bluuebunny/crossref_metadata_2025_split huggingface dataset:
Consultation with the Specialist
Authors: Kveton John F. 
Published: December 2021

Otitis media is the most common infectious disease seen in the pediatric population. Hearing loss is a well-recognized sequela of otitis media, whether acute or chronic. In acute cases, hearing generally returns as the resulting effusion resolves, which may take up to several months. Hearing loss in chronic otitis media often resolves during quiescent stages of the disease; persistent hearing loss that fails medical management is best treated through surgical intervention. Tympanosotomy tube insertion effectively recovers hearing in cases of chronic middle ear effusions, whereas tympanoplasty and ossiculoplasty, often in conjunction with mastoidectomy, are necessary for chronic draining ears. Hearing loss may occur in the absence of otitis media. In such cases the clinician must be aware of the potential ramifications of the hearing loss for the child as well as the proper method of evaluating such a patient.
Background
During the first 5 years of childhood, the ability to hear is related intimately to the degree of speech and language acquisition as well as to the development of emotional, social, and academic skills. It is estimated that a normal-hearing 5-year-old child has a vocabulary of 5000 to 26 000 words, whereas a profoundly hearing-impaired child has a vocabulary of 200 words. The effects on reading ability are equally astounding, with the average reading achievement for hearing-impaired 16-year-olds at the third- or fourth-grade level.
Cocaine: A Review
Authors: Wootton John , Miller Sheldon I. 
Published: December 2021

Epidemiology
Although there has been an encouraging decline in the number of Americans using cocaine in recent years, cocaine use remains at epidemic proportions. The National Household Survey on Drug Abuse showed a decrease from 12 million "past year" users in 1985 to 8 million in 1988. In 1988, the National Institute on Drug Abuse (NIDA) estimated that 30 million Americans had tried cocaine. Of that 30 million, 20% had gone on to become regular users and 5% had developed a compulsive pattern of use. In 1988 among 12- to 17-year-olds, cocaine use in the previous year was highest in Hispanics at 4%, followed by 3% in whites and 1% in African-Americans. However, the Drug Abuse Warning Network has documented a dramatic increase in the number of admissions to hospital emergency rooms as a result of cocaine use. In 1984, the number was 8831; it jumped to 46 020 in 1988.
The ready availability of "crack" cocaine in the US in 1985 may well be responsible for this dramatic increase of documented medical emergencies arising from cocaine use. Although the use of cocaine has decreased, the preferred method of ingestion—smoking—has increased. Sniffing of the drug has decreased. Concurrently, cocaine, which was once called the "champagne" of abused drugs, has dropped significantly in cost on the streets.
Consultation with the specialist
Authors: Bergman Ira 
Published: December 2021

Increased intracranial pressure (ICP) is both a symptom of serious intracranial pathology and a cause of irreversible neurologic injury. The following case history highlights the importance of prompt diagnosis and treatment of increased ICP.
Case History
An 18-month-old white male developed fever and lethargy. On physical examination he had nuchal rigidity and was lethargic but could be fully aroused. His cerebrospinal fluid (CSF) contained 1279/mm3 white blood cells, of which 90% were polymorphonuclear cells; the CSF glucose level was 5 mg/dL and protein was 63 mg/dL. Gram stain revealed Gram-negative rods. The child was treated with ceftriaxone. Five hours later, he had four generalized seizures. Serum sodium was 114 mEq/L, and an infusion of 3% saline at 80 mL/h was begun. Immediately following the seizures, the child was comatose but withdrew to pain. Thirty minutes later, he developed decerebrate posturing bilaterally and irregular respirations and had a dilated unreactive left pupil. He was given mannitol, pancuronium, and pentobarbital and was intubated and hyperventilated. Almost immediately the pupils became 3 mm in size bilaterally and equally reactive. A computed tomographic (CT) scan was obtained (Figure 1A). Twenty-four hours later, the child opened his eyes to mild stimulation and responded specifically to localized pain. The cerebral CT scan was repeated (Figure 1B).
Consultation with the specialist
Authors: Rabinowitz Ronald , Hulbert William C. 
Published: December 2021

Introduction
The term cryptorchidism originates from the Greek kryptos (concealed) and orchis (testis). The definition of the term cryptorchidism is appropriate; not only is the testis concealed, but so is much information regarding this common condition.
More than 200 years ago, John Hunter described descent of the testis during the last 3 months of gestation and reported that testes that remain in the abdomen are unhealthy and do not function well. He also discussed the possibilities of failure to descend causing testicular abnormality and testicular abnormalities causing failure to descend.
Cryptorchidism represents the most common genital abnormality seen by pediatric urologists. The incidence is 1 in 125 boys. The incidence is much higher in premature infants (1 in 3), and the lower the birth weight, the greater the incidence of cryptorchidism. This condition is seen in approximately 1 in 30 full-term infants, but in many of them, the testicles will descend during the first few months of life. There is a higher incidence of cryptorchidism associated with many chromosomal and single gene defects as well as with multiple malformation syndromes. In addition, there is a higher incidence of cryptorchidism in the siblings and sons of those who have or had cryptorchidism.
We will describe the anatomy of both the cryptorchid and retractile testis and discuss the embryology of testicular descent, with an emphasis on hormonal factors.
Cervical Adenopathy
Authors: Chesney P. Joan 
Published: December 2021

Definition
Enlargement of cervical lymph glands is common in children and in most cases represents a transient response to a benign local or generalized infection, most often of viral etiology. The increase in size may involve a single node or a localized group of nodes (regional adenopathy); it may be unilateral or bilateral; and it may be acute, subacute, or chronic in onset and course. Almost all normal children have small palpable cervical, axillary, and inguinal nodes. About 5% have small palpable suboccipital nodes. Distinctly uncommon are palpable postauricular, supraclavicular, epitrochlear, or popliteal nodes or radiologic evidence of mediastinal or abdominal adenopathy. The increase in size of a node may be the result of one of two processes: 1) proliferation of cells intrinsic to the node, including lymphocytes, plasma cells, monocytes, or histiocytes; or 2) infiltration of cells external to the node, such as malignant cells or neutrophils, having the potential for developing necrosis and suppuration.
In some instances the cause of the adenopathy may be obvious, such as in the case of lymph glands draining an obvious source of infection. In other cases of unexplained neck masses, congenital and neoplastic causes also must be considered before the etiology is assumed to be infectious.
Prevention of Allergic Disorders
Authors: Solomon William R. 
Published: December 2021

Allergic disease produces substantial pediatric morbidity and individual dysfunction, making its mechanisms an appropriate target for clarification and preventive strategies. Disease expression seems to reflect a constellation of determinants that controls IgE production variably, affects specific function of target organs, and determines exposure to putative allergens. Bases for the two former factors are being defined rapidly and appear to be controlled genetically. Therefore, although stronger eugenic motivation will be required to exploit even present information for effective prevention, parental phenotypes can provide a rough indication of post-conceptive risk.
Despite many divergent data, current evidence fails to support the value of gestational strategies undertaken to prevent allergic disease in the newborn; however, this risk apparently may be reduced by avoiding postnatal allergens. The protection afforded seems to be allergen-specific rather than somehow serving to abate "the allergic tendency." Evidence increasingly is persuasive that sensitization to pollens, foods, and possibly other agents is prone to occur in the first 6 to 12 months of life. Strategies that exclude potent food allergens from the diets of high-risk infants appear to reduce the occurrence of atopic dermatitis, but seem far less able to influence respiratory symptoms. Efforts to limit exposure to potent inhalant allergens (eg, dust mites, animal "danders") are now also feasible and offer quite effective secondary and, perhaps, primary prevention. Trials of these strategies and clarification of other domestic contaminant effects on child health offer "homely" but valid and potentially useful approaches to reducing the impact of allergic disease.
Tonsils and Adenoids: An Update
Authors: Deutsch Ellen S. , Isaacson Glenn C. 
Published: December 2021

Pediatricians frequently face the decision of whether to recommend that a child undergo a tonsillectomy, an adenoidectomy, or both. The reputation and the indications for these procedures have evolved over the years and continue to evoke controversy. The total number of tonsillectomies and adenoidectomies performed in the United States has decreased substantially over the past 30 to 40 years, although the proportion of procedures performed for obstructive sleep apnea (OSA) has increased. We will address the indications (Table), techniques, and complications of tonsillectomies and adenoidectomies, as well as current ideas concerning OSA.
The palatine tonsils, adenoids, and lingual tonsils comprise a circle of lymphoid tissue in the nasopharynx and oropharynx, sometimes referred to as Waldeyer ring (Fig. 1). Although this tissue is immunologically active, no postoperative immune deficits generally have been acknowledged other than an increased risk of complications from polio1 prior to the availability of polio vaccines.
Clinical Aspects
The most common problems attributed to the tonsils and adenoids are recurrent infection and OSA, or its milder manifestation, adenotonsillar hypertrophy with obstruction. Chronic middle ear disease can be related to adenoid pathology.
OBSTRUCTIVE SLEEP APNEA
OSA either is becoming more common in children or is being recognized more frequently. Sleep disturbances, cor pulmonale, pulmonary hypertension, and congestive heart failure are potential complications of OSA.
How to Use PIR for Renewal of Certification
Authors: H R J 
Published: December 2021

During 1995, many pediatricians will participate for the first time in the Pediatric Renewal of Certification Program (PRCP). Since Pediatrics in Review (PIR) and the Pediatrics Review and Education Program (PREP) began in 1979, their material has been integrated with the American Board of Pediatrics (ABP) renewal of certification program. The ABP sets the educational objectives (now called content specifications) and develops the examinations. The American Academy of Pediatrics (AAP) develops PREP education materials, PIR, and the Self-Assessment Exercise based on these.
Each year PIR covers about 1000 of the more than 4000 content specifications, including at least half of the 900 selected as the basis each year for the cognitive examination.
BACK TO BASICS
Authors: Fong Chin-To 
Published: December 2021

Many inborn errors of intermediary metabolism present during periods of poor oral intake or intercurrent illness. Under these conditions, the body switches to a predominantly catabolic state, when glycogen, fat, and protein are mobilized as alternative energy sources. If a genetic defect already exists in any of these catabolic pathways, the problem is accentuated because the catabolic state demands a high flux of metabolite through these pathways. Therefore, a cardinal principle in the management of children who have IEM is to prevent them from lapsing into a catabolic state. This can be done through: 1) aggressive nutrition management to promote positive nitrogen balance and decrease accumulation of toxic metabolites, and 2) immunizations to minimize the possibility of viral or bacterial illness. When catabolism does occur, high-dose glucose infusion is a potent method for turning off the catabolic state.
This simplistic view of the catabolic pathways neglects many details in each of the metabolic pathways and diseases cited in the article and questions. Nevertheless, it should provide a useful framework for explaining some of the clinical findings encountered in caring for this special group of patients. A partial list of more commonly encountered IEMs is contained in the Table. The different parts of the biochemical pathways discussed previously are combined into Figure 6.
Muscular Dystrophy
Authors: Spiro Alfred J. 
Published: December 2021

Several varieties of muscular dystrophy can be distinguished on clinical, genetic, morphologic, and physiologic grounds. The classification includes Duchenne and Becker muscular dystrophies, both X-linked disorders; facioscapulohumeral muscular dystrophy, which is autosomal dominant; and limb-girdle muscular dystrophy, generally autosomal recessive.
Duchenne muscular dystrophy (DMD), which occurs in approximately 1 in 3500 live male births, has no recognizable signs or symptoms at birth. However, markedly elevated serum creatine kinase always is demonstrable, even at birth. A molecular diagnosis can be made at any time in the patient's lifetime by demonstrating the defect in the dystrophin gene, the absence of dystrophin in a muscle biopsy, and the characteristic morphologic abnormalities.
What's New in Cardiology
Authors: Baldwin H. Scott 
Published: December 2021

Congenital heart diseases occur with a frequency of 0.5 to 1 case per 1000 live births, accounting for more than 50% of reported birth defects. In addition, they are the leading cause of infant mortality in the first year of life. Significant progress in the diagnosis and treatment of most defects has been made in the past few years. In addition, new experimental evidence suggests that we soon may be able to identify the genes involved in disturbed cardiac anatomy and function. The following is a brief overview of some of the more recent developments that have made an important impact on the contemporary management of the child who has congenital heart disease.
Transcatheter Ablation of Pediatric Tachyarrhythmias: A Cure Without Medication
The prevalence of tachyarrhythmias within the general pediatric population is such that virtually every practitioner is faced with diagnostic and management considerations that involve patients from birth through adolescence. Fortunately, most tachyarrhythmias can be managed with relatively benign pharmacologic therapies. However, there is a subset of patients who do not respond to "simple" medical intervention, requiring multiple or more potent antiarrhythmic medications that may involve frequent or prolonged hospitalizations for monitoring and optimization of therapeutic regimens. These medications also may cause significant side effects and often result only in a decrease, not elimination, of the arrhythmia.
Cytomegalovirus Infections
Authors: Hanshaw James B. 
Published: December 2021

The term cytomegalovirus (CMV) was proposed by Weller and his colleagues in 1960 to replace the names cytomegalic inclusion disease and salivary gland virus for two reasons: 1) the virus usually involved other organs, and 2) the term salivary gland virus had been used to designate unrelated agents that were recovered from bats.
Cytomegaloviruses belong to the class of herpesviruses, which includes the herpes simplex viruses 1 and 2, varicella-zoster virus, Epstein-Barr virus (EBV), human herpesvirus 6, the cause of roseola, and human herpesvirus 7, a virus in search of a disease. These viruses are known for their wide distribution in humans and a propensity for latency and reactivation during the lifetime of the host.
There apparently are no clearly distinct CMV serotypes, but strain differences have been noted in cross-neutralization tests and by molecular analysis of CMV viral DNA. Restriction enzyme analysis of DNA from CMV isolates has proven to be of great value in our understanding of the epidemiology of CMV infection because of the striking similarity of DNA fragments from common sources.
Epidemiology
CMV infection is ubiquitous, and evidence of seroconversion has been found in all populations tested to date. Antibody prevalence is influenced by age, socioeconomic group, geography, and cultural practices.
Clinical Manifestations of Scleroderma
Authors: Haber Patricia L. 
Published: December 2021

Scleroderma is a connective tissue disease of unknown etiology. Its most characteristic feature is thickening of the skin due to increased collagen deposition. However, the disease may involve multiple other organ systems. Two broad categories of scleroderma have been defined: localized and systemic. Although all forms of scleroderma are rare, localized scleroderma occurs more frequently than systemic sclerosis and has a more favorable prognosis.
Several types of localized scleroderma exist. Morphea is characterized by the presence of one or more patches of hard, ivory-colored skin lesions. They begin with erythema and progress to nonpitting edema before becoming sclerotic. The margins of active lesions often have a violaceous hue. Underlying muscle fibrosis and atrophy may occur.
Retinopathy of Prematurity
Authors: Phelps Dale L. 
Published: December 2021

Retinopathy of prematurity is a common disorder among extremely low-birthweight preterm infants and may cause total vision loss in as many as 2% to 4% of those weighing less than 2 pounds at birth. Regular examinations begun in the neonatal intensive care unit permit early detection and treatment of progressive ROP and allow a reduction in visual impairment.
Infants whose ROP has regressed should continue to receive regular ophthalmologic follow-up for the detection and treatment of myopia and strabismus and, if they have cicatricial sequelae, late retinal detachments as teens or adults. Early intervention and special education programs are important for the children whose vision loss is significant.
Consultation with the Specialist
Authors: Kenna Margaret A. 
Published: December 2021

Hoarseness in children is very common and usually self-limiting, but there are several very serious and potentially life-threatening causes of hoarseness that always should be considered. A careful history and physical examination usually can suggest underlying etiologies, with the definitive diagnosis usually made at the time of airway endoscopy. The following case and subsequent discussion attempt to clarify some of these issues.
Case Report
An 8-year-old boy presented to the emergency room with a 2-week history of increasing hoarseness, accompanied in the past 5 days by some respiratory distress. On physical examination he was alert and cooperative, with a hoarse but understandable voice and moderate inspiratory and expiratory stridor. Further history revealed that 6 weeks earlier he had been admitted to the pediatric intensive care unit with severe asthma that required 8 days of intubation and mechanical ventilation. He had done well after discharge for about 4 weeks, when his symptoms of hoarseness and then stridor developed.
Differential Diagnosis
The entities causing hoarseness can be divided primarily into congenital, neurogenic, neoplastic, inflammatory, physiologic, and traumatic (Table).
The most common overall etiology is laryngitis associated with an upper respiratory infection (URI), which generally is benign and self-limiting. Vocal nodules are the acquired lesions encountered most frequently and usually are not associated with airway compromise.
INDEX OF SUSPICION
Authors: Friedman Elliott M. , Turner Teri , Deeb Danuta 
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
A 6-week-old boy who has had no prenatal or newborn problems and has been well previously is brought to the emergency department because he suddenly has developed respiratory distress. On examination, the baby is lethargic, obviously cyanotic, and breathing at 36 breaths/min with intercostal retractions, nasal flaring, and grunting. His temperature is 94°F (34.4°C), heart rate is 140 beats/min, and blood pressure is 78/48 mmHg. Other positive signs include cool extremities and a capillary refill time of 4 sec. He is aerating his lungs well and his breath sounds are clear. No heart murmurs are heard and no hepatosplenomegaly is noted. His femoral and brachial artery pulses are equal but of diminished strength.
An intravenous line is put into an external jugular vein; the state of shock precludes a peripheral cannulation and the external jugular veins are prominent.
Consultation with the Specialist
Authors: Johnson Robert L. 
Published: December 2021

Adolescence is a time set aside in our culture for our children to learn how to be adults. Throughout history this societal responsibility has been satisfied in various ways by different cultural groups. Alex Hailey, in his book Roots, describes the ancient African adolescence of the young Kunta Kinte:
At 12 years of age the boys of the village were separated from their families and taken to a camp in the jungle. Over a period of 6 weeks, the men of the community taught the boys all the lessons of adulthood. At the end of the encampment they were tested to determine if they had learned these lessons of adulthood. Those boys who successfully passed the test were granted adult status and circumcised as a visible sign of their manhood. These young people who left their village as boys returned to their society as men.
Adolescents in our culture must accomplish the same task of adolescence as the young Kunte Kinte. They must:
1. Emancipate themselves within the structure that gave them nurture and support during their childhood (usually the family or some similar surrogate structure);
2. Establish their sexual identity—make decisions about maleness and femaleness and love-object gender;
Establish their intellectual identity and place themselves within the religious, cultural, ethnic, moral, and political constructs of our society;