New England Journal of Medicine Boston

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					psychic changes appeared related as much to the pre-          bility in lipids, the synthesis shows increased intestinal
operative clinical picture and duration of the disease, as    résorption of approximately 90%. Its toxicity seemed con¬
to the particular localization of the lesion.                 siderably less as compared to digoxin. The disesterification
                                                              of the /?-acetyldigoxin converts it to pure digoxin which
Functional Inactivation of the Human Brain Stem Re¬           then develops full pharmacological activity, and, on ac¬
  lated to the Level of Consciousness—G. Alemà et al (Clin-   count of its favorableintermediary release quote of about
  ica Neurochirurgica, Université, Genoa, Italy)              18%, it is especially suited for cardiac therapy. Acetyl-
                                                              digoxin was administered clinically to 264 patients with
           J Neurosurg 24:629-639 (March) 1966                various degrees of heart failure. Good tolerance and favor¬
   Amobarbital sodium, 100 mg three times daily, was in¬      able résorption permitted exclusively oral therapy, even
jected into the vertebral circulation of 19 patients. The     in cases of severe failure with advanced gastrointestinal
motor sensory phenomena observed indicate that the intra-     stasis.
vertebrally injected barbiturate has a depressive action on
the brain stem neurons, and active concentrations reach
the rostral midbrain, but not the thalamus. Structures          New England Journal of Medicine, Boston
of relevant importance for electroencephalographic activa¬
tion and for the maintenance of normal level of con¬
sciousness do not appear to be located in the medulla         Primary Tuberculosis in Children: I. Incidence of Drug-
oblongata, in the pons, or in midbrain, but seem to be           Resistant Disease—M. Steiner and A. Cosio (450 Clark-
located more rostrally, possibly in the diencephalon.            son Ave, Brooklyn, NY)

                                                                      New Eng J Med 274:755-759 (April 7) 1966
Calcified Subdural Hematomas in Childhood—R. L. Mc-
  Laurin and K. S. McLaurin (Cincinnati General Hosp,            Susceptibility tests to isoniazid, streptomycin, and PAS
  Cincinnati)                                                 were made on 101 strains of Mycobacterium tuberculosis
                                                              isolated from 332 untreated children. The incidence of pri¬
          J Neurosurg 24:648-655 (March) 1966                 mary drug-resistant strains to streptomycin and PAS was
  Although calcified subdural hematoma in childhood     oc¬   of a low order (3%) and comparable with that reported
curs rarely, previous reports have usually advocated    re¬   in adults. Combined drug resistance was found in only two
moval of the mass. The present report concerns six cases      of 101 strains. The incidence of primary isoniazid drug
encountered during 11 years, each patient having under¬       resistance when analyzed by the United States Public
gone removal of hematoma. The patients were studied pre-      Health Service criterion was 16.3% as compared with 6.3%
and postoperatively by psychometric testing and by elec-      by the Veterans Administration criteria for resistance,
troencephalography, as well as by standard neurological       both of which are greater than that reported for adults
evaluation. Psychometric examinations showed no indica¬        (2.6%) in New York City. The lower incidence in the
tion of improvement following operation. There was no         adult group may be in part a reflection of disease due to
evidence that seizure activity was altered by hematoma        endogenous reinfection by sensitive organisms acquired
removal. Removal of such lesion is not warranted unless       during childhood before the use of isoniazid. Clinical as¬
there is evidence of progressive neurological deterioration   pects of both sensitive and drug-resistant disease are
or intracranial hypertension. Evidence is presented from      tabulated.
roentgenologic material that a hematoma may be allowed
to exist long enough for calcification only if brain dam¬     Carotid Thrombosis Due to Intraoral Trauma—S. E. Pit-
age and atrophy have occurred. This brain damage prob¬         ner (858 Madison Ave, Memphis)

ably accounts for the symptoms which usually include                  New Eng J Med 274:764-767 (April 7) 1966
seizures and mental retardation.
                                                                Trauma is an unusual cause of internal carotid throm¬
                                                              bosis in adults but accounts for one fourth of the proved
                                                              cases in children. Nearly half of these have followed an
  M\l=u"\nchenerMedizinische Wochenschrift
                                                              accident almost unique to childhood—contusion of the ar¬
                                                              tery by falling on foreign objects carried in the mouth.
Nil Nocere: Cardiac Catheter Looping—H. Schickedanz and       The cases of a small child and an adolescent who de¬
 V. Voelkner (Chirurgische Universitätsklinik, Jena,          veloped internal carotid artery occlusion following blunt
  Germany)                                                    paratonsillar trauma from falling with a toy arrow and a
                                                              toothbrush in their mouths are reported. Specific inquiry
        München Med Wschr 108:701-706 (April 1) 1966          about such accidents should be made concerning any child
   Catheter loops or knots cut short 20 (2.5%) of 810         with an acute, focal neurological lesion.
catheter examinations. The mechanism of formation and
the possibilities of complications of catheter entangle¬      Comparative Fetal Mortality in Maternal Virus Disease:
ments in the heart are presented with special considera¬       Prospective Study on Rubella, Measles, Mumps, Chicken-
tion of cardiac rhythm disturbances on account of litera¬       pox, and Hepatitis—M. Siegel, H. T. Fuerst, and N. S.
ture and of own observations. The surgical removal of en¬       Peress (450 Clarkson Ave, Brooklyn, NY)
tangled catheters is inevitable if the disentanglement of
slings and knots is unsuccessful.
                                                                      New  Eng J Med 274:768-771 (April 7) 1966
                                                                 Comparative prospective data on fetal and neonatal
Experiences     With /3-Acetyldigoxin- A. Faerber and         deaths following maternal mumps, rubella, hepatitis, chick¬
  W. Riedel    (Medizinische Privatklinik, Herrsching, Ger¬   enpox, and measles revealed an increase in early fetal
  many)                                                       deaths for rubella and mumps, and an increase in peri¬
                                                              natal deaths following rubella and hepatitis. In mumps
     München Med Wschr 108:721-727 (April 1) 1966             and rubella, the results were related to infection early in
  /3-Acetyldigoxin is gained through esterification of the    gestation, and in hepatitis to illness late in pregnancy. The
pure glucoside digoxin. Corresponding to its high solu-       effects were attributable to severity of maternal disease

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in hepatitis and to early infection of the fetus in rubella.    taken daily and first morning urine specimens were assayed
In mumps, other factors related to gonadal infection and        for luteinizing hormone (LH) by immunochemical method.
to placental and hormonal changes early in pregnancy            In 22 of these cycles daily vaginal smears were taken and
may be implicated. The results in chickenpox and measles        studied for maximum estrogen effect. The highest titer of
were inconclusive for these groups as a whole. Maternal         LH occurred on or slightly before the day of temperature
and fetal death occurred in single cases of chickenpox,         shift and at the height of the maturation index. Eight
pneumonia and hepatitis.                                        women taking norethynodrel with mestranol were studied
                                                                in the course of 17 menstrual cycles and showed a sup¬
Pyridoxine-Responsive Hypolipidemia and Hypocholester-          pression of LH production. The immunochemical deter¬
   olemia in a Patient With Pyridoxine-Responsive Anemia        mination of LH in the urine, therefore, appears to be
   —N. Spitzer, T. F. Newcomb (University of Florida Col¬       a reliable method for the detection of ovulation.
   lege of Medicine, Gainesville), and W. D. Noyes
         New Eng J Med 274:772-774 (April 7) 1966                  Schweizerische Medizinische Wochenschrift,
   A case of pyridoxine-responsive anemia with pyridoxine-                               Basel
responsive hypolipidemia and pyridoxine-responsive hypo-
cholesterolemia is presented. Abnormalities of the serum         Effects of Low Sodium Chloride Intake in Idiopathic Hy¬
lipids are common but often unrecognized in patients with          percalciuria Syndrome of Children With Dvvarfism and
pyridoxine-responsive anemias. A mechanism to explain              Changes of Renal Function—P. Roy er (Inserm Hôpital
their   occurrence   is postulated.                                des Enfants Malades, Paris) and S. Balsan
                                                                      Schweiz Med Wschr 96:412-415 (April 2) 1966
  Obstetrics and       Gynecology,    New York                     The effect of a low sodium chloride intake has been
                                                                studied in three cases of the idiopathic hypercalciuria
                                                                syndrome of children with dwarfism and alterations of
Therapeutic Utility of Norethindrone-Mestranol in Abnor¬        renal function. High levels of calciuria during control
   mal Bleeding-P. G. McDonough and R. B. Greenblatt            periods decreased to normal or near normal values when
   (Medical College of Georgia, Augusta)                        sodium chloride intake was restricted to 10 mEq/day or
           Obstet Gynec 27:480-483 (April) 1966                 less. Selective restriction of chloride produced a slight
                                                                and inconsistent reduction; after selective restriction of
   Norethindrone, 10 mg combined with 0.06 mg mestranol         sodium, however, the reduction was marked. A maximum
was used as therapeutic agent to control diverse types of       effect was obtained by restricting both sodium and chloride.
atypical vaginal bleeding in 68 patients. This combination      Improvement in the calcium balance after restriction of
was utilized in acute and chronic dysfunctional uterine
                                                                the NaCl intake is due to decreased calciuria. Net intes¬
bleeding, postabortal bleeding, and cyclic hypermenorrhea.      tinal calcium absorption increased in one case and de¬
Arrest of acute bleeding was achieved within 72 hours           creased in the other. These findings are in agreement
using  10 mg to 120 mg of norethindrone. A maintenance          with those made in normal men and dogs.
dose of 10 mg to 30 mg was then continued for five to
thirty days or longer, depending on the degree of blood         Residual Activity of Defective Enzymes in Hereditary
loss and level of hemoglobin. Successful therapeutic results     Mono- and Disaccharide Malabsorption—F. Linneweh
were achieved in all groups of patients, except for five          et al (Universitätskinderklinik, Marburg/Lahn, Ger¬
patients with cyclic hypermenorrhea who failed to re¬             many)
spond satisfactorily. The value of this drug in controlling
atypical uterine bleeding is stressed.                                Schweiz Med Wschr 96:424-426 (April 2) 1966
                                                                   In hereditary mono- and disaccharide malabsorption
Prevention of Erythroblastosis by Obstetric Technique—          the residual activity of the defective enzymes was meas¬
  J. E. Doolittle and C. R. Moritz (9 S St. Joseph Ave,         ured by determining the absorption rate of 14C-labeled
  Niles, Mich)                                                  sugars. In a patient with monosaccharide malabsorption,
                                                                the glucose and galactose tolerance tests revealed absorp¬
                Gynec 27:529-531 (April) 1966
                                                                tion of 7.6% and 4.6%, respectively. In two siblings aged
  A delivery-room technique to prevent erythroblastosis         1 year and 6 years 9 months, respectively, with sucrose
developed from previous studies that revealed fetomater-        and isomaltose malabsorption, the absorption rates were
nal transfusions at time of delivery is described. The third    7.1% sucrose in the younger and 10.7% in the older child.
stage, three-step technique consists of avoidance of oxyto-     These absorption rates indicate the amount of sugar which
cin until the placenta is expelled; exsanguination of the       is tolerated in the diets of these patients.
placenta immediately after delivery of the infant, and
avoidance of any cord traction while delivering the placen¬     Toxic Epidermal Necrolysis—A. Holzel (Booth Hall Chil¬
ta. A total of 153 Rh-negative patients were studied, using       dren's Hosp, Manchester, England) and S. I. Jacobs
the new technique, with significantly lower incidence of
                                                                       Schweiz Med Wschr 96:427-430 (April 2) 1966
sensitization resulting (1.3% vs expected 9%). The infants'
Apgar scores and clinical course compared favorably with           A clinical picture closely resembling that seen in Ritter's
a control group.                                                disease of the newborn and the recently recorded condition
                                                                of toxic epidermal necrolysis was observed in six children
Immunochemical Detection of Ovulation: II. Further Ob¬          whose ages ranged from 10 months to 5Vi years. In five of
  servations—E. W. Bermes, Jr., and J. H. Isaacs (St.           the six cases Staphylococcus aureus was isolated and in
  Francis Hosp, 355 Ridge Ave, Evanston, 111)                   the four instances where the strain was phage-typed it
                                                                was found to belong to phage type 71. The association of
            Obstet   Gynec 27:575-579 (April)   1966            this particular phage type with the blister-forming class
  Forty-three women were studied in the course of 105           of staphylococcal skin disease is discussed, and it is sug¬
normal menstrual cycles. Oral basal temperatures were           gested that cases of toxic epidermal necrolysis in older

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