bluuebunny/crossref_metadata_2025 huggingface dataset:
MENINGOCOCCEMIA ASSOCIATED WITH INTRAVASCULAR COAGULATION
Authors: Abildgaard Charles F. , Corrigan James J. , Seeler Ruth A. , Simone Joseph V. , Schulman Irving
Published: December 2021

Changes indicating the occurrence of diffuse intravascular clotting (thrombocytopenia and depletion of fibrinogen, prothrombin, and factors V, VIII, and IX) were observed in a child with fulminant meningococcemia. Therapy with penicillin, heparin, epsilon-aminocaproic acid, and hydrocortisone resulted in rapid reversal of coagulation factor abnormalities and a favorable outcome. Determination of the incidence of intravascular clotting in meningococcemia and the influence of heparin therapy on the course of such cases requires further study. The findings of the present case suggest that (1) screening tests for intravascular clotting should be done in all cases of meningococcemia, and (2) heparin therapy may be beneficial when evidence of intravascular clotting is observed.
FACTORS PERTAINING TO PROLONGED PREGNANCY AND ITS OUTCOME
Authors: Zwerdling Michael A.
Published: December 2021

Pregnancies extending more than 3 weeks beyond the expected date of confinement were studied among 9,719 single, white births from the Child Health and Development Studies in Oakland, California, and 358,702 births representing all white, singleton pregnancies in New York City terminating from 1957 through 1959.

The incidence of prolonged pregnancy was 7.3% in the Child Health and Development Studies and 5.4% in New York City. Younger women, primigravidas, and women of high parity showed an increased incidence.

Fetal and neonatal mortality rates were approximately doubled in prolonged pregnancy in both Oakland and New York City. This relationship held for both primiparas and multiparas, for antepartum and intrapartum fetal deaths, and for all major causes of fetal and neonatal mortality.

Post-term infants weighing less than 2,500 gm (5½lb) had a neonatal mortality rate seven times the rate for prolonged pregnancies as a whole. There was no increase in neonatal mortality among post-term infants weighing more than 4,100 gm (9 lb) compared with prolonged pregnancy infants between 2,500 and 4,100 gm (5½ to 9 lb).

There was a slightly increased incidence of congenital anomalies in the prolonged gestation group. Neonatal mortality in infants with severe congenital anomalies was substantially higher in prolonged pregnancy.

The excess mortality experience of prolonged pregnancy children continued for at least the first 2 years of life. Hospitalization and clinic visit data also implied a poorer health status in these children over the first 3 years of life.

Data on growth and intelligence revealed no difference between children with prolonged and normal gestation in a small group examined at age 5.

There were no gross placental findings to support the hypothesis of placental senility as a cause of pathology in prolonged pregnancies.

A tendency was noted for prolonged pregnancy to recur in successive gestations.
POSTNATAL BONE GROWTH OF INFANTS WITH FETAL GROWTH RETARDATION
Authors: Wilson Miriam G. , Meyers Harvey I. , Peters Allen H.
Published: December 2021

Infants with fetal growth retardation, diagnosed by a birth weight less than the 10th percentile for gestational age, had shorter fibulas and retarded development of epiphyses at the knee, measured from radiographs, when compared to infants with normal weight for gestational age. The neonatal fibula growth rates of the infants with fetal retardation and normal infants were similar, indicating that most infants with fetal growth retardation grow postnatally at a normal rate. Of the 30 infants with fetal growth retardation, 3 showed profound failure of neonatal fibular growth. These infants had severe physiological disturbances in postnatal life resulting from congenital anomalies. In one of these infants, the failure of neonatal growth was evident 3 to 4 weeks before any other signs of her illness appeared.

It appears, therefore, that a small proportion—10% in this study—of infants with fetal growth retardation have significant congenital malformations that interfere with postnatal growth. The majority of infants who are small at birth for gestational age grow adequately at a normal rate during their neonatal life.
INTELLIGENCE OF THE UNIDENTIFIED PHENYLKETONURIC CHILD
Authors: Brown Eleanor S. , Waisman Harry A.
Published: December 2021

BESSMAN has raised a number of questions regarding treatment of patients with phenylketonuria (PKU), some of which can be answered by data presently available. The most important of these concerns the expected outcome for an untreated phenylketonuric child. If it is possible, as Bessman suggests, that PKU is often very benign and that we have identified only the atypical severe cases, then the apparent results of treatment may be due simply to observing the more usual course of the disease. Therefore, it is important to study a high-risk group of children who have not previously been tested for PKU. This group consists of those siblings who were already born at the time that the proband was diagnosed. Since routine testing for PKU has only been done recently, these children presumably have not been tested previously.

The number of PKU siblings expected in this group of previously untested brothers and sisters is partially dependent upon the frequency and degree of mental retardation in the disease as suggested by the following possibilities:

1. If mental retardation is incidental in PKU, then one fourth of these siblings would be expected to have PKU as determined by blood and urine tests, and their mental abilities, which might be normal, would be considered typical of untreated phenylketonuric individuals. This would also indicate that most families with PKU members have not been found during the past 10 years, when most cases were ascertained because of mental retardation.

2.If PKU causes severe retardation and urine and blood tests are done on all retarded children, then the first affected child would be identified as the proband in each family; all siblings born before the proband would be non-PKU, and all children with true PKU would be clearly identified.
THE BOBBLE-HEAD DOLL SYNDROME: A "TIC" WITH A NEUROPATHOLOGIC BASIS
Authors: Nellhaus Gerhard
Published: December 2021

A third patient with the "bobble-head doll syndrome" was reported. This is a "tic-like" movement disorder described thus far only in children. Its chief features are a 2 to 3 per second up-and-down or to-and-fro bobbing of the head, sometimes also of the trunk, which could be inhibited voluntarily and disappeared in sleep. Each child had chronic, slowly-progressive hydrocephaly, including marked enlargement of the third ventricle. In the patient presented here this was due to aqueductal stenosis, probably acquired; in the two patients presented previously a large cyst was found in the region of the third ventricle. Because surgical relief of hydrocephaly resulted in disappearance, or at least marked reduction of the head-bobbing, recognition of this "tic" with a neuropathologic basis is of therapeutic importance.
COMMITTEE ON NUTRITION
Authors: LOWE CHARLES U. , COURSIN DAVID BAIRD , HEALD FELIX P. , HOLLIDAY MALCOLM A. , O'BRIEN DONOUGH , OWEN GEORGE M. , PEARSON HOWARD A. , SCRIVER CHARLES R. , FILER L. J. , KLINE O. L.
Published: December 2021

THIRTEEN YEARS AGO a dietary approach to the therapy of phenylketonuria was proposed, and data on the usefulness as well as the very real limitations of this program have accumulated in the intervening years. At the present time studies on the application of special diets for use in this disease, as well as for many other hereditary metabolic diseases, are in progress. As wider use is made of procedures for detection of hereditary metabolic disease in the newborn, an increasingly larger number of patients who may benefit from appropriate nutritional therapy will be identified very early in life. For example, calculations based on the current birth rate and apparent incidence of phenylketonuria indicate that as many as 4,000 infants with this disorder in the United States alone could require dietary therapy in the next decade. There is, therefore, a need to evaluate the principles governing nutritional management of hereditary metabolic disease in order to develop optimal treatment facilities for use in conjunction with new detection methods. It seems anomalous that comparatively little has been done either to establish good treatment practices in hereditary metabolic disease or to mobilize scientific resources to ensure an optimistic out-come for therapeutic endeavors, while so much emphasis has been placed on detection.

Dietary treatment of hereditary metabolic disease is simple in theory; however, practical application may be unexpectedly difficult, or even hazardous, if not carefully supervised. It should be determined whether: (1) the untreated disease is in fact harmful, (2) the treatment is useful in preventing or reversing the unfavorable progression of the disease, (3) the therapy may be harmful by interfering with growth or development, and (4) the program may be harmful to others to whom it is inadvertently or inappropriately given.
Breathholding Spells
Authors: KIDD B. S. L. , PRICHARD J. S.
Published: December 2021

We have read with interest and admiration the recent paper by Drs. Lombroso and Lerman on breathholding spells (Pediatrics, 39:563, 1967) which does much to delineate the common cyanotic variety from the rare pallid variety. We wish to take issue, however, with their pathophysiologic considerations in the cyanotic variety and in particular with the "plausible combination of factors" leading to the attack (p. 575). No one would disagree with (2)—apnea leading to hypoxemia; but surely it is unnecessary to go further than this.
Down's Anomaly
Authors: ZELLWEGER HANS
Published: December 2021

The boom in genetics and, in particular, cytogenetics in the `60's has filled the shelves of our libraries. During the same period, however, only a handful of books on the best known of the chromosomal aberrations—mongolism—have been published. The appearance of a good book on mongolism is therefore most welcome. One of the authors, L. S. Penrose, has devoted over 30 years to this subject; the book reflects the special flavor which an original, and at times mathematically inclined, writer can bring to research.
MORTALITY FROM CONGENITAL CARDIOVASCULAR DISEASE IN OREGON
Authors: Menashe Victor D. , Osterud Harold T. , Griswold Herbert E.
Published: December 2021

Over one half of the deaths from all congenital malformations were due to congenital cardiovascular disease. There were 496 individuals who died of congenital cardiovascular disease in Oregon during 1957 thru 1961, and three fourths of the deaths occurred in infants under 1 year of age.

More males were affected by congenital cardiovascular disease than females, but, when congenital cardiovascular disease was present, the length of survival, as measured by life span, did not differ by sex.

One out of every four infants dying of congenital cardiovascular disease was of low birth weight; of these, 60% were over 37 weeks' gestation. However, there was no difference in the life span of low birth weight and normal birth weight infants who died with congenital cardiovascular disease. This would imply that the significant factor of death in these infants was the cardiac malformation rather than the low birth weight. One out of every three infants who died with congenital cardiovascular disease had malformations of other systems.

Fewer deaths than expected were identified among first born. Fetal deaths were noted more frequently in the population of mothers of children with congenital heart disease than in the overall population. The parental age in this group was significantly higher than in the general population and death rates of infants with congenital cardiovascular disease increased with advancing parental age. Thirty-two percent of the infants who died with congenital cardiovascular disease had single lesions.

Early diagnosis and treatment is to be stressed if mortality is to be reduced.
Jell-O-Water—An Adjunct in the Treatment of Infantile Dehydration
Authors: QUILLIAN WARREN W.
Published: December 2021

The objective of oral fluid therapy for the treatment of mild infantile gastroenteritis is the provision of adequate replacement of caloric, water, and electrolyte deficits without increasing stool losses. Solutions used to accomplish this should be accepted readily by the infant and be balanced to avoid accentuation of hypotonic or hypertonic conditions.

Jell-O-Water (85 gm package of Jell-O per liter of water) is an inexpensive and palatable mixture. The original package costs 10c. During the past few years we have found this solution useful in the oral treatment of mild dehydration during infancy.
Hazards of Glass Food Jars
Authors: GROSSMAN PERRY
Published: December 2021

I would like to call attention to a potential hazard to young infants which has received little or no publicity to my knowledge. I refer to the possibility of the glass in a standard baby food jar cracking underneath the label. This may go unnoticed until the child has consumed a substantial portion of the jar's contents.

We recently cared for a 1-year-old child who was involved in such a mishap. This child sustained lacerations of the pharynx with a retropharyngeal abscess.
Letters to the Editor
Authors: BUCKLEY REBECCA H.
Published: December 2021

Dr. Miller's point (suggested by the work of Kadowaki, et al.) is well taken that immunologically competent cells of maternal origin could likely survive in infants with thymic alymphoplasia and perhaps function as immunoglobulin-producing cells in the infant. We did not touch upon this point in our discussion because we had no karyotyping data on our patient and also because there was nothing present clinically to suggest a graft vs host reaction. In the case of Kadowaki, et al., the patient failed to grow after 3 months of age and was notably "runted."
Headaches in Children
Authors: LOCKE SIMEON
Published: December 2021

Headaches in Children is a collection of 10 essays divided almost evenly between those that deal with headache and those that deal with children. It is acknowledged that children are not miniature adults, but nothing about the pathophysiology, the clinical description, the mechanisms of development, or the pharmacotherapy of the disorder as described in this monograph suggests that headache is substantially different in children than in adults. Indeed, even the appropriate emphasis on psychological aspects of the juvenile headache syndrome shares this drawback.
DUTY OF CHILDREN TO PARENTS
Authors: C. T. E.
Published: December 2021

A little more than a century ago New England children between 10 and 13 years of age read and memorized passages in their readers which were frequently pious admonitions from the sermons and writings of the leading contemporary ministers, none of whom was more respected than William Ellery Channing (1780-1842). Yet children today, if their reading skills are up to it, will usually roll on the floor with disbelief and laughter when they read statements such as these taken from Channing's essay on the Duty of Children to Parents.

What greater monster can there be than an unthankful child, whose heart is never warmed by the daily expressions of parental solicitude; who, instead of requiting his best friend by his affectionate conduct, is sullen and passionate, and thinks his parents will do nothing for him, because they will not do all he desires?

Consider how much better they (parents) can decide for you than you can for themselves. You know but little of the world in which you live. You hastily catch at every thing which promises you pleasure; and unless the authority of a parent should restrain you, you would rush into ruin, without a thought or fear. In pursuing your own inclinations your health would be destroyed, your minds would run to waste, you would grow up slothful, selfish, a trouble to others, and burdensome to yourselves.
Pyelography, Cystography, Neuromuscular Blockade, and the Titles of Articles
Authors: LYON RICHARDS P.
Published: December 2021

In your April issue under Experience and Reason is a case described as "an unusual complication of retrograde pyelography; neuromuscular blockade." The article then goes on to describe the procedure of retrograde cystography carried out in perhaps a standard fashion with resulting filling of the upper urinary tracts under considerable distention due to failure of the ureterovesicle valve. The media used contained Neomycin, a known neuromuscular blockading agent. In the process of carrying out the cystogram, apparently rupture of the fornices of one of the kidneys took place, the dye then extravasating into the extraperitoneal tissues.
WILMS' TUMOR AND CONGENITAL HEMIHYPERTROPHY: REPORT OF FIVE NEW CASES AND REVIEW OF LITERATURE
Authors: Fraumeni Joseph F. , Geiser Clementina F. , Manning Miriam D.
Published: December 2021

Among 225 patients with Wilms' tumor seen at the Children's Cancer Research Foundation in Boston, 7 had congenital hemihypertrophy (a frequency of 1:32), bringing to 26 the number of cases reported in the literature with this association. In one child the cytogenetic study of leukocyte cultures revealed elongation of the long arms of both No. 16 chromosomes; each parent and two of four siblings had a similar anomaly affecting one chromosome of pair 16. Dermatoglyphics on this patient and three others in the series were unremarkable, as were studies of urinary gonadotropin excretion. From a review of all cases reported with Wilms' tumor and hemihypertrophy, little was found to indicate a relationship to other disorders, such as Silver's syndrome or neurofibromatosis, in which hemihypertrophy has been described. A role of inheritance was suggested in our series by one patient who had a sibling with hemihypertrophy, the seventh reported familial occurrence of this congenital defect. From the sparse evidence available, it would appear that the origins of hemihypertrophy are heterogeneous and include genic, chromosomal, and other factors which are presently obscure. The association between hemihypertrophy and Wilms' tumor may reflect common etiologic factors or a pre-neoplastic anlage in "hemihypertrophic" kidneys. Since hemihypertrophy seems to be related also to childhood neoplasms originating in the adrenal cortex and liver, further research on this anomaly should enhance our understanding of oncogenic mechanisms.
COMMITTEE ON FETUS AND NEWBORN
Authors: LUCEY JEROLD F. , BROWN AUDREY K. , BEARD ALICE GAMBLE , CORNBLATH MARVIN , GROSSMAN MOSES , LUBCHENCO LULA O. , METCOFF JACK , SCHAFFER ALEXANDER J. , SCHWARTZ ROBERT , GRUENWALD PETER , MURTAGH JUAN J.
Published: December 2021

THE physical design of and routine practices in neonatal units (especially nurseries for high-risk infants) are presently influenced almost entirely by considerations related to the risk of spreading infection in the nursery by fomites and personnel. The role of nursery design and specific routines in preventing epidemics is considered so important that the details are encoded in many local, state, and federal health laws or regulations. These are enforced by periodic inspections and conformity is made a prerequisite for official approval, allocation of funds, etc. Although there is little reason to doubt that these policies have had the effect of reducing the incidence of nursery epidemics, there is growing concern that official rigidity in these matters may interfere with optimal care of the very ill infant, as well as with research designed to improve care and find solutions to the overall problems of neonatal mortality and morbidity.

Infections are an important and frequent cause of disease in the newborn. They are, however, clearly outdistanced by major non-infectious disorders that account for the majority of deaths and brain damage in the neonatal period (respiratory distress, asphyxia, acidosis, hypoglycemia, and hyperbilirubinemia). Some of the precautionary techniques used to reduce the risk of infections have the practical disadvantages of making it difficult (1) to approach the neonatal patient and (2) to apply modern diagnostic maneuvers and therapeutic aids in order to improve the neonatal patient's chances for intact survival. As a result the nursery-based infants in this country are, in general, quite well protected from the risks of nosocomial infections; but, they receive less than ideal management for cardiorespiratory disorders, a major cause of neonatal mortality.

It is obvious that new solutions are required to solve the problem of hospital care of the sick neonate. Unfortunately, both the search for new approaches to neonatal care and the application of some newly established knowledge are now being impaired by rigid rules and construction codes which do not permit innovation. Although these rules cannot be completely abandoned until safe alternatives have been demonstrated, the Committee believes that public health administrators and hospital committees must permit cautious, responsible exploration and evaluation of new approaches to the multiple problems involved.
ACCEPTANCE OF THE PRESIDENCY OF THE AMERICAN ACADEMY OF PEDIATRICS
Authors: Logan George B.
Published: December 2021

THIS change of blue to purple ribbon on my badge is a great honor. I thank you for selecting me to serve the Academy in this way. However, acceptance of the presidency at this time gives me some feelings of trepidation, despite your support and the support of a strong Executive Board and Central Office staff.

American medicine is undergoing revolutionary changes: scientifically and educationally as well as in its methods of delivery. Pediatrics as a major division of medicine is not exempt from these changes. Government is playing an ever-increasing role in medical activities. Whether we agree with these changes or not is beside the point. The fact is, they are with us. But these changes are not unique to the United States. They seem to be part of worldwide scientific and social alterations.

This year, you as Academy members must become accustomed not only to the usual yearly change of a president but also to a change of executive directorship. Dr. Christopherson's years in this office have been years of tremendous accomplishment. We are all confident that Dr. Frazier's will be the same.

Those of us to whom the mantles of responsibility are being given are grateful for the firm foundation that has been built by our predecessors in office. We shall, to the best of our ability, face present and future problems with equanimity, dispatch, good sense, and the best possible judgment.

As we undertake these tasks we shall always keep before us the section of our Constitution which states: "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."
COMMITTEE ON NUTRITION
Authors: LOWE CHARLES U. , COURSIN DAVID BAIRD , HEALD FELIX P. , HOLLIDAY MALCOLM A. , O'BRIEN DONOUGH , OWEN GEORGE M. , PEARSON HOWARD A. , SCRIVER CHARLES R. , FILER L. J. , KLINE O. L.
Published: December 2021

FOR MORE than 40 years it has been known that vitamin D is essential for maintenance of normal calcium metabolism in man. Efforts over this period have been directed toward establishing an adequate intake of vitamin D throughout the population. National advisory committees in many countries have formulated recommended allowances for the various age groups, public health education programs have stressed the need for the vitamin and the value of sunshine, and the vitamin has been made available to the population at large through provision of inexpensive vitamin supplements and, more recently, the enrichment of milk and a number of commonly used foodstuffs. In consequence, vitamin D deficiency rickets, once a common pediatric problem, is now relatively rare in the United States and other parts of the world.

On the other hand, it has also long been known that vitamin D is potentially dangerous in very high dosage. It had been thought originally that the margin of safety between the requirement of vitamin D and its toxic dosage was very great. However, reports from Great Britain and Switzerland in 1952 drew attention to a group of infants with unexplained hypercalcemia. Additional cases of infantile hypercalcemia began to appear throughout the British Isles, and patients with mild or severe manifestations have been reported in the United States, Canada, and elsewhere. On the basis of circumstantial evidence, vitamin D was implicated in the pathogenesis of the disease, and, as a result, there has been a growing question about the safety of vitamin D intakes which appreciably exceeded the 400 I.U. daily allowance currently recommended for prevention of vitamin D deficiency during growth, pregnancy, and lactation.
Low-Phenylalanine Diets for Pregnant PKU Heterozygotes Are Unnecessary
Authors: BROWN ELEANOR S. , WAISMAN HARRY A.
Published: December 2021

Stevenson and Huntley (Pediatrics, 40:33, 1967) suggest that high maternal plasma phenylalanine levels do not invariably cause intrauterine damage to the developing fetus, but they do not suggest how high the level can be without causing damage. In pregnant heterozygotes, Kang and Paine found fasting levels as high as 6 mg/100 ml (modification of Udenfriend and Cooper decarboxylation method) and 13 mg/100 ml (LaDu method), and these levels were no higher when the infant was PKU than when the infant was normal.
THE LUNG, TRACHEAL FLUID, AND LIPID METABOLISM OF THE FETUS
Authors: Scarpelli Emile M.
Published: December 2021

The thoracic wall provides the major retraction force for the liquid filled fetal lung. This could assist the movement of air into the lung at birth.

The tone of the respiratory muscles in utero may set intrapulmonary pressure levels and facilitate movement of tracheal fluid out of the lungs.

Surface rather than elastic forces probably are most important in determining the static work of breathing in the newborn.

The lung is a source of tracheal fluid, and possibly amniotic fluid, phospholipids.

Albumin may be an important stabilizer of tracheal fluid phospholipids.

The lung synthesizes tracheal fluid phospholipids rapidly. Phosphatidyl ethanolamine is probably an important precursor of lecithin and this conversion may take place within tracheal fluid itself.

These studies confirm our previous findings that the first fraction obtained from the Sephadex separation of lung extracts contains the lung surfactant system and that lung surfactant is not lipoprotein.

There is little transfer of lipids from the fetus to the ewe.

Phospholipids probably are synthesized by brown adipose tissue in the fetus; lipids do not cross the fetal blood brain barrier.

The implications of these studies to pathogenesis of the respiratory distress syndrome was discussed.
PROTECTION AGAINST Rh SENSITIZATION AND PREVENTION OF ERYTHROBLASTOSIS FETALIS
Authors: Diamond Louis K.
Published: December 2021

Rarely has it been our good fortune to have a disease recognized, its cause clearly determined, its treatment successfully developed to a great extent, and then its prevention found, all in one generation. It is gratifying to be able to review such a sequence of events, especially the latest advance. In 1932, we1 drew together and defined as a single entity, generally called erythroblastosis fetalis, four conditions previously described separately, namely late fetal death with erythroblastosis in the tissues, fetal hydrops, congenital anemia of the newborn, and icterus gravis neonatorum.In 1941, Philip Levine and coworkers2 astutely surmised that the disease resulted from immunization of the mother against a blood group factor of her infant and the development of hemolytic anemia in the baby from the transplacental passage of maternal antibodies.
HEAD CIRCUMFERENCE FROM BIRTH TO EIGHTEEN YEARS
Authors: Nellhaus Gerhard
Published: December 2021

Head circumference graphs for boys and girls from birth to 18 years of age, calculated from reports in the world literature published since 1948, are presented.

No significant racial, national, or geographic differences in head circumferences were found.

A single "normal" head circumference, that is one which lies within two standard deviations above and below the mean for age and sex, may prove misleading, since it gives no clue as to rate of head growth. Serial head circumference measurements should, therefore, be a routine part of the physical examination of infants and children. When such measurements are plotted on the composite graphs, abnormal growth patterns are readily discernible. Rapid upward deviation may signify correctable conditions, such as hydrocephalus, subdural hematomas or effusions. Marked slowing or arrest of head growth offers a poor prognosis for mental development. But even a single measurement outside the range of normal should lead to further evaluation of the child.
NONBULLOUS CONGENITAL ICHTHYOSIFORM ERYTHRODERMA: A CASE TREATED WITH METHOTREXATE
Authors: Esterly Nancy B. , Maxwell Elizabeth
Published: December 2021

A 7½-year-old girl with severe congenital ichthyosiform erythroderma of the nonbullous (recessive) type has shown considerable improvement in physical appearance and joint mobility with weekly oral doses of methotrexate. The rationale for such therapy is the finding of increased epidermal proliferative activity analogous to that seen in psoriasis, a condition which responds to mitotic inhibitors. The possibility of longterm toxic effects secondary to treatment should be recognized.
The Innocent Murmur, A Problem in Clinical Practice, edited by Cesar A. Caceres, M.D., and Lowell W. Perry, M.D. Boston: Little, Brown and Company, 1967, 300 pp., $13.50
Authors: Wolf Katharine
Published: December 2021

This book grew out of a panel discussion of the innocent murmur by an impressive group of experts, clinicians, and researchers in cardiology. The problem of the innocent murmur is indeed an important one. The incidence of innocent murmurs has not been determilled to everyone's satisfaction; a table of studies in this book gives figures ranging from 1.7 to 100% of patients examined. But, everyone agrees that it is important for the physical, mental, and financial health of the patient to differentiate the innocent from the organic murmur.
A SYNOPSIS OF CHILDREN'S DISEASES, by John Rendle-Short, M.A., M.D., M.R.C.P., D.C.H. and O.P. Gray, M.B., Ch.B., M.R.C.P., D.C.H. Baltimore: The Williams and Wilkins Company, 1967, 684 pp., $10.50
Authors: Cone Thomas E.
Published: December 2021

The appearance of new editions of both these synopses of pediatrics must mean that they fill a need in the education of the medical student and practitioner. Perhaps, as textbooks become larger and more expensive and as time for leisurely reading for most of us becomes increasingly hard to find, books such as these which attempt to assemble in a tidy fashion the relevant facts the pediatrician needs to know will continue to be read by an everwidening number of readers.
RELATION OF MEDICINE TO THE PROBLEM OF RADIOACTIVE FALLOUT
Authors: Farr Lee E.
Published: December 2021

I have one additional item for the conference—a recommendation Dr. Joseph Sternberg wishes to bring before you to determine whether the conference participants are in agreement.

Throughout this conference many participants stressed the pediatric importance of radioactive isotope contamination before or during pregnancy. It is evident that studies of the effects of ionizing radiation upon the child must be begun even before the time of conception.

Therefore, this conference places upon the record the recognition of the great desirability and need of establishing closer and more effective liaison between appropriate public health officials, health physicists, radiobiologists, nuclear medicine physicians, obstetricians, and pediatricians that the problems faced by the conference may be more effectively and rapidly solved, and the members of this conference request this record be brought before appropriate organizations of each group for such further implementation as they may determine.

Is it the sense of this conference that this action be taken?

Let the record show that it is so ordered.

Dr. Seeds: I think we would be remiss if we became so engrossed in science as to forget the courtesy that the American Academy of Pediatrics has extended to all of us. I assert the privilege of giving them our thanks.

Dr. Farr: Thank you Dr. Seeds. There being no further items for discussion, the meeting stands adjourned.
MODEL FOR THE INVESTIGATION OF INTRACTABLE HYPOGLYCEMIA: INSULIN-GLUCOSE INTERRELATIONSHIPS DURING STEADY STATE INFUSIONS
Authors: Adam Peter A. J. , King Katherine , Schwartz Robert
Published: December 2021

The relationship between blood glucose and Plasma insulin concentrations in hypoglycemic infants was contrasted to that observed in normal subjects while maintaining blood sugar levels in a physiological range. Glucose was infused continuously by peripheral vein at four constant rates in sequence to the following groups of subjects: (1) nine normal adults, (2) four normal infants, (3) five children who had diabetes, and (4) four infants who had intractable hypoglycemia.

There was a direct relationship between blood glucose and plasma insulin concentrations in both normal groups. Although the relationship between blood glucose and plasma insulin concentrations was similar, normal infants disposed of the exogenous glucose load more rapidly than normal adults. Hypoglycemic infants had one of two responses: (1) moderate hyperinsulinemia at low blood glucose concentrations, or (2) low insulin concentrations at all blood glucose levels, a response similar to that observed in the diabetic children.
DEVIANT GENDER ROLE BEHAVIOR IN CHILDREN
Authors: G. M.
Published: December 2021

Deviant gender role behavior, reviewed in this issue by Bakwin, presents the practicing pediatrician with an infrequent but generally difficult, frustrating clinical problem–difficult because so little is known about the genesis of such disorders and frustrating because the effectiveness of one's therapeutic efforts is so difficult to assess.

There are no data on the incidence of such gender role problems as effeminacy in boys; indeed, there are few reports of any kind related to this problem. Although it is suggested that there is a significant relationship of adult homosexuality to deviant gender role behavior in children, there are no hard data to support this inference.
THOMAS PHAIRE (1510?-1560) AND HIS PRESCRIPTION FOR TREATING ENURESIS
Authors: C. T. E.
Published: December 2021

Every major pediatric textbook in use today will state that the treatment of enuresis in children is often slow and difficult. In fact, there is probably no other symptom for which so many therapeutic regimens have been suggested.

In Thomas Phaire's Boke of Chyidren, published in 1545 and the first pediatric text written in English, enuresis was treated in the following way:

Many times for debilitie of vertue retentiue [power of retention] of the reines [kidneys] or bladder as well old men as children, are often-times annoied, whā their urine issueth out either in their slepe or waking against their willes, having no power to reteine it whan it cōmeth, therefore if they wil be holpē, [helped] first they must avoid all fat meates til the vertue retentiue be restored again, & to use this pouder in their meates and drinkes.

Take the wesande [windpipe] of a cocke, and plucke it, then brenne [burn] it in pouder, and use of it twyse or thryse a daye. The stones [testicles] of an hedgehogge poudred is of the same vertue.

Item the clawes of a goate, made in ponder dronken, or eaten in pottage. If the pacient be of age, it is good to make fyne plates of leade, with holes in them, and lette them lye often to the naked backe.1

Perhaps, Phaire's powders might still give results equal to those obtained by the use of the drugs we now use in the treatment of enuresis.
SERUM FOLATE DEFICIENCY IN CHILDREN RECEIVING ANTICONVULSANT THERAPY
Authors: Miller Denis R.
Published: December 2021

The occurrence of megaloblastic anemia is not uncommon in adults receiving anticonvulsant therapy, but it rarely occurs in childhood. Macrocytosis and subnormal serum folate have been reported in many adults receiving anticonvulsant therapy. Hematologic studies including assays of serum folic acid were performed in 37 epileptic children receiving various anticonvulsant regimens and 20 healthy children. Values for hemoglobin, hematocrit, red cell count, red cell indices, and Arneth (polymorphonuclear lobe) counts were not significantly different in the two groups. Serum folate levels were significantly lower in the childiren receiving anticonvulsant drugs-mean 6.4 ± 4.8 mµg/ml compared to 12.7 ± 5.1 mµg/ml in the controls. Subnormal folate levels were found in 51% of epileptic children and slight macrocytosis was found in 19%, all of whom had subnormal folate levels. None were anemic. There was no correlation between the Serum folate level and either the age of the patient or the duration of anticonvulsant therapy. Although the exact etiology of subnormal folate levels is unknown, anticonvulsant drug-induced folate deficiency may be necessary for adequate seizure control.
FUNCTIONING ISLET CELL ADENOMA IN THE NEWBORN
Authors: Salinas Ezequiel D. , Mangurten Henry H. , Roberts Stuart S. , Simon William H. , Cornblath Marvin
Published: December 2021

Persistent hypoglycemia in the neonate is rare and may be due to inborn errors of carbohydrate metabolism, islet cell tumors, or unknown causes. A patient with the onset of symptomaric hypoglycemia at 36 hours of age had persistent hypoglycemia in spite of therapy with corticosteroids, A.C.T.H., Diazoxide, glucagon, parenteral glucose and fructose. She showed a normal hyperglycemic response to glucagon. Plasma insulin values were not diagnostic. At surgery, at 7 weeks of age, a discrete islet cell adenoma was found and removed with the body and tail of the pancreas. The spleen was not removed. Following surgery, she had a transient hyperglycemia and required insulin for 8 days with a wound infection. She has remained normoglycemic.
Sex Chromatin Survey in 3,000 Newborn Infants in Mexico
Authors: Márquez-Monter Héctor , Carnevale-López Alessandra , Kofman-Alfaro Susana
Published: December 2021

A survey of sex chromatin was carried out in 3,000 newborn children at the General Hospital of Mexico City; 1,484 were males and 1,516 were females. In the male group 4 infants (0.26%) had positive chromatin and were considered to have a possible XXY or XXYY constitution. In the female group 3 infants (0.19%) did not show sex chromatin and were possible carriers of an XO complement. No correlation was found between the maternal age and number of pregnancies and the discrepant children. A comparison was made between the results obtained in this study and similar studies carried out in other countries. Fourteen instances of congenital abnormalities were found in this study; Down's syndrome was the most frequent (1/750-0.13%).
Recurrent, Abdominal Pain of Organic Cause
Authors: Schmitt Barton D.
Published: December 2021

Dr. Donald G. Marshall's recent article1 on recurrent abdominal pain was greatly needed. His psychological comments are excellent and mark him as an exceptional surgeon, however, there are two points worthy of comment.

He emphasizes several times that "psychic recurrent pains are quite uncommon under 5 years of age." This is incorrect. It is based on Figure 1 (p. 17) of John Apley's beautiful monogram.2 Figure 1 illustrates the incidence of recurrent abdominal pain in 100 unselected school children, none of whom are under 5 years of age.
Letters to the Editor
Authors: Coleman Allan B.
Published: December 2021

I cannot disagree with Dr. Wolf's feeling that children are somewhat conditioned to look upon medicine tablets as confections, but I disagree with the conclusion that this is all caused by flavored medications in tablet form. Certainly, flavored tablets can be presented to children in such a way as to make clear the distinction between medicine and food. After all, many things in our milieu are dangerous if misused–the automobile being a prime example–but are not likely to be prohibited because of other advantages.
Indications for Fetal Transfusions
Authors: Bowman John M.
Published: December 2021

Two statements in Dr. Jenold Lucey's paper, "Current Indications and Results of Fetal Transfusions" (Pediatrics, 41:139, 1968), run counter to our experience in Winnipeg.

If a fetal transfusion is required before the twenty-eighth week of intrauterine life, we do not find "the risk to be very high." In the 26-month period ending January 2, 1968, 63% of all fetuses undergoing initial intrauterine transfusions before 26 weeks gestation have survived. Using exactly the criteria for fetal transfusion outlined by Doctor Lucey (his last sentence on page 139) , we have found it necessary to subject 27 fetuses–50% of all those undergoing transfusion–to their initial procedures before the twenty-sixth week of intrauterine life.
Common Symptoms of Disease in Children, by R. S. Illingworth, M.D., F.R.C.P., D.P.H., D.C.H. Philadelphia: F. A. Davis Company, 1967, 270 pp., $8.00
Authors: Webb Clarence H.
Published: December 2021

Those who deplore the shift away from careful clinical observations to dependence on the laboratory and the machine should be delighted with Professor Illingworth's latest book. The evidences of meticulous study of infants, children, and parents in the office and the home, regardless of how simple or humble the topics may seem, will give many American pediatricians a nostalgic recall of Joseph Brennemann or Katherine Dodd.

The author admittedly has written for the general practitioner and pleads guilty in the preface to a lack of profundity, repeatedly advising the practitioner to consult a specialist when in doubt.
The Newborn Child, ed. 2, by David G. Vulliamy, M.D., M.R.C.P., D.C.H. Boston: Little, Brown and Company, 1967, 182 pp., $9.50
Authors: Smith Clement A.
Published: December 2021

This is a good book, its narrow span wellfilled with information and good sense. It is also, to the American reviewer, a peculiar book, whose purpose might perhaps be differently met on this side of the Atlantic. Good as it is, one sometimes wonders if the purpose is sufficiently met on the other side of the Atlantic also.

First as to the book itself: Dr. Vulliamy, consultant paediatrician to West and East Donset Groups of Hospitals, hopes it "will provide a short general guide to help anyone entering medical practice after only a brief experience with the newborn child."
ENANTHEMS ASSOCIATED WITH UNCOMMON VIRAL SYNDROMES
Authors: Forman Marjorie L. , Cherry James D.
Published: December 2021

Viral studies were done on 37 patients with enanthems and 17 well persons during the summer and fall of 1966; two-thirds of each group were 3 years old or less. Twenty-nine (84%) of the ill patients and 3 (18%) of the control patients had evidence of viral infection. Although all ill patients were referred to us because of an enanthem, it is significant that the oral signs were often only part of broader disease. The most common concurrent sign was exanthem, found in 17 of 37 ill patients. Six of 11 patients with Coxsackie A4 infection had rash which began with or after defervescence as red macules and papules on the face and trunk and lasted 1 to 4 days before disappearing or becoming vesicular. The vesicular lesions persisted 1 to 2 weeks. Exanthem was also present in Coxsackie B2 and A5-12 associated illnesses. Of 10 patients infected with Coxsackie A 16 virus, 6 had significant submandibular adenopathy, and 2 of 5 with exanthem had urticaria. In several ill patients laboratory findings were unexpected in view of clinical diagnoses. This was particularly true with herpetic stomatitis and incomplete hand, foot, and mouth syndrome.
HEXOSE AND PROTEIN TOLERANCE TESTS IN CHILDREN WITH LIVER GLYCOGENOSIS CAUSED BY A DEFICIENCY OF THE DEBRANCHING ENZYME SYSTEM
Authors: Fernandes J. , van de Kamer J. H.
Published: December 2021

Galactose and fructose, administered orally to five children with liver glycogenosis due to deficiency of the debranching enzyme system, were found to be rapidly converted into glucose. A fluctuating glucose curve and a significant rise of blood lactate were observed during oral hexose challenge. Some proteins and amino acid mixtures, administered orally, induced a small and prolonged rise of blood glucose.
LONGITUDINAL EEG-CLINICAL CORRELATIONS IN CHILDREN FROM BIRTH TO 4 YEARS OF AGE
Authors: Torres Fernando , Blaw Michael E.
Published: December 2021

One hundred-thirty children who had an EEG during their first days of life and who were registered in a clinical longitudinal study were followed with concurrent clinical and EEG examinations every 4 months for the first year of life and at 2, 3, and 4 years of age. Thirty children had EEG characteristics which are frequently considered abnormal in their neonatal record. Twenty-three children had clinical abnormalities during the 4-year period covered by the study. There was no significant correlation between a single EEG and clinical abnormalities at any age. Newborn infants with more than one focal abnormality in their EEG presented clinical abnormalities more frequently than those with a single focus. The difference, however, did not attain statistical significance. Children with an abnormal EEG at birth and an additional abnormal record later, had a higher incidence of clinical abnormalities than those with only an abnormal neonatal EEG. However, this finding is of questionable significance because the children who had clinical abnormalities had a larger number of EEG's than the normal subjects.

It is expected that continued follow-up of these children at more advanced stages of their development may give a positive EEG-clinical correlation which was not found in this study.
XY/XYY MOSAICISM IN A PREPUBERTAL BOY WITH TALL STATURE, PROGNATHISM, AND MALFORMATIONS OF THE HANDS
Authors: Kajii Tadashi , Neu Richard L. , Gardner Lytt I.
Published: December 2021

A 10-year-old boy with learning difficulties, tall stature, prognathism, malformations of the hands, and abnormal dermatoglyphics is reported. Chromosomal analyses revealed an XY/XYY mosaicism with 3.5% XY and 92% XYY cells. Labelling studies of the chromosomes revealed that the two Y chromosomes in the XYY cell line replicate similarly and later than the other members of the C group. This appears to be the first described case of XY/XYY mosaicism.
ALLIED HEALTH WORKERS IN PEDIATRICS
Authors: Yankauer Alfred
Published: December 2021

An article summarizing the developments and concerns of the junior college1 may seem to be keeping strange company in a pediatric journal. Yet, the extraordinary growth spurt of this educational institution in recent years is far from remote to the issues facing pediatric practice in the United States. From global analyses of health manpower requirements and from the outcries of the consumer and health professional alike, comes the message that more personnel are needed to deliver health services to children. The growth of junior colleges and the development of "community" colleges as extensions of the public education system are healthy expressions of an American capacity for adjustment and innovation in the face of the personnel demands of a technological society.