bluuebunny/crossref_metadata_2025_split huggingface dataset:
STENOSIS OF A BRANCH OF THE RENAL ARTERY CAUSING HYPERTENSION IN A CHILD
Authors: Lambeth Charles B. , Derrick John R. , Hansen Arild E. 
Published: December 2021

Marked hypertension is known to have persisted for a 2½-year period in a 5-year-old child. The symptoms of polydipsia and polyuria with enuresis as well as hyperactivity had been noted. The only physical findings were hypertension and its associated retinopathy.
Attempts at translumbar aortography resulted in a large hemorrhage into the left pleural space. Two years later, however, a successful retrograde renal arteriogram revealed a stenosis of the superior branch of the right renal artery. Removal of this obstruction and re-anastomosis of the vessel resulted in the return of the blood pressure to normal as well as the complete relief of the symptoms. In the pediatric age group this is believed to be the first report of such a lesion treated successfully with vascular surgery.
On the basis of observation with this child, as well as data from the literature, it is concluded that hypertension in children is almost never essential and every effort should be made to determine the cause. Children with enuresis, or polyuria and polydipsia, should have careful blood pressure determinations.
A METHOD FOR CONTINUOUS URINEAND STOOL COLLECTION IN YOUNG INFANTS
Authors: Hepner Ray , Lubchenco Lula O. 
Published: December 2021

Metabolic investigations of premature and young infants have been hampered by difficulties in making quantitative urine and stool collections. Many studies have been limited to male infants and the duration of study has often been short, or interrupted by the development of skin irritation. Fragile or desperately ill patients who might benefit from investigation often are not studied because of the difficulties and hazards involved in available methods.
A special pan designed after the type used in animal metabolic cages has been adapted for urine and stool collections from infants in incubators. This device has made possible the continuous collection of urine and stool for as long as 8 to 13 weeks. This metabolism pan has also permitted investigations of female infants as well as males and, further, has been found to be satisfactory and valuable in the treatment of the very small, sick or postoperative patient.
See image in the PDF file
Figure 1 is a sketch of the stainless steel pan and complete equipment with the infant in place. The pan is a shallow funnel with connecting tubing extending into a bottle below. The nylon netting is shown stretched tightly over the top of the pan and held in this position by metal rods, threaded through seams in the nylon and clamped in place outside the pan.
The baby is placed prone or on his side on the netting with a bib under his head and a piece of nylon netting pinned loosely over his back or shoulders.
THE PEDIATRICIAN AS CONSULTANT IN A GENERAL PRACTICE AREA
Authors: Lee W. J. 
Published: December 2021

As long as births on this continent increase faster than the proportionate output of medical graduates, there will never be a sufficient number of trained pediatricians, "comprehensive" or otherwise, to attend the entire childhood population—even if this situation were ideal, and there are arguments against it being so—unless, of course, the proportion of pediatricians among total practitioners increases tremendously, which is improbable. The pediatrician-to-child population ratio is estimated to be 1 to 7000.1 In 1957, the United States had approximately one Board Certified pediatrician for every 40 physicians of all categories, and there appears to be no breaking of ranks by the generalists. The more comprehensively a pediatrician practices (that is, with close supervision of the child and extensive counselling of the family) the fewer patients will he be able to see and the more expensive will his services become. (It could be that this mode of pediatric candidate, as others have suggested.) Thus for practical reasons of availability and economy the less trained general practitioner must continue to assume the greatest share of the work, and he would still turn to the specialist pediatrician for particular help, as seems to be indicated from the foregoing presentation. If improved quality of child care is the aim of medical educators, then that emphasis should be placed as much on the training of the general practitioner as on that of the pediatrician,7 and the latter should look more to the field of consultation for his contribution to the nation's health.
The author readily admits that his way of practice is not without shortcomings and difficulties, part of which derive from the fact that he holds a minority view among his peers. Some of the problems can be surmised from between the lines of the material presented, but they need not be dwelt upon because they do not detract from the main theses of the study. A specialist with referrals justifies his status; without them his valuable knowledge and skills tend to rust from disuse. That the pediatrician consultant must minimize the scope of his counselling work need not mean that he stands unconcerned about general well-being of children and other pertinent issues; in such matters he can and should participate at the voluntary community level and thus play his distinctive part on the wider scene. By interposing himself between the grass roots and the ivory towers he becomes a key link in the chain of medical services to the child, and at the same time he assures himself of a satisfying professional existence.
GROUP PRACTICE
Authors: Lee Henry F. 
Published: December 2021

As the member of this panel who represents pediatric group practice, I believe it is for me to suggest how such group practice may aid or abet or, at least, fit into the concept of the "Newer Pediatrics."
I do not believe that there is truly a "New Pediatrics." I think we are simply attempting to define something that has been around a long time, but which has been successfully applied by only a fraction of practicing pediatricians.
Almost a year ago I gave a talk to a group of residents who had requested my thoughts on the meaning of the term, "Newer Pediatrics." I am not sure that I made myself entirely clear to them, which implies that I was not wholly clear myself as to all the implications in this concept. However, permit me to read to you the last paragraph of my talk. Further reflection has given me no cause to change the content.
"I conceive of the ‘Newer Pediatrics’ as being an approach to practice which requires the pediatrician not only to be well grounded in the diagnosis and treatment of disease, but to be sensitive to the psychological and emotional aspects of illness and general growth and development; furthermore, it requires that he be able, either by his own ability, or by using the abilities of his specialized colleagues, to make available to the families in his practice pediatric care which encompasses these factors in a fashion satisfactory to himself, to his patients, and to their families.
PSYCHOLOGIC ASPECTS IN PRACTICE
Authors: Cecil Henry S. 
Published: December 2021

For Some Time at the Children's Hospital of Philadelphia we have been concerned about the changing nature of pediatric practice. It seems apparent that the shifting morbidity and mortality patterns of childhood increasingly demand that the pediatrician assume an expanded responsibility in the psychosocial aspects of care. With this in mind we have focused our attention on the training needed to develop in the pediatrician the requisite skills to meet the demands of this expanded responsibility.
Many factors have contributed to changing needs of children seen in office practice. Increased knowledge of nutrition, electrolytes, immunizations and the antibiotics have influenced the entire spectrum of child hood illness. The population growth has brought increasing numbers of children to the pediatrician, and mobility of young families has led to isolation of parents from the support in child rearing formerly offered by close contact with their own families. Increasingly they turn to their physician for this support.
With the declining incidence of acute infectious disease, many children who would have died of congenital defects and metabolic disorders are now surviving. These cases are usually marked by high degrees of family disturbance and breakdown.
In addition, there has been a rising incidence of serious developmental disorders in very young children and an increasing parental concern about the supervision of emotional growth and development.
These and other factors have been well discussed by Richmond in a recent article in Pediatrics.1
Thus, the problems presenting themselves today both in office and in hospital practice, while they may be organic in symptomatology, are complicated by severe emotional components in increasing numbers.
CONCLUSIONS
Authors: Fischer Carl C. 
Published: December 2021

After reviewing the presentations of the four panelists and the informal question and answer period that followed, the following conclusions would seem to represent the consensus insofar as the panel is concerned:
(1) The practice of pediatrics as a specialty would seem to be here to stay—at least insofar as can be presently judged.
(2) The term "new" pediatrics is a misnomer in that many pediatricians have been practicing it for many years. Our present interest, then, lies not so much in a "new" or comprehensive pediatrics—but in better ways to accomplish it.
(3) Our undergraduate and postgraduate training must be brought up to date in order to better equip the pediatrician of the future for the comprehensive practice of pediatrics as it exists in his community.
(4) This does not necessarily mean more time or more formal training but rather better use of all available facilities, including participation in as well as full awareness and understanding of the emotional and social factors in the lives of the "little people" under their care.
Phenylketonuria in Jews
Authors: Laron Zvi , Yonis Zeev 
Published: December 2021

Until 1954, 513 cases of phenylketonuria were recorded in the literature.1 Since then many more cases have been reported, both from America and Europe. Interestingly, only one of the reported patients had Jewish ancestors;2 another Jewish patient is mentioned in a personal communication.3 Considering the rarity of this metabolic disorder in Jews, a preliminary report on several cases of phenylketonuria we have discovered in a family of Iraqui Jews seems justified.
In June 1958, a 21/2-year-o1d boy with mental and motor retardation was referred to our clinic for evaluation.
LEADERSHIP
Authors: Wheatley George M. 
Published: December 2021

Last month i closed with a reference to leadership. The thought running through my mind was that each of us owes something to our specialty—a kind of tribute to those who have gone before us and who gave of themselves to build the specialty of pediatrics. Ordinarily we think of this "debt" being paid off by the scientist in the laboratory and the clinician at the bedside. And, of course, their contributions have been and continue to be tremendous. But, I submit, everyone who is a pediatrician owes something to further the advance of pediatrics. The hallmark of our specialty from its beginning has been involvement in community service. Many pediatricians not only apply the new knowledge of disease prevention, nutrition and child care to the rearing of children in private practice, but by advice and personal service participate in community health projects to extend these new concepts to all children. Not only have these contributions of individual pediatricians aided greatly to establish pediatrics as a specialty, but have helped enormously to give it a privileged place in public opinion. Every practitioner can exercise this kind of leadership in his or her community.
This same dedication by many pediatricians has made the Academy a leader among medical organizations. The Academy exemplifies a new kind of medical society—an organization concerned not only with clinical problems but the social needs of patients. The Academy, I believe, was the first medical organization to recognize the value of co-operative relationships with nonmedical groups. One of its first committees was called the Committee for Cooperation with Nonmedical Groups.
COMMITTEEON NUTRITION
Authors:   Committee on Nutrition, Clement David H. , Forbes Gilbert B. , Fraser Donald , Hansen Arild E. , Lowe Charles U. , May Charles D. , Smith Clement A. , Smith Nathan J. , Fomon Samuel J. 
Published: December 2021

The majority of infants obtain total nutrition from milk during the early weeks or months of life. It seems logical, therefore, that knowledge of the usual composition as well as the variation in makeup of this biologic fluid should be of prime concern to those supervising the nutrition of infants. For this reason the memorandum which follows has been prepared by the Committee on Nutrition of the American Academy of Pediatrics.
Milk is not constant in composition from one human or animal to another, at all periods of lactation, or even hourly through the day. Unqualified statements about human or cow milk and comparison of the milks of different species may, therefore, be somewhat misleading when specific samples of milk are considered. It is fortunate that a significant and comprehensive literature is available concerning the variations to be expected.
SOURCES OF INFORMATION CONCERNING HUMAN AND COW MILK
A list of the major sources of such information is given here. These references are concerned with human milk or with cow milk as compared to human milk. Detailed data on cow milk are available in the extensive literature of the dairy industry.1,2
A series of 21 papers on the secretion and composition of both human and cow milk, including an extensive bibliography has been published in the British Medical Bulletin.3
Macy, I. G.: Composition of human colostrum and milk.4
Kon, S. K. and Mawson, E. H.: Human Milk. Wartime Studies of Certain Vitamins and other Constituents.5 This report presents 12 studies and a summarizing conclusion on the fat and vitamin content of milk.
STUDIES IN EXPERIMENTAL HYPERTONICITY
Authors: Sotos Juan F. , Dodge Philip R. , Meara Patricia , Talbot Nathan B. 
Published: December 2021

Hypertonicity of the body fluids was induced in rabbits by the intravenous infusion of different hypertonic solutions (NaCl. NaCl plus NaHCO3, sucrose, mannitol and urea). The results obtained in this study indicate the following.
There is no significant correlation between the clinical syndrome or death and values for total body water, total body solutes, total extracellular or intracellular volume, or concentration of sodium or chloride in the plasma. The clinical manifestations and death can occur in the absence of in tracranial hemorrhage.
Hypertonicity, by creating an osmotic gradient between extracellular fluid and brain, is the important factor in producing the characteristic clinical syndrome and death, but is not the immediate cause of these abnormalities. The osmolality necessary to produce these alterations was greater in animals infused with urea.
Hypertonicity produces these alterations by decreasing water and increasing ion concentration in the brain. The resulting functional impairment of neurones accounts for the clinical and electroencephalographic abnormalities. The increased values of sodium and chloride in the brain reflect an impairment of function of either brain cells, "blood-brain barrier," or both. Acidosis, hyperkalemia and hyerphosphatemia ensue as a result of hypertonicity.
Unless death is imminent, all of the abnormalities described are reversible.
INFLUENCES OF DEPLETION OF POTASSIUM, OF SODIUM, OR OF WATER ON FUNCTION AND STRUCTURE OF THE KIDNEY
Authors: Kerpel-Fronius E. , Romhányi G. , Gáti B. , Dobák E. 
Published: December 2021

Sublethal potassium losses were produced in rabbits by the repeated administration of theobromine. In experimental periods of 1 week, no significant decrease in the maximal concentrating ability of the kidneys, in creatinine urine:plasma (U:P) ratio and in creafinine clearance were observed, neither were histologic alterations evident.
See table in the PDF file
Prolongation of potassium deficiency (after theobromine-induced depletion) to 2-3 weeks by feeding a diet poor in potassium, reduced rabbits' ability to produce maximally concentrated urine, moderately decreased the creatinine clearance and induced damage in the renal collecting ducts and, subsequently, a striking dilatation of distal tubules. Presence or absence of metabolic alkalosis had no effect on renal alterations in potassium-depleted animals. Relations of structural (renal and myocardial) and functional alterations are discussed.
Sodium depletion reduced glomerular filtration rate (GFR) and concentrating ability much more than experimental potassium depletion. The defect in the concentrating mechanism is refractory to vasopressin both in sodium and in potassium depletion. Histologic changes accompanying sodium depletion consist in hydropic degeneration of the proximal convoluted tubules.
CONTACT-TYPE DELAYED HYPERSENSITIVITY IN INFANTS AND CHILDREN: INDUCTION OF RHUS SENSITIVITY
Authors: Epstein William L. 
Published: December 2021

The frequency of contact sensitization to a Rhus allergen, pentadecyl catechol, was determined in 102 infants and children 1 month to 8 years of age.
Children between 3 and 8 years were readily sensitized and showed a depth of sensitivity and intensity of reaction comparable to that seen in adults. Infants below the age of 1 year had a markedly depressed ability to react to Rhus allergens. Children between 1 and 3 years old assumed an intermediate position, being more reactive than infants, but less so than older children.
Theoretically these observations suggest that the mechanism of delayed hypersensitivity matures more slowly than other processes of immunity and resistance.
Clinically the findings mean that lack of exposure is a more important factor than lack of susceptibility in explaining the diminished incidence of clinical Rhus sensitivity in children below the age of 8 years.
STUDIES ON HYALINE MEMBRANES
Authors: Aronson Natalie 
Published: December 2021

Pulmonary hyaline membranes were studied by observations on their dissolution in vitro by proteolytic enzymes, by streptokinase and by urea with and without added thioglycollic acid. Pepsin, trypsin and chymotrypsin dissolved the hyaline membranes both in sections of human lungs as well as in sections of mouse lung with the experimentally produced disease, whereas streptokinase, alone, failed to do so. The combination of 8 molar urea with 2% thioglycollic acid partially removed the hyaline membranes from lung slices. These findings are consistent with the view that fibrin is an important component of pulmonary hyaline membranes.
Four possible therapeutic agents were evaluated in the experimental disease in mice, produced by prolonged exposure to high concentrations of oxygen. Chymotrypsin, trypsin and chloropromazine did not influence the mortality rate or incidence of pulmonary lesions. Heparin treatment led to a striking increase in mortality and to an increased incidence of pulmonary hyaline membranes.
STUDIES OF TOCOPHEROL DEFICIENCY IN INFANTS AND CHILDREN
Authors: Levin Stanley , Gordon Mordecai H. , Nitowsky Harold M. , Goldman Carmen , di Sant'Agnese Paul , Gordon Harry H. 
Published: December 2021

A bulb ergographic method for estimating muscle strength was modified to permit quantitative measurements. Studies in a group of 13 convalescent children without muscle disease established the reliability of the method for repeated observations.
Forty-five patients with cystic fibrosis, whose clinical conditions appeared stable, were accepted in a double-blind study comparing the effect of tocopherol or a placebo on serum tocopherol, S-GOT, weight gain, subjective improvement, and muscle strength as measured by the ergograph. Measurements were made at the beginning of the study, and 2 and 6 months after beginning tocopheryl acetate (10 mg/kg/day) or placebo therapy.
Although statistically significant increases in serum tocopherol, weight, muscle strength, and clinical improvement were found at 2 and 6 months after beginning of the study, there were no significant differences between the two groups, except in serum content of tocopherol. In the tocopherol treated group, serum tocopherol became normal (0.83 to 1.05 mg/100 ml), but remained low (0.20 to 0.33 mg/100 ml) in the placebo group.
Although the present study did not demonstrate a clinical functional effect of tocopherol therapy in patients with cystic fibrosis, its administration is recommended because of previously reported biochemical and pathologic evidence of vitamin E deficiency in these subjects.
THE EPIDEMIOLOGY OF ACCIDENTAL POISONING IN AN URBAN POPULATION
Authors: Wehrle Paul F. , DeFreest L. , Penhollow J. , Harris Virginia Goddard 
Published: December 2021

A group of 100 children who had experienced one episode of accidental poisoning were studied. A group of matched controls were selected from a previous randomized population derived from the City of Syracuse. The composition of study and control groups was similar in all gross characteristics tested.
The poisoned group was found to have many more subsequent episodes of poisoning than the control group. These children were more active and mischievous, were more likely to experience falls, had more frequent separation experiences from the parents, and the maternal-child relationships appeared to differ significantly in several characteristics.
It would appear that the repeater concept in accidental poisoning is established and presents a challenge to those presently concerned with prevention of accidental poisoning in children.
PRESIDENT'S MESSAGE
Authors: Wheatley George m. 
Published: December 2021

ONE OF THE most important projects of the Academy in recent years has been the sponsorship of postgraduate courses. This program grew out of discussions of the Executive Board, led by Carl Fischer. The idea was welcomed by the Committee on Medical Education, then chaired by Ed McClusky, and a subcommittee was named to study the proposal. They found few courses tailored to the pediatricans's need as a specialist. It was also evident that more opportunity for clinical conference teaching and teaching from patients should be provided. The architect of the report outlining the plan for these courses was the Subcommittee of the Education Committee headed by Harry Towsley. This Committee's report was accepted by the Executive Board in April, 1958. The Academy's program is designed to provide the membership with postgraduate courses both in subspecialty areas and in general pediatrics. The Academy's headquarters staff administers the courses under the capable direction of our Secretary, Bob Frazier, and the supervision of the Subcommittee on Postgraduate Education. Appropriately, the first postgraduate course was held at the University of Michigan Medical School, March 2, 3, 4 and 5 of 1959. Two courses were held the first year, the other being at Vanderbilt under Amos Christie. Four were conducted in 1960, and during this academic year, six courses have been planned.
With this experience of almost three years, judging by the member and the generally favorable comments of those who have attended, it is apparent that our postgraduate program has gotten off to a very good start. I congratulate all those who were instrumental in bringing this program into being.