bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Chronic Salt and Water Loading on the Tubular Defects of a Child With Fanconi Syndrome (Cystinosis)
Authors: Arant Billy S. , Greifer Ira , Edelmann Chester M. , Spitzer Adrian
Published: December 2021

A male child discovered to have cystinosis and Fanconi syndrome at the age of 2 years 8 months was hospitalized repeatedly for episodes of hyponatremic, hypokalemic dehydration and acidosis. Attempts to correct the fluid and electrolyte abnormalities by increasing progressively the supplements of sodium chloride, sodium bicarbonate, and potassium chloride resulted only in an exacerbation of the symptoms.

Tests of discrete renal functions and metabolic balance studies disclosed that, although all disturbances were expressions of the primary disease, their severity was enhanced considerably by the extracellular volume expansion induced by the vigorous therapy. Restriction in water intake resulted in an improvement in the renal performance and in the clinical condition.
Prolonged Pneumococcal Meningitis Due to an Organism With Increased Resistance to Penicillin
Authors: Paredes Abel , Taber Larry H. , Yow Martha D. , Clark Dorothy , Nathan William
Published: December 2021

For more than 30 years, penicillin has been the agent of choice for pneumococcal infections. During this time the majority of strains of Streptococcus pneumoniae have been highly susceptible to penicillin. However, during the last ten years there have been sporadic reports of pneumococci with increased resistance to penicillin. The case report of an 18-month-old white boy with meningitis due to a strain of S. pneumoniae with increased resistance to penicillin is presented. The MIC of the organism to penicillin was 0.2µg/ml and the MBC 0.39µg/ml. The patient had normal immunity and no demonstrable sequestered focus of infection but failed to respond to appropriate doses of intravenous penicillin. Treatment with chloramphenicol caused a dramatic bacteriologic and clinical response. This experience reemphasizes the existence of pneumococcal strains of intermediate penicillin sensitivity and the importance of in vitro susceptibility tests.
Air Lead and Blood Lead Levels in Children
Authors: Hower J. , Prinz B. , Gono E.
Published: December 2021

We read with great interest the communication by F. J. deCastro and co-workers,1 indicating the influence of air lead on blood lead levels in children.

Azar et al.2 have shown that in taxi drivers there is indeed a correlation between air lead and blood lead levels. Similar results were obtained by Knelson and Bridbord.3

We are carrying out systematic investigations on the significance of lead emission for mother and neonates in the highly industrialized Rhine-Ruhr area.4
Knowledge About and Attitudes Toward Genetic Screening Among High-School Students: The Tay-Sachs Experience
Authors: Clow Carol L. , Scriver Charles R.
Published: December 2021

High-school students (ages 15 to 18 years; No. = 930) taking biology in their curriculum were surveyed (the first survey), in the classroom, for their knowledge and attitudes about Tay-Sachs disease and other "public" issues in genetics. High-school students now constitute 38.9% of those screened for the Tay-Sachs gene in the Montreal program and the participation rate is 75% among eligible Jewish students. Knowledge and attitudes about the screening experience were also surveyed (the second survey) in a sample (No. = 120) containing equal numbers of carriers and noncarriers matched for sex and age. The response rate was 75% in the second survey.

The first survey revealed that the level of knowledge about Tay-Sachs disease is high among students, only 28% percent of whom were Jewish. Students have a very positive attitude toward genetic screening in general. These findings are associated with an effort to expand the human genetics content in the biology curriculum.

The second survey revealed a favorable attitude toward the screening experience and the self-knowledge obtained among screened students. The screening clinic in the schools, and literature provided by the screening authority, was an effective source of knowledge about the significance of Tay-Sachs heterozygosity. Carriers experienced initial anxiety; later attitudes were similar in carrier and noncarriers. Self-image was unchanged in 90% and diminished in 10% of carriers and enhanced in 10% of noncarriers. Heterozygous students perceive information about their genetic status as useful to themselves and 95% want to know the genotype of an intended spouse; 88.4% would marry a carrier and only 11.6% would "reconsider."

These findings encourage us to emphasise high-school screening as the preferred program in our community and to offer it as an effective aid to the physician faced with increasing demands in medical genetics. It is also an effective model for teaching some genetics and human biology in the schools.
Hypo-Hyperparathyroidism: Evidence for a Defective Parathyroid Hormone
Authors: Connors Matthew H. , Irias Julian J. , Golabi Mahin
Published: December 2021

Biochemical evidence for hypoparathyroidism and roentgenographic evidence for hyperparathyroidism were present in a 7-year-old girl with seizures and tetany. She was hypocalcemic (4.7 mg/dl), hyperphosphatemic (11 mg/dl), and normomagnesemic, with elevated parathyroid hormone level (2,603 pg/dl and 3,693 pg/dl in immunoassays utilizing two different antisera). Somatic features of pseudohypoparathyroidism were absent. Increased serum alkaline phosphatase activity (335 IU/liter) with evidence of subperiosteal bone resorption suggested parathyroid hormone activity on bone. Intramuscular administration of parathyroid extract caused a rise in serum calcium level (9.6 mg/dl) and a fall in serum phosphorus level (7.9 mg/dl). The serum calcium, phosphorus, and alkaline phosphatase activity became normal during vitamin D therapy. Parathyroid hormone values and bone roentgenograms became normal. With serum calcium and phosphorus levels normal, ethylenediaminetetraacetic acid infusion was followed by an increase in plasma parathyroid hormone level but not in urinary cyclic adenosine monophosphate (AMP) or phosphaturia; in contrast, parathyroid extract induced cyclic AMP excretion and phosphaturia. These results suggest that endogenous parathyroid hormone in this patient affects bone resorption but not renal handling of phosphate. We infer that this represents a defective endogenous parathyroid hormone.
Lipids and Lipoproteins in 927 Schoolchildren, Ages 6 to 17 Years
Authors: Morrison John A. , deGroot Ido , Edwards Brenda K. , Kelly Kathe A. , Mellies Margot J. , Khoury Philip , Glueck Charles J.
Published: December 2021

To elucidate associations of age. sex, and race with plasma lipoproteins, and to provide percentile distribution data for pediatric lipoproteins, 927 (684 white, 243 black) fasting schoolchildren, ages 6 to 17 years, were studied. During ages 6 to 11 there were no significant changes in lipids or lipoproteins in any of the sex-, racespecific groups, and no consistent trends were evident. For ages 12 to 17 in both black and white male subjects, mean triglyceride levels were higher (P<.001) and mean high density lipoprotein cholesterol (C-HDL) lower than that for ages 6 to 11 (P<.03). Comparing white female subjects in age groups 6 to 11 and 12 to 17, triglycerides and C-HDL did not differ, but the older children had lower low density lipoprotein cholesterol (C-LDL) (P<.001). There were no significant lipid and lipoprotein differences between older and younger black female subjects. In both racial groups, during ages 6 to 11, females had higher mean triglyceride levels and lower mean C-HDL levels than males, but during ages 12 to 17 there were no significant male-female differences in lipids and lipoproteins. For both ages 6 to 11 and 12 to 17, and for both sexes, black children had higher C-HDL levels and lower triglyceride levels than white children. The percentile levels for lipoproteins should allow the practitioner to accurately assess lipoprotein levels in children and facilitate differentiation, in hypercholesterolemic children, among those whose hypercholesterolemia is primarily accounted for by elevated C-HDL, or by elevated C-LDL, who respectively may be at lower and higher risk for eventual development of coronary heart disease.
Clinical Significance of Monitoring Anterior Fontanel Pressure in Sick Neonates and Infants
Authors: Vidyasagar Dharmapuri , Raju Tonse N. K. , Chiang Julie
Published: December 2021

The intracranial pressure was monitored via the anterior fontanel, using a noninvasive technique, in 78 acutely ill, 39 normal term, and 6 normal preterm infants. In normal term and preterm infants the anterior fontanel pressure (AFP) was 10.2 ± 0.4 and 9.5 ± 0.8 cm H2O, respectively. Infants with hyaline membrane disease had elevated pressure (13.3 ± 0.6 cm H2O), which was higher than that of normal preterm infants. Following an episode of intracranial hemorrhage in four infants, the AFP increased to 26.2 ± 2.5 cm H2O, Elevated pressure was noted in infants with meconium aspiration syndrome (24.1 ± 1.8 cm H2O); the pressure decreased during the phase of recovery (15.6 ± 3.5 cm H2O). Elevated pressure was noted in infants with meningitis and hydrocephalus. Repeated measurements helped to diagnose shunt obstruction in an infant with hydrocephalus.
Anti-Trisers—Where Are You?
Authors: Crikelair George F.
Published: December 2021

In the 1960s some of us wondered why so many children were deformed and killed from burning nightwear. We started a campaign to get the medical profession and industry and government interested in the problem. What happened? Three examples from the literature: (1) McLaughlin et al1 reported that in 1969 through 1973, 32% of children's burns resulted from sleepwear; in 1976, 4%; (2) Jay et al2 reported that "Direct ignition of clothing was a rare cause of burn injury in children ... " (3) In 1975, I reported saved lives to the Information Council on Fabric Flammability.3
Neonatal Necrotizing Enterocolitis Associated with Penicillin-Resistant, Toxigenic Clostridium butyricum
Authors: Sturm Randall , Staneck Joseph L. , Stauffer Larry R. , Neblett Wallace W.
Published: December 2021

The cause of neonatal necrotizing enterocolitis (NEC) is unknown. An association between NEC and clostridial infection has been reported from several centers, but the organisms have not been extensively characterized. Clostridium butyricum was isolated from the peritoneal fluid and cerebrospinal fluid of a neonate with NEC. The organism was resistant to the penicillins, but sensitive to vancomycin. Toxin production was demonstrated. Although the role of clostridial toxins in the pathogenesis of NEC is unknown, clostridial toxins are well established as the causes of two other intestinal diseases (antibiotic-associated pseudomembranous colitis and pig-bel). Further investigation of the role of clostridia in the pathogenesis of NEC and of the use of oral, nonabsorbable antibiotics in the treatment of NEC is needed.
Central Nervous System and Facial Defects Associated with Maternal Hyperthermia at Four to 14 Weeks' Gestation
Authors: Pleet Helaine , Graham John M. , Smith David W.
Published: December 2021

An analysis of 28 dysmorphic offspring with a retrospectively ascertained history of maternal hyperthermia during the first trimester of pregnancy showed a similarity in their pattern of CNS dysfunction and facial dysmorphogenesis. All survivors had mental deficiency and most of them demonstrated altered muscle tone, including hypotonia with increased deep tendon reflexes. Those exposed at four to seven weeks' gestation showed an increased prevalance of facial dysmorphogenesis. The duration of the high fever was usually one or more days, an unusual occurrence during the first trimester of pregnancy. The nature of these defects in relation to the relative timing of hyperthermia exposure is similar to that previously noted in animal studies. The morphogenetic implications of these findings are explored and the need for larger, controlled studies is suggested.
EIGHTH CENTURY IRISH RULES REGARDING THE CARE OF A SICK PERSON
Authors: C. T. E.
Published: December 2021

An early eighth century Irish manuscript contained the following sensible rules for the care of a sick person.

No games are played in the house.

No tidings are announced.

No children are chastised.

Neither women nor men exchange blows.

There is no fighting.

The patient is not suddenly awakened.

No conversation is held across him or across his pillow.

No dogs are let fighting in his presence or in his neighborhood outside.

No shout is raised.

No pigs grunt.

No brawls are made.

No cry of victory is raised. Nor shout in playing games.

No shout or scream is raised.
Prolonged Prostaglandin E1 Infusion: Histologic Effects on the Patent Ductus Arteriosus
Authors: Cole Roger B. , Abman Steven , Aziz Kalim U. , Bharati Saroja , Lev Maurice
Published: December 2021

An infant with Ebstein's malformation of the tricuspid valve and severe pulmonic stenosis under-went a 39-day course of prostaglandin E1 infusion, and a histologic study of the ductus arteriosus was undertaken after autopsy. There were marked alterations in the ductal and juxtaductal structures following this prolonged infusion of prostaglandin E1. The internal elastic lamella of the ductus was disrupted in many areas. The media showed widespread areas of disruption with cavity formation. The adventitia adjacent to the junction of the ductus with the pulmonary artery was thickened and infiltrated with mononuclear cells. The nerve trunks in the adventitia were markedly infiltrated with mononuclear cells and showed cavitation as well as considerable surrounding edema. Mucopolysaccharides were increased throughout the ductus. These changes produced increased fragility of the ductal and juxtaductal structures, thus increasing the likelihood of spontaneous aneurysms and rupture, or of tearing or rupture at the aortic and pulmonary junctions at the time of surgical closure of the ductus. Unusual fragility of the ductus, pulmonary artery, and aorta has been observed during ligation of the ductus following prostaglandin E infusions lasting seven and ten days. Additionally, another patient who had received prostaglandin E infusion for six days demonstrated aneurysmal fullness to the ductus arteriosus at autopsy. The histologic findings and intraoperative experience in this study suggest that there may be a real danger of spontaneous neous or surgically related rupture of the ductus arteriosus after prolonged infusion of prostaglandins.
Aplastic Anemia in Down's Syndrome
Authors: Weinblatt Mark E. , Higgins Gussie , Ortega Jorge A.
Published: December 2021

A child with Down's syndrome was seen with pancytopenia and was found to have an aplastic bone marrow. None of the known contributing etiologies of aplastic anemia could be identified in this patient. This is the first reported case of the simultaneous appearance of these two disorders.
EARLY VIABILITY OF THE FETUS—AN EXTRAORDINARY CASE (1845)
Authors: C. T. E.
Published: December 2021

Mid-nineteenth century medical journals frequently published single case reports of premature births. Precise physical measurements, or even gestational age, of the infant were rarely cited. Dr. William Kennedy of New Orleans who reported the following case was said to have been an outstanding and completely reliable physician. He was referring to the Civil War when he wrote, "my library and every vestige of household material passed from my possession under the ruthless hand of destructive war."

In 1845, Mrs. A.B., primipara, suffered, as she thought, during one whole night with colic. I saw her next morning, when I recognized that she was in labor, which had progressed so far that I made no attempt to arrest it. Within a half hour after my arrival she gave birth to a foetus. It was not more than eight inches long, and was as red as a piece of raw beef. True dermoid tissue could not be said to be organized, its general investiture being so delicate a membrane, as it were, that the eye could look through it on the tissues beneath. The eyes were still closed; there was no trace of cilia or supercilia; its chest was about two inches broad; the arms and legs were very slender, and the toes and fingers devoid of any traces of nails. The head was about the size of a small orange. The respiration was so feeble as scarcely to be perceptible, and not a sound was uttered after birth. I was almost afraid to handle it, as I could not divest myself of the idea that the slightest pressure of the fingers would thrust them into the soft, red, jelly-like mass before me.
Diet and Hyperactivity
Authors: Rapp Doris J.
Published: December 2021

The analysis of the entire problem of food and hyperactivity (Pediatrics 66:521, 1980) leaves the average pediatrician with more questions than answers. Let us just suppose for a minute that a child is sensitive to sugar and wheat as well as food coloring. If the control cookie has wheat and sugar, will no difference be seen when the test cookie is ingested, especially if the test cookie contains less food coloring than the child normally ingests? Children are individuals.
Progressive Expanding Congenital Porencephalies: A Treatable Cause of Progressive Encephalopathy
Authors: Tardieu Marc , Evrard Philippe , Lyon Gilles
Published: December 2021

In congenital porencephalies, diverticulation of the lateral ventricle is a dynamic process producing compression and stretching of the brain tissue bordering the diverticulum, bulging of the overlying skull, macrocephaly, and occasionally progressive neurologic signs (hemiplegia, raised intracranial pressure), even when the rest of the ventricular system is not dilated and the CSF pressure is normal. Ventriculoperitoneal shunting can result in remarkable improvement of focal motor deficits and may apparently also play a beneficial role on further mental development. Successive computed tomography scans demonstrate that the brain parenchyma, which had been stretched by the porencephalic pouch, is capable of regaining near normal thickness. Congenital porencephalies are initiated by a limited destructive brain lesion, but the gradual expansion of the ventricular herniation may imply a mechanism identical to that which has been postulated in normal pressure hydrocephalus. Nine cases of unilateral "expanding" congenital porencephalies are presented and the treatment of this condition is discussed.
Hemorrhagic Periventricular Leukomalacia: Diagnosis by Real Time Ultrasound and Correlation with Autopsy Findings
Authors: Hill Alan , Melson G. Leland , Clark H. Brent , Volpe Joseph J.
Published: December 2021

Hemorrhage into areas of periventricular leukomalacia may occur and range in size from microscopic to massive. Hitherto, the definitive diagnosis has been made only at autopsy. A case is described in which the diagnosis of hemorrhagic periventricular leukomalacia was made antemortem by real-time ultrasound scanning and confirmed at autopsy. Periventricular/intraventricular hemorrhage, a more common hemorrhagic lesion, may extend into periventricular white matter in a location ventral and medial to hemorrhagic periventricular leukomalacia. Real-time ultrasound scanning is a safe and reliable means of defining the topography of these two hemorrhagic lesions and, thereby, of suggesting the correct diagnosis.
Sudden Unexpected Death During Central Hyperalimentation
Authors: Franciosi Ralph A. , Ellefson Ralph D. , Uden Donald , Drake Robert M.
Published: December 2021

Two infants and one child died suddenly and unexpectedly while receiving central venous hyperalimentation. The catheter tip in each case was wedged against myocardium resulting in myocardial necrosis and pericardial effusion. The importance of avoiding intracardiac indwelling hyperalimentation catheters is stressed.
Chronically III Hospitalized Children's Concepts of Their Illness
Authors: Brewster Arlene B.
Published: December 2021

This study investigates the relationship between cognitive development and children's understanding of the cause of illness, intent of medical procedures, and role of the medical staff. A group of 50, chronically ill hospitalized children of normal IQ, aged 5 to 12 years, was given five tasks, scored in ascending order of cognitive maturation. Results indicated a correlation coefficient of responses (P <.01) among tasks. Analysis of variance yielded an age-related maturation of responses (P <.01). No significant difference in level of response beween high and low affect tasks was found. There was a three-stage sequence of conceptual development in understanding cause of illness: (1) illness is caused by human action; (2) illness is caused by germs; (3) illness is caused by physical weakness or susceptibility. A parallel three-stage sequence of understanding of the intent of medical procedures was discerned: (1) the child views procedures as punishment; (2) he/she correctly perceives the procedures, but believes that the staffs empathy depends on the patient's expressing pain; (3) the child can infer both intention and empathy from the medical staff. Specific illness, sex of the child, and length of hospitalization did not affect the child's level of response. Children process information about their illnesses through a predictable maturational cognitive sequence which medical staff members must address for comprehension to occur.
Hyponatremia and Seizures
Authors: Weir Michael R.
Published: December 2021

I was pleased to read the report by David et al1 concerning young infants who developed hyponatremia with seizures. I reported three such cases that appeared to be due to inappropriate secretion of antidiuretic hormone (SIADH).2 David et al1 argued that all of their cases were due to SIADH and presented convincing evidence in three (cases 1, 7, and 8). However, case 6 demonstrated low levels of arginine vasopressin (AVP) and urine sodium concentration. These findings suggest an intake of water greater than the renal excretory capacity.
Pertussis Vaccine: Still an Open Question?
Authors: Shaw Edward B.
Published: December 2021

The Public Health authorities in Britain have decided that pertussis vaccine is less risky at early ages than the whooping cough infection. This vaccine is usually given together with diphtheria, tetanus, and poliomyelitis vaccine. Only the pertussis component involves a significant risk of reaction; however, its use at an early age is believed to protect against the greater severity of the disease in infancy.

Because of the severity of the adverse reactions, this vaccine is not recommended for routine use past ages 5 to 7 years.
Tube Size, Lavage, and Emesis
Authors: Weir Michael R. , Patterson Harlan S.
Published: December 2021

Conventional wisdom holds that lavage and emesis are equally effective in gastric emptying and ingestant removal.1 An observation made at this institution during an epidemic of Jimson week ingestion may be of some consequence. Emergency room personnel and pediatric house officers noted that if lavage were performed following ipecac-induced emesis, significant amounts of recognizable material (seeds, stems, leaves, roots, etc) could be removed.2 The effectiveness of the emesis may have been diminished by the atropine-like activity of Jimson weed; however, productive lavage after emesis has been observed with such frequency in other ingestions, that delayed gastric emptying due to an anticholengergic effect seems not to be reason for the productive results.
THE PRESIDENT'S PAGE
Authors: BEAVEN PAUL W.
Published: December 2021

DURING this year this space will be used, as it was last year, to inform members of the plans which have been formulated by the Executive Board and the President to enlarge the usefulness of our organization. It is not possible nor is it desirable to describe in a single page any program for the coming year. Furthermore, such a program may have to be changed. Therefore, you are asked to turn to this page every issue, for an attempt will be made to keep you informed of those developments which your officers consider vital.

When you receive your Blue Book, you will note many changes. Dr. Clifford G. Grulee is no longer the Secretary-Treasurer but is now Executive Secretary. He will remain in that capacity until his retirement July 1st. Dr. Einor H. Christopherson is at the present time without portfolio but will, after July 1st, be Executive Secretary. He made a deep impression on those who met him in Chicago. He is not given to making quick pronouncements, and he will not talk until he is acquainted with our program. For the most part he listened and thought. Those of us who got to know him best felt that he was made for the job he is about to undertake.

You will note also that Mrs. Jewel Bundy is the new Business Manager. We could not have found anyone who knows the Academy business better. In addition, she is universally liked by every member. Dr. Grulee will act as Treasurer. Dr. William J. Orr, who is the new Program Chairman, was the first choice for this position of all those I consulted. It is also a fact that the Executive Board has been enthusiastically unanimous in making these appointments.
SPECIAL ARTICLE
Authors: HEWITT RICHARD M.
Published: December 2021

PHYSICIANS commonly complain that many of the characters projected from stereopticon slides at medical meetings are too small to be read. One physician had been sufficiently annoyed by illegible projections to suggest that an exhibit be prepared to demonstrate the causes of, and the remedy for, the difficulty. This was done.

The main parts of the exhibit were two frames (Figs. 1 and 2). Figure 1 was intended to demonstrate that, as the number of characters in the copy becomes smaller, each projected character becomes larger and thus more legible.

Figure 2 was planned to help the speaker who might object: "True. But what I have to present takes a lot of characters; what can I do about that?" Herein figure 2 is broken down to the essentials of the four panels of which the frame was composed.

A subsidiary part of the exhibit had to do with what might be dignified as the related forensics. It occupied the two wings of the booth. On one wing appeared the jingle:

He never was heard

And never was seen,

Who turned in the dark

And read from the screen.

On the other wing, the corresponding rhyme read:

His audience yawned,

It squirmed and it sighed;

He constantly put

Too much on a slide.

It may be helpful to add that a detailed table, suitable for publication, may be unsuitable for a slide. Slides are exhibits, and one principle of exhibiting is to eliminate all possible reading matter.
COMPRESSION OF THE TRACHEA OR ESOPHAGUS VASCULAR ANOMALIES
Authors: GROSS ROBERT E. , NEUHAUSER EDWARD B.D.
Published: December 2021

Description is given of five different types of anomalies of the great vessels in the superior mediastinum which can produce compression of the esophagus or trachea (or both). These malformations of the vascular system can give rise to difficulties in swallowing and to serious disturbances in pulmonary ventilation. These anomalies include double aortic arch, right aortic arch with a left ligamentum arteriosum, anomalous innominate artery, anomalous left common carotid artery, and an aberrant subclavian artery.

The various symptom complexes which can be found with these anomalies are described. Endoscopic visualization of the interior of the esophagus or trachea gives valuable information in some cases. The investigation of these subjects should include fluoroscopic and film studies of the esophagus and trachea by contrast media. Data gathered from such roentgenologic examinations usually give a fairly clear idea of the type of vascular anomaly which is present.

It is possible to attack surgically each of these vascular malformations. In general, the esophagus or trachea can be relieved by division of an anomalous vessel or by displacement of an artery in such a manner that it is carried away from the compressed structure. When necessary, these operative procedures can be undertaken in very young babies, even in the presence of a high degree of respiratory obstruction. All the operations have been through a left anterolateral, transpleural approach, under general anesthesia with a closed system. The results of operation in 40 patients are analyzed.

It is evident that many vascular anomalies in the thorax which disturb the functions of the esophagus or trachea can now be treated with an excellent chance of relieving the obstructive symptoms.
ACUTE HEMOLYTIC ANEMIA RELATED TO NAPHTHALENE
Authors: SCHAFER WILLIAM B.
Published: December 2021

A case of acute hemolytic anemia in a newborn infant apparently due to naphthalene poisoning is reported. It is thought that absorption through the oiled skin occurred following repeated exposure to diapers which had been stored in naphthalene mothballs and moth crystals.
AUREOMYCIN IN THE TREATMENT OF MOLLUSCUM CONTAGIOSUM
Authors: VOTTELER ROBERT E.
Published: December 2021

A 20 mo. old white female infant was admitted to the hospital because of a skin rash which had appeared 2 wk. before and was becoming rapidly worse. Also there was a history of eczema appearing at the age of 2 mo. This had responded to treatment with a milk substitute and had not been present for the past few months.

On examination there was extensive involvement of the entire body, most marked on the extremities and genital areas, by waxy, whitish umbilicated papules from each of which a mucoid plug could be expressed. Some areas were excoriated from scratching. Physical examination was otherwise not significant. The blood count and urinalysis were normal.

Smears from 1 of the lesions stained with hematoxylin and eosin showed uniform homogeneous structures indicative of molluscum contagiosum.

Treatment was started with aureomycin 250 mg. every 6 hr., and moist boric acid protective dressings. One day after treatment was started the papules had begun to exfoliate and disappear. In 2 days the typical lesions had completely disappeared leaving a circular macular reddish base. On the fifth day the site of the papules had become pigmented and dry.

Some nausea was noted and aureomycin ointment substituted.

The infant was discharged on the seventh day with only small faint pigmented macules remaining.
POSTINOCULATION POLIOMYELITIS
Authors: FABER HAROLD K.
Published: December 2021

POLIOMYELITIS following immunizing injections of presumably sterile material has occasionally been reported since 1921, as well as after Jennerian vaccination, but until quite recently the occurrence has been considered so rare as to have little practical significance. The publication in 1950, however, of four papers, three from England (London) and one from Australia, in which about 100 cases of this sort were reported, nearly all in young children, and of an editorial in the Journal of the American Medical Association has suddenly increased interest in the subject and made it a matter of general concern to practicing physicians, particularly pediatricians.
EFFECT OF DEHYDRATION PRODUCED BY WATER DEPRIVATION, DIARRHEA AND VOMITING ON RENAL FUNCTION IN INFANTS
Authors: CALCAGNO PHILIP L. , RUBIN MITCHELL I.
Published: December 2021

Dehydration when of sufficient severity depresses the glomerular filtration rate significantly. The high inulin and creatinine U/P ratios during dehydration indicate water conservation by the tubules. Depressed glomerular filtration rates may enhance this mechanism.

The tendency to the lower than expected rise in U/P ratio with low urine flows during dehydration in diarrheal disease suggests disturbed tubular mechanism for water reabsorption.

Glomerular filtration rate is rapidly restored with the intravenous administration of fluid. Restoration to normal values may proceed at a slower pace in the sick infant.
VITAMIN E BLOOD LEVELS IN PREMATURE AND FULL TERM INFANTS
Authors: WRIGHT STANLEY W. , FILER LLOYD J. , MASON KARL E.
Published: December 2021

Newborn infants showed serum tocopherol levels approximately one-fifth those of the maternal levels.

During the first six days after birth, the serum tocopherols of breast-fed infants increased much more rapidly than those of bottle-fed infants. These differences were still evident at 1 to 4, and at 5 to 8, months of age.

Premature infants fed an artificial formula low in vitamin E showed a rapid decline in serum tocopherol levels.

These studies confirm and amplify other evidence that placental transfer of vitamin E is decidedly limited while mammary transfer is much more extensive.
OUTBREAK OF AEROBACTER INFECTIONS ON INFANTS' WARDS
Authors: SMITH MARGARET H. D. , LOOSLI CLAYTON G. , RITTER MERLE H.
Published: December 2021

In the course of a study on the control of airborne infection by means of triethylene glycol vapor, there occurred an outbreak of infection due to a previously undescribed encapsulated gram-negative rod.

The morphologic and cultural characteristics of this organism place it in the Aerobacter-Klebsiella group. It was readily identified by its ability to show capsular swelling in the presence of sera against types 23 and 32 pneumococcus. Serologic studies showed it to be antigenically related to certain other strains of encapsulated, gram-negative rods, but not to Friedländer's bacillus, H. influenzae, meningococcus or pneumococcus other than the types mentioned above.

Some of the patients who acquired the organism developed mild respiratory infections or diarrhea, accompanied by fever, but most remained asymptomatic.

The organism spread in epidemic fashion on both glycolized and control wards and was recovered from the nasopharynx of 50 patients out of a total of 361 included in the study, also from numerous nurses, attendants and visitors. In the course of the epidemic the ward environment (air, dust, furniture, bedclothes, etc.) became heavily contaminated. It is postulated that patients with profuse nasal discharge and diarrhea may have served to infect the ward environment, which in turn served as the source of infection to other patients.
RELATION OF O2 CONSUMPTION TO CIRCULATION IN DIFFERENT STAGES OF INFANTILE MALNUTRITION
Authors: KERPEL-FRONIUS E. , VARGA F. , VÖNÖCZKY J. , KUN K.
Published: December 2021

The relation of O2 consumption to circulation was studied in varying stages of infantile malnutrition. In severe "dystrophy" O2 consumption and circulation are somewhat increased. In severe "atrophy" both cardiac output and O2 consumption fall to lower values, the lowered metabolic need of the tissues, however, being met by even a slower circulation. The condition is similar to that found in hypothyreotic patients. In athrepsia circulation collapses far below the metabolic need of the wasted organism; anoxia of the stagnating type ensues. Anoxia is, however, milder than in severe anhydremic circulatory shock, because the metabolic need of the tissues has decreased during the long atrophic and inanition period that preceded the terminal, athreptic stage of malnutrition. The poor circulation of the severely marantic infant may be an important factor in the high mortality rate when such patients suffer intercurrent infections, especially in pneumonia and diarrheal disease.
AURICULOTEMPORAL SYNDROME
Authors: PFEFFER WILLIAM , GELLIS SYDNEY S.
Published: December 2021

The auriculotemporal syndrome is described. It consists of sweating and redness of the cheek brought on by eating in a person who has sustained injury to the auriculotemporal nerve in the region of the parotid gland. A case of the auriculotemporal syndrome is reported in a child following parotitis of the newborn infant treated by incision and drainage.

The basic etiology of the syndrome is unknown. Certain physiologic considerations are discussed. The condition is benign, nonprogressive and one in which surgical division of the auriculotemporal nerve should be curative. Surgical interference in the parotid area should be avoided whenever possible to prevent the possible occurrence of the auriculotemporal syndrome.
The Use of Whole Cow's Milk in Infancy
Authors:   Committee on Nutrition
Published: December 2021

Breast-feeding with appropriate supplementation is the preferred method of feeding infants 6 to 12 months old. Although many mothers will continue to breast-feed or formula-feed their babies through the first year of life, there is at present no convincing evidence from well-designed research studies that feeding whole cow's milk after 6 months of age is harmful if adequate supplementary feedings are given.

Research to answer the crucial questions discussed here must be carried out before firm recommendations can be made concerning the age at which it is safe to introduce WCM in infants' diets. Until these questions can be answered, the following recommendations for feeding infants 6 to 12 months old pertain.

If breast-feeding has been completely discontinued and infants are consuming one third of their calories as supplemental foods consisting of a balanced mixture of cereal, vegetables, fruits, and other foods (thereby assuring adequate sources of both iron and vitamin C), whole cow's milk may beintroduced. The amount fed should be limited to less than 1 L daily. Most infants who are not breast-fed should be consuming a significant portion of their calories from supplemental foods after they are 6 months old; those who are not should be given an iron-fortified formula.

Reduced fat content milk is not recommended during infancy.
Hepatotoxicity from Isoniazid and Rifampin Among Children Treated for Tuberculosis
Authors: O'Brien Richard J. , Long Mary W. , Cross Floy S. , Lyle Mary Anne , Snider Dixie E.
Published: December 2021

To estimate rates of hepatotoxicity in the United States among children treated for tuberculosis, we conducted a retrospective survey of health departments and individual practitioners. We received 874 reports suitable for analysis of children treated during 1977 to 1979. A total of 16 hepatotoxic reactions were reported; 14/430 (3.3%) children receiving isoniazid and rifampin had a hepatotoxic reaction, which approximates the rate seen in adults taking these drugs. Half of the reactions occurred during the first month of therapy, and all of the well-documented reactions were noted during the first 10 weeks. Because the likelihood of hepatotoxicity may be increased with higher drug doses, limiting the dose of isoniazid to 10 mg/kg and that of rifampin to 15 mg/kg may help minimize hepatotoxic reactions. Because more serious disease, especially disseminated tuberculosis, may further increase the risk of hepatotoxicity, close monitoring of such children receiving isoniazid and rifampin should help minimize serious hepatotoxicity. Routine biochemical monitoring may not be necessary for all children, eg, those with mild forms of disease and those with normal pretreatment liver function who are treated with lower drug doses.
Bacterial Contamination of the Small Intestine as an Important Cause of Chronic Diarrhea and Abdominal Pain: Diagnosis by Breath Hydrogen Test
Authors: Davidson Geoffrey P. , Robb Trevor A. , Kirubakaran Chellam P.
Published: December 2021

Unsuspected bacterial contamination of the small intestine was indicated by breath hydrogen testing in nine patients aged 2 to 34 months during physical examinations for chronic diarrhea and abdominal pain. Elevated bacterial counts of questionable significance were found in duodenal aspirates before and after antibiotic treatment. There was no evidence of bile salt deconjugation or structural changes in the small intestine by light or electron microscopy. This may indicate that the site of colonization is distal to the biopsy site. Breath testing indicated lactose malabsorption in all patients, and four of five patients tested also malabsorbed sucrose. Duodenal disaccharidase levels in all patients were within the normal ranges, but in eight patients the lactasesucrase ratio was greatly elevated (0.80 ± 0.36; normal < 0.45). Dietary restriction alone did not cause complete cessation of symptoms, whereas all patients responded dramatically to oral antibiotic therapy. When patients were well, the lactase-sucrase ratio had returned to normal in those tested, and all nine had normal lactose and lactulose breath hydrogen tests. Unsuspected bacterial contamination of the small intestine, which is easily detected using the breath hydrogen test, may be more commonly associated with chronic diarrhea in children than has been previously realized. In such cases, therapy should be directed at removing the contamination.
Participation in Boxing Among Children and Young Adults
Authors:   Committee on Sports Medicine
Published: December 2021

The American Academy of Pediatrics opposes boxing in any sports program for children and young adults. Amateur boxing is potentially dangerous and yet youngsters are involved in boxing at ages 3 to 4 years. Approximately 15,000 boxers between ages 10 and 15 years are registered with the National Amateur Athletic Union (AAU) Junior Olympics boxing program.1 There may be an even larger number of young boxers in community organizations. Impoverished youths view boxing as a means of financial gain with the potential of providing a new life. Unfortunately, for many, it is a means of improving their physical condition at the risk of slow progressive brain injury, with occasional or no financial rewards. Other sports offer the same conditioning opportunity with minimal or no risk of brain injury.

In contrast to professional boxing, amateur boxing is apparently for prestige, recognition, and the enjoyment of winning. Proponents of boxing suggest that it teaches self-defense and discipline, that it builds character and confidence, and that it is relatively safe. Opponents of boxing stress that the principal goal is to render the opponent senseless.

Ironically, protective headgear may actually increase brain injuries.2 The degree of physical injury in boxing correlates with the physical strength and activity of the participants; the greatest risks exist when participants are obviously mismatched. The fatality rate in boxing is reported to be low.3 However, the frequency of chronic brain damage is an increasing concern in the medical community.1,4-8

Recent studies4-6 using computed tomography (CT) scanning have revealed brain injury in young boxers.
Heat Stress and School Closings
Authors:   Committee on School Health
Published: December 2021

During the last decade, the practice of opening public school in eary August has led to environmental stresses on students and teachers due to extremes of heat and humidity. In the South and Southwest, it is not unusual to have 15 to 20 days of 90°F(32.2°C) and relative humidity of 60% and higher during August. This puts a strain on teachers' and students' adaptability.

In surveying eight southern states, J. W. Trieschmann (unpublished data, 1983) found that the availability of air conditioning in public schools ranged from 15% in some states to 30% in others. The smaller, poorer, usually rural school districts had the least access to cooling equipment. Thus, a large school population is at the mercy of the elements. This is especially significant because the majority of this population has been acclimatized to air-conditioned homes and stores, and extremes of heat discomfort are not well tolerated.

Heat stress is defined as the overall effect of excessive heat on the human body. The important factors contributing to heat stress are air temperature, humidity, air movement, radiant heat, atmospheric pressure, physiologic factors (handicap or chronic disease), physical activity,1 and time exposure. Under normal conditions, temperature and humidity are the most important elements influencing comfort. The American Society of Heating, Refrigeration, Air Conditioning Engineers (ASHRAE) has published an index for determining heat stress based on human physiology, clothing, and standard room conditions.2 This index, called the "ET" or effective temperature (in Fahrenheit), is a measure of what hot weather feels like to the average person at different temperatures and humidities.
Brain Blood Flow
Authors: ROSENFELD CHARLES R.
Published: December 2021

To the Editor.—

Hansen and co-workers1 have taken the time to address a question of considerable import, ie, whether the use of Doppler continuous wave forms provides a means of reflecting changes in brain blood flow when the anterior cerebral artery is used. The question is important because of the conclusions that may result from the use of this technique in clinical research.2 Although Hansen et al report a high correlation and significant P value for the relationship between measurements of blood brain flow and the area under the velocity curve, peak systolic velocity, and end diastolic velocity, these are representative of nonlinear relationships as noted by the authors.
Brain Blood Flow
Authors: HANSEN NANCY B. , STONESTREET BARBARA S. , ROSENKRANTZ TED S. , OH WILLIAM
Published: December 2021

In Reply.—

We appreciate Rosenfeld's comments on our paper on the validity of Doppler measurements of anterior cerebral artery blood flow velocity. Rosenfeld raised two points regarding the validity of our correlation data between Doppler technique and cerebral blood flow measurements by the microsphere method. (1) Rosenfeld correctly pointed out that when we relate brain blood flow to any of the parameters obtained in the measurement of cerebral blood flow velocity, there is considerable variation in the values observed.
A Tragic Epidemic
Authors: VAN OST WILLIAM C.
Published: December 2021

To the Editor.—

Whenever discussion of the destructive psychosocial effects of chemical dependency emerges among medical professionals, a controversy invariably follows. Too often, discussion turns into debate, anger overcomes reason, and strong feelings are judged to be too emotional. A sad commentary about the majority of our profession is the abrogation of responsibility, leaving the major concern in the field of alcohol/drug abuse to the care of other health professionals.1-5

For those who require documentation of the belief, which I fully share, that chemical dependency can be successfully prevented and treated, I refer them to the recent "breakthrough" article by MacDonald6 as well as publications of the US Department of Health and Human Services.7,8
The Uvula and Sudden Infant Death Syndrome
Authors: GUILLEMINAULT CHRISTIAN
Published: December 2021

In Reply.—

Harpey and Renault postulate a relationship between the uvula, obstructive sleep apnea, and sudden infant death syndrome. Although I believe that obstructive sleep apnea syndrome may be one of the mechanisms leading to sudden infant death syndrome, this speculation is extremely controversial. I do concur with Harpey and Renault that obstructive sleep apnea can trigger esophageal reflux. A segment from a sleep recording of a 9-week-old, full-term infant with near-miss sudden infant death syndrome is presented in the Figure.
Sports and the Child with Epilepsy
Authors: SHAFFER THOMAS E.
Published: December 2021

In Reply.—

Berman's letter is supportive of the Academy's recommendation that children having a history of controlled seizures should be allowed to participate in physical education and competitive sports.1 The child and the parents must understand the possible risks of injury in the chosen sport and, together with leaders in the sport program, should agree on the child's participation under proper supervision.

Berman and Livingston have long been advocates for leniency in permitting strenuous activity for children who have a history of convulsive disorder.2,3