bluuebunny/crossref_metadata_2025 huggingface dataset:
PETIT MAL EPILEPSY
Authors: Holowach Jean , Thurston Donald L. , O'Leary James L.
Published: December 2021

Eighty-eight cases of petit mal epilepsy in children are reviewed. The clinical characteristics and differential diagnosis of petit mal are presented in detail. Aspects discussed and significant findings are as follows: Petit mal is a relatively infrequent type of epileptic manifestation (4.4%). Petit mal is rare before 2½ years of age. Twenty-three per cent of the children had attacks for over 3 years prior to their first visit suggesting the limitations of therapy. A history of seizures in parents or siblings was present in 21% of the cases. Whereas, only 10% had apparent lesions of the central nervous system, the incidence of intellectual retardation 24%, is similar to that found in our reviews of jacksonian and psychomotor epilepsy. Sixty-one per cent had non-petit mal seizures (chiefly grand mal). In 63%, these first appeared with or after the onset of petit mal. Petit mal attacks were precipitated by hyperventilation in 93% of the cases. Ninety per cent of the children had seizure formations in at least one electroencephalographic tracing. Sixty-four per cent showed spike and wave patterns; in 26%, other convulsive patterns were noted. Recommendations in therapy and results are reported. The review suggests that petit mal is not entirely benign and unaccompanied by cerebral pathologic changes with effect on mentality or personality, nor spontaneously cured at puberty. The high incidence of grand mal and other seizures in these children is emphasized and prophylactic therapy suggested.
JUVENILE LYMPHOCYTIC THYROIDITIS
Authors: Saxena Krishna M. , Crawford John D.
Published: December 2021

Lymphocytic thyroiditis was the most common cause of nontoxic goiters in childhood, comprising about 40% of these and 20% of all goiters seen in our pediatric endocrine clinic. The diagnosis should be considered whenever a nontoxic goiter does not diminish significantly in size within about two weeks in response to thyroid-stimulating-hormone (TSH) suppressive doses of USP thyroid.

Observations on 32 children with lymphocytic thyroiditis have been recorded. The diagnosis was proven histologically in 23. In nine patients the diagnosis was presumptive. The condition occurred mostly in preadolescent girls as a slowly developing firm, diffuse, and smooth or nubbly goiter with or without symptoms of anxiety, nervousness and pressure in the neck. The majority of patients were euthyroid when first encountered, though examples both of mild hyperthyroidism and hypothyroidism were also seen. A high protein-bound iodine value, a large discrepancy between protein-bound iodine and butanol-extractable iodine, and positive tanned erythrocyte antibody test results provided the best diagnostic criteria apart from biopsy.

The pathological picture is one of hyperplasia with lymphocytic infiltration and atrophy of thyroid follicles and epithelium. Treatment consisted in giving TSH suppressive doses of thyroid for a prolonged period. The results of treatment were not entirely satisfactory. Genetic predisposition, probably manifested in an abnormal cellular hypersensitivity, and excessive TSH stimulation of the thyroid seem for the moment the two factors in pathogenesis best supported by laboratory evidence.
AMEBIC PERFORATION OF THE INTESTINE IN CHILDREN
Authors: de S. Wijesundera C. , de Silva C. C.
Published: December 2021

Seven cases of amebic perforation of the large intestine in children are presented. Among the noteworthy features are (a) a misleading symptomatology, (b) the relative ineffectiveness of oxytetracycline, the hydroxyquinoline group of drugs, and emetine as amebicidal agents, and (c) the failure of surgical treatment. Attention is also drawn to the association of whipworm infestation, with a suggestion that this may possibly be aiding the amebic invasion of the large gut. Neither an operative nor a conservative regimen has met with any success at our hands in saving a single life so far.
PULMONARY FUNCTION IN THE NEWBORN INFANT
Authors: Nelson N. M. , Prod'hom L. S. , Cherry R. B. , Lipsitz P. J. , Smith C. A.
Published: December 2021

An open breathing circuit is described that is suitable for the newborn infant. The addition of an end-tidal sampler allows accurate study of many pulmonary functions. Data obtained with this equipment are quite comparable to those obtained with more classic methods in neonatal physiology. The low alveolar CO2 tension commonly observed in the first days of life may result from decreased CO2 production by the fasting newborn infant. [See Fig 7 in Source Pdf]
PULMONARY FUNCTION IN THE NEWBORN INFANT
Authors: Nelson N. M. , Prod'hom L. S. , Cherry R. B. , Lipsitz P. J. , Smith C. A.
Published: December 2021

The arterial-alveolar tension gradient for CO2 has been investigated in 17 normal new born infants and in 15 with some degree of respiratory distress. Whereas the normal infants had virtually no Pco2 gradient from pulmonary capillary to alveolus, an average difference of 13.9 mm Hg was detected in sick infants. This gradient for Pco2 is caused by increased alveolar (and total physiological dead space, the relative amount of which closely parallels the clinical course of the disease. The data obtained indicate the increase in alveolar dead space to be largely due to poor perfusion of ventilated alveoli. In severely ill infants more than 60% of ventilated alveoli appear to be under-perfused.
GENERALIZED ASPERGILLOSIS AND ASPERGILLUS ENDOCARDITIS IN INFANCY
Authors: Luke James L. , Bolande Robert P. , Gross Samuel
Published: December 2021

To our knowledge, this is the first reported case of Aspergillus endocarditis with widespread dissemination in infancy. The possible entry of the organism through the umbilical vein at birth during exchange transfusions, and the relatively silent clinical course in view of the spectacular postmortem findings, are noteworthy.
Pediatric Diagnosis
Authors: AMES MARY DANIEL
Published: December 2021

The second edition of Pediatric Diagnosis has continued the basic format of the first edition, adding several new chapters on more symptoms. As with the first, the second edition continues to be a combination of a differential diagnostic and general textbook, based on classroom lectures on pediatrics. It is, therefore, more useful as a symptom reference rather than a background reference. The additions and revisions in the second edition mirror the changes in the general approach to pediatric practice in the past decade.
A STUDY OF THE POSSIBLE RELATIONSHIP OF PROGESTERONE TO COLIC
Authors: Clark Robert L. , Ganis Frank M. , Bradford William L.
Published: December 2021

A series of 15 noncolic infants ranging in age from 6 days to 3 months was studied to determine pregnanediol glucuronide (PDG) excretion in urine. All these infants showed appreciable PDG spots by sensitive chromatographic techniques. In contrast, eight "colic" infants were studied, and it was found that these infants excreted none or only trace amounts of PDG in their urines. Seven other "colic" infants also showed no urinary PDG spots before hormone administration but demonstrated remission of symptoms and chromatographic spots after treatment. It is suggested that one cause of colic may involve progesterone deficiency and that in such instances the symptoms may be alleviated by the administration of a short course of oral progestational hormone.
NEONATAL GASTRIC PERFORATION WITH SURVIVAL
Authors: Reams Gerald B. , Dunaway James B. , Walls William L.
Published: December 2021

A case report of an infant with neonatal gastric perforation is presented, together with a review of the English literature. Almost two-thirds of cases of this condition occur in premature infants. Abdominal distention, absent bowel sounds, and dyspnea are the commonest clinical signs, each occurring in 70% or more of the cases. Seventeen of 39 reported patients who were treated surgically within 12 hours of onset of signs or symptoms survived. Operation more than 12 hours after onset has resulted in a sharp increase in mortality. No survivals have been reported without surgery.
ANTIBODIES TO COW'S MILK PROTEINS—THEIR PRESENCE AND SIGNIFICANCE
Authors: Peterson Raymond D. A. , Good Robert A.
Published: December 2021

A study was made of antibodies to cow's milk proteins in the sera of 288 persons, mostly children. The sera were assayed for both precipitating and hemagglutinating antibody. Comparisons between the two systems are presented. The incidence of precipitins and/or elevated hemagglutinating titers was analyzed by age, nature of illness, and duration of disability. Chronically disabled children, as a group, had sigficantly higher titers than did normal or acutely ill children. Grouped patients with recurrent or chronic pneumonia, and Aldrich's and Hurler's syndromes, had higher titers than even the other chronically ill children. In the majority of cases it was not possible to attribute a pathogenetic role to the observed antibody. Whether or not these antibodies can be responsible for disease under special circumstances remains unknown.
MEDICAL CARE IN THE 1960'S
Authors: McGuinness Aims C.
Published: December 2021

YOU ARE APPROACHING the end of the first of 3 days of a beautiful scientific program covering a broad range of medical problems, many of which are of regular and repeated concern to the practitioner. Medicine, however, as a blend of the physical and biological sciences on the one hand, and of the social sciences on the other, cannot be separated from the socioeconomic setting in which it is practiced. It is significant, therefore, that your program committee has recognized this fact in scheduling this afternoon's mid-meeting interlude.

A better title for this paper would be "Some Reflections on the Social and Economic Aspects of Medicine." I say "some reflections," for this is a vast subject, and about all I can hope to do in the time allotted is to skim over a few highlights which may serve as a stimulus to some of you to reflections of your own.

Any consideration of the social and economic forces which are so inextricably related to today's complex medical care problems, perhaps would best be brought into perspective by a brief historical review.

Self-sufficiency has been one of America's most cherished traditions—self-sufficiency of the individual, the family, the community, and the state; and in our federal system of government, action at national level has been invoked only to deal with problems of a magnitude and difficulty beyond the scope of the individual, and of government at state and local levels. It was in this context that Lincoln made his oftquoted statement to the effect that it is the function of government to do for the people only what they cannot do for themselves otherwise, or cannot do as well.
EFFECT OF ORAL POLIOVIRUS VACCINE IN NEWBORN CHILDREN
Authors: Sabin Albert B. , Michaels Richard H. , Krugman Saul , Eiger Marvin E. , Berman Peter H. , Warren Joel
Published: December 2021

The stools of 150 breast-fed newborn children who received either Type 1 oral poliovirus vaccine (total of 71) or a mixture of all 3 types (total of 79) during the first 11 to 59 hours after birth, as well as of 35 unvaccinated newborns in the same nurseries in a New York City hospital, were tested for virus. Neither poliovirus nor any other virus was recovered from the unvaccinated.

Among the infants who swallowed only Type 1 vaccine, in doses of 1 x 106.7 to 3 x 107.7 TCD50, the excretion rate was influenced by the titer of homotypic maternal antibody—82% among 22 infants with antibody titers of 128 or less, and 42% among 26 infants with titers of 192 or more. The infants who swallowed a mixture of all three types of vaccine excreted predominantly Type 2 poliovirus, and only rarely Types 1 or 3. In contrast to the findings with Type 1, the excretion rate of Type 2 poliovirus by 53 infants was not influenced by levels of maternal antibody ranging from 8 to 2,048. However while 90% of 20 infants who swallowed one or three doses of 107.7 TCD50 excreted Type 2 poliovirus, only 51% of 35 infants who swallowed one or three doses of 106.7 TCD50 excreted.

Analysis of our own data on breast-fed children and those of other studies carried out with aliquots of the same lots of vaccine, indicated that the titer of circulating placentally transmitted antibody did not by itself affect the multiplication of the ingested polioviruses in the intestinal tract. The ingestion of antibody-containing milk and the residual amniotic fluid, which may contain antibody especially when the level of maternal antibody is high, are factors of special importance. The very high gastric acidity present in most newborn infants during the first 24 hours appears to have no effect when very large doses of virus are swallowed, but cannot be disregarded when the smaller doses, ordinarily effective in older children are used.

When undiluted vaccine was merely swabbed on the posterior pharyngeal wall, 63% of 43 newborn infants excreted virus in the stools, but only 25% of 24 tested yielded small amounts of virus in swabbings obtained from the throat.

Only about 35% of 26 infants who excreted Type 1 virus and 59% of 29 infants who excreted Type 2 virus showed evidence of active antibody formation at 3 months of age—largely due to the low levels of antibody produced by the immunologically immature infants and the masking effect of the residual, placentally transmitted antibody.
Letters to the Editor
Authors: STERLING JULIAN A.
Published: December 2021

I agree with Dr. Hays's observations but not his conclusions, particularly when these are based on premises drawn out of context.

It is unsatisfactory to assume that prolongation of survival time is the sole reason for use of any technique or procedure. We are all familiar with the fact that today all infants, given modern care, live longer than infants did with the same congenital defects 30 years ago. That they live longer is more reason to try to do more for them.
ACUTE HEMATOGENOUS OSTEOMYELITIS
Authors: Hall J. E. , Silverstein E. A.
Published: December 2021

One-hundred cases of acute hematogenous seen at the Hospital for Sick Children in a 40-month period from January, 1956, to June, 1958, have been reviewed. These patients were treated on all services of the hospital (pediatric, general surgical, and orthopaedic). In the 68 cases in which positive cultures were obtained, nearly 50% were staphylococcus pyogenes, either partially or wholly resistant to penicillin. For this reason it was felt that antibiotic therapy should begin with a broad spectrum antibiotic (or on the basis of recent experience, methycillin). The best chance for aborting and controlling the disease conservatively comes in the first 3 days following the onset of symptoms. For this reason, early accurate diagnosis is urged, and prompt, effective treatment is necessary. Emphasis is laid on the fact that the diagnosis must be made on clinical, not x-ray, findings. On the basis of the recent literature and the findings in this series, a rational scheme of therapy for acute hematogenous osteomyelitis has been suggested.
STUDIES ON HYALINE MEMBRANE DISEASE
Authors: Ambrus Clara M. , Weintraub David H. , Dunphy Donal , Dowd John E. , Pickren John W. , Niswander Kenneth R. , Ambrus Julian L.
Published: December 2021

In the serum of normal prematures and premature infants with respiratory distress syndrome, plasminogen was absent. In mature newborns plasminogen levels were low, as compared to adults. In the euglobulin fraction of plasma, plasminogen level was highest in mature newborns, lower in healthy prematures, and lowest in prematures with respiratory distress syndrome. Antiplasmin level was exceptionally high in about a fourth of the premature infants with or without respiratory distress syndrome. Plasminogen activator activity was found more often in the blood of infants with respiratory distress syndrome than in normal infants. This may be due to the liberation of tissue activators as a consequence of hypoxia. Because of the absence of the substrate (plasminogen), this activator level may have no significance. Tissue activator activity was found in the lungs of premature infants whether they died of hyaline membrane disease or from other causes.

Forty-five infants with respiratory distress were treated in a therapeutic study. Twelve were treated in a preliminary series and 33 in a randomizd, double-blind investigation. Of the latter, 11 were treated with placebo, and 5 (45%) survived; 8 were treated with streptokinase activated human plasmin and 2 (25%) survived; 14 were treated with urokinase activated human plasmin and 12 (86%) survived. Among the infants who died, no definite hyaline membrane disease was found by histopathologic examination in two of the placebo group, one in the streptokinase-plasmin treated group, and the two who died in the urokinase-plasmin group. No significant side-effects of plasmin therapy were seen. Although considerable fibrinolytic and plasminogen-activator activity was generated in many treated patients, there was no significant fall in blood coagulation factors. Intracerebral hemorrhage, which appears to occur often in patients who die with hyaline membrane disease, was not more frequent in the plasmintreated group than in the placebo group.
THE INFLUENCE OF ADRENAL STEROIDS AND CORTICOTROPIN ON MASSIVE MYOCLONIC SEIZURES OF INFANCY
Authors: Bray Patrick F.
Published: December 2021

A 4-year follow-up study is reported on 10 infants whose minor motor seizures were treated intensively with cortisone and/or corticotropin. No correlation was found between the infants' initial clinical and electroencephalographic response to therapy and their follow-up intelligence quotients. The similar initial electroencephalographic findings, contrasted with the marked followup differences in levels of intellectual functioning, illustrate the limited prognostic value of the electroencephalogram in this syndrome. Similarly, no correlation was noted in the patients' initial response to therapy, and the presence or absence of microcephaly or focal neurological deficit. In the absence of any other rational treatment, and despite the dismal prospect suggested by this report and those of others, renewed efforts to treat patients earlier and more intensively with cortisone and corticotropin could be undertaken. However, in the light of 4 years' experience, such an approach might be a reflection more of therapeutic desperation than of rational expectation of good results.
SYSTEMIC BLOOD FLOW IN INFANTS AND CHILDREN WITH AND WITHOUT HEART DISEASE
Authors: Cayler Glen G. , Rudolph Abraham M. , Nadas Alexander S.
Published: December 2021

A technique for measuring cardiac output by the Fick method in small infants during cardiac catheterization is described. Data on resting oxygen consumption, arteriovenous oxygen difference and systemic cardiac output is presented for a group of 126 subjects composed mainly of infants and young children with congenital heart disease. It was found that (a) there was no significant difference in mean resting cardiac index for patients with body surface area under 1.0 square meter regardless of the presence of, or the severity of, heart disease, and (b) patients with heart disease who were larger than 1.0 square meter had significantly lower mean cardiac indices and higher arteriovenous oxygen differences than the control patients. An excellent linear correlation of cardiac output to body surface area was found. There was also a close correlation between index and regression lines for cardiac output leading support to the validity of the cardiac index concept for comparing cardiac outputs in various sized patients. The normal increase in cardiac output during exercise is greater for children than for adults. Forty-seven per cent (8 of 17) children with heart disease showed low cardiac output response to exercise.
HAGEMAN FACTOR DEFICIENCY IN A CHILD
Authors: Abildgaard Charles F. , Cornet Jo Ann , Alcalde Victor , Schulman Irving
Published: December 2021

A case of Hageman factor deficiency in a 13-year-old white female is presented and the laboratory procedures necessary for identification of this abnormality are outlined. No bleeding was observed at the time of tonsillectomy and adenoidectomy, confirming the benign nature of the disorder. Decreased Hageman factor activity was found in the plasma of other family members, being in accord with the autosomal recessive nature of the characteristic responsible for this factor.
SOME SOCIAL PSYCHOLOGICAL CONSEQUENCES OF HANDICAPPING
Authors: Richardson Stephen A.
Published: December 2021

HELPING A PERSON with a handicap to maximize his assets and minimize the negative consequences of the handicap has long been the goal of rehabilitation. If we examine the practice of rehabilitation, however, we find that the early emphasis on physical restoration and the maximization of physical function is still dominant. More recently increasing emphasis has been given to minimizing economic dependency through vocational training and placement and, in the case of children, special educational training. Least systematic attention has been paid to the effect of handicapping on a person's social development and the learning of human relations skills.

The purpose of this paper is to discuss some of the research and developing concepts bearing upon some of the social psychological consequences of handicapping. Two major questions exist. The first of these is whether handicapping has a blunting or sensitizing effect on a person. The second—in a sense the converse of the first—is whether the handicapped person develops certain specialized skills in managing his social relationships with the nonhandicapped.

By blunting effects of a handicap I mean the impoverishment of the individual's resources for dealing with other people and observing them; by sensitizing I mean the opposite. It has been argued—perhaps particularly on the basis of literary works—that a handicap tends to make a person especially sensitive. Some people believe, for example, that Byron's club foot on Elizabeth Barrett Browning's invalidism may have been partly responsible for their sensitivity as poets. Others have suggested that those who are forced to stand on the sidelines and watch life go by become sensitive as observers because so many of their satisfactions have to be derived vicariously rather than through direct involvement and participation.
THE STRUCTURE AND FUNCTION OF RENAL GLOMERULAR CAPILLARIES IN HEALTH AND DISEASE
Authors: Vernier Robert L.
Published: December 2021

In the belief that sequential studies of the pathology of the kidney might improve our understanding of the pathogenesis of a variety of forms of renal disease in childhood, we began to perform percutaneous renal biopsies in children in 1955. Our studies were stimulated by the pioneering investigations of Iversen and Brun1 in Europe, and Muehrcke, Kark, and Pirani2 in the United States. Our experience3 now includes more than 500 kidney biopsy specimens obtained from approximately 400 children of all ages. The incidence of complications has been low, and the method has proved to be safe enough to justify the small risk entailed. Bleeding into the perirenal tissues, sufficient to cause pain, or a measurable fall in hemoglobin, or the appearance of a mass, has occurred in eight children. Gross hematuria of more than transient nature has occurred in six additional children. There has been no recognized permanent renal functional impairment or other chronic sequelae of these accidents. Surgical exploration of the biopsied kidney has never been necessary and no deaths have occurred as a consequence of the procedure.

The confusion which exists regarding classification and diagnosis of many renal diseases arises because of inadequate knowledge of their etiology, and is further compounded by conflicting use of terminology by clinicians and pathologists. The terms nephritis, nephrosis, mixed nephritis-nephrosis, and the modifying terms acute, subacute, and chronic, are, for example, applied by these two groups of physicians in circumstances which differ widely depending upon the experience of the user. Widespread use of the renal biopsy technique over the past 7 years has not eliminated the difficulties in use of terminology, but some progress has been made.
What Drug Are You Prescribing?
Authors: Jacobziner Harold
Published: December 2021

There is at present much interest over the new regulations of the U.S. Food and Drugs Administration, requiring that the generic names shall accompany the trade name of drugs in advertisements and trade literature. This raises the question as to whether the same parallel requirement might not be imposed by editors in papers concerned with drugs. Often only the generic name appears in the title, especially if the article deals with some unfavorable aspect of the drug.
THE RESPIRATORY RESPONSE TO EXERCISE
Authors: Mcllroy Malcolm B.
Published: December 2021

THE pulmonary ventilation during mild or moderate muscular exercise in normal subjects is linearly related to the rate of doing work. In simple exercise involving large groups of muscles, as in walking on a treadmill or cycling on an ergometer, the efficiency of muscular exercise is constant. By efficiency is meant the relationship between the increase in oxygen consumption due to the work and the external work done. It may seem strange that all subjects, regardless of age, sex or disease, use almost the same amount of extra oxygen to do the same simple muscular task, but nevertheless it is true. This constant mechanical efficiency makes it possible to substitute external work rate for a measurement of oxygen consumption in exercise tests.

Before discussing exercise testing from a ventilatory point of view, the difference between the ventilatory response to mild or moderate exercise and the response to severe exercise will be considered. By severe exercise is meant exercise at a rate within 30 per cent or so of the maximum load that the subject can maintain for 6 minutes. The difference in normal subjects during steady-state exercise on a bicycle ergometer or on a treadmill is shown in Figure 1. This is an idealized graph based on a similar one from a review by Dejours and incorporating some data from our laboratory on directly measured arterial blood gas tensions corrected for changes in arterial or esophageal temperature.

The graph shows ventilation, blood lactic acid, arterial oxygen and carbon dioxide tensions and pH, together with respiratory exchange ratio[R] plotted against oxygen consumption, rate of doing work in kg-m per minute, and pulse rate. The first part of the graph, marked A, shows the relationships existing during mild and moderate exercise, and the second part, B, shows what happens during severe exercise.
RENAL AMYLOIDOSIS RESULTING FROM A CHRONICALLY INFECTED BURN
Authors: Hoffman Saul , Simon Bernard E. , Fischel Robert A. , Gribetz Donald
Published: December 2021

An interesting and unusual case of an 11-year-old white male with chronically infected burns of his lower extremities who developed amyloidosis and the nephrotic syndrome is reported. The case is considered from the following aspects: (1) the rarity of amyloidosis in burns, (2) the short duration between the onset of the primary disease and the amyloidosis, (3) the age of the patient, and (4) the striking clinical improvement of the renal manifestations after the treatment of the burn. The treatment of the burns, using homografts, and the importance of renal biopsy in the diagnosis and follow-up are also discussed.

Addendum: A third renal biopsy was performed in August, 1963, about one year following the second one. The amount of amyloid seen in the glomeruli did not seem to have diminished.
OBSTETRIC AND PEDIATRIC COMPLICATIONS OF JUVENILE PREGNANCY
Authors: Battaglia Frederick C. , Frazier Todd M. , Hellegers Andre E.
Published: December 2021

The outcome of 636 pregnancies occurring to girls aged 14 or less in the years 1936-1960 has been analyzed. A higher incidence of toxemia, contracted pelvis, prematurity, immaturity, and perinatal mortality than is contained in reports in the literature was found. The size of the problem in an Eastern seaboard city was studied by the use of Baltimore City Health Department data. The conclusion is reached that in the study of pregnancy outcome in very young girls one should guard against dilution of statistics pertaining to the very young, by data pertaining to those in their later teens.
SMOKING BEHAVIOR, RECREATIONAL ACTIVITIES AND ATTITUDES TOWARD SMOKING AMONG NEWTON SECONDARY SCHOOL CHILDREN
Authors: Salber Eva J. , Reed Robert B. , Harrison Sarah V. , Green Joseph H.
Published: December 2021

In November, 1959, questionnaires on smoking habits were answered by 6,810 students from grades 7 through 12, attending the public high schools in Newton, Massachusetts. In this report differences between smokers, discontinued smokers, and nonsmokers in the use made of leisure time activities and in their attitudes and beliefs about smoking and health are explored. Smokers spend a greaten amount of time watching television and less time reading books than do nonsmokers. Their friends are more often smokers, and they go to the movies more frequently, attend dances oftener, and are car owners more often than are nonsmokers. On the other hand, they play sports less and belong to fewer clubs and organizations than nonsmokers. More nonsmokers than smokers consider smoking to increase nervousness, to cause lung cancer, and to have a deleterious effect on growth, athletic ability, and health. Differences found between smokers and nonsmokers remain consistent within each social class.
Fibrinolysin, Fibrin, and Hyaline Membranes
Authors: LIEBERMAN JACK
Published: December 2021

Clara M. Ambrus et al, in their report on the fibrinolysin system in Hyaline-Membrane Disease (Pediatrics, 32:10, 1963) studied the plasminogen-activator content of the lungs by utilizing human fibrin as substrate. With their methods they appear to have found normal levels of this activator in the lungs of infants dying with hyaline-membrane formation, and therefore could not confirm my earlier observations of a lack of such activity in this condition. Inasmuch as I used a bovine-fibrin substrate in my studies, Ambrus suggests that the difference in our results may be due to the difference in substrate.
SCLEREDEMA "ADULTORUMIS" IN CHILDREN
Authors: Greenberg Lawrence M. , Geppert Charles , Worthen Howard G. , Good Robert A.
Published: December 2021

The literature on scleredema adultorum of Buschke "acute scleriasis" of Piffard) is reviewed, pointing out the clinical features, course, pathology, and therapy of the disease. Three cases of scleredema adultorum occurring in children are described, and the relatively high frequency of the disease in children is emphasized. Histochemical studies demonstrate a probable accumulation of a mucopolysaccharide into and between the collagen fibers of the dermis. The observations suggest that the material is either chondroitin sulfate A or hyaluronic acid. A basis for the accumulation of the increased amounts of the mucopolysaccharides is considered.
Lupus Erythematosus and Anticonvulsant Drugs
Authors: LEVINE MARK C.
Published: December 2021

It is alleged in the article "Systemic Lupus Erythematosus in Childhood," by Jerry C. Jacobs, M.D. (Pediatrics, 32:257, 1963), that 7 of the 35 reported cases were induced by anticonvulsant drugs (diphenylhydantoin, trimethadione or methylphenylethylhydantoin). It is quite obvious that this group of patients were rendered acutely ill by reactions (presumably allergic) to a variety of commonly employed anticonvulsants, but whether the illness described was actually SLE is open to question.

Obviously, the key issue lies in the acceptance of the presence of the LE cell as ipso facto evidence of SLE.
Lessons from Animal Behavior for the Clinician
Authors: RICHMOND JULIUS B.
Published: December 2021

This is a salmagundi of tasteless tidbits and warmed-over hash mixed with a few really succulent morsels. There is a chapter of what can only be called speculations by the editor, several perfunctory reviews of research, an article that is essentially a republication of one of the authors' earlier papers, and a brilliant analysis and exposition of the current state of the study of developmental animal behavior. It is just a little book (51 pages).
Protein Metabolism, Influence of Growth Hormone, Anabolic Steroids and Nutrition in Health and Disease. An International Symposium
Authors: FOMON SAMUEL J.
Published: December 2021

Even among scholarly pediatricians, few except those with particular dedication to endocrinology will be motivated to read through a major portion of this book. Most of the presentations concern mode of action or results of laboratory or clinical trials with anabolic steroids. Discussions after each of the formal presentations provide some interesting data and opinions, but in many instances these discussions appear to be nearly verbatim transcriptions in which the trend of thought is at times difficult to follow and some irrelevant material is included.
THE EFFECT OF ACUTE PULMONARY EDEMA UPON LUNG COMPLIANCE
Authors: Haddy Theresa B. , Haddy Francis J.
Published: December 2021

Thirty-eight puppies were paired according to weight and one of each pair was infused intravenously with normal saline and levarterenol in order to produce acute pulmonary edema. The lungs were immediately excised and the relationship of gas volume to airway pressure was examined in either the natural or gas-free postmortem state. The edematous lungs consistently opened at lower pressures than did the nonedematous lungs. After opening had occurred, the rise in airway pressure for a given increase in gas volume was often, but not invariably, greater in the edematous lung.

The effect of change in pulmonary vascular volume was studied in eight excised adult dog lungs. In the absence of pulmonary edema, an increase in vascular volume [SEE FIG. 5. IN SOURCE PDF] caused a slight increase in airway pressure. In the same lungs, massive pulmonary edema increased airway pressure independent of vascular pressure. [SEE FIG 4 IN SOURCE PDF]

These findings suggest that changes in the bronchial mucus-alveolar lining layer complex, parenchyma, and vascular volume all contribute to the changes in compliance seen in acute pulmonary edema. The change in the bronchial mucus-alveolar lining layer complex is of such a nature as to increase compliance, whereas the changes in the parenchyma and pulmonary blood volume decrease compliance.
JUVENILE XANTHOGRANULOMA WITH PULMONARY LESIONS
Authors: Lottsfeldt Fredrik I. , Good Robert A.
Published: December 2021

A case of juvenile xanthogranuloma with pulmonary lesions is presented. The benign course of this child's disease without therapy is stressed. Other reported cases of internal involvement in juvenile xanthogranuloma are reviewed.
MULTIPLE CONGENITAL ANOMALIES IN THE E1-TRISOMY (GROUP 16-18) SYNDROME
Authors: Rohde Russell A. , Hodgman Joan E. , Cleland Robert S.
Published: December 2021

In this paper are described the clinical, necropsy, and cytogenetic findings in an infant with multiple congenital anomalies associated with autosomal trisomy in group E. Thirty-three previously recorded cases having a similar chromosomal abnormality are reviewed. Because of uncertainty in identifying the trisomic chromosome in group E, we propose that these cases be termed the "E1-trisomy syndrome." The clinical features of this syndrome are sufficiently distinctive to afford tentative diagnosis. Although absolute diagnosis currently rests upon complete cytogenetic analysis, dermatoglyphics and biochemical defects may eventually prove to be of diagnostic value. Despite a normal mean gestational age, these infants are usually premature in weight. All but three cases have been reported in Caucasians and thus far there has been a preponderance of affected females.

Most patients die in infancy from infection or congestive heart failure. The mean age at death has been 102 days. Grossly evident malformations of heart, gastrointestinal tract and kidneys are the most consistently reported abnormalities at necropsy. The infrequent reports of histologic abnormalities include instances of ectopic pancreas and isolated descriptions of dysplastic changes in various organs. A unique microscopic lesion of the pancreas seen in this and one other reported case deserves further study. Two previously unreported gross lesions, thyroglossal duct cysts and gluteal lipoma, were found in this patient.

Occasionally, the E1,-trisomy syndrome may, apparently, be associated with partial trisomy, trisomy-translocations, mosaicism, double trisomies, and in one instance, an apparently normal chromosome pattern. Pathogenesis of the chromosomal disturbance remains unknown, although advanced parental age appears important. The role of infection and radiation reported infrequently in this disorder is not clear.

Further reporting of the E-trisomy syndrome in extensio, is expected to elucidate many of the unsolved features of the chromosomal syndromes, particularly those relating to the causal relationship of chromosomal aberration and pathogenesis.
DIAGNOSIS AND TREATMENT: USE AND MISUSE OF TEMPERATURE AND HUMIDITY IN CARE OF THE NEWBORN INFANT
Authors: Silverman William A.
Published: December 2021

INFANTS delivered from the warm uterus into a cool environment invariably experience a considerable loss of body heat, and since the rate of cooling is almost always greater than the rate of heat production body temperature promptly falls. The rate of fall, the final level of equilibrium, and the distribution of temperatures of the various tissues and organs are quite dependent upon the ambient conditions of temperature and humidity which are provided for infants in the first minutes, hours, and days of life.

If the artificial climate is too warm and humid to allow for the dissipation of heat liberated by metabolic processes the newborn infant becomes febrile and tachypneic. This is particularly likely in small infants whose physiologic mechanisms of heat loss are easily overwhelmed. The environmental conditions must be adjusted because death from hyperthermia may ensue rather quickly. However, there is usually no problem of recognition when warm limits have been exceeded; as a result temperature and humidity are never deliberately misused in this way in the care of newborn infants. Induced hyperthermia is almost always the result of technical accidents.

Since there is now convincing evidence that newborn infants exhibit homeothermic responses to thermal stimuli and that the survival of small neonates can he improved by placing them in warm and moderately humid environments, it may also be said that physicians rarely misuse temperature and humidity in a manner which would permit uncontrolled heat loss. Thus, if we omit the issue of deep hypothermia for the moment the present-day questions about the proper use of temperature and humidity are concerned not with the extremes but with the middle of the climatic scale.
An Occurrence of Argininosuccinic Aciduria
Authors: ARMSTRONG MARVIN D. , YATES KERIN N. , STEMMERMANN M. G.
Published: December 2021

The occurrence of two sibs with argininosuccinic aciduria is reported, and data are presented on their urinary metabolites. Neither of the children is severely mentally retarded, and one is almost in the low normal range of ability.
Letters to the Editor
Authors: GOLDMAN ARMOND S. , ANDERSON D. W. , HALPERN S. R. , SELLARS W. A.
Published: December 2021

In the study of oral challenge of allergic patients with milk, the inclusion of patients with milk sugar intolerance was minimized by using lactose-free purified milk proteins for confirmatory oral challenge tests. These purified milk proteins did contain sucrose, but the possibility of sucrose intolerance was excluded because the soybean milk used during the asymptomatic periods of milk elimination also contained sucrose.

We agree with Dr. Ingall that in the absence of oral challenge with purified milk proteins, it is difficult to distinguish between milk protein hypersensitivity and lactose intolerance in those patients exhibiting solely gastrointestinal reactions when challenged with lactose-containing cow's milk.
Fear of Childhood Injections as a Factor in Neuroses?
Authors: GREENBLATT JACOB
Published: December 2021

Practicing pediatricians have a unique opportunity to explore one problem in psychiatry. There is considerable claim that traumatic experiences during infancy and childhood cause neuroses and possibly psychoses in later life. It is also common knowledge that for at least the past generation, a considerable portion of our population has received prophylactic immunization injections during infancy and childhood. These were practically all traumatic psychological experiences, many of them severely so, as any pediatrician could testify.
The Child and His Symptoms: A Psychosomatic Approach
Authors: SMITH CLEMENT A.
Published: December 2021

Here are two good books by British pediatricians They interest the American reader, but they also puzzle him. He recognizes in them the breadth of experience and the clinical skill he has so often noted on the ward rounds and in the writings of his British colleagues. He wishes he found a little more evidence of these qualities in the American medical literature. But he wonders also whether the British medical student may be tempted to learn about sick children from such books alone, and how much the British doctor uses such books in the diagnosis and treatment of his pediatric patients.
Independent Adoptions, a Follow-up Study
Authors: RICE ELIZABETH P.
Published: December 2021

The research in this follow-up study was the joint undertaking of the Florida Department of Public Welfare, the Russell Sage Foundation and the United States Children's Bureau.

The study, made during 1936 and 1957, deals only with independent adoptions or those which did not involve social agencies in the adoption placement. The study is concerned with the outcome of 484 white Florida children about ten years after the children were adopted. It attempted to determine the success of the independent adoption and to see if certain factors, especially at the time of adoption. are predicative of adoption outcome.
STUDIES ON FOLIC ACID IN INFANCY
Authors: Matoth Yehuda , Pinkas Ariela , Zamir Rina , Mooallem Fouad , Grossowicz Nathan
Published: December 2021

The level of folic and folinic acid in whole blood was assayed in 373 healthy infants from birth to one year. Folic acid was high at birth and dropped gradually over the first 8 postnatal weeks. The mean value for the remainder of the first year was significantly below the adult mean. Folinic acid was likewise high at birth and dropped parallel with the folic acid. However, following the initial drop, folinic acid mean values remained well above the adult mean. Folic and folinic acid values were higher in breast-fed than in artificially fed infants and lower in infants whose economic status was poor than in babies belonging to families of higher income.
THE FETAL AND NEONATAL DEVELOPMENT OF TWINS
Authors: Naeye Richard L.
Published: December 2021

The current study presents prenatal data on body, organ and placental development of monovular and diovulvar twins. Most twin measurements match mean values for single gestations through the 24th gestational week. Subsequently, growth of body and organs is not as rapid in twins as in single-born infants. Most measurements for dizygotic twins are greater than measurements for monozygotic twins at equivalent stages of gestation. Finally, a marked intrapair discordance in many body and organ measurements was found in a group of monochorionic twins with a maternal history of hydramnios. This discordance was related to the cross placental transfusion syndrome. The growth retardation evident in a group of 26 twins at birth largely disappeared by the end of the first postnatal year.
THE USE AND MISUSE OF THYROID HORMONE IN PEDIATRIC PRACTICE
Authors: Bongiovanni Alfred M.
Published: December 2021

THYROID PREPARATIONS constitute the most widely employed hormonal agents in pediatric practice today with the possible exception of the steroids. The available forms of this hormone for therapeutic use and the indications for its employment merit reconsideration.

Desiccated thyroid U.S.P. is a relatively crude extract of animal glands and is the least expensive preparation on the market. In the United States the employment of the hormone in this form has been generally satisfactory although on rare occasions there have been reports of inadequate potency. The dosage of desiccated thyroid is based upon the weight of the standard preparation and standardization is officially prescribed according to the iodine content of the extract rather than the quantity of specific active hormone per unit weight. Certain extracts of the animal thyroid gland are more highly purified than the U.S.P. standard, but it is doubtful that they represent any major advantage and their cost is considerably greater. With the availability of synthetic 1-thyroxine there has been a tendency to favor this chemically pure hormone in pediatric practice and although its cost is greater than the crude preparation it is hardly to be considered an expensive drug. A still more active hormone of the thyroid gland available in pure form is 1-triiodothyronine but to date there is no proof that this last compound has any basic superiority in the treatment of most appropriate conditions. It would seem, therefore, that the choice lies between desiccated thyroid, U.S.P., and 1-thyroxine. The relative potency of these two substances is such that 60 mgm of the former is equivalent to 0.1 mgm of the latter.
THE SYNDROMES OF TOTAL LIPODYSTROPHY AND OF PARTIAL LIPODYSTROPHY
Authors: Senior B. , Gellis S. S.
Published: December 2021

The syndromes of partial and of total lipodystrophy have been reviewed and 27 further patients added, 25 with partial lipodystrophy and 2 with total lipodystrophy. For inclusion in the syndrome of partial lipodystrophy symmetrical loss of fat from the face with or without truncal loss, but with retention of distal adipose depots was required. In total lipodystrophy fat loss was generalized.

A number of additional features were commonly present in total lipodystrophy. These included increased height, advanced bone age, hirsuties, pigmentation, prominence of muscles, abdominal protuberance, penile or clitoridial enlargement, hepatomegaly, relatively insulin resistant hyperglycemia, hyperlipemia and hypermetabolism, as well as renal disease, disturbances of C.N.S. function and cardiomegaly.

Review of reports of patients with muscular hypertrophy suggested that several so described might have had total lipodystrophy.

A significant incidence of renal disease was encountered in the reports of partial lipodystrophy in the literature and more particularly in the group presented. Although much less frequently present, central nervous system dysfunction, hepatomegaly and a decreased glucose tolerance were also noted. It appears that there are features common to both syndromes other than disappearance of fat.

Possible pathogenetic mechanisms have been considered.
Phenylketonuria in Jews
Authors: LARON ZVI
Published: December 2021

I am writing to you regarding the article "Phenylketonuria in Yemenite Jews" by B. E. Cohen et al., Pediatrics, 32:1069, 1963 (December).

In the introduction it is stated, apparently by mistake, that only two Jewish patients with phenylketonuria have been previously reported. I would like to draw your attention to the fact that we have reported in your journal (Pediatrics, 26:885, 1960) four cases of phenylketonuria occurring in a Jewish family from Iraq. The neurologic and psychologic findings in this family have also been published.