bluuebunny/crossref_metadata_2025 huggingface dataset:
THE CLINICAL IMPLICATIONS OF HEMOGLOBIN STRUCTURE
Authors: Gerald Park S.
Published: December 2021

I FEEL DEEPLY HONORED to be named as one of the recipients of the 1962 Mead Johnson Awards for research in pediatrics. I am grateful for this opportunity to express my indebtedness and gratitude to the many who have aided me, and especially to my sponsor, Dr. Louis K. Diamond. His unwavering confidence and unselfish support were major contributing factors toward the successful completion of these research efforts. Lack of time prevents me from giving an adequate list of those other teachers and associates who contributed significantly toward my research efforts and training, but time can never be so short as to prevent me from mentioning my stimulating and energetic co-worker, Dr. Mary Efron. I have saved to the last, mention of my wife, as she has so often cheerfully been the vital silent partner of experiments that seemed always to last "just a little longer" than I expected.

In order to make this a coherent presentation, I am going to dwell solely upon the "Hb M diseases." This group of hemoglobinopathies is characterized by the presence of cyanosis in several generations of a given family, being transmitted as if determined by the presence of a single abnormal gene (i.e., "dominant" inheritance). In the first family of this disorder that came to our attention, the cyanosis was an incidental finding in a child whose chief complaint was an obscure peripheral neuritis. There seemed to be little relation between the peripheral neuritis and the cyanosis, since the child's brother, father, paternal aunt and other relatives also were cyanotic (Fig. 1), although lacking any neuritis.
COXSACKIE A9 INFECTIONS WITH EXANTHEMS
Authors: Cherry James D. , Lerner A. Martin , Klein Jerome O. , Finland Maxwell
Published: December 2021

Five cases of Coxsackie A9 virus infections with exanthems are described. Three of these are of particular interest because urticarial lesions were present; vesicular eruptions were noted in two of these cases.
Iron Intake, Hemoglobin, and Growth
Authors: STURGEON PHILLIP
Published: December 2021

I was pleased to read in the recent article by Beal et al. (Pediatrics, 30:518, 1963) that from the results of their observations they found no contraindication to the important principle of artificial iron supplementation with fortified cereals during the first year of life as a prophylaxis of iron deficiency. Although there is an inconsequential difference of opinion as to whether the daily intake of iron should be 0.5 or 1.0 mg, or even 1.5 mg/kg/day, it is not surprising in such a small and selected series as that studied by Beal et al. and in a series where the only measurement of iron nutrition was the hemoglobin determination, that most hemoglobin levels should be found in the normal range even with iron intakes on the lower end of the scale.
STUDIES OF TOCOPHEROL REQUIREMENTS IN HEALTH AND DISEASE
Authors: Goldbloom Richard B.
Published: December 2021

Premature infants were fed an artificial formula essentially free of tocopherol over the first 6 months of life. These infants were compared to two other groups of prematures one fed a formula of "average" tocopherol content, and the third group a tocopherol-fortified product. Although the use of the "tocopherol-free" product resulted in extremely low tocopherol concentration in serum, no significant differences were observed in the three groups of infants with respect to weight increment, hemoglobin concentration, erythrocyte counts, hematocrit value, or in erythrocyte glutathione and glucose-6-phosphate dehydrogenase activity. The requirements of the normal premature infant are met by a formula containing 3.0 mg of alpha tocopherol per liter of formula, in terms of achieving normal concentrations in serum during a 1-to-2-month period.

Absorption studies in healthy full-term infants in the first week of life failed to reveal any significant differences in the degree of absorption of tocopherol as d-alpha tocopherol acetate, d-1 alpha tocopherol acetate and d alpha tocopheryl polyethylene glycol succinate, when administered in test doses providing 2.0 and 10.0 mg of free tocopherol.

Observations on the effects of tocopherol supplementation on concentrations in serum of healthy full-term infants fed partly skim milk formula suggest that a daily supplement providing 0.5 mg of free tocopherol is adequate to produce a rapid rise to normal serum levels. However, except in terms of tocopherol concentrations, this study does not answer the question of true biological need for a tocopherol supplement in artificially fed infants.

Because of the variable but marked decrease in tocopherol absorption in children with fibrocystic disease, very large supplements are necessary to maintain normal levels in serum. The observations reported here suggest that a minimum supplement of 100 mg tocopherol per day (free to-copherol as d-alpha tocopheryl polyethylene glycol succinate) is likely to be necessary in such patients, in order to restore serum concentrations to normal.
TRIPLE MOSAICISM WITH AN ISOCHROMOSOME DERIVED FROM A PARTIALLY DELETED Y IN A MALE PSEUDOHERMAPHRODITE
Authors: Klevit Harvey D. , Mellman William J. , Eberlein Walter R.
Published: December 2021

A male pseudohermaphrodite with asymmetrical gonadal differentiation is described. Mullerian duct derivatives persisted on the side where a rudimentary gonad was found, and Wolffian duct structures developed on the side where a testis was present. Triple chromosomal mosaicism was present with a postulated 45/XO, 46/X-isochromosome long arm of Y (or partially deleted Y), 47/X-isochromosome long arm of Y (or partially deleted Y)-Y (long arm partially deleted) karyotype. The relationship of abnormalities of the Y chromosome to fetal gonadal differentiation and function is discussed.
ELECTRICAL CONDUCTIVITY OF SWEAT
Authors: Phillips William R.
Published: December 2021

An apparatus for determining the electrical conductivity of undiluted sweat has been described. The technique used and the results obtained have been presented. The results indicate that the instrument, when used with the technique described, is of value in the diagnosis of cystic fibrosis in children.
INFLAMMATORY LESIONS OF THE PANCREAS IN INFANCY AND CHILDHOOD
Authors: Frey Charles , Redo S. Frank
Published: December 2021

Eighteen children with acute pancreatitis, not including those with cystic fibrosis of the pancreas, were encountered at The New York Hospital from 1932 to 1962. Steroid administration, congenital anomalies, mumps, operative trauma, periarteritis nodosa, intestinal obstruction, and malnutrition and infection were thought to be factors in the etiology of acute pancreatitis in these patients. The ages of the children ranged from 1 day to 10 years. Fourteen of the children were male and four female. Fourteen patients died. Significant postmortem findings included kidney and renal lesions in addition to pancreatitis. Survivors were children 5 to 10 years of age whose pancreatitis was attributable to mumps, operative trauma, and annular pancreas. Liver and renal dysfunction in patients with pancreatitis appeared to augur a poor prognosis. All patients thought to have "idiopathic" pancreatitis had a history of poor nutrition and/or infection, which probably are etiologic factors in the development of pancreatitis in these children.
CLINICAL AND BIOCHEMICAL STUDIES ON TWO CASES OF HISTIDINEMIA
Authors: La Du Bert N. , Howell R. Rodney , Jacoby George A. , Seegmiller J. E. , Sober Eva K. , Zannoni Vincent G. , Canby John P. , Ziegler Lillian K.
Published: December 2021

Studies on two siblings with histidinemia have shown that the enzymatic defect in this metabolic disease is the absence of histidase. As a consequence, blood levels of histidine are greatly elevated, and histidine and imidazolepyruvic acid are excreted in the urine. Imidazolepyruvic acid in the urine of these patients gives a green color with ferric chloride, and the disease may be confused with phenylketonuria. Patients with histidinemia lack urocanic acid in the skin and sweat. Both siblings with histidinemia have speech defects but normal intelligence. The possible relationship between the defect in speech and the metabolic disease has been discussed. The mode of inheritance of this disease is not clearly established, but it may be a Mendelian recessive.
CHILD-REARING PRACTICES IN A LOW SOCIOECONOMIC GROUP
Authors: Wortis H. , Bardach J. L. , Cutler R. , Rue R. , Freedman A.
Published: December 2021

Our findings support the view that there are characteristics in child-rearing practices which are related to class status, and that these differences become more pronounced with the extremes of class.

In this sample of low-class mothers interviewed when tile child was 2½ years of age, we found some maternal rejection of the child, coldness, and physical punishment. There was lack of restrictiveness in regard to toilet training and training for manners. At 5 years there was much restrictiveness in regard to aggression against parents, and against sex play. There was great concern for education for the child, and a strong feeling that the child should fight back if molested. Some of these attitudes, we believe, came out of the mother's rejection of her own social situation and segregation into a lower caste.

The maternal attitudes and child-rearing practices which we have described and which were related to class, undoubtedly helped mold the developing child. If we can speculate, we would say that certain things in his environment were helpful to the child. He was permitted to grow at his own speed. If he was unable to perform, he did not meet with criticism and pressure to do better. He learned how to work. He was encouraged to fight for his rights. On the other hand, there was confusion as to who had authority over him and what behavior was acceptable, since many persons with different expectations had a parental role. He was accustomed to extremes of adult authority, being very controlled at times, and not at all controlled in others. He early became used to corporal punishment. He was treated with relative coldness and he was not praised for achievement. The stimuli which are supplied by books, toys, and cultural experiences were often missing. There was little opportunity for a boy to identify with a male figure. There was lack of interest in the personality characteristics which differentiate one individual from the other and which contribute to a strong feeling of self-identification.

Other elements in the environment were preparing the child to take over a lower class role. The inadequate incomes, crowded homes, lack of consistent familial ties, the mother's depression and helplessness in her own situation, were as important as her child-rearing practices in influencing the child's development and preparing him for an adult role. It was for us a sobering experience to watch a large group of newborn infants, plastic human beings of unknown potential, and to observe over a 5-year period their social preparation to enter the class of the least-skilled, least-educated, and most-rejected in our society.
Plastic Toy Injury
Authors: Wolf I. J.
Published: December 2021

The pediatrician should be alert to the dangerous potentiality of hard plastic toys and should warn parents against their purchase.
THE INFLUENCE OF AGE ON PERFORMANCE AS SHOWN BY EXERCISE TESTS
Authors: Dill D. B.
Published: December 2021

THE STUDY of work performance as related to age began in this country when Sid Robinson joined the group at the Fatigue Laboratory of the Harvard School of Business Administration. In the winter of 1936-7, he persuaded five champion milers who were in Boston for indoor meets to run on the Laboratory's treadmill on week-ends. Simultaneously, he was chiefly engaged in studying treadmill performance as related to age. This was the subject of his doctorate thesis published later under the title: "Experimental Studies of Physical Fitness as Related to Age". The 91 subjects ranged in age from boys 6 years of age to one man of 91. There were eight 6-year-olds, 10 between 8 and 13 and 20 between 48 and 76.

Robinson's background as an Olympic middle-distance runner and as an assistant track coach at Indiana University gave him skill in dealing with the many diverse problems that confronted him. Often he was faced with sociological-psychological problems more difficult to solve than the physiological problems. Indicative of his success is the fact that the subjects were volunteers—no money was offered as an inducement to come to the laboratory. Also worthy of note is that there was no untoward incident throughout the study.

Robinson's plan included respiratory, circulatory and metabolic observations in the basal state and in two grades of exercise. He describes the work experiments as follows: (pp. 251-3, reference 2)

"After the above observations were completed, the subject performed two grades of work on a motor-driven treadmill, set at an angle of 8.6% in all experiments. Each subject below 73 years of age first walked at 5.6 km per hour for 15 minutes; this raises the oxygen consumption 7 or 8 times the basal level. After resting 10 minutes, he ran or in some cases, walked, at a rate which exhausted him in 2 to 5 minutes.
Serum Levels of Potassium Penicillin V following Oral Administration to Febrile and Afebrile Children
Authors: WHITEHOUSE F. , OBENG S. A. , PEQUET A. R. , CHAMNESS J. K. , JENDER J. K. , WILSON J. L.
Published: December 2021

A single dose of 200-400,000 units of oral potassium penicillin V is absorbed rapidly in fasting febrile children and infants to produce high serum levels. These levels are similar to those of afebrile children in the same age groups. From this standpoint, therapy of acutely ill febrile children with oral potassium penicillin V in reliable when penicillin is indicated.
THE PRESENCE OF LACTULOSE IN THE URINE OF INFANTS WITH LACTOSURIA
Authors: Gerritsen Theo , Lemli Luc , Ptacek Louis J. , Waisman Harry A.
Published: December 2021

Two patients with failure to thrive are described who excreted lactose in the urine together with the non-naturally occurring disaccharide lactulose. It was demonstrated that both sugars originated from the diet, a canned liquid modified milk product. It is suggested that the β-galactosidase activity in the gut was decreased, although blood glucose levels during a lactose tolerance test were near normal. The patients outgrew this partial enzyme defect before the age of one year.
The Needs of Children
Authors: WEGMAN MYRON E.
Published: December 2021

This book is a compilation of certain fundamental reports and documents of interest to anyone looking at the needs of children internationally. It is published for the United Nations Children's Fund (UNICEF), a fund of the United Nations responsible to the General Assembly and depending for its income on voluntary contributions of governments and individuals. Although the technical responsibility for the programs in areas such as health, nutrition, education, and welfarelies with the respective specialized agencies of the United Nations, such as the World Health Organization and the Food and Africulture Organization, UNICEF has a fundamental role in centralizing and focalizing work for children.
Letters to the Editor
Authors: JACOBS JERRY C.
Published: December 2021

All of our "drug-induced" patients had signs and symptoms suggestive of systemic lupus erythematosus (SLE), with positive L-E preps done on lightly heparinized blood after a 1-hour incubation at room temperature (a relatively insensitive method). The only differentiating features in these patients were a history of seizures prior to the onset of other manifestations of SLE and treatment with anticonvulsant drugs. The purpose of our paper was to show that such patients, as a group, have a more favorable course than others, providing the offending agent is withdrawn.
NEONATAL NEUTROPENIA AND LEUKOAGGLUTININS
Authors: Payne Rose
Published: December 2021

Support for the existence of an immunoneutropenia of the neonatal period was not obtained. The leukocyte counts of 39 full-weight newborn infants who stimulated their mothers to form leukoagglutinins were compared with the counts of 76 newborns who failed to stimulate formation of these agglutinins. A significant difference between the mean total leukocyte or differential counts for the two groups was not observed. The leukocyte counts of both groups throughout the first four days of life were in close agreement with the accepted values for this period. The platelet counts for 10 full-weight newborn infants who stimulated white cell agglutinin formation did not differ over the first four days of life from a control group of 37 newborns. Transplacental passage of the leukocyte agglutinins was demonstrated in 15 of 49 newborns examined. Persistence of antibody in the serum of the newborn was variable It was concluded that in this series transplacental passage of leukocyte agglutinins from sensitized mothers to newborns with antigen did not induce significant leukopenia or neutropenia.
Etiocholanolone Fever
Authors: JACOBS JERRY C.
Published: December 2021

A 16-year-old girl with the clinical syndrome of periodic peritonitis since early infancy was found to have elevated serum levels of unconjugated etiocholanolone during an acute attack. Biopsy of her peritoneum at that time revealed peritonitis and an abundance of mast cells. The recently described entity of Etiocholanolone Fever was briefly reviewed.
Subject Matter of Pediatrics
Authors: ROSENZWEIG JOSEPH L.
Published: December 2021

For some time I have felt that Pediatrics has been failing in its responsibilities to those of us who are in the daily practice of general pediatrics. Subject matter continues to be aimed more and more at the research-oriented, and is of decreasing value to the practicing pediatrician.

I realize the necessity for continued research that it has to be published, and that every moment I practice I am utilizing and benefiting from the results of previous investigators. I am aware, too, of the economic factors that necessitate some articles.
Letters to the Editor
Authors: WESSEL MORRIS A.
Published: December 2021

I do appreciate Dr. Mendelsohn's kindness in writing to obtain further information regarding details of a pediatric prenatal visit for expectant couples. Although I do live in the city where Yale Medical Center is located, I conduct with an associate a full-time pediatric practice. Expectant couples seek appointments in our office because they have learned that this is a well-established routine.

I do not understand Dr. Mendelsohn's hesitancy in seeking information as to occupational and housing status of expectant parents.
Sex Ratio of Children Born of Leukemic Mothers
Authors: FRAUMENI JOSEPH F.
Published: December 2021

Previous report of a marked shift in the sex ratio of children born of mothers with acute leukemia suggested a potential clue to genetic changes in leukemia. In the study reported here, an exhaustive review of the world literature since 1930 on leukemia and pregnancy revealed that 24 males and 32 females were born alive to mothers suffering from acute leukemia, while 37 males and 28 females occurred among the liveborn offspring of mothers with chronic leukemia. These differences were not statistically significant. Within each series, the small numbers of male and female infants reported dead at birth were about equal. Since the deficiency of male live births among offspring of mothers with acute leukemia was restricted to the myeloid form, additional sex ratio studies appear indicated. The results of this study and a review of the literature reveal little, if any, evidence of a maternal-fetal transmission of leukemia.
Letters to the Editor
Authors: CORIELL LEWIS L.
Published: December 2021

It is difficult to construct an all inclusive table of antimicrobial dosage and the bacteria for which each is indicated because the subject is too complex and there are too many variables to compress all the pertinent information into a few words or symbols in a table. Selection of the optimal antimicrobial and its mode of use quires more knowledge of its pharmacology, the tissue infected, the infecting organism, its antibiotic sensitivities, and the probable duration of treatment than can be included in a table.
Animal Bites
Authors: CANBY JOHN P.
Published: December 2021

Animal bites are common in pediatrics practice, particularly in large clinics as in military hospitals. Although the "Red Book" of the Report of the Committee on the Control of Infectious Diseases of the AAP is a help in many diseases, I do not agree with the apparent flat recommendations for animal bites as published. I feel that Antirabies therapy for bites is not just a matter of "here is a bite, what does the book say to do?"
Mentally Retarded Children and Their Education
Authors: CLEMENTS JAMES D.
Published: December 2021

The author clearly and justifiably states his intent to clarify in the minds of parents, teachers, and administrators the difference between Mental Health, Mental Illness, and Mental Retardation. He suggests that the book might be of value as a text in college classes for teachers. He has listed methods, materials, and supplies that, in his opinion, are good for teaching the mentally retarded.

This book adequately discusses the definitions and differences in Mental Health, Mental Illness, and Mental Retardation from the layman's view.
Hemolytic Disease of the Newborn in South African Europeans and Bantu 1946-1960
Authors: LUCEY JEROLD F.
Published: December 2021

This thesis is a summary of the author's experience in the diagnosis and treatment of hemolytic disease of the newborn in the pre-exchange transfusion era 1946-1949 (35 infants) and in the exchange transfusion era 1951-1960 (322 infants).

The author's over-all mortality rate of 8.5% among all erythroblastotic infants receiving exchange transfusions compares favorably with that reported by other authors. Only twelve infants in this series required repeat exchange transfusions! The criteria used to select infants for repeat transfusions are not given.
ADJUSTMENT OF VENTILATION, INTRAPULMONARY GAS EXCHANGE, AND ACID-BASE BALANCE DURING THE FIRST DAY OF LIFE
Authors: Prod'hom L. Samuel , Levison Henry , Cherry Ruth B. , Drorbaugh James E. , Hubbell John P. , Smith Clement A.
Published: December 2021

Determinations of blood gases and of acid-base balance were done in umbilical vein and artery blood at birth and in arterial blood at the age of 20 minutes in 20 infants of diabetic mothers. All were born by cesarean section, 18 of them between 36 and 37 weeks gestation. None showed respiratory distress at any time.

Ventilation, gaseous metabolism, functional residual capacity, intrapulmonary gas exchange, and acid-base balance were determined at the age of 1, 4, and 24 hours in these 20 infants.

The results indicate the following conclusions with regard to infants of diabetic mothers.

1. Adjustment of ventilation to perfusion in the lung appears to be complete at 4 hours of life.

2. Throughout the first 24 hours there is a persistence of an over-all true right to left shunt of approximately 20-25% of the total cardiac output. The exact localization of this shunt is unknown.

3. Acid-base balance in cord blood and in arterial blood during the first day of life in infants of diabetic mothers differs only slightly from that of infants of nondiabetic mothers. At 1 and 4 hours of age there is some persistence of a slight respiratory acidosis.

4. At 24 hours infants of diabetic mothers have the usual low arterial Pco2 of other newborn infants, but a ventilation equivalent of 16.5, which is normal for adults.

5. Although 6 of the 17 infants studied at 4 hours have shown a respiratory rate above 60 without other signs of respiratory distress, these infants with high rates had small tidal volumes, high physiologic dead-space/tidal volume ratios, and relatively little increase in minute volume.
CURRENT STATUS OF USE OF EXCHANGE TRANSFUSION IN NEWBORN INFANTS
Authors: Mckay R. James
Published: December 2021

The only absolute indication for exchange transfusion is the appearance of clinical signs of early kernicterus whatever the level of serum bilirubin.

The decision as to whether or not to perform an exchange transfusion should be made on an individual basis and should take into consideration factors other than the serum bilirubin level. Such factors include the experience of the operator, the degree of illness of the infant, presence or absence of hemolytic disease, asphyxia, cyanosis, low blood pH, hypoglycemia, hypoproteinemia, and degree of immaturity. The PSP binding capacity of the patient's serum may also turn out to be a valuable guide or even an absolute indication after experience with it has accumulated.
THE VALIDITY OF pH AND Pco2 MEASUREMENTS IN CAPILLARY SAMPLES IN SICK AND HEALTHY NEWBORN INFANTS
Authors: Gandy Gillian , Grann Lotte , Cunningham Nicholas , Adamsons Karlis , James L. Stanley
Published: December 2021

This study has demonstrated that in healthy newborn infants over 3 hours of age, pH aIld Pco2 of "arterialized" capillary samples reflect closely the values of arterial blood.

Prior to this age and in infants with impaired cardiopulmonary function the agreement between samples from the two sources is less satisfactory. In these infants only limited conclusions regarding acid-base state and alveolar ventilation can be drawn from capillary blood pH and Pco2. The metabolic component of acid-base disturbances can be assessed with a fair degree of accuracy even if the capillary sample is "venous" in character.
Keeping Pediatricians in Practice (continued)
Authors: Berne Joel
Published: December 2021

I am writing to you in reference to Dr. Gould's letter in the May issue of Pediatrics concerning the more distressing aspects of pediatric practice. I have been in practice for only 8 months, and with a group to boot, so I cannot say how I will feel in the next years. I would, however, like to make some observations based on my admittedly limited experience.

Pediatric practice is undertaken in this country with the understanding that the patient and mother will be treated "totally."
Hospitalization of Children
Authors: WEGMAN MYRON E.
Published: December 2021

The Commentary on Hospitalization which appeared in the July issue of Pediatrics reported many cogent points made during the Paris International Children's Center meeting. In general, one can only applaud the fundamental thesis that hospitalization, both in terms of admission and duration of stay, should be based on medical reasons rather than extraneous considerations. A number of practical ways to achieve this are cited in the Commentary and it is refreshing to see the forward-looking approach of those in attendance in seeking solutions to the economic problems posed by increasing costs of hospitalization.
THROMBOTIC OCCLUSION OF THE BIFURCATION OF THE AORTA IN INFANCY
Authors: Raffensperger John G. , D'Cruz Ivan A. , Hastreiter Alois R.
Published: December 2021

Occlusion of the abdominal aorta is a rare and usually fatal event in infancy and childhood. The etiology remains uncertain in most of the 32 cases that have been reported so far in the pediatric age group. Inflammatory and degenerative aortic changes, low-grade umbilical sepsis, concomitant systemic infections, and spread of clot from a thrombosing ductus arteriosus are possible etiological factors.

This is a report of the occlusion of the aortic bifurcation by a thrombus in a 9-month-old Mongoloid infant. The success of the surgical procedure (embolectomy) performed on this patient is attributed to early diagnosis and therapy.
Chickenpox in Leukemic Patients— Factors in Prognosis
Authors: BODEY GERALD , MCKELVEY EUGENE , KARON MYRON
Published: December 2021

There is now ample evidence that chickenpox can produce fatal complications in patients with acute leukemia. The prognosis, however, is not invariably bad. In the past three years, we have observed twelve cases of varicella in leukemic patients, all of whom recovered (Table I).

Nine of the twelve cases occurred during two epidemics on the childrens' ward. The incubation period ranged from 14-24 days with a median of 19 days. The remaining three were infected at home. Eight children were in marrow remission, two were in partial remission (Nos. 9 & 10) and two had relapsed (Nos. 11 & 12). Three patients were severely ill (Nos. 10, 11 & 12), and none of these was in complete remission. Patient No. 11 had profound leukopenia and thrombocytopenia, but did not develop hemorrhagic lesions probably because of the frequent administration of platelet transfusions.
Letters to the Editor
Authors: WAISMAN HARRY A.
Published: December 2021

Dr. Waisman commented as follows: We are pleased to have the comments of Dr. Dent. The case, R. S., reported in our paper (Pediatrics, 33:413, 1964) had dislocated lenses in addition to the zonular cataracts. The second case, K.T., was included in the paper because the child excreted homocystine on repeated analysis although he did not altogether fit the clinical description, notably the absence of subluxated lenses. On several subsequent hospitalizations (since the manuscript appeared) the homocystine excretion decreased from 15 µg/ day to 0. At the present time, the intermittent appearance of homocystine cannot be explained and we prefer not to consider him a case of homocystinuria.
Opportunity to Advance Knowledge of Gaucher's Disease
Authors: BRADY ROSCOE O.
Published: December 2021

We are interested in the metabolic aberrations which occur in patients with sphingolipidoses and in particular in Gaucher's disease.

We have recently synthesized some glucoselabeled cerebroside and have examined the catabolism of this compound in normal rat and human spleen tissues. We have found a very active enzyme which splits this material in these tissues and we are particularly interested in examining spleen tissues from Caucher's patients to try to determine if this particular enzyme is present or absent in tissues from these patients.
The Skate Board: A New Cause of Accidents
Authors: DALE MILDRED B.
Published: December 2021

Within a group of approximately 40 pediatricians practicing in the Los Angeles area, it has recently become apparent that a new juvenile fad, the skate board, is producing an inordinate number of injuries to our patients, particularly fractures of the upper extremities.

Parents seem totally unaware of this danger and the following letter has therefore been sent to the Letters to the Editor Department of the metropolitan daily newspaper, The Los Angeles Times:

"In the hope of catching the attention of parents of skate board riders, I would like to point out the precarious nature of this new mode of juvenile locomotion.
Convulsive Disorders in Children, with Reference to Treatment with Ketogenic Diet
Authors: LAMBROSO CESARE T.
Published: December 2021

This 300-page book covers a wide range of so-called convulsive disorders in the pediatric age, such as neonatal seizures, febrile fits, breathholding spells, and "hypsarhythmia," as well as a review of antiepileptic drugs and a series of do and don't questions most often asked by anxious parents, supplied with well-thought-out answers.

Some 80 pages are devoted to a historical review, a description of the principles and the actual practice of ketogenic diets, including necessary but often neglected tables. This section, although clearly out of proportion to the general outline of the book, is possibly its greatest contribution, for it not only offers practical aid in a most difficult therapeutic enterprise, but also affords the reader some insight into the author's own experience.
Clinical Investigation in Medicine: Legal, Ethical and Moral Aspects. An Anthology and Bibliography
Authors: SHAW EDWARD B.
Published: December 2021

This book presents in 492 pages of a convenient paperback volume an astonishing anthology and bibliography of the ethical, moral, philosophical, and legal components of clinical investigation. The seven chapters include selections from the writings of many well-known essayists of Europe and America as well as the opinions and counsel of physicians, philosophers, psychiatrists, clergy, lawyers, publishers, sociologists, statisticians, and pharmacologists.

Only a very few will read this book in its entirety but it is a valuable reference for student, clinician, teacher, or researcher. It is difficult to review this book without yielding to the temptation of entering into the debate.
Gastrostomy for Prematures: Erudition for Pediatricians
Authors: TOW ABRAHAM
Published: December 2021

May I endorse wholeheartedly Dr. Keitel's objection to the use of gastrostomy for the feeding of prematures. The possible shortening of the stay in the hospital by a few days surely does not justify the additional risk inherent to a surgical procedure—even in the hands of the most skilled and experienced— which it will not be if taken up indiscriminately.

I cannot, however, subscribe to his criticism of the editorial management of "Experience and Reason—Briefly Recorded.
ALLERGIC RHINITIS IN EARLY INFANCY
Authors: Ingall Manuel , Glaser Jerome , Meltzer Richard S. , Dreyfuss Eric M.
Published: December 2021

An infant with severe, life-threatening respiratory distress due to allergic rhinitis is described. Since this has not been previously reported, a plea is made for the consideration of allergy as a cause of acute nasal obstruction in the newborn after other more common causes, and certain unusual ones reviewed above, have been ruled out.
Femoral Arteriovenous Fistula Following Venipuncture
Authors: DAVIS STARKEY D. , BAUM DAVID , DILLARD DAVID H.
Published: December 2021

A case of traumatic femoral arteriovenous fistula in a 3-year-old female is reported. The fistula is thought to have resulted from venipuncture at a level distal to the inguinal ligament where the femoral artery is immediately anterior to the vein.

This case emphasizes the importance of performing femoral venipuncture at a level near the inguinal ligament where the artery is lateral to the vein. Arteriovenous fistula is demonstrated to be a potential hazard of attempts at femoral venipunctures.
Alwall's Artificial Kidney Modified for the Treatment of Infants
Authors: KESSEL MICHAEL , PANN W.
Published: December 2021

We report the construction of a modified Alwall artificial kidney and hemodialysis treatment of a 9½-month-old infant.
Erythrocyte Metabolism in Galactosemia
Authors: ZIPURSKY A. , ROWLAND M. , FORD J. D. , HAWORTH J. C. , ISRAELS L. G.
Published: December 2021

Galactosemia is an inborn error of metabolism in which the enzyme galactose-1-phosphate uridyl transferase is deficient. The accumulation of galactose-1-phosphate in tissues exposed to galactose has been postulated as the mechanism responsible for the toxic manifestations of the disease. Previous reports suggested that the accumulation of galactose-1-phosphate within the red blood cell interferes with oxygen consumption, adenosine triphosphate (ATP) synthesis or breakdown, and the maintenance of other phosphate intermediates of glycolysis. The in vitro studies of Pennington and Prankerd were performed using erythrocytes suspended in a glucose-free medium. This lack of glycolytic substrate may have contributed to the diminished ATP and 2,3 diphosphoglyceric (2,3 DPG) synthesis observed.
Letters to the Editor
Authors: SMITH DAVID H.
Published: December 2021

As intimated by Dr. Olson, the origin of the thallium intoxication of the patients reported by us became a medico-legal problem. The results of these investigations are not, however, a matter for discussion.
Letters to the Editor
Authors: BERG ROBERT B.
Published: December 2021

The apparent basis of Dr. Keitel's disapproval of the use of gastrostomy in feeding certain premature infants, as stated in his first letter (Pediatrics, 34:293, 1964), rests in his premise "that gastrostomies may have increased the mortality rate." In that letter he noted that the over-all national mortality rate for infants weighing about 1,000 gm at birth is approximately 90%, and that approximately 65% expire within the first 24 hours. Subtracting 65% from 90% he determined that "the approximate death rate of infants with a birth weight of about 1,000 gm after the first day of life is 25%," a figure which (for reasons given below) was inappropriate for comparison with our mortality rate of 36% who survived the first day of life.
II. CONFIGURATION OF THE CHEST
Authors: Howatt William F. , DeMuth George R.
Published: December 2021

1. Various chest measurements have been made on 174 normal children ranging in age from newborn to 18 years and on 22 children with cystic fibrosis.

2. The patterns of growth of the anteroposterior (AP) and transthoracic (TT) and the sternal length (SL) in relation to height differ from that of the biacromial. After birth there is a rapid increase in the transthoracic and antero-posterior diameters, especially the former. Following this the growth of these two and the sternal length are relatively slow, accelerating again with increasing size.

3. The growth of a thoracic volume index (AP2.TT.SL) correlates well with the growth of the lung volumes in the ages where both are measurable. In younger children the growth pattern of the thoracic volume index is dissimilar to an extrapolation of the lung volume growth line.

4. Patients with cystic fibrosis have an increase in the antero-posterior and transverse diameters and to a lesser extent in the sternal length when compared with normal children of the same height. Because the transverse diameter is increased, a more sensitive indication of an abnormal chest is obtained from the AP diameter-height ratio than from the usual thoracic index (AP/TT).
IV. INTRAPULMONARY GAS DISTRIBUTION
Authors: DeMuth George R. , Howatt William F.
Published: December 2021

1. Three tests of intrapulmonary gas distribution (the nitrogen clearance, the single-breath oxygen, and the oxygen equilibration index) were included in a study of normal children. Several adaptations for children were made.

2. When the tests include lung volume adjustments, they show no correlation with changing body size, indicating no change in the uniformity of gas distribution with growth.

3. Values of the upper limits in normal subjects for four interpretations of the three tests are given.

4. No significant correlation among the three volume-adjusted tests was found in these normal subjects.

5. Longitudinal studies of the SBO test show that for the individual some quality related to evenness of gas distribution persists during growth.
MULTIPLE HEMANGIOMAS IN AN INFANT WITH CARDIAC HYPERTROPHY
Authors: Cooper Amiel G. , Bolande Robert P.
Published: December 2021

A case of multiple benign hemangiomas in a 10-week-old Negro female is presented. At autopsy, numerous cutaneous and visceral sites of involvement were found. The hemangiomas are believed to arise from a multicentric developmental abnormality but appear capable of limited independent growth and tissue destruction. Postmortem angiograms demonstrate the existence of numerous arteriovenous shunts, which are believed responsible for the marked cardiac enlargement and early congestive heart failure in this case, as well as in previously reported cases of infantile hemangioendothelioma of the liver. Visceral hemangiomatosis should be considered as a possible extra-cardiac cause of infantile cardiac hypertrophy or failure of unknown etiology, especially in the infant with cutaneous hemangiomas. Angiographic techniques may be of help in the diagnosis and determination of extent of visceral hemangiomas.
RADIOTHYROXINE METABOLISM IN EUTHYROID ADOLESCENT MALES IN DIFFERENT STAGES OF SEXUAL MATURATION
Authors: Hung Wellington , Gancayco Graciano P. , Heald Felix P.
Published: December 2021

The metabolism of radiothyroxine was studied in 10 normal euthyroid adolescent males, ranging in age from 13 to 18 years and at two stages of sexual maturation. The mean half-life for thyroxine in Stage 3 boys was 5.32 days, while that for Stage 5 boys was 5.82 days. The thyroxine half-life of the adolescent male is longer than that in the child (T½ 4.95 days) but is shorter than that in the young adult male (T½ 6.83 days). Some factor associated with age per se but not associated with the marked hormonal changes which occur at adolescence is responsible for the change in thyroxine half-life observed at this time.
STUDIES ON HYALINE MEMBRANE DISEASE
Authors: Ambrus Clara M. , Weintraub David H. , Niswander Kenneth R. , Ambrus Julian L.
Published: December 2021

Plasminogen appears to be absent from the blood of human embryos until shortly before term. In prematures plasminogen is usually absent or values are very low. Lack of plasminogen may deprive premature infants from a protective mechanism against pulmonary hyaline membrane formation.

Antiplasmin is present in the blood of fetuses from the fourth month of gestation. Levels are within the normal adult range. In prematures antiplasmin levels show greater variability, but are nevertheless significantly higher than in mature infants. The greatest variability of all groups analyzed is seen in prematures with respiratory distress syndrome.

Pulmonary plasminogen activator activity has been detected in human as well as guinea pig embryos at the fourth month and sixth week of gestation respectively. A sharp increase in activity occurs before term followed by a decrease in the postnatal period. The increase before term may represent a physiologic protective mechanism against pulmonary fibrin deposition which may occur at birth.
Letters to the Editor
Authors: STOWENS DANIEL
Published: December 2021

Thank you very much for the opportunity of reading Dr. Van Gelder's letter, and replying to it.

First let me correct the implication inherent in Dr. Van Gelder's letter to the effect that the stories circulated by the various news media were given directly to them. The study was presented at the annual meeting of the College of American Pathologists and the American Society of Pathologists at Bar Harbor, Florida, in October, 1964. The release of information concerning the paper was by representatives of the Society (indeed, I was not present at the meeting, being confined to my home by illness).
Letters to the Editor
Authors: VERNON DAVID T. A.
Published: December 2021

In response to Dr. Bergman's thoughtful consideration of our article we would like to stress the following points.

As we tried to make clear in the original article, the questionnaire data were offered only to illustrate a possibility which has received little consideration in research to date, not to present substantive findings on the relationship of age and response to hospitalization. The fact remains: the possibility that children may benefit psychologically from hospitalization has not been carefully considered in most research.
TAKAYASU'S DISEASE (PRIMARY AORTITIS) IN CHILDHOOD
Authors: Warshaw Joseph B. , Spach Madison S.
Published: December 2021

This is a case report of a 7-year-old child with the onset of the manifestations of Takayasu's disease (primary aortitis) at the age of 7 years. She exhibited a "prepulseless" stage with systemic symptoms of fever, fatigue, and weight loss. This early stage was also characterized by arthralgias and cardiac enlargement with laboratory findings of an elevated sedimentation rate and moderate leukocytosis. Within several months of the onset of the symptoms, she exhibited a "pulseless" or occlusive stage of the disease with absent arterial pulses of the arms and transient diminution of the carotid artery pulsations bilaterally. During this stage of her illness, she developed aneurysmal dilatation of the ascending aorta. Over a 3-year period she became asymptomatic with the disappearance of her anemia. Biplane angiocardiography demonstrated marked dilatation of the ascending aortic arch with associated discrete aneurysmal changes in the lower thoracic aorta. The patient recovered from her illness and remains asymptomatic 8 years following the onset of symptoms.

A review of the literature is presented which emphasizes the rarity of this disease in children in this country. Since aortitis may involve the aorta at any level, it is suggested that the name "Takayasu's disease" be extended to include those cases with involvement of the thoracic and abdominal aorta in addition to those with the classical picture of aortic arch involvement and absent pulses in the upper extremities.
ADJUSTMENT OF VENTILATION, INTRAPULMONARY GAS EXCHANGE, AND ACID-BASE BALANCE DURING THE FIRST DAY OF LIFE
Authors: Prod'hom L. Samuel , Levison Henry , Cherry Ruth B. , Smith Clement A.
Published: December 2021

1. Twenty-two newborn infants with early respiratory distress syndrome (all but one cyanotic in room air) were studied.

2. By the hyperoxia test (100% O2 during 30 minutes) differences in behavior of the expected (though unlocalized) true right to left shunt, during the first day of life, allowed separation into three patterns, designated as Types I, II, and III.

3. Type I (eleven infants) was characterized by a large right to left shunt at 4 hours, which increased further during the next 24 hours. Functional residual capacity was decreased; tidal volume to functional residual capacity (VT/FRC) ratio was normal or high. Mixed acidosis, present at 4 hours, remained unchanged during the next 24 hours. Eight infants died with atelectasis associated seven times with hyaline membranes, as shown by autopsy.

4. Type II (eight) infants had a right to left shunt within the normal range during the first day. Functional residual capacity was normal, with low VT/FRC ratio. The important mixed acidosis in infants of this type at four hours disappeared later as the lung condition improved. None died. It is suggested that this respiratory distress was related to aspiration.

5. Type III (three) infants showed a large right to left shunt between 1 and 4 hours of age, with rapid normalization in the next 24 hours. There was no evident association between this type of respiratory distress and a particular disease state.

6. Type I infants were treated with sodium bicarbonate solution, with no effect on CO2 retention or right to left shunt. Seven of the ten treated infants died.

7. The necessity of distinguishing between different types of the respiratory distress syndrome, and the importance of massive oxygen therapy in the type associated with hyaline membranes, became obvious during this study.
Magnesium Sulfate for Respiratory Distress
Authors: LEEUWEN GERALD VAN
Published: December 2021

I share Dr. Van Gelder's misgivings (Pediatrics, 35:355) over the wide publicity given magnesium sulfate enemas for the treatment of the respiratory distress syndrome. We, like Dr. Van Gelder, have not used this therapy because nearly all our patients have respiratory acidosis and electrolyte disturbances. But many physicians have asked me for information and advice.

I have recently learned of two deaths following administration of magnesium sulfate as described by Dr. Stowens. One infant died very promptly, the other 24 hours later, after increasing distress, bradypnea, fever, lethargy, and shrill cry.
Insight and Responsibility. Lectures on the Ethical Implications of Psychoanalytic Insight
Authors: JACOBS JERRY C.
Published: December 2021

In the preface to this delightful volume, Erik Erikson proposes to show how clinical insight sheds light on the responsibilities which each generation has for all succeeding ones. For pediatricians who have found his classic Childhood and Society helpful in their clinical work, Insight and Responsibility provides additional evidence of Erikson's scholarship. Those who read this new book first may be amazed to discover that a useful understanding of psychoanalytic principles of child development may be obtained by ordinary English-speaking workaday pediatricians, provided that this eminent analyst is the teacher.