American Journal of Diseases of Children

WORK, HENRY H.

1964 American Journal of Diseases of Children

doi: 10.1001/archpedi.1964.02090010221001pmid: 14168057

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Although fashions in medical care change more slowly than do those in feminine apparel, the movements are subject to some of the same pressures. Physicians, because of their own background and professional bias, may resent changes in diagnostic groupings and, therefore, adopt new diagnostic ideas reluctantly. Parents at times exert pressures to suit their own needs. They are particularly prone to urge diagnoses and embrace concepts that remove them as individuals from responsibility for a child's behavior. Their desire for the health of their child at times leads to overly optimistic hopes of nature's repair. This is particularly true in the field of behavior pathology. Here the concept of change-through-growth without medical treatment becomes especially manifest. In recent years, along with other medical "splinter" groups, there has been the rise of a concept concerned with "brain damage" or "the neurologically handicapped child." This interest has been pushed at us by

WOODWARD, KATHARINE F.;JAFFE, NORMA;BROWN, DOROTHY

1964 American Journal of Diseases of Children

doi: 10.1001/archpedi.1964.02090010223002pmid: 14168058

Abstract The very young child with retarded functioning who does not fit clearly into any of the well-defined organic categories, continues to be a kind of terra incognita. Parents become alarmed when they find that their child does not develop as other children do. In their search for help they often receive conflicting opinions or inadequate guidance. The fact is, that except for the known state institutions, there are very few existing resources for this kind of child. There are even fewer resources which attempt to explore intellectual potential before making a final judgment. A start is now being made in accumulating knowledge and techniques of therapy both for children and their parents in this situation. The authors have previously reported on a three-year program for preschool children with retarded functioning,1-3 some of whom were helped to achieve performance within normal limits. We have now had the chance to study References 1. Woodward, K. F., and Siegel, M. G.: Psychiatric Study of Mentally Retarded Children of Preschool Age: Preliminary Report , Pediatrics 19:119, 1957. 2. Woodward, K. F.; Siegel, M. G.; and Eustis, M. J.: Psychiatric Study of Mentally Retarded Children of Preschool Age: Report on 1st and 2nd Years of a 3-Year Project , Amer J Orthopsychiat 28:376, 1958.Crossref 3. Woodward, K. F.; Brown, D.; and Bird, D.: Psychiatric Study of Mentally Retarded Preschool Children: Report Four Years After Initiation of Project, With Emphasis on Psychiatric and Teaching Approach , Arch Gen Psychiat 2:156, 1960.Crossref 4. Bornstein, B.: On Psychogenesis of Pseudodebility , Int Z Psychoanal 16:378, 1930. 5. Chidester, L., and Menninger, K. A.: Application of Psychoanalytic Methods to Study of Mental Retardation , Amer J Orthopsychiat 6:616, 1936.Crossref 6. Rappaport, S. R.: Behavior Disorder and Ego Development in a Brain Injured Child , Psychoanal Stud Child 16:423, 1961. 7. Kaplan, S.; Abbott, J. A.; and Waldfogel, S.: Clinic on Psychosomatic Problems: Feeblemindedness or Pseudoretardation? Amer J Med 5:891, 1948.Crossref 8. Axline, V.: Mental Deficiency: Symptom or Disease , J Consult Psychol 13:313, 1949.Crossref 9. Heiser, K. T.: Psychotherapy in a Residential School for Mentally Retarded Children , Training School Bull 50:10, 211, 1954. 10. Kirk, S. A., et al: Early Education of Mentally Retarded: Experimental Study , Urbana, Ill: University of Illinois Press, 1958. 11. Skeels, H. M., and Dye, H. B. A.: Study of Effects of Differential Stimulation on Mentally Retarded Children : Proc Amer Ass Men Defic 63: 114-136, 1939. 12. Heath, S. R.: Making Up for Lost Time , Training School Bull 38:1-5, 1941-1942. 13. Garfield, S. L., and Affleck, D. C.: Study of Individuals Committed to State Home for Retarded Who Were Later Released as Not Mentally Defective , Amer J Ment Defic 64:907, 1960. 14. Martz, E. W.: Phenomenal Spurt of Mental Development in Young Child , Psychiat Quart 19:52, 1945.Crossref 15. Cobb, D., and Wilber, R. C.: Explorations in Family Care Placement for Retarded Children , Amer J Ment Defic 63:1089, 1959. 16. Barsch, R. H.: Subtrainable Child: Community Program , Amer J Ment Defic 67:33, 1962. 17. Strazzula, M.: Nursery School Training for Retarded Children , Amer J Ment Defic 61:141, 1956. 18. Jubenville, C. P.: State Program of Day Care Centers for Severely Retarded , Amer J Ment Defic 66:829, 1962. 19. Sloan, W.: Preschool Class at Lincoln State School and Colony , Amer J Ment Defic 56:755, 1952. 20. Mahler, M. S.: On Child Psychosis and Schizophrenia: Autistic and Symbiotic Infantile Psychosis , Psychoanal Stud Child 7:286, 1952. 21. Kanner, L.: Early Infantile Autism , J Pediat 25:211, 1944.Crossref 22. Kanner, L., and Lesser, L. J.: Early Infantile Autism , J Pediat Clin N Amer 5:711, 1958. 23. Goldberg, B., and Max, P.: Post Natal Psychological Causes of Mental Retardation , Canad Med Ass J 87:507, 1962.

MICHENER, WILLIAM M.;BROWN, CHARLES H.;TURNBULL, RUPERT B.

1964 American Journal of Diseases of Children

doi: 10.1001/archpedi.1964.02090010232003pmid: 14168059

Abstract The occurrence of ulcerative colitis in childhood is well documented.1-5 Most reports concerning this disease in children have emphasized the poor response to therapy, the possible emotional etiology of the disease, and the increased incidence of carcinoma of the colon in later life.6-10 When a child has frequent bloody stools, the diagnosis of ulcerative colitis is usually considered and then confirmed by roentgen studies of the colon after barium enema and by proctoscopic examination. Our experience, though, indicates that in children the presenting symptoms frequently differ from those in adults and the typical presenting symptoms may be obscured; consequently, there is considerable delay in diagnosis. This delay in diagnosis may well be an important factor affecting the response of the child to therapy. It is the purpose of this paper to discuss the diagnosis of ulcerative colitis in children, based on our experience with 80 children having the References 1. Hijmans, J. C., and Enzer, N. B.: Ulcerative Colitis in Childhood: Study of 43 Cases , Pediatrics 29:389-403 ( (March) ) 1962. 2. Jackman, R. J.; Bargen, J. A.; and Helmholz, H. F.: Life Histories of 95 Children With Chronic Ulcerative Colitis: Statistical Study Based on Comparison With Whole Group of 871 Patients , Amer J Dis Child 59:459-467 ( (March) ) 1940.Crossref 3. Kirsner, J. B.; Raskin, H. F.; and Palmer, W. L.: Ulcerative Colitis in Children: Observations in Selected Patients , AMA J Dis Child 90:141-152 ( (Aug) ) 1955. 4. Larkin, M. A.: Ulcerative Colitis in Children , Southern Med J 54:880-886, ( (Aug) ) 1961.Crossref 5. Lagercrantz, R.: Ulcerative Colitis in Children , Acta Paediat (Stockholm) ( (supp) ) 75:89-151, 1949.Crossref 6. Michener, W. M., et al: Prognosis of Chronic Ulcerative Colitis in Children , New Eng J Med 265:1075-1079 ( (Nov 30) ) 1961.Crossref 7. Rosenqvist, H., et al: Ulcerative Colitis and Carcinoma Coli , Lancet 1:906-908 ( (May 2) ) 1959.Crossref 8. Korelitz, B. I.; Gribetz, D.; and Danziger, I.: Prognosis of Ulcerative Colitis With Onset in Childhood: I. Pre-Steroid Era , Ann Intern Med 57:582-591 ( (Oct) ) 1962.Crossref 9. Korelitz, B. I., and Gribetz, D.: Prognosis of Ulcerative Colitis With Onset in Childhood: II. Steroid Era , Ann Intern Med 57:592-597 ( (Oct) ) 1962.Crossref 10. Fullerton, D. T.; Kollar, E. J.; and Caldwell, A. B.: Clinical Study of Ulcerative Colitis , JAMA 181:463-471 ( (Aug 11) ) 1962.Crossref 11. Hodgson, J. R., and Kennedy, R. L. J.: Roentgenologic Aspects of Chronic Ulcerative Colitis in Children , Radiology 65:671-678 ( (Nov) ) 1955.Crossref

MICHENER, WILLIAM M.;BROWN, CHARLES H.;TURNBULL, RUPERT B.

1964 American Journal of Diseases of Children

doi: 10.1001/archpedi.1964.02090010238004pmid: 14168060

Abstract Progress in the therapy of ulcerative colitis has been definite during the last ten years. A few reports have shown that definitive surgery, namely subtotal colectomy and ileostomy, can be lifesaving and return the child to normal health within several months.1-3 There has been a paucity of reports on the response to medical treatment in children.4 In part 1 of this report the various problems concerning the diagnosis of ulcerative colitis in children are discussed.5 It is the purpose of this report to describe in some detail the medical management of the child with ulcerative colitis and the indications for surgical therapy, and to discuss the results of therapy as well as the problems encountered during treatment of a group of 80 children with ulcerative colitis. Material From Jan 1, 1953, to Jan 1, 1963, at the Cleveland Clinic the diagnosis of ulcerative colitis was made in References 1. Michener, W. M., and Turnbull, R. B., Jr.: Surgical Treatment of Chronic Ulcerative Colitis in Children: Four Illustrative Case Reports , Cleveland Clin Quart 30:81-88 ( (April) ) 1963.Crossref 2. Ehrenpreis, T., et al: Surgical Treatment of Ulcerative Colitis in Children , Acta Paediat (Stockholm) 49:810-826 ( (Nov) ) 1960.Crossref 3. Brown, C. H.; Turnbull, R. B., Jr.; and Diaz, R.: Ileorectal Anastomosis in Ulcerative Colitis: Results in 27 Patients , Amer J Dig Dis 7:585-597 ( (July) ) 1962.Crossref 4. Kirsner, J. B.; Raskin, H. F.; and Palmer, W. L.: Ulcerative Colitis in Children: Observations in Selected Patients , AMA Amer J Dis Child 90:141-152 ( (Aug) ) 1955. 5. Michener, W. M.; Brown, C. H.; and Turnbull, R. B., Jr.: Ulcerative Colitis in Children: I . Diagnosis , this issue, pp 230-235. 6. Brown, C. H.: Clinical Evaluation of Librium in Gastrointestinal Diseases: Preliminary Report , Amer J Gastroent 35:30-36 ( (Jan) ) 1961. 7. Merlo, M., and Brown, C. H.: Effect of Diphenoxylate Hydrochloride on Diarrhea , Amer J Gastroent 34:625-630 ( (Dec) ) 1960. 8. Brown, C. H., and Merlo, M.: Topical Steroid Therapy for Ulcerative Colitis: Report of Fifty Cases , Amer J Gastroent 36:343-354 ( (Sept) ) 1961. 9. Fullerton, D. T.; Kollar, E. J.; and Caldwell, A. B.: Clinical Study of Ulcerative Colitis , JAMA 181:463-471 ( (Aug) ) 1962.Crossref 10. Michener, W. M., et al: Prognosis of Chronic Ulcerative Colitis in Children , New Eng J Med 265:1075-1079 ( (Nov 30) ) 1961.Crossref 11. Rosenqvist, H., et al: Ulcerative Colitis and Carcinoma Coli , Lancet 1:906-908 ( (May 2) ) 1959.Crossref 12. Crile, G., Jr., and Turnbull, R. B., Jr.: Mechanism and Prevention of Ileostomy Dysfunction , Ann Surg 140:459-466 ( (Oct) ) 1954.Crossref 13. Turnbull, R. B., Jr.: Instructions to Iloestomy Patient: Management of Stoma , Cleveland Clin Quart 28:213-228 ( (July) ) 1961.Crossref

POLK, HIRAM C.;BURFORD, THOMAS H.

1964 American Journal of Diseases of Children

doi: 10.1001/archpedi.1964.02090010245005pmid: 14168061

Abstract Emesis and regurgitation of feedings are common problems in pediatric practice. Vomiting, by history frequently indistinguishable from simple regurgitation, may be the presenting complaint in a wide range of diseases including food allergies, behavior problems, viral enteridites, more serious infections such as pyelonephritis and meningitis, and partial or complete obstruction of the alimentary tract. Common causes of the latter include hypertrophic pyloric stenosis, volvulus, intussusception, intestinal atresia, Meckel's diverticulum of the ileum, and disorders of the esophagus of a variable type. Material The records of the Saint Louis Children's Hospital for a 25-year period (1938-1962 inclusive) were reviewed. Admissions, limited to children 14 years of age and less, totaled 98,194. During this period, the most frequent esophageal lesions seen were tracheo-esophageal fistula, of which there were 111, and corrosive stricture, most commonly secondary to lye ingestion. Tracheo-esophageal fistula and lye stricture will not be discussed.Five disorders of the distal References 1. Allison, P. R.: Reflux Esophagitis, Sliding Hiatal Hernia, and Anatomy of Repair , Surg Gynec Obstet 92:419, 1951. 2. Barrett, N. R.: Hiatus Hernia: Review of Some Controversial Points , Brit J Surg 42:231, 1954.Crossref 3. Harrington, S. W.: Esophageal Hiatal Diaphragmatic Hernia , Surg Gynec Obstet 100:277, 1955. 4. Olsen, A. M., and Harrington, S. W.: Esophageal Hiatus Hernia of Short Esophagus Type, Etiologic and Therapeutic Considerations , J Thorac Surg 17:189, 1948. 5. Brown-Kelly, A. A.: Congenital Stenosis of Esophagus in Children Associated With Diaphragmatic Hernia of Stomach , Proc Roy Soc Med 23:1521, 1930. 6. Winkelstein, A.: Peptic Esophagitis: New Clinical Entity , JAMA 104:906, 1935.Crossref 7. Sweet, R. H.: Thoracic Surgery , ed 2, Philadelphia: W. B. Saunders Co., 1954, pp 294-308. 8. Merendino, K. A., and Dillard, D. H.: Concept of Sphincter Substitution by Interposed Jejunal Segment for Anatomic and Physiologic Abnormalities at Esophagogastric Junction , Ann Surg 142:486, 1955.Crossref 9. Kiriluk, L. B., and Merendino, K. A.: Experimental Evaluation in Dog of Esophagogastrectomy for High Lying Gastric Ulcer , Ann Surg 134:918, 1951.Crossref 10. Kiriluk, L. B., and Merendino, K. A.: Comparative Sensitivity of Mucosa of Various Segments of Alimentary Tract in Dog to Acid-Peptic Action , Surgery 35:547, 1954. 11. Sanders, G. B.: Esophageal Replacement With Reversed Gastric Tube , JAMA 181:944, 1962.Crossref 12. Jewett, T. C., Jr.; Carberry, D. M.; and Adler, R. H.: Metabolic Effects of Intrathoracic Stomach on Growing Child , J Thorac Surg 37:118, 1959. 13. Belsey, R.: "Surgery of Diaphragm," in J. Mason Brown, ed.: Surgery of Childhood , Baltimore: The Williams and Wilkins Co., 1963, pp 762-780. 14. Botha, G. S. M.: Gastro-Oesophageal Junction , Boston: Little, Brown & Co., 1962, pp 301-337. 15. Gross, R. E.: Surgery of Infancy and Childhood , Philadelphia: W. B. Saunders Co., 1953, p 103. 16. Miller, R. A.: Gastric Acidity During First Year of Life , Arch Dis Child 17:198, 1942.Crossref 17. Cutter, R. D.: Normal Gastric Secretion of Infants and Small Children Following Stimulation With Histamine , J Pediat 12:1, 1938.Crossref 18. Selye, H.: Experimental Production of Peptic Haemorrhagic Oesophagitis , Canad Med Ass J 39:5, 1938. 19. Maingot, R.: Abdominal Operations , ed 4, New York: Appleton-Century-Crofts, Inc., 1961, p 294. 20. Terracol, J., and Sweet, R. H.: Diseases of Esophagus , Philadelphia: W. B. Saunders Co., 1958, pp 199-208. 21. Bill, A. H., Jr.; Mebust, W. K.; and Sauvage, L. R.: Evaluation of Techniques of Esophageal Dilatation in Relation to Danger of Perforation , J Thorac Cardiov Surg 45:510, 1963. 22. Wooler, G. H., Cardiospasm , Thorax 3:53, 1948.Crossref 23. Payne, W. S.; Ellis, F. H., Jr.; and Olsen, A. M.: Treatment of Cardiospasm (Achalasia of Esophagus) in Children , Surgery 51:731, 1962. 24. Redo, S. F., and Bauer, C. H.: Management of Achalasia in Infancy and Childhood , Surgery 53:263, 1963. 25. Ferguson, T. B., and Burford, T. H.: Evaluation of Modified Heller Operation in Treatment of Achalasia of Esophagus , Ann Surg 152:1, 1960.Crossref 26. Neuhauser, E. B. D., and Berenberg, W.: Cardio-Esophageal Relaxation as Cause of Vomiting in Infants , Radiology 48:480, 1947.Crossref 27. Arroyave, R.; Clatworthy, H. W., Jr.; and Wangensteen, O. H.: Experimental Production of Esophagitis and Esophageal Ulcers in Dogs , Surg Forum 1:57, 1951. 28. Barrett, N. R.: Lower Esophagus Lined by Columnar Epithelium , Surgery 41:881, 1957. 29. Allison, P. R., and Johnstone, A. S.: Oesophagus Lined With Gastric Mucous Membrane , Thorax 8:87, 1953.Crossref 30. Rector, L. E., and Connerley, M. I.: Aberrant Mucosa in Esophagus in Infants and in Children , Arch Path 31:285, 1941. 31. Johns, B. A. B.: Developmental Changes in Oesophageal Epithelium in Man , J Anat 86:431, 1952. 32. Gruenwald, P., and Marsh, M. R.: Acute Esophagitis in Infants , Arch Path 49:1, 1950. 33. Dunbar, J. S.: Congenital Oesophageal Stenosis , Pediat Clin N Amer 1958, p 443. 34. Cross, F. S.; Kay, E. B.; and Smith, G. V., Jr.: Treatment of Regurgitant Esophagitis by Reconstruction of Cardiac Sphincter Mechanism in Patients With no Demonstrable Hiatal Hernia , Dis Chest 39:530, 1961.Crossref 35. Hiebert, C. A., and Belsey, R.: Incompetence of Gastric Cardia Without Radiologic Evidence of Hiatal Hernia , J Thorac Cardiov Surg 42:352, 1961.

BORIS, MARVIN;SELLERS, THOMAS F.;EICHENWALD, HEINZ F.;RIBBLE, JOHN C.;SHINEFIELD, HENRY R.

1964 American Journal of Diseases of Children

doi: 10.1001/archpedi.1964.02090010254006

Abstract Nasal carriers of pathogenic strains of Staphylococcus aureus are a potential hazard to their environment, their contacts, and themselves. At present, there is no known method which permanently eradicates "virulent" strains of S aureus from the nose of all persistent carriers. These investigations were undertaken to evaluate a new approach to a solution of the problem presented by adult carriers of virulent staphylococci. Shinefield and his associates have demonstrated that colonization of the nasal mucosa of newborns with one strain of coagulasepositive staphylococcus interferes with subsequent acquisition of a second strain of S aureus,1 and that, in fact, artificial colonization of newborns immediately after birth with a staphylococcus of low virulence can be employed to protect infants from infection by virulent "epidemic" strains.2-5 Epidemiologic data which would support the hypothesis of biologic competition between different strains of staphylococci have been reported by other groups of investigators.6-8 The References 1. Shinefield, H. R., et al: Bacterial Interference: Its Effect on Nursery-Acquired Infection With Staphylococcus Aureus; I. Preliminary Observations on Artificial Colonization of Newborns , Amer J Dis Child 105:646-654, 1963. 2. Shinefield, H. R., et al: Bacterial Interference: Its Effect on Nursery-Acquired Infection With Staphylococcus Aureus; II. Ohio Epidemic , Amer J Dis Child 105:655-662, 1963. 3. Shinefield, H. R., et al: Bacterial Interference: Its Effect on Nursery-Acquired Infection With Staphylococcus Aureus; III. Georgia Epidemic , Amer J Dis Child 105:663-673, 1963. 4. Boris, M., et al: Bacterial Interference: Its Effect on Nursery-Acquired Infection With Staphylococcus Aureus; IV. Louisiana Epidemic , Amer J Dis Child 105:674-682, 1963. 5. Shinefield, H. R., et al: Bacterial Interference: Its Effects on Nursery-Acquired Infection With Staphylococcus Aureus; V. Analysis and Interpretation , Amer J Dis Child 105:683-688, 1963. 6. Rountree, P. M., and Barbour, R. G. H.: Nasal Carrier Rates of Staphylococcus Pyogenes , J Path Bact 63:313, 1951.Crossref 7. Clarke, S. K. R.: Nasal Carriage of Staphylococcus Aureus , J Path Bact 73:253, 1957.Crossref 8. Berntsen, C. A., and McDermott, W.: Increased Transmissibility of Staphylococci to Patients Receiving Antimicrobial Drug , New Eng J Med 262:637, 1960.Crossref 9. Cohen, J. O., et al: Bacterial Interference: Its Effect on Nursery-Acquired Infection With Staphylococcus Aureus; VI. Detection of Implanted Staphylococcus Aureus Strain , Amer J Dis Child 105:689-691, 1963.Crossref 10. Sholts, E., and King, A.: Unpublished data. 11. Fleming, A.: Lysozyme , Proc Roy Soc Med 26:71-84, 1933. 12. Elek, S. D.: Staphylococcus Pyogenes and Its Relation to Disease , Edinburgh: E. & S. Livingstone, Ltd., 1959. 13. O'Grady, F., and Wittstadt, F. B.: Nasal Carriage of Staphylococcus Pyogenes , Amer J Hyg 77:187-194, 1963.

HUXTABLE, KATHRYN A.;TUCKER, ARTHUR S.;WEDGWOOD, RALPH J.

1964 American Journal of Diseases of Children

doi: 10.1001/archpedi.1964.02090010264007pmid: 14168063

Abstract Increasing attention has been focused upon the critical problems of staphylococcal pneumonia in early childhood. Several excellent articles have discussed the epidemiology, clinical findings, and the immediate course of the disease.1-9 Association with previous upper respiratory infection,3 frequent occurrence in infants less than six months of age,5 increasing yearly incidence since 1952,1 higher incidence in winter months (October through May), and the disproportionately high number of cases caused by "resistant staphylococci"1,8 have been described. Less information, however, is available on long-term follow-up for possible residual disability. One study10 reported residual radiographic abnormalities in 18% and recurrent pneumonia in 23% of their patients. This study was undertaken to evaluate the long-term prognosis of staphylococcal pneumonia in childhood and was designed to determine: The incidence of permanent radiographic changes Predisposition to recurrent pneumonia Incidence of chronic cough or exercise intolerance Incidence of References 1. Koch, R.; Carson, M. J.; and Donnell, G.: Staphylococcal Pneumonia in Children , J Pediat 55:473-484, 1959.Crossref 2. Rebhan, A. W., and Edwards, H. E.: Staphylococcal Pneumonia: Review of 329 Cases , Canad Med Ass J 82:513-517, 1960. 3. Morris, R.: Staphylococcal Pneumonia in Infants , Med J Aust 2:18, 625-629, 1959. 4. Kripke, S.: Infectious Pneumonias of Early Infancy , Amer J Dis Child 102:123-133, 1961. 5. Hendren, W. H. III, and Haggerty, R. J.: Staphylococcic Pneumonia in Infancy and Childhood , JAMA 168:6-16, 1958.Crossref 6. Meyers, H., and Jacobson, G.: Staphylococcal Pneumonia in Children and Adults , Radiology 72: 665-671, 1959.Crossref 7. Pryles, C. V.: Staphylococcal Pneumonia in Infancy and Childhood , Pediatrics 21:609-623, 1958. 8. Eichenwald, H., and Shinefield, H. R.: Problem of Staphylococcal Infection in Newborn Infants , J Pediat 56:665-674, 1960.Crossref 9. Beaven, D. W., and Burry, A. F.: Staphylococcal Pneumonia in Newborn: Epidemic With 8 Fatal Cases , Lancet 2:211-215, 1956.Crossref 10. Binder, L., et al: Later Fate of Children With Staphylococcal Pneumonia , Acta Paediat Acad Sci Hung 2:155-157, 1961.

BERGEN, STANLEY S.

1964 American Journal of Diseases of Children

doi: 10.1001/archpedi.1964.02090010272008pmid: 14168064

Abstract The appetite and growth stimulating properties of cyproheptadine were first reported by Lavenstein et al in 1962.1 During clinical evaluation of cyproheptadine, an antagonist of histamine and serotonin, these investigators noted significant weight gain and height increase in 28 outpatient asthmatic children. Lavenstein et al1 were unable to delineate the mechanism of these actions in their study, although no evidence of fluid retention, clinical stigmata of Cushing's syndrome, or hypothyroidism were noted. In order to examine these observations more thoroughly, a study was undertaken in a group of chronically hospitalized asthmatic children at the Asthmatic Unit of St. Luke's Convalescent Hospital. In order to appraise the possible effect of drug induced hypoglycemia as the cause of hyperphagia and thus weight gain, all subjects were studied for the effect of this agent on carbohydrate tolerance. A separate group of children were evaluated for a change in blood glucose concentration References 1. Lavenstein, A. F., et al: Effect of Cyproheptadine on Asthmatic Children , JAMA 180:912, 1962.Crossref 2. Nelson, N.: Photometric Adaptation of Somogyi Method for Determination of Glucose , J Biol Chem 153:375, 1944. 3. Bruch, H.: Obesity in Childhood: I Physical Growth and Development of Obese Children , Amer J Dis Child 58:457, 1939. 4. Bergen, S. S., Jr.: Unpublished data. 5. Van Itallie, T. B., and Hashim, S. A.: Personnel communication to the author. 6. Tepperman, H. M., and Tepperman, J.: Hexosemonophosphate Shunt and Adaptive Hyperlipogenesis , Diabetes 7:478, 1958.

MURRAY, WALTER A.;KHEDER, JAMIL;WHEELER, WARREN E.

1964 American Journal of Diseases of Children

doi: 10.1001/archpedi.1964.02090010276009pmid: 14168065

Abstract Recently, Kessner et al1 reported an extensive epidemic due to enteropathogenic Escherichia coli (EPEC) which occurred during the winter of 1960-1961 in the metropolitan Chicago-northwestern Indiana region. This report prompted us to recount our experience with a nosocomial epidemic, sparked by the Chicago outbreak, which plagued our hospital for a period of three months. Our epidemic started late in July, 1961, and was attributed to 8-month-old twins admitted with diarrhea. Their 18-month-old sibling had been discharged from a Chicago hospital two weeks previously. The epidemic involved 27 infants (25 of them cross-infections in our hospital) and contributed to the death of six children. During the preceding six years, suppression of contagion of EPEC by a neomycin sulfate "umbrella" was successful in reducing contagion in diarrhea patients admitted to the Children's Hospital, Columbus, Ohio.2 All newly admitted diarrhea patients under 2 years of age were given oral neomycin References 1. Kessner, D. M., et al: Extensive Community Outbreak of Diarrhea Due to Enteropathogenic Escherichia Coli 0111:B4: I. Epidemiologic Studies , Amer J Hyg 76:27-43, ( (July) ) 1962. 2. Wheeler, W. E.: Spread and Control of Escherichia Coli Diarrheal Disease , Ann NY Acad Sci 66:112-117 ( (Aug 10) ) 1956.Crossref 3. Ross, S.; Puig, J. R.; and Zaremba, E. A.: Colistin: Some Preliminary Laboratory and Clinical Observations in Specific Gastroeneritis in Infants and Children , Antibiot Ann 7:89-100, 1959-1960. 4. Weill, J.; Baruch, J.; and Costin, M.: Un nouvel antibiotique pour le traitement des diarrhees infantiles: la colimycine , Arch Franc Pediat 15:1227 ( (May) ) 1958. 5. Fleischhauer, G.: Über Resistenzprufungen und klinische Erfahrungen mit Colistin , Deutsch Med Wschr 85:1717-1719 ( (Sept 23) ) 1960.Crossref

KHEDER, JAMIL;WHEELER, WARREN E.

1964 American Journal of Diseases of Children

doi: 10.1001/archpedi.1964.02090010280010pmid: 14168066

Abstract In the preceding communication with Dr. Walter Murray,1 we reported our experience of the effectiveness of colistin in the management of an outbreak of infantile diarrhea caused by a neomycin resistant strain of Escherichia coli 0111:B4. Because of the small number of cases treated with colistin and the urgent need to halt the epidemic, we were unable to try different dosage schedules or to study other aspects of therapy such as the occurrence of side effects and the overgrowth in the stools of other microorganisms. Reports in the literature2,3 indicate that enteropathogenic E coli (EPEC) and non-enteropathogenic strains of E coli are inhibited by similar concentrations of colistin. Since patients excreting EPEC are not numerous, we studied the excretion of non-enteropathogenic E coli from patients with parenteral diarrhea. Method of Study A total of 114 children, 1 week to 2 years of age, were selected at random References 1. Murray, W. A., et al: Colistin Suppression of Escherichia Coli in Stools: I. Control of a Nosocomial Outbreak of Diarrhea Caused by Neomycin Resistant Escherichia Coli 0111: B4 Amer J Dis Child this issue , pp 274-277. 2. Ross, S.; Puig, J. R.; and Zaremba, E. A.: Colistin: Some Preliminary Laboratory and Clinical Observations in Specific Gastroenteritis in Infants and Children , Antibiot Ann 7:89-100, 1959-1960. 3. Wright, W. W., and Welch, H.: Chemical, Biological, and Clinical Observations on Colistin , Antibiot Ann 7:61-74, 1959-1960.