bluuebunny/crossref_metadata_2025 huggingface dataset:
Panel Discussion
Authors: HILL LEE FORREST , HUBBARD JOHN P. , HARRIS T. N. , JACKSON ROBERT L. , WHEATLEY GEORGE M.
Published: December 2021

Chairman Lee Forrest Hill, M.D., Des Moines, Iowa: I should like to introduce our panel speakers. Dr. George M. Wheatley is 3rd Vice President, Metropolitan Life Insurance Company, and Chairman of the Academy's Committee on Rheumatic Fever, New York City. Next is Dr. T. N. Harris of Philadelphia. Dr. Harris is Assistant Research Professor of Pediatrics of the School of Medicine, University of Pennsylvania. He is chief of the Rheumatic Fever Clinic at the Philadelphia General Hospital. He is Assistant Consultant to the Outpatient Department of the Children's Hospital in Philadelphia.

Dr. Hubbard is Assistant Professor of Pediatrics, School of Medicine, University of Pennsylvania. Dr. Robert L. Jackson is Associate Professor of Pediatrics, School of Medicine, State University of Iowa.

Magnitude of the Problem

Dr. Wheatley.—Because of the general acceptance of rheumatic fever as a major pediatric and public health problem, we find in an increasing number of localities both the medical profession and the public ready to support organized community efforts to find cases, to provide adequate treatment, and, in fact, willing to undertake most any logical measures which promise some control over this important cause of heart disease. For intelligent planning and evaluation at the community level or on a larger scale, facts showing the magnitude and relative importance of rheumatic fever are essential.

Perhaps at this point you wonder what expressions such as "community level" and "planning and evaluation" have to do with the practicing pediatrician. As a clinician your primary concern is with the individual child. When you are at the bedside puzzled by a syndrome suggestive of rheumatic fever, it is of little help to know facts and figures on the incidence, prevalence and severity of this disease. The reason is that as a pediatrician you have a dual responsibility.
Medical Writing
Authors: MCCULLOCH HUGH
Published: December 2021

The appearance of this addition is most welcome. It is hard to conceive of a writing style changing in a period so short as 10 years, but it does. The new words in use are an enormous number and there is a tendency to anglicize and shorten wherever possible. This book is the one authoritative source in the field of medical writing and has the backing of all attempts to organize and standardize the technic, if not the art, of writing. The latter is the more difficult to cultivate and attain.
Year Book of Pediatrics
Authors: MCCULLOCH HUGH
Published: December 2021

The 1948 edition of this popular Year Book marks a change of editorship to Dr. Poncher who is professor and head of the Department of Pediatrics, University of Illinois, College of Medicine, and who succeeds Dr. Isaac Abt. There is no major change in form or style and the book under its new editor should continue its popularity and usefulness. The editor states that the book is directed chiefly to readers who are general practitioners, as well as to practicing pediatricians.
Technique of Treatment for the Cerebral Palsy Child
Authors: PERLSTEIN M. A.
Published: December 2021

This book is well written and printed, containing good illustrations. It deals with the technic of actual physical therapy of children with cerebral palsy. It discusses clearly and in detail many of the modalities employed. These include massage, passive motion, active and active associated motion, resistant motion, automatic and conditioned motion, relaxation, balance work, and some of the skills. There is also included a list of various types of equipment which can be employed for the cerebral palsied.
THE PATHOGENESIS OF THE "VERNIX MEMBRANE"
Authors: MILLER HERBERT C. , HAMILTON TOM R.
Published: December 2021

The clinical records of 79 stillborn and live-born infants were correlated with the postmortem findings in their lungs.

Evidence of aspiration was found chiefly in the lungs of full term stillborn infants in the form of large numbers of blue-staining cornified epithelial cells together with large amounts of fat in the terminal air spaces.

Hyaline-like membranes were found in the terminal air spaces in greatest numbers in the lungs of live-born premature infants in whom there was no history of any maternal complication of pregnancy or labor.

It is suggested that the hyaline-like membranes may not be composed of aspirated vernix and amniotic sac contents but probably represent a reaction to an injury to the epithelium of the air spaces, especially the bronchioles and alveolar ducts.

The nature of the etiologic agent remains doubtful, but the similarity of these membranes to those found in older individuals dying of pandemic influenza and with rheumatic pneumonitis suggests that intrauterine inflammatory reaction may be a factor. The relationship to congenital alveolar dysplasia has been discussed.

It is suggested that the hyaline-like material is phagocytized by polymorphonuclear leukocytes and mononuclear cells. The presence of these phagocytes in the alveoli and bronchi in association with hyaline-like material is one of the chief forms of pneumonia in the newborn infant.
HUMAN EQUINE ENCEPHALOMYELITIS IN SASKATCHEWAN IN 1947
Authors: GAREAU URBAN J.
Published: December 2021

Eight cases of infants with human equine encephalomyelitis confirmed by neutralization tests have been presented, six having recovered completely and two left with residua, one mentally deficient.

Because six months later two additional patients who had abnormal mentality of an obscure nature, a suggestive clinical history and a positive neutralization test were considered to have had human equine encephalomyelitis in this epidemic, it would appear advisable to check the blood of all children with abnormal mentality of an obscure nature against the virus equine encephalomyelitis.
RETROLENTAL FIBROPLASIA AND LIGHT
Authors: HEPNER W. R. , KRAUSE ARLINGTON C. , DAVIS M. EDWARD
Published: December 2021

To discover whether exposure of the eye to light played any role in the pathogenesis of retrolental fibroplasia, the eyes of five premature infants were shielded for from 35 to 60 days after birth. Four of these five infants developed retrolental fibroplasia. One of the five infants developed no ocular abnormality of any kind. It is concluded that light is not an etiologic factor of retrolental fibroplasia in the premature infant.
MENINGOCOCCEMIA WITH MENINGITIS ACCOMPANIED BY BILATERAL GANGRENE OF THE LOWER EXTREMITIES (WATERHOUSE-FRIDERICHSEN SYNDROME)
Authors: DEFUCCIO CHARLES P. , DRESNER EVELYN E.
Published: December 2021

A case of meningococcemia with meningococcal meningitis, complicated by gangrene of the lower extremities, is reported. Amputation of the lower third of both legs was performed. The patient is living and in good health.
Viral and Rickettsial Infections of Man
Authors: HENLE WERNER
Published: December 2021

It has been the practice in the past that viral and rickettsial agents and the diseases caused by them were included in textbooks of bacteriology. Thus these chapters were written by authors who frequently were not experts in this field. Furthermore, the various aspects of these diseases often are sufficiently different from those caused by bacterial organisms to warrant separate treatment. This separation has been accomplished in "Viral and Rickettsial Infections of Man," edited by Thomas M. Rivers, and its companion "Bacterial and Mycotic Infections of Man," edited by René J. Dubos.
EFFECT OF AGE, SEX, AND CYSTIC FIBROSIS ON THE SODIUM AND POTASSIUM CONTENT OF HUMAN SWEAT
Authors: Lobeck Charles C. , Huebner Dorothy
Published: December 2021

The following observations were made on collections of sweat from 197 subjects without evidence of disease related to cystic fibrosis of the pancreas after production of localized sweating on the forearm by a standard pilocarpine iontophoresis procedure: 1. Sodium concentrations averaged less than 20 meq/l in children under 11 years of age, while in adults the average concentration rose to 45 meq/l. Sodium concentrations were less variable in children than in adults. Age variation in sodium concentration did not depend upon variation in the rate of sweating. 2. The average potassium concentration in all children and adult females was 11 meq/l. It was lower, 7 meq/l, in adult males. 3. Other sex differences, observed only in adults, were the higher rates of sweating and slightly higher sodium concentrations found in males. 4. Rates of sweating measured in children under 1 year of age were considerably more variable than those induced in older children or adults.

Comparison of these data with observations from 34 children with cystic fibrosis revealed the following facts: 1. Children with this disease always had higher sodium concentrations than pre-pubertal control subjects. Twenty-nine per cent of adult control subjects had concentrations within the cystic fibrosis range. 2. Children with cystic fibrosis had a higher average potassium concentration, 15.0 meq/l, than control children. 3. No sex differences were observed within this group, and the same increased variability in rates of sweating induced in control infants was noted in infants with the disease.

Observations on 53 parents and 18 siblings of the children with cystic fibrosis did not reveal any differences from control subjects of the same age. It was concluded that age, sex, and the presence of cystic fibrosis have a profound effect on the composition of sweat obtained after pilocarpine iontophoresis.
Techniques for Measuring Body Composition. Proceedings of a Conference Quartermaster Research and Engineering Center
Authors: FOMON SAMUEL J.
Published: December 2021

The science of nutrition seemed to be well on the way to achieving its purposes when composition of major foodstuffs had been determined, identity of various vitamins established, and preliminary estimates of dietary requirements made. Application of this knowledge in the United States largely eradicated nutritional deficiency disorders, and a lull seemed to creep over the field of nutrition as old concepts and techniques became less fruitful in further advancement of nutritional science. Perhaps increasing restlessness with old concepts has been largely responsible for resurgence of the attack on the difficult task of measuring composition of the body in the intact living being.
PERCUTANEOUS RENAL BIOPSY IN CHILDREN
Authors: Dodge W. F. , Daeschner C. W. , Brennan J. C. , Rosenberg H. S. , Travis L. B. , Hopps H. C.
Published: December 2021

The etiology of persistent glomerulonephritis is the source of much controversy. This debate has centered principally upon the role of typical acute post-streptococcal glomerulonephritis in the production of chronic glomerulonephritis. In adults, there appears to be convincing evidence that acute nephritis may frequently progress to "chronic diffuse proliferative post-streptococcal glomerulonephritis." Our experience in children suggests that a similar progression may occur; however, our data do not permit speculation as to the frequency of this occurrence.

The histopathologic glomerular changes in post-streptococcal acute glomerulonephritis follow a fairly definite pattern with passage of time from onset. Biopsy specimens obtained during the first 3 to 4 months after onset show glomerular cell proliferation, inflammatory cell exudation, and stalk edema. These changes may on occasion be focally accentuated in some glomeruli. In addition, an occasional patient's biopsy specimen may demonstrate the presence of capillary necrosis and hemorrhage in the early weeks after onset, and later fibroblastic crescents, adhesions, and fibrillar tuft scars.

In biopsy specimens obtained after 4 to 5 months, in those patients in whom there is clearing of urinary abnormalities, proliferation, exudation, and tuft edema is absent. At this time there is noted, instead, principally fibrillar axial stalk scars and, in an occasional specimen, fibrous tuft scars, fibroepithelial crescents or adhesions. These axial scars are believed to be static rather than progressive. Persistence of the proliferation at this time, however, in association with the usual changes, is probably indicative that this patient's disease will progress to "chronic diffuse post-streptococcal glomerulonephritis.'

Our experience also suggests that another etiologically separate form of chronic nephritis can be histologically distinguished from the nonspecific chronic nephritides. This is anaphybactoid nephritis, in which there appears to be a characteristic combination of two pathologic changes. These are: a variable severity of the histologic lesion from one glomerulus to the next in the same specimen, and the focal nature of the glomerular changes.
PEDIATRIC RESEARCH AND PEDIATRIC PUBLICATION
Authors: WALLACE WILLIAM M.
Published: December 2021

A part of the function of Pediatrics was epitomized by President Kennedy in his recent Health Message:

We must take steps to accelerate the flow of scientific communication. The accumulation of knowledge is of little avail if it is not brought within reach of those who can use it. Faster and more complete communication from scientist to scientist is needed, so that research efforts reinforce and complement each other: from researcher to practicing physician, so that new knowledge can save lives as swiftly as possible; and from the health profession to the public, so that people may act to protect their own health.
UNUSUAL EFFECTS OF POTASSIUM DEFICIENCY ON THE HEART OF A CHILD WITH CYSTINOSIS
Authors: Cherry James D. , Surawicz Borys
Published: December 2021

The case of a child with cystinosis in metabolic imbalance is presented in detail. This patient manifested multiple ectopic beats and serious atrioventricular and intraventricular conduction disturbances during intravenous administration of 5% glucose in 0.45% sodium chloride solution. The authors attribute these alarming manifestations to hypopotassemia. The conduction disturbances observed in this case have not been described in patients with hypopotassemia, but they have been frequently seen in experimental animals. The authors suggest that the sudden death of children with cystinosis during intravenous administration of glucose is caused by cardiac effects of potassium deficiency, possibly of the type presented in this case.
Office Visits and Emotional Health
Authors: KLEIN JULES I.
Published: December 2021

The very pertinent remarks of Dr. John H. Kennell (Pediatrics, 29:848, 1962) are basic to the future of pediatric practice. There are many "new frontiers" for the private practitioner. Emotional health must be of primary concern, both at the teaching level and in private practice. I am sure that future office visits will include an emotional discussion (E.D.) with the mother alone. She will come without the child, to discuss with the pediatrician the "normal" problems she faces in her role as a parent.
IRON NEEDS IN INFANCY
Authors: SCHULMAN IRVING
Published: December 2021

IN THIS ISSUE is an important paper by Beal et al., representing years of careful observation of healthy infants and children. The data, describing and documenting the progress of 59 children in their natural habitat, are unique in their completeness and derivation. The specific concern with iron nutrition is timely, in view of increasing commercial pressure for inclusion of additional iron in the diet of infants.

While it is apparent that the subjects of the study, a "selected group of middle class children ... under the care of private physicians . . . [and having] intelligent, trained parents" cannot be regarded as representative of the general population, it is apropos that attention be directed to these children since it is likely that in just such groups iron supplementation is prescribed most promiscuously.
A FATAL CASE OF ERYTHEMA MULTIFORME EXUDATIVUM (STEVENS-JOHNSON'S SYNDROME) FOLLOWING THERAPY WITH DILANTIN
Authors: Watts John C.
Published: December 2021

A fatal case of Stevens-Johnson syndrome that followed therapy with diphenylhydantoin sodium (Dilantin) is presented. The pathological findings at autopsy are described and briefly discussed.
FATAL LIVER NECROSIS AND DIPHENYLHYDANTOIN SENSITIVITY
Authors: Crawford Stanley E. , Jones Chester K.
Published: December 2021

The findings in a fatal case of liver necrosis in a child given diphenylhydantoin sodium are presented. Typical lymph node hyperplasia of the reticulum cells, with mitotic figures and eosinophils, were seen in this instance. These are a well-documented finding in hypersensitivity to this drug.
RENAL HISTOLOGY DURING TREATMENT WITH OXAZOLIDINE-DIONES (TRIMETHADIONE, ETHADIONE, AND PARAMETHADIONE)
Authors: Bergstrand A. , Bergstrand C. G. , Engström N. , Herrlin K. M.
Published: December 2021

Seven patients with petit mal seizures treated with trimethadione, ethadione, or paramethadione for long periods were subjected to renal biopsy at the age of 14½ 16½ years. None of the patients had clinical signs of renal disease at the time of the biopsy, but three of them had previously shown transient hematuria or proteinuria. The renal histology was studied by conventional methods and by electron microscopy, the latter method only including the glomeruli. The changes found must with the present knowledge be regarded as physiological. A short report is given of a patient with phenylketonuria and epilepsy who developed a nephrotic syndrome during treatment with tridione. No definite pathologic renal changes were demonstrated at the when the clinical symptoms had disappeared.
ADMINISTRATION OF ALBUMIN IN THE MANAGEMENT OF HYPERBILIRUBINEMIA BY EXCHANGE TRANSFUSIONS
Authors: Odell Gerard B. , Cohen Sanford N. , Gordes Ellen H.
Published: December 2021

A comparative study was done to evaluate the effect of the administration of albumin on the removal of bilirubin by exchange transfusion. The amounts of bilirubin removed by simple exchange were similar when the pre-exchange concentrations in serum were alike. The administration of one gram of albumin per kilogram of body weight 1 to 2 hours prior to the procedure resulted in the removal by exchange transfusion of an average of 41% more bilirubin per kilogram of birth weight. The amount of bilirubin removed from the infants given albumin did vary from infant to infant in spite of similar pre-albumin bilirubin concentrations in serum. This was interpreted to represent variation in the total body bilirubin content, even when serum levels are alike. The amount of bilirubin removed per kilogram of birth weight was not found to be related to the etiology of the hyperbilirubinemia, the infant's age, or to the body weight at the time of the exchange. The albumin administration was associated with an increase in bilirubin concentration in serum and a decrease in capillary hematocrit value. Adipose tissue did not seem to be a major source of the additional bilirubin removed.
"et al"
Authors: STICKLER GUNNAR B.
Published: December 2021

In Freeman and Borkowf's article on "Craniostenosis" in the July issue of Pediatrics(29:159, 1962), he authors quote Hemple "et al" frequently and correctly (their reference 1). It is unfortunate that the name of Dr. Lloyd E. Harris, a co-author of the Hemple paper, was not mentioned once in Freeman and Borkowf's paper except insofar as it was understood to be a part of "et al." As much as I have admired Dr. Hemple's effort and accomplishment, I feel obliged to point out that the revision of our thinking in regard to the surgical treatment of synostosis of the sagittal sutures was based on the clinical observations of my esteemed teacher, colleague, and friend, Lloyd E. Harris.
Hazards of Radioactive Fallout
Authors: CHUSID EMANUEL
Published: December 2021

I was disappointed with the response of the Committee on Environmental Hazards to my letter (Pediatrics, 29:850, 1962) and with the tenor of the Committee's report, in the same issue (Pediatrics, 29:845, 1962) on the hazards of radioactive fallout. These were, I am sure, meant to be reassuring, but in view of the information which is available to us, such reassurance is disturbing.

It is my opinion, contrary to the spirit of the Committee's response, that there is reason to believe that there is a definite morbidity and mortality related to fallout products of testing, and that there is genetic damage from this source.
TUBEROUS SCLEROSIS WITH A LOCALIZED ANGIOMATOUS MALFORMATION IN THE ILEUM AND EXCESSIVE ALBUMIN LOSS INTO THE LOWER INTESTINAL TRACT
Authors: Engström N. , Ljungqvist A. , Persson B. , Wetterfors J.
Published: December 2021

An infant presented with serious hypoproteinemia, intestinal edema, and polycystic kidneys. Test results on the liver, pancreas, suprarenal glands, and kidneys were normal, as were the fat and carbohydrate resorption. The hypoproteinemia was first considered to be idiopathic, but intravenous injection of I131-labelled albumin disclosed an enormous leakage of albumin in the lower part of the intestinal tract. The general condition was not influenced by steroids or human growth hormones, but large quantities of albumin supplied parenterally had a temporary effect.

The child died at 11 months, after the development of obscure neurologic symptoms. At autopsy, changes typical of the tuberous sclerosis complex were found. The extracerebral manifestations were cystic fibroangiomatous renal tumors, with polycystic changes of the "adult type" in the kidneys and a submucosal hemangioma of the distal ileum. The latter in all probability constituted the site of albumin leakage.
CONGENITAL CYSTIC ADENOMATOID MALFORMATION OF THE LUNG
Authors: Kwittken John , Reiner Leopold
Published: December 2021

Two new cases of congenital cystic adenomatoid malformation of the lung are reported. Both patients died shortly after birth, one at 36 hours and the other on the tenth postnatal day. Cystic adenomatoid malformation is a special form of cystic lung disease characterized by large and small cysts lined variably by a bronchial-type (respiratory) and by cuboidal epithelium. In spite of the bronchial-type epithelium in some of the cysts, bronchial wall elements such as cartilage and mucoserous glands were not demonstrated. There was much elastic tissue in these cysts, of a degree having no counterpart in normal lung. These observations together with the topographic interposition of the cysts with normal appearing alveolar structures suggest a developmental malformation affecting those segments of the lungs normally destined to become the terminal bronchioles, respiratory bronchioles, and alveolar ducts. In one case, groups of alveoli were lined with a tall mucogenic epithelium morphologically resembling that seen in pulmonary adenomatosis of man and jaagsiekte of sheep. The finding is considered the result of alveolar cell metaplasia.
FAMILIAL ECTODERMAL DYSPLASIA WITH SENSORI-NEURAL DEAFNESS AND OTHER ANOMALIES
Authors: Robinson Geoffrey C. , Miller James R. , Bensimon Joseph R.
Published: December 2021

This case report presents the pedigree of a family with hereditary ectodermal dysplasia of the hidrotic type in which various members showed sensori-neural hearing loss, polydactylism, and syndactylism. In addition the affected members showed an elevation of electrolyte concentrations in sweat. This appears to be a new syndrome.
SEAT BELTS IN THE PREVENTION OF AUTOMOBILE INJURIES
Authors:   COMMITTEE ON ACCIDENT PREVENTION
Published: December 2021

PHYSICIANS, by virtue of their access to and understanding of new scientific knowledge in the field of health, are usually leaders in the adoption of proven advances in prevention of disease and injury. Recent data on the use and promotion of automobile seat belts by members of the American Academy of Pediatrics are a good case in point, but illustrate also that, even among the well-informed, further information is needed.

In 1960 the Committee on Accident Prevention surveyed Academy members on the availability and use of seat belts in their own family cars through a questionnaire which accompanied the February News Letter. Approximately one-third responded. Of these, 33% had safety belts in their family cars (Table I), 6 to 10 times as many as reported from studies of the general public. However, only one-half of those with belts used them routinely. Even more surprising, only 38% of members with seat belts recommended them to the families of their patients, and this was identical to the percentage of members without seat belts who made similar recommendations!

In 1961, on the strong advice of physicians and others, American automobile manufacturers agreed to include seat belt attachments as standard equipment on most cars, and several state legislatures, including California and New York, made such attachments mandatory for the sale of all new cars. The facts that convinced the manufacturers and legislators still need full dissemination before seat belts will actually be widely used. The American Medical Association, the National Safety Council, the United States Public Health Service, and others are currently sponsoring a nationwide advertising campaign to bring these facts to the people.
BLOOD PRESSURE IN CHILDREN WITH DIABETES MELLITUS
Authors: Moss Arthur J.
Published: December 2021

Systolic arterial pressure was measured in 123 children with diabetes mellitus and in 889 normal children. Statistical analysis indicates that, when compared to normals, the pressure tends to increase significantly in diabetic children at about 13 years of age. It is postulated that this increase in pressure represents a prehypertensive state due to subclinical renal vascular disease.
THE DETECTION AND MANAGEMENT OF PEDIATRIC DIFFICULTIES CREATED BY DIVORCE
Authors: Bernstein Norman R. , Robey John S.
Published: December 2021

A large segment of the pediatric population comes from homes where the parents are divorced. These children have special emotional problems in growing up without both parents to help and guide them. Pediatricians may face many such family situations where emotional problems are disguished. Action by the physician can reveal the basic problems and help establish better conditions for the emotional development of these children. Cases typifying problems of divorced families are presented and the suggested pediatric handling is described. The role of hostility between the parents is stressed and the need for the physicians to bring this out in the open in order to control it. It is necessary for the pediatrician to state clearly the purpose and the limits of his intervention in order to bring specific help to the children and to avoid vague and ineffective counselling.
A NOTE ON HOSPITALISM
Authors: Rothman Phillip E.
Published: December 2021

IT IS GENERALLY agreed that infants and children deprived of a normal home life and placed in badly-supervised orphanages and residential nurseries may show certain changes in behavior as the result of emotional deprivation and absence of sensorial and social stimuli. With the aid of commonly used tests, it has been possible to demonstrate a statistically significant retardation in development which varies with the age, length of stay, degree of isolation of the children, the number of personnel taking care of them, and the emotional attitude of these persons. The changes that occur involve language, social adjustment neuromuscular development, and, in some instances, acquired attitudes that are said to persist into adult life. If the children are returned to a good home in the care of a capable and affectionate parent or substitute, the obvious changes usually disappear and retesting shows rapid progress in development. This disorder has been named "hospitalism" or "hospitalismus." The purpose of this communication is to suggest that similar disturbances in children observed in modern teaching hospitals may be due to causes that differ from those formerly responsible.

Following World War II, hospitalism was studied intensively, and a complete history is contained in Bowlby's report. The risks of emotional trauma in connection with hospitalization of children were emphasized by Bakwin, Spence, Wallgren, and others. Finally pressure from various groups interested in child psychology plus public enthusiasm forced the medical profession, to some extent, to include in the routine of the best pediatric centers certain measures designed to prevent emotional disturbances in the hospitalized child.
AN UNUSUAL EPIDEMIC OF METHEMOGLOBINEMIA
Authors: Johnson Robert R. , Navone Remo , Larson Ernest L.
Published: December 2021

An outbreak of secondary methemoglobinemia was directly traceable to an aromatic amino compound present in the soap used for the preparation of enema solutions. This compound, while not itself a producer of methemoglobin, did, under the conditions of use, become converted into a substance which produced methemoglobin. Users of materials containing aromatic amino compounds should be aware of the possibility of such occurrences.
THE VITAMIN B6 DEFICIENCY SYNDROME IN HUMAN INFANCY: BIOCHEMICAL AND CLINICAL OBSERVATIONS
Authors: Scriver Charles R. , Hutchison J. H.
Published: December 2021

A 14-month-old female infant with seizures, controlled by vitamin B6, was studied. Clinical and biochemical disturbances could be induced or corrected by manipulation of vitamin B6 intake. Seizures, hyperirritability, hyperacousis, and changes in growth rate comprised the important clinical manifestations. Biochemical disturbances affecting metabolism of tryptophan, cystathionine, and taurine were identified. Widespread impairment of PLP availability at apoenzyme sites is implied by the data. Elevated daily requirement for vitamin B6 were found, without excessive intestinal or renal loss of active vitamin, nor obvious vitamin antagonism. This suggested that a systemic abnormality of endogenous vitamin B6 metabolism, not restricted to brain, might account for the "deficiency" syndrome.
COR TRIATRIATUM: CLINICAL, HEMODYNAMIC AND PATHOLOGICAL STUDIES: SURGICAL CORRECTION IN EARLY LIFE
Authors: Jegier Wanda , Gibbons James E. , Wiglesworth F. W.
Published: December 2021

Experiences with three patients with cor triatriatum illustrate the urgent need for early recognition of this obstructing diaphragm in the left atrium. A 4-month old infant died with severe and progressive heart failure before cardiac studies were completed. A 3-year-old girl was under observation for one year prior to death in acute pulmonary edema. In spite of extensive studies the diagnosis was not established. A 16-month-old male had increasing dyspnea and fatigue for 3 weeks prior to referral. The hemodynamic studies revealed marked elevation of pulmonary capillary and pulmonary artery pressures. Unusual features included a continuous murmur high in the left axilla and striking enlargement of the left atrium. Excision of the obstructing membrane was accomplished at open operation with cardiopulmonary bypass, and striking clinical improvement has been maintained for 3 years.
CONGENITAL ABSENCE OF BETA-LIPOPROTEINS
Authors: Lamy M. , Frézal J. , Polonovski J. , Druez G. , Rey J.
Published: December 2021

From the two cases reported and a review of the literature, we conclude that congenital absence of beta-lipoproteins is an inborn eror of metabolism The outstanding features are a celiac syndrome with severe impairment of fat absorption, retardation of physical and mental growth, neurological ataxia, atypical retinitis pigmentosa, acanthocytosis, and finally, absence of beta-lipoproteins, depletion of alpha-lipoproteins, and a very low level of blood cholesterol, phospholipid, and total lipids. The condition manifests itself in homozygotes as a mutant autosomic gene. Heterozygotes could not be detected in either case.
Children's Radiographic Technique
Authors: SILVERMAN FREDERIC N.
Published: December 2021

The second edition of this book is of approximately the same size as the publication of 11 years ago, but it can be used more easily because of an expanded table of contents and an improved format. A section on protection from radiation has been added. Several of the techniques have been modified and some newer techniques are included. Expansion of the section on instructions to the technician, which can improve any examination, is a welcome addition.

Pediatric radiology departments usually have their own special routines and variations, but even for them the description of techniques used at the Children's Hospital of Boston will be useful.
CONGENITAL ABNORMALITIES OF THE GENITOURINARY TRACT: ABDOMINAL MUSCLE DYSPLASIA AND CHOANAL ATRESIA
Authors: Brierre Joseph T.
Published: December 2021

The case reported represents a broad spectrum of associated anomalies: obstructive uropathy, abdominal muscle dysplasia, bilateral failure of descent of testes, urachal cyst, oligohydramnios, amnion nodosum, and varus deformity of the lower extremities. The less common association of polycystic kidneys and absence of prostatic tissue was also observed. This represents the first case in which choanal atresia has been observed. The pathogenesis of the various lesions is discussed. Emphasis is placed on the early recognition of the underlying genitourinary pathology because of the possibility of prolonged useful life if amenable to correction and detected before advanced renal damage has taken place.
PORTAL HYPERTENSION—A COMPLICATION OF UMBILICAL VEIN CATHETERIZATION
Authors: Oski Frank A. , Allen Donald M. , Diamond Louis K.
Published: December 2021

The histories of four children with apparent extrahepatic portal vein obstruction and portal hypertension presumably secondary to umbilical vein catheterization are presented. Recommendations for the avoidance of this complication of exchange transfusion are made.
REPORT OF THE COMMITTEE ON NUTRITION
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

The current situation with respect to vitamin E is quite comparable to that which prevailed in 1959 when the Food and Drug Administration declared vitamin E essential for man but noted that diets in this country are amply supplied with the vitamin. On the basis of currently available evidence, the Committee concludes that premature and full-term infants receiving human milk on formulas of cow milk do not require supplementary administration of vitamin E except, possibly, when dietary intake of fat is markedly reduced, as is sometimes practiced in feeding premature infants.

It seems desirable to provide dietary supplements of vitamin E to patients with prolonged steatorrhea from any cause. Relatively large doses may be required to maintain normal plasma concentrations.
Cleft Palate and Speech
Authors: MACCOLLUM DONALD W.
Published: December 2021

This book has been a source book of speech training for children with cleft palates ever since it was first published in 1945. Since then it has gone through five editions. In those 17 years there have been many modifications in the treatment of cleft palates. The surgery, in general, has improved tremendously, aiming always for physiological closure of the enlarged nasopharynx during speech. Antibiotics and greatly superior anesthesia have cut down the mortality appreciably. Miss Morley has attempted to bring all this data up to date in this fifth edition.
Abnormal Urinary Findings Following Administration of Achromycin V
Authors: EHRLICH LEONARD I. , STEIN HOWARD S.
Published: December 2021

An unusual reaction to Achromycin V (tetracycline hydrochloride buffered with citric acid; Lederle) has occurred that we feel should be brought to the attention of the medical profession. It concerns abnormal urinary findings associated with the classic symptoms of diabetes. A brief history of our case follows.

The patient was a 13-year-old boy who had been well until the present illness, except for asthma which has been fairly well controlled with hyposensitization. Two days prior to the present illness he developed a respiratory infection for which he was given Achromycin V.
Letters to the Editor
Authors: METCOFF JACK
Published: December 2021

Dr. Chamberlain is an experienced pediatric surgeon with an extensive practical knowledge of surgical treatment in children. In his commentary on my Commentary on Burn Therapy (Pediatrics, 29:861, 1962) he takes issue with a previous paper by my colleagues and myself (New Engl. J. Med., 265:101, 1961). In that paper each of the arguments was based upon data gained from direct observation and measurement, with the exception of the accumulation of edema fluid in the burned area.

While Dr. Chamberlain apparently does not like the words "some theoretical estimates" to assess the quantity of edema fluid, even the "theoretical estimate" was based upon the measured skin water content in normal children, as well as that in experimental animals, with the calculated differences based upon the relative accumulation of fluid in the skin and subcutaneous area during frank edema (Pediatrics, 20:105, 1957) as well as the specific accumulation of fluid in tissues burned to varying degrees and by flame and scald techniques in experimental animals (Fox & Lasker: Surg. Gynec. Abst., 112:274, 1961; Fox & Baer, Amer. J. Physiol., 151:1947).
GINGIVAL MICROCYSTS IN INFANCY
Authors: Nichamin Samuel J. , Kaufman Myron
Published: December 2021

A congenital, developmental abnormality of the gingiva, in the form of clinically visible, multiple microcysts, appearing in an infant of 3 months of age, is described. Their duration and eventual disappearance beyond a period of 12 months was noted. Familiarity with this condition is helpful in formulating a favorable prognostic evaluation.
FUNCTIONAL CLOSURE OF BLADDER EXSTROPHY
Authors: Landau Stanley J. , Lattimer John K.
Published: December 2021

IN 1955, a program of functional closure for bladder exstrophy was initiated on the Pediatric Urological Service of Babies Hospital in New York. The experience with functional closure on this Service has now grown to more than 50 cases, and the length of follow-up has exceeded 3 years in enough cases to warrant an interim evaluation of the operative procedure and results. This review is part of a continuing study of functional closure of the exstrophied bladder. Earlier results have been reported previously. Close follow-up has been maintained on these patients in an effort to answer many questions. For example, is functional closure of the exstrophied bladder compatible with preservation of normal renal function and architecture? Is the achievement of urinary continence possible with this operation? Can a satisfactory cosmetic result be expected? The information collected in the quest of the answers to these questions forms the basis for this report.

MATERIALS AND METHODS

Fifty patients with exstrophy of the bladder treated by functional closure were studied (see Appendix). Thirty-four were males, and 16 were females. All of the cases, with one exception, were patients with complete bladder exstrophy. The one patient with incomplete exstrophy presented with epispadias and exstrophy of the lower portion of the bladder. Forty-two patients were "virgin" cases operated upon by various resident and attending urologists of the Staff. Eight patients were operated upon elsewhere and have been subsequently followed and/or operated upon further at our clinic, or were referred to us for a second attempt at closure.
THE TRIAD OF THROMBOCYTOPENIA, ECZEMA, AND RECURRENT INFECTIONS (WISKOTT-ALDRICH SYNDROME) ASSOCIATED WITH MILK ANTIBODIES, GIANT-CELL PNEUMONIA, AND CYTOMEGALIC INCLUSION DISEASE
Authors: Root Allen W. , Speicher Carl E.
Published: December 2021

A 3-year-old boy with the Wiskott-Aldrich syndrome has been described. In the course of study the child was found to have circulating antibodies to whole cow's milk; a peculiar cellular infiltrate in lymph nodes, spleen, and bone marrow; measles, giant-cell pneumonia, and cytomegalic inclusion disease. The patient improved on a milk-free diet, but no clear exacerbation of symptoms could be induced by milk ingestion. The combination of these clinical and pathological findings has not been reported previously in this syndrome.
THE PREHENSILE GRASP OF SPASTIC DIPLEGIA
Authors: Jensen Gordon D. , Alderman Margaret E.
Published: December 2021

The prehensile grasp of 24 normal and 45 cerebral palsied young children was studied by the use of cinema-analysis technique. A group of 18 diplegics of the cerebral palsy group were analyzed and yielded a description of the most prevalent abnormalities of function. Some physiological and developmental relationships are discussed. A case is presented which illustrates the clinical implications of recognition of the subtle manifestions of neurological abnormalities.
STUDIES OF CARBOHYDRATE METABOLISM IN THE NEWBORN INFANT
Authors: Baens G. S. , Lundeen Evelyn , Cornblath Marvin
Published: December 2021

Immediate processing of blood and the proper analytical procedures are necessary to obtain reproducible values for glucose in blood in premature infants. Expected levels of glucose in blood in premature infants the first 2 months of life may vary between 20 and 100 mg/100 ml after a 3 to 4½ hour fast on a normal diet. Replicate values of glucose below 20 mg/100 ml may be associated with symptoms of hypoglycemia. The level of glucose in blood the first week of life is influenced by the birth weight, race, and sex of the premature infant. Illness and gestational age could not be correlated with statistically significant differences in levels of glucose.
WORD-BLINDNESS—A SURVEY OF THE LITERATURE AND A REPORT OF TWENTY-EIGHT CASES
Authors: Heller Theodore M.
Published: December 2021

The literature on word-blindness has been reviewed from the time of Kussmaul, who invented the term in 1877, to the present. Twenty-eight selected cases of word-blindness are presented. A method of diagnosis and treatment are described, and a theoretical explanation for this special type of reading disability is proposed.
MAINTENANCE OF BODY TEMPERATURE OF PREMATURE INFANTS
Authors: DAY RICHARD L.
Published: December 2021

THE FINDING by William Silverman that prematurely born infants survive more often when kept warm would not have surprised older clinicians. Textbooks have often listed maintenance of a normal body temperature as the first of several logical measures, and various garments and heated beds were devised to insure a normal body temperature. Even as early as before World War II, however, some neonatologists condoned a more permissive attitude. They thought, erroneously, that a steady though subnormal temperature might be preferable to oscillations above and below normal induced by careless manual adjustment of the incubator thermostat. The crudity of early incubators made such permissiveness attractive to those in charge of units for premature infants where skilled nurses were scarce.
The Influence of Prednisone on the Mantoux Reaction in Children
Authors: SCHICK BELA , DOLGIN JOSEPH
Published: December 2021

The literature contains several references regarding the effects of steroid hormones on the tuberculin reaction. In most cases, the investigations were carried out on adults or animals. Only isolated references to work on children have been reported. Harris and Harris reported a suppression of the tuberculin reaction in rabbits and guinea pigs who were first given cortisone. These authors concluded : "The data presented here indicate that cortisone can suppress the manifestations of some of the reactions of hypersensitivity."

Cummings and Hudgins showed that the administration of cortisone to a group of guinea pigs sensitized to tuberculin with a heat-killed human strain of tubercle bacilli did not influence the passive transfer of tuberculin sensitivity.
INTESTINAL SUCRASE AND ISOMALTASE DEFICIENCY IN TWO SIBLINGS
Authors: Anderson Charlotte M. , Messer M. , Townley R. R. W. , Freeman Mavis
Published: December 2021

The absence of sucrase and isomaltase activity from the duodenal mucosa of two siblings has been demonstrated in biopsy specimens obtained via the oral route. Some of the problems of diagnosis of intestinal saccharidase deficiencies by indirect methods are described and the advantages of direct demonstration of enzyme deficiency pointed out. The possibility that intestinal saccharidase deficiency plays a role in some of the ill-defined cases of subacute or chronic diarrhea of infancy, such as those diagnosed as starch intolerance or cows' milk allergy, has been discussed. Some of the genetic implications of this condition have been discussed in the light of our observations and those of other authors.
CHYLOUS EFFUSIONS INTO THE INTESTINE IN A PATIENT WITH PROTEIN-LOSING GASTROENTEROPATHY
Authors: Stoelinga G. B. A. , Van Munster P. J. J. , Slooff J. P.
Published: December 2021

A girl had been affected with steatorrhea, lymphopenia, and hypoproteinemic edema from her fifth year of life; this edema was mainly localized in the legs. The hypoproteinemia was found to be due to abnormal loss of serum proteins into the intestine. A chylous fluid was occasionally obtained on duodenal intubation. Albumin levels were found to range from 20 to 500 mg/100 ml in this fluid; a considerable loss of protein into the intestine therefore might undoubtedly have resulted. Serum albumin was shown to pass fairly rapidly into the intestinal lumen. Fatty acid analysis of the chyle obtained, showed only the presence of high molecular saturated and unsaturated fatty acids. No low-molecular saturated fatty acids were found.

It is suggested in the literature that the obstruction of chyliferous vessels may give rise to this clinical picture. In view of the localization of the edema and the family history, the present authors believe that there is a relationship between localized familial lymphedema (Milroy's disease) and protein-losing gastroenteropathy. The two conditions may be due to changes in the lymphatics, the localization of the changes determining which symptoms will appear. Treatment consisted in ordering a fat-free diet; this had a limited effect.
The Treatment of Iron-deficiency Anemia—Palatable but Ineffective Iron Medication
Authors: DIAMOND LOUIS K , NAIMAN J. LAWRENCE , ALLEN DONALD M. , OSKI, FRANK A.
Published: December 2021

Experience with a new oral iron-carbohydrate complex (Jefron) in the treatment of iron-deficiency anemia shows that the therapeutic results are inferior to those obtainable with ferrous sulfate. Many children showed no response after months of treatment with this drug and when subsequently placed on ferrous sulfate therapy showed a rapid rise in hemoglobin to normal levels. Preliminary studies suggest that poor gastrointestinal absorption may be a factor in the inadequate therapeutic effects.
Hyperbilirubinemia Due to Glucose-6-phosphate Dehydrogenase Deficiency in a Newborn Chinese Infant
Authors: JIM ROBERT T. S. , CHU FRANCIS K.
Published: December 2021

A case of hyperbilirubinemia in a newborn Chinese infant, due to G-6-PD deficiency, is presented. Family study revealed two severely affected maternal uncles. The mother, maternal grandmother, two maternal aunts, and four female cousins appeared to be heterozygous female carriers. In a small survey of 53 healthy Chinese adults, moderate to severe G-6-PD deficiency was found in three males, or an incidence of approximately 5.6%.
Arteriomesenteric Duodenal Obstruction in the Newborn Infant
Authors: TAYLOR MAX T. , HOLLANDER RICHARD J.
Published: December 2021

An unusual cause of duodenal obstruction in the newborn infant has been presented. Two cases have been cited from the literature. Diagnoses must be based on symptoms of vomiting with a failure to gain weight, supported by x-ray findings of a dilated duodenum. Lymphadenopathy in the small bowel mesentery, following diarrhea, may have been the inciting cause. Treatment consists of a side-to-side duodenojejunostomy.