bluuebunny/crossref_metadata_2025 huggingface dataset:
THE CONTROL OF CHILD-ENVIRONMENT INTERACTION: A CONCEPTUAL APPROACH TO ACCIDENT OCCURRENCE
Authors: Wight Byron W.
Published: December 2021

Two decades ago, in a pioneering study, the Canadian psychiatrist John Tillmann demonstrated that drivers with a record of repeated automobile accidents did not confine their "accident" behavior to the highway. They were—to a substantially greater extent than accident-free drivers— "in trouble" in various aspects of their lives. Their records in a variety of social and legal agencies documented widespread pathology—economic, social, psychological, physical.

Tillmann's conclusion, "You drive as you live," has achieved wide currency, but it has taken almost two decades for his conceptual framework to be applied to nonvehicular accidents—and especially to childhood accidents. Where such attempts have been made—where the investigator has broadened his focus on the "mechanics" of the accident to include a view of the personal and social characteristics of the individuals involved—the findings have been striking. Waller's unpublished study of shooting accidents demonstrates, for example, that those who have such accidents are quite different from gun owners who are accident-free. The paper that follows demonstrates some significant differences between mothers suspected of physically abusing their children and mothers of children whose accidents do not involve the suspicion of abuse.

Perhaps because the early, largely discredited, concept of "accident proneness" was fundamentally a psychological one, there remains a tendency in many investigators to seek out psychological characteristics that distinguish child-abusing parents from those who do not abuse their children. Since the significant distinguishing psychological variables usually involve unusual sensitivity to social stresses or a general deficiency in coping ability, a remedial program may attempt either psychotherapy of the individual or a general alleviation of the social stresses. The social approach offers a practical alternative to the cost and uncertainty of the psychotherapeutic approach.
Coarctation-like Physiology with Cerebral Arteriovenous Fistula
Authors: Deverall P. B. , Taylor J. F. N. , Sturrock G. S. , Aberdeen Eoin
Published: December 2021

Hemodynamic signs of coarctation of the aorta were present in a neonate dying in cardiac failure. A cerebral arteriovenous fistula was found at autopsy. No obstructive lesion of the aortic arch was present.

Development of the aortic isthmus may be impaired if diminished flow through this segment is present.

Reduced flow may be present if most of the systemic output is diverted to a fistula proximal to the isthmus, distal systemic flow being maintained by flow from right-to-left through the ductus arteriosus.

Spontaneous duct closure after birth may then be followed by a reduction in distal systemic flow, resulting in signs suggestive of coarctation.
CRITICAL PERIODS AND COGNITIVE DEVELOPMENT IN THE FIRST 2 YEARS
Authors: Wolff Peter H. , Feinbloom Richard I.
Published: December 2021

There is no evidence at present to support the assertion that biologically fixed critical periods control the sequence of cognitive development, no evidence that scientifically designed toys are in any way superior to the usual household items available to most infants, no evidence that the systematic application of such toys accelerates intellectual development, and no persuasive evidence that acceleration of specific skills during the sensory motor phase of development, even if possible, has any lasting effects on intellectual competence. Until more persuasive evidence is presented, it seems unethical for toy companies to invoke the concept of critical periods to sell their products; for academic consultants in the behavioral sciences to lend their authority to the promotion of such toys; and for private industry and the federal government to join forces in creating an infant development market which will assure industry a large profit and which may become the means for "shaping" the development of infants in keeping with the misguided national interest, if such programs should ever become effective.

While there is also no established experimental evidence which demonstrates that early enrichment will harm the infant, clinical experience suggests that, when such programs are used by parents for focused mental training, the effort can interfere with the mutually nuturing relation of mother and infant. The spontaneous social interchange of parent and child is at least as important for the child long-term intellectual development as early academic achievement.

Therefore, there is little reason for pediatricians to encourage, and ample reason for them to discourage, the use of specialized toys when these are used for maximizing the rate of mental development in the first 2 years.

The principles of child-rearing advocated by Dr. Benjamin Spock are not as popular today as they were a decade ago. In an age when technological gadgetry and the authority of "scientism" are progressively displacing reason and moral responsibility, it is useful to remember that Dr. Spock stressed an approach to child rearing which would permit parents and children a broad latitude of alternatives in finding their optimal fit. He also cautioned that these alternatives should not be rigorously codified by experts. Dr. Spock advice pertained to emotional development and social training. With appropriate transformations it is just as relevant for the intellectual development of infants. The attitudes which encourage parents to accelerate the cognitive development of non-deprived infants seem to us to be diametrically opposed to such a view of child rearing.
OTITIS MEDIA: A CLINICAL AND BACTERIOLOGICAL CORRELATION
Authors: Howie Virgil M. , Ploussard John H. , Lester Richard L.
Published: December 2021

There were 858 instances of otitis media studied in a private pediatric practice over a 2-year period; these cases were studied by aspiration and culture of middle ear fluid. Clinical correlations were made with observations of bacterial etiology. Pneumococcal otitis media was far more likely than Hemophilus influenzal otitis to be associated with severe pain and high fever. H. influenzal otitis media tended to be associated with little fever or pain and was more apt to be bilateral.

The distribution of etiologic agents in the study was similar to that of previously reported series from this county. However, the previously reported decrease in incidence of H. influenza in patients over 3 years of age was not apparent in our series.
THE CRITICALLY ILL CHILD: ACUTE HEPATIC FAILURE
Authors: Trey Charles
Published: December 2021

The presumed causes of liver failure in 42 children are discussed. The aim of treatment (summarized in the Appendix) is to maintain the child until the liver function is improved. Other causes of coma must be investigated; hypoglycemia, infection, electrolyte imbalance, or gastrointestinal hemorrhage must be prevented if possible or promptly recognized and treated if they occur. Dietary protein is restricted, and alimentary protein breakdown by bacteria is decreased by oral antibiotics and purgatives. Glucocorticosteroids may be administered. If the deeply comatose child does not improve or deteriorates rapidly, procedures such as exchange blood transfusions should be used. All aspects of therapy may be required in the child recovering from the acute phase or in those with chronic liver failure. The mortality is high, and prevention or early detection of this syndrome is important.
THE CLINICAL HISTORY OF A FOUR-YEAR-OLD GIRL WHO IN FEBRUARY 1793 SWALLOWED AN IRON NAIL
Authors: C. T. E.
Published: December 2021

The report of a case is, as Fishbein reminds us, "the foundation of clinical medical literature." An excellent example of the literary style of an eighteenth century case report is that of Dr. Wilson, of Edinburgh, which follows:

A girl in the fourth year of her age in the month of February 1793, by accident swallowed an iron nail, nearly two inches in length. In its passage, it wounded the oesophagus, which bled freely; and a soreness was felt there for some time. In about a fortnight, a trifling cough supervened, with thirst and general fever. This fever had remissions and exacerbations; but the cough and thirst became incessant, with occasional sickness and pain in the stomach and bowels. In the winter, the child began to expectorate much phlegm, particularly in the morning. This was invariably attended with distressing pain in the region of the stomach. Her appetite, however, during the remissions of fever, was somewhat improved; and she gradually recruited her strength a little. But during the fifteen months for which the nail was present in her stomach, her growth was almost entirely suspended.

On the 5th of May 1794, I was consulted respecting the complaints of this child, on the supposition that she had worms. Not knowing anything of the former circumstances, I was ready to ascribe the above symptoms to the presence of worms; and I prescribed medicines with this view of the case. The child at this stage appeared to be in the last stage of a decline, having regular night sweats and hectic-fever.
Optic Glioma Presenting as Spasmus Nutans
Authors: Kelly Thomas W.
Published: December 2021

An optic glioma was found in a 3½-year-old boy who was diagnosed as having spasmus nutans at age 8 months. The incorrect assumption of SN was prompted by the appearance of nystagmus and head nodding. The author suggests that prompt recognition of impaired visual acuity, optic atrophy, and excessive head growth would have led to earlier correct diagnosis.
SOME CONSIDERATIONS FOR EVALUATING THE DOMAN-DELACATO "PATTERNING" METHOD
Authors: Cohen Herbert J. , Birch Herbert G. , Taft Lawrence T.
Published: December 2021

A method of rehabilitation therapy and development training named "patterning" has been considered. The theories upon which the method is based and the findings which have stemmed from its application have both been analyzed.

It has been concluded that the data thus far advanced are insufficient to justify affirmative conclusions about the system of treatment. Consideration of the statistics of individual case reports suggest that the changes obtained may reflect normal growth and development occurring independently of the method applied, or the inadvertent consequence of social stimulation and environmental change inherent in, or resulting from, the application of almost any method. We have also noted evidence that is available that justifies questioning the theoretical premises of the method.

The problem of selecting optimal therapy for patients with brain damage and cerebral dysfunction is complicated by the finding that sensory and motor function are not affected in a uniform and consistent manner by damage to the central nervous system. Lack of understanding of the fundamental mechanisms which integrate sensory and motor activities continues to make the selection of a therapy most difficult. Until we gain a greater understanding of sensory and motor integrative mechanisms, scientific (statistically corroborated) proof is needed before "patterning" or any other method may claim sufficient universal applicability to serve as the sole therapeutic approach to one or more disturbances of intellectual and motor function.
Who Will Provide Quality Health Care in the Poorer Areas?
Authors: Marks Ira
Published: December 2021

In their articles discussing the various avenues open to us to improve the delivery and quality of health care received by American children, Drs. Yankauer1 and Breslow2 barely touch on what may ultimately be the major problem in any proposal: what percentage of future Academy members will be willing to practice in the big city ghettos or the rural areas of this country?

I wholeheartedly agree with Dr. Yankauer when he says: "It is no longer tolerable that the food, or the quantity, quality, and personalized nature of health care which an infant receives should be determined by the income and race of his parents."
Letter To The Editor
Authors: Yankauer Alfred
Published: December 2021

Dr. Yankauer wrote:

Dr. Marks' point is moot. It has been raised previously in a Pediatrics Commentary. At about the same time a New England practitioner complained that private practice was being ignored in government programs.

The question of whether young men finishing their residencies will "go where they are needed" can only be answered by time. The problem is that they are needed just about everywhere (by the rich as well as the poor) because of mounting manpower shortages.3 It is worth mentioning that in urban areas outside of the large cities, where money does not lead to such sharply segregated residential districts and hospital out-patient departments are underdeveloped, practicing pediatricians are virtually the only source of health care.
Treatment of Hemorrhagic Shock
Authors: Hoffman Carl M. , Canby John P.
Published: December 2021

Dr. Replogle's recent review of hemorrhagic shock is very well presented. As a result of our experiences with children, as well as severely injured servicemen, we feel that two points may have been overemphasized. These are the emphasis on blood or colloid solutions for volume replacement and the emphasis on the use of the ankle saphenous vein as an infusion site.

Volume deficit replacement is the most important single item in treating hemorrhagic shock. The article appears to emphasize that colloid solutions, such as albumin or dextran, should be used while waiting for blood to be typed and cross-matched.
Letter To The Editor
Authors: Replogle Robert L.
Published: December 2021

The letter from Doctors Hoffman and Canby touches on one area about which there is probably widespread controversy, namely the type of fluid to be used for the immediate restoration of blood loss. I would strongly disagree with their recommendation that universal donor low titer blood be infused rather than wait 30 minutes for emergency cross-matched blood to be made available. Although the morbidity associated with incompatibility is low following infusion of low titer blood, the presence of residual transfused antibody to the patient's hereditary blood group may lead to a hemolytic transfusion reaction when subsequent transfusions of cross-matched blood are given.
Medical Embryology: Human Development, Normal and Abnormal, ed. 2, by Jan Langman, M.D., Ph.D. Baltimore: The Williams and Wilkins Company, 1969, 386 pp., $7.50
Authors: Avery Gordon B.
Published: December 2021

This book is the second edition of a compact and well written embryology text aimed primarily at the medical student. The broad acceptance of the first edition is evidenced by the translations into Spanish, French, Dutch, Portuguese, Italian, Japanese, Persian, and Korean. The second edition contains a new chapter on experimental embryology, as well as up-dating of the entire book. Compared with some of the older texts, this one is shorter, less expensive, and easier to read, and it dwells less on bizarre malformations—the "monsters" which seemed to fascinate some embryologists.
"Pseudorheumatoid" Nodules in Children: Report of 10 Cases
Authors: Burrington John D.
Published: December 2021

Subcutaneous nodules, composed of necrotic collagen surrounded by chronic inflammatory cells, occur in about 20% of individuals with rheumatoid arthritis, 10% of those with acute rheumatic fever, and 25% of children with granuloma annulare. Similar subcutaneous lesions indistinguishable from rheumatoid nodules may appear in children who do not develop other stigmata of disease. Mesara and ous lesions of granuloma annulare. Therefore, they felt that, in children, these nodules probably represented a clinical variant of granuloma annulare. Beatty3 described nine children aged 11 days to 9 years with nodules on the scalp, ulnar aspect of the arm, dorsum of the foot, and palm of the hand which appeared histologically to be rheumatoid nodules.
Flowers, Hospitality, and Ethics
Authors: Guttman Herta
Published: December 2021

I recently attended the Chicago meeting of the American Academy of Pediatrics, both as a companion to my husband and as a non-member physician. On the day following our arrival, we were quite amazed to find two large floral arrangements in our room, "from the Gerber baby." This initial feeling of amazement soon became a compound of humiliation and disgust; humiliation that the favors of doctors should be solicited in this way, disgust that the temendous amount of money wasted on such activities should be spreading from the drug industry to other industries as well, and in particular to producers of food for babies!
ION EXCHANGE CHROMATOGRAPHY OF THE FREE AMINO ACIDS IN THE PLASMA OF INFANTS UNDER 2,500 GM AT BIRTH
Authors: Dickinson Johanne C. , Rosenblum Herman , Hamilton Paul B.
Published: December 2021

The free amino acids in the plasma of 46 infants who were under 2,500 gm at birth were determined by an ion exchange chromatographic technique of high sensitivity and resolution. Ninety-two plasma samples were collected from the 46 infants on different days after birth, and the data for 23 amino acids plus taurine and ethanolamine were summarized and compared with newborn, full-term and adult levels. In 16 cases tyrosine levels were high; these values are listed separately. With respect to the remaining amino acids, many showed marked changes during the first few postnatal days; but, by the end of the first week, stable patterns had developed. The decrease or increase of the individual amino acid concentrations in these infants compared to infants with birth weights over 2,500 gm and to the adult was not great and seemed to be characteristic for each amino acid.

Attention was drawn to the technical details of preparing and analyzing physiological fluids which would minimize the changes in amino acid concentrations resulting from improper handling.
WHAT THE DILIGENT MOTHER OF THE 1820'S SHOULD HAVE IN THE HOME MEDICINE CHEST FOR THE PROPER CARE OF HER CHILDREN
Authors: C. T. E.
Published: December 2021

A comparison of the contents of today's medicine cabinets with those of a century and a half ago will interest contemporary pediatricians because almost all the items formerly recommended for the treatment of the sick child have not been mentioned in any textbook of pediatrics for many years. Have we lost something by discarding some of these drugs? The following items were considered necessary in 1820 if there were children in the home:

Alum

Aether

Blister Plaister [sic]

Borax

Castor Oil

Calomel

Cream of Tartar

Diluted Vitriolic Acid

Epsom Salts

Gum Arabic Powder

Jalap Powder

Ipecacuanha Powder

Laudanum

Magnesia

Nitre

Prepared Kali

Rhubarb

Spirit of Hartshorn

Spermaceti Cerate

Sweet Spirit of Nitre

Tincture of Myrrh

Turner's Cerate

Antimonial Powder

Aromatic Confection

Yellow Basilicon
NEONATAL SEIZURE STATES
Authors: Rose L. , Lombroso Cesare T.
Published: December 2021

In the March issue of Pediatrics two corrections should be made in the article by Drs. Rose and Lombroso:

Page 406: Table III, second footnote should read † 1. Two siblings with seizures which continued and were accompanied by mental retardation. 2. A case of transient familial neonatal seizures occurring in three generations and followed by normal development. 3. One sibship and a sporadic case of pyridoxine dependency. 4. A case of hypernatremia associated with hypocalcemia of unknown etiology. 5. A case of hemorrhagic disease of the newborn. 6. A case of congenital heart disease with transient seizures.

Page 418: Table referred to in second line, section on Pathologic Findings, should be XII rather than II.
CYTOGENETIC ANALYSIS OF A BOY WITH THE XXXY SYNDROME: ORIGIN OF THE X-CHROMOSOMES
Authors: Greenstein Robert M. , Harris David J. , Luzzatti Luigi , Cann Howard M.
Published: December 2021

A 3-year-old boy with radio-ulnar synostosis and mild mental retardation was found to have a 48/XXXY chromosome constitution in blood and skin cultures without evidence of mosaicism. Autoradiography of the cultured cells identified two late-labeling X-chromosomes. His buccal smear revealed double and single sex chromatin bodies. The patient and his family were studied for segregation of Xg blood types which are controlled by X-linked genes. This revealed the father to be Xg(a+), a positive hemizygote; the mother Xg (a-) was homozygous negative; and the proband was Xg(a-). These findings suggest that the three X-chromosomes of the proband came from his mother. It is proposed that nondisjunction occurred at both the first and second meiotic divisions of oogenesis, producing a triple-X (XXX) ovum which was then fertilized by the paternal Y-bearing sperm. This communication represents the first reported case of the XXXY syndrome in which informative cytogenetic evaluation has been obtained.
Letter To The Editor
Authors: Alpert Joel J.
Published: December 2021

We asked Dr. Alpert to comment for the Subcommittee. He writes:

Thank you for the opportunity to reply to Dr. Lin-Fu's letter. She makes several important points. The thrust of the committee statement was with clinical diagnosis and the treatment ment of lead poisoning. We must make a distinction between asymptomatic increased lead absorption and increased body lead burden on the one hand and lead poisoning on the other. A mass screening program should be designed to pick up the child with asymptomatic increased lead absorption or increased body lead burden prior to the appearance of actual lead poisoning.
Ergebnisse Der Bluttransfusionsforschung, Vol. X, edited by L. P. Hollander and M. Matthes. Basel, Switzerland: S. Karger, 1969, 348 pp., $18.95. (Distribution in the United States, Albert J. phiebig, P.O. Box 352, White Plains, New York 10602. In German.)
Authors: Diamond Louis K.
Published: December 2021

This book is not meant to be a textbook about blood transfusion, but rather a compendium of the papers presented at the Proceeding of the thirteenth meeting of the German Organization for Blood Transfusion, which was held in Graz, Austria, May 15-18, 1968.

There are 41 articles, edited somewhat, on a wide variety of subjects concerned with blood transfusion, the storage of plasma proteins, erythroblastosis fetalis, plus a scattering of other papers about transfusions of both whole blood and blood fractions.
RECURRENT ABDOMINAL PAIN IN CHILDHOOD
Authors: Stone Robert T. , Barbero Giulio J.
Published: December 2021

One hundred and two children with recurrent abdominal pain were studied and followed through hospitalization. The pain in this group was variable, with no consistent pattern in time, duration, and intensity. It was located in the periumbilical region in 50 of the patients. Associated symptoms frequently included headache, pallor, nausea, vomiting, constipation, dizziness, and poor appetite. The principal physical finding was tenderness on deep palpation over various sections of the abdomen. Proctoscopic findings in 88 of 90 patients examined were rectal dilatation, hyperemic areas, pallor, lymphoid hyperplasia, pellet stools, edema, and friability. There were no other abnormal laboratory or x-ray findings. Various behavioral manifestations were observed in this group of children. Some of the children were able to delineate points of stress as precipitants of episodes of pain.

During hospitalization there was total abatement of intestinal symptoms in 53% of the children and there was a decline in symptomatology in another 38%.

It is proposed that the abdominal manifestations of this group of patients can be described as the irritable bowel syndrome in childhood.
Transient Complete A-V Block in Two Siblings During Acute Rheumatic Carditis in Childhood
Authors: Stocker Franco P. , Czoniczer Gabor , Massell Benedict F. , Nadas Alexander S.
Published: December 2021

A report is given of a 12-year-old Negro girl and her 14-year-old brother who presented with transient complete A-V block, reversible with atropine, during an attack of acute rheumatic fever with carditis.
Congenital Bacterial Pneumonia with Intact Fetal Membranes
Authors: Monif Gilles R. G.
Published: December 2021

This paper reports a case of intra-uterine bacterial pneumonia which occurred in the presence of intact fetal membranes. IgM immunoglobulin levels and histology of the umbilical cord aided in the documentation of the probable time sequence of events.
Limb Development and Deformity: Problems of Evaluation and Rehabilitation, edited by Chester A. Swinyard, M.D., Ph.D. Springfield, Illinois: Charles C Thomas. 1969, 672 pp., $ 19.25
Authors: Garrard Sterling D.
Published: December 2021

This volume incorporates the papers and comments of 53 contributors to a colloquium on limb development and deformity which was held in the Netherlands in September 1963 in the aftermath of the thalidomide tragedy of 1959-1962.

The papers of the colloquium are grouped in sections under the following titles: normal limb development, experimental embryogenesis, genetic and exogenous induction of limb deformities, epidemiological studies, thalidomide-bio- chemistry and metabolism, morphological variations in thalidomide-related effects, orthopedic and prosthetic considerations, psychosocial problems and parental counseling, postnatal growth of the extremities, and related surgical problems.
Immunoglobulinopathies: Immunoglobulins, Immune Deficiency Syndromes, Multiple Myeloma and Related Disorders, by Ralph L. Engle, Jr., B.S., M.D. and Lila A. Wallis, B.A., M.D. Springfield, Illinois: Charles C Thomas, 1969, 270 pp., $17.50
Authors: Johnston Richard B.
Published: December 2021

This book is about the ups and downs of serum gamma globulin. Written by two members of the Department of Medicine (Hematology Division) , of the Cornell University Medical College, it is ". . . directed primarily to physicians, both general practitioners and specialists, who want to become familiar with the many diseases in which there is an abnormality of the immunoglobulins demonstrable by electrophoresis." These diseases known as the "immunoglobulinopathies" are segregated by the authors according to whether the serum gamma globulins are increased, decreased, or aberrant (the "hyper" "hypo," and "paraimmunoglobulinopathies," respectively).
EVALUATION OF THE ROUTINE PHYSICAL EXAMINATION OF INFANTS IN THE FIRST YEAR OF LIFE: REVIEW
Authors: Peebles Thomas C.
Published: December 2021

This paper focuses attention once again on the appropriate role the pediatric assistant, nurse-practitioner, or pediatric associate may play in relieving the physician of some of the routines of physical examination. The relatively low yield (1.9%) of significant abnormalities detected by pediatricians in the course of routine physical examinations is studied during the first year of life. The assumption is made, but not documented, that, with appropriate training, paramedical personnel could detect these abnormalities.

The cost-effectiveness aspects of this question can no longer be ignored because of pressing necessity to reduce overall cost of pediatric care generally and to spread the administrative talents and diagnostic skills of the pediatrician to encompass the greater needs of health care in the United States. Purposely ignored here is the role of the physician in parent and early childhood education, support for parental anxiety, and reorientation of abnormal behavior in parents and infant. All of these are important issues and must not be neglected in the overall picture of care delivery. Yet, these aspects of routine care can perhaps be adequately met by a carefully planned and supervised program of reading, group discussions, and audiovisual education, together with appropriate referral by paramedical personnel on specific indication of parental or child need for physician attention. It is also apparent that the high yield in physical abnormalities is on examination during the newborn period and the first or second month. These may be the times for the pediatrician to establish personal contact with parents and baby so that delegation of the succeeding, more routine examinations to other members of the closely cooperating team may be effected as is appropriate to the physical and emotional situation.
CORTICAL BLINDNESS FOLLOWING CONVULSIONS AND FEVER IN NIGERIAN CHILDREN
Authors: Olurin Oyin
Published: December 2021

The manuscript describes the occurrence of blindness of cortical origin and other neurologic defects in six children under 6 years of age, following febrile illnesses complicated by seizures. The pathogenesis of cortical blindness in these cases is discussed. Blindness was not detected in the hospital before discharge in nearly all the children, but it was suspected by the children's parents when the children returned home to their normal surroundings. Five of the six children are known to have recovered from the blindness and associated neurologic defects. In this manuscript a plea is made for thorough neurologic, behavioral, and, especially, ophthalmologic examination of children after seizures, particularly when focal neurologic signs persist.
Synchronous Diaphragmatic Flutter Occurring in Hypoparathyroidism
Authors: Baker Frances W. , Kenny Frederic M. , Zuberbuhler James R.
Published: December 2021

A 7-year-old patient with idiopathic hypoparathyroidism, Addison's disease, malabsorption, and unilateral diaphragmatic flutter synchronous with the heart beat (SDF) is reported. The flutter occurred shortly after the onset of malabsorption syndrome and disappeared after appropriate correction of serum magnesium, calcium, and Potassium levels. This unusual condition should be considered in the differential diagnosis of abdominal pulsations. The exact biochemical abnormalities that permit synchronous diaphragmatic flutter remain to be defined.
SIMULTANEOUS OCCURRENCE OF RING "G" CHROMOSOME AND GROUP "B" PERICENTRIC INVERSION IN THE SAME INDIVIDUAL: CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Singer Howard , Scaife Nona Suzann
Published: December 2021

A male infant with failure to thrive was found to have a previously unreported combination of chromosomal structural abnormalities. Evidence is presented which characterizes the abnormal chromosomes as a late-replicating G ring and a pericentric inversion in an early replicating B group chromosome. The mechanisms of pericentric inversion and ring formation are discussed, and possible genetic consequences are noted. The patient's phenotype differed significantly from that of previously reported subjects with G rings, G deletions, and structural abnormalities of the B group. This phenotypic difference could be attributed to the apparent fact that the proband's G ring was a late replicator (G1) and earlier cases were not, on to the seeming variability in ring size which suggested partial trisomy/partial monosomy, or perhaps to the probability that the abnormal B chromosome was pericentrically inverted rather than deleted.

The question of the etiologic significance of broken parental chromosomes must be raised, although more study is needed in the area of chromosome breakage, its relationship to abnormal progeny, and the possible role of environmental agents, e.g., drugs and irradiation.
RATES OF DELIVERY OF INSULIN INTO PLASMA IN CHILDREN WITH VARYING CARBOHYDRATE TOLERANCE
Authors: Reaven Gerald M. , Remen Naomi , Greenberg Robert E.
Published: December 2021

The rate at which labeled insulin is irreversibly lost from plasma has been determined in children with varying carbohydrate tolerance. Children with overt diabetes mellitus exhibited low plasma insulin concentration in relation to the degree of hyperglycemia and corresponding low delivery rates of insulin into plasma. Subjects with fasting euglycemia responded to lesser degrees of hyperglycemia with increased concentration of plasma insulin and proportional rates of insulin delivery into plasma. A direct linear relationship between plasma insulin concentration and insulin delivery rate into plasma has been documented in children with widely varying concentrations of plasma insulin and glucose. Failure of plasma insulin levels to increase in response to the stimulus of hyperglycemia in children with juvenile diabetes mellitus cannot be attributed to alterations in the rate of peripheral degradation of insulin. These studies support the proposal that juvenile diabetes mellitus represents a state of relative insulin deficiency, but do not prove that the primary defect resides in the insulin secretory mechanism.
DEVELOPMENTAL PATTERNS OF STATIC BALANCE ABILITY AND THEIR RELATION TO COGNITIVE SCHOOL READINESS
Authors: Kohen-Raz Reuven
Published: December 2021

Developmental patterns of static balance ability in children at ages 5 to 9 years were assessed by using a technique of electronic ataxiametry, consisting of the measurement of body weight displacement by pressure transducers, mounted to four footplates, each to bear one heel or toe part. The obtained fluctuation and weight displacement scores for various postures, none lasting more than 20 seconds, turned out to correlate significantly with teacher's evaluation of school readiness, basic arithmetic skills, and reading achievement in samples of normal school children (one kindergarten, two first grades, two second grades, and one third grade; total, 206).

Girls who were prococious in static balance ability in relation to boys tended to show higher within sex group correlations between equilibrium control and school and reading readiness. A sample of 33 undifferentiated educationally handicapped pupils at age 9, having a generally but not significantly lower static balance ability in postures with occluded vision, was efficiently divided by ataxiametric scores into balance-impaired and balance-unimpaired subjects.

The study seems to throw new light on the role of maturational and organic factors in the etiology of learning difficulties in normal and educationally handicapped children at the primary grades.
Study of the Glycoregulation in the Obese Child
Authors: Loeb H. , Ooms H. A. , Wolter R. , Brunet N.
Published: December 2021

The glucose kinetics are modified in obese children. This fact does not appear after an intravenous load of glucose, but it may be disclosed when the penetration of glucose into the cells is forced either by the oral administration of a large amount of glucose or by the neous intravenous injection of glucose and of a supramaximal dose of insulin.

The insulin response of the pancreas to oral glucose and intravenous tolbutamide is not significantly increased in obese children.

The rise of the fasting level of free fattyacids is significant, but the response of adipose tissue to glucose is comparable to that observed in normal children.
Subdural Effusions: An latrogenic Complication of Bacterial Meningitis
Authors: Cort Max
Published: December 2021

The article by F. Webrle, et al. on the management of acute bacterial meningitis prompts me to the following comment. On page 997 it is stated ". . . about 10% of infants and young children with acute purulent meningitis will develop clinically significant effusions." Throughout the years I have been wondering why this complication in pediatric practice in Holland is only very rarely observed. May it be that (too) liberal administration of intravenous fluids is important in this respect?
Pruritus in Juvenile Rheumatoid Arthritis
Authors: Calabro John J. , Katz Roger M. , Marchesano Joseph M.
Published: December 2021

The brief account by Schaller and Wedgwood on pruritis associated with the rash of juvenile rheumatoid arthritis deserves comment. First, pruritus is misspelled in the title and throughout their article. Second, they erroneously cite our 1968 (not 1958) paper as implying that rash is "invariably" nonpruritic. Actually, one of our 20 patients with rash had pruritus, as reported. The foremost issue is really the frequency of pruritus associated with this exanthem, data which are lacking in the Schaller and wedgwood report.
BRONCHOGRAPHY: OUTMODED PROCEDURE?
Authors: Avery Mary Ellen
Published: December 2021

Part of the "work-up" of chronic pulmonary disease has been, traditionally, a bronchogram. In 1955, Flake and Ferguson1 wrote "The use of contrast studies in the younger age groups . . .has steadily increased as improvement in medical and surgical technique for care and treatment has demanded more accurate diagnosis." Has it increased unnecessarily? Is the present utilization too great? The procedure usually requires hospitalization; in some centers a general anesthetic, in some a recent prior bronchoscopy, and in all a finite risk and degree of morbidity. It seems pertinent to ask first: When is bronchography indicated? The Committee on Therapy of the American Thoracic Society has recently offered instructive answers to this question.2
SHAKESPEARE AS A GENETICIST
Authors: C. T. E.
Published: December 2021

William Hazlitt (1778-1830), the English essayist, once wrote:

If we wish to know the form of human genius, we should read Shakespeare. If we wish to know the insignificance of human learning, we may read his commentators.

Shakespeare often surprises us by his prescience about many medical discoveries which were not appreciated until centuries after his death. That he was cognizant of the rudiments of genetics seems clear from this passage from The Winter's Tale:

. . . Behold, my lords,

although the print be little, the whole matter and copy of the father; eye, nose, lip, the trick of's frown, his forehead, nay, the valley,

the pretty dimples of his chin and cheek, his smiles,

the very mould and frame of hand, nail, fingers... The Winter's Tale, I, Sc. 7
Letter To The Editor
Authors: Klein Jerome O.
Published: December 2021

Dr. Strauss has concisely summarized present considerations of the role of encapsulated and nonencapsulated Hemophilus influenzae in infection and disease. A recent clinical review by Turk and May1 documents the predominance of Hemophilus influenzae type B in suppurative disease. In a survey of reports of cases of meningitis due to this agent, the authors found only 24 cases due to Hemophilus influenzae other than type B(type A = 6, type E = 1, type F = 3, and non-typable 14). The role of nonencapsulated Hemophilus influenzae strains in the pathogenesis of respiratory infections and otitis media is still unclear. The majority of H. influenzae strains isolated from the middle ear fluids of children with acute otitis media are nonencapsulated.2,3
"Diaper Dermatitis" from Allergens Excreted in Urine
Authors: Keiter W. E.
Published: December 2021

Discussions of "diaper dermatitis," although recognizing several categories, seem never to separate it into the pubic-perineal type as distinct from the peri-anal, belt-line, or generalized types. This topographical classification gives important clues as to its etiology and treatment.

In 1952 a little 1-month-old baby girl who was entirely breast fed, developed an unusually severe pubic-perineal "diaper dermatitis" which was refractory to any form of local treatment, including exposure to warm dry air without a diaper.
Physical Abuse of Children (Continued)
Authors: Helfer Ray E.
Published: December 2021

I am deeply concerned over Dr. Gil's report1 on his survey of child abuse. My concern covens many facets of his study: The definition of physical abuse; the use of reports from 1967 which was, for many states the first or second year of their reporting law; setting out to count a certain medical-social problem; and becoming lost in the forest of poverty and hunger of children and the willingness to "move from quantitative to the qualitative ...," and reaching conclusions that cannot be supported by the data.
THE CREATININE HEIGHT INDEX: ITS USE IN THE ESTIMATION OF THE DEGREE OF PROTEIN DEPLETION AND REPLETION IN PROTEIN CALORIE MALNOURISHED CHILDREN
Authors: Viteri Fernando E. , Alvarado Jorge
Published: December 2021

The creatinine height index (CHI), which consists of the following ratio:

CHI: 24 hour creatinine excretion of subject 24 hour creatinine excretion of normal child of same height

has been devised for estimating the relative muscle mass of children. Age is not considered because children of developing areas are very often retarded in height. The normal CHI is close to 1.0, both in well nourished children and in fully recovered malnourished ones, with heights ranging from 64.8 to 135 cm.

Protein calorie malnourished (PCM) children of the edematous type (kwashiorkor and kwashiorkormarasmus) had CHI's ranging from 0.25 to 0.75, lower CHI's were observed in more severely malnourished children and vice versa. In clinically marasmic children (PCM without edema) the CHI ranged from 0.33 to 0.85, independent of the degree of weight deficit or the clinical severity of marasmus, indicating that severe caloric deficiency can occur with a wide range of muscle wasting. No creatinine retention was observed in any PCM children with adequate urine flows.

Independent estimates of protein and calorie repletion were obtained during recovery by the use of CHI and weight for height. A significant negative correlation between CHI and N retention was found, indicating the physiological significance of the CHI in estimating protein nutrition.
Testicular Calcification in a 4-Year-Old Boy
Authors: Priebe Cedric J. , Garret Rudolf
Published: December 2021

Testicular calcification as seen on an x-ray film in a 4-year-old boy was produced by calcified intratubular testicular bodies. Histochemical studies indicated that these bodies contained calcium phosphate and neutral and acid mucopolysaccharides. This boy's ultimate testicular function is unknown.
"THERAPEUTIC ORPHANS" AND THE PACKAGE INSERT
Authors:   Committee on Drugs
Published: December 2021

In the practice of pediatrics, drugs which are not approved by the Food and Drug Administration (FDA)* as safe and effective in children are prescribed daily. This is due in part to the fact that many drugs released since 1962 carry an "orphaning clause" in the package insert such as, "not to be used in children, since clinical studies have been insufficient to establish recommendations for its use." What is the status of the package insert? Is it a legal directive to the physician, or is it intended as a guide for the physician in prescribing a drug?

The package insert, by legal definition of the Federal Food, Drug and Cosmetic Law, is the official information piece for a drug. The information it contains is derived from data supplied by investigators and submitted by the pharmaceutical firm to the FDA. The insert is written and printed by the drug manufacturer, but its contents must be approved by the FDA. The Food, Drug and Cosmetic Law, as amended in 1962, requires full disclosure of all known facts pertaining to the use of the drug. Therefore, a great deal of information is included in the insert, including the chemical structure of the drug, a summary of its pharmacological and toxicological action, its clinical indications and contraindications, precautions, reported adverse reactions, dosage recommendations, and available dosage forms.

Many drugs have package inserts approved by the FDA before the Drug Amendments of 1962 when manufacturers were required to show the safety but not the effectiveness of their products.
Intra-uterine Growth
Authors: Gruenwald Peter
Published: December 2021

Two recent issues of Pediatrics contain significant contributions to our knowledge of fetal growth as derived from birth weights at various gestational ages,1-3 and a comment by Tanner4 which is of particular interest because it comes from an expert viewing growth in a broader perspective than just the fetal period. The following comment will be limited to the early part of the third trimester when differences between reported data can be reconciled by correction. This is in contrast to differences between populations late in the third trimester; for instance, the recent reports of Babson, et al.1
GROUP A STREPTOCOCCAL INFECTIONS IN NEWBORN NURSERIES
Authors: Geil Carol C. , Castle Wilma K. , Mortimer Edward A.
Published: December 2021

Two outbreaks of group A streptococcal colonization of newborn infants over a 3-year period were observed. Manifestations of the outbreak included indolent oomphalitis in most infants, but two babies developed sepsis. Transmission to family members occurred after discharge in several instances. The offending strains were untypable by M protein precipitin techniques, but by T-agglutination techniques were identified as T28 in the first outbreak and T11/9 in the second out-break.

The origin of the first outbreak appeared to be an infant who acquired the strain from his mother's vaginal tract during delivery, but the origin of the second episode could not be identified. Perpetuation of the outbreaks appeared to be mediated by infant-to-infant transmission with the umbilical stump being the primary site of colonization.

Control of the first outbreak was not achieved until all infants with positive cultures were treated with penicillin and all exposed infants received prophylactic penicillin until a complete turnover of the nursery population occurred. This regimenfailed to eradicate the second outbreak, which was finally controlled by treating all affected infants with penicillin and applying bacitracin ointment to the umbilical stumps of all other infants for 15 days. It is possible that the difficulty in interrupting the second outbreak resulted from failure to identify a continuing carrier among personnel.
BOOK OF ACCIDENTS
Authors: Cone Thomas E.
Published: December 2021

drownings are presently the third leading cause of accidental death of children living in the United States.1 This statistic gives grisly evidence of the need to alter the grossly distorted picture most parents offer their children about water. Daily in their bath children are led to believe that they are unsinkable. "See baby swim," and "Mother won't let water hurt him" is scarcely realistic education for the child's first accidental solo exposure to a body of water.2

Even today one would search long and hard to find a lesson about accidental drowning with the trenchant impact of the figure and lesson below.3

Modern readers will also note that the unknown author of this little book was well aware of two well known facts about drowning; namely, that males drown far more frequently than do females (the incidence is 4:1), and that in the majority of drownings, the boy gets into trouble because of "not being sensible of the danger of water."
Letter To The Editor
Authors: Stowens Daniel
Published: December 2021

The article "Recurrent Abdominal Pain" by Drs. Stone and Barbero contains data of such importance that comment appears mandatory.

Under the section "X-ray and Laboratory Studies" the following is included: "An electroencephalogram was obtained in 70% of the patients. Of these 7% were described as epileptiform. Of the remainder, findings such as 14 and 6 per second spikes were reported in 16%, and instances of excess fast and slow activity were mentioned in 36%."

It is apparent that significant electroencephalognaphic abnormalities were present in approximately 50% of the patients on whom this examination was performed.
Letter To The Editor
Authors: Peltonen Tuomas
Published: December 2021

Stone and Barbero made a careful study of a number of children with abdominal distress and arrived at the diagnosis of irritable bowel syndrome. However, a more comprehensive entity was probably involved. Abdominal symptom is only one of many symptoms encountered in this syndrome. As the authors also stated there is headache, pallor, syncope, vertigo, and poor appetite. Certain circulatory symptoms also belong to this same syndrome. I described them in 1956.1

I see this syndrome as an entity which can be entered under the heading of neurovegetative dystonia.