bluuebunny/crossref_metadata_2025 huggingface dataset:
School Health Services
Authors: McLendon Prestion A.
Published: December 2021

Those who have read the article of the late Dr. H. H. Mitchell (edited by Dr. Frazier) and published in Pediatrics, June, 1965, cannot help but be grateful for his long and determinded efforts in the cause of quality school health services to children. His efforts deserve far greater recognition than was given during his lifetime.

His review of the progress of school health services, as they have developed, is clear and definitive for authoritative reference, and reflects commendation on the Academy for its part during its short consideration of this most important national problem.
Pulmonary Vasoconstriction and the Pharmacology of Respiratory Distress
Authors: Defoe Edward C.
Published: December 2021

The stimulating controversy over the R.D.S. problem between Dr. Ivanhoe and Dr. Clements and associates (Pediatrics, 36:451, 1965) prompts expression of a few additional thoughts.

Through a proponent of the theory that the basic problem in these infants is lack of normal sympathetic neurohormonal activity at time of initial inspiratory efforts, I must agree with Dr. Clements that direct evidence for such a deficiency is tenuous. However, the evidnce cited1 against the possibility is questionable.
Teen Skin, by Gordon C. Sauer, M.D. Springfield, Illinois: Charles C Thomas, 1965, 57 pp., $3.75
Authors: Perlman Henry Harris
Published: December 2021

There has been a long-felt need for a "down-to-earth" manual discussing the cause, clinical course, the manifestations and management of "teen-age" acne not just for the average person unfamiliar with medical terms; but also for the dermatologist, the pediatrician, and the general practitioner, who all too often cannot find ample time to discuss all phases of skin care with the patients. Dr. Sauer, a wellknown dermatologist, has admirably filled this gap.

In his preface, Dr. Sauer states that "teenagers are hungry for answers to their questions about skin problems."
Les Chromosomes Humains (Caryotype Normal et Variations Pathologiques) by Raymond Turpin and Jerome Lejeune. Paris: Gautier-Villars, 1965, 535 pp. 100 figures, 54 F
Authors: Migeon Barbara Ruben
Published: December 2021

From two of the pioneers in human cytogenetics comes an extensive discussion of the normal human karyotype and the known pathological variations in these karyotypes. Well aware of the difficulties inherent in critically reviewing papers pertaining to their subject before all data are available, the authors, nevertheless, wish to transmit to physicians and biologists the information which has accumulated to date.

The first part of the book consists of the necessary preliminary discussions by Lejeune: (1) an enumeration of observations relating to the number of human chromosome prior to 1956 including those of Tijo and Levan, (2) a description of tissue culture and cytological techniques requisite to the study of chromosome in various tissues, and (3) a definition of the normal karyotype with several of its nonpathological variations.
The Child Who Does Not Talk-Clinics in Develpmental Medicine 13, edited by Catherine Renfrew and Kevin Murphy. London, England: The Spastics Society Medical Education and Information Unit in Association with Heinemann Medical Books Ltd., 1964, 206 pp., $5.00
Authors: Pickering Ruth
Published: December 2021

Communication being crucial to the human way of life, and considered by some authorities to be the most recent evolutionary development, it is significant that The National Spastics Society held one of their Clinics in Developmental Medicine on this problem.

The Child Who Does Not Talk is the report of an International Study Group on the Development and the Disorder of Hearing, Language and Speech in children held in St. Mary's College, Durham, England, in 1963.
The Editing of Advertising
Authors: EIDELMAN ARTHUR
Published: December 2021

While it is stated that the responsibility of reviewing copy for advertisements is the sole responsibility of the Executive Director of the Academy of Pediatrics, it is the opinion of this subscriber, that the mere appearance of an advertisement in the official journal of the Academy implies de facto endorsement by the Academy of the safety (if not the efficacy) of the particular product and/or mode of therapy. As a result, one wonders, if the Editor of Pediatrics does not share to a certain degree the responsibility for the advertisement (June 1965) by the Merck Sharp and Dome Co. advocating the use of Decadron (dexamethasone) in the home treatment of croup.
On the Respiratory Spread of Varicella-Zoster Virus
Authors: Nelson Audrey M. , Geme Joseph W. St.
Published: December 2021

Encouraged by certain epidemiologic observations of the pre-eruptive transmission of varicella-zoster virus, an extensive search for oropharyngeal virus was conducted in 29 children with chickenpox. The procurement of 45 respiratory tract samplings, preceding and following the onset of vesicular rash, failed to yield varicella-zoster virus in a single instance. Some theoretical explanations for the perplexing elusiveness of varicella-zoster virus in the oropharynx are offerred and discussed.
HEREDITARY ANGIONEUROTIC EDEMA: A CLINICAL SURVEY
Authors: Donaldson Virginia H. , Rosen Fred S.
Published: December 2021

Inasmuch as hereditary angioneurotic edema has generally been overlooked in the pediatric literature, it is hoped that this report may alert pediatricians to the possibiity of the existence of the disease in children of families with appropriate histories. It is likely that the symptomatology will not be severe in childhood; nonetheless, swellings and abdominal attacks do occur. Most important, the possibility that abdominal surgery will be helpful during bouts of abdominal pain due to hereditary angioneurotic edema should be considered unlikely. Markedly edematous viscera may provide technical difficulty during surgery, and undue physical trauma is not helpful.

Hereditary angioneurotic edema differs from other non-allergic angioneurotic edema in that the tendency to attacks of edema is inherited as an autosomal dominant trait and swellings tend to be much more severe. The failure of anti-allergic medications and lack of evidence for allergy as a cause of attacks of hereditary angioneurotic edema tend to differentiate this disease from the more common allergic forms. Absence of serum inhibitor of C'lesterase further characterizes hereditary angioneurotic edema. Sera from persons with non-familial allergic and non-allergic angioneurotic edema have contained normal or greater than normal amounts of this inhibitor.7

In view of the definition of biochemical alterations in the blood of patients with hereditary angioneurotic edema and the possibility of identifying affected individuals before the onset of symptoms, it is to be hoped that a rational means for the prevention of symptoms can be devised.
Mental Retardation in Canada, Report Federal-Provincial Conference Ottawa, Canada, October 19-22, 1964. Ottawa, Canada: Department of National Health and Welfare, 1965, 307 pp., $3.00
Authors: La Veck Gerald
Published: December 2021

This is a full report of the proceedings of the first Canadian Federal-Provincial Conference on Mental Retardation, sponsored by the Minister of National Health and Welfare, and held in Ottawa, Canada, October 19-22, 1964. Since the main purpose of the conference was to indicate practical steps that might be taken to coordinate and improve preventive, treatment, training, and employment services for mentally retarded persons, it was decided to publish the proceedings in full, including formal presentations and discussions, so that the book might serve as a guide for present action and as a landmark against which to measure future progress.
ERYTHROCYTE DPNH DEPENDENT DIAPHORASE LEVELS IN INFANTS
Authors: Bartos Henry R. , Desforges Jane F.
Published: December 2021

Infants during the first 4 months of life are reported to be more susceptible than older children and adults to the acquisition of methemoglobinemia, and premature neonates are more susceptible than full-term infants. Erythrocyte DPNH-dependent diaphorase is the major enzyme which catalyzes the reduction of methemoglobin to hemoglobin. The data presented show that during the period of infancy in which susceptibility to methemoglobinemia has been reported there is decreased diaphorase activity, and this is postulated to be a major factor in the pathogenesis of methemoglobinemia in infancy.
ENZYME INDUCTION IN A CASE OF GLYCOGEN STORAGE DISEASE
Authors: Moses Shimon W. , Levin Stanley , Chayoth Reuben , Steinitz Kurt
Published: December 2021

In cases of glycogen storage disease Type III, low levels of liver glucose-6-phosphatase activity have frequently been found in addition to the complete absence of amylo-l, 6-glucosidase activity. Glucose-6-phosphatase regulates a key reaction in the homeostatic control of gluconeogenesis. It belongs to the group of adaptive enzymes, and it has been shown in rats that its activity can be induced by steroids and suppressed by insulin. Increasing evidence is accumulating to indicate that the hormonal control of this enzyme activity affects de novo synthesis at the gene level.

The subnormal activity of glucose-6-phosphatase in cases of amylo-1, 6-glucosidase deficiency could be the result of a double enzyme deficiency due to two structural gene defects, or secondary to a regulatory gene disorder resulting in suppression of glucose-6-phosphatase biosynthesis. If the low levels of glucose-6-phosphatase activity result from a structural gene mutation, hormonal induction of enzyme biosynthesis would be unlikely; whereas, if the markedly depressed activity of this enzyme is due to abnormal control affecting the regulation of enzyme synthesis, hormonal induction may be possible.

A case of amylo-1, 6-glucosidase type A is presented in which, in addition to complete absence of the debrancher enzyme, exceedingly low values of liver glucose-6-phosphatase were repeatedly demonstrated. Low insulin-like activity was found in the patient's plasma, but no significant abnormality of steroid metabolism could be shown. Triamcinolone administration resulted in fourfold increase of liver glucose-6-phosphatase activity. This enzyme induction by Triamcinolone suggests that the markedly reduced levels of glucose-6-phosphatase activity prior to steroid administration were due to a regulatory disorder of enzyme biosynthesis and not to a structural gene defect. It is suggested that the Triamcinolone induction test can be used in similar situations as a diagnostic tool to differentiate between a regulatory gene disorder affecting enzyme synthesis, and a structural gene defect.
RENAL SCARRING SECONDARY TO PERCUTANEOUS NEEDLE BIOPSY
Authors: Kikkawa Yutaka , Greifer Ira , Bernstein Jay , Edelmann Chester M.
Published: December 2021

Focal scarring has been observed in two patients in a second biopsy of the same kidney. It has been attributed to the trauma of the initial puncture, especially to the late effects of vascular spasm and disruption in a zone surrounding the needle track. To prevent confusion in histologic interpretation, the contralateral kidney should be used for a second biopsy.
HYPERGLYCINEMIA WITH KETOACIDOSIS AND LEUKOPENIA
Authors: Soriano Juan Rodriguez , Taitz Leonard S. , Finberg Laurence , Edelmann Chester M.
Published: December 2021

Metabolic investigations are reported in a patient with the clinical and biochemical features of "idiopathic hyperglycinemia." During ketoacidosis elevated concentrations in serum of numerous amino acids were noted, especially leucine, isoleucine, valine, glycine, and lysine. Hyperammonemia was found in association with ketoacidosis.

Clinical and biochemical amelioration was induced by restriction of protein intake to 1 gm/kg or less. Although exacerbation was produced by increasing the protein intake to 1.5 gm/kg, the patient was able to tolerate as much as 3.0 gm/kg of an amino acid mixture in which leucine, isoleucine, valine, methionine, and threonine were absent.

It is postulated that this disease, in contrast to hyperglycinemia caused by a specific disorder in glycine metabolism, represents a generalized defect in utilization of amino acids resulting in excessive deamination of certain amino acids in the muscle, with consequent hyperammonemia and ketoacidosis. The nature of the defect in amino acid metabolism is unknown.
STUDIES ON INTESTINAL DIGESTION OF STARCH IN MAN
Authors: Auricchio Salvatore , Pietra Domenico Della , Vegnente Angela
Published: December 2021

In 14 infants and small children the α-amylase activity and the carbohydrates of duodenal juice were studied after a test meal containing amylopectin.

In infants at the end of the first year of life and in small children the amylopectin is very rapidly hydrolyzed into glucose, maltose, maltotriose, and branched dextrins; these compounds are probably hydrolyzed into glucose by the action of mucosal glucosidases.

In infants 6 months old or younger the intestinal hydrolysis of amylopectin in the intestine is incomplete, with large amounts of dextrins containing more than 30 glucose units and, in the small oligosaccharides group, a decrease in the glucose and maltose content as well as an increase in the maltotetraose content.

The analysis of carbohydrates which accumulate in intestinal lumen during digestion of starch will be of value in studying pathogenesis of starch malabsorption.
AN UNUSUAL DISEASE OF THE NEWBORN DESCRIBED IN 1785
Authors: C. T. E.
Published: December 2021

Almost two centuries ago Dr. Bassignot described an unusual skin disease of newborn infants in these words:

Seyne or Sedna, a small town in Provence is the theatre of a very peculiar disease, which attacks almost all the new born infants at that place. Some authors have spoken of it under the name of crinons or comedons; but it is known by the people of the country under the name of cees, a corruption of ceddes, a provincial term which signifies a bristle. It sometimes manifests itself within the space of twelve hours, sometimes. however, not till the end of fifteen days, or even a month.

The symptoms by which this disease is known, are a very considerable itching, which is augmented by the heat of the bed, and prevents the infant from sleeping; a perpetual agitation; an inability to suck, the child's tongue not being able to accommodate itself to the nipple; and, at last, the noise of its cries being diminished, which become hoarse, and are indeed almost extinguished. This last sign appears to be the most certain; and they in general judge of the severity of the disease by the degree to which the voice is extinguished, and by the weakness of the cries of the infant.

When, by these signs, the disease is known to be present, they proceed immediately to the cure. This consists in frictions, which are performed by the women of the country, and who are so much in the habit of treating this disease, that they do not in general call in the aid of any medical practitioner. These frictions are performed on different parts of the body, according to the state of the disease that is present. And they distinguish these stages of it, which are sometimes very distinct, sometimes united.

In the first, the diminution of the noise in crying is conjoined with a total incapability of sucking. This required friction at the upper part of the sternum, on the fore and back parts of the neck, on the cheeks towards the angle of the inferior jaw, and on the temples. In the second state of the disease, the infant still enjoys a certain facility in moving the tongue, without, however, being able properly to seize the nipple; when the arms are set at liberty they are extended, the fingers are spread out with a considerable degree of tension, or the hand is firmly clenched. This state requires friction of the fore-arm, from the shoulder to the wrist. The third stage is distinguished merely by a diminution of the cries; then frictions are directed to the arms, the shoulders, the back, and even to the calves of the legs; which probably, as well as the hands, demonstrate the existence of crinons in these parts, by some particular movement, but which has not yet been sufficiently attended to.
PIGEON BREEDER'S LUNG IN CHILDREN
Authors: Stiehm E. Richard , Reed Charles E. , Tooley William H.
Published: December 2021

Diffuse interstitial pneumonitis associated with the prolonged exposure to pigeons is described in five boys ages 7 to 15. The clinical characteristics include a gradual onset of cough, shortness of breath, and weight loss; in three cases, acute onset of fever, chills, cough, and muscle aches occurred within 12 hours after heavy exposure. Physical findings consisted only of occasional rales and wheezes. The chest x-rays in four cases showed a diffuse interstitial pneumonitis. A lung biopsy in one case disclosed interstitial inflammation, round cell infiltration, and giant cell formation. The patients improved when the birds were removed. One severely ill boy was treated successfully with steroids.

Pulmonary function studies disclosed diminished vital capacity, absent or minimal airway obstruction, and a variable defect in diffusing capacity. Their sera contained normal or elevated complement levels, increased γG and γA globulin, and precipitating antibody to extracts of pigeon feathers, droppings, and plasma. Levels of precipitating antibody, measured by a new radial diffusion technique, tended to correlate with the severity of the disease and the degree of exposure to pigeons. Antibody levels fell progressively when pigeons were removed from the environment.

Except that the specific antigens differ, pigeons breeder's lung, Farmer's lung, bagassosis, maple bark stripper's disease and other similar syndromes are identical. They all differ sharply from allergic bronchial asthma in the symptoms and the mechanisms of the hypersensitivity. The histopathology of the biopsy, the elevated serum complement, and the absence of disease in some exposed individuals who have precipitins favor the interpretation that the pathogenesis of this illness is a delayed hypersensitivity to the inhaled antigens; but participation of an Arthus-type reaction cannot be excluded.
COMMITTEE ON FETUS AND NEWBORN
Authors: SILVERMAN WILLIAM A. , LECEY JEROLD F. , BEARD ALICE , BROWN AUDREY K. , CORNBLATH MARVIN , GROSSMAN MOSES , LITTLE JOSEPH A. , LUBCHENCO LULA O. , METCOFF JACK , SCHAFFER ALEXANDER J. , SPECTOR SAMUEL , GRUENWALD PETER , MURTAGH JUAN
Published: December 2021

A WORKSHOP MEETING of the Committee on Fetus and Newborn and Consultants was held in Chicago on October 22, 1966, to consider standard terms for the classification of newborn infants with respect to duration of gestation, birth weight, and intra-uterine growth.

INTRODUCTION

Liveborn infants have usually been classified according to weight at birth because of the close association between ponderal size and the risk of death in the first hours and days of life. This simple classification has been useful in developing uniform national and international vital statistics and the data have been used to plan public health programs aimed at reducing the incidence and the high mortality of neonates who are small at birth. However, the classification based on weight alone and the international definition of prematurity (≤2,500 gm), which equated birth size and fetal age, have had the effect of obscuring medically important differences between likesize infants of dissimilar gestational ages. In view of the evidence indicating that many of the neonates included within the limits of the international definition are not born prematurely (<37 weeks), the Expert Committee on Maternal and Child Health of the World Health Organization recommended that the concept of "prematurity" in the definition should give way to that of "low birth weight." Although the primary axis of classification (birth weight) remained unchanged, the new recommendation emphasized the need to use terms which make a clear distinction between size at birth and duration of gestation.

In the past few years careful appraisal of newborn infants has revealed a growing number of associations between specific disorders in the neonatal period (e.g., antenatal infections, hypoglycemia, chromosomal abnormalities, respiratory distress syndrome) and either gestational age or aberrant intra-uterine growth.
Letters to the Editor
Authors: AASE JON M.
Published: December 2021

It was with the great interest that I read Dr. Hammond's report of skin dimpling associated with congenital rubella (Pediatrics, 39:291, 1967). We are at present investigating a syndrome of musculoskeletal abnormalities occurring in the Eskimo population of Alaska. This condition somewhat resembles arthrogryposis multiplex congenita, and appears to have a familial distribution. In this syndrome, too, skill dimples are found on the extensor surfaces of the knees and elbows and occasionally over other joints. In each instance, however, this abnormality is associated with limitation of motion of the underlying joint.
Letters to the Editor
Authors: HAMMOND KEITH
Published: December 2021

In reply to Dr. Tuttle's letter, I can only state that I missed Dr. Caffey's references and should obviously have searched further.

Regarding Dr. Aase's letter, since reporting and describing the dimples in Pediatrics I have encountered them in a child with achondroplasia. Perhaps they have been described in this association also—I do not know—but it is interesting that Dr. Aase's patients also have musculoskeletal abnormalities. However, I also recently saw them in a young infant who seemed otherwise normal and in whom the history revealed nothing apparently significant. I have not noticed the limitation of joint motion.
VACCINATION OF CHILDREN WITH VARIOUS CHORIOALLANTOIC PASSAGES OF MEASLES VIRUS
Authors: MARIS ELIZABETH P. , GELLIS SYDNEY S. , SHAFFER FRANK , DUNHAM WOLCOTT B. , STOKES JOSEPH , RAKE GEOFFREY
Published: December 2021

An extensive study of the usefulness of a vaccine produced by the growth of the measles virus on the chorioallantoic membrane of the fertile hen's egg was undertaken as a joint study in Baltimore and Philadelphia. Four hundred ninety-seven children were vaccinated and followed for a period covering at least one close exposure to a major epidemic of measles. Eighteen of these children contracted measles within 13 days of their vaccination, and thus could not be included in final tabulations. Of the remaining 479 children, 330, or 69%, contracted the disease. Fifty unvaccinated children served as controls and of these, 44, or 88%, developed measles. The morbidity rate of 69% of the present series should be compared with the morbidity rate of 39% in a smaller series of vaccinated children described by some of the present authors elsewhere. Although the present study suffered from certain shortcomings, it is believed that the following conclusions can be drawn. First, that the chorioallantoic membrane vaccine produced mild symptoms of measles in a large number but not in the majority of children vaccinated, and second, that whatever protection was afforded by the vaccination procedure was minimal in degree. Unfortunately, the reasons for the failure of the vaccine to afford better protection are not evident, nor does it seem probable that they will be fully understood until better methods are available for working with the virus in vitro and in the laboratory.
BRONCHOGENIC CYSTS OF THE MEDIASTINUM
Authors: HARDY L. MARTIN
Published: December 2021

The successful removal of a bronchogenic cyst of the mediastinum in a 10 month old infant is recorded. The character, symptoms, methods of diagnosis and treatment of bronchogenic cysts are discussed.
THE PEDIATRICIAN AND THE PUBLIC
Authors: MORGAN HUGH J.
Published: December 2021

IT IS a pleasure and a great honor to come to the Old North State from a daughter state, Tennessee, to speak to you on the occasion of the 150th anniversary of the foundation of your Medical Society.

The conventional address for such an occasion would be a historical one. Certainly, old records of this Society provide extraordinarily rich and attractive material for the historian. Your current program of medical education, medical research and medical administration in relation to the improvement and extension of medical care, both preventive and curative, is a source of pride and stimulation for all of the southern states. North Carolina is leading the way in the South.

But I do not plan to review in detail the past or current accomplishments of the profession in North Carolina. This has just been done for us in a scholarly and inspiring address by Dr. Hubert A. Royster. Suffice it to say that the membership of your Society has exhibited a capacity, unusual in organized medicine, for self examination and self evaluation and has been alert to change. Your membership has been judged courageous and progressive, and the country in general and the South in particular has become accustomed to look to North Carolina for guidance and example. Perhaps some of you hardly recognize yourselves as I talk! Maybe there are a few of you like the thieving, prowling, lying and intemperate colored man on judgment day who read, as he arose from his grave at the sound of the trump, the inscription on a tombstone—provided by the faithful, generous wife who survived him—"Here lies an honest man, a faithful husband, a truthful citizen and a temperate, devoted churchman." "Scuze me, Lord," said our friend, "I done come up outer the wrong grave!"
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: HILBERT HORTENSE
Published: December 2021

THE effort to coordinate nursing organizations in the United States and make them more effective in the tremendous task of meeting the nation's constantly increasing demand for nursing care, which has become known among nurses as "the structure study," is currently being given fresh impetus as nurses all over the country hold workshops to consider two new plans prepared by their Committee on the Structure of National Nursing Organizations.

The study of the structure of organized nursing began more than a decade ago when the board of directors of the American Nurses' Association, in response to a recommendation of a state nurses' association, voted that a special committee be appointed to consider the possibility of consolidating the American Nurses' Association, the National League of Nursing Education, and the National Organization for Public Health Nursing.

Next definite action occurred in January 1944, when the boards of directors of those three organizations voted to undertake a joint survey of their "organization structure, administration, functions and facilities to determine whether a more effective means can be found to promote and carry forward the strongest possible program for professional nursing and nurses." A committee representative of all three organizations was formed, and in late 1944 and early 1945 representatives were named to the committee by three other organizations, the National Association of Colored Graduate Nurses, the American Association of Industrial Nurses, and the Association of Collegiate Schools of Nursing.
CYCLIC NEUTROPENIA IN AN INFANT
Authors: BORNE STANFORD
Published: December 2021

A case of cyclic neutropenia of over 2½ years' duration is reported in a female infant. The cyclic fluctuations of the clinical and hematologic picture over a long period of time is emphasized. A casual relationship between female sex hormone and cyclic neutropenia is suggested by estrin therapy and excretion.
BIRTH INJURY, FOCAL EPILEPSY AND CORTICAL EXCISION
Authors: PENFIELD WILDER , LIVINGSTON SAMUEL
Published: December 2021

This eight year old boy had a cerebral hemorrhage at birth. In spite of this, however, he held up his head at three weeks, sat alone at four months and mental development seemed to be normal until he reached six months of age. Recurring cerebral seizures
PROTEOLYTIC ENZYMES OF THE PREMATURE INFANT
Authors: MADEY STEPHEN , DANCIS JOSEPH
Published: December 2021

The duodenal contents of 16 premature infants were examined and found to contain normal concentrations of trypsin. The gain in weight of infants whose diet was supplemented with casein hydrolysate was found to be no better than that of infants supplemented with whole casein. It is concluded that it is unnecessary to supplement the diet of the premature with split protein.
NEW CONCEPTS OF THE ETIOLOGY, DIAGNOSIS AND TREATMENT OF CONGENITAL MEGACOLON (HIRSCHSPRUNG'S DISEASE)
Authors: SWENSON ORVAR , NEUHAUSER EDWARD B. D. , PICKETT LAWRENCE K.
Published: December 2021

Hirschsprung's disease, or congenital megacolon, is due to a functionally abnormal segment of bowel in the sigmoid or rectosigmoid. This can be demonstrated effectively by appropriate roentgenologic studies with barium as a contrast medium. The bowel above this abnormally functioning segment shows changes commonly found above an area of obstruction; the bowel is dilated and hypertrophied.

Removal of the functionally abnormal bowel (rectum or rectosigmoid) has relieved the patients' symptoms. A new operative technique is utilized in performing this resection. The fact is stressed that these children will have to be followed for a period of several years before any claims of a permanent cure can be made.
BRONCHIECTASIS IN CHILDHOOD
Authors: FIELD C. ELAINE
Published: December 2021

Non-aeration of alveoli is a feature common to the childhood illnesses predisposing to bronchiectasis and is regarded as the important factor in the aetiology of the disease, infection playing a subsidiary part.

Pulmonary collapse is therefore regarded as a prebronchiectatic state and in order to assess its importance two groups of cases have been studied: (1) 272 cases of pulmonary collapse; (2) 99 cases in which the diagnosis of bronchiectasis was doubtful at first examination.

Pulmonary collapse was seen most frequently in the right middle lobe and left lower lobe. It was usually persistent in the left upper lobe but frequently the right lower lobe reexpanded.

The duration of cough, according to the history, was commonly of three months' duration ion or less in cases of pulmonary collapse that reexpanded, in contrast to the long history of two years or more in the majority of cases that developed bronchiectasis.

Of the 272 cases of pulmonary collapse, only 157 reexpanded without permanent bronchiectatic changes. It was not uncommon, however, to find temporary bronchial dilatation in this group, the bronchi returning to normal calibre when the collapse reexpanded—a condition described as reversible bronchiectasis.

The treatment recommended for pulmonary collapse includes steam inhalations, postural drainage, and breathing exercises. Unless foreign body is suspected, immediate bronchoscopy is no longer considered necessary. No significant difference in the incidence of reexpansion of the lung was found between the cases treated with bronchoscopy and those treated without.

Ninety-nine cases were classified as doubtful bronchiectasis when first seen. Of these, 47.5% suffered from asthma, a disease frequently difficult to differentiate from bornchiectasis. Forty of the 99 cases have now developed true irreversible bronchiectasis after a period of three or more years. It was necessary to observe cases showing doubtful bronchial dilatation over a period of years, the bronchograms being repeated at intervals in order to determine the permanently diseased parts.
RUPTURE OF THE SPLEEN IN AN ERYTHROBLASTOTIC INFANT
Authors: SLOTKOWSKI EUGENE L. , HAND ALBERT M.
Published: December 2021

Rupture of the spleen is reported in an erythroblastotic infant who died during an exsanguination-replacement transfusion. The changes in the spleen incident to erythroblastosis fetalis render this organ more vulnerable to trauma and rupture. The predisposing and precipitating factors include extramedullary hematopoiesis in the splenic parenchyma, increased phagocytosis, weakening of the capsule and trabeculae, increased intra-abdominal pressure during the birth process, congestive splenomegaly, hemorrhagic tendency, displacement of the spleen and the increased blood volume during a transfusion.
DYNAMICS OF CIRCULATION IN INFANTILE MALNUTRITION
Authors: KERPEL-FRONIUS E. , VARGA F.
Published: December 2021

Hemodynamics in marantic infants were found to be on the margin of circulatory failure. Signs of disturbed circulation appear usually at a degree of wasting of more than 30% of the ideal weight. The condition is characterized by decreased blood pressure, cardiac output, stroke volume, by a longer circulation time and by increased capillary permeability for fluids and protein. Blood volume appears to be somewhat increased. A decrease in the physical work of the heart was found to be parallel to the wasting of the latter. Inequality of wasting of different organs results in a large brain, kidneys and body surface per unit of body weight, in contrast to an atrophic heart, and atrophic muscle system. The possible consequence of changed body proportion to circulation is discussed. The origin of circulatory disturbance in malnutrition was shown to be different from that observed in infantile toxicosis. The state of circulation in infantile marasmus seems to be one of the limiting factors in the rebuilding of the body and one of the causes of the high fatality rate following intercurrent banal infections.
PULMONARY TUBERCULOSIS IN CHILDREN TREATED WITH STREPTOMYCIN
Authors: MCENERY EUGENE T. , SWEANY HENRY C. , TURNER GEORGE C.
Published: December 2021

The use of streptomycin in the treatment of primary progressive tuberculosis has uniformly lessened and in most cases obliterated the toxic manifestations of the disease, and has reversed the general downward clinical course of the disease in a series of 21 cases. The physical findings improved and decreased roentgenologic changes followed the clinical and physical improvement. Conversion of sputum from positive to negative findings was completed in four to five months in 89% of primary progressive lesions.

The group of three cases with the adult type of pulmonary tuberculosis was too small to be statistically significant, but from observations of these children it is believed that the results were similar to cases of chronic pulmonary tuberculosis in adults treated with streptomycin in this and other institutions. Two of these cases were only temporarily improved. One of these died and the other is now in a terminal stage. The third child is awaiting surgery.

Streptomycin therapy should not be considered a cure-all; its use is still in the experimental stage and a larger number of cases will have to be observed over a longer period of time.
MECHANISM OF EMERGENCE OF RESISTANCE TO STREPTOMYCIN OF H. PERTUSSIS AND H. PARAPERTUSSIS DURING TREATMENT WITH THIS ANTIBIOTIC
Authors: ALEXANDER HATTIE E. , REDMAN WINIFRED
Published: December 2021

In large populations of H. pertussis and H. parapertussis which have never been exposed to streptomycin, it is possible to demonstrate the presence of cells resistant to streptomycin 1000 mcg./cc.

These highly resistant cells exhibit the following traits which are characteristic of mutants: 1. Irregular occurrence in different independent cultures of same population size and strain and therefore independence of the action of streptomycin. 2. Transmission of the resistant trait unchanged in degree through many subcultures in the absence of streptomycin and, therefore, inheritance of the trait. 3. A rate of occurrence consistent with mutation frequency; the mutation rate of cells resistant to 1000 mcg./cc. does not differ significantly between these two species.
FAMILIAL ALDOSTERONE DEFICIENCY: ENZYME DEFECT, DIAGNOSIS, AND CLINICAL COURSE
Authors: David R. , Golan S. , Drucker W.
Published: December 2021

A syndrome of growth retardation, salt wasting, hypoaldosteronism, and elevated urinary Porter-Silber reacting steroids is described in two infant siblings. Their excessive urinary excretion of 18-hydroxytetrahydro compound A (18-OH-THA), the major metabolite of 18-hydroxycorticosterone, suggested an enzyme defect in the dehydrogenation of 18-hydroxycorticosterone to aldosterone. A simple method is outlined for the detection of this syndrome based upon the finding of a distinctive pattern of urinary steroid response to suppressive doses of various hormones. Advantage was taken of the fact that 18-OH-THA is a Porter-Silber positive steroid. Thus, total urinary Porter-Silber chromogens, and specifically 18-OH-THA, (1) were increased by sodium deprivation, (2) were not suppressed by dexamethasone, but (3) were promptly suppressed to normal levels following the administration of salt and deoxycorticosterone acetate. A quantitative method for the determination of urinary 18-OH-THA based upon the Porter-Silber reaction is also outlined.

The subtle clinical manifestations of this disorder are emphasized. Growth retardation was the predominant feature in our patients. The abnormality in serum electrolytes was transient in one, although the biochemical defect persisted. Response to salt and mineralocorticoid therapy in both cases was manifested by prompt clinical improvement, especially in growth rate.
GLUCOCORTICOID-INDUCED PANCREATITIS IN CHILDREN
Authors: Riemenschneider Thomas A. , Wilson John F. , Vernier Robert L.
Published: December 2021

Six children with glucocorticoid induced pancreatitis are described and compared with the previously reported 19 adults and 15 children with this syndrome. The typical clinical symptomatology is emphasized and prompt diagnosis and early therapy are shown to be lifesaving.
NEUROLOGIC MATURATION AND AUDITORY EVOKED RESPONSES IN LOW BIRTH WEIGHT INFANTS
Authors: Graziani Leonard J. , Weitzman Elliot D. , Velasco Mutya S. A.
Published: December 2021

The maturation of the nervous system of two groups of infants of low birth weight was estimated by the results of a standardized clinical neurologic examination and by evaluation of the electroencephalographic responses to auditory stimuli (clicks). Algebraically summed responses to clicks were recorded simultaneously from 10 scalp electrodes, using a standard electroencephalograph, tape recorder, and a computer of average transients. The results obtained by the two methods were compared with the age postconception, estimated from the maternal history. One group consisted of infants whose birth weights were below the 10th percentile for their gestational age (37.1 ± 2.0 weeks); the other group consisted of infants whose birth weights were similar to the first group but were between the 25th and 75th percentile for their gestational age (31.0 ± 2.3 weeks).

In the small-for-age infants, the electroencephalographic responses and the neurologic reflexes were more mature than in the infants of similar birth weights who were not small for age. The results of both examination methods correlated well with the estimated postconception age but less well with birth weight, postnatal age, or somatic growth.
PULMONARY ALVEOLAR PROTEINOSIS IN THREE INFANTS
Authors: Wilkinson Robert H. , Blanc William A. , Hagstrom Jack W. C.
Published: December 2021

Chronic lung disease in children may present a perplexing diagnostic problem. While open lung biopsy usually will provide a diagnosis without excessive morbidity, we believe that pulmonary alveolar proteinosis can be diagnosed radiographically, and we wish to point out the early age at which this disease can occur.

The clinical course of three infants is described together with the necropsy findings. Two 3-month-old and one 23-month-old infants are reported. The radiographic appearance of diffuse alveolar consolidation and the progressive respiratory involvement should alert physicians to the true nature of this disease. Recovery is reported in adults, but results of treatment in infants is disappointing.
Lead Encephalitis as Cause of VI Nerve Palsy
Authors: Hart Terril H.
Published: December 2021

I would like to compliment Dr. Knox and his associates1 for separating an apparently benign clinical entity from an otherwise ominous group. With respect to the latter, I would like to add one unusual but important disease, namely, acute lead encephalopathy. Children so afflicated may present with unilateral VI nerve palsies and often will have an associated febrile illness. Although signs of increased intracranial pressure are often present, this is always so. Delay in diagnosis may frequently prove fatal.
PERINATAL MORTALITY—THE WOODS AND THE TREES
Authors: Smith Clement A.
Published: December 2021

"Practicing Physicians, not uncommonly, are suspicious of statistical reports and rates and one often hears pejorative comments about any statistics and all statisticians." So wrote Dr. Wegman in his latest "Annual Summary of Vital Statistics,"1 and most readers will only need to look within themselves to see what he was writing about. Yet, suspicious as we may be we can seldom resist looking at statistics about our own particular pediatric problems and even occasionally making some tabulations of our own data.

This is certainly true of one who has spent more Friday noon hours than he cares to think about in a weekly conference on the fetal and neonatal deaths of a large maternity hospital.
DIAGNOSIS AND TREATMENT: TONSILS AND ADENOIDS—A PROBLEM REVISITED
Authors: Haggerty Robert J.
Published: December 2021

Anyone who is sure of the indications for removing tonsils and adenoids is surely naive and anyone who attempts to write about it impolitic, for little in medicine elicits more strong or divergent opinions. Living in Rochester, New York, where Dr. Albert Kaiser carried out his courageous community studies1 over 40 years ago may give me some license to write about the problem but should also keep one humble for even here, its hometown, the study is little known.

In the early 1920's Kaiser was able to organize a community-wide program which accomplished the incredible job of removing tonsils and adenoids from 10,000 of the then 50,000 children in Rochester in a 5-month period. The major follow-up data2 were on 5,000 of these children who had the operation and were able to be followed for 10 years after operation. Comparison was made between a subsample of 2,200 of these and a like number who had been recommended for tonsillectomy and adenoidectomy but never had had the operation. While there are many defects in this study compared to the ideal controlled trial, it would comfort Dr. Kaiser to know that no other study since has been able to do much better, since clinical trials to determine the effectiveness of an operation can rarely be controlled in the sense of random assignment of patients and practically never double blind (this would require sham operations).

It is worth reading Kaiser's works again for, though widely touted as a condemnation of the procedure, they are in fact no such thing.
IMMUNOLOGIC ASPECTS OF CONGENITAL RUBELLA
Authors: Michaels Richard H.
Published: December 2021

A study of 16 infants with congenital rubella virus infection revealed that: (1) males tended to excrete virus longer than females; (2) termination of infection was often preceded by a transitional period of declining virus titers; (3) serum antibodies to rubella virus rose during this time; (4) prolonged elevation of serum IgM correlated with persistent infection; (5) a broad scale immunoparesis may be present during the infective period, involving both humoral and cellular factors as well as such diverse antigens as those from red blood cells, fungi, bacteria and viruses; and (6) this immunologic incompetence is not associated with immunoglobulin deficiency nor inability of the infant to produce antibodies against the rubella virus.
FAMILIAL NEUROBLASTOMA WITH REGRESSION AND MATURATION TO GANGLIONEUROFIBROMA
Authors: Griffin Max E. , Bolande Robert P.
Published: December 2021

Two sisters with congenital disseminated neuroblastoma are reviewed clinically and pathologically. Both showed regression of their retroperitoneal tumors to fibrocalcific residues and maturation to ganglioneuroma. In one case, metastatic tumor nodules of the skin, which had matured to ganglioneuroma, through continued loss of ganglion cells came to closely resemble neurofibromas. A similarity to von Recklinghausen's disease became apparent. The question of a genetic basis for neuroblastoma and its relationship to von Recklinghausen's disease is discussed.
TREATMENT OF HEAT RASH IN INFANTS IN 1746 ACCORDING TO DR. JEAN ASTRUC
Authors: C. T. E.
Published: December 2021

Jean Astruc (1684-1766) is best known for his book on venereal diseases, De Morbis Veneris (Paris 1736); it may surprise some that he was also interested in pediatrics. The English edition of his lectures on children's diseases published in 1756 contains many suggestions for the treatment of illnesses of infancy and childhood. The following is a good example of early 18th century pediatric practice.

Let the patient be lightly covered and his cloths frequently changed; let him also be kept in a cool place, and lye in clean linen in the afternoon, or during the heat; thus the tumours will vanish at last by the change of the season: but if they be too obstinate, order a decoction of mash-mallows and milk. If they degenerate into a sort of impetigo, order Galen's Cerat, which is made of wax and the oil of sweet-almonds, boiled to a proper consistence. You may add a little vinegar, of frog-spawn water, or boil these with wax, and anoint the tumours therewith; the patient must abstain from all salt and spiced meats, wine, etc., and let him take for his ordinary drink, pullet broth, or mineral waters; he may also drink of barley-water, or water mixed with lemon-juice, and use moderate exercise.1
CRICOPHARYNGEAL INCOORDINATION IN INFANCY
Authors: Utian H. L. , Thomas R. Glyn
Published: December 2021

Two cases of pharyngo-esophageal (cricopharyngeal) incoordination in infants are decribed. In both cases the cineradiographic swallow was characteristic. Both children had small lower jaws which opened poorly, difficulty in swallowing, and aspirated food repeatedly; one child died in one such episode. At autopsy this child demonstrated functional pharyngo-esophageal obstruction at the level of the cricopharyngeus. On histological section of the esophagus, nerve fibers but no ganglia were demonstrated in the wall of the upper third, while the lower two-thirds contained both nerve fibers and ganglia.
ALBUMIN METABOLISM IN CYSTIC FIBROSIS
Authors: Strober Warren , Peter Georges , Schwartz Robert H.
Published: December 2021

The cause of hypoalbuminemia in cystic fibrosis was investigated with I123-albumin and Cr51-albumin metabolic studies in 19 patients, including 10 patients with hypoalbuminemia. The mean plasma volume of hypoalbuminemia patients was 57.4 ± 9.4 cc/kg, while that of normoalbuminemic patients and control individuals was 43.6 ± 3.1 cc/kg and 42.0 ± 4.4 cc/kg, respectively. Mean albumin synthetic rates, total circulating albumin, and frational catabolic rates in the three groups did not differ significantly. Thus, hypoalbuminemia in older patients with cystic fibrosis results primarily from dilution of a normal albumin mass in an enlarged plasma volume. Seven of 14 patients with cystic fibrosis demonstrated slightly increased gastrointestinal clearance of Cr51-albumin. This was a contributing but relatively minor factor in the production of hypoalbuminemia. Two of the six patients with liver involvement exhibited decreased albumin synthetic rates. In one of these two cases, hyposynthesis was a significant contributing factor to hypoalbuminemia. Hypoalbuminemia in patients with advanced cystic fibrosis suggests the presence of severe cor pulmonale and is therefore of diagnostic significance.
Academy Meetings
Authors: Halpern Salmon R.
Published: December 2021

May I most strongly endorse the suggestion of Dr. B. K. Silverman (Pediatrics, 42:1010, 1968) that we hold our annual meetings in a more pleasant setting than the city of Chicago.