bluuebunny/crossref_metadata_2025 huggingface dataset:
ENDOCARDIAL FIBROELASTOSIS AND THE MUMPS VIRUS
Authors: Gersony Welton M. , Katz Samuel L. , Nadas Alexander S.
Published: December 2021

Sixteen patients who fit the diagnostic criteria of endocardial fibroelastosis were investigated by means of mumps skin tests and serum assays of mumps hemagglutination-inhibiting antibodies. No relationship was found between the clinical entity, endocardial fibroelastosis, and either mumps-specific antibodies or delayed cutaneous hypersensitivity to the mumps virus.
CHEMICAL THERMOGENESIS IN NEWBORN INFANTS: CATECHOLAMINE EXCRETION AND THE PLASMA NON-ESTERIFIED FATTY ACID RESPONSE TO COLD EXPOSURE
Authors: Schiff David , Stern Leo , Leduc Jean
Published: December 2021

Exposure to a cold environment resulted in a simultaneous increase in urinary noradrenalin excretion and plasma non-esterified fatty acid levels in eight newborn infants. A similar, though less constant, infants crease occurred in the excretion of urinary dopamine. The infusion of noradrenalin into two infants resulted in a rapid rise of plasma NEFA and a sustained increase in rectal temperature. It is proposed that the increase in plasma NEFA on exposure to cold represents an intermediary step in the role of noradrenalin as the mediator of chemical thermogenesis in the newborn infant.
Syndrome of Caudal Regression in Infants of Diabetic Mothers: Observations of Further Cases
Authors: PASSARGE EBERHARD , LENZ WIDUKIND
Published: December 2021

Skeletal anomalies of the lower extremities and lower spine have been observed in infants of diabetic mothers. Forty-three such cases have been collected from the literature. Maternal diabetes may play a role in the etiology of these malformations.
ATAXIA TELANGIECTASIA WITH CEREBELLAR TUMOR
Authors: Shuster J. , Hart Z. , Stimson C. W. , Brough A. J. , Poulik M. D.
Published: December 2021

Two patients with ataxia telangiectasia were studied. There is absence of γA immunoglobulin, poor delayed hypersensitivity skin reactions, and abnormal rejection of skin grafts. The susceptibility to sinopulmonary infections is probably related to the abnormal cellular and circulating antibody responses which these patients demonstrate. Experimental evidence indicates that the fundamental immunologic defect in this disease lies in thymus gland. The etiology of the neurologic abnormalities is unknown. The first instance of a cerebellar tumor to develop in this syndrome is reported.
Croup—Emergency Treatment
Authors: MARION GILLES
Published: December 2021

There is continuing discussion in medical journals about the doubtful value of cortisone for the treatment of "croup." My point is that everyone seems to have forgotten the tremendous value of antihistamines.

In the past 10 years, I have not had to admit to hospital more than two cases of "croup," and these because they vomited all oral medication that was given. Even though croup or laryngo-tracheitis is subdivided into various types: viral, bacterial, spasmodic, supraglottic, subglottic, etc., the clinical response to treatment has been excellent in all of my patients.
Newborn Sucking Behavior Affected by Obstetric Sedation
Authors: Kron Reuben E. , Stein Marvin , Goddard Katharine E.
Published: December 2021

Newborn infants whose mothers received a single dose of obstetric sedation during labor sucked at significantly lower rates and pressures, and consumed less nutrient than infants born to mothers who received no obstetric Fig. 5. Effect of obstetric sedation on nutrient consumption during sucking. sedation. Significant drug effects persisted throughout the 4-day period that the infants remained in the newborn nursery.
Letters to the Editor
Authors: RICHMOND JULIUS B.
Published: December 2021

I appreciate the opportunity to respond to Dr. Daschbach's letter concerning my presentation of the Head Start program to the Academy's membership (Pediatrics, 37:905, 1966). Dr. Dashbach's comments illustrate the main thesis of my discussion: that it is indeed difficult to develop a program with a high degree of local autonomy without encountering many variations. Certainly practicing pediatricians are not monolithic in their view of the development of programs; it is understandable, therefore, that there would not be universal acceptance of the pattern which develops in each community.
GASTRIC RESPONSE TO SPECIFIC DISEASE IN INFANTS
Authors: Avery Gordon B. , Randolph Judson G. , Weaver Thomas
Published: December 2021

1. A method of gastric analysis has been developed for the study of newborn infants. Results obtained with this method have shown it to reflect more accurately the ongoing secretory activity of the stomach. Previous methods of sampling left significant and varying amounts of acidity behind in the stomach rendering much of the available data inconclusive.

2. For the first time, gastric function has been correlated with specific disease states in the infant.

3. The volume, pH, total acidity, chloride content, and pepsin activity have been found to vary independently of one another.

4. Pneumonia and bronchiolitis, two conditions producing compromised respiratory function, were characterized by decreased total acidity, a more alkaline pH, and decreased pepsin activity.

5. Infants with short gut after bowel resection displayed highly significant increases in total gastric acidity and rate of acid formation, and a lower gastric pH.

6. Infants with acyanotic congenital heart disease showed significantly decreased pepsin content and increased chloride concentration despite normal acidity. Conversely, the few infants with cyanotic congenital heart disease studied had decreased volume of gastric juice and rate of acid formation.
The Pediatrician and the Distribution of Pediatric Care
Authors: PARTIN JOHN
Published: December 2021

I was struck by the cogency of David Toll's remarks in the last issue of Pediatrics. He has identified this decade as a pivotal decade in the development of American pediatrics and he has rightly indicated the special competence of the pediatric practitioner to lead and advise in which must eventually be looked upon as a revolution in American medical practice.

Pediatricians must take the lead in this time of change by rendering expert opinion, delineating problems, and establishing priorities after consultation with experts from all relevant sectors of our increasingly complex society.
Shigellosis: A Clue to Early Diagnosis
Authors: POH SUCHADA
Published: December 2021

A child with diarrhea who does not have parenteral disease and whose peripheral blood smear shows more band neutrophils than segmented ones (regardless of the number of total neutrophils), should be strongly suspected of having shigellosis.
Possible Oral-Facial-Digital Syndrome in a Surviving Male
Authors: BOON WONG HOCK
Published: December 2021

In the May issue of Pediatrics (37:812, 1966), Dr. Jacob Wahrman and his colleagues reported a male child with the oral-facial-digital syndrome whose chromosome karyotype revealed that in actual fact he was also an example of a Klinefelter's Syndrome 47 (XXY). Since the majority of these cases have been female, the authors reviewed previous published male cases and came to the conclusion that the gene for the OFD Syndrome would be lethal in a male with a normal male chromosome karyotype.
MUCOID IMPACTION OF THE BRONCHI IN CYSTIC FIBROSIS
Authors: Waring William W. , Brunt C. Hal , Hilman Bettina C.
Published: December 2021

Mucoid impaction of the bronchi (MIB) is an unusual complication of adult asthma. In a review of 675 serial chest radiographs of 68 children and 2 adults with cystic fibrosis (CF), opacifications consistent with the diagnosis of MIB have been noted in 22 children and 1 adult, an overall incidence of 33%.

The lesion of MIB in CF is a bronchusrelated complex of branched finger-like or nodular densities due to progressive distention of bronchi with tenacious mucopus. It is most commonly observed in the right upper lobe. Although it may spontaneously disappear, it tends to recur. Persistence of MIB for periods longer than 1 month can be related to subsequent bronchiectasis in the same segment. Clinical diagnosis is totally dependent on radiographic recognition, since symptoms and signs are characteristically lacking or non-specific. Atelectasis does not occur, probably because of collateral ventilation from adjacent uninvolved lung. Certain apparent differences have been noted between the adult (asthma) and childhood (CF) forms of MIB.

Planigraphic and bronchographic studies in selected patients confirm the intrabronchial location of this process. Bronchial lavage is effective in washing out some impactions that have not responded to more conventional mucolytic and physical therapy.

Recognition of MIB in a roentgenogram of a child should be considered presumptive evidence of CF, since similar opacifications are very rarely seen in children with other diseases. We believe that (1) progressive MIB at a subsegmental level is the major cause of bronchiectasis in CF and (2) secondary collateral ventilation may be the major cause of obstructive overinflation of the lungs in CF.
IN VITRO SENSITIVITY STUDIES OF HEMOPHILUS INFLUENZAE—TYPABLE AND NON-TYPABLE STRAINS
Authors: Sell Sarah H. Wood
Published: December 2021

In vitro tube sensitivity tests for 106 strains of H. influenzae (42 type b, 34 other types, and 30 non-typable) were performed in Levinthal's broth with erythromycin, tetracycline, cephaloridine, triple-sulfa and triple-sulfa plus erythromycin.

Non-typable strains were more sensitive to triple-sulfa than were the typable groups with similar reactions for b and the other types. At 10 mg/100 ml, about 40% of non-typable and 20% typable strains were inhibited.

Similar patterns of sensitivity were noted for type b, other types, and non-typable strains for the antibiotics tested.

Two drugs, tetracycline and erythromycin, were effective within the therapeutic ranges, while cephaloridine and triplesulfa were less efficient in this series.

The addition of triple-sulfa to erythromycin increased the efficiency of the latter by one tube in the doubling-dilution series, the significance of which is doubtful.
A Simple Chromatographic Screening Test for the Detection of Galactosemia in Newborn Infants
Authors: HAWORTH J. C. , BARCHUK N. H.
Published: December 2021

A simple chromatographic screening procedure for the detection of galactosemia in newborn infants is described. The test uses blood collected and dried on filter paper cards and depends upon the demonstration of blood galactose levels greater than 10 mg/100 ml, levels which are not found in normal newborn infants. The test is economical in materials and time.
CONGENITAL TOXOPLASMOSIS
Authors: GARD SVEN , MAGNUSSON J. HENNING , WAHLGREN F. , GILLE GUNNAR
Published: December 2021

An account is given of congenital toxoplasmosis in a child who died at the age of 43 days. The patient, who was somnolent from birth, showed the following symptoms: bilateral microphthalmia and chronic bilateral uveitis; considerable hydrocephalus internus, mainly symmetric, cerebral calcifications and pronounced typical changes in the cerebrospinal fluid, hypoprothrombinemia and eosinophilia; enlargement of the liver and spleen; marked lability of the body temperature with wide variations.

The postmortem findings, both macroscopic and microscopic, were typical in every respect, with pronounced necrotic encephalitis in the cerebrum and characteristic foci of granulomata in the brainstem and the spinal cord. Toxoplasma in the form of pseudocysts were demonstrated in the affected parts of the brain.

Typical Toxoplasma were isolated from the spinal fluid on three occasions, from material obtained by liver biopsy and from pieces of brain and spleen removed at autopsy.

Serum from the patient as well as from the mother gave a positive neutralization test in rabbits. The in vitro dye test according to Sabin and Feldman yielded a positive result with a high titer value.

The strain of Toxoplasma isolated ("G. L.") seems to be serologically identical with the American strains "RH" and "LM."
Round Table Discussion
Authors: COSTELLO MAURICE J.
Published: December 2021

Chairman Costello: The management of vascular nevi is of great interest to the pediatrician. He more than any other specialist, including the general practitioner, is first consulted regarding the advisability of treating a hemangioma and as to the best method of treatment which will insure a good therapeutic and cosmetic result. Since there appears to be no unanimity of opinion regarding these points, it was thought that a round table discussion by a small group would help us envision a better approach to this interesting and important problem.

Permit me to preface my remarks by stating that some pediatricians believe that the dermatologist and radiologist are apt to treat hemangiomas too early and that there are hemangiomas treated which would have disappeared spontaneously, this latter thought being influenced to a great extent by the report of Lister who claimed that superficial hemangiomas will disappear completely in the great majority of cases. The dermatologist and radiologist, on the other hand, believe that the pediatrician in some instances, because of the opinion expressed above, permits too long a time to elapse before treatment is instituted, thereby losing the golden opportunity for effective rapid permanent cure of these hemangiomas. There are arguments to be advanced in the substantiation of both opinions, and it is for this reason that we hope by free and open discussion to arrive at a more accurate answer to the questions which have been raised.

In this brief presentation it is hoped that I will be able to place in sharp relief all the important aspects of heredity or familial incidence of these lesions, the time of their occurrence, the types, their behavior and significance, the indicated type of therapy, and the results which may be accomplished in. their proper treatment.
Magnesium Intoxication in a Premature Infant
Authors: BRADY JUNE P. , WILLIAMS H. C.
Published: December 2021

This report of a premature infant with hypermagnesemia indicates that magnesium sulphate therapy for pre-eclampsia may have profound effects on the fetus. In this infant the toxic effects of motor and respiratory paralysis were immediately reversed when the serum magnesium level was lowered during an exchange transfusion.
Hematologic Reactions to Diazoxide
Authors: COMBS JEROME T. , GRUNT JEROME A. , BRANDT IRA K.
Published: December 2021

One case of neutropenia and one case of thrombocytopenia were seen in patients receiving diazoxide for hypoglycemia.
PROLONGED HYPERTENSION FOLLOWING CESSATION OF DESOXYCORTICOSTERONE THERAPY IN CONGENITAL ADRENAL HYPERPLASIA
Authors: Marks James F. , Fink Chester W.
Published: December 2021

Three children with the salt-losing form of congenital adrenal hyperplasia developed hypertension during the course of therapy with desoxycorticosterone (DOC). The hypertension persisted for a much longer period of time than could be explained by the usual duration of the pharmacological action of the medication.

The three children received DOC trimethylacetate. In none could other causes of hypertension be implicated. No other cases of persistent hypertension in children related to DOC administration were found.
A DEVELOPMENTAL STUDY OF CHILDREN'S SCRIBBLINGS
Authors: Baker Harry , Kellogg Rhoda
Published: December 2021

Pediatricians have always been alert to the study of the various phases of child development. Yet, for some reason we have continued to neglect childhood scribblings as an obvious facet important to pediatric study. We now have available to us some beginning insights into child art. Some of the implications of this work have been mentioned in this paper.

Certainly we should take a long look at the accepted psychological and psychiatric drawing tests which are currently used to study and assess children's mental development and childhood's emotional ills.

We should acquaint parents with the child's need to have access to scribbling experiences without adult interference. It may be that we have at hand a simple tool by means of which we can help prevent the development of reading problems in some children.

It is premature to suggest that in the study of adult phosphenes and childhood scribblings we have a tool for the study of developing neuronal patterns (and all that this implies), but the common denominators found in all child art deserve intensive scientific study.
Arterial Thrombosis Following Femoral Venipuncture in Edematous Nephrotic Children
Authors: GOLDBLOOM RICHARD B. , HILLMAN DONALD A. , SANTULLI THOMAS V.
Published: December 2021

In a recent discussion McKay emphasized certain hazards which may attend venipunctures which are performed for blood sampling.

We wish to call attention to a particular situation in which attempts to perform femoral venipuncture may be hazardous. We have seen three children who were affected with the idiopathic nephrotic syndrome and were edematous. In each instance attempts at femoral puncture were followed by arterial thrombosis requiring amputation of part of the lower extremity.

Case No. 1

An 18-month-old boy with nephrosis and edema was seen by one of us in consultation because evidence of acute right femoral artery occlusion had developed following femoral venipuncture.
THE EFFICIENCY OF METHODS USED TO EVACUATE THE STOMACH AFTER ACUTE INGESTIONS
Authors: Corby Donald G. , Lisciandro Richard C. , Lehman Richard H. , Decker Walter J.
Published: December 2021

Gastric lavage and the use of two pharmacologic agents (syrup of ipecac and apomorphine) were studied in puppies to assess rapidity of stomach evacuation and efficiency of removal of stomach contents. Apomorphine clearly acts faster to produce emesis and removes a larger amount of inert material than the two other methods. If studies in children corroborate these data in experimental animals, apomorphine will be clearly indicated as the pharmacological emetic of choice.
Evaluation of Precautions Before Entering a Neonatal Unit
Authors: SILVERMAN WILLIAM A. , SINCLAIR JOHN C.
Published: December 2021

The nursery for small neonates is generally a forbidding area in the modern hospital. Relatively few physicians enter this unit and those who do are discouraged from frequent visiting because of the elaborate precautions (e.g., scrubbing, gowning, etc.) which must be carried out before each entry. The situation is particularly unfortunate because the concentration of serious medical problems is undoubtedly greater here than in any other part of the hospital—witness the mortality rate, almost always the highest in the institution.
Acute Epiglottitis—Management with Prolonged Nasotracheal Intubation
Authors: Geraci Robert P.
Published: December 2021

The use of prolonged nasotracheal intubation in the management of two cases of acute epiglottitis is described. Some of the advantages of intubation over tracheostomy are outlined. In any given clinical situation, the expected duration of respiratory disability and the amount of tracheobronchial secretion anticipated will influence the choice between nasotracheal intubation and tracheostomy.
A Mail-in Technique for Detecting Penicillin in Urine: Application to the Study of Maintenance of Prophylaxis in Rheumatic Fever Patients
Authors: Markowitz Milton , Gordis Leon
Published: December 2021

A method for detecting penicillin in urine of rheumatic patients on oral prophylaxis is described. The use of a mail-in kit permits the participation of school nurses and other personnel in the field in community programs directed at preventing recurrences of rheumatic fever.
THE SIGNIFICANCE OF GRUNTING IN HYALINE MEMBRANE DISEASE
Authors: Harrison V. C. , de V. Heese H. , Klein M.
Published: December 2021

Grunting was investigated in 22 infants with hyaline membrane disease. It was demonstrated to be a modified Valsalva maneuver, as during expiration intrapleural pressure was increased by closure of the glottis and contraction of the abdominal muscles. Grunting could be prevented if the trachea was intubated; but, during this period the arterial oxygen tension fell. After detubation grunting recommenced and arterial oxygen tension rose to previous levels. Therefore, grunting appears to be a protective form of breathing, aimed at raising the PaO2. This is probably achieved by improvement of alveolar ventilation, but the exact mechanism is not known.
Pack Palsy: A Neurological Complication of Scouting
Authors: White Harry H.
Published: December 2021

Clinical histories of two cases of brachial plexus palsy occurring in Boy Scouts are presented. The proposed mechanism of this type of palsy is compression of the brachial plexus between the clavicle and first rib by the shoulder straps of a heavy camping pack. The importance of recognition and the favorable prognosis of this injury are discussed.
PRESUMPTIVE TESTS FOR CYSTIC FIBROSIS BASED ON SERUM PROTEIN IN MECONIUM
Authors: Green Morris N. , Shwachman Harry
Published: December 2021

The meconium obtained from siblings of patients with cystic fibrosis was studied for its protein content to determine whether this procedure could be used as a marker of the disease in the newborn. Over a 9-year period 196 specimens were studied. Forty-nine of the 196 infant siblings developed cystic fibrosis and only 4 of this group gave a negative protein reaction. In the remaining group of 147, the protein test was positive in 46, but in a lesser amount. Two methods of testing were employed—a trichloracetic acid ring test and a slide agglutination test using antihuman albumin. Random control samples from 1,600 full-term babies yielded negative tests. This presumptive test is suggested as a possible screening method for the detection of cystic fibrosis with a reliability of approximately 90%. The measurement of sweat electrolytes, although difficult and time consuming in the newborn period, appears to be the most reliable technique of detecting cystic fibrosis.
THE ELECTROENCEPHALOGRAM IN CHILDREN WITH MINIMAL CEREBRAL DYSFUNCTION
Authors: Capute Arnold J. , Niedermeyer Ernst F. L. , Richardson Frederick
Published: December 2021

The electroencephalogram (EEG) of 106 children with the syndrome of "minimal cerebral dysfunction" showed normal tracings in 53 cases and abnormalities in 53 cases. In 45 children the abnormalities ranged from "slight" to "moderate" while only 8 patients had markedly abnormal records. The incidence of paroxysmal abnormalities was low (14 patients, 6 of them exhibiting markedly abnormal EEG's), and non-focal abnormalities were more frequently encountered than focal deviations. Only five abnormal tracings were obtained in a control group of 33 physically and mentally healthy children. Patients with overt convulsive disorder, mental retardation, and gross neurological deficits were not included in the study.

This study de-emphasizes the diagnostic significance of the 14 and 6 per second positive spike pattern. There is also little reason to attribute the hyperkinetic and aggressive outbursts to epileptic mechanisms since seizure potentials were seldom encountered in our material.

The EEG is a valuable diagnostic tool in minimal cerebral dysfunction in spite of the fact that no specific findings can be expected. The diagnosis of minimal cerebral dysfunction should not be based upon the EEG alone.
A VIRILIZING ADRENAL TUMOR WITH BORDERLINE ELEVATION OF URINARY 17-KETOSTEROIDS
Authors: David R. , August G. , Gandy H. M.
Published: December 2021

In vivo and in vitro studies on a 6-year-old boy with a virilizing adrenal adenoma are reported. Of particular interest was the modest elevation of urinary 17-ketosteroids. The awareness of this observation is emphasized. The main biochemical findings were: elevated dehydroepiandrosterone sulfate (DHA-S), normal testosterone and androstenedione levels in plasma, and increased urinary excretion of dehydroepiandrosterone (DHA), 16-hydroxy-DHA, androstenediol and androstenetriol, which were isolated from the sulfate fraction. In vitro incubation of tumor tissue demonstrated its capacity to sulfurylate pregnenolone. It is postulated that DHA-S is the principal precursor of the urinary metabolites isolated, and that its metabolism in this case (possibly a function of age) led to a relatively small contribution of androsterone and etiocholanolone, in contrast to other steroids measured, particularly 16-hydroxy-DHA.
THE EFFECTS OF EARLY AND LATE FEEDING OF INTRA-UTERINE FETALLY MALNOURISHED (IUM) INFANTS
Authors: Rabor Iole F. , Oh William , Wu Paul Y. K. , Metcoff Jack , Vaughn Mary A. , Gabler Marjorie
Published: December 2021

The effects of early versus late feeding were evaluated in 28 infants with intra-uterine fetal malnutrition (IUM). The criteria for IUM include: (1) birth weight below the 10th percentile of the Colorado's intra-uterine growth chart, (2) body length longer than expected for weight, and (3) signs of postmaturity described by Clifford. In 13 IUM infants whose birth weights exceeded 2,040 gm, the blood glucose levels, acid-base status, and calcium and magnesium values were comparable to those of 10 nonmalnourished control infants. Early (4 hours) or late (24 hours after birth) oral feeding did not alter their values during the first 48 hours of life. In 15 IUM infants who weighed less than 2,040 gm at birth, 3 of 9 late-fed infants (24 hours) developed symptomatic hypoglycemia, while none of 6 early-fed infants (4 hours) developed such difficulty. The blood glucose values at 48 and 72 hours of age and response to glucagonepinephrine tolerance tests at 24 hours of life were significantly higher in the early-fed group. These observations suggest that the early feeding of infants with IUM, and birth weight below 2,040 gm may enhance glucose homeostasis in early neonatal life and prevent neonatal symptomatic hypoglycemia.
ENDOGENOUS RENAL TRANSPORT OF FREE AMINO ACIDS IN INFANCY AND CHILDHOOD
Authors: Brodehl Johannes , Gellissen Karl , Jäkel Annemarie
Published: December 2021

Endogenous renal transport of free amino acids was determined in 12 infants, between the ages of 16 days and 4 months, and in 12 children, between 2 and 13 years of age. Values of the serum concentrations, urinary excretion, renal clearance rates, net tubular reabsorption, and percentage tubular reabsorption of 17 amino acids were obtained by short-term clearance studies, including the determination of the glomerular filtration rate by inulin. The amino acids were determined by ion exchange chromatography.

A comparison of the values of infants and children revealed a specific feature of the kidney function in infancy. The urinary excretion of threonine, serine, proline, glycine, and alanine and the clearance rates of serine, proline, glycine, and alanine were significantly higher in infancy. The percentage tubular reabsorption of all amino acids was characteristically lower in infancy than in childhood, while the values of the net tubular reabsorption related to the glomerular filtration rate (TAA/CIn) were equal in both groups. These findings are thought to be due to a greater degree of heterogeneity of nephrons with increased glomerulotubular imbalance during the period of postnatal kidney development.
IgG-B1C CRYOGLOBULINS IN ACUTE GLOMERULONEPHRITIS
Authors: Grupe Warren E.
Published: December 2021

Eight children have been examined with cryoglobulinemia in association with acute post-streptococcal glomerulonephritis, representing 31% of patients admitted with that diagnosis in a 28-month period. The clinical features distinguishing these eight children include anemia (Hct <28%), a more marked elevation of the erythrocyte sedimentation rate than usually seen (>60 mm/hr) and hypergammaglobulinemia (>20%). The cryoglobulins have persisted from 2 weeks to 3 months after the onset of the renal lesion. Electrophoresis of fresh serum disclosed a distinct band with a mobility in the fast gamma region which disappeared with removal of the cryoglobulin; in these instances, the electrophoretic mobility of the isolated cryoglobulin was similar to the band seen in whole serum. All isolated cryoglobulins contained IgG and B1C globulins by immunodiffusion and immunoelectrophoresis; one of them contained trace amounts of IgA in addition and another contained small amounts of IgM.

Renal biopsy in four cases confirmed acute proliferative glomerulonephritis, and granular deposition of IgG and B1C along capillary loops has been observed by fluorescence microscopy in the three cases examined. Although their significance is unknown, the presence of a cold precipitable complex of IgG and B1C globulins in the serum and the presence of these same proteins in the glomeruli of children with this disease would suggest that cryoglobulins might be of immunopathologic importance in certain cases of acute glomerulonephritis.
Torsion of the Hydatid Testis: A Review of Thirteen Cases
Authors: Bender Leon , Prinz Leon , Presman David
Published: December 2021

The clinical and pathological findings in 13 cases of torsion of the hydatid testis are reviewed.

The etiology of this condition can be correlated with the morphological characteristics of the hydatid present in children and young adults.

Emergency exploration is mandatory because of the difficulty in differential diagnosis from torsion of the spermatic cord with gangrene of the testis.
Cystic Fibrosis in Non-Caucasian Patients
Authors: Oppenheimer Ella H. , Esterly John R.
Published: December 2021

The interpretation of a condition in genetically unusual circumstances is often handicapped by an atypical presentation, unusual course (variable penetrace?), or incomplete pedigree information, in addition to the constant hazard of unknown illegitimacy. For these reasons, the thorough study of two American Indian families with cystic fibrosis of the pancreas (Harris and Riley, Pediatrics, 41:733, 1968) is particularly valuable. The report prompted us to review the less satisfactorily documented non-caucasian patients with cystic fibrosis autopsied in the Johns Hopkins Hospital.
THE AGE OF ATTAINING BLADDER CONTROL
Authors: Oppel Wallace C. , Harper Paul A. , Rider Rowland V.
Published: December 2021

Data in life table form are presented from a 12-year prospective study of 859 children on the age of attaining bladder control for waking and sleeping hours by three indices: (1) age of initial dryness, (2) age of final dryness, and (3) the prevalence of dryness. By use of these indices the large contribution of relapsers to enuresis is seen.

The prevalence of bedwetting in the study population was greater than that reported in other studies; the validity of this finding is defended.

A larger proportion of female than male children attained both day and night dryness during the first 2 years of life. The percentage of Negro boys who first attained dryness was less than that of the other three race-sex groups after 2 years of age and was significantly less than that of Negro girls until 9 years of age.

One quarter of the 817 children who attained initial nighttime dryness by age 12 relapsed; these relapsing episodes had a median duration of 2.5 years. One tenth of 855 children who attained initial daytime dryness had relapses, and the median length of these was 1.2 years. Relapsing occurred much more frequently in Negro than Caucasian children; it also was seen more often in Caucasian males than in Caucasian females. Low birth weight children had a higher percentage of children wet for both waking and sleeping hours than did full birth weight children.
ABDOMINAL VISCERAL INJURIES IN BATTERED CHILDREN
Authors: Touloukian Robert J.
Published: December 2021

Five fatal cases of abdominal visceral injuries in battered children were summarized from the records of the Rhode Island State Medical Examiner's Office and the clinical files of the Rhode Island Hospital in a retrospective study from 1958 to 1967. Duodenal, proximal jejunal, pancreatic, and mesenteric injuries were the common findings and were usually accompanied by soft tissue bruising and ecchymosis. In this respect the patient's appearance was similar to that of battered children with coincidental craniocerebral and skeletal injuries. The high incidence of visceral injuries near a relatively fixed point is best explained by a punch or blow delivered to the mid-abdomen. A history of trauma inflicted by the parent or guardian is rarely elicited, but the diagnosis of "battering" should be suspected when the severity of the trauma is at variance with the history given.
DIAGNOSIS AND TREATMENT: PRACTICAL DIAGNOSTIC VIROLOGY
Authors: Wilfert Catherine M.
Published: December 2021

The clinician has several means for obtaining useful viral diagnostic information. Those for viral isolation require optimal conditions; specimens must be submitted quickly in an appropriate medium, with the information that is essential to the laboratory. Viral diagnosis may also be facilitated by pathological examination of tissues, body fluids, vesicles, and so forth. Viral culture information should be supplemented by appropriate serological studies done on acute and convalescent serum specimens. A brief discussion of the types of antibody measurement commonly used has been included.
Isolation of Hemophilus Species from Abscesses in Two Children
Authors: Sanders Doris Y. , Russell David A. , Gilliam Charles F.
Published: December 2021

Two infants with abscesses due to hemophilus species are reported. In both infants abscesses occurred at the site of previous penicillin injections. A brief review of unusual manifestations of hemophilus infections is presented.
ADVANTAGES AND COMPLICATIONS OF UMBILICAL ARTERY CATHETERIZATION IN THE NEWBORN
Authors: Cochran William D. , Davis Heather T. , Smith Clement A.
Published: December 2021

During a period of 5 years, 8 months, umbilical artery catheterization was performed on 387 infants in a newborn nursery. The indwelling catheter, at first introduced only to secure arterial blood for diagnostic and investigative purposes, was subsequently employed for intravascular fluid therapy in the same infant, and ultimately (in 51 of the 387 infants) for such fluid therapy alone. Complications observed were either vasospasm and temporary blanching of an extremity (13 infants: 11 surviving without apparent sequelae, 2 dying but without local complications at autopsy) or thrombosis, arteritis, or other inflammation noted at postmortem (18 infants).

Such complications were not causes of death at autopsy, but their finding suggests the need for limiting the procedure to infants in whom any other route of blood sampling or fluid administration is particularly difficult.
Acute Ethanol Intoxication in a Child
Authors: Dickerman Joseph D. , Bishop William , Marks James F.
Published: December 2021

Acute alcoholism is an important cause of morbidity and mortality in adults. The signs and symptoms of acute ethanol intoxication and the metabolic fate of ethanol in the body are well known.1 There are a few case reports of alcohol-induced hypoglycemia in young children2 and also case reports of withdrawal symptoms in infants of alcoholic mothers.3 Yet there is very little in the literature on the course, treatment, and prognosis of children with acute poisoning due to accidental alcohol ingestion. This report is designed to call attention to this entity, to describe a case whose blood alcoholic level was, as far as we know, the highest recorded in the pediatric literature in a survivor, to Suggest a mode of therapy, and, hopefully, to awaken pediatricians to thew possibility of ethanol intoxication in young children.
EFFECTS OF SINGLE UMBILICAL ARTERY LIGATION IN THE LAMB FETUS
Authors: Emmanouilides George C. , Townsend Duane E. , Bauer Robert A.
Published: December 2021

The effects of single umbilical artery ligation have been studied in 20 lamb fetuses, using chronic indwelling catheters placed in a retrograde fashion via the ligated umbilical artery in the fetal aorta. Fetal arterial blood pressure, heart rate, blood pH, PCO2 and PO2 were monitored at various intervals until the end of the gestation. The results indicate that prolonged fetal survival is possible. Although fetuses near term did not survive this insult, long-term survival (3 to 56 days) was observed in nine animals of earlier gestational age. After an initial period of hypoxia, acidosis, and hypercapnia, stabilization occurred and "normal" values for these parameters were observed. In spite of the apparently normal gas and hydrogen exchange between mother and fetus, profound fetal malnutrition was observed in two animals who survived 26 and 56 days, respectively. The possible mechanisms of fetal adaptation to this acute change in intra-uterine environment and the potential value of this "experimental model" for studying chronic fetal distress due to placental insufficiency are discussed.
SLEEP CYCLE CHARACTERISTICS IN INFANTS
Authors: Stern Evelyn , Parmelee Arthur H. , Akiyama Yoshio , Schultz Marvin A. , Wenner Waldemar H.
Published: December 2021

Within the sleep of adults and infants there are cyclic fluctuations between quiet and active sleep. These fluctuations may also persist during wakefulness as rest-activity cycles but are less readily detected. They constitute a fundamental biological rhythm on which other daily rhythms are superimposed.

In adults the rest-activity cycle is 90 minutes in duration. The quiet-active sleep cycles of term, 3-, and 8-month-old infants were determined by polygraphic recording of eye and body movements, respirations, and electroencephalogram. The cycle length at term was 47 minutes and 49 and 50 minutes at 3 and 8 months. The increase in cycle length with maturation was not significant, but there was a significant change in the proportion of quiet to active sleep within a cycle. At term they were equal, while at 8 months quiet sleep was twice as long as active sleep. Quiet sleep is a highly controlled state requiring complex feedback mechanisms. The increasing proportion of quiet sleep may be a significant measure of normal brain development.
Suck and Swallow in the Premature Infant
Authors: Gryboski Joyce D.
Published: December 2021

The determination of suck-swallow patterns and esophageal motility were performed on 40 premature infants between 1,700 and 2,500 gm birth weight. After initial mouthing, two types of suck-swallow patterns were noted. The first, "the immature suck-swallow pattern" consisted of a rate of 1 to 1.5 sucks per minute and consisted of short sucking bursts preceded or followed by swallows. The second, "the mature suck-swallow pattern" was characterized by bursts of over 30 sucks, and a rate of 2 per second. Swallows occurred frequently during sucking bursts. The smallest premature infants had poor penistalsis in the body of the esophagus and did not attain a "mature suck-swallow pattern" until after peristalsis had become propagative. It is postulated that the "immature suck-swallow pattern" prevents the delivery of a large amount of fluid which could not be handled by an esophagus which has not yet developed the ability for adequate peristalsis.
CORTICOSTEROIDS AS AN ADJUNCT TO TREATMENT IN BACTERIAL MENINGITIS
Authors: deLemos Robert A. , Haggerty Robert J.
Published: December 2021

Adrenal cortical steroids have been advocated as adjuncts to the treatment of severe bacterial infection, including meningitis. A double-blind controlled trial of the effect of large doses of methylprednisolone showed no significant differences between treated and placebo groups either at discharge from the hospital or 1 to 4 years later. There was a surprisingly large number (31%) of survivors who showed sequelae-mostly subtle perceptual motor problems.Methylprednisolone does not offer benefit to the usual patient with bacterial meningitis.
THERAPY IN CONGENITAL HYPERBILIRUBINEMIA: PHENOBARBITAL AND DIETHYLNICOTINAMIDE
Authors: Ertel Inta J. , Newton William A.
Published: December 2021

Two different drugs, phenobarbital and diethylnicotinamide (Coramine), were compared for their efficacy in treating congenital hyperbilirubinemia. Phenobarbital is known to be effective in reducing bilirubin levels in children and adults. The therapeutic effect of oral diethylnicotinamide has not been evaluated; the drug has only been used intramuscularly in newborn twins.

Two sisters, ages 4 and 10, with the clinical picture of the Crigler-Najjar syndrome were given therapeutic trials of phenobarbital and diethylnicotinamide. Both drugs lowered the serum bilirubin levels, but there were quantitative differences in their lowering effect. Phenobarbital (4 mg/kg/day, orally) caused a marked drop of the total bilirubin (from 23.6 to 4.8 mg/100 ml in the older child and from 11.6 to 2.4 mg/100 ml in the younger child), and both children became anicteric. Diethylnicotinamide (60 mg/kg/day, orally) was less effective in lowering their bilirubin. The lowest levels achieved in these two patients were 13.2 mg/100 ml and 8.8 mg/100 ml, respectively, and both remained jaundiced. There was also an enhanced lowering effect observed with a larger dose of phenobarbital (5 mg/kg/day) which was not observed when a larger dose of diethylnicotinamide (100 mg/kg/day) was administered.

These studies suggest that phenobarbital is the agent of choice for therapy of congenital hyperbilirubinemia. The medical indications for therapy are the prevention of kernicterus and the psychological advantage of rendering these children anicteric.
PLASMA INSULIN RESPONSE DURING ORAL GLUCOSE TOLERANCE TESTS IN NEWBORNS OF NORMAL AND GESTATIONAL DIABETIC MOTHERS
Authors: Pildes Rosita S. , Hart Robert J. , Warrner Richard , Cornblath Marvin
Published: December 2021

The plasma insulin, growth hormone, free fatty acids (FFA), and blood glucose responses to the oral ingestion of glucose were studied in eight infants of gestational diabetic mothers (IGDM) and in 11 normal newborns during the first 24 hours of life. Fasting blood sugars and growth hormone values were similar in the IGDM and the normal. Fasting plasma insulin values were significantly higher (14 ± 2 µU/ml) in the IGDM than those in the normal (7 ± 1 µU/ml), and FFA values were significantly lower (1268 ± 42 µEq/l versus 1627 ± 155 µEq/l). Blood glucose values at each sampling interval after the ingestion of glucose were significantly lower in the IGDM than those in the normal. Plasma insulin responses were prompt in the IGDM and delayed in the normal newborns; corresponding values at 30 minutes were 30 ± 6 µU/ml in the IGDM and 15 ± 3 µU/ml in the normals.
EFFECT OF ENVIRONMENTAL ILLUMINATION IN PREVENTION OF HYPERBILIRUBINEMIA OF PREMATURITY
Authors: Giunta Frank , Rath Jogeswor
Published: December 2021

A controlled study involving 96 babies weighing under 2,500 gm was done by placing 47 completely exposed infants, except for diapers, under environmental lights averaging 90 footcandles and 49 fully clothed infants under lights averaging 10 footcandles. A significantly lower serum bilirubin occurred in the light group from the second to the sixth day. Only three babies developed indirect bilirubin levels over 15 mg/100 ml in the light group against 14 in the control group. Exposure to this intensity of environmental lighting seems to be of much value in the routine treatment of premature infants for the prevention of hyperbilirubinemia.
EVALUATION OF VINCRISTINE SULFATE AND CYCLOPHOSPHAMIDE CHEMOTHERAPY FOR METASTATIC NEUROBLASTOMA
Authors: Sullivan Margaret P. , Nora Audrey H. , Kulapongs Panja , Lane Daniel M. , Windmiller Joan , Thurman William G.
Published: December 2021

Among 18 evaluated children with metastatic neuroblastoma who were treated with vincristine sulfate by the Pediatric Division, Southwest Cancer Chemotherapy Study Group, the overall response rate was only 28%. A cyclic regimen using vincristine sulfate and cyclophosphamide alternately weekly produced a response rate of 38% among 21 children. The median duration of remission in each of the treatment groups was 3 months. Previous reports of a high degree of effectiveness for the cyclic regimen could not be confirmed. The presence of definite antitumor effect, however, should encourage the further exploration of the potential of chemotherapeutic regimens as adjuvants to surgery and radiation and as prophylactic therapy for children in whom the disease has not yet become metastatic.
THE "IN VIVO SENSITIVITY TEST"—BACTERIOLOGY OF MIDDLE EAR EXUDATE
Authors: Howie Virgil M. , Ploussard John H.
Published: December 2021

During a 27-month study into the bacterial etiology of otitis media by needle aspiration and culture of the middle ear exudate, the efficacy of various antibiotics was evaluated. There were 858 episodes of otitis media studied with 1,233 aspirates and cultures performed, 271 of these during antimicrobial therapy-the "In Vivo Sensitivity Test." The antibiotics were prescribed to each patient on an individual basis with a general plan to alternate between two drugs during a given time period. When feasible, middle ear fluid was aspirated and cultured regardless of the patient's clinical response. Pneumococcus or H. influenzae was most effectively eliminated from middle ear exudate with ampicillin, phenoxymethyl penicillin with sulfonamides, and erythromycinsulfa. Long-acting sulfonamides, triple sulfonamide, and tetracycline are frequently ineffective against pneumococcus in middle ear exudate while benzathine penicillin, phenoxymethyl penicillin, and erythromycin are frequently ineffective against H. influenzae in middle ear exudate.
PENICILLAMINE-INDUCED NORMALIZATION OF CLINICAL SIGNS, AND LIVER MORPHOLOGY AND HISTOCHEMISTRY IN A CASE OF WILSON'S DISEASE
Authors: Falkmer Sture , Samuelson GÖsta , SjÖlin Stig
Published: December 2021

After 27 months of daily penicillamine administration (250 mg 3 or 4 times daily) a portal cirrhosis in a 10-year-old girl was found to have healed clinically and histopathologically.

This case shows that even an advanced portal liver cirrhosis in Wilson's disease can be healed by adequate penicillamine therapy. Hence, it is important that all patients with liver cirrhosis who are younger than 30 years of age are examined for any signs of Wilson's disease.

Copper metabolism studies with Cu64-labeled copper citrate revealed characteristic differences between the homozygote patient and her heterozygote parents and healthy subjects.
Cystic Fibrosis Presenting with Severe Hemorrhage Due to Vitamin K Malabsorption: A Report of Three Cases
Authors: Torstenson Ordean L. , Humphrey G. Bennett , Edson J. Roger , Warwick Warren J.
Published: December 2021

Three patients are discussed who presented with hemorrhagic diatheses who were subsequently diagnosed as having cystic fibrosis. Their prolonged prothrombin times and low levels of vitamin K-dependent clotting factors were due to vitamin K deficiency. In two patients we believe that the vitamin K deficiency was principally due to malabsorption caused by cystic fibrosis. In the third patient, malabsorption, diarrhea, antibiotic therapy, and low dietary intake all played a part in the development of vitamin K deficiency. Cystic fibrosis should be included in the differential diagnosis of patients under 1 year of age presenting with a bleeding tendency.
Letter To The Editor
Authors: Harrison Stanley L.
Published: December 2021

Dr. Clement A. Smith, Editor of Pediatrics, has forwarded your letter of February 11, 1970, on child abuse, to the Central Office of the Academy for reply.

I read with great interest your very thoughtul letter, with its proposal for child abuse centers similar to poison control centers to be located strategically in communities throughout the United States; and for the creation within the Academy structure of a standing committee on child abuse.

The Academy's Committee on Infant and Preschool Child has been very interested in this subject.