bluuebunny/crossref_metadata_2025 huggingface dataset:
Iatrogenic Hypophosphatemia in Infants with Renal Insufficiency
Authors: DODGE WARREN F. , TRAVIS LUTHER B.
Published: December 2021

Hyperphosphatemia and hypocalcemia are commonly associated with glomerular insufficiency. Provision of a reduced dietary phosphate intake to infants with renal insufficiency has been greatly simplified by the availability of low phosphate containing proprietary milk formulas. Caution should be exercised in combining the oral administration of aluminum hydroxide gel with these low phosphorus formulas lest excessive hypophosphatemia result.
Case Report: The Coincidence of Biliary Atresia and the Heterozygous State of Galactosemia
Authors: ROBERTSON A. F.
Published: December 2021

A case is presented in which biliary atresia and the heterozygous state of galactosemia occurred coincidentally. The mother was also heterozygous for galactosemia. A liver biopsy revealed changes compatible with biliary atresia and no evidence of galactosemia cirrhosis.
Practical Paediatric Problems
Authors: CONE THOMAS E.
Published: December 2021

This is an excellent, well-printed, and nicely illustrated book written by a single author and based on his personal knowledge of clinical developed through many years of experience in a large English medical school. Books written by a single pediatrician are becoming increasingly rare as the scope and complexity of our specialty continue to expand with ever increasing speed. Dr. Hutchinson s a courageous man to try it, and is to be admired for having done it so well.
A SCHOOL ADMINISTRATOR'S VIEW OF THE PEDIATRICIAN'S ROLE IN SCHOOL HEALTH
Authors: BROWN CHARLES E.
Published: December 2021

FOR THE School Administrator, the article, "School Medical Service in Perspective" (Pediatrics, p. 1011, this issue) provides a useful historical summary, factual, descriptive, and non-controversial. Its author did, however, touch on two topics of particular current concern to school people, and to these I should like to devote most of my comments. I have reference to his mention of the "lack of communication between school staff and practicing pediatricians" and his statement under the section entitled "Changing Role of Physicians in Schools" that "We [physicians] now try to understand problems of learning, behavior, sensory functioning, emotional reactions, social, familial, and cultural aspects of the child's development."
Mental Retardation—A Handbook for the Primary Physician. A Report of the American Medical Association Conference on Mental Retardation, Chicago, April 9-11, 1964
Authors: LAVECK GERALD D.
Published: December 2021

In recognition of the upsurge of interest in mental retardation, the Council on Mental Health and the Committee on Maternal and Child Care of the American Medical Association recently convened a group of 175 experts in mental retardation. Grouped in fourteen task forces, these authorities met in Chicago in April, 1964, to draw up guidelines to aid the practicing physican in meeting the needs of the mentally retarded individual and his family. This handbook is the result of the work of these task forces.
The Use of Priscoline in the Treatment of the Hypoperfusion Syndrome
Authors: COTTON ERNEST K.
Published: December 2021

In line with the report on pulmonary hypoperfusion as a possible mechanism in the etiology of hyaline membrane disease, we have been carrying out studies on newly born infants with this disease in order to correct the diminished pulmonary blood flow.

We have used drug therapy on a total of 5 infants, and this has been associated with considerable normalizing in various abnormalities caused by the disease. We have first corrected acidosis when present, and then given tolazoline HC1 (Priscoline).
SEROLOGICAL CHARACTERIZATION OF ESCHERICHIA COLI
Authors: Pryles Charles V. , Glagovsky Ann
Published: December 2021

The character and prevalence of the O, H, and combined O and H serotypes of E. coli from children with urinary tract infection are described. The data presented include 288 strains of E. coli isolated from 164 patients.

In addition the data from 28 patients with both an acute and a recurrent urinary tract infection are analyzed.

Eighty-five per cent of the recurrent infections were caused by an organism serologically at variance with that causing the initial infection. However, in approximately one-fourth of these there was some question whether the serologic difference represented a truly different strain. On this basis it would appear, contrary to earlier thinking, that most recurrences of infection represent reinfection with a new strain rather than relapse with an original strain.

The serologic characterization of strains of E. coli promises to aid materially our understanding of the natural history, epidemiology, and pathogenesis of pyelonephritis in infancy and childhood.
Fructose Tolerance in Tay-Sachs' Disease
Authors: SCHNECK LARRY , PERLE GUTA , VOLK BRUNO W.
Published: December 2021

1. Children with Tay-Sachs' disease and patients with hereditary fructose intolerance both have severely depressed levels of serum fructose-1-phosphate aldolase.

2. Administration of fructose to three patients with Tay-Sachs' disease did not precipitate the drop in serum glucose and inorganic phosphorus and the rise in serum magnesium that is characteristic of the response to exogenous fructose of patients with hereditary fructose intolerance.

3. The normal tolerance to exogenous fructose displayed by patients with Tay-Sachs' disease is consistent with the findings that their hepatic fructose-1-phosphate aldolase is reduced to only about 60% of normal, in contrast to the virtual absence of this enzyme in cases of hereditary fructose intolerance.

4. It is suggested that even though the serum fructose-1-phosphate aldolase is low in Tay-Sachs' disease, the defect in cerebral ganglioside metabolism may involve galactose rather than fructose.
PROPOSALS FOR A DEPARTMENT OF REHABILITATION FOR CHILDREN
Authors: Ames Mary D.
Published: December 2021

A department of rehabilitation for children is designed to offer the child with multiple problems from whatever cause the opportunity to achieve his potential in his pursuit of happiness as a contributing adult. This begins with his complete medical, psychological, and environmental evaluation by well-qualified specialists. The pediatrician, as director, distills the findings and recommendations of the various disciplines into a long-term program of management to extend throughout the school years. The doctors in the hospital and in the community co-operate to supervise the child's growth and development through the local therapeutic, social, and educational agencies. Re-evaluations at designated intervals are an integral part of this longitudinal program. By-products of such a program are better informed and trained personnel—both medical and paramedical.
THE TUBERCULIN TINE TEST COMPARED TO THE MANTOUX TEST WITH 5, 10, AND 100 TUBERCULIN UNITS
Authors: Rosenthal Sol Roy , Nikurs L. , Yordy E. , Hoder B. , Thorne M.
Published: December 2021

The tuberculin tine test corresponds very closely to 5 or 10 TU by the Mantoux method. The agreement among infants and children (2 months to 18 years of age) was 92%. Among the positive reactors the agreement was 89% and among the negative reactors it was 95%. Considering agreement and disagreement between the two tests, the correlation coefficient was very high (r = 0.835). This value is very highly significant statistically (p < 0.001).

There was poor agreement between the tuberculin tine test and 100 TU by the Mantoux test. The correlation coefficient was very low (r=0.192).

There was a very high degree of correlation between the tuberculin tine test and the Mantoux test quantitatively (r = 0.788; p < 0.001).

The tine test stores well at room and icebox temperatures at periods up to 23 months. Storage at 37°C showed very little drop in potency up to 4 to 9 months of storage. After 15 months of storage, a drop in potency was noted. The recommended method of storage is room temperature.

There were 1,664 infants and children tested and compared.
PETS, PARASITES, AND PEDIATRICS
Authors: Webb Clarence H.
Published: December 2021

"When Neolithic man learnt to domesticate animals and till the land he extended an open invitation to tetanus."1 Long before, when the dog attached himself to Paleolithic man as a scavenger and hunting partner, he initiated an intimate association between man and animal; his pups began the virtual symbiosis which has developed between children and their pets.

Zeuner,2 an authority on the domestication of animals, thinks it probable that the custom of making pets of a variety of animals—so universal in human groups that it must satisfy ancient basic traits (like the maternal instinct of women, the protective instinct of men, and the tactile gratification of children)—might have portended animal domestication.
SPEECH AND LANGUAGE DISORDERS IN PRESCHOOL CHILDREN: A PREVENTIVE APPROACH
Authors: Wyatt Gertrud L.
Published: December 2021

From 4 to 9% of elementary school children with normal to superior intelligence exhibit symptoms of developmental speech and language disorders, such as: stuttering (or stammering);* severely defective articulation in the absence of hearing loss; and finally the syndrome of multiple perceptual, motor, and language disorder. These developmental deviations or disorders interfere markedly with early school adaptation. If no adequate help is forthcoming the symptoms may increase in severity and interfere with the achievement and social adaptation of the children concerned. The sex ratio reported has been, as a rule, 75% boys to 25% girls.

The importance of the preschool years for language development has been established in many studies.1, 2 McCarthy referred to the "amazingly rapid acquisition of an extremely complex system of symbolic habits by young children,"1 while Penfield and Roberts3 mentioned the "biological time table for language learning," and assumed that the most intensive learning occurs between 2 and 4 years of age.

Studies in language development carried out earlier in the century were mostly normative, focusing upon the number of different sounds and words mastered by the majority of children at a given age1, 4, 5 Thus we expect the "average" child to begin using his first words between 10 and 18 months of age, to master approximately 300 words at age 2, and approximately 1,000 words at age 3. In a more recent study, Templin compared her findings concerning children's learning of consonant sounds with those of other investigators.6 The pediatrician, trying to evaluate a child's stage of language development may want to know what specific sounds a child should be able to master at what particular age.
A NEW SCREENING TEST FOR CYSTIC FIBROSIS
Authors: Gregg Robert H. , Boucher Rudrick E.
Published: December 2021

A device and method for analysis of sweat chloride concentration is presented. Analyses of tests done simultaneously on 85 subjects by two methods demonstrate clinical usefulness of the new test method. It is simple, inexpensive, and adaptable to use in the physician's office and in laboratories where sweat tests are done infrequently.
HEMODYNAMIC ADAPTATIONS IN THE NEWBORN INFANT
Authors: Gessner Ira , Krovetz L. J. , Benson R. W. , Prystowsky H. , Stenger V. , Eitzman D. V.
Published: December 2021

The dye dilution technique can provide useful information regarding the newborn cardiovascular system if attention is paid to certain limitations imposed by the peculiarities of the age group being studied. It is necessary that an accurate dye injection system be used and that analysis of the dye curves be done in specified manners.

All the newborns studied had a left-to-right shunt present during the first 2 hours of life. The size of the shunt was relatively constant, averaging 35%, and was not influenced by route of delivery. Although not proven by our studies, it seems probable that this shunt is through the ductus arteriosus. A right-to-left shunt, also presumed to be at the ductal level, was present in all babies up to the age of 40 minutes. After the age of 60 minutes, the majority no longer demonstrate such a shunt.

The average left ventricular output for the entire group was 3.9 1/min/m2. Left ventricular output and right ventricular output were both significantly greater in babies delivered vaginally than in those delivered by cesarean section, the difference being most marked at age 60 minutes. Since the size of the left-to-right shunt was the same for both groups, pulmonary blood flow was also higher in vaginally delivered babies. The significance of these important physiologic findings in terms of neonatal pathology, has not been determined.
Simple Method for Entering Scalp Veins for Venous Blood Samples or Venoclysis
Authors: KAUFMAN HERBERT S.
Published: December 2021

The dangers of venipuncture by an experienced pediatrician are minimal. Nevertheless, some slight risk does attend femoral or jugular vein puncture; moreover, many parents recoil from witnessing femoral blood samples being taken from their healthy child. Many techniques have been described and although laboratory microprocedures may be performed by the "heel-stick" method, many tests require more blood. Anke has modified the technique of Manús and has noted a preference for the scalp veins over other peripheral vessels.Our method for obtaining blood samples requires even less material and does not involve the somewhat hazardous pressure on both jugular veins.

PROCEDURE
Red Urine
Authors: SCHOEN AUSTIN H.
Published: December 2021

In regard to the article by S. Levin on page 135 of the July, 1965, issue of Pediatrics, it might be well to advise your readers that the phenomenon he mentions is unlikely to occur in the United States.

According to the FDA, Rhodamine B is not listed for use in foods in the United States. However, this dye may be used in drugs since it is provisionally listed for such use.

Under the circumstances, it is unlikely that physicians will encounter the red urine mentioned by Dr. Levin as being common in South Africa due to the use of this particular dye in foods and candies.
Ingestion of Cow's Milk in Etiology of Rectal Bleeding
Authors: LAHEY M. EUGENE , WILSON JOHN F. , HEINER DOUGLAS C.
Published: December 2021

In a paper dealing with Laparotomy for Rectal Bleeding (Pediatrics, 35:787, 1965) Shandling notes that no explanation was found at operation for enteric bleeding in 50 and 60% of infants and children. In view of this high percentage of "fruitlessly explored" patients, the author justifiably carefully analyzed the series of patients "to define indications for operation." Among the features studied were character of bleeding, relationship of bleeding to the stool, duration of symptoms, and the hemoglobin level—none of which were of particular diagnostic value.
Letters to the Editor
Authors: WISHINGRAD LESTER
Published: December 2021

We certainly agree that it is "difficult to establish 24 mg/100 ml or any other limit of safety from non-hemolytic hyperbilirubinemia in the premature." However, confronted with the care of premature infants, and the recommendation of others, to employ the level of 18 mg/100 ml as a guide to therapy, we found that 20% of the premature infant population in our nursery received exchange transfusions for non-hemolytic hyperbilirubinemia. If the level of 24 mg/100 ml is arbitrarily selected as a guide to the therapy in well premature infants the exchange transfusion rate goes down to 4%, without any apparent increase in risk of kernicterus from our data to date.
BONE GROWTH AND METABOLIC STUDIES OF PREMATURE INFANTS TREATED WITH HUMAN GROWTH HORMONE
Authors: Chiumello G. , Vaccari A. , Sereni F.
Published: December 2021

The influence of exogenous human growth hormone on growth and metabolism of premature infants was observed.

It was not possible to register any increase of linear bone growth after hormone administration; concomitantly urinary hydroxyproline excretion did not change significantly.

Nitrogen balance studies indicated a sharp increase of nitrogen retention, due to a reduced urinary excretion, in all infants. Calcium and phosphorus balances rose in three out of four premature infants treated with growth hormone, but the characteristic STH calciuric action of STH was not observed. Furthermore, STH failed to induce any significant increase in NEFA serum concentration of premature infants.

It may therefore be concluded that the metabolic response of premature infants to STH differs consistently from that normally observed in more mature subjects.
COMPARISON OF METHODS FOR RECORDING RESPIRATION IN NEWBORN INFANTS
Authors: Polgar George
Published: December 2021

The barometric method of Drorbaugh and Fenn for measuring respiratory rate and tidal volume in newborn infants has been compared by simultaneous recordings with an impedance pneumograph and a mercury-in-rubber strain gauge, using integrated flow rate measurements as the standard. The barometric method proved to be approximately as accurate as the others, but it allows the infant to be unrestricted with no interference by tactile stimulation during measurements, and it requires less instrumentation. Therefore a total body plethysmograph can be used confidently without additional equipment for intermittent recording of respiration in normal and diseased infants.
Granulopoiesis in Down's Syndrome
Authors: GALBRAITH PETER R. , VALBERG LESLIE S.
Published: December 2021

The rate of disappearance of granulocytes labeled with DFP32 from the circulation was normal in four subjects with Down's syndrome. The mean blood granulocyte mass and mean granulocyte turnover rate were also normal in these subjects.
REGULATION OF ERYTHROPOIESIS XVII: THE DETERMINANTS OF RED CELL SIZE IN IRON-DEFICIENCY STATES
Authors: Leventhal Brigid , Stohlman Frederick
Published: December 2021

A model for the kinetics of erythropoiesis, which has previously received support from experimental studies in animals was tested in human beings. This model predicts that in the face of severe anemia and high levels of endogenous erythropoietin production, the cell size will be determined by the availability of hemoglobin precursors, e.g., iron. This was tested in iron-deficient rodents and human beings by varying the dose of iron given to severly anemic subjects. As would be predicted by the model, when high doses of iron were given, macrocytes were produced; low doses produced an increase in hemoglobin but with the continued production of microcytes; intermediate doses resulted in the production of normocytes.
A HISTOCHEMICAL AND ELECTRON MICROSCOPIC STUDY OF SKELETAL MUSCLE IN A CASE OF POMPE'S DISEASE (GLYCOGENOSIS II)
Authors: Cardiff Robert Darrell
Published: December 2021

1. A case of Pompe's disease (glycogenosis II) without biochemically or histochemically demonstrable alpha-glucosidase activity is described.

2. Histochemical studies of skeletal muscle suggested that the glycogen is frequently stored as an acid mucopolysaccharide.

3. Electron microscopic studies revealed that the major glycogen deposits in most tissue were within membrane-limited sacs. Striated muscle was an exception because major deposits were frequently extrasaccular.

4. The findings in this case are discussed in relation to current concepts of Pompe's disease. In view of the extrasaccular glycogen deposits in skeletal muscle, it is suggested that an extralysosomal factor plays a significant role in the pathogenesis of Pompe's disease.
EVALUATION OF MUMPS VACCINE GIVEN AFTER EXPOSURE TO MUMPS, WITH SPECIAL REFERENCE TO THE EXPOSED ADULT
Authors: Meyer Mary B. , Stifler William C. , Joseph J. Mehsen
Published: December 2021

A critical evaluation of inactivated mumps vaccine, given to adults after exposure to mumps, was sponsored by the Maryland Chapter of the American Academy of Pediatrics and was carried out by a member of the Department of Epidemiology of the Johns Hopkins University School of Hygiene and Public Health, selected practicing pediatricians, and the Virology laboratory of the Maryland State Health Department. The study subjects were parents, seen when their children had mumps, who had not themselves had clinical mumps. In a part of the study, selection of subjects for vaccination was by a random method.

Among all parents with negative histories, 21/330 or 6.4% had definite clinical mumps. Among 176 vaccinees, 14 had mumps (8%). Among 153 controls 6 had mumps (3.9%).

Evaluation of tests for susceptibility indicated that no one with a neutralizing antibody titer of 1-8 or greater came down with mumps. Among controls, all mumps occurred in parents with titers of less than 1-2.

Hemagglutination inhibition titers were poorly correlated with immunity, and were not well correlated with neutralizing antibody at low titers. Therefore the HI test is not a reliable method for identifying susceptibles. Although a critical evaluation of the skin test was not made, two vaccinated individuals with positive skin tests came down with mumps. Skin test results did not correlate well with neutralizing antibody titers.

Mumps attack rates among exposed parents with negative histories were relatively low, and were lower among fathers than among mothers (5% and 10% respectively). The use of inactivated mumps vaccine in exposed parents is not recommended both for this reason and because of the lack of evidence for any efficacy.
IMPLANTATION OF CHARDACK-GREATBATCH ADJUSTABLE RATE AND CURRENT PACEMAKER IN A 4-MONTH-OLD INFANT
Authors: Martin Marie Vitória , Lime Adauto Barbosa , Almeida Cyro S. , Geretto Pedro , Nero Renato Del , Monfort Jose , Santos Rubens de G. , Felipozzi Hugo J.
Published: December 2021

The implantation of a definitive pacemaker in a 4-month, 11-day-old infant with congenital heart block, has been described. Following her first syncopal episode, signs of heart failure became increasingly worse and after unsuccessful hospital clinical treatment for one month the Chardack-Greatbatch adjustable rate and current pace maker was implanted, with a heart rate settled at 100, or slightly below the P-wave rate of the baby.

There was rapid improvement of the signs of heart failure, with beginning of weight gain and discontinuation of diuretics. She was discharged on the thirteenth postoperative day and the follow-up examination 3 weeks after the operation disclosed a baby with good color and a heart rate of 100, gaining weight, and without signs of heart failure. In spite of these encouraging results, it is realized that a much longer period will be required to establish the success of this treatment.

During surgery she was suspected of having a corrected transposition of the great vessels and possibly an associated septal defect. Further investigation of her associated malformation has been deferred to a more suitable opportunity.
Platelet Survival Studies in Aldrich Syndrome
Authors: KRVIT WILLIAM , YUNIS EDMUND , WHITE JAMES G.
Published: December 2021

1. Normal platelets were transfused into 4 patients with Aldrich syndrome. The response in platelet count indicated that little destruction of platelets was occurring. The survival of platelets was considered to be normal. Plasma transfusion alone did not correct the platelet counts. Platelet antibodies were not detected in two of these patients.

2. For control studies, normal platelets were transfused into two patients with amegakaryocytotic congenital thrombocytopenia and sex-linked recessive (non-Aldrich) familial thrombocytopenia. Their survival was normal.

Similarly, normal platelets were transfused into three patients with idiopathic thrombocytopenic purpura. Minimal increase in platelets and no significant length of survival of platelets was seen.

The thrombocytopenia of Aldrich syndrome was considered to be due to a defect in procduction and/or release of platelets.
Letters to the Editor
Authors: WHITTEN CHARLES F.
Published: December 2021

In our report (Pediatrics, 36:322, 1965), we indicated that the outlook for the use of desferrioxamine in the treatment of acute iron poisoning was encouraging, but that caution needed to be exercised in the selection of the rate of administration. The evidence cited was as follows:

1. Two children with acute iron poisoning developed hypotension which could be attributed to the infusion of desferrioxamine.

2. Hypotension occurred consistently in dogs given a high intravenous dose of desferrioxamine rapidly.
Pets, Parasites, and Pediatrics
Authors: CARITHERS HUGH A.
Published: December 2021

In his commentary "Pets. Parasites, and Pediatrics" (Pediatircs, 36:521, 1965), Webb clearly indicates by fascinating historical references as well as by stating that "there are estimated to be 25 million dogs in the United States, 28 to 30 million cats, and 15 million domesticated birds," that families are not likely to stop harboring pets in the home. Lest pet haters (their number is enormous) misuse his comments on the Zoonoses as arguments against beloved animals, it is well to state firmly that the danger from catching a disease from family pets is far outweighed by the pleasure they bring.
Health Problems of Adolescence: Report of a WHO Expert Committee. World Health Organization:
Authors: CONE THOMAS E.
Published: December 2021

This is a timely, concise, eminently practical, thoughtfully, even tenderly, written 28 page report of a recent WHO Expert Committee meeting on the health problems of adolescence. The members and the consultants to the Committee deftly summarize the major worldwide trends affecting our adolescent population. The size of this population is staggering; in the age group 15-19 years alone there are already 300 million adolescents in the world, and there seems every likelihood that these numbers will increase rapidly during the next decade.
Early Diagnosis and Treatment of Homocystinuria
Authors: PERRY THOMAS L. , DUNN HENRY G. , HANSEN SHIRLEY , MACDOUGALL LYNNE , WARRINGTON PATRICK D.
Published: December 2021

Homocystinuria was diagnosed in a newborn infant by detection of homocystine in urine on the fourth day of life, and by the demonstration of a marked elevation of serum methionine concentration on the fifth day. Treatment with a special low-methionine diet has reduced the concentrations of methionine in blood to near-normal levels. This metabolic disease should be searched for by routine screening of newborn infants, and may possibly respond favorably to dietary therapy.
Letters to the Editor
Authors: WEBB CLARENCE H.
Published: December 2021

Dr. Horowitz' letter and the previous communication from Dr. Hugh Carithers Padiatrics 37:386, 1966) are welcome because of the added facets which they introduce to the fascinating topic of the interaction between children and their pets, as well as other domestic animals. My brief commentary was concerned largely with the prehistoric and historic association of man and his animal domestics, with a few remarks concerning shared infections; whole volumes could additionally be written about allergic reactions, emotional responses, the value of pets in training children in areas of responsibility and self-esteem, fears, myths, and legends.
Psychological and Allergic Aspects of Asthma
Authors: GALDSTON RICHARD
Published: December 2021

This is an excellent book which is clearly written, and does just what the publisher claims. It "presents theoretical and empirical data relevant to the individual with asthma; discusses problems of methodology in psychosomatic research and suggests procedures for more rigorous experimentation." The bibliographic lists following each chapter are extensive and offer the interested reader an excellent source for more detailed reading.
VITAMIN B6 DEPENDENCY SYNDROMES: THEIR LARGER SIGNIFICANCE
Authors: SCRIVER CHARLES R.
Published: December 2021

DURING the past decade, the molecular biologist has shown us how mutation in the informational code of the gene is eventually translated into an alteration, either in the primary structure of a protein catalyst or in the rate of synthesis of the catalyst. In either case, the function of the catalyst is impaired and the phenotype of the organism is changed.

Another, albeit less remarkable, advance in knowledge during the past decade both enhances our view of molecular biology and directly benefits the care of our patients. In 1954 two papers appeared in this journal describing a new cause of convulsions in infancy.
ANTIBODY RESPONSE TO THE SOMATIC ANTIGEN OF SALMONELLA NEWPORT IN PREMATURE INFANTS
Authors: Gotoff Samuel P. , Cochran William D.
Published: December 2021

Antibody to the somatic antigen of S. newport was demonstrated by the hemagglutination technique in the sera of 11 premature infants 1 to 2 months old following a nursery outbreak of gastroenteritis. By ultracentrifugal analysis of selected sera from infected infants the antibody activity was exclusively associated with the rapidly sedimenting (19S) gamma M globulin fraction. Although antibody activity was found in the rapidly sedimenting fraction in all maternal sera tested, some antibody activity was also found in the slowly sadimenting immunoglobulin fractions in sera from 2 of 7 mothers suggesting recent or intensive antigenic stimulation. This evidence, coupled with a recent history of gastroenteritis, suggests that one of the mothers may have been the source of the epidemic. The low or absent antibody titers in the infants of these two mothers suggests that the antibody response may have been suppressed by the placental transfer of maternal slowly sedimenting antibody.

The usual sequence of immunoglobulin response to protein antigens is contrasted with the response to the somatic antigen of Gram-negative bacteria, and the role of serum antibody in immunity to Gramnegative bacteria is discussed.
Herpangina: An Example of the Need for Precise Description of Clinical Conditions
Authors: STEIGMAN ALEX J.
Published: December 2021

Herpangina is a clinical syndrome whose sine qua non is the direct observation of characteristic lesions. Once seen as in epidemics of herpangina the local lesions are not likely to be confused with other clinical conditions. Zahorsky's detailed description of the hallmark lesions and Curnen's in Nelson's textbook are explicit. The latter author succinctly writes, "the characteristic discrete lesions appear initially as white or greyish vesicles, later as shallow ulcers 1 to 5 mm in diameter, each surrounded by a red areola."
ARTERIAL AND VENOUS BLOOD PRESSURE RESPONSES DURING A REDUCTION IN BLOOD VOLUME AND HYPOXIA AND HYPERCAPNIA IN INFANTS DURING THE FIRST TWO DAYS OF LIFE
Authors: Young Maureen , Cottom Dennis
Published: December 2021

In 46 normal full-term infants (0.5-36.5 hours of age) the mean systolic pressure in the lower aorta, catheterized through the umbilical artery, was 70 S.D. ± 8 mm Hg and the mean diastolic pressure 44 S.D. ± 7 mm Hg. The mean venous pressure in the thoracic inferior vena cava, catheterized through the umbilical vein and ductus venosus was 1.4 S.D. ± 2 cm H2O. Higher pressures were recorded in the portal sinus. The mean arterial O2 tension in the lower aorta was 84 S.D. ± 13 mm Hg and the mean CO2 tension 37 S.D. ± 7 mm Hg. The mean rectal temperature was 36.2 S.D. ± 0.7°C.

Arterial pressure tracings recorded during, and in the recovery period following, a 10% reduction in blood volume suggest that vasomoter baroreceptor responses to a reduction in pulse pressure are not very active during the first 2 days of life. Cardiac responses are more active.

In contrast to the adult, passive tipping of the newborn infant into the head-up position caused little change in the inferior vena cava pressure or in the arterial pressure.

An increase in intratracheal pressure of 7-10 cm H2O caused immediate bradycardia. Frequently the heart rate was halved but little fall in mean pressure occurred over 10 seconds.

Breathing hypoxic mixtures caused hypotension and tachycardia. Hypotension was observed with no change in heart rate when the arterial CO2 was raised simultaneously.

Differences in blood volume distribution, and the relative size of the circulatory beds under reflex and chemical control, possibly share with the apparent unresponsiveness of the peripheral vessels in causing the differences in responses observed between the infant and the adult.
CONTROL OF A SINGLE SOURCE NURSERY EPIDEMIC DUE TO SERRATIA MARCESCENS
Authors: McCormack Regina C. , Kunin Calvin M.
Published: December 2021

Colonization of infants in a newborn nursery was suspected when S. marcescens was grown in cultures from six newborns with urinary tract infection, omphalitis, and balanitis. Umbilical culture of newborns in the nursery revealed S. marcescens in 20 of 31 (64.5%) infants. Extensive culture of personnel and equipment in the delivery room and the general and premature nurseries, however, failed to reveal the organism, with two exceptions. One was the presence of a pure, heavy growth of S. marcescens in 4 of 5 plastic bottles employed to apply saline to umbilical cords and a mixed growth of this and other organisms in suction tubing in the nursery. Within 6 days after removal of the plastic bottles, only 2 of 22 newborns were colonized and no new cases were found after 2 weeks. Almost all those colonized lost the organism within 4 weeks after discharge from the hospital. No familial spread occurred except for colonization of the breast of 2 of 9 nursing mothers.

These data are presented as an example of a single source, readily controlled epidemic due to a saprophytic organism associated with disease in a small number of infants. The importance of environmental contamination in nursery epidemics due to gram-negative bacilli, many of which are particularly virulent in the newborn, is discussed.
STUDIES ON MIMEAE ORGANISMS AS RELATED TO INFANTS AND CHILDREN
Authors: Donald William D.
Published: December 2021

The frequency of isolation of Mimeae organisms from the skin, upper respiratory tract, and rectal swabs of children has been presented. These organisms (Mima polymorpha and Herellea species) were cultured from 9.5% of 200 axillary cultures. They were cultured from only 1% of 500 throat and nasopharyngeal cultures and were not isolated from rectal swabs of 200 children.

By the use of the hemagglutination test antibody to two Mimeae organisms has been demonstrated in a majority of adults and children over 1 year of age. There is apparently very poor transfer of these antibodies from the mother to her offspring.
CHRONIC NASOPHARYNGEAL OBSTRUCTION AS A CAUSE OF CARDIOMEGALY, COR PULMONALE, AND PULMONARY EDEMA
Authors: Luke Mary Jane , Mehrizi Ali , Folger Gordon M. , Rowe Richard D.
Published: December 2021

Partial airway obstruction and respiratory abnormality due to enlargement of tonsils and adenoids is a well-recognized clinical entity, but the cardiorespiratory changes which severe chronic obstruction may cause have not been widely documented. Four patients with severe nasopharyngeal obstruction have been observed to have cardiorespiratory complications ranging from moderate cardiac enlargement and right ventricular hypertrophy to cor pulmonale and pulmonary edema. Hemodynamic studies showed swings in pulmonary artery and aortic pressures; pCO2 was varyingly elevated in arterialized capillary blood.

It is believed that hypoxia leads to increased pulmonary resistance and elevated pulmonary artery pressure which, over a period of months, results in right heart hypertrophy and failure. Furthermore, hypoxia may contribute to the development of pulmonary edema in a manner similar to that which occurs at high altitudes. Wide swings in intrathoracic pressure also probably played an important role in the etiology of pulmonary edema. Individual susceptibility to hypoxia and pressure changes is suspected to be an important etiologic factor.

The problem of chronic upper airway obstruction caused by tremendously enlarged tonsils and adenoids in children warrants further investigation and more widespread recognition as being potentially dangerous from cardiorespiratory standpoints.
SCINTILLATION SCANNING IN PEDIATRICS
Authors: Kay Chester , Freeman Leonard , Avnet Norman
Published: December 2021

Organ scanning is one of the newer, more exciting developments in radiology. The principles of liver, cardiac, renal, and brain scanning and their application to pediatrics are discussed. Estimates of dose delivered to the whole body and target organs are presented. The doses are usually lower than from commonly performed gastrointestinal or urographic radiographic examinations.

Organ scanning can be used in pediatrics in the same manner as any procedure entailing a potential risk. One must weigh the potential risk with the information that can be derived from the procedure.
Nils Rosén Von Rosenstein and His Textbook on Paediatrics
Authors: RADBILL SAMUEL X.
Published: December 2021

Nils Rosén von Rosenstein (1706-1773) is Sweden's most heroic medical figure. The Parentalia published by John Flodero in 1775 for this "most noble lord, archiatro and knight of the Polar Star" proclaimed the many honors that came his way. But the most lasting monument to his memory was his textbook of pediatrics which was published in 1764 and served for the next 200 years as a model for subsequent pediatric treatises. The present volume was issued to celebrate the two hundredth anniversary of the publication of this great pediatric text.
Disease in Infancy and Childhood, ed. 5, by Richard W. B. Ellis, M.D., and Ross G. Mitchell, M.D. Baltimore: The Williams & Wilkins Company, 1965, 712 pp., $14.50
Authors: Cone Thomas E.
Published: December 2021

In 1951 Professor Ellis of Edinburgh published the first edition of his popular and respected introduction to clinical pediatrics. Now, 14 years and four editions later a new edition appears under dual authorship for the first time. Professor Ross Mitchell of Aberdeen now shares responsibility for the text.

In reading through this new edition no marked changes are found. The order of contents follows the excellent arrangement of the past editions. There are minor alterations such as removing the discussion of diabetes mellitus from the chapter on disorders of growth and development and placing it more correctly in the chapter concerned with disorders of metabolism and storage.
Lettre to the Editor
Authors: Coleman Allan B.
Published: December 2021

For the Academy Committee, Dr. Coleman commented as follows: Dr. Stotzer's point is well taken. Perhaps we are all guilty of becoming too familiar with hexachlorophene in soaps, deodorants, and even in at least one brand of toothpaste so as to breed carelessness. Another near fatality in the current literature (Pilapil, V. R.: Amer. J. Dis. Child., 111: 333, 1966) occurred after a dispensing error.

The wide use of this substance, particularly in the form of Phisohex, makes the paucity of seriously poisoned children a point requiring comment.
CLINICAL-LABORATORY EXPERIENCES WITH COMBINED DRIED LIVE MEASLES-SMALLPOX VACCINE
Authors: Weibel R. E. , Stokes J. , Buynak E. B. , Hilleman M. R. , Grunmeier P. W.
Published: December 2021

A premixed and lyophilized preparation of Enders' live measles virus (Edmonston B) vaccine combined with calf lymph smallpox vaccine was evaluated in clinical and serologic studies in children in an institution. Susceptible recipients given the combined vaccine by jet gun showed the characteristic clinical and serologic responses expected when the 2 vaccines are given alone. There was no evidence of interference between the two viruses. Additionally, the children vaccinated with the combined lyophilized vaccine gave a dermal immune reaction when challenged subsequently with smallpox vaccine by the conventional method. Persons previously vaccinated with smallpox vaccine sometimes showed an elevation in hemagglutination-inhibiting antibody against vaccinia when given the combined measles-smallpox vaccine and, in one instance, such increase in antibody was obtained following conventional administration of smallpox vaccine. The level of vaccinia hemagglutination-inhibiting antibody declined rapidly after the initial response. Based on the experience, it was concluded that the combined measles-smallpox vaccine can be safely and effectively administered via jet gun with considerable saving in time and with minimal discomfort to the patient.
DIAGNOSIS AND TREATMENT INTUSSUSCEPTION—A SURGICAL CONDITION
Authors: Ravitch Mark M.
Published: December 2021

THE gradual increase in the employment of hydrostatic pressure reduction of intussusception with the use of the barium enema has resulted in a gratifying decrease in the number of laparotomies performed. It can also be expected, on the basis of past experience, to result in a decrease of the number of resections required, since some resections have been done on bowel mistakenly thought to be non-viable (and non-viable bowel will not be reduced by hydrostatic pressure properly performed), and in other instances resection has been required for bowel traumatized by the manual reduction itself. The other advantages of hydrostatic pressure reduction are familiar. If the possibility of intussusception is merely entertained, the diagnosis can be made with certainty and the treatment instituted at the same time by barium enema. When immediate operation is the standard treatment for intussusception there may be an understandable tendency to delay operation until the clinical diagnosis has been made unequivocally. Specific lesions causing intussusception, such as polyps, Meckel's diverticula, etc., are not in themselves significant and occur in only 5 or 6% of cases of intussusception. Intussusceptions of long duration may still be totally reducible and, in any case, in practically all of them the intussusceptum is reduced around to the cecum so that if operation is required a right lower quadrant exposure is sufficient and one is spared the necessity of manipulating the bowel around from the left colon to the right colon. Finally, it has been shown in a number of series that, in children who have operative reductions of intussusception, there is a significant incidence of late mechanical intestinal obstruction due to adhesions resulting from the intra-abdominal manipulation.
INTRAUTERINE GROWTH IN ACTIVE TISSUE MASS OF THE HUMAN FETUS, WITH PARTICULAR REFERENCE TO THE UNDERGROWN BABY
Authors: Sinclair John C. , Silverman William A.
Published: December 2021

Oxygen consumption of babies born after various lengths of gestation, measured between 2 to 10 days of post-natal life under resting, thermoneutral conditions, has been used as an index of intrauterine growth in "active tissue mass." A curve was constructed describing the median increase in oxygen consumption with increasing gestational age in babies who had experienced usual rates of growth in utero.

Babies who have grown normally in utero exhibit, with increasing birth weight and with increasing gestational age, an increase in oxygen consumption per kilogram birth weight. This phenomenon is proposed to result from changes in fetal body composition with increasing maturity whereby the cell mass constitutes an increasing percentage of total body weight as length of gestation increases.

Babies who have been undergrown in utero consume, as a group, more oxygen per kilogram body weight than do normally grown babies of similar birth weight; the degree of hypermetabolism is correlated with the degree of undergrowth. Undergrown babies, as a group, do not have a higher oxygen consumption per kilogram than normally grown babies of similar gestational age, although there is a tendency for those most undergrown to be hypermetabolic even for duration of gestation.

The relative hypermetabolism of undergrown neonates is proposed to depend on a dual etiology: a cell mass/body weight ratio characteristic of maturity rather than size, and, in the most undergrown subjects, an increased cell number/cell mass ratio as would occur with reduction in cell size. A model is developed which relates observations by others of changes in organ size and cell size, in malnutrition, to the present metabolic measurements.

Additional observations include external dimension—oxygen consumption relationship, colon—skin temperature gradients, and acid-base parameters, in babies either normally grown or undergrown in utero. Further study is needed of increments in oxygen consumption during the neonatal period in these two kinds of babies.
PHENYLKETONURIA: A STUDY OF HUMAN BIOCHEMICAL GENETICS
Authors: Hsia David Yi-Yung
Published: December 2021

ONE of the privileges extended to me upon receiving the E. Mead Johnson Award is to have an opportunity to express in public my gratitude to the several teachers who have contributed so heavily to my development. First and foremost, I want to thank Dr. Sydney Gellis, who first took me on as a research fellow, subsequently fired in me an excitement and enthusiasm for research, and has remained through the years a loyal friend and colleague. Next, I want to thank Dr. Charles Janeway who had the vision of urging me to become interested in the then embryonic field of "inborn errors of metabolism." In the pursuit of this interest, I want to thank Dr. Eugene Knox for teaching me the biochemistry and Professor Lionel Penrose for teaching me the genetics which subsequently led to the work on phenylketonuria. Finally, the late Dr. John Bigler and Dr. Robert Lawson gave me the encouragement and the freedom to pursue these studies in Chicago. On this occasion I would also like to express my appreciation to the Mead Johnson Company for having provided me with my first fellowship, which permitted me to go into research, and also for having manufactured the product which has played such a vital role in our understanding of phenylketonuria.

The concept of "inborn errors of metabolism" was first suggested by Sir Archibald Garrod in 1908. In the Croonian Lectures delivered at the Royal College of Physicians, he suggested that four metabolic disorders—albinism, alkaptonuria, cystinuria, and pentosuria—had certain features in common.
STUDIES ON HYALINE MEMBRANE DISEASE
Authors: Ambrus Clara M. , Weintraub David H. , Ambrus Julian L.
Published: December 2021

Fibrinolytic enzyme therapy of respiratory distress syndrome was explored in a controlled, randomized, double-blind clinical study. Of 100 infants entered in the study, 60 corresponded to all of the predetermined criteria and were included in the final evaluation. Infants with respiratory distress syndrome were admitted to the study if they were (1) premature, (2) from diabetic mothers, or (3) from mothers with hemorrhagic complications of pregnancy. In regard to sex, delivery route, maternal status, pretreatment respiratory rate, Silverman score, venous pressure, electrolytes, protein levels, and circulating levels of members of the fibrinolysin system, the placebo-treated control group and the experimental group were found to be comparable. The groups were comparable in regard to pretreatment blood pH and pCO2 as well, except that the subgroup that was treated with the enzyme preparation and expired showed a greater degree of acidosis than the other groups.

Patients in the experimental group received 5 RPMI units/kg of human plasmin activated with human urokinase (UK-plasmin) intravenously in 4 hours, plus 60 RPMI units/kg/day of enzyme by aerosol. In the placebo-treated control group, 11 of 28 infants recovered (39%) and in the UK-plasmin treated group, 23 of 32 recovered (72%). The difference is statistically significant at less than 5% level. Of the infants with a birth weight of 2 kg or less, 3 of 16 recovered in the placebo-treated control group (19%), and 10 of 16 recovered in the UK-plasmin treated group (63%); the difference is statistically significant at less than 5% level. No clinical side effects were seen in any of the patients.

Autopsy findings indicated a high degree accuracy of diagnosis. The incidence of hemorrhage diagnosed at autopsy was the same in the control and experimental groups. In all but one of the patients that expired in the UK-plasmin treated group, sufficient pathologic findings were obtained to account for death regardless of the presence of hyaline membrane disease. Similar findings were obtained in 9 of 17 patients who expired in the control group.

UK-plasmin therapy of respiratory distress syndrome of infants due to hyaline membrane disease appears to be worthy of further exploration. A diagram correlates certain features of the pathophysiology of this disease and the mechanism of action of therapy.