bluuebunny/crossref_metadata_2025_split huggingface dataset:
INTRACELLULAR COMPOSITION AND HOMEOSTATIC MECHANISMS IN SEVERE CHRONIC INFANTILE MALNUTRITION
Authors: Gordillo Gustavo , Soto Raphael A. , Metcoff Jack , Lopez Elizabeth , Antillon Luis Garcia 
Published: December 2021

The present report deals with preliminary results on the study of renal function in advanced malnutrition. The glomerular filtration rate (clearance of inulin) and renal plasma flow (clearance of para-aminohippurate) were studied in 10 children with severe chronic malnutrition. Osmolar clearance were also measured in six of these children. In three, with marked hypotonicity despite acute dehydration, the effects of intravenous administration of a load of sodium chloride were studied.
A significant reduction in filtration rate and renal plasma flow was encountered, which was most evident during dehydration. A decrease in osmolar clearance and the presence of "free-water" clearance in both non-dehydrated and dehydrated malnourished children suggested suspension of the usual antidiuretic mechanisms for conservation of water; however, the rise in osmolar clearance and reabsorption of osmotically free water following administration of hypertonic saline, indicated that the capacity of the renal tubules to respond to an adequate stimulus was not lost.
Administration of an hypertonic solution of saline produced a marked expansion of the volume of extracellular fluid. More than half of this expanded volume resulted from redistribution of intracellular "endogenous" water. Expansion of volume limited rise of osmolality of extracellular fluid in two cases, but failed to do so in the third.
A relatively large proportion of the filtered water was excreted during hypotonic dehydration. Filtration rates apparently decreased as the proportion of filtered water excreted became increased.
The possibility that reduction in filtration rate constitutes a volume defense mechanism and that the apparent anomalies in renal function represent an adaptation to the cellular hypotonicity of the malnourished subject are discussed.
Presidential Badge, British Paediatrics Association
Authors: CRAIG JOHN 
Published: December 2021

It occurs to me that I have seen no mention in Pediatrics of the badge of the British Paediatric Association which was acquired 4 years ago as part of a memorial to Sir Leonard Parsons.
We had plans for a medallion to be struck but eventually a medal of the Mother and Child by Louis Oscar Roty (done in 1897) was acquired. Dr. Bernard Schlesinger was largely responsible for its acquisition; and he put us further in his debt by presenting the Association with a fine leather-bound book which is written in copperplate handwriting and describes the life and work of Roty.
ATAXIA-TELANGIECTASIA
Authors: Boder Elena , Sedgwick Robert P. 
Published: December 2021

This paper based on eight cases and a necropsy report presents a familial symptom complex speaking strongly for a syndrome entity, for which the term ataxiatelangiectasia was proposed by the authors in a preliminary report. The main features are progressive cerebellar ataxia with onset in infancy; progressive telangiectasia of the bulbar conjunctivae, simulating conjunctivitis, and of the butterfly area of the face; frequent sinopulmonary infection, including bronchiectasis; and peculiarity of eye movements, simulating ophthalmoplegia.
The essential components of this familial syndrome are the ataxia and the telangiectasia, the most striking identifying feature being the characteristic telangiectases of the bulbar conjunctivae.
Retardation of statural growth with significant dwarfing is a frequent feature. Intelligence is essentially normal, although difficulty with tests dependent upon visualmotor co-ordination is consistently observed from early childhood; test results show wide scatter and I.Q. scores tend to drop below normal range as the ataxia progresses.
The available pneumoencephalograms give evidence of cerebellar atrophy. The necropsy provides microscopic evidence of progressive, apparently primary, diffuse, cortical cerebellar degeneration and of enlarged venules in the cerebellar leptomeninges and white matter, without significant changes in the spinal cord.
Recent tests of blood and urine of four children have failed to show evidence of an aberration in metabolism of iron or copper. Urinary concentrations of lead have also been within normal limits. Electrophoretic studies of serum in two patients have demonstrated that concentrations of gamma globulin are normal.
Ataxia-telangiectasia resists precise classification among the known entities of heredocerebellar ataxia. It is believed, however, that it may be properly viewed as a fifth entity in the group of phakomatoses, which presently is comprised of Von Recklinghausen's neurofibromatosis, tuberous sclerosis, Von Hippel-Lindau's disease and Sturge-Weber syndrome.
Awareness of the symptom complex of ataxia-telangiectasia will enable the clinician to recognize its varied and seemingly unrelated manifestations as those of a single clinical entity and will eliminate extensive and unrewarding diagnostic procedures.
Diagnosis will permit early recognition of the unusual susceptibility to sinopulmonary infections, so that appropriate antibiotic therapy can be promptly instituted in the management of acute episodes, or prophylactically.
With the possible exception of a clinical report of a single, nonfamilial case published in French in 1941, no reports of this syndrome were found in the literature. Since the publication of our preliminary paper, however, an as yet unpublished report based on four cases similar to those reported here and two necropsies was given by Biemond, at the First International Congress of the Neurological Sciences in July, 1957.
Radiation Diary
Authors: AMBERG JOHN R. 
Published: December 2021

The Supplement to the November issue of Pediatrics (20:921-946, 1957) represented a very fine summary of the problem of radiation hazard in pediatrics. However, I would like to take exception to the suggestion that a radiation diary be kept by the patient or by the patient's parents. I believe there are three questions that this idea provokes.
(1) Is it of investigative value?
At the present time it seems that only accurate gonadal and somatic doses are worth recording if anything of research value will be obtained from keeping these records.
ACUTE CEREBELLAR ATAXIA OF CHILDHOOD
Authors: King Geraldine , Schwarz Gabriel A. , Slade Harry W. 
Published: December 2021

The clinical reports of nine children who developed an acute cerebellar disorder are recorded. The etiology was not determined in any of the cases.
Similar cases were found reported in the literature as "acute cerebellar encephalitis" or "acute cerebellar ataxia," a form of nonsuppurative encephalitis.
The concept is developed that these cases represent a toxi-infectious process of variable etiology with the cerebellum or its systems as the major or only target organ. The main significance of these relatively benign forms of cerebellar disorder in children is their differentiation from cerebellar tumor; the major features of the disorder are outlined to help in the differential diagnosis.
ACUTE SUPPURATIVE ARTHRITIS IN INFANTS AND CHILDREN
Authors: Samilson Robert L. , Bersani Frank A. , Watkins Melvin B. 
Published: December 2021

Tardily treated suppurative arthritis in infants and children results in permanent disability. Early diagnosis determines ultimate prognosis.
In doubtful cases, the diagnosis should be established by aspiration or exploratory arthrotomy if necessary. This is particularly important in the newborn infant.
Diagnostic aspiration should precede the administration of any antibiotic.
Incision and drainage is the preferable method of evacuating an acutely infected joint.
Symptoms of residual incongruity of a joint lag far behind the roentgenographic signs and do not ordinarily appear until the third decade of life.
APPENDICITIS IN CHILDHOOD
Authors: Longino Luther A. , Holder Thomas M. , Gross Robert E. 
Published: December 2021

The results of the experience with all cases of acute appendicitis occurring on the Surgical Service at Boston Children's Hospital between July 1, 1944, and January 1, 1957, are presented. There were 1,358 cases.
Early diagnosis is of the utmost importance, although in small children this may be very difficult.
Prompt appendectomy is the treatment for all children with appendicitis. The importance of adequate preoperative preparation and postoperative care of the sicker children is stressed. If appendiceal rupture has occurred, the appendix is removed and the abdominal cavity is drained.
Of 1,358 cases, 611 (45%) had ruptured appendicitis. There was one death, a mortality of 0.07%. There have been no deaths in the last 12 years, during which 1,309 patients have been treated.
The most common complications were residual infections and obstruction of the small bowel. Most of the immediate postoperative obstructions could be managed with a long intestinal tube.
The fact that nearly half of the patients had rupture of the appendix before the time of hospitalization is strong proof that much has yet to be accomplished in improving the early recognition of this disease, thus permitting surgery to be performed before rupture and peritoneal soiling has occurred. The most important effort that can be made in this direction is (when the local physician cannot make frequent house calls to a sick child) to recommend 24 or 48 hours of observation in a hospital for any child in whom appendicitis is suspected. At little expense, this allows frequent checking by appropriate members of the resident or visiting staff of the hospital. If findings suggestive of appendiceal inflammation disappear, the child generally can be sent home the following day. For those in whom the abdominal findings become more impressive under observation, operation can be undertaken while there is still an opportunity to do so before appendiceal rupture has taken place.
SEPTICEMIA OF THE NEWBORN
Authors: Nyhan William L. , Fousek Mildred D. 
Published: December 2021

Experience with septicemia in 106 infants over a 25-year period has been reported. An almost 2:1 predominance of males was observed.
In the first 10 years of this study, the Group A, beta hemolytic streptococcus was the predominant infecting organism, while in recent years infections with coliform organisms were the most common, although Group A streptococcal infections continue to occur. Significant numbers of those patients observed in the last 15 years were found to be infected with Ps. aeruginosa and with beta hemolytic streptococci of groups other than A.
Fever, abdominal distention, icterus, and hepatomegaly were the most common clinical manifestations suggesting sepsis. However, in most patients the clinical picture was one of general, rather vague, systemic illness.
Optimal therapy is based on vigorous search for the infecting organism and rapid initiation of intensive antibacterial therapy.
Phenylketonuria
Authors: INGALL MANUEL 
Published: December 2021

I would like to comment on a statement made in the August 1957 issue of Pediatrics. Dr. Richmond Paine, in his article entitled "The Variability in Manifestations of Untreated Patients with Phenylketonuria" states that "diagnosis can be made only by the testing of a fresh urine specimen or by determination of the concentration of phenylalanine in the plasma."
I wish to expand on the first part of this statement. I have performed the ferric chloride test on the urines of several untreated phenylketonuric patients, and have observed the following:
AMERICAN BOARD OF PEDIATRICS
Authors:   THE EXAMINATIONS COMMITTEE
Published: December 2021

THE 1958 written examination of the American Board of Pediatrics was taken by 540 candidates on January 10. This is a larger number of candidates than in any previous year with the exception of 1953 when 607 physicians took the test. Grades earned by the 540 candidates ranged from a low mark of 27 to a high of 85, a range satisfactorily adequate for differential selection. After considerable study, the decision was reached to place the passing grade at 51.5. On this basis there were 35 examinees or 6.5% who failed and 505 who passed and were notified of their eligibility for oral examination.
Pertinent statistics follow: mean, 65.82; mode, 69.51; median, 67.05; first quartile, 59.56; third quartile, 72.51. Readers will note that the mean and the mode are 3.7 points apart and also that the range from the first quartile to the median is 7.5 points whereas the distance from the median to the third quartile is only 5.5 points. These statistics mean that the Committee continues to be successful in producing an examination that is skewed toward the lower grades. Such a distribution makes the test relatively sensitive in the critical range where a decision must be reached regarding passing or failing and relatively insensitive in selecting honor grades.
Calculation of the "probable error of estimate" (P.E.m) has yielded a lower figure than in any previous year. This statistic is computed by giving each candidate two grades, one based on his even numbered questions and the other on his odd numbered questions. The degree to which the two sets of grades are in agreement is a measure of the internal consistency of the examination.
BENIGN INTRACRANIAL HYPERTENSION AND OTITIC HYDROCEPHALUS
Authors: MILLICHAP J. GORDON 
Published: December 2021

BENIGN intracranial hypertension or pseudotumor cerebri, as the condition is termed more frequently, is a syndrome of increased intracranial pressure with a normal ventricular system and cerebrospinal fluid of normal composition. Headache of moderate degree is the most common symptom and vomiting, impairment of vision and diplopia occur less often; papilledema and abducens palsy are the usual neurologic signs. The prognosis is almost invariably good.
Although few reports of the syndrome are found in pediatric literature, its occurrence is relatively common during childhood. The review of reports by Davidoff, Foley, and others has disclosed that 84 (37%) of 224 patients were children and of these 75 (90%) were between 5 and 15 years of age. The infrequent occurrence or recognition of the syndrome in infants and young children is noteworthy.
DISTURBANCES OF ACID-BASE EQUILIBRIUM IN SALICYLATE INTOXICATION
Authors: Winters Robert W. , White James S. , Hughes Marilyn C. , Ordway Nelson K. 
Published: December 2021

The initial disturbances in acid-base equilibrium and the pathways of recovery have been studied in 33 patients, predominantly infants and young children, with salicylate intoxication due either to accidental ingestion or to therapeutic overdosage.
In nearly all patients there were significant reductions in the total content of carbon dioxide and in pCO2 of plasma; pH of the blood did not vary consistently: some patients were alkalotic, others were acidotic, while still others had no significant deviation in pH of the blood.
Evidence was obtained in many of the patients for a mixed disturbance in acid-base equilibrium with primary disturbances in the metabolic and in the respiratory components.
The nature of the component of metabolic acidosis has been analyzed by a detailed study of the anions in the serum of five patients with this disturbance. A variety of anions were present in excess: chloride, salicylate, and undetermined anion; in one patient the concentration of phosphate was also elevated. Reasons are presented suggesting that the undetermined anion fraction represents largely ketone bodies.
The pathway of return to normal acid-base equilibrium was studied with six patients presenting with acid pH. The predominent tendency of this group was to recover through a point at which pH of the blood was normal or even alkaline, even though pCO2 was still low.
In two patients initially presenting with acid pH, acute respiratory depression supervened after acute pulmonary edema. Respiratory depression was accompanied by a marked elevation of pCO2 and a marked fall in pH. One of these patients expired; the other was successfully ventilated by artificial means and made a full recovery.
The basic actions of toxic amounts of salicylate—respiratory stimulation, changes in metabolic rate, and disturbances in the metabolism of carbohydrate, protein and fat—are reviewed. The pathogenesis of the acid-base disturbances is formulated in terms of these known actions of toxic amounts of salicylate.
Several factors correlate with the particular type of disturbance which a given patient may develop and may be important as conditioning influences. These factors are age of the patient, duration of the intoxication, type of intoxication (i.e., whether accidental or the result of therapeutic over-dosage) and, perhaps, the amount of salicylate ingested.
ACTINOMYCIN D IN CHILDHOOD CANCER
Authors: Pinkel Donald 
Published: December 2021

Actinomycin D was administered intravenously to 13 children with inoperable cancer. Of eight children who received the agent alone, two experienced regression of tumor, of whom one had Wilms' tumor and the other rhabdomyosarcoma. Of five children who received the drug in association with radiation therapy, two had beneficial responses, which were apparently due to the Actinomycin D rather than to radiation. One of these children had rhabdomyosarcoma and the other a sarcoma of the mesentery.
Toxic manifestations consisted of nausea and emesis, oral ulcerations, depression of hematopoiesis, diarrhea, and alopecia, in that order of frequency.
The changes in the skin associated with x-radiation appeared to become exaggerated after therapy with Actinomycin D.
The estimated optimal dosage for children is 2.4 mg/m2 of body surface area. This amount produced benefit or mild oral toxicity without causing significant depression of the bone marrow. Lower doses are advised during second courses and for patients who have had prior therapy with bone marrow depressants or who have impaired renal function.
Further investigation of the usefulness of Actinomycin D alone and in combination with ionizing radiation in the treatment of cancer seems indicated.
MAPLE SYRUP DISEASE
Authors: Menkes John H. 
Published: December 2021

A mixture of alpha-keto acids, the most important of which has been identified as alpha-ketoisocaproic acid, was found to be excreted in large quantities in the urine of beta-methyl-n-valeric acid were present in smaller amounts.
Their excretion would suggest an impairment of the degradative metabolism of the branched-chain amino acids as an important cause of the cerebral degeneration in this condition.
PEDIATRICS AND SOCIETY
Authors: Glaser Kurt 
Published: December 2021

A considerable portion of a child's life is spent in school. His adjustment to this experience is of utmost importance for the later adjustments he will have to make as an adult. It is part of the pediatrician's duty to supervise the child's emotional and physical health and to help him and his parents maintain it in optimal condition.
Reluctance to attend school is a problem frequently encountered and of great importance. The pediatrician should be familiar with its various facets because he may be the first to be consulted if such a problem arises.
The child may openly express his fear or unwillingness to go to school or may present physical symptoms which prevent him from attending school. A precipitating factor, such as a minor illness of the child or an upsetting event in the family, is usually present. The underlying cause may be connected with the school itself, such as fear of teacher or children, too great demands for achievement by teacher or parents in relation to the capacities of the particular child, or inability of the child to face competition with peers or siblings. The cause may lie in anxiety caused by fear of separation between mother and child, the attendance at school being the first occasion when such a separation becomes mandatory.
Treatment consists of early return of the child to school, concurrent with, or followed by, treatment of the underlying cause, whenever such treatment is indicated, available and accepted by the parents. Delay in return to school increases the difficulties in the child's readjustment to normal acceptable behavior and makes treatment of the underlying cause more difficult.
Brief examples of the above situations are cited from experience with 38 children. The incidence of the presenting problems, the adjustment following treatment and the duration of treatment are presented.
Clinical Radiology of Acute Abdominal Disorders
Authors: SILVERMAN FREDERIC N. 
Published: December 2021

This is a volume which may be classified as one for functional reference rather than one for research reference, although it can serve as a good spring-board into serious review by virtue of its succinct phraseology and extensive bibliography.
The section on congenital malformations will be of particular interest to physicians dealing with pediatric problems, and includes approximately 25% of the text and illustrations.
CYSTS AND DUPLICATIONS OF NEURENTERIC ORIGIN
Authors: Nathan Max T. 
Published: December 2021

A case with a transdiaphragmatic duplication of the small intestine is reported. This was probably of neurenteric origin as it was attached superiorly to C3, and inferiorly to the terminal ileum. Five other similar cases from the records of this hospital are discussed.
A brief review of the literature and a discussion of the embryology of these anomalies is included.
THE DIAGNOSTIC USEFULNESS OF SKELETAL MATURATION IN AN ENDOCRINE CLINIC
Authors: Mellman William J. , Bongiovanni Alfred M. , Hope John W. 
Published: December 2021

Correlation of bone age and clinical status of 146 children referred to an endocrine clinic has been presented. Ninety-five subjects were retarded with respect to height, bone age, or both. In only 30% of this group was a true endocrinologic disorder present, and the majority were attributable to hypothyroidism. Retarda-of skeletal maturation alone, however, is not indicative of thyroid disease. The majority of the group with retardation had a "constitutional" disorder.
Fifty-one children exhibited acceleration of the bone age, stature, or both. In 20 it could be attributed to constitutional precocity. Such advancement, of a moderate degree, was associated with simple exogenous obesity. The most extreme alterations were seen in conjunction with adrenal hyperplasia or adenoma.
The importance of employing several centers for the estimation of bone age has been stressed, and the significant diversity which may occur between the hand and wrist and other regions, has been detailed in several instances. A summary of concepts relating the endocrine system to maturation, in terms of the clinical data described herein, has been presented.