bluuebunny/crossref_metadata_2025 huggingface dataset:
ATAXIA-TELANGIECTASIA
Authors: Boder Elena , Sedgwick Robert P.
Published: December 2021

This paper based on eight cases and a necropsy report presents a familial symptom complex speaking strongly for a syndrome entity, for which the term ataxiatelangiectasia was proposed by the authors in a preliminary report. The main features are progressive cerebellar ataxia with onset in infancy; progressive telangiectasia of the bulbar conjunctivae, simulating conjunctivitis, and of the butterfly area of the face; frequent sinopulmonary infection, including bronchiectasis; and peculiarity of eye movements, simulating ophthalmoplegia.

The essential components of this familial syndrome are the ataxia and the telangiectasia, the most striking identifying feature being the characteristic telangiectases of the bulbar conjunctivae.

Retardation of statural growth with significant dwarfing is a frequent feature. Intelligence is essentially normal, although difficulty with tests dependent upon visualmotor co-ordination is consistently observed from early childhood; test results show wide scatter and I.Q. scores tend to drop below normal range as the ataxia progresses.

The available pneumoencephalograms give evidence of cerebellar atrophy. The necropsy provides microscopic evidence of progressive, apparently primary, diffuse, cortical cerebellar degeneration and of enlarged venules in the cerebellar leptomeninges and white matter, without significant changes in the spinal cord.

Recent tests of blood and urine of four children have failed to show evidence of an aberration in metabolism of iron or copper. Urinary concentrations of lead have also been within normal limits. Electrophoretic studies of serum in two patients have demonstrated that concentrations of gamma globulin are normal.

Ataxia-telangiectasia resists precise classification among the known entities of heredocerebellar ataxia. It is believed, however, that it may be properly viewed as a fifth entity in the group of phakomatoses, which presently is comprised of Von Recklinghausen's neurofibromatosis, tuberous sclerosis, Von Hippel-Lindau's disease and Sturge-Weber syndrome.

Awareness of the symptom complex of ataxia-telangiectasia will enable the clinician to recognize its varied and seemingly unrelated manifestations as those of a single clinical entity and will eliminate extensive and unrewarding diagnostic procedures.

Diagnosis will permit early recognition of the unusual susceptibility to sinopulmonary infections, so that appropriate antibiotic therapy can be promptly instituted in the management of acute episodes, or prophylactically.

With the possible exception of a clinical report of a single, nonfamilial case published in French in 1941, no reports of this syndrome were found in the literature. Since the publication of our preliminary paper, however, an as yet unpublished report based on four cases similar to those reported here and two necropsies was given by Biemond, at the First International Congress of the Neurological Sciences in July, 1957.
Radiation Diary
Authors: AMBERG JOHN R.
Published: December 2021

The Supplement to the November issue of Pediatrics (20:921-946, 1957) represented a very fine summary of the problem of radiation hazard in pediatrics. However, I would like to take exception to the suggestion that a radiation diary be kept by the patient or by the patient's parents. I believe there are three questions that this idea provokes.

(1) Is it of investigative value?

At the present time it seems that only accurate gonadal and somatic doses are worth recording if anything of research value will be obtained from keeping these records.
ACUTE CEREBELLAR ATAXIA OF CHILDHOOD
Authors: King Geraldine , Schwarz Gabriel A. , Slade Harry W.
Published: December 2021

The clinical reports of nine children who developed an acute cerebellar disorder are recorded. The etiology was not determined in any of the cases.

Similar cases were found reported in the literature as "acute cerebellar encephalitis" or "acute cerebellar ataxia," a form of nonsuppurative encephalitis.

The concept is developed that these cases represent a toxi-infectious process of variable etiology with the cerebellum or its systems as the major or only target organ. The main significance of these relatively benign forms of cerebellar disorder in children is their differentiation from cerebellar tumor; the major features of the disorder are outlined to help in the differential diagnosis.
ACUTE SUPPURATIVE ARTHRITIS IN INFANTS AND CHILDREN
Authors: Samilson Robert L. , Bersani Frank A. , Watkins Melvin B.
Published: December 2021

Tardily treated suppurative arthritis in infants and children results in permanent disability. Early diagnosis determines ultimate prognosis.

In doubtful cases, the diagnosis should be established by aspiration or exploratory arthrotomy if necessary. This is particularly important in the newborn infant.

Diagnostic aspiration should precede the administration of any antibiotic.

Incision and drainage is the preferable method of evacuating an acutely infected joint.

Symptoms of residual incongruity of a joint lag far behind the roentgenographic signs and do not ordinarily appear until the third decade of life.
APPENDICITIS IN CHILDHOOD
Authors: Longino Luther A. , Holder Thomas M. , Gross Robert E.
Published: December 2021

The results of the experience with all cases of acute appendicitis occurring on the Surgical Service at Boston Children's Hospital between July 1, 1944, and January 1, 1957, are presented. There were 1,358 cases.

Early diagnosis is of the utmost importance, although in small children this may be very difficult.

Prompt appendectomy is the treatment for all children with appendicitis. The importance of adequate preoperative preparation and postoperative care of the sicker children is stressed. If appendiceal rupture has occurred, the appendix is removed and the abdominal cavity is drained.

Of 1,358 cases, 611 (45%) had ruptured appendicitis. There was one death, a mortality of 0.07%. There have been no deaths in the last 12 years, during which 1,309 patients have been treated.

The most common complications were residual infections and obstruction of the small bowel. Most of the immediate postoperative obstructions could be managed with a long intestinal tube.

The fact that nearly half of the patients had rupture of the appendix before the time of hospitalization is strong proof that much has yet to be accomplished in improving the early recognition of this disease, thus permitting surgery to be performed before rupture and peritoneal soiling has occurred. The most important effort that can be made in this direction is (when the local physician cannot make frequent house calls to a sick child) to recommend 24 or 48 hours of observation in a hospital for any child in whom appendicitis is suspected. At little expense, this allows frequent checking by appropriate members of the resident or visiting staff of the hospital. If findings suggestive of appendiceal inflammation disappear, the child generally can be sent home the following day. For those in whom the abdominal findings become more impressive under observation, operation can be undertaken while there is still an opportunity to do so before appendiceal rupture has taken place.
SEPTICEMIA OF THE NEWBORN
Authors: Nyhan William L. , Fousek Mildred D.
Published: December 2021

Experience with septicemia in 106 infants over a 25-year period has been reported. An almost 2:1 predominance of males was observed.

In the first 10 years of this study, the Group A, beta hemolytic streptococcus was the predominant infecting organism, while in recent years infections with coliform organisms were the most common, although Group A streptococcal infections continue to occur. Significant numbers of those patients observed in the last 15 years were found to be infected with Ps. aeruginosa and with beta hemolytic streptococci of groups other than A.

Fever, abdominal distention, icterus, and hepatomegaly were the most common clinical manifestations suggesting sepsis. However, in most patients the clinical picture was one of general, rather vague, systemic illness.

Optimal therapy is based on vigorous search for the infecting organism and rapid initiation of intensive antibacterial therapy.
Phenylketonuria
Authors: INGALL MANUEL
Published: December 2021

I would like to comment on a statement made in the August 1957 issue of Pediatrics. Dr. Richmond Paine, in his article entitled "The Variability in Manifestations of Untreated Patients with Phenylketonuria" states that "diagnosis can be made only by the testing of a fresh urine specimen or by determination of the concentration of phenylalanine in the plasma."

I wish to expand on the first part of this statement. I have performed the ferric chloride test on the urines of several untreated phenylketonuric patients, and have observed the following:
AMERICAN BOARD OF PEDIATRICS
Authors:   THE EXAMINATIONS COMMITTEE
Published: December 2021

THE 1958 written examination of the American Board of Pediatrics was taken by 540 candidates on January 10. This is a larger number of candidates than in any previous year with the exception of 1953 when 607 physicians took the test. Grades earned by the 540 candidates ranged from a low mark of 27 to a high of 85, a range satisfactorily adequate for differential selection. After considerable study, the decision was reached to place the passing grade at 51.5. On this basis there were 35 examinees or 6.5% who failed and 505 who passed and were notified of their eligibility for oral examination.

Pertinent statistics follow: mean, 65.82; mode, 69.51; median, 67.05; first quartile, 59.56; third quartile, 72.51. Readers will note that the mean and the mode are 3.7 points apart and also that the range from the first quartile to the median is 7.5 points whereas the distance from the median to the third quartile is only 5.5 points. These statistics mean that the Committee continues to be successful in producing an examination that is skewed toward the lower grades. Such a distribution makes the test relatively sensitive in the critical range where a decision must be reached regarding passing or failing and relatively insensitive in selecting honor grades.

Calculation of the "probable error of estimate" (P.E.m) has yielded a lower figure than in any previous year. This statistic is computed by giving each candidate two grades, one based on his even numbered questions and the other on his odd numbered questions. The degree to which the two sets of grades are in agreement is a measure of the internal consistency of the examination.
BENIGN INTRACRANIAL HYPERTENSION AND OTITIC HYDROCEPHALUS
Authors: MILLICHAP J. GORDON
Published: December 2021

BENIGN intracranial hypertension or pseudotumor cerebri, as the condition is termed more frequently, is a syndrome of increased intracranial pressure with a normal ventricular system and cerebrospinal fluid of normal composition. Headache of moderate degree is the most common symptom and vomiting, impairment of vision and diplopia occur less often; papilledema and abducens palsy are the usual neurologic signs. The prognosis is almost invariably good.

Although few reports of the syndrome are found in pediatric literature, its occurrence is relatively common during childhood. The review of reports by Davidoff, Foley, and others has disclosed that 84 (37%) of 224 patients were children and of these 75 (90%) were between 5 and 15 years of age. The infrequent occurrence or recognition of the syndrome in infants and young children is noteworthy.
DISTURBANCES OF ACID-BASE EQUILIBRIUM IN SALICYLATE INTOXICATION
Authors: Winters Robert W. , White James S. , Hughes Marilyn C. , Ordway Nelson K.
Published: December 2021

The initial disturbances in acid-base equilibrium and the pathways of recovery have been studied in 33 patients, predominantly infants and young children, with salicylate intoxication due either to accidental ingestion or to therapeutic overdosage.

In nearly all patients there were significant reductions in the total content of carbon dioxide and in pCO2 of plasma; pH of the blood did not vary consistently: some patients were alkalotic, others were acidotic, while still others had no significant deviation in pH of the blood.

Evidence was obtained in many of the patients for a mixed disturbance in acid-base equilibrium with primary disturbances in the metabolic and in the respiratory components.

The nature of the component of metabolic acidosis has been analyzed by a detailed study of the anions in the serum of five patients with this disturbance. A variety of anions were present in excess: chloride, salicylate, and undetermined anion; in one patient the concentration of phosphate was also elevated. Reasons are presented suggesting that the undetermined anion fraction represents largely ketone bodies.

The pathway of return to normal acid-base equilibrium was studied with six patients presenting with acid pH. The predominent tendency of this group was to recover through a point at which pH of the blood was normal or even alkaline, even though pCO2 was still low.

In two patients initially presenting with acid pH, acute respiratory depression supervened after acute pulmonary edema. Respiratory depression was accompanied by a marked elevation of pCO2 and a marked fall in pH. One of these patients expired; the other was successfully ventilated by artificial means and made a full recovery.

The basic actions of toxic amounts of salicylate—respiratory stimulation, changes in metabolic rate, and disturbances in the metabolism of carbohydrate, protein and fat—are reviewed. The pathogenesis of the acid-base disturbances is formulated in terms of these known actions of toxic amounts of salicylate.

Several factors correlate with the particular type of disturbance which a given patient may develop and may be important as conditioning influences. These factors are age of the patient, duration of the intoxication, type of intoxication (i.e., whether accidental or the result of therapeutic over-dosage) and, perhaps, the amount of salicylate ingested.
ACTINOMYCIN D IN CHILDHOOD CANCER
Authors: Pinkel Donald
Published: December 2021

Actinomycin D was administered intravenously to 13 children with inoperable cancer. Of eight children who received the agent alone, two experienced regression of tumor, of whom one had Wilms' tumor and the other rhabdomyosarcoma. Of five children who received the drug in association with radiation therapy, two had beneficial responses, which were apparently due to the Actinomycin D rather than to radiation. One of these children had rhabdomyosarcoma and the other a sarcoma of the mesentery.

Toxic manifestations consisted of nausea and emesis, oral ulcerations, depression of hematopoiesis, diarrhea, and alopecia, in that order of frequency.

The changes in the skin associated with x-radiation appeared to become exaggerated after therapy with Actinomycin D.

The estimated optimal dosage for children is 2.4 mg/m2 of body surface area. This amount produced benefit or mild oral toxicity without causing significant depression of the bone marrow. Lower doses are advised during second courses and for patients who have had prior therapy with bone marrow depressants or who have impaired renal function.

Further investigation of the usefulness of Actinomycin D alone and in combination with ionizing radiation in the treatment of cancer seems indicated.
MAPLE SYRUP DISEASE
Authors: Menkes John H.
Published: December 2021

A mixture of alpha-keto acids, the most important of which has been identified as alpha-ketoisocaproic acid, was found to be excreted in large quantities in the urine of beta-methyl-n-valeric acid were present in smaller amounts.

Their excretion would suggest an impairment of the degradative metabolism of the branched-chain amino acids as an important cause of the cerebral degeneration in this condition.
WILMS' TUMOR IN A HORSESHOE KIDNEY
Authors: Lawlor John B. , Lattimer John K. , Wolff James A.
Published: December 2021

A case report of Wilms' tumor in a horseshoe kidney is added to six other cases found in the English literature. This tumor occurred in a 3½-year-old girl who survived 14 months after surgery. She had six courses of radiation therapy, including Betatron-supervoltage treatments. She died of a spontaneous perforation of the distal ileum with fecal peritonitis, in the presence of abdominal metastases. The probable relationship between abdominal radiation and the terminal perforation is pointed out. The difficulties in differential diagnosis of tumor in a hydronephrotic, horseshoe kidney versus the alternate possibility of an occluded supernumerary renal pelvis, is discussed.
PEDIATRICS AND SOCIETY
Authors: Glaser Kurt
Published: December 2021

A considerable portion of a child's life is spent in school. His adjustment to this experience is of utmost importance for the later adjustments he will have to make as an adult. It is part of the pediatrician's duty to supervise the child's emotional and physical health and to help him and his parents maintain it in optimal condition.

Reluctance to attend school is a problem frequently encountered and of great importance. The pediatrician should be familiar with its various facets because he may be the first to be consulted if such a problem arises.

The child may openly express his fear or unwillingness to go to school or may present physical symptoms which prevent him from attending school. A precipitating factor, such as a minor illness of the child or an upsetting event in the family, is usually present. The underlying cause may be connected with the school itself, such as fear of teacher or children, too great demands for achievement by teacher or parents in relation to the capacities of the particular child, or inability of the child to face competition with peers or siblings. The cause may lie in anxiety caused by fear of separation between mother and child, the attendance at school being the first occasion when such a separation becomes mandatory.

Treatment consists of early return of the child to school, concurrent with, or followed by, treatment of the underlying cause, whenever such treatment is indicated, available and accepted by the parents. Delay in return to school increases the difficulties in the child's readjustment to normal acceptable behavior and makes treatment of the underlying cause more difficult.

Brief examples of the above situations are cited from experience with 38 children. The incidence of the presenting problems, the adjustment following treatment and the duration of treatment are presented.
Clinical Radiology of Acute Abdominal Disorders
Authors: SILVERMAN FREDERIC N.
Published: December 2021

This is a volume which may be classified as one for functional reference rather than one for research reference, although it can serve as a good spring-board into serious review by virtue of its succinct phraseology and extensive bibliography.

The section on congenital malformations will be of particular interest to physicians dealing with pediatric problems, and includes approximately 25% of the text and illustrations.
Orthopsychiatry and the School
Authors: KUGEL ROBERT B.
Published: December 2021

This book containing articles by 26 different authors is organized into 5 sections which are: 1) Orthopsychiatry's help to Education; 2) Orthopsychiatry and the Problems of Learning; 3) Orthopsychiatry and School Mental Health; 4) Teacher Education and Mental Health; and 5) Orthopsychiatry and Adolescent Problems. As the editor states in his introduction, "The purpose was not to present a unified point of view . . . , but rather to portray a wide variety of approaches in different situations. . . ." This objective is certainly achieved and as such represents a major deficiency in this book.
CYSTS AND DUPLICATIONS OF NEURENTERIC ORIGIN
Authors: Nathan Max T.
Published: December 2021

A case with a transdiaphragmatic duplication of the small intestine is reported. This was probably of neurenteric origin as it was attached superiorly to C3, and inferiorly to the terminal ileum. Five other similar cases from the records of this hospital are discussed.

A brief review of the literature and a discussion of the embryology of these anomalies is included.
THE DIAGNOSTIC USEFULNESS OF SKELETAL MATURATION IN AN ENDOCRINE CLINIC
Authors: Mellman William J. , Bongiovanni Alfred M. , Hope John W.
Published: December 2021

Correlation of bone age and clinical status of 146 children referred to an endocrine clinic has been presented. Ninety-five subjects were retarded with respect to height, bone age, or both. In only 30% of this group was a true endocrinologic disorder present, and the majority were attributable to hypothyroidism. Retarda-of skeletal maturation alone, however, is not indicative of thyroid disease. The majority of the group with retardation had a "constitutional" disorder.

Fifty-one children exhibited acceleration of the bone age, stature, or both. In 20 it could be attributed to constitutional precocity. Such advancement, of a moderate degree, was associated with simple exogenous obesity. The most extreme alterations were seen in conjunction with adrenal hyperplasia or adenoma.

The importance of employing several centers for the estimation of bone age has been stressed, and the significant diversity which may occur between the hand and wrist and other regions, has been detailed in several instances. A summary of concepts relating the endocrine system to maturation, in terms of the clinical data described herein, has been presented.
ENZYMATIC PATTERNS DURING DEVELOPMENT
Authors: Kretchmer Norman
Published: December 2021

I would like to express my gratitude to you, the American Academy of Pediatrics, for selecting me for an E. Mead Johnson Award. I accept the honor with humility because no scientific work is accomplished without inspiration from teachers and other investigators, and without actual participation of many colleagues. I appreciate this opportunity to acknowledge publicly those individuals who have been and are particularly influential in my progress.

Dr. Jean Oliver, the man to whom I owe my entry into medicine and pediatrics, with great effort instilled in me an everlasting appreciation for the inseparable relationship between structure and function. Fortunately, I have remained in close contact with Dr. Oliver throughout the years, continually reaping benefits from his advice and influence.

I conceived of function as only cellular and molecular until Dr. Henry L. Barnett introduced me to organ function, especially in relation to the young individual. In addition, he fostered in me an interest in the broader aspects of pediatrics, amid since that time has been available constantly for intimate exchange and crystallization of ideas.

I am indebted particularly to Dr. S. Z. Levine for leading me into the field of biologic development and insisting that my time be divided between clinical pediatrics and the laboratory. Dr. Levine has always emphasized that ideas, philosophies and problems originating in the ward or clinic can and should be considered in the laboratory.
AN INBORN ERROR OF LIPID METABOLISM
Authors: Bigler John A. , Mais Roland F. , Dowben Robed M. , Hsia David Yi-Yung
Published: December 2021

The present report concerns a new clinical syndrome characterized by hepatomeggaly, retardation of physical and mental growth, and a disturbance of lipids in the plasma.

The abnormalities are present in two siblings born of parents who are second cousins. As far as can be determined, none of the six other siblings is affected.

The disturbance of lipids is characterized by an increase in the concentrations of triglycerides and phospholipids in the plasma with relatively little increase in the concentration of total cholesterol. By means of paper and agar gel electrophoresis, the disturbance has been found to involve primarily an increase in the concentration of alpha2-lipoproteins. Using zone electrophoresis on starch medium, we have shown that there is an increase in concentration of phospholipids and triglycerides in the alpha2-lipoproteins and of triglycerides in the alpha1-lipoproteins. Analytic ultracentrifugation revealed an increase in each of the fractions, but was most marked in the lipoproteins with Sf 20-400.

It would appear that this represents a new third "inborn error of lipid metabolism" in man.
TREATMENT OF THE NEPHROTIC SYNDROME WITH TRIAMCINOLONE
Authors: Hellman Leon , Zumoff Barnett , Minsky Arnold , Kretchmer Norman , Kramer Benjamin
Published: December 2021

In this report, only acute remissions of the nephrotic syndrome following triamcinolone therapy are considered. No conclusions are drawn regarding the effects of this treatment on the ultimate fate of these children. With these reservations kept clearly in mind, this experience with 15 children with the nephrotic syndrome indicates that triamcinolone is a highly effective therapeutic agent.

With the 20 mg/day dose employed for 30-45 days in this series, side-effects were absent except for the occasional appearance of slight moon facies.

The incidence of complete remission in the entire series was 10 out of 15 patients (67%). Of patients whose disease was less than 12 months in duration, and who did not have hypertension, eight out of nine patients (89%) had a complete remission. These results compare favorably with the experience reported in the literature with other steroids.

The mere induction of acute remissions, no matter how readily or reproducibly, should not be the chief concern in therapy of nephrosis. The ultimate prognosis is still pessimistic, despite regimens of therapy with currently available steroids. A recent report suggests that the long-term results of steroid therapy in the nephrotic syndrome might be improved by earlier, more intensive, and more prolonged treatment. It is the present authors impression that triamcinolone is a useful steroid for such a program, because of its high potency and minimal side-effects. The doses employed did not cause hypertension or retention of sodium.
UTILIZATION OF PARENTERALLY ADMINISTERED NITROGEN BY INFANTS RECEIVING SUBOPTIMAL CALORIES
Authors: Calcagno Philip L. , Rubin Mitchell I. , Mukherji P. K.
Published: December 2021

The parenteral administration of 100 mg of amino-acid nitrogen/kg of body weight/ day given within 4 hours to infants who are underfed (40 cal/kg of body weight/day) and protein-starved can change the nitrogen balance from negative to positive or greatly reduce the degree of negative balance.

The retained nitrogen is not degraded to urea or excreted as amino acids in the urine in the after-period. It is postulated that the retained amino-acid nitrogen is utilized for synthesis of tissue.

Even when the total caloric intake is suboptimal, the administration of a protein hydrolysate during prolonged protein starvation in infants who are unable to ingest protein seems desirable.
LYMPHOPNEUMATOSIS CYSTOIDES INTESTINALIS WITH EOSINOPHILIA IN THE INFANT
Authors: Gagnon Jacques , Rheault Marcel
Published: December 2021

A study of five infants with lymphopneumatosis cystoides intestinalis and a review of the literature is presented.

There is an association between lymphopneumatosis cystoides and eosinophilia.

Lymphopneumatosis seems to result from the association of several factors, namely, gastrointestinal disturbances (generally accompanied by infection and followed by wasting and avitaminosis) and acidification of the gastrointestinal content. Nevertheless, the exact pathogenesis is obscure.

Eosinophilia does not seem to be produced by the gases in the cysts.
USES AND ABUSES OF ANTIPYRETIC THERAPY
Authors: Done Alan K.
Published: December 2021

FEVER is undoubtedly the most common symptom confronting the physician who treats children. It is fought as though it were the patient's primary disease, and its mere presence is often accepted as being sufficient indication for the institution of antipyretic therapy. It is not surprising, therefore, that therapeutists and pharmaceutical concerns have energetically sought new and better drugs for the control of fever. In the past few years there has appeared on the market a number of new formulations which are purported to offer distinct advantages in terms of antipyretic potency, acceptance by children, and/or reduced toxicity.

It is axiomatic that virtually any claim regarding a drug can be supported by published data, if the proper study is selected and interpretation is sufficiently influenced by conviction. Particularly is this true of antipyretic-analgesic drugs, where such factors as lability in the case of fever and lack of objectivity in the case of pain, make evaluation difficult. The claims and counterclaims which have been made concerning antipyretic drugs have led to considerable confusion and misunderstanding on the part of clinicians in general. The purpose of this presentation is to attempt to provide some clarification of this problem.

IS ANTIPYRESIS INDICATED?

More critical than the choice of an antipyretic is the question of whether or not such therapy is indicated in the individual case, for there is little doubt that these drugs are grossly overused, at times to the detriment of the patient. Therefore, before discussing the antipyretics themselves, it seems appropriate to review briefly a number of points which deserve consideration before one elects to use an antipyretic.

DuBois summarized a lifetime of study on fever and the regulation of body temperature with the statement: "Fever is only a symptom and we are not sure that it is an enemy. Perhaps it is a friend." The literature concerning the possible role of fever in body defenses is extensive and inconclusive.
THE USE AND ABUSE OF DRUGS IN THE TREATMENT OF ASTHMA IN CHILDREN
Authors: Ratner Bret
Published: December 2021

ASTHMA is among the serious manifestations of allergic disease for which patients require immediate relief. Because of its chronicity and tendency to recur there has been a continuous search for more effective symptomatic treatment.

A large number of drugs have been developed which are purported to relieve the symptoms of asthma. They are used and often abused to an extent which may actually endanger the life of the patient.

For some diseases, in which only one effective remedy is available, a calculated risk is justified to save the life of an individual. Under these circumstances the value of such treatment outweighs its danger. This situation should not often arise with asthma, for which the choice of remedies is wide enough to make it possible to avoid any one which may be hazardous in a particular patient. Let us, therefore, take stock of the measures used in the treatment of asthma and evaluate their respective merits.

We will begin with an example of a child who died from bronchial asthma after a surgical operation and whose case was presented at a hospital conference:

Post-mortem examination disclosed that the entire bronchial tree was completely filled with thick, gelatinous fluid. A discusser at the conference quite rightly criticized the use of atropine and stated that bronchoscopic aspiration, postural drainage and nasotracheal intubation should have been instituted. He added that adrenal steroids had also been indicated. To my astonishment he went on to recommend antihistaminics, aminophylline and epinephrine before, during and after anesthesia.

This discussion leaves one dismayed, for with a plugged bronchial tree many of the drugs suggested by the critic are as contraindicated as was the atropine. Antihistaminics, for example, with their drying, atropine-like action, are specifically contraindicated.
Art Therapy in a Children's Community
Authors: VOLLMER HERMANN
Published: December 2021

Edith Kramer is an excellent artist, has a sound knowledge of psychoanalytic theory and has had 7 years of experience as an art therapist with disturbed children. This rare combination probably explains the unusual qualities of her book, not shared by any other on this subject. Mainly the psychoanalytic training seems to be indispensable for a meaningful interpretation of artistic creations or their use in a therapeutic program.

Prinzhorn, whose book, The Art of the Insane, was a sensation when it appeared in 1922, had artistic sensitivity and psychiatric knowledge but failed utterly in his interpretations. Freud's writings were at hand but Prinzhorn, as many others, rejected Freud's dynamic psychology in favor of speculations, comparisons and mysticisms which left all basic questions about his unique collection unanswered. Subsequently, psychoanalytic thinking has influenced many fields besides psychiatry and led to Psychoanalytic Explorations in Art, culminating in Ernst Kris's masterful book with this title in 1951. Edith Kramer seems to continue this productive development with her present book.
CONGENITAL ANOMALIES ASSOCIATED WITH GONADAL APLASIA
Authors: Haddad Heskel M. , Wilkins Lawson
Published: December 2021

The congenital anomalies associated with the syndrome of gonadal aplasia were reviewed in 55 cases. All patients in this group were short in stature. Almost half of the group had webbed neck, 13 of whom were of the Bonnevie-Ullrich type. Seven of the latter, however, changed into the Turner's type of neck in early childhood. Edema of the extremities, aortic coarctation and cutis laxa seemed to be associated with the group of neck webbing. Other somatic anomalies, on the other hand, especially shield-like chest, cubitus valgus and abnormal facies and nails, occurred with almost equal incidence among the two groups: those with and those without webbed neck. All patients with webbed neck tested for chromosomal sex showed a male pattern, whereas, of 11 patients with normal necks whose chromatin pattern was studied, 4 had female patterns.

A high incidence of bone rarefaction ("osteoporosis") of unexplained nature, moderate hypertension of unknown etiology and multiple intestinal telangiectases was noticed. Several other anomalies, mostly of mesodermal origin, were found to be of a higher incidence in this group than the general population.

The embryogenesis and the pathogenesis of this syndrome are discussed. Diagnosis and treatment are briefly mentioned.
NECROTIZING ARTERITIS OF THE CORONARY VESSELS IN INFANCY
Authors: Munro-Faure Honor
Published: December 2021

A case of necrotizing arteritis of the coronary vessels in a 4-month-old infant is described. Death was due to thrombosis of the aneurysmally dilated coronary arteries. A review of the literature yields a total of 19 cases of necrotizing arteritis in infancy, 12 of whom showed a similar gross pathology. Of these 12 at least 8 have presented with a similar symptomatology.

Etiologic theories are discussed, and suggestions are made as to the possible management of infants presenting a similar diagnostic problem.
OCCURRENCE OF CHRONIC DIARRHEA IN THREE PATIENTS WITH GANGLIONEUROMAS
Authors: Green Morris , Cooke Robert E. , Lattanzi William
Published: December 2021

The occurrence of celiac-like symptoms in three patients who had either a ganglioneuroma or a ganglioneuroblastoma is reported.

The possibility of a causal relationship in these cases is suggested, and an hypothesis regarding this relationship is presented.
ACUTE SUBDURAL EFFUSIONS AND LATE SEQUELAE OF MENINGITIS
Authors: Platou Ralph V. , Rinker Andrew , Derrick Joseph
Published: December 2021

In a group of 343 consecutive patients under 36 months of age with acute purulent meningitis, survival rates were encouraging but neurologic sequelae were disturbingly frequent. Fifty-five infants had subdural collections during the acute phase of their disease. An attempt was made to evaluate the prognostic significance of these.

It appears clear that the frequency and severity of neurologic sequelae are related to the presence of early subdural collections, but these could not be specifically correlated as to volume, character, on time at which they occurred. Subdural collections are most frequent in the youngest patients, for whom early recognition of meningitis may be difficult or delayed.

It is assumed, but not proved, that factors similar to those responsible for production of the subdural collections also caused many of the evidences of brain damage that appeared concomitantly or developed later.
OFFICE EVALUATION OF INTELLIGENCE OF CHILDREN
Authors: Bakwin Ruth M.
Published: December 2021

For office diagnosis of intelligence, one's clinical judgment, based on the developmental history, medical history, observation of the child, and the child's ability to carry out a few simple directions, is fairly accurate in determining if the child is functioning at a retarded, average or superior level. Whether the child is actually feebleminded or suffering from brain damage on schizophrenia or affected by a reading problem is sometimes much more difficult and time-consuming, although there are suggestive findings in the office examination. If necessary the level of intelligence can be confirmed by more exact measurements.
INCIDENCE OF INFECTION IN CHILDREN AFTER SPLENECTOMY
Authors: Laski Bernard , MacMillan Angus
Published: December 2021

Eighty-one cases of splenectomy and 94 cases of appendectomy that were carefully followed are reviewed in relation to subsequent infections.

One child in each group developed purulent meningitis and four cases of aseptic meningitis were observed in the appendectomized group.

It would appear from this series that the incidence of serious infection in children after splenectomy is no higher than in a somewhat similar group after appendectomy.
THE RESPIRATORY DISTRESS SYNDROME OF PREMATURITY
Authors: Usher Robert
Published: December 2021

A study of 59 premature infants with respiratory distress syndrome has revealed the presence of severe increase in concentration of potassium with electrocardiographic changes. Thirty-six of 37 of these infants examined serially between 12 and 60 hours of age developed electrocardiographic abnormalities. Concentrations of potassium in serum of over 7.0 meq/l were associated with these prolonged conduction times. Concentrations of over 9.0 meq/l occurred in 12 infants, 11 of whom died. Parenteral administration of glucose, insulin, and bicarbonate produced a fall in the concentration of potassium in the serum and a correction of the electrocardiogram.

Control premature and full-term infants had concentrations of potassium between 4 and 7 meq/l and never showed electrocardiographic disturbances.

Evidence is produced that premature infants with the respiratory distress syndrome develop a toxic degree of hyperkalemia which is reversible.
COMPARATIVE STUDY OF HUMAN MILK AND A SOYA BEAN FORMULA IN PROMOTING GROWTH AND NITROGEN RETENTION BY INFANTS
Authors: Fomon Samuel J.
Published: December 2021

Four infants, 4 to 6½ months of age, were studied for periods of 38 to 73 days while receiving ad libitum feeding of a formula in which the protein was derived from soya bean. No other source of calories was provided. The content of protein in the formula was 1.14 gm/100 ml (6.8% of the calories supplied by protein) and the mean intake of protein by the infants was 1.7 gm/kg/ day. The amounts of methionine (mean intake, 38 mg/kg/day) and tryptophan (mean intake, 14 mg/kg/day) supplied by the formula were slightly less than currently accepted minimal requirements for infants.

The rate of gain in weight of the infants was normal and retentions of nitrogen (15 metabolic balance studies) were at least as great as those of normal full-term infants of similar ages fed human milk. This finding may be of value in consideration of protein allowances for children in technically underdeveloped areas of the world in which soya beans, but not animal protein, are available.
THE WOLFF-PARKINSON-WHITE SYNDROME IN INFANTS AND CHILDREN
Authors: Schiebler Gerold L. , Adams Paul , Anderson Ray C.
Published: December 2021

It is the belief of the authors that the Wolff-Parkinson-White syndrome, although frequently misinterpreted, is not an uncommon finding in infants and children. This electrocardiographic pattern occurred approximately once among every 200 children (0.5%) referred for cardiac evaluation.

Twenty-eight infants and children with the Wolff-Parkinson-White syndrome, 19 (68%) of whom were males, were arbitrarily classified into five general groups: 1) "traditional—9 cases; and those associated with 2) congenital heart disease–13 cases; 3) rheumatic heart disease–1 case; 4) familial cardiomegaiy–2 cases; and 5) disease of the central nervous system–5 cases. Only two patients were placed in more than one category.

The small number in the "traditional" group (9 of 28 cases) is striking. About half of the cases studied had associated congenital heart disease, particularly Ebstein's anomaly of the tricuspid valve. A review of reported cases with the Wolff-Parkinson-White syndrome and congenital heart disease appears to show that this syndrome may be associated with many congenital malformations of the heart, but particularly with dextrocardia and anomalies of the tricuspid valve (Ebstein's malformation and tricuspid atresia).

The association of the Wolff-Parkinson-White syndrome with diseases of the central nervous system and with congenital anomalies in other areas of the body is noted.

Fourteen of the patients (50%) had episodes of tachycardia, and paroxysms of tachycardia were suspected in two others.

Digitalis preparations have proved to be efficacious in terminating the bouts of tachycardia in children.

The prognosis in those individuals without any other congenital anomaly is usually good.

On the basis of this study, the authors consider that every child with this electrocardiographic pattern should be investigated for additional abnormalities.
OCCURRENCE OF ANEMIA AND POLYCYTHEMIA IN PHENOTYPICALLY DISSIMILAR SINGLE-OVUM HUMAN TWINS
Authors: Sacks Martin O.
Published: December 2021

Four sets of phenotypically dissimilar, apparently identical human twins are presented. In each set, among other differences, one twin was anemic, the other polycythemic. Cause, therapy, and certain speculations as to occurrence and severity are discussed.
THE EFFECT OF RUBEOLA ON TUBERCULOSIS UNDER ANTIMICROBIAL THERAPY
Authors: Kendig Edwin L. , Hudgens Robert O.
Published: December 2021

Measles is generally considered to be a cause of worsening of tuberculous disease. In 12 children with primary pulmonary tuberculosis, who received isoniazid immediately after detection of measles or were already under treatment with isoniazid, intercurrent measles appeared to exert no deleterious effect on the tuberculous disease.
New Diagnostic Test for Neural Tumors of Infancy: Increased Urinary Excretion of 3-Methoxy-4-hydroxymandelic Acid and Norepinephrine in Ganglioneuroma with Chronic Diarrhea
Authors: GREENBERG ROBERT E. , GARDNER LYTT I.
Published: December 2021

Green et al. (Pediatrics, 23:951, 1959) reported the occurrence of chronic diarrhea with abdominal distension and wasting as presenting symptoms in three children who had either a ganglioneuroma or ganglioneuroblastoma. Since all symptoms abated after removal of the tumor, they postulated the secretion of a chemical substance by the tumor, affecting gastrointestinal motility or water reabsorption or both.

We have made studies in an additional child, age 2½ years, who manifested a similar syndrome with a ganglioneuroma. The findings in this patient indicate that the ganglioneuroma was a functioning endocrine tumor, involved in the overproduction of 3-methoxy-4-hydroxymandelic acid, norepinephrine and perhaps two other compounds of unknown structure.
AN EVALUATION OF THE TREATMENT OF PHENYLKETONURIA WITH DIETS LOW IN PHENYLALANINE
Authors: Knox W. Eugene
Published: December 2021

Essentially all cases of phenylketonuria treated with a low phenylalanine diet and published up to December, 1959, were reviewed and evaluated. All untreated individuals with phenylketonuria with an I.Q. above 60 that have been recorded were tabulated. The number of these (20) verifies as reasonable the incidence of 2.5% of 466 untreated cases of phenylketonuria that have an I.Q. above 60. This figure was used as one basis of evaluation of the treatment.

Forty-four patients with phenylketonuria, over 3 years of age, have been treated without impressive change in mental or neurologic status. These were not considered further.

Forty-three patients with phenylketonuria, treated before 3 years of age, were tabulated and evaluated in detail. The mean age at start of treatment was 16.2 months, and the mean duration of treatment was 16.8 months.

The treated group had 18 times as many with an I.Q. above 60 and twice as many with a normal electroencephalogram as the untreated group. These differences were highly significant. The treated group also had fewer seizures.

Those treated before 16 months of age, compared with those treated between 16 months and 3 years of age, had four times as many with an I.Q. above 60 and fewer (none) with seizures. These differences were highly significant. The early treated group also has more with normal electroencephalograms.

For the whole group the final I.Q. was negatively correlated with age at the start of treatment in a highly significant manner (r = -0.67, P < .01). Over the 3-year period studied, a minimal loss of nearly 5 points in the I.Q. occurred each 10 weeks that treatment was delayed.

The low phenylalanine diet started in the early months of life is therefore effective as a preventative of mental deficiency and neurologic abnormalities. The diet is less effective in reversing changes which have already developed.
Pharmacokinetics of Acetaminophen in the Human Neonate: Formation of Acetaminophen Glucuronide and Sulfate in Relation to Plasma Bilirubin Concentration and D-Glucaric Acid Excretion
Authors: Levy Gerhard , Khanna Narinder N. , Soda David M. , Tsuzuki Osami , Stern Leo
Published: December 2021

The purpose of this study was to determine if certain physiologic parameters (plasma bilirubin concentration and urinary excretion rate of D-glucaric acid) can be used to predict a newborn infant's ability to eliminate a phenolic drug. and particularly to predict the ability to conjugate that drug with glucuronic acid. Twelve healthy 2-to 3-day-old full-term infants with plasma bilirubin concentrations of 1.0 to 11.6 mg/100 ml and D-glucaric acid excretion rates of 0.131 to 0.345 mg/kg/day received a single oral dose of acetaminophen, 12 mg/kg. Urine was collected serially for 48 hours and analyzed for acetaminophen, acetaminophen glucuronide, acetaminophen sulfate, and D-glucaric acid. The biologic half-life of acetaminophen was 3.5 ± 0.85 hours (average ± SD) as compared to average values of 1.9 to 2.2 hours observed in five reported studies on a total of 39 adults. The rate constant for acetaminophen glucuronide formation in neonates was considerably smaller, on the average, than in adults but the average rate constant for acetaminophen sulfate formation was somewhat larger than in adults. There is no statistically significant correlation between these rate constants and either plasma bilirubin concentration or D-glucaric acid excretion. The results of this study suggest that the limited ability of neonates to conjugate phenolic drugs with glucuronic acid is compensated to a degree by a well-developed capability for sulfate conjugation.
Pulmonary Valvular Dysfunction in Children With Ventriculovenous Shunts for Hydrocephalus: A Previously Unreported Complication
Authors: Hougen Thomas J. , Emmanoulides George C. , Moss Arthur J.
Published: December 2021

A hitherto unreported cardiovascular complication of ventriculovenous shunts for hydrocephalus, involving the pulmonary valve apparatus, is described in two boys. This complication was the result of catheter migration with its proximal end interfering with pulmonary valve function. In one case the embolized catheter was removed by thoracotomy resulting in disappearance of the cardiac findings, whereas in the other case the catheter was in situ because of its peripheral position in the lung and the relatively insignificant hemodynamic disturbance of the pulmonary valve. The pertinent literature on the cardiovascular complications of ventriculovenous shunts for hydrocephalus is also reviewed.