bluuebunny/crossref_metadata_2025 huggingface dataset:
Mumps Vaccine: Possible Reaction
Authors: Niv Molly
Published: December 2021

The following is a report of a reaction to the mumps vaccine, which has not been described before to the best of my knowledge. The patient, a healthy 12-year-old male, was given mumps vaccine (MUMPSVAX, Merck Sharp and Dohme) on January 9, 1969. Four days later he developed the following symptoms: dizziness, vomiting, extreme restlessness, and insomnia. When examined on January 16, 1969, there were no neurological signs, no pyrexia, and no abdominal findings. The heart rate was 88 and the blood pressure was 130/65. Vomiting continued for 3 days.
PROTECTIVE EFFICACY OF DUCK EMBRYO RUBELLA VACCINES
Authors: Stokes Joseph , Weibel Robert E. , Buynak Eugene B. , Hilleman Maurice R.
Published: December 2021

Merck (Benoit) strain rubella vaccine at attenuation level B in duck embryo cell culture afforded protection in all of 17 children who were intimately exposed to natural rubella in an epidemic which occurred 8 months following vaccination. Likewise, none of the children responding to Merck C and D level or HPV-77 vaccine became infected with rubella virus when exposed 10 months later to children who were given virus of low level attenuation (level A) and who were contagious to their contacts. Merck level B and HPV-77 vaccines prepared in duck cell cultures afforded high level persistent antibody without meaningful decline up to 33 and 12 months, respectively. Serial passage of the Merck strain virus in duck embryo cell culture resulted in further attenuation with slower and less antibody development initially, and in more rapid decline in antibody. Merck strain virus at attenuation level B and HPV-77 virus appeared to be optimal for use in children.
PARATHYROIDS AND CERVICAL THYMUS IN SUDDEN UNEXPECTED DEATH IN INFANCY
Authors: Ellis H. A. , Knight B.
Published: December 2021

It has recently been claimed that there is a reduction in the number of parathyroid glands and abnormal fusion of parathyroid and thymic tissues in the sudden unexpected death (SUD) syndrome in infancy. In the present study, the parathyroid glands and thymus were dissected under the stereomicroscope at autopsy in 55 infants, including 31 with features of SUD. The identity of the glands was confirmed histologically.

Parathyroid glands were identified in comparable numbers and sites in infants dying with the SUD syndrome or from some ascertainable cause. Cervical thymic tissue was commonly found in infants, whatever the cause of death, and fusion of parathyroid and thymic tissues was not confined to the SUD syndrome.

The study provides no evidence to support the claim that there is a deficiency of parathyroid glands in the SUD syndrome or that fusion of thymic and parathyroid tissues normally does not occur.
CARE OF THE CRITICALLY ILL CHILD: ENDOTOXIN SHOCK
Authors: Hodes Horace L.
Published: December 2021

F OR practical purposes we may consider that endotoxins of gram-negative bacteria are the cause of endotoxic shock. In general, endotoxins are produced by bacteria which form smooth colonies. However, it should be mentioned that small quantities of endotoxin have been found in colonially rough, gram-negative rods and in some gram-positive bacteria.

Endotoxins are found in the outer layers of the bacterial cell wall. They are so closely associated with other constituents of this structure that their isolation requires strong chemical treatment.1 Endotoxins are macromolecules which readily form complexes with each other and with other macromolecules. The two major constituents of endotoxins are lipids and polysacchanides. Endotoxins also contain a small percentage of peptides, so we may consider that endotoxins are lipid-polysaccharide-peptide macromolecules. All endotoxins contain phosphorus also. The polysaccharide moiety is composed of a number of different carbohydrates, such as glucose, galactose and mannose, as well as pentoses, heptoses, and hexosamines.2 Also present are di-deoxy hexoses, which are found only in endotoxins.

The lipid moiety contains even-numbered saturated and unsaturated fatty acids. The chemical constituents of endotoxins are arranged in three major zones in the macromolecule: the polysaccharide, the lipid-rich, and the amino acid-rich moieties. The backbone of the molecule is polysaccharide, to which are attached amino acids. The fatty acids are also attached to the carbohydrate backbone; these are ester bound to OH groups or amide bound to NH2 groups of the carbohydrate, probably through such compounds as glucosamine.2 The endotoxin molecule is unique in its fatty acid-carbohydrate linkages, which have not been found in any other natural substance.3 Phosphoric acid is found in both the lipid and carbohydrate moieties.
Practical Management of the Allergic Child, by Vincent J. Fontana, M.D. New York: Appleton-Century-Crofts (Division of Meredith Publishing Company, 440 Park Avenue So., New York, New York 10016), 1969, 371 pp., $15.00
Authors: Holt L. Emmett
Published: December 2021

There are many texts on allergy; a number of them deal with allergy in childhood. Why this one? What are the features that characterize Dr. Fontana's recent book?

The clinical manifestations of allergy in childhood are described in various chapters together with appropriate treatment. The book is well written, obviously the work of a master with an intimate first-hand knowledge of the subject. Particularly useful are the discussions of differential diagnosis included with each entity. Therapy to avoid as well as therapy to adopt is stressed.
CONGENITAL HYPOPARATHYROIDISM SIMULATING EPILEPSY, WITH OTHER SYMPTOMS AND DENTAL SIGNS OF INTRA-UTERINE HYPOCALCEMIA
Authors: Moshkowitz Abraham , Abrahamov Abraham , Pisanti Sara
Published: December 2021

A 10-year-old girl presented with bilateral cataracts, nail deformities, and dental changes associated with hypocalcemia. Past history revealed the occurrence of several episodes of epileptic seizures, which were treated unsuccessfully with anti-epileptic drugs. Clinical signs and laboratory tests confirmed the diagnosis of idiopathic hypoparathyroidism, and the patient was treated successfully with viatmin D2 and oral calcium.

The improvement in the patient's condition, as indicated by the rise of serum calcium level, was further demonstrated by improvement in the electrocardiographic and electroencephalographic examinations, which prior to treatment showed disturbed patterns of the type observed in severe hypocalcemia and convulsive disorders.

The interesting observation of episodes of intrauterine hypocalcemia, probably due to hypoparathyroidism in utero, is made on noting the effects on dentition. The problem of intrauterine suppression of the fetal parathyroid glands is discussed.
LIFE AND DEATH IN ADOLESCENCE
Authors: Solnit Albert J.
Published: December 2021

This issue contains an articley of unusual interest by the eminent English pediatrician and psychoanalyst, Dr. D. W. Winnicott. Winnicott for many years continued to function as pediatrician and psychoanalyst, enabling him to be in contact with a wide range of human experience centered on the child and his family. Such highly useful and creative concepts as "The ordinary devoted mother," "Transitional objects," "The capacity to be alone," are but a few examples of Winnicott's refreshing originality, invariably based on observations made while diagnosing and treating children and in connection with guiding parents to satisfying and confident parenthood. In his volume of collected papers, Through Pediatrics to Psychoanalysis, Winnicott wrote in the preface, "My clinical experience has been varied."
Letter to the Editor
Authors: Levin S.
Published: December 2021

"At the evidence of two witnesses . . . shall the matter be established." (Deuteronomy 19:15).

Concerning worms as a cause of urinary infections, I certainly do agree that pinworms carry B. Coli with them into the bladder, but I did not want to bring up this subject because my purpose was rather to draw attention to the syndrome of night cries in little girls. I have since observed a 10-year-old girl whose crepuscular crisis was caused by 2 pinworms on her hymen.
Child Health in the Tropics, ed. 3, edited by D. B. Jelliffe, M.D., F.R.C.P., F.A.P.H.A, D.C.H., D.T.M. and H. Baltimore: The Williams and Wilkins Company, 1968, 165 pp., $6.50
Authors: Weller Thomas H.
Published: December 2021

This Practical Handbook for Medical and Para-medical Personnel, by seven authors, now appears in its third edition. The subtitle succintly defines the intended audience, although the primary objective is obviously that of service as an abbreviated text for trainers of paramedical personnel. A prefatory note stresses that physicians and medical students will need to refer to standard pediatric textbooks and journals. The content reflects the broad practical experience of the authors in East Africa. Therapy is dogmatically outlined and suitably altered to meet the practicalities of the primitive village environment, a concept that deserves acceptance in the handling of disease found in the islands of poverty existent in all societies.
Progress In Pediatric Radiology, Vol. 2, edited by H. J. Kaufman. Chicago: Year Book Medical Publishers, Inc. (35 East Wacker Drive, Chicago, Illinois), 1969, 404 pp., $25.00
Authors: Griscom N. Thorne
Published: December 2021

This is the second of a series of volumes dealing with radiologic diagnosis in children; this volume is about the alimentary canal. The contributors are largely from western Europe, especially France and England. The format is similar to the first volume on the respiratory system. In the present volume there are four articles on techniques and the general approach to radiologic investigation of the child's alimentary canal, a major dissertation (in this case on portal hypertension) with comments by recognized authorities, and finally a number of articles on specific topics; the last category comprises more than half of the book.
Citogenética Humana: Normal y Pathologia, by Salvator Armendares Sagrera. Mexico: Editorial Interamericana, S.A., 1968, 255 pp., no price given
Authors: Zellweger Hans
Published: December 2021

This short text of cytogeneties (in Spanish) is for the pediatrician in this young and rapidly developing borderland between medicine and cell biology. Three short introductory chapters deal with tile ultrastructune of the cell, the biochemical components of the cell nucleus and cytoplasm, and with cell division. Chromosomal aberrations and the corresponding clinical conditions are discussed in the remaining chapters of the book. The author presents a number of patients with autosomal and especially sex chromosomal anomalies which he has observed in his own institution.
A STUDY OF STORAGE, CHILD BEHAVIORAL TRAITS, AND MOTHER'S KNOWLEDGE OF TOXICOLOGY IN 52 POISONED FAMILIES AND 52 COMPARISON FAMILIES
Authors: Baltimore Charles , Meyer Roger J.
Published: December 2021

Like the paper that immediately precedes it, the following paper casts serious doubts on widely used countermeasures against poisoning—the safe storage of toxic products and the education of parents as to the toxicity of products commonly used in the home. The significant variable in childhood poisonings, according to these investigators, is the characteristic behavior of the child. Like many other studies of the same general type, however, the present one raises two questions, one having to do with the methodology, the other with the implications of the findings.

In retrospective studies which rely on recollections or other subjective reports by an interested party, one must always suspect that the event being studied (in this case a poisoning incident) may very well have distorted the subjective report. Is the mother of a child who has recently been hospitalized for poisoning more likely to report that her child "is always getting into everything" than the mother who has not experienced the same sort of event? The use of a control group, no matter how carefully selected, offers no protection against such distortion. The only satisfactory solution is to rely on objective records made before the event (and these are usually difficult to obtain) or to make the study a longitudinal one (which is especially difficult in accident research because accidents occur infrequently).

Any study that relates accidental injury to the personal characteristics of the victim raises more questions than it answers with respect to the development of effective countermeasures. Should efforts be directed toward changing the child's behavior pattern—by working with the child or with his mother or both? Or, once the child's behavior pattern is identified, should efforts be made to protect his environment by educating the parent about toxicity or by safeguarding toxic products, or both? At present these questions remain unanswered.
THE INJURY CONTROL PROGRAM OF THE U.S. PUBLIC HEALTH SERVICE
Authors: Marland Richard E. , Burg Frederic David
Published: December 2021

Today the center for action and support of accident prevention activities within the Federal Government is the Injury Control Program. Therefore, it is appropriate to discuss the Government's role in solving this health problem.

The present stage of development in injury control allows us to define, comprehend, and control some injury types as if they were disease entities. If the appropriate funds were made available, the estimated 16 billion dollars per year lost to the economy from accidents, the 50 million injuries caused by accidents, the 100,000 plus deaths resulting from accidents, and the 20 million plus hospital bed days used up by accident victims could all be reduced by about 30%.

Figure 1 shows the benefit-cost potential to be found in the control of accidental injuries and is derived from study of cost-effectiveness of previous injury control programs. The present situation (point A) has been relatively static over the past few years-that is, a reasonably low return is being made from our investment. With a 20 to 30% increase in resources, the curve reaches a steeper slope where you will get the greatest benefits per dollars spent.

Fundamentally, injury control needs a high Federal priority to receive adequate resources to make progress in overcoming this health problem. The basic criteria used to ascertain a prioritY rating in preventive health programs are: (1) mortality rate (including age-specific rates), (2) morbidity rate (including age-specific rates), (3) financial impact on national economy, (4) utilization of space in our nation's hospitals by those involved in caring for those incapacitated or requiring care, (6) the control measures available for attacking the problem-or the case with which they can be attained, (7) available resources, both personnel and monetary, to attack and solve the problem, and (8) public reception to the idea of controlling the problem.
Acquired Factor X Deficiency in a Negro Boy
Authors: Bayer William L. , Curiel C. Dario , Szeto Isabel L. F. , Lewis Jessica H.
Published: December 2021

A Negro boy suffering from severe hemorrhagic disease associated with a single acquired defect in coagulation factor X is presented. No cause for this deficiency could be found. Vitamin K1 had no effect. He improved spontaneously and is completely healthy 6 months later.
LONG-TERM FOLLOW-UP OF RENAL FUNCTIONS OF 108 CHILDREN WHO UNDERWENT NEPHRECTOMY FOR MALIGNANT DISEASE
Authors: Mitus Anna , Tefft Melvin , Fellers Francis X.
Published: December 2021

To evaluate prognosis and to estimate the late effects of irradiation and chemotherapy on renal functions, renal studies were done on 108 children who underwent nephrectomy for malignant disease and were treated postoperatively with irradiation and chemotherapy. The time from nephrectomy to renal studies varied from less than 6 months to 18 years; the median time was 6.5 years. Postnephrectomy follow-up consisted of repeated urine examinations and cultures, clearances of endogenous creatinine, evaluations of Addis count and blood urea nitrogen, intravenous pyelograms, and radioisotopic renal scans with Hg197 tagged to chlormerodrin. The study indicated that normal renal functions could be preserved in pediatric patients after unilateral nephrectomy, irradiation, and administration of antitumor drugs, providing that irradiation of the remaining kidney was kept below 1,200 R. Although the incidence of urinary tract infections was higher than in normal children, no impairment of renal function followed, if adequate and prompt treatment was administered.
THE POT HOT SPOT
Authors: Nader Philip R. , Haggerty Robert J.
Published: December 2021

What is and what should be the pediatrician's role in marijuana use by young people? While the easy way would be to say that this is none of our business, our own position, based upon the philosophy of the American Academy of Pediatrics, "for the welfare of children" is that we do have a role. Our patients and their parents are affected—sometimes (but who knows how often?) adversely. We believe that we should assume the role of doing what we can with today's knowledge and of seeking to fill in the gaps with new knowledge. Some of this knowledge is presented in this issue of Pediatrics.
Effect of Tissue Preparation on Determinations of Disaccharidase Activities in Intestinal Mucosa
Authors: Antonowicz Irena , Ishida Sotoo , Khaw Kon-Talk , Shwachman Harry
Published: December 2021

The purpose of this paper is to call attention to certain variables in assaying and reporting disaccharidase activities in the intestinal mucosa and to urge the adoption of a standard technique.

In our initial studies we placed the specimen in about 50 ml of ice-cold isotonic saline and "rinsed" it by gently shaking the sealed plaStic vial. It was then removed from the saline; "dried" by sliding it over a cold, clean, glass surface, and weighed. After weighing, the mucosal specimen was homogenized in distilled water. Other investigators froze the specimen immediately after the biopsy, omitting the "rinsing" in the ice-cold isotonic saline.
Letter To The Editor
Authors: Deisher Robert W.
Published: December 2021

Dr. Deisher comments as follows:

It is, of course, impossible for pediatricians to agree on what should be considered appropriate areas of pediatric concern. Certainly, behavior and social areas are among the most controversial. It is unfortunate that many pediatricians are reluctant to take advantage of the opportunity they have to influence a child's environment in a positive manner so that children can grow up better able to fit into society in a productive manner.
Letter To The Editor
Authors: Karpatkin Margaret
Published: December 2021

I would like to comment on the report, "Split Products of Fibrin in Newborns," by Drs. Stiehm and Clatanoff. We have examined over 50 specimens of cord serum from babies delivered normally or by uncomplicated cesarean section, and have been unable to detect increased levels of fibrin degradation products (F.D.P.) in any of the samples.

The technique used is a modification of the Tanned Red Cell Hemagglutination Inhibition Immunoassay (TRCHII) described by Merskey, Kleiner and Johnson.1
Endocrine and Genetic Diseases of Childhood, edited by Lytt I. Gardner. London/Philadelphia/Toronto: W.B. Saunders Company, 1969, 1072 pp., $36.75
Authors: New Maria I.
Published: December 2021

There are relatively few books which review the subject of hormone and genetic disorders of childhood. This volume complements previous publications and has the outstanding attribute of being up-to-date in a rapidly changing field. Dr. Gardner is faithful to the purpose set forth in the preface, "to make available . . . in a single volume a source of information on the patho-hysiology, diagnosis and therapy of principal endocrine and genetic diseases in the pediatric age group."
MALFORMATIONS AND LEUKEMIA IN CHILDREN WITH DOWN'S SYNDROME
Authors: Fabia Jacqueline , Drolette Margaret
Published: December 2021

Among 2,421 children with Down's syndrome born alive to residents of Massachusetts from 1950 through 1966, approximately one-third had at least one malformation other than the characteristic diagnostic criteria of the syndrome itself. After congenital heart defect, the most common were duodenal obstruction, clubfoot, cataract, imperforate anus, syndactyly or webbed fingers and/or toes, cleft palate and/or lip, and congenital megacolon.

Males predominated among children with cataract, syndactyly, and congenital megacolon. Somewhat more females than males had congenital heart defect, although the excess was not significant. The mean maternal age was strikingly low for mongols with cleft palate and/or lip and for males with congenital megacolon. The mean birth weight was significantly lower for mongols with malformations, due primarily to a low birth weight of the children with duodenal obstruction.

Most malformations occurred more often in combination with other malformations than expected by chance. The exceptions were duodenal obstruction, congenital megacolon, and imperforate anus.

Among 23 mongols with leukemia, 5 died in the neonatal period—a very high age-specific leukemia mortality rate. The sex distribution of cases shifted over time from predominantly males to predominantly females. Leukemic mongols weighed somewhat more at birth than other mongols, although not significantly so. The risk of leukemia among mongols was not related to the presence or absence of congenital malformations.
NONSPHEROCYTIC CONGENITAL HEMOLYTIC ANEMIA DUE TO A NEW G-6-PD VARIANT: G-6-PD ALHAMBRA
Authors: Beutler Ernest , Rosen Robert
Published: December 2021

An 11-year-old boy was first known to have a hemolytic episode at the age of 8 years, and a diagnosis of nonspherocytic congenital hemolytic anemia due to G-6-PD deficiency was made soon after the hemolytic episode. The red cells of the patient contained a level of G-6-PD activity approximating 10 to 25% of normal. The residual enzyme was partly purified and characterized. It proved to be electrophoretically slow, and was kinetically essentially normal. The thermal stability of the enzyme was reduced and its stability in vivo was markedly diminished. This enzyme represents a new variant which has been named G-6-PD Alhambra.
Disseminated Intravascular Coagulopathy in Hyaline Membrane Disease: Massive Thrombosis Following Umbilical Artery Catheterization
Authors: Du Joseph N. H. , Briggs J. N. , Young Gerald
Published: December 2021

Disseminated intravascular coagulation in the newborn infant has received increasing attention in recent months1,2. In the cases reported so far it occurs in the very sick newborn, including those with hyaline membrane disease and intra-uterine infections, such as rubella, cytomegalic inclusion disease, and herpes simplex. The majority of the cases reported have been associated with severe hyaline membrane disease although the cause of the coagulation defect is not yet clear. Failure to recognize the coagulation defect in the past is probably due to inadequate coagulation studies.

The present management of hyaline membrane disease is based on the assumption that adequate ventilation is essential for the child's survival.
Letter To The Editor
Authors: Finklestein Jerry Z.
Published: December 2021

Dr. Finklestein writes as follows:

Thank you for allowing me to comment on the letter submitted to you by Drs. Leef, Kende, and Ramot.

It was not our intention to leave the reader with the impression that testicular involvement in acute leukemia is an uncommon clinical problem. Several references in the first sentence of the article document the fact that leukemia infiltration of the testes during a period of complete bone marrow remission is a well-known phenomenon.
NEONATAL SEIZURE STATES
Authors: Rose Arthur L. , Lombroso Cesare T.
Published: December 2021

The authors report on their experience gained through a prospective study of 144 infants who developed seizures during the first 3 weeks of life. Only full-term neonates weighing 2,500 gm or more were included. Follow-up averaged 4 years. Seven subjects were lost on follow-up, leaving a total of 137. The clinical features of the convulsive episode are described, and a classification is presented of the most common seizure types, which differ significantly from those met in older babies. Observation of these different types of neonatal seizures may assist in discovering etiological factors and in formulating a prognosis. While no etiological clues were found in one fourth of the neonates, factors of probable etiological importance were established in three-fourths. High in the list of presumptive etiology were metabolic disturbances; intracerebral birth injuries and perinatal anoxia, once considered main causes for neonatal seizures, were considerably less frequent in this series. Central nervous system infection or malformation were met with about equal incidence. The only factor in common in eight babies was a marked postmaturity, and there was a history of pre-eclamptic toxemia in five. More than one factor of potential etiological significance was present in several babies. The study showed that mortality and morbidity run high for neonates with seizure states, the outcome being poor for about half of the cases. In contrast, the other half of the convulsing babies did quite well, often with spontaneous remission and normal psychic and motor development. We found that prognosis based on abnormal (or normal) neurological signs in a convulsing neonate show poor correlation with the state of the child when reevaluated years later. Certain etiological factors, as well as certain types of seizures, seem to carry better prognostic significance.

Electroencephalographic investigation carried out along careful criteria during the newborn period has been found helpful for this series of convulsing babies. Neonates with seizures and a normal EEG had an 86% chance of normal development at age 4 years, regardless of other clinical data. In contrast, neonates with either a "flat," "periodic," or "multifocal" EEG had only a 7% chance of normal development. "Unifocal" EEG abnormalities showed more equivocal correlations. At the end of the study, about 50% of the subjects were found to be normal, while about 30% had survived with some serious neurological defect and 20% had died. There were 23 complete neuropathological examinations. The most helpful clinical and laboratory procedures for the "work-up" of a convulsing neonate are outlined, including a method for the rapid detection of metabolic disorders through diagnostic intravenous infusions.
QUEEN VICTORIA SETS A GOOD EXAMPLE OF CHILD HYGIENE
Authors: C. T. E.
Published: December 2021

I suspect that for most of us Punch—the weekly humorous magazine published in London—would seem an unlikely source for information about proper health regimens for young children. But the following mildly satiric quotation published almost a century and a half ago would suggest that Punch was keenly concerned about children's health.

We . . . did notice in the Court Circular . . . a paragraph from which some profit may be derived. In the midst of a series of announcements respecting the birth-day of Princess Alice, we came to the following:

"At five o'clock in the afternoon Her Majesty received a small juvenile party, etc. The Queen accompanied by the Royal children, received the youthful visitors in the saloon, in which the juveniles danced, and afterwards proceeded to the library, where refreshments were served. The juvenile party left the Palace soon after seven o'clock."

Here is an admirable example to those who are in the habit of giving children’s parties, commencing at eight or nine p.m., and terminating at one or two in the morning, when the jaded juveniles crawl away with at least six months' health taken out of them by late hours, excitement and fatigue. The Queen, as a mother and a sensible woman, knows when "it is time that all good children should be in bed," as the nurse's saying goes, and she most properly sets herself above the fashionable foolery of half killing children under the pretext of amusing them.

The juvenile party at the Palace was short and sweet, beginning early, breaking up in good time, and not interfering in the least with the usual hours that ought to be observed in all well-regulated families.
Acute Leukemia Presenting with Pericardial Tamponade
Authors: Jaffe Norman , Traggis Demetrius G. , Tefft Melvin
Published: December 2021

Two patients with acute leukemia who presented with pericardial tamponade as part of the initial manifestations are described. The diagnosis in one patient was confirmed by pericardiocentesis. Both patients responded satisfactorily to the simultaneous administration of radiotherapy and chemotherapy; therapeutic pericardiocenteses were not required. Ancillary measures to avoid the complications of hyperuricemia were employed.
Sensitivity to the Cockroach in Three Groups of Allergic Children
Authors: Schulaner Frederic A.
Published: December 2021

There is a definite tendency for allergic children exposed to cockroaches to develop positive skin tests. Suburban children, who were not exposed but had the same allergic problems of wheezing and nasal symptoms, had no positive tests. There is a suggestion that this sensitivity may play a role in perpetuating allergic symptoms in some children. The cockroach seems to be an important potential allergen in susceptible populations.
DIVISIONS OR MONOLITHIC PEDIATRIC DEPARTMENTS?
Authors: Scott Roland B. , Neel Ann F.
Published: December 2021

In summary, big universities are more likely to have divisions than small schools regardless of location or funding, and these divisions are more likely to include the more exotic, more technical, or more narrowly defined subspecialties. In addition, aspects of pediatric practice addressed to care in general may be found more in big departments, perhaps to provide identity and enforce the provision of such care. When small schools have divisions, they are in the more established subspecialties. Divisions are generally viewed as a means of enhancing departmental growth, especially by those who have them; those who do not have them do not ordinarily believe them to be useful.
Redbook's Young Mother
Authors: Haskin David
Published: December 2021

Today I received a copy of the Academy Newsletter and a publication entitled, Redbook's Young Mother, and I feel constrained to offer a few comments. Clearly the Academy's involvement in this venture not only implied the endorsement of certain products but also the rather extravagant claims made for them in the advertising found in this publication. In choosing an informative booklet for distribution to new mothers in the hospital, would it not be less confusing to offer one that did not have a dozen conflicting advertising claims for products alleged to prevent diaper rash?
Letter To The Editor
Authors: Smith Clement A.
Published: December 2021

When we started the abstract system, in Volume 41, No. 1 (January), 1968, a commentary described the plan as follows:

"With the new year this journal alters, slightly, the form of its articles. Most apparent will be the beginning of each article with an abstract, to be prepared by the author. In that position the abstract will not only suggest to the hesitant reader what he may expect to find below, but it will also allow him to photocopy (or tear) from the issue the abstract together with the adjoining title, author's name, and other useful items, including the key words under which the author advises indexing what he has written.
Letter To The Editor
Authors: Fireman Philip
Published: December 2021

Dr. Fireman commented as follows:

The data described by Drs. Kadowaki, Nihira, and Nakao are of interest because the in vitro responsiveness of peripheral leucocytes to phytohemagglutinin was suppressed temporarily during and shortly after natural measles infection, but was not suppressed following vaccination with attenuated measles virus. It is unfortunate that these investigators did not follow any other parameters of in vitro leucocyte responsiveness such as peripheral leucocyte counts, the response of leucocytes to allogeneic leucocytes, or specific antigens and in vivo cutaneous delayed hypersensitivity reactions to specific antigens.
CONGENITAL HEART BLOCK DUE TO A LESION IN THE CONDUCTION SYSTEM
Authors: Sotelo-Avila Cirilo , Rosenberg Harvey S. , McNamara Dan G.
Published: December 2021

The cardiac conduction system of an infant with congenital complete heart block was studied at postmortem examination by subserial sections of the interatrial and interventricular septa. A localized area of necrosis in the central fibrous body interrupted the penetrating portion of the bundle of His. The cardiac structure was intact, with no abnormality other than the lesions in the fibrous tissue. The lesion is interpreted as the result of an acquired inflammation late in intrauterine life, with damage localized to the cardiac central fibrous body.
Letter To The Editor
Authors: Smith Margaret H. D.
Published: December 2021

For the American Academy of Pediatrics, Committee on Control of Infectious Diseases, Dr. Margaret H. D. Smith commented as follows:

The patient reported by Lintermans and Sehynaeve is indeed perplexing, and is hard to clarify in retrospect. Several questions arise:

Why was the antituberculosis therapy which the patient was receiving ineffective? The tubercle bacilli recovered in November after 2 to 3 months of treatment with INH and streptomycin were INH resistant. While INH resistance not infrequently develops during therapy in patients with cavitary tuberculosis, where the populations of tubercle bacilli are huge, it rarely if ever develops during treatment in children with primary tuberculosis.
Renal Diseases in Children, by John A. James, M.B. (Edin), M.R.C.P., C.C.H. Saint Louis: The C. V. Mosby Company, 1968, 371 pp., $18.50
Authors: Worthen Howard G.
Published: December 2021

In spite of a number of excellent textbooks on renal diseases, many pediatricians have felt the need of a urologic textbook written for them rather than for the internist. Dr. James has now filled this need.

The book was written primarily for the pediatrician and the pediatric resident, but it can be also recommended to the general practitioner, the internist, and even the urologist who treats renal disease in children. It is a compact and well written volume by one who uses the English language well, and who has learned how to distill the essential information from a large mass of material and still present it in a manner which the pediatrician can understand.
THE TONGUE AND TASTE IN FAMILIAL DYSAUTONOMIA
Authors: Pearson John , Finegold Milton J. , Budzilovich Gleb
Published: December 2021

The extreme paucity of subcutaneous sensory nerves in the small tongue of a 1-year-old child with familial dysautonomia was correlated with the absence of taste buds in the light of prior experimental evidence, indicating a trophic influence of nerves on taste bud development. Motor nerves in the tongue were normal. Reduced neuron populations were found in sensory and autonomic ganglia.
EOSINOPHILIC GRANULOMA OF THE CERVICAL SPINE IN CHILDREN
Authors: Davidson Robin I. , Shillito John
Published: December 2021

Eosinophilic granuloma of the cervical spine is recorded in six children, two of whom had neurological deficits. A flaccid monoparesis occurred in one child with a C5 arch lesion. Pyramidal tract signs were present in a patient with a defect at the atlanto-occipital joint. Cervical pain, restricted range of movement, torticollis, and tenderness were other presenting signs and symptoms and occurred in all except one patient. A lytic defect in the arch or centrum of a cervical vertebra was associated with this presentation. Treatment following biopsy consisted of immobilization and radiotherapy in a range of 450 to 750 rads. Cure was effected in all instances.
HODGKIN'S DISEASE AND THYMIC ALYMPHOPLASIA IN A 5-MONTH-OLD INFANT
Authors: Bernuth Goetz von , Minielly John A. , Logan George B. , Gleich Gerald J.
Published: December 2021

An infant with Hodgkin's disease and thymic alymphoplasia is described. The infant died at 5 months of age after an illness clinically characterized by frequent respiratory infections, erythematous rash, oral thrush, and hepatosplenomegaly. The peripheral blood showed severe anemia and lymphopenia; IgG level was very low, and there was no mitosis of peripheral lymphocytes after stimulation with phytohemagglutinin. Autopsy revealed Pneumocystis carinii pneumonia, thymic alymphoplasia, and Hodgkin's lymphoma in lymph nodes, liver, spleen, and lungs. A reovirus type 3 was isolated from the lungs. The association of diseases as rare as Hodgkin's disease and thymic alymphoplasia suggests a relationship between them. This may consist of either an abnormal susceptibility to oncogenic virus or an inability to destroy mutant cells in an infant with congenital immunologic-deficiency syndrome.
RABIES: A RARE DISEASE BUT A SERIOUS PEDIATRIC PROBLEM
Authors: Cereghino James J. , Osterud Harold T. , Pinnas Jacob L. , Holmes Monroe A.
Published: December 2021

Human rabies encephalitis is of particular interest to the pediatrician in the United States since the highest incidence occurs in the under 15 age group. When a child has been exposed to wild or domestic animals, specific antirabic treatment must be considered. Factors to consider in establishing treatment include the health status and changes in the behavior of the biting animal, the extent and location of the bite, and the relative risk of infection in the involved species. Recommendations for immunization following exposure have been made by the World Health Organization Expert Committee on Rabies.

A case of human rabies encephalitis was imported to the United States from Egypt in 1967. The diagnosis was suspected but could not be confirmed antemortem. There are no readily available reliable tests for the diagnosis of rabies in the human prior to death.

The risk of obtaining rabies from a human contact may be small, but death is the only outcome if the disease is contracted. Screening of hospital personnel involved in the care of a human rabies patient revealed that isolation procedures had not eliminated possibility of exposure.

The value of rabies vaccines has been documented. Two forms of vaccine are presently available and others are in the experimental state. Antirabies serum is available for severely exposed individuals.
Quantitative Determination of Water-Soluble Proteins in Meconium
Authors: Rule Allyn H. , Baran Daniel T. , Shwachman Harry
Published: December 2021

A quantitative microcomplement fixation assay and quantitative protein determinations were used to determine albumin as a percentage of total soluble proteins in meconium. Significant differences (p < 0.001 ) were found between the meconium from infants who develop the symptoms of cystic fibrosis (CF) and between healthy siblings of known patients with CF or normal controls. No statistical differences were seen between newborn infants with CF requiring surgical intervention due to meconium ileus and those not requiring surgery.
Aortic Blood Pressure in the Normal Newborn: Hazards of the Umbilical Artery Catheter
Authors: Anderson Frederick P.
Published: December 2021

Although the authors of the study, "Aortic blood pressure in normal newborn infants during the first 12 hours of life" were sufficiently pleased with their results to recommend "that the aortic blood pressure be measured routinely in all infants who are apt to develop cardiopulmonary insufficiency and have indwelling umbilical arterial catheters," I feel obliged to raise two questions relative to its appropriateness and validity.

I am not aware that either premature labor and delivery (10 patients) , Premature twinnmg (2 patients), sibling with fatal RDS (3 patients) , or prolonged labor (2 patients) in and of itself constituted an indication for the employment of umbilical arterial catheterization.
TEACHING CHILD PSYCHIATRY TO PEDIATRICIANS
Authors: Marberg Hilde M.
Published: December 2021

The staff of a psychiatric outpatient clinic introduced two groups of pediatricians to child psychiatry in two differently organized programs. The course was divided into a theoretical part of lectures and case discussions and a practical part of examining children and their families. The main emphasis was laid on interview techniques, diagnosis, and preventive work. The aim of the program was to enable the pediatricians to detect and handle instances of incipient or slight psychologic disturbances in their pediatric clinics. The results were encouraging and justified the undertaking.
Prognosis of Childhood Leukemia
Authors: Pearson Howard A.
Published: December 2021

In his recent Commentary (Pediatrics, 45:191, 1970)on prognosis of childhood leukemia, the prime evidence cited by Dr. Holland to indicate significant improvement in survival due to vigorous antileukemic chemotherapy, is the performance of children in "Regimen D of AGLB, protocol 6601." He asserts "seventy-five percent of these children re alive at 24 months." The survival data plotted on his Figure 1 also indicate no deaths in the first year of therapy. These apparently remarkable therapeutic results become less impressive when the legend of Figure 1 is examined.
EVALUATION OF THE ROUTINE PHYSICAL EXAMINATION OF INFANTS IN THE FIRST YEAR OF LIFE: OBSERVATIONS
Authors: Yankauer Alfred
Published: December 2021

Studies of the kind Dr. Anderson has reported are important because of the issues they raise—issues that only time, social change and further study will finally resolve. The issues are both direct and indirect or inferential.

The direct issues apply only to young children who are receiving continuing comprehensive health care from a single medical source regardless of how the source is financed, and to the "routine" examination of such children to discover new somatic conditions in need of care. Dr. Anderson's findings challenge the rigidity of current American health supervision routines. They raise questions, not only about the extent to which other "examiners" can select (not diagnose or treat) children who require the pediatrician's special attention but also about the frequency, content and timing of such examinations, regardless of who carries them out.

The indirect issues are more sensitive and more difficult to deal with. They revolve around the questions which Dr. Webb has phrased so feelingly in terms that will be understood by many pediatricians: the nature of the pediatrician's expectations and the satisfactions he derives from his work; his ability to work with and through others rather than in simple one-to-one relationship; the numbers, training, and roles of other workers associated with him; the relative importance of "routine" physical examinations as compared to other aspects of his work; the acceptability of any change in routines to his patients; and the need to "sell" services in a competitive market subject to greater consumer control.

Statistical projections must always stumble over if's and but's.
Prognosis of Childhood Leukemia (Continued)
Authors: Stein R. C. , Ablin A. R. , Kushner J. A. , Zoger S.
Published: December 2021

Dr. Holland, in a lead Commentary, has been provided space to attack the position and data we presented in our letter to the Editor of Pediatrics. What the Editor referred to as our "modestly stated skepticism" has elicited a reply, which despite its vigor, fails to respond adequately to the basic issues raised: (1) that the public and medical profession are receiving overly optimistic assessments of survival in childhood leukemia, and (2) that convincing evidence regarding the superiority of aggressive multiple drug therapy is lacking.
Letter To The Editor
Authors: Turner J. A. Peter
Published: December 2021

Dr. Turner commented as follows:

With reference to the letter by Drs. Brickman, Beaudry, and Wise, I would reply that I agree in part with their declaration of the relative lack of infectivity of primary pulmonary tuberculosis. There also is little doubt that under therapy such infectivity may be quickly minimized.

One should, however, point out that, on the basis of the finding of tubercle bacilli in gastric washings, there is a potential for infection.
Cephalosporium Meningitis
Authors: Hughes Walter T.
Published: December 2021

I find it necessary to comment on the paper "Cephalosporium Meningitis" (Pediatrics, 44:749, 1969) in order to emphasize a word of caution to physicians who may encounter patients under circumstances similar to those described by Drs. Papadatos, Pavlatou, and Alexiou.

The patient reported was a newborn infant who on day 15 of life became irritable, listless, and refused feedings. In the absence of abnormal physical findings, the cerebrospinal fluid was examined and found to be slightly xanthochromic with 20 white blood cells per cu mm, and with normal chemical constituents.
Touchél
Authors: Brown George W.
Published: December 2021

The February issue of Pediatrics has a brief report concerning itching in juvenile rheumatoid arthritis, p. 296.

The Contents, the headline, and the article (12 times) spelled pruritus as pruritis. I guess the referee was a rheumatologist rather than a dermatologist. I note that the ad for CIBA Vioform (p. lii) spelled pruritus correctly.

Considering the usual punctiliousness of Pediatrics, this lapse is unusual. I wonder how many letters you will receive concerning this little matter.
CROSS RESISTANCE BETWEEN LINCOMYCIN AND ERYTHROMYCIN IN VIRIDANS STREPTOCOCCI
Authors: Sprunt Katherine , Leidy Grace , Redman Winifred
Published: December 2021

Twenty-four (67%) of 36 patients who received either lincomycin (L) or erythromycin (E) had oropharyngeal viridans streptococcal populations, appreciable proportions of which were resistant to one or both antibiotics. Viridans streptococci resistant to both antibiotics were demonstrated in 22 of the aforementioned 24 patients.

Studies of single colony isolates from the individuals with doubly resistant strains showed that a majority (15 of the 22 patients) carried streptococci resistant to 100 µg of erythromycin and 10 µg of lincomycin per milliliter. Clinical implications of these results are discussed.
INDIGENT NEGRO AND CAUCASIAN BIRTH WEIGHT-GESTATIONAL AGE TABLES
Authors: Freeman Malcolm G. , Graves William L. , Thompson Rita L.
Published: December 2021

Birth weight-gestational age tables have been calculated for 7,547 indigent Caucasian and 9,800 indigent Negro deliveries. Twin pregnancies, macerated stillborn fetuses, and incomplete cases were excluded.

The various collected data were tabulated by race and sex, and the 3rd, 5th, 10th, 25th, 40th, 50th, 60th, 75th, 90th, and 97th percentiles were determined. The 10th, 50th, and 90th percentiles are graphed. Ten standards for future birth weight-gestational age studies are suggested.
INDICATIONS FOR MECHANICAL VENTILATION IN INFANTS WITH HYALINE MEMBRANE DISEASE
Authors: Reynolds E. O.R.
Published: December 2021

One hundred and four infants with a diagnosis of hyaline membrane disease who weighed more than 1,000 gm at birth were admitted to the Neonatal Unit of University College Hospital during a period of 3 years. The management of the infants is described. Seventy-two infants survived without mechanical ventilation. The remaining 32 infants became apneic or collapsed with a heart rate of less than 80/minute, did not respond to simple resuscitative measures, and were mechanically ventilated; 7 of these 32 infants survived. Only one infant survived out of a total of 22 infants who became apneic within 24 hours of delivery. Six out of 10 infants survived when apnea occurred later than 24 hours after delivery. It is concluded that mechanical ventilation is unlikely to lead to the survival of the most severely affected infants, and that controlled trials of this form of treatment are both justifiable and desirable so that its effectiveness can be properly assessed.

Many infants with very severe abnormalities of gas exchange survived intact without needing mechanical ventilation. Therefore, it may be dangerous to select infants for mechanical ventilation on the basis of blood gas criteria because they may then be unnecessarily subjected to a potentially hazardous procedure.