Bacterial infection probably accounts for most of acute conjunctivitis in children. The organisms thought to be most common are Staphylococcus aureus, Haemophilus species including H influenzae and H aegyptius, and Streptococcus pneumoniae (Table I). Bacterial infection is frequently characterized by a purulent or mucopurulent discharge which is usually the source of transmission of infection. Towels and other commonly used articles may spread the infection from one person to another.
Although Staph aureus has traditionally been assumed to be a pathogen, the organism is frequently isolated from the conjunctivae of individuals without conjunctivitis.1,2 In a recent prospective study of acute conjunctivitis in children,1 Staph aureus was isolated from 24% of the children with acute conjunctivitis and 16% of the control subjects, a nonsignificant difference. It has been hypothesized that the increased isolation rate of Staph aureus seen in conjunctivitis may be secondary to the wetter environment of the infected eye rather than a direct cause of the infection.
Ethical Issues in the Care of Handicapped, Chronically III, and Dying Children
Authors: Fost Norman C. 
Published: December 2021

There is presently broad consensus that involuntary sterilization of an incompetent patient should be done only in the following unusual circumstances, and then only after approval by a court:
1. If the progeny would be so severely damaged that their lives would be arguably worse than nonexistence (eg, a disorder such as Lesch-Nyhan syndrome), OR a retarded female's physical or psychologic health would be seriously jeopardized by a pregnancy and/or abortion (eg, severe heart or lung disease), AND
2. There are no alternative, less restrictive ways of avoiding pregnancy (such as segregation, supervision, behavior control, or reversible forms of contraception), AND
3. There has been a court order, following a process designed to ensure that the procedure is necessary to protect the interests of the patient.
Dealing with Chronic Illness in Childhood
Authors: Swartz Donald R. 
Published: December 2021

Most pediatricians treat Children who are well or who, at worst, have an acute but Curable illness. Children with chronic illnesses don't fit. Our appointment schedules aren't structured to deal with them and they clash with our "health and normality" mind-set. Chronic diseases, incurable and possibly lethal, conflict with our need to heal, and the obvious pain and dismay of the parents is painful and dismaying to us as well. Practice might be more comfortable without them. Yet no group of patients can benefit more from the understanding of healthy development and knowledge of management of disease that are combined in today's pediatrician. The child with chronic illness is not just a case of a specific medical condition; he or she is also a child, with all of the development, psychosocial, and physical needs that are characteristic of children in general.
This discussion will focus on the ways in which a child and his or her family may be affected by chronic disease, and what the responses of each to chronic disease are likely to be. The physician's responses will also be examined, as well as how the physician caring for a child with chronic illness can facilitate the adjustments and adaptations that will allow the child and his or her family to attain their greatest potential for a normal and fulfilling life.
Childhood Dermatomyositis and Polymyositis
Authors: Spiro Alfred J. 
Published: December 2021

Childhood dermatomyositis has been recognized as a clinicopathologic entity for approximately two decades. Polymyositis in the pediatric age group, as in adults, is not a singly defined entity, as it may occur with or without evidence of one of the collagen vascular diseases. Because of overlap of some features of both disorders the terms "polymyositis" and "polymyositis—dermatomyositis Complex" have sometimes been used to include both of these disorders.
INCIDENCE
Polymyositis and dermatomyositis are uncommon disorders; even in a referral center, there may be only two or three cases seen per year. The limited number of epidemiologic studies have included both adults and children and have combined several types of inflammatory myopathy. By this imperfect method, the annual incidence of new cases has varied from 1 to 7.7 per million persons. There is an increased incidence in the second and seventh decades of life, with a lower incidence in the third decade. Most reports of dermatomyositis have shown a preponderance of girls. Onset most commonly occurs at school age, but children in their second year of life have been affected.
PATHOGENESIS
Studies of muscle biopsies from patients with juvenile dermatomyositis have demonstrated that the basic lesion involves the endothelial cells of intramuscular capillaries, arterioles, and veins.
Clinical Approach to the Child with Scoliosis
Authors: Jones Marilyn C. 
Published: December 2021

Although most children with scoliosis are otherwise structurally normal, spinal curvature may represent one feature in a broader problem of altered development with a specific prognosis and a specific risk of occurrence in siblings and children of the affected individual. A clinical approach to the evaluation of the child with scoliosis is proposed based upon the age of recognition of the curvature and a detailed physical examination.
Scoliosis is defined as a lateral curvature of the spine. In contrast to curves in the anteroposterior dimension (kyphosis and lordosis), scoliosis is never present in the normal spine. Although mild degrees of curvature are often asymptomatic, marked scoliosis produces severe disability and shortens lifespan by interfering with pulmonary mechanics, resulting in hyperventilation, pulmonary hypertension, and eventually, pulmonary and cardiac failure. Early diagnosis and promptly instituted treatment are effective in reducing long-term morbidity. It is critical to recognize that scoliosis is not a diagnosis. It is a description of a particular structural alteration which may be produced by a variety of pathogenetic mechanisms and which has many different etiologies. The vertical stability of an individual is maintained as a consequence of normal vertebral bodies, intervertebral disks, ligamentous and muscular attachments, and normal neuromuscular function. Alteration in any one of the above may lead to scoliosis.
Rubella Reimmunization
Authors: SCHMITT BARTON D. , BRUNELL PHILIP A. 
Published: December 2021

In the October 1980 issue (PIR 1980;2:126), Katz recommended that a second rubella immunization be given to 12-year-old girls. In the February 1983 issue (PIR 1983;4:256), Johnson recommended that the polio booster be given to all youngsters at age 12 years.
I went back to the recent AAP "Red Book" and could not find a similar recommendation. I reviewed Pediatrics for up-dated guidelines from the Committee on Infectious Diseases and could find no backing for the above two recommendations. What should standard practice be in 1984?
Reply: An article summarizing a report of the Institute of Medicine, concerning poliovirus vaccines, appeared in the New England Journal of Medicine (1977;297:249).
Use of Oral Fluids in Treatment of Diarrhea
Authors: Klish William J. 
Published: December 2021

The practicing physician cannot help but be somewhat surprised by the current interest and publicity given to oral rehydration therapy for diarrheal disease. Indeed, oral rehydration therapy has been used to some extent by all physicians who deal with diarrhea, and the history of its use as a folk remedy is probably as long as the history of diarrheal illness. Why, then, has interest in this rather mundane therapy reemerged? Only recently have we begun to understand how oral fluids are absorbed, and this has resulted in changes in the composition and indications for use of these fluids.
Even though the need for fluid intake during an episode of diarrhea has appeared always to have been a part of folk medicine, the medical profession did not consider this practice until the early 19th century. In 1832, after William O'Shoughnessy, an Irish physician, described the chemical composition of the stools in cholera, Thomas Latta of Scotland attempted to treat cholera by the intravenous infusion of water and salts. Of the 15 cases he reported in The Lancet, five patients survived. Latta was criticized severely for this therapy, but it was pointed out (in discussion in The Lancet) that these five patients were saved from almost certain death.
Viral Hepatitis: 1985 Update
Authors: Krugman Saul 
Published: December 2021

During the past two decades extraordinary advances in hepatitis research have clarified the etiology and natural history of the disease. At least four types of hepatitis have been identified: A, B, D (delta), and non-A, non-B. Hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis D virus (HDV) have been characterized. Serologic tests have been developed to detect the antigens and antibodies associated with these three hepatitis infections. As of the present time, the non-A, non-B viral agents have not been identified. Therefore, non-A, non-B hepatitis is diagnosed by excluding other viral causes of hepatitis, such as hepatitis A virus, hepatitis B virus, Epstein-Barr virus (EBV), cytomegalovirus (CMV), and others. A recent report indicating that non-A, non-B hepatitis may be caused by a retrovirus, if confirmed, may provide a specific marker of this infection.
The course of viral hepatitis is variable; it may be an asymptomatic, anteric infection, or it may be an acute illness characterized by fever, malaise, anorexia, nausea, abdominal pain, and jaundice. Most patients recover completely, but occasionally the infection may be complicated by chronic hepatitis, cirrhosis, and, occasionally, by a fulminant fatal outcome.
This review will be devoted predominantly to a discussion of the diagnostic and prophylactic aspects of hepatitis A and hepatitis B viral infections.
Department of Corrections
Authors: Springate James E. , Donn Steven M. 
Published: December 2021

A reader asks:
I recently had the opportunity to read Donn and Banagale's informative article entitled, "Neonatal Hyperammonemia" (Pediatrics in Review 1984; 5:203-208).
I am somewhat confused by Table 5 which lists the ingredients for 1.5% dextrose-bicarbonate peritoneal dialysate. The use of a total of 167 mEq/L of sodium seems nonphysiologic and combination of calcium and bicarbonate, if I remember correctly, leads to precipitation.
Dr. Donn replies:
There was an error in Table 5 in our review article. Unfortunately, the error was missed by both authors, internal reviewers, and external reviewers as well. As indicated, the total sodium concentration of the dialysis solution is too high. The total sodium concentration, the combination of sodium chloride and sodium bicarbonate should approximate 132 to 136 mEq/L. At the present time, our special peritoneal dialysis solution contains 95 mEq/L of sodium chloride and 40 mEq/L of sodium bicarbonate for a total of 135 mEq/L. This is certainly within the physiologic realm and avoids problems with sodium flux.
With regard to concern about the precipitation of calcium and bicarbonate, the concentrations of both calcium chloride and sodium bicarbonate are low enough that they do not exceed the solubility product and, therefore, remain in solution.
Disaccharidase Deficiency
Authors: Ulshen Martin H. 
Published: December 2021

Disaccharidases are enzymes of the small intestine, and they are essential for normal carbohydrate digestion. Carbohydrates are an important dietary component, providing about half of the calories in a typical Western diet. The smallest carbohydrate units, the monosaccharides, are the building blocks for more complex sugars and starches. The monosaccharides of dietary importance include glucose, galactose, and fructose. Carbohydrates are present in an average diet, primarily in the form of dissacharides (two monosaccharides linked together) and starches (glucose polymers). The disaccharide lactose is the major carbohydrate in milk and accounts for about 40% of the caloric content of human milk as well as commercial cow milk formula. Lactose is composed of the monosaccharides glucose and galactose; sucrose is composed of glucose and fructose. During the first year of life, juices and solids are introduced into the diet in increasing amounts and, therefore, sucrose and starches provide an increasing proportion of the dietary calories. By the adult years, about 50% of dietary carbohydrate is ingested in the form of starch, and lactose is often a minor component of the diet.
Among the dietary carbohydrates, only the monosaccharides can be transported intact across the luminal surface of the small intestine. The moroe complex carbohydrates must undergo digestion prior to assimilation.
Diseases of the Scalp
Authors: Rasmussen James E. 
Published: December 2021

The scalp is far more important than its small surface area would suggest. It is usually the first part the infant presents to the world and is responsible for much cosmetic concern throughout life. In the general scheme of organization, regional dermatology is an easy way to categorize many diseases. This article will review several regional dermatoses that affect the scalp more commonly than other sites. There will be no attempt to discuss all diseases that may occur on the scalp, particularly those that have more important or characteristic manifestations at other body sites.
Diseases of the scalp can be conveniently grouped into those that are congenital, those that are acquired, and those that are associated with normal or abnormal amounts of hair loss (Table 1). The reader will rapidly appreciate that it is difficult to separate some diseases of the scalp from primary hair disorders, particularly when the mouth of the follicle or the hair root is the primary target.
It is also useful to organize scalp diseases in a roughly chronologic sequence from birth through maturity and senescence (Table 2). Diseases that commonly occur prior to puberty are frequently not seen after that time; they are replaced by a variety of problems related to hormonal changes.
Stuttering and Stammering
Authors: Guitar Barry E. 
Published: December 2021

Stuttering is a disorder characterized by intermittent difficulty in producing a smooth flow of speech. Stutterers may repeat or prolong sounds or may sometimes be unable to utter any sound without a great deal of effort. The disorder usually begins a year or two after the child has first learned to speak. The earliest symptoms are usually repetitions of parts of words. Signs of the problem may gradually progress, in a matter of months or during a period of several years, from these minor repetitions to prolongations of sounds, longer hesitations, and complete blockings of speech. Accessory signs and symptoms such as facial squeezing, tremors of the speech musculature, and eye blinks, as well as fear and avoidance of particular words and situations, often occur in more severe cases. At times stuttering may be "internal," ie, apparent only to the child involved, or manifested only by pauses in speech.
TERMINOLOGY
Stuttering v Stammering
"Stammering" is a term no longer in common usage in the United States. It is still used in Europe, as it was once used here, to denote tense blockages of speech, as opposed to "stuttering," which was applied to the repetition of sounds and syllables. Current usage in this country favors the term "stuttering" for all forms of the disorder.