bluuebunny/crossref_metadata_2025 huggingface dataset:
PROGNOSTIC SIGNIFICANCE OF ELECTROMYOGRAPHY IN CONGENITAL TORTICOLLIS
Authors: Baxter Chadwick F. , Johnson Ernest W. , Lloyd James R. , Clatworthy H. William
Published: December 2021

The selection of the patients with congenital muscular torticolis for early surgical treatment is of paramount importance because in severe cases the deformity is progressive, and surgical treatment produces the best results when the diseased and restraining muscle is removed in early infancy. Electromyography appears to be of some value as an adjunct to clinical evaluation in determining which patient should have such early surgical treatment.

The electromyogram permits the physician to obtain an objective estimate of the amount of destruction present in any given muscle. If few muscle fibers are working, he may conclude that the muscle has been replaced by fibrous tissue and that structural deformities are likely to progress due to the disproportionate growth of the diseased area in comparison to the surrounding normal boney and soft tissues. Conversely, if there are many normal muscles fibers functioning within the mass he may predict a more favorable outcome in terms of muscle length and function and consequently less deformity in the future.

Our observations to date indicate that if there is a severe reduction in electrical activity of the involved sternoleidomastoid muscle, as indicated by the electromyogram, the histologic studies will show evidence of extensive destruction of normal muscle and replacement with scan tissue. In such a patient early surgical excision is probably justified. Conversely, if there is minimal or moderate reduction in electrical activity, conservative management with physical therapy and repeated observations is the treatment of choice.
The Management of Pediatric Practice: A Philosophy and Guide
Authors: WEBB CLARENCE H.
Published: December 2021

This is a valuable book for the pediatric resident who plans to enter into private practice, for the young pediatrician who seeks help with the practical problems he has experienced, and for the general practitioner whose practice includes more than an occasional infant or child. The pediatrician who has been in practice for 10 years or more has, in one or another way, resolved most of the problems dealt with; hence he will find this volume largely of interest in comparing the solutions that he himself has achieved with those advocated by the authors.
HYPOGLYCEMIA IN NEONATAL PERIOD
Authors: SCHWARTZ ROBERT
Published: December 2021

RECOGNITION of the relative instability of the concentration of glucose in the infant's blood during the initial hours after delivery has stimulated study and consideration of the factors that influence the concentration of glucose during the neonatal period. The increased use by pediatric chemistry laboratories of the Somogyi-Nelson sugar method, which measures true glucose concentration and which gives a lower range of values compared to the older Folin-Wu technique, has intensified the interest in the problem of hypoglycemia of the newborn infant. The glucose concentration in blood depends upon the balance between entry (from placental, alimentary or hepatic sources) and removal (by peripheral utilization). The principal factors concern placental transfer of maternal glucose prior to separation of the cord, hepatic glycogen reserve, hepatic responsiveness and peripheral uptake.
VITAMIN D AND CALCIUM AND PHOSPHATE TRANSPORT
Authors: Harrison Harold E.
Published: December 2021

I am indeed grateful for the honor of the Borden Award of the American Academy of Pediatrics. At this time it is fitting that I express my indebtedness to three great teachers in pediatrics whose influence has been of the utmost importance to me: Grover Powers, Daniel Darrow and Edwards Park. I should also remind you that this award is really a recognition of the joint work of my wife, Dr. Helen C. Harrison, and myself. We have both participated in all aspects of experiment and theory which will be summarized in this paper.

It is a great privilege to be asked to present to the American Academy of Pediatrics observations that we have made on a problem that historically has had tremendous significance to pediatricians. A review of the history of rickets and of the discovery of vitamin D is exciting in part because of the brilliant success achieved in the solution of all important problem, but also because of the number of American leaders in pediatrics who participated in this triumph over a disease that had afflicted children in Europe and the United States for generations.

THE FIRST experimental evidence of the existence of a fat-soluble organic substance with antirachitic properties was submitted by the British nutritionist Mellanby in 1918.
FAILURE OF THE HEART AFTER UNDUE ASPHYXIA AT BIRTH
Authors: Burnard E. D. , James L. S.
Published: December 2021

Thirty-three mature infants became ill in the neonatal period after suffering undue asphyxiation at birth. Dyspnea was a prominent symptom. Nineteen died and 14 recovered.

The transverse diameter of the cardiac silhouette in most cases was greater than the average in healthy infants. The progressively increasing size of the heart between 1) healthy infants, 2) those who appeared healthy, but had suffered undue asphyxiation at birth, and 3) those in whom signs of illness developed after asphyxia, indicated that the illness and cardiac enlargement were related. Dilatation rather than hypertrophy was the likely cause of the greater roentgenographic size. This was most obvious on the right. There was also evidence suggestive of left ventricular dilatation. The size of the heart diminished as the infants recovered. In three infants who died serial films showed that enlargement remained or increased, and hypertrophy of both ventricles was present at necropsy in the one who survived the longest time. Roentgenographic changes in the lungs did not correlate well with either the signs of illness or with the presence of cardiac enlargement. The possibility existed that vascular congestion and transudation could be responsible for abnormal appearances in the lungs, when these were present.

Biochemical changes resulting from severe asphyxia were observed soon after birth in four cases, and their presence in the others at this time was inferred from the depressed state of the infant as judged by the Apgar score. The quick recovery of the deranged acid base status which occurs after normal birth was not seen in most of the patients. Exceptions were those in whom the illness was brief. The abnormal biochemical status was characterized by arterial hypoxia and metabolic acidosis. The partial pressure of arterial carbon dioxide was distributed over a wide range. These findings are compatible with the presence of left ventricular failure.

The left atrial pressure was high in comparison with that of healthy newborn infants. Venous pressure was also increased on the right. Consideration of the results of the three different kinds of investigation led to the suggestion that left ventricular failure occurred early in the illness. Disproportion between different signs in individual cases might have been related to attempted compensation by the heart and to the rate at which failure of the right heart might follow, as well as to the severity of the illness and the rate of recovery. While atelectasis and infection may have been present, there was evidence that heart failure could be the explanation of dyspnea in life and pulmonary vascular congestion at necropsy. The cause of failure is not known. It is related to the metabolic disorder from undue birth asphyxia. A disturbance in hemodynamics that requires more investigation is present.
ULCERATIVE COLITIS IN CHILDHOOD
Authors: Hijmans Jacqueline C. , Enzer Norbert B.
Published: December 2021

Forty-three cases of ulcerative colitis in children, seen at Duke Hospital during a 28-year period, have been analyzed with regard to the nature, course and outcome of this disease in the pediatric age group. Emphasis has been placed on the correlation of the clinical and laboratory features with the course and prognosis of the disease. Cases have been cited to demonstrate that the disease is serious, the diagnosis difficult, the course variable, and the prognosis unpredictable. A diagnosis of ulcerative colitis in childhood necessitates careful and continuous observation throughout the pediatric age and into adult life. Because of the chronicity, the complexity, and the seriousness of the disease, therapy demands the close co-operation of the pediatrician, the psychiatrist, and the surgeon.
METHODS FOR DETERMINING COMPOSITION OF THE HUMAN BODY
Authors: Forbes Gilbert B.
Published: December 2021

The early nineteenth century witnessed the first concerted application of chemical techniques to the investigation of biologic materials. Milk was chemically analyzed, von Liebig discovered the chemical contrast between potassium-rich cells and sodium-rich tissue fluids, and Carl Schmidt analyzed blood serum in great detail. Soon these methods were applied to the study of the entire human body.

The advent of isotopic dilution techniques in the 1930's and 1940's brought about a renewed interest in body composition. More recently these and other techniques have been used in an attempt to study the nutritional aspects of body composition. It is the purpose of this report to present the various methods now in use and to discuss the virtues and limitations of each.

DIRECT CHEMICAL ANALYSIS

Whole Body

During the past century a number of human carcasses have been analyzed for water, fat, nitrogen, sodium, potassium, chloride, calcium, magnesium, and phosphorus. These include the fetus, newborn, and adult. The few analyses done on children have included subjects suffering from conditions known to profoundly affect water and electrolyte metabolism.

Data for total body content in the new-born and adult are presented in Table I, both on a fresh-weight and a fat-free fresh-weight basis. The latter basis for expressing values avoids discrepancies that arise because of alterations in fat content. It is evident that significant changes in body composition occur during growth. Water, sodium, and chloride contents decline, while contents of nitrogen, calcium, potassium, magnesium and phosphorus all increase. In these data, body fat content is not strikingly different in the two age groups.
Hazards of Foods
Authors: Garrison Roy F.
Published: December 2021

I would like to inform my fellow pediatricians of a very dangerous situation which sometimes occurs in feeding glass jar baby food. Apparently the lids are unscrewed at times because ambitious shoppers like to smell what the infant is going to eat, and it has been reported to me that some even take a finger swipe to taste the ingredients. This results in a syndrome I have personally encountered three times, once with my own daughter.
Lest We Be "Status Quo" Seekers
Authors: Ambuel J. Philip
Published: December 2021

The article by Green and Segar1 which proposes a new design for patient care suggests some sweeping changes in our traditional methods of providing pediatric education and medical services. It should be evaluated as a serious proposal designed to bring simultaneous improvement to both fields.

While the commentary by McKay makes some pertinent recommendations regarding the improvement of inpatient medical care (in the Children's Hospital of Columbus the monthly statistics for 1961 show that the average length of stay varied from 6 days to 7.3 days), his suggestion that Green's proposal "circumvents rather than meets the problem" suggests to me that he has missed its main purpose.
Varicella and Steroid Therapy
Authors: Aceto Thomas , Blizzard Robert M. , Migeon Claude J.
Published: December 2021

In a recent paper, "Mortality From Varicella in Children Receiving Adrenocorticosteroids and Adrenocorticotropin," Dr. K. C. Finkel1 stated, "In the author's opinion the administration of adrenocorticosteroids need be stopped (during varicella) only in patients with leukemia or diseases involving the reticuloendothelial system. In patients with other diseases which seem to carry less risk, the dosage can be reduced to a suitable maintenance level, i.e., 25 to 50 mg of cortisone daily." Dr. R. C. Eley wrote a Letter to The Editor2 in which he commented that he disagreed with Dr. Finkel.
THE ORAL-FACIAL-DIGITAL SYNDROME: A MULTIPLE CONGENITAL CONDITION OF FEMALES WITH ASSOCIATED CHROMOSOMAL ABNORMALITIES
Authors: Ruess Aubrey L. , Pruzansky Samuel , Lis Edward F. , Patau Klaus
Published: December 2021

The oral-facial-digital (OFD) syndrome is a congenital condition found only in females and with variable anomalies of the oral, facial, and digital tissues. Defects of the oral region are fairly constant, while involvement of the face and digits may, or may not, be found. Radiographic and cephalometric analyses reveal syndrome-specific characteristics of the skull and digital bones. Alopecia, coarse skin, and minimal hypotelorism may be present. Central nervous system disorders with mental retardation were found in some of our cases. On the basis of this study, and previous reports, it can be tentatively concluded that between one-third and one-half of the patients are mentally retarded. Two OFD patients, a mother and her daughter, have an insertion in one No. 1 chromosome. It appears likely that the syndrome generally is caused by partial trisomy for a specific chromosome segment. The inserted extra piece will usually be undetectable in the microscope. A familial pattern is demonstrable in some of the cases with this condition. The OFD syndrome seems to be lethal for males. The nature of the anomaly points to the need for long-term multidisciplinary treatment and planning in the majority of cases.
THE PEDIATRICIAN AND THE PUBLIC
Authors: HARPER PAUL
Published: December 2021

THE editors of the column thought it would be interesting to learn the ideas and possible plans in the minds of teachers of pediatrics, if increased funds became available to the medical schools from either the A.M.A. or the federal government, for the improvement and perhaps extension of medical education.

Dr. James L. Wilson, Dr. Harry H. Gordon, and Dr. Sidney S. Chipman and Dr. Myron E. Wegman, the latter two writing as joint authors, have been kind enough to comply with our request. The readers of the column will find Dr. Wilson's letter of particular interest, both because it contains a sharp arraignment of the teaching of medical schools in the habit of today, and gives corresponding constructive suggestions for change.
AUREOMYCIN IN STAPHYLOCOCCIC MENINGITIS COMPLICATING SUBARACHNOID HEMORRHAGE IN SICKLE CELL ANEMIA
Authors: ALMKLOV JOHN R. , HANSEN ARILD E.
Published: December 2021

The rare occurrence of a spontaneous subarachnoid hemorrhage in an 11 year old Negro boy with sickle cell anemia is recorded. Of the eight reported cases five have occurred in children. In the study of sickle cell anemia it is evident there is an increasing awareness of this as well as other neurologic complications.

This patient developed staphylococcus albus meningitis which for 12 days resisted combined penicillin, streptomycin and sulfadiazine therapy. The response to aureomycin as a sole therapeutic agent was dramatic, and this represents the first reported case of meningitis treated with this drug.

The use of aureomycin as the only antibiotic in this staphylococcic infection seems to have been fortunate in view of the laboratory findings. In vitro studies disclosed that when penicillin and aureomycin or streptomycin and aureomycin were combined, the result was a decrease in the effectiveness of either drug on staphylococci.
UNCLASSIFIED MYCOBACTERIA AS A CAUSATIVE AGENT IN THE POSITIVE TUBERCULIN REACTION
Authors: Kendig Edwin L.
Published: December 2021

One hundred four children with a positive tuberculin reaction measuring at least 5 mm in diameter of induration were retested with Old Tuberculin solution and the skin test antigens of the photochromogens, scotochromogens, and the nonchromogenic group. In only seven instances could it be justifiably concluded that no tuberculous infection existed. Further testing with PPD-S and PPD-B apparently ruled out tuberculous infection in 17 other patients. It appears that tuberculosis is the major cause of a positive tuberculin reaction in the Richmond area, but infection with one of the mycobacteria (photochromogens, scotochromogens, and nonchromogens) may also be a cause of a positive tuberculin reaction measuring less than 10 mm in diameter of induration.
Calcium, Strontium, and Fallout
Authors: ESTY GEOFFREY W.
Published: December 2021

Dr. Chusid's concern (Pediatrics, 29:850) over radioactive fallout, and particularly strontium-90 levels, in milk from nuclear bomb testing, is unfortunately shared by many persons, mainly from newspaper accounts. There is an erroneous impression that milk contains more fallout than other foods. This misapprehension is due to the fact that milk is used for surveying strontium-90 levels because samples are easily obtained at all seasons, and because milk is rich in calcium.

The strontium-90 from fallout accompanies calcium as the calcium is absorbed from soil by plants, and as the calcium in plant foodstuffs is eaten and absorbed in turn by animals.
URINARY EXCRETION OF TRYPTOPHAN METABOLITES IN THE HEALTHY INFANT
Authors: Vassella Franco , Hellström Bo , Wengle Bo
Published: December 2021

Urinary excretion of tryptophan metabolites was studied qualitatively by two-dimensional paper chromatography in a group of 50 healthy infants with no tryptophan supplementation. Twenty-two infants of this group were given 100 mg of L-tryptophan per kilogram of body-weight, and the 24-hour urinary excretions of kynurenine, kynurenic acid, 3-hydroxykynurenine, 3-hydroxyanthranilic acid, and xanthurenic acid were estimated by quantitative paper chromatography. A high excretion of kynurenine was found to be a distinguishing feature. Various possibilities to explain this difference as compared to adults are discussed.
MUSCULAR SUBAORTIC STENOSIS IN CHILDHOOD
Authors: Wood Roy S. , Taylor W. Jape , Wheat Myron W. , Schiebler Gerold L.
Published: December 2021

The clinical findings in three siblings with muscular subaortic stenosis are presented, showing the progression of this disease entity within the pediatric age group. In two of the children the diagnosis was supported by hemodynamic findings, supplemented by surgical and autopsy observations in one of these cases. In the youngest member of the family group the diagnosis is based on the clinical examination, thoracic roentgenograms, and electro-vector-cardiographic evidence of left ventricular hypertrophy. It is probable that the father and paternal grandfather died of the same disease.

Approximately one-half of the reported cases of this lesion have been familial, supporting the concept that this disease is transmitted by a dominant Mendelian gene. Slowly progressive fatiguability with exertion, palpitations, angina, and syncope are the most frequent symptoms. Congestive heart failure is rare, but sudden unexpected death is common. A harsh systolic ejection murmur at the left sternal border and apex is a constant physical finding; this is often accompanied by paradoxical splitting of the two components of the second heart sound. Chest roentgenograms demonstrate progressive left ventricular hypertrophy and a normal-sized aorta. The electrocardiogram and vectorcardiogram usually show left ventricular hypertrophy, often accompanied by negative T-waves in the left precordial leads.

Characteristic hemodynamic findings are a distinctive pulse contour, the narrowing of the peripheral arterial pulse pressure following a premature ventricular contraction, and a pressure gradient between the body and outflow tract of the left ventricle. Left ventricular angiocardiography shows a narrowing of the muscular obstruction during systole and a widening during diastole. Excision of this muscular obstructive lesion has been reported to produce marked symptomatic relief in some patients.
PRESIDENTIAL ADDRESS
Authors: Fischer Carl C.
Published: December 2021

INASMUCH as our by-laws specifically state that "a meeting of the Academy shall be held each year, to be known as the Annual Meeting, at which time the conferring of Fellowships shall take place and a presidential address shall be delivered," neither you nor I have any choice in the matter! Nothing is specified, however, regarding either the length or the content of such an address so that this would appear to be left to the discretion of each President—leaving the membership to hope that he will use this discretion wisely.

I have just finished re-reading each of the Presidential Addresses given by my 31 predecessors—and I heartily recommend that you do likewise if you are interested in receiving a most stimulating review not only of the history of our Academy, but of American pediatrics since 1930.

I found that these addresses varied greatly as to length, style, and content—reflecting the individual viewpoints and natures of their authors. Some were highly optimistic, a few distinctly pessimistic, about our specialty. Nearly all reviewed the major accomplishments of their year in office in varying detail, and many referred to the influence of the times in which they wrote upon pediatrics in general and the Academy in particular. Many reiterated the importance of the objectives of the Academy as defined with prophetic vision by our Founding Fathers, and despite the variations in viewpoint and in time, all stressed, as I too would like to, the broad emphasis upon "the welfare of children" contained in the opening sentence of Section I of Article II— "The object of the Academy shall be to foster and stimulate interest in pediatrics and correlate all aspects of the work for the welfare of children which properly come within the scope of pediatrics."
Congenital Cardiac Disease: A Review of 357 Cases Studied Pathologically
Authors: GRAHAM BRUCE D.
Published: December 2021

This book is a result of a combination of necropsy study of 357 cases of congenital cardiac disease undertaken at the Mayo Clinic between 1920 and 1954 and an extensive review of the literature on this subject. Inasmuch as this study is selective in nature, the authors specifically point out that the exact incidence in the general population, the sex distribution, causes of death, and frequency of occurrence of various complications cannot be determined without qualification.
ROLE OF LINOLEIC ACID IN INFANT NUTRITION
Authors: Hansen Arild E. , Wiese Hilda F. , Boelsche Arr Nell , Haggard Mary Ellen , Adam Doris J. D. , Davis Helen
Published: December 2021

Four hundred and twenty-eight infants over a 4-year period were studied for approximately 4,000 patient-months of observation while receiving five different milk mixtures varying in linoleic acid content from less than 0.1 to 7.3% of the calories. It was found that linoleic acid is a required nutrient for the young human infant. The following pertinent observations were made. (1) Evidences of linoleic acid deficiency developed in young infants who received either a diet practically devoid of fat or one providing 42% of the calories as fat but extremely low in linoleic acid (less than 0.1% of the calories). (2) Manifestations of the deficiency state disappeared promptly when linoleic acid was given as the ester or triglyceride or in a milk mixture providing 1% or more of the calories as linoleic acid. (3) The most characteristic feature of the deficiency state was dryness of the skin with desquamation, thickening and later intertrigo. (4) The incidence of bacterial skin infections was the same in the different groups. It was noted that young infants receiving diets very low in linoleic acid seemed to react severely when outbreaks of staphylococcal infection developed in the hospital environment. (5) Records for rate of growth showed unsatisfactory progress for many of the infants on low linoleic acid intakes, whereas the course of events was satisfactory in almost all of the infants who received 1.3 to 7.3% of the calories as linoleic acid. (6) Blood serum levels for dienoic acid of 5.6 ± 1.8% of the total fatty acids were indicative of the deficiency state, whereas values of 12.9 ± 2.6% of the total fatty acids represented the minimal normal. (7) Histologic alterations in the skin of infants on diets low in linoleic acid showed the same characteristics as seen in experimental animals. (8) Infants given milk mixtures extremely low in linoleic acid had a gradual amelioration of fat deficiency manifestations as well as increasing levels of dienoic acid in the blood serum following the introduction of cereals to their diet.
THE ETIOLOGY OF RESPIRATORY ILLNESSES OCCURRING IN INFANCY AND CHILDHOOD
Authors: Wenner Herbert A. , Christodoulopoulou Georgia , Weston Jean , Tucker Virginia , Liu Chien
Published: December 2021

Twenty-six agents were recovered from pharyngeal samples obtained from 194 infants and children ill of respiratory infections. Fourteen were parainfluenza, five were adenoviruses, and two were influenza A2 viruses; five agents were unidentified. Seroconversion against homologous virus occurred in 6 of 12 patients.

In four of six patients ill of croup, the infection was associated with parainfluenza, type 1, virus. Respiratory syncytial virus was not associated with bronchiolitis, and was associated with pneumonia only in about 10% of patients. Essentially similar seroconversion rates were obtained for other respiratory syndromes and for the small group of patients with nonrespiratory illnesses. Although seroconversion was obtained for influenza C virus, particularly in patients with bronchiolitis and pneumonia, the large fraction of individuals seropositive during early infancy, and the high frequency of seropositives in subsequent age groups suggests that the virus may have a pathogenic potential not yet fully appreciated. Influenza A2 and B viruses were active during the period of study, apparently recruiting those still at risk.

The results of this study failed to associate any one of the 10 respiratory viruses with a major proportion of the separate clinical syndromes. Probably too much has been expected in the delineation of selective anatomical sites of injury by some of these viruses! Information is needed also on the combined effects of pathogenic bacteria and viruses in the pathogenesis of respiratory diseases.
SEX-LINKED HYDROCEPHALUS
Authors: Needleman Herbert L. , Root Allen W.
Published: December 2021

Two families, each containing more than one hydrocephalic male member, have been reported. Chromosomal analysis has been normal in one member of each family. Reports of 11 families have been found in the literature with multiple male hydrocephalic members and without affected female members. From an analysis of these families it seems likely that there is a sex-linked factor in the heredity of one form of hydrocephalus.
STAPHYLOCOCCAL ANTAGONISM TO PENICILLIN-G THERAPY OF HEMOLYTIC STREPTOCOCCAL PHARYNGEAL INFECTION
Authors: Simon Harold J. , Sakai William
Published: December 2021

Twelve pharyngeal specimens containing both group A hemolytic streptococci and coagulase-positive staphylococci were tested individually and together against penicillin-G and oxacillin. The hemolytic streptococci were always completely inhibited at very low concentrations of penicillin-G when tested individually. When combined with cultures of coagulase positive. penicillin-G destroying staphylococci, the inhibitory concentrations rose by a factor of 200. Similar tests with oxacillin showed no increase for inhibitory or bactericidal concentrations when the organisms were tested singly or in combination. Penicillin-G resistent staphylococci seemed to protect group A hemolytic streptococci from the action of penicillin-G. This was not the case when oxacillin was exhibited.
Payment for Pediatric Care
Authors: HAMMOND KEITH
Published: December 2021

I, and I am sure there were many others, was so happy to see Doctor Brad Cohn's letter published in Pediatrics (December, 1962, p. 1012). So much space has been given to promotion of the idea that physicians should charge other colleagues and their families for medical services that I am afraid there are those who feel that doctors in general hold this attitude. On the other hand, those who render courtesy services to medical families apparently seldom take pen in hand, for I am sure that the practice is a customary one rather than the exception. To do otherwise would be unthinkable to me, and I am sure that most physicians are of the same opinion.
A SEQUENTIAL TRIAL OF THE NONTHERMAL EFFECT OF ATMOSPHERIC HUMIDITY ON SURVIVAL OF NEWBORN INFANTS OF LOW BIRTH WEIGHT
Authors: Silverman William A. , Agate Frederic J. , Fertig John W.
Published: December 2021

A sequential trial was conducted to study the nonthermal effect of two conditions of humidity on survival of premature infants in the first 5 days of life. No important effect on survival was observed among infants whose body temperatures in moderate and high humidities were kept the same.
Teaching about Mental Subnormality
Authors: DENNISTON JOSEPH C.
Published: December 2021

The excellent presentation by Dr. Hilda Knoblock (Pediatrics, 31:146, 1963) concerning the need of pediatric training in mental retardation is to be commended. As a pediatrician and superintendent for a state institution for 1,400 mentally retarded, I am keenly aware of the needs of more adequate preparation for all physicians in this area. Our medical profession has received considerable criticism by parent groups for an alleged lack of interest and diagnostic acumen when dealing with the retarded.
Unclassified Mycobacteria in the Etiology of Cat-scratch Fever: A Skin Test Evaluation
Authors: CARITHERS, HUGH A.
Published: December 2021

In this study the skin test reactions of 20 children who had recovered from cat-scratch fever, except for one in whom the disease was still active, and 20 controls who gave no history compatible with the disease were evaluated. From this appraisal it may be concluded that skin test reactions give no indication that classified or unclassified mycobacteria are the cause of cat-scratch fever.
UNSUSPECTED TRAUMA WITH MULTIPLE SKELETAL INJURIES DURING INFANCY AND CHILDHOOD
Authors: McHenry Thomas , Girdany Bertram R. , Elmer Elizabeth
Published: December 2021

This report concerns the experience at the Children's Hospital of Pittsburgh with 50 children who had skeletal lesions considered to be the result of trauma. The peak age incidence was 3 months. The presenting complaints included disability of an extremity, skin lesions, failure to do well, convulsions, vomiting and diarrhea, and large head. The initial impressions of house officers ranged through the gamut of possible skeletal disorders and blood dyscrasias. Interviews with the parents indicated that the families of these injured children were characterized by parental failure, caused by immaturity, failure to accept responsibility, and other psychosocial afflictions. The seriousness of this disease is indicated by the deaths of five of the infants and the continued injury of others after their return home from the hospital.
Poisoning: Chemistry—Symptoms—Treatment
Authors: PRESS EDWARD
Published: December 2021

Considering its size, this book is an unusually comprehensive compendium of the commonest types of solid and liquid substances involved in accidental and intentional poisoning. It groups the poisoning likely to be encountered in the average clinical practice into several easily recognized major classes and devotes a chapter or section to each. These include ones on insecticides; rodenticides and other pesticides; drugs; detergents, sanitizing and polishing agents; cosmetics and toilet articles; and miscellaneous compounds. There is also a section on the general considerations in the treatment of poisoning.
FETAL INFECTION IN CHICKENPOX AND ALASTRIM, WITH HISTOPATHOLOGIC STUDY OF THE PLACENTA
Authors: Garcia Aparecida G. P.
Published: December 2021

Four cases of congenital viral disease are presented. Two cases were of chickenpox (a 2-day old infant and a macerated abortion) and two were of so-called alastrim, which is probably mitigated smallpox (macerated abortions). In all of them one special type of lesion was present: focal, irregularly sized areas of necrosis, with calcium deposits in the central part, sharply demarcated from the surrounding normal parenchyma and accompanied by slight or absent peripheral inflammatory reaction . In Case 1 (an infant who lived 2 days) such lesions were disseminated to all the viscera, especially the brain; the microscopic aspect was like that of congenital toxoplasmosis, and the microscopic examination revealed an essentially necrotizing inflammatory process with extensive calcification and glial reaction. The placenta, examined in two cases of alastrim and one of chickenpox, exhibited similar lesions both on gross and microscopic examination. On the surface and on the cut section there were numerous minute, irregularly spread yellowish areas. The histology showed the presence of tuberculoid-type granulomatous lesions in the villi and extensive areas of necrosis, the intervillous space being occupied by necrotic material and cellular debris. In one of the cases of alastrim (Case 3), there was predominance of the granulomatous lesions; in the other (Case 4), necrosis predominated; in Case 2, of chickenpox, beside the granulomatous lesions, there was extensive necrosis. In the decidual cells there were characteristic inclusions of both the virus diseases. Such placental lesions apparently have not previously been described.
Spontaneous Closure of Ventricular Septal Defects
Authors: VOGEL JOHN H. K.
Published: December 2021

I am writing to you in regard to an article by Dr. M. H. Agustsson entitled "Spontaneous Functional Closure of Ventricular Septal Defect in 13 Children" which appeared in Pediatrics in June, 1963 (31:958). In this article the important observation that ventricular septal defects may close is again emphasized and a number of cases are presented in support of this. However, somewhat confusing is the fact that evidence is clearly given that although the patients' clinical findings changed, the ventricular septal defects were still open in six of the patients.
DIAGNOSIS AND TREATMENT: USE AND MISUSE OF OXYGEN IN TREATMENT OF PREMATURES
Authors: Smith Clement A.
Published: December 2021

Dr. Comroe once stated (in conversation) that while it may sometimes be difficult to prove the value of oxygen therapy, there is ample evidence of its hazards. This is particularly true in premature infants. Should oxygen, therefore, be used at all in the premature nursery? If so, for what infants? And how can they be protected from its misuse?

1. Progressive hypoxemia leads to anoxia in most severe or fatal disease in newborn and premature infants. Circumstances associated with anoxia are often followed by brain damage. Therefore, a severely reduced blood oxygen saturation or tension in a sick premature or term newborn should be raised if this can be done safely.

2. Thus, additional oxygen should be used for those infants whose arterial blood (when they breathe air) is carrying significantly less oxygen, than that to be expected of normal infants in air.

3. Oxygen is misused if it increases blood oxygen much above that normal in air-breathing. Such misuse is not only wasteful. It may cause retrolental fibroplasia. Impaired vision from this cause is still being seen, and we cannot yet be positive that excess oxygen causes no other pathologic changes in prematures besides those in the retina.

The problem of misuse may be better stated in terms of oxygen tension (or pressure —hence pO2) than of oxygen percentage or concentration. As 21% of the atmosphere, oxygen has a partial pressure of 160 mm Hg in air at sea level and pO2 in the pulmonary alveoli of normal term and premature infants is (like that of adults about 105 mm Hg.2 In the arterial blood of such infants pO2 is usually within or near a range of 70-80 mm Hg, so that a normal gradient or pressure loss of 25-35 mm Hg occurs between alveolus and capillary.
THE GASTROINTESTINAL EFFECTS OF IRON-DEFICIENCY ANEMIA
Authors: Naiman J. L. , Oski F. A. , Diamond L. K. , Vawter G. F. , Shwachman H.
Published: December 2021

A group of 14 infants and children with nutritional iron-deficiency anemia were studied with respect to gastrointestinal function and structure both before and after iron treatment. A high incidence of abnormalities was found, consisting of gastric achlorhydria, impaired absorption of xylose and vitamin A, and steatorrhea. Duodenal biopsies revealed varying degrees of chronic duodenitis and mucosal atrophy. There was poor correlation between structure and function. Following treatment with oral iron most of the abnormalities reverted to normal. A control group of 8 children with long-standing anemias not due to iron deficiency were subjected to similar studies, most of which yielded normal results. These observations indicate a diffuse and reversible enteropathy in children as a result of iron deficiency. The pathogenesis and practical implications are discussed.
FETAL ASCITES AND PORTAL DYSPLASIA OF THE LIVER (POLYCYSTIC DISEASE WITHOUT CYSTS)
Authors: Ehrlich Joseph C. , Goodfriend Milton J. , Shinohara Yuuji , Seki Masako
Published: December 2021

An experience with dystocia due to fetal ascites is described. It was necessary to perform intrauterine fetal abdominal paracentesis to complete the delivery. The ascites was associated with a diffuse hepatic developmental anomaly interpreted as a form of polycystic disease without cysts. Associated anomalies included cystic lung and a very rare variety of pulmonary arteriovenous fistula. The structural abnormality in the liver, though in an exceptionally undifferentiated stage, belongs to the category of so-called congenital hepatic fibrosis, which, in turn, is a noncystic variant of congenital polycystic disease. Theoretical aspects of the pathogenesis of the ascites are discussed. A new term, portal dysplasia of the liver (polycystic disease without cysts), descriptively adequate to embrace all of the structural variations of this developmental hepatic abnormality, is suggested.
Gruntled Pediatricians
Authors: RANDALL ALEXANDER , RANDALL J. PERLINGIERO
Published: December 2021

Until tonight we had decided to "write-off" Dr. Vandersall's Letter, "The Disgruntled Pediatrician Syndrome" from Pediatrics, 32:465 as from just another unhappy misfit. However, during an evening at one of our country's great Pediatric centers, it was interesting to see that a considerable number of those in attendance took exception to his point of view. While we trust that he will find the desired intellectual challenge in Psychiatry and we agree that most pediatricians could use a much wider experience in this area, we cannot leave unchallenged the implication that many who have recently entered the practice of Pediatrics are dissatisfied.
Diseases of the Adrenal Glands: Radiologic Diagnosis
Authors: SILVERMAN FREDERIC N.
Published: December 2021

The author presents a succinct view of diseases of the adrenal glands in which radiologic diagnosis, especially with presacral retroperitoneal air injections is an important consideration There are 15 brief chapters well illustrated and effectively documented (324 items are listed in the bibliography) of which 10 are devoted to individual adrenal mass lesions. The first 5 chapters include a classification of adrenal tumors and survey of clinical syndromes comments on conventional radiographic techniques and the technique of presacral retroperitoneal pneumography, and a consideration of adrenal calcifications and normal radiographic anatomy.
Kanamycin and the Red Book
Authors: KEITEL HANS G.
Published: December 2021

The impressive effectiveness of Kanamycin for certain serious infections, particularly those that occur in the neonatal period, prompts me to suggest that there may be errors in the most recent edition of "A Report of the Committee on the Control of Infectious Diseases." Specifically, in the case of Kanamycin, it is indicated that gonococci are not sensitive to Kanamycin. The articles by Kirsh and Finland (Amer. J. Med. Sci., 239, pp. 33-40, 41-50) tend to refute this suggestion.
Body Fluids and Their Neutrality
Authors: HOLLIDAY MALCOLM A.
Published: December 2021

It is not often that a medical textbook contains the qualities of a fresh style in writing, lucidity, and due respect for scientific accuracy. Dr. Christensen achieves this in the book Diagnostic Biochemistry and now in the shorter paper-bound version.

Each chapter deals with a physico-chemical aspect of body fluids and relates it to clinical chemistry and to clinical disease. At the end of each chapter one finds a series of questions, not very easy ones at that, to provoke the intellectually curious into thought and library research.
The Child Who Has Had One Convulsion
Authors: LIVINGSTON SAMUEL
Published: December 2021

In the March, 1964, issue of Pediatrics (33:431), Dr. Sidney Carter states that I recommend daily anticonvulsant medication for a period of four years for the child who has had one convulsion. However, he also states that I believe that such therapy is unwarranted in the management of seizures which occur only in association with fever. This latter statement was taken out of context from one of my papers entitled "Management of the Child with One Epileptic Seizure" which appeared in the Journal of the American Medical Association, September 10, 1960, Vol. 174, pp. 135-139, and as an isolated sentence, it does not represent my method of treatment of convulsions occurring in association with fever which I described in brief in the heretofore mentioned article and in more detail in many prior and subsequent articles.
THE TREATMENT OF TETANUS
Authors: Box Quellin T.
Published: December 2021

Results of treatment of 73 consecutive cases of tetanus admitted to a pediatric service during 1948-1962 are presented. A reduction in mortality for all ages from 52% during 1948-1955 to 24% during 1956-1962 was achieved. Excluding newborn infants, a reduction in mortality from 44% to 9% was achieved. A survival rate of 64% was attained in tetanus of the newborn during 1956-1962. The treatment program used is outlined. A review of causes of death in fatal cases and of significant complications in survivors suggests that even further lowering of tetanus mortality is possible through improvement in this approach to treatment, with continuing emphasis upon a total patient care regimen by an interested and devoted team rather than upon any individual aspect of treatment.
FAILURE TO THRIVE AND SHORT STATURE ASSOCIATED WITH XXY-CHROMOSOMAL PATTERN
Authors: Khorsandi M. , Alexander D. S. , Bryans A. M. , Haust M. Daria
Published: December 2021

A case of a two-year-old male child with dwarfism and failure to thrive, having a chromatin-positive buccal smear and 47 chromosomes, with XXY sex chromosomes, is presented. The testicular biopsy supports the diagnosis of Klinefelter's syndrome. Most adult patients with Klinefelter's syndrome are tall, but this case suggests that it may be useful to perform buccal smears for nuclear sex determination in dwarfed children with male phenotype, when a definitive diagnosis is not readily evident.
Letters to the Editor
Authors: WATERS WILLIAM J.
Published: December 2021

Dr. Zoger's point is well taken. We hope to be able to give a satisfactory follow-up report in the future. I believe as Dr. Byers indicated in his article that close observation of the jaundiced infant will help to detect early signs of neurological disturbance. Increasing lethargy and decreasing response of Moro, suck, and grasp should alert the clinician to the possibility of irreversible brain damage (bilirubin encephalopathy).
SENSORY RADICULAR NEUROPATHY AND RETINITIS PIGMENTOSA
Authors: Landwirth Julius
Published: December 2021

A case of sensory radicular neuropathy and retinitis pigmentosa in an 8-year-old child is presented. Although past reports have suggested a relationship between these two diseases, this is believed to be the first report of their simultaneous occurrence in a single patient.
TRISOMY 17-18(E): STUDIES IN LONG-TERM SURVIVAL WITH REPORT OF TWO AUTOPSIED CASES
Authors: Weber Wendell W. , Mamunes Peter , Day Robert , Miller Phebe
Published: December 2021

Clinical, cytological, and dermatoglyphic studies on a girl born with multiple anomalies and surviving at 10½ years of age showed that she had trisomy 17-18(E). The extra chromosome appeared to be most compatible with an 18 chromosome. Her growth and development are described.

A survivorship table based on 101 cases of trisomy 17-18 is included. The chance of survival to 1 month, 1 year, and 10 years is 70%, 10%, and 1% respectively.
ESOPHAGEAL ATRESIA AND TRACHEOESOPHAGEAL FISTULA
Authors: Holder Thomas M. , Cloud Daniel T. , Lewis J. Eugene , Pilling George P.
Published: December 2021

The members of the Surgical Section of the American Academy of Pedatrics were surveyed regarding their results in treating patients with esophageal atresia and tracheoesophageal fistula for the five-year period ending January 1, 1963. Information on 1,058 patients was received. The data was processed with the aid of a computer and the results, not easily summarized, have been presented.
CURRENT CONCEPTS IN DIAGNOSIS AND MANAGEMENT OF CONGENITAL DISLOCATION OF THE HIP
Authors: Silverman Frederic N.
Published: December 2021

MANY OF US whose formal medical education was obtained more than ten years ago may, as a result, approach the problem of congenital dislocation of the hip (hereafter CDH) with concepts whic could profitably be abandoned.

In many medical centers, CDH has been considered a consequence of failure of development of the acetabulum (acetabular dysplasia). It was usually recognized in the infant around the time of standing or walking, confirmed by radiologic examination, and treated by various types of restraining apparatus designed to replace the dislocated femoral head in proper relationship to the acetabular cavity, and to maintain it there for a period of months at least. The management in older children required hospitalizations for prolonged traction , forceful manipulation and plaster casts, radiographs, and changes of casts. And, in as many as 30% of the children, the involved hip, even if replaced, failed to develop properly so that aseptic necrosis of the femoral head (Legg-Calve-Perthe's disease) occurred and osteo-arthritis was frequent in adult life.

Early diagnosis and treatment has been the goal of orthopedic surgeons for at least the last 30 years. Pediatricians have been instructed to look for abnormal body contours, shortening of a lower extremity, asymmetrical skin folds in groins and thighs, and limitation of motion of the involved hip. When any of these still useful clinical signs were observed, radiographs of the hips were requested for measurements of acetabular angles.

In 1956, Coleman and Caffey independently challenged the validity of the available "standards" for acetabular angles, some of which were based on measurements from as few as 23 children. Caffey's report is the most extensive study to date and the most reliable statistically.
CHRONIC DIARRHEA AND FAILURE TO THRIVE DUE TO INTESTINAL DISACCHARIDASE INSUFFICIENCY
Authors: Clarke John T. , Quillian Warren , Shwachman Harry
Published: December 2021

An infant with chronic diarrhea due to suspected generalized disaccharidase insufficiency is described. The clinical condition of the infant improved following the removal of lactose and sucrose from the diet. The fermentative and acidic stool with free lactose and lactic acid also improved. However, the infant was too ill to undergo direct assay of intestinal mucosal tissue for disaccharidase activity or for challenge with offending sugars. Postmortem tissue assay revealed less than 10% of normal activity for lactase, sucrase, maltase, and isomaltase in the intestinal mucosa.