bluuebunny/crossref_metadata_2025 huggingface dataset:
Neopterin as a Marker of C Hepatitis in Thalassaemia Major
Authors: Leonardi S. , Avola E. , Sciacca A. , Di Gregorio F. , Musumeci S.
Published: January 2024

The authors studied serum neopterin in 106 patients with β thalassaemia major. A good correlation was found between neopterin values and glutamic pyruvic transaminase (GPT) mean values of the last 6 months, whereas no correlation was found between neopterin values and some siderosis indexes (iron/body weight, total accumulated iron). A statistically significant correlation was found between neopterin values (>10 nM/L vs. < 10 nM/L) and histological liver findings (chronic hepatitis vs. siderosis). Neopterin values were also statistically different between splenectomized and not splenectomized patients. Moreover serum neopterin was higher in HCV‐Ab positive than in HCV‐Ab negative patients, and 91.6% of the HCV‐Ab positive group also showed histological signs of chronic hepatitis. These data suggest that increased serum neopterin might help to identify chronic C hepatitis in thalassaemic patients.
Severe Infantile Colic and Food Intolerance
Authors: Iacono Giuseppe , Carroccio Antomio , Montalto Giuseppe , Cavataio Francesca , Bragion Elisabetta , Lorello Domenico , Balsamo Vincenzo , Notarbartolo Alberto
Published: January 2024

To determine the relationship between infantile colic and cow's milk protein intolerance (CMPI) in formula‐fed infants, 70 infants (38 male, 32 female) were selected, with mean age 30.2 ± 21.4 days, with severe colic (duration of crying >4 h per day for 5 days per week). In 50 of the infants in the study group (71.4%) there was a remission of symptoms when cow's milk protein (CMP) was eliminated from the diet. Two successive challenges caused the return of symptoms in all these 50 infants. There was a positive anamnesis for atopy in 9 of 50 of the patients with CMP‐related colic and in 1 of 20 of those with non‐CMP‐related colic (p > 0.05). A follow‐up period of 18 months' mean duration showed that 22 of 50 (44%) of the infants with CMP‐related colic and 1 of 20 (5%) of those with non‐CMP‐related colic developed an overt alimentary intolerance (p < 0.02). We conclude that a considerable percentage of the infants with severe colic also have CMPI and that in these cases, dietetic treatment should be the first therapeutic approach
Clinical Trial of Modified Whole Milk, Lactose‐Hydrolyzed Whole Milk, or Cereal‐Milk Mixtures for the Dietary Management of Acute Childhood Diarrhea
Authors: Brown Kenneth H. , Perez Fernando , Gastañaduy Arturo S.
Published: January 2024

A randomized, double‐masked clinical trial was completed to compare the effects of four dietary regimens for the nutritional management of 116 Peruvian children between 3 and 24 months of age with acute diarrhea. Diets consisted of a modified whole milk formula (group M), a lactose‐hydrolyzed milk formula (HM), wheat noodles and whole milk (N‐M), or wheat noodles and lactose‐hydrolyzed whole milk (N‐HM), all offered in amounts up to 55 kcal/kg body weight/day for the first 2 days of treatment and up to 110 kcal/kg/day for 4 days thereafter. The clinical characteristics of the patients in each group were similar initially. Treatment failure rates in the two milk groups combined (M = 14.3%, HM = 20.0%) were greater than in the two noodle‐milk groups combined (N‐M = 3.4%, N‐HM = 3.4%), p = 0.03. The average stool outputs by children in both M groups (range 40–66 g/kg body weight per day on all study days) were consistently greater than those by children in both N‐M groups (range 29–50 g/kg/day). The differences by dietary group were statistically significant on days 3 and 4 (p < 0.04, analysis of variance). The estimated median durations of illness [and 95% confidence limits (CL)] in each milk group (M = 138 h, CL: 88–214; HM = 113 h, CL: 75–170) were significantly greater than in each noodle‐milk group (N‐M = 52 h, CL: 35–76; N‐HM = 67 h, CL: 45–100), p < 0.001–0.071. In this group of patients, noodle‐milk mixtures produced fewer treatment failures, lower fecal outputs, and shorter durations of diarrhea than did milk alone, regardless of the lactose contents of the respective milks or mixed diets. Small differences in intestinal absorption and changes in body weight by dietary group that were identified were of minor clinical importance during the short duration of study. Thus, the noodle‐milk diets employed during this study were safer than the milk diets for the dietary management of children with acute diarrhea.
Mucosal Immune Activation and Maturation of the Small Intestine at Weaning in the Hypothymic (Nude) Rat
Authors: Cummins A. G. , Thompson F. M. , Mayrhofer G.
Published: January 2024

Activation of the mucosal immune system peaks at weaning on days 21 and 22 of life in the rat. We have investigated activation in the gut associated lymphoid tissue and maturation of intestinal mucosa in hypothymic (nude) and in phenotypically normal heterozygous CBH rats at 22 days of life. Intestinal maturation, as assessed by villus area, crypt length, crypt cell production rate and disaccharidase activity, was similar in hypothymic and normal rats, and indices of mucosal immune function were elevated in both groups at this time. The proportion of mononuclear cells from the mesenteric lymph node expressing IL‐2R was 11% in heterozygous and 14% in hypothymic rats as determined by flow cytometry. Immunoperoxidase staining of MLN sections confirmed the presence of IL‐2R+ cells in the T‐dependent interfollicular areas. However, the number of T‐cells was considerably depleted in hypothymic rats. Intraepithelial lymphocyte counts and serum rat mucosal mast cell protease II concentrations were similar in the two groups, while counts of jejunal mucosal mast cells and eosinophils were paradoxically increased in hypothymic animals. As T lymphocyte function is thought to be impaired in hypothymic rats, the intact mucosal immune activity in hypothymic rats could be due to activation of intrinsic “thymic independent” T lymphocytes in hypothymic rats, or to engraftment with extrinsic maternal milk‐derived lymphocytes and their activation in the infant rat gut.
Pitfall in Diagnosis of Crohn's Disease in a Cystic Fibrosis Patient
Authors: Lerner Aaron , Gal Nahum , Mares Abraham J. , Maor Esther , Iancu Theodore C.
Published: January 2024

Cystic fibrosis (CF) and Crohn's disease may both present as failure to thrive and recurrent intestinal obstruction. Proper treatment and adequate nutrition may reverse these manifestations and improve the patient's quality of life. We describe a girl with CF who, despite appropriate management, failed to grow and had several episodes of bowel obstruction. After the additional diagnosis of Crohn's disease was reached, the patient improved on antiinflammatory and nutritional therapy. This patient illustrates the pitfall in the diagnosis of Crohn's disease in a CF patient due to the clinical overlap between the two conditions. We suggest that therapeutic failure in a chronic disease justifies additional diagnostic efforts resulting in a completion of diagnosis and significant changes in management.
Nutritional Issues in Pediatric Inflammatory Bowel Disease
Authors: Seidman E. , LeLeiko N. , Ament M. , Berman W. , Caplan D. , Evans J. , Kocoshis S. , Lake A. , Motil K. , Sutphen J. , Thomas D.
Published: January 2024

Malnutrition, characterized by weight loss, growth failure and micronutrient depletion, are prominent features of inflammatory bowel disease (IBD) in the pediatric age group. Accurate evaluation of the patient's nutritional status and appropriate nutritional support, whether enteral or parenteral, constitute integral parts of the management of the growing child with IBD. Over the past two decades, a number of studies have supported the potential use of nutritional therapy to induce remission and to control disease activity in symptomatic Crohn's disease. More recently, preliminary studies on the use of dietary supplements of marine‐oil‐derived omega‐3 fatty acids have also indicated a beneficial effect in IBD patients. In parallel with these clinical trials, scientific research has recently focused on the concept that specific dietary alterations can modulate the immune response. Components of the diet that may have particular relevance to mucosal immunity and the pathogenesis of IBD include polyunsaturated fatty acids, nucleotides, and amino acids such as glutamine and arginine. Future research in the interactions between specific nutrients and the immune system will likely increase our understanding of the causes of IBD, as well as enhance the development of novel nutritional therapies for IBD patients.
Alkaline Gastroesophageal Reflux in Infancy
Authors: Vandenplas Yvan , Loeb Helmuth
Published: January 2024

Alkaline gastroesophageal reflux is a rare disorder, although it has been suggested as a cause of esoph‐agitis. However, up to now, there exists no unequivocally accepted diagnostic method for alkaline reflux that can be routinely applied. “Normal ranges” of episodes of pH greater than 7.0–7.5 in asymptomatic as well as in symptomatic infants are proposed. In the asymptomatic infants (n = 83), the mean percentage of time the pH was > 7.0 was 1.3 ± 2.6, and the number of episodes in 24 h with a pH > 7.0 was 10.4 ± 16.4. In the symptomatic group (n = 60), including infants with chronic vomiting, the mean percentage of time the pH was greater than 7.0 was 0.15 ± 0.5, and the number of episodes with a pH greater than 7.0 was 2.8 ± 5.5. In all but six infants the percentage of time the pH was greater than 7.5 was less than 0.1. In three of four of these infants (endoscopy was refused by two parents) whose conditions exceeded the cut‐off limits, there was a histologically proven esophagitis. To evaluate the proposed “normal” ranges for episodes of pH greater than 7.0 and 7.5, 200 symptomatic children were included in a prospective study. Symptoms were repetitive vomiting (n = 110), excessive crying (n = 53), and chronic respiratory disease (n = 37). Esophagoscopy was performed in 18 babies (9%) because pH monitoring data exceeded the proposed limits for the percentage of time the pH was greater than 7.0. The percentage of time the pH was greater than 7.5 was increased in 13 (6.5%) infants. Esophagitis was proven by histologic study in nine infants (4.5% of the total group): in three of nine, reflux was “mixed” (acid and alkaline); in six of nine, reflux was alkaline. If data exceed the proposed limits of episodes with a pH greater than 7.5, alkaline reflux is likely to occur and should be further investigated (e.g., by double esophageal or combined gastric and esophageal pH monitoring) to confirm the diagnosis of alkaline reflux.
Impaired Intestinal Function in Symptomatic HIV Infection
Authors: Guarino A. , Tarallo L. , Guandalini S. , Troncone R. , Albano F. , Rubino A.
Published: January 2024

A longitudinal (10–22‐month) evaluation of intestinal symptoms and function was performed in five children with symptomatic human immunodeficiency virus (HIV) infection. All received cotrimoxazole, ketocon‐azole, and immunoglobulins. A search for enteric pathogens and intestinal function tests were repeatedly performed in all patients. Mild episodes of diarrhea were observed in two children. One had cow's milk protein intolerance. Giardia lamblia was found in an asymptomatic carrier. Evidence for impaired intestinal function was found in all patients. These consisted of positive D‐xylose and iron oral loads, increased steatorrhea, increased fecal excretion of α1antitrypsin, abnormal intestinal permeability, and increased food antibody levels. Our results suggest that severe diarrhea may be uncommon in children with HIV infection receiving antimicrobial prophylaxis, but that the intestinal function is frequently, and often markedly, impaired.
Effect of Cholesterol Deprivation on Piglet Small Intestine and Serum Lipids
Authors: Engelhardt Elizabeth L. , Sankar Mira , Wu‐Wang Chi Ying , Thomas M. Rita , Walker W. Randy , Neu Josef
Published: January 2024

Using the neonatal piglet, the effects of dietary cholesterol deprivation on growth, intestinal enzyme activity, intestinal and hepatic 3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase (HMG‐CoA reductase), and serum lipid were studied. Six litters of piglets were randomly assigned to one of two feeding regimens: restricted (800 ml of formula//24 h) versus unrestricted (1,200 ml of formula/24 h). Within litters, piglets were separated by sex, then randomly assigned to a formula containing low cholesterol (<2 mg/dl) or high cholesterol (145 mg/dl). Piglets were fed for 2 weeks. Male piglets in the restricted low cholesterol group gained significantly less weight per milliliter of formula than the restricted high cholesterol males. No effect was observed in the females. Microvillus membrane lactase activity was greater in males fed a high versus low cholesterol diet. Intestinal and hepatic HMG‐CoA reductase activities and serum lipid profiles showed a trend toward compensation for dietary cholesterol deprivation but did not differ statistically between the cholesterol‐fed versus ‐deprived groups. It is concluded that dietary cholesterol deprivation in the male neonatal pig causes alterations in growth, but no other statistically significant responses were detectable in this study
Nondairy‐Creamer‐Induced Kwashiorkor
Authors: Catto‐Smith Anthony G. , Barr Cameron , Fagan Joel E. , Parsons Howard G.
Published: January 2024

Failure to thrive may not be a result of organ disease, physical abuse, or intentional neglect. We describe an infant who developed kwashiorkor with a high‐fat, low‐protein, nondairy coffee creamer diet. The elimination diet was administered on the advice of a family friend for a facial rash. The child presented at 10 months of age with decreased weight for height, rash, hepatomegaly, edema, hypoproteinemia, hypoalbuminemia, anemia, hypoglycemia, and evidence of hepatic sequestration of lipids. A rapid recovery of biochemical abnormalities was evident on reinstitution of a full diet. An intellectual assessment at age 5 years showed normal results
A Pattern of Breath Hydrogen Excretion Suggesting Small Bowel Bacterial Overgrowth in Burmese Village Children
Authors: Pereira Stephen P. , Khin‐Maung‐U  , Bolin Terry D. , Duncombe Vic M. , Nyunt‐Nyunt‐Wai  , Myo‐Khin  , Linklater James M.
Published: January 2024

Breath hydrogen tests (BHTs) were performed on 340 Burmese village children aged 1–59 months. Normalization (correction of breath H2 values to a constant mean O2 level) eliminated the variations in H2 levels due to sleep, storage temperature, or duration of storage. After a 10 g lactulose test meal, 145 (42.6%) children produced <10 ppm H2 above basal values (non‐H2 producers). Of 195 H2 producers, a pattern of breath hydrogen excretion suggesting small bowel bacterial overgrowth (SBBO)—recognized as a transient peak at the 20, 40, or 60 min breath samples following the lactulose test meal and distinguishable from the later colonic peak— was observed in 53 (27.2%), being significantly more frequent in male children, and exhibiting an age‐prevalence pattern similar to that of acute childhood diarrhea in these villages. Diarrhea did not alter the state of H2 production (non‐H2 producers remain non‐H2 producers, and H2 producers remain H2 producers) although the magnitude of peak breath H2 changed.
Lecithin
Authors: Spear M. L. , Amr S. , Hamosh M. , Pereira G. R. , Corcoran L. G. , Hamosh P.
Published: January 2024

Plasma cholesterol and lecithin concentrations are regulated by the serum enzyme lecithin:cholesterol acyltransferase (LCAT). LCAT activity is low in cord blood of premature infants, suggesting that in these infants the hypercholesterolemia associated with Intralipid infusion might be due to low LCAT activity. The serum LCAT activity has not been quantitated in preterm infants receiving intravenous fat emulsions. We have therefore quantitated LCAT activity in eleven premature infants maintained on total parenteral nutrition (TPN). Ten infants were studied during the first 2 weeks after birth; they received daily infusions of Intralipid at a rate of 0.5–2.0 g/kg/day over 15 h. One infant received 3.8 g/kg/day during the second week. In addition to LCAT, serum apoprotein A1 (the cofactor of LCAT), cholesterol, triglycerides, and free fatty acids were quantitated. Blood specimens were taken before the start of the infusion and 15–45 min before its completion. The LCAT activity and apoprotein A1 concentrations remained, respectively, 21–24% and 30–35% of adult levels. However, serum cholesterol levels remained in the normal range during the fat infusion. It remains to be established whether low LCAT activity and apoprotein A1 levels are due to the administration of Intralipid (which lowers LCAT activity in rats), to the lack of enteral feedings, or to prematurity per se. Our data suggest that administration of Intralipid at a rate not exceeding 1–2 g/kg/day does not impair the clearing of Intralipid‐lecithin and the metabolism of cholesterol.
Oral Neurotensin Increases Gastrointestinal Transit in Suckling Rats
Authors: Tomomasa Takeshi , Itoh Ken , Hyman Paul E. , Kuroume Takayoshi
Published: January 2024

Several neuropeptides known to alter gastrointestinal motility are present in milk. We investigated the effect of gastric administration of neurotensin, bombesin, somatostatin, and vasoactive intestinal polypeptide on gastrointestinal motility in suckling rats. We gavage fed 7‐to 10‐day‐old rats with a meal consisting of 10 μl/g of body weight of 0.9% NaCl with 51Cr tracer and one of the peptides (0, 0.1, 10, and 1,000 ng/ml). We estimated the rates of gastric emptying and the small intestinal transit from the distribution of the radioactivity in the gut. Approximately one‐half of the counts emptied from the stomach in 15 min. Both gastric emptying and small intestinal transit were time dependent and were accelerated by metaclopramide and inhibited by butylscopolamine. Neurotensin 1 μg/ml accelerated the gastric emptying by 35% (p < 0.02). Small intestinal transit was also accelerated (p < 0.05). The other neuropeptides had no effect on gastric emptying and small intestinal transit. Neurotensin did not change either the gastric emptying or small intestinal transit in weaned rats, 40–50 days old, studied in the same manner. These data suggest that the intraluminal administration of neurotensin may increase gastrointestinal motility in suckling animals.
Steatocrit Test After a Standard Fatty Meal
Authors: Iacono Giuseppe , Carroccio Antonio , Montalto Giuseppe , Cavataio Francesca , Balsamo Vincenzo , Notarbartolo Alberto
Published: January 2024

The steatocrit test, a simple semiquantitative method for determining fat content in stool, was performed after a standard fatty meal to detect malabsorption in patients with celiac disease. Thirty‐seven children (mean age 2.6 ± 2.1 years) with total atrophy of the intestinal villi and 79 controls (mean age 3.5 ± 2.8 years) were studied. All subjects underwent a small‐bowel biopsy, a D‐xylose absorption test, a rapid triglyceride absorption test, and a steatocrit determination first on an uncontrolled diet and then again after a standard fatty meal. The steatocrit test after a fatty meal did not detect any false‐positive or false‐negative results, while the D‐xylose test showed two false‐negative and four false‐positive results, and the rapid triglyceride absorption test found two false‐negative and 23 false‐positive results. We conclude that the determination of steatocrit after a standard fatty meal is a useful, simple, and noninvasive test to identify patients with total intestinal villous atrophy.
Erosions of the Angelchik Prosthesis in Pediatric‐Sizeed Developmentally Disabled Patients
Authors: Jakaite Dalia , Gourley Glenn R. , Pellett John R.
Published: January 2024

We reviewed case histories of 40 pediatricsized developmentally disabled patients who had previously participated in a study comparing the Nissen fundoplication with the Angelchik prosthesis for the surgical treatment of severe gastroesophageal reflux. Five of these patients had experienced erosions of the prosthesis into the gastrointestinal tract. These erosions were diagnosed between 2 years and 2 years 8 months following surgical insertion of the device. Erosions were associated with a variety of symptoms including vomiting, increasing discomfort, melena, anemia, coffee ground gastric residuals, and repeated small bowel obstructions. In no case was erosion associated with the development of peritonitis. Despite the documented advantages of the Angelchik prosthesis, the 12.5% erosion rate in this patient population is excessive. We recommend that use of the Angelchik prosthesis is not advisable in pediatric‐sized developmentally disabled patients.
Lactose in Blood in Nonpregnant, Pregnant, and Lactating Women
Authors: Arthur Peter G. , Kent Jacqueline C. , Potter Julia M. , Hartmann Peter E.
Published: January 2024

Summary: Lactose synthesized in the mammary gland can pass into the bloodstream by either a paracellular or transcellular pathway. In nonpregnant, nonlactating women, the concentration of lactose in the blood plasma was 1.5 ± 0.1 μM (mean ± SEM) in 9 women and undetectable in another 11 women. During pregnancy, this concentration was 3.7 ± 0.4 μM at 10–21 weeks of gestation, with an increase to 8.7 ± 1.8 μM by 38–40 weeks of gestation. At the initiation of lactation, the concentration of lactose peaked 3–5 days after birth, with a mean peak concentration of 75 ± 18 μM, and then decreased to 30 ± 8 μM when lactation was well established at 6 weeks after birth. These findings suggest that the mammary glands are synthetically active by the beginning of the second trimester of pregnancy and reach maximum synthetic capacity soon after birth. Measurement of concentrations of lactose in the blood plasma during pregnancy and lactation may allow an assessment of the successful initiation of both lactogenesis I and II.
Immunogenicity Evaluation of Protein Hydrolysates for Hypoallergenic Infant Formulae
Authors: Cordle Christopher T. , Mahmoud Mohamed I. , Moore Victor
Published: January 2024

Summary: Casein and soy protein were enzymatically hydrolyzed for potential use in a hypoallergenic infant formula. To assess the relative immunoreactivity of the hydrolysates, rabbits were immunized with either the intact proteins or the protein hydrolysates using a vigorous immunization protocol. Serum samples were tested using ELISA methods that quantitated IgG antibody specific for the immunizing protein hydrolysates and the corresponding intact proteins. The results showed that the protein hydrolysates had substantially lower immunogenicity than the parent proteins. Also, antibody specific for the parent protein showed very low cross‐reactivity with the hydrolysates. Both of the protein hydrolysates seem to be promising candidates for use in hypoallergenic infant feeding systems.
Coincidence of Congenital Toxoplasmosis and Biliary Atresia in an Infant
Authors: Glassman Mark S. , Dellalzedah Sallah , Beneck Deborah , Seashore John H.
Published: January 2024

Summary: A 4‐week‐old infant presenting with neonatal cholestasis was found to have congenital toxoplasmosis and biliary atresia. This is the first patient in which their coincidence is reported. Because biliary atresia can coexist with either congenital infection or inborn errors of metabolism, evaluation for an obstructive etiology of jaundice in infants with a recognized cause of intrahepatic cholestasis is necessary.
The Oxidation of 3‐Hydroxybutyrate in Developing Rat Jejunum
Authors: Kimura Robert E. , Ilich Jasminka Z.
Published: January 2024

Ketone bodies and glutamine are the primary oxidative substrates in the intestine of fasting adult rats. Because suckling rats consume the majority of their calories in the form of lipid and as a result have elevated blood ketone concentrations similar to fasting adult rats, we examined the role of ketone oxidation as a source of energy in the intestine of suckling rats. In suckling rats the rate of [3–14C]DL‐3‐hydroxybutyrate oxidation in intestinal tissue slices, enterocytes, and intestinal mitochondria was 0.15 ± 0.01 nmol/h/mg wet wt, 8.6 ± 1.1 nmol/h/mg protein and 8.3 ± 1.3 nmol/h/mg protein, respectively. In suckling rats the rate of intestinal oxidation of [3–14C]DL‐3‐hydroxybutyrate was 75% lower than the rate in weaned rats in intestinal tissue slices, 55% lower in enterocytes, and 50% lower in intestinal mitochondria. The activity of two enzymes involved in ketone oxidation, 3‐hydroxybutyrate dehydrogenase, and acetoacetyl‐CoA thiolase was 38% and 55% higher in intestinal homogenates of suckling rats compared with adult rats. In contrast, 3‐oxoacid CoA‐transferase activity, an enzyme also involved in 3‐hydroxybutyrate oxidation, was one third that of adults. These studies indicate that intestinal oxidation of 3‐HB occurs in suckling rat pups, but is lower than the rate of oxidation in the intestine of weaned rats.
Determining Esophageal Length from Crown‐Rump Length
Authors: Putnam Philip E. , Orenstein Susan R.
Published: January 2024

Since esophageal length varies linearly with height, intraluminal pH monitoring can be performed at a position within the esophagus that is determined by an equation. Alternatively, pH probes can be positioned under fluoroscopic guidance, though no radiographic landmarks indicate the position that is 87% of esophageal length (where the monitoring is usually accomplished). Our aims were to determine whether a relationship might exist between crown‐rump length and esophageal length, for use in patients in whom height is difficult or inappropriate to measure, and to determine whether the mid‐right atrium can be used as a radiographic landmark in fluoroscopic pH probe placement. Height, crown‐rump length, and distance from the suprasternal notch to the left anterior superior iliac spine were measured in 65 consecutive children undergoing 24‐h pH monitoring. As the pH probe was inserted under fluoroscopy, distances from the nose to diaphragm and mid‐right atrium were determined. Equations were derived by simple linear regression to describe the relationships between each of the body measurements and esophageal length. There is excellent correlation between crown‐rump length and the distances from the nose to diaphragm and to mid‐right atrium. The mid‐right atrium corresponds to 87% of the nose to diaphragm distance in many patients.
The Intestinal Absorption of 3‐O‐Methyl‐D‐glucose in Methotrexate‐Treated Rats
Authors: Erdman Steven H. , Hart Michael H. , Park Jung H. Y. , Vanderhoof Jon A.
Published: January 2024

The in vivo absorption of 3–0‐methyl‐D‐glucose (3MG) as a marker of intestinal function has not been studied in an animal model. We evaluated the use of 3MG as a marker of intestinal absorption when given en‐terally to rats recovering from small bowel mucosal injury induced by methotrexate (MTX). Radiolabeled 3MG was administered into the duodenum of control (CON) and MTX‐treated rats and blood samples were obtained at specified intervals. Mucosal permeability was also assessed using radiolabeled mannitol and polyethylene glycol 900 (PEG). Concentration time points were plotted, and area under the curve was calculated as an approximation of absorbed dose. Mucosal weight, maltase activity, and protein content were determined on mucosal scrapings. During the acute phase (day 5), 3MG absorption and maltase‐specific activity were significantly decreased in the MTX group when compared to the CON group (p < 0.001). The MTX group showed a trend toward greater permeability to mannitol when compared to the CON group; however, this was not statistically significant. Mucosal permeability to PEG was similar in both groups. During a later stage in the recovery process (day 12), the area under the curve calculations for 3MG absorption were the same for both CON and MTX animals, with maltase activity in the MTX group recovering to control values. Changes in 3MG absorption paralleled total maltase activities following severe injury. These results suggest that the combined active and passive transport of 3MG in vivo could be of use as a marker of intestinal absorption in states where the small intestine has sustained major damage resulting in compromised absorption as well as brush border digestion.
Calcium Metabolism in Children During Long‐Term Total Parenteral Nutrition
Authors: Larchet Michel , Garabédian Michèle , Bourdeau Agnes , Gorski Anne‐Marie , Goulet Olivier , Ricour Claude
Published: January 2024

Hypercalciuria and bone disease are frequently associated with total parenteral nutrition (TPN) in children and adults. The aim of this study was to assess the influence of calcium, phosphorus, and vitamin D intakes on hypercalciuria. We observed seven children aged 4–13 years receiving home cyclic TPN for 4 consecutive years. Calcium and phosphorus intakes, constant during the 1st year, were reduced during the last 3 years to 50 and 30% of the initial intakes, and vitamin D was stopped during the 3rd and the 4th years. All children had hypercalciuria and one of them had acute painful osteopenia and nephrocalcinosis at the beginning of the study. Hypercalciuria was corrected and painful bone disease did not occur during the three following years, with TPN daily intakes of calcium, 0.35 mmol/kg, and phosphorus, 0.70 mmol/kg. Cessation of vitamin D administration during 48 months led to no further decrease in calciuria nor to the occurrence of clinical or biological signs of vitamin D deficiency. However, we hypothesize that excessive vitamin D intake may have facilitated the occurrence of the TPN‐related bone disease in one patient and should be avoided. The possible role of parenteral aluminum loading is also discussed.
Nutritional Rehabilitation Increases Resting Energy Expenditure Without Affecting Protein Turnover in Patients with Cystic Fibrosis
Authors: Vaisman Nachum , Clarke Ruth , Pencharz Paul B.
Published: January 2024

The effect of nutritional rehabilitation on several nutritional parameters was studied in eight malnourished patients with cystic fibrosis during the first year after gastrostomy tube insertion. Body composition was studied by fat skinfold measurements and by total body potassium count, resting energy expenditure (REE) by indirect calorimeter, and protein turnover by a single dose administration of [15N]glycine. Weight gain was accompanied by a significant increase in the various body compartments: weight 41.4 ± 7.5 to 46.1 ± 8.4 kg (p < 0.0002), fat body mass 5.6 ± 2.8 to 7.7 ± 3.4 kg (p < 0.005) and fat‐free body mass (FFBM) 35.7 ± 6.3 to 38.3 ± 6.9 kg (p < 0.0003). REE increased significantly per kg of body weight as well as per kg of FFBM. No significant differences were found in protein turnover during reefed‐ing nor in pulmonary function. We conclude that nutritional support restores body composition, but is accompanied by an increase in energy expenditure. This increase could not be attributed to increased protein turnover
Effects of Short‐Term Growth Hormone Therapy in Rats Undergoing 75% Small Intestinal Resection
Authors: Shulman Dorothy I , Hu Cheng Shih , Duckett Gregory , Lavallee‐Grey Muriel
Published: January 2024

Thirty 250‐g male rats underwent 75% small intestinal resection and received s.c. injections of water [short gut (SG)—control], human growth hormone (hGH) at 0.1 mg/kg/dose [SG‐low‐dose (LD) GH], or hGH at 1.0 mg/kg/dose [SG‐high‐dose (HD) GH] every other day for 28 days. Ten additional rats underwent sham operation and received water injections (sham control). After 28 days, SG‐control and SG‐LDGH rats weighed significantly less than the sham control group; the mean weight of the SG‐HDGH group was not different from other groups. Weight per centimeter of the distal ileum was greater in all SG groups compared to the sham control group, and was greater in the SG‐HDGH than in the SG‐control group. Mean mucosal height of the distal ileum was greater in both SG groups receiving GH than in sham controls. No differences in ileal mucosal DNA content or ileal insulin‐like growth factor‐1 (IGF‐1) content were identified between groups. Mucosal sucrase activity was not increased in hGH‐treated rats. Serum calcium and phosphorus concentrations were higher in SG‐HDGH rats than in SG‐control animals. HDGH increased body weight, distal ileal weight/cm, and mucosal height in rats undergoing 75% small bowel resection. A trend toward normalization of serum calcium, phosphorus, and plasma IGF‐1 concentrations was also observed. Further longer‐term studies are indicated to learn if GH has a beneficial effect upon gut growth and function in the SG syndrome.
Bilirubin Uridine Diphosphate Glucuronosyltransferase Hepatic Activity in Jaundice Associated with Congenital Hypothyroidism
Authors: Labrune P. , Myara A. , Huguet P. , Folliot A. , Vial M. , Trivin F. , Odievre M.
Published: January 2024

Hepatic bilirubin uridine diphosphate glucuronosyltransferase activity was assayed in an infant with prolonged jaundice and congenital hypothyroidism before thyroid therapy. This activity was nil, suggesting a possible delayed maturation of the enzyme. Although further studies will be necessary to confirm this hypothesis, prolonged jaundice associated with congenital hypothyroidism may be due to a delayed maturation of the hepatic glucuronidation of bilirubin.
Transient Elevation of Urinary Catecholamine Excretion and Cholestatic Liver Disease in a Neonate With Hypopituitarism
Authors: Krähe J. , Hauffa B. P. , Wollmann H. A. , Käser H.
Published: January 2024

Hypothalamic hypopituitarism was diagnosed in a 3‐month‐old boy presenting with cholestatic liver disease, which resolved 5 weeks after the start of replacement therapy with hydrocortisone and human growth hormone. Clinical and pathohistological features of liver disease associated with neonatal hypopituitarism in this patient are compared to those of patients reviewed from the literature. Urinary excretion of dopa and 3‐methoxytyramine but not of other catecholamine metabolites was elevated during cholestatic liver disease. 3‐Methoxy‐tyramine excretion normalized when cholestasis resolved. Altered hepatic metabolism of catecholamines due to growth hormone and Cortisol deficiency may explain this observation.
Eicosanoids Content in Small Intestinal Mucosa of Children with Celiac Disease
Authors: Branski D. , Hurvitz H. , Halevi A. , Klar A. , Navon P. , Weidenfeld J.
Published: January 2024

Celiac disease (CD) is characterized by diarrhea, growth retardation, and weight loss in genetically susceptible subjects on a gluten‐containing diet. The exact pathogenesis of CD is still obscure, but it is considered to be immunologically mediated. We have previously shown elevated prostaglandin E2 (PGE2) and thromboxane B2 (TxB2) content in small intestinal mucosa obtained from active celiac children. In the present study, we found significantly elevated PGE2, leukotriene B4 (LTB4), and leukotrienes C4,D4, and E4 (LTC4D4E4) content in small bowel mucosa from children suffering from CD on a gluten‐containing diet in comparison to control subjects. PGE2 was 25,278 ± 7,761 vs. 4,478 ± 426 pg/mg of protein (mean ± SEM), respectively. LTB4 was 8,807 ± 3,706 vs. 403 ± 63 pg/mg of protein (mean ± SEM), respectively. LTC4D4E4 was 15,369 ± 4,085 vs. 2,998 ± 279 pg/mg of protein (mean ± SEM), respectively. We conclude that the elevated content of arachidonic acid metabolic products via cyclooxygenase and lipoxygenase pathways may contribute to the diarrhea and may be involved in the pathogenesis of mucosal injury.
Evaluation of Reflux Episodes During Simultaneous Esophageal pH Monitoring and Gastroesophageal Reflux Scintigraphy in Children
Authors: Vandenplas Y. , Derde M. P. , Piepsz A.
Published: January 2024

Gastroesophageal pH monitoring and reflux scintigraphy were simultaneously performed in 65 children, who were being investigated for suspected gastroesophageal reflux disease. The aim of the study was to compare, peak per peak, the information provided by the two techniques during a 1‐h simultaneous‐recording period. During this period, 123 reflux episodes were recorded with both techniques, but only six occurred simultaneously. Significantly more reflux episodes were recorded on scintigraphy (n = 88; p < 0.05), particularly during the first half‐hour period (n = 62), if compared with the number of pH drops greater than 1 unit, even at pH levels higher than 4 (n = 41; p < 0.05). It is concluded that the two techniques explore differently the reflux phenomenon.
Plasma and Gastric Juice Levels of Prostaglandins in Critically Ill Children
Authors: Lopez‐Herce Jesus , Codoceo Rosa , Delgado Miguel A. , Elola Pilar , Dorao Paloma , Benito Consuelo , Ruza Francisco
Published: January 2024

The levels of prostaglandin (PG) E2 and 6‐keto‐PGF1α (stable metabolite of prostacyclin) in plasma and gastric juice were determined in 113 critically ill children and adolescent, and compared to those registered in a plasma control group of 24 children and a gastric juice control group of 15. The gastric juice concentration of PGE2 is our patients [9.2 × 3.1 (SEM) pg/ml] was significantly lower (p = 0.001) than in the control group [81.1 × 18.1 (SEM) pg/ml]. There were no differences in plasma levels of PGE2 and plasma gastric juice levels of 6‐ketoPGF1α between the patients and the control groups. Children who died had lower plasma levels of PGE2 [6.2 × 2.2 (SEM) pg/ml] and gastric juice levels of PGE2 [2.3 × 0.8 (SEM) pg/ml] than the survivors (p < 0.05). The gastric juice concentration of PGE2 was also lower in children who suffered important upper gastrointestinal bleeding, although the difference did not reach statistical significance.
Hypertrophic Gastropathy with Transient Sessile Polyps
Authors: Pesce F. , Barabino A. , Dufour C. , Caffarena P. E. , Callea R F. , Gatti R.
Published: January 2024

We report an 8‐year‐old boy with hypertrophic gastropathy (HG) associated with duodenal Giardia lamblia infestation. The follow‐up was complicated by the development of gastric polyps at the site of previous biopsies that spontaneously disappeared within 15 months. Despite the histological similarity, the different course between Ménétrier's disease (MD) in adults (chronic, with frequent development of sessile or pedunculate polyps) and HG (uncomplicated and usually spontaneously resolving) suggests a different pathogenesis. Viral (cytomegalovirus) and bacterial (Helicobacter pylori) infections have been described in association with HG and they could play an important pathogenetic role. The term HG better defines the childhood disease in which a conservative management is recommended.
Effect of Diosmectite on Intestinal Permeability Changes in Acute Diarrhea
Authors: Dupont C. , Moreno J. L. , Barau E. , Bargaoui K. , Thiane E. , Plique O.
Published: January 2024

The effect of diosmectite on intestinal permeability changes in acute diarrhea was measured during a double‐blind placebo‐controlled trial carried out in 59 Gabonese children aged 5–35 months. Intestinal permeability tests (IPTs), measuring the urinary elimination of orally administered lactulose and mannitol at a dosage of 1 g/10 kg each, were performed during the morning following admission and repeated 2 days later after treatment by diosmectite or placebo. During the first IPT, urine volume and lactulose and mannitol urinary recoveries were comparable in the diosmectite and in the placebo groups: 50 vs. 35.5 ml (median; p = 0.21), 1.01 vs. 1.27% (p = 0.35), and 2.20 vs. 2.87% (p = 0.12). As a result, the lactulose/mannitol (L/M) ratio was similar in the two groups: 44.44 vs. 35.33% (p = 0.98). During the second IPT, the urinary lactulose recovery decreased similarly in both groups (‐0.18 vs. −0.29%; p = 0.76), whereas the urinary mannitol recovery exhibited opposite variations, the increase in the diosmectite group (+1.43%) contrasting significantly with the decrease in the placebo group (‐0.47%; p = 0.01). When comparing the first and the second IPT, the decrease of the L/M ratio was significant in the diosmectite group (44.44 vs. 28.32%; p = 0.02) and not in the placebo group (35.33 vs. 48.23%; p = 0.91). During gastroenteritis, diosmectite appears to enhance absorption of mannitol, a marker of intestinal absorptive area.
Helicobacter pylori Infection in Children
Authors: Prieto G. , Polanco Isabel , Larrauri J. , Rota Lucia , Lama Rosa , Carrasco Sira
Published: January 2024

We have assessed 270 consecutive patients (age range 0.8–20 years) referred for endoscopic study because of abdominal pain during 32 months. Helicobacter pylori (HP) was detected by culture in 91 cases (33.7%). HP colonization increased significantly with age (p < 0.01). Nine patients <5 years of age were colonized by HP. A previous history of peptic ulcer disease in first‐degree relatives was significantly more frequent in the HP‐positive group (p < 0.001). The frequency of HP positiveness as related to diagnosis was: normal, 3.3%; non‐active chronic gastritis, 100%; active chronic gastritis, 97.2%; gastric ulcer, 75%; and duodenal ulcer, 90.9% (p < 0.001). Endoscopic nodular antritis was a frequent (67%) and specific finding; this presence was associated with that of lymphoid follicles in the histopathological study. Signs of histological activity were observed in 55.9% of the HP‐positive patients. The histological colonization by HP was assessed semiquantitatively, and a significantly greater HP colonization score was observed in patients with signs of histological activity (p < 0.001). A significant correlation was found between HP colonization score and histological score (rs = 0.574), with a significant association between the degree of HP colonization and the histologic categories (p < 0.001). The present study suggests a pathogenic role of HP in the development of gastroduodenal disease in children.
1β‐Hydroxylated Bile Acids in the Urine of Healthy Neonates
Authors: Obinata K. , Nittono H. , Yabuta K. , Mahara R. , Tohma M.
Published: January 2024

In order to clarify the metabolism of bile acids in neonates, 1β‐hydroxylated bile acids in the urine of healthy newborns were examined by gas chromatogra‐phy‐mass spectrometry. The results showed that the percentage of total lβ‐hydroxylated bile acids, 3β,12a‐dihydroxy‐5‐cholenoic acid and hyocholic acid in neonates was significantly higher than in older children. The ratio of lβ‐hydroxylated bile acids to their comparable primary bile acids was also higher in neonates than in older children. These results suggest that 1β‐ and 6α‐hydroxylation of bile acids are the predominant pathways of bile acid metabolism in neonates.
Comparison of Two Preterai Formulas With or Without Addition of Medium‐Chain Triglycerides (MCTs). II
Authors: Sulkers E. J. , Lafeber H. N. , Degenhart H. J. , Lindemans J. , Sauer P. J. J.
Published: January 2024

Medium‐chain triglycerides (MCTs) are included in the fat blend of several preterm formulas because of their complete absorption and rapid oxidation. The effects of two different fat blend compositions on calcium (Ca), phosphorus (P), and magnesium (Mg) balances and plasma levels and on plasma levels of parathyroid hormone (PTH), alkaline phosphatase (AP), and 1,25‐dihydroxyvitamin D [1,25‐(OH)2D] were investigated in 28 healthy very‐low‐birth weight infants at 4 weeks of age. A preterm formula with a traditional corn oil/MCT blend containing 38% MCTs (MCT group) was compared to a new fat blend, designed to resemble human milk more, containing 6% MCTs (LCT group). There was a higher absorption of Ca in the MCT group (73% vs. 60%. p < 0.005), and an equal absorption of P (both 92%). The excretion of Ca correlated with the excretion of fat (p < 0.00005). The LCT group showed a higher median PTH level (MCT: 2.1 pmol/L, LCT: 4.7 pmol/L, p < 0.01) and a higher urinary P excretion (p < 0.001). Mg absorption was also lower with LCT, but retention of Mg exceeded intrauterine values in both groups. Mineral plasma levels were in the normal range in both groups. AP was not different between groups and in the upper part of the reference range, whereas 1,25‐(OH)2D levels were above the normal range and also not different between groups. We conclude that with the LCT formula, Ca absorption is slightly lower than with the MCT formula, whereas P absorption is unaffected. The resulting imbalance in absorption is compensated for by an increased urinary excretion of P. We conclude that current recommendations for the maximum Ca/P ratio in preterm formulas (2:1) might be too low in formulas containing only LCT.
Comparative Effects of Atrial Natriuretic Peptide and E. coli Heat‐Stable Toxin on Rat Intestinal Transport
Authors: Guarino Alfredo , Tarallo Luigi , Canani Roberto Berni , Nocerino Agostino , Iafusco Michele , Raimondi Francesco , Rubino Armido
Published: January 2024

Conflicting data have been published in favor of or against a secretory effect of atrial natriuretic peptide (ANP) in the intestine. The reported effects resemble that of Escherichia coli heat‐stable enterotoxin (ST). In this work the effects of ANP were studied in well established experimental systems and compared with that of ST. Both peptides induced a prompt secretion of water, Na, and Cl with no effects on K net transport in the in vivo rat perfused jejunum. The addition of ST, but not of ANP, evoked an increase of short circuit current in rat intestinal mucosa mounted in Ussing chambers. ST induced a significant increase in guanylate cyclase activity in intestinal homogenates, whereas ANP showed no effect. No binding sites for ANP were detected in basolateral or brush border membranes, nor in isolated enterocytes by a suction filtration technique. In conclusion, ANP acts as a short‐lived intestinal secretagogue in the rat. Its mechanism of action is different from that of E. coli ST and appears to be indirect, since is not mediated by specific intestinal receptors and is not evident in vitro.
Measurement of Colonic Tissue Cyclosporine Concentration in Children with Severe Ulcerative Colitis
Authors: Sandborn William J. , Goldman Deborah H. , Lawson George M. , Perrault Jean
Published: January 2024

Recent studies suggest that cyclosporine may be an alternative to colectomy in children with severe ulcerative colitis who fail traditional therapy with bowel rest and high‐dose corticosteroids. We report the clinical course of two such children. Patient I received oral cyclosporine at 15 mg/kg/day for 1 week followed by 8 mg/kg/day for 6 weeks. Clinical remission occurred within 5 days and has been sustained for 24 weeks after azathioprine was substituted for cyclosporine. Patient 2 received oral cyclosporine at 7–8 mg/kg/day for 7 days after which colectomy was performed due to lack of clinical improvement. Blood cyclosporine levels for patient 1 ranged from 95 to 406 ng/ml and for patient 2 from 36 to 65 ng/ml. Sigmoid colonic tissue cyclosporine concentrations for patients 1 and 2 were 10,058 and 3,205 ng/g, respectively. The patient who responded had significantly higher blood and colonic tissue cyclosporine concentrations than the patient who did not respond. Further studies with larger numbers of patients are needed to determine if there is a correlation between blood and colonic tissue cyclosporine concentrations and clinical response.