bluuebunny/crossref_metadata_2025 huggingface dataset:
Retention of radiostrontium, strontium, calcium, and phosphorus by infants
Authors: Kahn B. , Straub C. P. , Robbins P. J. , Wellman H. N. , Seltzer R. A. , Telles N. C.
Published: December 2021

This study of strontium-90 retention in infants was undertaken by the Research Branch of the Division of Radiological Health (now the Bureau of Radiological Health) to contribute data toward the development of radiation protection standards for what may be the most radiosensitive age sector of the population. The study was begun in 1960, at a time when national and international agencies– the Federal Radiation Council, National Committee on Radiation Protection, and International Commission on Radiological Protection–were particularly interested in obtaining metabolic information for predicting internal exposure from the ingestion of strontium-90 deposited in world-wide fallout. The long-term metabolic balance study was feasible because the strontium-90 content in the normally available food was sufficiently high to be determined accurately when measured with care. The advantages of determining retention under actual home conditions without altering the environment and the diet of the infants were believed to outweigh the known difficulties and the inherent errors in such a balance study.

The 4-year experimental program was performed by Radiological Health Research Activities, Cincinnati, Ohio. It enjoyed the full support of the Chiefs of the Research Branch, Dr. Paul Tompkins and Dr. Arthur Wolff. Specific participation is noted in the Acknowledgment; in addition, many other staff members of Radiological Health Research Activities contributed to the study. The authors cooperated in all phases of the work, but some specialization may be recognized: Dr. Conrad P. Straub conceived, planned, and directed the entire study; Drs. Norman C. Telles, Henry N. Wellman, and Ronald A. Seltzer were the medical officers directly responsible for the study–initiated and supervised by Dr. Telles during the first year, by Dr. Wellman during the second and third years, and by Dr. Seltzer during the final year; Mr. Phillip J. Robbins directed the analytical program at the end of the study; and Dr. Bernd Kahn was responsible for providing analytical procedures and writing the report.
Rhabdomyosarcoma of the Spermatic Cord
Authors: Ross Lawrence A. R.
Published: December 2021

There have been 24 previous cases reported of rhabdomyosarcoma of the spermatic cord. Two thirds of these cases were in children under 18 years of age. The presence of transillumination, such as in our patient, does not rule out the existence of a solid tumor.
Neonatal Hyperbilirubinemia Associated with Ingestion of Maternal Blood
Authors: Egan Edmund A. , Julius Richard L. , Gessner Ira H.
Published: December 2021

A newborn infant presented with bloody stools at birth associated with swallowing maternal blood following partial abruption of the placenta. Hyperbilirubinemia appeared in the first 12 hours of life, and the usual causes were excluded. The postulate is made that the hyperbilirubinemia was the result of the absorption of heme from the ingested maternal blood.
Letter to the Editor
Authors: Aballi Arturo J. , Desposito Franklin
Published: December 2021

The patient reported in the foregoing letter is of particular interest in view of the recent observations on patients with tnisomy 21 and cystic fibrosis. The multiple possibilities that could explain the clinical presentation have no doubt been considered by the authors. However, the description of "hypoplastic thrombocytopenia" and later pancytopenia in this patient, associated with pancreatic insufficiency, leads to the serious consideration of Shwachman's syndrome (pancreatic insufficiency and bone marrow dysfunction). The wide discrepancy between the sodium and chloride concentrations in the sweat reported in their letter indicates that evaporation of water may have occurred from the sweat sample, leading to an apparently higher sodium and chloride concentration.
Familial Non-Hemolytic Jaundice: Light Therapy
Authors: Nichols Myron M.
Published: December 2021

After reading the tragic case report of a 16-year-old with non-hemolytic jaundice by Blumenschein, S. D., et al. (Pediatrics, 42: 786, 1968), the question of a trial with fluorescent light to reduce serum bilirubin, as recommended by Lucey, J. (PEDIATRICS, 41: 1047, 1968), occurred to me. I would appreciate the views of the authors (or the editors of Pediatrics) on the use of fluorescent light in the event of a future case.
The Developing World—and Child Health
Authors: Pinto Peter S.
Published: December 2021

It is easy to agree with Dr. Norman Kretchmer regarding the problems of child health in the developing world, that we in our affluent society are not doing enough to alleviate their suffering. After all, it is a fact that we are 6% of the world population and we are constantly using 50% of the world nonrenewable resources. How long this can continue without the poorer majority objecting and taking our luxuries fronl us will be seen in the decades ahead.
SERUM IMMUNOGLOBULIN LEVELS IN POSTMATURE INFANTS
Authors: Ackerman Bruce D. , Taylor William F. , O'Loughlin Bernard J.
Published: December 2021

Ten of 40 infants with a history of prolonged gestation had elevated concentrations of IgA in the cord serum. The IgA present at birth appears to be of fetal origin. IgG levels were higher for postmature than for term infants, while IgM levels were similar for the two groups. An elevated concentration of IgA at birth, in the absence of an elevated concentration of IgM, is of value for confirming an impression of prolonged gestation.
NEONATAL HEPATIC NECROSIS
Authors: Ruebner Boris H. , Bhagavan Belur S. , Greenfield Alan J. , Campbell Peter , Danks David M.
Published: December 2021

Hepatic necrosis resembling acute yellow atrophy in the neonatal period appears to be rare. Five infants with this condition are described. The three patients who died shortly after birth presented chiefly with hemorrhagic phenomena, while those which survived longer were severely jaundiced. In four of the babies there were few surviving hepatocytes apart from a few giant cells. In the fifth infant there was partial hepatic necrosis. Noteworthy among the histologic features were marked hemosiderin deposition in all cases, focal calcification in one case, and nodule formation in another. Virus studies in three cases were negative.

Unfortunately, the etiology of the hepatic necrosis in our patients has not been established and may well be multiple. The hepatocytic giant cells are reminiscent of those seen in "neonatal hepatitis" but this disease does not represent an etiological entity.
The Health and Education of the Economically Deprived Child, by Sol Adler, Ph.D. St. Louis: Warren H. Green, Inc. (10 South Brentwood Boulevard), 1968, 170 pp., $7.50
Authors: Seham Max
Published: December 2021

The author of this timely, compact, well documented book of 170 pages is a skilled technician in audiology and speech pathology. He is also a humanist who pulls no punches in stressing the ineffectiveness of current health and educational programs to "help economically deprived youth participate more fully in democracy's presupposed equality of opportunity."

Assuming correctly the unfamiliarity of most physicians with medical sociology, the author first outlines a short clinical introduction to the sociology of poverty and the serious impact this can have on the mental, physical, and emotional health of the deprived child.
An ABC of Modern Immunology, by E. J. Holborow, M.D. (Cantab.). Boston: Little, Brown and Company, 1968, 89 pp., $3.95
Authors: Johnston Richard B.
Published: December 2021

This small book first appeared as eight articles in The Lancet in 1967. A bibliography for each chapter and two new chapters were added for publication in book form. Subjects covered include the formation, structure, and properties of antibodies; immunologic memory; the role of the thymus and small lymphocytes in the immune response; the possible function of the macrophage in antibody formation; immune tolerance and paralysis; and autoimmunity. The author states concisely what he feels are the fundamental concepts of present-day immunology; he describes the experimental data basic to these concepts and the techniques used to derive the data.
Overweight: Causes, Cost and Control, by Jean Mayer, Ph.D., B.Sc., A.M. (hon.). Englewood Cliffs, New Jersey: Prentice-Hall, Inc., 1968, 213 pp., $2.45 (paper)
Authors: Gallagher J. Roswell
Published: December 2021

This very useful book is, as the author points out, about obesity and not about merely being overweight. Practicing physicians will find it an up-to-date and authoritative review of the many aspects of obesity, and yet the general public, dietitians, and other health professionals will also find it easy to understand and never dull. It is written in a clear, concise style, enlivened by comments that reflect the author's viewpoint, and by his genuine concern for those who are obese.
THE THERAPEUTIC USE OF LEECHES IN CHILDREN AS DESCRIBED IN 1825
Authors: C. T. E.
Published: December 2021

Leeches were used in the treatment of many pediatric conditions until relatively recently. Many physicians prescribed leeches, especially in the treatment of the purported symptoms caused by teething. William Moss,1 for example, advised applying two or three leeches at one time on the foot or heel of teething infants where "bleeding is a remedy much to be depended on when the symptoms of heat, fever, drowsiness, and startings are urgent."

The following is an excellent description of the indications for leeching in children, as given by Dr. James Kennedy in 1825:

Leeching, so as to abstract blood from a particular part sustaining inflammation, fulness, or pain, is very useful in many diseases especially those of children. . . . When the leech is of the right or medicinal kind, its body has a blackish brown colour, marked on the back with six yellow spots, and edged with a yellow line on each side:—these spots, however, as well as the lines, grow faint and almost disappear at certain seasons. . . . The mouth forms, as it were, the body of a pump and its tongue the sucker; and, by the working of this . . . mechanism, the blood is made to rise up into the conduit which conveys it to the animal's stomach. . . .

Leeches may be employed in every case where topical bleedings are required, or where venesection cannot be performed. Before applying them, all the parts should be carefully washed;—first, with hot water and soap, for the purpose of removing, as much as possible, the particles of the cutaneous excretion which the leech instinctively dislikes, especially if impregnated in any degree with the odour of medicine;—and secondly, with milk and water as warm as can be endured, with the object of stimulating the superficial vessels and filling them with red blood.
ANDROGEN METABOLISM IN CONGENITAL ADRENAL HYPERPLASIA DUE TO 11 β-HYDROXYLASE DEFICIENCY
Authors: Frasier S. Douglas , Horton Richard , Ulstrom Robert A.
Published: December 2021

The plasma concentration of androstenedione and testosterone, metabolic clearance rate of androstenedione, and in vivo conversion ratio of androstenedione to testosterone have been studied in a normotensive 5-year-old female with congenital adrenal hyperplasia due to a deficiency of 11 β-hydroxylase.

Prior to glucocorticoid administration, the urinary excretion of 17-ketosteroids varied from 2.2 to 4.9 mg/24 hours, urinary excretion of pregnanetriol varied from 0.7 to 2.2 mg/24 hours, and total 17-hydroxysteroid excretion varied from 1.2 to 7.5 mg/24 hours. Urinary tetrahydro-11-deoxy cortisol (TSH) was detected at a concentration of 550 µg/24 hours. The plasma concentration of androstenedione varied from 100 to 530 mµg/100 ml and the plasma concentration of testosterone varied from 40 to 90 mµg/100 ml. These values are significantly elevated when compared to those obtained in normal prepubertal females. Urinary steroid excretion and plasma androgen concentrations fell to normal in response to glucocorticoid administration.

The metabolic clearance rate of androstenedione was 890 liters per day per M2 and the in vivo conversion ratio of androstenedione to testosterone was 11%. The calculated production rate of androstenedione was 4.7 mg per day per M2. Virilization in congenital adrenal hyperplasia due to 11 β-hydroxylase deficiency can be explained by an elevated plasma concentration of testosterone, which can be accounted for on the basis of conversion from androstenedione.
Ringworm in an Infant
Authors: Alden Errol R. , Chernila Selbert A.
Published: December 2021

A case of extensive tinea corporis, due to Microsporum canis, occurring in an infant less than 3 weeks of age is described. This is the youngest infant reported to have this disease. It responded promptly to topical therapy with tolnaftate solution.
Letter to the Editor
Authors: Gleason Doris
Published: December 2021

While I cannot walk a mile in Dr. Concklin's or any other physician's boots, or "scrub up and gown up" as suggested in his letter, I have taken footprints and know that persons can be taught to take good, readable footprints quickly and easily in a delivery room without disrupting any vital time schedules. However, before suggesting how this can be done, one point made in his letter needs clarification.

Nowhere did I make the charge he attributed to me that "faulty technique is the sole cause of improper imprints."
Insulin Binding
Authors: Marks James F.
Published: December 2021

I read with interest the recent article on Insulin Binding in Children with Diabetes Mellitus by Murthy, Guthrie, Womack, and Jackson. I am most pleased that their work extends the observations which we made 3 years ago. There are some differences in both technique and results. It is most interesting that Murthy, et al. studied the insulin binding in this disease for both bovine and porcine insulin. Our data, as did theirs, showed a substantial presence of insulin binding in children with diabetes in comparison to a normal population.
Interactions of Numrrion and Infection (World Health Organization Monograph Series No. 57), by Nevin S. Scrimshaw, Ph. D., M. D., M. P. H., Carl E. Taylor, M. D., Dr. P. H., F. R. C. P. ( Canada), and John E. Gordon, Ph. D., M. D., F. R. C. P. ( Lond. ). Geneva: World Health Organization, 1968, 329 pp., $ 9.00 (clothbound)
Authors: Eichenwald Heinz F.
Published: December 2021

In the past several years, there has been a renewal of interest in malnutrition. More importantly, perhaps, approaches to the study of human malnutrition have become increasingly sophisticated; it has been recognized that this condition does not constitute a single definable entity. Rather, malnutrition occurs primarily among underprivileged populations; thus, it is located in a particular physical, social, psychological, and biological environment. In other words, studies of the effects of malnutrition in human population groups rarely peimit the identification of a single cause for a specific effeet; rather, a series of complex interactions leads to an observed result.
Acid-Base Chemistry in Medicine, by Wilhelm R. Frisell, Ph.D. New York: The Macmillan Company (866 Third Avenue, New York, New York 10022), 1968, 118 pp., $2.95 paper, $6.00 hardbound
Authors: Holliday Malcolm A.
Published: December 2021

Wilhelm Frisell was an admiring student of William Mansfield Clark, who was a scholar capable of bringing to medical students and interested physicians some of the less familiar concepts of physical chemistry in an imaginative and appealing manner that did not do violence to the principles he was dealing with.

In the present book, the author has greatly narrowed his scope to the field of acid-base chemistry. Starting from the assumption that his students have yet to be introduced to high school chemistry, he continues to write in this vein thereafter.
EUTHYROID GOITERS IN CHILDREN: CORRELATION OF NEEDLE BIOPSY WITH OTHER CLINICAL AND LABORATORY FINDINGS IN CHRONIC LYMPHOCYTIC THYROIDITIS AND SIMPLE GOITER
Authors: Ling Shun M. , Kaplan Solomon A. , Weitzman Jordan J. , Reed George B. , Costin Gertrude , Landing Benjamin H.
Published: December 2021

All children with euthyroid goiters examined over a period of 3 years underwent study of thyroid function, needle biopsy, and measurement of thyroid antibodies. Sixty-six of 71 children studied had satisfactory biopsies of the thyroid. Of these, 43 (65%) had chronic lymphocytic thyroiditis and 23 (35%) had simple goiter as determined by histologic examination of the biopsy specimen. Elevated titers of anti-thyroid antibodies were found in 50% of the patients with thyroiditis by the tanned red cell method and in 63% by the indirect Coons method. Neither antibody was present in significant quantity in 20% of the patients. Abnormal levels of antibody were rarely detected in children with histologic evidence of simple goiter. Treatment with thyroid extract has little effect on the progression of the disease process to fibrosis and atrophy. Such treatment may be necessary to anticipate the development of hypothyroidism or for replacement if thyroid function is already diminished. There is no evidence that simple goiter is associated with hypothyroidism, and treatment of this disease with thyroid preparations is necessary only for cosmetic purposes. Needle biopsy is the most useful means for making a distinction between thyroiditis and simple goiter.
THE CRITICALLY ILL CHILD: MANAGEMENT OF STATUS EPILEPTICUS
Authors: Carter Sidney , Gold Arnold P.
Published: December 2021

Status epilepticus is the clinical definition of a state in which the patient has a series of recurrent convulsions without recovering consciousness between episodes. It can occur with any seizure type, but a true medical emergency usually exists only with the generalized or focal motor varieties of status. This definition of status epilepticus clearly excludes epilepsia partialis continua, in which there is no alteration of the state of consciousness, and serial epilepsy, where consciousness is regained between attacks.

Status epilepticus occurs in 5 to 10% of children with epilepsy and requires immediate and continued medical attention, for, if uncontrolled, death or permanent neuronal damage could result. Death occurs in approximately 15% of patients with status and may either be related directly to status epilepticus or, as emphasized by Lombroso, may result from the untoward effect of intravenous sedatives or hypnotic compounds on the already depressed medullary centers. The immature nervous system is particularly vulnerable to status epilepticus; and, in one recently reported study, 50% of the children were 2 years of age or less. Prompt management is mandatory, as both the neurologic residua from irreversible cerebral damage and mortality are higher in this young age group.

The true pathophysiology of status epilepticus is poorly understood. However, the condition is more common in children with symptomatic epilepsy of infectious, metabolic, vascular, or structural etiology. Rapid or sudden withdrawal of anticonvulsants and intercurrent infections are the common triggering mechanisms. Injudicious withdrawal of drugs either prior to an electroencephalogram or after a seizure-free state of relatively short duration, and a sudden change in the anti-convulsant regimen, are frequent precipitating factors.
Urine Screening for Disorders of Mucopolysaccharide Metabolism
Authors: Klein M. , Whelan D. , Clow C. , Scriver C.
Published: December 2021

In our laboratory, we have been troubled by difficulties in the interpretation of alcian blue and toluidin blue spot tests for mucopolysacchanide disorders. We have tried to provide the clinician with information that would assist him in diagnosis, but were hampered by the apparent high incidence of "false positive" tests. In response to this problem, we reviewed our expenience with 67 referred patients and with 181 retarded institutionalized patients.

A positive correlation between test results and chemical disease was found mainly in patients where the diagnosis of mucopolysaccharidosis was already obvious.
Cystic Fibrosis of Pancreas and Down's Syndrome
Authors: Rovescalli A.
Published: December 2021

Dr. A. Milunsky describes (Pediatrics, 42:501, 1968) the observation "for the first time" of cystic fibrosis of the pancreas in three children with Down's syndrome. I would like to point out that such association has been observed in several autopsied cases at the Department of Pathology in University Medical School of Milan. I think this association occurs very frequently in Down's syndrome, and I described it in the book "Il Mongolismo, auxopatia somatopsichica caniotipica," by E. Aldeghi and A. Maderna, in the chapter devoted to the pathological anatomy of the syndrome (page 69).
Chromosomes and Sex in Hypospadias
Authors: Fane Larry R.
Published: December 2021

The recent article by Juberg, et al., titled "Chromosome Studies in Patients with Hypospadias" has aroused my concern. The authors state that the most common associated genital anomaly in hypospadias is cryptorchism, and from their study of 21 patients, they state "there appears to be no genetic basis for the assumption that hypospadias in the male represents a form of intersexuality." This appears to be in conflict with nearly all previously published studies and one wonders how a study of such a small number warrants such a conclusion.
TRADITIONAL SAFETY MEASURES AND ACCIDENTAL POISONING IN CHILDHOOD
Authors: Sobel Raymond
Published: December 2021

Although few drugs, surgical technique, and public health measures are put into widespread use today without rigorous testing and evaluation, such assessment of efficacy is the exceplion rather than the rule with countermeasures against accidental injury. Many countermeasures now in use have never been evaluated; others continue in use long after they have been proved to be ineffective. Driver education, for example, is being widely adopted in the face of mounting evidence that it does nothing to prevent accidents. Programs of "home safety education" continue to be formulated despite considerable evidence that they do not produce the intended results.

This unconcern for—if not downright resistance to—systematic research on effectiveness has several consequences: (1) It permits programs of questionable value to absorb funds and manpower that might better be used in developing effective programs. (2) It precludes the possibility of a cost-effectiveness approach, which promises to be at least as useful in injury control as it has been in other areas of social concern. (3) It develops and strengthens vested interests connected with established programs—and thus it increases the resistance against objective evaluation. (4) It lulls the lay public into a false sense of security, since the public is likely to assume that accident countermeasures have the same degree of validity as other public health measures.

The signal contribution of the paper that follows lies in its challenge of a "safety measure" that has long been accepted and disseminated by professionals and laymen alike. Although the population studied is both small and in some respects atypical, the findings are strong enough to warrant further study of larger and different populations.

The methodology employed is also worth emulating. Recognizing the bias inherent in medical records and the difficulty of obtaining valid and representative responses to mail questionnaires, the investigator resorted to both interviewing and observation, which, though unquestionably expensive, are probably the most effective methods of data collection available to the research worker studying accidental injury.
CHILDHOOD INJURY CONTROL: WHO WILL TAKE WHAT ACTION
Authors: Harrison Stanley L.
Published: December 2021

RESEARCH

Three areas of research were listed by many at the National Childhood Injury Symposium:

1. Epidemiologic study of injury circumstances, relating these to cause and prevention: (a) Demographic data on social class, incidence data, sex-age related to injury, to determine those who are at greatest risk from what methods of trauma. More uniform methods of classification, reporting, and participation are urged; (b) specific study of children and their development, the human environment that failed them and permitted injury, i.e., risk-taking behavior, impulse control of both children and adults. (c) Environmental hazards and why specific individuals or groups were singled out and injured by them. (d) Multivariant cluster analysis to determine circumstances of causation and natural history of injury, particularly by each method of injury. (e) Traditional incidence data, from health departments, physicians, hospitals, National Health Survey, and others, on continuing basis to determine nature of the problem.

2. Operational research: assessment of existing programs' effectiveness, and ongoing tests of programs as they are developed, e.g., do laws passed actually alter the childhood injury problem, and do codes, statutes, campaigns do anything? What is being taught in schools and colleges, and to what effect?

3. Research into underlying factors not directly concerned with the above, hut relevant to injuries: development of perception, risk-taking, attitude study, etc. A need was felt by many to periodically assess child safety research and communicate this to those in a position to use it most effectively.
Translumbar Pyelography in the Child
Authors: Lalli Anthony F.
Published: December 2021

We have performed percutaneous translumbar pyelography on 4 patients in the pediatric age group with varying types of congenital anomaly and obstructive uropathy. By this procedure definitive information was successfully added for all 4 patients prior to the performance of any surgical procedure. The technique and its potential utilization have been discussed.
Transplacental Passage and Persistence in Serum for 6 9/12 Years of Iophenoxic Acid (Teridax) in a Child
Authors: Carakushansky Gerson , Cárdenas Luis E. , Gardner Lytt I.
Published: December 2021

Investigation of discordantly high PBI values in a child disclosed the presence of iophenoxic acid (Teridax) in sera of both the patient and her mother. This iodinated compound persisted for 6 8/12 years in the serum of the child; it had passed across the placenta from her mother, who had ingested it for x-ray studies about 21 months before the child's birth.
Ambulatory Pediatricians, Continued
Authors: Gersh Marvin J.
Published: December 2021

I agree with Dr. Richard B. Goldbloom's comment concerning the awkwardness of the term "Ambulatory Pediatrics," which appeared in August Pediatucs. I have a proposal which I suspect would obviate this semantic difficulty.

Since it is only the relatively rare child who is admitted as an inpatient or non-ambulatory patient, I propose the term ambulatory pediatrics be dropped, and that the department be referred to simply as pediatrics. What was formerly the In-patient Service, should be referred to as Decubitus Pediatrics.
Chlorpropamide Intoxication—Treatment with Peritoneal Dialysis
Authors: Graw Robert G. , Clarke Ronald R.
Published: December 2021

A case of chlorpropamide poisoning with subsequent severe neurologic sequelae is reported. A brief discussion of the drug is included. Peritoneal dialysis was performed and appeared to be of no value in the removal of chlorpropamide from serum.
Homozygosity for Achondroplasia? Report of a Possible Case, with Congenital Heart Disease and Severe Mental Deficit
Authors: Morgan Beverly C. , Aase Jon M. , Graham C. Benjamin
Published: December 2021

This report describes the child of two achondroplastic parents, who himself had achondroplasia, transposition of the great arteries, and marked mental retardation. The question is raised whether this represents the homozygous state of the gene for true achondroplasia.
Letter To The Editor
Authors: Ekert H.
Published: December 2021

I am forced to comment on the far-reaching deductions drawn from the article by Dr. E. Richard Steihm and Dallas V. Clatanoff.1 Collection of blood from the cut surface of the umbilical cord invariably involves contamination of the blood with mucopolysaccharides of Wharton's jelly. These substances have a similar chemical structure to heparin and, like heparin, they exert a strong anti-thrombin effect. This can readily be confirmed by comparing the thrombin times of cord blood and blood obtained by venipuncture.
Letter To The Editor
Authors: Chessells Judith M. , Pitney W. R.
Published: December 2021

Drs. Stiehm and Clatanoff (Pediatrics, 43: 770, 1969) report a high incidence of split products of fibrin (SPF) in the cord blood of healthy newborn infants. This is contrary to our own experience which had indicated the presence of SPF in only 5% of healthy newborns. We use a hemagglutination inhibition technique which is at least as sensitive as the tube precipitin assay employed by Drs. Stiehm and Clatanoff. The two methods differ in one important aspect, however; we have tested cord blood drawn into a mixture of sodium citrate and epsilon amino-caproic acid to inhibit in vitro fibrinolysis.
Letter To The Editor
Authors: Stiehm E. Richard
Published: December 2021

In our study, "Fibrin Split Products in the Serum of Newborns" (Pediatrics, 43: 770, 1969) , we did not use thrombin or a fibrinolytic inhibition in the collection of our serum samples for the fibrin split product (FSP) determinations; in retrospect, this is a deficiency in our study. Since receiving the foregoing letters, 12 additional cord blood samples were studied, collected with and without the addition of .5 cc of .1M epsilon amino caproic acid (EACA) and/or 100 units of thrombin per 10 ml.
Cellular Immunology, Books I and II Combined, by Sir F. Macfarlane Burnet, K.B.E., O.M., F.R.S. New York: Cambridge University Press, American Branch, 1969, 725 pp., $18.50
Authors: Smith Richard T.
Published: December 2021

One of the rare privileges in the life of an academician is to interact with a truly germinal intellect. This opportunity comes only a few times in a professional life time. This reviewer was first privileged to meet Sir Macfanlane Burnet in 1957, when he was on his way to Nashville, Tennessee, to evocate his clonal theory of immunity for the first time.

Sir Mac, as he is known by friends all over the world, had been invited to a Ross conference on developmental immunology in Dallas, Texas.
HEREDITARY ADRENOCORTICAL UNRESPONSIVENESS TO ACTH
Authors: Franks Robert C. , Nance Walter E.
Published: December 2021

The syndrome of hereditary congenital adrenal unresponsiveness to ACTH is described in an additional consanguineous kindred. Abnormal pigmentation from birth was noted in affected male and female offspring. Investigations between 3 and 4 years of age in the female proband revealed that plasma ACTH values determined by both radioimmunoassay and bioassay were greatly elevated. However, subnormal levels of plasma and urinary 17-hydroxycorticosteroids and impaired responses to exogenous ACTH were associated with a normal response to sodium deprivation. These findings are interpreted as representing normal development of the adrenocortical zona glomerulosa but in utero failure of the zona fasciculata and reticularis to differentiate in response to normal ACTH.

Analysis of an autosomal recessive hypothesis as the mode of inheritance reveals an excess of males and a deficiency of consanguineous matings among reported cases. Although data are limited, they suggest the occurrence of both autosomal recessive and X-linked recessive forms of the disorder.
THIRSTING AND HYPERNATREMIC DEHYDRATION —A FORM OF CHILD ABUSE
Authors: Pickel Stuart , Anderson Charles , Holliday Malcolm A.
Published: December 2021

Three cases of hypernatremic dehydration following periodic water deprivation by psychotic mothers are presented as examples of child abuse. This represents a previously unreported form of child abuse and a previously unrecognized cause of hypernatremia in children in the range from 2 to 8 years of age.

From the acute changes in body weight and sodium concentration in serum in the period of hydration, it was deduced that the dehydration sustained by these children was not associated with NaCl deficits.
THE MOTHER'S TIE TO HER CHILD
Authors: Richmond Julius B.
Published: December 2021

Several years ago John Bowlby wrote a paper entitled "The Nature of the Child's Tie to His Mother."1 This and the growing literature on "imprinting" pioneered by the ethologists have focused attention on the significances of early experiences for the development of the young organism-human and nonhuman.

The nature of "the mother's tie to the child" has not received as much attention. Therefore, it is heartening to note an early report of a study, "Neonatal Separation: The Maternal Side of Interactional Deprivation," in this issue.2 Maternal behavior has been explored thus far mainly in animal studies. Some years ago we demonstrated that brief separation of newborn goats from their mothers resulted in a significant interference with the specificity of the mother's affection for her young.3
THE USE OF CHLORPROPAMIDE IN DIABETES INSIPIDUS IN CHILDREN
Authors: Ehrlich Robert M. , Kooh Sang Whay
Published: December 2021

Oral chlorpropamide was administered to 17 children with diabetes insipidus (D.I.). The cause of the D.I. was idiopathic, six; histiocytosis, five; craniopharyngioma, three; pinealoma, two, and post-traumatic, one. Twenty-four-hour urine volume and measurements of serum and urine osmolality at the beginning and end of a 7-hour water deprivation test were used to evaluatechlorpropamide therapy. Administration of 150 to 400 mg of chlorpropamide per day by mouth caused a reduction in urine volume in all patients (range 8 to 67%). No change in aldosterone, 17-hydroxycorticoids, or electrolyte excretion was noted. Serum electrolytes and glomerular filtration rate were not affected by therapy. Glucose tolerance and plasma insulin response remained normal in those patients tested. Mild leucine sensitivity without significant change in plasma insulin was induced in four children.

During water deprivation, seven patients with secondary D.I. but only one with idiopathic D.I. produced hypertonic urine.

Hypoglycemia developed in seven children and is the major hazard of treatment.

Long-term management of D.I. has been possible in nine children. Oral chlorpropamide is a useful drug in children with vasopressin-sensitive diabetes insipidus.
PERIPHERAL AND RENAL VEIN PLASMA RENIN ACTIVITY IN COARCTATION OF THE AORTA
Authors: Strong William B. , Botti Robert E. , Silbert Daniel R. , Liebman Jerome
Published: December 2021

Fifteen patients (ages 4 to 21 years) with coarctation of the aorta were studied. Ten patients were catheterized prior to surgery and both peripheral and renal vein plasma renin activity (PRA) were measured. Twelve patients were operated upon and peripheral PRA was measured pre-operatively and during the acute (postoperative day 0 to 10) and long-term postoperative (M = 112 days) period.

Three children, not as yet operated upon, have been catheterized. Prior to catheterization, each received a sodium restricted diet (less than 500 mg NaCl) for 48 hours.

The peripheral plasma renin activity was within the range of normal both preoperatively (18 ± 10 ng/ml) and long-term postoperatively (12 ± 5 ng/ml) p > 0.1 . The three patients who received sodium restriction prior to catheterization showed borderline to moderately elevated peripheral and renal vein PRA, suggesting that the renin apparatus responded to appropriate stimulation.

During the acute postoperative period, each patient had a transient elevation of peripheral PRA. This elevation might be a partial stimulus to aldosterone production in the acute postoperative period.

There was no correlation between peripheral PRA and blood pressure levels in the postoperative period. It was concluded that the renin-angio-tensin system does not play a significant role in maintaining the chronic hypertension which is associated with coarctation of the aorta.
Light and Hyperbilirubinemia
Authors: De Heer J. L.
Published: December 2021

Dr. Thomas H. Milby, et al., of the California Department of Public Health1 described a significant (p. < .01) seasonal variation in the incidence of neonatal nonhemolytic unconjugated hyperbilirubinemia, observed in a hospital in a small, predominantly agricultural Californian community during a 4-year observation period (1963-1966). An excess of cases occurred during the fourth quarter of each of the 4 years reviewed, as compared with the other quarters of these years. A similar trend (p. < .5) was apparent in a nearby hospital during 2 of the 33 years reviewed (1964-1966).
Environmental Illumination and Hyperbilirubinemia: Design of Study
Authors: Ament Marvin E.
Published: December 2021

I believe that there is a basic flaw in the study "Effect of Environmental Illumination in Prevention of Hyperbilirubinemia of Prematurity"1 which appeared in the August issue of Pediatrics. The authors were purporting to show the effect of environmental illumination on hyperbilirubinemia, yet they failed to make their experimental groups equal except for the one variable of foot candles. One group was fully exposed to 90 foot candles of light because they wore only diapers; the other group was fully clothed and exposed to 10 foot candies of light.
Letter To The Editor
Authors: Giunta Frank
Published: December 2021

Dr. Giunta commented as follows:

The doctor is perfectly correct in questioning whether there was a reason for doing the study as we did.

From the start, it was apparent that the study would include very sick premature infants such as those with respiratory distress syndrome who would require intensive nursing care, frequent monitoring of equipment, as well as blood gas determinations and chemistries.

Since supplemental lighting such as with gooseneck lamps had been used in the past during feeding, monitoring, and drawing blood samples, it was felt that clothing the control group would expose them to a minimum of additional light.
Testicular Leukemia
Authors: Leef F. , Kende G. , Ramot B.
Published: December 2021

The paper by Dr. Finklestein and others,1 leaves one with the impression that testicular involvement in acute leukemia, an almost general finding at post mortem, is an uncommon clinical problem.

We wonder whether lack of awareness might not be responsible for this, as our own experience suggests. In a clinic that follows at any time about 20 children and young adults with acute leukemia, we had seen only one case of testicular involvement (presenting symptom) in 3 years.
THE SMALL INTESTINE IN VITAMIN D DEPENDENT RICKETS
Authors: Hamilton Richard , Harrison Joan , Fraser Donald , Radde Lngeborg , Morecki Rachel , Paunier Luc
Published: December 2021

We have demonstrated impaired intestinal absorption of calcium in a child with active vitamin D dependent rickets (hereditary pseudovitamin D deficiency rickets) at a time when the patient had normal anti-rachitic activity in her serum. Calcium absorption improved greatly in response to vitamin D, administered in the massive dosage that was necessary to heal the rachitic lesions. Phosphorus absorption may have been slightly impaired in the same patient, but no other absorptive defect was found. We studied intestinal function in five additional patients after they had been placed on vitamin D therapy. No abnormalities were found. In these treated patients, calcium absorption was not measured. Duodenal mucosa studied by light and electron microscopy was normal in all patients. Future investigation of intestinal transport of calcium in these patients should help to explain the pathogenesis of this disease.
SEVERE GROWTH RETARDATION IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE
Authors: McCaffery Thomas D. , Nasr Khosrow , Lawrence A. M. , Kirsner Joseph B.
Published: December 2021

From a group of 130 youngsters with inflammatory bowel disease, 22 were severely growth retarded (below the third percentile in height). This had preceded gastrointestinal symptoms for 1 to 11.4 years in 8 patients and corticosteroid therapy in 14. Endocrine evaluation demonstrated abnormally low 24-hour urinary gonadotropins in five of six patients more than age 16, and depressed growth hormone response to insulininduced hypoglycemia in 11 of 13 tested. Growth retardation in this group was attributed to a secondary hypopituitarism.
LSD Exposure in Utero
Authors: Warren Richard J. , Rimoin David L. , Sly William S.
Published: December 2021

In spite of the many recent reports on the damaging effects of LSD on human chromosome in vitro1,2 and in vivo3-6 and its ability to produce congenital malformations in rodents7, the teratogenic potential of this drug in humans is still uncertain. Two infants with limb malformations who had been exposed to LSD in utero have thus far been reported8,9. On the other hand, Cohen, et al.5, reported nine children and Hulten, et al.6, one child, all of whom had been exposed to LSD in utero and had no obvious birth defects although chromosome damage was apparent. Hecht and his co-workers9 have pointed out the need for additional data on infants who had in utero exposure to LSD, regardless of the presence or absence of congenital malformations, so that the teratogenic properties of the drug could be evaluated.
Enzyme Activity in the Platelets of Newborn Infants
Authors: Oski Frank A. , Murphy Scott , Gardner Frank H.
Published: December 2021

Platelet hexokinase, phosphofructokinase, phosphoglycerate kinase, enolase, pyruvate kinase, lactic dehydnogenase, glucose-6-phosphate, dehydrogenase, and glutamic-oxaloacetic transaminase activity was assayed in platelets from newborn infants and contrasted with those of adults. Platelet phosphofnuctokinase activity was decreased and platelet phosphoglycerate kinase and glutamic-oxaloacetic transaminase activity were elevated in the platelets of newborn infants. It would appear that certain biochemical properties of the erythrocytes of the newborn are shared by the platelets as well. The metabolic consequences of these differences remain to be explored.
Physical Abuse of Children
Authors: Fontana Vincent J.
Published: December 2021

The article entitled "Physical Abuse of Children" by Gil,1 in a recent supplement to Pediatrics on "Childhood Injuries-Approach and Perspectives," deserves comment concerning the pediatrician's viewpoint in order to avoid any misconceptions that might arise from reading this article.

Dr. Gil is not a physician or a pediatrician and probably has not had the unfortunte experience of seeing an abused or "battered" child. He has stated his findings and expressed his recommendations and opinions concerning the problem.
Letter To The Editor
Authors: Gezon Horace M.
Published: December 2021

Dr. Gezon commented:

Dr. Lee's comparing the ecology of the Siaphylococcus in the newborn nursery to that of soft-shell clams on the coastline is quite appropriate. It is entirely possible that some of the success attributed to hexachlorophene bathing and handwashing was in fact the natural disappearance from the nursery of Staphylococcus aureus phage patterns 80/81, 80 and 80/81/52/52a which were the principal pathogenic strains in U.S. hospitals in the late 1950's and early 1960's.
GENETIC AND CLINICAL CONSIDERATIONS OF LONG-ARM DELETION OF THE X CHROMOSOME
Authors: Hsu Lillian Y. F. , Hirschhorn Kurt
Published: December 2021

A 13-year-old girl with short stature and obesity was found to have 46, XXq-in 90% of cultured leukocytes and 45, X in 10%. Autoradiographic studies showed the long-arm deleted X to be the late replicating X chromosome. In no cell was the normal X chromosome found to be late replicating. Our findings, combined with others from the literature, imply genetic inactivation of all structurally abnormal X chromosomes. Therefore, a previous hypothesis regarding the location of the Xga gene on the short arm of the X chromosome is not valid.

The hypothesis that normal somatic development in females may require the presence of the short arm of both X chromosomes prior to X inactivation remains likely. The XO line found in our patient probably accounts for her short stature.
Low Spinal Fluid Sugar in Meningitis
Authors: Weichsel Manfred
Published: December 2021

Dr. John H. Menkes's review of the factors responsible for the lowering of the spinal fluid sugar in bacterial and tuberculous meningitis1 presents evidence that the primary factors for the low spinal fluid sugar in bacterial meningitis may be a combination of increased utilization of glucose by the brain, combined with a defective glucose transport. We2 presented evidence over 30 years ago that the lowering of the spinal fluid sugar in tuberculous meningitis was not due predominantly to utilization of the glucose by either bacteria or leukocytes:
Screening for Lead Poisoning
Authors: Lin-Fu Jane S.
Published: December 2021

As one deeply interested in the problem of childhood lead poisoning, I am glad to see that the American Academy of Pediatrics has recently issued a statement on this important but neglected pediatric problem.1 This comprehensive statement will be a useful guideline to pediatricians and other health workers.

However, I am concerned about the screening tests recommended for lead poisoning. The statement "Pending improvements in the analysis of lead in blood, the urine ALA test of Davis and Andelman and the analysis of lead in hair, which are currently under study, offer the best substitute for the purpose of mass screening" would have been correct if it were made 2 years ago when these tests were first reported, before they were studied by other investigators.
Pediatric Decalogue
Authors: Schnitzer William F.
Published: December 2021

You might find these commandments suitable for publication among the Letters. I wrote them several years ago:

PEDIATRIC COMMANDMENTS

1. Never use the word hurt: it's use creates more apprehension and fear.

2. Please hold the child securely: when necessary, it is much more considerable than repeated restraint.

3. Empty mouths of chewing gum and candy: and please don't bring crackers, cookies or soda to the office.

4. No climbing on furniture: it is embarassing as well as painful to sustain an injury here.
GENETIC DETERMINATION OF ACUTE DISSEMINATED HISTIOCYTOSIS X (LETTERER-SIWE SYNDROME)
Authors: Juberg Richard C. , Kloepfer H. Warner , Oberman Harold A.
Published: December 2021

Male twins first developed maculopapular eruption of the scalp at 9 months of age and then of other cutaneous areas during the next 3 months. They manifested otorrhea, anemia, and abdominal enlargement at 11 months. They had fever, massive hepatosplenomegaly, and moderate lymphadenopathy when admitted to the hospital at 12 months. There were histiocytes in the skin and bone marrow. The clinical impression of monozygosity was confirmed by several criteria.

One twin died at 15 months with diarrhea, and the other twin died at 21 months after developing scattered osteolytic lesions and diabetes insipidus. Autopsy findings in both twins were characteristic of acute disseminated histiocytosis X with diffuse infiltration of nonlipidic histiocytes. An unusual finding was extensive liver involvement in both twins.

Evidence for genetic determination of the disease consists of analysis of the literature reports in three categories. Twin studies show three of four pairs of monozygotic twins concordant for the trait. Sibship analysis of the familial occurrence by the a priori method with correction for multiple ascertainment is consistent with the genetic hypothesis. One consanguineous mating has been reported among the seven sibships of familial occurrence.

We conclude that at least some instances of this disease result from a single, autosomal, recessive gene with slightly reduced penetrance.