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Spontaneously echolalic autistic children who had never used the pronoun Iwere exposed to short sentences containing several personal pronouns in all positions in a 3-word utterance. It was found that there was no tendency for children to avoid the repetition of I,once sentence position was controlled. A number of children echoed the final word of the sentence while others repeated the whole utterance. The findings provide no support for a psychogenic theory of speech behavior in autistic children.

Fourteen hundred and forty-seven 12–16-yr-old subjects in selected fluoridated and non-fluoridated areas were assessed for caries experience (DMFS index) and enamel fluoride (biopsy technique). Fluoride was measured as log e mass F corrected to a standardized depth. A square root transformation of decayed, missing and filled surfaces (DMFS) was carried out in order to achieve homogeneity of variance for this variable across all levels of fluoride. A simple, linear relationship was found between log e mass F and √(DMFS). Taking age into account, the Pearsonian correlation was R = 0.40, corresponding to 16 per cent of the variance explained. Within communities the fluoride-caries relationship was consistent with the overall model but could not be demonstrated as securely because of the smaller sample sizes and the limited range of fluoride values at this level of disaggregation.

The paper presents statistical data on the therapeutic effects and radiation sequelae following Chaoul contact therapy of 818 cutaneous hemangiomas treated between 1938 and 1952. 73.3% of all irradiated hemangiomas showed initial improvement but complete involution with an excellent cosmetic result was observed in only 50% of lesions 5 years after treatment. During the same period of time, more than one-third of all patients developed mild to moderate cutaneous radiation sequelae (hyper- or hypopigmentation and telangiectases, rarely atrophy). The high incidence of late radiation effects is probably relation to the high total doses administered in this series of patients, the very short intervals between treatments and the age of the patients. Other radiation radiation hazards are also discussed. Since large studies have proven conclusively that spontaneous involution occurs in 95% of hemangiomas after several years, indications for radiotherapy of hemangiomas are extremely limited.

A combination of affinity chromatography with the macrophage electrophoretic migration (MEM) test has been used to study the antigenic similarities between encephalitogenic factor (EF) and measles virus. These have determinant(s) sufficiently closely related to account for the elevated level of circulating antibody to measles in multiple sclerosis.

A massive dose vitamin A prophylaxis program is currently in operation in several States of India. Evaluation of this program on a large scale has so far been difficult due to lack of baseline data on the prevalence of vitamin A deficiency in children. In this study, a simple evaluation method which makes use of the linear relationship that exists between age on one hand and prevalence of ocular signs of vitamin A deficiency (Bitot's spots) on the other is described. Regression coefficients between age and prevalence of vitamin A deficiency of areas not covered by the program (control areas) were found to be significantly different both from zero and from regression coefficients of regularly covered areas (experimental areas). Also, all regression lines of control areas were found to be above the regression zone of experimental areas. These differences between the experimental and control areas which were significant, indicate the impact of the program in areas where the program is in operation. The regression coefficient calculated for one area where the program was discontinued after some time was found to be significantly different from zero, also it was different from the regression zone of the experimental areas. However, the regression coefficient of the discontinued area was found to be significantly different from the experimental areas only at 10% level, indicating a lesser degree of efficiency of the program in this area as compared to regularly fed areas. It is, therefore, suggested that evaluation of the massive dose prophylaxis program be done against the null hypothesis beta = 0.0065--the regression coefficient achievable under field conditions.

Varying reactions of the vegetative nerve system to various point combinations (for example: vomiting, dizziness, diarrhea, urge to urinate, fatigue or drowsiness, headache), especially to the needling of Tai Chong (Li 3), induced us to perform biochemical studies before and after acupuncture treatment. A group of children and a group of adults were studied. The material studied was urine and blood; from the children, urine only. The following were determined in the urine: indolacetic acid, 5-hydroxy-indol-3-acetic acid, homovanillic acid, and vanillic-mandelic acid; in the blood, tyrosine and tryptophan (free and bound). Individual points with wide influence (He Gu = LI 4; Zu San Li = St 36; Tai Chong = Li 3) and their combination with generally effective points were tested. The needling of Tai Chong especially showed a clear increase in indolamine metabolism. Isolated increases in metabolites of catecholamine metabolism could be correlated with the patient's increased physical activity after acupuncture. Noteworthy is the observation that no significant chemical reactions were evident if local reactions to the needling no longer appeared at the end of a series of acupuncture treatments.

Atrial (A) and A-V nodal (AVN) effective and functional refractory periods (ERP & FRP) were determined by atrial extrastimulus technique in 40 children, aged 7 months to 16 years, with normal P-R intervals and QRS durations. These data were compared to adult data at longest cycle lengths (CL) assuring atrial capture. All values are listed in msec as means plus or minus standard errors of the means. CL was 566 plus or minus 15 in children and 699 plus or minus 29 in adults (P less than .001). Refractory periods (RP) in children and adults were, respectively: AERP 196 plus or minus 9 and 239 plus or minus 13 (P less than .01), AFRP 225 plus or minus 8 and 284 plus or minus 11 (P less than .001), AVNERP 239 plus or minus 11 and 293 plus or minus 7 (P smaller than .001), AVNFRP 360 plus or minus 13 and 403 plus or minus 7 (P smaller than .005). RP were then compared at three equivalent CL ranges: CL1, 850-600; CL2 599-460; CL3 459-280. The following RP were significantly shorter in children (P smaller than .05-.001): AERP, AFRP, AVENERP and AVNFRP at CL2 and CL3. RP of the bundle branches were compared and tended to be shorter in children. In conclusion, atrial and A-V nodal ERP and FRP are shorter in children than adults. This shortening is only partially related to the shorter CL in children. These data are germane to understanding the maturation of the conduction system in man.

The rationale for splenectomy in childhood is briefly described, the technique employed is discussed, some complications are elucidated, and the expected mortality is considered.

The authors describe the development of a community-oriented therapeutic nursery that serves the mental health needs of a day-care population of over 600 children. It makes use of a flexible treatment program, in conjunction with a consultation program, involving the children, parents, and day-care staff The authors discuss the advantages of a clinical treatment program that is embedded in the network of a day-care system.

Twelve children with lumbar-level myelodysplasia (average age, eight and three-quarter years) underwent twenty-one pelvic displacement osteotomies for subluxated or dislocated hips. Nineteen of the twenty-one hips remained reduced on three-year follow-up. Gains in gait pattern, ease of bracing, and reduced pelvic obliquity were noted. Active function about the hips was not improved, nor was there a decrease in the amount of bracing needed following the osteotomy. Pelvic displacement osteotomy can be utilized in selected cases as part of the over-all management of chronic hip dislocation in myelodysplasia.

The fatty acid distribution of the main lipid fractions: triglycerides (TG), phosphatidylcholine (PCh), phosphatidylethanolamine (PE), and sphingomyelin (Sph) of muscle from 6 patients with progressive muscular dystrophy (p.m.d.), Duchenne, 8 to 12 years old was estimated and compared with normal controls of different age. In view of the results of several authors about varied fatty acid distribution in immature muscle a third group comprising samples of neonatal muscle was studied. 1. The fatty acid pattern of the lipid fractions TG, Sph, and PE from muscle of patients with p.m.d. shows no important variation in comparison to normal controls. In contrast to this the fatty acid distribution in PCh is extremely varied: the percentage of 18:2 is decreased and corrrespondingly the content of 18:1 is increased. In view of the high percentage (nearly 10%) in which linoleic acid is substituted by oleic acid in PCh, effects on the plasma membrane are to be expected. 2. The fatty acid pattern in neonatal muscle shows in narly all positions of the fractions TG, Sph, PE, and PCh a different distribution from normal or dystrophic muscle. In view of the most important variation in dystrophic muscle it must be stated that generally 18:2 is decreased. This deficit was replaced by an increase of all other fatty acids (not only at a substitution by 18:1 as given in p.m.d.). Therefore the diminished content of linoleic acid in PCh of neonatal and dystrophic muscle cannot be interpreted as expression of a corresponding or similar lipid metabolism in both tissues. The results were seen as signs of significant qualitative alterations especially of PCh in p.m.d. They were discussed as proof of our thesis that the basic defect in p.m.d. concerns the specific acylation of PCh with linoleic acid.

Three male siblings with familial goitrous hypothyroidism due to a defect of thyroidal iodide organification have been studied. Withdrawal of thyroxine therapy from 2 of the brothers led to a rapid return of clinical hypothyroidism in one but the other brother remained euthyroid for approximately 3 years off his thyroxine therapy despite continuing evidence of defective iodide organification in his thyroid. The phenomenon is contrasted with that produced by massive administration of thyroid hormones ("Stoss therapy"), but no satisfactory explanation for its occurrence can be given.

Twelve patients hospitalized with a confirmed diagnosis of Lassa fever were studied during an epidemic of this disease in Sierra Leone. Clinical observations confirmed and extended those made in previous outbreaks in Liberia and Nigeria. Two patients were treated with plasma containing antibodies to Lassa virus; both had a favorable response. Lassa virus was isolated from serum, throat swabs, or urine from all patients sampled during the first 15 days of illness. Virus was recovered from the pharynx of patients with circulating complement-fixing (CF) antibodies. CF antibodies were detectable by the 3rd week of illness. A strain of Lassa virus from one of the patients was compared with strains recovered in Liberia and Nigeria by CF test. Serum from convalescent patients infected with Nigerian virus did not fix complement in the presence of strains from Liberia or Sierra Leone; this result may indicate antigenic differences between Lassa virus strains which must be confirmed by neutralization test.

From the Departments of Pediatrics, Pharmacology and Therapeutics, Physiology, and Environmental Health, University of CincinnatL College of Medicine, and from the Children's Hospital Research Foundation. Supported in part by United States Public Health Service grant HD06337 and by the Children "s Hospital Research Foundation. *Part I appeared in the April, 1975, issue o f THE JOURNAL; Part l l I will appear in the June, 1975, issue of THE JOURNAL. **Reprint requests: Division of Clinical Pharmacology, Children "s Hospital Research Foundation, Elland A re., Cincinnati, Ohio 45229. tion will also be given to those diuretics which are considered useful as adjunctive therapy (e.g., spironolactone) and to some agents which have been of historical importance in the development of our current concepts of diuretics and diuretic therapy. At the outset, it should be said that diuretic therapy is almost always adjunctive and that every attempt should always be made to influence the course of the primary, underlying disease which is producing the edematous state

Toxicity and failure of treatment with amphotericin B are stimuli for researchers to evaluate alternative antifungal antimicrobics. Also, data from susceptibility tests of Coccidioides immitis are sparse. With use of a defined, synthetic culture medium, C. immitis (25 strains). Candida albicans (21 strains), and Cryptococcus neoformans (21 strains) were tested against flucytosine, clotrimazole, and amphotericin B. Molecule for molecule, the sequency of activity was: clotrimazole greater than amphotericin B greater than flucytosine (totally inactive) C. immitis; and clotrimazole greater than amphotericin B greater than flucytosine with C. albicans and C. neoformans. With four strains of C. immitis, the minimal inhibitory concentration (of amphotericin B) was the same when inocula of arthrospores were tested as when corresponding spherules/endospores were tested simultaneously and identically. The clinical outcome of coccidioidomycosis in 17 patients treated with amphotericin B correlated best with minimal inhibitory concentration after incubation of cultures for 48 hr; a favorable response was associated with minimal inhibitory concentrations of less than or equal 1.0 mug/ml. Because clinical isolates of fungi appear to vary in susceptibility, in vitro tests may have clinical utility.

The caries prophylactic effect of dentifrices with a low fluoride (F) content has been tested in a 2-year double-blind experiment on 1,150 schoolchildren aged 11–14 years who have had fortnightly F mouthrinses as a basic prophylaxis. Clinical registration of new DMFS and new smooth surface caries showed only insignificant differences for the groups treated with regular, weak or F-free dentifrices. Radiographic investigation showed a tendency towards fewer decayed surfaces in the groups treated with a monofluorophosphate (MFP) dentifrice with regular F content and CaCO3 as polishing agent, but no significant effect with the corresponding dentifrice with lower F content. In groups treated with a dentifrice with silicon dioxide as the polishing agent both the regular content of MFP and a weak concentration of NaF resulted in fewer radiographically diagnosed carious lesions in the groups of girls, who had a higher caries rate than the boys. These and other data are combined in the Discussion into a hypothetic model for the mode of action of MFP and NaF dentifrices, with a view to continued development towards optimal clinical results with minimal F absorption.

Recordings and phonetic transcriptions of deaf children's speech were examined for nonstandard interjected elements associated with consonant production. Vowel release of both stop consonants and fricatives is found in word‐final position and between abutting or normally blended sounds, particularly where assimilation ordinarily occurs, such as between stops or between a stop and fricative. A lateral /1/ is also used as a release. Stop positions are arrived at too slowly, introducing a fricative of similar place and voice. A stop released with overeffort produces an affricate. A fricative may be preceded by a stop of similar place and voice. Cessation of nasality without movement from a position produces a plosive following the nasal sound. Extra nasals are inserted before or after a stop in the same place. The substitutions in deaf children's speech often result from undershoot of the articulatory target. Some interjected elements apparently represent overshoot, which may be due to conscious effort at articulatory placement, while others stem from slowness of movement of the articulators.

Since it is still uncertain whether moderate degrees of alpha1-antitrypsin deficiency predispose to the development of lung disease, data obtained from a stratified random sample of white households in Tucson, Arizona, consisting of 2586 subjects over five years of age, were analyzed. No relation was found between serum alpha1-antitrypsin levels, measured as trypsin inhibitory capacity, and ventilatory function, respiratory symptomatology, or frequency of diagnosed pulmonary diseases even among cigarette smokers. The data indicate that an intermediate level of alpha1-antitrypsin deficiency (i.e., inhibitory capacity between 20 and 62 per cent of the population's mean value) is not an important risk factor for the development of chronic obstructive lung diseases. The data militate strongly against the use of any quantitative determination of alpha1-antitrypsin as a test to identify subjects with moderate deficiency for the purpose of predicting later development of chronic respiratory disorders. The rate of severe deficiency is so low as to make population screening for such subjects impractical.

Erythrocyte transketolase activity and the effectof thiaminpyrophosphate stimulation have been determined for 134 infants and children inThailand.Thisstudyincluded 87 apparentlyhealthyinfants and children,36 sickinfantsand childrenadmittedtopediatric wards,8 patientswith malnutrition, and 3 patientswith clinical beriberi. All three patients with clinical beriberi had definitely abnormal values for thiamin pyrophosphate stimulation. In addition,10-17% of the subjectsin each of theothergroupshad biochemicalevidenceof thiamin deficiency, although there was no clinical evidence of beriberi. Measurement of thiamine pyrophosphate stimulation appears to be more specific than measurement of erythrocytetranskitolase activity in confirming the diagnosis of beriberi. Possible reasons for thehighprevalenceofthiamindeficiency in Thai infants and children are discussed. Am. J.