bluuebunny/crossref_metadata_2025_split huggingface dataset:
Round Table Discussion
Authors: NAJJAR VICTOR A. , MCQUARRIE IRVINE , HOLT L. EMMETT , GARDNER LYTT I. , BAKWIN RUTH , NOONE ERNEST L. 
Published: December 2021

The administration of ACTH or 11-oxygenated steroids to animals results in: (a) increased blood sugar and liver glycogen concentrations, partially as a result of decreased glucose oxidation; (b) increased urinary N excretion; (c) increased total body fat, and (d) tendency toward Na retention and K deficit. In clinical studies these findings have been largely confirmed, using indirect technics. Children on long-term treatment with full doses of adrenal hormones present a special problem, since the foregoing metabolic abnormalities cause inhibition of somatic growth. Periodic clinical appraisal of these patients with careful longitudinal measurements, body weight and x-rays for bony maturation are suggested. The importance of a food intake adequate to offset a negative N balance is stressed, as well as the provision of added K to prevent chronic K deficiency.
Question: How soon after you start treatment does K deficiency develop? That is. if you are using cortisone.
Dr. Gardner: Compared with desoxycorticosterone, cortisone is a relatively weak K depleting agent, and the development of clinically measurable K deficiency on full doses of cortisone may take several weeks or even longer. This variability of K depleting effect may depend to a great extent upon the dietary intake of Na, since K deficit appears to develop much more readily in the presence of adequate or more than adequate Na intake.
Chairman Najjar: In bringing this discussion to an end, I would like to repeat some of the highlights presented here. We know now that some cases of hypoglycemia show absence of the alpha cells of the islet tissue of the pancreas. When pancreatic tissue is obtained under circumstances requiring surgical exploration, one must look for the alpha cells. These cells excrete a hormone, heretofore unsuspected, the hyperglycemic hormone. This is in the process of being produced commercially and should be available in the future. This hormone may well have the therapeutic potentialities for those cases, as insulin has for diabetic patients. Cases with glycogen disease may show severe and irreversible hypoglycemia. Some cases show abnormal glycogen and there is a good possibility that a defect in the enzyme system is responsible. Hormones play a significant role in carbohydrate metabolism and, when uncontrolled, may have a deleterious effect as witnessed by the development of Cushing's syndrome following ACTH therapy.
ACUTE BENIGN PERICARDITIS IN CHILDHOOD: COMPARISONS WITH RHEUMATIC PERICARDITIS, AND THERAPEUTIC EFFECTS OF ACTH AND CORTISONE
Authors: FRIEDMAN SIDNEY , ASH RACHEL , HARRIS T. N. , LEE HENRY F. 
Published: December 2021

Six cases of acute benign pericarditis in childhood have been studied.
The importance in childhood of the differentiation of acute benign pericarditis from acute rheumatic pericarditis has been emphasized and demonstrated by a comparison of the clinical findings and subsequent courses in patients with these two types of pericardial involvement.
The results of treatment of acute primary pericarditis with the hormones ACTH and cortisone are presented and discussed.
Some negative findings in the study of the etiology of this disease are presented.
STUDIES ON ABSORPTION AND DISTRIBUTION OF TERRAMYCIN IN CHILDREN
Authors: HUNT ANDREW D. , KELLEY RICHARD S. , CORIELL LEWIS L. , MURPHY M. LOIS , TASHMAN SYLVIA G. , STEVENS CAROLINE 
Published: December 2021

The absorption of terramycin from the gastrointestinal tract is rather similar to that of aureomycin. Peak levels are low, tend to be achieved in 2 to 6 hours after ingestion, and are prolonged for several hours.
Single oral doses of 11 mg/kg. body weight give peak serum levels ranging from 0.20 to 1.95 µg./cc., with a mean of 1.0 µg./cc.
Doubling or tripling this single dose did not produce marked increases in serum levels.
Dosage of 11 mg./kg. orally every six hours (44 mg./kg./24 hours) resulted in peak serum levels on the third day which were essentially identical with those after the initial dose. However, when a dosage of 33 mg./kg. was given orally every six hours (132 mg./kg./24 hours), marked cumulation in the serum was noted. The mean serum level on the first day on this schedule was 2.7 µg./cc., and on the third day, 8.0 µg./cc.
Diffusion into the cerebrospinal fluid in three cases was poor. With spinal fluid and serum levels simultaneously obtained, the spinal fluid levels were ¼, ⅙ and ⅛, respectively of the serum levels.
Intravenously administered terramycin in dosage of 6.6 mg./kg. gave peak serum levels at one-half hour, ranging from 10.0 to 12.8 µg./cc. Six hours after injection, serum levels ranged from 1.8 to 4.4 µg./cc., and at 12 hours, from 0.78 to 2.6 µg./cc.
Terramycin given rectally in perforated capsules was well tolerated. However, in four patients given 66 mg./kg. by this route, peak serum levels ranged from 0 to 1.0 µg./cc.
Recommended terramycin dosage: (a) Oral: 11 mg./kg./dose every six hours (44 mg./kg./24 hours). Adequate antibacterial serum levels for most susceptible organisms are produced with this dosage.
Increasing the dosage to 33 mg./kg./dose every six hours (132 mg./kg./24 hours) may be done in cases when high serum levels seem indicated. (b) Intravenous: 6.6 to 11 mg./kg./dose every 6 to 8 hours.
AGAMMAGLOBULINEMIA
Authors: BRUTON OGDEN C. 
Published: December 2021

A hitherto unrecognized entity manifested by complete absence of gamma globulin with otherwise normal serum proteins and recurrent pneumococcal sepsis is described in an 8 year old male. The patient appears to be normal in other respects and after extensive study no structural or functional change could be demonstrated in any body system although gamma globulin by electrophoretic analysis of his serum was consistently absent. He was unable to produce antibody for the pneumococcus with the four antigenic substances used; a positive Schick test persisted in spite of numerous attempts to reverse it with diphtheria toxoid. No antibody could be demonstrated following administration of typhoid vaccine in the usual manner and his serum was negative for complement-fixing antibodies of epidemic parotitis after he experienced a typical clinical picture of that disease.
Gamma globulin could be demonstrated in his serum after concentrated immune human serum globulin was administered subcutaneously, and its gradual disappearance could be followed by electrophoretic analysis over a period of approximately six weeks. Concurrently, and following the administration of human globulin (3.2 gm. gamma globulin) at monthly intervals, he has been free of pneumococcal sepsis for more than a year, whereas he had experienced clinical sepsis at least 19 times in the previous four years in which eight different types of pneumococci had been recovered from blood culture during 10 different episodes.
It is postulated that by some acquired "influence" the patient's antibody mechanism has been altered so that he is no longer able to synthesize and/or hold antibody to a specific organism. A complete defect of plasma proteins cannot be excluded.
Lichen Striatus: Simultaneous Occurrence in Siblings
Authors: KANEGAYE JOHN T. , FRIEDEN ILONA J. 
Published: December 2021

Lichen striatus is a benign, self-limited linear dermatosis of unknown etiology seen primarily in children. We report here the unusual simultaneous occurrence of this condition in siblings, a manifestation which may offer insight into the pathogenesis of this condition.
CASE REPORTS
Patient 1
A 2-year-old Japanese girl had a nonpruritic 0.5 x 5 cm hypopigmented band located on the right wrist and forearm, which had been present for several weeks. The past medical history was unremarkable, but family history was notable for atopic disease: asthma in a cousin and allergic rhinitis in her mother. A clinical diagnosis of lichen striatus was made, and the patient was observed without treatment.
ECMO for Infection
Authors: HOCKER JAMES R. , SIMPSON PIPPA M. , RABALAIS GeRARD P. , STEWART DAN L. , COOK LARRY N. 
Published: December 2021

In Reply.—
Dr Fisher criticizes the manner in which we have grouped our patients to compare survival between patients treated with ECMO and conventional therapy. We feel we have adequately addressed this criticism in our reply to Dr LeBlanc.1 Regarding the degree of illness of patients referred from other centers during the ECMO era, 75% required mechanical ventilation and 83% of ventilated neonates were hypotensive. This is compared to 57% and 38%, respectively, during the pre-ECMO era when very few patients were referred to our center from outside our region.
Decreased Thymus Size on Chest Radiography: A Sign of Pediatric Human Immunodeficiency Virus Infection?
Authors: MEYERS ALAN , PEPE NICHOLAS , CRANLEY WILLIAM , MCCARTEN KATHLEEN 
Published: December 2021

The early diagnosis of infection with the human immunodeficiency virus (HIV) in infancy is clinically important but remains problematic in the asymptomatic child born to an HIV-infected mother. In addition, many such women are unaware of their HIV infection until their child manifests symptomatic HIV disease. Nonspecific signs of pediatric HIV infection, such as generalized lymphadenopathy, hepatosplenomegaly, or persistent thrush, may be important in alerting the clinician to consider the possibility of HIV infection in the child whose history of HIV risk is unknown. We report one such sign which may be evident on plain chest radiography.
The pathology of the thymus gland in pediatric acquired immunodeficiency syndrome has been described by Joshi and colleagues,1-3 who have reported precocious involution with marked reduction in thymus size and weight.
Managed Care
Authors: SAPIN SAMUEL O. 
Published: December 2021

To the Editor.—
The recent report in Pediatrics1 of a random survey of American Academy of Pediatrics Fellows, titled "Barriers to Pediatric Referral in Managed Care Systems" paints a picture of managed care with brushstrokes which are much too broad. Managed care is an extremely heterogeneous entity and the authors of the report do not emphasize sufficiently the fact that pediatricians in certain types of managed care systems practice with no barriers to appropriate referrals for subspecialty or inpatient care.
Managed Care
Authors: LAWS HARRY F. 
Published: December 2021

To the Editor.—
The publication of an article in the February 1992 issue of Pediatrics by Cartland and Yudkowski1 gravely concerns me, because it seems to reflect a conclusion unsubstantiated by factual information. I am referring specifically to the implication that the managed care system limits necessary access to pediatrics subspecialty and inpatient care. The authors present data that support a limitation of access within a managed care system, but their anecdotal stories fail to convince me that all these referrals were "necessary."
Managed Care
Authors: CARTLAND JENIFER D. C. , YUDKOWSKY BETH K. 
Published: December 2021

In Reply.—
Dr Robbins' criticism of our paper1 essentially makes two points. First, Dr Robbins criticizes the evaluation of physicians' perceptions of managed care systems because, he feels, these perceptions are largely self-serving. (We presume that Dr Robbins does not criticize the whole field of survey research.) Second, Dr Robbins is concerned that the reported perceptions are not validated by patient-level analysis.
As mentioned repeatedly in the paper, the survey was designed to measure perceptions. Whether these perceptions are self-serving cannot be determined by the research tools that we used, or by any others that we know of.
Serum Enzyme Monitoring in Asthma Patients
Authors: PRESS SHIRLEY , LIPKIND REINA S. 
Published: December 2021

To the Editor.—
We read with interest the article by Maguire et al entitled "Cardiotoxicity During Treatment of Severe Childhood Asthma."1 Many of the symptoms that these asthmatic patients exhibited are similar to the manifestation of acute myocarditis, ie, tachycardia, elevated CPK-MB levels, electrocardiogram abnormalities, in addition to their severe respiratory distress. In our study of seven children with acute myocarditis, two of them had an initial diagnosis of status asthmaticus.2 Do the authors feel that it is possible that some of the children in their study may in retrospect have had myocarditis that responded to the treatment of severe status asthmaticus?
Abraham Jacobi Award Address, April 14, 1992 The Medical Home: Pediatric Practice and Child Advocacy in the 1990s
Authors: Sia Calvin C. J. 
Published: December 2021

It is with the deepest humility that I accept the Abraham Jacobi Award from the American Medical Association (AMA) and the American Academy of Pediatrics. Dr Jacobi represented the best in pediatrics, a practitioner in New York in 1853, Professor of Diseases of Children at New York Medical College in 1859, Chairman of the AMA Section Council on Pediatrics, founder and president of the American Pediatrics Society, and president of the American Medical Association. He was perhaps best known as a child advocate. Dr Jacobi believed that physicians should take an active interest in public policy. At an early age he was, and remained throughout his life, what would now be termed a "troublemaker." He actively pursued legislation for women and children in Albany, the state capitol, and in Washington, DC. Throughout his long and productive life, he felt comfortable only when championing a good cause.1-4 It is truly an honor to receive an award bearing his name.
Before I begin my address, I would like to pay personal tribute to my dear wife Kathie, who has stood by me for 40 years throughout my shortcomings as a husband and father, as I pursued my interest in organized medicine as a child advocate. She has suffered through long waits for late dinners because of my practice or meetings, the yardwork that was never done because of office or hospital emergencies, and cared for our family alone while I attended meetings on the mainland. I would also like to honor my mentor, the late Dr Irvine McQuarrie, who "fathered" me during my first year of pediatrics residency in Hawaii.
Neonatal Genital Prolapse
Authors: BAYATPOUR MAHIN , PHELPS HOPE , MCCANN JOHN , HARRIS TONI 
Published: December 2021

Neonatal vaginouterine prolapse is a rare condition. The problem usually occurs at birth or during the first few days of life. A high percentage of the reported cases have been associated with congenital spinal defects, occult or otherwise. The treatment has been primarily surgical or through the use of a pessary.
In this report we present a case of a newborn who was treated conservatively with a simple digital reduction procedure. Follow-up at six and twelve months showed no evidence of a recurrence.
Although previously reported in the obstetric, gynecologic, and surgical literature, no cases of neonatal vaginouterine prolapse have appeared in the general pediatric literature.
Meconium and Tracheal Aspiration
Authors: DENK LARRY 
Published: December 2021

To the Editor.—
I thank Drs Wiswell and Henley for their article on meconium aspiration sydnrome (MAS).1 They have provided helpful data on a subject that requires further elucidation. I think they could have emphasized further the benefits of suctioning by pointing out the following statistics derived from their study: 12 (9.0%) of 133 newborns not suctioned developed MAS, whereas only 24 (3.9%) of the 608 newborns who were suctioned developed MAS.
My training and subsequent practice have been to intubate and suction all newborns with thick meconium, and all newborns with any type of meconium who have not yet cried.
Meconium and Tracheal Aspiration
Authors: REYNOLDS DAVID W. 
Published: December 2021

To the Editor.—
Based on a retrospective analysis of neonates born at Walter Reed Army Medical Center from 1985 through 1989 with meconium-stained amniotic fluid (MSAF), Drs Wiswell and Henley conclude that all such newborns should have their tracheas suctioned immediately after birth.1 This study was undertaken primanly to address the recommendation of Cunningham et al that intratracheal aspiration be reserved for babies requiring positive pressure resuscitation.2
Although Wiswell and Henley found a significantly higher incidence of meconium aspiration syndrome (MAS) in all nonsuctioned neonates (12/133) compared with all suctioned neonates (24/608), this was clearly not true for babies with thin meconium.
Does Denver II Produce Meaningful Results?
Authors: JOHNSON KATHERINE L. , ASHFORD LINDA G. , BYRNE KAREN E. , GLASCOE FRANCES PAGE 
Published: December 2021

To the Editor.—
We commend Frankenburg et al for their efforts to revise the Denver Developmental Screening Test.1 The authors have wisely incorporated suggestions from many researchers who conducted validity studies on older versions of the measure.2-5 As a consequence, the Denver II appears to be substantially improved, particularly in its measurement of language. This is quite important because the more prevalent developmental disabilities share language deficits as a common characteristic.
Yet despite its manny improvements, the Dennver II is clearly unnfinished adn unready for marketing.
Does Denver II Produce Meaningful Results?
Authors: FRANKENBURG WILLIAM K. 
Published: December 2021

In Reply.—
We are grateful to Johnson et al for raising the issue of validity of the Denver II. It has offered us an opportunity to clarify the purpose and use of the Denver II. One must consider two kinds of validity. The first type of validity is the degree to which an instrument measures that which it purports to measure. As the authors have stated, the Denver II presents norms of development of specific skills just as growth curves present growth norms.1
Caveats on Abdominal Central Venous Pressure Measurement
Authors: TONG TIMOTHY K. 
Published: December 2021

To the Editor.—
I applaud the important study done by Lloyd et al on the "Accuracy of Central Venous Pressure Measurement From the Abdominal Inferior Vena Cava"1 Those of us who help take care of critically ill children know too well the risks and technical difficulties of establishing internal jugular and central venous lines in children.
The authors report that the intra-abdominal venous pressure closely reflects that of the intrathoracic venous pressure. They offer the caveat that this may not be accurate in patients with an obstruction to the inferior vena cava by a thrombus or extrinsically by a tumor.
INTRODUCTION
Authors: HAGGERTY ROBERT J. 
Published: December 2021

The William T. Grant Foundation supports eight consortia, each devoted to a specific issue, and each consisting of ten to twenty members from a Variety of scientific disciplines. Our purpose is to provide a forum for discussion of ideas, research, and conceptual and theoretical bases of that research to individuals who work in related areas, but who might not under other circumstances have easy communication with each other, especially in the preliminary stages of the development of their research projects. By the time national meetings occur, projects are of necessity completed, and there is no chance for modification using an interdisciplinary approach.
We have been very pleased with this device to bring research workers of different disciplines together. The newest of these consortia is devoted to the Developmental Psychobiology of Stress and includes pediatricians, psychologists, and anthropologists who work on both human and animal models. This group moved promptly in their first meeting to bring together a talented group of researchers from different disciplines; the results of their research are presented in this supplement. They well exemplify the advances that have been made in recent years in methodology to study mind-body interactions in infants and older children. Methodologic barriers in the past have limited research on stress in humans. It is stimulating and exciting to see that these barriers are beginning to be overcome, and that research such as is presented here is illuminating this exciting new field. It has enormous application to pediatric practice and child health in the future.
Acute Pancreatitis in a 12-Year-Old Girl After an Erythromycin Overdose
Authors: BERGER THOMAS M. , COOK WALTER J. , O'MARCAIGH AENGUS S. , ZIMMERMAN DONALD 
Published: December 2021

A variety of drugs including certain antibiotics have been implicated in causing acute pancreatitis.1 So far, there have been three reported cases in adults in which erythromycin was identified as a possible cause of acute pancreatitis.2-4 We report the first case of erythromycin-induced acute pancreatitis in childhood. We suggest a possible pathophysiological mechanism based on the known motilin agonist properties of erythromycin.
CASE REPORT
A 12-year-old girl was brought to the Emergency and Trauma Unit, with acute, crampy abdominal pain and vomiting. These symptoms had started 1 hour earlier, approximately 30 minutes after the deliberate ingestion of 20 tablets of erythromycin (Erythromycin Base Filmtab, 250 mg, Abbot Laboratories, Pharmaceutical Products Division, North Chicago, IL) after an argument with her parents and her boyfriend.
`Guidelines' Versus the Legal Standard of Care and Screening for Polycythemia
Authors: REYNOLDS DAVID 
Published: December 2021

To the Editor.—
Belated thanks to the Academy for acknowledging the fact that almost nothing in medicine is certain. Beginning in June 1991, all committee reports are accompanied by a paragraph recognizing that alternative management strategies may be appropriate and that the opinions expressed do not constitute standards of medical care.
The first part of this qualification accepts the fact that each clinical encounter is unique. Decision making based on an attitude of patient uniformity demeans the human nature of the patient and his or her family as well as the physician.
Bereavement
Authors: PANOSH WANDA K. 
Published: December 2021

To the Editor.—
I applaud the Academy's insightful report on "The Pediatrician and Childhood Bereavement."1 Despite training culminating in board certification in Pediatrics and Internal Medicine, I received no effective formal guidance in the area of grief and bereavement. Only since the sudden death of my 7-year-old son and the painful readjustment my family has been forced to undergo since, has it been obvious how deficient we physicians are in this area of caring. Thus I would like to add the following comments:
European Surfactant Trial: Questions About the Protocol
Authors: SPEER CHRISTIAN P. , GEFELLER OLAF 
Published: December 2021

In Reply.—
We appreciate Dr Deichsel's interest in the Randomized European Multicenter Trial of Surfactant Replacement Therapy1 and welcome the opportunity to clarify the points raised in his letter. Although we agree with Dr Deichsel that protocol violations are a pervasive problem in any clinical trial, we feel puzzled by his line of reasoning. Why does he argue that "a remark on the loopholes which inevitably occur during the conduct of a trial with intensive care patients" is missing? The correct observations that 35% of the patients in the multiple-dose group required only one surfactant dose and the 25th percentile of the distribution o the total time of exposure to oxygen in the same group is as high as 26 hours leads him to the strange conclusion that only protocol violations in our trial could explain this discrepancy.
Sleeping Position and Sudden Infant Death
Authors: BARNESS LEWIS A. , GILBERT-BARNESS ENID 
Published: December 2021

To the Editor.—
The recognition by the Academy1 that altering the recommendation for the sleeping position of infants may lower the incidence of sudden infant death may help decrease the diagnosis of sudden infant death syndrome as one of us (E. G.-B.) reported in 19892 and as Professor John Emery reported in 1968.3 In addition, recognition of other possible causes of sudden infant death,4 eg, beds and bedding, overlying, metabolic diseases, child abuse, and felicide will further help to limit the diagnosis of Sudden Infant Death Syndrome, essentially a diagnosis of unknown cause made by exclusion.