Harold K. Faber

Early operation in premature cranial synostosisfor the prevention of blindness and other sequelae

Summary Five cases are reported in which linear craniectomy was performedduring infancy on patients with premature synostosis of the cranial sutures for the purpose of preventing the common late sequelae of increased intracranial pressure and severe deformity. The results obtained would appear to be encouraging.

Progressive facial hemiatrophy

Summary 1. Two cases of progressive facial hemiatrophy with cerebral calcification and convulsions in a girl twelve and a boy fifteen years old are presented. 2. Roentgenograms demonstrating cerebral calcification conform most closely to proved cases of calcified hemiangioma. 3. It is believed that in the first case the convulsions, which antedated the hemiatrophy by three or four years, were directly related to the calcified cerebral lesion. In the second case, also, it is believed that the convulsions were related to a hemangioma, which later became calcified. It does not seem probable that the history of trauma bore any relation to the convulsions. 4. The relation of the intracranial process to the hemiatrophy in both cases is not determined.

Acute coccidioidomycosis with erythema nodosum in children

Summary An acute febrile illness has been described, caused by the fungus Coccidioides immitis , characterized by initial systemic symptoms commonly followed by erythema nodosum, and accompanied by a marked specific sensitivity to the products of the fungus. It is common among children. The prognosis, in contrast to that of coccidiodal granuloma which is caused by the same organism, is favorable. While the endemic focus is in the west, migration of persons in theincubation period could permit the disease to break out sporadically in other localities.

Chronic stridor in early life due to persistent right aortic arch

Summary 1. Stridor was the presenting symptom in two cases of persistent right aortic arch discoverd in early life and led to the appropriate x-ray investigation which established the diagnosis. 2. In congenital or chronic stridor not due to obvious causes, persistent right aortic arch should always be considered and investigated. The diagnosis of enlarged thymus and “thymic stridor,” based on a broad shadow in the upper mediastinum, should not be accepted until persistent right arch has been excluded.

The prognosis in acute glomerulonephritis in children

Summary 1. Of 102 children observed in this institution during the initial stage ofglomerulonephritis and for adequate periods thereafter, approximately 81 per cent fully recovered; 11 per cent died and 8 per cent still showed activity for two years or more after the onset, when the chances of recovery had become negligible. Six per cent died during the initial stage, and 5 per cent died later of chronic nephritis. 2. Of those surviving the initial stage 86.5 per cent were cured; 8.3 per cent had remained active for more than two years, and 5.2 per cent died of chronic nephritis. 3. The differences in prognosis expressed by our data and by those of others are discussed. 4. We question the existence of geographical differences in prognosis.

Mediterranean anemia (cooley) in a Negro girl

S. B., was admitted Feb. 16~ 1945, to the Childrens Ward of Stanford University Hospital, because of frequent nosebleeds and anemia. She was born Feb. 15, 1939~ in Arkansas. Her nmther was dark-skinned, with typical Negro features. Her father was under treatment for syphilis in the Oklahoma State Hospital for Negro Insane. The motlmr had one stillborn child; a son who was feeble-minded and in the same institution as the father; and three other children who were alive and well. The latter have been observed by us and were typically Negro. The aiother appeared to be in good health, but no Wassermann or other test for syphilis had been taken, to her knowledge.

Inactivation of poliomyelitis virus in relation to gastric and intestinal digestion.

Summary At the pH levels prevailing in the stomach when only gaitric juice is present, and at the height of digestion of carbohydrate and mixed meals containing meat, poliomyelitis virus is rapidly inactivated. Pepsin contributes slightly to inactivation. Since the pH levels necessary for virus inactivation are present in the Stomach only part of the time, and since part of the gastric contents are evacuated before such level can be attained, acertain proportion of ingested virus has the opportunity to escape intactinto the duodenum, here and in the rest of the intestine the pH is too high to inactivate and trypsin has no inactivating effect. Virus entering the bowel therefore must be presumed to remain active, thus providing conditions suitable for secondary intestinal entry of infection, and also for concentration of virus in the contents of the large intestine.

A modification of the Du Bois height-weight formula for surface areas of newborn infants

In 1916 Sawyer, Stone and Du Bois announced a series of measurements by which the surface area of adults and children could be estimated with an average error of 1.3 per cent. In a subsequent paper of the same series (1916) by Du Bois and Du Bois, a new formula based on height and weight alone was presented which was stated to have an error of

Microcytic, hypochromic (iron-deficiency) anemia in infancy and childhood: Its relation to gastric anacidity and to simple achlorhydric anemia of adults

pL 5 per cent. This formula is as follows: or The constant C was found to be 71.84 (log 1.857). It was not known whether the formula held for children under two years. Since the first method is based on a separate estimation of the surfaces of the extremities, head and trunk there seems to be no reason why this method should not be applicable at any age. The height-weight formula should however apparently be checked for young infants. In a series of 100 newborn babies, none over 12 days old, ranging in weight from 2,140 to 4,520 grams and in height from 45.2 to 56.9 cm., the surface area was measured by the Sawyer, Stone and Du Bois method and compared with the results obtained by the height-weight formula of Du Bois and Du Bois. Taking the former as the correct measure, we found that the latter showed a constant deviation below the former which averaged 191 sq. cm. or a mean error of −8.6 per cent. Correcting the constant, it was found that the surface area could be computed in these infants by the height-weight formula with an average error of ± 2.5 per cent. For newborn infants the corrected formula is as follows: or

Visualization of Preparalytic Lesions of Poliomyelitis by Intravital Staining.

Summary 1. In ten patients between the ages of seven months and two years with anemia of the “nutritional” or “iron-deficiency” type, gastric analysis after histamine demonstrated a marked secretory defect: free acid was absent in six and low in the other four; total acidity and volume were low in all cases. 2. The blood showed marked hypochromia and microcytosis before treatment was begun. 3. When soluble iron was administered in adequate amounts, there was a striking immediate response with reticulocytosis and increased size of red cells (transient macrocytosis) accompanying an increase in hemoglobin. This was followed by a decline of reticulocytes, by a return to an approximate distribution of cell sizes, and by a continued rise in hemoglobin. A certain number of microcytes tended to persist. 4. Twins who at the age of about eight months had anacidity and anemia were reexamined seven years later. One still had nearly complete anacidity and a mild degree of anemia. The other was able to produce a moderate amount of acid (though probably less than the normal minimum) and still had microcytosis but without hypochromia. 5. On the basis of a comparison with the normal values for later childhood and adult life, the average presumptively healthy child in the latter half of the first year and for a few years thereafter has a mild hypochromic anemia. Such figures as are available show that at least during the first and second years children secrete small amounts of gastric juice containing a relatively small amount of acid. It is probable that in this period of life the absorption of iron from ordinary diet is difficult and might be improved by administering soluble iron as a routine measure and by taking into account the acidabsorbing (buffer) effect of milk, in regulating diet. 6. The close resemblance between “iron-deficiency” anemia of infancy and childhood and the hypochromic, microcytic anemia of adults is noted.