bluuebunny/crossref_metadata_2025 huggingface dataset:
State of the Art Vitamin K in Human Milk
Authors: Canfield Louise M. , Hopkinson Judy M.
Published: January 2024

Breast‐feeding is the sole source of vitamin K for most of the world's children and breast‐fed infants are at risk for vitamin K‐responsive hemorrhagic disease of the newborn (HDNB). Recent advances in high performance liquid chromatography methodology have made possible the first quantitative studies of vitamin K in human milk. Although much progress has been made, much remains to be done. Innovative improvements in methodology are needed, as detection of nanogram quantities of vitamin K in milk is at the limit of current methodology. Additional studies are needed over the lactation period. A better understanding of colostrum is needed with regard to other nutrients as well as vitamin K. Vitamin K in the milk of mothers who gave birth prematurely has not been measured. The significance of menaquinones as a vitamin K source to the infant is undetermined. The mechanism regulating vitamin K secretion into milk has not been investigated. The localization of vitamin K in milk is undetermined as is the relationship of vitamin K to other milk lipids. The effects of fat‐soluble vitamins in the diet on vitamin K concentrations in milk is unknown. The pharmacokinetics of vitamin K supplementation of mothers is particularly important in cultures where vitamin K is not routinely administered at birth. Finally, most critical at this point is our ignorance about the relationship of the maternal vitamin K status to the vitamin K status of the infant. As breast milk is the sole source of vitamin K for most of the world's infants, HDNB remains a very real threat to the health of infants and warrants concentrated study.
Early Prediction of Relapse During Gluten Challenge in Childhood Celiac Disease
Authors: Mayer Marina , Greco Luigi , Troncone Riccardo , Grimaldi Massimo , Pansa Giampiero
Published: January 2024

Thirty‐seven children, in whom celiac disease had been diagnosed because of flat mucosa on a gluten‐containing diet and recovery on a gluten‐free diet, were challenged with gluten powder, 10 g/day, in addition to an otherwise gluten‐free diet. A small intestinal biopsy was performed before the challenge; clinical symptoms, a 1‐h blood xylose test, and gliadin antibody measurement were used to establish the timing of the confirmatory biopsy. All but one case relapsed within 205 days (mode, 60 days). In no case was the relapse clinically evident. Raised levels of gliadin antibodies, a fall in xylose absorption, or both predicted the relapse in 37%, 7%, and 57% of cases, respectively. Evaluated individually, each test gave a considerable rate of false negative results. Discriminant coefficients produced for each test were used to compute a score that allowed the classification of patients into relapse/no relapse categories with a good degree of accuracy. The discriminant score rose sharply after only 15 days of challenge, indicating that it is possible to predict the relapse long before any clinical symptom appears.
The Effect of Short‐Term Refrigeration of Milk and Addition of Breast Milk Fortifier on the Delivery of Lipids During Tube Feeding
Authors: Lavine Margery , Clark Richard M.
Published: January 2024

Both storage of breast milk for 3 days at 4°C and the addition of breast milk fortifier containing lipid improved the delivery of lipids during continuous pump infusion. The percentage of the original lipid delivered after 8 h of pumping was 9, 25, 58, and 66% from the freshly collected milk, stored milk, freshly collected milk mixed with fortifier, and stored milk mixed with fortifier, respectively. Phospholipid and cholesterol levels also were measured. Their loss during delivery through the tube was similar to the loss of total lipid. While storage improved the delivery of lipids from breast milk, the additional lipid delivered from milk mixed with fortifier was primarily due to lipids from the fortifier.
Low Breast Milk Phosphorus Concentration in Familial Hypophosphatemia
Authors: Jonas Adam J. , Dominguez Barbara
Published: January 2024

We report breast milk mineral concentrations in a mother with familial hypophosphatemia that was untreated due to poor compliance with medical advice. Milk phosphorus content was extremely low despite normal maternal serum phosphorus concentrations. Milk calcium concentrations were only modestly decreased so that the ratio of calcium to phosphorus was greatly elevated. It appears that mothers with this disorder who breast feed should have their milk mineral content carefully monitored during lactation. If milk mineral content is abnormal despite maternal therapy with phosphorus and vitamin D, infants may require supplementation of mineral intake.
Heterogeneity in Intraepithelial Lymphocyte Subpopulations in Fetal and Postnatal Human Small Intestine
Authors: Spencer J. , Isaacson P. G. , Walker‐Smith J. A. , MacDonald T. T.
Published: January 2024

Intraepithelial lymphocytes (IEL) are present in fetal human small intestine from 14 weeks' gestation independent of exogenous dietary or microbial antigens. We have now studied the heterogeneity of IEL in 18–22‐week‐old human fetal intestine and in postnatal small intestine by single and sequential immunoenzyme histochemistry. In normal children and adults, there were 6–27 CD3 + IEL per 100 epithelial cells, whereas in fetal gut there were 3–5 CD3 + IEL per 100 epithelial cells. Postnatal intestine contained a population of CD3 ‐,7 +, non‐T cell IEL (7–25% of total CD7 + ). These cells were absent from fetal IEL but were occasionally seen in the fetal lamina propria. About 6% of CD3 + postnatal IEL were CD4 ‐,8 ‐. In contrast in the fetus, 35–70% of CD3 + IEL were subset negative. Since CD3 and CD7 are always co‐expressed on fetal IEL, 28–58% of fetal IEL were also CD7 +,4 ‐,8 ‐. Only about 20% of the CD3 + IEL expressed the γδ chains of the T cell antigen receptor. We conclude from these studies that CD3 +,4 ‐,8 ‐ T cells migrate to the epithelium in the absence of exogenous antigen and that there is a population of CD3 ‐,7 + non‐T cells in postnatal gut which is absent in fetal gut.
Relationship Between Results of Laboratory Tests and Inflammatory Activity Assessed by Colonoscopy in Children and Adolescents with Ulcerative Colitis and Crohn's Colitis
Authors: Holmquist Lars , Åhren Christer , Fällström Sven Petter
Published: January 2024

The relationship between the results of nine laboratory tests and inflammatory activity in the colon assessed macroscopically (macro) and histologically (hist) has been studied in 60 children and adolescents, 36 with ulcerative colitis (UC), and 24 with Crohn's colitis (CC). The mean duration of disease was 38 months. Eleven patients were newly diagnosed and not treated. Special attention was paid to severe and extensive colitis (SEC), in other words, moderate or severe inflammation in at least six of eight colon segments. A significant correlation was found between some laboratory parameters and the inflammatory activity of colonic mucosa. In UC, the following abnormal laboratory test results only occurred in SEC/macro: thrombocytosis, low serum albumin, and high serum orosomucoid. The combination of low serum iron and low or normal total iron binding capacity (TIBC) occurred in seven cases, six of whom had SEC/macro. Eleven of the 17 patients with SEC/macro had at least one of these four test results. SEC/hist was indicated only by thrombocytosis and high orosomucoid. In CC, a combination of low serum iron and low TIBC only occurred in SEC/macro. Thirteen of 36 patients with UC (36%) and four of 24 with CC (17%) had no abnormal test results.
Upper Small Intestinal Microflora in Diarrhea and Malnutrition in Nigerian Children
Authors: Omoike I. U. , Abiodun P. O.
Published: January 2024

The upper small intestinal microflora was determined quantitatively and qualitatively in a group of well‐nourished diarrhea‐free Nigerian children and compared with those of well‐nourished children with acute diarrhea and malnourished children with or without diarrhea. Intestinal aspirate was collected by intubation after a 6‐h fast. Well‐nourished children without diarrhea had flora consisting predominantly of gram‐positive cocci. Total bacterial counts were <105 organisms/ml; 18.2% of aspirates were sterile. In contrast, malnourished children with or without diarrhea had a wider microbial spectrum including Entcrobacteriaceae, Bacteroides, and Candida. Total bacterial counts were between 103 and 109 organisms/ml; none were sterile. In both well‐nourished and malnourished groups, no significant quantitative bacteriologic differences were found between patients who had diarrhea and those who did not. Candida and Pseudomonas were found more frequently in malnourished patients with diarrhea. In such diarrheal patients, Pseudomonas, Klebsiella, and enteropathogenic Escherichia coli grew as pure isolates in intestinal aspirates and could be detected concomitantly in their stools. These results establish the upper small intestinal flora of well‐nourished diarrhea‐free Nigerian children, confirm bacterial overgrowth as a feature of malnourished children with or without diarrhea, and suggest that Candida, Pseudomonas, and Klebsiella may account partly for the diarrhea seen in malnourished children.
Accuracy of Anorectal Manometry in the Diagnosis of Hirschsprung's Disease
Authors: Low Poh‐Sim , Quak Seng‐Hock , Prabhakaran K. , Joseph V. T. , Chiang Gilbert S. C. , Aiyathurai Eric J.
Published: January 2024

The value of anorectal manometry as a diagnostic tool for Hirschsprung's disease (HD) was assessed in 50 children presenting with chronic constipation. Anorectal manometric studies and rectal biopsy were performed on all children. Biopsy specimens were stained with hematoxylin and eosin and serial sections were examined for ganglion cells. Forty‐five children had concordant manometric and histologic results, 15 of whom were positive for HD and 30 negative. In five children, the results were discordant. Using histologic aganglionosis as the reference point for the final diagnosis of HD, the overall accuracy of anorectal manometry as a discriminative test was 90.0%. The sensitivity, specificity, and positive and negative predictive values of manometric studies for the diagnosis of HD were 0.79, 0.97, 0.94, and 0.88, respectively. Factors responsible for the inaccuracies of manometric studies are discussed.
Evolution of Some Biochemical Characteristics of the Intestinal Mucosa During the First Postnatal Weeks in C57 Mice. Effects of Thyroxine and Putrescine
Authors: Etienne‐Poncin A. , Dandrifosse G. , Forget P. , Lepoint A.
Published: January 2024

In C57 mice, during the third week after birth, there is a rapid conversion of the intestinal epithelium from fetal to mature adult status. Some characteristics (lactase, maltase, diamine oxidase, and sucrase activity; putrescine, spermine and spermidine concentrations; mitotic index) have been analyzed for the proximal, middle, and distal parts of the intestine in mice of different ages: 8, 15, 19, and 60 days. The most important observations recorded were as follows: (a) sucrase‐ and maltase‐specific activities as well as spermine and spermidine contents increased abruptly on the 19th postnatal day and then decreased; (b) decrease of lactase and diamine oxidase‐specific activity was recorded between the 15th and 19th postnatal days, (c) later, diamine oxidase‐specific activity increased, whereas putrescine content decreased in the proximal part of the intestine; and (d) mitotic index was not significantly different when estimated for the crypts on days 11 and 19. No similar variations of these biochemical parameters were observed over a period of 3 days when mice were injected with thyroxine on the 8th day or when mice received putrescine per os on the 9th day, as explained in the text. Only a slight but significant variation in sucrase‐ or maltase‐specific activity with thyroxine and a variation of the lactase or DAO‐specific activity of the distal part of the intestine with putrescine were recorded.
Cyclosporine Treatment of Fulminant Colitis
Authors: Hyams Jeffrey S. , Treem William R.
Published: January 2024

Improved treatment of individuals with severe inflammatory bowel disease with potent immunosuppressive medications such as 6‐mercaptopurine has been previously demonstrated. Unfortunately, the use of this medication in individuals with fulminant disease is often limited by its very slow onset of action. This has suggested a potential role for alternative immunosuppressive agents in selected patients with inflammatory bowel disease. We now describe the course of two adolescents with fulminant colitis who were being considered for colectomy and who were treated with oral cyclosporine. Each appeared to have a prompt response to this medication, and both entered into a complete clinical remission. A mild increase in serum creatinine and hirsutism were the only side effects noted. These observations suggest the need for controlled trials to define the potential role and long‐term toxicity of cyclosporine in individuals with severe inflammatory bowel disease.
Esophageal Aperistalsis Due to Reflux Esophagitis
Authors: Cucchiara S. , Staiano A. , Paone F. M. , Basile P.
Published: January 2024

Two small infants with gastroesophageal reflux disease and esophagitis are reported. Esophageal manometry revealed in both patients severe abnormalities consisting of aperistalsis and simultaneous low‐amplitude motor waves. In one of the patients, defective relaxation of lower esophageal sphincter was also noted. Short‐term intensive treatment with H2 antagonists resulted in symptomatic and endoscopic improvement as well as in manometric normalization. It is suggested that severe esophagitis may affect control mechanisms of esophageal motility, resulting in loss of coordination and decreased amplitude of contractions.
Clinical and Immunological Heterogeneity of Anti‐Liver‐Kidney Microsome Antibody‐Positive Autoimmune Hepatitis in Children
Authors: Codoñer‐Franch Pilar , Bernard Olivier , Maggiore Giuseppe , Alagille Daniel , Alvarez Fernando
Published: January 2024

A group of children with autoimmune hepatitis is characterized by the presence in their sera of anti‐liver‐kidney microsome antibody (LKMA) as defined by immunofluorescence. Immunoblot analysis of the sera of 21 such children using rat‐liver microsome total proteins as antigen allowed separation into three groups—group 1, whose sera recognized a 50 kDa protein; group 2, whose sera recognized a 66 kDa protein; and group 3, whose sera recognized both proteins. Patients with the anti‐66‐kDa reactivity more often displayed an acute onset of the disease, less signs of portal hypertension, better sensitivity to immunosuppressive therapy, and less tendency to relapse. They also displayed a lower titer of anti‐rat‐liver microsome antibody in enzyme‐linked immunosorbent assay (ELISA) and a serum reactivity with a rat‐liver cytosolic protein. These results (a) indicate that the LKMA‐positive autoimmune hepatitis of children is heterogeneous from both clinical and immunological view points, (b) suggest that children with anti‐66‐kDa reactivity could have a less severe disease than children with the 50‐kDa reactivity, and (c) indicate that immunoblot analysis should be added to ELISA and immunofluorescence studies to achieve better characterization of these patients.
Factors Influencing the Duration of Acute Diarrheal Disease in Infancy
Authors: Househam K. C. , Bowie D. C. , Mann M. D. , Bowie M. D.
Published: January 2024

The majority of episodes of acute infectious diarrhea in infancy are of relatively short duration. Prolongation of the diarrhea presents problems in management, deterioration of the infant's nutritional status, and an increased mortality. As part of a prospective study of the etiology of acute infectious diarrhea, some factors associated with the probability (more or less) of having self‐limiting disease have been identified. The well‐nourished infant over 6 months of age is more likely to have self‐limiting disease, whereas this outcome is least likely in the very young infant under 3 months of age, particularly if underweight for age. With the exception of Shigella, bacterial enteropathogens (Campylobacter fetus jejuni, Salmonella B, and certain enteropathogenic Escherichia coli types) were also associated with a decreased likelihood of self‐limiting disease. Rotavirus infection was associated with self‐limiting disease except in the infant under 3 months of age, where the probability of self‐limiting disease was decreased.
The Accuracy of Test Weighing for Preterm Infants
Authors: Meier Paula P. , Lysakowski T. Yvonne , Engstrom Janet L. , Kavanaugh Karen L. , Mangurten Henry H.
Published: January 2024

A series of recent studies has suggested that preterm infants are capable of breast feeding at weights <1,500 g. However, estimating intake during breast feeding for these small infants is important for safe clinical practice and valid research. The purpose of this study was to compare the accuracy of test weighing as an estimate of intake for preterm infants using two types of scales: a mechanical scale (Toledo) commonly used in many special care nurseries, and a new electronic scale (SMART; Olympic Medical). Fifty clinically stable preterm infants, weighing between 1,088 and 2,440 g (mean =1,599 g), who were clothed identically for all weights and feedings, were studied. Two experienced neonatal nurses (RN‐1 and RN‐2) collected the data. Before feeding, each infant was weighed once on each scale by each nurse; the order of nurse and scale was assigned randomly. Then, RN‐1 administered a prescribed volume of feeding. After feeding, RN‐2 weighed each infant twice on each scale; the order of scale was assigned randomly. RN‐1 was blind to postfeed weights, and RN‐2 was blind to actual volume of intake. Results indicated that differences between the actual and estimated volumes of intake were smaller for the electronic than for the mechanical scale on all measures. These findings suggest that test weighing with an electronic scale provides an accurate estimate of intake for preterm infants, and support the use of this instrument in clinical practice and research.
A Simple Technique to Feed Newborn Piglets
Authors: McClead Richard E. , Lentz Mary E. , Vieth Robert
Published: January 2024

We describe a simple and relatively inexpensive technique for feeding conventionally reared newborn pigs. The feeding system consists of a nipple assembly and an enteral feeding bag. Piglets are weaned at 4–10 h of age and are initially bottle‐fed a simulated sow's milk formula. After adaptation to the synthetic nipple and artificial milk, the piglets are placed on the semiautomatic feeding system. Piglets fed in this manner gain weight at rates comparable to sow‐reared animals or animals fed via completely automated systems.
Chylous Peritonitis in Children
Authors: Holcomb George W. , Gheissari Ali , Shorter Nicholas A. , O'Neill James A.
Published: January 2024

Sixty‐one cases of acute chylous peritonitis have been reported in all age groups in the surgical literature. Only seven of these cases have been noted in children. We report an additional case of a 7‐year‐old child who presented with acute peritoneal irritation and, at laparotomy, was found to have chyle in the peritoneal cavity and retroperitoneum. Proposed etiologies and management of this surgical entity are reviewed.
Varicella and Perforation of the Stomach
Authors: Paret G. , Yahav J. , Cohen O. , Nass D. S. , Barzilay Z.
Published: January 2024

Involvement of the gastrointestinal tract is rare in varicella. We report a previously healthy young girl with perforation of the stomach that appeared to be a complication of varicella. Varicella inclusion bodies were demonstrated at the site of gastric perforations. On surgery, an organoaxial volvulus of the stomach was demonstrated.
Caustic Ingestion and Esophageal Function
Authors: Cadranel S. , Di Lorenzo C. , Rodesch P. , Piepsz A. , Ham H. R.
Published: January 2024

The aim of the present study was to investigate esophageal motor function by means of krypton‐81 m esophageal transit scintigraphy and to compare the results with the functional and morphological data obtained by means of triple lumen manometry and endoscopy. In acute and subacute stages of the disease, all clinical, anatomical, and functional parameters were in good agreement, revealing significant impairment. In chronic stages, the severity of the dysphagia was not correlated to the importance of the residual stenosis. Conversely, 81mKr esophageal transit and manometric's findings were in good agreement with the clinical symptoms, during the entire follow‐up period ranging between 3 months to 7 years. The 81mKr test is undoubtedly the easiest and probably the most physiological technique currently available for long‐term functional evaluation of caustic esophagitis.
Regulation of Intestinal Ontogeny by Intraluminal Nutrients
Authors: Castillo Ricardo O. , Feng John J. , Stevenson David K. , Kerner John A. , Kwong Linda K.
Published: January 2024

Major events in gastrointestinal ontogeny occur in the infant rat in association with weaning, resulting in striking alterations in small intestinal structure and function. Although the dietary changes attendant to weaning are not essential for the initiation of these events, dietary nutrients have been shown to participate in the maturation of some intestinal parameters. In order to define more precisely the role of intraluminal nutrients in the regulation of small intestinal ontogeny, a longitudinal study was conducted using a unique animal model in which intraluminal nutrients were excluded from the intact maturing intestine in vivo throughout the entire weaning period without major compromise in nutritional status. The absence of intraluminal nutrients over the weaning period resulted in diminished lengthening and accretion of mucosal mass, suggesting a slower rate of intestinal growth. Lower mucosal DNA, protein, and mitotic indices in intestines of animals receiving no intraluminal nutrients suggested that the lack of intraluminal nutrients resulted in the blunting of the striking increases in cellular proliferation normally exhibited by the developing intestinal mucosa at this time. Maturation of intestinal lactase‐phlorizin hydrolase and maltase‐glucoamylase was not affected by the absence of intraluminal nutrients. Although the appearance of sucrase‐isomaltase was not altered by the absence of intraluminal nutrients, activity levels rose to only 50% of control levels. These data suggest that during this period of rapid intestinal maturation, intestinal growth is more dependent upon intraluminal nutrients than are the characteristic enzymic alterations normally expressed during this period. The lack of alteration in patterns of intestinal maturation in animals receiving intraluminal nutrients in elemental form compared with normally weaned animals suggests that intraluminal nutrients regulate intestinal maturation by mechanisms that do not depend upon nutrient form.
Alanine Stimulation of Water and Sodium Absorption in a Model of Secretory Diarrhea
Authors: Wapnir Raul A. , Zdanowicz Martin M. , Teichberg Saul , Lifshitz Fima
Published: January 2024

We investigated the effectiveness of L‐alanine (Ala) addition to oral hydration solutions (OHSs) during secretory conditions induced by ileal instillation of 10 m M theophylline in anesthetized rats using a perfusion procedure, and monitoring water and sodium transport. Ala was added to two hypotonic OHSs in which the sodium:glucose ratio was 2:1, and compared with the OHS recommended by the World Health Organization (WHO), which has a sodium:glucose ratio of 0.81:1. Theophylline had the expected secretory effect on water and sodium absorption in the WHO‐recommended OHS, and on sodium transport in a formula containing 60 m M sodium and 30 m M glucose. However, an OHS with 90 m M sodium and 45 m M glucose canceled the secretory effect of the‐ophylline and yielded a greater rate of net water absorption than the WHO formula. Addition to this solution of either 15 or 30 m M Ala enhanced water and sodium absorption of both control and theophylline‐treated rats. In the hypotonic OHS with 60 m M sodium and 30 m M glucose, Ala had little effect on both sodium and water transport. Therefore, the data support the view that Ala added to solutions with 90 m M sodium, containing sufficient glucose to maintain a sodium:glucose ratio of not less than 2:1, is most effective at compensating fluid and sodium losses under secretory conditions. Ala presumably exerts its sodium‐sparing effect because of its cotransport with sodium and the consequent water influx into the intestinal cells.
Evidence for a Pathogenic Role of ω6 Polyunsaturated Fatty Acid in the Cutaneous Manifestations of Biotin Deficiency
Authors: Mock Donald M.
Published: January 2024

Abnormalities in fatty acid composition have been detected in biotin deficiency in humans and in the rat. However, the pathogenetic role of these abnormalities, if any, in the cutaneous manifestations of biotin deficiency is not clear. In a nutrient interaction experiment, we tested the hypothesis that an abnormality of ω6 polyunsaturated fatty acid (PUFA) metabolism plays a pathogenetic role in the cutaneous manifestations. Five rats were fed an egg white diet that induces biotin deficiency; these rats developed the characteristic cutaneous abnormalities of biotin deficiency. Five additional rats were pair‐fed the egg white diet and received Liposyn [77% linoleic acid (18:2ω6)]; these rats did not develop the cutaneous manifestations of biotin deficiency. The two groups had similar decreases in the rates of urinary excretion of biotin, the serum concentrations of biotin, the amounts of biotin in liver, and the hepatic activities of two biotin‐dependent carboxylases; the two groups had similar increases in the rates of urinary excretion of 3‐hydroxyisovaleric acid. These observations provide evidence that (a) some abnormality in ω6 PUFA metabolism has a pathogenetic role in the cutaneous manifestations of biotin deficiency and (b) this pathogenetic role can not be explained as a difference in biotin nutritional status due to a biotin‐sparing effect of Liposyn.
Failure of Liver Transplantation in Wilson's Disease with Pulmonary Arteriovenous Shunting
Authors: Mews Catherine F. , Dorney Stuart F. , Sheil A. G. , Forbes David A. , Hill Richard E.
Published: January 2024

A 12‐year‐old boy with Wilson's disease developed exertional dyspnea, cyanosis, and finger clubbing 10 months after diagnosis. The hypoxemia was caused by arteriovenous shunting, demonstrated by radionuclide scanning and pulmonary arteriography. Orthotopic liver transplantation was performed after the development of severe hypoxemia. There was no apparent reversal of the intrapulmonary arteriovenous shunting and he died 10 days posttransplantation of multiple organ failure secondary to hypoxemia. Monitoring arterial oxygen saturation in children with cirrhosis is warranted since the presence of significant arteriovenous shunting may influence prognosis and decisions regarding liver transplantation.
Do Esophageal pH Monitoring Data Depend on Recording Equipment and Probes?
Authors: Vandenplas Yvan , Goyvaerts Harry , Helven Rudy
Published: January 2024

Esophageal pH monitoring data are influenced by numerous patient‐ and/or technical equipment‐related factors. In this study, data obtained with 10 pH recording devices of two different companies and 10 pH glassmicroelectrodes with an external reference electrode of one company, calibrated by different persons, were compared. Pearson correlation coefficients regarding the reflux index (the percentage of the investigation time with a pH < 4) ranged from 0.93 to 1.00. The lowest correlation coefficient (0.73) was obtained by comparing the number of episodes with a pH < 4 recorded with devices from different companies. These results suggest that differences in pH monitoring data recorded in comparable conditions with one type of pH electrode are irrelevant as far as clinical routine investigations are concerned. Data are not significantly influenced by the recording devices themselves, the age of the electrodes, or the skinpotential differences induced by the person calibrating the probes.
Sonographic Evaluation of Portal Hypertension in Children
Authors: Rabinowitz Simon S. , Norton Karen I. , Benkov Keith J. , Yeh Hsu‐Chong , Leleiko Neal S.
Published: January 2024

Portal hypertension, an expected consequence of cirrhosis, often has an insidious course in children. A noninvasive technique using abdominal sonography has been previously employed by several investigators as a means of diagnosing this condition. Their technique involves sonographically measuring the diameter of the lesser omentum, which increases as a result of engorged collaterals. In this communication, the method is successfully employed in two children, an infant in whom cirrhosis developed who eventually died from acquired immunodeficiency syndrome, and one whose portal hypertension was relieved after orthotopic liver transplantation. Although successful in these two instances, the theoretical basis on which this technique is based is critically evaluated. Anatomical relationships are reviewed that would caution sonographers who attempt to duplicate these studies. Modifications of the technique that will minimize potential false positive results are also discussed.
Treatment of Duodenocutaneous Fistula with Somatostatin Analog in a Child with Dermatomyositis
Authors: Inamdar Sarla , Slim Michel S. , Bostwick Howard , Godine Louise
Published: January 2024

A 6‐year‐old girl with juvenile dermatomyositis complicated by five duodenal perforations is described. The treatment consisted of suture closure of the perforations, reinforcement of the suture line with an omental graft, and adequate drainage of the closure site. The use of a somatostatin analog was successful in promptly arresting a leak from the duodenal perforations that had persisted for 3 months after the operation despite prolonged bowel rest and total parenteral nutrition. On follow‐up observation 2 months later, the patient had no abdominal complaints and was tolerating oral intake without problems.
Yersinia pseudotuberculosis
Authors: Rich Edward J. , McDonald Ruth A. , Christie Dennis L.
Published: January 2024

Yersinia pseudotuberculosis is an uncommon gastrointestinal pathogen, recognized as a causative agent in some cases of mesenteric adenitis. We report the clinical and endoscopic features of a case of a 6‐year‐old girl with abdominal pain and bloody diarrhea. Colonoscopic examination revealed aphthous ulcers in the right colon, and mucosal biopsy culture grew Yersinia pseudotuberculosis. This case documents right colonic ulcers and bloody diarrhea with Yersinia pseudotuberculosis.
Impact on Iron Status of Introducing Cow's Milk in the Second Six Months of Life
Authors: Penrod James C. , Anderson Kathryn , Acosta Phyllis B.
Published: January 2024

To determine the impact on iron status of introducing cow's milk (CM) into the diet during the second 6 months of life, nutrient intake was assessed and iron status measured in 100 infants. Nutrient intake for 40 of the 45 infants, age 8 to 13 months, fed CM as the primary beverage for at least 3 months prior to the study and for 45 of 55 infants the same age fed a milk‐based infant formula (FF) as the primary beverage for at least 3 months were assessed. All infants in the study were healthy, and the majority were taking no medications or supplements other than vitamins or fluoride for 3 weeks prior to the assessment. Blood drawn by peripheral venipuncture was analyzed by Coulter Counter for complete blood count; plasma albumin, iron, ferritin, transferrin saturation, and total iron‐binding capacity were measured in all infants. CM‐fed infants had significantly lower mean iron and vitamin C intakes, plasma albumin, transferrin saturation, and ferritin than did FF infants. The frequency of low plasma iron, low transferrin saturation, and low plasma ferritin was significantly greater in CM‐fed than in FF infants. The percentage of subjects with three or more abnormal iron indices was more than twice as great in CM‐fed infants (58%) as in FF infants (23%). Feeding infants iron‐fortified formula to 12 months of age appears to deter iron deficiency.
Modifications of Intestinal Permeability During Food Provocation Procedures in Pediatric Irritable Bowel Syndrome
Authors: Barau Edith , Dupont Christophe
Published: January 2024

An intestinal permeability test analyzing the differential urinary elimination of lactulose and mannitol orally ingested at the same dosage was carried out first in fasting condition, then combined with specific food ingestion, in 17 children with clinical symptoms of irritable bowel syndrome (IBS). Foods were selected based on a suggestive clinical history or on a positive radioaller‐gosorbent or prick test. Comparison of the results with those of a control population reported in a previous study showed that in nine IBS patients, specific food ingestion was associated with a modification of intestinal permeability. The nine children all had a personal and/or familial history of allergy and/or raised total IgE. The symptoms disappeared in the nine patients after food exclusion either alone (seven patients) or together with further treatment by cromolyn (two patients). We conclude that, at least in some children, symptoms of IBS may be related to food hypersensitivity.
Anti‐Liver‐Kidney Microsome Antibody‐Positive Autoimmune Hepatitis Presenting as Fulminant Liver Failure
Authors: Porta Gilda , da Costa Gayotto Luis Carlos , Alvarez Fernando
Published: January 2024

A 17‐month‐old girl presented with acute hepatitis, which took a fulminant course leading to death 2 months after onset. No known cause of fulminant liver failure could be identified. Postmortem examination of the liver showed massive multilobular necrosis and areas of severe piecemeal necrosis. A high level of total serum μ‐globulins raised the possibility of autoimmune hepatitis. Search for anti‐liver‐kidney microsome antibody in the patient's serum was positive by immunofluorescence and enzyme‐linked immunosorbent assay. Western blot analysis showed reactivity of the antibody with a 50‐kDa protein identical to that observed in children with autoimmune hepatitis. This patient's history strongly suggests that autoimmune hepatitis can present as fulminant liver failure in children. Early diagnosis in such a patient could lead to early immunosuppressive therapy.
A Study of the Relationship between Bile Salts, Bile Salt‐Stimulated Lipase, and Free Fatty Acids in Breast Milk
Authors: Forsyth J. S. , Donnet L. , Ross P. E.
Published: January 2024

Breast milk jaundice has been reported to be associated with increased lipase activity and elevated free fatty acid (FFA) concentrations within breast milk. We have previously shown that bile salts are present in small concentrations in breast milk and the aim of this study was to examine the relationship of bile salt‐stimulated lipase (BSSL) activity, FFA concentration, and bile salt concentration in milks of normal infants and the milk of infants with breast milk jaundice. Mothers of healthy newborn infants were recruited in the early newborn period and 42 provided breast milk samples at 2 weeks, 30 at 6 weeks, 16 at 10 weeks, and 13 at 14 weeks postnatally. We initially studied the effect of lactation on bile salts and found there was a significant decline in both cholate and chenodeoxycholate levels with duration of lactation (p < 0.05). There was also a significant fall in BSSL activity with duration of lactation (p < 0.05), but no correlation was found between BSSL activity and bile salt concentration. FFA concentrations were similar throughout lactation and were not related to either BSSL activity or bile salt concentration. There was a significant increase in the concentration of cholate and the cholate‐to‐chenodeoxy‐cholate ratio in the milks of 12 infants with breast milk jaundice compared with normal milks, the BSSL activity was similar and contrary to previous reports, the FFA concentration was not increased in the milks of infants with breast milk jaundice.
Variation in Macronutrients in Human Bank Milk
Authors: Michaelsen Kim Fleischer , Skafte Lisbeth , Badsberg Jens Henrik , Jørgensen Merete
Published: January 2024

Protein (P), fat (F), and carbohydrate (C) concentration in expressed human bank milk was determined by infrared analysis of 2,554 samples from 224 mothers. The mean contents of P, F, C, and energy (E, calculated from P, F, and C) were 9.0 g/L, 39.0 g/L, 71.9 g/L, and 696 kcal/L, respectively. There was a large variation in the concentration of energy‐yielding macronutrients. The contents of P. F, C, and E in the samples with the highest values (97.5 percentile) were 2.3‐, 4.8‐, 1.2‐, and 2.3‐fold, respectively, above the contents in the samples with the lowest values (2.5 percentile). The P content decreased exponentially during the 1st 8 months, followed by an increase during the following months. The F content decreased during the 1st 4 months, followed by an almost linear increase. The possible influence of different maternal characteristics on the macronutrient content of the milk was examined. The main results were as follows: the P and F contents increased slightly with increasing body mass index of the mother, the P content decreased with increasing amounts of milk delivered to the milk bank, and the F content was higher in mothers delivering large amounts of milk. By selecting incoming milk with a high P content, we have developed a “high‐protein” milk with a P content of about 12 g/L (true protein) and an E content of about 725 kcal/L. Thus, by continuous monitoring of macronutrient content in human bank milk it is possible to develop a “high‐protein” milk with sufficient P and E content to cover the needs of preterm infants with very low birth weights (< 1,500 g).
Prevention of Neonatal Necrotizing Enterocolitis
Authors: Carrion Vivien , Egan Edmund A.
Published: January 2024

Small premature infants are often hypochlorhydric, and frequently their stomachs are colonized by enteric, gram‐negative bacteria. We tested a hypothesis that gastric pH affected the colonization of the stomach with enteric bacteria and that this colonization was causally related to the risk or severity of necrotizing enterocolitis. A prospective, double‐blind study was conducted that compared a group of infants supplemented with 0.01–0.02 ml of 1 N HCl/ml of milk to a group with a similar supplement of water. Gastric pH, gastric enteric bacteria counts, and the incidence and severity of necrotizing enterocolitis were monitored. The median gastric pH of the HCl‐supplemented group was lower (3.0) than controls (4.0) throughout the study (p < 0.001). The gastric enteric bacterial colonization rate and the quantitative bacterial counts were strongly correlated with gastric pH over 4 (p < 0.001). Somatic growth rates in infants in the HCl‐supplemented group were equal to, or exceeded, those in the control group. There was 1 case of necrotizing entero‐colitis among the 34 infants in the HCl‐supplemented group and 8 cases among the 34 in the control group (p = 0.02). It appears that acidifying the feedings of small premature infants to a pH low enough to inhibit bacterial proliferation in the stomach significantly lowers the risk of necrotizing enterocolitis.
Growth Acceleration and Final Height After Treatment for Delayed Diagnosis of Celiac Disease
Authors: Bosio L. , Barera G. , Mistura L. , Sassi G. , Bianchi C.
Published: January 2024

The only presenting clinical feature of diagnosing celiac disease (CD) late may be short stature. At the start of treatment with a gluten‐free diet (GFD), celiac children show an accelerated growth rate. The real duration of catch‐up growth and influence of diet on the final stature has not yet been defined. In order to evaluate the effect of a GFD on growth parameters, 24 children diagnosed late with CD were studied at our center. During the period of diagnosis, weight, height standard deviation score (HSDS), weight and height velocities (WV and HV), bone age (BA), and pubertal stage were recorded. Predicted height (PH) according to the Tanner method, parental height, and target height (TH) were also evaluated at diagnosis. All patients initially presented because of short stature or retarded growth (100% of patients with height <5th percentile). Patients showed an increased HV and WV during the first 3 years on a GFD, with maximum growth velocity occurring during the first year, but the catch‐up growth was incomplete over 3 years (mean HSDS ± SD, −1.77 ± 0.6). Puberty began in all patients at a normal age. The 12 patients who completed pubertal development reached their target height, whatever the duration of the GFD. The final height (between the 1st and 25th percentile) seemed influenced mainly by familial characteristics; height was below the 3rd percentile in 31% of parents examined.
Serum Carnitine and Nutritional Status in Children Treated with Continuous Ambulatory Peritoneal Dialysis
Authors: Murakami Ryusuke , Momota Tetsuya , Yoshiya Kunihiko , Yoshikawa Norishige , Nakamura Hajime , Honda Masataka , Ito Hiroshi
Published: January 2024

The serum carnitine (total carnitine), total protein, amino acid, and triglyceride levels were determined in children on continuous ambulatory peritoneal dialysis (CAPD). Compared with levels in controls, serum carnitine levels were significantly decreased in patients on CAPD for more than 4 months, while those of patients on CAPD for 1–3 months were not decreased. Patients on CAPD for more than 4 months also showed lower serum total protein levels than in normal controls. The mean triglyceride levels in patients on CAPD for both 1–3 months and more than 4 months were higher than those in normal controls. Among the amino acids, the serum levels of tryptophan, isoleucine, leucine, tyrosine, valine, serine, and aspargine were significantly lower in patients treated with CAPD than in normal controls, whereas the levels of other amino acids were either increased or not changed. Isoleucine and leucine levels showed a strong correlation with serum carnitine. Our data suggest that malnutrition plays a role in the decrease of serum carnitine levels in patients receiving CAPD.
Congenital Short Gut, Malrotation, and Dysmotility of the Small Bowel
Authors: Kern I. B. , Leece A. , Bohane T.
Published: January 2024

A familial syndrome of congenital short small bowel, malrotation, and functional bowel obstruction is presented and illustrated in three male siblings with one long‐term survivor. Including the present three cases there have been 18 similar cases found in the literature. This disorder appears to be a sex‐linked recessive inheritance. Early barium meal and follow through in siblings of patients with this condition will detect malrotation that should be surgically corrected in order to prevent mid‐gut volvulus. Intravenous alimentation and early introduction of enteral feeding is important, not only to maintain nutrition but to encourage adaptation of the associated short and dysmotile bowel. These measures aim to improve the outcome of this frequently, but not invariably, fatal disorder.
Enterocolonic Fistula Due to Incarcerated Inguinal Hernia
Authors: Kneepkens C. M. F. , Bijleveld C. M. A. , Zwierstra R. P.
Published: January 2024

A 2 1/2‐year‐old boy presented severely underweight and with an extremely distended abdomen. He was born prematurely and at age 6 months had an incarcerated inguinal hernia, which had been treated conservatively. Laboratory investigations at the time of presentation showed evidence of bacterial overgrowth. Barium studies revealed a fistula between the jejunum and sigmoid colon. Resection of the fistula was followed by complete recovery. We suggest that the incarcerated hernia underlies this fistula. Until now, this series of events has not been published.
Influence of Cow's Milk Proteins and Gluten on Human Duodenal Mucosa in Organ Culture
Authors: Fluge Gjermund , Aksnes Lage
Published: January 2024

Forty‐five duodenal biopsies from 33 children and 3 adult patients were maintained in organ culture for 24 h and exposed to various cow's milk proteins and gluten. In 10 of 11 celiac patients with a flat duodenal mu‐cosa, and in 2 of 4 patients with partial villous atrophy, a significant reduction in the mean enterocyte height was found after in vitro gluten exposure, compared to culture in basic culture medium. Three patients had coexisting celiac disease and cow's milk protein intolerance. α‐Lactalbumin and β‐lactoglobulin exhibited toxic effects on flat biopsies from two of these patients, and casein was toxic in one. In 10 patients with cow's milk protein intolerance, a significant reduction in enterocyte height was noted in one case with gluten, and in three patients with casein and lactoglobulin, whereas lactalbumin did not affect the tissues. In seven control patients having a normal duodenal mucosa, no in vitro influences were noted, whereas in four patients with partial villous atrophy, a toxic reaction to gluten was seen in one and a reduced enterocyte height was seen after lactoglobulin exposure in another. In vitro toxicity induced by gluten corresponded well with the diagnosis of celiac disease, whereas toxic reactions to cow's milk proteins during organ culture were inconsistent in cow's milk intolerance, except for cases in which a marked enteropathy was documented.
Neonatal Hepatitis Syndrome with Paucity of Interlobular Bile Ducts in Cystic Fibrosis
Authors: Furuya Katryn N. , Roberts Eve A. , Canny Gerard J. , Phillips M. James
Published: January 2024

A male infant presenting with neonatal hepatitis syndrome, characterized by conjugated hyperbilirubinemia and very mild liver function test abnormalities, at 2 weeks of age was found to have no excretion of radioisotope into the intestinal tract on hepatobiliary scan. Liver biopsy revealed severe interlobular bile duct paucity. Other features of Alagille's syndrome were not present; other conditions frequently associated with interlobular bile duct paucity were also excluded. Subsequently, the infant was found to have cystic fibrosis. Cystic fibrosis is thus another disease that may be associated with paucity of interlobular bile ducts presenting as neonatal hepatitis syndrome, and this represents a different pathogenesis of cholestatic jaundice in neonates with cystic fibrosis besides those previously recognized.