bluuebunny/crossref_metadata_2025_split huggingface dataset:
Plagues on Our Children
Authors: Nopar Robert E. 
Published: November 2007

Twenty-five years ago, at the beginning of World War II, chemical and biological weapons began to be developed in this country. At that time, President Franklin Delano Roosevelt stated: "Use of such weapons has been outlawed by the general opinion of civilized mankind ... we shall under no circumstances resort to the use of such weapons unless they are first used by our enemies." A few years later the United States became the first country to use nuclear weapons. More recently, we have been employing non-lethal gases (tear and nausea gases) against the Viet Cong in South Vietnam. The world's press has been terming the use of these gases a form of chemical warfare. As for biological warfare activities, the current published position of the United States on this matter is stated in Army Field Manual FM 27-10: "The United States is not a party to any treaty, now in force, that prohibits or restricts the use in warfare of toxic or nontoxic gases, of smoke or incendiary materials, or of bacteriological warfare." Many military leaders believe that if non-lethal chemicals and diseases were employed as weapons there would be less killing and less destruction of homes and factories. It is not our purpose here to discuss whether these weapons are truly less humane than flame-throwers, napalm, and nuclear bombs. But once we have accepted the use of chemical and biological weapons, there is no guarantee that only non-lethal ones will be used. As Sidel and Goldwyn * pointed out recently, there has been little public discussion by the medical profession on the ethics or advisability of developing and using chemical and biological weapons. Yet we must remember that it is our medical and other scientists, both in civilian and in military positions, who are helping to perfect these weapons and also the defenses against them. To collaborate in or even simply to condone the imposition of disease on a population of civilians is certainly a contravention of Hippocrates' oath: "... I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course...." This issue is complex and uncomfortable, but each physician must evaluate his rights and duties—both as a citizen and as a doctor. The dilemma has perhaps been best expressed by Albert Einstein when he said: Science has brought forth this danger, but the real problem is in the minds and hearts of men. —ROBERT E. NOPAR, M.D.
Screening for Hemolytic Disease of the Newborn by Cord Blood Coombs Testing—
Authors: Clifford John H. , Mathews Pat , Reiquam C.W. , Palmer H.D. 
Published: November 2007

An accepted diagnostic feature of hemo lytic disease of the newborn due to isoimmu nization by any of the Rh factors is a posi tive direct antiglobulin reaction (Coombs test) with umbilical cord blood. Not so well documented is the usefulness of the direct antiglobulin test for the recog nition of hemolytic disease associated with ABO grouping differences. Some believe the test to be generally negative or weakly posi tive in infants who clinically and hemato logically have hemolytic disease related to ABO incompatibility, whereas others claim to find the direct test positive in 90 per cent of such infants. The latter contention is supported by the findings in the study here described. The direct Coombs test on cord blood is suggested as a useful screening test particu larly when Rh or ABO grouping of the parents is either not known, or so related to each other that a potential isoimmunization problem may ensue in the infant.
Acute Pancreatitis and Hypoglycemia
Authors: Laraya-Cuasay L.R. , Wolfe Richard , Hughes Walter T. 
Published: November 2007

Although hyperglycemia is a better rec ognized feature of acute pancreatitis, hypo glycemia may and does occur at times. Cli nicians should be aware of this possibility. These authors add three cases to the lit erature. Two patients died with acute hem orrhagic pancreatitis; the third is alive after an attack associated with mumps.
Immunologic Deficiency States
Authors: Fulginiti Vincent A. 
Published: November 2007

Immunologic deficiency states are variable, but several fairly distinct entities have been identified in recent years. This report summarizes current knowledge of immunologic development and presents several "new" diseases which illustrate nature's defects in development. Concepts have been simplified to make them understandable and recognizable in an individual patient. This well written, up-to-date work by a recognized authority on clinical immunology and infectious disease will be of great value to clinicians.
Scalp Defects in Trisomy 13
Authors: Abuelo Dianne , Feingold Murray 
Published: November 2007

A chromosomal abnormality should be suspected in every patient with multiple congenital anomalies. It is important to determine the specific type in order to provide the parents with a prognosis and proper genetic counseling. In patients with multiple congenital anomalies who have scalp defects, the most likely diagnosis is Trisomy 13.
225 Skateboard Injuries in Children
Authors: Illingworth Cynthia M. , Jay Ann , Noble Dilys , Collick Mary 
Published: November 2007

Among 225 skateboard accidents treated at the Children's Hospital, Sheffield, in 8 months from August 1977, there were 92 fractures (40.9 per cent), of which 19 required manipulation under general anesthetic. Most involved the upper limb. Next most frequent were lacerations, bruises, abrasions, and injuries of joints and soft tissues. Four children had concussions (one with a fractured skull), 8 others had minor head injury, and 23 had soft tissue injuries of the head and neck. As for the reasons for the accidents, 20 per cent were due to hitting a stone, 10 per cent to a hole or bump in the pavement, 8 per cent to collisions, and three accidents to faults in the skateboards. Sixteen of the children were injured on the first day of their skateboarding. The role of protective clothing was uncertain. The city has no skateboard parks. Injuries due to skateboards were compared to injuries due to playground equipment.
Systemic Hemophilus influenzae Infection
Authors: Lerman Stephen J. 
Published: November 2007

In Omaha, from 1974 to 79, 30 (12.5%) of 240 patients with Haemophilus influenzae bacteremia or meningitis had a wide variety of conditions known to be associated with increased susceptibility to bacterial infection. Neonates and adults accounted for 47 per cent of the infections. Non-type b and non-typable strains caused 41 per cent of the episodes. Forty-one per cent of patients had bacteremia with no detectable focus of infection. The incidence of meningitis was low. Mortality was 28 per cent, considerably higher than in patients who were previously healthy. A review of the medical literature indicated that low-birth weight infants and patients with leukemia and other malignancies undergoing chemotherapy, splenectomy, congenital asplenia, sickle cell anemia, immunoglobulin deficiency diseases, cerebrospinal fluid shunts, and skull de fects are at greater risk for systemic H. influenzae disease than the general population.
Neonatal Seizures
Authors: Boer Henry R. , Gal Peter 
Published: November 2007

A nationwide survey of neonatologists and pediatric neurologists was conducted to ascertain their methods of evaluating and managing neonatal seizures. Of the sampled 750 physicians, 284 (38%) responded to the single mailing. Most respondents use a routine for seizure workup which includes glucose, calcium and electrolyte determinations, and a lumbar puncture. On the other hand, there was a great variation in the use of an EEG, CT scan, skull x-ray, and a drug and metabolic screen. Phenobarbital was the initial drug of choice and phenytoin usually the second drug. Neurologists used higher loading doses for phenobarbital and phenytoin. Most physicians monitored blood levels to adjust maintenance doses. Drug therapy was usually continued for two months to one year after seizure control. Criteria for discontinuation were often arbitrary but included a normal electroencephalogram and the absence of seizures. The results demonstrate a lack of consensus in the evaluation and management of neonates with seizures.
The Telephone in Pediatric Medicine
Authors: Fosarelli Patricia D. 
Published: November 2007

From a review of numerous studies and reports of management of pediatric illness by tele phone, it is concluded that innovative methods of teaching effective diagnosis and management by telephone still need to be explored. More research should be done on patient outcomes to assess the adequacy of the initial decision-making process, rather than relying solely on the number of questions asked. This will necessitate studies using actual patient telephone vignettes rather than simulated ones. Finally, research needs to be done on the efficacy of the "telephone hour" used by many physicians to manage their day more efficiently. Such studies could compare patient outcome and parent and physician satisfaction, in practices where the "telephone hour" is standard, to those practices where patient calls are managed as they occur.
Atopic Dermatitis
Authors: Oakes Raymond C. , Cox Alan D. , Burgdorf Walter H. C. 
Published: November 2007

Atopic dermatitis, one of the common dermatologic abnormalities encountered by pediatri cians in clinical practice, is a chronic pruritic skin disorder occurring in individuals with a personal or family history of atopic disease such as asthma or allergic rhinitis. Atopic dermatitis appears to be an inherited disease, although the mode of inheritance has not been sestablished. Clinically, its course can be divided into stages: infantile, childhood, and adult. Recognition of atopic dermatitis in any of these stages should facilitate appropriate treatment. This general overview examines several aspects of the disease, including current concepts of clinical manifestations, differential diagnosis, pathogenesis, and treatment.
Hypernatremic Dehydration in Infants with Gastroenteritis
Authors: Khuffash Faisal A. , Majeed Hassan A. 
Published: November 2007

Of 1045 children admitted with gastroenteritis over a 12-month period and studied retrospectively, serum sodium level was tested in 802. Sixty patients (7.5%) had hypernatremic dehydration (HD). The peak incidence of HD, the highest serum sodium levels, and the worst outcome were all encountered in infants under the age of 3 months. An association with pre-admission high solute feeding was less obvious. Pre-admission volume intake could not be evaluated. There was no association of HD with the etiological pathogen or climatic conditions. The weight-for-age was below the fifth percentile in 21 patients (35%). One patient (1.7%) died, another (1.7%) developed peripheral gangrene, and four (6.7%) were left with significant neurologic complications. All of these patients were under the age of 4 months. In this subtropical country, the most important risk factor for the development of hypernatremia in the course of gastroenteritis is the young age. Environmental risk factors do not seem to play a significant role.
The Endocrine Spectrum of Septo-optic Dysplasia
Authors: Izenberg Neil , Rosenbtum Mindy , Parks John S. 
Published: November 2007

Six children with septo-optic dysplasia were evaluated at the Children's Hospital of Philadelphia. There was a common history of young, nulliparous mothers. The clinical presentation of these children differed according to age of presentation and was a function of the degree and type of hypctthalamic-prituitary and ophthalmologic impairment. Endocrine evaluation revealed four of six children to be growth hormone deficient, four of six to have hypothalamic hypothyroidism, and two of four to have elevated prolactin levels. One of the patients demonstrated adrenocorticotropic hormone deficiency, and one had diabetes insipidus. Neuroanatomic findings in the children were variable, but, in general, the rare syndrome did not carry as grave a morbidity as had been reported previously. Our data support a high degree of hypothalamic impairment in septo-optic dysplasia.
Correlation of Nasopharyngeal and Conjunctival Cultures with Middle Ear Fluid Cultures in Otitis Media
Authors: Groothuis Jessie R. , Thompson Juliette , Wright Peter F. 
Published: November 2007

Eighty children with acute otitis media (AOM) were prospectively studied to determine the correlation and clinical usefulness of nasopharyngeal (NP), conjunctival (CONJ), and middle ear fluid (MEF) cultures. NP cultures correlated more accurately with MEF (p < 0.01) than did CONJ cultures (p < 0.05) for both Streptococcus pneumoniae and Haemophilus influenzae (H. flu). The positive predictive value of NP cultures for positive MEF was only 47%, but the negative predictive value was 87 percent. NP cultures, therefore, appear to have significant predictive clinical value only when negative in identifying children likely to have sterile MEF. High correlation of NP, CONJ, and MEF in children with H. flu conjunctivitis (p < 0.01) suggests that early systemic rather than topical antibiotic treatment for H. flu conjunctivitis in small children may avert subsequent occurrence of the "conjunctivitis-otitis" syndrome.
Recurrence Rate of Febrile Convulsion Related to the Degree of Pyrexia During the First Attack
Authors: Sahib El-Radhi A. , Withana K. , Banajeh S. 
Published: November 2007

Ninety-four children consecutively admitted to the hospital between January 1980 and December 1982 with their first febrile convulsion (FC) were studied to assess the influence of the degree of pyrexia on the recurrence rate of FC. Thirty-eight of sixty-three children between 6 and 18 months of age (the peak incidence of FC) with fever above 40°C were almost seven times less likely to have subsequent convulsions with fever, than those whose initial febrile convulsion was associated with a lower degree of pyrexia. It is suggested that the degree of pyrexia is a factor that influences the recurrence of FC. This may explain why some children have a reduced frequency of subsequent FC compared with others who appear to be at comparable risk.
Providing Free Samples of Baby Items to Newly Delivered Parents
Authors: Hayden Gregory F. , Nowacek George A. , Koch William , Kattwinkel John 
Published: November 2007

Recent studies have suggested that providing free sample packs of baby items to newly delivered parents may adversely influence parental health behavior. To determine the extent of this practice in Virginia, the head nurses of all 68 newborn nurseries and a random sample of 200 pediatricians were surveyed. Formula samples were being distributed at all hospitals. Formula packs were given to breast-feeding mothers at 65 (95%) hospitals although only 66 percent of the surveyed pediatricians approved of this practice. Samples of baby items other than formula (e.g., baby powder) were being distributed at 66 (97%) hospitals. Some physicians (18%) objected to the distribution of these non-formula samples, and others were not familiar with the content of these packs. In most instances, the hospital medical staff had not voted to approve the distribution of these packs. Parents were being informed only rarely about the source and intent of the packs. The provision of sample packs to newly delivered parents affects approximately 3,000,000 babies each year in the United States. The short- and long-term effects of providing these packs have been inadequately explored. Physicians should make an active decision whether to distribute sample packs. Those physicians choosing to dispense these samples may wish to review and edit the content of the packs and to enclose in the pack a brief note explaining that the provision of the products does not constitute a medical endorsement.
Onset of Hemophilus influenzae Type-b Meningitis During Cefaclor Therapy for Preseptal Cellulitis
Authors: Brady Michael T. , Barson William J. , Cannon Harold J. , Grossman Lindsey K. 
Published: November 2007

Second generation cephalosporins are frequently used for the treatment of bacteremic Hemophilus influenzae type b infections. "Breakthrough" meningitis during cefamandole therapy has documented the need for adequate cerebrospinal fluid penetration by these antibiotics if they are to be used in the therapy of Hemophilus infections. A child with H. influenzae type b preseptal cellulitis is reported who initially responded to treatment with intravenous cefuroxime and oral cefaclor. However, while still receiving cefaclor, the child was readmitted with H. influenzae meningitis. Microtiter broth dilution susceptibility testing performed during the second admission showed the isolate to be relatively resistant to cefuroxime (minimum bactericidal concentration [MBC] = 4 μg/ml) and resistant to cefaclor (MBC > 16 μg/ml). This experience documents the need to monitor the clinical response closely during therapy of H. influenzae bacteremic infections with these second generation cephalosporin treatment regimens. In addition, attention should be paid to minimum inhibitory concentrations of these cephalosporins, since variations in H. influenzae type b susceptibility to these agents may limit their efficacy.
Outpatient Radiographic Exposure in the First Five Years of Life
Authors: Fosarelli Patricia D. , DeAngelis Catherine 
Published: November 2007

Young children receive a variety of diagnostic radiographs over time. In some cases the exposure to radiation may be unwarranted because the films may yield confusing results, or may also need to be repeated because of poor technical quality. Even when the results are clearly negative, the subsequent treatment may proceed as if the film had been positive because of the child's clinical condition. The cumulative effect of such low-dose radiation on infants and children over time is unknown. The number and types of outpatient radiographs received by a cohort of poor children from a hospital-based continuity clinic during their first 5 years of life were reviewed. Also noted were the reason for obtaining the film, whether it was positive for that reason or another, whether the child had a chronic condition that prompted the use of radiograph, and the child's sex, race, and age when the film was obtained. Of the 218 children, 132 (60.6%) received 349 sets of films in their first 5 years. There was no difference in the number of films by race or sex. Chest and posttrauma bone or joint films accounted for 315 sets of films or 90.3% of the total. Overall, 25.8% of the 267 chest films were positive; this varied by age. Only 15% of the chest films were positive in the first year compared with 29 to 49% in the second through fifth years (p < 0.001). Cough was the respiratory symptom most reliably associated with a positive chest film, both for the cohort (p < 0.0001) and for children in the first year of life (p < 0.01). Of the 132 children who had received a radiograph, 77 (58.3%) had some type of chronic condition, but only 33.5% of their films were directly related to those conditions. Of the children who received films, those with any chronic condition received more films in general (2.99 versus 2.10, p < 0.01) and chest films in particular (2.39 versus 1.44, p < 0.01) than did children without a chronic condition.
A Simulated "Acquired" Imperforate Hymen Following the Genital Trauma of Sexual Abuse
Authors: Berkowitz Carol D. , Elvik Sandra L. , Logan Nary 
Published: November 2007

Imperforate hymen, a condition in which the hymen has no aperture, usually occurs congenitally, secondary to failure of development of a lumen. A case of a documented simulated "acquired" imperforate hymen is presented in this article. The patient, a 5-year-old girl, was the victim of sexual abuse. Initial examination showed tears, scars, and distortion of the hymen, laceration of the perineal body, and loss of normal anal tone. Follow-up evaluations over the next year showed progressive healing. By 7 months after the injury, the hymen was replaced by a thick, opaque scar with no orifice. Patients with an apparent imperforate hymen require a sensitive interview and careful visual inspection of the genital and anal areas to delineate signs of injury. The finding of an apparent imperforate hymen on physical examination does not eliminate the possibility of antecedent vaginal penetration and sexual abuse.
Totally Implantable System for Venous Access in Children With Cystic Fibrosis
Authors: Cassey J. , Ford W.D.A. , O'Brien L. , Martin A.J. 
Published: November 2007

Thirteen children with cystic fibrosis had a totally implantable reservoir surgically inserted for repeated courses of intravenous antibiotics. The youngest patient was 17 months at the time of implantation. The catheters have been in place for an average of 463 ± 200 days. Forty seven courses of intravenous antibiotics have been given over a total of 832 treatment days. Three patients had complications. One experienced catheter separation from the portal, one catheter became occluded, and a third catheter fractured and migrated to the right atrium but was successfully retrieved percutaneously. The catheters were accepted well by patients and parents. We conclude that implantable reservoir systems, although moderately expensive and not totally free of complications, offer another modality in the management of cystic fibrosis patients.
Half-strength TAC Topical Anesthetic
Authors: Bonadio William A. , Wagner Virginia 
Published: November 2007

A prospective evaluation of 75 consecutive children with lacerations of the face, lip, and scalp who received TAC (tetracaine, epinephrine [adrenalin], cocaine) topical anesthetic for the repair of their wound was performed. The TAC preparation contained one-half the conventional concentration of cocaine (5.9%) and tetracaine (0.25%) previously used in other studies that have evaluated its anesthetic efficacy. A maximal dosage of 3 ml of TAC (containing 175 mg cocaine and 7.5 mg tetracaine) was applied to each laceration. The diluted TAC preparation provided complete anesthesia for approximately 95% of the more than 400 sutures placed. No adverse reactions were noted in any patient who received TAC, and in no instance did a complication of wound healing occur. The original formulation of TAC was arbitrarily composed, and the maximum concentration per dosage of the potentially toxic component medications of TAC that can be "safely" applied to dermal lacerations in children remains to be defined. Utilization of this diluted preparation will diminish the risk of potential systemic toxicity from the absorbed component medications of TAC without compromising anesthetic efficacy.
Breastfeeding Among Low-Income, High-risk Women
Authors: Grossman Lindsey K. , Larsen-Alexander Janet B. , Fitzsimmons Sharon M. , Cordero Leandro 
Published: November 2007

Data from a state supported project providing multidiscipline (clinical social work, nursing, nutrition, obstetrics, and pediatrics) assistance to low-income women judged to be at high perinatal risk by medical and social history were analyzed regarding infant feeding decisions. Data from 2,124 subjects delivered from 1976 to 1985 were available for analysis. The population tended to be single (77%), black (66%), poorly educated (63% less than a high school education), and young (mean age 21.8 years). Thirty-six percent were primiparas. The decision to breastfeed was associated with white race, older maternal age, higher educational level, marriage, and earlier utilization of prenatal care. Prenatal infant feeding plans were compared with actual postpartum decisions for 1,168 women. Only 3 percent of those initially planning to bottle feed changed their minds postpartum and breastfed although 31 percent of those initially planning to nurse ultimately chose artificial feeding. Ten percent of women were initially undecided; one-third of this group ultimately breastfed, two-thirds bottle fed. Overall the percentage of women in the project who were breastfeeding rose from 15 percent to 22 percent from the early to later years of the project (p < 0.0001).