bluuebunny/crossref_metadata_2025_split huggingface dataset:
Value of Tracheal Aspirates Questioned
Authors: Goldman Steven L. 
Published: December 2021

The extensive study recently reported by Sherman and co-workers attempts to evaluate the use of early tracheal aspiration in diagnosing congenital pneumonia.1 Their findings are of interest and confirm some previous studies and clinical impressions.
However, the authors' conclusion that "early direct tracheal aspiration ... appears to be a specific ... procedure for the early diagnosis of congenital pneumonia" does not seem to be supported by the data they present.
Specifically, for their conclusion to be valid, a definite correlation of positive tracheal aspirates with presence of pneumonia must be made.
CHARLES DICKENS ON THE MEDICAL USE OF TAR-WATER
Authors: C. T. E. 
Published: December 2021

Bishop George Berkeley (1685-1753), the Anglo-Irish philosopher and Bishop of Cloyne, a remote diocese in County Cork, published a remarkable book in 1744 on the panacean value of tar-water.
Berkeley recommended that tar-water be prepared by pouring a gallon of water over a quart of tar, then stirring and mixing thoroughly for three or four minutes with a ladle or flat stick. After standing for 48 hours to allow the tar to settle, the clear supernatant layer was poured off and kept for use. Berkeley claimed that a pint of tar-water a day would cure almost every disease then known.1
Although the tar-water craze had abated by the end of the 18th century, it was apparently still in use in England as late as 1861, as is evident in this quotation from Dickens's Great Expectations.2
Toxic Shock Syndrome— Scientific Uncertainty and the Public Media
Authors: Todd James K. 
Published: December 2021

After languishing in relative obscurity since its description in 1978,1 toxic shock syndrome has recently been thrust into the public domain by its reported association with tampon use.2,3 The myths, partial truths, and gross misconceptions promulgated in the media, presumably with the intent of informing the public, must now be brought into the perspective of existing data, necessitating a reconsideration of the balance between the public's "right to know" and the evolutionary process of scientific knowledge.
Toxic shock syndrome is an acute febrile ifiness with mucocutaneous manifestations and multisystem involvement, the most severe manifestations being hypotension, renal failure, myocardial failure, and "shock lung syndrome."
Chloramphenicol Study Questioned
Authors: Kauffman Ralph E. , Dajani Adnan S. 
Published: December 2021

The article on chloramphenicol kinetics by Sack, Koup, and Smith1 contains several assumptions that raise serious questions regarding the validity of the calculated values for half-life, clearance, and volume of distribution of the drug.
The methods used to calculate T½, Vd, and clearance assume that chloramphenicol succinate is instantaneously and completely hydrolyzed following infusion. This has not been our experience. We found the succinate ester to persist in the serum for three hours in most patients and up to six hours in some patients.2
GALACTOSEMIA AND ITS RELATION TO LAENNEC'S CIRRHOSIS
Authors: TOWNSEND EDWARD H. , MASON HOWARD H. , STRONG PAUL S. 
Published: December 2021

Five additional cases of galactosemia are added to the steadily increasing number of reports in the literature. A follow-up note is included regarding a sixth case in a patient now 18 years of age, previously reported from this hospital.
Two of these cases developed cirrhosis of the liver in a manner suggesting that galactosemia per se was the cause. Histologic examination of the liver in both cases confirmed the anatomic diagnosis.
A 10 year follow-up on Mason and Turner's reported Case 7 demonstrates that the illness is chronic but that with advancing years, demonstrable evidence of somatic damage is lacking. Mental retardation is a common complication of the disorder in the present investigators' experience. Cirrhosis of the liver accompanying galactosemia appears to be reversible, so far as can be determined.
Febrile Children
Authors: SOMAN MICHAEL P. 
Published: December 2021

To the Editor.—
The attempts of McCarthy et al to understand quantitatively the clinical assessment of degree of illness in febrile children are fascinating, and their most recent publication in this area1 is a significant breakthrough. The task of understanding and characterizing clinical judgment to the point of testing its sensitivity, specificity, and predictive value is an enormous one, but the ramifications of decreased need for laboratory evaluation are great in terms of economics and emotional well-being (physician, patient, and parents).
Icosaphobia
Authors: HART WILLIAM E. 
Published: December 2021

To the Editor.—
In coining a new word, one should attempt to maintain consistency in the use of the root language. Thus eikosaphobia, or icosaphobia, from the Greek: eikosi (twenty), is preferable to vigintiphobia1 since the latter is a hybrid. That a hybrid is established in common usage, eg, claustrophobia, does not justify a repetition.
Patient Tampering with Electronic Intravenous Fluid Regulators
Authors: OKSTEIN CHARLES J. 
Published: December 2021

Intravenous (IV) fluid controllers and pumps have generally made administration of parenteral fluids and medications safer and more reliable. In addition, they have permitted more effective utilization of nursing services to pediatric patients, because less time is required to monitor the progress of IV fluid infusions.
These devices may be classified as either volumetric infusion controllers or volumetric infusion pumps. In the former type, the force of gravity provides the fluid flow through the IV tubing, and an electronic controller limits the flow of solution to a rate that the operator has preset on an indicator. Such infusion controllers are useful for the delivery of most parenteral fluid therapy when moderate flow rates are needed.
Protest Views of Singer
Authors: CALLIE ALBERT S. 
Published: December 2021

To the Editor.—
Singer, in his article "Sanctity of Life or Quality of Life?" (Pediatrics 1983;72:128-129) has rejected the "sanctity-of-life view"—as he defines it. He calls it "the obsolete and erroneous notion of the sanctity of all human life." He states that "the philosophical foundations of this view have been knocked asunder." He adds "We can no longer base our ethics on the idea that human beings are a special form of creation made in the image of God."
Ethical Issues in the Prenatal Diagnosis of Phenylketonuria
Authors: Holtzman Neil A. 
Published: December 2021

Clinicians often view ethical dilemmas in terms of individual patients: would couple X, who have a normal 2-year-old child with phenylketonuria (PKU) (due to early treatment), want prenatal diagnosis with subsequent pregnancies? Eventually, the question will be posed on that level, but not yet. At this stage, we are still dealing with a new, unproven technology; a more generic analysis is needed. We must consider whether the technology is ready to be disseminated, and if so, how. Until recently these questions were seldom asked. As a result, modern medicine is replete with examples of technologies—drugs, surgical operations, laboratory tests—whose lack of effectiveness became evident, sometimes at great cost, only after they became part of routine medical practice.1 Lack of "effectiveness" of prenatal diagnosis for PKU could mean the abortion of fetuses unaffected with the disorder, and the unwanted birth of affected infants. The technology introduces a new ethical issue as well: the appropriateness of abortion for treatable conditions.
Three issues should be addressed before new technologies are disseminated: validation, acceptance, and proliferation. I will use prenatal diagnosis for PKU to illustrate them. Several items to be discussed under "acceptance" also apply at the personal level. I pose them because they are important in deciding if and how the new technology should be made available, which is a matter of public policy. Lest one think these decisions have all been made for prenatal diagnosis for PKU, consider the following: (1) Research funding must continue to discover other restriction endonuclease sites, develop better probes, and simplify the techniques.
Use of Tricyclic Medications in Children
Authors: RAUBER ALBERT , MARONCELLI REGINA 
Published: December 2021

In Reply.—
Our attention was first caught by Food and Drug Administration statistics1 that showed that across the nation, the incidence of toxic events paralleled the number of prescriptions for tricyclic antidepressants except when one of them was prescribed for a child or sibling less than 10 years of age and suffering from enuresis. In these circumstances, there was a greater risk of a poisoning episode than when the drug was prescribed for neuropsychiatric reasons for an adult.
Use of Denver Developmental Screening Test
Authors: ALLAN WALTER C. , DRANSFIELD DOUGLAS A. , TITO ALISON M. 
Published: December 2021

In Reply.—
We would agree with VanDervoort and Lee that the Denver Developmental Screening Test is a screening instrument and as such does not make a diagnosis of developmental delay. We referred to the test because it had been administered to all infants and because it represents a commonly known set of developmental landmarks. It was our purpose to emphasize the differences between the group of infants who had grade IIB or grade III hemorrhage with posthemorrhagic hydrocephalus and the infants in other categories.
Children as Victims of Parental Conflict
Authors: REINHART MICHAEL A. 
Published: December 2021

To the Editor.—
The article by Nelson1 included particularly vivid examples of the manner in which children may become victims of parental conflict. In the experience of University of California Davis Medical Center's Suspected Child Abuse and Neglect Team, similar cases (although less severe) account for approximately 2% of the physical abuse cases reviewed. Social services agencies tend to view such occurrences as "accidents," and are reticent to provide services to such families. Physicians must take an active role in advocating that the families and children receive appropriate services.
Meat Tenderizer and Bee Stings
Authors: FIKAR CHARLES R. 
Published: December 2021

In Reply.—
Cardoni et al have scientifically studied the question of whether a papain paste, in the form of commercially available meat tenderizer, is efficacious in bee sting treatment. Their experimental model (Toxicon 1981;19:851-855) showed no beneficial effect of topically applied papain. However, as stated in that article, their method of artificially injecting the venom via syringe and needle may explain the lack of efficacy. Some bees leave the stinger and venom sack at the wound site.
Use of a Microcomputer for Calculation of Total Parenteral Nutrition for Very Low-Birth-Weight Infants
Authors: ARMON Y. , ROLL D. , BRANSKI D. , GALE R. 
Published: December 2021

To the Editor.—
In addition to the various uses of microcomputers in general pediatrics described by Schwartz and Hammer1 and their use for self-evaluation in pediatric practice as noted by Gouyon et al,2 we would like to draw attention to another application as used in our neonatal intensive care unit.
We have developed an interactive microcomputer program for the daily calculation of total parenteral and combined parenteral and enteral nutrition for very low-birth-weight infants and other sick neonates.
E-Ferol: What Happened and What Now?
Authors: PHELPS DALE L. 
Published: December 2021

In October 1983, an intravenous form of vitamin E was marketed as a nutritional supplement but promoted and used pharmacologically for the prevention of retinopathy of prematurity (ROP). By April 1984, E-ferol was recalled following the deaths of 38 infants who had received the drug. Why did they die, does vitamin E even prevent ROP, and can it be given safely?
WHY DID THEY DIE?
Naturally occurring vitamin E is tocopherol, a fatty alcohol that is absorbed unchanged with other fats from the gastrointestinal tract. Several esters of the parent compound are available. The acetate ester is the form generally found in oral preparations, and the form available in parenteral multivitamin preparations.
Risk Factors of Diabetic Retinopathy
Authors: MARKS IRA 
Published: December 2021

To the Editor.—
In their article on risk factors for diabetic retinopathy in youth, Malone et al1 make note of the recent report of Goldstein and associates2 of a direct association between antecedent long-term glycemic control and the development of diabetic retinopathy in a population with age and duration of diabetes similar to those in the study population of Malone et al.
However, Malone et al do not mention a significant difference between their study group and that of Goldstein et al: the group of Malone et al had no well-controlled diabetics whereas the group of Goldstein et al had many.
Does Statistical Significance Equal Real Significance
Authors: FERGUSSON D. M. 
Published: December 2021

In Reply.—
Hersher's letter resurrects an old controversy about methods of assessing the size of effect in epidemiologic research. The basis of this conflict is implicit in the figures he quotes: on the one hand high exposure to adverse life events was associated with a sixfold increase in risks of hospital admission, whereas on the other hand, the life events measure explained only 3% of the variance in hospital admission. The former statistic suggests an association of importance, whereas the amount of explained variance is disappointingly small.
Adolescents and Ritalin
Authors: HUESSY HANS R. 
Published: December 2021

To the Editor.—
I continue to see patients in late adolescence with serious social and psychological problems that had been treated successfully with Ritalin. The medication was stopped at age 12 years because "the condition goes away at that age."
Attention deficit disorder may indeed spontaneously remit at any age. Such remissions are unpredictable. Many patients continue with their problems long into adult life.
If a child had problems related to attention deficit disorder of sufficient degree to warrant the use of medication, such medication should be continued as long as it exerts an obviously beneficial effect.
Role of National Organizations in the Education and Evaluation of Professionals Who Care for Children
Authors: Burg Fredric D. 
Published: December 2021

Imagine a time when any family with a sick child can be assured that any physician licensed to care for their young has had a planned educational experience designed to assist that physician to perform in a competent fashion. Imagine a time where any physician licensed to care for their young has recently demonstrated competency in managing the problems facing their sick child. Imagine a time when programs accredited to educate physicians will routinely document the ability of their students to perform competently.
The purpose of this paper is to provide suggestions for ways to improve the system of education and evaluation of professionals responsible for the health care of infants, children, and adolescents in the United States of America.
These suggestions are based on an empirical analysis of the existing systems. On the basis of that analysis, I believe that the systems, as presently designed and operated, are not fully meeting the needs of our profession. There are steps that we can and should take to improve these important processes, and I believe that we should begin to work to enhance and make better our educational and evaluative systems. Hopefully, from these efforts a model for others within the health care world will emerge.
This paper will have four parts. First, a presentation of the functions that a system of national organizations should carry out in the education and evaluation of those persons professionally responsible for the health care of children. Second, a discussion of how those functions are presently met through the activities of national organizations.
Epilepsy and Swimming
Authors: FREEMAN JOHN M. 
Published: December 2021

To the Editor.—
In the article on prevention of childhood injuries, Greensher states that "it is prudent to recommend limiting swimming (in patients with epilepsy) until these patients are seizure-free for 1 year."
We believe that all activities that children—and adults—undertake carry some risk. The risk is slightly greater for a child with epilepsy than for one without. The dimensions of that risk depend on the frequency and type of seizures. However, there are major risks in limiting activities for children and adults.
Gallbladder Disease Terminology
Authors: LOGAN GEORGE B. , THISTLE JOHNSON L. 
Published: December 2021

To the Editor.—
Diseases of the gallbladder and bile ducts, while uncommon among infants and children, still occur with sufficient frequency that they must be remembered by all pediatric clinicians. One of the problems in this regard is that of terminology.
If stones are present in the gallbladder or ducts there is no problem, though one has to know that pigmented and nonpigmented (usually cholesterol) stones are both found in children. Cholelithiasis, with or without cholecystitis, is the proper diagnosis.
Pediatric Generalists in an Academic Setting
Authors: ADLER ROBERT , KORSCH BARBARA M. 
Published: December 2021

A generation ago, the general pediatric practitioners participating in patient care, education, and research in academic centers, usually were members of a part-time faculty based in private practice outside of the center. They were respected consultants and teachers who constituted attractive role models for students and trainees. They modeled the practice of pediatrics not only from a technical perspective, but also exemplified the humane role of pediatricians with their young patients and their families, as well as within the community.
As technology became more complex and constituted a larger proportion of care provided in the hospital, community-based physicians found it increasingly difficult to keep up with technical progress and found themselves less effective and less respected in the academic world.
Protein-Fortified Milk in Premature Infants
Authors: GREER FRANK R. 
Published: December 2021

To the Editor.—
Rönnholm and colleagues1 have documented the increase in serum amino acid levels in premature infants fed human milk fortified with human milk protein. They have also demonstrated that serum amino acid concentrations were not affected by supplements of medium-chain triglyceride (MCT) oil. Of practical, clinical interest would be whether or not these supplements of fat or protein had any effects on the growth parameters in these infants? The authors have not addressed this issue in their report; yet, this would have a major impact on its clinical significance.
Why Orajel?
Authors: MACK RONALD B. 
Published: December 2021

To the Editor.—
I believe Pediatrics casts a long shadow in the lives of many of its readers; I know it does for me. Therefore, it disturbs me to see an advertisement (Pediatrics 1985;75:A47) concerning the use of benzocaine-containing baby Orajel for "teething" pain. I realize that the ad contains no direct endorsement by the Academy, but it does imply, at least to me, tacit approval by its very existence in the journal. The section in the ad marked "Important Note" implies that the Committee on Drugs of the American Academy of Pediatrics believes that Orajel is alright to use because it does not contain alcohol.
Health Insurance, Medical Care, and Children's Health
Authors: VALDEZ R. BURCIAGA , LEIBOWITZ ARLEEN , WARE JOHN E. , DUAN NAIHUA , GOLDBERG GEORGE A. , KEELER EMMETT B. , LOHR KATHLEEN N. , MANNING WILLARD G. , ROGERS WILLIAM H. , CAMP PATRICIA , SHERBOURNE CATHY A. , BROOK ROBERT H. , NEWHOUSE JOSEPH P. 
Published: December 2021

We welcome this opportunity to respond to previously published commentaries by Drs Haggerty, Starfield, and Dutton on our discussions of how cost sharing affects the use of medical services and health status.1,2 Our purpose in responding is threefold: to reiterate succinctly the major conclusions of the Rand Health Insurance Experiment, to respond to issues raised by the commentators, and to emphasize certain points of agreement with them. Our goal is to promote a better understanding of the experiment and spur further discussion about the structure of health insurance for children.
WHAT DID WE SHOW?
In the Rand Health Insurance Experiment, a total of 1,844 children from six areas participated in a randomized experiment on the effects of cost sharing in health insurance policies.
Endotracheal Tube Placement in Infants
Authors: GOLDENRING JOHN M. 
Published: December 2021

To the Editor.—
The use of illuminated endotracheal tubes as described by Drs Heller and Cotton may represent a significant advance. In addition to decreasing radiation exposures and costs thereof with initial intubations, there may be an additional saving by identifying endotracheal tubes that have come out of position, either riding up too high, or, more commonly, slipping down into a mainstem bronchus. The use of the tube tip light source may also be very helpful in the rapid evaluation of a decompensating neonate by quickly indicating that the cause of poor gases is a change in the endotracheal tube position.
Apnea Monitoring—It Doesn't Discriminate
Authors: DRANSFIELD DOUGLAS 
Published: December 2021

To the Editor.—
The discussion section of the paper by Orr et al1 left this reader with an implication that obstructive apnea predicts being at risk for sudden infant death syndrome (SIDS) or, at least, that they are causally related. The authors state (p 835), "These data are especially relevant to the observations of Guilleminault et al who found that the frequency of upper airway obstruction effectively discriminates [emphasis added] infants with a high risk for SIDS from normal control infants."
Children's Hospital Nuclear Warhead Bomb
Authors: JOHNSON CHARLES F. 
Published: December 2021

To the Editor.—
I appreciate the liberal editorial attitude displayed by your and your staff that has enabled me to publish:
1 cartoon
1 poem
and 1 scholarly article
during the past several years in Pediatrics. The following article from Time magazine (March 4, 1985) has stimulated my creative interests into a new direction.
Bigger bucks for smarter bombs. Missile-guidance computer programs so complex that they can be written and tested only by other computer programs.
Failure of the Overgown to Prevent Nosocomial Infection in a Pediatric Intensive Care Unit
Authors: Donowitz Leigh G. 
Published: December 2021

In a pediatric intensive care unit we conducted a 1-year prospective study of 454 patients to determine whether wearing a gown decreased the overall nosocomial infection rate, incidence of intravascular catheter colonization, breaks in handwashing technique, and traffic.
The overall infection rate was 26 (13%) of 198 admissions during the gown-wearing periods v 23 (9%) of 256 admissions for the periods when gowns were not worn (P &lt; .25). Of 348 intravascular catheter tips cultured 16 (4.6%) were colonized during gown-wearing periods compared with 21 (6.3%) of 330 when no gowns were worn (P &lt; .25). Of 78 patient contacts 54 (69%) were followed by no handwashing during gown-wearing periods and 59 (70%) of 84 contacts were followed by no handwashing during periods when no gowns were worn. The mean occurrence of visits per patient per hour and total visits per hour differed between gown-wearing and no-gown-wearing periods by analysis of variance, P &lt; .01 and P &lt; .005, respectively. Although traffic was decreased during periods of gown use, overgowns are an expensive, ineffective method of decreasing nosocomial infection rates, vascular catheter colonization rates, and breaks in handwashing technique.