bluuebunny/crossref_metadata_2025 huggingface dataset:
RICKETTSIAL DISEASES OF ANIMALS TRANSMISSIBLE TO CHILDREN
Authors: Luoto Lauri
Published: December 2021

BECAUSE rickettsial infections occur sporadically, pediatricians may not be as thoroughly familiar with them as they are with common diseases of children that are characterized by rash. Hence, the rickettsias are infrequently considered in the etiology of febrile exanthemas or fevers of undertermined origin. Rickettsial diseases of primary interest in this country are Rocky Mountain spotted fever, murine typhus, rickcttsialpox and Q fever. The agents causing these diseases exist as latent infections in arthropods and animals, and they are transmitted accidentally to man through well-defined channels of spread. An awareness of the epizootiology of rickettsial diseases in nature and of the means by which these agents are transmitted to man is helpful in establishing a diagnosis of a rickettsial disease. Therefore, salient features of the natural cycles of infection which may suggest a clinical diagnosis will be stressed, and characteristics of these diseases in children will be reviewed briefly.

Rocky Mountain spotted fever is usually contracted during the spring or summer through the bite of an infected tick although infection also may be acquired by dermal contact with tissues of a crushed or improperly removed tick. The wood tick, Dermacentor andersoni, the dog tick, D. variabilis, and the lone-star tick, Amblyomma americanum, which are found, respectively, in the western, eastern, and southern United States are responsible for transmitting the organism to man. Natural infection with Rickettsia rickettsii in these species is maintained by transovarial passage of the agent and by the feeding of immature stages on infected small mammals. Environmental factors such as rainfall, temperature, food supply of small mammals, and prevalence of predators indirectly affect the abundance of ticks.
Annual Review of Medicine, Vol. 8
Authors: BEAN WILLIAM B.
Published: December 2021

While the Annual Review series has been increasingly popular and continues to be very useful for the busy physician, this particular number has special appeal for pediatricians. The pattern of reviews has now reached a pretty regular and high standard. In addition to those topics which are reviewed annually, there is a special section on pediatrics, a detailed review of experiments on retrolental fibroplasia and a chapter on the special therapeutics of helminthic disease. Whereas the reviews in these volumes consistently have been more than the mere enumeration and listing of work which has been done, perhaps the increase in complexity on the speed with which research is advancing has resulted in some decline in the critical element and some increase in the trend of these reviews in the direction of catalogs or indices.
CLINICAL CONFERENCE
Authors: Krugman Saul , Ward Robert
Published: December 2021

Dr. Krugman: Since 1953 approximately 400 cases of infectious hepatitis with jaundice have been observed at the Willowbrook State School on Staten Island. The studies to be described were carried out in collaboration with Dr. Robert Ward and Dr. Joan Giles of our staff, Dr. A. Milton Jacobs of Willowbrook State School and Dr. Oscar Bodansky of Sloan-Kettering Institute. I should like to present a progress report of our investigations which have been concerned with the prevention and natural history of infectious hepatitis at Willowbrook. (A report of these studies has recently appeared in the New England Journal of Medicine (248:407, 1958) to which the reader may refer for further details.)

It had been previously reported by Stokes and associates that the administration of gamma-globulin was followed by not only a lower incidence of hepatitis but also a prolongation of the protective effect. Stokes postulated that "passive-active" immunity was responsible for this phenomenon. The epidemic of hepatitis at Willowbrook provided us with an opportunity to test this hypothesis.

Effect of Gamma-globulin on the Frequency of Infectious Hepatitis. Figure 1 illustrates the course of the outbreak at Willowbrook beginning in January, 1955. As can be seen, hepatitis continued to occur at a rate of about two to three cases per week. The cases, predominantly in children, occurred in 18 buildings in the institution. In June of 1956 gamma-globulin, 0.01 ml/lb, was administered to approximately a third of the inmates of each building. The control and inoculated groups were comparable as to age and time of admission to Willowbrook.
THE INFLUENCE OF THE THERMAL ENVIRONMENT UPON THE SURVIVAL OF NEWLY BORN PREMATURE INFANTS
Authors: Silverman William A. , Fertig John W. , Berger Agnes P.
Published: December 2021

The influence of two contrasting environmental temperatures upon time survival rates of premature infants in the first 5 days of life was studied. Infants who were placed in incubators with an air tamperature of 31.7°C (89°F) had a higher survival rate than controls who were in incubators maintained at 28.9°C (84°F).

In this clinical trial a sequential, matched-pairs plan was used to evaluate the differences in survival under the two study conditions.
THE TREATMENT OF ALLERGY WITH EXTRACT OF TOXICODENDRON QUERCIFOLIA: A CONTROLLED SERIES
Authors: Kamin Sheldon H. , Nastasi Leo , Westlin William , Kline Allen H.
Published: December 2021

A controlled study, using the doubleblind placebo method, has been utilized to evaluate the effects of administration of an extract of Toxicodendron quercifolia in the treatment of allergic patients. Thirty children received the extract and 26 received comparable injections of normal saline. Six weeks after the onset of treatment the children were re-evaluated. No statistically significant difference between the groups could be ascertained.

A most important corollary to this study has been the number of patients who improved while receiving placebo. Attention is called to the great "healing powers" inherent in the positive attitude of the doctor treating allergy, above and beyond the mode of treatment being used.
THE EFFECTS OF ANOXIA ON THE METABOLISM OF HUMAN FETAL TISSUES
Authors: Villee Claude A. , Hagerman Dwain D. , Holmberg Nils , Lind John , Villee Dorothy B.
Published: December 2021

The problem of any organism surviving under anaerobic conditions is to convert the potential energy of its substrate molecules into biologically useful energy without having to use molecular oxygen. The resistance of the fetal and newborn mammal to hypoxia might depend upon some unique chemical reaction, upon quantitative differences in the rates of certain enzymatic reactions common to fetal and adult tissues, or upon a lower rate of cellular metabolism in fetal tissues. These experiments with human fetal tissues favor the second of these three possibilities.

Tissue slices of human liver, cerebral cortex, brain stem, heart, lung, kidney and skeletal muscle were incubated in a medium containing C14 labeled glucose, fructose, pyruvic acid or acetic acid. These experiments showed that there is a fourfold greater rate of glycolysis in fetal liver midway through gestation under anaerobic conditions than under aerobic conditions. In contrast, the rate of lipogenesis under anaerobic conditions was only one-tenth as great as the rate under aerobic conditions. Experiments revealed that after a slice of liver or cerebral cortex had spent a full hour in complete anoxia, its ability to synthesize fatty acids and to oxidize substances by way of the Krebs cycle was essentially unimpaired. All of the experiments were designed to test the maximal activity of the enzyme systems involved. An excess of substrate was provided so that the activity of the cellular enzymes, and not the concentration of the substrate, was the ratelimiting factor. These experiments provide an estimate of the upper limit of the metabolic activity of the tissue in oxygen and in nitrogen. They do not provide an estimate of metabolic rates in vivo. Observations on human tissues near term showed that the rate of aerobic lipogenesis was much less than that observed in tissues of younger fetuses. This was equally true with labeled glucose, pyruvate and acetate as substrates. The pattern of lipogenesis is comparable to that in the liver of a rat 24 hours after parturition and not to the pattern which obtains in the rat just before birth. The rate of anaerobic lipogenesis is substantially less than that under aerobic conditions. These observations may be correlated with the idea that the newborn rat is more immature than the newborn human. These experiments indicate that lipogenesis is of no significance in the ability of the human fetus one half way through gestation to withstand hypoxia, for under anaerobic conditions lipogenesis is decreased whereas glycolysis is increased.
Oral Feeding in Diarrhea and Hypertonic Dehydration
Authors: HOLT L. EMMETT
Published: December 2021

Confusing issues can sometimes be clarified by discussion. It is in the hope of so doing that I take up the cudgels once more to engage my worthy adversary Dr. Finberg on the subject of oral feeding in diarrhea and hypertonic dehydration. The questions at issue (Pediatrics, 22:1024, 1958) were two: (1) should infants with acute diarrhea receive early oral food; and (2) does such practice lead to hypernatremia? Concerning the management of chronic recurrent diarrhea when the disease approaches a "near fatal undernutrition" we agree—they should be fed. We differ in regard to measures that might prevent that untoward state of affairs.
Specificity of the Iodized Oil Test for Fat Absorption
Authors: O'BRIEN DONOUGH , WALKER DOROTHY M. , IBBOTT FRANK A.
Published: December 2021

The concentration of iodine excreted in a single specimen of urine on saliva at a given interval after the ingestion of a test dose of iodized oil has been advocated as a simple and effective screening test to determine the presence of malabsorption of fat in conditions such as cystic fibrosis of the pancreas. However, in assaying the results of this test in a group of normal children, using the original technique, the present writers encountered certain unexpected results which were investigated and are reported herein.
Antisera, Toxoids, Vaccines and Tuberculins in Prophylaxis and Treatment
Authors: MILLER C. ARDEN
Published: December 2021

This book begins: "Biological products used in infectious diseases may be divided into three groups, namely: 1) Sera of various types for prophylaxis and treatment by passive immunization; 2) Prophylactics, such as toxins, toxoids, and vaccines (both bacterial and viral), for active immunization; 3) Diagnostic products, such as diluted toxins and tuberculins, used by the clinician to detect the presence or absence of immunity and also of allergy. Most of these materials come within the scope of this book.
SPECIMENS OF URINE OBTAINED FROM YOUNG GIRLS BY CATHETER VERSUS VOIDING
Authors: Pryles Charles V. , Steg Nina L.
Published: December 2021

The pertinent literature on bacteriologic study of the urine has been reviewed in brief.

Bacteriologic studies, including cultures, Gram stains and colony counts, of catheterized and voided specimens of urine from girls aged 2 to 12 years, were carried out in three groups: Group I: paired specimens (catheter and clean voided). Group II: clean voided specimens. Group III: random non-clean voided specimens.

There was a 96.5% positive correlation between catheter and clean voided specimens obtained by a standardized technique from the same patients; the time interval between the two types of examinations was less than 1 hour.

Colony counts provide a valid means of differentiating infection from contamination in both clean voided and catheter specimens from female children. The data suggest that urines containing less than 1,000 colonies/ml are indicative of contamination; urines containing between 1,000 and 100,000 colonies/ml are to be suspected of infection, and urines containing more than 100,000 colonies/ml of urine are indicative of infection.

Clean voided specimens are valid only if the patient is prepared before collection of the specimen as carefully as for catheterization.

Where doubtful results are obtained, the study of more than one specimen of urine is absolutely necessary. In our experience, follow-up studies resolved doubtful findings in every instance.

Under certain circumstances, catheterization must remain a necessary procedure in the diagnosis and management of infection of the urinary tract, with the full realization that the use of this instrumentation may involve the risk of introducing infection.

Our results confirm previous findings that the presence of organisms in Gram stains in the absence of epithelial cells from catheter or clean voided specimens of urine is of diagnostic significance.
HYPERBILIRUBINEMIA OF NEWBORN INFANTS ASSOCIATED WITH THE PARENTERAL ADMINISTRATION OF A VITAMIN K ANALOGUE TO THE MOTHERS
Authors: Lucey Jerold F. , Dolan Robert G.
Published: December 2021

Seven cases of marked hyperbilirubinemia occurring among premature infants within the first 40 to 72 hours of life are reported. The mothers of these infants had received 72 mg of a vitamin K analogue (Hykinone®) intramuscularly or intravencusly from 2 to 112 hours prior to delivery. The evidence presented indicates that this medication predisposed the infants to hyperbilirubinemia.

The hypothesis is presented that the vitamin K analogue passed through the placenta and exerted a hepatotoxic effect upon the newborn infant. Because of possible serious consequences to the infant, new drugs should be used with caution when administered to pregnant women or to newborn infants, and medications should be given in doses no larger than necessary to obtain a desired and proven therapeutic or prophylactic effect.
REDUCTION OF METHEMOGLOBIN BY ERYTHROCYTES FROM CORD BLOOD
Authors: Ross Jean D. , Desforges Jane F.
Published: December 2021

Studies were made of the ability of erythrocytes from 18 cord bloods to reduce methemoglobin in vitro. Erythrocytes of cord blood reduced significantly less methemoglobin than did those of adult controls in the presence of lactate, lactate and methylene blue, or glucose. These findings are interpreted as evidence of a transient deficiency of either DPNH-dependent methemoglobin reductase or of one of the enzymes responsible for the generation of DPNH in the erythrocyte. The severity of this defect was highly variable.

In contrast, TPNH-dependent reduction of methemoglobin by erythrocytes of cord blood in the presence of glucose and methylene blue was only infrequently deficient. Evidence is presented to suggest that this deficiency, when present, is due at least in part to deficiency of generation of TPNH.

The frequency of deficient DPNH-dependent reduction of methemoglobin may explain the ease with which young infants develop methemoglobinemia.
Advances in Clinical Chemistry, Vol. I,
Authors: GRUMBACH M. M.
Published: December 2021

In this initial volume of a new series of "Advances," the editors state in the preface that their aim "is to provide a readable account of selected important developments [in clinical chemistry], of their roots in the allied fundamental disciplines, and of their impact upon the progress of medical science." The editors have drawn on eminent authorities from Australia, Sweden and Switzerland as well as Great Britain and the United States to contribute nine chapters on a wide variety of subjects. The reviews, which in general are of exceptional quality, provide a critical evaluation of important advances in methods of analysis and their clinical significance. In addition to much useful information on analytic techniques of value to the investigator, the reviews contain a wealth of information clearly and succinctly presented which reflect the authors' thorough syntheses of recent advances in their special fields. The extensive bibliographies include a large number of references in the foreign literature.
PRESIDENTIAL ADDRESS
Authors: Clifford Stewart H.
Published: December 2021

IT IS Academy tradition that your outgoing President be afforded this opportunity to render to the Fellows his evaluation of present Academy activities and his recommendations as to the future. It is a healthy experience for any organization to pause for a moment to reflect on the path it has come and take fresh bearings on the course to be charted toward the Academy's goal of improving the total health and welfare of all children.

The routine business of the Academy is being efficiently carried out by the central office staff at the Academy headquarters in Evanston under the able leadership of our Executive Secretary, E. H. Christopherson. We have been very fortunate in having the loyal services of our Business Manager, W. J. Becker, whose department is the increasingly complex business and financial affairs of the Academy as well as attention to many of the details of our Annual and Spring Meetings.

The Executive Board is the authoritative group having control over all Academy activities. Every effort is made to keep their load of routine business as light as possible that full attention can be directed toward committee activities and to decision on Academy policy. Between Board meetings, the Executive Secretary represents the Board on matters of established Academy business. An Executive Committee has been created to act jointly for the Board in areas where no established policy exists and where prompt action is required.

The productive activities of the Academy having to do with children originate in the Board and in the various special and standing committees. The standing committees are in general of two types—one is concerned with functions and conditions that may affect all age groups; the other is concerned with the broad problems that may occur in specific age groups. The problems encountered in any age group may involve the applied activities and thinking of many disease or function oriented committees.
Pseudo-pseudo-hypoparathyroidism
Authors: SMYTH FRANCIS SCOTT
Published: December 2021

It is my understanding that the term pseudo-pseudo-hypoparathyroidism is applied to those patients who are similar in every way to the pseudo-hypoparathyroid except that the blood chemistry is normal.

In the March issue of Pediatricas (23:520, 1959), Ray and Gardner have reported what they contend is the youngest patient with pseudo-pseudo-hypoparathyroidism. The physical characteristics of round face, stubby fingers (short phalanges), wide finger nails, soft-tissue calcification and the failure to respond to intravenous panathyroid extract are typical of both syndromes. However, the authors report that the serum inorganic phosphorus ranged from 6.9 to 7.8 mg/100 ml.

The writer finds it difficult to accept these as normal concentrations for a 7½-year-old girl. He is strongly of the opinion that this patient represents pseudo-hypoparathyroidism.
THE NATURE OF SCARLATINAL ARTHRITIS
Authors: Crea Maria A. , Mortimer Edward A.
Published: December 2021

In order to determine the relationship of scarlatinal arthritis to rheumatic fever, 18 patients who experienced joint symptoms early in the course of scarlet fever were interviewed and examined 1 to 20 years later to establish the incidence of subsequent rheumatic symptoms.

Two patients experienced definite pancarditis during the original illness, and the course of the arthritis in two additional cases was highly suggestive of rheumatic fever. Subsequent stigmata of rheumatic fever appeared in six other patients. Thus, the episode of scarlatinal arthritis probably represented rheumatic fever in eight instances, and possibly in two more.

It is concluded that scarlatinal arthritis is most likely a manifestation of rheumatic fever.
GENERALIZED TUBERCULOUS ADENITIS IN BANTU CHILDREN IN SOUTH AFRICA
Authors: Harris L. C.
Published: December 2021

Fifteen cases of generalized tuberculosis in Bantu children are described. Though this condition is not uncommon in the Bantu, it is rare in white people and the literature on the subject is relatively scanty.

The superficial glands may be markedly enlarged, especially cervical and axillary glands, but occasionally inguinal as well; hilar, paratracheal and intra-abdominal glands may all be involved. In three patients in this series the primary focus was roentgenographically demonstrable in the lungs. There was no evidence in any patient of multiple primary foci.

Two patients had miliary tuberculosis and tuberculous meningitis and died, but in uncomplicated cases the response to chemotherapy with isoniazid and paraaminosalicylic acid is good. In the course of healing, some glands may suppurate, requiring surgical drainage and irrigation with a solution of streptokinase and streptodornase.

The condition is believed to result from lymphohematogenous spread but the reason for this phenomenon is unknown. The condition appears to be generally more common among Negroes.
X-ray Diagnosis of the Alimentary Tract in Infants and Children
Authors: CAFFEY JOHN
Published: December 2021

This new monograph describes and explains the radiographic findings in the healthy and the abnormal alimentary tracts of infants and children. The author's emphasis on the important normal variants should be helpful, especially to medical students and radiologists in training. The first chapter deals with the indications for radiologic examinations, which should alert the examiner to the most probable lesions present and also suggest to him the optimal type of examination. The second chapter details the techniques of examination of the upper gastrointestinal tract (esophagus, stomach, jejunum and ileum); this short chapter is one of the most valuable in the book because it will not only facilitate examinations, but also prevent undue radiation exposure of both the patient and the examiner, if the author's methods are followed.
GROUP DISCUSSIONS WITH MOTHERS OF HOSPITALIZED CHILDREN
Authors: Glaser Kurt
Published: December 2021

Many articles have been written about the trauma of hospitalization to the child, but only little has been published about parents' reactions to the hospitalization of their children.1,2

The following observations concerning group discussions with parents of hospitalized children may suggest a three-fold approach to alleviate some of the trauma to the parents: directly through the anxiety-relieving effect of the discussions and indirectly through the experience gained from these group sessions when applied to the training of staff as well as to the setting up of administrative policies.

The present study was undertaken with five objectives in mind:

1) Imparting of information, correction of misinformation, ventilation and clarfication of feelings, and the supportive effect of group interaction are aimed at relieving the anxiety of the parents and improving the interrelationships between parents, children, the hospital and its personnel.
COMPARATIVE STUDY OF ADEQUACY OF PROTEIN FROM HUMAN MILK AND COW'S MILK IN PROMOTING NITROGEN RETENTION BY NORMAL FULL-TERM INFANTS
Authors: Fomon Samuel J.
Published: December 2021

Eight normal full-term infants have been studied during ad libitum ingestion of a formula (Formula 1257) containing 60 calories/100 ml and providing 7% of the calories as protein from cow's milk, 50% from a mixture of vegetable oils and 43% from lactose. The mean concentration of nitrogen in this formula was slightly less than the mean concentration in human milk in a previous study.4

Growth of the infants is interpreted as within normal limits.

The mean concentration of urea nitrogen in the serum was 6.0 mg/100 ml. Between 1 and 6 months of age the mean concentration of total protein in the serum was 5.7 gm/100 ml.

Both the mean volume of intake and the mean concentration of nitrogen in the feeding were slightly less than those of the infants fed pasteurized human milk. Consequently, in 44 of 60 metabolic balance studies with infants receiving Formula 1257, intakes of nitrogen were less than the mean intakes of infants of similar age receiving pasteurized human milk (Fig. 3). Similarly, retentions of nitrogen in 37 of the 60 metabolic balance studies fell below the regression calculated for infants fed pasteurized human milk (Fig. 4). The retentions of nitrogen were generally in the range of those of infants fed pasteurized human milk and it is concluded that the two feedings have similar abilities to promote retention of nitrogen by infants.
VITAMIN B6-DEPENDENCY AND INFANTILE CONVULSIONS
Authors: Scriver Charles R.
Published: December 2021

Another patient with the rare convulsive disorder termed "vitamin B6 (or pyridoxine) dependency" is presented. The case of a deceased sibling, suspected of having had the same disorder, is also presented. The characteristic features of the syndrome, as illustrated in these patients, are discussed.

The unusual daily requirement for 10 or 11 mg of pyridoxine supplementation has persisted during the first 20 months of the surviving child's life. The response to pyridoxine is specific and impressive, suggesting a biochemical lesion underlying the convulsive disorder.

The probable nature of this biochemical disorder, the significance of a peculiar pattern of urinary excretion of vitamin B6 and related products, and the sequence of vitamin B6 dependent enzyme involvement, are discussed; the disease may be an inborn error of metabolism involving an enzyme of the brain.

Nothing can be lost, and perhaps much will be gained, if a diagnostic trial with pyridoxine therapy produces impressive improvement in any "idiopathic" convulsive disorder of infancy and childhood.
Acupuncture and Transdermal Electrostimulation in the Treatment of Deafness
Authors: Bess Fred H. , Schwartz Daniel M. , Seestedt Linda I. , McConnell Freeman E.
Published: December 2021

A review and critique of the research on acupuncture and transdermal electrostimulation therapy in treating sensorineural hearing loss is presented. Of 111 subjects who had undergone acupuncture treatment only 4% showed improvement. Some of the subjects in these studies were noted to exhibit a decrease in hearing sensitivity. Additional data collected at our clinics on four preschool hearing-impaired children failed to provide evidence of improvement following acupuncture. Similar results are reported with transdermal therapy, suggesting that both procedures are inappropriate for the treatment of sensorineural hearing loss.
Myelofibrosis-Myeloid Metaplasia in Childhood
Authors: Boxer Laurence A. , Camitta Bruce M. , Berenberg William , Fanning Joseph P.
Published: December 2021

A child with idiopathic myeloid metaplasia is described and her course contrasted with another child having myeloid metaplasia secondary to reticulum cell sarcoma. Despite prior reports the idiopathic form of illness may pursue a relatively indolent course in children. A thorough search should be made for underlying disease when myeloid metaplasia is first diagnosed.
The apnea monitor business
Authors: Bergman Abraham B. , Beckwith J. Bruce , Ray C. George
Published: December 2021

Perhaps the most fruitful dividend from research into the sudden infant death syndrome (SIDS) in the past decade has been its establishment as a distinct disease entity. Though this knowledge is still not universally distributed throughout the medical profession, at least some of the veil of mystery and superstition has been lifted, and authoritative guidelines for the recognition and management of SIDS have been issued.

Among the characteristics of SIDS, four deserve special emphasis, and serve as the basis for most of the research currently being conducted: (1) Most cases of SIDS occur between 4 and 16 weeks, suggesting some physiologic vulnerability during this age period.
The Needs of Foster Children
Authors: Seidel Henry M. , Daniel William A. , Davis Joseph H. , Harris Ruth C. , Sherry S. Norman , Tillman Mary A.T. , Karelitz Samuel , Lewos Donald , Work Henry H.
Published: December 2021

Approximately 350,000 children live with 150,000 foster families in the United States during any given year. These children are in foster homes because the degree of social disorganization in their natural families has led to a societal decision to separate them from their natural families. Significant basic causes include unemployment, poor education, poor housing, and bias. There are also more subtle factors which may, in part, lie beyond our present understanding.

Foster children comprise a population at high risk. At the time of placement, most of them have not had access to sufficient physical and emotional nourishment and necessary medical care. One recent study revealed handicaps in some 40% of the children studied; of these, 15% had multiple handicaps, 33% had emotional and behavioral problems, 19% were mentally retarded, and 13% had various physical ills. Twenty percent had not been evaluated at all. Indeed, there are many kinds of handicaps. Thirty percent of foster children have not seen their natural parents within six months. The average placement has been longer than five years; 68% of placements range from four to eight years, with frequent movement of a child from one family setting to another.

The community, with the process of foster care, assumes or accepts the responsibility for a child's care through the mechanism of count order and/ or voluntary agreement with natural parents. The implied promise of such a move is the satisfaction of apparently unfulfilled needs. The implication is that a period of planned substitute family care can serve as a positive rehabilitative force.
Foltz and Silver Reply
Authors: Silver George A. , Foltz Anne-Marie
Published: December 2021

Hass and Scovell make a good point. However, the question we dealt with was the degree to which compliance with the law was being observed. EPSDT is a federal mandate for coordinated, comprehensive health care for the 12% of America's children who are under the Medicaid program. These needy children may be receiving fragmented care from other sources but, if the state Medicaid agencies are ignorant of these doings and not coordinating them, federal policy is not being carried out.
Marasmus and Kwashiorkor
Authors: Gupte Suraj
Published: December 2021

There is a great paucity of well-planned studies reported in the literature concerning the dietetic situations leading to nutritional marasmus and kwashiorkor. Most of the conclusions have emerged from data obtained through unreliable techniques. We have been interested in the problem of protein-calorie malnutrition (PCM), a major cause of morbidity and mortality among growing infants and children in this part of the subcontinent, for nearly seven years. Our experience regarding average daily intake of calories and proteins, based on an oral questionnaire technique, is summarized in Table I.
Benign Rheumatoid Nodules
Authors: Estelle F. , Simons R. , Schaller Jane G.
Published: December 2021

Fifteen asymptomatic children with benign rheumatoid nodules, followed up to 12 years, are described. Nodules are characterized by subcutaneous location with predilection for pretibial regions and scalp, occasional large size, spontaneous regression, and frequent recurrence. Granuloma annulare was present in two patients. All 15 children were healthy and free from rheumatoid arthritis, rheumatic fever, or any other recognizable systemic disease at followup and none had positive tests for antinuclear antibodies or rheumatoid factors.

Histologically the nodules closely resembled those seen in adult-onset rheumatoid arthritis. Though biopsy may be useful for confirmation of the clinical diagnosis of benign rheumatoid nodules, wide surgical excision, skin grafting, and treatment with medication are unnecessary in this selflimited syndrome.
Psychological Preparation for Surgical Pediatric Patients: The Effect on Children's and Parents' Stress Responses and Adjustment
Authors: Visintainer Madelon A. , Wolfer John A.
Published: December 2021

This clinical experiment tested variations of psychological preparation and supportive care designed to increase the adjustment of children (and their parents) hospitalized for elective surgery. Eighty-four children, aged 3 to 12, admitted for tonsillectomies were randomly assigned to one of three treatment conditions or to a control group: (1) a combination of systematic preparation, rehearsal, and supportive care conducted prior to each stressful procedure; (2) a single-session preparation conducted after admission; and (3) consistent supportive care given by one nurse at the same points as in the first condition, but including no systematic preparation or rehearsal.

The children's hospital adjustment was measured by blind ratings of behavioral upset and cooperation during the blood test, medication injection, transport to surgery, induction, and postoperative fluid intake and by recovery room medications and pulse rates and time to first voiding. Post-hospital adjustment was assessed with Vernon et al.'s Post Hospital Behavior Inventory. Parent outcome measures included self-ratings for anxiety and satisfaction with information and care. As hypothesized, the results demonstrated that children who received condition one showed significantly less upset and more cooperation and their parents reported significantly greater satisfaction and less anxiety than did children or parents in the other groups. Younger children were significantly more upset and less cooperative than older children.
Children as Passengers in Automobiles: The Neglected Minority on the Nation's Highways
Authors: Shelness Annemarie , Charles Seymour
Published: December 2021

The federal government is urging states to enact legislation requiring that safety belts be worn. Small children are excluded from this requirement.

Following the neonatal period, the motor vehicle poses the greatest single threat to a child's life. Contrary to popular belief, more small children are killed and injured inside the vehicle than outside. The majority of children now ride in cars unprotected or inadequately protected.

Standard safety belts are unsuitable for small children. Special devices capable of distributing collision forces over a large body area should be used.

Original children's car "safety" seats were not intended to protect their occupants in a crash. These seats became subject to a government safety standard in April 1971. Shortly after this standard came into effect it was shown to be grossly inadequate in ensuring crash protection. A proposal for revising current safety criteria was issued in March 1974— to be implemented in September 1975.

A number of progressive companies have developed crashworthy devices. As public awareness is being awakened, manufacturers are beginning to find that "safety" sells.

Child crash protection has not escaped the attention of safety experts whose writings are reviewed, but it is shown that lack of parent awareness and concern can be directly related to sparse and often inaccurate and incomplete information available. Many popular child care books ignore the subject entirely.

Because correct use of devices is of such critical importance, instructions detailing what parents must do should be prominently displayed on a permanent label attached to the device. observation of car seats in use confirms that correct installation of the device itself and/or proper securement of the child within the device is the exception rather than the rule.

The development of child restraints is of recent date. It is essential to keep abreast of advances made in the field. Earlier recommendations may be superseded by more recent research findings.

It has been found that parents are most receplive to new ideas prior to and immediately following the birth of a new baby. In-hospital instruction of expectant and new parents is showing promising results.

There is an urgent need for pediatricians to become involved in this vital area of "preventive medicine."
Sudden Infant Death Syndrome in a Hospitalized Infant on an Apnea Monitor
Authors: Lewak Nomman
Published: December 2021

The death of a 4-month old infant from SIDS which occurred while the child was on an apnea monitor in the hospital is reported. This death, along with those of two others who died during home monitoring programs, seems to cast doubt on the claims being seen in the lay press that SIDS can somehow be "prevented" by use of an apnea monitor.
Inaccuracies in Administering Liquid Medication
Authors: Yaffe Sumner J. , Bierman C. Warren , Cann Howard M. , Cohen Sanfod N. , Freeman John , Segal Sydney , Soyak Lester F. , Weiss Charles F. , Chudzik Gregory , Ballin John C. , Del Pratto Pierre S. , Done Alan K. , Farchione Louis , Oakley Godfrey , Sawchuk Steven , Scott C. P. , Simopoulos Artemis P.
Published: December 2021

Although pediatricians usually take great care in accurately calculating medication for their patients, the important processes of measuring and administering the dose are often overlooked. Many of the problems encountered in the administration of tablets and capsules to small children have been overcome by the production of medications in liquid form. However, the advantage gained in the administration of liquid products is often lost because of the inaccuracy of the devices used to measure and administer them.

Liquid doses may be inaccurate for several reasons. The measuring devices commonly used today include household spoons, cups, and specific devices provided by pharmaceutical manufacturers to be used with their products. Teaspoons are particularly poor measuring and administering devices. The measured capacity of the teaspoon has been shown to be within the range of 2.5 to 7.8 ml.1,2 In addition, teaspoons are a poor delivery device because they tip easily. Furthermore, the same spoon, when used by different persons, may deliver from 3 to 7 ml.3 Such variations may be related to factors such as pouring the liquids from different-sized bottles, the color of the liquids, and the adequacy of available light. Perhaps the most important factor in measurement is related to the care practiced by the person doing the measuring.

Although the American Pharmaceutical Association (in 1902) and the American Medical Association (in 1903) defined the "standard teaspoonful" as 5 ml, this recommendation has not been universally adopted.4 The practice of some pharmaceutical manufacturers of establishing doses in 4-ml and other fractions of a "teaspoon" tends to confuse the prescribing physician when it comes to instructing patients.
Basilar Artery Migraine in Young Children
Authors: Golden Gerald S. , French Joseph H.
Published: December 2021

Eight children with recurrent attacks of neurologic dysfunction referable to the brainstem and cerebellum are reported. The episodes occur suddenly, clear completely, and leave the patient without residua. The most frequent signs are ataxia, alternating hemipareses, and vertigo. The majority of patients are girls, and most have the onset of the condition prior to the age of 4 years.

Headache was definitely present in three children, and possibly present in four. A striking history of migraine was found in seven families, accounting for 16 affected relatives. Fifteen of these were female and 14 were on the maternal side.

Follow-up of the children has not provided any evidence for progressive neurologic disease. The patient followed for the longest period of time has developed classic migraine.
The Surgical Management of Pediatric Breast Masses
Authors: Turbey Wilson J. , Buntain William L. , Dudgeon David L.
Published: December 2021

Information regarding the surgical management of breast masses in the pediatric age group is sparse and is primarily directed at unusual neoplasms. We have reviewed the surgical treatment of 50 patients with inflammatory and neoplastic breast masses occurring in a 15year period (1957 to 1973) at the Children's Hospital of Los Angeles.

There were 42 girls and 8 boys, ranging in age from 12 days to 18 years. All patients had either surgical excision or incision and drainage of the masses with a subsequent histologic diagnosis.

A variety of pathologic entities were encountered, but there were no primary malignancies. There were 33 patients with fibroadenomas, including four patients with multiple masses. Thirteen patients, six of whom were male, had cellulitis with an underlying breast abscess. The offending organism was gram-negative in one third of these abscesses.

While none of the masses in this series were malignant, surgery was indicated to (1) establish diagnosis, (2) allay fears of patient, family, and referring physician, and (3) correct an obvious cosmetic deformity. Surgical drainage encouraged resolution of the inflammatory process, aided in the recovery of the organism, and assured appropriate drug therapy.
Urbanization and Differentials in White and Nonwhite Infant Mortality
Authors: Chabot Marion Johnson , Garfinkel Joseph , Pratt Margaret W.
Published: December 2021

This study analyzes infant deaths in the United States, 1962 to 1967, by place of residence, to determine to what degree variations in age at death are related to degree of urbanization and race. Results of the study indicate that: (1) after one day of life infant mortality increases progressively as degree of urbanization decreases; (2) the differences between urban and rural death rates are greatest in the posthebdomadal (1 week or older) period; (3) in all age groups at all levels of urbanization, the nonwhite infant is at a marked disadvantage relative to the white infant; (4) the older the infant, the greater the disadvantage for nonwhite infants in rural areas; (5) had the white infant mortality rate prevailed among the nonwhite population over the six-year period from 1962 to 1967 an estimated annual total of 11,597 nonwhite infants would have survived their first year of life; (6) 40% of the excess deaths are in infants under 7 days and 60% in the posthebdomadal period; (7) fetal death rates increase progressively as degree of urbanization decreases, complementing a direct relationship between under 1 day mortality and urbanization resulting in a level trend for perinatal mortality.
Dural Sinus Occlusion in Leukemia
Authors: David Ronald B. , Hadfield M. Gary , Vines Frederick S. , Maurer Harold M.
Published: December 2021

The case of a 7-year-old child with acute lymphocytic leukemia who, while in relapse, developed a superior sagittal sinus thrombosis is documented by angiography and post-mortem examination. Review of the literature suggests that cerebral spinal fluid (CSF) pleocytosis which usually accompanies the arachnoid infiltration of central nervous system (CNS) leukemia may be absent in some patients as in this case. In the absence of CSF pleocytosis, cerebral venous sinus thrombosis may mimic the other signs and symptoms of CNS leukemia and consequently may be a more frequent complication of acute leukemia than is presently appreciated. Therapy directed to the CSF axis generally would not under these circumstances be appropriate.
Hemophilus Influenzae b Pericarditis in Children
Authors: Echeverria Peter , Smith Edward W. P. , Ingram David , Sade Robert M. , Gardner Pierce
Published: December 2021

Recent experience in the diagnosis and management of Hemophilus influenzae b pericarditis is described in five children. Anterior pericardectomy appears to be the preferred method of surgical drainage because it was associated with a shorter hospitalization than pericardiocentesis or closed or open pericardotomy and removed the risk of recurrent cardiac tamponade and constrictive pericarditis. Countercurrent immunoelectrophoresis of sera and pericardial fluid was used to rapidly identify the etiology of pericarditis in four of four patients tested. The observation that three children appeared to develop pericarditis in the absence of a contiguous infectious focus suggests that bacteremic seeding of the pericardium may be important in the pathogenesis of this disease.
Comments on Breast Feeding: Second Thoughts
Authors: Jelliffe Derrick B.
Published: December 2021

It was timely to read the article by Dr. John Gerrard on the proven immunological value of human milk.

In fact, similar review papers could also be written concerning anti-allergic, contraceptive, economic, emotional, and metabolic-nutritional advantages.

A major difficulty in keeping up with the flood of recent "hard" scientific data in this field is because these reports have been published in a wide spectrum of journals ranging, for example, from endocrinological to sociological to psychological and to those concerned with family planning, "tropical pediatrics," and economics.
Superfluous Impedimenta
Authors: Carey Donald E. , Harris George S. , Pilliod James P.
Published: December 2021

We were astonished to receive the recent statement on snowmobile safety from the Committee on the Pediatric Aspects of Physical Fitness, Recreation and Sports of the American Academy of Pediatrics with its implicit acceptance, ce, and perhaps even approval under certn circumstances, of this so-called sport.

These superfluous impedimenta of our affluent gadgethappy appy society should be permanently relegated to limbo. But then, there probably is not as much money to be made from ski touring.
Presumptive Histoplasmosis Presenting as Cerebellar Ataxia With Spontaneous Recovery
Authors: Shearer William T. , Kobayashi George , Prensky Arthur L.
Published: December 2021

There have been relatively few reported cases of histoplasmosis of the central nervous system in children and no reported survivors without therapy.1-5 Most reported cases involving the central nervous system in children are described at postmortem examination.1,2 Involvement of extrapulmonic organ systems with Histoplasma capsulatum without a prominent preceding or concomitant pulmonic infection occurs occasionally.

The reported neurological signs and symptoms of histoplasmosis of the central nervous system in children are: vomiting, irritability, opisthotonos, clonus of extremities, Babinski sign, progressive weakness of extremities, deterioration of vision, ptosis, weakness of facial muscles, bladder and anal atony, bilateral spastic hemiparesis, delayed motor development, and coma.1-5
More Questions Regarding Arginine Hydrochloride Inhalation
Authors: Cotton Ernest K.
Published: December 2021

Dietzsch et al. have confirmed observations that we reported to the Cystic Fibrosis Research meeting in April 1968.1 In summary, we found that when the sodium ion, in the form of sodium bicarbonate or sodium hydroxide, is added to L-arginine hydrochloride an irritating solution to the airway is formed. During the discussion, Mancos suggested that the sodium transport mechanism may be additionally interferred with. Our studies indicated that cystic fibrosis patients breathing the sodium-buffered L-arginine definitely lowered their airway conductance while L-arginine buffered with the free base improved airway conductance.
The Spectrum of Growing Skull Fracture in Children
Authors: Rothman L. , Rose J. S. , Laster D. W. , Quencer R. , Tenner M.
Published: December 2021

The genesis and complications of the growing skull fracture in children is discussed. Four patients are presented to illustrate the common and uncommon features of growing skull fractures. The need for complete radiological evaluation as well as the timing of follow-up examinations is stressed.