bluuebunny/crossref_metadata_2025 huggingface dataset:
PATHS OF LYSINE DEGRADATION IN PATIENTS WITH HYPERLYSINEMIA
Authors: Woody Norman C. , Ong Eng Bee
Published: December 2021

Study of lysine metabolites in the urine of two children with hyperlysinemia indicates that several pathways for lysine breakdown exist in man. Two of these are demonstrated to be functioning and are shown to be of secondary importance for lysine degradation in these children. One of the paths, via homocitrulline and homoarginine, has been demonstrated for humans by others. The second, through \g=elunate\-N-acetyl-L-lysine, is documented here for the first time in man. These pathways are not the site of the metabolic block, and another path of lysine degradation must be postulated as the site of the metabolic block in these patients with hyperlysinemia.
SWEATING IN CONGENITAL HEART DISEASE
Authors: Alter Blanche P. , Czapek Emily E. , Rowe Richard D.
Published: December 2021

Sweating was found to be increased in children with congenital heart disease who had a propensity to congestive heart failure, e.g., children with endocardial fibroelastosis or large or moderate sized left-to-right shunts. This was suggested in a review of cardiac clinic records of 220 patients and was supported by the results of pilocarpine sweat tests which were performed on 34 cardiac patients. By history and by measurement of the amount of sweat produced, children with a history of or tendency toward heart failure could be predicted though patients did not need to be in failure when tested. Contrary to previous opinion, the left-to-right shunt was not in itself sufficient to cause the child to sweat. The shunt had to be large enough to be associated with failure at some time.

It is suggested that the pilocarpine sweat test might actually be useful as an aid in predicting a child's potential for heart failure. Several theories regarding the mechanism of sweating in these situations are discussed.
CEREBRAL GIGANTISM
Authors: Stephenson John N. , Mellinger Raymond C. , Manson Gordon
Published: December 2021

Studies are reported of 10 children having physical findings previously reported in cases classified as showing cerebral gigantism. These findings included mental retardation; advanced height, weight, and bone age; and a characteristic facies. Six had pneumoencephalography and all showed communicating hydrocephalus. Karyograms were normal. Urinary 17-KS steroid excretion was increased for chronologic age, but levels were compatible with physiologic age. Adrenal response to dexamethasone suppression and metyrapone administration was normal. The condition is regarded as a reflection of congenital central nervous system dysfunction with mental retardation and altered hypothalamic control of anterior pituitary function.
Chlorpropamide Poisoning
Authors: Greenberg Barry , Weihl Carl , Hug George
Published: December 2021

Clinical signs of hypoglycemia developed in a 3½-year-old boy 24 hours after he had eaten some of the attractively blue-colored chlorpropamide tablets. Low blood sugar values persisted for 4 days after the ingestion concomitant with an increase in serum insulin concentration. On the fifth day, the blood sugar rose to normal levels. The serum insulin concentration was not significantly out of the normal ranges on each of the four follow-up examinations.
Advances in Pediatrics, Vol. XIV, edited by S. Z. Levine, M.D. Chicago: Year Book Publishers, Inc., 1966, 307 pp., $11.50
Authors: Worthen Howard G.
Published: December 2021

Of the books which attempt to bridge gap between textbooks and medical journals, one of the most successful over the years has has been Advances in Pediatrics, edited by Dr. S. Z. Levine. The continued excellence of this series of books has been due, in large part, Dr. Levine's choice of subjects and authors. These have made each volume a mixture of definitive articles on some subjects combined with occasional controversial and thought-proyoking ones on other subjects.
EFFECTS OF IONIZING RADIATION FROM THE ATOMIC BOMB ON JAPANESE CHILDREN
Authors: Miller Robert W.
Published: December 2021

The total number of delayed organic effects of atomic irradiation among Japanese children has been small. The most prevalent late effect, difficult to document, is the fear of late effects, a most unfortunate circumstance in view of the small risk indicated by the results to date.
FETAL AND NEONATAL COMPLICATIONS ASSOCIATED WITH RECURRENT CHORIOANGIOMAS
Authors: Battaglia Frederick C. , Woolever C. Allen
Published: December 2021

This report presents a case in which two successive pregnancies were complicated by the development of multiple chorioangiomas. The first infant was stillborn, but of normal term birth weight. The second infant had a birth weight of 1,800 gm at term. The neonatal course in the second infant was complicated by edema, hyponatremia, and hypoproteinemia. The possible relationship between these neonatal complications and the placental tumor is discussed.
BELA SCHICK, 1877-1967
Authors: Hodes Horace L.
Published: December 2021

Bela Schick was born in Bolgar, Hungary, on July 16, 1877. He received his medical degree from Karl Franz University at Graz in 1900. After a period of 6 months in the Austro-Hungarian army, he returned to Graz where he became a voluntary assistant in the clinic of Professor Theodore Escherich. In 1902 when Professor Escherich left Graz to accept the chair in pediatrics in Vienna, Dr. Schick was invited to accompany him. In Vienna, Dr. Schick was appointed volunteer to work with Dr. Clemens von Pirquet, who was an assistant at the Children's Clinic of the University. A perfect life-long friendship sprang up at once between these two men of genius.
TREATMENT OF MALIGNANT SYMPATHETIC TUMORS IN CHILDREN: CLINICOPATHOLOGICAL CORRELATION
Authors: Perez Carlos A. , Vietti Teresa J. , Ackerman Lauren V. , Kulapongs Panja , Powers William E.
Published: December 2021

The results of treatment in a series of 46 children with malignant sympathetic tumors are reported with an absolute cure rate of 47% at 2 years and 46% at 5 years. Thirty-two percent of the patients with distant metastasis have survived tumor free 2 years or longer.

Factors affecting the prognosis and the various methods of treatment are analyzed. Aggressive radiation therapy of these patients is advocated, depending on their clinical condition, even in the presence of distant metastasis. The primary role of irradiation in the sterilization of these malignant sympathetic tumors is postulated. Chemotherapy with cyclophosphamide and vincristine produced only transient regression of some of the tumors, with limited palliative results. The indication of chemotherapeutic agents is questioned in the treatment of patients with localized tumor because it is felt that this may impair the host resistance of the patient. Intensive chemotherapy may adversely affect survival, although admittedly all patients receiving this form of therapy had far advanced disease.
LIMB-GIRDLE MUSCULAR DYSTROPHY: CLINICAL MANIFESTATIONS AND DETECTION OF PRECLINICAL DISEASE
Authors: Jackson Charles E. , Strehler Don A.
Published: December 2021

The clinical picture of limb-girdle muscular dystrophy is described as seen in 37 affected individuals from two large Amish kindreds. The disease is characterized by an autosomal recessive mode of inheritance with as many females as males being affected, and with affected individuals being the product generally of consanguineous matings. The age of onset was observed to be between 4 and 15 years of age (average 8½) with a quite variable age of confinement to a wheelchair (12 to 44 years ). The disease was compatible with a life span in one patient to 67 years of age. The involvement of proximal shoulder and pelvic girdle muscles was similar to that in the X-linked recessive, Duchenne type of muscular dystrophy; however, the zygomaticus muscles of the face are preserved and a normal upturned smile is noted in this type of muscular dystrophy rather than the flat transverse smile noted in the X-linked recessive type.

Muscle biopsy abnormalities in two individuals very early in the course of their disease suggest that biopsy would probably be useful in detection of preclinical disease in this type of muscular dystrophy. Gross abnomalities of serum enzymes in 12 younger siblings of affected individuals in these two families suggest that these enzyme determinations are useful in detecting preclinical, limb-girdle muscular dystrophy. When therapy for muscular dystrophy becomes available, the determination of preclinical disease by these techniques will become of greater clinical significance.
DEVIANT GENDER-ROLE BEHAVIOR IN CHILDREN: RELATION TO HOMOSEXUALITY
Authors: Bakwin Harry
Published: December 2021

There is ample evidence to show that homosexuality, in a certain proportion of cases, has its roots in childhood. Follow-up observations in the literature, as well as those reported here, show a high risk of homosexuality in children with deviant gender-role behavior, that is, effeminate or sissy boys and tomboyish girls. Family backgrounds of those children show no consistent pattern.

A discussion of whether gender-role behavior is inborn or learned is included. The author inclines to the view that it is inborn.

Suggestions for management, which are designed to encourage gender appropriate behavior and to prevent homosexuality are offered.
Infektionskrankheiten, Volume I in two sections, edited by O. Gsell and W. Mohr. Berlin-Heidelberg-New York: Springer-Verlag, 1967, Section 1–1198 pp., Section 2–752 pp. (available only as a unit), $61.25
Authors: Eichenwald Heinz F.
Published: December 2021

This publication represents the first segment of a projected three-volume treatise on all infectious diseases of man. The first volume deals with virus diseases and virus-like illnesses, the second, to be published soon, with bacterial infections, and the third with diseases of fungal origin. Volume I consists of two sections, each bound separately and available only as a unit.The first section discusses all illnesses definitely proven to be due to viruses; the second, of almost equal length, discusses illnesses of probable viral etiology such as infectious mononucleosis, cat-scratch fever, and epidemic vomiting, as well as diseases caused by the psittacosis lymphogranuloma group, by coxiella and mycoplasma.
Letters to the Editor
Authors: Lucey Jerold F.
Published: December 2021

Dr. Bowman's letter citing his recent improved unpublished experience with intra-uterine transfusions demonstrates the value of having this procedure carried out by experts. Technical skill is obviously very important in those transfusions being carried out before the twenty-eighth week.

His experience with the treatment of hydrops fetalis is encouraging. Perhaps it is due to the fact that he is not just doing a "simple" fetal transfusion. He has been treating both mother and fetus (sometimes directly) with other medications.
Heart Disease in Infancy and Childhood, ed. 2, by John D. Keith, M.D., Richard D. Rowe, M.B. (N.Z.), F.R.C.P. (Edin.), and Peter Vlad, M.D. New York and London: The Macmillan Company, 1967, 1239 pp., $35.00
Authors: Gersony Welton M.
Published: December 2021

After 9 years, a substantially enlarged second edition of Heart Disease in infancy and Childhood has been published. The past decade has witnessed enormous progress in our knowledge of congenital heart disease; the authors have performed a masterful effort in updating their highly successful first edition. Several of the chapters have been completely revised; others have been significantly amended. The sections on complete transposition of the great arteries, single ventricle, chamber localization, and dextrocardia have been rewritten in collaboration with Dr. Richard Van Praagh.
CONGENITAL PULMONARY LYMPHANGIECTASIS ASSOCIATED WITH A BLIND COMMON PULMONARY VEIN
Authors: Rywlin Arkadi M. , Fojaco Rita M.
Published: December 2021

Three main theories have to be considered in the pathogenesis of congenital pulmonary lymphangectasis: obstruction of major pulmonary lymphatics, obstruction to pulmonary venous flow, and anomalous pulmonary development. The authors report an infant with congenital pulmonary lymphangiectasis associated with a blind common pulmonary vein. Previously reported cases of congenital pulmonary lymphangiectasis associated with cardiac lesions causing obstruction to pulmonary venous flow are reviewed. This association appears too frequently to be merely coincidental. Obstruction to pulmonary venous flow provides a cause for the persistence of prominent fetal lymphatic channels and thus seems of pathogenetic importance in some cases of congenital pulmonary lymphangiectasis.
EFFECT OF THE THERMAL ENVIRONMENT ON COLD RESISTANCE AND GROWTH OF SMALL INFANTS AFTER THE FIRST WEEK OF LIFE
Authors: Glass Leonard , Silverman William A. , Sinclair John C.
Published: December 2021

Twelve matched pairs of small (1,001-2,000 gm birth weight) asymptomatic neonates, age 1 week, were placed in either of two frequently recommended thermal environments ("standard": abdominal skin controlled at 35.0°C to approximate the thermal state commonly realized in nurseries for premature infants; "warm": abdominal skin controlled at 36.5°C to approximate thermoneutral condition). Both groups were fed 120 calories/kg/day.

Before and after 2 weeks in the test environment, the infants were placed in a simulated room environment-28°C incubator wall—for 1 hour and the change in body temperatures was measured.

Cold resistance–the ability to prevent a fall of deep body temperature in the 28°C environment– was significantly greater among infants who had spent 2 weeks in the slightly cooler environment. The rate of increase in body weight and length was significantly faster in the warmer condition.
PREVENTION OF HYPERBILIRUBINEMIA OF PREMATURITY BY PHOTOTHERAPY
Authors: Lucey Jerold , Ferreiro Mario , Hewitt Jean
Published: December 2021

The ideal treatment for hyperbilirubinemia of prematurity would be a safe and simple method for preventing its occurrence. In 1958 it was first demonstrated that serum bilirubin concentrations of newborn infants can be reduced by exposure to light. This treatment has not been widely used because of doubts as to its effectiveness and concern for the possible toxicity of the photochemical decomposition products of bilirubin. Recent experimental evidence indicates that these products are non-toxic. A controlled clinical trial has been carried out among 111 premature infants to test the effectiveness of artificial blue light in preventing hyperbilirubinemia of prematurity. Treated infants were placed in light from 12 to 144 hours of age and serial bilirubin determinations were carried out. The control (58 infants) and treated (53 infants) groups were comparable with respect to birth weight, gestational age, fluid intake, and weight loss. The results indicate a statistically significant difference between the groups.

By taking advantage of this alternate route of elimination of bilirubin in the newborn infant, it should be possible to greatly reduce the need for exchange transfusion for hyperbilirubinemia of prematurity.
Further Changes of Format Suggested
Authors: Corby Donald G. , Ong Beale H.
Published: December 2021

We are greatly pleased with the recent change in format of Pediatrics. The new policy of including abstracts of articles presented will undoubtedly prove a very valuable addition to the Journal. The ideas expressed in your Commentaries in the January issue regarding the use of these abstracts for filing is well taken. However, we feel the value of this service would be greatly enhanced if the journal would include a section devoted to the publication of abstracts of articles appearing in that issue.
REPRODUCTIVE AND ENVIRONMENTAL CASUALTIES: A REPORT ON THE 10-YEAR FOLLOW-UP OF THE CHILDREN OF THE KAUAI PREGNANCY STUDY
Authors: Werner Emmy , Bierman J. M. , French Fern E. , Simonian Kenneth , Connor Angie , Smith Ruth S. , Campbell Myrna
Published: December 2021

The effects of perinatal complications and quality of environment were studied in a cohort of 1955 births and a selected sample of 1956 births in the Kauai Pregnancy Study. The 10-year follow-up of the 866 children utilized records, teachers' ratings, and group tests as screening devices and diagnostic examinations by psychologists, pediatricians, and allied disciplines. Independent environmental ratings of socioeconomic status, educational stimulation, and emotional support were based on home interviews. Differences found between children with and without perinatal stress centered on a small group of survivors of severe complications who had a significantly higher proportion of major physical handicaps, predominantly of the central nervous and sensory systems, a higher proportion of I.Q.'s below 85 and lower mean scores on the factors V, R, N, and P of the Primary Mental Abilities Test. No differences were found between children with and without perinatal complications in the proportion of poor grades and the incidence of language, perceptual, and emotional problems, except for those in institutions. Environmental ratings showed a significant association with intellectual, achievement, and emotional problems at age 10. Many more children were affected by unfavorable environment than by severe perinatal stress.
Letters to the Editor
Authors: Low Merritt B.
Published: December 2021

This appears to be a most timely warning and once again shows the value of an accurate history in the understanding and prevention of accidents in children. The Committee hopes that pediatricians will become more aware of this specific problem and the possible structural causes or factors, that by wise education of the engineers we can build out such hazards and be more conscious of the opportunities of building in safety. We believe that the more voluntarily this can be done the better, in all our children's vehicles and other gadgets.
SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Wedgwood Ralph J.
Published: December 2021

It has been commonly held that systemic lupus erythematosus ( S.L.E. ) in childhood is a generally progressive disease terminating fatally. Once a definite diagnosis was made, the physician and the family prepared themselves for the death of the child within, at the best, a few years. This is no longer necessarily true. The description of the "L.E." cell phenomenon, increased diagnostic awareness, and perhaps an increase in the numbers of such patients have led to the inclusion under this diagnosis of a larger and more diverse spectrum of disease than in former years. The introduction of the use of antibiotics, corticosteroids, and, more recently, antimetaholites in the treatment of the disease appears to have further modified the expression and the course of the illness as it appears in children and adults.
SYSTEMIC LUPUS ERYTHEMATOSUS IN CHILDHOOD
Authors: Meislin Aaron G. , Rothfield Naomi
Published: December 2021

Data on 42 children with systemic lupus erythematosus have been analyzed and compared with data from 200 adults with the disease. Among the children, the age of onset ranged from 3 to 15 years of age, with a peak for girls during adolescence. The age of onset among male patients, both adult and children, was constant for all decades and there was no cluster at any particular age.

The disease in children was similar to that in adults except for a higher incidence of hepatosplenomegaly and lymphadenopathy among the children. Renal disease occurred with similar frequency in the two groups. It was generally unusual for additional system involvement to occur following diagnosis, although some patients who had no renal disease at the time of diagnosis did develop renal disease subsequently. Combined antimalarial and moderately high dose steroid therapy was employed. Renal involvement at the time of diagnosis reduced survival among both the adults and the children. The prognosis in childhood was decidedly worse than in adults. Models of survival were developed based upon crude mortality rates. Similar survival models may serve to study prognosis of other diseases and other management of lupus.
SERUM IMMUNOGLOBULINS. II. LEVELS IN CHILDREN SUBJECT TO RECURRENT INFECTION
Authors: Buckley Rebecca H. , Dees Susan C. , O'Fallon W. M.
Published: December 2021

In serum immunoglobulin analyses of 600 children reported to be subject to frequent respiratory or cutaneous infection, 263 (44%) demonstrated concentrations of one or more immunoglobulins which were outside the normal bounds for age. In contrast, similar analyses in 181 normal subjects of comparable ages revealed only 14 sera (7.7%) which had immunoglobulin concentrations outside normal bounds (normal bounds = antilogs of the mean logs of the normal subject data at each of 18 ages ± two pooled standard deviations of the logs). A chi square test comparing the number of sera in each group with values outside the normal bounds revealed a highly signicant difference (p < 0.0001) between the two groups. The abnormalities observed fell into 11 different categories of multiple or single immunoglobulin alterations. No particular type or focus of infection distinguished any one category from another. Infections were somewhat more severe in subjects with multiple immunoglobulin deficiencies. Clinical allergy was observed frequently in 9 of the 11 categories. These studies strongly suggest that immunoglobulin abnormalities are more common than published reports indicate. The detection of such abnormalities is not an indication for arbitrary gamma-globulin therapy but for further immunologic evaluation.
THE EXOCRINE PANCREAS AND PROTEIN-CALORIE MALNUTRITION
Authors: Barbezat G. O. , Hansen J. D. L.
Published: December 2021

Pancreatic function tests, using a dual-tube technique and stimulating the pancreas with secretin and pancreozymin, were performed on patients with kwashiorkor (before and after treatment), marasmus, and chronic malnutrition as well as on a group of control children. The volume output from the pancreas, the pH of the juice and the enzymes amylase, lipase, trypsin, chymotrypsin, and ribonuclease were studied. The color index of the juice was also measured. The results demonstrated that the volume output and the ability to raise the pH of the pancreatic juice was not affected in the malnourished children. Patients with kwashiorkor and marasmus, however, had a grossly deficient enzyme output. There was complete and early restoration of pancreatic function after the initiation of dietary therapy in kwashiorkor and marasmus. The older chronically malnourished patients demonstrated a range of results varying from normal to abnormal. A significant positive correlation was demonstrated between enzyme output and the serum albumin concentration. There was no quantitative deficit in the output of bile among children with protein-calorie malnutrition.
METABOLIC ASPECTS OF DEEP SURGICAL HYPOTHERMIA IN INFANCY
Authors: Baum David , Dillard David H. , Mohri Hitoshi , Crawford Edward W.
Published: December 2021

Aspects of carbohydrate and lipid metabolism were examined in 10 infants whose core temperatures were lowered by external cooling to 15 to 20°C during cardiovascular surgery.

Modest hyperglycemia, found with ether anesthesia, persisted in three patients not given glucose, but it was markedly increased in others given glucose infusions. Despite continued glucose infusion, plasma glucose returned toward prehypothermic levels with rewarming, provided epinephrine was not administered. When epinephrine was given, the return was slowed. These observations suggest diminished glucose utilization during hypothermia and arouse speculation concerning a related insulin abnormality.

In general, plasma lactate and glycerol levels increased during hypothermia, reaching a peak after circulatory arrest and with rewarming. Plasma free fatty acid concentrations changed little until rewarming when they usually became depressed. Death occurred in all five infants in whom plasma glycerol and lactate levels were rising at the procedure's end, while plasma glycerol and lactate concentrations were falling on completion of the operation in patients who did well. These findings and the known importance of the liver in lactate and glycerol metabolism suggest that the course of plasma lactate and glycerol levels may prove useful as a reflection of hepatic dysfunction in patients undergoing hypothermic surgery.
CHRONIC MUCOCUTANEOUS CANDIDIASIS—ASSOCIATED IMMUNOLOGIC ABNORMALITIES
Authors: Landau Joseph W.
Published: December 2021

Candidiasis (moniliasis, candidosis) includes a group of fungous diseases varying in severity from commonly encountered local superficial involvement of the oral mucosa to fulminating systemic infections rapidly terminating in death.1 The etiologic agent is Candida albicans or occasionally another species of candida. These fungi are frequently found as saprophytes in the oral cavity, gastrointestinal tract, and vaginal area. Some local or systemic impairment of host defense mechanisms usually appears to be an essential predisposing factor for the development of candidiasis.

The term chronic mucocutaneous candidiasis refers to a heterogeneous group of fungous diseases characterized by persistent or recurrent candida infection of mucous membranes, nails, and skin.1-3 Involvement of internal organs seldom, if ever, occurs.
STUDIES ON INFANT DIARRHEA. III. CHANGES IN COMPOSITION OF SALINE AND GLUCOSE-SALINE SOLUTIONS INSTILLED INTO THE COLON
Authors: Torres-Pinedo R. , Conde E. , Robillard G. , Maldonado M.
Published: December 2021

Saline and glucose-saline solutions were instilled into the distal colons of infants with acute infectious diarrhea. Samples of the fluid were obtained at hourly intervals. Clear-cut differences in compositional changes were observed with the saline and glucose-saline solutions. The net effects induced by glucose were: (1) generation of organic acids and subsequent formation of poorly absorbable organic acid salts, and (2) osmotic inflow of water. The overall process led to a net gain of hydrogen ion by the body fluids, decrease in sodium absorption, augmented potassium loss, and net increase in volume of the colonic fluid.
FAMILIAL ABSENCE OF MIDDLE PHALANGES WITH NAIL DYSPLASIA: A NEW SYNDROME
Authors: Bass Harold N.
Published: December 2021

A family in which four generations have had a unique and heretofore undescribed form of brachymesodactyly and nail dysplasia is reported. The disorder is characterized by brachydactyly, hypoplastic finger and second toe nails, absent middle phalanges in the fingers and lateral four toes, duplicated distal phalanges of the thumbs, and possible hypoplasia of the auricular cartilage. It is transmitted by an autosomal dominant pattern.
SLEEP PATTERNS IN PRE-ADOLESCENT CHILDREN: AN EEG-EOG STUDY
Authors: Ross John J. , Agnew Harman W. , Williams Robert L. , Webb Wilse B.
Published: December 2021

The typical all-night sleep pattern of the pre-adolescent male was determined by analyzing the simultaneous EEG-EOG tracings of 18 healthy schoolboys (range 8 to 11 years). The sleep patterns of these boys resembled that of older subjects by the occurrence of a more or less orderly sequence of sleep stages which spontaneously shifted from one stage to another. Stability of the pattern for a given boy was observed in the consistent amount of time spent in each sleep stage and in the number of sleep stage changes night after night.

When compared with the adult sleep patterns, pre-adolescent total sleep time was 2½ hours longer with unequal distribution of the added time to each of the sleep stages. Sleep stages in children are longer in duration than in adults, and the sleep patterns are as stable as that of the adult.
Clinical Comparison of Pharmacologic Emetics in Children
Authors: Corby Donald C. , Decker Walter J. , Moran Martin J. , Payne Carl E.
Published: December 2021

A simple method has been developed for the determination of the efficacy of pharmacologic emetic agents in children based on measuring the efficiency of stomach content return. The following conclusions can be reached from the study: (a) apomorphine can be safely administered by paramedical personnel, (b) it is not associated with significant CNS depression or protracted vomiting as has previously been feared, (c) it is faster acting than syrup of ipecac, and (d) it is equally effective in removing test material from the stomach as syrup of ipecac. However, it is apparent from this investigation that neither agent is truly effective or predictable in removing stomach contents, hence a search should be made for a more efficacious means of treating acute ingestions. Until more effective methods are found, it is recommended that syrup of ipecac be used as a first-aid measure in the home, and apomorphine be used in the emergency room.
U. S. Mortality from Letterer-Siwe Disease, 1960-1964
Authors: Glass Andrew G. , Miller Robert W.
Published: December 2021

Study of mortality in the United States from Letterer-Siwe Disease revealed a striking concentration of deaths in the first 2 years of life and aggregation in five sets of siblings, including one pair of twins. These findings indicate that Letterer-Siwe disease (in common with certain childhood neoplasms) has prenatal origins.
Guide for the Care of Infants in Groups, by Sally Provence, M.D. New York: Child Welfare League of America, Inc., 1967, 104 pp., soft cover, $2.50
Authors: Sherry S. Norman
Published: December 2021

To write yet another guide for the care of infants today is a bold undertaking. This guide specifically concerns the care of infants who live in institutions or groups. It has been established that children deprived of a close maternal relationship, especially in the first year of life, have difficulty forming close, lasting relationships with others. If a child spends his first year of life in a group setting, his development quotient may be considerably lower than his family-bred peer.
RULES OF EVIDENCE APPLIED TO TREATMENTS OF NEONATAL HYPOXEMIA AND ACIDOSIS
Authors: Prod'hom L. S.
Published: December 2021

BIOCHEMICAL MONITORING of the low birth weight infant during the first 24 hours of life frequently reveals abnormalities of acid-base balance and hypoxemia; these anomalies are very striking in infants with clinical signs of respiratory distress. The clinician is then faced with two problems: the first in diagnosis, the second in treatment.

In the past few years certain regimes for respiratory distress have been recommended with varying degrees of fact and forcefulness. These include the careful maintenance of thermal balance to keep oxygen consumption at a minimum, correction of acidosis by NaHCO3 or THAM in rapid or slow infusion, adequate oxygenation sometimes requiring an inspired O2 concentration above 40%, assisted ventilation (either through a tracheal tube or by a negative pressure tank), and, finally, administration of agents acting on vasomotor tone.
MORBIDITY OF LOW BIRTH WEIGHT AND/OR PRETERM CHILDREN COMPARED TO THAT OF THE "MATURE"
Authors: van den Berg Bea J.
Published: December 2021

Medically attended illnesses were investigated in 357 children, representing 100% of all the low birth weight children in a cohort of some 10,000 white, single, liveborn infants; in a random sample of 180 children who weighed more than 2,500 gm at birth after a gestation period of less than 37 weeks; and in a random sample of equal size of children who weighed more than 2,500 gm at birth after a gestation period of more than 37 weeks. The low birth weight and the preterm children did not suffer higher acute disease rates between discharge from the hospital after their birth and their second birthday than did the "mature" children.
Electron Microscopy of Cutaneous Capillaries of Newborn Infants: Effects of Placental Transfusion
Authors: Pietra Giuseppe G. , D'Amodio Mabel D. , Leventhal Monika M. , Oh William , Braudo J. Leonard
Published: December 2021

Two hundred and ten capillaries taken by punch biopsy at 2 to 5 hours of age from term, normal, newborn infants were examined by electron microscopy. Six infants had early cord clamping and five had late cord ligation. In the late-clamped group, the capillaries were more distended morphologically as shown by a smaller endothelial index (endothelial area/total capillary area). In comparison to the early-clamped group, the late-clamped infants also had a larger number of fenestrated small blood vessels. Since fenestration is an anatomical structure related to rapid fluid exchange, it is suggested that this finding is an indication of a more active fluid transudation from the intravascular to the extravascular compartment in the late-clamped infants in response to a greater circulatory volume deriving from placental blood transfusion at birth. It is also suggested that the large number of fenestrated vessels in the late-clamped infants is a result of an increased number of openings of arteriovenous communications.
Follow-up of Infectious Lymphocytosis Cases
Authors: Oleinick Arthur , Glass Andrew G.
Published: December 2021

We were interested in the editorial of Clement1 which accompanied the recent article of Putnam, Moore, and Mitchell2 concerning the 19-year follow-up of patients in an epidemic of infectious lymphocytosis in 1947. Although no instance of leukemia or lymphoma was detected, the size of the study sample seemed to us too small to assess properly the risk of malignancy in these patients. To evaluate the adequacy of the sample size, we computed the expected number of cases of leukemia and lymphoma using the person years at risk of the individual cases and the 1964 U.S. mortality rates for leukemia and lymphoma.
Non-immunologic Hydrops Fetalis Associated with a Large Hemangioendothelioma
Authors: Daniel Sara Jo , Cassady George
Published: December 2021

Non-immunologic hydrops fetalis has been reported in association with such conditions as maternal diabetes mellitus, fetal infection, multiple fetal malformations (particularly cardiac), congenital nephrosis, homozygous alpha-thalassemia, prenatal closure of the foramen ovale, sublethal umbilical or chorionic vein thrombosis, and parabiotic syndrome.1-3 To our knowledge, the following case represents the first reported instance of fetal and placental hydrops associated with a tumor which acts as a fetal arteriovenous malformation.

A female infant was delivered to a 38-yearold Japanese woman at a calculated gestational age of 32 weeks. One previous pregnancy with the same Caucasian father had resulted in a living, normal child.
THE PRESIDENT'S MESSAGE: ACADEMY STUDY OF THE DELIVERY OF HEALTH CARE TO CHILDREN
Authors: Logan George B.
Published: December 2021

The delivery of health care has become one of the most talked about subjects in medical circles in recent years. Governmental agencies, labor groups, insurance companies, and consumer groups also have become concerned about it. The Brookings Institution began a short series of public policy conferences for physicians in the fall of 1967, their first venture into the field of health. The delivery of care has been discussed from many standpoints in all of them.

Within the Academy we have become increasingly aware of the shortcomings of our present "system" of medical practice as it relates to children. It is not that the system is altogether bad. It seems that primarily there are too few pediatricians and family physicians and the ones available are not well distributed. Certain aspects of the investigation of the problems of practice have been and are being studied by the Council on Pediatric Practice, which has been in existence since 1964. The urgency and necessity of doing even more was pointed out in the Spring of 1967 by the report of an ad hoc committee of the Executive Board, the chairman of which was Dr. John MacQueen. This then led to the appointment of an ad hoc committee of the Academy to study means of approaching this complex problem. This committee recommended a detailed investigation which would require the services of a chairman who was experienced and who could devote at least one half of his time to it. Dr. Carl Fischer of Philadelphia was selected for this position.
HEALTH SERVICES FOR CHILDREN IN SOME WESTERN EUROPEAN COUNTRIES: THEIR SIGNIFICANCE FOR THE UNITED STATES
Authors: Miller Herbert C.
Published: December 2021

A personal survey was made during the fall of 1967 of child health services in selected western European countries. Particular attention was given to the different roles of government and private practice in the delivery of health services to children, the amount and kinds of preventive health services provided in public health clinics and school health services, availability of health personnel, and the training of physicians and nurses involved in health services for children. There appears to be widespread acceptance of the point of view that good health is a right of all children. Implementation of this point of view has gone forward in all countries while maintaining the concept of private practice and free choice of physician.
GAPS IN DOCTOR-PATIENT COMMUNICATION
Authors: Korsch Barbara M. , Gozzi Ethel K. , Francis Vida
Published: December 2021

Eight hundred patient visits to the walkin clinic of the Childrens Hospital of Los Angeles were studied by means of tape recording the doctor-patient interaction and by follow-up interview. Seventy-six percent of the patient visits resulted in satisfaction on the part of the patient's mother; in 24% there was dissatisfaction. A number of communication barriers between pediatrician and patient's mother were found to contribute significantly to patient dissatisfaction: notably lack of warmth and friendliness on the part of the doctor, failure to take into account the patient's concerns and expectations from the medical visit, lack of clearcut explanation concerning diagnosis and causation of illness, and use of medical jargon.
How to Test Patency of Nasal Choanae
Authors: Abel James R.
Published: December 2021

I continue to be amazed by the elaborate means by which physicians attempt to ascertain the patency of a newborn's choanae (Pediatrics, 41:147, 1968, and Pediatrics, 42:216, 1968). I would like to inform others of my method, as it is very simple and painless.1 Besides, it requires no accessory equipment. Simply occlude the child's mouth by holding it shut, then obstruct a naris with the examiner's thumb. The examiner can hear or feel air passing out of the unobstructed naris, and, if he does, that naris has to be patent.
Letters to the Editor
Authors: Mortimer Edward A.
Published: December 2021

Dr. Mortimer answers Dr. Greenblatt as follows:

You are probably aware that the Public Health Service Advisory Committee On Immunization Practices has recommended that influenza vaccine be given intradermally under only one circumstance, as a booster dose to older individuals who have previously experienced undue reactions to influenza vaccine.

You are correct in saying that there is not a satisfactory study of intradermal influenza vaccination in childhood. This is in part because such a study is extremely difficult to set up.
Our Jimmy, by Ruth K. Doorly and illustrated by Kenneth Boudreau. Westwood, Massachusetts: Service Associates (Box 224, Westwood, Massachusetts 02090), 1967, 24 pp., $3.95
Authors: Winter William D.
Published: December 2021

To educate parents to accept the possibility that one of their children may be mentally retarded and then to counsel and guide them through all the family and personal difficulties of adjusting their lives to this possibility is a difficult and protracted procedure. The acquisition of similar understanding by the retarded child's normal siblings, or by the neighborhood children, can be an even more complex process. As a partial answer to this problem, Mrs. Ruth K. Doorly has written the text and Kenneth Boudreau, a 15-year-old former pupil of Mrs. Doorly's, has illustrated Our Jimmy.
Letters to the Editor
Authors: Gleason Charles H.
Published: December 2021

I was absolutely astounded by the views of Drs. Carey and Sibinga (Pediatrics, 42:106, 1968) regarding the social relationship between the pediatrician and the parents of his patients. It would seem that if a physician does not have sufficient control over his emotions to allow him to mingle socially with his patients or their parents, or if he does not have the strength to do what he knows should be done regardless of his relationship with the patient's parents, then he needs help.
Excellent Suggestion for Transfer of Medical Information
Authors: Wessel Morris A.
Published: December 2021

Pediatricians frequently receive requests from preparatory schools or colleges for medical information concerning a patient who has been under care for many years. Many physicians are rightfully hesitant to send information of any consequence because the doctor's primary obligation is to maintain the confidentiality of the doctor-patient relationship. There is another important fact to consider when the medical report form is given to a physician with an envelope, addressed to the registrar or to the admissions office.
A MULTIPLE-PURPOSE CRIB FOR NEONATAL INTENSIVE CARE
Authors: Cooke Roy , Larsson Harry , Olsson Torsten , Victorin Lars , Karlberg Petter
Published: December 2021

Recent advances in neonatal intensive care have introduced many practical difficulties. A multiple-purpose crib and incubator combination is described which facilitates the introduction (with fluoroscopy) and aftercare of umbilical catheters. A method for fixation of respirator tubing during intermittent positive pressure ventilation to allow regular postural drainage and to avoid accidental extubation of the endotracheal tube has been developed. Radiography, in three planes, is possible with less risk to the infant and surrounding equipment. Intensive care equipment can be incorporated into this incubator-crib combination with the maintenance of good observation and an unobstructed access to the infant.
PENICILLIN RESISTANT ALPHA STREPTOCOCCI IN PHARYNX OF PATIENTS GIVEN ORAL PENICILLIN
Authors: Sprunt Katherine , Redman Winifred , Leidy Grace
Published: December 2021

Patients who have received oral penicillin may carry in the oropharynx alpha hemolytic streptococci, of which varying proportions are resistant to one or more units of penicillin per milliliter. Since the use of oral penicillin is increasing and penicillin is the drug of choice for prevention of endocarditis before oral or pharyngeal trauma, semiquantitative methods have been used to document (1) the frequency of α-streptococci resistant to 1 or more units of penicillin per milliliter in patients receiving prophylactic penicillin orally and intramuscularly, (2) the frequency and rate with which significant numbers of α-streptococci appear after exposure to oral penicillin, (3) the proportion and degree of resistance of α-streptococci which emerge resistant, and (4) the rate at which the numbers of resistant organisms are reduced to a presumably insignificant level when penicillin is withdrawn. The results show that there is a statistically significant increase (P <.001) in the proportion of α-streptococci resistant to at least 1 U per milliliter of penicillin in the pharynx of patients receiving their prophylactic penicillin in oral form (75%) in comparison with those on intramuscular penicillin prophylaxis (15%). Similarly, 17 of 22 patients on oral penicillin therapy developed flora containing resistant streptococci. Six such patients carried α-streptococcal populations, 7 to 50% of which were resistant to 1 but not 5 U. Eleven carried streptococci, 1 to 100% of which were resistant to 5 or more units per milliliter. Of 12 patients followed closely, 8 developed resistant streptococci within the first week of therapy, one after 2 days.

Resistant streptococci decreased rapidly when therapy was discontinued. Eleven of 12 patients showed less than 20% of their streptococcal population resistant to 1 unit at 15 days and less than 10% at 30 days. Low levels (< 10%) persisted in six patients followed for intervals longer than 30 days and up to 144 days.
SMALLPOX VACCINATION: BEFORE OR AFTER ONE YEAR OF AGE?
Authors: Neff John M. , Lane J. Michael
Published: December 2021

Data have been reported recently indicating that complications following smallpox vaccination occur more frequently in children less than 1 year old than in any other age group. A review of illnesses attributed to smallpox vaccination in England and Wales from 1951 to 1960 demonstrated that dermal complications, particularly generalized vaccinia, occurred two to three times as frequently in children vaccinated before the first birthday as in any other childhood age group.1,2 A review of smallpox vaccination complications in the United States in 1963 yielded similar results.3,4 As a result, the American Academy of Pediatrics Committee on the Control of Infectious Diseases and the Public Health Service Advisory Committee on Immunization Practices have recommended that primary smallpox vaccination be deferred until after the first birthday.5,6 Despite this, many physicians have expressed reluctance to adopt this recommendation as was most evident by the general comments made at the recent panel on immunization at the meetings of the American Academy of Pediatrics in October 1967 and by letter to members of the Smallpox Eradication Program at the National Communicable Disease Center. The purpose of this paper is to review briefly the arguments for and against routine smallpox vaccination in children under 1 year of age.

The principal objections to deferring vaccination until after the first birthday are as follows:

1. If vaccination is not routinely practiced during the first several well-baby clinic visits, many children, particularly those from clinics in the large cities. might not return for subsequent clinic visits and therefore might not have the benefit of a smallpox vaccination.
Glucose-galactose Malabsorption Complicated by Monilial Arthritis
Authors: Pruitt Albert W. , Achord James L. , Fales Frank W. , Patterson Joseph H.
Published: December 2021

An infant is reported with malabsorption of actively transported monosaccharides; she presented with profound diarrhea and severe dehydration. Her course was complicated by the development of monilial arthritis. The failure to absorb glucose was demonstrated over a 24-month follow-up period. A glucose-galactose free, fructose diet appeared to be lifesaving. The monilial arthritis responded to intra-articular doses of amphotericin B and unusually low doses of intravenous therapy.
Chronic Hemodialysis of a 2-year-old Child
Authors: Williams Arthur V. , Hargest Thomas S. , Wohltmann Hulda J.
Published: December 2021

A 2-year-old, totally anunic child was hemodialyzed for 3 months with a SCIRT pump and coil kidney utilizing a low flow system. No complications occurred. All clinical and chemical monitoring remained within satisfactory limits. Edema was controlled with two penitoneal dialyses during this time period. It is believed that this represents the longest reported hemodialysis, utilizing a Scribner shunt, in a child of this age.
Reactions to Booster Doses of Tetanus Vaccines, Continued
Authors: Arena Jay M.
Published: December 2021

Dr. Ricardo Perez-Martin's inquiry regarding tetanus toxoid booster (Pediatrics, 42:711, 1968) is a timely one. The use of 0.1 ml of tetanus fluid toxoid (not alum precipitated) intradermally, instead of 0.5 ml intramuscularly, will give more than adequate booster response, with no or little local and systemic reactions. In addition, the allergic phenomena may be minimized.
Sudden Death in Infancy, by Preben Geertinger, M.D. Springfield, Illinois: Charles C Thomas, 1968, 107 pp., $6.75
Authors: Valdes-Dapena Marie
Published: December 2021

According to the foreword, Dr. Geertinger intends that this work survey the entire subject of sudden, unexpected death in infancy. Instead, it is an extended apology for his own hypothetical explanation of the mechanism responsible for deaths of this type. His theory is that sudden death occurs because of either total absence or faulty development of the parathyroids due to some deleterious effect on their embryogenesis in the fourth to sixth week of fetal life.