bluuebunny/crossref_metadata_2025_split huggingface dataset:
IDIOPATHIC HYPONATREMIA IN AN INFANT WITH DIFFUSE CEREBRAL DAMAGE
Authors: McCrory Wallace W. , Macaulay Duncan 
Published: December 2021

A female infant, 5 months of age, with evidence of diffuse cerebral damage was found to have hyponatremia in the course of ordinary investigation.
Measurements of total body chloride by the thiocyanate-space method at widely different concentrations of chloride in the serum yielded results within the expected normal range. The infant was unable to excrete an acute water load as rapidly as normal infants. Serum from the patient during a hyponatremic phase showed significantly greater antidiuretic activity than that of a normal child.
We concluded that the hyponatremia was due to dilution of body fluids secondary to water retention on the basis of disturbed renal function. The hyponatremia was resistant to correction by administration of salt or mineralo-corticoids. A relation between fluid intake and concentration of sodium in the serum was demonstrated which suggested that on normal fluid intakes the child was unable to excrete solute-free water in a normal manner. This may represent the result of damage to the cerebral osmoreceptors as part of generalized brain damage. The data do not support the concept that the hyponatremia resulted from true salt-wasting, either cerebral or renal in mediation. If correction of such a state is desirable, the most useful therapeutic measure would appear to be limitation of the intake of fluid to slightly more than the amount needed to cover water expenditure from insensible losses, obligatory urine volume and growth requirements.
INTAKE OF VITAMIN B6 AND INFANTILE CONVULSIONS: A FIRST APPROXIMATION OF REQUIREMENTS OF PYRIDOXINE IN INFANTS
Authors: Bessey Otto A. , Adam Doris J. D. , Hansen Arild E. 
Published: December 2021

Nine infants, 1 to 12 months of age, with convulsions due to inapparent cause, have remained free of seizures after a change to a diet providing an increased amount of vitamin B6, or after administration of vitamin B6 as such. Five of these infants had been receiving a proprietary milk mixture found by analysis to be low in content of vitamin B6 (0.085 mg/l), two were breastfed and two, who developed convulsions in the neonatal period, had been receiving an evaporated milk mixture.
Seven of the infants became free of convulsions when given an evaporated milk mixture supplying an average of 0.26 mg of vitamin B6 daily. Four of these seven infants were studied for biochemical evidence of deficiency of vitamin B6 by the use of a tryptophan loading test. All four excreted large amounts of xanthurenic acid after receiving 0.54 gm/kg of DL-tryptophan. One to 1.4 mg of vitamin B6 daily were required to prevent the excretion of xanthurenic acid. In contrast, 10 of 11 control infants receiving 0.2 to 0.5 mg of vitamin B6 daily failed to excrete xanthurenic acid when similarly tested and two of these infants, who began to excrete xanthurenic acid after receiving for 1 month a diet low in content of vitamin B6, ceased to do so after receiving 0.3 to 0.4 mg of vitamin B6 daily. This suggests that the requirement of vitamin B6 of the seven infants who had developed the deficiency is, for some reason greater than that of the average infant.
The two infants whose convulsions appeared in the neonatal period required 2 to 5 mg of vitamin B6 daily to eliminate the seizures. One of these is still dependent upon a supplement of 2 mg of vitamin B6 daily. However, these two infants, like the control infants, required only 0.3 to 0.4 mg of vitamin B6 daily to prevent excretion of xanthurenic acid after receiving a dose of tryptophan. It seems probable that these two infants have anomalous metabolism of vitamin B6 rather than simple deficiency.
In view of the above observations, it is recommended that an infant's diet contain 0.2 to 0.3 mg of vitamin B6 daily. However, since there are occasional instances of anomalous requirements, it is suggested that a therapeutic trial dose of 5 to 10 mg of pyridoxine hydrochloride daily be given to any infant with convulsions resulting from inapparent cause.
AN EVALUATION OF THE FLUSH METHOD FOR DETERMINING BLOOD PRESSURES IN INFANTS
Authors: Moss Arthur J. , Liebling Wilbert , Austin Wallace O. , Adams Forrest H. 
Published: December 2021

Using the flush technique, determinations of blood pressure were made on 294 normal infants from 1 day to 1 year of age and on 23 additional infants and older children with congenital heart disease. Analysis of the data showed that:
The method was found to be a practical and relatively accurate procedure in the office or clinic.
The pressure at the ankle was usually significantly lower than that at the wrist.
Comparative studies with auscultatory and direct measurements indicated that values obtained by the flush technique represent the mean rather than the systolic blood pressure.
Readings obtained with a 5 cm blood pressure cuff did not differ significantly from those obtained with a 7.0 cm or 9.5 cm cuff.
Radiology of the Alimentary Tract in Infancy
Authors: CAFFEY JOHN P. 
Published: December 2021

This book deals chiefly with the radiographic problems of the alimentary tract during the first 12 months of life. It contains 282 pages. Its seven sections are illustrated profusely with clear and carefully cropped prints of roentgenograms and several line drawings.Numerous illustrative case histories are given at the end of each main section; it is questionable whether these add sufficiently to justify the increase in the bulk of the book.
The first section on the esophagus is probably the best in the book. The discussion of gastroesophageal incompetence covers 34 pages.
RADIATION HAZARDS IN THE FIELD OF PEDIATRICS
Authors: Robinow Meinhard , Silverman Frederic N. 
Published: December 2021

The different types of injury from external sources of ionizing radiation are briefly described and the manifestations of radiation injury in the fetus, the infant and the child are reviewed.
If radiation therapy for malignant disease is excluded from consideration, it is found that x-ray damage to skin, other tissue destruction, and growth impairment are relatively minor radiation hazards compared to the dangers of leukemia and other malignancy and of radiation-induced genetic damage.
Consideration is given to somatic radiation injury as largely an individual problem and genetic injury as a population problem. This point of view is reflected in the differing recommendations concerning "permissible doses" for individuals and for populations.
Medical radiation represents a major and presumably growing source of exposure to individuals and to the population in the United States. Various ways are shown in which excessive diagnostic exposure to x-rays, especially in children, can be reduced without interference with requirements of diagnosis.
Control of avoidable radiation can be accomplished by combined attack from different fronts. The more important approaches to radiation safety are discussed. They include attention to technical detail, personnel monitoring, maintenance of radiation records, radiation safety through legislative control and public education.
The responsibility of the physician in promoting public understanding of radiation hazards is emphasized.
INFANTILE BERIBERI ASSOCIATED WITH WERNICKE'S ENCEPHALOPATHY
Authors: Davis Ruth Alice , Wolf Abner 
Published: December 2021

An infant, 5½ months of age, died after a brief acute illness characterized by irritability and somnolence leading terminally to coma, and by excessive sweating, abdominal distension, tachypnea and tachycardia. Acidosis and azotemia were marked. He was found at necropsy examination to have pathologic findings compatible with both beriberi and Wernicke's encephalopathy.
Investigation of the dietary history and analysis of the formula fed the patient confirmed the suspicion of deficient intake of thiamine.
This is the first case report in which the coexistence of these two pathologic conditions in a child proven to have had an inadequate diet, has been documented. It lends further support to the thesis that Wernicke's encephalopathy is caused by nutritional deficiency.
The importance of vitamin supplementation of restricted diets used in the therapy of infantile eczema is emphasized.
KERNICTERUS IN PREMATURE INFANTS ASSOCIATED WITH LOW CONCENTRATIONS OF BILIRUBIN IN THE PLASMA
Authors: Harris Ruth C. , Lucey Jerold F. , MacLean J. Robert 
Published: December 2021

Concentrations of bilirubin in the plasma of 85 premature infants weighing less than 2000 gm at birth were measured daily for the first 6 days of life. These measurements are presented and discussed. Nine cases of kernicterus which developed with relatively low concentrations of plasma bilirubin are reported.
Laboratory studies are cited to support the hypothesis that the development of kernicterus in these infants was enhanced by the use of the antibacterial combination of penicillin and Gantrisin®.
Attention is called to the effect which antibacterial therapy may have upon the concentration of bilirubin in the plasma of premature infants and to the lower values for plasma bilirubin which occur in dying infants.
CHEMICAL AND CLINICAL OBSERVATIONS DURING TREATMENT OF CHILDREN WITH PHENYLKETONURIA
Authors: Berry Helen K. , Sutherland Betty S. , Guest George M. , Umbarger Barbara 
Published: December 2021

Three children with phenylketonuria between the ages of 2½ and 4½ years have been treated with three different diets low in content of phenylalanine during the past 18 months. In Diets I and III restriction of phenylalanine was accomplished by use of casein hydrolysates from which phenylalanine had been removed and other amino acids added. In Diet II intake of phenylalanine was limited by restriction of total intake of protein in the diet. Diets II and III were commercial preparations. All diets were fed in semisolid form combined with natural foods. After an initial period of hospitalization for regulation of intake of phenylalanine, treatment was carried out at home. Except during the early months of treatment intake of phenylalanine was not severely restricted. Nutritional disturbances were encountered as a result of apparent amino acid deficiencies in Diet I. Inadequate caloric intake and low intake of protein also contributed to poor nutritional status at one stage in the treatment.
Biochemical abnormalities characteristic of phenylketonuria were improved when phenylalanine was restricted in the diets of the three children. All three showed improvement in motor ability, increased awareness, lengthened attention span, decreased tenseness and irritability. No change in mental status on objective testing was demonstrated. The improvement in behavior motor control, and ease of handling was such that the parents were unwilling for the children to receive diets with normal content of phenylalanine. This reaction of the parents should be taken into consideration whenever administration of a diet low in content of phenylalanine is considered.
DIALYSIS IN PEDIATRICS, INCLUDING USE OF THE ARTIFICIAL KIDNEY
Authors: HOLLIDAY MALCOLM A. 
Published: December 2021

AN EXTENSIVE experience has been reported on use of the artificial kidney in adults. In contrast, two reports concerning 10 patients comprise the bulk of published experience in the pediatric age period. None of the children in these reports was less than 5 years old. This discrepancy suggests either that clinical situations requiring dialysis are less frequent in children or a more suitable alternate means of dialysis is available for children, or both.
The artificial kidney is used in four clinical circumstances in adults: 1) acute tubular necrosis from prolonged shock, nephrotoxic poisons, drug sensitization and hemolysis, 2) acute glomerular failure associated with acute glomerulonephritis, cortical necrosis, thrombotic thrombopenic purpura and other acute vascular disorders; 3) acute renal failure in patients with chronic renal disease in whom decompensation results from a reversible state, such as an infection; 4) acute poisoning with a dialyzable agent.
HAZARDS OF TECHNOLOGIC ADVANCE
Authors: RICHMOND JULIUS B. 
Published: December 2021

ELSEWHERE in this issue appears an article on hazards relating to the entrapment of children in refrigerators and their potentialities for obtaining release. This represents an excellent application of a developmental approach to a significant hazard. It also provides interesting and important data concerning reactions of children to a specific stressful situation.
This study points to a great need in our modern, industrial society. As technologic advances continue, it is well to evaluate these in relationship to potential hazards. As pediatricians we have a specific responsibility to point to hazards relating to children.
Industry too would do well to consider their responsibilities to society more specifically.
DIAGNOSIS OF HISTOPLASMOSIS USING PRECIPITIN REACTIONS IN AGAR GEL
Authors: Heiner Douglas C. 
Published: December 2021

An easy-to-perform immunologic test for histoplasmosis is described.
The test, involving precipitin reactions in agar gel, appears to have greater sensitivity and specificity than currently available tests for histoplasmosis. It is useful in the study of small or large numbers of patients.
It has been possible to demonstrate at least one antigen common to H. capsulatum, B. dermatitidis, and C. immitis. This antigen may be responsible for cross reactions. Instances are cited wherein problems of cross reactions and false-positive reactions have been clarified by means of precipitin-in-gel studies.
Precipitin reactions in agar have provided presumptive diagnosis of histoplasmosis in a patient with acute pericarditis, which rapidly progressed to constrictive pericarditis necessitating pericardiectomy.
RECENT TRENDS IN ACCIDENT PREVENTION
Authors: Starbuck George W. 
Published: December 2021

ALTHOUGH pediatricians have always been concerned, as individuals, with the problem of child safety, the intense interest of the American Academy of Pediatrics in accident prevention dates back only to 1950. At that time, the spectacular conquest of the common childhood diseases during the previous three decades had forced a remarkable drop in the mortality rate from disease, whereas, in sharp contrast, decrease in the accident death rate had remained alarmingly slow—in fact, almost static (Figs. 1 and 2). This has focused attention and renewed emphasis on the still formidable problem of accidents, aptly described by Dietrich as childhood's greatest killer. Then, as now, accidents were the leading cause of death among children 1 to 14 years of age, accounting for fully one-third of all deaths at the elementary-school ages, and causing untold crippling, suffering and disability (Table I).
NEW NATIONAL COMMITTEE SETS ITS OBJECTIVES
When these facts were demonstrated to the Executive Board of the American Academy of Pediatrics, it established for the first time, in 1950, a Committee on Accident Prevention with Dr. George M. Wheatley serving ably as chairman.
The Committee adopted three broad approaches in its attack on accidents of childhood: education, engineering, and legislation. Physicians caring for children were to be alerted to the magnitude of the accident problem and encouraged to educate parents by pointing out specific hazards and initiating safety training of children. The Committee was to work with strategic groups, such as the American Standards Association, toward developing manufacturing standards for minimizing accidents involving such products as children's toys, clothing and furniture.
CLINICAL CONFERENCE
Authors: Smith Margaret H. D. 
Published: December 2021

Dr. Margaret H. D. Smith: We have been using adrenal steroids in the treatment of tuberculosis in children. We have a relatively small number of cases, not enough to set up a controlled, randomized, case study. We decided a couple of years ago, when we embarked on this study, to treat consecutive cases for certain indications, and see where we got, hoping to find out in the first place whether steroids seemed to do good or whether they seemed to do harm; in the second place, if they did seem to do good, to try and find out what sort of treatment dosage, what treatment schedule, and so forth, might be indicated. We thought then that, if we actually ended up with some sort of positive experience and data, that perhaps we might, under other circumstances, be able to do a properly controlled study. Our observations on the use of steroids in the treatment of tuberculosis have really been patterned on the experience of various European investigators, who started us on our way.
I am not going to say very much about the use of steroids in tuberculous meningitis because that is an indication for the use of steroids which is fairly generally accepted. I think that the data which have been gathered in Italy, in South Africa, and in many other parts of the world, as well as in the few cases that we have had occasion to treat here, make one realize that steroids are a very valuable adjunct in the treatment of tuberculous meningitis.
DUODENAL-MOTILITY PATTERNS IN INFANTS AND CHILDREN
Authors: Barbero Giulio J. , Kim Ih Chin , Davis Jean 
Published: December 2021

Intraluminal pressure in the duodenum has been recorded in infants and children utilizing a strain gauge transducer and an open tube method. This method was used in a group of 31 normal children, 11 children with cystic fibrosis of the pancreas and 6 with the celiac syndrome. All the waves of the duodenum could be divided into two main wave forms. The most frequent wave seen was of a duration of less than 8 seconds, classified as a type I wave. Such waves occurred in both rhythmic and non-rhythmic bursts with a consistent frequency of 12 waves/min. The non-rhythmic type I wave was the most common wave form observed in the duodenal motility of children. The second wave form, type III, consisted of an elevation of the base-line longer than 8 seconds in duration with superimposed type I waves and a frequency of 96.8 waves/hr. No significant difference was present in the three groups in both total wave activity and in the incidence of specific wave types.
Duodenal motility resulting from a milk feeding of 60 ml was studied in 16 normal children and 5 with cystic fibrosis of the pancreas. A significant response in total activity resulting from a rise in the number of non-rhythmic type I waves followed milk ingestion. Concurrent with the rise in total activity and non-rhythmic type I waves seen after ingestion of milk, there was a significant decline in the rhythmic type I wave bursts.
The response to 0.1 mg/kg dose of bethanichol chloride injected subcutaneously was observed in 10 normal children. A significant increase in total activity, manifested principally by a rise in the non-rhythmic type I waves, was demonstrated. At the same time there was a significant decrease in the incidence of type I rhythmic wave bursts and type III waves.
The duodenal motility of children had a higher incidence of type I rhythmic wave bursts and frequency of non-rhythmic waves than the duodenal motility reported previously in adults. Under the conditions of this experimental method there was a lower incidence of non-rhythmic type I waves and type III waves in children compared to the results reported in adults.
TREATMENT OF TUBERCULOUS PLEURAL EFFUSIONS WITH PARTICULAR REFERENCE TO ADRENAL CORTICOSTEROIDS
Authors: Smith Margaret H. D. , Matsaniotis Nicholas 
Published: December 2021

On the basis of our own experience with tuberculous pleural effusions in children as well as on the more extensive experience of other clinicians working with adult patients, we believe that adrenal corticosteroids, given simultaneously with adequate antituberculous drug therapy, not only exert no deleterious effect on the underlying tuberculous infection, but frequently hasten clinical and roentgenographic improvement.
Six consecutive patients with tuberculous pleural effusions are here presented. Diagnosis was established with the aid of tuberculin test, cultures of gastric washings and pleural fluid, and pleural biopsy. Treatment included administration of INH, PAS and prednisone. The clinical and roentgenographic response was unusually prompt in the five patients with early effusions. On the basis of this experience we recommend the following treatment: INH (20 mg/kg/24 hr) for a period of at least a year, PAS (0.5 gm/kg/24 hr) for the same length of time; and prednisone (1.0 mg/kg/24 hr) for a period of about 4 to 6 weeks, with diminishing doses during the ensuing 2 weeks. The general care should be that given to any child with early active tuberculosis, including bed rest during the febrile period but rarely beyond it. If such treatment can be instituted early, the incidence of pleural adhesions, with ventilatory impairment and development of scoliosis, is probably lessened.
The sixth patient, who was suffering from fibrocaseous pleurisy at the time of admission to our hospital, recovered slowly; in this case adrenal corticosteroid therapy appeared to exert no effect on the course of the disease.
RENAL TUBERCULOSIS IN CHILDREN
Authors: Lattimer John K. , Boyes Truman 
Published: December 2021

Genitourinary tuberculosis in children is not easily detected because symptoms are usually minimal, the erythrocyte sedimentation rate is not elevated and the number of leukocytes in the urine may be very few even when the renal destruction is far advanced. The disease is serious because it tends to invade and destroy both kidneys if untreated.
Nephrectomy alone failed to arrest the disease in two of six children with cavitary tuberculosis. Chemotherapy with three drugs arrested the disease in all of the five patients with cavitary lesions treated to date. The follow-up of the cases treated by chemotherapy is shorter than that of the nephrectomy cases.
Ten patients with noncavitary kidney tuberculosis have all had negative urine cultures since multiple-drug chemotherapy. Tuberculosis showed a tendency to lie dormant in the kidneys for long periods (up to 12 years) and then become active again.
Although this series is small and the follow-up is short, the results to date parallel those found in our larger experience with chemotherapy in adults with genitourinary tuberculosis. In general, as in adults, modern triple-drug chemotherapy appears to be about as effective, if not more effective, then nephrectomy, as treatment for this potentially bilateral disease.
As a consequence, at the authors' clinic, nephrectomies are currently being deferred indefinitely, due to the apparent success of chemotherapy. Whether chemotherapy will entirely replace excisional therapy for genitourinary tuberculosis is still problematical, but it has certainly greatly enhanced the outlook for patients with this once lethal disease.