bluuebunny/crossref_metadata_2025 huggingface dataset:
PROGNOSIS IN INFANTILE SPASMS
Authors: Burnett L. L. , Gibbs E. L. , Gibbs F. A.
Published: December 2021

A follow-up study has been conducted on 27 patients who had infantile spasms and normal electroencephalograms before the age of 1 year, and who did not have hypsarhythmia, the electroencephalographic abnormality which is usual in this condition. The purpose of the study was to determine whether the absence of electroencephalographic abnormality alters the prognosis. Less than half of the patients were found to be physically or mentally retarded and only one quarter still had seizures, which is somewhat better than was previously reported for cases with hypsarhythmia. However, the difference in prognosis is most evident as regards mental development: The present data indicate that there is a 55% chance that a child with infantile spasms and a normal electroencephalogram will develop normal mentality; the chance is only 15% with hypsarhythmia.
STUDIES OF DISTAL COLONIC MOTILITY IN CHILDREN
Authors: Davidson Murray , Bauer Charles H.
Published: December 2021

Three patients with fecal impaction and soiling are described. In each a short area of achalasia proximal to the anus was demonstrable by motility studies.

Surgical resection of the achalasic segment resulted in improvement in all, although ganglia could be demonstrated in this segment in each child.

The relationship of this syndrome to congenital aganglionic megacolon and to psychogenic obstipation is discussed.
EXPERIMENTAL SALICYLATE POISONING: OBSERVATIONS ON THE EFFECTS OF CARBONIC ANHYDRASE INHIBITOR AND BICARBONATE
Authors: Kaplan S. A. , del Carmen F. T.
Published: December 2021

In a series of experiments on dogs it has been shown that injection of the carbonic anhydrase inhibitor acetazoleamide (Diamox®) is followed by an increase in the renal excretion of salicylate. However, the increased excretion of salicylate is achieved only at the expense of paralyzing the powers of the kidney to deal with metabolic acidosis. As a result, administration of acetazoleamide increases the mortality of animals which have received large doses of salicylate. It is therefore strongly recommended that acetazoleamide not be used in the treatment of patients poisoned with salicylate.

On the other hand our animal experiments suggest that administration of sodium bicarbonate to patients with salicylate poisoning is not harmful even when given early in the course of the development of symptoms. As a result, we have been administering amounts of bicarbonate calculated to raise the concentration of bicarbonate in the plasma by 5 to 10 mEq/l, repeated not more than once every 12 hours.

The mechanism of production of acidosis in salicylate poisoning is discussed in the light of present knowledge of the inhibitory effects of salicylates on certain steps of intermediary metabolism of carbohydrates and fats. The means by which acidification of the urine (in an attempt to compensate for the existing metabolic acidosis) further impairs the excretion of salicylates is also discussed.
HISTAMINE AND RELATED COMPOUNDS IN URTICARIA PIGMENTOSA: ANALYSES OF TISSUES HAVING MAST-CELL INFILTRATION
Authors: Gardner Lytt I. , Tice Artelissa A.
Published: December 2021

Tissue from the liver and spleen of a child with urticaria pigmentosa have been analyzed chemically for histamine and related compounds. Both tissues were infiltrated with mast cells. Trichloroacetic acid extracts of tissue from the liver of the child with urticaria pigmentosa were chromatogaphed on paper. Histamine was demonstrated as a double-spot formation similar to that described by previous workers who have chromatographed histamine-rich tissues. The histamine was present in the tissue in several hundred times the normal concentration, and exceeded the values for human tissue reported in the available literature. No serotonin could be detected in these human mast cells, a finding in contrast with previous reports of increased serotonin content in rodent mast cells, and in agreement with the findings of Sjoerdsma et al. who could find no serotonin in skin from a patient with urticaria pigmentosa. Our studies suggest that the decarboxylation of 5-hydroxytryptophan to serotonin does not take place in the human mast cell. Instead the accumulation of compounds such as 5-hydroxytryptophan, kynurenine or hydroxylated kynurenine may take place. There was no increase in xanthine oxidase activity.

Acetone extracts of tissue from the liver were made and the residues chromatographed. In addition to histamine, there were noted three substances of unknown structure resembling tryptophane and/or its metabolites. Chemical evidence suggesting the presence of large amounts of a substance resembling mucoitin sulfuric acid (? heparin) in this tissue was obtained. The possible relationship of such compounds to the biochemical error in urticaria pigmentosa is briefly considered. There are at present no data to indicate whether the enzymatic defect is primary to the intermediary catabolism of histamine or of heparin.
Precocity of African Children
Authors: COBB JOHN C.
Published: December 2021

The article, "Gesell tests on African children" by M. Geber, et al. (Pediatrics, 20:1055, 1957), gives support to observations made by many of us in this country who have been working with both Negro and white children. It is undoubtedly true that Negro infants are, on the average, more capable (especially in motor activity) than white infants of the same age. This is probably, as Geber suggests, due to genetic and cultural factors. It may be more evident in some African tribes than in others.
Perinatal Loss in Modern Obstetrics
Authors: POTTER EDITH L.
Published: December 2021

Today the aim of every obstetrician is to have a healthy, happy mother and a vigorous, well-adjusted infant at the conclusion of each pregnancy. Until recently concern for the welfare of the mother has so engrossed medical thought that proportionately little attention has been paid to the fetus, but now medical and social care of women during pregnancy and confinement has advanced sufficiently to make fatal maternal complications a rarity and attention can be focused on the product of conception.
ECZEMA VACCINATUM
Authors: Reynolds Audrey H. , Joos Howard A.
Published: December 2021

Nine cases of eczema vaccinatum are presented, including two fatalities. Seven were caused by contact of a child with eczema with a recently vaccinated sibling.

Suddenly appearing umbilicated vesicles superimposed upon atopic eczema are almost diagnostic of eczema vaccinatum or eczema herpeticum. These do not occur with mere secondary bacterial infection.

Hyperimmune vaccinal gamma-globulin is now available for specific therapy.

Eczema vaccinatum is frequently iatrogenic and uniformly preventable.

The following steps are recommended for prophylaxis: 1) No child with atopic eczema or other skin disorder should be vaccinated. 2) No child should be vaccinated if any member of his family has eczema or other skin disorder. 3) Parents of children with eczema should be notified at the onset of the disease of the danger from vaccination contact. 4) If a sibling of a child with atopic eczema is vaccinated, he must be completely separated from that child for at least 21 days. 5) Forms used by state and local health departments for parents' consent to vaccination should include an appropriate warning of the contraindications. 6) Eczema vaccinatum should be a reportable disease. 7) Patients recently vaccinated must be excluded from pediatric wards containing patients with atopic eczema, other diseases of the skin, burns or healing surgical incisions. 8) Vaccination may be recommended at 2 months of age, especially for babies from strongly allergic families.
THE HAMMAN-RICH SYNDROME IN CHILDHOOD
Authors: Diamond Israel
Published: December 2021

The Hamman-Rich syndrome is described in a 4-year-old Negro male. The clinical picture was that of persistent cough and progressive dyspnea beginning at 4 months of age. Diagnosis was made ante mortem by lung biopsy. The fibrotic process and arteriolosclerosis were more marked in the right lung. The disease may have been initiated by a bout of aspiration. There was accompanying stenosis of the right pulmonary artery and vein and occlusion of the lumen of the right pulmonary vein at its entrance to the left atrium. The hilar vascular findings are believed to be secondary to hilar areolar inflammation.
CLINICAL SIGNS OF NEONATAL TETANY: WITH ESPECIAL REFERENCE TO THEIR OCCURRENCE IN NEWBORN BABIES OF DIABETIC MOTHERS
Authors: Craig W. S.
Published: December 2021

The occurrence of hypocalcemic tetany in seven newly born infants is described. Six of the infants were born to mothers with a history of diabetes mellitus. The mother of the seventh infant was obese and had a prediabetic type of glucose tolerance curve.

Clinical signs of tetany appeared within 24 hours of birth. They were severe in five infants and mild in two. Chemical findings in the blood are summarized. All seven infants were born prematurely. Diagnosis and differential diagnosis are discussed.

It is considered that hypocalcemic tetany probably occurs with a significant frequency in babies newly born to diabetic mothers. It is suggested that the occurrence of hypocalcemic tetany is favored by the temporary decline which normally occurs soon after birth in the concentration of calcium in the serum, more particularly in premature babies; and that disturbance of the normal maternal hormonal adjustments of pregnancy and especially of adrenopituitary function in diabetic mothers, may be a determining factor.
COUNSELING PARENTS OF MENTALLY DEFICIENT CHILDREN
Authors: Watson Ernest H.
Published: December 2021

DIAGNOSIS of mental retardation, which must precede counseling, is the responsibility of the pediatrician or family physician. In the absence of certain stigmata such as hydrocephalus, microcephaly or unmistakable signs of mongolism, the diagnosis can seldom be made in the neonatal period. The physician should have his suspicions aroused by failure of the newly born infant to suck, cry, exhibit Moro and tonic neck reflexes on proper stimulus. However, predictions based on behavior in the first days of postnatal existence are best kept in the physician's mind or, perhaps, carefully inscribed on the hospital chart. Cyanosis, twitchings on frank convulsions in the postnatal period are ominous, but not necessarily followed by permanent damage. The physician must be as certain as possible in medical prognostication before making parents aware of his fears for the future mental development of their child.

As the infant progresses through the first few months of life he will give clearly discernible signs of mental development if he is normal. By the second month he should be looking at objects, and soon thereafter be able to follow a moving object with his eyes. By the third month he should respond with some facial expressivity to words, to the usual "clucking" sounds or low whistles, commonly directed at small infants. Somewhere between the second and sixth months the physician should be able to detect retarded mental development, preferably before the mother suspects anything is wrong. Dr. Watson believes that the physician should confine his opinions to himself, or a few judicious words entered on the chart, until he is quite certain of the retardation or until the mother raises the question.
THE INFLUENCE OF SURGERY ON RENAL FUNCTION IN INFANCY AND CHILDHOOD
Authors: Rubin Mitchell I. , Calcagno Philip L. , Mukherji P. K. , Singh Walter S. A.
Published: December 2021

There was no statistical difference in the mean excretion rate of sodium following a test load of hypertonic sodium chloride solution between "control" infants and infants, studied 12 to 24 hours after a variety of surgical procedures.

Normal infants between the ages of 1 and 9 months, when given a hypertonic sodium chloride load, excrete sodium at a rate comparable to adults.

Two of thirteen infants in the post-surgical period excreted sodium at a rate lower than one standard deviation below the mean for the group. Possible reasons for the lowered excretion rate in these two infants are discussed.

Four olden children, given a smaller sodium load than the infants, had a lower excretion rate of sodium pre-surgically. Three of these four children excreted sodium at a lower rate after surgery than they did before surgery. The possible reasons for this are discussed.

As measured by glomerular filtration rate, concentration of sodium in the urine, U/P ratio for sodium and the relationship of sodium to water excretion, there does not appear to be an intrinsic defect of renal capacity in handling sodium in the post-surgical state, even in the patients with a lowered sodium excretion rate.

From the data collected in this study, there seems to be no reason for altering the generally accepted principles of parenteral fluid therapy in regard to sodium and chloride for the uncomplicated post-surgical patient, following recovery from anesthesia, from that designed for sick children in general.
CONCERNING THE NATURE OF THE PROPERDIN SYSTEM
Authors: Wedgwood Ralph J.
Published: December 2021

The properdin system, which is composed of properdin, magnesium and complement, has a variety of activities in vitro. Among these are the lysis of certain bacteria and abnormal erythrocytes, the inactivation of some viruses, and the ability to interact with polysaccharides from such diverse sources as bacteria, yeasts and normal or neoplastic mammalian tissues.

Methods are available to demonstrate these activities and to measure the presence of properdin in sera, under various conditions.

The broader biologic interpretation of data regarding the properdin system is difficult; acquaintance with the system is in its infancy. The interactions of properdin have revealed a biologic unity among a variety of seemingly dissimilar agents.

It seems improbable that a system with such diverse activities would exist without a biologic function in vivo, but such a function has yet to be demonstrated.

Further studies are needed to determine what part properdin plays in the host response called "natural resistance."
CAN THE NEW PEDIATRICS BE PRACTICED?
Authors: MAY CHARLES D.
Published: December 2021

WITHOUT "putting an ear to the ground," one can hear vague rumblings of discontent with the practice of pediatrics, not just from those still under the spell of their recent education. Could it be that the skills of pediatricians have reached a degree of excellence which cannot be put into practice simply because the public is not prepared to pay the price? Can "comprehensive care," including mental hygiene, be dispensed hurriedly in visits kept brief by economic necessity? What can be expected but frustration and disappointment if what one is allowed to do does not keep pace with that which one believes should be done?
EVALUATON OF THE EFFICACY OF LAVAGE AND INDUCED EMESIS IN TREATMENT OF SALICYLATE POISONING
Authors: Arnold Franklin J. , Hodges John B. , Barta Rudolph A. , Spector Samuel , Sunshine Irving , Wedgwood Ralph J.
Published: December 2021

Studies in experimental salicylate poisoning were carried out to ascertain the therapeutic value of gastric lavage and to compare it with the effect of emesis. Fasted dogs, 6 to 10 kg in weight, were given sodium salicylate in tablet form, and lavage was performed or emesis induced at varying time intervals following ingestion. Salicylate recovery was determined in the lavage and emesis fluids.

The data indicate that in the recovery of ingested salicylate: 1) Initial aspiration of the stomach before introduction of fluid is equally as important as succeeding lavage. 2) Lavage carried out within 15 minutes is no more effective than emesis induced within 30 minutes of ingestion; 3) lavage carried out 1 hour after ingestion is inefficient and far less effective than emesis produced within the same time interval. 4) Spontaneous emesis is not as effective as induced emesis. 5) Emesis induced immediately, or even when delayed as long as 1½ hours after ingestion, appears to be the more effective and thus the preferable form of therapy. 6) Neither lavage nor emesis under the most optimal conditions are consistent in their effectiveness, so that all patients after either form of therapy should be followed carefully for signs of increasing drug intoxication, and treated if a specific form of therapy is available.
SCROFULA CAUSED BY ATYPICAL MYCOBACTERIA
Authors: Chapman John S. , Guy L. Ruth
Published: December 2021

A series of cases of scrofula caused by atypical Mycobacteria is presented and a characteristic syndrome suggestive of this type of infection is described.

The organisms isolated from the children with scrofula and from the pharynges of apparently healthy children belong to the general group of chromogenic Mycobacteria, but differ too much among themselves to be regarded as a single strain.

These organisms are well differentiated by many standard procedures from both bovine and human strains of M. tuberculosis.

The pathology of the lymph node caused by infection with these organisms is described.

The pathogenesis of this disease seems to be invasion by chance of the deeper structures by oropharyngeal contaminants, perhaps preceded by ordinary infections in the oropharynx. No evidence points clearly to person-to-person transmission.
PUBLIC HEALTH, NURSING, MEDICAL SOCIAL WORK
Authors: Felten Zelma
Published: December 2021

GROWING acceptance on the part of adoption agencies as well as the general public that "any child is adoptable who is legally free and who can benefit from family life" has brought about new ideas and modification of criteria for adoptive parents as well as children placed for adoption. Not the least of these has been the advancement of the interdisciplinary approach to adoption. Particularly in the placement of older children and handicapped children have agencies become aware of the need for a complete pediatric and psychologic evaluation of each individual child. When considering a handicapped child for placement it is exceedingly important that the implications of the handicap be known insofar as possible: the severity of the handicap, what the handicap will mean to the child as he matures, whether it is a progressive disorder, what medical care will be required, and so forth.
LEUKEMIA AND MEDICAL RADIATION
Authors: Polhemus Donald W. , Koch Richard
Published: December 2021

Radiation histories were compiled on 251 leukemic children and compared with an equal number of matched controls. In general, exposure to radiation was significantly more frequent among the leukemic group.

Thymic irradiation was found to be associated with six times the usual incidence of leukemia, the data being highly significant (p <.01). Statistical analysis of the data relative to fluoroscopic studies of the heart or gastrointestinal system, even though not highly significant, does indicate the possibility of a relationship between this type of radiation and an increased incidence of leukemia (p <.05). Diagnostic roentgenograms had been performed more frequently in the leukemic group, but the level of significance was not great (p <.05).

Maternal exposure to roentgen rays during pregnancy had occurred somewhat more commonly in the leukemic group, but the difference was too small to be significant (p <.10).
PRIMARY PULMONARY OBLITERATIVE VASCULAR DISEASE IN INFANTS AND YOUNG CHILDREN
Authors: Husson George S. , Wyatt Tyree C.
Published: December 2021

Extensive clinical studies of three children with primary pulmonary obliterative vascular disease are reported. Two were siblings. The pathology is described from two necropsies. On the basis of the present study and a review of the literature a concept of the pathogenesis is developed.
PSEUDO-PSEUDO-HYPOPARATHYROIDISM IN A CHILD
Authors: Ray Esten W. , Gardner Lytt I.
Published: December 2021

This is a report of the youngest known patient with pseudo-pseudo-hypoparathyroidism and the first child with the syndrome to be described in the American literature. In 1952 Albright et al. first reported this syndrome in an adult. The prefix "pseudo-pseudo-" was adopted because in a previously described syndrome, pseudo-hypoparathyroidism, the clinical findings described below plus convulsions had been associated with elevated concentrations of inorganic phosphorus and depressed concentrations of calcium in the serum.

The patient is a white girl, age 7½ years, with retarded intellectual development and obesity (41.3 kg). There was no history of tetany or convulsions. Physical examination revealed round face, strabismus and stubby fingers. The fingernails and toenails were short and very wide. There were circular bluish areas over the thorax, abdomen and thighs. Concentrations of calcium, magnesium, total protein, albumin and globulin were normal as was the alkaline phosphatase activity. Concentrations of inorganic phosphorus in the serum ranged from 6.9 to 7.8 mg/100 ml. An Ellsworth-Howard test was negative, but the parathyroid extract used may not have been potent. Roentgenograms of the hands revealed abnormally short, bowed metacarpals and short phalanges, with bone age of 13 to 14 years. There was calcification of soft tissues of the feet.

The ratio of width to length of the thumbnail was 2.8. Similar ratios obtained with children of similar age ranged from 1.1 to 1.4. It is suggested that the ratio of width to length of the thumbnail be included in the physical examination of children with convulsions of unknown etiology, in an effort to identify more patients with pseudo-hypoparathyroidism.

The mother had marked shortening of the fifth digit of each hand, with the site of the fifth knuckle replaced by a dimple. Her face was not especially round and she appeared to be of average intelligence. Roentgenogram of the mother's hands showed shortening of the right fourth and fifth metacarpals and the left fourth metacarpal, with extensive calcification of soft tissues in both hands and wrists.

Pseudo-pseudo-hypoparathyroidism and pseudo-hypoparathyroidism exhibit a "vertical" familial pattern. This genetic pattern may be seen in diseases due to genes in the heterozygous state (i.e., so-called dominant genes). There is as yet no evidence that the two syndromes represent sex-linked genetic patterns.
A TEST FOR CONCENTRATION OF ELECTROLYTES IN SWEAT IN CYSTIC FIBROSIS OF THE PANCREAS UTILIZING PILOCARPINE BY IONTOPHORESIS
Authors: Gibson Lewis E. , Cooke Robert E.
Published: December 2021

A method of performing the test for chloride or sodium in the sweat of patients with cystic fibrosis of the pancreas is presented. It utilizes pilocarpine by iontophoresis and has the advantage of being both rapid and painless. Data are presented to show that the method is reliable.
ATTITUDE STUDY OF PARENTS WITH MENTALLY RETARDED CHILDREN
Authors: Koch Richard , Graliker Betty V. , Sands Russell , Parmelee Arthur H.
Published: December 2021

Attitudes toward the medical care of mentally retarded infants as recorded from 105 families are presented. Only 52% of these families were satisfied. Slightly more were satisfied with the care received from general practitioner (55%) than with that from pediatricians (47%), but the difference is not significant. Changes in the curriculum of the Department of Pediatrics of the University of Southern California School of Medicine and in the training program of the Los Angeles Childrens Hospital stimulated by these findings are described.
Pediatric Surgery
Authors: MAY CHARLES D.
Published: December 2021

The dedication pays the tribute seemingly expected in this matriarchal culture by a nod to the wife and children "who patiently endured the preparation of this book." What a shameful excuse for not washing the dishes and changing diapers!

After this groveling start the author assumes his full stature and we have the benefit of his calloused self indulgence. Those who know the author away from his home consider him to be intelligent, forthright, confident and penetrating, but not dogmatic. These qualities permeate his book and make it a stimulating and balanced presentation.
A MODIFICATION OF THE LÓPEZ BANÚS METHOD FOR COLLECTING SAMPLES OF VENOUS BLOOD FROM YOUNG INFANTS
Authors: Ducharme Jacques R. , Grumbach Melvin M.
Published: December 2021

CHEMICAL studies in premature and newborn infants have been hampered by the difficulties inherent in current techniques for collecting blood. Although capillary blood has been used for a wide variety of microchemical analyses, certain determinations require larger quantities of blood or venous blood.

Lépez Banús described a technique for obtaining samples of venous blood which, with modifications, has proven most useful in our experience. This procedure avoids the risks of repeated punctures of the femoral or internal jugular veins, and provides a means of sampling as much as 3 to 4 ml of venous blood without significant trauma to the infant. Proficiency in the performance of the scalp-vein technique is required; once this is achieved, success can be expected in a high proportion of attempts.

MATERIALS

1. 20-or 21-gauge Gardner-Murphy needle.

2. 13-gauge needle.

3. Short test tube, approximately 5 cm in length and 1.5 cm in external diameter.

4. Propipette (Instrumentation Associates, 17 West 60th St., New York 23, New York).

5. Apron-type rubber stopper (National Surgical Supplies Co., 458 Broadway, New York 13, New York).

6. Polyethylene catheter No. PE-60, approximately 15 cm in length.

7. Plastic tubing approximately 30 cm in length and 5 mm in internal diameter (the distal portion of an infusion set can be used).

8. Becton Dickinson vacutainer adapter (No. 3200A).

9. Male Luer slip adapter for 5 mm tubing (B-D No. 5000A).

10. Mosquito forceps.

11. Siliclad®, water-soluble silicone preparation (Clay-Adams Inc., 141 East 25th St., New York 10, New York).

ASSEMBLY OF APPARATUS

The apparatus is shown in Figure 1. A 21-gauge Gardner-Murphy scalp-vein needle is attached to a PE-60 polyethylene catheter. The free end of the catheter is threaded through a 13-gauge needle into a short test tube covered with an apron-type rubber stopper (insert, Fig. 1). A 30-cm section of plastic tubing is connected at one end to a B-D vacutainer adapter which is inserted into the rubber stopper and, at the other end, to a male Luer slip adapter which is attached to the S-arm of the Propipette. The Propipette provides a means of obtaining constant suction and can be operated easily with one hand.
Letters to the Editor
Authors: RAY ESTEN W. , GARDNER LYTT I.
Published: December 2021

We acknowledge Dr. Smyth's concern for the elevated serum inorganic phosphorus values in the case which we described as pseudo-pseudo-hypoparathyroidism. At one insane moment, while we were writing up the case we debated the possibility of creating still another syndrome: "pseudo-pseudo-pseudo-hypoparathyroidism." This because our patient's elevated serum inorganic phosphorus differed from Albright's description of pseudo-pseudo-hypoparathyroidism, and our patient's lack of tetany on hypocalcemia differed from his description of pseudo-hypoparathyroidism. This dangerous inclination of ours was further provoked when Dr. Robert Klein at the American Pediatric Society, May, 1958, independently suggested the term: "pseudo-pseudo-pseudo-hypoparathyroidism."
ACUTE GLOMERULONEPHRITIS WITH THE NEPHROTIC SYNDROME
Authors: Wilson S. G. F. , Heymann Walter
Published: December 2021

Five cases in children of acute glomerulonephritis associated with mild and transient nephrotic syndrome are described. At the beginning of the illness each patient developed more marked edema than usually seen, marked proteinuria, hypoproteinemia, hypoalbuminemia and hyperlipemia and thus presented the characteristic features of the nephrotic syndrome. A diagnosis of acute glomerulonephritis was established by (a) the short duration of the disease, (b) the presence in four of the five patients of elevated titers of antistreptolysin "O" and the presence of beta hemolytic streptococci in throat cultures, and (c) followup examination, which showed that all had recovered completely without exacerbations.

Mild nephrotic syndrome may complicate approximately 4 to 5% of cases of acute glomerurlonephritis in children.
DERMOID CYSTS OF THE OVARY PRESENTING AS A CAUSE OF ACUTE ABDOMINAL PAIN IN CHILDHOOD
Authors: Ferguson Colin C. , Goodhand Thomas K.
Published: December 2021

Benign dermoid ovarian cysts uncommonly cause symptoms in young girls. It is estimated that they constitute 0.35% of all tumors occurring in children of both sexes less than 15 years of age.

Symptoms produced by the cysts may mimic other intra-abdominal disease, and in three of the four cases reported in this series the girls were initially considered to have either acute appendicitis or infection of the urinary tract. All three had a pelvic mass palpable per rectum. The fourth girl was found to have bilateral calcified densities in the ovaries when examined roentgenographically for low back pain.

In three of the four children, calcified or ossified material in the pelvis was seen in roentgenograms of the lower abdomen, and this finding was considered by the radiologist to be indicative of ovarian dermoid cyst.

In two patients the cysts and associated Fallopian tubes had undergone torsion with infarction, and salpingo-oophorectomies were performed. In one girl, a simple oophorectomy was carried out, and, in the fourth child with bilateral dermoids, a bilateral ovarian cystectomy with preservation of tubes and as much ovarian tissue as possible was performed.

All four girls have subsequently made satisfactory progress.
PERFORATION OF THE RECTUM OR COLON IN INFANCY DUE TO ENEMA
Authors: Santulli Thomas V.
Published: December 2021

Nine cases of perforation of the rectum or colon in infancy due to enema are presented and the scant literature is reviewed.

Although rare, perforation is a catastrophic complication of a simple procedure which carries a high mortality.

The mechanism of perforation and the factors contributing to the complication are discussed.
SYMPOSIUM ON OFFICE EVALUATION OF INTELLIGENCE AND SPECIAL SENSES
Authors: Bordley John E.
Published: December 2021

STATISTICAL studies undertaken in many communities of this country show rather marked variation as to the percentage of children suffering from significant handicaps in communication. However, none of those making such surveys would feel it an exaggeration if one ventured to state that the instance of handicapping impairments of hearing range somewhere between 1 and 2% in the preschool and early school age children. The number of crippling hearing problems apparently is growing. This growth paradoxically seems to be proportional to the improvement in the obstetrician's and pediatrician's ability to save children, particularly children born after severe trauma, and premature children.

The national picture of the hearing handicapped child is changing. Thirty years ago our deaf schools were filled with children whose hearing impairments were caused by sequelae of meningococcic meningitis or of other infections that involved the ears. This no longer pertains, and we are faced today with a population of children whose hearing handicaps include lesions not localized to the middle or inner ear on even to the auditory nerve. Very few of these children arc completely deaf. They suffer either distorted hearing as the result of damage to the end-organ, or, due to some central damage they are unable to understand speech because they cannot properly comprehend on synthesize speech patterns without special training. Often such youngsters suffer from multiple neurologic handicaps.

Many children have an amazing ability to learn communication both from an auditory and a speech point of view, provided that their problem is detected early and carefully evaluated, and that they are placed in a well-designed training program. After the age of 6 on 7 years, children with such injuries can rarely be trained with as good results as are obtained in the preschool group. Early detection therefore is of the utmost importance.
OFFICE EVALUATION OF SPECIFIC READING DISABILITY IN CHILDREN
Authors: Eisenberg Leon
Published: December 2021

An operational definition of the clinical syndrome of specific reading disability is proposed. Its clinical symptomatology is described, with emphasis on the invariably present emotional concomitants. A scheme for differential diagnosis is outlined. Theories of etiology and the evidence on which they rest are briefly reviewed. The basis for a treatment plan is provided.

Throughout, emphasis is placed on the role of the pediatrician, both as a key figure in early diagnosis and prompt treatment, and as community leader in the development of adequate educational resources for the non-reader.

There is even reason to believe that methods for the early detection and rehabilitation of children with reading disorders may make a significant contribution to the problem of juvenile delinquency. The high rate of reading disability among delinquents suggests that at least some of the poor motivation for academic achievement among these children, and their reactive antisocial behavior, may have one source in the repeated experience of frustration and failure that accompanies their reading difficulty.
PSYCHOLOGIC EFFECTS OF HOSPITALIZATION IN INFANCY
Authors: Schaffer H. R. , Callender W. M.
Published: December 2021

Although increasing recognition is being given to the psychologic needs of children in hospital, many gaps still exist in our knowledge about this topic. The present paper is concerned with one of these, namely, the significance of maternal deprivation occurring in the early months of life.

Under standardized conditions of observation and analysis of data, 76 infants less than 12 months of age were observed while undergoing short-term hospitalization. Observations were focused on three points: the period immediately after admission, the period preceding discharge, and the period after return home. From the data thus obtained two main syndromes emerged, each linked to a certain age range, with a dividing point at approximately 7 months. Those above this age showed essentially the same type of behavior as that described in other studies of the preschool group, namely, considerable upset when admitted to hospital and a period of disturbance after return home, both centering around the need for the physical presence of the mother. In the group less than 7 months of age, on the other hand, separation from the mother evoked no observable disturbance and, instead, an immediate adjustment to the new environment and the people in it was found. On return home a marked change of behavior occurred in most of these younger infants, but it was generally of very brief duration.

On the basis of the data presented it is suggested that the critical period, when separation from the mother is experienced as a traumatic event, does not commence until after the middle of the first year of life, and that consequently in those cases where there is a choice, hospitalization should be arranged to occur before the crucial age is reached.
The Child with a Handicap
Authors: DENHOFF ERIC
Published: December 2021

Occasionally, a simple, heart-warming document appears unexpectedly to win the public's heart. In the parlance of show business, such a presentation is called a "sleeper," i.e., a film or play that makes a hit.

The Child with a Handicap, edited by Dr. Martmer, a past-president of the American Academy of Pediatrics, deserves the right to be called a "sleeper." Those of us who devote a major part of our practice to the handicapped child are often exposed to articles and textbooks which more often complicate an already complicated subject. The Child with a Handicap helps neutralize material which tends towards frightening pediatricians away from knowing more about an important phase of pediatric practice.
Toward Understanding Stuttering
Authors: BROWN SPENCER F.
Published: December 2021

This little book is an excellent example of how a complex subject can be treated simply, effectively, and without condescension by one whose knowledge is sufficiently broad and deep. Dr. Johnson has done more research on stuttering than any other worker and writes from a background of impressive erudition and experience. In this booklet he discusses how the problem of stuttering develops and what can be done by parents to prevent trouble. This is a good book to give parents who are concerned about the non-fluent speech of preschool children. It will give the practicing pediatrician a sound basis for understanding the problems it covers.
Letters to the Editor
Authors: BAKWIN HARRY
Published: December 2021

Dr. Jacques May's experience with his autistic twins is not unique. Fortunately the leaders in psychiatry are coming to appreciate the role of psychiatry in increasing parental feelings of anxiety and guilt and a change of attitude is in the air.

I would agree with Dr. Grunebaum that the parents are important for the child as his first environment and that their influence On personality and character formations is profound. But this is not to say that the parents, as environment, are of prime importance in the genesis of serious behavior disorders in children. There are many reasons why children misbehave and it is for the clinician to approach a behavior problem as he does a problem in other branches of clinical medicine, namely by trying to make a diagnosis.
CLINICAL AND EPIDEMIOLOGIC OBSERVATIONS ON ENTEROVIRUS INFECTION IN A CIRCUMSCRIBED COMMUNITY DURING AN EPIDEMIC OF ECHO 9 INFECTION
Authors: Lepow Martha Lipson , Carver David H. , Robbins Frederick C.
Published: December 2021

A clinical, epidemiologic and laboratory study was undertaken in a housing development during an epidemic of illness due to ECHO virus, type 9.

The clinical manifestations varied with age. The younger children exhibited an exanthem while older persons frequently had evidence of irritation of the central nervous system. Multiple cases occurred within families, with the incidence of illness highest in the younger age groups. No serious consequences of the illness were seen.

Echo 9 virus was recovered with greater frequency from the intestinal contents of young children with illness than from ill adults, although serologic evidence of recent infection in these adults could be demonstrated. The rate of inapparent infection with ECHO 9 virus was low. Virus rarely persisted in the feces beyond 14 days after onset of illness.

Group B Coxsackie viruses, type 4 and type 5, were found also to be the cause of many infections within the same population at the same time. Illnesses due to these viruses were similar to those due to ECHO 9 virus, except that no eruption was observed. The rate of inapparent infection was higher than that observed with ECHO 9 virus. Simultaneous infection with ECHO 9 virus and Coxsackie B4 or B5 virus was rare.
ENDOCARDIAL FIBROELASTOSIS ASSOCIATED WITH GENERALIZED GLYCOGENOSIS
Authors: Wilson Reginald A. , Clark Nigel
Published: December 2021

The occurrence of generalized glycogenosis in three siblings is reported, two of whom also were found to have endocardial fibroelastosis at necropsy. The present status of our knowledge of abnormal glycogen storage is reviewed. Attention is drawn to the occurrence of fibroelastosis of the endocardium in cases with abnormal storage of glycogen in the myocardium. Possible factors in the pathogenesis of fibroelastosis are discussed, and a grouping of cases according to these factors is given.
PROGNOSIS OF INFANTS BORN OF TUBERCULOUS MOTHERS
Authors: Kendig Edwin L.
Published: December 2021

Of 41 infants born of mothers with supposedly inactive tuberculosis, 20 became infected with the disease. Of the 16 infants who were separated at birth from their mothers for periods ranging from 7 weeks to 2 years, 8 developed tuberculous infection.

This study suggests that isolation of infants until the mother's sputum is negative for tubercle bacilli and she is considered to have inactive disease may not be enough to prevent infection in the infant.

Supportive evidence is not presented here but, on the basis of studies by others with BCG vaccine, it is suggested that temporary isolation from the mother and BCG vaccination appear to constitute the best approach to prevention of infection of the infant.
Rural Perinatology
Authors: Hein Herman A. , Christopher M. Christina , Ferguson Norma N.
Published: December 2021

An evaluation of perinatal care practices in Iowa community hospitals is presented. Seventy-two hospitals were visited by a University-based perinatal care team. After an initial assessment, educational programs aimed at correcting deficient care practices were carried out in the community hospitals. A review of the data indicates an improvement in the care of the perinatal patient. The authors feel the methodology employed can be utilized in other rural areas to improve basic perinatal care.
Subcutaneous Calcium Deposition in the Neonate Associated With Intravenous Administration of Calcium Gluconate
Authors: Ramamurthy Rajam S. , Harris Vivian , Pildes Rosita S.
Published: December 2021

Nine infants who had severe local manifestations following intravenous administration of calcium gluconate are presented. The lesions appeared at the intravenous sites as firm subcutaneous nodules or areas of inflammation with central softening and fluctuation. The interval between appearance of the lesion and calcium administration was 13 ± 2.5 (mean ± SEM) days. Five infants were treated with antibiotics and three of the five had incision and drainage. Roentgenographic evidence of subcutaneous calcification was seen in all cases at the time the lesions were first noticed. In two infants the entire cephalic vein was calcified. Induration and inflammation completely subsided in six infants, four of whom had follow-up roentgenograms showing complete resolution of calcification. A conservative approach in management is recommended.
Special Devices as Aids in the Management of Child Self-Mutilation in the Lesch-Nyhan Syndrome
Authors: Letts R. M. , Hobson Douglas A.
Published: December 2021

The Lesch-Nyhan syndrome is a rare inborn error of purine metabolism associated with hyperuricacidemia, mental retardation, and an insatiable urge for self-mutilation, especially of the extremities. Insensitivity to pain and severe muscle spasms create very difficult management problems, especially for children being cared for at home. Fortunately this syndrome is rare (1 per 380,000 live births). Four known patients are under treatment in Manitoba, of which two brothers are the subject of this study.

In general, the medical management of these patients has been unsuccessful, especially in controlling self-mutilation. It therefore was decided to manage these children by the use of mechanical aids. Through the utilization of custom-designed seating devices control of the self-mutilation has been obtained, reducing the burden of family care. It is now possible for the children to attend regular school on a half-day basis. They are also able to engage in community activities without the fear that a mishap will occur when not under the vigilance of the immediate family.
Acetaminophen Poisoning and Toxicity
Authors: Rumack Barry H. , Matthew Henry
Published: December 2021

Acetaminophen (paracetamol in British literature) is a metabolite of phenacetin which has become increasingly popular as a substitute for salicylates.1 The popularity of acetaminophen has been encouraged by the medical profession because it is allegedly safer than aspirin.2 However, experience in Britain indicates that acute acetaminophen overdosage is both common and significantly more toxic than of salicylates.3-7 Although it is widely used in the United States, only one report describing a single American patient has appeared in the literature.8 This is a puzzling situation. It is axiomatic that if you do not look for something you will not diagnose it. This may provide the answer as there is apparently a general lack of knowledge in the United States concerning the toxicity of acetaminophen. Indeed, one of us (B.H.R.) contacted nine American University poison services in the spring of 1973 and discovered that none had clinical experience or analytical methods in operation. During the past year, however, with a high index of suspicion in Denver, 156 ingestions with four fatalities have been recorded.

Because of the nonspecific initial features of acute overdosage, the lack of coma, the delay in onset of jaundice and the rapid fall in detectable plasma levels of acetaminophen, the cause-and-effect relationship may be missed in even a floridly ill or dying patient. Hepatoxicity is the most remarkable feature and the question must be raised as to how many cases of "jaundice of unknown etiology" are actually due to this drug.

This review is intended to provide an understanding of the current knowledge of this drug. It should be noted that although toxicity and fatalities have occurred in the adolescent age group, only one death in younger children has been recorded.
Cosmetic Nasal Deformities Complicating Prolonged Nasotracheal Intubation in Critically III Newborn Infants
Authors: Baxter Richard J. , Johnson John D. , Goetzman Boyd W. , Hackel Alvin
Published: December 2021

Complications following prolonged endotracheal intubation in neonates have been widely reported.1-4 With increasing intact survival of infants who have received prolonged ventilatory assistance, these complications assume greater importance. This report concerns the particular complication of cosmetic nasal deformities secondary to nasotracheal intubation in critically ill newborn infants. A high incidence of this complication has not been previously reported.

The secure fixation of endotracheal tubes in neonates for long periods of ventilatory assistance is difficult. Techniques for fixation of both orotracheal and nasotracheal tubes2,6,7 have been described. Those utilizing adhesive tape are not entirely satisfactory. Secretions invariably dampen the tape, rendering the fixation ineffective.
Fetal Addiction to Pentazocine
Authors: Kopelman Arthur E.
Published: December 2021

A case of neonatal withdrawal symptoms following maternal use of pentazocine was recently reported.1 This is the report of a second case with severe withdrawal symptoms which were successfully treated with phenobarbital.

CASE REPORT

A 2,180-gm, small-for-date, black female infant was delivered by cesarean section at 37 weeks' gestation. The mother, a 26-year-old gravida 3, para 0 woman with sickle cell anemia, had several painful sickle cell crises, congestive heart failure, pneumonia, and a urinary tract infection during this pregnancy. The two previous pregnancies had ended in abortion. In the second half of this pregnancy, she was treated with frequent packed-cell transfusions in order to decrease to less than 50% the number of her erythrocytes with sickle hemoglobin and hence the risk of clinical sickling.
What's Going On With Car Seats?
Authors: Weiss Jeffrey
Published: December 2021

I was recently asked by a patient's mother for help in choosing a car seat for her child. Although I had seen advertisements for this type of product, none of my pediatric journals contained any information about the child automobile restraint devices available. Looking elsewhere, I found only confusing and conflicting statements.

The material from the American Medical Association pointed out that although car seats built after April 1971 had to meet federal standards, many unsafe models built earlier could still be purchased.
Evidence of Placental Transfer of Acetaminophen
Authors: Levy Gerhard , Garrettson Lorne K. , Soda David M.
Published: December 2021

Various surveys have shown that pregnant women frequently take mild analgesics. The most widely used nonprescription analgesics are aspirin, acetaminophen, and its precursor phenacetin. Acetaminophen has been detected in the urine of ten out of 250 women attending an antenatal clinic in Australia.1 We have recently studied and reported on the kinetics of salicylate elimination by newborn infants of mothers who ingested aspirin before delivery, either in single small doses2 or regularly in large doses.3