bluuebunny/crossref_metadata_2025 huggingface dataset:
EPIDEMIOLOGIC ASPECTS OF LEPTOSPIROSIS
Authors: Steele James H.
Published: December 2021

MORE than 70 years have passed since Weil first described several cases of leptospirosis in humans although he had no knowledge of the etiologic agent. In 1905, Stimson, in New Orleans, first observed leptospires in kidney sections from a patient believed to have died of yellow fever. A few years later (1915) pathogenic leptospires were isolated first from patients with Weil's disease in Japan by Inada et al. and independently in Germany by Uhlenhuth and Fromme in the same year. About the same time the Japanese workers found that the rat (Rattus norvegicus) is a carrier of Leptospira icterohemorrhagiae. Since this early work, extensive investigations have shown that leptospirosis occurs in humans and animals in all parts of the world and is not a single disease but a group of diseases caused by a variety of leptospiral serotypes. Possible explanations for the wide distribution of these diseases may be (1) that they are insidious infections which have appeared gradually and become established almost unnoticed, or (2) that they have been present for many years and remained largely undetected because of the variable masking symptoms and the problems associated with laboratory diagnosis. Although considerable attention has been directed toward studies of leptospiral infections by European and Asian investigators since the early 1930's much of our knowledge regarding the epidemiology, public health importance and distribution of these diseases in the United States has been gained only during the past decade.

The epidemiology of the leptospiroses has been shown to follow a characteristic pattern based, in part, upon the fact that they are zoonoses, diseases transmitted from animal to animal and from animal to human.
GYNECOLOGY OF CHILDREN AND ADOLESCENTS
Authors: Huffman John W. , Wieczorowski Elsie
Published: December 2021

THE DISCUSSANTS began the round table with a few general comments concerning various phases of development of the female. At birth and for the first week or more of life, the effects of maternal hormones on the newborn infant may be evidenced by hypertrophy of the breasts, prominence of the genitalia with nonpurulent vaginal secretion and occasional uterine bleeding. Throughout the remainder of infancy, until late childhood, there are no changes in the genitalia, and the mucosa of the vagina remains shrunken, producing little or no secretion. From the period of late childhood to early adolescence—that phase extending from the first menstrual period until the onset of ovulation—secondary sex characteristics develop and the vaginal mucosa undergoes cornification, becomes succulent and produces an increased quantity of secretion. Late adolescence is defined as that phase from the first ovulation to full maturity. The phases of adolescence are never clearly demarcated.

Certain pathologic conditions commonly seen in female children were then described. The relative incidence of these conditions as seen in a special clinic reflects their incidence in a general pediatric practice.

Nonspecific Vulvovaginitis

The majority of children (75%) are referred to the gynecologic clinic because of vulvovaginitis. Of these, 75% are found to have nonspecific vulvovaginitis. Etiologic agents and their relative incidence in the remainder of patients are: monilia, 15%; foreign body, 5%; and infections due to trichomonas, gonococcus and pinworms, 5%. Children under 10 years of age are most commonly affected. Those found to have vulvovaginitis due to fungi have usually given a history of recent antibiotic therapy.
OBSTRUCTIVE FACTORS IN THE PULMONARY HYALINE MEMBRANE SYNDROME IN ASPHYXIA OF THE NEWBORN
Authors: Craig John M. , Fenton Kevin , Gitlin David
Published: December 2021

By injection of gelatin-India ink and latex masses under controlled conditions into the lungs of infants with asphyxia associated with hyaline membrane formation, it has been shown that such membranes prevent the filling of the distal alveoli. It is postulated that these membranes obstruct the flow of air to the distal alveoli and prevent their expansion, thus decreasing the compliance of the lung. Plasmin, introduced into the lung, has been shown to cause dissolution of the hyaline membranes in vitro.
STUDIES OF CONGENITAL HEMOLYTIC SYNDROMES
Authors: Erlandson Marion E. , Schulman Irving , Stern Gertrude , Smith Carl H.
Published: December 2021

Rates of destruction of erythrocytes and of effective production of erythrocytes and hemoglobin have been determined in 10 patients with homozygous Cooley's anemia. The method employed was based upon survival of Cr51-labeled cells in patients in whom a state of equilibrium of erythrocytes was present.

While a marked hemohytic defect is present, this defect does not, by itself, determine the degree of anemia present.

Rates of effective production of erythrocytes are increased above normal but are not increased to the same degree found in patients with other hemolytic diseases.

Rates of effective synthesis of hemoglobin were found to be less than those obtained for production of erythrocytes.

The rates of production of fetal hemoglobin in these patients are remarkably elevated but cannot be directly correlated with the rate of destruction of erythrocytes, rate of production of erythrocytes, or the degree of anemia present.

The hemolytic defect in patients with intermediate Cooley's anemia was comparable to that in the majority of the patients with the severe form of disease. However, the most marked hemolytic defects were among patients with the severe and not with the intermediate form of disease. Production of erythrocytes and hemoglobin did not differ significantly in the two forms of this disease.

Results in two splenectomized patients did not differ significantly from results in the non-splenectomized group of patients. However, since pre-splenectomy data were not available, no statement may be made as to possible individual benefit derived from the operation.

The final status of each patient is determined by the particular balance obtained between rates of destruction and production. Neither production nor destruction alone determines the degree of anemia.

The compensation index, as a measure of final status in each patient, was lowest in the severe form of Cooley's anemia. It is presumed to be lower still in many patients who could not be studied because transfusion therapy was in progress. The compensation index is somewhat higher in patients with intermediate Cooley's anemia and in two splenectomized individuals not requiring frequent transfusions. Values in these patients approach the higher levels found in patients with sickle cell anemia and congenital spherocytosis.
EQUIVALENCE OF PASTEURIZED AND FRESH HUMAN MILK IN PROMOTING NITROGEN RETENTION BY NORMAL FULL-TERM INFANTS
Authors: Fomon Samuel J. , Thomas Lora N. , May Charles D.
Published: December 2021

Twenty-nine nitrogen balance studies were performed with 10 normal full-term infants fed fresh human milk either from the breast (eight nitrogen balance studies with four infants) or by bottle. Six of the infants (Group I) were solely breast-fed before and between the metabolic balance periods. Four infants (Group II) were fed pasteurized human milk before and between the metabolic balance periods during which fresh human milk was fed.

The mean intake of nitrogen by the infants fed fresh human milk was less than that of previously studied infants who received pasteurized human milk. Reasons for the smaller mean intakes of nitrogen by infants of Group I may have included voluntary decrease in volume of intake on the part of infants because of time unfamiliar environment or because milk was fed from a bottle. An additional factor may have been decreased supply of milk by the mother (and possibly decreased concentration of nitrogen in the milk) because of altered conditions for nursing and multiple trips to the Metabolism Ward. Decreased concentrations of nitrogen in the milk fed to infants of Group II may have resulted from longer duration of lactation of the women providing the milk and greater volume of milk produced. The relation of retention of nitrogen to intake of nitrogen was the same for infants fed fresh human milk as had been found for those fed pasteurized human milk.

Four of the infants (Group II) studied while receiving fresh human milk by bottle were also studied while receiving pasteurized human milk. Intakes and retentions of nitrogen were similar with both feedings.

The literature concerning nitrogen balance studies of full-term infants was reviewed. Mean intakes and retentions of nitrogen are similar to those of the present study but considerably greater variability was encountered, as might be expected in view of the lack of uniformity of experimental conditions among the different studies.

Processing (pasteurization and freezing) of human milk apparently does not alter its nutritional properties in such a way as to affect nitrogen balance of infants. It is concluded that the retentions of nitrogen of the infants fed processed human milk in the previous study may be considered representative of the retentions of nitrogen by normal breast-fed infants.
THE EFFECT OF MERCUROUS CHLORIDE (CALOMEL) AND EPINEPHRINE (SYMPATHETIC STIMULATION) ON RATS
Authors: Cheek Donald B. , Bondy Robert K. , Johnson Lorna R.
Published: December 2021

It has been found that calomel will produce retardation of growth and loss of sodium and chloride from tissue with or without associated functional renal insufficiency. The findings are compared with data obtained by injecting a mercurial diuretic, Mercuhydrin®, into rats. In young rats given 10 mg of calomel, no renal structural change is seen 1 to 4 days after ingestion but the concentration of urea nitrogen in the blood is slightly elevated. If one injection of epinephrine (0.5 mg) is given to the young rat treated with calomel, hemoconcentration, hypertension, 16% loss of total content of chloride from the body and reduction in volume of the chloride space, increased insensible water loss, moderate rise in concentration of urea nitrogen in the blood and a renal lesion in the outer area of the renal medulla (upper portion of Henle's loop) are all found within 24 hours. The animals developed a weak, scrawny appearance, and in some instances distinct coldness to palpation and blueness of the extremities. Epinephrine, when injected into normal rats, produced a lesser increase in insensible loss of water and only 6% loss of content of chloride from the body. Hypertension was not sustained.

The changes demonstrated in the current experiments with rats resemble many of the findings in acrodynia. In acrodynia, sweating, hypertension, tachycardia, vasospasm, increased insensible loss of water, raised venous pressure, and increased excretion of steroids all support the concept of sympathetic preponderance. Increased adrenal cortical function also exists but to a lesser extent. Hence, acrodynia must represent "failure of adaptation" or failure to withstand stress.

It is suggested that mercury potentiates directly or indirectly the action of epinephrine in the body and that the coexistence of sympathetic stress plus calomel can give rise to acrodynia. Loss of extracellular volume resulting from mercurial diuretic effects, and from loss of water from the skin potentiates sympathetic and adrenal activity. Adrenal hormones are ineffective in conserving sodium chloride at the renal level in the presence of mercury. Augmented sympathetic activity leads to renal anoxia, vasospasm, and renal pressor effects. Renal damage may result and augment the vasospasm and hypertension.
SERIAL STUDY OF BONE MARROW IN HEMOLYTIC DISEASE OF THE NEWBORN (ERYTHROBLASTOSIS FETALIS)
Authors: Dillon Hugh C. , Krivit William
Published: December 2021

Fourteen infants with erythroblastosis fetalis were studied with particular reference to bone marrow activity and its relation to anemia in the infants. Serial studies of the marrow were done in 12 of the 14 infants, and single specimens were examined in two infants.

No attempt is made to define the etiology or pathogenesis of the anemia of erythroblastosis fetalis. The purpose of this study was to determine the relationship between degree of anemia and normoblastic activity of bone marrow, as ascertained by morphologic techniques.

On the basis of a review of the literature and the experience with this series of infants, true "aregenerative anemia" appears to be a rare occurrence. Indeed, to suggest that the anemia of erythroblastosis is commonly due to a cessation of erythropoiesis seems totally unjustified, because these infants show hyperplasia of the marrow which is analogous to that seen in other compensated hemolytic anemias.

Human and Sturgeon have stated, and the authors agree, that a relative hypoplasia may occur as cell destruction exceeds cell production. This does not necessarily imply marrow failure or an "aregenerative state," but it may indicate that the balance can be in favor of blood destruction and an anemia of some degree is the result. In a previous report, infants after exchange transfusion did show excessive destruction of donor erythrocytes. The rate of destruction of Rh-negative cells in erythroblastosis fetalis was twice that of normal.

Some of the cases reported in the literature as "aregenerative anemia" lack adequate marrow studies and cannot be accepted as well-documented. It should be emphasized that it may be unwise to conjecture about activity of the bone marrow from reticulocyte studies of the peripheral blood alone.

In this series, the percentage of normoblats in the bone marrow was increased in proportion to the degree of anemia.
THE TREATMENT OF HYPERBILIRUBINEMIA OF THE NEWBORN WITH SODIUM GLUCURONATE
Authors: Danoff Stuart , Boyer Audrey , Holt L. Emmett
Published: December 2021

Twenty-five cases of hyperbilirubinemia have been treated with parenteral sodium glucuronate, most of them being patients with hemolytic disease (erythroblastosis).

The authors believe the results have been encouraging and warrant a further experimental trial of this form of therapy by critical investigators.
LEAD POISONING
Authors: Byers R. K.
Published: December 2021

A review of the recent and some older pertinent literature relative to lead poisoning in childhood is presented.

Forty-five cases of lead poisoning from the author's experience are described. All were treated with intravenous or intramuscular administration of edathamil during the acute stages.

Oral administration of edathamil produced no shortening of the prolonged period of coproporphyrinuria following the cessation of intravenous use of edathamil.

In the acute stage, oral use of edathamil was less efficient than intravenous or intramuscular administration in returning the aberrant porphyrin metabolism toward normal. The selective effect of intravenous use of edathamil on the urinary excretion of coproporphyrin as opposed to the relatively slight effect on erythrocyte porphyrins confirms the notion that lead interferes with porphyrin metabolism at several physiologically distinct points; and that the hematopoietic marrow is not freed of lead by edathamil.

Edathamil given orally in the presence of lead in the intestinal tract is a very dangerous drug, and there is a hint that administration of even intravenous edathamil may promote lead absorption from the intestinal tract and its transport to the brain. Therefore, emptying the intestinal tract by enemata may be an important preliminary to treatment. Dehydration by severe catharsis would be undesirable.

With adequate treatment, half or more of the victims of lead poisoning should be returned to competitive life. Those persistently damaged intellectually suffer from acute encephalopathy and have often been re-exposed to lead after treatment of the acute disease.
GRULEE AWARD FOR 1958
Authors: GRULEE CLIFFORD G.
Published: December 2021

THE RECIPIENT of the Clifford G. Grulee Award for 1958 is a most unusual person. He has served many disciplines in the child health field, all with distinction, and he has also found time to give invaluable services to the American Academy of Pediatrics in furthering its objectives.

Myron E. Wegman was born in Brooklyn about fifty years ago. After graduating from the College of the City of New York, he received an M.D. degree from Yale University in 1928. Dr. Wegman served as an interne, assistant resident, resident and instructor in Pediatrics at the New Haven Hospital and Yale University. In 1937 he returned to school and in 1938 received a Master of Public Health degree from Johns Hopkins University. After a short period as pediatric consultant to the Maryland State Health Department, Dr. Wegman became Assistant Professor of Child Hygiene at the School of Tropical Medicine at San Juan, Puerto Rico, where he served until 1942.

From 1942 until 1946 Dr. Wegman served as Director of School Health for New York City and as an instructor in pediatrics and public health at Columbia University and Cornell University.

In 1946 Myron Wegman was appointed Professor of Pediatrics and Head of the Department at Louisiana State University and Pediatrician-in-Chief to Charity Hospital, New Orleans, where he served until 1952. From 1952 to 1957 he held the position of Chief of the Division of Education and Training in the Pan American Sanitary Bureau and in 1957 became Secretary-General of the Pan American Sanitary Bureau and the Regional Office of the World Health Organization.

Dr. Wegman has served on many committees and commissions in all parts of the world and is recognized as a world authority on child health matters.

In addition to his position as a Contributing Editor to Pediatrics, Dr. Wegman has found time to serve as Chairman of the Academy's Committee on Latin American Affairs and consultant to the newly organized District IX Committee.
THE IMPORTANCE OF CONTACT ECZEMA IN CHILDREN
Authors: Hill Lewis Webb
Published: December 2021

In 200 consecutive cases of eczema in children from the age of 7 weeks to 14 years, 53 were thought to be caused by outside contact with allergenic or irritating material.

The cause was determined in 31 cases, the probable cause in 18, and in 4 it was entirely unknown.

The cause was thought to be due to something connected with the clothes (including diapers and shoes) in 40 cases (74%).

Contact eczema, as seen in young children, differs from contact eczema in adults in that: it is more likely to be due to the clothes than to anything else, a high degree of sensitization with resulting vesiculation (although it can occur) is not so common as in adults, and primary irritants of relatively low irritating power are more likely to be causes than they are in adults.

Too many children are dieted for eczema when the cause is really something which contacts the skin from the outside.
Metabolism of Tryptophan in Phenylketonuria
Authors: BESSMAN SAMUEL P. , TADA KEIYA
Published: December 2021

The finding by Armstrong et al. of increased indolelactic acid, indoleacetic acid and indoleaceturic acid in the urine of patients with phenylketonuria (Arch. Biochem. & Biophys., 52:287, 1954; Fed. Proc., 13:175, 1954) suggests a lesion of tryptophan metabolism. The report by Pare et al. (Lancet, 1:551, 1957 and 2:1099, 1958) of diminished conversion of 5-hydroxytryptophan to 5-hydroxyindoleacetic acid in this disease discloses another lesion in the tryptophan pathways.

Recently we have observed an abnormality which further documents the metabolic error involving tryptophan in phenylketonuria, which appears worthy of attention because it is so easily demonstrable and may represent a method of testing for the tryptophan defect.
Letters to the Editor
Authors: AMBUEL J. PHILIP
Published: December 2021

The answer to the question posed in the recent editorial (Pediatrics, 23:253, 1959), "Can the New Pediatrics Be Practiced?" may be conveniently divided into three parts:

1) What is the job of the pediatrician?

2) Do present training programs in pediatrics prepare their graduates for the "new pediatrics?"

3) Can the "new pediatrics" be practiced under the present set-up of medical economics?

What is the job of the pediatrician? Names compartmentalize our thinking processes and terms sometimes restrict our ability to think. Thus the term specialist, which now lumps the pediatricians, internist, general surgeon, cardiovascular surgeon, ophthalmologist, psychiatrist, etc., etc. into one big compartment, should be limited to those physicians who specialize in treating a part of the patient, on the whole patient for a very limited period of time or when he has a particular illness.
Raising Pediatric Fees
Authors: WILSON JAMES L.
Published: December 2021

This letter is written to support the idea that it would be a good thing for the children of this country if pediatricians raised their fees. This bald and mercenary-like statement can be made particularly by me without question of a selfish motive, and I make it only to emphasize certain trends in pediatric practice which I think are not to the advantage of the public or of the pediatricians. Most pediatricians work too hard and see too many patients.

I assume the privilege of a confirmed professional teacher of pediatricians with a background approaching 30 years, to "point with pride" and "view with alarm" certain trends in pediatric practice.

I believe we can name hardly any more important influence for the well-being of the children in this country than the modern development of the practice of pediatrics as influenced by the American Board of Pediatrics and the American Academy of Pediatrics.
GLUCURONIC ACID CONJUGATION BY PATIENTS WITH FAMILIAL NONHEMOLYTIC JAUNDICE AND THEIR RELATIVES
Authors: Childs Barton , Sidbury James B. , Migeon Claude J.
Published: December 2021

Observations have been made on the capability of two patients with familial nonhemolytic jaundice and the relatives of these and other such patients to make glucuronic acid conjugates of several substances.

Studies of the physiologic disposition of 4-C14-cortisol and of tetrahydrocortisone in one patient demonstrated a partial deficiency in the conjugation of the reduced steroids with glucuronic acid.

One patient showed a like deficiency when treated with trichloroethanol. One parent of this patient showed a milder deficiency in conjugation of the same substance; the value for the other parent was below the range for controls.

Tests using sodium salicylate were carried out with both patients, their parents, three shared grandparents, and four sibs, as well as with both parents of a third patient, and both parents and several sibs of three other patients. Again, the patients showed marked impairment in glucuronide conjugation, while all but one parent, two of the grandparents, and several of the sibs showed an impairment intermediate between that of the patients and the normal values given by the controls.

Both patients and many of the relatives showed a better capability to make acyl glucuronide than the phenolic type.

The gene responsible for this disease is recessive with respect to jaundice, but shows incomplete dominance with respect to glucuronide conjugation of the test substances.
TYPES OF EXSTROPHY OF URINARY BLADDER AND CONCOMITANT MALFORMATIONS
Authors: Uson Aurelio C. , Lattimer John K. , Melicow Meyer M.
Published: December 2021

The records of 72 cases with exstrophy of urinary bladder are reviewed and the various findings tabulated. Ten additional cases on which complete data were not available are included in the study of sex distribution only. The types of exstrophy, their incidence, associated anomalies and considerations on management are discussed.
Medulloblastoma
Authors: RAUSOHOFF JOSEPH
Published: December 2021

This monograph, one of Charles C Thomas' American Lecture Series, is written mainly from a neurosurgical point of view.

Part I, almost one-third of the book, is a careful consideration of this neoplasm against the background of our current knowledge of neoplasia in general. In addition, the relationship of medulloblastoma to the other neuroectodermal neoplasms as well as to leptomeningeal sarcomas is reviewed.

Part II of the book is a review of the clinical aspects of this disease. Material was collected from the University of Chicago Clinics, Yale University and the Lahey Clinic, as well as from the Brain Tumor Registry at New Haven.
THE EFFECT OF ACTINOMYCIN D ON CANCER IN CHILDHOOD
Authors: C. Tan Charlotte T. , Dargeon Harold W. , Burchenal Joseph H.
Published: December 2021

Actinomycin D has a slight but definite effect in producing regression of tumors in patients with cancer. Wilms' tumor and lymphomas have shown better response than other tumors. Although the effect of the combination of actinomycin D and x-ray therapy is difficult to evaluate, these agents appear to be additive in producing temporary regression of the tumor in some patients.

The usual single course of actinomycin D intravenously is 75 µ.g/kg of body weight divided into four or five daily doses. The oral dose of actinomycin D is 3 to 10 mg daily. About 5% of actinomycin D given orally is absorbed as evidenced by production of systemic toxicity. However, severe local gastrointestinal effect usually prevents adequate oral administration of the drug.

The toxic effects of actinomycin D are local on the gastrointestinal tract with ulceration of the mouth, nausea, vomiting, anorexia, occasional abdominal pain and diarrhea; exacerbation of skin reaction in previously irradiated areas; alopecia; decrease in leukocyte and platelet counts. The toxicity after intravenous administration of actinomycin D usually develops within the first 2 weeks and disappears within the next 2 weeks.

The duration of improvement after a single course of actinomycin D intravenously was usually from 1 to 10 weeks. Two children, one with Wilms' tumor and one with embryonal carcinoma, had no recurrence for 24 and 7 months, respectively. Both received maintenance doses of actinomycin D orally.
PREVENTIVE IMPLICATIONS OF A STUDY OF 100 CHILDREN TREATED FOR SERIOUS BURNS
Authors: Jensen Gordon D.
Published: December 2021

The epidemiology of 100 cases of burns occurring to children in the city of Seattle, which were severe enough to require hospitalization, was studied for the purpose of discovering preventive techniques.

Burns to children occur primarily between the ages of 6 and 18 months of age. During the age of greatest incidence of burns, boys are burned twice as often as girls.

The most common cause of a burn in this series was accidental spilling of hot coffee or tea.

The most common place for occurrence of a burn is in the kitchen.

When burns occur, parents are in the room with the child as often as not.

Morbidity exceeded mortality by 99 to 1. Practical use can be made of this knowledge in efforts at accident prevention by the physician.
EDUCATION
Authors: May Charles D.
Published: December 2021

ONE may be saddened by the ending of the careers of great men and at the same time deeply thankful that they have lived and spread their influence. So it is with Bronson Crothers and James L. Gamble, two of Boston's Greats, whose careers ended only weeks apart not long ago.

Pediatrics has been profoundly affected by the views and achievements of these men and successive generations will continue to be inspired by their deeds and through their disciples.

This is not an obituary to record the prosaic facts of dates, origins, migrations, degrees and honors, nor is it a eulogy by a close friend or devoted co-worker. These are memories, stirred by the ending of these careers, in one who never ceased to be aware of their influence on him as a medical student and hospital resident.
THE PEDIATRICIAN AND THE INDIVIDUAL DELINQUENT
Authors: Richmond Julius B.
Published: December 2021

The Current Concern over juvenile delinquency has brought this problem more forcefully to the attention of physicians. It becomes important, therefore, in a period when people are charging off in all directions in search of a panacea for the prevention of juvenile delinquency, for us to remain aware of the fact that juvenile delinquency is a symptom and not a diagnosis. Just as headache and abdominal pain are symptoms which challenge the diagnostic skill of the physician, so juvenile delinquency is a symptom which is similarly challenging. The symptom per se never tells us the cause; the cause becomes a matter for further investigation.

Those who seek a single formula for the prevention of all delinquency are destined to experience nothing but frustration. We should recall that some very good minds have struggled with this problem over many years. In this field, as in all others, those who are ignorant of history are destined to repeat it.

A brief historical note is in order to indicate that the role of physicians in programs concerned with the prevention and treatment of the delinquent is not a new one. A Chicago physician, Dr. William Healy, in 1909 organized the first child guidance clinic in the world in an effort to deal with children brought to the attention of the court because of their antisocial behavior. The establishment of this clinic under medical auspices served as a stimulus for the development of child psychiatry as a discipline. Dr. Healy left behind him in Chicago the Institute for Juvenile Research which has carried on work in the field of delinquency for 50 years; he then went on to found the Judge Baker Clinic in Boston.
TEMPORARY GASTROSTOMY IN PEDIATRIC SURGERY
Authors: Holder Thomas M. , Gross Robert E.
Published: December 2021

It is difficult to evaluate critically the credit side of the ledger as to the actual number of lives saved or the decrease in morbidity. It is our clinical impression that the more liberal use of the temporary gastrostomy in babies is the most significant single improvement made in this institution in the past few years in the general care of the small surgical patient.
Critical Issues in Newborn Intensive Care: A Conference Report and Policy Proposal
Authors: Jonsen A. R. , Phibbs R. H. , Tooley W. H. , Garland M. J.
Published: December 2021

This article presents several cases and certain key clinical-ethical questions associated with the provision of neonatal intensive care. Summaries of five papers on major considerations affecting these issues are included. The authors propose a moral policy stating areas of responsibility and ethical guidelines for decisions about care of newborn infants.
An Analysis of Air Transport Results in the Sick Newborn Infant: Part I. The Transport Team
Authors: Pettett Gary , Merenstein Gerald B. , Battaglia Frederick C. , Butterfield L. Joseph , Efird Ruth
Published: December 2021

Regionalization of neonatal intensive care has necessitated air transport of the critically ill infant in sparsely populated areas. All newborn air transports to four Denver area newborn intensive-care units over a 14-month period were reviewed. An emergency-care nurse and a neonatal intensive-care nurse provided the basic transport team with physician assistance in selected cases. Infants were evaluated and stabilized at the referring hospital before moving the infant. The transports were analyzed for the type of aircraft utilized, reason for referral, and mortality. The results indicate that prior planning will permit the use of the most appropriate aircraft and transport team. When using well-trained transport personnel, the presence of a physician may be limited to specific situations without adversely affecting overall neonatal mortality.
Intrauterine Rubella, Head Size, and Intellect
Authors: Macfarlane David W. , Boyd Robert D. , Dodrill Carl B. , Tufts Emily
Published: December 2021

The assumption that congenital rubella is commonly associated with microcephaly and mental retardation was examined. Among a rubella clinic population of 111 children, 92 children had vision sufficient to allow testing by the Leiter International Scale. The mean IQ for this group was 99.46 (SD, 19.5). Head circumference in this group correlated well with stature but poorly with intellect. The authors conclude that children with intrauterine rubella should be viewed as small children rather than children with small heads and that such children are poorly served if mental subnormality is assumed without careful study.
Pulmonary Hypersensitivity Associated With Pancreatin Powder Exposure
Authors: Bergner Arthur , Bergner Renee K.
Published: December 2021

A 25-year-old woman with obstructive, reversible pulmonary and nasal hypersensitivity apparently induced by casual, repeated inhalation of pancreatin powder (desiccated pork pancreas) is described. The powder was being employed as a dietary supplement for the patient's son, diagnosed as having cystic fibrosis. Two challenges of the patient by reproducing home use of the powder resulted in repetition of a hypersensitivity symptom complex on both occasions. Vitalometry demonstrated an immediate and late response. Avoidance of pancreatin powder exposure resulted in subsidence of symptoms. Immunologic mechanisms are suggested but not proven.
THE FIRST ARTICLE PUBLISHED IN THE FIRST AMERICAN PEDIATRIC JOURNAL (1884)
Authors: E. T. C.
Published: December 2021

The first volume of the first American pediatric journal was published in 1884. The title and author of the first article in the January 1884 of this journal was "Convulsions in Children" by William T. Plant, M.D.

The first few paragraphs of Dr. Plant's article demonstrate his use of the active voice, his preference for positive assertions and his use of definite, specific, concrete language.

As likely as not your first patient will be a baby in a fit. The seizure has been sudden; the appearances are appalling; death is thought to be imminent and you are sent for because near at hand and likelier to be in than the older and usual family attendant. It may be a new experience for you and in dismay you ask yourself what you shall do. I will tell you. In the first place, go! "Stand not on the order of your going, but go at once!" Indeed the summons is so urgent that you can hardly do otherwise. And as you go you may get comfort from the thought that quite likely the fit will be over and the child asleep by the time you arrive and also that a convulsion does not very often end fatally.

We will suppose that the fit is not over and that you find the little one in such condition as I shall now describe. It is lying perhaps in a small bed-room. The ladies of the block or neighborhood, as many as can get in, are there, consternation in their faces and pity in their hearts, all anxious to help if they only knew what to do.
Lettrt To The Editor
Authors: Scherz Robert G.
Published: December 2021

Dr. Weiss expresses the frustrations of many conscientious physicians who recognize the need to educate the general public and the physicians effectively so that the infants and children in our motorized society will have a safer ride. The Accident Prevention Committee of the A.A.P. has been quite active during the last year in support of an awakening of our society to the realization that the motor vehicle is the most common cause of death and permanent disabling injury of children and youths.
FLAME OR BIRD?
Authors: Fuerst Harold T.
Published: December 2021

The acronym Torch has become common currency for a group of infections which, though heterogeneous in some attributes, share the characteristic of producing disseminated disease in the fetus and newborn. Several other infections have the same tendency but one omission from the schema is particularly disturbing, namely syphilis. I therefore propose that the letter "S" be prefixed to the acronym, giving STORCH. As the German for "stork," the connotation with the perinatal period seems highly suitable.

I have discussed the proposal with two flawed authorities (a couple of microbiologists) and their enthusiasm for change is surpassed only by my own.
Nasotracheal Intubation in Epiglottitis
Authors: Rapkin Richard H.
Published: December 2021

Significant numbers of patients with epiglottitis have been treated using nasotracheal intubation. Evidence is accumulating that this procedure is safe, effective and reliable when used in this disease. Nasotracheal intubation should be considered a suitable alternative to tracheostomy in epiglottitis.
Effects of Thyrotropin-Releasing Hormone in Minimal Brain Dysfunction
Authors: Tiwary C. M. , Rosenbloom A. L. , Robertson M. F. , Parker J. C.
Published: December 2021

Synthetic thyrotropin-releasing hormone (TRH) has effected mood elevation in depressed patients and calmed labile behavior in a retarded adolescent. The present study was conducted to determine the effect of TRH in two children of normal intelligence with minimal brain dysfunction (hyperkinetic impulse disorder).

MATERIALS AND METHODS

Two 6 1.2year-old unrelated Caucasian subjects, a boy and a girl, were included in the double-blind cross-over study. Both were in good physical health and had unremarkable perinatal histories. Motor development and intelligence quotient were normal in both children, but the boy had delayed speech.
Blistering Distal Dactylitis: A Clinically Recognizable Streptococcal Infection
Authors: Hays Gerald C. , Mullard Janice E.
Published: December 2021

Superficial blistering distal dactylitis caused by β-hemolytic streptococcus is an infrequent but easily recognizable and well-defined clinical entity.
The Optimum Time To Operate for Cryptorchidism
Authors: Marshall Donald G.
Published: December 2021

I would like to comment on the article by Lattimer et al. in the January 1974 issue of Pediatrics. I agree with the idea that the testis should be brought down, ideally between 4 to 5 years of age. There are a number of things in the article, though, that made my crew-cut stand right up on end.

I too am a great believer in the psychological value of the testis being in the scrotum and I have, therefore, used testicular prostheses when doing orchiopexies and either had to remove the testis or couldn't find one, over the past seven years in 25 boys.
Dr. Lattimer and Colleagues Reply
Authors: Lattimer John K. , Smith Arthur M. , Dougherty Louis J. , Beck Leah
Published: December 2021

We certainly appreciate the opinions of those whose letters comment regarding our position on the problem of the cryptorchid testes. These indicate the spectrum of divergent views that accompanies every discussion of cryptorchidism.

We are in complete agreement that precise surgery on the genitourinary structures in children is a refinement of the art and requires the services of a urologist who deals with these problems on a continuing basis.

Looking back over the years at the cryptorchid children (and their families) whom we have treated, and having followed their progress and personality development as they grew, it is apparent that we previously dwelt too much just on the testicles.
Persistence of the Fetal Cardiopulmonary Circulatory Pathway: Survival of an Infant After a Prolonged Course
Authors: Levin Daniel L. , Cates Lynn , Newfeld Edgar A. , Muster Alexander J. , Paul Milton H.
Published: December 2021

The first case of "idiopathic" persistence of the fetal cardiopulmonary circulatory pathway with survival after a prolonged course is documented by serial cardiac catheterizations. All previously reported infants have either markedly improved within the first week of life or subsequently died. This entity has been described in term infants with prenatal or perinatal distress who present with tachypnea and cyanosis from birth. The chest radiograph is remarkable for the absence of pulmonary parenchymal pathology and the hemoglobin and hematocrit are normal. Blood gas determinations indicate hypoxia and acidosis with or without hypercarbia. Cardiac catheterization and angiography reveal an anatomically normal heart with severe pulmonary hypertension, left ventricular pressure lower than right ventricular pressure, and right-to-left venoarterial shunting through the fetal channels (atrial and or ductal levels). It is postulated that this entity may result from antenatal factors that affect the pulmonary vasculature and its subsequent adjustment to extrauterine life. These factors may include abnormal intrauterine stress resulting in excessive hypertrophy of the pulmonary arteriolar smooth muscle, or abnormal pulmonary vascular responsiveness to the usual vasoactive stimuli before or after birth, or an immature or dysfunctioning enzyme system necessary for the normal decrease in pulmonary artey pressure.
Stimulation of Growth Hormone Secretion by Levodopa-Peopranolol in Children and Adolescents
Authors: Collu Robert , Leboeuf Gilles , Letarte Jacques , Ducharme Jacques R.
Published: December 2021

Levodopa, 0.5 gm/1.73 sq m, and propranolol, 0.75 mg/kg, were administered orally to 23 children with short stature and 10 children suffering from various disorders. Glucose and insulin tolerance tests and arginine infusions were also utilized in some of these subjects to determine growth hormone (GH) response. Seventeen subjects with short stature had a GH peak greater than 5 ng/ml to the combined levodopa-propranolol provocative test (DPPT). The mean GH peak concentration obtained in this group was 19.6 ± 1.8 (SEM) ng/ml, and in 94.1% of these children the peak was obtained at either 30, 60, or 90 minutes following the administration of the two drugs. Six subjects with short stature who failed to respond to the DPPT had abnormal responses to at least two other stimulatory tests and were classified as GH-deficient. Two subjects among the ten suffering from various disorders failed to respond to the DPPT. The first was a case of chromophobe adenoma of the pituitary gland with primary amenorrhea and luteinizing hormone deficiency, and the second a case of Hand-Schüller-Christian disease.

The DPPT appears to be a reliable, safe, and easy-to-perform test to determine GH reserve.
A Limitation in the Use of Office Records for Health Care Evaluation
Authors: Long Thomas , Rogers K. D.
Published: December 2021

A potential limitation of physician office records for ambulatory health care evaluation is their completeness. Criteria used to evaluate care of a specific problem not only should be of major importance in its diagnosis and treatment but should also be likely to be recorded in the physician's records. It is possible that a physician may not record certain kinds of observations and actions even though he performs them. Further, whether or not the physician enters information in his record may not be related to his opinion about its importance for patient care.

The specific questions asked in this study were whether practices deemed desirable by practitioners for diagnosis and management of sore throat of possible streptococcal origin were actually performed and, if so, whether the performance was recorded.
Reflections of Dietary Studies With Children in the Ten-State Nutrition Survey of 1968-1970
Authors: Lowe Charles U. , Forbes Gilbert , Garn Stanley , Owen George M. , Smith Nathan J. , Weil William B. , Nichaman Milton Z.
Published: December 2021

Physical (anthropometric) and biochemical evidence of malnutrition or of " nutritional risk" among children in the Ten-State Nutrition Survey reflected primarily an inadequacy of total energy intake and not improper selection of foods or "unbalanced" diets. Thus, the quantity of food—not the quality—was the major dietary problem highlighted by the Ten-State Nutrition Survey.
Family intervention
Authors: Kempe C. Henry
Published: December 2021

It may be presumptuous to point out to pediatricians new ways of insuring that children have improved health care and the benefits of preventive pediatrics from early infancy. As a group, we have done a great deal in moving academic departments towards expanding the role of ambulatory services and making the ambulatory setting a place where exciting educational developments take place. We have also made a real contribution in bringing the needs of preventive pediatrics to the attention of various levels of government as well as incorporating outpatient departments as important sites for the teaching of medical students, house staff, and a wide variety of health professionals.
Acute Hemorrhagic Leukoencephalitis: Report of Three Cases and Review of the Literature
Authors: Byers Randolph K.
Published: December 2021

Attention is directed to the diagnosis of acute hemorrhagic leukoencephalitis and the possibility of its clinical recognition is discussed. Three case histories, two diagnosed at autopsy and one clinically, are presented. The latter was treated with very generous doses of steroids and recovered spectacularly. On omission of steroids, a mild, temporary clinical recurrence occurred. Clinical, clinicopathologic, and pathologic aspects of the disease are discussed, and etiologic factors mentioned. Some thoughts on the relationship of this disease to experimental allergic encephalomyelitis are mentioned. Differential diagnosis is considered and the use of biopsy for confirmation of diagnosis especially from herpes encephalitis considered. A plea is made for the trial of treatment with large doses of steroids.
Renal Function in Obstructive Nephropathy: Long-Term Effect of Reconstructive Surgery
Authors: Mayor Georges , Genton Noël , Torrado Antonio , Guignard Jean-Pierre
Published: December 2021

Renal function was studied in 24 children with chronic hydronephrosis and renal insufficiency. The follow-up period after reconstructive surgery was 1 to 12 years. Glomerular filtration rate (GFR) was assessed by the clearance of endogenous creatinine or inulin. Effective renal plasma flow was assessed by the clearance of PAH. Reconstructive surgery was performed during the first year of life in 12 out of 24 patients, between one and two years of life in 6 patients, and after two years of life in 6 patients. Three different patterns of evolution could be observed after relief of obstruction: (1) An improvement or a normalization of renal function only occurred in patients operated upon before one year of life. (2) A stabilization of renal function without normalization was observed in patients operated upon between one and two years of life. (3) A pro-gressive deterioration of renal function towards terminal renal failure was observed in five out of six patients operated upon after two years of age. This deterioration could not be explained by recurrence of detectable urinary tract infection or urinary stasis. The changes in GRF in four patients with a solitary kidney followed the same pattern.

We conclude that it is essential to correct severe chronic hydronephrosis associated with renal insufficiency before one year of age if a lasting improvement of renal function is to be expected.
Trisomy 8 Mosaicism Syndrome
Authors: Fineman Robert M. , Ablow Ronald C. , Howard Rufus O. , Albright James , Breg W. Roy
Published: December 2021

Chromosome 8 is the largest autosome thus far found to be trisomic among liveborn infants. Trisomy 8 "mosaicism" syndrome (T8mS) consists primarily of individuals whose chromosome complement is mosaic for chromosome 8 (T8m),i.e. patients with a chromosomally normal cell line in addition to the trisomic 8 cell line, and a few known individuals with full trisomy 8 (T8),i.e. each cell observed contains an extra chromosome 8. Reported cases of both types share a number of common features and thus have helped to delineate a new syndrome. Common features of T8mS include mild-to-moderate mental retardation, strabismus osseous and soft tissue abnormalities, lowset and/or malformed ears, broad bulbous nose, palate deformity, various types of congenital cardiovascular disorders, hypronephrosis, cryptorchidism, and characteristic dermatoglyphics. Since chromosomal mosaicism is often present in this syndrome it is not surprising that considerable phenotypic variation exists. The present report of one of the youngest individuals yet described with T8m adds two more physical findings (dense corneal clouding and a heretofore undescribed clavicular deformity) to the constellation of abnormalities associated with T8mS. On the basis of the phenotypic and cytogenetic findings in this and 17 similar patients previously reported it is proposed that T8mS is a distinct clinical entity.