bluuebunny/crossref_metadata_2025 huggingface dataset:
Letter to the Editor
Authors: Torg Joseph S.
Published: December 2021

Thank you very much for the opportunity of seeing Dr. Maller's letter addressed to your journal dated February 24, 1972. I compliment Dr. Maller on swinging at our "curve."

I think that his letter can be most appropriately answered by referring to the last paragraph of our article: "We recognize that the data and observations presented in this paper are not conclusive. We believe, however, that they do suggest that to subject a preadolescent pitcher to an intensely competitive situation is not in his best interest from the standpoint of healthy development and maturation."
Cycling With a Toddler
Authors: Gibson Lewis E.
Published: December 2021

As a pediatrician and a bicyclist, I was dismayed by the article "The Toddler as a Bicycle Passenger," by Berry et al. in the March issue of Pediatrics. Cycling with toddlers is not, as I thought, an enjoyable, nonpolluting exercise but rather an approximation of child abuse.

The facts presented are not overwhelming. None of the 14 accidents reported involved the use of a complete passenger seat. Five parents could not even remember how the child was carried.
INDIRECT ESTIMATION OF SYSTOLIC AND DIASTOLIC BLOOD PRESSURE IN THE NEWBORN
Authors: Walker Colin H. M. , West Phillip J. , Simons Sanford L. , Whytock Anthony R.
Published: December 2021

An impedance plethysmographic method for measuring systolic and diastolic blood pressures in small infants using standard electro-cardiogram recorders has been studied. The overall 95% confidence limit of the mean of five estimations was found to be ±3.74 mm Hg for the systolic and ±3.72 mm Hg for the diastolic value.

Comparing this method with intra-arterial measurements gave correlation coefficients (r) of 0.95 (bias 10.09 mm Hg) for systolic pressure and 0.89 (Bias 10.09 mm Hg) for diastolic pressure. Values for the comparison with auscultation were 0.98 (bias 19.29 mm Hg) systolic and 0.86 (bias 10.17 mm Hg) diastolic, and for the comparison of the arithmetic mean value with the flush method 0.84 (bias 30.17 mm Hg). These results reveal a good correlation with the intra-arterial measurements and indicate that this technique can be used for the periodic or continuous blood pressure monitoring of infants.
ALTERATIONS IN HUMAN BRAIN BIOCHEMISTRY FOLLOWING INTRAUTERINE GROWTH RETARDATION
Authors: Chase H. Peter , Welch N. Noreen , Dabiere Carol S. , Vasan N. S. , Butterfield L. Joseph
Published: December 2021

Analyses of brains from six infants whose birth weights were "small for gestational age" (SGA) and ten infants whose birth weights were ‘appropriate for gestational age" (AGA) show the cerebellum to be the area of the brain most greatly affected by intrauterine underdevelopment. The SGA cerebellar weight was reduced 37% and cellularity 35%, compared to reductions of only 21% and 19% for weight and cellularity in the remainder of the brain. The myelin lipids, cerebroside and sulfatide, were significantly reduced (p < .01) in concentration or total quantity in the brains of SGA infants, in contrast to phospholipids, cholesterol, and gangliosides which did not show a similar reduction. Galactolipid sulfotransferase activity, important in sulfatide formation, was also significantly reduced (p < .01) in the brains from SGA infants.
INTELLECTUAL AND PERSONALITY DEVELOPMENT IN CHILDREN WITH GALACTOSEMIA
Authors: Fishler K. , Donnell G. N. , Bergren W. R. , Koch R.
Published: December 2021

This study deals with the developmental and intellectual status of 45 treated galactosemia patients, 23 females and 22 males, followed longitudinally for up to 23 years. Intellectual achievement, visual-perceptual ability, and EEG findings are analyzed. The intellectual status of the parents and unaffected siblings of the galactosemia patients are also considered.

The findings indicate that the preschool age group of children show the best developmental progress by the psychometric tests used, those of school age level scoring lower, but still within the low normal range. Adult patients demonstrate better intellectual achievement than the school age children, possibly due to a compensatory process. The greatest incidence of visual-perceptual difficulties was found in the school-age group, and remedial educational programs were necessary for some of these children. In each group, emotional-social characteristics were observed which may reflect the continuing nature of dietary restriction.

The overall findings indicate that early treatment results in a more favorable outcome than does a delay in initiation of dietary restriction.
PAROTITIS IN CHILDREN WHO HAD PREVIOUSLY RECEIVED MUMPS VACCINE
Authors: Brunell Philip A. , Brickman Anthony , Steinberg Sharon , Allen Elaine
Published: December 2021

Twenty children who had previously received mumps vaccine developed parotid swelling which was diagnosed as mumps 3 to 39 months following inoculation. In only eight of seventeen children who were studied serologically could the diagnosis of mumps be confirmed. Since these children were immunized over a 4-year period in four different pediatric offices, it is not likely that a particular lot of vaccine or immunizing procedure was at fault. These eight children probably represent vaccine failure. Serologic, virus isolation, clinical or epidemiologic studies failed to reveal the cause of parotid swelling in the remaining children.

It is apparent that children who develop parotid swelling following immunization with mumps vaccine cannot be assumed to have mumps. Serologic studies are required to identify the vaccine failures.
INSULIN SUPPRESSION IN CHILDREN WITH CONGESTIVE HEART FAILURE
Authors: Hait Gershon , Gruskin Alan B. , Paulsen Elsa P.
Published: December 2021

Children in congestive heart failure have impaired oral glucose tolerance tests. Suppression of insulin release appears to serve as a contributing mechanism for this abnormality in that an inverse relationship is observed between the severity of the congestive heart failure and the insulin response to hyperglycemia. Preliminary results also indicate a significant increase in serum amino acid levels in these children. These findings suggest that the suppression of insulin release is the cause for inefficient utilization of carbohydrates and that this state of catabolism superimposed on a deficient diet encountered in these infants may contribute to their growth retardation.
Cushing's Disease With a Spontaneous Remission
Authors: Putnam Theodore I. , Aceto Thomas , Abbassi Valiollah , Kenny Frederic M.
Published: December 2021

We have described a teen-age boy with spontaneous remission in Cushing's disease and propose that this phenomenon be looked for in other such patients.
RNA Methylation—A Possible Genetic Marker in Cystic Fibrosis
Authors: Rennert Owen M. , Julius Richard L. , LaPointe David
Published: December 2021

Cystic fibrosis (CF) of the pancreas was initially thought to be an inborn error of metabolism affecting only exocrine tissue. In 1969, the demonstration by Danes and Bearn1 of metachromasia in cultivated fibroblasts obtained from patients with CF gave experimental support to the hypothesis that all CF cells reflect the basic biochemical defect. After this initial report several investigators observed that tissue cultured cells from some patients with CF and heterozygotes accumulated increased quantities of acid mucopolysaccharides and glycogen. No basic defect in these cell culture systems has been identified. No definitive test for the detection of the heterozygote state is available.

See table in the PDF file
Letter to the Editor
Authors: Tired I. M.
Published: December 2021

Hooray for Team D! The Ivory Tower triumphs once again.

However, I would like to see an "unbiased" group from community hospitals do the same type of review and see what the score is then.

Also, perhaps the Ivory Tower could rotate residents through community hospitals so that we too could become wise and efficient.
Living with Handicap, edited by Eileen Younghusband, Dorothy Birchall, Ronald Davie, and M. L. Kellmer Pringle. London: National Children's Bureau, 1970, 372 pp., $6.00
Authors: Maginnis Elizabeth
Published: December 2021

This book is a valiant effort on the part of a professional "working party on children with special needs" to describe and analyze problems of children with physical and other disabilities within the social and educational service systems of the British Commonwealth. Its usefulness to the general professional public, especially outside the Commonwealth, would seem to be extremely limited. As a documentation of "task force" assignments, it is not a readable volume either in literary or scientific terms.
PREVENTION OF HYALINE MEMBRANE DISEASE
Authors: Avery Mary Ellen
Published: December 2021

The articles by Liggins and Howie and Baden, et al. in this issue of Pediatrics are of great interest to perinatologists because they describe efforts to extend to premature infants results of recent studies on maturation of lungs of lambs and rabbits in the prevention of hyaline membrane disease. The two reports provide both promise and caution. When labor can be delayed at least 24 hours in infants under 32 weeks, infusion of betamethasone into the mother can prevent respiratory distress in the infant. Results in infants over 32 weeks' gestation suggest a positive benefit, but the number of infants in the series was too small to reach statistical significance.
A CONTROLLED TRIAL OF ANTEPARTUM GLUCOCORTICOID TREATMENT FOR PREVENTION OF THE RESPIRATORY DISTRESS SYNDROME IN PREMATURE INFANTS
Authors: Liggins G. C. , Howie R. N.
Published: December 2021

A controlled trial of betamethasone therapy was carried out in 282 mothers in whom premature delivery threatened or was planned before 37 weeks' gestation, in the hope of reducing the incidence of neonatal respiratory distress syndrome by accelerating functional maturation of the fetal lung.

Two hundred and thirteen mothers were in spontaneous premature labor. When necessary, ethanol or salbutamol infusions were used to delay delivery while steroid or placebo therapy was given. Delay for at least 24 hours was achieved in 77% of the mothers. In these unplanned deliveries, early neonatal mortality was 3.2% in the treated group and 15.0% in the controls (p 0.01). There were no deaths with hyaline membrane disease or intraventricular cerebral hemorrhage in infants of mothers who had received betamethasone for at least 24 hours before delivery. The respiratory distress syndrome occurred less often in treated babies (9.0%) than in controls (25.8%, p 0.003), but the difference was confined to babies of under 32 weeks' gestation who had been treated for at least 24 hours before delivery (11.8% of the treated babies compared with 69.6% of the control babies p. 0.02).

There may be an increased risk of fetal death in pregnancies complicated by severe hypertensionedema-proteinuria syndromes and treated with betamethasone, but no other hazard of steroid therapy was noted.

We conclude that this preliminary evidence justifies further trials, but that further work is needed before any new routine procedure is established.
Prognosis With Vesicoureteral Reflux
Authors: Perlmutter Alan D. , Dwoskin Joseph Y.
Published: December 2021

Blank and Girdany's attempt to disprove a relationship between pyelonephritis and vesicoureteral reflux is at variance with other published reports. We followed 281 children with vesicoureteral refiux and a history of urinary infection at Boston Children's Hospital Medical Center. Using accepted radiographic criteria, 35% initially had some evidence of unilateral or bilateral pyelonephnitis, a prevalence similarly reported by MacGregor et al. The positive relationship noted between grades of reflux severity and the proportion of children having pyelonephritic changes was also noted by Rolleston et al. In our series, 80% had reflux of moderate or lesser degree; a minority thus fell into categories of more severe reflux and more prevalent renal damage.
Letter to the Editor
Authors: Riley Harris D.
Published: December 2021

Dr. Zinaman misinterpreted the report of the Committee on Indian Health. The report did not state that the Oklahoma City Area, Indian Health Service (IHS) was a prototype for the entire Indian Health Service. However, it did state that it was hoped that the exchange program which has been established in the Oklahoma City Area, IHS, in which residents in pediatrics at the Children's Memorial Hospital, University of Oklahoma Medical Center, are exchanged with medical officers at IHS facilities might serve as a prototype for the initiation of exchange programs in other geographic areas.
Routine Temperature Taking
Authors: Navia Alvaro
Published: December 2021

I also assure Dr. Sarshik that he is not alone in his thought about routine temperature taking in pediatrics. I was accepted as a correspondent member of Colombia's National Medicine Academy in 1966 with an essay on this subject, in which I stated that during my 24 years of practicing pediatrics I never routinely took temperatures of children in my office. Besides, I criticize routine rectal temperature taking because of hygienic and esthetic reasons, and possible psychological damages during the anal phase.
The Social Psychology of the Epileptic Child, by Christopher Bagley. Coral Gables, Florida: The University of Miami Press, 1971, 307 pp., $12.00
Authors: Wallace Sheila J.
Published: December 2021

The author, a sociologist, describes his monograph as an "empirical study of the interaction of social, psychological and biological factors leading to behavior disorder in epileptic children."

The first part of the book consists of a brief introduction to the problems it was felt relevant to investigate and to the sources of patients and of information received about them. A second section is devoted to an examination of the literature. This is comprehensive and well-argued.
Verhandlungen der Deutschen Gesellschaft Für Pathologie, edited by G. Seifert. Summaries and Subtitles in English. Stuttgart: Gustav Fischer Verlag, 1971, 646 pp., no price given
Authors: Vawter Gordon F.
Published: December 2021

With this volume, the sacrosanct Association of German Pathologists has just published the proceedings of its 55th Annual Meeting, held in 1971, which was almost entirely devoted to neonatal and pediatric pathology. Moreover, a large number of the presentations were delivered by persons representing other disciplines such as neonatology, pediatrics, radiology, and anesthesiology. Perhaps a pediatric pathology subspeciality, is in the offing in Germany? The proceedings are published with subtitles and summaries in English and deal with respiratory distress (88 pages), viral pneumonia (17 pages), pediatric endocrinopathies (65 pages), immunology (40 pages), leukemias and tumors (102 pages) , consumption coagubopathy (41 pages), inherited metabolic diseases (88 pages ), submitted papers and a round table on sudden deaths (28 pages), and a useful index (in German).
Management of High-Risk Pregnancy and Intensive Care of the Neonate, ed. 2, by S. Gorham Babson, M.D. and Ralph C. Benson, M.D., St. Louis: The C. V. Mosby Company, 1971, 313 pp., $16.50
Authors: Gluck Louis
Published: December 2021

The authors have prepared a timely and up-to-date treatise on two major but interdigitating areas in medicine as their title suggests and have done a thorough but concise and work-man-like job of presenting the material in out-line form.

Frequently outline books are either too sketchy or they are so concise that they are of little value.
Epidural Abscess in a 3-Week-Old Infant: Case Report
Authors: Palmer Jacques J. , Kelly William A.
Published: December 2021

A case of staphylococcal epidural abscess in a 3-week-old infant is presented. This is the youngest reported patient successfully treated by decompressive laminectomy. Methods for early diagnosis and treatment are stressed. The question of future spinal stability is raised.
Thrombocytopenia as Evidence of Local Thrombus: The Umbilical Arterial Catheter
Authors: Nachman Richard L. , Thomas Mary , Patel Deksha , Gottbrath Emalee
Published: December 2021

A recent nursery experience seems to corroborate and amplify the findings of Neal et al. concerning the thrombogenic properties of the indwelling catheter.

On July 5, 1972, a 600-gm, 24-week AGA female was born. A No. 3.5 French Argyle catheter was inserted into an umbilical artery with the tip resting at the level of the diaphragm. A 10% dextrose water solution free of heparin but containing small amounts of sodium bicarbonate was infused for two days.
RIBOFLAVIN ABSORPTION IN CHILDREN WITH THYROID DISORDERS
Authors: Levy Gerhard , MacGillivray Margaret H. , Procknal Josephine A.
Published: December 2021

The absorption of riboflavin (administered as riboflavin-5'-phosphate) was studied in infants and children with thyroid disorders. The kinetics of elimination and the urinary recovery of riboflavin after intramuscular injection of the vitamin did not differ in hypothyroid and hyperthyroid children. On the other hand, oral administration of a large dose of riboflavin resulted in much more than normal absorption in hypothyroid children and in less than normal absorption in hyperthyroid children. Riboflavin absorption became normal in both groups upon successful treatment of the thyroid disorder. The duration of absorption was considerably prolonged in the hypothyroid children and shorter than normal in the hyperthyroid children. This is consistent with the hypothesis that the differences in the extent of absorption are caused by differences in intestinal transit rates due to the thyroid disease. It is likely that changes in intestinal transit rate will also affect the absorption of some drugs. This possibility should be taken into consideration when assessing the response of patients with thyroid disorders to oral medication.
The Use of Neomycin in the Treatment of Methylmalonic Aciduria
Authors: Snyderman Selma E. , Sansaricq Claude , Norton Patricia , Phansalkar Sadashiv V.
Published: December 2021

Two trials of oral neomycin therapy resulted in the reduction of the urinary excretion of methylmalonic acid and a fall in the plasma level of this metabolite in a child suffering from methylmalonic aciduria. It is quite probable that the antibiotic effect on the gastrointestinal bacteria resulted in decreased propionate production; propionate is the immediate precursor of methylmalonic acid. This therapy might be of special benefit during periods of acute acidosis in this disease.
Juvenile Rheumatoid Arthritis: A Review
Authors: Schaller Jane , Wedgwood Ralph J.
Published: December 2021

Juvenile rheumatoid arthritis (JRA) is a disease of varying clinical manifestations, although all patients share the common property of arthritis. In following 124 children with JRA at a children's arthritis clinic (mean disease duration, 7.5 years), it was apparent that there were three distinct subgroups of disease distinguished by their clinical manifestations, prognosis for joint disability, types of extra-articular complications, and serologic findings.

Systemic disease, characterized by high intermittent fevers and rheumatoid rash as well as other systemic manifestations, occurred in 32 of 124 patients (26%). All patients also had polyarthritis, generally beginning during the first six months of disease. More boys (18) than girls (14) were affected. No patient had iridocyclitis or positive tests for antinuclear antibodies or rheumatoid factor. Systemic symptoms alone were not a cause of permanent morbidity, but eight of 32 patients have incurred severe joint disability.

Polyarticular disease unassociated with prominent systemic disease occurred in 46 of 124 patients (37%), predominantly girls (38 girls, eight boys). Multiple joints were involved, characteristically including small hand joints. Ten patients had antinuclear antibodies; six had positive latex agglutination tests for rheumatoid factor. Eight of 46 had severe joint disability.

Persistent pauciarticular disease, characterized by arthritis limited to five or fewer joints, occurred in 46 of 124 patients (37%), predominantly girls (34 girls, 12 boys). Large joints were chiefly affected (knees, ankles, elbows); small hand joints were spared. Nine of 46 patients had antinuclear antibodies. No patient has had severe joint disability, but 12 of 46 have had iridocyclitis and ten have suffered some degree of permanent visual damage.

Recognition of these disease patterns is useful in the diagnosis and care of children with JRA. Furthermore, these observations suggest that what we now call JRA may in fact be more than a single disease.
Reading Disabilities, Continued
Authors: Svoboda William B.
Published: December 2021

I have reviewed with concerned interest the article by Kenny et al. and the letters in response. I feel that though the primary remediative responsibilities should fall within educational facilities, the identification of the learning-handicapped individual in need of further investigation and the monitoring of the adequacy of response to remediative therapy is the responsibility of all involved in working with children . . . medical, psychologic, and educational disciplines.

The data given are superficial in content and give no specifics as to the testing techniques, the historical data sought, the neurophysical examination details, nor the specific referring complaints.
Letter to the Editor
Authors: Cohen Matthew
Published: December 2021

I wish to thank Dr. Todd for his pertinent remarks. Accuracy in the diagnosis of urinary tract infections is an important problem.

We have attempted to keep the number of false-positive urine infections in our study to a minimum. To be certain of the reliability of our urine collection techniques, at the start of our study, clean voided midstream (CVMS) urine cultures were obtained in 167 patients who were well and were being seen for a routine physical exam.
THE CHILD HEALTH ASSOCIATE—WHAT'S IN A NAME?
Authors: Yankauer Alfred
Published: December 2021

"Physicians' Assistant," "Medex," "Limited Physician," "Feldsher," "Officier de Santé," "Behadar," "Hakim"—there are at least 19 different terms for the same job according to a recent WHO questionnaire.1 Now that six of the first nine graduates of Dr. Silver's program are at work2,3 the term Child Health Associate can be added to the glossary. Previously, perhaps in jest, Dr. Silver had proposed still other titles: the "Syniatrist Associate" and the "Syniatrist Assistant."4 Dr. R. A. Smith, the promoter of Medex, has proposed still another list: "Flexner," "Kruser" and "Osler," to name a few.5 It is possible that before too long the American language alone will have produced more than the 19 terms, unearthed in the recent world survey, as well as a few trainees to match each term.

All this semantic confusion does not even take into consideration newly coined terms that involve nursing: "Nurse Practitioner," "Nurse Associate," "Primex," etc. In spite of Dr. Silver's assertion to the contrary, and in spite of efforts by nursing leaders to preserve a nursing "identity,"6 it is very difficult to differentiate between job descriptions of the "Pediatric Nurse Associate" and the "Child Health Associate."

Nevertheless, neither jest nor a dissection of the research "evidence" from Colorado will serve to dismiss Dr. Silver's advocacy and Dr. Greeb's testimonial.7 Dr. Ross' frank and thoughtful reflections add weight to the charge to consider their implications seriously.8 The fact is that, whether we like it or not, a very substantial effort is now underway in the United States to train "physician extenders" or personnel with primary caretaking responsibilities that ten years ago would have been considered physician responsibilities.
Phototherapy in Nonobstructive, Nonhemolytic Jaundice
Authors: Altay Çigdem , Say Burhan
Published: December 2021

An infant with Crigler-Najjar syndrome of Arias Type I has been presented and the efficiency of light therapy is discussed.
TRANSRACIAL ADOPTION
Authors: Feiertag Richard B. , Daniel William A. , Earlywine Josephine L. , Lewis Donald , Seidel Henry M. , Sherry S. Norman , Tillman Mary A. T. , Work Henry H.
Published: December 2021

Transracial adoption must allow the child a chance to grow up confident that, though he was not born into this family and may have external features that are different– as well as a different cultural heritage– he is loved and accepted for what he is, an individual.

In our haste to get black children out of institutions and into adoptive homes, we must not lose sight of the primary goal of any adoption–the welfare of the child. This goal must receive the highest priority. Placement must be made to provide the child with an opportunity to grow up in a wholesome family setting that will offer the affection, security, and understanding needed for his best development. Unless we adhere to this goal, rather than to a social, humanitarian, psychologic, or other egostrengthening motive of the parents, the child will surely be sacrificed to the popular movement of his day.
Letters to the Editor
Authors: Frothingham Thomas E.
Published: December 2021

I found the Commentary, "A New Role for the School Physician," surprisingly unimaginative and pessimistic regarding the role of the general pediatrician in the management of school problems. In this community, several of us have evolved a simple approach based on common sense and on the local availability of specially trained personnel. We find that "setting aside an hour or two" or referral to a pediatric neurologist or child psychiatrist" is rarely indicated. Drug therapy enters the picture only when hyperactivity is a feature of the problem.
Otitis Media and Milk Allergy
Authors: Ziering William H.
Published: December 2021

Bad manners are always out of style, but Dr. Richard Bland's retort on Dr. Barry Phillips' Letter to the Editor1 dramatizes the defect of intellectual pompousness. Quoting from "Folk Medicine" and a Bulletin from the Bishop Muscum is academically cute but irrelevant and irreverent. Dr. Phillips made a simple plea: consider milk allergy as a cause of recurring otitis media in infancy by substitution of a soybean formula for a trial period prior to polyethylene tube placement with or without adenotonsillectomy.
AUDIT OF MEDICAL RECORDS FROM PEDIATRIC SPECIALTY CLINICS
Authors: Meyers Alan
Published: December 2021

The medical records of 500 children attending pediatric specialty clinics were audited for the presence of data-base items that were deemed necessary for comprehensive evaluation and care. The charts were deficient in the following respects: no birthweight (22%), no gestational age (28%), no immunization record (44%), no nutritional data (53%), no growth chart (45%), no tuberculin test (73%), and no communication with referring physicians (20%). Forty-six percent of the records were deficient in four or more of these items. The findings demonstrate the need for a more structured data-base collection system.
EPIDERMOID CYSTS OF THE SPLEEN
Authors: Blank Eugene , Campbell John R.
Published: December 2021

Epidermoid cysts of the spleen must be considered in the differential diagnosis of splenomegaly in children. The diagnosis of these large fluid-filled masses is suggested in the asymptomatic child, and in the absence of a history suggesting a parasitic cause and with appropriate radiographic studies, a preoperative diagnosis can be made with considerable accuracy. The characteristic radiographic findings are those of a mass in the left upper quadrant of the abdomen which displaces gut and left kidney. Although selective arteriography may help to confirm the correct preoperative diagnosis, arteriography is not often necessary. This report describes four cases of epidermoid cysts of the spleen.
SOLITARY THYROID NODULES IN 30 CHILDREN AND REPORT OF A CHILD WITH A THYROID ABSCESS
Authors: Kirkland Rebecca T. , Kirkland John L. , Rosenberg Harvey S. , Harberg Franklin J. , Librik Leon , Clayton George W.
Published: December 2021

The occurrence of an abscess within the thyroid of a child prompted a survey to determine the nature of solitary nodules in 30 children. The pathological diagnoses revealed thyroid carcinoma in 40% with a variety of benign lesions which included follicular adenomas, nodular goiters, lymphoid struma, cysts, an abscess, absence of the isthmus, and fibrous thickening of the capsule.
NORMAL GRANULOCYTE INFUSION THERAPY FOR ASPERGILLOSIS IN CHRONIC GRANULOMATOUS DISEASE
Authors: Raubitschek Andrew A. , Levin Alan S. , Stites Daniel P. , Shaw Edward B. , Fudenberg H. Hugh
Published: December 2021

An 8-year-old boy with chronic granulomatous disease (CGD) was admitted in moribund condition with aspergillus pneumonia. Because of the gravity of the situation, normal granulocyte infusions were used as adjuncts to the more conventional antimicrobial therapy. White blood cells, derived from a total of 58 units of whole blood obtained by leukophoresis of the father, were given in two separate doses. The first dose, totaling 2.8 x 1010 granulocytes, was coincident with significant improvement, and the second, totaling 3.0 x 1010 granulocytes, was coincident with the onset of clinical improvement and interim recovery. Transient improvement in in vitro granulocyte function was noted in cells taken from the patient's blood immediately after infusion. No adverse effects of the infusions were noted in either the patient or the donor. Although it is impossible to divorce the therapeutic effect of the granulocyte infusions from the more conventional therapy, we conclude that normal granulocyte infusions can be considered a valid adjunct in children with CGD who are suffering from a life-threatening infection.
DEATH: A CONCEPT IN TRANSITION
Authors: Delmonico Francis L. , Randolph Judson G.
Published: December 2021

The concept has been put forth that "brain death" constitutes the true death of the patient, regardless of supported cardiorespiratory function. This premise has not been uniformly accepted by the medical profession or the laity.

The study presented evaluates opinions of 100 lay persons and 100 physicians as to their concept of death. In addition, a group of 70 freshman medical students were interviewed representing the transition from the lay to the medical orientation.

Forty-six percent of the physicians, forty-two percent of the freshman medical students and sixty percent of the lay people did not consider brain death an adequate definition of cessation of life. It would appear that the classic concept of death is ingrained in the majority of the laity as well as a sizable percentage of the medical profession. This has important connotations for the field of organ transplantation and for individual situations which evoke crucial decisions about the cessation of artificial support of individuals in various clinical states.

It is important that the medical profession as a whole assess the facts and standards which have been recommended from reliable sources on the subject of irrevocable death, so that some unification of thought will be realized. Only then can public education proceed, minimizing confusion, doubt, and misplaced hope.
HOW YELLOWNESS OR JAUNDICE WAS TREATED IN 1764
Authors: C. T. E.
Published: December 2021

Dr. John Theobald in his book entitled The Young Wife's Guide in the Management of Her Children, published in London in 1764, and compiled at the command of His Royal Highness The Duke of Cumberland, had this to say about the treatment of jaundice in children:

Many children are afflicted with this disorder, soon after birth, and some are born extremely yellow, when the mother has had the jaundice during her pregnancy: if the child is costive, once in two or three days, give it a little syrup of rhubarb, sufficient to purge it once, or twice, and on the intermediate days, give it night and morning the following powder in a spoonful of its mothers or nurses milk. Take bezoar mineral, and saffron, each one grain; powder of red coral three grains, mix them together for one dose. The nurse must be sure not to neglect this distemper, for if proper care is not taken, the child will fall into the watery gripes, which commonly carries it off.1
Letters to the Editor
Authors: S. C. A.
Published: December 2021

We cast a rather wide net for fillers and might well have included the prayer by Hutchison (not Hutchinson) among them. Your introduction of it here may draw wider attention to it than its appearance in Pediatrics, 43:127.

But to see the Hutchison words as a defense of good comprehensive care in pediatrics seems to us as indefensible as to regard the Dornhorst and Hunter quotation as an attack upon it. And would you not prefer "the man who knows most about so-and-so" if that illness were life-threatening, and in your family?
Additional References on the Tension-Fatigue Syndrome
Authors: Sandberg Douglas H.
Published: December 2021

The article by Dr. Jacob Øster1 describes very well the symptom complex which is now recognized by allergists under the name "the allergic tension-fatigue syndrome." As a pediatrician working primarily with gastrointestinal disorders, I have come in intimate contact with many children and parents with this symptom complex. In many of them I have seen remarkable improvement or complete disappearance of such symptoms with institution of elimination diets restricting common food allergens such as milk, wheat, and corn.
Gonorrheal Infection and Diagnostic Procedures: A Response to the Statement of the Committee on Youth
Authors: Ris Hania W.
Published: December 2021

The report of the Academy's Committee on Youth on "Venereal Disease and the Adolescent," in your September issue1 is most timely.

I would like to comment on the diagnosis of gonorrhea. While the cervix is considered the best site for culture of N. gonorrhoeae, our recent study2 of 1,899 girls yielded positive cultures in 213; 94.2% of these were from the vagina, while subsequent cervical cultures revealed only an additional 13 (5.8%) positive cases. Lucas et al3 found only a similar minor difference, with 92.4% of cervical and 89.5% of vaginal cultures positive in the same patient.
Letters to the Editor
Authors: Hazards Sprague H.
Published: December 2021

The information contributed by Dr. Ris regarding her success with vaginal cultures for N. gonorrhoeae is a welcome addition to the Academy's statement "Venereal Disease and the Adolescent," as are her comments on experience with Thayer-Martin medium. The incidence of the disease in the environment where Dr. Ris has conducted her studies has undoubtedly increased her preference for the mode of culturing she recommends. Meticulous attention to the details of culturing and the handling of the media en route to the incubator, as well as skillful laboratory interpretation, are of proven importance in recovering and identifying this elusive organism.
Infantile Hiatal Hernia in North America and Europe
Authors: Riggs Webster , Guttman Frank
Published: December 2021

In discussing the causes of the difference in the incidence of infantile hiatal hernia between North America and Europe,1 it interests me that the author gives only slight and indirect mention to what I think is the most important variable–the role of the radiologist. It is he alone who makes the diagnosis, based largely on fluoroscopic findings.

Nothing in radiology is so complex and controversial as is the radiologic diagnosis of hiatal hernia. I have personally observed that European pediatric radiologists are more liberal with this diagnosis, describing small hiatal hernias that most American pediatric radiologists would call chalasia, or within normal limits.
Public Health and the State: Changing Views in Massachusetts, 1842-1936, by Barbara Gutmann Rosenkrantz. Cambridge, Massachusetts: Harvard University Press, 1972, 259 pp., $9.00
Authors: Schmidt William M.
Published: December 2021

This book was written in commemoration of the 100th anniversary of the founding of the Massachusetts State Board of Health. It is a record of events in mid-l9th century Massachusetts which led to the establishment of the Board of Health and of the changes in structure and functions of the State health authority from 1869 to 1936. It is, however, much more than this. As the subtitle indicates, this is a history of views and opinions about public health, particularly conflicting views as to the nature and extent of the Commonwealth's public health responsibilities.
CONTROL OF STAPHYLOCOCCAL INFECTIONS AND DISEASE IN THE NEWBORN THROUGH THE USE OF HEXACHLOROPHENE BATHING
Authors: Gezon Horace M. , Thompson Donovan J. , Rogers Kenneth D. , Hatch Theodore F. , Rycheck Russell R. , Yee Robert B.
Published: December 2021

Efforts to control staphylococcal infection in newborn infants by rigidly enforced asepsis in an ideal nursery environment failed. Partial success was obtained using a 3% hexachlorophene detergent emulsion once or six times a day to bathe the diaper area only or as a daily whole body bath during the nursery stay when half of the babies were so treated. The reservoir of staphylococcal infections in the untreated infants resulted in this limited success. The incidence of infection was further reduced when all of the infants in the nursery were bathed with this emulsion or had ½% hexachlorophene applied to the skin daily after a water bath. The maximum reduction in staphylococcal disease in infants was obtained when hexachlorophene-containing preparations were used daily throughout the first 3 weeks of life. Comparable reduction in infection and disease was obtained with daily application of neomycin-bacitracin-polymyxin ointment to the umbilicus-circumcision sites during the hospital stay followed by hexachlorophene bathing at home.
PEDIATRICS AND THE ADOLESCENT
Authors: Janeway Charles A.
Published: December 2021

It gives me particular pleasure to participate in this ceremony today because of personal associations with the two men we are honoring by it. When, in 1946, as a very green convert to pediatrics, in my fourth year of on the job training at the Children's Hospital, I found myself about to take over the responsibility for a distinguished academic department, Dr. Richard M. Smith, knowing full well the deficiencies in my pediatric training, wisely told me that I ought to go to Rochester, Minnesota and see what Andy Aldrich was doing in his comprehensive child health care project there. For nearly a week I enjoyed the warm hospitality of the pediatric staff at the Mayo Clinic, particularly the Helmholtzes and the Aldriches, and spent my days with Dr. Aldrich, watching him as he made his rounds in the newborn nursery or counselled mothers in the child health clinic. It was a rare privilege to be able to sit at the feet of a great master, and learn from him in the one-to-one relationship which has always been the basis of the best in education. I remember well his infectious enthusiasm for detecting temperamental differences in babies in their first few days of extrauterine life. He used to carry a spring scale for weighing fish in his pocket, with a loop at its end which he'd put around the baby's ankle, in an effort to quantitate the differences in muscle tone, which might, at some later date, be correlated with motor development or emotional responses in the growing child.
PERSISTENCE OF IMMUNITY FOLLOWING MONOVALENT AND COMBINED LIVE MEASLES, MUMPS, AND RUBELLA VIRUS VACCINES
Authors: Weibel Robert E. , Buynak Eugene B. , Stokes Joseph , Hilleman Maurice R.
Published: December 2021

Neutralizing antibody following Jeryl Lynn mumps virus vaccine persisted for at least six years after vaccination without substantial decline in titer, and protective immunity was solidly retained through the sixth observation year. Hemagglutination-inhibiting antibodies following vaccination with Enders' original Edmonston and more attenuated Moraten and Schwarz lines measles vaccines were retained in comparable level through the fourth year.

Antibody following HPV-77 duck rubella vaccine was retained without important decline for at least 3½ years. The pattern for antibody persistence following combined measles-mumps-rubella and mumps-rubella vaccine measured at three years and for measles-rubella vaccine measured at two years was the same as for the monovalent vaccines indicating no alteration in the retention of immunity. None of the children in this study lost his antibody completely. Subclinical reinfection evidenced by antibody increase was commonly seen in vaccinated persons.
EFFECT OF FEEDING ON SCREENING FOR PKU IN INFANTS
Authors: Dontanville Virginia K. , Cunningham George C.
Published: December 2021

No relationship between the phenylalanine content of the feedings prior to the PKU screening test and a positive test result (≥4 mg/100 ml) could be demonstrated in a study of hospital records of 68 phenylketonuric, 14 atypical, and 26 hyperphenylalaninemic infants.

The mean age at testing was 62.8 hours. The median intake before testing was 383 mg of phenylalanine with a range of 0 in five cases to over 3,000 mg for two late tested infants. One quarter of the infants with positive tests had ingested less than 200 mg of phenylalanine, while only one of the 11 with negative tests had less than 200 mg. The "missed" cases were represented at each intake interval, and intakes ranged from 174 to 1,326 mg phenylalanine.

Screening test results ranged from 1 to 40 mg/100 ml (mean of 10.0) with wide variation at all intervals of phenylalanine intake. There was a gradual increase in mean levels from 7.1 mg/100 ml in the group with least intake to 13.0 for those having the most. This increase was attributable mainly to the PKUs whose mean levels were higher than those of the atypicals and hypers at all intake intervals, and went much higher with increased intake. Serial tests on 20 infants who had repeat testing in the first few days of life when feeding was documented demonstrated the rapid rise in serum levels in PKUs as feeding continued in contrast to the atypicals and hypers who showed only slight increases during this period.

The authors conclude there is no evidence that missed cases are significantly related to feeding protein or early testing in routine PKU screening of the newborn infant.
PEDIATRIC FRACTURES OF JAW AND FACIAL BONES
Authors: Waite Daniel E.
Published: December 2021

The author has reviewed the literature in the area of jaw and facial fractures in the pediatric patient. There are differences in incidence and treatment between the pediatric and adult patient. A review of the treatment principles for pediatric patient management is provided. Special attention is devoted to the use of "stock" trough splints in the treatment of mandibular fractures. The conservative treatment of condylar fractures is advocated.
The Risk of Lumbar Puncture in Pediatric Patients With Cardiac and/or Pulmonary Disease
Authors: Margolis Carmi Z. , Coox Charles D.
Published: December 2021

In the setting of a large hospital, and probably particularly in a teaching hospital, the dictum, "Do no harm," is often ignored in the rush to do all imaginable tests and "look for zebras" when at least the major diagnosis may be obvious. Three examples, encountered in a one-year period, of infants with primary cardiac or pulmonary diseases who suffered fatal or near fatal effects from an unnecessary lumbar puncture are the basis of this report.

Case 1

A 4½-month-old black male presented in the emergency room with a one-day history of vomiting and diarrhea. The patient was a 1,710-gm first dizygotic twin born at 36 weeks to a 36-year-old multipara who had premature rupture of the membranes.
ARTIFICIAL VENTILATION IN HYALINE MEMBRANE DISEASE: THE USE OF POSITIVE END-EXPIRATORY PRESSURE AND CONTINUOUS POSITIVE AIRWAY PRESSURE
Authors: Cumarasamy Niloufer , Nüssli Rosmarie , Vischer Dieter , Dangel Peter H. , Duc Gabriel V.
Published: December 2021

During the years 1969, 1970, and 1971, 120 infants with hyaline membrane disease were studied, of whom 71 were treated with artificial ventilation. Among other changes in 1971, positive end-expiratory pressure was applied during mechanical ventilation and continuous positive airway pressure maintained during the weaning period. The survival rate of the ventilated babies increased from 23% in the preceding two years to 70% in 1971. As this study is not a controlled trial, the observed increase in survival cannot be ascribed to the application of increased airway pressure alone. The data presented, though necessarily inconclusive, may be useful for continuing comparisons with other pediatric centers.
X-LINKED AQUEDUCTAL STENOSIS: CLINICAL AND NEUROPATHOLOGICAL FINDINGS IN TWO FAMILIES
Authors: Holmes Lewis B. , Nash Andrea , ZuRhein Gabriele M. , Levin Michael , Opitz John M.
Published: December 2021

Significant variation in the neuropathological abnormalities associated with X-linked aqueductal stenosis has been found in males from two unrelated families. Family A is the first reported family with this disorder. A recently born male infant had stenosis and forking of the aqueduct, whereas his uncle had only stenosis. In family B one male had extensive midline fusion of the thalami in addition to aqueductal stenosis and forking. These findings of phenotypic variability indicate broader criteria for establishing the diagnosis of X-linked recessive aqueductal stenosis.
THE CHRONIC DISEASE FLOW SHEET IN AMBULATORY PEDIATRICS
Authors: Schmitt Barton D.
Published: December 2021

The comprehensive management of chronic diseases can be very taxing on the pediatrician. One of the more difficult aspects is how to locate the pertinent data, both past and current, necessary for making medical decisions. The chronic disease flow sheet provides a system for easier monitoring of the multiple interacting variables present in chronic diseases. General recommendations are offered for designing new flow sheets. Sample flow sheets are included as working models for 19 common chronic conditions. The value of chronic disease flow sheets in patient care, teaching, and clinical research is discussed.
Thiamine Deficiency: Probable Wernicke's Encephalopathy Successfully Treated in a Child With Acute Lymphocytic Leukemia
Authors: Shah Narayan , Wolff James A.
Published: December 2021

The classical clinical picture of the syndrome described by Wernicke1 consists of disturbances of consciousness, ophthalmoplegia, and ataxia. It has been ascribed to thiamine deficiency, although other dietary deficiencies may contribute to its development. The fullblown triad is frequently not present, a confused state often being the only manifestation. This may progress to stupor or coma. The condition has been described in adults with alcoholism, in chronic gastrointestinal disease, in prisoners of war maintained on very precarious diets and in obese patients kept on restricted diets without adequate vitamin supplementation.2

Guerrero3 in 1949 reported two infants with Wernicke's syndrome due to vitamin B deficiency.
Prolonged Apnea, Vagal Overactivity, and Sudden Infant Death
Authors: Bachman David S.
Published: December 2021

The article on prolonged apnea and the sudden infant death syndrome (SIDS) by Steinschneider1 is very exciting in that it suggests the possibility of identifying infants at risk from SIDS before the final event. Obviously, it is of great importance to learn the mechanism causing the preceding apneic episodes. Do they represent vagal overactivity?

Stimulation of the intact vagus nerve in the unanesthetized monkey causes apnea, as well as bradycardia and even arrhythmias.2 In fact, we have seen myocardial myocytolysis secondary to vagal stimulation.3
Urine VMA Screening for Neuroblastoma: Is It Worth the Cost?
Authors: Hallett George W.
Published: December 2021

In a recent article in the Journal of Pediatric Surgery, Leonard et al.1 recommend that the VMA test strip be performed during the first seven years of life as a routine screening test for neuroblastoma. A pediatric manual of the Massachusetts General Hospital, 1972, also states on page 3, item 5: "Urine VMA screening dipstick should be done routinely on all infants, and annually on all children under four." Lest pediatricians accept these recommendations without further examination, it would be worthwhile to analyze cost factors before embarking on this "simple" screening program.