bluuebunny/crossref_metadata_2025_split huggingface dataset:
KERNICTERUS
Authors: Day Richard 
Published: December 2021

Toxicity of heme pigments, in addition to that previously reported has been demonstrated as follows:
By depression of oxygen uptake by bilirubin bathing relatively intact cells of yeast and diaphragm; by hematin bathing yeast, diaphragm and minced brain, and by mesobilirubin bathing mouse diaphragm.
Oxidation cancels the toxicity of bilirubin. Cytochrome C cancels the toxicity of bilirubin and hematin. Mesobilirubin was not tested with cytochrome C.
By immobilization of Tetrahymena pyriformis by bilirubin at a concentration as low as 15 mg./100 ml. Oxidation of the bilirubin or the addition of cytochrome C cancels the action of the bilirubin. Hematin does not immobilize the animals. Removal of the bilirubin restores the protozoa to full activity.
Survival of newborn rats following intraperitoneal injection with bilirubin or hematin is impaired.
RECENT DEVELOPMENTS IN INFECTIOUS DISEASES
Authors: Hodes Horace L. , Steigman Alex J. , Gribetz Donald 
Published: December 2021

TEN major topics and several minor ones were discussed during this seminar. The following is a summary of the major points of the discussion and includes some of the pertinent questions raised by the participants.
POLIOMYELITIS VACCINE
Two types of vaccine are potentially available to immunize a person against a virus disease. A "killed" virus vaccine is one which induces immunity despite the fact that it is made of virus which has been rendered noninfectious by physical or chemical means (ultraviolet light, formaldehyde, phenol, etc.). A "live" virus vaccine contains virus mutants which produce only a modified infection and yet induce immunity against the original virus disease. The modified infection may be accompanied by no clinically recognizable disease (yellow fever) or by a recognizable mild illness (vaccinia). The former type of vaccine has the advantage of producing immunity without producing infection. Its disadvantages include difficulties with "killing" and problems concerning the safeguards against noninfectiousness. The "live" vaccine has the advantage of producing a higher degree of, and longer lasting immunity than the "killed" vaccine. Disadvantages are concerned with possible virulence of the virus mutants, with production of disease in the injected individual, and spread of the infection to others. The presently available Salk vaccine for immunization is of the "killed" virus vaccine variety, the virus having been made noninfectious by treatment with formaldehyde.
The need for active immunization of the population against poliomyelitis is emphasized by the facts that virtually no children 3 to 5 years of age have antibody against all 3 types of poliomyelitis virus and less than 40 per cent of this age group have antibody against even 1 type.
THE USE OF INDIRECT ARTERIAL PULSE TRACINGS IN THE DIAGNOSIS OF CONGENITAL HEART DISEASE
Authors: Kuhn Leslie A. , Sapin Samuel O. , Grishman Arthur , Donoso Ephraim 
Published: December 2021

The femoral, radial and carotid pulse curves of 22 normal patients and 33 patients with coarctation of the aorta were studied by indirect means using a crystal microphone and a standard electrocardiograph machine for recording purposes.
In general, certain definite abnormalities can be noted in the pulse tracings of patients with coarctation when compared with the normal group. In the normal patients, the femoral and radial pulsations began, on the average, simultaneously, whereas in the patients with coarctation of the aorta, there was an average delay of 0.01 second in the onset of the femoral pulsation as compared to the radial. There was considerable variation in both normal patients and those with coarctation, however, in the relative time of onset of the two pulses. This variation renders the use of the time of onset of the two pulses a poor diagnostic criterion for coarctation of the aorta, unless the femoral delay exceeds 0.02 second. It was also demonstrated that the relative priority of onset of the femoral or radial pulsation had little relationship to the age of the patient or the relative proximity to the heart of the two pulses, but more probably was dependent upon the speed of propagation of the pulse wave to the two extremities.
More valuable information, from a diagnostic standpoint, can be derived from analysis of the contour of the femoral pulse curve and its relationship to the carotid pulse curve. The patients with coarctation of the aorta showed a definitely prolonged ascent of the femoral pulse, regardless of the time of onset in relation to the radial. The time interval between the peak of the femoral pulse wave and dicrotic notch of the carotid pulse was constantly considerably less in the patients with coarctation than in the normals.
It is felt that pulse wave recording by indirect means reflects the pulse curve relationships derived by direct arterial puncture with satisfactory accuracy and gives the same useful information in the diagnosis and postoperative follow-up of cases of coarctation of the aorta. In addition, it is simpler and quicker than direct arterial puncture and is associated with no discomfort for the patient.
ADVERTISING IN PEDIATRICS
Authors: MAY CHARLES D. 
Published: December 2021

THE WELFARE of children is greatly improved by the many essential and useful products provided through the enterprise of commercial organizations. An important service is rendered the practicing physician when such products are brought to his attention by appropriate advertising. Advertising in a medical journal is a favorite means for accomplishing this purpose. A twofold benefit results; to the purveyor of the product, and to the physician—who not only becomes acquainted with a product he may use to the benefit of his patients, but also, through the financial support the journal receives, he may be served by a better medical literature.
It is evident that the advertising pages should be considered as a source of information. As such, these pages impose a grave responsibility upon us; it is our aim to have all the information brought to the readers of Pediatrics both accurate and clear.
PATENT DUCTUS ARTERIOSUS WITH REVERSAL OF FLOW
Authors: Anderson Ray C. , Adams Paul , Varco Richard L. 
Published: December 2021

Ten cases are presented of children having patent ductus arteriosus with reversal of shunt. Cyanosis, often greater in the toes, was present in all. Exertional dyspnea developed early. Murmurs were of no diagnostic value, but an accentuated pulmonic second sound was uniformly present. Right ventricular preponderance was found in all cases on the electrocardiogram. Cardiac size varied on roentgenography, but there was usually prominence of the pulmonary artery segment. Six cases showed evidence of bi-directional shunts, one showed only a reversed shunt, while data were insufficient to determine this point in the remaining three. Three patients had surgery, one with a successful outcome. The latter was a 1-year-old infant in whom lung biopsy at surgery revealed only minimal pulmonary arterial changes.
Forty-five cases are reviewed from the literature. The majority of these occurred in adults. Twenty-two have been subjected to surgery, four with good results, three of the latter being children.
The differential diagnosis is briefly discussed. The safest and simplest diagnostic test to perform is the determination of oxygen saturation of samples of blood obtained simultaneously from the right brachial and femoral arteries. Angiocardiography and cardiac catheterization also provided helpful information. The diagnosis will not be made unless the examiner keeps the entity in mind. The entity can no longer be considered rare.
Surgical treatment of the condition has been very disappointing, especially in the adult. There is reason to believe that surgical intervention very early in life will yield a higher salvage rate.
EXPERIMENTAL STUDIES OF ALLERGIC COLIC
Authors: Fries Joseph H. 
Published: December 2021

The purpose of this presentation is to discuss true allergic colic—as differentiated from the many other forms of colic. An allergic etiology probably accounts for only a small fraction of the colic seen in infancy. Nevertheless, it is worth emphasis because it is in this field that one can present objective evidence.
It used to be generally assumed that "infantile colic" implied only a spastic disturbance of the small intestine. In the light of present understanding, this spastic phenomenon may involve not only the small intestine, but also the colon, and even the pylorus of the stomach.
THE EXPERIMENTAL STUDIES
One does not have to speculate on the "modus operandi." It has been possible to demonstrate visible evidence of this otherwise subjective phenomenon by roentgenogram. In atopic children, specifically chosen because they were subject to intestinal cramps from known foods, it was possible to activate various parts of the gastrointestinal tract by feeding these allergenic foods concealed in barium. These studies were published in detail some time ago.
We could produce segmental contraction of the small intestine, demonstrating configurations on the roentgenogram comparable to those seen in sprue or celiac disease; and observe pylorospasm and colonic spasm in association with cramping abdominal pain, varying from mild to severe. Many of these children had confirmatory positive cutaneous tests to the provocative foods. Although these observations were made on children 4 to 14 years of age, there is no reason to doubt that similar mechanisms are operative in infants. Obviously infants are not suitable subjects for such studies.
THE GENERAL STATE OF AMERICAN PEDIATRICS IN 1855 WITH PARTICULAR REFERENCE TO PHILADELPHIA
Authors: Caulfield Ernest 
Published: December 2021

IN VIEW of the tremendous advance in pediatrics during the past half century, one might think that a full century ago no one could have known very much about the care of children. To read the newspapers of that day, one might also conclude that it was an age primarily of quacks and patent medicines—of worm cures, hive syrups and of little liver pills. But to appreciate the true status of American pediatrics in 1855 one must judge it not only by the standards of our time but also by the standards of a century earlier, and when that is done it will be seen that American pediatrics in the mid-Nineteenth Century had also made considerable progress. In 1755 the care of the sick was generally in the hands of well-meaning yet untrained practical nurses whereas in 1855 people were turning to physicians who were usually medical school graduates, well acquainted with a vast number of new and important publications. More and more pediatric articles were appearing in the many American journals; and in the review of a new book, one writer mentioned "the numerous publications on the management of infants and children with which the press has been loaded." Indeed, the press was loaded, for the Philadelphia physician had at his command no less than 8 fairsized textbooks in English devoted exclusively to the care of children.
The second quarter of the Nineteenth Century saw a definite trend toward pediatrics as a specialty. There is no need to discuss here the numerous elementary guides which were intended primarily for mothers and which were precursors of the textbooks, or the many systems of general medicine with their chapters on pediatric subjects, especially since this trend may be well illustrated by mentioning only the impressive list of textbooks published in Philadelphia.
THE ROLE OF OXYGEN IN RETROLENTAL FIBROPLASIA
Authors: Patz Arnall 
Published: December 2021

The results of a controlled nursery study, supported by observations of others in both uncontrolled and controlled studies, clearly established the overuse of oxygen in the premature nursery as an important and probably the principal factor in the development of retrolental fibroplasia.
The clinical data is supported by observations in the newborn or young mouse, rat, kitten, and puppy where retinal lesions, identical to those seen in early human retrolental fibroplasia are produced following exposure to an enriched oxygen environment.
Fundamental to all these experiments, and apparently to the pathogenesis of human retrolental fibroplasia, is the uniform ocular susceptibility to oxygen when the retinas are immaturely vascularized, and a resistance to oxygen damage where vascularization is complete.
The animal lesions produced by oxygen are proportional to the concentration of oxygen administered and the duration of exposure, and inversely proportional to the degree of vascularization of the retina. Duration of exposure to oxygen proved to be the most important single factor in these experiments.
The ocular effects of oxygen on the immature retina can be divided into a primary phase of vasoconstriction and obliteration and a secondary phase of vascular proliferation.
These clinical and experimental data justify recommendations for a rigid supervision of oxygen administration to the premature infant to avoid any unnecessary overuse of this potentially toxic agent.
Epileptic Seizures
Authors: DAVIDSON DOUGLAS T. 
Published: December 2021

Where can a physician, a social worker, psychologist, or educator find a single not-too-technical book about epilepsy? This 165-page effort fills the bill. Seventeen qualified contributors including Wilder Penfield cover the subject from historical, diagnostic, therapeutic, psychologic, educational and employment asaspects. In this respect the work is unique for a book of its size. Up-to-date bibliographies accompany many of the presentations.
If the pediatrician hooks in vain for a statement as to the relative numbers of patients who require surgical as opposed to medical treatment, or for a discussion of febrile convulsions or genetic considerations, if he suspects that the book's pediatric contributions are lighter than he would like, he will probably forgive these shortcomings because of its many excellent features.
DYSMENORRHEA IN ADOLESCENCE
Authors: Heald Felix P. , Masland Robert P. , Sturgis Somers H. , Gallagher J. Roswell 
Published: December 2021

Primary dysmenorrhea is common in adolescence; dysmenorrhea secondary to a cyst or inflammation or other organic pathologic process is rare. During adolescence many girls find it difficult to assume, either physiologically or psychologically, the new demands which the process of maturing into an adult female has put upon them. It is therefore necessary to understand the endocrine and reproductive systems of this age group and also their worries and conflicts. It is important to know that dysmenorrhea does not occur in the absence of ovulation and that cramps can be evidence of underlying tension and worry.
For most girls who have this complaint, a thorough but thoughtful examination, reassurance, a careful explanation of the association between ovulation and menstruation and a little attention to them, will suffice. Others who have the sort of worries and conflicts which plague this age group should be given an opportunity to express their feelings and relieve their tension. In an occasional adolescent, incapacitating menstrual cramps may be the somatic focus of a disorder which will require psychiatric care.
When both the physiologic and the psychologic characteristics of adolescents are kept in mind, the physician can at least do much to insure these patients a more satisfactory adjustment to womanhood and perhaps also to relieve their discomfort. If success does not follow from one's efforts, the assistance of more experienced physicians should be sought.
THE ADRENOGENITAL SYNDROME, SALT-LOSING TYPE
Authors: Faber Harold K. 
Published: December 2021

Case reports of two brothers with the adrenogenital syndrome, followed from birth to the ages of 7 and 5 6/12 years, respectively, are presented.
Virilism and addisonian crises were prevented with fair success in both by cortisone and DOCA.
Along with reduction of urinary output of androgens, growth was moderately retarded, but when cortisone dosage was lowered output of androgens increased and marked acceleration of growth, including skeletal maturation, occurred.
An episode of hypertension occurred in each case, but was preceded and followed by periods of normal blood pressure. These episodes may have been due to accelerated release of desoxycorticosterone from implanted DOCA pellets.
CLINICAL CONFERENCE
Authors: Ransohoff Joseph 
Published: December 2021

Dr. Ransohoff: I want to draw your attention to a group of infants with chronic subdural hematoma. The distinctive feature of these patients is marked enlargement of the skull. This megalocephaly was of such a degree in eight patients we treated that they were all admitted to the hospital with a tentative diagnosis of internal hydrocephalus. The presence of subdural hematoma was only discovered in these children at the time of tipping the subdural space through the enlarged anterior fontanelle prior to carrying out ventriculography. When air is injected into the subdural space in these patients, roentgenograms reveal fairly normal-sized cerebral hemispheres surrounded by hugely distended subdural spaces. We believe that it is this disproportion between the size of the boney vault and the size of the underlying brain which makes this group a special therapeutic problem (Fig. 1).
When a surgeon drains blood and fluid from the subdural space, he expects the underlying compressed brain to re-expand and obliterate the remaining cavity. If the lesion is of long standing, he may find it necessary to remove the inner membrane of the subdural hematoma, which is covering the surface of the brain, before the expected re-expansion can occur. However, when the cranium has been so enlarged by bilateral subdural collections that it is considerably larger than the normal-sized brain, the brain cannot be expected to re-expand sufficiently to fill the entire cavity.
We became aware of this therapeutic dilemma after applying the usual techniques of treatment to a 3-month-old infant admitted in 1952 with a definite history of trauma. After the removal of about 350 ml of subdural fluid by daily subdural taps, we made bone flaps, bilateral and frontoparietal, and removed the inner membranes of the subdural hematomas, 1 week apart.
Effect of Testosterone on Fetus
Authors: TRIMBLE GEORGE X. 
Published: December 2021

Reference is made to the report of a case of female pseudohermaphrodism in an infant after administration of testosterone to the mother during pregnancy, submitted by Doctors Grunwaldt and Bates (Pediatrics, 20:503, September 1957).
I think it would be of interest to note that the question of hormonal production of fetal hermaphrodism was raised in a 1955 case report of such an instance occurring in an infant born of a mother under treatment with male hormone for pruritus during pregnancy.
A SURVEY OF RADIATION EXPOSURE IN PEDIATRIC PRACTICE
Authors: Zavon Mitchell R. , Valaer Peter J. 
Published: December 2021

The work habits and equipment of 44 Cincinnati pediatricians who use fluoroscopes in office practice were studied to determine radiation exposure. Several pediatricians shared fluoroscopes, so the study involved 34 machines, representing 14 different makes.
A time-totalizer, made expressly for this study, obtained time-of-use data on 29 of the 34 fluoroscopes.
Sixteen fluoroscopes were used less than 1½ minutes per week. Three exceeded 7 minutes per week, with the maximum being 11¾ minutes per week.
A laboratory coat with 10 pocket chambers was given to each physician for a week to be worn during fluoroscopy. The pocket chambers were located over various areas of the body to determine exposure at each point.
All chambers worn by 31 physicians recorded less than 50 mr. Five doctors had one or two chambers that went beyond the 200 mr scale of the chamber.
Twenty-two fluoroscopes had useful-beam dose rates greater than the presently accepted maximal allowable limit.
HYPOPARATHYROIDISM IN CHILDREN AND ADOLESCENTS
Authors: Soper Robert T. , Mason Edward E. , Buckwalter Joseph A. 
Published: December 2021

Eight cases of hypoparathynoidism in patients less than 17 years of age have been presented and discussed. One case was primary in type and seven were secondary to thyroidectomies performed for thyrotoxicosis or carcinoma of the thyroid gland. The similarity of symptomatology, time of onset, treatment and long-term management between cases of hypoparathyroidism in the younger age group and in adults has been emphasized.
Prophylaxis against the development of hypoparathyroidism following thyroid surgeny is the responsibility of the surgeon. When present, the disorder must be recognized early and treated promptly with adequate dosages of appropriate drugs. Conscientious long-term clinical and laboratory follow-up examinations are necessary to avoid the serious complications of chronic hypocalcemia. Tests to quantitate more accurately degrees of parathyroid function are needed in secondary hypopanathyroidsm which is thought to be temporary in nature. Children and adolescents with hypopanathyroidism deserve special care in diagnosis, treatment and long-term management.
EDUCATION
Authors: Hill Lee Forrest 
Published: December 2021

Should the role of the private hospital in pediatric education be that of service to patients only, or should it attempt a teaching role in addition? The advantages to all concerned—patients, physicians, community—are so great when teaching is in effect that all qualified private hospitals should serve an educational as well as service function. Private pediatric patients are as suitable for teaching as service patients. Residency responsibility can be made adequate. Teaching assumed by a private staff is conducted under a severe handicap as compared to the professional educators in a university, but it can be done well if there is sufficient desire.
The make-up of the clientele in a private hospital simulates more closely that of private practice than does that of some university centers. Inability of a private hospital to carry out basic research is its most serious defect in the role of education. However, the type of research best suited to the first 2 years of residency training is clinical and this type can be readily pursued in a private hospital.
While outpatient experience is difficult to arrange in a private pediatric hospital, it is essential and can be accomplished with co-operation from the staff. Private hospitals which possess personnel and facilities justifying designation as pediatric centers are likely to have sufficient referrals of unusual and difficult cases to insure adequate inpatient teaching on the less common disorders.
When private hospitals undertake teaching programs, standards of pediatric care are raised in the hospitals and in the communities they serve.
Provision of general physicians for children is a unique system obtaining only in America. It has given American children a high standard of medical care. Many more physicians of this type are needed to meet the demand. How many more is unknown, but perhaps two or even three times as many as are available. Until the demand has been met, properly qualified private pediatric hospitals should establish or continue educational as well as service programs.