bluuebunny/crossref_metadata_2025_split huggingface dataset:
SYMPOSIUM ON TUBERCULOSIS
Authors: Lincoln Edith M. , Sifontes Jose E. 
Published: December 2021

A BRIEF review of present concepts of the fate of the primary complex may serve as a useful introduction to the problem of treating the infant or child with asymptomatic primary tuberculosis.
The primary lesion persists for months and gradually disappears, usually leaving calcification in the site of the primary focus and the corresponding lymph nodes. In most instances recovery is uneventful despite the almost universal occurrence of a hematogenous or lympho-hematogenous spread of tubercle bacilli, but this accounts for most of the severe complications of primary tuberculosis such as tuberculous meningitis and skeletal tuberculosis. The spread may be of various types and degrees but is usually an occult hematogenous dissemination from the primary lesion, which may take place during the incubation period or during the first few months after the appearance of the primary complex. Hematogenous spread also may be massive, resulting in miliary tuberculosis. Tubercle bacilli in the tracheo-bronchial lymph nodes may spread to other lymph nodes or other areas of the body through lympho-hematogenous dissemination. Common sites of invasion are the cervical lymph nodes and tonsils. The primary lesion may progress locally by excavation and by bronchogenic dissemination; it is then often called locally progressive primary tuberculosis.
The majority of the complications appear within the first year of infection in an infant or a child who has previously been asymptomatic.
In children, reinfection or chronic, adult type of tuberculosis is most common in adolescence. It may be of exogenous or endogenous origin. The endogenous type might be considered a distant complication of primary tuberculosis, since it is believed to occur as a result of activation of a dormant focus.
HEARING AND SPEECH DEFECTS
Authors: Bloomer Harlan , Herman George 
Published: December 2021

The presentation stressed the importance of speech and language in the child's social and personality development; the far-reaching effects of speech and language disorders; the latitude of factors contributing to the various types of such disorders in children; and the therapeutic approach to the child with defective speech.
Speech consists of sounds produced by the upper respiratory and alimentary tracts and is described in terms of its phonologic elements (vowels and consonants); vocal pitch, volume and quality; melody and stress pattern; temporal factors of rate, rhythm, duration and phrasing; and expressive gestures. Spoken language is the symbolic use of these sounds.
Functions of speech and language are threefold: Emotional expression, self-communication and interpersonal communication. The last, in turn, serves the purposes of social interchange, interchange of information and social control.
Disorders of speech and language result in impairment of sociability, communication and effective social control. A child thus handicapped is likely to become socially retarded and psychologically maladjusted. Of high school children in the United States, roughly 5% suffer from some speech defect and over 2,000,000 of them would benefit from special help.
Symptomatically, speech and language disorders may be classified into five groups: (1) "articulatory disorders," characterized by substitutions, omissions and distortions of sounds; (2) "cluttering," defined as rapid, dysrhythmic slurring and clustering of sounds; (3) "stuttering," the repetition, prolongation or blocking of sounds and words, often associated with overflow facial grimacing and spasmodic movements of trunk and extremities and, usually, psychologic reactions to stuttering; (4) "voice disorders," ranging from complete absence to abnormalities in quality, pitch, intensity and melody; and (5) "language disorders," subdivided into (a) "delayed speech" (after age 3 years) and (b) "aphasia," resulting from lesions in the central nervous system. An additional group of speech disorders has as etiology some physical abnormalities: (1) "cleft palate speech," with disturbed voice quality and articulation; (2) "cerebral palsy speech," with disturbances in articulation, voice, rhythm and sometimes also delay in language development; and (3) "hearing impairment," which results in improper development of articulation, voice and language.
TOLERANCE OF INFANTS AND CHILDREN TO FAT ADMINISTERED INTRAVENOUSLY
Authors: Williams Margaret L. , Kaye Robert 
Published: December 2021

One hundred forty-six intravenous infusions of fat emulsions were given to 78 infants and children. In 15 subjects receiving 3 to 6 infusions on successive days, no significant changes occurred in concentration of nonprotein nitrogen, bilirubin or alkaline phosphatase in the serum; the cephahin flocculation test, concentration of urobilinogen in the urine and routine urinalysis were not abnormal. Three instances of increased values in the zinc turbidity test were noted. Four infants developed mild anemia.
During infusions administered at an average rate of 5 ml/kg/hr for periods of 4 to 6 hours, concentrations of ketones in the blood increased an average of 7.1 mg/100 ml (1.2 mM/l) in non-fasted subjects and 13.2 mg/100 ml (2.3 mM/l) in fasted subjects. This is interpreted as suggestive evidence of utilization of fat during the infusion.
Temperature elevations of more than 1.1°C (2°F) occurred during or after the infusion in 23.9% of infusions with a marked increase in frequency at infusion rates greater than 5 ml/kg/hr. Vomiting occurred in 12.3%. Other unfavorable reactions were uncommon.
CLINICAL CONFERENCE
Authors: Eichenwald Heinz F. 
Published: December 2021

Dr. Moore (Resident): E.P., a male born of Greek parentage, was 6 weeks of age at the time of his first admission to the New York Hospital. He had been well until 8 days prior to admission when he began to sneeze frequently, and his eyes began to water and his cry became hoarse. On the following day the family physician made a diagnosis of croup and prescribed tetracycline, 50 mg every 6 hours, nose drops, cough syrup and syrup of ipecac. Six days before admission an intermittent cough was noted. The patient's condition remained essentially unchanged until 2 days prior to admission when he became febrile, anorectic and developed a paroxysmal type of cough which occasionally terminated in vomiting. At this time penicillin, intramuscularly, was added to the regimen. He was admitted to the New York Hospital with the diagnosis of pneumonia.
The past history, family history and review of systems were noncontributory.
Physical examination revealed a well-nourished, white male with no evidence of respiratory distress. Rectal temperature was 39.3°C, apical pulse rate was 150/min, respirations were 30/min. There was no retraction on cyanosis. Examination of the ears was normal. There was a grayish-white, plaque-like, exudative lesion over the left lateral aspect of the soft palate. The pharynx was injected. Shotty lymphadenopathy was present in the cervical chains bilaterally. There was a sinus tachycardia with no cardiac murmurs audible. The lungs were clear to percussion and auscultation. The liver was palpable 1 to 2 cm below the costal margin. The spleen and kidneys were not palpable. The remainder of the examination was not remarkable.
DENTISTRY IN CHILDREN
Authors: Losch Paul K. , Boyers Charles L. 
Published: December 2021

IT SEEMS only proper to begin this discussion with a few words about dental decay. Certainly in view of the prevalence of this disease, it deserves recognition as one of the great health problems.
The study of dental caries as a disease process has received a striking amount of attention in the past few years, yet we are forced to go back to an early theory of the etiology of this disease in order to discuss it intelligently.
Many years ago a theory was proposed in which it was stated that bacteria, with their enzyme systems working on a substrate of fermentable carbohydrate found primarily in plaques upon the smooth surfaces of teeth, lead to the decalcification of the mineral portion of the tooth. The theory also stated that the organic material is then destroyed by proteolysis. Much of the work which has been done in the field of caries since the time of this proposal has borne out the soundness of the original theory. But certainly we cannot regard dental caries as such a simple and straightforward disease. As a matter of fact, we know that dental caries is an extremely complex disease and each new area of research merely emphasizes this point. For instance, we know that dental caries cannot arise without bacteria being present. This has been demonstrated in the experiments with animals raised in a germ-free environment in which it has been shown conclusively that no caries occurs. To further elucidate the picture, we also know from the experiments of Shaw and Kite that animals fed by stomach tube will not develop dental decay.
COMPLICATIONS OF HYPERBILIRUBINEMIA IN THE NEWBOR—POSSIBLE RELATION TO THE METABOLISM OF AMMONIA
Authors: Gorten Martin K. , Shear Sheila , Hodsdon Marilee , Bessman Samuel P. 
Published: December 2021

Concentrations of ammonia in blood from the umbilical vein have been determined during the course of 20 exchange transfusions on 16 infants. One of these infants subsequently died of kernicterus and another died with liver damage and intracranial hemorrhage. Only these two infants had concentrations of ammonia in blood from the umbilical vein greater than 2 µg/ml during exchange transfusion when half of the blood had been administered. The only other infants with significantly elevated concentrations of ammonia in blood from the umbilical vein had siblings who had died of kernicterus.
A steady but gradual rise in the content of ammonia in stored blood has been shown to occur during storage. There is no relation between the content of ammonia in stored blood and the concentration of ammonia in the blood of the patient during exchange transfusion.
It is postulated that the ammonemia of the patient with impairment of liver function due to hyperbilirubinemia causes a failure of energy metabolism of nerve cells, resulting in an increased permeability of the cells to bilirubin. Once the cells are stained, the lesion is irreversible.
CONCERNING THE CHOICE OF THERAPY FOR CHILDHOOD HYPERTHYROIDISM
Authors: Arnold Mary B. , Talbot Nathan B. , Cope Oliver 
Published: December 2021

Representative experiences with surgical and medical (i.e., propylthiouracil) methods of managing juvenile thyrotoxicosis have been summarized and compared. The findings indicate that these methods are equally capable of eliminating the overt clinical manifestations of Graves' disease and that they yield approximately equal numbers of "cured" patients at the end of a 2-year period. Provided due care is taken, the risk of serious complications due to these forms of treatment also can be kept very low.
While the surgical and medical regimens may be similar in the foregoing respects, they appear to differ considerably in terms of their impact on the life of the patient and his family. One involves a brief period of detailed medical supervision culminating in hospitalization for surgery with its very slight, but definite mortality risk. Thereafter apart from possible need to take a dose of thyroid daily, the patient may be considered essentially normal. By contrast, the other requires that the patient remember to take a dose of medication approximately every 8 hours for a minimum of 2 years. One of these doses may of necessity have to be taken in the middle of the night at an hour when children are normally allowed to sleep undisturbed. Medical therapy also requires that the patient remain accessible to his physician for regulation of dosage and for prompt recognition of drug toxicity, which should be suspected every time the child has a sore throat or fever. It is concluded that these requirements of medical management may in themselves constitute a significant handicap to the child and his parents. It follows that they are deserving of consideration in choosing between subtotal thyroidectomy and prolonged chemotherapy as treatment for children with Graves' disease.
ACCIDENTAL INGESTION OF ESTROGENS BY CHILDREN
Authors: Hertz Roy 
Published: December 2021

History: The first family consisted of a boy, 5 years of age (Case 1) and a girl, 7 years of age (Case 2). The mother had noted distinct enlargement and nodularity of the breasts in both children and had consulted a pediatrician. The changes in the breasts became apparent in both children at about the same time. The pediatrician had rather complete records of the physical development of the children since the early postnatal period and had never previously noted any abnormality in them.
Physical Findings: When the children were first seen by the author there was unquestioned enlargement of the breasts in both the boy (Fig. 1) and the girl (Fig. 2). In the girl each breast (Fig. 3) contained a nodule, 1 cm in diameter, which was firm and slippery and free from the overlying skin. There was distinct stimulation of the areolae but the mammary glands were not especially prominent to direct inspection. No secretion could be expressed from either breast. There was a fine fuzz of pubic hair but no axillary hair. The labia showed distinct enlargement and the vaginal mucosa was unduly moist and vascular. Rectal examination revealed no uterine enlargement. There was a fine but unquestioned increase in the hair on the upper lip and the mother felt this was of recent origin. The skin was clear of acneiform or other type of eruption and the remainder of the physical findings were not remarkable.
The breasts of the boy (Fig. 4) also presented a distinct nodular enlargement.This was more readily palpable than visible. In addition he had been noted to have a recent enlargement and increased turgidity of the penis (Fig. 1).
Children Without Tears
Authors: RILEY CONRAD M. 
Published: December 2021

I read with interest Dr. Pryles' letter in Pediatrics (20:920, 1957) in which he commented on the not infrequent phenomenon of crying without tears among retarded children. He also stated that such children displayed other phenomena of dysautonomia.
During the years in which I have been interested in dysautonomia I have had occasion to see a moderate number of individuals who fail to produce tears when crying but who could not be considered to have dysautonomia. These have ranged all the way from an otherwise normal Irish boy, who also had corneal anesthesia, to retarded epileptics.
CORRECTED TRANSPOSITION OF THE GREAT VESSELS ASSOCIATED WITH INTRACARDIAC DEFECTS
Authors: Fink Burton W. , Adams Forrest H. , McFall Russell A. , O'Loughlin Bernard J. 
Published: December 2021

Four patients are presented to show how associated defects, such as ordinary transposition and interventricular septal defect, may confuse the diagnosis of corrected transposition of the great vessels. Three patients had interventricular defects, one of whom also had a patent ductus arteriosus associated with the primary defect.
The diagnoses were confirmed by surgery in two patients, and necropsy examination in one of these. Cardiac catheterization and angiocardiography should be performed prior to surgical repair in patients suspected of having an interventricular septal defect.
CLINICAL CONFERENCE
Authors: Davidson Murray 
Published: December 2021

Dr. Levine: The patient to be presented is an infant who had chronic diarrhea. Studies performed on this patient by Dr. Murray Davidson, Assistant Professor of Clinical Pediatrics, suggest that there are multiple factors involved in the production of the celiac syndrome. Dr. Davidson will discuss the patient's illness and observations made.
Dr. Murray Davidson: To many pediatricians the diagnosis of celiac syndrome means difficulty in absorption of nutrients. According to this concept the diagnosis cannot be made unless there is evidence of excessive stool loss of ingested material. An important contribution to our understanding of the condition has been made by the Dutch and British workers who have demonstrated steatorrhea related to the ingestion of gluten in patients with the celiac syndrome.
On the other hand, to some, celiac syndrome merely implies a state of chronic diarrhea. Thus, some cases of diarrhea related to milk ingestion have been called celiac syndrome because of chronicity of symptoms. To the best of our knowledge there are no published reports of such patients in whom detailed study has revealed evidence of malabsorption or a relationship to a specific protein in milk as has been shown in the studies with gluten.
In this paper it is our intention first to report a patient who fulfilled the criteria for celiac syndrome upon ingestion of a specific milk protein, and then to examine the current classification of the conditions which make up the celiac syndrome.
D.B., a 5-week-old infant, was admitted to the New York Hospital with a history of severe and chronic diarrhea from birth, manifested while receiving evaporated and skim milk formulae as well as Nutramigen®.
Stool cultures failed to reveal any pathogens. Study of the urinary tract, gastrointestinal tract and adrenal function revealed no cause for diarrhea.
STATEMENT FROM THE EXECUTIVE BOARD
Authors:   THE EXECUTIVE BOARD
Published: December 2021

THE FOLLOWING is an excerpt from the Abstracts of the Executive Board Meeting of October 2 to 5, 1957, presented at the Business Meeting of the Academy during the Annual Meeting on October 9, 1957. It is published here at the request of the Executive Board.
The following statement was adopted by the Board to be given to the members at the Annual Meeting by the President, transmitted to advertisers in Pediatrics by the Business Manager of Pediatrics and appear in the official publication of the Academy, Pediatrics:
The American Academy of Pediatrics recognized the Physicians' Council for Information on Child Health as an independent organization engaged in a program seeking to improve the health of children. The American Academy of Pediatrics has no connection with the Physicians' Council for Information on Child Health. The two organizations are not related in any way. The American Academy of Pediatrics has no control over the Physicians' Council, its directors, executive committee, officers or members. The Academy has no special knowledge of the program, policy or actions of the Physicians' Council, other than is disclosed by the publications of the Physicians' Council. The policy of the American Academy of Pediatrics is to co-operate with any organization interested in the improvement of child health and welfare.
SYMPOSIUM ON CONGENITAL METABOLIC DISEASE
Authors: Lowe Charles U. , Childs Barton 
Published: December 2021

MOST of the conditions to be considered in this symposium share one feature: their genetic origin. It could be profitable then to outline some of the principles of gene action and of the characteristics of genetic disease which will apply equally to all of the disorders to be reviewed.
To begin, a definition of gene action is offered. This must be an empirical one since it is not known, with any precision, what a gene is. However, it is known that the genetic material provides the most basic mechanism for homeostasis, ensuring that offspring will exhibit the characteristics of the parent, whether the offspring be daughter cells or human beings. This is accomplished by means of control over the formation and design of the vital molecules of the organism; those molecules which in their turn control its intricate and interrealted metabolic functions. It is for the most part these metabolic functions which we attempt to measure in the elucidation of gene action in disease, and it will be seen in the ensuing discussions that only rarely is one able to make any direct assessment of the physicochemical properties of these molecules which bear a specific relationship to the gene.
Much more commonly, a measurement is made of some form of activity of such substances, and a stepwise elucidation may be accomplished of the secondary effects which are consequent upon alterations in reaction rates or reaction failure. It is, in general, these secondary, tertiary, or consequential effects which are most easily measured, and which are the overt expressions of the disease. The principle illustrated here is, what a gene is said to do, depends upon which function we measure.
Letters to the Editor
Authors: EBERLING E. W. 
Published: December 2021

The following comments in regard to the letter from Dr. Heinz Wittig are respectfully submitted.
First, we have seriously considered acute virus pneumonia in our patient, as well as interstitial pneumonia with giant cell reaction due to virus, and acute disseminated inclusion disease of the newborn. No evidence for the presence of any of these pathogens could be found during life or at autopsy. We made careful examinations for the presence of intranuclear or intracytoplasmic inclusion bodies throughout various tissues throughout the body, but were unable to identify any such evidence of virus infection.
Fluoride and Dental Caries
Authors: DOTY J. ROY 
Published: December 2021

I wish to direct attention to a report by the Council on Dental Therapeutics of the American Dental Association (J. Am. Dental A., April, 1958) on prescribing supplements of dietary fluorides.
An examination of the letter by Dr. Trieger (Pediatrics, 20:919, 1957) reveals several areas of possible confusion. (1) There was an inadvertent confusion of sodium fluoride with the fluoride ion, which makes up less than half of the weight of the compound. Thus the quantity of fluoride suggested is somewhat less than half the quantity which was probably intended to be incorporated in the prescription.
HYDRAMNIOS AS AN AID TO THE EARLY DIAGNOSIS OF CONGENITAL OBSTRUCTION OF THE ALIMENTARY TRACT: A STUDY OF THE MATERNAL AND FETAL FACTORS
Authors: Lloyd James R. , Clatworthy H. William 
Published: December 2021

ALTHOUGH the association between hydramnios and congenital anomalies of the alimentary tract of the fetus has been recognized for more than 75 years, little emphasis has been placed upon this prenatal maternal abnormality as an aid to the earlier diagnosis of obstructive disease in the newborn. With the exception of isolated case reports which were summarized by Taussig in 1927 and the more recent observations of Mengert and Bourland, Castanier et al., and Clatworthy and Lloyd, the diagnostic significance of this relationship has not received proper recognition. Fortunately, today, the majority of anatomic abnormalities of the alimentary tract which are encountered in the neonate can be surgically corrected, if the diagnosis can be established and the treatment instituted before the infant has deteriorated irreversibly. A more general appreciation of the importance of hydramnios as a diagnostic sign of obstructive disease by physicians responsible for the care of the infant during the perinatal period should improve infant salvage.
Recent surveys of our experience at the Columbus Children's Hospital with neonates having obstructing lesions of the esophagus or intestine attracted our attention to the fact that many of these infants were delivered of mothers who suffered from acute or chronic hydramnios. In an effort to determine the significance of the interrelationship between hydramnios in the mother and congenital obstruction of the alimentary tract in the fetus, a study was undertaken which included not only a survey of all infants admitted to the Children's Hospital with alimentary tract obstruction but also an analysis of a series of obstetric cases at the University Hospital in women with pregnancy complicated by hydramnios.