bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Study of the Pathogenesis of Choledochal Cyst and Pancreatitis, with Special Reference to the Role of Bile Acids and Pancreatic Enzymes in the Anomalous Choledocho‐Pancreatico Ductal Junction
Authors: Yamashiro Y. , Miyano T. , Shimomura H. , Suda K. , Matsumoto M. , Nittono H.
Published: February 2024

To investigate the mechanisms initiating pancreatic enzyme activation followed by the development of a choledochal cyst and/or pancreatitis under anomalous choledocho‐pancreatic ductal junction (ACPDJ), choledocho‐pancreatic end‐to‐side ductal anastomosis was successfully performed in 40 puppies as an experimental model of ACPDJ. As a result, reflux of pancreatic juice into the common bile duct readily and continuously occurred, and all pancreatic enzymes in bile obtained from the common bile duct were activated. Total bile acids increased about 2 months after surgery, and the ratio of taurodeoxycholic acid to total bile acids increased within the first months after surgery. Various degrees of common bile duct dilatation developed in all puppies within 7 to 10 days after the surgery, and no further dilatation occurred in the subsequent period. Histological change in the pancreatic duct was less prominent than that in the common bile duct, but histologically proved chronic pancreatitis was found in three of 23 sacrificed dogs, in which there was strong evidence of free and massive regurgitation of the bile‐pancreatic juice mixture between the bile and the pancreatic duct systems. These findings in this experimental study constitute the first step to prove that ACPDJ, which is often found in patients with choledochal cyst, is an important etiologic factor not only for choledochal cyst but also for pancreatitis, and bile acids play an important role in the mechanism of pancreatic enzyme activation under the condition of ACPDJ.
Antibodies to Liver‐Specific Lipoprotein in Children with Chronic Liver Disease Due to “Autoimmune” Chronic Active Hepatitis, Cystic Fibrosis, and α1‐Antitrypsin Deficiency
Authors: Larcher V. F. , Macdonald A. , Vegnente A. , Mowat A. P. , Eddleston A. L. W. F. , Williams R.
Published: February 2024

Antibodies to a liver‐specific lipoprotein complex (LSP) were determined by radioimmunoassay in the sera of 65 children with possible chronic liver disease. Thirteen had “autoimmune” chronic active hepatitis (CAH), 21 α1‐antitrypsin deficiency PiZ (α1‐ATD), all having significant liver disease, while 10 of 31 children with cystic fibrosis (CF) had abnormal biochemical tests of liver function, six having cirrhosis. Sera from 12 (92%) of 13 untreated CAH patients contained detectable anti‐LSP antibodies, the highest titres occurring in those with anti‐liver/kidney microsomal or smooth muscle antibodies. Titre of anti‐LSP antibodies correlated with piecemeal necrosis of periportal hepatocytes in liver biopsies, but not with standard biochemical tests of liver function or serum immunoglobulin concentrations. The incidence of LSP antibodies fell as liver damage improved with immunosuppressant therapy, being positive in 18 of 26 sera from children in whom the transaminases were still above normal, but positive in only two of 20 in whom transaminase values were within the normal range (2 = 16, p<0.001). Sera from two of 31 patients (6%) with CF contained anti‐LSP antibodies as did sera from six of 21 patients with α1‐ATD. Antibody concentrations were lower than in CAH, and in α1‐ATD the presence of anti‐LSP could not be correlated with the presence or absence of piecemeal necrosis on liver biopsy. Our data suggest that autoimmune mechanisms involving antibody to hepatocyte membrane components have a role in the pathogenesis of chronic liver disease in autoimmune CAH in children as in adults. Autoimmune mechanisms involving antibodies to LSP may perpetuate or potentiate liver damage in some patients with α1‐ATD, but the precise pathogenic role and factors controlling it remain to be defined.
Splenic Cyst Presenting as a Gastric Mass
Authors: Berquist William E. , Diament Michael , Fonkalsrud Eric W.
Published: February 2024

A 14‐year‐old girl with bulimia was found to have an apparent submucosal mass of the gastric cardia by upper gastrointestinal series and endoscopy. At laparotomy the mass was found to be a 5 cm in diameter subcapsular serous splenic cyst compressing the stomach but not attached to it. The clinical and diagnostic features of this unusual lesion are reviewed, with particular emphasis on the endoscopic findings.
Sulfated and Nonsulfated Bile Acids in Urine of Patients with Biliary Atresia
Authors: Nittono H. , Obinata K. , Nakatsu N. , Watanabe T. , Niijima S. , Sasaki H. , Arisaka O. , Kato H. , Yabuta K. , Miyano T.
Published: February 2024

To elucidate urinary bile acid patterns in patients with biliary atresia (BA), 15 sulfated and nonsulfated bile acids in urine were separately measured by high‐performance liquid chromatography. This relatively simple technique for fluorescence detection utilizes the enzyme 3α‐hydroxysteroid dehydrogenase (3α‐HSD) to reveal urinary bile acid patterns. By this method, recovery rates of sulfated and nonsulfated bile acids in urine were satisfactory, and this analysis was shown to be applicable to clinical situations. In 10 patients with BA, the mean level of total bile acids in urine (23.35 ± 18.51 μmol/day) was seven times higher than the mean level in eight normal infants (3.05 ± 2.05 μmol/day). In the infants with BA, the mean level of total sulfated bile acids was about half of the total bile acid level. The main components of urinary nonsulfated bile acids in BA were glycocholic acid (6.21 ± 5.55 μmol/day) and taurocholic acid (2.28 ± 1.33 μmol/day), whereas the main components of the urinary sulfated bile acids were glycochenodeoxycholic acid (4.58 ± 6.97 μmol/day) and taurochenodeoxycholic acid (3.67 ± 3.54 μmol/day). Chenodeoxycholic acid, which is relatively toxic to the liver, may more easily be conjugated with sulfate and, hence, excreted into urine at a faster rate than cholic acid. Marked individual variations in urinary bile acid patterns were observed not only in BA patients but also in normal controls.
A Prospective Randomized Double‐Blind Study of Gastroesophageal Reflux Surgery in Pediatric‐Sized Developmentally Disabled Patients
Authors: Gourley Glenn R. , Pellett John R. , K. Li B Ulysses , Adkins William N.
Published: February 2024

In order to compare the standard Nissen fundoplication with the more recent Angelchik antireflux prosthesis, 47 pediatric‐sized, developmentally disabled patients were prospectively randomized to receive either of these gastroesophageal antireflux procedures. The two groups were comparable at the time of surgery with regard to age, weight, surface area, emesis, number of chest radiographs, medications, lower esophageal sphincter pressure, and number and duration of reflux episodes during standard acid reflux testing. The Angelchik group required significantly less anesthesia time than the Nissen group: 107.4 ± 22.6 min (mean ± SD) versus 156.5 ± 42.4 min (p < 0.001). There was no difference in length of postsurgical hospital stay. Six months after surgery, both groups showed improvement. There was no significant difference between the Angelchik and Nissen groups in mean subjective assessment score, increased weight gain, decreases in emesis, numbers of chest radiographs, hospital days, or medications, increased lower esophageal sphincter pressure, or decreased numbers and duration of reflux during acid reflux testing. Long‐term follow‐up of eight Angelchik and 10 Nissen patients 12–30 months postsurgery (Angelchik 21.6 ± 6.0 months, Nissen 21.9 ± 5.0 months) demonstrated no significant difference in the percent of time the distal esophageal pH was below 4.0. Significant complications potentially related to the type of procedure developed in 1/21 patients in the Angelchik group and 1/17 patients in the Nissen group. We conclude that both procedures are usually effective for the surgical treatment of gastroesophageal reflux. Further study is indicated in order to establish the long‐term superiority of one procedure.
Incisionless Gastrostomy for Nutritional Support
Authors: Mago Hernan , Chen Chao‐Long , Wesson David E. , Filler Robert M.
Published: February 2024

A technique of percutaneous endoscopic gastrostomy was evaluated in 51 children and young adults aged 4 months to 26 years (mean, 9.7 years). Indications for gastrostomy included malnutrition secondary to cystic fibrosis, severe CNS disease, and others. The procedure was performed in 26 patients using local and topical anesthesia. General anesthesia was employed in children under 8 years of age. Duration of operative procedure ranged from 20 to 60 min. The average time for maintenance of feeding gastrostomy was 5.6 months. No procedure‐related deaths were observed. Significant complications occurred less frequently than with traditional gastrostomy. We conclude that this procedure is technically simpler than, and at least as safe as, other methods of gastrostomy. It is especially useful in children for whom general anesthesia is best avoided.
Protein Quantity and Quality in Term and Preterm Infants
Authors: Rassin David K. , Gaull Gerald E. , Raiha Niels C. R. , Heinonen Kirsti , Jarvenpaa Anna‐Liisa
Published: February 2024

The effect of dietary protein quantity and quality on the excretion of creatinine in preterm and term neonatal infants has been investigated. Whey protein predominant formulas result in increased creatinine excretion as compared with either casein protein predominant formulas or with pooled human milk in preterm infants (p < 0.01 by ANOVA). The volume of human milk (170 versus 185 versus 200 ml/kg/day) appears to have little effect in these infants. In term infants, few differences among the feeding groups were observed, although creatinine excretion did increase with time. The pattern of creatinine excretion among feeding groups was similar regardless of whether or not the data were expressed in milligrams per deciliter or in milligrams per 24 hours. Small correlations of creatinine excretion with birth weight were observed, but these appeared to vary, depending on the type of feeding. These diet‐induced differences in creatinine excretion indicate the need for caution in expressing other urinary metabolites, such as amino acids, relative to creatinine excretion.
Milk Protein Quality in Mothers Delivering Prematurely
Authors: Britton John R.
Published: February 2024

Because reports comparing the nitrogen content of breast milk from mothers delivering prematurely and at term have conflicted, the present study sought to compare these milks during the first month of lactation with respect to total protein and the distribution of protein among individual protein species and amino acids. No significant differences in total protein concentration were established. However, immunoglobulin comprised a greater proportion of protein in preterm milk than in term milk. The major component of the milk casein fraction, β‐casein, was present in similar proportions in early term and preterm milk, yet increased with time in term milk but not preterm milk. Lactoferrin and lactalbumin were similar in both milks. Differences in amino acid composition were found for serine, arginine, and tyrosine. With respect to protein composition, preterm milk and term milk thus differ during the first month of lactation, and the different patterns of change in individual components suggest that factors other than milk volume contribute to protein content.
Return of Peristalsis in a Child with Esophageal Achalasia
Authors: Cucchiara S. , Staiano A. , Di Lorenzo C. , D'Ambrosio R. , Andreotti M. R. , Auricchio S.
Published: February 2024

The clinical case of a 14‐month‐old girl with esophageal achalasia is described. Manometry revealed aperistalsis throughout the esophageal body and impaired relaxation of the lower esophageal sphincter. Six months after Heller's myotomy, manometric examination of the esophagus showed the return of peristalsis.
Gastrointestinal Tract Angiography in Infants and Children
Authors: Afshani Ehsan , Berger Paul E.
Published: February 2024

In the past 10 years since the development of newer imaging modalities, the method of evaluation of gastrointestinal diseases has changed to less invasive examinations. Angiography of the gastrointestinal tract and its accessory organs, which once was one of the primary procedures for hepatic tumors especially, is now considered nonessential except for occasional demonstration of vascular distribution prior to attempted surgery. As for gastrointestinal bleeding, although the incidence of ulcer disease is not as common in children as in adults, a child with bleeding who is at high risk for surgery will benefit occasionally from intra‐arterial infusion of vasopression. As the major cause of gastrointestinal bleeding in children is from esophageal varices, though great anatomical detail of portal circulation can be seen in computed tomography and ultrasound, the coronal mapping of vascular anatomy of portal circulation is of utmost benefit prior to any attempt for surgery. Intra‐arterial portography and splenoportography can be very helpful to delineate the anatomy and hemodynamics of portal hypertension, as well as for evaluation of suspected shunt thrombosis. Briefly, an update of information on digital subtraction angiography in gastrointestinal pathology will be given though the pediatric application has not been as popular as in adults.
Evaluation of the Nutritional Condition and Absorptive Capacity of Nine Infants with Short Bowel Syndrome
Authors: Ohkohchi N. , Igarashi Y. , Tazawa Y. , Abe H. , Kobayashi Y. , Ohi R. , Kasai M.
Published: February 2024

Nutritional conditions and absorptive capacity of nine infants with short bowel syndrome were investigated during a long follow‐up period from 1.5 years to 14 years and 7 months. The length of the residual small intestine ranged between 13‐90 cm. The nine infants had normal meals at home and most of them did not suffer from persistent diarrhea. Most of the infants were thin. Nutritional parameters were kept relatively normal. The results of dxylose absorption test had gradually improved, but the absorptive capacity of sugars and amino acids, observed by potential differences, were within the normal limits or slightly subnormal except for one infant. This indicated that the absorptive capacity of sugars and amino acids per a given area of the residual small intestine did not increase. Severe steatorrhea continued for several years in infants with less than 50 cm of small intestine. In these infants the concentration of serum vitamin D and total cholesterol were below the normal limits and the absorption of bile acids was disrupted. From our examination, infants with less than 50 cm of small intestine must be followed up for a long period and nutritional supplements are necessary.
Use of Powdered Formula and Incidence of Underweight Among Infants of Educated and Uneducated Mothers in Ile‐Ife, Nigeria
Authors: Ojofeitimi E. O. , Elegbe I. A. , Afolabi O. A.
Published: February 2024

The duration of usage of a tin of powdered formula and the incidence of underweight among 250 infants 14 days to 12 months old, whose parents were educated and uneducated, are reported. Twenty‐two percent of the educated mothers and 42% of the uneducated mothers started their infants on formula from the 14th day of life. Only 6 % of all the mothers exclusively breastfed for 1 month, and a meager 2% of the uneducated mothers exclusively breastfed for 3 months. There was a significant (p < 0.001) increase in the duration of usage of a tin of powdered formula among the uneducated mothers as compared to the educated ones. Of the 250 infants, 93 (37.2%) ≥ 1 month old were assessed as underweight for age. Most of the underweight infants had uneducated mothers. Practical ways of improving feeding practices and curbing early introduction of supplementary feeds are suggested.
Release of Membrane from Milk Fat Globules by Conjugated Bile Salts
Authors: Patton Stuart , Borgström Bengt , Stemberger Bridget H. , Welsch Ulrich
Published: February 2024

We investigated the capacity of conjugated bile salts to remove the membrane, a barrier to lipolysis, from milk fat globules. Cow, goat, and human globules were subjected to varying concentrations of the bile salt taurodeoxycholate at 37°C for 2 min, and the released material was obtained by centrifugation at 2°C and 50,000 g for 1 h. Sedimented pellets were analyzed for phospholipid and protein and were characterized further by sodium dodecylsulfate‐polyacrylamide gel electrophoresis. Pellets were examined in the electron microscope. Measurable amounts of membrane were sedimented from globules incubated at 37°C for 2 min in 0.5 mM taurodeoxycholate. Taurocholate also exhibited this membrane‐releasing ability. However, disintegration of milk fat globule membrane appears to be the principal effect of these salts at 37°C. Our results show that conjugated bile salts within their normal concentration range (2‐6 mM) in digesta of term and preterm infants are capable of removing membrane from milk fat globules.
Forms of Human Milk Folacin and Variation Patterns
Authors: Brown Cecelia M. , Smith Anne M. , Picciano Mary Frances
Published: February 2024

The pattern of folacin in 180 human milk samples collected from 16 women was studied before and after pteroylglutamic hydroxylase (conjugase) treatment. The differential response of Lactobacillus casei versus Streptococcus faecalis distinguishes N‐5‐methyltetrahydro‐folate from other forms. Growth of Pediococcus cerevisiae differentiates the reduced monoglutamates, other than the N‐5‐methylated derivative, from oxidized folacins. Mean folacin activity with L. casei was 85.3 ng/ml. Prior to conjugase treatment of samples, mean activity was 46.9 ng/ml with this organism. The responses of S. faecalis and P. cerevisiae were 48% and 7.6%, respectively, of the total L. casei active folacins. The total L. casei active folacins increased from 76.5 ng/ml at 6 weeks of lactation to 97.1 ng/ml at 12 weeks of lactation. Increases were also observed with time of day: from morning (65.7 ng/ml), to afternoon (80.0 ng/ml), and to evening (114.7 ng/ml). Hindmilk had greater total L. casei activity (100.0 ng/ml) than foremilk (73.8 ng/ml). Although folacins active for S. faecalis and P. cerevisiae were not affected by duration of lactation, increases in folacin activity with time of day and from foreto hindmilk were observed using both of these organisms. Values for the folacin content of human milk are therefore dependent on sampling procedures. Pteroylpolyglutamates of ≥ 3 glutamic acid residues and N‐5‐methyltetrahydrofolate are the predominant forms of human milk folacin based on differential growth responses of L. casei, S. faecalis, and P. cerevisiae to these forms.
Chronic Gastroenteritis in a Patient with Histiocytosis‐X
Authors: Sutphen James L. , Fechner Robert E.
Published: February 2024

We describe a 5‐year‐old white girl who presented at 18 months of age with an ileal perforation and radiographic evidence of segmental intestinal narrowing. Her initial diagnosis was Crohn's disease; however, on subsequent microscopic review, her lesion consisted of mixed histiocytic and eosinophilic infiltration characteristic of histiocytosis‐X. The case is unique in its clinical similarity to Crohn's disease and its paucity of extraintestinal manifestations in the face of persistent mild chronic intestinal symptoms. She remains well controlled on prednisone therapy.
Risk Factors for Developing and Dying from Necrotizing Enterocolitis
Authors: Milner Martha E. , de la Monte Suzanne M. , Moore G. William , Hutchins Grover M.
Published: February 2024

Summary: A case‐control study was performed to identify risk factors for developing and dying from necrotizing enterocolitis (NEC). Eighty‐six infants observed at The Johns Hopkins Hospital who had clinical and/or pathological evidence of this disease during the past 10 years were studied. Birth weight matched autopsied control infants without NEC were also studied for comparison with the autopsied infants who died with NEC. Patients with NEC had a mean birth weight of 1,620 ± 198 g, and those who died from NEC had even lower birth weights (1,418 ± 109 g). The development of NEC was correlated with significantly higher frequencies of oral feeding (p < 0.005) and septicemia (p < 0.001). Death with NEC was correlated with earlier onset and more extensive disease (both p < 0.05), hypotension (p < 0.001), septicemia (p < 0.001), persistent respiratory distress (p < 0.05), a patent ductus arteriosus (p < 0.05), and lower 5‐min Apgar scores (p < 0.05). These findings suggest that NEC is caused by overwhelming hypotensive/ischemic injury to the intestines in association with enterosepticemia. Intestinal immaturity and oral feedings appear to be important predisposing factors in this condition.
Maltase‐Glucoamylase and Residual Isomaltase in Sucrose Intolerant Patients
Authors: Skovbjerg Hanne , Krasilnikoff Peter A.
Published: February 2024

Summary: Small intestinal biopsies from nine patients with sucrase‐isomaltase deficiency (sucrose‐intolerance) were analyzed. All patients lacked sucrase activity and three patients had a residual isomaltase activity and a corresponding isomaltase precipitate following immunoelectrophoresis. By polyacrylamide gel electrophoresis in sodium dodecyl sulfate followed by immunoblotting the residual isomaltase appeared as a single polypeptide with molecular weight of ∼145,000. Maltase‐glucoamylase in the biopsies was specifically quantitated by crossed immunoelectrophoresis. One of the patients had an almost total deficiency of maltase‐glucoamylase in the biopsy, three patients had a normal amount of maltase‐glucoamylase, and five patients constituted an intermediary group. These results indicate that some of the sucrase‐isomaltase deficient patients also have a more or less pronounced deficiency of maltase‐glucoamylase. The patients constitute an even more heterogeneous group than earlier suggested and should be classified by the amount not only of sucrase and isomaltase but also of maltase‐ glucoamylase.
Mechanism of D‐Xylose Transport in Human Small Intestine
Authors: Ohkohchi N. , Himukai M. , Igarashi Y. , Kasai M.
Published: February 2024

Summary: The transport mechanism of D‐xylose across the mucosal border of small intestine was investigated in humans both in vitro and in vivo. A comparative study was also made between infants and adults. We investigated the Na+ dependence of D‐xylose influx from the mucosal solution into the epithelial cells, the phlorizin sensitivity of the influx, transport kinetics and electro‐genie property of the D‐xylose transport. The results of kinetic study indicated that the transport of D‐xylose was completely diffusional. The influx of D‐xylose across the mucosal border of human small intestine was Na+ independent and phlorizin insensitive. The electrical property of D‐xylose transport could not be observed. There was no difference in the characteristics of D‐xylose transport between small intestines of infants or adults. These results in the present study suggest that D‐xylose does not share a common transport mechanism of D‐glucose, and xylose tolerance test does not give any information about the absorptive capacity of D‐glucose.
Diamine Oxidase in Serum and Small Intestinal Biopsy Tissue in Childhood Celiac Disease
Authors: Forget P. , Grandfils C. , Van Cutsem J. L. , Dandrifosse G.
Published: February 2024

Summary: Diamine oxidase (DAO) activities were measured in small intestinal biopsies and in serum from control children and children with florid celiac disease. Mucosal DAO activities were found to be significantly higher in control children when compared with children with celiac disease (mean ± SEM: 486 ± 39 versus 121 ± 22.1 nmol h‐1 g‐1 wet weight, p < 0.001). Similarly, serum DAO activities were significantly higher in control children when compared with children with celiac disease (mean ± SEM: 39 ± 12 versus 13.6 ± 2 pmol h‐1 ml‐1 serum, p < 0.002). The lower serum activities associated with low mucosal values support the hypothesis that serum DAO activity reflects small bowel integrity.
Effects of Increased Calcium and Phosphorous Formulas and Human Milk on Bone Mineralization in Preterm Infants
Authors: Chan Gary M. , Mileur Laurie , Hansen James W.
Published: February 2024

Summary: By photon absorptiometry, extrauterine bone mineralization was evaluated in preterm infants (< 1,600 g birth weight) fed either (a) a commercial premature formula containing 117 mg calcium, 58.5 mg phosphorus/100 kcal, (b) the same formula containing higher phosphorus (82 mg/100 kcal), (c) the same formula with higher calcium (140 mg Ca) and phosphorus (82 mg/100 kcal), or (d) their own mother's milk. All infants had serum protein, albumin, calcium, phosphorus, bicarbonate, 25‐hydroxy‐vitamin D, and alkaline phosphatase levels done at the start of the study and every 2 weeks until they weighed 1,900 g. At the start of the study, birth weight and gestational ages were similar in all four groups. There were no biochemical differences among the four groups except for a lower serum P in the human milk group. The human milk group had lower bone mineralization rate compared with the three formula groups. Bone mineral content was similar in the three formula‐fed groups. However, only formulas containing 117 mg Ca and 58.5 mg P or 140 mg Ca and 82 P mg/100 kcal approximated intrauterine bone mineralization. Human milk fed infants did not approximate and were significantly different from the intrauterine rate.
Fulminant Hepatic Failure with Intractable Ascites Due to an Echovirus 11 Infection Successfully Managed with a Peritoneo‐Venous (LeVeen) Shunt
Authors: Gillam Geoffrey L. , Stokes Keith B. , McLellan James , Smith Arnold L.
Published: February 2024

Summary: A case is described of an infant who at 5 days of age developed an echovirus 11 infection with hepatic failure and intractable ascites, refractory to medical treatment. The ascites was successfully controlled with a peritoneo‐venous (LeVeen) shunt inserted at 6 weeks of age. The shunt was subsequently removed when the infant was 4 months of age with no recurrence of ascites. At long‐term follow‐up he is growing and developing normally. This case shows that an adult LeVeen shunt can be successfully modified for use in the newborn with worthwhile long‐term survival.
Long‐Term External Catheter Biliary Drainage for Recurrent Cholangitis After Hepatoportoenterostomy
Authors: Gleghorn Elizabeth E. , Rosenthal Philip , Vachon Linda , Diament Michael
Published: February 2024

Summary: An infant developed relapsing cholangitis following hepatoportoenterostomy for extrahepatic biliary atresia. The source of recurrent infection seemed to be an intrahepatic cyst. Short‐term percutaneous cholangiodrainage of such cysts, resulting in eradication of infection, has been described. However, this child required continuous drainage because of persistence of infection in the reaccumulating bile. The insertion of a nephrostomy catheter and use of enterostomal appliances have allowed continuous uneventful biliary drainage for 15 months.
Protein‐Losing Enteropathy in Prolonged Post‐Ischemic Ileitis
Authors: Thompson John F. , Levy Joseph , Stolar Charles J. H. , Wigger H. Joachim
Published: February 2024

Summary: A 10‐year‐old boy developed internal herniation of the small intestine associated with significant ischemia, which was reduced without resection. Severe diarrhea, hypoalbuminemia, and lymphopenia ensued while he was receiving total parenteral nutrition. Resolution of symptoms occurred only after resection of an area of ileum, which revealed persistent inflammation and atrophy. Postischemic epithelial cell regeneration of the intestine is discussed in light of this patient's protein‐.
Subcellular Localization of Class I (A,B,C) and Class II (DR and DQ) MHC Antigens in Jejunal Epithelium of Children with Coeliac Disease
Authors: Sarles J. , Gorvel J. P. , Olive D. , Maroux S. , Mawas C. , Giraud F.
Published: February 2024

Thin frozen sections of 11 jejunal biopsies from 10 children at different stages of coeliac disease were stained by immunofluorescence technique using a panel of anti‐HLA class I (A, B, C) and anti‐HLA class II (DR and DQ) monoclonal antibodies. On the epithelium of flattened mucosa, in contrast with control sections, the intensity of the labeling on the basolateral membranes with both anti‐class I and class II DR antibodies decreased strongly from the bottom to the upper part of the crypts, and no bright patchy staining was observed on the apical part of enterocytes with anti‐HLA DR antibodies. Numerous cells with large granules expressing class I and class II DR antigens were found in the epithelium of the small intestine. Children with a fully recovered mucosa expressed MHC antigens identical to those previously observed in normal epithelium. On the other hand, children with intermediate mucosal lesions showed the presence of MHC antigens in varying degrees. The results of this report indicate that immunological mechanisms may play a prominent role in coeliac disease.
Portal Vein Measurement by Ultrasonography in Patients with Long‐Standing Cystic Fibrosis
Authors: Kumari‐Subaiya Sheila , Gorvoy Jack , Phillips Gail , Ross Peter , Riddelsberger M. M.
Published: February 2024

Adult cystic fibrosis (CF) patients are increasingly diagnosed with hepatic cirrhosis, cholecystitis, and cholelithiasis. A continuing diagnostic problem is the early detection of cirrhosis prior to diffuse liver involvement. Sonography has been used in evaluating the pancreas, gallbladder, liver, and spleen in cystic fibrosis patients. We used a real‐time mechanical sector scanner to study the portal veins in adult CF patients randomly selected from our CF population and correlated the portal vein diameters with liver function studies. A measurement > 12 mm was interpreted as a probable sign of portal hypertension. Of 21 patients studied, 14 had portal veins that measured >12 mm, and 12 patients had (although not necessarily at the time of the exam) elevated serum alkaline phosphatase levels. Three patients had associated splenomegaly and thrombocytopenia, and 10 patients also exhibited cholelithiasis and abnormal gallbladders on sonography. Initial results indicate that portal vein measurement may be a sensitive indicator of early portal hypertension. Sonography may, thus, isolate patients at high risk for possible future complications. Serial sonograms can be performed easily in evaluating the progress of liver disease.
Variance in Fasting Breath Hydrogen Concentrations in Guatemalan Preschool Children
Authors: Barillas‐Mury Carolina , Solomons Noel W.
Published: February 2024

The concentration of hydrogen (H2) in expired air after an overnight fast is receiving interest as a diagnostic indicator in itself. We analyzed 319 fasting samples collected from 90 healthy, well‐nourished preschool children aged 29–72 months in two institutional settings in Guatemala City. The overall range of fasting H2 concentration was 0–40 ppm, with an arithmetic mean of 4.4 ± 5.4 ppm (± SD) and a geometric mean of 3.2 ppm. No differences between boys and girls was found, but there was a progressive increase in the mean levels and an increase in the number of samples with H2 concentrations >10 ppm with decreasing chronological age. One child with three of six samples having H2 concentrations >40 ppm was found to have intestinal multiple parasitism and hence was excluded from the sample. As compared with a previous report from the United States of fasting breath H2 concentrations in older children, the mean and distribution of values for Guatemalan preschoolers is identical. Intraindividual coefficients of variation in 48 children studied on four occasions had a mean of 62 ± 31% (range 0–143%).
Primary Sclerosing Cholangitis in Children
Authors: Classen Martin , Götze Hermann , Richter Hans‐Joachim , Bender Steffen
Published: February 2024

Primary sclerosing cholangitis (PSC) in eight children, five males and three females between the ages of 4 and 13 years, presented with minimal clinical symptoms and few signs of liver disease. Diagnosis was made by a highly characteristic histology in all and additional endoscopic retrograde cholangiography (ERC) in four patients. Six children suffered from concomitant inflammatory bowel disease (IBD). Laboratory abnormalities consisted of mild elevation of transaminases and alkaline phosphatase, with marked elevation of immunoglobulin G in seven and detection of anti‐nuclear antibodies in four of the eight children. In all cases, needle liver biopsy specimens revealed portal tracts considerably expanded by edema and chronic inflammation diagnostic of nonsuppurative cholangitis and nonsuppurative fibrosing pericholangitis. ERC showed decreased arborization in the whole biliary tree. In two patients, changes were confined to the intrahepatic portion of the biliary tract. No specific drug therapy was given to our patients. Those with concomitant IBD were treated with salazosulfapyridine (SASP). The clinical course has been mild in all patients up to now. It is concluded that PSC may be much more frequent in childhood than was considered before, especially in children with IBD.
Different Degree of Antibody Response to Hepatitis B Virus Vaccine in Breast‐and Formula‐Fed Infants Born to HBsAg‐Positive Mothers
Authors: de Martino Maurizio , Resti Massimo , Appendino Claudio , Vierucci Alberto
Published: February 2024

Antibody response to hepatitis B virus vaccine was compared in 47 breast‐and 112 formula‐fed infants born to hepatitis B surface antigen‐(HBsAg‐) positive mothers. No difference was observed as to the percentage of infants who seroconverted. However, formula‐fed infants developed transient but significantly higher anti‐HBs antibody levels as compared to breast fed infants. Suppressive factors in human milk or orally induced tolerance may explain this finding. The latter hypothesis may be supported by the presence of HBsAg in more than a half of the milk samples we studied.
Cricopharyngeal Dysfunction in Childhood
Authors: Dinari Gabriel , Danziger Yardena , Mimouni Marc , Rosenbach Yoram , Zahavi Ilan , Grunebaum Michael
Published: February 2024

A 3‐year‐old child with Cricopharyngeal dysfunction is reported. Swallowing difficulties, nasal regurgitation, and gagging developed at 2 months of age. Repeated aspirations and over 40 episodes of pneumonia necessitating multiple hospitalizations occurred up to 2 years of age, along with pharyngcal pooling of saliva and inability to swallow solid food. Barium was held up at the Cricopharyngeal level, and a prominent esophageal impression was seen at the same level. Symptoms were completely alleviated after two esophageal dilatations by mercury dilators, and the relief persisted for the 6 months of follow‐up. The diagnosis of Cricopharyngeal dysfunction is discussed, and the necessity for manometric studies, in the face of often misleading radiologic appearance, is emphasized. It is suggested that early use of esophageal dilatations might prevent prolonged morbidity and afford long‐term symptomatic relief.
Gastroesophageal Scintigraphy
Authors: Fernández F. González , Martin F. Argûelles , de Quesada B. Rodriguez , Hachero J. González , Sánchez de Puerta A. Vails , Gentles M.
Published: February 2024

Ninety children with signs and symptoms of gastroesophageal (GE) reflux were studied. All of them had GE scintigraphy, barium, and endoscopy, and 50, in addition, ultrasound examination. The sensitivity of the GE scintigraphy, in comparison with the other methods, was 92.5%. It is a useful screening test for GE reflux.
Milk Feeding and Changes in Intestinal Permeability and Morphology in the Newborn
Authors: Weaver L. T. , Laker M. F. , Nelson R. , Lucas A.
Published: February 2024

The contrasting effects of natural versus cow's milk formula (CMF) on upper gastrointestinal development in the newborn were studied. The passive intestinal permeability of neonatal human infants and guinea pigs was measured using the nonmetabolisable markers lactulose and mannitol. Mucosal morphology was examined in guinea pigs by light microscopy. Nineteen full‐term human infants and 63 guinea pigs were studied during the 1st week of extrauterine life. The naturally fed infants showed a decline in intestinal permeability to lactulose following the onset of feeding. This was not shared by those fed CMF. The CMF‐fed guinea pigs showed a persistently higher intestinal permeability than the naturally fed animals throughout the 1st week of life. No differences were observed in the villous heights or crypt depths between feeding groups, but both showed an increase in intraepithelial lymphocyte number during the 1st week. Cow's milk formula may cause a persistently higher intestinal permeability, or natural feeding may promote a decline in permeability in the enterally fed newborn.
Lactose Malabsorption and Intolerance in Uruguayan Population by Breath Hydrogen Test (H2)
Authors: Maggi Rodolfo , Sayagues Beatriz , Fernandez Alicia , Romero Beatriz , Barusso Patricia , Hernandez Carmen , Magariños Mabel , Mendez Graciela , Dilascio Cristina , Martell Miguel
Published: February 2024

This study of 200 Uruguayans between 0 and 86 years old was designed to determine the prevalence of lactose malabsorption. Lactose intolerance is defined as a clinical syndrome of abdominal pain, diarrhea, flatulence, and bloating after the ingestion of a standard lactose tolerance test dose (2 g of lactose per kilogram of body weight or 50 g/m2 of body surface area, maximum 50 g in a 20% water solution). Lactose malabsorption refers to the state in which dietary lactose remains unhydrolyzed and subsequently unabsorbed from the gastrointestinal tract; symptoms may or may not result from lactose malabsorption. The technique of breath hydrogen (H2) was used after ingestion of 2 g/kg body weight to a maximum of 50 g in a 20% solution. There was no lactose malabsorption in children younger than 5 years old. The prevalence increases progressively after the age of 5, and in adolescence the percentage of malabsorption is similar to that in adults, who show 65% lactose malabsorption, with 25% asymptomatic and 40% intolerant. In 109 white adults, the prevalence of lactose malabsorption is 63%, with 24% asymptomatic and 39% intolerant. In 11 black adults, lactose malabsorption is 82%, with 27% asymptomatic and 55% intolerant. The difference between white and black adults is statistically significant (p < 0.05). The H2 test is simple, reliable, noninvasive, and appropriate to study large populations.
Comparison of the Macronutrient Intake of Healthy Controls and Children with Cystic Fibrosis on Low Fat or Nonrestricted Fat Diets
Authors: Daniels Lynne , Davidson Geoffrey P. , Martin A. James
Published: February 2024

This study compares the nutrient intake of two cross‐sectional groups of patients attending the CF Clinic at the Adelaide Children's Hospital (A.C.H.). The first group (n = 33) was studied in 1979 while on low fat diets (LF), the second (n = 36) in 1983 on nonrestricted fat diets (NRF). The aim of the study was to assess the degree to which a change in fat intake has been achieved and the effect on nutrient intake and fat absorption. Data from both groups have also been compared with a group of 57 healthy controls. The study showed that when using a NRF rather than LF diet CF patients can achieve significantly improved, although not quite normal, fat intakes. There was a corresponding increase in energy intake such that intakes of CF patients on the NRF diet exceeded those of healthy controls and the RDA. The higher fat intakes appeared to be well tolerated with no evidence of increased steatorrhoea or stool energy loss. Growth improved in the younger group, but further studies on patients who have been established on the NRF diet since birth are needed to confirm that normal fat diets contribute to improved growth.
Relationship Between Breath and Total Body Hydrogen Excretion Rates in Neonates
Authors: Modler Siv , Kerner John A. , Castillo Ricardo O. , Vreman Hendrik J. , Stevenson David K.
Published: February 2024

Our study examined the relationship of H2 excreted in breath to total body H2 excreted by neonates. We report simultaneously measured end‐tidal H2 concentrations, plus breath H2 and total body H2 (breath H2 plus flatus H2) excretion rates in 10 neonates. End‐tidal H2 concentrations varied from 2.4 to 192 ppm. Breath H2 excretion rates ranged from 0.20 to 6.5 and total body H2 excretion rates from 0.29 to 15.0 ml/h. The fractional breath H2 excretion in these infants was 48% (range 33–69%), compared with 21% reported in adults. The correlation coefficient for end‐tidal derived H2 excretion and directly measured breath H2 excretion rates was 0.95 (p < 0.001). We conclude that the proportion of total H2 excreted in the breath of neonates is increased compared with adults, suggesting that caution must be exercised when interpreting newborn breath H2 measurements and using adult norms.
Controlled Clinical Trial on the Efficacy of Rice Powder‐Based Oral Rehydration Solution on the Outcome of Acute Diarrhea in Infants
Authors: El‐Mougi Mahmoud , Hegazi Ehab , Galal Osman , Akkad Nayyera El , El‐Abhar Ahmed , Nour Nadia , Emam M. El‐Hadi , Ahmadi Abdel Rahman
Published: February 2024

We report a controlled clinical trial of rice powder‐based oral rehydration solution (ORS) versus glucose ORS on the outcome of acute diarrhea in infants. The rice ORS group (n = 30) received ORS containing 50 g rice powder instead of standard WHO solution (20 g glucose, n = 30). Formula‐fed male infants were enrolled to enable calculation of milk intake and excretion of urine. Patient allocation to either group depended on the method of random permuted blocks. Both groups were comparable regarding age (4–18 months), duration of diarrhea, number of bowel movements or vomiting per 24 h, rectal temperature, dehydration score, and nutritional status. Results revealed that the rice ORS group had a shorter duration of diarrhea (28.4 ± 5.1 vs 34.3 ± 2.3 h) and greater mean weight gain in the first 24 h as percentage of recovery weight (5.7 ± 0.5% vs 4.1 ± 0.6%). Furthermore, the mean amount of ORS intake, mean stool output, and mean number of episodes of vomiting were lower in the rice‐ORS group as compared with the glucose ORS group. All differences were statistically significant. Due to its observed superiority and low cost, the widespread use of rice ORS should be considered for treatment of acute diarrhea.
Nutritional Copper Deficiency in Severely Handicapped Patients on a Low Copper Enteral Diet for a Prolonged Period
Authors: Higuchi Shigenori , Higashi Akimasa , Nakamura Toshiro , Matsuda Ichiro
Published: February 2024

Six cases of nutritional copper deficiency were identified in a nursery institute for severely handicapped patients. All had been on prolonged enteral feeding of a copper‐deficient diet and all had abnormalities related to the copper deficiency. Two of them had leuko‐penia, with or without macrocytic and normochromic anemia. After the oral administration of copper, the clinical and laboratory observations including neutrophil counts and serum copper and ceruloplasmin levels showed a complete recovery. The dietary copper requirement was estimated to be ∼20 μg/kg/day for these patients, based on the correlation between the dietary copper intake and the levels of copper in the serum.
Decreased Cholestasis with Enteral Instead of Intravenous Protein in the Very Low‐Birth‐Weight Infant
Authors: Brown Marily R. , Thunberg Barbara J. , Golub Leonard , Maniscalco William M. , Cox Christopher , Shapiro Donald L.
Published: February 2024

Thirty to 50% of very low‐birth‐weight infants have parenteral nutrition‐associated cholestasis. To test the hypothesis that the incidence of cholestasis would be decreased if parenteral amino acids were avoided and protein given enterally, infants with a gestational age of <30 weeks were randomized to two groups. One group received amino acid‐free parenteral nutrition and whey protein enterally with added premature infant formula. The control group received standard parenteral nutrition with amino acids and enteral premature formula. At the end of 3 weeks of parenteral nutrition, infants who had a direct serum bilirubin level of >3 mg/dl were considered to have significant cholestasis. Twenty‐nine infants required parenteral nutrition for 3 weeks, 17 in the whey group and 12 in the control group. No instances of significant cholestasis were observed in the whey group (0/17), whereas seven of 12 infants (58%) in the amino acid control group had cholestasis (p < 0.001).
Quantitation and Properties of Fecal and Upper Small Intestinal Aerobic Microflora in Infants and Young Children with Persistent Diarrhea
Authors: Bhan M. K. , Raj P. , Khoshoo V. , Bhandari N. , Sazawal S. , Kumar R. , Srivastava R. , Arora N. K.
Published: February 2024

The duodenal juice and fecal aerobic microflora was investigated in 54 patients with persistent diarrhea (age ≤2 years). The duodenal aspirates yielded increased aerobic bacteria (>105 organisms/ml) in 28 (51.9%) of the patients. Established enteric pathogens were isolated from the duodenal aspirates of 12 (22.2%) of the 54 patients, viz., enteroadherent Escherichia coli (EAEC) (5), enterotoxigenic E. coli (ETEC) (3), enteropathogenic E. coli (EPEC) (1), nontyphoidal Salmonella (1), and Giardia lamblia (2). The total aerobic bacterial count was >105 in all 12 patients positive for specific pathogens apart from one case in whom E. coli showing diffuse adherence to HEp‐2 cells were identified. Among the remaining 42 specific pathogen‐negative patients, 19 (45.2%) also had >105 aerobic organisms/ml in the small bowel. Eight strains of Klebsiella from four of the patients were negative for enterotoxin production in a rabbit ileal loop assay and for adherence to HEp‐2 cells. In contrast, 28/54 (51.9%) of the same patients had known enteric pathogens in their stools, viz., nontyphoidal Salmonella (8 or 14.8%), Shigella (2 or 3.7%), Campylobacter (1 or 1.9%), ETEC (4 or 7.4%), EPEC (2 or 3.7%), EAEC (7 or 13.0%), and G. lamblia and Entameba histolytica (3 or 5.6%). Further search for potential virulence factors among aerobic bacteria colonizing the upper small intestine in persistent diarrhea is warranted.
The Urinary Excretion of Polyethylene Glycol as a Test for Mucosal Integrity in Children with Celiac Disease
Authors: Lifschitz Carlos H. , Polanco Isabel , Lobb Kelly
Published: February 2024

We compared the results of various noninvasive tests with small bowel histology in 61 children with celiac disease. The most sensitive predictors of small bowel histology were serum levels of anti‐gliadin antibodies (AGAs) (90%) and the urinary excretion of polyethylene glycol (PEG) (69%). The sensitivity for the fecal fat analysis was 61% and for the d‐xylose test 34%. The specificity was 96% for both the PEG and the d‐xylose tests, 92% for the fecal fat, and 68% for AGAs. The predictive value of the PEG test was significantly better than that of d‐xylose (p < 0.05). The best combination of tests for the prediction of small bowel histology was the PEG test and the measurement of serum levels of AGAs. Agreement in the results of these two tests helps to time appropriately the second and third small bowel biopsies.