bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of Human Milk pH During Course of Lactation to Concentrations of Citrate and Fatty Acids
Authors: Morriss Frank H. , Brewer Eileen D. , Spedale Steven B. , Riddle Lavon , Temple David M. , Caprioli Richard M. , West M. Stewart
Published: December 2021

Human milk pH was measured in 309 samples obtained from 52 women who had delivered at term and lactated for as long as 10 months thereafter. The mean pH decreased from 7.45 for colostrum to a nadir of 7.04 during the second week of lactation. Thereafter, the pH of milk remained between 7.0 and 7.1 until 3 months postpartum and then increased gradually to 7.4 by 10 months. The change in hydrogen ion concentration in milk was associated with corresponding changes throughout lactation in the concentration of citrate but not with the concentration of lactose. Lactose concentration increased gradually for 3 weeks; the concentration of saturated medium-chain fatty acids increased more rapidly. One interpretation of these findings is that the hydrogen ions and citrate generated by mammary secretory cell metabolism are used after the second week of lactation for de novo synthesis of fatty acids more rapidly than they are synthesized. Milk samples from ruminants were found to have concentrations of hydrogen ions and citrate that are greater than and pH that is less than the respective measurements in human milk. The significance for the recipient infant of the predictable changes in human milk pH during lactation and of the higher pH of human milk throughout lactation relative to bovine milk is unknown. However, drug excretion into milk, milk enzyme activity, milk leukocyte function, and neonatal gastroin-testinal function are affected by ambient pH and may be influenced by the pH of milk.
Ionized Calcium, Cardiac Function, and Electrocardiogram in Preterm Neonates
Authors: MÖLLER JENS , TEGTMEYER F. K.
Published: December 2021

To the Editor.—

We would like to add some comments on the article by Venkataraman et al.1 In one respect it might be quite dangerous not to measure the ionized calcium in preterm neonates. If you find prolongation of QTc or QoTc intervals in the ECG during cardiac failure in these infants and find subnormal total serum calcium levels, you might make a wrong conclusion on causal relationship.

Until now, we have seen five preterm neonates with OTc/QoTc prolongation and profound low total serum calcium levels, whereas the measured ionized calcium level was normal.
Comprehensive Asthma Care Reduces Hospitalization
Authors: LEWIS CHARLES E. , RACHELEFSKY GARY S. , LEWIS MARY ANN , DE LA SOTA ANN , KAPLAN MICHAEL S.
Published: December 2021

To the Editor.—

The article describing a trial of "Asthma Command" by Rubin et al1 represents another interesting addition to the armamentarium of programs to enhance the self-management capacities of children with asthma. The program achieved an increase in knowledge, which is not surprising. (Tests designed to evaluate a specific intervention not provided to others should demonstrate a significant gain among the experimental group.) The failure to demonstrate differences in morbidity data in terms of children's visits to physicians, emergency rooms, and hospitals is not surprising.
Comprehensive Asthma Care Reduces Hospitalization
Authors: RUBIN DAVID H.
Published: December 2021

In Reply.—

Children who were exposed to Asthma Command (the interactive asthma-specific computer game) showed a significant improvement in (1) their knowledge of asthma, (2) behaviors related to the management of their disease, and (3) behaviors toward their disease in areas that were addressed directly by Asthma Command.1 The test used to evaluate "knowledge of asthma" was not an instrument designed to specifically evaluate Asthma Command. The Parcel Knowledge of Asthma Questionnaire is a nonspecific assessment of knowledge of the principles of asthma.2
Pleiotropy Versus Heterogeneity in Proteus Syndrome
Authors: KOUSSEFF BORIS G.
Published: December 2021

To the Editor.—

I read with interest the article by Costa et al1 on a "new" clinical feature in Proteus syndrome. It appears that there is a lot to be learned about hamartoses and localized growth deficiency. This is apparent from the article and the existence of children with multiple hamartomas defying the current classification of these unique conditions. The classification includes the "new" Bannayan, Zonana, and Riley-Smith syndromes, 2-4 in addition to the "old" neurofibromatosis, tuberous sclerosis, Klippel -Trenaunay -Weber, and Cowden syndromes.
Persistent Colonization During Therapy for MHaemophilus influenzae Type b Disease
Authors: BARTON LESLIE L.
Published: December 2021

To the Editor.—

Dr Gilsdorf's rather reassuring recommendation to discontinue respiratory isolation for children with Haemophilus influenzae type b infections after 24 hours of parenteral therapy, "without increased risk of nosocomial infection," was based on her failure to show nasopharyngeal colonization with H influenzae type b after 24 hours of appropriate antibiotics.1 Although this is in accord with currently recommended isolation policies, a modicum of skepticism should remain.

Previous studies have demonstrated the persistence of H influenzae type b in the nasopharynx and throat for up to six days after parenteral antibiotic therapy.2,3
Alternative to Diagnosis-Related Groups for Newborn Intensive Care
Authors: Phibbs Ciaran S. , Phibbs Roderic H. , Pomerance Jeffrey J. , Williams Ronald L.
Published: December 2021

Clinical and billing data were collected on all admissions to six California newborn intensive care units during a 6-month period. Charges were adjusted to costs using Medicaid cost to charge ratios and for inflation, and patients were classified by the diagnosis-related group (DRG) system. Costs were from 97% to 708% more than the proposed DRG reimbursement levels. Regression analysis showed that DRGs explained 22% of the variation in costs. An alternative model using binary variables to control for birth weight, assisted ventilation, surgery, survival, multiple births, and mode of discharge explained 42% of the variation in costs. In contrast to other proposed DRG alternatives, this simple model does not require special training or subjective decision-making.
Aspiration of Pacifiers
Authors: JAIN LUCKY , SIVIERI EMIDIO , BHUTANI VINOD K.
Published: December 2021

To the Editor.—

The report by Millunchick and McArtor1 about the aspiration of a "makeshift" pacifier underscores the serious concerns of the widespread use of such pacifiers. As the authors point out, the nipple can easily detach from its unattached collar in the presence of high negative pressures within the nipple cavity. Colley and Creamer2 have previously reported a pressure of 250 cm H2O in low-flow teat nipples. We have recently documented the pressures generated by term babies sucking on such makeshift pacifiers.
Violent Death in Children in a Metropolitan County: Changing Patterns of Homicide, 1958 to 1982
Authors: Paulson Jerome A. , Rushforth Norman B.
Published: December 2021

Death rates from homicide in children younger than 15 years of age in the United States have increased during the last 30 years. Previous studies have suggested a typology consisting of fatal child abuse in young children and community violence in older children. We reviewed the data from the Cuyahoga County, Ohio, coroner's office pertaining to homicides in children less than 15 years of age between 1958 and 1982 and obtained similar findings. The homicide rates for city children increased from 1.1 to 6.7/100,000 in the first 20 years and then stabilized. Nonwhite boys had the highest death rates except in one period. Assailants were usually adolescent and young adult men of the same race; however, 43% of children less than 5 years of age were killed by women. The older the child, the more likely the homicide was to have been committed by a nonrelative, outside of the home, and with a firearm. Overall, firearms are the leading cause of homicide (36.2%). The temporal characteristics of child homicides are also described.
Computed Tomography of the Head in the Evaluation of Microcephaly
Authors: Jaworski Margie , Hersh Joseph H. , Donat Jane , Shearer Loretta T. , Weisskopf Bernard
Published: December 2021

Eighty-five infants and children found to have microcephaly had computed tomographic (CT) brain scans performed. A greater degree of microcephaly correlated with the finding of atrophy or ventricular dilation on CT scan. Patients who had known preceding destructive brain insults had the highest incidence of abnormal findings on scans (20/22). Patients who had CNS dysfunction of unknown etiology had the lowest frequency of abnormal findings (12/33); however, in three of these patients, a previously unsuspected brain malformation was found on CT scan. Patients who had other congenital anomalies had an intermediate proportion of abnormal findings on CT scans (20/30), and in 11 of these scans, a previously unsuspected or only partly suspected brain malformation was diagnosed. Discovering previously unsuspected information or finding supportive data regarding the basis for the underlying disease process, being able to provide a more specific developmental prognosis and accurate genetic counseling, justifies the inclusion of a CT scan of the head in the evaluation of the microcephalic child.
Osteoarticular Infections in Children With Sickle Cell Disease
Authors: Syrogiannopoulos George A. , McCracken George H. , Nelson John D.
Published: December 2021

Thirteen children with sickle cell disease were identified as having 14 episodes of osteoarticular infection in a review of 27 years' experience. There were eight episodes of osteomyelitis or osteoarthritis and six of suppurative arthritis alone. The etiologic agents in osteomyelitis or osteoarthritis were Salmonella sp in four cases, Escherichia coli in one, Enterobacter aerogenes in one, Staphylococcus aureus in one, and Haemophilus influenzae type b in one. Five of the cases with infection limited to the joint were caused by Streptococcus pneumoniae; the sixth was caused by H influenzae type b. Fever (≥38.3°C) was present in all children and the temperature was in excess of 39°C in 62%. The mean duration of pain before admission was 4.5 days. The initial total white blood cell count ranged from 5,200 to 29,700/µL (mean 19,436/µL) and the total band neutrophil count ranged from 0 to 5,103/µL (mean 1,660/µL). The ESR was greater than 20 mm/h in eight of the ten patients who were tested. Management consisted of antibiotic therapy in all. Needle aspiration was performed in two patients with osteomyelitis and in three with suppurative arthritis. Incision and drainage was performed in two cases of osteomyelitis and in four with suppurative arthritis. The outcome was satisfactory in all except one patient who had several complications as a consequence of femoral neck osteomyelitis. Recurrence was reported in only one patient.
Neonatal Pemphigus Vulgaris
Authors: Merlob p. , Metzker A. , Hazaz B. , Rogovin H. , Reisner S. H.
Published: December 2021

The case history of a baby with neonatal pemphigus vulgaris is presented. This is the 13th case of pemphigus vulgaris during pregnancy reported in the literature. The correlations between the clinical, histologic, and immunofluorescent findings are discussed and a review of all previously reported cases is presented.
Aluminum Toxicity in Infants and Children
Authors:   Committee on Nutrition
Published: December 2021

During the last 15 years, accumulating evidence has implicated aluminum in disorders associated with chronic renal failure.1-6 The well-recognized manifestations of systemic aluminum toxicity include fracturing osteomalacia, dialysis encephalopathy, and microcytic hypochromic anemia. More recently, aluminum loading has been demonstrated in premature infants receiving intravenous fluid therapy.7 Although the clinical importance of this finding is unclear, it warrants careful attention. The association between aluminum excess and neurologic dysfunction, which has been reported in patients with chronic renal failure, suggests the possibility that aluminum overload may contribute to the pathogenesis of CNS damage in the sick premature infant.7,8

ALUMINUM EXPOSURE

Aluminum, which is the most abundant metal in the earth's crust, is ubiquitous in its distribution.7 There is constant exposure to this element through ingestion of water and food and exposure to dust particles.10 Because aluminum sulfate (alum) is used as a flocculating agent in the purification of municipal water supplies, drinking water may contain high levels of aluminum (up to 1,000 µg/L). Aluminum cans, containers, and cooking utensils, as well as aluminum-containing medications, are also potential sources of oral intake of aluminum. Increase in aluminum intake as a result of transfer through the skin is probably negligible; however, exposure is common due to use of aluminum in deodorants.10 Some inhaled aluminum is retained in pulmonary tissue and in the peribronchial lymph nodes, but it is largely excluded from other tissues. Pulmonary aluminum concentration increases with age; unlike aluminum levels in other tissues, the concentration in the lung does not correlate with that in other tissues.
Retinopathy of Prematurity and Iron: A Modification of the Oxygen Hypothesis
Authors: SULLIVAN JEROME L.
Published: December 2021

To the Editor.—

Despite several decades of study, retinopathy of prematurity remains incompletely understood. The role of oxygen in the pathogenesis of retinopathy of prematurity has received much attention.1,2 I wish to suggest a modification of the hypothesis that retinopathy of prematurity is caused by oxidative damage to the developing retina. I propose that during the first few weeks of life the developing retina is abnormally susceptible to damage by oxygen because it is exposed to elevated concentrations of ionic iron capable of catalyzing the formation of toxic oxygen species.
Is Chronic Lung Disease in Low Birth Weight Infants Preventable? A Survey of Eight Centers
Authors: Avery Mary Ellen , Tooley William H. , Keller Jacob B. , Hurd Suzanne S. , Bryan M. Heather , Cotton Robert B. , Epstein Michael F. , Fitzhardinge Pamela M. , Hansen Cheryl B. , Hansen Thomas N. , Hodson W. Alan , James L. Stanley , Kitterman Joseph A. , Nielsen Heber C. , Poirier Theresa A. , Truog William E. , Wung Jen-Tien
Published: December 2021

Chronic lung disease in prematurely born infants, defined as the need for increased inspired oxygen at 28 days of age, was thought to be more common in some institutions than in others. To test this hypothesis, we surveyed the experience in the intensive care nurseries at Columbia and Vanderbilt Universities, the Universities of Texas at Dallas, Washington at Seattle, and California at San Francisco, the Brigham and Women's Hospital in Boston, Texas Children's Hospital in Houston, and Mt Sinai Hospital in Toronto. The survey included 1,625 infants with birth weights of 700 to 1,500 g. We confirmed the relationship of risk to low birth weight, white race, and male sex. Significant differences in the incidence of chronic lung disease were found between institutions even when birth weight, race, and sex were taken into consideration through a multivariate logistic regression analysis. Columbia had one of the best outcomes for low birth weight infants and the lowest incidence of chronic lung disease.
Comparison of Four Surfactants: In Vitro Surface Properties and Responses of Preterm Lambs to Treatment at Birth
Authors: Ikegami Machiko , Agata Yotaro , Elkady Tarek , Hallman Mikko , Berry David , Jobe Alan
Published: December 2021

Natural sheep surfactant, rabbit surfactant, human surfactant, and surfactant TA were compared for in vitro surface properties and for responses of preterm lambs to treatment. Equivalent amounts of sheep, rabbit, and human surfactants were needed to lower the surface tension to less than 10 dynes/cm, whereas four times less surfactant TA similarly lowered the surface tension. Surface-spreading rates were similar for the surfactants. The surface adsorption of the batch of human surfactant tested was much slower than was adsorption of the other surfactants. Ventilation was significantly improved in all surfactant-treated lambs relative to the control lambs, indicating the general efficacy of the surfactant treatments. Overall, surfactant TA had the best in vitro characteristics, yet the preterm lambs treated at birth with surfactant TA had lower Po2 values and higher ventilatory requirements than did the sheep surfactant-treated lambs. The in vivo responses to rabbit surfactant were intermediate between the responses to sheep surfactant and to surfactant TA. Human surfactant resulted in the least effective clinical response. More of the phosphatidylcholine associated with human surfactant and surfactant TA was lost from the alveoli and lung tissue after four hours of ventilation than was lost from sheep or rabbit surfactant-treated lambs. More intravascular radiolabeled albumin leaked into the alveoli of the surfactant TA-treated lambs than sheep or rabbit surfactant-treated. lambs. The four surfactants also had different sensitivities to the effects on minimum surface tensions of the soluble proteins present in alveolar washes. The study demonstrates that the range of clinical responses was not predictable based on the in vitro surface properties that we measured. The surfactants behaved differently with respect to loss from the lungs and sensitivity to soluble proteins. Factors other than surface properties are important for the in vivo responses to surfactant treatments.
Prospective Surveillance of Haemophilus influenzae Type b Disease in Dallas County, Texas, and in Minnesota
Authors: Murphy Trudy V. , Osterholm Michael T. , Pierson Lynne M. , White Karen E. , Breedlove J. A. , Seibert G. Burton , Kuritsky Joel N. , Granoff Dan M.
Published: December 2021

Among children less than 12 years of age residing in Dallas County, Texas, and in the state of Minnesota we conducted prospective, active surveillance of invasive Haemophilus influenzae disease. During 18 months, 616 cases were identified, of which 600 were caused by type b organisms. The annual incidence of disease was significantly greater in Dallas than in Minnesota (109 v 68/100,000 children younger than 5 years of age, P < .001) and was greater in Dallas, even when rates for white children in the two regions were compared (P < .001). Other regional differences were observed. In Dallas, a larger proportion of cases were in children attending day-care centers (27% compared with 12% in Minnesota, P < .001) and more patients attended day care for greater than 40 h/wk (56% compared with 30% in Minnesota, P < .001). Outer membrane protein subtyping of isolates revealed that in Dallas 6U isolates were associated significantly with cases in black children who attended day care. In Minnesota, but not in Dallas, isolates with subtype 1H were associated significantly with cases in children in day care. These data indicate that there are regional differences in the epidemiology of type b Haemophilus disease that may relate to differences in strains, day-care practices, or other unknown cultural or environmental factors. Finally, because only 15% of systemic Haemophilus disease in these regions occurred in children in the age groups recommended for vaccination (24 to 59 months), the new Haemophilus type b polysaccharide vaccine is expected to have a limited impact on the overall incidence of disease.
High-Density Lipoprotein-Cholesterol Subfractions in Adolescent Twins
Authors: Bodurtha Joann N. , Schieken Richard , Segrest Jere , Nance Walter E.
Published: December 2021

Data on the levels of high-density lipoprotein-cholesterol (HDL-C) and subfractions in 102 adolescent twin pairs and their parents are presented. Children with a family history of premature cardiovascular death had lower levels of HDL2-C than did those without such a history. White girls reporting a high level of physical activity had higher levels of HDL-C and HDL2-C than did their more sedentary peers. In general, children of mothers who smoked had lower HDL2-C than did children of nonsmoking mothers. These findings suggest that low levels of HDL2-C in children may identify families in which there is an increased risk of coronary heart disease and that parental smoking may contribute to changes in this risk factor in the children of smokers as well as in the smokers themselves.
Health, Developmental, and Nutritional Status of Adolescent Alcohol and Marijuana Abusers
Authors: Farrow James A. , Rees Jane M. , Worthington-Roberts Bonnie S.
Published: December 2021

The impact of alcohol and marijuana abuse on the physical health and nutritional status of adolescents has not been well documented. The health consequences of alcoholism and chemical abuse in adults may not relate to the pediatric population. Forty-nine adolescent boys (mean age 15.8 years) with varying degrees of alcohol and marijuana use by self-report were evaluated as to their general health, pubertal development and nutritional status using health and dietary history, physical examination, anthropometrics, and biochemical assays of liver function and tissue nutrients. Thirteen (27%) were alcohol and marijuana abusers, 20 (41%) marijuana abusers, and 16 (32%) nonusers. There were significant differences between alcohol and marijuana abusers and marijuana abusers compared to nonusers with respect to endorsing symptoms of nutritional deficiency (muscle weakness, bleeding gums, tiredness, etc) (P < .001). There were no significant differences between subgroups in other nutritional measures except plasma zinc concentration which was low in marijuana abusers (mean 85µg/dL). All adolescents reported consuming adequate nutrients, although alcohol and marijuana abusers reported eating more snack foods and less fruit, vegetables, and milk than other groups. There were no significant differences in hemotologic status (complete blood cell count, transferrin, folate), liver function (γ-glutamyltranspeptidase), or anthropometric and sexual maturational indices of growth. There were no chronic signs of chemical abuse by physical examinations. It appears that health and nutritional disability from chemical abuse in adolescents relates more to poor dietary habits and symptomatic deterioration in general health than to specific effects on growth or nutritional status. Studies with larger numbers of subjects need to document these findings.
The Saint
Authors: SMILKSTEIN MARTIN J.
Published: December 2021

Joseph W. St Geme Jr, MD, died in my emergency department on Oct 11, 1986. Our relationship began when I served as one of his residents when he was the Chief of Pediatrics at Harbor-UCLA. It ended when I pronounced him dead. In the intervening years, I entered emergency medicine, and he became the Dean of the University of Colorado School of Medicine. He achieved recognition and status reserved for very few, with a list of awards, titles, and affiliations that is truly magnificent. While most will describe his greatness by recounting this list, a fortunate few have been touched by, and recall instead, another kind of greatness that had nothing to do with his rank, title, or achievements.
Ribavirin
Authors: ISAACS DAVID
Published: December 2021

Immunization has proved to be the most effective way of controlling viral diseases, and the development of antiviral drugs has lagged behind the development of antibacterial agents. Many of the early antiviral agents were DNA nucleoside analogs such as idoxuridine, cytarabine, and vidarabine, which competitively inhibited replication of DNA viruses, especially herpes viruses. An important advance was the deliberate synthesis of a purine nucleoside analog, acyclovir, which is only active following phosphorylation, which is carried out selectively by virus-coded thymidine kinase. Acyclovir is active against some herpesviruses, particularly herpes simplex virus, but not against RNA viruses, and appears to have low toxicity because of the low level of phosphorylation by host cell thymidine kinase.
Residents on the Phone
Authors: FOSARELLI PATRICIA , KATZ HARVEY
Published: December 2021

To the Editor.—

Dr Wood has raised a number of valid points in her article, "Pediatric Resident Training in Telephone Management: A Survey of Training Programs in the United States" (Pediatrics 1986;77:822-825). Residents do manage many patient-initiated telephone calls in clinics and emergency rooms. The acquisition of diagnostic skills and efficiency in "telephone medicine" during residency is important not only for practice as a resident but also for the practicing pediatrician, in fee-for-service or prepaid (HMO) group practice.
Absent Hypoxic and Hypercapnic Arousal Responses in Children With Myelomeningocele and Apnea
Authors: WARD SALLY L. DAVIDSON , KEENS THOMAS G.
Published: December 2021

In Reply.—

CNS anomalies associated with myelomeningocele and Arnold-Chiari malformation (Neurosurgery 1986;18:559-564) could account for the abnormal arousal responses we described (Pediatrics 1986;78:44-50). They may also explain the failure of posterior fossa decompression surgery to correct apnea in some patients with myelomeningocele. We were not able to study children before and after posterior fossa decompression surgery; nor did we examine postmortem specimens. Consequently, our paper does not determine whether the cause of abnormal arousal responses is due to mechanical compression or anatomical anomalies of the brainstem.
Passing Out—On Purpose
Authors: WALTERSPIEL JUAN N.
Published: December 2021

To the Editor.—

I recently saw a teenager in Mobile, AL, perform a remarkable act. She bent over and forcefully inhaled and exhaled to the count of 20. This was followed by a rapid change to the erect position while placing both hands over her carotids. The combination of a respiratory alkalosis, orthostatic hypotension, and carotid sinus massage induces a state of altered consciousness.
Neonatal Intracranial Hemorrhage and Phenobarbital
Authors: KUBAN KARL C. K. , BROWN ELIZABETH , LEVITON ALAN , KRISHNAMOORTHY KALPATHY
Published: December 2021

In Reply.—

We appreciate the comments by Dr Battisti et al. As noted in the inclusion criteria for our study,1 all intubated babies with birth weights less than 1,751 g were eligible for the study. One of the advantages of a randomized double-blind study is that babies with other risk factors, including presence of a fluctuating cerebral blood flow pattern on Doppler ultrasound testing, should have equal chances of being in the treated and placebo groups.
Computerized Ventilation
Authors: CARLO WALDEMAR A. , PACIFICO LUCIA , CHATBURN ROBERT L. , FANAROFF AVROY A.
Published: December 2021

In Reply.—

We are delighted that Dr Anbar has had the opportunity to independently test the validity and effectiveness of our algorithm on assisted ventilation against simulation programs. It is reassuring that, as in our group of infants, the simulated arterial blood gas derangements responded well to the ventilatory management recommended by our "expert system." The excellent rate of correction of blood gas values in both studies (89% and 90%) suggests that this area of medical care suits itself to the application of algorithms.
Is Intrauterine Growth Retardation a Risk Factor for Child Abuse?
Authors: Leventhal John M. , Berg Anne , Egerter Susan A.
Published: December 2021

A case-control study was conducted to determine whether infants with intrauterine growth retardation are at an increased risk of child abuse. Case children were those who had been born at Yale-New Haven Hospital and were reported to the hospital's child abuse committee because they had been physically abused. For each case, one control child was chosen from the hospital's log of births and matched to the case child by age, gender, race of the mother, method of payment for the hospitalization, and the provider of the child's health care at the time of birth. Infants were defined as having intrauterine growth retardation if they had either a ponderal index or a birth weight that was less than the tenth percentile for gestational age using the Kansas City or Denver growth standards. We identified 117 case-Control l pairs that met those criteria. The matched odds ratios for each of the four definitions of intrauterine growth retardation were less than one, indicating that infants with intrauterine growth retardation are at a decreased risk of abuse. The matched odds ratio for a low ponderal index according to the Kansas City standard was 0.4 (95% confidence interval 0.19, 0.83). This result was not affected by such possible confounding factors as the mother's age. We conclude that infants with intrauterine growth retardation are not at an increased risk and may be at a decreased risk of physical abuse.
FABIOLA, A FOURTH CENTURY ROMAN LADY, AND THE ORIGIN OF THE FIRST PUBLIC HOSPITAL
Authors: C. T. E.
Published: December 2021

Public hospitals for Roman citizens were established in many Roman cities during the early Christian era; the first of which was established at Rome in the fourth century by a Christian lady named Fabiola, as follows.

The origin of public hospitals is remarkable, and not generally known. Ecclesiastical history informs us, that this, perhaps the grandest and most successful effort for alleviating human misery, arose from no common species of benevolence, but from the impulse of singular piety upon the sensibility of a female mind, softened by a series of domestic afflictions, and urged by the desire of atoning for imaginary guilt. In the fourth century, a Roman lady, of a noble birth, by name Fabiola, by religion a Christian, left by the death of her husband in sole possession of an affluent fortune, was the first who built an infirmary for the reception of the sick and houseless, where they were supplied with every comfort. Jerom[e] calls her the glory of the Christians, the wonder of the Gentiles! The account which he gives of her is this: Divorced from her first husband, who proved an abandoned libertine, during the life of the first she married a second husband, who was sincerely attached to her, and whom she survived. Among the melancholy reflections consequent upon his death, being led to conceive her second marriage criminal, she voluntarily underwent a solemn penance, assumed the plainest dress, defaced her beauty, submitted to the meanest drudgery, sold her estates, which were answerable to her noble birth, and converted them into money, for the relief of the poor, and was the first to build an infirmary, into which sick and distressed objects of every description were collected from the streets. Many who were afflicted with distempers, the most loathsome and offensive she attended in person, carried them in her arms, bathed their sores, moistened the lips of the dying with her own hands, and so tenderly assuaged their miseries, that many who were well envied the sick. Rome was a scene too confined for her charity; she visited, either in person or by her deputies, all the country round, and even crossed the sea in quest of new objects of compassion. At length she took a sudden and unexpected resolution of visiting Jerusalem; on which occasion she was entertained a short time by Jerom[e] in his retreat in Bethlehem. She returned to Rome, and devoted all her property and all her time to relieving the sick and the indigent till she died. Her funeral is said to have been attended by a more numerous concourse, and with a zeal infinitely more fervent, than the triumphs of Scipio or Pompey.
Growth and Development of Infants Surviving Respiratory Distress Syndrome: A 2-Year Follow-up
Authors: Piekkala Paula , Kero Pentti , Sillanpää Matti , Erkkola Risto
Published: December 2021

In a regional birth cohort of 5,356 live-born infants, during 12 consecutive months, 46 (0.9%) infants suffered from respiratory distress syndrome. Ten of them died before the age of 2 years. The cause of death was respiratory distress syndrome in two cases, intracerebral hemorrhage in four cases, asphyxia in one case, and congenital erythropoetic anemia in one case. Of the 36 survivors, 34 could be traced for the follow-up. Growth and development of the survivors with respiratory distress syndrome were compared with that of 3,375 term infants in the birth cohort with birth weights at the tenth percentile or above with no risk factors recognized during pregnancy, labor, delivery, or the neonatal period. Normal development was found in 85% of the survivors with respiratory distress syndrome and 99% of the control infants at the age of 2 years. Intracerebral hemorrhage and low one- and five-minute Apgar scores were associated with unfavorable outcome at 2 years in the survivors with respiratory distress syndrome. The developmental scores were significantly poorer than those of the controls at 2 years for gross motor, audiovisual, and psychosocial categories, whereas for fine motor development, the difference disappeared by the 2 years of age. The growth of the survivors with respiratory distress syndrome was satisfactory even if their heights remained below that of their control peers.
Foodborne Snow Mountain Agent Gastroenteritis in a School Cafeteria
Authors: Guest Charles , Spitalny Kenneth C. , Madore H. Paul , Pray Katherine , Dolin Raphael , Herrmann John E. , Blacklow Neil R.
Published: December 2021

In 1984, an outbreak of gastroenteritis occurred at a school with 1,860 students in Brooklyn, NY. In a single-stage cluster sample of 375 students, 129 (34%) had illnesses that met our case definition of vomiting or diarrhea. The mean incubation period was 26 hours, and the mean illness duration was 24 hours. All case students had eaten in the cafeteria on at least one day between Nov 13 and 16, compared with 174/214 (81%) noncase students (P = 10-8, Fisher exact test). Foods implicated were french fries (relative risk 1.7, 95% confidence limits 1.4, 2.0) and hamburgers (relative risk 1.6, 95%, confidence limits 1.2, 2.1). Two cafeteria employees had served those foods while affected by diarrhea. By a recently developed blocking enzyme-linked immunosorbent assay, six of 11 (55%) case students showed fourfold antibody increases between acute-and convalescent-phase serum samples for Snow Mountain agent, a Norwalk-like virus, compared with one of ten (10%) noncase students (P = .04, Fisher exact test). We strongly suspect, but cannot document conclusively, that the Snow Mountain agent was spread to students on a vector of hot foods contaminated by ill food handlers. Implicated foods conferred low relative risks and could only have accounted for 74% of cases of illness. The strong association between cafeteria exposure and illness, therefore, suggests that additional modes of spread occurred.
Diphtheria-Tetanus-Pertussis Immunization and Sudden Infant Death: Results of the National Institute of Child Health and Human Development Cooperative Epidemiological Study of Sudden Infant Death Syndrome Risk Factors
Authors: Hoffman Howard J. , Hunter Jehu C. , Damus Karla , Pakter Jean , Peterson Donald R. , van Belle Gerald , Hasselmeyer Eileen G.
Published: December 2021

The possible association between diphtheria-pertussis-tetanus (DTP) immunization and the subsequent occurrence of sudden infant death has been examined using data from the National Institute of Child Health and Human Development (NICHD) Sudden Infant Death Syndrome (SIDS) Cooperative Epidemiological Study, a large multicenter, population-based, case-control study. In a preliminary report based on the first 400 eligible singleton SIDS victims and 800 matched living control infants, no temporal association between SIDS and DTP immunization was found. From the final sample of 800 eligible singleton SIDS victims, 95% (n = 757) were defined as definitely or probably having died of SIDS on the basis of pathology data. Data from these 757 case infants and their corresponding control infants (n = 1,514) are presented in this report. Two control infants, both living, were randomly selected for each case infant: an age-matched control A and an age-, race-, and low birth weight-matched control B. Overall, case infants were less likely to have received any DTP immunization. Only 39.8% of case infants had received at least one DTP immunization compared to 55.0% of control A infants and 53.2% of control B infants. Based on maternal interviews and postnatal medical records, 1.8% of case infants (five infants) immunized with DTP died within the first 24 hours following immunization. Similarly, 5.0% of control A infants (n = 21) and 2.2% of control B infants (n = 9) had been immunized within 24 hours of the maternal interview, which represents the comparable time frame for the age-matched control infants. These results confirm the earlier preliminary findings from the NICHD SIDS Cooperative Epidemiological Study and suggest that DTP immunization is not a significant factor in the occurrence of SIDS.
MODIFICATION OF THE TECHNIC OF TREATING ERYTHROBLASTOSIS FETALIS BY EXCHANGE TRANSFUSION
Authors: WIENER ALEXANDER S. , WEXLER IRVING B.
Published: December 2021

A simplified method of treating erythroblastosis by exchange transfusion is described in which the patient is bled and simultaneously transfused with compatible packed red cells. A table is presented which gives the final hematocrit and percentage of inagglutinable red blood cells in the patient's body at the termination of the exchange transfusion, in relation to the patient's initial hematocrit and the amount of blood exchanged. An exchange transfusion with 100 to 150 cc. of packed cells appears to be adequate regardless of the severity of the anemia.

Statistical analysis of the result of 106 exchange transfusions shows a progressive drop in mortality rate from 23.7% in 38 cases treated with 500 cc. of whole citrated blood, to 14.6 cc. in 48 cases treated with 1,000 cc. of whole citrated blood, and to 10.0% in 20 cases treated with 120 cc. of packed cells. While the improvement may be accidental, there is no doubt that exchange transfusion with packed cells is a simpler procedure which avoids the introduction into the patient's body of large amounts of adult plasma, and potentially toxic doses of citrate and calcium. Two cases are described in detail which have unusual serologic and clinical features and illustrate the types of problems which may arise when treating erythroblastotic babies.
Round Table Discussion
Authors: BUFFUM WILLIAM P. , MUELLER HARRY L. , MANACE GORDON , MCBRIDE R. H.
Published: December 2021

Chairman Buffum: The treatment of the patient with asthma is often a difficult and complicated problem. In this discussion we are concerning ourselves only with "hyposensitization," which is only a part and sometimes a very small part of the treatment.

Probably it is best to treat with all the inhalant allergens that are causing or seem likely to be causing symptoms. From the history and the tests it is decided which substances are important in a given case, and extracts of these allergens are injected regularly.

House dust is almost always given in perennial asthma. It seems to be the commonest trouble maker in the patients, and is usually used in treatment, unless the dust skin tests are negative and also something else is clearly indicated. Animal danders, for instance, are also used, when they seem to be a likely source of trouble, and when they cannot be completely avoided.

The pollens are used which by history and by skin test seem to be indicated. For instance, if a patient is worse in June and gives a positive skin test to grass pollen, grass pollen is given as part of the treatment. If, in addition he gives a good positive test to ragweed, and is not worse in September, ragweed should not be included in the treatment.

Molds undoubtedly play a part in some cases. Patients who have trouble in the summer may be sensitive to molds. Not uncommonly pollen patients whose treatment is not successful are found to be sensitive to molds also. Alternaria is much the most important of these, with hormodendron a poor second. There are several other molds which may be important in a given case. A patient who has trouble in the summer, and who has positive tests to one of these molds, should have that mold included in his treatment.

If the patient has had symptoms limited to the ragweed season, and if our treatment is started well before the season, our problem is relatively simple. We start treatment with a dilution of ragweed that we know by experience will be safe with this patient, and give injections once or twice a week increasing the size of the dose each time.
REPEATED RECOVERY OF A SPIRILLUM BY BLOOD CULTURE FROM TWO CHILDREN WITH PROLONGED AND RECURRENT FEVERS
Authors: SHWARTZMAN GREGORY , FLORMAN ALFRED L. , BASS MURRAY H. , KARELITZ SAMUEL , RICHTBERG DOROTHEA
Published: December 2021

A spirillum was repeatedly recovered by blood culture from two children. This organism resembled the Spirillum minus which has long been associated with one form of rat bite fever, Sodoku. In Sodoku the spirillum is usually recovered by animal inoculation and no previous record has been found in which a diagnosis has been made by blood culture.

The organisms recovered from the two patients were morphologically indistinguishable from the classical Spirillum minus, but were unique in that they could be maintained for many months on standard liquid and solid bacteriologic media. Their in vivo resistance to penicillin and arsenicals was marked and therefore also unusual.

Both patients were seen because of recurrent fever, eruption and symptoms referable to the central nervous system, respiratory and intestinal tracts. The first child was admitted to The Mount Sinai Hospital debilitated and febrile. A spirillum was recovered repeatedly on routine blood culture, although there was no definite history of rat bite. Treatment with arsenicals and penicillin and streptomycin failed and the patient died. The second child was admitted with a history of repeated respiratory infections and indolent skin ulcers and hemiplegia. He had apparently been bitten by a rat while in Florida 3½ years before the spirillum was first recovered from his blood. Treatment with penicillin and sulfarsphenamine was ineffectual. The organism was sensitive in vitro to streptomycin but as much as 2 gm. a day for several months failed to do more than induce several negative blood cultures. Treatment with aureomycin finally succeeded in sterilizing the blood stream and healing the ulcers. Coincident with this there was a striking improvement in the child's general condition.

The clinical course of these two patients and the unusual bacteriologic findings set them apart from classical rat bite fever and suggest use of the term "Spirillum Fever."
TREATMENT OF CHRONIC SHIGELLA INFECTION IN CHILDREN WITH ORAL POLYMYXINS
Authors: LIEBERMAN DANIEL , JAWETZ ERNEST
Published: December 2021

Many chemotherapeutic agents can alleviate the symptoms of acute bacillary dysentery and suppress the causative organisms. In chronic Shigella infection, however, most agents have only limited usefulness. In an institution for mentally defective children 93% of 116 fresh cases of shigellosis responded to conventional chemotherapeutic measures, but only 63% of 78 chronic cases.

Polymyxin B and E are highly bactericidal for Shigella organisms in vitro. These drugs are stable and are not significantly absorbed from the intestinal tract when taken by mouth. Twenty-three children with chronic intestinal infections due to Shigella paradysenteriae (Flexner) were given daily oral doses of 15 to 20 mg./kg. polymyxin for 10 days. Twenty (87%) were unequivocally cured of their infection which had previously resisted therapy with sulfonamides and other antimicrobial agents. No toxic side-effects were observed. Polymyxin appears to be a useful drug for the oral treatment of chronic Shigella infection.
STUDIES ON THE ABSORPTION AND DISTRIBUTION OF CHLORAMPHENICOL
Authors: KELLY RICHARD S. , HUNT ANDREW D. , TASHMAN SYLVIA G.
Published: December 2021

Chloramphenicol is readily absorbed from the gastrointestinal tract. Peak serum levels, while usually reached within two hours, are occasionally not attained for six or more hours. In general absorption is markedly more rapid than in the case of aureomycin, which seems to be absorbed slowly over a period of several hours.

Eleven mg./kg. body weight, which is an adequate single dose of aureomycin, in the case of chloramphenicol produces serum levels too low to be detected by the authors' method. Twenty-two mg./kg. produces two hour levels averaging 8.3 µg./cc. and 44 mg./kg. raises this level to a mean of 22 µg./cc.

Rectal administration of perforated chloramphenicol capsules produces peak serum levels approximately one-fifth of those effected with comparable oral dosage.

Diffusion of chloramphenicol into cerebrospinal fluid occurs readily and after a few days administration spinal fluid levels, in three cases, were approximately 50% of the serum levels.

These data suggest that effective oral dosage of chloramphenicol ranges from 22 to 44 mg./kg./dose and that the antibiotic should be given at 6 to 8 hour intervals.
OUTBREAK OF ACUTE NEPHRITIS IN ADOLESCENT SCHOOLBOYS
Authors: KEMPE C. HENRY , OLMSTED RICHARD W. , CURNEN EDWARD C.
Published: December 2021

An outbreak of acute nephritis is reported which occurred among adolescent boys who were students at a private day school. Four boys in one class had clinically typical acute glomerular nephritis. Seventeen other members of this and one other class were found to have hematuria with or without associated albuminuria. The total incidence of hematuria among the 73 students in these two classes was 29%. Fifteen of the 21 boys with hematuria still had abnormally elevated Addis sediment counts approximately seven weeks after the initial examination.

Cultures of the nasopharynx were made from 85 students. Hemolytic streptococci were detected in 11 (13%) of the boys including three with hematuria. The results of attempts to identify the streptococci by serologic technics indicated that at least five immunologically different varieties were represented.

Determinations of antihyaluronidase, antistreptolysin "O" and antistreptokinase in serum from 17 boys with hematuria and 20 without apparent hematuria revealed wide variations in titer but no significant differences between the two groups.
ISOLATED CERVICAL LYMPHOGRANULOMA VENEREUM IN A CHILD
Authors: ROTH DANIEL , SCHULICK RAYMOND
Published: December 2021

A case of lymphogranuloma venereum manifested solely by involvement of a cervical lymph node in a boy 6 years of age is reported. The disease is uncommon in children and rare when the cervical region alone is involved.
METHOD OF OBTAINING ANAEROBIC ARTERIAL BLOOD SAMPLES FROM INFANTS
Authors: HYTTEN FRANK E. , CHERRY RUTH B.
Published: December 2021

A SATISFACTORY method for obtaining anaerobic arterial blood samples from newborn infants requires at least the following conditions:

1. It must be safe.

2. The sampling must be sufficiently rapid to give blood values for any given half a minute or less.

3. Pain must be minimal so that crying can be avoided.

4. Repeated sampling on one infant should be possible.

Arterial puncture is both safe and rapid in only a few experienced hands and repeated sampling is even less safe or sure. Crying is seldom avoided.

Cutaneous bleeding from heel puncture frequently produces mixed blood and bleeding is almost always too slow to give an accurate picture of the state of the blood at a given moment. Crying is the rule. In addition, the usual method of collection under oil introduces further inaccuracies: oil slows the bleeding, absorbs a considerable amount of carbon dioxide, and is extremely difficult to exclude from pipettes.

The present investigators have evolved a method which has proved satisfactory in about 50 consecutive cases. "Cutaneous" arterial blood is sampled from the foot, the site of puncture being over the soft tissue area containing the plexus of arterioles from the lateral malleolar artery (Fig. 1).

Equipment

Three pieces of equipment, easily made in any laboratory, are required:

1. As shown in Fig. 2, this consists of a 1" X 1" square of adhesive tape which has a centrally punched hole of ⅛" diameter, centered over which and sealed by rubber cement is a ¼" length of soft rubber tubing of ⅛" bore and 3/32" wall thickness.