bluuebunny/crossref_metadata_2025_split huggingface dataset:
Swallowing Syncope in a Child
Authors: WOODY ROBERT C. , KIEL ERNEST A. 
Published: December 2021

Sudden loss of consciousness in children may be caused by either cardiac or neurologic dysfunction. Generalized seizure activity, breath-holding spells, and vasovagal syncope precipitated by a variety of factors frequently occur.1,2 The following case illustrates an unusual cause of repeated loss of consciousness in a child.
CASE REPORT
A 4-year-old white girl was in excellent health until 18 months of age when she first appeared to faint. During following 3 months, she was asymptomatic but then began having similar fainting episodes several times a day. For the next 2 years, the mother sought medical attention from pediatricians, cardiologists, neurologists, and otolaryngologists and began keeping detailed daily records of all spells.
Idiopathic Hypoparathyroidism: A Case Study on the Interactions Between Exogenous, Parathyroid Hormone Infusion and 1,25-Dihydroxyvitamin D
Authors: SANTOS FERNANDO , CHAN JAMES C. M. 
Published: December 2021

Idiopathic hypoparathyroidism is a rare entity which is clinically characterized by episodes of hypocalcemia and hyperphosphatemia with deficient endogenous parathyroid hormone secretion.1,2 Exogenous parathyroid hormone administration elicits the appropriate renal phosphaturic response,3,4 and no associated endocrinopathies have been reported.1,2 Treatment with 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) is currently recommended.1,2,5
Responses to exogenous parathyroid hormone infusion consist not only of an increase in urine phosphate excretion but, more definitively, an increase in nephrogenous cyclic adenosine monophosphate (cAMP) production.6 Studies of these parameters in pediatric patients have been reported,3 but little is known about the influence of parathyroid hormone administration on the urine calcium excretion of hypoparathyroidism in children and how the renal response to parathyroid hormone may be modified by the 1,25-(OH)2D3 therapy.
Infant Mortality and the American Academy of Pediatrics
Authors: SMITH MARTIN H. 
Published: December 2021

In recent years, there has been a surge of renewed interest on the part of numerous groups in the subject of infant mortality, a source of continued concern to pediatricians for many years. The constancy of concern of the American Academy of Pediatrics about infant mortality is evident in the fact that Pediatrics has published a summary of national statistics on the subject annually since 1950. That yearly analysis by Dr Myron Wegman appears in this issue.1
In addition, a statement of the Academy's current position on infant mortality also appears in this issue.2 As this position paper makes clear, there are several reasons for a renewed concern about infant mortality.
Nuclear Accident at Chernobyl: Implications for Pediatricians
Authors: BALK SOPHIE J. , NEUSPIEL DANIEL R. , BERGER DAVID K. 
Published: December 2021

To the Editor.—
The accident at the Chernobyl nuclear reactor on April 26, 1986, was the worst nuclear accident of this sort to date. This accident and its implications raise great concern among many individuals and groups. As pediatrcians, we are anxious to place the issue of nuclear energy on the agendas of all health care professionals, especially those who care for children.
As of late spring, 26 people had died and 187 of 299 previously reported were still hospitalized with radiation sickness (The New York Times, June 6, 1986, p A11).
Alcohol, Drugs, and Head Injury
Authors: JACOBSON MARC S. , RUBENSTEIN ELAINE M. , HEALD FELIX P. 
Published: December 2021

In Reply.—
Dr Schwarz has brought out an interesting point in the etiology of adolescent closed head injury, but our study showed a predictable pattern of difficulties after injury regardless of prior substance abuse. In fact, the blood alcohol level was elevated in half of a sample of closed head-injured adolescents admitted to our unit; other substances of abuse were not systematically studied, but our experience suggests that they are also frequently involved. We routinely prescribe abstinence from alcohol and other drugs in our posttraumatic care.
Transfusion-Associated Acquired Immunodeficiency Syndrome—What Is the Risk?
Authors: FISHER MARGARET C. 
Published: December 2021

Relatively few pediatricians will ever care for a child with the acquired immunodeficiency syndrome (AIDS); yet, all will be asked questions about this disease. Parents want to know the risk of their children acquiring AIDS. The fear and even panic surrounding AIDS continues to escalate. To educate our patients and control panic, we must understand the disease and the routes of transmission.
It is now clear that AIDS is one end of the spectrum of illness caused by the human immunodeficiency virus (HIV, formerly called HTLV-III/LAV). The virus is present in blood and body fluids. It is transmitted from person to person by sexual contact and by exchange of blood.
High-Frequency Ventilation and Tracheal Injuries
Authors: MAMMEL MARK C. , OPHOVEN JAN , GORDON MARGARET J. , BOROS STEPHEN J. , LEWALLEN PATRICK 
Published: December 2021

In Reply.—
Dr Wiswell and colleagues raise a number of questions about our recent report of tracheal injury following high-frequency ventilation.1 We appreciate their concerns but disagree with their conclusions.
We think the title of the paper is a good one. It is true that an individual perusing only the title of this report might assume that we studied all types of high-frequency ventilation currently available and conclude that all produce tracheal damage. Would a longer, more detailed title have been better? We think not for a number of reasons.
Lack of Statistical Power
Authors: PASCOE JOHN M. 
Published: December 2021

To the Editor.—
Dr Donowitz described an interesting research project in which the efficacy of overgown use in the prevention of pediatric intensive care unit nosocomial infection was examined.1 He concludes that "overgowns were an expensive and ineffective method of preventing or decreasing nosocomial infections."1 Although Dr Donowitz may be correct, his inattention to sample size and statistical power in this negative trial makes his argument less than compelling.
Given the nosocomial "base rate" of about 10% without gowns, the detection of an infection rate difference of 50% between the nongown and gown subgroups (α = .05, β = .2) would require a sample size of about 500 in each subgroup.2
SOURCE OF ERROR IN TEST FOR STOOL TRYPSIN
Authors: GAFFNEY PAUL C. 
Published: December 2021

A source of error in the gelatin film test for stool trypsin is reported. Identical results are obtained with Kodak and DuPont film when incubation at room temperature for two hours is used.
The gelatin on DuPont film incubated at 37° C. for one hour is digested by stools from infants with mucoviscidosis and also by distilled water as well as by stools from healthy infants. Stools from some infants with mucoviscidosis will digest the gelatin on Kodak film when incubated at 37° C. for two hours.
Kodak film should be used if the preparations are to be incubated at 37° C. for one hour, as recommended in the original description of the technic.
POLIOMYELITIS AND COXSACKIE VIRUSES IN PARALYTIC POLIOMYELITIS
Authors: CURNEN EDWARD C. , MELNICK JOSEPH L. 
Published: December 2021

Tests for the presence of Coxsackie virus were carried out with specimens of feces and swabbings of the nasopharynx from 20 infants and children suspected of having poliomyelitis who were admitted to a hospital during the summer of 1949 in New York City.
Both Coxsackie virus and poliomyelitis virus were recovered from feces collected during the course of illness from each of two children with paralysis.
The strains of Coxsackie virus which were isolated from both of these patients were found to be serologically related to Dalldorf's Type 1 Coxsackie virus.
The Coxsackie and poliomyelitis viruses which were isolated from one of these patients were found not to be immunologically related to each other.
Tests with specimens of serum from both patients showed that one but not the other developed, during convalescence, an increase in the capacity to neutralize the strains of Coxsackie virus which were isolated from them.
SPECIAL ARTICLE
Authors: WASHBURN ALFRED H. 
Published: December 2021

EVER since accepting the kind invitation of your President I have known what I wanted to talk to you about tonight. However, when it came to giving my talk a title—a label which would suggest my main theme—then I was stumped. I want to talk a bit about a number of things—about the Child Research Council, about human growth, about education, about pediatric research, and about the responsibilities of the pediatrician in the half century ahead of us. I might then call the talk a "Pediatric Potpourri." The only difficulty with this title is that Mr. Webster, in his fourth definition of the term, says, "a literary production composed of parts brought together without order or bond of connection." While it may be that some of you will decide by the end of this talk that it has been a veritable potpourri yet I hope to succeed in welding a definite "bond of connection" between the various topics discussed. Perhaps the growth, the development, and the adaptation of the human organism is the cementing substance which should run as a golden thread of continuity from the beginning to the end of my discourse.
I have used the term "human development" rather than "child development" because my talk tonight is as much concerned with the development of mature and thoughtful pediatricians as it is with the sound and happy development of children who may some day become physicians, lawyers, engineers, businessmen or senators. In fact I'm going to start talking about the Child Research Council not merely as a particular sort of research approach to child development but also as an educational experience for the investigators involved in the venture.
ANEURYSMS OF THE SINUSES OF VALSALVA
Authors: FOWLER RICHARD E. L. , BEVIL HAROLD H. 
Published: December 2021

A case of aneurysm of a sinus of Valsalva, with rupture, in a four year old female child is presented. This is believed to be the youngest patient with rupture as yet reported.
Studies on the case undertaken in an attempt to verify the diagnosis in vivo included cardiac catheterization, which yielded results compatible with a stream of arterial blood entering the venous circulation at the level of the right ventricle; arterial oxygen analyses; and oxygen uptake determination. From figures obtained by these procedures the extent of the left-to-right shunt was calculated to be about 18% of the systemic blood flow. An attempt was made to correlate the unusually benign clinical course with the results obtained from these procedures.
THE PRESIDENT PAGE
Authors: BEAVEN PAUL W. 
Published: December 2021

THE report of the Committee on Medical Education will appear in full in the minutes of the Executive Board. Your earnest attention to this summary is desired. I shall refer to it only briefly here.
I wish to emphasize that here we have a committee with a problem and they have solved it well. The goal they sought was the continuation of the work begun by the Educators' Conferences under the sponsorship of the ICH Committee. Not only have they carried on these conferences, but they have enlarged and improved them.
As I have pointed out before, other committees have done equally well with their assignments, but the significance of the work of the Committee on Medical Education is that it was assigned one of the great projects of the ICH Committee. We have not let that committee down nor have we let ourselves down. The Committee on Medical Education has underscored the great object of our society "to establish and maintain the highest possible standard for pediatric education in medical schools and hospitals, pediatric practice and research."
This committee made two innovations. Prior to last year the United States and Canada were divided into 10 regions, so that there were 6 to 11 medical schools in each region. Last year it was divided into 8 regions and the Canadian schools met with the United States representatives. This year the Canadian medical school representatives met as Canadians and the conference was held in Toronto. This was done because they have problems individual to themselves and it turned out to be a wise move.
CLINICAL SURVEY OF VASCULAR COMPLICATIONS IN "JUVENILE DIABETES MELLITUS"
Authors: GRAYZEL HAROLD G. , WARSHALL HYMAN B. 
Published: December 2021

In diabetes mellitus we are dealing primarily with a profound carbohydrate disturbance in which a state of hypoinsulinism plus imbalance of the anterior pituitary and adrenal cortical hormones are present. This extensive disturbance affects metabolic functions of many organs and tissues. Because of the interrelationship between carbohydrate, protein and fat and even mineral and water metabolism, there must be varying degrees of change both normal and abnormal, in all of these metabolic processes. The aberrations may be transitory or more prolonged, depending upon the persistence and severity of the metabolic derangement. Since no juvenile diabetic patient, even with the assistance of present-day insulin and prescribed diet, can respond in a completely physiologic manner to his food intake, activity, etc., we must expect metabolic deviations from the normal. It is logical to assume that the closer the approximation of the diabetic patient to a normal physiologic state, the more desirable it is and the less likely is he to suffer qualitatively and quantitatively from the results of his metabolic disorder.
In this small series to date none of the patients whose control was considered good developed detectable vascular lesions even though they had the disease for 10 to 28 years.
This survey adds to the slowly accumulating clinical data indicating decided benefits of a well controlled diabetic state in humans.
ASPHYXIAL ATTACKS IN THE NEWBORN INFANT DUE TO CONGENITAL OCCLUSION OF THE POSTERIOR NARES
Authors: MEDOVY HARRY , BECKMAN I. H. 
Published: December 2021

Asphyxial attacks in newborn infants may occasionally be due to congenital occlusion of the posterior nares. The diagnosis may be made by observation of the infant during feeding, by inability to pass a catheter or probe through the nares into the nasopharynx and by roentgenographic studies with lipiodol in the nasal passages.
Treatment is surgical and may be carried out successfully in early infancy if the condition is bilateral, Treatment of the unilateral cases may be deferred to later childhood. Autopsy on a case of sudden asphyxial death in an infant should not be considered complete until the nasal openings are examined.
SEXUAL PRECOCITY IN FEMALES
Authors: PRAY L. G. 
Published: December 2021

Two cases of sexual precocity in female children are reported. One child with the McCune-Albright syndrome had her onset of menses at 3 years of age. Surgical removal of an ovary containing luteinized follicular cysts and primordial follicles has resulted in arrest of her sexual precocity over a period of almost four years, giving her a more normal childhood than would otherwise have been possible.
The other child has findings diagnostic of the constitutional type of precocity, by far the most common type. Vaginal bleeding in her case began at 4 years of age. In view of the favorable effect of finding and removing a cystic ovary in the child with McCune-Albright disease, this child was explored surgically. There were early adolescent changes in the uterus, tubes and ovaries, but no other abnormalities were found.
THE TESTIS
Authors: SOBEL EDNA H. , SNIFFEN RONALD C. , TALBOT NATHAN B. 
Published: December 2021

The history, physical appearance and laboratory studies performed on eight boys with premature masculinization are presented. The histologic appearance of their testicular tissue is described. Four of the patients had true precocious puberty, which was complete in one and incomplete in three of them. Four had pseudoprecocious puberty, due to adrenal hyperplasia in three of the patients; two of these had associated metabolic disturbances; in the fourth child pseudoprecocity resulted from an adrenal cortical carcinoma.
Comparison of the two groups of patients shows that physically they are similar, although bilateral enlargement of the testes or metabolic disturbances in some instances may indicate the source of the precocity. The children with adrenal virilism excreted large amounts of 17-ketosteroids, possibly arising from abnormal precursors, while the patients with true precocity excreted only small amounts of 17-ketosteroids. The observations further suggest that testicular biopsy may be a simple additional means of distinguishing between true precocity and adrenal precocity. In the former the stimulation seems to be all inclusive with respect to the gonads, leading to the development of large interstitial cells and to tubular maturation and spermatogenic activity of varying degree. In precocity of adrenal origin the interstitial cells do not develop. The appearance of the interstitial cells is apparently the essential feature which differentiates the histology of the testis in these two conditions.
HEPATITIS AND NEPHROSIS DUE TO SOLUBLE BISMUTH
Authors: KARELITZ SAMUEL , FREEDMAN AARON D. 
Published: December 2021

An instance of jaundice, abdominal pain and anuria due to administration of sodium bismuth thioglycolate (thiobismol®) with liver and kidney damage is reported.
The great toxicity of the water soluble preparation of this heavy metal in this and other similiar cases is stressed.
Attention is drawn to the use of BAL therapy in the early or first phase, to the need for caution in fluid administration in cases of lower nephron nephrosis caused by bismuth during the anuric and oliguric phases, and to the need for covering the loss of fluid and electrolytes in the subsequent diuretic phase.
The use of soluble bismuth preparations should be limited to specific conditions and only to those cases which fail to respond to less toxic drugs.
School Performance and Theophylline
Authors: RACHELEFSKY GARY S. 
Published: December 2021

In Reply.—
In regard to your comments:
1. The parents' and teachers' check lists were indeed not the same because they were each evaluating different settings/behaviors.
2. The check lists have been standardized and are published (Melvin Levine, MD). The mood items and hyperactivity items are presented in different forms to allow for more complete evaluation.
3. School performance, as evaluated by the children's individual teachers, was adversely affected as determined by the parameters presented in the table.
School Performance and Theophylline
Authors: RACHELEFSKY GARY S. , WO JULIE , ADELSON JUDIH , MICKEY M. RAY , SPECTOR SHELDON L. , KATZ ROGER M. , SIEGEL SHELDON C. , ROHR ALBERT S. 
Published: December 2021

In Reply.—
Dr Twarog and colleagues raise a number of questions about our report of the adverse effects of theophylline. We appreciate their concerns and we hope the following satisfies them.
The study was double blinded and randomized; the investigators, the children, the teachers, and the parents had no way of knowing which child was receiving theophylline or placebo, and there was no prior experience with theophylline titration. A "designated'tant' physician monitored the theophylline levels.
Defecation Dynamics
Authors: SCHMITT BARTON D. 
Published: December 2021

To the Editor.—
The recent article by Loening-Baucke et al helps our understanding of defecation dynamics. However, her recommendation that "children with encopresis should have their rectal sensation and their ability to defecate balloons evaluated" (p 678) seems like diagnostic overkill.
1. What are normal values for these tests?
2. Will such testing change the diagnosis or etiology? Couldn't the inability to relax the external sphincter during defecation be a consequence of chronic stool holding (due to either painful bowel movements or harsh toilet training) rather than a cause of stool holding? How do you know the children were cooperative during this test?
POLITICIANS SHOULD MEET STANDARDS, TOO
Authors: L. J. F. 
Published: December 2021

I read with interest the article concerning the New York panel that wants to have physicians take competency tests for relicensure.
I welcome this effort and would encourage this with one qualification: that our elected officials, especially those at the state and federal levels, have some basic education before governing similar to that required of physicians before practicing medicine. We cannot begin to practice medicine until we have gone through years of rigorous, demanding preparatory education, then must pass competency tests (board exams).
Our elected officials, however, have no such requirements. I would suggest that these elected officials have some basic education in governing and be required to maintain a certain grade-point average before they are permitted to run for office. They should be required to take competency tests concerning world history, economics, human relations, and world affairs. Politicians also should not be exempt from recertification. Certainly, world politics have changed as much or more than anything in the field of medicine.
OPINION IS NOT GOOD ENOUGH
Authors: Student  
Published: December 2021

Clinical freedom is dead, and no one need regret its passing. Clinical freedom was the right-some seemed to believe the divine right—of doctors to do whatever in their opinion was best for their patients. In the days when investigation was non-existent and treatment as harmless as it was ineffective the doctor's opinion was all that there was, but now opinion is not good enough. If we do not have the resources to do all that is technically possible then medical care must be limited to what is of proved value, and the medical profession will have to set opinion aside.
Clinical freedom died accidentally, crushed between the rising cost of new forms of investigation and treatment and the financial limits inevitable in an economy that cannot expand indefinitely. Clinical freedom should, however, have been strangled long ago, for at best it was a cloak for ignorance and at worst an excuse for quackery. Clinical freedom was a myth that prevented true advance. We must welcome its demise, and seize the opportunities now laid out before us.
In Reply: SI Unit Dangers
Authors: ROBERTS ROBERT J. 
Published: December 2021

Although the original Committee statement was correct, the two errors pointed out by Dr Perlman were introduced and not caught in the final galley proof reading.
Dr Perlman's point is well-taken and reiterates the Committee's conclusion that drug dosing should continue to be reported in mass units to avoid the possibility of dosing errors. We agree with Dr Perlman and will continue to vigorously oppose this potentially confusing and certainly unnecessary conversion.