bluuebunny/crossref_metadata_2025 huggingface dataset:
Prolonged and Recurring Diarrhea in the Northeast of Brazil
Authors: McAuliffe Jay F. , Shields David S. , de Sousa Maria Auxiliadora , Sakell Janet , Schorling John , Guerrant Richard L.
Published: January 2024

From prospective daily surveillance of diarrhea in a poor rural area of northeastern Brazil, this study of prolonged diarrheal episodes identified the 3% of diarrheal episodes that lasted 15 days or longer. These episodes also defined a subpopulation of children who spent over 16% of their days with diarrhea. Such children warrant further attention in an attempt to define potentially treatable causes as well as to assure appropriate nutritional support. There was no single season for these prolonged illnesses, but they appeared to involve both the wet, slightly warmer season of peak enterotoxigenic Escherichia coli diarrhea as well as the dry, slightly cooler season of peak rotaviral infections. Limited etiologic data support this idea that multiple pathogens are found, often in combination with each other, that may work together to contribute to the important problem of chronic diarrhea. Future studies should focus attention on further defining risk factors, mechanisms, and appropriate therapy for the subset of children who experience prolonged diarrhea in this type of setting.
Cutaneous Polyarteritis Nodosa in a Patient With Ulcerative Colitis
Authors: Volk Donna M. , Owen Lafayette G.
Published: January 2024

Skin disease is common in patients with inflammatory bowel disease. Described herein is a child with ulcerative colitis and cutaneous polyarteritis nodosa. Review of the literature suggests cutaneous polyarteritis must be considered as another skin lesion associated with inflammatory bowel disease. Cutaneous polyarteritis tends to run a chronic relapsing course independent of bowel disease, however.
Severe Gastrointestinal Involvement in Children with the Acquired Immunodeficiency Syndrome
Authors: McLoughlin Lucille C. , Nord Kenneth S. , Joshi Vijay V. , Oleske James M. , Connor Edward M.
Published: January 2024

Summary: Five children with the acquired immunodeficiency syndrome (AIDS) and unusual gastrointestinal disease are described. Two children presented with malnutrition, abdominal distention, and diarrhea. One was found to have moderately severe villus atrophy on jcjunal biopsy and was initially thought to have celiac disease. Jejunal biopsy from the second child revealed infiltration of the mucosa with acid‐fast bacilli‐laden macrophages. A third child suffered recurrent abdominal pain, progressive weight loss, diarrhea, and severe gastrointestinal hemorrhage secondary to infection with cytomegalo‐virus. Pseudomembranous necrotizing jejunitis associated with overgrowth of Klebsiella pneumoniae in the duodenal fluid occurred in one patient. The fifth child presented in the newborn period with Serratia marcescens cholecystitis. Gastrointestinal disease in children with AIDS may be due to idiopathic villus atrophy and bacterial or opportunistic infection.
Disease Specificity and Dynamics of Changes in IgA Class Anti‐endomysial Antibodies in Celiac Disease
Authors: Kapuscinska Alicja , Zalewski Tadeusz , Chorzelski Tadeusz P. , Sulej Jadwiga , Beutner Ernst H. , Kumar Vijay , Rossi Thomas
Published: January 2024

We evaluated the sensitivity and kinetics of serum IgA class anti‐endomysial antibodies in the diagnosis of celiac disease (CD) as established by the criteria of the European Society for Pediatric Gastroenterology and Nutrition (ESPGAN). Eighty‐four cases that satisfied the ESPGAN criteria for CD were evaluated for IgA‐EmA titers during various phases of establishing the diagnosis. Thirty‐three cases were infants and children <5 years of age undergoing intestinal biopsies for symptoms of CD and 51 were previously diagnosed adults. Of the 33 children, 11 were untreated and symptomatic and were IgA‐EmA positive at initial presentation. Twenty‐two children previously controlled on a gluten‐free diet (GFD) exhibited IgA‐EmA titers during gluten challenge. Furthermore, the antibody levels declined in all cases (usually to negative) when the patients were again placed on a GFD for 6–12 months. Changes in intestinal histopathology paralleled the changes in antibody tilers in six cases undergoing serial biopsies. Of the 51 adult patients with proven CD who were prescribed a GFD for at least 12 monlhs, IgA‐EmA were detected in 10 cases who were noncompliant to their GFD, whereas the antibodies was found in only 1 of the remaining 41 patients striclly adhering to their diet. The sera of 140 aged‐matched children wilh various inleslinal problems, 87 healthy adults, and 67 patients with dermatological diseases served as controls and were also IgA‐EmA negative. On the basis of these findings, we suggest a role for the IgA‐EmA as a serological screening test for active CD. It further offers the potential for monitoring compliance to diet in established cases of CD and also indicates the proper timing for biopsy in patients undergoing evaluation of CD.
Intestinal Permeability to [51Cr]EDTA in Children with Crohn's Disease and Celiac Disease
Authors: Turck D. , Ythier H. , Maquet E. , Deveaux M. , Marchandise X. , Farriaux J. P. , Fontaine G.
Published: January 2024

[51Cr]EDTA was used as a probe molecule to assess intestinal permeability in 7 healthy control adults. 11 control children, 17 children with Crohn's disease, and 6 children with untreated celiuc disease. After subjects fasted overnight. 75 kBq/kg (=2 μCi/kg) 51Cr‐labeled EDTA was given by mouth; 24‐h urinary excretion of [51Cr]EDTA was measured and expressed as a percentage of the total oral dose. Mean and SD were as follows: control adults 1.47 ± 0.62, control children 1.59 ± 0.55, and patients with Crohn's disease or celiac disease 5.35 ± 1.94. The difference between control children and patients was statistically significant (p < 0.001). These results show that intestinal permeability to [51Cr]EDTA is increased among children with active or inactive Crohn's disease affecting small bowel only or small bowel and colon, and with untreated celiac disease. The [51Cr]EDTA permeability test could facilitate the decision to perform more extensive investigations in children suspected of small bowel disease who have atypical or poor clinical and biological symptomatology.
Discriminant Analysis for the Diagnosis of Childhood Celiac Disease
Authors: Greco Luigi , Troncone Riccardo , De Vizia Basilio , Poggi Vincenzo , Mayer Marina , Grimaldi Massimo
Published: January 2024

A new statistical approach to the analysis of laboratory data has been introduced to optimize the use of absorption tests and gliadin antibody measurement for the diagnosis of childhood celiac disease. Serum anti‐gliadin antibodies, as well as blood xylose, iron, and try‐glycerides after oral load, were evaluated in 40 celiac children and 43 age‐matched patients affected by other gastrointestinal diseases. Each test evaluated individually gave a considerable rate of false‐positive and false‐negative results. Discriminant coefficients produced for each test were used to compute a score that allowed correct classification of 99% of patients; 2.3% of false‐positive and no false‐negative results were recorded. This approach improves significantly the overall sensitivity and specificity for celiac disease of these laboratory tests and we propose its use for screening patients to be submitted to jejunal biopsy.
Quantitative Histological Changes in the Small Intestine of Rats Artificially Reared on Different Milk Substitutes
Authors: Harvey David , Austin Hilary , Mahon Michael , Harris Philip F. , Tonkiss John , Smart James L.
Published: January 2024

Growth of the small intestine was studied in rats reared normally by their mothers (MR) or artificially reared (AR) by intragastric infusion of milk substitutes from postnatal day 5. Two milk substitutes were used: one high in carbohydrate and low in protein as compared with rats' milk (Messer) and the other closely resembling rats' milk in its composition (Auestad). Pups reared on these formulae are termed ARM and ARA, respectively. Pups were killed at 7, 12, and 20 days for quantitative histological measurements on transverse sections of duodenum and ileum. They included cross‐sectional areas of muscle and of mucosa and submucosa combined (other tissue), internal and external perimeters, and length of longest villus profile. Artificial rearing affected mucosal and submucosal measures, but did not affect muscle. The effects depended on age, type of milk substitute, and site within the small intestine. There was a tendency for deficient growth of small intestine in the early stages of artificial rearing, especially in the ileum of ARA pups. Enhancement of growth as shown by cross‐sectional area of mucosa and submucosa and by longest villus profile occurred later—by 12 days in the duodenum and by 20 days in the ileum of ARM pups. Enhanced growth was less evident in ARA rats, being apparent only in the duodenum, and not until 20 days were the cross‐sectional area of mucosa and submucosa and the longest villus profile increased.
Hyperosmolal Feedings and Gastrointestinal Blood Flow and Oxygenation in Newborn Lambs
Authors: Buchanan Donald E. , Holzman Ian R.
Published: January 2024

Hyperosmolal feedings have been implicated as a cause of potential disruption to the physiology of the neonatal intestinal tract. To evaluate this we studied eight awake lambs (11 ± 2 days old) with chronically implanted catheters in the portal sinus, descending aorta, and left and right ventricles. Blood flow (Q) was calculated with the radionuclide‐labeled microsphere technique and O2 delivery (DO2) and consumption (VO2) by the Fick principle using blood O2 contents. Lambs were studied initially after a 4‐h fast and sequentially at 2, 3, and 4 h after eating a hyperosmolal (590 mOsmol) formula. Cardiac output (mean ± SEM, 332 ± 22 ml ± min‐1 ± kg‐1) and whole animal VO2 (16.5 ± 2.5 ml O2 ± min‐1 kg‐1) remained stable. Total gastrointestinal (GI) blood flow increased 28% by 3 h. Small intestine Q increased 21% 3 h after feeding and then returned to baseline. Similarly, large intestinal Q increased 77% after feeding and remained elevated. There was no effect on stomach Q. Total GI vascular resistance fell 28% 3 h after feeding then returned to baseline. DO2 to the GI tract increased at 3 h and returned to baseline. There was no change, though, in GI VO2 (3.9 ± 0.4 ml O2 ± min‐1 ± 100 g‐1) or in the extraction (VO2/DO2) of oxygen (21.2 ± 1.8%) during the study. Furthermore, there was no evidence for GI tract acidosis at any time. Systemic organ blood How (except hepatic arterial blood flow) remained unchanged. While hyperosmolal feedings caused a GI hy‐peremia confined to the small and large intestine, they had no effect on intestinal VO2, nor did they produce disturbances that might be related to more serious diseases.
Comparison of Dietary Therapy and Portacaval Shunt in the Management of a Patient with Type IB Glycogen Storage Disease
Authors: Borowitz Stephen M. , Greene Harry L. , Gay James C. , Neblett Wallace W.
Published: January 2024

A patient with glyeogen storage disease type IB (GSD‐Ib) is described. Beginning at age 34 months, the patient was managed with dietary measures, including nocturnal intragastric feedings. Therapy caused substantial biochemical and clinical improvement while the patient remained hospitalized; chronic noncom‐pliance at home, however, resulted in profound growth failure and biochemical abnormalities. Due to a previous case report describing clinical, biochemical, and hemato‐logical improvement following a portacaval shunt in a similar patient, portacaval shunt was performed in our patient at age 13 years. During the 12 months following surgery, there was no improvement of our patient's growth or of biochemical or hematological abnormalities. Due to the lack of improvement following surgery. 24‐hour constant infusion intragastric feedings were instituted and have been associated with substantial benefit.
Measurement of the Milk Intake of Breast‐Fed Infants
Authors: Arthur P. G. , Hartmann P. E. , Smith M.
Published: January 2024

Infant test weighing and maternal test weighing are two independent methods for determining milk intake by the breast‐fed infant. The sources of error in both these test weighing methods were examined with particular emphasis on the importance of evaluating and correcting for evaporative water loss (EWL). EWL ranged from 3 to 94% of the mother's change in weight after a single breast feed and from 3 to 55% of the infant's change in weight after a single breast feed. Correcting for EWL during a breast feed involved determining the time between the pre‐ and postfeed weighings and measuring the rate of EWL after breast feeding. Significant correlations (p < 0.001) were found between milk volume intake measured by test weighing the mother and correcting for maternal EWL, and milk volume intake measured by test weighing the infant and correcting for infant EWL. An improved method for measuring 24‐h milk intakes by maternal test weighing using a sensitive electronic balance and correcting for EWL is described. The milk intakes, corrected for EWL, ranged from 690–1,041 g/24 h. If no correction for EWL was made then the average overestimate of milk intake by maternal test weighing was 14 ± 6%.
Long‐Term Effects of Early Kwashiorkor Compared with Marasmus. I. Physical Growth and Sexual Maturation
Authors: Galler Janina R. , Ramsey Frank C. , Salt Patricia
Published: January 2024

Physical growth and sexual maturation were measured in a follow‐up study of Barbadian girls and boys aged 11–18 years with histories of kwashiorkor (n 54) or marasmus (n 56) in their first year of life. They were compared with healthy neighborhood children matched by sex and age who had normal patterns of growth in early childhood (n 59). Girls with histories of marasmus hail significant delays in the onset of menarche compared with healthy comparison girls. However, their rate of growth during the previous 2 years was accelerated, and the differences in size were smaller than at the earlier testing, confirming catch‐up. This pattern was not evident for girls with histories of kwashiorkor, who did not differ from the healthy comparison girls on either onset of menarche. Tanner ratings of sexual maturation, or measures of physical growth. In contrast, boys with histories of kwashiorkor or marasmus did not differ from healthy comparison boys in physical growth or Tanner ratings at these ages.
Membranous Obstruction of the Inferior Vena Cava with Budd‐Chiari Syndrome in Children
Authors: du P. Hoffman H. , Stockland B. , von der Heyden U.
Published: January 2024

Membranous obstruction of the inferior vena cava (IVC) with Budd‐Chiari syndrome is a rare condition in children. Nine children with tins lesion are described, eight of them from the Ovambo tribe in Namibia. Clinical features included hepatomegaly, splenomegaly, ascites, and dilated superficial abdominal veins draining cephalad below the umbilicus. Liver enzymes and serum proteins were slightly abnormal in most cases, and the ascitic fluid, when present, had a high protein content. Liver histology showed a wide range of changes, from almost normal to signs of severe chronic congestion. Angiographic appearance varied from a thin membrane between the IVC and right atrium to nonvisualization of the IVC except for dilated collaterals. Simultaneous injection of contrast medium into catheters positioned in the upper IVC and right atrium, through both the femoral and antecubital routes, is the most accurate way of demonstrating the extent of the obstruction and the patency of the hepatic veins.
Exercise‐Induced Gastroesophageal Reflux in an Athletic Child
Authors: Motil Kathleen J. , Ostendorf Judy , Timothy Bricker J. M. , Klish William J.
Published: January 2024

Exercise‐induced gastroesophageal reflux (GER) is described in an athletic child with chronic abdominal pain and vomiting in conjunction with strenuous exercise. Although continuous 24‐h pH probe monitoring was negative for GER, simultaneous pH probe and exercise stress testing treadmill) showed a prolonged, continuous episode of acid reflux throughout exercise and the 30‐min recovers phase. The authors are unaware of other cases of 'exercise‐induced GER in children and suggest that simultaneous pH probe and exercise stress testing may be a useful technique to evaluate exercise‐induced symptoms in children. Moreover, the presence of acid reflux during stress may warrant exercise restriction during the early management of reflux esophagitis.
Effect of Soy Protein on the Small Bowel Mucosa of Young Infants Recovering from Acute Gastroenteritis
Authors: Iyngkaran N. , Yadav M. , Looi L. M. , Boey C. G. , Lam K. L. , Balabaskaran S. , Puthucheary S. D.
Published: January 2024

The effect of soy protein on the small bowel mucosa of 18 infants with acute gastroenteritis was studied. The infants were maintained on a protein hydro‐lysate formula for 6–8 weeks, following which they were readmitted for soy protein challenge studies. Jejunal biopsy was performed before and 24 h after challenge. On the basis of the clinical and histological reaction to soy protein challenge, three groups were identified. Group 1 consisted of three infants who had clinical and histological reaction. There was associated depletion of mucosal enzymes, lactase, sucrase, malatase, alkaline phosphatase, and blood xylose levels. Group 2 consisted of seven infants who had histological reaction but no clinical symptoms. Two of these seven infants, however, developed clinical reaction when rechallenged with soy protein 2 and 90 days later. Following challenge, mucosal enzymes and blood xylose levels were depressed in five of the seven infants tested. Group 3 consisted of eight infants who did not have either a clinical or a histological reaction. The mucosal enzymes and blood xylose levels were not depressed in four infants tested. The present study shows that the small bowel mucosa of some young infants recovering from acute gastroenteritis remains sensitive to soy protein for a variable period of time. The feeding of soy protein to these infants may result in the persistence of mucosal damage and perpetuation of diarrhea. These findings have an important bearing in the nutritional management of infants recovering from AGE; the exclusion of soy protein from the diet of these infants, particularly during the period when the mucosa is damaged, may reduce the risk of the development of soy protein sensitive enteropathy and the attendant complication of protracted diarrhea.
Effects of Cytochalasin B on the Synthesis and Secretion of Plasma Proteins by Developing Rat Liver
Authors: Kaufman Stuart S. , Tuma Dean J. , Park Jung H. Y. , Grandjean Carter J.
Published: January 2024

Antimicrotubular drugs such as colchicine impair plasma protein secretion markedly less from developing liver than from mature tissue, suggesting the reduced participation of microtubules in hepatic protein secretion during liver development. In order to evaluate the possible contribution of microfilaments to protein export by immature liver, we incubated slices prepared from adult and gestation day 19 fetal rat liver for up to 4 h with the antimicrofilamentous agent cytochalasin B and with colchicine in various concentrations. In adult tissue, cytochalasin B did not reduce either the synthesis or secretion of [14C]leucine‐labeled proteins and albumin. Cytochalasin B decreased apparent albumin synthesis by fetal liver, but otherwise, its effects on [14C]leucine incorporation did not differ from those observed in the adult. In contrast with leucine, the uptake of [3H]glucosamine into both adult and fetal liver was reduced by cytochalasin B. When this reduced uptake was normalized to that in corresponding control incubations, [3H]glucosamine incorporation into glycoproteins was markedly diminished in fetal slices, but was unaffected in the adult. Despite this age‐dependent difference, cytochalasin B only minimally affected glycoprotein secretion in each group. Cytochalasin B never modified the antisecretory effects of colchicine. These results suggest that during early development, liver protein synthesis is more sensitive to toxic effects of cytochalasin B than during adulthood. However, microfilaments are not required for plasma protein export at either time.
Food Proteins and Maturation of Small Intestinal Microvillus Membranes (MVM). II. Binding of Gliadin Hydrolysate Fractions and of the Gliadin Peptide B3142
Authors: Stern Martin , Gellermann Barbara , Belitz Hans‐Dieter , Wieser Herbert
Published: January 2024

To investigate in vitro interactions between gliadin peptide fractions that have been shown to be toxic to celiac small intestinal mucosa in humans and small intestinal microvillus membranes (MVM) from rats during postnatal maturation, MVM were prepared from newborn, 18‐day‐old preweanling, and adult rats. Partially hydrolyzed gliadin peptide fractions B1‐B4, and the pure gliadin peptide B3142 were radioiodinated and used for binding assays. Miniature ultracentrifugation was used for separation of unbound material. Binding of gliadin fractions to MVM was weak and nonspecific in terms of lacking saturation and inhibition. There was no inhibition of binding by mannan. Enzyme pretreatment of MVM (trypsin, neuraminidase, phospholipase C) did not result in any significant change of binding. Compared with peptides prepared from bovine serum albumin as a control, there was no significant difference in binding of gliadin peptide fractions to MVM. Thus, a lectin‐like effect of gliadin peptides toward MVM, or the existence of a specific intestinal surface receptor for gliadin peptides appeared improbable. There were, however, consistent maturational changes in MVM binding in that newborn MVM bound more B1‐B4 and B3142 compared with adult controls (p < 0.001). Nonspecific binding of gliadin fractions to MVM might be related to the initiation of nonspecific in vitro effects of gliadin, particularly toward the immature small intestine. The MVM binding model in the rat clearly does not provide a system for studying celiac disease pathogenesis, but it might help clarify basic processes in the interaction between food‐derived substances and elements of the gastrointestinal mucosal barrier.
Excessive Fecal Taurine Loss Predisposes to Taurine Deficiency in Cystic Fibrosis
Authors: Thompson Geoffrey N.
Published: January 2024

Elevation of the ratio of glycine:taurine‐conjugated bile acids (G/T ratio) is thought to contribute to fat malabsorption in cystic fibrosis (CF). The cause, extent, and reversibility of taurine deficiency in CF were assessed using balance studies in 6 subjects (ages 8–14 years) who were supplemented with taurine (0.24–2.4 mmol/kg/24 h) for 1 week. Taurine reduced the G/T ratio both in serum and duodenal juice in all children. The mean fecal taurine loss in CF subjects [10.8 μmol/kg/24 h ± 9.9 (SD), range 0.9–27.9] was much greater than that in controls (< 0.1 μmol/kg/24 h, n = 4) and approximated the dietary taurine intake (mean 14.6 ± 4.4 μmol/kg/24 h, n = 12). Absorption of an oral taurine load appeared to be normal in CF. Excessive fecal taurine loss appears to predispose CF children to bile acid taurine deficiency, a deficiency that can be corrected by oral taurine supplements.
Pancreatic Function Testing in Meconium Disease in CF
Authors: Lands Larry , Zinman Raezelle , Wise Melvin , Kopelman Hinda
Published: January 2024

We report two infants with cystic fibrosis (CF), presenting with meconium ileus and meconium plug, who had no clinical or biochemical evidence of pancreatic insufficiency during infancy. They underwent pancreatic secretory function testing at 11 and 9 months of age, respectively. Both patients had sufficient lipase and colipase secretion to maintain normal digestion of fat, confirming that meconium disease in CF does not necessarily imply pancreatic insufficiency and the need for enzyme supplementation in infancy. Nonetheless, we documented markedly reduced enzyme secretion in both patients, implying a potential role for the pancreas in the pathogenesis of meconium disease, even when clinical pancreatic insufficiency is absent. In addition, our patient with meconium ileus had a severely limited fluid secretory capacity (10.3% of mean normal values). In contrast, the patient with the milder presentation of meconium plug had a far greater ability to secrete fluid (75% of mean normal), but had poorer pancreatic proteolytic activity. We suggest that impaired fluid secretion may be a very significant factor in the pathogenesis of meconium ileus, and we speculate that an inability to maintain sufficient intraluminal fluid relative to the degree of pancreatic proteolytic deficiency may more adequately explain the risk of occurrence and the severity of intestinal obstruction in CF than either factor alone.
Graft‐versus‐Host Disease
Authors: Kessler Bradley H. , Cochran William J. , Wagner Milton L. , Hawkins Hal K. , Klish William J.
Published: January 2024

Bone marrow transplantation is an accepted form of treatment for aplastic anemia and end‐stage hematological malignancies. Despite a satisfactory outcome in selected patients, more than one‐half develop acute graft‐versus‐host disease (GVHD), characterized typically by involvement of the skin, liver, and gastrointestinal tract. We describe an unusual case in which a 10‐year‐old girl developed gastrointestinal symptoms as the only manifestation of GVHD. The patient presented with a rectovaginal fistula and had clinical, radiological, and histological features of gastrointestinal GVHD without evidence of liver or skin involvement.
Celiac Disease in Two Different Population Groups of South Tirol
Authors: Pittschieler Klaus , Reissigl Hans , Mengarda Giuseppe
Published: January 2024

The expression of celiac disease is assumed to be influenced by both genetic and environmental factors. Our study investigated the prevalence and HLA type in two different ethnic groups: a German group and an Italian group living in South Tirol. Intermarriages are rare between these population groups. The live birth rate during 1973–1982 (10 years) was 42,739 for the German group and 14,874 for the Italian group. Fifty people with celiac disease, born during this period, were diagnosed according to the ESPGAN criteria: 45 were German and five were Italian. The incidence in the German group was 105 per 100,000, and 33 per 100,000 in the Italian group. HLA typing was performed in 40 patients, and in 50 German and 50 Italian controls. Of the patients with celiac disease, 43% were positive for HLA B8, 85% for DR3, and 66% for DR7. Although lower, no difference was found in the expression of HLA B8, DR3, and DR7 in the Italian and German controls. The data presented here strongly suggest that there is little association between the incidence of the disease and HLA type in the two ethnic populations. However, from preliminary data, it is postulated that the age of the infant when gluten is added to its diet will affect the incidence of celiac disease.
A Prospective Survey of Serial Maternal Serum Zinc Levels and Pregnancy Outcome
Authors: Higashi Akimasa , Tajiri Akiko , Matsukura Makoto , Matsuda Ichiro
Published: January 2024

Serum zinc levels were monitored serially in pregnant women. Compared with those of age‐matched nonpregnant women, their serum zinc levels were significantly decreased in the first trimester (p < 0.005) and further decreased in the second trimester (p < 0.005) but then remained unchanged until delivery. Cord blood zinc levels and the ratio of cord blood to maternal serum zinc at delivery were significantly higher in preterm than term (≥ 37 weeks) infants (p < 0.05, p < 0.05). The maternal serum zinc level in the second trimester was not related to the birth weights of the infants. Mothers with serum zinc levels of <65 μg/dl in the last trimester showed a higher incidence of birth weights of less than the 50th percentile (p < 0.005) and also of less than the 25th percentile (p < 0.005) on term delivery. The incidences of birth weights of less than the 10th percentile on term delivery were similar for mothers with serum zinc levels of ≥65 μg/dl. This observation suggested that a relatively lower birth weight may be associated with lower maternal serum zinc levels in the third trimester, but an additional factor (factors) is also involved in the outcome of low birth weight infants.
Effect of Zinc Level in the Refeeding Diet in Previously Starved Rats on Plasma Somatomedin C Levels
Authors: Cossack Zafrallah T.
Published: January 2024

White male growing rats were fed rat chow diet for 4 days after which they were fasted for 72 h. At the end of fasting, rats were allotted into four dietary treatments that varied only in the level of zinc (Zn): Zndeficient group (ZnD), 30. 90. and 140 ppm of Zn. A group of eight rats were not fasted and were fed the rat chow diet throughout the experimental period. Blood was obtained at intervals from all groups for the measurements of Zn and somatomedin C (SMC) in the plasma. Eight rats were randomly selected at zero time (t0) and at the end of fasting period were killed for the measurement of tibia Zn. At the end of refeeding, all rats were killed for tibia Zn determination as well. Results showed that plasma SMC decreased to the hypopituitary level at the 3rd day of fasting. At 48 and 72 h of refeeding. the levels of plasma SMC increased significantly in all experimental groups and the differences among groups were not significant. The levels of SMC in groups fed 140 and 90 ppm of Zn continued to increase significantly with progressive refeeding. However, in groups fed 30 ppm and ZnD diets the levels of SMC started to decline after 72 h of refeeding. The levels of plasma Zn followed similar trend as SMC levels. In addition, the levels of Zn in the tibia were comparable in all groups with SMC and plasma Zn levels at the end of fasting or refeeding period. Previous reports showed that plasma SMC level is a more reliable index used to monitor nutritional responses; thus, it could be concluded that the level of Zn in the diet should be considered carefully when planning nutritional intervention for severe malnutrition or starvation.
Multifocal Adenocarcinoma of the Stomach in a Child With Common Variable Immunodeficiency
Authors: Conley Mary Ellen , Ziegler Moritz M. , Spencer Borden IV , Huff Dale S. , Boyle John T.
Published: January 2024

The clinical course of a child who developed an adenocarcinoma of the stomach at 11 years of age is described. At 6 years of age, the child was evaluated for abdominal pain, weight loss, and vomiting. She was found to have hemorrhagic, atrophic gastritis, achlorhydria, and panhypogammaglobulinemia. The gastritis improved with corticosteroid therapy, but relapsed each time that the steroid dosage was tapered. The clinical course was marked by severe growth failure, recurrent infections, and intermittent abdominal pain. Radiographic studies done when the patient was 11 years of age demonstrated a large fungating mass on the lesser curvature of the stomach. Endoscopy and biopsies done 1 year previously had not revealed any sign of malignancy. A radical gastrcctomy was performed. Microscopic studies revealed multifocal adenocarcinoma of the stomach with no evidence of invasion of the submucosa or local lymph nodes. The patient died of Candida septicemia and pneumonia 6 months after the gastrectomy. There was no evidence of recurrence of the tumor on autopsy. The relationship between common variable immunodeficiency and gastrointestinal disease is described.
Prognostic Value of Serum Pepsinogen I in Children with Peptic Ulcer
Authors: Oderda Giuseppina , Altare Franco , Dell'Olio Domenico , Ansaldi Nicoletta
Published: January 2024

Serum pepsinogen I (PG I) levels were determined by radioimmunoassay in 23 children with peptic ulcer disease (PUD) before and after treatment with ranitidine and in 44 children who were being investigated for recurrent abdominal pain. Upper gastrointestinal endoscopy was performed in all. No lesions were detected in controls, while 18 patients showed a duodenal ulcer, 4 had an antral ulcer, and 1 had both. An 8‐week course of ranitidine healed PUD in 93.5% of them, while long‐term (1–5 years) endoscopic follow‐up showed a 41.9% ulcer relapse rate after stopping treatment. Gastric acid secretion after pentagastrin stimulation [maximal acid output (MAO)] was tested in all controls and in 22 PUD patients: While controls had normal MAO values for their age. 65% of patients had a secretion above the normal range. No significant correlation was detected between serum PG I and MAO either in controls or in patients. Mean serum PG I concentrations were not significantly higher in the whole patient group than in controls, but PUD patients who relapsed after discontinuing ranitidine treatment had shown on admission significantly higher PG I levels when compared both with those who did not relapse and with controls. All patients who relapsed, but only 42.8% of those who did not, had a serum PG I concentration above the normal upper limit for a pediatric population (56.7 ng/ml). None of the PUD patients who had serum PG I levels under this limit relapsed. Our results suggest that pretreatment serum PG I levels in children with PUD may predict fairly accurately which will not relapse after attaining ulcer healing by a short‐term ranitidine course.
Indirect Test Weighing
Authors: Imong Stella M. , Jackson Dorothy A. , Woolridge M. W. , Wongsawasdii Lumduan , Ruckphaophunt Somsri , Amatayakul Kosin , Baum J. D.
Published: January 2024

Summary: Indirect test weighing (ITW), a new method for measuring nighttime breast milk intake, is based on separate weighings of the mother and infant at the start and end of the nighttime sleep period. All other incidental weight changes overnight are measured, so that the corrected infant's overnight weight gain and the mother's overnight weight loss are then accounted for by breast milk transfer and evaporative water loss (EWL) alone. The combined EWL is partitioned between mother and infant on the basis of metabolic body size (body weight raised to the power of 0.73). The infant's EWL is added onto the corrected overnight weight gain to give nighttime milk intake. A field validation study on 24 northern Thai infants, conducted in the subject's homes, in which ITW was compared with nighttime direct test weighing (DTW) on the same night, gives 95% confidence intervals for the method of × 39 g for a range of milk intakes of 77–344 g. Confidence intervals for estimates using feeding patterns alone, or multiplying 12 h intakes by a constant, range from × 104 to 180 g, indicating that these methods are insufficiently accurate for individual estimates.
Localized Intestinal Perforation Following Intravenous Indomethacin for Patent Ductus Arterious
Authors: Scholz Thomas D. , McGuinness Gail A.
Published: January 2024

We describe a very low birth weight infant given intravenous indomethacin for a symptomatic patent ductus arteriosus who subsequently developed a gastrointestinal perforation. Although this is a well‐known complication of enteral preparations. it has not been described with the intravenous form. Various mechanisms described in the literature by which the intravenous route of administration may compromise the bowel are presented. Although rare, gastrointestinal complications with intravenous indomethacin may become more prevalent with its increased use.
Metoclopramide Pharmacokinetics and Pharmacodynamics in Infants with Gastroesophageal Reflux
Authors: Kearns Gregory L. , Butler Helen L. , Lane Judy K. , Carchman Susan H. , Wright George J.
Published: January 2024

The pharmacokinetics and pharmacodynamics of metoclopramide oral solution were evaluated in six infants (0.9–5.4 months) with gastroesophageal reflux (GER) following the initial and 10th dose of 0.15 mg/kg administered every 6 h. Metoclopramide pharmacodynamics were assessed by pre‐ and post‐dose comparison of esophageal pH monitoring data and clinical evaluation of improvement in GER symptoms. A significant reduction in the number of episodes of pH <4 for greater than 5 min and the longest episode of GER was seen between the predose and 10th dose (steady‐state) evaluation periods. Four of the 6 patients had a 75% reduction in reflux time and demonstrated improvement in clinical symptoms by the 10th dose. Metoclopramide pharmacokinetics were best characterized by a one‐compartment open model following the first and 10th doses. Metoclopramide serum concentrations (mean ± SD) ranged from 56.2 ± 23.5 to 32.7 ± 13.2 ng/ml within a 6‐h dosing interval at steady state. There were no significant differences between the first versus tenth dose values for Tmax (2.0 ± 0.5 versus 2.2 ± 0.4 h), Kel (0.14 ± 0.03 versus 0.17 ± 0.04 h−1), Vdarea, (4.9 ± 0.4 versus 4.4 ± 0.6 L/kg), or clearance (0.66 ± 0.16 versus 0.67 ± 0.13 L/h/kg). The youngest subject (3.5 weeks) had a metoclopramide t1/2, of 23.1 h following initial dose, which decreased to 10.3 h at steady‐state. Care should be exercised in using the 0.15 mg/kg dose in infants less than 1 month of age as prolonged clearance may produce excessive serum concentrations.
Developmental Changes of Lactose Malabsorption in Normal Chinese Children
Authors: Ting Chi‐Wen , Hwang Betau , Wu Tzee‐Chung
Published: January 2024

The malabsorption of a physiological dose of lactose (0.5 g/kg body weight) was studied in 726 healthy Chinese children, ranging in age from 3 to 18 years, using the breath hydrogen test. The prevalence of lactose malabsorption was found to increase with age: it occurred in <15% of preschool‐age children and in — 45% of younger school‐age and 60% of older school‐age children. Approximately 70% of adolescents measured showed malabsorption. The critical period of change was from 6 to 7 years of age. with the lactose malabsorption rate rising abruptly from 12 to 43%. The incidence of lactose intolerance in teenagers and adolescents was 27 and 33%, respectively. The great majority of them had only dull abdominal pain. No case of lactose intolerance was seen in children <9 years of age. These results indicated that preschool Chinese children can absorb a physiological dose of lactose (equivalent to the average amount of milk consumed daily) without any adverse effects. In contrast, one half of school‐age children and two thirds of adolescents were malahsorbers.
Pancrease Gastroresistance
Authors: Lenaerts C. , Beraud N. , Castaigne J‐P.
Published: January 2024

In order to avoid inactivation in the stomach, pancreatic enzymes have been prepared as pH‐sensitive, enteric‐coated microspheres (Pancrease). An in vitro study was performed to evaluate the pH‐related dissolution of Pancrease and to confirm its resistance to gastric acidity. Two assay methods were used with three different batches of Pancrease: (a) Enzyme absorbency at 280 nm was measured at unit pH intervals from pH 1 to pH 8 and at 0.5 pH intervals from the start of dissolution to pH 8. (b) Proteolytic activity was measured at pH 6.8. Significant enzyme dissolution started at pH 5.5 and was maximal at pH 6.0. At pH 6.8, the pH of simulated intestinal fluid, dissolution was complete in less than 15 min. At pH 5.0, no dissolution occurred within the first 10 min and only 13% dissolution was observed after 2 h. At pH 7.0, 100% dissolution was seen within 10 min. Results of the two assay methods were comparable with all three enzyme batches assayed. This study confirmed the gastroresistance of Pancrease. Because of the enteric coating of Pancrease, liberation of enzymes occurs in the duodenum and jejunum, providing maximal enzymatic efficacy in exocrine pancreatic insufficiency.
In Vivo and In Vitro Studies of Microsphere Pancreatic Supplements
Authors: Littlewood J. M. , Kelleher J. , Walters M. P. , Johnson A. W.
Published: January 2024

Over the past 5 years, the Leeds Regional Cystic Fibrosis (CF) Unit has provided comprehensive annual assessments of CF patients that include dietary assessments and fat absorption studies. Enteric‐coated microsphere pancreatic enzyme preparations (micro‐sphere preparations) were compared to conventional enzymes as therapeutic agents for these patients. Presently in the U.K., two microsphere preparations are licensed for use and a further two products are likely to receive licenses in the near future. The success of these preparations is dependent on the ability of the microsphere coating to resist dissolution until the pH exceeds approximately 5.5 and thus prevent inactivation of lipase in the acid environment of the stomach. A study comparing Pancrex V Forte, a conventional enzyme preparation, to three microsphere preparations, Pancrease, Creon, and pancreatin Merck, confirmed the superiority of Pancrease and Creon over Pancrex V Forte and pancreatin Merck with regard to control of symptoms, and nitrogen and fat absorption. Because of differences in the physical characteristics of various microsphere preparations, the dissolution rates of Pancrease, Creon, and pancreatin Merck were compared in vitro. In aqueous buffers, striking differences among the preparations were seen at pH 5.5; whereas only 25% of available lipase was released from Creon, both Pancrease and pancreatin Merck show almost complete dissolution at this pH. Only at pH 6.5 and above do all three preparations show complete dissolution. In duodenal juice, as in aqueous buffers, lipase release from Creon takes place at a lower rate than with the other two preparations until pH 6.0 or higher is attained. Bile salts at pH 5.75 accelerate lipase release from Creon microspheres but not from those of Pancrease or pancreatin Merck. Albumin at pH 5.75 had no effect on the dissolution rate of any of the three microsphere preparations.
Malabsorption in Cystic Fibrosis
Authors: Bouquet J. , Sinaasappel M. , Neijens H. J.
Published: January 2024

Malabsorption of nutrients in cystic fibrosis (CF) has a multifactorial origin. The factors involved in malabsorption include malfunction of the exocrine pancreas and liver, bile acid metabolism, and disordered intestinal resorptive processes. Therapeutic measures presently employed are only partially effective. Improvement of fat malabsorption is attained by using a pancreatic enzyme supplement consisting of pH‐sensitive, enteric‐coated microspheres (microsphere preparations) that prevent enzyme degradation in the stomach and travel with the chyme to the small intestine. Microsphere preparations, however, do not improve bile salt deficiency. The detergent Tween‐80, given orally to simulate bile salt activity, does not improve fat absorption. The mucus viscosity is probably enhanced in the intestinal epithelium of CF patients and can be decreased by N‐acetylcysteine, which breaks down sulfide bonds. However, the addition of a high oral dose of this mucus solvent to pancreatin preparations does not improve fat absorption. Further studies on the disturbed intestinal resorptive mechanism seem warranted since recent investigations point to an abnormal chloride secretion as the primary defect in the intestinal epithelia of CF patients.
Human Lactoferrin Supplementation of Infant Formulas Increases Thymidine Incorporation into the DNA of Rat Crypt Cells
Authors: Nichols Buford L. , McKee Kathryn , Putman Margaret , Henry Joseph F. , Nichols Veda N.
Published: January 2024

Lactoferrin has been identified as the factor in human colostrum that accounts for the increased incorporation of thymidine into DNA in a rat crypt enterocyte bioassay. Commercially available infant formulas used in the refeeding of infants who have severe dietary intolerance associated with mucosal atrophy were tested in this bioassay. In contrast to human milk, no stimulation was observed with these formulas in the assay. All formulas inhibited basal thymidine incorporation. The degree of inhibition of the basal assay progressed from 14% with cow's‐milk formula to 30% with soy‐based formulas to 45% with hydrolyzed casein formulas. When the formulas were supplemented with lactoferrin to match the level of that in human milk, the result was a 35% relative increase in thymidine incorporation into DNA. The quantitative level of response was primarily influenced by the baseline inhibitions associated with the specific formulas. The most profound effect was observed with the hydrolyzed casein formula, when lactoferrin supplementation reversed the baseline inhibition but did not result in a response greater than that seen in control basal bioassays. The supplementation of infant formulas with lactoferrin improved the thymidine incorporation in rat crypt enterocytes; a response equivalent to that of human milk, however, would require a redesign of other formula components to reduce basal inhibition.
Immunohistochemical Study of Lymphoplasmacytic Infiltrate and Epithelial HLA‐DR Expression in the Rectal and Colonic Mucosae of Children with Ulcerative Colitis
Authors: Arató A. , Savilahti E. , Tainio V. ‐M. , Klemola T.
Published: January 2024

Lymphocyte subpopulations, plasma cells in the lamina propria, and the expression of HLA‐DR antigens on the epithelium of the rectal and colonic mucosae were studied in eight children with ulcerative colitis and 12 control subjects using a panel of monoclonal antisera and the peroxidase technique before any treatment and 3 months later (four patients). The numbers of intraepithelial lymphocytes were similar in specimens from patients and controls. The majority of these cells (on average, 73% in the patients and 84% in the controls) were mature CD3+ T cells; among them, CD8+ suppressor‐cytotoxic cells were preponderant. In both untreated and treated patients, the numbers of mature T cells in the rectal mucosae were supranormal (1,870 ± 205 cells/mm2, p <0.01 and 1,537 ± 214 cells/mm2, p < 0.05, respectively; controls, 1,105 ± 214 cells/mm2). In rectal specimens from untreated patients, the number of helper T (CD4+) cells was increased (1.094 ± 74 versus 801 ± 74 cells/mm2, p < 0.05); the same specimens had more B‐l‐positive (CD20+) B cells and pre‐B cells (122 ± 21 versus 71 ± 17 cells/mm2, p < 0.05). The number of IgG‐containing cells was significantly greater than in the controls (1,058 ± 263 versus 359 ± 64 cells/mm2, p < 0.01), and the commonest isotype in the plasma cells of patients was IgG. The number of IgE‐containing cells was also significantly elevated (230 ± 40 versus 95 ± 16 cells/mm2, p < 0.01). The numbers of IgA‐ and IgM‐containing cells were similar in patients and controls. Anti‐HLA‐DR serum stained neither the surface nor the crypt epithelial cells of 11 controls, whereas it did stain the surface and crypt epithelium in all five colonic specimens, and the surface epithelium of five of eight untreated patients and the crypt epithelium of six of eight untreated patients (for rectal specimens, p < 0.01 and p < 0.001 versus controls, respectively). Our findings suggest that maturation of B cells takes place locally in the intestinal mucosae of patients with ulcerative colitis, and a strong systemic type of humoral immune reaction develops in that location.
Diagnosis of Giardiasis in Infants and Children by Endoscopic Brush Cytology
Authors: Bendig Donald W.
Published: January 2024

Eight pediatric patients with presenting symptoms of chronic diarrhea, abdominal cramps, weight loss, and/or recurrent emesis were diagnosed as having giardiasis by duodenal brush cytology. All patients had at least three stool specimens examined for ova and parasites, which failed to reveal Giardia lamblia cysts or trophozoites. In each patient, the small intestinal mucosal biopsies as well failed to reveal giardia. No complications were encountered during any of the procedures. Duodenal brush cytology for giardiasis appears to be a valuable diagnostic adjunct potentially superior to stool examination as well as endoscopic grasp small bowel biopsy.