bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Follow-Up of 58 Patients with Histidinemia Treated With a Histidine-Restricted Diet: No Effect of Therapy
Authors: Widhaim Kurt , Virmani Kiran 
Published: December 2021

Objective. There is no general agreement as to whether or not patients with histidinemia should be treated with a histidine-restricted diet because the majority of the patients are asymptomatic. Between April 1969 and December 1986 124 children with histidinemia were detected in the Austrian Neonates Screening Program and they received long-term follow-up.
Design. Fifty nine patients were treated with a histidine-restricted diet (35 mg/kg). The follow-up included determining biochemical parameters, physical examination and psychological assessment of 58 treated and 43 untreated patients. After termination of the Screening Program information about the patients' development was obtained through questionnaires and follow-up of 20 patients aged 11 to 17 years.
Results. Histidine blood levels decreased after institution of the diet, but rose again after termination of the diet. In the untreated patients histidine levels were highest at 1 year of age, decreasing with age. When the IQ scores of the treated and the untreated group were compared, significantly higher IQ scores were found in the 4-year-old and 6-year-old untreated patients (P &lt; .05). Clinical symptoms were found in 27 patients; treated and untreated patients were equally affected. The clinical observations included speech defects, psychomotor and general retardation, emotional disturbances, recurrent respiratory infections, and miscellaneous symptoms such as atopic dermatitis.
Conclusion. We conclude that patients with histidinemia do not benefit from dietary treatment.
Perseverance Pays Off: Health Care Providers' Impact on HIV Testing Decisions by Adolescent Females
Authors: Goodman Elizabeth , Tipton Ann C. , Hecht Liza , Chesney Margaret A. 
Published: December 2021

Background and objective. Although HIV counseling and testing of adolescents has increased rapidly in recent years due to increasing HIV seroprevalence rates, little is known about adolescents' use of HIV testing services. The aims of this study were to determine what proportion of high risk adolescent girls would use confidential HIV testing services linked to primary care and to explore the characteristics, beliefs, and experiences that distinguish those teenage girls who obtain HIV testing in this setting from those who do not.
Design. Prospective cohort study.
Setting. General pediatrics clinic with adolescent-specific appointments at a large urban HMO.
Participants. Convenience sample of 124 adolescent girls engaging in risky behaviors identified by chart review before regularly scheduled clinic appointments.
Intervention. Subjects completed a self-report questionnaire assessing HIV-related knowledge, attitudes, beliefs, and behaviors before the medical visit. During their provider visit, teens were counseled about their risk behaviors and the availability of HIV testing services at the clinic. Subjects were also given the opportunity to view an educational video about HIV testing designed for adolescents.
Main outcome measures. Use of HIV counseling and testing services at the clinic and HIV test results.
Results. Forty-one percent of these adolescent girls obtained HIV testing at the clinic on the day of their scheduled appointment. Univariate analysis revealed that adolescents who obtained testing had initiated sexual intercourse at a younger age (mean age 13.8 vs 14.4 years, P = .02) and were more likely to have had a prior discussion about HIV testing with a health care provider [RR = 2.02, 95% CIs (1.22, 3.36)]. Those who did not view the video were less likely to test [RR = 0.20, 95% CIs (0.07, 0.58)]. Multiple logistic regression modeling revealed that a prior discussion with a health care provider was the only independent predictor of obtaining an HIV test [OR = 3.47 95% CIs (1.26, 9.52)].
Conclusions. A significant proportion of adolescent girls engaging in risky behaviors will use confidential HIV counseling and testing services that are linked to primary care. Health care providers play an important role in helping teens address their risk for and concerns about HIV infection by engaging adolescents in repeated discussions about HIV testing.
False Positive EBNA IgM and IgG Antibody Tests for Infectious Mononucleosis in Children
Authors: Levine Dorothy , Klenk Rosemary , Morelli Alan , Hofreuter Nancy , Tilton Richard C. , Parry Michael F. 
Published: December 2021

Objectives. To assess the reliability of the Monolert test, a new enzyme-linked immunosorbent assay for the diagnosis of acute infectious mononucleosis (IM).
Design. A retrospective laboratory and clinical analysis of 38 children diagnosed with acute IM.
Setting. A suburban pediatric practice in Connecticut.
Patients. Thirty-eight children (ages 18 months to 17 years) who were diagnosed with acute IM using the Monolert test during the period October 1992 to August 1993.
Results. Eighty-three percent of these children had no evidence of Epstein-Barr virus infection on subsequent investigation. The false positive results of the Monolert test could not be explained on the basis of elevated antibody titers to either cytomegalovirus or Borrelia burgdorferi.
Conclusion. Monolert is a poor screening test and is of little apparent value as a diagnostic test for acute Epstein-Barr virus infection in pediatric patients.
Evaluation of an Hygienic Intervention in Child Day-Care Centers
Authors: Kotch Jonathan B. , Faircloth Ann H. , Weigle Kristen A. , Weber David J. , Clifford Richard M. , Harms Thelma O. , Rolandelli Pamela S. , Loda Frank A. , Gallagher Philip N. , Edwards Robert W. , LaBorde Danielle , McMurray Marsha P. 
Published: December 2021

The growing use of child day-care centers (CDCCs) has produced a significant rise in morbidity due to infectious diseases which carry such consequences as discomfort, disability, and parental anxiety.1,2 Haskins conservatively estimated the cost of day-care illnesses among children to be $1.8 billion.3 To this must be added the cost of parents' and care givers' excess illness attributable to CDCCs.
No published study describes a successful intervention to reduce the risk of upper respiratory disease in CDCCs. Although many research groups have advocated hand washing and diapering hygiene as a means of reducing the spread of enteric disease in CDCCs,4-11 there are only two controlled studies in the literature. In their pioneering work, Black et al showed the incidence of diarrhea in CDCCs following a rigorously monitored hand-washing program to be nearly twice that in intervention centers.12 Bartlett et al monitored the impact of hand washing in randomly assigned CDCCs and found no intervention effect. However, rates of diarrhea were significantly lower among children in the actively monitored centers regardless of intervention status.13
These studies share several limitations: the sources of incidence data were not blinded to center intervention status, the analyses did not statistically control for potential confounders, and non-independence of multiple diarrhea episodes in the same child were not accounted for. The purposes of our study were to develop a feasible, multicomponent hygienic intervention and to carefully measure its impact while controlling for sources of bias.
Use of trade names is for identification only and does not constitute endorsement by the Public Health Service, the Centers for Disease Control and Prevention, or any of the other co-sponsors of this conference.
Dural Sinus Thrombosis Complicating Subclavian Vein Catheterization: Treatment With Local Thrombolysis
Authors: Gebara Bassam M. , Goetting Mark G. , Wang Ay-Ming 
Published: December 2021

Local venous thrombosis is a known complication of subclavian vein catheterization.1,2 The clot can extend to the noncatheterized ipsilateral internal jugular vein.3,4 It is usually asymptomatic, however, signs of venous congestion can occur. Dural sinus thrombosis has been reported in association with retrograd catheterization of the internal jugular vein,5 but not the subclavian vein. We report a case of symptomatic right sigmoid sinus, transverse sinus, and bilateral internal jugular vein thrombosis without subclavian vein thrombosis in an infant few hours after placement of right subclavian vein catheter.
CASE REPORT
A 9-week-old girl was seen in the emergency room for lethargy, cyanosis, and apnea.
Medical Research: A Prescriptive View
Authors: Kramer Michael S. 
Published: December 2021

Why should we do research? The word "should" here indicates that I am being prescriptive, rather than descriptive. (To be perfectly honest, these views do not even accurately describe my own research; I wish I had done a better job of following my own prescription.). If you are willing to play a collective Dante to my Virgil let me lead you up the five levels of the Mount Purgatory of Medical research, each representing a goal or reason for doing research (Fig 1).
The lowest goal for the medical researcher is Level 1, improving one's curriculum vitae. Unfortunately, all too many academics appear to be caught in pisitions where they are expected to do research in which they have no interest and which is highly unlikely to lead to one of the higher levels, and where the sole aim is to improve their CVs in preparation for promotion or tenure review. In my view, people who are doing research because they have to should be doing something else. Nor should academic departments expect all department members to be researchers, but that is a topic for another day.
Next on our upward journey is Level 2, where the goal is to derive personal satisfaction. Although it is obviously easier to recruit potential clinicians and others to a demanding activity like research when that activity is personally satisfying, Level 2 is an insufficient goal on its own to justify the time, effort, and money involved. Besides, researchers who reach one of the higher levels can gain additional satisfaction above and beyond that gained by doing the research itself.
Continuous Versus Multiple Rapid Infusions of Indomethacin: Effects on Cerebral Blood Flow Velocity
Authors: Hammerman Cathy , Glaser Joram , Schimmel Michael S. , Ferber Benjamin , Kaplan Michael , Eidelman Arthur I. 
Published: December 2021

Objective. Therapeutic administration of indomethacin for patent ductus arteriosus (PDA) closure has been documented to decrease cerebral blood flow velocity which may be harmful to the vulnerable premature neonate. We have therefore compared the effects of administering indomethacin by rapid injection versus slow, continuous indomethacin infusion at the same total therapeutic dose on middle cerebral artery (MCA) systolic and diastolic flow velocity, resistance index, and cerebral blood flow (as reflected by the integrated area under the curve).
Methods. Premature neonates (&lt;1750 g) documented echocardiographically to have a PDA were randomized to receive indomethacin either by three rapid injection doses or by continuous intravenous infusion over the ensuing 36 hours, providing an equivalent total dose. Echocardiograms and transcranial color flow mapping of the MCA flow velocity were measured at baseline and serially following initiation of therapy in both groups. Effects on cerebral blood flow velocity are presented.
Results. Eighteen infants [rapid injection-1.2 ± 0.3 kg (n = 9) and continuous-1.1 ± 0.2 kg (n = 9)] were studied. In the rapid injection treated infants decreased flow velocity in the MCA as manifested by abrupt, significant decreases in systolic (to 70 ± 8% baseline) and diastolic (to 65 ± 13% baseline) flow velocity and area under the curve (to 60 ± 10% of baseline) were evident by 4 minutes and progressed to 30 minutes after treatment initiation. These changes were not observed in the group treated with continuous indomethacin. Both therapeutic modalities were equally successful in closing the ductus, although the numbers are too small to definitively determine therapeutic efficacy.
Conclusions. Slow, continuous infusion eliminated the decrease in cerebral flow velocity and appears to be effective in closing the PDA.
TIPP—The First Ten Years
Authors: Bass Joel L. 
Published: December 2021

In April 1983 the American Academy of Pediatrics (AAP) officially launched the first major nationwide drive by a national medical association to prevent injuries: TIPP (The Injury Prevention Program). TIPP was introduced officially at the spring meeting of the AAP in Philadelphia by Surgeon General C. Everett Koop, who stated that "Accidents, poisonings, and injuries have emerged as one of the greatest threats to our children's health."1
TIPP had its origin in three state projects funded by the Title V—Maternal and Child Health Program in California, Massachusetts, and Virginia. Each one of these state programs had developed injury prevention strategies for practitioners.
The Pediatrician's Role in Helping Children and Families Deal with Separation and Divorce
Authors: Yablin Bernard A. 
Published: December 2021

The Psychosocial Committee is to be commended for its report on the pediatrician and divorce in the July issue of Pediatrics.
I would like to add the following:
The role of the pediatrician should extend well beyond the divorce and immediate adjustment process.
Firstly, there should be greater involvement between both the pediatrician and the Family Court system to help prevent misplacement of the child in custody decisions. (I believe that various groups within the American Academy of Pediatrics are already working with judicial/legal groups to bring to them a greater knowledge of child development and mental health).
Letters to the Editor
Authors: Stein Martin T. 
Published: December 2021

The American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health appreciates Dr Yablin's comments on our recent statement, The Pediatrician's Role in Helping Children and Families Deal with Separation and Divorce (Pediatrics 1994;94:119-121).
He is correct when he points out that pediatricians have a potentially beneficial role during the child custody decision process. Too often these crucial decisions for the children and family are guided by lawyers without input from professional child advocates—either pediatricians, psychologists, or psychiatrists.
Medical "Experts" for Hire!
Authors: Schrager Gloria O. 
Published: December 2021

Recent experiences as a medical expert in malpractice cases have made me increasingly disheartened by the damage done to innocent colleagues by members of our own profession. We tend to inveigh against malpractice lawyers as our adversaries, but they could accomplish very little without the full cooperation and enthusiastic support of medical consultants. The following case illustrates several abuses that I believe are important to bring to the attention of the medical community.
A full-term female neonate was born by normal spontaneous delivery after an uncomplicated pregnancy.
TEXTBOOK COMPLIANCE COMMISSION
Authors: L. J. F. 
Published: December 2021

In 1988 education author Harriet Tyson wrote A Conspiracy of Good Intentions: America's Textbook Fiasco. It tells a chilling tale. "California," says Tyson, "has a special [textbook] ‘compliance commission’ that checks for compliance with all the social issues that are being pursued by special interest groups including feminists, a black power advocate, environmentalists, family values advocates and the like. The compliance commission counted how many female lead characters there are in the textbook, how many blacks and Chicanos appear in pictures, and so on."
If the head counts didn't come out to their liking, the textbook either had to be rewritten or it would be rejected.
Carbohydrate Absorption From Fruit Juice in Young Children
Authors: Smith Melanie M. , Davis Michael , Chasalow Fred I. , Lifshitz Fima 
Published: December 2021

Objective. To compare carbohydrate absorption following ingestion of apple juice and white grape juice in 28 healthy children.
Design. Randomized, double-blind crossover study.
Setting. Outpatient pediatric clinic at Maimonides Medical Center.
Participants. A total of 18 healthy infants (mean age 6.3 months) and 10 toddlers (mean age 18.0 months), representing those ages when juice is first introduced (6 months) and when juice comprises a large portion of the diet (18 months).
Methods. Breath hydrogen (H2) testing was performed after age-specific servings of white grape juice or apple juice, 4 and 8 ounces respectively, were consumed. These portions provided approximately 1 g of fructose per kg of body weight. Breath H2 responses of &gt;20 ppm were considered positive, indicating incomplete absorption of fruit juice carbohydrates.
Results. In the combined age groups, carbohydrate malabsorption occurred more frequently after apple juice consumption (54%) than after white grape juice (19%; P &lt; .001). Significant differences in area under the breath H2 curve (AUC) were also found between the two juices in both age groups. Among toddlers, the differences between the mean peak breath H2 responses were significant (48 ppm after apple juice consumption compared with 12 ppm after white grape juice; P &lt; .001). These differences were not significant in the infant group. Significant differences (P &lt; .05) were seen between the two age groups after consumption of apple juice; the toddlers exhibited a greater number of positive breath H2 responses and higher peak responses compared with the infants. Data from the children who drank both juices showed significant differences in peak breath H2 responses after consumption of apple juice compared with white grape juice (P &lt; .005).
Conclusions. The study demonstrated less carbohydrate malabsorption following ingestion of white grape juice compared with apple juice in healthy 6- and 18- month-old children.
THE VIEW FROM COLUMBIA-PRESBYTERIAN MEDICAL CENTER: Is This Really the Future?
Authors: L. J. F. 
Published: December 2021

Emerging as hospitals' most promising source of new patients are clinics like Columbia-Presbyterian Eastside, which, in health care jargon, are called "centers," lest potential patients confuse these gleaming outposts with conventional clinics that cater to the poor and uninsured. To attract middle-class patients wary of leaving their protected blocks, the city's huge hospitals are branching out to ethnic enclaves, upscale New York neighborhoods, affluent suburban communities, and even distant American expatriate communities in Eastern Europe.
Four months ago, Columbia-Presbyterian created a satellite in Moscow and more centers are planned for Warsaw, Prague, St. Petersburg, Budapest, and possibly Beijing.
"Our feeling is that there will be no hospitals in the future," said Dr. William T. Speck, president of Columbia-Presbyterian. "And probably, in the next 10 or 20 years most of the activity will take place in a center or maybe even in homes."
At Columbia-Presbyterian, the top executives are already mulling over what to do with the huge Washington Heights hospital as it empties out to the satellites.
"Hospitals are going to get smaller and smaller and maybe the hospitals might turn into something else," Dr. Speck said. "Perhaps a gymnasium or a flower shop."
Myelin in SIDS: Assessment of Development and Damage using MRI
Authors: Lamont Phillipa , Sachinwalla Toos , Pamphlett Roger 
Published: December 2021

Objective. Abnormalities of myelin that have been reported in Sudden Infant Death Syndrome (SIDS) include a delay in development and focal lesions presumed to be secondary to hypoxia. Magnetic resonance imaging (MRI) gives excellent images of white matter and can be used to map the progress of myelination and to demonstrate focal lesions. It was the aim of this study to determine whether any MRI abnormality of myelin could be detected in the brains of SIDS compared to control infants.
Methods. The brains of 28 SIDS and 14 control infants were fixed in formalin and scanned with MRI. The proton density, T2-weighted, and inversion recovery scans were assessed for the presence of focal white matter lesions. The amount of myelin in 26 sites was measured in the proton density scans, using a densitometer. The amount of myelin present could be assessed in 21 of 26 sites.
Results. In 15 of 21 sites the amount of myelin for age was the same in SIDS and controls. In three sites the rate of myelination was greater in SIDS than control and in another three sites the amount of myelin for age was greater in SIDS than control infants, but these differences were not seen in infants aged less than 8 months. No focal abnormalities of white matter were seen in either SIDS or control infants.
Conclusions. The development of white matter in brains of SIDS infants less than 8 months old is the same as in controls, and in older SIDS infants white matter development may be slightly advanced compared to controls. No hypoxic changes can be seen in SIDS white matter on MRI.
Letters to the Editor
Authors: Williams Robert K. 
Published: December 2021

Use of the laryngeal mask airway (LMA) has grown considerably over the past few years in both adults and children.1,2 The LMA may have special benefits in the management of severe airway problems and the American Society of Anesthesiologists have incorporated its potential use into its algorithm on management of the difficult airway.3 Recently, its use in resuscitation of neonates has been advocated.4,5
I have used the LMA in my practice of pediatric anesthesia and have generally been pleased with its performance in spontaneously breathing patients under general anesthesia.
Letters to the Editor
Authors: Clark Frank 
Published: December 2021

I appreciate the opportunity to respond to Dr Frader's comments. In particular, I would like to address his third concern. The last thing I would want is to add any further confusion to this issue.
First, Dr Frader correctly notes that the origins of the 1984 Federal Child Abuse Amendments (FCAA) are different than the various state child abuse and neglect reporting statutes. The FCAA were explicitly passed to provide the substantive legal foundation upon which the Department of Health and Human Services could issue replacement regulations for the original Baby Doe rules.1
Epidemiologic Pictures of Kawasaki Disease in Japan: From the Nationwide Incidence Survey in 1991 and 1992
Authors: Yanagawa Hiroshi , Yashiro Mayumi , Nakamura Yosikazu , Kawasaki Tomisaku , Kato Hirohisa 
Published: December 2021

Objective. Since 1970, twelve nationwide epidemiologic surveys of Kawasaki disease (KD) have been conducted throughout Japan every two years to describe KD in Japan. By the end of 1992, a total of 116 848 cases were reported. This paper summarizes the statistical analysis of the latest survey for the 2-year period from January 1991 through December 1992.
Method. A questionnaire form and diagnostic guidelines for KD were sent to all pediatric departments of hospitals with 100 or more beds throughout Japan and information was obtained on patients with KD diagnosed during the 2-year period from January 1991 through December 1992.
Results. The summary of the results is: 1) the number of patients reported was 11 221 (6604 males and 4617 females; male/female ratio = 1.43) with a yearly incidence rate of 90 per 100 000 children &lt;5 years old; 2) the monthly number of patients was higher in winter and summer, although the monthly difference was not marked; 3) age-specific incidence rates showed a unimodal peak at 1 year of age; 4) the proportion of patients with a family history of KD in a sibling was 1%; 5) the proportion of recurrent patients was 3%; 6) the proportion of patients with cardiac sequelae 1 month after disease onset was 13%; and 7) the number of patients who died was 9, which conforms to 0.08% of total patients.
Conclusion. The incidence rates of KD in Japan are ten times higher than those reported in western countries and almost constant over 6 years. The descriptive epidemiology of the disease, which supports the infection theory, does not change for years.