bluuebunny/crossref_metadata_2025 huggingface dataset:
Custody of the Myelodysplastic Child: Implications for Selection for Early Treatment
Authors: Hayden Patricia W. , Shurtleff David B. , Broy Arline B.
Published: December 2021

Of 173 patients with myelodysplasia followed in the Birth Defects Center at University Hospital between 1968 and 1972, 30 (17%) have been placed outside their natural families for temporary or long-term care. Only one has been adopted and five have been institutionalized; the remainder have been in foster home care. High level paralysis, mental retardation, and lower socioeconomic status correlate positively with placement. In this series, gender was not a contributory factor. An initial "hopeless" prognosis and/or selection for "no treatment" were decisions often made prior to referral to this center but were highly correlated to placement. Considering the multiple medical, emotional, and economic problems facing these families, relinquishment of custody should be anticipated in a significant percentage of cases. To date, placement outside the natural family has been viewed primarily as abandonment or as an emergency solution to a crisis. Long-term follow-up study of this group of children may indicate that transfer of custody can be a positive therapeutic alternative for the child and his family.
Management of Juvenile Diabetes Mellitus: Usefulness of 24-Hour Fractional Quantitative Urine Glucose
Authors: Forman Barr H. , Goldstein Paul S. , Genel Myron
Published: December 2021

The use of quantitative urine glucose determinations permits accurate assessment of glucose homeostasis in diabetic children. Four specimens from a representative 24-hour period are collected, generally from 8 AM to noon, noon to 4 PM, 4 PM to 8 PM, and 8 PM to 8 AM and measured for total glucose excreted. When performed on an ambulatory basis, this test best reflects actual conditions the child faces each day and takes into account time, dose and type of insulin adminstered as well as diet, activity and stress. The test is inexpensive, easily performed and allows the physician to make rational changes in therapy. Children are usually cooperative and can understand what the actual amount of glucose spilled represents in terms of calories lost and total control. In those children in whom increases in NPH would be made to achieve better nighttime coverage, afternoon hypoglycemia can be prevented by changing to a combination of semilente and ultralente insulins without fear of long-acting insulin effect.
The Bowel Bag: A Sterile, Transportable Method for Warming Infants With Skin Defects
Authors: Sheldon Roger E.
Published: December 2021

A simple, easily available method can simultaneously protect against heat loss, drying and bacterial contamination in newly born infants with skin defects. The method applies to infants with omphalocele, gastroschisis, meningomyelocele, epidermolysis bullosa congenita letalis, severe hydrops with skin tears and the harlequin fetus among others.

Typically in the past, the child with one of these defects was packed in saline-soaked gauze in an effort to prevent drying.
Racemic Epinephrine in Croup (continued)
Authors: Dardick Kenneth R.
Published: December 2021

Gardner et al. failed to show the effectiveness of nebulized racemic epinephrine in the treatment of what they called "croup." Perhaps their study failed as a result of their definition of croup. Croup (subglottic edema) and epiglottitis are each distinct clinical entities by anatomy, etiology, pathophysiology, and, therefore, therapy.

It will be interesting to see the fate of the null hypothesis if the data are re-examined from this perspective.
Problems in Paediatric Urology, edited by J. H. Johnson and R. J. Scholtmeijer. Amsterdam: Excerpta Medica, 1972, 301 pp., $27.50
Authors: Lattimer John K.
Published: December 2021

This slim volume of 13 chapters represents an interesting blend of both practical information and basic theortical considerations relevant to a number of fundamental problem areas in pediatric urology. In 13 well documented essays, the contributors, many of whom are leaders in their respective fields, touch upon such basic subjects as the results of management of posterior urethral valves, functional restoration of decompensated ureters, problems in diagnosis and management of ectopic ureters and ureteroceles, reconstructive surgery for bladder exstrophy, and a critical appraisal of the management of ureteric reflux.
Zen Macrobiotic Dietary Problems in Infancy
Authors: Robson John R. K. , Konlande J. E. , Larkin F. A. , O'Connor P. A. , Liu Hsi-Yen
Published: December 2021

Two infants fed Kokoh, a Zen macrobiotic food mixture comprising cereal grains, legumes, and oil seeds, for a period of several months weighed 4.96 kg and 5.81 kg at 7 and 13 months of age, respectively. Kokoh formulas were evaluated by computation using food composition tables and chemical analysis. The computed energy value of Kokoh was within 3% of that measured by calorimetry. The daily intake of energy by the infants from Kokoh and other supplementary foods was about 400 Calories. This represents only 40% of the Recommended Dietary Allowances (R.D.A.) for the United States. The estimated protein intake was 11 gm for one child, and 13 gm for the other. The quality of the Kokoh protein as determined by computation was adequate for growth, but the analytical data suggested that the amino acid pattern was poor. The unsatisfactory nature of the formulas given to the infants was due to excessive dilution. There is a need for more definitive data on the feasibility of feeding infants Kokoh and similar foods, at a concentration that will meet energy needs. Further information is required on the amino acid content of plant foods used for infant feeding. Until more is known about feeding infants on plant food proteins, infants and children fed Kokoh should be kept under strict surveillance.
Reversible Inhibition of Lung Cell Number After Glucocorticoid Injection Into Fetal Rabbits to Enhance Surfactant Appearance
Authors: Kotas Robert V. , Mims LeRoy C. , Hart Lana K.
Published: December 2021

Recent enthusiasm concerning hydrocortisone therapy to prevent respiratory distress syndrome in human infants has aroused natural concern over possible untoward effects. There are both ethical and experimental reasons why human infants are not suitable for well-controlled investigation of untoward effects of steroid treatment. Therefore, we studied the effect of hydrocortisone injection on the lung cell number of the rabbit, an animal whose pulmonary development has been studied extensively. Fetal rabbits treated with single injections of hydrocortisone in utero had a lower number of lung cells when compared to similar weight controls. The decreased cell number, reflected by decreased DNA per lung, was also associated with lower lung weights and lower body weights but was not associated with significant changes in lung water or protein content. After birth, with adequate nutrition, "catch-up" in body weight occurred by 30 days' postnatal age. Animals killed at that time anti at 60 to 65 days had lung DNA content similar to untreated rabbits. Although lung cell number and body weight were decreased in fetal animals treated with a single dose of glucocorticoid late in gestation, with adequate nutrition growth of both body and lung recovered by 30 days' postnatal age.
Chelation Therapy in Children With Subclinical Plumbism
Authors: Chisolm J. Julian
Published: December 2021

Findings in a recent study1 are consistent with the hypothesis that the total body lead burden is divided among three major compartments: (1) a rapidly exchangeable pool consisting of lead in blood and some soft tissue components; (2) another rapidly exchangeable pool consisting primarily of lead in soft tissue and lead loosely bound to bone; and (3) a very large portion (60% to 90% of the total burden2) tightly bound in the skeleton, with a turnover time estimated as one to two decades.

This third large pool is not associated with any known toxicity: it may be considered a "sink" which probably is virtually inaccessible to chelating agents. The effectiveness of chelating agents is associated with their ability to reduce the concentrations of lead in the two small, but mobile compartments where toxic effects do occur. The "metabolically active" fraction3,4 of the total body lead burden is probably similar to the "rapidly exchangeable" compartments.

The three chelating agents used to treat plumbism in the United States are edathamil calcium disodium (CaEDTA), 2,3-dimercaptopropanol (BAL) and d-penicillamine (PCA). PCA is available in oral dosage form only (250-mg capsules) and is classified by the FDA as an investigational drug if used for lead poisoning. When equimolar amounts of these agents were infused in rats under identical experimental conditions, PCA was appreciably inferior to CaEDTA and BAL in terms of the quantity of lead mobilized and excreted.5,7 Furthermore, a transitory increase in the lead content of some soft tissues was noted during mobilization with PCA, but not with either CaEDTA or BAL.
Diagnostic Use of I131 in Children: Changing Normal Values for Thyroidal Iodine Uptake in Relation to Safety
Authors: Mosier H. David , Dore Earl K. , Hayes Michael
Published: December 2021

In Pediatrics, May 1973, there are articles by Pilch et al. and a commentary by Treves and Crigler on the dangers of radioactive iodine procedures in childhood. The commentary was timely and well written and the calculations of radioactive dosimetry presented by Pilch et al. were useful. The presentation of the case report of Pilch et al., however, provided no support for the thesis of the authors. This is because the doses of radioactive iodine used in this patient were unknown.
Letter to the Editor
Authors: Pilch Ben Z. , Kahn C. Ronald
Published: December 2021

We appreciate Dr. Mosier's thoughtful comments and agree that it is indeed unfortunate that the information as to the precise dosage of I131 administered to the patient under discussion is not available. We do feel, however, that a dosage estimate of 25µc is not unreasonable. A study from the Michael Reese Hospital appearing in January 1957 reported using I131 tracer doses of 22 to 25µc in children under 10 years of age (one as young as 23½ months) to determine thyroidal I131 uptakes and PBI131 levels.
Sickle Cells and Anesthesia
Authors: Abelson Herbert T.
Published: December 2021

The implication by McGarry and Duncan that sickle cell trait carries an increased risk of death following anesthesia should be carefully weighed against their proffered evidence. In two of their five cases, a hematologic diagnosis was not established, but rather implied by postmortem findings. These two cases could therefore represent an additional, mixed, sickle hemoglobinopathy. In addition, postmortem sickling can hardly serve as an indicator of premortem pathophysiology. Since previous firm documentation of anesthetic deaths associated with sickle cell trait are not available, the following questions would seem to be pertinent: (1) what is the overall incidence of anesthetic deaths in the authors' institution and (2) over what period of time were these cases collected?
Congenital Malformations in Offspring of a Chronic Alcoholic Mother
Authors: Palmer R. Heather , Ouellette Eileen M. , Warner Lyle , Leichtman Sandra R.
Published: December 2021

Three cases in one family—a girl and monozygotic girl twins, the offspring of a chronic alcoholic mother —are presented. They show a pattern of prenatal onset of growth deficiency and developmental delay, with microcephaly, small palpebral fissures, and multiple minor anomalies, recently described in a series of 11 unrelated cases by Jones et al. and named by them the "fetal alcohol syndrome." After considering alternative theories, we conclude, with them, that the cases demonstrate an association between the maternal alcohol intake and the abnormalities found in the offspring. We report these three cases in confirmation of their findings.
Psychomotor Epilepsy in Childhood
Authors: Gold Arnold P.
Published: December 2021

The most poorly understood and most frequently misdiagnosed seizure state of childhood is psychomotor epilepsy. Difficulties in diagnosis are related to the variety of possible clinical manifestations which characteristically differ from one child to another. In addition, psychomotor epilepsy can occur at any age, even during infancy. Therefore, the child's ability to verbalize the perceptive and affective sensations of this seizure state is obviously limited by his chronologic age.

The diagnostic dilemma is further complicated as physicians tend to confuse psychomotor seizures and petit ma! epilepsy.

INCIDENCE AND ETIOLOGY

The terms psychomotor and temporal lobe epilepsy are often used synonymously and interchangeably. At times the seizure state may also be called uncinate epilepsy, epileptic automatisms or epileptic fuges. However, not all psychomotor seizures are associated with temporal lobe lesions, nor is temporal lobe pathology always productive of psychomotor epilepsy. Abnormalities and electrical foci from areas other than the temporal lobe can produce this seizure state. For these reasons, the term psychomotor epilepsy is preferred, and temporal lobe epilepsy, if used, should be restricted to those psychomotor seizures that result from primary temporal lobe pathology.

Ten to 20% of children in most pediatric seizure clinics have psychomotor epilepsy. Focal lesions are often considered to be the responsible etiologic factor, but diffuse encephalopathies, above all in children, are more commonly encountered. Prolonged febrile convulsions, perinatal trauma and hypoxia, craniocerebral trauma or meningoencephalitis can be the specific etiologic condition. Expansive lesions including neoplasms, vascular malformations, cysts and abscesses must be considered, especially when there is clinical or electrical evidence of a focal lesion.
Letter to the Editor
Authors: Hudson Russell E. , Allen Richard P. , Safer Daniel
Published: December 2021

Dr. Hoeffler inaccurately argues that statistics were misapplied in our April article in Pediatrics on the effects of stimulants on growth of hyperactive children. Dr. Hoeffler raises several issues. First, he implies statistics we used require randomization; they do not. The validity of the conclusions depend upon the assumption that no systematic error was introduced by the treatment assignment. This assumption is a matter of scientific judgment and is often made when dealing with experiments in "nature."
Sigmoid Volvulus in Children
Authors: Campbell John R. , Blank Eugene
Published: December 2021

Sigmoid volvulus occurred in a boy when he was 6 and 10 years of age. He also had nonobstructive malrotation of the midgut. Reduction both times was effected by proctosigmoidoscopy and the insertion of a rectal tube. Examination of the gastrointestinal tract with barium after the second reduction showed a large sigmoid colon with rough mucosa. At elective operation the dilated, non-obstructed sigmoid was resected.

Sigmoid volvulus is primarily a disease of adults, and in one large series 88% of the patients were 50 years or older. Sigmoid volvulus is also a disease which shows large geographical variations in its incidence. Despite the infrequency of its occurrence in North America and Western Europe and its rarity in children, it may cause acute strangulating obstruction in children.
Environmental Effects on the Embryos and Fetuses of Experimental Animals
Authors: Brent Robert L.
Published: December 2021

In examining the offspring of experimental animals or man in relation to exposures to environmental agents, account should be taken of certain principles developed over the past five decades.

TERATOGENESIS

Before the Period of Implantation

Experimental embryologic studies have shown that before implantation there is a so-called omnipotential period of development, when all cells have the ability to form a complete embryo. During this interval it is difficult, if not impossible, to induce congenital malformations. This interval extends to 6½ days in the mouse, 8 days in the rat, and about 12 to 13 days in man.

Teratogenic Period

The interval during which teratogenesis may be induced in man is short relative to the total gestational period, in contrast to the period of susceptibility in the mouse or rat, in which it is about one third of the gestational period.

Fetal Period

Subsequently, classical teratogens do not produce gross malformations that are easily observable at birth. Exposures to hazardous agents may still produce other effects throughout the later period of gestation, namely, cell deletions or tissue hypoplasia. This is a new area about which we do not yet understand very much, even with respect to high doses. When the mouse embryo is exposed late in gestation to 200 rad, a marked depletion has been observed in the cerebral cortex. This easily visible difference from normal upon inspection of the brain has little effect on behavior.

In the same way, x-irradiation of the mouse testes produced hypoplasia, but no defect in morphogenesis.
Mental and Motor Development in Monozygotic Co-Twins With Dissimilar Birth Weights
Authors: Fujikura Toshio , Froehlich Luz A.
Published: December 2021

Developmental measures in 125 monozygotic twin sets with unequal birth weights between co-twins were studied. There were no significant differences between co-twins in the Bayley Mental and Motor Scores at 8 months nor the Stanford-Binet IQ at 4 years. A reportedly higher IQ for the heavier of monozygotic twins was not confirmed in this study, even among pairs with large birth-weight differences. Although the effects of nutrition on the mental development of the fetus are currently of great concern, these data suggest that the developing human brain seems to have a strong resistance to intrauterine deprivation.
Child Neurology in the Community Hospital Setting
Authors: Weichsel Morton E.
Published: December 2021

Data are presented relating to the first 100 child neurological consultations seen in both ambulatory and inpatient settings in a community hospital practice in conjunction with a medical school teaching program. These data suggest that a great variety of interesting child neurology cases for teaching may present at the community hospital. Such cases may offer students at all levels the advantage of seeing a greater variety of neurological diseases earlier in the course of evolution, and provide a more realistic environment for a comprehensive approach to the psychosocial problems related to chronic neurological disease in childhood.
Immunofluorescence of Tracheal Secretions in Neonatal Syphilis
Authors: Macias Enrique G. , Eller Jerry J. , Huber Thomas W. , Abraham Gloria , Diserens Harold W. , Crawford Stanley E.
Published: December 2021

A case of congenital syphilis was diagnosed by aspiration of tracheobronchial secretions and immunofluorescent stain. The value of this microscopic technique for prompt diagnosis of neonatal infection is emphasized.
The Role of a Dialyzable Serum Factor in the Increased O2 Affinity of Hemoglobin in the Red Cells of Hypoxic Newborns
Authors: Boda Domokos , Murányi László , Eck Erna , Szilágyi Magda
Published: December 2021

Attempts to treat infants with neonatal adaptation disturbance by improving the O2 transport function of their blood with exchange transfusion are significant. Oski, in his recent E. Mead Johnson Award Address, noted that the exchange transfusion, in addition to influencing the fetal hemoglobin and 2, 3-DPG concentration in the red cells, alters many other factors that have been claimed to modify both morbidity and mortality in these infants. He said, "Among these factors are included the serum albumin level, blood coagulation factors and the presence of unidentified, but dialyzable toxins."

See image in the PDFfile
An Attacked Committee Replies
Authors:   Committee on Drugs
Published: December 2021

The number of the Letters to the Editor in response to the reply of the Committee on Drugs to the letter by Drs. Livingston et al. regarding amphetamines and epilepsy indicates that the Committee has kicked a hornet's nest. This is perhaps due to the fact that the Committee is in a sense challenging the empiric use of drugs, a practice which we all engage in everyday.

There is no question in the Committee's opinion that certain drugs are used in the physician's best judgment in instances where scientifically acceptable data are not available.
The Disabled Learner: Early detection and intervention (Modern approaches to the diagnosis and instruction of multi-handicapped children, vol. 8), edited by P. Satz, and J. Ross. The Netherlands: The Rotterdam University Press, 1973, 297 pp., $18.65
Authors: Cavanaugh James J. A.
Published: December 2021

In The Disabled Learner editors Satz and Ross present a potpourri of articles previously delivered at a conference held to acquaint physicians, educators and psychologists with new basic information in the field of learning disorders and to review new methods of intervention. The book falls far short of this goal.

The biology is naive, the language development section is uninformed, or at least systematically ignores a broad literature in this discipline, and the chapters that deal with specific learning disability and developmental dyslexia are unrewarding.
FOLLICLE STIMULATING HORMONE (FSH) AND LUTEINIZING HORMONE-HUMAN CHORIONIC GONADOTROPIN (LH-HCG) CONCENTRATIONS IN PAIRED MATERNAL AND CORD SERA
Authors: Penny Robert , Olambiwonnu N. Olatunji , Frasier S. Douglas
Published: December 2021

Penny, R., Olambiwonnu, N. O., and Frasier, S. D.: Follicle stimulating hormone (FSH) and luteinizing hormone-human chorionic gonadotropin (LH-HCG) concentrations in paired maternal and cord sera. Pediatrics, 53:41, 1974.

An error was made by the authors under the Materials and Methods section of the above article which appeared in the January issue. The last two sentences should read:

To convert to nanograms of LER 907, multiply FSH concentrations by 24 and LH concentrations by 17. For conversion to International Units of commercial HCG, divide LH-HCG concentrations by 0.55.
Training pediatricians for primary medical care
Authors: Shiller Jack G.
Published: December 2021

A recent issue of this Journal carried the Kenneth G. Blackfan Memorial Lecture delivered to the Children's Hospital Alumni Association in Boston on May 30, 1973.1 It was given by Dr. Cicely Williams and entitled "Health Services in the Home." In her message directed at pediatric academia, Dr. Williams essentially said, "Be off with your ultrascience, your superspecialists ... Give thought instead to the thousands who are sick ... Teachers, stop seducing the very best into your snare of enzymes, isotopes and transducers, leaving only a small group to replace our dwindling cohort of primary care deliverers."

That very same issue carried a commentary entitled "Primary Medical Care and Medical Research Training" by Dr. David G. Nathan of the Children's Hospital Medical Center.2
DR. JOHN LOVETT MORSE OF BOSTON ON A CHILD WITH DIABETES MELLITUS (1916)
Authors: C. T. E.
Published: December 2021

Dr. John Lovett Morse (1865-1940), Professor of Pediatrics, Harvard Medical School, published a popular texthook in 1913 entitled Case Histories in Pediatrics. The method of case teaching which had been used in the Harvard Law School from about 1890 on, was introduced into the Harvard Medical School in 1900 at the suggestion of Dr. Walter B. Cannon, then a student in the school. Dr. Morse was an enthusiastic supporter of case history teaching because he believed that "this method of teaching is far superior to recitations, quizzes, and conferences."1 The case history below of a child with diabetes mellitus, taken from the second edition of Morse's book (1916), points out the grim prognosis of this disease in the pre-insulin days.

Charles W., eleven years old, was the child of healthy parents. One brother was living and well. There had been no deaths or miscarriages. His maternal grandfather had had diabetes, but had died of tuberculosis.

He was born at full term, was normal at birth and weighed six pounds. He had whooping-cough when one year old, mumps and chicken-pox when small, and measles at four years, but had otherwise been well. He had always eaten much candy and had craved sweet foods. He had passed much more urine during the last month than formerly, and had drunk large quantities of water. He had to get up several times at night to urinate and to allay his thirst. His appetite was large. He had had no itching of the skin and no eruption.
Dilemma of Trust: Relationship Between Medical Care Givers and Parents of Fatally Ill Children
Authors: Kirkpatrick J. , Hoffman I. , Futterman E. H.
Published: December 2021

A major aspect of the course of parental psychosocial adaptation to childhood leukemia is described, focusing specifically upon the course of the parents' relationship with the physician and other care givers. At each stage of illness, situational components which are conducive to trust in the physician are identified along with others that are conducive to mistrust and doubt. Parents are seen as struggling with the dilemma of maintaining trust on the one hand and dealing with skeptical attitudes and angry reactions on the other. With interview data serving as the empirical base, variations in the balance between trust and mistrust are described in relation to stages in the course of the illness. An optimal role for parents in the care of the child is discussed, with the recommendation that parents be included in a meaningful way in decision-making processes.
Gingival and Periodontal Problems in Children
Authors: Polson Alan M.
Published: December 2021

This review will concentrate on the gingival and periodontal problems which the pediatrician may see as part of his care of the child patient. The age period covered is from the time of first tooth erruption to the middle teens. In considering specific conditions, the clinical appearance will be described, together with etiology and recommended management. Although the majority of gingival and periodontal problems are chronic in nature, a section is included on acute conditions.

The periodontium is the investing and supporting structure of the tooth. It comprises the gingiva, periodontal ligament, alveolar bone and cementum. The tooth is suspended in the alveolar bone socket through the periodontal ligament fibers which are embedded at one end in the cementum covering the root surface and in the alveolar bone at the other end. The gingiva is that portion of the oral masticatory mucosa which surrounds the teeth and is attached to the alveolar process of the jaws. In order to recognize pathological changes in the gingiva it is necessary to know how the normal appears (Fig. 1). The gingival tissues which extend into and fill the interdental or interproximal area form the gingival papillae. The gingiva has a thin edge where it meets and surrounds the tooth in a collar-like fashion. There is a potential space between the tooth and the marginal gingiva into which a blunt probe may be passed to a depth of 1 to 2 mm. The gingiva in health is pale pink and firm, and does not bleed on probing, brushing, mastication or spontaneously.
Letter to the Editor
Authors: Cohen Michael W. , Comerci George D.
Published: December 2021

Dr. Marcel Kinsbourne's lecture on school problems which appeared in the November 1973 issue of Pediatrics1 has prompted the following comments. Issue should be taken with the statement "children hate to take medication because it means they are different, and the last thing a hyperactive child wants to do is take methylphenidate or dextroamphetamine." Our experience has been quite different. Hyperactive children appear to be acutely aware of their difference when they are responding chaotically and impulsively to environmental stimuli.
Interaction of ultrasound and biologic tissues-potential hazards
Authors: Meyer Richard A.
Published: December 2021

The application of diagnostic ultrasound in pediatrics has become widely accepted and is being utilized more frequently in the diagnosis and management of patients. Since the technique is accurate, painless and without known risk, it has great appeal as a noninvasive diagnostic method. When a method is extensively used, it is essential to know about its safety. The purpose of this discussion is to provide some understanding of the interaction of ultrasound and biologic tissue and the possible potential hazards of the technique.

Diagnostic ultrasound as applied in medicine may be utilized in three ways-as continuous Doppler, pulsed-sonar or Doppler-sonar.
Helium Flow-Volume Curves in the Detection of Early Small Airway Disease
Authors: Fox William W. , Bureau Michel A. , Taussig Lynn A. , Martin Richard R. , Beaudry Pierre H.
Published: December 2021

To assess small airway disease in cystic fibrosis (CF) patients with minimal pulmonary involvement, maximal expiratory flow volume (MEFV) curves were obtained while the patients were breathing first air and then an 80% helium-20% oxygen gas mixture. Fifteen CF patients and 24 controls were studied. Flow rates at 50% and 25% vital capacity (VC) were calculated from the air and helium-mixture MEFV curves and were compared to give flow ratios at these lung volumes. At 50% VC, the helium/air flow ratios were similar in CF patients and normal subjects. At 25% VC, the flow ratio was significantly lower (p<0.05) in the CF patients. The air and helium MEFV curves were superimposed and the point where the curves crossed (point of identical flow, PIF) was determined and expressed in % VC. For the CF patients, the mean PIF was 18% and for the controls, 5% (p<.001). Nine of the 15 CF patients had PIF values greater than 2 standard deviations (SD) from the normal mean. None of the following tests were abnormal in more than three patients: FEV1/FVC, MMEF, RV/TLC, Vmax 50% TLC (TLC/see), and Vmax 25% VC (TLC/sec). Arterial oxygen tensions were below 86 mm Hg in four patients. Closing volumes by the 100% helium bolus technique were normal in all patients. Determination of the PIF appears to be a simple, noninvasive, and sensitive test for the detection of early small airway involvement.
The Effect of Uneven Dietary Protein to Calorie Distribution on Nitrogen Retention and Weight Gain
Authors: MacLean William C. , Morales Enrique , Graham George G.
Published: December 2021

To test the hypothesis that nitrogen utilization is maximal if protein is ingested in parallel to calories, balance studies were carried out in nine children, 4 to 26 months old and weighing 6 to 8 kg, convalescing from protein-calorie malnutrition. Diets provided 2 gm of protein and 125 Kcal/kg of body weight per day in five feedings. During the control period (6 to 12 days) protein was evenly distributed. During the study period (6 to 15 days) one half the daily protein was given in a single meal to three children, all the daily protein being given in a single meal to the other six. Calories were evenly distributed throughout the day. Apparent nitrogen retentions, changes in serum proteins and fractional urine nitrogens were similar on both diets. Weight gain was significantly less while consuming the diet with uneven distribution of protein. The child appears able to retain nitrogen adequately while consuming all his protein in a single meal without regard to calorie distribution. Difference in rates of weight gain between the two diet periods may reflect a difference in composition of tissue laid down.
Chronic Granulomatous Disease in a Child With Klinefelter's Syndrome
Authors: Sanders Doris Y. , Goodman H. O. , Cooper M. Robert
Published: December 2021

A 1-year-old white male child with Klinefelter's syndrome (chromosomal count of 47 XXY) was diagnosed as having chronic granulomatous disease (CGD). As this association is previously unreported to our knowledge, the case is recorded briefly.

CASE REPORT

This 1-year-old white male child was followed in the pediatric clinic of the Bowman Gray School of Medicine since the age of 3 months for hepatosplenomegaly, recurrent ear infections and a persistent skin rash involving the external nares and right submandibular area. The genitalia were observed to be small by the attending physician although both testes were palpable in the scrotum.

Laboratory studies at the age of 3 months included a hemoglobin of 9.6 gm/100 ml, hematocrit of 26%, red blood cell count of 3.2 million, white blood cell count of 24,300/cu mm, with a differential count of 55 neutrophils, 28 lymphocytes, 14 monocytes and 3 eosinophils.
Placidyl® Poisoning or Withdrawal?
Authors: Nieburg Phillip
Published: December 2021

In the November issue of Pediatrics, Rumack and Walravens reported a case of ethchlorvynol (Placidyl) withdrawal in a neonate.1 A careful reading of their report led me to a diagnostic conclusion somewhat at variance with theirs.

Based on the data presented, I would propose that their infant was suffering the effects of ethchlorvynol poisoning (i.e., toxicity) rather than withdrawal. The reported CNS depression and jitteriness correspond as well to intoxication symptoms of this drug as they do to possible withdrawal symptomatology.2
Letter to the Editor
Authors: Rumack Barry H. , Walravens Phillip
Published: December 2021

We must reject Dr. Phillip Nieburg's conjectures as invalid.

Central nervous system depression and jitteriness do not correspond well to the ethchlorvynol intoxication syndrome. Patients treated for acute overdosage here, as elsewhere,1-3 demonstrate marked CNS depression, hypothermia, hypertension, hyporeflexia and respiratory depression. This classic syndrome of ethchlorvynol intoxication is not to be confused with the withdrawal syndrome4 of tremors, hallucinations and convulsions. Chronic ingestion of large quantities of ethchlorvynol does not produce toxic features but rather the abstinence syndrome upon termination of the drug.
Nasotracheal Tubes Preferred for Epiglottitis
Authors: Sweeney D. B.
Published: December 2021

On reading Dr. Rapkin's article, "Tracheostomy in Epiglottitis,"1 I feel that his series is rather small to recommend tracheostomy as an alternative to intubation as treatment for epiglottitis.

I agree with him that elective airway relief on diagnosis is the treatment. This view is further supported by Baxter,2 who recommends immediate tracheostomy on diagnosis, but I do not agree that tracheostomy is still the method of choice. Dr. Rapkin quotes only five cases of elective tracheostomy and although he states they all survived, he gives no details of morbidity or complications.
Comment on TV Ads
Authors: Feinbloom Richard I.
Published: December 2021

The findings of the effects of television advertisements on the health beliefs and behaviors of school children reported in the March issue1 have led the authors of the article to design a classroom exercise in which commercials pertaining to health are critically analyzed and students are trained in decision-making. I suggest an additional course of action.

In January 1973, on the television program The Advocates, Nicholas Johnson, until recently a commissioner of the Federal Communications Commission, and I took the pro position on the topic "Should Drug Advertisements Be Banned From TV?" My basic argument was that any commercial advertisememit on a health matter is inherently misleading.
Noise Pollution: Neonatal Aspects
Authors: Miller Robert W. , Brendel William B. , Brent Robert L. , Chisolm J. Julian , Doyle John L. , Ebbin Allan J. , Fagan Emmett L. , Finberg Laurence , Mendez-Cashion Dolores , Mulvihill John Joseph , Falk Stephen A. , Flynt J. William , Frantz Christopher , Knelson John H. , Knutti Sarah H.
Published: December 2021

The deafening effect of high intensity noise is well known—from rock music, aircraft, snowmobiles, motorcycles and the shooting of guns. The effects of hospital noise and its interaction with ototoxic drugs are less well known. The subject is of particular importance to pediatricians, because infants in incubators are exposed to substantial noise from the motor, airflow, respirators, slamming of incubator doors and the baby's own crying. Furthermore, animal experimentation1 shows that the ototoxic drug, kanamycin (often given to the premature infant to combat sepsis), can potentiate the effect of noise on hearing loss as much as 100-fold. Whether or not an interaction between noise and potentially ototoxic drugs occurs in man is as yet unknown.

MEASUREMENT

Noise has frequency and intensity. Frequency is measured in cycles per second, designated hertz (Hz). The young human ear is sensitive to a frequency range of 20 to 20,000 Hz. White noise, the auditory counterpart of white light, has equal energy in each frequency in the audible range.

Intensity is measured in decibels on a scale which is linear with respect to audible frequencies. This measurement is designated dB (linear). Since the human ear is more sensitive to the damaging effects of high frequency sound than to low frequency, a better correlate with noise-induced hearing loss can be obtained when low frequencies are filtered out. Filtered sound level, measured on a so-called A-weighted scale, is designated dB(A). Room conversation produces 60 to 70 dB(A), rock music 100 to 120 dB(A) and snowmobiles 105 to 135 dB(A) for the driver.
Hyperactivity: The Henderson-Dahlin-Partridge-Engelsing Hypothesis
Authors: Oettinger Leon
Published: December 2021

In the October 1973 issue, Henderson et al.1 discuss hyperactivity and its etiology. The short discussion deals with early symptoms and not with etiology. No approach to the cause of the colic and hypertonicity is made.

All we who have worked with hyperkinetic behavior syndrome in children have been aware of these symptoms for many years. The therapeutic approach is interesting and worth following up. The difference between etiology and symptoms is a real one, and the two should not be confused.
Dr. Manning's Reply
Authors: Manning P. J.
Published: December 2021

The short commentary article published in the Febniary issue of Pediatrics was a condensation of a larger work, and several references were deleted from the original work. No reference to health conditions of Eskimos could be made without quoting from investigations by Otto Schaefer. Unfortunately, a mistake was made in the deletion of one of Dr. Schaefer's publications, as he has pointed out.

Our point about breast-feeding arises from our own observations in this Zone.
Question Raised Regarding Diagnosis of Hunter Syndrome
Authors: Kelly Thaddeus E.
Published: December 2021

In Pediatrics, March 1974, an article by Booth and Nadler reported demonstration of the heterozygous state in the Hunter syndrome. The authors suggested that this technique may provide a method for detecting at least some heterozygotes for the Hunter gene. While this technique may allow certain females to be identified as carriers of the Hunter gene, application of this technique will not significantly alter current genetic counseling and application of amniocentesis for the prenatal diagnosis of the Hunter syndrome.
Why Another Growth Chart?
Authors: Owen George M. , Garn Stanley M.
Published: December 2021

The paper by Duncan and colleagues in a previous issue1 presents growth charts based on an earlier report by McCammon2 which summarized measurements collected by the Denver Child Research Council since 1933. Any "new" growth charts should have compelling advantages over those already in common use.3,4 Such advantages might reflect the nature and size of the sample, the up-to-date character of the sample, and artistic or novel features of the charts themselves.

It is only in the latter category that the Denver charts seem to have succeeded. That is, weight, height, and head circumference measurements are depicted graphically for two age intervals on one sheet of paper.
A SIXTEENTH CENTURY CURE FOR AN ENGLISH INFANT AFFLICTED WITH A FEVER AND WORMS
Authors: C. T. E.
Published: December 2021

Dr. John Hall (1529?-1568?), an English poet and medical writer, and also a member of The Worshipful Company of Chirurgeons, used the following regimen to treat the Countess of Salisbury's son who was afflicted with a fever and worms.

Talbot, the first-born of the Countess of Salisbury, aged about one year, being miserably afflicted with a fever and worms, so that death was only expected, was thus cured. There was first injected a clyster of milk and sugar. This gave two stools, and brought away four worms. By the mouth was given hartshorn burnt, prepared in the form of a julep and to the pulse was applied Ung. Populeon drams mixed with spiders webs, and a little powder of nutshells. It was put to one pulse of one wrist one day, to the other the next. To the stomach was applied Nithridate; to the navel, and emplaster against worms. And thus he became well in three days, for which the Countess returned me many thanks, and gave me a great reward.1
Galactokinase Deficiency in Twins
Authors: Monteleone James A. , Monteleone Patricia L. , Bert Michael , Hilliard Richard
Published: December 2021

The recent article by Olabiwonnu et al., reporting two new cases of galactokinase deficiency, deserves comment.

The authors reported the results of serum and urine studies for galactose and galactose derivatives on their patients while on a "galactose-free diet." The urine galactose and galactitol levels were rather high. We recently followed a six-week-old classic galactosemic (galactose-1-phosphate uridyltransferase deficiency) while on Nutramigen and Prosobee and determined urine galactose and galactitol levels; in addition we have done urine and serum galactose and galactitol levels on the galactokinase deficient family we have been following and which was quoted in the article.2
Haloperidol in Stuttering
Authors: Milman Doris H.
Published: December 2021

A response to the letter of Dr. C. E. Healy (Pediatrics, 53:587, 1974) on the use of haloperidol in stuttering and more especially to the reply of the Committee on Drugs is in order.

To address the Committee's reply first, I agree that controlled conditions, a double-blind protocol, and appropriate statistical analysis are desirable. None of this, however, will come about until someone, Dr. Healy for example, records a clinical experience that inspires the indicated investigation.
Salicylate, pharmacokinetics, and the pediatrician
Authors: Done Alan K.
Published: December 2021

Clinicians may, at first glance, wonder why the paper in this issue by Levy and Yaffe1 on the volume of distribution of salicylate in children should concern them or, indeed, why it even appears in their journal.

This important and excellent study is a prime example of the growing influence and involvement of clinical pharmacology and pharmacokinetics in medicine generally and pediatrics particularly. Already substantial, with the growing complexity of pediatric therapeutics, this relationship stands to become even more widespread and intense as a result of increasing emphasis on more and better pediatric drug studies. Evolving ethical-legal constraints notwithstanding,2 these must and will expand.
THE IDEOLOGY OF GROWTH
Authors: Barnet Richard , Muller Ronald
Published: December 2021

Driven by the ideology of infinite growth, the (global) corporations act as if they must expand or die, and in multiplying they have made thrift into a liability and waste into a virtue. Their growth depends upon converting ever-greater portions of the earth into throw-away societies—ever-greater unusable waste produced with each ton of increasingly scarce mineral resources, ever-greater consumption of non-disposable and non-returnable packaging, ever-greater consumption of energy, and ever-more heat in our water and our air. In short, ever more ecological imbalance. As central planners, hoarders of information, and creators of sophisticated hierarchies, the corporate managers are seeking to legitimize new organizational loyalties to rival family, town, church, and state, and in so doing they are accelerating the process of alienation which aggravates psychological distress.
LIVE LIFE TO ITS FULLEST
Authors: Mumford Lewis
Published: December 2021

In Moby Dick, Melville conquered the white whale in his own consciousness: instead of blankness there was significance, instead of aimless energy there was purpose, and instead of random living there was life. The universe is inscrutable, unfathomable, malicious, so—like the white whale and his element. Art, in the broad sense of all humanizing effort, is man's answer to this condition: for it is the means by which he circumvents or postpones his doom, and bravely meets his tragic destiny. Not tame and gentle bliss, but disaster, heroically encountered, is man's true happy ending.
PUBLISH OR PERISH
Authors: Simpson M. A.
Published: December 2021

Poor research and semiliterate publication [are overvalued] . . . partly, because quantity in number of publications, is easier to measure than quality. I am reminded of the story of the Centurions who stood at the foot of the Cross. One said "I hear He was a great Teacher." "Yes," said the other, "but He never published anything."
Dr. Kendig Replies
Authors: Kendig Edwin L.
Published: December 2021

It should first be pointed out that in Nansemond County, Virginia, the incidence of presumptive sarcoidosis is 500 per 100,000 population, more than three times greater than that noted anywhere else in the world. Other nearby counties appear to be similarly affected and sarcoidosis is a common diagnosis in the geographic area served by the Medical College of Virginia Hospitals.

Dr. Pickering correctly states that "sarcoidosis is difficult to define and protean in its manifestations and simulates many disease entitles such as tuberculosis, fungal infection, leprosy, syphilis, berylliosis, silicosis, tumor, and foreign bodies."
WHY IT IS WRONG TO EDUCATE CHILDREN OF THE LOWER CLASSES: TWO EIGHTEENTH CENTURY VIEWS—ONE FRENCH, THE OTHER ENGLISH
Authors: C. T. E.
Published: December 2021

The two quotations below are representative examples of eighteenth century French and English views about the undesirability of offering too much education to the children of the poor.

Today, [1763] even the lower classes want to study. Laborers and artisans send their children to boarding schools in the small towns where living is cheap, and when they have received a wretched education, which has taught them merely to despise their fathers' trades, they fling themselves into the monasteries, become priests or officers of justice, and frequently turn out to be a danger to society.

The Brothers of Christian Doctrine, nicknamed the "Ignorantines," have made things worse. They teach reading and writing to people who should never have learned more than a little drawing or how to handle the plane or the file and who now don't want to do this . . . . The good of society requires that the lower classes' knowledge should go no further than their occupations. No man who can see beyond his depressing trade will ply it with patience and courage. The lower classes scarcely need to know how to read or write except for those members of it who live by these skills or are helped by them to make their living . . . . it is better to have few students provided they are well educated . . . . [L. R. Caradeuc de la Chalotais, Essai d'education nationale].

England, 1792. However desirable it may be to rescue the lower kinds of people from ignorance . . . . it cannot be right to train them all in a way which will probably raise their ideas above the very lowest occupations of life and disqualify them for those servile offices which must be filled by some members of the community, and in which they may be equally happy with the highest, if they will do their duty . . . .
Lettrt To The Editor
Authors: Frazier Robert C.
Published: December 2021

The Academy is making an effort to meet rising costs with vigorous attention to expenditures, as well as exploration of opportunities for industry and foundation support of special projects. As part of this exploration the Academy contacted Mead Johnson for funding support and staff assistance in distributing the Red Book to all Academy members through the routine visits to pediatricians by Mead Johnson sales and service personnel. Delivery was never meant to be contingent on a personal visit with the Academy members, though Mead Johnson staff felt they were doing a service and would be received in that light.