bluuebunny/crossref_metadata_2025_split huggingface dataset:
CARDIO-ESOPHAGEAL RELAXATION (CHALASIA) AS A CAUSE OF VOMITING IN INFANTS
Authors: BERENBERG WILLIAM , NEUHAUSER EDWARD B. D. 
Published: December 2021

Repeated vomiting in the newborn or young infant may be produced by persistent relaxation of the hiatus esophagus. Twenty-four patients with this condition have been observed during the past five years. Milder variants may occur more often than have been recognized.
The syndrome in the majority of patients is produced by a temporary neuro-muscular dysfunction. When some organic defect such as a congenitally short esophagus is the causative factor the condition is more apt to be persistent or to start later in life.
The diagnosis is suggested by persistent, otherwise unexplained vomiting which can be alleviated by keeping the patient in an erect position. An absolute diagnosis can be made only by fluoroscopic examination with a barium swallow. The diagnostic change is persistent relaxation of the hiatus esophagus with retrograde filling of the esophagus during inspiration or with increase in intra-abdominal pressure.
Therapy is empiric and consists of the use of thickened formulae and of keeping the patient in the erect position, particularly after feedings.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: WILSON EUNICE W. 
Published: December 2021

The term "handicapped child" tends to put emphasis upon the handicap rather than the child. There is still undue emphasis in many types of physical disability upon how a specific handicap can be overcome by special education or training methods, without sufficient attention to whether the child is having the normal relationships and social experiences necessary to equip him later to compete in adult society. If the ultimate goal for the child who is handicapped is participation with nonhandicapped children in normal life situations, the total needs of the child, as well as those for his specific handicap, must be considered.
This discussion portrays a method which individualizes a child and his needs in order to facilitate his social adjustment. Although the principles expressed have been drawn from experience with preschool children, they are applicable to some extent to all age groups. It is recognized, however, that problems arising in school age and adolescence may require different or additional types of service.
The reaction of parents to knowledge of a child's handicap is of great significance in the child's adjustment. The following reactions seem fairly general:
1. The basic parent-child relationship is somewhat threatened and feelings about the child may undergo change.
THE PRESIDENT'S COLUMN
Authors: SHAW EDWARD B. 
Published: December 2021

THE returns of the vote on reorganization were overwhelmingly in favor of both propositions.
There was some misunderstanding of proposition 2. The purpose of this proposal was to provide the Executive Committee with a directive to select, upon the retirement of Dr. Clifford G. Grulee, a successor to his office best suited to fulfill the requisites of this position who is, at the same time, available for appointment. The second proposal was perhaps unnecessary. Authority to select an Executive Secretary is vested in the Executive Board and it was suggested by Dr. Veeder in his letter of transmissal that changes might have to be undertaken slowly and involve a certain amount of pragmatism.
It is expected that Dr. Grulee will continue under the reorganization plan as Executive Director until his retirement in July of 1951. Meanwhile the Board is proceeding most thoughtfully with the consideration of possible appointees to this important position. It is necessary, of course, that this man should have the confidence and respect of the membership but he must, at the same time, have executive ability, business acumen and an unusual capacity to reconcile the divergent views of our powerful organization into a pattern of Academy activities. The nature of his office makes it almost inescapable that the popularity of the Executive Director will vary from time to time with one or another segment of the membership.
It is obviously to the advantage of the Academy and for the continuity of an over-all program to have the same individual remain in this position for many years.
TULAREMIA AS A PEDIATRIC PROBLEM
Authors: LEVY HAROLD B. , WEBB CLARENCE H. , WILKINSON JACQUES D. 
Published: December 2021

The results obtained, it would appear that the lack of any pathognomonic clinical feature, tardy appearance of specific agglutinins, and variations from the typical adult course render imperative a high index of suspicion if an early diagnosis of tularemia is to be made in a child. Careful questioning concerning possible ingestion of infected meats, animal contact or tick bite must be stressed. Involvement of siblings may be a strong point in favor of ingestional tularemia.
Painstaking search for a local lesion should be made in every case with unexplained adenitis or appearance of sepsis; the frequency of pharyngo-tonsillar involvement must be appreciated. Usual laboratory aids may be of little value in early diagnosis in the average hospital or office at the present time. Early appearance of the heterophile cross-agglutination reaction may alert the observer to the possibility of tularemic infection.
A severely ill patient, for whom a definitive diagnosis cannot be reached, failing to respond to therapy for other suspected illnesses, and in whom any of the factors just mentioned prevail, should receive the benefit of a therapeutic test with streptomycin. Favorable response and survival, as is true of effective antibiotic therapy for other acute illnesses, may permit of later retrospective diagnosis in some whose illnesses or deaths would otherwise have remained unexplained.
THE PEDIATRICIAN AND THE PUBLIC
Authors: LENNOX WILLIAM G. 
Published: December 2021

I enclose a portion of an address, "Epilepsy Then, Now and A Century Hence," delivered at the Centenary of the Boston University School of Medicine. In the belief that the subject discussed will become increasingly timely, I request space for it in "The Pediatrician and the Public." Pediatricians occupy a strategic position with respect to genetics and childbearing and, because of their associations, pediatricians should be unusually youthful minded and forward looking.
From our little Mount Pisgah we have gazed hopefully toward the Promised Land of Epilepsy Control. Now we must descend to the common plain of economics. Fruitful research in any field depends primarily on inspired minds, but money, with its supporting stable politico-economy, seems increasingly important. What will be the state of the world a century hence? Who or what threatens its stability?
At the moment we fear the power of the fissured atom. We physicians envy atomic scientists with their billions to spend, and we feel superior because our labors do not engender fears of catastrophic destruction. And yet, what will people think of us a century hence? By then, we are told, the population of the earth, excessive with respect to its natural or man-made resources, will present a wider and more insoluble menace to peace and prosperity than the split atom. For this menace our profession will be chiefly to blame.
Medical science and public health forces have wonderfully reduced the scourge of sickness and death; but the doubled life span means a doubled population—and, for the added portion of that span, economic unproductivity. A passion for prolonging all lives, including the genetically unfit (coupled with war's destruction of the fit), has violated nature's plans for humanity's improvement. Flattered for past achievements in prolonging life, we physicians ignore the complementary problem of excessive births. We see no danger and cry no alarms. Knowing most about human genetics and the physiology, endocrinology and psychology of reproduction, we nevertheless have not grappled seriously with the vast problems involved in widespread efforts towards the limitation and the genetic improvement of the human breed.
POSTINFANTILE CORTICAL HYPEROSTOSIS WITH SUBDURAL HEMATOMA
Authors: BERREY BEDFORD H. 
Published: December 2021

The coexistence of postinfantile hyperostosis and subdural hematoma, an association hitherto unreported, it described in a child 29 months old and a brief review of the 32 previously reported cases of infantile and postinfantile cortical hyperostosis is presented.
The cause of the syndrome is not known but hereditary, infectious, traumatic, allergic and hematologic factors have been considered. Hypervitaminosis A appears to be a definite etiologic possibility in the postinfantile form.
Hyperirritability, fever and anemia with leukocytosis are the outstanding clinical manifestations; characteristic shadows of external thickenings of the corticallis of the bones are pathognomonic.
Since the course of the disease is self-limited, treatment is directed toward symptomatic relief and reduction of intake of vitamin A when it has been excessive.
EFFECT OF INFUSIONS OF CITRATED PLASMA ON THE PLASMA CITRATE LEVEL OF INFANTS
Authors: AMES R. , SYLLM I. , RAPOPORT S. 
Published: December 2021

The effect of infusions of citrated plasma given at varying rates on the plasma citrate level of infants has been studied. The plasma citrate as a rule rose from 0.17 to 2.0 mM/1. after single infusions to fall rapidly at first and more slowly later. In two instances levels of 2.6 and 2.8 mM/1. were observed. Considerable decreases in the calcium ion concentration, assuming unchanged total calcium values, were calculated. ECGs indicated some lengthening of the duration of the Q-T interval, compatible with a decrease in the calcium ion concentration, but to a degree less than expected.
One infant suffered a nearly fatal reaction, considered to be tetanic in nature. The examination of the citrate in the plasma of an infant dead after infusion of plasma showed a high citrate level of 2.8 mM/1. It is assumed that normally physiologic forces are operative to counteract the calcium-ion-lowering effect of citrate.
HYDRANENCEPHALY: CLINICAL DIAGNOSIS
Authors: HAMBY WALLACE B. , KRAUSS RUTH F. , BESWICK WILLIAM F. 
Published: December 2021

DURING the past two years the authors have identified in living infants seven examples of a cerebral anomaly which presents some of the clinical characteristics of hydrocephalus but which consists essentially of serious maldevelopment, or even complete absence, of the cerebral hemispheres, with intact meninges and cranium.
The Anomaly
The anomaly consists primarily of absence of the cerebral hemispheres within intact meninges and skull, the resulting cavity being filled with cerebrospinal fluid. The fluid circulation may be normal or the outlets of the ventricles may be closed; "hydrocephalus" results in either case. At operation or autopsy the most striking feature noted is absence of the cerebrum, although a few islands or bands of it may persist. The pia-arachnoid usually is intact, although in some cases it also may have broken down. In the authors' surgical cases the transparent membrane was intact and the attenuated major branches of the middle cerebral artery were pulsating vigorously. As the fluid is aspirated, two egg-shaped, white, glistening bodies representing the basal ganglia are seen on the floor of the skull. Different specimens reveal variable amounts of residual cerebral tissue in the periphery of the tremendously expanded and freely communicating lateral ventricles. The anatomic description of these residual masses of nervous tissue as investigated in autopsy specimens (Cases 1, 3, 6 and 7) will be presented elsewhere.
Etiology and Terminology: The cause of the condition remains controversial, but since the meninges and cranium are intact, it must be assumed that the anlage of the neopallium was present during the period of formation of these layers. Cruveilhier described the anomaly as hydrocephalic anencephaly ("l'anencéphalie hydrocéphalique") and contrasted it with anencephaly associated with absence of the cranial vault.
KERNICTERUS
Authors: ZUELZER WOLF W. , MUDGETT ROXIE T. 
Published: December 2021

A study of etiologic factors in 55 consecutive cases of kernicterus seen at autopsy disclosed the existence of a large, seemingly heterogeneous group in which erythroblastosis fetalis was not a causative factor.
In 21 cases which had shown the characteristic features of erythroblastosis fetalis as regards family history, order number of pregnancy, racial distribution, clinical symptoms, hematologic findings and autopsy observations, the distribution of Rh types of mothers and infants was typical of erythroblastosis fetalis and maternal isoimmunization against Rh was readily demonstrated in 20 instances, the 21st having been studied before adequate technics were available.
By contrast the clinical features were not characteristic of erythroblastosis in a second group of 32 patients which also differed from the first by its incidence of first born infants and by a high percentage of Negroes. In 20 of these 32 case studies of the Rh types of mothers and infants had been made, showing only one instance in which the combination of Rh-negative mother and Rh-positive infant was present. In no instance was it possible to demonstrate maternal Rh antibodies or sensitization of fetal erythrocytes. In the majority of the cases tested mother and infant were compatible in regard to blood group A-B-O. The incidence of incompatibility between mother and child in the A-B-O system was higher than expected in this group and appeared statistically significant. In no instance, however, was it possible to demonstrate unusually high agglutinin titers or immune antibodies against A or B in the maternal serum. The over-all clinical picture of the A-B-O incompatibility group did not differ from that of the patients with compatible blood groups. A-B-O incompatibility may be a predisposing factor in kernicterus but no conclusive evidence for this hypothesis was uncovered by these studies.
The conclusion was reached that kernicterus does not represent a specific entity. Prematurity, severe infections, diarrheal disease, pulmonary and cerebral hemorrhage and maternal diabetes were the chief conditions encountered in those cases of kernicterus in which erythroblastosis fetalis was excluded.
POSSIBILITIES OF SPECIFIC PREVENTION AND TREATMENT OF POLIOMYELITIS
Authors: HAMMON WILLIAM MCD. 
Published: December 2021

Particular emphasis is placed on possibilities of passive immunization, because it is felt that this offers practical and theoretic advantages over active immunization. A vaccine is not available at present and may never be available in adequate quantities for all immunologic types or at reasonable cost. Furthermore, if an inactivated vaccine is used, annual revaccination for duration of life might logically ensue. Experimental work has demonstrated the effectiveness of serum prophylaxis in animals and has been given field trials in man, the results of which are suggestive but inconclusive. Gamma globulin from adults should contain antibody to all prevalent types and has been shown to be active in monkeys against three types. It has been used on a small scale as a human prophylactic agent but not on an experimental basis. Gamma globulin, on the basis of inadequate experiment and epidemiologic reasoning, might not prevent infection, though it would be expected to prevent clinical disease. If this proves to be a fact, it would not prevent the development of permanent immunity through inapparent infection, a decided practical advantage. Its use would be recommended only during epidemic years and for only the more susceptible age groups. Dosage and interval would have to be determined. Since gamma globulin is now available, it is felt that a carefully controlled field experiment to determine its effectiveness is in order. There is still no evidence that a serum, gamma globulin or other immunologic agent, has any therapeutic effect, or abortive effect, once illness has begun.
So far, no report of a reliable nature has appeared for a practical therapeutic or prophylactic antibiotic or chemotherapeutic agent against poliomyelitis. However, developments in this field as applied to rickettsial diseases and a few other virus diseases lead to considerable optimism. It is believed that the most likely final control methods will be developed along these lines.
Should we stop using the P value in descriptive studies?
Authors: Jekel James F. 
Published: December 2021

Statistical tests of significance are often (and incorrectly) used in analyzing data from descriptive studies to determine what variables are associated with each other. The standard tests of significance are usually invalid for this purpose and their use leads to unimportant findings being reported and important findings being omitted.
There is no substitute for the mind of the investigator considering each relationship to determine its importance; in this search, a statistical test of the strength of association will be more useful than a statistical test of significance.
Such a change in approach to the analysis of descriptive data would result in greater clarity and reproducibility of studies. I don't know what the "probability" of such a change occurring is, but I do believe such a change would be "important."
Dr. Collu Replies
Authors: Collu Robert 
Published: December 2021

The question raised by Dr. Rowe et al. concerning the occurrence of hypoglycemic episodes during the levodopapropranolol test is a valid one since we have observed one such episode in a 5-year-old boy with short stature and ketogenic hypoglycemia whose baseline glucose levels were already low.
I must emphasize, however, that this is the only complication we have experienced in more than 50 tests performed over a two-year period. In all such cases, including 12 cases of hypopituitarism, blood glucose levels tended to increase slightly as already shown in the article.
Children's Behavior During Automobile Rides: Do Car Seats Make a Difference?
Authors: Christophersen Edward R. 
Published: December 2021

The behavior of children riding in automobiles with their mothers was assessed by having an observer accompany them on repeated 15-minute automobile rides. Children riding in car seats exhibited very high levels of appropriate or safe behavior, whereas children not riding in car seats exhibited very low levels of appropriate behavior. When car seats were introduced to those children who previously had not used them, the level of appropriate behavior improved dramatically. These results were maintained at three-month follow-up observations.
Prevention or reduction of disruptive child behavior on car rides is an obviously important, but previously unreported, benefit of the use of child restraint seats. This fact might very well be used by the pediatrician to further encourage or persuade parents to purchase and use child restraint seats. The use of a child restraint seat to reduce disruptive behavior during automobile rides is an advantage, beyond the safety aspects, of introducing car seats to young children.
Gasoline Sniffing and Tetraethyl Lead Poisoning in Children
Authors: Boeckx R. L. , Postl B. , Coodin F. J. 
Published: December 2021

Two cases of acute organic lead poisoning following gasoline sniffing, with one death, are reported. Signs of lead encephalopathy with elevated blood lead levels and markedly decreased levels of erythrocytic δ-amino levulnic dehydratase (ALAD) were demonstrated.
Erythrocytic ALAD activity was used as a screening test for the detection of tetraethyl lead (TEL) poisoning in a group of 43 children who were presumed gasoline sniffers. Their mean ALAD activity was 190 units compared to a mean of 538 units for a control group.
A survey of schoolchildren in another isolated community revealed that 59% had decreased ALAD activity, which correlated well with a history of gasoline sniffing. Only 5% of the children had blood lead levels over 40 µg/dl.
The two surveys herein reported suggest that there may be large numbers of children living in isolated communities who are suffering from TEL poisoning as a result of gasoline sniffing. This constitutes a major medical, public health, and social problem heretofore virtually unrecognized.
A GIANT BIRTH-A MALE INFANT WEIGHING 23 3/4 POUNDS-REPORTED IN 1879
Authors: C. T. E. 
Published: December 2021

I believe the infant reported below is the heaviest ever recorded.
The mother . . . stands 7 feet 9 inches . . . [her husband] is 7 feet 7 inches in height. . . . At 12 M., January 15, 1879, I was called upon to attend this lady in confinement. . . . I found her surrounded with competent attendants, and everything in order. . . . After a convenient time . . . I proceeded to make an examination, but was unable to reach the os uteri, it being so far up. . . . At the end of 36 hours the pains became more frequent, and on examination I found the os dilating and labor progressing favorably. The head engaged . . . notwithstanding the long interval between pains, the head made good speed through the great depth of [the] pelvis. At 4 P.M., on the 18th . . . the membranes gave way spontaneously and the amniotic fluid came pouring out so profusely as to startle every one. . . .The bed was well protected with rubber blankets, which carried the waters over the side of the bed, where they were caught in vessels to the amount of five gallons. That lost by absorption and evacuated with succeeding pains, would make the total of water not less than six gallons. Soon after the rupture of membranes the foetal head . . . disengaged. . . . The mother was in good condition, the foetus seemed strong and healthy, and everything mdicated a speedy and successful termination.
Dr. McDaniel Replies
Authors: McDaniel David B. 
Published: December 2021

We are very pleased that our article stimulated Dr. Overend and his associates to review their immunization activities. Their vaccine-specific levels appear to be higher than those we reported. However, the differences in study design make a direct comparison impossible. Our study was designed to evaluate preschool immunization levels exclusively. The selection of 2-year-old children allows for little delay in the performance of the required vaccinations. Consequently, lower overall and vaccine-specific levels were obtained than would be the case had older children been used.
See table in the PDF file
Caution on Overdiagnosis
Authors: Reinhart John B. 
Published: December 2021

I am writing to comment on the article by Bugenstein and Phibbs, which appeared in the December 1975 issue of Pediatrics (page 1073). I do not question that such herniations do occur and may need surgical intervention on occasion. Whether they cause generalized abdominal pain or cause confusion in diagnosis to the pediatrician or surgeon who takes a careful history and does a careful physical examination is my question.
There is already the tendency to make a diagnosis on a "rule out" basis, and, in my opinion, there is excessive use of gastrointestinal x-ray and other laboratory procedures.