bluuebunny/crossref_metadata_2025 huggingface dataset:
CHEMORECEPTOR REFLEXES IN THE NEWBORN INFANT: EFFECT OF CO2 ON THE VENTILATORY RESPONSE TO HYPOXIA
Authors: Brady June P. , Dunn P. M.
Published: December 2021

In the newborn infant, hypoxia has an initial stimulant but secondary depressant effect on breathing. To find out whether CO2 would augment this response, eight healthy term infants (6 hr to 11 days) were made hypoxic (Pao2, 60 mm Hg) at three different CO2 levels on 13 occasions. Ventilation was unaffected by 0.2% CO2 in air (Pao2, 110 mm Hg) and increased 6% with 0.2% CO2 plus hypoxia; with 2.3% CO2 there was a 43% increase in breathing at a Pao2 of 110 mm Hg and a 52% increase with hypoxia; with 4.4% CO2 there was a 151% increase at a Pao2 of 110 mm Hg and a 179% increase with hypoxia. This additional hyperventilation was poorly sustained, except in the 11-day-old infant, and breathing tended to decrease during the second and third minutes of hypoxia.

In six additional infants, a small but significant decrease in capillary pH occurred with 4.4% CO2 plus hypoxia.

Our findings suggest that CO2 does augment the initial stimulant effect of hypoxia in the newborn infant, but this is not sustained. The failure to maintain hyperventilation with hypoxia conveys no apparent benefit to the newborn infant.
CHLORPROPAMIDE TREATMENT OF DIABETES INSIPIDUS IN CHILDREN
Authors: Vallet H. L. , Prasad M. , Goldbloom Richard B.
Published: December 2021

Oral chlorpropamide therapy was assessed in 10 children with pitressin-sensitive diabetes insipidus. A significant increase in urine osmolality occurred in eight of nine children studied pre- and post-treatment, with concomitant reduction in urine output and free water clearance. Mean 24-hour urine output during control periods was 5,410 ml (range, 3,000 to 12,000 ml). On chlorpropamide therapy, mean output fell to 2,790 ml (range, 1,200 to 5,500 ml). Complete withdrawal of intramuscular pitressin therapy was possible in 9 of the 10 patients, and these children have now been maintained on chlorpropamide alone for periods of up to 12 months.

The principal complication of therapy was symptomatic hypoglycemia, which occurred in half the patients studied during the early phases of treatment. However, it was possible to eliminate this problem by reducing the dose of chlorpropamide while retaining sufficient antidiuretic effect to permit reasonable control of water balance. Current evidence suggests that the antidiuretic action of chlorpropamide may be due to enhancement of the sensitivity of the renal tubule to small amounts of vasopressin.

For many, though not all, children with pitressin-sensitive diabetes insipidus, chlorpropamide is a fairly effective therapeutic agent. It is readily accepted by the patients in preference to frequent intramuscular injections of pitressin.
Intra-abdominal Hemorrhage Complicating a Balloon Atrial Septostomy for Transposition of the Great Arteries
Authors: Ehmke D. A. , Durnin Robert E. , Lauer Ronald M.
Published: December 2021

In 1966, Rashkind and Miller1 described a non-surgical technique for palliation of transposition of the great arteries by using a balloon-tipped intracardiac catheter to create an atrial septal defect. This method has been frequently employed, as reported by several

[see pdf for the Figure]

authors2,3. The purpose of this report is to describe a patient with intra-abdominal hemorrhage as a complication of this procedure.

Case Report

A 2-week-old male infant was seen at The University of Iowa Hospitals with the chief complaint of intermittent cyanosis since birth. Physical examination, electrocardiogram, and chest x-ray were compatible with the clinical diagnosis of transposition of the great arteries.
Sodium Levothyroxine (Synthroid R) Intoxication in a Child
Authors: Funderburk Steve J. , Spaulding John S.
Published: December 2021

This article presents a 3-year-old boy who ingested a large dose of thyroxine and developed only a mild illness. From this and previously reported cases, it seems reasonable to expect relatively mild toxicity in children with thyroid poisoning, although desiccated thyroid, due to its triiodothyronine content, may produce acute symptomatology.
Parathyroids in Sudden Death in Infancy: Further Evidence of Normality
Authors: Valdes-Dapena Marie
Published: December 2021

With regard to the article of Ellis and Knight on the parathyroids in sudden death in infancy, I should like to record the fact that our own investigation of the subject was delivered in the form of a preliminary report in February 1969, at The Second International Conference on Sudden Death in Infancy, Eastsound, Washington.

Our data can be summarized. There were 85 infants who died suddenly and whose deaths were not explained at autopsy, and 50 control infants of similar age whose deaths were adequately explained at autopsy.
Letter To The Editor
Authors: Breslow Lester
Published: December 2021

We asked Dr. Breslow to comment. He wrote:

I am pleased that the papers by Dr. Yankauer and myself have stimulated a thoughtful response.

In response to the question which Dr. Marks addresses to me, I am not certain how we will finally induce physicians to go where they are most needed. An essential feature of any such "inducement," however, would probably be an opportunity to practice good medicine with reasonable and secure income.

The recent rapid and continuing changes in the attitudes of medical students and young physicians make it difficult to estimate how long they will "sustain their ideals."
Letter To The Editor
Authors: Hillman E. S.
Published: December 2021

We also asked Dr. Elizabeth Hillman, because of her association with the energetic McGill Student Health Organization in Montreal. She writes:

Dr. Mark's concern is a common one, but surely we can deal with the students' disinterest in the non-ivory tower pursuits by making them equally exciting if we really honestly believe they are exciting. We can't pretend. Personally, I do believe delivery of pediatric care can be rewarding and exciting, but only if one can keep experimenting with new methods; paramedical help, different kinds of groups, questionnaires, pre-registrations, programmed learning for parents, visual aids, team approaches to problems, and so on.
Further on Hiatus Hernia
Authors: Carré I. J.
Published: December 2021

In their article, Drs. McNamara, Paulson, and Urschel draw attention to the occurrence of respiratory complications in children with a hiatus hernia and gastro-oesophageal reflux. Despite their failure to obtain objective evidence of nocturnal aspiration, Dr. McNamara and his colleagues attribute the respiratory complications to the inhalation of regurgitated gastric contents while lying recumbent at night. In view of their contention, which I believe to be not only logical but correct, the results of a confirmatory study on this subject which I published 9 years ago based on observations recorded on 78 children aged 1 to 5 years with a partial thoracic stomach (hiatus hernia), have particular relevance and may thus be of interest to your readers.
ADOLESCENT ENURESIS: A UROLOGIC STUDY
Authors: Murphy Solbritt , Chapman Warren
Published: December 2021

Twenty-seven adolescent enuretics without known major organic pathology were submitted to urological investigation. Seventy-five percent of those with completed evaluations showed some form of organic abnormality. Urethral strictures and stenoses were the most common type of pathology found.

Physicians seeing these patients should be aware of the foregoing and obtain a minimum of a cystourethrogram and intravenous pyelogram on each patient as well as the more routine physical examination. The cystourethrogram was the most productive examination in terms of numbers, although some of the more major pathology was found on intravenous pyelograms.
CARE OF THE CRITICALLY ILL CHILD: MAJOR BURNS
Authors: Herrin John T. , Crawford John D.
Published: December 2021

Burns are the third most important cause of accidental death in childhood, outranked only by automobile casualties and drownings1. In the United States 12,000 deaths occur annually, but over the same period 2,000,000 patients are hospitalized for burns2. Among these, a very large numher of children must undergo prolonged, painful, and restrictive hospitalization from which they emerge with scars to both body and personality profoundly affecting their social and emotional development.

The tragedy is that the great majority of burn injuries are preventable. In the toddler stage the most common accident occurs when the youngster reaches up and pulls on a pot handle at the front of the stove, resulting in a scald of the extended arm, shoulder, and chest. With the advent of summer, burns from the outdoor barbecue become epidemic. These are flash flame burns of face, hands, arms, and chest, usually in boys, that follow explosive ignition of the outdoor fire on which the victim has poured gasoline, kerosene, or other highly flammable starter fluid. The pant-leg burn is prevalent during the autumn when the burning of leaves is common. At all seasons one encounters burns, principally of the chest when the loose, frilly nightdresses of young girls ignite from too close proximity with the open fire, gas range, or candelabrum. Mandatory treatment of cloth with fire retardants could greatly reduce the incidence of these injuries at a negligible cost. As early as possible children should be taught never to run should their clothing ignite but rather to fall to the ground and smother the fire by rolling.
Detection of Glass in Soft Tissue by X-ray
Authors: Felman Alvin H. , Fisher Mary S.
Published: December 2021

The widely held concept that glass must contain lead or other heavy metals to be seen radiographically is invalid; all glass, regardless Fig. 1. Fragment of unknown type of glass. Removed surgically. of type or lead content, is radiopaque and should be visible on a properly exposed and positioned radiograph. By varying the position and obliquity of the part to be x-rayed, the glass fragment may be thrown free of overlying structures. It is apparent that the chances of demonstrating glass on a radiograph will depend to some extent on the relative size of the fragment to that of the part examined, but the density of any fragment should be sufficient to differentiate it from surrounding tissue. In the usual clinical situation wherein one must decide on the presence or absence of glass in soft tissue, a properly positioned and exposed radiograph should provide the answer.

see pdf for figures
Letter To The Editor
Authors: Hughes Gerald E.
Published: December 2021

Dr. Gerald Hughes commented as follows:

I can share Dr. Guttman's feeling of amazement on finding the floral arrangements, since kindly touches of this sort are becoming quite rare. However, humiliation and disgust seem rather strong reactions to a gesture which could as well have been motivated by an expression of hospitality as by a desire to keep the product before the doctor. I would hope not to be so unfeeling as to hold all such gestures suspect.
Reduction of Phytohemagglutinin.— Induced Lymphocyte Transformation in Patients with Measles
Authors: Kadowaki Jun-ichi , Nihira Makoto , Nakao Thru
Published: December 2021

Fireman, et al. noted in your journal that administration of live attenuated measles (rubeola) vaccine temporarily suppressed the recipients' cutaneous delayed hypersensitivity and the in vitro transformation of their lymphocytes by specific antigens. Lymphocyte transformation by the non-specific mitogen phytohemagglutinin (PHA) was not suppressed. We have also observed that PHA-induced transformation was not suppressed in the lymphocytes of 30 subjects given attenuated measles vaccine.

We have studied the relationship between chromosomal aberrations and viral infections since 1967 and have found that lymphocyte blastic transformation rate (BTR) and absolute mitotic cell number (MCN) decrease transiently during the course of measles.
THE CLINICAL TOXICITIES OF L-ASPARAGINASE
Authors: Zubrod C. Gordon
Published: December 2021

The therapeutic activity of L-asparaginase, an enzyme that makes exogenous L-asparagine unavailable to cells, came suddenly to the attention of most physicians via the press. Unlike most such shooting stars, the light of these initial observations continues to shine. It is clear from the first publicationsl, 2 that L-asparaginase induces complete remissions in about 50% of patients with acute lymphocytic leukemia. This trial of L-asparaginase was based on the brilliant observations of Kidd,3 who discovered the effect of guinea pig serum upon mouse leukemia; of Broome,4 who proved this effect to be due to L-asparaginase; and of Mashburn and Wriston,5 who found that E. coli could be used as a source of the enzyme.
PLACENTAL CLEARANCE AND FETAL OXYGENATION
Authors: Battaglia Frederick C.
Published: December 2021

The flow-limited clearance of 3H2O or antipyrine has been used to define a maximum clearance across the sheep and rhesus monkey placentas. This has served as a reference point for comparison of rates of transfer of other solutes. In addition, these studies have shown that the sheep placenta functions as a concurrent flow system, emphasizing the importance of uterine venous concentrations in interpreting changes in umbilical venous blood.

A description of preparations is provided which permit repeated measurements of fetal and total uterine oxygen consumptions. These preparations have been used to study the effect of maternal hyperoxia, acute exposure to high altitude, and fetal exchange transfusions upon fetal oxygenation.
C AUTOSOMAL TRISOMY WITH MOSAICISM: A NEW SYNDROME?
Authors: Eys Jan van , Nance Walter E. , Engel Eric
Published: December 2021

The presence of a C trisomy with euploid mosaicism was observed in the blood and marrow cells of a 2-month-old boy. The autosomal nature of the supernumerary chromosome was inferred from the absence of sex chromatin bodies, the lack of "drumstick" appendages on polymorphs, and a failure to identify a late-replicating member among the submedian chromosomes of aneuploid cells which were studied by autoradiography.

Malformations included an asymmetrical head, corneal opacity, abnormal ears, tapered fingers with joint limitations, anomalies of the right kidney, and a probable congenital heart defect. Analysis of amino acid excretion revealed a high renal clearance for proline, hydroxyproline, and glycine. The patient's condition has been compared to seven other patients with a C trisomy, five of which had euploid mosaicism. Certain recurrent findings, such as normal stature, advanced bone age, skeletal anomalies, particularly of the ribs and vertebrae, narrow pelvis, joint limitations, finger retractions, and hypertonicity, were noted. Therefore, it is possible that a rare trisomy for a C autosome exists which may be responsible for a definite syndrome.
STATEMENT OF PURPOSE, SCOPE, AND FUNCTION
Authors: Grossman Herman , Altman Donald , D'Angio Giulio , Gwinn John , Tefft Melvin , White Harvey , Wilkinson Robert , Baker David H. , Kirkpatrick John A. , Shopfner Charles E.
Published: December 2021

The Committee on Radiology of the American Academy of Pediatrics was created to improve the general care of children as it pertains to radiology. Its primary purposes are to keep the physicians who are responsible for the welfare of children informed of new procedures and techniques in radiology, and to present a balanced view of the benefits and hazards inherent in diagnostic and therapeutic procedures using ionizing radiations, including those emanating from radioactive isotopes. Communication will be established with pediatricians, surgeons, and others caring for children to introduce new roentgenographic examinations of proven value and to discourage the use of multiple or unnecessary procedures.

The Committee also will have responsibility in the field of medical education. It will work with the Committee on Medical Education of the Academy to improve training in pediatric radiology during residency training and in postgraduate courses for pediatricians.

It will be the goal of the Committee to also work closely with other action committees of the Academy, such as the Committee on Environmental Hazards and Neoplastic Disease, and with committees and section committees of the Academy (i.e., Urology, Surgery, Cardiology, and diseases of the Chest). In many subspecialty areas of pediatrics, the diagnostic information, research potential, and critical evaluation provided by the pediatric radiologist has not been fully appreciated.

Concept and methods in radiotherapy are advancing and changing rapidly. General principles pertaining to uses of radiotherapy will be presented by this Committee rather than the treatment of specific disease entities. Long-term survivors treated with radiotherapy are now being evaluated, and the various complications will be reviewed by the Committee.
NEONATAL HYPOCALCEMIA IN LOW BIRTH WEIGHT INFANTS
Authors: Tsang Reginald C. , Oh William
Published: December 2021

During an 8-month period, 37 of 124 infants (29.8%) admitted to a low birth weight (LBW) nursery developed hypocalcemia at a mean age of 29 hours. Ten factors were associated with hypocalcemia, three of which appear particularly relevant: (1) low gestational age (32 weeks or less) with appropriate birth weight, (2) low oral calcium intake, (3) correction of acidosis with NaHCO3. Biochemical determinations showed that, in hypocalcemic infants, there were: (1) lower serum total calcium values at 8 hours of life, prior to the actual development of hypocalcemia at 29 hours; (2) elevated serum phosphorus values; (3) acidotic values in the first hours of life, corrected to normal values at the time of hypocalcemia, and (4) lower serum protein values at 8 hours of life. Three signs were significantly related to hypocalcemia, namely, twitching of one or more extremities, high-pitched cry, and hypotonia.
IDIOPATHIC, RECURRENT CHOLESTASIS
Authors: Ruymann Frederick B. , Takeuchi Akio , Boyce H. Worth
Published: December 2021

Idiopathic, recurrent cholestasis is characterized by episodes of obstructive jaundice often preceded by pruritus, steatorrhea, and purpuric rash. Between episodes of jaundice the liver histology is normal. We report a case of idiopathic, recurrent cholestasis occurring in a 14-year-old Caucasian girl who has experienced seven episodes of jaundice since 8 years of age. Serum alkaline phosphatase elevation preceded clinical jaundice. During remission the bromsulphalein excretion was normal. Response to oral steroids occurred when used after 4 weeks of jaundice. Cholestyramine resin and cyproheptadine relieved pruritus and in combination may have prevented progressive jaundice when administered early. Light microscopy during exacerbation showed centrilobular cholestasis with a slight mononuclear infiltration of the portal triad.

The electron microscopic examinations demonstrate dilated bile canaliculi with altered microvilli. Serial liver biopsies over 6 years show no fibrosis or cytoplasmic alterations of hepatocytes. Of the 24 reported cases of idiopathic, recurrent cholestasis, two-thirds have been in males and had onset of jaundice under 20 years of age. This younger age of onset merits a greater awareness by the practicing pediatrician. After the diagnosis is established by clinical, biochemical, and morphologic studies, a benign course can be anticipated.
WHAT TO LOOK FOR IN A WET-NURSE ACCORDING TO JOHANNES WENDT WRITING IN 1827
Authors: C. T. E.
Published: December 2021

The following is the beau ideal of a good nurse, according to Dr. Wendt:

Youth, fullness of health, plenty of milk, and good build of breasts and nipples—a rather phlegmatic temperament—a quiet disposition, and no inclination to sensuality or dissolute habits—a white, delicate skin traversed by blue veins, and covered with freckles—fair or reddish hair, large blue eyes, sound teeth, a fresh breath, a clean skin, no disagreeable odor, no unnatural discharges, a bluishwhite—rather thin, than thick and tenacious milk, which dropped upon the thumb-nail flows off rather quickly—it should have no smell, and a mildly sweet taste—along with these, large and firm nipples, a cleanly person, and a harmless temper—form the ideal of a good nurse.

Soranus (A.D. 98-117) of Ephesus is the first writer to mention the method of testing the breast milk by the behavior of a drop of milk which was placed on one's finger-nail.2 This test continued in use for more than 1,700 years.
RIBOFLAVIN ABSORPTION AND EXCRETION IN THE NEONATE
Authors: Jusko William J. , Khanna Narinder , Levy Gerhard , Stern Leo , Yaffe Sumner J.
Published: December 2021

The absorption and excretion of riboflavin, a vitamin which is absorbed in adults by a saturable transport process in the proximal small intestine, was investigated in healthy, 5-day-old infants. After oral administration of a saturation dose of the vitamin (150 mg/sq m), the urinary recoveries of riboflavin in the neonates were similar (about 7% of the dose) to those obtained previously in 3-to 6-month-old infants. However, the maximum excretion rate (per unit of body surface area) of riboflavin was much lower and the duration of maximum excretion rates was much longer in the neonates than in older infants. Data obtained after parenteral administration of riboflavin show that the low maximum excretion rate was not due to limited renal capacity and that the longer duration of excretion was due to prolonged absorption of the vitamin from the intestinal tract.
Aberrant Serum Protein Inheritance in a Patient with a Ring D Chromosome
Authors: Daniel William L.
Published: December 2021

A ring D chromosome was observed in 67% of the peripheral leukocytes from a patient with microcephaly, mental deficiency, micrognathia, protruding nose, and other minor congenital malformations. Chromosomal mosaicism was also evident in the cells from this patient. Approximately 26% of the cells lacked the ring or exhibited random loss of B, C, D, or E group chromosomes. A deficiency of a posttransferrin protein band was observed in the patient. Further tests failed to demonstrate identity of this protein with haptoglobin, transferrin, ceruloplasmin, or the major immunoglobulin groups. The possible causal relationship of a deletion with the deficiency of the serum protein is discussed.
The Infectiousness of the Tuberculin-Positive Child
Authors: Briceman Helen , Wise Melvin B. , Beaudry Pierre H.
Published: December 2021

We read with interest the account by Burchak and Turner1 of their policy of treating tuberculin reactors with INH. These authors thus join many other centres, including our own, in implementing the recommendations of the American Thoracic Society and of the Fourth National Tuberculosis Conference of Canada.

However, we do not share their concern that tuberculin reactors may infect their contacts. For we are indeed impressed with the overall low infectivity of pulmonary tuberculosis in childhood: the rarity in children of highly infectious lesions such as acute laryngeal tuberculosis and lung cavities, the paucity of tubercle bacilli in the gastric contents of children with primary lesions, let alone in their sputum (usually absent), and the rarity of cough needed to render these scanty organisms airborne, all explain why tuberculous children can scarcely give out airborne tubercle bacilli in concentrations known to be required to cause infection.2
REFLEX-ARC LATENCY MEASUREMENTS IN NEWBORN INFANTS AND CHILDREN
Authors: Eisengart Marvin A.
Published: December 2021

Measurements of biceps reflex latency were made in newborn infants, older infants, and children at the National Naval Medical Center and in infants and children at a child and youth clinic in the District of Columbia. Relating reflex latency to a standard skeletal measure, an average "reflex velocity" was calculated which reliably reflects the maturational changes reported for motor nerve conduction velocity.

In newborn infants reflex velocity was found to be more closely related to gestational age than to birth weight.

There were no differences found in the absolute values or rates of maturation of reflex velocity among the children in the two clinic populations.
HEREDITARY ONYCHO-OSTEODYSPLASIA (THE NAIL-PATELLA SYNDROME) WITH NEPHROSIS-LIKE RENAL DISEASE IN A NEWBORN BOY
Authors: Similä Seppo , Vesa Liisa , Wasz-Höckert Ole
Published: December 2021

A newborn boy is presented with proteinuria, edema, aplasia of patellae, and extension defect in the elbows. Seven of his relatives have, or have had, nephropathy and skeletal deformities and two of them have only skeletal deformities.

Spontaneous recovery of proteinuria and edema occurred at 2 weeks of age. The family history, clinical signs, and rapid improvement in the patient's condition confirmed the diagnosis of hereditary onycho-osteodysplasia (HOOD) with neonatal nephrosis-like disease. Other causes of the neonatal nephrotic syndrome, such as congenital nephrosis, congenital syphilis, and renal vein thrombosis could be excluded. The patient described remained symptomless, with the exception of skeletal deformities until the age of 24 months. The incidence and prognosis of nephropathy in HOOD is discussed on the basis of the reported family and data from the literature.
DEVELOPMENTAL BIOCHEMISTRY—A RELEVANT ENDEAVOR
Authors: Kretchmer Norman
Published: December 2021

The Borden Award is usually given to one investigator, but he is always indebted to a group of colleagues, and to his teachers, without whose help and understanding he could not have attained this achievement.

My colleagues I will note, but my teachers are many. Biochemistry was taught to me by Dr. G. O. Burr and the devotion of the late Dr. C. P. Barnum.

The beauty of the cell, the intrigue of scientific endeavor, and the mystery of syntax and medicine were the gifts of a most exceptional man, Dr. Jean Oliver. Pediatrics and its lure I learned from my teachers and friends, Dr. H. Barnett and Dr. S. Z. Levine.

I owe particular gratitude to the faculty and staff of the Department of Pediatrics at Stanford University for their tolerance and loyalty.

Finally to Miss R. Hurwitz and Miss H. MacNamara I will be forever indebted for their unselfish devotion and efforts in my behalf.

It is only fitting that on this occasion I thank all of them for their compassion, understanding, and patience.

For some years it has been the custom for the recipient of the Borden Award to review those scientific accomplishments which resulted in his selection. In general, I will follow this tradition, but in view of recent events in Bethesda, and on medical school campuses, I would like to take some advantage of the freedom of the podium and respond to the accusations of irrelevance launched at many aspects of medical science.

"We need relevant activities," is the cry not only of the youth of the western world, but also of our relatively conservative government agencies.
INTELLIGENT, SMALL FOR DATES BABY BORN TO OLIGOPHRENIC PHENYLKETONURIC MOTHER AFTER LOW PHENYLALANINE DIET DURING PREGNANCY
Authors: Arthur L. J. H. , Hulme J. D.
Published: December 2021

Routine Phenistix urine testing in antenatal clinics in Derby (5,000 births annually) revealed an undiagnosed case of phenylketonuria in an otherwise healthy young married woman of I.Q. 65. A synthetic diet containing 30 mg/kg/day of phenylalanine kept her blood level between 2 and 6 mg/100 ml. Pregnancy was terminated at 38 weeks, with the birth of a 1,910 gm girl whose sole physical abnormality, apart from low birth weight, was a single umbilical artery. After a transient tyrosinemia she has developed normally; her growth recovered to about the 25th percentile. Her developmental quotient at 10 months of age was 98. It may be as suggested by Auerbach that positive urine tests for phenylketones in the mother are a better guide to risk of fetal brain damage than arbitrary levels of blood phenylalanine, in that this gives a direct indication of body handling of the raised blood phenylalanine. However, we still do not know if the baby has normal intelligence because of, or in spite of, the diet.
RADIOLOGIC DEMONSTRATION OF POSTNATAL LIQUID IN THE LUNGS OF NEWBORN LAMBS
Authors: Fletcher Barry D. , Sachs Barry F. , Kotas Robert V.
Published: December 2021

The liquid which occupies the potential air spaces of the fetal lung is, at birth, displaced by air and removed by the pulmonary blood and lymphatic circulations. Delayed resorption of this liquid from the interstitial spaces may be associated with decreased lung compliance and be the cause of the syndrome "transient tachypnea of the newborn." Chest roentgenograms of these infants have shown the presence of alveolar and interstitial edema and pleural effusions which cleared during the first few days of life.

We chose to test the possibility that a delay in clearance of lung liquid might occur and be associated with tachypnea and radiologic evidence of pulmonary edema in newborn lambs.

Serial chest radiographs were obtained in 18 newborn lambs delivered at term by Caesarean section. The radiographs demonstrated the presence of lung liquid which gradually cleared in an average time of 2 hours following onset of breathing. Lung weight—body weight ratios obtained following sacrifice at various stages of clearing—decreased as pulmonary aeration increased. Microscopic examination of the lungs showed no evidence of inflammatory exudate or squamous debris but distension of perivascular tissues with liquid was demonstrated. An association between increasing lung aeration and decreasing respiratory rates was found.
CLINICALLY SIGNIFICANT PHYSIOLOGIC CHANGES FROM RAPIDLY ADMINISTERED HYPERTONIC SOLUTIONS: ACUTE OSMOL POISONING
Authors: Kravath Richard E. , Aharon Albert S. , Abal Güner , Finberg Laurence
Published: December 2021

The rapid injection of hypertonic solutions, e.g., 0.9M sodium bicarbonate, creates a potential hazard from intracranial hemorrhage secondary to the shift of water from the CNS and the accompanying fall in cerebrospinal fluid (CSF) pressure. CSF pressure and other relevant variables were followed as 2.5M sodium chloride in a dosage of 10 mEq/kg given intravenously to cats over periods of 3 and 60 minutes. The fast infusion produced a sharp rise in CSF pressure followed by a precipitous fall. The rise parallelled the rise in venous pressure and fall in hemoglobin secondary to a transient increase in plasma volume. The slower infusion produced neither the sudden rise in CSF pressure nor the marked expansion of plasma volume, but did produce the same fall in CSF pressure. The rise in plasma volume and fall in hemoglobin concentration following a rapid hypertonic infusion may transiently improve the appearance of a cyanotic patient without necessarily improving his oxygenation. Since the osmolal load of these experiments is in the range of current clinical usage, when such osmolal loading is necessary, slow administration is suggested to avoid hemorrhage.
Preferable Antibiotics for Neonatal Sepsis
Authors: Franciosi Ralph A.
Published: December 2021

A recent survey (see Figure 1) of antibiotic sensitivity of various organisms in our microbiology laboratory has raised a serious doubt in my mind as to the security most people may feel in treating neonatal sepsis with a combination of ampicillin and kanamycin. Since the majority of neonatal sepsis is secondary to gram negative organisms, particularly E. coli, our finding that 66.6% of E. coli were sensitive to kanamycin and 63.7% to ampicillin was bothersome.
ATTITUDES TOWARD HEALTH AMONG CHILDREN OF DIFFERENT RACES AND SOCIOECONOMIC STATUS
Authors: Marshall Carter L. , Hassanein Khatab M. , Hassanein Ruth S. , Paul Carol L.
Published: December 2021

The semantic differential, a means of measuring attitudes, was administered to 178 fourth grade students to compare attitudes toward health. One school was composed almost entirely of black children from the inner city, the other contained white children from upper middle class homes.

When the children were divided into the two groups by sex, differences between the groups were not statistically significant but there were highly significant differences between the races. Generally, white children held more positive attitudes toward health personnel and health institutions than black children, while on the average black children were less concerned about sickness than white children. Whether these differences in attitude are in some way ethnically determined or based rather on a "culture of poverty" could not be determined from this study.
ILLNESS AFTER HEALTH SUPERVISION VISITS
Authors: Hurst Peter L. , Greenlick Merwyn R.
Published: December 2021

The incidence of infectious disease was recorded in infants under 2 years of age following clinic visits for health supervision.

The infants were randomly assigned to clinics especially reserved for well babies and clinics where well and sick babies and children were mixed.

No difference in incidence of infection during a 30-day post-clinic visit period was noted.

Also, the onset of illnesses was scattered over the 30-day period in both groups and not clustered within a few days following the visit, as would be expected if the infections were contracted at the clinic.

It is concluded that the infectious disease risk of a health supervision visit under conditions of ordinary office and clinic pediatric practice is not sufficiently great to warrant special isolation precautions.
AN ABNORMALITY OF KERATIN IN THE HARLEQUIN FETUS
Authors: Craig John M. , Goldsmith Lowell A. , Baden Howard P.
Published: December 2021

A harlequin fetus was born to unrelated parents with a negative family history for any form of ichthyosis. The child was grossly deformed, showing thick plaques on the cutaneous surface, and survived only 48 hours. Pathological studies of the skin showed marked thickening of the stratum corneum, but no other distinctive changes. X-ray diffraction analysis of the horny layer revealed the presence of a cross-β fibrous protein rather than the usual α-protein. The epithelial surface of other organs appeared normal. The thymus gland was involuted and showed changes in the corpuscles. Abnormalities were also observed in the conversion of cartilage to bone.
Marijuana and the Pediatrician: An Attitude Survey
Authors: Abrams Alfred L. , Dessauer Bonnie L. , Shenker I. Ronald
Published: December 2021

It has become increasingly clear in the last year that the use of marijuana by today's youth is escalating to epidemic proportions. The number of articles on this subject appearing in popular and scientific journals, as well as the amount of news and editorial coverage by our newspapers, attests to this fact. Mounting public concern has been accompanied by ambivalent attitudes. Many ask: is it safe? Does it have less effect than alcohol? Will it trigger psychological problems? And will longterm usage have deleterious physical effects? These and other questions are being raised. Yet, opinions by the population in general and the professionals in particular are varied and often diametrically opposed.
INFANT METHEMOGLOBINEMIA
Authors: Filer Lloyd J. , Lowe Charles U. , Barness Lewis A. , Goldbloom Richard B. , Heald Felix P. , Holliday Malcolm A. , Miller Robert W. , O'Brien Donough , Owen George M. , Pearson Howard A. , Scriver Charles R. , Weil William B. , Kine O. L. , Cravioto Joaquin , Whitten Charles
Published: December 2021

In the United States and Canada, processed infant foods have not been implicated in methemoglobinemia associated with food or water intake in infants. Although raw spinach and beets have a higher nitrate content than do other infant foods, one or more protective factors may prevent the extrinsic or intrinsic formation of toxic levels of nitrite from these foods as commercially processed for feeding of infants.

Nitrate contamination of drinking water which may occur from run-off from fields fertilized with nitrates, represents a potential hazard.
Handbuch der Kinderheilkunde, Herausgegeben von H. Opitz and F. Schmid, Band VIII/1, Neurologie, Psychologie, Psychiatrie. Berlin / Heidelberg / New York: Springer-Verlag, 1969, 1060 pp., $96.25 (in German)
Authors: Eichenwald Heinz F.
Published: December 2021

The reader of these pages is probably wondering if this series of German Books (and reviews) is ever going to be completed. Courage, dear friend, after this volume only two more are scheduled for publication (Volume VIII, Part 2—Tumors, and Volume I—Growth and Development).

In previous reviews we have praised the scholarly and exhaustive approach of the editors and their colleagues, the clarity of expression, the lack of unnecessary duplication, and the high quality and even beauty of illustrations which together with the use of fine paper, error free and elegant typography, and sturdy bindings make these books a pleasure to read and to refer to.
CORTICOSTEROIDS IN THE TREATMENT OF ENGELMANN'S DISEASE: PROGRESSIVE DIAPHYSEAL DYSPLASIA
Authors: Allen David T. , Saunders Alex M. , Northway William H. , Williams Gordon F. , Schafer Irwin A.
Published: December 2021

Engelmann's disease, progressive diaphyseal dysplasia, is a rare disorder of bone of unknown etiology characterized clinically by muscle weakness, waddling gait, and crippling leg pain. The diagnosis is confirmed radiologically by sclerotic thickening of diaphyses of long bones and histologically by the absence of osteoclasts with definite evidence of decreased bone remodeling.

Three affected children who were treated with corticosteroids showed remission of clinical symptoms. In one boy, tetracycline labeling was performed and biopsied fibular bone was studied histologically and by microradiographs prior to steroid administration and 4 months later. The administration of steroids in this patient was associated with increased bone resorption and histologic evidence of osteon formation with secondary remodeling. The mechanism through which steroids act, remains undefined, but based on changes found in bone histology, we believe that the clinical improvement in this patient is related to specific changes in bone physiology produced by the drug. In this disease, corticosteroids appeared to stimulate osteoclasis, decrease lamellar bone deposition, and thereby produce a more normal histologic picture in bone, Although Engelmann's disease is a rare disorder, it can produce crippling disability. Our studies suggest that steroids deserve further clinical trials in the treatment of this disease.
THE BENIGN EFFECTS ON RABBITS' LUNGS OF THE ASPIRATION OF WATER COMPARED WITH 5% GLUCOSE OR MILK
Authors: Olson Mary
Published: December 2021

A 5% solution of glucose in water is often used for the first feeding, on the assumption that if aspirated it would be less injurious to lungs than milk.

We have tested that assumption on 56 rabbits, divided into seven groups, anesthetized, and intubated with a polyethylene tube. They were sacrificed at 15 minutes or 24 hours after the instillation of 5% glucose, water, on milk. Comparisons of the treated groups with one group of control rabbits were made with respect to blood gases, resting lung volumes, lung weights, pressure-volume curves, and histology. The results showed no significant differences between milk and 5% glucose by any criterion at 15 minutes or 24 hours. The water-treated rabbits had significantly less damage to their lungs. This suggests that water would be a safer test substance for the first feed than 5% glucose or milk.
BENIGN PERSISTENT ASYMPTOMATIC PROTEINURIA IN CHILDHOOD
Authors: McLaine Peter N. , Drummond Keith N.
Published: December 2021

Persistent asymptomatic proteinuria was detected by routine urinalysis in six children. The mean 24-hour protein excretion was less than 2 gm. Renal biopsy showed no abnormal findings except for minor focal mesangial changes in one; there was no glomerular deposition of immunoglobulin G, betaio globulin, or fibrin. No evidence of progressive nephropathy was detected over a mean follow-up period of 4.6 years.

It is recognized that persistent asymptomatic proteinuria occurs during the course of various renal diseases in children; however our experience with patients in whom proteinuria is the sole presenting feature is that the majority have a benign condition.
PYELO-CYSTOURETHROGRAPHY: METHODOLOGY
Authors: Shopfner Charles E.
Published: December 2021

Children who require roentgen evaluation of the urinary tract need examination of the entire tract, which is accomplished with a cystourethrogram and an intravenous pyelogram. Cystourethrography yields a higher incidence of pathology than intravenous pyelography, but the procedures are complementary to each other. Intravenous pyelography, which examines the upper urinary tract, includes a large volume dosage of contrast agent, double injection, fluoroscopy, and multiple films during peak excretion, all applied according to the needs of the individual patient. Cystourethrography evaluates the lower urinary tract and utilizes nonirritating contrast agents, fluoroscopy, and sequential spot-films. Retrograde pyelography is indicated only when the collecting system is not visualized by either the intravenous pyelogram or refluxing cystogram. Fluoroscopy and multiple spotfilms assure accuracy in detection and documentation of pathology. Total body opacification is helpful in evaluating abdominal masses of small infants.
BEHAVIORAL REACTIONS TO MINOR ILLNESS IN PRESCHOOL CHILDREN
Authors: Mattsson Ake , Weisberg Israel
Published: December 2021

Over a 3-year period 35 preschool children were observed during minor physical illness at home while they were cared for by their mothers. The children came from one pediatrician's private practice and had no history of chronic illness or hospital admission. A total of 76 periods of illness were observed. During the acute phase of illness all children showed some temporary loss of age-appropriate behavior. Particularly striking were the changes in the children's relationship with their mothers. These changes constituted two types of reactions which were related to age. Reaction 1, predominant among the ill 2-year-olds, was characterized by the child's clinging, whiny dependence while children over the age of 3 tended to show Reaction 2. Its main feature was a self-contained, rather undemanding state. During convalescence all children demonstrated a few days of irritable, impatient behavior. The preschool child's reactions to acute illness at home appear to change with age in an orderly continuum toward self-contained, rather independent behavior. The findings allow for a discussion of the possible role of minor illness in promoting the young child's reality sense and responsibility for the care of his body.
THE CRITICALLY ILL CHILD: ACUTE METABOLIC DISEASE IN INFANCY AND EARLY CHILDHOOD
Authors: O'Brien Donough , Goodman Stephen I.
Published: December 2021

The need to consider a primarily metabolic etiology of serious illness in infancy is reviewed. The details of conditions known to present in this manner are summarized and the diagnostic approach outlined.
Familial Congenital Duodenal Atresia
Authors: Mishalany Henry G. , Der Kaloustian Vazken M. , Ghandour Mustafa
Published: December 2021

Two patients with congenital duodenal atresia are reported. All four parents are first cousins of each other. An autosomal recessive type of inheritance is suggested. The source of the proposed gene for both families is traced to a single individual.
Reducing Substances in Neonatal Stools Detected by Clinitest
Authors: Davidson A. G. F. , Mullinger M.
Published: December 2021

Kerry and Anderson have described a simple test for fecal reducing substances which uses Clinitest tablets and which is useful as a screening test to detect diarrhea that may be due to sugar malabsorption. Results of this test are graded from 0 to 4+ and values greater than 1+ in children are considered abnormal and strongly suggestive of the presence of intestinal malabsorption of sugar. Although sugar malabsorption can also be a serious problem in the neonatal period, there has been no adequate data to indicate whether Kerry and Anderson's test is similarly applicable to this age group, and there have been conflicting reports as to the amounts of sugars normally found in the neonate's stools.2, 3
Letter To The Editor
Authors: Fong Susie W. , Margolis Alan J.
Published: December 2021

Drs. Fong and Margolis comment as follows:

This is in regards to the letter to the Editor by Dr. J. M. Bowman, commenting on our paper, "Intra-uterine Transfusions: Fetal Outcome and Complications."1

The initial localization of the needle in the fetal abdomen was performed by the instillation of carbon dioxide but was subsequently checked by injection of radio-opaque material as described in a previous report.2

Dr. Bowman's point is well taken in regards to the use of reduced volumes of blood for improved survival after IUT.
Diabetes Mellitus and Congenital Rubella
Authors: Plotkin Stanley A. , Kaye Robert
Published: December 2021

The article by Forrest, Menser, and Harley1 prompts us to report two further cases of diabetes in children whose mothers were infected with rubella while pregnant during the American epidemic of 1963 to 1964.

The first patient, a boy, was born at term in January 1965, weighing only 2,200 gm. His mother had an illness diagnosed as rubella in the first week of gestation. The family history of diabetes consisted of maturity-onset disease in the paternal grandfather and also in the materal great-grandmother.
Letter To The Editor
Authors: Gil David G.
Published: December 2021

Professor Gil's answer to Dr. Fontana's letter (Pediatrics, 45:509) covers many of the questions raised by Dr. Helfer. He comments on Dr. Helfer's letter as follows.

Dr. Helfer expresses concern with the definition of child abuse which I used, but fails to state what was wrong with this definition nor does he suggest an alternative one. He is concerned with my having used data from 1967 abuse reports since state reporting mechanisms were then too new.
KIDNEY TRANSPLANTATION IN CHILDREN
Authors: LaPlante Michael P. , Kaufman Joseph J. , Goldman Ralph , Gonick Harvey C. , Martin Donald C. , Goodwin Willard E.
Published: December 2021

Seventeen kidney transplants have been performed in children during the last 8 years. Four patients were under the age of 12, while 13 patients were in the 12 to 17-year-old range. The technical features of kidney transplanatation in the pediatric age group are discussed and special problems of accommodating adult kidneys are considered.

Of 11 patients receiving kidneys from living related donors, seven are alive with functioning transplants, whereas three patients in this group are dead and one patient is on chronic dialysis. The results with one unrelated and five cadaver donor kidneys are not as good. Only one patient in this group has a functioning kidney. The complications within the first 8 weeks were technical, immunological, and secondary to infection while late complications included hypertension, diabetes, and evidence of drug toxicity. There have been only two failures after the first 2 months; one of chronic rejection and one of probable recurrence of the original disease.
Soybean Sensitivity: Case Report
Authors: Mendoza Josefina , Meyers Jordan , Snyder Richard
Published: December 2021

A case of severe soybean sensitivity is presented and confirmed by the Prausnitz-Kustner technique and provocative tests. Previously reported cases are also reviewed.
Vascular Changes in the Mandibular Alveolar Mucosae of Diabetic Children
Authors: Gellin Milton E. , Bautista Arturo , Haley John V. , Mabry C. Charlton
Published: December 2021

Photographs were made of the mandibular labial alveolar mucosae of 21 diabetic and 27 nondiabetic children. Each photograph was rated four times (twice by two dentists) on a 4 point scale. A rating of 1 represented the normal vascular pattern; patterns 2 to 4 suggested progressively abnormal vascularity. Statistical analysis revealed an overall difference in the ratings of the diabetics and nondiabetics that was significant at the p .02 level, indicating that deviations from the normal alveolar vascular pattern were more common among diabetic children than among nondiabetic children.