bluuebunny/crossref_metadata_2025 huggingface dataset:
TREATMENT OF OMPHALOCELE BASED ON INDIVIDUAL CHARACTERISTICS OF THE DEFECT
Authors: Wesselhoeft Conrad W. , Randolph Judson G.
Published: December 2021

The treatment of 27 infants presenting with omphalocele or gastroschisis was analyzed. Several different methods of therapy were available, but various treatment plans were chosen on an individual basis. The defects were classified according to the size of the anomaly, the presence or absence of sac rupture, and the presence of coexisting abnormalities. Infants with intact omphalocele sacs less than 5 cm in diameter were best treated by surgical closure of the musculofascial defect or by skin closure alone. Intact omphaloceles over 5 cm in diameter or those associated with other life-threatening anomalies were treated conservatively with local applications of mercurochrome. Ruptured omphalocele or gastroschisis required immediate surgical coverage. If skin closure was not possible, a plastic prosthesis of Silastic covered Marlex was useful as a temporary cover for the exposed intestine. Infectious complications from the exposed prosthesis were minimized by the use of 0.5% silver nitrate dressings. An overall survival rate of 70% was obtained using the most appropriate treatment plan for the particular anomaly.
Anaerobic Collection and Storage of Blood Micro Samples
Authors: Klein M. , Heese H. de V. , Harrison V. C. , Abel Lydia
Published: December 2021

A simple method for taking anaerobic blood micro samples directly from indwelling arterial, venous, and cerebrospinal fluid needles or catheters is described. This method allows full advantage to be taken of the micro techniques available for blood-gas and acid-base analysis.

The tubes may be stored in metal thermometer cases which have previously been imbedded in ice.
Night Cries in Little Girls
Authors: Levin S.
Published: December 2021

If a young girl wakes at night with loud cries, or complains during the course of the evening that she has a "sore wee," there is a good chance that the cause will be found by opening the labia and observing a pinworm moving over the hymen. Nocturnal restlessness due to pinworms affects boys as well as girls.
Cytogenetic Analysis of Postmortem Cultured Leukocytes
Authors: Harrod Emma K. , Cohen Maimon M.
Published: December 2021

Cytogenetic analysis was successful in 32 of 37 fetuses and children whose peripheral leukocytes were cultured between 2 and 288 hours after death. Viable leukocytes from older infants and children were obtained tip to 48 hours postmortem and as late as 117 hours postmortem from young fetuses. Blood from infants whose body temperatures remained at 25°C or greater for prolonged periods after death usually failed to grow, as did cardiac blood after exposure to hypertonic medications used for resuscitation. Bacterial or fungal contamination of blood did not prevent successful cultures, and chromosome breakage compared favorably with that in routine cultures.
Co-existing Guillain-Barré and Visceral Larva Migrans Syndromes
Authors: Phillips John A. , McLean William T. , Huntley Carolyn C.
Published: December 2021

We have recently observed a patient with both the Guillain-Barré syndrome and the visceral larva migran syndrome. This may indeed be a chance association, but we report the case in hopes that we will be informed of similar patients elsewhere if they exist.

A 2 and 8/12-year-old Negro male was admitted to the North Carolina Baptist Hospital on December 4, 1968. He had developed coryza, fever, and cough 8 days previously; this was followed in 4 days by weakness of the legs, which progressed to involve the trunk and upper extremities.
Albumin Metabolism in Cystic Fibrosis
Authors: Johnson A. Myron
Published: December 2021

The study by Strober, Peter, and Schwartz, "Albumin Metabolism in Cystic Fibrosis," demonstrates without question that there is a correlation between serum albumin levels and plasma volume. Causal relationships are more difficult to ascertain, however.

It has been well documented that alterations in colloid osmotic pressure result in inverse alteration of albumin synthesis in normovolemic subjects. The previous studies cited by Strober, et al. have all demonstrated, and frequently commented upon, the correlation between hypoalbuminemia in cystic fibrosis patients beyond infancy and elevated levels of immunoglobulins and, when measured, α1- and α2-globulins.
Bile Plugs and Bile Sludge
Authors: Harris Ruth C.
Published: December 2021

Doctors Bernstein, Braylan and Brough have called attention to a rare but important cause of extrahepatic biliary obstruction, namely, bile sludge. Curiously, even though bilirubin conjugation normally does not occur before birth, gallstones have been found in the bladders of stillborn fetuses; also, maternal hyperbilirubinemia over a period from the seventh to the ninth fetal month has resulted in the development of complete maturation of the glucuronyl transferase system by the time of birth. It is important to consider such sludge or even stones in young infants who have signs of biliary obstruction so that appropriate surgical intervention may be considered.
Letter to the Editor
Authors: Bernstein Jay , Brough A. Joseph
Published: December 2021

Dr. Harris raises some interesting points about bilirubin metabolism in the fetus. She may be right in postulating that increased bilirubin production resulting in prehepatic overload is of importance in causing bile "sludge," an apt term. Hepatocellular damage may also play a role.

We (pathologists) would not have thought that conjugation does not normally take place before birth. Meconium is green, and the gallbladder usually contains some bile, even in stillborns. The rate of conjugation may ordinarily be low, in part because the load of bilirubin is low, and a capacity to respond under abnormal conditions does seem, as Dr. Harris notes, to be present.
THE CONTROL OF RUBELLA
Authors: Meyer Harry M. , Parkman Paul D. , Hopps Hope E.
Published: December 2021

An attenuated strain of rubella virus was established by passage of the virus in primary African green monkey kidney cell cultures (GMK). In the first rubella vaccine clinical trial with seventy-seventh passage GMK material, none of eight inoculated children evidenced rubella-like illness and all developed antibody. The vaccine-induced infections were not transmitted to intimate contacts. Trials with large numbers of children confirmed the early findings of safety and immunogenicity of the vaccine. The second successfully attenuated virus, the Benoit strain, was developed by Hilleman and co-workers by adapting low GMK passages of virus to duck embryo cell cultures (DE). The Benoit strain, tested at several levels of tissue culture passage, designated A, B, C, D, and E, served as a clear demonstration of how rubella virus is modified by passage in mammalian or avian cells. Vaccines prepared from A and B level materials were not suitable, since they were either communicable or produced rubella-like symptoms. The C and D level materials were attenuated, but the higher passaged E level vaccine was termed "over-attenuated" since it induced antibody in only 60% of the vaccinees. More recently, the Cendehill strain, attenuated in primary rabbit kidney cell cultures (RK) and the RA 27/3 strain, attenuated in WI-38 cells, have been tested clinically.

Vaccines which are now being produced by biologics manufacturers and considered candidates for license in the United States are: the HPV-77 strain passed 5 times in DE(HPV-77, DE5); the HPV-77 strain passed 12 times in dog kidney (DK) cell cultures (HPV-77, DK12), and the Cendehill strain passed 4 times in GMK and 53 times in RK (Cendehill GMK 4, RK 53). With each of these vaccines, antibody was detected in 90 to 100% of recipients.

Fully attenuated rubella virus vaccines have not produced significant clinical reactions in children. However, mild rubella-like symptoms have been observed in adult women receiving vaccine; transient rashes, lymphadenopathy, arthralgia, and arthritis have been observed. Since the risk of spread of attenuated virus to the fetus in vaccinated women cannot be readily determined, the use of the vaccine during pregnancy would be potentially hazardous.

Intranasal challenge of HPV-77 vaccinees with natural rubella virus demonstrated that vaccine-induced antibodies were protective against the clinical and virologic manifestations of rubella. Observation of vaccinated children over a 3-year period has demonstrated little evidence of a decline in the antibodies.
INFLAMMATORY RESPONSE IN THE NEONATE RE-EXAMINED
Authors: Bullock Joseph D. , Robertson Alex F. , Bodenbender Joann G. , Kontras Stella B. , Miller Charles E.
Published: December 2021

The inflammatory response was studied in 84 neonates by the skin window technique. Slides were changed 2, 4, 6, and 24 hours after skin abrasion. Polymorphonuclear cells were the dominant cell in all windows but decreased with time. Mononuclear cells increased with time but never rose above 40%. Eosinophilia in the early exudate was not a consistent finding, but 13 of 61 babies over 24 hours of age had a marked early skin window eosinophilia. A possible correlation between early skin window eosinophilia and an allergic diathesis is suggested.
RED CELL METABOLISM IN THE NEWBORN INFANT. V. GLYCOLYTIC INTERMEDIATES AND GLYCOLYTIC ENZYMES
Authors: Oski Frank A.
Published: December 2021

Previous studies demonstrated that the erythrocytes of the newborn infant have a relative phosphofructokinase deficiency and inappropriate glucose consumption for cell age. In view of these findings, an analysis of red cell glycolytic intermediates and all Embden-Meyerhof pathway enzyme activities was made in the red cells of infants, normal adults, and subjects with reticulocytosis to define further differences in metabolism and search for evidence of a metabolic blockade.

The erythrocytes of subjects with reticulocytosis were found to possess increased quantities of glucose-6-phosphate, fructose-6-phosphate and 2,3-diphosphoglycerate. The elevation of the hexose phosphates was even greater in the red cells of the premature infants and was associated with a decrease in levels of 2,3-diphosphoglycerate and phosphoenolpyruvate.

Measurement of enzyme activities indicated that, in addition to the phosphofructokinase deficiency, the cells of the newborn infant have markedly increased activities of enolase and phosphoglycerate kinase.

It is suggested that the increase in the level of the hexose phosphates in the erythrocytes of the infants and subjects with reticulocytosis is a reflection of this relative phosphofructokinase deficiency, with this deficiency being greater in newborn infants. The differences in the enzymatic profile between the erythrocytes of the newborn and those of the normal adult is not solely a function of their younger age. Some of the differences are a reflection of the presence of a cell unique to this period of life.
IRIDOCYCLITIS IN JUVENILE RHEUMATOID ARTHRITIS
Authors: Schaller Jane , Kupfer Carl , Wedgwood Ralph J.
Published: December 2021

Eight of 70 children with juvenile rheumatoid arthritis have developed iridocyclitis. This complication occurred more frequently in patients with monoarticular and pauciarticular disease (29%) than in patients with polyarticular disease (2%). Seven of eight patients with iridocyclitis have monoarticular or pauciarticular disease; none has had prominent systemic manifestations or evidence of ankylosing spondylitis. Iridocyclitis preceded joint manifestations in two of the patients and followed arthritis by 1 to 10 years in six of the patients.

Activity of iridocyclitis and arthritis seemed unrelated; four patients developed iridocyclitis while arthritis was inactive. In seven children iridocyclitis began insidiously without acute symptoms. Eye involvement has remained unilateral in six patients. Six children have had significant decrease in visual acuity, and six continue to have active ocular inflammation despite therapy.

Iridocyclitis is potentially a major cause of disability in juvenile rheumatoid arthritis. Early signs and symptoms may be minimal. Patients at risk are those with limited forms of joint disease. Early detection and therapy are crucial for prevention of permanent ocular damage. Careful eye examination should be a routine part of physical examination of children with rheumatoid arthritis, and periodic slit lamp examinations should be performed even when arthritis is in remission.
HYPOXEMIA DURING RECOVERY FROM SEVERE HYALINE MEMBRANE DISEASE
Authors: Adamson T. M. , Hawker J. M. , Reynolds E. O. R. , Shaw J. L.
Published: December 2021

Serial samples of arterial blood were taken during the illness of 10 infants with severe hyaline membrane disease, four of whom required mechanical ventilation. After the first few days of the illness had passed, there was little true right-to-left shunting of blood, but severe hypoxemia was found during the breathing of room air. Normal gas exchange was present by a mean time of 14 days from birth in infants who did not require mechanical ventilation, but it was delayed for many weeks in mechanically ventilated infants. From the results of blood gas analyses during air and oxygen breathing, it is concluded that hypoxemia during recovery from hyaline membrane disease is probably caused by inequalities of ventilation and perfusion in the lungs. Careful monitoring of the arterial oxygen tension is necessary so that an appropriate concentration of oxygen can be given in the inspired gas.
GIANT HYDRONEPHROSIS IN CHILDREN
Authors: Uson Aurelio C. , Levitt Selwyn B. , Lattimer John K.
Published: December 2021

Giant hydronephrosis in children, and particularly in infants, is frequently responsible for abdominal masses. High dose intravenous urography has proved very useful in studying the degree of pyelocalyceal dilatation, as well as the amount of residual renal parenchyma and the possible recovery of these kidneys. Reparative surgery, rather than primary nephrectomy, should always be considered. Renal transplantation may save those with giant bilateral hydronephrosis who appear now to be beyond the possibility of surgical repair.
Urinary Excretion of Catecholamines by Full-term and Premature Infants
Authors: Nicolopoulos Demetre , Agathopoulos Anthony , Galanakos-Tharouniati Maria , Stergiopoulos Constantin
Published: December 2021

As part of a study of the role of catecholamines during the newborn's adaptation to extra-uterine life, the excretion of dopamine, norepinephrine, and epinephrine in the urine of nine full-term and 11 premature infants was determined on the first and fifteenth day after birth. The following observations were made.

On the first day the excretion of dopamine by the premature infants was questionably less than that by full-term infants. On the fifteenth day, excretion by the premature infants had more than tripled in amount, whereas that by the full-term infants had increased only by about 50%.

On the first day, the norepinephrine excreted by premature infants was about one third of the amount excreted by full-term infants. On the fifteenth day, although the amount excreted had increased, it remained lower than the amount excreted on the first day by the full-term infants.

On the first day, the amount of epinephrine excretion by premature and full-term infants differed very slightly. On the fifteenth day, excretion by both groups had increased so that the amounts were about equal. The difference noted between premature and full-term infants in this study and the high amount of VMA excreted by premature infants on the fifteenth day measured in a previous study, permit the supposition of a defect in catecholamine biosynthesis—a defect due to an insufficiency of the enzymatic system of dopamine-oxidase and of catechol-O-methyl-transferase.
Hemophilia B (Christmas Disease) in a Female
Authors: Strauss Herbert S. , Olson Sandra L.
Published: December 2021

A case of hemophilia B in a girl, who is the product of a marriage between a hemophilic father and a probable carrier mother, who are first cousins, is described.
Anti-vaccinia Immunoglobulins in Anti-hemophilic Globulin?
Authors: Berne Joel E.
Published: December 2021

I recently gave a 16-month-old male hemophiliac, classical, a smallpox vaccination approximately 2 weeks after an intravenous injection of 270 units of antihemophiliac globulin (Courtland Precipitate).

Instead of the usual, brisk response, he developed a very small papule which formed a crust of only 2 mm approximately 2 weeks after inoculation.

It has been my experience that most inoculations for smallpox are either negative or quite marked; it is rare to have so mild a reaction.
Letter to the Editor
Authors: Hodes Horace L.
Published: December 2021

Dr. Aaron Rauson and I have addressed ourselves to the problem raised by Dr. Berne.

Dr. Berne gave a 16-month-old hemophiliac infant an intravenous injection of 270 units of antihemophilic globulin (Courtland precipitate) 2 weeks before he vaccinated the child against smallpox. We determined the amount of IgG, IgA, and 1gM in 270 AHC units of two batches of Lot #50201 of the Courtland precipitate. We found that the IgC ill 270 units of batch #1 of the Courtland precipitate was 95 mg; there were 3 mg of IgA and 10 mg of IgM in it.
Footprinting for Identification of Infants
Authors: Concklin C. L.
Published: December 2021

Miss Gleason's letter, which appeared in the December 1968 issue of Pediatrics, is commendable. We all desire positive identification of newborn infants and make conscientious efforts in this direction. However, that charge that faulty technique is the sole cause of improper imprints is oversimplified. But, since Miss Gleason advances this claim, it seems no more than cricket that she clearly state, step by step, the exact procedure she considers adequate for this purpose.

The salvage of a baby under the circumstances you mention must be balanced against the lives lost due to delay in providing the newborn with other, more life-sustaining services such as suctioning, protection from overchilling-especially in our air conditioned delivery suites-and so forth.
Letter to the Editor
Authors: Murthy D. Y. N.
Published: December 2021

The lack of significant difference in insulin binding as mentioned by Dr. Marks may be explained on the basis of the size of the group and slight differences in the techniques employed. The proportion of bovine insulin in the bovine-porcine insulin mixture used to treat the diabetics might also contribute to differences in the insulin binding.
Pediatric Surgery, Vol. 2, ed. 3, edited by Orvar Swenson, M.D. New York: Appleton-Century Crofts, Education Division, Meredith Corporation, 1969, 1417 pp., $45.00 (Vol. 1 and 2)
Authors: Kiesewetter William B.
Published: December 2021

Ten years ago there were two standard textbooks of pediatric surgery in English, one of which had only recently been written by Dr. Swenson. Since that time, the whole field has been inundated by a variety of books on the entire field of pediatric surgery, as well as many of its sub-specialties. In spite of this, Dr. Swenson's third edition of his book will serve a very real purpose both for pediatricians and surgeons.

The current edition is an ambitious undertaking in two volumes by the members of the surgical staff of the Children's Memorial Hospital in Chicago.
Cephalosporium Meningitis
Authors: Papadatos Constantine , Pavlatou Maria , Alexiou Demosthenes
Published: December 2021

The first reported case of cephalosporium meningitis in a newborn infant is presented. The diagnosis was suspected by the morphological features of the yeast-like organisms on direct smears in two separate cerebrospinal fluid specimens and confirmed by two cerebrospinal fluid cultures.

The outcome was entirely satisfactory. We consider it possible that recovery was spontaneous and that amphotericin B could be instrumental in the patient's recovery only if cephalosporia were present in foci other than the cerebrospinal fluid.
SMOKING AND CHILDREN: A PEDIATRIC VIEWPOINT
Authors: Wehrle Paul F. , Brent Robert L. , Doyle John L. , Farr Lee E. , Fagan Emmett L. , Finberg Laurence , Nahmias Andre J. , Pickering Donald E. , Yamazaki James N. , Horton Robert J. M.
Published: December 2021

The pediatrician is in an unusually favorable position to reduce the frequency of smoking among young people because of his interest in the prevention of disease and his special experience in dealing with children and teenagers. The hazards of smoking are well-known, and there seems no question but that smoking is etiologically related to carcinoma of the lung and cardiovascular disease. Other conditions, such as pulmonary fibrosis, other malignancies, and emphysema may or may not be etiologically related but do occur more commonly in smokers.

At least three aspects of the smoking problem relate directly to children and teenagers:

1. the short-term effects of smoking by teenagers and children;

2. the effect of tobacco smoke on non-smokers, be they adults or children;

3. suggestions for changes in the anti-smoking advertising campaigns so that they are geared to prevent children from adopting the smoking habit and to recruit the non-smoker into more anti-smoking activities.

There is very little information dealing with the short-term effects of smoking on children and teenagers. There is little doubt that the earlier one starts smoking the greater his chances of developing one of the late effects, but this is not our present concern. Actually, there are data that indicate that smoking teenagers have physical symptoms associated with their habit. Children who smoke have more respiratory symptoms, cough, phlegm, breathlessness, wheezing, and colds, than nonsmokers.

There are other clinical symptoms and personality traits which occur more cornnionly in smoking teenagers. These may have a coincidental relationship or simply reflect personality factors predisposing to smoking. For example, teenage boys have a higher incidence of traumatic injuries and teenage girls have a higher incidence of urinary infections than do their nonsmoking associates.
Treatment of Enuresis: The Rented Alarm Bell
Authors: Nickman Steven L.
Published: December 2021

Recently I was intrigued by a newspaper advertisement placed by the "National Enuresis Foundation." Free information about bed-wetting was offered to concerned parents if they filled out the coupon. Listing a fictional 8 year old son, I responded, and received a leaflet from the organization, which evidently is based in Florida. The leaflet provided a mixture of sound statements (e.g., that neither punishment nor reward is appropriate in managing bed-wetting) and subtly frightening suggestions (e.g., that enuretic children, if not cured, often become juvenile delinquents).
Night Cries and Pinworms
Authors: Curran John P.
Published: December 2021

I very much agree with Dr. Levin's observation that pinworms are the cause of a specific disorder affecting little girls. The symptom complex is characterized by the sudden onset of intense nocturnal discomfort, referred to the vulvar area by older children, and not infrequently associated with painful urination, frequency or urinary retention.

During the past five years we have seen 6 patients who presented with this clinical picture. They were all girls, the youngest twentytwo months and the oldest eleven years.
Harriet Lane Handbook: A Manual for Pediatric House Officers, ed. 5, edited by Jerry A. Winkelstein, M.D. and Herbert M. Swick, M.D. Chicago: Year Book Medical Publishers (35 East Wacker Drive), 1969, 264 pp., $4.25
Authors: Reece Robert M.
Published: December 2021

The Harriet Lane Handbook, now in its fifth edition, continues to be a valuable vade macum for pediatric house officers and practitioners who are involved in day-to-day contact with patients. Packed in the book's 264 pages is a prodigious amount of practical information which will be a source of comfort for the physician who remembers to place this little handbook in his side pocket. Some might prefer that the publishers had issued this edition in loose-leaf format, but in its present binding loss of individual pages is no longer a potential danger.
Clinical Electroencephalography of Children Vol. II, edited by Peter Kellaway and Ingemar Peterśen. New York/London: Grune & Stratton, Inc., 1968, 332 pp., $16.75
Authors: Lombroso Cesare T.
Published: December 2021

This book contains twenty papers read in the summer of 1967 at a conference in Gäteborg, Sweden. This was the second symposium within the span of 4 years on the subject of electroencephalognaphy and clinical neurophysiology relating to early life. The holding of the conference is certainly an index of the great surge of interest among pediatricians, neurologists and neurophysiologists in matters pertaining to the normal development of the central nervous system as well as in the pathologic deviations of this system.
INTRODUCTION: THE HORIZON OF CHILDHOOD INJURY
Authors: Meyer Roger J.
Published: December 2021

The search for childhood injury control, while encountering new advances in safety engineering, human understanding and techniques of study, continually leads to receding child safety horizons. Technologic gains pose new threats to child and family life; the increasingly rapid pace of living creates problems for children and those who supervise them. Each method of injury is a "disease" unto itself in terms of epidemiologic factors involving the child and his human and physical environment that interact to produce injury and disability.

Two years ago, a group of scientists, pediatric practitioners, and public health authorities met in Charlottesville, Virginia, for the first National Childhood Injury Symposium. Many disciplines were represented and a variety of views of the childhood injury problem were offered; it became apparent that this leading health problem of children required all of these disciplines not only to understand the issues involved but to launch an attack upon it. As a result of this first meeting, a score of new studies were developed, more effective communication between investigators and those interested in prevention was initiated, and a more adequate understanding of the complex health problem was obtained. It soon became apparent from participants and other interested workers that another meeting would have an advantage for these reasons. The papers which follow reflect some of the extent of this interest and knowledge which has developed concerning childhood injury. The interdisciplinary nature of the representation of intensive workshop activities was a part of the program, although not included here due to limitations of space.
SOME APPLICATIONS OF DELINQUENCY THEORY TO CHILDHOOD ACCIDENTS
Authors: Klein David
Published: December 2021

The past two decades have witnessed an increasing recognition on the part of the physician and the behavioral scientist that the state of a person's health—indeed, even his likelihood of surviving infancy or of being institutionalized for mental illness-is closely related to his social status and to the social, political, economic, and cultural characteristics of his community, his state, and his nation. With the growth of interdisciplinary and multidisciplinary research, such "purely biological" phenomena as infant mortality, mental illness, malnutrition, and venereal disease have come to concern the sociologist and the anthropologist as strongly as they have the physician and the epidemiologist.

Accidental injury and death, however, have to a large extent remained outside the sphere of interdisciplinary scrutiny. One reason for this neglect stems from the fact that data on accidental injury are so much less reliable than other health data as to be virtually unusable. Perhaps another reason is that the concept of an accident as an "act of God" persists in the minds of otherwise sophisticated persons—and "acts of God" seem somehow unrelated to the social and cultural environment in which they occur.

Regardless of the reasons, however, the fact remains that, although a good deal is known about the socioeconomic and cultural conditions that influence the infant mortality rate, mental illness, and cardiovascular accidents, very little is known about the relationship between social conditions and the incidence of accidental injury and death.

The following paper does nothing to advance our knowledge of this relationship. But it points out the gaps in our present knowledge, warns against pitfalls that are more familiar to behavioral than to medical scientists, and pleads for the application of sound sociological theory to a problem which is as much social as it is medical.
THE EPIDEMIOLOGY OF BURNS
Authors: Smith E. Ide
Published: December 2021

The following paper is a useful example of the kind of epidemiological data gathering that is essential before effective countermeasures can be devised or deployed for maximal cost benefit. Regardless of the dedication and the methodological sophistication of the investigator, such studies cannot produce widely generalizable findings if they are carried out on patients whose socioeconomic characteristics cannot be precisely defined and whose differences from the total population at risk cannot therefore be specified.

Differences in the patterns of utilization of medical services by various socioeconomic levels have long been recognized. Such differences may be less pronounced with respect to childhood accidents than with respect to prenatal care. But, as the author is careful to point out, they are sufficient to prevent generalization—especially since burn accidents involve both environmental hazard and patterns of child-rearing, both of which differ widely with socioeconomic status. The solution of this problem is not a simple one. It involves longitudinal studies, a very high level of detailed case reporting, and continuous monitoring to ensure that the population studied is a representative sample of the population at risk.

The author's conclusions about the influence of poverty-related social conditions on the incidence of burns document further the conclusions of investigators who have studied other types of childhood injuries.
ACCIDENTAL FALLS FROM ELEVATED SURFACES IN INFANTS FROM BIRTH TO ONE YEAR OF AGE
Authors: Kravitz Harvey , Driessen Gerald , Gomberg Raymond , Korach Alvin
Published: December 2021

This work is typical of the efforts of the gifted practitioner concerned with an important problem encountered in pediatric practice. It has all the limitations which time and sampling impose and does not satisfy the more precise investigative criteria for control populations, statistical treatment and other considerations which further studies by this group may encompass. It represents an effort which seeks a practical solution and it enlists allies in a well known safety organization. It is the method of collaboration and the clues that are developed which makes this paper a vital contribution. The practitioner requires supportive workers in this type of investigation, but is in a superb position to give additional information about the child and his family, and to implement findings that might be related to prevention. The "event tree" method of study and action which is proposed and illustrated offers a model for injury control of many types. Community workers who are concerned about the problem of falls as the leading method of childhood injury are hereby offered a useful method of study which does not require extensive or complicated efforts. The leads that the paper offers with respect to cultural differences in types of falls and circumstances should be explored. It is unclear either in this work or in the literature whether the method of control posters, campaigns, etc. are indeed effective or not. All existing methods of fall control should be encouraged as they raise the level of awareness of the hazards to children, but a number of investigators have indicated that it is the mother's attitude and distractions from childbearing which offer a strong current of causation. Approaches with the same population using evaluated techniques suggested by the authors are a next step.
HOW SAFE IS PUPIL TRANSPORTATION?
Authors: Charles Seymour , Shelness Annemarie
Published: December 2021

Abstract of a study of school bus laws, regulations and practices in the United States, conducted by the Physicians for Automotive Safety.
A COMMUNITY APPROACH TO DROWNING PREVENTION
Authors: Morgan John
Published: December 2021

A COMMUNITY can initiate a program of injury control not only in the prevention of drownings, but in other areas of accidental deaths by the application of criteria based on: need-the identification and analysis of problem area or areas in order to bring about effective programming to reduce accidental deaths or injuries; ohjective-how many deaths could he prevented by a demonstration project in the community and what resources are available within the comniunity to bring about this project; method-plan of attack by these community resources on what approach or approaches can he taken to reduce the number of deaths or injuries attributed to the area or areas selected; evaluation-to be done at periodic intervals in order to determine how effective the model program is and ways it can be strengthened. Effective programming can be brought about when these simple criteria are applied.
Bacteriological Findings in Positive Tuberculin Reactors in Childhood
Authors: Burchak Edward C. , Turner J. A. Peter , Robson Ann
Published: December 2021

Gastric washings from 58 children with positive tuberculin tests measuring more than 10 mm of induration of 5 TU of Old Tuberculin, but no other evidences of tuberculous infection, were studied by mycobacterial cultures and guinea pig inoculation. Two children had positive cultures for M. tuberculosis hominis. In one child the source of infection was readily identifiable. In the other, no index case has been discovered. In a third child, whose tuberculin test was less than 10 mm of induration, a scotochromogen was found on gastric lavage cultures.

While it would be impractical to suggest that all children with positive tuberculin tests should have gastric lavage cultures, the possibility that such a child has the potential to infect others must he borne in mind. The routine use of isoniazid is recommended in all such tuberculin-positive children, not for "chemoprophylaxis" technically, but, more precisely, for specific treatment of the infection indicated by the tuberculin reaction itself.
Seborrheic Dermatitis of Infants: Treatment with Biotin Injections for the Nursing Mother
Authors: Nisenson Aaron
Published: December 2021

Four cases of extensive seborrheic dermatitis or Leiner's disease are presented which dramatically improved after the nursing mother was given injections of biotin.

The relationship between seborrheic dermatitis in infants and biotin deficiency is discussed and the literature reviewed. From this review it appears that breast milk is deficient in biotin in comparison to cow's milk. The deficiency is further aggravated by poor maternal nutrition. Infection and diarrhea in the infant may also contribute to low blood levels of biotin.

On the basis of this limited experience, injections of biotin to the nursing mother appear to be a useful treatment for the breast-fed infant with extensive seborrheic dermatitis.
SINGLE INJECTION CLEARANCE IN CHILDREN
Authors: Sakai Tadasu , Leumann Ernst P. , Holliday Malcolm A.
Published: December 2021

The renal clearance of sodium iothalamate I125 after a single intravenous dose of 10 to 25 µCi was calculated from the plasma disappearance curve. The endogenous creatinine clearance was compared with these results. Thirty-eight studies in 35 pediatric patients with all levels of renal function were performed. Eight studies were excluded because of grossly incomplete urine collection, and 5 studies were not analyzed further because of very low glomerular filtration rate. The correlation between both methods in the 21 studies was good (Ccreat = 0.91 x Csi + 4.9, r = 0.91). It was significantly better in the nine patients with a serum creatinine of 0.7 mg/100 ml or more (Ccreat = 1.01 x Csi — 1.2, r = 0.97) than in the 16 patients with a serum creatinine of 0.6 mg/100 ml or less (Ccreat = 0.82 x Csi + 11.5, r = 0.84). In the latter group, the accuracy of the serum creatinine determination was often poor, and even variations of ± 0.1 mg/100 ml could lead to a gross error in the calculation of the clearance.

In four patients, the clearance was obtained by external counting and agreed well with the clearance calculated from the plasma samples.

The single injection clearance is especially indicated in children (1) when no adequate urine collection is obtainable, (2) at low serum creatinine concentrations, and (3) in outpatients.
DOUBLE BLIND FLUID THERAPY EVALUATION IN PEDIATRIC CHOLERA
Authors: Gutman Robert A. , Drutz David J. , Whalen George E. , Watten Raymond H.
Published: December 2021

Pediatric cholera has often had higher morbidity and mortality than adult cholera when treated in the same fashion. Because children have a greater need for free water and, in addition, produce cholera stools which are appreciably lower in sodium concentration than adult stools, the use of isotonic or hypertonic intravenous solutions designed for adults has been held partially responsible for the higher figures. Moreover, such solutions often contain insufficient dextrose, potassium, and alkali for optimal treatment of pediatric cholera. A pediatric cholera replacement solution (PCRS) formulated to overcome these problems was field tested in double blind fashion against lactated Ringer's solution in children with acute cholera. PCRS resulted in more rapid return of normal potassium and bicarbonate values, over-came the tendency toward hypoglycemia, and reduced the need for oral fluids. Despite its hypotonic composition and high potassium content, it produced neither hyponatremia nor hyperkalemia. The utility and safety of plasma specific gravity as a means of objectively quantitating the degree of dehydration in children is emphasized.
SORANUS (A.D. 98-138) OF EPHESUS' FINGERNAIL METHOD OF TESTING THE QUALITY OF BREAST MILK—A CLINICAL TEST WIDELY USED FOR ALMOST 20 CENTURIES
Authors: C. T. E.
Published: December 2021

Soranus seems to be the first writer to mention the method of testing the breast milk by the behavior of the drop of milk placed on one's fingernail.1 This test continued in use at least until 1827, a period of approximately 2,000 years.

Thomas Phaire, who in 1545 wrote the first book in English on children's diseases, describes the test in almost the same words as in Soranus' original description:

That mylke is goode that is whyte and sweete; and when ye droppe it on your nayle and do move your finger, neyther fleteth abrod . . nor will hange faste upon our naile, when ye turne it downeward, that whyche is betwene bothe is beste.2

As late as 1827 Johannes Wendt in outlining the qualities one should look for in the ideal wet nurse also mentions Soranus' nail-test:

A bluish-white rather than tenacious [breast] milk, which dropped upon the thumb-nail flows off not too quicky. - - .3
Vincristine Therapy in an Infant With Probable Hepatoblastoma
Authors: Lascari André D.
Published: December 2021

A 4-month-old infant with a diffuse hepatoblastoma was treated over a 2-year period with vincristine. After this period, no evidence of tumor could be found at laparotomy or in the biopsy speciments.

The excellent response of this patient justifies further evaluation of vincristine in the treatment of this tumor.
An Accessory Lobe of Lung in a Newborn
Authors: Klein Zolton L.
Published: December 2021

A lower accessory lobe is an extremely uncommon anomaly, which probably arises during embryonic life by separation of a part of the primitive pulmonary anlage from the remainder of the lung. However, this unusual cause of respiratory distress in the infant should be considered in differential diagnosis; if present, as in the case reported, it should be treated by surgical removal.

[See pdf for the Figure]
III. COMPARISON OF THE EFFECTS OF MARIJUANA AND ALCOHOL ON SIMULATED DRIVING PERFORMANCE
Authors: Crancer A. , Dille J. D. , Delay J. C. , Wallace J. C. , Haykin M. D.
Published: December 2021

The authors studied simulated driving performance of a group of adults who were experienced marijuana smokers, familiar with the effects of alcohol, who were licensed motor vehicle operators, and were engaged in educational or vocational pursuit.

Simulated driving performance was studied in a darkened chamber with the subjects at the controls of a driver-training simulator containing control and instrument equipment relevant to driving, and facing a screen upon which a test film was projected. The effects of marijuana (two cigarettes totalling 1.7 gm over a 30-minute period) , alcohol to 0.10% blood concentration (about 6 oz 86-proof liquor for a 120 lb subject), and no treatment were compared.
DEVELOPMENTAL TESTING OF PRE-TERM AND SMALL-FOR-DATE INFANTS
Authors: Parmelee Arthur H. , Schulte Franz J.
Published: December 2021

Twenty-five full-term, newborn infants and 22 small-for-date infants born at term had comparable nerve conduction velocities and were considered to be of equal neurological maturity. Twenty-six pre-term infants equal in weight to the small-for-date infants had significantly slower nerve conduction velocities and were considered on this basis more immature at birth than the term and small-for-date infants. All of these infants were given Gesell developmental tests at approximately 40 weeks of age by an examiner with no knowledge of their neonatal condition. The objective was to determine to what degree performance later in infancy is dependent on neurological maturity at birth.

The full-term infants and the small-for-date infants performed at their age level with average developmental quotients of 99 and 96, respectively. The pre-term infants performed at less than their age from birth with an average D.Q. of 88; but, when their age was corrected for weeks of prematurity, the average D.Q. was 99. These findings substantiate the concept that performance on the Gesell schedules is dependent on time from conception rather than time from birth. Preterm infants should have their age determined from their expected date of birth for purposes of calculating a developmental quotient.
THE PHARMACOLOGIST'S DILEMMA: WHEN IS A DRUG SAFE FOR GENERAL CONSUMPTION?
Authors: Dews Peter B.
Published: December 2021

The inclusion of marijuana with heroin under the Harrison Narcotic Act, and in the criminal codes of most states, was never based on pharmacological evidence. Heroin can cause a rapid development of tolerance and physical dependence. The routine of securing and injecting regular doses becomes preemptive. The normal physiological and social factors governing conduct tend to be replaced by the heroin habit, constituting what may be called malignant addiction. Marijuana does not cause malignant addiction.

By the standards applied to therapeutic agents, marijuana is also a safe drug. Like heroin, it seems to be free from direct toxic effects to parenchymatous organs—liver, lung, kidney, bone marrow, and so on.
AUTOMOTIVE RESTRAINT DEVICES FOR THE PEDIATRIC PATIENT
Authors: Burg Frederic D. , Douglass John M. , Diamond Eugene , Siegel Arnold W.
Published: December 2021

Last year 6,300 children under 15 years of age died in motor vehicle accidents. This number would have been reduced if all children and infants had been properly restrained. The purpose of this paper is to give information and suggestions to help enable the practicing physician to understand what restraining devices to prescribe.

It is recommended that children from birth to the time they are 12 lb in weight be transported in a rear seat bassinet or car bed held in place by front and rear seat safety belts. The bassinet should be parallel to the long axis of the car, with the infant in a feet-forward position. Children from 12 to 24 lb should be placed in a properly constructed rear seat safety harness. Children from 24 to 48 lb should be placed in a rear seat, shield-type system. Children weighing more than 50 lb should use the adult lap belt, and, when their height exceeds 55 in., the adult shoulder harness should also be used.

The physician is in a position to be effective in prescribing the proper device.
FRESH APPROACHES TO PROSPECTIVE STUDIES OF HIGH RISK INFANTS
Authors: Drillien C. M.
Published: December 2021

The widespread development of special care and premature units is providing an added stimulus to neonatologists and their colleagues to embark on prospective studies of the later development of high risk infants. Indeed, it is only thus that one can judge the efficacy of new techniques in postnatal care made possible by concentrating numbers of such infants in special units.

Since low birth weight is associated with a higher incidence of handicap than any other commonly occurring perinatal complication, low birth weight infants have been and continue to be the most popular subjects for long-term study. The reports by Eaves,et al.1 and Parmelee and Schulte in this issue are current examples.
HEPATIC HEMANGIOENDOTHELIOMA DURING INFANCY: PATHOLOGY, DIAGNOSIS AND TREATMENT WITH PREDNISONE
Authors: Touloukian Robert J.
Published: December 2021

A hepatic hemangioendothelioma is a benign vascular tumor of infancy which usually involves the entire liver. Many infants have associated cutaneous hemangiomas and are first seen in high output congestive heart failure with massive abdominal distension and hepatomegaly. Arteriovenous shunting within the liver is confirmed by the presence of an epigastric systolic bruit and a characteristic "blush" within the liver on selective celiac axis angiography. We report a 7½-month-old infant with a hepatic hemangioendothelioma who improved dramatically following a 2-week course of prednisone. There was no evidence of shunting on post-treatment angiography. Other forms of therapy previously attempted, including resection, irradiation and hepatic artery ligation, are discussed.
THE ACQUISITION OF DELAYED HYPERSENSITIVITY FOLLOWING ATTENUATED MUMPS VIRUS INFECTION
Authors: Horowitz Sheldon D. , Nagatani Michael S. , Bowen George S. , Holloway Ada W. , St. Geme Joseph W.
Published: December 2021

The ability of live attenuated mumps virus to induce delayed hypersensitivity and humoral antibody was studied in a prospective fashion. Thirty-five children between 15 months and 5 years of age with no history of overt mumps in the past received the attenuated virus subcutaneously. At the beginning of the study there was complete correlation between delayed hypersensitivity and neutralizing antibody in 83% of the children (26 skin-test negative and seronegative, 3 skin-test positive and seropositive).

In the group initially seronegative and skin-test negative, 88% developed mumps neutralizing antibody following attenuated virus infection, and 91% of these seroresponsive children developed a positive mumps skin test. Therefore, a positive mumps skin test can serve as a simple marker for vaccine-induced immunologic response. Application of the mumps virus and avian placebo antigens simultaneously is necessary for meaningful interpretation of the mumps skin test.

Two patients developed delayed hypersensitivity following vaccination without developing detectable humoral antibody. The possible significance and explanation of this partial, dissociated immunologic response is discussed.
Mumps Antibody: Placental Transfer and Disappearance During the First Year of Life
Authors: Hodes David , Brunell Philip A.
Published: December 2021

Mumps neutralizing antibody was transferred quantitatively across the placenta. Antibody was still detectable (≥ 1:2) in 18 of 19 infants at 2 months of age. The finding of antibody in 13 of 19 infants at 5 months of age probably accounted for the failure to immunize infants at this age successfully in previous studies. Neutralizing antibody was not detectable sera of any of the 18 infants who were tested at 1 year of age. Although serum antibody during the early months of life was presumably all IgG since it was passively acquired, the neutralization test appeared to be far more sensitive than the complement fixation test for the determination of mumps antibody.