bluuebunny/crossref_metadata_2025 huggingface dataset:
Absorption of Medium Chain Triglycerides in the Stomach of the Human Infant
Authors: Faber J. , Goldstein R. , Blondheim O. , Stankiewicz H. , Darwashi A. , Bar‐Maor J. A. , Gorenstein A. , Eidelman A. I. , Freier S.
Published: January 2024

Following previous observations that medium chain triglycerides (MCT) are absorbed from the stomach of suckling rats, this study was devoted to studying absorption of MCTs in human infants. Four groups of patients were studied: (a) infants suffering from pyloric stenosis, (b) premature infants, (c) children suffering from cystic fibrosis, (d) infants with miscellaneous conditions. Infant formulae with known amounts of MCT were introduced by gastric tube and samples were removed at 0, 20, 40, and 60 min. In patients with pyloric stenosis there was an 18.1% decrease in MCT during the first 20 min. No significant changes in MCT took place during the subsequent 40 min. A similar response was observed in the group of premature infants. Older infants with miscellaneous diagnoses and children with cystic fibrosis showed an even rate of disappearance of MCT during the 60‐min test period, and ∼30% of the original MCTs present disappeared during this period. We conclude that MCTs are absorbed in the stomach of infants and children. Absorption appears to improve with age. Because MCT are an important constituent of formulae for premature infants and children with defects of small intestinal digestion and absorption of fat, these observations have practical implications.
Comparison of a Lactose‐Free Cereal‐Based Formula and Cow's Milk in Infants and Children with Acute Gastroenteritis
Authors: Bhan M. K. , Arora N. K. , Khoshoo V. , Raj P. , Bhatnager S. , Sazawal S. , Sharma K.
Published: January 2024

Sixty children < 2 years of age suffering from mild acute gastroenteritis with < 5% dehydration were randomly assigned to two different isocaloric feeding regimens, viz., a locally prepared milk‐free formulation (group A) of rice, lentil, sugar, and coconut oil and a spray dried commercial cow's milk formula (group B). There were two treatment failures in group A and one in group B. The postintervention duration of diarrhea (days) in group A (11.0 ± 10.0) was higher than in group B (7.6 ± 10.8), but these differences were not significant (p > 0.05). The energy intake (kcal/kg/24 h) on postintervention day 4 was 78.7 ± 31.7 in group A and 101.3 ± 41.1 in group B (p > 0.05). The corresponding values for day 7 were 74.2 ± 29.1 and 110.0 ± 41.1, respectively (p < 0.05). The mean weight gain (g/kg/24 h) between admission and the day of recovery in group A (2.0 ± 4.2) was significantly lower (p < 0.05) than in group B (5.8 ± 7.8). Similar trends in weight gain were observed at days 4 and 7. These findings suggest that a cow's milk‐based formula is well tolerated by majority of the infants with mild acute gastroenteritis after initial rehydration with ORS. The infants who were fed the milk‐free cereal‐based diet showed significantly less energy intake and gained weight less rapidly than those who were fed the cow's milk‐based formula.
Characterization of Binding of Simian Rotavirus SA‐11 to Cultured Epithelial Cells
Authors: Keljo David J. , Smith Angela K.
Published: January 2024

Rotavirus causes enteritis in both man and animals. The identity of the rotavirus receptor is not known. The nature of the binding interaction and the relationship between virus binding and internalization have not previously been reported. We studied the binding of [5,6‐3H]uridine‐labeled rotavirus SA11 to confluent monolayers of MA104 cells. We found approximately 13,000 receptor units per cell. The binding was sodium‐dependent, pH‐insensitive between 5.5 and 8, independent of added calcium, and dependent on sialic acid residues in the membrane. It could be inhibited by mucin. These features may provide clues to the identity of the receptor. Virus was not internalized to significant extent at 4°C. After warming to 37°C, virus was internalized over about 60 min. All binding sites appeared to be equally internalizable. The techniques developed to distinguish between binding and internalization may help to elucidate the mechanism of internalization.
An Unusual Presentation of Pancreatic Carcinoma in Childhood
Authors: Weisselberg B. , Yahav J. , Ben‐Ami T. , Engelberg S. , Morag B. , Sack J.
Published: January 2024

Carcinoma of the pancreas is rare in the pediatric population, with only 58 cases described in subjects under 16 years of age (1–3). The clinical presentation generally consists of abdominal pain and mass. We present a case of carcinoma of the pancreas in an 11‐year‐old girl, with abdominal pain and unusual behavior.
Familial Extrahepatic Biliary Atresia
Authors: Lachaux A. , Descos B. , Plauchu H. , Wright C. , Louis D. , Raveau J. , Hermier M.
Published: January 2024

Only a small number of cases with familial extrahepatic biliary atresia, suggesting a recessive autosomal inheritance, have been reported. However, the cases reported in twins are consistent with an acquired disease. Here the case of two brothers with familial atresia of the extrahepatic biliary system is studied. Diagnosis was confirmed by laparotomy and histologic study of biliary fibrous remnants. In the present cases parental consanguinity might suggest a recessive autosomal inheritance. However, clustering of cases in a family might also suggest a common exposure to responsible factors not so far identified.
Familial Achalasia with Absent Tear Production
Authors: Nussinson E. , Hager H. , Samara M. , Bar‐Nathan N. , Siplovich L.
Published: January 2024

Three of five siblings were evaluated because of dysphagia and failure to thrive. Radiologic and manometric studies were consistent with achalasia of the cardia. All of these siblings had deficient tear production. This report documents the unusual association of familial achalasia and deficient tear production, which is probably an autosomal recessive inherited syndrome.
Gastroduodenal Endoscopic‐Histologic Correlation in Pediatric Patients
Authors: Black Dennis D. , Haggitt Rodger C. , Whitington Peter F.
Published: January 2024

The histopathologic abnormalities in endoscopic biopsies from the stomach and duodenal bulb were correlated with the visual findings of upper gastrointestinal endoscopy in 94 children (mean age, 8.4 years; 51 boys and 43 girls) with a variety of complaints. Histology was graded by observers blinded to the endoscopic findings, and both endoscopy and histology were graded using scales reflecting increasing severity with increasing grade. In all three locations studied (gastric body, antrum, and duodenal bulb), endoscopic grade was significantly higher than the histologic grade. Correlation was especially poor with mild endoscopic findings such as erythema and granularity/nodularity, which had little predictive value for histologic inflammation. Few patients had severe disease with eight of 94 having ulcer by endoscopy and seven of 94 having greater than grade 2 histologic disease in any location. We conclude that endoscopy without biopsy should not be used to diagnose gastroduodenal inflammation in pediatric patients.
Heterogeneity of Pepsinogens in the Urine of Children
Authors: Nevoral J. , Tomáŝová H. , Ŝrajer J.
Published: January 2024

The existence of a significant linear relationship between the concentration of chlorides and the activity of pepsinogen (PG) in the urine was ascertained in the case of full‐term infants 3 days to 6 weeks of age. At the age of 4–6 weeks, a significant relationship was found between the urinary pepsinogen activity and the urinary creatinine concentration, and between the urinary pepsinogen activity in the urine and the urine osmolality. Immediately after birth, the Pg7 fraction of PG II in the urine was found in all cases and, at the age of 4–6 weeks, in 11% of cases. In regard to the time factor, the conspicuous drop in the occurrence of the Pg7 fraction corresponds to the new qualitative relationship between the pepsinogen activity in the urine and the creatinine concentration in the urine and between the former and the urine osmolality. In premature infants, the Pg7 fraction disappears more slowly. The spectrum of pepsinogens in the urine was examined in children suffering from various diseases. In a girl with lymphoma, we found the Pg7 fraction, but this finding was temporary only.
Reaction of Rectal Mucosa of Celiac Patients to Direct Contact with Gluten
Authors: de Sousa J. Salazar , Ramalho P. Magalhães , Scares Jorge , Rodrigues Carlos , Costa M. Virgínia , da Silva Aires
Published: January 2024

It is assumed that the eolonic mucosa of celiac patients is not sensitive to gluten. This assumption has been supported by the absence of clinical manifestations of colonic involvement in patients with active celiac disease which, by itself, does not confirm insensitivity to gluten. Eight children, aged from 11 to 25 months, with an initial diagnosis of celiac disease were studied: in five children a definite diagnosis has already been confirmed. Rectal gluten challenge was done by means of retention enemas. A volume of 100 ml of a 10% gluten suspension in water was introduced into the rectum three times per day for 8 days: each enema was retained at least 1 h. Rectosigmoidoscopies and rectal biopsies were done before and at the end of the challenge period. The endoscopic appearance of rectal mucosa was normal in all the children either before or after gluten challenge. The means of total mucosal thickness, intraepithelial lymphocyte counts, mitotic crypt cell activity, and cellular infiltration of lamina propria increased after challenge; the mean of goblet cell/epithelial cell ratio in the surface epithelium decreased. The differences between each pair of means (before and after challenge), however, were not significant except for total mucosal thickness (p < 0.05). the meaning of which is unclear. This study did not definitely demonstrate that the rectal mucosa of celiacs is insensitive to gluten. For practical clinical purposes, however, it behaves as such. This makes the rectal mucosa a useless tool for the final diagnosis of celiac disease.
Crohn's Disease of the Esophagus
Authors: Treem William R. , Ragsdale Bruce D.
Published: January 2024

Esophageul involvement wilh C'rohn's disease has been rarely reported and pathologic documentation of granulomutous disease is often missing. A 12‐year‐old hoy who presented initially with dysphagia, odynophagia, and weight loss was found to have granulomatous esophagitis, gastritis, and subsequent colitis by endoscopic examination. Esophageal manometry showed a hypertensive lower esophageal sphincter with normal peristalsis and sphincter relaxation. The esophageal symptoms responded to oral steroids and sulfasalazine without any specific treatment for acid peptic disease. This case is the youngest reported patient with Crohn's disease of the esophagus. A review of the medical literature illustrates salient clinical, radiographic, endoscopic, and pathologic features of esophageal involvement in Crohn's disease. This case and the summarized cases emphasize the potential significance of esophageal symptoms in patients with Crohn's disease.
Giant Colonic Ulcers Associated with Hirschsprung's
Authors: Peters Mary Ellen , Li B. Ulysses , Kalayoglu Munci
Published: January 2024

Giant colonic ulcers arc described in an infant with Hirschsprung's associated with enterocolitis.
Evaluation of a New Catheter for Total Parenteral Nutrition
Authors: Superina Riccardo A. , Wesson David E. , Bahoric Andre , Filler Robert M.
Published: January 2024

Central venous catheters play an important role in the management of children with a variety of disorders. Desirable characteristics of such catheters include case and reliability of placement, secure fixation, low rates of complication, and ease of removal. We describe our experience with a new form of catheter that displays all of these characteristics. One hundred twenty‐nine catheters were inserted in III paients over a 2‐year period for a total of 5.729 treatment days. This catheter is made of silicone rubber and is positioned by using P‐wave changes seen during intraoperative electrocardiography. x‐Ray confirmation is not routinely necessary. The catheter is fixed in position by use of a grommet, which is sutured in the neck at the site of the venotomy. This form of fixation allows the catheter to be casily in position for the duratio of use. Our experience with this catheter has been associated with a low incidence of septic (1.1–4.2 septic episodes per 1.000 patient days) and mechanical (2.3 episodes per 1,000 patient days) complications in a setting that includes both in‐hospital and home total parenteral nutrition patients. It is felt that this new form of eatheter and catheter fixation offers several advantages over other types of central venous catheters currently in use.
Iron Status in the First Year of Life
Authors: Morton R. E. , Nysenbaum A. , Price K.
Published: January 2024

Summary: The iron status of babies of different race born at term to mothers in an inner city area was studied at birth and during the first year of life and related to maternal iron status. Haemoglobin and ferritin were measured in the mother at term (n = 81) and in the baby in cord blood (n = 55), and at 1 year (n = 51). No relationship was found between the iron status of mothers and their babies at birth. However, iron stores at birth did affect later iron status, cord ferritin being significantly related to ferritin at 6 months (r = 0.42, p < 0.01) and 1 year (r = 0.55, p < 0.01) but not to haemoglobin at these ages. No relationship was found between haemoglobin iron at birth and subsequent iron status. Introduction of full cow's milk before the age of 6 months was associated with iron deficiency at this age and at 1 year. By the age of 1 year, iron deficiency was also associated with feeding >900 ml whole cow's milk a day, inadequate feeding with solids, and higher weight gain. No stool parasites were found at the age of 1 year, and the presence of occult blood in stools did not significantly affect iron status at this age. At 1 year of age, 49% of these infants had low iron stores, including 20% with iron deficiency anaemia. Considerable improvement could result from simple changes in dietary practices.
Changes in the Fatty Acids Pattern of Red Blood Cell Phospholipids Induced by Type of Milk, Dietary Nucleotide Supplementation, and Postnatal Age in Preterm Infants
Authors: Pita María L. , Fernández María R. , De‐Lucchi Carolina , Medina Antonio , Martínez‐Valverde Antonio , Uauy Ricardo , Gil Angel
Published: January 2024

Summary: The fatty acid profile of red blood cell phospholipids and the total phospholipid and cholesterol contents of erythrocyte membrane in preterm infants in the first month of life were studied. Influences of human milk and adapted formula and dietary nucleotides supplementation at a level similar to that found in human milk were evaluated. Nineteen preterm newborn infants with adequate weight for gestational age were fed their own mother's preterm human milk, 18 with a standard milk formula and 18 with the same formula supplemented with nucleotides. Blood samples were obtained at birth from cord blood, and at 30 days of age. At 1 month of life, linoleic acid rose in formula fed infants compared to those fed human milk (p < 0.05) and relative amounts of 20:3w6, 20:4w6, 22:4w6, 22:5w6, and total polyunsaturates of the w6 series greater than 18 carbon atoms were significantly decreased in standard milk formula fed infants (p < 0.05–0.01). No significant differences for these fatty acids were found between human milk and nucleotide milk formula infants. Docosahexaenoic acid (22:6w3) decreased from birth to 1 month of age in formula fed infants (p < 0.01) but not in human milk fed infants. Infants fed nucleotide milk formula showed intermediate values for 20:3w6 and 20:4w6 (p < 0.1) between infants fed human milk and those fed standard milk formula. The unsaturation index of erythrocyte phospholipids was significantly decreased in the standard milk formula fed infants as compared to those fed human milk (p < 0.01) and it showed a trend to be decreased as compared to those fed nucleotide milk formula (p < 0.1). Membrane cholesterol was increased in infants fed standard milk formula compared to those fed nucleotide milk formula (p < 0.05) and those fed human milk (p < 0.1) and the cholesterol/phosphorous molar ratio showed a trend to be increased in standard milk formula fed infants (p < 0.1). We suggest that dietary nucleotides may improve the “in vivo” conversion of parent essential fatty acids to their polyunsaturated long chain derivatives during early life.
Tracheal Obstruction Secondary to Esophageal Achalasia
Authors: Akhter Javeed , Newcomb Richard W.
Published: January 2024

A 12‐year‐old girl presented with cough, emesis, and weight loss of 18‐month duration. She was diagnosed as having achalasia of the esophagogastric junction. Flow‐volume loops done because of the cough revealed a configuration consistent with variable intrathoracic tracheal obstruction. A barium swallow revealed the cause of obstruction to be massive dilatation of the esophagus. Balloon dilatation of the esophageal sphincter resolved all symptoms and normalized the flowvolume loops. This case illustrates that some pulmonary symptoms in achalasia can be due to direct tracheal obstruction in addition to the usual aspiration of esophageal contents.
Development of Glutaminase Along the Villus–Crypt Axis in the Jejunum of Rat
Authors: Nagy Laura E. , Pittler Arlyn , Kretchmer Norman
Published: January 2024

The activity of glutaminase (E.C. 3.5,1.2), the entry enzyme for oxidation of glutamine, was measured in enterocytes isolated along the villus‐crypt axis from rat jejunum. Specific activity of glutaminase was 5.05 ± 0.24 μmol glutamate/mg protein/h in villus cells (fully differentiated cells) and 4.16 ± 0.30 in the deep crypt (undifferentiated cells). Activity of glutaminase was significantly (p < 0.05) increased in cells isolated from the villus–crypt junction (differentiating cells) compared to the activity of the enzyme in both the villus and crypt at 6.21 ± 0.45. A similar pattern of activity of glutaminase was observed when the cells of the villus–crypt gradient were separated by sequential horizontal sectioning with a cryostat. Oxidation of L‐[U‐14C]glutamine to 14CO2 was also significantly (p < 0.01) higher in cells isolated from the villus–crypt junction compared to both villus or deep crypt cells. The quantity of glutaminase protein was determined by a dot immunobinding assay using an antibody to purified glutaminase. Immunoreactive glutaminase protein relative to total cellular protein was 6.06 ± 0.40 cpm/μg homogenate protein in the villus cells, 3.01 ± 0.24 (p < 0.05) at the villus–crypt junction, and 4.49 ± 0.57 (p < 0.05) in the deep crypt. Thus, the highest activity of glutaminase present in the villus–crypt junction is the result of an increase in activity of the enzyme rather than an increase in the enzyme protein.
Effect of Diet on Intestinal and Pancreatic Enzyme Activities in the Pig
Authors: Flores Carlos A. , Brannon Patsy M. , Bustamante Sergio A. , Bezerra Jorge , Butler Kevin T. , Goda Toshinao , Koldovský Otakar
Published: January 2024

Intestinal and pancreatic enzyme activities are known to respond to changes in dietary composition. Studies in rats and humans suggest that adaptive mechanisms differ between species in response to altered intakes of carbohydrate and fat. Because of increased use of the pig in the study of human nutrition, we compared the responses of pancreatic enzymes and intestinal disac‐charidases in groups of 7− to 10‐week‐old pigs fed either high‐carbohydrate/low‐fat (70 cal% starch, 25% protein, 5% fat) or low‐carbohydrate/high‐fat (5, 25, 70%, respectively) diets for 7 and 30 days. No changes were observed in the activities for lactase, trypsin, or chymotrypsin or in the tissue protein concentrations, regardless of diet duration. High‐carbohydrate/low‐fat intake resulted in higher specific activities of sucrase, maltase, and amylase for both periods studied. Low‐carbohydrate/high‐fat intake resulted in higher specific activities of pancreatic lipase for both periods studied. The response of the intestinal disaccharidases differs from that observed previously in rodents but resembles the response reported in humans. Conversely, amylase and lipase responded similarly to the pattern in the rat. These data support the continued use of the pig as a suitable model in the study of adaptation to altered intakes of carbohydrate and fat.
The Occurrence of Intramitochondrial Ca2+ Granules in Valproate‐Induced Liver Injury
Authors: Kimura A. , Yoshida I. , Yamashita F. , Kuriya N. , Yamamoto M. , Nagayam K.
Published: January 2024

Two epileptic patients treated with anticonvulsants of valproic acid, phenobarbital, nitrazepam, and diphenylhydantoin developed anorexia, convulsions, and unconsciousness. The liver biopsy samples showed degenerated hepatocytes containing enlarged mitochondria with a distorted matrix. The matrix granules in the mitochondria were enlarged in size as compared with those of chronic hepatitis (P0 = 0.0009). X‐ray microanalysis has revealed the presence of calcium in large mitochondrial matrix granules. Both patients were thought to have valproic acid intoxication because they recovered quickly after the withdrawal of valproic acid.
Longitudinal Assessment of Type I Procollagen in Children with Inflammatory Bowel Disease Subjected to Surgery
Authors: Hyams Jeffrey S. , Moore Robert E. , Leichtner Alan M. , Carey Dennis E. , Goldberg Burton D.
Published: January 2024

Using radioimmunoassay we have measured the serum concentrations of the C‐terminal propeptide of type 1 procollagen (pColl‐1‐C) in 12 Tanner I‐II subjects (aged 9–16 years) with severe Crohn's disease (8 patients) or ulcerative colitis (4 patients) and markedly decreased growth velocity who were subjected to surgery and 50 similarly aged children with either ulcerative colitis (20 patients) or Crohn's disease (30 patients) and normal growth. Prior to operation, the mean growth velocity and pColl‐1‐C concentration in the former group of 12 children were 0.03 ± 0.02 cm/month (normal >0.5 cm/month) and 14.1 ± 1.9 μg/dl, respectively. This pColl‐1‐C concentration is comparable with that previously reported for adults (5–17 μg/dl) and significantly lower than found in the 50 normally growing children with inflammatory bowel disease (IBD) (46.9 ± 2.0 μg/dl) (p < 0.001). All 12 children subjected to surgery had a marked increase in growth velocity and pColl‐1‐C concentration to 0.73 ± 0.08 cm/month and 59.1 ± 5.6 μg/dl, respectively (p < 0.001 compared with preoperative values). Changes in pColl‐1‐C concentrations antedated measurable changes in linear growth. These data suggest that pColl‐1‐C concentrations can reflect growth velocity in children with IBD subjected to surgery and may provide a rapidly available measure of current “growth activity.”
Functional Capacity of Colostral Leukocytes from Women Delivering Prematurely
Authors: Schlesinger Liana , Muñoz Carlos , Arevalo Marianela , Arredondo Sonia , Mendez Gloria
Published: January 2024

The phagocytic, bactericidal, and metabolic activity of colostral leukocytes from mothers delivering preterm infants was compared with that of colostral leukocytes from mothers of term infants. In addition, the proliferative capacity of colostral lymphocytes was compared. Preterm adherent colostral leukocytes had a significantly higher phagocytic index than term colostral adherent leukocytes. Mean ± SEM values were 5.4 ± 0.5 versus 2.7 ± 0.2, respectively (p < 0.001). Bactericidal capacity against Escherichia coli and nitroblue tetrazolium reduction of preterm and term colostral leukocytes were comparable. Lymphocyte proliferative response was equivalent in preterm and term milk. We conclude that colostral leukocytes from preterm mothers are at least as functional in their antimicrobial activity and possibly phagocytose even better than the colostral cells of mothers of term infants.
Cimetidine Treatment of Reflux Esophagitis in Children
Authors: Cucchiara Salvatore , Gobio‐Casali L. , Balli F. , Magazzú G. , Staiano A. , Astolfi R. , Amarri S. , Conti‐Nibali S. , Guandalini S.
Published: January 2024

The effectiveness of cimetidine (30–40 mg/ kg/day) was evaluated in 32 children with gastroesophageal reflux disease complicated by esophagitis who entered a random double‐blind trial for 12 weeks. Esophagitis was diagnosed in all patients by endoscopy with biopsy. Seventeen patients (age, mean ± SD: 21.7 ± 97.65 months) received cimetidine (c‐pts), and 15 (age, mean ± SD: 29.03 ± 39.73 months) received a placebo (p‐pts). All patients received intensive postural therapy. Based on clinical and endoscopic (and histologic) data, 12 c‐pts and three p‐pts were healed (p < 0.01), the condition of four c‐pts and three p‐pts had improved (not statistically significant), and the condition of one c‐pt and nine p‐pts had worsened (p < 0.01). Both clinical and esophagitis scores significantly decreased only in the c‐pt group, as compared with p‐pts. Improvement of esophagitis was seen in all (100%) of c‐pts with mild or moderate esophagitis versus 57.14% of p‐pts (p < 0.01) and in 87.5% of c‐pts with severe esophagitis as compared with 25% of the p‐pt group (p < 0.01). We conclude that cimetidine is an effective agent for treatment of reflux esophagitis in children. Although gastroesophageal reflux disease in infancy has a naturally self‐limited course with conservative care (thickened feedings and posture adjustment), extensive pharmacologic therapy is needed in the presence of esophagitis.
Patterns of Gastroesophageal Reflux (GER) in Patients with Apparent Life‐Threatening Events
Authors: Newman Leonard J. , Russe J. , Glassman Mark S. , Berezin Stuart , Halata Michael S. , Medow Marvin S. , Dozor Allen J. , Schwarz Steven M.
Published: January 2024

The incidence and temporal patterns of gastroesophageal reflux (GER) in infants presenting with an apparent life‐threatening event (ALTE) was compared with GER characteristics of infants evaluated for persistent emesis, utilizing continuous 24 h intraesophageal pH monitoring. These data indicate that the incidence of significant GER was similar in both groups, despite the absence of a clinical vomiting history in 46% of ALTE patients. Furthermore, infants with ALTE demonstrate a significantly higher incidence of steep reflux when compared with control infants presenting with vomiting alone (27 vs. 0%, p < 0.001). Awake GER beyond the first two postprandial hours was not observed in either study group. Monitoring results, therefore, indicate that significant GER is common in infants with ALTE; and these infants manifest an apparently unique pattern of GER distinct from that observed in age‐matched controls with GER alone. Possible relationships between GER in ALTE patients and the development/onset of apneic episodes are discussed.
Active and Passive Sugar Absorption in Pancreatic Insufficiency
Authors: Murphy M. S. , Sheldon W. , Brunetto A. , Pearson A. D. J. , Laker M. F. , Eastha E. J. , Nelson R.
Published: January 2024

Urinary excretion of lactulose, mannitol, and 3‐O‐methylglucose, following oral administration (5 g, 5 g, and 2 g, respectively, in 100 ml H2O; 80 ml/m2), has been measured in subjects with cystic fibrosis (CF) (22), Shwachman syndrome (3), chronic pancreatitis (3), and normal controls (46). Mean lactulose excretion was increased 10‐fold in CF (p < 0.001), and two‐fold in other disorders associated with pancreatic insufficiency (PI) (p < 0.05). Mean mannitol excretion was 1.6 times greater in CF (p < 0.001), compared with controls, but was reduced in other forms of PI (p < 0.03). The mean lactulose/mannitol excretion ratio was increased in all types of PI (p < 0.001). There were no significant differences in 3‐O‐methylglucose excretion. This study confirms the large increase in lactulose absorption recently reported in CF and also demonstrates increased absorption of mannitol; these changes are different than those in other forms of PI. This study provides further evidence for a specific abnormality of the mucosal barrier to the absorption of passively absorbed, water soluble molecules in CF.
Enzyme‐Linked Immunosorbent Assay and Immunoblotting Determination of Antibody Response to Major Component Proteins of Soybeans in Patients with Soy Protein Intolerance
Authors: Burks A. Wesley , Casteel Helen B. , Fiedorek Stephen C. , Williams Larry W. , Connaughton Cathie , Brooks James R.
Published: January 2024

To evaluate the role of food‐specific antibody response to soy protein and its fractions in patients with soy protein intolerance, allergen‐specific IgG and IgE to these proteins were measured by enzyme‐linked immuno‐sorbent assays (ELISAS) and immunoblotting. A crude soy extract and the 7S, 11S, and whey fractions were isolated from commercial defatted soy flakes. Of 23 patients who underwent standardized soy challenges, seven were positive. The ELISA results showed no statistically different responses between the challenge‐positive and challenge‐negative groups in IgG or IgE specific to either the crude soy extract or the 7S, 11S, and whey fractions (p > .3 for all variables). In comparing the soy‐positive patients, the level of IgE specific for 7S and 11S was significantly different compared with whey; the level of IgE specific for crude soy extract and 7S was significantly different compared with whey. The immunoblots reveal that IgG and IgE are present in varying amounts to multiple fractions of the soy protein. The study does not provide evidence for a pathogenic role of serum food‐specific antibodies in soy protein intolerance.
Bone Mineralization and Mineral Homeostasis in Very Low‐Birth‐Weight Infants Fed Either Human Milk or Fortified Human Milk
Authors: Pettifor John M. , Rajah Rashid , Venter Andre , Moodley Gopal P. , Opperman Lynne , Cavaleros Meropi , Ross F. Patrick
Published: January 2024

Abnormalities in bone mineral metabolism are frequently found in very low‐birth‐weight infants, especially if fed breast milk. To assess the efficacy of a breast‐milk fortifier in the feeding of these very small infants, very low‐birth‐weight babies (between 1,000 g‐1,500 g at birth) were randomly assigned to one of two groups on day 4 of life. The fortified group received the fortifier mixed in equal proportions with their own mother's milk, while the breast‐milk group received only their own mother's milk. All infants received an oral vitamin D supplement of 750 IU/day. The study was continued until the infants weighed 1,800 g, at which stage breast feeding was encouraged. Thirty infants in the breast‐milk group and 29 in the fortified group completed the study. Infants in the fortified group had significantly lower alkaline phosphatase values, a greater bone mineral content (BMC) and BMC/bone width ratio, and lower urinary calcium excretion than the breast‐milk group at a weight of 1,800 g. At follow‐up study 3 months after delivery, when most of the infants in both groups had been breast fed for at least 6 weeks, the breast‐milk group's biochemical and BMC abnormalities were almost totally corrected and were now similar to those of the fortified group. Thus, the addition of the fortifier to breast milk during the first 4–6 weeks of life decreased the biochemical evidence of abnormal bone mineral homeostasis and increased BMC in very low‐birth‐weight infants. By 3 months of age, however, the breast‐milk group had almost totally corrected its abnormalities.
Fatal Multisystem Disease with Immune Enteropathy Heralded by Juvenile Rheumatoid Arthritis
Authors: Pearson Richard D. , Swenson Ida , Schenk Eric A. , Klish William J. , Brown Marilyn R.
Published: January 2024

The prognosis of juvenile rheumatoid arthritis (JRA) is generally good, although premature death occurs in a subset of children. Secondary infections, chronic amyloidosis, and heart disease have been reported as common causes. Our experience indicates that JRA can also herald the development of a severe immune enteropathy. In the case presented, typical JRA was followed by fulminant hepatitis; skin rashes; recurrent, severe, watery diarrhea; malabsorption; and ultimately death. Biopsies of the small bowel exposed to the patient's serum revealed deposition of complement and immunoglobulins in the epithelium. Although not widely appreciated, JRA can herald a multisystem syndrome characterized by severe immune enteropathy.
Oral 5‐Aminosalicylic Acid in Children with Colonic Chronic Inflammatory Bowel Disease
Authors: Tolia Vasundhara , Massoud Neil , Klotz Ulrich
Published: January 2024

Five children between the ages of 10 and 17 years with chronic inflammatory bowel disease with involvement of colon had intolerance to sulfasalazine, and desensitization trials had failed in them. In addition, they were steroid dependent. Therefore treatment was tried with an oral 5‐aminosalicylic acid (5‐ASA) preparation coated with the pH sensitive polymer Asacol. Three of these patients responded to the new drug and were weaned off the steroids. However, the other two patients developed repeated side effects from the medication. Plasma levels and urinary excretion of 5‐ASA and its major metabolite in four of these patients were determined and were noted to be similar to those in the adults. Range of variable steady state plasma level of 5‐ASA was 0.1–5 mg/L and of its acetyl‐metabolite (Ac‐5‐ASA) was 1–8 mg/L.
A Swine Model for Studying Intestinal Circulation of the Newborn
Authors: Bustamante Sergio A. , Lundgren Ove
Published: January 2024

We describe a newborn swine model to study intestinal hemodynamics of developing mammals. The preparation is designed to allow measurement of perfusion pressure and blood flow in an isolated segment of ileum under controlled conditions. Piglets in this study had a mean blood pressure of 65 ± 14 (SD) mm Hg and mean intestinal blood flow of 80 ± 20 (SD) ml/100 g/min at an average age and weight of 6.1 ± 3 (SD) days and 1,718 ± 427 (SD) g (n = 21). Experiments were performed to evaluate the effects of common physiologic perturbations: (a) Increased venous pressure caused a decrease in blood flow proportional to the lower perfusion pressure, but the relative change in vascular resistance was greater than the blood flow change. This effect, suggestive of a myogenic response, was significantly greater at a venous pressure increase of 20 cm of water over baseline compared with an increase of 10 cm water, (b) Gradual decrease in mesenteric artery blood pressure by clamping resulted in proportional decreases in blood flow. The calculated peripheral vascular resistance remained constant at blood pressure greater than 50 mm Hg and then increased as blood pressure decreased, (c) Stimulation of periarterial, postganglionic nerves surrounding the mesenteric artery produced a characteristic initial vasocon‐striction followed by “autoregulatory escape.” Frequency response tests using trains of stimulation of 6 ms and 12 V demonstrated responses starting at 2 Hz and maximal at 16 Hz. We suggest that this model should be applicable to a number of physiologic studies including assessment of water and nutrient flux in the intestine concomitant to changes in the circulation.
Recurrent Infantile Vomiting Due to Intentional Ipecac Poisoning
Authors: Colletti Richard B. , Wasserman Richard C.
Published: January 2024

Recurrent vomiting is a common symptom in infancy that, when severe, may prompt an extensive diagnostic evaluation. We report a 1‐year‐old infant whose recurrent vomiting eluded diagnosis until ipecac syrup was detected in vomitus and urine. Separation of the infant from the mother resulted in complete resolution of the symptoms. In Munchausen syndrome by proxy, a disorder in which a mother fabricates or induces illness in her child, most reported fatalities are due to intentional poisoning. In atypical cases of recurrent vomiting, early screening of body fluids for unexpected drugs, particularly ipecac, may prevent potentially fatal delays in diagnosis.
Acute Self‐Limited Colitis Associated with Cryptosporidium in an Immunocompetent Patient
Authors: Hart Michael H. , Kruger Robert , Nielsen Stephen , Kaufman Stuart S.
Published: January 2024

A case report of acute self‐limiting colitis associated with enteric Cryptosporidium infection in an immunocompetent child is presented. This case broadens the spectrum of symptoms and manifestation of Cryptosporidium infection in a normal human host.
Chronic Inflammatory Bowel Disease in Children in Western Norway
Authors: Olafsdottir Edda J. , Fluge Gjermund , Haug Kjell
Published: January 2024

The incidence of Crohn's disease (CD) and ulcerative colitis (UC) in children in western Norway was estimated in a prospective epidemiological study during the years 1984 and 1985. The total population in the area was 807,000 and the child population was 198,570 (1984). There were 27 new cases of chronic inflammatory bowel disease (IBD) in children aged 15 years or less, 10 new cases of CD, and 17 of UC. The mean annual incidence of CD in the child population was 2.5/100,000/year, whereas the incidence of UC in the child population was 4.3/100,000/year. Nearly all the children had abdominal symptoms. In this study, we found an incidence of CD in children that is the highest hitherto reported, to our knowledge. To the contrary, the incidence of UC was considerably lower than previously reported from northern Europe.
Breast‐Milk Fatty Acids of Rural Gambian Mothers
Authors: Prentice Ann , Jarjou Landing M. A. , Drury Patrick J. , Dewit Odile , Crawford Michael A.
Published: January 2024

The influence of diet and maternal parity on the fatty acid composition of mature breast milk have been studied in 23 rural Gambian mothers. The subjects' habitual diet was low in fat (16% total energy), groundnuts (peanuts) constituting the principal fat source. The high abundance of oleic and linoleic acids in groundnut fat were reflected in the proportions of these fatty acids in breast milk (47.0 ± 1.5 and 13.0 ± 0.3 g/100 g fat, respectively), which were elevated compared with mothers in other African communities. Estimates of daily breast‐milk fatty acid secretion indicated that there was little risk of essential fatty acid deficiency in Gambian infants. The proportions of fatty acids synthesized de novo (10:0, 12:0, 14:0) were less than expected from published studies of mothers consuming low‐fat diets, averaging 16.8 ± 1.4 g/100 g fat. As the study was conducted at a time of food shortage and high energy expenditure, it is argued that mobilisation of body fat during negative energy balance increased the availability of long‐chain fatty acids to the breast. The proportion of endogenous fatty acids was markedly reduced in the milk of mothers of very high parity (parity 1 = 19.3 ± 1.6 g/100 g fat; parities 10 + = 11.4 ± 1.5 g/100 g fat; p < 0.01). It is hypothesised that this represents an impairment of the ability to synthesise breast‐milk fatty acids de novo in these mothers.
Identification of the Cause of Separation (Creaming) of Lipid Emulsions in Intravenous Infusion
Authors: Rattenbury J. M. , Timmins J. G. , Cawthorne E. A. , Ganapathy S. , Taylor C. J.
Published: January 2024

Over a 2‐month period, white deposits were found in infusion sets delivering parenteral nutrition mixtures that included a lipid emulsion. When components of the infusion were mixed in the laboratory, separation (creaming) of the emulsion could be demonstrated, and this enabled us to predict the concentrations of the prescribed infustes that were likely to cream. Further investigations showed that creaming occurred when the lipid emulsion was mixed with heparin and calcium ions at concentrations above 1 U/ml and 1 μmol/ml, respectively.
Acute Pancreatitis from a Duodenal Foreign Body in a Child
Authors: Dabadie A. , Roussey M. , Betremieux P. , Gambert C. , Lefrancois C. , Darnault P.
Published: January 2024

A 14‐month‐old child was admitted to the hospital with acute pancreatitis, abdominal pain, and shock. An abdominal radiograph revealed a paper clip standing out at the duodenal level. The foreign body was removed by endoscopy, revealing an edematic and hemorrhagic duodenal papilla. The patient progressed favorably after the foreign body was removed. This observation underlines the necessity of digestive transit surveillance of a foreign body that has not been endoscopically removed and the relevancy of duodenal endoscopy for acute pancreatitis of indefinite etiology.
Retrograde Esophagoscopy for Foreign Body Removal
Authors: Winkler Ann Rody , McClenathan Daniel T. , Borger James A. , Ahmed Nasim
Published: January 2024

Foreign bodies of the esophagus may penetrate the wall and migrate extralumenally, requiring a thoracotomy for removal. We report two children who swallowed coins that went undetected for several months and slowly eroded into the esophageal wall. These coins could not be retrieved by upper endoscopy, because of proximal strictures and granulation tissue at the perforation sites. Following surgical gastrostomy and retrograde flexible endoscopy, the coins were successfully removed. Retrograde endoscopy should be considered for removal of foreign esophageal objects before undertaking a thoracotomy.
Survival Rate in Children with Fulminant Hepatitis Improved by a Combination of Twice Daily Plasmapheresis and Intensive Conservative Therapy
Authors: Shin Kenji , Nagai Yoji , Hirano Chiaki , Kataoka Natsue , Ono Ichiro , Yamamura Eiji , Moriyama Chiaki , Horigome Yumi , Ehara Takao , Kamoda Tomohiro , Sumazaki Ryo , Hanada Takashi , Hamano Kenzo , Ogata Takesaburo , Takita Hitoshi
Published: January 2024

Six of seven children with fulminant hepatitis (FH) were treated with a combination of twice daily plasmapheresis and intensive conservative therapy including special amino acid solution, glucagon‐insulin therapy, dexamethasone, and so on. The remaining child was treated with intensive conservative therapy only because his condition was not so severe, in spite of being diagnosed as having fulminant hepatitis. Although five patients with biopsy‐documented bridging hepatic necrosis or confluent hepatic necrosis in the acute phase made recoveries, the remaining two with massive hepatic necrosis died (the overall survival rate was 71%). The prognostic factors were considered to be the degree and pattern of liver cell necrosis, the degree of coma, and the etiology. The combination of twice daily plasmapheresis and intensive conservative therapy was effective for these pediatric patients with fulminant hepatitis, except those with massive hepatic necrosis.
Prognostic Significance of Epithelioid Granulomas Found in Rectosigmoid Biopsies at the Initial Presentation of Pediatric Crohn's Disease
Authors: Markowitz James , Kahn Ellen , Daum Fredric
Published: January 2024

The prognostic significance of epithelioid granulomas in Crohn's disease (CD) remains controversial. We have determined the prognostic significance of epithelioid granulomas noted in endoscopic rectosigmoid biopsies obtained from untreated pediatric patients at initial presentation of CD. Data collected from 19 subjects with rectosigmoid granulomas and inflammation (Group 1) were compared to those obtained from another 37 subjects (Group 2) with CD of the rectosigmoid, but in whom no granulomas were present. Both groups had similar ages at disease onset [Group 1: 11.6 + 3.6; Group 2: 10.4 + 4.0 years (X + SD)]. At diagnosis, Group 1 had more extensive CD (small bowel and colon involvement, with Group 1 74% versus Group 2 30%; isolated rectosigmoid involvement, with Group 1 11% versus Group 2 35%; p < 0.01). Perianal disease was also more common in Group 1 (58% versus 27% Group 2; p < 0.05). However, CD activity scores and clinical laboratory findings were comparable. Duration of follow‐up was identical (5.6 + 3.3 years) for both groups. By the end of the period of follow‐up, 43% of Group 2 had developed small bowel involvement, but Group 1 continued to have more extensive CD (p < 0.05). Perianal fistulae and abscesses and anal stenosis were more frequent in Group 1. Throughout this period, the need for oral and parenteral corticosteroids, 6‐mercaptopurine, and nutritional support modalities were similar in the two groups. Although the number of subjects requiring hospitalization and the number of hospitalizations per patient were similar in both groups, Group 1 had more surgery (p < 0.05). Rectosigmoid epithelioid granulomas appear, therefore, to be a finding associated with a poorer prognosis when discovered at the time of initial diagnosis of CD in children.
Nutritional Balance Studies of VLBW Infants Fed Their Mothers' Milk Fortified with a Liquid Human Milk Fortifier
Authors: Raschko Paula K. , Hiller Jan L. , Benda Gerda I. , Buist Neil R. M. , Wilcox Kim , Reynolds John W.
Published: January 2024

This article reports the results of a study designed to compare human milk fortified with a liquid human milk fortifier to a preterm infant formula by analyzing the metabolic balances of certain nutrients when these milks are fed to premature infants. Ten very low birth weight (VLBW) infants were studied during 4‐day equilibration periods, then 4‐day metabolic balances of N, fat, Ca and P. while each consumed a 1:1 mixture of a pool of its own mother's milk and the liquid human milk fortifier (HM/LF). For comparison, another 10 VLBW infants were studied in similar fashion while consuming the preterm infant formula (PF). Percent nitrogen retentions were 77 + 4% ( + SD) and 79 + 4%, and fat absorptions were 94 + 7% and 92 + 5% in the HM/LF and PF groups, respectively, and did not differ between the groups. Calcium retention was 86 + 21 mg/kg/day (51 + 12%) in the HM/LF group and 104 + 43 mg/kg/day (45 + 19%) in the PF group. The percent Ca retentions did not differ. Phosphorus retentions were 56 + 7 mg/kg/day (67 + 9%) and 77 + 18 mg/kg/day (61 + 14%) in the HM/LF and PF groups, respectively. Increases in weight, length, and occipitofrontal circumference (OFC) were similar and normal in both groups. We conclude that VLBW infants fed the HM/LF, mixed 1:1 with their mothers' milk, had rates of absorption and retention of Ca, P, N, and fat similar to rates found in the concurrent study of VLBW infants fed a commercially available PF.
Diminished Brush Border Membrane Na‐Dependent L‐Alanine Transport in Acute Viral Enteritis in Piglets
Authors: Rhoads J. Marc , MacLeod R. John , Hamilton J. Richard
Published: January 2024

We studied sodium‐dependent uptake of L‐alanine into small intestinal brush border membrane vesicles (BBMV) isolated from piglets 40 h after infection with transmissible gastroenteritis (TGE) virus. Vesicles from TGE‐infected pigs and uninfected litter‐mate controls showed comparable degrees of enrichment and purity. In BBMV prepared by conventional techniques, [3H]L‐alanine “overshoot” (peak uptake/equilibrium uptake) in the presence of a Na gradient was preserved in TGE BBMV, unlike [3H]D‐glucose “overshoot,” which was reduced. When these experiments were repeated using vesicles of greater purity, initial rates of Nadependent L‐alanine influx were reduced in BBMV from infected piglets under voltage clamped conditions with valinomycin. These studies demonstrate a specific amino acid transport defect in the small intestinal epithelium during acute viral diarrhea. They demonstrate too that brush border L‐alanine‐Na co‐transport, although reduced, is present after viral damage, confirming previous studies that showed additive effects of amino acid and glucose on jejunal epithelial Na+ transport in transmissible gastroenteritis. Our findings support the concept that, in viral enteritis, oral rehydration solutions containing amino acid and glucose have a theoretical advantage over glucose electrolyte solutions because they facilitate brush border Na+ entry by two carrier mechanisms.