bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE CRITICALLY ILL CHILD: SALICYLATE INTOXICATION
Authors: Segar William E. 
Published: December 2021

Salicylate is a potent pharmacologic agent, and the rational therapy of salicylate intoxication must be based on an understanding of its pharmacologic actions and consequent pathophysiologic effects.l Because it acts to uncouple oxidative phosphorylation in a manner analogous to that of 2,4-dinitrophenol, salicylate is, first of all, a general metabolic stimulant.2 Oxygen consumption, carbon dioxide formation, and heat production are increased by its action; consequently, oxygen requirement, blood CO2 concentration, and the need to eliminate heat are also increased. Respiration, heart rate, and cardiac output must increase to satisfy the demands imposed by the acceleration of metabolic processes.
Second, saiicylate interferes in a complex manner with the normal metabolism of carbohydrate.3 Many factors seem to be involved, some tending to decrease and others to increase the blood glucose concentralion, and, clinically, either hyperglycemia or hypoglycemia may be observed. Hyperglycemia may be partially explained by the release of epinephrmne due to activation of hypothalamic sympathetic centers. However, large doses of salicyiate also decrease aerobic metabolism and increase glucose-6-phosphatase activity, effects which tend to increase the blood glucose level. Hypoglycemia, on the other hand, may be caused by an increased utilization of glucose by peripheral tissues or by interference with gluconeogenesis by salicylates. Recent studies suggest that brain glucose concentration may be decreased despite minimal alterations in blood glucose level.4
As a result of these salicylate-mnduced alterations in carbohydrate metabolism, organic acids, particularly lactic, pyruvic, and acetoacetic, accumuiate.5 Infants appear to be particularly susceptible to the toxic effects of salicylate on carbohydrate metabolism and are more likely to have disturbances in blood glucose concentration and metabolic acidosis than are older children.
Children with Fevers: I
Authors: Heller George 
Published: December 2021

The article by Dr. Thomas E. Cone, Jr. (Pediatrics, 43:290, 1969), is worthwhile if only the section under Management is respected by our colleagues. However, a little nit picking may be called for.
1. Certainly in private, as opposed to hospital practice, infections of the urinary tract are much less frequent than he suggests. Roseola, the exanthemata, gastroenteritis—even fever of undetermined origin—are way, way ahead, in my experience.
2. I'd hate to have a mother or a nurse insert the thermometer 2 in. into the child's rectum.
Children with Fevers: II
Authors: Whipple Deryle T. 
Published: December 2021

In a recent article in Pediatrics (43:290, 1969) , Dr. Cone reviewed the approach to a child with fever. The list of patients with fever of undetermined origin will shrink markedly in the presence of a complete physical examination (especially the ears), a CBC, and urinalysis performed properly.
I am surprised Dr. Cone omits infectious mononucleosis from his admittedly limited coverage of this subject. In the young child the Mono test or Heterophile may remain consistently normal.
Children with Fevers: III
Authors: Shaw Edward B. 
Published: December 2021

I enjoyed reading Dr. Cone's excellent paper, "Diagnosis and Treatment: Children with Fevers" (Pediatrics, 43:290, 1969), which contains many things that physicians and, hopefully, mothers should heed. I hope he will not object to two or three comments.
Just what is sepsis, or septicemia as an isolated phenomenon independent of a source? The blood culture may be positive and the source not easily determined, but a continuous bacteremia must be fed from somewhere. Sinus thrombosis, S.B.E., osteomyelitis, lymphangitis due to streptococci, infection of the umbilical vessels in the newborn, and so forth.
Children with Fevers: IV
Authors: Myers Burt 
Published: December 2021

In a recent review article by Dr. T. E. Cone, Jr., (Pediatrics, 43:290, 1969), the author referred to Familial Mediterranean Fever as an example of one of the periodic fevers.
The early descriptions of this disease referred to it as a "periodic disease." However, more comprehensive studies from 1955 to the present clearly indicate that this disease is characterized by episodes of irregular (non-periodic) recurrent attacks of fever and serositis. Thus, the reference to Familial Mediterranean Fever as a periodic disease is misleading.
Letter to the Editor
Authors: Hughes Gerald E. 
Published: December 2021

Thank you for the opportunity to reply to the letters from Drs. Silverman, Halpern, and Hervada. Questions about the selection of sites for the Academy's meetings arise periodically, and the reasons for the selections should be reviewed periodically in response to these questions.
As an initial consideration, the Executive Board of the Academy, after questionnaires to the members and discussions with District Committees and Chapter Chairmen, has decided that it is preferable that the Annual Meetings be held in hotels and under one roof.
Diagnostic Sign of Otitis Media: Belching and Pain
Authors: Newman Arthur J. 
Published: December 2021

I should like to call to the attention of your readers a symptom which I have encountered in my general pediatric practice which has been of considerable diagnostic assistance.
Infants with otitis media who are too young to rub at or touch the affected ear frequently evidence pain, discomfort, and crying following belching.
It is my impression that belching can produce a modified Valsalva manuever, with increased pressure being exerted on the tympanic membrane through the eustachian tubes.
Developmental Language Disability: Adult Accomplishments of Dyslexic Boys, by Margaret B. Rawson. Baltimore: The Johns Hopkins Press, 1968, 127 pp., $5.50
Authors: Gallagher J. Roswell 
Published: December 2021

Physicians, educators, psychologists, and parents frequently ask how much improvement they can expect in those children who, despite average or better intelligence and freedom from a primary emotional disorder, experience difficulty in learning to read, write, and spell.
The author of this book, a wise and exceptionally competent teacher who has had years of experience, reports the bong-range educational and vocational accomplishments of a group of such boys. All of these boys, and the ones with which she compared them (who found little or no difficulty in learning Ianguage skills), attended the elementary grades of the same small independent school between 1930 and 1947.
CONGENITAL ASYMMETRY: REPORT OF 10 CASES WITH ASSOCIATED DEVELOPMENTAL ABNORMALITIES
Authors: Parker David A. , Skalko Richard G. 
Published: December 2021

Ten patients with total congenital asymmetry were found in a review of the charts of some 860,000 admissions to The New York Hospital-Cornell Medical Center over the interval 1932-1966.
Associated abnormalities described include two instances of adrenal neoplasm, one case of bilateral medullary sponge kidneys, and a possible case of Beckwith's syndrome. Six of the 10 patients had abnormalities of the genitourinary system. An oncogenic-teratogenic relationship and a possible biologic system for the study of such a relationship are suggested.
PEDIATRIC PRACTICE IN THE UNITED STATES
Authors: Yankauer Alfred , Connelly John P. , Feldman Jacob J. 
Published: December 2021

This is a report of a mail survey undertaken on behalf of the Subcommittee on Pediatric Manpower of the Council on Pediatric Practice of the American Academy of Pediatrics. Its purposes were: (1) to collect information about how practitioners of pediatrics utilize their own time and that of other health workers for the performance of specific tasks carried out in the course of ambulatory pediatric care; (2) to ascertain the degree to which practice characteristics, including task delegation, were related to characteristics of the physician, his practice arrangement and his practice load; and, (3) to sound out general pediatric opinion concerning task delegation in ambulatory pediatric care.
The genesis of this survey and its relationship to current health manpower shortages have been discussed elsewhere.1 Prior to this survey no information on a national basis had been available concerning the extent and nature of task delegation in pediatric office practice or the opinions of pediatricians about this subject. Although most American children receive preventive and therapeutic health care from physicians in private office practice, extraordinarily little information about the characteristics of this system of care is available.
A structured, precoded questionnaire was designed to collect the desired information. In the summer of 1967, the first version was pretested on 273 Regular Fellows of the Academy of Pediatrics residing in Massachusetts and a 2% random sample of Fellows residing in the other 49 states and the District of Columbia. The results of this major pretest have been described elsewhere. Slight modifications were made in the original version of the questionnaire and the revised version was mailed in the late fall of 1967 to 6,820 Regular Fellows of tile American Academy of Pediatrics residing in the United States.
Letter To The Editor
Authors: Johnson Roswell D. 
Published: December 2021

It is with deep satisfaction that I note the article on marijuana in the contributors section in the January issue of Pediatrics.
As an Academy member and now as a full time Director of a university health service, I have found it necessary to devote a great deal of time to the literature, and to community and regional programs on "drugs," and an extensive day by day as well as night by night dialogue with students of all persuasions on the problem of behavior alterants, particularly marijuana.
Letter To The Editor
Authors: Nader Philip , Haggerty Robert 
Published: December 2021

Dr. Haggerty and Dr. Nader write:
We are pleased to have stimulated at least some pediatricians to a consideration of their own views on the marijuana issue. On Dr. Gleason's letter we have no comment. We hope that Drs. Dohner and Ott reread our commentary and note we are quoting others' views, not expressing our own in the introductory paragraph they refer to.
We are encouraged by the responses and also agree with Dr. Milman that all available data should be considered.
Letter To The Editor
Authors: Yankauer Alfred 
Published: December 2021

Second, Dr. Yankauer:
"Disgraceful and totally unacceptable" are inflammatory adjectives. They stir up uncomfortable feelings of personal guilt and blame. It would be reassuring if the differences between infant mortality rates in the United States and those of several small European countries with relatively homogenous populations and stable traditions could be explained away as statistical artefacts.
Unfortunately the differences cannot be explained away. Clear evidence for their substance is the fact that infant death rates after the first month of life are three times as high in the United States as in Sweden.
Whose Trudeau Now?
Authors: Joven I. B. 
Published: December 2021

This is in reference to the article on tuberculin reactors by Drs. Burchak and Turner and Ann Robson from Toronto in the December 1969 issue.1
I did not realize that the American Trudeau Society (ATS), if ever there was such a one, had as one of its activities the production of a culture media designed to allow the growth of M. tuberculosis.
I wonder if the authors (if they were canadian) meant this as a compliment to their colorful prime minister, Pierre Elliot Trudeau.
ON HOW TO BECOME A MODEL PARENT ACCORDING TO BERNARD SHAW
Authors: C. T. E. 
Published: December 2021

My parents took no moral responsibility for me. I was just something that had happened to them inevitably and had to be put up with and supported. They did not worry themselves uselessly about my character and my future. I suffered nothing from the intolerable meddlesomeness of the conscientious parents who are so busy with their children's characters that they have no time to look after their own. I cannot remember having ever heard a single sentence uttered by my mother in the nature of moral or religious instruction.
My father made an effort or two. When he caught me imitating him by pretending to smoke a toy pipe, he advised me very earnestly never to follow his example in any way; and his sincerity so impressed me that to this day I have never smoked, never shaved, and never used alcoholic stimulants. He taught me to regard him as an unsuccessful man with many undesirable habits, as a warning and not a model. In fact he did himself less than justice lest I should grow up like him; and I now perceive that this anxiety on his part was altogether admirable and lovable, and that he was really just what he so carefully strove not to be: that is a model father.
Many of us who are parents go through agonies of hypocrisy to win a respect from our children which we do not deserve. In our virtuous resolution to do our duty as parents we become humbugs, and when our children are old enough to find us out, as they do at a very early age, they become cynical and lose the affectionate respect which we have destroyed ourselves morally to gain.
CLINICAL EVALUATION OF ABNORMAL ENZYME CONTENT IN THE PANCREATIC JUICE OF CHILDREN
Authors: MCDOUGALL CLARICE 
Published: December 2021

One hundred and sixty-five children were intubated and the enzyme activity of their duodenal juice studied. Seventy-six patients showed normal potency of all the pancreatic enzymes and had clinical conditions apparently unrelated to pancreatic secretions. The other 89 patients were included in this study and grouped as follows:
Group I: Twenty-three children had minimal pancreatic enzyme activity and presumably were suffering from fibrocystic disease of the pancreas.
Group II: Two children with minimal enzyme activity may have had a pancreatic deficiency of different etiology from that of Group I.
Group III: Four children had transitory partial suppression of trypsin, lipase and amylase. In three, after recovery, repeated studies showed that their enzymes were normal. The fourth child died without the enzyme studies having been repeated. A fifth child had complete suppression of enzyme activity while ill with a respiratory infection. She is included in this group because, coincident with her clinical recovery, there was an appreciable return of enzyme activity. Clinically, these five children had nothing in common.
Group IV (a): Twenty-five children had suppression of lipase activity in conjunction with a normal level for trypsin and amylase. Most of them had some type of gastrointestinal disturbance. Four had diseases of the respiratory system. Sixteen of these children were restudied. The return of lipase activity coincided roughly with a return to health: those who were studied at a time they were clinically well had normal enzyme activity, while those who were not well still had a reduced secretion of pancreatic lipase. None proved to be early cases of progressive pancreatic deficiency.
Group IV (b): There were no children with deficient trypsin activity in the presence of normal lipase and amylase.
Group IV (c): Sixteen children were deficient in amylolytic activity in conjunction with normal trypsin and lipase. Most of these children had gastrointestinal symptoms. Six of them had celiac disease.
Group V: Eighteen children with extreme malnutrition had normal enzyme activity.
THE PRESIDENT'S COLUMN
Authors: SHAW EDWARD B. 
Published: December 2021

The President and the Executive Board send their greetings to the membership of the Academy of Pediatrics for the new year.
This column will appear irregularly from time to time in an effort to keep the membership apprised of developments which affect the Academy and which must be considered by the Executive Board. The President and the District Chairmen are elective officers of the Academy and in the true sense of democratic representation can only attempt to interpret the opinions of the membership in their action on problems which arise. American medicine is now confronted with many problems upon which neither the individual nor the organization can avoid taking a position. The action of your executive officers must be predicated upon the expression of opinion by the membership. It is hoped that you will keep your officers informed of individual and group opinions upon controversial issues in order to guide their action. The columns of Pediatrics IATRICS are open to the membership in "The Pediatrician and the Public" but it is most desirable that you communicate with your officers directly for their information.
The San Francisco session was astonishingly well attended considering the handicap which distance imposed upon many of the members. I should be remiss in not expressing the pleasure of the local Fellows that so many should have come so far and contributed so much. Dr. Edgar E. Martmer and his Program Committee are to be congratulated not only because of the excellence of the program but also because they were able to effect last minute substitutions for participants who, because of illness, were unable to attend, without impairing the structure of the meeting.
LOUISIANA'S PROGRAM FOR THE CARE OF THE PREMATURE INFANT
Authors: CHIPMAN SIDNEY S. , TREUTING WALDO L. 
Published: December 2021

Louisiana's program for the care of the premature infant has been discussed in terms of the need for such a program and of its component parts.
Little effort has been directed towards expansion of case finding since all facilities available for the care of the prematures are already overtaxed.
Hospital placement at the present time centers around the unit constructed in the Charity Hospital in New Orleans, where facilities have been planned to accommodate 80 to 100 infants. Because of the large numbers involved many problems have arisen regarding construction and organization.
A system of home investigation and follow-up has been well developed in the New Orleans area.
Plans for the training of nurses and physicians in the care of the premature are complicated by the need for minimizing the number of contacts with these infants. Members of the house staff and undergraduate nurses participate in the activities of the unit. Courses for graduate nurses will begin shortly and a more comprehensive training progam will be developed.
OBSERVATIONS ON ACUTE LEUKEMIA IN CHILDREN TREATED WITH 4-AMINOPTEROYLGLUTAMIC ACID
Authors: MILLS STEPHEN D. , STICKNEY J. M. , HAGEDORN ALBERT B. 
Published: December 2021

THE RECENT publications of Farber and co-workers dealing with the treatment of acute leukemia in children have awakened widespread interest. Their investigations have stimulated hope for the amelioration of symptoms of this fatal disease and indicated the possibility of provoking remissions that lengthen the lives of those patients affected by it, while making them more comfortable at the same time.
In investigating leukemia and allied conditions of a neoplastic nature, Farber and co-workers noted what they termed an "acceleration phenomenon" in the blood and bone marrow of leukemic children treated with folic acid or its conjugates such as diopterin (pteroyldiglutamic acid) or teropterin (pteroyltriglutamic acid). There was marked hyperplasia of the marrow as well as of other sites of leukemic involvement at postmortem examination. They reasoned that if folic acid or its conjugates speeded up the leukemic process, an antagonist to folic acid might be devised in order to retard the progress of the disease or stop it altogether. Through co-operation with the research division of one of the major pharmaceutical firms, a series of folic acid antagonists was soon developed. One of these was aminopterin (4-aminopteroylglutamic acid). It differs from folic acid only in the substitution of the NH2 group for the OH radical in the fourth position of the pteridine group. Of several compounds synthetically made, it has been the most effective and yet most toxic agent in its action on the leukemic process.
Farber and co-workers first employed aminopterin in the treatment of acute leukemia of children in December 1947.
PENICILLIN REGIMENS IN PEDIATRIC PRACTICE
Authors: HILDICK-SMITH GAVIN , MCNAIR SCOTT THOMAS F. , WHITLOCK COLEMAN M. 
Published: December 2021

A study was made of the blood levels and the clearance rates of penicillin that follow different doses and routes of administration of penicillin, in normal children from 2 to 11½ years with normal kidney function.
Following intramuscular injection of aqueous penicillin, optimal bactericidal levels (cf.Eagle and Musselman) were obtained with a daily dose of 5000 u./lb. if given every three hours, or 10,000 u./lb. given every six to eight hours. If adequate doses of oral caronamide were added to the latter dosage scheme, the above levels could be obtained for 8 to 12 hours.
Procaine penicillin of the large particle size (procaine penicillin A) used in this study, when given in doses of 6000 u./lb., provides optimal bactericidal levels for 24 hours or more in some instances. Furthermore, the same dosage scheme using preparations of a smaller particle size (procaine penicillin B), which did not sustain bactericidal levels for quite as long, resulted in successful therapy on clinical trial. Caronamide added by mouth does not increase the initial height of the blood levels appreciably, but does delay the plasma penicillin clearance rate.
Oral penicillin is variable in its action. It appears to be more reliable if given in a buffered form and the addition of caronamide improves the levels obtained.
The therapeutic application of these different regimens is discussed.
OBSERVATIONS REGARDING ARTIFICIALLY INDUCED SUBCUTANEOUS NODULES IN RHEUMATIC FEVER PATIENTS
Authors: MASSELL BENEDICT F. , COEN WILLIAM B. , JONES T. DUCKETT 
Published: December 2021

Subcutaneous nodules indistinguishable from spontaneously occurring nodules have been artificially induced in rheumatic patients by the subcutaneous injection of blood.
The frequency, size and duration of the induced nodules correlated closely with the severity and duration of the rheumatic process. Only infrequently could nodules be induced in control subjects suffering from conditions unrelated to rheumatic fever.
Although citrated blood obtained from patients with highly active rheumatic fever seemed to be more effective in inducing nodules in quiescent and mildly active rheumatic patients than did the patient's own blood, the active rheumatic blood was not more effective than blood obtained from healthy young adults.
The daily injection of convalescent rheumatic serum into the site of the nodule test did not interfere with the induction of nodules.
Saline, as well as blood, effectively induced nodules in certain patients, provided that it was injected with the standard traumatizing technic.
It is concluded that the development of nodules results from injury to the subcutaneous fibrous tissue, the reactivity of which is altered by the rheumatic process, and that the hypothesis of a nodule-stimulating substance present in the blood of active rheumatic patients is untenable.
Nodules have been induced in some rheumatic patients by the subcutaneous injection of hyaluronidase. These observations, together with the observations of others that trypsin is also an effective nodule-inducing agent, suggest that enzymes may play a role in the mechanism of nodule formation. However, it is also possible that these substances act in quite a nonspecific way and set off the nodule reaction merely by injuring the subcutaneous fibrous tissue.