bluuebunny/crossref_metadata_2025 huggingface dataset:
A Subacute Rabbit Model for Hepatobiliary Dysfunction During Total Parenteral Nutrition
Authors: Gleghorn Elizabeth E. , Merritt Russell J. , Henton Donaby H. , Neustein Harry M. , Landing Benjamin , Sinatra Frank R.
Published: January 2024

Total parenteral nutrition (TPN) in children is associated with the complicating syndromes of cholestasis and cholelithiasis. The causes of these syndromes are not completely clear. Gastrointestinal hypomotility associated with enteral fasting may be involved in the pathogenesis of both syndromes. We compared weanling rabbits maintained solely on TPN with chow pair‐fed and free‐fed controls over a 10‐day period. Gastrointestinal transit time, assessed with a solid marker technique, was significantly greater in the TPN‐treated animals. No difference in intestinal or biliary bacterial flora was demonstrated by aerobic or anaerobic cultures. Gallbladder bile contained a higher percentage of lithocholic acid, unconjugated bilirubin, and total calcium in the TPN‐treated animals. Markers of hepatic dysfunction were elevated in the serum of the TPN‐treated animals. Mild steatosis and edema were the only histologic differences in the livers of the TPN‐treated animals. We conclude that gastrointestinal hypomotility associated with enteral fasting plays a role in the pathophysiologic changes leading to TPN‐associated hepatobiliary dysfunction. This dysfunction may be mediated by an increase in the absolute and relative concentrations of lithocholic acid in the bile of TPN‐treated animals.
Intestinal Mast Cells and Neutrophil Chemotactic Activity of Serum Following a Single Challenge with Gluten in Celiac Children on a Gluten‐Free Diet
Authors: Horváth K. , Nagy L. , Horn G. , Simon K. , Csiszár K. , Bodánszky H.
Published: January 2024

The number of one subtype of mast cells (formalin fixation, toluidine blue staining), cells of the lamina propria, and intraepithelial lymphocytes were counted in the intestinal biopsy specimens of 14 children with treated celiac disease following a single challenge with gluten. The serum neutrophil chemotactic activity was measured at 0, I, 3, 5, and 24 h after challenge. There was no significant change in the number of intraepithelial lymphocytes, but the biopsy samples obtained at 5 h showed a marked increase in the inflammatory cells of the lamina propria and a significant decrease in the number of mast cells. A pronounced decrease was present at 3–5 h in the number of eosinophil cells in the blood. The neutrophil chemotactic activity of sera showed a significant increment in 10 of 14 patients. The intestinal permeability of patients became abnormal, as detected by the increased absorption of lactulose. These findings suggest that degranulation of mast cells may be involved in the pathogenesis of the small intestinal mucosal injury in children with celiac disease.
Changes in Cholesteryl Esters of Human Milk with Total Milk Lipid
Authors: Clark Richard M. , Hundrieser Kenneth E.
Published: January 2024

Twenty‐five milk samples with a wide range of total lipid and degree of fatty acid saturation were chosen for this study. The milk samples were analyzed for total lipid, total cholesterol, and free cholesterol. The cholesteryl esters and triacylglycerols in these samples also were isolated and the fatty acids associated with each lipid class determined. Total cholesterol averaged 13.5 ± 3.1 mg/dl of milk and was significantly correlated (r = 0.60, p < 0.05) with total lipid. Free cholesterol averaged 10.9 ‡ 2.3 mg/dl of milk and also was significantly correlated (r = 0.72, p < 0.05) with total lipid. As total milk lipid increased, the fatty acids in cholesteryl esters became more saturated. The fatty acids most affected were 18:2 and 20:4. Total milk lipid and 18:2 in cholesteryl esters were inversely related (r = −0.49, p < 0.05). There was also a negative correlation (r = −0.51, p < 0.05) between 20:4 in cholesteryl esters and total lipid. The fatty acids in triacylglycerol were not correlated with total lipid. From these results it appears that the fatty acids esterified to cholesterol and triacylglycerol in milk may be drawn from different substrate pools.
Chest Pain and Dysphagia in Adolescents Caused by Diffuse Esophageal Spasm
Authors: Milov David E. , Cynamon Harry A. , Andres Joel M.
Published: January 2024

Five adolescents, 13–18 years of age, underwent esophageal manometric studies because of chronic symptoms suggestive of esophageal dysfunction. Four of five patients had episodic nonexertional midchest pain; two patients experienced intermittent dysphagia. The manometric findings for these adolescents were consistent with a primary motility disorder known as diffuse esophageal spasm, a condition not previously reported in this age group. This represents approximately 1% of all pediatric patients undergoing esophageal manometry at our institution for the past 5 years. They have been followed for at least 2 years and three have experienced gradual resolution of their symptoms with normalization of manometric findings. Our report emphasizes two main points: (a) Diffuse esophageal spasm may cause chest pain and dysphagia in adolescents; and (b) the clinical history and esophageal manometric findings establish the diagnosis of diffuse esophageal spasm.
Milk Lactose, Citrate, and Glucose as Markers of Lactogenesis in Normal and Diabetic Women
Authors: Arthur Peter G. , Smith Margaret , Hartmann Peter E.
Published: January 2024

A study was undertaken to define an appropriate marker of lactogenesis II (the onset of copious milk secretion) in mothers, and to determine the effect of diabetes on this marker. Changes in the concentrations of three milk components—lactose, citrate, and glucose—were measured in 38 normal mothers and 6 type I diabetic mothers up to 10 days after birth. Milk yield was measured in 12 of the normal mothers, and all mothers were asked to note the time of milk “coming in” (the feeling of overfullness of the breasts). The average concentrations of lactose, citrate, and glucose in milk were low for the first 24 h after birth, then between 24 and 48 h after birth there was a rapid increase in the concentrations of lactose and citrate, and this transitional period was followed by a plateau period that began between 60 and 84 h after birth. For individual mothers the transitional period for citrate began 32 ± 9 h (n = 13) and finished 77 ± 10 h (n = 17) after birth, and for lactose the transitional period finished at 53 ± 12 h (n = 29) after birth. For diabetic mothers these times were significantly later. The average 24‐h milk intake by infants increased from 82 to 556 ml/24 h between 24 and 144 h after birth. Milk intakes were correlated with the concentration of lactose (r = 0.52, n = 51, p < 0.001), citrate (r = 0.47, n = 47, p < 0.001), and glucose (r = 0.69, n = 50, p < 0.001). The time of milk “coming in” was highly variable (59 ± 13) (X ± SD) and occurred well after the onset of copious milk secretion between 24 and 48 h after birth. We conclude that for individual mothers, milk lactose and citrate are useful markers of lactogenesis II. The changes in the concentrations of these markers suggested that lactogenesis II was delayed in type I diabetic mothers.
Apolipoproteins A‐I and B in Obese Children
Authors: Sveger Tomas , Flodmark Carl‐Erik , Fex Göran , Henningsen Nels Christian
Published: January 2024

Body mass index (BMI), the distribution of fat, birth weight, physical fitness, apolipoproteins (apo) A‐I and B, total cholesterol (TC), and high‐density lipoprotein cholesterol (HDLC) were studied in 38 obese 10− to 11‐year‐olds in comparison to 52 age‐matched controls. Obese children had higher concentration of apo B and a lower apo A‐I:B ratio. Significant correlations were found between (a) apo A‐I and physical fitness (r = 0.35, p < 0.015), triceps skinfold thickness (r = 0.44, p < 0.01), and birth weight (r = −0.33, p < 0.05); (b) physical fitness and triceps skinfold thickness (r = 0.38, p < 0.05), and (c) the apo A‐I:B ratio and triceps skinfold thickness (r = 0.31, p < 0.05). When both obese and control children were grouped together, a correlation was found between BMI and TC (r = 0.24, p < 0.05), apo B (r = 0.37, p < 0.001), and the apo A‐I:B ratio (r = −0.31, p < 0.01). Multiple regression analyses indicated a significant positive contribution to the apo A‐I level by HDLC and physical fitness and a negative one by birth weight.
Serum Concentrations of Vitamin D Metabolites in Rachitic Libyan Children
Authors: Elzouki Abdelaziz Y. , Markestad Trond , Elgarrah Maha , Elhoni Neama , Aksnes Lage
Published: January 2024

Twenty‐two consecutive patients with rickets were studied in Benghazi, Libya. All were less than 2 years old. Rickets was associated with traditional cultural habits that limited sunshine exposure of the mothers and their infants, and with breast‐feeding. Serum concentrations of the vitamin D metabolites 25‐hydroxyvitamin D (25‐OHD), 1,25‐dihydroxyvitamin D, and 24,25‐dihydroxyvitamin D, and other parameters of mineral metabolism were typical of vitamin D deficiency disease, as was the biochemical and clinical response to treatment. Minimum safe serum levels of 25‐OHD (20 nmol/L), and the serum levels of vitamin D metabolites in response to vitamin D treatment, were identical to previously obtained results from native Norwegian and Norwegian immigrant children with rickets, suggesting lack of racial differences in response to vitamin D. Fifty percent of the patients had adequate levels of vitamin D metabolites at the time of diagnosis, indicating that they had recently received oral vitamin D or cutaneous exposure to sunshine. Many cases of rickets in the area may, therefore, be spontaneously cured when the children's maturity allows adequate mobility and independence to achieve exposure to sunshine.
Concurrent Pancreatic and Growth Hormone Insufficiency in Johanson‐Blizzard Syndrome
Authors: Sandhu B. K. , Brueton M. J.
Published: January 2024

Exocrine pancreatic insufficiency is one of the recognised features of the Johanson‐Blizzard syndrome; other features include hypothyroidism, sensorineural deafness, aplastic alae nasi, developmental delay, and growth retardation. Twenty‐one cases of the syndrome have been described to date. The child reported here was diagnosed in the neonatal period, but despite early pancreatic and thyroid replacement therapy his growth remained poor. Anterior pituitary function studies demonstrated growth hormone deficiency, subsequent administration of growth hormone has resulted in an improvement in his growth velocity. This feature has not been well documented and should be considered as a factor contributing to the growth retardation which is a constant feature of this syndrome.
Diagnostic Significance of Epithelioid Granulomas in Crohn's Disease in Children
Authors: Keller K. M. , Bender S. W. , Kirchmann H. , Ball F. , Schmitz‐Moormann P. , Wirth S. , Baumann W.
Published: January 2024

Out of 528 children with Crohn's disease in a Multicenter Paediatric Crohn's Disease Study Group, 37 cases had epithelioid granulomas but did not fulfill defined radiographic criteria of the disease. Follow‐up studies including clinical, biochemical, radiological, endoscopic, and histological investigations were done in these patients. Initially, all patients showed clinical symptoms and 27 of them had biochemical signs of chronic inflammation. After a mean follow‐up of 3 years, all 37 children treated for Crohn's disease got a complete upper gastrointestinal series with small bowel followthrough and 8 children in addition had barium enemas. Colonoscopies were done in 23 patients. Radiographic examination revealed Crohn's disease in 14 and endoscopy additionally confirmed Crohn's disease in 8 further cases. One child was diagnosed as having chronic granulomatous disease. Thirteen children still remained unclassified after these follow‐up studies including radiographs and endoscopy. An interval of 3 years may in some cases be too short to express the complete radiographic pattern of Crohn's disease. Our studies demonstrate that in addition to initial radiological, endoscopic, and histological investigations, a thorough follow‐up is necessary in early diagnosed patients. In these children, epithelioid granulomas are of high diagnostic validity proceeding radiological changes of Crohn's disease often for years.
Ultrastructural Changes in the Pancreas of Carbonyl Iron‐Fed Rats
Authors: Iancu Theodore C. , Ward Roberta J. , Peters Timothy J.
Published: January 2024

Diabetes mellitus is found with increased frequency in patients with both primary and secondary hemochromatosis. In these conditions, the pancreas shows fibrosis and iron overload of acini, interstitium, and islet B cells. Previous morphological studies have only described changes found in advanced stages of disease, while abnormalities of the initial stage of iron overload have, as yet, not been reported. Rats fed a carbonyl iron‐supplemented diet for 4–15 months showed storage iron deposition (ferritin and hemosiderin) in many organs, in a pattern similar to primary human hemochromatosis. Electron microscopic examination of the pancreas showed ferritin particles segregated in lysosomes of acinar cells, as well as diffuse cytosiderosis of macrophages in the interstitial septa. In the islets, iron deposits were discrete and only in B cells. In the absence of electron‐microscopic studies of incipient pancreatic cytosiderosis in human subjects, the present experimental animal study may contribute to a better understanding of the pathway leading to the extensive lesions found in the advanced stages of the human iron overloading diseases.
Apolipoprotein A‐I
Authors: Sveger Tomas , Fex Göran , Flodmark Carl‐Erik , Kjellström Thomas , Borgfors Nils
Published: January 2024

The apolipoprotein (apo) A‐I:B ratio and the apo B concentration were determined by radial immunodiffusion in dried blood spot samples from 1,767 10‐and 11‐year‐old children. Children with either apo A‐I:B ratios below the first percentile or apo B levels above the 99th were recalled and plasma lipid and apolipoprotein profiles were determined for both children and parents. Of 17 children (one family was lost to follow‐up) recalled due to abnormal apo A‐I:B ratios, apo B levels were above the 95th percentile in 13 children, and of 18 children with abnormal apo B screening levels (three of them also had abnormal apo A‐I:B ratios), the plasma apo B level was elevated in 13 children. The 23 children with abnormal blood lipid and/or apolipoprotein concentrations were divided into two main groups: (a) children with type IIa hyperlipoproteinemia and (b) children with hyperapo B lipoproteinemia (hyperapo B) and normal blood lipid levels. Twelve children had the type IIa pattern. Five children likely had familial hypercholesterolemia (FH), the other seven children may have hypercholesterolemia due to obesity or environmental factors. Eleven children had the hyperapo B abnormality. In four children, the elevated apo B level probably was an indication of the occurrence of familial combined hypercholesterolemia (FCH) in the family. Of the remaining seven hyperapo B children, three children also had a parent with hyperapo B and a fourth family suffered from obesity. In conclusion, screening for FH using the apo A‐I:B ratio and apo B level with an arbitrary recall of 1% of each group together with their parents yielded 1 in 350 with a FH lipoprotein profile. In addition, children and parents with FCH, hyperapo B, and environmental hypercholesterolemia, disorders also associated with premature coronary artery disease, were found.
Intestinal Lymphangiectasia Without Protein Loss in a Child with Abdominal Pain
Authors: Van der Meer S. B. , Forget P. P. , Willebrand D.
Published: January 2024

A 7‐year‐old white girl presented with recurrent abdominal pain because of gastroesophageal reflux. At endoscopy, we found intestinal lymphangiectasia in the duodenal biopsy. There were no physical signs, nor any laboratory evidence of enteric protein loss.
Giardiasis with Protein‐Losing Enteropathy
Authors: Korman Stanley H. , Bar‐Oz Benjamin , Mandelberg Avigdor , Matoth Israel
Published: January 2024

Giardia lamblia infection was documented by jejunal biopsy in a previously healthy 2‐year‐old boy with acute onset of hypoproteinemia due to protein‐losing enteropathy. All symptoms and abnormal laboratory findings resolved with anti‐Giardia therapy. This is only the second case report of giardiasis with documented proteinlosing enteropathy. Further application of the fecal α1‐antitrypsin assay may help to clarify the relationship between Giardia infection and protein‐losing enteropathy and its role in development of malnutrition.
Modulation by Human Milk of IgG Subclass Response to Hepatitis B Vaccine in Infants
Authors: Azzari Chiara , Resti Massimo , Rossi Maria E. , Lami Caterina Adami , Vierucci Alberto
Published: January 2024

The influence of breast and formula feeding on specific anti‐hepatitis B surface antigen (HBsAg) IgG subclass production and distribution has been investigated in 40 healthy infants, born to HBsAg‐positive mothers and vaccinated against hepatitis B virus (HBV). Twenty children were bottle fed and 20 were breast fed. Specific subclasses were detected at the 4th and 12th months using an enzyme‐linked immunosorbent assay with monoclonal antibodies. A defect in total IgG and IgG subclasses was previously excluded. Significant differences were observed both at the 4th and 12th months for IgG1 and IgG2. Breast‐fed infants had significantly higher levels of specific IgG2 (about three times higher), while IgG1 levels were significantly higher in formula‐fed infants. Anti‐HBsAg IgG4 levels were always higher in bottle‐fed infants, but a statistical significance was never present. No difference was found in specific IgG3 levels. This study reports the evidence that breast feeding influences specific IgG subclass synthesis against a viral antigen and suggests an immunologic modulation of the response to vaccines dependent not only on age but also on factors present in human milk.
Esophageal Reflux in Symptomatic and Asymptomatic Infants
Authors: Dreizzen E. , Escourrou P. , Odievre M. , Guilleminault C. , Gaultier Cl.
Published: January 2024

Twenty‐two full‐term infants, nine asymptomatic and 13 symptomatic for chronic digestive problems, had long‐term (mean = 21 h) esophageal pH monitoring. All children were observed in strictly standardized conditions including meals and body position. Symptomatic infants presented significantly more esophageal refluxes, spent a greater percentage of time with a pH below 4, had a longer reflux duration (longer clearing time) and presented more refluxes lasting more than 5 min. We performed a determination of the circadian variations of parameters associated with esophageal reflux. Asymptomatic and symptomatic infants presented significant circadian variations of the percentage of time below pH 4 and of the longest duration of reflux. However, symptomatic infants had significantly higher mean values and increased amplitudes of circadian rhythms. Moderate phase lag existed for certain variables between symptomatic and asymptomatic infants. These findings can be helpful when interpreting the results of long‐term esophageal pH monitoring.
An in Vitro Model to Study Aspects of the Pathophysiology of Murine Rotavirus‐Induced Diarrhoea
Authors: Starkey W. G. , Candy D. C. A. , Thornber D. , Collins J. , Spencer A. J. , Osborne M. P. , Stephen J.
Published: January 2024

An in vitro system is described and validated for studying transport of solutes and water in both uninfected and rotavirus‐infected neonatal mouse intestine. Control intestine exhibited stable water absorption for periods of up to 40 min. Water absorption was temperature‐dependent, Na‐dependent, and enhanced by glucose‐containing perfusion solutions. Theophylline induced net secretion of water by control intestinal tissue. Water transport by rotavirus‐infected lower small intestine was significantly depressed as compared to control levels, and rotavirus‐infected middle small intestine exhibited net secretion of water. Upper small intestine and colon from infected animals did not differ significantly from control tissues in their ability to transport water. Water secretion by infected middle small intestine was reversed to absorption by glucose‐containing solutions.
Manometric Variations Following Spiral Myotomy for Long‐Gap Esophageal Atresia
Authors: Levine Jeremiah J. , Shoshany Gideon , Davidson Murray , Kimura Ken
Published: January 2024

We have previously demonstrated that a spiral myotomy and delayed definitive procedure is a viable alternative for esophageal reconstruction in long‐gap esophageal atresia. In this study we sought to determine whether this procedure leads to esophageal motility disturbances and to compare the manometric findings with controls as well as with those seen in children with esophageal atresia and primary anastomosis. Six beagles had esophageal transection and a spiral myotomy, one had esophageal transection without a myotomy, and two served as normal controls. Following esophageal reconstruction, esophageal manometry was studied in all dogs using a standard pull‐through technique. We found that the three control dogs all had similar manometric findings with normal peristalsis. In contrast, the dogs with a spiral myotomy all had propagation of waves in the myotomized segment but termination of waves at the anastomotic site. There was delayed velocity through the myotomized segment and retrograde peristalsis distally. Finally, upper esophageal sphincter pressure was elevated, while lower esophageal sphincter pressure was similar to that in the normal dogs. These findings are similar to those described in children with primary anastomosis and suggest that (a) spinal myotomy is a good alternative to other esophageal replacement options in patients with long‐gap esophageal atresia and that (b) the motility dysfunction observed in children with esophageal atresia following primary anastomosis may be secondary to the disruption of the vagus nerve and that may be part of the congenital abnormality or secondary to surgical trauma.
Comparison of Evaluation of Gastroesophageal Reflux in Infants Using Different Feedings During Intraesophageal pH Monitoring
Authors: Tolia Vasundhara , Kauffman Ralph E.
Published: January 2024

The effect of two different types of feedings on results of esophageal pH monitoring was prospectively studied in 49 infants undergoing evaluation for gastro‐esophageal reflux (GER). Infants were randomly assigned to receive either apple juice (AJ) or formula for the first feeding during extended pH monitoring (EPM). Each infant received the alternate liquid for the second feeding. During the rest of the monitoring period, infants received formula feedings. The percentage of time that esophageal pH was less than 4.0 following both types of feedings and the percentage of time that pH was lower than 5.0 following formula feedings were determined. Following AJ feeding, the mean percentage of time pH was less than 4.0 was 43.8% in contrast to 5.1% following formula feeding. However, following formula feeding, pH was less than 5.0 35.7% of time, similar to the percentage of time pH was less than 4.0 after AJ feeding. Ability to detect GER with short‐term monitoring after the two feedings was compared to detection following extended monitoring. Detection of GER with short‐term monitoring following AJ feeding correlated well with extended monitoring (r = 0.67; p < 0.001). There was a weaker, although significant, correlation between short‐term monitoring following formula feeding using pH less than 5.0 as the reflux criterion and extended monitoring (r = 0.3; p < 0.01). We conclude that outpatient GER evaluation with intraesoph‐ageal pH monitoring during a feeding interval following an AJ feeding may serve as an acceptable substitute for extended pH monitoring when it is not practical or desirable to admit the patient to the hospital.
Taurocholate Transport by Brush‐Border Membrane Vesicles from the Developing Rabbit Ileum
Authors: Schwarz Steven M. , Watkins John B. , Ling Saidee C.
Published: January 2024

To examine the ontogenesis of bile acid transport in the rabbit ileum, brush‐border membrane vesicles (12− to 20‐fold purified) were prepared from 14− to 49‐day‐old animals. Taurocholate uptake was characterized by the emergence of secondary active, Na+ ‐dependent transport at the start of weaning (21 days). Transient intravesicular accumulation (overshoot) of taurocholate occurred at 5–10 s of incubation, and the overshoot maximum increased significantly from 21 days (349.2 ± 22.4 nmol/mg protein) to 35 days (569.0 ± 84.3 nmol/mg protein; p < 0.001), without further increase at maturity (49 days, ± 607.6 ± 136.7 nmol/mg protein). No significant taurocholate active uptake component was noted at 14 days; however, ileal vesicles from sucklings showed carrier‐mediated, Na+ D‐glucose cotransport. In ± 35‐day‐old rabbits, osmolarity studies at 20 s of incubation showed that only 12% of [14C]taurocholate uptake was secondary to bile acid‐to‐membrane binding. Conversely, at 20 min, >95% of radiolabel incorporation represented solute bound to the external and/or internal membrane surface. Arrhenius plots establish brush‐border membrane taurocholate uptake as an intrinsic, lipid‐dependent process, with a slope discontinuity between 24 and 28°C, similar to the membrane lipid thermotropic transition region. Steady‐state fluorescence polarization studies (1,6‐diphenyl‐1,3,5‐hexatriene) demonstrate a temporal association between the maturation of taurocholate uptake and age‐related decreases in ileal brush‐border membrane fluidity. These data indicate that maturation of bile acid secondary active transport in the rabbit ileum may be regulated, at least in part, by changes in brush‐border membrane lipid dynamics.
Defined Formula Diets Alter Characteristics of the Intestinal Transport of Amino Acid and Peptide in Growing Rats
Authors: Ohkohchi Nobuhiro , Andoh Tadashi , Ohi Ryoji , Mori Shozo
Published: January 2024

Recently defined formula diets are widely used for patients with digestive diseases. Long‐term administration of such diets is presumed to change the absorptive characteristics of the small intestine. We investigated the influence of the defined formula diet on the absorptive capacity of growing rats by measuring the potential difference of sugars, amino acid, half‐maximum concentration (kt) of these substrates, the activities of disaccharidase and dipeptidase, and the portal amino acid concentrations. There was no significant difference in the body weight of rats fed amino acid or peptide diets and those given the normal chow, but the administration of the defined formula diets reduced the absorption of amino acid and small peptide per serosal area and kt. On the other hand, absorption of sugars was not significantly influenced by the type of the diets. The differences in the absorptions of amino acid and peptide following the administration of the defined formula diet might be associated with the change in the resistance of the unstirred water layer or the alteration in the active transport system of amino acids or peptides in the small intestine. No significant differences were observed between the influences of the amino acid and the peptide diets.
Diet‐Induced Alterations of Lipids During Cell Differentiation in the Small Intestine of Growing Rats
Authors: Alessandri J.‐M. , Arfi T. S. , Thevenoux J. , Léger C. L.
Published: January 2024

The lipid components of columnar cells harvested from rat small intestine were analyzed at each step of cell maturation. The effect of dietary lipids on the evolution of lipids in differentiating cells was studied using two diets representative either of a control or of an essential polyunsaturated fatty acid deficient lipid supply. Two groups of weanling rats were fed a semisynthetic diet composed of corn oil (control diet) or hydrogenated coconut oil (deficient diet) for 11 weeks. Intestinal cells were extracted according to their position along the villus column. Linoleic and arachidonic acids constitutive of cell phospholipids increased as cells migrated from the lower to the mid‐part of the crypt‐villus axis only with the control diet. This gradient disappeared after a 3‐week feeding period with hydrogenated coconut oil diet so that columnar cells of essential fatty acid deficient rats exhibited the same overall fatty acid composition all along the crypt‐villus axis. Essential fatty acid deficiency resulted in an increase of both the triene to tetraene and arachidonic acid to linoleic acid weight ratios regardless of the maturational step of cells. As compared to the control diet, the essential fatty acid deficient diet induced a decrease of both the cholesterol and free fatty acid to phos‐pholipid molar ratios only in lower villus cells. We conclude that (a) progressive compositional modifications of lipids occur while ascending the crypt‐villus axis and (b) essential fatty acid deficiency induces substantial alterations of the lipid evolution normally linked to cell differentiation.
Steatocrit Test
Authors: lacono G. , Carroccio A. , Cavataio F. , Montalto G. , Mancuso C. , Balsamo V. , Notarbartolo A.
Published: January 2024

In order to define the normal values of steat‐ocrit during the first 3 months of life and the normal correlation between fecal fat content and steatocrit values, 60 full‐term healthy unweaned infants (30 bottle‐fed, 15 breast‐fed, and 15 mixed‐fed) were studied. The steatocrit micromethod was performed in these babies at 7, 14, 21, 28, 45, and 90 days after birth. Steatorrhea often occurs during the first month and then decreases, as shown by the fall in the steatocrit curve from 7th to 28th day in our subjects; at 45 days, few babies have steatorrhea. The 90th percentile profile of steatocrit values shows a value of 25% at the first week of life and a value of 13% at the fourth week. After the end of the third month, babies with steatocrit values higher than 2% should be put under close observation. Moreover, fat absorption can be greatly influenced by diet; in breast‐fed babies, steatorrhea disappears more rapidly and steatocrit values are lower at every age than in partly or totally formula‐fed babies. The good correlation between steatocrit values and fecal fat content (r = 0.97) confirms that this micromethod can be used for monitoring steatorrhea instead of other more cumbersome and expensive methods.
Alterations of Intestinal Permeability to Sugars in Infants Following Neonatal Surgery
Authors: Dupont Christophe , Goutail‐Flaud Marie‐Francoise
Published: January 2024

The 12‐h urinary elimination of orally ingested mannitol and lactulose was studied in 29 infants aged 3 days‐20 months admitted in an intensive care unit of gastrointestinal surgery, and in 24 age‐matched healthy controls. In patients with short bowel syndrome, there was a significant fourfold reduction in urinary mannitol elimination compared with controls. The lactulose/mannitol urinary ratio was significantly increased in patients with necrotizing enterocolitis (p < 0.01) and in patients with disorders of intestinal propulsion during episodes of diarrhea with a monomorphic fecal flora (p < 0.01). The urinary recovery of mannitol and lactulose after oral loads is a good marker of intestinal mucosal damage in infants with surgical disorders of the digestive tract.
Pattern of Expression of γ‐Glutamyl Transpeptidase in Rat Liver and Kidney During Development
Authors: Jacquemin Emmanuel , Bulle Frédérique , Bernaudin Jean‐Francois , Wellman Maria , Hugon Rose‐Noëlle , Guellaen Georges , Hadchouel Michelle
Published: January 2024

We used an in situ hybridization technique using single‐stranded RNA probes to study the expression pattern of γ‐glutamyl transpeptidase (GGT) in rat liver and kidney during development. The results were compared to those obtained with an immunoperoxidase technique and with Northern blot analysis of GGT mRNA. In the kidney, northern blot revealed a 20‐fold increase of GGT mRNA between day 18 of gestation and adulthood. Protein and mRNA localization clearly identified the proximal tubules as the site of synthesis of GGT. In the liver, the expression was lower than in the kidney and Northern blot showed a dramatic decrease of expression after birth. Using immunohistochemistry, the protein was detected within parenchymal cells in embryo and hepatocyte membranes and bile ducts in adults. Using in situ hybridization, GGT mRNA was only detected on days I and 2 after birth and exclusively in hepatocytes. Immunoperoxidase may be more sensitive than in situ hybridization to study the expression of minor liver protein such as GGT. However, the study of GGT expression using in situ hybridization is possible in cases of increased expression such as alcoholism, cholestasis, and carcinogenesis.
Visceral Neuropathies Responsible for Chronic Intestinal Pseudo‐Obstruction Syndrome in Pediatric Practice
Authors: Navarro J. , Sonsino E. , Boige N. , Nabarra B. , Ferkadji L. , Mashako L. M. N. , Cezard J. P.
Published: January 2024

Twenty‐six children aged from 1 day to 15 years (18 boys and 8 girls) with visceral neuropathies are analyzed. Clinical symptomatology is dominated by abdominal distension, attacks of occlusion, abdominal pain, and malnutrition. Intestine bacterial overgrowth is frequent. From aspiration biopsies, surgical rectal biopsies, and, in some cases, ileal or ileocolic biopsies, histopathological studies revealed two patterns. One group had abnormalities of the myenteric plexus identified by conventional light microscopic studies, with two patterns: [myenteric plexus hyperplasia (9 patients), characterized by large ganglionic nodes, penetration into the mucosal zone, and altered argyrophilic neurons]. Clinically this pattern was observed in four patients with multiple endocrine neoplasia syndrome with risk of medullary thyroid carcinoma. The second pattern observed was characterized by glial cell hyperplasia (15 patients). Ganglion cells are present but are small and sparse, often infiltrated by collagen tissue; Schwann nerve fibers are hypertrophic. Eleven patients presented with neonatal intestinal obstruction. The second group is characterized by normal conventional light microscopic examination, but silver stains revealed important abnormalities of argyrophobic cells (one case) or argyrophobic cells (one case). In the two groups, most of the patients needed intestinal derivation and prolonged nutritional support with total parenteral nutrition.
Immunogenicity of Haemophilus influenzae Type B Vaccines in Children with Hepatoportoenterostomies
Authors: Rosenthal Philip , Wong Victor , Ross Lawrence A. , Kim Kwang Sik
Published: January 2024

To assess the immunogenicity of HIB vaccines in patients in whom hepatoportoenterostomies were performed for biliary atresia, eight such children received Haemophilus influenzae type b‐polyribosylribitol phosphate (HIB‐PRP) vaccine and had pre‐ and postvaccination total serum anti‐PRP antibody concentrations determined by radioimmunoassay. Preimmunization anti‐PRP antibody levels ranged from <0.125 to 0.40 μg/ml [geometric mean antibody titer (GMT) 0.106 μg/ml], while postvaccination levels ranged from 0.161 to 1.192 μg/ml (GMT = 0.489 μg/ml). Five children who did not achieve postimmunization anti‐PRP antibody levels >1.0 μg/ml received 15 μg of either PRP coupled to diphtheria toxoid (PRP‐D) or PRP coupled to an outer membrane protein complex of Neisseria meningitidis group B (PRP‐NOMP) conjugate vaccine. Anti‐PRP antibody levels 1 month after immunization with HIB conjugate vaccines ranged from 1.51 to 10.35 μg/ml (GMT = 3.386 μg/ml). Patients with extrahepatic biliary atresia and hepatoportoenterostomies who previously received the HIB‐PRP vaccine should be revaccinated with PRP protein conjugate vaccines to ensure adequate protection against H. influenzae type b disease.
Serum Antibodies to Dietary Antigens
Authors: Scott Helge , Ek Wohan , Havnen Jacob , Michalsen Helge , Brunvand Leif , Howlid Hans , Brandtzaeg Per
Published: January 2024

We examined 1,541 consecutive serum samples from 707 children with suspected food intolerance and 32 with treated celiac disease (CD) for IgG and IgA antibody reactivities to antigens from gluten, egg, and cow's milk by an enzyme‐linked immunosorbent assay (ELISA). Samples from 72 patients showed increased IgA and/or IgG reactivity to gluten antigens; four were known CD patients not complying with a gluten‐free diet, 13 were suspected CD patients challenged with gluten, and 30 most likely had CD as suggested by small intestinal villous atrophy and histological and/or clinical improvement on a gluten‐free diet. The remainder with increased antigluten activity had other disorders that might have affected mucosal permeability. Nevertheless, the median IgA reactivity to gluten was significantly higher in the CD group, and the probability for CD increased from 25 to 100% when this reactivity was above 2.4 optical density (OD) units in our ELISA. Sixteen CD patients (but none of those without CD) had IgA reactivity to gluten higher than 2.4 OD units. We conclude that ELISA determinations of levels of serum antibodies reacting to dietary antigens is a valuable adjunct in the diagnosis of CD in children.
Unifocal Stricture of the Common Bile Duct in Two Children
Authors: Sokal Etienne M. , de Ville de Goyet Jean , Buts Jean Paul , Habets Sophie , Gosseye Serge , Clapuyt Philippe , Claus Dominique , Otte Jean Bernard
Published: January 2024

A 4‐year‐old boy and a 14‐year‐old girl referred for a cholestatic syndrome were found to have a unifocal stricture of the extrahepatic bile duet. Both radiological (endoseopic‐retrograde‐choledocopancreatography) and histological findings were suggestive of primary sclerosing cholangitis. There was no past history of chronic inflammatory bowel disease nor any other disorder. Serum autoimmune markers were negative. Complete remission was observed after surgical drainage, and both patients remained symptom‐free after a follow‐up of 12 months and 8 years, respectively. Such unifocal form of the disease may have a better prognosis than the plurifocal disease. The absence of associated disorders and autoimmunity may also be an indicator of better prognosis in these patients.
Intraoperative Endoscopic Diagnosis of Heterotopic Gastric Mucosa in the Ileum Causing Recurrent Acute Intussusception
Authors: Turck Dominique , Bonnevalle Michel , Gottrand Frédéric , Farriaux Jean‐Pierre
Published: January 2024

Heterotopic gastric mucosa (HGM) may be found anywhere in the gastrointestinal tract, most often in a Meckel's diverticulum. Approximately 30 cases of HGM, located in the small bowel beyond the ligament of Treitz and not associated with a Meckel's diverticulum, have been reported. They were most often revealed by intestinal intussusception, occasionally by perforation of an intestinal ulcer or intestinal bleeding. We report a 4‐year‐old boy who had three attacks of acute intestinal intussusception over a 5‐month period resulting in surgery. Both physical examination and barium examination of the small bowel and large intestine were found to be normal between attacks. Peroperative palpation of the small bowel was normal during the three laparotomies. During the third operation, he underwent an intraoperative endoscopy (IOE), which revealed a polypoid mass 2 cm in diameter and 0.5 cm in height, 40 cm proximal to the ileocaecal valve. Histologic examination showed HGM with fundic glands, and chief and parietal cells. This case emphasizes the interest of IOE, the main indications of which are the localization of unknown sites of gastrointestinal bleeding and the search for hamartomatous polyps of the Peutz‐Jeghers syndrome for polypectomy and/or segmental resection.
Dependability of Esophageal pH‐Monitoring Data in Infants on Cutoff Limits
Authors: Vandenplas Y. , Lepoudre R. , Helven R.
Published: January 2024

The cutoff limit for pathologic gastroesophageal reflux (GER) has been arbitrary, although generally accepted determined at pH 4.00. The influence of a small pH error (0.25 pH units above or below pH 4.00) was analyzed in 173 consecutive pH monitorings. This appeared to cause a misinterpretation of the data in 51 of 173 infants (29%). We propose the introduction of a new parameter measuring the percent of time of the total investigation that the recorded pH varies between 4.25 and 3.75: the “oscillatory index” (OI). The index ranged from 0–42%. The higher the OI, the more pH data that are recorded between pH 4.25 and 3.75. The OI is related to the arbitrary aspects of a boundary level. The Pearson correlation coefficient between the percent of time of the investigation the pH was <4.00 and the OI was 0.75. If an OI of more than 10% in infants with normal pH‐monitoring data of more than 15% in infants with a GER pathology would be considered as abnormal, pH‐monitoring data of 45 infants should be considered for reclassification (26%). Prior to general application, this parameter should be evaluated by more centers in different patient populations, and other "oscillatory ranges" should be analyzed.
β2‐Microglobulin Levels in Celiac Disease
Authors: Bonamico M. , Culasso F. , Pitzalis G. , Mariani P. , Morellini M. , Procopio A. , Triglione P. , Signoretti A. , Ballati G.
Published: January 2024

The serum levels of β2‐microglobulins (β2‐m) were studied in 65 celiac children. Significant statistical differences (p < 0.05) were found between the values of patients on a gluten‐containing diet (mean ± SD, 1.92 ± 0.64mg/L) and those on a gluten‐free diet for less than (mean ± SD, 2.38 ± 0.76 mg/L) or greater than (mean ± SD, 1.46 ± 0.77 mg/L) 8 months. A significant difference was also found between the first group and the 15‐subject control group, who underwent intestinal biopsy for low stature or chronic diarrhea but had normal intestinal mucosa (mean ± SD, 1.56 ± 0.42 mg/L). Serum β2‐m levels were above normal values (<2 mg/L) in 10 of 26 (38.5%) celiac patients on a gluten‐containing diet and in two of 15 (13.3%) subjects of the control group. The β2‐m values of patients on a gluten‐free diet for ±8 months were significantly different (p < 0.001) from those of patients on a gluten‐free diet for >8 months, as well from those of the control group. No significant differences were found between patients on a gluten‐free diet for >8 months and the control group. A significant correlation between the anti‐gliadin antibody (AGA) IgA and β2‐m in the patients on a gluten‐free diet for >8 months and control‐group patients was found. The significant statistical difference (p < 0.05) of the mean values of β2‐m between patients with DR3+/DR7− and DR3+/DR7+ phenotypes (if confirmed by a wider case study) could indicate a genetic heterogeneity of celiac disease. The β2‐m, because of its specificity (86.7%), even if the sensitivity (38.5%) is not high, could be used with AGA to select candidates for intestinal biopsy. The increase of β2‐m serum levels in the first months of the gluten‐free diet is probably due to active regeneration of the intestinal mucosa. As the time necessary for serum values being normal is about 8 months, this could be the gluten‐free period necessary before proceeding to a second biopsy.
A Dot Immunobinding Assay to Detect Anti‐α‐gliadin Antibodies in Celiac Disease
Authors: Bittolo Manuela , Not Tarcisio , Perticarari Sandra , Cauci Sabina , Graziosi Giorgio , Marzari Roberto
Published: January 2024

A dot immunobinding assay to detect anti‐α‐gliadin‐specific antibodies in the sera or whole blood of enteropathic patients is described here. The method is based on the adsorption of α‐gliadin as a spot onto nitrocellulose sheets. After incubation with the patient sample, the detection of specific antibodies is performed with alkaline phosphatase‐conjugated goat anti‐human (IgA or IgG) antibodies. Twenty‐one celiac serum samples together with 18 enteropathic or disease controls and 44 healthy controls were analyzed. The classical ELISA test and the dot test gave comparable results. The dot test gave reliable result even when whole blood was tested. The method proved to be simple and sensitive.
Vitamin B12 and Folic Acid Absorption and Hematological Status in Children with Postenteritis Enteropathy
Authors: Paerregaard Anders , Hjelt Karsten , Krasilnikoff Peter Andreas
Published: January 2024

In a group of nine children with postenteritis enteropathy (i.e., persisting small‐intestinal mucosal damage and failure‐to‐thrive after an acute episode of gastroenteritis), absorption capacities for vitamin B12 and folic acid were studied and compared with hematological status in peripheral blood. The fractional absorptions of vitamin B12 (FAB12) and folic acid (FAFol) were determined by means of a double‐isotope technique employing a single‐stool‐sample test. The children were examined when growth retardation was maximal, and examinations were repeated during the late recovery period. In spite of considerable small‐intestinal mucosal damage, only the absorption of vitamin B12 was markedly affected, while that of folic acid was almost intact. When growth retardation was maximal, FAB12 was below the normal age‐correlated range in half of the children. FAB12 was also severely reduced in all longitudinally observed children when compared with the results obtained during the late recovery period (p < 0.005). FAFol was below the normal range in one fourth of the children, but the reduction was modest and insignificant when compared with the results of repeated examinations during the late recovery period. A moderate iron deficiency was detected in half the children. High levels of plasma vitamin B12, folic acid, and erythrocyte folate were detected at both early and later examinations, indicating that these parameters were not affected by the reduced absorption capacities. However, if malabsorption and chronic diarrhea are combined with low dietary intake of vitamin B12, as is the case for many children in the Third World, depletion of vitamin B12 stores may result.
Usefulness of Immunocytochemical Demonstration of Neuron‐Specific Enolase in the Diagnosis of Hirschsprung's Disease
Authors: M. F. Nogueira Ana Margarida , Barbosa Alfredo J. A. , Carvalho Alex A. , Pinheiro Fernando C. , Coelho Marcilene , Cabral Mônica M. D. A. , Andrade Inês E. D.
Published: January 2024

The work reported here was carried out to study the importance of immunocytochemical staining of neuron‐specific enolase (NSE) in the diagnosis of Hirschsprung's disease and to compare its results with those obtained by hematoxylin‐eosin (H&E) staining in consecutive sections. A retrospective study was made on 51 rectal mucosal biopsies and 19 colorectal surgical specimens from 52 patients clinically suspected of Hirschsprung's disease. Several consecutive sections from all cases were restained by H&E and for NSE demonstration. Sixteen (31%) patients had a histological diagnosis of Hirschsprung's disease, 9 (17%) had hypoganglionosis, 4 (8%) had neuronal intestinal dysplasia, and 2 (4%) had normal histology. In eight patients (15%) hypoganglionosis remained dubious, and in 10 (19%) the diagnosis was inconclusive. Although the NSE staining improved the identification of the nervous tissue of the colon, both H&E and NSE staining proved to be of equal value in the assessment of the presence of neurons in the rectal wall of people with clinically suspected cases of Hirschsprung's disease. Ten H&E‐stained sections from different levels of the biopsy specimen would be enough to detect ganglion cells in most cases.