Stickler, Gunnar B.

"U.S. 6th-graders do poorly on math, science tests." That was the sober, accurate headline given by the Minneapolis Star and Tribune to an Associated Press story on Dec 12, 1983. The judgment "poorly" was based on comparison with students in seven other countries. Prominent American scientists and academicians—Glenn Seaborg, Stephen Willoughby, Joseph Stoltman, and Gilbert White—developed the tests on mathematics, science, and geography. They were given to sixth-grade students in Australia, Canada, England, France, Japan, Sweden, Switzerland, and the United States in schools selected to represent the average in their countries. In geography, the Swedes were first with 54.1 and Americans were fourth with 45.8.

Fluid in the ear, glue ear, and conductive hearing loss have replaced the "infected, large, or hypertrophied tonsils" and "enlarged adenoids" as a major concern of primary physicians caring for children and the special domain of ear, nose, and throat physicians. Having myringotomy tubes put into the ears has become a favorite topic of discussion for parents marveling at the positive effects. Indeed, these devices must be something of a fashion or status symbol, because it is estimated that tubes of various configurations and materials are placed into the tympanic membrane of at least 1 million children per year in this country.

Observations on two girls in whom an unusual type of chronic renal insufficiency developed many months after the onset of nephrotic syndrome are reported. Each patient became free of edema in spite of persistent massive proteinuria. Growth was retarded and rickets and attacks of tetany developed. The chemical disturbances of the blood were characterized by hypocalcemia, hypokalemia, azotemia and metabolic acidosis. Hyposthenuria, proteinuria, amino-aciduria, and minimal erythrocyturia, cylindruria and glycosuria were present. Healing of the rickets and cessation of attacks of tetany followed the administration of vitamin D and calcium salts. Prednisone was administered to one patient and thereafter proteinuria decreased and renal tubular function improved. Both girls are relatively asymptomatic 11 and 9 years after the onset of nephrotic syndrome, although they are rather small and still have evidence of renal disease. It is possible that cells of the renal tubules have been damaged as a result of prolonged massive proteinuria.

Records of 34 hyperventilating children aged 18 years or younger seen at the Mayo Clinic over a 25-year period were reviewed. Five different clinical subtypes were identified. Evaluation and treatment varied considerably. At follow-up, 40% were still hyperventilating as adults, and many had signs and symptoms of chronic anxiety. Hyperventilation in childhood can be a signal that the child is experiencing severe anxiety, which may persist into adulthood.