bluuebunny/crossref_metadata_2025 huggingface dataset:
THE EPILEPTIC CHILD AND COMPETITIVE SCHOOL ATHLETICS
Authors:   COMMITTEE ON CHILDREN WITH HANDICAPS
Published: December 2021

THE RISK of injury during competitive athletics is real and constant for all children, even in the presence of well supervised programs. Injury may occur despite efforts to select the proper sport and to ensure that individual skills are sufficiently developed, that the environment and terrain are suitable, and that the equipment is properly designed and fabricated. To keep this risk at a minimum, it is necessary at times to modify the athletic program of children with certain health disorders. One of these is epilepsy.

In children with epilepsy, as in children with any chronic disorder, it is important that the patient and his family recognize early during the course of the disease that certain adjustments in the daily routine may need to be made. However, in considering adjustments, one must strike a balance between the needs of the child to participate with his peers in their daily activities and the limitations to living a full life which any restriction may impose. With proper balance in these areas and optimal management of the disease process, the child with chronic illness would be able to develop the self-confidence necessary to live independently in the community as an adult.

Epilepsy is a disorder which may accompany or follow a large number of known medical conditions. However, from a quantitative point of view, the major problem is the group of children with seizures of unknown etiology, or idiopathic epilepsy. The convulsive seizure results from a sudden hypersynchronous discharge which disrupts the usual pattern of neuronal activity, resulting in a variable disturbance in some function of the nervous system.
Acid Base Physiology In Medicine: A Self-Instruction Program, by Robert W. Winters, M.D., Knud Engel, Mag.Sc., and Ralph B. Dell, M.D., and programmed by Richard P. Berkson, A.B. Westlake, Ohio: The London Company, 1967, 290 pp., $3.85
Authors: Sweeney Michael James
Published: December 2021

For some years, the senior author of this book and his associates have contributed much to our understanding of the physiologic aspects of acid-base balance. The present text represents major educational effort on their part to offer a "systematic presentation of acid-base physiology in the format of programmed instruction." The primary audience the book is directed toward are those who already have the "feel" of clinical medicine and who desire "an integrated picture of acid-base physiology as a background for their clinical activities."
What Is Allergy: A Guide for the Allergic Person, by Raymond T. Benack. Springfield, Illinois: Charles C Thomas, 1967, 158 pp., $6.75
Authors: Fontana Vincent J.
Published: December 2021

Dr. Benack achieves the goal of his book by defining clearly and completely the nature of allergic diseases and by including the responsibilities of the patient in the therapeutic regimen as well as the value of currently acceptable measures in the treatment of allergies. The discussion of the emotional aspects of allergies is particularly significant. For once the emotional element is examined in proper perspective, since the patient's emotional state may intensify, aggravate, and even prolong an allergic disease.
THE INFLUENCE OF FAMILY ORGANIZATION ON THE UTILIZATION OF PEDIATRIC EMERGENCY SERVICES
Authors: Wingert Willis A. , Larson William , Friedman David B.
Published: December 2021

Patterns of obtaining medical care for children from broken, lower socioeconomic families did not differ significantly from that of intact families. Many separated and divorced mothers handled their children's health problems adequately in spite of economic and transportation problems. Stability and intactness are not synonymous. The broken family may actually be quite stable due to hidden mates, guidance from appropriate social agencies and social norms which assign medical nursing care to the mother. This parental coping mechanism may be developed by long experience in dealing with the usual problems of a disadvantaged population: unemployment, desertion, poor housing and frequently, open violence.
FAMILIAL NONHEMOLYTIC JAUNDICE WITH LATE ONSET OF NEUROLOGICAL DAMAGE
Authors: Blumenschein Sarah D. , Kallen Ronald J. , Storey Bruce , Natzschka Jürgen C. , Odell Gerald B. , Childs Barton
Published: December 2021

A patient with familial nonhemolytic jaundice is described. The child had been normal, apart from his jaundice, for all of his life. But, at 16 years of age he developed neurological disabilities which progressed to his death 6 months later. The signs were similar to those of kernicterus seen in infants. Attempts to reduce the bilirubin level of the blood and so to reverse the nervous system damage were unsuccessful.
CAT SCRATCH DISEASE: NONBACTERIAL REGIONAL LYMPHADENITIS
Authors: Margileth A. M.
Published: December 2021

Of 145 patients with nonbacterial lymphadenitis observed over a period of 10 years, 115 had clinical cat scratch disease (CSD) with a positive cat scratch antigen skin test. In this group 86% had a typical benign course of CSD; the remaining 16 (14%) had an atypical form. These unusual forms were: Parinaud's oculoglandular syndrome in 7, encephalopathy in 3, atypical pneumonia in 2, and recurrent suppurative lymphadenopathy in 1. Two typical cases occurred after a dog scratch or bite, and one after a monkey scratch.

The disease was most prevalent in late fall and early winter; 80% of patients were under age 20 years. Primary lesions were detected in 55%, node suppuration occurred in 26%, and lymphadenopathy lasted 2 weeks to 2 months in most patients. Symptoms were absent in 35% of cases. Fever occurred in 26%, and exanthem was present in 4%. Lymphadenopathy was most common in the extremities (57%), and head and neck (43%). Cat scratch antigen was found to be a reliable diagnostic skin test. A negative test was found in 98% of control patients; a positive test was found in 94% of patients who were clinically suspected to have CSD and a history of cat scratch.

Management consisted of reassurance, symptomatic therapy, and closed aspiration of enlarged nodes if suppuration occurred. Antibiotics were not effective. The disease is self-limited and has an excellent prognosis in the majority of patients. An etiologic agent could not be isolated in this study. Until the causative agent is known, it will be difficult to carry out preventive measures.
Heart Disease in Infants, Children and Adolescents, edited by Arthur J. Moss, and Forrest H. Adams, M.D. Baltimore: The Williams and Wilkins Company, 1968, 1140, $48.50
Authors: Nadas Alexander S.
Published: December 2021

This reviewer of the mammoth multiauthor volume, edited by Doctors Moss and Adams, has to confess that he finds himself overwhelmed by it all. Somebody said, many decades ago, that the critic's lot is really not all that bad; the subject of critical review may indeed be resentful, but all the others, his competitors, will rejoice. In that bygone era then, sharp criticism resulted in a net increase of the critic's friends. In the age of the multiauthor opus, this is obviously not the case.
ON THE INDIRECT DETERMINATION OF SYSTOLIC AND DIASTOLIC BLOOD PRESSURE IN THE NEWBORN INFANT
Authors: Nelson Nicholas M.
Published: December 2021

Classical oscillometry was used to determine indirect systolic/diastolic blood pressure in nine newborn infants. The measurement was facilitated by a relatively simple and inexpensive electronic oscillometer, the construction of which is described. Comparisons between indirect leg and direct intra-aortic blood pressure revealed a systolic difference of 0 to 5 mm Hg and a diastolic difference of 0 to 10 mm Hg, depending on respiratory variations and accuracy of calibration.
THE SERIAL ORGANIZATION OF SUCKING IN THE YOUNG INFANT
Authors: Wolff Peter H.
Published: December 2021

The sucking rhythms of infants with a benign perinatal course are compared to those of infants with a history of perinatal distress. The ontogenesis of sucking rhythms, and the sucking patterns of children with major congenital malformations of the brain and various metabolic disorders are described. The analysis of rhythms of non-nutritive sucking discriminates to a statistically significant degree between normal infants and infants with a history of perinatal distress who have no gross neurological signs.
VITAMIN D AND CRANIOFACIAL AND DENTAL ANOMALIES OF SUPRAVALVULAR STENOSIS
Authors: Rowa Richard D. , Cooke Robert E.
Published: December 2021

Few pediatric disorders have undergone such fascinating extensions to their clinical picture as has been the case in idiopathic hypercalcemia of infancy during the past decade.

Features of the infantile illness were described in the early 1950 by workers in England and Europe. Ten years later an apparently unrelated vascular disorder comprising a peculiar facies, mental retardation, supravalvular aortic and pulmonary stenosis and dental anomalies was reported from New Zealand and Germany. Black and Bonham Carter, at the Hospital for Sick Children, Great Ormond Street, through recognizing a similarity between the facial apperance of these retarded older children and the elfin facies characteristic of infantile hypercalcemia, were able to postulate a relationship between the two clinical entities.
Neuroblastoma, Presenting as Myasthenia Gravis in a Child Aged 3 Years
Authors: Robinson M. J. , Howard R. N.
Published: December 2021

A case is recorded of ganglioneuroblastoma in a child of 3 years of age, who has to date survived for 18 months after treatment by combined surgery, radiotherapy, and chemotherapy.

Clinical features of this case were those of myasthenia gravis, and they disappeared after excision of the tumor. Such an association has not previously been reported.

The capacity of the ganglioneuroblastoma group to act as "functioning" tumors is discussed.
Screening Test for the Diagnosis of Chronic Granulomatous Disease
Authors: Johnston Richard B.
Published: December 2021

Normal phagocytes suspended in plasma when mixed with latex particles for ingestion and nitroblue tetrazolium dye will reduce the dye to a blue color which may be easily seen in a test tube. This reaction depends on the release of enzymes from phagocytic lysosomal granules after phagocytosis. Since such release is deficient in patients with CGD, no blue color develops in the tube. This has proved to be a simple, reliable, screening test which should allow the more rapid and widespread diagnosis of CGD.
John Thomson: Pioneer and Father of Scottish Paediatrics, by W. S. Craig. Edinburgh and London: E. and S. Livingstone Ltd., 1968, 96 pp., 21 s ($2.50)
Authors: Cone Thomas E.
Published: December 2021

Of the triumvirate who created and ennobled British pediatrics, the names of two, Sir George Frederic Still (1868-1941) and Sir Thomas Barlow (1845-1945) are well-known; the third, Dr. John Thomson (1856-1926), is far less known, not only to the cisatlantic pediatrician but also to his transatlantic counterpart.

Fortunately, Professor Craig's short biography of John Thomson will introduce most readers for the first time to one of the greatest pediatricians of this century. The book is obviously a labor of love because the author-as did everyone else who knew Thomson-was deeply inspired by his gentleness, his kindness, and his ungrudging, unsparing, and unyielding efforts to improve the care and cure of children.
The Neonate with Congenital Heart Disease, by Richard D. Rowe, M.D., Ch.B., F.R.C.P. (Edin.), and Au Mehrizi, M.B. Philadelphia: W.B. Saunders Company, 1968, 445 pp., $12.50
Authors: Dushane James W.
Published: December 2021

The Neonate with Congenital Heart Disease should prove to be a successful member of the monograph series on major problems in clinical pediatrics. The book is highly recommended for the physician interested in neonatobogy, pediatrics, or pediatric cardiology.

The early chapters cover those aspects of the anatomy, physiology, physical examination, electrocardiography, radiology, incidence, and etiology of congenital heart disease that pertain to the newborn. The text, while brief, successfully summarizes the subject in a concise and lucid manner, using a strikingly extensive and current bibliography.
SMALLPOX VACCINATION: BEFORE OR AFTER ONE YEAR OF AGE?
Authors: Neff John M. , Lane J. Michael
Published: December 2021

The telephone number for Abram S. Beneson, M.D. (PEDIATRICS, 42:989, 1968) should have read 215/829-6916 instead of 215/829-6816.
PATHOGENESIS OF SEIZURES OCCURRING DURING RESTORATION OF PLASMA TONICITY TO NORMAL IN ANIMALS PREVIOUSLY CHRONICALLY HYPERNATREMIC
Authors: Hogan Gwendolyn R. , Dodge Philip R. , Gill Sheila R. , Master Susan , Sotos Juan F.
Published: December 2021

The present study describes the results of rehydration of rabbits rendered chronically hypernatremic by the administration of one molar sodium chloride solution by nasogastric tube for 23½ to 5 days. When these animals were rehydrated intravenously over a 4-hour period with 2.5% dextrose in water, returning the plasma sodium level to normal, 55% of them developed focal or generalized convulsions.

The mean water content of brain tissue of the group of animals who had seizures was significantly greater than that of a normal group of animals and comparable to that found in a water-intoxicated group of animals. This elevation of water content could be accounted for by both an elevated content of potassium and chloride in the brain. The potassium content of the brain was higher in the rehydrated group of animals without than those with seizures. Ways by which the observed changes may be related to the development of seizures are discussed.
CONGENITAL ATRESIA AND STENOSIS OF THE DUODENUM
Authors: Fonkalsrud Eric W. , deLorimier Alfred A. , Hays Daniel M.
Published: December 2021

A review is presented of 503 patients with congenital duodenal obstruction, compiled from 65 hospitals by the Surgical Section of the American Academy of Pediatrics. Four hundred eighty-seven patients underwent primary operative correction of the malformation with an overall early and late mortality rate of 36%.

Complications from associated major congenital malformations were the leading cause of death. Many of these anomalies were potentially correctable had they been recognized and early treatment instituted. More than half of the infants with duodenal atresia had associated malformations. Thirty percent of the patients had Down's syndrome.

End-to-side or side-to-side duodenoduodenostomy or jejunostomy are the most commonly used operative techniques for duodenal atresia. General anesthesia and tube gastrostomy are usually employed.
Methadone Toxicity in a Child
Authors: McCurley William S. , Tunnessen Walter W.
Published: December 2021

A case of methadone poisoning with recovery is reported. An increased incidence of poisoning may occur because of recent innovations in the usage of this drug. A brief discussion of the drug and the treatment of acute intoxication is included.
Medical Aspects of Fitness to Drive Vehicles: A Guide for Medical Practitioners, edited by Leslie G. Norman. (Report by the Medical Commission on Accident Prevention). London: Royal College of Surgeons, 50 Brompton Road, London, S.W. 7, 1968, 48 pp. 5 shillings ($0.10)
Authors: Coleman Allan B.
Published: December 2021

In the book review of Medical Aspects of Fitness to Drive Vehicles: A Guide for Medical Practitioners (Pediatrics, 42:1020, 1968) the price 5 shillings ($0.10) should have read 5 shillings ($0.60).
HYPOGLYCEMIA AND HYPERINSULINEMIA ASSOCIATED WITH ERYTHROBLASTOSIS FETALIS
Authors: Raivio Kari O. , Österlund Kalle
Published: December 2021

In a survey of blood glucose levels in 232 erythroblastotic infants during the first 3 days of life, 12 cases of significant hypoglycemia were revealed. Most of these had a severe primary disease; the incidence of hypoglycemia was 17.8% in patients with cord hemoglobin concentrations below 10 gm per 100 ml and 1.9% in those with higher cord hemoglobin levels. The low glucose values were usually observed during the first day of life and were unassociated with recognizable symptoms. Plasma insulin levels, determined in 39 cases before age 24 hours and prior to treatment, were shown to be negatively correlated with the cord hemoglobin concentrations.

Hyperinsulinemia, directly correlated with the severity of the erythroblastosis, is postulated to be the cause of the low blood glucose levels. As another consequence of the hyperinsulinemia, a depression of the plasma free fatty acid concentrations was documented.

The mechanism of the hyperinsulinemia, the therapeutic and prognostic implications of the hypoglycemia, as well as the effect of the depression of free fatty acid levels on the bilirubin-binding capacity of serum are briefly discussed.
BILE-PLUG SYNDROME: A CORRECTABLE CAUSE OF OBSTRUCTIVE JAUNDICE IN INFANTS
Authors: Bernstein Jay , Braylan Raul , Brough A. Joseph
Published: December 2021

Conjugated hyperbilirubinemia in the newborn period and early infancy can result from choledochal obstruction or hepatocellular damage. Examples of the former include biliary atresia, choledochal cyst, and choledochal bile plugs. The recognition of these conditions and their differentiation are of importance in determining the best and most effective course of therapy. Choledochal cysts and bile plugs can be corrected surgically, and the presence of these two conditions is best determined by surgical exploration and transcholecystic cholangiography. Previous liver biopsy is helpful in establishing the presence of an obstructive lesion; but, because of the similarity of histopathological effects on the liver, it will be of little help in differentiating the causes of obstruction.
ADRENAL FUNCTION, GROWTH, AND INSULIN IN PATIENTS TREATED WITH CORTICOIDS ON ALTERNATE DAYS
Authors: Sadeghi-Nejad Abdollah , Senior Boris
Published: December 2021

Fourteen children treated with corticosteroids in a single dose on alternate days for periods of up to 50 months were studied. None had a Cushingoid appearance. Growth was normal or accelerated in 12 of the children. The concentration of growth hormone in the serum and its maximal increase after insulin were like those of normal children. Regulation of the secretion of cortisol as judged by the response to insulin was depressed on the day when the corticoid was given, but it was nearly normal 28 hours later. The concentration of insulin in the serum was slightly higher in the treated than in the normal children.
AVAILABILITY, EFFECTIVENESS, AND ECONOMY OF CHILD HEALTH SERVICES
Authors: Butler Allan M.
Published: December 2021

The critical state of medicine in the United States has been amply documented by the National Conference on Medical Costs, June 1967, and the Report of the National Advisory Commission on Health Manpower, November 1967. In spite of our wealth, science, technology, medical schools, hospitals, research facilities, and budgets; our relatively high ratio of 1 doctor per 700 people; and the exemplary quality of our best medicine, international health indices give the United States not only poor, but also falling ratings-due of course to the poor education, nutrition, socioeconomic circumstances, and health care that result in the high mortality and morbidity of 30% of our population.

RETURN ON THE HEALTH DOLLAR SPENT

Meaningful and accurate comparative costs of medical care are hard to come by. But the following approximations give an order of magnitude of costs that, with our relatively poor health ratings, indicate a poor return on the health dollar in the United States. In 1963 the medical care of the 45,000,000 people of Great Britain cost approximately $4,000,000,000-or $90 per person-while the medical care of our 180,000,000 people cost approximately $33,000,000,000-or $194 a person. In 1965 Great Britain spent roughly 4.5% of its Gross National Product on health care as compared to our 6%-and her per capita Gross National Product was, of course, less than ours. The United States is now spending approximately 6.3% of its annual Gross National Product of approximately $800,000,000,000, or $50,000,000,000 on annual health care. This is $250 a person per year for our 200,000,000 people.
Pasteurella multocida in Dog and Cat Bite Infections
Authors: Torphy D. E. , RAY C. G.
Published: December 2021

The infected dog or cat bite is a common problem, particularly in pediatrics. These infected bites can produce moderate tissue destruction, and, if on the face or neck, disfigurement may result. Careful debridement is indicated; and, unless primary repair is necessary for cosmetic reasons, the wound should not be sutured.

Although a variety of organisms have been cultured from infected bites, Pasteurella multocida is the most common. Since P. multocida is extremely sensitive to penicillin, the prophylactic use of this antibiotic in potentially disfiguring wounds should be considered. In the already infected animal bite wound, penicillin or one of its analogues is recommended.
Evaluating the Early Treatment of Neonatal Hypoxia and Acidosis
Authors: Aclin Richard R.
Published: December 2021

I share Dr. Prod'hom's enthusiasm concerning the article by Sinclair, Engel, and Silverman on the treatment of hypoxia and acidosis in low birth weight infants, which was in the October issue of Pediatrics. We have long needed an article such as this. Hopefully similar articles will follow to enlighten us more on this perplexing subject.

I would like to make a new comments on the article in subject with respect to the use of intravenous sodium bicarbonate.
THE PATIENT BOY—A POPULAR LESSON, READ TO CHILDREN IN THE 1820'S
Authors: C. T. E.
Published: December 2021

The story below depicts a favorite subject of those who wrote for children in the early days of our country. The inebriated father leading his family inexorably into destitution by his intemperance is counterbalanced by a son who holds the family together. During the last century many children cried over this and similar stories.

The Patient Boy

There was a journeyman bricklayer in this town, a good workman, but a very drunken idle fellow; he spent at the dram shop almost all he earned, and left his wife and children to take care of themselves; to get food and clothes as they could.

They might all have starved, but for the eldest son, whom his father had brought up to help him at his work; and who was so industrious and attentive, that being now at the age of thirteen or fourteen, he was able to earn pretty good wages, every penny of which that he could keep out of his father's hands, he brought to his mother.

When the brute of a father came home drunk, cursing and swearing, and in such an ill humour that his mother, and the rest of the children, durst not come near him for fear of a beating, this good lad (Tom was his name) kept close to him, to pacify him, and get him quietly to bed. His mother looked upon Tom as the support of the family, and loved him dearly.

It happened one day, Tom in climbing up a high ladder, with a load of mortar on his head, missed his hold, and fell down to the bottom, on a heap of bricks and rubbish.
INSULIN BINDING IN CHILDREN WITH DIABETES MELLITUS
Authors: Murthy D. Y. N. , Guthrie R. A. , Womack W. N. , Jackson R. L.
Published: December 2021

Insulin employed in the treatment of most diabetics is of bovine origin, or a mixture of bovine and porcine insulins. The measurement of insulin binding of bovine and porcine insulins by adsorption chromatographic technique is simple, rapid, and of assistance in the management of some diabetics with high insulin requirements. Most diabetic children develop mild degrees of insulin binding during the first 6 months of insulin therapy which remains relatively constant with longer duration of the disease. An occasional diabetic child develops higher insulin binding, especially to bovine insulin with a concurrent rapid increase in insulin requirement. The demonstration of selective binding for one type of insulin has therapeutic significance. Substitution of an insulin for which there is little insulin binding results in a decrease in insulin requirement and better regulation of diabetes.
Oral Antibiotics in Patients with Heart Disease: Case Report of Child Facing Oropharyngeal Surgery with Oropharyngeal Viridans Streptococci Resistant to Penicillin and, Following Oral Erythromycin Therapy, to Penicillin, Erythromycin, and Lincomycin
Authors: Sprunt Katherine , Redman Winifred M. , Leidy Grace
Published: December 2021

The patient to be described illustrates dramatically one of the potential hazards of theoral use of antibiotics in patients with heart disease.

Case Report

A. S., a 3-year-old girl, was admitted to the Babies Hospital for repair of a cleft palate. She was noted at birth to have acyanotic congenital heart disease, which was diagnosed at 5 months as atrial and ventricular septal defects with multiple pulmonary artery stenosis. From the time of diagnosis, she had received penicillin prophylactically in various forms. Recently, for more than 6 months, she had received phenoxymethyl penicillin syrup (Pen Vee), 200,000 units orally, twice a day.
Disappearance of a 47,XX,C+ Leucocyte Cell Line in an Infant Who Had Previously Exhibited 46,XX/47,XX,C+ Mosaicism
Authors: Neu Richard L. , Bargman Gerald J. , Gardner Lytt I.
Published: December 2021

Follow-up observations are reported on an infant with numerous phenotypic abnormalities who had been reported at 7 months of age to have an extra C group autosome in 17% of her peripheral leucocytes. Examination of the patient at age 2½ years revealed that the physical findings were essentially unchanged, except for increased prominence of the sixth, seventh, and eighth thoracic vertebrae. The abnormal cell line was found to have disappeared from her leucocytes in cultures repeated at ages 2½ and 2[unknown] years. Analysis of bone marrow metaphases showed that 7% were of the 47,XX,C+ karyotype.

Other reported examples of disappearing abnormal cell lines are reviewed. These findings may help explain those cases having the clinical appearance of a syndrome associated with chromosomal abnormality, but whose karyotypes are normal. It is possible that a mosaicism existed during fetal life, and that the cytogenetically abnormal cell line caused abnormal organogenesis prior to its later disappearance.
Vienna, 1971
Authors: Bloch Harry
Published: December 2021

In an airconditioned room in Mexico City, a group of men, who had forgotten, voted to hold the next international pediatric meeting in Vienna, Austria.

The decision was to many as dumbfounding a horror as reading the reports of the genocide of the Nazi Final Solution, or of the "murder of over a million Jewish children, separated by force from their mothers, torn to pieces before their parents eyes, their little heads smashed against the walls."
Letter to the Editor
Authors: Knelson John H. , Avery Mary Ellen
Published: December 2021

The letter from Drs. Stefan, Leschin, and Gray raises the important question of the validity of measurements of the partial pressure of oxygen (PO2) in capillary blood. We concur that measurements of oxygen tension are essential in monitoring ambient oxygen levels, and we would agree that, in the absence of shock, values on capillary blood reflect the levels in arterial blood. Fortunately, data exist, at least in normal newborn infants breathing air, that permit evaluation of the usefulness of capillary samples.
Aspects of Praematurity and Dysmaturity (Nutricia Symposium), edited by J. H. P. Jonxis, M.D., H. K. A. Visser, M.D., and J. A. Troelstra, M.D. Springfield, Illinois: Charles C Thomas, 1968, 356 pp., $18.50
Authors: Avery Gordon B.
Published: December 2021

The past decade has witnessed widespread recognition of the crucial distinction between two groups of low birth weight infants: one, those whose period of gestation is shortened; the other those whose low birth weight is the result of inadequate intra-uterine nurture by the maternal and placental life support systems. The present work contains the proceedings of a 3-day symposium dealing with both groups of infants which was held in Gronigen, The Netherlands, May 10 to 12, 1967.
RESPONSE TO EXERCISE IN PATIENTS WITH TETRALOGY OF FALLOT WITH SYSTEMIC-PULMONARY ANASTOMOSES
Authors: Gold Warren M. , Mattioli Leone F. , Price Albert C.
Published: December 2021

Cardiopulmonary function was studied at rest and during exercise in 17 patients with Fallot's tetralogy who had systemic-pulmonary anastomoses to determine the factors which limit their work capacity (Wmax) and produce their limiting symptoms. The patients stopped exercise at a mean work rate of 355 kg-M·min-1 because of dyspnea or leg pain. The average pattern observed in room air was: a fall in arterial pO2 from 64 mm Hg at rest to 47 mm Hg during exercise due to increased right-to-left shunting; alveolar hyperventilation at rest (arterial pCO2 = 31.6 mm Hg) and during exercise (arterial pCO2 = 35.2 mm Hg); a progressive fall in arterial pH during exercise to pH = 7.369; and increased levels of wasted ventilation (VD:VT = 50.6) during exercise. Wmax was directly related to pulmonary blood flow, anaerobic threshold, and O2 pulse, and inversely related to the size of right-to-left shunt during exercise.

Exercise response during O2 breathing in 16 patients studied showed decreased hypoxemia, decreased acidosis, and decreased minute ventilation. These results suggest that the excessive ventilation observed in these patients when they breathed room air was partly due to a chemoreceptor drive.

Exercise response in the supine posture in seven patients studied was improved with decreased dyspnea, decreased minute ventilation, and decreased wasted ventilation without changes in the right-to-left shunt. These results suggest that the excessive ventilation observed was partly due to an increased wasted ventilation. Dyspnea appeared to be related to the inappropriateness of the level of ventilation relative to the metabolic needs of exercise.
A CONTROLLED STUDY OF FEEDING GASTROSTOMY IN LOW BIRTH WEIGHT INFANTS
Authors: Vengusamy Shakunthala , Pildes Rosita S. , Raffensperger John F. , Levine Harry D. , Cornblath Marvin
Published: December 2021

The present controlled study was to evaluate the effect of a feeding gastrostomy on the survival of infants with birth weights between 750 and 1,250 gm utilizing sequential analysis. A total of 122 infants were entered into the study at 48 to 72 hours after birth. A successful outcome was survival at 21 days. Of 54 matched pairs, 34 had a similar outcome and did not contribute to the sequential analysis. The outcome of the discordant pairs was recorded according to a prearranged scheme of sequential analysis. With the completion of the twentieth "untied" pair, the decision was made that mortality with gastrostomy was higher than that with routine feedings.
ACID-BASE LANGUAGE VERSUS ACID-BASE MEASUREMENTS
Authors: Filley Giles F.
Published: December 2021

The PAPERS of Kildeberg and Engel and of Nelson and Riegel continue what has been called, inaccurately, "The Great Transatlantic Acid-Base Debate" betsveen two schools of acid-base physiology. Historically at least, these can be called the Continental and Anglo-American Schools and their current dispute a war of words. We will sketch their beginnings, describe some of their differences, and indicate the importance of the distinction between fundamental and derived measurement.

The Continental School was probably founded by Hasselbalch, who in 1916 began the apparently never-ending search for a chemical index of a "metabolic component," i.e., a number indicating the quantity of non-volatile acid added to or lost from the body-"corrected" for respiratory effects. Hasselbalch index was typical of the genre because it required exposing a blood specimen in vitro to known CO2 gas mixtures and was called a "reduced hydrogen ion concentration." His successors have tended to work meticulously in chemical laboratories, to give special names to defined magnitudes, and to incorporate these into logical formulations. One example was that of Singer and Hastings, which was based on a thoroughgoing study of blood as a physicochemical system at various states of equilibrium outside the body. Another recent and carefully developed one is that of Siggaard-Andersen. Despite this and other authors warnings, this school formulations are subject to abuse perhaps especially by those who assume that an "Astrup determination" is a substitute for clinical judgement.

The other school is less systematic, its members being more often physiologists or physicians than physical chemists.
DR. JOSEPH CLARKE IN 1797 DESCRIBES HIS TREATMENT OF OBSTINATE COSTIVENESS IN INFANTS
Authors: C. T. E.
Published: December 2021

Many well-known physicians of a century or two ago who treated infants and children considered constipation to be a cause of violent convulsions and an incitement to recurrent fever.1 For this reason the treatment of obstinate costiveness in infants was mentioned frequently in the publications of many physicians of the eighteenth and of the first half of the nineteenth centuries. One of the most widely respected of these was Dr. Joseph Clarke (1758-1834), Master of the Rotunda (Maternity) Hospital in Dublin. His enthusiastic recommendation of calomel in the treatment of constipation in infants in one of his papers published in 1797, and quoted here, was widely accepted by practitioners as the drug of choice for this complaint for well over a century. (It wasn't until 1948 that mercury was found in the urine of children with acrodynia.)

Every one, acquainted with the constitution of infants, knows that it is natural to them to have three or four stools every twenty-four hours; and that without such discharges they seldom enjoy perfect health. A few instances occur in practice where the intestines of infants never discharge their contents unless irritated by some kind of physic. I have met with a good many such cases, and trying all the ordinary laxative medicines I could not say that any of them was entitled to a preference. The effects of all were temporary only. An ingenious friend and correspondent in London first suggested to me a trial of calomel in such obstinate cases.
The Scratch of the Newborn
Authors: Schorer C. E.
Published: December 2021

For a number of years, I have been interested in newborn infants who scratch themselves. About 20% of normal neonates do this, usually on one cheek or the other, until spontaneous cessation at a mean age of 4 months.

In my observations, I have found significant correlation between such scratching, low parity of the mother, and full-term gestation. The nonscratchers had significantly shorter gestation and their mothers greater multiparity. On follow-up 1 year later, after periodic checks, the only significant difference between 26 scratchers and their matched controls was the greater incidence of skin disorders (mostly atopic dermatitis) in the former group.
Platelet Counts in Prematures
Authors: Gross Samuel
Published: December 2021

The article1 in the October 1968 issue on "Platelets in Prematures" deserves more than a few remarks in the commentary relative to the incidence and hazards of thrombocytopenia. The article is good in that it serves as a guideline relative to the range in platelet levels among premature infants, but the reader should not accept this simply as the normal range. For example, there is no discussion on the remarkably large number of infants with platelet counts above 400,000/mm3.
Annual Summary of Vital Statistics—1967
Authors: Bratu Marcel
Published: December 2021

I am pleased with the continuous decrease of the infant mortality rate.

As a pediatrician involved in community programs as well as in hospital programs, I feel that some data have to be presented in evaluating the infant mortality rate.

For instance, it will be helpful to know how much of the infant mortality the neonatal death rate represents and how much of the neonatal death the prenatal death rate represents. After this breakdown, let us compare with other countries the infant mortality rate divided in age groups: 0 to 1 month, 1 to 3 months or 1 to 6 months, and 6 to 12 months.
More on Poisoning
Authors: Scherz Robert C.
Published: December 2021

I agree with Dr. Coleman (Pediatrics, 43:143, 1968) that focusing on whether or not a medication is flavored does overemphasize a factor of its attractiveness to a child who subsequently ingests it. Nevertheless, it must be obvious to all that children who like candy, when given a choice, will more readily ingest a good tasting medication than a bad tasting one.

However, until that "some day" when useless and unduly toxic substances are banned from homes of small children and directors of motivational research can give us practical guidelines for favorably influencing the driven child, we should actively support the widespread use of adequately tested, child-resistant containers to package those harmful or potentially harmful consumer products that are commonly found in the home.
FURTHER EXPERIENCE WITH THE USE OF PERCUTANEOUS SUPRAPUBIC ASPIRATION OF THE URINARY BLADDER
Authors: Saccharow Leonard , Pryles Charles V.
Published: December 2021

Percutaneous suprapubic urinary bladder aspirations were carried out in 654 infants and children. Five hundred of the aspirations were in patients admitted to the hospital with acute illness, and 154 were in patients being followed in the Pediatric Renal Clinic because of a history of recurrent infections of the urinary tract. In the latter group, a clean-voided sample of urine was obtained immediately after the suprapubic aspiration for a comparative bacteriologic study. In the first group of 500 patients, four unsuspected infections were uncovered, all of them in boys in whom a structural abnormality of the urinary system was demonstrated. These four boys represented 1.4% of the males in the group, giving an incidence of infection that is almost three times that shown in a study of boys in a school population. In the second group of 154 patients, three patients demonstrated a "bladder" bacteriuria in the presence of an indeterminate clean-voided bacteriuria. These patients were considered to have a low-grade bacteriuria and active, albeit suppressed infection. Thus, suprapubic bladder aspiration may be one means of resolving the problem of low bacterial counts in patients with chronic infection of the kidney and urinary tract.

Percutaneous suprapubic aspiration of the urinary bladder is a safe, easy, and useful method of obtaining urine for accurate diagnosis of urinary infection. Its use as a routine procedure in all ill infants and children may reveal unsuspected infection.

A comparative bacteriologic study of urine obtained by percutaneous aspiration of the bladder (vesicopuncture) and blood obtained by venipuncture may be fruitful and is presently under way.
HOW TO PREDICT THE SEX OF THE UNBORN INFANT
Authors: C. T. E.
Published: December 2021

A fascinating book, entitled The Ladies Dictionary, was published in 1694 in London. The author, who identified himself only by the initials N. H., stated in his preface that he wrote the book "for the use of the Fair-Sex to serve them as a Secret Oracle to consult in all difficult cases." The book is filled with advice and "information" about many intimate topics which women of that period would have probably been too embarrassed to have asked their husbands or physicians. Many answers to questions that N. H. felt women of that period would have wished to have asked the "Learned Men" are fallacious. The following is an excellent example of the untruths offered to the readers of this book:

We come now to a nicer Point which we should be difficulty brought to undertake were we not warranted by divers Learned Men who have given their Opinions about it. They tell as if it be a Male Child, that when it is come to some Perfection in the Womb, the Right-Eye of the mother would to appearance move swifter and sparkle more than the other. The Right Pap [breast] rise and swell more than the left, and become harder, the Niple [sic] sooner changing Colour, and the increase of the Milk be more speedy, and being milked out and set in the Sun, it will settle to a Pearl Colour. Her right cheek will often glow and colour more than the other, and she a livelier Blush on all Occasions, than at another time, and is more brisk and free from sadness than if she conceiv'd a Female.
FINE SENSORIMOTOR CONTROL IN HEALTHY CHILDREN
Authors: Simard Thérèse
Published: December 2021

To establish methods of training the voluntary control of the activity of a single motor unit on children (previously reported on adults), a series of electromyographic experiences was undertaken. Healths children from 3 to 12 years of age were trained to gradually and consciously suppress the neuromuscular activity and to isolate and maintain in a repetitive activity a single motor unit chosen into the rhomboid muscle. The degree of motar control was verified qualitatively and quantitatively with no body movements and during the activity of drinking. Inhibition and maintenance of a single motor unit in the activity during drinking were successful. This was most evident among the 7- to 9-year-old children. The children demonstrated the same motor ability as adults, and the variation between age groups consists mainly in the duration of attention span. The observation of doublets with young normals is at least similar in frequency as with adults.
Letter to the Editor
Authors: White John J. , Dupré John
Published: December 2021

The observations of Dr. Pildes, et al. concerning the elevated glucose and insulin levels in portal compared to peripheral venous blood following oral glucose administration appear to agree with our findings in adults. With the realization that the umbilical vein remains patent in the adult, we have utilized indwelling catheters stationed at the umbilicoportal vein junction to assess liver disease with hepatoportography and have been able to measure simultaneous portal and peripheral glucose and insulin changes with both oral and parenteral glucose administration.
Exchange Transfusion versus Assisted Ventilation for Drug-Induced Respiratory Depression
Authors: Hall Bryan D.
Published: December 2021

A recent Experience and Reason article discussed the use of exchange transfusion in a newborn with respiratory depression secondary to maternal analgesics. The conclusions reached are not supported by the data given. Primarily, there are no biochemical studies to substantiate abnormal blood levels in either mother or infant. Pre- and post-exchange levels in the infant were not obtained; thus, the efficiency of the exchange in removing the analgesic (Glutethimide) is not known. This is particularly pertinent since the authors cite evidence that glutethimide is slowly released into the bloodstream from body fat deposits.
STUDIES OF THE MOLECULAR BASIS OF CONGENITAL MALFORMATIONS
Authors: Mackler Bruce
Published: December 2021

With recent advances in treatment of many acute and chronic diseases, the problems associated with congenital malformations in children have assumed a greater importance in pediatrics. Previous to the work of Warkany and Nelson in 19401, it was recognized that many congenital defects were genetically determined and hereditary. The finding by Warkany and co-workers1-3 that modification of the prenatal environment by severe states of riboflavin deficiency produced congenital malformations in mammals demonstrated clearly the importance of the prenatal environment in the development of the fetus and gave impetus to searches for other environmental factors of importance to the developing organism.

The syndrome resulting from severe maternal riboflavin deficiency in rats is characterized mainly by micrognathia and reduction type of defects in the distal extremities of the fetuses, and by a wide number of other anomalies such as cleft palate and hydronephrosis. More recently, Nelson and co-workers4 demonstrated that galactoflavin, a synthetic analog of riboflavin, produced a rapid riboflavin deficiency syndrome in pregnant rats. The addition of galactoflavin to a riboflavin-deficient diet materially shortened the time required to produce riboflavin deficiency, and permitted much better regulation of the experimental model.

In other studies of riboflavin deficiency, Miller and co-workers5 showed a lower flavin content in fetuses from riboflavindeficient rats than in control fetuses, suggesting the possibility that there may be corresponding deficiencies in the activities of flavin-dependent enzymes such as the terminal electron transport systems (ETP). Other investigators6 have reported studies of enzymatic activities in liver mitochondria of adult rats fed a riboflavin-deficient diet with added galactoflavin, but with varying results.
Transfer of Medical Information, Continued
Authors: Davis Joseph H.
Published: December 2021

I would like to second the "gripe" of Dr. Tom Auld that appeared in the December issue in the Letters to the Editor column. I too am annoyed when a doctor sends me a xerox copy of his handwritten office notes on a patient or when he sends me the original file of handwritten notes intact.

To me, the most important information that I can give a new pediatrician about my patient is the unwritten information that I have learned through the years about family behavior, habits, and so forth that would enable me to more effectively take care of this child as a patient.
STUDIES ON INTERACTION OF BACTERIA, SERUM FACTORS AND POLYMORPHONUCLEAR LEUKOCYTES IN MOTHERS AND NEWBORNS
Authors: Dossett John H. , Williams Ralph C. , Quie Paul G.
Published: December 2021

The bactericidal capacity of newborn infants' whole blood for E. coli was deficient compared to the mothers, and attempts were made to identify cellular or humoral factors responsible for this deficiency. Separated polymorphonuclear leukocytes from newborn infants were found to be similar to polymorphs from mothers in capacity to engulf and kill E. coli and other bacteria so that cellular deficiency was not evident.

Comparison of the serum opsonic capacity of newborn infants' and mothers' sera revealed deficient opsonic capacity for E. coli in newborn sera. The mean opsonic titer for E. coli was 46.7 in mothers and 4.3 in neonates. Serum opsonic titers for Staph. aureus and group B streptococcus were similar. The opsonic capacity for all bacterial species was decreased when the sera were heated or decomplemented with immune complexes indicating the phagocytosis amplifying role of complement.

The newborn-maternal difference in opsonic capacity for E. coli was presumably a result of deficient 19S antibodies, the primary opsonic antibodies for this organism. Maternal 19S serum fractions alone, however, showed no opsonic capacity for E. coli. Addition of a complement source (newborn serum absorbed with E. coli) revealed the opsonic capacity of these 19S maternal serum fractions for E. coli. Antibodies in 19S serum fractions therefore are efficient opsonins for E. coli; however, complement is necessary to demonstrate their opsonic potential.
THE PEDIATRIC NURSE PRACTITIONER IN THE OFFICE OF PEDIATRICIANS IN PRIVATE PRACTICE
Authors: Schiff Donald W. , Fraser Charles H. , Walters Heather L.
Published: December 2021

The experience of a two-man pediatric practice with a pediatric nurse practitioner indicates that this is an economically sound means of partially relieving the immediate manpower shortage and of improving medical care to children. The pediatric nurse practitioner provides skill and competent services to patients and their parents which is well accepted by them. Having the pediatric nurse practitioner in the office is an economic asset. She is a valuable associate in managing a variety of day-to-day problems. Her presence has resulted in an increase in the number of patients seen and an overall improvement of services provided.