bluuebunny/crossref_metadata_2025_split huggingface dataset:
REPEATED RECOVERY OF A SPIRILLUM BY BLOOD CULTURE FROM TWO CHILDREN WITH PROLONGED AND RECURRENT FEVERS
Authors: SHWARTZMAN GREGORY , FLORMAN ALFRED L. , BASS MURRAY H. , KARELITZ SAMUEL , RICHTBERG DOROTHEA 
Published: December 2021

A spirillum was repeatedly recovered by blood culture from two children. This organism resembled the Spirillum minus which has long been associated with one form of rat bite fever, Sodoku. In Sodoku the spirillum is usually recovered by animal inoculation and no previous record has been found in which a diagnosis has been made by blood culture.
The organisms recovered from the two patients were morphologically indistinguishable from the classical Spirillum minus, but were unique in that they could be maintained for many months on standard liquid and solid bacteriologic media. Their in vivo resistance to penicillin and arsenicals was marked and therefore also unusual.
Both patients were seen because of recurrent fever, eruption and symptoms referable to the central nervous system, respiratory and intestinal tracts. The first child was admitted to The Mount Sinai Hospital debilitated and febrile. A spirillum was recovered repeatedly on routine blood culture, although there was no definite history of rat bite. Treatment with arsenicals and penicillin and streptomycin failed and the patient died. The second child was admitted with a history of repeated respiratory infections and indolent skin ulcers and hemiplegia. He had apparently been bitten by a rat while in Florida 3½ years before the spirillum was first recovered from his blood. Treatment with penicillin and sulfarsphenamine was ineffectual. The organism was sensitive in vitro to streptomycin but as much as 2 gm. a day for several months failed to do more than induce several negative blood cultures. Treatment with aureomycin finally succeeded in sterilizing the blood stream and healing the ulcers. Coincident with this there was a striking improvement in the child's general condition.
The clinical course of these two patients and the unusual bacteriologic findings set them apart from classical rat bite fever and suggest use of the term "Spirillum Fever."
TREATMENT OF CHRONIC SHIGELLA INFECTION IN CHILDREN WITH ORAL POLYMYXINS
Authors: LIEBERMAN DANIEL , JAWETZ ERNEST 
Published: December 2021

Many chemotherapeutic agents can alleviate the symptoms of acute bacillary dysentery and suppress the causative organisms. In chronic Shigella infection, however, most agents have only limited usefulness. In an institution for mentally defective children 93% of 116 fresh cases of shigellosis responded to conventional chemotherapeutic measures, but only 63% of 78 chronic cases.
Polymyxin B and E are highly bactericidal for Shigella organisms in vitro. These drugs are stable and are not significantly absorbed from the intestinal tract when taken by mouth. Twenty-three children with chronic intestinal infections due to Shigella paradysenteriae (Flexner) were given daily oral doses of 15 to 20 mg./kg. polymyxin for 10 days. Twenty (87%) were unequivocally cured of their infection which had previously resisted therapy with sulfonamides and other antimicrobial agents. No toxic side-effects were observed. Polymyxin appears to be a useful drug for the oral treatment of chronic Shigella infection.
STUDIES ON THE ABSORPTION AND DISTRIBUTION OF CHLORAMPHENICOL
Authors: KELLY RICHARD S. , HUNT ANDREW D. , TASHMAN SYLVIA G. 
Published: December 2021

Chloramphenicol is readily absorbed from the gastrointestinal tract. Peak serum levels, while usually reached within two hours, are occasionally not attained for six or more hours. In general absorption is markedly more rapid than in the case of aureomycin, which seems to be absorbed slowly over a period of several hours.
Eleven mg./kg. body weight, which is an adequate single dose of aureomycin, in the case of chloramphenicol produces serum levels too low to be detected by the authors' method. Twenty-two mg./kg. produces two hour levels averaging 8.3 µg./cc. and 44 mg./kg. raises this level to a mean of 22 µg./cc.
Rectal administration of perforated chloramphenicol capsules produces peak serum levels approximately one-fifth of those effected with comparable oral dosage.
Diffusion of chloramphenicol into cerebrospinal fluid occurs readily and after a few days administration spinal fluid levels, in three cases, were approximately 50% of the serum levels.
These data suggest that effective oral dosage of chloramphenicol ranges from 22 to 44 mg./kg./dose and that the antibiotic should be given at 6 to 8 hour intervals.
OUTBREAK OF ACUTE NEPHRITIS IN ADOLESCENT SCHOOLBOYS
Authors: KEMPE C. HENRY , OLMSTED RICHARD W. , CURNEN EDWARD C. 
Published: December 2021

An outbreak of acute nephritis is reported which occurred among adolescent boys who were students at a private day school. Four boys in one class had clinically typical acute glomerular nephritis. Seventeen other members of this and one other class were found to have hematuria with or without associated albuminuria. The total incidence of hematuria among the 73 students in these two classes was 29%. Fifteen of the 21 boys with hematuria still had abnormally elevated Addis sediment counts approximately seven weeks after the initial examination.
Cultures of the nasopharynx were made from 85 students. Hemolytic streptococci were detected in 11 (13%) of the boys including three with hematuria. The results of attempts to identify the streptococci by serologic technics indicated that at least five immunologically different varieties were represented.
Determinations of antihyaluronidase, antistreptolysin "O" and antistreptokinase in serum from 17 boys with hematuria and 20 without apparent hematuria revealed wide variations in titer but no significant differences between the two groups.
METHOD OF OBTAINING ANAEROBIC ARTERIAL BLOOD SAMPLES FROM INFANTS
Authors: HYTTEN FRANK E. , CHERRY RUTH B. 
Published: December 2021

A SATISFACTORY method for obtaining anaerobic arterial blood samples from newborn infants requires at least the following conditions:
1. It must be safe.
2. The sampling must be sufficiently rapid to give blood values for any given half a minute or less.
3. Pain must be minimal so that crying can be avoided.
4. Repeated sampling on one infant should be possible.
Arterial puncture is both safe and rapid in only a few experienced hands and repeated sampling is even less safe or sure. Crying is seldom avoided.
Cutaneous bleeding from heel puncture frequently produces mixed blood and bleeding is almost always too slow to give an accurate picture of the state of the blood at a given moment. Crying is the rule. In addition, the usual method of collection under oil introduces further inaccuracies: oil slows the bleeding, absorbs a considerable amount of carbon dioxide, and is extremely difficult to exclude from pipettes.
The present investigators have evolved a method which has proved satisfactory in about 50 consecutive cases. "Cutaneous" arterial blood is sampled from the foot, the site of puncture being over the soft tissue area containing the plexus of arterioles from the lateral malleolar artery (Fig. 1).
Equipment
Three pieces of equipment, easily made in any laboratory, are required:
1. As shown in Fig. 2, this consists of a 1" X 1" square of adhesive tape which has a centrally punched hole of ⅛" diameter, centered over which and sealed by rubber cement is a ¼" length of soft rubber tubing of ⅛" bore and 3/32" wall thickness.
INTERPRETATION OF THE BASAL METABOLIC RATE OF CHILDREN OF UNUSUAL BODY BUILD
Authors: ILIFF ALBERTA , LEE VIRGINIA A. , LEWIS ROBERT C. 
Published: December 2021

The relative predictive value of six methods of reference frequently used to determine the BMR of children of unusual body build has been studied. The methods of reference based on the Child Research Council standards which were employed for this purpose were those for cal./hr./sq. m., cal./hr./kg. and cal./hr./cm., each referred to age, and cal./hr. referred to surface area, weight and height, respectively.
An analysis was made of 558 determinations of basal metabolism obtained on 86 healthy children of the Child Research Council, of 946 basal metabolism tests on 793 children described in the literature and of 80 basal metabolism tests on 74 children observed by Gordon. The study included children between 2 and 16 years of age whose weight or height or both weight and height fell above the 90th percentile or below the 10th percentile of all the children of similar age on whom the Council standards had been established.
The results of this analysis show that the methods of reference of cal./hr. referred to surface area and of cal./hr. referred to weight are reliable for the interpretation of BMR determinations on children of all six types of body build. This is also true of cal./hr./sq. m. referred to age except in the case of very small children or dwarfs for whom high BMR are found. These observations might well have been anticipated since height and weight and surface area increase with age in children, but weight and surface area give a better evaluation of body mass than does height.
The methods of reference of cal./hr./kg. referred to age, cal./hr./cm. referred to age and cal/hr. referred to height are not so reliable, either individually or collectively, for routine clinical use as are the other three methods of reference. Nevertheless, the deviations in the BMR obtained by these less satisfactory methods of reference may be of considerable importance in understanding the problems of a child of unusual body build. The use of the proper methods of reference based on reliable standards will result in trustworthy BMR for children of unusual body build.
Annual Meeting of the Section on Pediatric Urology
Authors: GLASSBERG KENNETH I. 
Published: December 2021

The Section of Urology of the American Academy of Pediatrics met for three days in conjunction with the 54th annual meeting of the Academy in San Antonio. Papers of interest to the pediatrician are summarized herein according to topic. The number of basic research papers is continuing to increase. The second annual Pediatric Urology Medal was awarded to Sir David Innes Williams for contributions made to the field.
ANDROLOGY
Testicular Torsion
Some recent studies suggest that individuals who undergo testicular torsion may have a higher incidence of infertility than the normal male population.1,2 A number of papers were presented at the 1984 meeting debating a possible immune response that is initiated by the torsed testicle and that plays havoc on the nontorsed testicle. One such paper presented this year by Howards and Turner could not find any contralateral testicular damage following surgically induced torsion on rats. Hadziselimoyic and co-authors studied biopsies taken from the nontorsed testicle in 38 boys who underwent surgery for unilateral testicular torsion. In 20 of the 38 patients (58%), preexisting contralateral testicular abnormalities could be identified, which suggests that the infertility in patients with unilateral testicular torsion may be a consequence of preexisting testicular pathology rather than an immunopathy.
Cryptorchidism
Contralateral Testicle. Three studies addressed the problem of infertility in patients with a history of cryptorchidism and the effect of the undescended testicle upon the contralateral testicle.
In one study, Kogan and associates set out to determine whether surgically induced cryptorchidism produces a deleterious effect upon the normally descended contralateral testicle.
School Performance and Theophylline
Authors: RAPPAPORT LEONARD , FENTON TERRANCE , TWAROG FRANCIS 
Published: December 2021

To the Editor.—
In a recent article, Rachelefsky et al (Pediatrics 1986;78:1133-1138) described behavioral abnormalities and poor school performance due to oral theophylline preparations in children with asthma. There were a number of methodologic and reporting issues that we believe should be elucidated by the authors.
First, Table 4, which contains the only positive findings in the study, does not make sense. The legend says that the scores in this table are a sum of 53 items, each of which were scored as 1, 2, or 3.
What's New in Pediatric Surgery
Authors: Touloukian Robert J. 
Published: December 2021

Advances in the pathophysiology, diagnosis, and treatment of congenital malformations, trauma, tumors, and innovations in organ transplantation form the cornerstones of progress in pediatric surgery during the past year. Significant new contributions presented at the past year's meeting of pediatric surgical organizations, including the 56th Annual Meeting of the Surgical Section of the American Academy of Pediatrics, are summarized, and selected references from the pediatric and surgical literature are presented.
PRENATAL DIAGNOSIS/FETAL SURGERY
In the area of fetal surgery, Manning et al1 summarized the experience with 74 cases of catheter decompression for fetal hydronephrosis and hydrocephalus reported to the International Fetal Surgery Register. The center reported an overall survival rate of 41% for urinary obstruction with a procedure-related death rate of 4.6%. The results of ventriculoamniotic shunt procedure for obstructive hydrocephalus were even less encouraging with a procedure-related mortality of 10%; moreover, more than 50% of survivors had serious neurologic handicaps. Sauer et al2 studied the relative importance of an abdominal mass and oligohydramnios causing pulmonary hypoplasia in fetal rabbits. Animals having bladder outlet obstruction developed severe pulmonary hypoplasia, whereas other subjects having a synthetic mass inserted into the abdomen of a size equal to that of the obstructed bladder showed minimal signs of pulmonary hypoplasia. Results of the study suggest that prenatal catheter decompression be limited to the fetus with oligohydramnios.
The wisdom of planning the mode of delivery for babies with major congenital malformations referred to a maternal high-risk unit for evaluation remains controversial.
Experiences With Sickle Hemoglobin Testing in the Texas Newborn Screening Program
Authors: Therrell Bradford L. , Simmank Jennifer L. , Wilborn Mae 
Published: December 2021

Since Nov 1, 1983, we have tested more than 1 million infants for sickling hemoglobinopathies. The laboratory procedures used for analysis of the filter paper blood spots include a combination of cellulose acetate and citrate agar electrophoresis. Isoelectric focusing offers an alternative screening procedure. Satisfactory interpretations of electrophoretic patterns are generally acceptable on specimens analyzed within five days of collection. Specimen age does not seem to be as critical a factor with isoelectric focusing. Consumable supply costs are slightly more with isoelectric focusing protocol (approximately $0.50 v $0.25), however, and the technical complexity and time involved are also somewhat higher.
We have found the incidences to be as expected. Annual births in Texas number approximately 42,000 blacks, more than 90,000 Hispanics, and more than 175,000 whites. The newborn screening program is detecting approximately 100 cases of sickle cell anemia, 40 cases of SC disease, and 4,200 sickle hemoglobin carriers annually. Although the morbidity and mortality data demonstrating the effectiveness of this program will take some time to accumulate, support for its continuation from the physician community and the general public appears widespread. Follow-up of disease conditions is an integral part of the protocol, and the involvement and recommendations of an advisory committee, including qualified pediatric hematologists, have proven extremely beneficial. Both educational literature and treatment protocols have been addressed by the department and its advisers. Although the program still lacks a strong genetic counseling effort, and there are considerable communication and transportation problems associated with the state's geography, the Texas Department of Health remains dedicated to improving the public health of infants throughout the state with its quality newborn screening program.
Northern California's Experience
Authors: Hurst Deborah 
Published: December 2021

Future plans involve continued expansion of cord blood screening in the Bay Area until no babies with hemoglobin diseases are missed. Modification of screening and trait follow-up procedures will continue as necessary to allow screening of increased numbers despite limitations in funding. To reduce the need for intensive trait follow-up by the center, we will continue to develop community resources. There must be more general public information about hemoglobin traits, more well-run prenatal testing and counseling programs, and continued education of health care professionals.
It is also essential to assess the effect of hemoglobin trait notification on the involved families. A definitive trait follow-up study could help state public health departments design optimal screening programs that provide satisfactory trait follow-up without detrimental psychologic effects or prohibitive expense. Historical studies of the effects of trait screening at other times or in other ethnic groups for different diseases may not be applicable to our population. For example, in trait follow-up today, initial parental anxiety when notified of an abnormal blood test in the baby more often involves fear of acquired immunodeficiency syndrome than fear of sickle cell disease. Most people now can be reassured about the difference between trait and disease and about the fact that their baby with trait is healthy. Clearly, the level of public knowledge has increased since the early years of screening because of the sickle cell center's educational outreach as well as general exposure to information on television and in public school curricula. These impressions should be documented by studies to assess the levels of understanding and anxiety in families before and after counseling.
In addition, information concerning the 17% of individuals who make appointments but never appear for counseling and the 28% who are not contacted by either telephone or mail would be useful. There is no way of knowing how many of these people simply do not need or want counseling, how many never receive the information, and how many avoid further contact because of inappropriate anxiety. Tracking these individuals would be a major undertaking, beyond the scope of current staffing, but an important future study.
MARKET FOR RECYCLED NEWSPAPERS IN UNITED STATES COLLAPSES, ADDING TO SOLID WASTE WOES
Authors: M. R. J. 
Published: December 2021

The bottom has fallen out of the market for recycled newspapers, exacerbating the nation's already critical garbage problems.
The market's collapse stems from a sudden deluge of old newspapers, the result of new recycling programs by several Eastern states. In response, Korean and other foreign and domestic paper companies have greatly lowered the price they are willing to pay for old papers.
The result: Municipalities that just two or three months ago were receiving as much as $25 a ton for their newspapers from brokers now are having to pay these brokers $5 to $25 a ton just to haul the old papers away. . .
Worse is yet to come, according to the American Paper Institute, the industry's trade group. It predicts that so much old paper will soon flood the market that some of it may have to be dumped in landfills. . .
To be sure, nobody predicts the end of recycling because, especially on the East Coast, landfills are full, and many new incinerator projects are stalled by citizen's groups worried about possible adverse health effects. . .
Michael Koplik, president of Percy H. Koplik & Sons, Inc., which buys old newspaper for paper companies, says the current depression in the market could last a year or longer. But he also calls the downturn an opportunity, in that he expects paper companies to commit to building more plants that use recycled paper.
Joseph Salomondo, editor of Recycling Times, also foresees new uses for recycled newsprint—in particular, as housing insulation and as animal bedding. . .
Embolization of Ectopic Kidney to Control Incontinence
Authors: DE GROOTE B. , VAN LAER P. , MAURUS K. , VAN BIERVLIET J. P. , MEEUS L. 
Published: December 2021

Ureteral ectopy in girls can cause dribbling incontinence if the ectopic ureter ends below the continence mechanism of bladder neck and external sphincter. Approximately 25% of ectopic ureters drain into the vagina. The corresponding renal tissue is often hypoplastic or dysplastic. Surgery used to be the treatment of choice. Depending on the quality of the corresponding renal tissue, one had the choice between ureter reimplantation or partial or total nephrectomy. We succeeded in treating a girl with a hypoplastic kidney and an ectopic ureter nonsurgically by embolizing the corresponding renal artery.
CASE REPORT
A 5-½-year-old girl had leakage of urine in spite of a normal voiding pattern.
Drug Screening
Authors: FOST NORMAN , SCHONBERG S. KENNETH , SCHYDLOWER MANUEL 
Published: December 2021

In Reply.—
The writers raise a number of issues involving process, fact, and ethics. We can only respond to a few of the main points.
Regarding process, a major impetus for the statement was requests from private practitioners seeking the Academy's support to help them resist demands, from school districts and parents, that they screen athletes and patients surreptitiously. There was extensive involvement by private practitioners in the writing, review, and approval of the statement by three committees, the Council on Child and Adolescent health, and the Executive Board, which is comprised predominantly of private practitioners.
Early Treatment for Congenital Hypothyroidism
Authors: DUSSAULT JEAN H. , FARRIAUX J. P. 
Published: December 2021

To the Editor.—
We would like to respond to the allegation of Fisher et al1 that 10% to 15% of our treated hypothyroid children did not attain a normal development because they were undertreated at the time of therapy initiation. First, the Quebec cohort of patients do not include those who were treated with triiodothyronine (T3) because this clinical trial was accomplished early in our program (1974 to 1975). Thus goes the argument for the deleterious effect to T3 treatment vs thyroxine (T4) (ie, the majority of the T3 in brain originates from T4 to T3 conversion.
Sports Deficit Disorder
Authors: BURKE BRYAN L. , MCGEE DANIEL P. 
Published: December 2021

In Reply.—
Our report on Sports Deficit Disorder has struck a responsive chord among your readers. Each letter which we have received has been from yet another pediatrician who feels that he is a victim of this disease.
Dr Crook understands that part of the reason we wrote this satire was to help deal with our own personal frustration concerning Attention Deficit Disorder, a disorder whose diagnosis and proper treatment are frustratingly nebulous. Like Dr Crook, our subjective impression is that Ritalin is prescribed too frequently, with not enough emphasis placed on treating the underlying problems of the child and family in a nonpharmacologic manner.
Behavior in Klinefelter Syndrome, or Where There Is Smoke There May Not Be a Fire
Authors: MILLER MARVIN E. , SULKES STEPHEN 
Published: December 2021

In Reply.—
Drs Hecht and Hecht smell smoke but see no fire. They also may not see the forest for the trees.
When we became aware of four individuals with Klinefelter syndrome in our clinical practice who had significant fire-setting behavior, we thought this was likely more than a coincidence. Our primary reason for reporting this observation was not for counseling issues in Klinefelter syndrome, but for alerting health care providers who evaluate firesetters that Klinefelter syndrome rome may be a small subset of firesetters.