bluuebunny/crossref_metadata_2025_split huggingface dataset:
AN EPIDEMIC OF ASEPTIC MENINGITIS SYNDROME DUE TO ECHO VIRUS TYPE 6
Authors: King Dudley L. , Karzon David T. 
Published: December 2021

Ninety-three patients with aseptic meningitis syndrome due to ECHO virus type 6 were evaluated 3 years following their acute infection to determine the extent of neuromuscular residua. In addition, 9 patients with aseptic meningitis due to other enteroviruses and 19 patients with paralytic poliomyelitis were similarly evaluated. Forty-four individuals with no history of central nervous system disease were studied for comparison.
Residua following aseptic meningitis were minimal and fell into two categories: 1. Approximately 20% gave a history of minor changes in behavior, easy fatigability, headaches or pain, stiffness or subjective weakness of the back or legs, the onsets of which were associated with the acute illness. 2. On examination approximately 25% revealed subtle neuromuscular changes such as altered reflexes, minor weaknesses in anterior neck or trunk muscles, or slight skeletal abnormalities, particularly scoliosis. The group with no history of central nervous system disease demonstrated an appreciable, but somewhat lesser, incidence of minor neuromuscular changes, further tending to minimize the specific significance of the findings in the study group.
COMMENT ON METABOLIC BALANCE STUDIES AS A METHOD OF ESTIMATING BODY COMPOSITION OF INFANTS
Authors: Fomon Samuel J. , Owen George M. 
Published: December 2021

It seems probable that several factors must be considered jointly in explaining the falsely high body content of protein calculated on the basis of nitrogen balance studies. Of these, the most important are probably cumulative errors in balance techniques, nitrogen loss in sweat and desquamated epithelium, and differences in retention of nitrogen during balance studies and in intervals between balance studies. Confirmation or refutation of the conclusion based on metabolic balance studies—that feeding of high-protein diets results in accumulation of relatively large amounts of protein in the body—must certainly come from assessments of body composition of normal infants made with techniques other than metabolic balance studies.
Similar errors are inherent in calculating body content of calcium, phosphorus, sodium, and other minerals from results of metabolic balance studies. However, in these instances the systematic procedural error will be relatively greater because a smaller percentage of the intake is retained. With some substances, e.g., sodium and potassium, failure to measure losses from skin will introduce a much greater error than is the case with nitrogen.
The unsuitability of metabolic balance studies as a means for estimation of body content of a substance indicates that the absolute values obtained with the methods are not precise. The methods are nevertheless useful when only relative results are sought, as in the nutritional evaluation of two foods fed to comparable groups of infants at similar intakes of nitrogen or in comparison of performance of normal subjects with subjects having certain metabolic abnormalities. The usefulness of balance technique is also obvious in the study of patients in whom large retention or losses are to be anticipated.
GLUCOSE-6-PHOSPHATASE DEFICIENCY GLYCOGEN STORAGE DISEASE
Authors: Howell R. Rodney , Ashton Doris M. , Wyngaarden James B. 
Published: December 2021

Three siblings with glycogen storage disease have been studied. These children demonstrated the classic physical findings of von Gierke's disease. Liver enzyme assays on one sibling revealed very low glucose 6-phosphatase activity. Hepatic phosphoglucomutase, phosphorylase, glucose 6-phosphate dehydrogenase, and fructose 1,6-diphosphatase activities were within normal limits. Erythrocyte glucose 6-phosphate dehydrogenase activity was also normal.
Incubation of liver slices with glucose 1-C14 and glucose 6-C14 revealed an initial rate of C14O2 production at which CO2 from C-1 was three times that from C-6. This is strong evidence for the active operation of the phosphogluconate oxidation pathway in this patient, and taken with the normal assay value of hepatic glucose-6-phosphate dehydrogenase, constitutes a negation of the concept of a dual enzyme defect recently proposed for von Gierke's disease.
Striking elevations of free fatty acids in serum, triglycerides, phospholipids, cholesterol, and blood ketones were noted. Potential mechanisms for these elevations have been discussed.
Marked hyperuricemia was a persistent finding and was associated with a somewhat low renal clearance of urate in the one patient studied. All three had striking elevations of lactic acid in blood, which is known to interfere with renal urate excretion. Thus renal factors may have contributed to the hyperuricemia, previously considered solely a consequence of enhanced nucleoprotein catabolism secondary to persistent hypoglycemia.
Long-term intramuscular administration of glucagon did not produce significant clinical or laboratory improvement in the one patient in whom it was employed.
TEMPORAL LOBE SYNDROME IN CHILDREN
Authors: Bray Patrick F. 
Published: December 2021

Twenty children with a well-defined temporal lobe electroencephalographic focus were studied for a period averaging 7 years. A careful search was conducted for etiologic factors, and correlation of psychological patterns with electroencephalographic findings was carried out. In addition neurologic deficit, psychometric findings and social adjustment were studied.
A genetic etiology was suspected in half of the patients on the basis of a clear history of epilepsy, a severe psychiatric disturbance, or the presence of a temporal lobe focus in a close relative, although a familial incidence was well documented in only 3 of the 10 patients. Hippocampal sclerosis secondary to herniation of the temporal lobe uncus and compromise of its circulation was thought to be etiologic in two small premature infants who experienced marked neonatal asphyxia, and in one child who suffered a severe head injury. A cystic astrocytoma had caused focal motor seizures in one patient for a 7-year period prior to its total removal.
A wide pattern of psychologic diagnosis was noted, ranging from four normal to six psychotic, four hyperactive, four neurotic and two retarded children. All psychotic children had either a unilateral midtemporal spike focus or spike foci arising independently in both temporal lobes. Three of the four patients with bilateral abnormalities were psychotic, a finding that might be related to the bizarre behavioral changes in animals which have undergone bilateral temporal lobectomy. Neurologic abnormalities were restricted to mild speech disorders in two patients with normal intellect, a finding possibly related to the expressive language functions centered in the temporal lobe.
Eighteen of the 20 patients were functioning in the normal intellectual range, 2 were mentally deficient and the other 3, although functioning in the subnormal range, had normal intellectual potential.
Social maladjustment, resulting from serious behavioral and psychologic disturbances and incomplete control of psychomotor seizures, affected 15 of the 20 patients in the early phase of the study. Follow-up examinations revealed improvement in six of the socially handicapped patients. This improvement occurred with all types of temporal lobe electroencephalographic abnormality, excluding those with anterior temporal spike activity.
All 11 patients who had psychomotor seizures were incompletely controlled after vigorous, prolonged attempts at medical management. Grand mal attacks were seen in 15 of the patients and were easily controlled. Surgery for the relief of seizures was performed in three patients and benefited only the one whose tumor was removed. The other two patients, who underwent limited subpial resections, showed no improvement.
Unsterile Formulas
Authors: Grossman Elmer R. 
Published: December 2021

As a pediatrician who has taught unsterile formula preparation for several years, I was unconvinced by the Report of the Committee on Fetus and Newborn on this topic in Pediatrics (28:674, 1961).
It seemed to me that the weakness of their position was exemplified by the last paragraph of the report which recommended that formulas be sterilized "until the age of the infant, the care and co-operation of the parents, and the initial cleanliness and safety of the milk and supply of water would offer reasonable assurance that the sterilization of the preparation could be stopped."
INBORN ERROR OF HISTIDINE METABOLISM
Authors: Ghadimi H. , Partington M. W. , Hunter A. 
Published: December 2021

A 3-year-old girl with fair hair and blue eyes came under observation because of speech retardation. The patient was given a phenylalanine-free diet, since persistently positive urine tests with ferric chloride and reagent strips (Phenistix) were strongly suggestive of phenylketonuria. On further investigation she was found to be suffering from a totally different and not heretofore recognized condition, the salient features of which were an abnormally high concentration of histidine in the blood and an excessive output of histidine in the urine. The child's sister, one year older, presented the same metabolic anomaly. In each case both the concentration of histidine in plasma and the daily output were directly related to the amount of protein in the diet; but even at their lowest levels they greatly exceeded those of normal children of the same age. An oral load of histidine was followed by an increase of histidine in plasma much higher and more prolonged than that observed in controls, and by the excretion of a much larger fraction of the ingested dose.
The urine of each sister contained not only excessive amounts of histidine but also notable quantities of imidazole-pyruvic, imidazole-acetic, and imidazole-lactic acid, histidine derivatives of which normal urine contains only traces. It is concluded that in the two sisters the normally predominant pathway of histidine catabolism, which leads through urocanic acid to glutamic acid, was partially or completely blocked. Since, even after histidine loading, the urines never contained detectable amounts of urocanic acid, the block must precede the formation of that substance. The condition presented is therefore due primarily to a deficiency or total lack of histidine-alpha-deaminase; the enzyme which converts histidine to urocanic acid. As a result of this defect histidine is forced to take the alternative but less efficient pathway which begins with its transamination to imidazole-pyruvic acid. This substance is the one responsible for positive reactions in the ferric chloride and Phenistix tests.
All urine specimens examined, whether from the patient or from normal controls, contained considerable quantities of an unidentifiable imidazole compound ("X"), which does not appear to have been previously reported. The existence of this substance may call for some modification of current concepts of histidine metabolism in man.
PRESIDENT'S MESSAGE
Authors: TOOMEY JOHN A. 
Published: December 2021

TWO things have disturbed our members: first is the appeal for Federal Aid; second, the dictatorial manner in which the appeal for Federal Aid was presented. 1st. All must realize by now that there exists an acute financial situation in many medical schools. This has had the earnest thought of the Committee on Medical Education of the AMA and the deans of the Association of Medical Colleges who met just two weeks ago.
The educators are fully apprized of the reasons against such a move which would eventually mean the loss of their liberty and State Medicine; they realize that the Supreme Court has ruled that subsidies imply control; they know that Government operation is wasteful, inept and graft-ridden; they see the Army build unnecessary hospitals, the Navy, the Public Health Service and Veterans and some sub-departments likewise, and then they cry for more competent men to run ill-conceived and duplicating projects; they see full Army Camps open and unnecessary staffs on duty; they note the senseless unnecessary demand for more medical schools and for more medical students; they note government dispensaries are kept open—and to prove the need for their existence count every visitor that enters; they wonder how one could justify the purchase of a yacht for the study of fish and wildlife; they have not forgotten the WPA nor the relief measures for schools handled by Federal Agencies during the war; they have not forgotten the PWA, the NYC, The Lanham Act, the GI Bill and the CCC's; they know it will be more costly in taxes for any community to get funds through the Federal Government; they know that once they accept subsidies they cannot turn back; they feel that in the end one will have a "Police State," and we pediatricians will have a Pediatric W.P.A.
THYMOL TURBIDITY VALUES IN THE SERA OF NEWBORN AND PREMATURE INFANTS AND OF MOTHERS AT TERM
Authors: DESMOND MURDINA MACFARQUHAR , ZIMMERMAN HYMAN J. , SWEET LEWIS K. , THOMAS LAWRENCE J. 
Published: December 2021

The sera of 108 infants (premature and full term), 65 pregnant women at term, and 28 adult normal controls were studied with the thymol reagent. The mean degree of thymol turbidity of infant sera (0.77 ± 0.55 units) was found to be significantly lower than that of adult normals (1.65 ± 1.15 units) and pregnant women at term (2.1 ± 1.00 units).
No correlation could be demonstrated to exist between the absolute globulin level or albumin-globulin ratio on the one hand, and the degree of thymol turbidity in the serum of either infants or mothers at term on the other.
In the newborn group of premature and full term infants, no correlation could be found between the degree of thymol turbidity and the level of blood bilirubin as found in physiologic jaundice.
It is suggested that the low thymol turbidity values obtained in infants may be related to low blood lipids or low beta-globulin concentration as described by other authors.
SPECIAL REVIEWS
Authors: GLASER JEROME 
Published: December 2021

The management of the child with chronic asthma is discussed. The importance of possible prophylactic measures is mentioned. Environmental control is emphasized with special reference to the avoidance of house dust, feathers, wool, animal pets and strong odors. Change of climate is not always successful and it is important to do all that one can to relieve the child in his own community before this is considered.
The asthmatic child must be protected against respiratory infections. The usual measures of prophylaxis in pediatric practice must not be omitted but are all the more urgently indicated in the case of asthmatic children.
Recurrent lymphadenoid tissue in the nasopharynx following adenotonsillectomy is discussed in its relationship to bronchial asthma.
The possible use of physiotherapeutic measures for the prevention of asthmatic chest deformities and for assisting in the relief of chronic bronchial asthma is mentioned.
Psychosomatic factors are important and consist chiefly in giving the child a sense of security by means of a thorough understanding by the parent of the symptomatic treatment of asthma; the avoidance of coddling or rejection of the child; and teaching the child to excel in some special field so as to experience a feeling of superiority in competition with non-asthmatic children.
The asthmatic child should be aided in the selection of a career in which, if asthma persists or recurs, the earning of a living will not be impossible.
It is pointed out that the nature of the asthmatic problem is such that special facilities should be made available for research in all phases of the problem.
THE PEDIATRICIAN AND THE PUBLIC
Authors: HARPER PAUL 
Published: December 2021

THE problem of health services for children of school age is particularly timely in view of current interest in such services. The editors of this column have asked several authorities in this field to state their opinion of the objectives of a school health service and to describe practical methods of attaining these goals. The first two letters in the current issue deal with this subject; other letters on health services for children of school age will be published in subsequent issues. Dr. James L. Wilson is professor of pediatrics at the University of Michigan; Dr. Jessie M. Bierman is professor of maternal and child health at the University of California School of Public Health; and Dr. Dorothy B. Nyswander is professor of Public Health Education in the same school, and the author of "Solving School Health Problems, the Astoria Demonstration Study," the Commonwealth Fund, 1942.
The last two letters are from Dr. Albert D. Kaiser, health officer of Rochester, New York. Dr. Kaiser has described the program of the Council of Rochester Regional Hospitals for improving medical care in the 11 counties served by the member hospitals in the June issue of this column. His first letter in this issue describes how these services might be extended if additional funds were available. His second communication serves to make clear what was meant by "institutes conducted for . . . governing boards" as described in the eighth paragraph of his first letter.
RENAL CLEARANCES OF SODIUM PENICILLIN G, PROCAINE PENICILLIN G, AND INULIN IN INFANTS AND CHILDREN
Authors: BARNETT HENRY L. , MCNAMARA HELEN , SHULTZ SELMA , TOMPSETT RALPH 
Published: December 2021

Reports of unexpectedly high serum concentrations of procaine penicillin G suggested the possibility that, in addition to the major factor of slow absorption, the renal clearance of procaine penicillin might be lower than that of the sodium salt.
Measurements of inulin clearances and clearances of either sodium penicillin G or procaine penicillin G in 10 children and four premature infants showed no significant difference between the clearances of the two penicillin salts. A reduced clearance of procaine penicillin, therefore, does not explain the apparent occurrence of unexpectedly high serum concentrations of penicillin in normal subjects.
Critical evaluation of data on the maintenance of drug levels with a particular preparation of procaine penicillin requires consideration of the limits imposed by the clearance data presented.
Penicillin clearances in premature infants suggest that if penicillin is given to small infants in dosages proportionate to their surface area, the duration of drug concentrations in the blood should be six times as long as in children and adults and three times as long if the dosage is proportionate to body weight.
STUDIES IN THE RELATION OF THE HEMOLYTIC STREPTOCOCCUS TO RHEUMATIC FEVER
Authors: HARRIS T. N. , HARRIS SUSANNA , NAGLE RUTH L. 
Published: December 2021

Titrations of antibodies to four streptococcal antigens have been carried out in the sera of patients with rheumatic fever and of convalescents from streptococcal infections. These antigens are the hyaluronidase, the hemolysin, and two somatic fractions, the cytoplasmic particles and supernate proteins.
Mean titers to all of these antigens were elevated in both rheumatic and streptococcal infection. The mean titer was somewhat higher in rheumatic than in streptococcal infection in the case of three of these antibodies. In the case of the fourth, antihyaluronidase, this difference was considerably greater.
The antihyaluronidase titer showed better correlation with changes in the activity of the rheumatic infection than did the other tests. There was, however, no striking correlation between this titer and the severity of the illness.
Application was made of these findings to the problem of laboratory diagnosis of rheumatic fever by streptococcal serology. A method is presented for assessing the relative usefulness of such tests in terms of the, distribution of their titers in this disease and in health. By this method the antihyaluronidase test was found to be most useful of the four.
The comparative diagnostic value for rheumatic fever was studied in the case of the antihyaluronidase test, the antistreptolysin test, and of combinations of both tests.
Round Table Discussion
Authors: ELEY R. CANNON 
Published: December 2021

Chairman Eley: It is advisable to state the proper title of the discussion, should read, "Therapeutics of Tuberculosis in Infancy and Childhood with Special Reference to Chemotherapy." As you will see, this immediately enlarges the field of discussion and does not necessarily limit it to streptomycin.
The U. S. Public Health Service has been conducting a cooperative study on the evaluation of antituberculosis chemotherapeutic agents in juvenile tuberculosis. These studies are being made in several pediatric centers throughout the country and especially in those localities where teaching hospitals are available. Dr. Floyd Feldman of the U. S. Public Health Service is the medical director and coordinator of this huge undertaking. Dr. Ralph Platou is the director of this work at Tulane University, Louisiana, and Dr. William Berenberg has charge of the program at the Childrens Medical Center, Harvard Medical School, Boston.
During the past decade amazing progress has been made, both in the control and treatment of diseases resulting from bacterial invasion. It would naturally follow therefore that these same measures might be applied to the treatment of tuberculosis. The in vitro results obtained by the use of the sulfonamides and their related compounds (i.e., promin, diasone and promizole) suggested their trial in the treatment of tuberculosis in experimental animals. These studies showed that in the hypersensitive guinea pig a deterrent effect on the infection could be demonstrated, but that the infection was not eradicated. When these agents were applied to man, the results were even less favorable as no regression of the disease, quiescence or cure was demonstrated.
Studies have also been made with agents that might prove effective by altering the metabolism of the organism. For example, benzoic and salicylic acids were studied with the possibility that the growth of the organism might be inhibited by interference with its oxidization. None of these substances has as yet proved satisfactory for the treatment of human tuberculosis.
To date streptomycin has been more effective in the treatment of this disease than any other antibiotic agent employed. However, it has its disadvantages as illustrated by (1) the development of resistance of the organism to the agent after its administration over a given period of time, and (2) the appearance of labyrinthine disturbances following prolonged or massive therapy. It is, however, believed that sufficient evidence has been obtained to justify the therapeutic use of streptomycin in certain tuberculous conditions such as: (1) Miliary tuberculosis. (2) Acute tuberculous pneumonia. (3) Tuberculous meningitis. (4) Extra-pulmonary tuberculosis.
THE PEDIATRICIAN AND THE PUBLIC
Authors: HARPER PAUL 
Published: December 2021

WE ARE publishing two additional letters in the series devoted to the health problems of children of school age. The first is from Mr. John L. Bracken, Superintendent of Schools, Clayton, Missouri, who has been recently elected President of the American Association of School Administrators. Charles C. Wilson, M.D., is Professor of Education and Public Health at Yale University.
The letter from Dr. Caroline A. Chandler is self-explanatory. The editors wish, however, to take this opportunity to note that Dr. Chandler's letter has called attention to an incomplete quotation in their statement as published in the January issue of this column in answer to the letter of Dr. John K. Glen; the resolution which is quoted in the third from the last paragraph of the statement was passed by the Academy in the form given in Dr. Chandler's letter.