bluuebunny/crossref_metadata_2025 huggingface dataset:
INCIDENCE OF HYPOGLYCEMIA IN NEWBORN INFANTS CLASSIFIED BY BIRTH WEIGHT AND GESTATIONAL AGE
Authors: Lubchenco Lula O. , Bard Harry
Published: December 2021

The incidence of hypoglycemia was determined in newborn infants in a general obstetric service.

A random sample of patients was studied from nine birth weight-gestational age groups before the first feeding at 3 to 6 hours after birth. The highest incidence of hypoglycemia, 67% (serum glucose level < 30 mg/100 ml), occurred in the preterm SGA group. It was 25% in the term SGA infants and 18% in post-term SGA babies. Full term appropriately grown infants were noted to have a 10% incidence, and the preterm AGA group had a general shift toward lower prefeeding glucose levels. Infants of diabetic mothers were generally large for gestational age and delivered before term; hence, there was a 38% incidence of hypoglycemia in the preterm LGA group. When a serum glucose level of < 20 mg/100 ml was used to define hypoglycemia, the incidence in the preterm SGA groups was least reduced, i.e., to 40 and 21% respectively.

Except for IDM's, evidence of intra-uterine growth retardation from the physical examination and confirmed by the weight/length ratio was demonstrated in infants who became hypoglycemic.

An added stress in the form of birth hypoxia was present in the majority of the infants who became hypoglycemic. The combination of reduced energy reserves in newborn infants with intra-uterine growth retardation, plus the increased utilization of carbohydrates during birth hypoxia, resulted in a high incidence of neonatal hypoglycemia in the first few hours after birth.
SMITH-LEMLI-OPITZ SYNDROME WITH CARDIOVASCULAR ABNORMALITY
Authors: Robinson Carl D. , Perry Lowell W. , Barlee Amnat , Mella Gordon W.
Published: December 2021

Smith, Lemli, and Opitz in 1964 described in three unrelated male children a syndrome consisting of failure to thrive, mental retardation, microcephaly, disorders of the neuromuscular system, typical facies with anteverted nares, micrognathia, broad maxillary ridge, and low set ears. Over 95% of males with the syndrome have hypospadias with or without cryptorchidism. Females have normal genitalia. Cutaneous syndactyly of the second and third toes commonly occurs. Chromosome karyotype is normal. The present case represents the fortieth to be reported. Of the 40 reported cases, eight or 20% had congenital heart disease which would appear to be emerging as a common feature of the syndrome. No specific cardiac lesion is predominantly seen.
IgE LEVELS IN SERA OF CHILDREN WITH ASTHMA
Authors: Kumar Lata , Newcomb Richard W. , Ishizaka Kimishige , Middleton Elliott , Hornbrook Margaret M.
Published: December 2021

Concentrations of the immunoglobulin that is associated with reaginic activity, IgE (γE), were measured in sera of 116 children with bronchial asthma. High γE (>700 ng/ml) were found in only 30. High γE levels were found in children with many positive skin tests (P < 0.01) and with active atopic dermatitis (P < 0.01). Long term, systemic corticosteroid therapy was found to be associated with normal γE values (P < .001) even when the characteristics of the disease would otherwise have indicated high values.

As no correlation is found to be evident between severity of the disease and γE levels, it may be suggested that corticosteroids may decrease intravascular γE. The serum γE values failed to reveal two or more clinically different groups among our patients.
Calcium Deficiency Rickets?: Fanconi Syndrome?
Authors: Fareau Gerard , Holliday Malcolm A.
Published: December 2021

With regard to the article1 by Drs. Maltz, Fish, and Holliday in the December, 1970, issue, it seems to me that a child who keeps having severe diarrhea on regular feedings and improves on a milk substitute diet is probably suffering from cow's milk allergy. The fact that the patient tolerated cow's milk at 13 months of age does not rule this out. I would also like to point out that all the clinical, laboratory, and x-ray findings described by the authors are those of Vitamin D deficiency rickets.
THE XYLOSE EXCRETION TEST IN NORMAL CHILDREN AND IN PEDIATRIC PATIENTS WITH TROPICAL SPRUE
Authors: Santiago-Borrero Pedro J. , Santini Rafael , Maldonado Norman
Published: December 2021

The 5-hour urinary xylose excretion test was performed in 158 normal Puerto Rican school children 2½ to 13 years of age after the administration of a 5 gm oral dose of D-xylose. The values ranged from 0.7 to 2.3 gm with a mean of 1.44 gm and a standard deviation of ± 0.35 gm. Seven children excreted 0.9 gm or less (18% of the oral dose), which was the upper limit of excretion by the patients with untreated tropical sprue. All except one of the values below 1.0 gm occurred in children less than 6½ years of age.

Thirty children with proven untreated tropical sprue showed a range of 0.2 to 0.9 gm, with a mean of 0.54 gm and a standard deviation of ± 0.20 gm Seventeen patients with tropical sprue treated for 6 months to 2 years showed a xylose excretion of 1.0 to 2.3 gm with a mean of 1.48 gm and a standard deviation of ± 0.36 gm. The lowest value obtained in this group, 1.0 gm, is higher than the seven lowest values in the control group. Our study confirms that the xylose excretion test is a simple and very reliable test of intestinal absorption. It is very useful as a screening test for the diagnosis of tropical sprue and in the follow up of treated patients.
THE DANGER OF PUTTING A BABY TO BED IN A LARGE BED
Authors: C. T. E.
Published: December 2021

Sarah Brown writing in 1779 in her pamphlet entitled A Letter to a Lady on the Management of the Infant gives the following vivid account of her sleeping infant's narrow escape from mechanical suffocation.

I sincerely hope no child will ever experience the like narrow escape of being suffocated as one of mine did when 6 weeks old. I went to spend the day with a friend in the country and took my youngest girl and my infant with me. The evening proving wet we stayed all night and, not having a servant with me, I got up early in the morning to dress my child whom I had suckled and put to sleep on the bed; but being used to a cradle I forgot to pin him to the pillow. While I dressed his sister I desired a little boy who was standing by me to go and listen whether the baby cried. He brought me word that it was fast asleep. I then took the opportunity of dressing myself for the day, during which time I desired my little girl to go and look at her brother; who returned and informed me she could not see him but heard him cry very faintly. I instantly went into the room and to my great surprise found the child at the very bottom of the bed. He had cried till he was almost dead and sweat dropped off him fast. . . . To all appearance at this time the child seemed dead and every one about me pronounced he was quite gone.
NEWBORN URINARY CYCLIC AMP AND DEVELOPMENTAL RENAL RESPONSIVENESS TO PARATHYROID HORMONE
Authors: Linarelli Louie G. , Bobik John , Bobik Caroline
Published: December 2021

Since the renal action of parathyroid hormone is known to be mediated via 3',5'-adenosine monophosphate (cyclic AMP), urinary cyclic AMP studies were used to determine proximal tubular maturation. Ten formula fed full-term male infants showed a thirty- to sixtyfold increase in phosphate clearance and excretion with a three- to fourfold increase in urinary cyclic AMP comparing their first and third day 24-hour urines (2.37 ± 0.41 to 6.93 ± 0.96 Nm/mg creatinine M. ± S.E.M. first and third days respectively). Seven breast-fed infants showed cyclic AMP excretion of 3.6 ± 0.3 S.E.M. and 6.5 ± 0.3 S.E.M. on Day 1 and Day 3 respectively, showing an insignificant difference to the formula-fed infants. An additional 10 formula-fed infants 5 to 10 days of age excreted 7.0 ± 0.9 S.E.M. Nm/mg of creatinine which is comparable to the 3 to 4 days of age group. The threefold increase in cyclic AMP after the first day of life may possibly reflect increasing parathyroid renal responsiveness. One- and 3-day-old infants and adults were given a 1-hour parathyroid (PTH) infusion (5 U/kg/hr) with measurement of urinary cyclic AMP in time periods before and after the infusions. Peak increases in responses from baseline of cyclic AMP were 1.64 ± 0.34, 7.1 ± 1.5, and 36.0 ± 0.73 Nm/mg of creatinine M. ± range on first day, third day, and in adults respectively with similar relationships of increasing phosphate excretion. Thus, there is most likely a maturational renal proximal tubular responsiveness to PTH on the cellular cyclic AMP level.
Congenital Thyrotoxicosis With Paroxysmal Atrial Tachycardia
Authors: Riopel Donald A. , Mullins Charles E.
Published: December 2021

A case of a neonate is presented who was referred because of heart failure and paroxysmal atrial tachycardia and who subsequently was found to have congenital thyrotoxicosis. The arrhythmia was easily treated with Digitoxin. However, a labile heart rate continued until his LATS level was normal. This is the first known reported case of paroxysmal atrial tachycardia associated with congenital thyrotoxicosis.
Reversible Neutrophil Defect in Ataxia Telangiectasia
Authors: Kretschmer R. R. , Osuna M. Lopez , Valenzuela R. H.
Published: December 2021

Ataxia telangiectasia is a complex syndrome characterized by cerebellar ataxia, oculocutaneous telangiectasias, and frequent sinopulmonary infections. The pathogenesis of this condition remains unknown, but the increased susceptibility to infections has been related to IgA and IgE deficiency, as well as to faulty cellular immunity. According to the W.H.O. classification of primary immunodeficient disorders, both B-cells (Bursal) and T-cells (Thymic) are defective in this syndrome. Recently, Feigin, et al. described a case of ataxia telangiectasia associated with granulocytopenia. We would like to report a case of ataxia telangiectasia where a reversible, apparently intrinsic, neutrophil defect was detected along with some of the immune defects that usually accompany this syndrome.
A Complicated Case of Congenital Vaccinia
Authors: Harley J. D. , Gillespie Ailsa M.
Published: December 2021

A case of congenital vaccinia is described, notable for the complications of scarring of an eyelid, choroiditis with destruction of the macula of the other eye, and hypoplastic bone changes, despite relatively mild skin involvement and good progress during childhood. It is suggested that further attention be paid to the possibility that relatively mild stigmata may result from prenatal vaccination, particularly after the first trimester.
An Investigation of the Efficacy of the Frostig Program for the Development of Visual Perception
Authors: Bishop John S. , Gayton William F. , Bassett John E.
Published: December 2021

In recent years there has been increased concern with those children of normal intelligence without apparent emotional disturbance or sensory impairment who manifest severe learning disabilities. Clinical examination of these children often indicates a number of significant problems including hyperactivity and marked perceptual difficulties. Of special interest to educators has been the alleged interference of the above-noted deficits with the acquisition of basic educational skills. There is some evidence to suggest that the perceptually disabled child is inferior in a number of school subjects such as reading and arithmetic with a cumulating deficit as he passes from one grade to another.
The Umbilical Artery Catheter: Prevention of Bleeding After Its Removal
Authors: Phelps Dale L.
Published: December 2021

During the course of removing a number of umbilical arterial catheters, I have come upon this helpful trick to avoid bleeding.

First, turn off the constant infusion pump. Next, turn the stopcock and slowly draw back with a small syringe until you can just see the intravenous (IV) fluid-blood interface; shut off the stopcock so that no flow can occur from the infant. Note: The IV fluid-blood interface is pulsatile.

With the infant restrained, withdraw the catheter until there are only 3 cm remaining within the infant and stop.
The Steam Vaporizer
Authors: Washington John A.
Published: December 2021

The report "Steam Vaporizers—Therapy or Tragedy," in the January 1972 issue, points out that little scientific data substantiates the use of these appliances. It must be conceded that practitioners, who measure their successes partly on their avoidance of hospitalizations, tend to follow well worn routines wearing blinders.

I share with Dr. Barich a dread of devices, common in the past, which heat to scalding temperatures a half gallon or more of water. Since the introduction of squat plastic vaporizers which emit steam from a core fed from an unheated reservoir, I have seen no accidents.
BODY GROWTH IN COOLEY'S ANEMIA (HOMOZYGOUS BETA-THALASSEMIA) WITH A CORRELATIVE STUDY AS TO OTHER ASPECTS OF THE ILLNESS IN 138 CASES
Authors: Logothetis John , Loewenson Ruth B. , Augoustaki Olga , Economidou Joanna , Constantoulakis Mathios
Published: December 2021

A cross-sectional study of 138 patients with Cooley's anemia, from 2 to 28 years of age, demonstrated retardation in height and weight except for children under the age of 4 years. Head circumference showed no consistent deviation from normal. A tendency was found for both height and weight to fall further behind the normal average with increasing age during the growing years. The degree of retardation appeared of significant magnitude only by the age of 9 to 10 years which is probably the age when the retardation in growth became noticeable to the observer. The degree of anemia showed only slight correlation with the degree of retardation in height and weight. Systemic abnormalities, however, that reflect the severity of the illness appeared to parallel the retardation of growth.
HOW TOXIC IS HEXACHLOROPHENE?
Authors: Lockhart Jean D.
Published: December 2021

Previously published, and unpublished, data relating to the toxicity of hexachlorophene (other than dermal) are reviewed. These data were considered by the Food and Drug Administration in formulating regulatory proposals on hexachlorophene.
BACTERICIDAL FUNCTION OF HUMAN POLYMORPHONUCLEAR LEUKOCYTES
Authors: Quie Paul G.
Published: December 2021

Serum from most normal persons contains specific antibodies which react with common bacterial species preparing their surfaces so that phagocytosis by leukocytes can take place. The Fab part of these antibodies reacts with immunologic specificity with antigens on the surface of bacteria. Another part of the immunoglobulin molecule termed the Fc portion is activated during the attachment of the Fab portion to bacteria and becomes a site for attachment of bacteria to receptors on the surface of phagocytic cells. This activity is greatly amplified by heat-labile serum factors.

Normally bacteria are rapidly killed by human polymorphonuclear leukocytes after engulfment occurs. However staphylococci and gram-negative species of bacteria survive in the leukocytes of patients with the syndrome "Chronic Granulomatous Disease of Childhood."

These patients have suffered recurrent severe infections with bacterial species that are part of the body's resident bacterial flora. By contrast these patients are not at increased risk to infection from such pyogenic bacterial species as group A streptococci or pneumococci. The leukocytes from patients with chronic granulomatous disease produce little hydrogen peroxide during phagocytosis. Catalase-producing staphylococci and gram-negative bacteria are not killed, but hydrogen peroxide-producing streptococci and pneumococci are killed. A normal metabolic response to phagocytosis as well as release of lysosonial factors are essential for the bactericidal activity of human polymorphonuclear leukocytes.
FEASIBILITY STUDY OF A PEDIATRIC TELEPHONE CONSULTATION SERVICE
Authors: Mapes Russell W. , Lewis Elmore W. , Covell David G. , Peterson Hugh M. , Manning Phil R.
Published: December 2021

A pediatric telephone consultation service with consultants based at Childrens Hospital of Los Angeles has been made available to a group of physicians practicing in Southern California. Data collected reveal that this service has been utilized by many pediatricians and general practitioners. Ninety-one percent of the calling physicians indicated that they were helped by the consultation, and in over one-third of the instances both the practitioner and the consultant felt that the outcome of the problem was changed by the consultation.

In the majority of instances, incoming calls were efficiently handled by an experienced nurse-operator and an appropriate consultant was made available within 5 minutes 38% of the time and within 1 hour in 86% of all calls.

Among the pediatric telephone consultants who provided the service, the majority (76%) felt that this kind of service, if expanded, would favorably affect patient care in a signifficant way. Among practitioners who used the service, 94% asked that such a service be continued.
Letter to the Editor
Authors: Faigel Harris C.
Published: December 2021

Kenny et al. are wrong in their assertion that because the medical evaluations of 92 children with an assortment of problems affecting their ability to learn in school showed no consistent pattern, medical evaluation has little to offer such youngsters. Denhoff et al. have shown medical evaluation can be very helpful.

Lumping all children with school problems together and looking for common symptoms is indeed a fruitless exercise. Kenny et al. do not permit the reader access to the specific data on which they base their conclusions, nor do they even provide general data on the subgroups within the larger group of youngsters.
Childhood Diet and Coronary Artery Disease
Authors: Canby John P. , Wilde Henry
Published: December 2021

The statement of the Committee on Nutrition concerning childhood diets and coronary heart disease is raising a timely subject. The grouping of hyperlipoproteinemic patients into Fredrickson's classes I to V has important therapeutic implications and has now been widely accepted. There is, however, a great need for long-term studies, starting as early in life as possible, which should evaluate the effects of dietary and pharmacologic manipulation on such young hyperlipoproteinemic individuals. The report of the Committee stresses the recognition of type II hyperlipoproteinemia in childhood and recommends treatment with the now standard low cholesterol, low saturated fat diet of the National Heart and Lung Institute and American Heart Association.
The Pediatric Nurse Practitioner, by Fernando J. deCastro, M.D., M.P.H., F.A.A.P., F.A.P.H.A. and Ursula T. Rolfe, B.A., M.D. Saint Louis: The C. V. Mosby Company, 1972, 154 pp., $6.50
Authors: Yankauer Alfred
Published: December 2021

This text is apparently intended for a wide variety of nurses: those desiring "to expand their empirical knowledge of ambulatory pediatrics," "recnt pediatric nurse practitioner graduates," "public health nurses," and "nurses working in a doctor's office." Its 138 pages (at five cents pen page) are divided into a section on health appraisal, a section on clinical problems, and a section on social problems. The first two sections occupy 88% of the content.

Altogether the volume provides a sparse taste of ambulatory pediatric procedures and problems, many of which are dealt with in greater depth and with more precision in standard nursing textbooks.
CYCLOPHOSPHAMIDE IN THE TREATMENT OF THE NEPHROTIC SYNDROME IN CHILDHOOD
Authors: Spitzer Adrian
Published: December 2021

To what extent, if any, adrenocortical steroid drugs have changed the ultimate outcome of children with the nephrotic syndrome is, and probably will remain, a moot question. This mode of therapy, however, has modified the natural course of this syndrome so dramatically that it has resulted in a reclassification of patients according to their response to steroid treatment. Two categories of problem patients thus have emerged: those who fail to attain remission (nonresponders), and those who do respond but relapse frequently, becoming steroid-dependent and steroid-toxic (frequent relapsers).

A new hope for these patients has arisen from the increasing body of anecdotal evidence suggesting that a favorable effect can be obtained by treatment with various antimetabolites and alkylating agents.
The Dangerous Toy Balloon
Authors: Ching Yi-Chuan , Huitt J. Dempsey , Nagao George I.
Published: December 2021

Two cases, one of death and one of near-death, due to obstruction of the airway by toy balloons are presented to call attention to the danger which can lurk in even those most innocuous of playthings.
Pathogenicity of H. parainfluenzae
Authors: Krishnaswami R. , Schwartz J. , Boodish W.
Published: December 2021

We would like to report an experience with H. parainfluenza meningitis in a 4-year-old boy at our hospital. The organism, recovered from both cerebrospinal fluid and blood cultures, was confirmed as H. parainfluenzae. With a clinical presentation and course not appreciable different from the usual H. influenzae type B meningitis, an unremarkable recovery occurred on ampicillin therapy.

Barnshaw and Phillips reported their case of H. parainfluenzae infection in a 4-year-old boy who also made a good recovery on ampicillin; review of the recent literature revealed one other such case, this in a newborn infant reported by Gullekson and Dumoff.
Health Problems of Migrant Children: A Dissenting View
Authors: Gilbert Arnold
Published: December 2021

Eisner et al. recently described an unproductive screening program but omitted any consideration of the serious issues that affect the health of migrant children. There is no longer a need to document the health problems of California's rural poor, nor the ineptness with which health facilities handle those needs. The health concerns of farm workers remain sanitation, housing, diet, child care, and access to ongoing medical care.

The following data may correct the possible implication from their article that there is no serious health problem among "migrant" children:
Letter to the Editor
Authors: Singer Harvey S. , Schafer Irwin A.
Published: December 2021

The fluorogenic substrate used by Dr. Patrick and his colleagues may offer the method of choice. An increase in sensitivity would enable performance of the test with a smaller volume of heparinized blood. It would help those of us concerned with differential diagnosis of the lipoidoses if the details of their assay procedure were published.
HUMAN FETAL GROWTH RETARDATION: III. PROTEIN, DNA, RNA, ADENINE NUCLEOTIDES AND ACTIVITIES OF THE ENZYMES PYRUVIC AND ADENYLATE KINASE IN PLACENTA
Authors: Rosado A. , Bernal A. , Sosa A. , Morales M. , Urrusti J. , Yoshida P. , Frenk S. , Velasco L. , Yoshida T. , Metcoff J.
Published: December 2021

Placentas were obtained at the moment of delivery from mother-infant pairs comprising 35 small for gestational age infants with intrauterine growth retardation (considered as intrauterine malnutrition, [IUM]), 28 prematurely born, but of appropriate size for gestational age (AGA), and 17 normal full-term (FT) infants. The placentas were chilled and perfused immediately, aliquots were analyzed for DNA, RNA, protein/DNA, some enzymes, and adenine nucleotide contents.

Body weight of the infants at birth was directly correlated with placental weight. Placentas of IUM and ACA infants were of similar size, and were smaller than FT placentas. Nuclear (DNA) and cytoplasmic (RNA) contents of the IUM placentas were smaller, but cell size (prot/DNA) was larger than FT placentas. Cytoplasmic mass (RNA/DNA) of IUM placenta was largest. There was a direct linear correlation between cell size and cytoplasmic mass in all groups. Pyruvic (PK) and adenylic kinase (AK) activities of IUM placentas were equal to those of FT and higher than the AGA. In all groups PK activity correlated with birth weight. ADP and ATP levels of IUM placenta were similar to those of the FT, but greater than the AGA. AMP content of IUM placentas was lower than FT; but higher than AGA. Apparently the metabolic features of the small IUM placentas do not differ appreciably from those of FT infants, in contrast to previously demonstrated differences in cord blood and maternal leukocytes. The low values found for AGA infants suggest that the parameters of placental metabolism which we studied reflect gestational age. Except for the reduced DNA content, but larger cytoplasmic mass, the metabolic components of the placenta after 38 weeks do not reflect the prior growth process of the fetus, in contrast to metabolism of the maternal or fetal leukocytes, which may be an index of fetal growth.
VITAMIN B12 AND FOLIC ACID VALUES IN PREMATURE INFANTS
Authors: Pathak Ambadas , Godwin Herman A. , Prudent Luis M.
Published: December 2021

The relationship of serum vitamin B12 and folic acid was studied in 24 premature infants. In 14 of the 24, low serum vitamin B12 values were found around 40 days of age. Serum folic acid concentrations were less frequently depressed and were usually associated with normal red cell folate values. No correlation between hematocrits and vitamin B12 or folate levels was found. It is suggested that low concentrations of serum folate and vitamin B12 result from low dietary intake coupled with increased demand by the prematurely born infant.
. . . THE PASTORAL FALLACY
Authors: Dornhorst A. C. , Hunter Alastair
Published: December 2021

The pastoral fallacy is a creation of a section of the profession, and probably arises as a reaction, by those no longer able to keep abreast, to the technical complexities of modern medicine. Its proponents emphasize the distinction between the patient and his disease, and claim to treat the whole man, and to regard the patient as a peryon. They stress the frequency and educational importance of the more trivial disorders and their interrelation with emotional factors. There is an implication that much of the elaboration of modern investigation and treatment could be dispensed with, if doctors were trained to acquire wisdom rather than to accumulate technical knowledge. Pervaded by an excessive belief in a unique therapeutic relation between doctor and patient, they aim to substitute a pastoral role for technical care, which is assumed to be necessarily impersonal or even inhumane. . . . The essential superficiality, and indeed dishonesty, of this attitude is revealed when one of its advocates is faced with illness in himself or in his family. The call then is not for the wise father figure, but for the man who knows most about so-and-so.
RAPID PROTOPORPHYRIN QUANTITATION FOR DETECTION OF LEAD POISONING
Authors: Kammholz Larry P. , Thatcher L. Gilbert , Blodgett Frederic M. , Good Thomas A.
Published: December 2021

A rapid fluorescent method for estimation of free erythrocyte protoporphyrin (FEP) is described. Simple ethyl acetate-glacial acetic acid extractions are performed, fluorescence quantitated in a fluorimeter and expressed numerically by comparison with known coproporphyrin standards.

Fifty-six children were studied and the extent of lead poisoning was evaluated initially and at different follow-up intervals. A clear relationship was shown between FEP fluorescence and blood lead levels. A correlation was also seen for the intensity of fluorescence and evidence for increased absorption of lead, as estimated by x-ray evidence of ingested lead and deposits in bone. Children with iron deficiency anemia also showed elevations of FEP fluorescence.

This FEP fluorescence test allows for a rapid, numerical determination which appears to be useful as a screening test for lead intoxication. It can quickly select patients that may have markedly increased lead absorption and need prompt therapy or select those that at least require further studies for possible lead exposure or the presence of anemia.
Indian Health Service
Authors: Zinaman J. Martin
Published: December 2021

I was surprised at how little resemblance there was between the Indian Health Service described in your Committee on Indian Health Report (October 1971) and the IHS Oklahoma Area where I served for two years (Tahlequah and Claremore Indian Hospitals) . If it were to serve as a prototype for all Federal agencies with health problems then we would have

1. many government-run unaccredited hospitals;

2. frequent shortages and limited selection of drugs;
SID, SIDS, and SUDS
Authors: Fields Donald L.
Published: December 2021

Just when we became familiar with the meaning of SUDS (Sudden Unexpected Death Syndrome) we find in the same issue of Pediatrics (June 1972) SIDS (Sudden Infant Death Syndrome) and SID (Sucrase Isomaltase Deficiency).

Nothing is sacred.
Once a Classicist, Always a Classicist
Authors: Heller Richard H.
Published: December 2021

Although admittedly a bit late to be concerned with the territorial boundaries of Greek and Roman culture, the proper term is Condyloma acuminatum (Pediatrics, Condyloma acuminata in Childhood, 50:153, 1972). Grammar notwithstanding, the case presentation was informative and useful.
Spezielle Patholocische Anatomie, vol. 2, edited by W. Doerr, G. Seifert, and E. Uehlinger. Berlin/Heidelberg/New York: Springer-Verlag, 1971, 1077 pp., $115.60
Authors: Vawter Gordon F.
Published: December 2021

This volume of a multivolumed, encyclopedic German treatise of pathology is concerned with diseases of the esophagus and stomach (and related duodenal abnormalities). The slightly more than 1,000 pages include a 32-page index, 198 pages of bibliography (through 1966), 96 pages dealing with the esophagus, and the remainder concerned with the stomach (including 38 pages of physiology as well as aspects of ultrastructune and molecular biology). The text is written in modern scientific German; the work is fairly easy to follow by one with only minimal or moderate familiarity with the German language.
PATIENT CARE AND STUDENT LEARNING IN A PEDIATRIC CLINIC
Authors: Duff Raymond S. , Rowe Daniel S. , Anderson Frederic P.
Published: December 2021

The problems of a random sample of 25 children visiting a general pediatric clinic were physical (12%), psychosocial (36%), and a combination of these (52%). In terms of management, these problems were simple (20%), moderately complicated (20%), very complicated (24%), and extremely complicated (36%). The visit resulted in major contributions to problem solving in 24%, minor contributions in 20%, and no contribution in 56%. Students rated the teaching exercise as good in 48%, mediocre in 20%, and poor in 32%. Students and families were least satisfied when the children's difficulties were psychosocial in nature. Such problems usually were not given serious consideration in the clinic. Pediatric specialists were occupied with diseases of primary concern to them while other pediatricians were unpaid, spent minimal time in the clinic, and had a primary interest in private practice. Under these circumstances, no pediatrician could give more than token interest to the complex physical and psychosocial problems for which help had been sought. This was no match for the service and teaching challenges in the clinic.
RESISTANCE TO DEALING WITH PARENTS OF BATTERED CHILDREN
Authors: Sanders R. Wyman
Published: December 2021

Resistance to dealing with parents of battered children appears to be a transcultural phenomenon as well as an individual issue involving the caretakers who work with each battered child and his family. In this paper, the author reviews some of the pertinent literature on the topic and gives some specific case examples to support this hypothesis. Finally, some suggestions are made of ways to deal more effectively with these families.
CONGENITAL DYSERYTHROPOIETIC ANEMIA, TYPE II: REPORT OF TWO CASES AND A REVIEW OF THE LITERATURE
Authors: Murphy Sharon , Oski Frank
Published: December 2021

Two children with congenital dyserythropoietic anemia type II, are described and contrasted. This recently recognized disorder of unknown pathogenesis is characterized by variable degrees of anemia, splenomegaly, and jaundice. Diagnosis was established by the demonstration of erythroid hyperplasia and erythroblastic multinuclearity in the bone marrow, and a positive acidified serum test.

Erythrokinetic studies revealed a significant degree of ineffective erythropoiesis. One of the patients demonstrated Gaucher cells in the marrow as a presumed consequence of the increased rate of red blood cell destruction. Means of distinguishing this autosomal recessive disorder from other refractory anemias is discussed.
INOCULATION FOR SMALLPOX (VARIOLATION) AS PERFORMED IN ENGLAND PRIOR TO JENNER'S DISCOVERY
Authors: C. T. E.
Published: December 2021

Variolation, or the attempt to transfer smallpox artificially from human to human, introduced into England in 1721 by Lady Mary Wortley Montagu (1689-1762), was widely practiced there until superseded by the much safer method of vaccination discovered by Edward Jenner (1749-1823).

A good description of how variolation was performed in eighteenth century England is given below.

The most proper time of the year to inoculate for the small-pox appears to me to be in April or May, and the most suitable age to be between a child getting its teeth and twelve or thirteen years of age, though if natural infection be feared or convenience requires it the business may be safely done at any other age, or in any other season of the year. The diseases which seem to forbid inoculation to be performed upon any person, are only those of a feverish kind, or which are attended with a feverish state such as the ague.

When a determination is made to inoculate any one, I would advise the intended patient to abstain from animal food, spirituous and fermented liquors and spices for ten days or a fortnight before. He may eat milk, bread, light pudding, vegetables, fruits of all kinds, panada etc. He should also avoid cold, fear, and every excess. An adult at this time may take from three to five grains of mercurius dulcis at bed-time, and an ounce or an ounce and a half of Glauber's salts dissolved in water in the morning so as to procure a gentle purging.
SEX DIFFERENCES IN RETARDATION OF SKELETAL DEVELOPMENT IN RURAL GUATEMALA
Authors: Blanco Ricardo A. , Acheson Roy M. , Canosa Cipriano , Salomón Joao B.
Published: December 2021

This is a cross sectional study of the cortical thickness of the second metacarpal as judged from radiographs of the hand and wrist of 1,409 children under 7 years of age (691 boys and 718 girls) from a rural area of Guatemala. The data were compared with standards of United States children. All the films were read by the senior author. It was found that after reaching the age of 2 years the cortices of the boys were consistently thinner than those of the girls. Both sexes had age-specific mean values which were significantly lower than those of healthy U.S. children of the same age. However, the boys lagged further behind the U.S. standards than did the girls, and this difference in retardation between the sexes was significant.
Phytotic (Mycotic) Intracranial Aneurysm With an Unusual Pathogenesis
Authors: Steele Jeffrey J. , Kilburn H. Lee , Leech Richard W.
Published: December 2021

Aneurysms which are formed when the wall of an artery is weakened from within by infection are generally called "mycotic" even though the most common infection is by pyogenic bacteria rather than by fungi. This report documents the unusual and unexpected postmortem finding of an awn of a grass inflorescence as the nidus for the pathogenesis of a mycotic aneurysm of the right middle cerebral artery. Such an etiology should typically be termed "phytotic."

Case Summary

A previously healthy 5½-year-old boy was treated for otitis media three weeks prior to admission. This responded to a combination of intramuscularly and orally administered antibiotics.
The Corporate Pediatrician
Authors: Balfour G. A.
Published: December 2021

I read with interest the numerous reports in this and other journals about pediatric manpower. I have recently had a nightmare which I must share with you in the diagram below.
Venereal Disease and the Pediatrician, Updated
Authors: Barton Leslie L.
Published: December 2021

The Committee on Youth's recent statement on Venereal Disease and the Pediatrician is of obvious timely importance. The treatment recommended for gonorrhea is, however, outdated. The Venereal Diseases Branch of the Center for Disease Control has recently revised its recommended treatment schedules for gonorrhea. Both males and females should receive 4.8 million units of intramuscular, aqueous procaine penicillin G preceded by 1 gm of oral probenicid. Ampicillin, 3.5 gm, administered orally with 1 gm of probenicid is a suitable alternative.
Condyloma Acuminata
Authors: Dandoy Suzanne
Published: December 2021

In the article by Patel and Groff on Condyloma Acuminata in Childhood, the authors state the following: "Laboratory data: all results, including a tine test (Venereal Disease Research Laboratory) and Fluorescent treponemal antibody-absorbed test were within normal limits."

The tine test is a test for tuberculosis; the Venereal Disease Research Laboratory (VDRL) test is a test for syphilis. I do not recall that the Venereal Disease Research Laboratory in Atlanta has ever used the tine test as a diagnostic tool for venereal disease. Which test was actually performed in this case?
CURRENT CONCEPTS CONCERNING THE HEPATITIS VIRUSES
Authors: Carver David H. , Seto Dexter S. Y.
Published: December 2021

While the discovery of Australia antigen and its relationship to hepatitis B has provided both the stimulus and the mechanism for much productive research, further work with both of these agents is essential before the diseases they produce are thoroughly understood and eventually eliminated.

More detailed descriptions of recent developments in hepatitis research are available in three recent journal issues entirely devoted to the subject. The American Journal of Diseases of Children in April 1972 (vol 123) published the papers given at the International Children's Centre Seminar on Viral Hepatitis and the British Medical Bulletin for May 1972 (vol 28) published a number of papers designed to give a survey of current knowledge in this field. A special issue of the Canadian Medical Association Journal (vol. 106, February 26, 1972) includes the proceedings of the 1971 International Symposium on Viral Hepatitis which was held in Toronto, Canada.
Simplified Screening for Bacteriuria in Children
Authors: Rabinowitz Howard K. , Saitz Edward W.
Published: December 2021

Since this study was completed, we have continued to screen only females for bacteriuria. Using the above guidelines, 20 children were positive on screening in 1971 . Sixteen of them returned for repeat clean catch cultures. Nine of these returns were within one week, and an additional four within two weeks of the original screen. Of all of the repeat cultures, 12 were positive, two negative, and two questionable. These results are similar to those reported above with the exception that the repeat cultures were obtained within a shorter period of time.
The School Physician
Authors: Brown George W.
Published: December 2021

Contrary to a statement in the editorial by Dr. Menkes1 the pediatrician need not be limited in getting information about school children. If he makes a reasonable effort to show interest and to exchange information with teachers, counselors, administrators, and others, he will find tremendous interest in the schools. They will eagerly provide observations, test results, behavior descriptions, and other valuable insights on the performance and learning style of the child. Beside these school people, special parent groups (e.g., ACLD), and PTA's will also respond.
Management Of Juvenile Diabetes Mellitus, by Howard S. Traisman, M.D., ed. 2, St. Louis, Missouri: C. V. Mosby Company, 1971, 223 pp., $19.75
Authors: Azubuike J. Chukwuemeka
Published: December 2021

Dr. Traisman assumes complete responsibility for the second edition of this book; the first edition with Dr. Newcomb as co-author was published in 1965. About 70 pages have been added because of the inclusion of a few new chapters; these deal with the pathogenesis of diabetes mellitus, transplantation of the pancreas for this disease, the psychologic aspects of diabetes, and with hypoglycemia. The latter two chapters are most welcome in this day and age when medical progress is helping to prolong the lives of juvenile diabetics.
Atlas Of Roentgen Anatomy Of The Newborn And Infant Skull (Including Illustrations of Some Pathologic Changes and Congenital Variations with Emphasis on Fetal Radiology), by Charles N. Chasler, B.S., M.D., F.A.C.R. St. Louis: Warren H. Green, Inc., 1972, 212 pp., $22.50
Authors: Heller Richard M.
Published: December 2021

While no new frontiers are opened, and there is no information to startle most pediatric radiologists, Dr. Chasler has produced a beautifully illustrated and well written monograph on radiology of the newborn and fetal skull. Its merit lies in the straight forward presentation of common problems and their solution.

The atlas is only 212 pages long. The first four of the seven sections discuss and illustrate the normal anatomy of the premature and fullterm infant skull as visualized by X-ray, abnormalities in size and shape of the newborn skull, congenital dysplasias limited to the skull (e.g., lückenschädel, premature craniosynostosis), and the skull in the congenital dysplasias (e.g., osteopetrosis).
PULMONARY HYPOPLASIA: A MORPHOMETRIC STUDY OF THE LUNGS OF INFANTS WITH DIAPHRAGMATIC HERNIA, ANENCEPHALY, AND RENAL MALFORMATIONS
Authors: Reale Frank R. , Esterly John R.
Published: December 2021

The type and severity of underdevelopment of the lungs in infants with three congenital malformations were studied in histologic sections. The mean lung weight:body weight ratios were significantly decreased in infants who had diaphragmatic hernia, anencephaly, and a group of renal anomalies. Radial alveolar counts of the distal airways were also significantly decreased, although the range for each group included normal values. The data suggest that decreased proximal branching is a component of pulmonary hypoplasia in these malformations, because in the majority of infants, the decrease in lung weight was greater than could be explained by the decrease in the number of peripheral air spaces. No apparent qualitative differences in the type of hypoplasia were found in these infants; changes in the histologic appearance were correlated with severity and were independent of the type of associated malformation.
PATHOGENESIS OF HEMORRHAGIC PULMONARY EDEMA AND MASSIVE PULMONARY HEMORRHAGE IN THE NEWBORN
Authors: Cole Valerie A. , Normand I. C. S. , Reynolds E. O. R. , Rivers R. P. A.
Published: December 2021

Clinical observations, coagulation studies, and analysis of simultaneously obtained samples of lung effluent and arterial or venous blood for hematocrit and protein composition as determined by gel filtration were performed on 15 infants collapsing with blood stained liquid flowing from their tracheas. The results indicate that (1) The lung effluent was in most cases hemorrhagic edema fluid and not whole blood. (2) The most important precipitating factor was probably acute left ventricular failure due to asphyxia, although other factors favoring increased filtration of liquid from pulmonary capillaries or causing lung damage may have played a contributory role in pathogenesis. (3) Coagulation disorders probably served to exacerbate the condition but not initiate it.
HYPERDIBASICAMINOACIDURIA IN A MENTALLY RETARDED HOMOZYGOTE WITH A PECULIAR RESPONSE TO PHENOTHIAZINES
Authors: Kihara Hayato , Valente Mario , Porter Myna T. , Fluharty Arvan L.
Published: December 2021

A mentally retarded patient believed to be homozygous for the transport mutant, hyperdibasicaminoaciduria, is described. The trait is characterized by increased excretion rates of the basic amino acids, lysine, arginine, and ornithine. Plasma levels of these amino acids are normal, so renal excretion is not the result of increased plasma levels, but is rather due to impaired renal tubular reabsorption of the basic amino acids. Subnormal increase in plasma lysine levels after oral lysine loading implies impaired intestinal as well as renal transport of basic amino acids.

The parents of the proband are first cousins of Italian extraction. Their excretion rates of basic amino acids, while modest relative to those of the proband, are considerably higher than in control subjects.

This patient came to our attention because of a history of adverse reactions to chlorpromazine (Thorazine), thioridazine (Mellaril), and fluphenazine (Prolixin) consisting of dysarthria, Parkinsonian movement, and bradykinesia. She recovered fully after the chlorpromazine and the thioridazine were discontinued. However, after the fluphenazine was discontinued she was left with a permanent residual of dysarthria and athetosis.
STILBESTROL AND ADENOCARCINOMA OF THE VAGINA
Authors: Yaffe Sumner J. , Bierman Charles W. , Cann Howard M. , Gold Arnold P. , Kenny Frederic M. , Riley Harris D. , Schafer Irwin , Stern Leo , Weiss Charles F. , Chudzik Gregory , Shirkey Harry C. , Soyka Lester F. , Leger Jacques , Farchione Louis , Lockhart Jean D. , Sawchuk Steven , Ballin John C. , Simopoulos Artemis P. , Done Alan K.
Published: December 2021

One of the most important concepts in pediatric pharmacology is that exposure to drugs or chemicals may have latent, unforeseen effects on the child later in life. Some of the most dramatic occurrences, other than teratogenesis, are those in which hormonal exposure during the fetal or newborn period alters adult sexual development. However, none of these episodes is more impressive and ominous than that reported by Herbst et al.1 Herbst, an obstetrician at the Massachusetts General Hospital, was intrigued by the presentation of seven patients with adenocarcinoma of the vagina, an extremely rare tumor not previously seen at the hospital. The patients ranged in age from 14 to 22 years and sought medical advice because of vaginal bleeding. Several had benign adenosis, suggesting that the malignant change seen in all was based on a fundamental alteration in the biology of the vaginal epithelium. Six of the patients were treated with radical surgery, and one was treated with wide, local excision. One of the patients died after surgery.

In what could serve as a model of a scientifically conducted, epidemiologic study, each of the seven patients, plus an additional patient from another hospital, was matched with four controls born in the same hospital within four days. Thus, the "control" group was chosen in a manner to eliminate many biases of artificially contrived control populations. A wide variety of possible influences in both mothers and offspring were considered, e.g., maternal age, smoking habits, exposure to X-rays, breast-feeding, birth weight, age at menarche, medications during pregnancy, and so forth.