bluuebunny/crossref_metadata_2025_split huggingface dataset:
Guidelines for the Pediatric Cancer Center and Role of Such Centers in Diagnosis and Treatment
Authors:   Section on Oncology-Hematology
Published: December 2021

GUIDELINES FOR PEDIATRIC CANCER CENTERS
The pediatric cancer center cannot be defined simply in terms of restriction by diagnosis and age group. It implies a multidisciplinary approach by a team of pediatric, surgical, radiologic, nursing, and paramedical specialists. The care of the pediatric oncology patient should be coordinated by a trained pediatric oncologist in a center that includes the following facilities and capabilities: (1) pediatric oncology nursing care in a specific area; (2) a pediatric intensive care unit; (3) pediatric radiologist and radiologic services that include lung tomography, computed axial tomography, ultrasonography, and angiography; (4) hematopathologic laboratory services capable of doing cell marker studies; (5) laboratories for the routine provision of drug levels; (6) blood cell component therapy; (7) a pharmacy familiar with antineoplastic agents; (8) clinical pharmacology services; (9) protective isolation; (10) personnel familiar with pediatric total parenteral nutrition techniques; (11) radiotherapist familiar with pediatric oncology problems and radiotherapy equipment which includes cobalt-60 or an accelerator with nominal beam energy of 6 meV or greater; (12) rapid section studies and operating room consultation at any time; (13) a multidisciplinary tumor board or its equivalent; (14) surgeons specializing in pediatric oncology; and (15) trained oncology social workers.
ROLE OF CENTERS IN DIAGNOSIS AND TREATMENT
Each year cancer is discovered in about 6,000 children in the United States. Fifty percent of these cancers are curable when the diagnostic and therapeutic techniques available today are instituted promptly. There are many reasons, some beyond any physician's control, for the failure to realize this potential cure rate, but among recognized factors are late detection, misdiagnosis, and inappropriate treatment.
Chance and Ventricular Septal Defect
Authors: NEWMAN THOMAS B. 
Published: December 2021

In Reply.—
I expected that Dr Nora might respond to my paper, and I appreciate the opportunity to address his thoughtful comments.
Dr Nora and I are in agreement on several points: that there is a large element of chance in the etiology of congenital heart defects, that the "rough approximations" for multifactorial inheritance he used in the past are wrong and should be abandoned, that continued vigilance is essential to identify new teratogens and genetic syndromes, and that parents should not feel guilty about congenital heart defects in their offspring.
Constipation
Authors: CHEN DOOLEY , SULLIVAN BRADLEY 
Published: December 2021

To the Editor.—
Among the frequently encountered problems of a general or referral pediatrician are constipation and/or encopresis. We recently had a patient who presented with a chief complaint of increased stooling pattern, the cause of which may be an acceptable addition to the therapeutic modalities applied to constipated children.
A 10-year-old boy, previously in good health, was brought in because his stool pattern had changed in the past 4 months. He was an individual who, prior to the change, went unnoticed as to his bowel habit.
Revised First Aid for the Choking Child
Authors:   Committee on Accident and Poison Prevention
Published: December 2021

Aspiration of a foreign body is a common hazard in infancy and childhood. In the last 5 years, there has been a great effort to educate the public on the prevention of choking due to accidental inhalation of foods or small objects by children. Concomitantly, there has been a campaign to teach the first aid measures essential for evaluation and treatment of choking.
LITERATURE REVIEW
Much of the existing data on treating the choking child has been anecdotal. In 1981, the Committee on Accident and Poison Prevention of the Amencan Academy of Pediatrics reviewed the available literature; the Committee recommended that a foreign body in the upper airway be considered an immediate threat to life and that such a foreign body required urgent removal.1 In addition, the Committee recognized the effectiveness of natural coughing and recommended that, if a choking child could breathe and was able to speak and/or cough, all maneuvers were unneccessary and potentially dangerous. If the choking child could not breathe, cough, or make a sound, a series of back blows and chest thrusts was recommended. The Committee recommendations resulted in a spirited controversy concerning the most effective management of the choking child.2-6
At the July 1985 National Conference on Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care, the American Heart Association, American College of Cardiology, and the American Red Cross convened a panel on Management of Foreign Body Airway Obstruction to review and revise the past recommendations. The panel recommended use of the abdominal thrust—the Heimlich maneuver—as the exclusive method of treating foreign body airway obstruction for adults and children older than 1 year.
The Pediatric Intensivists' Viewpoint
Authors:   PEDIATRIC INTENSIVE CARE NETWORK OF NORTHERN AND CENTRAL CALIFORNIA,   PEDIATRIC INTENSIVE CARE NETWORK OF SOUTHERN CALIFORNIA
Published: December 2021

To the Editor.—
Dr Joseph W. St Geme, Jr, has expressed an understandable concern about the direction of the field of pediatrics, with particular emphasis on the "subspecialty" movement.1 He voices discomfort about the growing number of subspecialists and sees a potential surfeit of "special care hospital subspecialist" competing with and draining clinical opportunities from the sphere of the general pediatric specialist. We do not seek to minimize the challenge to the general pediatrician to retain a meaningful place in the care of the hospitalized child.
Cardiovocal Syndrome
Authors: POLANER DAVID M. , BILLET AMY L. , RICHARDSON MARK A. 
Published: December 2021

To the Editor.—
We were interested in the recent report of Condon et al (Pediatrics 1985;76:22-25) of two cases of cardiovocal or Ortner's syndrome. We are following a patient with paralysis of the recurrent laryngeal nerve secondary to cardiomegaly not from intrinsic congenital heart disease but from high output failure caused by massive hepatic hemangiomatosis.
The patient was a 4,150-g girl born at term to a 22-year-old gravida 2, para 2 mother whose pregnancy was complicated only by mild pregnancy-induced hypertension. Several small (less than 5 mm) cutaneous hemangiomata were noted at birth. During the next several weeks, the mother noted that the infant fed poorly at one- to two-hour intervals and that she became diaphoretic during feeding.
Ionized Calcium, Cardiac Function, and Electrocardiogram in Preterm Neonates
Authors: MÖLLER JENS , TEGTMEYER F. K. 
Published: December 2021

To the Editor.—
We would like to add some comments on the article by Venkataraman et al.1 In one respect it might be quite dangerous not to measure the ionized calcium in preterm neonates. If you find prolongation of QTc or QoTc intervals in the ECG during cardiac failure in these infants and find subnormal total serum calcium levels, you might make a wrong conclusion on causal relationship.
Until now, we have seen five preterm neonates with OTc/QoTc prolongation and profound low total serum calcium levels, whereas the measured ionized calcium level was normal.
Comprehensive Asthma Care Reduces Hospitalization
Authors: LEWIS CHARLES E. , RACHELEFSKY GARY S. , LEWIS MARY ANN , DE LA SOTA ANN , KAPLAN MICHAEL S. 
Published: December 2021

To the Editor.—
The article describing a trial of "Asthma Command" by Rubin et al1 represents another interesting addition to the armamentarium of programs to enhance the self-management capacities of children with asthma. The program achieved an increase in knowledge, which is not surprising. (Tests designed to evaluate a specific intervention not provided to others should demonstrate a significant gain among the experimental group.) The failure to demonstrate differences in morbidity data in terms of children's visits to physicians, emergency rooms, and hospitals is not surprising.
Comprehensive Asthma Care Reduces Hospitalization
Authors: RUBIN DAVID H. 
Published: December 2021

In Reply.—
Children who were exposed to Asthma Command (the interactive asthma-specific computer game) showed a significant improvement in (1) their knowledge of asthma, (2) behaviors related to the management of their disease, and (3) behaviors toward their disease in areas that were addressed directly by Asthma Command.1 The test used to evaluate "knowledge of asthma" was not an instrument designed to specifically evaluate Asthma Command. The Parcel Knowledge of Asthma Questionnaire is a nonspecific assessment of knowledge of the principles of asthma.2
Pleiotropy Versus Heterogeneity in Proteus Syndrome
Authors: KOUSSEFF BORIS G. 
Published: December 2021

To the Editor.—
I read with interest the article by Costa et al1 on a "new" clinical feature in Proteus syndrome. It appears that there is a lot to be learned about hamartoses and localized growth deficiency. This is apparent from the article and the existence of children with multiple hamartomas defying the current classification of these unique conditions. The classification includes the "new" Bannayan, Zonana, and Riley-Smith syndromes, 2-4 in addition to the "old" neurofibromatosis, tuberous sclerosis, Klippel -Trenaunay -Weber, and Cowden syndromes.
Persistent Colonization During Therapy for MHaemophilus influenzae Type b Disease
Authors: BARTON LESLIE L. 
Published: December 2021

To the Editor.—
Dr Gilsdorf's rather reassuring recommendation to discontinue respiratory isolation for children with Haemophilus influenzae type b infections after 24 hours of parenteral therapy, "without increased risk of nosocomial infection," was based on her failure to show nasopharyngeal colonization with H influenzae type b after 24 hours of appropriate antibiotics.1 Although this is in accord with currently recommended isolation policies, a modicum of skepticism should remain.
Previous studies have demonstrated the persistence of H influenzae type b in the nasopharynx and throat for up to six days after parenteral antibiotic therapy.2,3
Aspiration of Pacifiers
Authors: JAIN LUCKY , SIVIERI EMIDIO , BHUTANI VINOD K. 
Published: December 2021

To the Editor.—
The report by Millunchick and McArtor1 about the aspiration of a "makeshift" pacifier underscores the serious concerns of the widespread use of such pacifiers. As the authors point out, the nipple can easily detach from its unattached collar in the presence of high negative pressures within the nipple cavity. Colley and Creamer2 have previously reported a pressure of 250 cm H2O in low-flow teat nipples. We have recently documented the pressures generated by term babies sucking on such makeshift pacifiers.
Aluminum Toxicity in Infants and Children
Authors:   Committee on Nutrition
Published: December 2021

During the last 15 years, accumulating evidence has implicated aluminum in disorders associated with chronic renal failure.1-6 The well-recognized manifestations of systemic aluminum toxicity include fracturing osteomalacia, dialysis encephalopathy, and microcytic hypochromic anemia. More recently, aluminum loading has been demonstrated in premature infants receiving intravenous fluid therapy.7 Although the clinical importance of this finding is unclear, it warrants careful attention. The association between aluminum excess and neurologic dysfunction, which has been reported in patients with chronic renal failure, suggests the possibility that aluminum overload may contribute to the pathogenesis of CNS damage in the sick premature infant.7,8
ALUMINUM EXPOSURE
Aluminum, which is the most abundant metal in the earth's crust, is ubiquitous in its distribution.7 There is constant exposure to this element through ingestion of water and food and exposure to dust particles.10 Because aluminum sulfate (alum) is used as a flocculating agent in the purification of municipal water supplies, drinking water may contain high levels of aluminum (up to 1,000 µg/L). Aluminum cans, containers, and cooking utensils, as well as aluminum-containing medications, are also potential sources of oral intake of aluminum. Increase in aluminum intake as a result of transfer through the skin is probably negligible; however, exposure is common due to use of aluminum in deodorants.10 Some inhaled aluminum is retained in pulmonary tissue and in the peribronchial lymph nodes, but it is largely excluded from other tissues. Pulmonary aluminum concentration increases with age; unlike aluminum levels in other tissues, the concentration in the lung does not correlate with that in other tissues.
Retinopathy of Prematurity and Iron: A Modification of the Oxygen Hypothesis
Authors: SULLIVAN JEROME L. 
Published: December 2021

To the Editor.—
Despite several decades of study, retinopathy of prematurity remains incompletely understood. The role of oxygen in the pathogenesis of retinopathy of prematurity has received much attention.1,2 I wish to suggest a modification of the hypothesis that retinopathy of prematurity is caused by oxidative damage to the developing retina. I propose that during the first few weeks of life the developing retina is abnormally susceptible to damage by oxygen because it is exposed to elevated concentrations of ionic iron capable of catalyzing the formation of toxic oxygen species.
Residents on the Phone
Authors: FOSARELLI PATRICIA , KATZ HARVEY 
Published: December 2021

To the Editor.—
Dr Wood has raised a number of valid points in her article, "Pediatric Resident Training in Telephone Management: A Survey of Training Programs in the United States" (Pediatrics 1986;77:822-825). Residents do manage many patient-initiated telephone calls in clinics and emergency rooms. The acquisition of diagnostic skills and efficiency in "telephone medicine" during residency is important not only for practice as a resident but also for the practicing pediatrician, in fee-for-service or prepaid (HMO) group practice.
Absent Hypoxic and Hypercapnic Arousal Responses in Children With Myelomeningocele and Apnea
Authors: WARD SALLY L. DAVIDSON , KEENS THOMAS G. 
Published: December 2021

In Reply.—
CNS anomalies associated with myelomeningocele and Arnold-Chiari malformation (Neurosurgery 1986;18:559-564) could account for the abnormal arousal responses we described (Pediatrics 1986;78:44-50). They may also explain the failure of posterior fossa decompression surgery to correct apnea in some patients with myelomeningocele. We were not able to study children before and after posterior fossa decompression surgery; nor did we examine postmortem specimens. Consequently, our paper does not determine whether the cause of abnormal arousal responses is due to mechanical compression or anatomical anomalies of the brainstem.
Passing Out—On Purpose
Authors: WALTERSPIEL JUAN N. 
Published: December 2021

To the Editor.—
I recently saw a teenager in Mobile, AL, perform a remarkable act. She bent over and forcefully inhaled and exhaled to the count of 20. This was followed by a rapid change to the erect position while placing both hands over her carotids. The combination of a respiratory alkalosis, orthostatic hypotension, and carotid sinus massage induces a state of altered consciousness.
Neonatal Intracranial Hemorrhage and Phenobarbital
Authors: KUBAN KARL C. K. , BROWN ELIZABETH , LEVITON ALAN , KRISHNAMOORTHY KALPATHY 
Published: December 2021

In Reply.—
We appreciate the comments by Dr Battisti et al. As noted in the inclusion criteria for our study,1 all intubated babies with birth weights less than 1,751 g were eligible for the study. One of the advantages of a randomized double-blind study is that babies with other risk factors, including presence of a fluctuating cerebral blood flow pattern on Doppler ultrasound testing, should have equal chances of being in the treated and placebo groups.
Computerized Ventilation
Authors: CARLO WALDEMAR A. , PACIFICO LUCIA , CHATBURN ROBERT L. , FANAROFF AVROY A. 
Published: December 2021

In Reply.—
We are delighted that Dr Anbar has had the opportunity to independently test the validity and effectiveness of our algorithm on assisted ventilation against simulation programs. It is reassuring that, as in our group of infants, the simulated arterial blood gas derangements responded well to the ventilatory management recommended by our "expert system." The excellent rate of correction of blood gas values in both studies (89% and 90%) suggests that this area of medical care suits itself to the application of algorithms.
FABIOLA, A FOURTH CENTURY ROMAN LADY, AND THE ORIGIN OF THE FIRST PUBLIC HOSPITAL
Authors: C. T. E. 
Published: December 2021

Public hospitals for Roman citizens were established in many Roman cities during the early Christian era; the first of which was established at Rome in the fourth century by a Christian lady named Fabiola, as follows.
The origin of public hospitals is remarkable, and not generally known. Ecclesiastical history informs us, that this, perhaps the grandest and most successful effort for alleviating human misery, arose from no common species of benevolence, but from the impulse of singular piety upon the sensibility of a female mind, softened by a series of domestic afflictions, and urged by the desire of atoning for imaginary guilt. In the fourth century, a Roman lady, of a noble birth, by name Fabiola, by religion a Christian, left by the death of her husband in sole possession of an affluent fortune, was the first who built an infirmary for the reception of the sick and houseless, where they were supplied with every comfort. Jerom[e] calls her the glory of the Christians, the wonder of the Gentiles! The account which he gives of her is this: Divorced from her first husband, who proved an abandoned libertine, during the life of the first she married a second husband, who was sincerely attached to her, and whom she survived. Among the melancholy reflections consequent upon his death, being led to conceive her second marriage criminal, she voluntarily underwent a solemn penance, assumed the plainest dress, defaced her beauty, submitted to the meanest drudgery, sold her estates, which were answerable to her noble birth, and converted them into money, for the relief of the poor, and was the first to build an infirmary, into which sick and distressed objects of every description were collected from the streets. Many who were afflicted with distempers, the most loathsome and offensive she attended in person, carried them in her arms, bathed their sores, moistened the lips of the dying with her own hands, and so tenderly assuaged their miseries, that many who were well envied the sick. Rome was a scene too confined for her charity; she visited, either in person or by her deputies, all the country round, and even crossed the sea in quest of new objects of compassion. At length she took a sudden and unexpected resolution of visiting Jerusalem; on which occasion she was entertained a short time by Jerom[e] in his retreat in Bethlehem. She returned to Rome, and devoted all her property and all her time to relieving the sick and the indigent till she died. Her funeral is said to have been attended by a more numerous concourse, and with a zeal infinitely more fervent, than the triumphs of Scipio or Pompey.
MODIFICATION OF THE TECHNIC OF TREATING ERYTHROBLASTOSIS FETALIS BY EXCHANGE TRANSFUSION
Authors: WIENER ALEXANDER S. , WEXLER IRVING B. 
Published: December 2021

A simplified method of treating erythroblastosis by exchange transfusion is described in which the patient is bled and simultaneously transfused with compatible packed red cells. A table is presented which gives the final hematocrit and percentage of inagglutinable red blood cells in the patient's body at the termination of the exchange transfusion, in relation to the patient's initial hematocrit and the amount of blood exchanged. An exchange transfusion with 100 to 150 cc. of packed cells appears to be adequate regardless of the severity of the anemia.
Statistical analysis of the result of 106 exchange transfusions shows a progressive drop in mortality rate from 23.7% in 38 cases treated with 500 cc. of whole citrated blood, to 14.6 cc. in 48 cases treated with 1,000 cc. of whole citrated blood, and to 10.0% in 20 cases treated with 120 cc. of packed cells. While the improvement may be accidental, there is no doubt that exchange transfusion with packed cells is a simpler procedure which avoids the introduction into the patient's body of large amounts of adult plasma, and potentially toxic doses of citrate and calcium. Two cases are described in detail which have unusual serologic and clinical features and illustrate the types of problems which may arise when treating erythroblastotic babies.
Round Table Discussion
Authors: BUFFUM WILLIAM P. , MUELLER HARRY L. , MANACE GORDON , MCBRIDE R. H. 
Published: December 2021

Chairman Buffum: The treatment of the patient with asthma is often a difficult and complicated problem. In this discussion we are concerning ourselves only with "hyposensitization," which is only a part and sometimes a very small part of the treatment.
Probably it is best to treat with all the inhalant allergens that are causing or seem likely to be causing symptoms. From the history and the tests it is decided which substances are important in a given case, and extracts of these allergens are injected regularly.
House dust is almost always given in perennial asthma. It seems to be the commonest trouble maker in the patients, and is usually used in treatment, unless the dust skin tests are negative and also something else is clearly indicated. Animal danders, for instance, are also used, when they seem to be a likely source of trouble, and when they cannot be completely avoided.
The pollens are used which by history and by skin test seem to be indicated. For instance, if a patient is worse in June and gives a positive skin test to grass pollen, grass pollen is given as part of the treatment. If, in addition he gives a good positive test to ragweed, and is not worse in September, ragweed should not be included in the treatment.
Molds undoubtedly play a part in some cases. Patients who have trouble in the summer may be sensitive to molds. Not uncommonly pollen patients whose treatment is not successful are found to be sensitive to molds also. Alternaria is much the most important of these, with hormodendron a poor second. There are several other molds which may be important in a given case. A patient who has trouble in the summer, and who has positive tests to one of these molds, should have that mold included in his treatment.
If the patient has had symptoms limited to the ragweed season, and if our treatment is started well before the season, our problem is relatively simple. We start treatment with a dilution of ragweed that we know by experience will be safe with this patient, and give injections once or twice a week increasing the size of the dose each time.