bluuebunny/crossref_metadata_2025 huggingface dataset:
BEDSIDE CABINET FOR THE NEWBORN INFANT DESIGNED FOR ROOMING-IN FACILITIES
Authors: MCLENDON PRESTON A. , PARKS JOHN
Published: December 2021

IT IS necessary to provide convenient and practical methods of infant handling in adopting the principle of rooming-in and selective feeding procedures. This is important, since the mother plays a prominent role in the daily care of her infant. The infant must be available to her for a greater part of the day. She deserves consideration in the ease with which she can handle her infant. The carriage for the newborn infant, therefore, becomes an all important link in this service.

The bassinet in use on the maternity service at the George Washington University Hospital fills most of these requirements. In the over-all planning of this service, the bassinet was designed to fulfill the following demands: 1. simplicity; 2. ease of cleaning; 3. mobility—to move to and from the mother's room; 4. drawers and compartments to store bedside and nursery equipment sufficient for complete care of the infant; 5. foolproof attachment to the mother's bed in adjustable positions; 6. moveable bassinet on top of the cabinet for convenient and easy lifting-out and replacing the infant; 7. clear plastic bassinet for observation of the infant by nurse and mother.

The cabinet-bassinet is easily moveable and is provided with 5 inch casters. The cabinet is 19 inches wide, 28½ inches long and 30 inches deep (legs included) surmounted by the bassinet held in a frame which can be pulled laterally for a distance of 18 inches, just clearing the top of the mother's bed. This places the infant in such a position that, without strain or awkwardness, he can be lifted out by the mother.
BRONCHIECTASIS IN CHILDHOOD
Authors: FIELD C. ELAINE
Published: December 2021

In a study of 160 cases of irreversible bronchiectasis in childhood the following observations have been made:

From the history given by the parents, it was found that the age at onset of symptoms lay in the first year of life in approximately one fifth of the cases, the number thereafter declining with advancing age (except for a slight and possibly insignificant rise at age 5). In 55.6% of cases the parental history associated the onset of symptoms with an attack of pneumonia or pertussis.

The characteristic features of the disease included a constant cough with or without sputum (this is often swallowed by children). Haemoptysis was rare, but in 33.1% of cases there were associated asthmatic symptoms. More children were underweight than overweight for age and many had abnormal chest deformities. Clubbing occurred in 43.7% and when present was diagnostic of irreversible bronchiectasis in this series. Physical signs in the chest were variable, but the most useful diagnostic finding was localized rales on deep inspiration over the suspected area of lung.

In comparison with nonpulmonary and normal children, there was a marked increased incidence of pneumonia at all ages. There was, however, no suggestion that bronchiectasis increased or decreased susceptibility to tuberculosis.

Sinusitis is frequently associated with bronchiectasis although its exact relationship remains obscure.

In diagnosis, roentgenographic findings are frequently inconclusive, unless confirmed by bronchogram. Bronchography is by far the most important diagnostic procedure and is an invaluable method of studying the development of the disease.

Tubular dilatation was the commonest type of bronchiectasis.

In 85.6% of cases the disease was situated in the left lower lobe, and in 65.6%, in the lingula lobe, but in no case was the lingula affected as the only lobe. The disease has shown a predilection for lobes whose bronchi are directed upwards against gravity towards the main bronchus and those which have an anatomic peculiarity impeding drainage.

Massive collapse of the lung was associated with bronchiectasis in 74 (46.3%) cases.

It is important to recognize in children that bronchial dilatation may be reversible. In the diagnosis of irreversibility, duration of the dilatation and its contour are helpful.

Bronchoscopy was not helpful in diagnosis or localization of bronchiectasis.

The sedimentation rate was frequently raised, but was of little help in assessing activity of the disease. Alterations in the blood count were few and usually only of significance in severe active cases of the disease.

Complications were infrequent, the commonest being pneumonia which occurred in 16.3% of cases.
STUDIES OF PENICILLIN IN PEDIATRICS
Authors: KAGAN B. M. , KISHNER L. , MILZER A. , SACKS M.
Published: December 2021

A study is made of the relative degrees of in vitro sensitivity to penicillin of various pathogenic bacteria. Different strains vary considerably in their sensitivity to penicillin. The concentrations of penicillin obtained in the serum following varying dosages per unit body weight in infants and children when given in the following forms are reported: crystalline sodium penicillin G in saline given intramuscularly; the same compound of penicillin in gelatin capsules and in cocoa-butter and beeswax suppositories given rectally; crystalline sodium penicillin G in sesame oil given intramuscularly, and crystalline potassium penicillin G in a new type Romansky formula given intramuscularly. The last preparation, when given in doses of 4,000 u./lb., maintained serum penicillin concentrations 24 hours after administration in 94% of cases, which was above the minimum concentration required to inhibit most strains of α and β Str. hemolyticus and of M. pneumoniae, and the serum concentrations obtained with this preparation 12 hours after administration were equal to or above the minimum concentration required to inhibit most strains of Staph. aureus hemolyticus and of meningococcus.
CHRONIC RESISTANCE TO SLEEP IN INFANCY
Authors: SPOCK BENJAMIN
Published: December 2021

TWENTIETH century America has no stable tradition about how children should be reared. In fact, it has a tradition against traditions. Parents in a quandary do not ask themselves what their own parents or grandparents would have done under the circumstances. They ask what is the latest theory. Twenty years ago, strictness and regulation were the psychologic and pediatric laws of the land. Now we are in the midst of a strong, even violent, swing in the opposite direction. The first impetus came from psychiatrists and educators who had observed the unfortunate effects on at least some individuals, both children and parents, of extreme rigidity in upbringing. Pediatricians began to experiment with new approaches. The so-called self-demand method of feeding, which seemed anarchistic when it was first reported only a few years ago, is now becoming the normal procedure in various parts of the country. There is a tendency to postpone weaning and toilet training and to inaugurate them with regard for the baby's readiness. It no longer takes courage for a physician or psychologist to advocate cuddling.

We seem to be moving in the right direction; a more friendly attitude toward babies, a more natural, relaxed regimen for their care, a respect for their individual needs and developmental levels is good for both them and their parents. But this swift transition is not without its difficulties. The same unstable responsiveness to a new theory, which 25 years ago made some people so enthusiastic for regulation, is today making the corresponding minority totally and uncritically devoted to self-regulation and self-expression.
A NEW REPOSITORY PENICILLIN (A FORM OF AQUEOUS PENICILLIN G PROCAINE) IN INFANTS AND CHILDREN
Authors: GEZON HORACE M. , CHOY DUKE CHO , HELLYER DAVID T. , SMITH WILLIAM H. , STRICKER FRED L.
Published: December 2021

Eighty-two children with a variety of infectious diseases were treated with a daily injection of a new repository penicillin, aqueous penicillin G procaine (Abbott).

Clinical success was obtained in 68 of 75 patients. In one, the results were considered fair, in three poor, and in three unknown.

Thirty-five patients had a beta Str. hemolyticus, and 10 a pneumococcus isolated from the nose or throat. Bacteriologic success was obtained in all streptococcal infections, but in only 6 of 10 pneumococcal infections.

All of the streptococci were sensitive to penicillin when tested by in vitro methods.

Penicillin serum levels with a mean maximum of approximately 2 u./ml. were observed at two hours, and mean minimum of approximately 0.063 u./ml. at 24 hours. The curve of intermediate values approximated a normal curve.
STREPTOMYCIN INTRAMUSCULAR DOSAGE PER UNIT BODY WEIGHT CORRELATED WITH SERUM LEVELS IN INFANTS AND CHILDREN
Authors: HUNT ANDREW D. , FELL MARY B.
Published: December 2021

Predictable serum levels of streptomycin can be obtained by calculating dosage on a basis of mg./unit body weight. Dosage can be determined in this fashion in all age groups.

The serum streptomycin levels following single intramuscular injections of 6.6, 11.0, and 15.4 mg./kg. body weight are graphically illustrated.

The serum level following a single intramuscular injection falls more slowly during the newborn period. This is probably the result of dehydration and consequent low urine output.

Healthy children with apparently normal kidney function show little accumulation of streptomycin in the serum during intermittent intramuscular injection at the three and six hour intervals.

Eleven mg./kg. body weight every six hours is recommended as a satisfactory dosage schedule when it is desirable to keep the blood streptomycin level constantly above 5 µ. per milliliter.
EMBRYOMA OF KIDNEY (WILMS' TUMOR) IN CHILDREN
Authors: DICKEY LLOYD B. , CHANDLER L. R.
Published: December 2021

A series of 12 cases of Wilms' tumor, in which the diagnosis was confirmed in all instances by examination of the gross or microscopic tissue, is reported, with a survival rate of 33.3%. Four patients are living and well, 4, 8, 10, and 15 years, respectively, after treatment. All recurrences appeared less than 10 months after treatment.

The sex incidence, and the sex survival incidence were exactly equal. Six tumors were in the left kidney, and six in the right.

Eight of the patients were under 2 years of age when first diagnosed and treated, and all were under 7 years.

The history of breast or bottle feeding was irrelevant.

In a large number of these and reported cases, the presence of the tumor was the first symptom, and in a considerable number the only symptom. This fact stresses the importance of careful physical examination of infants and young children, regardless of complaint, or of lack of it.

The finding of calcification in the tumor is possibly a good prognostic sign. All three patients in whom calcification was noted in the tumor are living and well.

Immediate removal of the tumor by transperitoneal nephrectomy, with postoperative radiation to the area, seems to be the advisable treatment.
WOLFF-PARKINSON-WHITE SYNDROME WITH CONGENITAL HEART DISEASE
Authors: KLEIBER ESTELLE E.
Published: December 2021

The syndrome of the shortened P-R interval associated with widened QRS as an anomaly of the conduction system of the heart has long been recognized in the adult.

Since few cases of Wolff-Parkinson-White syndrome have been reported in children in association with congenital heart disease, a case report is presented in a boy whose first episode of paroxysmal tachycardia occurred at seven months of age.

The diagnosis of congenital heart disease seems likely in view of the finding of a pronounced, widely heard systolic murmur first noted at the age of 2½ years, and never associated with rheumatism or other signs of infection.

A history of paroxysmal tachycardia in infants and children warrants cardiographic investigation between attacks.
MECHANISM OF EMERGENCE OF RESISTANCE TO STREPTOMYCIN IN FIVE SPECIES OF GRAM NEGATIVE BACILLI
Authors: ALEXANDER HATTIE E. , LEIDY GRACE
Published: December 2021

The following evidence has been presented as proof of the mutational origin of streptomycin resistant variants of five different species—E. coli, Salmonellae, Shigellae, S. typhosa and Ps. aeruginosa:

1. Demonstration of their independence of the action of streptomycin by showing their continuous irregular occurrence with different prevalence in independent cultures of same population size and strain.

2. Transmission of resistance unchanged in degree through many subcultures in the absence of streptomycin.

3. A low rate of occurrence of the resistant variants, not varying significantly among different strains of the same species.

A fraction of the resistant mutants of each of these five organisms grows poorly or not at all in the absence of high concentrations of streptomycin.

The therapeutic implications of these facts are discussed.
CURRENT TRENDS IN HEMATOLOGY
Authors: ZUELZER WOLF W.
Published: December 2021

IT IS a great honor to have been chosen for the first Mead Johnson Award of 1948. As I look over the list of the distinguished men and women who were the earlier recipients of this Award I am aware of the obligation imposed upon me by your choice. At the same time I am grateful for the encouragement which this recognition will mean to my associates and to myself in our future work.

It goes without saying that the contributions which form the basis of your selection were the result of the work and the ideas of many members of our group at the Children's Hospital of Michigan. I want to pay special tribute to the memory of the late Dr. Thomas B. Cooley who founded the hernatologic tradition in Detroit and who opened my eyes to the many interesting problems in this field.

A review of our studies on megaloblastic anemia of infancy was only recently presented to members of the Academy. To avoid repetition, I shall not summarize this work again in detail but merely take certain aspects of it as a pretext and point of departure for a larger and more pretentious subject which I propose to call current trends in hematology. In order to illustrate this theme, I shall draw freely on the work of others.

It is my belief that this topic is a timely one. In the last decade new tools of hematologic investigation have become available with the result that many basic concepts are even today undergoing profound modification. Because of the rapidity of these developments the newer concepts have not yet been generally applied in the clinical practice of pediatrics.
PSYCHOLOGIC ASPECTS OF POLIOMYELITIS
Authors: SEIDENFELD MORTON A.
Published: December 2021

While many more contributions may be made by the physician in caring for the child with poliomyelitis there are at least five principal areas in which he plays a major psychologic role in addition to his ordinary responsibilities in regard to medical care of the patient. These are:

(a) in dealing with the relief of the patient's psychologic reactions to the acute phase of the disease; (b) in reducing psychologic trauma attendant upon the removal of the patient from his normal environment and placing him in the treatment environment of the hospital or nursing institution; (c) by explaining and correcting misconceptions that the patient may have about his illness and its ultimate effects; (d) by aiding the parents to avoid erroneous concepts, feelings of personal guilt and improper attitudes toward their child and the family as a whole during the child's illness; and (e) by correcting community misconceptions regarding the needs of the child with polio and by fostering adequate community cooperation in helping disabled children make the best possible socio-economic and psychologic adjustment to life.
NEVOXANTHO-ENDOTHELIOMA WITH OCULAR INVOLVEMENT
Authors: BLANK HARVEY , EGLICK PAUL G. , BEERMAN HERMAN
Published: December 2021

Nevoxantho-endothelioma is a benign nevus with xanthomatous changes. It appears at birth or shortly thereafter. The process may occasionally be mistaken for sarcoma, but usually follows a benign course with crops of new lesions which eventually tend toward spontaneous involution. This case demonstrates that the eye can be involved by lesions having the same histologic structure as those of the skin. Because of the favorable course of patients suffering from this disease and the realization that visceral lesions may occur in nevoxantho-endothelioma, early diagnosis insures an accurate favorable prognosis.
IMMUNIZATION AGAINST PERTUSSIS DURING THE FIRST FOUR MONTHS OF LIFE
Authors: MILLER JOHN J. , FABER HAROLD K. , RYAN MARY LOUISE , SILVERBERG ROSALIE J. , LEW EDITH
Published: December 2021

Agglutinative reactions with H. pertussis were performed on 108 pairs of maternal and cord blood sera. A correspondence in titer within the range of experimental error was demonstrated in 77% of the pairs. Fifty per cent of the maternal sera contained demonstrable agglutinins. Transplacental transmission of antibody was demonstrated in 63% of the 54 sero-positive mothers.

Saline-suspended H. pertussis vaccine was administered to infants on the fifth day of life and repeated at one and at two months of age. With total doses of 50 billion H. pertussis only 15% of 41 infants produced agglutinins in a titer of 1-320 or higher—the level which in older children has been found consonant with clinical immunity. When the total dose in a second group of infants was increased to 100 billion H. pertussis, the above titer was demonstrated in 25% of 145 infants.

The serologic response of infants whose cord blood had contained no agglutinins was not superior to that of infants with agglutinins. Thus no depression of the immune response by transplacentally acquired antibody was demonstrable.

In a third group of 134 slightly older infants, saline-suspended H. pertussis vaccine was administered in a total dose of 80 billion cells divided into three monthly injections. The first injection was given at four to eight weeks of age. Forty-eight per cent of these infants manufactured agglutinins in a titer of 1-320 or higher. However, three months later only 36% were carrying this high titer. General febrile reactions were not uncommon and one proved case of mild pertussis occurred in this group.

In a fourth group of 151 infants, alum-precipitated H. pertussis vaccine was injected in a total dose of 40 billion cells divided into three injections at monthly intervals. The first injection was given at four to eight weeks of age. Only two febrile reactions, one associated with a local reaction which did not break down, occurred. Sixty-two per cent of 115 infants whose sera were tested four to eight weeks later developed H. pertussis agglutinins in a titer of 1-320 or higher. Twelve months later 60 per cent still carried these high titers. This satisfactory response at this age with this product is confirmatory of the studies of Sako, Treuting, Witt and Nichamin. It adds support to their thesis that active immunization with alum-precipitated vaccine can be accomplished before the sixth month of life.

A schedule for immunizations during the first year of life, embodying H. pertussis immunization beginning at four to eight weeks of age, is described.
HEMOPHILUS INFLUENZAE MENINGITIS
Authors: CROOK WILLIAM G. , CLANTON B. REED , HODES HORACE L.
Published: December 2021

The results obtained in the treatment of 110 infants and children with H. influenzae meningitis are presented and the various agents used in the therapy of the disease are evaluated. Eighty-seven (79%) survived. Sixty-eight (62%) recovered completely. Eight of the 23 deaths occurred within the first 24 hours after hospital admission. Slightly over one half the children were less than one year of age. Only 69% of this group survived as compared with 90% in the group over one year of age; only 50% of the younger group recovered completely as compared with 75% of the older group.

The plan of therapy underwent various modifications and additions during the eight year period covered in this study. Forty-four per cent of the patients were treated with specific H. influenzae rabbit antiserum and sulfadiazine; 48% were treated with these agents together with streptomycin (and in many instances penicillin). The remaining 8% were treated with streptomycin alone or in combination with sulfadiazine. The survival and complete recovery rates of those treated with serum, sulfadiazine and streptomycin were not significantly different from the rates of those treated with serum and sulfadiazine alone. The number of patients treated with streptomycin without serum was too few for analysis.

Specific antiserum used early and in large doses seemed to be a valuable therapeutic agent in these studies. It is believed that this antiserum should be used in the treatment of all patients except perhaps older children and younger children who are only mildly ill. The high cost of this serum, however, remains a major problem. Streptomycin undoubtedly is a valuable therapeutic agent in the disease; in this study, however, there has been no striking improvement in the over-all results since its introduction.

Sulfonamides and especially sulfadiazine appear to have been of limited but definite value in the treatment of this disease and their continued use in all patients is recommended. Penicillin when given in high dosages would also seem to be a helpful therapeutic adjunct when used along with other agents.

Follow-up data on 64 of the 87 surviving patients are presented.
LIMB-GIRDLE MUSCULAR DYSTROPHY: ITS LARGER SIGNIFICANCE
Authors: C. S.
Published: December 2021

The current literature reflects the interest of pediatricians, neurologists, and internists in the neuromuscular disorders of childhood.1-5 Clinical awareness and the availability and refinement of ancillary procedures, such as electromyography, measurement of nerve conduction velocities, determination of serum enzymes and muscle biopsies, have made it possible to differentiate many of these conditions and correctly localize the pathology of these lower motor neuron disorders to the anterior horn cells, the peripheral nerves, and/or the muscles.1

Primary muscle disease is the most frequent cause of progressive muscular weakness in children with neuromuscular disorders.2 The primary myopathies are either hereditary or acquired. The muscular dystrophies and the myotonic syndrome are representative of the genetic variety, while the acquired disorders are recognized clinically as polymyositis and dermatomyositis.
URINARY EXCRETION OF GONADOTROPINS IN CONGENITAL ADRENAL HYPERPLASIA
Authors: Stevens Vernon C. , Goldzieher Joseph W.
Published: December 2021

Four normal children and eight subjects with congenital adrenal hyperplasia (ranging in age from 4 to 29 years) were studied for their urinary excretion of steroids, follicle stimulating hormone (FSH), and luteinizing hormone (LH) under control conditions and during suppression with corticosteroids. In the normal children, urinary FSH and LH excretion was less than 0.5 and 0.24 I.U. per day, respectively, whereas in four of five children with congenital adrenal hyperplasia they were detectable and often of adult magnitude. Gonadotropin levels in the adult patients were more variable. Suppression of steroid output by corticosteroid therapy caused a fall of FSH in three of six patients. LH excretion was unchanged in five and rose in two. These findings suggest that the compensatory pituitary hyperactivity in congenital adrenal hyperplasia is not limited to the pituitary-adrenal mechanism but has repercussions in gonadotropin regulation as well.
RESECTION OF METASTASES IN WILMS' TUMOR: A REPORT OF THREE CASES CURED OF PULMONARY AND HEPATIC METASTASES
Authors: Wedemeyer Phillips P. , White James G. , Nesbit Mark E. , Aust Joseph B. , Leonard Arnold S. , D'Angio Giulio J. , Krivit William
Published: December 2021

Three cases of Wilms' tumor metastatic to both the lungs and liver are described. The first case had pulmonary metastases on three occasions. The initial episode was treated with radiation, the second by excision, and the third by combined chemotherapy. The second case also had three recurrences of pulmonary metastases; the first two were treated by excision and the third was treated by radiation followed by excision of residual tumor. Pulmonary involvement occurred only once in the third case and was treated by combined radiation and actinomycin D.

All three cases had hepatic metastases. Hepatic lobectomy was employed in two cases and radiation was used in a third. The apparent cure of these cases emphasizes the importance of vigorously applying the therapeutic modalities currently available.

The frequent use of surgical excision in these cases was based upon three advantages of this modality: minimal damage to normal tissues, undiminished effectiveness on repeated use, and ability to discover metastases otherwise undetectable. The indications for resection for pulmonary metastases are discussed. Hepatic lobectomy, previously unreported in Wilms' tumor, would appear to merit more extensive use.
RED CELL METABOLISM IN THE PREMATURE INFANT
Authors: Oski Frank A. , Smith Charles , Brigandi Ernestine
Published: December 2021

Erythrocyte glucose consumption was measured in the cells from premature and term in fants, adults, and subjects with reticulocytosis. Glucose consumption was related to red cell age as reflected in red cell G-6-PD and GOT activities. The erythrocytes of the premature infant appeared to consume less glucose than would be expected from their mean cell age.

Studies in reconstituted hemolysates indicated that the hexokinase reaction was the rate limiting step in cells from all groups and that glucose consumption could be markedly increased in newborn hemolysates by the addition of adenosine triphosphate. The presence of a different isoenzymatic form of hexokinase in cells of the neonate is discussed as one possible factor contributing to the difference in glycolytic rate.
POPLITEAL PTERYGIUM SYNDROME
Authors: Gorlin Robert J. , Sedano Heddie O. , Cervenka J.
Published: December 2021

The name of popliteal pterygium syndrome is suggested for a well defined complex that consists of popliteal pterygium (usually bilateral), intercrural pterygium, various digital anomalies that include hypoplasia or agenesis of digits, valgus or varus deformities of the feet and syndactyly, genitourinary anomalies (such as cryptorchidism, absent or cleft scrotum, inguinal hernia, hypoplasia or aplasia of the labia majora, and oral anomalies (such as cleft lip-palate, syngnathia and lower labial pits). There may also be filiform adhesion of the eyelids.

This syndrome is but one of perhaps 20 or more that involve clefting of the lip and/or palate. It is inherited as an autosomal dominant trait with variable expressivity. Rarely is it transmitted from affected parent to offspring due to genital hypoplasia. The authors point out the importance of the awareness of the surgeon who corrects the popliteal pterygium since the sciatic nerve runs beneath the fibrous septum that forms the free edge of the pterygium.
RELAPSE FOLLOWING AMPICILLIN TREATMENT OF ACUTE HEMOPHILUS INFLUENZAE MENINGITIS
Authors: Young Lily M. , Haddow James E. , Klein Jerome O.
Published: December 2021

A case of meningitis due to Hemophilus influenzae in a 6-month-old child treated with ampicillin is presented. The child had a recurrence of bacteremia with orbital cellulitis 3 days after the conclusion of 14 days of parenteral treatment with 200 mg per kilogram per day. Although a substantial amount of clinical experience has already been presented as to the value of ampicillin in acute bacterial meningitis due to the common agents, careful observation of each patient for signs of lingering infection is still necessary.

This case represents a failure of ampicillin to eradicate H. influenzae infection.
Letters to the Editor
Authors: Knox David L.
Published: December 2021

We appreciate Dr. Hart's compliments and his reminder of acute lead encephalopathy as a cause of VI palsy.
CYSTIC FIBROSIS IN THE AMERICAN INDIAN
Authors: Harris Robert L. , Riley Harris D.
Published: December 2021

Cystic fibrosis is a generalized, familial disorder exhibiting a marked ethnic variation. This paper presents the first two cases of this disorder reported in the American Indian population. The family pedigrees of these patients are described and certain genetic aspects of this disease are discussed briefly. Possible anthropological reasons for the occurrence of this disease in this racial group are mentioned.
TUMORS OF THE BREAST IN ADOLESCENT FEMALES
Authors: Daniel W. A. , Mathews Michelle D.
Published: December 2021

Ninety-five patients, 12 to 21 years of age, had tumors of the breast removed during a 10-year period. Fibroadenomas were found in 94% and none of the tumors were malignant. Symptoms were rarely of a degree to cause the patient to seek medical advice, and the tumors were usually found by the physician during the course of a complete physical examination. Laboratory procedures have not been effective in differentiating the types of tumors preoperatively in the adolescent age group. Careful physical examination remains the greatest diagnostic tool. Many girls who discover the tumor themselves erroneously assume it is malignant and may postpone medical examination due to fear or because they dread an assumed postoperative appearance. We advocate early discussion of the problem with the adolescent girl and teach her to examine her own breasts once a month. Hopefully, our program will prevent psychological trauma should she develop a mammary tumor.
THE ANAL SPHINCTER IN FECAL INCONTINENCE
Authors: Gryboski Joyce D. , Spiro Howard M. , Gelfand Martin
Published: December 2021

Anal sphincter characteristics were studied in eight children who had repair of an imperforate anus. Six of the eight had problems with fecal impaction and soiling. Resting yield pressure (RYP) was measured by gradual distension of a balloon within the sphincter and defined as the point at which a pressure plateau was reached and further distension of the balloon produced no further increase in recorded pressure. At this point the patients were asked to "squeeze down on the balloon" and this superimposed voluntary pressure was termed the "squeeze pressure." Both of these pressures were lower in the patients who had been operated on than in age-matched controls. Two patients who had developed continence had pressures approaching normal. Six patients with psychogenic constipation had sphincter pressures similar to the normal controls. This simple method of recording anal pressures may help to differentiate organic from non-organic types of fecal soiling.
A SWEDISH REGISTER OF CONGENITAL MALFORMATIONS
Authors: Källén Bengt , Winberg Jan
Published: December 2021

A national register of congenital malformations covering about 80,000 annual births is described. The registration is intended to serve as an early warning system, should a new teratogen become widely spread in the environment. Such an instrument is very much needed, since existing methods for evaluation of teratogenic effects of exogenous factors–-especially drugs and other chemical substances–give no reliable protection to the human embryo.

The essential of the registration procedure is that malformations observed during the newborn period are reported monthly to a malformation register by a verbal diagnosis or description–not by code numbers. The frequency of different malformations is thus kept under continuous control.

The method was tested with available Swedish data from the thalidomide period. The results suggest that, had the register been at work at that time, it should have identified an epidemic some 5 months after the appearance of the first thalidomide embryopathies.

A special effort has been made to analyze infants with multiple malformations. In only a minority of such cases can the child have been affected by two or more unrelated teratogens.
LISTERIOSIS AMONG NURSERY MATES
Authors: Florman Alfred L. , Sundararajan Venkatesan
Published: December 2021

Two newborn infants who had shared a nursery for 36 hours presented within 1 week of each other with generalized listeriosis. Since multiple cases among nursery mates are infrequent, these two cases are described in detail. The circumstances surrounding them are compared with those in two published reports of small nursery outbreaks. Together they support the possibility of an occasional newborn to newborn spread of L. monocytogenes. Review of the information which is pertinent for man suggests that, although the epidemiology of most instances of listeriosis is still unknown, it is a disease which needs to be considered more often by pediatricians.
MORTALITY RISK OF EXCHANGE TRANSFUSION
Authors: Weldon Virginia V. , Odell Gerald B.
Published: December 2021

The exchange transfusions performed at The Johns Hopkins Hospital over a 6-year period have been reviewed. During this period there were 351 exchange transfusions performed on 232 infants with 11 deaths. The mortality rates in the present series are as low as any in the literature, even though the procedures have been carried out by a large group of pediatric house officers. The mortality risk in the premature infants was no greater than that for the full-term infant.
AN EIGHTEENTH CENTURY FATHER ASKS HIS SON TO GET HIS HAIR CUT
Authors: C. T. E.
Published: December 2021

The current antipathy of many boys toward barbers is a common cause of friction between fathers and sons. It may comfort today's fathers to learn that other fathers in other times were similarly bothered, as is evident in the letter below written almost 200 years ago by Henry Fox to his son at Eton.

One thing you know I much wanted to see your hair cut to a reasonable and gentlemanlike shortness. You and some Eton boys wear it as no other people in the world do. It is effeminate, it is ugly and it must be inconvenient. You gave me hopes that if I desired it, you would cut it. I will, dear Ste (Steven), be much obliged if you will.1

Once again, plus ça change, plus c'est la méme chose!
Estimation of Nasotracheal Tube Length in Neonates
Authors: Coldiron John S.
Published: December 2021

Analysis of postmortem measurements of pre-term and term infants indicated that estimation of appropriate nasotracheal tube length from external dimensions is practical. Figures are presented by which proper tube length can be predicted.
CRANIOSYNOSTOSIS: A REVIEW OF 519 SURGICAL PATIENTS
Authors: Shillito John , Matson Donald D.
Published: December 2021

A review has been made of 519 patients with craniosynostosis operated upon at The Children's Hospital Medical Center from 1930 through 1966. The mortality rate was 0.39% and the overall morbidity rate was 14%. Lasting undesirable sequelae occurred in only 0.58%. Operation is carried out primarily for cosmetic purposes with the realization that by thus allowing the brain to resume its normal shape the possibility of any brain damage, local or general, has been minimized. Surgical technique is outlined. The frequency of the various combinations of suture closure, associated congenital abnormalities, familial incidence, occurrence of increased intracranial pressure, and the presence of a patent anterior fontanelle are indicated. The importance of partial involvement of a suture in the diagnosis and apparent progression of the condition is noted.
Lactic Dehydrogenase and SGOT in the Newborn
Authors: Lopez Rafael
Published: December 2021

In the November 1967 issue of Pediatrics (40:847) the following article is published: "Thrombocythemia in the Myeloproliferative disorder of Down's syndrome," by Miller, Sheril, and Hathaway. The following notation appears in the case report: "A lactic dehydnogenase of 6750 units (normal 100-350 units) SGOT of 58 units (normal of 8-40 units)." No time is given as to when the tests were carried out, but surely it was before 5 weeks, the date of expiration.

May I call attention to the fact that these values are not in accord with recent publications.
Letters to the Editor
Authors: Lucey Jerold F.
Published: December 2021

The points that Dr. Brent makes in his letter regarding pathology and interpretation of liver biopsies are good ones and I am pleased that he brought them up. I cannot agree with his suggestion that "anybody who is interested in acquiring this skill [needle liver biopsy] could do so in a short period of time whether he is based at a medical center or a small community hospital."
Phylogeny of Immunity, edited by R. T. Smith, M.D., P. A. Miescher, M.D., and R. A. Good, M.D. Gainesville, Florida: University of Florida Press, 1966, 276 pp. $15.00
Authors: Rosen Fred S.
Published: December 2021

It has been stated that the adaptability of higher organisms to environmental changes and stress is most vividly manifested by the organization of mind, the detoxifying versatility of liver, and the responsiveness of immune mechanisms. Thus, the evolutionary and developmental aspects of any of these systems are of broad biological interest, beyond the realm of the molecular biologists and their now incisive comprehension of E. coli. In two successive volumes the editors have assembled a distinguished collection of presentations in the balmy isolation of Sanibel Island, Florida.
SURVIVAL OF A PREMATURE SCOTTISH INFANT WEIGHING LESS THAN 1,000 gm IN 1815
Authors: C. T. E.
Published: December 2021

Even today with the best of pediatric and nursing care, survival of premature infants with a birth weight of about 1,000 gm is precarious. The description below by Dr. John Rodman of Paisley, Scotland, proves that a low birth weight infant could survive without an incubator or any of our contemporary regimens for the care of the such infants.1 Dr. Rodman's report gives a fascinating account of how premature infants were cared for in Scotland more than a century and a half ago. Being employed as accoucheur on the 19th of April 1815, when the mother who had born five children . . . attributed . . . premature labour to fatiguing exertions on the preceding day . . . I had the happiness to deliver her of a living male infant.

Not daring to allow the washing of this infant's body, he was speedily wiped and wrapped in flannel, with only an opening in the dress around his mouth, for the admission of air; and by the time the dressing was over, the mother was ready to take him into the warm bed with herself. It is common, if there be much apparent weakness, to feed a child the first twelve hours after birth very frequently, yet, in this instance, although the child was weak, no feeding was attempted till beyond that time; the nourishing heat with the mother in bed was relied on. . . . The child was kept regularly and comfortably warm by the mother and two other females alternately lying in bed with him, for more than two months. . . .
A SIMPLE, RELIABLE METHOD OF MEASURING GLOMERULAR FILTRATION RATE USING SINGLE, LOW DOSE SODIUM IOTHALAMATE I131
Authors: Cohen Melvin L. , Smith Fred G. , Mindell Robert S. , Vernier Robert L.
Published: December 2021

The renal clearances of sodium iothalamate I131 after a single intravenous dose of 10 µCi were compared with inulin clearances and endogenous creatinine clearances. In a total of 40 comparative studies made between the isotope and inulin clearances, correlation was excellent (r = .995) with a very small standard error (±5.9), suggesting that sodium iothalamate I131 clearance accurately measures glomerular filtration rate. In 43 comparative studies between endogenous creatinine and inulin clearances, correlation was good (r = .935) only when determined simultaneously, and even then the standard error was so great (± 18.7) that any individual creatinine clearance was of limited value.

In performing the isotope clearance, adequate hydration is maintained orally. Ten microcuries of sodium iothalamate I131 are injected intravenously. After a 30 to 60 minute equilibration period, the bladder is emptied by voiding and a blood specimen obtained. A timed, voided urine is then collected and again a blood specimen obtained at the time of voiding. Both blood specimens and the urine are counted in a well-type scintillation counter with gamma spectrometer. The mean of the beginning and end-point plasma radioactivity is used in the clearance formula. This isotope method is recommended as the test of choice in measuring glomerular filtration rate.
ACCELERATED NODAL PACEMAKER
Authors: Rodriguez-Coronel Alberto , Miller Robert A.
Published: December 2021

Acceleration of the nodal pacemaker can occur in children as a result of inflammation, drug toxicity, or trauma. The rapid nodal rate leads to A-V dissociation which may persist for days. In acute rheumatic fever a persistent nodal rate in excess of 80 per minute seems to be a highly specific indication of carditis often preceding other evidence of cardiac involvement. This arrhythmia is frequently seen after cardiac surgery, particularly when the atrial or the ventricular septum is the site of the operation. An accelerated nodal pacemaker can also occur due to digitalis toxicity. Hypokalemia appears to make children with congenital heart disease more susceptible to this arrhythmia. The A-V dissociation caused by an accelerated nodal pacemaker must be differentiated from the A-V dissociation seen in normal children with sinus arrhythmia. The cardiac surgeon should recognize that, although there may be complete A-V dissociation, he can separate this entity from surgically induced heart block because the nodal rate is over 80 per minute.
REYE'S SYNDROME: AMMONIA INTOXICATION AS A POSSIBLE FACTOR IN THE ENCEPHALOPATHY
Authors: Huttenlocher Peter R. , Schwartz Allen D. , Klatskin Gerald
Published: December 2021

Ten patients with the syndrome described by Reye and co-workers as encephalopathy with fatty degeneration of the viscera have been studied over a 5-year period. This disorder represents a rather common cause of acute, severe cerebral disturbance in childhood. It appears to include a great majority of the cases previously diagnosed as "acute toxic encephalopathy" and "acute brain swelling."

A prodromal illness, which was thought to be of viral etiology, was present in all of the children of the present series, and in two the prodrome consisted of typical chickenpox. The viral illness appeared to have run its course by the time the hepatic and central nervous system disorder manifested itself. Viral cultures at the time of the encephalopathy were negative. Abnormalities in selected liver function tests were striking, with marked elevations in SGOT in all patients and with evidence of ammonia intoxication in the three patients in whom blood ammonia levels were followed. Serum bilirubin, on the other hand, remained normal or only slighth elevated. In both the survivors and those with irreversible brain damage, there was a very rapid return of liver functions to normal. Histologic changes in the liver also disappeared rapidly and completely. There were five deaths in the series and one of the survivors was left with severe brain damage. Vigorous treatment for hepatic failure was attempted in three patients. The results of this therapy have so far been disappointing, with only one survivor. The etiology of this disorder remains obscure, but present evidence suggests that it is best classified as a postviral syndrome.
ESSENTIAL FAMILIAL HYPERCHOLESTEROLEMIA WITH XANTHOMATOSIS
Authors: Hould Fernand , Leclerc Roland , Marcoux Jean
Published: December 2021

Hyperbetalipoproteinemia, a syndrome characterized by an increased level of low density lipoproteins and their associated lipid components, is frequently manifested externally by xantholasma and xanthomata tendinosum and/or xanthoma tuberosum. A large kindred of 57 living members was extensively investigated and is described in detail in view of the rarity of such observations. Concerning the inheritance of such familial hypercholesterolemia, this study lends support to Wilkinson's views suggesting that severe generalized xanthomatosis is evidence of homozygosity.
TOOTH-RASHES AS DESCRIBED BY MICHAEL UNDERWOOD (1737-1820), THE FOUNDER OF MODERN PEDIATRICS
Authors: C. T. E.
Published: December 2021

I know of no contemporary pediatrician who believes that the cutting of deciduous teeth causes skin rashes. But, almost all the great figures in the history of pediatrics believed firmly that teething was associated with a riety of rashes. Michael Underwood, who more than anyone else laid the foundation of modern pediatrics, wrote about tooth-rashes as follows:

A very common rash, appears chiefly in teething children, which yery much resembles the measles, and has been sometimes mistaken for it. It is preceded by sickness at the stomach, but is attended by very little fever; though the rash continues very florid for three days, like the measles, but does not dry off in the manner of that disease. . . .

While the double or eye-teeth are cutting, I have noticed a rash Which at its first appearance is very similar to the above, and has likewise been mistaken for the measles. It, however, soon spreads into larger spots and patches of bright red, and afterwards of a darker hue, resembling the ill-looking petechiae which appear in bad fevers, but is, nevertheless, of a benign nature. It is, indeed, attended with some fever, arising possibly from the irritation occasioned by teething, and has been followed by small and hard round tumours on the legs, which softening in two or three days, always appear as if they would suppurate, though I believe they never do . . . [? erythema nodosum, T. E. C., Jr.]

I have seen a third kind of rash, in appearance resembling the measles, and, like it, covering the whole body, but with larger intermediate patches, like the eruption in the scarlet fever. . . .
DIAGNOSIS AND TREATMENT: PERORAL INTESTINAL BIOPSY
Authors: Shwachman Harry , Khaw Kon-Taik , Antonowicz Irene
Published: December 2021

Understanding of the function and appearance of the intestinal mucosa in health and disease has rapidly increased with the development of instruments for taking small intestinal biopsies by the oral route. Early studies in the adult, little more than a decade ago, employed a variety of ingenious devices developed by Royer and co-workers,1 Shiner,2 Crosby and Kugler,3 Rubin and co-workers,4 and others. Most of them "sucked up" a bit of the mucosal surface into a small orifice of a capsule, appropriately placed in the intestine, detached the section by a sharp knife blade, and withdrew it in the capsule. Early workers were understandably reluctant to study pediatric patients, but in recent years a number of pediatricians have used these devices effectively.

METHODS

Although the mucosal biopsy obtained from any segment of the small bowel generally weighs only 5 to 15 mg, it may be profitably examined by numerous techniques: the gross morphological, the histological, histochemical, biochemical, and electron microscopic. For routine study, considerable information can be gained by observing the specimen under a dissecting microscope and by histologic examination of carefully oriented and cut sections. Rubin has pointed out the difficulties and errors in interpretation of inadequately prepared sections. The plane of sectioning should be parallel to the villi and perpendicular to the luminal suface. Microtechniques for assay of disaccharidasese can be applied with a high degree of reliability. The activity of lactase, sucrase, maltase, and palatinase can be expressed as activity per unit of wet weight of tissue or per unit of tissue protein content.