bluuebunny/crossref_metadata_2025_split huggingface dataset:
STUDIES ON CONGENITAL HEMOLYTIC SYNDROMES
Authors: Erlandson Marion E. , Schulman Irving , Smith Carl H. 
Published: December 2021

Four adult patients were studied in whom classic congenital spherocytic anemia was evident clinically and by laboratory examination. Anemia, as determined by total volume of erythrocytes, was marked although concentrations of hemoglobin were only slightly low. Rates of destruction and production of erythrocytes were markedly accelerated.
Six pediatric patients with minimal clinical manifestations but definite laboratory evidence of congenital spherocytosis were evaluated. Anemia, in terms of total volume of erythrocytes, was present in all patients despite normal concentrations of hemoglobin in some patients. A potential for future severe clinical manifestations was shown to be present in five of six children by the demonstration of marked hemolytic defects equivalent to the hemolytic defects present in adult patients with classic congenital spherocytic anemia.
In the present series of patients with congenital spherocytosis in whom concentrations of hemoglobin were normal or slightly low, values for the total volume of erythrocytes and the compensation index were similar to values in patients with intermediate (homozygous) thalassemia and in many patients with sickle cell anemia.
Abnormally low values for total volume of erythrocytes and compensation index were present in four patients in whom the rate of destruction of erythrocytes was less than six times normal. Rates of production of erythrocytes were less than six times normal in the majority of patients studied. This is contrary to a previous concept of the capacity for erythropoietic compensation in such patients. These values imply that some factor(s) which has not as yet been identified regulates the rate of erythropoiesis in these patients.
Studies of four family groups of patients with congenital spherocytosis demonstrated the absence of any specific familial pattern of manifestations of the disease.
It has been suggested that management of children with minimal symptoms resulting from the presence of this disease consists of careful observation, splenectomy being deferred until late in childhood to avoid a maximal risk of infection after splenectomy. It has also been suggested that splenectomy be performed before the age of 10 years in order to avoid the complication of gallstones, and that splenectomy be performed at an even earlier age if persistent severe symptoms are present.
The existence of a truly mild hemolytic defect was demonstrated in only 1 of the 10 patients studied. It would seem that splenectomy is not indicated in this unusual patient.
CHILD REARING
Authors: MAY CHARLES D. 
Published: December 2021

MUCH of the practical concern of pediatricians with mental hygiene involves concepts of child rearing. The way parents seek to influence the development of their children is determined by many factors, not the least of which are the prevalent attitudes of the "experts." Parents expect the pediatrician to be among the "experts" or at least be familiar with current authoritative opinions on the "best" ways to rear children.
This means that we should occasionally take stock of the present notions about rearing children and try to discern the direction the currents of opinion may be carrying us. It requires rare ability to gain the perspective needed to set forth the essential issues in so complex a problem and to see the paths being taken to reach the goals. This has been done with great skill in an article by Dorothy Barclay, reprinted in this issue of Pediatrics (Education).
EDUCATION
Authors: Barclay Dorothy 
Published: December 2021

AS WE OBSERVED the family scene over the year just past, it seemed to us that public talk about the family, about what it is and what it should be, was taking a definite turn for the wiser. By this we mean that discussions of this sort seemed to become more logical and realistic—more "common-sense," if you will. In 1958 we saw a general easing up on parents, a tapering off of the blame-them-beat-them type of criticism that had flourished in recent years.
The experts—and we include under this heading speechmakers from a wide range of fields who make pronouncements on "the right way" to live—continue to recognize parents as the single greatest influence on children's lives. But they recognize that there are other influences at work, too. Some are totally beyond parental control. They include hereditary or constitutional factors affecting the individual child, neighborhood conditions, the quality of community schools and services and, indeed, the whole state of the world.
PEDIATRIC OPHTHALMOLOGY
Authors: Miller James E. 
Published: December 2021

THE ROUND TABLE covered two principal topics: first, external diseases of the eye, especially in relation to infection and to lid and conjunctival lesions; and, second, growth and development of the eye with stress upon eye movements, refractive errors, and strabismus.
External diseases of the eye are often primary, but pathology in this area frequently is found to reflect systemic illness.
LID
Various glands of the lid were defined and the pathology of each reviewed. In the fibrous tarsal portion of the lid lies the Meibomian gland, the sebaceous secretion of which prevents the spillage of tears and protects the lid margin. The acute inflammation is usually staphylococcal, and tends to persist to produce a granuloma surrounded by fibrous tissue. A chronic chalazion consists of round, epithelial and giant cells without acid-fast organisms. Heat may be useful initially in the acute stage; however resolution is slow and usually terminates in a hard, persistent nodule. The removal of the chronic chalazion is by curettage.
The glands of Zeiss are the sebaceous glands for the lash follicles. By contrast, infection of these results in a self-limited disease, hordeolum or stye, which drains itself spontaneously or may require local incision. Rarely are there complications following a hordeolum. Some individuals are more susceptible to repeated infections, and prevention remains an unsolved problem.
The sweat glands of the lid, or glands of Moll, may form simple cysts on the lid margins which rupture easily.
The lacrimal glands in the upper part of the lid are seldom involved in an inflammatory process, except occasionally in mumps or sarcoid.
Letters to the Editor
Authors: BROOKE WILLIAMS R. D. 
Published: December 2021

I am writing regarding the editorial in the February issue of Pediatrics concerning discontent with the practice of pediatrics, and would suggest several factors that may be contributory.
Many pediatricians, whether of the old original school or of a more recent vintage, have taken up the practice of pediatrics because of the inspiration and satisfaction they have obtained from working with the fine group of men who run the pediatric departments in the medical schools, and often because they enjoy a close relationship with parents and children.
Letters to the Editor
Authors: TOMPKINS CHARLES A. 
Published: December 2021

Your excellent editorial in the February issue of Pediatrics should be provocative of additional constructive thinking on the problems of the practice of pediatrics.
I believe the new pediatrics can be practiced, but not in old frameworks. This is new wine and cannot be contained in old wine skins.
Comprehensive care means a new focus. The focus shifts from "shot and formula" and "diseases," to the whole child in whole families. The approach is longterm. Philosophically the concern is with the child and his family's total fulfillment, emotional and physical. The concern is not merely with illnesses as such, but with the child with an illness, whether it be emotional or physical and how it effects the fulfillment of his potential destiny in the family and social milieu.
Test to Aid in Diagnosis of Phenothiazine Intoxication
Authors: NELLHAUS GERHARD 
Published: December 2021

In connection with the recent article by Shaw and coworkers (Pediatrics, 23:485, March, 1959) on the possibility of neurologic complications following the use of phenothiazine tranquilizers, attention is called to a simple laboratory test, first pointed out by Fellman (J. Nerv. & Ment. Dis., 123:575, 1956) and later popularized by the Forrests (Am. J. Psych., 113:931, 1957) which—especially in the absence of a good history—may help to establish the diagnosis.
A few drops of the urine of a patient who has taken one of the phenothiazides will give a red to purple color when mixed with ferric chloride solution (usually stocked as a 10% solution). A similar color reaction is obtained with Phenistix®, a paper strip impregnated with ferric chloride ions, marketed by the Ames Company, Inc. for the testing of urines to detect phenylketonuria.
ERYTHROPOIETINE
Authors: STOHLMAN FREDERICK 
Published: December 2021

ERYTHROPOIETINE is a protein, capable of stimulating erythrocyte production, which is found in the plasma of animals subjected to hypoxia or following the administration of cobalt. Sufficient data have been accumulated in the more common hematologic disorders to draw some tentative conclusions about its etiologic and therapeutic significance in clinical medicine.
The highest concentrations of erythropoietine have been observed in diseases associated with erythroid aplasia. Substantial levels have been observed in congenital hypoplastic anemia, aplastic anemia, marrow aplasia due to chloramphenicol, and acute lymphocytic leukemia.
In diseases associated with hemolysis and erythroid hyperplasia, such as Cooley's erythroblastic anemia and sickle cell disease, concentrations of erythropoietine in the plasma are not as high as in patients with similar hemoglobin levels due to aplasia.
INTRACARDIAC PHONOCARDIOGRAPHY IN THE DIAGNOSIS OF CONGENITAL HEART DISEASE
Authors: Lewis David H. , Ertugrul Ali , Deitz George W. , Wallace John D. , Brown James R. , Moghadam Abdol-Nabi 
Published: December 2021

Intracardiac phonocardiography, the recording of sounds from within the heart, has been carried out with 63 patients with congenital heart disease. Studies have also been done with 11 patients in the pediatric age range who did not have heart disease. This new technique of recording heart sounds has been shown to provide a degree of localization of heart sounds and murmurs not heretofore obtainable. It is by virtue of this property that intracardiac phonocardiography has an important place in the diagnosis of congenital heart disease. Records from several lesions are shown to illustrate this point.
It is believed that intracardiac phonocardiography should be made a part of the routine studies done at the time of cardiac catheterization.
The prospects for intracardiac phonocardiography are discussed.
ESTIMATION OF SEVERITY OF THE NEPHROTIC SYNDROME IN CHILDHOOD AS A GUIDE TO THERAPY AND PROGNOSIS
Authors: McCrory W. W. , Rapoport M. , Fleisher D. S. 
Published: December 2021

The degree of clinical and biochemical improvement observed in 20 children with the nephrotic syndrome who received a similar course of adrenocortical steroid therapy has been correlated with the severity of the existing renal glomerular damage.
It appears that the clinical response of children with nephrosis to hormone therapy and their behavior shortly thereafter can provide the physician with information of prognostic value at an earlier period in the course of the disease than has been possible heretofore. This was especially true in the case of patients destined to have a favorable outcome.
The immediate and long-term therapeutic benefits obtained in a small group of patients with nephrosis, who received sufficient adrenocortical hormone therapy to induce and maintain maximal improvement in all measurable abnormalities, are superior to the results obtained by therapy aimed only at control of edema.
EXUDATIVE ENTEROPATHY
Authors: ULSTROM ROBERT A. 
Published: December 2021

Loss of plasma protein into the gastrointestinal tract in the absence of actual bleeding has recently been demonstrated as a cause of "idiopathic hypoproteinemia." The euphonious name, "exudative enteropathy," has been used by Gordon to describe a group of nine patients, including a 2-year-old boy, whose common finding was hypoproteinemia due to loss of plasma protein into the gastrointestinal tract. A concomitant report by Schwartz and Jarnum confirms the association of these events in four additional patients. Although the first such patient reported had quantities of plasma protein present in the gastric juice sufficient to allow their demonstration by electrophoresis, the rapid digestion of the proteins by the enzymes normally present in the gastrointestinal tract has required the use of less direct methods in most of the subsequent cases.
Using a preparation of I131-labelled polyvinyl pyrrolidone (a plasma substitute with average molecular weight the same as serum albumin) Gordon has devised a test that avoids the problems created by the gastrointestinal digestion of protein.
DIENCEPHALIC SYNDROME OF EARLY INFANCY ASSOCIATED WITH BRAIN TUMOR
Authors: Braun Frederick C. , Forney William R. 
Published: December 2021

A case of a diencephalic syndrome in early infancy is presented along with a review of nine previously reported cases.
This patient, as well as previously reported cases, had a glioma of the third ventricle. Massive hemorrhage secondary to a duodenal ulcer was a heretofore unreported complication.
The syndrome is characterized primarily by alertness and euphoria in the presence of marked emaciation.
A GUIDE FOR INTRODUCING CATHETERS WHEN CANNULATING SMALL VESSELS
Authors: Hohn Arno R. , Vlad Peter 
Published: December 2021

THE INTRODUCTION of a catheter into a vein or artery in the pediatric age group is often difficult because of the small size of the vessels. A guide is herein described which greatly facilitates the insertion of a catheter. This instrument both dilates the vessel and guides the placement.
The guide is a curved probe tapering to a point, with a groove on its underside and a phlange on one end to facilitate its manipulation (Fig. 1, A). It is fashioned from 23 gauge. #316 stainless steel. Several sizes are made for the various sized catheters. The inside diameters of the guide vary from ⅛ to 3/64 of an inch and the length is 1½ inches. The phlange measures 1 by ¾ inches.
The technique of catheter introduction is as follows: a small longitudinal incision is made in a previously isolated vessel, the pointed end of the guide is then inserted and threaded up the vessel for a distance of two to eight millimeters. With one hand holding the guide in place, the catheter is slipped along the groove in the underside of the guide and into the vessel (Fig. 1, B). Once the catheter is in place, the guide is withdrawn.
Advantages of the guide are its structural simplicity and the speed with which [SEE FIG I IN SOURCE PDF] catheters can be inserted or replaced. No forceps or hemostats are needed. Catheters can now be readily inserted into small vessels. There is little trauma to the vessel aside from the initial incision. The latter becomes important when vessels are repaired following catheterization. Such is the case for all retrograde arterial catheterizations.
In addition to its use during cardiac catheterization, the guide should make easy the insertion of plastic tubing for exchange transfusion and in exposure of veins for intravenous therapy, especially in infants.
Prevention of Poisoning
Authors: DRESCHER ALEXANDER N. 
Published: December 2021

The education of parents to the danger of accidental poisoning is an important aspect of office and clinic pediatrics. Since this preventive instruction can be time-consuming and incomplete in the usual medical interview, attention is called to the simple device of a display cabinet in the waiting room. In the display used in our clinic, the upper shelf shows common items actually ingested by our patients; the middle shelf contains those responsible for fatalities; the lower shelf demonstrates some of the discomforting elements of treatment.
The effectiveness of this exhibit has been attested to by a decreased incidence of poisonings and continued parental interest in the information presented.
Letters to the Editor
Authors: COHEN MELVIN I. 
Published: December 2021

I fully appreciate and understand the nature of Dr. Bates' request. The many patients seeking treatment at our clinics make me uncomfortably aware of the problem. I wish I were able to give a more satisfactory answer.
Many of the orthodontic problems, especially the severe ones, are best explained on a genetic basis. Therefore, prevention, except for a rather indelicate perusal of the family albums prior to the nuptial vows, is often not possible. In specific instances where the environment is unfavorable, such as crossbite and late thumbsuckers, the orthodontists and pedodontists can and are eliminating more extensive treatment by instituting preventive measures. However, these constituite a minority of the cases.
Myleran and Malformations
Authors: Sherman Jacques L. 
Published: December 2021

Diamond and co-workers (Pediatrics, 25:85, 1960) make the statement that "strong circumstantial evidence implicates Myleran transmitted through the placenta as the direct cause of the stunting, congenital anomalies and cytomegaly found in the infant described here." I believe that several comments are in order.
Can Myleran be implicated? One of the bits of evidence cited by the authors is: "There is no known published experience in humans to exonerate this drug as there is with 6-mercaptopurine."
BIOFEEDBACK TRAINING: A REVIEW OF EVIDENCE
Authors: Blanchard E. B. , Young L. D. 
Published: December 2021

The wonders of biofeedback training for treatment of many psychosomatic disorders such as hypertension, migraine headaches, cardiac arrhythmias, and epilepsy have appeared in Playboy, National Observer, and Medical World News, as well as in professionally edited journals. Alpha wave control by EEG feedback has become a popular executive creativity induction method. In a careful review of the published papers with good controls clinical effectiveness has been established only for EMG feedback training to eliminate subvocal speech during reading, in muscle retraining of paralytics, and in treatment of tension headaches. The therapeutic value of EEC biofeedback on alpha rhythms has not been demonstrated. Substantial reduction of blood pressure and cardiac arrhythmias has been achieved but convincing control data are not available. Modification of gastric acidity or migraine has not been demonstrated.
It would seem premature to hail biofeedback training as a panacea for psychosomatic and other disorders, but the evidence is interesting and highly provocative.
Why Such High Serum Levels of Vitamin A?
Authors: Garry Philip J. 
Published: December 2021

The article by Glueck et at.1 dealing with the effect of cholestyramine and of diet therapy on the level of plasma vitamin A in familial type II hyperlipoproteinemia patients is somewhat disturbing because of the reported high levels of vitamin A found in the plasma of both normal and type II children.
In Table I of the article the vitamin A levels are reported in µmol/liter. Converting these values to the more familiar notation, µg/dl, one obtains the results shown in Table I.
Total Parenteral Nutrition in Pediatrics: The Borden Award Address
Authors: Winters Robert W. 
Published: December 2021

Research in parenteral nutrition in infants has proceeded rapidly over the past few years, thanks in large part to the perfection of safe central venous delivery of hypertonic nutritive infusates.
At present, there are clear definitions of indications and expectations of results for this method of therapy in two well-defined groups of patients-i.e., selected surgical neonates and infants with chronic intractable diarrhea. In addition, we have suggestive evidence of another potentially valuable application in the nutritional management of very low birthweight infants. However, in this group, a controlled study will be necessary before the role of total parenteral nutrition (TPN) in neonatal care of such infants can be determined precisely. Results obtained with TPN in adults with inflammatory bowel disease or acute renal failure suggest that trials of this technique in pediatric patients with these disorders should be carried out.
As a result of the research in TPN carried out thus far, we have learned how to minimize or to treat many of the complications of the technique and we have identified at least the ways by which still others can be prevented. The future holds many new advances not only in the refinement of existing parenteral nutritional solutions but also, and perhaps of even greater importance, in the perfection of individualized total nutritional therapy for specific patients using the enteral route for those discrete components of intake for which digestive and/or absorptive mechanisms are unimpaired and using the parenteral route for the remainder.
The Sodium Pertechnetate Tc 99m Scan: An Aid in the Evaluation of Gastrointestinal Bleeding
Authors: Ho Judith E. , Konieczny Kurt M. 
Published: December 2021

Twenty pediatric patients presenting primarily with unexplained gastrointestinal bleeding were evaluated with sodium pertechnetate Tc 99m imaging. Three patients had normal barium enemas and scans consistent with Meckel's diverticulum. These three patients and three additional patients with normal scans underwent surgical exploration. Meckel's diverticula containing gastric mucosa were found in all three patients with positive scans. No diverticula were found in the three patients with normal scans.
Four other patients had scans that were considered abnormal but not felt to represent Meckel's diverticula. In one of these patients a radiographic gastrointestinal study performed after the scan demonstrated a large duodenal ulcer. In another patient, a nonspecific terminal ilial ulcer without gastric mucosa was found at surgery. The two other patients had normal radiographic gastrointestinal studies and no further evaluation was carried out.
The etiology of gastrointestinal bleeding in pediatric patients is frequently unexplained even after thorough evaluation including celiotomy. The sodium pertechnetate Tc 99m scan is a safe, simple, non-invasive procedure that can demonstrate Meckel's diverticula with greater certainty than the barium enema and can suggest suspicious areas that can then be evaluated by more definitive procedures.