bluuebunny/crossref_metadata_2025 huggingface dataset:
THE EFFECT OF IMMATURITY AND PRENATAL ASPHYXIA ON THE LUNGS AND PULMONARY FUNCTION OF NEWBORN LAMBS: THE EXPERIMENTAL PRODUCTION OF RESPIRATORY DISTRESS
Authors: Reynolds E. O. R. , Jacobson H. N. , Motoyama E. K. , Kikkawa, Y. , Craig J. M. , Orzalesi M. M. , Cook C. D.
Published: December 2021

1. The effect of immaturity on the lungs and pulmonary function of newborn lambs was assessed by delivering and observing 13 animals of varying gestational ages. In lambs of approximately 125-129 days gestation changes closely resembling those of human respiratory distress syndrome developed without asphyxia. These changes consisted of retraction of the chest wall, poor gas exchange, grossly liver-like lungs, reduced pulmonary surface activity, and, on histological examination, severe atelectasis, alveolar necrosis, and hyaline membranes.

2. Similar changes were found in 4 of 6 lambs subjected to severe prenatal asphyxia lasting for up to 4 hours which were between approximately 130-136 days gestation but not in three of four comparable control animals.

3. Prolonged prenatal asphyxia was followed by changes suggesting respiratory distress in only 1 of 6 lambs above 136 days gestation. One further lamb at 140 days gestation, acutely asphyxiated to the point of cardiac arrest, developed severe changes.

4. It is postulated that the experimental disease and the syndrome seen in the human infant are produced by similar mechanisms, and that the influence of prematurity is more important than that of asphyxia.
IDIOPATHIC EDEMA AND HYPERALDOSTERONURIA: POSTURAL VENOUS PLASMA POOLING
Authors: Fisher Delbert A. , Morris Manford D.
Published: December 2021

A female adolescent with onset of the syndrome of "idiopathic edema and secondary hyperaldosteronuria" is reported. Investigations conducted over a 28-month period documented hyperaldosteronuria and an increased aldosterone response to salt restriction. The usual diurnal variation of salt and water excretion was observed. Recumbent posture, spirolactone or sympathomimetric drugs were observed to produce salt and water diuresis.

Recumbent renal function tests were normal; erect posture, however, produced a marked decrease in sodium excretion and in PAH and creatinine clearance. Immediately exchangeable plasma volume (30 min I131 albumin space) increased 38% between 8:00 A.M. and 6:00 P.M. during erect posture. An "arterial anemia" pattern of vascular response to erect posture was observed in tilt table studies; diastolic pressure increased normally but pulse rate increase was excessive. Blood pressure response to infusion of exogenous angiotensin II was normal; that to norepinephrine infusion seemed abnormal and was associated with a rather marked decrease in pulse rate and increase in pulse pressure suggesting mobilization of "sequestered" blood volume. Four-hour recumbent excretion of catecholamines and the 4-hour excretion response of norepinephrine to erect posture seemed normal. Partial elimination of the edema occurred with chronic sympathomimetic drug therapy.

It is concluded that this unusual syndrome probably occurs secondary to a defect in peripheral venous structure or autonomic vasomotor innervation leading to excessive blood volume pooling in the lower body, excessive reduction in renal blood flow and glomerular filtration rate, and hyperaldosteronuria. Consequent retention of salt and water with increase in plasma volume and dependent edema ensues. Sympathomimetic drug therapy may enhance peripheral venous tone and produce clinical improvement.
DIAGNOSIS AND TREATMENT: ACUTE RENAL FAILURE
Authors: Holliday Malcolm A.
Published: December 2021

ACUTE RENAL FAILURE is an uncommon emergency which faces pediatricians. It is usually easy to recognize. The management in the early phase is critical to the survival potential of the patient. The purpose of this review is to cite the causes, characteristics, and principally the management of acute renal failure.

Renal failure is defined as a state in which there is not sufficient kidney function to prevent the development of severe uremia or to maintain plasma electrolyte values in a range compatible with ordinary activities. Clinically the condition is associated with mental confusion, stupor, and frequently convulsions. Persistent hiccoughs, irregular respirations, and muscle cramps also may occur. Usually though not always, there is obvious oliguria. Since urine flow is ordinarily but 0.2-2,0% of glomerular filtration rate, and since glomerular filtration rate reduction to 5-10% may be associated with uremia, it is possible to have renal failure without oliguria. It is also possible to have physiological oliguria (< 300 ml per square meter) in response to rigid water restriction that is not related to renal failure. Hence, the term must be defined in terms of its effect on plasma composition rather than in terms of urine flow.

The presence of certain clinical conditions known to result in acute renal failure should alert the physician. These include: nephrotoxie agents; hemoglobinuria or myoglobinuria; shock with anoxic damage; acute, diffuse renal disease; acute dehydration in patients with chronic advanced renal disease; and acute obstructive uropathy. Nephrotoxic agents, hemoglobinuria, and shock all result in acute tubular necrosis, and recovery depends upon the capacity of the nephron to regenerate on an intact basement membrane.
Massive Gastrointestinal Hemorrhage in the Newborn Infant
Authors: STANLEY-BROWN EDWARD G. , STEVENSON STUART S.
Published: December 2021

During the nine-year period from 1955 to 1964 we have cared for eight newly born infants with massive gastrointestinal hemorrhage. No patient died, none was operated upon, and all eight required blood replacement by transfusion. In each case there was hematemesis as well as tarry stools with the onset of bleeding as early as 24 hours of age to as late as 5 days. Each patient received Vitamin K medication and none had hematuria, purpura, or any evidence of bleeding from sites other than the gastrointestinal tract.

Brayton suggests that peptic ulceration of the duodenum or stomach is probably the actual cause of many gastrointestinal hemorrhages which have heretofore been classified as idiopathic.
Human Milk and Breast-Feeding
Authors: HUDSON BARBARA W.
Published: December 2021

It was refreshing and reassuring to read an article on human milk and breast-feeding (Pediatrics, 34:837, 1964), after thumbing through eleven advertisements for artificial feeding in the same issue.

The joy of breast-feeding is fast becoming a lost art in our modern culture. Breast-feeding is a natural and unique system of supply and demand which best serves mother and baby. Breast-feeding has not become complicated, only our attitudes toward it have created problems.
Familial Juvenile Nephronophthisis
Authors: CASSADY GEORGE
Published: December 2021

The recent article entitled "Familial Juvenile Nephronophthisis" by Mangos, et al. (Pediatrics, 34:337, 1964) is marred by a single unsubstantiated statement in the opening paragraph: "Recognition and study of this disease (hereditary nephritis and deafness) had led to the demonstration of a biochemical defect in affected individuals." The carefully worded and informative work of Schafer, et al. (New Engl. J. Med., 267:51, 1962) neither supports nor openly suggests a cause and effect relationship between defective amino acid metabolism and the syndrome of hereditary renal dysfunction and deafness.
Letters to the Editor
Authors: MANGOS JOHN A.
Published: December 2021

In regard to the "Letter to the Editor" by Dr. George Cassady, we feel that he has misinterpreted the opening paragraph of our article "Familial Juvenile Nephronophthisis" (Pediatrics, 34:337, 1964). We did not suggest that the excellent work of Shafer, Scriver, and Efron supported a cause and effect relationship between the described biochemical defect and the syndrome of hereditary nephritis and deafness. Our statement "recognition and study of this disease has led to the demonstration of a biochemical defect" simply intends to emphasize the importance of recognition of specific clinical syndromes which lead to the study of more cases and frequently to the discovery of important biochemical or other abnormalities in affected individuals.
PROSPECTS IN PRENATAL PHYSIOLOGY, DIAGNOSIS, AND TREATMENT
Authors: DAWES G. S.
Published: December 2021

A GROUP of papers in this issue summarize new and very interesting advances in the treatment of erythroblastosis fetalis and in our understanding of the pathophysiological processes which lead to death from this condition. They also mark a new technical feat; for the first time it has been possible to treat, and to treat successfully, the human infant in utero for a hitherto fatal condition. It is interesting to follow the processes by which these advances in knowledge have developed, and to survey the wealth of new information on many different problems which has accrued.

Diagnosis precedes treatment, and the first need was to obtain a better forecast of the rate of development of the disease in Rh-isoimmunized pregnancies than the maternal antibody titer.
SYMPTOMATIC HYPOGLYCEMIA, VISCERAL FATTY METAMORPHOSIS, AND AGLYCOGENOSIS IN AN INFANT LACKING GLYCOGEN SYNTHETASE AND PHOSPHORYLASE
Authors: Parr Justin , Teree Thomas M. , Larner Joseph
Published: December 2021

An infant 4 months of age had severe hypoglycemia, acidosis, and hepatomegaly. She died with what was thought to be a glycogen storage disease. Glycogen was absent from liver, skeletal muscle, kidneys, and adrenal glands. Enzymatic assays of liver and muscle revealed a marked deficiency of glycogen synthetase and phosphorylase. Marked fatty metamorphosis was present in liver and kidneys. The clinical, pathological, and biochemical findings are correlated.

Three siblings died in early infancy. All presented with apnea, coma, and central nervous system signs. Two were examined postmortem, and fatty metamorphosis of liver was a common finding.

Correlations between the three siblings and the infant 4 months of age are suggested.
THE PROGNOSTIC VALUE OF THE ELECTROENCEPHALOGRAM IN NEONATAL CONVULSIONS
Authors: Tibbles J. A. R. , Prichard J. S.
Published: December 2021

The initial E.E.G.'s of 135 neonates with convulsions or suspected convulsions of multiple causes have been reviewed without knowledge of their clinical outcome. Seventy per cent of those with normal E.E.G.'s have developed normally. Sixty-four per cent of those with an abnormal E.E.G. subsequently either died or had significant neurological sequelae. In a number of cases it was not possible to place the E.E.G. in the normal or abnormal category and the reasons for this are discussed.
LAPAROTOMY FOR RECTAL BLEEDING
Authors: Shandling Barry
Published: December 2021

THE PROBLEM of the infant or child with rectal bleeding is familiar to all clinicians. The term "rectal bleeding" has through common usage come to mean the passage of blood from the rectum–whether it be bright red or dark, unrelated to, on the surface of, or mixed with the stool. Anal or gastrointestinal bleeding would be a more accurate term, but for the purposes of this paper rectal bleeding will be used in its widest connotation. This study was undertaken to attempt to evaluate the place of surgery in the investigation and treatment of this perplexing condition.

The literature is surprisingly barren of any series of this kind. Several authors of textbooks on pediatric surgery do not even mention the possibility of a fruitless abdominal exploration. Others appear to hazard a guess. However, Nixon and O'Donnell state that probably one-third of patients with rectal bleeding never have the cause diagnosed. White and Dennison give 20% as a likely figure. Gross, in a small review of 65 patients presenting with rectal bleeding as a diagnostic problem, could find no cause for the bleeding in 18, i.e., 27%. Of the 18 patients who were operated upon, only 4 had negative laparotomies. Nevertheless, he states that in an astounding proportion of cases the cause for the rectal bleeding is never found, even after extensive investigation and laparotomy.

Macbeth in a recent paper refers to the difficulties in gathering a series of cases with available methods of coding. Fortunately, at The Hospital for Sick Children, Toronto, case notes are coded in such a way that the histories of patients with rectal bleeding are readily available.
Hemophilus Influenzae Meningitis in a Premature Infant
Authors: MATHIES ALLEN W. , HODGMAN JOAN , IVLER DANIEL
Published: December 2021

A case of fatal Hemophilus influenzae meningitis in a 3-day-old premature male is reported. The infection probably occurred at this age because of a lack of passively acquired maternal antibody.
GENETIC ORIGIN OF SOME SEX DIFFERENCES AMONG HUMAN BEINGS
Authors: Childs Barton
Published: December 2021

Sexual reproduction helps to ensure the survival of species by providing opportunities for new combinations of chromosomes in individuals. Organisms have evolved means to accomplish this end by establishing special sex-determining chromosomes which must contain the genes which decide the reproductive attributes of the individual. This decision sets in motion a train of events determining many characteristics related to and stemming from the reproductive sex of the individual which, taken in the aggregate, formulate much of his or her role in life as a male or female. Differences between the sexes are thus created which sometimes appear to be unrelated to reproductive functions, but which are traceable ultimately to them, and some of these differences might represent a hazard to one or other sex, due either to biological or cultural inequalities.

Though there are occasional errors and imperfections of sex determination, the mechanism is on the whole a good one and even unsophisticated people are seldom unsure or imprecise in the diagnosis of sex among human beings. But establishment of the sex chromosomes in the forms they have taken in various organisms has resulted in certain consequences which, though they might be beneficial in some instances, certainly contribute to inequalities between the two sexes in ways not necessarily related to the reproductive aspects of sex. The disparity in size between the X and Y chromosomes, for example, means that the homogametic sex (female) is diploid with regard to many loci, while the heterogametic sex (males) must be always haploid. If these chromosomes contain genes which control functions apart from aspects of reproductive sex, even though these be compensated, the genes will be making contributions to aspects of maleness and femaleness which are not accommodated in the usual, practical definition of sex.
Response and Responsibility
Authors: GANELIN ROBERT S.
Published: December 2021

I find the letter of Dr. Stowens which was published in the February issue of Pediatrics (35:355) an extremely disturbing one; not because of its defense of original thinking which is being followed by appropriate, controlled observations, but for its petulant rebuke of an honest request for objective information.

It is true that the inquiring physician will make observations regarding poorly understood illnesses and develop therapeutic approaches therefrom. The person who stops at this point, however, deludes himself regarding his objectivity and becomes a menace to his patients.
1964-1965 Year Book of Pediatrics
Authors: CONE THOMAS E.
Published: December 2021

The 1964-1965 Year Book of Pediatrics is one of the few annual publications most of us anxiously look forward to with ardent hopes of fulfilling our never ending desire to keep abreast of the increasing number and complexity of the pediatric literature. As we get farther away from our house officer days this quest becomes ever more elusive and each year the papers we read seem to acquire a more recondite tone. Somehow even skimming through the Year Book revives the feeling of once again being the resident who is one up on the attending physician.
Urethral Lesions in Infancy and Childhood
Authors: PERLMUTTER ALAN D.
Published: December 2021

Convincing arguments for the usefulness of micturition cysto-urethrography in the study of childhood urinary tract disorders are presented in this excellent monograph. Considerable effort and thought have obviously been given to analysis of data which have been derived from the examination of a large group of children. The bibliography is extensive and current.

Some aspects of the technique of performing micturition cysto-urethrography might be questioned. For example, it is possible and useful to do a residual urine determination prior to cystography, with a co-operative child, and this should be attempted routinely.
Growth Disorders in Children and Adolescents
Authors: SIEVERT ALAN J.
Published: December 2021

The practicing physician is frequently consulted because a child is not "growing normally." Sometimes the answer to this problem is simple, but frequently the practitioner is unsure of his next step after the physical examination has been completed. Should he adopt a conservative view and observe the child while he reassures the parents that he will probably catch up with his peers in the future; or, should he launch into a battery of expensive laboratory tests to determine if there is an organic explanation for the suspected growth disorder?
Pratique NéO-Nétale, L. Michon. Paris: L'Expansion Scientifique Française, 1965, 216 pp., no price given
Authors: Cone Thomas E.
Published: December 2021

This is a small pocket-sized, paperbound text tersely written in easily understandable French by a physician with a decade of daily and intimate hospital contact with the newborn infant. The author wrote the book not to compete with those already available for the specialist in neonatology but rather for the general practitioner who still is responsible for the care of most newborns even in affluent countries.

In an orderly and schematic fashion he outlines the essential items to be considered in examining the normal and in treating the ill newborn infant.
THYROXINE METABOLISM IN OBESE ADOLESCENT MALES
Authors: Hung Wellington , Gancayco Graciano P. , Heald Felix P.
Published: December 2021

The metabolism of radiothyroxine was studied in 9 obese euthyroid adolescent males, ranging in age from 12 to 16 years and at two stages of sexual maturation. The mean half-life for thyroxine in stage 3 boys was 5.22 days, while that for stage 5 boys was 5.50 days. The mean half-life for thyroxine in non-obese stage 3 boys is 5.32 days, while that for non-obese stage 5 boys is 5.82 days. Our studies fail to detect any abnormalities of thyroxine metabolism in obese adolescent males. We feel that there is no justification for the use of desiccated thyroid in the treatment of obesity in adolescents.
A NEW TYPE OF IDIOPATHIC HYPERGLYCINEMIA WITH HYPO-OXALURIA
Authors: Gerritsen Theo , Kaveggia Elizabeth , Waisman Harry A.
Published: December 2021

A 5½-year-old male is described, with severe mental retardation, failure to thrive, inability to make adequate muscular movements, seizures, and spasticity. Laboratory studies revealed hyperglycinuria and hyperglycinemia, but a much reduced excretion of oxalic acid in the urine. It seems likely that this represents an inborn enzymatic defect, probably of glycine oxidase.
QUANTITATIVE ASSAY OF DISACCHARIDASE ACTIVITIES OF SMALL INTESTINAL MUCOSAL BIOPSY SPECIMENS IN INFANCY AND CHILDHOOD
Authors: Townley R. R.W. , Khaw K. T. , Shwachman H.
Published: December 2021

The disaccharidase activities of small bowel biopsy specimens obtained from 34 infants and children with various disorders were measured quantitatively. One example of a primary disaccharidase deficiency and several of a secondary type were encountered. The advantages of quantitative measurements in the recognition of these two groups are discussed. Small bowel biopsy, even in small infants, is felt to be a safe procedure, with considerable potential for study of many other metabolic aspects of intestinal mucosal function.
PREVALENCE OF MENTAL RETARDATION IN A PEDIATRIC OUTPATIENT CLINIC POPULATION
Authors: Oppenheimer Sonya , Whitman Pearl , Rutman Hedy , Werrenrath Kirsten
Published: December 2021

For a period of 4 weeks, all children coming to the pediatric outpatient clinics at Babies and Childrens Hospital were screened for possible mental retardation. On the basis of history and clinical observation, 125 were referred to a special diagnostic team. Of these, 68 proved to have measured intelligence below 75 which gives an over-all prevalence rate for this clinic population of 9.4%. This is higher than previously reported prevalence rates indicating that this is a high-risk population. The results of this investigation contrasted with the results of other surveys in that (1) the number of severely retarded nearly approximated the number of mildly retarded (42.6 compared with 57.4%); (2) a definite medical diagnosis was established in the majority of cases 54.4%); and (3) the cases were fairly evenly distributed over the total age range with about 10% prevalence in the children under the age of 5 years. A high percentage (nearly 42%) of the school-age clinic children of normal intelligence had a history of academic failure. Mental retardation is presented as a modifiable symptom rather than a disease which must follow a predetermined course. The children identified as retarded by this survey may not be permanently handicapped but they are assumed to have special needs. The implications for pediatric management and preventive services are briefly discussed.
DIAGNOSIS AND TREATMENT: GROUP A STREPTOCOCCAL INFECTIONS
Authors: Mortimer Edward A. , Boxerbaum Bernard
Published: December 2021

In spite of adequate means of therapy, streptococcal disease and its complications continue to present problems to the physician who cares for children. For accurate diagnosis and control of streptococcal disease inexpensive bacteriologic culture facilities are required and the physician must assure himself of the accuracy of the results. To prevent the sequelae of streptococcal occal pharyngitis, therapy sufficient to eradicate the offending organism is required. Optimum therapy of streptococcal infections is intramuscular benzathine penicillin; oral therapy with penicillin or erythromycin should be followed by a throat culture to ensure that the streptococcus has been erdicated.
Septicemia Due to Group B Streptococcus: Report of Two Siblings Presenting with Lesions Resembling Erythema Nodosum
Authors: Sicherman Mark J.
Published: December 2021

Two siblings with septicemia due to betahemolytic streptococci, Lancefield Group B, are reported. Both patients had fever of unknown origin and a rash present on the extremities similar to erythema nodosum. The mode of transmission is obscure although it is likely that person-to-person spread could account for this episode.
A Child Goes to the Hospital, by Harold Geist. Springfield, Illinois : Charles C Thomas, 1965, 128 pp., $5.75
Authors: Terrell John s.
Published: December 2021

The medical aspects of a particular illness may often overshadow the need for adequate preparation and care of children before, during, and after the child's admission to the hospital. Hospitalization with the child's reaction to separation from the parents is more often than not a traumatic event, especially in the child under four, and a causative factor in disturbances of the child-parent relationship.

The author, a consulting clinical psychologist in Berkeley, California, outlines not only the effect of hospitalization on the child-parent relationship, but also the importance of the child-nurse and the nurse-parent relationship.
Congenital Heart Disease-Corrleation of Pathologic Aanatomy and Angiocaridograpy, by Jesse E. Edwards, Lewis S. Carey, Henry R. Neufeld, Richard G. Lester. Philadelphia: W. B. Saunders, 1965, Volume I, pp. 1-396, Volume II, pp. 397-890, $45.00 the set
Authors: Friedman Sidney
Published: December 2021

These two profusely illustrated volumes containing over 2,500 illustrations attempt to present in a concise and readily accessible form a correlation of the pathologic anatomy of the heart with the roentgenographic and angiocardiographic findings in patients with congenital cardiovascular anomalies. In the organization of the text, a practical classification of cardiovascular anomalies is employed which is based upon two features: one, the presence or absence of cyanosis, and second, the status of the pulmonary vasculature as observed in the plain roentgenograms of the chest.
DIAGNOSIS AND TREATMENT: INTERPRETATION OF RESULTS OF BLOOD SCREENING STUDIES FOR DETECTION OF PHENYLKETONURIA
Authors: Berry Helen K. , Sutherland Betty S. , Umbarger Barbara
Published: December 2021

THE American Academy of Pediatrics Committee on Fetus and Newborn recently recommended that a blood test for elevated concentration of phenylalanine be performed for all newborn infants prior to discharge. As results become available from wide application of blood screening tests, a number of questions have arisen regarding the interpretation of positive findings of elevated blood phenylalanine levels. Some reports suggest that diagnosis of phenylketonuria is determined by elevation of blood phenylalanine. The conclusion may be erroneously drawn that such a finding in an infant calls for immediate treatment with a low-phenylalanine diet. There are instances in which children were fed a phenylalanine restricted diet for periods up to 18 months and subsequently were proven not to have phenylketonuria. In another study plasma phenylalanine levels up to 40 mg/100 ml in a premature infant, accompanied by elevation of tyrosine, were shown not to result from phenylketonuria. Some investigators urge that tests for urinary metabolites characteristic of phenylketonuria be a necessary part of the diagnosis, while others consider urine testing of little value.

The cause for the mental defect in phenylketonuria has not been established with certainty. No satisfactory explanations have been proposed to account for the rare individuals with normal intelligence and biochemical phenylketonuria. It is not known whether elevation of phenylalanine from disorders other than phenylketonuria might result in mental impairment.

We have carried on a broad-scale urinescreening program since 1958 and a bloodscreening program since 1961. At the same time we have accumulated 70 patient years of experience in treatment of phenylketonuria.
THE ROLE OF THE SPLEEN IN IMMUNITY
Authors: Ellis Elliot F. , Smith Richard T.
Published: December 2021

IN VIEW Of the success of splenectomy in dealing with certain clinical problems, and the lack of any clearly unfavorable effects of this procedure, the idea that the spleen is not physiologically essential has been widely accepted. The first serious challenge to this concept arose with the clinical observation of King and Schumaker of a high incidence of serious bacterial infection following splenectomy performed in infancy. This original report has been supplemented during the last decade by additional clinical data, and renewed interest in the role of the spleen in immunity has resulted.

Recent experimental data have defined more clearly immunological functions for the spleen that are of special significance during early development. The purposes of this are paper are (1) to review the clinical problem which led to re-examination of the role of the spleen in immunity, particularly, as it relates to the early development of the immune mechanism, and (2) to offer a hypothesis which may explain the clinical observation of overwhelming infection after splenectomy in the young infant.

THE CLINICAL PROBLEM

In 1952 King and Schumaker reported an unusual incidence of infection in infants who had undergone splenectomy for congenital hemolytic anemia. The hazards of splenectomy in early life were pointed out in a number of papers which appeared subsequently with large series of cases reinforcing the validity of the earlier observations. Most recently Horan and Colbatch have incisively reviewed the problem and added a number of their own cases to those already in the literature. In spite of the preponderance of evidence, dissenting reports have appeared and the subject remains somewhat controversial.
ISOZYMES: A NEW CHAPTER IN MOLECULAR DIVERSITY
Authors: NITOWSKY HAROLD M.
Published: December 2021

ONE of the first demonstrations of human diversity at the molecular level was the observation that sickle cell hemoglobin moves more slowly in an electrophoretic field than does normal hemoglobin. In recent years, a qualitatively similar type of molecular diversity has been recognized in which multiple forms of an enzyme with the same substrate specificity may exist in a single tissue or even in the same cell. The terms "isozyme" or "isoenzyme" have been applied to this form of enzyme heterogeneity. Studies of this phenomenon have provided new insight into the nature of enzymes and enzyme action, and have also suggested both a basis for biochemical heterogeneity as well as some mechanisms for metabolic regulation and biochemical evolution in the tissues of complex multicellular organisms. In addition, these studies have shown that isozymes may have important clinical applications.
STUDY OF VIRAL ANTIBODIES BY THE PAPER-RADIOACTIVE VIRUS METHOD
Authors: Hodes Horace L. , Berger Ruth , Ainbender Eugene , Zepp Helen D. , Hevizy Maria M.
Published: December 2021

1. A filter paper-radioactive virus method for the detection and study of viral antibodies in human serum is described. The method gives accurate and reproducible results. It is particularly suitable for antibody testing on a mass basis. A slight modification makes the method more sensitive than standard tissue culture neutralization tests.

2. The major poliovirus antibody in human serum combines with the virus to form a particle which is non-infectious and of low mobility.
THE EFFECT OF L-LEUCINE ON HEPATIC GLUCOSE FORMATION
Authors: Greenberg Robert , Reaven Gerald
Published: December 2021

A direct inhibitory effect of leucine on hepatic glucose output has been suggested by previous observations in our laboratory. However, it has not been possible to separate the action of leucine from that of insulin. The current studies were undertaken in order to determine the effect of leucine on hepatic glucose formation in vitro, in the absence of insulin.

In liver slices from fasted mice, leucine was shown to inhibit the incorporation of C14 from various C14-labeled precursors into glucose. These results are consistent with the postulate that leucine inhibits the rate of gluconeogenesis, and thus hepatic glucose output, independent of insulin.

Accordingly, the effect of leucine on production of hypoglycemia cannot be regarded as a specific cause of hypoglycemia in certain infants. Assuming that the action of leucine is similar in all individuals, the induction of hypoglycemia by leucine in some individuals must reflect underlying defects in the intracellular regulation of the complex, multi-enzyme pathway of gluconeogenesis. Clarification of the mechanism of action of leucine on gluconeogenesis should contribute to current understanding of the means by which hepatic glucose output is regulated.
THE OXYGEN COST OF BREATHING IN THE PREMATURE INFANT
Authors: Thibeault Donald W. , Clutario Bella , Auld Peter A. M.
Published: December 2021

Work of breathing, oxygen cost of breathing, and calculated mechanical efficiency were studied in normal prematures using the plethysmograph method. The results indicate that the oxygen cost of breathing in these subjects averaged 0.9 ml per 500 ml ventilated. Calculated mechanical efficiency averaged 4.1%. These results were compared with those reported for normal adults, and premature infants were shown to have a higher oxygen cost of breathing and a lower mechanical efficiency. The sources of error of the method are discussed and emphasis is given to the fact that the absolute quantitative results may not be exact.
COMMITTEE ON FETUS AND NEWBORN
Authors:   COMMITTEE ON FETUS AND NEWBORN
Published: December 2021

THE Committee on Fetus and Newborn and consultants met in Chicago, Illinois, on October 23, 1965, to consider the problem of decontamination of fomites in neonatal units to reduce the incidence of nosocomial infections. It was agreed that there is insufficient evidence available to make authoritative recommendations for uniform procedures to deal with problems of decontamination of incubators, bassinets, respirators, and other equipment used in present day neonatal facilities. However, the participants suggested that certain statements could be made at this time which would serve to stimulate the interest of those concerned with the management of neonatal units and to emphasize the need to obtain objective information for a satisfactory solution to the problems posed.

Agreement was reached on the following statements:

1. Emphasis must be placed on cleansing and housekeeping procedures. Chemical disinfection is not a substitute for mechanical scrubbing and removal of dirt or organic matter. Moreover, organic matter inactivates many chemical disinfectants.

2. Manufacturers of equipment used in the newborn nursery must be encouraged to design equipment which can be easily cleaned and disinfected. Adequate cleansing of occupied incubators poses an almost insurmountable problem; ingenious engineering solutions are badly needed. Component pants of intricate devices should be removable for easier cleaning. Teflon coating of surfaces would ease mechanical cleansing. Nebulizing equipment should use air which has passed through a bacterial filter, sterile water from freshly opened bottles, and a closed system for delivery of water to the nozzle. Nebulizers should be designed for easy disinfection, preferably sterilization.
PKU, State Legislation, and Maltreatment of Children
Authors: WAKEMAN EDWARD T.
Published: December 2021

I noted with interest Dr. Isabel P. Robinault's letter concerning mandatory PKU testing, published on page 147 of the July 1966 issue, Volume 38, of Pediatrics. In this letter she states,

There is no longer question about states' rights to protect a child from being battered physically (some 20 states now have this legal protection for children).

As of September 1965, 47 states had passed legislation dealing with the abused child (Committee Statement by the Committee on Infant and Pre-School Child, "Maltreatment of Children," Pediatrics, 37:377, 1966).
TB, PPD, AND INH
Authors: DAVIS STARKEY D. , WEDGWOOD RALPH J.
Published: December 2021

EPIDEMIOLOGIC studies and prophylaxis trials over the last decade have radically altered our concepts of tuberculosis. Some old ideas have gone out the window and some important new methods have been developed. Vigorous application of these newer concepts will speed the eradication of tuberculosis in this country. Some of the important new ideas which pertain particularly to children will be discussed.

The annual infection rate is low and falling. The falling reactor rates in naval recruits illustrate this point. Among white, male, naval recruits (aged 17-21) 6.6% were reactors to tuberculin in 1949-1951. In 1958-1964 the reactor rate had fallen to 4.1%.
HYPERVALINEMIA
Authors: Dancis Joseph , Hutzler Joel , Tada Keiya , Wada Yoshiro , Morikawa Toshio , Arakawa Tsuneo
Published: December 2021

The metabolism of the peripheral leucocyte has been studied in a child presenting with mental retardation and hypervalinemia. A defect in the transamination of valine was demonstrated. Evidence is presented that the transamination of value is dependent on an enzyme that is specific for valine. Transamination of valine is demonstrable in placenta, suggesting the possibility that the diagnosis may be made before birth.
THE TOLBUTAMIDE TOLERANCE TEST IN THE EVALUATION OF CHILDHOOD HYPOGLYCEMIA
Authors: Schotland M. G. , Kaplan S. L. , Grumbach M. M.
Published: December 2021

The intravenous tolbutamide tolerance test has been evaluated in normal children and in children with ketotic hypoglycemia, idiopathic hypoglycemia, and the leucine-sensitive form of idiopathic hypoglycemia.

Following tolbutamide administration to normal children, the concentration of blood glucose falls 26% below fasting levels within 15 to 30 minutes and returns to fasting levels at the end of 2 hours. This is similar to the response of normal adults.

Some children with idiopathic hypoglycemia and with the leucine-sensitive form of idiopathic hypoglycemia have a prolonged hypoglycemic response to tolbutamide similar to that seen in patients with insulin secreting tumors.

The tolbutamide tolerance test in children appears to be of little help in differentiating islet cell adenoma from leucine-sensitive, ketotic, or idiopathic hypoglycemia.

Further evidence is presented that leucine and tolbutamide mediate insulin release from the pancreas by different mechanisms of action.
THE CIRCUMFERENCE OF THE HEAD OF NEWBORN INFANTS FIRST MEASURED IN 1785
Authors: C. T. E.
Published: December 2021

Dr. Joseph Clarke, physician to the Dublin Lying-In Hospital, was the first to measure the head circumference of newborn infants because he believed one reason males were more often stillborn than females was that their heads were larger than female infants and that this might add an extra hazard in the delivery of males. Not being able to find any previous study of head circumference of newborn infants, he measured 20 infants of each sex in July, August, and September 1785, "taking such children as appeared to have arrived at the full period of gestation promiscuously as they happened to be born. . . . For measuring their heads, I made use of a piece of painted or varnished linen tape, divided into inches, halves, and quarters. The varnish has the good effect of preventing the length of such a measure being readily affected by variations in the humidity of the atmosphere; and it has little or no elasticity.

Clarke found that the males had an average head circumference of 13.9 in. (35.3 cm) and the females 13.6 in. (34.5 cm). Perhaps, the present-day practitioner will be surprised to learn that Clarke's measurements of the average head circumference at birth are almost exactly the same as those obtained more than a century and a half later in a much larger and more sophisticated study by Vickers and Stuart (35.3 cm for the male and 34.7 cm for the female).
HYPERTENSION AND HYPOKALEMIC ALKALOSIS ASSOCIATED WITH UNDERPRODUCTION OF ALDOSTERONE
Authors: Aarskog Dagfinn , Støa Karl F. , Thorsen Thor , Wefring Karl W.
Published: December 2021

A 10-year-old girl presented with a syndrome characterized by hypertension, hypokalemic alkalosis, and inability of the kidneys to concentrate the urine and conserve potassium. The aldosterone excretion and secretion rate were subnormal to low both when she was on a liberal sodium intake and on restricted sodium intake. Treatment with Triamterene resulted in potassium retention , restoration of normal serum potassium level, abolition of the alkalosis, normalization of the blood pressure, and increase of aldosterone secretion rate. The differential diagnosis in conditions associated with hypokalemic alkalosis and renal wastage of potassium is discussed.
SOME ASPECTS OF CARDIAC PATHOLOGY IN INFANCY AND CHILDHOOD
Authors: Esterly John R. , Oppenheimer Ella H.
Published: December 2021

Histologic material from 450 cases of congenital cardiac malformations was reviewed for myocardial, endocardial, and coronary artery lesions. Myocardial necrosis, calcification, or scarring were found in 106 cases. The myocardial changes appeared to result from reduced coronary perfusion rather than oxygen desaturation. The most frequent involvement was seen in defects which cause hypoperfusion; aortic and pulmonary valve defects and anomalous origin of the left coronary artery. The changes in these cases were also the most acute and widespread. Similar lesions were found in congenital mitral stenosis in the absence of shunting defects. Myocardial lesions were infrequent in defects which result in arterial desaturation—transposition and tetralogy of Fallot.

Significant coronary sclerosis was present in several types of malformation but was not always associated with myocardial lesions. Endocardial proliferation was found overlying myocardial scarring in some cases, but, in spite of its morphologic similarity, it could not be related to the coronary artery lesions.
Cystic Fibrosis: A Handbook for Parents
Authors: SHWACHMAN HARRY
Published: December 2021

This well illustrated, 65 page handbook was written to give parents of children with cystic fibrosis an understanding of the present state of our knowledge of this disease. Although the text is written so the average parent would have no difficulty in understanding it, the author has thoughtfully added a five page glossary of medical terms commonly used in discussing cystic fibrosis.

The sections on mist tents and postural drainage are well done, as is the discussion of emotional difficulties.
The Year Book of Pediatrics, 1966-67 Series
Authors: CONE THOMAS E.
Published: December 2021

Dr. Gellis' ability year in and year out to abstract and to interpret for us the great and ever-changing international advances in pediatrics continues to dazzle most of us. Again I find myself asking, "How can one man know so much about so many things, no matter how recondite?"

The Year Book, as in past years, is divided into 17 sections covering the major areas of pediatrics. The papers abstracted make up an international survey of pediatric achievement because they were culled from more than 75 different medical journals published in at least 15 different countries, including those of Central Africa.
Polycystic Kidneys, Internal Hydrocephalus and Polydactylism in Newborn Siblings
Authors: SIMOPOULOS ARTEMIS P. , BRENNAN GLORIA G. , ALWAN AFFAN , FIDIS NICHOLAS
Published: December 2021

Three male siblings with polycystic kidney disease, internal hydrocephalus, and polydactylism are presented. These identical anomalies in three siblings constitute a new syndrome. It is recommended that future studies on polycystic kidney disease with central nervous system anomalies occurring in siblings should be reported in detail if the pathogenesis of the disease is to be understood.
Does Outpatient Teaching Need to be Upgraded?
Authors: WINEBERG JULIUS J.
Published: December 2021

On reading the Supplement, "Pediatric Residency Training," I am struck by the disagreeable fact that the men we are seeking to modernize our pediatric residency training program are the same men largely responsible for our present manpower crisis. They are biased against practice and look upon it as a lower brand of medicine.

My reason for pointing this out is that the Council on Pediatric Practice of the American Academy of Pediatrics, in its booklet Looking Ahead, wisely recommends revising and upgrading the outpatient teaching programs.
Letters to the Editor
Authors: FRAAD LEWIS M.
Published: December 2021

Dr. Wineberg's letter would have had a considerable degree of validity 10 to 15 years ago. However, times are indeed changing for various reasons. Outpatient departments in most teaching centers, which include large voluntary hospitals with residency training programs, have competent and well paid directors of pediatric outpatient services. Some recently appointed professors of pediatrics are products of the outpatient department: Haggerty, Morris Green, Olmstead.

A number of institutions have fellowship training in outpatient departments.
Use of Lambs in Pediatric Research
Authors: ALEXANDER GEORGE
Published: December 2021

Medical research workers are hampered by the lack of opportunity to experiment on the animal (man) on which their professional interest is focussed. For many years now, and increasingly so of late, physiologists and pediatrics have been turning to the sheep to provide a readily available experimental subject of much the same birth weight as the human infant.

While most of these workers appear to realize that Homo sapiens and Ovis aries do have points of physiological dissimilarity, few could tell if their experimental material was normal and many could be trapped into errors of interpretation through unfamiliarity with ovine biology.
Letters to the Editor
Authors: Moss ARTHUR J.
Published: December 2021

The Editor always jealous of those who know their ovine fetuses and newborns so much better than we know our human ones (yet not quite willing to exchange), received the following comment from Dr. Moss:

There is no question that the points made by Dr. Alexander are both important and well taken. We recognize that a record of mating dates is the best means of estimating gestational age, and members of our faculty have negotiated in the past with members of the Davis Campus in attempts to obtain these services. Unfortunately, this was never achieved. However, other means for provision of this service are currently being explored, and, hopefully, it will be forthcoming in the near future.
Undiscovered Urinary Tract Infections
Authors: WOLK MELVYN H.
Published: December 2021

The occurrence of urinary tract infections in children has become an increasing problem. Pediatricians, especially those experiencing the "unhappy pediatric syndrome," should delight in investigating the manifold signs and symptoms with which these children may present. We have been taught that urologic symptoms, such as dysuria and frequency, may indicate an underlying urinary tract infection. However we must look further, for signs rather than symptoms in infants and children, for they may not be the best historians.
Dangerous Psychotherapy
Authors: LOW MERRITT B.
Published: December 2021

Our Committee's attention has been drawn to a recent article (Medicine at Work, July 1966) suggesting that there are beneficial results if people have a chance to blow off steam and get rid of tensions through the use of fireworks. This has been called "psychotherapy with a bang."

The promulgator of this illogical, irresponsible absurd, potentially maiming concept is Dr. William E. Schumacher, Director of Mental Health for the State of Maine.
Letters to the Editor
Authors: S. C. A.
Published: December 2021

Editor's Comment: That physicians should still need reminding, after all that has been written about the care of such children and their families may seem surprising. Doctor Hasitavej's letter indicates that it is nevertheless true. Incidentally, the substance of the letter argues strongly against the opinions of certain "high-hat" physicians mentioned in its last paragraph.
ANAPHYLACTOID PURPURA COMPLICATED BY AN IRREDUCIBLE INTUSSUSCEPTION
Authors: BENSON CLIFFORD D. , MARTMER EDGAR A.
Published: December 2021

A case of anaphylactoid purpura complicated by an irreducible intussusception is reported. Resection and immediate intestinal anastomosis resulted in recovery.