bluuebunny/crossref_metadata_2025_split huggingface dataset:
Learning Disabilities in Children
Authors: Wender Esther H. 
Published: December 2021

Of the many factors that may combine to produce school problems, learning disabilities constitute the most prevalent underlying cause. This article is devoted to a better understanding of this complex disorder. Following a brief discussion of diagnosis, etiology, and prevalence, the focus will be on controversies surrounding therapy arising from recent outcome studies and the attention given to dietary treatment. Objectives of this report include reviewing the evidence that suggests limitations of medication as the only treatment for this disorder, some of the possible harmful effects of medication, and the efficacy of diet as a mode of therapy. The discussion will also acquaint the clinician with major aims of therapy and suggest multiple approaches to treatment.
DEFINITION AND TERMINOLOGY
Learning disabilities can be broadly defined as a cluster of biologically based disturbances in development that significantly impair school performance. These developmental problems fall into two broad categories that differ in the kind of symptoms that predominate, the manner in which school performance is affected, the regions of the central nervous system most likely involved, and the types of therapy needed. The first category affects primarily the acquisition of specific academic skills (such as reading individual words, spelling, handwriting, and mathematic computation) information remains intact.
Cardiac Dysrhythmias in Children
Authors: Gillette Paul C. 
Published: December 2021

As our understanding of heart rate and rhythm disorders is changing, so too is the terminology. Hence, the words in the title of this article are "cardiac dysrhythmias" rather than "cardiac arrhythmias." The word "arrhythmia" means totally without rhythm. The only rhythm abnormality that fits this definition is fibrillation, either atrial or ventricular. The word "dysrhythmia," meaning an abnormal rhythm, conveys our meaning more precisely.
FREQUENCY
The number of pediatric patients with cardiac dysrhythmias is increasing, mainly because a common sequela of cardiac surgery is damage to the specific conduction system and working myocardium. Dysrhythmias also are being recognized more frequently in children who have no structural heart disease. This discovery is probably due to increased awareness on the part of pediatricians that certain cardiac dysrhythmias in otherwise normal children are important. We must not let this new awareness lead to overenthusiasm that might label a child with a benign dysrhythmia a "cardiac patient." A basic tenet in evaluating the pediatric patient with a dysrhythmia is that very few dysrhythmias in children with otherwise normal hearts are life-threatening, although some are persistent and even disabling. On the other hand, any rhythm abnormality in a child with an abnormal heart should be viewed with concern.
A Hard Look at Stimulating and Predicting Development: The Cases of Bonding and Screening
Authors: McCall Robert B. 
Published: December 2021

An axiom of medicine is to diagnose and treat a disease in its formative stages before it becomes so advanced that treatment is difficult or impossible. The same theme runs through aspects of neonatology and developmental pediatrics—organ systems and processes are laid down early in development and supportive or deleterious factors operating during these early stages can permanently influence or alter the course of development.
Belief in "formative Stages was applied to behavior by Sigmund Freud who emphasized the crucial contribution of early experiences to adult personality. A half century later, the same general principle was used to justify Head Start, an educational program that was supposed to equalize the social classes by providing an intellectual boost to disadvantaged children during their formative years.
The principle of "formative years" pervaded theory and practice in developmental psychology for decades, but there were always dissonant findings. For example, five decades of research shows quite clearly that test scores obtained within the first year or two of life do not predict later intelligence for normal children.1 Weight and especially skinfold thickness assessed during infancy do not predict later weight or obesity, and early social disadvantage and stress do not necessarily lead to later psychosocial dysfunction. Indeed, today the emphasis in some quarters of developmental psychology is on change, modifiability, and unpredictability in development rather than on consistency.2
Migraine in Children and Adolescents
Authors: Shinnar Shlomo , D'Souza Bernard 
Published: December 2021

Migraine is a genetic disease with wide clinical expression and is a fairly frequent cause of headache in children and adults. This poorly understood disorder is characterized by paroxysmal attacks of vasoconstriction and vasodilation. The vasoconstrictive phase is responsible for the aura and the neurologic deficits when present, whereas the vasodilatory phase is associated with the headache.
The headaches are classically unilateral and throbbing and are associated with nausea and vomiting. A prodromal phase is found in classic migraine. Attacks may occur as frequently as twice a week or as rarely as once a year. They are often precipitated by stress, fatigue, exertion, illness, or other trigger factors, with stress being the most common. Attacks may last from 30 minutes to a day and are often terminated by vomiting and then sleep. Attacks in children tend to be briefer than in adults and have more pronounced autonomic features. Establishing a proper diagnosis is important as specific, effective therapeutic modalities are now available for migraine. This review will summarize the different migraine syndromes and present an approach to the management of the child with migraine.
INCIDENCE AND EPIDEMIOLOGY
Migraine was once thought to be relatively rare in children, but it occurs in all age groups and is a common form of childhood headache.
The Multiple Forms of Neurofibromatosis
Authors: Riccardi Vincent M. 
Published: December 2021

Von Recklinghausen neurofibromatosis (NF)1 has multiple forms in several senses. First, there is the matter of heterogeneity: There is more than one disease designated by the term NF, for example "classical" NF as originally described by Von Recklinghausen2 and "acoustic" NF characterized by bilateral acoustic neunomas.3,4 Second, there is the matter of marked variability in the overall severity and progression of classical NF, the disorder to be considered in this review. NF can cause serious problems, and even death in the newborn period,5 or be associated with only a relatively mild or modest burden into the seventh decade and beyond. In almost all patients NF becomes obvious in the first year of life and some form of specific problems or compromise develops before age 20 years.
NF is a heritable disorder, with a frequency of 1 in 3,000.6 This means it affects at least 80,000 Americans, making it much more common than is ordinarily supposed. Indeed, it is more common than Huntington chorea, Duchenne muscular dystrophy, and Tay-Sachs disease combined.4 However, in spite of its commonness,6-10 a realistic appreciation of NF's importance for pediatrics, and for medical care and research in general, is only a recent development. This long overdue change in emphasis reflects a recognition that NF's pathogenesis has bearing on a number of issues in basic biology, including neural crest embryology and genetic influences on the origin of cancer,1 the establishment of several NF clinical research programs, and the activities of several NF patient self-help groups.
Diagnosis and Evaluation of Acute Paraplegia
Authors: Freeman John M. 
Published: December 2021

CASE REPORT
A 14-year-old high school student is admitted to the pediatric neurology service because of the sudden onset of inability to use her legs. When she had gotten up in the morning she was unable to stand.
INTRODUCTION
Acute neurologic deficit in an adolescent girl (or in anyone else) always represents an emergency requiring immediate evaluation by a physician competent to analyze the deficit, localize its source, develop a differential diagnosis of possible etiologies, organize appropriate tests, and, when indicated, initiate emergency treatment.
Acute paraplegia (weakness or paralysis in the legs) is a particular emergency because acute compressive lesions of the cord are reversible. Hours of compression may result in irreversible damage. For this reason neurologic and neurosurgical consultation should be obtained promptly.
EVALUATION
The evaluation of an individual with an acute paraplegia is best performed with a differential diagnosis in mind. The major cause of paraplegia is spinal cord disease, and its differential diagnosis is shown in Table 1. Spinal cord disease with paraparesis (weakness) may be simulated by lesions in the parasagittal area of the brain, by muscle weakness in the legs (muscular dystrophy or polymyositis), and by conversion reaction.
History
In evaluating the patient with an "acute" paraplegia one must establish how acute is acute. An immediate total loss of function is almost always vascular.
The Teenager with Failing Grades
Authors: Sahler Olle Jane Z. 
Published: December 2021

School failure during adolescence is rarely caused by occult physical impairment. Instead, cognitive disability or psychological disturbance are commonly seen. Through the unique clinical skills of history taking and physical examination, the physician can and must consider a broad range of possible causes of the teenager's failure.
The physician's recognition that such behavioral syndromes as school phobia, truancy, substance abuse, underachievement or boredom are possible sequelae of a misfit between the student and the classroom can be the most important element in stimulating the school to examine more closely an individual student's needs or abilities.
Actually, the physician rarely acts wholly independently in evaluating and remedying a student's school problems, even if the basic underlying disorder is physiologic disturbance. Rather, a cooperative approach that includes the student, the family, the school, and the physician is essential to providing special services and helping the student adjust to and follow remediation recommendations.
Congenital Hemolytic Anemia
Authors: Addiego Joseph E. , Hurst Deborah , Lubin Bertram H. 
Published: December 2021

Anemia due to premature destruction of RBCs is classified as hemolytic, and may be secondary to acquired or inherited (congenital) abnormalities in RBC membrane, hemoglobin, or metabolism. This article reviews the topic of congenital hemolytic anemias and points out a practical approach to diagnosis and therapy.
PATHOPHYSIOLOGY
The primary function of RBCs is to transport oxygen from the lungs to the tissues. The normal RBC circulates within the vascular system for about 120 days. Survival to its full life span depends upon effective metabolism of glucose to generate high-energy phosphates such as adenosine triphosphate (ATP) and to maintain adequate levels of reduced glutathione. ATP is essential for cellular deformability and for function of many RBC enzymes, whereas reduced glutathione protects the cell against damage from oxidants. The water and cation content of the cell is maintained by barriers to permeation, and by transport mechanisms located within the cell membrane. The integrity of the membrane is determined by a group of membrane proteins (skeletal proteins) and by the lipid bilayer surrounding the cell. Genetic or acquired defects of any of these components of the RBC may lead to cellular damage and result in hemolytic anemia.
CLINICAL FEATURES
Hemolytic anemia should be suspected in any child with anemia, jaundice, and splenomegaly.
Legg-Calvé-Perthes Disease
Authors: Bunnell William P. 
Published: December 2021

Perthes disease is a condition of unknown etiology in which the vascular supply of the developing femoral head is temporarily interrupted, causing necrosis and collapse of the bony femoral head, followed by spontaneous revascularization and healing of the necrotic bone. It was independently described by four different authors (Legg, Calvé, Perthes, and Waldenstrom) in 1909 and 1910. They identified the condition as an affliction of the hip distinct from trauma and infection. The term "coxa plana" was applied to the characteristic flattening of the femoral head seen in Perthes disease. It was not until 10 years later that the actual pathology of avascular necrotic bone was described.
EPIDEMIOLOGY
The condition has its onset in children ranging in age from 2 to 12 years, with the majority of patients presenting between the ages of 4 and 8 years. Boys are affected four times more frequently than girls, and the condition is bilateral in approximately 15% of affected children.
Certain constitutional factors are frequently found in children with Perthes disease. Skeletal age is delayed in nearly 90% of children affected with it. Affected boys have been found to be an average of 1 in shorter and affected girls 3 in shorter in height than their unaffected peers. Birth weight of affected children is frequently lower than average.
Recognition of Sexual Abuse in Children
Authors: Krugman Richard D. 
Published: December 2021

Although sexual abuse of children has likely been present for ages, its recognition in the United States and other countries has dramatically increased in the past 5 years. Reported cases, which represent an unknown fraction of actual cases, now account for approximately 25% of all abuse and neglect reports. Local, county, and state agencies are staggering under the load, and many are relying heavily on pediatricians to assist them in their work.
DEFINITION
Sexual abuse can be defined as the engaging of a child in sexual activites that the child does not understand, to which the child cannot give informed consent, or which violate the social taboos of society. This definition is broad and includes intrafamilial and extrafamilial forms and all types of sexual activities (eg, exhibitionism, fondling, child pornography, oral, anal, and genital sexual contact).
The interface between "normal sexual exploratory behavior" and "sexual abuse" is not clearly defined. Pediatricians should, however, use common sense. If two 4-year-old children are found to be playing without clothes, touching each others' genitals and giggling, there is probably little to worry about. The same is true if two 15-year-old adolescents are discovered together. A probably exists if the 15-year-old child (some states set statutory 2- to 4-year limits within which sexual activities are not to be considered abuse) or if one 4-year-old child is engaging in fellatio or attempting intercourse with another preschool-aged child.
Recognition of Sexual Abuse in Children
Authors: MILBURN WILLIAM H. 
Published: December 2021

The concept of child sexual abuse is so repulsive to most physicians and lay persons that to view the topic scientifically and nonjudgmentally is difficult. The article by Krugman in this issue is informative and should help the pediatrician in identifying cases he otherwise would have missed. The position taken by Krugman is relatively simple and safe. He recommends that the practitioner search for and report all cases of known or suspected child sexual abuse. If the pediatrician does this, he is protected by law. If he does not, he is risking legal penalties or a malpractice suit.
When dealing with a possible child rapist or sadist, no reasonable person would question Krugman's recommendations.
Can Child Health Promotion Be More Rewarding?
Authors: LAND MARSHALL L. 
Published: December 2021

In his article, "Behavioral and Developmental Components of Child Health Promotion: How Can It be Accomplished?" Dr Morris Green tries to sell us on the idea that we (as practicing pediatricians) can give more to our patients in child health supervision visits and that these, visits can be more rewarding to both families and physicians. I agree.
Many students and practicing pediatricians summarize a well-child visit with this presentation:
Billy Smith is a 9-month-old boy who is in for his regular check-up. He has a healthy past history, is growing normally, and his physical examination is normal. His hemoglobin is 12 g. His immunizations are up to date, and he should return in 3 months.
Counter that with Green's statement: "The chief justification for health promotion visits today relates to child development and behavior."
Genes, Syndromes, and Cancer
Authors: Miller Robert W. 
Published: December 2021

Children are not equally susceptible to cancer. Some are at high risk, as recognized clinically and epidemiologically. Laboratory studies of these children and their neoplasms have recently provided new understanding of human carcinogenesis, which would not have come from animal experimentation alone. Certain mechanisms are proving to be the same for a spectrum of cancers. Hence, from the study of rarities, generalizations are becoming apparent, and they have implications for medical practice.
Clinicians have played an important role in this regard, because their observations have led to the recognition of high-risk groups. Sometimes a single case report starts an avalanche of productive research, as when Bruton1 first described congenital X-linked a-γ-globulinemia in 1952.
When mechanisms are delineated, strategies can be developed for prevention, early diagnosis, and better treatment. The pediatrician in practice should know the characteristics that put children at high risk of cancer, so the parents can be advised of exposures to be avoided. This will enable the physician to adjust the frequency and nature of examinations to allow detection of neoplasia early when the prospect for cure is greatest.
LEUKEMIA
Disorders With Preesistent Chromosomal Aberrations
Down Syndrome. In 1953 to 1955, individuals with Down syndrome were first noted to have a high frequency of leukemia. The observation was simple: three or four cases were identified within a short time on pediatric wards in Paris, North Carolina, and Minnesota.
Dermatology Potpouri
Authors: Rasmussen James E. 
Published: December 2021

Pearly penile papules are common but not commonly seen in a physician's office. These multiple, white, coronal papules are rarely, if ever, the source of a disease but may cause the adolescent and young adult patient some surprise when they are first noticed. "Discovery" may occur after careful self-examination following suspected contact with venereal disease, sexual exposure, masturbation, or other situations that may be associated with anxiety. Frequently, the patient believes that the lesions originated "overnight"; this is never the case and usually represents inaccurate observation.
Lesions of pearly penile papules are characteristic in morphology and locale. They occur exclusively in postpubertal patients. Neinstein and Goldenring1 found pearly penile papules in 23 of 151 (15.2%) boys and men ranging from 11 to 22 years of age. Lesions were not noted in patients less than 14 years old or with a sexual maturity rating less than a Tanner 3. Glicksman and Freeman2 examined 229 men and found these lesions in 45 (20%). There does not appear to be any racial tendency, and whereas one series found a greater percentage in uncircumcised patients,2 a second could not substantiate this possibility.1 Although no surveys have been done in prepubertal patients, it is my clinical impression that these lesions do not occur in this age group.
Prognosis of Attention Deficit Disorder and Its Management in Adolescence
Authors: Klein Rachel Gittelman 
Published: December 2021

Historical Background
The disorder now called attention deficit disorder with hyperactivity (ADDH), which will soon be renamed attention deficit/hyperactivity disorder, was first delineated by behaviorally oriented pediatricians. Their clinical descriptions are strikingly up-to-date.1,2 Moreover, their early clinical observations of the effectiveness of psychostimulants such as dextroamphetamine and methylphenidate have been amply substantiated by extensive investigations.3
Probably the major shift in our understanding of the disorder has occurred with regard to its prognosis. The standard expectation was that the disorder was self-limited, becoming attenuated with time and eventually remitting completely. Understandably, the clinical management of such children was affected by the perception of its natural history. As a result, psychostimulants were not recommended during adolescence when they were believed to cease to be antihyperactivity drugs and to have the typical stimulating effects well known in adults. As a matter of fact, the stimulants were believed to be potentially dangerous drugs in adolescence because of the expectation that they would lead to euphoria, tolerance, and addiction, in those who had previously been quieted with the drugs. There is now considerable evidence indicating that ADDH is not a maturational disorder that bears a benign prognosis. However, like many observations of astute practitioners, the opinion that children with hyperactivity regularly outgrow theirdifficulties in adolescence was not altogether wrong. The condition is not static; a proportion of affected children do improve, some to the point of being free of significant behaviour problems, but many do not.
Partnerships in Pediatrics
Authors: Menna Vincent J. 
Published: December 2021

I believe that I am an expert in the field of partnerships having been a member of four since 1970, not including 2 years in the army working with four other pediatricians. Lest I be thought unstable and a vagabond, let me state that I have been a member of my most recent partnership for the past 10 years and have no intention of leaving. What appears as instability was actually a search for the utopian place to live and practice which, as we all know, does not exist. As the cliché"life is a compromise," and this has taken a while to learn.
When my army tour was half over, I looked for a place to practice.
Advances in Medical Genetics: Huntington Disease
Authors: Hecht Frederick 
Published: December 2021

Medical genetics is currently enjoying a time of exploration and discovery. Huntington disease has long been of interest in adult medicine. The onset of clinical signs and symptoms is usually delayed until midadulthood. It may seem strange in this context to focus on Huntington disease, but advances in molecular genetics have brought Huntington disease into the purview of pediatrics.
These advances in molecular genetics make it possible to detect Huntington disease in a preclinical stage at or even before birth. The molecular approach does not replace prior approaches to Huntington disease but is synergistic and provides a model of the new genetics.
Huntington disease is synonymous with Huntington chorea. It is named after George Huntington who, like his father and grandfather before him, studied the disease in families on Long Island, NY.
Huntington disease is a more common hereditary disorder than phenylketonuria, which occurs in one of about 10,000 newborns in the United States. By contrast, about one in 2,000 persons is at risk for Huntington disease.
Although most cases start clinically in midadulthood, usually between 35 and 42 years of age, there is great variability in age of onset. About 3% of cases are diagnosed as juvenile Huntington disease before the age of 15 years. Late onset is well known after 50 years of age.