bluuebunny/crossref_metadata_2025 huggingface dataset:
Sigmoidoscopy, Colonoscopy, and Radiology in the Evaluation of Children with Rectal Bleeding
Authors: Cucchiara S. , Guandalini S. , Staiano A. , Devizia B. , Capano G. , Romaniello G. , Poggi V. , Tamburrini O. , Settimi A. , de Ritis G.
Published: January 2024

The authors evaluated the diagnostic role of sigmoidoscopy, colonoscopy, and double contrast radiology in 103 children with rectal bleeding, with or without other gastrointestinal symptoms. The children's mean age was 44 months, with a range from 1 month to 12 years. In 74.5% of the subjects investigated, visual inspection of the anus and sigmoidoscopy with rectal biopsy disclosed a positive diagnosis. Of the remaining patients, a conclusive diagnosis was reached by either colonoscopy or double contrast radiology in all but six patients. These six, with mild painless hematochezia, remained without a diagnosis. The diagnostic procedure in pediatric patients with rectal bleeding should include an initial visual inspection of the anus, and sigmoidoscopy; air contrast enema and colonoscopy should be performed only in children whose sigmoidoscopy is negative, in diagnostic assessment of inflammatory bowel disease, and in cases of recurrent bleeding after removal of rectal polyps. Colonoscopy is important also in the follow‐up examination of children with inflammatory bowel disease and allows the removal of polyps located in the proximal colon.
Effects of Biliary Diversion to the Ileum on the In Situ Disaccharidase Activities of Duodenal and Heal Mucosa in the Rat
Authors: Gutschmidt Siegfried , Gartemann Hermann
Published: January 2024

In order to study the influence of biliary secretions on the in situ kinetic data of brush border disaccharidases in relation to small intestinal villus‐crypt architecture, an anastomosis was constructed between the common bile duct, which had been divided before its entrance into the pancreatic head, and the ileum in adult female Wistar rats. Simple attachment of the terminal ileum to the liver hilum was performed in the controls. Six weeks after the operation, tissue sections were prepared from duodenum and ileum of biliary‐diverted and control animals (n = 5 in each group) and examined by section biochemistry and morphometry. In both groups the apparent Vmax values of neutral α‐glucosidase and lactase/β‐glucosidase, measured at the villus base and at its apex, and the villus height were decreased from the duodenum towards the distal ileum. After biliary diversion to the ileum, an increase in villus height ensued in this segment, and the increasing gradient of glucosidase activity towards the villus apex, as seen in the ileum of the controls, was no longer detectable. In the duodenum, however, villus height remained unaltered and the in situ activity of the disaccharidases was increased at both villus sites when compared with the controls. The results indicate different effects of bile on mucosal morphology and function in the proximal and distal small intestine.
Portal Vein Thrombosis Following Hepatic Portoenterostomy
Authors: Hyams Jeffrey S. , Conard Frederick U. , Hight Donald W.
Published: January 2024

Life‐threatening ascites developed in a 4‐month‐old infant with biliary atresia 1 month after hepatic portoenterostomy. Although initially ascribed to progressive liver failure, the ascites was subsequently found to be partially caused by portal vein thrombosis. Documented recanalization of the portal venous system was accompanied by resolution of the ascites. Refractory as cites in patients with biliary atresia generally signals end‐stage cirrhosis and consideration of liver transplantation. Portal vein patency should be evaluated before referral of such patients for this procedure.
Unusual Presentation of Vitamin A Intoxication
Authors: Schurr Daniel , Herbert Joseph , Habibi Elyiahu , Abrahamov Ayala
Published: January 2024

A 10.5‐year‐old boy was admitted to hospital because of a focal motor seizure. He had suffered from impaired attention span and emotional instability from the age of 6 years. From the age of 5 years he received daily a multivitamin preparation containing 5,000 IU vitamin A. The cause of his symptoms was found to be vitamin A intoxication, with an unusual acute presentation of microscopic hematuria, electroencephalographic abnormalities, and convulsions.
Applications of Stable Isotopes to Pediatric Nutrition and Gastroenterology
Authors: Klein Peter D. , Klein E. Roseland
Published: January 2024

The naturally occurring, nonradioactive, stable isotopes, 2H, 15N, 18O, and in particular, 13C, are valuable tracers in studies of pediatric nutrition and gas‐troenterology. Techniques using these isotopes have been developed for the measurement of digestion, absorption, utilization, and excretion of nutrients in premature and term infants, as well as in young children. Compounds labeled with 13C enable quantitative measurements of nutrient oxidation rates and percent nutrient malabsorption. Illustrations of these applications are presented in studies of simple and complex carbohydrate metabolism, of medium‐ and long‐chain triglyceride absorption and malabsorption, and of bile salt conservation and loss in the neonate. Modular protocols for the determination of nutrient absorption, oxidation, and loss now can be applied in longitudinal studies which involve comparisons of diet or which monitor recovery following malnutrition or disease. Instrumentation to be available in the future will simplify isotope ratio determinations and create ready access to the methodologies described.
The Effect of Early Feeding on the Onset of Symptoms in Celiac Disease
Authors: Greco L. , Mayer M. , Grimaldi M. , Follo D. , De Ritis G. , Auricchio S.
Published: January 2024

The appearance of celiac disease in infancy has often been related to the time when gluten is introduced into the diet, and more recently, to the kind of milk received in the early months. This retrospective study attempts to clarify the relation between breast‐feeding and gluten introduction to the onset of symptoms of the disease. One hundred forty‐six children with celiac disease, aged from 4 months to 11 years, were studied. The timing and types of feeds were recorded as well as the presenting symptoms of the disease. Data were analyzed by nonparametric statistical methods, as well as by parametric analysis after appropriate transformation. Children breast‐fed for 3 months or more showed a marked delay in the onset of the disease and a longer latency time from gluten introduction to onset of disease, when compared with bottle‐fed children. This relationship was present for both statistical analyses and was unrelated to the age at gluten introduction into the diet. Onset of disease was positively correlated to the duration of breast‐feeding and not related to the age at gluten introduction.
Spontaneous Endotoxinemia in Premature Infants
Authors: Scheifele David W. , Olsen Edna , Fussell Susan , Pendray Margaret
Published: January 2024

Infants admitted to a tertiary care nursery were tested serially to determine the frequency and epidemiology of spontaneous endotoxinemia, a phenomenon suggested by previous studies. Plasma and stools were tested for endotoxin‐like activity (ELA) using a Limulus amoebocyte lysate method and results were correlated with clinical data. We detected ELA in plasma of 28 of 47 infants (60%) tested throughout their hospital stay: only two of 58 separate episodes could be attributed to infection. Endotoxinemia was not consistently associated with classical signs of fever, shock, and jaundice. Prior to oral feeding, little or no ELA was detected in stools and endotoxinemia was ascertained in only six of 45 infants (13%). With feeding, fecal ELA concentrations rose sharply, and endotoxinemia was detected in 56% of remaining infants (p < 0.001). Bowel disease predisposed to endotoxinemia: 16 of 20 infants (80%) with necrotizing enterocolitis or difficult establishment on feeding were affected, compared to five of 17 infants (29%) without such problems (p < 0.01). Fecal ELA concentrations were not abnormally elevated in those with bowel disease. We conclude that endotoxinemia occurs commonly in immature infants as their fecal flora develops with feeding but the amount of circulating endotoxin required for injury and the patterns this takes require further investigation.
Lactose Absorption and Malabsorption in Healthy Italian Children
Authors: Roggero P. , Offredi M. L. , Mosca F. , Perazzani M. , Mangiaterra V. , Ghislanzoni P. , Marenghi L. , Careddu P.
Published: January 2024

Using breath hydrogen analysis after an oral lactose load (2 g/kg; maximum 50 g), we investigated the prevalence of lactose malabsorption in 61 healthy Italian children aged 6–13 years. We also examined the relationship between symptoms and small bowel transit time and the degree of sugar malabsorption. Three of 61 subjects produced no H2 after both lactose and lactulose load and thus were eliminated at the outset. Lactose malabsorption was defined as excretion of >20 ppm H2. Lactose intolerance was classified as mild (colicky pain, flatulence, abdominal distension, borborygmi) or severe (diarrhea). The frequency of lactose malabsorption in the children aged 6–8 years (group I) was 25%; in the children aged 8–11 years (group II), it was 35%, and in the children aged 11–13 years (group III) 56%. The differences in frequency between the first and the third groups were significant (p = 0.05). Three of 20 (15%) in group I, two of 20 (10%) in group II, and three of 18 (17%) in group III were classified not only as lactose malabsorbing, but also as lactose intolerant, with symptoms during and after the test. We found no difference in the small bowel transit times or in the quantities of malabsorbed lactose in symptomatic and asymptomatic malabsorbing subjects. Other factors that may play a role in symptom production are discussed.
Trace Elements (Copper, Zinc, Manganese, and Selenium) in Plasma and Erythrocytes in Relation to Dietary Intake During Infancy
Authors: Hatano Shuichi , Aihara Katsuaki , Nishi Yoshikazu , Usui Tomofusa
Published: January 2024

All determinations of copper, zinc, manganese, and selenium were performed with a flameless atomic absorption spectrophotometer. Seventy‐three full‐term infants aged 1 to 52 weeks were divided into three age groups. Each age group contained two subgroups, breast‐fed and formula‐fed. No statistically significant differences between formula‐fed and breast‐fed subgroups were found in regard to the levels of copper and zinc in plasma and erythrocytes. At 1 to 5 weeks of age, the manganese concentration of erythrocytes was higher in formula‐fed than in breast‐fed infants (p < 0.001). This might be due to the high dietary intake of this element in the formula‐fed subgroup. On the other hand, plasma selenium concentrations were significantly higher in breastfed than in formula‐fed infants of all ages (p < 0.01 at 1 to 5 weeks and p < 0.05 at 6 to 52 weeks). This suggests that selenium compounds are biologically more available for infant nutrition in breast milk than in formula.
Serum Levels of 1,25‐Dihydroxyvitamin D in Children Receiving Parenteral Nutrition with Reduced Aluminum Content
Authors: Klein Gordon L. , Horst Ronald L. , Alfrey Allen C. , Slatopolsky Eduardo
Published: January 2024

Both adults and children receiving total parenteral nutrition (TPN) have been found to have low serum levels of 1,25(OH)2‐vitamin D [1,25(OH)2D]. Many of these were subsequently found to have inadvertently received large quantities of aluminum in the TPN solution. Since aluminum administration to dogs is associated with a fall in serum 1,25(OH)2D levels, the present study was designed to prospectively follow serum levels of this sterol while patients received a TPN solution low in aluminum. Nine children received a TPN solution comparable to that previously administered to children who demonstrated low serum levels of 1,25(OH)2D, except for a moderately reduced phosphorus and markedly reduced aluminum content. Serum was obtained during the first and fourth weeks of TPN treatment and analyzed for 1,25(OH)2D, 25‐hydroxyvitamin D [25(OH)D], immuno‐reactive parathyroid hormone (iPTH), calcium, and phosphorus. Results revealed normal or high serum levels of 1,25(OH)2D and normal levels of iPTH, calcium, phosphorus, and 25(OH)D. Thus, low aluminum‐containing TPN does not produce a fall in serum 1,25(OH)2D, providing evidence that aluminum may have been a factor in causing the reduced serum 1,25(OH)2D in those children previously receiving TPN.
Transient Neutral Fat Steatorrhea, Elevated Sweat Chloride Concentration, and Hypoparathyroidism in a Child with Celiac Disease
Authors: Foulston Charlotte , Gall Grant , Mitchell Ian , Cooper David M. , Scott R. Brent
Published: January 2024

A patient with celiac disease and the unusual features of transiently elevated sweat chlorides, reversible exocrine pancreatic insufficiency, symptomatic hypocalcemia/hypomagnesemia, and transient secondary hypoparathyroidism is presented along with a brief discussion of the physiologic mechanisms thought to underlie their development.
Growth As a Measure of Nutritional Status
Authors: Sutphen James L.
Published: January 2024

Growth data have been used as a measure of nutritional status and disease activity in children. This review discusses common anthropometric techniques and emphasizes the inference of nutritional status from these measurements. As multiple factors influence growth, it is often difficult to isolate the effects of nutrition alone.
Comparison of the Clinical and Biochemical Effect of Increased α‐Linolenic Acid in a Safflower Oil Intravenous Fat Emulsion
Authors: McClead Richard E. , Meng H. C. , Gregory Susan A. , Budde Chris , Sloan Howard R.
Published: January 2024

We report the results of a randomized comparison of two intravenous safflower oil (fat) emulsions in neonates who required total parenteral nutrition. The fat emulsions differed only in their content of α‐linolenic acid: in one emulsion the α‐linolenic acid content of the oil was 0.1% of fatty acids, while in the other emulsion the α‐linolenic acid content of the oil was 3.0 ± 1.5% (SD) of fatty acids. Group 1 and 2 patients received the “low” and “high” α‐linolenic acid emulsions, respectively. Ten patients were studied in each group. The mean daily fat dosage was 1.70 g/kg in patients of Group 1 and 1.56 g/kg in those of Group 2. No significant difference in the clinical effects of either fat emulsion could be detected between the two study groups. Both emulsions prevented or corrected biochemical signs of essential fatty acid deficiency. The major statistically significant difference between study groups was in the level of α‐linolenic acid and its metabolite, eicosapentaenoic acid. After 2 weeks of fat therapy, these fatty acids were increased in the high α‐linolenic acid group; however, another metabolite of linolenic acid, docosahexaenoic acid, decreased during intravenous fat therapy in both study groups. Both study groups had significantly decreased arachidonic acid levels and increased linoleic to arachidonic acid ratios.
Esterase Acyl Binding Site of Human Milk Lipase
Authors: O'Connor Charmian J.
Published: January 2024

The hydrolysis of a series of 4‐nitrophenyl alkanoates and of 4‐nitrophenylbenzoate and ‐methylbenzoate, catalysed by human milk lipase in the absence and presence of cholate stimulation, has been measured at pH 7, 3, 37.5°C. It has been shown that the enzyme possesses a specific esterase acyl binding site that is hydrophobic in nature and wide enough to accommodate one fatty acid chain, but not two. This binding site is unaffected by bile salt stimulation of the enzyme.
Adoptive Transfer of Small Bowel Intraepithelial and Peyer's Patch Lymphocytes from Orally Immunised Animals
Authors: Lyscom Nicole , Brueton M. J.
Published: January 2024

Intraepithelial (IEL) and Peyer's patch lymphocytes (PPL) were isolated from the small bowel mucosa of mice in which specific systemic antibody responses to ovalbumin (OVA) had been suppressed by oral exposure to that antigen. These lymphocytes were then adoptively transferred into syngeneic animals. The PPL transferred 24 h after oral OVA showed a tendency to depress secondary serum antibody responses to intraperitoneal OVA in the recipients. Conversely, IEL transferred 1–5 days after oral OVA significantly enhanced specific serum antibody responses.
Tubular Duplication of the Jejunum and Ileum Lined Entirely by Gastric Mucosa
Authors: Bar‐Maor J. A. , Shoshany G. , Israel O. , Halpern M. , Etzioni A.
Published: January 2024

A 3‐year‐old boy who suffered from severe colicky abdominal pain is presented. Laboratory studies, including ultrasound, upper gastrointestinal films, and 99mTc‐scan, were interpreted as normal. On exploration of the abdomen a tubular duplication of the small bowel was found. The duplication had a common mesentery with the normal bowel. By meticulous dissection the duplication was resected without interfering with the blood supply of the normal bowel. The entire duplication was found to be covered by gastric mucosa.
Continuous Gastric pH Measurement in Young and Older Healthy Preterm Infants Receiving Formula and Clear Liquid Feedings
Authors: Sondheimer Judith M. , Clark David A. , Gervaise Elaine P.
Published: January 2024

Gastric pH was recorded with an intragastric pH electrode for 12 h in two groups of healthy, preterm infants with similar birth weights (range 1.4 to 2.0 kg). Group I infants (n = 13) were less than 7 days old and Group II infants (n = 10) were 7–15 days old. Infants were fed three formula feedings and one clear liquid feeding during the study. In Group I, mean gastric pH measured at 15‐min intervals was above 4.0 for 3 h after either feeding. In Group II mean gastric pH was lower particularly after clear liquid feedings, where it remained below pH 4.0 for the entire 3‐h postprandial period. The percent of monitored time at gastric pH less than 4.0 was low in Group 1–15.2 ± 4.2% and 20.6 ± 6.4% after formula and clear liquid, respectively. The percent time was greater in Group II‐42.7 ± 8.0% and 61.9 ± 7.3% after formula and clear liquid, respectively. In the younger preterm infant, gastric pH does not appear sufficiently low to support peptic activity.
Toddler Diarrhoea
Authors: Hamdi I. , Dodge J. A.
Published: January 2024

Aspirin reduced plasma concentrations of prostaglandin (PG) Fα in 11 of 12 children with toddler diarrhoea, and usually, but not always, controlled the symptom. Loperamide consistently controlled toddler diarrhoea in 10 patients but had no effect on plasma PGFα. In eight patients experiencing spontaneous remission of symptoms, plasma PGFα was significantly lower than during diarrhoeal episodes. These results suggest that (a) toddler diarrhoea is in some cases mediated by PG, and (b) the effect of loperamide is independent of PG levels.
Oral Rehydration, Rapid Feeding, and Cholestyramine for Treatment of Acute Diarrhea
Authors: Isolauri Erika , Vesikari Timo
Published: January 2024

Different combinations of fluid therapy, feeding regimen, and cholestyramine were compared in search for optimal treatment of infants hospitalized for acute diarrhea. The infants (n = 81) received either rapid oral rehydration using the oral rehydration solution‐World Health Organization formula (sodium 90 mmol/L, ORS‐WHO) or traditional oral fluid replacement using a commercial glucose‐electrolyte solution (sodium 35 mmol/L). One‐half of the infants in both groups received full feedings at 24 h of hospitalization; in the remaining infants, feedings were gradually introduced over a period of 5 days. In addition, all the children were randomized to receive either cholestyramine 2 g four times daily or an equivalent amount of placebo. Rehydration with ORS‐WHO, but not traditional fluid replacement therapy, led to correction of initial metabolic acidosis after 6–10 h; no cases of hypernatremia were observed with the use of ORS‐WHO. Rapid return to full feedings appropriate for age, including milk products, was associated with better weight gain and significantly shorter duration of diarrhea compared with gradual introduction of feedings. Cholestyramine treatment further shortened the duration of diarrhea without adverse effects in those children who had received ORS‐WHO and thus were properly rehydrated. In contrast, in children with poor initial hydration, cholestyramine treatment was associated with prolonged metabolic acidosis. We conclude that treatment of acute diarrhea by rehydration with ORS‐WHO and rapid introduction of full feedings is effective and safe, and this combination forms a therapy of choice for typical hospitalized cases of acute infantile diarrhea in Finland. Cholestyramine may be of value as an adjunct therapy after adequate rehydration.
Value of Breath Hydrogen Analysis in Management of Diarrheal Illness in Childhood
Authors: Davidson Geoffrey P. , Robb Trevor A.
Published: January 2024

Breath hydrogen tests were carried out on 157 children either because they had chronic diarrhea or because they were on disaccharide‐free diets. Lactose malabsorption was common in patients with postgastroenteritis syndrome (43%), and sucrose malabsorption was readily detected in patients with congenital sucrase‐isomaltase deficiency. Secondary sucrose malabsorption and small bowel bacterial overgrowth were also detected. In predicting clinical response to dietary change, the breath hydrogen test, as we perform it, was clearly the most specific and sensitive and had a predictive accuracy of 96%. Duodenal biopsy results mobtained from 48 of the children gave a 23% incidence of misleading disaccharidase results (16.7% falsely normal, 6.3% falsely abnormal), but biopsy remains vital in the diagnosis of congenital sucrase‐isomaltase deficiency. False negative breath hydrogen results were obtained on occasions (4%) but in most instances were related to recent antimicrobial therapy or failure of the breath test mechanics (e.g., vomiting, length of sampling).
Hydrophobic Interactions of Human Milk Lipase
Authors: O'Connor Charmian J. , Wallace Robert G.
Published: January 2024

The hydrolysis of a series of n‐alkyl esters of 4‐nitrobenzoic acid, and of isopropyl 4‐nitrobenzoate, 4‘‐nitrophenyl 4‐nitrobenzoate, and 4‐nitrobenzoyl 1‐mono‐glycerol, catalyzed by human milk lipase in the absence and presence of cholate stimulation, has been measured at pH 7.3, 37.5°C. It has been shown that the enzyme possesses a specific alkyl binding site which is hydrophobic in nature and wide enough to accommodate two fatty acid chains lying side by side or a phenyl ring lying flat. The hydrophobic nature of this site is affected by bile salt stimulation of the enzyme. Hydrophobicity parameters have been calculated for hydrocarbon chains lying in the acyl and alkyl binding sites of human milk lipase. A mechanism is suggested for the role of bile salts in stimulating the enzyme in its activity against water soluble esters and water soluble triacylglycerols.
Specificity of Human Milk Bile Salt
Authors: Jensen Robert G. , Tardiff Gay S. , Clark Richard M.
Published: January 2024

A crude preparation of the bile salt stimulated lipase in human milk did not differentiate between the primary and secondary esters of several synthetic tri acylglycerols. The dioleoyl ester of 2,3 butanediol was also digested, unequivocal confirmation of the absence of positional specificity. Preferential release of 18:2 relative to 16:0 and 18:1 as compared to 18:It (trans) was observed. The lipase did not differentiate between 16:0 and 18:1 or 16:0 and 18:0.
Relationships Between Lysozyme Concentration of Human Milk, Bacteriologic Content, and Weight Gain of Premature Infants
Authors: Braun O. H. , Sandkühler H.
Published: January 2024

Lysozyme concentrations and bacterial colony counts were determined in 399 human milk samples obtained from 42 mothers (18 mothers of term infants, 24 mothers of preterm or small for date neonates). The average lysozyme concentration was 21.39 ± 13.19 mg/L. Lysozyme concentrations were significantly greater in preterm (24.99 ± 15.05 mg/L) than in term milk (14.89 ± 9.83 mg/L) (p < 0.05). Bacterial colony counts did not decline with increasing lysozyme concentration, i.e., no correlation between lysozyme concentration and bacterial count was found. Despite this lack of correlation, a significant correlation between lysozyme concentration and rate of weight gain was observed: the higher the lysozyme concentration, the better the weight gain. The mechanism of this observation remains to be elucidated; a trophic effect of lysozyme is suggested as a possible mechanism.
Human Milk Lipase Substrates
Authors: O'Connor J. , Wallace Robert G.
Published: January 2024

The hydrolysis of a series of 4' nitrophenyl 4 substituted benzoates, catalyzed by human milk lipase in the absence and presence of cholate stimulation, has been measured at pH 7.3, 37.5A°C. There is no evidence for an acyl site electronic interaction in the rate determining step of the esterolytic reaction. Substrate inhibition, arising from restricted rotation of the aryl residues about the ester linkage in the esterolytic site, is exhibited by these substrates.
Anorectal Manometry for the Exclusion of Hirschsprung's Disease in Neonates
Authors: Loening Vera , Pringle Kevin C. , Ekwo Edem E.
Published: January 2024

We studied the usefulness of anorectal manometry in excluding Hirschsprung's disease in 25 neonates with signs and symptoms of intestinal obstruction. An intraluminal pressure transducer or perfused side opening catheters were used to evaluate anal tone, anal rhythmicity, and internal sphincter relaxation during rectal distention. Hirschsprung's disease was diagnosed by rectal biopsy in 16% of the neonates. Studies using anorectal manometry gave one false positive and one false negative diagnosis of Hirschsprung's disease, which resulted in 75% sensitivity, 95% specificity, and a K coefficient of 0.7. We found that anorectal manometry, a rapid and atraumatic test, is a reliable screening test for exclusion of neonatal Hirschsprung's disease. By using the combination of manometry and contrast enema, it is possible to eliminate the need for a confirmatory rectal biopsy in many neonates suspected of having Hirschsprung's disease.
Growth, Digestion, and Protein Metabolism in Neonatal Pigs Given Diets Containing Whey as the Predominant or Only Source of Milk Protein
Authors: Newport Michael J. , Henschel Michael J.
Published: January 2024

Milk substitutes containing ratios of casein/ whey protein ranging from 80:20 to 0:100 were given to neonatal pigs. A ratio of 60:40 gave maximum growth rate, efficiency of feed utilization and nitrogen retention, and the lowest concentration of urea in blood plasma. This ratio is close to that in sow's milk, suggesting the hypothesis that in each species the milk may be adapted to the protein requirements of their young; by analogy, a casein/whey protein ratio of 20:80 in humanized milk formula might lead to more efficient protein utilization by the infant. In general, changes in the proportion of casein and whey proteins in the diet produced similar effects on the free amino acids in blood plasma as were found in clinical studies reported in the literature, providing further evidence of similarities in the protein metabolism of infants and neonatal pigs. The amount of nitrogen in the digesta remaining in the stomach at 1 h after a meal indicated that whey proteins empty from the stomach more rapidly than casein.
Thrombosis as a Complication of Inflammatory Bowel Disease in Children
Authors: Paradis Khazal , Bernstein Mark L. , Adelson Joel W
Published: January 2024

Thrombosis and thromboembolism have rarely been reported in inflammatory bowel disease (IBD) in children. Four cases of thrombosis, two with apparently serious thromboembolism, are reported in three patients with ulcerative colitis and one with Crohn's disease. Two patients were on steroid treatment at the time of the initial thromboembolic event. Thrombosis may result from a “hypercoagulable state“ that occurs in IBD, brought about by a combination of altered clotting factors and the presence of a thrombogenic gastrointestinal mucosa, the risk of which is increased by steroid medications. Children and adolescents with IBD are at risk for serious thromboembolic complications.
Desquamative Interstitial Pneumonitis Complicating Inflammatory Bowel Disease of Childhood
Authors: Teague William G. , Sutphen James L. , Fechner Robert E.
Published: January 2024

Sulfasalazine has been associated with bronchopulmonary complications of inflammatory bowel disease (IBID) in adults. We describe a 12 year old boy who developed desquamative interstitial pneumonitis and hepatic cirrhosis several years following the onset of ulcerative colitis. The restrictive lung disease progressed despite cessation of sulfasalazine and initiation of corticosteroid therapy. We discuss a variety of bronchopulmonary complications of IBD and their association with sulfasalazine.
Protracted Diarrhea in Infancy
Authors: Fagundes‐Neto Ulysses , Wehba Jamal , Viaro Tania , Machado Nelson Lourenço , da Silva Patricio Francy Reis
Published: January 2024

Summary: Protracted diarrhea is a clinical entity characterized by diarrhea lasting >2 weeks, starting before 3 months of age, with severe nutritional aggravation and negative stool culture for enteropathogens. This report deals with the ultrastructural abnormalities found in the intestinal mucosa of children with protracted diarrhea. Forty children (mean age 5.1 months) were studied. They were submitted to the following tests of intestinal function: D‐xylose, triglyceride tolerance, small bowel biopsy (light and electron microscope), sigmoidoscopy, and sweat test. D‐Xylose absorption and triglyceride tolerance test in these patients were both significantly tower than controls. Ultrastructural analysis of the small bowel of 12 patients showed various degrees of alterations, mainly shortening of the micovilli, increased number of multivesicular bodies, and vacuolation of mitochondria and endoplasmic reticulum. These lesions were totally reversible after clinical and nutritional recovery, as could be proven in two children. The most common cause of protracted diarrhea in these patients was secondary carbohydrate intolerance and dietary protein cow's milk and soy bean intolerance, which resulted in colitis or malabsorption as a consequence of intestinal mucosa injury due to acute gastroenteritis.
Alterations of Serum Bile Acid Profile in Breast‐Fed Infants with Prolonged Jaundice
Authors: Yamada Masaaki , Tazawa Yusaku , Nakagawa Michiko , Konno Tasuke , Tada Keiya , Goto Junichi , Nambara Toshio
Published: January 2024

Summary:

Serum bile acid conjugates in breast‐fed infants with prolonged jaundice were analyzed by a newly developed procedure using high‐performance liquid chromatography with fluorescence labeling. Major bile acids were cholate and chenodeoxycholate conjugates. Some of the breast‐fed jaundiced infants had high levels of serum bile acid conjugates (>25 μmol/L), but the mean levels of individual bile acid conjugates found in jaundiced breastfed infants were not significantly different from those in breast‐fed infants without jaundice. The glycine‐to taurine‐conjugated bile acid ratio in breast‐fed jaundiced infants was significantly lower than in breast‐fed nonjaundiced infants or bottle‐fed nonjaundiced infants. In breast‐fed infants, the portion of taurine‐conjugated bile acids increased in proportion to serum bilirubin levels. These findings suggest that alteration in conjugated bile acid patterns of breast milk jaundice is related to an increased enterohepatic circulation of bile acids as well as bilirubin in infants fed on breast milk that contains high amounts of taurine.
Zinc Status of Untreated Histidinemic Children
Authors: Kitano Akito , Higashi Akimasa , Nagata Noriyuki , Matsuda Ichiro , Hase Yutaka , Oura Toshiaki
Published: January 2024

Summary:

In order to study zinc status in histidinemia, serum and hair zinc cocentrations were measured in 40 untreated children with histidinemia (age 2 months‐5 years). In 20 children (> 2 years of age) zinc content and carbonic anhydrase activity of erythrocytes and urinary excretion of zinc were also studied. The amount of zinc excreted was elevated in histidinemic children and showed a positive correlation with the urinary histidine concentration (γ = 0.57, p < 0.005). The means of serum zinc concentration, erythrocyte zinc concentration, and erythrocyte carbonic anhydrase activity were all similar in the histidinemic and the control children. Hair zinc concentration of histidinemic children was compared with that of controls of five different age groups: <5 months, 5–18 months, 18 months‐2 years, 2–4 years, and 4–5 years. In all of these age groups, hair zinc content was similar. The incidence of low‐hair‐zinc level (<80 μg/g) in histidinemic children >5 months of age (9 of 34) was significantly higher than in controls (18 of 180, p < 0.05). The observation suggested the possibility that untreated histidinemia may cause chronic mild zinc deficiency in some histidinemic children.
Reduced Bile Output with Chronic Enteral and Parenteral Infusion of Amino Acids, Glucose, and Fat Emulsion in Rabbits
Authors: Zahavi Ilan , Shaffer Eldon A. , Kelly James , Gall D. Grant
Published: January 2024

Summary:

To assess the effect of chronic administration of amino acids, glucose, and fat on hepatic excretory function, bile flow and bile salt secretion were directly measured in adult rabbits alimented either intravenously or intragastrically Five groups of anunals were studied after 9–11 days on different nutritional regimes: the first, controls, received 154 mM NaCl intravenously and rabbit chow ad libitum; the second, 2.5% amino acid‐10% glucose‐10% fat emulsion intravenously; the third, the same nutrients intragastrically; the fourth, reduced intake of rabbit chow to match the weight change in the intragastrically fed animals; the fifth was allowed rabbit chow ad libitum and then received the nutrient solutions intragastrically only during bile collection. Bile was collected directly at laparotomy from the common bile duct during three 1‐h periods: a basal period when no exogenous bile salt was infused, then with the addition of 1, and finally 2 μmol/min/kg of glycodeoxycholic acid, the main bile acid of rabbits. During the 3‐h experiment either saline (control) or the nutrient solution was administered by the respective route. Chronic adminis± intragastrically, significantly (p < 0.05) reduced bile flow and bile salt secretion compared with controls and the rabbits on a reduced chow intake. The chronic intravenous route had a more pronounced cholestatic effect than the intragastric route. Acute intragastric nutrient infusion had no effect. The decreased bile output in the chronic groups resulted from a reduction in both bile salt secretion and bile sail‐independent flow. Thus, chronic administration of amino acid, glucose, and fat, whether intravenously or intragastrically, can produce cholestasis.
Widespread Cutaneous Crohn's Disease Presenting in Childhood
Authors: Puntis J. W. L. , Candy D. C. A. , Alexander‐Williams J. , Kelsey A.
Published: January 2024

Summary:

Cutaneous lesions containing Crohn's granulomata are rare and tend to occur in submammary or abdominal wall skin folds when they are to be found (1). Crohn's disease of the skin in nonflexural locations has been reported (2,3) although not in children. We report a 5‐year‐old girl with extensive colonic Crohn's disease, who at presentation was noted to have a generalised erythematous papular rash which histologically showed typical noncaseating granulomata.
Sucrose Malabsorption in Children
Authors: Gudmand‐H$oSyer E.
Published: January 2024

Thirty‐one children with sucrose malabsorption are reported. All had a flat blood sugar curve after sucrose ingestion but a normal one after monosaccharides. Seventy‐five percent were malnourished and 11 were dehydrated at admission to hospital. Seven had to have intraveneous rehydration. After institution of a sucrose‐free diet, the symptoms disappeared and the patients gained weight. Eighteen had had symptoms for >1 year, 13 for >2 years, and 7 for >5 years before their cause was discovered. Familial occurrence of sucrose malabsorption was shown in three to five cases. Four children were reinvestigated 7–15 years after diagnosis. All had chronic dyspepsia, and none kept a strictly sucrose‐free diet. Three of the four patients were underweight for their age by from 5 to 16 kg, whereas the fourth was as underweight as compared to height. It is concluded that the high incidence of sucrose malabsorption found in Greenland together with the high sucrose consumption might be of nutritional hygienic significance for the population.
Serum IgA and IgG Gliadin Antibodies and Small Intestinal Mucosal Damage in Children
Authors: Lindberg T. , ‐Å. Nilsson L. , Borulf S. , Cavell B. , Fällström S. P. , Jansson U. , Stenhammar L. , Stintzing G.
Published: January 2024

Serum immunoglobulin (Ig) A and IgG gliadin antibodies were determined with a simple, rapid, and inexpensive method—diffusion‐in‐gel enzyme‐linked immunosorbent assay (DIG‐ELISA)—and the results were related to small intestinal mucosal morphology in 234 children suspected of having malabsorption. Fifty‐six of 58 children with flat intestinal mucosa had increased IgA and/or IgG gliadin antibody levels (sensitivity 97%). Fifty‐four of the 58 children had celiac disease (CD) (n = 25) or probable CD (n = 29). Four children with flat mucosa had cow's milk protein and/or soy protein intolerance and three of these had increased gliadin antibody levels. Seventeen percent of 132 children with normal intestinal mucosa had increased IgA and/or IgG gliadin antibody levels. IgA and IgG gliadin antibody levels decreased significantly in the celiac children on a gluten‐free diet and increased significantly after gluten challenge. Determination of serum IgA and IgG gliadin antibodies by means of DIG‐ELISA is a sensitive test for small intestinal mucosal damage in children. When malabsorption is suspected, we suggest that this assay be used to select children for a small intestinal biopsy. It is also very useful for the follow‐up of adherence to a gluten‐free diet and to determine the effect of gluten challenge in celiac children.
Studies of Intestinal Lymphoid Tissue. VIII. Use of Epithelial Lymphocyte Mitotic Indices in Differentiating Untreated Celiac Sprue Mucosa from Other Childhood Enteropathies
Authors: Marsh Michael N. , Miller Victor
Published: January 2024

The mitotic activity of epithelial lymphocytes (expressed as percentage mitotic figures/3,000 lymphocytes/mucosal biopsy) was determined in a random sample of jejunal biopsies performed on 44 children with malabsorption, diarrhoea, or failure to thrive. The mitotic index (MI) exceeded 0.2% in 19 biopsies obtained from children with untreated celiac sprue (CS); there were no false positives. The remaining 25 biopsies (MI of <0.2%) were considered to be "nonceliac" in origin, among which were several with a severe degree of villous flattening. Conditions in this latter category excluded by a low MI included cow's milk protein enteropathy, selective immunoglobulin A deficiency, combined variable immunodeficiency, Crohn's jejunitis, and intractable diarrhoea of infancy. A high MI (>0.2%) prospectively distinguishes mucosal lesions due to untreated CS from other causes of malabsorption, particularly those associated with villous flattening, but in which the MI is <0.2%. This index is therefore proposed as a simple, reliable, and prospective histological marker of CS, and one that could: (a) reduce the need to perform multiple biopsies during a gluten‐free diet; and (b) avoid the necessity for follow‐up "diagnostic" gluten challenges, especially in very young children.
Disaccharidase Activities, Jejunal Morphology, and Carbohydrate Tolerance in Children with Chronic Diarrhea
Authors: Calvin R. T. , Klish W. J. , Nichols B. L.
Published: January 2024

Children with chronic diarrhea were examined for their carbohydrate tolerance, small bowel morphology, and specific disaccharidase activities to determine whether disaccharidase enzymatic activity is related to villus height and thus may be viewed as an independent variable that controls digestive capacity. Results indicated that 65–78% of all abnormal biopsy samples had specific disaccharidase activities that fell within the normal range. Clinical disaccharide tolerance studies indicated that specific enzyme activity did not correlate with disaccharide tolerance.
Intestinal Alkaline Phosphatase Activity in Relation to Age in Humans
Authors: Welsh Jack D. , Stevenson Dennis E. , Poley J. Rainer , Walker Anthony W.
Published: January 2024

Early studies of a few subjects suggested that intestinal alkaline phosphatase (IAP) activities in children 5 years of age or less were higher than in older individuals. To further investigate this finding, the IAP and disaccharidase activities of 298 subjects (133 were 5 years of age or less) with normal intestinal histology were assayed. Ninety‐five of the children had serum alkaline phosphatase determined. The youngest individual with a low lactase activity was 5 years of age, which supported the earlier findings. When the whole population was tested, there was no correlation between the intestinal and serum alkaline phosphatase values. The mean IAP activity of subjects 1 year old and less was greater than in older individuals, but there was greater statistical dispersion and the data were not normally distributed. When studying the natural logarithm of the data, a wide dispersion of values about the mean in the 0 to 3 year‐old age group was observed. This qualitative behavior is characteristic of functions involving the base of the natural logarithm and of processes that “age” in a simple way.
Interaction of Intestinal Disaccharidases with Phospholipids
Authors: Tiruppathi Chinnaswamy , Alpers David H. , Seetharam Bellur
Published: January 2024

Although the rat intestinal brush border disaccharidases are the most easily solubilized protein components, the nature of the lipid‐protein interactions in the membrane is incompletely understood. Phospholipid vesicles were prepared using the lecithin fraction from brush border membranes and synthetic lecithins. Addition of cholesterol to brush border lecithins enhanced the binding of disaccharidases, but not of alkaline phosphatase. The addition of cholesterol to synthetic lecithin vesicles enhanced the binding of disaccharidases only when added above the transition temperature of the lecithin used. The maximal effect occurred at an equimolar ratio of lecithin to cholesterol. Binding of disaccharidases to phospholipid vesicles was independent of charge or the nature of the polar head group, and the enzyme was inserted so that the catalytic domain was excluded from the lipid matrix. These results demonstrate that membrane attachment of disaccharidases is hydrophobic, involving primarily fatty acyl chains and an interaction with cholesterol. The membrane interaction does not seem to affect enzyme activity.
Effect of Lectins on the Activity of Brush Border Membrane‐Bound Enzymes of Rat Small Intestine
Authors: Erickson Roger H. , Kim Johann , Sleisenger Marvin H. , Kim Young S.
Published: January 2024

Highly purified microvillus membrane vesicles isolated from rat small intestine were enriched in sucrase, maltase, and aminopeptidase activities. Approximately 90–95% of each enzyme was released from the membrane fraction by treatment with detergent (Triton X‐100) and sonication. Using untreated and solubilized preparations, the effect of lectin binding on the activity of each of the three enzymes was measured. It was observed that wheat germ agglutinin (WGA) and phytohemagglutinin (PHA) dramatically enhanced the activity of membrane‐bound maltase but had much less effect on the detergent solubilized enzyme. Under the same conditions aminopeptidase activity was inhibited by WGA and PHA while sucrase activity was not affected. These alterations in enzyme activity occurred at lectin concentrations that also precipitated each solubilized enzyme from solution. Inhibitory sugars prevented the alterations in enzyme activity suggesting that the effect is due to the binding of lectin to specific carbohydrate structures. Enhancement of membrane‐bound maltase activity by WGA and PHA was shown to be temperature dependent indicating that the lipid environment of the microvillus membrane may play a role in mediating the lectin effect. A kinetic analysis of the changes in maltase activity induced by these two lectins was due solely to an increase in Vmax. Two other lectins used in this study (concanavalin A and Ricinus communis agglutinin) did not readily precipitate the enzymes in question or alter their activity. These results show that binding of lectins to brush border membranes can induce variable changes in the activity of several membrane associated hydrolases, and suggest that similar changes may occur in vivo in the presence of dietary lectin. The consequences of such alterations on the ability of the intestinal mucosa to hydrolyze and absorb various dietary constituents is at present unknown.
Membrane Distribution in Human Milks Throughout Lactation as Revealed by Phospholipid and Cholesterol Analyses
Authors: Huston Gail E. , Patton Stuart
Published: January 2024

Membrane distribution in human milk was investigated. Milk samples from six women taken at intervals throughout 9 months of lactation were fractionated into fat globules, skim milk, fluff, and cells. These fractions and the intact milks were analyzed for protein, total lipid, and membrane material as revealed by phos‐pholipid and cholesterol contents. All fractions showed initial levels of membrane that dropped by 1 month and then remained relatively unchanged thereafter. Total lipid (fat globules) in the milks was the primary factor determining membrane content. Distribution of membrane in mature milks was: fat globules, 80%; skim milk, 20% (including fluff, 5%); and cells, less than 1%. Mature milk assures the infants a relatively steady supply of membrane material. However, there appears to be approximately twice as high a concentration of it in milk during the first several weeks of lactation. At that time, the skim milk phase accounts for approximately 30% of milk membrane as compared to 20% during subsequent lactation.
Plasma Carnitine and Breast Milk Carnitine Intake in Premature Infants
Authors: Cederblad G. , Svenningsen N.
Published: January 2024

Ten premature infants with a mean gestational age of 29 weeks (range, 27–32) and a mean birth weight of 1,294 g (range, 930–2,300) and without complications at birth were studied during the first 14 days after birth. Their breast milk intake was recorded and the carnitine content determined in each daily portion. During the first week, the daily mean carnitine intake was low and increased to 6–7 μmoles/kg and day during the second week. Breast milk carnitine concentration ranged from 17 to 148 n, moles/L. Plasma carnitine and its derivatives did not change during the observation period. No relationship was found between the individual cumulative breast milk carnitine intake and total plasma carnitine levels or between carnitine and its derivatives and nonesterified fatty acids or 3‐OH‐butyrate. The urinary carnitine excretion, in millimoles of carnitine per mole of creatinine, was higher during the second week. In other studies, declining plasma carnitine levels have been observed in premature infants on total parenteral nutrition. The results from this study indicated that premature infants without complicating disorders were able to maintain their plasma carnitine levels.