bluuebunny/crossref_metadata_2025_split huggingface dataset:
LEUKEMIA IN TWINS
Authors: Falletta John M. , Starling Kenneth A. , Fernbach Donald J. 
Published: December 2021

A disorder for which identical twins are not completely concordant must be caused, at least in part, by environmental factors. Acute childhood leukemia is such a disorder, with concordance ratios as follows: approximately 1:5 for monozygotic twins, approximately 1:80 for dizygotic twins, and more than 1:500 for ordinary siblings.
Of all malignancies, only acute childhood leukemia carries such an extraordinary risk of twin concordance. It is the only childhood malignancy in which a large number of circulating malignant cells are found. In most instances, twins with concordant leukemia have their onset of illness within weeks or months of each other, suggesting a similar inciting event. Since placental cross-circulation is found commonly in monozygotic twins and occasionally in dizygotic twins, cross-infusion of malignant cells has been postulated to account for the high twin concordance ratios. Leukemia in most twins might then represent only one occurrence of leukemia and not two.
This hypothesis, while consistent with most observations, does not explain the pattern of disease in the twins described in this paper. Our proband became ill at nearly 6 years of age, and her twin's illness occurred more than 6 years later. These twins probably remained at risk of concordant disease because of postnatal factors affecting predisposed siblings. Whether the predisposition was due to genetic or to prenatal environmental factors remains unknown.
Umbilical Catheters and Hepatic Abscesses
Authors: Brans Yves W. , Ceballos Ricardo , Cassady George 
Published: December 2021

In contrast to interstitial hepatitis which often accompanies septicemia, solitary liver abscesses are rare in newborn infants. Thirteen cases appear in the literature. A single recent report implicates an umbilical venous catheter as the responsible agent. The present observations provide clinical as well as postmortem evidence which again strongly incriminates an umbilical venous catheter.
See figure in PDF file
Case Report
A 2,610-gm male Caucasian infant of a gestational diabetic mother, delivered electively at "term" by cesarian section, developed respiratory distress and was referred to the High Risk Nursery of University Hospital on October 26, 1970, a few hours after birth. No instrumentation was performed before transfer.
Effect of a Mailed Appointment Reminder on Appointment Keeping
Authors: Nazarian Lawrence F. , Mechaber Judith , Charney Evan , Coulter Molly P. 
Published: December 2021

Poor appointment keeping is a major problem in many health facilities. At The Anthony L. Jordan Health Center, we studied 670 pediatric appointments to see if a postal card reminder mailed one week before the appointment would make a difference in the keep rate (kept plus canceled appointments, divided by kept plus canceled plus broken appointments). The appointments studied were 12 days to eight weeks from the time of scheduling.
In the control group, the keep rate was 48%. Those receiving mailed reminders had a keep rate of 64%, a significant difference (X2 = 16.92; p &lt; 0.001).
The effects on the keep rate of age, interval to appointment, time of day, referral pattern, reason for appointment, and prior keep rate were minor.
The use of a mailed reminder can improve appointment keeping and facilitate better care and more efficient scheduling and use of personnel.
Characterization of Newborn Fecal Lipid
Authors: Watkins John B. , Bliss C. Michael , Donaldson Robert M. , Lester Roger 
Published: December 2021

Fecal lipid excretion was quantitated and analyzed in two groups of normal infants 3 to 11 days and 23 to 72 days of age. Total lipid excretion was similar in both groups averaging 10.8% of dietary intake. Fecal lipid was partitioned into four fractions: neutral lipids, insoluble divalent calcium soaps, ionized fatty acids and bound lipids. The neutral lipid fraction predominated in both groups, equalling 56 ± 5.3% (mean ± S.E.M.) of fecal lipid. It contained significant quantities of glycerides (13.6 ± 6.0% of the total lipid excreted). Calcium soaps comprised the other major fraction (25 ± 5.3%); analysis of this fraction by gas liquid chromatography showed that it contained primarily long-chain saturated fatty acids.
The demonstration of glycerides in fecal lipid establishes that lipolysis is defective in newborn infants. Identification of long-chain saturated fatty acids in the calcium soap fraction documents the association between calcium and saturated fatty acid excretion. The presence of fecal monoglyceride, while conceivably the result of colonic bacterial hydrolysis of triglyceride, raises the possibility that lipid micellization and/or mucosal transport is insufficient for optimal lipid absorption. Thus, the intraluminal phase and possibly the mucosal phase of lipid absorption are not fully developed in the full-term newborn infant.
A Study of Nutritional Status of Preschool Children in the United States, 1968-1970
Authors: Owen George M. , Kram Kathryn M. , Garry Philip J. , Lowe Jay E. , Lubin A. Harold 
Published: December 2021

INTRODUCTION
Evaluation of nutritional status of population groups has been undertaken in many areas of the world during the past 40 years. Attempts have been made to standardize procedures and methodologies in order to allow comparisons of results from different studies.13
During the 1950s and 1960s, under the auspices of the Interdepartmental Committee on Nutrition for National Defense, a number of surveys were undertaken in developing countries of the world where children comprise the majority of the population. The preschool child was particularly vulnerable to malnutrition and mortality rates were quite high, often exceeding 50% in the first five years of life. Most infants in these countries seemed to thrive during the first 6 to 12 months of life, particularly if they were breast-fed. After this period, their diets declined nutritionally, both in quality and in quantity. Combined effects of malnutrition and of infection largely accounted for the high mortality rates in the postweaning age.
In view of such high mortality rates, it was obvious that a substantial proportion of youngsters who did not die almost surely experienced overt malnutrition or some degree of nutritional deprivation during critical periods in development. Increasing attention has been given to study of these "survivors" from the standpoint of physical and intellectual development and behavioral characteristics.4-9
It was apparent in the mid 1960s that we knew little about the nutritional status of young children in the United States. Studies had been undertaken on various segments of the U.S. population,10 but were often limited in scope (only dietary surveys or anthropometric determinations) and in sample size (adolescents or adults in selected areas or occupations).
Neutrophil and Band Counts in the Diagnosis of Neonatal Infections
Authors: Akenzua Gregory I. , Hui Yin T. , Milner Ruth , Zipursky Alvin 
Published: December 2021

A system has been developed for the evaluation of hematological data in the newborn. Normal values were established for segmented (neutrophil) and nonsegmented (band) polymorphonuclear leukocytes in the peripheral blood of 169 healthy full-term infants during the first five days of life. This normal data is displayed graphically and the values for infants under study are compared directly.
Newborn infants with proven bacterial infections had normal neutrophil counts; however, the band counts increased significantly beyond the normal range. Therefore, the simple laboratory procedure for ennumerating band neutrophils with comparison of absolute values and changes to a normal range represents a hematologic technique of major importance in the diagnosis of sepsis of the newborn infant.
The Role of the Pediatrician in Dental Caries Detection and Prevention
Authors: Ripa Louis W. 
Published: December 2021

Dental caries is a disease that usually begins very early in life and from which few people remain unaffected. However, because caries is associated with local etiologic vectors, it can be controlled. Altering the diet to render it less cariogenic and making tooth surfaces more resistant to acid attack through the use of fluoride are two potent mechanisms of prevention.
Pediatricians are in a unique position to contribute to the dental health of their young patients because of the early age at which children are brought to their offices and because mothers are accustomed to accept their recommendations.
The pediatrician's role in caries control includes diagnosis, referral, and preventive therapy. Early referral of children who appear dentally healthy as well as those in which there are obvious cavities in the teeth has been stressed. As part of a caries preventive program, a system of systemic fluoride supplementation has been outlined for those children who are not drinking optimally fluoridated water. In addition, food-caries relationships have been discussed and practical suggestions for reducing the cariogenicity of a child's diet have been made.
Although toothbrushing is considered a traditional method of caries prevention, it has not been discussed in this article for two reasons. First, published evidence does not conclusively support the premise that toothbrushing per se significantly reduces dental caries. Second, the results of the general efforts of the dental profession to motivate patients to adopt either meticulous or frequent brushing habits have been poor. It would be unrealistic to expect the medical profession to initiate procedures that would significantly alter the behavior of their patients' toothbrushing habits. Toothbrushing in the young child, especially the preschooler, should be regarded as another method for providing topical fluoride to the teeth. Parents should be encouraged to brush their young children's teeth as soon as they erupt. A soft, child-size toothbrush should be employed with a scrubbing motion. An anticariogenic toothpaste§ that has proven effective in controlled clinical trials should be recommended by the pediatrician or his nurse.
It is hoped that the mechanisms for influencing children's dental health that were discussed in this article can be incorporated with minimum effort into the normal routine of pediatricians' practices.
Narcotic Poisoning of Children (1) Through Accidental Ingestion of Methadone and (2) in utero
Authors: Blatman Saul 
Published: December 2021

Narcotics have been known to man since prehistoric times, and they continue to be among the most used analgesics in the practice of medicine. They comprise a group of drugs whose analgesic effect is coupled with euphoria and somnolence. In addition, their spasmogenic effect on smooth muscle has made them useful agents in the alleviation of certain gastrointestinal tract symptoms. For most narcotics, therapeutic dosage does not produce serious untoward effects. Unfortunately, they have a depressant effect on respiration by directly influencing the respiratory center of the brain. This may be life threatening when recommended dosages are exceeded.
Narcotics have been abused since the recognition that they can induce euphoria and a feeling of well being. Tolerance and physical and psychological dependence result from their repeated use. The occurrence of withdrawal symptomatology in humans using these drugs repeatedly helps to produce a pattern of drug dependence; an individual has but to repeat a dose of drug in order to prevent withdrawal symptoms. Abuse liability is thus great.
All narcotics share this addiction potential. Those most frequently prescribed in clinical medicine are morphine, trieperidine, codeine and methadone. Heroin (diacetylmorphine), the most commonly abused narcotic, available only illicitly, is not prescribed in clinical practice. After injection, it is hydrolyzed to morphine which produces its pharmacological action. While morphine and heroin are absorbed only following parenteral administration, some narcotics are absorbed readily from the gastrointestinal tract as well as after injection (methadone, codeine, meperidine). Regardless of the mode of administration, narcotics taken by a pregnant addict readily pass the placental barrier and are capable of producing effects on the infant in utero and after birth.
The Effect of Phototherapy on the Hyperbilirubinemia of Rhesus Incompatibility
Authors: Shennan Andrew T. 
Published: December 2021

A retrospective analysis was made of the case records of 141 infants with jaundice due to rhesus incompatibility born in one unit over a six-year period during which phototherapy was introduced, in order to ascertain the effect of this form of treatment on the serum indirect bilirubin concentration. The infants were allocated to four groups of severity based on cord blood findings and the curve of bilirubin concentration drawn over the first 48 hours of life. Infants born before the advent of phototherapy acted as controls for those treated. There was a highly significant reduction in the level of indirect bilirubin reached in the mildest group not requiring exchange transfusion at birth, the mean bilirubin at 48 hours being lowered by 3.5 mg/100 ml in the treated group. Phototherapy exerted a lesser effect on the jaundice of more severely affected groups but still significantly reduced the rate of rise and the number of second and subsequent exchange transfusions.
It is concluded that phototherapy is a valuable addition to the current methods of treatment of hemolytic disease due to rhesus incompatibility.
The Sudden Infant Death Syndrome in Hospitalized Babies
Authors: Peterson Donald R. , Beckwith J. Bruce , Benson E. A. 
Published: December 2021

"If infants die because, while passing through a period of increased physiological vulnerability, some critical combination of intrinsic and extrinsic factors proves lethal, then it would be strange if death occurs only in the course of minor and not major illnesses. Is it possible that sudden unexplained death does happen in hospital, but is not recognized as such because the major diagnosis is judged to be the cause of death, or do the resuscitative measures which are readily available prevent it?"
This provocative question, posed in an editorial in late 1971,1 drew a response from Raphael, who submitted rather convincing evidence of an instance of sudden unexplained infant death in a Canadian hospital.2
Pneumothorax and Pneumomediastinum in Infants With ldiopathic Respiratory Distress Syndrome Receiving Continuous Positive Airway Pressure
Authors: Hall Robert T. , Rhodes Philip G. 
Published: December 2021

A review of infants with idiopathic respiratory distress syndrome developing pneumomediastinum and pneumothorax reveals (1) an incidence of 20% in patients receiving CPAP with an 11% incidence in comparable infants not receiving this mode of therapy; (2) in the CAPA-treated group the occurrence was at a stage in the illness when the inspired oxygen concentration was being lowered and when ventilation was stable; (3) the inspired oxygen concentration in the CPAP group at the time of the PM and/or PT was 52% (± S.D. 15%) at a mean age of 33 hours (± S.D. 23 hr).
These observations suggest that distending airway pressure creates excessive alveolar distention as an underlying mechanism of the air leak. It is recommended that distending airway pressure be lowered prior to achieving an inspired oxygen concentration of 60%. A controlled study is in progress to delineate the optimum distending airway pressures at specific inspired oxygen concentrations in order to reduce the incidence of alveolar rupture to a minimum.
Prevention of Apnea and Bradycardia in Low-Birthweight Infants
Authors: Shannon Daniel C. , Gotay Felicita , Stein Israel M. , Rogers Mark C. , Todres I. David , Moylan Fergus M.B. 
Published: December 2021

The efficacy of theophylline in preventing severe apnea was evaluated in 17 low-birthweight infants (mean weight, 1,400 gm). Apnea was detected and accurately quantified by 13-hour pneumogram recordings and correlated with serum theophylline levels. Nursing observations coupled with on-line alarm systems detected only 39% of severe apneic episodes as compared to the pneumogram recording technique.
Theophylline in six hourly oral doses (1.5 to 4.0 mg/kg) yielded two-hour serum concentrations of 6.6 to 11.Oµg/ml which completely controlled apneic spells exceeding 20 seconds in duration and markedly reduced 10- 19-second apneic episodes and any resultant bradycardia. At these serum levels, toxicity was not observed.
Therapy with theophylline should be instituted at a dose of 2 to 3 mg/kg every six hours and the optimum therapeutic dose should be individualized as determined by objective quantitation of apnea and serum theophylline concentration.
Sudden Infant Death Syndrome: Hypothesis of Causation
Authors: Tonkin Shirley 
Published: December 2021

The airway of the young infant is anatomically vulnerable at the oropharyngeal level between the soft palate and the base of the skull. Airway occlusion at this level might occur during the muscle relaxation which occurs during REM sleep, facilitated by a hypermobile mandible, by the hypotonia of infection, perhaps by an enlarged tongue with a strong backwards sucking action which might be the result of the artificial feeding of the infant.
It is possible that "cot deaths" (SIDS) may be precipitated by such oropharyngeal airway occlusion, cardiac arrest following variable periods of partial or complete oxygen deprivation.
SUBDURAL EFFUSIONS COMPLICATING BACTERIAL MENINGITIS
Authors: SMITH MARGARET H. D. , DORMONT RICHARD E. , PRATHER GEORGE W. 
Published: December 2021

Twenty cases of subdural effusion are presented occurring in infants under the age of 14 months during their convalescence from acute bacterial meningitis due to H. influenzae type b, D. pneumoniae, paracolon bacillus and Ps. aeruginosa.
The incidence of these effusions must be quite high, since at least 20 out of 43 cases of meningitis under the age of 2 years had fluid in the subdural space at some time during their hospital stay.
The authors believe that subdural taps should be performed on admission for diagnostic purposes whenever the patient has been treated with antibiotics before coming to the hospital, and has no organisms in the spinal fluid at the time he is first seen, as well as in all patients who give evidence of prolonged fever, focal neurologic signs, convulsions, etc., following meningitis.
The trauma incident to subdural taps is probably not itself responsible for causing subdural effusions, since in most cases fluid was present at the first tap.
The matter of age incidence needs investigation. There is no reason to believe that such effusions are limited to infants. The possible presence of a subdural effusion should be considered in an older patient whose convalescence from meningitis is slow, accompanied by prolonged fever, headaches and any suggestive focal neurologic signs.
The authors' experience, as well as a review of the older literature, indicates that from the confusing clinical entities known as subdural hygroma, pachymeningitis hemorrhagica interna, etc., one group can be singled out as occurring on the basis of an underlying infection. Its frequent occurrence in recent years is owing to the high survival rate in bacterial meningitis.
The actual pathogenesis of this lesion; the incidence of loculated fluid; the incidence of "membranes"; the possible influence of different treatment regimens on the occurrence of this syndrome; the possibility suggested by analogy with "pleuropneumonia" that subdural effusions, when infected, may serve as foci for later recurrences of meningitis; the possible influence of early recognition and treatment of subdural effusions on the ultimate prognosis in meningitis are matters for the future to determine.
MEAT IN THE DIET OF PREMATURE INFANTS
Authors: SISSON THOMAS R. C. , EMMEL ANNE F. , FILER LLOYD J. 
Published: December 2021

Meat protein is as well retained and utilized as milk protein by the premature infant and is therefore as safe and efficient a source of protein as milk. The fat absorption of the premature infant is not significantly altered when the milk fat in the diet is partly or wholly replaced by meat fat or meat fat and olive oil.
Strained meats do not contain a sufficient quantity of Ca and P to maintain an adequate intake of these minerals for the premature infant without further supplementation from other sources such as milk or pure mineral supplements.
Strained meats are an excellent and readily available source of Fe for premature infants. The Fe of meat is absorbed by them, but how well it is stored and utilized by them requires further investigation.
VITAMIN A POISONING
Authors: GRIBETZ DONALD , SILVERMAN SAMUEL H. , SOBEL ALBERT E. 
Published: December 2021

Two cases of hypervitaminosis A have been presented together with a review of experimental and clinical literature.
The first case presented the highest reported fasting plasma vitamin A level, the increase being chiefly due to a high vitamin A alcohol fraction. This elevated level of alcoholic vitamin A probably denotes large stores of vitamin A in the liver and data have been given to show that it is a better index of hypervitaminosis A than is the total vitamin A level. In addition, evidence has been presented that the toxic factor in hypervitaminosis A is the permanent elevated plasma vitamin A level.
The similarity between the experimental studies in animals and the observations in the authors' first case has been shown.
The important points necessary for making a diagnosis of hypervitaminosis A have been discussed and several similar conditions have been differentiated.
It cannot be emphasized too strongly that excess vitamin intake may be as dangerous as a deficient intake.
Homosexuality and Adolescence
Authors:   Committee on Adolescence
Published: December 2021

In 1974, the American Psychiatric Association ended its classification of homosexuality as a mental disorder, labeling it rather as an alternate choice of sexual expression. This decision was based on the beliefs of the majority that there were insufficient data to label such individuals as being ill and that the deleterious social consequences of the pathologic designation were so grievous as to demand the declassification.1
Although theories regarding the etiology of homosexuality have been based on genetic, hormonal, psychological, and environmental models, there is little reason to believe that any one of the arguments alone explains all homosexual orientation or behavior.2 Homosexuality has existed in most societies for as long as recorded descriptions of sexual beliefs and practices have been available. Although little agreement exists concerning the etiology of homosexuality, and any definition of terms will be arbitrary, some operational definitions are necessary (Table).3
Four assertions can be made regarding homosexuality during the teenage years:
1. Some homosexual experimental behavior is experienced by many adolescents. This may include fondling of the body or genitalia or mutual masturbation. In the vast majority of cases these homosexual encounters do not predispose to later obligatory homosexuality, but appear to be a common exploratory behavior en route to conventional heterosexual development.
2. Homosexual4 characteristics appear to be established before adolescence. Although many individuals do not participate in overt homosexual play during childhood, the self-conscious psychological state probably often exists before adolescence.
3. Some previously heterosexually oriented adolescents will become involved in homosexual activities if circumstances reinforce this behavior or if heterosexual alternatives are not available.