bluuebunny/crossref_metadata_2025 huggingface dataset:
ROLE OF THE CHILD PROTECTIVE ORGANIZATION
Authors: Cameron James S.
Published: December 2021

A Review of recent literature and press pronouncements has no doubt left many confused about what degree of concern should be channeled into the problem of the abused child.

Part of the confusion results from a tendency to resort to the numbers game in trying to highlight the critical child welfare problems that face this nation, state, and city. Rather than wonder which numbers to believe, or whether physical and emotional battering of children is increasing, I think that the abuse and neglect of children in New York City is of such significant proportions as to justify our dedicated concern.

For some years there has been a specialized approach to the problems of the neglected and abused child. This specialized approach has been termed child protective services. It has been developed in response to the problems of abused and neglected children, which the community feels must be looked into and treated.

The Child Welfare League defines protective service as "A specialized child welfare service which carries a delegated responsibility to offer help on behalf of any child considered or found to be neglected."

The New York State Department of Social Services defines protective services as "Those provided to children living in their own homes who are seriously neglected, abused, or subjected to demoralizing circumstances by their parents or others responsible for their care."

Child protective service is not a new service. It has a very illustrious history that really started in this city, back in the late 1800s, through the development of the Society for the Prevention of the Cruelty to Children.
ENERGY METABOLISM AND PROTEIN SYNTHESIS IN HUMAN LEUKOCYTES DURING PREGNANCY AND IN PLACENTA RELATED TO FETAL GROWTH
Authors: Metcoff Jack , Wikman-Coffelt Joan , Yoshida Takashi , Bernal Alfonso , Rosado Adolfo , Yoshida Pablo , Urrusti Juan , Frenk Silvestre , Madrazo Ricardo , Velasco Luis , Morales Myriam
Published: December 2021

Fetal malnutrition may compromise about 3% to 5% of pregnancies; about one-third of infants having birth weights below 2,500 gm may have fetal malnutrition and be "small-for-dates" (rather than premature). Fetal malnutrition predisposes to perinatal episodes of hypoglycemia, to congenital defects, and to poor postnatal growth, and may increase the chance for neurologic defects and/or poor mental development. Beside toxemia of pregnancy, unfavorable socioeconomic status predisposes to fetal malnutrition in our urban and rural populations, as poverty is a major factor in developing countries. To date, only circumstantial evidence relates maternal malnutrition to human fetal malnutrition.

Prevention of fetal malnutrition requires diagnosis early in pregnancy. Because metabolism of the peripheral blood leukocyte is distinctly altered in protein-calorie malnutrition, and at term in mothers who deliver infants with fetal malnutrition, it seemed worthwhile to investigate patterns of metabolism in maternal leukocytes during the last trimester. Metabolism of the peripheral blood leukocyte is presumably a reasonable index of cell metabolism in other organs such as liver and muscle, moreover, in some genetically determined enzyme deficiencies, the enzyme defect may also be found in the leukocyte. It, therefore, seemed likely that maternal leukocyte metabolism might serve as a "marker" for intrauterine growth of the fetus.

The present studies indicate some patterns of energy metabolism and protein synthesis during the last trimester of pregnancy. Energy metabolism, indicated by the ATP levels and adenylate and pyruvic kinase activities of maternal leukocytes, was shown to increase during the last six to eight weeks of gestation; RNA synthesis, reflected by the level of RNA polymerase activity in the maternal leukocyte, also rises and appears to correlate with the birth weight of the infant.
SERUM TOTAL CORTICOID AND CORTISOL LEVELS IN PREMATURE INFANTS WITH RESPIRATORY DISTRESS SYNDROME
Authors: Reynolds John W.
Published: December 2021

Serum total corticoid and cortisol levels were measured in premature infants with fatal hyaline membrane disease (HMD), nonfatal HMD, and benign respiratory distress syndrome (BRD). The streoids were determined by a competitive protein-binding assay, the cortisol being isolated by LH-20 Sephadex column chromatography.

The mean cortisol level in the first three days of life was significantly greater in fatal HMD than in BRD (22.2 ± 3.7 SEM versus 6.8 ± 1.2 p. < .001). The mean cortisol level also was greater in fatal HMD than in BRD after 6 days of age (10.9 ± 1.5 versus 3.5 ± 0.6 p. < .001). Patients in all diagnostic categories responded to adrenal stimulation by cosyntropin with rises in serum cortisol levels. The elevated serum cortisol levels in fatal HMD are appropriate for the stress of the disease. The study provides no evidence that postnatal adrenal hypofunction plays a role in the pathogenesis or course of HMD.
TRANSIENT MONOSACCHARIDE INTOLERANCE IN A NEWBORN INFANT
Authors: Akesode Fatiu , Lifshitz Fima , Hoffman Kenneth M.
Published: December 2021

A newborn infant with transient monosaccharide intolerance of noninfectious origin is described. During the first day of life the patient suffered severe anoxia with several episodes of prolonged apnea and cyanosis. On the second day of life she was fed 5% glucose and water and severe diarrhea ensued. After oral feedings were stopped the diarrhea ceased. On the third and fourth day of life similar episodes of diarrhea induced by glucose and water feedings occurred. The stools were acid and contained carbohydrates. However, when the patient was fed sterile water or a carbohydrate free diet, the diarrhea improved. The stools remained normal with fecal pH of 7.0 and no carbohydrates present as long as she was given no carbohydrates by mouth during the first 22 days of life. The intolerance to oral glucose extended to other monosaccharides like fructose and D-xylose. However, after being free of diarrhea for 16 days she began tolerating increasing quantities of glucose in the diet. The capacity to tolerate fructose and xylose was also recovered at 40 and 42 days of life. Disaccharide intake was begun the 44th day of life. She was fed dextrimaltose as a source of carbohydrate in the diet with good results. Sucrose was not tolerated on the 67th day of life. Severe diarrhea, dehydration, and metabolic acidosis ensued after "sugar and water" was fed. However, this disaccharide was well tolerated by 150 days of life. Lactose was not tolerated on the 81st day of life. Milk formula feedings induced diarrhea with stools being acid and containing large quantities of carbohydrates. However, all dietary carbohydrates were tolerated by 180 days of life, lactose was fed with good results. The patient had no infection of the upper segments of the small intestine demonstrable to account for the monosaccharide and disaccharide malabsorption. It is tempting to speculate that anoxia in the newborn period might have played a role in the intolerance to carbohydrates seen in this patient during the first six months of life.
Urinary Vaginal Reflux in Children
Authors: Kelalis Panayotis P. , Burke Edmund C. , Stickler Gunnar B. , Hartman Glen W.
Published: December 2021

The method of collection of urine for bacteriologic investigation is of utmost importance. Catheterization and midstream collection* are both acceptable and widely employed methods of obtaining urine from the female child for colony counts. Nonetheless, neither is practical nor possible in many instances. Often urine must be collected by having the child void into a sterile container after thorough cleansing of the area. Frequently, in such instances, evidence of bacteriuria is found which may be puzzling in the absence of symptoms or other evidence of urologic disease. Contamination in such cases is a likely source and we wish to point out what is considered a significant observation that may have important influence on the method of collection of urine.
Excerpt XI: Dog and the Shadow
Authors: Cone Thomas E.
Published: December 2021

The moral of the fable illustrated below bears out a commonly taught belief found in an early American children's book, which is:

Deliver me, O Lord, from that

evil man, myself.
Safety Clips Prevent Hemorrhage
Authors: Fischer Gerald W. , Scherz Robert C.
Published: December 2021

Severe hemorrhage has been noted twice in our nursery due to accidental disconnecting of the three-way stopcock from the infusion tubing.

Hemorrhage or exsanguination is a known complication of umbilical artery catheterization and this most often occurs when the catheter is inadvertently removed from the artery by the baby or nursery personnel.

Because numerous manipulations of the stopcock are made during blood gas sampling, this also appears to be a potentially dangerous area for hemorrhage.
METHYLMALONIC ACID
Authors: Barness Lewis A.
Published: December 2021

Methylmalonate studies have led to some understanding of vitamin B12 metabolism as well as certain inborn errors of metabolism. These, in turn, have served as models of a group of diseases related to acidosis, so that the study of organic aciduria at present is similar to that of amino aciduria 20 years ago. Techniques for studying these have been developed.

Many unanswered questions remain.

(1) What does methylmalonate do? Does it, itself, cause the acidosis? Does it cause a deficiency of succinate in the oxidative cycle?

(2) Are more direct ways of increasing succinate available?

(3) What is the relation of methylmalonate to combined system disease or vitamin B12 neuropathy?

(4) Are enzymes defective or absent?

(5) What is the significance of methylmalonate in the newborn?

(6) How does one counsel or treat families which include members with methylmalonic aciduria?
GASOLINE SNIFFING AMONG CHILDREN IN A PUEBLO INDIAN VILLAGE
Authors: Kaufman Arthur
Published: December 2021

To determine the incidence of gasoline sniffing, and the characteristics of Pueblo Indian children indulging in this practice, a questionnaire was given to the 72 children attending a Pueblo Indian village school. Forty-five (62%) stated they had sniffed gasoline as an intoxicant at least once, and many were repeated users. Those who sniffed gasoline did not appear to differ significantly in home environment from schoolmates who did not sniff gasoline.
RARE DISEASES, OLD DRUG, NEW KNOWLEDGE
Authors: Lucey Jerold F.
Published: December 2021

Some drugs, like women. become more interesting with age. Phenobarbital seems to be such a drug. It's come a long way since its mundane use for convulsive disorders and sedation. It is showing signs of becoming a minor wonder drug. Two articles in this issue point to its usefulness in the symptomatic treatment of pruritis associated with liver disease.1,2 Diseases causing a disturbance of bile salt metabolism aren't exactly at the top of a pediatrician's list of "Common Problems I need to know Something About," but phenobarbital is a drug that's used daily in practice and pediatricians should certainly be well informed about its effects.
CHILDHOOD BURN INJURIES AND DEATHS
Authors: Berman William , Goldman Armond S. , Reichelderfer Thomas , Mofenson Howard C.
Published: December 2021

Accidents kill more people in the United States between 1 and 34 years of age than any single disease. Burns are the second leading cause of nonvehicular "accidental" death. Thirty percent of the 7,800 Americans who die from burns each year are under 15 years of age. In the 1- to 4- year-old age group, burns are the leading cause of accidental death in the home environment and second only to vehicular injuries overall; in the 5- to 14-year-old age group, burn deaths place third, behind motor vehicle and drowning fatalities.1

Each year approximately 2 million people in the United States seek medical attention for burn injuries.
Atrioventricular Block Following Brain Abscess Aspiration
Authors: Rowland Thomas W. , Gharib Mohsen
Published: December 2021

Significant cardiac conduction disturbance in patients with central nervous system disease rarely occurs. While commonly induced in the experimental animal the appearance of such arrhythmias in the human has been limited to single reports of ectopic tachycardia and atrioventricular (AV) block with several CNS disorders.1-5

This article presents a child with cyanotic congenital heart disease who developed persistent AV block following needle aspiration of a right thalamic brain abscess.

Case Report

L.D. is a 9-year-old girl with tetralogy of Fallot for which she has undergone three systemic-pulmonary arterial anastomoses. Following the last of these, a Waterston shunt in 1965, she had done well on digoxin, .090 mg twice a day with minimal exercise intolerance and cyanosis.
THE TEN-STATE NUTRITION SURVEY: A PEDIATRIC PERSPECTIVE
Authors: Lowe Charles U. , Forbes Gilbert B. , Garn Stanley , Owen George M. , Smith Nathan J. , Weil William B. , Filer L. J.
Published: December 2021

In 1967 the 90th Congress of the United States attached an amendment to the Partnership for Health Act requiring the Secretary of the Department of Health, Education, and Welfare to undertake a survey of "the incidence and location of serious hunger and malnutrition–in the United States." In response to the legislative mandate the Ten-State Nutrition Survey was conducted during the years 1968 through 1970. The sample was selected from urban and rural families living in the following ten states: New York, Massachusetts, Michigan, California, Washington, Kentucky, West Virginia, Louisiana, Texas, and South Carolina.

The families selected were those living in some of the census enumeration districts that made up the lowest economic quartiles of their respective states at the time of the 1960 census. During the eight years after the 1960 census the social and economic characteristics found in some of the individual enumeration districts had changed, so that there was a significant numer of families in the surveys with incomes well above the lowest income quartile. Thus, it was possible in analyzing results to make some comparisons on an economic basis.

Thirty thousand families were identified in the selection process; 23,846 of these participated in the survey. Data regarding more than 80,000 individuals were obtained through interviews and 40,847 of these individuals were examined.

The survey included the following: extensive demographic information on each of the participating families; information regarding food utilization of the family; a 24-hour dietary recall for infants up to 36 months of age, children 10 to 16 years of age, pregnant and lactating women, and individuals over 60 years of age.
Multidisciplinary Team Consultation In Day Care
Authors: Henry William B.
Published: December 2021

From 1970 to 1972 I had the opportunity to participate as a pediatrician in a community funded demonstration project to test the possible effectiveness of a truly integrated team approach in bringing to bear the knowledge of six specialists upon two representative day care centers. One of these day care centers served a suburban community and the other an inner city population. The other specialists were a master teacher, Doris Sharpe, M.A.; a social worker, Iris E. Wolfson, M.S.W.; a nutritionist, Rhea Lawton, B.S.; a public health nurse, Ruth D. Abbott, R.N., M.S.; and a child psychiatrist, Paul N. Graffagnino, M.D. The latter also served as chairman of the pool.
Pediatric Cardiology, ed. 3, by Alexander S. Nadas, M.D., F.A.A.P., and Donald C. Fyler, M.D., F.A.A.P. Philadelphia/London/Toronto: W. B. Saunders Company, 1972, 749 pp., $25
Authors: Lind John
Published: December 2021

The third edition of Alexander Nadas' textbook has maintained the same general indexing as the earlier edition but a lot of the content has been revised and parts rewritten in cooperation with Dr. Donald C. Fyler. The general part on diagnostic work-up is crystal clear with high-class illustrations and covers most of the diagnostic routines in a cardiac unit.

Dr. Nadas, like so many of his transatlantic colleagues, seems convinced that the cardiothoracic index is the method of choice for the assessment of cardiac enlargement, a conviction that the reviewer finds hard to share.
HIPPOCRATES ON THE SEVEN DIVISIONS OF A MAN'S LIFE
Authors: C. T. E.
Published: December 2021

Hippocrates (c460-c360 B.C.) divided a man's life into periods of seven, connected no doubt with the mystic significance attached at a much earlier time in the world's history to the number seven.

He wrote:

"In man's nature their are seven periods which they call ages; infant, child, adolescent, youth, man, elderly man, old man: an infant is up to 7 years, the cutting of teeth; a boy up to the beginning of puberty, 14 years; an adolescent, up to the appearance of down on the chin at 21 years; youth to the end of development at 28 years; man up to 49 years; elderly, up to 57 years; and after this an old man."1
PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS
Authors: Ballow Mark , Margolis Carmi , Schachtel Bernard , Hsia Y. Edward
Published: December 2021

Two brothers with an early onset of fluctuating jaundice, pruritus, malabsorption, and rickets are reported. Biochemical features included conjugated hyperbilirubinemia, elevated alkaline phosphatase, normal cholesterol, slightly elevated transaminase, elevated serum bile salts, and hypoglycemia. There was also evidence of rickets and deficiency of the fat soluble vitamins. Histological appearance of the liver showed bile stasis and paucity of the interlobular bile ducts. The familial incidence, clinical course, biochemical findings, and liver histology in our cases and in similar reported cases, are distinctive of an intermediate form of familial progressive intrahepatic cholestasis, milder than congenital intrahepatic biliary atresia, but more severe than benign recurrent intrahepatic cholestasis. A defect in the hepatic excretory mechanism is postulated for this group of intrahepatic cholestatic disorders which appear to be genetically determined with an autosomal recessive pattern of inheritance. Both brothers had symptomatic and chemical improvement with phenobarbital therapy.
ANOMALOUS PHENYLALANINE LOADING RESPONSES IN RELATION TO CLEFT LIP AND CLEFT PALATE
Authors: Tocci Paul M. , Beber Bernard
Published: December 2021

Oral phenylalanine loads were given to 15 mothers of children with cleft lip and palate defects and 19 control women. Four of the 15 mothers exhibited unusual tolerance curves, i.e., the phenylalanine levels did not rise appreciably during four hours nor did the tyrosine levels increase normally.

Two of the women studied also showed a deviation from normal in the appearance of tyrosine in the blood after a tyrosine load. Attempts to stress the mothers who exhibited a normal response to the single phenylalanine load by giving them a double load were not successful. The possible implications of these findings are discussed.
CONTINUOUS DISTENDING PRESSURE IN HYALINE MEMBRANE DISEASE: Of Devices, Disadvantages, and a Daring Study
Authors: Chernick Victor
Published: December 2021

The report of Gregory et al.1 at the May 1970 meeting of the Society for Pediatric Research on six infants with severe hyaline membrane disease treated with continuous positive airway pressure now seems ancient history. Application of a constant distending pressure during both artificial and spontaneous respiration has rapidly become almost a routine in many centers in North America and elsewhere. Particularly benefited is that ± 50% of infants with severe disease (defined as an arterial Po2 < 50 mm Hg while breathing at least 80% oxygen) who do not require respirator therapy, by virtue of arterial Pco2 below 65 to 70 mm Hg and absence of severe apneic spells.
THE FINAL ANSWERS TO SINGLE UMBILICAL ARTERY?
Authors: Benirschke Kurt
Published: December 2021

When the "Collaborative Study"1 was conceived it was undertaken with the hope of obtaining definitive answers to some complex questions in the field of obstetrics and perinatology. It could be anticipated that, by the meticulous collection of data on prenatal, natal, and postnatal events in thousands of pregnancies, indisputable evidence might be gained as to certain causes of mental retardation, birth defects, infectious complications of pregnancy, and the like. Ultimately, it was hoped that the application of such evidence might lead to measures for prevention.

The study was enormous. An incredible amount of data still awaits analysis. The paper by Froehlich and Fujikura1 in this issue is but one small step toward the realization of the goals originally set.
INTERACTION OF ENVIRONMENTAL AND GENETIC FACTORS IN KLINEFELTER'S SYNDROME
Authors: Leonard Martha F. , Rosenberg Leon
Published: December 2021

The complexity of the interaction of genetic and environmental factors on human behavior is both a fascination and a frustration. It is fascinating to try to assess the relative contribution of each factor to the development and personality of individual patients. It is frustrating to try to separate genetic and environmental influences, which begin to interact even before birth. Any investigator who reports behavioral characteristics of patients with a genetic abnormality has the important responsibility to document the genetic diagnosis and to include data about psychosocial factors, so that the reader may make a critical appraisal of his conclusions with regard to multiple interacting influences on development.
CONTINUING MEDICAL EDUCATION FOR PEDIATRICIANS
Authors: Klingberg William Gene , Bailey John , Bell William Reed , Birdsong McLemore , Cherry Arthur C. , Cortner Jean A. , Fowler Richard E. L. , Gellis Sydney S. , Grossman Moses , Oliver William J. , Robertson William O. , Robinson Saul J.
Published: December 2021

Recognizing the paramout importance of optimal health care for all children as a legitimate concern of pediatricians and of all society, the American Academy of Pediatrics reiterates its long-standing commitment to pediatric education in its broadest sense including undergraduate, graduate, and continuing medical education. Several approaches to assure the quality of such care, such as peer review, evidence of participation in continuing education activities, and recertification have been suggested by a variety of governmental and other nonprofessional agencies. The Academy believes strongly that such undertakings must remain the responsibility of appropriate medical organizations and that the appropriate organization in all affairs related to the health of children is the American Academy of Pediatrics.

The Academy desires, therefore, to assist its members in maintaining and improving their expertise and in preparing them to demonstrate their ability to respond to the demands of a changing society. Recognizing that society will require demonstration of expertise and ability to maintain quality of health care, the Academy has assumed the initiative in developing methods for the determination of competency. Vital to the maintenance of such competency is the level of continuing education. The Academy reaffirms its determination to assist the pediatrician in maintaining and demonstrating his competence.
BALANITIS XEROTICA OBLITERANS: REPORT OF A CASE IN AN 11-YEAR-OLD AND REVIEW OF THE LITERATURE
Authors: Mikat Dorothy M. , Ackerman Howard R. , Mikat Kurt W.
Published: December 2021

An 11-year-old male with phimosis was found to have balanitis xerotica obliterans on the foreskin, apparent grossly and microscopically as indurated plaques. This relatively uncommon sclerosing disease is most common between 30 and 49 years of age.

This particular child is the youngest reported in the American literature to have this condition. It may be more common than presently recognized and physicians should be familiar with the appearance and treatment because of the severe, progressive urological complications that may ensue. Recommended therapy includes total excision of the lesion or topical or intralesional corticosteroids if the lesions are unexcisable.
THE INTERPLAY OF BIOLOGICAL AND ENVIRONMENTAL FACTORS IN A PRESCHOOL-AGE PATIENT WITH KLINEFELTER'S SYNDROME
Authors: Campbell Magda , Breuer Harry , Wolman Sandra R.
Published: December 2021

A 3-year-old male with 47XXY karyotype is presented as an example of how various genetic and environmental (including psychosocial) factors can contribute to delayed and/or disturbed behavior. The young preschool child's behavioral repertoire is so small, undifferentiated, and nonspecific that a variety of causes can evoke the same symptom(s) and behavior, and the danger of misdiagnosis, therefore, is great. Such disturbances may not be entirely or partially caused by a disturbed parent-child relationship. The pediatrician is usually the first to see such a young patient and in a position to initiate appropriate referrals for a complete diagnostic work-up, including cytological, hearing, and speech studies, not only for accurate diagnosis, but also for prognosis, treatment, and parental counseling.
GLUCOSE DISAPPEARANCE RATE IN SYMPTOMATIC NEONATAL HYPOGLYCEMIA
Authors: Pildes Rosita S. , Patel Daksha A. , Nitzan Menachem
Published: December 2021

The present study was undertaken to determine the rate of glucose disposal in the pathogenesis of symptomatic neonatal hypoglycemia. Intravenous glucose (1 gm/kg) was injected rapidly into 11 hypoglycemic and eight control newborn infants. The percentage (mean ± SEM) disappearance rate per minute (Kt) was significantly higher (p < 0.001) in the hypoglycemic newborn infants compared with that of the controls (2.8 ± 0.1 versus 1.2 ± 0.1, respectively). Baseline plasma insulin concentrations were significantly higher (p < 0.01) in the hypoglycemic (16.8 ± 3.9µU/ml) than those of the controls (3.5 ± 1.0µU/ml). Baseline plasma growth hormone values in the hypoglycemic newborns were 16.6 ± 5.7 mµg/ml. Growth hormorne values rose in the hypoglycemic to 36 ± 10 mµg/ml at 10 minutes and to 64 ± 13 mµg/ml by 60 minutes.
ISOVALERIC ACIDEMIA: RESULTS OF FAMILY STUDY AND DIETARY TREATMENT
Authors: Levy Harvey L. , Erickson Arline M. , Lott Ira T. , Kurtz Donald J.
Published: December 2021

Detailed clinical and biochemical studies are reported in two siblings with isovaleric acidemia ("sweaty feet syndrome"). The younger of these siblings was begun on treatment with a low-leucine diet at the age of 17 days and was the subject of a previous brief report (Pediatrics, 49: 616, 1972). Within one day of the beginning of treatment urinary isovaleric acid dropped from 1661.4µmoles/24 hr to 94.1µmoles/24 hr and urinary isovalerylglycine dropped from 480 mg/23 hr to 150 mg/24 hr. Until the age of 3 years he was maintained on this diet and had many less episodes of vomiting and acidosis than his affected but untreated sister had had at corresponding ages. Psychosocial functioning has been at low normal levels whereas the affected sister has a moderate degree of mental retardation. It is postulated that isovaleric acidemia may be added to the growing list of disorders that can cause mental retardation but that may be amenable to dietary therapy begun in early infancy.
USE OF HEMODIALYSIS IN THE TREATMENT OF QUINIDINE POISONING
Authors: Reimold Ekkehard W. , Reynolds Walter J. , Fixler David E. , McElroy LaVerne
Published: December 2021

Hemodialysis was used in addition to forced diuresis in the treatment of quinidine poisoning of a 3-year-old girl. The estimated retained dose of quinidine was 1,600 mg. During a 36-hour treatment period the patient excreted through the kidneys 768.1 mg quinidine (21.3 mg/hr). Hemodialysis almost doubled the quinidine elimination by removing 145 mg in eight hours (18.1 mg/hr): renal excretion, 55%; hemodialysis, 45%. The quinidine elimination with dialysis is high when high blood flow rates through the artificial kidney can be maintained. Adequate glomerular filtration rate and urine acidification are necessary for high renal excretion of quinidine.
MEDULLARY CARCINOMA OF THE THYROID WITH MARFAN-LIKE BODY HABITUS
Authors: Forsman Patricia J. , Jenkins Melvin E.
Published: December 2021

A 15-year-old girl with medullary carcinoma of the thyroid is described. She presented with a Marfan-like body habitus and nodularities of the tongue. Her clinical features led to the diagnosis, and removal of the thyroid gland confirmed the clinical impression.
LENNOX'S SYNDROME AND LEAD INTOXICATION
Authors: Fejerman Natalio , Gimenez Estela R. , Vallejo Norma E. , Medina Carlos S.
Published: December 2021

Three male and two female children with Lennox's syndrome linked etiologically with lead intoxication were followed for up to three years. The diagnosis of Lennox's syndrome was made on the basis of clinical and EEG findings which are categorized in detail. Biochemical determinations used for the detection of "undue absorption of lead" were lead blood levels, urinary lead excretion, and delta-amino-levulinic-acid dehydratase (ALA-D) concentration in erythrocytes, considering a positive diagnosis of lead intoxication upon the finding of decreased enzymatic activity plus values higher than normal for lead blood levels or lead excretion in urine.

Significant improvement in the EEG abnormalities and/or the number of seizures has been observed in these five patients after specific treatment of their plumbism, without changes being made in the concomitant anticonvulsant therapy. Two patients are free of seizures and their EEGs became normal. Two other patients had only one seizure in the last year and their EEGs now show only sporadic spike foci.

These findings open new possibilities for etiological diagnosis and therapeutic approach for some of the patients with chronic epileptic encephalopathies with slow spike-and-wave discharges in the EEG.
Validity of Neonatal Blood Pressure Obtained By The Manometric Method
Authors: Leake Rosemary D. , Williams Paul R. , Oh William
Published: December 2021

In neonatal intensive care units where direct arterial blood pressures obtained via a transducer are unavailable, a fluid-filled spinal manometer has been used. The latter method is practical and convenient although its validity has not been confirmed. This study is designed to establish the precise relationship between the blood pressure obtained by the manometric method and by direct recording via the arterial transducer.

Materials and Methods

Eleven infants with umbilical artery catheters in place 1 to 2 cm above the diaphragm were selected for the study. In all instances, the arterial catheters were placed for clinical management of various illnesses.
Letters to the Editor
Authors: Metcalf Thomas J.
Published: December 2021

Drs. Piomelli et al.1 propose the free erythrocyte protoporphyrin (FEP) test as a screen for "undue lead absorption." With the backing of Dr. Chisolm's Commentary,2 the FEP test may become the method of choice for screening population at risk for lead toxicity.

I would like to suggest three points of caution: (1) By defining "undue risk" in terms of "ambiguous levels" of 40 to 59µg/100 ml of whole blood lead, the authors may miss the significant number of children shown by Drs. de la Burdé and Choate3 to have behavioral and fine motor deficits after asymptomatic lead exposure (> 30 to 40µg/100 ml with radiological evidence of ingestion).
Letters to the Editor
Authors: Piomelli Sergio , Davidow Bernard , Guinee Vincent F.
Published: December 2021

Drs. McLaren et al. and Dr. Metcalf suggest that a threshold value of 250µg/100 ml RBC may be too high for a positive FEP. A threshold of 100µg/100 ml RBC, however, seems to us far too low since in children 1 to 6 years with blood Pb ≤ 20µg/100 ml the mean FEP level is higher (79 ± 26µg/100 ml RBC) than in adult males (47 ± 15µg/100 ml RBC). With a threshold of 160µg/100 ml RBC (= mean + 3 standard deviations), the FEP test identifies all samples with blood Pb ≥ 60µg/10O ml, 87% of those 50 to 59µg/100 ml, 72% of those 40 to 49µg/100 ml but also 14% of those ≤ 39µg/100 ml.
LINEAR NEVUS SEBACEOUS SYNDROME: REPORT OF TWO CASES AND A REVIEW OF THE LITERATURE
Authors: Lovejoy Frederick H. , Boyle William E.
Published: December 2021

Two cases of linear nevus sebaceous syndrome are described and a review of the eleven cases now reported in the literature is undertaken.

The first patient has retardation, seizures, and classic ectodermal lesions while the second patient manifests typical cutaneous lesions and only an elevated cerebrospinal fluid protein as evidence of neurologic disease. The rationale for defining the syndrome as an entity distinct from other neurocutaneous syndromes is discussed and a pleomorphic presentation of the syndrome is suggested.
Cystic Astrocytoma of the Spinal Cord Presenting as an Acute Abdominal Crisis
Authors: Weichsel Morton E. , Knickerbocker Donald E. , Jakubiak Paul J.
Published: December 2021

A case of a spinal intramedullary cystic astrocytoma presenting with acute lower abdominal pain has been documented. The rarity of these initial symptoms in a spinal tumor has been noted and the difficulties in diagnosis of spinal cord tumors in childhood have been emphasized.
HEALTH EDUCATION
Authors: Rinker Andrew , Eldredge L. L. , Poncher John R. , Rogers Kenneth D. , Shackleford E. C. , Schell Norman B. , Sia Calvin C. J. , Smull Ned W. , Schneider Elsa , Shultz Carl S.
Published: December 2021

The American Academy of Pediatrics has long supported preventive health measures as part of comprehensive health care to all children and youth. Health education of children is an essential ingredient in the prevention of disease and the promotion of good health and optimal development.

Good health is a dynamic state of physical, mental, and social well-being which is influenced by many environmental and hereditary factors over which an individual exercises varying degrees of control. It is a constantly changing entity, and acquisition of good health should never be left to chance.

Many Americans do not understand, accept, or utilize current biologic, psychologic, and social knowledge. They obviously are not profiting from medical and technological achievements. The dissemination of general health information and its utilization for healthful living both need to be improved.

Parents and parental attitudes are the most important and basic elements of any successful health education program. Health education begins during infancy in the home, and the school is a supplementary and complementary element to the home experiences. Further development, correction, and reinforcement of knowledge, attitudes, and habits of health begun in early life should be among the essential objectives of formal education.

The pediatrician is experienced in caring for the total child and is well aware of personal and social tragedies that might have been avoided by adequate health education, therefore, he is especially sensitive to the need for optimal health education programs in the schools. Health education is a core element in comprehensive health care delivery. Understanding of this fact by schools and parents is essential if all children are to enjoy the good health and successful living potentially available to them.
FETAL MALNUTRITION IN WHITE NEWBORN INFANTS: MATERNAL FACTORS
Authors: Miller Herbert C. , Hassanein Khatab
Published: December 2021

Fetal malnutrition was diagnosed in white, full-term infants who had low ratios of birth weight to body length in the presence of characteristic physical signs of malnutrition and in the absence of clinical evidence of congenital defects and intrauterine infections.

The maternal factors significantly associated with fetal malnutrition included a poor maternal weight gain, lack of prenatal visits, the unmarried state, preeclampsia, chronic major illness, and obesity. Two or more of these six maternal factors occurred in 51% of pregnancies involving malnourished infants, and in 9% of pregnancies involving control infants.
MENTAL AND DEVELOPMENTAL MILESTONES OF NONINSTITUTIONALIZED DOWN'S SYNDROME CHILDREN
Authors: Melyn Michelle A. , White Delilah T.
Published: December 2021

Developmental data from 612 patients with Down's syndrome have been collected over a period of 20 years from an outpatient clinic for mentally retarded children. Ss' ages ranged from birth through 16 years, all being reared in their homes.

With higher percentages of children with Down's syndrome remaining in the home environment and eventually attending day care programs, questions naturally arise concerning the developmental expectations of such children. To answer some of these questions developmental information was abstracted from the clinical records and subjected to statistical analysis. These data include motor and language development and intellectual growth. Despite the limited sample developmental norms for children with Down's syndrome were established, which should prove useful in clinical evaluation.
Diagnostic Open Lung Biopsy in the Critically Ill Child
Authors: Roback Stacy A. , Weintraub William H. , Nesbit Mark , Spanos Panayiotis K. , Burke Barbara , Leonard Arnold S.
Published: December 2021

Forty-six open biopsies in 40 acutely ill children with rapidly decreasing pulmonary reserve were performed at the University of Minnesota Hospitals between January 1, 1970, and January 1, 1972. Tissue obtained was adequate in all patients and no serious complications ensued. Information obtained resulted in the change in treatment in 30 patients. This procedure is recommended over closed biopsy when the magnitude of the patient's illness and degree of pulmonary function do not allow acceptance of the risks known to occur with a closed biopsy technique and when histologic examination of lung tissue is required.
Unusual Case of Aminophylline Intoxication
Authors: Barter Bruce , Roberts Robert J.
Published: December 2021

Although aminophylline and ampicillin have completely different pharmacologic properties, both are employed in the treatment of certain respiratory illnesses such as bronchial asthma. The following case report involves an accidental aminophylline intoxication subsequent to an order for ampicillin being mistaken for aminophylline. Aminophylline blood levels were quantitatively determined during the hospitalization.

CASE REPORT

A 4-year-old female child weighing 17 kg, with a 24-hour history of croup-like symptoms, was admitted to a local hospital. She was febrile (39.2C) and listless with labored respirations and wheezing. The patient was placed in oxygen and mist and an order was written for ampicillin, 500 mg intramuscularly immediately, and 250 mg intramuscularly every six hours.
Triphalangeal Thumbs Associated With Hypoplastic Anemia
Authors: Jones Barbara , Thompson Havelock
Published: December 2021

Aase and Smith1 reported male siblings with congenital hypoplastic anemia and triphalangeal thumbs, and distinguished their disorder as an entity separate from Fanconi's pancytopenia and radial aplasia-thrombocytopenia. Recently, Murphy and Lubin2 described a third patient, also a male, with a similar thumb anomaly, aregenerative anemia, and several associated anomalies not present in the siblings described in the original report.

This report describes a fourth male patient with this syndrome and adds the data of an eight-year follow-up with hematologic response to prednisone therapy.

CASE REPORT

R.P. was initially evaluated at West Virginia University Hospital in 1964 at 10 years of age; he had a history of chronic anemia.
Encephalopathy Following CNS Prophylaxis in Childhood Lymphoblastic Leukemia
Authors: McIntosh Sue , Aspnes Gregg T.
Published: December 2021

In our clinic population of children with acute lymphoblastic leukemia an increased frequency of encephalopathy occurred during a 12-month period. During the same period no encephalopathy was observed in 23 leukemic children who had not received prophylactic central nervous system treatment but were receiving systemic chemotherapy. The reason for this high incidence of encephalopathy is far in excess of what has been reported from other centers employing similar CNS prophylaxis. Whether this reflects geographical differences in virus infection or other factors is not clear.

Encephalopathy in a leukemic child must be differentiated among infection, meningeal leukemia, toxic effects of intrathecal methotrexate, or unknown causes. Concurrent respiratory or gastrointestinal symptoms, normal intraspinal pressure, pleocytosis with no evidence of "blast" cells on careful examination of the cerebrospinal fluid, and exclusion of bacteria and fungal infection by appropriate stains and culture suggest a viral, protozoan, mycoplasma, or unknown etiology. Erroneous treatment with intrathecal methotrexate or irradiation may inhibit spontaneous recovery. In most cases the meningoencephalopathy is self-limited and requires only supportive care.

With the advent of new approaches to the therapy of childhood leukemia which have prolonged survival, complications and toxicities of therapy not previously appreciated will probably become apparent. Observation and reporting of such complications will be of benefit and interest to pediatricians who care for leukemic children and to their patients.
Interposed Advertising
Authors: Reader Invaded
Published: December 2021

Beginning with the July issue of Pediatrics, advertising pages are interleafed with textual pages. How was the decision, to intrude thus on the reader's "space," arrived at? Were those most affected polled for an opinion?

When the camel puts his nose in the tent it's time to yell: "Get out!"
Incubator Burns: A Hazard of Improperly Fitted Mattresses
Authors: Dweck Harry S. , Reynolds David W. , Cassady George
Published: December 2021

We bring attention to an incubator hazard responsible for thermal burns in a neonate.

A 2,280-gm black female born after 35 weeks' gestation was cared for in a non-servo-controlled incubator (Air Shields Model #C-86). Incubator temperature was maintained from 31.2 C to 32.7 C with maintenance of the baby's axilliary temperature between 36.5 C and 37 C.

Four days after birth while routine vital signs were taken, the baby's arm and leg were noted to extend beyond the mattress on to the supporting metal deck of the incubator.
A Hypothesis on the Etiology of Hyperactivity, With a Pilot Study Report of Related Nondrug Therapy
Authors: Henderson Arvin T. , Dahlin Irmeli , Partridge Cloyd R. , Engelsing Elizabeth Lyman
Published: December 2021

The growing number of hyperactive children in our practices has caused many of us to look about for alternatives to medication therapy. Our recent experience in one such technique prompts this letter. We hypothesize that hyperactivity may make its first appearance in the toddler or preschool child, but is detectable from early infancy. The tense, colicky, hypertonic infant seems to be the infantile precursor to the hyperactive older child. We consider that both are the result of a chronic state of arousal manifested in these children as increased activity level and muscular tension and later by frantic limit testing at home and behavior and learning problems at school.
The Genetic, Metabolic and Developmental Aspects of Mental Retardation, by Robert F. Murray, Jr., M.D., M.S., F.A.C.P., and Pearl Lockhart Rosser, M.D., F.A.A.P. Springfield Illinois: Charles C Thomas, 1972, 343 pp., $16.75
Authors: Kolodny Edwin H.
Published: December 2021

At first glance, I expected this text to be another in the growing list of recently published atlases of mental retardation. If so, then the authors would probably have neglected to include the numerically most common causes of mental subnormality, namely, malnutrition and cultural deprivation. The emphasis in this text, however, is not in cataloguing. Rather, it is in providing an overview of the full range of diagnostic and educational possibilities for the child with mental deficiency.
Indian Health Services, Continued
Authors: Kohen Daniel P. , Yost Gerald , Lyle Jerry
Published: December 2021

We applaud Dr. Edward Mortimer's Commentary on the health status of the American Indian population (Pediatrics, 51:1065, 1973). Public statements that "Indian health care is inadequate because it is inadequately funded" and ". . . less than the minimum (money) is provided" are long overdue, and we concur completely with the necessity for us all to help Indians express and fulfill their health needs.

We wish, however, to take issue with several remarks regarding the quality and scope of care provided in and through the Indian Health Service.
RHEUMATOID SERA AND SOLUBLE COMPLEXES: NITROBLUE TETRAZOLIUM DYE TEST AND HEXOSE MONOPHOSPHATE SHUNT ACTIVATION
Authors: Pachman Lauren M. , Jayanetra Panida , Rothberg Richard M.
Published: December 2021

An increased number of cells containing reduced dye in the nitroblue tetrazolium (NBT) test were observed when peripheral blood leukocytes of adult rheumatoid arthritis (RA) patients having rheumatoid factor (RF), as well as RF-negative pediatric RA patients were studied. Therefore, the relationship between soluble antigen -antibody complexes and NBT dye reduction following phagocytosis was investigated. After intravenous injection of 131I labeled bovine serum albumin (IBSA) into six rabbits, the mean onset of immune clearance was 8.2 days (range, 7 to 9). NBT-positive cells increased from control levels (3% to 10%) at four to six days and were maximal at six days. The mean maximal response was 35% (range, 22% ot 47%).

In vitro studies of the hexose monophosphate (HMP) shunt activity of human leukocytes exposed to BSA-anti-BSA complexes demonstrated a twofold to threefold stimulation in the range of slight antigen excess. Leukocyte NBT reduction was not consistently increased above that of the controls. However, when high titer RF sera was incubated with normal human leukocytes, maximal NBT responses were observed when the RF titer was 200 to 600 units (mean, 27%; controls, 2% to 8%) and 14CO2 evolution via the HMP shunt was accelerated. RF-negative sera from children with RA elicited a slight increase in NBT-positive cells and a definite increase in 14CO2 evolution was observed.

It was then concluded that soluble antigen-antibody complexes in slight antigen excess altered hexose monophosphate shunt activity and increased NBT dye reduction. The NBT-positive cell in RA may be due to phagocytosis of RF accompanied by metabolic activation.
ANXIETY IN THE DYING CHILD
Authors: Spinetta John J. , Rigler David , Karon Myron
Published: December 2021

Twenty-five leukemic children aged 6 to 10 years related significantly more stories that contained elements of preoccupation with threat to their body integrity and functioning than did 25 control children with nonfatal chronic illnesses. Although they made no overt reference to the concept of death, the children with fatal illness showed an awareness of intrusion into their body integrity and functioning, and expressed a greater degree of both hospital-related and nonhospital- related anxiety than did the children in the control sample.

The fatally ill child of 6 to 10 years appears to be aware of the seriousness of his illness, even though he may not yet be capable of talking about this awareness in adult terms.
Prodromal Arrhythmias Preceding the Onset of Paroxysmal Supraventricular Tachycardia in a Newborn
Authors: Silver Walter , Joos Howard A. , Lamazor Eugene , Nussbaum Arnold
Published: December 2021

A case of PST in a newborn is presented which was immediately preceded by apparent prodromal arrhythmias. The infant had a fracture of the right clavicle and was delivered by mid-forceps. The importance of electrocardiographic monitoring of rhythm disturbances is emphasized.