bluuebunny/crossref_metadata_2025 huggingface dataset:
The Frequency of Vaginal Reflux During Micturition—Its Possible Importance to the Interpretation of Urine Cultures
Authors: DAVIS LAWRENCE A. , CHUMLEY WILLARD F.
Published: December 2021

Voided urine specimens collected from patients in the supine position will have contacted the vagina in about one-half of the examinations.
Results of a Questionnaire Concerning the Use of Aminophylline in the Therapy of Childhood Asthma
Authors: BIERMAN C. WARREN
Published: December 2021

Since 1937, when intravenous administration of theophylline-ethylenediamine (aminophylline) was shown to be effective in treating status asthmaticus, theophylline preparations have been employed extensively in the therapy of asthma. Reports of severe toxicity and deaths from aminophylline in children, have made the proper use of such drugs in childhood asthma a matter of concern to pediatricians. Accordingly, questionnaires about the use of aminophylline in asthmatic children were sent to 15 members of the Section on Allergy of the American Academy of Pediatrics, the majority of whom head Pediatric Allergy Fellowship Programs. The replies received from 14 are summarized here.
SEROLOGICAL EVIDENCE OF RESPIRATORY VIRUS INFECTIONS IN MOSCOW CHILDREN, 1948 TO 1956
Authors: Ritova V. V. , Zhdanov V. M. , Schastny E. I.
Published: December 2021

1. The study of sera collected between 1948 and 1956 from children with acute respiratory disease showed that outbreaks were caused by adenoviruses, parainfluenza viruses, reoviruses, rhinoviruses, ECHO viruses, and Coxsackie viruses.

2. Adenovirus infections were the most prevalent. Other viral infections were prevalent in certain years.

3. Mixed infections with two viruses constituted about 10% of all cases.
A CONTROLLED STUDY OF EARLY FLUID ADMINISTRATION ON SURVIVAL OF LOW BIRTH WEIGHT INFANTS
Authors: Cornblath Marvin , Forbes Audrey E. , Pildes Rosita S. , Luebben Gertrude , Greengard Joseph
Published: December 2021

A controlled study was done to evaluate the effects of early administration of fluids versus 24 to 72 hours starvation on the survival at 14 days of 90 premature infants with birth weights less than 1,500 gm. Mortality was 30% in the 30 infants who were given intravenous fluids as compared to 50% in those who were given nasogastric fluids or those who were starved.

A reduction in mortality was noted in the group of infants between 765 and 1,250 gm who received parenteral fluids early (mean, 6 hours; range, 2 to 15 hours). The early administration of fluids via a nasogastric tube did not influence mortality. Since limitations to those lower-weight groups had not been included in the protocol, a further controlled study is indicated.

There was no significant difference in the 72-hour weight loss, the biochemical determinations, the morbidity, or the autopsy findings of the three groups studied.
COLD AGGLUTININS, EATON AGENT, AND RESPIRATORY INFECTIONS OF CHILDREN
Authors: Sussman Sidney J. , Magoffin Robert L. , Lennette Edwin H. , Schieble Jack
Published: December 2021

Twenty-eight of 444 children under 4 years of age developed cold agglutinins in association with a respiratory illness. Infection with the Eaton agent, Mycoplasma pneumoniae, could not be established by C-F tests in any of these 28 cases. In 18 cases, pathogens other than the Eaton agent were implicated. A positive cold agglutinin test was of no value in making an etiologic diagnosis. Complement-fixation tests for antibody to the Eaton agent in 106 children with respiratory illnesses showed an antibody titer rise in 1 case and stationary titers in 12 others.

These observations covered a 4-year period on the pediatric inpatient service of a large metropolitan general hospital. Sporadic cases of pneumonia due to Mycoplasma pneumoniae, confirmed by C-F antibody titer rises, were observed in older children and adults in the same metropolitan area during this period, but no evidence of epidemic occurrence was observed.
The Use of THAM in the Treatment of Status Asthmaticus
Authors: STRAUSS JOSE , FINE RICHARD N. , MEDINA DAVID A. , DONNELL GEORGE N.
Published: December 2021

The treatment of status asthmaticus (epinephrine-fast state in an acutely ill asthmatic patient) has been described frequently; however, the need to correct the respiratory and metabolic acidosis which accompanies this condition has not been emphasized. Recently such recommendations have appeared in the nonpediatric literature of this country and of Europe. The purpose of this paper is to report two pediatric patients with status asthmaticus who recovered after administration of Tris (hydroxymethyl) aminomethane (THAM), an amine alkalinizing agent.

Methods

The Astrup technique employing the ME-l equipment and Sigaard-Andersen's nomogram were used to determine pH, pCO2, Base Excess (B.E.), Buffer Base (B.B.) and Standard Bicarbonate (S.B.) of capillary blood. Serum electrolytes were determined by conventional methods. [SEE TABLE I AND II IN SOURCE PDF].
PROBABILITY, RARITY, INTEREST, AND SURPRISE
Authors: Weaver Warren
Published: December 2021

THE unusual is often interesting. Moreover, the frequency definition of probability, which is the one consciously or tacitly used in all applications to experience, makes it clear that an improbable event means precisely a rare event. Hence, an improbable event is often interesting. But is an improbable event always interesting? We shall see that is is not. If an event actually occurs, and if its probability, as reckoned before its occurrence, is very small, is the fact of its occurrence surprising? The answer is that it may be, or it may not be.

Suppose one shuffles a pack of cards and deals off a single bridge hand of thirteen cards. The probability, as reckoned before the event, that this hand contain any thirteen specified cards is 1 divided by 635,013,559,600. Thus the probability of any one specified set of thirteen cards is, anyone would agree, very small.

When one hand of thirteen cards is dealt in this way there are, of course, precisely 635,013,559,600 different hands that can appear. All these billions of hands are, furthermore, equally likely to occur; and one of them is absolutely certain to occur every time a hand is so dealt. Thus, although any one particular hand is an improbable event, and so a rare event, no one particular hand has any right to be called a surprising event. Any hand that occurs is simply one out of a number of exactly equally likely events, some one of which was bound to happen. There is no basis for being surprised at the one that did happen, for it was precisely as likely (or as unlikely, if you will) to have happened as any other particular one.
THE APPEARANCE OF THE ADOLESCENT AS A DIAGNOSTIC INDICATOR
Authors: Easson William M.
Published: December 2021

Since the teen-ager is markedly hesitant about sharing emotional feelings and conflicts, to help in his diagnostic process, the pediatrician needs to utilize the multiplicity of nonverbal cues the adolescent gives as to his personality status. This paper describes how the appearance of an adolescent can be used to provide such clinically valid information.
Resuscitation of the Newborn Infant
Authors: AVERY MARY ELLEN
Published: December 2021

The 6 years since the first edition of this book have been marked by numerous laboratory and clinical studies which are included in this updated and carefully documented edition. The reader who takes the title literally may be surprised to find chapters on pathology, anemia, surgical emergencies, and infections. The explanation for this is stated by Doctor Abramson in his preface when he notes that resuscitation "represents only the initial step in the restoration of breathing.
EFFECT OF EARLY FEEDING OF SOLID FOODS ON NUTRITIVE INTAKE OF INFANTS
Authors: Guthrie Helen A.
Published: December 2021

The early introduction of solid foods to the diet of bottle-fed infants living in a college town causes some significant changes in the nutritive content of the diet but does not increase the adequacy of the diet before 3 months as evaluated by allowances recommended for infants by the National Research Council. Diets containing solid foods provide significantly more iron and thiamine, two of the nutrients used to enrich infant cereal products. Most of the infants were receiving nutritional supplements of vitamin A and D in spite of the fact that their diets were adequate in these nutrients. The need for a supplement of ascorbic acid was evident for some infants.

The feeding of solid foods apparently had no effect on the sleeping pattern of the infants as evidenced by the number of feedings, nor did it increase the cost of the food itself. It did, however, increase the time and effort involved for the mother. Since there was no increase in the caloric content of the diet, the solid foods must have replaced milk rather then to have supplemented it, a fact confirmed by the observations of many mothers. At least 10% of the infants experienced some form of allergic reaction to solid foods.

All of the infants in the study had been introduced to solid foods by 9 weeks, 2 to 4 weeks prior to the age at which the American Academy of Pediatrics suggests that there is a rational basis from a nutritional and developmental point of view to begin supplementing the diet. Although there was no evidence of adverse reactions other then allergies to the pattern of early feeding observed in this group, there was no evidence to indicate that the infant benefitted from a nutritional standpoint.

Lack of evidence of benefits and an accumulating body of information on hazards from the early introduction of solid foods suggest a re-examination of current emphasis on the early supplementation of the milk diet in infants.
CYTOLOGIC STUDY OF URINARY SEDIMENT IN THE EVALUATION OF SEX HORMONE PRODUCTION IN CHILDHOOD
Authors: Silver Henry K. , Kirchner Robert L.
Published: December 2021

Cytologic examination of desquamated cells in voided urine was performed in 236 children. The urinary sediment of 95% of girls and 80.5% of boys of all ages exhibited changes consistent with sex-hormone stimulation. Cytologic changes were most marked in the neonatal period and at puberty; during the first week of life, the most striking alteration occurred in low-birth-weight infants.

Our findings suggest that the quantity of sex hormones known to be produced in both sexes throughout childhood may be sufficient to cause discernible changes in cells derived from the urogenital tract.
INTRAESOPHAGEAL PHONOCARDIOGRAPHY IN THE DIAGNOSIS OF OCCULT RHEUMATIC MITRAL VALVE DISEASE
Authors: Vongprateep Choompol , Lauer Ronald M. , Diehl Antoni M.
Published: December 2021

Twenty-nine rheumatic subjects and 16 normal individuals have been studied by intraesophageal phonocardiography. In the normal group no unusual sounds or murmurs were discovered by this technique. However, in rheumatic patients with clinical mitral regurgitation the esophageal phonocardiogram more clearly recorded the murmur than the surface phonocardiogram. In five patients murmurs of mitral disease were recorded by the intraesophageal technique that were not discernible by clinical examination or surface phonocardiography. Intraesophageal phonocardiography is particularly valuable in clinical situations wherein rheumatic heart disease is suspected and the typical clinical findings of mitral regurgitation are absent or equivocal.
FACTITIAL HYPERKALEMIA DUE TO ICING BEFORE ANALYSIS
Authors: Oliver T. K. , Young G. A. , Bates G. D. , Adamo J. S.
Published: December 2021

Both adult and newborn blood plasma potassium concentration rose significantly when whole blood was kept on ice for periods of 5 hours. This appears to be due to inhibition of red cell glycolysis. The rise in plasma potassium concentration of blood from newborn infants is significantly greater than that occurring in blood from adults; this difference is a function of the neonate's increased red cell volume. Meaningful interpretation of potassium concentration, particularly in the newly born, demands that the plasma be separated immediately.

The plasma potassium concentration of normal newborns at birth does not differ significantly from adults; in this study the mean value in 20 infants was 4.81 mEq/l.
Locking the Medicine Cabinet
Authors: CROOK WILLIAM G.
Published: December 2021

I would like to commend Dr. J. Albright Jones for his suggestion (Pediatrics, 38:124, 1966) for poison control in the pediatric age group. Certainly, parents who are willing to purchase such a box and outfit with a lock are apt to be parents whose children will rarely suffer from accidental poisoning.

But, as Dr. Jones pointed out, "there are some [familiesj who have to be urged and cajoled to protect their children properly." For this reason I would hope that Dr. Jones' suggestion might be carried one step further, so that the job would be made easy for any family who has a medicine chest in the house.
THE RESPONSE OF THE THYROID GLAND TO THYROID-STIMULATING HORMONE (TSH) IN INFANTS WITH MALNUTRITION
Authors: Beas Francisco , Mönckeberg Fernando , Horwitz Isidoro
Published: December 2021

The thyroid response to TSH was studied in a group of 16 infants with severe marasmus and 9 normal controls of the same age.

The radioiodine uptake, the BEI, and the oxygen consumption were determined in both groups before and after the administration of a single dose of TSH.

The results suggest that the low function of thyroid gland found in marasmic infants is due mainly to a decrease of TSH stimulation but there is also a deficit of thyroid function per se.

These results are discussed in relation to previous data.
PLACENTAL TRANSFER OF VARICELLA-ZOSTER ANTIBODY
Authors: Brunell Philip A.
Published: December 2021

Eight pregnant women who had varicella-zoster infections were studied. Newborn serum antibody titers approximated those of their mothers when more than 5 days elapsed between the onset of maternal varicella and delivery. When this interval was shorter, maternal antibody titers tended to exceed those of cord sera. These differences could not be attributed to the placental barrier to IgM, since maternal antibody was found to be predominantly 7S. Neonatal varicella occurred in all three infants born without detectable serum V-Z antibody yet only one of these infants was found to have a detectable antibody response. Since newborn infants were found to be limited in their ability to synthesize V-Z antibody, it is unlikely that fetal synthesis could have accounted for the antibody found in infants who had antibody titers comparable to those of their mothers. It must be assumed that some, if not all of this antibody was maternal in origin and was transported across the placenta.
XX/XO MOSAICISM IN NINE PREADOLESCENT GIRLS
Authors: Leāo José Carneiro , Voorhess Mary L. , Schlegel Robert J. , Gardner Lytt I.
Published: December 2021

Clinical and chromosomal studies are presented on nine preadolescent girls with XX/XO mosaicism, investigated because of short stature alone or in association with other complaints. Short stature was the sole reason for seeking medical advice in most of the cases and was the most important clue in making the diagnosis, since these patients do not have the "textbook picture" of Turner's syndrome. All nine patients were under the 3rd percentile for height. No lymphedema, web neck, or congenital heart disease was observed in the present series.

The quantitative buccal smear for sex chromatin was found to be a useful preliminary screening test in indentifying these patients. The possibility of XX/XO mosaicism should be explored in all girls with unexplained short stature.
STEROID MEDIATED CHANGES OF LEUCOCYTE ALKALINE PHOSPHATASE ACTIVITY IN DOWN'S SYNDROME
Authors: McCoy Ernest E. , Ebadi Manuchair , England Jack
Published: December 2021

A study of the increase of leucocyte alkaline phosphatase (LAP) activity following oral anhydroxyprogesterone or intramuscular prednisolone was carried out in a group of Down's syndrome subjects and paired controls. The increase in LAP activity was greater in the Down's syndrome patients at p < .025 with anhydroxyprogestrone and at p < .005 with prednisolone. Simultaneous assays were carried out in another group of patients for LAP and the X chromosome-linked enzyme glucose 6-phosphate dehydrogenase (G6PDH). The increase in LAP activity was greater in Down's syndrome but the increase in G6PDH activity was similar in the two groups. Several possible reasons for the greater increase in LAP activity following the steroids were discussed. The authors favor the view that the increase is related to greater rates of synthesis of the enzyme in Down's syndrome and to trisomy for chromosome 21.
MANAGEMENT OF INFANTS WITH VENTRICULAR SEPTAL DEFECT, A CONTROVERSY
Authors: NADAS ALEXANDER S.
Published: December 2021

THE provocative paper by Sigmann, et al. in this issue is an excellent exposé of the activist point of view in pediatric cardiology. One cannot but congratulate the authors on their diagnostic and surgical skills. Still, being a reluctantly adopted citizen of conservative New England, this member of the Editorial Board feels called upon to present a critique of the Ann Arbor publication and to propose an alternate, more restrained, approach to treatment of infants with ventricular septal defect.

First, we ought to compare the mortality rates of Doctor Sigmann's patients who were operated on, if possible, with those they treated medically themselves and with those so managed elsewhere.
R. W. B. Ellis 1902-1966, Some American Memories
Authors: DIAMOND LOUIS K.
Published: December 2021

The Obituary Section of the September 24, 1966, issue of The Lancet carried a notice of the death of Dr. R. W. B. Ellis with eulogies from six associates and friends. It seems fitting that an additional one from this side of the ocean be added. I enclose a letter which Dr. Eley, Dr. Sherwood, and I have sent to the Editor of The Lancet. We hope this note plus our letter to Lancet can be published in Pediatrics to bring to the attention of pediatricians in this country the death of a leading teacher, writer, and practitioner in pediatrics, who once was associated with the Children's Hospital.
Depigmented Nevi and Tuberous Sclerosis
Authors: GARCÍA MANUEL ANADOR
Published: December 2021

I read with real interest the paper by Drs. Arnold P. Gold and John M. Freeman on the early diagnostic values of depigmented areas of the skin in tuberous sclerosis (Pediatrics 35:1003, 1965).

In a revision of cases in this Hospital from 1960 through 1964, we found this sign in six out of seven cases. We consider this a remarkable fact, since, prior to the reference appearing in your magazine, we have found no indication as to the value of the cutaneous manifestations in the early diagnosis of the disease.
THE REVERSIBILITY OF PULMONARY HYPERTENSION IN PATIENTS WITH CYSTIC FIBROSIS
Authors: Kelminson Leslie L. , Cotton Ernest K. , Vogel John H. K.
Published: December 2021

1. The present study was concerned with the evaluation of the acute and chronic effects of tolazoline, O2, and sleep on the pulmonary circulation of six subjects with cystic fibrosis and pulmonary hypertension.

2. Right heart catheterization was performed and observations were made at rest, after tolazoline and after O2. In four subjects, changes in pulmonary artery pressure (PAP) induced by various agents and sleep were observed for periods ranging from 3 hours to 4 days.

3. Resting mean PAP ranged from 22 to 67 mm Hg; arterial PO2 from 37 to 47 mm Hg; pH from 7.252 to 7.408, cardiac index from 2.64 to 3.91 1/min/m2, and total pulmonary resistance (TPR) from 440 to 1,330 dynes sec cm-5-m2.

4. Following tolazoline, the average mean PAP dropped from 51 to 28 mm Hg, average cardiac output rose from 3.20 to 4.08 1/min/m2; TPR dropped from 880 to normal. This decrease in PAP and TPR was achieved with little change in either pH or arterial pO2.

5. The addition of O2 to tolazoline lowered the mean PAP further by 8 mm Hg.

6. Observations were made during sleep in three of the patients. In each, there was an increase in PAP ranging from 9 to 23 mm Hg.

7. Repeated administration of tolazoline resulted both in progressively lower PAP and less tendency for its return to control level.

8. Postmortem pulmonary arteriograms and histological examination of the pulmonary vessels were performed in one patient. Despite the presence of numerous abscesses and diffuse bronchopneumonia, the pulmonary vessel was found to be relatively normal. Only medial hypertrophy of the small arterioles was seen.

9. The factors involved in the development of hypoxic pulmonary hypertension and possible mechanisms by which tolazoline effects acute and sustained reduction of PAP are discussed.

10. It is concluded that acute and repetitive pharmacologic treatment is effective in the reduction of pulmonary hypertension in patients with cystic fibrosis. Further, it is suggested that patients with cystic fibrosis and reactive pulmonary hypertension would benefit from residing at sea level.
SUBTOTAL PANCREATECTOMY IN THE MANAGEMENT OF SEVERE PERSISTENT IDIOPATHIC HYPOGLYCEMIA IN CHILDREN
Authors: Hamilton James P. , Baker Lester , Kaye Robert , Koop C. Everett
Published: December 2021

Twelve cases of severe persistent idiopathic hypoglycemia of infancy treated by partial pancreatectomy since 1950 are reviewed. Eleven of these maintained normal blood sugars postoperatively. Six patients of this group required medical supportive treatment for various periods of time in addition to the surgery.

A total of 45 other operative cases are reviewed and presented in table form. Overall, 89% of these cases were able to achieve acceptable control of their hypoglycemia. Subtotal pancreatectomy in an infant is a technically simple procedure and should not be equated with the formidable procedure of pancreatectomy in adults.

It is concluded that partial pancreatectomy deserves a role in the treatment of severe persistent idiopathic hypoglycemia of infancy. Subtotal pancreatectomy should not be considered as an alternative to a medical regimen. It should not be entered into lightly but should be considered as one of several means which may have to be used, often simultaneously, in the vigorous treatment of these children.
HYALINE-MEMBRANE FORMATION AND PULMONARY PLASMINOGEN-ACTIVATOR ACTIVITY IN VARIOUS STRAINS OF MICE
Authors: Lieberman Jack , Kellogg Frederick
Published: December 2021

Various strains of mice were found to differ in the frequency with which they developed pulmonary hyaline-membranes in response to breathing 90% oxygen. Of 13 strains tested, Swiss-Albino and C3H/HEJ strains developed hyaline membranes most readily, and AKR and MA/J strains were most resistant. No difference in plasminogen-activator content of lung tissue could be detected between these strains of mice. The formation of pulmonary hyaline membranes did not seem to affect the survival time of mice in oxygen, but membranes were found most consistently in animals that had been in oxygen for 100 hours or more. An elevation of environmental temperature to 32°C hastened the death of the mice in oxygen but also reduced the incidence of hyaline-membrane formation. The use of suitable strains of mice is recommended as an experimental model for pulmonary hyaline-membrane formation.
PLACING AND GRASPING OF THE FEET AT VARIOUS TEMPERATURES IN EARLY INFANCY
Authors: Zappella Michele
Published: December 2021

Forty infants 6 months of age and under were tested for the grasping reflex of the toes and for the placing reflex against an iron bar. The temperature of the bar was varied between 10° and 45°C. Grasping was present at every temperature used in the experiment. In the first 4 months of life, placing was usually present at temperatures below 25 to 30°C and it was often absent between 30 and 40°C. This motor ability of the lower limbs was found to be present more frequently if one of the lower limbs was held in passive flexion. In the fifth and sixth months of life, placing did not appear to be affected in a significant way by differences in the temperature of the bar or by the method of testing.
MIST THERAPY
Authors: AVERY MARY ELLEN , GALINA MORTON , NACHMAN RICHARD
Published: December 2021

AN ARTICLE on mist tent therapy in this issue opens with the remarkable comment that no objective evidence of the efficacy of mist in patients with cystic fibrosis has been published. The authors conducted a clinical study which led to the conclusion that under the conditions of their study mist was effective as judged by improvement in some aspects of pulmonary function. It may be even more remarkable to note the absence of objective evidence of the role of mist in the wide variety of circumstances in which it is commonly used on most pediatric services.

A review of some physical principles involved in water exchange, of observations on the deposition of aerosolized particles in the lung, and of the uses and hazards of mist therapy seems pertinent.
Removal of Ear Wax—A Technological Advance
Authors: KEITER W. E.
Published: December 2021

The problem of washing impacted wax from the ear canal has been the most cumbersome and unpleasant task the pediatrician performs. Now using the Water Pik (manufactured by Aqua Tec Corp., Denver, Colorado) this task has been made easy and pleasant. The nozzle of this little machine directs a fine intermittent stream, the pressure of which can be varied and controlled, and can be directed easily into even the small ear canals. The addition of an off and on foot switch into the electrical circuit facilitates still more the ease of operation.
LIVE ATTENUATED MUMPS VIRUS VACCINE. II. EARLY CLINICAL STUDIES
Authors: Stokes Joseph , Weibel Robert E. , Buynak Eugene B. , Hilleman Maurice R.
Published: December 2021

Groups of children in institutions who were initially without mumps antibody were inoculated subcutaneously with twelfth chick embryo and chick embryo cell culture passage (level A) or seventeenth passage (level B) Jeryl Lynn strain mumps virus vaccine. All children developed mumps antibody following inoculation of either strain. The level A vaccine, however, was insufficiently attenuated for routine immunization, since roughly 25% of the vaccine recipients developed parotitis and excreted mumps virus. Children who received B level virus failed to develop fever or parotitis or any other significant clinical reaction to the vaccine and serum amylase values were not significantly altered. Mumps neutralizing antibody persisted for at least 7 months following vaccine B, the longest period tested. A study among children in a community showed that as little as 317 50% tissue culture infectivity doses of virus in level B vaccine induced neutralizing antibody in 100% of children vaccinated. The B level vaccine proved entirely safe and highly effective in inducing protective antibody against mumps.
TRANSIENT TYROSINEMIA OF THE NEWBORN: DIETARY AND CLINICAL ASPECTS
Authors: Avery Mary Ellen , Clow Carol L. , Menkes John H. , Ramos Angeles , Scriver Charles R. , Stern Leo , Wasserman Barbara P.
Published: December 2021

Neonatal tyrosinemia occurs with high frequency in newborn infants. The severity and prevalence of tyrosinemia is greater with higher protein intakes (e.g., 6 gm/kg/day) and in the more immature infant. Ascorbic acid in "recommended" amounts will not always prevent tyrosinemia if the substrate intake is great and the infant immature and presumably deficient in apoenzyme (p-hydroxyphenylpyruvic acid oxidase). Tyrosinemia itself produces no consistent clinical syndrome and in general can be deemed relatively innocuous but each infant should be assessed as an individual, since the occasional patient shows clinical manifestations of lethargy. There appears to be no indication for a change in general dietary recommendations for newborn infants.
SOLVENT SNIFFING
Authors: Press Edward , Done Alan K.
Published: December 2021

THOUSANDS of adolescents and teen-aged youngsters in many cities throughout the United States and other countries are deliberately inhaling vapors of a wide variety of volatile organic solvents in order to induce repeated states of inebriation. Although the practice itself is not new, its occurrence in epidemic proportions in many areas and the passage of legislation prohibiting the act in many cities and states in the United States have brought the problem into nationwide prominence.

Some of the solvents used (such as carbon tetrachloride, trichlorethane, benzene, and acetone) have been implicated in previous industrial exposures as the cause of serious toxic effects, including fatalities. The possibility of similar ill effects from these and other solvents when used in much higher concentrations at shorter, but frequently repeated intervals as currently practiced, is one that has been raised repeatedly. Consequently, the Panel on Household and Economic Chemicals of the American Medical Association's Section on Adverse Reactions (Council on Drugs) invited this appraisal of the problem. Included is an assessment of the potential problem from the standpoints of incidence, acute effects, behavioral difficulties, possible chronic or cumulative toxic effects, and possible remedial measures.

SOURCES OF INFORMATION

This report summarizes the authors' investigations of the problem over the period of the last several years. In addition, it includes a review of published reports, the results of extensive discussions and correspondence with medical and law enforcement personnel in many areas of the United States, Sweden, and elsewhere. Also direct medical and hospital studies of a sample of habitual sniffers by one of us (A.K.D.) in Salt Lake City, Utah, and a detailed comparison of four other similar studies and a personal experiment on simultaneous electroencephalographic tracings and blood level measurements during inhalation by the other (E.P.).
Iontophoretic Sweat Test for Cystic Fibrosis: Technical Details
Authors: GIBSON LEWIS E.
Published: December 2021

Since developing the iontophoretic sweat test for cystic fibrosis, I have talked to a number of laboratory directors and a number of patients who have complained of burns occurring in the iontophoretic sweat test. When I have investigated the procedure causing the burns, I have usually found that steel electrodes were used. Dr. Cooke and I originally suggested that the electrodes be made of copper. I believe that this was a wise suggestion because commercial copper sheet is a good conductor and is relatively pure.
Early Versus Late Feeding
Authors: TOW ABRAHAM
Published: December 2021

In a recent article "Early Fluids and Low Birth Weight Infants" (Pediatrics, 38:547, 1966) Cornblath, et al. say: "Initially, early feeding of low birth infants was advocated by Goodhart, Hess, and others." As one of the others (Tow, A: Diseases of the Newborn. New York: Oxford Medical Press, p. 77, 1937) I stated: "It is my procedure to give a 5% sugar solution after six to twelve hours and then to follow the routine of a three hour interval with sugar solution between feedings. . . ."
Medicine Cabinets
Authors: COHEN ROBERT
Published: December 2021

I would like to add a word or two regarding medicine cabinets. As a former member of the American Academy of Pediatrics Accident Prevention Committee of the southern California section I displayed a model of a safety medicine cabinet. An electric switch was installed on the top shelf. It was the same type that lights the bulb in refrigerators or when automobile doors are open. The only modification was that instead of turning on the light when the medicine cabinet door was open it rang a shrill alarm that could be heard throughout the entire house.
A CASE OF HYPERLYSINEMIA: BIOCHEMICAL AND CLINICAL OBSERVATIONS
Authors: Armstrong Marvin D. , Robinow Meinhard
Published: December 2021

Clinical and biochemical observations on a mentally retarded 4-year-old boy who has a lysinuria and hyperlysinemia are presented and discussed. He differed clinically from the three patients described previously in that he did not have marked muscle weakness. His endogenous renal clearance of lysine while fasting was twice the upper limit of normal for children, and after fasting his plasma lysine level had decreased to within the normal range. After a test dose of lysine (150 mg/kg orally) his plasma lysine level was increased from 2.43 to 15.2 mg/100 ml after 2½ hours, and after 7 hours it was still 7 mg/100 ml. No evidence for the degradation of a significant amount of lysine by any new pathway could be obtained. Homoarginine was identified in his urine and detected in his blood; homocitrulline was measured in his urine. α-Aminoadipic acid could not be detected in his urine. Nα and N\g=elunate\-Acetyllysines were identified in his urine at approximately three times the concentration as in the urine of a normal child of the same age; neither of these derivatives had been identified previously as components of human urine.

The possibility is suggested that in this patient the lysine abnormality may be coincidental with and not a causative factor for his mental retardation.
Letters to the Editor
Authors: HOLLIDAY MALCOLM A.
Published: December 2021

Thank you for the chance to reply to Dr. Skinner's letter. The problem he cites, hyperosmolality due to powdered milk being diluted insufficiently, is certainly more common than the one we cited where water intoxication resulted from making milk too dilute. In a similar way commercial electrolyte solutions apparently were associated with development of hypernatremia in diarrhea.

Dr. Skinner's suggestion to the manufacturer seems to be reasonable and I would endorse this.
Letters to the Editor
Authors: RUDOLPH NATHAN
Published: December 2021

Thank you for the opportunity to comment on Dr. Gordon Millichap's letter.

I agree with Dr. Millichap that perinatal cerebral trauma or cerebral hypoxia cannot be overlooked as a possible additional etiological factor in the elevation of serum CPK levels in some infants. However, the lack of correlation with 1-minute Apgar scores, and the frequency of elevated serum enzyme levels in newborns who do not exhibit clinical signs of neurological damage, make it unlikely that a central neurogenic mechanism is operative in the majority of cases.
THE RELATIONSHIP BETWEEN PSYCHIATRY AND PEDIATRICS: A DISPUTATIOUS VIEW
Authors: EISENBERG LEON
Published: December 2021

THE Aldrich Award Address by Dr. Julius Richmond in this issue requires careful reading. Within its sober, low-keyed assessment of the state of developmental research in pediatrics is a perceptive critique of the present and an exciting preview of a possible future. Writing as a pediatrician, Dr. Richmond chides, but only gently, my psychiatric colleagues and indicates, but only modestly, the potential contribution of pediatrics. As a child psychiatrist not under (or at least not admitting to) such restraints, I feel freer to comment on certain aspects of the relationship between the two specialties.

Child psychiatrists cite the importance of knowledge of child development for fully effective pediatric practice, bemoan the grossly inadequate training in medical psychology presently afforded pediatric house officers, had decry the unsympathetic reception they have receive from pediatrics faculties when they have ample justification.
STUDIES OF ACID-BASE DISTURBANCES
Authors: Winters Robert W.
Published: December 2021

In summary, the work which I have described here represents a quantitative approach to answering certain questions in the acid-base field which are physiologically important and practically useful as well. Encouraged by the results we have thus far obtained, we hope to pursue this general approach in answering other similar questions in this general area.
METABOLIC REFERENCE STANDARDS FOR THE NEONATE
Authors: Sinclair John C. , Scopes Jon W. , Silverman William A.
Published: December 2021

Oxygen consumption of 92 normally grown newborn babies of birth weight 750 to 3,940 gm has been expressed in terms of various metabolic reference standards in order to identify any systematic variation in expression of metabolic rate that is introduced by these bases of reference in the newborn population.

It is postulated that differences in body composition comprise a contributory factor to the variation among newborn babies in rate of oxygen consumption per kilogram body weight.

The predictive error from a mean value is increased if surface area, body weight, or fat-free body weight is substituted for body weight as a metabolic reference standard.

By taking into account known changes in body composition of the fetus with increasing maturity, a compartment representing the active tissue mass is calculated. This corresponds closely to body weight minus extracellular fluid and includes fat. Rate of oxygen consumption is proportional to the size of this compartment over the range of body weights studied.

Implications are discussed as to the metabolic rate of adipose tissue in the newborn and body composition among undergrown babies.
Letters to the Editor
Authors: Bozic C.
Published: December 2021

I have read with interest Doctors Adams' and El-Salawy's comments on my case report identified in their letter as the "Lausanne baby."

I do think that the "Lausanne baby" represents a case of pulmonary vascular sequestration inasmuch as the inferior lobe of the left lung received its blood supply by means of three arterial branches coming off directly from the aorta.

On the other hand, I do not think that the "Lausanne baby" is a case of pulmonary parenchymal sequestration and this because the inferior lobe of the left lung was proven to be, at least to my satisfaction, in direct communication with the remainder of the respiratory tract.
RICKETS IN NEWBORN INFANTS
Authors: RANSTRÖM STIG , SYDOW GERT VON
Published: December 2021

In a series of 181 consecutive cases of infants who had died soon after birth, 103 (56.9%) showed definite histologic signs of rickets. Of the 69 infants dying during the first day of life, 20 (29%) had rachitic changes and in these the rickets must be regarded as congenital. Of the 181 cases, 154 were premature, weighing less than 2,500 gm. at birth. The incidence of rickets was about the same in the premature and the full term infants in this material. The incidence of rickets increases rapidly with increasing age during the first weeks of life.
THUMBSUCKING; FREQUENCY AND ETIOLOGY
Authors: KLACKENBERG G.
Published: December 2021

The investigation was carried out for the purpose of establishing the frequency of thumbsucking and the importance of the sucking factor for the etiology. Thumbsucking and other comparable sucking occurred at the age level of one year in 50% of the cases. At the age of four years there was a frequency of 36%. These figures include both the mild and the more severe degrees of thumbsucking. If only the latter are taken into account the figure for age four is about 14%. One of the primary determinant factors in the arisal of the habit, as far as can be judged, is the degree of satiation in infants of the sucking activity. The probability of this appeared from comparisons of the mode of feeding. In any event, none of the at least four year old children who had used a dummy teat (rather more than 10% of the entire series) had ever been thumbsuckers.
HOSPITAL FATALITY RATES FOR PREMATURE INFANTS
Authors: BAIN KATHERINE , HUBBARD JOHN P. , PENNELL MARYLAND Y.
Published: December 2021

Data are presented from about half of the hospitals in the United States caring for 50 or more premature infants a year. In these hospitals there were about 600,000 births during 1946.

The incidence of prematurity, using as the definition of a premature infant one that was born alive weighing 2,500 gm. or less, was 6.1%. For white infants it was 5.6% and for nonwhite 9.5%.

The fatality rate for the group born in the hospital was 21.5% and for those born outside, 36.6%.

The close relation between survival and weight at birth is shown.

For nonwhite infants the fatality rate was higher than for white infants—27.7% for the group born in the hospital and as contrasted with 24.5, and 43.9 for those born outside as contrasted with 31.5.

There is need for better hospital records and for more comprehensive data on survival among premature infants.
RADIOIODINE UPTAKE CURVE IN HUMANS
Authors: LOWREY GEORGE H. , BEIERWALTERS WILLIAM H. , LAMPE ISADORE , GOMBERG HENRY J.
Published: December 2021

The rate of uptake of radioactive iodine by the thyroid gland was measured in a series of 26 children. Twelve of these children were normal with regard to being free of any disease that would markedly alter body metabolism. All these subjects showed similar and characteristic curves of uptake of the isotope.

Fourteen abnormal children were studied similarly. The curves of 12 of these clearly deviated from those of the normal group. All patients in this series with established thyroid dysfunction showed similar and characteristic curves and could be easily divided into three categories: hypofunction, hyperfunction and colloid goiter. Three patients (one mongolian idiot, one dwarf and one hypothalamic syndrome) showed abnormal curves which varied from that typical of definite hypothyroidism but were similar. One patient with gargoylism had a curve typical of hypothyroidism. It can be postulated that these patients may have primary or secondary (to the pituitary or neurogenic mechanisms) hypothyroidism. One patient each with nephrosis and rheumatic fever displayed normal curves.

From the results reported in this communication, plus others that have been reported in the literature, it would appear that the procedure is a valuable one in estimating the relative degree of thyroid function. It is a tool of diagnostic importance and has a greater specificity than most of the other methods used in measuring thyroid function in infants and children. It should be recognized, however, that others have demonstrated a certain degree of overlapping in the radioiodine uptake curves obtained on normal and abnormal subjects.
MYIASIS DERMATOSA IN INFANCY
Authors: ISRAELS SYDNEY , SHUMAN BEN
Published: December 2021

Two cases of myiasis dermatosa due to Wohlfahrtia vigil (Walker) are reported. A review of the literature on myiasis-producing Diptera is presented.
VARIABLE RESPONSE TO VITAMIN B12 OF MEGALOBLASTIC ANEMIA OF INFANCY
Authors: WOODRUFF CALVIN W. , RIPY HOWARD W. , PETERSON J. CYRIL , DARBY WILLIAM J.
Published: December 2021

Two cases of megaloblastic anemia in infancy have improved following treatment with vitamin B12. A third case failed to respond to this factor but subsequently responded to pteroylglutamic acid (folic acid). It is suggested that megaloblastic anemia may be a syndrome which embraces more than one entity.
PHEOCHROMOCYTOMA
Authors: LITMAN NEIL N. , STATE DAVID
Published: December 2021

A case of pheochromocytoma in a girl 11 years of age is reported. The difficulties in establishing the diagnosis as well as the other pathologic states which must be considered in the differential diagnosis of this condition are discussed.

A new preparation, N,N-dibenzyl-B-chloroethylamine dibenamine®, was used in establishing the diagnosis and in the therapy of the case. The drug was found useful in reducing the hypertension but its preoperative use was apparently ill-advised.

The case study confirms the findings of others that benzodioxane compounds are helpful diagnostic aids and that tetra-ethyl-ammonium chloride has little value in either the establishment of the diagnosis in or treatment of patients with pheochromocytoma.

The problems associated with surgical care of patients with pheochromocytoma are discussed.
SKIN REACTIONS TO TOXOPLASMIC ANTIGEN IN PEOPLE OF DIFFERENT AGES WITHOUT KNOWN HISTORY OF INFECTION
Authors: FELDMAN HARRY A. , SABIN ALBERT B.
Published: December 2021

One hundred forty-two residents of the Cincinnati area ranging in age from 3 months to 81 years were surveyed for their reaction to the intracutaneous injection of toxoplasmic antigen prepared from infected chorioallantoic membranes of chicken eggs. The skin test antigen is also present in abundance in mouse peritoneal exudate freed of Toxoplasma by centrifugation and its concentration appears to be proportional to that of the complement-fixing antigen. The positive reactions, consisting of red, indurated, swollen, tender and itching lesions ranging in size, from 60 x 50 mm. to 10 x 10 mm. (the latter being relatively rare), reach their maximum in 30 to 48 hours. The incidence of positive reactions among at least 20 individuals in each age group listed was as follows: 0 to 4 years—0; 5 to 9 years—5%; 10 to 19 years—14%; 20 to 29 years—20%; 30 to 39 years—50%; 40 to 49 years—65%; 50 to 81 years—65%. A positive skin test was invariably associated with demonstrable toxoplasmic antibody in the serum. Toxoplasmic antibody in varying titer was also found in the serum of 7 of 18 persons (39%) with negative skin tests. Further evidence in favor of the high incidence of toxoplasmic antibody among the "normal" adult population was obtained when a 15 to 20 fold concentrated, commercial preparation of gamma globulin prepared from the plasma of more than 20,000 American adults was found to contain toxoplasmic antibody in a titer of 1:256 as determined by the dye test. Since no agent having an antigen in common with Toxoplasma and capable of giving rise to antibodies for this protozoon parasite has been found thus far, one must consider the possibility that inapparent infection with Toxoplasma may be widespread, although it is rather curious that the incidence of antibodies (and presumably infection) should rise so sharply after the 20th year of life. The toxoplasmic skin test is not useful for diagnosis because a strongly positive test bears no relationship to titer of antibody and a negative test is encountered too often in the presence of antibody.
A Child is Born: The Drama of Life Before Birth
Authors: WHIPPLE DOROTHY V.
Published: December 2021

With spectacular beauty and accuracy Lennart Nilsson has captured the mystery of life within the womb. His serial photographs portray a living human being from the moment of conception to the completion of intra-uterine development. The detail of these amazing pictures is so clear that one can vividly see the stages of human reproduction from fertilization to birth.

One cannot give the pictures too much praise—the union of scientific accuracy and artistry here reaches a pinnacle of achievement Mr. Nilsson won the 1966 Photographer of the Year Award for these pictures—would that every year such masterpieces of photography could compete for this award.
THE NEPHROTIC SYNDROME OF INFANCY: CLINICAL, MORPHOLOGIC, AND IMMUNOLOGIC STUDIES OF FOUR INFANTS
Authors: Hoyer J. R. , Michael A. F. , Good R. A. , Vernier R. L.
Published: December 2021

Two types of infantile nephrotic syndrome were studied in four patients. The disease in the first type was hereditary and congenital and showed characteristic renal morphology and resistance to corticosteroid therapy. In the second, the syndrome started at 6 months of age, showed no morphologic evidence of microcysts in the kidney, and was responsive to prolonged intravenous ACTH therapy. Immunologic investigation of three of these children included immunofluorescent studies of the kidneys, complement determinations, and skin grafts to their mothers. Evidence that immune factors are not primary in the pathogenesis of the nephrotic syndrome of infancy was obtained.