bluuebunny/crossref_metadata_2025 huggingface dataset:
CONTINUOUS NEGATIVE CHEST WALL PRESSURE IN HYALINE MEMBRANE DISEASE: ONE YEAR EXPERIENCE
Authors: Chernick V. , Vidyasagar D.
Published: December 2021

Application of a continuous positive transpulmonary pressure by producing a continuous negative chest wall pressure (CNP) was utilized in the treatment of 49 infants with severe hyaline membrane disease (HMD). In 23 infants in whom spontaneous alveolar ventilation was adequate, CNP was associated with an average elevation in arterial Po2 of over 40 mm Hg while inspired oxygen concentration remained unchanged. Alveolar-arterial O2 tension difference (A-aDo2) decreased significantly. All of these infants survived. In 26 infants with severe alveolar hypoventilation, CNP was used in conjunction with artificial ventilation. Arterial Po2 increased significantly and A-aDo2 decreased. Twelve of these infants survived (46%). The overall survival rate was 71.5%. CNP appears to be an important adjunct to the therapy of severe HMD.
Pagophagia and Iron Deficiency Anemia in Adolescent Girls
Authors: Brown Wallace D. , Dyment Paul G.
Published: December 2021

Four cases of iron deficiency anemia associated with pagophagia, or ice eating, in young adolescent girls are described. This symptom was reversible in each case shortly after the institution of oral iron therapy.
Samuel Z. Levine
Authors: Barnett Henry L. , Fraad Lewis M. , Gordon Harry H. , Kretchmer Norman
Published: December 2021

This letter is written to call to the attention of the Pediatric community the death on July 14, 1971, at age 75, of Dr. Samuel Z. Levine, Professor Emeritus of Pediatrics, at Cornell University Medical College. Dr. Levine was a founding member of the Society for Pediatric Research. His professional accomplishments as investigator, clinician, and teacher were recognized by his colleagues in his election as President of the Society and of the American Pediatric Society, in his receipt of the Borden Award of the American Academy of Pediatrics, and the Howland Award of the American Pediatric Society.
In Reply: Radionuclide Brain Scans in Convulsive Disorders?
Authors: Tefft Melvin
Published: December 2021

I have noted the review of the experience of the Children's Hospital Medical Center, by Page, et al., in which gliomas related to epilepsy had an incidence of only 0.3%. However, as noted in the original article as published in Pediatrics of November 1971, lesions other than low grade gliomas may cause epileptiform seizures, including various benign lesions, and thus the overall incidence of abnormality might well be raised above the 0.3% level for malignant lesions.
A NEW ROLE FOR THE SCHOOL PHYSICIAN
Authors: Menkes John H.
Published: December 2021

In the last decade the practicing pediatrician has encountered an ever-increasing number of children who are referred to him on the basis of having shown varied degrees of difficulty in learning material presented to them in school. They come to the pediatrician's office because parents and schools are increasingly aware of the importance of education, and because it is now common practice to consider such children to be in need of medical evaluation and treatment. A manual recently circulated by the American Academy of Pediatrics tacitly assumes that the general pediatrician is the person who logically is responsible for the rehabilitation of the child with a learning disorder.
INTELLECTUAL LEVELS OF SCHOOL CHILDREN SEVERELY MALNOURISHED DURING THE FIRST TWO YEARS OF LIFE
Authors: Hertzig Margaret E. , Birch Herbert G. , Richardson Stephen A. , Tizard Jack
Published: December 2021

Intellectual functioning at school age was studied in boys who had been severely malnourished during the first 2 years of life (index cases). IQ in these index cases was compared with that of male siblings closest in age and unrelated class mates or neighbors matched for sex and age (comparisons). Full Scale, Verbal and Performance IQs were lowest for the index cases. All IQ measures were significantly lower in the index cases than in the comparisons. Full Scale and Verbal IQ were significantly lower in the index cases than in the siblings. Siblings differed from comparison children only in Performance IQ. No association was found between the intellectual level of index cases and the ages at which they had been hospitalized for the treatment of severe malnutrition during the first 2 years of life.
SUCCESSFUL USE OF ELECTRIC SHOCK IN A LIFELESS CHILD AS REPORTED IN 1774
Authors: C. T. E.
Published: December 2021

The report given below, published in 1774, is the first, to my knowledge, about the use of electrotherapy for children.

ELECTRICITY RESTORED VITALITY

One part of our benevolent design is to manifest the possibility of recovery in the various instances of sudden death, where the vital powers are suspended, without any essential injury to the frame. This extraordinary relation of resuscitation also manifests the admirable powers of the electrical shock; which we would earnestly recommend in all cases of suspended animation.

Sophia Greenhill, on Thursday last, fell out of a one-pair-of-stairs window, and was taken up by a man to all appearance dead. The SURGEONS at the Middlesex Hoapital, and an APOTHECARY, declared that nothing could be done for the child.—Mr. Squires, tried the effects of electricity.—Twenty minutes elapsed before he could apply the shock, which he gave to various parts of the body in vain;—but upon transmitting a few shocks through the THORAX, he perceived a small pulsation; in a few minutes the child began to breathe with great difficulty, and after some time she vomited.—A kind of stupor, occasioned by the depression of the cranium, remained for several days, but, by the proper means, being used, her health was restored.1
EVALUATION OF INFANT HEALTH CARE BY A NURSE PRACTITIONER
Authors: Chappell James A. , Drogos Patricia A.
Published: December 2021

A Pediatric Nurse Practitioner managing all well child care for 110 successively-enrolled infants in a low-income housing project attained set goals for well child care in a high proportion, had good acceptance by parents, and a low appointment-failure rate. This experience was similar to that attained in an upper middle class pediatric practice where care was given by three pediatricians. Health status of infants at age 1 year was similar in the two groups. Approximately 23% of infants coming for well care were found to have physical illness or abnormality which the Nurse Practitioner was required to identify and manage either by herself or in conjunction with a physician. In order for the Pediatric Nurse Practitioner to function effectively, even if her practice is limited to "well" children, she must be prepared to identify and manage certain problems beyond routine physical appraisal, immunization, and counseling.
GIANT AXONAL NEUROPATHY
Authors: Berg Bruce O. , Rosenberg Sidney H. , Asbury Arthur K.
Published: December 2021

Progressive muscle weakness of at least 3 years' duration is described in a 6-year-old Caucasian girl. Neurological abnormalities included loss of muscle bulk without fasciculation, muscle weakness, areflexia, and impairment in perceiving touch, position sense, and vibration. The cerebrospinal fluid was normal. A clinical diagnosis of polyneuropathy was made and electrophysiological studies were consistent with that diagnosis.

No gross abnormality of a left sural nerve biopsy was detected, but light microscopic study of transverse paraffin sections revealed abnormally large argentophilic masses scattered through each fascicle Examination of 2 microns-thick plastic embedded sections showed the argentophilic masses were axons which were segmentally enlarged to enormous proportions.

Ultrastructurally, axons were distended by masses of tightly woven neurofilaments. Unusual features included the tendency to occur in massive whorls and the frequent occurrence of electron dense condensations into which parallel skeins of neurofilaments appeared to gather. The nature of the electron dense condensations could not be further resolved.

Axonal collections of neurofilamentous masses have been described in experimental neuropathies due to acrylamide, mitotic spindle inhibitors and in some cases of motor neurone disease. However, the accumulation of neurofilamentous masses in these disorders does not approach the proportions encountered in this case.
DRUG INTERACTIONS—PART II
Authors: Stern Leo
Published: December 2021

Unlike its conjugated (direct acting) counterpart, unconjugated (indirect acting) bilirubin is insoluble in water, but highly soluble in lipids. Hence, it tends to diffuse out of plasma into the lipid-rich CNS with resultant kernicterus. This does not occur when unconjugated bilirubin is bound to albumin, as the complex is too large for diffusion. The production of kernicterus thus involves the increase of free, unbound, unconjugated bilirubin in plasma, either by dissociation from its albumin binding sites or by the introduction of one or more anions which compete preferentially for a common or shared site, thus displacing the bilirubin from its albumin bond.

FACTORS AFFECTING BINDING

Lowering the pH promotes bilirubin-albumin dissociation,1 and acidosis has thus been implicated as a factor in kernicterus occurring at low levels of serum bilirubin.2-5 In addition, competition for bilirubin binding sites is exhibited by a number of endogenously occurring substances as well as exogenously administered agents. Both hematin (increased in hemolytic states) and the nonesterified fatty acids (increased under conditions of both hypothermia6 and hypoglycemia7 are capable of displacing bilirubin from its albumin binding sites. In addition, a number of drugs, among which sulfisoxazole (Gantrisin) is the most widely known in view of both its clinical8 and experimental9 production of kernicterus in this fashion, are capable of causing similar displacement in vitro.

Among the techniques employed to demonstrate an increase in free bilirubin is the measurement of displacement of spectral curves.10,7 The technique depends on a difference in absorbance of free (420 to 440 nm) versus bound (460 to 465 nm) bilirubin, with changes in the shapes of the curves as the amounts of free and bound bilirubin are altered.
Letter to the Editor
Authors: Pick Walter
Published: December 2021

Thank you for permitting debate on the important issue of the role of the nurse practitioner in pediatrics.

Dr. A. H. Matlin comes to the surprising conclusion that nurse practitioners often practice better anticipatory guidance than physicians and "their services should, if anything, be worth more." If Dr. Matlin is serious in his view, he should experiment by referring physicians' children to the nurse practitioners for this "better guidance" and observe the subsequent reaction. In our society, a professional man is compensated for his service on the basis of his training and the responsibility he takes.
When Should One Ligate the Umbilical Cord?
Authors: Haire John R.
Published: December 2021

Having observed and photographed obstetrical techniques and practices on six continents in 1971, I am struck by the differing views of renowned physicians in the various developed and developing countries as to the relative merits of early and late clamping of the umbilical cord. While specialists in the Netherlands, a country with a low incidence of infant mortality essentially equivalent to that of Sweden, stress the importance of placental transfusion as a normal part of the physiological sequence of birth which lessens the likelihood of maternal hemorrhage and anemia in the growing child, Yao et al. in their recent paper published in the December 1971 issue of PEDIATRICS, suggest that placental transfusion causes "overloading" of the vascular bed and therefore should be avoided by early clamping.
L-Arginine, the Sickling Phenomenon, and Cystic Fibrosis
Authors: Solomons C. , Hathaway W. , Cotton E.
Published: December 2021

The action of urea in stabilizing s-hemoglobin is thought to be due to its ability to alter the conformation of proteins. Compounds such as guanidine and arginine, which also possess chemical groups capable of altering protein structure, have been alluded to as logically possible alternatives or adjuncts to the use of urea. Neutralized L-Arginine is particularly attractive because of its low toxicity and well known clinical effects. In addition, arginine is thought to stimulate the urea cycle: an intermediate of this cycle, carbamyl phosphate, has recently been shown to reduce sickling.
LONG BONE INVOLVEMENT IN SICKLE CELL ANEMIA
Authors: ALMKLOV JOHN R. , HANSEN ARILD E. , SCHNEIDER MARTIN
Published: December 2021

Two types of pathologic changes may occur in the long bones of patients with sickle cell anemia. A hyperplastic bone marrow represents the response to continued destruction of erythrocytes and this produces a wide medullary cavity and a thin cortex. The thromboses of vessels in the marrow and bone result in abnormal areas of calcification and new bone formation producing a thick cortex and a small medullary cavity. The findings on roentgenographic examination will depend upon which of the two processes is dominant.

A 21 month old Negro infant whose symptoms of sickle cell anemia began at 4 months of age showed typical roentgenographic findings resulting from a hyperplastic marrow. The cortex in the femur had become so thin that a pathologic fracture resulted. This is the first reported instance of the occurrence of a pathologic fracture in sickle cell anemia.
SPECIAL REVIEWS
Authors: WHEATLEY GEORGE M.
Published: December 2021

THERE has been a marked change in our concept of the term "school health service." Early activities in this field were almost wholly devoted to the control of communicable disease. Today, thanks to immunization, the antibiotic drugs and health education, most of the old enemies of child health have been conquered. As a result, the years that a child spends in school have been made the healthiest period of life, when appraised by the crude measure of mortality.

Why then school health service? Let me first define what I mean by this term. It comprises health supervision of the school child by educators, public health nurses and school physicians for case-finding and health guidance. At no other time of life is the child or family so readily available for preventive medical service and health education. Public health cannot afford to neglect this ready access to so large a segment of the population—actually more than 20 million persons.

Entrance to kindergarten and first grade is perhaps the most valuable of these opportunities. For all too many children, this is the first health examination since the first year of life. Habit disorders or physical defects which have developed in the preschool years can be brought to light and treatment advised.

A convincing demonstration of the value of a good medical examination at this time of life occurred recently when I was instructing a group of fourth year medical students. As part of their pediatric training, they visited a school to do some examinations under supervision.
SUBDURAL FLUID AS A CONSEQUENCE OF PNEUMOENCEPHALOGRAPHY
Authors: SMITH HONOR V. , CROTHERS BRONSON
Published: December 2021

When lumbar or cisternal pneumoencephalography is carried out on children with nonprogressive brain lesions causing mental deficiency, cerebral palsy or epilepsy, air is seen in the subdural space in at least a third of cases. This proportion is much larger in children 2 years of age or under.

The roentgenographic appearances of subdural air are described and the importance of not attributing these appearances to cerebral atrophy or hypoplasia is emphasized.

In approximately one third of cases in which air enters the subdural space, that is, in from 10% to 15% of all cases, recovery from pneumoencephalography is delayed by the development of signs and symptoms suggesting a rise in intracranial pressure.

In such cases fluid can usually be found by needling the subdural space. Typically this fluid is characteristic of that found in subdural hematoma. There is no evidence that such a collection of fluid was present before pneumoencephalography.

It is therefore suggested that as air enters the subdural space and the brain falls away from the dura, vessels may be torn as they cross this space to reach the superior longitudinal sinus, with the formation of what may be termed subdural hematoma artefacta.

Although the incidence of this complication is moderately high, its effects are seldom serious, provided the situation is appreciated and suitable treatment given. The length of time the child spends in the hospital is, however, often greatly prolonged and occasionally operation proves necessary for removal of a subdural membrane.

Since the subdural hematoma is an artefact occurring in the course of treatment, its removal does not influence the ultimate prognosis.
RIGHT HEART CATHETERIZATION OF THE AORTA THROUGH A PATENT DUCTUS ARTERIOSUS
Authors: ADAMS FORREST H. , LABREE JOHN , STAUFFER HERBERT M.
Published: December 2021

Two patients with atypical findings of a patent ductus arteriosus are presented in whom right heart catheterization proved its existence by the catheter passing through the ductus into the aorta.

Right heart catheterization in one of these patients demonstrated a right descending aorta in the presence of a left aortic arch, the fourth patient with this anomaly to be reported.
FURTHER OBSERVATIONS ON THE ABSORPTION OF VITAMIN A
Authors: LEWIS J. M. , COHLAN SIDNEY Q. , MESSINA ANGELINA
Published: December 2021

Experiments carried out on infants revealed that vitamin A, as it occurs naturally in milk, was more effectively absorbed than when administered in an oily vehicle, but not quite as well absorbed as when given in an "aqueous" preparation. The high degree of absorbability of vitamin A in milk is due to the relatively small particle size of the butter fat globule.

By reducing the particle size of a fish liver oil preparation (oleum percomorphum) to 1 to 2 µ by homogenization into milk or water, the absorption of vitamin A was considerably enhanced in children and in rats.

The relationship of the particle size of the vehicle of vitamin A to absorption is further demonstrated by the results of the administration in children and in rats of three vitamin A preparations of varying particle size. Thus, the highest absorption occurred following the administration of a preparation containing particle size of submicroscopic proportion ("aqueous"); the lowest absorption resulted following the preparation containing particles macroscopic in size (oil) and intermediate absorption was observed following the use of a preparation containing particle sizes varying from 1 to 20 µ (emulsion).

Similarly, in a child having cystic fibrosis of the pancreas, the absorption of vitamin A was dependent upon the particle size of the vehicle employed.
STAPHYLOCOCCUS AUREUS IN AN OUTBREAK OF INFANTILE DIARRHEA
Authors: LYON HARVEY B. , RANTZ LOWELL A.
Published: December 2021

An outbreak of infantile diarrhea in newborn infants, caused probably by Staph. aureus, is described. The disease was short-lived, mild and self-limited.
POSTPRANDIAL LIPEMIC RESPONSE IN INFANTS AND CHILDREN
Authors: ELGHAMMER W. ROBERT , REICHERT JOHN M. , PHILIPSBORN HERBERT F.
Published: December 2021

The chylomicrograph is a simple and time-saving method of serially determining [See Table II in source pdf] neutral blood lipid levels. It is of value in studying chronic intestinal indigestion.

The clinical significance of the chylomicrograph is equal to that of the vitamin A curve.

The advantages of the chylomicrograph over the vitamin A curve are its simplicity, rapidity, availability and use of capillary blood specimens.
EFFECT OF GLUTAMIC ACID ON MENTAL FUNCTION
Authors: KERR WILLIAM J. , SZUREK S. A.
Published: December 2021

These results do not substantiate previous reports that glutamic acid will increase measurable intelligence. Attitudinal effect on the part of nurses, psychologists and psychotherapists, which might influence the results, has been minimized by the use of careful controls and different psychologists in each test situation.

Because of the small number of cases here reported, further studies are needed on larger groups using similar controls. A hospital with a large stable population of children with low testable intelligence would be preferable to the Langley Porter Clinic. One such study is soon to be reported. The results are in essential agreement with these.
STUDIES OF PENICILLIN IN PEDIATRICS
Authors: KAGAN B. M. , NIERENBERG M. , GOLDBERG D. , MILZER A.
Published: December 2021

Table I summarizes most of the pertinent data in this report on the serum penicillin concentrations 12 and 24 hours after intramuscular injection of K penicillin G in peanut oil and beeswax, which is fluid at room temperature, and of three different procaine penicillin preparations. These three preparations are procaine penicillin G in sesame oil, procaine penicillin G in peanut oil with 2% aluminum monostearate, and procaine penicillin G in water with Na-carboxymethylcellulose. When they were given in a dosage of 8000 u./lb. to infants and children, weighing between 4.5 and 18.0 kg., there was no statistically significant difference in the serum levels obtained. A dosage schedule for these preparations is suggested for pediatric use. The aqueous preparation offers some advantages which are discussed. Experiences are reported which emphasize the necessity of avoiding intravenous administration of all these preparations.
INTERNATIONAL NEWS AND REPORTS
Authors: KERSHAW JOHN D.
Published: December 2021

The Chief Medical Officer of the Ministry of Education, in his latest report,1 deals with the 2 years 1946 and 1947. It is appropriate that this should be so, for the 2 year period is one of special significance during which the full implications of the Education Act of 1944 for School Health work were being realised, while the National Health Service was not yet in operation to take its share of the burden. This latter point had considerable influence, for some local authorities were understandably shy of incurring expense in developing school health activities which might prove unnecessary when the National Health Service came into being.
ERYTHEMA BULLOSUM MALIGNANS FOLLOWING DILANTIN THERAPY
Authors: HELLER GEORGE , SLOANE MILTON
Published: December 2021

A case of erythema bullosum malignans in a child 9 years of age is presented. No conclusion concerning the etiology of this condition is warranted, but the coincidental occurrence of the disease following the use of dilantin® in this case and other reported cases should alert clinicians to the possibility of more severe reactions to that drug than is generally appreciated.

It is felt that antibiotic agents and intravenous alimentation, especially the free use of whole blood, may be life-saving in tiding the patient over the protracted period of hypoproteinemia caused not only by weeping from the skin surface, but also by loss of substance from unrecognized visceral lesions.
TRENDS
Authors: WEBB CLARENCE H.
Published: December 2021

THE following report, submitted by Dr. Clarence H. Webb, official liaison representative from the Academy to the Children's Bureau, summarizes the highlights of the meeting of the Advisory Committee on Maternal and Child Health and Crippled Children's Services at The Children's Bureau, January 30 and 31, 1950.

This general advisory committee, constituted in 1948, meets once or twice annually to advise with the Maternal and Child Health and Crippled Children's Services concerning the policies and programs of these divisions of the Children's Bureau. It is to be distinguished from smaller technical committees which study and give advice on specific technical problems. Academy members in attendance at the meeting were: Harry H. Gordon, Chairman of the Advisory Committee, Allan M. Butler, John P. Hubbard, Thomas F. Shaffer, Clarence H. Webb, James L. Wilson, Leona Baumgartner, Associate Chief of the Children's Bureau, and Katherine Bain, Director of Division of Research in Child Development.

Dr. Edwin F. Daily reviewed important developments since the last committee meeting. Attention was directed to the Annual Report of the Children's Bureau in the December issue of The Child, wherein significant increases in child population and changes in maternal and infant mortality rates are reviewed. Cooperative planning and action between the Children's Bureau and voluntary agencies has been fruitful.
PHYSIOLOGIC AND CHEMICAL RESPONSE OF PREMATURE INFANTS TO OXYGEN-ENRICHED ATMOSPHERE
Authors: GRAHAM BRUCE D. , REARDON HELEN S. , WILSON JAMES L. , TSAO MAKEPEACE U. , BAUMANN MARY L.
Published: December 2021

Arterial blood studies were performed on 44 premature infants while in atmosphere and greater concentrations of oxygen. Analyses were made for oxygen content, oxygen capacity and hematocrit. Concomitant plethysmographic studies were made on 29 occasions. Results were as follows:

1. Only 25% (7) of the premature infants studied breathed regularly in atmosphere; the remaining individuals breathed with some degree of periodicity (44%) or completely irregularly (30%).

2. As the concentration of oxygen being breathed was raised, then more of the group shifted to a regular type of respiration until when in 75-85% oxygen, 88% of the group then breathed with a regular type of respiration.

3. a. The percentage arterial oxygen saturation of the group averaged 93% in atmosphere, 96% in 30-55% oxygen, 100% saturation in 70-79% oxygen being breathed and 102% in 80-89% oxygen.

b. In atmosphere, when compared on age basis, the younger group (1-14 days) had essentially the same arterial oxygen saturation as the older group (14-65 days). In an atmosphere of 70-90% oxygen, the saturation of the younger group increased to 102% while the older group rose to 100%.

c. When compared on body weight basis, the 0.9-1.3 kg. group increased the arterial oxygen saturation of 85% in atmosphere to 102% when 70-85% oxygen was administered; the 1.3-1.8 kg. group, 93% to 101%; the 1.8-2.3 kg. group, 9% to 100%. (It is noted that either on age or body weight basis the group with higher hematocrit attained higher arterial oxygen saturation when 70-85% oxygen was administered than the group with lower hematocrit.)

4. a. A statistical analysis of the respiratory records revealed an average rise of 30% in minute volume when 30-40% oxygen was administered, this rise being significantly maintained as higher concentrations (to 90%) of oxygen were administered.

b. An average significant rise in respiratory rate of 30% was noted when 30-40% oxygen was administered which slowly fell to the original rate level as oxygen administered was increased to 80-90% concentration.

c. Consequently, the tidal volume (volume per respiration) gradually increased to 30% above the level in atmosphere as oxygen administered was increased to 80-90% concentration.
ABSORPTION OF FAT AND VITAMIN A IN PREMATURE INFANTS
Authors: MORALES SOLEDAD , CHUNG ARTHUR W. , LEWIS J. M. , MESSINA ANGELINA , HOLT L. EMMETT
Published: December 2021

Eight premature infants manifesting steatorrhea were placed on diets containing low and high amounts of fat in order to ascertain how economically the premature infant could utilize large amounts of fat. At the same time the effect of administering large amounts of fat on the vitamin A absorption of premature infants was investigated. The results of these studies indicated that in spite of steatorrhea the percentage of fat absorbed was essentially the same whether the diet contained high or low amounts of this food. Thus, the net absorption of fat was correspondingly higher following the use of a high fat diet. The absorption of vitamin A was approximately the same following the low or high fat regimen.

The finding that relatively high fat diets given to premature infants not only result in better fat retention but are also well borne clinically suggests that the currently advocated restriction of fat in these subjects is unnecessary and possibly undesirable.
USE OF PARENTERAL POTASSIUM THERAPY IN SURGICAL PATIENTS
Authors: LOWE CHARLES UPTON , ROURKE MARGARET , MACLACHLAN ELSIE , BUTLER ALLAN M.
Published: December 2021

IT HAS been observed frequently that following surgery patients may have a low serum chloride concentration. The shocklike state which occasionally occurs has been assumed to be the result of this low serum Cl. Therapy as radical as parenteral use of dilute hydrochloride acid has been advocated. Animal experiments indicate that when there is a deficit of potassium and an excess of sodium within the cells, the concentration of Cl in the plasma decreases while that of HCO3 increases. With the ingestion of K there is a retention of Cl and rise in serum Cl. Such changes in tissue and serum concentration also occur in the hyperadrenalism of Cushing's syndrome and of the alarm reaction in rats. That such an alarm reaction may result from operations is indicated by a fall in circulating eosinophiles and an increase in urinary 11-oxycorticoids. Moreover, such starvation and parenteral saline as may be incident to operation favor these alterations in tissue and serum concentrations.

The following studies were undertaken to determine whether the use of parenteral K in surgical patients would increase the intracellular potassium concentration and prevent a loss of Cl from the body. The results augment the affirmative evidence that has been accumulating since these studies were made.

Plan of Study

Five patients with surgical disease were studied. Those patients that were chosen had no stools during the period of observation. Two infants, 21 mo. and 7 mo. of age, had intussusception. Three children had perforated appendices with peritonitis, two 9 yr. old and one 14. The 2 children (S.L. and A.B.), who were the same age and weight and had perforated appendices, were felt to be ideal subjects for comparison between the 2 types of therapy. Therefore, throughout periods of study one (S.L.) received Na, Cl and glucose, the other (A.B.) a similar regime to which K had been added.
WEIGHT IN RELATION TO FETAL AND NEWBORN MORTALITY; INFLUENCE OF SEX AND COLOR
Authors: BAUMGARTNER LEONA , PESSIN VIVIAN , WEGMAN MYRON E. , PARKER SYLVIA L.
Published: December 2021

Analysis was made of 209,055 live births, 6978 fetal deaths subsequent to 20 weeks of gestation, and 5048 neonatal deaths, reported in New York City in 1939 and 1940. Comparison was made of fetal death rates per 1000 unborn children in each weight group by means of a modified life table method and of neonatal death rates per 1000 live births in each birth-weight group, for the two sexes and for the white and nonwhite races.

For all infants, fetal death rates, so calculated, are relatively low and neonatal death rates very high in the lower weight groups. Both rates go up sharply in the higher weight groups, indicating that infants much over average weight are not good risks.

Lower fetal death rates were observed for females in the weight groups below 3000 gm. and for males in the weight groups above 3000 gm. Neonatal death rates were lower for females throughout.

The implication appears to be that relative maturity is more important than size in regard to variation in fetal death rate.

Comparison by race indicates consistently higher nonwhite fetal death rates for nonwhite infants in all weight groups. Neonatal death rates were similar for white and nonwhite infants in the lower weight groups but higher for nonwhite infants in the upper weight groups. A study in 22 hospitals, giving presumably better care than the city-wide average, showed lower neonatal rates for the nonwhite infants in the lower weight groups. It is inferred that comparisons of observed mortality differences by race must consider differences between the races in regard to extrinsic factors such as economic status, nutrition and care.

For practical purposes a uniform criterion of birth weight, 2500 gm., should be maintained in the diagnosis of prematurity.

Using a method of combining fetal and neonatal mortality experience to measure the total risk to unborn children of different weights, it was possible to calculate "best birth weights." These were found to be about 120 gm. lower for female than for male, and about 160 gm. lower for nonwhite than for white births.
SELF-DEMAND FEEDING IN THE FIRST WEEK OF LIFE
Authors: OLMSTED RICHARD W. , JACKSON EDITH B.
Published: December 2021

The foregoing data reveal that in babies breast fed and artificially fed on a flexible schedule there is evidence of a definite patterning of the feeding behaviour even within the first seven days of life. Of practical importance in the management of infant feeding on such a regime, as is indicated graphically, is the ability of pediatrician to predict and to prepare the mother to expect rather frequent feedings on the third to sixth days compared with the first two, and to assure her that even though the baby is fed when he demands feeding, he will, at a very early age, be requiring a number of feedings not far in excess of that which he would be given on the ordinary three or four hour schedule feeding regime.
GLYCOGEN STORAGE DISEASE OF THE HEART
Authors: DI SANT'AGNESE PAUL A. , ANDERSEN DOROTHY H. , MASON HOWARD H. , BAUMAN WILLIAM A.
Published: December 2021

Two cases of glycogen storage disease of the heart occurring in siblings are reported. The first patient died at the Babies Hospital in 1922 and the diagnosis was established at autopsy. The second patient was admitted in 1948 and died after 33 days in the hospital. The family history reveals that the mother of the two patients had eight other children, of whom two are suspected of having succumbed to the same condition.

Detailed clinical, chemical and pathologic studies were carried out on the second patient. Numerous chemical determinations were performed both before and after death.

The pathologic changes were characteristic of those previously described in cases of glycogen storage disease of the heart. Despite the name of the disease, the abnormal glycogen accumulation and the consequent altered cellular structure were not limited to the heart, but were found in many other organs and tissues of the body.

The chemical data revealed an apparently normal sequence of events in the mechanisms for carbohydrate metabolism that could be investigated. It was therefore hypothesized that the metabolic error lay in an excessive rate of accumulation of glycogen in the tissues. It was suggested that this might be consequent to the formation of a polysaccharide closely allied to glycogen, but differing from it in its chemical structure, or to inability of these patients to transform carbohydrate to fat.
THE PEDIATRICIAN AND THE PUBLIC
Authors: PARKER MARY E.
Published: December 2021

For the past few years, many patients have been unable to secure adequate nursing care because there are not enough nurses in the whole world to give it. Unfortunate as this is, it has had one salutary effect. It aroused the public, the administrators of institutions, the physicians and the nurses to the need for doing "something" so that this situation will not continue and will not occur again.

This is very similar to the situation in World War I and immediately following. At that time also there was a shortage of nurses, and a committee of outstanding people in medicine and nursing sat down to try to find out what was wrong and to make recommendations to make things right. Out of this in 1923 came the Goldmark Report. The recommendations were excellent and are still good today, but little was done about them. Then came the depression, and there were too many nurses for the people who could afford to pay for this service. This situation gradually improved until we had reached the other extreme, a shortage of nurses due to expansion of nursing service in hospitals and public health agencies and the needs of the armed forces. Much criticism was leveled at the nursing profession, some of it justified, some of it not justified.
EFFECT OF PANCREATIN ON PLASMA VITAMIN A CURVES IN THE CELIAC SYNDROME
Authors: GIBBS GORDON E.
Published: December 2021

Vitamin A concentrations of the plasma have been determined following administration of halibut liver oil with and without pancreatin in infants and children. Thirty-three patients with cystic fibrosis of the pancreas were so studied. Without pancreatin the vitamin A concentration failed to rise. With pancreatin (in dosage of 0.15 gm./kg.) an average rise in vitamin A occurred approximating 39% of that found in normal control patients. No consistent effect of pancreatin was found in 10 cases of celiac disease.
ERYTHROBLASTOSIS FETALIS
Authors: DIAMOND LOUIS K. , VAUGHAN VICTOR C. , ALLEN FRED H.
Published: December 2021

Certain clinical manifestations of erythroblastosis fetalis in live born infants have been studied in relation to outcome. The likelihood of recovery is inversely related to the degree of anemia and hepatosplenomegaly present at birth, but kernicterus, which is the chief threat to eventual complete recovery, bears no close relation to these signs. Serologic studies in newborn infants with erythroblastosis fetalis have been generally of little value in establishing a prognosis. Male infants appear to have a more severe illness and a worse prognosis than female infants. Jaundice of the skin and scleras has not been found at the time of birth in any baby with erythroblastosis fetalis.
REMODELING MEDICAL EDUCATION
Authors: MITCHELL JOHN MCK.
Published: December 2021

THE position of science in the modern world has been aptly compared to that of the church in medieval times. Just as the manifestos of the church were then accepted without question, today the pronouncement that "it has been scientifically proved" is sufficient authority for the general public.

In somewhat similar vein, a statement to the effect that medical education has not kept pace with the rapid changes in medical practice is accepted without critical analysis by many physicians and taken to mean that a sweeping revision of the entire medical curriculum is indicated. Is this position justifiable? Should we choose a new site, lay a new foundation and erect a new edifice to house medical education? Or is the old building structurally so sound that it would be better to modernize it from within? Can additions be made without spoiling the "lines" which are of such symmetry that they have been admired throughout the world?

This is a question of great importance to which I will not attempt to give a categorical answer. On the other hand, there is no doubt that the present building is in urgent need of a thorough house cleaning, and that some remodeling is in order.

It is the objective of this paper to offer suggestions for certain simple changes and additions which are needed now.

Student Body

We must face the fact that there is a wide variation in the level of instruction among the approximately 800 approved colleges in the United States. This is clearly attested by the great difference in the mean scores of students from the different colleges on the Medical College Admission Test.
ALBUMIN THERAPY IN NEPHROSIS
Authors: GALAN ENRIQUE , GARCÍA OTTO , ESTABLE MANUEL PEREZ , FAES ORLANDO GARCÍA , PRADO ELISEO , ALFONSO GILBERTO
Published: December 2021

Twelve nephrotic children were treated with intravenous injections of low-sodium concentrated human plasma albumin. Favorable response, as judged by the decrease in weight and edema and the increase in diuresis, was only seen in five cases.

Lack of therapeutic effect on nephrotic edema was due in the majority of cases to the great urinary loss of injected albumin and to the inability of the kidney to excrete the edema fluid mobilized into the circulation by the osmotic effect of albumin.
STUDY OF THE INFLUENCE OF SEX OF DONOR ON THE SURVIVAL OF ERYTHROBLASTOTIC INFANTS TREATED BY EXCHANGE TRANSFUSION
Authors: SACKS MILTON S. , SPURLING C. L. , BROSS IRWIN D. J. , JAHN ELSA F.
Published: December 2021

An analysis of 74 cases of erythroblastosis fetalis treated by exchange transfusion has been presented. The over-all mortality was 17.6%, a figure comparable to the 15% rate of the Boston group. No advantage for the use of female blood in exchange transfusion was found. It is suggested that the disparity between these data and those of Allen et al. may well be due to the preponderant use in the latter series of male blood for infants severely affected by erythroblastosis fetalis. [SEE TABLE 4 IN SOURCE PDF.]
Bacterial Meningitis Secondary to Abscess of the Nasal Septum
Authors: Eavey Roland D. , Malekzakeh Mohammed , Wright Harry T.
Published: December 2021

Abscess of the nasal septum is an important consideration in the differential diagnosis of conditions such as nasal obstruction, hematoma of the nasal septum, nose pain, and swollen nasal turbinates. Surgical drainage and antibiotic coverage should be initiated as soon as the diagnosis of abscess of the nasal septum is made to prevent severe deformities. Intracranial complications can become apparent even after appropriate therapy has been initiated.
Error in Dr. Gold's Letter
Authors: Soyka Lester F.
Published: December 2021

The June 1975 issue of Pediatrics contains a letter to the editor from Arnold P. Gold, M.D. (p. 897). In this letter he attempted to correct an error in reporting the desired serum level of diphenylhydantoin. His original numbers probably should have been 10 to 20 mg/liter, in that the usually quoted desired diphenylhydantoin blood level is 10 to 20 µg/ml, not 100 ml, as he states.

I thought I would call this to your attention for it may leave a number of readers confused.
Possible Complications of the Levodopa-Propranolol Test
Authors: Rowe David W. , Sare Zlatko , Kelley Vincent C.
Published: December 2021

The article by Collu et al. (56:262, August 1975) suggests that the simultaneous administration of propranolol with levodopa decreases the number of nonresponders to the levodopa-stimulated growth hormone tests and provides a safe test to determine growth hormone reserve. We recently have used their protocol and have experienced complications in two patients.

Case Reports. An apparently normal 6-year-old boy with short stature complained of headache and nausea 60 minutes after administration of the test dose of levodopa and propranolol; sweetened orange juice was given and he vomited shortly thereafter.
Geographic Prevalence of Mucocutaneous Lymph Node Syndrome
Authors: John T. Jacob , Wilson H. David
Published: December 2021

In the March 1976 issue of Pediatrics (57:431, 1976), Goldsmith et al. reported a case of mucocutaneous lymph node syndrome (MLNS) in New Jersey. They stated that this syndrome has not been reported from any area other than Japan and Hawaii. This is incorrect, as eight cases of MLNS had been described in Korea in 1973.1 These cases were referred to in an article by Kato et al.,2 which was cited by Goldsmith et al. Nearly 7,000 cases of MLNS have been reported in Japan since 1970,2 and not 4,000 since 1967 as stated by Goldsmith et al.
C-Reactive Protein in Streptococcal Pharyngitis
Authors: Kaplan Edward L. , Wannamaker Lewis W.
Published: December 2021

This study was designed to explore whether the test for C-reactive protein (CRP) is useful in differentiating bona fide streptococcal infection from the symptomatic carrier at the time of the acute visit to the physician. Serial blood samples from 157 children with symptomatic pharyngitis and a positive culture for group A streptococci were analyzed for the presence or absence of CRP. These data were compared with the patients' antibody responses to two streptococcal extracellular antigens (antistreptolysin O and antistreptococcal deoxyribonuclease B). Seventy-eight percent of patients with serologically confirmed streptococcal pharyngitis had a positive CRP test at the initial visit. Conversely, if the CRP test was negative at the acute visit, only about 25% later showed an antibody response. This latter finding held regardless of the degree of positivity of the initial culture, the presence of exudate or adenitis, or the presence of a temperature greater than 38.3 C (101 F) or coryza. These data suggest that the CRP test may be helpful to the clinician, especially if this abnormal protein is absent at the time of the acute visit.
Serum Gastrin Levels in Infants and Children
Authors: Janik Joseph S. , Akbar A. M. , Burrington John D. , Burke Gerald
Published: December 2021

Fasting serum gastrin concentrations were determined by radioimmunoassay for 124 infants and children free of gastrointestinal disease. Values for the entire group ranged from 1.1 to 167.9 pg/ml (mean, 32.3 pg/ml). Mean serum gastrin levels for children who fasted eight or more hours were 22.5 ± 23.9 pg/ml while the mean serum gastrin levels for children who fasted four to eight hours ranged from 42.4 ± 33.9 pg/ml to 59.2 ± 49.6 pg/ml. The mean serum gastrin levels varied inversely with body surface area among children who fasted the same length of time.
Treatment of Chronic Childhood Asthma With Beclomethasone Dipropionate Aerosol: I. A Double-Blind Crossover Trial in Nonsteroid-Dependent Patients
Authors: Klein Robert , Waldman David , Kershnar Harvey , Berger William , Coulson Anne , Katz Roger M. , Rachelefsky Gary S. , Siegel Sheldon C.
Published: December 2021

Twenty-two children with chronic asthma requiring daily administration of bronchodilators but not steroids were administered 400 µg of beclomethasone dipropionate aerosol (BDA) or a placebo (vehicle) in a double-blind crossover study. The experimental design consisted of four study periods (four weeks each): (1) baseline, (2) BDA or placebo treatment, (3) washout, (4) BDA or placebo treatment. Evaluation of effectiveness was assessed by daily symptom and medication scores, Wright Peak Flow (WPF) measurements three times each day, and weekly spirometry. Pituitary-adrenal function was evaluated by diurnal measurement of cortisol level, intravenous (IV) metyrapone tests, and IV adrenocorticotropic hormone responses. Quantitative throat cultures for Candida were taken monthly.

Twenty-one of 22 patients correctly identified BDA. The mean weekly symptom score was 76.5 ± 10.8 (mean ± SE) during placebo compared to 21.3 ± 5.3 during BDA therapy (P < .005). The number of attacks per week was 7.1 ± 1.4 in those receiving placebo and 1.6 ± 0.6 in those receiving BDA (P < .005). Mean medication score was 39.6 ± 3.6 during placebo and 21.6 ± 1.3 during BDA therapy (P < .005). Mean weekly average WPF measurements increased 33% with BDA therapy compared to placebo. Eighty percent of patients showed an increase in forced expiratory volume in one second and in maximum midexpiratory flow rate during BDA therapy. All throat cultures were negative. No pituitary-adrenal function suppression was noted in any of the parameters studied.

BDA was shown to be highly effective in controlling asthma and produced no adverse effects.
Antibody Persistence After Primary Immunization With Trivalent Oral Poliovirus Vaccine
Authors: Krugman Richard D. , Hardy George E. , Sellers Clyde , Parkman Paul D. , Witte John J. , Meyer Barbara C. , Meyer Harry M.
Published: December 2021

Five years after primary infant immunization with trivalent oral poliovirus vaccine, employing either a three-dose primary series as recommended by the U.S. Public Health Service Advisory Committee on Immunization Practices (ACIP) or a four-dose series as recommended by the Committee on Infectious Diseases of the American Academy of Pediatrics, 115 children were serologically tested for persistence of neutralizing antibodies by the microneutralization test. Of the 57 individuals immunized according to the ACIP recommendation, antibody persistence was demonstrated in 92% for type 1 poliovirus, 98% for type 2, and 84% for type 3. Of those 58 individuals originally receiving a four-dose primary infant immunization series, the persistence of antibody was 98% to type 1, 98% to type 2, and 87% to type 3. Twenty-one of 24 negative sera showed neutralizing ability when tested by a more sensitive plaque reduction test. Thus, individuals completing either immunization schedule demonstrated satisfactory persistence of neutralizing antibody to all three poliovirus types over a five-year period.