bluuebunny/crossref_metadata_2025_split huggingface dataset:
SERIOUS UNTOWARD REACTIONS TO THERAPY WITH CORTISONE AND ADRENOCORTICOTROPIN IN PEDIATRIC PRACTICE (PART I)
Authors: Good Robert A. , Vernier Robert L. , Smith Richard T. 
Published: December 2021

THE INTRODUCTION of cortisone and adrenocorticotropin (ACTH) into clinical medicine by Hench et al. has profoundly influenced both medical practice and medical science. Voluminous literature which has collected during the 5 years since their introduction establishes securely the effectiveness of these hormonal agents in diseases previously refractory to medical management.
In the laboratory these drugs have also opened whole fields to investigation with a new experimental approach. Data already available suggest that ultimate discovery of the basis of the action of cortisone and ACTH will carry broad inmplications concerning physiologic function and mechanisms of disease.
A natural consequence of the introduction of such potent and versatile weapons into clinical medicine is that they should be widely used. In almost every human disease, ranging from the common cold to disseminated malignancy, the steroid hormones and ACTH have been tried. For example, it can be factually stated that few truly ill patients reach the diagnostic medical center without having had at least small amounts of cortisone or ACTH, and it is the extremely unusual patient who reaches the necropsy table without the "benefit" of ACTH, cortisone or one of its analogues.
As these drugs have been studied, it has become ever more apparent that they are extraordinarily potent pharmacologic agents which effect or control mammalian physiology in multitudinous areas, perhaps in several different ways. More gradually it has been realized that their effects are not all beneficial. Because of enthusiasm engendered by the availability of potent new pharmacologic agents, reporting from most clinics to date has emphasized the dramatic beneficial effects and tended to minimize the untoward side effects, toxic reactions and potential hazards of hormone therapy.
It is the purpose of this report to review some of the hazards of treatment with cortisone and ACTH in pediatric practice.
A COMPARISON OF ORAL AND INTRAMUSCULAR BENZATHINE PENICILLIN G FOR THE PREVENTION OF STREPTOCOCCAL INFECTIONS AND RECURRENCES OF RHEUMATIC FEVER
Authors: Markowitz Milton , Ferencz Charlotte , Bonet Alberto 
Published: December 2021

The incidence of recurrences of rheumatic fever and streptococcal infections in 50 rheumatic subjects receiving a 200,000 unit tablet of benzathine penicillin G daily was compared with that of 56 rheumatic patients receiving 1,200,000 units of benzathine penicillin G intramuscularly every 4 weeks.
Three children in the oral penicillin group, who did not take their medication regularly, developed recurrences of rheumatic fever. No recurrences occurred among the patients receiving parenteral penicillin.
In patients who took the oral medication regularly, the incidence of streptococcal infections, as determined by a significant rise in antistreptolysin O titer, was the same as in those who received penicillin intramuscularly. Group A streptococci were found in the throat in about the same number of patients in each group.
Only one patient receiving oral penicillin developed an allergic reaction in contrast to four in the intramuscular group. In 12 additional patients in the latter group, medication was discontinued because of repeated local reactions or because the injections upset the child emotionally.
During the period of this study, in children followed in an outpatient clinic, a single daily dose of oral benzathine penicillin G, taken regularly, proved as effective in the prevention of rheumatic fever as monthly intramuscular injections of 1,200,000 units of benzathine penicillin G. The disadvantage of parenteral penicillin is the occurrence of reactions. While the use of this method is preferable for patients who cannot be relied upon to take oral medication regularly, its routine use for all patients does not appear necessary.
STUDIES OF RESPIRATORY INSUFFICIENCY IN NEWBORN INFANTS
Authors: Miller Herbert C. , Smull Ned W. 
Published: December 2021

Serial measurements have been made of the resting tidal and minute volumes and respiratory rates on 40 premature infants during the first 2 weeks after birth.
The 40 infants were divided into three groups according to the trend of their respiratory rates. Infants whose respiratory rates were normal from birth (Group I) had the highest mean resting tidal volumes during the first 2 weeks. Mean resting tidal volumes were significantly lower throughout the first week among infants whose respiratory rates were initially high during the first hour and subsequently declined to normal (Group II) and among infants whose respiratory rates significantly increased after the first hour (Group III). Infants in Group III had the lowest tidal volumes and the most severe degrees of respiratory insufficiency. The mean resting tidal volume among infants in Group III was less at the end of the first week than that of infants in Group I at the end of the first day. Although tidal volumes in infants in Group II were in general much lower than normal the first few days after birth, exceptions to this rule may occasionally be encountered.
Although all three groups showed an increase in mean tidal volumes of about 25% at the end of 24 hours over the volumes obtained during the first 3 hours after birth, the respiratory rates were different. In Group I the increase in tidal volume was accompanied by no significant change in respiratory rate; in Group II, by a significant decrease in respiratory rate; in Group III, by a significant increase in respiratory arte. During the second day Group III showed clinical improvement accompanied by a significant decrease in mean respiratory rate but not by any significant increase in mean tidal volume.
Fluctuations in mean minute volumes in Groups II and III on the first 2 days were largely dependent on changes in respiratory rates.
PHYSICOCHEMICAL DIFFERENCES OF MUCOPROTEINS IN DUODENAL FLUID OF PATIENTS WITH CYSTIC FIBROSIS OF THE PANCREAS AND CONTROLS
Authors: di Sant'Agnese Paul A. , Dische Zacharias , Danilczenko Antonina 
Published: December 2021

An abnormality of mucous secretions has been postulated repeatedly in order to explain many of the pathologic findings and clinical symptoms of cystic fibrosis of the pancreas. However, little evidence in support of this hypothesis has been forthcoming heretofore. Investigations reported in this paper have shown that the mucoproteins in duodenal fluid obtained from patients with cystic fibrosis of the pancreas have a different physicochemical behavior as compared with a group of controls.
In 89 out of 92 normal individuals and patients (children and adults) with a variety of disease the mucoproteins of duodenal contents after precipitation with an ethanol-benzene mixture were completely soluble in water. In 58 out of 64 patients with cystic fibrosis of the pancreas a considerable part of the precipitated mucoproteins was not soluble in water. This water-insoluble fraction could not be brought into solution by the action of trypsin, but dissolves in 1N NaOH after heating.
The water-insoluble mucoprotein was present in the duodenal contents of all patients with cystic fibrosis of the pancreas who also had pancreatic achylia, and in 8 of 14 patients with cystic fibrosis of the pancreas who had retained a significant degree of pancreatic function. Absence of a water-insoluble mucoprotein from the duodenal contents of 6 of the 64 children in whom the diagnosis of cystic fibrosis of the pancreas was established may be explained on the variablity of involvement in this disease.
The fact that a water-insoluble mucoprotein was recovered from the duodenal contents of three patients in whom the diagnosis of cystic fibrosis of the pancreas could not be established calls for additional observation; it is still possible that some or all of these three cases actually have this disease in an unrecognized form.
Complete correlation has not been demonstrable between the presence of water-insoluble mucoprotein in the duodenal contents and the fully established clinical and laboratory picture of cystic fibrosis of the pancreas. Lack of complete correlation does not interfere to an important degree with the usefulness of the determination of the solubility of the mucoprotein fraction of the duodenal content as a diagnostic measure.
SERIOUS UNTOWARD REACTIONS TO THERAPY WITH CORTISONE AND ADRENOCORTICOTROPIN IN PEDIATRIC PRACTICE (PART II)
Authors: Good Robert A. , Vernier Robert L. , Smith Richard T. 
Published: December 2021

The problem confronting the pediatrician who considers the use of ACTH and cortisone in treatment of a patient is considered.
Serious untoward side reactions observed in the treatment of 340 children with ACTH and adrenocortical hormones are documented.
Potential hazards of treatment with ACTH and adrenocortical hormones, not yet expressed clinically, are indicated.
The implications of these observations in the use of ACTH and steroid hormones in clinical pediatrics are considered.
COMMITTEE ON NUTRITION
Authors:   COMMITTEE ON NUTRITION, American Academy of Pediatrics, Inc.
Published: December 2021

THE DEMONSTRATION of the importance of the content of solutes in the food of infants has introduced a new and important consideration in infant feeding. It is now apparent that a formula or diet satisfactory in all other respects may, under certain circumstances, be detrimental to the infant because of the excessive load of solutes presented to the kidney. Such circumstances include principally the feeding of unusually large amounts of electrolytes and protein to normal infants exposed to relatively high environmental temperatures for prolonged periods of time or to infants with renal insufficiency.
The purpose of the present communication is to consider whether any practical advantage is achieved by feeding a normal infant, in a normal environment, a formula containing fewer solutes or relatively more water than are contained in one composed of cow's milk and carbohydrate in the usual proportions, fed at a concentration of 150 ml/100 cal (20 cal/oz). From this point of view the question can be raised as to whether there is any advantage in feeding unusually dilute formulas to newborn infants.
Origin of the Renal Solute Load
The load of solutes requiring excretion by the kidneys is derived almost entirely from the protein and electrolyte in the diet. In Table I the content of nitrogen and electrolytes is listed for human and cow's milk. Also given in the table are calculated values for the approximate quantity of solutes requiring excretion by the kidney. It will be noted that an infant receiving 133 cal/kg from human milk would be required to excrete 14.0 m0sm/kg/day while an infant receiving 133 cal/kg from whole cow's milk without added carbohydrate would be required to excrete 60.9 m0sm/ kg/day. Furthermore, it is apparent that an infant receiving two-thirds of the calories from cow's milk and one-third from added carbohydrate would need to excrete only two-thirds the quantity of solutes excreted by the infant fed cow's milk without added carbohydrate (2/3 X 60.9 = 42.7 m0sm/kg/day).
SKIN TURGOR AS A QUANTITATIVE INDEX OF DEHYDRATION IN RATS
Authors: Laron Zvi , Crawford John D. 
Published: December 2021

ADMISSIONS to hospitals in many areas of the world are still composed to a great extent of infants with severe dehydration secondary to diarrhea, vomiting, heat prostration and the like. Laboratory facilities are sometimes unavailable; frequently even when at hand, their analytic results are not returned with sufficient promptness to help in the initial therapeutic decisions. Thus, there are needed easy and at least semiquantitative methods of estimation of the extent of dehydration. Preferably these methods should be such that they can be carried out at the patient's bedside.
In pediatric and medical textbooks1-3 loss of skin turgor is often mentioned as a sign of dehydration. Apparently few efforts have been made to see whether there is a quantitative correlation between changes in skin turgor and extent of water boss. In the experiments to be reported, skin turgor has been quantitatively related to the extent of dehydration in rats. The correlation has been studied in two types of deficiency state, primary water depletion with relatively small loss of solute and, alternatively, primary solute depletion with concomitant water deficiency. The results obtained suggest that a standardized clinical technique of estimation of skin turgor may be of value in assessing degrees of dehydration and fill the aforementioned need for a simple bedside index.
MATERIAL AND METHODS
Albino rats weighing 230 to 310 gm were used. Two groups were studied: Group I consisted of 36 rats dehydrated for periods up to 50 hours by simple water deprivation, dry rat chow* being offered ad libitum meanwhile in order to reduce weight loss from inanition.
SKIN TURGOR AS A QUANTITATIVE INDEX OF DEHYDRATION IN CHILDREN
Authors: Laron Zvi 
Published: December 2021

SKIN TURGOR measured quantitatively in rats with induced dehydration, has been demonstrated to vary with the degree of dehydration. However, two different correlations have been found depending on whether dehydration was primarily due to water loss or primarily due to loss of electrolyte as well as water.1
The present study was undertaken in an attempt to evaluate the application of this simple measurement to children. In the following report, the correlation of skin turgor time and degree of dehydration in children with primary water depletion and in children suffering from diarrhea are presented.
MATERIAL AND METHODS
The patients studied form two groups. The age distribution and the size of the groups are shown in Table I.
The patients in the first group were infants with diarrhea who were admitted to the isolation ward of the Children's Hospital of Pittsburgh during the winter of 1956. Determinations of the weight, skin turgor, concentrations of electrolytes in serum and nonprotein nitrogen in the blood were made before therapy with fluids was begun and afterwards at various intervals, usually 12 and 24 hours. Change in weight was used as an index of change in hydration. Normal weight was considered to be the weight achieved after complete rehydration as judged by clinical state and "plateauing" of the rapid weight gain. This method of assessment correlated well with the data obtained on three of the patients who happened to have been weighed by their own physician prior to their illness. Patients in whom complete rehydration was not achieved in 36 to 48 hours after admission to the hospital were excluded from this study.
THE RHEUMATIC CHILD AND HIS WORLD
Authors: Galdston Iago 
Published: December 2021

IT IS PROVERBIAL that a fool can ask more questions than a wise man can answer. It is not proverbial that for the question-asking fool there is some hope and for the others, none. Now it is my intention on this occasion to play the fool awhile, to ask a great number of questions, and I cordially invite you to join me in this game.
I want to inquire into The World of the Rheumatic Child, into his internal as well as into his external world, or, as Claude Bernard has phrased it, into his milieu interieur and into his milieu exterieur. Now there is some method to my folly, and it amounts to this. We know a great deal about the disease rheumatic fever and about its devastating effects within the body of its victim. But we do not know a great deal, indeed only a very little, about the victim within whose body the disease effects its devastations. I said—we know a great deal about the disease itself. In preparation for this talk I "re-surveyed the literature" and I found it, as I have known it to be, not only enormous in quantity but most impressive in quality. It is literally studded with masterpieces of etiologic research, of clinical surveys, of pathologic studies, of follow-up surveys, of epidemiologic analyses, and of therapeutic enterprises. In my review of the literature I came upon some old and esteemed friends whose works I had witnessed "in the making," the studies, for example, of Wyckoff, and those of Alfred Cohn; Claire Ling's penetrating statistical analyses, Pearl Raymond's biologic speculations, May Wilson's classical and encyclopedic résumé of knowledge—and upon a host of others, too numerous, really, to catalogue.
TREATMENT OF AN INFANT WITH PAROXYSMAL AURICULAR TACHYCARDIA
Authors: MOORE ROBERT L. 
Published: December 2021

Paroxysmal tachycardia occurs more frequently in infants, than is generally recognized; and, undoubtedly, is frequently misdiagnosed.
A case is reported of an infant who had 31 attacks of paroxysmal tachycardia between the ages of eight days and five and a half months. Many of the paroxysms would not stop spontaneously and heart failure would occur.
Quinidine, acetyl-beta-methylcholine, and digitalis were all found to be effective in controlling the attacks. The first two seemed to be more effective than the last. Because of the violent reaction to acetyl-beta-methylcholine, it is thought best to use this method only if the other two fail to bring relief.
Round Table Discussion
Authors: MCBRYDE ANGUS , MULHERIN PHILIP A. , HARRIS JEROME S. , LONDON ARTHUR H. 
Published: December 2021

Chairman McBryde: Diarrhea is a symptom which may result from many causes. For the sake of simplicity let us state that it may be due to (1) enteric infections, notably the dysentery and salmonella groups, (2) to parenteral infections, and (3) the absence of those factors which result in the relative freedom from severe diarrhea in the private patient group. These factors are proper food, as to quantity, quality, and clean preparation, reasonable clothing, adequate vitamin intake, regularity of schedule, regular advice as to feeding, and the tendency to seek medical advice at an early hour. These factors often do not obtain in the rural and lower economic classes due to ignorance, to lack of cleanliness and to the remoteness or non-availability of medical advice and hospital facilities. I would like to show the following slides concerning the incidence of diarrhea.
Slide #1 is taken from reports of the Bureau of Census and is probably grossly inaccurate. Nevertheless it shows the general trend of infant mortality rates due to diarrhea and enteritis under one year of age in the United States. There has been a steady decrease in the death rate from diarrhea and enteritis under one year of age from a level of 44 per 1000 population in the ago group in 1900 to only 4 in 1940. Many of the data here are from estimated figures. The roles played by the development of logical infant feeding with clean milk, education of the public, increased medical knowledge, and availability of medical care need not be commented upon.
The following table shows the infant mortality (death under 1 year per 1000 living births) from diarrhea and enteritis for individual states for the year 1940, exclusive of reported cases of dysentery, and is quite instructive. Lack of proper bacteriologic studies again cloud the data. It can be seen, however, that we are in an appropriate area for the discussion of the management of diarrhea in infancy. The states not listed have mortality rates between 1.2 and 3. Dysentery rates, especially in the southern states are about one-tenth those of diarrhea and enteritis, while in the north few dysentery deaths are reported.
Proceeding of Conference on Methods for Evaluating Nutritional Status of Mothers, Infants and Children
Authors: STUART HAROLD C. 
Published: December 2021

The comments of Dr. Icie Macy Hoobler, Chairman, and 22 guest conferees, well qualified to discuss this subject, are reported in the Conference Proceedings. The first half of this Report is devoted to problems relating to the determination of food intakes and the conversion of items of foods into specific nutrients.
The diet history is contrasted with a food intake record, the former being an attempt to find an "average" intake drawn from a long period of time, while the latter aims at recording accurately what was eaten during a short but specific period. Either a three or a seven day period is usually chosen for the food intake record. It is stressed that the diet history should be taken by an experienced interviewer who has the ability to obtain the desired information regarding the patient's food habits.
EDITORIAL
Authors: WHEATLEY GEORGE M. 
Published: December 2021

THE application of the principles of preventive medicine to children has brought about almost unbelievable improvement in mortality from the so-called common childhood diseases. In fact, the control today over smallpox, diphtheria, the diarrheal diseases, pneumonia, and others, has brought pediatrics face to face with the present leading cause of childhood mortality—accidents. Accidents not only kill more children after infancy than does any single disease but also, in the ages from one to 14 inclusive, accidents take as many lives as pneumonia, diarrhea and enteritis, measles, diphtheria, meningitis, poliomyelitis, whooping cough, and scarlet fever combined.
This month the Academy, in cooperation with the U. S. Children's Bureau, the National Safety Council, and the Metropolitan Life Insurance Company, is beginning a sustained national effort to reduce accidents to young children.
TOXOPLASMOSIS IN CHILDREN
Authors: ADAMS FORREST H. , ADAMS JOHN M. , KABLER PAUL , COONEY MARIAN 
Published: December 2021

Five proven cases of toxoplasmosis in infants and nine cases in which the clinical and laboratory evidence strongly suggested this diagnosis in infants and children are presented.
We have pointed out that only one or two of the cardinal manifestations may be evident in a patient in whom the diagnosis has been established by the finding of the typical pathologic lesions and the organism. This was the case in two of the patients reported, both of whom had internal hydrocephalus but did not have either cerebral calcification or chorioretinitis.
The presence of internal hydrocephalus particularly with spinal fluid changes such as elevated protein and pleocytosis should suggest to the clinician the diagnosis of toxoplasmosis. When the classical triad or tetrad of symptoms and signs of the disease is present and the neutralization test is positive, the diagnosis probably should be made since isolation of the organism from the patient is so difficult at the present time.
Jaundice can be the presenting complaint in a patient with congenital toxoplasmosis.