bluuebunny/crossref_metadata_2025 huggingface dataset:
Water-Soluble Vitamin D in Human Milk: A Myth
Authors: Greer Frank R. , Reeve Lorraine E. , Chesney Russell W. , DeLuca Hector F.
Published: December 2021

For the past 50 years, repeated analyses of human milk have shown an average of 20 IU/liter of vitamin D activity. Following the 1977 report of Lakdawala and Widdowson,1 which found that a large amount of water-soluble vitamin D sulfate was present in the whey (or water-soluble) fraction of human milk, the previous studies appeared to be in question. This study by Lakdawala and Widdowson reportedly confirmed earlier reports from Japan2-4 and France5 which not only demonstrated large quantities of vitamin D sulfate in human milk, but also strongly suggested that this vitamin D metabolite had biologic activity in rats.
Clinical Reactions and Serologic Responses After Vaccination with Whole-Virus or Split-Virus Influenza Vaccines in Children Aged 6 to 36 Months
Authors: Bernstein David I. , Zahradnik John M. , DeAngelis Charles J. , Cherry James D.
Published: December 2021

The reactogenicity and immunogenicity of whole-virus and split-product influenza vaccines were studied in 77 children between the ages of 6 and 36 months. Subjects initially received monovalent vaccine containing either A/USSR/77 (H1N1) antigen in 1978 or A/Brazil/78 (H1N1) antigen in 1979. One month later a trivalent preparation was given which contained the respective H1N1 antigen plus A/Texas/77 (H3N2) and B/Hong Kong/72 antigens. Temperatures of ≥37.8 C (≥100 F) were observed more commonly after initial vaccination with whole-virus vaccine (35%) than after split-product vaccine (14%). No child had a temperature of ≥39.4 C (103 F) or a febrile convulsion. The trivalent vaccines were more reactogenic than the monovalent vaccines although none of the reaction indices exceeded 0.9. The whole-virus vaccine appeared to be more immunogenic, especially in those children who were initially seronegative (preimmunization hemagglutination-inhibiting antibody titer <5). Only 50% of children vaccinated with split-product vaccines with initial hemagglutination-inhibiting titers of <5 achieved titers of ≥20 to the H1N1 antigen after two doses of vaccine compared with 97% in similar whole-virus vaccine recipients. The degree of antibody response to the A/Texas/77 component of the vaccines was greater than the response to the A/Brazil/78 or A/USSR/77 antigens.
Neonatal Hyperviscosity II. Effect of Partial Plasma Exchange Transfusion
Authors: Goldberg K. , Wirth F. H. , Hathaway W. E. , Guggenheim M. A. , Murphy J. R. , Braithwaite W. R. , Lubchenco L. O.
Published: December 2021

To determine the effect of partial plasma exchangetransfusion, 20 newborn infants with neonatal hyperviscosity were randomly assigned to observation or treatment with partial plasma exchange transfusion within the first eight hours after birth. They were studied for organ involvement by roentgenogram, blood count, coagulation studies, and neurologic behavior and were followed up using the Brazelton Neonatal Behavior Assessment scale at 8, 24, and 72 hours and 2 weeks of age; in addition, ten control infants without hyperviscosity of similar birth weights and gestational ages were also studied. Exchange transfusion improved blood viscosity but both hyperviscous groups showed a higher proportion of abnormal results than did the control subjects. Infants receiving exchange transfusions subsequently improved during the period from 8 hours to 2 to 3 weeks of age, until they were indistinguishable from the control subjects. Neurologic improvement in hyperviscous infants who had not received exchange transfusions were significantly slower during this period. At 8 months of age, abnormal neurologic and developmental findings were impressive in both groups; no significant differences in neurologic abnormalities were noted at that time. Developmental delays, tremors, spastic diplegia, and monoparesis were found in four of six untreated infants and five of ten infants who had received exchange transfusions. A fine tremor was present in one control child.
Salmonellosis in Infants: The Importance of Intrafamilial Transmission
Authors: Wilson Rickey , Feldman Roger A. , Davis Jeffrey , LaVenture Martin
Published: December 2021

In a retrospective review of Wisconsin Salmonella surveillance data, we found that 73 (39%) of 187 families with infant index patients had at least one family member with prior diarrheal illness, compared with only 20 (13%) of 158 families with 5- to 9-year-old index patients (P < .0001). Prior diarrheal illness was also more commonly identified in families with an infant index patient 0 to 2 months of age (28 of 52 families) than in families with an index patient 3 to 11 months (45 of 135 families) (P < .02); this difference was found largely in families of infant index patients with siblings. Intrafamilial transmission of Salmonella may explain a large proportion of cases of infant salmonellosis. Older children and adults with salmonellosis may be the most important exposures for infants 0 to 2 months of age.
Pulmonary Artery Sling: A New Diagnostic Tool and Clinical Review
Authors: Rheuban Karen S. , Ayres Nancy , Still J. Gordon , Alford Bennett
Published: December 2021

The pulmonary artery sling is a vascular anomaly that produces severe respiratory disease in infancy. The differential diagnosis is lengthy, and the diagnostic work-up frequently includes such invasive maneuvers as bronchography, bronchoscopy, and cardiac catheterization. In this paper the use of a new noninvasive diagnostic tool, computed tomography, to aid in the diagnosis of this form of vascular ring, is discussed and a review of salient features of this cardiovascular malformation is presented.
Altered Theophylline Clearance During an Influenza B Outbreak
Authors: Kraemer Michael J. , Furukawa Clifton T. , Koup Jeffrey R. , Shapiro Gail G. , Pierson William E. , Bierman C. Warren
Published: December 2021

During the 1980 influenza B outbreak in King County, Washington, 11 children whose asthma had previously been controlled with a stable theophylline dose, developed theophylline toxicity on this same dose. Two had seizures, eight had nausea and vomiting, and three had headaches. All had clinical evidence of a febrile viral illness. The toxicity appeared to be related to decreased theophylline clearance, which gradually returned to preillness levels over a period of one to three months. Six of ten children had serologic evidence of influenza B, which is presumed to be the cause of the altered clearance. In children receiving chronic theophylline therapy, symptoms of vomiting, headaches, or seizures during a viral illness may be due to theophylline toxicity rather than the virus. Such patients should have an immediate serum theophylline determination, even if previous levels have been in the therapeutic range.
Congenital Rubella and Myxedema
Authors: AvRuskin Theodore W. , Brakin Mario , Juan Christina
Published: December 2021

Thyroid disorders have been reported following congenital rubella: four cases of thyroiditis1-4 and two patients with thyrotoxicosis5,6 are known. We report a patient with childhood myxedema and congenital rubella, and indicate that myxedema may occur as a sequela to rubella. This combination of disorders should be added to thyroiditis,5 hypopituitarism7 and adrenal insufficiency4 in the spectrum of possible late diabetes mellitus complications of the congenital rubella syndrome. Patients with congenital rubella should be tested periodically for these endocrine deficiencies.

CASE REPORT

An 8[unknown]-year-old white girl was the product of a seven-month gestation complicated by maternal rubella in the first trimester. Birth weight was 1 kg.
Letters to the Editor
Authors: Ortega Jorge A.
Published: December 2021

McWilliams and Dunn report a case of aplastic anemia in Down's syndrome similar to our recently reported case. We can expect a flurry of other such case reports. However, since the association of aplastic anemia and Down's syndrome is still unusual, it will be interesting to document difference in predisposing factors and response to various forms of therapy.
Is Myelomeningocele a Disappearing Disease?
Authors: Stein Sherman C. , Feldman Joseph G. , Friedlander Marvin , Klein Robert J.
Published: December 2021

The incidence of major congenital anomalies of the central nervous system was determined in a study of more than 233,000 births in Brooklyn, New York hospitals during the years 1968 to 1979. Anencephaly, myelomeningocele, and hydrocephalus occurred at frequencies of 47.1, 42.4, and 49.3 cases per 100,000 total births, respectively. During the 12 years of the study, the incidence of myelomeningocele decreased at a linear rate of approximately 4.6 cases per 100,000 births per year. A review of comparable reports on births in the northeastern region of the United States shows that a relatively consistent linear decline in myelomeningocele incidence has been proceeding at this rate for the past 50 years. It is concluded that minor local fluctuations and variability in data collection have obscured the steady decrease in occurrence. No significant declines were seen in the incidence rates of anencephaly or hydrocephalus, nor were uniform secular trends for these anomalies evident from previous reports. Epidemiologic differences between myelomeningocele and anencephaly are noted and their common etiology is questioned.
The Foster Care System and Health Status of Foster Children
Authors: Schor Edward L.
Published: December 2021

The foster home care system is the most commonly used alternative for the care of dependent children in the United States. However, it often fails to achieve its objective of returning the child to his home or providing a permanent substitute family. Children entering foster care have frequently suffered social, emotional, and medical neglect, and physical abuse. They have a high rate of chronic medical problems, educational handicaps, and severe emotional impairment. In many cases the health care that foster children receive fails to recognize and/or adequately address their disabilities. In order for the pediatric practitioner to work successfully with a foster child, he must not only provide comprehensive health care, but also must be familiar with the social welfare system within which the child lives.
MODERN CHILD'S VIEW
Authors: Swingle Hanes M.
Published: December 2021

I recently gave my 18-month-old daughter and 3-year-old son lollipops. My son tasted his sister's orange lollipop and said, "Daddy, that comes from oranges."

"That's correct," I replied proudly.

He then licked his own grape lollipop, reflected for a moment, then exclaimed, "This one comes from Dimetapp!"

One might interpret this as a commentary on current pediatric practice.
Role of Hyaline Membrane Disease in Production of Later Childhood Lung Abnormalities
Authors: Stahlman Mildred , Hedvall Gunnel , Lindstrom Dan , Snell James
Published: December 2021

Between 1961 and 1970, 177 survivors of hyaline membrane disease have been followed clinically and roentgenologically for a minimum of three years to determine the long-term pulmonary outcome. Of these, 153 have been seen for at least six years and 61, for 11 years or more. A total of 175 batteries of pulmonary function tests have been performed on 129 children at age 7 and/or 11 years, Final roentgenograms showed fibrosis in 12 instances, and these changes were positively correlated with the severity of the initial disease, the use of a positive pressure respirator (but not negative pressure respirator), time on the respirator, and length of time in O2, but not high O2 concentrations. Residual symptoms in the first years of life were also correlated with positive pressure respirator use, length of use, and with secondary infection. Pulmonary function tests showed minimal abnormalities in 12 children when last seen. None of these children had a history of exercise intolerance or chronic respiratory symptoms. The ultimate pulmonary history of this population of patients is unknown, but overt childhood lung disease following hyaline membrane disease is not a frequent occurrence.
Neonatal Pneumoperitoneum Without Significant Adventitious Pulmonary Air: Use of Metrizamide to Rule Out Perforation of the Bowel
Authors: Cohen Mervyn D. , Schreiner Richard , Lemons James
Published: December 2021

Pneumoperitoneum in the neonate may be due to air that has dissected from the chest. Four infants, in whom pneumoperitoneum, from thoracic air dissection, occurred in the absence of pneumothorax or pneumomediastinum are reported. The absence of abnormal collections of air in the chest is of no value in deciding whether a pneumoperitoneum is due to bowel perforation or air dissecting from the chest. Contrast bowel studies are needed in all cases of pneumoperitoneum in the infant to distinguish bowel perforation from intrathoracic origin of the air.
Caring for Foster Children
Authors: Sokoloff Burton Z.
Published: December 2021

The poor quality of health services rendered to the half million foster children in this country is well documented elsewhere in this issue.1 This is an area of pediatric care of which we cannot be proud. Schor's "unfortunate discovery that children who have been under the protective and hopefully remedial care of the foster care system continues to demonstrate evidence of inadequate health supervision" must serve as a stimulus for changes. I strongly agree with Schor that the pediatric literatore has contributed to the problem by failing to describe adequately the special problems inherent in children in foster care—a population at high risk.
Sense of Worth
Authors: Weinberg Horst D.
Published: December 2021

"Let's Speak Up for Pediatricians" (Pediatrics 68:734, 1981) is a timely note. Joseph W. St. Geme, Jr, touches on an important topic for all pediatricians. As a group, pediatricians do have a poor self-image. I do not feel that economics is the root of the problem. There is no question that we in the medical specialties are less well paid than our surgical colleagues. That is not the cause of our poor self-image. What is it then?
Cognitive and Behavioral Knowledge About Insulin-Dependent Diabetes Among Children and Parents
Authors: Johnson Suzanne Bennett , Pollak R. Timothy , Silverstein Janet H. , Rosenbloom Arlan L. , Spillar Rebecca , McCallum Martha , Harkavy Jill
Published: December 2021

Youngsters' knowledge about insulin-dependent diabetes was assessed across three domains: (1) general information; (2) problem solving; and (3) skill at urine testing and self-injection. These youngsters' parents completed the general information and problem-solving components of the assessment battery. All test instruments used showed good reliability. The test of problem solving was more difficult than the test of general information for both parents and patients. Mothers were more knowledgeable than fathers and children. Girls performed more accurately than boys, and older children obtained better scores than did younger children. Nevertheless, more than 80% of the youngsters made significant errors on urine testing and almost 40% made serious errors in self-injection. A number of other knowledge deficits were also noted. Duration of diabetes was not related to any of the knowledge measures. Intercorrelations between scores on the assessment instruments indicated that skill at urine testing or self-injection was not highly related to other types of knowledge about diabetes. Furthermore, knowledge in one content area was not usually predictive of knowledge in another content area. The results of this study emphasize the importance of measuring knowledge from several different domains. Patient variables such as sex and age need to be given further consideration in the development and use of patient educational programs. Regular assessment of patients' and parents' knowledge of all critical aspects of diabetes home management seems essential.
A NATIONAL COLLECTION OF MATERIAL RELATED TO THE HISTORY OF PREMATURE-INFANT CARE
Authors: Davis Audrey B.
Published: December 2021

An effort is under way to establish a collection of materials which will trace the development of perinatal-care technology in The National Museum of American History at Smithsonian Institution. Readers of Pediatrics are urged to cooperate in this national effort to locate materials of historical interest in back rooms of hospitals and in private collections.

The material of interest ranges from incubators (Lion-type used in incubator-baby exhibits to the present-day models), resuscitation and ventilating devices (delivery-room apparatus, Bloxom Air-Lock, rocking bed, respirators...), feeding items (gavage equipment, nasal spoons, indwelling tubes...), photographs, hospital records (statistical reports, examples of patient records...) and equipment used in landmark investigations (calorimetry, oxygen consumption...).
Pediatric Plague
Authors: Mann Jonathan M. , Shandler Laurence , Cushing Alice H.
Published: December 2021

The large reservoir of animal plague in the American West led to 121 cases of human plague from 1970 to 1980. The majority (55%) of recent cases have occurred in children 16 years of age and younger. In New Mexico 38 pediatric plague cases were reviewed to determine the epidemiologic, clinical, and laboratory features of this disease. Thirty-one patients (82%) had bubonic plague and seven (18%) had primary septicemic disease. Primary septicemic plague had a significantly higher case-fatality ratio (71% vs 3%; P = .0002) and an increased risk of plague pneumonia (57% vs 6%; P = .01) compared with bubonic disease. Symptoms at onset, physical examination, and laboratory data at hospitalization (mean of three days after onset) were consistent with an acute, systemic febrile illness. Recovery from plague was slow, requiring an average of 5.9 days from initiation of effective antibiotics until fever lysis. Only a minority of plague patients were initially suspected to have plague, even by the time of hospitalization. Whereas clinical evidence, particularly in bubonic disease, should suggest plague, residing in or visiting a rural area of the West (especially from June through September) during the week prior to illness may be the only useful epidemiologic clue for the majority of patients who lack a history suggestive of exposure to animals or fleas. The importance of pediatric plague stems from the recent increase in cases, the significant increase in the proportion of all cases occurring in children, the public health implications of plague pneumonia (16% of cases), and the demonstrated potential for plague patients to travel to areas of the country unfamiliar with the disease and its sylvatic home in the American West.
Zinc Dependency as a Cause of Chronic Diarrhea in Variant Acrodermatitis Enteropathica
Authors: Krieger Ingeborg , Evans Gary W. , Zelkowitz Patricia S.
Published: December 2021

Two siblings with chronic diarrhea, growth failure, mood changes, and occasional cheilosis responded repeatedly to treatment with either pharmacologic doses of zinc or pancreatin (Viokase), and their symptoms were exacerbated after withdrawal of therapy. Pancreatic exocrine deficiency was ruled out in both cases. Proteolytic activity was 20% of normal in one infant tested. Plasma zinc concentration was normal. Plasma picolimc acid concentration was low in these two patients and in one previously reported patient (mean 3.6, normal 12.4 ± 3.3 µmoles/liter). This is a characteristic shared with acrodermatitis enteropathica. The response to Viokase may be due to its content of picolinic acid and/or zinc or the correction of a deficiency of carboxypeptidase, a zinc requiring enzyme.
THE IMPORTANCE OF BENJAMIN JOWETT'S KNEE JERK TO SCIENCE AT OXFORD
Authors: C. T. E.
Published: December 2021

Benjamin Jowett (1817-1893), Master of Balliol College, Oxford, and one of the greatest educators England has had, was violently opposed to research as a university ideal.

Logan Pearsall Smith (1865-1946),1 the Anglo-American author, in his biography suggests that his ability to elicit Jowett's knee jerk, as depicted in the quotation below, may have played a significant role in bringing science to Oxford.

The word ‘research’ as a university ideal had, indeed, been ominously spoken in Oxford ... some years ago; but the notion of this ideal, threatening as it did to discredit the whole tutorial and examinational system which was making Oxford into the highest of high schools for boys, was received there with anger and contempt. In Balliol, the birthplace and most illustrious home of this great system, it was regarded with special scorn .... The ideal of endowment for research was particularly shocking to Benjamin Jowett, the great inventor of the tutorial system which it threatened. I remember once ... inadvertently pronouncing the ill-omened word. ‘Research!’ the Master exclaimed. ‘Research!’ he said. ‘A mere excuse for idleness; it has never achieved, and will never achieve any results of the slightest value.’ At this sweeping statement I protested; whereupon I was peremptorily told, if I know any such results of value, to name them without delay .... The only thing that came into my head was the recent discovery, of which I had read somewhere, that on striking a patient's kneecap sharply he would give called, a judgement could be formed of his general state of health.
FIRST RECORDED CHILD ABUSE?
Authors: Robinow Meinhard
Published: December 2021

The following, written by Michel de Montaigne (1533-1592), is perhaps the first description of child abuse inflicted under the guise of discipline:

Passing along our street, how many times I have wished to stage a thumping row in order to avenge the lads I have seen attacked, beaten, and flayed by some father or mother insane with wrath! You see them sally forth, their eyes on fire and throats aroar, often against a babe just come from the breast. And, behold, the little fellow lamed and stunned with blows, while our courts take no notice of it—as though these maimed and crippled victims were not members of our commonwealth. No one would hesitate to send to the gallows a judge who had condemned a criminal out of anger. Why, then, are parents and teachers permitted, out of passion, to lash and punish their children? It is no longer correction, but revenge. Chastisement is a medicine for the young, and would we tolerate a doctor who raged against his patient?
Pulsatility Index, Patent Ductus Arteriosus, and Brain Damage
Authors: Bejar Raul , Merritt T. Allen , Coen Ronald W. , Mannino Frank , Gluck Louis
Published: December 2021

The study of CBF velocity by external Doppler method appears to offer the clinician a noninvasive tool with which to gather information related to changes in cerebral hemodynamics. Inasmuch as the clinical condition of sick preemature infants is different from that of adults with obstructive vascular disease, and as the arteries under study are deeper than those for which the technique originally was intended, we suggest that absolute values for the frequency shift and the mean velocity observed be reported rather than the pulsatility index. Obviously, this will require calibration of each instrument (to obtain an appraisal of the blood velocity) and an estimate of the experimental error, using the actual measurements of blood velocities.

Finally, we believe that the mechanisms by which PDA can cause IVH or ischemic damage remain to be solved. It is conceivable that the worsening of respiratory distress syndrome associated with a severe PDA, with significant hypercapnea, hypoxemia, and shock, requiring vigorous ventilatory assistance, could play a more important role in the pathogenesis of brain damage than the hemodynamic alterations in the brain circulation as estimated by measuring only changes in the PI.
Testing and Stuffing Cotton Balls in Your Ears
Authors: Desch Larry W. , Laskowski Randy P.
Published: December 2021

The recent article by Paradise,1 dealing with the sequelae of repeated otitis, again cautions the clinician to be wary of reports that for some people serve as justification for aggressive treatments. His review of the literature, which consists of many diverse articles, seems accurate and appears to present fairly the differing view-points as well as some of the problems with conducting research in this area.

One statement in the article deserves further enhancement, and is something that has been worrisome to us since the first publications on this type of research.
Airplane Travel and Child Safety
Authors: Sheldon Stephen H. , Wilson Richard R.
Published: December 2021

As regular airline travelers will readily attest, infants and small children constitute a small but vocal minority of the passengers on commercial flights. Both of the authors have children less than 4 years of age and child restraint safety seats meeting the standards of the National Highway Traffic Safety Administration are routinely used for automobile travel. Use of safety seats has been routinely recommended to families receiving medical care from us.

On several occasions, we have attempted to bring these same safety seats on board commercial aircraft for use by our children in seats for which we paid the fare.
SERENDIPITY, OR HOW SCIENTIFIC IDEAS ARE SOMETIMES GENERATED
Authors: Radbill Samuel X.
Published: December 2021

Heinrich Finkelstein (1865-1942), convinced at the beginning of the twentieth century that diarrhea in infancy was metabolic in nature, formulated a high protein milk for infant feeding in 1906 which he called "Eiweissmilch" (Cone TE Jr: 200 Years of Feeding Infants in America. Columbus, Ohio, Ross Laboratories, 1976, p 81). This was introduced into the literature in 1910 in association with L. F. Meyer (Jahrbuch für Kinderheilkunde 71:525, 1910) and became quite popular in the United States for a while. The following is an interesting anecdote about how Finkelstein hit upon the idea, told to me by Dr. Robert Rosenthal, formerly of Vienna, now in St. Paul, Minnesota:

I was at Finkelstein's clinic in 1923 and he told me how he hit on the idea of Eiweissmilk. At that time one of the most feared intestinal disturbances was the diarrhea secondary to other infections—which was so very often fatal. Despondent about any clue as to how to treat these infants, he took a walk. There he observed a dog defecating. The dog had a lot of trouble because dogs usually are rather constipated. Then came the idea: dogs eat almost 100% protein food! How about trying that, he thought.
Milk Protein Quantity and Quality in the Term Infant I. Metabolic Responses and Effects on Growth
Authors: Järvenpää Anna-Liisa , Räihä Niels C. R. , Rassin David K. , Gaull Gerald E.
Published: December 2021

The growth and metabolic response of healthy, term infants during the first 12 weeks of life to feeding one of two formulas or human milk have been measured. Two groups of infants were fed ad libitum a 1.5 gm/100 ml bovine protein formula made up of either 60% whey and 40% casein proteins or 18% whey and 82% casein proteins. A third group of infants was breast-fed ad libitum. No consistent significant differences were observed among the groups with respect to rate of gain in weight, crown-rump length, crown-heel length, or head circumference. Blood urea concentration was significantly higher, and there was evidence suggesting compensation for an increased acid load from the second to the fourth weeks in both of the formula-fed groups compared with the breast-fed group. Blood cholesterol was significantly lower in both the formula-fed groups compared with the breast-fed group (P < .001) and lower in the group fed the casein-predominant formula than it was in those fed the whey-predominant formula (P < .05).
Milk Protein Quantity and Quality in the Term Infant II. Effects on Acidic and Neutral Amino Acids
Authors: Järvenpää Anna-Liisa , Rassin David K. , Räihä Niels C. R. , Gaull Gerald E.
Published: December 2021

The response of the plasma and urine concentrations of acidic and neutral amino acids to two bovine protein formulas (1.5 gm/100 ml) containing, respectively, 60% whey proteins and 40% caseins or 18% whey proteins and 82% caseins was measured in term infants. These two groups of infants were compared with a group of infants that were breast-fed; all infants were fed ad libitum. Concentrations of citrulline, threonine, phenylalanine, and tyrosine in the plasma and urine were higher in the formula-fed infants than in the breast-fed infants and were a reflection of the amount of protein provided. Concentrations of tyrosine and phenylalanine were higher in the plasma and urine of infants fed the casein-predominant formulas than they were in those fed whey-predominant formulas. The opposite was true for threonine, which was present in higher concentrations in plasma and urine of infants fed whey-predominant formulas than it was in infants fed casein-predominant formulas. Concentrations of taurine were lower in the plasma and urine of formula-fed infants than they were in breastfed infants. These differences give further evidence that formulas now in common use may provide a protein intake in excess of protein requirements and that there is a dietary requirement for taurine in man which is not satisfied by such formulas. Although these differences have not been established as nutritionally deleterious, neither can they be assumed to be entirely acceptable.
Reversible Nephrotoxic Reactions to a Combined 2,3-Dimercapto-1-propanol and Calcium Disodium Ethylenediaminetetraacetic Acid Regimen in Asymptomatic Children with Elevated Blood Lead Levels
Authors: Moel Donald I. , Kumar Kusum
Published: December 2021

One hundred thirty children aged 1 to 8 years with blood lead levels > 50 µg/100 ml of whole blood (WB) and free erythrocyte protoporphyrin (FEP) concentration > 250 µg/100 ml of WB received 207 chelation treatments for plumbism. All chelation treatments consisted of CaNa2 ethytenediaminetetraacetic acid (EDTA) 25 mg/kg per dose every 12 hours and 2,3-dimercapto-1-propanol (BAL) 3 mg/kg per dose every four hours for five days. Seventeen children demonstrated a transient doubling of pre-chelation treatment serum creatinine (≤ 2.0 mg/100 ml) during or following chelation treatment; 5/17 also had mild proteinuria. Four children developed severe oliguric (> 250 ml/sq m/day) acute renal failure. Serum creatinine levels were elevated six to seven days after chelation treatment was started and reached maximal values of 3.9 to 8.4 mg/100 ml, three to six days later. Renal function returned to pre-chelation treatment values during the subsequent six to 18 days. In the 21 nephrotoxic patients and the 109 nontoxic patients there were no significant differences in age (3.8 ± 0.6 vs 3.2 ± 0.2 years), sex (61% vs 53% males), percent who received multiple chelation treatments (38% vs 30%), blood lead levels (85 ± 5 vs 79 ± 1 µg/100 ml of WB), FEP (380 ± 30 vs 382 ± 18 µg/100 ml of WB), hemoglobin (11.5 ± 0.4 vs 11.1 ± 0.2 gm/100 ml, and pre-chelation treatment serum creatinine (0.46 ± 0.06 vs 0.58 ± 0.03 mg/100 ml). It was concluded that 13% of children with plumbism who received chelation treatments developed mild transient biochemical evidence of nephrotoxicity and another 3% developed acute renal failure characterized by oliguria four to eight days after chelation treatment was discontinued.
Metastatic Medullary Thyroid Carcinoma in Young Children with Mucosal Neuroma Syndrome
Authors: Kaufman Francine Ratner , Roe Thomas F. , Isaacs Hart , Weitzman Jordan J.
Published: December 2021

Multiple endocrine neoplasia, type 2b (MEN 2b) is a disorder characterized by a distinct phenotype and a predisposition for medullary thyroid carcinoma (MTC) and pheochromocytoma. Two siblings aged 3 and 6 years with MEN 2b, who had elevated plasma calcitonin levels suggesting the presence of MTC are described. Microscopic foci of MTC were found in their thyroid glands and the glands were removed. In the younger child, a metastatic focus was present in a cervical lymph node. Of 12 previously reported children with MEN 2b and MTC who were less than 10 years of age at diagnosis, five had metastases. One of the present patients is the youngest described with this complication. The high frequency of metastases in very young patients with this syndrome has not been emphasized previously. These findings indicate the need for early diagnosis of MEN 2b and the importance of thyroidectomy at the earliest possible age when MTC is suspected by calcitonin screening tests.
Neonates of ≤1,250 Grams Birth Weight: Prospective Neurodevelopmental Evaluation During the First Year Post-term
Authors: Ment Laura R. , Scott David T. , Ehrenkranz Richard A. , Rothman Stephen G. , Duncan Charles C. , Warshaw Joseph B.
Published: December 2021

Although the development of sophisticated neonatal intensive care has permitted the increasing survival of many small and critically ill preterm neonates, the incidence of major neurologic and developmental problems in this population has not significantly changed during the past decade,1-4 and much attention has been directed to the early identification of infants at risk. Motor handicaps and the delayed acquisition of milestones have been noted in the survivors of neonatal intensive care during the first several years of life.5,6 Learning difficulties and behavior problems may be later sequelae.7 Inasmuch as patients who have experienced intraventricular hemorrhage (IVH) have been shown to have a greater risk for neurodevelopmental handicaps than their peers who have not experienced hemorrhage,8-11 we report the first year post-term data from a prospective study of 67 consecutive preterm neonates of ≤1,250 gm birth weight who were admitted to our Newborn Special Care Unit and survived >36 postnatal hours; data include computed tomographic (CT) and/or postmortem evaluations for the determination of the incidence of IVH and neurodevelopmental followup of surviving infants.
Noninvasive Investigation of Cerebral Ischemia by Phosphorus Nuclear Magnetic Resonance
Authors: Delpy D. T. , Gordon R. E. , Hope P. L. , Parker D. , Reynolds E. O.R. , Shaw D. , Whitehead Michelle D.
Published: December 2021

Brain damage in newborn infants who require intensive care commonly results from cerebral hemorrhage or ischemia leading to infarction.1 Hemorrhages are easy to detect with ultrasound2,3 or computed tomography,4 but neither of these techniques reliably identifies ischemic lesions until loss of brain substance has occurred.

Phosphorus (31P) nuclear magnetic resonance (NMR) can be used to measure, noninvasively, the relative concentrations of mobile phosphorus compounds involved in energy metabolism in living systems,5 including the brain of animals in vivo.6,7 Intracellular pH can also be estimated. With the introduction of surface radiofrequency coils6 and topical NMR,8 it has recently become possible to make measurements in human subjects, and these methods are already proving valuable for exploring disorders of muscle (references 9 to 11, and M. J. Dawson, R.H.T. Edwards, R. E. Gordon, et al, unpublished data, 1982).
ORAL REHYDRATION THERAPY
Authors:   Student
Published: December 2021

A bibliography is now available that presents abstracts from a collection of 133 separately published articles dealing with oral rehydration therapy—a prime vehicle for reducing the mortality caused by diarrhoea. Compiled through efforts supported jointly by PAHO and several USA Government agencies, the bibliography is designed to assist perusal and use of a large body of information that has recently emerged on this important subject.

The abstracted articles have been organized into five categories: the history, implementation, and impact of oral rehydration therapy, clinical trials, and work dealing with the composition of the oral rehydration solution. Articles relating to more than one of these categories have been placed in the section to which they relate most closely and have been cross-listed in all other appropriate categories. Overall, it is expected that this bibliography will prove useful to those immediately involved with oral rehydration therapy and also to those concerned more generally with the problems posed by diarrhoeal disease.

Copies may be obtained free of charge from Distribution and Sales, Pan American Health Organization, 525 Twenty-third Street, N.W., Washington, DC 20037, USA. The bibliography exists in English and Spanish versions.
Atypical Fetal Hydantoin Syndrome
Authors: Lubinsky Mark S.
Published: December 2021

The pattern of malformations observed by Bartoshesky et al1 is atypical for fetal hydantoin syndrome, suggesting the possibility of an additional teratogenic influence. No mention was made of chromosome studies, either blood or tissue, in the infant, and the possibility of aneuploidy should be considered.

I have seen two children with de novo chromosomal abnormalities whose mothers had been on anticonvulsants. The first, the daughter of a mother taking hydantoin, had dysmorphic features and extra chromosomal material of uncertain origin attached to the short arm of chromosome 17. Both parents had normal karyotypes.
Cardiac and Ophthalmic Malformations and in Utero Exposure to Dilantin
Authors: Pai G. S.
Published: December 2021

The report by Bartoshesky et al1 prompts me to make the following comments. The authors provided inadequate information to conclude that the infant they described was malformed due to prenatal exposure to diphenylhydantoin. Neither an absence of exposure to other teratogens nor a negative family history permits one to conclude that the ingestion of diphenyihydantoin by the mother caused the infant's malformations. Similarly, the subsequent birth of a normal child after the drug was stopped suggests nothing.
Central Nervous System Infections as a Limiting Factor in the Intelligence of Children with Myelomeningocele
Authors: McLone David G. , Czyzewski Danita , Raimondi Anthony J. , Sommers Renee C.
Published: December 2021

The expectation for intellectual performance of children born with myelomeningocele has often been reported to be significantly decreased due to the presence of hydrocephalus. This study examines the medical histories as well as psychological performance scores of 167 patients observed in our multidisciplinary clinic. Based only on medical histories, the subjects were placed into one of three groups: nonshunted, shunted, and shunted with a history of ventriculitis. Their IQ scores were then compiled and resulted in the following performance breakdown of mean IQs: nonshunted, IQ = 102; shunted, IQ = 95; shunted with a history of ventriculitis, IQ = 72, There were no cases of central nervous system infections in patients who did not have hydrocephalus. Visual motor integration scores were also categorized in the same manner, illustrating a similar trend for severely depressed scores in the group that was shunted and had a history of ventriculitis, while at the same time showing the two remaining groups to be statistically similar. These results have significant importance in the management of hydrocephalus and/or infection as well as indicating the nonpredictability of simple hydrocephalus in the ultimate outcome for intellectual function of those persons born with myelomeningocele.
An Evaluation of the Initial Treatment of Acute Asthma
Authors: Ben-Zvi Zvi , Lam Carin , Hoffman Jane , Teets-Grimm Katherine C. , Kattan Meyer
Published: December 2021

Two treatment regimens for the initial treatment of acute asthma in 50 patients between the ages of 12 and 20 years seen in the emergency room were evalvated. The treatments were randomized such that 26 patients received 2.5 mg of the β2-agonist fenoterol by nebulizer and 24 patients received 0.3 mg of epinephrine followed by 0.75 mg of Sus-Phrine. Clinical assessment and spirometry were performed over a two-hour period. Both groups responded within ten minutes and peak improvement was reached within one hour. Peak expiratory flow and clinical score were better following fenoterol treatment in the first hour (P < .05). The one-second forced expiratory volume and the forced expiratory flow in the middle half of the vital capacity were greater at 20 minutes with fenoterol (P < .05). Those with more severe obstruction (forced expiratory volume < 30%) receiving aerosol therapy also had significantly greater improvement in the first 20 minutes compared with those who received injections. Four patients failed to respond to epinephrine whereas all patients showed improvement with fenoterol (P < .05). These results demonstrated that an inhaled β2-agonist is effective in the initial treatment of acute asthma in children, regardless of severity, and avoids the need for injections.
NEUROPSYCHIATRIC DISORDERS
Authors: Haggerty Robert J.
Published: December 2021

Eighty-five patients with childhood-onset pervasive neuropsychiatric disorders (infantile autism, pervasive developmental disorders, developmental language disorders, severe attentional deficit disorders with learning difficulties, and Tourette's syndrome of chronic multiple tics) underwent computed tomographic scanning of the brain. Clinical assessments of each image of the patients' scans by a diagnostic radiologist, who was "blind" to the neuropsychiatric diagnosis, were used in the first phase of the study, which is reported here. Twenty-four percent of the scan series revealed clear abnormalities and 13% showed mild asymmetries in ventricular and/or hemispheric size. Of the children with pervasive developmental disorders, 59% had abnormal scans, as did 44% of those who were language impaired and 38% of those with Tourette's syndrome. No distinct abnormality was isolated by which diagnostic categories could be separated, nor was an increased prevalence of scan abnormalities associated with overall severity of symptoms. Mild asymmetries, involving increased size of the left hemisphere and/or left ventricular system, were found in all diagnostic groups, and may be associated with one or more behavioral or cognitive disturbances found in the five syndromes. No systematic relationship was found between computed tomography (CT) scan abnormalities and EEG abnormalities. Critical methodologic issues involving diagnostic formulation and assessment of brain status through computed tomographic scanning are discussed.
Hemorrhagic Pityriasis Rosea: An Unusual Variant
Authors: Paller Amy S. , Esterly Nancy Burton , Lucky Anne W. , Milstone Ellen B. , Higgins Thomas P.
Published: December 2021

Four patients with a hemorrhagic form of pityriasis rosea are described. This condition must be differentiated from purpura pigmentosa chronica, a dermatologic disorder that persists or recurs over months to years without response to therapy. In addition, recognition of the hemorrhagic form as a variant of pityriasis rosea makes hematologic evaluation unnecessary.
Renal Calcifications: A Complication of Long-Term Furosemide Therapy in Preterm Infants
Authors: Hufnagle Karen G. , Khan Shadid N. , Penn Duna , Cacciarelli Alexander , Williams Paul
Published: December 2021

During the last four years ten premature infants developed renal calcifications while receiving long-term furosemide therapy. The drug was used in infants with patent ductus arteriosus and later in the same infants with chronic lung disease. They had received furosemide in a dose of at least 2 mg/kg/day for at least 12 days before calcifications were noted on abdominal roentgenograms. Calcifications included small flecks, isolated stones, staghorn calculi, and nephrocalcinosis. Analysis of stones received from four infants showed calcium oxalate and calcium phosphate. Infants who were not receiving furosemide had no calcifications. The infants with renal calcifications had rates of calcium excretion ten to 20 times that of normal, age-matched premature infants in our nursery. When chlorothiazide was given to the infants, in addition to furosemide, a four- to 15-fold decrease in calcium excretion and a radiologic dissolution of the renal calcifications were documented. It is concluded that furosemide, in doses of at least 2 mg/kg/day for at least 12 days can be associated with renal calcifications. The probable mechanism of the stone formation is hypercalciuria, primarily caused by furosemide.
Use of Tetrahydropterins in the Treatment of Hyperphenylalaninemia due to Defective Synthesis of Tetrahydrobiopterin: Evidence that Peripherally Administered Tetrahydropterins Enter the Brain
Authors: Kaufman Seymour , Kapatos Gregory , Mclnnes Roderick R. , Schulman Joseph D. , Rizzo William B.
Published: December 2021

Substantial amounts of tetrahydrobiopterin and 6-methyltetrahydropterin can be detected in CSF when these pterins are given peripherally to patients with hyperphenylalaninemia due to defective biopterin sunthesis. Results of this study suggest that administration of either of these pterins in proper doses may prove to be a treatment not only for the impaired peripheral phenylalamne metabolism, but also for the neurologic disorders that are characteristic of the variant forms of hyperphenylalaninemia due to defective tetrahydrobiopterin synthesis or metabolism.
Ultrasonographic Detection of Perinatal Intracerebellar Hemorrhage
Authors: Reeder John D. , Setzer Emmalee S. , Kaude Juri V.
Published: December 2021

Intracerebellar hemorrhage in premature infants represents a life-threatening event. Prompt diagnosis of this form of intracranial hemorrhage is crucial, as surgical intervention may dramatically improve the prognosis. Whereas clinical signs associated with posterior fossa pathology in infants remain nonspecific, ultrasound provides a rapid, noninvasive means of identifying this potentially treatable abnormality. A case is presented.
INTERNATIONAL DEVELOPMENT ISSUES
Authors:   Student
Published: December 2021

The annual military bill is now approaching 450 billion US dollars, while official development aid accounts for less than 5 per cent of this figure. Four examples:

1. The military expenditure of only half a day would suffice to finance the whole malaria eradication programme of the World Health Organization, and less would be needed to conquer river-blindness, which is still the scourge of millions.

2. A modern tank costs about one million dollars; that amount could improve storage facilities for 100,000 tons of rice and thus save 4000 tons or more annually; one person can live on just over a pound of rice a day. The same sum of money could provide 1000 classrooms for 30,000 children.

3. For the price of one jet fighter (20 million dollars) one could set up about 40,000 village pharmacies.

4. One-half of one per cent of one year's world military expenditure would pay for all the farm equipment needed to increase food production and approach self-sufficiency in food-deficit low-income countries by 1990.