bluuebunny/crossref_metadata_2025_split huggingface dataset:
SURGICAL EXPLORATION IN OBSTRUCTIVE JAUNDICE OF INFANCY
Authors: Santulli Thomas V. , Harris Ruth C. , Reemtsma Keith 
Published: December 2021

From a review of 71 cases and an evaluation of frozen-section examinations of liver biopsies, the authors propose the following method of management of infants with prolonged obstructive jaundice.
All patients are carefully selected on the basis of history, clinical findings and appropriate laboratory investigation. Laboratory studies found to aid in the differential diagnosis are: serial determinations of bilirubin (conjugated and unconjugated) in the serum, zinc sulfate turbidity test, cholesterol and cholesterol esters in serum, estimation of bile pigment in urine and stool, studies of the maternal and infant blood factors and erythrocyte fragility. Determinations that have not been useful in the differential diagnosis are: cholesterol esterase, alkaline phosphatase and cephalin fiocculation.19 The activity of transaminases in the serum may prove helpful and are currently under study. The measurement of the prothrombin time should be included in the preoperative studies.
If the diagnosis is impossible by the age of 7 weeks, then surgical exploration is carried out. This consists of exposing the liver, taking a biopsy for frozen-section examination and performing a cholangiogram, if possible. With increasing experience, confidence has been acquired in interpretation of the frozen-section of the liver biopsy at this age. The authors are convinced of its value in helping the surgeon establish the diagnosis before proceeding with further exploration of the bile ducts.
By this method of management, surgical exploration need not be delayed beyond 7 weeks of age. Thus a patient with congenital atresia of the bile ducts, who may be fortunate enough to have a correctable lesion, will not be deprived of the only possible chance of cure. At this age it is unlikely that biliary cirrhosis will have progressed to a severe degree. Admittedly, it would be preferable to explore such a case earlier, but more experience is needed in diagnosis by frozen-section examination at an earlier age.
It does not appear that any patient with hepatitis or other non-surgical condition has been harmed either by the anesthesia or surgical trauma attendant on this limited procedure. One of the greatest advantages of the frozen-section examination has been the information provided to the surgeon at a crucial time during the exploration. With this information the surgeon should be able to avoid unnecessary exploration of the bile ducts and possible injury to patent ducts, as well as unnecessary biliary-intestinal anastomoses which have been performed in the past because of mistaken diagnoses.
THE RELATIONSHIP OF PULMONARY HYALINE MEMBRANE TO CERTAIN FACTORS IN PREGNANCY AND DELIVERY
Authors: Cohen Myron M. , Weintraub David H. , Lilienfeld Abraham M. 
Published: December 2021

A review of neonatal mortality at the Maternity Division of the Buffalo Children's Hospital from 1948 to 1957 has been presented, with primary emphasis on the occurrence of pulmonary hyaline membrane.
During this period there were 26,109 infants born alive, including 2,001 below 2,500 gm in weight, a prematurity rate of 7.7%.
Using a factor to correct for dead infants not necropsied, an incidence of hyaline membrane of 39.1 per 1,000 live-born prematures and 0.7 per 1,000 live-born full-term infants was obtained. These rates are compared to those previously reported.
Among singleton infants under 2,500 gm birth weight the frequency of hyaline membrane was greater for those infants born to mothers with either bleeding or toxemias as complications of pregnancy. An increased rate among premature infants delivered by cesarean section was also obtained, but this increase was limited to those pregnancies with bleeding.
Infants delivered of mothers with a history of prior stillbirths had a nearly three-fold greater incidence rate of hyaline membrane than did those mothers without such history. However, mothers with previous premature births or miscarriages did not show this increase.
The suggestion is advanced that hyaline membrane, and perhaps other instances of respiratory distress of the newborn, may result from a process of intrauterine asphyxia, which in many instances is manifested also by maternal bleeding.
Present status of the prevention of neural tube defects
Authors: Nadler Henry L. 
Published: December 2021

During the past two decades, a number of dramatic changes have taken place in the treatment of infants born with myelomenmgocele. Since the development in the 1950's and early 1960's of more effective methods for treating hydrocephalus, urinary incontinence, and paraplegia, aggressive treatment regimes have been initiated. Numerous articles and editorials have questioned these various treatment modalities based on the lack of objective long-term studies documenting their effectiveness. More recently, dissatisfaction with the results of current surgical prodecures for children with myelomeningocele has led to the development of selective criteria for early treatment.1,2
The purpose of this commentary, however, is not to discuss the merits of selective treatment for myelomeningocele but rather to discuss some of the recent developments for the prevention of this disorder.
EMPATHY AND REPRESSION
Authors: Vaux Kenneth 
Published: December 2021

Today's physician and scientist, indeed any human, faced with a malnourished child or a young adult dying from leukemia cannot accept [a] verdict of resignation . . . Consider the following: the delicate decisions requiring a balancing of needs against limited resources, decisions of triage and priority; decisions to impede, accelerate or merely attend a patient in the dying process.
In these cases the ability to understand the conflicting values of hope and resignation is necessary to avoid two unfortunate responses. On the one hand there is empathy that can foster debilitating guilt; the biologist Gilbert Hardin has pointed up in recent papers the destructiveness of thoughtless benevolence. On the other hand there is that systematic repression that slowly renders one an automation without conscience. Those forced to render decisions in medicine must delicately transact the tension between hope and resignation.
A NATIONAL HEALTH PROGRAM: ORGANIZED DIVERSITY
Authors: Starr P. 
Published: December 2021

The pivotal long-range question in medical reform is whether medicine should be viewed as a technical activity with occasional moral or social overtones or, alternatively, as a social and moral activity with a technical substratum. Is . . . medical care . . .more like the supply of water or the provision of education?
If medical care is ultimately a technical activity like water supply, its management can be safely entrusted to experts in the field.
If, on the other hand, medical care is primarily a moral and social activity like education, the situation is quite different . . . . Consequently, in organizing our institutions, we have good reason to provide for both participation and diversity. We may also wish to sacrifice some of the "efficiency" of a single, professionally run system for the relative inefficiency of variegated institutions sometimes in conflict with one another.
In the system advocated . . . the government would pay the basic annual cost, although families would choose to spend more for additional services.
What I am proposing here is an organized system that uses competition in a premeditated fashion: competition under constraint.
Children Out of Step With Immunization
Authors: Phillips Carol F. 
Published: December 2021

From the many studies cited several points can be seen.
(1) Diphtheria and tetanus are good immunizing agents which produce long-term immunity. (2) A series of two diphtheria-tetanus plus a booster one year later is adequate for basic immunization. (3) Two injections of pertussis at least 60 days apart produce levels of agglutinin that are equal to the amount produced by three injections. (4) Prolonged time between the injections of the basic series of diphtheria-tetanus does not interfere with the final immunity. There is no need to "restart" a DPT series. (5) After the basic series and booster a DT every ten years is adequate to preserve immunity. (6) A series of two trivalent oral polio doses eight weeks apart and a booster one year later is adequate for basic immunization. (7) Live viral vaccines can be given together, and, if desired, oral polio, smallpox, measles, and mumps can be given simultaneously.
For a child over the age of 1 year who has had no immunizations, the following schedule could be utilized. First visit: DPT (or DT), trivalent polio, tine test; two months later: DPT (or DT), trivalent polio, measles; and one year later: DT, trivalent polio. If desired, mumps and rubella can also be given at the time of the second visit. With current information available, it is now possible for us as physicians to adequately immunize in three visits the child who is out of step with immunization.
Comments on a Startling Article: "Loss of Limb Following Intravenous Diazepam"
Authors: Tassinari C. A. , Roger J. , Dravat C. , Gustaut H. 
Published: December 2021

Referring to the article "Loss of Limb Following Intravenous Diazepam,"1 we would like to comment on two points, one related to the case itself and the other concerning the use of diazepam in status epilepticus.
Concerning the case reported by Drs. Schneider and Mace, it is a matter of an injection during status epilepticus of "2 ml containing 10 mg of diazepam (Valium), intravenously in the volar aspect of the left wrist," followed by hand and forearm necrosis due to the thrombosis of the ulnar radial and brachial arteries which necessitated amputation above the elbow six days later.
Ileoscopy in the Diagnosis of lleal Lymphosarcoma
Authors: Katz Seymour , Katzka Irwin , Schneider Keith , Silverberg Mervin 
Published: December 2021

Recent advances in flexible fiberoptic endoscopy have permitted direct visualization of segments of the gastrointestinal tract hitherto considered inaccessible. Preoperative diagnoses of diseases of these areas are subject to the vagaries of roentgen interpretation. The following case report illustrates the value of the colonoscope in distinguishing intralumenal ileal neoplastic disease from an inflammatory process (e.g., ileitis, appendiceal abscess).
CASE REPORT
W. M., a 15-year-old white youth, was referred for eveluation of intermittent lower abdominal pain of six weeks' duration. Prior to his admission, he experienced cramping abdominal pain, fever, cough, emesis, and diarrhea. This gradually abated, leaving a residuum of recurrent abdominal pain which was relieved partially with fiexion of the right thigh.
A Case of Down's Syndrome Complicated by Retinoblastoma and Celiac Disease
Authors: Bentley Donald 
Published: December 2021

The association of retinoblastoma with Down's syndrome has been described previously but the incidence of these two conditions coupled with celiac disease is either rare or such cases are not being cited in the literature. I have not to date seen a case reported of celiac disease and mongolism and so wish to describe the problems of a male mongoloid with these conditions.
CASE REPORT
At the age of 2 years he was noted to have a moving opacity behind his right pupil with a grey reflex. As a consequence of these ominous findings, the eye was enucleated for a suspected tumor and pathology confirmed a retinoblastoma endophytum with seedling deposits scattered throughout the vitreous and anterior chambers.
A Plea for Facts, Not Opinions
Authors: Martin Lester W. 
Published: December 2021

Some of the opinions expressed by Lattimer et al. in the January 1974 issue of Pediatrics, regarding the time to operate for cryptorchidism, are based on personal opinion rather than scientific fact, and are therefore open to serious question.
The concept of treating "migratory testes" or "bashful testes" with hormone injections would appear unwise. On the basis of a personal experience over a 20-year period with approximately 500 patients with this condition, not a single testis has been encountered which failed to descend of its own accord at the time of puberty.
SCHOOLS AND AUTHORITY
Authors: Postman Neil , Weingartner Charles 
Published: December 2021

If you go through the daily papers and listen attentively to the radio and watch television carefully, you have no trouble perceiving that our political and social lives are conducted to a very considerable extent, by people whose behaviors are almost precisely the behaviors their school environments demanded of them. We do not need to document for you the pervasiveness of dogmatism and intellectual timidity, the fear of change, the ruts and rots caused by the inability to ask new or basic questions and to work intelligently toward verifiable answers.
The best illustration of this point can be found in the fact that those who do question must drop out of the "Establishment." The price of maintaining membership in the establishment is unquestioning acceptance of authority. acceptance of authority.
Frequency of tuberculin testing
Authors: Steigman Alex J. , Kendig Edwin L. 
Published: December 2021

In a statement from the Section on Diseases of the Chest of the American Academy of Pediatrics entitled "The Tuberculin Test,"1 the second paragraph of a comprehensive article begins as follows: "A routine tuberculin test should be performed sometime during the first year of life and annually or biennially thereafter."
This recommendation for the frequency of routine tuberculin testing differs from that currently proposed by others.
The same issue of Pediatrics contains an article by Dr. Phyllis Q. Edwards entitled "Tuberculin Testing of Children."2 The Summary of the article states "The pediatrician should review and analyze tuberculin test results based on his personal experience.
"THINGNESS"
Authors: Postman N. , Weingartner C. 
Published: December 2021

The structure of our language is relentless in forcing upon us "thing" conceptions. In English, we can transform any process or relationship into a "thing" by the simple expedient of naming "it" into a noun.
We have done this with "rain" and "explosions," with "waves" and "clouds," with "thought" and "life." Professor Allen Walker Read in researching the origin and uses of the word "psychosomatic" provides us with a recent example. The word was evidently coined to express a relationship and process, explicitly to deter us from thinking that illness can always be categorized as either physical or mental. What happened is typical. We began to use "psychosomatic" as a synonym for "mental." ("Give it to me straight, Doc. Am I sick or is it only psychosomatic?")
Even the term "the whole child," in spite of its good intentions is as static a metaphor as any of the others. "Child" is a "thing" word, and there is no stage of human growth that is more visibly a process than "childhood."
The Pediatric Internship as a Teaching Technique: A Comparison of Learning Experiences in Five Hospitals
Authors: Roghmann Klaus , Pizzo Philip , Graham Elinor , Graham David , Guyer Bernard , Harris Peter 
Published: December 2021

Five interns joined in a collaborative study to assess their learning experiences during the internship year. A 3x5-inch data form was completed for each patient for whom the intern was responsible. Information was gathered on demographic characteristics of the patient, the teaching that involved this patient, and what skills were acquired.
Nearly 30% of the patients were under 1 year of age; 55% were boys. More than one half of the contacts were in an outpatient or emergency department. Over 80% of the patients had not been seen before; continuity patients made up less than 9% of the contacts. Well-child care was the largest care category (19%), followed by respiratory problems (15%) and injuries (9%).
About 40% of the contacts involved a teaching input, mainly from residents, attending physicians, and faculty. Care skills most frequently acquired were physical examination (49%), reading (15%), and interviewing (11%). Crosstabulations showed that most learning was reported for inpatients, for patients with rare diseases, and when some teaching was involved.
A Different View of the Facts
Authors: Demetrakopoulos George E. 
Published: December 2021

In response to the article, "Why Circumcision," where the authors conclude that "the medical and economic advantages of neonatal circumcision far outweight the disadvantages tages,"1 I would like to review their arguments.
Medical Reasons—The authors assert that "In 1942 Ravich postulated that circumcision decreased the incidence of cervical cancer and prostatic cancer."Dr. Ravich's "statistics are as follows:
"In a survey of the prostatic operations performed by me from 1930 to date (1942) . . . on patients whose religious status was readily available to me, the following ...reveals very interesting data" [tabulation summarized from Ravich]:
Propranolol-Augmented, Exercise-Induced Human Growth Hormone Release
Authors: Maclaren Noel Keith , Taylor Glen Edward , Raiti Salvatore 
Published: December 2021

Serum growth homone (HGH) responses to 20 minutes of exercise 90 minutes after orally given propranolol (0.5 mg/kg; maximum, 40 mg), were assessed in 15 short but otherwise normal children, in 2 obese teen-agers, in 3 hypopituitary children, and in 8 healthy adult volunteers. In six adults HGH responses to exercise alone were also assessed one week previously.
Normal children responded with a peak serum HGH concentration of 10 ng/ml or greater, except one whose peak was 7 ng/ml (normal,7 ng/ml). The obese girls showed smaller responses to exercise with propranolol (ex/prop) (peak HGH, 6 ng/ml), to hypoglycemia, and to levodopa (peak HGH, 7 and 4 ng/ml). The three hypopituitary children did not respond to ex/prop or to two other stimuli. In the volunteer adults, the mean HGH responses were greater to ex/prop than to exercise alone, although two out of six did not have increased levels with exercise. There were also elevations of fasting serum HGH levels before exercise and propranolol on repeat testing.
These results suggest that orally given propranolol improves the exercise-HGH stimulation test both in the number of responders and in the degree of response. Some individuals have an anticipatory HGH secretion before exercise due to a conditioned response.
"Family Practitioners" and Pediatrics
Authors: Bloom Henry Robert 
Published: December 2021

I am a second-year resident in family practice who has been reading Pediatrics since medical school. More and more, especially with the new "Pediatrics for the Clinician" series" series, it is a journal of distinct value to those who deal with children in primary care. As such, I have recommended it to many other students, interns and residents, in family practice and in pediatrics.
I think, though, that the references to the "unique position" of pediatricians as primary care practitioners for children should not go without remark.
Etiology of Respiratory Tract Infections in Children in Cali, Colombia
Authors: Escobar Jorge A. , Dover Arthur S. , Dueñas Alvaro , Leal Ermilson , Medina Pablo , Arguello Antonio , de Gaiter Mercedes , Greer Donald L. , Spillman Rupert , Reyes Marco A. 
Published: December 2021

One hundred eighty children hospitalized for acute respiratory disease were studied in Cali, Colombia. In the majority of patients, pneumonia was the reason for hospitalization and remained the final diagnosis. Fifty-one cases of pneumonia of indeterminate etiology comprised the largest single diagnostic category, followed by 38 cases of pneumonia associated with measles, and 22 cases associated with serologic evidence of infection with other viral agents or Mycoplasma pneumoniae.
Etiologic diagnosis could be assigned with a reasonable degree of confidence in 116 of the 180 patients (64%). The laboratory procedure found most likely to provide the etiologic diagnosis in this series was paired sera specimens for demonstration of rise in antibody titer against the common viral respiratory pathogens. Those most frequently implicated serologically as etiologic agents in the cases studied were, in order of decreasing frequency, measles, influenza, parainfluenza, and adenoviruses.
Dr. Grossman Replies
Authors: Grossman Herman 
Published: December 2021

I appreciate Dr. Scheidt's concern about the use of diagnostic ultrasonography. However, I do not think his statements negate any part of the report on ultrasonography in children by the Committee on Radiology.1
Dr. Scheidt refers to neurological lesions being caused by ultrasound in the treatment of Meniere's disease; the level of ultrasound used for patients with Meniere's disease is much greater than for diagnostic ultrasonography. The level of pulsed ultrasound used in diagnostic work is many times less than that for any measurable effects.2
Comments by Drs. Soyka and Neese
Authors: Soyka Lester F. , Neese Allen L. 
Published: December 2021

In response to the letter of Drs. Ivey and Kattwinkel pertaining to the safety and efficacy of Actifed-C, we would like to make the following points.
The definition of a therapeutic serum level for codeine is difficult at present. Table I contains a tabulation of the three studies in adult patients we could find in the literature and depicts this problem. The 700-fold range in serum levels shown renders any sort of therapeutic range based on these data meaningless.
Questions Regarding Arginine Hydrochloride Inhalation
Authors: Solomons Clive 
Published: December 2021

With regard to the recent study of Dietzsch et al.1 on the use of arginine hydrochloride inhalation in cystic fibrosis patients, I wish to point out that these investigators acted irresponsibly in exposing their patients for an appreciable period (seven weeks) to a preparation which is known to be irritating. They chose to disregard published instructions which are devised to protect the patients.2 Specifically, they used sodium hydroxide instead of arginine free base for neutralization to obtain a solution which was about three times as acid at pH 7.0 as the recommended solution (pH 7.4 to 7.6).
In addition to exposing their patients to this hazard, they also leave the reader with the mistaken impression that the previously reported arginine treatment is dangerous or ineffective.
Drs. Russo and Gururaj Reply
Authors: Russo Raymond M. , Gururaj Vymutt J. 
Published: December 2021

The involvement of health care providers, whose patient records are to be reviewed, in evolving a set of audit criteria would appear to be an important compliance determinant. And, while its degree of importance remains to be determined, ideally all providers should be involved in creating self-audit criteria.
There is, however, an issue of practical importance that arises when large staffs are to be audited, and particularly when a part of this staff is assigned only temporarily to the outpatient service, e.g., house staff officers or medical students.
Comment on Commentaries
Authors: Schowalter John E. , L. J. F. 
Published: December 2021

After savoring the commentaries which inaugurate the March 1975 issue of Pediatrics, I am moved to respond. These parsimonious but learned callings of attention to important issues in pediatrics provide a very useful service, and I wish to cast an enthusiastic vote for this increasingly important section. Keep up the good work.
Editor's Note: It is nice to have compliments. We will continue to try harder.