bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFECT OF CORTISOL ON THE MATURATION OF FETAL RABBIT LUNGS
Authors: Motoyama E. K. , Orzalesi M. M. , Kikkawa Y. , Kaibara M. , Wu B. , Zigas C. J. , Cook C. D.
Published: December 2021

The effect of cortisol on the maturation of fetal lungs was investigated in two series of experiments in rabbits. In one series cortisol (10 to 30 mg/kg) was injected into 16 pregnant does for 3 days. Twenty-one does were injected with saline and served as controls. In the second series involving 21 does, cortisol (0.5 to 1.0 mg) was injected directly into some fetuses and amniotic sacs 2 to 3 days prior to premature delivery while their littermates were given saline and were used as controls. Fetuses were delivered by cesarean section at gestational ages between 26 and 29 days (full term: 30 days). Following maternal injection many fetuses were dead at delivery and the remaining live fetuses were smaller and weighed less than controls. There was no evidence of accelerated lung maturation. Fetuses directly injected with cortisol were more active, breathed better, and their lungs were better aerated when compared with their control littermates. In treated animals surfactant appeared at 26 to 27 days, a day earlier than controls and on electronmicroscopy there was evidence of accelerated maturation of alveolar epithelial cells. Thus, direct fetal injection of cortisol accelerates maturation of lungs and synthesis of surfactant, and promotes earlier extra-uterine adaptation of premature fetuses.
THE RED CELL PEROXIDE HEMOLYSIS TEST IN THE DIFFERENTIAL DIAGNOSIS OF OBSTRUCTIVE JAUNDICE IN THE NEWBORN PERIOD
Authors: Lubin Bertram H. , Baehner Robert L. , Schwartz Elias , Shohet Stephen B. , Nathan David G.
Published: December 2021

The erythrocyte peroxide hemolysis test (PHT) was compared to the I131 rose bengal excretion test (RBE) in the detection of complete biliary obstruction in the newborn period. Twenty-three infants with obstructive jaundice were studied.

In 16 infants with surgically proven biliary atresia both the PHT and RBE were abnormal. During the course of evaluation of the other seven patients, with neonatal hepatitis, the PHT was normal in six and abnormal in one, whereas, RBE was normal in two patients and abnormal in five. The simplicity and reliability of the PHT and the ease with which it can be repeated indicate that it may be more valuable than the RBE in evaluating the cause of obstructive jaundice in infants.
MANAGEMENT OF A CHILD IN A STATE OF FEVER ACCORDING TO DR. G. ACKERLEY OF NEW YORK CITY IN 1836
Authors: C. T. E.
Published: December 2021

Childhood fevers have always alarmed parents but perhaps even more so before the advent of modern medicine or the development of the clinical thermometer. In the 1830's when Dr. Ackerley offered the advice below on the management of a febrile child, most parents, as well as their physicians, considered fever a disease rather than a symptom. Dr. Ackerley wrote:

A child in a state of fever should be kept cool, but not cold. It should lie on a soft mattrass (sic), over which a few folds of a blanket and a sheet may be laid. Feather beds envelope the child too much, and in warm weather prevent the extra heat generated from passing off. The coverings should be light, as great injury is done by too much covering. The child should be frequently examined, and the covering added or removed according to its state at the time. The head of a child should be particularly attended to, and when hot and the seat of disease, should be kept as cool as possible. For this purpose the cap should be removed; and if there be much hair, it should be cut off close, in order that the cool air may come in contact with the skin. The feet and hands should be kept sufficiently warm. If the child be very hot and thirsty, its drink should be pure cold water, or very weak tea: its nourishment gruel or arrow root-milk should be avoided: even its mother's milk is improper in the quantities generally allowed to be taken.
Mercury Poisoning with Central and Peripheral Nervous System Involvement Treated with Penicillamine
Authors: Swaiman Kenneth F. , Flagler David G.
Published: December 2021

A 14-year-old boy developed acrodynia during the first year of life from topical ammoniated mercury ointment and developed the Guillain-Barré syndrome from chronic mercury vapor poisoning beginning at age eleven.

Treatment of mercury poisoning with penicillamine is efficacious in promoting mercury excretion, and reducing symptoms.
Double-Blind Trial of Aminophylline in Status Asthmaticus
Authors: Pierson William E. , Bierman C. Warren , Stamm Stanley J. , VanArsdel Paul P.
Published: December 2021

Significant improvement in ventilatory function without observable adverse effects has been demonstrated by this double-blind controlled trial of intravenous aminophylline in status asthmaticus. Aminophylline appears to have a beneficial therapeutic effect when given in addition to other accepted medications in appropriate dosage and under careful medical supervision to hospitalized children with status asthmaticus.
Iron Deficiency and Iron-Fortified Milk
Authors: Diamond Louis K.
Published: December 2021

Judging by personal inquiries to me as well as by your correspondence columns, iron supplementation of infant feeding regimens continues to be a red-hot subject with a surprising number of practicing pediatricians recording themselves as against it, despite the large volume of supporting data on which the A.A.P. Nutrition Committee's statement was based. Dr. Filer's clear answers (Pediatrics, 48:152, 1971) could not touch on all points. I wish to consider a few additional questions posed by the negative side.
Who Should Certify the Pediatrician?
Authors: Altstatt Leslie B. , Anderson John A , Wright F. Howell
Published: December 2021

You may be interested in the following comments about examinations for certification by the American Board of Pediatrics. The comments were related to me by a colleague who, after recently (and successfully) completing the oral portion of the board examination, was asked to submit some comments about the examination.

Medical board examinations for the purposes of certification should be discontinued. Certification ought to be the prerogative of the individual(s) conducting the training program, for he is a better judge of the suitability of the candidate than the purveyors of examinations.
Penis Tourniquet Syndrome
Authors: Sahn David J.
Published: December 2021

We have observed a condition similar to, and equally as serious as that described by Dr. Quinn as the "Toe Tourniquet Syndrome."1 Last year, while practicing as a resident physician in a busy pediatric emergency room, we treated five male infants for a condition which consisted of prolonged crying and tourniquetting of the penis by human hair.

The duration of this condition was shorter than that described by Quinn, probably because the frequency of maternal inspection of this part of the anatomy is higher than that of the toes.
BIOLOGIC SIGNIFICANCE OF THE SECRETORY γA IMMUNOGLOBULINS
Authors: Bellanti Joseph A.
Published: December 2021

The secretory γA globulins have been shown to be the active antiviral neutralizing principle in the respiratory tract. These antibodies are part of the system found in other fluids in contiguity with the exterior, the external secretory system. The presence of these γA associated antibodies has been shown to be correlated with protection particularly in the case of certain infections which are localized in their pathogenesis. The production of these antibodies are favored by either natural infection, attenuated vaccine, or by local application of viral antigens directly to the respiratory tract. When this system is inappropriately stimulated, hypersensitivity phenomena may occur. Finally, these observations suggest that the secretory γA globulins serve as a basis for an understanding of resistance mechanisms in the normal, and for the development of new approaches to the use of vaccines.
PARTIAL 3β-HYDROXYSTEROID DEHYDROGENASE (3β-HSD) DEFICIENCY IN A FAMILY WITH CONGENITAL ADRENAL HYPERPLASIA: EVIDENCE FOR INCREASING 3β-HSD ACTIVITY WITH AGE
Authors: Kenny Frederic M. , Reynolds John W. , Green Orville C.
Published: December 2021

In the siblings reported, two affected boys have perineal hypospadias and bifid scrotum, and two affected girls have slight clitoral enlargement with otherwise normal genitalia. All are mild "salt losers" with spontaneous crises occurring late (3 months and 2 years) in the boys. The girls had negative sodium balance and hyponatremia only when stressed by salt deprivation at age 3 weeks and 4 years respectively. All had elevated 17-ketosteroid excretion when diagnosed, and in the two youngest, urinary dehydroisoandrosterone (DHA) exceeded androsterone. Cortisol production and/or 17-hydroxycorticosteroid excretions were normal. Steroid excretion patterns showed an increase of 3β-hydroxysteroid dehydrogenase (3-βHSD) activity with increased age, but with a persisting high excretion of pregrienetriol. At 2 months of age, one girl excreted per 24 hours: pregnanetriol–0.23 mg, pregnenetriol–1.2 mg, 17α- OH-pregnenolone–-2.6 mg, 16α-OH-pregnenolone– 8.2 mg, 16α-OH-DHA–5.4 mg, and DHA–0.5 mg. Her sister, at age 10 years, during withdrawal of cortisone therapy, excreted per 24 hours: pregnanetriol– 24 mg, pregnenetriol–14 mg, DHA–1.2 mg, and no 16αOH-pregnenolone or 16α-OH-DHA. We conclude that these patients have partial 3β-HSD deficiencies on the basis of inadequate fetal virilization and persistent postnatal excretion of large amounts of pregnenetriol. Possible explanations for the preponderance of urinary C-21 over C-19 steroids and for the large excretion of pregnanetriol are presented.
Rheumatic Fever, Throat Cultures, and Penicillin
Authors: Lapin Joseph H. , Mortimer Edward A.
Published: December 2021

E. A. Mortimer, Jr., commenting on the "Role of the Pediatrician in Rheumatic Fever Control,"1 deplores the fact that first attacks of rheumatic fever have been reduced only 30% compared with the "prepenicillin" era, whereas prophylaxis has reduced recurrences by 75%. He feels that this is because (A) a significant proportion (from 34% to 56%) of initial attacks occurred in patients whose physicians either did not recognize or treated inadequately the antecedent streptococcal infection, and (B) parents failed to seek medical help for ‘pharyngitis of insufficient severity."
Continuous Positive Airway Pressure in Hyaline Membrane Disease
Authors: Marchal Claude , Leveau Philippe , Genet Yves
Published: December 2021

It is possible to employ the isolette incubator-respirator for application of a constant negative pressure (CNP) without the modification described by Vidyasagar.

The solenoid valve is blocked in "up position" by a simple mechanical procedure which is easily reversible. Tank is employed in "incubator position." The motor driven vacuum is then acting continuously and creates CNP.

Several applications of this method envisioned by us have been practiced on 20 infants.

1. It is a useful adjunct at oxygen therapy in hyaline membrane disease (HMD).
Letter to the Editor
Authors: Chernick V. , Vidyasagar D.
Published: December 2021

We are aware that a continuous negative pressure may be obtained with the Air-Shields incubator-respirator without the use of an override switch. The method suggested by Outer-bridge, et al. was used on the two machines we have but produced maximum pressures of only 3 to 5 cm of water. It is possible to modify the expiratory vacuum control to produce higher pressures. However, if the highest pressure obtainable is only 15 cm of water this would be inadequate since we have had two infants who required higher pressures.
Letter to the Editor
Authors: C. T. E.
Published: December 2021

Dr. O'Connor puts himself on the side of the angels by his concern about the distressing confusion caused by the terms rubeola and rubella to both the layman and physician (Pediatrics, 46:978, 1970 and 47:789, 1971). His letter confirms what Sir Francis Bacon had in mind in 1620 when in his Novum Organum he wrote: "The ill and unfit choice of words wonderfully obstructs the understanding."

No one would question Dr. O'Connor's statement that we as pediatricians, "with responsibility for the life and well-being of our patients do not need to follow the herd and should at least adopt and use a terminology that is truly scientific in that confusion would be impossible. . . ."
Corticosteroids in Croup: Reply from Ground Level
Authors: Menachof Louis
Published: December 2021

The letter by Dr. Coffin demonstrates very clearly unacceptable reasoning. His unequivocal endorsement of the use of steroids in viral croup is equally as irrelevant to the issue as is my own 12 years' experience demonstrating failure of steroids to affect the outcome and excellent results using only supportive measures.

What is relevant is the attempt to establish solid recommendations based on double blind studies, with all modes of therapy, including steroids, antibiotics, and racemic epinephrine being evaluated.
Letter to the Editor
Authors: Brown Robert E.
Published: December 2021

Doctor Madge and I are familiar with Doctor Eskes' case of Reye's syndrome and we are in complete agreement with his interpretation and handling of the case.

In addition to the case we reported in our letter to the Editor, there have been three other cases in succession of Reye's syndrome successfully treated at the Medical College of Virginia using insulin and glucose.

We hope other physicians will try this therapeutic approach and we will continue to receive feedback so that we can assess its efficacy in the treatment of Reye's syndrome.
CONGESTIVE HEART FAILURE FROM INTRACRANIAL ARTERIOVENOUS FISTULA IN INFANCY
Authors: Holden Alys Mae , Fyler Donald C. , Shillito John , Nadas Alexander S.
Published: December 2021

The clinical recognition of an intracranial arteriovenous fistula in a newborn infant depends on finding good peripheral pulses, a hyperdynamic cardiac impulse, cardiomegaly, and a cranial bruit. Dilated scalp veins and visible vascular malformations over the head will point toward the diagnosis.

Cardiac catheterization can be diagnostic through recognition of a wide pulse pressure in combination with high oxygen saturations in the jugular veins and the right heart chambers.

Cerebral angiography provides required anatomic detail. Surgical clipping of the feeding arteries may be helpful and even curative.
CARDIORESPIRATORY STATUS OF ERYTHROBLASTOTIC INFANTS
Authors: Phibbs R. H. , Johnson P. , Kitterman J. A. , Gregory G. A. , Tooley W. H.
Published: December 2021

We evaluated cardiorespiratory and hematologic status at birth, and changes in arterial oxygen tension and pH during the first hour of life in 61 prematurely born infants with moderate to severe erythroblastosis fetalis and compared the findings with their subsequent neonatal course. Intrapartum asphyxia was common and often followed by respiratory distress of varying severity. Twenty infants died; all had the idiopathic respiratory distress syndrome and pathologic finding of pulmonary hyaline membrane disease. These complications were related to the interacting effects of prematurity, anemia, hydrops fetalis, and intrapartum asphyxia and, in particular, to delayed recovery from asphyxia as manifested by persistent hypoxemia and acidemia during the first hour of life.
A FILTER PAPER SAMPLING METHOD FOR THE URIC ACID:CREATININE RATIO IN URINE
Authors: Mclnnes Roderick , Lamm Peter , Clow Carol L. , Scriver Charles R.
Published: December 2021

A simple method is described for determining the uric acid: creatinine ratio (UA/C ratio) in urine collected on filter paper. Uric acid and creatinine can be eluted quantitatively from Schleicher and Schuell 903 filter paper in alkaline buffer; the eluate is analyzed for the two compounds simultaneously by an automated method.

The mean UA/C ratio was defined in 820 newborn infants in the postnatal period of life. After the third day, the average is 1.49 ± 0.60 (mean ± 1SD), falling from a high value of 2.25 ± 0.85 on the second day. There is no significant sex difference or diurnal variation at this age and neither gestational age nor birth weight apparently affects the ratio.

The technique can be used to screen population, particularly the neonate after the 3rd day of life, for disorders of purine metabolism. An abnormal ratio (i.e., above 3.29 or > 3SD above the mean) would indicate such a disorder. Transient high UA/C ratios can be anticipated in at least 0.5% of samples often because of acquired perinatal complications.
USE OF UTILIZATION REVIEW TO ASSESS THE QUALITY OF PEDIATRIC INPATIENT CARE
Authors: Duff Raymond S. , Cook Charles D. , Wanerka Gary R. , Rowe Daniel S. , Dolan Thomas F.
Published: December 2021

Between 100 and 123 medical records of children hospitalized in each of three community hospitals and one major teaching hospital were examined to determine the need for and the quality of the care administered. Twenty-five percent of all patient days were considered unnecessary; this varied from 7% in the teaching hospital to a mean of 38% in the community hospitals. The cost of unnecessary hospital days and laboratory and x-ray studies for the 428 patients was $37,460, or $88 per patient discharged; the means per patient discharged from the three community hospitals and the teaching hospital were $101 and $54 respectively.

About one-third of all the patients received less than optimal care; this varied from 13% in the teaching hospital to 43% in the community hospitals. Misuse of antibiotics and questionable use of other drugs accounted for 79% of instances of questionable care.
A SURVEY OF HEALTH PROBLEMS, PRACTICES, AND NEEDS OF YOUTH
Authors: Sternlieb Jack J. , Munan Louis
Published: December 2021

In a study of the health needs of youth, about 1,400 young adults were questioned on their health habits, health status, and the need for a special type of clinic.

Concerning medical care practices, most consult their physician less than once a year and many never do so because they are not sick. A surprising number use the services of pseudo-medical men.

Of the health problems of youth, nervousness and dental troubles are most frequent. Acne is considered an important problem by both sexes as is anxiety over health. Among the problems classed as personal, scholastic problems rate highest with family problems second in frequency and sex and religious problems taking third and fourth rank. The problems of most concern to some segments of our society today, namely drugs and alcoholism, rate lowest as problems personally affecting youth.

Most wanted in a youth clinic are physicians, friends, and parents. The characteristics most sought in a physician are a high degree of understanding, a good personality, and informality. His age, sex, and dress seem to be of minor concern. A youth clinic should provide counsel and information on sex, drugs, venereal diseases, and alcoholism.
RELATIONSHIP OF ELEVATED BLOOD TYROSINE TO THE ULTIMATE INTELLECTUAL PERFORMANCE OF PREMATURE INFANTS
Authors: Menkes John H. , Welcher Doris W. , Levi Helene S. , Dallas Joseph , Gretsky Neil E.
Published: December 2021

Blood tyrosine concentrations were followed from birth to nursery discharge in 71 premature infants fed a high protein formula supplemented by 60 mg/day of ascorbic acid. In 89% of infants blood tyrosine concentrations were abnormal, and in 38% of infants the maximum level observed was 15.0 mg/100 ml or higher. Maximum blood tyrosine levels correlated significantly with gestational age (p = < 0.05) but not with birth weight.

In a follow-up study performed at 15 months of age, infants with high tyrosine levels had no increase in the incidence of neurological abnormalities. Between 7 and 8 years of age a second follow-up study was performed on 62 children. This included a WISC, a Wide-Range Achievement Test (WRAT), and tests for psychomotor and language maturity. Two children had died in the interval, and five of the 62 were retarded for full testing.

The full scale WISC I.Q. of all children correlated with birth weight at the 10% confidence level (p = < 0.1). The mean WISC I.Q. of high and low tyrosine subjects was 82.9 and 81.6 respectively. When infants were grouped by birth weight, a significant difference was detected in subjects weighing 2,000 gm or more.

High tyrosine infants had a significantly lower performance I.Q. than low tyrosine infants (82.4 and 97.8 respectively; p = < 0.02). Significant differences were recorded in the scores on Object Assembly, Picture Assembly, and Picture Completion of the WISC. Significant differences were also seen on the Spelling subtest of the WRAT (p = < 0.02).

We observed no adverse effect of high tyrosine levels on the intellectual performance of smaller premature infants, who on the whole have a greater risk for other complications of prematurity.
MEASUREMENT IN MANAGEMENT OF ANXIETY IN CHILDREN FOR OPEN HEART SURGERY
Authors: Barnes Corinne M. , Kenny Frederic M. , Call Thomas , Reinhart John B.
Published: December 2021

A study of neuro-endocrine and behavioral response to psychological stress of 11 children having heart surgery was initiated. An attempt was made to learn if more overtly anxious children would respond differently during hospitalization and surgery than those who appeared to have better emotional control.

All children in this study survived the surgery. It is suggested that prognosis is greatly related to the coping capacity of a child and his family to stress; that prognoses can be predicted if adequate assessments can be made; and that as more precise methods for evaluation of the neuro-endocrine response become available it will be useful to employ them to explore the complicated relationship between the central nervous system and the endocrine organs in relation to children under stress.

Assessment of anxiety in affect and function was made by a child psychiatrist and a pediatric nurse specialist during the hospitalization and at outpatient follow-up. Twenty-four-hour urine collections were made after suture removal and pre- and post-discharge and analyzed for 17-hydroxycorticosteroids by a modification of the method of Porter and Silber.

In terms of emotional stimulation of the adrenocortical axis, the days before surgery and of return from intensive care were the most stressful of the days studied. The mean value on the day before surgery was significantly greater than that on the day before discharge. Values for the day before and after suture removal were also elevated in comparison with the day before discharge. Hospitalization was seen as stressful in terms of the parameter studied with the mean of all inpatient values including the day of discharge being approximately double that obtained by pooling all outpatient determinations.

Surprising to the researchers was the fact that no difference was found between values for overtly excessively anxious children versus their less anxious counterparts on specific days, or when pooled in-hospital values were contrasted. The degree of elevation of 17-OHCS was related to the situation. No correlation between our estimate of anxiety and 17-OHCS levels was found.
The Long Free-Flowing Scarf—A New Health Hazard to Children
Authors: Meguid Michael M. , Gifford George H.
Published: December 2021

Accidents in childhood are common. In our present society with its rapid pace and frequent changes, we are often unaware of the high risks associated with particular objects and situations. One such risk with a case report is presented. It draws attention to a recent and hazardous fashion: The long, flowing scarf.
Prevention of Falls from Windows
Authors: Lathrop Fred
Published: December 2021

Doctors Sieben, Leavitt, and French1 reported falls from windows to be common cause of death in New York City slums. My patients are trained to lower the windows from the top for ventilation when they have small children on upper floors, rather than to raise the windows from the bottom. If you have triple track storm windows and screens, the window units can be left at the bottom, and the screen raised to the top to correspond.
Letter to the Editor
Authors: Morse Thomas S.
Published: December 2021

I interpret Doctor Hathaway's letter to say that the laboratory values quoted were inconsistent with a diagnosis of Factor X deficiency. This is correct. In our text we state that we were unable to establish a diagnosis at the time we treated the boy but that upon subsequent admission he was finally shown to be deficient in Factor X (Stuart). We were not alert enough to correct this statement in the galley proofs. The correct statement should have been that upon subsequent admission the boy was finally shown to be deficient in Factor IX (Christmas).
Atlas of Neuroanatomy and Special Sense Organs, by Jean Bossy. Philadelphia/London/Toronto: W. B. Saunders Company, 1970, 348 pp., $11.00
Authors: Gilles Floyd H.
Published: December 2021

Two paragraphs in the Preface to this volume set the tone of what is to follow. In the first place we are given to understand that it "... is neither a textbook nor a formal manual. It is intended as a teaching aid to facilitate correlation of the theoretical and practical studies of the nervous system and special sense organs, for the express purpose of clarifying clinical and pathological manifestations of disorders and dysfunctions." In the second place we are told "The morphological drawings approximate nature as closely as possible in order to facilitate practical study but where necessary, subtle simplification has been introduced to aid understanding." The first notion would imply the utmost in neuroanatomical accuracy; the second in visual clarity.
Pediatric Conferences with Sydney Gellis, Tape #1, Audio Cassette Tape (C-60, 2 track), issued 6 times per year, directed by Sydney Gellis, M.D. Philadelphia: W. B. Saunders Company, 1971, $47.50. (Sold by subscription only.)
Authors: Cone Thomas E.
Published: December 2021

This is the first review in our Book Reviews section of a standard C-60, 2 track 1-hour tape cassette. This cassette, containing six pediatric conferences, directed by Sydney Gellis, the first of a bimonthly series, emanates from one of the most respected publishers of medical books in the United States.

Many of our readers, including myself, will wonder if Dr. Gellis' prescience long ago convinced him that Marshall McLuhan is really proclaiming the death of print as a medium of instruction.
MEASUREMENT OF IMMUNITY FOLLOWING LIVE MUMPS (5 YEARS), MEASLES (3 YEARS), AND RUBELLA (2½ YEARS) VIRUS VACCINES
Authors: Weibel Robert E. , Buynak Eugene B. , Stokes Joseph , Hilleman Maurice R.
Published: December 2021

Data are presented to indicate persistence of immunity for at least 5 years after Jeryl Lynn mumps vaccine, 3 years after Moraten line measles vaccine, arid 2½ years after HPV-77 duck cell vaccine. Antibody retention was roughly the same following Enders' original, Moraten and Schwarz vaccines.
THE PREVENTION OF INJURIES TO CHILDREN IN AUTOMOBILES
Authors: Pless Ivan B. , Roghmann Klaus , Algranati Paula
Published: December 2021

A telephone survey of 162 randomly selected parents revealed that less than one-fifth locked doors, seated children in the rear, and used restraints when last traveling with their children in automobiles.

Eleven percent of the parents stated that they took none of these precautions. In general, greater but statistically insignificant safety behavior was associated with highway travel, fewer child passengers, and the absence of other adults.

A series of 200 roadside observations confirm these reports. In only 11% of the cars observed were all children seated in the rear and restrained. In 22% none of these precautions were noted. Again, slight, but nonsignificant differences are noted in association with the number of children and the site of journey.

Postal questionnaires were returned by 61 of the 67 American Academy of Pediatrics pediatricians in the county. Three percent of the respondents indicated that they always advised parents about auto safety precautions. A further 55% stated that they did so sometimes or often. The frequency of the pediatric advising was unrelated to parent safety behavior. The need for a more aggressive approach by pediatricians in this area is discussed in the light of the increased risks associated with failure to observe safety precautions.
Hexachlorophene: Is the FDA Position Justifiable?
Authors: Nordstrom Frank B.
Published: December 2021

They've taken away our pHisoHex for newborn skin care: at least anyone foolhardy enough to use it after the FDA announcement is risking a malpractice suit. Seems that newborn monkeys bathed in the stuff for 90 days developed significant blood levels of hexachlorophene. Since most newborn infants are bathed once, we could presume that they acquired 1/90th of this blood level. But no mater, do away with a practice which prevented almost totally the pyodermas that were once so common, and, on occasion, so devastating.
Immunosuppressive Drugs in Nephrotic Syndrome
Authors: Spitzer Adrian
Published: December 2021

Big numbers are always impressive, and the reader of medical journals is biased to remember those articles which refer to large samples. The purpose of this letter is to counteract this tendency and, hopefully, to demonstrate that big numbers, like small numbers, may be misleading if generated and interpreted in an indiscriminate fashion.

It is common knowledge that a clinical trial should ask specific questions, and should be based on simultaneous, properly controlled observations, made on a well-defined, homogeneous population.
Functional Hyposplenia in Congenital Heart Disease: Comments
Authors: Freedom Robert M.
Published: December 2021

I read with interest the communication of Pearson, et al.1 on functional hyposplenia in cyanotic congenital heart disease. Their point is well-taken that manifestations of splenic hypo-function in a patient with congenital heart disease is not a sine qua non of the asplenia syndrome. But several other points should be made.

Functional hyposplenia as manifested by the presence of Howell-Jolly and Heinz bodies is the rule rather than the exception in the normal human newborn and should not be construed to be related causally to cyanotic congenital heart disease.
Leprosy in Five Young Men, by George J. Hill, M.D. Boulder, Colorado: Associated University Press, 1971, 204 pp., $8.00
Authors: von Lichtenberg Franz C.
Published: December 2021

Despite the vast literature on leprosy there is still no single text available which gives sufficient guidance to the average pediatrician or internist to manage a patient with this disease without the help of an expert "leprologist." This volume narrows the communications gap and embraces Hansen's disease back into internal medicine; it is not a reference text, nor does it deal exhaustively with the pathogenesis or immunology of leprosy.

The author gives us a meticulous, yet somewhat repetitious account of five young Mexican lepers who were studied and treated at the National Institutes of Health (N.I.H.) in Bethesda, Maryland for periods of over several months each, thus permitting an exceptionally accurate evaluation and follow-up.
NEWBORN TEMPERATURE AND CALCULATED HEAT LOSS IN THE DELIVERY ROOM
Authors: Dahm Lida Swafford , James L. Stanley
Published: December 2021

Newborn infants lose heat rapidly at birth and during the first half hour of life. This investigation was undertaken to determine whether the initial heat loss was due principally to evaporation, and whether or not establishment of breathing would be irregular or delayed if the initial cold stress was reduced.

Five groups, each of 10 infants, were studied during the first half hour of life. Infants in Groups I and IV remained wet and were exposed to either room air or placed under a radiant heater. Those in Groups II, III, and V were dried promptly and exposed to room air, wrapped in a blanket or warmed by means of a radiant heater. Heat loss due to radiation and convection together was twice that from evaporation. Reduction of cold stress by placing the infant under a radiant heater as soon as he is born does not impede or delay the onset of breathing. Wet infants exposed to room air lost nearly five times more heat than those who were dried and warmed.

In vigorous infants, the simple maneuver of drying and wrapping in a warm blanket is almost as effective in diminishing heat loss as placing them under a radiant heater. However, in depressed or immature infants who may be more asphyxiated or have reduced energy stores, radiant heat maintains body temperature while allowing access to the patient.
HEREDITARY PARATHYROID HYPERPLASIA: A SURGICAL EMERGENCY OF EARLY INFANCY
Authors: Goldbloom Richard B. , Gillis D. A. , Prasad M.
Published: December 2021

Two siblings with idiopathic familial parathyroid hyperplasia were identified in early infancy, bringing to 11 the number of known affected infants. Both survived as a result of early subtotal parathyroidectomy, though continuing hyperfunction of remaining tissue necessitated reoperation in both. Despite the presence of hypoparathyroidism, both infants are developing normally.

Review of the 11 cases suggests strongly that the disorder is of autosomal recessive inheritance. Only two other infants are known to have survived, emphasizing that early diagnosis and surgery offer the only chance of survival.
RECOVERY OF CYTOMEGALOVIRUS FROM THE CERVIX IN PREGNANCY
Authors: Montgomery R. , Youngblood Leona , Medearis D. N.
Published: December 2021

Virological studies were performed on urine and cervical swab specimens, and sera were tested for complement fixing antibody to cytomegalovirus to determine the frequency and nature of cytomegalovirus infection in 71 unselected pregnant Navajo women, 81 newborn Navajo babies, and 125 women who attended the prenatal clinic of the Magee-Womens Hospital, Pittsburgh. Cytomegalovirus was recovered from 11% of the women studied but from none of the babies. It was recovered more frequently from the cervix (8%) than from urine (3%), more frequently from the cervices of Navajo women (14%) than from those of Negro (5%) or Caucasian women (4%). The virus was recovered more often in the third trimester than in the second or first, and more often from younger and primiparous women than from those who were older than 25 years and those who had had more than three pregnancies. Cytomegalovirus was recovered with equal frequency from the cervices of those Navajo and Pittsburgh women who had serologic evidence of CMV infection. The outcome of pregnancy did not seem to be affected by this infection although the possibility of low birth weights should be explored further. We would speculate that cytomegalovirus infection of the cervix in pregnancy represents activation of latent infection by hormonally induced local changes, changes to which older, multiparous women are resistant.
POLIOMYELITIS IN A HIGH RISK POPULATION: DO WE NEED TO IMMUNIZE THE NEWBORN?
Authors: Miller Louis W. , McGowan John E. , Leffingwell Lois M.
Published: December 2021

While the incidence of polio has declined steadily in the rest of the United States since 1966, the incidence of polio in Texas has not followed this pattern and almost all these cases have been associated with type 1 poliovirus. In 1970, a total of 38 cases of paralytic disease in children were investigated in Texas, and in 22 Texas residents, type 1 poliovirus infection was confirmed.

The majority of these cases occurred in South Texas and the lower Rio Grande Valley. Of the 38 cases investigated, 33 (87%) were children under 2 years of age. Immunization records on 36 cases showed that 35 (97%) had inadequate or no immunization against polio, and all but one of the children were Caucasians of Latin-American descent.

Some areas of South Texas are representative of regions of the United States that not only have a high risk of poliomyelitis in infants due to type 1 poliovirus infection, but also present special problems for health personnel in immunizing those at risk. In areas such as these, newborn feedings of type 1 oral polio vaccine is suggested.
Schönlein-Henoch Syndrome: Observations on Some Atypical Clinical Presentations
Authors: Sahn David J. , Schwartz Allen D.
Published: December 2021

Case records of 20 children with Schönlein-Henoch syndrome are reviewed. The clinical manifestations are similar to those described in previous reports except for a 38% incidence of testicular involvement in males. In several cases a long duration of abdominal pain and joint involvement was noted prior to the onset of rash. We believe that this syndrome should be considered in the differential diagnosis of children with abdominal pain, edema, or hematuria prior to the onset of rash. Occasionally the disease may occur sine eruption.
Fingernail Nitrogen Content in Neonates
Authors: Lockard Dudley , Pass Robert , Cassady George
Published: December 2021

Fingernail changes such as spooning, clubbing, banding, and streaking are useful observations in the diagnosis of a variety of clinical disorders.1 Recently, more careful analysis of these epidermal structures has revealed changes in composition concurrent with such disorders as cystic fibrosis2 and renal failure.3 These findings, demonstrating the value of altered nail composition in the diagnosis of certain metabolic disorders, have prompted our interest in the potential usefulness of "nail biopsies" in neonatal anabolic disorders. This preliminary report confirms that samples of satisfactory size may be collected within days of birth and provides nail nitrogen values for the normal neonate.
Letter to the Editor
Authors: Martin Gilbert I.
Published: December 2021

I read with interest the article by Pierson, et al. concerning the use of aminophylline in status asthmaticus which appeared in the October issue of Pediatrics. In employing aminophylline in the therapy of status asthmaticus, I have noted minimal improvement (if any) and occasionally toxic reactions in children under 7 or 8 years of age. However, in the older child or adolescent, there is often a striking clinical improvement as noted by the authors in their discussion.
Occupational Diseases (Royalty Division): Listeriosis, and Unwise Nutrition
Authors: Hart William E.
Published: December 2021

The effect of the recent article attempting to relate Queen Anne's poor obstetrical history to Listeria infection may be somewhat blunted by an error which appears in the first sentence.

It is not John, but his great-grandfather Henry I, whose death in 1135 is invariably associated with lampreys. The last days of the unfortunate John saw the loss of his treasure and possessions during an ill-advised crossing of a tidal river, an ensuing rage which found outlet in excessive consumption of peaches and new cider, and a subsequent fatal dysentery whose effect was undoubtedly augumented by therapeutic bleeding.
THE UNSOLVED PROBLEM OF KERNICTERUS IN THE SUSCEPTIBLE LOW BIRTH WEIGHT INFANT
Authors: Lucey Jerold F.
Published: December 2021

The article by Keenan, et al.1 in this issue of Pediatrics once again calls attention to the complex, frustrating problem of kernicterus associated with low serum concentrations of bilirubin in small sick premature infants. The new and important information contained in this article is the observation that despite the use of late phototherapy and exchange transfusion, kernicterus occurred in these four infants. Kernicterus has certainly occurred before in premature infants who have received exchange transfusions.2-6 But with regard to phototherapy, the results are open to two interpretations.

One view will be that phototherapy is not effective. The other will be that it has only been shown here to be ineffective when used too late to expect any effect.
SYMPOSIUM: BEHAVIOR MODIFICATION BY DRUGS
Authors: Eisenberg Leon
Published: December 2021

Having reviewed what is known, what is only surmised, and what is not known about the psychopharmacology of stimulant drug use in children, the clinician must decide for which patient to use what drug for how long. Medical practice does not permit the physician the luxury of deferring decisions until knowledge is certain. His task is to weigh putative benefits against putative risks in a strategy designed to maximize the probability of improvement for a particular patient.

The risks that concern the pediatrician are not only those visible in the short run during drug administration but include effects on development, effects which may not become apparent for some time after treatment has been discontinued. In the case of stimulant drugs, public controversy has centered on behavioral rather than pharmacological toxicity, both short and long run. In the short run, are the drugs being used indiscriminately to stifle independence and creativity among exceptional children? Over the long run, does childhood drug use predispose to adolescent drug addiction? Before attempting to answer these questions, let us first consider the medical indications for the use of stimulants and the mode of their administration.

The clinical syndromes which respond to stimulants are characterized by motor restlessness, short attention span, poor impulse control, learning difficulties, and emotional lability. Current American Psychiatric Association diagnostic nomenclature1 includes the term: "hyperkinetic reaction of childhood" to describe this set of symptoms; the World Health Organization2 is proposing: "hyperkinetic syndrome." Both terms have the virtue of stressing the symptom constellation and of by-passing the uncertainties surrounding cause.
ASSOCIATED ACRAL AND RENAL MALFORMATIONS: A NEW SYNDROME?
Authors: Curran Anita S. , Curran John P.
Published: December 2021

A 7-year-old male with associated anomalies of the limbs and urinary tract, very similar to three previously reported patients, is described.

Acral malformations noted in the four patients have been oligodactyly, ectrodactyly, brachydactyly, and polydactyly in varying but characteristic combination. A pattern of distribution of the limb defects has been evident. The limb anomalies in the present case are a composite of those described in the previously reported patients.

Urinary tract abnormalities include unilateral renal agenesis and duplication of the collecting system. Minor anomalies present in two or more patients were arched palate, sternal deformity, hypoplastic auricular helices, widely spaced teeth, coxa valga, cinodactyly of the fifth finger, hypospadias, cryptorchidism, antimongoloid slanting of palpebral fissures. Findings not previously reported were Brushfield's spots, vertically grooved nasal tip, deficient pectoralis major muscle, hypoplastic twelfth ribs, spina bifida occulta of L5.

All patients have been phenotypic males, with increased paternal reproductive age in three.

The authors suggest that a new syndromic (acro-renal) relationship of unknown etiology has been established.
PROSPECTIVE STUDY OF A MIXED COXSACKIE VIRUS B3 AND B4 OUTBREAK OF UPPER RESPIRATORY ILLNESS IN A CHILDREN'S HOME
Authors: Hierholzer John C. , Mostow Steven R. , Dowdle Walter R.
Published: December 2021

In the late summer of 1968 an outbreak of moderately severe upper respiratory illness occurred among the 120 children living in a children's home. Coxsackie viruses B3 and B4 were isolated from throat swabs and eye swabs of 21 children who were clinically ill. Neutralization tests were performed on serum specimens collected from each child before, during, and after the outbreak. Fifty-two percent of the children in the home experienced an infection with B3 or B4, 10% were sequentially infected with both types, and 38% remained uninfected. Coxsackie B3 accounted for 57% of all infections, and B4, for 43%. Infection was clearly related to age, and to preexisting antibody. Preexisting B3 and B4 serum neutralizing antibody levels of 1:20 and greater were fully protective against reinfection by the respective virus type. These viruses caused a wide spectrum of symptoms and physical findings which ranged from inapparent infections to aseptic meningitis. Conjunctivitis, exudative tonsillopharyngitis, otitis, and enanthem, were more frequently associated with B3 than B4, and aseptic meningitis was more frequently associated with B4 than B3. One child, experiencing a distinctly biphasic pattern of illness, exhibited a delayed antibody response concomitant with persistent virus shedding from the throat for a duration of 57 days. Using figures corrected for the effect of protective preexisting antibody, the reported illness rate for Coxsackie B3 in the total population was 24%, and the unreported illness rate was 21%; the ratio was 1:1. For type B4, the reported rate was 18% and the unreported rate 38%, for a 1:2 reported: unreported ratio.
The Incubator-Respirator*: Methods for Improving Its Reliability
Authors: Somerwill Lawrence , Brown Edwin G. , Sweet Avron Y.
Published: December 2021

Failure of the incubator-respirator has been traced primarily to the triac and mechanical deterioration of the RYl contacts. Reasons for the failures and methods for overcoming these problems are discussed. After appropriate modifications to the incubator are made, the method originally proposed by Vidyasagar and Chernick for conversion to CNP is possible. Suggestions are made to revise this system to reduce deterioration of other valuable operating components as well.
Otitis Media: Bacteriology and Antibiotics
Authors: St. Geme Joseph W. , Cohn Walter L. , Meyer Donald L.
Published: December 2021

It will be difficult to match the superb studies of Howie, Ploussard, and Lester1,2 on the clinical and microbial nature of otitis media, as well as their definitive evaluation of different antibiotic regimens. These three clinicians in full-time pediatric practice have contributed the classic piece of investigation in this field.

In 1966 we initiated a similar pilot study of otitis media. We wished to learn how rapidly bacteria were cleared from the middle ear following antibiotic-decongestant therapy or the use of decongestants alone.
Imipramine Poisoning: Successful Treatment
Authors: Schneider Sanford
Published: December 2021

In the otherwise excellent report by Fouran and Chicoine1 of fatal accidental imipramine (Tofranil) ingestion, an interesting earlier reference is not mentioned. In 1968 Doctor Robert Penny described a 3½-year-old who ingested 650 mg of imipramine and survived.2 The electrocardiographic changes in the two case reports are identical, but the abnormalities described by Penny responded dramatically to an infusion of potassium chloride, a treatment not mentioned by the authors, although they do briefly discuss potassium shifts.1
THE SCHOOL HEALTH SERVICE: A NEW MODEL
Authors: Nader Philip R. , Emmel Anne , Charney Evan
Published: December 2021

A pilot school health project delivering services through an OEO-University operated Neighborhood Health Center, has utilized a health paraprofessional, the School Health Assistant. It developed new roles for school physician and nurse through linking the school health service in an inner-city elementary school with a source of a family-focused primary medical care in the same geographic area.

Comparison of it with a traditional school health program indicated further program development and evaluation should be undertaken.
CONGENITAL SUCRASE-ISOMALTASE DEFICIENCY
Authors: Antonowicz I. , Lloyd-Still J. D. , Khaw K. T. , Shwachman H.
Published: December 2021

Observations over a period of 6 years are reported on 10 children in whom the diagnosis of congenital sucrase isomaltase deficiency (SID) was confirmed by quantitative estimation of disaccharidase activity of the small intestinal mucosa. Repeat biopsies were performed on eight of the ten patients and showed no evidence that sucrase isomaltase activity is acquired. Sucrose tolerance tests (2 gm/kg) showed no significant rise in blood glucose in the seven patients in whom they were performed.

This condition may appear in young infants with severe diarrhea resulting in a malabsorption syndrome and failure to thrive. It may also be manifest in a milder clinical presentation with bothersome diarrhea in spite of normal growth and development in the older infant or young child. The diagnosis in this latter group can be difficult, and is frequently missed.