bluuebunny/crossref_metadata_2025 huggingface dataset:
RESEARCH ISSUES IN CHILD HEALTH A HEAD START RESEARCH SEMINAR
Authors: North A. Frederick
Published: December 2021

The purpose of the conference reported in this series of papers was to find answers to three questions. What do we know from past and current research with enough certainty that it merits widespread application now? What are the most critical needs for new knowledge that might be acquired through research? Which of these needs are of highest priority because they are basic to further understanding or because they are vulnerable to rapid solution by techniques already at hand? Each author answered each of these questions with many specifics, but certain themes recurred throughout all the papers.

Each author pointed out that many of the most important issues in child health are social and political issues, not research issues. Failure to make the distinction between these kinds of issues can lead to inappropriate action in either research or social and political action. All authors emphasized that society and individuals must decide and act now, in the face of imperfect knowledge, and not wait for the kind of evidence that could lead to truly rational decisions.

In the face of this social imperative to make decisions on the basis of imperfect evidence, each author urged that suitable mechanisms for self-evaluation and feedback be built into individual activities, programs, and health care settings. Without such feedback mechanisms, great harm may be done by apparently innocent acts or programs. The design and application of such feedback and evaluation systems for health and health care is one of the major research and development priorities, basic further study of new programs, financing mechanisms, and delivery systems for child health.
Developmental and Psychological Test Scores in Children of Low Birth Weight
Authors: Eaves Linda C. , Klonoff Harry , Dunn Henry G.
Published: December 2021

In the printing of our article on the subject in the January issue of Pediatrics (45:9, 1970) the wording of a sentence on page 10 was unfortunately changed in such a manner as to distort the personal communication we had received from Dr. Ruth Griffiths in London, England. As printed, the sentence is: "It does not seem admirable to try and meaningful to correct such D.Q. figures according to gestational age at birth." The statement we wished to make was: "It does not seem advisable to try and correct such D.Q. figures according to gestational age at birth."
Letter To The Editor
Authors: King Katherine C. , Adam Peter A. J. , Clemente Geronima A. , Schwartz Robert
Published: December 2021

Dr. King and her colleagues comment as follows:

In his letter criticizing the article entitled "Infants of Diabetic Mothers: Attenuated Glucose Uptake without Hyperinsulinemia," Dr. McCann takes issue with both the selection of cases, and the concept that hyperinsulinemia may not exist after 2 hours of age. Before study of the infants, pregnant subjects were selected on the basis of the criterion stated in the article. The glucose disappearance rate of less than 1% per minute is beyond the normal range, and more than two standard deviations below the normal mean in the third trimester.1
Skimmed Cows' Milk
Authors: Resnick Jack
Published: December 2021

It seems incongruous that in the issue of November, 1969, there are two separate articles with regard to use of cow's milk. In the first, Drs. Berenberg, Mandell, and Fellers1, again emphasize the supposedly well known hazard of using high solute skimmed cow's milk, either boiled or non-boiled, in the treatment of acute diarrhea of infancy. The all too frequent production of hypernatremic dehydration with its higher incidence of mortality and neurologic sequelae are again reiterated.
Letter To The Editor
Authors: Tefft Melvin
Published: December 2021

The recovery of an 11-year-old girl with an apparent inoperable grade III astrocytoma of the lower brain stem and upper cervical cord is of interest.

The details of management and the exact clinical course are not well defined.

From the information given, one notes that the child's clinical condition improved approxi-mately 3 months following a "prolonged course" of radiation therapy and placement of an atrioventricular shunt. The improvement is attributed to amphotericin B. Treatment with amphotericin B began , apparently, 3 months after the shunt and completion of radiotherapy.
The Surgery of The Common Congenital Cardiac Malformations, by Christiaan N. Barnard, M.D., M.Med. (Cape Town), M.S., Ph.D. (Minnesota), F.A.C.S., F.A.C.C., and Velva Schrire, M.Sc., Ph.D., M.D. (Cape Town), F.R.C.P.E., F.R.C.P., F.A.C.C. New York: Hoeber Medical Division, Harper and Row, Publisher (49 E. 33rd Street, New York, New York 10016), 1969, 179 pp., no price given
Authors: Bernhard William F.
Published: December 2021

This short (179 pages), well-composed text includes a presentation of the anatomy, hemodynamic characteristics, and surgical management of five congenital cardiovascular abnormalities. Although not much in the way of new information is offered, the material is easy to read and is followed by an excellent bibliography. Chapters dealing with patent ductus arteriosus, coarctation, atrial and ventricular septal defects, and tetralogy of Fallot comprise the materials covered by the text. With certain exceptions, for instance, the routine use of chloramphenicol as a postoperative antibiotic, the discussion of the surgical treatment and postoperative management of these anomalies is very well done.
SELF-MUTILATION: CASE OF A 13-YEAR-OLD GIRL
Authors: Simpson James S. , Hawke William A.
Published: December 2021

Self-mutilation, rare in children except for those suffering from schizophrenia or mental retardation, is difficult to diagnose and treat. The case history of a 13-year-old girl with bizarre abdominal complaints leading to an exploratory laparotomy and subsequent breakdown of her abdominal scar 5 months later, emphasizes some of the problems. No reason could be found for the scar separation and, after repeated and unsuccessful attempts to promote healing, we became convinced the patient was tampering with the wound. It appeared that her displacement as the focal point in the family with the remarriage of her mother and the stern discipline exhibited by her step-father motivated her to punish her parents and gain attention in this fashion.
Letter To The Editor
Authors: Moriyama I. M.
Published: December 2021

We are grateful to two authorities for the following replies to Dr. Nickey. First, Dr. Moriyama:

Is the differential between the infant mortality rate for the United States (22.4 per 1,000 live births in 1967) and the corresponding rate for Sweden (13.7), the Netherlands (13.4), Norway (14.8), and other countries of low mortality real?1, 2

One possible reason for the large differential is the contribution that the nonwhite population makes to the relatively high mortality rate for the United States.
Sex-Linked Cleft Palate in a British Columbia Indian Family
Authors: Lowry R. B.
Published: December 2021

An Indian family from British Columbia is described in which 12 males have an incomplete cleft of the secondary palate, some belonging to the submucous variety. The symptoms and signs which should prompt a physician to make this diagnosis are nasal regurgitation of fluids in infancy, nasal speech, repeated attacks of otitis media, bifid uvula, and a palpable notch in the posterior edge of the hard palate. It is suggested that this type of cleft is the result of a sex-linked gene.
On the Nonautoimmune Aspects of Endocardial Fibroelastosis: Continued Inquiry into the Significance of Delayed Sensitivity to Mumps Virus
Authors: St. Geme Joseph W. , Noren George R. , Evans Charles M. , Ozwoeld Lois
Published: December 2021

Using both the capillary precipitin and the agar gel immunoprecipitin methods, we were unable to identify cross-reacting antigenic determinants between human heart and chicken tissues. These observations do not support the premise that the positive cutaneous delayed hypersensitivity to mumps antigen in some children with primary endocardial fibroelastosis might represent nothing more than nonspecific avian sensitivity. Furthermore, there was no support for the notion that endocardial fibroelastosis represents an immunopathogenic phenomenon of shared antigenic relationships between mumps virus and human heart like that suggested for the group A beta-hemolytic streptococcus and myocardial and valvular tissue in acute rheumatic fever.4-6

We continue to believe that the positive mumps skin test in certain children with primary endocardial fibroelastosis may represent the immunologic marker of previous intrauterine antigenic exposure to briefly replicating mumps virus.
DR. MICHAEL UNDERWOOD WRITES ABOUT AN INFANT WHO WAS ACCIDENTALLY KILLED BY A PIN
Authors: C. T. E.
Published: December 2021

The most advanced writer on the diseases of children in the eighteenth century was Michael Underwood (1737-1820)1. He laid the foundation of modern pediatrics in his Treatise on the Diseases of Children, published first in 1784. This book went through at least seventeen editions and remained in great favor all over the world for more than 60 years.

Underwood cites many personal clinical histories in his text, but none is more tragic than the following:

A gentlewoman many years ago informed me, that one of her children, after long and incessant crying, fell into strong convulsions, which her physician was at a loss to account for, nor was the cause discovered until after death; when (shocking to relate!) on the cap being taken off (which had not been changed on account of its illness), a small pin was discovered sticking up to the head (of the pin) in the large fontanelle, or moule.

Underwood was referring to the straight or common pin; the modern safety pin was invented by the American inventor Walter Hunt in 1849. Hunt's pin was not the first safety pin. Thousands of years earlier the ancient Egyptians had used pins similar to those rediscovered by Hunt. But, the idea was lost and until Hunt's day no one thought of developing a safety pin. In England the "new-fashioned safety pin" with a solid guard to cover the point did not appear for general use until 1878.
Le Problème de L'HéréDité Dans les Syndromes Epileptiques, by Renaud Delaveleye. Paris: Expansion Scientifique Français (15, rue Saint-Benoit), 1969, 235 pp., $7.50
Authors: Lombroso Cesare T.
Published: December 2021

This monograph deals with the eugenically vexing problem of the hereditary factors in epilepsy. Its first section covers quite adequately the literature on the subject, and presents some of the conflicting opinions. In a second section the author presents his own data. His conclusions are that the epilepsies do not show a unitary genetic aspect, but rather they are the resuits of a constellation of factors of which some are genetically determined. A useful monograph results both because of its abundant reference material, and new observations reproted.
INCREASED INTRACRANIAL PRESSURE ASSOCIATED WITH PROBABLE VITAMIN A DEFICIENCY IN CYSTIC FIBROSIS
Authors: Keating James P. , Feigin Ralph D.
Published: December 2021

Two 4-month-old infants with signs of intracranial hypertension associated with vitamin A deficiency are reported. Intestinal malabsorption due to cystic fibrosis was the underlying cause for the hypovitaminosis A. The recognition of vitamin A deficiency was delayed because of failure to appreciate that bulging anterior fontanelle is a sign of deficiency of this vitamin.

These cases serve to reemphasize this infrequently reported association and serve to remind the pediatrician that vitamin deficiency disease in the United States is of more than historical interest. Prompt recognition of this syndrome and appropriate therapy can prevent blindness and death.
THE CRITICALLY ILL CHILD: MANAGEMENT OF TRACHEOSTOMY
Authors: Crocker Dean
Published: December 2021

The indications for and methods of performing a tracheostomy in children are many and varied. There is still controversy as to the size, types, and placement of the tube; the type of incision; the relative indications for tracheostomy in infants and older children; the use of prolonged endotracheal intubation in preference to tracheostomy; and even the type of instruments used to perform the tracheostomy. However, problems discussed here are mainly the proper care of the child with a tracheostomy tube, including those associated with its removal.

Whatever the disease state from which the child suffers, certain basic principles must be kept in mind during all tracheostomy care. These relate to: (1) inspired gas mixtures, (2) humidification in inspired gas, (3) suctioning of secretions, (4) positive pressure breathing, (5) chest physiotherapy, (6) weaning of a patient from tracheostomy, (7) home care of tracheostomy by parent, and (8) complications of tracheostomy. Let us now examine these factors in detail.

INSPIRED GAS MIXTURES

Gas mixtures most commonly administered via tracheostomy are of oxygen and air, in percentage that will maintain arterial oxygen tension (PaO2) at near normal. Sometimes this will require 100% oxygen or sometimes 100% air, which is, of course, 20% oxygen. Whatever the mixture, the PaO2 should never exceed 250 mm Hg; ideally, it should never approach this figure.

Immediately following tracheostomy, arterial blood gases should be measured with the patient breathing room air, providing that his clinical condition will tolerate this minimal oxygen percentage. If by clinical judgment additional oxygen is required, the inspired percentage should be carefully measured at the time blood is drawn for gas determination.
Factors Needed for Prevention of Child Abuse and Neglect
Authors: Fontana Vincent J.
Published: December 2021

An acute awareness of child abuse in the last decade by society and the medical profession has resulted in the passage of child abuse laws in every state of the nation. Unfortunately however, these laws have done little to stem the increase in the maltreatment of children and have not effectively lessened the plight of the abused and neglected child. It is the purpose of this communication to comment on certain defects in the present management of child abuse cases that have contributed to the inadequate protection of these children.
ON A FIFTEENTH CENTURY TEST FOR STERILITY
Authors: C. T. E.
Published: December 2021

Barren marriages until the present century were usually considered a sign of Divine displeasure. But as knowledge of the phsyiology of reproduction was a closed book until recently, many preternatural methods for determining whether sterility was the fault of either husband or wife may be found in the medical literature of the Renaissance. None is more fanciful than the following from an English leechbook of the fifteenth century:

Knowing the default of conception, whether it belong to the man or the woman. Take two new earthen pots, each by itself; and let the woman make water in the one, and the man in the other; and put in each of them a quantity of wheatbran, and not too much, that it be not thick, but be liquid or running; and mark well the pots for identification, and let them stand ten days and ten nights, and thou shalt see in the water that is in default small live worms; and if there appear no worms in either water, then they be likely to have children in process of time when God will.1

Dawson2 writes that this and similar experiments are ancient ones and are described in Egyptian papyri.
RENOVASCULAR HYPERTENSION IN CHILDREN
Authors: Leumann Ernst P. , Bauer Robert P. , Slaton Paul E. , Biglieri Edward G. , Holliday Malcolm A.
Published: December 2021

Three children with renovascular hypertension are presented in order to demonstrate the wide clinical spectrum of this disease. Two patients had relatively minor symptoms, but one with neurofibromatosis showed frank hypokalemia, polyuria, and hyponatremia.

Three different anatomical lesions were found: bilateral renal artery stenosis in the patient with neurofibromatosis, fibromuscular hyperplasia in the patient with stenosis of one renal artery, and an isolated malformation of one small intrarenal artery.

The last of our patients presented a complicated diagnostic problem which required repeated arteriograms and renal vein catheterizations for differential renin assay. Renovascular hypertension should be excluded in any pediatric patient with otherwise unexplained hypertension.
REYE'S SYNDROME: AN EPIDEMIOLOGIC APPROACH
Authors: Glick Thomas H. , Likosky William H. , Levitt Lawrence P. , Mellin Harold , Reynolds David W.
Published: December 2021

In a selective epidemiologic study of Reye's syndrome (acute encephalopathy with fatty degeneration of the viscera) 62 cases were reported from parts of the United States and Puerto Rico over a 30-month period. Most of these cases were reported from a few areas where the diagnostic index of suspicion was high, suggesting that the overall national incidence may be considerably higher than has been generally appreciated. Several areas reported epidemic patterns in February and March 1969, concurrent with outbreaks of influenza B virus infection. Seven additional sporadic cases in the 30-month period were associated with chickenpox. Patterns of incidence of such viral infections may account for variations in incidence of Reye's syndrome beyond those attributable to differences in index of suspicion and case finding. Epidemiologic data do not support an etiologic role for exogenous toxins or medications. An inverse relationship between the manifestation of hypoglycemia or hypoglycorrhachia and age of patient was demonstrated.

The growing evidence found associating Reye's syndrome with infection by common viral agents, such as influenza B, suggests a potential role for immuno- or chemo-prophylaxis.
MEASLES (RUBEOLA) IN PREVIOUSLY IMMUNIZED CHILDREN
Authors: Baratta Robert O. , Ginter Myrna C. , Price Morris A. , Walker James W. , Skinner Richard G. , Prather E. Charlton , David Joseph K.
Published: December 2021

Within a 3-month countywide epidemic of measles in Jacksonville, Florida, 28 cases occurring among a kindergarten enrollment of 145 were carefully studied since 25 of these children had been previously immunized with a live, attenuated measles virus vaccine and immune globulin. Nineteen children had been vaccinated prior to their first birthday. Six children were vaccinated at 13 to 20 months of age. The median measles (rubeola) hemagglutination-inhibition (HI) antibody titer in sera of five convalescent patients immunized before their first birthday was 1:320 and for complement fixation it was 1:128. Sera from nine classmates who did not contract the disease showed a median HI antibody of 1:40 and a median complement fixing antibody (CF) of 1:16. Six had been vaccinated before their first birthday.

In a control group of five other children, three had been immunized prior to 12 months of age, one at 13 months, and one at 18 months. Sera from the three earliest contained no antibody; however, sera from the other two had detectable antibody.

The analysis of serologic data supported the contention that the outbreak was causally related to defective protection associated with the use of vaccine plus globulin in infants. It also demonstrated persistence of CF antibody many years after immunization and suggested the presence of a booster phenomenon.

A review of the clinical illness of the 25 children who had been given the vaccine and 22 who had not revealed little difference in the severity of the disease.
DIFFUSE NEONATAL HEMANGIOMATOSIS
Authors: Holden Kenton R. , Alexander Fred
Published: December 2021

Two infants with diffuse neonatal hemangiomatosis are presented. One infant developed thrombocytopenia and bleeding while the other infant with more widely diffuse lesions succumbed to extensive central nervous system involvement.

Steroid therapy caused no obvious alteration in either of the patient's course. The vascular lesion in this disease is possibly congenital absence of vessel wall pericytes.

Six previous cases of diffuse neonatal hemangiomatosis are briefly reviewed in relation to the sites of the lesions, cause of death and malignant potential.
Letter To The Editor
Authors: Charles Seymour , Shelness Annemarie
Published: December 2021

Thank you for giving us the opportunity of replying to Dr. Johnson's remarks.

The omission immediately below the column heading "Annual Mileage" in the table referred to occurred in the printing.

Although Iowa may require the reporting of all accidents, it is doubtful if every scratch and bump is recorded.

Pupil mileage is difficult to ascertain. The National Safety Council (Accident Facts 1969) estimates it to be 40% of the total. The mileage recorded is the actual number of miles traveled by each vehicle; no attempt has been made to compute "passenger miles."
THE URINARY EXCRETION OF AMINOIMIDAZOLECARBOXAMIDE IN THE LESCH-NYHAN SYNDROME
Authors: Newcombe David S.
Published: December 2021

The urinary excretion of aminoimidazolecarboxamide (AIC), an intermediate in purine synthesis, was studied in five patients with the Lesch-Nyhan syndrome. The mean urinary AIC level for these subjects was 12.03 ± 6.9 mg AIC/mg creatinine as compared to a mean urinary excretion in normal subjects of 1.2 ± 0.6 mg AIC/mg creatinine. None of the patients had clinical evidence of megaloblastic anemia at the time of the study, and their serum folate levels were within the normal range. The increased urinary AIC excretion probably represents a reflection of the deranged purine metabolism in this syndrome and its measurement can be used as a screen for the Lesch-Nyhan syndrome and other disorders of purine and/or folate metabolism.
EXCRETION OF CATECHOLAMINE METABOLITES BY CHILDREN WITH FAMILIAL DYSAUTONOMIA
Authors: Gitlow Stanley E. , Bertani Laura M. , Wilk Elizabeth , Li Biao Lan , Dziedzic Stanley
Published: December 2021

Although a defect in catecholamine metabolism has been suggested in familial dysautonomia, the specific nature and extent of this abnormality has not been defined. Highly specific and sensitive assay techniques were used to measure the excretion of vanillylmandelic acid (VMA), 3-methoxy-4-hydroxyphenylethyleneglycol (HMPG), total metanephrines (TM), normetanephrine (NM), and homovanillic acid (HVA) of 52 dysautonomic patients and 180 normal subjects. Twenty parents of dysautonomic patients and age-matched control subjects were studied similarly. Patients with familial dysautonomia were found to excrete elevated quantities of HVA, diminished quantities of VMA and HMPG, and normal amounts of TM and NM in comparison with normal subjects. The excretion of the sum of the deaminated catecholamine metabolites proved to be more aberrant in familial dysautonomia than any other biochemical parameter measured. The findings of this study are more compatible with an abnormality in catecholamine synthesis rather than in release. Parents of dysautonomic subjects excreted normal amounts of vanillylmandelic acid and homovanillic acid.
Intolerance to Lactose in Negro Children
Authors: Sandberg Douglas H.
Published: December 2021

Recent advances in understanding of individual and racial differences in intestinal digestion of lactose have provided evidence that milk is not well tolerated by large segments of the world population. This is particularly true of the nonwhite majority. Studies have reported as high a percentage as 70% of Negroes to be intolerant of lactose.1 In spite of this information milk is still being used to provide dietary protein supplementation in Africa, Asia, South America, and many parts of the United States. In particular, milk has been a major food in school free lunch programs for years.
Letter To The Editor
Authors: Mortimer Edward A.
Published: December 2021

I think Dr. Klein has probably already answered your letter of April 6, but I shall also add a comment or two. I hope that Dr. Klein and I agree in our answers and that my comments do not serve to muddy the waters.

You are correct that most infections due to H. flu are type b. You are also correct that a proper search for H. flu in the upper respiratory tract of normal individuals, using appropriate media, yields the organism from at least half of normal children and adults, and probably even more.
Possible Hazards of Handling Antineoplastic Drugs
Authors: Ng Lawrence M.
Published: December 2021

The introduction of the newer experimental antileukemic and antineoplastic drugs like L-asparaginase, 5-fluorouracil, dibromodulcitol, pseudourea, and so forth, and the published data of the group studies give light to the outlook of childhood cancers. However, most of these new drugs in addition to the older ones (including daunomycin, actinomycin D, vincristine, cytosine arabinoside, and so forth) have to be prepared fresh and given by intravenous or intramuscular injections. As a hematology resident, I have to give four to six such injections daily.
Urinary Retention, Fecal Impaction, and Neurogenic Disease of the Colon
Authors: Canby John P.
Published: December 2021

The recent article1 by Doctors Gallo and Presman entitled, "Urinary Retention Due to Fecal Impaction in Children" in the February 1970 issue of Pediatrics certainly has an important lesson, for the urologist in particular. However, I disagree with his recommendation that any child with urinary retention and a fecal impaction requires a barium enema. I believe that on the basis of the clinical history and the fact that impacted stool is felt on the rectal examination, there is sufficient clinical evidence in the vast majority of cases to rule out neurogenic disease of the large bowel.
Dynamic Genetic Counseling for Clinicians, by Henry T. Lynch, M.D., Spring-field, Illinois: Charles C Thomas, 1969, 354 pp., $15.00
Authors: Gerald Park S.
Published: December 2021

Genetic counseling includes the offering of genetic advice to individuals and families who are concerned about inherited disease. The counsellor must accurately define the genetic etiology of the disease(s) in question, determine the risk for each individual, insure that the advice given is adequately understood and, finally, offer whatever support is indicated to offset the impact of the information upon the recipient. It is obviously difficult for any single volume text to cover adequately all these areas.
SHOULD INFANTS BE ALLOWED TO DRINK TEA?
Authors: C. T. E.
Published: December 2021

An apothecary named James Nelson (1710-1794) who lived in Red Lion Street, Holborn, London in the 1750's wrote an excellent book about the art of rearing children titled, An Essay on the Government of Children Under Three General Heads: viz. Health, Manners and Education. Nelson's book, according to Still,1 shows more of balance and common sense than John Locke's Thoughts on Education, first published in 1692-1693.

Tea drinking had become very fashionable in England by the time Nelson wrote his book. (Tea was first sold in England at Garway's Coffee House in London in 1657). Nelson cautioned against its use in children as follows:

Tea to young child, if we omit the milk, has not a single Ingredient to recommend it: . . . the water, (as Tea is usually drank too hot,) serves to scald (sic) Mouth and Throat, or at best relax the Stomach and weaken the tone of it...

Tea may be consider'd like some certain Drugs, which in skilful (sic) hands are safe and useful, but in ignorant ones poisonous. That the intemperate and indiscriminate use of Tea is hurtful, is too well known to be disputed; some it is true are manifestly refresh'd, comforted and enliven'd by it; others feel not the least sensible effect from the longest use of it, and drink it purely thro' Custom; but again there are others, and those much the majority, who impair their Health so visibly by this pernicious Practice, that they shorten their Lives. . . . Now who that considers these things well, or but once reflects, that `tis at least' ten to one that their Children are Sufferers by it, can speaking be hasty in bringing them to it; especially too if we reflect, that by a seeming magic Power it often enslaves People even to Infatuation.
AN APPROACH TO THE ESTIMATION OF THE TRUE NUMBER OF CONGENITAL MALFORMATIONS
Authors: Khalili Abbass , Marienfeld Carl J. , Wright Harley T. , Weiss Edward S.
Published: December 2021

Vital statistics reports of congenital malformations are of widely varying quality and completeness. They remain, however, the major data source for population studies of birth defects.

The Environmental Surveillance Center of the University of Missouri in using birth defects as a measure of possible environmentally caused health effects required an estimate of the true number of such defects occurring in a particular place during a specified time.

This article presents a method for making such an estimate and is based upon the matching of birth certificate reports describing birth defects and infant death certificates. The reasonable assumption is made that the death rate among the children with known birth defects is the same as the death rate among all infants with congenital anomalies.

The estimated rates using this method closely resemble those rates obtained in hospital record studies.
A Spot Test for Detection of Lead in Paint
Authors: Sayre James W. , Wilson David J.
Published: December 2021

Lead poisoning is one of the most important environmental health hazards in inner-city children today. The disorder almost always results from the child eating chips of paint, putty, or plaster containing toxic quantities of lead. Identification of painted surfaces which contain dangerous quantities of lead is an extremely important part of the household investigation in any case of lead poisoning. Furthermore, paint testing is a valuable means of locating potentially dangerous areas in homes where there are small children. Window sills, walls, and other interior surfaces are pointed out as particularly common sources of lead.1,2 Heretofore, testing of paint samples by spectroscopic methods has been tedious, expensive, and required that specimens be submitted to a laboratory.
The Treatment of Cyanide Poisoning in Children
Authors: Berlin Cheston M.
Published: December 2021

The widely published schedule for the treatment of cyanide poisoning by the nitrite thiosulfate method of Chen is based on adult work and is potentially lethal for children under 25 kg in weight. Unless a dose of sodium nitrite appropriate for the amount of hemoglobin in the child is chosen, lethal methemoglobinemia may result. The dose of NaNO2 for children with a hemoglobin of 12 gm/100 ml is 10 mg/kg per body weight immediately and 5 mg/kg repeated within 30 minutes if necessary.
THE BOOK OF ACCIDENTS
Authors: Cone Thomas E.
Published: December 2021

Death of children caused by playing with loaded firearms continues to be among the leading causes of accidental death in childhood.1 The figure below from a book about accidents written for children in 18302 vividly illustrates the fatal consequences of playing with firearms. The lesson is written in a style more direct and moralizing than that used in contemporary children's literature. No longer would children read a sentence which minces no words as in the second one below: "We behold a little boy shooting his sister dead!" Nor would they read in any contemporary book the phrase found in the last line, "encourage them in virtuous habits." But the tone of this lesson is not at all surprising if one recalls Max Beerbohm's comment that adults, less than a century ago, thought of children as "a race apart whose very nature was held to be sinful." Lies and sloth, untidiness and irreverence and a tendency not to listen to their elders were taken to be a child's nature. (Editorial query: Have Children really changed?).
A STUDY OF THE EARLY DEVELOPMENT OF MONGOLS, by Valerie A. Cowie, M.D., Ph.D., D.P.M.: New York: Pergamon Press, 1970, 109 pp., $8.00
Authors: Zellweger Hans
Published: December 2021

This book, an abridged version of the author's Ph.D. thesis at the University of London, appears as the first of a new series of monographs published by the Institute for Research into Mental Retardation. Dr. Cowie studied the development of 79 mongol children through the first 10 months of life by neurological and psychological testing, observation of the pattern of evolution, and dissolution of the early neurological reflexes. Particular attention was given to muscle tone, traction response, Moro reflex, palmar and plantar grasp, tendon reflexes, and placing reaction.
ALPHA1-ANTITRYPSIN DEFICIENCY AND DISEASE
Authors: Alper Chester A. , Johnson A. Myron
Published: December 2021

The major serum inhibitor of proteolytic enzymes is the α1-globulin, α1-antitrypsin. Hereditary deficiency of this protein is immediately recognizable on inspection of stained serum electrophoretic strips (agarose, agar, and cellulose acetate, as well as paper) in that the normal α1 band is absent (Fig. 1). Although the protein concentration of the α1-globulin zone is usually subnormal in deficient sera, it is not always so; and, the ultimate criterion for the establishment of the diagnosis must be made by genetic typing, as will be shown.

Almost coincidental with the discovery of α1-antitrypsin deficiency by Laurell and Eriksson,1 in Sweden, was their observation that many persons with this abnormality had early onset chronic obstructive lung disease.
IMMUNOFLUORESCENT DEMONSTRATION OF ENTEROPATHOGENIC ESCHERICHIA COLI IN TISSUES OF INFANTS DYING WITH ENTERITIS
Authors: Drucker Moshe M. , Polliack Aaron , Yeivin Rina , Sacks Theodore G.
Published: December 2021

Intestinal sections from twenty-eight autopsies of infants with diarrhea were examined by immunofluorescent (IF) staining for the presence of enteropathogenic E. coli (EEC). EEC were identified in seventeen (61%) of these infants, and in more than 80% of them the serotype was 0111:B4. In only six of the sixteen cases identified by the retrospective staining had the causative organism been cultured during life or at autopsy. All seventeen infants showed inflammatory changes in the intestine, and in nine infants the changes were found to be severe. Escherichia coli were identified in the lungs in seven infants.

It is suggested that IF staining for EEC is a useful method for arriving at a specific etiological diagnosis, when bacteriological findings during life were negative.

In view of the evidence of spread of the bacteria beyond the intestinal mucosa, it is suggested that systemic treatment with antibiotics may be indicated in certain cases of gastroenteritis.
Deficiency of α1-Antitrypsin in Childhood Liver Disease
Authors: Johnson A. Myron , Alper Chester A.
Published: December 2021

Visual examination of serum electrophoretic patterns and determination of total antitryptic activity using BAPNA as substrate are efficient screening techniques for deficiency of α1-antitrypsin in patients with neonatal hepatitis, childhood cirrhosis, or pulmonary emphysema. However, the finding of a few infants and children with deficient levels but normal allotypes suggests that definitive diagnosis of the genetic disorder associated with qualitatively and quantitatively abnormal α1-antitrypsin requries genetic typing and, when possible, confirmation by evaluation of the parents. The rather ominous outcome in those children so far diagnosed as having liver disease associated with this deficiency makes unequivocal diagnosis imperative for both prognostic and genetic counselling.
Letter To The Editor
Authors: Feldman William
Published: December 2021

I take issue with many of the points raised in Drs. Stone and Barbero's article on recurrent abdominal pain.1 First, their conclusion that recurrent abdominal pain in childhood is a form of "the irritable bowel syndrome" is not helpful-it is like substituting the word idiopathic for unknown.

Second, they exposed their patients to considerable irradiation-102 upper gastrointestinal series and barium enemas were done. All of these examinations were normal, as anyone who has dealt with recurrent abdominal pain in childhood might have predicted.
Letter To The Editor
Authors: Crook William G.
Published: December 2021

I've just finished reading the article in the May, 1970 issue of Pediatrics, entitled, "Recurrent Abdominal Pain in Childhood," and I am writing to suggest respectfully that many of the 102 children who were studied and hospitalized might suffer from food intolerance or allergy. Such an allergic diagnosis can be made rather simply by an elimination diet. The most common foods implicated in producing allergic abdominal pain are milk, chocolate, corn, citrus, egg, legumes, and wheat. Disappearance of the symptoms on such a diet usually will occur within 7 to 10 days.
The Autistic Child, by I. Newton Kugelmass, M.D., Ph.D., Sc.D. Springfield, Ill.: Charles C Thomas, 1970, 371 pp., $16.50
Authors: Finch Stuart M.
Published: December 2021

This book is probably the most comprehensive, up to date review of that complex syndrome we call early infantile autism. Beginning with a detailed description of the behavior of the autistic child, the author then deals at length with the assessment of such a child, from physical, emotional, mental, language, and behavioral standpoints. He then turns to the difficult area of differential diagnosis, including such syndromes as mental retardation and aphasia.
Infektionskrankheiten, Vol. III, edited by O. Gsell and W. Mohr. New York: Springer-Verlag, 1969, 311 pp., $24.20
Authors: Eichenwald Heinz F.
Published: December 2021

Volumes I and II dealing with viral and bacterial diseases of man, respectively, were published simultaneously and were discussed in a previous review. The present volume covering diseases due to fungi was issued more recently. The chapters on pneumococcal and klebsiellal diseases are somewhat incongruously incorporated in this last volume, perhaps in order to produce a series of books of approximately equal size.

Basically, there is little that need be said. The book represents a workman-like job, with, not unexpectedly, the same strengths and weaknesses pointed out in the earlier review: a certain unevenness of emphasis, an occasional hint of quaintness, a lack of selectivity between what is important and what is not, combined with fine clinical descriptions and great clarity of expression.
NEONATAL RUPTURE OF THE SPLEEN
Authors: Leape Lucian L. , Bordy Marvin D.
Published: December 2021

Few patients with neonatal rupture of the spleen survive. A patient is presented in whom splenectomy was carried out on the ninth day of age after bleeding had stopped. Diagnosis was suspected because of ecchymoses and a falling hemoglobin.

Palpation of a mass, which was found to be radiolucent on total body opacification studies, confirmed the diagnosis. Spontaneous cessation of bleeding is rare and should not be anticipated when ruptured spleen is suspected in a newborn infant. Prompt surgical intervention is usually required if the patient is to survive.
Biochemical Changes of Catechol-O-Methyltransferase During Development of Human Liver
Authors: Agathopoulos A. , Nicolopoulos D. , Matsaniotis N. , Papadatos C.
Published: December 2021

COMT is found in human liver before birth and its activity increases with age until the sixth decade. There is also evidence of change in properties of the enzyme within adult age Fig. 2) . The increased amounts of metacate-cholamines and VMA excreted during the first day of life in the urine of full-term versus premature infants18 and, still more, in the urine of adults, if compared to newborn, could be attributed to the increased COMT activity with advancing age.
Cardiac Arrhythmia in a Child Due to Chloral Hydrate Ingestion
Authors: Nordenberg A. , Delisle G. , Izukawa T.
Published: December 2021

The recommended hypnotic dose of chloral hydrate depresses the cerebral hemisphere and induces sleep without significant change in respiration, blood pressure, or heart rate. With higher doses the respiratory rate may be depressed and the blood pressure reduced due to inedullary depression and peripheral cutaneous vasodilation.1,2

Chloral hydrate "in large doses depresses the contractility of the myocardium and shortens the refractory period."1 Toxic doses produce untoward cardiac effects especially in patients with heart disease.1

Reports of significant cardiac arrhythmia caused by chloral hydrate are rare.3-5. We present what we believe to be the first report of serious cardiac arrhythmia caused by chloral hydrate in a child.
THE TELEMETERED EXERCISE ELECTROCARDIOGRAM IN CONGENITAL AORTIC STENOSIS
Authors: Halloran Katherine H.
Published: December 2021

Since children with aortic valve stenosis, who are at risk of syncope or sudden death, cannot be identified by the resting electrocardiogram or vectorcardiogram, the exercise electrocardiogram was evaluated and compared with the hemodynamic data obtained during cardiac catheterization. Telemetered exercise electrocardiograms were obtained in 31 children, ages 8 to 18 years, with aortic valve stenosis and in 25 normal children of comparable age. Electrocardiographic leads V1, V5, and V6 were obtained prior to, during, and following exercise on a variable resistance bicycle ergometer. Subjects pedalled until a heart rate of 170 per minute or greater was attained and maintained for at least 2 minutes. An increase in T-wave amplitude was observed in both control children and in those with aortic stenosis. No S-T segment abnormalities were noted in the normal children. Of the 16 patients with peak systolic left ventricular to aortic pressure gradients of less than 50 mm Hg, only one showed a segmental S-T depression. Of the 15 children with aortic valve gradients of 50 to 100 mm Hg, however, all except one showed an S-T segment depression in lead V5 of 2 mm or greater.

No correlation between the resting electrocardiogram or the vectorcardiogram and the aortic valve gradient or left ventricular peak systolic pressure could be made. In addition, the abnormal S-T segment response to exercise could not be predicted from or correlated with the resting electrocardiogram. Since an ischemic S-T segment response to exercise was found uniformly in those with the higher gradients, this test appears to have a high degree of specificity in the clinical evaluation of these patients.
MEASUREMENTS OF EFFECTIVE PULMONARY BLOOD FLOW IN THE NORMAL NEWBORN HUMAN INFANT
Authors: Cotton Ernest K. , Cogswell Jeremy J. , Chir B. , Cropp Gerd J. A. , Losey Rosalind
Published: December 2021

Effective pulmonary blood flow was measured in 32 normal infants by an indicator gas technique. To check the accuracy of this technique in the absence of shunts, we obtained 39 pairs of measurements of pulmonary blood flow in anesthetized rabbits by the gas technique and dye dilution. The results showed a high degree of correlation between the two methods of measurement (r = 0.986). Effective pulmonary blood flow was 1.1% less than total pulmonary flow (p < 0.005); this difference was attributed to venoarterial shunting through non- ventilated parts of the lung.

Measurements of effective pulmonary blood flow in normal newborn infants increased with age. Before 24 hours of age, mean effective pulmonary flow averaged 138 ml/min/kg or less and gradually rose to a mean value of 166 ml/min/kg (±25.6 SE) at a mean age of 81 hours. It is possible that our measurements of effective pulmonary blood flow before 24 hours of age were falsely low because of the presence of clinically undetectable left-to-right shunts.
SYNOVITIS OF THE HIP IN CHILDREN AND ITS SIGNIFICANCE
Authors: Jacobs Bernard W.
Published: December 2021

Transient synovitis of the hip and Legg-Calve-Perthes (LCP) disease are the commonest causes of painful hip in young children. While the prognosis for transient synovitis is generally good, the experience with this series of patients indicates that LCP disease may be antedated by a stage of synovitis indistinguishable from transient, self-limiting synovitis. Since the prognosis for LCP disease is drastically different from that of transient synovitis, early differential diagnosis is essential. To this end closer observation of children with transient synovitis is warranted.
ANENCEPHALY AND SPINA BIFIDA IN ISRAEL
Authors: Naggan Lechaim
Published: December 2021

An analysis of 776 cases of anencephaly and spina bifida, born to Jewish mothers in Israel between 1958 and 1968, is presented. A prevalence of 0.86 per 1,000 total births for anencephaly and 0.60 for spina bifida was observed. A high sex ratio for anencephaly (44.1% male) was observed and it is suggested that high ratios may be characteristic of some populations with a low prevalence of neural tube defects. High rates (2.1 per 1,000 for both anomalies) were observed among children of mothers who emigrated from Iraq and Iran. Lowest rates were observed among Israeli mothers. Prevalence rates had their strongest associations with birth order, from a low of 1.25 per 1,000 among first births to a high of 2.40 per 1,000 for the sixth and higher birth orders. The effect of birth order was independent of maternal age and ethnic variation. No significant seasonal variation of affected births was detected. But a very strong downward trend was observed during the study period, mainly in spina bifida (from a prevalence of 1.05 per 1,000 in 1958 to 0.44 in 1968). The trend could not be explained by changes in parity or ethnic composition of the population and an environmental hypothesis is proposed.
Aplasia of the Diaphragm
Authors: Feingold Murray
Published: December 2021

According to Butler and Claireaux,1 approximately 8% of congenital malformations causing death during the first few days of life are secondary to diaphragmatic defects. The reported incidence is 1 out of every 2,200 births.2 To our knowledge, diaphragmatic defects in siblings, specifically aplasia of the diaphragm, have not been reported in the American literature although there have been six reported families in the European literature.3-8 Passarge, et al.7 have recently reported a family and reviewed the literature. We would like to report another family with aplasia of the diaphragm and stress the importance of proper genetic counseling.

CASE HISTORIES

The first infant was the product of the first pregnancy of a 25-year-old mother and a 27-year-old father.
ECTOPIC HORMONE SYNDROMES ASSOCIATED WITH TUMORS IN CHILDHOOD
Authors: Omenn Gilbert S.
Published: December 2021

Ectopic production of hormones by tumors can serve as a clue to diagnosis of the tumor and as a focus for management of the patient.

Impressive numbers of cases of hypercortisolism, hypoglycemia, precocious puberty, and hypercalcemia due to tumors of nonendocrine tissues have been reported in children already, and it is likely that many others go unrecognized.

The types of tumors and the effects of ectopic hormones in children are quite similar to those in adults, though the tumors most commonly associated reflect the relative frequencies of those tumors in the different age groups.

The unifying hypothesis of genetic derepression accounts for the ectopic hormone syndromes and predicts that additional unusual tumor products can be detected.
Letters to the Editor
Authors: Moriyama I. M.
Published: December 2021

We showed Dr. Nichols' letter to Drs. Moriyama and Yankauer. Dr. Moriyama writes:

Dr. Nichols makes reference to problems of definitions and registration practices in three countries, namely, the Netherlands, Sweden, and the United Kingdom. By applying these criteria to data from several hospitals in the United States, he points out the large differences between the derived and observed rates.

I will not comment on the "artefacts" that Dr. Nichols has created with his arithmetic. Rather, I shall confine my remarks to the specific issues which Dr. Nichols has raised.