bluuebunny/crossref_metadata_2025 huggingface dataset:
DRUGS AND SPORTS
Authors: Diamond Eugene F. , Heffelfinger John C. , Kennell John H. , Poncher John R. , Shaffer Thomas E. , Thornton Melvin
Published: December 2021

Young people today grow up with the notion that there is a drug to hasten recovery from practically every illness and that a healthy person can be even better off if he has something special in his diet or in his manner of living. The result of these beliefs and attitudes is a host of misconceptions about ways by which a healthy individual can be improved by a miracle drug, a special diet, a vitamin, a hormone, particular exercises, or some other procedure. There is no scientific basis for any such practices, although they are usually not actually hazardous. However, a number of drugs, including those allegedly capable of increasing performance, may indeed be harmful.

Some athletes and their coaches, in their eagerness to excel, are now using a variety of ergogenic aids in an attempt to increase work output and thus improve performance. Such attempts to enhance physical ability have involved the use of nutritional, physical, and pharmacological agents.

The subject of dietary measures to improve physical performance can be dealt with in a few words. There is no evidence to support claims that any special food, vitamin, or other nutritional supplements can improve athletic ability of an individual already receiving an adequate diet.

There also is no scientific evidence that the use of physical ergogenic aids (breathing oxygen, use of massage, ultraviolet light, mechanical devices, and so forth) will bring about better physical performance. Oxygen cannot be stored in the tissues, and so its inhalation before exercise has no effect on performance or rate of recovery.
Lead Poisoning: Status of the FEP and Other Tests
Authors: Fischer Robert D.
Published: December 2021

The recent articles by Piomelli et al.1 and Chisolm2 represent another welcomed investigation and discussion on the use of free erythrocyte porphyrin (FEP) test in the control of lead poisoning. These investigators, however, have greatly overstated the potential of this test as a primary screening tool in community lead control programs.

The policy statement of the Surgeon General of the Public Health Service, developed in consultation with Dr. Chisolm, has established that "The prime goal of screening programs is the prevention of lead poisoning" [emphasis added].3
Pédiatrie Sociale, by Raymond Mande, Nathalie Masse, and Michael Manciaux. Paris: Flammarion Médecine-Sciences, 1972, 699 pp., no price given
Authors: Falkner Frank
Published: December 2021

It is a pity that this good book is published in French, the sole reason for this odd statement being that it would deservedly be read by a much larger readership of this journal if it were available in English. I know of no such comparable up-to-date book that embraces so well the whole complex of social pediatrics and child health.

The editors have divided the contributions of 34 contributors into four parts: demography and vital statistics, the normal child, social factors related to the main illnesses of childhood, and organization of services designed to protect the child's health and optimal social development.
ON DETERMINING THE SEX OF THE UNBORN CHILD
Authors: C. T. E.
Published: December 2021

Dr. Eugene Beckland, considered by some of his contemporaries to be the most distinguished French physiologist of the first half of the 19th century, offered the rules cited below for telling the sexes of children before they were born.*

There are tolerably conclusive rules, for telling the sexes of children before they are born; and were I to be guided entirely by the testimony of my own experience, I would say, that these rules are infallible. Ladies experience more sickness with boys than with girls, probably because they are generally larger and more lively. Their foreign appetites are also of a stronger, better defined, and more natural character. For instance, with one they will long for meat, spiritous liquors, etc.; with the other, for chalk, isinglass, and various substances, which would be quite repugnant to her at other times. Anain roundness of form promises a boy; whereas when the tendency is nearly all to the front, and the hips and back give but little evidence of the lady's situation, the great probability is, that the little stranger is a girl. At all events, these indications never have deceived me.1
QUINTILIAN ON EDUCATION OF THE CHILD
Authors: C. T. E.
Published: December 2021

Marcus Fabius Quintilianus (c. A.D. 35-c. 95) was born in Calagurris, Spain, and was brought as a child to Home. Emperor Vespasian appointed him public teacher of oratory in Rome; among his pupils were Pliny the Younger and the future emperor Hadrian. At the age of 48 Quintilian retired from teaching to find time to write his celebrated Institutio Oratoria. The quotations below taken from this book demonstrate that his ideas on childhood education might have been written by a contemporary educator.

Above all things we must take care that the child, who is not yet old enough to love his studies, does not come to hate them and dread the bitterness which he has once tasted, even when the years of infancy are left behind. His studies must be made an amusement.

Study depends on the good will of the student, a quality that cannot be secured by compulsion.

I disapprove of flogging, although it is the regular custom and meets with the acquiescence of Chrysippus [the Stoic philosopher], because in the first place it Is a disgraceful form of punishment and in any case it is an insult, as you will realize if you imagine its infliction at a later age.

I will content myself with saying that children are helpless and easily victimized, and that therefore no one should be given unlimited power over them.

There are no subjects in which, as a rule, practice is not more valuable than precept.1
KINKY HAIR SYNDROME: RESPONSE TO COPPER THERAPY
Authors: Bucknall William E. , Haslam Robert H. A. , Holtzman Neil A.
Published: December 2021

A 3-month-old male with kinky hair syndrome was given copper salts and purified ceruloplasmin, and the clinical and chemical responses measured. Initial plasma copper concentration was l5µ/100 ml and ceruloplasmin was undetectable. A seven-day course of oral cupric sulfate did not raise plasma copper or ceruloplasmin concentrations. After intravenous administration of cupric acetate on two occasions ceruloplasmin was detectable by chemical and immunological assays. Intravenous administration of purified human ceruloplasmin raised plasma ceruloplasmin levels acutely to normal. The in vivo half-life of this ceruloplasmin was within the range observed in infants with nutritional copper deficiency.

These results support the contention of Danks et al. (Lancet, 1:1100, 1972) that intestinal copper absorption is defective in this syndrome. They further demonstrate that ceruloplasmin synthesis and decay appear normal when copper is available. The patient's clinical condition showed no change after copper and ceruloplasmin administration, suggesting that the neurological damage was irreversible. The possibility remains that earlier administration of copper or ceruloplasmin might be effective.
PEDIATRIC FAMILIAL TYPE II HYPERLIPOPROTEINEMIA: THERAPY WITH DIET AND CHOLESTYRAMINE RESIN
Authors: Glueck C. J. , Fallat R. , Tsang R.
Published: December 2021

Effects of a low cholesterol (<300 mg/day), polyunsaturate rich (P:S 1.5/1) diet and cholestyramine (12 gm active resin/day) were studied in 36 children with familial type II hyperlipoproteinemia. In 11 children after six months on diet alone, cholesterol and low density lipoprotein cholesterol (LDL) were reduced to normal levels. Twenty of the 25 children whose cholesterol and LDL remained elevated on diet received 12 gm of cholestyramine per day in addition to diet. Ten of these 20 children had good drug adherence. Cholesterol and LDL cholesterol fell to normal or near normal levels in six of these ten children on cholestyramine and diet for 6 and 12 months. Ten of the 20 children had fair drug adherence (8 gm of cholestyramine taken per day) and none sustained notable decrements in cholesterol or LDL after 6 and 12 months of cholestyramine and diet. Overall, there were reductions of LDL cholesterol to normal or near normal levels in 11 of 38 children (31%) with diet alone, and in six of ten children (60%) with diet and added cholestyramine.
ACUTE INFECTIOUS SINUSITIS IN CYANOTIC CONGENITAL HEART DISEASE
Authors: Rosenthal Amnon , Fellows Kenneth E.
Published: December 2021

The prevalance and sequelae of infectious sinusitis in a hospitalized group of children with and without congenital heart disease (CHD) were studied. Sinusitis was more common (1% versus 0.3%) in the CHD group and occurred predominantly (90%) in the cyanotic patients. It was associated with subacute bacterial endocarditis in 20% (5 of 20) and brain abscess in 15% (3 of 20) of the CHD cases. It is postulated that proliferation and distension of the venous channels and marrow spaces in patients with cyanotic CHD enhances the hematogenous spread of bacteria from the paranasal sinuses.
SCHOOL PROBLEMS
Authors: Kinsbourne Marcel
Published: December 2021

School problems result from factors of three types: environmental, emotional, and developmental. The great bulk of illiteracy in this country derives from socioeconomic adversity and cultural alienation that presents a primarily political rather than a medical challenge. But some children, even when offered adequate schooling under tolerable conditions, fail to achieve at a level to be expected from normally intelligent children at that age. Such children often also appear to be emotionally disturbed, and it may be difficult to decide what is the primary cause of the school failure. There are some cases in which the emotional disorder was clearly antecedent. These I will not discuss. I will talk about children who underachieve for no obvious reason.

Learning disorder is very much a matter of unexpected school failure, of the child doing less well than his parents or teachers expected. Before he does anything else, the clinician needs to satisfy himself that the child is really underachieving. There are two parts to this investigation: achievement tests and intelligence tests. It is not necessarily true that the child is doing badly because the teacher says so nor because the parents say so. You cannot know whether the child in fact is falling well short of national norms without a reading achievement test such as the California, Metropolitan, or Wide Range. An advantage of these tests is that they do not only give information about the child's ability in reading and writing, which for some reason are almost the only subjects ever complained of (and on which I will, therefore, concentrate), but they also measure his ability in arithmetic.
Letters to the Editor
Authors: Holliday Malcolm A.
Published: December 2021

The Chairman of the A.A.P. Committee on Nutrition answers as follows:

The Committee on Nutrition is preparing a broad statement on the use of milk, which will, when completed, provide you information on the questions raised. The Committee has stated its position relating diet to atherosclerosis in a memorandum (Pediatrics, 49:305, 1972) . The AMA Council on Food and Nutrition recently published a similar statement (JAMA, 222:18, January, 1973; December 25, 1972). Specifically, we believe that skim milk as well as whole milk are suitable depending upon whether weight reduction is desired or not.
Letters to the Editor
Authors: Mahon Jean L.
Published: December 2021

For the Committee on the Handicapped, the Chairman commented as follows:

Dr. Mock emphasizes an important aspect which was alluded to in the original statement in the recommendation that if a hearing loss was suspected, the child should be referred for a thorough diagnostic evaluation following which a plan would be developed to meet the child's physical, psychological, and social needs. The audiogram is only a small part of the overall assessment. For a detailed description of hard of hearing vs. deaf, refer to: Educational Audiology Hard of Hearing, Frederick S. Berg, Ph.D., United States Office of Education, Bureau of Education for the Handicapped, May 1973.
Medicine In A Changing Society, by Lawrence Corey, M.D., Steven E. Saltman, M.D., and Michael F. Epstein, M.D. Saint Louis: The C. V. Mosby Company, 1972, 228 pp., $6.50
Authors: Smith Donald C.
Published: December 2021

Nineteen hundred and sixty-eight was a vintage year for student activists. Conflicts between students and faculty were the rule rather than the exception. When they occurred in medical schools they frequently focused on the teaching of the social and preventive aspects of medicine. Such was the case at the University of Michigan, where "frustration with the public health course" led students into an open confrontation with the School of Public Health. In the discussions which followed, a number of changes were agreed upon.
HEALTH SERVICES IN THE HOME
Authors: Williams Cicely D.
Published: December 2021

1. The hospital is the power source for patient care, for teaching, for supervision and research. But if it loses sight of the home situation and of other agencies, the treatment and the teaching become inadequate, the research unrealistic; it is spinning its wheels and failing to maintain any progress.

2. Maternal and child health in advanced countries has adopted a pattern of "preventive but little or no curative" care. It is only when there is a properly integrated service that care of the sick, teaching and research will be effective. Service must be comprehensive in content and extent. This type of integrated service is the most suitable for developing areas.

3. There has been an artificial separation between preventive and curative medicine. Public health services provide preventive medicine in its major operations and with the mass approach. But personal or individual medicine must be both preventive and curative. In treating a minor disorder we are preventing a major catastrophe. It would be preferable if the division came not between curative and preventive, but between individual and mass medicine. Then hospitals, health centers, and homes could provide rational settings for continuity of care.

4. Continuity of care is essential. The public health nurse, health visitor, community nurse, midwife, district nurse, and their aides are the most essential workers. Their numbers should be increased and their training improved. The first diagnosis is made by the mother when she decides to take the child to the doctor, the hospital, or the clinic. The second diagnosis is made by the nurse when she decides to refer the child to the doctor. Without continuity in this chain of diagnosis, the whole system is inefficient.

5. Training of personnel needs to be revised with these objects in view.
CONGENITAL CYTOMEGALOVIRUS INFECTION: CONSECUTIVE OCCURRENCE DUE TO VIRUSES WITH SIMILAR ANTIGENIC COMPOSITIONS
Authors: Stagno Sergio , Reynolds David W. , Lakeman Alfred , Charamella Leigh J. , Alford Charles A.
Published: December 2021

The occurrence of congenital cytomegalovirus infection in two siblings born three years apart is reported. Based on clinical and immunologic findings, the older child seems to have been exposed to a strong and prolonged antigenic stimulus, while the younger was probably affected by a reduced or modified load. Simultaneous complement-fixing (CF) and neutralizing (NT) antibody determinations done in infants and maternal sera suggest that the viruses isolated from both cases, if not identical, are antigenically quite similar and, furthermore, they are very close to AD-169 and Davis prototypes. Therefore, although the mother showed a significant antibody rise and became viuric during the second pregnancy, it is very unlikley that a new primary infection with an heterologous strain occurred, and we suggest endogenous reactivation or reinfection with the homologous virus. The implications of this finding with respect to counseling parents of a congenitally infected child about future pregnancies are discussed.
GALEN ON THE HYGIENE OF THE NEWBORN
Authors: C. T. E.
Published: December 2021

Claudius Galenus is one of the most remarkable figures in medical history. Born at Pergamos in Asia Minor, A.D. 131, he travelled extensively, studied medicine at Alexandria, and in 162 settled in Rome, where in 169 he became the personal physician to the Emperor Marcus Aurelius. In his text entitled Hygiene (De Sanitate Tuenda) he described the care of the newborn infant as follows:

The newborn infant, in his entire constitution, should first be powdered moderately and wrapped in swaddling-clothes, in order that his skin may be made thicker and firmer than the parts within. For during pregnancy everything was equally soft, since nothing of a harder nature touched it from without, and no cold air came in contact with it, whereby the skin would be contracted and thickened, and would become tougher and denser than it was before and than the other parts of the body. But when the baby is born, it is necessarily going to come in contact with cold and heat and with many bodies harder than itself. Therefore it is appropriate that his natural covering should be best prepared by us for exposure.

For infants who are in accordance with nature, a simple salt dusting-power is sufficient; for those whom it is necessary to sprinkle with dried leaves of myrrh, or something else of this sort, are obviously abnormal. But at present it is our purpose to discuss those of the best constitution. These, then, as has been said, having been wrapped in swaddling-clothes, should receive milk for nourishment, and baths of pure water; for they require a completely moist regime, since they have a moister constitution than those of other ages. . . .
DR. GEORGE ARMSTRONG WRITES ABOUT THE DISINTEREST OF PHYSICIANS IN THE CARE OF SICK CHILDREN
Authors: C. T. E.
Published: December 2021

Dr. George Armstrong (1719-1789), one of the first of the English physicians to devote his time entirely to the care of children, and the originator of the first dispensary for sick children in the English speaking world, had this to say about the lack of concern of physicians of his day in the care of children:

If we take a survey of the different provinces of medicine, we shall readily discover, that one which happens to be of the greatest consequence to society, as the population of every country in a great measure depends upon it, I mean that which regards the diseases of infants, has hitherto lain uncultivated. I do not pretend to account for this strange neglect, nor is it to my purpose: but certain it is, that though the human species can only be preserved by taking proper care of the infant race, which is much more helpless than the young of other animals; and though a much greater number of our species in proportion to the whole, than of any that we know, dies very young; yet the care of infants, even with regard to medicine, has commonly been left to old women, nurses, and midwives, so that it has long been a common saying in this country, that the best doctor for a child, is an old woman. . . .

I know there are some of the physical tribe who are not fond of practicing among infants; and I have heard an eminent physician say, that he never wished to be called in to a young child; because he was really at a loss to know what to order for it.
A Controlled Trial of Hydrocortisone Therapy in Infants With Respiratory Distress Syndrome: II. Pathology
Authors: Taeusch H. William , Wang Nai San , Baden Melvin , Bauer Charles R. , Stern Leo
Published: December 2021

The pathological findings from seven infants who died with respiratory distress syndrome and had been treated with placebo are compared with seven infants with comparable disease treated with hydrocortisone. Differences in lung, liver, adrenal, thymus, heart and spleen pathology attributable to steroid treatment did not occur between the two groups. A statistically significant association was found between intraventricular hemorrhage and steroid treatment. The pathological findings are consistent with the clinical results in that no beneficial effect occurs when steroids are used after an infant manifests respiratory distress. The possibility that elevated steroid levels increase the likelihood of intraventricular hemorrhage in association with respiratory distress syndrome is raised by these observations, although further information is needed to establish such a relationship.
The Influence of Hexachlorophene Scrubs on the Response to Placebo or Penicillin Therapy in Impetigo
Authors: Ruby Ronald J. , Nelson John D.
Published: December 2021

Recent studies of childhood impetigo have claimed that penicillin or erythromycin therapy accelerates the healing rate of lesions.1-3 Several therapeutic regimens were variables in two of those studies1,3 but common to all patients was the use of scrubbing with hexachlorophene-containing soaps. In the other study,2 in which hexachlorophene was not used as adjunctive therapy, both penicillin and erythromycin were found to be effective. In the Syrian hamster model simulating human impetigo Dajani et al.4 found that pHisoHex scrubbing retarded healing and promoted new satellite lesions. Untreated animals' lesions healed in 6.4 days but healing time with pHisoHex scrubbing once daily was prolonged to 14.0 days (p< .001).
Cutis Aplasia and Cerebral Malformation
Authors: Fowler Glenn W. , Dumars Kenneth W.
Published: December 2021

A patient with cutis aplasia and gross malformation of the brain is described. A defect in fetal development appears to be the most probable pathogenesis rather than mechanical causes. Genetic factors seem to be important in some families.
Crystal Formation: A New Complication of Total Parenteral Nutrition
Authors: Pomerance Herbert H. , Rader Richard E.
Published: December 2021

Since 1971, the Newborn Intensive Care Unit (NICU) of the Charleston Area Medical Center has developed considerable experience with Total Parenteral Nutrition (TPN). A new technical complication of this procedure has been encountered and is reported herewith. It is not the purpose of this communication to repeat the background of TPN,1 or to detail the case histories involved.

Initially, like others, we used a mixture containing a casein hydrolysate (5% Amigen and 5% Dextrose Injection*), additional glucose, and minerals including calcium gluconate. In May 1972 we changed our formula to include a fibrin hydrolysate (Aminosol 5% in D5W†). At the same time, we added phosphate ion by changing from potassium chloride to potassium acid phosphate (Table I) .
Complications Arising From Head Wrapping for the Treatment of Hydrocephalus
Authors: Meyer Harold , Price Benjamin E. , Reubel Catherine D.
Published: December 2021

Two cases of hydrocephalus treated by head wrapping are presented. Complications not heretofore encountered are described.
ACETAMINOPHEN: POTENTIAL PEDIATRIC HAZARD
Authors: W. C. F.
Published: December 2021

Acetaminophen, long popular in Europe, has received increasing use in the United States as an analgesic and antipyretic, in both adult and pediatric practice. This increased use has come about partly because of concern over side effects of aspirin, especially its interference with blood-clotting mechanisms. Pediatric use of acetaminophen has been facilitated because it can be formulated into a stable suspension, easy to administer to children.

Acetaminophen is available in many forms and formulations, alone and in combination, in both prescription and over-the-counter products. The table at the end of this section, admittedly incomplete, lists some 200 brand names of products containing this compound which are marketed in the United States.

The extensive availability of acetaminophen increases the probability of accidental ingestion of toxic quantities by infants and children. Although package inserts characterize this drug as having exceptional safety in recommended doses, ingestion of moderately large quantities can cause kidney and liver damage resulting sometimes in death. Adverse side effects have been reported from lesser quantities. It is, therefore, important to alert practitioners to the potential toxicity, symptomatology and procedures for handling overdose. A highly significant aspect in such incidents is that early signs of poisoning may be minimal, even in cases where death ultimately occurs. Unaware of this, a physician might delay intensive therapy.

Poisoning by acetaminophen and its treatment have been extensively studied in the United Kingdom where consumption of this drug has progressively risen over the past decade and has been accompanied by an increasing number of poisonings.
THE ATHLETE AND MEDICATION
Authors: Yaffe Sumner J. , Bierman C. Warren , Cann Howard M. , Gold Arnold P. , Kenny Frederic M. , Riley Harris D. , Schafer Irwin , Soyka Lester F. , Stern Leo , Weiss Charles F. , Chudzik Gregory , Shirkey Harry C. , Ballin John C. , Done Alan K. , Farchione Louis , Scott C. P. , Lockhart Jean D. , Sawchuk Steven , Simopoulos Artemis P.
Published: December 2021

The Committee on Drugs unites with the Joint Committee on Physical Fitness, Recreation, and Sports Medicine in condemning the use of drugs to improve athletic performance. However, the Committee on Drugs would like to clearly distinguish between the promiscuous use of drugs and their pharmacologic use to control a specific disease state enabling the adolescent to participate in sports, for example, the use of insulin for diabetes, anticonvulsants for epilepsy, digitalis for heart disease, or bronchodilators for asthma.

Children and adolescents with handicaps should be given the same advantages as other children, including participation in athletic activities. Athletes with medical conditions controlled by drugs should not be placed in the same category as youths taking drugs for other purposes, and there should be minimal, if any, restrictions imposed on them. One recent example of the type of restrictions which should not be imposed is the athlete with exercise-induced bronchoconstriction who was disqualified in the 1972 Olympics in Munich because he used a bronchodilator prescribed by his physician. Exercise-induced bronchospasm is a common handicap of allergic youth, and may occur in between 60% and 80% of individuals with allergic respiratory distress.1 Such bronchoconstriction can be modified by the administration of theopylline,2 theophylline ephedrine combinations,3 or cromolyn sodium.4,5 The Committee on Children with Handicaps also recommends that children with asthma participate in sports and physical education and that every effort be made to minimize restrictions.6

At the annual meeting of the American Academy of Allergy in Washington, D.C., February 14, 1973, the following resolution was approved unanimously: "Participants in competitive athletics with asthma and other allergic conditions should not be disqualified because of the use, with medical supervision, of therapeutic doses of ephedrine before and during athletic competition."7
Radiographic Diagnosis of Sinusitis
Authors: Thompson Robert S.
Published: December 2021

The article by Kogutt and Swischuk(Pediatrics, 52:121, 1973), purporting to show the utility of sinus x-rays in the diagnosis of sinusitis in infants and children does no such thing. Rather, I believe it demonstrates that uncontrolled trials often give misleading results.

This conclusion is demonstrated by perusal of the work of Maresh and Washburn1 who did serial sinus films on 100 normal children from birth to adolescence. These authors showed that radiographic changes often considered to be diagnostic of sinus disease are found in nearly 60% of normal children in the birth to 1-year age group, 33% of those aged 5 to 6 years, and 14% of those 11 to 12 years old.
Policy of the Academy on Day Care: Some Doubts I. From Indiana
Authors: Sweeney Robert M.
Published: December 2021

The policy statement on day care released in Pediatrics has been discussed at length by the Executive Committee of the Indiana Chapter of the American Academy of Pediatrics.

It is understood that it is necessary on the part of the American Academy of Pediatrics to make such a policy statement regarding daycare centers. One does, however, become somewhat concerned regarding the general tone and philosophy of the statement. It is felt that it mainly glosses over the fact that, for most children, child care and guidance are best given in the homes by the families.
II. From Pennsylvania
Authors: Aronson Susan S.
Published: December 2021

The Academy's "Policy Statement on Day Care" published in the May issue of Pediatrics placed appropriate emphasis on comprehensive developmental services needed by many of the nation's children. However, on behalf of the Day Care Committee of the Pennsylvania Chapter of the American Academy of Pediatrics, I wish to express concern about the implication in the second paragraph that the choice of a work role by a mother is to be condoned only as a necessary evil of economic or social misfortune.
Educational Pediatrics
Authors: Nader Philip R. , Dodge Warren F.
Published: December 2021

In our view the establishment of a subspecialty of "educational pediatrics" holds a dangerous possibility for further compartmentalization of the delivery of useful health and education services in schools. One of the historic difficulties has been the lack of a link between primary care givers and health programs within schools. Subspecialization may widen this gap.

Many practicing pediatricians have areas of special interest such as adolescent medicine, growth problems, diabetes or neonatology, without devoting full time to this single area of practice.
FOLLICLE STIMULATING HORMONE (FSH) AND LUTEINIZING HORMONE-HUMAN CHORIONIC GONADOTROPIN (LH-HCG) CONCENTRATIONS IN PAIRED MATERNAL AND CORD SERA
Authors: Penny Robert , Olambiwonnu N. Olatunji , Frasier S. Douglas
Published: December 2021

FSH and LH-HCG concentrations were determined by radio-immunoassay in paired maternal and cord sera. The sera of 50 mothers and 51 infants, 25 female and 26 male (one set of twins), were assayed.

Mean (± SD) FSH concentration of mothers (3.4 ± 0.9 mIU/ml) giving birth to female infants was not different, p>0.1, from that of mothers (3.7 ± 0.7 mIU/ml) giving birth to male infants. In contrast, mean (± SD) LH-HCG concentration of mothers (15.99 ± 3.1 IU/ml) giving birth to female infants was significantly, p<0.005, greater than that of mothers (11.37 ± 5.0 IU/ml) giving birth to male infants.

Cord serum FSH mean (± SD) concentration was significantly, p<0.005, greater in female infants (3.7 ± 0.5 mIU/ml) than male infants (2.4 ± 0.8 mIU/ml). However, mean (± SD) LH-HCG concentrations in female infants (0.122 ± 0.015 IU/ml) was significantly, p<0.005, less than that of male infants (0.156 ± 0.040 IU/ml).

Poor correlation, on an individual basis and on a statistical basis, between maternal and cord serum FSH and LH-HCG concentrations was observed.

The data of this investigation are consistent with fetal pituitary gonadotropin secretion, confirm previous observations that women bearing a female fetus have higher LH-HCG concentrations than those bearing a male fetus, and suggest a sex difference in cord serum gonadotropin concentrations.
Lethal Forms of Chondrodysplastic Dwarfism
Authors: Curran John P. , Sigmon Becky A. , Opitz John M.
Published: December 2021

Thanatophoric dwarfism and achondrogenesis are lethal forms of skeletal dysplasia with clinical, radiographic, and genetic features distinct from classic achondroplasia. Both of these forms of lethal chondrodystrophy continue to be mistaken for achondroplasia, with serious genetic implications, since present evidence suggests that at least achondrogenesis is the result of autosomal recessive inheritance.

This report presents the clinical, radiographic, and autopsy findings in three short-limbed infants who died soon after birth. Early death is due to respiratory insufficiency secondary to severe pulmonary hypoplasia and, in one case, dysplasia of the tracheal rings. The incidence of lethal chondrodystrophies is about one in 19,000 live births. It is suggested that the differential diagnosis between thanatophoric dwarfism and achondrogenesis can be established unequivocally on radiographic grounds, as can the differentiation of these two lethal skeletal dysplasias from classic achondroplasia. It is important for proper genetic counseling that these distinctions be made.
The Detection of Fetal Asphyxia in Labor
Authors: Beard R. W.
Published: December 2021

In recent years the search for a means of improving the physical and mental health of children has inevitably led to a more critical assessment of the influence of intrauterine environment, particularly with regard to intrapartum asphyxia.

In this paper the current state of knowledge concerning the methodology and clinical results from utilizing the two most widely used techniques for monitoring the fetus in labor-continuous fetal heart monitoring and fetal blood sampling will be discussed.
Beta-Ketothiolase Deficiency As A Cause of the "Ketotic Hyperglycinemia Syndrome"
Authors: Hillman Richard E. , Keating James P.
Published: December 2021

A patient was investigated who had the "ketotic hyperglycinemia syndrome" with normal propionate and methyimalonate metabolism, but with a markedly decreased ability to catabolize isoleucine. Gas liquid chromatography of her urine revealed excretion of large amounts of α-methyl β-hydroxybutyrate and α-methyl-acetoacetate. Thin layer chromatography of dinitrophenylhydrazones of urinary ketones showed large quantities of butanone and smaller amounts of pentanone and hexanone. Incubation of her fibroblasts with isoleucine-u-14C demonstrated the production of butanone-14C. These findings suggest that this child has deficient activity of the β-ketothiolase reaction which cleaves α-methylacetoacetyl CoA to propionyl CoA and acetyl CoA. This child indicates that another potentially treatable disease must be considered in a young infant who presents with vomiting and acidosis.
Dextroamphetamine and Methylphenidate in the Treatment of Hyperactive/Aggressive Children
Authors: Winsberg Bertrand G. , Press Mark , Bialer Irv , Kupietz Samuel
Published: December 2021

This study reports on the comparative effectiveness of dextroamphetamine and methylphenidate for the treatment of severe behavior disorders among children hospitalized for neuropsychiatric conditions. Findings indicate that both drugs attenuate hyperactive and aggressive behaviors and that children who respond to one may he expected to respond to the other. Side effects were generally equally distributed between both medications and were of modest degree. One case each of methylphenidate-induced dyskinesia and of dextroamphetamine-induced toxic psychosis is reported. The clinical implications of our findings are discussed, and directions are suggested for future research on some of the observed clinical problems.
Obstetrics and Perinatal Infections, edited by David Charles, M.D., and Maxwell Finland, M.D. Philadelphia: Lea & Febiger, 1973, 652 pp., $22.50
Authors: Eichenwald Heinz F.
Published: December 2021

The specialty of perinatology has developed more rapidly during the late 1960's and early 1970's than most other areas of medicine, spurred on by major research efforts directed at increasing our understanding of maternal-fetal interactions. As a result of this rapid evolution of knowledge, a number of books have appeared in recent months dealing with the subject in general or specific terms. To this reviewer's knowledge, no one has previously attempted to collect the available information on the effect of infection on mother, fetus, and infant, the subject of the present volume.
Selective treatment of myelomeningocele: To treat or not to treat?
Authors: Lorber John
Published: December 2021

There never was and perhaps never will be a really satisfactory method of treatment for infants born with severe myelomeningocele, nor for the management of their families, in spite of the best technical advances and the most humane attempts. The best hope for the future lies in prevention of conception of such infants, but we are far from that. The next best hope is early antenatal diagnosis so that at least we can prevent the birth of such infants. The recent discovery that abnormally high levels of alpha-fetoprotein are present in the amniotic fluid of women carrying an infant with spinal or cranial dysraphism has already been put to routine practical use.
Group Meetings in a Pediatric Intensive Care Unit
Authors: Rosini Lawrence A. , Howell Mary C. , Todres I. David , Dorman John
Published: December 2021

Work relationships among staff in a pediatric intensive care unit (ICU) are probably of critical importance to patient care, as well as to staff well-being. Group discussions were introduced in one ICU to encourage the staff to raise issues about work relationships and about the effectiveness of the care they were providing. Three kinds of issues recurred: work roles and functions, leadership and decision making, and conflict arising from stereotypic assumptions about opposed groups. The frequency of conflicts rooted in these issues demonstrated their origin in factors over and above individual "personality problems." While there were clear limitations to what such group meetings could accomplish, they did provide a forum for the expression of tensions and anxieties, the identification and resolution of some conflict, and the initiation of needed policy change. The authors encourage further experimentation with this practice, and studies of its effectiveness.
Demonstration of the Heterozygous State in Hunter's Syndrome
Authors: Booth Carol W. , Nadler Henry L.
Published: December 2021

In vitro manipulation of tissue culture conditions may provide a valuable tool for ascertaining carrier status in inborn errors of metabolism. Skin fibroblast cultures from five obligate heterozygotes and three potential heterozygotes for Hunter's syndrome displayed abnormal mucopolysaccharide metabolism after prolonged maintenance in culture or routine freezing. The mechanism for this phenomenon appears to be preferential survival of cells carrying the Hunter gene. Tissue culture techniques appear to permit identification of Hunter heterozygotes.
Serum Aldosterone Concentrations Related to Sodium Balance in the Newborn Infant
Authors: Siegel Sharon R. , Fisher Delbert A. , Oh William
Published: December 2021

Serum aldosterone concentrations and sodium (Na) balance were studied between 24 and 48 hours of life in 39 newborn infants of various gestational ages and in infants with or without respiratory distress syndrome (RDS) . The serum aldosterone levels in the neonatal period were high but not related to gestational age. The serum aldosterone levels of small-for-gestational-age (SGA) infants were similar to those of the full-term infants. In normal infants (preterm and full term) and in SGA infants, the mean oral Na intake was 1.0 mEq/kg/24 hr; in this group of infants, no correlation was observed between Na intake and excretion or between Na intake and serum aldosterone concentrations, probably due to the narrow range of Na intake. In preterm infants with RDS, Na was given in larger quantities and by the parenteral route. In this group, significant correlations were observed between Na intake and Na excretion and between Na intake and serum aldosterone concentrations. These data suggest that the expected sodium dependent regulatory mechanism for aldosterone secretion is functional 10 the preterm infants with RDS when given a large sodium load; and that the quantity of Na excretion is consistent with the variations in aldosterone concentrations.
"Typus Edinburgensis?"
Authors: Habel Alexander
Published: December 2021

An Edinburgh family is reported in which five infants, four female and one male, were found to have a consistently abnormal facial appearance, true or apparent hydrocephalus, retardation in motor and mental development, failure to thrive and death in the first months of life. Two infants had unexplained neonatal hyperbilirubinemia; the proposita had advanced bone age which may be a pointer to this condition. A superficial similarity to the Brachmann-De Lange syndrome exists, and the important clinical and genetic differences are discussed.
Racemic Epinephrine in Croup (continued)
Authors: Adair John C. , Ring Wallace H. , Jordan William S. , Elwyn Richard A.
Published: December 2021

We believe the article by Gardner et al., "The Evaluation of Racemic Epinephrine in the Treatment of Infectious Croup," in the July 1973 issue of Pediatrics deserves comment.

In our paper, "Ten-Year Experience with IPPB in the Treatment of Acute Laryngotracheobronchitis," referred to by Gardner et al., we described a method which, in our hands, totally eliminated the necessity for tracheostomy in infectious croup, with no mortality. To date we have found it necessary to perform tracheostomies on two patients with croup, both of whom were subsequently found to have congenital tracheal stenosis necessitating long-term tracheotomies; otherwise the effectiveness of our regimen in the treatment of infectious croup remains unchanged (100%), now over a 13-year period.
Essentials of Pediatric Cardiology, by James H. Moller, M.D. Philadelphia: F. A. Davis Company, 1973, 116 pp., $4.50
Authors: Liebman Jerome
Published: December 2021

Dr. Moller is an excellent pediatric cardiologist at a university teaching hospital, who has spent a great deal of time and given a great deal of thought to the teaching of pediatric cardiology to medical students and other non-cardiologists. This short paperback booklet of 106 pages, without references, proposes to formulate guidelines so as to better approach the patient with congenital heart disease. In so doing, the author wished to keep things simple and short, which he has done quite successfully.
Foetal and Neonatal Physiology (Proceedings of the Sir Joseph Barcroft Centenary Symposium). New York: Cambridge University Press, 1973, 641 pp., $32.50
Authors: Smith Clement A.
Published: December 2021

A collection of 66 contributions to seven different areas of fetal and neonatal physiology can hardly be reviewed. Perhaps it may not even be described. How, then, can it be used?

Not many clinicians may be expected to dip into these pages but those who consider themselves neonatologists certainly should, while those learning to think seriously as perinatologists must do so. One hopes all those who dip, and even a few who merely skim, will at least learn something about Joseph Barcroft, whatever else they find here.
Lomotil® Poisoning
Authors: Rumack Barry H. , Temple Anthony R.
Published: December 2021

Accidental and therapeutic intoxication from ingestion of Lomotil, a combination preparation intended for treatment of diarrhea, continues to occur. FDA package insert guidelines for Lomotil prohibit the use of the drug under the age of 2, but physicians continue to prescribe within this age group. Sixteen pediatric patients and nine adults are reported representing one year's experience from two poison centers. Prolonged gastric emptying with recovery of tablets 27 hours after ingestion is reported. Five patients, who were vomited shortly after exposure, demonstrated delayed onset of coma and respiratory depression. Time until onset of symptoms was greater than four hours in nine of 16 pediatric patients. One death occurred and no residual defects were noted in the survivors. A rational therapeutic outline is presented.
Surgical Treatment of A Ruptured Intracerebral Arteriovenous Malformation In A Newborn
Authors: Beatty Robert A.
Published: December 2021

Intracranial hemorrhage in the newborn is not common, excluding bleeding secondary to traumatic birth. It is the author's experience that the medical community generally regards intracranial bleeding in infants as hopeless and often favors a nihilistic therapeutic approach. This paper describes a newborn who appeared in extremis from a ruptured intracerebral arteriovenous malformation (AVM) which was successfully resected.
Congenital Ichthyosis and Neonatal Pulmonary Disease
Authors: Perlman M. , Bar-Ziv J.
Published: December 2021

An atypical pulmonary aspiration syndrome occurred in two prematurely born siblings with congenital ichthyosis; pneumothorax and pneumomediastinum were seen in a third neonate with less severe ichthyosis. These pulmonary manifestations were probably complications of aspiration of amniotic fluid containing abnormally high concentrations of epithelial squames. The severity of the lung disease appeared to be correlated with the severity of the ichthyosis. Amniotic fluid enters the fetal respiratory tract either chronically, during physiological fetal respiratory movements or, acutely, by way of gasping initiated during fetal distress.
Blood Sampling From Scalp Arteries
Authors: Allué Xavier
Published: December 2021

I would like to offer a comment to Schlueter et al. regarding their report on blood sampling from scalp in the January 1973 issue of Pediatrics.

One should not be discouraged by the occasionally sluggish blood flow from a scalp artery. Letting it flow through the butterfly infusion set without applying pressure to the syringe, we have been able invariably to fill, at least, the infusion set system. We then replace the cap, withdraw and bend the needle, and send the butterfly set to the laboratory.
Minimal Cerebral Dysfunction in Children, edited by Stanley Walzer, M.D., and Peter M. Wolff, M.D. New York: Grune & Stratton, Inc., 1973, 117 pp., $7.50
Authors: Mac Keith R. C.
Published: December 2021

Only a polymath could properly review these eight essays giving experimental and clinical data related to the issues of brain injury and to the clinical pictures included under the term minimal cerebral dysfunction (MBD). The introduction shies away from definitions but writing on genetic issues, Gilbert S. Omenn defines MBD as hyperactivity, distractibility, inpulsivity and learning difficulties plus favorable effects by drugs which stimulate the central nervous system. (I would prefer to call the first half of his definition the "hyperactivity-etc." or "Strauss-Lehtinen" syndrome and to leave the second half out from any definition.)
Nasotracheal intubation in the Treatment of Acute Epiglottitis
Authors: Milko David A. , Marshak Gabriel , Striker Theodore W.
Published: December 2021

Acute epiglottitis is characterized by fever, rapidly progressing dyspnea and dysphagia. In case of difficulty in confirming the diagnosis of this well-defined entity, a "direct" bedside evaluation of the larynx is safe and definitive. In the rare case where respiratory difficulty is present, conservative medical management is suggested, but only by an expert team. However, when respiratory difficulty is present or develops in a patient with confirmed epiglottitis, a short-term nasotracheal intubation with accompanying antibiotics is a suitable therapeutic regimen.
Cooling as First Aid for Burns
Authors: Kravitz Harvey
Published: December 2021

I would like to refer Doctors Epstein and Crawford to my paper, "First-Aid Therpay for Burns-Cool It," which appeared in Clinical Pediatrics in 1970.

We have anticipated their suggestions regarding dissemination of this vital piece of information. As a member of the National Accident Prevention Committee of the American Academy of Pediatrics, my colleagues and I have put this information into the first aid chart published by the American Academy of Pediatrics also. Through the kind courtesy of Mead-Johnson and Company, hundreds of thousands of posters on the use of cold water for burns have been distributed across the country and are found in hospital outpatient and neighborhood clinics.
Negative Urine Sugars in Galactosemia
Authors: Harris Ruth C.
Published: December 2021

Drs. Wadlington, and Riley apparently have not had the unfortunate experience in their dependence on negative urine sugars in suspected galactosemia as we have had.

Eleven years ago a physician's 2-month-old baby failed to thrive, had vomiting and diarrhea. Among other tests a careful examination of three urine specimens following milk feeds showed protein, amino acids and no reducing substance. Unfortunately, this was a time when no enzyme studies were available nor was a galactose tolerance performed.