Henry L. Barnett

Salicylate intoxication in infants and children

Summary 1. Five cases of salicylate intoxication are presented. 2. In four of the five cases the intoxication occurred during therapeuticadministration of the salicyl compound. 3. Unusually large quantities of alkali may be required to correct the acidosis of salicylate intoxication because of the intense and persistent ketosis. 4. The importance of glycogen depletion specifically associated with the increased metabolic activity due to salicylates in the development of ketosis and acidosis is suggested, and the effect of this on prevention and treatment of the intoxication is discussed.

Certain aspects of tyrosine metabolism in the young. I. The development of the tyrosine oxidizing system in human liver.

The major pathway for tyrosine catabolism in the animal is the non-oxidative transamination of tyrosine to p-hydroxyphenylpyruvate and its subsequent oxidation to homogentisate. The homogentisate is oxidized to fumarylacetoacetate (maleylacetoacetate), which is finally hydrolyzed to fumarate (malate) and acetoacetate. The enzyme system responsible for this catabolism, tentatively called the tyrosine oxidizing system, is soluble and a partial purification can be accomplished with high speed centrifugation of homogenates of liver (1) and kidney (2). When these preparations are used it has been observed (3) that one mole of tyrosine will be completely oxidized to one mole of acetoacetate and one mole of fumarate, with the utilization of two moles of oxygen. In order to obtain maximal tyrosine

RENAL WATER EXCRETION IN PREMATURE INFANTS

It is generally believed that, after water ingestion, the young infant can neither dilute his urine nor increase the rate of urine flow as rapidly or as effectively as the adult (1-4). Although several sound investigations (4-6) have demonstrated that the kidneys of newborn animals are relatively inefficient in this regard, there have been very few direct observations on these important functions in infants. The present investigation was undertaken, therefore, to compare the renal response of the young premature infant with that of the older infant and adult to ingestion of water.

The effect of corticotropin (ACTH) on glomerular permeability to albumin in children with the nephrotic syndrome.

Present evidence indicates that proteinuria in patients with the nephrotic syndrome is the result of increased permeability of the glomerular capillary walls to proteins, particularly to albumin (1, 2). A rough indication of the permeability to albumin, relative to permeability to water, is provided by the ratio of the concentration of albumin in glomerular fluid to that in plasma. Assuming that no albumin is excreted by the tubules, the rate of albumin excretion (in mg. per min.) divided by the rate of glomerular filtration of water (GFR, in ml. per min.) represents the lowest possible concentration of albumin in glomerular fluid (in mg. per ml.) ; if some albumin is reabsorbed by the tubules, as seems likely, the actual concentration of albumin in glomerular fluid would be greater than this calculated value. If it is accepted that the clearance of inulin (CIN) is equivalent to GFRin children with the nephrotic syndrome (3), it follows that the renal clearance of albumin (CALB) divided by CIN, i.e., CALB/CIN, represents the minimum ratio of the albumin concentration in glomerular fluid to that in plasma. Chinard, Lauson, and Eder (4) showed that in patients with the nephrotic syndrome the renal clearance of the blue dye, T-1824 (CT_1824), was somewhat less than but approximately proportional to CALB. It would appear, therefore, that where large changes in permeability are expected CT_1824 should be a satisfactory substitute for CALB. The

Food, man, and society

Nutrition and Science.- Food and History.- Proteins in Medieval Northern Europe.- The Global Pattern of the History of Food.- References.- Geographic Perspectives on Mans Food Quest.- Beef Eating and the Hindu Sacred Cow Concept.- References.- Availability of Food.- Food Production and Population.- Food Availability and Physiological Requirements.- Patterns of Food Availability.- Distribution of the Available Food with a Country.- Future Prospects for Food Availability.- Reference.- Clinical Manifestations of Malnutrition.- Protein-Calorie Malnutrition.- Clinical Signs.- Edema.- Anthropometric Measurements.- Weight for age.- Height for age.- Weight for Height.- Arm Circumference.- Biochemistry.- Vital Statistics - Age-Specific Death Rates.- Birth Weight.- Socioeconomic Development.- Avitaminosis A.- References.- Attacking the Malnutrition Problem.- The Root Causes.- Poverty.- Food Supply and Population Growth.- The Health-Nutrition Interface.- Knowledge and Beliefs.- Nutrition Planning.- Nutritional Interventions.- General Food Subsidies.- Targeted Food Subsidies.- Fortification.- Genetic Breeding.- New Protein Foods.- Nutrition Education.- An Integrated Approach.- References.- Food and Socioeconomic Development.- Sociocultural Factors.- Mode, Time, and Place.- Migrations.- Acculturation.- Education.- Feeding Practices.- Summary.- References.- Ethical and Cultural Aspects in Human Food Behavior Implication in Food Planning.- Nutritional Planning.- Food.- Mother Earth.- The Work.- The Communications.- The Economy.- Nutritional Diseases.- Nutritional Needs.- Concluding Remarks.- References.- Benefit-Risk Decision Making and Food Safety.- The Need for Technology.- The Benefits of Technology.- The Risks and Alternatives.- Types of Benefit-Risk.- The Ethics of Benefit-Risk Decision Making.- References.- Food, Tradition, and Prestige.- Food for Display.- Prestige and Gastronomy.- Food, Prestige and Aristocracy.- Rural Areas.- Urban Societies.- Three Concrete Examples.- The Moussey.- Celebrations.- The Massa.- Toupouri.- References.- Food Faddisms.- The Health Food Bonanza.- Definitions.- Why So Much Food Faddism and Quackery.- Eating - Safely - Through the Eighties.- Food and Disease.- Food in a Growing World.- Conclusion.- Teaching Aspects Education and Training in Nutrition.- Nutrition in Medical Study Programs.- Paramedical Staff Concerned with Nutrition Problems.- Nutrition and a Subejct and as a Scientific Discipline.- Nutrition and a Subject Within Other Fields.- Education in Food and Nutrition.- Better Care for Children.- Malnutrition in Highly Developed Industrialized Countries.- Summary.- References.- Food and Health: Considerations of the Protein Metabolism with Special Reference to Amino Acid Requirements and Imbalance.- Basic Facts and Definitions.- Amino Acid Requirements and Biological Value of Proteins.- The Utilization of Protein Combinations in Man.- Amino Acid Imbalance and Amino Acid Fortification.- Mechanisms Regulating Protein Metabolism.- Assessment Problems.- Outlook.- References.- Food and Genetic Development.- Induced Mutagenesis.- Evolution and Selection.- Food and Expression of Genes.- Genetic Regulation.- DNA, Genes, and Gene Mapping.- Messenger RNA.- Genetic Regulation in Higher Organisms.- Levels of Genetic Regulation.- Regulator Genes.- Food and Genetic Regulation.- Concluding Remarks.- Acknowledgment.- References.- Food and Psychological Development.- References.- Food and Human Brain Development.- References.- Nutrition and Development.- References.- Biochemical Development and Nutrition of the Newborn.- Biochemical Immaturity.- Protein in the Feeding of Preterm Infants.- Conclusion.- References.

Renal Physiology in Infants and Children. II. Inulin Clearances in Newborn Infant with Extrophy of Bladder

Interest in the renal function of newborn infants has been aroused by recent studies which indicate that the glomerular filtration rate is relatively low during the newborn period. The application of a method devised by one of us 1 to 7 apparently normal full-term infants ranging in age from 4 to 9 days suggested glomerular filtration rates between 20 and 40% of the average normal adult values. McCance and Young 2 have since published an extensive study of renal function of newborn infants, in which are included observations on inulin clearances in 3 infants, aged 6 to 13 days, with meningoceles. Urine collections were made by means of catheterization, and the determined inulin clearances were of the order of 43% of the average adult value. These workers pointed out that the inulin clearances varied considerably with the minute urine volumes. In addition, they observed corresponding changes in urea clearances. Gordon, Harrison, and McNamara, 3 determining urea clearances in premature and full-term infants ranging in age from 7 to 70 days, also obtained values considerably below the normal adult levels. They did not find increases in the urea clearances when the flow of urine, initially 0.05 to 0.20 cc per minute or 0.4 to 1.0 cc per square meter per minute, increased by 25 to 100%. The observations reported here were made on a 24-hour-old infant, weighing 2100 g, who was admitted to the St. Louis Childrens Hospital on July 18, 1941, because of an extrophy of the bladder. The 2 ureteral orifices were visible and readily accessible. Ureteral catheters were inserted easily and a steady flow of urine was obtained. Blockage necessitating irrigation of the catheters was not encountered during the period of the studies to be described and it was felt that accurate collections were made with a minimum of manipulation.

Histoplasmosis: Report of a case in an infant and experimental observations

Summary 1. A case of generalized histoplasmosis in a male infant, 11 months of age, with autopsy, mycologic, and experimental studies is reported. Lesions were found in the lungs, liver, spleen, adrenal glands, kidneys, colon, appendix, bone marrow, lymph nodes, and blood vessels. 2. Macroscopically visible colonies of Histoplasma capsulatum were observed on blood agar plates (indubated aerobically at room temperature) on the fourth day following inoculation with blood taken from the heart at autopsy. 3. Yeast like forms of the fungus were observed in blood films prepared post mortem. 4. Experiments indicate that Histoplasma capsulatum is resistant to drying and to low temperatures (from 5 to 8° C.). 5. Histoplasma capsulatum is destroyed in milk by heating at from 62 to 63° C. for twenty minutes. 6. Infection of guinea pigs, normal and vitamin C deficient, could not be established by oral feedings with large numbers of organisms.

Influence of Eosinophile Cells of Hypophysis on Kidney Function

White, Heinbecker and Rolf 1 reported that removal of the glandular division of the hypophysis in dogs resulted in a reduction of 50% or more in inulin and diodrast clearances and in maximal tubular excretion of diodrast at high plasma levels. These changes indicate a depression of renal blood flow and of renal tubular excretory capacity and were in evidence within 7 days after the removal of the glandular hypophysis. They have persisted under observation for a period of 2 years. It can be stated, therefore, that the glandular hypophysis exercises a humoral influence on the kidney. Evidence that the eosinophile cells of the hypophysis are responsible for this influence is presented in this paper. Observations on the urea clearance of 5 patients with acromegaly revealed values of 130, 83, 135, 231, and 100%, respectively, of the normal standard. Three of these values are definitely above the upper limit of normal. An eosinophil tumor was found at autopsy in the first of these patients. The kidneys weighed 420 g. Microscopically the glomeruli and tubules were slightly hypertrophied. There was generalized arteriosclerosis of the renal vessels. Some increase in kidney size is a usual finding in acromegaly. Since eosinophil cell hyperplasia or eosinophil tumor formation has been found in all cases of acromegaly 2 coming to autopsy, the increase in renal function and in renal size observed in this disease perhaps may be attributed to hyperfunction of the eosinophil cells of the glandular hypophysis. The degree of secretory activity of the hypophysial tumor should be reflected in the extent of increase in renal function. Winternitz and Waters 3 and White, Heinbecker and Rolf 4 have shown that in dogs a single remaining kidney fails to hypertrophy after removal of the glandular division of the hypophysis.

Primary care pediatrics : a symptomatic approach

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