bluuebunny/crossref_metadata_2025 huggingface dataset:
Myocarditis in Children with Inflammatory Bowel Disease
Authors: Frid Christina , Bjarke Björn , Eriksson Margareta
Published: January 2024

Inflammatory bowel disease (IBD) in children and adults is often associated with extracolonic manifestations in other organs, such as the joints, skin, and liver. Cardiac manifestations are considered to be very rare; in a recent survey of the literature we found only 23 cases, most of them in adults. Several extensive reviews and standard textbooks of IBD do not even mention perimyocarditis as a complication. During the past 10 years we have treated 106 patients with IBD in the Department of Pediatrics at St. Goran's Children's Hospital. Of these patients, two adolescent boys developed myocarditis as an extracolonic manifestation. In reporting these two cases, we wish to point out that cardiac involvement occurs in children and we also wish to show that the prognosis is usually good. Another interesting feature was that both of these boys developed myocarditis at a time when one of them had only minor gastrointestinal symptoms and the other had not yet been diagnosed as having IBD.
Zollinger‐Ellison Syndrome Associated With a Renal Gastrinoma in a Child
Authors: Nord Kenneth S. , Joshi Vijay , Hanna Moneer , Khademi Mansour , Saad Saad , Marquis James , Pelzman Henry , Verner Edwina
Published: January 2024

Renal gastrinoma has not been previously reported. A 12‐year‐old boy with Zollinger‐Ellison syndrome was found to have a renal tumor. No other tumor was detectable by imaging techniques, and selective venous sampling for gastrin showed a significant renal vein to vena cava gradient. Nephrectomy was performed, and examination of the tumor showed typical histologic features of an endocrine tumor. G cells were apparent by electron microscopy, and immunoperoxidase staining for gastrin, neuron‐specific enolase, and chromogranin were positive. The gastrin content was unusually low for gas‐trinomas: 128 pg/g. Following nephrectomy, fasting gastrin and secretin stimulation testing were normal. Basal acidity was reduced by 60% but remained elevated at 39 mmol H + /h (hydrogen ion per hour). We speculate that renal gastrinoma may be characterized by uniquely poor gastrin storage and that curative resection of all gastrinoma tissue may not necessarily be associated with immediate complete suppression of hyperacidity.
Determination of the Normal Position of the Anus (with Reference to Idiopathic Constipation)
Authors: Bar‐Maor J. A. , Eitan A.
Published: January 2024

The position of the normal anus was numerically defined by the ano‐genital index, which is the distance from the anus to the vagina or scrotum divided by the distance between the vagina or scrotum and the coccyx. In idiopathic constipation, one must look for an anterior displacement of the anus, which might be the cause of the constipation.
Comparison of Feeding History of Children with Indian Childhood Cirrhosis and Paired Controls
Authors: Bhave S. A. , Pandit A. N. , Tanner M. S.
Published: January 2024

One hundred prospectively studied children with Indian childhood cirrhosis (ICC) in Pune District, India, differed from 100 matched controls with respect to feeding history. Animal milk was used in all ICC cases but not in 27 controls. It had been started by 3 months in 63 cases and by 6 months in 82 cases of ICC, as compared with 15 and 25 controls. Twenty‐four ICC cases received no breast feeding, and 45 and 60 were breast fed for <3 and <6 months, respectively; only 10 control children were breast fed for <6 months. All ICC children's feeds had been in contact with brass vessels. Copper vessels were used for water carriage with equal frequency in cases and controls. Girls predominated amongst healthy older siblings of cases. Ninety‐one healthy siblings of cases had been fed similarly to controls. Three pairs of twins with similar feeding histories died with ICC. whereas two pairs were discordant for feeding and outcome. Hepatic copper loading in ICC is attributable to copper contamination of early animal milk feeds.
Yersinia Enterocolitis in Iron Overload
Authors: Kelly D. A. , Price E. , Jani B. , Wright V. , Rossiter M. , Walker‐Smith J. A.
Published: January 2024

Yersinia enterocolitis with peritonitis and septicaemia developed in a 4‐year‐old child with thalassemia intermedia and iron overload. It is likely that the illness was exacerbated by continued administration of desfer‐rioxamine, a bacterial siderophore, which facilitated systemic spread of Yersinia. It is recommended that Yersinia enterocolitis be considered in children with iron overload and that desferrioxamine be discontinued and prophylactic antibiotics be administered while Yersinia is sought.
Intussusception
Authors: Bruce James , Huh Young Soo , Cooney Donald R. , Karp Melvyn P. , Allen James E. , Jewett Theodore C.
Published: January 2024

The records of 583 children who were treated for intussusception at the Children's Hospital of Buffalo in the period 1930–1985 were reviewed. Following a change in management in 1970 from operative treatment to hydrostatic reduction of the intussusception by barium enema, two main groups are defined. In earlier years 95% of patients underwent operative reduction whereas in the latter period 92% had barium reduction attempted. The remaining 8% in this group had clinical contraindications for hydrostatic enema attempt. Ten percent had pathological lead points. Recurrent intussusception occurred in 50 cases (8.5%), 66% following barium enema reduction and 33% after surgery. The mortality in the earlier group was 3.9% and 1.3% in the latter group. No deaths occurred in patients treated successfully with barium enema reduction, and there were no deaths in the children with simple uncomplicated intussusception requiring surgery.
Early Nutrition with a High‐Cholesterol Diet Alters Normal Age‐Related Changes in Intestinal Active Transport
Authors: Thomson A. B. R. , Keelan M. , Tavernini M.
Published: January 2024

This study was undertaken in the young and growing rabbit to establish the effect of feeding a highcholesterol (2%) diet on the intestinal in vitro uptake of glucose, galactose, leucine, and cholic acid. Three groups of animals were fed standard Purina chow for 14, 28, and 42 days. A fourth group was fed chow for 14 days followed by high‐cholesterol diet for 10 days followed by chow for 4 days. A fifth group was fed chow for 14 days followed by the high‐cholesterol diet for 10 days followed by chow for 18 days. Short‐term feeding with a high‐cholesterol diet reversed the normal developmental decline in the jejunal uptake of some nutrients (e.g., glucose), enhanced the age‐related uptake of other nutrients (e.g., galactose and leucine), but had no effect on others (e.g., jejunal uptake of cholic acid). Two weeks after stopping the high‐cholesterol diet, there was enhanced jejunal uptake of all nutrients. Colonic uptake of glucose, galactose, and leucine was unresponsive to the effects of early development or of a high‐cholesterol diet, whereas the colonic uptake of cholic acid did increase. This altered uptake is not explained by nonspecific mechanisms such as changes in body weight gain, intestinal mass, or effective resistance of the intestinal unstirred water layer. In summary, early feeding of rabbits for a short interval with a high‐cholesterol diet is associated with transport changes that may persist, progress, or appear for the first time when the animals are switched from the high‐cholesterol diet back to chow. Thus, early feeding with a high‐cholesterol diet alters the normal development of intestinal transport function.
Endoscopic Findings in Pediatric Patients with Henoch‐Schonlein Purpura and Gastrointestinal Symptoms
Authors: Tomomasa T. , Hsu J. Y. , Itoh K. , Kuroume T.
Published: January 2024

We report the gastrointestinal endoscopic findings in nine patients with Henoch‐Schonlein purpura. Eight patients underwent upper gastrointestinal endoscopy, which revealed erosive gastritis in one patient, hemorrhagic‐erosive duodenitis in four, and both findings in one. The rectum and the sigmoid colon were examined in six patients. Aphthoid ulcers were noted in two. In one of these patients, a rectal ulcer was also noted. Severe inflammatory changes and angiitis were found in the biopsy specimens obtained from the duodenum and the colon. The vascular abnormalities in the gastrointestinal mucosa are similar histologically to those found in the skin in Henoch‐Schonlein purpura.
Alternate Day Infusion of Calcium and Phosphate in Very Low Birth Weight Infants
Authors: Hoehn George J. , Carey Dennis E. , Rowe Jonelle C. , Horak Eva , Raye John R.
Published: January 2024

Very low birth weight infants require greater intakes of calcium and phosphate than can be supplied simultaneously in parenteral nutrition. We investigated the biochemical effects and retention of calcium and phosphate when each was administered for 24 h on an alternate day schedule as part of total parenteral nutrition. Serum and urine were collected during a 24 h basal period and during randomly ordered 24 h infusions of either calcium or phosphate in 14 infants during the first week of life. In general, the urinary excretion of the infused mineral (calcium or phosphorus) increased during the 24 h period of its infusion. The serum phosphorus level fluctuated widely from day to day while the serum calcium level did not change. During the 24 h infusion of phosphate, phosphate retention was 67.9 ± 7.4% and during the 24 h infusion of calcium, calcium retention was 72.5 ± 4.3%. However, ongoing excretion of each mineral on the day it was not infused meant that 48.3% of the 48 h phosphate intake and 42.2% of the 48 h calcium intake were lost in the urine. We conclude that excessive amounts of the administered mineral were excreted and that alternate day infusion of calcium and phosphate is an unsatisfactory method for providing these minerals. Attainment of sufficient retentions of calcium and phosphate will require development of novel methods of simultaneous administration which provide calcium and phosphate in high concentrations.
The Effects of Formula Change on Triglycerides and Free Fatty Acids in Preterm Infants
Authors: Weinstein Marie Ritthamel , Haugen Katheryn , Hewitt John , Finan Diane
Published: January 2024

We measured preprandial and 2‐h postprandial plasma triglycerides (TG) and free fatty acids (FFA) in 13 preterm infants weekly for 3 consecutive weeks to examine the effects of a premature, medium‐chain triglyceride (MCT)‐containing formula advancing to a term, long‐chain triglyceride (LCD‐containing formula. The infants were on premature formula for the first 2 weeks of the study and were switched to term formula 4–5 days before the last sampling. Significant increases were seen in preprandial and 2‐h postprandial TG when the infants were advanced from the premature to the term formula. It was speculated that this increase was due to the predominace of LCT in term formula, which differed in its absorption and metabolism from MCT. Whether these increases persist and if their clinical significance requires further investigation. No consistent change was observed in the preprandial or postprandial FFA.
Effect of Sympathectomy on Ontogeny of Small Intestinal Disaccharidases in the Rat
Authors: Grunwald Zvi , Marcus Hedva , Zahavi Ilan , Rozenbach Yoram , Nitzan Menachem , Dinari Gabriel
Published: January 2024

In the present study the effect of chemical sympathectomy on the development of small intestinal enzymes in the rat was analyzed. Eight doses of guanethidine sulfate were administered subcutaneously every 48 h to 34 newborn rats, starting at birth. The last dose was given at 14 days of age. Twenty‐two littermates served as controls. Intestinal lactase, maltase, sucrase, and alkaline phosphatase were determined at 15, 17, 20, 23, and 25 days of age. Sympathectomy was demonstrated by reduction of the number of perikarya in the superior cervical ganglia in treated rats as compared with control rats. A normal developmental pattern of activities of the disaccharidases in the small intestine was observed in both groups. The activity of alkaline phosphatase was significantly lower (p < 0.01) in the 15− and 17‐day‐old treated animals.
Tin‐Protoporphyrin Inhibits Carbon Monoxide Production in Adult Male Wistar Rats with Common Bile Duct Ligation
Authors: McMillan James J. , Vreman Hendrik J. , Stevenson Daavid K.
Published: January 2024

The excretion rate of CO (VeCO), an index of total bilirubin production, and the total plasma bilirubin level are significantly elevated by 72 h after ligation of the common bile duct in adult male Wistar rats. At 72 and 96 h, rats prepared in this manner were subcutaneously injected with 50 μmol/kg body weight of tin‐protoporphyrin IX (TP) (n = 5) or saline (n = 6). At 120 h after surgery, the VeCO had fallen from the pretreatment level in the TP‐treated animals by 22% (p < 0.025) compared with no significant change in the saline‐treated controls. The plasma total bilirubin level of the experimental animals had also declined by 32% (p < 0.0005) compared with their pretreatment level. The hyperbilirubinemia of the saline‐treated controls was not significantly modified. These results suggest that TP reduces bilirubin production and plasma total bilirubin levels in adult rats with surgically created obstructive jaundice.
Protracted Hemorrhagic Gastritis in an Infant Recovering from Acute Pancreatitis
Authors: Casaubon Pablo R. , Vargas Jorge , Ament Marvin E.
Published: January 2024

This case report describes the course and management of a 10‐week‐old boy with idiopathic hemorrhagic pancreatitis who presented initially with ascites. His hospital course was complicated by severe recurrent intraperitoneal bleeding, requiring, in less than 5 days three exploratory laparotomies to control the hemorrhage. In the following 11 weeks he had five major bleeding episodes attributed to ulcers, gastritis, and esophagitis. Continuous infusion of H2 blockers, antacid drip, and sulcrafate combined with Nissen fundoplication, elective vagotomy, and pyloroplasty were used unsuccessfully to control the bleeding until a prostaglandin E2 analogue at 18 μg/kg/day in four divided doses was given enterally. During the following 19 months, there has been no recurrence of bleeding.
Removal of a Colonic Foreign Body by Enteral Lavage
Authors: Casaubon Pablo R. , Berquist William
Published: January 2024

A 14‐year‐old boy was evaluated for the presence of a foreign body in the descending colon. It successfully passed after oral colonic lavage solution (Golytely), obviating endoscopic intervention. The approaches to colonic foreign body removal are reviewed.
Milk Composition of Insulin‐Dependent Diabetic Women
Authors: Butte Nancy F. , Garza Cutberto , Burr Robert , Goldman Armond S. , Kennedy Kathy , Kitzmiller John L.
Published: January 2024

The macronutrient, trace mineral, and immunological contents of milk of five moderately controlled, insulin‐dependent diabetic women were studied at 3 months postpartum. Concentrations of total nitrogen, lactose, fat, and energy were not distinguishable from those in milk of nondiabetic women. Glucose concentrations in milk from diabetic women were significantly higher (p 0.001) and more variable. The macro‐ and trace minerals (Ca. P. Mg. K. Zn. Cu. and He) were within normal ranges with the exception of Na which was higher in milk from the diabetic women (p 0.05). The concentrations of lactoferrin and secretory IgA were not statistically different from reference norms. Milk composition of five insulin‐dependent diabetic women was not distinguishable from that of the reference population, with the exceptions of Na and glucose concentrations, which were slightly elevated.
A Randomized Study of Oral Metoclopramide in Small Bowel Biopsy of Infants and Children
Authors: Grunow John E. , Howard Sharon
Published: January 2024

As an intravenous injection is not used in our premedication of infants and children for small bowel biopsy, we investigated what effects oral metoclopramide might have on small bowel biopsy procedure time and fluoroscopy time. Eighteen infants and children were randomized to receive 0.2 mg/kg metoclopramide or placebo orally, 40–45 min before starting the procedure, and the procedure was monitored for the time required for the biopsy capsule to reach the pylorus, to cross into the proximal duodenum, and to reach the biopsy site. Corresponding fluoroscopy times were recorded as well. Mean total procedure time was less for those treated with metoclopramide, 43.7 ± 11 min, than for controls, 86.5 ± 15.5 min (p < 0.005). Mean total fluoroscopy time was also less in treated patients (40.9 ± 11.5 s versus control 84.4 ± 17 s) (p < 0.005). The effect of metoclopramide occurred in the interval for the biopsy capsule to cross the pylorus (15.1 ± 2.7 min versus control 60.8 ± 16.6 min) (p < 0.005) and in fluoroscopy time required (15.1 ± 1.9 s versus control 46 ± 17 s) (p < 0.005). Oral metoclopramide is effective in reducing procedure time for small bowel biopsy, and its predictable action facilitates reduction in fluoroscopy exposure.
A New Hepato‐pancreato‐renal Disorder Resembling Tyrosinemia Involving Neuropathy and Abnormal Metabolism of Polyunsaturated Acids
Authors: Sharp H. L. , Lindahl J. A. , Freese D. K. , Burke B. , Englund J. , Johnson D. , Johnson S. B. , Holman R. T.
Published: January 2024

This report describes a new disorder resembling hereditary tyrosinemia (HT) but differing from it in several respects. Similarities include failure to thrive with hypoproteinemia, micronodular cirrhosis, α‐fetoprotein positive hepatocellular carcinoma, renal Fanconi syndrome with renal tubular ectasia, hypermethioninemia, and hypoglycemia associated with islet cell hyperplasia. However, the tyrosine metabolic pathway was intact. Unique findings include optic atrophy, cerebellar degeneration, and exocrine pancreatic hypoplasia. Polyunsaturated fatty acid (PUFA) status was evaluated in the serum and liver. Initial PUFA profile to serum phospholipids revealed grossly elevated linoleic acid and subnormal linolenic acid. All PUFAs derived from these precursors were absent suggesting gross abnormalities in the utilization of these two essential fatty acids for synthesis of longer chain highly unsaturated structural PUFA. Analysis of liver phospholipids indicated that linoleic acid was lower and w3 and monenoic acids were higher than in the liver specimens from two cases of HT. The gross abnormalities in PUFA pattern, although perhaps secondary to another cause, represent serious structural and functional abnormalities of essential membrane lipids and potentially of eicosanoids derived from them.
Changes of Plasma Free Amino Acids and Renal Clearances of Carnitines in Premature Infants During L‐Carnitine‐Supplemented Human Milk Feeding
Authors: Melegh Béla , Szücs László , Kerner János , Sándor Attila
Published: January 2024

Eighteen breast‐fed infants with a mean postnatal age of 26 days (range 16–41 days) were studied. Following 1 control day, the infants were fed for 7 consecutive days with pooled human milk supplemented with 300 nmol L‐carnitine/ml milk. Both plasma fractions of acid‐soluble carnitines increased as a consequence of carnitine application. The level of β‐hydroxybutyrate also increased significantly. Of the circulating free amino acids, the levels of alanine (p < 0.025) and glutamine (p < 0.01) were found to be lower, with a decreased urea level (p < 0.005) by the last day of carnitine administration, compared with the control day. The urinary output of total nitrogen also decreased. There were no statistically significant changes in the level of free fatty acids and glucose. On the control day, the renal clearance rate of esterified carnitines significantly exceeded that of free fraction, thus the relative renal reabsorption calculated on the base of creatinine excretion rates was higher for free (mean 98.1%) than for acylated (mean 90.6%) carnitine. In response to enhanced carnitine intake, the clearance rates for each fractions of carnitines significantly exceeded the presupplementary values. The increased clearance rates was more pronounced for free (mean 13.2‐fold) than for esterified (mean 8.08‐fold) carnitines. Despite the increased clearance rates, considerable relative reabsorption was seen for free carnitines (mean 70.0%) as well as for acylcarnitines (mean 65.3%).
Methodology of Nutrient Balance Studies in the Preterm Infant
Authors: Cooke Richard J. , Perrin Fran , Moore Jamae , Paule Chuck , Ruckman Karen
Published: January 2024

Although nutrient balances are used to determine nutrient assimilation, the balance technique is not well described in the preterm infant. Our purpose is to describe the balance technique; discuss factors that may interfere with complete balance collections; and determine the effects of intake, patient characteristics, and formula fed on nutrient assimilation in the preterm infant. Fifty‐four 84‐h balances were performed in a group of well premature infants receiving either a casein‐(Similac with Iron) or whey‐predominant (Similac with Whey plus Iron) infant formula. Mean (±SD; range) birth weight, gestation, postnatal age, and balance weight were 1,320g (±200; 820–1.720). 32.0 weeks (±2.0: 27–34). 36 days (±14.8; 15–87). and 1,729 g (±146; 1.435–2.070). respectively. Although absorption and retention varied, results were comparable with previous studies in the preterm infant. Results of linear regression analysis, using the stepwise regression procedure, indicate that variability in nutrient intake (mg/kg/day) accounted for 97 and 84% of the variability in nitrogen absorption and retention (mg/kg/day). Variability in nutrient intake (mg/kg/day) also accounted for 96 and 57% of the variability in phosphorus absorption and retention (mg/kg/day). Effects due to intake, birth weight, gestation, postnatal age. balance weight, and formula fed also accounted for a substantial part of the variability in calcium, zinc, and copper absorption and retention. The results of this study indicate that factors other than birth weight, gestation, and the type of formula fed have a significant effect on absorption and retention of nutrients and should be considered as confounding variables when interpreting effects due to treatment.
Plasma Levels of Somatostatin and Gastrin in Sick Infants and Small for Gestational Age Infants
Authors: Marchini G. , Lagercrantz H. , Milerad J. , Winberg J. , Uvnäs‐Moberg K.
Published: January 2024

Sick neonates often have a disturbed gastrointestinal motility. As somatostatin inhibits various gastrointestinal functions, we investigated whether or not somatostatin levels are high in sick infants. Somatostatin and gastrin levels were measured in plasma samples collected from sick and healthy neonates. Somatostatin levels were found to be significantly elevated in sick infants when compared to healthy ones, both term (91 versus 5 pM) and preterm (35 versus 5 pM). We suggest that the gastrointestinal symptoms seen in infants during illness may be related to an enhanced secretion of gastric somatostatin.
Effects of Feeding Regimen on Blood Glucose Levels and Plasma Concentrations of Pancreatic Hormones and Gut Regulatory Peptides at 9 Months of Age
Authors: Salmenperä J. , Perheentupa J. , Siimes M. A. , Adrian T. E. , Bloom S. R. , Aynsley‐Green A.
Published: January 2024

Little is known about the development of gut endocrine responses to food intake in infants after the first postnatal month. To examine this question and to ascertain whether the mode of feeding from birth affects postprandial endocrine changes, blood glucose levels and the plasma concentrations of 11 regulatory peptides were measured at 9 months of age before and after a breast feeding in 13 exclusively breast‐fed infants and before and after a formula feeding in 7 infants infants weaned during the first 3 months of life. In the prefeeding concentrations of these substances, no significant differences were found between the two groups, with the possible exception of the plasma concentration of pancreatic polypeptide (p = 0.06). Postprandially, the respnses were significantly smaller in the breast‐fed infants, whose plasma concentrations of insulin, gastric inhibitory polypeptide, pancreatic polypeptide, and cholecystokinin were lower than in the formula‐fed infants. In addition, the overall level of the insulin–glucagon ratio was lower (p = 0.03) in the breast‐fed infants. A difference in the opposite direction was observed for plasma gastrin levels. No significant differences appeared between the groups for blood glucose, or plasma glucagon, vasoactive intestinal polypeptide, motilin, enteroglucagon, secretin, or neurotensin concentrations after feeding. It is concluded that at 9 months of age, the gut regulatory responses to milk feeding are of lower magnitude than during the neonatal period, but even at this age the response patterns still depend on the mode of feeding.
Isolation and Characterization of an Amphiphilic Form of Human Intestinal Aminopeptidase N
Authors: Caporale Carlo , Troncone Riccardo
Published: January 2024

An amphiphilic detergent‐solubilized human adult intestinal microvillous aminopeptidase N (EC 3.4.11.2) was purified by immunoadsorbent technique using meconial aminopeptidase N antibodies. Its molecular and kinetic properties were investigated to confirm the differences previously observed from the meconial enzyme.
Barrett's Ulcer and Campylobacter‐like Organisms Infection in a Child
Authors: De Giacomo Costantino , Fiocca Roberto , Villani Laura , Bertolotti Laura , Maggiore Giuseppe
Published: January 2024

Barrett's esophagus is a gastrointestinal metaplasia of the esophageal epithelium occurring frequently in adults with long‐standing peptic esophagitis. Recent reports of Barrett's esophagus in children with gastroesophageal reflux (GER) showed that also at the pediatric age intestinal metaplasia of the esophagus may occur in association with peptic esophagitis. Recently a close association between Campylobacter‐like organisms (CLOs) and gastritis has been found in the stomach of both adults and children with a variety of peptic diseases, but evidence of such infection in specimens of Barrett's epithelium has never been described in children. We report here a child with Barrett's esophagus and GER, treated with H2 blockers, who showed a Barrett's ulcer in association with CLO infection. The addition of amoxicillin to antireflux treatment was accompanied by healing of the ulcer, suggesting that bacterial infection of Barrett's epithelium may have an important role in determining its inflammation and possibly ulceration.
Propylthiouracil Hepatotoxicity
Authors: Jonas Maureen M. , Eidson Margaret S.
Published: January 2024

We have observed isolated hepatotoxicity in two children treated with propylthiouracil (PTU) for hyperthyroidism. Neither patient had risk factors for or clinical evidence of preexisting liver disease. In one patient the drug was promptly discontinued when signs of liver disease were noted. This patient quickly recovered. The second patient continued to receive PTU for several days after developing symptoms. Her illness progressed to fulminant hepatic failure with encephalopathy, and she died. These are the third and fourth pediatric cases reported, and there have been 10 cases reported in adults in the English language literature. Thirteen of the 14 patients are female. The literature regarding all these patients is reviewed. Propylthiouracil may cause lethal hepatic damage. This drug should be discontinued immediately if signs or symptoms of hepatic injury are detected.
Hepatic Na, K‐ATPase Development in the Rat
Authors: Duffy Lynn F. , Karl Peter I. , Daum Fredric , Fisher Stanley E.
Published: January 2024

The development of the enzyme Na, K‐ATPase was studied in hepatic tissue from Sprague‐Dawley rats at 18–20 days of gestation. 1, 3, 5, 7, 14, 21, and 30 days, and young adulthood (45 days). A developmental pattern was demonstrated for total and membrane‐associated Na, K‐ATPase activity. The activity in tissue homogenate, expressed per gram tissue, increased from late fetal life, 43.4 ± 1.3 μmol Pig liver−1 h−1.until 21 days of age, when an adult level of 187.3 ± 19.6 μmol Pi g liver −1 h−1 was attained. A less pronounced ontogenic pattern was observed when enzyme levels were expressed as specific activity per milligram protein. The activity profile in a crude membrane preparation was similar. The potential for stimulation of enzyme activity by glucocorticoids was studied in 11‐day‐old animals injected with cortisone acetate (10 mg 100 g body weight−1) for 3 days. Enzyme specific activity was inducible: Specific activity was greater in cortisone‐treated animals, 1.794 ± .043 μmol Pi mg protein −1 h −1, versus controls, 1.258 ± 0.043 μmol Pi mg protein−1 h−1 (p < 0.01). We postulate that this developmental pattern for hepatic Na, K‐ATPase activity may be a reflection of, or a contributing factor in, the ontogeny of sodium‐dependent hepatic transport, such as that for bile salts.
Effects of Oral Administration of Tin and Zinc Protoporphyrin on Neonatal and Adult Rat Tissue Heme Oxygenase Activity
Authors: Vreman Hendrik J. , Hintz Susan R. , Kim Charles B. , Castillo Ricardo O. , Stevenson David K.
Published: January 2024

The purpose of this study was to investigate if oral metalloporphyrin treatment could suppress intestinal heme oxygenase (HO) activity and thus prevent HO‐mediated heme degradation in this organ. Six hours after a single 40 μmol/kg oral dose of tin protoporphyrin (TP). zinc protoporphyrin (ZP), or heme to adult rats, no significant difference in the HO activity of the intestine was observed relative to control tissues. Moreover, the activity was not inhibited by in vitro exposure to 40 μM TP or ZP. Liver and spleen HO activity was also not significantly inhibited in vivo after oral administration of metalloporphyrins: however, in vitro exposure to TP or ZP decreased the HO activity of preparations from these organs significantly. Like adults, the intestinal HO activity of neonates was not inhibited effectively by oral administration of either metalloporphyrin. The results of subsequent in vitro exposure of control neonatal tissue preparations to ZP or TP was similar to those using adult tissue preparations. Even at 100 μM, only ZP seemed to have some in vitro inhibitory effect on the intestinal HO of suckling rats. We conclude that intestinal HO is less inhibitable by TP or ZP reaching the intestine via the stomach in concentrations at least 30‐fold greater than those achieved after parenteral 40 μmol/kg doses, which cause significant hepatic and splenic HO inhibition. Intestinal absorption and enterohepatic circulation of heme, TP. and ZP do not seem to occur in amounts sufficient to consistently and significantly affect HO activity in liver or spleen.
Clinical Remission and Disappearance of Radiologic Manifestations in Crohn's Disease After Oligopeptide Diet Treatment
Authors: Pfeil Annette B. , Schuster Antje T. , Kemperdick Helmut
Published: January 2024

A 9.6‐year‐old patient was treated exclusively with an oligopeptide diet at initial diagnosis and at first relapse of Crohn's ileocolitis. The patient achieved complete remission in both episodes. Control radiologic examinations 14 months after diagnosis revealed complete disappearance of radiologic manifestations of Crohn's disease.
The Management of Enzymatic Therapy in Cystic Fibrosis Patients by an Individualized Approach
Authors: Costantini Diana , Padoan Rita , Curcio Lauretta , Giunta Annamaria
Published: January 2024

We evaluated nutritional status, pulmonary impairment, nutritional intake, and fat absorption in 73 cystic fibrosis (CF) patients to identify the primary factors) influencing growth. In general, the growth pattern in our patients was satisfactory since 60/73 were not underweight. When caloric intake is greater than or equal to 95% of RDA, wasting does not occur regardless of the degree of malabsorption, dietary fat content, or lung involvement. In the group of patients who consume less than the RDA, underweight is related to the severity of pulmonary disease; indeed, 11/13 underweight patients have a chest x‐ray score over 15. Steatorrhea is well controlled in most patients; only 11 of 73 show a fat excretion >25% of fat intake. The daily number of capsules of Pan‐crease varies from 4 to 57. The amount of Pancrease to be given was individualized to meet each patient's requirements using fat balance studies to determine the necessary daily Pancrease dose, then distributing the total dose in proportion to the fat content of each meal.
Efficacy of Pancrease
Authors: Chazalette J‐P. , Dain M. P. , Castaigne J‐P.
Published: January 2024

An open crossover study in patients with documented cystic fibrosis (CF) compared the efficacy and acceptability of Pancrease (Cilag, PC), consisting of pH‐sensitive, enteric‐coated microspheres, with those of Eurobiol, consisting of lyophilized total pancreas. Eleven patients, age 6–17 years, were hospitalized for study. A hypercaloric, normal fat diet as well as previous antibiotic, vitamin, and other CF therapy were maintained during the 2‐week study period. During the first study week, eight patients were given four divided doses of either Pancrease, 8 capsules daily, and two patients were given Eurobiol, 2 bottles daily. One patient received six Pancrease capsules or 1.5 bottles of Eurobiol daily. Patients were switched to the alternate drug for the second study week. Stools were collected for analysis over the final 3 days of each week. Steatorrhea (mean ± 1 SD) with Pancrease was 11.8 ± 6.6 g/24 h and with Eurobiol was 17.9 ± 11.7 g/24 h. The coefficient of lipid absorption was 74.1 ± 13.3% for Pancrease and 58.6 ± 22.5% for Eurobiol (p < 0.02). The decrease in steatorrhea and increase in lipid absorption with Pancrease compared to Eurobiol were 33.9% and 26.5%, respectively. All patients considered the acceptability of Pancrease superior to that of Eurobiol. No adverse effects were seen with either drug.
Serum α‐Fetoprotein Levels in Normal Infants
Authors: Lee Ping‐Ing , Chang Mei‐Hwei , Chen Ding‐Shinn , Lee Chin‐Yun
Published: January 2024

Age‐dependent changes of serum α‐fetoprotein (AFP) levels were analyzed in 284 normal infants, including 113 full‐term neonates and 171 infants between 1–12 months old. Serial statistical analyses attempted to clarify some confusing and conflicting observations presently existing in the literature. The results showed the following: (a) variations of AFP values were homogeneous throughout infancy, after the logarithmic transformation that is essential in dealing with AFP data. (b) To obtain an approximately 95% prediction band of normal AFP levels in infancy, the regression analysis should be based on the power regression rather than the exponential progression model: log Y = 7.397 ‐ 2.622 · log (X + 10), where X = age in days and Y = AFP level in nanograms per milliliter. (c) A sex‐related difference existed with higher mean values for male babies between 2–4 days of age, a fact that may be missed with casual analysis. In addition, the mean AFP level was found to be relatively constant at some time during the 1st week of life, in contrast to its subsequent extremely rapid decline. These characteristic changes deserve further investigation.
Chronic Duodenal Ulcer in Children
Authors: Chiang Bor‐Luen , Chang Mei‐Hwei , Lin Min‐I , Hsu Jei‐Yun , Wang Cheng‐Yi , Wang Teh‐Hong
Published: January 2024

Chronic duodenal ulcer is diagnosed more frequently in children since recent advances in panendoscopy techniques. From 1976 to 1986, chronic duodenal ulcer was diagnosed in 33 children in this hospital. There was a marked male preponderance (male:female = 4.5:1). Family history for peptic ulcer was positive in 36% of the patients. The important element of emotional stress was identified in 39% of the patients. Thirty patients received medical treatment, and 26 were observed for more than 1 year (1–10 years). In 11 children, medication was changed because of symptom recurrence and change in the mode of treatment. The patients were divided into three groups with different treatment regimens: antacid (12 cases), cytoprotective agent (sucralfate, 17 cases), and histamine H2‐receptor antagonist (cimetidine, eight cases). The response to short‐term (eight‐week) therapy was similarly good (83–94%) in the three treatment groups. However, sucralfate is superior to antacid in the ongoing maintenance therapy of chronic duodenal ulcer in childhood. Because chronic duodenal ulcer recurred frequently, it is crucial to give long‐term maintenance therapy.
Clinical Features of Gastroduodenal Crohn's Disease in Adolescents
Authors: Griffiths Anne Marie , Alemayehu Efrem , Sherman Philip
Published: January 2024

Ten cases of gastroduodenal inflammation were diagnosed by endoscopy among a series of 196 children with evidence of Crohn's disease involving other regions of the intestinal tract. Endoscopic and histologic confirmation of upper gastrointestinal tract involvement was performed only in those cases with suggestive symptoms. The mean age at presentation in the 10 cases with gastroduodenal inflammation was 14.6 ± 1.9 (±SD) years, with involvement identified at the time of initial diagnosis of Crohn's disease in five of the 10. Eight of 10 cases occurred in boys. The major presenting symptoms were weight loss in five cases, epigastric pain in three, and recurrent vomiting in two. Hematemesis and melena occurred in only one of the 10 cases. Endoscopic and histological evidence of mucosal inflammation was seen in all 10 cases. Three of 10 cases had noncaseating granuloma present in biopsies of the stomach or duodenum. Two cases also had endoscopic and histological evidence of esophageal involvement. All cases were initially treated with oral corticosteroids, and in each instance a good clinical response was noted. Sucralfate (n = 1), 6‐mercaptopurine (n = 1), and H2 receptor antagonists (n = 3) were used as adjunct therapy. After follow‐up for 2.7 years (range, 0.5–5.5 years), none of the 10 cases required surgical intervention. Therefore, at least in the short‐term, the outlook for adolescents with gastroduodenal Crohn's disease appears to be good and their medical management need not differ from those patients with Crohn's disease involving only more distal portions of the small intestine.
Serum Transferrin Levels in the Longitudinal Assessment of Protein‐Energy Status in Preterm Infants
Authors: Georgieff Michael K. , Amarnath Uma M. , Murphy Edrie L. , Ophoven Janice J.
Published: January 2024

We prospectively measured serum transferrin levels weekly from birth until discharge in 33 preterm newborn infants hospitalized on the newborn intensive care unit (n = 130 weeks) to study whether transferrin levels accurately reflect recent nutritional intakes and predict subsequent changes in anthropometric measurements and serum protein levels. Mean daily protein and caloric intakes were no greater during weeks when transferrin levels increased than when levels decreased. There were weak but statistically significant linear relationships between protein intake and transferrin levels (r = 0.24, p < 0.01), caloric intake and transferrin levels (r = 0.27, p < 0.01), and magnitudes of weekly changes in protein intake and transferrin levels (r = 0.31, p < 0.001), and magnitudes of weekly changes in caloric intake and transferrin levels (r = 0.27, p < 0.01). Transferrin levels did not reflect same‐week weight or midarm circumference (MAC) gains, nor did they predict the following week's gains. Mean anthropometric measurement gains were similar following weeks when transferrin levels increased or decreased. There were no positive linear relationships between the magnitudes of changes in transferrin levels and same‐week weight gain (r = −0.35), same‐week MAC gain (r = −0.27), or following‐week MAC gain (r = 0.01). Weak correlations were found with following‐week albumin levels (r = 0.32, p < 0.001) and with same‐week transthyretin levels (r = 0.44, p < 0.001). Weekly serum transferrin levels are not useful for longitudinal surveillance of protein‐energy status in preterm infants.
Effect of Prednisone on DR‐Positive T Cells in Children with Chronic Active Hepatitis B
Authors: Pignata Claudio , Vajro Pietro , Vegnente Angela , Monaco Giuseppe , Fontanella Angiola , Nuzzo Vincenzo , Ciccimarra Filippo
Published: January 2024

The effect of short‐term immunosuppressive treatment on the percentage of circulating DR‐bearing T cells was investigated in 16 children with HBsAg‐positive chronic active hepatitis. DR‐positive T cells, thought to represent activated T cells, were significantly increased in all patients as compared to 10 age‐matched controls [14.5 ± 4.2% (mean ± SD) vs. 0.4 ± 0.1%, p < 0.001]. Fifty‐six percent of patients showed a decrease in the percentage of DR‐positive T cells after 72 h of prednisone therapy. A response did not correlate with the presence of HBeAg, anti‐HBeAg, or anti‐delta antibodies. There was an inverse relationship (r = −0.56; p < 0.05) between the decrease of the percent of DR‐positive T cells during immunosuppression and pretreatment alanine aminotransferase levels. The persistence of high levels of circulating DR‐bearing T cells during therapy may represent the immunological counterpart of more severe disease, and of nonresponsiveness to corticosteroids.
Biliary Lipid Composition in Patients with Cystic Fibrosis
Authors: Becker Michael , Staab Doris , Leiss Ottmar , von Bergmann Klaus
Published: January 2024

Lipid composition of gallbladder bile was determined in 20 patients with cystic fibrosis (CF) (9 females and 11 males, ranging in age from 3 to 18 years). The results were compared with 47 normal subjects matched for age, sex, and pubertal stage. In patients with CF, bile was undersaturated with cholesterol before puberty in both sexes and no differences with normal controls could be observed. After puberty, a similar increase in cholesterol saturation was noted in females with CF (85 ± 15% vs. 130 ± 38%, p < 0.01) and normal controls (82 ± 11% vs. 138 ± 31%, p < 0.01). No change in cholesterol saturation could be observed in male patients and controls after puberty. Molar percentage of chenodeoxy‐cholic acid (CDCA) was lower (p < 0.05) in postpubertal females (31 ± 9%) and males (36 ± 7%) with CF compared to controls (42 ± 8% and 40 ± 5%, respectively), while cholic acid (CA) was higher in all patients with CF. In females with CF, lithocholic acid (LCA) increased after puberty (2.2 ± 0.8% vs. 5.3 ± 2.6%, p < 0.05) and was higher compared to controls (2.2 ± 0.8%, p < 0.001). An increase was also noted for deoxycholic acid (DCA) in postpubertal females with CF (1.7 ± 2.6% vs. 10.8 ± 7%, p < 0.05), but it was lower in both sexes after puberty than in respective controls. The present results suggest that cholesterol saturation of bile in patients with CF is not different from respective controls. Thus, the higher incidence of gallstone disease in patients with CF reported in the literature might be related to other hepato‐biliary disorders known in this disease.
Effect of Cisapride on Esophageal pH Monitoring in Children with Reflux‐Associated Bronchopulmonary Disease
Authors: Saye Z. , Forget P. P.
Published: January 2024

Clinical evaluation and prolonged esophageal pH monitoring were performed before and during treatment with cisapride (0.3 mg/kg t.i.d.) for 1 month in 19 children with reflux‐associated bronchopulmonary disease. Results (mean ± SEM) show that cisapride significantly decreases the frequency of long duration (>5 min) reflux episodes (from 9.7 ± 0.7 to 5.7 ± 1.2), the percentage of total time pH was <4 (from 15.9 ± 2.5 to 7.7 ± 1.1%), the percentage of time pH was <4 at night (from 18.0 ± 3.9 to 4.9 ± 1.5%), the duration of the longest reflux episodes (from 44.5 ± 6.4 to 19.7 ± 2.7 min), as well as the duration of reflux at night (from 100.1 ± 28.0 to 28.2 ± 10.1 min). The frequency of reflux episodes, however, remains unaffected by cisapride. Cough fits at night disappeared completely in 12 out of 13 children. We conclude that cisapride given for 1 month significantly decreased gastroesophageal reflux as well as cough episodes at night.
Does Proctosigmoiditis in Inflammatory Bowel Disease Presage the Imminent Onset of Symptoms?
Authors: Daum Fredric , Markowitz James , Rosa Joanne , Kahn Ellen , Simpser Edwin , Aiges Harvey
Published: January 2024

This study was undertaken to determine if asymptomatic children and adolescents with inflammatory bowel disease and moderate to severe anorectosigmoid inflammation might remain symptom‐free for at least 12 months without specific intrarectal therapy. We prospectively studied 13 asymptomatic patients 6–21 years of age (four with Crohn's disease and nine with nonspecific colitis) with previously documented anorec‐tosigmoid inflammation. Of these 13, four had moderate to severe anorectosigmoid inflammation both endoscopi‐cally and histologically. These four patients (two with Crohn's disease and two with nonspecific colitis) were entered into the second phase of the study. Three were receiving sulfasalazine, and one received methylpredni‐solone, 4 mg/day, and 6‐mercaptopurine, 50 mg/day. None received intrarectal therapy. Clinical evaluation revealed that all four remained asymptomatic for 12 months despite the continued presence of moderate to severe anorectosigmoid inflammation. These results indicate that in children and adolescents with inflammatory bowel disease, the presence of inflammation of the anorectosigmoid does not necessarily correlate with or presage the onset of symptoms of proctosigmoiditis. Therefore, active inflammation of the anorectosigmoid is not the sole prerequisite for intrarectal therapy. The clinician should be guided by the symptoms of the patient, not by the presence or absence of active anorectosigmoid inflammation.
Intussusception
Authors: Lee Hung‐Chang , Yeh Horng‐Jen , Leu Yi‐Jang
Published: January 2024

During the past four years in our hospital, real‐time sonographic examinations were performed prior to barium enema reductions in 48 proven intussusception cases. Four major sonographic findings were noted. First, a length of target configuration consisting of two rings of low echogenicity separated by an intermediate hyper‐echoic ring was seen on the cross‐sectional image of the intussuscepted bowel. Second, a doughnut configuration consisting of a hypoechoic rim and a dense central echogenic core was noted on the cross section near the apex of the intussusceptum. Third, no demonstrable movement or change was observed in the target or doughnut configuration. Fourth, all of the exterior sonolucent rims of the target were thicker than 0.6 cm. Operative reductions were necessary in all 13 cases whose exterior rims were thicker than 1.6 cm. On the contrary, only 15 of the remaining 35 cases whose exterior rims were between 0.6 and 1.5 cm needed surgical management (p = 0.0033, Fisher's exact test).
Bilirubinuria
Authors: Friesen Craig A. , Gamis Alan S. , Riddell Laurel D. , Roberts Charles C. , Jackson Mary Anne
Published: January 2024

We report four cases of gallbladder hydrops associated with Kawasaki disease diagnosed over a 7.5 year period. Despite varying clinical presentations, all four of these patients had the common finding of bilirubinuria prior to clinical symptoms or at the time of admission. Review of 40 other cases of Kawasaki disease without evidence of hydrops over this time period revealed that urinalysis had been performed in each and bilirubinuria was present in only one case. Bilirubinuria appears to be an early indicator of hydrops in these patients.
Solitary Ulcer Syndrome of the Rectum in Children
Authors: Figueroa‐Colon Reinaldo , Younoszai M. Kabir , Mitros Frank A.
Published: January 2024

We present two children with solitary ulcer syndrome of the rectum (SUSR): a 7‐year‐old and an 11‐year‐old. Although well recognized in the adult literature, the pediatric experience with this condition is limited. We review the clinicopathologic features of SUSR with emphasis on the pediatric experience. Greater awareness of this syndrome by both the pediatrician and pathologist may lead to more diagnosed cases in children.