bluuebunny/crossref_metadata_2025 huggingface dataset:
COMPARISON OF THE TOLERANCES OF ANESTHETIZED ADULT DOGS AND PUPS TO KCI INFUSION
Authors: Taylor Paul M. , Seder Harold B. , Mering James , Watson Doris W.
Published: December 2021

The hypothesis that pups might tolerate hyperpotassemia better than adult dogs was tested. Adult dogs and newborn pups (2 hours to 4 days old), anesthetized with pentobarbital sodium, were infused with 1.0% KCl solution at the rate of 0.5 ml/kg/min until death. Criteria for tolerance to hyperpotassemia were survival time, plasma K concentration at loss of P wave on ECG, and plasma K concentration at death. Spontaneously breathing adult dogs and pups did not differ significantly in any of these criteria. Both adult dogs and pups developed metabolic acidosis during KCl infusion. The adult dogs hyperventilated, appropriately, during KCl infusion, but the pups hypoventilated and became hypoxemic and hypercapneic. Maintaining pups at near-normal arterial pH during KCl infusion by artificial hyperventilation did not improve their tolerance to hyperpotassemia.
Down's Syndrome in Children of Parents exposed to Radiation
Authors: THELANDER H. E.
Published: December 2021

I have under my care a mongol 18 months of age born to young healthy parents with good family history and after a normal pregnancy. A second child born a year later has several small anomalies. Recently the grandmother to these children gave the mother her "baby record" and in it the mother found that in her infancy she had had x-ray therapy for an enlarged thymus. The mother wondered if this therapy during her infancy had any causative relationship to her mongol offspring. I also am wondering about it.
HYPERALDOSTERONISM, HYPERPLASIA OF THE JUXTAGLOMERULAR COMPLEX, NORMAL BLOOD PRESSURE, AND DWARFISM: REPORT OF A CASE
Authors: Bryan George T. , MacCardle Ross C. , Bartter Frederic C.
Published: December 2021

A patient with the syndrome of hyperaldosteronism, hyperplasia of the juxtaglomerular complex, dwarfism, and normal blood pressure is reported in detail. In this patient, the aldosterone secretion rate increased significantly and the serum potassium rose slightly with sodium deprivation. With a low-sodium diet urinary sodium fell to zero. Spironolactone with a low-sodium diet raised serum potassium to normal. Infusion of albumin, however, resulted in a rapid increase in serum potassium and a fall in aldosterone secretion rate. The unique features in this patient are the response to albumin and the lowering o urinary sodium to zero in response to a low-sodium intake. In all other essentials, the case resembles the two previously reported cases. Treatment by subtotal adrenalectomy was not curative.
FAMILIAL DE LANGE SYNDROME WITH CHROMOSOME ABNORMALITIES
Authors: Falek Arthur , Schmidt Rina , Jervis George A.
Published: December 2021

Familial de Lange syndrome is described in three siblings and a maternal first cousin. A new chromosomal aberration has been found in this family in all affected children and in 7 unaffected carriers. Karyotypic differences between carriers and their affected children present evidence of an excess of some chromosome A 3 material producing the clinical disorder.
VISUAL RESPONSES IN THE NEWBORN
Authors: Brazelton T. Berry , Scholl Mary Louise , Robey John S.
Published: December 2021

Ninty-six infants were tested for their ability to fix on, pursue, and alert to a test object visually. These infants were evaluated for subsequent development. Of the 9 infants later deemed to be abnormal or suspect, none showed positive visual responses in the newborn period. However, 57.5% of the normal infants demonstrated this ability. Opticokinetic responses were obtained in 76% of the normal group but in none of the suspect.

Eliciting visual responses as part of the neonatal examination may offer reassurance to the clinician as to the infant's future prognosis. Their absence on any one examination is not a definite indication of central nervous system deficit. The capacity of a neonate to fix, follow, and alert to a visual stimulus appears to be good evidence for an intact central nervous system.
EARLY CHILDHOOD SEPARATIONS
Authors: Kennell John H. , Bergen Mary E.
Published: December 2021

Every child in this long-term study of child rearing showed significant reactions to ordinary separations by about 1 year of age.

The similar pattern of response in this group of children suggests a biologically determined cause. The clinging reaction appeared when the child became mobile and able to move away from his mother, regardless of the frequency or duration of his separations.

The majority of the mothers did not understand this natural phenomenon and regarded the clinging and crying of the 1-year-old as evidence of spoiled or regressed behavior.

The pediatrician can be helpful to a mother by anticipating and explaining separation responses, by indicating their universality, and by giving specific recommendations for gradual changes to modify these reactions.
COMMITTEE ON INFANT AND PRE-SCHOOL CHILD
Authors:   COMMITTEE ON INFANT AND PRE-SCHOOL CHILD
Published: December 2021

MALTREATMENT OF CHILDREN, or child abuse, takes many forms. It may be serious gross neglect of the child's welfare to the point of starvation, cruelty resulting in emotional damage to the child, or physical assault by a parent, older sibling, or person charged with the care of the child, as described in the term "battered child syndrome." We do not know the actual number of maltreated children, nor their subdivision into physical and emotional abuse. It is likely that the battered child is the least frequent yet currently the most discussed. This paper will concern itself primarily with the physically abused child.

Recently, the problem of maltreatment of children has received much attention. Perhaps part of the recent public interest in this problem has resulted from the dramatic phrase "battered child syndrome," which was first used by Kempe, et al. during a panel discussion at an annual meeting of the American Academy of Pediatrics.

But long before the phrase was coined, interest in the problem of multiple injuries had begun. About 20 years ago Caffey described x-ray findings of multiple fractures in the long bones, and a diagnostic tool was developed. Since then the child with multiple injuries indicating new or recent injuries superimposed on old has come under increasing scrutiny, especially in the last three or four years. Later studies by hospital pediatric and x-ray departments added to the earlier reports of "skeletal trauma in infants" which, in turn, have alerted pediatricians, roentgenologists, and other physicians to the possibility of child abuse.
Desferrioxamine in Acute Iron Poisoning
Authors: MCENERY JOHN T.
Published: December 2021

In the September issue of Pediatrics (36: 322, 1965) Dr. Charles Whitten reported his experiences in the use of Desferrioxamine-B, an iron specific chelating agent, in children with acute iron poisoning. He stated that the iron-desferrioxamine complex was toxic to dogs.

Since the complexing of desferrioxamine and ferrous salts is a logarithmic progression after binding 50% of the serum iron in excess of the iron-binding protein it is most likely that the dogs died of the effects of iron poisoning.
Head Circumference, Mental Retardation and Growth Failure
Authors: KRIEGER I.
Published: December 2021

A recent publication in Pediatrics (36:62, 1965) by O'Connell, Feldt, and Stickler focused very timely attention on the frequent occurrence of growth failure, small head size, and mental subnormality in noninstitutionalized North American children. The degree of mental subnormality did not correlate with head size; however, children with growth failure and normal intelligence did apparently without exception have a normal circumference for age, i.e., a "disproportionately large head" for body size. An analysis of causal relationships was not possible because of the heterogenous case material.
THE USE AND MODE OF ACTION OF ETHACRYNIC ACID IN NEPHROGENIC DIABETES INSIPIDUS
Authors: Brown David M. , Reynolds John W. , Michael Alfred F. , Ulstrom Robert A.
Published: December 2021

The use of diuretic agents in the treatment of nephrogenic diabetes insipidus had been reported to result in decreased urine volume and decreased clearance of free water. A study of the use of ethacrynic acid, a potent saluretic agent, was instituted in patients with nephrogenic diabetes insipidus in an attempt to achieve a significant antidiuretic response while allowing a liberal sodium diet. Intravenous ethacrynic acid resulted in decreased urine volume, decreased clearance of free water and decreased RPF and GFR. Prolonged oral administration of ethacrynic acid promoted a significant antidiuretic response when the daily sodium intake was limited to 60 mEq. The effect of ethacrynic acid on renal function, potassium and chloride. excretion, and uric acid metabolism are discussed.
Crib-Side Sampling of Blood from the Radial Artery
Authors: BUCCI GIOVANNI , SCALAMANDRÈ ANTONIO , SAVIGNONI PIER GIORGIO , ORZALESI MARCELLO , MENDICINI MODESTO
Published: December 2021

In the newborn infant sampling of arterial blood is usually performed from the umbilical or temporal artery. Both techniques have been employed in our laboratory, the latter with approximately 90% success after the age of 36 hours. However, the introduction of an umbilical catheter may be impossible after the early hours of life and the rare occurrence of pallor of one leg requires the catheter's immediate removal. Sampling from the temporal artery is difficult in infants with scalp edema, which is often present in the first hours after birth.

To the best of our knowledge, sampling from the radial artery has been performed in children and adults but never in newborn infants.
HAND, FOOT, AND MOUTH SYNDROME
Authors: Cherry James D. , Jahn Charles L.
Published: December 2021

During the summer and fall of 1963, 76 patients with exanthematous disease were studied and 6 cases of hand, foot, and mouth syndrome due to Coxsackie A 16 virus were noted. Nine virus strains were isolated from the throat in five cases, vesicle fluid in two, rectal swab in one, and serum in one. All strains were isolated in MK tissue culture and many were also isolated in primary human amnion and WI-38 tissue cultures and suckling mice. Five of the 6 patients had a fourfold or greater rise in neutralizing antibody titer to Coxsackie A 16 virus. Fifty-two per cent of all patients with exanthem had convalescent serum neutralizing antibody titers of 40 or greater to Coxsackie A 16 virus and three of these children without virus isolation also had greater than fourfold antibody titer rises. Serum neutralizing antibody to Coxsackie A 16 virus was prevalent in Wisconsin in 1963 but was observed in only one of 50 (2%) serums collected in 1957.
HAND-FOOT-AND-MOUTH-DISEASE RESEMBLING MEASLES A LIFE-THREATENING DISEASE: CASE REPORT
Authors: Gohd Robert S. , Faigel Harris C.
Published: December 2021

A case of a seriously ill child with hand-foot-and-mouth disease is presented. In its early stages it resembled rubeola. Coxsackie virus type A-16 was isolated from throat washings. Its presence as the etiologic agent was inferred by serologic tests.

Pitfalls in the clinical diagnosis of hand-foot-and-mouth disease are discussed.
COOPERATIVE MEASLES VACCINE FIELD TRIAL
Authors: Guinee Vincent F. , Henderson Donald A. , Casey Helen L. , Wingo Sara T. , Ruthig Delmar W. , Cockburn T. Aidan , Vinson T. O. , Calaflore Dorothy C. , Winkelstein Warren , Karzon David T. , Rathbun Margaret L. , Alexander E. Russell , Peterson Donald R.
Published: December 2021

The efficacy of two measles vaccine schedules was tested in a double-blind, placebo-controlled field trial. One group of children received three injections of 0.5 ml of inactivated measles virus vaccine. A second group received two injections of inactivated measles virus vaccine followed by 1400 TCID50 of live attenuated virus measles vaccine. Half of the participating children received placebo injections.

The 4,758 participating children in kindergarten and first and second grades were kept under surveillance over a period of 14 months. Among these children 504 cases of clinically diagnosed measles occurred; 430 were in the placebo group.

The inactivated measles virus vaccine, although providing good protection against cases of typical severity during the immediate 3 months after vaccination, showed a progressively decreasing level of efficacy over a year's period. At the end of a year, efficacy had fallen to 75%. The combined vaccine schedules demonstrated a consistently high order of protection, of about 95% or better, throughout the study period.

The efficacy of two measles vaccine schedules—three injections of 0.5 ml of inactivated measles virus vaccine and two doses of inactivated virus vaccine followed by one dose of live vaccine—was tested in a double-blind, placebo-controlled study among 4,758 children in kindergarten and first and second grades. Measles hemagglutination inhibition antibody titers were measured on a randomly selected sample of study participants immediately before and 1, 8, and 14 months after the third injection.

Although over 90% of those given the inactivated virus vaccine demonstrated detectable hemagglutination inhibition antibody 1 month post-vaccination, only 50% were seropositive 14 months later. Some clinically typical measles cases did occur among children in whom the inactivated virus vaccine had evoked an initial antibody response. Of those children receiving two doses of inactivated virus vaccine followed by live vaccine, 97% showed seroconversion 1 month post-vaccination. Fourteen months later 89% still had detectable antibody.

Fourfold or greater titers occurred in some children in both vaccine groups without evident clinical measles illnesses. These titer "boosts" were considered to be on the basis of subclinical measles infections.
Aplastic Anemia Following Hepatitis
Authors: SCHWARZ ELIAS , BAEHNER ROBERT L. , DIAMOND LOUIS K.
Published: December 2021

Three cases of aplastic anemia following hepatitis are described, and the possible relationship of these two disorders is discussed. A beneficial effect of testosterone and prednisone treatment occurred in two of the patients.
THE RELATIONSHIP OF NON-PROGRESSIVE HYDROCEPHALUS TO INTELLECTUAL FUNCTIONING IN CHILDREN WITH SPINA BIFIDA CYSTICA
Authors: Badell-Ribera Angeles , Shulman Kenneth , Paddock Nancy
Published: December 2021

Seventy-five patients with variable degrees of spinal cord dysfunction secondary to spina bifida cystica have been studied with special reference to their neurological and psychological status. Their ages ranged from 5 to 21 years. The patients were divided into five different groups on the basis of functional disability secondary to spinal cord dysfunction. Those patients with a history of rapid head enlargement and who had not had neurosurgical treatment for this problem comprised 62% of the population studied (total seventy-five). These patients were considered to have non-progressive hydrocephalus. The hydrocephalic subgroup scored lower in psychological testing and presented a significant discrepancy between verbal and performance scores which could be considered a characteristic sign of brain damage. The psychological test scores of the patient with the same severe paralytic defect but without hydrocephalus were essentially normal. The physical rehabilitation potential of these patients is dependent upon the degree of physical disability, but their over-all rehabilitation achievement is largely determined by their intellectual capacity and psychosocial adjustment.

We believe that if we are to improve the long-range prognosis of such children, one of the objectives of neurosurgery should be early and effective treatment of the hydrocephalus.
THE ORAL-FACIAL-DIGITAL SYNDROME: A MALE-LETHAL CONDITION IN A BOY WITH 47/XXY CHROMOSOMES
Authors: Wahrman Jacob , Berant Moshe , Jacobs Joseph , Aviad Ithamar , Ben-Hur Nahum
Published: December 2021

A male infant is described showing all the major features of the oral-facial-digital syndrome (OFD): lobulated tongue with hypertrophic frena, fibrous bands extending into alveolar clefts, pseudocleft of upper lip, cleft palate, hypoplastic alae nasi, dystopia canthorum, various digital anomalies, and typical X-ray appearance of the skull. A partial agenesis of the corpus callosum with a lipoma was indicated by pneumoencephalography and angiography.

The OFD syndrome is confined to females. In the present case an XXY chromosome constitution was demonstrated by cytogenetic studies. The occurrence of OFD and Klinefelter's syndrome in one and the same person is ascribed to a very rare coincidence. OFD is considered to be due to an X-linked dominant mutant gene, with a recessive lethal effect. X-linkage is supported by the pattern of a more extreme lethal expression in hemizygous males versus viability of heterozygous females. An XXY individual is viable, presumably because of the normal allele which is active in a fraction of its cells.

Other reports of males with OFD are critically evaluated.
"Late" Neonatal Jaundice following Maternal Treatment with Sulfamethoxypyridazine
Authors: HARLEY J. D. , ROBIN HELEN
Published: December 2021

In relation to Brown and Cevik's recent communication, we are writing to draw attention to our earlier report of the above syndrome. This G6PD-deficient Italian male was discharged well from the obstetric hospital at the age of 7 days, then re-admitted at the age of 13 days with marked anemia and jaundince. The mother breast-fed the infant from birth, and from the sixth to thirteenth day postpartum took sulfamethoxypyridazine 0.5 gm twice daily for a mild urinary tract infection.
The Biosocial Basis OF Mental Retardation, by Sonia F. Osler and Robert E. Cooke. Baltimore: The Johns Hopkins Press, 1965, 151 pp., $5.50
Authors: Kucel Robert B.
Published: December 2021

With the increasing interest in mental retardation more articles, monographs, and books appear on the subject. The Biosocial Basis of Mental Retardation is a collection of seven essays originally delivered at the John Hopkins Hospital. Although pediatricians have turned their attention in mental retardation mostly to the biological components of mental retardation, there is a growing awareness that social and psychological factors also play a significant role. The interrelationship of biological and social factors is virtually an unchartered sea.

The several authors who originally presented these essays are attempting to highlight some of the social factors and, where appropriate, to point out how some of the social features relate to biological ones. For example, the well known relationship of the high incidence of prematurity in low socioeconomic group families is a fact most pediatricians know but the implication of this fact as far as prevention is concerned is a large and important concern and as yet poorly understood. With the increasing amount of federal interest in programs for low income families, many pediatricians will want to become better informed about the implications. Some of these points are considered in the chapter by Janet Hardy.

For the person concerned with medical remedies for mental retardation, there will be little of interest in this book. On the other hand, for those who are anxious to know more about social and psychological factors as they relate to mental retardation, this is a very useful and fascinating compendium of articles. Particularly intriguing are the articles by Eli Ginzberg who discusses the mentally handicapped in an increasingly technological society.
STUDIES IN ACUTE IRON POISONING:
Authors: Whitten Charles F. , Chen You-chen , Gibson George W.
Published: December 2021

Up to 50% of acutely iron-poisoned dogs survived when treated with various dosages of intravenous and intestinal desferrioxamine and supportive therapy. These results support the current optimism relative to the value of this drug in the treatment of acute iron poisoning in children.

The results of the use of adjuvants with intestinal and intravenous desferrioxamine were not encouraging. Corticosteroids and hemodialysis did not improve the survival rate and levarterenol worsened it.

It was confirmed that the iron desferrioxamine complex is absorbed and that both desferrioxamine and ferrioxamine can exhibit toxicity.
OTITIS MEDIA IN THE PRACTICE OF PEDIATRICS
Authors: Coffey John Dixon
Published: December 2021

In this study cultures of middle ear exudate were obtained from 267 cases of otitis media in infants and children. Pneumococci were found in 34.5%, Hemophilus influenzae in 27%, Group A beta hemolytic streptococci in 1.9%, and pneumococci mixed with hemophilus influenzae in 2.8%. Neisseria, probably Neisseria catarrhalis, were grown in pure culture in 5.2%. Pseudomonas aeruginosa, Staphylococcus hemolyticus (coagulase positive), and Escherichia coli were found in isolated cases. The remaining 27.7% were sterile, these usually being from chronic exudative (secretory) otitis media cases.

The incidence of Hemophilus influenzae otitis media found in this study is higher than that reported in previous studies. The finding of Neisseria catarrhalis in exudate from otitis media has been reported only by Gronroos, et al., and observation of the organisms in an intracellular state was not reported.

Examination of exudate obtained from recurrences or relapses of acute exudative otitis media often reveals a different organism from that found in previous infections; one cannot assume that an apparent relapse is due to the same organism cultured previously.

Most cases of otitis media occur in infants who cannot localize their symptoms, and diagnosis requires careful examination of the ears.

Adequate bacteriological studies of exudate from the tympanic cavity require uncontaminated specimens which are best obtained with an apparatus using a needle attached to a collecting trap and a source of negative pressure.
VINCRISTINE IN THE TREATMENT OF ACUTE LEUKEMIA IN CHILDREN
Authors: Heyn Ruth M. , Beatty E. C. , Hammond D. , Louis J. , Pierce M. , Murphy M. L. , Severo N.
Published: December 2021

Vcr induced complete marrow remission in 43% of children with all types of acute leukemia who were refractory to other antileukemic therapy. The median duration of disease before Vcr treatment was 13.5 months. The marrow response in those patients achieving an A marrow was rapid with a marked clearing of the blasts by 14 days and a complete remission by 28 days. The median duration of complete remission with and without maintenance therapy was 63.5 and 59 days, respectively.

Drug toxicity occurred in about half the patients, limiting the total dose of drug that could be given. Leukopenia, alopecia, gastrointestinal symptoms, and neurotoxicity were the most common problems seen. These were reversible on withdrawal of the drug.

Remissions were not improved by increasing the dose of Vcr to 0.1 mg/kg for two or more doses after 4 doses of 0.075 mg/kg. The reduction in dose necessitated by drug toxicity was not detrimental to a good response since the children attaining complete remissions experienced the greatest number of alterations in dose prior to the onset of remission.
THE PLACENTA
Authors: Dancis Joseph
Published: December 2021

I AM greatly indebted to the Borden Award Selection Committee for inviting me here today. I am also grateful for the opportunity to acknowledge another debt, the one that I owe to Dr. L. Emmett Holt. Last night was passed pleasantly in the company of several old friends. As has become common on such evenings, our talk turned to Dr. Holt, because all of us there felt that he had exerted a strong influence on the course of our lives. It was Dr. Holt that made it possible for me to enter the field of research, and then provided me with an example of a teacher who is not above being taught, of an inquirer who doesn't resent being questioned, of a tireless worker capable of concentrated effort but with broad interests.

Pleasant as these reminiscences are, I realize that I have been invited here to talk about the placenta, and that is what I intend to do. An occasion such as this offers the speaker the opportunity of summarizing experiences and concepts that have developed over an extended period of preoccupation with a subject. This is particularly pleasurable if one can discern a continuity that spans the years and provides a unifying theme for the countless details and apparently isolated observations involved in research. Now that teleology is becoming more respectable it is no longer quite as improper to seek to interpret experimental results in terms of a harmonious design obeying a logic of selection for survival. It is in that context that I would like to review the results of some of our studies of placental function.
VARYING EXPRESSION FOR SALT LOSING IN RELATED PATIENTS WITH CONGENITAL ADRENAL HYPERPLASIA
Authors: Rosenbloom Arlan L. , Smith David W.
Published: December 2021

Among 8 families in which more than one member had the salt losing manifestations of non-hypertensive virilizing congenital adrenal hyperplasia, there was a lack of expression for salt losing in an affected sibling in three families and in an affected first cousin in one family. The finding of differences in the expression for salt losing in related patients who are expected to have the same mutant alleles demonstrates that the salt losing and non-salt losing forms are not necessarily due to different genetic defects. This report emphasizes the importance of examining all siblings of an affected propositus and of considering all affected children to be at risk for the development of salt losing manifestations.
INCREASING PULMONARY VASCULAR RESISTANCE DURING INFANCY IN ASSOCIATION WITH VENTRICULAR SEPTAL DEFECT
Authors: Hoffman Julien I. E. , Rudolph Abraham M.
Published: December 2021

Three children with big ventricular septal defects, large pulmonary blood flows, and pulmonary hypertension were catheterized at the ages of 3, 6, and 6 months. Pulmonary vascular resistance was low in two and slightly raised in the other. Recatheterization at the ages of 9, 16, and 26 months, respectively, showed increases of pulmonary vascular resistance in all, and the ventricular septal defects were successfully closed by open-heart operation soon thereafter. In the one child who was recatheterized only after there was clinical evidence of a raised pulmonary vascular resistance, postoperative catheterization showed a progressive rise in pulmonary vascular resistance indicating progressive pulmonary vascular disease. The other two children who were clinically well were recatheterized specifically to try and detect early pulmonary vascular changes and, in contrast, in both of these children pulmonary arterial pressures and vascular resistances have returned to normal after operation.

These patients demonstrate that in those at risk of developing pulmonary vascular disease (big ventricular septal defect with high pressures and flows), pulmonary vascular resistance can rise rapidly in early life. In these patients progressive pulmonary vascular disease could be prevented if surgery to lower pulmonary arterial pressure and blood flow is done early enough. Even in patients who appear to be improving, recatheterization is necessary to demonstrate a moderate rise in pulmonary vascular resistance, since a moderate rise is not detectable by current clinical techniques.
Clinical Roentgenology of Collagen Diseases
Authors: LOPRESTI JOSEPH M.
Published: December 2021

This is an excellent monograph which is concise, brief, and accurate. Not only does the author cover the collagen disorders and the radiographic changes which they produce, but he also includes a pathological and clinical summary of each disease entity. The reproductions of the radiographs are unusually sharp and representative. Although the collagen diseases usually occur in the adult, an excellent chapter is included in this monograph describing the roentgenologic findings in these diseases as they occur in children.
VINCRISTINE SULFATE THERAPY IN CHILDREN WITH METASTATIC SOFT TISSUE SARCOMA
Authors: Sutow W. W. , Berry D. H. , Haddy T. B. , Sullivan M. P. , Watkins W. L. , Windmiller Joan
Published: December 2021

Sixteen children with metastatic or recurrent lesions from soft tissue sarcoma, mostly rhabdomyosarcoma, were treated with vincristine sulfate in a protocol-controlled cooperative study. Complete, though not permanent, regression of tumor occurred in two patients. Significant partial control of disease was achieved in three other children. Gastrointestinal or neurologic side-effects resulted in alteration of drug dosage schedule in 4 of 15 patients. The degree of antitumor activity in several of these cases was such that the further study of the effectiveness of the drug, particularly in combination with surgical and radiation therapy, in children with soft tissue sarcoma seems indicated.

Generic and trade names of drugs: vincristine sulfate—Oncovin; cyclophosphamide—Cytoxan; chlorambucil—Leukeran; dactinomycin—Actinomycin-D.
Congenital Clubfoot
Authors: GRIFFIN PAUL P.
Published: December 2021

In this short, well written and illustrated book the author gives an excellent review of the literature related to the etiology and pathology of the congenital form of clubfoot. In the first part of the book he clearly describes the physical findings one would see in clubfeet of varying degrees of severity. The remainder of the book is devoted to techniques and principles of treatment, several of which are only of historical interest. Doctor Hauser describes a method for the treatment of congenital club-foot which in his hands has given uniformly excellent results over a period of 23 years
KERNICTERUS: REVISED CONCEPTS OF PATHOGENESIS AND MANAGEMENT
Authors: DIAMOND IVAN
Published: December 2021

BILIRUBIN ENCEPHALOPATHY occurs almost exclusively in newborn infants with severe unconjugated hyperbilirubinemia. When these babies succumb to this condition the brain usually shows localized yellow staining (kernicterus) which is due in part to accumulation of unconjugated bilirubin. There is strong circumstantial evidence that bilirubin is responsible for the neuropathologic changes characteristic of kernicterus but the factors governing the entry of the pigment into the central nervous system have long been a matter of speculation.

In the plasma, most of the bilirubin is transported firmly bound to albumin. However, whether the pigment enters the brain bound to albumin or only after being detached from its albumin carrier has not been established.
JEJUNAL BIOPSIES IN INFANT MALNUTRITION: WITH SPECIAL REFERENCE TO MITOTIC INDEX
Authors: Brunser Oscar , Reid Alejandro , Mönckeberg Fernando , Maccioni Alejandro , Contreras Iván
Published: December 2021

The histological aspect and the mitotic index of jejunal biopsies were studied in 8 normal infants, in 18 marasmic infants, and in 10 infants with kwashiorkor. The mucosa of the marasmic infants was similar to the normal controls, although thinner. In kwashiorkor the mucosa was similar to celiac disease.

In marasmic infants fed on the same diet, the mitotic index is significantly lower in infants who do not show weight increase when compared with those who do increase in weight. In kwashiorkor the mitotic index is closer to, although also significatively lower than, normal.

It is suggested that these differences are due to the low caloric intake in marasmus where the energy supply is not sufficient to maintain the rate of cell proliferation; a hormonal mechanism governed by the pituitary gland is also suggested. In kwashiorkor the histological aspect similar to celiac disease seems to indicate a common pattern of reaction of the jejunal mucosa due to different causes.
DENSITY AND SECRETORY ACTIVITY OF ECCRINE SWEAT GLANDS IN PATIENTS WITH CYSTIC FIBROSIS AND IN HEALTHY CONTROLS
Authors: Huebner Dorothy E. , Lobeck Charles C. , McSherry Nona R.
Published: December 2021

The number of active sweat glands was observed in patients with cystic fibrosis and healthy, age-matched controls following stimulation of sweating on the inner forearm surface by pilocarpine iontophoresis. Though gland density appeared to be higher and more variable in cystic fibrosis, statistical analysis of this relationship was inconclusive but did not allow a rejection of the hypothesis that patients have higher gland densities at a given age than controls.

The amount of sweat produced in cystic fibrosis was related to the number of active glands; this was not true of controls. The parameter of gland density, added to the previously described sweat test procedure, has allowed calculation of the average sweat output per gland on the forearm. This output increased with increasing age in both controls and patients with cystic fibrosis.
LINGUAL AND SUBLINGUAL THYROID GLANDS IN EUTHYROID CHILDREN
Authors: Hung Wellington , Randolph Judson G. , Sabatini Domenic , Winship Theodore
Published: December 2021

Five clinically euthyroid children with lingual or sublingual thyroid glands were seen during a 12-month period. Certain recommendations have been formulated based upon our experience with these patients. A careful physical examination should be performed to demonstrate the presence of a normally located thyroid gland in all children presenting with midline masses in the lingual or sublingual areas. When the thyroid gland cannot be palpated with certainty in these children, a scintiscan with I-131 should be carried out to determine if the mass is an ectopic thyroid gland and if a normally located thyroid gland is present. All children with lingual on sublingual thyroid glands should have a trial of full replacement thyroid hormone therapy before excision is contemplated. Thyroid therapy will prevent further hypertrophy and hyperplasia. Surgical intervention should be reserved for those children in whom there is dysphagia, dysphonia, ulceration, or hemorrhage due to a lingual thyroid gland or if the ectopic thyroid gland fails to decrease in size following a course of treatment with thyroid hormones.
Unusual Occurrence of Neonatal Meningitis Due to Group B Beta-Hemolytic Streptococci
Authors: WINTERBAUER RICHARD H. , FORTUINE ROBERT , EICKHOFF THEODORE C.
Published: December 2021

Two cases of sepsis and meningitis due to Group B beta-hemolytic streptococci occurred within 1 week in newborns on a small maternity unit in southwestern Alaska. The same physician and nurse cared for the first infant during his terminal illness, while simultaneously attending the labor and delivery of the mother of the second infant. Although the coincidental occurrence of these two infections could not be ruled out, cross infection may well have occurred during that critical interval.
The Private Pediatrician's Role in Head Start and Other Health Services
Authors: DASCHBACH R. J.
Published: December 2021

It was interesting to note in Dr. Richmond's article on Project Head Start (Pediatrics, 37:905, 1966) that they have found that one of the great difficulties in the health aspect was integrating the various community health facilities. Dr. Richmond went on to enumerate these various facilities, mentioning the Aid To Dependent Children program, the health departments' infant and child health clinics, the school health services, the university clinics and hospitals, immunization clinics, etc. It strikes me as a glaring omission that in this lineup Dr. Richmond did not mention the private pediatricians and general physicians.
Should Additional Training be Required for Board Certification?
Authors: VAN LEEUWEN G.
Published: December 2021

As a young academician I hesitate to be critical of the Board of Pediatrics' recommendation that additional training be required for certification. (Pediatrics, 37:861, 1966). The points I wish to raise were certainly discussed and were likely omitted from publication for the sake of brevity.

However, the addition of an entire year of training in problems of behavior, school-life, etc., as recommended, may well be patchwork of old problems rather than insight into the future.
SEPTIC ARTHRITIS OF THE HIP: A COMPLICATION OF FEMORAL VENIPUNCTURE
Authors: Asnes Russell S. , Arendar Gregory M.
Published: December 2021

Four cases of septic arthritis of the hip in neonates, felt to be valid examples of a complication arising from femoral venipuncture, are presented. Each of the cases seen occurred 5 to 9 days after femoral venipuncture. Staphylococcus aureus was cultured in three cases, Staphylococcus albus in one, and the skin is considered to be the source of contamination. Severe residuals resulted in each instance. Because of the severe disability that may result, greater care in skin preparation and performance of femoral venipuncture is suggested. In addition, it is recommended that, whenever possible, the external jugular vein be used in preference to the femoral vein.
Recent Results in Cancer Research, Neuroblastomas. Biochemical Studies
Authors: VOORHESS MARY L.
Published: December 2021

This short book contains the papers which were presented by a distinguished group of investigators at a "Symposium on The Biochemistry of Neuroblastoma" held at the Institut Gustave Roussy, Villejuif (Seine), France, on May 29 and 30, 1964. Research scientists who are concerned with catecholamine metabolism and tumors of neural crest origin will find this collection particularly informative because it brings together much of the knowledge (to 1964) in this important field either in the text, per se, or in the references.
Pulmonary Surfactant and Stability of Aeration in Young Human Fetuses
Authors: GRUENWALD PETER
Published: December 2021

The striking predominance of prematurity among infants with the respiratory distress syndrome (RDS) is well-known. It has, therefore, been interesting to study in young fetuses the specific pulmonary surface activity which governs stability of aeration. Both surface activity and stability of aeration are characteristically deficient in the RDS. Stability of aeration, as determined by artificial inflation and deflation of a lung specimen, correlates well with surface activity, varying with changes in area as determined on a Wilhelmi surface balance. Information based on either method is equally pertinent, as is that obtained by studying the stability of bubbles from lungs.
COMMITTEE ON NUTRITION
Authors: LOWE CHARLES U. , COURSIN DAVID B. , HEALD FELIX P. , KAYE ROBERT , O'BRIEN DONOUGH , OWEN GEORGE M. , SCRIVER CHARLES R. , SWEENEY MICHAEL J.
Published: December 2021

WITH A note of sadness, the Committee on Nutrition of the American Academy of Pediatrics wishes to call to the attention of the membership the death of Robert Ramapatnam Williams. A noted chemist and scientist, Dr. Williams obtained world renown for his work on the isolation, identification, and synthesis of vitamin B1. He died at his home in Summit, New Jersey, in October 1965.

Born in Nellore, India, February 16, 1886, of American missionary parents, he began teaching in the Philippines in 1908 and considered the Islands his second home.

Williams never found time to earn a doctorate, although he attended Ottawa University (Kansas) and the University of Chicago for undergraduate and postgraduate work. He earned a B.S. in 1907 and an M.S. in 1908 and received honorary LL.D. and D.Sc. degrees from numerous universities.

The story of his work with beriberi is one of the most exciting in the field of nutrition. While working in the Philippines in 1910 with the Chemical Division of the Bureau of Science, he became interested in the disease. He assisted in treating an infant dying of beriberi with brown-rice bran syrup. The child's dramatic recovery stirred the synthesis of thiamine chloride. His work culminated in extensive field trials, again in the Philippines, shortly after World War I. For this study, the Bataan peninsula was divided into two parts. In the western area the inhabitants ate plain white rice; those in the eastern area received plain white rice enriched with rice coated with vitamin B1, concentrate. Within weeks the death rate from beriberi dropped dramatically in the eastern area. It remained high in the western area until smugglers began "running in" the treated rice.
PLASMA VOLUME STUDIES IN LOW BIRTH WEIGHT INFANTS
Authors: Cassady George
Published: December 2021

An average plasma volume of 46.8 ± 7.1 ml/kg and blood volume of 87.9 ± 13.6 ml/kg was found in 69 true premature infants studied during the first 12 hours of life. Respiratory distress syndrome in these infants was not associated with an altered plasma or blood volume. However, the degree of maturity, estimated by either birth weight or gestational age, was found to be inversely related to the plasma volume.

Intra-uterine growth retardation, defined on the basis of disproportionately low birth weight in relation to gestational age, was associated with an elevated average plasma volume (52.0 ± 7.8 ml/kg) during the 4 hours after birth. Despite rapid adjustment of this volume to normal between 4 and 12 hours of age, the average blood volume in this group of infants was significantly elevated (102.0 ± 18.7 ml/kg).

These studies reveal direct, objective and measurable differences between growth-retarded and true premature low birth weight infants and represent an attempt toward more accurate definition and understanding of intra-uterine growth retardation.
Pediatric Practice
Authors: FISCHER CARL C.
Published: December 2021

The articles by Drs. Bergman, Dassel, and Wedgwood, "Time-Motion Study of Practicing Pediatricians," and by Drs. Breese, Disney, and Talpey, "The Nature of a Small Pediatric Group Practice" as well as Dr. Ross's pertinent commentary on these two reports all attest to the increasing interest in the economic and service aspects of pediatric practice.

Academy Fellows should know that for the past several years the Academy has had a Council on Pediatric Practice created to study such problems and give every possible guidance to our membership in these areas.
CYTOMEGALIC INCLUSION DISEASE OF INFANCY
Authors: Emanuel Irvin , Kenny George E.
Published: December 2021

Clinical, laboratory, and virological data are presented for a series of seven infants with cytomegalic inclusion virus disease who have milder and more varied clinical features than were found in other series. These babies were born within a 15-month period in the Seattle area.

Only one patient had the typical picture of fulminant neonatal disease. All patients had jaundice which tended to be prolonged, but in most cases this appeared to be associated with mild hemolytic anemia rather than with obstructive hepatitis. Hepatomegaly was seen in six patients and splenomegaly in four. Thrombocytopenic hemorrhagic phenomena occurred in three patients. Two babies had Rh incompatibility associated with obstructive hepatitis, suggesting that cytomegalovirus infection may be an occasional factor in the liver disease in such patients.

These patients have been followed for from 2½ to 19½ months. Six patients have been chronic excretors of virus. One patient has microcephaly and spastic hemiparesis, and another is definitely retarded. There were no cases of choroidoretinitis, intracranial calcifications, or seizure disorders.
FAMILIAL RETICULOENDOTHELIOSIS: CONCURRENCE OF DISEASE IN FIVE SIBLINGS
Authors: Miller Denis R.
Published: December 2021

A fatal syndrome characterized by failure to thrive, eczema, recurrent skin, ear, and respiratory tract infections, lymphadenopathy hepatosplenomegaly, pulmonary infiltrations, and terminal peripheral pancytopenia and hypergammaglobulinemia is described in a complete sibship of five girls. Histologically, there was diffuse reticulum cell infiltration in the lungs, liver, spleen, lymph nodes, bone marrow, gastrointestinal and genitourinary tracts, and central nervous system. The lymphoid architecture was obliterated and there was a marked plasmacytosis. Death occurred between the ages of 20 months and 4 9/12 years and was associated with pulmonary insufficiency, septicemia, and candidiasis. Attempts to identify an etiologic agent were unsuccessful.

Although similar to other reviewed cases of familial reticuloendotheliosis, the involvement of a complete sibship appears to be a unique occurrence.
Dangers of Hydrogen Peroxide in Enemas or Lavage
Authors: SHAW ANTHONY , DANIS RICHARD
Published: December 2021

We wish to bring to the attention of pediatricians the danger of using hydrogen peroxide for colon lavage in infants. Since Olim described its use combined with saline, various dilutions ranging from 0.75% to 1.25% have been recommended by increasing numbers of authors for infants who have meconium plug syndrome or those with meconium ileus.

We have seen lethal and near lethal complications resulting from the use of such dilutions of hydrogen peroxide in the small and large bowel of infants, and we have first hand information of similar complications in the hands of other pediatric surgeons.
SUDDEN, UNEXPECTED DEATH IN INFANCY
Authors: Geertinger Preben
Published: December 2021

THE PROBLEM of sudden, unexpected death in infancy (SUD) has become increasingly important in recent years in forensic medicine. Mortality in infancy from well defined causes has rapidly decreased, and the proportion of SUD of unknown cause has, therefore, been still more evident. Today SUD cannot be considered a problem for forensic medicine only; many other branches of medicine have an interest in this problem.

In the past SUD has been attributed to suffocation by overlaying, by aspiration of vomitus, or by bedclothes. During the last 10 years it has widely been presumed that SUD is due to an overwhelming viral infection. Although much effort has been spent in an attempt to demonstrate the possible viral agent, the results have mainly been negative. Hypogammaglobulinemia as a possible cause of SUD was indicated by Harboe and Gormsen, and more recently it was suggested that SUD results from an anaphylatic reaction to cow's milk inhaled into the larynx or trachea. Many authors have pointed out that SUD might be connected with rickets or some more obscure kind of disorder in the calcium metabolism, and in 1962 Maresch demonstrated a significantly low content of calcium in heart musculature in these infants and presumed that one and the same basal disorder of metabolism might lead to rickets and spasmophilia as well as to SUD.

However different the theories, two facts seem to be generally accepted by all authors in this field. Nearly all claim that SUD is significantly most frequent at the age of about 3 to 4 months.
LIPID METABOLISM IN THE NEWBORN. I. PHOSPHOLIPIDS IN CORD AND MATERNAL SERA
Authors: Zee Paulus
Published: December 2021

Lecithin, sphingomyelin, lyso-lecithin and cephalins were determined in the cord serum of ten newborns and in the serum of their respective mothers, drawn just prior to their delivery. Significant differences were found in the amount and distribution of serum phospholipids, as well as in the fatty acid pattern of serum lecithins, between newborn and mother.

The findings were interpreted to mean that at parturition a placental barrier exists between maternal and fetal serum phospholipids.

The mothers, at the conclusion of their pregnancy, showed characteristic differences in their serum phospholipid concentrations and in the fatty acid distribution of serum lecithin from non-pregnant women.