bluuebunny/crossref_metadata_2025 huggingface dataset:
COARCTATION OF THE ABDOMINAL AORTA IN CHILDREN: REPORT OF THREE CASES AND REVIEW OF THE LITERATURE
Authors: Riemenschneider Thomas A. , Emmanouilides George C. , Hirose Frank , Linde Leonard M.
Published: December 2021

Three patients with coarctation of the abdominal aorta who were observed in an 8-year period illustrate some of the problems in diagnosis and management of this lesion. Coarctation was located at the level of the renal arteries in two instances, and above the renal vessels in the third. Bypass graft resulted in significant improvement in one patient. The second patient is presently asymptomatic with only mild systemic hypertension. A promotion thrombosis complicated the clinical course of the third infant and contributed to her early death. Histologic examination of the aortic wall revealed a unique pattern of fibromuscular dysplasia in this patient.

Sixty-nine additional instances of this malformation have been reported in children. On the basis of this review, coarctation of the abdominal aorta may be classified into segmental and hypoplastic types. Renal arterial abnormalities are frequently associated. Physical examination reveals systolic murmurs and thrills in the epigastric and lumbar areas. Roentgenographic studies demonstrate a normal aortic arch and absence of rib notching. The atypical location of the coarctation is confirmed by abdominal aortography.

The primary factor affecting ultimate prognosis is the presence of associated renal artery pathology. Operative procedures must include repair or bypass of significant renal arterial abnormalities.
Transient Hyperglycemia and Aketotic Hyperosmolar Acidosis with Heat Stroke
Authors: Monteleone James A. , Keefe David M.
Published: December 2021

Five children are described with aketotic, hyperosmolar, and non-diabetic hyperglycemia. Four of the children were suffering from heat stroke, the etiology was undetermined in the fifth. The cases of heat stroke were managed by reduction of the elevated temperature and fluid replacement. No insulin was used and the elevated blood sugars returned promptly to normal. A possible mechanism is discussed.
Scarlet Fever with Hydrops of the Gallbladder
Authors: Strauss Ronald G.
Published: December 2021

A 69/12-year-old white boy with acute distension of the gallbladder during an episode of scarlet fever is reported. Case reports of nine children with acute distention of the gallblader are reviewed. This condition is found in both boys and girls at many ages. Abdominal pain is invariably present, while fever, jaundice, or an abdominal mass are less frequently seen. The pathogenesis is obscure, but mesenteric adenopathy has been noted and these nodes may obstruct the biliary tree. It is important to recognize acute distention of the gallbladder because the therapy is simple aspiration or cholecystostomy.
ADOLESCENT PROCESS AND THE NEED FOR PERSONAL CONFRONTATION
Authors: Winnicott D. W.
Published: December 2021

In brief, it is exciting that adolescence has become vocal and active, but the adolescent striving that makes itself felt over the whole world today needs to be met, needs to be given reality by an act of confrontation. Confrontation must be personal. Adults are needed if adolescents are to have life and liveliness. Confrontation belongs to containment that is non-retaliatory, without vindictiveness, but having its own strength. It is salutary to remember that the present student unrest and its manifest expression may be in part a product of the attitude that we are proud to have attained toward baby care, and child care, Let the young alter society and teach grownups how to see the world afresh; but, where there is the challenge of the growing boy or girl, there let an adult meet the challenge. And, it will not necessarily be nice.

In the unconscious fantasy these are matters of life and death.
Night Cries and Otitis
Authors: Multach David
Published: December 2021

I read with interest S. Levin's article on Night Cries in Little Girls. May I suggest a similar comment on Night Cries in Little Babies.

In the past several years I automatically question every parent who calls concerning a cold in their infant of less than one year of age, asking them how well their child slept. If the child was restless or whimpered or was just up more than normal, I will ask the mother to bring the baby to be seen and in the great majonity of cases the baby has an otitis media.
Problems in Child Behavior and Development, by Milton J. E. Senn, M.D., and Albert J. Solnit, M.D. Philadelphia: Lea and Febiger, 1968, 268 pp., $8.50
Authors: Cohen Donald J.
Published: December 2021

The question, "Training for what?" is difficult to answer in pediatrics. The resident works hard to become competent in pediatric cardiology, hematology, neurology, and the other medical specialties. Rarely will he have the same kind of opportunity to be trained in child psychiatry—in the techniques of psychological study and care and in the theory that makes these techniques rational. When his training is over, the resident may be expected to participate with parents in raising their children.
Il Mongolismo, Auxopatia, Somatopsichica, Cariotipica, by Enrico Aldeghi and Amelia Maderna, with the collaboration of Aureliano Rovescalli and Nardo Calvi. Torino, Italy: Edizioni Minerva Medica, 1968, 418 pp. (price approximately $18.00). In Italian
Authors: Zellweger Hans
Published: December 2021

The multitude of laboratory methods available nowadays in our diagnostic armamentanium often lead the physician to under estimate and to disregard the clinical signs and symptoms. This has become true even for conditions such as mongolism which (in the pre-cytogenetic era) was recognized only by its clinical criteria. It was pleasing, therefore, to read the monograph of Aldeghi and Maderna, both from the Child Psychiatric Division of the Psychiatric Institute of the Province of Milan, Italy.
Vision Screening of Preschool Children, by Leon J. Taubenhaus, M.D., M.P.H., D.H.L. (Hon.) and Anne A. Jackson. Springfield, Illinois: Charles C Thomas, 1969, 106 pp., $8.75
Authors: Robb Richard M.
Published: December 2021

This book is primarily concerned with the organizational aspects of a preschool vision screening program. Chapter titles such as Public Relations, Volunteer Recruitment, and General Procedure for Conduct in a School, give the flavor of the subject matter. For information about the relative value of various kinds of acuity testing at a given age one would have to consult the references listed at the end of the book. The author's personal expenience is with the Snellen illiterate E, the Sjogren hand, Allen picture cards, and the Titmus screener.
Firecracker Injuries of the Eye
Authors: Fishman Ronald S.
Published: December 2021

An exploding firecracker drove a large plastic fragment into the eye of a 9-year-old boy. Eventual extrusion of this intraocular foreign body necessitated removal of the eye. The eye of another boy was ruptured by a firecracker a few days before the fourth of July, resulting in permanent severe visual loss. Eternal vigilance in prohibiting the sale of firecrackers is necessary to prevent such injuries.
SOCIAL HEALTH
Authors: Thompson Hugh C.
Published: December 2021

During the past four decades, while our knowledge of physical disease has increased enormously, the scope of concern in pediatrics has broadened to inelude the intellectual development, school performance, emotional maturation, and behavioral disorders of children. Pediatricians are increasingly aware that much of the pathology of whatever nature in the children they treat has causes which lie in the social environment of their families and ultimately in the ill health of society itself—often, and most especially, in poverty. This paper is about these latter problems and about our responsibility, as mdividuals in society, as physicians, and as members of the American Academy of Pediatrics, to promote-by all the means at our disposal social health—that condition of the environment which will allow for the optimum functioning of tile individuals within it.

We may think of the etiology of much childhood ill health as a series of steps, each one further removed from the actual illness. The chain of causality leading to disease could be illustrated by a multitude of illnesses : prematurity, cerebral palsy, enteric diseases, drug abuse, teenage pregnancy. Accidental drug poisoning will be used as an example because it is simple and familiar to us all and because its relation to social health may not be clear initially. The traditional area of medical activity is the diagnosis and treatment of the poisoning itself. Physicians attempt as well to prevent such poisoning by dealing with its immediate cause, the child's finding and ingestion of the toxic substance. We substitute acetaminophen for aspirin, provide safety closures for medicine bottles, and urge locked medicine cabinets.
Handbuch der Medizinischen Radiologie-Encyclopedia of Medical Radiology: Roentgen Diagnosis of Diseases of the Skeletal System, Vol. 5, part 3, edited by L. Diethelm, O. Olsson, F. Strnad, H. Vieten, and A. Zuppinger. Berlin/Heidelberg/New York: Springer-Verlag, 1968, 846 pp., $79.50 (In German)
Authors: May Detlef A.
Published: December 2021

The authors present a detailed description of congenital and acquired diseases of the skeletal system by dividing the subject into four sections. The first section reviews the hereditary skeletal abnormalities, and the second covers inflammatory and degenerative joint diseases, benign and malignant joint tumors. Section III deals with abnormalities of growth and maturation, and the last section outlines the complicated anomalies of the skeletal system.

Each chapter encompasses detailed descriptions of skeletal diseases with detailed presentation of the essential finding, synonyms, mcidence, hereditary and familial influence, sex, age, clinical manifestations, radiographic appearance, and clinical and radiographic course.
AORTIC BLOOD PRESSURE IN NORMAL NEWBORN INFANTS DURING THE FIRST 12 HOURS OF LIFE
Authors: Kitterman Joseph A. , Phibbs Roderic H. , Tooley William H.
Published: December 2021

Indwelling umbilical arterial catheters were used without difficulty to measure direct arterial blood pressure in newborn infants. Normal values were determined for mean aortic blood pressure during the first 12 hours of life in 45 infants who were expected, from history, to be subject to cardiopulmonary insufficiency at birth but who, after birth, were judged to be clinically well. Birth weights of these infants ranged from 1,050 to 4,220 gm, and gestational age ranged from 26 to 41 weeks. All infants were of appropriate weight for gestational age. Mean blood pressure correlated closely with birth weight and the relationship was best described by a parabolic regression [y = 35.53 + 0.36 (x) + 1.01 (x2)], where y = mean aortic blood pressure in millimeters mercury and x = birth weight in kilograms. The lower limit of normal mean aortic blood pressure was 30 mm Hg at 1,001 to 2,000 gm, 35 mm Hg at 3,000 gm, and 43 mm Hg at 4,000 gm.

It is recommended that aortic blood pressure be measured routinely in all infants who are apt to develop cardiopulmonary insufficiency and have indwelling umbilical arterial catheters.
FAMILIAL HEARING LOSS ASSOCIATED WITH BRANCHIAL FISTULAS
Authors: Rowley Peter T.
Published: December 2021

A family is presented with cervical and preauricular branchial fistulas and congenital hearing loss. The hearing loss is unusual in having both conductive and sensorineural components. The basis of the conductive defect in the propositus was demonstrated at surgery to be a malformation of the ossicles. Hypoplasia of the mandible was present in two individuals. The syndrome was inherited as an autosomal dominant trait with variable expressivity and apparently incomplete penetrance.

The occurrence of branchial fistulas should precipitate a search for defective hearing among relatives, especially in young children where early diagnosis and correction may permit the normal development of speech.
A DESCRIPTIVE STUDY OF A PEDIATRIC INTERNSHIP
Authors: Levine Melvin D. , Robertson Leon S. , Alpert Joel J.
Published: December 2021

The patient content of a pediatric internship was studied. While 60% of the internship is spent on inpatient services, almost 90% of the defined patient contacts occurred in the ambulatory services. The intern was more likely to provide care to advantaged families in the inpatient services. In this paper the development of a teaching program in the ambulatory services is suggested as an essential part of pediatric education.
THE CRITICALLY ILL CHILD: MANAGEMENT OF ACUTE BACTERIAL MENINGITIS
Authors: Wehrle Paul F. , Mathies Allen W. , Leedom John M.
Published: December 2021

The presently available, effective antimicrobial therapy has substantially decreased the frequency of disability due to meningitis and has been even more effective in reducing mortality. Optimum therapeutic results are dependent upon prompt clinical recognition of disease, the specific identification of the infectious agent, the prompt administration of bactericidal drugs by the intravenous route, and proper monitoring of the patient during the acute illness. Indeed, rapid diagnosis, monitoring the patient for shock with prompt restoration of effective circulation, early detection of complications, and proper concern toward rehabilitative measures are features of therapy which may be as important as choosing the right antimicrobial.
I. CLINICAL AND PSYCHOLOGICAL EFFECTS OF MARIJUANA IN MAN
Authors: Weil A. T. , Zinberg N. E. , Nelsen J. M.
Published: December 2021

Not to prove or disprove popularly held ideas on marijuana, but to collect "some long overdue pharmacological data," a series of experiments on acute marijuana (cannabis sativa) intoxication were conducted in 1968 in the Behavioral Pharmacology Laboratory of The Boston University School of Medicine.

Three previous studies, Siler, et al1., The La Guardia Report2, and Williams, et al3., had reported a variety of consequences, including minimum physiological response. No controls were provided, and there was no dosage control.

The authors present the first known controlled double-blind study. Nine subjects who had not smoked marijuana were found with extreme difficulty and after 2 months of interviewing among the Boston student population.
II. THE EFFECTS OF MARIJUANA ON HUMAN BEINGS
Authors: Zinberg N. E. , Weil A. T.
Published: December 2021

The authors review and discuss the findings which they reported in Science, December 13, 1968. No human experiments with marijuana designed according to modern principles of drug testing had been previously performed.

The pharmacologic action of a drug is but one of three factors in its effect; the others are "set"—the individual's expectations of what the drug will do—and "setting" —the total environment (physical and social) in which a drug is taken. Set and setting can overshadow pharmacologic action. Asking drug users what effect they get is grossly unreliable; on the other hand, laboratory studies must be designed so that, through environmental manipulation, an observed effect may be ascribed to a known cause (as the administration of a drug).
CALCITONIN: ITS NATURE AND ROLE IN MAN
Authors: Haymovits Asher , Rosen John F.
Published: December 2021

In the short span of 7 years since the first evidence for the existence of the hypocalcemic, hypophosphatemic principle, calcitonin, was advanced by Copp, et al., the study of this hormone has revealed many aspects of its chemical properties, biological action, and phylogenetic significance. Recently, the study of this hormone culminated in the structure determination and synthesis of the poncine and human hormones.

During this period, the subject has been reviewed by several authors and it has been discussed at three international meetings.

The purpose of this communication is to deal with the recent information that accrued since publication of those reviews. This newer information will be discussed with particular reference to the role of the hormone in children and adults.

Consideration will be given to the distribution in nature, structure, and physicochemical and biological properties of the hormone; its measurement, regulation of secretion, and laboratory synthesis; and, finally, its role in health and disease in humans.

DISTRIBUTION IN NATURE

Calcitonin on calcitonin-like activity has been demonstrated in tissues derived from embryological precursors of the thyroid and other pharyngeal glands of every mammalian species tested to date. A partial list includes the guinea-pig, rabbit, sheep, goat, pig, cattle, monkey, and man. In vertebrates other than mammals, calcitonin activity is widely distributed, although its role and action in these forms await further study.

Tissue of Origin

Copp's original experiments in the dog did not differentiate between the thyroid and parathyroid glands as the source of calcitonin. However, the thyroid origin of the hormone in some mammals was later suggested by perfusion studies in the goat and pig and finally proved by a demonstration of calcitonin activity in thyroid homogenates.
Letter To The Editor
Authors: Nathan David G.
Published: December 2021

Dr. Stiehm is preparing a reply. Dr. Nathan comments as follows:

Several important points are made by the letters of Drs. Chessells and Pitney, Ekert and Hathaway. It is certainly true that the collection of blood in the presence of an inhibitor of fibrinolysin will reduce in vitro formation of fibrin split products. In addition, it is clear that failure to clot the blood completely will permit the continuous action of fibrinolysin on fibrinogen or seriously obfuscate an immunological assay of fibrin split products since residual immunoreactive fibrinogen will remain in the "serum" if clotting is not complete.
Letter To The Editor
Authors: Ekelund Hans , Hedner Ulla , Nilsson Inga Marie
Published: December 2021

The May 1969 issue (Pediatrics, 43: 770) contained an article by Stiehm and Clatanoff on "split products of fibrin in the serum of newborns." The authors discuss the origin of these split products and their possible clinical significance in different pathological conditions in the newborn.

At our laboratory we have recently completed a study of the fibrinolytic system in newborns which will be published in Acta paediatrica Scandinavia (accepted for publication July 16, 1969). Our material consists of 207 normal, full term newborns, where blood has been collected by catheterization of the umbilical vein during the first 5 days of life.
THE INFLUENCE OF MATERNAL GLUCOSE INFUSIONS ON FETAL GROWTH HORMONE LEVELS
Authors: Wolf H. , Stubbe P. , Šabata V.
Published: December 2021

The present investigation was designed to provide information on growth hormone response to changing blood glucose levels in the neonatal period. Three groups of mothers and their infants were studied. The first group consisted of 10 women in labor who received constant glucose infusions, the second group consisted of 10 women who received glucose-insulin infusions; a third group of 20 mothers received no infusion at all. It was shown that the normally high levels of growth hormone in cord blood may be still further elevated by maternal glucose or glucose-insulin infusions shortly before birth. If the utilization and reserves of carbohydrates during the neonatal period are insufficient, high growth hormone levels may help to initiate the mobilization of fat needed to supply energy.
DR. WILLIAM BUCHAN'S (1729-1805) THOUGHTS ON CROUP; ITS CAUSE TREATMENT, AND PREVENTION IN CHILDHOOD
Authors: C. T. E.
Published: December 2021

No book was more sought after by families in the early decades of our country than Buchan's Domestic Medicine, which was first published in England in 1769 and passed through 19 editions during the following 50 years. Buchan described the signs, symptoms and treatment of children with croup as follows:

Children are often seized very suddenly with this disease, which, if not quickly relieved, proves mortal. . . . This disease generally prevails in cold and wet seasons. It is most common upon the seacoast, and in low marshy countries. Children of a gross and lax habit are most liable to it. . . . It generally attacks children in the night, after having been much exposed to damp cold easterly winds through the day. Damp houses, wet feet, thin shoes, wet clothes, or any thing that obstructs the perspiration, may occasion the croup.

It is attended with a frequent pulse, quick and laborious breathing, which is performed with a peculiar kind of croaking noise, that must be heard at a considerable distance. The voice is sharp and shrill, and the face is generally much flushed, though sometimes it is of a livid colour.

When a child is seized with the above symptoms, his feet should be immediately put into warm water. He ought likewise to be bled, and to have a laxative clyster administered as soon as possible.

He should be made to breathe over the steams of warm water and vinegar; or an emollient decoction, and emollient cataplasms or fomentations may be applied round his neck.
Urinary Retention Due to Fecal Impaction in Children
Authors: Gallo David , Presman David
Published: December 2021

The relationship between fecal impaction and urinary retention in children is demonstrated by a report of three such instances. The importance of a routine rectal examination in all children with urinary difficulty is emphasized in order to avoid performing needless diagnostic and surgical procedures.
Phototherapy of Neonatal Hyperbilirubinemia (Continued)
Authors: Rosenfeld Charles R.
Published: December 2021

It is of interest that in recent articles about phototherapy for hyperbilirubinemia, one frequently finds statements such as, "the photochemical breakdown products must be considered safer than the unconjugated bilirubin, which is known to be toxic." I think that in this day and age of modern medicine and scientific research, one cannot accept this as good reasoning until it can be proven beyond a shadow of doubt that there is no danger to the patient. Others state that there are over 1,000 infants treated this way,2 but do not state studies with adequate follow-up which show that there are no sequelae.
VITAMIN D DEPENDENCY
Authors: Scriver Charles R.
Published: December 2021

A condition still quite unfamiliar to many physicians is discussed in this issue of Pediatrics. The disease, called "Vitamin-D-dependent rickets" in the accompanying article, was first segregated from the array of "Vitamin-D-resistant rickets" by Fraser and Salter2 (Type III, A, ii, in their classification), and by Prader and colleagues3 (hereditary pseudo-vitamin-D-deficiency rickets, in their terminology). The condition is characterized by signs and symptoms which appear in the first year of life, and which are easily mistaken for those of severe (Stage III) vitamin D deficiency4. As revealed in typical case reports of the condition3,5, manifestations include muscular weakness, convulsions, severe rickets, growth failure, hypophosphatemia, low or normal total serum calcium, mild renal tubular acidosis, and hyperaminoaciduria.
WATER AND ELECTROLYTE LOSSES DUE TO CHOLERA IN INFANTS AND SMALL CHILDREN: A RECOVERY BALANCE STUDY
Authors: Mahalanabis Dilip , Wallace Craig K. , Kallen Ronald J. , Mondal Arabindo , Pierce Nathaniel F.
Published: December 2021

Complete recovery balance studies on six infants with severe cholera are reported. Supporting data from a larger group of children with cholera, with particular reference to stool and small intestinal fluid composition, are also reported. The mean and range (in parentheses) for net retention at the end of the balance studies were: water, 96 gm (47—119); sodium, 10.5 mM (5.3—16.7); chloride, 8.9 mM (5.8—12.5); and potassium, 6.5 mM (4.3—9.7); all values are per kilogram of final body weight. Mean values for average evaporative water losses over day and night ranged from 31 gm to 63 gm/kg/24 hours. Stool output requiring parenteral replacement continued for 24 to 60 hours in five of six patients, and 48-hour stool output equaled 1:3 to 22% of final body weight.

Stool composition in pediatric cholera is compared to that in infantile diarrhea and adult cholera. Significant differences from each of the latter two are described in this paper.
Child Abuse: A Different Point of View
Authors: Joos Thad H.
Published: December 2021

Woolley and Evans1 were among the first to report a series of children in whom abuse at the hands of adults led to serious bodily harm in the child. Since their paper, other authors2,3 have contributed articles attesting to this sad and ever present threat to the well-being of youngsters.

Child abuse, in a very subtle form, is encountered almost daily by the Pediatric Allergist when he sees children suffering from severe allergic rhinitis or asthma, in whom environmental allergens, such as household pets, play a prominent role.
INTRA-UTERINE TRANSFUSION: FETAL OUTCOME AND COMPLICATIONS
Authors: Fong Susie W. , Margolis A. J. , Westberg J. A. , Johnson P.
Published: December 2021

One hundred and ten intra-uterine transfusions (IUT) were performed on 73 fetuses selected primarily on the basis of serial amniotic fluid analyses at the 450 mµ peak. In support of IUT for the current pregnancy, all but five of the mothers had a history of previous stillbirths and infants severely affected by hemolytic disease of the newborn.

Eighteen (2 hydropic and 16 nonhydropic) of the 73 fetuses survived. The extremely poor outcome of those who exhibited excessive ascitic fluid at the time of paracentesis would lead us to believe that IUT is of questionable value after the development of hydrops fetalis. The survival rate of nonhydropic fetuses was better than 50% when slow blood infusion and the use of smaller blood volumes was initiated.

One of the 16 nonhydropic infants suffered severe respiratory depression after birth, which resulted in cerebral damage. No neurological, developmental, or immunological aberrations were observed in the remaining 15 survivors after 4 years of follow-up.
HOW BOSTON YOUNG LADIES IN 1836 SHOULD ACT TOWARD YOUNG MEN
Authors: C. T. E.
Published: December 2021

Young girls once received much advice about how to behave toward young men. The following is quite typical of the rules of behavior or taught to proper Boston young girls in the 1830's:

If the natural feelings of modesty are not sufficient to guard you from all personal familiarity with the young men of your acquaintance, let good breeding, and good taste, aid you in laying down rules for yourself on this head. Never join in any rude plays, that will subject you to being kissed or handled in any way by gentlemen. Do not suffer your hand to be squeezed, without showing that it displeases you by instantly withdrawing it. If a finger is put out to touch a chain that is round your neck, or a breast-pin that you are wearing, draw back, and take it off for inspection. Accept not unnecessary assistance in putting on cloaks, shawls, over-shoes, or anything of the sort. Be not lifted in and out of carriages, on or off a horse; sit not with another in a place that is too narrow; read not out of the same book; let not your eagerness to see anything induce you to place your head close to another person's. These, and many other little points of delicacy and refinement, deserve to be made fixed habits, and then they will sit easily and gracefully upon you, heightening the respect of all who approach you, and operating as an almost invisible, though a very impenetrable fence, keeping off vulgar familiarity, and that desecration of the person, which has too often led to vice.1
PURIFIED INFLUENZA VACCINE TRIAL IN A CHILDREN'S HOME
Authors: Phillips Carol F. , Phillips Charles A. , Forsyth Ben R.
Published: December 2021

Twenty-two of 30 children residing in a children's center and 32 adult employees received a single inoculation of purified, killed, monovalent, influenza virus vaccine prepared with the Hong Kong variant of influenza A2 virus. All children showed significant four-fold or greater rises in HI antibody titer following vaccination, while 28 of 32 adults (88%) showed four-fold or greater rises in HI antibody titer. Twenty-five children living outside of the children's center were also immunized and those from whom paired sera were obtained (eight) showed four-fold or greater rises in HI antibody titer. Geometric mean titer rises from <10 to 93.6 in children and from < 10 to 70.9 in adults were recorded. Local reactions were limited to mild redness in one half of the children, and transient redness or soreness was seen in one half of the adults. No systemic reactions were seen in the children, but one adult had fever and malaise of 24 hours' duration.

In contrast to previously available influenza vaccines, the highly purified vaccine seems to be more satisfactory for use in children of school age; it should be particularly advantageous for use in children who are being immunized because of an underlying debilitating disease.
DIRECT EVIDENCE OF MUTATION AT THE LOCUS FOR GALACTOSE-I-PHOSPHATE URIDYL TRANSFERASE
Authors: Mellman William J. , Allen Fred H. , Baker Lester , Tedesco Thomas A.
Published: December 2021

An apparent fresh mutation has been identified at the human transferase locus (Gt) that has resulted in an occurrence of the heterozygous state for galactosemia (Gt+/GtG). The individual concerned is the mother of a child with galactosemia, neither of whose parents was found to be heterozygous for galactosemia.

Recently discovered human genetic markers and established blood group antigens have been used to test for non-paternity as an alternative explanation to mutation. Paternity was proven in this instance with greater than 98% confidence.

This paper illustrates the feasibility of determining biochemically the mutation rates for specific genetic loci and the improved confidence that can be achieved in paternity testing with more recently described human genetic polymorphisms.
THE "INCIDENTAL" SYSTOLIC MURMUR
Authors: Moss Arthur J.
Published: December 2021

The child with symptomatic heart disease is not generally much of a problem for the practicing pediatrician. He is promptly referred to a cardiac center or to a pediatric cardiologist for further evaluation. However, such is not the case with the asymptomatic child in whom a systolic murmur is heard incidentally during the course of a routine physical examination. This very Common event requires that the pediatrician decide in each instance whether the murmur can be safely ignored or whether further studies are indicated. For a detailed description of murmurs in childhood, the reader is referred to the excellent work of Castle and Craige.1

The overwhelming majority of systolic murmurs discovered in asymptomatic children are either innocent or are caused by a ventricular septal defect. The present discussion is limited to the two most common innocent murmurs, the vibratory and the pulmonic ejection murmur, and their differentiation from murmurs due to ventricular septal defect, mitral insufficiency, and other organic lesions. The venous hum, also a frequently encountered innocent murmur, is not included because it is easily recognizable by the louder diastolic component, the location over the base of the heart, and the characteristic diminution in intensity or complete disappearance with compression of the neck vessels, with movement of the head from side to side, or when the patient lies down. It is sometimes confused with the murmur of patent ductus arteriosus; but, because of the foregoing features and because it is usually located parasternally to the right rather than to the left, the differentiation is not difficult.
Letter To The Editor
Authors: Menkes John H.
Published: December 2021

I am grateful to Dr. Weichsel for calling to my attention his beautiful paper on low spinal fluid sugar in tuberculous meningitis.1 As Dr. Weichsel indicates, the rapid rise of blood sugar following the intraspinal injection of glucose is contrary to the conclusions one would have drawn from the data of Prockop and Fishman. The latter used 3-0-methylglucose (3MG) because, like glucose, it has a strong affinity to the membrane carrier system and yet does not support glycolysis.
Remission of Grade III Astrocytoma after Irradiation and Amphotericin B
Authors: Rubissow M. Joyce
Published: December 2021

I would like to share an experience and receive comment regarding a child who has experienced an apparent remission of an astrocytoma grade III of the lower brain stem with amphotericin B.

This is an 11-year-old school girl with an inoperable tumor of the upper cervical cord and lower brain stem, diagnosed by open biopsy 6 months ago, and unresponsive to a prolonged course of radiation therapy. An atrioventricular shunt was performed 2 weeks after diagnosis because of increased intracranial pressure secondary to obstruction.
Letter To The Editor
Authors: Kitterman Joseph A. , Phibbs Roderic H.
Published: December 2021

Dr. Anderson has questioned our study on two counts. He asked whether the infants in our study could be considered normal when normality was based oniy on physical examination, hematocrit, and arterial blood gases and pH. This is an important point, but we think it is adequately covered in the Discussion section of our report.

He also questioned whether the indications for umbilical arterial catheterization in some infants were valid in view of the potential hazards associated with the procedure.
STANDARDS FOR BIRTH WEIGHT OR INTRA-UTERINE GROWTH
Authors: Tanner J. M.
Published: December 2021

One of the consequences of the present interest in perinatal biology is a demand for standards of intra-uterine growth as reliable and useful as the standards for weight and height of children after birth. Since the first papers of Lubchenco and her colleagues1, several authors have tried to satisfy this demand, though none to date can be said to have entirely succeeded. However, two recent attempts, Thomson, et al.2 and Sterky2, deserve special appraisal.

The problems in constructing prenatal standards are generally similar to those in constructing postnatal ones. In some respects they are simpler; since at present fetuses cannot be weighed serially in utero, standards of rate or "velocity" of growth, though in theory more critical than standards of "distance" or weight attained, are not obtainable.
Pneumopericardium in the Newborn
Authors: Matthieu Jean-Marie , Nussle Daniel , Torrado Antonio , Sadeghi Hossein
Published: December 2021

Pneumopericardium complicating the course of hyaline membrane disease in a newborn, premature infant is reported. The details of other instances of neonatal pneumopericardium although unassociated with hyaline membrane disease are reviewed. The clinical manifestations, similar to those of pneumomediastinum, appear very suddenly and can lead to cardiac tamponade. Most cases described in the newborn infant are a complication of assisted ventilation by intermittent positive pressure. The chest x-ray characteristically shows a zone of diminished density surrounding the cardiac silhouette. The prognosis is bad unless emergency treatment (puncture and aspiration) is promptly performed.
AN EVALUATION OF THE PHARMACOLOGIC APPROACHES TO LEARNING IMPEDIMENTS
Authors: Weiss Charles F. , Yaffe Sumner J. , Cann Howard M. , Gold Arnold P. , Kenny Frederic M. , Riley Harris D. , Schafer Irwin , Stern Leo , Shirkey Harry C.
Published: December 2021

Studies indicate that certain drugs have a promising effect in the treatment of children with learning impediments. The valid assessment of the true pharmacologic effect necessitates an accumulation of comparable, long-term, properly controlled studies and a careful evaluation of these data compared alone and with adjunctive therapy.
Fetal Response to Glucose Infusion: How Much Credit Does the Fetal Pancreas Deserve?
Authors: Cordero Leandro , Grunt Jerome A. , Anderson Gerald G.
Published: December 2021

Your recent publication on the effects of glucose infusion during labor1 was comparable to our own studies which were reported at the meetings of The American College of Obstetrics and Gynecology (Halifax, October 1968) and at the Annual Meeting of the Society for Gynecologic Investigation (Denver, March 1969).

Since the reports of our observations are in press2,3 and, therefore not available as yet, we believe that your readers and the authors of the article on fetal insulin response1 may be interested in the following comments: In our studies, the infusion of 1 gm of glucose per kg of maternal body weight was given over a 10minute period at a concentration of 30%.
What Should Kernicterus Mean as a Clinical Diagnosis?
Authors: Ackerman Bruce D.
Published: December 2021

The term kernicterus is frequently used to describe both a pathologic entity and a clinical syndrome. There appears to be no great difficulty in interpreting what the word kernicterus means as a pathologic diagnosis. It is the purpose pose of this letter to comment on the use of the term as a clinical designation.

The long-term clinical effects of kernicterus were classically described as a very characteristic syndrome, of which athetoid cerebral palsy and hearing loss were regarded as the most important elements.1
Immunologic Factors in Infants with Hyperbilirubinemia—Another Possibility
Authors: Rapkin Richard H.
Published: December 2021

The conclusion reached by Nejedlá in his brief communication "The Development of Immunological Factors in Infants with Hyperbilirubinemia" (Pediatrics, 45:102, 1970) that bilirubin plays an important role in the development of the immune response is not supported by the data. All the infants with hyperbilirubinemia had maternal fetal blood group incompatibility. Until a group of neonates with hyperbilirubinemia without incompatibility are studied, an equally tenable conclusion would be that maternal placentally transferred blood group antibodies suppress subsequent development of antibodies by the infant.
Letter To The Editor
Authors: Stark Earl W. , Borton Thomas E.
Published: December 2021

In general, the critical comments of Dr. Reynolds concerning the validity of case finding in maternal rubella are well taken. Some, however, are ambiguous and worthy of response.

First, Dr. Reynolds suggests that the case records examined have little clinical value "unless the two Illinois State agencies are remarkable exceptions..." because the data "often become increasingly nebulous with each successive transcription." The state agencies involved are indeed remarkable and Dr. Reynold olds's stated reason for lacking confidence in the case records is unintelligible to us.
THE DISTRIBUTION AND TOXICITY OF BILIRUBIN
Authors: Odell Gerard B.
Published: December 2021

I am very honored and grateful to have been selected as a recipient of an E. Mead Johnson Award. It is indeed flattering to have one's professional efforts receive such special recognition, and it is a moment to be savored for a lifetime. Although this distinction is awarded to me, it belongs to many; and, I wish to give public recognition to some of the persons who have made this occasion possible.

I was fortunate to have had my introduction into pediatrics at Yale under the gifted faculty of Dr. Grover F. Powers. It was the originality and scientific integrity of Dr. Daniel C. Darrow that served as a model for me in the application of basic science principles to the understanding of clinical problems. It was Dr. Robert E. Cooke who taught me at the laboratory bench that the application of a method requires a thorough understanding of what it can measure quantitatively and that duplicate analyses are not a sign of weakness. He also taught me that the best experiments to test a hypothesis are those designed to prove it wrong rather than yield results that are compatible with it. It has also been Bob's continuing interest and support over the subsequent years as Chairman of the Department of Pediatrics at Johns Hopkins that has provided me the freedom to pursue my interests in bilirubin. Behind the scenes, not willing to accept credit, is Dr. Harry H. Gordon who provided my initial research support and most of my knowledge of newborn infants.
Paediatric Endocrinology, edited by Douglas Hubble, C.B.E., M.D. (Lond.), F.R.C.P. (Lond.). Philadelphia: F. A. Davis Company (1915 Arch Street, Philadelphia, Pa. 19103), 1969, 492 pp.,$26.00
Authors: Bongiovanni Alfred M.
Published: December 2021

Pediatric endocrinology has a flavor of its own because of the special neurohumoral effects on the fetus and the growing child. In an era of a plethora of medical texts there are not too many in the English language which comprehensively cover this area. The latest edition of the monumental and "one man" Wilkins is becoming out of date. The recent multiauthored Gardner is excellent, well balanced, and somewhat more detailed than the volume herein reviewed.
ABNORMAL BLOOD GLUCOSE REGULATION IN COCKAYNE'S SYNDROME
Authors: Cotton Robert B. , Keats Theodore E. , McCoy Ernest E.
Published: December 2021

Review of all previous reports of Cockayne's syndrome indicates that the disorder is a unique entity readily identified by certain physical findings and radiographic features. A 16-year-old Negro female with the disorder was found to have hyperglycemia and elevated plasma insulin. Increased serum growth hormone levels were not demonstrated.
SWEDISH STANDARD CURVES FOR INTRA-UTERINE GROWTH
Authors: Sterky Göran
Published: December 2021

The classification of newborn infants according to intra-uterine growth must take into account gestational age as well as birth weight. Also important is the intrauterine growth pattern of the population from which individual and epidemiological data are derived and to which they are to be compared. In constructing a definition of "normal" intra-uterine growth, the only practical approach now seems to be a statistical definition from data on live born infants of supposedly normal pregnancies. In Sweden it has been possible to collect such information from material compiled primarily for forensic purposes. Because the resultant curves have been published only in Swedish1, and because the birth weight at term in Sweden has been said to be the highest so far obtained2, the curves are presented here for readers from other countries.

The Swedish National Board of Health instructed all maternity wards to report certain data on all infants born from July 1, 1956, to June 30, 1957. Due to various reasons, some small hospitals could not take part. After an intense correspondence to complete the reports, the material included 92,348 infants (51.7% boys). It was calculated that about 110,000 infants were born in the whole country during the period in question. Stillborn and malformed infants were excluded, as were those born to mothers with clinical diabetes mellitus and toxemia (proteinuria at two separate occasions and/or resting systolic blood pressure above 150 mm Hg). Only single births were included. The material now contained 82,011 infants (51.0% boys).

Before constructing the curves, it was also decided that the normal menstrual pattern of the mothers had to be known and had to be regular with intervals within 21 to 35 days.
LOBAR EMPHYSEMA AND PATENT DUCTUS ARTERIOSUS
Authors: Leape Lucian L. , Ching Nathaniel , Holder Thomas M.
Published: December 2021

The development of lobar emphysema while under observation is described in a 16-month-old boy with patent ductus arteriosus. Lack of typical x-ray findings of mediastinal shift or depression of the diaphragm, together with the late age of development in the patient, delayed diagnosis and treatment. Successful lobectomy was followed by division of the patent ductus.

We believe this is the first case in which the development of lobar emphysema has been documented radiologically. The mechanism appears to be compression of the lobar bronchus by a dilated right pulmonary artery.
HUMAN MATERNAL BEHAVIOR AT THE FIRST CONTACT WITH HER YOUNG
Authors: Klaus Marshall H. , Kennell John H. , Plumb Nancy , Zuehlke Steven
Published: December 2021

To explore and eamine maternal behavior in human mothers at the first postnatal contact with their young, we quantitatively analyzed photographs taken every second during the first 10 minutes of each contact. We recorded and studied this behavior in 12 mothers 1/2 to 13 1/2 hours following delivery, with their normal, full-term infants undressed and placed beside them, and in 9 other mothers during their first three tactile contacts with their premature infants (weighing 1,150 to 1,870 gm) in incubators. An orderly progression of behavior was observed in mothers of full-term infants: the mothers started with fingertip touch on the infants' extremities and proceeded in 4 to 8 minutes to massaging, encompassing palm contact on the trunk. In the first 3 minutes fingertip contact was 52%, with 28% palm contact. In the last 3 minutes of observation, fingertip contact decreased to 26% and palm contact increased to 62%. An intense interest in eye-to-eye contact was observed at the first contact. Mother-to-infant eye-to-eye contact appears to be an important exchange during the development of affectional ties. Mothers of normal premature infants permitted to touch them in the first 3 to 5 days of life followed a similar sequence, but at a much slower rate. Our results reveal suggestive evidence of species-specific behavior in human mothers at the first contact with their full-term infants and suggest that a re-evaluation is required of the present hospital policies which regulate care of the mother and infant.
HYPERBILIRUBINEMIA AND KERNICTERUS IN SMALL PREMATURE INFANTS
Authors: Ackerman Burce D. , Dyer Geraldine Y. , Leydorf Mary M.
Published: December 2021

In the article by Bruce D. Ackerman, et al. in the June issue of Pediatrics, 45:918, 1970, the sentence beginning on line 2 of the left hand column of page 923 should be two sentences, which should read as follows: Case 6 did not show the spastic signs described by Van Praagh,28 but did show slowing of the respiratory rate and decreased depth of respiration. Case 4 showed these respiratory changes, in addition to spasticity.
SYNDROME OF HYPERPLASTIC FETAL VISCEROMEGALY AND NEONATAL HYPOGLYCEMIA (BECKWITH'S SYNDROME)
Authors: Sotelo-Avila Cirilo , Singer Don B.
Published: December 2021

The syndrome of hyperplastic visceromegaly (Beckwith's syndrome) was studied clinically in three patients and at autopsy in four patients. The findings in these cases were compiled with those in 31 previously reported cases. Clinical features in decreasing order of frequency were omphalocele, macroglossia, increased birth weight, nephromegaly, facial flame nevus, and hepatomegaly. Neonatal hypoglycemia has been chemically documented in only 18% of the cases but is likely to be one of the most common features of the syndrome.

Pathologic features include adrenal cortical cytomegaly, renal medullary dysplasia, pancreatic islet hyperplasia, adrenal cortical cysts, pancreatic acinar hyperplasia, diaphragmatic hernias, and persistent glomerulogenesis in decreasing order of frequency.

Two of the three surviving patients in this series were mentally retarded at 13 and 8½ years of age respectively. Four patients studied at autopsy disclosed, in addition to features common to the syndrome, many incidental developmental defects of the cardiovascular system, the genitourinary system, the gastrointestinal tract, and other organ systems.

The significance in recognition of this syndrome lies in the sometimes disastrous effects of neonatal hypoglycemia. In those patients who survive beyond the neonatal period, the possible development of renal or adrenal malignancy should be borne in mind.
THE BOOK OF ACCIDENTS: DESIGNED FOR YOUNG CHILDREN
Authors: Cone Thomas E.
Published: December 2021

Falls are presently responsible for about one half of all accidental injuries in children under 5 years of age. And yet, I know of no contemporary publication on accident prevention which so vividly and engagingly illustrates the consequences of falling than the lesson depicted in the figure below. which is taken from a children's book published in 1830.