bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFECTS OF SODIUM BICARBONATE BY RAPID INJECTION AND OF OXYGEN IN HIGH CONCENTRATION IN RESPIRATORY DISTRESS SYNDROME OF THE NEWBORN
Authors: Russell George , Cotton Ernest K.
Published: December 2021

Following the rapid intravenous injection of sodium bicarbonate in 19 infants suffering from the respiratory distress syndrome of the newborn (RDS), arterial oxygen tension, arterial oxygen saturation and base excess rose, while arterial carbon dioxide tension and hydrogen ion concentration fell. Effective pulmonary blood flow rose, and right-to-left shunting diminished.

Following the administration of increased oxygen to 6 infants with less severe RDS, there was a rise in arterial oxygen tension and a fall in arterial carbon dioxide tension.

It is suggested that the changes which occur after both forms of therapy are due to a decrease of pulmonary vascular resistance, reduced right-to-left shunt, and improved pulmonary capillary perfusion.
CEREBROSPINAL FLUID LDH IN 287 CHILDREN, INCLUDING 53 CASES OF MENINGITIS OF BACTERIAL AND NON-BACTERIAL ETIOLOGY
Authors: Neches William , Platt Martin
Published: December 2021

Cerebrospinal fluid lactic dehydrogenase activity was determined in 287 children. Among these, 87 had no central nervous system disease and were considered to be controls. Mean lactic dehydrogenase activity in 69 controls (excluding newborn infants) was 14 units. In 18 control infants less than 1 week of age, the mean lactic dehydrogenase activity was 50 units. Thirty-two patients with bacterial meningitis had a mean cerebrospinal fluid lactic dehydrogenase of 251 units on the initial examination; 20 patients with aseptic meningoencephalitis had a mean lactic dehydrogenase activity of 23 units. The difference between the lactic dehydrogenase activity in children with bacterial and aseptic meningitis was highly significant (p < 0.005). The clinical course of the patients studied was reflected by the change in cerebrospinal fluid lactic dehydrogenase activity on serial determinations. Spinal fluid isoenzyme patterns were studied in a few patients with bacterial and non-bacterial central nervous system disorders. This study indicates that the determination of lactic dehydrogenase in spinal fluid is a useful adjunct to other cerebrospinal fluid parameters in the differential diagnosis of central nervous system infections.
ELECTROCARDIOGRAPHIC STUDIES IN CHILDREN WITH LEAD POISONING
Authors: Silver Walter , Rodriguez-Torres Ramon
Published: December 2021

Electrocardiographic studies before and after treatment were performed in 30 children with lead poisoning. It was found that abnormal electrocardiograms were present in 70% of the patients on admission. After completion of therapy, the electrocardiographic findings remained abnormal in only four (13%) of the patients. The abnormalities described most likely represent myocardial damage.

It is proposed that a cardiovascular evaluation should be made as a routine procedure in every child with lead poisoning.
DIAGNOSIS AND TREATMENT: ORGANIZATION FOR CONVALESCENCE
Authors: Maginnis Elizabeth
Published: December 2021

The accent on a child rather than his disease requires constant emphasis when the pressures for concentration on pathologic parts so readily conspire to narrow perspective. The introduction of social services into teaching hospitals came about initially from an awareness within the medical and nursing professions of the restrictive tendencies of specialization. In recent times, there has been a refreshing impetus to return to those early values of responsibility for the patient in his total environment, now fortified by the growth of behavioral and social sciences.

My own practice of social work for over 15 years in a pediatric hospital has provided convincing evidence of the oneness of mind and body in illness and handicap. Direct clinical participation in three massive epidemics of poliomyelitis served to add dimension and force to this awareness. Through these opportunities, it has been possible to observe the acute, the convalescent, and residual stages of a particular illness and to compare it with the spectrum of handicapping disease seen in the pediatric hospital. Similar temporal boundaries have revealed themselves in social and elliotional developmellts. Although the physician logically perceives these progressive stages in relation to specific medical diagnosis, parents and families do not experience the disability of a child in quite the same context. Transitions are demarcated for them according to the adaptations demanded by the disease, illness, or injury of the child. From their vantage point, sequential shifts occur as they pass through the apprehension and tolerance of a diagnosis, into participation in treatment, and finally towards acceptance and reorganization within the facts of irreversible damage.
Sources of Error in Testing for PKU
Authors: Kane Roger B. , Kratka Harold B. , Katz Mervyn
Published: December 2021

It is routine practice in our office to test wet diapers with fernic chloride 10% solution at 1-and 2-month well-baby visits. We also do this on all new patients who are 1 year or less as part of the first visit routine. We frequently see abnormal colors from certain urinary constituents, such as the by-products of aspirin metabolism, or from other substances in the diapers, such as detergent residue. In our experience, these have never given the classical blue-green color of phenylketonuria, which is quite characteristic.
Letters to the Editor
Authors: Smith Margaret H. D.
Published: December 2021

The Committee on Control of Infectious Diseases of the American Academy of Pediatrics did not recommend the use of influenza vaccine in normal children for several reasons. First of all, such children are at minimum risk from the standpoint of mortality. Secondly, the logistics of such mass immunization programs are considerable, particularly when one notes that the immunity is relatively short-lived.

In my opinion there are other reasons why this recommendation is a good one. First of all, it is difficult for the manufacturers on short notice to produce sufficient vaccine for everyone.
Cerebral Gigantism in Childhood
Authors: Milunsky Aubrey
Published: December 2021

The latest paper on cerebral gigantism by Stephenson and his associates1 made interesting reading. Clearly the syndrome is being diagnosed with increasing frequency. In our report of two cases2 the dermatoglyphic patterns showed combined ridge counts two standard deviations above normal. Since dermatoglyphic patterning is complete by about the eighteenth week of gestation and remains nochanged thereafter, except for absolute growth,3 it would have been of great interest to know the result of these studies in the 10 patients reported by Stephenson and associates.
CONGENITAL PERNICIOUS ANEMIA: EFFECTS ON GROWTH, BRAIN, AND ABSORPTION OF B12
Authors: McNicholl Brian , Egan Bridget
Published: December 2021

Three Irish children, two of them siblings, developed megaloblastic anemia around one year; deficiency of intrinsic factor (I.F.), presumably congenital, was shown by Schilling tests and assay of gastric juice. Congenital pernicious anemia (P.A.), in contrast to adult P.A., shows normal gastric mucosa and acidity and no antibodies to gastric mucosa or I.F. Adult type P.A., with gastric atrophy and achlorhydria, if occurring in childhood, can be called "juvenile P.A.," "congenital P.A." being reserved for the type described here. P.A. associated with polyendocrinopathy and the type described by Imerslund due to specific B12 malabsorption should be named accordingly. Congenital P.A.'s inheritance is thought to be autosomal recessive.

Growth retardation and acceleration appeared to be related to B12 deficiency and treatment. I.Q.'s of around 70 in each child may represent the effects of B12 deficiency on cerebral growth. An initial malabsorption of B12 was shown to improve markedly with B12 treatment. In diagnosis of megaloblastic anemia, only that due to B12 deficiency will respond to dosage of 2 to 5 µg B12 (intramuscular) daily. Early diagnosis and treatment may prevent brain damage.
MOTOR NERVE CONDUCTION VELOCITY IN TERM, PRETERM, AND SMALL-FOR-DATES NEWBORN INFANTS
Authors: Schulte F. J. , Michaelis R. , Linke Ilona , Nolte Renate
Published: December 2021

Nerve conduction velocity has been reported to have a positive relationship to degree of myelination. In this study peripheral motor nerve conduction velocity was found to be dependent on the conceptional age but independent from the birth weight of preterm, full-term, and small-for-dates newborn infants, plus twins of different birth weight.
AGENESIS OF THE LUNG
Authors: Maltz David L. , Nadas Alexander S.
Published: December 2021

One hundred sixty-four cases of agenesis of the lung are reviewed, including 36 not previously reviewed and 8 not previously reported. Agenesis, affecting both hemithoraces and both sexes almost equally, should be separated for physiologic reasons from hypoplasia by the total absence of lung parenchyma, bronchial tree, as well as supporting vasculature. Genetic, teratogenic, and mechanical factors may have a bearing on etiology. Chest roentgenograms suggest the diagnosis initially, but careful bronchographic and angiocardiographic studies are necessary for confirmation. The electrocardiogram is helpful in the differential diagnosis of the patients with dextrocardia. Severe respiratory infections are common in infancy and may lead to pneumonia and death. The condition, however, is not uniformly fatal; 24 of 36 patients reported since 1954 were alive at the time of reporting. There is no evidence at present that resting pulmonary artery hypertension or emphysema develops in patients with agenesis of the lung and an intact cardiovascular system. Diagnostic studies reveal pulmonary artery hypertension in a number of patients with a combination of systemicpulmonary communication and agenesis of the lung. Coexisting abnormalities may involve the skeletal, cardiovascular, gastrointestinal, and genitourinary systems.
Head Circumference in Children with Idiopathic Hypopituitarism
Authors: Cloutier Mark D. , Stickler Gunnar B.
Published: December 2021

We continue to agree with Dr. Nellhaus1 concerning the clinical value of the measurement of head circumference in children. Since publication of the paper by O'Connell and colleagues2 the opportunity has presented at the Mayo Clinic to study in detail a group of 15 children with idiopathic hypopituitary dwarfism. It was generally agreed that the children with this type of growth failure and normal intelligence do not have head circumferences of less than -2 standard deviations (S.D.).
Accidents and those Bizarre Bicycles
Authors: Howell T. R.
Published: December 2021

Since the invention of the bicycle about 1860, physicians have seen isolated and sporadic instances of trauma following falls from bicycles. Recently, at this ilospital, we have become acutely aware of an increasing number of specific craniofacial injuries in children from this cause. We suspect that the "epidemic" may be related to the recent popularity of bicycles with small front wheels, low set front axles, long, narrow seats, and high, wide handle bars.

Facial trauma in these children may be an emengency if brisk hemorrhage or mandibular fracture compromising the airway occurs.
Immunization of Rh-negative Mother with Rh Antisera
Authors: Winbaum Edward S.
Published: December 2021

After reading Dr. Diamond's article on the history and advances made against erythroblastosis, I am encouraged to submit (with his approval) a copy of a letter dated August 23, 1957, received from Dr. S. Gellis in reply to an idea which came to me about 11 years ago. The general pediatrician might consider it an interesting footnote to the "erythroblastosis story" and perhaps be more persevering in his own original thoughts.

I might add that Dr. Gellis's reply was the only encouraging response verbal or written, from many opinions received.
VASCULAR RESPONSES TO POSTURAL CHANGES IN NORMAL, NEWBORN INFANTS
Authors: Moss Arthur J. , Emmanouilides George C. , Monset-Couchard Michelle , Marcano Bertrand
Published: December 2021

Blood pressure response to head-up tilting was studied in 40 normal, full-term, newborn infants. An initial fall in pressure with a consistent return to pre-tilt levels was observed in the majority. This supports the concept that baroreceptor reflexes are present and active in the full-term, newborn infant.
Lesch-Nyhan Syndrome Treated from the Early Neonatal Period
Authors: Marks James F. , Baum John , Keele Doman K. , Kay Jacob L. , MacFarlen Alice
Published: December 2021

An infant with the Lesch-Nyhan Syndrome was treated from 4 days of life with allopurinol. Such therapy was not successful in preventing the appearance of mental retardation, spasticity, and self-mutilation, which are the hallmarks of this disease.
HYPERGALACTOSEMIA AND GALACTOSURIA DUE TO GALACTOKINASE DEFICIENCY IN A NEWBORN
Authors: Thalhammer O. , Gitzelmann R. , Pantlitschko M.
Published: December 2021

The detection in a screening program of a newborn infant with galactokinase deficiency is reported. Hypergalactosemia, galactosuria, and mild hepatosplenomegaly were the symptoms. Hypergalactosemia after milk intake was shown to be of rather short duration. It is recommended that blood samples for screening procedures be taken no sooner than 1 hour after the first milk feeding of the day, or, better still, 1 to 2 hours after the second milk feeding of the day.
BOSTON MOTHERS OF THE 1830'S WARNED THAT LORD BYRON'S PROFLIGACY AND MORAL WRETCHEDNESS WERE CAUSED BY HIS MOTHER'S SINFUL CHARACTER
Authors: C. T. E.
Published: December 2021

Many Boston mothers of the 1830's avidly read Abbott's The Mother at Home in hopes that this book would guide them in the proper rearing of their children. This was an age of certainty about how mothers should act if they were to raise their children to be Christian men or women. The instruction given was simplistic and free of anxieties about which psychologic approach or school of thought was correct. The mother was told that she alone was the most powerful influence in the formation of her son's character. A pious, faithful mother, free from what in that Calvinistic society were considered sinful attributes (indolence, permissiveness, and wastefulness) could expect her son to be a credit to society. But if a mother who lacked these "good" qualities, her son might become as great a profligate as did Lord Byron. Abbott sternly warned:

Byron had a mother just the reverse of lady Washington [sic]; and the character of the mother was transferred to the son. We cannot wonder then at his character and conduct, for we see them to be the almost necessary consequences of the education he received, and the scenes witnessed in his mother's parlor. She would at one time allow him to disobey with impunity; again she would fly into a rage and beat him. She thus taught him to defy all authority, human and devine; to indulge without restraint in sin; to give himself up to the power of every maddening passion. It was the mother of Byron who laid the foundation of his pre-eminence in guilt.
LACTASE DEFICIENCY IN PATIENTS WITH CYSTIC FIBROSIS
Authors: Antonowicz Irena , Reddy Vinodini , Khaw Kon-Taik , Shwachman Harry
Published: December 2021

Disaccharidase (lactase, maltase, sucrase, and palatinase) assays were performed on small intestinal mucosal biopsies obtained from 28 patients with cystic fibrosis and 90 controls.

Seven patients with cystic fibrosis showed a significant reduction in lactase activity with normal values for sucrase, maltase, and palatinase. In the remaining 21 patients the enzymatic activities, expressed in units per gram of wet weight of tissue and per gram of protein, were comparable with the 90 controls. The mucosal histology showed normal villous structure. Oral tolerance tests for glucose revealed excellent absorption in all cases tested. Patients with cystic fibrosis having normal lactase activity also had good lactose absorption. However, in the patients with lactase deficiency, flat oral lactose tolerance tests were found. Five of the seven patients with lactase deficiency were able to tolerate some lactose, whereas two others were very intolerant and required elimination of lactose from their diet.

This study brings out the high incidence of intestinal lactase deficiency in patients with cystic fibrosis and suggests that the lactase deficiency may be a primary genetic disorder. At present no explanation for this genetic association is available.
THE ROLE OF PHYSICIANS TRAINED IN MATERNAL AND CHILD HEALTH IN COMMUNITY SERVICE AND TEACHING: A FOLLOW-UP REPORT
Authors: Wallace Helen M. , Dooley Samuel , Eisner Victor , Thiele Ronald , Fraser Constance
Published: December 2021

A review of the current status of 91 graduates of the Maternal and Child Health Teaching Program of the University of California School of Public Health at Berkeley over a 5-year period shows that 76 are employed in organized community health work. A third of the group have full-time or part-time teaching responsibilities. Four fifths of that group are certified or eligible for certification by a medical specialty board (predominantly the American Board of Pediatrics). This high proportion suggests that the public health profession is giving greater recognition to the value of basic clinical training with the increase in the provision of combined, preventive, treatment, and rehabilitation services in a community setting.
Maternal Rh Antibody Titer and Amniocentesis
Authors: Zuelzer Wolf W.
Published: December 2021

The January issue of Pediatrics carried an article by Dr. Lucey1 concerning the current indications and results of fetal transfusions. He makes a flat statement concerning the indication for amniocentesis to the effect that a maternal Rh antibody titer of 1:16 in the fourth or fifth month of pregnancy constitutes an indication for amniocentesis. This statement should not go unchallenged. One must ask what the evidence is on which it is based, other than Liley's original papers, considering the fact that the hazards of amniocentesis including the possible enhancement of maternal sensitization are not yet fully established and that this procedure shou'd not be used indiscriminately.
URINARY CATECHOLAMINE EXCRETION IN INFANTS OF DIABETIC MOTHERS
Authors: Stern Leo , Ramos Angeles , Leduc Jean
Published: December 2021

A transient, often profound, hypoglycemia is usually found in newborn infants of diabetic mothers. Normally, hypoglycemia results in large increases in urinary catecholamines, mainly as the adrenaline fraction. Multiple excretion rate studies were carried out in 21 infants of diabetic mothers in hypo ("low") and normoglycemic ("high") periods assigned on the basis of blood sugars below or above 40 mg/100 ml. Mean level was 25 mg/100 ml (range, 7 to 39) for the "low" and 72 mg/100 ml (range, 45 to 133) for the "high" periods. Mean urinary catecholamines were for adrenaline, 0.030 ± 0.006 nanograms(ng)/kg/minute in the "high" and 0.029 ± 0.009 ng/kg/minute in the "low" periods. For noradrenaline the comparable values were 0.388 ± 0.060 ng/kg/minute falling to 0.281 ± 0.044 ng/kg/minute. In 16 of the 21 infants comparative studies were available for each infant in both periods. Analyzed as the differences between pairs, there was no change in adrenaline but a highly significant (p < 0.001) decline in noradrenaline following hypoglycemia. In addition to the failure of the anticipated hypoglycemic increase, the resting (normoglycemic) levels for both fractions were extremely low compared to two groups of normal infants within the first 24 hours, as well as the first week, of life. These findings are suggestive of an adrenal medullary exhaustion phenomenon consistent with the view that the hypoglycemia is of long standing (intra-uterine) duration. The seemingly inappropriate noradrenaline depletion is likely a reflection of the different composition of the neonatal as opposed to the adult gland.
INTRA-UTERINE HYPERPARATHYROIDISM SECONDARY TO MATERNAL HYPOPARATHYROIDISM
Authors: Bronsky David , Kiamko Rosario T. , Moncada Rogelio , Rosenthal Ira M.
Published: December 2021

Two cases of intra-uterine hyperparathyroidism secondary to maternal hypoparathyroidism are recorded. The skeletal manifestations of hyperparathyroidism were present at birth in one infant but not in the other. Both mothers had a remission of clinical tetany during their pregnancy.

The infants' hyperparathyroidism may have been the result of hyperplasia of the fetal parathyroid glands in response to decreased placental transfer of calcium and fetal hypocalcemia. The relief of maternal tetany could have been accomplished either by passage of fetal parathyroid hormone or of calcium to the mother.
Reactions to Booster Doses of Tetanus Vaccine
Authors: Perez-Martin Ricardo
Published: December 2021

I am a pediatrician who started private practice recently in Pasadena, Texas.

For quite some time I have been bothered by a question; but, since starting private practice I have felt compelled to ask this question of some authorities in this matter.

Every pediatrician, general practitioner, and any physician (M.D.) who takes calls in the emergency room of a hospital, sometimes has found children or adults with a laceration who need a booster of D.P.T., D.T., or just plain tetanus toxoid, according to age, because it has been more then one year since they have had one, and they tell you that they are allergic to tetanus toxoid.
HYALINE MEMBRANE DISEASE, RESPIRATORY DISTRESS, AND SURFACTANT DEFICIENCY
Authors: Reynolds E. O. R. , Roberton N. R. C. , Wigglesworth J. S.
Published: December 2021

Clinical observations and measurements of arterial blood gas tensions and pH were made in 55 infants surviving for more than 4 hours but dying in the newborn period. After death the pressure-volume characteristics of the lung were investigated and correlated with the estimation of pulmonary surfactant and the histological appearance of the lung. Infants dying with deficiency of pulmonary surfactant always had clinical respiratory distress, unless they were unable to make spontaneous respiratory efforts on which an assessment could be based, and hyaline membranes, dilatation of alveolar ducts, and atelectasis were always present in the lungs. Calculated right-to-left shunts were no greater at 4 hours of age in infants dying from hyaline membrane disease than in infants who died from other causes. Clinical respiratory distress was associated with a variety of conditions, and terminology is discussed. Normal pulmonary surface activity was found in infants who had hyaline membrane formation due to massive pulmonary hemorrhage or hydrops fetalis. Pulmonary surfactant was present in functionally significant amounts by the twenty-fourth week of gestation in infants dying from illnesses other than hyaline membrane disease and increased in amount as term was approached. It is concluded that the state at birth of the mechanism responsible for the production of pulmonary surfactant is the crucial factor determining the development of hyaline membrane disease, and that this illness arises because the synthetic mechanism is so immature that it cannot supply the demand for surfactant or because it has been damaged by prenatal or intrapartum asphyxia, or because of the interaction of these two influences.
Spontaneous Sexual Development in a Chromatin Negative Female with XO Blood Leukocyte Karyotype
Authors: MacGillivray Margaret H. , Cohen Maimon M. , Aceto Thomas , Capraro Vincent J. , Davidson Ronald G.
Published: December 2021

Although Turner's syndrome is usually associated with a spectrum of phenotypic abnormalities, the relatively constant features are short stature and the absence of breast development, menstruation, and fertility. An unusual exception to this general prognosis was the case reported by Bahner, et al.1,2 Their patient had short stature and a low occipital hairline; she was chromatin negative and karyotypically XO in cultures of bone marrow, skin, and both ovaries. She showed normal sexual maturation and at age 31 years delivered a normal male infant. The present report describes a chromatin negative patient who exhibited spontaneous breast development at age 12 years. This prompted a histologic and chromosomal investigation, the results of which are discussed below.
Selective Immunoglobulin A Deficiency and Intestinal Nodular Lymphoid Hyperplasia: Correction of Diarrhea with Antibiotics and Plasma
Authors: Gryboski Joyce D. , Self Thomas W. , Clemett Arthur , Herskovic Teodoro
Published: December 2021

A 13-year-old boy with chronic diarrhea and abdominal pain since 6 months of age, and recurrent fevers since 12% years of age, was found to have deficiency of IgA and nodular lymphoid hyperplasia of the small intestine. This disorder was similar to that of "dysgammaglobulinemia and intestinal lymphoid hyperplasia" described in adults in 1966. An associated giardiasis was eliminated by atabrine therapy and a malabsorption syndrome, cleared after treatment with tetracycline. Diarrhea and abdominal pain were not alleviated until he was treated with monthly fresh frozen plasma infusions.

It is to be emphasized that other forms of chronic diarrhea not related to immunoglobuun deficiencies do not respond to this type of therapy.
Letters to the Editor
Authors: Niedermeyer Ernst , Richardson Frederick
Published: December 2021

Doctors Niedermeyer and Richardson comment as follows:

Some of us would agree with Dr. Copple that there are limitations as to the information obtained from the electroencephalogram. However, perhaps Dr. Copple's remarks reflect her subjective and impressionistic view concerning the clinical value of electroencephalography in general.

No attempt should be made to convert Dr. Copple into a "believer in brain waves." Electroencephalographers should be painfully aware of technical limitations and gladly abstain from missionary zeal.
Postgraduate Medical Education
Authors: Harvey Norman A.
Published: December 2021

With seasonal regularity the practicing pediatrician must decide exactly which seminar, round table, or postgraduate course he will take this time. Unfortunately, like the individual with a tin ear who always selects the same tune, the man in practice tends to select for study those subjects he is most interested in and, therefore, most familiar with. He thus becomes even more deficient in those areas where his knowledge is always lacking; the whole vicious circle process being somewhat at odds with the professed goals of postgraduate medical education.
Another Lesson from the Health Care of European Children
Authors: Forbes Gilbert B.
Published: December 2021

In the current flurry of excitement, and dismay, at the relative ranking of the United States mortality rates,1 I should like to direct the reader's attention to a 25-year-old article which should make us–and also our Swedish colleagues–feel even worse.

I refer to Sigismund Peller's study of the health of the ruling families of Europe over the last 400 years.2 One of the calculations which Peller made was that of the infant mortality rates for this group of favored citizens.
Assessment of Cerebral Palsy, Vol. II, by K. S. Holt, M.D., M.R.C.P., D.C.H. and J. K. Reynell, B.Sc., Ph.D. London: Lloyd Luke (Medical Books) Ltd., 1967, 187 pp., $5.60
Authors: Paine Richmond S.
Published: December 2021

This is a companion piece to Volume I on motor function, which appeared in 1965. In Volume II Dr. Holt presents methods of appraising vision hearing, speech and communication, with special reference to children with cerebral palsies which are also applicable to many other neurologically handicapped children. The methods and their interpretations are clearly described and include many that the author has personally developed. These are methods that can be used by the pediatrician in a cerebral palsy clinic or in his office, rather than tools for the specialist in audiology or speech pathology.
The Drug Scene, by Donald B. Louria, M.D. New York: McGraw-Hill Book Company, 1968, 215 pp., $5.95
Authors: Blaine Graham B.
Published: December 2021

Donald Louria has written a thoroughly readable book about the drug problem. He attacks it from many different perspectives-etiological, sociological, international, historical and prognostic-to name a few. The style is journalistic but the facts and the statistics show that the author has a broad and accurate scientific foundation on which to build. The colloquialisms as well as the free use of drug culture slang make one feel part of the "scene" but the words of warning and caution keep the reader from losing touch with reality.
THERAPEUTIC TRIALS IN THE INBORN ERRORS
Authors: Crocker Allen C.
Published: December 2021

Like the policeman's lot, that of the therapist for syndromes with inborn errors of metabolism is usually not a happy one. In these circumscribed human experiments the pitfalls are manifold.1 This is especially true when the affected biochemical element is involved in the structure of the central nervous system and with the handicap expressed early in development (for example, disturbances of glycolipid, phospholipid, or mucopolysaccharide metabolism). For any theoretically useful therapeutic trial to be launched, four criteria must be met: (1) diagnosis should be established in very early life (? newborn period, or earlier), preferably utilizing both laboratory and clinical evidence; (2) direct scientific pertitience should exist relative to the selection of the agent for the trial; (3) the program of therapy should be technically simple enough, and sufficiently free of noxious side effects, that relatively bugterm employment is possible; and (4) there should be available several discrete markers of the altered metabolism of the syndrome, which can be used in efforts at quantitation of the effects of the plan.
THE IN VITRO RESPONSE OF HUMAN LYMPHOCYTES CHALLENGED BY RAGWEED ANTIGEN
Authors: Young Stuart H. , Zimmerman Raymond E. P. , Smithwick Elizabeth M.
Published: December 2021

More than 50% of human peripheral lymphocytes in culture will transform to a blastlike cell when incubated with phytohemagglutinin. To a lesser degree, the lymphocytes of a sensitive individual incubated with the appropriate antigen will also undergo blastogenesis. This phenomenon occurs not only in antigen-antibody systems associated with circulating antibody (e.g., tetanus) but also in those systems associated with delayed sensitivity (e.g., tuberculin). This study demonstrates that lymphocytes from a sensitive individual will also undergo blastogenesis when incubated with the appropriate antigen from the reagin group, in this case, ragweed antigen.
Hirschsprung's Disease in the Neonate Presenting as Cecal Perforation
Authors: Ajayi O. O. A. , Solanke T. F. , Seriki O. , Bohrer S. P.
Published: December 2021

Two cases of cecal perforation in neonates due to Hirscbsprung's disease are presented.

The clinical features in the two cases were increasing abdominal distension due to dilated bowel and pneumoperitoneum. The diagnosis was missed in the first case and, as a result, the infant was treated by simple closure of the perforation. A correct diagnosis was made in the second case and treatment was by closure of perforations and a transverse colostomy.

The diagnosis may be suspected pre-operatively and should be suspected at surgery if a colonic perforation is discovered without any apparent cause.

Biopsy of the rectum at the time of the laparotomy is suggested in order to avoid a second anesthetic prior to definitive operative treatment.
IRON BALANCE AND REQUIREMENTS IN INFANCY
Authors: Lowe Charles U. , Coursin David B. , Filer Lloyd J. , Heald Felix P. , Holliday Malcolm A. , O'Brien Donough , Owen George M. , Pearson Howard A. , Scriver Charles R.
Published: December 2021

1. The iron endowment of the newborn is proportional to the initial hemoglobin mass. This in turn depends upon the birth weight and initial hemoglobin level. The presence of low birth weight or decreased hemoglobin level in the first few days of life may identify infants with special iron requirements during the first 18 months of life.

2. It is recommended that the diet of normal term infants provide 1.0 mg/kg/day of iron by 3 months of age to a maximum intake of 15 mg/day. This requirement can be easily met by inclusion in the diet of appropriate amounts of foods which have been enriched with iron, such as infant cereals or milk formulas.

3. Infants with low birth weight and others with reduced iron endowment require as much as 2.0 mg of iron per kilogram per day beginning by 2 months of age. This amount of iron will not ordinarily be provided by the diet, even if iron-supplemented cereals are given. Attainment of these larger amounts requires the use of medicinal iron or iron-supplemented milk formula.

4. Attention should be directed to providing a variety of iron-enriched dietary staples to be used routinely for feeding American infants during the period of life from 3 to 18 months of age and to more precisely determining the best form of iron supplementation. At the present time iron fortified baby cereals and milk formulas are the iron supplemented foods most generally available. These are not utilized by the segments of the American population which have the greatest need for them.
CHILD HEALTH IN THE DEVELOPING WORLD
Authors: Kretchmer Norman
Published: December 2021

It Was November 18, 1960, when President Kennedy requested the formation of task forces to formulate foreign policy and posed a specific question for Africa, "What special propositions should we make-in regard to raising the educational level, the fight against disease and improving the available food supply?" The year before, in mentioning the national preoccupation with the missile gap, he referred to another gap, "the economic gap," by which he meant, "the gap in living standards and income level and hope for the future. It is this gap which presents our most critical challenge today-and it is to this gap we have responded most sporadically, most timidly and most inadequately." During his administration, AID was established, the Peace Corps entered the field, and the percent of total health research funds devoted to international support rose from 9.7% in 1960 to 28.7% in 1963 and, regretfully, the percent has since remained stable.

A critical examination of the title of this talk immediately raises the question-what in fact is the developing world and why is it considered to be developing? We generally speak of developing countries in terms of their political and economic emergence, but from a medical point of view they may be viewed as receptacles of vast, almost overpowering, health problems, in a perpetual struggle between population and fulfillment of the needs for a good life. Consequently, overpopulation cannot be defined simply in terms of square footage of land, but rather it relates the available facilities to the basic needs of man for food, shelter, physical protection, and human dignity.
URINARY GLYCOLIPIDS IN FABRY'S DISEASE
Authors: Philippart Michel , Sarlieve Louis , Manacorda Alberto
Published: December 2021

Urinary lipids extracted from normal subjects contain only small quantities of ceramide trihexoside (CTH) and ceramide dihexoside (CDH). Although there is some overlap, two urinary glycolipid excretory patterns may be distinguished within families affected by Fabry's disease. Type I, found in all affected males, is marked by a striking increase of CTH and a slightly high CDH output. Type II, found in female carriers, consists of a slight increase in both CTH and CDH. Since the concentration of urinary glycolipids does not change with age, examination of urinary lipids may aid in confirming the diagnosis of Fabry's disease and in predicting whether an apparently normal male will ultimately develop clinical manifestations.
POSTNATAL GROWTH RETARDATION IN CONGENITAL RUBELLA
Authors: Michaels Richard H. , Kenny Frederic M.
Published: December 2021

Three patterns of postnatal growth were found among a group of 16 infants with congenital rubella. Most remained smaller than average during infancy but grew at a normal rate. Several showed a "catch up" phase, the growth spurt in some cases occurring at about the time of apparent termination of infection. Others had a marked postnatal deceleration in growth associated with prolonged infection.

Infants of mothers with rubella during the first 8 weeks of gestation showed more stunting than those born of mothers who had had rubella after this time. Males with congenital rubella tended to have greater postnatal growth failure in both length and weight than females. There was some relationship between continued infection and the degree of postnatal growth retardation.

Growth hormone assays and other endocrine studies failed to reveal a hormonal basis for the postnatal growth failure of congenital rubella. No relationship between growth retardation and pituitary, thyroid, cardiac, renal, or hepatic dysfunction was found.
RUBELLA AND IMMUNOLOGIC RESPONSE
Authors: M. D. N.
Published: December 2021

As students of pediatrics continue to seize opportunities provided by disease in infants to learn more about human developmental biology, two common contagious exanthemata of childhood are now providing unique information on human immunologic function. The various manifestations of measles virus infections ["normal" measles, measles virus-induced giant cell pneumonia in leukemia, and subacute sclerosing panencephalitis (SSPE)] were the basis of a recent lecture by Sir MacFarlane Burnet, in which he clearly confirmed the hypothesis that in man as in animals, thymus and gut derived immunocytes differ in function. He also offered the second hypothesis that SSPE is the result of non-responsiveness of the thymus-derived immunologic system induced by measles infection of the thymus and brain.
PHENOBARBITAL IN THE PERINATAL PERIOD
Authors: Wilson John T.
Published: December 2021

Reports have appeared recently which propose the administration of phenobarbital during the perinatal period in order to reduce neonatal hyperbilirubinemia. One investigator also has suggested that phenobarbital was responsible for a decline in the death rate among small newborn infants. Since phenobarbital is known to alter the cellular metabolism of many compounds in addition to bilirubin, a brief review of present knowledge and comments on the possibility of unintentional effects of this drug in the perinatal period are warranted. It must be understood that much of the information on the effects of phenobarbital in animals may eventually have little or no clinical relevance; but, knowledge of the experimental evidence concerning the multisystem action of phenobarbital should help to identify areas of study and surveillance in the human subject.
APNEA IN PREMATURE INFANTS: MONITORING, INCIDENCE, HEART RATE CHANGES, AND AN EFFECT OF ENVIRONMENTAL TEMPERATURE
Authors: Daily William J. R. , Klaus Marshall , Belton H. , Meyer P.
Published: December 2021

The respiratory patterns of 22 premature infants were continuously monitored using an impedance plethysmograph which activated an alarm system for apnea. Apnea of greater than 30 seconds' duration occurred in about 25% of the infants studied in the first 10 days of life. Bradycardia of less than 100 beats per minute occurred within 30 seconds or less of the onset of apnea. The fall in heart rate was more rapid during those apneic episodes most difficult to terminate. All apneic episodes began in expiration during periodic breathing. The response to a standardized method of stimulation to re-initiate breathing was evaluated.

In most instances, cutaneous stimulation resulted in resumption of breathing. However, 8% of the episodes required resuscitation with oxygen by bag and mask. Apneic episodes of 45 or more seconds' duration resulted in mottling, cyanosis, hypotonia, and unresponsiveness to stimulation suggesting that early intervention is required to prevent significant hypoxia and central depression from apnea. In six additional infants having apnea, higher environmental temperatures (near the upper limit of the "thermoneutral zone") were associated with an increased incidence of apnea. Continuous monitoring of respiration in small infants is now clinically feasible.
RECOVERY FROM RENAL FAILURE DUE TO ACUTE DIFFUSE INTERSTITIAL NEPHRITIS
Authors: Knepshield James H. , Carstens Per Henrik Becher , Gentile Dominick E.
Published: December 2021

A 3-year-old girl developed acute oliguric renal failure and Coombs' positive hemolytic anemia during the course of a Group A, β-hemolytic streptococcal infection. Renal biopsy established the diagnosis of acute diffuse interstitial nephritis (ADIN) in combination with tubular necrosis. Electron microscopy of the biopsy specimen confirmed the finding of tubular necrosis and revealed focal areas of dilatation of the basal infoldings from the plasma membrane. The tubular basement membrane was fragmented. Peritoneal dialysis and other supportive measures sustained the patient until adequate renal function returned. To our knowledge, this patient represents the first reported case of recovery from ADIN associated with a streptococcal infection. The latent period between the onset of the infection and the renal manifestations, and the nature of the cellular response seen in the renal biopsy suggest an antigen-antibody reaction as the cause of the renal injury. The cause of oliguria in ADIN remains obscure. However, tubular necrosis is a well-known cause of acute oliguric renal failure and this lesion probably plays a role in the functional impairment of ADIN.
ACQUIRED LACTOSE MALABSORPTION IN THAI CHILDREN
Authors: Keusch Gerald T. , Troncale Frank J. , Miller Louis H. , Promadhat Varuni , Anderson Pearl R.
Published: December 2021

One hundred seventy-two normal Thai infants and children were studied to determine the prevalence of lactose malabsorption and lactase deficiency. These abnormalities became manifest after infancy, and by age 2 years virtually all children studied were abnormal. Sucrase and maltase activities and sucrose and glucose absorption were normal in most. Calculation of ratios of median maltase/lactase, sucrase/lactase, and maltase/sucrase activities also indicated the major abnormality to be isolated lactase deficiency. Lactose malabsorption appeared earlier in life in a group of normal institution Thai children compared to a group of village children. This suggests that environmental factors may be important in the pathogenesis of lactase deficiency in Thai children, although genetic influences cannot be excluded.
APPENDECTOMY IN CHILDREN WITH ACUTE RHEUMATIC FEVER
Authors: Lin Jer-Shoung , Rodriguez-Torres Ramon
Published: December 2021

Clinical and laboratory data on five patients with appendectomy, later proved to have acute rheumatic fever, are presented in detail. The findings indicate that abdominal pain simulating acute appendicitis can be presented as the only initial symptom in acute rheumatic fever. Awareness and knowledge of the presence of clues-high fever, rapid sedimentation rate, prolonged P-R interval, and 4 plus C-reactive protein-usually help to make the differential diagnosis. However, if doubt remains, the right approach is to go ahead with surgery since these patients tolerate anesthesia and laparotomy very well.
Intramural Fibroma of the Heart: A Case Report
Authors: Osano Mitsuru , Yashiro Kimio , Oikawa Tadao , Takeuchi Yoshinao , Matsuo Nobutake , Inoue Tadashi , Nagai Izumi , Yamamoto Hiroshi
Published: December 2021

A primary cardiac tumor was clinically diagnosed in an asymptomatic 10-year-old Japanese boy who was noted to have an abnormal cardiac contour from infancy. It was histologically an intramural fibroma of the heart. The tumor was suspected on the basis of an abnormal EKG, chest film, and angiocardiography. Although this tumor is benign, it carries the possibility of sudden death due to a conduction disturbance. It is believed that this tumor can be diagnosed clinically.
Diabetic Ketoacidosis with Fatal Cerebral Edema
Authors: Warren Philip , Villaluz Erlinda S. , Rosenberg Harold
Published: December 2021

One case of diabetic ketoacidosis with irreversible cerebral edema in a 10-year-old boy is presented. Death ensued in spite of apparently adequate fluid, electrolyte, and insulin therapy, and it followed a brief period of clinical and chemical improvement suddenly and unexpectedly. Although the pediatric literature makes no note of this syndrome, a review of the general medical literature does reveal some scattered case reports which deal with a similar pattern.

The pathogenesis is discussed with several mechanisms presented as possible factors. Suggestions are made regarding modification of therapy, but these are admittedly tentative and require further studies.
Capillary Po2 in Neonates
Authors: Stefan L. , Leschin A. , Gray K.
Published: December 2021

Capillary samples were obtained from warmed heel punctures of 30 full-term, healthy neonates 3 to 23 hours after birth (3 samples between 3-4 hours, 15 samples between 5-12 hours, and 12 samples between 12-23 hours). The blood was processed promptly, observing usual precautions, using London-Astrup equipment. Corrections were made to 37°C,assuming a rectal temperature of 36°C.After ternperatune correction, oxygen saturation was calculated from pH using Nelson's oxygen dissociation curve and Helleger's and Schruefer's pH corrections.
Changing the Family, by Warren M. Brodey, M.D. New York: Clarkson N. Potter, Inc. (23 East 67th Street, New York, New York 10021), 1968, 160 pp., $6.00
Authors: Blaine Graham B.
Published: December 2021

This is a disorganized book, but I think it is purposely so. Dr. Brodey states at one point that the family therapist's main role is that of example, and the style of this volume is an example of the freedom of expression which the author feels is essential to healthy family living.

Dr. Brodey believes that traditions and stereotypes destroy families and cause illness in family members. He emphasizes the importance of the here and now over the past and stresses the value of evolvement and constant change to adapt to changing circumstances and to individual growth.