bluuebunny/crossref_metadata_2025 huggingface dataset:
ACUTE RESPIRATORY ILLNESS ASSOCIATED WITH COXSACKIE B4 VIRUS IN CHILDREN
Authors: Ray C. George , Plexico Kathryn L. , Wenner Herbert A. , Chin Tom D. Y.
Published: December 2021

An outbreak of respiratory illness in a children's home, associated with Coxsackie B4 infection, occurred in the summer of 1964. The illness was mild, characterized primarily by mild to moderate pharyngitis, fever, and rhinorrhea. The duration of symptoms was 3 to 7 days. No pleurodynia, aseptic meningitis, or other syndromes frequently associated with Coxsackie B4 were noted.

An analysis of sera available from both before and after the outbreak showed that all children without preexisting antibody titers (<1:8) had serological evidence of infection following the outbreak; one-third of the children with preexisting antibody titer (≥1:8) also showed evidence of reinfection. The ratio of subclinical to clinical infections was 3.4 to 1. The data also suggest that the presence of preexisting antibodies did not prevent the development of respiratory illness.

The high prevalence of Coxsackie B4 antibodies in this group and in other studies is noted and may be related to a broad clinical spectrum with a probable preponderance of minor illnesses and frequent inapparent infections.
BENIGN INTRACRANIAL HYPERTENSION IN CHILDREN
Authors: Rose Arthur , Matson Donald D.
Published: December 2021

The clinical features of 23 cases of benign intracranial hypertension occurring in childhood have been reviewed. Eight cases followed minor bacterial or viral infections, four cases occurred in association with head or neck injury, four cases occurred with otitis media, and one case followed sudden cessation of corticosteroid treatment. There were no apparent associated clinical factors in the remaining six cases. Benign intracranial hypertension thus emerges as a clinical syndrome of varied etiology, generally with a short course, good prognosis, little tendency to recurrence, and only rarely requiring surgical intervention. Clinical evidence suggests that, in addition to otitis media, cerebral venous thrombosis may, in certain circumstances, follow head injury, trauma to the jugular vein, and thrombosis in the pterygoid venous plexus. Therefore, it is suggested that complete visualization of the venous cerebral circulation should be attempted in the investigation of patients with benign intracranial hypertension.

In view of the occurrence of the syndrome following gastroenteritis, upper respiratory tract infections, and chickenpox, diagnostic virological studies, including culture of cerebrospinal fluid, are of special interest. Other precipitating causes of this clinical syndrome are discussed. The occurrence of benign intracranial hypertension as an initial manifestation of two well defined endocrine abnormalities is described. It is possible in the future that systematic endocrine study of patients, particularly pre-pubertal females, will reveal other hormonal defects.

It appears probable that transient generalized cerebral edema of any type may be responsible for the occurrence of this syndrome. The elucidation of its pathophysiology will probably have to wait more accurate and safe methods of clinical measurement of intra- and extra-cellular fluid shifts within the brain, as well as more reliable understanding of cerebrospinal fluid and cerebral blood flow alterations.
URINARY CATECHOLAMINE EXCRETION BY HEALTHY CHILDREN
Authors: Voorhess Mary L.
Published: December 2021

There is increase in the daily urinary excretion of dopamine (DA), norepinephrine (NE), epinephrine (E), and 3-methoxy-4-hydroxymandelic acid (VMA) with age. The mean output in micrograms per 24 hours for various age groups is as follows: birth to 1 year-DA 60.9 (± 24.3), NE 10.6 (± 3.4), E 1.3 (± 1.2), VMA 569 (± 309); 1 through 5 years—DA 124.1 (± 40.7), NE (18.8 ± 7.0), E 3.2 (± 2.7), VMA 1348 (± 433); 6 through 15 years—DA 169.3 (± 72.6), NE 37.4 (± 16.6), E 4.8 (± 2.4), VMA 2373 (± 698); over 15 years—DA 249.1 (± 74.9), NE 50.7 (± 15.7), E 7.1 (± 3.3), VMA 3192 (± 699).

The studies suggest that the daily output of these compounds in the various age groups is similar when related to body surface area after infancy.
Galactose-1-Phosphate Uridyl Transferases Activity in Hemolysates of Newborn Infants
Authors: NG WON G. , BERGHEN WILLIAM R. , DONNELL GEORGE N. , HODGMAN JOAN E.
Published: December 2021

Kabacy, et al. have shown by the uridine diphosphate glucose (UDPG) consumption assay that galactose-1-phosphate uridyl transferase (transferase) activity in hemolysates of newborn infants is significantly lower than for normal adults. Recent studies of hemolysate UDPGalactose-4-epimerase (epimerase) in newborns have suggested the possibility that the results of Kabacy, et al. may have been influenced by regeneration of UDPG by the epimerase reaction. A necessary condition for assay of transferase by UDPG consumption is that epimerase activity be negligible. We now have shown that epimerase activity in hemolysates from newborn infants is markedly elevated and, in contrast to findings with normal adults, substantial epimerase activity is present in the absence of exogenous oxidized nicotinamide adenine dinucleotide (NAD).
THE PATHOGENESIS OF MENTAL RETARDATION IN PHENYLKETONURIA AND OTHER INBORN ERRORS OF AMINO ACID METABOLISM
Authors: Menkes John H.
Published: December 2021

It is clear that, although further screening programs of neurologically defective subjects are bound to uncover more unusual defects in intermediary metabolism, we are still at a loss to explain the pathogenesis for the cerebral abnormality in the most common of the amino acid disorders. It is likely that no single answer will be found but rather that cerebral malfunction is the outcome of a number of chemical abnormalities occurring within the brain as a consequence of a deranged internal milieu present during a critical phase of its development. However, until we obtain a better concept of the abnormalities in the chemical composition and structure of the brain which occur in these conditions and the specific intermediary metabolite or metabolites responsible for them, treatment for these disorders will of necessity continue to be empirical.
Letters to the Editor
Authors: DANUFSKY PHILIP C.
Published: December 2021

Dr. Silverman's Commentary on informed consent (Pediatrics, 38:373, 1966) set me thinking so much I haven't finished reading the September issue. It seems, at last, our profession is examining its legal and moral responsibilities before political and community pressures interfere with clear thinking.

At present the minor's parents or guardians have full legal responsibility for furnishing consent for treatment and investigation; the law is not likely to change soon.
Letters to the Editor
Authors: SILVERMAN WILLIAM A.
Published: December 2021

Doctors Mosier and Danufsky seem to have misinterpreted my comments and Guttentag's proposals. An argument was not made to the effect that physicians cannot or should not be both compassionate and objective. It was, however, advised that in the special circumstance surrounding the consent issue in formal clinical investigation it is wise to separate artificially these two aspects of the normal physician-patient relationship as an additional safeguard for the patient. It is quixotic to overlook the ever-present conflict between concern for the patient and concern for the truth.
Relationship Between Erythrocyte Glucose-6-Phosphate Dehydro- and the Hemolytic Anemia of Infection
Authors: KATTAMIS CHRISTOS A.
Published: December 2021

Publication of the interesting report of relationship between erythrocyte glucose-6-phosphate dehydrogenase (G-6-PD) and the hemolytic anemia of infection by Fikrig, et al. raises some crucial points concerning the pathogenesis and, especially, the frequency with which hemolytic anemia develops in individuals with G-6-PD deficiency when exposed to infections or certain other noxious agents, such as aniline derivatives, nitrofurantoin, naphthalene, fava beans, etc.
Letters to the Editor
Authors: FIKRIG SENIH
Published: December 2021

While we are aware of the G-6-PD variants, we have not done the specific tests on our patients. Actually, all of the patients with low G-6-PD activity, irrespective of whether they developed hemolysis or not, were Negroes and, therefore, could be classified as B(-) variant. As far as we know this variant had not been implicated in relation to favism or severe neonatal jaundice.

The enzyme variant had also not been specified for the group of patients reported by Kattamis, et al. We agree that factors beside G-6-PD must play a role in hemolytic anemias due to viral or bacterial infections.
THE CURRENT PREVALENCE OF GONOCOCCAL INFECTIONS IN CHILDREN
Authors: Nazarian Lawrence F.
Published: December 2021

In one 6-month period, nine children, ages 11 months through 14 years, presented with gonococcal infections to the Strong Memorial Hospital Pediatric Emergency Department. These patients included young girls with vaginitis whose mothers had gonorrhea and a 10-year-old boy whose sexual contact was a 9-year-old girl. Gonorrhea in children is increasing and takes the form of conjunctivitis, arthritis, or genitourinary infection. The infection seems to be transmitted most often by contamination in the infant, involuntary sexual contact in the young child, and voluntary sexual contact in the older but not necessarily pubescent child. The physician treating children must be aware of the prevalence and characteristics of this type of infection and should use his influence in a preventive manner as well.
A TWENTY-FIVE YEAR FOLLOW-UP STUDY ON THE HYPERKINETIC CHILD WITH MINIMAL BRAIN DYSFUNCTION
Authors: Menkes Miriam M. , Rowe Jane S. , Menkes John H.
Published: December 2021

Eighteen patients who had been evaluated at a child psychiatry clinic a mean of 24 years ago were selected for follow-up by the following criteria: the presenting symptoms had been hyperactivity and short attention span, none had seizures, all had an I.Q. over 70, and all had indications of neurologic abnormalities such as poor coordination, visual motor dysfunction, or speech impairment. Eleven of the 18 were reexamined fully and an interview or information was obtained about three more. Neurologic examination showed definite abnormalities in eight subjects and suspicious findings in one, but it was normal in two. Hyperactivity was still present in three subjects aged 22 to 23 years and had disappeared between the ages of 8 and 21 in the others. Four subjects were institutionalized as psychotic, two others were retarded and supported by their families, and eight were self-supporting. Of the latter, four have spent some time in institutions. A major prognositc factor was the I.Q. obtained during initial evaluation; all but one of the subjects who were self-supporting had scored an I.Q. above 90.
ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS PRESENTING AS HYPERTENSIVE ENCEPHALOPATHY WITH MINIMAL URINARY ABNORMALITIES
Authors: Hoyer John R. , Michael Alfred F. , Fish Alfred J. , Good Robert A.
Published: December 2021

A case of acute poststreptococcal glomerulonephritis with hypertensive encephalopathy as the only clinical manifestation is described. The diagnosis was established by isolation from the throat of a nephritogenic (type 12) group A beta hemolytic streptococci, the presence of elevated streptococcal antibody titers in the serum, a decrease in serum complement, and the characteristic renal morphology by light, fluorescent, and electron microscopy. Normal findings or minimal sporadic abnormalities were present in the urine.
Pancreatic Insulin Content in Severe Erythroblastosis Fetalis
Authors: DRISCOLL SHIRLEY G. , STEINKE JURGEN
Published: December 2021

The pancreatic insulin content of 16 infants with lethal erythroblastosis fetalis was determined and compared with 17 controls of similar gestational ages. Significantly higher insulin levels, comparable to those exhibited by newborn infants of diabetic mothers, were found in the babies with hemolytic disease of the newborn.
ADOPTING A CHILD
Authors:   COMMITTEE ON ADOPTIONS
Published: December 2021

THE painting Adopting a Child by Frederick Bacon Barwell (1857), calls our attention to the great forward strides effected in adoption procedures. The Committee on Adoptions of the Academy has recommended that, whenever possible, adoptions be consummated through established agencies. While the Committee has not taken the stand that only agency adoptions can be successful, we do believe that adoption agencies, on balance, can render superior service because they have the resources required to serve the diverse persons involved in this delicate and sensitive human relationship.

This English genre or narrative painting affords an interesting insight into what is involved in an adoption. If one is permitted to mix retrospective analysis with speculation about the future, one could predict that the adoption portrayed in this picture would terminate in difficulties.

The central figures are the natural mother and her child. In modern adoption procedures we recognize the importance of casework for the natural mother in her great decision to yield her child for adoption. The poignant despair revealed in the features of the mother indicates the lack of such necessary help to this unfortunate female. The absence of legal and moral privacy between the natural parent and the adopting parents derogates the possibility of a successful transfer of the child from one home to another.
Electrocardiography in Infants and Children
Authors: GERSONY WELTON M.
Published: December 2021

This volume represents a collection of papers originally delivered by 16 cardiologists and electrocardiographers to the postgraduate course on "Electrocardiography in Infants and Children" presented at the Henry Ford Hospital, Detroit, under the auspices of the American College of Chest Physicians. These lectures were revised and edited for publication as a textbook by Drs. Cassels and Ziegler. The result is an impressively broad view of modern pediatric electrocardiography from workers representing various approaches and attitudes in their presentation of this subject.
Creatine Phosphokinase as an Indicator of Birth Trauma
Authors: MILLICHAP J. GORDON
Published: December 2021

In the article by Drs. Nathan Rudolph and Ruth T. Gross (Pediatrics, 38:1039, 1966), muscle damage is postulated as a likely cause for an increase in serum creatine phosphokinase (CPK) activity observed in some newborn infants following a complicated labor. The authors' introduction includes reference to CPK in nervous tissue, but brain trauma or anoxia as a possible factor in causation of the elevated serum CPK is not mentioned in discussion.
A New Look at Child Health
Authors: CONE THOMAS E.
Published: December 2021

This little paperback book is a gem which may escape the attention of readers on this side of the Atlantic because it deals mainly with the state of contemporary pediatrics in Great Britain. For us not to be aware of this book would be a mistake; many of the problems and shortcomings which Drs. Joseph and MacKeith discuss are equally germane to the United States.

The authors attempt to define in 11 chapters such elusive things as just what pediatrics really is, what are the crucial current problems, how the changing patterns of death and morbidity in childhood have altered the demands on pediatricians, and—throughout the book as a leitmotiv—how to make medical students and physicians more aware of preventive aspects of medicine.
The Disabled Reader: Education of the Dyslexic Child
Authors: EICHENWALD HEINZ F.
Published: December 2021

Literacy is essential for an individual's participation in our society. The inability of a child to attain proficiency in reading has profound social and emotional consequences; it results in anxiety on the part of the child, and perhaps, even more, on that of his parents. This in turn leads to demands for changes in the educational system and a frantic search for cures. Thus, it is not surprising that during the past 60 years well over 20,000 books, articles, and papers have been published on reading disability.
"EARLY" VERSUS "LATE" FEEDING OF LOW BIRTH WEIGHT NEONATES: EFFECT ON SERUM BILIRUBIN, BLOOD SUGAR, AND RESPONSES TO GLUCAGON AND EPINEPHRINE TOLERANCE TESTS
Authors: Wu Paul Y. K. , Teilmann Peter , Gabler Marjorie , Vaughan Mary , Metcoff Jack
Published: December 2021

Effects of early (2 hours after birth) and late (24 to 36 hours after birth) feeding were studied in 42 "well born" and clinically well low birth weight infants in the 1,250 to 2,000 gm birth weight range. Twenty-one of these, selected at random, were early fed and 21 were late fed.

In the early-fed infants weight loss was less (mean 4.7% of birth weight) and regained earlier (mean 7.3 days); in the late-fed infants weight loss was greater (7.4% of birth weight) and regained later (mean 12.6 days).

Blood glucose was higher in the early-fed group than in the late-fed group at 24 hours of age.

A higher response in blood glucose level was seen in the early-fed infants following glucagon and epinephrine administration at 24 hours.

No adverse effects were observed as a result of early feeding. Such feedings may indeed have an advantage in reducing serum bilirubin levels, raising blood sugar, and increasing liver glycogen reserves.
A PROGRAM TO INCREASE HEALTH CARE FOR CHILDREN: THE PEDIATRIC NURSE PRACTITIONER PROGRAM
Authors: Silver Henry K. , Ford Loretta C. , Steady Susan G.
Published: December 2021

The pediatric nurse practitioner program herein described is a new educational and training program in pediatrics for professional nurses which has been developed to provide increased health care for children in both rural and urban areas. The program prepares nurses to furnish comprehensive well child care to well children, to identify and appraise acute and chronic conditions, and to evaluate and temporarily manage emergency situations until medical assistance is available.

The details of the educational and training program and its implications in improving the utilization of scientific manpower are described.
Hypertension and Seizures Following Methyldopa Infusion
Authors: FELDMAN WILLIAM , HILLMAN DONALD , BALIAH TADLAH , DRUMMOND KEITH N.
Published: December 2021

A 6-year-old girl with hypertension secondary to chronic glomerulonephritis was given two infusions of methyldopa in an attempt to lower the blood pressure. A paradoxical hypertensive response occurred both times; after the second infusion seizures developed. It is felt that this untoward response indicates the need for caution when methyldopa is given intravenously.
An Opportunity to Help in Vietnam
Authors: MACRAW CHARLES E.
Published: December 2021

I would like to call the attention of your readers to the formation of the Committee of Responsibility, a national, non-profit, humanitarian group organized to provide proper medical care in the United States to war-burned and war-injured Vietnamese children. Among the honorary chairmen are Dr. Albert Sabin, Dr. Benjamin Spock, and Dr. Helen Taussig. A program of this type is necessary because of the deplorable medical conditions in Vietnam, particularly the lack of long-term, rehabilitative treatment for burned and injured youngsters.
Management of Infants with Ventricular Septal Defects
Authors: GUNTHEROTH WARREN G.
Published: December 2021

Having written recently to agree with Dr. Nadas on a controversial subject, I feel less qualms about disagreeing with some of his observations expressed in the editorial in the January Pediatrics. Although Dr. Nadas implied criticism of the use of numbers by the Michigan group, he omitted any figure for the combined mortality of his surgical group for banding of the pulmonary artery plus the ultimate repair with open-heart techniques. If it is less than the 20% which Dr. Sigmann reported for complete repair during infancy, it would be surprising.
DIAGNOSTIC TESTS FOR TOXOPLASMOSIS
Authors: ADAMS F. H. , KABLER P. , COONEY M. , ADAMS J. M.
Published: December 2021

Results of a correlation study of the rabbit neutralization, complement fixation, skin and slide neutralization tests for toxoplasmosis are presented. The agreement between these is fairly striking, except those from the complement test.

Reversal of a positive test was found to occur in the sera of six patients, and, in three instances, the prozone phenomenon was revealed.

The new slide neutralization test of Sabin and Feldman appears to be the most accurate, the most economical and the quickest test available at present for the diagnosis of toxoplasmosis.
BASAL METABOLIC RATE IN OBESE CHILDREN
Authors: ILIFF ALBERTA , GORDON HARRY H. , MCNAMARA HELEN , BELL W. RANDAL
Published: December 2021

An analysis of the results of 524 observations of the basal metabolism of 348 obese children is presented. Since only 3% of the basal metabolic rates were lower than minus 15% of the Child Research Council surface area-age standards, it is suggested that these standards can be used satisfactorily in the management of children with obesity. For reasons which are not obvious these standards do not suffice for children with dwarfism.
DOUBLE AORTIC ARCH
Authors: GRISWOLD HERBERT E. , YOUNG MAURICE D.
Published: December 2021

The anatomic nature of a double aortic arch is described. Reference is made to the history of the malformation. The clinical picture and radiographic findings described by various authors are discussed.

Two cases are reported which demonstrate two types of double aortic arch, One, a relatively common type, had a large right arch with a retro-esophageal component and a left descending aorta; the second, a rare type, had a large left arch with a retro-esophageal component and a right descending aorta. Further, one was an infant who had symptoms of constriction whereas the other was an adult who had no symptoms referable to the double aortic arch.

Analysis is made of these cases and 47 other cases reported in the literature. This analysis reveals that:

1. There is a striking correlation between the occurrence of symptoms and the age and duration of life, but there is no correlation between the occurrence of symptoms and the type of double aortic.

2. A double aortic arch in which both components are patent throughout is more likely to produce symptoms than a double aortic arch in which one component is partially obliterated. The process of obliteration does not appear to give rise to symptoms.

3. There is considerable variation in the relative sizes of the components of a double aortic arch. The right component is usually the larger; part of the left component may be obliterated. To date, no case has been reported of obliteration of part of a persistent right Component.

4. A double aortic arch occurs more commonly with a left descending aorta than with a right descending aorta.

5. It is unusual for a double aortic arch to be associated with a malformation of the heart. The association of a double aortic arch with other vascular abnormalities is less rare.

The two principal problems raised by the demonstration of a retro-esophageal vessel are discussed. The first concerns the nature of the malformation; the second concerns the advisability of operation in the given individual.
Rheumatic Heart Disease and Pregnancy in Adolescent Rheumatic Fever Patients
Authors: GORDIS LEON , MARKOWITZ MILTON
Published: December 2021

A sociomedical problem of increasing importance is that of unplanned pregnancies in adolescents. The extent of this problem is shown, for example, by the fact that over 800 girls below the age of 16 drop out of Baltimore City schools each year because of pregnancy. Complex and often tragic problems accompany such pregnancies for the new mother, for the infant, and, often, for the putative father. Therefore, considerable attention has focused on means of preventing undesired pregnancies in this age group. The difficulties in attacking this problem lie in determining which preventive services are best suited for this age group and in identifying the population at risk to whom such services should be directed.
Transferase Activity in Hemolysates of the Newborn
Authors: MELLMAN WILLIAM J. , TEDESCO THOMAS A.
Published: December 2021

The recent report by Ng, et al. (Pediatrics, 39:293, 1967) was welcomed by us since it offered an explanation for the difference between our experience and theirs with the measurement of galactose-1-phosphate uridyl transferase (transferase) in the newborn by the UDPG consumption assay. We have found high normal or increased activity in newborn hemolysates by a modification of the UDPG consumption assay that we have employed.
Letters to the Editor
Authors: BERGREN WILLIAM R. , NG WON G. , DONNELL GEORGE N.
Published: December 2021

The point made by Mellman and Tedesco in their note concerning the effect of dithiothreitol on the UDPG consumption assay for galactose-1-phosphate uridyl transferase is well taken. It adds emphasis to our view on the need to consider the conditions in the assay for interpretation of the findings.

Our hypothesis that low estimates of transferase activity in hemolysates of newborns might be obtained by the UDPG consumption procedure was based on our finding of epimerase activity in hemolysates of newborn infants independent of supplementary NAD.
AIRWAY OBSTRUCTION IN A NEWBORN BY PEDUNCULATED PHARYNGEAL DERMOID
Authors: Loeb William J. , Smith Earl E.
Published: December 2021

A case has been presented of a true dermoid tumor in the newborn, arising from the superior surface of the soft palate. This is an unusual type of lesion and one which threatens neonatal survival by obstructing the nasopharyngeal airway. Its early recognition and removal is essential.
Studies of Granulopoiesis and Granulocyte Kinetics in Down's Syndrome
Authors: PEARSON HOWARD A.
Published: December 2021

Normal mitotic and maturation granulocyte pools in Down's syndrome are evidenced by the finding of normal marrow cellularity and morphology. Normal marrow granulocyte reserves are indicated by a normal response to endotoxin injection. The normal levels of serum muramidase support the concept of a normal granulocyte turnover rate. Therefore, it is considered unlikely that there is a significant abnormality of granulocyte kinetics in Down's syndrome. It is also unlikely that increases in leukocvte enzymes in this condition are due to a relatively immature granulocyte population. Rather, they may reflect some general effect of genetic imbalance.
COLLABORATIVE RESEARCH IN PEDIATRIC PRACTICE
Authors: HAGGERTY ROBERT J.
Published: December 2021

RESEARCH IN PRACTICE, including astute clinical observations of new clinical problems, analyses of series of patients, and clinical therapeutic trials, has been performed by physicians who must have been well aware of the demands and pressures of their professions. For example, Sir James MacKenzie, the famous British cardiologist, made most of his observations on cardiovascular physiology in his general practice. Closer to home both geographically and temporally, Harvey in Acton, Massachusetts, and Breese and Townsend in Rochester, New York, have demonstrated how high can be the value of data thus obtained. This type of research in individual practices should be encouraged.
HOUSEHOLD PRODUCTS—OBSOLETE CONTAINERS—INEVITABLE POISONINGS
Authors: BREAULT HENRI J.
Published: December 2021

ACUTE ingestions and poisonings are clearly a by-product of rapidly advancing technology, certainly related to aggressive advertising, and completely preventable parts of our tragic twentieth century accident epidemic. These facts are well-known by the pediatrician, whose therapeutic armamentarium does not include an immunizing agent against accidents of any kind.

The communication below from Dr. Breault summarizes an impressive community effort. Although safety cap enclosures and more appropriate packaging are not the only answer to the problems of accidental poisoning, such efforts may create an awareness of the dangers, such as has been achieved in the field of automotive safety.
FOLLOW-UP STUDY OF EXCHANGE TRANSFUSION FOR HYPERBILIRUBINEMIA IN INFANTS IN JAPAN
Authors: Ose Toru , Tsuruhara Tsuneo , Araki Masayoshi , Hanaoka Toshiyuki , Bush Ovid B.
Published: December 2021

A follow-up study of 157 consecutive patients who had hyperbilirubinemia was undertaken by questionnaire. Parents of 153 patients answered the questionnaire. Complete examination was carried out on 131 (83.4%) patients and, if the 17 who died are included, a 94.2% follow-up was made.

The relationship between the level of the serum bilirubin and the development of cerebral palsy showed that 90% of the patients who had a bilirubin level of 35 mg/100 ml and above either died or had cerebral palsy or physical retardation. Of the 131 cases followed up, there were 17 (13.0%) patients who had definite cerebral palsy, 21 (16.0%) who were physically retarded, and 93 (71.0%) who were normal.

In 129 infants checked for developmental retardation, no instances were found when the serum bilirubin level was below 20 mg/100 ml. There was developmental retardation in 15 patients who had a bilirubin level of 20 mg/100 ml and above. It is felt that this shows there is a definite relation between the height of the bilirubin and the development of cerebral palsy and/or developmental retardation. In this series there were 26 infants with bilirubin levels of 30 mg/100 ml and over. Based on our results, we would suggest that the indication for exchange transfusion should be a total bilirubin level of 20 mg/100 ml for full-term, incompatible infants and for all premature infants; the level for full-term, compatible infants should be 25 mg/100 ml.
PURULENT PERICARDITIS IN INFANCY
Authors: Gersony Welton M. , McCracken George H.
Published: December 2021

Seven patients less than 2 years of age with purulent pericarditis were encountered. Four infants survived, including the first infant reported with meningococcal pericarditis. Including the present patients, 50 infants with suppurative pericarditis have been described in the literature. The overall mortality was 67%; it was 47% among patients in whom the diagnosis was made clinically. Staphylococcus aureus was the most common infecting organism, and it was responsible for the greatest number of deaths. Pulmonary infection was by far the most frequently observed associated illness, whereas purulent pericarditis occurring as a primary infection was rare.

Survival from purulent pericarditis depends upon adequate pericardial drainage with antimicrobial therapy. Antibiotics alone have not been successful in the treatment of this disease.
Results of Testing a Child-resistant Medicine Container
Authors: STRACENER CARL E. , SCHERZ ROBERT G. , CRONE RICHARD I.
Published: December 2021

Accidental poisoning, particularly by medications, is a cause of significant morbidity and mortality in children. A practical, inexpensive, child-resistant, medicine container was recently devised and has been tested. The test container is markedly superior to the prescription container presently used by our pharmacy. This test container, widely used, could conceivably lower the incidence of childhood poisonings due to the accidental ingestion of prescription medicines.
ANOMALOUS LEFT CORONARY ARTERY ORIGINATING FROM THE PULMONARY ARTERY
Authors: Wagner Henry R. , Nadas Alexander S. , Hugenholtz Paul G.
Published: December 2021

The follow-up of two infants subjected to ligation of an anomalous left coronary artery at its insertion in the pulmonary artery, are presented. Both patients are essentially asymptomatic, one 7 years and the other 2 years postoperatively.

Mitral regurgitation, a dominant feature in both infants preoperatively, disappeared some months after coronary artery ligation.

A large preoperative atrial left-to-right shunt, secondary to mitral regurgitation and disappearing postoperatively, masked the presence of the shunt into the pulmonary artery in one patient.

Although both patients are doing extremely well clinically, evidence of appreciable residual cardiac damage is present in the electrocardiogram, in the chest x-ray, at cardiac catheterization, and in the left ventricular volume studies of one patient.
GASTROINTESTINAL MILK ALLERGY IN INFANTS
Authors: Gryboski Joyce D.
Published: December 2021

Twenty-one patients have been admitted to the Yale-New Haven Hospital during the past 16 years with the diagnosis of gastrointestinal milk allergy. All of the patients had gross or occult blood in their stools at some time, and most stools contained mucus. The predominant complaint was chronic diarrhea which varied from the passage of three to four semi-formed stools to 20 watery movements per day. Seven infants developed cardiovascular collapse after milk challenge and two of these had gastrointestinal hemorrhage as well. Sigmoidoscopy and rectal biopsy performed on eight children revealed changes of colitis which reverted to normal after the elimination of milk from the diet. Lactose tolerance tests were normal in seven of the eight. There was no correlation between the degree of symptomatology in infancy and the subsequent development of cutaneous or respiratory allergy. It is suggested that milk-induced colitis be considered a histologically documented and distinct entity.
THE EVILS OF BICYCLE RIDING IN GROWING BOYS
Authors: C. T. E.
Published: December 2021

Dr. S. A. K. Strahan, a most proper Victorian, reached the following conclusions on what he believed were the evil effects of bicycle riding on young boys: The pressure upon the perineum whether it be continuous and increased at every jolt, or whether it be made up of jolts alone, must be injurious. It causes irritation and congestion of the prostate and surrounding parts, tends to exhaust and cause atrophy of the delicate muscles of the perineum, and also calls the boy's attention to the organs of generation, and so lead to a great increase in masturbation in the timid, to early sexual indulgence in the more venturesome and ultimately to early impotence in both. For support of the latter conclusion the "disease of the Scythians" and the impotence among the Tartars from horse-back riding are cited.
Malaria as a Pediatric Diagnostic Problem in the United States
Authors: SCOTT SAMUEL E.
Published: December 2021

At the suggestion of Dr. Floyd Denny, Chairman of the Department of Pediatrics at the University of North Carolina School of Medicine, the following interesting and instructive case is presented as a Letter to the Editor.

A difficult diagnostic problem in a 9-year-old girl consisting of high fever, leukopenia, hemolytic anemia and splenomegaly is presented.

C. W., a 9-year-old, white female, is the dependent of an Air Force Captain. She was well until February 17, 1967, when she was sent home from school with a fever.
An Association for Child Care in Hospitals
Authors: BRAZELTON T. BERRY
Published: December 2021

In the past 2 years a new national organization, called the American Association for Child Care in Hospitals, has evolved. This organization was initiated by the six "play ladies" who are in charge of the children's hospital programs in Baltimore, Boston, Cleveland, Montreal, Philadelphia, and Pittsburgh. Two years ago, the Children's Hospital Medical Center (CHMC) in Boston was host to 50 participants from these institutions to found the organization. This initial meeting was abetted by the CHMC's concern for total patient care and was made possible by the backing of the administration and the pediatric and psychiatric departments.
Relationship of Regional Medical Programs to Children's Cancer Clinics
Authors: Sloan Margaret H.
Published: December 2021

THE Division of Regional Medical Programs was established about a year ago in the National Institute of Health to implement the legislation known as Public Law 89-239 or the Heart Disease, Cancer, and Stroke Amendments of 1965. This has been a very busy Division and, by the end of this calendar year, we shall probably have awarded about 40 planning grants for regional medical programs involving 38 states, plus or minus. By June 1967 we expect that almost the entire United States will be involved in some kind of regional program, many of which will involve many of you in the audience today. The size of these grants is varied; from one limited to 6 counties to one involving 4 states. The sums awarded have varied markedly according to the population to be served and the needs which have been identified within the regions.

Now, what are the Regional Medical Programs supposed to do? What sorts of things have been supported or are considered for support under such grants? In order to understand the potential of this program, I think some reference to the actual wording of the legislation would be important. First of all, the legislation underwent very marked changes during the course of its legislative history and the "regional medical complexes" described in the President's Commission Report, which was published in December 1964, gradually evolved into "regional medical programs" which would originate from local initiative. Now, the legislation says that the purposes of this title are: "through grants to encourage and to assist in the establishment of regional cooperative arrangements among medical schools, research institutions and hospitals for research and training, including continuing education, and for related demonstrations of patient care in the fields of heart disease, cancer, stroke and related diseases.
Role of the Nurse in a Children's Cancer Clinic
Authors: Tonyan Angela B.
Published: December 2021

THE Hematology and Oncology Clinic here at Children's Orthopedic Hospital and Medical Center under the direction of Dr. John Hartmann started with one small room. We admitted all patients to the hospital inpatient service for intravenous medication, bone marrows, and blood transfusions. Recognition of the growing importance of outpatient care led to the establishment of our present clinic which consists of four rooms: a waiting room, an office for doctors and nurses, and two treatment rooms. There is a very relaxed atmosphere in our small waiting room which includes a large fish bowl. One of the walls in the waiting room is covered with pictures, either sketched, drawn, or colored by the patients. The personnel give sincere praise when a child comes in with a sample of his art work, and snapshots of every patient are hung plainly in view. The children are always bringing something to the nurse or to the aide. For example, a little 3-year-old child came in the other morning clutching a crushed dandelion for the aide.

Staffing is one of the most important things in setting up a hematology clinic. We have one regular nurse and one aide, Monday through Friday. Weekend and evening coverage is by emergency room nurses, and after midnight it is by the night supervisor. We have a nurse and social worker who make home visits when necessary. There are also two volunteers who give of their time and of themselves in every way.

The nurses rotate in the 40 different specialty clinics of the outpatient department. This is not true of our hematology clinic.
Role of the Social Worker in a Children's Cancer Clinic
Authors: Pieroni Antoinette L.
Published: December 2021

THE social worker must function as a member of the medical team whose purpose is helping the patient and his family live as normal a life as possible from the first diagnostic visit through the treatment period to the final hospitalization. As a member of this team she has the responsibility of following the philosophy of the center in which she works and of conveying the same thoughts to the parents and to the other members of the family as does the physician. It is terribly important that there be no minority opinion—that no team member gives a "personal" opinion which the parents or the child may interpret differently from that of the others on the team.

The primary responsibility of talking to the parents belongs to the physician, but tile most effective method is the 1-2 punch. It works in this way: approximately 24 to 48 hours after the physician's interview and explanation, the social worker sees the parents and reviews with them what the physician has told them. She must know intimately and in detail what has been said. Experience has shown that very little of the initial interview with the physician has been heard or absorbed. The worker's interview then gives the parents an opportunity to hear it again and ask questions about the topics covered, for example, the philosophy of the clinic, the disease and how its course will affect their child, themselves, the other family members and the community of which the child is a part. It also gives the social worker an opportunity to assess the family.
PHYSICAL, INTELLECTUAL, AND EDUCATIONAL CHARACTERISTICS OF A SAMPLE OF JOB CORPS TRAINEES
Authors: Deisher R. W. , Hammar S. L. , Ramsey Otis , Gode Richard , Seligman Fred
Published: December 2021

Fifty trainees were selected from a Job Corps Camp for medical and psychological evaluation. A significant number had health problems, many of which might have been modified by regular medical care.

Although mean school grade completed was the ninth, performance on reading and arithmetic tests was estimated at midfourth grade. This was below expectation based on results of intelligence testing and would imply that a more thorough appraisal should be made of the health status and cognitive functioning of these young men if maximal help is to be provided them through the Job Corps program.
PLAGUE MENINGITIS
Authors: Martin Albert R. , Hurtado Felix P. , Plessala Richard A. , Hurtado Elisa G. , Chapman Charles E. , Callahan Edward L. , Brutsché Robert L.
Published: December 2021

Three cases of acute Pasteurella pestis meningitis occurred in a plague outbreak in New Mexico in 1965. Acute plague meningitis has occasionally been seen in other areas of the world. This entity almost invariably develops as a secondary complication of bubonic plague, and a critical review of the literature raises serious question about the existence of primary meningitis due to P. pestis. Treatment of these three cases and experience with plague therapy are discussed. Early recognition of plague infection, including its more unusual complications (such as meningitis), is essential for appropriate treatment and cure.
DIAGNOSIS AND TREATMENT: ANTIBIOTIC THERAPY OF INFECTIOUS DIARRHEA IN CHILDREN
Authors: Cushing Alice H.
Published: December 2021

THE PURPOSE of this review is to summarize the present status of antibiotic therapy of diarrhea in infancy and childhood. Such a review is currently pertinent because increased knowledge of the natural history of bacterial enteric diseases and the effects exerted by antibiotics on the course of these diseases enables the physician to approach such therapy on a more rational basis.

Most diarrhea in infancy and childhood is not identifiable as bacterial in etiology. While in some communities 5% or less of such patients can be shown to harbor recognizable bacterial pathogens, as many as 60% of patients in other areas may yield bacterial pathogens on culture. The etiology of diarrhea in the absence of identifiable bacterial pathogens is obscure, although the results of a number of studies indicate that certain enteroviruses are frequently responsible.

BACTERIOLOGIC STUDIES

Of paramount importance in the management of patients with diarrhea is a careful search for bacterial pathogens because the decision as to whether to employ an antibiotic—and, if so, which antibiotic—is based upon the results of appropriate studies. Such studies comprise culture of the stool on specific media or examination by fluorescent antibody techniques. Serologic examinations are ordinarily unavailable for infections due to shigellae and EPEC, and they are of value in only a few salmonella infections; in addition, they do not afford prompt answers.

The expense involved in such bacteriologic examinations is considerable and indicates the need for some selectivity in determining which patients should be studied for the presence of bacterial pathogens.
Bronchiolitis and Asthma
Authors: HOROWITZ LEON
Published: December 2021

Dr. Holdaway and his associates would make it appear that bronchiolitis is a clearly defined entity in which, although it may be simulated by asthma (and other diseases), "attention to the details of the case history and clinical findings will usually exclude these conditions." I wish it were that simple.

I find the differential diagnosis of the wheezing infant "most difficult" as do others, particularly with reference to asthma. The fact that the wheezing does not respond to sympathomimetics does not prejudice in favor of bronchiolitis since it is well-known that the presence of dehydration or infection with asthma will make these drugs relatively ineffective.
BODY COMPOSITION OF THE MALE REFERENCE INFANT DURING THE FIRST YEAR OF LIFE
Authors: Fomon Samuel J.
Published: December 2021

DESCRIPTION of the changes with age in gross chemical composition of an "average" infant, referred to as the male reference infant, should aid considerably in developing a broader concept of normal growth in infancy. In addition, such a description may have important nutritional implications. For example, estimates of the average daily requirement for protein between two ages during infancy might be based, in part, on a knowledge of the gain in protein content of the body between these ages. Similarly, since much of the caloric requirement for growth may be accounted for by synthesis of lipid and protein, knowledge of the net gain in each of these components between two ages would permit a rough estimate of that portion of caloric intake needed for growth.

While it is not yet possible to provide a precise description of changes in body composition of individual infants or even of an "average" infant, the general direction of the changes can be indicated. An attempt will be made to identify areas in which important data are lacking and to examine the assumptions on which the calculations are based.

Data on total body water and several of the assumptions employed here are believed to be superior to those presented previously.

METHOD OF APPROACH

In the presentation that follows, the body is considered to consist of lipid and a lipid-free portion. This latter portion, spoken of as fat-free body mass, is considered to include water, protein, and a residual of dry, protein-free, lipid-free material referred to as "other."
Ototoxicity of Topical Neomycin Augmented by Dimethyl Sulfoxide
Authors: HERD J. KENNETH , CRAMER A. , HOAK F. C. , NORCROSS B. M.
Published: December 2021

A 9-year-old white girl with extensive dermatomyositis developed numerous shallow skin ulcerations concomitantly with calcinosis universalis. Following treatment of the skin with a variety of topical ointments she suffered complete loss of eighth cranial nerve function with total deafness, vertigo, and nystagmus. Careful review of the topical medications suggests that the cranial nerve damage was due to neomycin toxicity which resulted from increased cutaneous absorption brought about by dimethyl sulfoxide.
Skin Rash with Infectious Mononucleosis and Ampicillin
Authors: PATEL B. M.
Published: December 2021

Thirty-eight consecutive cases of infectious mononucleosis were observed. Antibiotics were prescribed for some because of actual or suspected secondary infections. It was noted that all 13 patients who had received ampicillin developed a characteristic skin rash unlike that seen in mononucleosis.