bluuebunny/crossref_metadata_2025 huggingface dataset:
The Cycloergometer as a System for Studying Exercise-induced Asthma
Authors: Eggleston Peyton A.
Published: December 2021

Although bicycle exercise induces less asthma than does treadmill running, the cycloergometer offers definite advantages for quantitative testing of bronchospastic response, extensive knowledge of normal responses, lack of training artifact, and ease of physiologic monitoring. Using maximal heart rate to tailor the exercise load to a given subject, reliable responses can be obtained from subjects as young as 7 years old. To obtain such results, diurnal variations in response to exercise, resting bronchial tone, and previous medication must be controlled, and pulmonary function measurements must be taken frequently after exercise.
The Effect of Cromolyn Sodium on Exercise-Induced Bronchospasm Using a Free Running System
Authors: Shapiro Gall G. , Pierson William E. , Blerman C. Warren
Published: December 2021

This study was designed to assess the effectiveness of comolyn sodium in modifying exercise-induced bronchospasm (EIB). Twenty children and adolescents with EIB were given either cromolyn or placebo in a prerandomized double-blind fashion. They then performed a free running maneuver. Pulmonary function tests were obtained before and after this exercise. Patients returned one week later to repeat the same procedure. This time subjects took placebo if they had previously taken cromolyn and vice versa.

Significant beneficial effects of cromolyn were noted in forced vital capacity and forced expiratory volume in one second measurements but not in forced expiratory flow between 25% and 75% of the flow-volume curve) (FEF 25%-75%). This suggests that larger airway disease is preferentially helped by cromolyn when subjects are stressed maximally as with a free running system. Subjects who received placebo on study day 1 and cromolyn on study day 2 showed the most striking benefit from cromolyn. This may be related to the better baseline status of subjects on day 2 as well as to familiarity with the procedure and medication.
Exercise-Induced Asthma and Competitive Athletics
Authors: Fitch Kenneth D.
Published: December 2021

Although swimming is their optimum sport and exercise, asthmatics should be encouraged to embrace a full and varied program of sport and physical education. Sports exclusion should be infrequent as possible. Pre-exercise cromolyn sodium will significantly reduce exercise-induced athma (EIA) and salbutamol may be administered pre-exercise should EIA supervene. "Warm-up" is recommended. The current ruling which classes selective β2-adrenocepter agonists as doping agents in sports should be rescinded.
Airway Smooth Muscle in Exercise-Induced Bronchospasm: Some Speculations
Authors: Middleton Elliott
Published: December 2021

Some possible neurophysiolal, biochemical, and pharmacological pathways affecting the state of contractility if airway smooth muscle in exercise-induced bronchospasm (EIB) are described. No unifying hypothesis can be set forth at this time. Indeed, it is likely that the heterogeneous nature of EIB is a reflection of the numerous biochemical loci in smooth muscle cells that could be affected by the various metabolic changes accompanying heavy exertion.
Summary
Authors: Blerman C. Warren , Pierson William E.
Published: December 2021

Asthma is the most frequent chronic respiratory illness of childhood. It is the number one cause of school absenteeism and forces afflicted youngsters to miss a total of 9 million school days annually. Athma and other respiratory allergies such as hay fever and perennial allergic rhinitis account for nearly one third of all chronic conditions in children Under 17 years of age.

Among many of these young people, bronchosmasm induced by exercise is a physical handicap which is frequently overlooked by the child's parents, physician, teachers and often by the child himself. This condition may have lasting physical and psychological effects, for the individual with exercise bronchospasm may avoid sports and other physical activities. This can result in poor physical condition and poor self-image, which is reinforced by ridicule from peers, teachers, and physical education instructors.

Exercise-induced asthma (EIA) or exercise-induced bronchospasm (EIB) as it has been variously termed has been mentioned from time to time in medical writings since the third century A.D. Only during the past decade, however, has it been studied in a systematic fashion as to incidence, physiological changes, and pharmacological therapy. Few of these studies, however, are readily available to pediatricians.

This symposium has been organized to compile existing knowledge concerning exercise and asthma for physicians caring for allergic children and adolescents as a guide to early recognition since effective therapy is available for EIB. Thus, the physician's goal should be pharmacologic prevention rather than physical restriction, so that the child can participate in normal activities with his peers with the resulting physical and emotional benefits.
DR. TOBIAS SMOLLETT ON THE EVILS OF URBANIZATION (1771)
Authors: C. T. E.
Published: December 2021

Tobias Smollett (1721-1771), usually remembered as a brilliant novelist, was also a surgeon in the Royal Navy. He published a number of satirical novels on English social life. In one of these, The Expedition of Humphrey Clinker (1771), Smollett described how urbanization was changing London as follows:

But notwithstanding the improvements, the capital is become an overgrown monster; which, like a dropsical head, will in time leave the body and extremities without nourishment and support. The absurdity will appear in its full force, when we consider, that one sixth part of the natives of this whole extensive kingdom, is crowded within the bills of mortality. What wonder that our villages are depopulated and our farms in want of day-labourers? The abolition of small farms is but one cause in the decrease of population. Indeed, the incredible increases in horses and black cattle to answer the purposes of luxury, requires a prodigious quantity of hay and grass, which are raised and managed without much labour; but a number of hands will always be wanted for the different branches of agriculture, whether the farms be large or small. The tide of luxury has swept all the inhabitants from the open country. The poor squire, as well as the rich peer, must have his house in town, and make a figure with an extraordinary number of domestics. The plough-boys, cow-herds and lower-hinds are debauched and seduced by the appearance and discourse of those coxcombs in livery, when they make their summer excursions. They desert their dirt and drudgery, and swarm up to London in hopes of getting into service, where they can live luxuriously and wear fine clothes, without being obliged to work; for idleness is natural to man.
Primary Peritonitis Due to Group G Streptococcus: A Case Report
Authors: Khan Abdul J. , Evans Hugh E. , Macabuhay Marylu R. , Lee Yu-En , Werner Robert
Published: December 2021

Beta-hemolytic Streptococcus group G, a rare human pathogen, has long been implicated in human disease as causing pharyngitis, puerperal sepsis, empyema, and even septicemia. We are reporting a rare, life-threatening, acute illness, primary peritonitis, due to this organism, whose etiological source probably was a family dog.

Case Report

R.K., a 2-year-old girl, was admitted with the complaints of anorexia, vomiting of three days' duration, and severe abdominal distension of one day's duration. The symptoms started following a burn injury over the face and lips three days prior to admission. Past history was noncontributory.

Physical examination revealed an ill child of average size, fully conscious.
A New Method of Evaluating the Chemosensitivity of the Respiratory Center in Children
Authors: Cosgrove John F. , Neunburger Naftoli , Bryan M. H. , Bryan A. C. , Levison Henry
Published: December 2021

Decreased ventilatory response to carbon dioxide is often present in lung disease. This can be due to a reduction in the output of the respiratory center or an inability of the respiratory pump to respond to a normal output because of the size or impedence of the pump. To separate these mechanisms we have measured the isometric force developed by the respiratory muscle during brief airway occlusion, by measuring the pressure generated at 100 msec ( PM100). We studied 43 subjects ranging in age from 6 to 50 years, and nine neonates. We found a linear rise of PM100 with rising PAco2 during carbon dioxide rebreathing maneuvers. Our results also show that although there are wide variations in slopes of Pm100 to carbon dioxide tension (SPm100/PAco2) between individuals, in a given subject this slope remains constant even following repeated studies. It also remains constant for age and size, indicating that the neuromechanical output of the respiratory apparatus does not change with growth. In contrast the ventilatory response either assessed as Ve/PAco2 or Vt/PAco2 depended on age and lung size. The results suggest that throughout growth, comparison of Pm100/ PAco2, and Ve/PAco2 can distinguish between abnormalities of neuromuscular output from other causes of ventilatory impairment.
THE TERRIBLE INFLUENCE READING NOVELS WOULD HAVE ON YOUNG GIRLS-AN 1815 VIEW
Authors: C. T. E.
Published: December 2021

For more than three centuries the almanac served as the newspaper, the radio, the television, and almost the only source of information and news for millions of Americans. An example of the morality found in a widely read almanac of 1815 follows:

The indiscriminate reading of Novels and Romances is to young females of the most dangerous tendency . . . it agitates their fancy to delirium of pleasure never to be realized . . . and opens to their view the Elysium fields which exist only in the imagination . . . fields which will involve them in wretchedness and inconsolable sorrow. Such reading coverts them into a bundle of acutely feeling nerves and makes them "ready to expire of a rose in aromatic pain" . . . The most profligate villain, bent on the infernal purpose of seducing a woman, could not wish a symptom more favorable to his purpose than a strong imagination inflamed with the rhapsodies of artful and corrupting novels.1
Live Attenuated Influenza Virus Vaccine Trial in Children
Authors: Hall Caroline Breese , Douglas R. Gordon , Fralonardo Sharon A.
Published: December 2021

Thirty-four children received intranasally a live attenuated influenza A virus vaccine, and were then followed for six months to evaluate the vaccine safety, immunogenicity, and efficacy. All but one of the 31 children with hemagglutination inhibition (HI) titers 64 before inoculation responded with at least a four-fold rise in antibody titer to a single dose of vaccine. One child required two doses. Seven (21%) of the vaccinees also responded with production of nasal neutralizing antibody. The vaccine was well tolerated with few clinical reactions. Two vaccinees developed fever possibly attributable to the vaccine. No transmission of the vaccine virus to any of the 25 unvaccinated contact children was demonstrable. Five months after this vaccine trial an influenza epidemic due to a heterologous influenza A strain occurred in the community. During this outbreak acute febrile and/or respiratory illness occurred in 12 or 52% of the contact controls, and in six or 19% of the vaccinees. In two of these six vaccinees, influenza A infection was confirmed by at least a four-fold increase in HI titer. This study suggests that this vaccine is safe, easily administered, highly immunogenic in children, and is protective against a heterologous strain epidemic in the community.
Osteomyelitis: Early Scintigraphic Detection in Children
Authors: Treves S. , Khettry Jayant , Broker Frederik H. , Wilkinson Robert H. , Watts Hugh
Published: December 2021

The value of scintigraphy in the early detection of osteomyelitis is demonstrated in children who had signs and symptoms suggestive of bone infection. Nine patients between 2 and 13 years of age were evaluated with technetium Tc 99m diphosphonate bone scintigrams and roentgenograms. Blood cultures were performed in all patients, and bone biopsy or drainage was obtained in six patients. The diagnosis of osteomyelitis was made in seven patients; one patient had a subperiosteal abscess surrounded by osteomyelitis, and one patient had cellulitis. The seven children with osteomyelitis had focal increase of radiopharmaceutical uptake in the bone. The child with the subperiosteal abscess had an area of decreased uptake in the center of the abscess surrounded by a zone of increased uptake of the radioactive bone-seeker. The patient with cellulitis had soft tissue changes by X-ray and a normal bone scintigram. In the seven patients with osteomyelitis, the bone scintigram was performed during the early phase of the disease and no bony changes were present on the roentgenogram. In one patient with subacute osteomyelitis, soft tissue changes were seen radiologically. Only three of the seven children with osteomyelitis developed radiological bony changes. Since bone scintigraphy can detect early local bone derangement, it is recommended in the initial evaluation of children in whom osteomyelitis is suspected.
Continuous Monitoring of Arterial Oxygen Tension Using a Catheter-Tip Polarographic Electrode in Infants
Authors: Conway M. , Durbin G. M. , Ingram D. , McIntosh N. , Parker D. , Reynolds E. O. R. , Soutter L. P.
Published: December 2021

An oxygen electrode mounted in the tip of an umbilical artery catheter was used in 36 newborn infants with severe respiratory illnesses, 28 of whom survived. Thirty-seven electrodes were used. The median age at insertion was 4 hours (range, 30 minutes to 122 hours). Three electrodes failed to work and they were removed or replaced, and two could not be properly evaluated. Thirty-two electrodes functioned satisfactorily for 10 to 190 hours (mean, 75 hours) after a one-point calibration against blood sampled through the catheter. Twenty-two did not need recalibrating before they were removed after 10 to 190 hours (mean, 88 hours). Four of the remaining ten electrodes were recalibrated once after 33 to 97 hours and then functioned until removed 15 to 55 hours later. The other six electrodes failed after 32 to 105 hours (mean, 49 hours). Complications were few. A total of 356 arterial blood samples, obtained after the initial calibration and before any recalibration was necessary, gave a correlation coefficient of 0.93 (P < .0001) against an independent system for measuring arterial oxygen tension (Pao2) (Radiometer Type E.5046 oxygen electrode). We conclude that the catheter-tip electrode is a safe and reliable instrument for continuously recording Pao2 in newborn infants which much simplifies the management of serious respiratory illnesses.
Generic Prescribing
Authors: Yaffe Sumner J. , Bierman C. Warren , Cann Howard M. , Cohen Sanford N. , Freeman John , Kagan Benjamin M. , Kauffman Ralph , Pruitt Albert , Segal Sydney , Soyka Lester , Weiss Charles F. , Chudzik Gregory , Ballin John C. , Del Prato Pierre S. , Done Alan K. , Farchione Louis , Oakley Godfrey , Sawchuk Steven , Scott C. P. , Simopoulos Artemis P.
Published: December 2021

During the last several years there has been continued pressure from consumers, legislators, and health administrators to mandate generic prescribing. It has been proposed that requiring physicians to prescribe by generic rather than brand name and allowing pharmacists to substitute generically equivalent drug products would save consumers millions of dollars. These assumptions and the following events have stimulated the American Academy of Pediatrics to bring this issue to the attention of its membership.

(1) The report of the Office of Technology Assessment, Drug Bioequivalence Study Panel, entitled "Drug Bioequivalence," concluded that current standards and regulatory practices do not ensure bioequivalence for drug products, although most of the analytical methodology and experimental procedures for the conduct of bioavailability studies in man are available.1 Additional work may be required to develop the means of applying them to certain drugs and to special situations of drug use.

(2) The Drug Research Board of the National Academy of Sciences (October 25, 1974) recommended that the physician "should be required to delegate to the pharmacist, or explicitly to retain to himself, selection of the particular drug product to be dispensed."2

(3) The Maximum Allowable Cost Proposal published in the Federal Register (November 15, 1974)3 would establish a system to fix a "maximum allowable cost" for reimbursement for drugs dispensed under health financing and service programs of the Department of Health, Education, and Welfare which have multiple sources and are deemed bioequivalent. Other provisions of this proposal call for a fixed dispensing fee and supplying comparative price information to physicians and pharmacists.
Dr. Yaffe Replies
Authors: Yaffe Sumner J.
Published: December 2021

Although we know of no data to indicate that teeth discolored by tetracyclines are caries-resistant, it is known that administration of tetracyclines to young children can result in hypoplastic areas of enamel, a condition conducive to increased susceptibility to decay. However, as Dr. Goebel concluded, the tooth-staining reports were cited in the Committee statement for the purpose of substantiating that tetracyclines are in fact still being given to children. The degree of tooth staining is a nice index of tetracycline dosage.1
Central Hypoventilation During Quiet Sleep in Two Infants
Authors: Shannon Daniel C. , Marsland David W. , Gould Jeffrey B. , Callahan Barry , Todres I. David , Dennis Jane
Published: December 2021

Expired ventilation (VE), tidal volume (VT), frequency (f), and alveolar PCO2 (PACO2) were examined in six normal infants at 41 to 52 weeks post-conceptional age and in two infants who were apneic at birth. Their response to breathing 5% carbon dioxide in air and to 100% oxygen in quiet sleep were compared to those in rapid eye movement (REM) sleep.

VE in normal infants was 259 ml/kg/min in REM and 200.2 ml/kg/min in quiet sleep with the difference being due to decreased carbon dioxide production and to decreased dead space. VE increased 34.4 ml/kg/min/mm Hg of PCO2 elevation with 5% carbon dioxide breathing during REM and was not significantly different during quiet sleep. During oxygen breathing VE fell by 32.7% at 30 seconds before increasing again.

In the affected infants, VE and PACO2 during REM at 1 and 4 months were normal. At 1 month, during quiet sleep, each infant became apneic and PACO2 rose 9 and 8 mm Hg/min respectively. At this time mechanical ventilation was begun. At 4 months, during quiet sleep, VE was 0.064 and 0.063 ml/kg/min at PACO2 of 66 mm Hg in each infant. The change was due entirely to a decrease in VT to 2.3 and 2.5 ml/kg. At this time 5% carbon dioxide breathing given during normal ventilation in REM produced an abrupt fall in VT to 2.0 and 2.2 ml/kg with no change in frequency.

Oxygen breathing during REM at one month had no effect but at 4 months produced apnea requiring mechanical ventilation after one minute.

The findings suggest that the ventilatory response to carbon dioxide is (1) important in initiation of extrauterine ventilation and (2) in sustaining ventilation particularly in quiet sleep. It is not necessary in sustaining ventilation awake or in REM sleep and it represents a balance between the stimulatory and depressant effects of carbon dioxide on the central nervous system.
Incidence and Clinical Features of Patent Ductus Arteriosus in Low-Birthweight Infants: A Prospective Analysis of 150 Consecutively Born Infants
Authors: Siassi Bijan , Blanco Carlos , Cabal Luis A. , Coran Arnold G.
Published: December 2021

The incidence of persistent patency of the ductus arteriosus beyond the third day of life was prospectively determined in 100 preterm infants with birthweights of 2,000 gm or less and 50 infants with birthweights of 2,001 to 2,500 gm. The overall incidence was 21% and was inversely related to increasing gestational age and birth-weight The data suggest that immaturity is the major determinant of the persistent patency of the ductus arteriosus. Spontaneous delayed closure of the ductus occurred in 79% of patients that survived the immediate neonatal period. There was a high degree of association between the presence of a patent ductus arteriosus (PDA) and respiratory distress syndrome (RDS). Eight infants with severe RDS and PDA developed heart failure and four required surgical ligation of the ductus. None of the infants with birthweights greater than 2,000 gm who had PDA developed heart failure or required surgical ligation of the ductus arteriosus.
Insulin Responses During Catch-up Growth of Infants Who Were Small for Gestational Age
Authors: Colle Eleanor , Schiff David , Andrew Gail , Bauer Charles B. , Fitzhardinge Pamela
Published: December 2021

Growth characteristics of 15 full-term infants, selected because of weights more than 2 SD below the mean for gestational age, are described. The response to an intravenous injection of glucose was utilized to measure the insulin response of the infants at 6 months.

Infants small for gestational age grow at a faster rate than appropriate-for-age infants during the first six months of life. There was a positive correlation between the growth velocity of the period and insulin release and a negative correlation between growth velocity and birth length. There was no correlation between these variables and increases in weight during the same period.

Growth velocity during catch-up growth is related to the degree of preceding retardation but insulin may play a permissive role.
The Pediatrician and Malpractice
Authors: Brown Rowine Hayes
Published: December 2021

The issue of medical liability has reached crisis proportions in the United States today. Such is a consequence of the burgeoning number of suits, the exorbitant damages awarded, and the excessive premiums or inavailability of medical liability insurance. Pediatrics has until recently been a low-risk specialty, but now suits are being brought against pediatricians with increasing frequency, especially against neonatologists. Medical liability suits are brought on many different legal theories. Broad attempts are being made to solve the problem. Pediatricians can and should take prophylactic steps to ward off such suits.
The Consequences of Imitative Behavior in Children: The "Evel Knievel Syndrome"
Authors: Daven Joel , O'Conner J. F. , Briggs Roy
Published: December 2021

Televised violence, especially during sporting events and news reporting, is increasingly implicated in imitative and aggressive behavior exhibited by children. This behavior often results in severe injury. We are all aware of the numerous injuries sustained by children participating in such contact sports as ice hockey and football, yet the number of such injuries due to identification with sports heroes and imitation of their exploits is unknown. The corresponding literature on this aspect of imitative behavior is nonexistent.

During the late summer and fall of 1974, the daredevil exploits of Evel Knievel received extensive media coverage, especially on the sports segments of television news programs.
Phototherapy for Neonatal Hyperbilirubinemia in "Healthy" and "Ill" Infants
Authors: Tan K. L.
Published: December 2021

The effectiveness of phototherapy for nonhemolytic hyperbilirubinemia was evaluated in two groups of closely matched newborns, one group consisting of "healthy" and the other of "ill" infants. Phototherapy was equally effective in reducing bilirubin levels in both groups of infants. It would seem to be the treatment of choice in all infants with nonhemolytic hyperbilirubinemia, especially ill infants in whom its simplicity, safety, and effectiveness would make it an ideal form of therapy.
Insecticide Exposure of Mothers and Newborns in a Rural Agricultural Area
Authors: D'Ercole A. Joseph , Arthur Robert D. , Cain Jimmie D. , Barrentine Ben F.
Published: December 2021

Pregnant women in a rural agricultural area were found to have levels of residues of chlorinated hydrocarbon insecticides in their serum which were comparable to those found in occupationally exposed men. Cord blood of offspring also had significant residue levels. Residues were higher in blacks and in mothers living in rural areas where exposure was more intense. In newborns no signs or symptoms compatible with acute chlorinated hydrocarbon poisoning were found. Despite the lack of DDT use during most of the study period, over 90% of the mothers, 84% of the black newborns, and 45% of the white newborns demonstrated evidence of recent DDT exposure.
ABO Hemolytic Disease in Puerto Rico and North Carolina
Authors: Huntley Carolyn C. , Lyerly Anne D. , Littlejohn Miriam P. , Rodriguez-Trias Helen , Bowers Glenn W.
Published: December 2021

A prospective study was carried out at the University of Puerto Rico Hospital (UPRH) and at the North Carolina Baptist Hospital (NCBH) in order to establish the incidence of ABO hemolytic disease (ABO HD) in the two populations and to determine the relationship of intestinal parasitic infection of the mother to ABO HD in the infant. The incidence of ABO HD among UPRH at risk pregnancies (type O mother with type A or B infant) was 28.3% or 1 in 3.5 as compared with 18.4% or 1 in 5.4 of NCBH at risk pregnancies (P > .05). Indirect Coombs' tests in cord sera, representing the passive transfer from mother to fetus of antibodies directed toward antigens on the infants' erythrocytes, were positive in 58.8% of UPRH at risk infants as opposed to 40.4% of NCBH at risk infants (P < .001). Maternal isohemagglutinin titers at term were higher in type O UPRH mothers than in type O NCBH mothers (P < .01). A relationship between helminth parasitic infection of the mother and ABO HD in the infant was suspected but not proved.
Ophthalmia Neonatorum: A Chart Review
Authors: Armstrong John H. , Zacarias Fernando , Rein Michael F.
Published: December 2021

Cases of ophthalmia neonatorum diagnosed at Grady Memorial Hospital 1967-1973 were reviewed. Of 302 cases 43 could be diagnosed as gonococcal, 86 chlamydial, 3 gonococcal and chlamydial, 31 staphylococcal, and 5 chemical. Silver nitrate prophylaxis was routinely employed. Gonococcal cases peaked during the third quarter of the year and chlamydial during the fourth quarter. Gonococcal cases were associated with a longer duration of ruptured fetal membranes. Definitive etiologic diagnosis could not be established on clinical grounds alone. Chlamydial ophthalmia was more common among black babies but other forms of ophthalmia were equally distributed with respect to race. The risk of gonococcal ophthalmia developing in an infant born to an infected mother was less than 2% if Credé prophylaxis is used. Therapy with topically applied sulfonamides was effective against chlamydial ophthalmia. Therapy with parenterally administered penicillin and topically applied antibiotics was effective against gonococcal ophthalmia.
Host Defense Mechanisms in the Gastrointestinal Tract
Authors: Walker W. Allan
Published: December 2021

In this review of host defense mechanisms in the gastrointestinal tract, I have attempted to update the current conception of basic host defenses. Nonimmunologic defenses such as indigenous intestinal flora, peristalsis, secretions, gastric barrier, and antibacterial substances (lysozymes, bile salts, and natural antibodies) were discussed with respect to their contribution in preventing the penetration of microorganisms, enterotoxins, and other antigens across the mucosal surface. The local immunologic system, including SIgA, cell-mediated immunity and other immunoglobulins were discussed. It was emphasized that the immune response at epithelial surfaces was independent from the systemic immune response and related to the antigenic stimulus at the epithelium. Several conditions, including prematurity, malnutrition, and primary immunodeficiencies, were reviewed in order to illustrate that altered host defenses may predispose to pathologic uptake of antigens from the gut and the development of clinical disease. Finally, it was suggested that an approach to the management of these conditions requires the passive replacement of defense substances by an oral route in order to maintain protection within the gastrointestinal lumen. The use of human colostrum/milk as a substitute was suggested.
Citrullinemia: Phenotypic Variations
Authors: Whelan Donald T. , Brusso Terry , Spate Marilyn
Published: December 2021

An 18-month-old female infant was found to have citrullinemia on routine plasma screening by the Seriver Method at 5 days of age. At 10 days of age, plasma citrulline concentration was 0.704µmol/ml (normal, 0.010 to 0.030µmol/ml) and has remained 60 to 80 times higher than normal. Urine citrulline concentration was markedly elevated. Hyperammonemia occurred at 1 month of age. The serum ammonia concentration was 473µg/100 ml (normal, 50 to 250µg/100 ml) and rose to 770µg/100 ml at 4 months of age. Dietary protein was restricted to 1.6 gm/kg/day. Without further change in protein intake, the serum ammonia concentration decreased to 280µg/100 ml and, since then, it has returned to normal. The addition of three synthetic L-amino acids was required for a short time during dietary therapy. At 10 months of age, the infant was given a normal diet. At 18 months of age, her physical and mental development is normal. Activity of argininosuccinic acid synthetase measured in skin fibroblasts was 0.0037µmol of radioactive carbon dioxide per milligram of protein per hour. To demonstrate heterozygosity, fasting plasma citrulline concentrations were measured in five members of the family.

Comparison of findings in this patient with those reported in the literature suggests phenotypical variation of the disease, probably due to genetic heterogeneity.
A Modified Peripheral Capillary Blood Culture Sampling Technique
Authors: Jennings Paul B. , Dixon Robert S. , McCarthy Mary K. , Mettler Pamela R.
Published: December 2021

Previous reports from this facility described a method of blood culture sampling in three animal species using 0.2 ml or less of arterial and peripheral capillary blood.1,2 When ten or more organisms per milliliter of blood were present, the small sample method was as effective in detecting Escherichia coli bacteremia as was the standard blood culture technique using larger quantities of blood. However, when using the micro blood collecting tube method, contamination of the sample with air or skin microorganisms was a distinct problem. In this report, refinement of the micro sampling method was attempted to reduce contamination.

Ten Beagle puppies (five male and five female), in the weight range between 5.7 to 9.0 kg, were utilized.
Pericardial Window Complicated by Acute Congestive Heart Failure in a Patient With Chronic Pericardial Effusion
Authors: Herzog David B. , Gilbert Enid M. , Levy Jay M. , Chung Kyung J.
Published: December 2021

Pericardial effusion, as part of the post-pericardiotomy syndrome, appears in the early postoperative period and is generally benign and self-limited.1

Recently, a patient developed chronic pericardial effusion with cardiac tamponade after repair of Ebstein's anomaly. Surgical drainage of the pericardial effusion resulted in acute cardiac failure and death.

The purpose of this paper is to present this case and to discuss the pathophysiology and prevention of cardiac failure as a complication of chronic pericardial effusion.

CASE REPORT

L. B. (UWH No. 684 090) had Ebstein's anomaly confirmed at age 6 weeks by cardiac catheterization. Because of progressive cyanosis and exercise intolerance, at the age of 13 years she underwent total repair of tricuspid valvulopasty and closure of atrial septal defect.
Tympanometric Detection of Middle Ear Effusion in Infants and Young Children
Authors: Paradise Jack L. , Smith Clyde G. , Bluestone Charles D.
Published: December 2021

Tympanometry, a test of middle ear status new to clinical pediatrics, was carried out on 280 subjects, 10 days through 5 years of age. The tympanograms obtained were compared with otoscopic findings and, in 107 of the subjects, with findings at myringotomy. Seven distinct tympanometric curve types were identified and defined, based on their degree of correlation with the presence or absence of middle ear effusion.

In subjects 7 months of age and older, curves suggesting normal (high) tympanic membrane compliance in combination with atmospheric or near-atmospheric middle ear air pressure were rarely associated with effusion. Conversely, curves suggesting low tympanic membrane compliance were highly correlated with the presence of effusion. Curves suggesting intermediate compliance or reduced middle ear air pressure were also correlated with effusion, but the degree of correlation was dependent on the shape of the curve.

In infants less than 7 months of age, many of the ears with effusion had "normal" tympanograms, presumably because external auditory canal walls in such infants tend to be highly distensible.

Tympanometry is a simple, rapid, atraumatic, valid, and objective test, easily administered by paraprofessional personnel. Its use can result in improved detection of middle ear effusion and other middle ear abnormalities, and also appears to promote improvement in diagnostic acumen.
Postoperative Trifascicular Block Complicating Tetralogy of Fallot Repair
Authors: Yabek Steven M. , Jarmakani Jay M. , Roberts Nigel
Published: December 2021

Transient and residual conduction defects, including early and late complete heart block, are not uncommon in children following the intracardiac repair of tetralogy of Fallot. The case of a young girl is described, in whom early, transient complete heart block was found to be due to trifascicular damage. Through serial electrophysiological studies, gradual improvement in the conducting system was documented, although residual trifascicular damage remained. It is believed that all children with evidence of residual trifascicular damage are subject to possibly fatal bradyarrhythmias due to late postoperative complete heart block.
Syndrome of Intrahepatic Biliary Dysgenesis and Cardiovascular Malformations
Authors: Greenwood Ronald D. , Rosenthal Amnon , Crocker Allen C. , Nadas Alexander S.
Published: December 2021

Peripheral pulmonary stenosis with or without intracardiac disease is described in 14 patients with intrahepatic biliary dysgenesis. Cardiovascular malformations were not present among a large group of patients with extrahepatic biliary dysgenesis. This association of intrahepatic biliary dysgenesis and vascular malformations is postulated to be a specific malformation syndrome resulting most probably from intrauterine infection. The cardiovascular disease is usually mild. The liver dysfunction varies in severity, and is accompanied by a notable hyperlipoproteinemia with secondary xanthomata which can be ameliorated by long-term treatment with cholestyramine resin and/or vegetable oil supplements.
Leiomyosarcoma of the Duodenum in a 10-Year-Old Boy
Authors: Solomons Noel W. , Wagonfeld James B. , Thomsen Sharon , Hill J. Laurence , Kirsner Joseph B.
Published: December 2021

An unusual instance of a duodenal leiomyosarcoma in a 10-year-old boy is presented. The corrected diagnosis was made after a 27-month course of occult gastrointestinal bleeding, vague abdominal complaints, and anemia. Gastrointestinal radiography and upper gastrointestinal endoscopy were useful in localizing the lesion. The tumor was removed at exploratory surgery by simple excision. On frozen section, the tumor was thought to be benign, but fixed microscopic histological sections revealed a well-differentiated, malignant smooth muscle tumor. The presentation of this tumor in a child is compared to previously reported cases in adults, and the biological and clinical characteristics of malignant smooth muscle tumors of the gastrointestinal tract are reviewed.
Car Safety for Infants: Effectiveness of Prenatal Counseling
Authors: Kanthor Harold A.
Published: December 2021

In a pediatric office setting, car safety counseling was provided to 16 primigravida women during a prenatal pediatric interview. A control group of 19 women received no counseling during a similar interview. Forty-two percent of noncounseled mothers and 69% of counseled mothers were using a safe infant restraint system at the six-week well-child visit.

Preventive counseling in car safety is an important role for the pediatrician.
Nosocomial Transmission of Group B Streptococci
Authors: Aber Robert C. , Allen Nancy , Howell James T. , Wilkenson Hazel W. , Facklam Richard R.
Published: December 2021

Group B streptococci are an important cause of infant septicemia and meningitis. A prospective study of group B streptococcal colonization in a 300-bed community hospital disclosed rates of 29% of 297 third-trimester women, 37% of 242 newborn infants, and 45% of 22 hospital personnel. Colonized parturients were more frequently black and anemic on admission for delivery. Infant colonization was statistically associated with a positive maternal genital culture, low birthweight, and prematurity.

Nosocomial transmission of group B streptococci was strongly suggested by observations that 41% of colonized infants were born to culture-negative women and such infants became colonized later in their hospital stay than did colonized infants born to colonized women. Furthermore, hospital personnel working in the labor-delivery and nursery areas had a significantly higher prevalence of the organism than did personnel from other areas.

Clearly, more information is needed about the epidemiology of group B streptococcal disease before appropriate and rational control measures can be recommended.
A Sequential Study of Various Modes of Skin and Umbilical Care and the Incidence of Staphylococcal Colonization and Infection in the Neonate
Authors: Johnson John D. , Malachowski Natalie C. , Vosti Kenneth L. , Sunshine Philip
Published: December 2021

The rates of colonization and infection of newborns with coagulase-positive staphylococci were studied during five sequential periods using various modes of skin care in the nursery. Colonization and infection were low during the baseline period when total body bathing with 3% hexachlorophene was employed (period 1), but increased dramatically (80% colonization, 9.5% infection) when hexachlorophene was discontinued and replaced by Ivory Soap baths (period 2). Reinstitution of hexachlorophene (period 3) reduced both colonization and infection, but not to the low levels seen during period 1. A second Ivory Soap period (period 4) resulted in a return to high colonization (77%) and infection (11.5%) rates. During period 5, daily Ivory Soap baths were continued and bacitracin ointment was applied to the umbilical area at least three times daily. Colonization was reduced to 10% and infection to 3.0%. Bacitracin could not be detected in serum in 15 infants studied.

Colonization with gram-negative enteric bacilli was highest while using hexachlorophene or Ivory-bacitracin, but no increase in gram-negative infections was seen. Colonization of newborns with non-group A β-hemolytic streptococci was not influenced predictably with various modes of skin care.

The local application of bacitracin is a safe and effective method of controlling staphylococcal colonization and disease for infants in nurseries.
On Failing in School
Authors: Menkes John H.
Published: December 2021

As our society becomes increasingly complex, higher premiums attend success and, as an inevitable corollary, the adverse impact of failure has a greater effect. For the school-aged child, success or failure in mastering educational basics usually determines his future career, his role in society, and, all too often, his personal esteem. It is little wonder, therefore, that school failure represents a major catastrophe affecting both the child and his family. Although there is considerable evidence that learning can improve when the school environment is rectified to match individual needs, in the majority of cases, both parents and schools have turned to the pediatrician for assistance in handling the slow or defective learner. Often the pediatrician shoulders this burden willingly, and, in fact, is probably the most interested and adept person available. But what a confused and confusing field learning disorders are!

There are almost as many approaches to the evaluation and treatment of school failure as there are physicians involved in this area. The literature, while extensive, is of little help, and even such obvious questions as when to perform electroencephalography or what role drug therapy plays yield the most divergent replies.

In this symposium, the Editors of Pediatrics have asked four individuals, each an authority in the area of learning disorders, to describe their management of the child with school failure. As a consequence of the diversity of their professional backgrounds and divergent characteristics of the patient population, each of the authors stresses a different aspect.

For instance, it is clear from the paper of Drs. Hogan and Ryan that, in Mississippi, school problems do not plague physicians or educators to the extent that they do in California.
The Assessment of the Child at School Entry
Authors: Bax Martin C. O.
Published: December 2021

Most learning and behavior disorders in school children present as "crisis situations," when anxious parents or exasperated teachers suddenly call for medical or psychological help with a child aged 9, 10, or 11 who is in severe difficulties. It is not surprising that remedial efforts to help these children are often unsuccessful. It seems likely that if we could identify the children earlier and try to help them before they get into difficulties, the results would be much better. However, the correlation between abnormalities found in babies in the newborn period or in the early years of life, although significant, are quite low, and we cannot identify with any degree of reliability children who may have school difficulties at this earlier age. On the other hand, we have shown that a thorough assessment of the child at school entry will allow one to identify quite a large proportion of the children who are going to get into difficulties.1 A careful assessment, therefore, of children at school entry is an essential part of educational pediatrics.

There are a number of other reasons why preschool assessments cannot identify potential problems. The main one is that there are a number of functions emerging about age 5 or 6 which cannot be adequately studied in the early years. A further, and very important, reason for putting a great deal of emphasis on the initial examination at school is that whatever administrative arrangements, under the various systems of medicine that operate in different countries, are made in the preschool period to see children, it is difficult to be certain of seeing all the children. It is just those children who are not brought by their parents for regular preschool examinations who are most likely to be among those who run into difficulties.
Immunologic Reconstitution in Severe Combined Immunodeficiency Following Transplantation With Parental Bone Marrow
Authors: Geha Raif S. , Malakian Artin , LeFranc Gerard , Chayban Denise , Serre Jean-Louis
Published: December 2021

A 9-month-old girl with severe combined immunodeficiency was transplanted with BM cells from her father. The child had complete restoration of cell-mediated immune functions. Humoral immune functions remain absent nine months after transplant. Child and father were HL-A identical and their lymphocytes were nonreactive in mixed lymphocyte culture. The parents of the child were first cousins and shared an HL-A haplotype. In countries like Lebanon, where there is a high incidence of first-cousin marriages (15%) and where villages are relatively isolated, the search for histocompatible graft donors should extend beyond the siblings to other members of the family.
Intralipid and Cystic Fibrosis
Authors: Beveridge John
Published: December 2021

Stimulated by Professor R.B. Elliott of Auckland, Australia, we have administered Intralipid regularly to a small number of babies in the last two years. The volume used has been 10 ml of the 10% solution per kilogram of body weight. This volume is administered every three weeks, the infusion taking approximately three hours.

The four entrants in the trial are all doing well clinically. The details of their sweat electrolyte studies are shown in Table I.
Comment on Continuous Positive Airway Pressure Device Claims
Authors: Gregory George A.
Published: December 2021

As I travel around the country, I am becoming confused by some of the statements made by companies selling continuous positive airway pressure (CPAP) devices. Their standard pitch is that somehow their devices are approved and tested. The question they can never answer is, approved by whom and tested under what circumstances? They also imply that devices which are handmade or built from existing parts (such as the ones we used for the original CPAP device) are somehow inferior to theirs.
Dextromethorphan Toxicity: Reversal by Naloxone
Authors: Shaul William L. , Wandell Michael , Robertson William O.
Published: December 2021

Naloxone has been shown to be effective in antagonizing the effects of a number of narcotic and related drugs. Its successful use in managing a patient with an overdose of dextromethorphan extends its application as a specific antidote.
Breast Milk Banks: The New Model
Authors: Jelliffe Derrick B. , Jelliffe E. F. Patrice
Published: December 2021

Present evidence seems to suggest increasingly that fresh human milk has a protective role in the syndrome of acute necrotizing enterocolitis. For this reason (and many others), there appears to be an understandable increase in interest in the development of breast-milk banks.

Considerable information already exists concerning the organization of such banks in the early decades of the present century and prior to that time. However, the milk stored in such earlier banks was not usually fresh, as it was primarily required for feeding rather than for the control of bacterial colonization of the intestine.
Does Participation in Teaching Improve Your Ability As a Physician?
Authors: Fleisher Daniel S.
Published: December 2021

At one time in my career I tried to find the evidence supporting the then generally accepted practice of 40 years of keeping children with acute glomerulonephritis in bed for prolonged periods of time. Laborious review of many reports led me to two conclusions. First, no good evidence supporting that practice existed. Second, as far as I could determine the practice became generally accepted through at least one, but probably more, misinterpretations or misquotes of previous articles.
Antibody-Dependent Cellular Cytotoxicity to Target Cells Infected With Herpes Simplex Viruses: Functional Adequacy in the Neonate
Authors: Shore Steven L. , Milgrom Henry , Wood Phyllis A. , Nahmias André J.
Published: December 2021

The functional adequacy of antibody-dependent cellular cytotoxicity (ADCC) in the human neonate was evaluated in a 51Cr release assay which employs tissue culture cells acutely infected with type 1 or type 2 herpes simplex virus (HSV) as targets. Two aspects of ADCC were assessed: cytotoxic effector activity in cord blood mononuclear cells (MC) and the ability of the antibody mediating ADCC to pass the placenta. Although effector cell activity was readily detected in all 13 cord blood specimens tested, cord blood MC showed moderately reduced cytotoxic activity when compared with blood MC from normal adults at the same effector cell:target cell ratio. This finding suggests that effector cells in cord blood make up a reduced proportion of the total circulating MC population and may be of relevance to the newborns increased susceptibility to HSV infection. On the other hand, the number of MC in cord blood was found to be almost twice that of adult blood, suggesting that the absolute number of ADCC effector cells in cord blood was within the adult range. The antibody mediating ADCC to HSV-infected cells was shown to be transferred (quantitatively across the placenta, providing further evidence that it is an IgG immunoglobulin.