bluuebunny/crossref_metadata_2025_split huggingface dataset:
In Reply: Encopresis, Enemas, and Gold Stars
Authors: Levine M. D. , Bakow Harry 
Published: December 2021

Dr. Fleisher's letter about our article on children with encopresis is certainly provocative and presents some alternative views about treatment.
We would certainly agree that pediatricians need to understand this symptom in depth in order to treat it adequately. Further knowledge of the physiology of defecation can be quite valuable in this respect. Dr. Fleisher's own review in Pediatric Annals is certainly helpful.
We agree that the distinction between nonretentive and retentive fecal soiling needs to be made.
Penicillin-Resistant Pneumococcal Meningitis
Authors: Iyer Prabhamani V. , Kahler John H. , Jacobs Norman M. 
Published: December 2021

The problem of pneumococcal meningitis due to a relatively penicillin-insensitive organism was noted by Paredes et al. (Pediatrics 58:378, September 1976) and by others.1 We have recently had experience with a similar case.
The patient was an 8-month-old black boy with a one-week history of coryza and a one-day history of fever. Initial physical examination revealed a febrile (39.4 C), irritable, lethargic child with otherwise normal results of physical examination. Initial laboratory results showed a hemoglobin level of 10 gm/dl and a WBC count of 13,500/cu mm (56% polymorphonuclear leukocytes; 27% band forms; 15% lymphocytes; 1% monocytes; 1% eosinophils).
The Value of Pulsus Paradoxus in Assessing the Child With Status Asthmaticus
Authors: Galant Stanley P. , Groncy Charles E. , Shaw Kathryn C. 
Published: December 2021

The presence of pulsus paradoxus (PP) in 13 episodes of status asthmaticus in 12 children, ages 13 months to 15 years, was compared sequentially to a clinical score, peak expiratory flow rate (PEFR), heart rate, arterialized capillary pH, carbon dioxide pressure (Pco2), and the ratio of inspired oxygen to oxygen pressure (FIo2)/Po2) during the first 48 hours following admission.
There was a significant correlation (P &lt; .01) between the presence of a PP (≥ 5 mm Hg) and the clinical score (r = .79), PEFR (r = .55), and heart rate (r = .49). This was particularly striking when the PP was ≥ 20 mm Hg. There was no significant correlation between the mean PP and the Pco2 or FIo2/Po2, ratio. However, a mean Pco2, exceeding 40 mm Hg was associated with a highly significant (P &lt; .005) difference in mean PP (22.2 mm Hg) compared to the mean PP (12.2 mm Hg) when the Pco2 was below 40 mm Hg. Although the PP technique can easily be learned by physician and nursing personnel, there are potential problems. The difficulties in children are compared to those in adults.
The PP is a valuable clinical tool in assessing the severity of airway obstruction in status asthmaticus. The presence of a PP, particularly greater than 20 mm Hg, is associated with moderate to severe airway obstruction. In conjunction with the overall clinical status of the patient and frequent blood gas determinations, the PP allows for better evaluation of the patient with status asthmaticus.
Blood Glucose and Plasma Amino Acid Concentrations in Infants of Diabetic Mothers
Authors: Soltész Gyula , Schultz Károly , Mestyán Julius , Horváth Imre 
Published: December 2021

Postnatal blood glucose and individual plasma free amino acid levels were measured in 14 newborn infants of diabetic mothers. All infants had a significantly lower blood glucose concentration than normal controls but no significant correlation was observed between the blood glucose values and any of the amino acids determined. As regards the quantitative and qualitative changes of the plasma aminogram, the total concentration of amino acids and the level of a few individual amino acids (glycine, alanine, taurine, and valine) were significantly elevated in full-term babies. However, no significant difference was found in the total plasma concentration of amino acids between premature infants of diabetic mothers and premature control infants, but the plasma alanine level was higher in the former. It is of interest that total plasma amino acid, alanine, and glycine levels were elevated in the asphyxiated babies.
This suggests that the postnatal hyperaminoacidemia observed in infants of diabetic mothers was due to birth asphyxia rather than to impaired gluconeogenesis. The possible role of a defective gluconeogenesis in the etiology of postnatal hypoglycemia in infants of diabetic mothers is not supported by these data.
Epidemic Neonatal Hyperbilirubinemia and Use of a Phenolic Disinfectant Detergent
Authors: Wysowski Diane K. , Flynt J. William , Goldfield Martin , Altman Ronald , Davis A Todd 
Published: December 2021

Between March 28 and April 12, 1972, nine neonates in a New Jersey hospital received exchange transfusions for idiopathic hyperbilirubinemia. Five infants who had peak bilirubin concentrations from 23.9 to 42 mg/100 ml were treated within a 36-hour period. Affected infants had no other illnesses, and they and their mothers did not differ significantly from unaffected infants and their mothers regarding factors which could explain the epidemic. The increase in exchange transfusions began in January, which coincided with the time that the nursing staff increased the concentrations of a phenolic disinfectant detergent used for cleaning bassinets and mattresses. Preceding the cluster of cases in April they had vigorously cleaned the nursery with the disinfectant detergent. After use of the phenolic compound was discontinued, the epidemic of hyperbilirubinemia ceased.
These findings are similar to those of a subsequent outbreak in 1975 in a Wyoming hospital in which idiopathic hyperbilirubinemia developed in ten (18.5%) of 54 newborn infants; two received exchange transfusions. The same phenolic compound was used in excessive concentrations to clean incubators and bassinets. In addition, nursery ventilation was inadequate. When use of the cleaning compound was discontinued and the ventilation defects were corrected, the epidemic of hyperbilirubinemia ceased. These two episodes suggest a causal association between use of excessive concentrations of this phenolic disinfectant detergent and neonatal hyperbilirubinemia.
ME AND MY IV
Authors: Kohn Joshua 
Published: December 2021

Through the IV medicine squirms,
If you don't change it, it will fill with germs.
And into your body the germs will flow,
Sometimes fast and sometimes slow.
Occasionally the IV will open.
Out pours the fluid and I'm hopin'
That I won't start whinin' and mopin'
Over the irrigation of my IV.
So I gotta start coping with the IV that broke open.
Hyperactive Children: A Ten-Year Study
Authors: Miller James S. 
Published: December 2021

My experiences in practice during the past ten years lead me to believe that "hyperactivity" is primarily an emotional problem. Currently, however, the diagnosis is often made-and drugs administered-on the basis of fragmentary information about the child's behavior and with little attempt to explore the child's inner state or the family relationships.
These statements are based on observations made while following up 290 children whose diagnosis was hyperactivity. I was the family pediatrician in these cases and, as such, was eventually admitted to the interior of the families. Additionally, I gathered school records for the children and medical records for most of the adult family members. This broad data base, combined with my long personal relationship with the families, is the basis for the conclusions I present here. I submit that the data base is both more intensive and extensive than that which an academic institution or clinic can usually achieve; that is why a relatively apparent aspect of hyperactivity has been, until now, neglected.
THE SAMPLE
The period covered is from July 1965 through June 1975. My practice at that time was in Hayward, a suburb of the east San Francisco Bay. Omitting consultations, I followed up 1,016 families with 2,427 children for a mean of 61 months (SD, 29 months). I have matched my practice demographically to both the U.S. census and several regional surveys and have found the practice to be within 5% on occupational, marital, racial, and economic criteria. The diagnosis of hyperactivity for the 290 patients whose cases I will discuss had been made by either school personnel, parents, another physician, or, in some cases, all three.
Acute Respiratory Distress in a Child After Steroid-Induced Pancreatitis
Authors: Goldberg Barry H. , Bergstein Jerry M. 
Published: December 2021

Acute pancreatitis is a well-known but rare complication of corticosteroid therapy in both children1-3 and adu1ts.4,5 In adults, respiratory insufficiency may follow the onset of acute pancreatitis.6-8 This report describes a child with systemic lupus erythematosus (SLE) in whom acute respiratory distress developed after steroid-induced pancreatitis.
CASE REPORT
A 12-year-old girl with SLE in remission (maintenance therapy, 60 mg of prednisone on alternate days) was admitted to the University of California Los Angeles Hospital with a one-week history of fever, dysuria, facial rash, and joint pain. A urinary tract infection was detected and the patient was placed on a regimen of antibiotics.
Studies With Live Varicella Vaccine and Inactivated Skin Test Antigen: Protective Effect of the Vaccine and Clinical Application of the Skin Test
Authors: Baba Koichi , Yabuuchi Hyakuji , Okuni Hidekazu , Takahashi Michiaki 
Published: December 2021

In December 1975, a patient with varicella was admitted to a ward for children less than 2 years of age. Among 76 children without a history of varicella, 33 children more than 1 year of age were immediately vaccinated with a small viral dose of 80 plaque-forming units per person. Forty-three children less than 1 year of age were left unvaccinated. Among the vaccinated children, only eight exhibited mild varicella, while typical varicella developed in all 43 unvaccinated children during the next ten weeks.
In July 1976, another patient with varicella was admitted to a ward with 49 children 3 to 5 years old. The children were immediately given the skin reaction test with mactivated varicella antigen. Seventeen of the 20 children with negative reactions were vaccinated, while the index patient and two children with fever were not vaccinated. Only one of the 17 vaccinated children showed mild varicella symptoms within two weeks after vaccination, while typical varicella developed in two unvaccinated children during the four weeks after appearance of the index case. Varicella developed in none of the 29 children who had positive skin tests. In the sequential skin test of seven vaccinated children, a positive skin reaction was observed as early as five days after vaccination, which preceded the appearance of neutralization antibody by seven to nine days.
EQUITY IN HEALTH SERVICES
Authors: Anderson O. W. 
Published: December 2021

It is demonstrated that the increase in the use of physician and hospital services between 1963 and 1970 ... had no impact on health indicators as measured by disability days. It is often argued from results like these that a comprehensive national health insurance scheme would be a misallocation of resources in the public sector, if the objective is to improve health levels. Rather, it is argued, it would be a wiser policy to allocate fewer resources to a comprehensive curing system and more to programs designed to inculcate healthful life styles.
Life styles do not lend themselves easily to manipulated change, at least in the short haul. Public opinion will dictate that the health services delivery system will have to cope with the deleterious effects of prevailing life styles somehow. I do not believe there will ever be a puritanic majority who are so healthy and ascetic that they can legislate against a minority who are hedonistic and unhealthy.... Differentiating between life style saints and sinners is then not a tenable public policy. National health insurance will be designed therefore to serve both the prudent and the profligate, a policy I would regard as equitable.
Prolonged Apnea
Authors:   Task Force on Prolonged Apnea
Published: December 2021

Prolonged apneic spells in infants may lead to morbidity and occasional mortality. Prolonged apnea is defined as cessation of breathing for 20 seconds or longer, or as a briefer episode associated with bradycardia, cyanosis, or pallor. Present etiological considerations in prolonged apnea include seizure disorders, severe infections, significant anemia (especially in infants who were preterm), gastroesophageal reflux, hypoglycemia and other metabolic disorders, and impaired regulation of breathing. It further seems likely that some victims of the sudden infant death syndrome (SIDS) have succumbed to unrelieved prolonged apnea.
Beyond specific treatment of any underlying disorder, 24-hour surveillance is critical to the management of prolonged apnea. Settings for intensive observation and care may include the appropriately staffed and equipped acute care hospital, and the infant's home. In addition, a long-term care facility or foster home may be considered.
Skilled care-givers are crucial to continuous observation and management of an infant in any setting. Care-givers should be trained in infant cardiopulmonary resuscitation and provided with continuing medical, technical, and psychosocial support. In the home setting, relief personnel should be available. Electronic or other monitors of the heart or respiratory rate may be useful adjuncts to 24-hour surveillance, but should be used only under medical supervision. There is presently no consensus concerning the relative advantages and disadvantages of cardiac and respiratory monitors-both present problems. Moreover, a successful outcome for every baby with prolonged apnea cannot be guaranteed, despite continuous surveillance (with or without monitors) and appropriate intervention.
Pediatricians must keep in mind that there is a significant psychological impact on all the members of the family of an infant with prolonged apneic spells, whether or not monitors are included in the management plan.
Eustachian Tube Function and Allergy in Otitis Media
Authors: Bluestone Charles D. 
Published: December 2021

Otitis media with effusion (OME) is one of the most common diseases of childhood. Acute OME is usually of the suppurative type, although it may be serous, while chronic OME has many synonyms, including "serous otitis media," "mucoid otitis," "nonsuppurative otitis media," "glue ear," and "allergic otitis media." The following discussion is a review of some of the factors that influence the etiology and pathogenesis of OME in general, and more specifically the role of Eustachian tube (ET) function and allergy in the disease process of OME.
The pathogenesis of OME appears to be related to abnormal function of the ET. Investigation into the exact nature of this dysfunction requires an understanding of the system constituted by the palate, nasal cavity, nasopharynx, ET, middle ear, and mastoid air cells. Within this system the ET has at least three physiologic functions with respect to the middle ear: protection from nasopharyngeal sound pressure and secretions, clearance into the nasopharynx of secretions produced within the middle ear, and ventilation of the middle ear to equilibrate air pressure in the middle ear with atmospheric pressure and to replenish oxygen which has been absorbed (Fig. 1).
ROENTGENOGRAPHIC STUDIES
The protective and clearance functions of the ET have been assessed by a radiographic technique.1,2 Radiopaque material was instilled through the nose of patients in order to observe the retrograde flow of the medium from the nasopharynx into the ET. Patients were considered to have normal protective function when radiopaque material entered only the nasopharyngeal or isthmic portion of the tube but did not enter the bony portion of the tube or middle ear cavity.
Advanced Techniques for Measuring Middle Ear Function
Authors: Northern Jerry L. 
Published: December 2021

The use of acoustic impedance measurement as a means of evaluating the physiological function of the middle ear system is gaining wide interest by pediatricians.1-3 The impedance technique is extremely sensitive to differentiating between normal and pathological middle ears.
Children with middle ear effusions are typically identified by physicians through an otoscopic examination, or by audiologists when the child fails the traditional hearing screening test at school. Most physicians use otoscopy to visually examine the tympanic membrane, but with varying degrees of success.4 Otologists teach that pneumatic otoscopy is an absolute necessity to identify the presence of middle ear disease, yet only 25% of physicians use the pneumatic otoscope.5 In a recent study of the accuracy of otoscopic diagnoses, 15% to 20% of ears in children under 3 years of age with effusions were missed clinically. This high miss rate was noted in a group of examiners from a medical center who were aware that their diagnostic skill was being evaluated and thus should have been motivated to perform their most careful otoscopy.6 Accurate otoscopy and pneumotoscopy require skilled and experienced individuals. Our experience in training health professionals shows considerable variability in interpretation of otoscopic observations. Other problems in otoscopy include difficulty in visualizing the tympanic membrane, the removal of cerumen prior to examination, and the unwillingness of some children to cooperate with the examination.
TYMPANOMETRY
Tympanometry resolves many of the disadvantages of conventional audiology and otologic assessment. It requires only passive cooperation from children since no overt response is required.
Surgical Management of Eustachian Tube Dysfunction and Its Importance in Middle Ear Effusion
Authors: Donaldson James A. 
Published: December 2021

One of otology's most significant advances in this century has been the reintroduction by Armstrong1 of the concept and the technique for restoration of middle ear ventilation. Previous attempts by such legendary otologists as Toynbee2 and Politzer3 had been ineffective and short-lived. The consequences of ineffective ventilation of the tympanum have plagued otologists for many years. In many instances, adequate ventilation of the tympanum can be accomplished by appropriate medical management. In others it is necessary to ventilate the tympanum by maintaining a tympanic membrane perforation with a ventilating tube.
Problem
Otologists are confronted daily with patients whose ears are not functioning optimally because of poor middle ear ventilation and/or middle ear fluid. The middle ear fluid may persist as the residual from a middle ear infection which has not yet been completely treated. (Complete treatment would necessarily require restoration of hearing and eradication of fluid.) It has been estimated that 10% of patients with acute suppurative otitis media treated with appropriate antibiotics and oral or topical nasal vasoconstrictors, with or without initial myringotomy, have residual middle ear fluid.4 Recent data suggest that children with persistent otoscopic, tympanometric, and audiologic changes have restricted development of some auditory processing skills as well as distortion of integrational patterns.5 This was found even when the hearing loss for speech frequencies averaged only 30 dB.
In addition to persistent middle ear fluid, otologists are concerned about middle ear vacuum associated with hearing loss or with middle ear atelectasis. The atelectasis is an especially disturbing problem because it is part of a continuum which may progress from asymptomatic middle ear vacuum through varying degrees of reversible atelectasis to irreversible atelectasis or adhesive otitis media (Figure).
Dysgerminoma Presenting as a Calcified Abdominal Mass With Hypercalcemia
Authors: Nelken Robert P. , Nieburg Phillip I. , Bergstrom William H. , Richman Robert A. 
Published: December 2021

Ovarian neoplasms account for less than 2% of all pediatric malignant tumors. About one third of these tumors are pure dysgerminomas, which rarely present with abdominal calcification or hypercalcemia. This communication reports the unusual occurrence of both a calcified dysgerminoma and hypercalcemia in a 101/2-year-old girl.
CASE REPORT
A 101/2-year-old white girl was hospitalized for evaluation of anorexia of six months' duration, an 11-kg weight loss, polyuria, and polydipsia. On admission, she appeared weak and cachectic. Blood pressure was 110/80 mm Hg; pulse rate, 120 beats per minute; respirations, 28/mm; temperatare, 38.2 C; height, 130 cm; and weight, 25 kg. A left-lower-quadrant abdominal mass extended across the midline.
A LESSON ABOUT DRUNKARDS IN THE 1879 EDITION OF MCGUFFEY'S FIFTH ECLECTIC READER
Authors: C. T. E. 
Published: December 2021

Many have hailed the McGuffey Eclectic Readers as major influences not only in American education but in American morals and culture as well. It is estimated that 122,000,000 copies were sold between 1836 and 1920.
A recurrent lesson in these Readers is the evils of drink. In the 1879 edition of the Fifth Reader, McGuffey chose this piece by John Greenleaf Whittier (1807-1892) to show the young reader the wretched effects of alcohol.
. . . One fine morning, not long ago, I strolled down the Merrimac, on the Tewksbury shore. . . . The path winds, green and flower-skirted, among beeches and oaks, through whose boughs you catch glimpses of waters sparkling and dashing below.
. . . Half fatigued with my walk, I threw myself down upon a rocky slope of the bank, where the panorama of earth, sky, and water lay clear and distinct about me. . . . Over all a warm but softened sunshine melted down from a slumberous autumnal sky.
My revery was disagreeably broken. A low, grunting sound, half bestial, half human attracted my attention. I was not alone. Close beside me, half hidden by a tuft of bushes, lay a human being, stretched out at full length, with his face literally rooted into the gravel. A little boy, five or six years of age, clean and healthful, with his fair brown locks and blue eyes, stood on the bank above, gazing down upon him with an expression of childhood's simple and unaffected pity.
Committee on School Health Health Education
Authors: Cook Donald E. , Andringa Conrad L. , Hess Karl W. , Kishner Leonard L. , Leavitt Samuel R. , Novak Stanley F. , Rogers Kenneth D. , Stackpole J. Ward , Wiggins Casper 
Published: December 2021

The American Academy of Pediatrics believes that it is necessary to reaffirm its support for the concept of school health education, from kindergarten through grade 12, for all schoolchildren in the United States.
A basic concept of pediatrics is prevention, and health education is a basic element in the delivery of comprehensive health care. The public is continually bombarded by the media about the high cost of medical care and the overutilization and incorrect use of medical facilities. The media also writes about the problems of increasing promiscuity and illegitimacy; the money wasted on quackery; practices that are detrimental to the health of people in the United States; and the lag in the dissemination of new health information and facts to the public. The Committee on School Health believes that community health education programs, of which school health education programs from kindergarten through grade 12 are an integral part, are one of the most viable methods to help alleviate these and similar problems. Therefore, the Committee on School Health makes the following recommendations and urges action for them at state and local levels.
1. Health education is a basic education subject, and it should be taught as such. Health education is compatible with other traditional subjects and can enhance the contribution that other basic subjects make to general life experience, understanding, and skills.
2. Planned, integrated programs of comprehensive health education should be required for students from kindergarten through grade 12. Instruction should be given by teachers qualified to teach health education.