bluuebunny/crossref_metadata_2025 huggingface dataset:
PUBLIC HEALTH
Authors: Koumans Alfred J. R.
Published: December 2021

Certain etiologic factors relating to accidental ingestion of medication (pills) in children under 5 years of age were studied. There seemed to be a purposeful behavior behind the "accident". Availability, easy accessibility and oral exploration are questioned as factors playing a dominant role. Remembered attractiveness seems important as far as baby aspirin is concerned. A less attractive form of this medication would seem indicated.

Of the children poisoned by medication other than baby aspirin, 67% frequently observed their parents taking pills. This was found in only 13% of a comparison group of children who ingested baby aspirin. This factor is suggested as playing an additional role, and could be minimized by proper parent education.
STUDIES ON HUMAN PROTEINURIA
Authors: Slater R. J. , O'Doherty N. J. , DeWolfe M. S.
Published: December 2021

Observations on the transfer of labelled albumin from plasma into urine were made in five children with postural proteinuria. Transfer of labelled protein occurs rapidly during lordosis. During the period of decreasing proteinuria that occurs upon cessation of lordosis, no transfer of labelled protein could be observed. These findings suggest that the functional alteration causing postural proteinuria is rapidly reversible, occurring only during the orthostasis. Despite the similarity in composition of proteins in postural proteinuria and in lymph, the rates of protein transfer and the similar specific activity of serum and urinary protein suggest that the site of transfer is the glomerular capillary.

Immunologic study of the urinary proteins indicate that the γ-globulin excreted in postural proteinuria is similar to that of serum, in contrast to the γ-globulin excreted in exercise proteinuria and "normal" urinary protein which reveal altered characteristics.
COMPARISON OF ORAL AND INTRAMUSCULAR ADMINISTRATION OF IRON FOR PREVENTiON OF THE LATE ANEMIA OF PREMATURE INFANTS
Authors: Sitarz Anneliese L. , Wolff James A. , Von Hofe Frederick H.
Published: December 2021

Intramuscular administration of iron, given at the time a weight of 2,100 grams is reached, is as effective as oral use of iron in the treatment of the late anemia of prematurity.

No toxicity or untoward side effects were noted when iron was given intramuscularly in the manner and dosage described.

Intramuscular administration of iron is preferred when follow-up of infants after discharge from the nursery is difficult. Where follow-up is assured, orally administered iron remains the treatment of choice. (See Addendum.)
Management of Otitis Media
Authors: Chamberlin Robert W.
Published: December 2021

In the past few years I have read several review articles by ear, nose and throat specialists similar to one by Dr. Charles F. Ferguson in Pediatrics, 25:1043, 1960.

In all of these articles, myringotomy is strongly advocated as the proper treatment for bulging ear drums. They frequently cite various intracranial complications as evidence that myringotomies should have been done. However, in examination of these histories it is apparent that most of these people received inadequate antibiotic treatment and were not properly followed in the period before these complications developed.
LIVER FUNCTION TESTS IN INFANTS WITH BILIARY ATRESIA
Authors: Kumate Jesus , Beltrán Francisco , Benavides Lázaro , Flores Marí Antonieta
Published: December 2021

Simultaneous changes of serum bilirubin (direct/total ratio), flocculation tests (thymol and cephalin-cholesterol), transaminases (GOT and GPT), serum cholinesterase and serial clearance of BSP were studied in 30 cases of biliary atresia confirmed by exploratory laparotomy or necropsy.

Serum bilirubin generally showed a tendency to increase as age advanced (more evident after the fourth month) although its correlation was poor (r = 0.31). In over 80% of the cases, the direct/total ratio was 0.50 or greater.

Flocculation tests showed abnormal values in over 35% of the cases and were more marked as age and degree of malnutrition increased.

Transaminase activities in the serum showed slight increases (about 100 units/ml), predominantly of GOT and without relation to age, nutritional condition or flocculation tests.

Subnormal activity of cholinesterase was observed in three-fourths of the cases; it was more evident in older patients and no relation was found to percentage of the patient's theoretic weight.

Serial study of BSP clearance showed increase of retention at 45 minutes (about 30%) and exponential elimination (with a half-life of 2.4 days) and levels above 6% by the fifth day following administration of the dye.
THE DIMENSIONS OF COMPREHENSIVE PEDIATRICS
Authors: Rose John A.
Published: December 2021

The Case material presented in the paper by Kennell and Rolnick in this issue of Pediatrics illustrates some of the problems encountered in a project for the study of child rearing, particularly in reference to the unanticipated high incidence of cases in which the survival of a newborn infant was threatened by a health complication. In a way, the project might be said to have had bad luck in encountering such complications in two out of three cases, rather than in one out of five, as might have been expected. However, tile statistical mischance, which would have tended to correct itself as the number of cases in the sample increased has served a useful purpose by calling attention to a problem that is becoming more and more important for pediatric training and practice, as well as for studies in normal child development.
SALICYLATE INTOXICATION
Authors: Done Alan K.
Published: December 2021

Studies on 38 children and adults who ingested large amounts of salicylate revealed a poor correlation of salicylate level in serum with clinical severity of salicylate intoxication.

Serial measurements of serum salicylate levels in dogs and in 17 previously well patients revealed that the disappearance of salicylate from circulation is a first-order reaction in the post-absorptive period. It is possible, therefore, to calculate the half-life of circulating salicylate. In the present study the mean salicylate half-life in 17 patients was 20 hours.

It is possible to eliminate the variable of time since ingestion by utilizing the rate of removal (half-life) of salicylate to extrapolate from the observed salicylate level at any time following ingestion to a theoretical zero-time salicylate concentration (So). There was found to be an excellent correlation of So with the clinical severity of salicylate intoxication. A nomogram that eliminates the necessity for calculating So is presented. Calculation of So or use of the nomogram provide better means than were previously available for predicting the severity of salicylate intoxication on the basis of measurements of blood salicylate. Particularly noteworthy was the fact that four patients who died despite intensive conventional treatments had So values which greatly exceeded those found in patients who recovered. This observation suggests that an So of greater than 160 is essentially incompatible with life and that measures for rapidly reducing salicylate levels, such as hemodialysis or exchange transfusion, should be instituted.

The data are not sufficient to permit conclusions to be drawn concerning the influence of various factors on salicylate removal and toxicity. However, the use of So and salicylate half-life should facilitate such studies.
NEONATAL ASCITES AND OBSTRUCTIVE UROPATHY
Authors: Marx Kurt , Dale W. Andrew
Published: December 2021

A case of neonatal ascites associated with severe, obstructive uropathy is described.

Recovery followed correction of the urinary tract obstruction.

Follow-up data, including those pertaining to growth and development, over a 4-year period are presented.

Attempts to demonstrate leakage of urine or a direct communication between the urinary tract and the peritoneal cavity were made, but failed.

The pathogenesis of congenital ascites in infants with bilateral hydronephrosis and hydro-ureters remains obscure.
FATAL ACUTE CHLOROQUINE POISONING IN CHILDREN
Authors: Cann Howard M. , Verhulst Henry L.
Published: December 2021

Four cases of acute chloroquine poisoning in children are presented. In three instances death occurred within 2½ hours of ingestion of larger than therapeutic amounts of the drug. The rapid occurrence of death in acute chloroquine poisoning is probably explained by complete and rapid absorption of the drug from the gastrointestinal tract resulting in high blood concentrations which depress vasomotor function and respiration. Cardiac arrest follows and may be caused by the direct myocardial action of chloroquine, to anoxia, or to both. The similarity of the manifestations of acute chloroquine poisoning and those of acute quinine and quinidine poisoning suggests that acute toxicity may be attributed to the quinoline ring portion of these drugs.
INHERITED FACTOR-VII DEFECT IN A NEGRO FAMILY
Authors: Glueck Helen I. , Sutherland James M.
Published: December 2021

A case of factor-VII deficiency of a congenital nature in a Negro male child has been reported. As far as can be determined, this is the first case reported in this race. The defect was detected at 6 hours of age.

Prothrombin, as contrasted to factor VII, after initially low levels normally found in infants, rose to adult levels. The patient's one-stage prothrombin time has ranged between 25 to 35 second (normal 11 to 12 seconds). In spite of this, he has never shown any manifestations of hemorrhage.

The patient's family was studied and the findings indicate that the patient's defect represented a homozygous state and that both parents with a less severe deficiency were heterozygous for the trait. The defect is an autosomal disorder directly inherited. It is clinically apparent and easily detected only in the homozygous state. The heterozygous state is characterized by a very slight prolongation of the one-stage prothrombin time, the difference from the control value being so minimal as to be overlooked. In one subject studied, an aunt of the propositus, the quantitative defect (42% of normal) could not be regularly detected by the usual methods. Only by using the plasma of the propositus as the test plasma, was the defect in her plasma detected, thus explaining the transmission of the trait to her offspring. These findings explain the difficulties previously encountered in understanding the inheritance of the disorder.
Prematurity: The Diagnosis, Care and Disorders of the Premature Infant
Authors: DANCIS JOSEPH
Published: December 2021

The publisher states on the fly-leaf, "This book is an endeavor to meet the need of the whole team of workers"—clinicians, investigators, nurses, social workers, etc. This is an impossible objective, and it is doubtful that the author hoped to achieve it. However, it is evident that he did plan a very complete treatment of the subject of prematurity. The result is a large book (587 pages), wealthy in detail and in bibliography, with about one-third devoted to physiology in the broad sense and the rest to the clinical aspects of the premature infant. Dr. Corner has put much effort into this work, and the resulting volume has much to reward the reader.

However, the attempt to be all-encompassing was unfortunate. The review of the complete development of the human fetus is so cursory as to contribute little of value to the physician.
"BREAK-THROUGH IN CYSTIC FIBROSIS"
Authors: MATTHEWS LEROY W. , SPECTOR SAMUEL
Published: December 2021

IT WOULD BE good news indeed if a "break-through through in cystic fibrosis" was really here as has been put forth in the promotional material on Cotazym by Organon, Inc. in an energetic campaign to sell their pancreatic preparation. Uncritical acceptance of unsupported statements in this promotional material would actually be a set-back in the comprehension of present knowledge of cystic fibrosis and the place of pancreatic substitution therapy in the management of patients with this disorder. False hope may be raised in physicians and in the parents of the unfortunate victims of this distressing disease.

Though we do not wish to minimize the importance of the pharmaceutical development of an improved pancreatin preparation we believe that presenting Cotazym as a "break-through in cystic fibrosis" is unwarranted and misleading.
TRANSFUSION REACTIONS DUE TO LEUKOCYTE AGGLUTININS
Authors: Gens Robert D.
Published: December 2021

A patient who had received multiple blood transfusions and whose serum exhibited a leukocyte agglutinin is reported. This patient developed transfusion reactions characterized by chills, fever and lethargy when administered routine bloodbank and leukocyte-rich blood. No transfusion reaction was noted when the patient received leukocyte-poor blood.
COARCTATION OF AORTA IN INFANCY
Authors: Freundlich Emil , Engle Mary Allen , Goldberg Henry P.
Published: December 2021

Thirty infants with cardiac symptoms and with coarctation of the aorta were observed during the period from 1949 to 1959. The infants were treated first by medical management. Failure of medical management was the indication for additional diagnostic studies and for early surgery on the coarctation or the associated lesion if feasible. Three babies were operated upon; none survived. Including these three, there were 15 deaths during infancy, all in the first 8 months and 11 in the first 3 months of life. All who died and half who survived had intracardiac defects in addition to the coarctation. The associated lesions sometimes masked the presence of the coarctation making the latter diagnosis difficult. Among the 19 where the diagnosis of coarctation could be made with certainty on physical examination, there were 15 who survived infancy. There were no deaths among the eight patients with uncomplicated coarctation in the observation period of 5 to 10 years.
A 5-YEAR SURVIVAL OF AN INFANT AFTER SURGICAL EXCISION OF AN EMBRYONAL HEPATOMA
Authors: Peterson Raymond D. A. , Varco Richard L. , Good Robert A.
Published: December 2021

The case is presented of a patient who survived for 5 years after surgical excision of an embryonal hepatoma.
THE NATURAL HISTORY OF PULMONARY HYPERTENSION IN CHILDREN WITH VENTRICULAR SEPTAL DEFECTS ASSESSED BY SERIAL RIGHT-HEART CATHETERIZATION
Authors: Stanton Robert E. , Fyler Donald C.
Published: December 2021

The natural history of the pulmonary arterial pressure in 23 children with isolated ventricular septal defects has been evaluated by serial night heart catheterization.

In none of the 23 patients was there a significant increase in pulmonary arterial pressure. Eight patients showed a significant decrease. The direction of shunts did not change between procedures, and the clinical status was stable.

Our experience correlated well with the majority of institutions. It would appear that the natural course of pulmonary arterial pressure in ventricular septal defect is not commonly one of progressive rise.
HYPERVITAMINOSIS D
Authors: Kowarski Avinoam , Shapiro Tehila R. , Biezunski Naomi , Kowarski Chana
Published: December 2021

A case of vitamin D intoxication with resultant hypercalcemia is described. Sodium sulfate by mouth proved to be effective in decreasing the concentration of calcium in serum and improving clinical conditions. The action of sodium sulfate on calcium metabolism and its therapeutic possibilities are discussed.
REPAIR OF VENTRICULAR SEPTAL DEFECT IN INFANCY
Authors: Kirklin John W. , DuShane James W.
Published: December 2021

Data on 65 infants treated surgically for ventricular septal defect by open intracardiac repair are presented, and important features of the preoperative, operative and postoperative care are discussed. The low hospital mortality following surgical repair during a 2-year period and the excellent results support the present policy of recommending operation for infants who fail to thrive under medical management.
MECONIUM PERITONITIS: PROGNOSTIC SIGNIFICANCE
Authors: Smith Blanca , Clatworthy H. William
Published: December 2021

The experience of the authors with meconium peritonitis and a review of the [See Table IV in Source Pdf] literature form the basis of this report. Physicians are unjustifiably pessimistic regarding the management of newborn infants with meconium peritonitis. The salvage of such patients demands early surgical treatment, usually including the resection of all pathologic or extensively involved and entrapped intestine, and the immediate restoration of intestinal continuity.

There is a marked contrast in prognosis of meconium peritonitis between those infants who have meconium ileus and those who have other types of obstructive lesions. There has been only 1 long-term survivor among the 10 patients in our series who were suffering from cystic fibrosis of the pancreas, whereas there were no deaths among the last 9 patients with meconium peritonitis due to other causes.
PRESIDENT'S MESSAGE
Authors: Wheatley George M.
Published: December 2021

I HAVE JUST FINISHED reading "Action for Mental Health," the challenging report of the Joint Commission on Mental Illness and Health. This comprehensive 5-year study, completed in 1960 and just published, presents this complex and enormous health problem realistically, pointing out that progress depends on removing those three well-known obstacles of manpower, facilities and costs.

One of the Commission's recommendations for a national mental health program is better use of present knowledge and experience. There is an acute shortage of professional resources for the care of mentally ill patients, as we know. Of all categories of psychiatrists, the Commission reports, Child psychiatrists are in shortest supply, "children being especially trying to work with and requiring the close co-operation of the parents and infinite patience on the part of therapists." Because pediatricians offer a considerable potential for helping emotionally disturbed children, the Commission recommends that the National Institute for Mental Health provide support for resident training programs in pediatrics that incorporate adequate psychiatric information and that it provide allowances for pediatricians who wish to take postgraduate courses in psychiatry. The aim is not to convert pediatricians into psychiatrists (although a good pediatrician certainly has an abundance of the "infinite patience" required) but to increase the resources of the community.

Actually, of all medical specialties, pediatrics has for many years played a key role in mental health, as we know, both in early recognition of emotional maladjustments in childhood and in prevention by fostering good mental health concepts in child rearing. This has applied not only to private practice but to public health work such as well child conferences and school health service.
Biology of Pyelonephritis
Authors: PRYLES CHARLES V.
Published: December 2021

This volume contains the papers presented at an international meeting of recognized authorities in the field of renal disease; it represents the most noteworthy attempt in some 4 decades to synthesize existing knowledge of renal infection, long neglected by medical investigators. Having attended the 3-day session, I found the proceedings of great personal value, highly informative and stimulating.

A wide variety of subjects is covered in the seven sections, each of which consists of five to eight papers (chapters) relating to studies not only of the structure and function of the kidney and its alterations by disease but also the origin, development and distribution of pyelonephritis, as well as its pathology and treatment.
RENAL INVOLVEMENT IN BOECK'S SARCOIDOSIS
Authors: Kogut Maurice D. , Neumann Lois Lyon
Published: December 2021

The case of a 10-year-old Negro male with classic sarcoidosis, hypercalcemia and moderate renal involvement is presented. The causes of renal disease in sarcoidosis and the relationship between hypercalcemia and renal insufficiency are discussed. Hypercalcemia appeared to have a direct adverse effect on renal function. When the calcium concentration in serum was decreased, the nonprotein nitrogen value returned to normal, the specific gravity of the urine increased, and the abnormal urinary sediment became normal. The possible mechanisms responsible for hypercalcemia are discussed. The treatment of choice for hypercalcemia and renal insufficiency in sarcoidosis appears to be the use of cortisone or one of its analogs.
APATHETIC THYROID STORM IN A 10-YEAR-OLD CHILD
Authors: Grossman Aaron , Waldstein Sheldon S.
Published: December 2021

A case of apathetic hyperthyroidism with thyroid storm occurring in a 10-year-old girl is reported. Satisfactory response to treatment with propylthiouracil, cortisone and penicillin was obtained. Neglected hyperthyroidism in children, as in adults, may lead to the serious complications of apathetic hyperthyroidism and thyroid storm.
PUBLIC HEALTH
Authors: Corsa Leslie , Stallones Reuel A.
Published: December 2021

Inquiry was made into certain factors related or believed to be related to the occurrence of accidental poisoning of children by interviewing members of the families of 466 children reported as poison cases from the hospitals of Alameda and Contra Costa Counties, California. Two other groups, one drawn from the birth certificate files, and one selected from families residing near the families of the poisoned children, were interviewed for comparison.

The poison cases were similar in most respects to those reported previously in the literature. The risk of poisoning reached an abrupt peak at 29 months of age and was slightly higher for boys than for girls. Aspirin and other drugs were the offending materials in two-thirds of the cases. Mothers were responsible for the supervision of the poisoned child in over 80% of the events.

The families of the poison case group and the comparison groups were more remarkable in their similarities than in their differences. Although they were similar in composition, the parents of the poisoned children were, on the average, 3 to 5 years younger than the parents of the comparison group families. The mothers of the poisoned children were 3 times as likely to have jobs outside the home as were the mothers in the comparison group. The families of the poison cases reported previous similar incidents involving their children more often than the families of the comparison groups. This study indicates to some degree the complexity of the factors that apparently influence the risk of childhood poisoning other than simply the availability and accessibility of toxic materials.
CUSHING'S SYNDROME IN ASSOCIATION WITH RENAL GANGLIONEUROBLASTOMA
Authors: Kogut Maurice D. , Donnell George N.
Published: December 2021

A 13-month-old female with ganglioneuroblastoma originating in the lower pole of the left kidney has been described. This patient had the classic findings of Cushing's syndrome, namely, moon facies, buffalo hump, hypertrichosis, acne, plethora, hypertension, polyuria, polydypsia, osteoporosis and an elevated blood sugar concentration. In addition, there was increased excretion of 17-ketogenic steroids, 17-ketosteroids, aldosterone and vanillylmandelic acid in urine. After removal of the tumor, the abnormal clinical findings and the abnormally high excretion rate of corticosteroids and vanillylamandelic acid returned to normal. The adrenal glands were not hyperplastic nor were they the site of tumor formation.

The possible role of catecholamines in the pathogenesis of Cushing's syndrome is discussed. A most likely explanation for the association in this case is that catecholamines secreted by the tumor stimulated the adrenals or pituitary causing hyperactivity and Cushing's syndrome. Several cases have been cited that imply a closer functional relationship between chromaffin tissue and adrenal cortex than has been previously realized. The embryology of neurogenic tissue and its relation to secretion of catecholamines is discussed.
BENIGN CONGENITAL HYPOTONIA WITH CHROMOSOMAL ANOMALY
Authors: Dunn Henry G. , Ford Denys K. , Auersperg Nelly , Miller James R.
Published: December 2021

The present concepts of amyotonia congenita are briefly outlined. Particular reference is made to the clinical syndrome of benign congenital hypotonia, which corresponds to Oppenheim's original concept of a sporadic benign condition and represents the cases of amyotonia not due to infantile progressive muscular atrophy on symptomatic of any other disease entity. The case of a boy is reported who has such a benign form of hypotonia, as well as undescended testes, delayed osseous development and a few other congenital stigmata. He has been studied from birth to the age of nearly 3 years and has been found to have an extra small chromosome resembling the Group 21-22 + Y. The diagnosis and findings are discussed, with particular reference to the possible significance of the chromosomal anomaly. Suggestions for the future investigation of similar cases are made.
ROUTINE ROENTGENOGRAMS OF THE CHEST IN ASYMPTOMATIC INFANTS
Authors: Nickey Laurance N.
Published: December 2021

RECENT ARTICLES in the medical literature have cautioned about the undue hazard associated with x-radiation of infants. Because of this concern, this paper reports the findings and value, if any, of 1,037 consecutive chest roentgenograms for physically normal infants.

METHODS AND RESULTS

One thousand thirty-seven consecutive posteroanterior roentgenograms of the chest were obtained for asymptomatic and physically normal infants between the ages of 4 and 24 months. The roentgenograms were included as part of the "well infant care" for these patients. There were 525 records for males and 512 for females, available for study. It was hoped that all roentgenograms could be obtained at 9 months of age for standardization and comparison purposes. However, the high attrition rate of this group of patients necessitated compromise. Immediately prior to having roentgenograms taken, all infants had physical examinations performed that were interpreted as giving normal results. Table I lists the distribution of roentgenograms according to age and sex. From the entire group there were only nine that were reported as indicating either suggestive or definite pulmonary pathology. There were no unsuspected cardiac or bony abnormalities visualized. All patients with initially suspected pulmonary pathology were returned for repeat roentgenograms of the chest within 10 to 14 days.

Of the nine patients all were asymptomatic, and again the physical examinations revealed normal findings. The repeat roentgenograms revealed only one patient with persistant pulmonary pathology, a 9-month-old male reported as having "fibrotic scarring and atelectasis of the right upper lobe." This abnormality cleared spontaneously within a 4-week period. Intracutaneous skin tests for tuberculosis (PPD intermediate) and fungi (histoplasmin and coccidioidin) were performed for all patients with suspected pulmonary involvement, and negative results were obtained.
POSTGRADUATE COURSE
Authors: McLean Donald M.
Published: December 2021

Discussion of clinical recognition and differential diagnosis of purulent meningitis in children, and especially infants, is followed by an outline of therapeutic regimens currently employed at the Hospital for Sick Children. The clinical features and use of steroids in measles encephalitis are outlined. The differential diagnosis between poliomyelitis and the Guillain-Barré syndrome is discussed, together with points regarding early management of respiratory complications.
Varicella and Steroid Therapy
Authors: ELEY R. CANNON
Published: December 2021

The recent article, Mortality from Varicella in Children Receiving Adrenocorticosteroids and Adrenocorticotropin, by Dr. K. C. Finkel, in Pediatrics 28:436, 1961, is of interest and poses some questions or policies of therapy, especially the statement, "In the author's opinion the administration of adrenocorticosteroids need be stopped only in the patients with leukemia or diseases involving the reticuloendothelial system." If all the deaths of patients with varicella, who were receiving steroid therapy, had occurred only among patients with leukemia, such a statement might appear justified, but this is certainly not the case.
FURTHER OBSERVATIONS ON THE CORRECTED BROMIDE SPACE OF THE NEONATE AND INVESTIGATION OF WATER AND ELECTROLYTE STATUS IN INFANTS BORN OF DIABETIC MOTHERS
Authors: Cheek Donald B. , Maddison T. G. , Malinek M. , Coldbeck J. H.
Published: December 2021

The present study extends previous observation on the extracellular volume and total body chloride of infants in the neonatal period. It is shown that the decrease in the corrected bromide space is most rapid in postnatal life during the first 2 weeks when 40 ml/kg are lost. By the end of the second week, body weight approaches birth weight. Hence by that time there is a gain of 40 gm/kg, and mainly of protein and cell water. Growth processes are in full progress. The values obtained by other workers for the chloride space of muscle in premature, full-term and 6-month-old infants do not vary considerably from the corrected bromide space for the whole body at these age periods.

Nine infants born around the thirty-sixth week of gestation, and of diabetic mothers, were investigated concerning composition and distribution of water and electrolytes, mainly on the third day of postnatal life. It was found that total water was reduced on a weight basis by 37 ml/kg, and this reduction can be explained on the basis of increased body fat, as demonstrated by other workers. The corrected bromide space (on the basis of weight, not age) was reduced by 50 ml/kg of weight, and it was considered that part of this reduction was not due to body fat increase. As much as 40 ml of water/kg of lean body weight probably shifts from the extracellular to the intracellular phase. There is a reduction of extracellular sodium and chloride in infants born of diabetic mothers. This finding was supported by muscle analysis of one infant who died of the respiratory distress syndrome. No change was found in the plasma osmotic pressure or in the concentrations of sodium and chlorides in plasma. The urea content of plasma was elevated, due perhaps to the reduction in extracellular volume.
UROLOGICAL EMERGENCIES IN NEWBORN INFANTS
Authors: Lattimer John K. , Uson Aurelio C. , Melicow Meyer M.
Published: December 2021

Children who do not void after birth should be recognized as being in great danger. Where obstructing urinary lesions are found, drainage by nephrostomy is always safer than by a suprapubic cystostomy or a urethral catheter, which is necessarily small, and might lead to lethal sepsis in this situation. The treatment of obstructions of the bladder neck is surgical. Patent urachus may result from obstructions of the bladder outlet. The treatment is surgical and the obstruction should be relieved before the urachus is closed. Children born with deficient abdominal musculature, even when partial, usually have an accompanying severe obstruction of the bladder neck, dilation and infection of the urinary tract. They are also prone to have undescended testes and other extraurinary anomalies, such as club foot. Obstructions must be relieved and a corset prescribed.

Neurogenic bladders in children are troublesome and must be assumed to be present when meningoceles, sacral defects and neurologic deficits of the perineum and legs are found. Urological studies may be deferred, but for a few weeks only. Masses in the abdomen must be considered to be Wilms tumors or sympathocoblastomas until proven otherwise by pyelograms or even exploration. The kidney is by far the most common organ to cause a surgical mass in the abdomen, whether it be enlarged from tumor, cystic disease or hydronephrosis.

The treatment of undescended testes can usually be put off until the age of 5 or 6 years, unless a large hernia is present, whereupon operation can be done at once. A trial of hormone therapy is advised before age 6; if it is unsuccessful, orchidopexy should be done before age 7. Exstrophy of the urinary bladder may now be treated by functional closure in most cases, and every child should be offered at least one good chance at this anatomic restoration, either at birth or at the age of 3 months. Traumatic torsion of the genitalia, if severe, usually requires surgery. The contralateral testis should be fixed in place, to forestall its possible torsion at some future date.

Thromboses of the renal vein with dehydration and omphalitis can be treated hopefully with anticoagulants and chemotherapy and other supporting measure. Surgery may be considered, but is precarious. Salt-losing tendencies in newborn children with congenital adrenogenital syndrome and dehydration can be treated medically and successfully if recognized in time.

Fistulas between rectum and urethra, accompanying imperforate anus, can be treated surgically after the child is several months old and better able to tolerate anesthesia. Masses presenting at the vulva, with or without urinary obstruction, may be prolapsing ureteroceles or imperforate hymens with mucocolpos. Large teratomas are sometimes seen attached to the perineum causing urethral obstruction, and they must be removed.
SPINAL LESIONS IN TETANUS IN CHILDREN
Authors: Sujoy Enrique
Published: December 2021

Of 17 tetanus patients exhaustively studied from the clinical and roentgenographic point of view, 15 presented spinal lesions. The lesions were observed at the level of the fourth, fifth, and sixth thoracic vertebrae, though the grossest damage was suffered by the fifth thoracic vertebra. In six patients one vertebra was affected; in three, two vertebrae; in three, three vertebrae; and in two, four vertebrae. The severity of the lesions varied from slight damage undiagnosed by the clinician and revealed only by roentgenography, to serious alterations requiring orthopedic correction. Due to the frequency of spinal lesions, every tetanus patient should have a thorough roentgenographic examination before discharge in order to eliminate any possibility of spinal sequellae. Obligatory immunization of the total child population is the only effective prophylactic measure for the control of spinal lesions in tetanus.
CLINICAL AND LABORATORY ASPECTS OF THYROID FUNCTION
Authors: Pickering Donald E.
Published: December 2021

It is an honor to have been selected as a recipient of the E. Mead Johnson Award for Research in Pediatrics; more specifically, for research in thyroid gland function. At mid-century it seemed reasonable to explore quantitatively the role of thyroid in the developing primate and thus, hopefully, to provide a more secure base whereby therapeutic criteria could be ascertained.

The gross effects of thyroid ablation and their general elimination following administration of crude thyroid gland were known before the turn of the century, and thyroxine was identified as the primary thyroid gland hormone and was chemically characterized and synthesized during the first two decades of this century.

At the turn of the century the late Sir William Osler,1 in a classic presentation reviewing sporadic cretinism on this continent, in all optimism made the following statement.

Not the magic wand of Prospero or the brave kiss of the daughter of Hippocrates ever effected such a change as that which we are now enabled to make in these unfortunate victims, doomed heretofore to live in hopeless imbecility, an unspeakable affliction to their parents and to their relatives.

Unfortunately, the optimism expressed in this statement has not come to fruition. Mental retardation remains the most significant sequella of thyroid deficiency in the pediatric age group and is of high incidence in sporadic cretinism, without regard to clinical classification; i.e., whether the dysfunction represents athyrosis or an inborn error of hormonogenesis or is of some other origin.2,3

It has been the opinion of our group, both clinically and experimentally, that most cases of thyroid deficiency are treated too late and with far too little hormone.
CERVICOMEDIASTINAL CYSTIC HYGROMA
Authors: Camishion Rudolph C. , Templeton John Y.
Published: December 2021

Two cases of cervicomediastinal hygroma are presented. The important aspects of symptoms, diagnosis, and treatment have been discussed. Surgical excision of the cervical and mediastinal portions of the cyst at staged operation is recommended as the best method of treatment of this lesion.
RETENTION OF NITROGEN BY NORMAL FULL-TERM INFANTS RECEIVING AN AUTOCLAVED FORMULA
Authors: Fomon Samuel J. , Owen George M.
Published: December 2021

Formula 1257, a specially prepared formula that had been studied previously and supplied a relatively small percentage (7%) of the calories as protein, was fed to four normal full-term infants as the sole source of energy from age 5 days to age 4 months. Analysis of data from balance studies carried out between 30 and 121 days of age demonstrated that retentions of nitrogen for a specified intake of nitrogen were somewhat greater in studies with infants receiving autoclaved Formula 1257 than in studies with infants receiving three other feedings (unheated Formula 1257, pooled human milk, and Similac). It is clear that the heat processing employed in this study did not interfere with the ability of Formula 1257 to support nitrogen balance.
BODY WATER COMPARTMENTS IN THE PREMATURE INFANT, WITH SPECIAL REFERENCE TO THE EFFECTS OF THE RESPIRATORY DISTRESS SYNDROME AND OF MATERNAL DIABETES AND TOXEMIA
Authors: Clapp Wesley M. , Butterfield L. Joseph , O'Brien Donough
Published: December 2021

Normal values for both total body water and extracellular water have been determined in 86 premature infants aged 1 to 90 days and weighing 940 to 2,435 gm, with use of the techniques of deuterium oxide and bromide dilution. Nine full-term infants aged 1 to 6 days and weighing 2,590 to 4,985 gm were similarly studied. Nine infants with the respiratory distress syndrome and eight infants of toxemic mothers studied in the first 24 hours of life showed no significant difference in their body water compartments in comparison to a control group of normal infants matched for age and weight. Seven infants of diabetic mothers studied in the first 24 hours of life showed a significant decrease in total body water, expressed as percentage of body weight, with a normal intracellular to extracellular water ratio. These data indirectly support other evidence that there is an increase in body fat in these infants at birth.

See Table in the PDF file
DETERMINATIONS OF BILIRUBIN IN SERUM AS THE CRITERION FOR EXCHANGE TRANSFUSION
Authors: MCKAY R. J.
Published: December 2021

IN THIS ISSUE OF Pediatrics two papers bearing on the reliability, or, perhaps more accurately, unreliability of bilirubin determinations in serum are published. The point which both emphasize is that, although the error of the determination in an individual hospital laboratory may be small enough to mislead one into the belief that it is reasonably accurate, the comparability of determinations from different laboratories is distressingly poor. Both papers trace this poor comparability of results to differences in the bilirubin standards used. The sources of error in the standards may arise because of differences in the material used for the primary standard, or because of deterioration or other changes in the primary standard during its storage or preparation for use.
THE PHYSICIAN'S CHILDREN AS PATIENTS
Authors: Kennell John H. , Boaz Willard D.
Published: December 2021

THE LACK OF ATTENTION—in the medical literature—to the care of physicians' families is in sharp contrast to the degree of concern and controversy about this subject. Medical writers may have hesitated, as have the present authors, to report their observations, because of uneasiness about revealing confidential material or their fear that they would seem critical of their colleagues. Because the authors' experience with physicians' children as patients has convinced them that the management of illness and the fostering of health in the families of physicians present very special problems, this report is presented.

The authors have reviewed their experiences with more than 100 physicians' families in preparation for this report. They found deplorable gaps and variations in their records. These difficulties highlight some of the unusual features of medical care for physicians' families. Physicians move frequently while they are in medical school, residency training, fellowships, and military service. There is a great variation among physicians' families in the use they make of their pediatrician and in the frequency of their visits. Some records are distressingly abbreviated because so much of the medical discussion has taken place in corridor consultations.

In this paper names and personal details have been changed to preserve the anonymity of the subjects. The examples come from different cities, states, and countries.

THE PHYSICIAN-FATHER'S ANXIETIES

Every physician, no matter what his training and practice, has accumulated a storehouse of anxieties about disease. These often make minor illnesses take on major significance. The pediatrician must always keep in mind that the physician consulting him about a family health problem may well have many more serious concerns and a higher degree of anxiety than other parents, no matter how well he covers this with jokes.
SHOULD NOT PHYSICIANS' FAMILIES BE ALLOWED THE COMFORT OF PAYING FOR MEDICAL CARE?
Authors: Spock Benjamin M.
Published: December 2021

THE TRADITION that doctors give care to each other and to each other's families without charge is an ancient and honorable one. It demonstrates in action some of the noble aspirations of man—generosity, loyalty to his profession, pride in service, devotion to an ideal.

Every physician is touched when a colleague turns to him for care. Even the doctors' doctor, who is already carrying an excessive share of such service, feels honored by each new request, for it is a tribute from a particularly discriminating patient.

But this is only one side of the relationship—the donor's. I am convinced that in a majority of medical situations (particularly those in the areas of pediatrics and internal medicine) the recipient physician's family is receiving insufficient care, not through any fault of the donor but because the recipient is so inhibited in asking for it. It is hard to say whether the recipient physician or his wife is in the more uncomfortable spot. The physician, when he or a member of his family develops a symptom, particularly a minor one, is promptly involved in a conflict of feelings. He cannot, unless he is a most unusual person, detach himself emotionally while he takes a history and does a physical examination. His natural anxiety tends to make him vacillate between exaggerating and minimizing the significance of the symptom. From the start he is debating in his mind whether it would be appropriate to call the proper physician. Consciously or unconsciously he is wondering how that colleague would view the request for help.
Unsterile Formulas
Authors: HASKIN DAVID
Published: December 2021

The decision of the Committee on Fetus and Newborn to disapprove the so called "instant" method of formula preparation (Pediatrics 29:676) is of interest to me since I have used this method exclusively in my practice for almost 7 years. The use of one of the several prepared mixtures of milk powder and an appropriate sugar eliminates the hazard of storing a potential culture medium such as evaporated milk. Water supplied to our community has a daily average of seven coliform organisms per cubic milliliter.
Release of Information to the Lay Press
Authors: KATCHER AVRUM LABE
Published: December 2021

A recurrent problem is the release of information about pediatric research by investigators to the lay press prior to, or without, any dissemination of adequate information in the professional literature. The pediatrician, all too frequently, must provide guidance and advice to parents who have read articles or stories in newspapers or magazines, without being able to speak from his own reading or from information derived by personal contact or attendance at meetings and postgraduate courses. The recent proliferation of free throwaway periodicals has compounded the problem.
CRANIOSTENOSIS
Authors: Freeman John Mark , Borkowf Shirley
Published: December 2021

Thirty-four cases of craniostenosis are presented. Of the 19 cases of sagittal stenosis, 14 were unoperated. Four of these patients were retarded. This retardation was not believed to be caused by the craniostenosis. Of the five operated patients, three were seen at follow-up, and one was retarded. There was no difference in cosmetic results between the operated and unoperated cases. In the four cases of coronal stenosis there was no detectable difference in mental or cosmetic results between the operated and unoperated cases. In the combined stenosis group of 11 cases, four persons developed papilledema. There was no difference in mental or cosmetic results between those operated on before one year of age and those operated on when symptoms became evident. There is evidence to suggest that in sagittal and coronal stenosis growth of the brain is not restricted by closure of the suture. It would thus seem that there is little need for prophylactic operations but that instead operations should be performed only for papilledema or very severe deformity.
THE VALUE OF SERIAL CATECHOLAMINE DETERMINATIONS IN CHILDREN WITH NEUROBLASTOMA
Authors: Voorhess Mary L. , Gardner Lytt I.
Published: December 2021

Urinary catecholamine excretion was measured in a 4-year-old child with neuroblastoma arising from the right adrenal. Initially urinary dopamine and norepinephrine output was high. Because the tumor was inoperable a course of radiation therapy and chemotherapy was given. Following this treatment catecholamine excretion decreased but never reached normal levels. Although there was no clinical evidence of persistent tumor, the elevated urinary output of dopamine and norepinephrine indicated residual neuroblastoma. Therefore surgical exploration was performed and tumor was found overlying the superior pole of the right kidney. After removal of this persistent neuroblastoma the urinary excretion of catecholamines returned to normal and remained at this level. The child has no evidence of recurrent disease and appears healthy. To our knowledge this represents the first reported case wherein the indication for surgical removal of residual neuroblastoma was based solely on elevated output of urinary catecholamines.
Plasma Adrenaline and the Respiratory Distress Syndrome
Authors: CHEEK DONALD B. , MALINEK MALVINA , FRAILLON J.
Published: December 2021

The letter from Drs. Marini and Alessandri from Italy regarding catecholamines, T waves, and newborn infants (Pediatrics, 29:500, 1962) asks the question whether or not there is an increase in catecholamines in the blood of premature infants with the respiratory distress syndrome. Using the method of Weil-Malherbe and Bone (Biochem. J., 67:65, 1957) as modified by Goldfien et al. (J. Clin. Endocrinol, 21:281, 1961) we find that there is a fourfold increase in the plasma adrenaline (p < 0.005) concentration of these infants when compared with ordinary premature infants, and a nonsignificant increase in the noradrenaline levels.
Prenatal Influences
Authors: REID DUNCAN E.
Published: December 2021

This book, which comprises a discussion of the factors concerned with fetal development, is written evidently with the design of capturing both medical and lay readers. Hence, some of the statements that appear throughout the book might seem a bit trite and obvious to the physician.

In a somewhat dramatic form, the book opens with a factual account of the development of the conceptus. This is followed by most complete chapters on placental transport and nutrition.