bluuebunny/crossref_metadata_2025 huggingface dataset:
Vitamin K Administration to Mothers
Authors: Dyggve Holger V.
Published: December 2021

Although I fully agree with the recommendation of the Committee on Nutrition of the American Academy of Pediatrics (Pediatrics, 28:501 et seq., 1961) that vitamin K1 should be given to infants at birth in a dose of 1 mg intramuscularly for the prevention of hemorrhagic disease, I do not think that the use of vitamin K substitutes in a dose of 10 mg per day orally during the last week of pregnancy should be abandoned.
In Reply: Positive Schick Test after Diphtheria Immunization, as Evidence of Hypogammaglobulinemia
Authors: Coriell Lewis L.
Published: December 2021

Use of the Schick test in DPT immunized children to detect patients with hypogammaglobulinemia before smallpox vaccination may be a useful procedure, but more data would be needed to prove this. For instance, what percentage of children with a positive Schick test were hypogammaglobulinemic? Routine use of the Schick test to guide the immunization program is no longer justified if a regular schedule of injections and boosters is followed, and established proof of its efficacy would be required to revive it as a case-finding tool for hypogammaglobulinemia.
INTRADURAL LIPOMAS IN CHILDREN
Authors: Swanson Homer S. , Barnett Joseph C.
Published: December 2021

A series of nine cases of intradural spinal lipomas presenting in childhood or infancy are discussed. In all instances, associated congenital defects and a history of insidious neurological deficit were characteristic findings. In seven of the nine cases a subtotal removal of the intradural lipoma was accomplished, with resulting improvement in the neurological condition. In all instances the pathological interpretation of the lesion was that of an adult type of lipoma. Despite the benign connotations of lipoma, total surgical removal of these lipomas occurring intradurally has often been found not feasible and is probably not necessary. The inclusion of lipoma tissue within the substance of the spinal cord and nerve roots renders manipulation and excision extremely hazardous in terms of retaining the integrity of the nervous structures involved. In these instances subtotal surgical removal and decompression have proven beneficial in all instances in this series. Although exaggeration of neurological deficit may occur postoperatively, if the above surgical principles are adhered to, this deficit is not necessarily of a permanent nature.
DISTURBANCES OF WATER AND ELECTROLYTES IN INFANTILE DIARRHEA
Authors: DARROW DANIEL C. , PRATT EDWARD L. , FLETT JAMES , GAMBLE ALICE H. , WIESE HILDA F.
Published: December 2021

Balances of water, nitrogen, chloride, sodium, potassium, phosphorus and calcium are reported in eight cases of diarrhea.

Average deficits/kg. in severe dehydration due to diarrhea are H2O, 125 gm.; Cl, 9.2 mM; Na, 9.5 mM; and K, 10.4 mM. These figures may be about 10% too high for H2O, Na and Cl because of overexpansion of extracellular fluids in some cases.

These findings, especially the approximately equal retentions of Na and Cl during recovery, indicate 1. that intracellular Na is slightly high during dehydration in many cases; 2. that NaCl without NaHCO3 should suffice to restore all deficits of Na and Cl; 3. that acidosis is explained chiefly by deficit of K which leads to transfer of extracellular Na into the cells during dehydration; 4. that fluids used to replace deficits of H2O and electrolyte in diarrhea should contain K as well as Na and Cl; 5. that administration of NaHCO3 without potassium salts so as to restore rapidly the concentration of serum HCO3 in acidosis is likely to aggravate the abnormality in cellular composition and may produce alkalosis and low concentration of K in serum.

Losses of H2O as sweat are frequently 50 ml./kg./day; the maximum measured was 100 ml./kg./day. Losses of H2O in stools are frequently 50 ml./kg./day; maximum measured was 85 ml./kg./day. Nitrogen losses are rapidly replaced when milk feedings are instituted even at low caloric intakes. In the development of dehydration, losses of water in sweat are quantitatively as important as losses in stools.

Relation of these findings to treatment of infantile diarrhea is discussed.
SEPSIS OF OBSCURE ORIGIN IN THE NEWBORN
Authors: SILVERMAN WILLIAM A. , HOMAN WILLIAM E.
Published: December 2021

Twenty-five cases of sepsis in the first month of life, without preceding major illness, have been collected over an 11-year period at the Babies Hospital. A high incidence of males was noted. Fever, jaundice, and pyelonephritis were the most common manifestations. Five cases were observed to have an increase of lymphocytes in sterile spinal fluid. Coliform organisms were responsible for the majority of the infections. Thirty-five comparable cases were assembled from the literature. Neither this series nor the collected published evidence afforded statistical proof of the efficacy, or the lack of efficacy, of present day therapy in this syndrome of sepsis of obscure origin. Recommendations for work-up and initial therapy are offered.
PANCREATIC ENZYMES: NORMAL OUTPUT AND COMPARISON OF DIFFERENT METHODS OF ASSAY
Authors: VÉGHELYI PETER V.
Published: December 2021

Serial analyses of duodenal juices of 47 children were made by parallel estimations with different methods of amylase, trypsin and lipase assay for studying normal conditions and to establish a common denominator which would, independently from the method of estimation used and from the enzyme in question, indicate the normal or pathologic character of the findings. On the basis of more than 1,200 determinations it is proposed to take the lowest values recorded as 100% and to express any value below these figures as their fractions in per cent.

No differences of importance could be found between the enzyme values of different age groups and there were certainly no variations in the lipase levels.

No periodicity could be observed in the output of enzymes. Fluctuations occurred but these showed no periodicity and it could be proved that they were due to dilution of the pancreatic juice by bile. Fasting secretion continuously occurred in these healthy children and the amount of enzymes put out was constant in units of time.

A strict parallelism in the output of the three enzymes was observed in all the present cases. This holds true also following stimulation by pilocarpine and inhibition by atropine and whatever variation occurred happened simultaneously with each enzyme.

Six children were given unbalanced diets to determine whether the production of enzymes is adapted to the food given. The changes found during and after the diets could by no means be connected with the type of food eaten.

It is emphasized that all the above data were found in healthy and normal children and that the conditions described are thoroughly different in most pathologic conditions.
VENTILATORY STUDIES IN PRESCHOOL CHILDREN
Authors: Rivera Luis M. , Snider Gordon L.
Published: December 2021

Forced expiratory pneumotachygrams were made after a full inspiration in 30 normal preschool children and 21 preschool children suffering from chronic respiratory tract disease. The peak expiratory flow rate and maximum expiratory acceleration were studied. The maximum expiratory acceleration was predictable from the peak expiratory flow rate. Since the peak expiratory flow rate was easier to measure and was reproducible, it was considered the preferable determination. The peak expiratory flow rate correlated significantly with height and age, but not with weight. A regression equation has been formulated to predict peak expiratory flow rate in liters per minute, with height and age used as independent variables. It is concluded that the peak expiratory flow rate is a feasible, stable, and useful measure of ventilatory capacity in preschool children. It is especially useful for following the course of pulmonary disease.
ESSENTIAL FATTY ACIDS IN PREMATURE INFANT FEEDING
Authors: Combes Mollie A. , Pratt Edward L. , Wiese Hilda F.
Published: December 2021

The weight gain, caloric intake, and serum levels of total fatty acids, dienoic, trienoic, and tetraenoic acids and cholesterol were measured in premature infants fed to satiety on three diets identical in all respects except for the amounts of partially hydrogenated coconut and corn oil. The calories from fat were kept at 18% of the total, but Diet A6 provided 0.01%, Diet B8 0.05%, and Diet C7 4.5% of the calories as linoleic acid. All infants appeared clinically well and gained regularly throughout the study.

Infants on the diet containing 4.5% of the calories as linoleic acid had a slightly better partial caloric efficiency ratio than that of the infants on the diet with 0.01% of the calories as linoleic acid. The serum lipid values in the infants fed the lower amounts of linoleic acid (lower amounts of corn oil) resembled those reported in experimental animals with recognizable essential fatty acid deficiency. The serum lipid values for the group receiving 4.5% of the calories as linoleic acid (also ingesting the largest amount of corn oil) approach those reported in infants fed human milk.

The significance of these observations to practical infant feeding is not clear until more is known concerning the inter-relationships of essential fatty acids and numerous other food substances in human nutrition.
MEDICAL THERAPY OF THYROTOXICOSIS IN CHILDREN
Authors: Hung Wellington , Wilkins Lawson , Blizzard Robert
Published: December 2021

This report concerns 34 children and adolescents with hyperthyroidism who were treated with anti-thyroid drugs in the Endocrine Clinic of the Harriet Lane Home. In all instances except when there was drug sensitivity (two cases) or lack of co-operation (one case), anti-thyroid therapy was successful in establishing and maintaining a euthyroid state. Nineteen of 25 patients who were treated for a 2-year period remained well after discontinuing all therapy. Two of the remaining six patients relapsed and subsequently were thyroidectomized, two relapsed and resumed medical treatment, and two have not discontinued therapy. Nine patients did not complete 2 years of therapy, thyroidectomy was performed in three, and a fourth relapsed after discontinuing therapy after 8 months. Five patients are currently receiving anti-thyroid therapy but have been treated less than 2 years. Although we realize that some of the 19 patients who are in remission may relapse at some future date, 13 have remained well for 1 to 13 years after discontinuing therapy. On the basis of these favorable responses we believe that surgical therapy of thyrotoxic children should be reserved for those patients who fail to co-operate or who relapse after prolonged medical therapy. In addition to the data discussed above, results concerning the triiodothyronine suppression tests and the incidence of antithyroid antibodies in thyrotoxic children are presented and discussed.
ENTERIC CANDIDIASIS
Authors: Kozinn Philip J. , Taschdjian Claire L.
Published: December 2021

Direct microscopic examination of fecal smears permits differentiation between the saprophytic and the pathogenic phase of intestinal Candida albicans. The pathogenic phase is characterized by the presence of mycelia (M) in direct smears. When C. albicans is present saprophytically, direct fecal smears are negative or show the yeast form (Y) only. MY-positive fecal smears were found with nine times higher frequency in abnormal than in normal-appearing stools of infants with oral thrush who yielded C. albicans in stool cultures. Candidal enteritis was diagnosed on the basis of MY-positive fecal smears in 27 patients, and was ruled out on the basis of MY-negative fecal smears in six patients who yielded the organism in cultures only. The validity of the a priori diagnosis was tested by the comparative response of the MY-positive and the MY-negative patients to specific anticandidal therapy (nystatin) given by mouth. Of the patients, 88% responded clinically and mycologically as predicted on the basis of direct mycological stool examinations. Of the MY-positive patients, 80% responded to nystatin within an average of 3 days' therapy. All six MY-negative patients failed to respond within an average of 12 days' therapy. The difference in response was found to be statistically significant. Oral and/or cutaneous candidiasis was present in 85% of the MY- positive patients. The presence of oral and/or cutaneous candidiasis in a patient with diarrhea furnishes a clinical clue to probable candidal etiology of the enteritis.
BRONCHIOGENIC MEDIASTINAL CYSTS IN INFANTS: CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Opsahl T. , Berman E. J.
Published: December 2021

A case of bronchiogenic mediastinal cyst in an infant is presented, which was treated successfully surgically even though the cyst itself was not roentgenologically demonstrable preoperatively. The literature is reviewed. When the lesion has been demonstrable on x-ray, successful surgical intervention has been the rule. When the lesion has not been demonstrable on x-ray, procrastination and death have often occurred. Clinically this pathology will be manifested by periodic and usually progressive attacks of dyspnea, wheezing, stridor, and cyanosis—all aggravated by crying and feeding and ameliorated by oxygen therapy. Roentgenologic and endoscopic studies are mandatory, but even if negative, when these clinical findings are present, exploratory thoracotomy should be carried out.
PRIMUM NON NOCERE
Authors: KRETCHMER NORMAN
Published: December 2021

IN THE PAST few months many words have been written concerning the hazard of indiscriminate administration of drugs to pregnant women and infants. This concern has simmered in the minds of pediatricians and obstetricians for some time. It is tragic that the impulse to do something constructive emerged only after an international disaster. This Commentary is not directed solely to the specific problem of thalidomide, for Taussig, elsewhere and in this issue, and other authors have ably reviewed the tragedy in light of scientific information. I wish to stress some of the biologic aspects of administering drugs during pregnancy and infancy, and more particularly the responsibility of the physician to be informed so that he will be able to protect the health of the public.
IRON INTAKE, HEMOGLOBIN, AND PHYSICAL GROWTH DURING THE FIRST TWO YEARS OF LIFE
Authors: Beal Virginia A. , Meyers Aldula J. , McCammon Robert W.
Published: December 2021

The variety of infant diets given subjects in this group during the first year all provide iron in amounts of 0.5 mg/kg/day or more except in one of the 59 children. This level of dietary iron intake was adequate to meet iron requirements for hemoglobin synthesis and to prevent development of hematologic or clinical evidence of iron deficiency. Food intake adequate to support rapid growth rates contains enough iron to support the needed relative acceleration of hemoglobin synthesis. Lower intakes of iron are associated with higher percentage utilization in hemoglobin synthesis and higher intakes result in lower utilization. Supplementation of diets with iron in several forms occurred in 25% of the group without hematologic evidence of response as compared with the group dependent on dietary iron alone.
METACHROMATIC LEUKODYSTROPHY: CLINICAL, HISTOCHEMICAL, AND CEREBROSPINAL FLUID ABNORMALITIES
Authors: Allen Richard J. , McCusker James J. , Tourtellotte Wallace W.
Published: December 2021

A child has been reported with histochemically proven metachromatic leukodystrophy. Central nervous system degeneration began at the age of 20 months and continued to the time of death at the age of 49 months. Prior to death a "cherry red spot" became evident in the retina and is the only known instance of this finding. This adds to the evidence that metachromatic leukodystrophy is one of the neurolipidoses, but the metabolic defect apparently affects primarily the cerebroside sulfuric acid esters. Repeated analyses of cerebrospinal fluid demonstrated an elevated total protein and a "midzone" gold curve. Lipid analysis of serum and cerebrospinal fluid demonstrated findings which are discussed in detail and correlated to the histochemical changes. In addition, comparisons are made with the cerebrospinal fluids in Tay-Sach's and Niemann-Pick's disease. This too revealed important differences between the various neurolipidoses.
AN EPIDEMIOLOGICAL INVESTIGATION OF A STREPTOCOCCAL AND RHEUMATIC FEVER EPIDEMIC IN DICKINSON, NORTH DAKOTA
Authors: Zimmerman Robert A. , Siegel Alan C. , Steele C. Patton
Published: December 2021

Data have been presented relating 11 cases of acute rheumatic fever to a high prevalence rate of Group A streptococci in a population of school children in Dickinson, North Dakota. The majority of cases of rheumatic fever did not have a clear cut antecedent streptococcal infection which came to the attention of the examining physicians. Carrier rates for beta-hemolytic streptococci approached 50 to 60% on the initial survey, and rapidly diminished over a 6-week period. Approximately 60% of the Group A streptococci were typeable, and one-third of these were Group A, Type 5.

Convalescent antistreptolysin O titers obtained on a group of fifth grade school children, of two schools followed, clinically revealed significantly high titers above any described in previous civilian epidemiological studies but comparable to epidemic strains seen in the military. A virulent Group A, Type 5 streptococcus explosively spread through this community and undoubtedly was responsible for a high attack rate of rheumatic fever. Recommendation for civilian mass prophylaxis on the basis of the data obtained from this epidemic may be made for the first time.
FATAL PULMONARY DISEASE DUE TO PNEUMOCYSTIS CARINII IN A 22-MONTH-OLD CHILD
Authors: Dreyfuss M. L.
Published: December 2021

A case of fatal pulmonary disease due to Pneumocystis carinii in a child, debilitated but without demonstrable other active infection or neoplastic disease, is reported. This is the first case of its kind to be reported in New York State.
SIMPLE GEL DIFFUSION MICROMETHOD FOR GAMMA-GLOBULIN DETERMINATION
Authors: Huntley Carolyn C.
Published: December 2021

A simple gel diffusion method for the measurement of gamma-globulin in serum has been presented. It can also be adapted for gamma-globulin determinations in cerebrospinal fluid. The accuracy of this method is greater at low concentrations of gamma-globulin, and it is primarily useful as a screening test for hypogammaglobulinemia. Sera of 50 normal children aged 5 to 18 years were examined by this method. The range of gamma-globulin was 0.9 to 2.2 gm/100 ml, with a mean of 1.41. Comparison with serum concentrations on normal children determined by electrophoresis indicates that the values for the gel diffusion method are slightly higher.
Testing of Drugs
Authors: WILSON JAMES L.
Published: December 2021

The Commentary by Dr. Norman Kretchmer, appearing as the lead article in the October, 1962, issue of Pediatrics, eloquently expresses the concern that all thoughtful physicians have for the harm that attempts at progress in medical care may bring about. Although the total benefit that our drugs, hormones, and vaccines accomplish for our public far outweighs the harm, we look back with a shudder at some of the mistakes. To mention a few, the Lübeck disaster with BCG; several frightening experiences in the early attempts at poliomyelitis immunization; the early mistake in the manufacture of the Salk vaccine; the horrible disaster from retrolental fibroplasia about which I feel particularly guilty; the increase of brain damage from bilirubinemia resulting from a general prophylactic use of the sulfa drugs; and now this most horrible disaster from thalidomide; all should keep us in a healthy state of alert worry.
Should All Newborn Infants Be Tested for Phenylketonuria?
Authors: NORDSTROM FRANK B.
Published: December 2021

I have read the increasing spate of correspondence dealing with phenylketonuria.

It would seem that the writers have already assumed that universal testing of newborns is necessary and only ask how. I practice in a town of 20,000. In practical terms this means that I would probably test for this disease for a lifetime and discover one case. Would the vast expenditure of time and money be worth it? To carry the testing program further, why not test for mucoviscidosis with a routine sweat test?
WEIGHT AND SEX OF CHILDREN HOSPITALIZED WITH INFECTIOUS CROUP
Authors: Berg Robert B.
Published: December 2021

An analysis of the sex and weight of 850 hospitalized children with infectious croup is presented. The results confirm previous reports that this respiratory disease occurs predominantly in males. Furthermore, children hospitalized with infectious croup tend to be heavy.
TRANSIENT 19S GAMMA1-GLOBULIN DEFICIENCY IN THE NEWBORN INFANT, AND ITS SIGNIFICANCE
Authors: Gitlin David , Rosen Fred S. , Michael J. Gabriel
Published: December 2021

Sera were obtained from 52 mothers and their infants, from 36 additional children from 1 week to 3 years of age, from 15 individuals with congenital or acquired agammaglobulinemia, and from 2 children with type 1 dysgammaglobulinemia. The bactericidal activity of these sera against Salmonella typhosa 0901 and Escherichia coli 0127 in the presence of human complement was studied. Selected maternal and cord sera were fractionated by electrophoresis and by ultracentrifugation, and the bactericidal activity of the fractions also studied. The following results were obtained. Most of the newborns lacked serum bactericidins against 0901 and 0127, and in those infants where bactericidins were found, the activity was low compared to that of the mother. When there were no detectable serum bactericidins in the newborn infant, all or almost all of the activity in the mother's serum was present as 195 gamma1-globulin. When the newborn infant did possess serum bactericidins, activity similar in amount to that in the infant's serum was present in the mother's 7S gamma2-globulins, although most of the activity of the maternal serum was 19S gamma1-globulin. Bactericidins in cord sera, when present, separated with the lower molecular weight serum proteins, and none was found in the 195 macroglobulin fraction. There was little or no bactericidal activity in sera from patients with agammaglobulinemia, and high concentrations in two children with type 1 dysgammaglobulinemia. The bactericidins measured were specific for each of the two organisms tested and appear to be specific antibodies. The data are in accord with the observation that the newborn's serum is markedly deficient in 19S gamma1-globulins and that there is transplacental transfer of 7S gamma2-globulins from mother to fetus. As a result the newborn infant is deficient in bactericidins to Gram-negative enteric bacilli.
Useful Suggestion for Detection of Hernia
Authors: TERHUNE CHARLES B.
Published: December 2021

It might be of interest to other practitioners of pediatrics to learn of a technique that I have found most helpful in detecting hernias in young children. It has been my practice to keep a supply of small rubber balloons in my office and to routinely, in the course of pediatric examination, ask the youngster to see if he can blow up the balloon. It seems that even the youngest toddlers are willing and able to attempt to blow up the balloon, with the exception of a very small minority who would probably be uncooperative in the face of any request. By employing this technique over the past several years, it has been possible for me to detect several inguinal hernias and one femeral hernia which had not been noted previously by the parent, in youngsters of pre-school age group.
PLASMA ADRENALINE AND NORADRENALINE IN THE NEONATAL PERIOD, AND INFANTS WITH RESPIRATORY DISTRESS SYNDROME AND PLACENTAL INSUFFICIENCY
Authors: Cheek Donald B. , Malinek Malvina , Fraillon J. M.
Published: December 2021

The fluorometric method of Weil-Malherbe and Bone was used to investigate plasma catecholamine levels in the neonatal period. Full-term normal infants were found to have plasma adrenaline levels of 0.35 ± 0.64 µg/l and noradrenaline levels of 2.39 ± 2.69 µg/l. Premature infants had plasma adrenaline levels of 0.86 ± 1.21 µg/l and noradrenaline levels of 3.24 ± 2.03 µg/l. Twelve premature infants with the respiratory distress syndrome showed a significant and fourfold increase in adrenaline concentration and a nonsignificant increase in the level of noradrenaline. In seven infants with placental insufficiency and postmaturity there was a significant and eightfold increase in adrenaline. The importance of these findings is discussed, particularly with respect to hypoxia.
THE EFFECT OF A CENTRAL NERVOUS SYSTEM STIMULANT (DEANOL) ON BEHAVIOR
Authors: Kugel Robert B. , Alexander Theron
Published: December 2021

The effect of deanol on the problem solving and emotional behavior of 42 children between the ages of 6 and 13 years was investigated. Both medical and psychological appraisals were made of the subjects, leading to diagnosis of either central nervous system or behavior disorder. A cross-over, double-blind experimental design was used, with the drug being administered in a dosage of 100 mg daily. The drug did not produce significantly different scores, on the measures employed, over the scores obtained while the subjects were given the placebo. No important side-effects of the drug were observed during the experimental period.
THE EXCRETION OF DIHYDROXYPHENYLALANINE, DOPAMINE, AND DIHYDROXYPHENYLACETIC ACID IN NEUROBLASTOMA
Authors: Sourkes T. L. , Denton R. L. , Murphy G. F. , Chavez Beatriz , Cyr Simone Saint
Published: December 2021

Six cases of neuroblastoma and one of ganglioneuroma were studied with respect to excretion of dopamine and dopac (3,4-dihydroxyphenylacetic acid) in the urine. The quantities of these compounds were found to reflect the clinical status of the patient. In general, they were low during remission and increased just before and during relapse. In the urine of one patient, 3,4-dihydroxyphenylalanine was identified.
CLINICAL IMPROVEMENT IN CHRONIC RENAL HYPERTENSION IN CHILDREN
Authors: Caliguiri Lawrence A. , Shapiro Alvin P. , Holliday Malcolm A.
Published: December 2021

Four children having diffuse renal disease and proteinuria were hospitalized because of hypertension developing after the onset of the kidney disease. The lability of the blood pressure particularly in response to anxiety in these children was far greater than is generally noted in adult patients with hypertensive renal disease. All of the patients had complete relief of symptoms due to their hyptertension, and in all four significant reduction in blood pressure was attained. The proteinuria associated with the kidney disease diminished in all four and disappeared in two patients. These results were associated with the use of hypotensive agents and with measures taken to relieve anxiety the patients had about their disease. The importance of the latter was suggested from the sensitivity in blood pressure response associated with anxietyproducing states.
PNEUMOTHORAX AND MEDIASTINAL AND SUBCUTANEOUS EMPHYSEMA IN CHILDREN WITH BRONCHIAL ASTHMA
Authors: Jorgensen Jacqueline R. , Falliers Constantine J. , Bukantz Samuel C.
Published: December 2021

In a review of a population of 269 asthmatic children at Children's Asthma Research Institute and Hospital (CARIH), there were three cases of pneumothorax and four with subcutaneous and mediastinal emphysema. The pertinent findings, management, and outcome have been summarized. Four of the five episodes of pneumothorax occurring in three patients were treated by closed thoracotomy. Two patients experienced recurrences. A review of the literature since 1950 disclosed reports of 11 additional cases of pneumothorax or subcutaneous, mediastinal, or interstitial emphysema among asthmatic children. These are also summarized in an effort to ascertain the incidence, severity, and prognosis of these complications. It appears that such complications are not rare during a severe asthmatic attack and must always be kept in mind. It is probably wisest to evacuate extrapleural air immediately by closed thoracotomy in any asthmatic patient with spontaneous pneumothorax.
Colic
Authors: HELLERSTEIN STANLEY
Published: December 2021

This is written to call attention to urinary tract infections as one of the causes of the colic-syndrome in infants. Though many esoteric entities have been mentioned, neither the article by Clark et al. (Pediatrics, 31:65, 1963) nor others I've surveyed mention cystitis in the differential diagnosis of infantile colic.

During the past 18 months our two-man pediatric practice has encountered urinary tract infection as the cause of "colic" in three infants. In the first of these we had been aware of a very tense family situation from experience with the two older children.
PROTEOLYTIC ENZYME ACTIVITY AND THE ROLE OF DESOXYRIBOSE NUCLEIC ACID (DNA) IN CYSTIC FIBROSIS SPUTUM
Authors: Lieberman Jack , Kurnick Nathaniel B.
Published: December 2021

Proteolytic enzyme activity in sputum was found to be related to the degree of purulency of the specimen and not to reflect any specific disease entity. Protease activity was demonstrated in the respiratory secretions of all patients with cystic fibrosis tested and in the majority of patients with bronchiectasis, but in few of the specimens from patients with other respiratory diseases. The same enzyme was found in eight specimens of pus. The inhibition of proteolysis within purulent sputum by its DNA content is discussed, and a role for DNA in the development of the highly viscous respiratory secretions in cystic fibrosis is postulated.
Letters to the Editor
Authors: GUTELIUS MARGARET F.
Published: December 2021

The information in Dr. Catzel's letter is most interesting. It supports my impression that there are at least two types of pica which are recognizable syndromes. One group is found in rural areas, or at least in residences where earth is available. The children tend to have severe anemia and are cured of geophagy by treatment for the anemia. I am becoming most curious about the underlying psychologic or environmental reasons which cause the excessive consumption of milk in these children in the first place.
Academy Recommendations and Public Health Regulations
Authors: HARVIE F. H.
Published: December 2021

A recent communication (Pediatrics, 31:156, 1963) opens with a somewhat extended interpretation of comments from a previous letter of mine. If space permits, I should like to make some additional comments based principally on a few words from this same earlier letter: "Circumstances differ from one hospital to another."

The whole idea of wide spacing implies that a newborn infant presents considerable infectious risk to those in neighboring cribs. The degree of this risk will depend on the management of the maternity service as a whole and should be very small in any well-conducted unit.
HAS PSYCHOLOGIC MALNUTRITION TAKEN THE PLACE OF RICKETS AND SCURVY IN CONTEMPORARY PEDIATRIC PRACTICE?
Authors: Talbot Nathan B.
Published: December 2021

WHILE MEDICAL HISTORIANS cannot provide us with accurate statistics concerning the incidence of rickets and scurvy in centuries past, they leave little room for doubt about the high prevalence of these disorders prior to the advent of modern scientific medicine. Thus, Castiglione has written that in the sixteenth century scurvy raged throughout northern Europe, in Scandinavia, on the shores of the Baltic, and in the interior of Germany. It is interesting to note, however, that Jacques Cartier, whose sailors had been ravaged by scurvy, learned in 1536 from the Indians that the malady could be cured by juices of the almeda tree. This was 200 years before James Lind demonstrated the curative effects of lemon juice in his treatise on scurvy published in 1753 and almost 400 years before ascorbic acid, which was isolated by Szent-Gyorgi in 1928, was recognized to be vitamin C by Waugh and King in 1932.

Rickets, likewise, was occurring in a large portion of children prior to the discovery of the existence of vitamin D by Hess, Steinbock, and Windaus in 1918, of its therapeutic value by Mellanby in 1919, of the equivalent role of sunlight by Hess in 1921, and of the chemical composition of the vitamins by Windaus in 1922. But 200 years earlier Friedrick Hoffman had the answer to the control of this disease almost in hand. He attached much importance to climatic conditions as a factor in rickets, noting that if anything is specially powerful in producing this affliction, it is a surrounding atmosphere of cold foggy air. He cited as striking evidence of this the famous emporium of England, London, which he found to be specially apt to produce and foster this disease.
Heal the Hurt Child
Authors: WORK HENRY H.
Published: December 2021

An unusual experiment in the application of education and psychotherapy is set forth at considerable length in this book. Using what appears to be considerable knowledge and apparently an equal amount of well-applied intuition, Dr. Riese, a European-trained physician, has organized a special treatment center for extremely deprived children in the city of Richmond. The treatment center has been in operation since 1942. In describing the work with these children, the book sets forth the concept of educational therapy, a method of help more commonly applied in Europe than in this country. Dr. Riese's book describes this process in considerable detail.
SIGNS OF PYRIDOXINE DEPENDENCY MANIFEST AT BIRTH IN SIBLINGS
Authors: Waldinger Clara , Berg Robert B.
Published: December 2021

The histories of three siblings suffering from apparent pyridoxine dependency are described. The last born infant was successfully treated at 3 hours of age with the exclusive use of pyridoxine. Review of the available literature indicates that this is the earliest example of such therapy. The three infants showed similar signs of distress which have not been previously described. It is recommended that when such cases are anticipated or suspected that large doses of pyridoxine be given to the mother at term and during labor. The importance of a diagnostic trial of pyridoxine therapy in cases of idiopathic neonatal seizures cannot be over-emphasized.
Phenylketonuria
Authors: HOLT L. EMMETT
Published: December 2021

The chapter headings of this book bespeak its quality: Incidence and Inheritance, by Eugene Knox; Biochemistry, by Marvin Armstrong; chapters on The Clinical Picture, the Pathology and the Pathogenesis of the Mental Defect, by George Jervis; on the Detection, Tests and Reagents, by Willard Centerwall, Helen Berry, and L. I. Woolf; the Management, by Horst Bickel and W. Grüter; a chapter on Diets and Recipes, by Frank Lyman; and, finally, The Experimental Approach, by Harry Waisman. It is clear that the leading authorities on the various aspects of the disease have been tapped and given space to tell their story. An introductory chapter on the discovery of the disease by Siegried and Willard Centerwall gives a charmingly written picture of Asbjörn Fölling—"the man who started it all."
INTESTINAL LACTASE DEFICIENCY IN A PATIENT WITH CYSTIC FIBROSIS
Authors: Cozzetto Frank J.
Published: December 2021

The case of a 3 7/12-year-old boy with coexistent cystic fibrosis and intestinal lactase is reported. Disaccharide tolerance studies revealed normal serum glucose levels after oral ingestion of maltose, sucrose, and glucose-galactose, but abnormally low levels of serum glucose were obtained after lactose loading. Enzyme assay of a biopsy of the jejunal mucosa revealed normal sucrase, but markedly reduced lactase activity.
THE DIAGNOSIS OF MAPLE SYRUP URINE DISEASE (Branched-chain Ketoaciduria)
Authors: Dancis Joseph , Hutzler Joel , Levitz Mortimer
Published: December 2021

The metabolism of the three branched-chain amino acids has been investigated in vitro, using the peripheral leukocyte. The normal leukocyte can transaminate and decarboxylate the three amino acids. These functions are demonstrable at birth. Five cases of maple syrup urine disease (branched-chain ketoaciduria) were studied. The peripheral leukocyte could transaminate the three amino acids, but decarboxylation was greatly reduced or absent. This confirms the site of metabolic block in maple syrup urine disease, and suggests an early and specific approach to diagnosis. Oxidative-decarboxylation of the branched-chain ketoacids involves an enzyme common to all three ketoacids.
Experience with Testing for Phenylketonuria in Massachusetts
Authors: MACCREADY ROBERT A.
Published: December 2021

Because it seems unfortunate that misunderstandings in some places have delayed the inauguration of screening programs for phenylketonuria (PKU) in newborns, I am sending this or a similar letter to the editors of five or six medical journals. It occurred to me that a preliminary published note regarding the 10-month experience of Massachusetts in the nation-wide PKU newborn screening project might be of value to physicians and health officers of other states, especially in states not presently participating or participating only on a limited basis.
Unsuspected Bacterial Interference with Antibiotic Therapy
Authors: CANBY JOHN P.
Published: December 2021

The problem of the recurrent streptococcal pharyngitis after apparently adequate antibiotic (especially penicillin) therapy has been a thorny problem which often plagues those in clinical medicine. Dr. Simon and Sakai are certainly to be congratulated for the very interesting paper on "Staphylococcal Antagonism to Penicillin Therapy Streptococcal Infection" (Pediatrics, 31:463, 1963). Perhaps this will help to solve this problem in clinical medicine.

I wish to point out that this may not be an isolated instance of staphylococcal interference with antibiotic therapy for what should be nonresistant organisms.
Letters to the Editor
Authors: SIMON HAROLD J. , SAKAI WILLIAM T.
Published: December 2021

Major Canby's points are well taken and we share his opinions. Our published studies dealt exclusively with the role of coagulase-positive penicillin-G-destroying staphylococci. It is entirely possible that other microorganisms may act in a similar fashion, as shown recently by Sabath and Finland (J. Bact., 85:314, 1963). This matter is currently under investigation in our laboratories. Although we have no final answers to this particular question, these studies have thus far convinced us that such microbial interactions are by far the most important causes of failure to eradicate group A hemolytic streptococci from the nasopharynx; microbial persistence, drug indifference, and conversion to "I" forms seem to be of little clinical significance in this setting.
The Asthmatic Child: Psychosomatic Approach to Problems and Treatment
Authors: WERMER HENRY
Published: December 2021

In December, 1961, a symposium concerning the psychosomatic aspects of asthma in childhood was held at Downstate Medical Center, State University of New York, College of Medicine. That symposium forms the basis of this book, in which 18 authors, mainly psychiatrists, have contributed to a survey of the psychiatric knowledge of the asthmatic child. Detailed case histories are included in 10 of the 15 papers that comprise this volume. These histories provide interesting and generally well-written vignettes of certain asthmatic children. In many cases the mother-child relationships are manifestly disturbed.
CONGENITAL ECTODERMAL DYSPLASIA OF THE FACE
Authors: Setleis Howard , Kramer Benjamin , Valcarcel Marta , Einhorn Arnold H.
Published: December 2021

Five children are described who have a previously undescribed collection of defects. The children are all of Puerto Rican ancestry. The features of their defects are: (1) an aged, leonine appearance; (2) absent eyelashes from either lid, or multiple rows of lashes on the upper lids with absence of those of the lower lids; (3) eyebrows which slant sharply upward and laterally; (4) scarlike defects on each temple erroneously attributed at first, to obstetrical forceps injury; (5) skin which is puckered around the eyes, as in an elderly person; (6) a scarlike median ridge of the chin; and (7) a nose and chin which seem rubbery when palpated. The temporal defects and abnormalities of the eyelashes are thought to be due to the multiple effects of a single gene. We suggest that this combination of cutaneous lesions limited to the face is probably the expression of an autosomal reccessive inheritance.
VINCRISTINE (LEUROCRISTINE) SULFATE IN THE TREATMENT OF CHILDREN WITH METASTATIC WILMS' TUMOR
Authors:   Writing Committee
Published: December 2021

Metastatic Wilms' tumor was temporarily controlled by vincristine (leurocristine) sulfate in 9 of 13 children. The responses to the drug were prompt, becoming apparent within 3 weeks in 75% of the patients. The duration of the responses was relatively short, however, being less than 2 months in half the group. No cross-resistance in antitumor effect with previously administered chemotherapy or radiotherapy was observed.

The vincristine was administered in "priming" doses for 5 days, and thereafter in weekly maintenance doses. Although some of the patients had two or more toxic manifestations, i.e., alopecia, nausea, vomiting, increased irritability, pain in the abdomen and in the jaws, disturbances of gait, and hematuria, only two patients required a temporary alteration of the dosage regimen. No deleterious effects upon the body weight or blood count of any of the patients were detected.

The potential usefulness of vincristine sulfate as a palliative treatment for patients with Wilms' tumor is discussed.
RELATION OF INTENSITY OF STAPHYLOCOCCAL INFECTION IN NEWBORN INFANTS TO CONTAMINATION OF NURSES' HANDS AND SURROUNDING ENVIRONMENT
Authors: Love Gory J. , Gezon Horace M. , Thompson Donovan J. , Rogers Kenneth D. , Hatch Theodore F.
Published: December 2021

A method for measuring the intensity of staphylococcal infection and contamination was devised and used to study staphylococcal infections in a newborn nursery. Four hundred infants had multiple cultures from various body sites and from their immediate environment. The degree of intensity of infection at any given body site was associated directly with total body infection intensity and intensity of contamination in the surrounding environment. When nurses contacted babies with staphylococci on their bodies or in their immediate environment, staphylococci could be isolated subsequently from the nurses' hands 11.8% of the time, in contrast with 0.6% with uninfected and uncontaminated babies. Approximately 95% of the time the phage type from the hand was the same as that in the contacted infant. Two percent of the time, nurses' hands were found to be contaminated with staphylococci before they contacted babies, a majority of which were of the same phage type as found on the baby she had just left. Heavily infected babies contaminated nurses' hands more frequently than did lightly infected babies and certain kinds of nursing care, such as diapering and routine morning care, resulted in more intense nurse hand contamination than did other activities. It is suggested that the measures of infection intensity used in this study have identified babies with different potentials for spreading staphylococcal infections.
CYTOCHROME c CONCENTRATIONS DURING RAT AND GUINEA PIG DEVELOPMENT
Authors: Dallman Peter R. , Schwartz Herbert C.
Published: December 2021

Cytochrome c concentrations were determined in tissues of the rat and the guinea pig, two mammalian species of contrasting developmental pattern. The relatively mature newborn guinea pig had approached adult concentrations of cytochrome c by one day of age. The less mature newborn rat did not attain comparable values until later in its development. The increase from the low fetal tissue concentrations to adult values occurred in the following sequence: heart concentrations increased earliest, followed by brain, skeletal muscle, and liver. Renal concentrations were the last to rise. Changes in cytochrome c concentration could be related to functional changes within these tissues as well as the over-all pattern of maturation represented by each of these species.
GROUP A STREPTOCOCCAL INFECTIONS IN A CHILDREN'S HOME
Authors: Moffet Hugh L. , Cramblett Henry G. , Smith Annie
Published: December 2021

All children admitted to a children's home infirmary for illnesses other than skin diseases or trauma during a period of 2 years were cultured for Group A streptococci and viruses. Almost 90% of the children with fever and unequivocal exudative pharyngitis had throat cultures containing more than 10 colonies of Group A streptococci. About 90% of the illnesses with sore throat or minimal erythema without fever or exudate were not associated with a similarly positive culture. About 50% of the children with only two of the three features of fever, pharyngeal exudate, and erythema had positive cultures, and it was this group of patients for whom throat cultures were most useful. Although Group B Coxsackie viruses and adenoviruses were recovered from some of the children, Group A streptococci were clearly the most frequent cause of moderate or severe pharyngitis in children of school age and were recovered from 50% of all children with an oral temperature of 38.3°C (101°F) or higher.
MECHANICS OF RESPIRATION IN BRONCHIOLITIS
Authors: Krieger Ingeborg
Published: December 2021

Data on the pressure-flow-volume relationships in bronchiolitis were obtained by recording simultaneously tidal volumes and esophageal pressures per unit of time in 24 infants with bronchiolitis. All infants had acute pulmonary hyperinflation. The values for dynamic compliance were markedly decreased. The decrease is presumably caused by unequal ventilation at high respiratory frequencies and by the increased retractive force active in a previously normal lung at a high level of inflation. The mean tidal volume/m2 was lower and the mean minute volume/m2 higher than normal. Expiratory flow was rapid and expiration shorter than inspiration in most cases. The mean expiratory resistance was lower than the mean inspiratory resistance and below normal when compared with the values of 24 normal infants. The mean combined resistance was in the normal range.

Judging from known anatomical changes in bronchiolitis, an elevated combined resistance had been expected. The finding of low values for resistance can be explained by Otis' theory of the "equality of time constants," i.e., when flow is rapid in a system of unequally obstructed airways, the measured resistance will approximate that in the larger airways. It thus appears that the measurement of resistance in the common pathway does in certain conditions not represent the true resistance in the peripherie, particularly not the resistance of the more severely affected branches.

It is suggested that the finding of a short expiratory phase is caused by the increased elastic recoil, which distends the airways at high lung volumes and consequently facilitates flow in those bronchioles which are only minimally involved by the disease process. Flow in the more severely obstructed bronchioles will decrease when a given pressure is greater than that necessary for maximal flow. It appears that the measured flow in the present cases with bronchiolitic pulmonary hyperinflation is not representative of over-all effective flow as indicated by the findings of paradoxically low values for resistance.