bluuebunny/crossref_metadata_2025_split huggingface dataset:
GIANT AXONAL NEUROPATHY
Authors: Berg Bruce O. , Rosenberg Sidney H. , Asbury Arthur K. 
Published: December 2021

Progressive muscle weakness of at least 3 years' duration is described in a 6-year-old Caucasian girl. Neurological abnormalities included loss of muscle bulk without fasciculation, muscle weakness, areflexia, and impairment in perceiving touch, position sense, and vibration. The cerebrospinal fluid was normal. A clinical diagnosis of polyneuropathy was made and electrophysiological studies were consistent with that diagnosis.
No gross abnormality of a left sural nerve biopsy was detected, but light microscopic study of transverse paraffin sections revealed abnormally large argentophilic masses scattered through each fascicle Examination of 2 microns-thick plastic embedded sections showed the argentophilic masses were axons which were segmentally enlarged to enormous proportions.
Ultrastructurally, axons were distended by masses of tightly woven neurofilaments. Unusual features included the tendency to occur in massive whorls and the frequent occurrence of electron dense condensations into which parallel skeins of neurofilaments appeared to gather. The nature of the electron dense condensations could not be further resolved.
Axonal collections of neurofilamentous masses have been described in experimental neuropathies due to acrylamide, mitotic spindle inhibitors and in some cases of motor neurone disease. However, the accumulation of neurofilamentous masses in these disorders does not approach the proportions encountered in this case.
DRUG INTERACTIONS—PART II
Authors: Stern Leo 
Published: December 2021

Unlike its conjugated (direct acting) counterpart, unconjugated (indirect acting) bilirubin is insoluble in water, but highly soluble in lipids. Hence, it tends to diffuse out of plasma into the lipid-rich CNS with resultant kernicterus. This does not occur when unconjugated bilirubin is bound to albumin, as the complex is too large for diffusion. The production of kernicterus thus involves the increase of free, unbound, unconjugated bilirubin in plasma, either by dissociation from its albumin binding sites or by the introduction of one or more anions which compete preferentially for a common or shared site, thus displacing the bilirubin from its albumin bond.
FACTORS AFFECTING BINDING
Lowering the pH promotes bilirubin-albumin dissociation,1 and acidosis has thus been implicated as a factor in kernicterus occurring at low levels of serum bilirubin.2-5 In addition, competition for bilirubin binding sites is exhibited by a number of endogenously occurring substances as well as exogenously administered agents. Both hematin (increased in hemolytic states) and the nonesterified fatty acids (increased under conditions of both hypothermia6 and hypoglycemia7 are capable of displacing bilirubin from its albumin binding sites. In addition, a number of drugs, among which sulfisoxazole (Gantrisin) is the most widely known in view of both its clinical8 and experimental9 production of kernicterus in this fashion, are capable of causing similar displacement in vitro.
Among the techniques employed to demonstrate an increase in free bilirubin is the measurement of displacement of spectral curves.10,7 The technique depends on a difference in absorbance of free (420 to 440 nm) versus bound (460 to 465 nm) bilirubin, with changes in the shapes of the curves as the amounts of free and bound bilirubin are altered.
Letter to the Editor
Authors: Pick Walter 
Published: December 2021

Thank you for permitting debate on the important issue of the role of the nurse practitioner in pediatrics.
Dr. A. H. Matlin comes to the surprising conclusion that nurse practitioners often practice better anticipatory guidance than physicians and "their services should, if anything, be worth more." If Dr. Matlin is serious in his view, he should experiment by referring physicians' children to the nurse practitioners for this "better guidance" and observe the subsequent reaction. In our society, a professional man is compensated for his service on the basis of his training and the responsibility he takes.
LONG BONE INVOLVEMENT IN SICKLE CELL ANEMIA
Authors: ALMKLOV JOHN R. , HANSEN ARILD E. , SCHNEIDER MARTIN 
Published: December 2021

Two types of pathologic changes may occur in the long bones of patients with sickle cell anemia. A hyperplastic bone marrow represents the response to continued destruction of erythrocytes and this produces a wide medullary cavity and a thin cortex. The thromboses of vessels in the marrow and bone result in abnormal areas of calcification and new bone formation producing a thick cortex and a small medullary cavity. The findings on roentgenographic examination will depend upon which of the two processes is dominant.
A 21 month old Negro infant whose symptoms of sickle cell anemia began at 4 months of age showed typical roentgenographic findings resulting from a hyperplastic marrow. The cortex in the femur had become so thin that a pathologic fracture resulted. This is the first reported instance of the occurrence of a pathologic fracture in sickle cell anemia.
SPECIAL REVIEWS
Authors: WHEATLEY GEORGE M. 
Published: December 2021

THERE has been a marked change in our concept of the term "school health service." Early activities in this field were almost wholly devoted to the control of communicable disease. Today, thanks to immunization, the antibiotic drugs and health education, most of the old enemies of child health have been conquered. As a result, the years that a child spends in school have been made the healthiest period of life, when appraised by the crude measure of mortality.
Why then school health service? Let me first define what I mean by this term. It comprises health supervision of the school child by educators, public health nurses and school physicians for case-finding and health guidance. At no other time of life is the child or family so readily available for preventive medical service and health education. Public health cannot afford to neglect this ready access to so large a segment of the population—actually more than 20 million persons.
Entrance to kindergarten and first grade is perhaps the most valuable of these opportunities. For all too many children, this is the first health examination since the first year of life. Habit disorders or physical defects which have developed in the preschool years can be brought to light and treatment advised.
A convincing demonstration of the value of a good medical examination at this time of life occurred recently when I was instructing a group of fourth year medical students. As part of their pediatric training, they visited a school to do some examinations under supervision.
SUBDURAL FLUID AS A CONSEQUENCE OF PNEUMOENCEPHALOGRAPHY
Authors: SMITH HONOR V. , CROTHERS BRONSON 
Published: December 2021

When lumbar or cisternal pneumoencephalography is carried out on children with nonprogressive brain lesions causing mental deficiency, cerebral palsy or epilepsy, air is seen in the subdural space in at least a third of cases. This proportion is much larger in children 2 years of age or under.
The roentgenographic appearances of subdural air are described and the importance of not attributing these appearances to cerebral atrophy or hypoplasia is emphasized.
In approximately one third of cases in which air enters the subdural space, that is, in from 10% to 15% of all cases, recovery from pneumoencephalography is delayed by the development of signs and symptoms suggesting a rise in intracranial pressure.
In such cases fluid can usually be found by needling the subdural space. Typically this fluid is characteristic of that found in subdural hematoma. There is no evidence that such a collection of fluid was present before pneumoencephalography.
It is therefore suggested that as air enters the subdural space and the brain falls away from the dura, vessels may be torn as they cross this space to reach the superior longitudinal sinus, with the formation of what may be termed subdural hematoma artefacta.
Although the incidence of this complication is moderately high, its effects are seldom serious, provided the situation is appreciated and suitable treatment given. The length of time the child spends in the hospital is, however, often greatly prolonged and occasionally operation proves necessary for removal of a subdural membrane.
Since the subdural hematoma is an artefact occurring in the course of treatment, its removal does not influence the ultimate prognosis.
RIGHT HEART CATHETERIZATION OF THE AORTA THROUGH A PATENT DUCTUS ARTERIOSUS
Authors: ADAMS FORREST H. , LABREE JOHN , STAUFFER HERBERT M. 
Published: December 2021

Two patients with atypical findings of a patent ductus arteriosus are presented in whom right heart catheterization proved its existence by the catheter passing through the ductus into the aorta.
Right heart catheterization in one of these patients demonstrated a right descending aorta in the presence of a left aortic arch, the fourth patient with this anomaly to be reported.
FURTHER OBSERVATIONS ON THE ABSORPTION OF VITAMIN A
Authors: LEWIS J. M. , COHLAN SIDNEY Q. , MESSINA ANGELINA 
Published: December 2021

Experiments carried out on infants revealed that vitamin A, as it occurs naturally in milk, was more effectively absorbed than when administered in an oily vehicle, but not quite as well absorbed as when given in an "aqueous" preparation. The high degree of absorbability of vitamin A in milk is due to the relatively small particle size of the butter fat globule.
By reducing the particle size of a fish liver oil preparation (oleum percomorphum) to 1 to 2 µ by homogenization into milk or water, the absorption of vitamin A was considerably enhanced in children and in rats.
The relationship of the particle size of the vehicle of vitamin A to absorption is further demonstrated by the results of the administration in children and in rats of three vitamin A preparations of varying particle size. Thus, the highest absorption occurred following the administration of a preparation containing particle size of submicroscopic proportion ("aqueous"); the lowest absorption resulted following the preparation containing particles macroscopic in size (oil) and intermediate absorption was observed following the use of a preparation containing particle sizes varying from 1 to 20 µ (emulsion).
Similarly, in a child having cystic fibrosis of the pancreas, the absorption of vitamin A was dependent upon the particle size of the vehicle employed.
POSTPRANDIAL LIPEMIC RESPONSE IN INFANTS AND CHILDREN
Authors: ELGHAMMER W. ROBERT , REICHERT JOHN M. , PHILIPSBORN HERBERT F. 
Published: December 2021

The chylomicrograph is a simple and time-saving method of serially determining [See Table II in source pdf] neutral blood lipid levels. It is of value in studying chronic intestinal indigestion.
The clinical significance of the chylomicrograph is equal to that of the vitamin A curve.
The advantages of the chylomicrograph over the vitamin A curve are its simplicity, rapidity, availability and use of capillary blood specimens.
EFFECT OF GLUTAMIC ACID ON MENTAL FUNCTION
Authors: KERR WILLIAM J. , SZUREK S. A. 
Published: December 2021

These results do not substantiate previous reports that glutamic acid will increase measurable intelligence. Attitudinal effect on the part of nurses, psychologists and psychotherapists, which might influence the results, has been minimized by the use of careful controls and different psychologists in each test situation.
Because of the small number of cases here reported, further studies are needed on larger groups using similar controls. A hospital with a large stable population of children with low testable intelligence would be preferable to the Langley Porter Clinic. One such study is soon to be reported. The results are in essential agreement with these.
ERYTHEMA BULLOSUM MALIGNANS FOLLOWING DILANTIN THERAPY
Authors: HELLER GEORGE , SLOANE MILTON 
Published: December 2021

A case of erythema bullosum malignans in a child 9 years of age is presented. No conclusion concerning the etiology of this condition is warranted, but the coincidental occurrence of the disease following the use of dilantin® in this case and other reported cases should alert clinicians to the possibility of more severe reactions to that drug than is generally appreciated.
It is felt that antibiotic agents and intravenous alimentation, especially the free use of whole blood, may be life-saving in tiding the patient over the protracted period of hypoproteinemia caused not only by weeping from the skin surface, but also by loss of substance from unrecognized visceral lesions.
TRENDS
Authors: WEBB CLARENCE H. 
Published: December 2021

THE following report, submitted by Dr. Clarence H. Webb, official liaison representative from the Academy to the Children's Bureau, summarizes the highlights of the meeting of the Advisory Committee on Maternal and Child Health and Crippled Children's Services at The Children's Bureau, January 30 and 31, 1950.
This general advisory committee, constituted in 1948, meets once or twice annually to advise with the Maternal and Child Health and Crippled Children's Services concerning the policies and programs of these divisions of the Children's Bureau. It is to be distinguished from smaller technical committees which study and give advice on specific technical problems. Academy members in attendance at the meeting were: Harry H. Gordon, Chairman of the Advisory Committee, Allan M. Butler, John P. Hubbard, Thomas F. Shaffer, Clarence H. Webb, James L. Wilson, Leona Baumgartner, Associate Chief of the Children's Bureau, and Katherine Bain, Director of Division of Research in Child Development.
Dr. Edwin F. Daily reviewed important developments since the last committee meeting. Attention was directed to the Annual Report of the Children's Bureau in the December issue of The Child, wherein significant increases in child population and changes in maternal and infant mortality rates are reviewed. Cooperative planning and action between the Children's Bureau and voluntary agencies has been fruitful.
PHYSIOLOGIC AND CHEMICAL RESPONSE OF PREMATURE INFANTS TO OXYGEN-ENRICHED ATMOSPHERE
Authors: GRAHAM BRUCE D. , REARDON HELEN S. , WILSON JAMES L. , TSAO MAKEPEACE U. , BAUMANN MARY L. 
Published: December 2021

Arterial blood studies were performed on 44 premature infants while in atmosphere and greater concentrations of oxygen. Analyses were made for oxygen content, oxygen capacity and hematocrit. Concomitant plethysmographic studies were made on 29 occasions. Results were as follows:
1. Only 25% (7) of the premature infants studied breathed regularly in atmosphere; the remaining individuals breathed with some degree of periodicity (44%) or completely irregularly (30%).
2. As the concentration of oxygen being breathed was raised, then more of the group shifted to a regular type of respiration until when in 75-85% oxygen, 88% of the group then breathed with a regular type of respiration.
3. a. The percentage arterial oxygen saturation of the group averaged 93% in atmosphere, 96% in 30-55% oxygen, 100% saturation in 70-79% oxygen being breathed and 102% in 80-89% oxygen.
b. In atmosphere, when compared on age basis, the younger group (1-14 days) had essentially the same arterial oxygen saturation as the older group (14-65 days). In an atmosphere of 70-90% oxygen, the saturation of the younger group increased to 102% while the older group rose to 100%.
c. When compared on body weight basis, the 0.9-1.3 kg. group increased the arterial oxygen saturation of 85% in atmosphere to 102% when 70-85% oxygen was administered; the 1.3-1.8 kg. group, 93% to 101%; the 1.8-2.3 kg. group, 9% to 100%. (It is noted that either on age or body weight basis the group with higher hematocrit attained higher arterial oxygen saturation when 70-85% oxygen was administered than the group with lower hematocrit.)
4. a. A statistical analysis of the respiratory records revealed an average rise of 30% in minute volume when 30-40% oxygen was administered, this rise being significantly maintained as higher concentrations (to 90%) of oxygen were administered.
b. An average significant rise in respiratory rate of 30% was noted when 30-40% oxygen was administered which slowly fell to the original rate level as oxygen administered was increased to 80-90% concentration.
c. Consequently, the tidal volume (volume per respiration) gradually increased to 30% above the level in atmosphere as oxygen administered was increased to 80-90% concentration.
ABSORPTION OF FAT AND VITAMIN A IN PREMATURE INFANTS
Authors: MORALES SOLEDAD , CHUNG ARTHUR W. , LEWIS J. M. , MESSINA ANGELINA , HOLT L. EMMETT 
Published: December 2021

Eight premature infants manifesting steatorrhea were placed on diets containing low and high amounts of fat in order to ascertain how economically the premature infant could utilize large amounts of fat. At the same time the effect of administering large amounts of fat on the vitamin A absorption of premature infants was investigated. The results of these studies indicated that in spite of steatorrhea the percentage of fat absorbed was essentially the same whether the diet contained high or low amounts of this food. Thus, the net absorption of fat was correspondingly higher following the use of a high fat diet. The absorption of vitamin A was approximately the same following the low or high fat regimen.
The finding that relatively high fat diets given to premature infants not only result in better fat retention but are also well borne clinically suggests that the currently advocated restriction of fat in these subjects is unnecessary and possibly undesirable.
USE OF PARENTERAL POTASSIUM THERAPY IN SURGICAL PATIENTS
Authors: LOWE CHARLES UPTON , ROURKE MARGARET , MACLACHLAN ELSIE , BUTLER ALLAN M. 
Published: December 2021

IT HAS been observed frequently that following surgery patients may have a low serum chloride concentration. The shocklike state which occasionally occurs has been assumed to be the result of this low serum Cl. Therapy as radical as parenteral use of dilute hydrochloride acid has been advocated. Animal experiments indicate that when there is a deficit of potassium and an excess of sodium within the cells, the concentration of Cl in the plasma decreases while that of HCO3 increases. With the ingestion of K there is a retention of Cl and rise in serum Cl. Such changes in tissue and serum concentration also occur in the hyperadrenalism of Cushing's syndrome and of the alarm reaction in rats. That such an alarm reaction may result from operations is indicated by a fall in circulating eosinophiles and an increase in urinary 11-oxycorticoids. Moreover, such starvation and parenteral saline as may be incident to operation favor these alterations in tissue and serum concentrations.
The following studies were undertaken to determine whether the use of parenteral K in surgical patients would increase the intracellular potassium concentration and prevent a loss of Cl from the body. The results augment the affirmative evidence that has been accumulating since these studies were made.
Plan of Study
Five patients with surgical disease were studied. Those patients that were chosen had no stools during the period of observation. Two infants, 21 mo. and 7 mo. of age, had intussusception. Three children had perforated appendices with peritonitis, two 9 yr. old and one 14. The 2 children (S.L. and A.B.), who were the same age and weight and had perforated appendices, were felt to be ideal subjects for comparison between the 2 types of therapy. Therefore, throughout periods of study one (S.L.) received Na, Cl and glucose, the other (A.B.) a similar regime to which K had been added.
WEIGHT IN RELATION TO FETAL AND NEWBORN MORTALITY; INFLUENCE OF SEX AND COLOR
Authors: BAUMGARTNER LEONA , PESSIN VIVIAN , WEGMAN MYRON E. , PARKER SYLVIA L. 
Published: December 2021

Analysis was made of 209,055 live births, 6978 fetal deaths subsequent to 20 weeks of gestation, and 5048 neonatal deaths, reported in New York City in 1939 and 1940. Comparison was made of fetal death rates per 1000 unborn children in each weight group by means of a modified life table method and of neonatal death rates per 1000 live births in each birth-weight group, for the two sexes and for the white and nonwhite races.
For all infants, fetal death rates, so calculated, are relatively low and neonatal death rates very high in the lower weight groups. Both rates go up sharply in the higher weight groups, indicating that infants much over average weight are not good risks.
Lower fetal death rates were observed for females in the weight groups below 3000 gm. and for males in the weight groups above 3000 gm. Neonatal death rates were lower for females throughout.
The implication appears to be that relative maturity is more important than size in regard to variation in fetal death rate.
Comparison by race indicates consistently higher nonwhite fetal death rates for nonwhite infants in all weight groups. Neonatal death rates were similar for white and nonwhite infants in the lower weight groups but higher for nonwhite infants in the upper weight groups. A study in 22 hospitals, giving presumably better care than the city-wide average, showed lower neonatal rates for the nonwhite infants in the lower weight groups. It is inferred that comparisons of observed mortality differences by race must consider differences between the races in regard to extrinsic factors such as economic status, nutrition and care.
For practical purposes a uniform criterion of birth weight, 2500 gm., should be maintained in the diagnosis of prematurity.
Using a method of combining fetal and neonatal mortality experience to measure the total risk to unborn children of different weights, it was possible to calculate "best birth weights." These were found to be about 120 gm. lower for female than for male, and about 160 gm. lower for nonwhite than for white births.
GLYCOGEN STORAGE DISEASE OF THE HEART
Authors: DI SANT'AGNESE PAUL A. , ANDERSEN DOROTHY H. , MASON HOWARD H. , BAUMAN WILLIAM A. 
Published: December 2021

Two cases of glycogen storage disease of the heart occurring in siblings are reported. The first patient died at the Babies Hospital in 1922 and the diagnosis was established at autopsy. The second patient was admitted in 1948 and died after 33 days in the hospital. The family history reveals that the mother of the two patients had eight other children, of whom two are suspected of having succumbed to the same condition.
Detailed clinical, chemical and pathologic studies were carried out on the second patient. Numerous chemical determinations were performed both before and after death.
The pathologic changes were characteristic of those previously described in cases of glycogen storage disease of the heart. Despite the name of the disease, the abnormal glycogen accumulation and the consequent altered cellular structure were not limited to the heart, but were found in many other organs and tissues of the body.
The chemical data revealed an apparently normal sequence of events in the mechanisms for carbohydrate metabolism that could be investigated. It was therefore hypothesized that the metabolic error lay in an excessive rate of accumulation of glycogen in the tissues. It was suggested that this might be consequent to the formation of a polysaccharide closely allied to glycogen, but differing from it in its chemical structure, or to inability of these patients to transform carbohydrate to fat.