bluuebunny/crossref_metadata_2025_split huggingface dataset:
DIAGNOSIS AND TREATMENT: MANAGEMENT OF THE CHILD WHO HAS HAD ONE CONVULSION
Authors: Carter Sidney 
Published: December 2021

FOR MOST PARENTS their child's first convulsion is a dramatic, frightening event which demands immediate medical attention. The physician, on the other hand, may see the patient after recovery from the attack and may tend to minimize the severity of the situation and assume a wait-and-see attitude before investigation and treatment are initiated.
The convulsion is a symptom that indicates a disturbance of cerebral neurones. This disturbance may be the result of underlying organic disease of the brain, either fixed or progressive, or it may be an indication of a functional disturbance related to a circulatory or metabolic disorder. The first attack may be so mild that the child is unaffected but subsequent attacks may be prolonged, or result in status epilepicus, and produce a mild or severe degree of mental impairment. There is considerable evidence to indicate that anoxia associated with convulsions can cause brain damage and for this reason every child who has had a convulsion should be investigated and, with rare exception, placed on prophylactic daily anticonvulsant medication when no specific treatable condition is discovered.
EVALUATION
The first step in the study of a child who has a convulsion is to document its occurrence. Anxious parents are, as a rule, poor witnesses. Despite this, every effort should be made to obtain a description of the seizure, particularly premonitory symptoms, loss of consciousness, convulsive movements, duration of the attack, and the state of the patient following the attack. In infants breath-holding spells may simulate convulsive seizures. In breath-holding spells there is always a precipitating factor, usually a slight injury or some emotional disturbance which results in violent crying, ending suddenly in respiratory apnea. The cyanosis in such attacks appears before the loss of consciousness and convulsive movements.
THE THYMUS AND OTHER LYMPHOID TISSUES IN CONGENITAL AGAMMAGLOBULINEMIA
Authors: Gitlin David , Rosen Fred S. , Janeway Charles A. 
Published: December 2021

The capacity to develop delayed hypersensitivity to Candida albicans, 2,4 dinitrofluorobenzene and 2,4 dinitrochlorobenzene was examined in a child with thymic alymphoplasia and congenital agammaglobulinemia, or congenital alymphocytosis, and in 7 patients with the nonlymphopenic form of congenital agammaglobulinemia. Delayed hypersensitivity to Candida albicans was also tested in 5 children with neither lymphopenia nor agammaglobulinemia. All of the 12 persons without lymphopenia demonstrated delayed hypersensitivity reactions to the intradermal injection of a Candida extract but the child with congenital alymphocytosis did not. Hyperergia to the halogenated dinitrobenzenes was induced in 5 of the 7 nonlymphopenic agammaglobulinemic patients, but could not be induced in the other 2 nor in the child with alymphocytosis.
Normal skin and thymic tissues transplanted to the child with alymphocytosis survived without evidence of rejection until the patient's death due to bilateral pneumonitis 40 days later, although there was some degeneration of the transplanted thymic tissue. The donor of the transplanted tissues proved to be hypersensitive to Candida, and 22 days after the homografting, the recipient was shown to have acquired this hyperergia. There was no improvement in the patient's condition nor was there a significant rise in circulating lymphocytes after the thymic implants.
The data suggest that the impairment in the capacity for the development of delayed hypersensitivity as well as the survival of the homografts observed in this child with thymic alymphoplasia may be attributable to the paucity of lymphocytes seen in this condition.
ATRIAL SEPTAL DEFECT IN INFANTS
Authors: Nakamura Frances F. , Hauck Anna J. , Nadas Alexander S. 
Published: December 2021

1. Ten patients between the ages of 5 months and 2 years with the secundum variety of atrial septal defect were diagnosed by cardiac catheterization.
2. The hemodynamic and physiologic data classically associated with secundum atrial defects were found except for the unexplained existence in two cases of a pressure gradient between the atria.
3. Most of these patients were relatively asymptomatic, and the few who developed congestive heart failure were controlled medically until the optimum age for elective repair was reached.
4. All 10 patients are alive at the time of this writing.
How Important Are Macroglobulin Antibodies to the Newborn Infant?
Authors: DAVIS STARKEY D. , WEDGWOOD RALPH J. 
Published: December 2021

In a letter to the editor in the February issue of Pediatrics (33:310, 1964), Rosen and Janeway suggested that infants dying from progressive vaccinia probably had the lymphopenic or athymic variety of agammaglobulinemia. Of interest in regard to this observation are recent reports of fatal progressive BCG vaccination in infants (Acta Paediat., 53:55, 1964). These cases also had hypoplasia of the thymus and agammaglobulinemia.
We would also like to comment on the paper by Rosen, Gitlin, and Michael in Pediatrics (31:197, 1963). The authors demonstrated (as have others) that antibodies in human serum against Gram-negative bacteria are almost entirely macroglobulins. Macroglobulins do not cross the placenta and are absent from the serum of newborn infants.
IMMUNOLOGICAL TOLERANCE AS A DEVELOPMENTAL PHENOMENON
Authors: Smith Richard T. 
Published: December 2021

MY ATTRACTION to research and to the general problems of resistance and immunity can be directly traced to events of an internship thirteen years ago when I was stimulated by the clinical problem of neonatal sepsis. In my first attempts to understand some of the underlying mechanisms, I was drawn irrevocably into the center of scientific ferment which was then growing in the Department of Pediatrics at the University of Minnesota. Here McQuarrie had brought under one roof, nearly simultaneously, Robert Good, Lewis Thomas, Chandler Stetson, Lewis Wannamaker, and Floyd Denny. To each of them, as teacher, colleague, and abiding friend, I acknowledge an enduring debt, for they exposed me to their imaginative ways of thinking habits of productivity, high scientific standards, and devotion to truth. My colleagues of the subsequent years—Robert Bridges, Donald Eitzman, John Robbins, and Joseph Bellanti—have each contributed their ideas, hard work, and enthusiasm to building the body of data for which this Mead Johnson Award is bestowed. We are signally honored and are sincerely grateful to the American Academy of Pediatrics and to the donors of the prize.
When the startling discovery of immunologic tolerance was made by Peter Medawar and his colleagues in 1953, our minds were prepared to accept the premise that profound immunologic deficiencies were characteristic of the neonatal period. The few clinical and experimental data available until then indicated clearly that the newborn infant was a poor antibody former, dependent upon an umbrella of transplacental antibody until the third or fourth month of life; that he was highly susceptible to bacterial and certain viral infections; and that he was deficient in localizing inflammatory stimuli. Medawar's disclosure was that perinatal injection of spleen cells from a donor mouse permanently endowed the recipient with a capacity to retain an otherwise unacceptable homograft. This experiment seemed to confirm the prediction of Sir McFarlane Burnet that foreign tissues or antigens which were encountered by the fetus during certain critical periods of development were endowed with self-markers of structural proteins, and, therefore, not recognized as foreign.
STUDIES OF SMALL INTESTINE DURING DEVELOPMENT
Authors: Sunshine Philip , Kretchmer Norman 
Published: December 2021

Five infants with intolerance to lactose or sucrose and one infant with intolerance to both lactose and sucrose have been studied. These infants were symptomatic with fermentative diarrhea, vomiting, and failure to gain weight. The tolerance of these patients to disaccharides was measured, and the sugar or sugars to which they were intolerant were removed from their diets. The infants began to gain weight as their diarrhea abated. After they were asymptomatic and thriving for a period of time, they were re-examined and were found to respond normally to the ingestion of disaccharides.
Disacchariduria was detected in 5 of the 6 infants during the acute period of their disorders, but not at the time of their reexamination. This finding is probably correlated to the amount of disaccharide ingested and the activity of the specific intestinal disaccharidase at the time of the test.
The clinical symptoms and signs of these patients with acquired intolerance to disaccharides were identical to those of patients with congenital absence of intestinal disaccharidases.
MEDICAL RESPONSIBILITY AND DRUG ADDICTION
Authors: Eisenberg Leon 
Published: December 2021

The dismaying extent of addiction among young people, the complexity of its causation, and the grossly unsatisfactory results from current methods of management are all sharply posed in the accompanying review by Freedman and Wilson. This thoughtful condensation of the available literature may disappoint those looking for neat and simple formulations as to cause or cure. Easy slogans and hoary nostrums abound; they lack only facts to support them.
The correlations between low socioeconomic status, membership in ethnic groups shut out from full participation in American society, and the prevalence of addictive practices point to social class factors as important determinants of the behavior patterns that eventuate in addiction; yet addiction is not universal among the disadvantaged and is being discovered to an increasing extent among privileged youth.
BODY TEMPERATURE AND SURVIVAL OF PREMATURE INFANTS
Authors: Day Richard L. , Caliguiri Lawrence , Kamenski Carolyn , Ehrlich Florence 
Published: December 2021

One hundred and twenty-five premature infants were divided into two groups, one being treated in incubators at an air temperature of 31.8°C (89°F) and the other in the same style of incubator, but with more careful regulation of body temperature by a radiant heat device actuated by a thermistor taped to the abdomen and set for 36°C (97°F). There was a trend toward lower mortality among the heat lamp babies which was present in males and females, whites and Negroes, and which was not related to an accidental distribution of high risk infants to the control group. The advantage was most pronounced among babies vaginally born in the vertex position between birth weights of 800 and 1,599 gm inclusive. The cause of the excess mortality was not revealed by autopsy data. The results confirm those of Silverman, but extend them in that his "normothermic" babies were in conditions similar to our cold or control babies.
The trends shown in this paper, taken in combination with those of the previous studies of Silverman, of Jolly et al., and of Buetow and Klein14 in this issue, point to the desirability of care in the control of the temperature of premature infants.
PLASMA AMINO ACIDS AFTER BIRTH
Authors: Ghadimi H. , Pecora P. 
Published: December 2021

The concentration of the free amino acids of plasma during the neonatal period were studied by ion-exchange column chromatography in infants born prematurely or at term.
In prematures the effects of 4% protein formula were compared with 2% protein formula. The changes in concentration at 1, 2, 3, and 4 hours postprandial were also studied in two prematures aged 10 and 25 days.
A wide range for most amino acids especially in the premature group was observed. Increased concentrations of tyrosine up to 26 mg/100 ml as late as the fiftyseventh day of life were noted.
A steady postnatal decrease for lysine, taurine, and threonine was found in the few days of life from the high cord blood concentrations toward the base-line values of infancy.
In Reply: Gastrostomy for Feeding Premature Infants
Authors: S. C. A. 
Published: December 2021

Dr. Keitel is comparing mortality in a selected group of infants (those chosen by Dr. Berg and his colleagues for gastrostomy after 24 hours of age) with that of infants in the same weight range but from an unselected group. Statisticians tell us such comparisons are not valid.
Neither Experience and Reason nor any other section of Pediatrics (except Letters to the Editor) is for the easy or careless publications of anything, whether intriguing but benign on the one hand, or potentially harmful on the other.
Rh Disease—Pregnancy Interruption
Authors: Bowman John M. 
Published: December 2021

May I comment upon the article "Rh Disease–Pregnancy Interruption" by T. R. Boggs, Pediatrics, 33:758, 1964.
Dr. Boggs uses past history alone in determining the value of early induction and indications for its use in Rh isoimmunization. For the past ten years, we have used past history of disease and antibody titer together in deciding the same thing, and since December, 1961, have added spectrophotometric examination of amniotic fluid as a third and most important factor in arriving at a prognosis of impending fetal death, before stillbirth makes any effort at salvage hopeless.
In Reply: Rh Disease—Pregnancy Interruption
Authors: Boggs Thomas R. 
Published: December 2021

I want to thank Dr. Bowman for his comments on my reporting of our experience in managing Rh-sensitized pregnancies. It is obvious, from his letter that Dr. Bowman and his co-workers are doing an excellent job in their efforts on behalf of the sensitized woman and her infant. It is gratifying to hear that he has met with greater success in the earlier terminations than we.
It is unfortunate if Dr. Bowman has gained the impression that we rely on maternal history alone in deciding which pregnancy to interrupt.
CHRONIC ACIDOSIS DUE TO AN ERROR IN LACTATE AND PYRUVATE METABOLISM
Authors: Israels S. , Haworth J. C. , Gourley Beth , Ford J. D. 
Published: December 2021

A description is given of two unrelated North American Indian children who, at 11 and 9 months of age respectively, were found to have metabolic acidosis, associated with a high concentration of lactate and pyruvate in the blood. Both children were mentally retarded, suffered from convulsions, and showed obesity and muscular hypotonia.
Liver glycogen disease, diabetes mellitus, and chronic hypoxia were excluded in both cases. Decreased removal of pyruvate and lactate from the blood due to some, as yet, undetermined metabolic block appeared to be the most likely causative mechanism. As well as a defect in the metabolism of lactate and pyruvate, evidence of an abnormality of α-keto glutarate metabolism was found in one case.
Letters to the Editor
Authors: FINBERG LAURENCE 
Published: December 2021

Dr. Jaffe is, of course, correct that it is often possible to culture H. pertussis from patients with whooping cough. Our statement in the paper referred to the facts as they are for our series, even though we regret the state of affairs.
We therefore very carefully listed the criteria by which the diagnosis was made in the absence of finding the specific etiologic agent. The method referred to by Dr. Jaffe for culturing the organisms was not the one that was employed by the Bacteriology Laboratory of the hospital.
Keeping Pediatricians in Practice
Authors: FAIGEL HARRIS C. 
Published: December 2021

I read with great interest the letter from Dr. Gould (Pediatrics, 33:789) regarding pediatricians and their practices, and I must agree wholeheartedly that the flight of pediatricians into other fields is a tremendous problem.
I cannot agree entirely with Dr. Gould's suggested changes. What he has described (skilled nurses doing routine care) is basically the feldscher system as it has operated in Russia since the days of the czars. Whether or not the American public would accept this is immaterial. What is really needed is a reappraisal of the reasons physicians become pediatricians and the training they take in preparation for practice.
INDICATIONS FOR OXYGEN THERAPY IN THE NEWBORN
Authors: Tizard J. P. M. 
Published: December 2021

IT IS ALWAYS a difficult task to praise famous men, the more difficult for me in the case of Dr. Blackfan since this particular Blackfan Memorial Lecture is also linked with the memory of Dr. Bronson Crothers. Dr. Wilson's admirable biographical memoir of Dr. Blackfan could bring him to life for the reader if anything could. Yet the fact is that I knew Dr. Crothers: I mourned his death and he is therefore as alive for me as if he was sitting in the front row lighting and relighting a much tortured pipe.
As you know, Dr. Crothers was to me a hero, as evidently was Dr. Blackfan to his students, yet in the schoolboy sense of the word he lacked one conventional attribute of heroism. I refer to the olympian attitude of mind which one is apt to expect from the favorites of the Gods and which was so conspicuous a part of the therapeutic armamentarium of the physicians of the nineteenth century and indeed some of them today. He was the antithesis of Robert Louis Stevenson's fashionable physician, Sir Faraday Bond, who as you may remember, would call you back even after you had paid your fee, to say with stentorian emphasis "I had forgotten one caution: avoid kippered sturgeon as you would the very devil." In his gentle way, Dr. Crothers spoke the truth to the parents of his patients; if they found it too uncomfortable they might leave him but they always came back eventually when they realized that it was on the basis of acceptance of the tragic fact of the permanency of brain damage that most could be done to help their children.
MORQUIO'S DISEASE
Authors: Schenk Eric A. , Haggerty James 
Published: December 2021

The radiologic and morphologic changes seen in a patient with Morquio's disease who came to autopsy are described and discussed. Pathologic changes were limited to cartilage and consisted of cytochemically definable lesions of the matrix characterized by the presence of amorphous and fibrillar lesions and the accumulation of foam cells. An abnormal accumulation of mucopolysaccharides in foam cells and cartilage matrix was present. No evidence of visceral storage of mucopolysaccharides, such as is seen in Hurler's disease, was present. In addition to Morquio's disease, this patient had a patent ductus arteriosus.
Clinical features and radiologic changes in an older living sibling, who has had Morquio's disease and is now apparently developing the Morquio-Ullrich variant, are described.
The Child Who Has Had One Convulsion
Authors: CASTIGLIONE JOHN B. 
Published: December 2021

Dr. H. Lester Medlinsky's letter (Pediatrics, 34:438, 1964) regarding his clinical experience with febrile convulsions certainly expresses a view with which I agree.
On the basis of my own experience, I have concluded that the course of simple febrile convulsions is altered by daily medication. Almost all of my patients who have been on daily medication have not had recurrences of the simple febrile seizures. I agree wholeheartedly with Dr. Medlinsky that the impact of a convulsive disorder on a family unit is profound and disrupting.
Hospitalization of Children
Authors: STRAUS PIERRE 
Published: December 2021

I would be very thankful if you would publish in your columns "Letters to the Editor" these few comments concerning hospitalization of children:
I have read with most interest Dr. Bongiovanni's Commentary (Pediatrics, 34:1) on the International Seminar on the Hospitalization of children as well as the letters of Dr. Wegman and of Dr. Meyer respectively published in the September and November issues of Pediatrics.
As my contribution to this Seminar has been partly the subject of the discussion may I add some comments:
THE BACTERIOLOGIC FINDINGS, STREPTOCOCCAL IMMUNE RESPONSE, AND RENAL COMPLICATIONS IN CHILDREN WITH IMPETIGO
Authors: Markowitz Milton , Bruton H. David , Kuttner Ann G. , Cluff Leighton E. 
Published: December 2021

1. Cultures of the skin, nares, and pharynx were examined in 303 children with impetigo. One hundred and seventy-two skin cultures were positive: 50 for beta hemolytic streptococci, 104 for coagulasepositive staphylococci, and 18 for both organisms. Beta hemolytic streptococci were present in nasopharyngeal cultures of 26 children, 18 of whom also had these organisms in the skin. Staphylococci were found in 114 cultures of the nares and in 58 children these bacteria were also present in the skin culture.
2. Of the 68 strains of beta hemolytic streptococci cultured from the skin, 53 were group A, one was group C, and 14 could not be grouped.
3. Only 4 of the group A strains were typable by the precipitin reaction. None of the strains were known nephrotoxic types. Twenty-one strains were typed by slide agglutination: 20 showed agglutination patterns considered to be characteristic of impetigo strains.
4. Twenty-five of 68 children with streptococci in the skin lesion had an elevated ASO titer. In 76 children with negative skin cultures, there was serologic evidence of streptococcal infection. On the basis of combined bacteriologic and serologic findings, 144 children (48%) with impetigo had evidence of streptococcal infection.
5. Ninety-nine of the 122 strains of staphylococci isolated from the skin and 86 of 114 strains cultured from the nose were phage-typed. Phage-type 71 was the most common typable strain from both sources.
6. At the first visit, 6 children had acute glomerulonephritis and 8 had microscopic hematuria. An additional 14 patients showed transient hematuria on follow-up examination.
7. The group of children with pure cultures of streptococci who received penicillin appeared to improve more rapidly than those who received only local treatment. On the other hand, in patients with mixed cultures of streptococci and staphylococci as well as those with pure cultures of staphylococci, there was no difference in response in those given penicillin as cornpared with those treated with ammoniated mercury.
8. In 5 children, microhematuria was not prevented by the administration of penicilun 7 to 10 days before the appearance of the abnormal urinary findings.
9. The strains of group A streptococci isolated from skin lesions showed several distinctive patterns by the slide agglutination technique similar to those observed by other workers. Also in accord with English investigators, one phage-type of staphylococcal predominated in the strains isolated from the skin lesions.
10. Abnormal urinary findings are cornmon in children with impetigo, but are usually not associated with infection with the known nephrotoxic types of group A streptococci.
Kernicterus in Small Premature Infants
Authors: STERN LEO , L. DENTON RONALD 
Published: December 2021

The hyperbilirubinemia of prematurity is considered to be the result of an immaturity of the glucuronyl transferase system in the liver. Although hyperbilirubinemia is common, kernicterus, in the absence of hemolytic disease is said to be rare. Thus, the indication for exchange transfusion in icterus of prematurity and the level at which it should be performed remain subjects for considerable difference of opinion.
We have recently observed the occurrence of six cases of kernicterus in small premature infants in the absence of hemolytic disease. There were five female and one male infants in the group. All six were premature, both by weight and gestational ages.