bluuebunny/crossref_metadata_2025 huggingface dataset:
Legal Action and the "Battered Child"
Authors: WILSON REGINALD A.
Published: December 2021

I support the views expressed in Pediatrics (31:899, 1963) on this subject by F. V. Harper and others. However, this and many similar articles may generate a climate in which the social agencies will become overaggressive, and the punitive pendulum swing too far. I feel this happened in the following instance:

The patient was an infant, age four months, with subdural haematoma, blindness, fragmented metaphysis, and subperiosteal callus (right femur). There was a history of minor injury when the car stopped suddenly with the crib loose on the rear seat.
AN OUTBREAK OF URINARY TRACT AND OTHER INFECTIONS DUE TO E. COLI
Authors: Sweet Avron Y. , Wolinsky Emanuel
Published: December 2021

In a premature infant nursery 3 infants died of E. coli infections and 5 babies contracted urinary tract infection due to E. coli within a 5-month period. The causative organisms were found to be resistant to tetracycline, streptomycin, chloramphenicol, and sulfisoxazole, and sensitive to kanamycin, polymyxin B, and nitrofurantoin. From throat and stool cultures of 25 infants in the nursery, E. coli with this susceptibility pattern were recovered from 13. Of these, 9 were serotype 04:H5 and one was group 04 but nonmotile. Isolates from the urine of 3 infants with urinary tract infection and meninges of one fatal case were serotype 04:H5. Stool cultures revealed group 04 E. coli only in infants with that organism in the throat.

The findings indicate that an outbreak of infections due to E. coli 04:H5 had occurred as a consequence of widespread colonization with that organism in a premature infant nursery. The unusual incidence of urinary tract infection due to a specific E. coli serotype indicates that urosepsis in the newborn can occur in epidemic form.
CARDIOVASCULAR MALFORMATIONS IN TURNER'S SYNDROME
Authors: Rainier-Pope Christopher R. , Cunningham Russell D. , Nadas Alexander S. , Crigler John F.
Published: December 2021

1. Cardiovascular disease associated with Turner's syndrome is more frequent than hitherto reported. In this study, 36 patients were investigated and it was found that in 16 (44%) there was some form of cardiovascular abnormality.

2. Pulmonic stenosis was found to be as frequent as the more commonly reported coarctation of the aorta.

3. Patients with typical Turner's syndrome, who are chromatin negative, may have coarctation of the aorta or pulmonic stenosis. When buccal smears are chromatin positive, stature is within normal limits, or hypertelorism is present, the most likely cardiovascular lesion will be pulmonic stenosis.
A THERAPEUTIC APPROACH IN 100 CASES OF THE RESPIRATORY DISTRESS SYNDROME OF THE NEWBORN INFANT
Authors: Hutchison James H. , Kerr Margaret M. , Douglas T. A. , Inall J. A. , Crosbie J. C.
Published: December 2021

A method of treatment in 100 cases of the idiopathic respiratory distress syndrome of severe degree is described. This includes the rapid correction of metabolic acidosis with 8.4% solution of sodium bicarbonate (1 ml = 1 mEq). The sodium bicarbonate is given by periodic intravenous injections by the umbilical vein, and the dosage is controlled by frequent estimations in the blood of the pH, pCO2, plasma standard bicarbonate and base excess by means of the Astrup micro-apparatus. The total daily fluid intake by the same route is brought up to 60 ml/kg with 20% fructose solution.

In view of the serious prognostic significance of severe or persisting respiratory acidosis, which cannot be relieved by sodium bicarbonate, a trial of Tris-(hydroxymethyl)-aminomethane (THAM) was made in 26 cases. In each of these very severely affected infants the pCO2 was above 70 mm Hg. The results failed to show sufficient advantage to justify the increased risks with THAM.

The mortality figures in the trial series have been compared with those recorded in the same hospital in cases of comparable severity which were treated by standard methods in 1960 and 1961. The over-all mortality rates in 1960, 1961, and the trial series, including patients who also had intraventricular hemorrhage or other major complications, were 66, 64, and 46% respectively. The mortality rates in cases of the uncomplicated respiratory distress syndrome in 1960, 1961, and the trial series were 49, 44.7, and 11.5% respectively.

It is considered that the improvement in the mortality figures with this type of supportive therapy is sufficiently striking to encourage its trial use in other centers.
DIAGNOSIS AND TREATMENT: MANAGEMENT OF IDIOPATHIC THROMBOCYTOPENIC PURPURA
Authors: Schulman Irving
Published: December 2021

THE TERM idiopathic thrombocytopenic purpura (ITP) should be reserved for that hemorrhagic disorder characterized by a subnormal platelet count (usually below 50,000/cu mm) in the presence of a normal marrow containing normal or increased megakaryocytes and the absence of systemic disease capable of inducing thrombopenia. Bone marrow examination is mandatory to rule out leukemia, other infiltrative disorders, and hypoplastic and aplastic states; an L.E. preparation is indicated as are the careful search for systemic infection and renal disease and the detailed inquiry concerning drug ingestion. Although no specific antecedent event can be identified in most cases of ITP, it is recognized that some of the common childhood exanthemata may occasionally be followed by thrombocytopenic purpura (e.g., rubella, rubeola, varicella).

The rational approach to treatment must be based upon understanding of the natural history of the disease. Acute ITP has an excellent prognosis and approximately 80% affected children will make a complete and permanent recovery without specific therapy. Of these, three-quarters will recover within 3 months of onset, most within 4 to 6 weeks. Approximately 20% of cases will persist longer than 6 months and are then usually designated as chronic.

The mortality rate in acute ITP is extremely low and most of the urgency for treatment stems from concern over central nervous system hemorrhage. It seems clear that the incidence of CNS bleeding is no greater than 2-4% and that in most series reporting a greater incidence cases were not limited to ITP but included instances of thrombotic thrombocytopenic purpura and purpura fulminans, i.e., disease states associated with vasculitis.
Warm Nape of the Newborn
Authors: SILVERMAN WILLIAM A. , ZAMELIS ANSIS , SINCLAIR JOHN C. , AGATE FREDERIC J.
Published: December 2021

The nape of the neck in small newborn infants remains relatively warm, compared with the exposed surface temperature of other body regions, in a heat-losing environment.
Pediatric Hazards of Drugs in Solutions Convenient for Administration to Adults
Authors: AXLINE STANTON G. , SIMON HAROLD J.
Published: December 2021

Studies on the clinical pharmacology of drugs in newborn infants have uncovered a problem of overdosage which may be more common than generally appreciated. Several medicaments are available only in a limited number of highly concentrated formulations. The requirements of premature and full-term newborn infants for very small total dosages necessitate very careful measurements of minute quantities of drug, and overdosage can readily occur.

Specifically, Kanamycin is available in only two formulations for injection containing respectively 250 and 333 mg/ml. The dosage of this agent for newborn infants is approximately 8 mg/Kg of body weight 12 hourly.
Correction to be Expected from the Pan American Medical Association
Authors: HODES HORACE L.
Published: December 2021

Recently many pediatricians received a letter stating that Dr. Lawrence B. Slobody and I had proposed them for certification as DIPLOMATE in the Pediatric Section of the Pan American Medical Association, Inc.

I write to inform the readers of this Journal that neither Dr. Slobody nor I ever proposed anyone for certification for Diplomate in the Pan American Medical Association. Furthermore, I did not authorize the use of my name in this connection, and Dr. Slobody has informed me that he did not do so either.
Survival Rates in Rh Sensitization
Authors: ERLANDSON MARION E.
Published: December 2021

There appears to be a popular impression among pediatricians and obstetricians that the pregnancy in which initial sensitization against the Rh (D) factor occurs is a "low risk pregnancy." This terminology was employed by Dr. Boggs in his recent interesting article entitled "Survival Rates in Rh Sensitizations" (Pediatrics 33:758). I admire and am envious of his remarkably good results. However, we observed 3 stillbirths in first immunized pregnancies in the year 1962 which would not have been prevented by his classification and plan of management which includes induction at 38 weeks in the "low risk" group.
LUNG COMPLIANCE AND LUNG VOLUME MEASURED CONCURRENTLY IN NORMAL FULL-TERM AND PREMATURE INFANTS
Authors: Chu Josephine S. , Dawson Peter , Klaus Marshall , Sweet Avron Y.
Published: December 2021

Lung compliance and functional residual capacity have been measured simultaneously, using a body plethysmograph, in 35 full-term and 29 premature infants. The results suggest the following conclusions:

1. Lung compliance increases in the early hours of life, while no significant change of FRC is demonstrated. This may reflect a true alteration of lung tissue properties.

2. Specific lung compliance in full-term infants older than 24 hours of age is similar to that of older children and young adults.

3. Premature infants have a larger FRC/kg of body weight than full-term infants, but, when lung weight is used as the basis for comparison, the FRC in infants of all weights is similar.

4. In evaluating infants with the respiratory distress syndrome, one should be aware of the small specific lung compliance noted in full-term infants younger than 3 hours of age.
DISACCHARIDASES OF INTESTINAL MUCOSA IN A PATIENT WITH SUCROSE INTOLERANCE
Authors: Launiala Kari , Perheentupa Jaakko , Visakorpi Jarmo , Hallman Niilo
Published: December 2021

A thorough clinical and enzymological study is reported in a patient suffering from typical sucrose intolerance. In addition to sucrose intolerance, a subclinical intolerance of maltose was demonstrated.

Enzyme assay in a specimen of duodenal mucosa obtained by peroral tube biopsy revealed decreased activities of isomaltase, sucrase, and maltase. The assay was repeated following a three-month period on a sucrose-free diet with identical results.

In the light of these findings the present information on intestinal α-glucosidases is discussed. The authors suggest that sucrose intolerance is due to a defect of one mucosal enzyme, the various α-glucosidase activities of which are differently affected by heat.
INFANTILE AMAUROTIC FAMILY IDIOCY AND GARGOYLISM IN SIBLINGS
Authors: Salam Maria , Idriss Hassan
Published: December 2021

Typical cases of infantile amaurotic family idiocy and gargoylism occurring in two siblings are presented. Biopsies of the brain were done in both patients and showed many similarities in their histochemical findings. The occurrence of A.F.I. and gargoylism in the same family may be due to a genetic coincidence. On the other hand, the possibility of these two conditions presenting the same basic metabolic disorder with different clinical pictures is raised.
HEMOLYTIC DISEASE OF THE NEWBORN DUE TO ABO INCOMPATIBILITY: A STUDY OF THE USE OF GROUP O ERYTHROCYTES IN AB PLASMA
Authors: Goldfarb Donald L. , Ginsberg Victor , Kaufman Mary , Robinson Margaret G. , Watson R. Janet
Published: December 2021

Twenty-four infants with hemolytic disease of the newborn due to ABO incompatibility requiring exchange transfusion were treated randomly with either group O blood low in titer for iso-antibodies or washed packed group O erythrocytes resuspended in group AB plasma. No significant differences in survival, sequelae, number of exchange transfusions required or the course of postexchange bilirubin levels was observed. It is concluded that group O cells in AB plasma is not an improvement over conventional group O blood.
RESPIRATORY SYNCYTIAL VIRUS NEUTRALIZING ANTIBODIES IN PERSONS RESIDING IN CHICAGO, ILLINOIS
Authors: Beem Marc , Egerer Rosalie , Anderson Julia
Published: December 2021

The R.S. virus neutralization test was examined in terms of several factors bearing on the consistency and specificity of antibody response to a single strain (Randall) of this virus. It was found that this virus detected significant rises in antibody titer in 90% of 30 patients over 6 months of age who were infected with wild strains of R.S. virus between the years 1958 and 1962. Heterologous neutralizing antibodies to R.S. virus did not occur following human infections with various myxoviruses, adenoviruses, enteroviruses and herpesvirus. Indirect evidence was presented indicating that tile neutralizing activity of human serums is due to specific antibody and not due to non-specific, heat stable neutralizing substance.

The titer of R.S. neutralizing antibodies was determined in the serums of 26 parturient mothers, and their 27 newborn babies, and 186 other individuals between the ages of 6 months and 69 years. Longitudinal observations of antibody titer were also conducted on 12 other infants. Neutralizing antibodies to R.S. virus were found to reach the term fetus at undiminished titer. In the longitudinal observations, serum neutralizing antibody titers were found to fall during the first months of life, decreasing by half in an average time of 43 days. Neutralizing antibodies, actively formed in response to R.S. virus infection, were observed to occur with rapidly increasing frequency in relation to age in subjects older than 6 months.

These serologic findings indicated that among individuals residing in the metropolitan Chicago area, R.S. virus infection has been experienced by many during the first 2 years of life, most by school age, and all by 7 years of age. Geometric mean antibody titers were found to show a small, but probably significant, increase with age. The restriction of low titer reactors to pre-school children was noted. These serologic findings were interpreted as evidence that re-infections with R.S. virus occur, perhaps quite commonly.
The Adolescent in Psychotherapy
Authors: HEALD FELIX P.
Published: December 2021

This book is divided into three sections. The first two sections confine themselves to psychotherapy of the adolescent on an inpatient basis and are highly sophisticated and technical from the viewpoint of the pediatrician. The author obviously has had considerable experience with adolescents and he is able to translate this experience into an easily readable form. His case illustrations are particularly well chosen and clearly illustrate the points that he is trying to make. These sections of the book are well suited to the pediatrician who has a special interest and training in emotional problems of adolescence or for the fully trained child or adult psychiatrist who is interested in adolescent psychotherapy.
Letters to the Editor
Authors: S. C. A.
Published: December 2021

We agree with all of this excellent letter, including its last sentence. That was true when today's old pediatricians were young pediatricians, as it is true for those now starting in practice or even in school. But as long as there are people to give us the calm perspective of this letter it will not be quite so late as many have thought, and not nearly as late as quite a few have feared. We thank Dr. Bruce.
Abbrevations and the Subject Matter of Pediatrics
Authors: BOLDUAN NILS W.
Published: December 2021

It is becoming increasingly difficult to enjoy reading and attempting to learn when the printed page is overrun by a host of upper and lower case abbreviations. The straw, or rather the leaf that broke this camel's back was "Figlu" in an article by Gross, Keefer, and Newman, pages 315 to 323 in the September, 1964, issue of Pediatrics.

I can see the necessity for chopping so formidable a term as formimino-glutamic acid into its parts. However, Figlu might be read by some as a shortened form of fig-glue, and since the article deals with platelets (a form of glue) a discussion of Figlu might be quite appropriate.
The Use of Glucagon-Gel in Idiopathic Spontaneous Hypoglycemia of Infancy
Authors: FRASIER S. DOUGLAS , SMITH FRED G. , NASH ANDREA
Published: December 2021

The response of idiopathic spontaneous hypoglycemia of infancy and childhood to therapy is variable. There is no single therapeutic agent which will uniformly maintain blood sugar concentration in the normal range in these patients. It has been suggested that a long-acting glucagon preparation may be of value when idiopathic spontaneous hypoglycemia is refractory to control by diet, corticosteroids, ACTH, ephedrine, or various combinations of these agents. It is the purpose of this paper to report our experiences with glucagon in maintaining the blood sugar concentration of a patient with idiopathic spontaneous hypoglycemia.

Case Report

History and Physical Examination: A 6-month-old Mexican-American boy was evaluated for convulsions which had begun at 2½ months of age.
VI. THE INTERRELATIONS OF THE DIFFERENT LUNG TESTS
Authors: DeMuth George R. , Hill Bruce M. , Howatt William F.
Published: December 2021

1. The data from a variety of pulmonary function tests on 101 subjects who participated in a longitudinal study were analyzed to determine the interrelations of the tests. The data were first adjusted for body size (height) so that the effects of changing size did not overwhelm the other relations. To 10 variables from these studies were added 3 non-pulmonary ones. The 13 variables are as follows: vital capacity, functional residual capacity, diffusing capacity, peak expiratory flow rate, peak inspiratory flow rate, the E50 flow rate, the 2' N2 clearance, the oxygen equilibration index, the single-breath oxygen test, the AP diameter of the chest, and indices of the intelligence, reading ability, and body strength.

2. The first two of four distinct axes obtained in the factor analysis by the varimax rotation help to gain insight into the correlations found. The first axis suggests that in addition to the variation in lung volume associated with sex and body size (height) there is a lung volume variation which involves both the vital capacity and functional residual capacity and carries with it the diffusing capacity, the thoracic cage size, and to a certain extent the peak inspiratory flow rate. The second axis is closely related to the flow rates and less so to the oxygen equilibration index. The pattern is similar to that seen in obstructive defects. For the other two axes the meanings are less clear, but the patterns are provocative.

3. Other interesting correlations are those of strength (grip quotient) with the 2'N2 clearance and with the E50 and that of the intelligence with peak flow rates.
ON THE TRANSPORT OF INSULIN ACROSS THE HUMAN PLACENTA
Authors: Gitlin David , Kumate Jesús , Morales Carlos
Published: December 2021

The maternofetal transfer of I131-labeled human insulin was studied in 9 women undergoing caesarean section. The data suggest that insulin readily traverses the human placenta and that the amount transferred from mother to fetus is equivalent to 33% of the insulin utilized by the normal fetus at term and this amount is also equal to 33% of the insulin synthesized by the normal fetus at term. The placenta appears to be equally permeable in the direction of fetus to mother.
CONGENITAL HYPOPLASIA OF THE ADRENAL GLANDS
Authors: Roselli Anadil , Barbosa Luiz Torres
Published: December 2021

The cases of two sisters with extreme bilateral adrenal hypoplasia, verified at necropsy, have been presented. Two other siblings died in infancy with symptoms which make it very likely that they also had adrenal hypoplasia. A review of the medical literature revealed 23 cases in which necropsy had been performed. These included 15 males and 8 females as well as one set of twins and 3 siblings. Although the incidence of reported cases of adrenal hypoplasia is low, the authors suggest that many cases may have been missed in the past. The clinical picture and possible etiology of this condition have been discussed.
EFFECT OF TRIVALENT ORAL POLIOVIRUS VACCINE IN AN INSTITUTIONALIZED POPULATION WITH VARYING NATURAL AND ACQUIRED IMMUNITY TO POLIOMYELITIS
Authors: Lepow Martha L. , Spence David A.
Published: December 2021

Ninety-one children in an orphanage, who had varying degrees of natural and acquired immunity to polioviruses, were given three doses of a trivalent poliovirus vaccine at monthly intervals. It was found that among children who lacked protection to one or two types, a single dose of trivalent vaccine resulted in seroconversion to that type. For those who had antibody levels of less than four to all three types, the type 1 component of the vaccine appeared to be less effective than the other two types. An elevation in serum antibody titer was noted more frequently in children who had preimmunization titers of 1:64 or less than in those with high preimmunization titers. Although the mechanism of acquisition of prior immunity was unknown, it must be assumed that many of the subjects had had natural poliovirus infection in the past.
HUMAN SERUM PRECIPITINS TO GOAT'S MILK PROTEINS AND TO COW'S MILK PROTEINS
Authors: Lee Melvin
Published: December 2021

Antigenic relationships of cow's milk, cow's serum, goat's milk, and goat's serum were studied, using techniques of agar double-diffusion, DEAE-cellulose fractionation of milk proteins, and human sera containing precipitins to cow's milk. Immunologically similar proteins are present in goat's serum and cow's serum, and evidence is presented for the occurrence of crossreacting antigenic serum proteins in milk of both species. However, the samples of milk also contain other proteins, unreleated to serum proteins, which react with rabbit and human antisera.

Several human sera which contained antibodies to cow's milk were studied. Antibodies to goat's milk could be demonstrated in most of these, and to cow's serum and goat's serum in some of them. No precipitin lines were formed when rabbit or human sera were tested against commercial evaporated goat's milk, although precipitin lines were formed with reconstituted commercial dried goat's milk.

Milk samples were separated into 16 fractions by column chromatographic procedures and tested against human sera. One serum sample contained antibodies only to whey proteins while two other sera contained antibodies to all 16 fractions in both cow's milk and goat's milk.
Nasal Glioma
Authors: JAMIESON KENNETH G.
Published: December 2021

An intranasal glioma presenting at birth as a readily visible polyp without any evidence of nasal deformity is an uncommon lesion. The purpose of this report is to record one such case in which the site of attachment of the glioma to the brain was studied at operation.

Case Report

On the day after his birth, August 26, 1958, a boy (A.R.) was referred to the Brisbane Children's Hospital with a provisional diagnosis of nasal encephalocoele. A reddish fleshy lump was to be seen just within the left nostril. There was no other evidence of nasal abnormality, and, in particular, the nasal bridge was normal.
Psychological Benefit from Hospitalization?
Authors: BERGMAN ABRAHAM B.
Published: December 2021

Vernon and Schulman's desire to collect more precise information about reactions of children to hospitalization is laudable (Pediatrics, 34:694, 1964), but their cause is not served by the data they present. Clinical research usually follows clinical observations. Perhaps a reason that hospitalization as a source of psychological benefit to preschool children has been neglected in previous studies is that it rarely is seen clinically.

In their study, children's behaviour following hospitalization was not observed but rather parents' reports of their perceptions of behaviour
Extraction Methods for Bilirubin Assay; Bilirubin Monoglucuronide in Neonatal Hyperbilirubinemia
Authors: WATSON DEREK
Published: December 2021

As Tsvet, the originator of adsorption chromatography, remarked in 1920: "Although all scientific progress is progress in technic, technic is not uncommonly the weakest part of scientific investigation." Certainly, the experiences of Mr. Ibbott and Dr. O'Brien (Pediatrics, 34: 418, 1964) provide a good illustration of this, and I entirely agree with their conclusions that solvent partition methods for measuring neonatal serum bile pigments are unsatisfactory and that earlier "conclusions on the possible significance of the monoglucuronide are invalid."
INFANTILE GENETIC AGRANULOCYTOSIS
Authors: Lang J. Eugene , Cutting Hunter O.
Published: December 2021

A 4½-year-old white boy has been followed for 14 months with chronic agranulocytosis. This case is an example of the rare, non-sex linked recessive disease of the hematopoietic system, first described definitely by Kostman in 1956, and termed "Infantile Genetic Agranulocytosis." The primary defect is a severe depression of the neutrophilic granulocytes. The other marked morphological and clinical abnormalities we believe are secondary to the neutropenia and the attending infections. A brief comparison with other "primary" chronic neutropenic states reported in childhood and clinically similar to infantile genetic agranulocytosis has been made. The differential diagnostic features are stressed.
CARDIAC ARRHYTHMIAS IN PREMATURE INFANTS
Authors: Morgan Beverly C. , Bloom Ronald S. , Guntheroth Warren G.
Published: December 2021

The cardiac rhythm has been monitored in 20 normal premature infants for a period of 5 hours utilizing a slow-speed electrocardiographic tape recorder. In contrast to studies using conventional electrocardiographic techniques, this survey revealed a high incidence of marked sinus arrhythmia, sinus bradycardia, and nodal rhythm.
Infantile Autism
Authors: BROWN JANET L.
Published: December 2021

This book, which the author defines as a "working paper," is divided into three parts. In Part I, Rimland summarizes the literature on etiology and epidemiological variables in infantile autism, and attempts to make a sharp differentiation between this condition and other early profound disturbances in development such as childhood schizophrenia. In Part II, he hypothesizes that a localized lesion in the reticular system is the basic etiological factor. Part III contains a broadly ranging and frankly speculative attempt to formulate a theory of brain functioning based on neurophysiological data and the hypotheses developed earlier in the book.
Essentials of Paediatric Cardiology
Authors: SCOTT LEWIS P.
Published: December 2021

It is the intention of the author to provide a precise, general review of pediatric cardiology for the student, generalist, and pediatrician. The book is not intended to be a definitive text on the subject.

The author's excellent approach to the physical diagnosis of heart disease in children largely reflects the teaching of the late Dr. Paul Wood to whom the author gives appropriate acknowledgment. The discussion of individual lesions, however, is scanty, and the severity or natural history of the various lesions cannot be determined from the material presented in the text. Virtually no statistical data are presented.
Medical Aspects of Mental Retardation
Authors: LAVECK GERALD D.
Published: December 2021

It is the purpose of this publication to present systematically in a single volume pertinent medical knowledge and recent biomedical advances in mental retardation. Although planned to aid the busy physician in diagnosing this disability and counseling parents, the book is also intended for medical students and scientists interested in this problem. Topics covered include genetics, metabolic defects, malformations, infections, injury, endocrine disorders, new growths, and other medical aspects of this handicapping condition.

Over thirty authors, many of whom are recognized authorities in the field, have contributed to this volume.
RADIOISOTOPE RENOGRAPHY IN CHILDREN. I. THE RENOGRAM IN CHILDREN WITHOUT RENAL DISEASE
Authors: Wenzl James E. , Tauxe W. Newlon , Burke Edmund C. , Hunt James C. , Stickler Gunnar B.
Published: December 2021

Isotope renograms (ortho-iodohippurate-I were obtained from 30 children who had no evidence of renal disease. Determinations were made by a standardized technique with the subjects in a state of relative dehydration; in 15 children the renogram was repeated under conditions of hydration (14 children) or further dehydration (1 child).

Values for the point of initial peak (point A), point of maximal radioactivity (point B), and the differences between these points (B-A) were calculated. These values were plotted arithmetically against surface area to obtain regression lines and estimates of the variability of the observations about the line. The time from appearance of radioactivity to peak radioactivity was calculated and found to fall into a relatively narrow range.

Similar attempts to correlate mathematically the height of timed segments of the decreasing slope of the renogram with surface area were successful in children with a body surface area of 1.15 m2 or greater. The state of hydration appeared to influence the excretory slope of the renogram; this effect was most pronounced in children whose total body surface area was less than 1.15 m2.
PSYCHOLOGIC EVALUATION OF THE CHILD WITH INTERSEX PROBLEMS
Authors: Money John
Published: December 2021

Psychosexual differentiation is a function of age. Therefore, the weight to be given it in hermaphroditic sex-assignment decisions is also a function of age. Psychosexual differentiation roughly parallels language differentiation and both are dependent on social stimulation and experience. By kindergarten age the critical period has been passed and the psychosexual identity, though not fully mature, fixed.

Psychosexual identity may contradict chromosomal, gonadal, or hormonal sex. It more generally agrees with the external genital morphology and the assigned sex. Rarely, psychosexual identity and assigned sex are discrepant, in which case a sex assignment is feasible in later childhood or adolescence. Otherwise, sex reassignment is for the most part contraindicated. It is not obligatory that assigned sex should agree with chromosomal or gonadal sex, but it should agree with external morphology, surgically corrected, and with hormonal sex correctly regulated at puberty.
ENCEPHALOPATHY AND FATTY CHANGE IN THE LIVER AND KIDNEY
Authors: Golden Gerald S. , Duffell David
Published: December 2021

Reports of a new syndrome, the chief manifestations of which are hypoglycorrhachia disturbances of the state of consiousness, and vomiting, are reviewed and a case presented. The pathological manifestations are quite consistent and include massive fatty infiltration of the liver without necrosis, fatty changes in the epithelium of the proximal convoluted tubules of the kidney, and deposits of fat in the endothelium of many of the cerebral vessels. Although a toxic etiology has been suggested no known cause is really apparent at the present time.
Health Observation of School Children,
Authors: GREEN JOHN L.
Published: December 2021

This is a neatly organized, practical medical text written in easily understandable language covering the major physical and emotional problems of school-age children. The eighteen chapters review for non-medical personnel each organ system of the body including the special senses; there are sections, too, on the physical, emotional, intellectual, and social maturation of children. The appendices outlining the latest recommended immunization schedules and the essential information concerning the natural history of the common communicable diseases are complete and up to date.
THE HANDLING OF SOYA ALPHA-GALACTOSIDES BY A NORMAL AND A GALACTOSEMIC CHILD
Authors: Gitzelmann Richard , Auricchio Salvatore
Published: December 2021

1. No alpha-galactosidase activity in homogenates of human small intestinal mucosa was demonstrated either with stachyose, raffinose, or melibiose.

2. In a healthy child, oral raffinose and melibiose loads failed to produce changes in blood glucose, blood galactose, or red cell galactose-1-phosphate. Trace amounts of either saccharide were excreted in the urine. Following the raffinose load, diarrhea occurred and raffinose and melibiose as well as their hydrolysis products were found in the feces.

3. In a galactosemic patient, red cell galactose-1-phosphate rose as expected after ingestion of 2 gm of galactose. No such rise was seen after administration of equivalent and of double equivalent amounts of stachyose. Prolonged dietary supplementation with raffinose did not significantly alter non-fasting erythrocyte galactose-1-phosphate.

4. It is concluded that soybean formulas are generally safe for galactosemic infants; however, caution is advised for patients suffering from diarrhea.
The Silver Electrode Method for Rapid Analysis of Sweat Chloride
Authors: WARWICK WARREN J. , HANSEN LELAND
Published: December 2021

The silver electrode sweat test provides quantitative sweat chloride values comparable to values obtained with the standard pilocarpine iontophoresis method of Gibson and Cooke. The silver electrode sweat test is faster.
Letters to the Editor
Authors: FINE RICHARD N. , WOO WANG MAY Y. F. , HEATH CLARK W.
Published: December 2021

We wish to thank Drs. Hecht and Scott for their comments. We agree with their statistical analysis of our data, and do not argue with the fact that nuclear projections in neutrophils are statistically more frequent in peripheral blood smears from patients with D1 trisomy than in control smears. The point of our paper, however, was not to dispute this statistical fact. We wished instead to demonstrate that the mere presence of nuclear projections per se is not of practical help in diagnosing D1 trisomy since such projections are present in normal smears, both male and female. This, of course, is particularly true for female patients where, as Drs. Hecht and Scott point out, "drumstick and sessile" projections further complicate the picture.
A PEDIATRIC HOME CARE PROGRAM IN LONDON—TEN YEARS EXPERIENCE
Authors: Bergman A. B. , Shrand H. , Oppé T. E.
Published: December 2021

RECENT YEARS have seen a resurgence of interest in organized Home Care programs as a variety of factors have spurred the search for alternatives to hospital care. Chief among them has been the economic burden of spiraling hospital costs.

Many programs have been devised to enable chronically ill persons in the older age group—the "home-bound" geriatric patient—to be supervised in their own homes. There are, however, special reasons for attempting to control the admission of children to hospitals. Illness is a time when a child becomes more dependent than usual and seems to need the security of parents and the comfort of familiar home environment. Even though enlightened hospitals now encourage visiting, many parents cannot take advantage of this for such reasons as distance and having to care for the other children at home. There is debate as to the amount of emotional harm caused by hospitalization of small children; most workers would say it does no good, and, in some cases, can lead to serious sequelae.

The Home Care Program for sick children at St. Mary's Hospital in London was started in April, 1954. One of us (A.B.B.) had the opportunity of participating in this program in 1961 while serving as an Exchange Registrar from Children's Hospital (Boston). It is felt that even though conditions in the United States and Great Britain may be different, there are enough similarities to make a descriptive account of the program of interest to American physicians.

The Development of Home Care Schemes

Historically, doctors looked after the sick in their own homes when private fees could be afforded.
Tay-Sachs Disease
Authors: CROCKER ALLEN C.
Published: December 2021

Rarely in this history of pediatrics has a single group of workers so rapidly and effectively brought into focus the special problems of an uncommon disease as have the staff of the Jewish Chronic Disease Hospital in Brooklyn with their studies on Tay-Sachs disease. For a decade they have maintained a steady program of intense interest in this disease led by Drs. Stanley Aronson, Bruno Volk, and Abraham Saifer. A valuable series of personal contributions to the knowledge of this syndrome have resulted, but even more they have stimulated a widespread concern for these pediatric patients in the medical world generally.
NEONATAL NEUROBLASTOMA
Authors: Schneider Keith M. , Becker Jerrold M. , Krasna Irwin H.
Published: December 2021

Four cases of neonatal neuroblastoma are reported. The literature has been reviewed in an attempt to distinguish characteristics peculiar to neuroblastoma in the newborn. The various therapeutic modalities are discussed.
ANABOLIC STEROIDS IN THE MANAGEMENT OF MUSCULAR DYSTROPHY
Authors: Charash Leon
Published: December 2021

A group of 21 patients with muscular dystrophy, 17 of them boys with the pseudohypertrophic form, were treated with a regimen including the use of an anabolic steroid, digitoxin, and physical exercise. This program had previously been reported to be efficacious.

One year after the initiation of treatment all patients in the present study were significantly worse. None showed any change which could be interpreted as representing improvement. Five boys displayed rather rapid progression of the disease leading to loss of ambulation.

Physicians at eight other centers, with experience in trials of identical therapy in approximately 300 patients, report no evidence of any objective benefit from the use of this steroid therapy in muscular dystrophy.
Eosinophilia and Agammaglobulinemia
Authors: HUNTLEY CAROLYN C. , COSTAS MARGARITA C.
Published: December 2021

While studying a group of children with the visceral larva migrans syndrome we encountered in the patient group a child with agammaglobulinemia. This child, in spite of an almost complete absence of immune globulins, exhibited the massive eosinophilia characteristic of the tissue phase of helminth infections.

Case Report

L.C.S., a 16-month-old Puerto Rican boy, was admitted to the University Hospital in San Juan on February 19, 1963, because of fever, wheezing and cough of 3 weeks' duration. His past history revealed chronic diarrhea and episodes of purulent conjunctivitis, otitis, and pneumonia. Pica had been noted for 5 months, and dogs, cats, pigs, and cows were present near the child's play area.
HEMIHYPERTROPHY
Authors: Ringrose Robert E. , Jabbour J. T. , Keele Doman K.
Published: December 2021

A case of hemihypertrophy with many manifestations of a congenital neurocutaneous syndrome is presented; the previously reported cases of hemihypertrophy are reviewed and tabulated with many of their accompanying characteristics. The [See Table IV. in Source Pdf.] etiological hypotheses for hemihypertrophy that have been postulated in the literature are listed.

The views expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Navy nor the Department of Defense.
THYROID DISEASE AMONG CHILDREN WITH DOWN'S SYNDROME (MONGOLISM)
Authors: Hayles Alvin B. , Hinrichs Ward L. , Tauxe W. Newlon
Published: December 2021

Observations on two mongoloid children, one having primary hypothyroidism and the other having primary hyperthyroidism, have been reported. Primary hypothyroidism in the mongoloid child, in each of the three cases reported to date, has been associated with uterine bleeding attributed to hormonal overlap in the pituitary feedback mechanism. The significance of this phenomenon is not clean. A total of sixteen cases of mongolism with hyperthyroidism have been described. There is no evidence that altered thyroid function plays a role in the clinical manifestations of mongolism, and significant alteration in thyroid function is uncommon among such patients.

Both of the carrier protein systems responded to the stresses of the superimposed disease processes in these mongoloid children as they do in normal children. Specifically, the values for the erythrocytic uptake of 1-I131-triiodothyronine and thyroxine and the triiodothynonine binding capacities (Case 2 only) were all in the expected ranges for both thyroid derangements involved.

Similarly, in Case 2, where an iron-deficiency anemia was also present, the increase in the iron binding capacity and presumably in the level of transferrin was on the order of that to be expected for the degree of iron deficiency.

The response to stress of both carrier protein systems in Down's Syndrome suggests that protein synthesis of transferrin and TBG is normal.
Editor's Note
Authors: Cotton Ernest K. , Kelminson Leslie L.
Published: December 2021

Drs. Cotton and Kelminson commented s follows:

We have measured pulmonary capillary blood flow in the following situations: prior to any therapy, when 100% oxygen was being administered alone, following the IV administration of sodium bicarbonate by push, and following the use of Pniscoline through an umbilical vein catheter placed in the inferior vena cava with the patient breathing 100% oxygen. The greatest increase in pulmonary blood flow occurred with the combination of Priscoline and 100% oxygen; sodium bicarbonate was less effective while 100% oxygen caused the least increase in pulmonary capillary blood flow.
COMPLEX FORMATION BETWEEN BASIC ANTIBIOTICS AND DEOXYRIBONUCLEIC ACID IN HUMAN PULMONARY SECRETIONS
Authors: Potter Joseph L. , Matthews LeRoy W. , Spector Samuel , Lemm Joy
Published: December 2021

1. Complex formation and precipitation of DNA by neomycin, with consequent inactivation of the antibiotic, has been shown to occur in the pulmonary secretions of patients with cystic fibrosis.

2. Highly polymerized DNA from a variety of sources, as well as two samples of RNA, were precipitated by neomycin in vitro. Polymixin, kanamycin, colymycin, and streptomycin similarly co-precipitate with DNA in vitro.

3. The minimum chain length of polynucleotide required for precipitation in the DNA-neomycin system was 10.

4. The complex is readily attacked by DNase I resulting in the splitting of the DNA and the liberation of the antibiotic. Both components of the complex are solubilized in M sodium chloride.

5. The resistance of purulent foci of infection to therapy with basic antimicrobial agents may, in part, be due to the complex formation with the high levels of DNA found at the site of infection.
ETHNIC GROUP DIFFERENCES IN PLASMA BILIRUBIN LEVELS OF FULL-TERM, HEALTHY SINGAPORE NEWBORNS
Authors: Brown William R. , Boon Wong Hock
Published: December 2021

In full-term Chinese, Malay, and Indian infants of Singapore neonatal hyperbilirubinemia generally is more severe and of longer duration than in Singapore-born British infants. The ethnic group differences in neonatal bilirubin levels might be the expression of previously unrecognized genetic differences in bilirubin metabolism, although the importance of some environmental factors is not completely understood. The ordinary definitions of "physiologic" jaundice, which have evolved principally from observations in Western countries, are not appropriate to Singapore-born Asian infants and may not be appropriate to infants in many parts of the world. Further geographic studies of neonatal bilirubinemia are indicated.
Letters to the Editor
Authors: NAEYE RICHARD L.
Published: December 2021

We would like to respond to each of Dr. Gruenwald's points.

1. We have recalculated our organ data using Dr. Gruenwald's score 0 standards. This change in standards does not significantly change any of our findings.

3. Dr. Gruenwald suggests that we used organ measurements without attention to the circumstances under which they were collected. In one institution, all organ weights were recorded under the supervision of a pathologist having a special interest in such measurements.
Letters to the Editor
Authors: SHANDLING BARRY
Published: December 2021

I am grateful to you for providing me with an opportunity to reply to a letter from Drs. Lahey, Wilson, and Heiner. Their suggestion that certain cases of otherwise unexplained rectal bleeding may be the result of a milk allergy is an excellent one. Certainly, apart from the child with an exsanguinating gastrointestinal hemorrhage, an attempt should be made to determine the effects of ingestion of cow's milk. This is especially indicated in the infant under 2 years of age. An older child, say of 8 years, presenting for the first time with unexplained rectal bleeding is not likely to have cow's milk incriminated.
Caring for Your Disabled Child
Authors: DELEMOS ROBERT
Published: December 2021

At a first glance, Dr. Spock's most recent effort appears to be a collection of self-evident facts, well-worn clichés and repetitions—the reader has the feeling that he has heard all of this before.

However, when the reviewer reread the opening sentences and realized that the text is aimed, not at the pediatrician or trained worker in the field, but at the guilty, anxious, and often desperate parent, then the full value of this work became apparent.
Limitations of Footprinting as a Means of Infant Identification
Authors: SHEPARD KENNETH S. , ERICKSON TERRY , FROMM H.
Published: December 2021

Over the past years, the habit of footprinting newborn infants in the delivery room as a means of identification has spread throughout the United States. In many hospitals today this technique is now being questioned, and, indeed, in many states, the process has been dropped. This report will present data designed to show just how satisfactory this technique is under controlled and reasonable conditions.

Materials and Methods

Procedures: Fifty-one newborn infants were footprinted as per routine in the delivery room of this hospital. The nurses doing the printings were familiar with the technique and were careful to prepare the infants' feet before printing.
ISOZYMES: BIOLOGICAL AND CLINICAL SIGNIFICANCE
Authors: Zinkham William H. , Blanco Antonio , Kupchyk Luba
Published: December 2021

A RECENT and rather surprising discovery in biochemistry was the finding that a single enzyme can exist in several different forms within a single tissue. This discovery not only led to the development of new information concerning the nature of enzymes and enzyme action, but also has contributed to our knowledge of enzyme changes in disease. The purpose of this brief review is to describe the methodology used to recognize the different forms of an enzyme; to indicate the general biological significance of the phenomenon, and in particular, to focus on those areas which have broadened our understanding of the metabolic changes accompanying growth and development; and finally, to present data obtained from the clinical application of enzyme heterogeneity to medical diagnosis.

DEFINITION OF ISOZYMES

Over the years a major objective of the enzymologists has been to prepare enzymes in pure crystalline form. Once this had been accomplished, it was assumed that all of the molecules in the preparation were alike in regards to size, shape, amino acid composition, and the substances (substrates) on which they acted. Enzymes are proteins, and when newer techniques for separating proteins were applied to some of the crystalline enzyme preparations, a heterogeneous population of molecules with the same substrate specificity was discovered. This and other observations suggested to Markert and Møller that the classification of enzymes based on substrate specificity alone would have to be extended. For this reason they proposed the term isozyme to describe the different molecular forms in which proteins with the same enzymatic specificity may exist" within single organism. The most extensively studied enzyme from the point of view of molecular heterogeneity is lactate dehydrogenase (LDH).