bluuebunny/crossref_metadata_2025 huggingface dataset:
CHRONIC GRANULOMATOUS DISEASE: CORRELATION BETWEEN PATHOGENESIS AND CLINICAL FINDINGS
Authors: Johnston Richard B. , Baehner Robert L.
Published: December 2021

Chronic granulomatous disease (CGD) results from a failure of patients' phagocytic cells to kill ingested bacteria. The inability to kill intraphagocytic microorganisms leads to granuloma formation and abscesses throughout the reticuloendothelial system. Thus, the clinical picture of CGD is characterized by suppurative lymphadenitis, hepatosplenomegaly, pneumonia, and hematologic evidence of chronic infection. The bactericidal defect which characterizes CGD phagocytes appears to be due to their inability to generate hydrogen peroxide (H2O2). The organisms which infect patients are those which require phagocytic production of H2O2 for death–staphylococci and gram-negative enterics. There are simple means of confirming a clinical diagnosis of CGD, and prolonged therapy with specific antibiotics may therefore suppress the frequency of such serious infections.
EVALUATION OF THE EFFECTIVENESS OF COMPREHENSIVE AND CONTINUOUS PEDIATRIC CARE
Authors: Gordis Leon , H. P. , Markowitz Milton
Published: December 2021

Two controlled studies were undertaken to evaluate the effectiveness of comprehensive and continuous pediatric care. In the first study, 220 infants of primiparous adolescents were randomly allocated to either a comprehensive care (CC) or traditional care (TC) group. CC infants received all medical care, preventive and therapeutic, in a hospital-based program staffed by a pediatrician, public health nurse, and social worker. Mothers of TC infants were left to obtain care from emergency rooms, well-baby and outpatient clinics. One year after delivery, each mother was interviewed and her infant's medical records abstracted. No differences were found between CC and TC infants in completeness of immunization, utilization of medical resources, morbidity, or mortality.

In a second study, it was hypothesized that patient compliance with physicians' recommendations would be favorably influenced by continuous care. Seventy-seven children on daily oral penicillin prophylaxis for history of rheumatic fever (RF) were studied. For one year, compliance was determined by periodic urine tests for penicillin. Patients were then stratified for age, sex, and compliance and randomly allocated to continuous care (CC) or traditional care (TC) groups. CC patients received all medical care, even for problems unrelated to RF, from the same two physicians for 15 months. TC patients continued to receive specialty clinic care, were seen at the RF clinic by different physicians and referred elsewhere for all problems unrelated to RF.

Urine specimens were tested periodically for penicillin. After 15 months, no differences were observed between CC and TC groups in proportion of noncompliers or in internal shifts in compliance which had occurred during the study. Thus, neither of these studies was able to demonstrate that comprehensive and continuous care was more effective than conventional ambulatory care for children.
PROGNOSIS WITH VESICOURETERAL REFLUX
Authors: Blank Eugene , Girdany Bertram R.
Published: December 2021

One hundred and fifteen children with vesicoureteral reflux have been followed for 5 or more years. In 86 children the findings on excretory urography have remained normal. In one girl the findings became abnormal. In 11 with abnormal findings on excretory urography, the abnormalities were present at the time of the first examination, and they did not change. In 17 children the findings on follow-up excretory urography were inconclusive because the renal margins or the calices were not satisfactorily defined, or slight dilatation of a calix due to normal variation in caliber could not be differentiated from pathological dilatation.

The clinical course of these children has been different from that of a separate group of 16 children with the microscopic diagnosis of chronic pyelonephritis.
BIOCHEMICAL STUDIES ON A VARIANT OF BRANCHED CHAIN KETOACIDURIA IN A 19-YEAR-OLD FEMALE
Authors: Fischer Milton H. , Gerritsen Theo
Published: December 2021

Branched chain ketoaciduria (BCKA) or maple syrup urine disease is a rare, serious, and usually early fatal disease found in newborn infants. The finding of 233 mg of branched chain α-keto acids in the urine of a young adult was therefore surprising. The patient was physically in good health and had a full scale IQ of 76. The excretion of branched chain amino acids and branched chain α-keto acids could be increased by feeding a diet high in protein. Branched chain α- keto acid dehydrogenase activities in the peripheral leukocytes and in skin fibroblasts were found to be decreased to only a very small fraction of control values and were comparable to the levels found in a case of classic BCKA.
Arthritis Complicating Varicella Infection
Authors: Mulhern Lawrence M. , Friday Gilbert A. , Perri John A.
Published: December 2021

The second case of chicken pox with associated arthritis is described. Clinical features, as well as the results of serological investigation and synovial fluid analysis, are reported. The differential diagnosis and rarity of this complication is discussed.
The Combined Effect of Phototherapy and Phenobarbital on Serum Bilirubin Levels of Premature Infants
Authors: Blackburn Michael G. , Orzalesi Marcello M. , Pigram Penelope
Published: December 2021

The effectiveness of phototherapy in the prevention and treatment of neonatal hyperbilirubinemia is well established. There is also sufficient evidence to indicate that phenobarbital is effective in decreasing serum bilirubin levels in newborn infants. Since light is thought to break down bilirubin in the skin by photo-oxidation, and phenobarbital is known to induce bilirubin conjugating activity in the liver, the possibility of an additive effect in combined therapy was investigated in the present study.

Materials and Methods

Six sets of premature identical (monochorionic) twins (33 to 35 weeks' gestation) were studied after obtaining parental permission. Each set of twins was admitted to the study at 12 hours of life if both infants were considered normal with the exception of prematurity.
The Fetoplacental Circulation during Parturition Illustrated by the Interfetal Transfusion Syndrome
Authors: Klebe Joachim G. , Ingomar Carl Joh.
Published: December 2021

On the basis of cases reported in the literature and on three sets of twins observed by the authors, it is discussed why the volumes of circulating blood may differ essentially in monochorionic twins in whom the interfetal transfusion syndrome is in evidence. It is suggested that the observed differences may be due to some placental transfusion during and after birth, and also that the technique used for clamping of the umbilical cord is of significance. It is concluded that the choice of techniques to be used for the clamping of the umbilical cord is of importance whenever the interfetal transfusion syndrome is suspected.
Opacification of the Gallbladder in a Child Following Administration of Urographic Contrast Medium
Authors: Shea Thomas E. , Pfister Richard C.
Published: December 2021

A young child demonstrating opacification of the gallbladder following intravenous urography is described. This is the fourth reported instance of this phenomenon occurring in childhood although it is probably not a rare occurrence. Factors promoting the heterotopic biliary excretion of renal contrast media include prolonged recirculation of urographic contrast agents because of reduction in glomerular filtration rate due to intrinsic renal disease or ureteral obstruction; the current propensity for high doses of iodinated contrast agents for urography; gallbladder stasis; and, possibly, increased protein binding of urographic contrast media in the presence of uremic acidosis.
The Effectiveness of Health Screening in a School Program for Migrant Children
Authors: Eisner Victor , Cobb Otis , Tortosa Richard
Published: December 2021

This program shows again the price paid for fragmented health services. The provision of screening teams outside of normal channels of health care resulted in the discovery of many health defects, but in the treatment of less than half of them. Several ways might be found to improve the program.

At the present time we believe that an effective school health assessment can be made without physical examinations. Instead, if it is felt that heart disease should be detected in school, heart-sound screening could be added to the test battery. Teacher observation should be utilized by emphasizing the teacher-nurse conferences. This would result in referral not only of physical abnormalities, but of children with behavioral symptoms, and children with such conditions as hyperactivity and dyslexia. Such a procedure has been advocated for nearly 30 years. It would leave unsuspected hernias, which are rare, and inapparent otitis without pain, fever, or hearing loss which is probably of little significance, as the major abnormalities liable to be overlooked in health assessment. The program described here would have been far more effective had nursing time been used in the follow-up of health defects rather than in physical examinations. For instance, two of the four nurses on the screening teams might have worked with community nurses and school personnel to reach the parents.

In our opinion, abandoning physical examinations and redirecting nursing time into coordination and follow-up would result in better health care for the children in the program.
Fetal Effects of Lead Exposure
Authors: Scanlon John
Published: December 2021

Dr. Chisolm's commentary on increased lead absorption in September's Pediatrics was thoughtful and timely. One part of the lead picture which needs a great deal of further study is the fetal effects of exposure to increasing amounts of lead from the environment.

It has been demonstrated recently that concentrations of lead found in the "average" child (20 to 40 µg/100 gm whole blood) can inhibit Δ-aminolevulinic acid (ALA) dehydratase activity. This same article points out that in suckling rats these "usual" lead levels inhibit ALA dehydratase activity in both blood and brain.
Measles, Morbilli, Rubeola, Rubella
Authors: O'Connor James A.
Published: December 2021

After reading the letters of Dr. Lewak and Dr. Ebbin one must conclude that there is something seriously wrong with a so-called scientific nomenclature that can confuse even the elite for whose sole benefit it was in the first place devised. What sort of scientific terminology is this that obviously confounds rather than clarifies?

May I suggest that we already have to hand a system of nomenclature that will keep these two distinct diseases very certainly apart?
Elements of Pediatric Anesthesia, ed. 2, by C. R. Stephen, B.Sc., M.D.C.M., F.F.A.R.C.S., E. Warner Ahlgren, M.D., Edward J. Bennett, M.B., B.S., F.F.A.R.C.S. Springfield, Illinois: Charles C Thomas 1970, 202 pp., $8.00
Authors: Smith Robert M.
Published: December 2021

Dr. Stephen, now assisted by two colleagues, Drs. Ahlgren and Bennett, has again presented us with a concise and practical outline of pediatric anesthesia in its most recent phase. Stephen has always stressed safety and simplicity, and in the current craze for complexity and confusion his return to basic fundamentals is most welcome.

The presentation is straightforward and easy to read; the book's format, in keeping with the text, is well organized and edited. Although the authors naturally prefer their own methods, other approaches are described.
LONG-TERM SEQUELAE OF HEMOPHILUS INFLUENZAE MENINGITIS
Authors: Sell Sarah H. W. , Merrill Robert E. , Doyne Emanuel O. , Zimsky Edmond P.
Published: December 2021

The long-term effects of H. influenzae meningitis were studied in 86 patients who were treated with acceptable antibiotic therapy during acute episode in 1950 to 1964 in Nashville, Tennessee. Follow-up revealed that 11 were dead (eight died within first 24 hours of hospitalization).

Fifty-six of them returned to Vanderbilt Medical Center for the following appraisals: history, general physical and neurological examinations; pure tone audiometry evaluation; and psychological testing by Wechsler Intelligence Scale for Children. Nineteen others sent information by questionnaire.

Results indicated that 26 (29%) survivors had severe or significant handicaps; 12 (14%) had possible residuals; and 37 (43%) were free of detectable deficits.

It was concluded that prevention of this disease should now be a prime goal.
ENTERIC MICROFLORA AND CARBOHYDRATE INTOLERANCE IN INFANTS WITH DIARRHEA
Authors: Coello-Ramirez Pedro , Lifshitz Fima
Published: December 2021

Enteric microflora were studied in relation to carbohydrate tolerance in 50 infants with severe diarrhea. During the acute stage, 16 infants tolerated lactose, 23 patients had a specific lactose intolerance, eight had a generalized disaccharide intolerance, and three had monosaccharide intolerance. All patients had bacterial proliferation in the small intestine. A linear increase in the bacterial counts in duodenal aspirates (<103 to 105) was observed with an increasing severity of carbohydrate intolerance. The least bacterial growth (mean 103) was found in the lactose tolerant infants. A moderate growth occurred in patients with specific lactose (104-5) and disaccharide (106) intolerance; and a severe infection (108) in those with monosaccharide intolerance. Seven patients, who developed a more severe carbohydrate intolerance after a period of diarrhea, had an increase in their bacterial count as well. After recovery from diarrhea, the bacterial counts of the duodenal aspirates decreased and all patients rapidly recovered the capacity to tolerate all carbohydrates. The types of bacteria grown were similar in all patients: klebsiella species most often, then Escherichia coli (nonpathogenic), enterococci, pseudomonas and proteus species. A mixed flora was often present. In 24 patients, the bacteria isolated from the small intestine were different from those found in the feces. The proliferation of bacteria within the small bowel of infants with diarrhea may be related to the presence of undigested carbohydrates.
The Question of Diarrhea and Phototherapy
Authors: Washington Juan L. , Brown Archie W. , Starrett Andrea L.
Published: December 2021

In a series of 600 infants with a birth weight below 5 pounds, the incidence of diarrhea among those receiving more than 24 hours of phototherapy was 17.1% (13/76), whereas the incidence in controls was 14.8% (55/371). This study fails to confirm a significantly increased incidence of diarrhea in low birth weight infants receiving phototherapy.
An Unusual Complication of Umbilical Artery Catheterization
Authors: Lackey Donald A. , Taber Paddy
Published: December 2021

Attention is called to the clinical course of a neonate who experienced the accidental retro-grade loss of part of a polyvinyl catheter into the aorta. This had occurred after treatment via an umbilical artery had been completed, and attempts to remove the catheter had resulted in its breaking. The management of this problem is presented, and the various complications of umbilical vessel cathethenization are reviewed.
Follow-Up of Low Birth Weight Infants—The Predictive Value of Maternal Visiting Patterns
Authors: Fanaroff Avroy A. , Kennell John H. , Klaus Marshall H.
Published: December 2021

Present hospital regulations and the facilities for the care of high-risk infants often result in prolonged mother-infant separation, with restricted visiting and minimal physical contact. Reports of cases of child abuse and of infants who fail to thrive in the absence of organic disease reveal a disproportionately high incidence of prematurity. In the failure-to-thrive syndrome, 25 to 41% of the reported infants have been premature. Prematurity or serious illness in the newborn period resulting in maternal-infant separation was a feature in 23 to 31% of the battered infants. With such a high incidence of "mothering disorders" it is important to evaluate the mothers of high-risk infants carefully before discharge.

See table in the PDF file
Benign Red Pigmentation of Stool Resulting from Food Coloring in a New Breakfast Cereal (The Franken Berry Stool)
Authors: Payne John V.
Published: December 2021

It has long been known that certain drugs and foods can cause alteration in the color of stools. These alterations in color may be of concern to parents and physicians unless recognized. The following case is presented as yet another example of a product which may alter stool color. The breakfast cereal under discussion has only been on the market a few weeks and physicians should be aware of its potential for producing reddish stools.

Case Report

A 12-year-old Negro boy presented to the outpatient department with the chief complaint of passing red stools for 2 days that were somewhat loose and unassociated with abdominal pain or other symptoms.
Coagulase-Negative Staphylococcus Bacteriuria in a Child
Authors: Deinard Amos S. , Libit Sherwood A.
Published: December 2021

A 5-year-old boy with persistent nocturnal enuresis was found to be infected with coagulase-negative staphylococci. Evaluation showed major urologic abnormalities with significant histologic changes. Review of the literature revealed a paucity of data relative to the pathogenicity of coagulase-negative staphylococci in urinary tract disease. The present case emphasizes that association, calls attention to the significance of persistent nocturnal enuresis and suggests an approach to the evaluation of the child with enuresis.
CHILDHOOD DIET AND CORONARY HEART DISEASE
Authors: Filler L. J. , Barness Lewis A. , Goldbloom Richard B. , Haworth James C. , Holliday Malcolm A. , Miller Robert W. , O'Brien Donough , Pearson Howard A. , Scriver Charles R. , Weil William B. , Whitten Charles F. , Cravioto Joaquin , Kline O. L.
Published: December 2021

A subcommittee of the Inter-Society Commission for Heart Disease Resources recently recommended an immediate, nationwide change in dietary habits to reduce the risk of coronary heart disease in later life.1 Specifically, the Commission urges that people eat less than 300 mg of cholesterol each day, that the total calories from fat be less than 35% of the diet, and that the fat calories essentially be divided equally among saturated, monounsaturated, and polyunsaturated sources. (A commentary on these recommendations appears in this issue of Pediatrics.2)

The Committee on Nutrition, realizing that pediatricians will increasingly be asked about diets for children to reduce the risk of heart disease in later life, has evaluated the Commission's report for its application to pediatric practice. The Committee stresses that such dietary intervention is, at present, experimental and recommends against dietary changes for all children. Dietary intervention may be warranted in special circumstances, but not before 1 year of age. Reasons for these recommendations will be given in this report.

The evidence relating dietary cholesterol to coronary heart disease is summarized as follows:

1. Some inborn or acquired diseases with hypercholesterolemia are associated with premature atherosclerosis.

2. Serum cholesterol levels are higher than usual in persons with coronary heart disease.

3. Persons with high cholesterol levels in prospective studies developed coronary heart disease more often than those with normal levels.

4. The mortality rate from coronary heart disease in different countries varies in relation to the average blood cholesterol values (or dietary fat intake).

5. Experimentally induced hypercholesterolemia in animals is associated with atherosclerotic deposits.
Prevention of Unintentional Esophageal Intubation
Authors: Niccum W. L.
Published: December 2021

I read with interest the experience of Stool, Johnson, and Rosenfeld in unintentionally introducing an endotracheal tube into the esophagus.1 I would like to relate that 15 years or so ago we had a similar type of problem with one of my young patients.

We have solved the problem of unintentional esophageal intubation in a different and it seems to me a more simple way. Each one of our Foregger endotracheal tubes has on its proximal end approximately 6 in. of #3 black silk looped through a perforation on the tube.
THE FETAL ASPECTS OF TAY-SACHS DISEASE
Authors: Schneck Larry , Adachi Masazumi , Volk Bruno W.
Published: December 2021

Chemical studies were performed on three fetuse with Tay-Sachs disease. Only two chemical abnormalities were detected. One was the absence of hexosaminidase A activity in all tissues analyzed. The second was an increase in the percent of cerebral Gm2-ganglioside. In addition, abnormal inclusion bodies were seen in fetal neurons. These lipid cytosomes differed from the classical membranous cytoplasmic bodies seen in the postnatal state of Tay-Sachs disease. Screening of the Ashkenazi population and monitoring of high-risk pregnancies by amniocentesis is a means of reducing the incidence of Tay-Sachs disease.
LEUKOCYTE BETA-GALACTOSIDASE ACTIVITY IN THE DIAGNOSIS OF GENERALIZED GM, GANGLIOSIDOSIS
Authors: Singer Harvey S. , Nankervis George A. , Schafer Irwin A.
Published: December 2021

GM1 generalized gangliosidosis is an autosomal recessive inherited disease, characterized by the storage of GM1 ganglioside in brain and visceral tissues secondary to a deficiency of the enzyme β-galactosidase. The enzyme deficiency found in brain, liver, and cultured flbroblasts is also present in the leukocyte. Using leukocytes as the test tissue two GM1 gangliosidosis putients were clearly identified from patients with clinically similar storage diseases. The enzyme activity in obligate heterozygotes showed intermediate levels between their affected children and normal controls, suggesting that heterozygotes may be identified using the leukocyte as the test tissue.
HEREDITARY ISOLATED SOMATOTROPIN DEFICIENCY: EFFECTS OF HUMAN GROWTH HORMONE ADMINISTRATION
Authors: Sheikholislam Bagher M. , Stempfel Robert S.
Published: December 2021

The clinical and laboratory appraisal of a familial isolated growth hormone deficiency is reported. The lack of consanguinity and the absence of other short members in the family speak for the occurrence of a mutation in the father which he then transmitted as a dominant trait to four of his seven children. Growth hormone administration not only resulted in an increase in linear growth in those members of the family whose epiphyses were not closed, but also the rapid appearance of secondary sexual characteristics in the 18-year-old sexually infantile female and an increase of body hair and libido in both the father and the 21-year-old sexually mature, staturally retarded sister.

These observations strengthen the contention that the diagnosis of hypopituitarism cannot be excluded on the basis of eventual sexual development in individuals whose statural growth is retarded.

It is concluded that induction of sexual maturation during growth hormone therapy is not related to increased pituitary gonadotropin release. Growth hormone administration appeared to have no effect on thyroid function or on adrenal responsiveness to administered ACTH and metyrapone. An antiinsulinogenic effect of growth hormone was demonstrated during both oral and intravenous glucose tolerance tests.
FETAL GROWTH AND NEONATAL MORTALITY
Authors: Miller Herbert C.
Published: December 2021

Birth weight and calculated fetal age traditionally have served to predict risk of dying in the newborn period. Birth weight describes new-born infants inadequately, and calculated or estimated fetal age is uncertain. In the present study, well-defined fetal growth patterns observed in newborn infants replaced birth weight; crown-heel length was substituted for fetal age as a measure of fetal maturity.

Four high-risk groups and two low-risk groups of infants were identified. High-risk groups included infants with extremely high or low ponderal indices, infants disproportionately grown, and normally grown infants with body lengths of 45 cm or $$Word$$. Low-risk groups included normally grown infant; with body lengths over 45 cm and infants whose only fetal growth pattern was their short body lengths for their fetal ages.
RESPIRATORY DISEASE IN GROUP DAY CARE
Authors: Loda Frank A. , Glezen W Paul , Clyde Wallace A.
Published: December 2021

The frequency of occurrence and etiology of respiratory disease during a 40-month period in a day care center is reported. The day care center had a maximum enrollment of 39 children ranging in age from 1 month to 5 years. Sick children were not excluded from the center. During the period of the study there was not an excessive amount of respiratory illness in the children in day care when compared with the reported illness occurrence in children receiving home care. In the total group there were 8.4 respiratory illnesses per child-year with the highest rate in infants under 1 year of age.

The agents responsible for the respiratory disease in the day care center were similar to those reported as significant in the community, and the patterns of virus isolation were similar to those in the community in age incidence, seasonal occurrence, and illness association. Respiratory syncytial virus and parainfluenza virus type 3 were the agents most often implicated in lower respiratory disease. Adenovirus types 2 and 5 frequently caused febrile upper respiratory illness in infants. The study suggests group day care is safe medically for infants and that exclusion of sick children is unnecessary in a day care program with adequate space and staffing.
The Toddler as a Bicycle Passenger
Authors: Berry Teresa , Burg Fredric D. , Kravitz Harvey
Published: December 2021

Although the actual incidence is unknown, the problem of bicycle spoke injuries involving children is one commonly encountered both in private offices and in hospital emergency rooms. The child who rides as a passenger on a "bicycle built for one" all too frequently entangles a foot between the frame and the spokes of a wheel. As part of an injury surveillance survey sponsored by the Food and Drug Administration, our research group at Children's Memorial Hospital in Chicago has observed 12 such injuries during the period June through November, 1970, and we have supplemented our own data with two cases reported by private physicians in our area.
FLUORIDE AS A NUTRIEN
Authors: Filer L. J. , Barness Lewis A. , Goldbloom Richard B. , Holliday Malcolm A. , Miller Robert W. , O'Brien Donough , Pearson Howard A. , Scriver Charles R. , Weil William B. , Whitten Charles F. , Cravioto Joaquin , Kline O. L.
Published: December 2021

The association of mottled enamel and dental fluorosis with community drinking water was detected before 1920 and was specifically related to the fluoride content of the water when Churchill, in 1931,1 was able to measure trace amounts of fluoride in drinking water. Also, in areas with communal water supplies naturally contaming increased amounts of fluoride, the occurrence of dental caries was lower than that seen in the general population.2 These observations and subsequent studies3 led to the practice of adding fluoride to communal waters, with a consequent significant reduclion in the incidence of dental caries. Nearly 90 million persons in 7,500 communities4 use water supplies containing an amount of fluoride effective in reducing the dental caries rate.

Fluoride is present in the customary diet and in most potable water sources in amounts that vary from 0.1 to 0.5 parts per million (ppm).5 The average dietary intake of fluoride is approximately 0.5 mg daily from these two sources. In the temperate zone, fluoridated community water supplies are increased in fluoride content to a level of 1.0 ppm, thus providing, on the average, a total fluoride ingestion of 1.5 mg per day. A lesser level of fluoridation may be sufficient in warmer climates conducive to a higher water consumption. Fluoride is regarded as an essential nutrient6 and it is now well known to be effective in the maintenance of a tooth enamel that is more resistant to decay.

Fluoride is a normal component of tooth enamel and bone. Studies in vivo and in vitro demonstrate that the calcified tissues of both enamel and bone are made up of a combination of hydroxy- and fluor-apatites of varying composition, depending on the abundance of fluoride at the site of formation.
Letter to the Editor
Authors: Provenzano R. William
Published: December 2021

It was with great interest and pleasure that I read the article written by Naeye, et al.,1 the Commentary by Reynolds and the Letter to the Editor by Tow3 describing the successful use of steroids in hyaline membrane disease.

The use of adreno-cortical extract in pediatrics, its beneficial effects in adrenal hypoplasia of the newborn,4 on the respiratory system of the newborn,5 and its possible use in atelectasis6 (a term previously used to describe the respiratory distress syndrome and now termed hyaline membrane disease), was reported in 1950, 1951, and 1952.
Contamination of Umbilical Vessel Catheters: Encouraging Information
Authors: Powers William F. , Tooley William H.
Published: December 2021

In his recent editorial, Dr. Cook1 mentions bacterial contamination as one of the complications of umbilical artery catheterization, and refers to a report by Krauss, et al.2 who grew bacteria from 6 of 11 (55%) umbilical artery catheters. Balagtas, et al.3 have also published similar findings with umbilical vein catheters, 52% of which had bacterial colonization on removal. These reports stress the significant risk of generalized infection with umbilical vessel catheters.

On the other hand, Casalino and Lipsitz4 report a 5% incidence of bacterial contamination.
Letter to the Editor
Authors: Pachioli Renato
Published: December 2021

It is quite clear that Doctor Spitzer, who is certainly very able to perform scientific research, has forgotten that we are essentially physicians, whose main concern is for the treatment of our patients. For this reason we preferred to change schemes of treatment repeatedly in order to fit them to the clinical condition of each patient and the evolution of the illness, rather than allow too rigid therapeutic regimens.

Our results (mainly obtained on patients in different phases of illness and already subjected to previous therapeutic treatments) are not quite suitable to a statistical evaluation, but have the worth of having been made on a large number of cases, through personal and continuous observations, for a period of 17 years.
Concepts of Disease: A Textbook of Human Pathology, edited by Joel C. Brunson, M.D. and Edward A. Gall, M.D. New York/London/Toronto: The Macmillan Company, 1971, 1134 pp., $23.95
Authors: Vawter Gordon W.
Published: December 2021

This is a lusty 7½ pound newborn book with most organ systems more than adequately mature to assure a long and fruitful life. The two senior obstetricians enlisted the aid and advice of 36 other especially knowledgeable specialists to assure successful delivery.

Concepts of Disease is a textbook of pathology with a novel design, emphasizing pathology as process, and incorporates much of the newer information derived from cell biology, and from the recent developments in ultrastructural and immunofluorescent techniques.
Progress in Pediatric Surgery, vol. 2, edited by P. P. Rickham, W. Ch. Hecker, and J. Prévot. Baltimore/London/Tokyo: University Park Press, 1971, 178 pp., $12.50
Authors: Ravitch Mark M.
Published: December 2021

This is a pleasant little book derived from a series of lectures given at the Alder Hey Children's Hospital in Liverpool in July 1970. The book is perhaps rather more successful than ventures of this kind tend to be. Several of the contributions are indeed apparently direct transcriptions of the talks given and suffer from the use of a style more suitable to a spoken paper than one written for publication. On the other hand, Hendren's contribution on low urinary obstruction in the newborn is detailed, well illustrated, and well documented.
THE END OF ROUTINE SMALLPOX VACCINATION IN THE UNITED STATES
Authors: Kempe C. Henry
Published: December 2021

1971 was the year in which the Surgeon General of the United States Public Health Service, the Redbook Committee of the American Academy of Pediatrics, and the Territorial Health Officers agreed that the time had come to discontinue routine primary smallpox vaccination for American children. As a result of this it may also be expected that school vaccination laws presently in effect in some 28 states will soon be repealed or will not be enforced with vigor.

The American pediatrician views these developments with mixed feelings, since there have been extensive and often spirited debates regarding the timing for discontinuation of routine smallpox vaccination.
MULTINODULAR HEMANGIOMATOSIS OF THE LIVER IN INFANCY
Authors: McLean Robert H. , Moller James H. , Warwick Warren J. , Satran Leon , Lucas Russell V.
Published: December 2021

Multinodular hemangiomatosis of the liver (MHL) is characterized pathologically by multiple hemangiomas, primarily in the liver but also in other organs. The hepatic hemangiomas act as small arteriovenous fistulae and their combined effect may result in a massive peripheral arteriovenous shunt and high output congestive cardiac failure.

Patients with MHL may be recognized clinically by the classical triad of congestive cardiac failure, hepatomegaly, and cutaneous hemangiomas.

All but 2 of 31 cases of MHL herein reviewed had the onset of symptoms prior to 6 months of age.

High output cardiac failure were severe and resulted in a 70% mortality. Hepatomegaly was massive and out of proportion to the degree of cardiac failure.

Therapy includes intensive treatment of congestive cardiac failure and judicious transfusion in anemic patients. Irradiation of the liver and corticosteroids have been utilized in attempts to speed evolution of the hepatic arteriovenous fistulae. The data are not sufficient to establish the efficacy of either of these treatment modalities.
LEFT ATRIAL MYXOMA IN A CHILD
Authors: Steinke William E. , Perry Lowell W. , Gold Harvey R. , McClenathan James E. , Scott Lewis P.
Published: December 2021

A 9-year-old female presented with mitral regurgitation, heart failure, fever, abnormal serum proteins, elevated sedimentation rate, and elevated antihyaluronidase titer. At first thought to have rheumatic fever, she initially responded favorably to medical therapy which included corticosteroids. Evidence of progressive disease led to cardiac catheterization and angiography which demonstrated a left atrial myxoma which was successfully excised.

Review of the literature reveals that 23 children with left atrial myxomas have been reported. These may present with embolic, obstructive, or constitutional symptoms. Most children have clinical evidence of mitral regurgitation. Associated heart failure, anemia, elevated sedimentation rate, elevated antihyaluronidase titer and initial favorable response to medical therapy often lead to the incorrect diagnosis of acute or chronic rheumatic heart disease.

In these patients, increased endogenous hyaluronic acid excretion from tumor cells may lead to increased hyaluronidase and antihyaluronidase activity, abnormal serum proteins and elevated sedimentation rate.
COMPARISON OF DAILY AND TWICE-WEEKLY SCHEDULE OF L-ASPARAGINASE IN CHILDHOOD LEUKEMIA
Authors: Jaffe Norman , Traggis Demetrius , Das Lakshmi , Kim Byung Soo , Won Hie , Hann L. , Moloney William C. , Dohlwitz Anders
Published: December 2021

A two dosage therapeutic regimen of L-asparaginase was investigated to determine the differences in the production of abnormal reactions and remission induction in pediatric patients with leukemia. Among 35 patients, 17 were randomized to receive 200 I.U./kg daily for 2 weeks and 18, 5,000 I.U./kg twice weekly for 2 weeks. Of the 17 children on the daily schedule there were nine complete remissions and one improved marrow; among the 18 children in the twice-weekly schedule there were nine complete remissions, two partial remissions, and two improved marrows. The median duration of remission in each group was 9 weeks. Hypocellular marrows were noted in each regimen. Anaphylactoid reactions occurred only in the twice-weekly schedule. In the latter, one patient developed pancreatitis and another hyperglycemia not related to pancreatitis. Greater aberrations in the blood ammonia and serum amylase were noted in the twice-weekly regimen. A high intermittent dose schedule, while permitting less frequent clinic visits, increases the risk of side effects without adding to the beneficial effects of the drug.
Lead Paint Exposure in Migrant Labor Camps
Authors: Osband Michael E. , Tobin James R.
Published: December 2021

During the summer of 1970, 117 migrant farm labor camps were studied for lead paint hazard. Of these, 115 had lead-based paint on their structures. The average dwelling had 50% of its surfaces painted with lead-based paints. The average dwelling had 40% of its paint in a peeling or chipping state. We conclude that all children living in such housing should be recognized as having been subjected to lead exposure. Because of this, lead poisoning should be more thoroughly looked for in rural settings.
The Incidence of Associated Anomalies in 105 Patients with Congenital Adrenal Hyperplasia
Authors: Kirkland Rebecca T. , Kirkland John L. , Librik Leon , Clayton George W.
Published: December 2021

A survey of 105 patients with defective adrenal steroid 21-hydroxylation, the most common defect in congenital adrenal hyperplasia, has been carried out to determine the presence of additional congenital or developmental anomalies. The following is a report of this survey.

The diagnosis of congenital adrenal hyperplasia was suspected in infants who presented with ambiguous genitalia or with defect in electrolyte metabolism manifested by failure to thrive, vomiting and dehydration with hyponatremia and hyperkalemia. Measurement of elevated levels of urinary 17-ketosteroids, 11-keto pregnantriol and pregnantriol confirmed the diagnosis. Seventy-two (68.6%) of the 105 patients surveyed demonstrated defects in electrolyte metabolism and 39 of these were males.
Dietary Treatment of an Infant with Isovaleric Acidemia
Authors: Lott Ira T. , Erickson Arline M. , Levy Harvey L. , Kennedy Joseph P.
Published: December 2021

A male infant, diagnosed as having isovaleric acidemia at 12 days of age, has received dietary therapy for 2 years. In contrast to an untreated older sister with the same disorder, the treated infant has had fewer periods of acidosis and has manifested normal psychomotor development.
Fluid Deposition in Airways after Mist Tent Therapy
Authors: Chadwick David L.
Published: December 2021

In the October issue of Pediatrics, S. K. Bau, et al. record observations that neatly demonstrate the failure of mist tents to deposit fluid in the lungs of their occupants. They conclude, "If in fact mist tents are of therapeutic value in the treatment of cystic fibrosis the benefits must accrue for reasons other than the deposition of fluid in the lung, thinning the mucous secretions and promoting their removal from the airways."

The hypothesis implicit in the use of mist tents is not that they deposit water in the lung.
Aminophylline in Status Asthmaticus: Some Questions
Authors: Caplinger Kelsy J.
Published: December 2021

The report of a double blind trial of aminophylline in status asthmaticus by Pierson, et al. seems indeed to have shown that significant improvement in ventilatory function resulted without serious side effects.

Aminophylline toxicity is a very real and potentially serious complication of the treatment of status asthmaticus. There is a wide variation in the recommended children's dose of aminophylline. Since this study showed apparent good improvement in ventilatory function (when used with other accepted medications in appropriate doses) and serious side effects were avoided, it would be of interest to know the dose of aminophylline required in these patients.
Letter to the Editor
Authors: Pierson William E.
Published: December 2021

This study was carried out because of the dichotomy between theoretical effectiveness and reported toxicity of aminophylline in children. The authors employed aminophylline dosages which are noted in the appendix: 7 mg/kg was administered as a priming dosage, placed into the intravenous tubing and administered over a 10-minute period, and followed by 9 mg per kilogram per 24 hours administered with intravenous fluids.

(To Dr. Martin)

Since this study of the effectiveness of aminophylline in status asthmaticus was based on objective data obtained by pulmonary function tests which required patient cooperation, we included only children over age 5 years.
H. Influenzae Meningitis: Is Ampicillin Proper Treatment?
Authors: Marder Gerard
Published: December 2021

I am somewhat disappointed with the Pediatric Establishment for what I consider a lapse in the scientific method in the case of the assessment of proper therapy for H. influenzae meningitis. Every practicing pediatrician sees cases of H. influenzae meningitis each year. It is a serious disease and accurate information as to what is best treatment is important.

As recently as the 16th edition of the Red Book the Committee on Infectious Diseases recommended chloramphenicol as the Number 1 treatment for H. influenzac meningitis.
Treatment of Acne with Antibiotics: Monilial Vaginitis as Complication
Authors: Litt Iris F.
Published: December 2021

We have successfully used oral tetracycline in the treatment of acne, in approximately 250 teenagers in the past 4 years, as described in the recent report by the Committee on Drugs published in the October issue of Pediatrics.1 However, we would caution others about the complication of monilial vaginitis which we have encountered not infrequently in this group.
Letter to the Editor
Authors: Gruenwald Peter
Published: December 2021

When the designation of hyaline membranes quoted by the Editor was used, I did not know how pertinent it really is. It has since become abundantly clear that hyaline membranes prevent neither entry nor exit of air. When a lung with hyaline membranes removed at necropsy from an infant dying about 6 to 24 hours after birth is inflated and then gradually deflated, it loses air at a higher pressure and more completely than does a normal one, and returns to its previous atelectatic state.
WHY T & A REMAINS MOOT
Authors: Paradise Jack L.
Published: December 2021

Tonsillectomy is the most frequently performed operation in the United States; about 1,000,000 children are subjected to this procedure annually.1 There exists a general feeling among critical observers that the majority of these operations may be unnecessary or actually harmful, but even thoughtful and conscientious pediatricians maintain divergent attitudes and practices on the matter. Thus, some of them, cognizant of potential anesthetic, immunologic, and psychologic risks, and of widely publicized condemnations of the procedure, almost routinely refuse to consider tonsillectomy for any of their patients; others, having cared for children who appear to have been helped—sometimes dramatically—by tonsillectomy or adenoidectomy or both, continue to recommend surgery for selected patients.
THE SMALL-FOR-DATE INFANT I. LATER GROWTH PATTERNS
Authors: Fitzhardinge P. M. , Steven E. M.
Published: December 2021

In a prospective study, 96 of a possible 131 full term small-for-date (SFD) infants have been followed for a minimum of 4 years. Serial measurements for weight, height, and head circumference have been compared with the Stuart growth percentiles. By 4 years of age the mean weight and height were between the 10th and 25th percentiles with 35% below the 3rd and only 8% above the 50th percentiles. Increase in head circumference paralleled linear growth. Bone age showed a high positive correlation with height age.

Siblings of normal birth weight tended to be larger than the study children with 3% below the 3rd and 45% above the 50th percentiles. Heights of parents were normal, mothers were slightly underweight.

There was no difference in the 6-year height or weight between the most severely intra-uterine retarded babies and their less affected counterparts.

The growth pattern of the SFD children was similar to the normal child with the greatest velocity of growth occurring in the first 6 months. Those children whose 4-year height exceeded the 3rd percentile showed an accelerated velocity of growth in the first 6 months.
SYMPOSIUM: BEHAVIOR MODIFICATION BY DRUGS
Authors: Conners C. Keith
Published: December 2021

A number of myths have grown up regarding the behavioral effects and use of stimulant medications with children. The first is that there is a type of child uniquely responsive to stimulant compounds, namely, the hyperkinetic child. The second is that the hyperkinetic child is any child who is sufficiently overactive to be considered a menace by adults. The third is that the stimulant medications act primarily to reduce motor activity in a paradoxical "sedative" fashion; and finally, that the drugs do not influence cognitive and perceptual functioning in these children. I believe that these myths are due partly to the historical accident of the manner in which they were first studied, partly to the imprecision in diagnosis and terminology of classification of patients, and partly to the paucity of systematic data on sufficiently large samples under sufficiently varied experimental conditions. I would like to present the results of studies which bear on these issues, and try to draw some general conclusions regarding the present state of knowledge with regard to the use of the various psychostimulants. In this paper I will deal with dextroamphetamine, methylphenidate, and magnesium pemoline.

I. METHYLPHENIDATE AND DEXTROAMPHETAMINE

The children for this study were referred from schools, pediatricians, and social agencies for either academic or behavioral difficulties, or both. The subjects retained for the drug study comprised about ⅔ of the original referral sample. They were selected to fit the description of the child with "minimal brain dysfunction" as defined by the National Institute of Neurological Diseases and Stroke (NINDS) Task Force I report.
ALTERATIONS IN BLOOD BIOCHEMICAL TESTS IN PROGRESSIVE PROTEIN MALNUTRITION
Authors: Kumar Vijay , Chase H. Peter , Hammond Keith , O'Brien Donough
Published: December 2021

The effects of progressive protein deprivation have been studied in the monkey to determine which laboratory tests are affected early and which laboratory tests reflect the severity of protein deprivation. BUN levels and serum amylase activity were significantly reduced after 2 weeks, and hematocrit values after 4 weeks of protein deprivation. They continued to be decreased in poorly nourished animals thereafter, but did not reflect progressive protein deprivation. Total serum protein, albumin, and transferrin were affected later in the course of protein deprivation and appeared to reflect the severity of deprivation. Five of seven measured essential amino acids showed statistically significant reductions in serum concentrations after 8 weeks of low protein diet but did not show further diminution after 14 weeks. The ratio of nonessential to essential serum amino acids was also increased after 8 weeks of protein deprivation but was not further decreased after 14 weeks. Serum alkaline phosphatase and cholesterol levels were variable throughout the 20 weeks of deprivation and did not appear to be good screening tests for protein malnutrition.