bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improvement of Hospital Pediatric Clinics
Authors: Kendall Colin 
Published: December 2021

Your reviewers echo Dr. Duff in lamenting teaching clinics' shortcomings.1 Perhaps the pediatric risorgimento is at hand!
Crowding, noise, lack of interest, divided responsibility, and impecuniosity are everywhere and at their glaring worst in certain provincial clinics.
Patients and physicians are bound to agree that "services and teaching are . . . confused and inadequate."
The authors conclude, bleakly, that clinics cannot improve until society changes. Must we then wait for the millennium?
I know no remedy for society's ills (except that money is not the solution) but can offer three modest proposals for hospital clinics:
Letters to the Editor
Authors: Duff R. S. , Rowe D. S. , Anderson F. P. 
Published: December 2021

Regarding letters concerning our article (Pediatrics, 50:839, 1972) we respond as follows:
The experiences described by Orenstein and Dietrich no doubt are very instructive. We suspect that learning through observation is a promising and perhaps neglected pedagogic technique. But since students surely retard the work of the observed practitioners, one must ask what is a just compensation. We suggest the customary "prestige" payment (a university appointment) is unsatisfactory.
The sequences of learning and the continuity of care described by Kafka seem reasonable to us.
DIAGNOSIS OF SINUSITIS IN INFANTS AND CHILDREN
Authors: Kogutt Marvin S. , Swischuk Leonard E. 
Published: December 2021

A study was undertaken to evaluate sinusitis in infants and children and to correlate the clinical and radiographic findings. Symptoms were often minimal, even in the face of marked sinus involvement, and persistent rhinorrhea, cough, and otitis media were the most common findings. Symptoms such as fever, localized tenderness, and pain were much less frequently encountered, and indeed, were conspicuous by their absence.
Radiographic examination was found to be valuable both in assessing the initial extent of involvement and in following the response to therapy, but probably is not necessary in every case.
The Demonstration of Insulinopenia in Familial Dysautonomia
Authors: Cole Harold S. 
Published: December 2021

Children with familial dysautonomia have a marked retardation in height and weight. Nine children with familial dysautonomia and seven control children were studied by means of rapid IVGTTs. The KG and serum levels in insulin and GH were obtained to determine the existence of abnormalities in any of these parameters which might be responsible for growth failure.
There were no significant differences in the KG or GH values between the groups. The insulin values of the dysautonomic children were lower than those of the control children at all the sampling times during the 1-hour test and were statistically significantly lower when the total insulin areas were compared.
These lower levels of serum insulin growth might reduce its effectiveness as an anabolic agent and result in the growth failure of dysautonomic children.
Letters to the Editor
Authors: Costin Gertrude , Kogut Maurice D. 
Published: December 2021

Drs. Costin and Kogut comment as follows:
We were pleased to read Dr. Comas' letter in which he describes a 12-4/12-year-old girl whose clinical data suggest that she may be an example of the syndrome that we reported. The evidence for this was the occurrence of menstruation, pubic hair, and breast development when the patient was hypothyroid and disappearance of menstruation following treatment with thyroid hormone. It is not clear why Dr. Comas' patient had an increase in pubic hair and appearance of axillary hair following treatment at a time when her menstrual periods ceased; in all the reported female patients regression of the secondary sexual characteristics was noted following adequate therapy.
Human Pituitary Growth Hormone, by Allen W. Root, M.D. Springfield, Illinois: Charles C Thomas, 1972, 259 pp. $10.50
Authors: Kaplan Selna L. 
Published: December 2021

This book, divided into four sections, provides a comprehensive review of the biochemical effects of growth hormone as well as the clinical syndromes associated with abnormalities of its secretion and metabolism.
The book opens with a historical résumé of the "discovery" of this hormone, identification of its varied biologic actions, and isolation from the pituitary gland. The second part discusses the development of radioimmunoassay for measurement of growth hormone by Roth and associates and the subsequent surge in studies of the control mechanisms for the secretion of growth hormone.
EFFECTIVE PULMONARY BLOOD FLOW IN PRETERM INFANTS WITH AND WITHOUT RESPIRATORY DISTRESS: A SIMPLE BEDSIDE METHOD USING NITROUS OXIDE
Authors: Orme Richard L'E , Featherby Elizabeth A. , Rigatto Henrique , Cervantes Francisco J. , Brady June P. 
Published: December 2021

We have devised a method of measuring pulmonary capillary blood flow (Qpc eff) suitable for infants with idiopathic respiratory distress syndrome (IRDS). The uptake of nitrous oxide is measured during a 40-second period of rebreathing 40% nitrous oxide in oxygen from a 40- to 80-ml bag. The rate of uptake of nitrous oxide is divided by the solubility in cord blood and the mean alveolar concentration to give Qpc eff.
We studied 14 preterm infants, 7 hours to 14 days of age, on 73 occasions; nine had classical IRDS and five were healthy preterm infants (controls). During the first five days of life Qpc eff was significantly lower in infants with IRDS than in the control infants, 106 ml/kg/min compared with 177 ml/kg/min (P &lt; 0.001). Qpc eff was not related to arterial Po2, Pco2, or pH but was inversely related to the inspired oxygen concentration needed to keep the arterial Po2 within normal limits (P &lt; 0.02). Qpc eff showed a highly significant increase with age in infants with IRDS (P &lt; 0.001). This method provides a reasonably rapid, safe and noninvasive technique for estimating effective pulmonary blood flow in sick infants.
LACK OF CHROMOSOMAL BREAKAGE IN CONGENITAL RUBELLA
Authors: Wolman Sandra R. , McMorrow Lydia E. , Ziring Phillip R. , Cooper Louis Z. 
Published: December 2021

We recently examined lymphocyte cultures from 24 children with laboratory-confirmed congenital rubella. Seventy percent of these children were under 1 year of age and thirty percent were virus excretors. The mean percentage of gaps plus breaks in children with congenital rubella was 11.2% versus 8.7% in age-matched controls.
This was not statistically significant. The mitotic response to phytohemagglutinin was not depressed. The apparent discrepancies between these results and those of previous investigations are probably best explained by the broad spectrum of clinical severity in congenital rubella and the fact that a small, but variable, minority of fetal cells become infected in utero.
THE TAY-SACHS DISEASE FIBROBLAST MODEL: FAILURE TO RESPOND TO EXOGENOUS HEXOSAMINIDASE A
Authors: Schneck Larry , Amsterdam Daniel , Brooks Steven E. , Rosenthal Arthur L. , Volk Bruno W. 
Published: December 2021

In vitro studies with Tay-Sachs disease (TSD) fibroblast cultures treated with β-D-N-acetylhexosaminidase A (Hex A) did not reveal any detectable incorporation of the enzyme into cultured cells as measured by activity against the fluorogenic substrate or intracellular radioactivity of the 125I-labeled enzyme.
Futhermore, there was no demonstrable alteration of 14C-labeled GM2 (TSD) ganglioside in treated cells. It was concluded that parenteral administration of this enzyme to affected infants is not clinically justifiable.
YOUNG BENJAMIN FRANKLIN DECIDES TO BECOME A VEGETARIAN
Authors: C. T. E. 
Published: December 2021

When Franklin (1706-1790) was about 16 years old he read a book by Thomas Tryon (1634-1703) extolling the health benefits of a vegetable diet. Although Franklin did not adhere to such a diet for prolonged periods of time, he periodically would become a vegetarian because it "promoted clearness of ideas and quickness of thought."
"At the time Franklin wrote the passage below he was serving as a printer's apprentice to his older brother, James.
When about 15 years of age I happened to meet with a book written by one Tryon,1 recommending a vegetable diet, I determined to go into it. My brother, being yet unmarried, did not keep house, but boarded himself and his apprentices in another family. My refusing to eat flesh occasioned an inconveniency, and I was frequently chid for my singularity, I made myself acquainted with Tryon's manner of preparing some of his dishes, such as boiling potatoes or rice, making hasty pudding, and few others, and then proposed to my brother, that if he would give me, weekly, half the money he paid for my board, I would board myself. This was an additional fund for buying books, but I had another advantage in it. My brother and the rest going from the printinghouse to their meals, I remained there alone, and, despatching presently my light repast, which often was no more than a brisket of a slice of bread, a handful of raisins or a tart from the pastry-cook's, and a glass of water, had the rest of the time till their return for study, in which I made the greater progress, from that greater clearness of head and quicker apprehension which usually attend temperence in eating and drinking."2
"CHILD HEALTH SUPERVISION–IS IT WORTH IT?" A RESPONSE
Authors: Heavenrich Robert M. 
Published: December 2021

Dr. Yankauer's statement that "the methods of child health supervision deserve to be based upon scientific study of their effectiveness and efficiency rather than on outmoded traditions and current fashionable methods"1 is indisputable. Such a study, though difficult to design, is possible. Of necessity the study would be longitudinal, continuing, and costly. Hopefully, conclusions drawn from it could justify the effort.
Others have challenged the sacrosanct methods of child health supervision. The unpublished Schedule for Preventive Health Care (Child Health Supervision) for Children and Youth promulgated by the Committee on Standards of Child Health Care of the American Academy of Pediatrics2 suggests fewer visits to physicians' offices or clinics than have any previous schedules.
GONORRHEAL OPHTHALMIA NEONATORUM
Authors: Shaw Edward B. 
Published: December 2021

A national epidemic of gonococcal infection accounts for nearly 50,000 cases monthly, as reported by the U.S. Public Health Services. Admittedly many are unreported. This may include most of those in pediatric patients, like that in an unusual site1 and the other in a more commonly recognized focus,2 described in this issue of Pediatrics. Gonorrheal ophthalmia in the newborn has not occurred very frequently in recent years, although it was previously the most frequent cause of blindness. It might be anticipated that the adult incidence of gonorrhea would cause a corresponding increase in ophthalmia neonatorum.
This neonatal form of infection is not reported in national statistics but in California, where it is reported, there is an average of 8,000 adult cases each month but only two or three newborn cases.
The Parents' Guide to Drugs, by Matthew Andrews, Garden City, New York: Doubleday & Company, 1972, 186 pp., $2.50
Authors: Faigel Harris C. 
Published: December 2021

I have always opened a new book with a sense of adventure promising satisfaction on the one hand and risking disappointment on the other. Generally, I enjoy books; I dislike disappointments. This one is disappointing.
Written in 1971 and published in 1972, it contains nothing about the changing patterns of alcohol, heroin, barbiturate, or soporific abuse of the last two years and is curiously out of date in 1973.
Despite the author's assertions to the contrary, youngsters do use barbiturates and amphetamines for euphoria right from the start.
ANTICHOLINERGIC POISONING: TREATMENT WITH PHYSOSTIGMINE
Authors: Rumack Barry H. 
Published: December 2021

The increased incidence of poisoning by overdoses of commonly used drugs with anticholinergic properties (Table I) and the general lack of knowledge concerning a specific treatment for these poisons warrants a summary of the problem at this time. Some plants containing anticholinergic alkaloids are also included in this group as they may also be taken intentionally or accidentally.
Drugs with anticholinergic properties primanly antagonize acetylcholine competitively at the neuroreceptor site. Cardiac muscle, exocrine glands, and smooth muscle are most markedly affected.1 Action of the inhibitors is overcome by increasing the level of acetylcholine naturally generated in the body through inhibiting the enzyme (choline esterase) which normally prevents accumulation of excess acetylcholine. It does this by hydrolyzing that compound to inactive acetic acid and choline. Agents which inhibit this enzyme, so that acetylcholine accumulates at the neuroreceptor sites, are called anticholine esterases.
Physostigmine, one of the anticholine esterases which is a tertiary amine, crosses into the central nervous system and can reverse both central and peripheral anticholinergic actions2. Neostigmine and pyridostigmine are also anticholine esterases but they are quaternary amines and are capable of acting only outside the central nervous system because of solubility and ionization characteristics.
The anticholinergic syndrome has both central and peripheral signs and symptoms. Central toxic effects include anxiety, delirium, disorientation, hallucinations, hyperactivity, and seizures.2 Severe poisoning may produce coma, medullary paralysis, and death. Peripheral taxicity is characterized by tachycardia, hyperpyrexia, mydriasis, vasodilatation, urinary retention, diminution of gastrointestinal motility, decrease of secretion in salivary and sweat glands, and loss of secretions in the pharynx, bronchi, and nasal passages.
Letters to the Editor
Authors: Mofenson Howard C. 
Published: December 2021

Each year 1,000 children under the age of 5 are killed riding in automobiles and another 60,000 suffer disabling injuries.
Crash protection does not mean holding a child on the lap of the parent. If an automobile strikes a solid object or comes to a sudden stop the unrestrained passenger continues forward at the rate of speed of the car until stopped by a surface within the vehicle or ejected through the windshield. The geometric increase of the child's weight would not allow the parent's arms to restrain the child.
How "Regular" (and What?) Is the "Regular Source of Medical Care?"
Authors: Mindlin Rowland L. , Lobach Katherine S. 
Published: December 2021

The paper by Starfield et al.1 presents useful and interesting data about medical care utilization in a sample of Baltimore children, but it fails to address itself to the question posed in its title.
The paper examines several important attributes (type of provider, accessibility, and financial requirement) of the patients' regular sources of care. It also includes data about the regularity with which those sources are actually used. However, there are no data or tables which specifically show the relationship between regularity of use and the other attributes studies.
DISORDERS OF GONADAL DEVELOPMENT
Authors: Stempfel Robert S. 
Published: December 2021

In 1947, Professor Alfred Jost completed a series of classical experiments with the fetal rabbit from which it was shown that early castration in utero resulted in phenotypic femaleness, regardless of genetic sex.1 These observations indicated that masculine differentiation of the internal ducts and of the primordia from which the external genitalia evolve depends solely upon the presence of the fetal testis. It followed also that the fetal ovary is not a determinant of feminine organogenesis, while the testis blocks feminization and induces masculinization.
At about the seventh gestational week, both female (Müllerian) and male (Wolffian) ducts are present in the fetus.
LYDIA MARIA CHILD ON THE MANAGEMENT OF GIRLS DURING THEIR TEENS
Authors: C. T. E. 
Published: December 2021

Lydia Child (1802-1880), an American author and reformer, was one of the most prominent women of her day. Her advice to mothers on the management of their teen-age daughters would be exceedingly difficult for contemporary mothers to follow. She wrote:
The period from twelve to sixteen years of age is extremely critical in the formation of character, particularly with regard to daughters. The imagination is then all alive, and the affections are in full vigor, while the judgment is unstrengthened by observation, and enthusiasm has never learned moderation of experience. During this important period, a mother cannot be too watchful. As much as possible, she should keep a daughter under her own eye; and, above all things, she should encourage entire confidence towardr herself. This can be done by a ready sympathy with youthful feelings, and by avoiding all unnecessary restraint and harshness. I believe it is extremely natural to choose a mother in preference to all other friends and confidants; but if a daughter, by harshness, indifference, or an unwillingness to make allowance for youthful feeling, is driven from the holy resting place, which nature has provided for her security, the greatest danger is to be apprehended. Nevertheless, I would not have mothers too indulgent, for fear of warning the affections of children. This is not the way to gain the perfect love of young people; a judicious parent is always better beloved, and more respected, than a foolishly indulgent one. The real secret is, for a mother never to sanction the slightest error, or imprudence, but at the same time to keep her heart warm and fresh, ready to sympathize with all the innocent gaiety and enthusiasm of youth.
The Pediatrician, the Epidemic, and the Community
Authors: Seifert Milton H. 
Published: December 2021

Sometimes it takes an epidemic to make a practicing physician feel a deep sense of community–not only with his home town but with the resources of his state and nation.
An encephalitis epidemic1 is capable of causing him plenty of discomfort, too. When your neighbor describes some worrisome symptoms over the telephone; when the house call on the daughter of a close friend gives you evidence of CNS involvement; when you are attempting to manage choking and convulsions in the middle of the night–you know these are part of the job of being a family physician, but you also know the ignorance, the fear, and the sense of loneliness.
THE URINARY MANIFESTATIONS OF ANXIETY IN CHILD
Authors: Galdston Richard , Perlmutter Alan D. 
Published: December 2021

This report comprises concurrent studies of the urologic and psychiatric manifestations of intrapsychic conflict among a group of children who had been admitted to the surgical wards of The Children's Hospital Medical Center, Boston, between 1965 to 1970 for complaints of disordered urination.
Experience with these children indicates that anxiety can alter the frequency and disturb the adequacy of voiding to a degree sufficient to dispose the child to urinary tract infection. This effect of anxiety can occur both in the presence or absence of a demonstrable anatomic lesion. It suggests that an assessment of the degree and nature of the child's anxiety should be an integral part of the pediatric urologic examination.
Letters to the Editor
Authors: Froehlich Luz A. 
Published: December 2021

Dr. Froehlich commented as follows:
With regard to the method of examination of the cord, we wish to reassure Dr. Van Leeuwen that all the examinations were done by pathologists. Based on the "name of examiner" indicated on the standard protocol, it can be clearly stated that the examinations were done in the vast majority of instances by the project pathologist himself or under his supervision. In addition, the protocol required that when a single umbilical artery was initially noted on bisecting the mid-portion of the cord, the rest of the umbilical cord throughout its length was to be examined at one-inch intervals.
CARDIORESPIRATORY STATUS OF ERYTHROBLASTOTIC NEWBORN INFANTS: II. BLOOD VOLUME, HEMATOCRIT, AND SERUM ALBUMIN CONCENTRATION IN RELATION TO HYDROPS FETALIS
Authors: Phibbs R. H. , Johnson P. , Tooley W. H. , Johnson B. Bradley , Sudman D. , Schlueter M. 
Published: December 2021

We measured hematocrit and serum albumin concentration at birth and red blood cell and plasma volume soon after birth in prematurely born infants with erythroblastosis fetalis of varying severity and examined the realtionships between these variables and the presence and severity of hydrops fetalis.
Blood volumes in most of these infants were similar to the established normals for newborn infants without erythroblastosis. There was no simple association between blood volume and the presence of hydrops. Nonhydropic and severely hydropic infants had, on the average, similar and normal blood volumes, while mildly hydropic infants had low blood volumes. Anemia correlated fairly well with severity of hydrops but almost a quarter of the infants with severe hydrops were only mildly anemic. Red blood cell volume decreased and plasma volume increased proportionally with the degree of anemia at birth. Thus, hydropic infants with severe anemia had large plasma volumes while those with milder anemia did not. On the other hand, hypoalbuminemia was common and correlated closely with severity of hydrops.
We suggest that hydrops results at least in part from low plasma colloid osmotic pressure due to hypoalbuminemia.
Diagnostische und Therapeutische Techniken in der Pädiatrie, by Dr. med. Roland Gädeke. Berlin/Heidelberg/New York: Springer-Verlag, 1972, 184 pp., $12.10 (in German)
Authors: Eichenwald Heinz F. 
Published: December 2021

What a shame that this small soft-cover volume is not available in English, since it contains a mountain of practical information — tricks of the trade that most of us accumulate only through many years of experience and occasionally more by error than trial!
What Dr. Gädeke has done is to concern himself with the handicraft ("handwerk") of pediatrics: techniques of measurement, diagnosis, therapy, restraint, bandaging, the collection of biological fluids, minor surgical procedures, etc., which the pediatrician and pediatric nurse use in the hospital, in the office, and for parent instruction.
Increased Lead Absorption: Paint Is Not the Only Problem
Authors: Mitchell Douglas G. 
Published: December 2021

In the first half of fiscal 1972, over 65,000 children in the United States were screened for undue absorption of lead as part of 47 federally funded lead-poisoning control programs. Many state, county, city and citizens groups are carrying out similar programs reaching at least another 65,000 children. This screening is concentrated in decaying urban areas, where many children are exposed to paint chips containing up to 20% lead. Primary emphasis is placed upon detecting children with undue lead absorption and then physically separating them from the lead source: chipped and peeling paint on walls, windows, and skirting boards.
There is little doubt that ingestion of leaded pigmented paint is the prime cause of overt lead poisoning.
Comments
Authors: Sarett Herbert P. 
Published: December 2021

Lamm and Rosen's paper in this issue compares levels of lead they reported for processed infant formulas in 1971 with those they found in 1972-1973.
Their comparison is not valid, since an entirely different method of analysis was used in the present report and the levels cannot be compared. The first levels of lead reported in formulas by Lamm et al. were erroneously high; much lower levels were found at that time by the FDA, by the New York City Department of Health, and by manufacturers of infant formulas. Differences in methods of analysis can give wide discrepancies between findings in various laboratories, especially when only "traces" of a substance are measured.