bluuebunny/crossref_metadata_2025 huggingface dataset:
Posttransfusion and Community‐Acquired Hepatitis C in Childhood
Authors: Bortolotti Flavia , Jara Paloma , Diaz Carmen , Vajro Pietro , Hierro Loreto , Giacchino Raffaella , de la Vega Angela , Crivellaro Carlo , Camarena Carmen , Barbera Cristiana , Nebbia Gabriella , Zancan Lucia , de Moliner Lorena
Published: January 2024

Following a longitudinal study of chronic non‐A, non‐B hepatitis in Italy and Spain, we evaluated the epidemiologic and clinical features of chronic hepatitis C in 77 consecutively observed children (35 male; mean age, 4 years) without underlying systemic diseases. All subjects were positive for antibody to hepatitis C virus in serum by second‐generation tests. Forty‐six patients had received blood transfusions in the perinatal period; 12 had a mother with antibodies to HCV in serum (five of these mothers were drug users or partners of a drug user); seven had a history of putative percutaneous exposure; and 12 had not been exposed to any risk factors for viral hepatitis. At presentation, only 22% were symptomatic, mean alanine‐aminotransferase levels were three times the upper normal value, and liver histology showed active disease in only nine of 28 cases (32%). During a mean observation period of 6 years, only 11 of 57 patients (19%) complained of symptoms and 11 of 40 cases (27%) had histologic features of active hepatitis. Two patients had severe hepatitis with associated cirrhosis. However, only six of 57 cases (10%) achieved sustained biochemical remission. The clinical features and the outcome were similar in both the posttransfusion and the community‐acquired cases. These results indicate that transfusions in the perinatal period are the single most important cause of hepatitis C in otherwise healthy children. Community‐acquired cases represent an heterogeneous epidemiologic group in which maternal transmission, whether perinatal or postnatal, could be relevant. Histologically severe hepatitis and cirrhosis seem to be an infrequent feature of chronic hepatitis C virus infection in childhood and adolescence, in spite of persistent liver damage.
Repeated Technetium‐99m Pertechnetate Scanning for Children with Obscure Gastrointestinal Bleeding
Authors: Kong Man‐Shan , Huang Shou‐Chih , Tzen Kai‐Yuan , Lin Jer‐Nan
Published: January 2024

From 1980 to 1992, we found false negative results from Technetium (Tc)‐99m abdominal scans in seven children with massive gastrointestinal bleeding from ectopic gastric mucosae. Other examinations—including endoscopy, gastrointestinal series studies, an‐giography, and Tc‐99m‐labeled red blood cell scans to search for the source of the bleeding—were all in vain. Positive results were only obtained after repeated Tc‐99m abdominal scans. Surgical specimens confirmed that ectopic gastric tissue was the source of bleeding in five patients with Meckel's diverticulum and two patients with enteric duplication.
Efficacy of Twice‐Daily Cimetidine in Pediatric Peptic Ulcer
Authors: Kato Seiichi , Ozawa Akira , Shibuya Hidenori , Ohtake Masatoshi , Nakagawa Hiroshi
Published: January 2024

The clinical efficacy of twice‐daily cimetidine (20 mg/kg/day) was retrospectively studied in 19 children with gastric ulcer (GU) and 23 with duodenal ulcer (DU) in the active stage. Endoscopically confirmed cumulative healing rates at 2,4, and 8 weeks of treatment were 53.5, 73.7, and 94.7% in the GU group and 15.4, 50.0, and 87.0% in the DU group, respectively. There was no significant difference between the groups at each time point. The mean period of time until complete disappearance of symptoms in the GU and DU groups was 3.5 ± 2.6 and 4.2 ± 3.3 days, respectively (NS). With regard to symptoms, abdominal tenderness rather than spontaneous pain appeared to be a better indicator of ulcer healing. Ulcer recurrence was found endoscopically during follow‐up in 2 of 13 GU patients (15.4%) and 11 of 19 DU patients (57.9%); thus, the cumulative recurrence rate of the DU group was higher than that of the GU group (p < 0.05). No adverse effects related to cimetidine were demonstrated during treatment or short‐term follow‐up. We conclude that twice‐daily cimetidine at a dosage of 20 mg/kg/ day is as effective for the symptomatic improvement and healing of peptic ulcer as the conventional three‐ or four‐times‐daily regimens. The optimal dosage of cimetidine requires further study.
The Results of Strictureplasty in Pediatric Patients with Multifocal Crohn's Disease
Authors: Oliva L. , Wyllie R. , Alexander F. , Caulfield M. , Steffen R. , Lavery I. , Fazio V.
Published: January 2024

This study is a retrospective review of eight pediatric patients with multifocal intestinal Crohn's disease who underwent strictureplasty with or without concomitant bowel resection between January 1978 and April 1992. The patients ranged in age from 9.9 years to 18.5 years. Indications for surgery were partial intestinal obstruction (n = 6), failure of medial therapy or steroid dependence (n = 4), growth failure (n = 2), and entero‐cutaneous fistula (n = 2). Thirty‐six strictureplasties were performed in the eight patients (median, 4.5 strictureplasties per patient; range, 1–12). Bowel resection was performed in six of the eight patients in areas where strictureplasty was not feasible. The mean length of resection was 40 cm (range, 15–82 cm). The only complication was intestinal hemorrhage, which was conservatively managed in two patients. The patients were followed for a mean of 19 months (range, 3–55 months). Five patients had a weight below the fifth percentile prior to surgery. Postoperatively, there was a weight gain in seven patients, including all five patients who were originally below the fifth percentile. A statistically significant weight gain was found when a paired t test analysis was applied to the entire group (p = 0.04). Five of six patients who were on steroid medication at the time of surgery were successfully weaned within 1.5–3 months (mean, 2.3 months) from the time of surgery. Seven of eight patients had relief of their intestinal symptoms. Strictureplasty with small‐bowel resection, or perhaps strictureplasty alone, in pediatric patients with multifocal intestinal Crohn's disease can improve gastrointestinal symptoms, promote weight gain, and allow discontinuation of steroid medications. Strictureplasty should be considered for patients who are refractory to medical therapy or dependent on chronic steroid medication for control of their symptoms.
Prognostic Value of Esophageal Manometry in Antireflux Surgery in Childhood
Authors: Cullu F. , Gottrand F. , Lamblin M. D. , Turck D. , Bonnevalle M. , Farriaux J. P.
Published: January 2024

To assess the predictive value of preoperative esophageal manometric study in the outcome of antire‐flux surgery, 14 children with severe gastroesophageal reflux (GER) who underwent surgery were studied retrospectively. Five patients had neuromuscular disease; one had been operated on for esophageal atresia. After extended (gt; 20 h) esophageal pH monitoring and/or barium swallow study, all patients underwent preoperative manometric study. After surgery, the patients were followed for 4 months to 4 years. Functional complications were noted after mechanical complications were eliminated. All patients had normal upper esophageal sphincter pressure (UESp); the resting lower esophageal sphincter pressure (LESp) was decreased in four patients, and seven had esophageal body motility trouble. Functional complications occurred in two patients. One was a neu‐rologically involved patient who had had a normal preoperative manometric study; the other was the patient who had been operated on for esophageal atresia. No complications occurred in four patients who had had abnormal preoperative manometric studies. We conclude that, in this group of patients, esophageal manometric study has no predictive value in the outcome of the surgical procedure; however, it still would be interesting to elucidate the mechanisms of GER, especially in congenital abnormalities such as esophageal atresia.
Stimulation by Recombinant Human Growth Hormone of Growth and Development of Remaining Bowel After Subtotal Ileojejunectomy in Rats
Authors: Benhamou Pierre‐Henri , Canarelli Jean‐Pierre , Leroy Catherine , De Boissieu Delphine , Dupont Christophe
Published: January 2024

The impact of human recombinant growth hormone (GH) after massive small bowel resection was studied in 38 weaning female Wistar rats (65 + 5 days old; 193 + 26 g). Animals underwent a 80% small bowel resection, leaving in place similar lengths of jejunum and ileum. Animals were assigned to four groups: group A (n = 9), small bowel resection only; group B (n = 10), resection and treatment with 0.2 GH units (GHU) s.c. every other day; group C (n = 9), resection and 0.4 GHU; and group D (n = 10), laparotomy without intestinal resection. Twenty‐eight days later, weight gain (percentage of initial weight) was 1 + 3 in group A, 12 + 8 in group B, 12 + 9 in group C, and 16 + 7 in group D; p < 0.001, groups B‐D. Time to recover initial weight was 26.2 + 3.3 days in group A; 11.7 + 5.4 days in group B (p < 0.001); and 16 + 6.1 days in group C (p < 0.001 vs. A). The size of the intestinal remnant after the rats were killed was 1.3 + 0.6 cm (13 + 10% of initial length) in A; 5.15 + 2.4 cm (37 + 18%) in B (p < 0.01); 4.2 + 2.3 cm (33 + 20%) in C (p < 0.01 vs. A); and 4.4 + 3.5 cm (5.8 + 4.9%) in D (p < 0.001 vs A). Villus height and diameter, average number of mitosis per field, and muscular layer and wall thickness were greater in groups A, B, and C than in group D (p < 0.001). Villus height and muscular thickness of the jejunal part were increased in group C compared with A (p < 0.05). In conclusion, GH improves the postoperative intestinal adaptation process in terms of both weight gain and small bowel lengthening.
Are Bioelectric Impedance Measurements Valid in Patients with Cystic Fibrosis?
Authors: Borowitz Drucy , Conboy Kathleen
Published: January 2024

This pilot study compared the use of bioelectric impedance analysis (BIA), a rapid, portable, and painless method of measuring body composition, to isotope dilution in patients with and without cystic fibrosis (CF). Many methods exist for measuring body composition but these measures can be difficult to use in the clinical setting. BIA has been validated as a tool for nutritional assessment in healthy adults, but it must be validated in patient populations with specific disease‐related nutritional problems, such as CF. Ten ambulatory patients with CF were selected along with ten controls matched for age, sex, and body mass index (BMI; wt/ht2). Total body water (TBW) was determined using isotope‐ratio mass spectrometry on urine specimens before and after patients consumed 0.2 g/kg deuterium‐rich water. BIA was performed using a tetrapolar technique; 500 μA of current at 50 kHz was introduced and the voltage drop measured. Seven men and three women were studied in each group. Median age was 27 (range, 18–39) and median BMI was 19.2 (range, 16.7–30.1) in CF adults. Median age was 27.5 (range, 15–43) and median BMI was 20.7 (range, 19.4–31.6) in controls. The resistance index (RI; ht2/resistance) correlated strongly with TBW in patients with CF (r = 0.88; y = 0.482 x + 11.138; p < 0.05) as well as in controls (r = 0.87; y = 0.661x + 1.299; p < 0.05). We conclude that BIA is a rapid, portable, and painless method for measuring body composition that correlates well with the deuterium‐dilution method. However, CF‐specific regression equations will need to be developed and confidence intervals defined using large numbers of patients before this technique can be widely applied to patients with CF.
Prevalence of Helicobacter pylori in Neonates and Young Infants Undergoing ERCP for Diagnosis of Neonatal Cholestasis
Authors: Guelrud Moises , Mujica Cesar , Jaen Domingo , Machuca Jensi , Essenfeld Harold
Published: January 2024

This study was carried out to determine the prevalence of Helicobacter pylori infection in 20 neonates and young infants from lower socioeconomic background undergoing endoscopic retrograde cholangiopancreatography (ERCP) examination for diagnosis of neonatal cholestasis. One young asymptomatic infant (5%) who was breast‐feeding with complementary formula had H. pylori infection. Endoscopy showed a normal appearing mucosa and histology demonstrated mild superficial acute gastritis. A follow‐up gastroscopy performed 14 months after the initial study showed normal histology without evidence of H. pylori suggesting that the infection was transient. Nineteen (95%) of the 20 mothers had H. pylori infection, including the mother with the infant positive for H. pylori. All mothers had gastritis on biopsy specimens. Despite the high prevalence of H. pylori in the mothers, infection in neonates and young infants was uncommon.
Metabolites of Lactose Synthesis in Milk from Diabetic and Nondiabetic Women During Lactogenesis II
Authors: Arthur Peter G. , Kent Jacqueline C. , Hartmann Peter E.
Published: January 2024

The concentrations of lactose, glucose, glucose 6‐phosphate (G6P), glucose 1‐phosphate (G1P), UDPglucose (UDPglc), UDPgalactose (UDPgal), and inorganic phosphate (Pi) (metabolites in the lactose synthesis pathway) were measured in mammary secretion from nondiabetic (ND) and insulin‐dependent diabetic (IDD) mothers during the first 10 days postpartum to determine their relationship with the amount of lactose synthesized and their association with the delay in lactose synthesis in IDD mothers. For all mothers the concentrations of all metabolites were low initially, and in ND mothers the first increases occurred as follows: lactose day 2; glucose, G6P and Pi—day 3; G1P and UDPglc—day 4; and UDPgal—day 6. The first increases for IDD mothers occurred 1–4 days later than for ND mothers. The concentrations of glucose, G6P, G1P, UDPglc, and Pi were related to the amount of lactose synthesized. Since the rate of lactose synthesis and concentrations of other metabolites were less than half‐maximal while the concentration of glucose was low, and since there was a delay in the increase in mammary gland concentrations of glucose in IDD mothers, it is concluded that glucose availability has the potential to play a role in the regulation of the rate of lactose synthesis at lactogenesis II.
Bradycardia and Gastroesophageal Reflux in Term and Preterm Infants
Authors: Suys Bert , De Wolf Danial , Hauser Bruno , Blecker Uwe , Vandenplas Yvan
Published: January 2024

Conflicting data are published regarding the influence of acid gastroesophageal reflux on the heart rate. In this study, heart rate was monitored simultaneously with esophageal pH in 50 infants with symptoms suggestive of gastroesophageal reflux disease (frequent vomiting and regurgitations). The data of 25 preterm infants (born at 28–366/7 weeks) were compared to those of 25 term infants (born after 37 weeks of gestation). However, both groups were investigated at identical postconceptional age of 47–49 weeks. Not one significant bradycardia (heart rate %80/min during 3%10 s) was recorded, although 71 “relative bradycardia episodes” (heart rate %s80/min during s%5 beats) were detected, none lasting for >5 s. Although the number of infants with relative bradycardia episodes did not differ between groups, the relative bradycardia episodes occurred more frequently in some preterm infants (53 episodes in preterm infants vs. 18 in term babies). Acid gastroesophageal reflux episodes were observed in 46 infants (92%). Neither the number of reflux episodes nor their duration was different in both groups. Simultaneous relative bradycardia episodes and acid reflux episodes were observed in three of 23 preterm and two of 23 term infants (NS). It is concluded that in a population of preterm and term infants with symptoms suggestive of a moderate gastroesophageal reflux pathology, investigated at comparable postconceptional age, most reflux episodes are not time‐related to changes in heart rate.
The Interobserver Reproducibility of Bioelectrical Impedance Analysis Measurements in Infants and Toddlers
Authors: Vettorazzi Carolina , Smits Els , Solomons Noel W.
Published: January 2024

Summary: Although nomograms to convert readings of resistance (R) and reactance (Xc) into estimates of body composition have begun to emerge for children as well as adults, there has been reluctance to use bioelectrical impedance analysis (BIA) in very young children due to the irritability of children, measurement instability, positioning of electrodes, and, of course, reproducibility of measurements. The precision of completely independent measurements of BIA indices was evaluated by two observers by comparing a series of 40 measurements of R and Xc and 36 measurements for weight in four malnourished children on 10 different days during the course of their nutritional recuperation. For weight, the CV (coefficient of variation) was 3.5% for observer A and 3.8% for observer B. There were no differences in the means across observers with respect to weight, R, and Xc. The results obtained in this study illustrate that properly trained observers following the same standards can produce equivalent data for BIA and weight measurements even in sick children.
Intensive Nutritional Support and Remedial Surgical Intervention for Extreme Short Bowel Syndrome
Authors: Chaet Mark S. , Farrell Michael K. , Ziegler Moritz M. , Warner Brad W.
Published: January 2024

Summary: Management of extreme short bowel syndrome (SBS) has changed dramatically over the last 20 years with notable improvements in survival and quality of life in patients with this syndrome. A review of our institution's medical records over a 12‐year period (1980–1992) revealed 32 patients with <100 cm (range, 14–94; median, 40) of functional small bowel after intestinal resection. The causes of intestinal loss included necrotizing enterocolitis (11 cases), atresias (8 cases), long‐segment Hirschsprung's disease (5 cases), midgut volvulus (5 cases) and gastroschisis (3 cases). The mean follow‐up period was 4.2 years, and four deaths were recorded (12.5%). Survival of eight of nine (88.9%) patients without an ileocecal valve (ICV) and with <40 cm of small bowel was noted. The absence of an ICV, however, was associated with significantly prolonged total parenteral nutrition. Follow‐up surgical procedures, including intestinal lengthening, tapering enteroplasty, Martin's procedure, longitudinal myectomy‐myotomy, and ostomy takedown, were performed in 20 of the patients (64%). Prolonged survival and normal development can be expected for the patient with severe SBS who is given meticulous nutritional support and treated with carefully planned secondary surgical intervention. These results are also seen in patients with extreme SBS (<40 cm residual small bowel length) and no ICV.
Intestinal Microflora in Colicky and Noncolicky Infants
Authors: Lehtonen Liisa , Korvenranta Heikki , Eerola Erkki
Published: January 2024

Summary: To find out whether intestinal microflora in colicky infants is different from that in noncolicky controls, stool samples were collected from colicky infants during colic (n = 55) and at the age of 3 months (n = 46) and compared with samples from age‐matched controls (n = 49 and n = 45, respectively). The samples were cultured on several selective and unselective aerobic and anaerobic culture agars, and gas‐liquid chromatography of bacterial cellular fatty acids was used to produce fatty‐acid profiles of the stool samples. In quantitative bacterial cultures, no differences were found between the colicky and control groups in the amounts of each bacterium. The colicky infants were more frequently colonized with Clostridium difficile during the time of colic than were the age‐matched controls. This difference disappeared by age 3 months. The fatty‐acid profiles did not differ between the colicky and control groups as a whole at the time of colicky symptoms. At age 3 months, a difference in fatty‐acid profiles was found between the colicky infants who had suffered from severe colic and the control infants. The fatty‐acid profiles were also influenced by the age of the infant, the mode of delivery, antimicrobial drugs taken by the mother during delivery, and breast‐feeding and type of feeding. In conclusion, no difference in intestinal microflora was found between the colicky infants at the time of colic and the controls. However, a difference in bacterial cellular fatty‐acid profiles at the age of 3 months was found that correlated with severe infantile colic. This difference may contribute to the cause(s) of colic, or it may be secondary to the colic, which may influence the microbial environment of the intestine.
Potential Aluminium Toxicity in Infants Fed Special Infant Formula
Authors: Hawkins Nicole M. , Coffey Susan , Lawson Margaret S.
Published: January 2024

Aluminium was measured in samples of plasma and samples of feed obtained from 74 infants with normal renal function established on various feeds (breast, whey‐based, fortified whey‐based, preterm, soy, and casein hydrolysate). All infants were bolus fed, and blood samples were collected midway between feeds. Aluminium was measured using electrothermal atomization and atomic absorption spectrometry. Mean aluminium concentrations in milks were as follows: breast, 9.2 (xg/L [95% confidence interval (CI), 5.6–12.7]; whey‐based, 165 μLg/L (95% CI, 151–180); fortified, 161 μg/L (95% CI, 143–180); preterm, 300 μg/L (95% CI, 272–328); soy, 534 (μg/L (95% CI, 470–598); casein hydrolysate, 773 μg/L (95% CI, 632–914). Mean plasma aluminium concentrations in infants receiving different milks were as follows: breast, 8.6 μg/L (95% CI, 5.6–10.6); whey‐based, 9.2 μg/L (95% CI, 7.4–11.0); fortified, 10.3 μ,g/L (95% CI, 8.3–12.3); preterm, 9.7 μg/L (95% CI, 5.3–17.1); soy, 12.5 μg/L (95% CI, 5.0–20.0); casein hydrolysate, 15.2 μg/L (95% CI, 10.7–19.8). Mean plasma aluminium concentration was significantly different in infants fed casein hydrolysate formulae than in those fed breast milk (difference, 6.7 μg/L; 95% CI, 2.8–10.5; p = 0.028). We conclude that infants may be at risk from aluminium toxicity when consuming formula containing >300 μg/L–in particular, casein hydrolysate formulae. We speculate that the aluminium compounds found in breast milk are more bioavailable than those found in other milks and that some constituents of infant formula affect aluminium absorption from the gut lumen.
Insulin‐Like Growth Factor‐I in Celiac Disease
Authors: Weile Birgitte , Krasilnikoff Peter A. , Giwercman Aleksander , Skakkebæk Niels E.
Published: January 2024

To contribute to the description of the physiopathological mechanisms of celiac disease, changes in insulin‐like growth factor I (IGF‐I) were folio wed‐up in 21 children suspected of suffering from celiac disease. Thirteen children were suffering from celiac disease according to the original criteria of the European Society of Paediatric Gastroenterology and Nutrition. Ten celiac children changing from a gluten‐containing to a gluten‐free diet presented a significant rise in IGF‐I (+1.54 mM per month). In a group of eight celiac children challenged with gluten, seven had a significant decrease in IGF‐I (‐1.11 mM per month), and five celiac children returning to the gluten‐free diet after challenge with gluten had a marked but not significant increase in IGF‐I (+1.7 mM per month). Eight children not suffering from celiac disease, but challenged with gluten, had a significant increase in IGF‐I (+ 0.29 mM per month), corresponding to the expected age‐dependent increase. The significant changes in IGF‐I described under the diagnostic dietetic phases of celiac disease reflect the extent of growth retardation caused by the disease. IGF‐I may be a supplementary aid in the diagnosis of celiac disease in describing individual changes under the dietetic phases.
Catch‐up Growth in 60 Children with Celiac Disease
Authors: Damen G. M. , Boersma B. , Wit J. M. , Heymans H. S. A.
Published: January 2024

The growth pattern of 28 girls and 32 boys with celiac disease was analyzed up to the ages of 10 and 12 years, respectively. Fifty‐four patients (90%) were diagnosed before 4 years of age and six patients (10%) between 5 and 9 years of age. At diagnosis, 18 of 60 patients (30%) had a height SD score below ‐ 2.0, and 45 of 59 patients (76%) had a weight‐for‐height below the median. The mean height SD score showed increasing growth retardation in the year before diagnosis, relatively quick catch‐up growth in the year after diagnosis, and complete catch‐up in 2–3 years. Mean weight‐for‐height showed a progressive decrease 12–18 months before diagnosis, increased to a maximum at the end of the first year of therapy, and returned to normal 15 months after dietary treatment. Independent of age at diagnosis, initial degree of wasting, diagnostic delay, and strictness of gluten‐free diet, catch‐up growth was complete in this group of patients who were diagnosed before 9 years of age.
The Prevalence of Helicobacter pylori Positivity in Human Immunodeficiency Virus‐Infected Children
Authors: Blecker Uwe , Keymolen Kathelijn , Lanciers Sophie , Bahwere Paluku , Souayah Hicham , Levy Jack , Vandenplas Yvan
Published: January 2024

To investigate the prevalence of Helicobacter pylori infection in pediatric patients infected with the human immunodeficiency virus, we sought to detect the presence of antibodies against this organism in 23 human immunodeficiency virus‐infected children of central African ethnic origin by means of a second‐generation enzyme‐linked immunoassay (ELISA) test for the detection of immunoglobulin G (IgG) antibodies to Helicobacter pylori (Malakit Helicobacter pylori, Biolab, Limal, Belgium). They were compared to an asymptomatic control population matched for age and ethnic origin. Blood samples were taken during routine blood analysis before the monthly administration of intravenous γ‐globulins in the human immunodeficiency virus‐infected patients and during preoperative blood analysis in the control population. Despite the fact that most human immunodeficiency virus‐infected patients had IgG antibodies against other frequently encountered pathogens, none of them had a positive serology for Helicobacter pylori, compared to 10 of 52 patients (19.2%) in the control population. This difference is statistically significant (p = 0.01)
The Renin‐Angiotensin‐Aldosterone System and Vasopressin in Early‐Stage Liver Cirrhosis after HBV Infection in Children
Authors: Winnicki Cezary , Warnawin Krzysztof , Januszewicz Pawel , Socha Jerzy
Published: January 2024

We evaluated the dynamic response of renin, aldosterone, and vasopressin to intravenous water loading (20 ml 5% glucose/kg b.w.) in 12 children (aged 7–18 years) with postinflammatory liver cirrhosis after hepatitis B virus (HBV) infection. All of the patients had early‐stage liver cirrhosis; according to Child's classification, nine patients had group A; three, group B cirrhosis. A group of 17 children with chronic persistent hepatitis served as the control. The diagnoses were confirmed in all of the patients by liver biopsy. The patients followed a diet containing 3 mmol NaCl/kg/day, maximum 100 mmol per day for 6 days. Water loading was performed in recumbency over ± 45 min. Renin, aldosterone, and vasopressin, assayed by radioimmunoassay (RIA), were determined before, 1 h, and 5 h after starting the water load. Prestudy hormone levels were within normal range in both groups. Renin and aldosterone concentration change patterns were similar in both groups and characterized by suppression of hormone activity caused by central volume expansion and recovery to prestudy levels after 5 h. However, the pattern of change of vasopressin concentrations differed in the control and study groups. In contrast to that of the controls, volume expansion did not suppress vasopressin in the group with liver cirrhosis. We conclude that failure to suppress vasopressin activity after central volume expansion may be one of the early mechanisms responsible for water‐electrolyte imbalance in liver cirrhosis in children.
Quantitative Analysis and Immunohistochemical Studies on Small Intestinal Mucosa of Food‐Sensitive Enteropathy
Authors: Nagata S. , Yamashiro Y. , Ohtsuka Y. , Shioya T. , Oguchi S. , Shimizu T. , Maeda M.
Published: January 2024

Quantitative analysis and immunohistochemical studies of small intestinal mucosa were performed to investigate the mechanism of mucosal damage in 10 patients with food‐sensitive enteropathy. Jejunal biopsy specimens were taken before and after treatment and after clinical relapse following a challenge test. The low villous height of untreated patients normalized after introduction of an elimination diet but declined again to subnormal level after a challenge test. Several other types of cells were significantly increased in the untreated patients in comparison to controls. These included HLA‐DR+ (DR + ) CD4+ cells in the lamina propria and intraepithelial CD8+ cells. Moreover, those cell patterns, such as increased DR+ CD4+ cells and CD8+ cells, normalized with treatment but regressed to pretreatment levels when the patients were challenged. These findings suggest that activated CD4+ cells in the lamina propria of the small intestinal mucosa, probably by releasing cytokines, may play an important role in contributing to mucosal damage in patients with food‐sensitive enteropathy.
Lack of Neuronal Nitric Oxide Synthase in Nerve Fibers of Aganglionic Intestine
Authors: Larsson L. T. , Shen Z. , Ekblad E. , Sundler F. , Aim P. , Andersson K. E.
Published: January 2024

The lack of nonadrenergic, noncholinergic (NANC) inhibitory innervation in aganglionic intestine is typical of Hirschsprung's disease. Several neuropeptides participating in the intestinal NANC innervation are greatly reduced in aganglionic intestine. However, these findings do not fully explain the pathophysiology of the disease. Recently, nitric oxide (NO) has been presented as a potent smooth muscle relaxant, and the enzyme responsible for its formation, nitric oxide synthase (NOS) has been demonstrated in neuronal elements in both the central and peripheral nervous system. In our study, nicotinamide adenine dinucleotide phosphate (NADPH)‐diaphorase staining, a marker for NOS, and NOS immu‐nohistochemistry revealed a dense innervation of the smooth muscle layers and the myenteric ganglia in ganglionic non afflicted intestine from patients with Hirschsprung's disease. By contrast, there was an almost complete lack of NOS‐immunoreactive and NADPH‐diaphorase‐positive nerve fibers in the afflicted aganglionic bowel. NOS and vasoactive intestinal peptide were found to be partially colocalized in nerve fibers and neuronal cell bodies in the ganglionic but not in the aganglionic intestine. The lack of NO‐producing nerve fibers in the aganglionic intestine probably contributes to the inability of the smooth muscle to relax, thereby causing lack of peristalsis in Hirschsprung's disease.
Absence of NADPH‐Diaphorase Activity in Internal Anal Sphincter (IAS) Achalasia
Authors: Hirakawa Hitoshi , Kobayashi Hiroyuki , O'Briain D. Sean , Puri Prem
Published: January 2024

We studied the internal anal sphincter (IAS) muscle from 10 patients with achalasia and five normal controls using histochemical staining for NADPH‐diaphorase and acetylcholinesterase (AChE). Normal control IAS muscle contained occasional AChE‐positive nerve fibers, whereas IAS achalasia specimens demonstrated prominent AChE‐positive nerve fibers in muscle layers. NADPH‐diaphorase activity was strongly expressed in nerves in the normal IAS muscle but was absent or scanty in the muscle of patients with IAS achalasia. Our findings of increased AChE‐positive nerves and the absence of NADPH‐diaphorase activity taken in conjunction with reports of abnormal peptidergic innervation indicate that complex neural abnormalities occur in IAS achalasia. The primary event remains obscure, but it is possible that a single defect, such as nitrergic nerve depletion, may lead to compensatory changes in the other nerve fibers.
Applied Potential Tomography in the Measurement of Gastric Emptying in Infants
Authors: Nour S. , Mangnall Y. F. , Dickson J. A. S. , Johnson A. G. , Pearse R. G.
Published: January 2024

The aim of this study was to investigate the feasibility of using applied potential tomography (APT), a noninvasive and nonradioactive method, to measure the rate of gastric emptying in preterm babies and infants <3 months old. APT, a form of electrical impedance tomography, creates tomographic images of tissue resistivity to a small electrical current and has been used to study gastric emptying in adults. The rate of gastric emptying of 53 preterm infants and 29 term infants was measured. The test feed was either milk (formula milk or expressed breast milk) or Dioralyte (a commercial rehydration solution). When a nasogastric tube was present, the results obtained by APT were validated by comparing the volume of feed estimated to be present with the volume that could be aspirated. All infants completed the investigation without any problems. APT demonstrated a slower rate of emptying of milk feeds than Dioralyte and showed that milk and Dioralyte feeds in preterm babies emptied at a similar rate to feeds in term infants. In validation studies, gastric emptying has been observed in 44 of 47 studies, and this finding was confirmed by aspiration of the nasogastric tube. Applied potential tomography is a safe, noninvasive method for measuring gastric emptying in small infants.
Differentiation and Polarity Alter the Binding of IGF‐I to Human Intestinal Epithelial (Caco‐2) Cells
Authors: Oguchi S. , Walker W. A. , Sanderson I. R.
Published: January 2024

This study examined whether insulin‐like growth factor‐I (IGF‐I) bound to specific functioning IGF receptors on the surface of Caco‐2 cells and how this binding was affected by the differentiation and polarity of these cells. IGF‐I, which increased cell proliferation in a dose‐dependent manner, bound to a specific receptor on the surface of Caco‐2 cells. Affinity cross‐linking with labeled IGF‐I followed by reducing sodium dodecylsul‐fate‐polyacrylamide gel electrophoresis (SDS‐PAGE) showed Mrs at 135,000, 270,000 and 355,000 bands, which was inhibited by unlabeled IGF‐I. A Scatchard analysis of radioligand‐receptor binding showed the presence of a single class of receptors with high affinity for IGF‐I. This class of receptors was specific for IGF‐I, the affinity of IGF‐I to the receptor being four and 150 times greater than IGF‐II and insulin, respectively. There was no difference in the affinity of IGF‐I to type 1 IGF receptors between less‐differentiated [dissociation constant (Kd) = 3.81 nM] and well‐differentiated cells (Kd = 3.78 nM); however, well‐differentiated cells showed a 2.4‐fold higher maximum number of binding sites (Bmax) than less‐differentiated cells (3.45 vs. 1.44 x 104 sites/cell), indicating an increase in the density of IGF‐I receptors with differentiation. Furthermore, the number of type 1 IGF receptors on the basolateral surface of well‐differentiated cells was 2.4 times greater than that seen on the apical surface. In summary, IGF‐I binds to a single class of specific Caco‐2 cell‐surface receptors, which increase in number with differentiation and are found on both aspects of the epithelium.
Etiology and Risk Factors of Severe and Protracted Diarrhea
Authors: Guarino Alfredo , Spagnuolo Maria Immacolata , Russo Stefania , Albano Fabio , Guandalini Stefano , Capano Guglielmo , Cucchiara Salvatore , Vairano Paola , Liguori Roberto , Casola Antonella , Rubino Armido
Published: January 2024

Severe and protracted diarrhea (SPD) is the most severe form of diarrhea in infancy and has also been defined as intractable diarrhea. Its etiology is poorly defined. We have retrospectively evaluated the etiology, the outcome, and the risk factors of 38 children, admitted with protracted diarrhea and need for total parenteral nutrition (TPN) from 1977 to 1993. Children with anatomic abnormalities and/or primary immunodeficiency were excluded. There was an inverse relationship between the number of patients and the age of diarrheal onset (mean age, 2.9 ± 3.5 months). Etiology of SPD was an enteric infection in 18 cases (eight Salmonella, three Staphylococcus, five rotavirus, one adenovirus, one Cryptosporidium), multiple alimentary intolerance (eight cases), familial microvillous atrophy (two), autoimmune enteropathy (two), celiac disease, lymphangectasia, eosinophilic enteropathy, intestinal pseudoobstruction, and intestinal neurodysplasia (1 case each). Etiology was not detected in three cases. Overall, 12 children died, five are presently being treated, and 21 had full remission. Comparative evaluation of risk factors between children with SPD and a control population of children with diarrhea but without the need for TPN showed that low birth weight, no breast feeding, history of fatal diarrhea in a relative, and early onset of diarrhea had a significantly higher incidence in the former. Social background was similar in the two populations. We conclude that a specific etiology can be identified in the majority of cases of SPD. The etiologic spectrum of SPD is broad, but an enteric infection is the most common cause of SPD. The severity of this condition is related, at least in part, to established risk factors.
The Prognostic Significance of Caffeine Half‐Life in Saliva in Children with Chronic Liver Disease
Authors: Baker A. , Girling A. , Worthington D. , Ballantine N. , Smith S. , Tarlow M. , Kelly D.
Published: January 2024

To evaluate its clinical value, the half‐life of caffeine (1,3,7‐trimethylxanthine) in saliva (SCT) after 3 mg/kg‐1 oral caffeine was measured in 53 children with chronic liver disease (mean age, 4.41 years) and 48 control children (mean age, 6.26 years) in five samples over 24 h and compared with parameters of liver function and outcome. Sensitivity was 60.3% and specificity 97% of SCT for diagnosis of chronic liver disease. The correlation of SCT with serum albumin (ALB) was −0.52 (p < 0.001), total bilirubin (SBR) was 0.585 (p < 0.001), prolonged prothrombin time (PT) was 0.387 (p = 0.004), and aspartate aminotransferase (AST) was 0.538 (p = 0.001). The correlation of SCT with a clinical score of liver dysfunction calculated from the presence of features of hepatic decompensation was 0.627 (p < 0.001) and with Malatack's paediatric prognostic score was 0.505 (p < 0.001). Serial SCT and liver function tests were performed on 53 patients on 127 occasions during a mean follow‐up of 361 days (range, 4–709). Of this group, 18 were listed for liver transplantation. Predictive values of outcome by analysis of variance expressed as ratio of mean squares were SBR, 34.1 (p < 0.001); log10 SCT, 20.6 (p < 0.001); ALB, 5.2 (p < 0.05); PT, 1.2 (NS). SCT correlated with clinical and biochemical parameters of severity of liver disease, but SBR was a better predictor of listing for liver transplantation in this group of paediatric patients.
Grasp Biopsy, Suction Biopsy, and Clinical History in the Evaluation of Esophagitis in Infants 0–6 Months of Age
Authors: Friesen Craig A. , Zwick David L. , Streed Cindy J. , Zalles Carola , Roberts Charles C.
Published: January 2024

Fifty‐three infants 0–6 months of age with abnormal 24‐h intraesophageal pH monitoring were evaluated by esophageal suction biopsies and endoscopic grasp biopsies. Histologic esophagitis was present in 30% of the infants. Of the infants with esophagitis, 88% were accurately identified by suction biopsy, and 75% were accurately identified by endoscopic grasp biopsy. Suction biopsy alone was not significantly different from combined grasp and suction biopsy, while differences between grasp biopsy and combined biopsy approached significance (p = 0.051). Twelve clinical symptoms and 21 intraesophageal pH monitoring parameters were evaluated for their ability to predict esophagitis, and none were found to be useful. We conclude that endoscopic esophageal biopsy, while more costly, offers no advantage over suction biopsy for the detection of esophagitis in young infants.
Vitamin E in Plasma and Milk of Lactating Women with Insulin‐Dependent Diabetes Mellitus
Authors: Lammi‐Keefe Carol J. , Jonas Carolyn R. , Ferris Ann M. , Capacchione Constance M.
Published: January 2024

We measured levels of plasma and milk ã‐to‐copherol in women with insulin‐dependent diabetes mellitus (IDDM), women without IDDM, and healthy reference women. Milk collections were made at 7, 14, 42, and 84 days postpartum; blood was collected at 3, 14, and 42 days. Postprandial glucose at 80 min was used to describe metabolic control of women with IDDM postpartum. There was no difference between the groups for plasma a‐tocopherol, which was within normal reported levels. Tocopherol (μg/g lipid) decreased by 50% in all groups between 7 and 14 days. The trend for milk tocopherol was similar when expressed as μg/dl. Metabolic control did not have a significant effect on mean milk or plasma ã‐tocopherol. We have shown that this group of women with IDDM produced a milk with vitamin E content similar to control and reference women. We conclude that the infant of the breast‐feeding woman with IDDM who is in good metabolic control during pregnancy and who receives good prenatal counseling most likely receives adequate vitamin E from the mother's milk
Polyamine Profiles in Human Milk, Infant Artificial Formulas, and Semi‐elemental Diets
Authors: Buts Jean‐Paul , De Keyser Nadine , De Raedemaeker Laurence , Collette Elisabette , Sokal Etienne M.
Published: January 2024

Using a sensitive high‐performance liquid chromatography method, we quantified the concentration of polyamines (putrescine, spermidine, and spermine) in human milk as well as in a representative group of commonly used artificial infant formulas. Variations in polyamine levels were also analyzed in human milk during the immediate postnatal period. During the first week postpartum, putrescine levels in human milk remained very low and varied little, while spermidine and spermine concentrations rose markedly during the first 3 days, reaching plateau levels that were 12 and eight times higher, respectively, than the values measured on day 0. The mean total polyamine concentration was 557 ± 18 nmol/dl with the following profile: spermine, 313 ± 16; spermidine, 220 ± 20; and putrescine, 24 ± 3.5. In artificial powdered formulas, the polyamine concentration was 10 times lower than in human milk, with no difference in putrescine and spermine contents between first‐age and second‐age formulas. By contrast, semi‐elemental diets prepared by hydrolytic procedures using crude extracts of pancreatic enzymes were shown to be major sources of polyamines with a profile similar to that of human milk. Compared with first‐age formulas, mean concentrations in spermine and spermidine were 39 and six times higher, respectively, in these semi‐elemental diets, whereas putrescine levels remained almost equivalent in all types of milk tested. These data indicate that human milk and some semi‐elemental diets provide substantial amounts of spermine and spermidine to neonates and infants that could potentially modulate intestinal maturation.
Enhancement of Lysozyme Trypsin‐Mediated Decay of Intestinal Bifidobacteria and Lactobacilli
Authors: Heine W. , Braun O. H. , Mohr C. , Leitzmann P.
Published: January 2024

Lysozyme‐mediated lysis of Bifidobacteria and Lactobacilli was studied in in vitro tests using the agar gel plate and turbidometric Micrococcus luteus (lysodeikticus) procedure as a standard. Suspensions of the strains Bifidobacterium infantis, B. infantis liberorum, B. breve, B. longum, B. ssp, and Lactobacillus acidophilus proved to be resistant to egg white lysozyme and human milk lysozyme when incubated at 37°C in concentrations of 5, 50, and 500 mg lysozyme/L, respectively, through 30 and 60 min. Heat treatment at 100°C for 1 h and pretreatment with ether, acetone, ascorbic acid, and hydrogen peroxide failed to incline the bacteria to the lytic effects of lysozyme. Consecutive incubation of the lysozyme‐pretreated bacteria with trypsin resulted in a significantly enhanced bacteriolysis in all strains of bacteria, with the exception of B. longum. The mode of action of lysozyme and proteolytic enzymes on Bifidobacteria and Lactobacilli offers an explanation for the release of microbial building blocks and their colonic absorption and retention in the breast‐fed baby
Determination of Iron Absorption Using Erythrocyte Iron Incorporation of Two Stable Isotopes of Iron (57Fe and 58Fe) in Very Low Birthweight Premature Infants
Authors: Zlotkin Stanley H. , Lay Deborah M. , Kjarsgaard John , Longley Teresa
Published: January 2024

Due to limited erythropoiesis, iron needs for the premature infant during the first 2 months of life are low. With the potential for increased use of erythropoietin in the preterm infant, iron requirements may become markedly higher. The ability of the preterm infant to absorb iron, therefore, becomes crucial. Previous studies using single stable isotopes of iron without metabolic balances were unable to quantitatively determine iron absorption since the percentage of absorbed iron appearing in the erythrocyte could not be measured. The objective of the current study was to determine iron absorption using the method of erythrocyte iron incorporation of two stable isotopes of iron given by the enteral and parenteral route to very low birth weight (VLBW) infants. Results obtained were compared to iron absorption values from studies using single isotopes and metabolic balance techniques. Six VLBW premature infants (gestational age 26.8 ± 1.7 weeks, postnatal age 3.6 ± 1.9 weeks, birth weight 863 ± 117 g) were studied. Iron dosages were (i.v.) 0.15 mg/kg (57FeSO4) and (enteral) 1.5 mg/kg (58FeSO4). Erythrocyte isotope ratios, 57Fe/54Fe and 58Fe/54Fe, were determined by inductively coupled plasma mass spectrometry (ICP/MS) from single blood samples (100 μl) collected before and after concurrent enteral (58Fe) and parenteral (57Fe) administration of isotopes. Only 17.8% of the i.v.‐infused iron dose was incorporated into hemoglobin on day 15. Using a correction factor based on the percentage of i.v. iron (57Fe) incorporated into erythrocytes, the corrected incorporation of 58Fe was calculated to be 26.3 ± 13.0% of the enteral dose of 58FeSO4. This value is comparable to those obtained in previous studies, which utilized alternate techniques to measure iron absorption.
Intestinal Mucin Inhibits Adhesion of Human Enteropathogenic Escherichia coli to HEp‐2 Cells
Authors: Smith Christopher J. , Kaper James B. , Mack David R.
Published: January 2024

Mucins are complex glycoproteins that cover the intestinal mucosal surface and are thought to provide protection against enteropathogenic infections by preventing bacterial adherence and subsequent colonization, invasion, and toxin delivery. The aim of this study was to evaluate the capacity of intestinal mucin to inhibit epithelial cell adhesion by human enteropathogenic Escherichia coli (EPEC). EPEC strain E2348/69 (serotype O127:H6), known to produce a 94‐kd epithelial cell‐adhesion‐mediating outer membrane protein called intimin and known to contain an EPEC adherence factor (EAF) plas‐mid, and three of its mutants were studied. Crude mucus was obtained from rabbit small‐intestinal mucosal scrapings. Purified mucins were isolated by serial cesium chloride density gradient ultracentrifugation. Bacterial adhesion to HEp‐2 epithelial cell monolayers in the presence of purified intestinal mucins was quantified by recovery of live viable bacteria as colony‐forming units. EPEC strain E2348/69 adhesion was inhibited in a concentration‐dependent manner by increasing amounts of mucin (adhesion suppressed to <1% by 150 μg mucin). The relative magnitudes of inhibition of adhesion of E2348/69 and its mutants [JPN15 (EAF plasmid negative), JPN15.96(pMAR7) (intimin negative), and JPN15.96 (intimin negative, EAF plasmid negative)] were similar in the presence of equal amounts of mucin. The presence of the intimin protein and EAF plasmid are not necessary to the proficiency of mucin to inhibit HEp‐2 epithelial cell adhesion.