bluuebunny/crossref_metadata_2025_split huggingface dataset:
A CASE OF HYPERLYSINEMIA: BIOCHEMICAL AND CLINICAL OBSERVATIONS
Authors: Armstrong Marvin D. , Robinow Meinhard 
Published: December 2021

Clinical and biochemical observations on a mentally retarded 4-year-old boy who has a lysinuria and hyperlysinemia are presented and discussed. He differed clinically from the three patients described previously in that he did not have marked muscle weakness. His endogenous renal clearance of lysine while fasting was twice the upper limit of normal for children, and after fasting his plasma lysine level had decreased to within the normal range. After a test dose of lysine (150 mg/kg orally) his plasma lysine level was increased from 2.43 to 15.2 mg/100 ml after 2½ hours, and after 7 hours it was still 7 mg/100 ml. No evidence for the degradation of a significant amount of lysine by any new pathway could be obtained. Homoarginine was identified in his urine and detected in his blood; homocitrulline was measured in his urine. α-Aminoadipic acid could not be detected in his urine. Nα and N\g=elunate\-Acetyllysines were identified in his urine at approximately three times the concentration as in the urine of a normal child of the same age; neither of these derivatives had been identified previously as components of human urine.
The possibility is suggested that in this patient the lysine abnormality may be coincidental with and not a causative factor for his mental retardation.
Letters to the Editor
Authors: HOLLIDAY MALCOLM A. 
Published: December 2021

Thank you for the chance to reply to Dr. Skinner's letter. The problem he cites, hyperosmolality due to powdered milk being diluted insufficiently, is certainly more common than the one we cited where water intoxication resulted from making milk too dilute. In a similar way commercial electrolyte solutions apparently were associated with development of hypernatremia in diarrhea.
Dr. Skinner's suggestion to the manufacturer seems to be reasonable and I would endorse this.
Letters to the Editor
Authors: RUDOLPH NATHAN 
Published: December 2021

Thank you for the opportunity to comment on Dr. Gordon Millichap's letter.
I agree with Dr. Millichap that perinatal cerebral trauma or cerebral hypoxia cannot be overlooked as a possible additional etiological factor in the elevation of serum CPK levels in some infants. However, the lack of correlation with 1-minute Apgar scores, and the frequency of elevated serum enzyme levels in newborns who do not exhibit clinical signs of neurological damage, make it unlikely that a central neurogenic mechanism is operative in the majority of cases.
THE RELATIONSHIP BETWEEN PSYCHIATRY AND PEDIATRICS: A DISPUTATIOUS VIEW
Authors: EISENBERG LEON 
Published: December 2021

THE Aldrich Award Address by Dr. Julius Richmond in this issue requires careful reading. Within its sober, low-keyed assessment of the state of developmental research in pediatrics is a perceptive critique of the present and an exciting preview of a possible future. Writing as a pediatrician, Dr. Richmond chides, but only gently, my psychiatric colleagues and indicates, but only modestly, the potential contribution of pediatrics. As a child psychiatrist not under (or at least not admitting to) such restraints, I feel freer to comment on certain aspects of the relationship between the two specialties.
Child psychiatrists cite the importance of knowledge of child development for fully effective pediatric practice, bemoan the grossly inadequate training in medical psychology presently afforded pediatric house officers, had decry the unsympathetic reception they have receive from pediatrics faculties when they have ample justification.
METABOLIC REFERENCE STANDARDS FOR THE NEONATE
Authors: Sinclair John C. , Scopes Jon W. , Silverman William A. 
Published: December 2021

Oxygen consumption of 92 normally grown newborn babies of birth weight 750 to 3,940 gm has been expressed in terms of various metabolic reference standards in order to identify any systematic variation in expression of metabolic rate that is introduced by these bases of reference in the newborn population.
It is postulated that differences in body composition comprise a contributory factor to the variation among newborn babies in rate of oxygen consumption per kilogram body weight.
The predictive error from a mean value is increased if surface area, body weight, or fat-free body weight is substituted for body weight as a metabolic reference standard.
By taking into account known changes in body composition of the fetus with increasing maturity, a compartment representing the active tissue mass is calculated. This corresponds closely to body weight minus extracellular fluid and includes fat. Rate of oxygen consumption is proportional to the size of this compartment over the range of body weights studied.
Implications are discussed as to the metabolic rate of adipose tissue in the newborn and body composition among undergrown babies.
Letters to the Editor
Authors: Bozic C. 
Published: December 2021

I have read with interest Doctors Adams' and El-Salawy's comments on my case report identified in their letter as the "Lausanne baby."
I do think that the "Lausanne baby" represents a case of pulmonary vascular sequestration inasmuch as the inferior lobe of the left lung received its blood supply by means of three arterial branches coming off directly from the aorta.
On the other hand, I do not think that the "Lausanne baby" is a case of pulmonary parenchymal sequestration and this because the inferior lobe of the left lung was proven to be, at least to my satisfaction, in direct communication with the remainder of the respiratory tract.
HOSPITAL FATALITY RATES FOR PREMATURE INFANTS
Authors: BAIN KATHERINE , HUBBARD JOHN P. , PENNELL MARYLAND Y. 
Published: December 2021

Data are presented from about half of the hospitals in the United States caring for 50 or more premature infants a year. In these hospitals there were about 600,000 births during 1946.
The incidence of prematurity, using as the definition of a premature infant one that was born alive weighing 2,500 gm. or less, was 6.1%. For white infants it was 5.6% and for nonwhite 9.5%.
The fatality rate for the group born in the hospital was 21.5% and for those born outside, 36.6%.
The close relation between survival and weight at birth is shown.
For nonwhite infants the fatality rate was higher than for white infants—27.7% for the group born in the hospital and as contrasted with 24.5, and 43.9 for those born outside as contrasted with 31.5.
There is need for better hospital records and for more comprehensive data on survival among premature infants.
RADIOIODINE UPTAKE CURVE IN HUMANS
Authors: LOWREY GEORGE H. , BEIERWALTERS WILLIAM H. , LAMPE ISADORE , GOMBERG HENRY J. 
Published: December 2021

The rate of uptake of radioactive iodine by the thyroid gland was measured in a series of 26 children. Twelve of these children were normal with regard to being free of any disease that would markedly alter body metabolism. All these subjects showed similar and characteristic curves of uptake of the isotope.
Fourteen abnormal children were studied similarly. The curves of 12 of these clearly deviated from those of the normal group. All patients in this series with established thyroid dysfunction showed similar and characteristic curves and could be easily divided into three categories: hypofunction, hyperfunction and colloid goiter. Three patients (one mongolian idiot, one dwarf and one hypothalamic syndrome) showed abnormal curves which varied from that typical of definite hypothyroidism but were similar. One patient with gargoylism had a curve typical of hypothyroidism. It can be postulated that these patients may have primary or secondary (to the pituitary or neurogenic mechanisms) hypothyroidism. One patient each with nephrosis and rheumatic fever displayed normal curves.
From the results reported in this communication, plus others that have been reported in the literature, it would appear that the procedure is a valuable one in estimating the relative degree of thyroid function. It is a tool of diagnostic importance and has a greater specificity than most of the other methods used in measuring thyroid function in infants and children. It should be recognized, however, that others have demonstrated a certain degree of overlapping in the radioiodine uptake curves obtained on normal and abnormal subjects.
PHEOCHROMOCYTOMA
Authors: LITMAN NEIL N. , STATE DAVID 
Published: December 2021

A case of pheochromocytoma in a girl 11 years of age is reported. The difficulties in establishing the diagnosis as well as the other pathologic states which must be considered in the differential diagnosis of this condition are discussed.
A new preparation, N,N-dibenzyl-B-chloroethylamine dibenamine®, was used in establishing the diagnosis and in the therapy of the case. The drug was found useful in reducing the hypertension but its preoperative use was apparently ill-advised.
The case study confirms the findings of others that benzodioxane compounds are helpful diagnostic aids and that tetra-ethyl-ammonium chloride has little value in either the establishment of the diagnosis in or treatment of patients with pheochromocytoma.
The problems associated with surgical care of patients with pheochromocytoma are discussed.
A Child is Born: The Drama of Life Before Birth
Authors: WHIPPLE DOROTHY V. 
Published: December 2021

With spectacular beauty and accuracy Lennart Nilsson has captured the mystery of life within the womb. His serial photographs portray a living human being from the moment of conception to the completion of intra-uterine development. The detail of these amazing pictures is so clear that one can vividly see the stages of human reproduction from fertilization to birth.
One cannot give the pictures too much praise—the union of scientific accuracy and artistry here reaches a pinnacle of achievement Mr. Nilsson won the 1966 Photographer of the Year Award for these pictures—would that every year such masterpieces of photography could compete for this award.
VENTILATION AND RESPIRATORY GAS TRANSFER OF INFANTS WITH INCREASED PULMONARY BLOOD FLOW
Authors: Lees Martin H. , Way R. Clifton , Ross Benjamin B. 
Published: December 2021

Ventilation and respiratory gas transfer was studied in 44 infants; 13 of whom had pulmonary overperfusion without pulmonary edema or transposed great arteries. In order to assess the evenness of ventilation/perfusion ratios throughout the lung, (VA/Q distribution) measurements were made of the urine-alveolar nitrogen tension difference (U-Ā)DN2 in a separate group of six normal children and seven children with pulmonary overperfusion.
Infants with pulmonary overperfusion (left-to-right shunts) had normal alveolar ventilation (149.6±18.2 ml/minute/kg). Respiratory rate (38.1±10.2) was slightly increased and tidal volume (6.0±1.3 ml/kg) was diminished, possibly due to reduced lung compliance. Measurements of dead space, dead space/tidal volume ratio, and alveolar ventilation/oxygen consumption ratio were unremarkable.
No significant arterial-alveolar CO2 difference was detected in either normal subjects or those with heart disease, but a significantly increased alveolar-arterial O2 tension difference (A-a)DO2 of 22.4±8.6 mm Hg was found in infants with overperfused lungs.
Measurements of (A-a)DO2 during 100% oxygen breathing and measurements of (U-Ā)DN2 in the air-breathing subjects both suggested that intrapulmonary venous admixture rather than VA/Q unevenness was the principal factor causing lowered oxygen tensions in the arterial blood of infants with overperfused lungs.
Lowered arterial oxygen tension was associated with only trivial arterial unsaturation (92.8±2.4%) due to the high affinity of hemoglobin for oxygen.
CONGENITAL DIAPHRAGMATIC HERNIA AND HYPOPLASTIC LEFT HEART
Authors: Firestone Frederick N. , Popper Robert W. , Taybi Hooshang , Leonards Richard 
Published: December 2021

An infant with the rare combination of congenital diaphragmatic hernia and hypoplastic left heart has been reported. Although herniated viscera in the chest impair bronchial division and cause hypoplastic lungs, this patient demonstrated lung growth and histologic maturation after successful correction of the diaphragmatic hernia. No subsequent change of the hypoplastic left heart toward normal occurred. There is no apparent causal relationship between these two defects.
Creation of an atrial septal defect has been useful in the treatment of hypoplastic left heart. Further clinical trials are encouraged.
THE EFFECTS OF TOBACCO SMOKING IN CHILDREN
Authors: C. T. E. 
Published: December 2021

The very first issue of the Journal of the American Medical Association contained the following abstract of a paper published originally in the French Revue d'Hygiene of March 20, 1883 on the evil effects of tobacco smoking in children.
Dr. G. Decaisne, in a paper read before the Paris Société de Médicine Publique, gives observations upon thirty-eight children, between nine and fifteen years of age, where decided effects [due to smoking] were produced in twenty-seven.
Twenty-two had disturbances of the circulation, bruit de souffle in the carotids, palpitation of the heart, difficulty in digestion, indolent intelligence and a decided taste for strong drinks.
Thirteen had an intermittent pulse.
Eight showed a notable diminution of blood corpuscles.
Twelve had frequent attacks of nosebleed.
Ten were restless in their sleep with nightmares.
Two showed slight ulcerations of the buccal membrane, which disappeared promptly on their giving up smoking for a few days.
In one case pulmonary phthisis seemed to have resulted from a profound alteration of the blood due to the long continued use of tobacco.
In eleven children who gave up smoking entirely, with six these symptoms disappeared in less than six months; three still suffered in a minor degree at the end of a year.
He concludes, as the result of his observations collected through twenty years, that the pernicious effects of smoking upon children are incontestable. That it produces intermittence of the pulse, alteration of the blood, and the principal symptoms of chloroanemia, pallor of the countenance, emaciation, bruit de souffle in the carotids, palpitation of the heart, diminution of the normal quantity of the blood corpuscles, and difficulties of digestion. That the mental faculties become sluggish, with a fondness for strong drinks. That the ordinary treatment for chloroanemia produces no effect while the habit continues, and, finally, that with those children who are without organic lesion, all these disorders disappear promptly and without leaving any traces behind, when the habit is discontinued.
Could French tobacco of the 1880's have been all that potent, or was Doctor Decaisne an alarmist?
COMMITTEE ON NUTRITION
Authors: LOWE CHARLES U. , COURSIN DAVID BAIRD , HEALD FELIX P. , HOLLIDAY MALCOLM A. , O'BRIEN DONOUGH , OWEN GEORGE M. , PEARSON HOWARD A. , SCRIVER CHARLES R. , FILER L. J. , KLINE O. L. 
Published: December 2021

Despite an imposing body of information derived from research, our ignorance concerning the etiology, pathogenesis, and treatment of obesity is remarkable.
It is clear that when considering a given patient the terms "overweight" and "obese" are not necessarily synonymous. Evidence derived from various viewpoints suggests that obesity cannot be regarded as an etiologically unique metabolic disorder. It is likely that an excess of adipose tissue in man will ultimately prove to represent a clinical end-point common to a variety of hereditary and acquired disorders, as in the case of experimental animals, rather than a singular morbid condition with unique pathogenesis. The identification and evaluation of the inherited, acquired, metabolic, and psychogenic determinants of obesity still present an urgent challenge for future research.
Mortality and morbidity rates for diabetes and cardiovascular disease are higher in obese adults than in those of average weight. These risks appear to be diminished by weight reduction. Because the majority of obese children do tend to remain obese as adults and because our society exerts considerable pressure towards relative leanness as a criterion for social acceptability, early treatment of obesity would seem to be a worthy objective. However, the fact is that no methods of treatment have as yet achieved more than minor success in significant sustained weight reduction. Since the natural history of childhood obesity remains ill-defined, the results of testimonials from inadequately controlled studies with short follow-up periods (less than 2 or 3 years) must be viewed with skepticism.
Any attempts to achieve lasting weight reduction in obese children and adolescents should be tempered by a realization of the inherent difficulties of treatment and by sympathy for those children who, for reasons poorly understood by their physicians. lack the ability to regulate the delicate balance between physical activity and caloric intake. It appears that when treatment is directed at only a single element of the thermodynamic equilibrium, caloric intake, the chances of successful and lasting weight reduction are small.
Prophylaxis may offer the most logical method for dealing with obesity. Prevention is necessary in high-risk families and should be undertaken by the family physician. The role of public health programs implemented by education may decrease the level of obesity in the remainder of the population. The efficacy of either approach remains to be determined.
While there is knowledge of some of the metabolic derangements characteristic of the obese adult, little is known about these in childhood. In view of the apparent hazards of obesity in adult life, the patent failures characteristic of virtually all therapeutic approaches and the scientific void in knowledge of pathogenesis or pathophysiology make the study of obesity a compelling undertaking for the investigator.
Reactions of Those Who Treat Children with Cancer
Authors: Rothenberg Michael B. 
Published: December 2021

IT IS MY impression that the reactions of those who treat or otherwise work with children who are dying of cancer or other fatal illnesses develop from a core conflict within each worker. This conflict arises because two powerful and normal, but antithetical emotional responses are elicited simultaneously when one is involved with the care of the dying—or even possibly dying—child. On the one hand, there is the response of compassion which produces the impulse to move toward the child with aid and comfort at every level. On the other hand, there is the response of repulsion by the threat of death which produces the impulse to move away from the dying child in order to begin to protect oneself from the impending shock of separation and loss. The degree of success with which this conflict is resolved determines the degree of success of the individual health care worker in providing comprehensive care for the child with cancer. Before discussing some suggested ways to approach a successful resolution of this conflict, I should like to outline some of the more common feelings and reactions of those who treat children with cancer which may interfere with such a resolution.
All those who have chosen the provision of health care services to the sick as their vocation—be they physicians; nurses; practical nurses; nurses' aides; occupational, physical, or recreational therapists; or medical social workers—have in common the desire to help sick people get well. One may ask why one should find it necessary to make such a blatantly obvious statement.
RESTRICTION VERSUS EXPLORATION IN THE NEWBORN NURSERY
Authors: S. C. A. 
Published: December 2021

THE last few decades have witnessed interesting developments in the hospital care of newborn infants. But the visible manifestations of these may have been less significant than the changes in fundamental principles underlying them. Two brief items in this issue of Pediatrics suggest that such a shift of basic theory is now finding expression.
One who participated in the efforts which culminated in the first Standards and Recommendations for Hospital Care of Newborn Infants in 1943 recalls the procedure unconsciously or consciously followed. Indeed, it is explicit in the name of the publication. We searched for rules and routines.
RUBELLA ANTIBODY DETERMINATIONS
Authors: Sever John L. , Fuccillo David A. , Gitnick Gary L. , Huebner Robert J. , Gilkeson Mary Ruth , Ley Anita C. , Tzan Nancy , Traub Renee G. 
Published: December 2021

Four methods were used to determine rubella antibody titers in patients with acquired and congenital rubella and in gamma-globulin. These methods include hemagglutination inhibition (HI), neutralization (Neut), fluorescence (FA), and complement fixation (CF). With acquired rubella, all four methods showed a rapid development of antibody shortly after the occurrence of rash. Maximum titers appeared within a few weeks, following which HI and CF titers began to decrease and the FA tests showed a weakening of fluorescence. HI titers were four- to sixteenfold higher than Neut, FA, and CF levels. Ten or 20 years after rubella, HI, Neut, and FA tests continued to show detectable antibody but half of the patients no longer had CF antibody. HI titers were still higher than Neut and FA but were considerably lower than convalescent levels. There was complete agreement between HI and Neut tests in the detection of antibody in young adults.
For congenital rubella, HI, Neut, and FA antibody persisted in the affected children at least through adolescence. HI and CF antibody increased occasionally during the period 8 to 12 months after birth.
Gamma-globulin titers with the HI and Neut methods were in close agreement. Convalescent rubella gamma-globulin gave titers two- to fourfold higher than standard commercial gamma-globulin.
Variations in the HA and HI tests were caused by modification of the method of treatment of the antigen, the concentration of red cells used, the size of the test (macro versus micro), the pH of the test, and the treatment of sera. The most significant effects were related to the treatment used to eliminate nonspecific inhibitors in the sera. Improper treatment can give false negative or false positive tests. When properly performed and appropriately controlled, the HI test gives results essentially identical to the Neut method, although the titers are consistently higher than the Neut test. This new method, then, is rapid and convenient for obtaining reliable information on the antibody status and susceptibility of patients.