bluuebunny/crossref_metadata_2025 huggingface dataset:
CARDIORESPIRATORY SYNDROME OF OBESITY (PICKWICKIAN SYNDROME) IN CHILDREN
Authors: Cayler Glen G. , Mays James , Riley Harris D.
Published: December 2021

The clinical, pulmonary and hemodynamic findings in two boys with the Pickwickian syndrome are presented. In contrast to adults with this syndrome, all four children thus far reported have been mentally retarded. Both of our cases were cyanotic, lethargic and in congestive heart failure at the time of admission. They both exhibited polycythemia, cardiac enlargement, electrocardiographic evidence of right atrial and right ventricular hypertrophy, decreased pulmonary function without evidence of obstructive pulmonary disease and pulmonary arterial hypertension. Symptoms of cardiorespiratory disease subsided following weight reduction. The pathophysiologic mechanisms of alveolar hypoventilation, pulmonary arterial hypertension, and congestive heart failure in patients with this disease complex are discussed. The clinical recognition of this syndrome is of practical importance because: 1) it is a preventable disease, 2) the changes are reversible following weight reduction and 3) because of the dangers of oxygen administration.
THE INFLUENCE OF THE NUMBER OF BREAST FEEDINGS ON MILK PRODUCTION
Authors: Egli G. E. , Egli N. S. , Newton Michael
Published: December 2021

Previous research on the relationship of the number of feedings of milk production was reviewed. Studies on animals and on women in early lactation and late lactation indicate that milk production increases when numbers of feedings are increased.

The present study concentrated on the middle period of lactation. The number of feedings was altered experimentally, and the resulting changes in milk production were observed. The subjects for the experiment were a breast feeding mother and baby 5½ months post-partum.

When the number of feedings and the total nursing time were decreased, significantly less milk was obtained by the baby. When the number of feedings and the total nursing time were again increased experimentally the amount of milk obtained by the baby did not change for 48 hours, but then rose to the control level observed at the beginning of the study.

The findings of this research support the previous observations in the field. Mothers who wish to increase their milk supply should be urged to feed their infants two or three extra times each day.
FAMILIAL ANORECTAL ANOMALIES
Authors: VanGelder D. W. , Kloepfer H. W.
Published: December 2021

A family is reported in which all four children, equally divided between the sexes, manifested anorectal anomalies ranging from an anorectal stenosis to a type III imperforate anus. There is no knowledge of similar anomalies in other relatives. It is suggested that in this family the anomaly could be caused by either an autosomal dominant or recessive gene.
THE ALDRICH SYNDROME
Authors: Kildeberg Poul
Published: December 2021

After a brief survey of our present knowledge of Aldrich's syndrome a case of this strange illness is reported. The clinical picture—with eczema, thrombocytopenic bleedings and recurrent infections–and the almost complete lack of natural isoagglutinin in the patient's serum conforms with the descriptions given by other authors. However, persistent distressing vomiting, at least partially due to a relative stenosis of the pyloric canal, was a prominent feature in our case. It was not possible to establish the sex-linked, recessive inheritance originally demonstrated by Aldrich et al.; in fact, no other members of the patient's family have with certainty suffered from the disease.

The possibility of an inborn error of immunoprotein metabolism is discussed, and the close genetic, clinical and serologic similarities in Aldrich's syndrome and various forms of congenital immunoparesis are emphasized. Analyses of the patient's proteins in serum, including immunoelectrophoresis disclosed a generalized hyperimmunoglobulinemia various abnormalities of the gamma globulins and an excess of three specific alpha2-globulins. The genetic serum type was found to be Gm(a÷).
CLINICAL MANIFESTATIONS OF DUPLICATION OF THE BOWEL
Authors: Mellish R. W. Paul , Koop C. Everett
Published: December 2021

Thirty-eight cases of duplication of the gastrointestinal tract are presented. The embryogenesis of duplications is briefly considered.

Duplications may arise at any point along the alimentary tract but are most frequent in the abdominal cavity. Heterotopia of the mucous membrane is often present. When acid secreting mucosa lines the lesion, hemorrhage or erosion may result. Anatomically, duplications can be classified into spherical or tubular forms. The spherical seldom communicate with the normal bowel lumen, whereas the latter may open into the intestine at some point.

The anatomic distribution, sex, racial incidence and age of onset are summarized.

Other visceral anomalies are frequently associated. Vertebral anomalies often are discovered with thoracic duplications.

Diverse symptoms and signs may lead to the finding of a duplication. In this series respiratory difficulty predominated in five patients, abdominal pain in six patients, an abdominal or anal mass in seven patients, an acute abdominal problem in seven patients and on ten occasions duplications were discovered when patients underwent investigations or operative procedures for other problems.

Thirty-six of the 38 patients had surgical procedures. Interference was deemed unnecessary in one patient. Among the 36 surgical cases, 35 survived and have had no susequent difficulties.

There were two deaths in infants with multiple anomalies, in whom the duplications was an incidental finding in one and a necropsy finding in the other.
THE EARLY SYMPTOMS OF PHENYLKETONURIA
Authors: Partington Michael W.
Published: December 2021

The early clinical histories of 36 patients with phenylketonuria were studied. It was found that more than half the patients had suffered from symptoms of one sort or another in the early weeks of life. These symptoms began months before any sign of mental defect was evident to the parents. The main symptoms found were vomiting (17 patients), irritability (12 patients) and infantile eczema (6 patients). Some patients had more than one symptom. Three children had pyloric stenosis.

The findings are discussed. It is suggested that in these patients vomiting and irritability in early life may be due to a "toxic" effect of phenylalanine or its derivatives on the brain. It is recommended that all infants having these symptoms, as well as those with infantile eczema, a peculiar smell, seizures, suspected or actual mental retardation or a retarded (or phenylketonuric) sibling, should be tested for phenylketonuria.
REPORT OF SUBCOMMITTEE ON ACCIDENTAL POISONING
Authors:   SUBCOMMITTEE ON ACCIDENTAL POISONING
Published: December 2021

LEAD INTOXICATION occurs most frequently in children between 1 and 3 years of age. (In the various series of cases reported in the literature approximately 85% of the cases were first diagnosed in the children in this age range.) For reasons not completely understood approximately 80% of symptomatic cases occur during the summer months. With rare exceptions children exhibiting clinical lead intoxication reside in the older sections of urban areas where they may have ready access to crumbling, peeling or easily chipped paint. Lead pigment paints were widely used for indoor painting until approximately 25 years ago. Lead pigments are still found in exterior paints, particularly those specified as mildew suppressants. Since the absorption of lead from the intestine proceeds slowly a child must nibble upon these flakes for several months before a quantity of lead sufficient to produce toxic manifestations is absorbed into the body. The child need ingest only a few chips each week; but if he continues this practice for longer than 3 to 6 months the clinical manifestations of lead intoxication to be described may occur thereafter, especially during the summer months. Although a history of pica may be a valuable question to ask in public health surveys, one must not overlook the possibility of pica even when it is denied. It is important for the clinician to realize that mothers may or may not observe their children eating a paint chip now and then. Even when they do see it they may not attribute much importance to the ingestion of the paint. If the clinician strongly suspects the possibility of lead poisoning he should proceed with the necessary laboratory diagnostic steps.
RELATION OF OPTIC NEURITIS TO MULTIPLE SCLEROSIS IN CHILDREN
Authors: Kennedy Charles , Carter Sidney
Published: December 2021

Eight children of a previously reported series of 30 with optic neuritis of unknown cause were found to have developed multiple sclerosis in variable periods after the episode of visual failure. The clinical findings are reported here in detail. There were no distinctive characteristics of the ocular findings to indicate those who would eventually show evidence of multiple sclerosis, although simultaneous bilateral involvement and papillitis would appear to be seen more frequently in the children than in the adults who later developed multiple sclerosis. Six of the eight children developed evidence of dissemination within a 2½-year period. In the other two, dissemination did not occur until 12 and 16 years later.
COMPARISON OF FLUOXYMESTERONE AND METHYLTESTERONE AS GROWTH STIMULANTS
Authors: Mellman William J. , Bongiovanni Alfred M. , Garrison Mortimer , Steiker Daniel D.
Published: December 2021

Fluoxymesterone was found to be comparable to methyltestosterone in accelerating growth of physically normal pre-adolescents in a short-term controlled study. Both androgenic agents accelerated bone age more than height age, although there was considerable variation within the study groups. Similar findings were observed in a group of normal children of short stature, who were given varying regimens of fluoxymesterone therapeutically, but in this series an occasional subject realized greater growth than advancement of epiphysial maturation. Under the conditions of this study fluoxymesterone has no clear advantage over other orally given androgens as a growth stimulant. It should be used with the same good judgment and reservation required of all androgens, lest the ultimate stature of some children be compromised. The many factors that may operate in determining the response to such agents are poorly defined at present.
SPECIAL ARTICLE
Authors: Goddard Katharine E. , Broder George , Wenar Charles
Published: December 2021

A study of reliability of elementary facts in the developmental histories of pediatric patients in a clinic population is reported. The results show that mothers do not report gestation time reliably, that many mothers are incorrect when they state that forceps were not used in the delivery, that few mothers can report accurately the immediate difficulties at the delivery of their infant. Feeding histories revealed many discrepancies in duration of nursing and knowledge of formula composition. Many mothers forget or overlook a significant number of illnesses. On the other hand, the mother's evaluation of difficulty of labor and delivery agrees with that of the physician; facts concerning weight at birth, and at subsequent yearly intervals, and details of motor development are reported with accuracy.

The significance of reliability is stressed in interpreting the relevance of factual developmental data to differential diagnosis in deviant behavior, perinatal studies, etc., and further areas of investigation of reliability are suggested.
TUBERCULIN SENSITIVITY IN CHILDREN INFECTED WITH MYCOBACTERIUM BALNEI
Authors: Schaefer Werner B. , Blatman Saul , Bravo Lydia
Published: December 2021

Of 56 children infected with Mycobacterium balnei, 48 had a positive intradermal tuberculin reaction to 0.1 mg of old tuberculin 18 months or more after the appearance of skin lesions. A tuberculin prepared from a strain of Myco. balnei also produced positive skin reactions in these children. The reactions to Myco. balnei tuberculin were not significantly different from those produced by the corresponding old tuberculin.
HUMAN BODY COMPOSITION
Authors:   Committee on Nutrition, Blumberg Richard W. , Forbes Gilbert B. , Fraser Donald , Hansen Arild E. , Smith Nathan J. , Sweeney Michael J. , Fomon Samuel J.
Published: December 2021

Although it is self-evident that the study of human nutrition has as its goal the optimal nutrition of man, the nutritional status of the body best suited to optimal performance, i.e., optimal nutrition, has unfortunately not yet been satisfactorily defined. Body composition of animals may be measured by direct chemical analysis and correlated with dietary intake and with the various aspects of performance; studies of body composition of living man, on the other hand, must rely on indirect measure ments.

The following two reports, which give an account of the current status of the attack on the difficult task of measuring body composition in living man, are sponsored by the Committee on Nutrition to call attention to the resurgence of effort in this field during recent years. A fuller knowledge of the gross composition of the human body and its relation to preceding diet will constitute a significant step towards realization of the ultimate goal of nutritional science. Even then, a particular body composition will be of importance primarily in terms of functional performance. The availability of newer techniques should do much to stimulate physicians and nutritionists in defining body composition as an essential step in arriving at a more exact definition of optimal nutrition.
IDIOPATHIC RETROPERITONEAL FIBROSIS
Authors: Farrer John , Peterson Carl G.
Published: December 2021

The first case of juvenile idiopathic retroperitoneal fibrosis is reported. The disease is a well-recognized entity characterized by nonspecific retroperitoneal inflammation and fibrosis of unknown etiology. Fibrotic involvement of the ureters frequently leads to hydronephrosis.
THALIDOMIDE AND PHOCOMELIA
Authors: Taussig Helen B.
Published: December 2021

THALIDOMIDE [alpha (N-phthalimido) glutarimide] is a synthetic drug with the structural formula shown in Figure 1. Thalidomide was invented by the firm of Chemie Grünenthal as a sedative, but when tested on animals was found to be ineffective. Chemie Grünenthal was, however, so certain that thalidomide must have some quieting effect on the central nervous system that it was then tested on man for its effect on epilepsy, and promptly reported to be useless as an anti-convulsant but an excellent sedative. By 1957, thalidomide, marketed under the trade-name of Contergan, was widely used as a sedative and for mental patients. It was considered "safe" to keep in the home because an overdose caused a sound sleep but never produced fatal poisoning. Thalidomide was added to other preparations for conditions where sedation would be beneficial, such as headaches (Algosedive, which is aspirin, phenacetin, and thalidomine), migraine, cough, asthma, gastrointestinal disturbances, grippe, arthralgia, and arthritis. A preparation with a small amount of thalidomide was sold as a tranquilizer.

The rights to market the drug were sold to a number of foreign pharmaceutical firms, and the drug was exported to many other countries. Thus, to my certain knowledge, more than a dozen preparations have been placed on the market in a minimum of 16 countries, excluding the United States, where it was distributed to over 1,000 physicians for investigation. Table I gives a list of these drugs which the author has been able to check. Evidence is steadily accumulating which indicates that both the number of preparations and the number of countries is far in excess of the above figures.
MULTIPLE ANTIGEN IMMUNIZATION OF INFANTS AGAINST POLIOMYELITIS, DIPHTHERIA, PERTUSSIS, AND TETANUS
Authors: Barrett Clarence D. , McLean I. William , Molner Joseph G. , Timm Eugene A. , Weiss Charles F.
Published: December 2021

This study was designed to determine the earliest age in infancy at which immunization against poliomyelitis, diphtheria, tetanus, and pertussis can be started using a multiple antigen containing component antigens against all four diseases. Subjects ranged in age from 1 day old through 6 months old at time of initial injection. All were given a series of four injections of 0.5 ml of DPT-polio antigen 4 weeks apart followed by a fifth dose (0.5 ml) of the same material 6 months later. A control group received 0.5 ml of a DPT antigen at monthly intervals for their first four doses, but were given a DPT-polio injection (0.5 ml) for their fifth dose.

Although it is evident that there is a progressive response in relation to age of the infant at time of initial inoculation, in respect to poliomyelitis and pertussis immunization, it was apparent that the capacity of the 3-month-old infant to respond to active immunization closely approximates that of the 6-month-old. Ninety per cent showed definite evidence of an immune response to all three poliovirus types despite extremely high levels of preprimary maternal antibody in the majority of 3-month-old infants under study.

Pertussis antibody response, as measured by agglutinin titers, was as good in the 3-month-old as in the 6-month-old infants. The response in the 2-month-old infants was relatively poor at the postprimary stage but was equivalent to that of the older infants at the postbooster interval. There was no indication that response to pertussis immunization was impaired by the inclusion of pertussis antigen in the quadrivalent antigen under study.

Diphtheria and tetanus antitoxin titers were excellent regardless of age at initial inoculation.

The results indicate that four doses of DPT-polio combined antigen given at monthly intervals will overcome the interference of high levels of maternal antibody in respect to poliomyelitis immunization and that the primary series of injections may be started as early as the third month of life. It is important, however, that this primary series of inoculations be followed by a booster dose of the same antigen preparation in about 6 months in order to reinforce the basic immunity.
NEONATAL THROMBOCYTOPENIC PURPURA
Authors: Anthony Bascom , Krivit William
Published: December 2021

Thrombocytopenia without other demonstrable disease has been recognized in 14 newborn infants of seven families at the University of Minnesota Hospitals. The majority of infants were born to mothers with chronic idiopathic thrombocytopenic purpura in states of activity, spontaneous remission, and post-splenectomy remission. All infants recovered without apparent sequellae. While a serious mortality is given in earlier reports, our experience and the literature of recent years indicate that this is usually a benign entity that requires no more vigorous management than careful, expectant observation.
INFLUENCE OF SIBLINGS ON STUDENT SMOKING PATTERNS
Authors: Salber Eva J. , MacMahon Brian , Harrison Sarah V.
Published: December 2021

Questionnaires on the smoking habits of school children, their parents, and their siblings were completed by 6,810 students (91%) in the public high school system of Newton, Massachusetts. Smokers tend to come from larger families than do nonsmokers. The larger sibship size results from smokers having more older siblings rather than more younger siblings. Frequency of smoking is much higher among children who are members of families in which there is an older sibling who smokes than among children of families where there are older siblings who do not smoke or where there are no older siblings. The risk of smoking to the index child does not vary with the sex of the older sibling to whom he is exposed. Older siblings who do not themselves smoke exert a slight deterrent effect on student smoking. These findings, together with earlier reports of the influence of parental smoking habits on the smoking patterns of children, are consistent with general concepts of the motivation of American (and perhaps all) teen-agers. They raise questions as to the advisability of health-education campaigns directed exclusively at children.
FAMILIAL PAROXYSMAL CHOREA-ATHETOSIS
Authors: Williams Jonathan , Stevens Harold
Published: December 2021

A patient with familial paroxysmal chorea-athetosis is described. Analysis of the sequential evolution and pattern of the involuntary movements was facilitated by study of movies taken during induced attacks. Attacks were evoked by having the patient sit immobile and then suddenly rise and walk briskly, and also by hyperventilation. Crossing of hen legs or other voluntary movements minimized the likelihood of an attack. Typically, there was no loss of consciousness, neurological findings were negative, and intellectual faculties were unimpaired. Brief, single, and limited movements of the legs were observed in our patient between attacks. This feature had not been described in the two prior reports of this rare hereditable syndrome. It is suggested that a metabolic defect may underlie the pathogenesis. Diphenylhydantoin (Dilantin) reduced the attacks, but not the leg movements.
PEDIATRIC CARDIOLOGY, AND THE SUB-BOARDS
Authors: NADAS ALEXANDER S.
Published: December 2021

MUCH HAS BEEN WRITTEN about the "crisis" in Pediatrics in recent years. The pages of this journal were filled at one time with discussions on the New Pediatrics, and still a sporadic Letter to the Editor reveals the soul-searching of a colleague. It may perhaps be timely to comment upon formal subspecialization, a type of New Pediatrics, representing a career opportunity for a limited number of physicians.

My remarks will obviously pertain principally to the Sub-board of Pediatric Cardiology, though I understand that they are more or less pertinent to the Allergy Sub-board as well.

The first question to be answered is, why is a Sub-board necessary?
ORIGIN OF THE LEFT CORONARY ARTERY FROM THE PULMONARY ARTERY WITHOUT COLLATERAL CIRCULATION
Authors: Armer Robert M. , Shumacker Harris B. , Lurie Paul R. , Fisch Charles
Published: December 2021

A 4-month-old infant with repeated painful shock-like episodes was shown by the progression of electrocardiographic findings to have coronary insufficiency and finally a myocardial infarction. Selective cineangio-cardiography demonstrated anomalous origin of the left coronary artery from the main pulmonary artery with flow from the pulmonary artery to the myocardium. Preparations for surgical transplantation to the aorta were being made when the infant died. The feasibility of the proposed operation was demonstrated post mortem. A segment of the main pulmonary artery was excised with the coronary ostium at its base and converted into a tube which was anastomosed to the aorta. The defect in the pulmonary artery was repaired with a patch graft of Dacron.
INTRAUTERINE GROWTH AS ESTIMATED FROM LIVEBORN BIRTH-WEIGHT DATA AT 24 TO 42 WEEKS OF GESTATION
Authors: Lubchenco Lula O. , Hansman Charlotte , Dressler Marion , Boyd Edith
Published: December 2021

Percentile curves representing intrauterine growth of Caucasian infants in Colorado are constructed from the birthweights of liveborn infants at gestational ages ranging from 24 to 42 weeks. The median weights of Colorado babies were found to be lower at 40 weeks of gestation than the national median, and mean weights at 40 and 42 weeks were lower than those given by other authors. The use of the intrauterine growth chart in studying the nutrition of babies at birth and during their postnatal growth period has been described.
THE EARLY MOTHER-INFANT ADJUSTMENT
Authors: Brazelton T. Berry
Published: December 2021

The ability of the physician to evaluate and predict the individual innate capacities of an infant for interaction with his environment can be blended with an understanding of the mother to effect a positive start in the mother-infant relationship. The psychological adjustments required of a new mother and the psychophysiological homeostatic mechanisms of the baby's first week offer the pediatrician opportunities for important observation and effective assistance. Two cases serve to demonstrate divergent reactions between mothers and their new babies, as they adjust to each other. The recognition of the role each of the participants plays in this first adjustment becomes important to the pediatrician in his efforts to strengthen a positive mother-infant relationship.
REDUCTION OF MORTALITY FROM RESPIRATORY DISTRESS SYNDROME OF PREMATURITY WITH EARLY ADMINISTRATION OF INTRAVENOUS GLUCOSE AND SODIUM BICARBONATE
Authors: Usher Robert
Published: December 2021

In a controlled series evaluation of early administration of intravenous glucose and sodium bicarbonate, the mortality rate among 35 treated premature infants with respiratory distress syndrome was 17%, while among 35 controls it was 37% (p = 0.06). The mortality rate was similarly reduced among the total number of premature infants who have been treated by the author for this condition over the past five years: 24/118, or 20%, mortality with early intravenous therapy versus 38/94, or 42%, mortality with conventional therapy (p<0.01). Intravenous therapy had little or no effect in premature infants weighing less than 1,500 gm.

With this therapy for respiratory distress syndrome, the mortality rate among 736 premature infants consecutively delivered at two hospitals was exceptionally low—5.7% of infants weighing 1,001 to 2,500 gm.

There was no evidence that the therapy operated to reduce mortality by lessening the respiratory distress process, which was equally severe among treated and untreated infants. The fluids administered to these infants did not produce heart failure or fluid overload. Sudden collapse which may have been due to reactive hypoglycemia sometimes resulted, however, when intravenous therapy was stopped before the infant was receiving adequate enteral feedings.

It is concluded that early administration of intravenous glucose and sodium bicarbonate to premature infants with respiratory distress (hyaline membrane) syndrome can reduce the mortality rate by two-thirds among those who weigh more than 1,500 gm.
AUTONOMIC FUNCTION IN THE NEONATE
Authors: Lipton Earle L. , Steinschneider Alfred , Richmond Julius B.
Published: December 2021

Forty-two babies under 5 days of age were observed for prolonged periods in a laboratory with instruments which markedly facilitate detection of cardiac rate and respiratory changes. Many newborn infants often manifest remarkable cardiac slowing associated with such diverse activities as hiccups, yawning, and defecation. The nasogastric intubation of premature infants has, at times, been followed by abrupt bradycardia. Sinus arrhythmia is a frequent occurrence. These seemingly diverse observations have implications for developmental physiology and may be relevant to some pathologic conditions unique to this period of life.
ECHO II OUTBREAK IN NEWBORN INFANTS AND MOTHERS
Authors: Berkovich Sumner , Kibrick Sidney
Published: December 2021

A late summer outbreak of illness involving newborn infants and mothers is described. Seven infants and five mothers were studied. Although three enterovirus types were recovered from the infants, the outbreak was associated with infection by a variant of ECHO 11. Clinical signs included fever, diarrhea, upper respiratory disease, and aseptic meningitis. In three infants the antibody response significantly exceeded that of the mother. The evidence for an etiologic association of ECHO 11 infection with disease is reviewed.
THE COEXISTENCE OF SICKLE CELL DISEASE AND CONGENITAL HEART DISEASE: A REPORT OF THREE CASES, WITH REPAIR UNDER CARDIO-PULMONARY BY-PASS IN TWO
Authors: Harris Leonard C. , Haggard Mary Ellen , Travis Luther B.
Published: December 2021

Sickle cell disease, characterized by protean manifestations, has been confused frequently with rheumatic fever and congenital heart disease. Though it has been described in combination with rheumatic mitral stenosis, little on no consideration has been given to the association of sickle cell disease with congenital heart disease. This communication describes the occurrence of hemoglobin S disease in combination with congenital heart disease in three patients, the lesions being an atrial septal defect of the secundum type in one and pulmonary stenosis in two other patients. The congenital cardiac abnormalities were repaired under cardiopulmonary by-pass in the case of atrio-septal defect and the more severe case of pulmonary stenosis. Preparation for surgery consisted in the suppression of hemoglobin S formation by blood transfusions. During cardiopulmonary by-pass, further dilution of the hemoglobin S cells occurred so that their concentration in the patients' blood was negligible. Following surgery, it was necessary to administer greater amounts of intravenous fluid than usual to allow for the reduced ability to concentrate urine. Convalescence was unremarkable in each case.
GROWTH OF "WELL-BORN" AMERICAN INFANTS FED HUMAN AND COW'S MILK
Authors: Jackson Robert L. , Westerfeld Roy , Flynn Margaret A. , Kimball E. Robbins , Lewis Ray B.
Published: December 2021

Weight and length of 599 well-born, healthy infants were recorded from birth through six months of age. Two hundred ninety-three (293) of the infants were breast fed and 306 were artificially fed; 57 of the breast-fed boys and 32 of the breastfed girls were observed for one year. Variations in feeding patterns were recorded to evaluate the effects of such variations on growth. The consistency and predictability of growth in length of normal infants is emphasized. The aggregate growth curves of the total 599 infants are similar to the Iowa Growth norms of 1945. They differ in that, compared to the Iowa norms, the girls are slightly taller, and after the second month of life, the boys' weight gain is somewhat less. More worldwide effort to collect accurate weight and length values for healthy, well-born infants given optimum care is needed to establish normal growth standards for various ethnic groups living in different areas of the world.
Corticosteroid Treatment of Croup
Authors: EDEN ALVIN N. , LARKIN VINCENT DE PAUL
Published: December 2021

The value of corticosteroids in the treatment of acute croup has not been clearly established. Martensson et al., Novik, and Coffin have claimed that the course of the disease has been shortened while Leegaard and Turner and Morgan do not feel that the corticosteroids affect its course. The review by Hawkins allowed no conclusions. To resolve this question, a double blind study was conducted on a random sampling of fifty (50) hospital cases of acute croup.

Materials and Methods

Fifty patients were admitted to the hospital for the treatment of acute "croup." All patients with acute respiratory infections characterized by hoarseness, inspiratory stridor, and a barking cough were included.
RECURRENT VENTRICULAR TACHYCARDIA IN AN INFANT—USE OF HIGH VOLTAGE DC SHOCK THERAPY IN MANAGEMENT
Authors: Canent Ramon V. , Spach Madison S. , Morris James J. , London Will L.
Published: December 2021

The case of a 17-month-old infant with ventricular tachycardia has been presented. The diagnosis was confirmed by esophageal and right atrial electrocardiography. No cardiac abnormalities were demonstrated by bilane angiocardiography. Quinidine and steroid therapy were effective temporarily for conversion to normal sinus rhythm. Gradually, conversion became more difficult and sustained ventricular tachycardia became refractory to drug therapy. A Lown Cardioverter was employed with a single countershock discharge of 8 to 15 watt seconds (1,000 to 1,370 volts). The shock was electronically timed to occur at the peak of the QRS complex to avoid the vulnerable period of the cardiac cycle (T-wave), wherein the shock may initiate ventricular fibrillation. Normal sinus rhythm was established on five occasions with the administration of a single shock. Following this therapy, the patient remained well and maintained a normal sinus rhythm for ten months while on Quinaglute duratabs® and reserpine.
THE PLATELETS IN IRON-DEFICIENCY ANEMIA. I. THE RESPONSE TO ORAL AND PARENTERAL IRON
Authors: Gross Samuel , Keefer Vicki , Newman Arthur J.
Published: December 2021

In summary, it appears that thrombocytosis frequently accompanies the less severe anemia of iron deficiency and may be related to platelet stimulation in a manner analogous to the erythropoietin increase seen in many of the anemic states. In some of the severely anemic individuals, thrombopenia has been observed related suggestively to several factors, including severe depletion of iron as iron enzymes, a folate deficiency or a transient thrombopoietin deficit. In order to determine with any degree of certainty the etiology of the thrombocytopenia, one would have to evaluate the platelet response in a similarly afflicted group of infants treated with folic acid or simply thrombopoietin rich plasma prior to iron therapy. In regard to the intriguing difference in the platelet response to oral and parenteral iron, subsequent studies, using either extremely small amounts of parenteral iron or large amounts of oral iron, regardless of the initial platelet and hemoglobin values, might cast light on the etiology of this occurrence.
STUDIES OF SUSTAINED HYPONATREMIA DUE TO CENTRAL NERVOUS SYSTEM INFECTION
Authors: Mangos John A. , Lobeck Charles C.
Published: December 2021

Studies are reported on a 19-month-old boy with hydrocephalus and severe central nervous system infection, who developed sustained hyponatremia and water intoxication with maximally concentrated urine, urinary sodium loss, and no clinical signs of contraction of the extracellular fluid volume. Inappropriate secretion of antidiuretic hormone was postulated as the cause of this syndrome. The increased levels of antidiuretic activity in the plasma, its suppression after ethanol administration, and failure to dilute the urine after a water load confirmed this contention. Though the neurohypophysis was not sensitive to changes in plasma osmolality, the mechanism of suppression of the secretion of antidiuretic hormone in response to an acute expansion of the extracellular fluid volume was intact. After water loads ethanol administration invariably caused water diuresis. The hyponatremia was corrected by a regime of restricted water intake and increased sodium intake. However, the child recovered from this syndrome only with proper treatment of his central nervous system infection.
V. FORCED FLOW RATES
Authors: DeMuth George R. , Howatt William F. , Hill Bruce
Published: December 2021

1. Data from normal subjects on the peak expiratory flow rate, the peak inspiratory flow rate, and the flow rate at the point where half the vital capacity has been expired (E50), have been obtained as part of a longitudinal study of the growth of lung function in school children.

2. The peak flow rates grow in a manner similar to that of the lung volumes.

3. The E50, in contradistinction, grows in a manner similar to airway conductance (the reciprocal of airway resistance).

4. Longitudinal studies of the peak flow rates indicate that individuals tend to maintain their positions in relation to the group.

5. A theoretical postulation of the forced flow-volume relationship has been suggested. According to this postulation the lungs of the normal subject empty as a unit or nearly so. The flow (after the initial acceleration) at any point in time is dependent on his vital capacity and an emptying factor. This emptying factor decreases somewhat with increasing body size. This is more evident in the girls.

6. In the patient with airway obstructive disease (as asthma) the lung can be thought of as composed of multiple units in parallel with varying amounts of reduction in their emptying factor.

7. The theoretical advantages of clinical tests based upon flow in the mid or later portions of the forced expiration have been given.
THE FAMILY HISTORY OF SPINA BIFIDA CYSTICA
Authors: Lorber John
Published: December 2021

1. The family histories of 722 infants who were born with spina bifida cystica were studied.

2. The index cases were referred for surgical treatment and were not selected in any way from the genetic point of view.

3. Intensive inquiries were made to obtain a complete family pedigree, including a prospective follow-up of siblings born after the index case.

4. Of 1,256 siblings 85 or 6.8% had gross malformation of the central nervous system: spina bifida cystica in 54, anencephaly in 22, and uncomplicated hydrocephalus in 9.

5. Of 306 children born after the index case 25 (8%) or 1 in 12 were affected.

6. There was a progressive increase in multiple cases in the family with increasing family size. In sibships of five or more, multiple cases occurred in 24.1%.

7. In 118 families cases of gross malformation of the central nervous system were known to have occurred among members of the family other than siblings. Cases occurred in three generations.

8. It is possible that spina bifida cystica might be a recessively inherited condition.
RENAL RADIOLOGIC CHANGES IN SICKLE CELL ANEMIA
Authors: Plunket Daniel C. , Leiken Sanford L. , LoPresti Joseph M.
Published: December 2021

Excretory urography in 18 children with sickle cell anemia revealed a high incidence of renal enlargement and collecting system deformity. Sterile pyuria and modest elevations of blood urea nitrogen were less common findings. With one exception none of the patients had histories of genitourinary symptoms or signs.

It is probable that the majority of kidney damage in sickle cell states, including the changes noted here, is the result of intravascular sickling in the renal medulla. The findings herein reported emphasize that gross medullary damage is not necessarily attended by genitourinary signs in sickle cell disease.
INFANTS OF DIABETIC MOTHERS: A QUANTITATIVE, MORPHOLOGIC STUDY
Authors: Naeye Richard L.
Published: December 2021

A quantitative morphologic study has been made of organ composition in infants with diabetic mothers. Cellular hyperplasia and hypertrophy were responsible for the organ enlargement observed in 21 overweight infants. This abnormal growth is most easily attributable to fetal hyperinsulinism. Four underweight infants had anatomic evidences of prenatal malnutrition. Infants in both groups had some evidences of hyperadrenocorticism.
ACUTE RESPIRATORY DISEASE IN INFANCY AND CHILDHOOD: PRESENT UNDERSTANDING AND PROSPECTS FOR PREVENTION
Authors: Chanock Robert M. , Parrott Robert H.
Published: December 2021

DURING the past ten years there has been an exponential increase in our understanding of the etiology and epidemiology of acute respiratory disease. Unfortunately development of the means for control of these illnesses has not kept pace with etiologic or epidemiologic understanding. In this presentation an attempt will he made to summarize the role of a number of viruses and mycoplasmas in acute respiratory disease of infancy and childhood. In addition the ecology of such infections will be discussed, particularly those aspects of infection which have relevance to the problem of immunoprophylaxis.

Much of the information to be discussed is derived from studies at the Children's Hospital of D.C. and the Junior Village Welfare Nursery of D.C. In many instances similar findings have been reported from other localities so that the conclusions which can be drawn from the Washington, D.C., studies would appear to have more than local significance. Since the Washington D.C., studies represent the longest continuous inquiry into the nature of acute pediatric respiratory disease primary emphasis will be placed on the interpretation of these findings.

Bacteria

Although group A beta hemolytic streptococci play an important role in upper respiratory tract disease it would appear that these organisms are relatively unimportant in the more serious types of illness in which lower respiratory tract involvement occurs. The careful studies of Babe, Beem, and co-workers indicate that pathogenic bacteria are not important primary etiologic agents in lower respiratory tract disease of infancy and childhood. For this reason major emphasis in this presentation will be given to the role of viruses and mycoplasmas in respiratory disease.
HEAD CIRCUMFERENCE, MENTAL RETARDATION, AND GROWTH FAILURE
Authors: O'Connell Edward J. , Feldt Robert H. , Stickler Gunnar B.
Published: December 2021

The purpose of this study was to re-affirm our clinical impression that non-institutionalized children whose head circumference was below minus 2 standard deviations were mentally subnormal and frequently had growth failure. A group of 134 children with a head circumference below minus 2 standard deviations from the mean were studied, and all but one were mentally subnormal. The most severe mental retardation was noted in the group of children with a head circumference of minus 4 standard deviations or below. We found, as have others, that children with mental retardation have height and weights below the expected norm and that children with a head circumference below minus 2 standard deviations have even lower mean heights and weights.

The head circumference of 31 children with growth failure and normal intelligence was normal for age and sex, therefore disproving the concept that the abnormally small child has a proportionally small head. In the child with growth failure, should the head be proportionally small (below minus 2 standard deviations), mental subnormality should be suspected.

We feel that the head circumference measurement has taken on new clinical significance in that our data support its use in suspecting the association of mental subnormality in children with growth failure and a head circumference of below minus 2 standard deviations from the mean for age and sex.
PRIMARY PULMONARY VASCULAR OBSTRUCTION IN CHILDREN
Authors: Thilenius Otto G. , Nadas Alexander S. , Jockin Hubert
Published: December 2021

1. Nine patients with primary pulmonary vascular obstruction observed at the Children's Hospital Medical Center between 1953 and 1963 are presented.

2. The clinical profile is quite uniform and corresponds well with the 26 pediatric patients reported in the literature. Symptoms begin predominately under 3 years of age and consist principally of consequences of low cardiac output, including fatigue, dyspnea on exertion, and syncope. Signs are those of pulmonary artery hypertension leading to right-sided congestive failure. Death, often instantaneous, occurs usually within 1 year after onset of symptoms.

3. Findings at cardiac catheterization consist of pulmonary artery hypertension (exceeding systemic pressures), low cardiac output, pulmonary vascular obstruction, and a normal pulmonary capillary mean pressure. There are no left to right shunts present; a small right to left shunt at the atrial level (patent foramen ovale at autopsy was seen once.

4. Etiologic clues were not discovered. Detailed family histories are compatible with the possibility of a recessive trait. Familial incidence is reported.

5. No effective therapy is available.
Pharmacology of Respiratory Distress
Authors: DIAMOND EUGENE F. , DEYOUNG VERNON R.
Published: December 2021

We found the "Preliminary Report on the Pulmonary Hypoperfusion Syndrome" by Chu, et al. (Pediatrics 35:733) a most erudite and provocative approach to better understanding of neonatal respiratory distress.

We were particularly interested in the use of acetyl choline to dilate the pulmonary vessels. Although the authors used only acetyl choline, oxygen, and sodium bicarbonate to relieve vasoconstriction, they suggest that "it may be that another cholinergic, antiadrenergic, or gangliono-plegic drug will be more convenient and successful."
EVALUATION OF A PROPHYLACTIC AND THERAPEUTIC PROGRAM FOR PATIENTS WITH CYSTIC FIBROSIS
Authors: Doershuk Carl F. , Matthews LeRoy W. , Tucker Arthur S. , Spector Samuel
Published: December 2021

Data has been presented in support of the prophylactic utilization of a comprehensive therapeutic program for patients with cystic fibrosis. Ninety-eight consecutive patients have been followed for 3 to 7 years (average 4½ years). The course of the disease as shown by the clinical evaluations of General Activity, Physical Examination of the Chest, Nutrition, and Chest X-ray for the 49 of these patients considered to be on prophylactic therapy has been significantly different from the accepted natural course of the disease and from that of the 49 patients who had irreversible pulmonary damage when first seen. Objective data collected on these patients including growth and weight changes, morbidity and mortality experience, and pulmonary function studies showed good correlation with the clinical evaluations. No evidence of significant progression in the pulmonary lesion was observed by any criteria for the prophylactically treated group. Indeed, mean pulmonary function test results for these patients were well within the range of normal values even at the end of the average 4½-year follow-up period at an average age of 7 years. No deaths occurred in this group. The mortality rate of only 2% per year of follow-up, with no deaths under 6 years of age, for the entire group of 98 patients indicates the over-all effectiveness of the therapeutic program. This study supports the need for early diagnosis and the prophylactic approach to treatment.
An Unusual Cause of Bromidrosis
Authors: GOLDING IRVIN M.
Published: December 2021

Bromidrosis or osmidrosis is the term which denotes a malodrous condition of human perspiration. It is usually a local condition, but may be generalized. The most commonly encountered form of local bromidrosis results from the decomposition of organic matter on the skin surface via the enzymatic action of certain bacteria and/or fungi which thrive in the. presence of sweat. This decomposition alters the constituents of sweat, the lipids of the sebum, and the protein components of hydrated keratin.

Generalized bromidrosis may have a variety of causes. It may come about due to substances present in the native sweat, or it may be "idiopathic" and caused by certain substances which normally are not present in the sweat or at best in small quantities.
BREAST-FEEDING IN BOSTON
Authors: Salber Eva J. , Feinleib Manning
Published: December 2021

Incidence of breast-feeding has been examined in 2,233 women who gave birth to babies in hospitals in Boston, Brookline, and Newton in August or September, 1963. Information on breast-feeding was obtained from the mothers by mailed questionnaires and by telephone.

Twenty-two per cent of the mothers attempted breast-feeding. Five per cent of the total population breast-fed their babies for 6 months or more.

Sex and birth weight of babies do not affect frequency of breast-feeding.

Social class is found to be the most important variable affecting incidence of breast feeding. Women who are married to students exhibit the highest incidence of breast-feeding (69.3%). Upper social class women breast-feed more frequently (39.8%) than women in lower social classes (13.6%). Students do not show any variation in breast-feeding patterns by age of mother, parity, or birthplace, but these variables do influence the breast-feeding patterns of women in other social classes.
DIAGNOSIS AND MANAGEMENT: CONGENITAL RUBELLA
Authors: Cooper Louis Z. , Krugman Saul
Published: December 2021

Studies on the natural history and course of congenital rubella are currently in progress in various pediatric centers in the United States. Long term observation of many infants with this disease should clarify many of the problems difficult to cope with today. When additional information becomes available, a more definitive report on diagnosis and treatment may be indicated. The final solution of the rubella problem is dependent upon the development of a safe and effective vaccine.
Diphenylhydantoin Toxicity; Lymphadenopathy and Low Platelet Count
Authors: LAURIAULT CLAUDE D. , JIM ROBERT T.S.
Published: December 2021

DPH, an anticonvulsant in use for over 20 years, may cause adverse reactions in some persons. A 15-year-old male developed lymphadenopathy and a low platelet count while on Dilantin. Both of these responded when this medication was discontinued. The responsibilities of the prescribing physician in regard to the complications of his therapy are discussed.