Abraham M. Litvak

Cerebral complications in pertussis

Summary 1. Over a period of fifteen years, 6,002 cases of pertussis were seen at the Kingston Avenue Hospital. Forty-seven of these were complicated by clinical cerebral manifestations. 2. (a) During the years 1932 to 1938 inclusive, 2,758 patients were admitted and 261 died, a general mortality rate of 9.4 per cent. Twenty-four cases were associated with cerebral complications. Six patients died, a mortality rate of 25 per cent. (b) From 1939 to 1946 inclusive, 3,244 patients were admitted and 109 died, a general mortality rate of 3.3 per cent. Twenty-three cases were complicated by cerebral manifestations and thirteen patients died, a mortality rate of 56.5 per cent. 3. Of the forty-seven patients with cerebral complications, 28 survived and nineteen died, an average mortality rate of 40.4 per cent. 4. The onset of cerebral complications was almost always accompanied by convulsions and a sudden rise in temperature. 5. Fifty per cent of the patients who developed cerebral complications were under one year of age, and 60 per cent were under 2 years of age. 6. In 72.5 per cent of the patients, the onset of the cerebral complications occurred during the third and fourth weeks of the disease. 7. Spinal fluid studies were made in thirty-eight of the forty-seven patients. The findings were normal in all but eight cases. There was no correlation between the prognosis for life or sequelae and the spinal fluid findings. 8. The prognosis in patients with cerebral complications in whooping cough epends upon the age of the patient, the severity of the paroxysm, the nutritional state of the patient, the length of the convulsive seizure, the duration of the coma, and upon the presence of an associated complication. 9. In round figures, one-third of the patients with cerebral complications die, one-third recover to develop sequelae, one-third recover completely. 10. Twelve of the twenty-eight surviving patients in our series were followed over periods ranging from two months to eight years. Five (43 per cent) of them showed a tendency to further central nervous system manifestations. 11. The pathologic changes in the brains of thirty-four autopsied patients with cerebral complications were edema and congestion of the brain, petechial hemorrhages, subarachnoid hemorrhages, and thrombosis of cerebral veins and sinuses. 12. No changes of an inflammatory nature were observed. 13. The pathologic changes may be considered due to vascular disturbances or degenerative changes incident to anoxemia rather than inflammatory in origin. 14. The term “encephalopathy” appropriately covers these pathologic changes. 15. Treatment is entirely symptomatic. There is no effective specific therapy. 16. Present trends in age distribution of pertussis indicate a greater incidence in infants under one year of age.

Congenital familial steatorrhea with fibromatosis of the pancreas and bronchiolectasis

Summary Two cases of congenital familial steatorrhea with fibromatosis of the pancreas and bronchiolectasis are presented, one with post-mortem findings. The past and present concepts of the terms “steatorrhea” and the “celiac syndrome” are described. The steatorrheas are classified as the idiopathic variety, including celiac disease, and the pancreatogenous. Into the latter division fall most of the cases reported in the literature, which begin soon after birth, are refractory to treatment, and show characteristic post-mortem changes in the pancreas. This includes one and presumably the other of our cases. Suggestions for the recognition of these cases are offered. The association of respiratory symptoms and pulmonary findings with the steatorrheas is discussed, and the reasons for considering the pathologic phenomena of both pancreas and bronchi to be based on congenital anomalies are given. The appearance of symptoms from birth, the familial incidence of the disease, the characteristic pertussis-like cough, the presence of transitory glycosuria, and the finding of fatty changes in the liver are mentioned.

Statistical analysis of 242 cases of meningococcus meningitis

Summary A statistical analysis of 242 cases of meningococcus meningitis observed over a five-year period is presented. Thirty-four cases of other types and eight cases of meningococcemia seen during this period are compared statistically. Drug therapy including types, methods of administration, and complications are discussed at length. The conclusion from this study is that sulfadiazine alone gives the optimal results and that spinal puncture should be reserved for diagnostic purposes only.

The hospital progress of nine hundred ninety-two premature infants fed evaporated milk-carbohydrate mixtures

Summary An analysis of 992 premature live births at the Beth-El Hospital is presented. These babies were all under the care of various members of the pediatric staff. All were fed and cared for according to a basic regime which is set forth in detail. The feedings were all evaporated milk-Dextri-Maltose formulas used in varying proportions. Among the 992 premature babies there were 134 deaths, a mortality rate of13.5 per cent. More than one-half of the deaths occurred during the first twenty-four hours and three-fourths during the first two days of life. In the group of infants weighing up to 1,000 Gm. at birth the mortality rate was 98 per cent. Where the birth weight was between 1,000 Gm. and 2,000 Gm. the mortality rate was 26.2 per cent and in the babies weighing between 2,000 Gm. and 2,500 Gm. there was a mortality rate of only 3.1 per cent. The infants made noteworthy progress on the routine outlined. The averageday on which birth weight was regained was 5.8 days with an average hospital stay of 16.4 days. Our babies made an average daily weight gain of 0.92 ounces (26.1 Gm.) during the second to fourth weeks of life and were discharged at an average weight of 88.7 ounces (2,514.6 Gm.). There was an over-all mean daily weight gain during the period from the second to fourth week of 11.2 Gm. per kilogram of body weight. We feel that our babies have done exceptionally well on the evaporated milk-Dextri-Maltose regime outlined, and that its simplicity and uniformity, together with the excellent results herein reported, militate for its more general use in the care of premature infants.

The influence of human serum albumin on edema in erythroblastosis fetalis

Summary Two cases of erythroblastosis fetalis complicated by severe generalizededema successfully treated with concentrated human serum albumin are reported. The first was one of twins, in which the untreated sibling died. In the second case, blood studies were done and it was found that the use of the serum albumin corrected an early fall in the blood protein level with subsequent elimination of the severe generalized edema. It is postulated that liver damage, frequently a feature in severe erythroblastosisfetalis, with a disturbed blood protein level was the causative mechanism of the edema, and that the serum albumin restored the level. Studies are now in progress further to elucidate these factors.

A case of erythroblastosis fetalis caused by isoimmunization with the agglutinogen B

Summary A case of erythroblastosis fetalis caused by isoimmunization of an Rhpositive, type O mother by a type B baby is reported with confirmatory blood serologic findings. It is suggested that when an erythroblastotic infant is seen, whose mother is type O and her Rh factor is unknown, the baby be transfused with type O, Rh-negative blood. This would obviate the possibility of giving the infant blood to which he has circulating isoagglutinins.