bluuebunny/crossref_metadata_2025_split huggingface dataset:
FAILURE OF THE HEART AFTER UNDUE ASPHYXIA AT BIRTH
Authors: Burnard E. D. , James L. S. 
Published: December 2021

Thirty-three mature infants became ill in the neonatal period after suffering undue asphyxiation at birth. Dyspnea was a prominent symptom. Nineteen died and 14 recovered.
The transverse diameter of the cardiac silhouette in most cases was greater than the average in healthy infants. The progressively increasing size of the heart between 1) healthy infants, 2) those who appeared healthy, but had suffered undue asphyxiation at birth, and 3) those in whom signs of illness developed after asphyxia, indicated that the illness and cardiac enlargement were related. Dilatation rather than hypertrophy was the likely cause of the greater roentgenographic size. This was most obvious on the right. There was also evidence suggestive of left ventricular dilatation. The size of the heart diminished as the infants recovered. In three infants who died serial films showed that enlargement remained or increased, and hypertrophy of both ventricles was present at necropsy in the one who survived the longest time. Roentgenographic changes in the lungs did not correlate well with either the signs of illness or with the presence of cardiac enlargement. The possibility existed that vascular congestion and transudation could be responsible for abnormal appearances in the lungs, when these were present.
Biochemical changes resulting from severe asphyxia were observed soon after birth in four cases, and their presence in the others at this time was inferred from the depressed state of the infant as judged by the Apgar score. The quick recovery of the deranged acid base status which occurs after normal birth was not seen in most of the patients. Exceptions were those in whom the illness was brief. The abnormal biochemical status was characterized by arterial hypoxia and metabolic acidosis. The partial pressure of arterial carbon dioxide was distributed over a wide range. These findings are compatible with the presence of left ventricular failure.
The left atrial pressure was high in comparison with that of healthy newborn infants. Venous pressure was also increased on the right. Consideration of the results of the three different kinds of investigation led to the suggestion that left ventricular failure occurred early in the illness. Disproportion between different signs in individual cases might have been related to attempted compensation by the heart and to the rate at which failure of the right heart might follow, as well as to the severity of the illness and the rate of recovery. While atelectasis and infection may have been present, there was evidence that heart failure could be the explanation of dyspnea in life and pulmonary vascular congestion at necropsy. The cause of failure is not known. It is related to the metabolic disorder from undue birth asphyxia. A disturbance in hemodynamics that requires more investigation is present.
METHODS FOR DETERMINING COMPOSITION OF THE HUMAN BODY
Authors: Forbes Gilbert B. 
Published: December 2021

The early nineteenth century witnessed the first concerted application of chemical techniques to the investigation of biologic materials. Milk was chemically analyzed, von Liebig discovered the chemical contrast between potassium-rich cells and sodium-rich tissue fluids, and Carl Schmidt analyzed blood serum in great detail. Soon these methods were applied to the study of the entire human body.
The advent of isotopic dilution techniques in the 1930's and 1940's brought about a renewed interest in body composition. More recently these and other techniques have been used in an attempt to study the nutritional aspects of body composition. It is the purpose of this report to present the various methods now in use and to discuss the virtues and limitations of each.
DIRECT CHEMICAL ANALYSIS
Whole Body
During the past century a number of human carcasses have been analyzed for water, fat, nitrogen, sodium, potassium, chloride, calcium, magnesium, and phosphorus. These include the fetus, newborn, and adult. The few analyses done on children have included subjects suffering from conditions known to profoundly affect water and electrolyte metabolism.
Data for total body content in the new-born and adult are presented in Table I, both on a fresh-weight and a fat-free fresh-weight basis. The latter basis for expressing values avoids discrepancies that arise because of alterations in fat content. It is evident that significant changes in body composition occur during growth. Water, sodium, and chloride contents decline, while contents of nitrogen, calcium, potassium, magnesium and phosphorus all increase. In these data, body fat content is not strikingly different in the two age groups.
Lest We Be "Status Quo" Seekers
Authors: Ambuel J. Philip 
Published: December 2021

The article by Green and Segar1 which proposes a new design for patient care suggests some sweeping changes in our traditional methods of providing pediatric education and medical services. It should be evaluated as a serious proposal designed to bring simultaneous improvement to both fields.
While the commentary by McKay makes some pertinent recommendations regarding the improvement of inpatient medical care (in the Children's Hospital of Columbus the monthly statistics for 1961 show that the average length of stay varied from 6 days to 7.3 days), his suggestion that Green's proposal "circumvents rather than meets the problem" suggests to me that he has missed its main purpose.
THE PEDIATRICIAN AND THE PUBLIC
Authors: HARPER PAUL 
Published: December 2021

THE editors of the column thought it would be interesting to learn the ideas and possible plans in the minds of teachers of pediatrics, if increased funds became available to the medical schools from either the A.M.A. or the federal government, for the improvement and perhaps extension of medical education.
Dr. James L. Wilson, Dr. Harry H. Gordon, and Dr. Sidney S. Chipman and Dr. Myron E. Wegman, the latter two writing as joint authors, have been kind enough to comply with our request. The readers of the column will find Dr. Wilson's letter of particular interest, both because it contains a sharp arraignment of the teaching of medical schools in the habit of today, and gives corresponding constructive suggestions for change.
AUREOMYCIN IN STAPHYLOCOCCIC MENINGITIS COMPLICATING SUBARACHNOID HEMORRHAGE IN SICKLE CELL ANEMIA
Authors: ALMKLOV JOHN R. , HANSEN ARILD E. 
Published: December 2021

The rare occurrence of a spontaneous subarachnoid hemorrhage in an 11 year old Negro boy with sickle cell anemia is recorded. Of the eight reported cases five have occurred in children. In the study of sickle cell anemia it is evident there is an increasing awareness of this as well as other neurologic complications.
This patient developed staphylococcus albus meningitis which for 12 days resisted combined penicillin, streptomycin and sulfadiazine therapy. The response to aureomycin as a sole therapeutic agent was dramatic, and this represents the first reported case of meningitis treated with this drug.
The use of aureomycin as the only antibiotic in this staphylococcic infection seems to have been fortunate in view of the laboratory findings. In vitro studies disclosed that when penicillin and aureomycin or streptomycin and aureomycin were combined, the result was a decrease in the effectiveness of either drug on staphylococci.
Calcium, Strontium, and Fallout
Authors: ESTY GEOFFREY W. 
Published: December 2021

Dr. Chusid's concern (Pediatrics, 29:850) over radioactive fallout, and particularly strontium-90 levels, in milk from nuclear bomb testing, is unfortunately shared by many persons, mainly from newspaper accounts. There is an erroneous impression that milk contains more fallout than other foods. This misapprehension is due to the fact that milk is used for surveying strontium-90 levels because samples are easily obtained at all seasons, and because milk is rich in calcium.
The strontium-90 from fallout accompanies calcium as the calcium is absorbed from soil by plants, and as the calcium in plant foodstuffs is eaten and absorbed in turn by animals.
MUSCULAR SUBAORTIC STENOSIS IN CHILDHOOD
Authors: Wood Roy S. , Taylor W. Jape , Wheat Myron W. , Schiebler Gerold L. 
Published: December 2021

The clinical findings in three siblings with muscular subaortic stenosis are presented, showing the progression of this disease entity within the pediatric age group. In two of the children the diagnosis was supported by hemodynamic findings, supplemented by surgical and autopsy observations in one of these cases. In the youngest member of the family group the diagnosis is based on the clinical examination, thoracic roentgenograms, and electro-vector-cardiographic evidence of left ventricular hypertrophy. It is probable that the father and paternal grandfather died of the same disease.
Approximately one-half of the reported cases of this lesion have been familial, supporting the concept that this disease is transmitted by a dominant Mendelian gene. Slowly progressive fatiguability with exertion, palpitations, angina, and syncope are the most frequent symptoms. Congestive heart failure is rare, but sudden unexpected death is common. A harsh systolic ejection murmur at the left sternal border and apex is a constant physical finding; this is often accompanied by paradoxical splitting of the two components of the second heart sound. Chest roentgenograms demonstrate progressive left ventricular hypertrophy and a normal-sized aorta. The electrocardiogram and vectorcardiogram usually show left ventricular hypertrophy, often accompanied by negative T-waves in the left precordial leads.
Characteristic hemodynamic findings are a distinctive pulse contour, the narrowing of the peripheral arterial pulse pressure following a premature ventricular contraction, and a pressure gradient between the body and outflow tract of the left ventricle. Left ventricular angiocardiography shows a narrowing of the muscular obstruction during systole and a widening during diastole. Excision of this muscular obstructive lesion has been reported to produce marked symptomatic relief in some patients.
PRESIDENTIAL ADDRESS
Authors: Fischer Carl C. 
Published: December 2021

INASMUCH as our by-laws specifically state that "a meeting of the Academy shall be held each year, to be known as the Annual Meeting, at which time the conferring of Fellowships shall take place and a presidential address shall be delivered," neither you nor I have any choice in the matter! Nothing is specified, however, regarding either the length or the content of such an address so that this would appear to be left to the discretion of each President—leaving the membership to hope that he will use this discretion wisely.
I have just finished re-reading each of the Presidential Addresses given by my 31 predecessors—and I heartily recommend that you do likewise if you are interested in receiving a most stimulating review not only of the history of our Academy, but of American pediatrics since 1930.
I found that these addresses varied greatly as to length, style, and content—reflecting the individual viewpoints and natures of their authors. Some were highly optimistic, a few distinctly pessimistic, about our specialty. Nearly all reviewed the major accomplishments of their year in office in varying detail, and many referred to the influence of the times in which they wrote upon pediatrics in general and the Academy in particular. Many reiterated the importance of the objectives of the Academy as defined with prophetic vision by our Founding Fathers, and despite the variations in viewpoint and in time, all stressed, as I too would like to, the broad emphasis upon "the welfare of children" contained in the opening sentence of Section I of Article II— "The object of the Academy shall be to foster and stimulate interest in pediatrics and correlate all aspects of the work for the welfare of children which properly come within the scope of pediatrics."
THE ETIOLOGY OF RESPIRATORY ILLNESSES OCCURRING IN INFANCY AND CHILDHOOD
Authors: Wenner Herbert A. , Christodoulopoulou Georgia , Weston Jean , Tucker Virginia , Liu Chien 
Published: December 2021

Twenty-six agents were recovered from pharyngeal samples obtained from 194 infants and children ill of respiratory infections. Fourteen were parainfluenza, five were adenoviruses, and two were influenza A2 viruses; five agents were unidentified. Seroconversion against homologous virus occurred in 6 of 12 patients.
In four of six patients ill of croup, the infection was associated with parainfluenza, type 1, virus. Respiratory syncytial virus was not associated with bronchiolitis, and was associated with pneumonia only in about 10% of patients. Essentially similar seroconversion rates were obtained for other respiratory syndromes and for the small group of patients with nonrespiratory illnesses. Although seroconversion was obtained for influenza C virus, particularly in patients with bronchiolitis and pneumonia, the large fraction of individuals seropositive during early infancy, and the high frequency of seropositives in subsequent age groups suggests that the virus may have a pathogenic potential not yet fully appreciated. Influenza A2 and B viruses were active during the period of study, apparently recruiting those still at risk.
The results of this study failed to associate any one of the 10 respiratory viruses with a major proportion of the separate clinical syndromes. Probably too much has been expected in the delineation of selective anatomical sites of injury by some of these viruses! Information is needed also on the combined effects of pathogenic bacteria and viruses in the pathogenesis of respiratory diseases.
DIAGNOSIS AND TREATMENT: USE AND MISUSE OF OXYGEN IN TREATMENT OF PREMATURES
Authors: Smith Clement A. 
Published: December 2021

Dr. Comroe once stated (in conversation) that while it may sometimes be difficult to prove the value of oxygen therapy, there is ample evidence of its hazards. This is particularly true in premature infants. Should oxygen, therefore, be used at all in the premature nursery? If so, for what infants? And how can they be protected from its misuse?
1. Progressive hypoxemia leads to anoxia in most severe or fatal disease in newborn and premature infants. Circumstances associated with anoxia are often followed by brain damage. Therefore, a severely reduced blood oxygen saturation or tension in a sick premature or term newborn should be raised if this can be done safely.
2. Thus, additional oxygen should be used for those infants whose arterial blood (when they breathe air) is carrying significantly less oxygen, than that to be expected of normal infants in air.
3. Oxygen is misused if it increases blood oxygen much above that normal in air-breathing. Such misuse is not only wasteful. It may cause retrolental fibroplasia. Impaired vision from this cause is still being seen, and we cannot yet be positive that excess oxygen causes no other pathologic changes in prematures besides those in the retina.
The problem of misuse may be better stated in terms of oxygen tension (or pressure —hence pO2) than of oxygen percentage or concentration. As 21% of the atmosphere, oxygen has a partial pressure of 160 mm Hg in air at sea level and pO2 in the pulmonary alveoli of normal term and premature infants is (like that of adults about 105 mm Hg.2 In the arterial blood of such infants pO2 is usually within or near a range of 70-80 mm Hg, so that a normal gradient or pressure loss of 25-35 mm Hg occurs between alveolus and capillary.
Body Fluids and Their Neutrality
Authors: HOLLIDAY MALCOLM A. 
Published: December 2021

It is not often that a medical textbook contains the qualities of a fresh style in writing, lucidity, and due respect for scientific accuracy. Dr. Christensen achieves this in the book Diagnostic Biochemistry and now in the shorter paper-bound version.
Each chapter deals with a physico-chemical aspect of body fluids and relates it to clinical chemistry and to clinical disease. At the end of each chapter one finds a series of questions, not very easy ones at that, to provoke the intellectually curious into thought and library research.
TRISOMY 17-18(E): STUDIES IN LONG-TERM SURVIVAL WITH REPORT OF TWO AUTOPSIED CASES
Authors: Weber Wendell W. , Mamunes Peter , Day Robert , Miller Phebe 
Published: December 2021

Clinical, cytological, and dermatoglyphic studies on a girl born with multiple anomalies and surviving at 10½ years of age showed that she had trisomy 17-18(E). The extra chromosome appeared to be most compatible with an 18 chromosome. Her growth and development are described.
A survivorship table based on 101 cases of trisomy 17-18 is included. The chance of survival to 1 month, 1 year, and 10 years is 70%, 10%, and 1% respectively.
CURRENT CONCEPTS IN DIAGNOSIS AND MANAGEMENT OF CONGENITAL DISLOCATION OF THE HIP
Authors: Silverman Frederic N. 
Published: December 2021

MANY OF US whose formal medical education was obtained more than ten years ago may, as a result, approach the problem of congenital dislocation of the hip (hereafter CDH) with concepts whic could profitably be abandoned.
In many medical centers, CDH has been considered a consequence of failure of development of the acetabulum (acetabular dysplasia). It was usually recognized in the infant around the time of standing or walking, confirmed by radiologic examination, and treated by various types of restraining apparatus designed to replace the dislocated femoral head in proper relationship to the acetabular cavity, and to maintain it there for a period of months at least. The management in older children required hospitalizations for prolonged traction , forceful manipulation and plaster casts, radiographs, and changes of casts. And, in as many as 30% of the children, the involved hip, even if replaced, failed to develop properly so that aseptic necrosis of the femoral head (Legg-Calve-Perthe's disease) occurred and osteo-arthritis was frequent in adult life.
Early diagnosis and treatment has been the goal of orthopedic surgeons for at least the last 30 years. Pediatricians have been instructed to look for abnormal body contours, shortening of a lower extremity, asymmetrical skin folds in groins and thighs, and limitation of motion of the involved hip. When any of these still useful clinical signs were observed, radiographs of the hips were requested for measurements of acetabular angles.
In 1956, Coleman and Caffey independently challenged the validity of the available "standards" for acetabular angles, some of which were based on measurements from as few as 23 children. Caffey's report is the most extensive study to date and the most reliable statistically.
PEDIATRIC PRACTICE: HUMAN MILK AND BREAST-FEEDING
Authors: Smith Clement A. 
Published: December 2021

AT THE END OF 1962, the local Directory for Mother's Milk closed its doors. The decision to terminate the work of a pioneer institution which, at least for the early part of its 52-year existence, had filled vital needs, was not easy. The decision was made, of course, not because human milk had been demonstrated to be inherently any less valuable than it always was for babies. But with the advance of nutritional and technological knowledge, with the rapidly widening availability of sterilizing and refrigerating equipment, and the more prompt control of infections by antibiotic drugs, other ways of feeding babies had become inherently better. It is of some interest that this all happened in one pediatric lifetime. Dr. Fritz B. Talbot, who spoke at the closing ceremonies of the Directory, was the organizer of the service at its beginning (as a Directory for Wet Nurses) in 1910. With rare objectivity and perception, Dr. Talbot chose to express gratitude for a half-century of public health and pediatric progress, rather than alarm over a reduction in the local availability of human milk.
Most pediatricians today would probably feel similarly. Many would also join those who reflected that today's need for services to help mothers initiate breast-feeding is greater than that for organizations to preserve and dispense the milk of one mother so that it can be fed to the infants of others. Few would nowadays think that persuading mothers to initiate breast-feeding is as necessary as helping them to do so. Quite a few mothers are now seeking help which pediatricians and obtetricians might arrange for them in the hurried routines of today's hospitals.
ANTIBODIES TO GAMMA-GLOBULIN IN INFANTS AND CHILDREN EXPOSED TO ISOLOGOUS GAMMA-GLOBULIN
Authors: Stiehm E. R. , Fudenberg H. H. 
Published: December 2021

Isoantibodies directed against human gamma-globulin were found in children receiving single and repeated injections of gamma-globulin and in those who had received blood transfusions at birth. Nine of 14 children receiving repeated gamma-globulin injections had anti-gamma-globulin antibodies. One-third of all children exposed to gamma-globulin by transfusion or injection, but only 6% of unexposed children had anti-gamma-globulin antibodies. Females appear to have a higher incidence of sensitization than males.
The possibility exists that these antibodies may be implicated in reported anaphylactic reactions to gamma-globulin.
The Difficult Child
Authors: WORK HENRY 
Published: December 2021

This book is very different from most in its field. Written particularly for the school teacher, it has divided difficult children into groups which are not common medical categories. For example, there is a chapter on, "The Lazy Child" and one on "The Pampered Child."
This fractionation of children leaves the reader with the difficult task of pulling these symptoms together to comprehend the troubles of any one child. Very little attention is paid to any over-all understanding of children of which these problem might be symptomatic
PLASMA BILIRUBIN DETERMINATION IN THE NEWBORN INFANT
Authors: Michaëlsson M. , Nosslin B. , Sjölin S. 
Published: December 2021

A method for plasma bilirubin determination is described. It is a modification of the Jendrassik and Grof alkaline diazo-coupling procedure and allows determination of both conjugated and unconjugated bilirubin in small amounts of plasma.
Five commonly used diazo-coupling methods are compared with special reference to the influence of hemolysis in the sample.
The Jendrassik and Grof method as modified by Nosslin and Michaëlsson is shown to have the smallest methodological error and to be insignificantly influenced by hemolysis in the sample, in contrast to the methods of Malloy and Evelyn, Lathe and Ruthven, Ducci and Watson, and Powell.
The bilirubin standardization procedure, methodological errors, and the influence of hemolysis in the sample are discussed.
The Effects of Steroids in the Treatment of Typhoid Fever
Authors: ESKES PHILIP W. H. 
Published: December 2021

The results are presented of the treatment of 99 infants and children with initially Uncomplicated typhoid fever. The effect of addition of steroids to the chloramphenicol treatment and usual therapeutic regime is discussed. The rapid relief of fever and toxicity, noted eleswhere, was confirmed. This changed our treatment from a mostly inpatient to a mostly outpatient basis, such as is particularly useful, when possible, for hospitals in overcrowded, underdeveloped areas.
The striking reduction in mortality and morbidity in steroid-treated patients warrants further investigation. Caution is recommended in the use of steroids in patients with history of fever for 2 weeks or more, as most typhoid perforations occur in the third week.