bluuebunny/crossref_metadata_2025 huggingface dataset:
Rectosigmoidoscopic Findings During Isolated Rectal Bleeding in the Neonate
Authors: Dupont Christophe , Badoual Jean , Luyer Bernard Le , Bourgeois Corinne Le , Barbet Jacques‐Patrick , Voyer Marcel
Published: February 2024

This study describes a group of 34 infants under 1½ months of age presenting with isolated rectal bleeding not related to hemorrhagic disease of the newborn or to campylobacter infection and with spontaneously favorable evolution. Systematic rectosigmoidoscopy showed the presence of mucosal alterations in the form of either longitudinally stretched ecchymoses lying on a normal mucosa or diffuse ecchymotic patches dispersed on a congestive and friable mucosa, rarely associated to visible micro‐ulcerations. Biopsies showed mucosal hemorrhage, capillary vessel congestion, and epithelial erosions, as well as various grades of inflammation. Clinical data indicate that this hemorrhagic colitis is a heterogeneous group where dietary protein intolerance may account for some cases.
Alpha2 HS‐Glycoprotein Levels in Children with Protein‐Energy Malnutrition and Infections
Authors: Abiodun Ph. O. , Olomu I. N.
Published: February 2024

Serum alpha2 HS‐glycoprotein levels were studied, using the single‐radial immunodiffusion method, in 39 severely malnourished children (22 kwashiorkor, 17 marasmus) of whom 15 (8 kwashiorkor, 7 marasmus) were infected and 24 (14 kwashiorkor, 10 marasmus) had no signs of infection. Thirty‐two well‐nourished children, 16 of whom were infected, served as controls. The uninfected controls had higher serum alpha2 HS‐glycoprotein levels than the uninfected kwashiorkor (82.0 ± 14.7; 57.0 ± 15.8; p < 0.001) and marasmic children (82.0 ± 14.7; 45.0 ± 13.9; p < 0.001). Infection was associated with a significant decrease in the mean serum alpha2 HS‐glycoprotein levels in the well‐nourished (82.0 ± 14.7; 57.0 ± 7.7; p < 0.001) and kwashiorkor (57.0 ± 15.8; 34.0 ± 20.4; p < 0.02) children, while no such decrease was observed in the marasmic children. While the mean serum glycoprotein level in the infected controls was higher than that in the infected kwashiorkor children (57.0 ± 7.7; 34.0 ± 20.4; p < 0.02), it was comparable to that in the infected marasmic children (57.0 ± 7.7; 50.0 ± 11.6; p > 0.05). Furthermore, the mean alpha2 HS‐glycoprotein level in the infected malnourished children was higher in marasmus than in kwashiorkor (50.0 ± 11.6; 34.0 ± 20.4; p > 0.05); this difference was, however, not statistically significant. It is suggested that the lower level of alpha2‐HS glycoprotein observed in children with kwashiorkor, both in the presence and absence of infection, might be a contributory factor in the impairment of the host defense mechanisms in these children with consequent higher morbidity and mortality from infection as compared to well‐nourished and marasmic children.
The Influence of Gestational Age, Size for Dates, and Prenatal Steroids On Cord Transferrin Levels in Newborn Infants
Authors: Chockalingam Uma , Murphy Edrie , Ophoven Janice C. , Georgieff Michael K.
Published: February 2024

Serum transferrin levels assess protein status in older children and adults. To generate standards for its use in newborn infants, we measured umbilical cord serum transferrin levels in 161 appropriate (AGA), 25 large (LGA) and 16 small (SGA) for gestational age infants between 25 and 43 weeks' gestation. We also assessed the effects of intrauterine growth, exposure to prenatal steroids, and presence of pulmonary maturity on neonatal transferrin levels. Cord transferrin levels in AGA infants were significantly correlated with increasing gestational age (r = 0.60; p < 0.001). Infants born before 37 weeks' gestation had significantly lower transferrin levels, when compared with those born at term (p < 0.001). LGA infants had significantly higher levels than age‐matched AGA infants (253 ± 75 vs. 214 ± 53 mg/dl; p < 0.025). Despite significantly lower mean birth weights (p < 0.001), SGA infants also had significantly higher levels than gestational age‐matched AGA controls (227 ± 63 vs. 167 ± 40 mg/dl; p < 0.005). For infants <35 weeks' gestation, neither the 20 preterm infants with exposure to prenatal steroids (maternal betamethasone), nor the 26 infants with pulmonary maturity had significantly elevated transferrin levels, when compared with gestational age‐matched control infants. Newborn transferrin levels correlate well with gestational age and are significantly affected by size for dates, but not by a brief course of prenatal steroids or by pulmonary maturity.
Test‐Retest Reproducibility of Hydrogen Breath Test for Lactose Maldigestion in Preschool Children
Authors: Barillas‐Mury Carolina , Solomons Noel W.
Published: February 2024

The test‐retest reproducibility of the H2 breath test within the same individual has not been rigorously evaluated in preschool children. In the present study, 10 children‐5 of whom were diagnosed as lactose‐digesters on their first testing, and 5 of whom were diagnosed as lactose‐maldigesters at first screening—were retested under identical conditions of a second opportunity. In each case, the same diagnostic classification was provided, for a reproducibility of 100%. Regression of the area under the curve of the change in breath H2 concentration during the 3 h of the test had a Pearson's correlation coefficient of 0.59 (p = 0.05). The time course of 3‐h H2 breath tests in 43 children with lactose maldigestion revealed a peaking of the concentration of H2 most commonly 120 min following the oral dose of 240 ml whole milk. Seventy‐seven percent of the children who eventually proved to be lactose maldigesters were so diagnosed by the end of the second hour of the breath test. Thus, even the abbreviated breath sampling schedule used in children is sensitive, and few maldigesters would go undetected because of a late rise in breath H2 concentration.
Kinetics of Copper Absorption in Zinc‐Overload States and Following the Withdrawal of Zinc Supplement
Authors: Cossack Zafrallah T. , van den Hamer Cornells J. A.
Published: February 2024

Zinc (Zn), in therapeutic dosages, has been used to inhibit copper (Cu) absorption in patients with Wilson's disease. A series of experiments were conducted to substantiate the effects of high dosages of Zn on Cu absorption using the experimental animal model. In the first experiment, five groups of mice were fed five different levels of Zn: 6 ppm (basal diet), 30 ppm (control), 750 ppm, 1,000 ppm, and 2,400 ppm, for a period of 35 days. 64Cu‐loading test was conducted to measure whole body retention (WBR) of 64Cu at the 10th, 14th, 21st, and 35th day. Results showed that the inhibition of 64Cu absorption by Zn is dose‐and time‐dependent. However, maximum inhibition occurred in mice fed 1,000 ppm of Zn, and no additional effect was observed in mice fed 2,400 ppm of Zn. In the second experiment, the distribution between the gastrointestinal tract (GIT) and gut‐free carcass, of the retained dose of 64Cu, was measured in controls and in the group fed 750 ppm of Zn. While WBR of 64Cu was significantly lower (p < 0.01) in mice fed 750 ppm of Zn, the distribution of the retained dose was not affected. In the third experiment, a group of mice was fed 30 ppm of Zn for a period of 70 days (control), and a second group was fed 1,000 ppm of Zn for the first 35 days (repletion), after which they were switched to the basal diet (6 ppm) for the following 35 days (depletion). WBR of 64Cu was conducted in intervals throughout the experimental period. Endogenous fecal Zn (MFZn) was determined at the end of repletion (0 t), and at intervals during depletion. Results from this experiment indicated that the effect of Zn on 64Cu absorption continued for up to 21–35 days, following the withdrawal of Zn supplement. In addition, WBR of 64Cu correlated significantly (r = −0.92, p < 0.005) with MFZn. We conclude that (a) high doses of Zn may not cause a complete inhibition of Cu absorption, and (b) endogenous Zn secreted into the GIT (as MFZn) plays a major role in inhibiting Cu absorption and thus, the maintenance of high endogenous Zn status is essential for maximal inhibition of Cu absorption.
Congenital Agastria
Authors: Dorney Stuart F. A. , Middleton Archie W. , Kozlowski Kazimierz , Benjamin Bruce N. P. , Kan Alex E. , Kamath K. Ramanand
Published: February 2024

Congenital agastria has never before been reported. Congenital microgastria is rare but is well documented. We have cared for a Melanesian child in whom there was no radiological, anatomical, or physiological evidence of either a rudimentary stomach or a pylorus. The esophagus joined the first part of the duodenum directly. At this esophago‐duodenal junction there was microscopic evidence of fundic‐type gastric mucosa. The intestine was normally rotated and there was a functioning spleen. The child also had a severe micrognathia and a cleft soft palate and required a tracheostomy to relieve upper airway obstruction. The combination of micrognathia and agastria presented a difficult nutritional delivery problem. A jejunal pouch was constructed and placed between the esophagus and duodenum to provide some storage capacity. The child grew and developed well for almost 3 years. He suffered three episodes of severe acute enteritis, probably related to lack of the protective acid‐pepsin barrier against ingested microorganisms. Unfortunately, the third episode of acute enteritis caused his death 3 months after returning home to his own country.
An Analysis of Cereals That React with Serum Antibodies in Patients with Coeliac Disease
Authors: Troncone Riccardo , Auricchio Salvatore , De Vincenzi Massimo , Donatiello Anna , Farris Evelina , Silano Vittorio
Published: February 2024

Sera from six children with active coeliac disease, and elevated titres against gliadins and from six age‐matched controls, were examined for IgG antibodies against different cereal proteins by a solid‐phase radioim‐munoassay. Antibodies to the major wheat proteins and the prolamines of other cereals were present in low titre in all control sera. In coeliac sera, significantly higher titres were found against A‐gliadin, as well as against hexaploid and tetraploid wheat whole gliadins. Gliadin peptic‐tryptic digest retained a significant antigenic activity, completely lost by peptic‐tryptic‐pancrealic digest. High titres were also found when coeliac sera were tested against wheat glulenins, albumins, and globulins, as well as against barley, oats, and maize prolamines; rice prolamines gave lower titres. Serum from whole gliadins and A‐gliadin immunized rabbils showed a similar spectrum of reactivity against prolamines as coeliac sera. Our results indicate a dissociation belween immunogenic properlies of cereal proteins and loxicily in coeliac disease.
Breath Hydrogen Test in Children with Giardiasis
Authors: Vega‐Franco Leopoldo , Meza Carlos , Romero Jose Luis , Alanis Soledad E. , Meijerink Jeanette
Published: February 2024

Respiratory hydrogen excretion was measured in 50 children with giardiasis in order to study lactose absorption. Samples of expired air were collected before and after the children drank 250 ml of whole cow's milk. The test was repeated after successful elimination of Giardia lamblia following treatment with tinidazol. The number of children showing a rise in breath hydrogen excretion >20 ppm decreased from 33 (72%) before treatment to 20 (44%) after treatment. This study permits the conclusion that the presence of G. lamblia in the intestine might interfere with optimum lactose absorption.
Efficacy of Mung Bean (Lentil) and Pop Rice Based Rehydration Solutions in Comparison with the Standard Glucose Electrolyte Solution
Authors: Bhan M. K. , Ghai O. P. , Khoshoo Vikram , Vasudev A. S. , Bhatnagar S. , Arora N. K. , Rashmi  , Stintzing Gudmund
Published: February 2024

Children with acute diarrhea and moderate dehydration between 3 months and 5 years of age were randomly assigned to receive treatment with standard WHO oral rehydration solution (ORS) (n = 33) and two other solutions in which the 20 g/L glucose was substituted by 50 g/L of pop rice (n = 31) and 60 g/L of mung bean (lentil) powder (n = 29). Satisfactory oral rehydration, as assessed clinically and by changes in PCV and total serum solids (TSS), was achieved in 90.9% with WHO ORS, 96.8% with pop rice, and 96.6% in the mung bean ORS treated group (p > 0.05). The purging rates (ml/kg/h) until recovery were 2.49 ± 1.5 (pop rice); 2.91 ± 2.0 (WHO), and 3.41 ± 1.7 in the mung bean group (p > 0.05). The percentage of patients recovering from diarrhea within the 72 h study period was 58.0 (pop rice), 48.4 (WHO), and 44.8 for mung bean group (p > 0.05). Though differences in stool volumes and duration in the three groups were not statistically different, there was a trend toward improvement in efficacy with the pop rice ORS in several parameters: greater weight gain, higher percentage decline in TSS, higher urine output despite lower ORS intake, and lower purging rates. The intake of semisolids in the 24–72 h study period was also higher in the pop rice group as compared to the other two groups (p < 0.05). The number of breast feeds and intake of artificial milk was however similar in all groups (p > 0.05).
Straight Ileoanal Anastomosis and Ileal Pouch‐Anal Anastomosis in the Surgical Management of Idiopathic Ulcerative Colitis and Familial Polyposis Coli in Children
Authors: Odigwe L. , Sherman P. M. , Filler R. , Shandling B. , Wesson D.
Published: February 2024

We compared the postoperative course in children and teenagers who underwent subtotal colectomy, mucosal proctectomy, and either straight ileoanal anastomosis (group 1, n = 8) or ileal pouch‐anal anastomosis (group 2, n = 10) for the surgical treatment of idiopathic ulcerative colitis (n = 15) and familial polyposis coli (n = 3). Two of eight children in group 1 developed intractable diarrhea that persisted despite revision of the anastomosis to include an ileal pouch; therefore, ileostomies were necessary in both cases. One patient in group 2 had a diverting ileostomy as a result of abscess formation at the site of the ileoanal anastomosis. Despite a longer period of postoperative follow‐up (48.9 ± 11.8 months), the remaining six patients in group 1 had a significantly greater number of bowel movements each day (7.8 ± 6.5) as compared with the nine patients in group 2 who had 4.8 ± 2.6 stools each day (p < 0.05) at a mean follow‐up of 15.7 ± 9.0 months. A proportion of children in both groups had a poor postoperative functional outcome as determined by fecal incontinence (2 of 6 in group 1, 6 of 9 in group 2), perianal dermatitis (2 of 6, 4 of 9), and therapy with the antidiarrheal agent loperamide (4 of 6, 2 of 9). Increased school attendance (5 of 6, 7 of 7) and improvement in level of participation in social activities (5 of 6, 7 of 7) as compared with the 6‐month period prior to surgery occurred, however, for most of the children with ulcerative colitis in both groups. We conclude that although significant complications can develop following the formation of an ileoanal anastomosis, with or without an ileal reservoir, many children achieve a good functional outcome.
Effect of the Lectin Concanavalin A on the Neonatal Guinea Pig Gastrointestinal Mucosa in Vivo
Authors: Weaver L. T. , Bailey D. S.
Published: February 2024

The effect of intrapharyngeal infusion and subsequent passage of the lectin concanavalin A through the gastrointestinal tract of neonatal guinea pigs was examined. The lectin, administered at a concentration of 1 mg/ml, caused considerable mucosal damage in the stomach. Subsequent passage of the lectin through the small intestine caused little cellular damage to the mucosa, as judged by light and electron microscopy. Parallel morphometric analyses of the jejunum showed a decrease in mean villus height and an increase in mean crypt depth of 8% after 5 h of lectin administration. A 4.7‐fold increase in jejunal crypt cell production rate was observed, accompanied by a statistically significant increase in the number of intraepithelial lymphocytes. These morphologic and kinetic changes were accompanied by a threefold increase in the urinary lactulose:mannitol excretion ratio, indicative of a loss of mucosal integrity. No systemic antibody response to concanavalin A was demonstrated within 5 h of intragastric infusion of the lectin. Concanavalin A, conjugated with 10 nm colloidal gold particles, was also directly infused into the lumen of the jejunum in vivo. Within 60 min, both villous and crypt epithelial cells contained gold particles, demonstrating the rapid accessibility of crypt cells to the lectin. Intercellular spaces appeared within the villous epithelium, although both junctional complexes and spot desmosomes were retained. The brush border was abnormal with signs of incipient vesicularization. These findings have implications for our understanding of the pathogenesis of childhood coeliac disease and for the vulnerability of the neonatal gut to food proteins.
Use of a Long‐Acting Somatostatin Analogue (SMS 201–995) in Controlling a Significant Ileal Output in a 5‐Year‐Old Child
Authors: Ohlbaum Ph. , Galperine R. I. , Demarquez J. L. , Vergnes P. , Martin Cl.
Published: February 2024

We report the efficacy of a long‐acting somatostatin analogue, associated with conventional therapy, in controlling profuse ileostomy losses in a child with short bowel syndrome following a volvulus. The first therapeutic effects of the treatment [50 to 100 μg/day of SMS 201–995 (Sandoz Ltd.) subcutaneously] appeared 48 h after institution. Ileal output was reduced on an average from 1,800 to 600 ml. The transit time to the ileostomy was prolonged from 20 to 360 min. The loss of chloride and sodium was reduced. Clinical tolerance was good. This treatment allowed rapid weaning of parenteral nutrition and implementation of a constant rate enteral infusion with rapid nutritional restitution. Hospitalization was shortened and this treatment raises future opportunities in the short bowel syndrome.
The Occurrence and Significance of the Bilirubin Species, Including Delta Bilirubin, in Jaundiced Infants
Authors: Ostrea Enrique M. , Ongtengco Edgar A. , Tolia Vasundhara A. , Apostol Emmanuel
Published: February 2024

An improved technique for bilirubin analysis, using high‐performance liquid chromatography, has enabled us to study the occurrence and significance of four species of bilirubin (unconjugated, monoconjugated, diconjugated, and delta bilirubin) in 40 infants with jaundice of various etiologies. We found that: (a) infants with indirect hyperbilirubinemia showed >90% of their total serum bilirubin as unconjugated bilirubin. The small remaining fraction consisted of conjugated bilirubin; predominantly delta bilirubin (5%); (b) infants with elevated direct serum bilirubin (≥2 mg/dl) showed almost twice more monoconjugated than diconjugated bilirubin fractions; (c) the standard diazo test for bilirubin analysis

underestimates the direct bilirubin by as much as 34%; and (d) delta bilirubin, a tightly protein bound bilirubin, was observed in significant amounts in infants with elevated

direct bilirubin. Its concentration, which ranged from 10–73% of the total bilirubin, was related to the duration rather than to the cause of the jaundice. It was also observed at birth in an infant with giant‐cell hepatitis. It is concluded that the identification of more specific bilirubin species in jaundiced infants, especially in those with elevated direct serum bilirubin, will further help in the understanding and management of their disease.
Role of Type 1 Somatic Pili (Fimbriae) in Mucosal Attachment of the Enteroadherent Escherichia coli, Strain RDEC‐1, in Rabbits
Authors: Sherman P. , Soni R. , Boedeker E.
Published: February 2024

We have previously shown that attachment of the rabbit enteroadherent Escherichia coli, strain RDEC‐1, to ileal brush borders in vitro is mediated by both man‐nose‐resistant, AF/R1 pili and mannose‐sensitive, type 1 pili. Because the role of type 1, somatic pili as adhesins that mediate bacterial enteroadherence in vivo remains controversial, we examined adherence of RDEC‐1 expressing either type 1 pili or AF/R1 pili to rabbit ileum in ligated loops and after oral infection of rabbits. A rabbit fecal commensal E. coli, 640, which also expressed type 1 pili was used as a control. After oral infection of rabbits we evaluated: (a) diarrhea, (b) fecal shedding of organisms, (c) luminal colonization of jejunum and ileum, and (d) mucosal adherence of bacteria to jejunum, ileum, and colon. RDEC‐1 expressing either type 1 or AF/R1 pili adhered to enterocytes both in ileal ligated loops and in the distal ileum, cecum, and proximal colon of infected rabbits. In contrast, enteroadherence of 640 was not observed. Diarrhea developed in rabbits challenged with either type 1 or AF/R1 piliated RDEC‐1, but not in rabbits fed 640. Seven days after infection of rabbits with RDEC‐1 bearing type 1 pili, luminal colonization of jejunum (4.22 ± 0.55 CFU/g, X ± SE) and ileum (6.34 ± 0.55) was the same as after infection with AF/R1 piliated RDEC‐1 (jejunum 4.47 ± 0.20, ileum 5.81 ± 0.70) and significantly greater than luminal colonization by type 1 piliated 640 (jejunum > 2.22 ± 0.14, ileum > 2.06 ± 0.15). Indirect immunofluorescence using polyvalent antiserum produced against type 1 pili (purified from RDEC‐1) was positive for RDEC‐1 adherent to ileal enterocytes both in ligated loops and after oral infection of rabbits. These findings support the hypothesis that type 1 pili could mediate adherence of enteroadherent E. coli to intestinal mucosal surfaces during infection in vivo.
Barrett's Esophagus in an Infant
Authors: Nibali S. Conti , Barresi G. , Tuccari G. , Rivosecchi M. , Magazzù G.
Published: February 2024

Data on the frequency of regression of Barrett's esophagus after medical therapy or antireflux surgery in adult patients are conflicting; these data, with regard to Pediatric age, where Barrett's esophagus is considered rare, are scarce and disappointing after antireflux surgery. We report a 4‐month‐old infant affected by severe reflux esophagitis who developed a junctional‐type Barrett's epithelium. Histochemical procedures to detect mucin pattern were also carried out. The regression of Barrett's esophagus was observed 4 months after antire‐flux surgery whereas medical therapy had been unsuccessful. We suggest that esophageal biopsy should also be performed in the presence of severe esophagitis. Longer follow‐up observations of other patients may clarify the role of antireflux surgery when Barrett's esophagus complicates gastroesophageal reflux (GER).
Infantile Colitis
Authors: Chong S. K. F. , Wright V. M. , Nishigame T. , Raafat F. , Isaacs D. , Morson B. C. , Walker‐Smith J. A.
Published: February 2024

A brother and sister of first cousin Pakistani parents presented with recurrent mouth ulcers and chronic diarrhoea in the neonatal period. Diarrhoea persisted in spite of treatment with oral prednisolone and sulphasalazine. Both children required subtotal colectomy with ileostomy. Histopathology of the resected colons was virtually identical and showed multiple deep “flask”‐shaped ulcers, often penetrating to the serosa, in the presence of chronic inflammation, but without any of the characteristic histological features of Crohn's disease. The appearance closely resembled the colitis of Behcet's syndrome. Both children (aged 6 and 3.5 years, respectively) have continued to have recurrent perianal disease with intermittent bloody diarrhoea since the operation. Apart from the initial symptoms of oral aphthous ulcerations in both children, no other major criteria have developed so far. Intestinal Behcet's syndrome should be considered in the differential diagnosis of chronic inflammatory bowel disease in childhood.
Changes in Phospholipid and Cholesterol Concentrations of the Rat Microvillus Membrane During Maturation
Authors: Engelhardt Elizabeth L. , Neu Josef , Sankar Mira B. , Gimotty Phyllis A. , Meyer Jay W.
Published: February 2024

We studied the cholesterol and phospholipid content and the cholesterol‐to‐phospholipid molar ratio of the small intestinal microvillus membrane in fetal, weanling, and adult rats. We also investigated the effect of glucocorticoid administration on these lipids and the ontogeny of 1,2‐diglycerol‐CDP choline phosphocholine transferase (PCT). Cholesterol and phospholipid concentrations decreased with maturation, phospholipids declining more than cholesterol. Thus, the cholesterol‐to‐phospholipid molar ratio rose with maturation. A similar decline was seen with PCT activity. Glucocorticoid treatment had no effect on cholesterol, phospholipids, or PCT. However, the maturational increase in the cholesterol‐to‐phospholipid molar ratio was blunted by glucocorticoid administration in the weanling and adult rats.
Serotonergic Mediation of Vomiting
Authors: Gale Jem D.
Published: February 2024

In the latter part of the 20th century, significant advances have been made in the understanding of the emetic reflex. As a result, there have been major improvements in the treatment of vomiting, particularly that associated with chemo‐ and radiotherapeutic treatments for neoplastic disease. The 5‐HT3 receptor antagonists (ondansetron and granisetron) have been demonstrated to be of benefit in treating the profound emesis observed during cancer treatment. This observation, together with results from pharmacologic and physiologic investigations in both animals and humans, have identified 5‐hydroxytryptamine (5‐HT or serotonin) to be of fundamental importance in the pathogenesis of emesis. 5‐HT appears to be released by radiation and chemotherapeutic agents from enterochromaffin cells within the wall of the intestine, and possibly from neurons within the brainstem. Stimulation of 5‐HT3 receptors, located centrally in the dorsal medulla of the brainstem and peripherally on vagal afferent terminals in the gastrointestinal tract, appears to play a pivotal role in eliciting emesis. The interaction of 5‐HT with non‐5‐HT3 receptors, particularly 5‐HT1A and 5‐HT4 receptors, may be important in the emetic reflex. The development of agents that interact with these receptors may offer alternative approaches to the treatment of nausea and vomiting.
Management of Cyclic Vomiting Syndrome
Authors: Fleisher David R.
Published: February 2024

The general goals of treatment of cyclic vomiting syndrome (CVS) are: interruption of established episodes, amelioration of symptoms in patients whose episodes cannot be interrupted, aborting episodes during prodromal symptoms, prophylaxis to abolish or lessen the frequency of episodes, and recovery. Complications of cyclic vomiting episodes include esophagitis, hematemesis, depletion of intracellular electrolytes, hypertension, and secretion of inappropriate antidiuretic hormone.
Prophylactic Therapy in Cyclic Vomiting Syndrome
Authors: Forbes David , Withers Geoffrey
Published: February 2024

The experience with prophylactic therapy for cyclic vomiting syndrome (CVS) at Princess Margaret Hospital for Children, Perth, Western Australia was retrospectively reviewed by questionnaire. Data was collected from 31 patients, aged 2.9‐21.75 years who reported a mean of nine attacks per year. Eleven patients had utilized prophylactic therapy. Parental assessment of benefit was recorded. Propranolol was the most effective agent with reported benefit in four of six cases, other antimigraine agents were deemed effective in two of seven cases. Anticonvulsants and antidepressants were not considered use ful. Homeopathic and vitamin supplements were thought to be beneficial in three of six cases. Prophylaxis was less likely to be beneficial in the more severe cases of CVS, but was of benefit in those patients whose attacks were precipitated by infection or who had features consistent with migraine. Prophylactic therapy with propranolol or serotonin receptor antagonists should be considered in children with frequent or severe symptoms.
Treatment of Cyclic Vomiting in Childhood with Erythromycin
Authors: Vanderhoof Jon A. , Young Rosemary , Kaufman Stuart S. , Ernst Laura
Published: February 2024

Cyclic vomiting syndrome (CVS) is an unusual cause of episodic emesis in children. It manifests as intermittent episodes of severe vomiting, similar in time of onset and duration, with no symptoms during the intervening period. Dehydration necessitating intravenous fluid therapy may occur. Most therapeutic maneuvers have proven unsuccessful. We report the use of erythromycin as a prokinetic agent in the treatment of cyclic vomiting in 24 children (10 boys, 14 girls). Many patients had mild associated abdominal pain with their vomiting. Fourteen patients had previously been given metoclopramide but none responded. Two patients were mildly developmentally delayed. Twenty‐four patients were given oral erythromycin ethylsuccinate, approximately 20 mg/kg/ day, in two to four divided doses for 7 days. This dose was repeated as needed when symptoms reappeared. Eighteen of 24 patients reported total resolution of symptoms when re‐evaluated at 2 and 6 months. All males responded, eight of 18 responders were female, and all six with partial or no response to therapy were female. This uncontrolled trial suggests that erythromycin may be a useful prokinetic agent in the treatment of CVS in childhood. Because the study was uncontrolled, placebo effect cannot be excluded. Case‐controlled, double‐blinded prospective trials should be considered to evaluate the effectiveness of erythromycin in CVS.
Abdominal Migraine in Children With Neurofibromatosis Type 1: A Case Series and Review of Gastrointestinal Involvement in NF1
Authors: Heuschkel Robert , Kim Sarah , Korf Bruce , Schneider Gretchen , Bousvaros Athos
Published: February 2024

Background

Symptomatic involvement of the gastrointestinal tract in children with neurofibromatosis type 1 (NF1) is rare. Most reported complications in adults are caused by the presence of neurofibromas in the stomach, small bowel, or mesentery. In contrast, abdominal pain in children with NF1 may be the result of nonanatomic causes, such as migraine. There are no previous reports of an association between abdominal migraine and NF1.

Methods

Children with abdominal migraine were identified from a group of children with NF1, all of whom had been followed up for a minimum of 3 years. Medical records of cases were reviewed independently by two authors. MEDLINE was searched via PubMed for all reports of children with NF1 and any associated gastrointestinal involvement.

Results

Six children with NF1 and intermittent, episodic, severe abdominal pain are reported. Investigations for obstructive or inflammatory causes of abdominal pain were negative. All patients had previously been diagnosed with migraine headaches by a neurologist. In five of the six patients, propranolol (10–15 mg three times daily) resulted in relief of their abdominal pain within days of starting therapy. Our review identified 24 children in the medical literature with gastrointestinal complications of NF1, mostly secondary to visceral neurofibromas. In almost all of these cases, clinical examination and simple radiologic investigations led to the definitive diagnosis. There were no reports of abdominal migraine complicating NF1.

Conclusions

Abdominal pain secondary to migraine is an unrecognized cause of abdominal pain in children with NF1 and may be more common than anatomic causes of abdominal pain in children with NF1. In children with NF1 and severe recurrent abdominal pain in whom an evaluation for anatomic lesions is negative, a trial of migraine therapy may be indicated.
Efficacy of Lansoprazole in the Treatment of Gastroesophageal Reflux Disease in Children
Authors: Tolia Vasundhara , Ferry George , Gunasekaran Thirumazhisai , Huang Bidan , Keith Roberta , Book Linda
Published: February 2024

Objectives:

To assess the efficacy of lansoprazole for the relief of symptoms due to gastroesophageal reflux disease (GERD) in children 1 to 11 years of age. In addition, the efficacy in healing of erosive esophagitis (EE) was determined in those children with EE who were enrolled in the study.

Methods:

In this phase I/II, open‐label, multicenter (11 sites). U.S. study, children with symptomatic GERD, EE by endoscopy, and/or intraesophageal pH < 4 for greater than 4.2% of the time' based on 24‐hour pH testing were assigned, on the basis of body weight, to lansoprazole 15 mg (≤ 30 kg) or 30 mg (> 30 kg) once daily for 8 to 12 weeks. At the discretion of the investigator, the dosage of lansoprazole was increased up to 60 mg daily in children who continued to be symptomatic after 2 weeks of treatment. Symptom response was assessed by investigator interview and daily diary. Esophagitis healing was evaluated by repeat endoscopy after 8 and, if applicable, 12 weeks of treatment.

Results:

Sixty‐six children were enrolled. At week 8, 78% (21/27) of the children with EE at baseline had healed; the remaining six children were healed by week 12 (100%, 6/6). By investigator interview, 70% of children experienced resolution or improvement in their overall symptoms of GERD by their final visit. Statistically significant reductions from baseline in the severity of each symptom were reported with the exceptions of wheezing, hematemesis, and melena. Based on daily diary data, improvement in overall GERD symptoms was reported in 76% (47/62) of all children. With few exceptions, significant (P < 0.05) reductions from baseline occurred during each of the 2‐week treatment intervals of the study period in the percentage of days and the average daily severity of GERD symptoms, the percentage of days antacid was used, and the average number of antacid tablets used per day.

Conclusion:

In children 1 to 11 years of age, lansoprazole is efficacious in healing EE and in relieving GERD‐related symptoms.
Pharmacokinetics and Pharmacodynamics of Lansoprazole in Children with Gastroesophageal Reflux Disease
Authors: Gremse David , Winter Harland , Tolia Vasundhara , Gunásekaran Thirumazhisai , Pan Wei‐Jian , Karol Michael , Chiu Yi‐Lin , Pilmer Betsy , Book Linda
Published: February 2024

Objectives:

To evaluate the pharmacokinetics and pharmacodynamics of lansoprazole in children between 1 and 11 years of age with gastroesophageal reflux disease (GERD).

Methods:

In a multicenter, open‐label trial of pediatric patients with symptomatic GERD, children were assigned, based on their weight, to receive lansoprazole 15 mg (patients weighing ≤30 kg) or lansoprazole 30 mg (patients weighing > 30 kg) once daily. The effects of lansoprazole on 24‐hour median intragastric pH, the percentages of time intragastric pH was above 3 and 4, and pharmacokinetic parameters were assessed at the day‐5 visit and compared to baseline.

Results:

Sixty‐six children were enrolled in the study. Mean lansoprazole Cmax values of 790.9 ng/mL and 898.5 ng/mL and Tmax values of 1.5 hours and 1.7 hours were observed in the ≤30 kg and the > 30 kg body weight treatment groups, respectively. AUC0‐24 values of 1707 ng‐h/mL and 1883 ng‐h/mL and T1/2 values of 0.68 hours and 0.71 hours were observed in the ≤ 30 kg and > 30 kg lansoprazole body weight treatment groups, respectively. There was no statistical significant difference in AUC0‐24 between the two groups (P = 0.2571). After 5 days of treatment lansoprazole produced significant increases in patients' 24‐hour mean intragastric pH and the percentages of time intragastric pH was above 3 and 4 compared to baseline.

Conclusion:

The observed pharmacokinetic properties of lansoprazole in children between 1 and 11 years of age with GERD were similar to those previously observed in healthy adult subjects. Lansoprazole significantly increased the mean 24‐hour intragastric pH and the percentages of time intragastric pH was above 3 and 4 when children were dosed with either 15 or 30 mg according to body weight.
Partial Protection against Dextran Sodium Sulphate Induced Colitis in Histamine‐Deficient, Histidine Decarboxylase Knockout Mice
Authors: Bene László , Sápi Zoltàn , Bajtai Attila , Buzás Edit , Szentmihályi Anna , Arató András , Tulassay Zsolt , Falus András
Published: February 2024

Objectives:

Chemically induced mucosal inflammation in animal models is a suitable tool for studying factors in the pathogenesis of inflammatory bowel disease. The aim of this study was to determine whether absence of histamine has an effect on the development of experimental colitis.

Methods:

Histamine‐deficient, histidine decarboxylase (HDC) knockout Balb/c mice and genetically identical control animals with intact HDC were studied. Colitis was induced by the administration of 2% dextran sodium sulphate in drinking water. Mice were killed after 5 days and disease activity assessed by clinical, histologic, and immunohistologic parameters. Bacterial components of stool were examined.

Results:

Clinical disease activity was higher in the mice with intact HDC (disease activity index, 2.21) than in the histamine‐deficient knock‐out mice (1.88). Histologic findings were similar in the two groups. On day 5, the inflammation score of the HDC sufficient group was 5.25 (±1.055) and the crypt score was 5.00 (±1.128). The scores in the HDC knock‐out group were 4.667 (± 0.707) and 4.667 (± 0.86), respectively. There was a significant difference in the number of interleukin (IL‐10)–producing lymphocytes in colon mucosa. Large numbers of IL‐10–positive lymphocytes were observed in wild type mice both those with DSS induced colitis and untreated controls. Only sporadic IL‐10 positivity was found in histamine‐deficient mice. Significant differences were found in the composition of the fecal bacterial flora between the two groups.

Conclusion:

The reduced number of IL‐10–positive lymphocytes in the intestinal mucosa of histamine‐deficient, histidine decarboxylase knockout mice and the altered fecal bacterial flora in these animals suggest that histamine may play a role in the pathophysiology of inflammation in the colon of normal animals by upregulating local IL‐10 production and stimulating a local shift to Th2 response.
Oral Rehydration Solution Containing a Mixture of Non‐Digestible Carbohydrates in the Treatment of Acute Diarrhea: A Multicenter Randomized Placebo Controlled Study on Behalf of the ESPGHAN Working Group on Intestinal Infections
Authors: Hoekstra J. H. , Szajewska H. , Zikri M. Abu , Micetic‐Turk D. , Weizman Z. , Papadopoulou A. , Guarino A. , Dias J. A. , Oostvogels B.
Published: February 2024

Objective:

A randomized, double‐blind, placebo‐controlled multicenter study to evaluate efficacy and safety of a mixture of non‐digestible carbohydrates (NDC) as an adjunct to oral rehydration therapy in treatment of acute infectious diarrhea in children with mild to moderate dehydration.

Methods:

144 boys aged 1 to 36 months with diarrhea defined as three or more watery stools per day for >1 day but <5 days with mild or moderate dehydration (World Health Organization criteria) were randomly assigned to receive hypotonic oral rehydration solution (ORS) (Na 60 mmol/L, glucose 111 mmol/L) with or without a mixture of NDC (soy polysaccharide 25%, α‐cellulose 9%, gum arabic 19%, fructooligosaccharides 18.5%, inulin 21.5%, resistant starch 7%).

Results:

Intention‐to‐treat analysis did not show significant differences in mean 48 hour stool volume (ESPGHAN‐ORS with NDC versus ESPGHAN‐ORS, 140 ± 124 g/kg versus 143 ± 114 g/kg; P = 0.41). Duration of diarrhea after randomization was similar in both groups (82 ± 39 hours versus 97 ± 76 hours, P = 0.24). There were no significant differences in the duration of hospital stay (111 ± 44 hours versus 126 ± 78 hours; P = 0.3). Unscheduled intravenous rehydration was similar in both groups (21.4% versus 16.2%, P = 0.42).

Conclusion:

In boys with acute non‐cholera diarrhea with mild to moderate dehydration a mixture of non‐digestible carbohydrates was ineffective as an adjunct to oral rehydration therapy.
Electrogastrography Reveals Post‐prandial Gastric Dysmotility in Children with Cystic Fibrosis
Authors: Schäppi Michela G. , Roulet Michel , Rochat Thierry , Belli Dominique C.
Published: February 2024

Objectives:

Cystic fibrosis patients have a wide spectrum of gastrointestinal disorders. The aim of this study was to investigate the function of gastroenteric neuromusculature and its response to a prokinetic.

Methods:

14 CF children aged 8.6 + 1.3 years were studied by electrogastrography and compared to 10 age‐matched controls. A second recording was performed in CF patients after administration of cisapride (0.3 mg/kg). Parameters analyzed were percentage of normal gastric rhythm (2.0 to 4.0 cpm), percentage of tachygastria (4.0 to 9.0 cpm), dominant frequency instability coefficient and power ratio.

Results:

CF and control groups were not different in age, height or weight. A significant post‐prandial increase in percentage of tachygastria (26.7 + 4.5 versus 12.4 + 2.6; P < 0.05) was seen in CF patients, which was not corrected by cisapride. The power ratio showed a statistical increase in 3 cpm (3.7 + 0.8 versus 1.6 + 0.3; P < 0.05) and in tachygastria (5.3 + 1.2 versus 1.7 + 0.4; P < 0.03) in CF compared with controls. Cisapride had an effect on tachygastria power ratio (3.0 + 0.5; P < 0.04). Analysis of normal rhythm and the dominant frequency instability coefficient were not statistically different in CF and controls.

Conclusion:

This study provides evidence of gastric dysmotility in CF patients.
Extraction of Di‐ethylhexyl‐phthalate from Perfusion Lines of Various Material, Length and Brand by Lipid Emulsions
Authors: Loff Steffan , Subotic U. , Reinicke F. , Wischmann H. , Brade J.
Published: February 2024

Background:

The plasticizer di‐ethylhexyl‐phthalate (DEHP) is extracted especially by lipid emulsions from polyvinylchloride infusion systems. The aim of this study was to systematically examine the extraction from perfusion lines commonly used in our hospital for lipid emulsion infusions.

Methods:

Perfusion lines made from polyvinylchloride of various lengths and brands, polyethylene, polyvinylchloride/polyethylene (PVC/PE) and polyvinylchloride/polyurethane (PVC/PU), were perfused with lipid emulsions according to the circumstances of newborns on an intensive care unit, i.e. high temperature, 24‐hour duration and low quantities. Concentration of di‐ethylhexyl‐phthalate was determined with gas chromatograph mass spectrometry.

Results:

The lipid emulsions before perfusion had a contamination with DEHP of 0.82 μg/ml. Pure PVC lines of 1.5 m length leached between 74 μg/ml and 107 μg/ml. Sterilization of the lines did not influence DEHP extraction. After perfusion of DEHP‐free PVC lines and PVC‐free lines, the emulsions had a contamination with DEHP of 0.23 μg/ml and 0.11 μg/ml, respectively. PVC/PU co‐extruded lines leached 73 μg/ml. PVC/PE lines leached 41.6 μg/ml.

Conclusions:

Lipid emulsions contain a production‐inherent load of DEHP. Perfusion through PVC‐perfusion lines extracts a varying large amount of DEHP depending on length and brand of the perfusion lines. Co‐extruded PVC/PU and PVC/PE lines, intended to avoid DEHP contamination, leach a similar amount of DEHP and thus do not avoid the DEHP toxicity issue. The load accumulated by a baby on an intensive care unit easily reaches several milligrams of DEHP per day. As its effect upon biologic systems has been proven, and alternatives (PE or PU perfusion lines) are available, PVC and PVC co‐extruded perfusion lines should be abandoned for infusions, especially in babies.
Adult‐type Hypolactasia: Clinical, Morphologic and Functional Characteristics in Brazilian Patients at a University Hospital
Authors: Escoboza Patrícia Martins Luizari , Fernandes Maria Inez Machado , Peres Luiz César , Einerhand Alexandra Wilhelmina Carla , Galvão Lívia Carvalho
Published: February 2024

Background:

Adult‐type hypolactasia (AH) is the most common form of disaccharidase deficiency in humans, with a prevalence that varies among ethnic groups. In Brazil, the few available studies suggest a high prevalence of this condition. The objective of this study was to determine the prevalence of AH in Brazilian patients at the Ribeirão Preto University Hospital, and to study its morphologic and functional expression.

Methods:

One hundred fifteen patients between 5 and 60 years undergoing upper gastrointestinal endoscopy were included. Mucosal biopsy specimens were obtained from the second portion of the duodenum. AH was defined by the disaccharidase activity (lactase/sucrase ratio) of the duodenal mucosa. The morphologic expression of lactase was studied by immunohistochemistry.

Results:

The mean age of the subjects was 28.8 ± 14.8 years. Seventy of the 115 subjects (60.8% prevalence) had AH by enzyme activity measurements. Milk drinking was common and similar in patients with and without AH. Among the patients, 91.3% of the nonwhite and 53.2% of the white individuals had hypolactasia (P = 0.002). Immunohistochemistry revealed the presence of lactase in 73.3% of individuals with normal lactase activity. Two different expression patterns were found in patients with AH.

Conclusions:

The prevalence of AH was high in our subjects and similar to that reported in other Brazilian studies. Hypolactasia was more common among nonwhites. Immunohisto‐chemistry permitted the identification of two phenotypes of AH, the first characterized by the absence of both stainable lactase and lactase activity, and the second by the presence of stainable lactase without significant activity.
Dynamic Color Doppler Sonography of Intestinal Wall in Patients with Crohn Disease Compared with Healthy Subjects
Authors: Scholbach Th. , Herrero I. , Scholbach J.
Published: February 2024

Objective:

Chronic inflammatory bowel diseases are characterized by inflammatory hyperperfusion of the intestinal wall in affected bowel segments. We applied a novel method to quantify color Doppler signals dynamically along a complete heart cycle inside the bowel wall. The aim was to describe bowel wall perfusion in Crohn disease patients in comparison with healthy probands and to compare a conventional activity index (Pediatric Crohn Disease Activity Index) with perfusion measurements as an indicator of inflammatory activity.

Method:

Color Doppler sonographic videos of bowel wall perfusion from 34 healthy children (aged 5 to 18 years) and from 14 patients with Crohn disease (aged 8.2 to 15.9 years) were recorded under defined conditions. Perfusion signals (color hue, color area) were automatically measured inside the bowel wall. Specific tissue perfusion was calculated as mean flow velocity of a region of interest during one full heart cycle. Bowel wall perfusion was compared using the Pediatric Crohn Disease Activity Index in 12 patients.

Results:

Specific bowel wall perfusion was significantly elevated in bowel segments of Crohn disease patients compared with healthy subjects (P < 0.001). Specific flow in small bowel was 0.025 cm/s in healthy probands and 0.095 cm/s in patients with Crohn disease, whereas large bowel wall perfusion of 0.012 cm/s in healthy probands clearly differed from 0.082 cm/s in patients with Crohn disease. No differences of perfusion between moderate and high Pediatric Crohn Disease Activity Index levels could be demonstrated despite a weak significant overall correlation.

Conclusion:

The new method of dynamic, automatic noninvasive perfusion quantification is useful to describe local inflammatory activity in bowel segments affected by Crohn disease and adds new information to activity evaluation by Pediatric Crohn Disease Activity Index. Specific wall perfusion in intestines of Crohn patients is significantly elevated and reaches up to sevenfold intensity compared with healthy subjects.