bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of prostaglandin receptors in regulating cerebral blood flow in the perinatal period
Authors: Chemtob Sylvain , Li Ding‐You , Abran Daniel , Hardy Pierre , Peri Krishna , Varma Daya R
Published: January 2008

Prostaglandins exert significant effects on the range of cerebral blood flow autoregulation. However, the newborn exhibits a narrow cerebral blood flow autoregulatory range compared to the adult, and this apparently contributes to the susceptibility of the newborn to major perinatal complications such its intraventricular cerebral haemorrhage. Reduced vasoconstriction in response to prostaglandins due to the fewer prostaglandin receptors, especially for PGE2 (EP) and PGF2α (FP), seems to contribute in part to the narrower range of cerebral blood flow autoregulation in the newborn. Evidence suggests that high levels of prostaglandins in the perinatal period are responsible for the down‐regulation of neurovascular EP and FP receptors. We review the pharmacology of prostaglandin receptors, in particular PGE2 and PGF2α receptors, their ontopeny on the neural vasculature. the perinatal regulation of their expression, and how these changes relate to the control of neural blood flow autoregulation.
Spirometry, bronchodilator test or symptom scoring for the assessment of childhood asthma
Authors: Linna O
Published: January 2008

The value of spirometry, the bronchodilator test and 2 weeks' symptom scoring for the assessment of the severity of childhood asthma was studied in a series of 65 consecutively referred school‐aged asthmatic children, with the diurnal peak expiratory flow (PEF) variability in home recordings serving as a golden standard. The amplitude of the peak expiratory flow rate (PEFR) variation could be best predicted by the baseline forced expiratory volume in 1 s (FEV1) and the past history of the symptom rate, the correlation with FEV1 being ‐ 0.48, p < 0.001, Although the baseline forced expiratory flow between 25 and 75% of the forced vital capacity (FEF25‐75%) and the responses of FEV1 and FEF25‐75% to salbutamol also showed significant correlations with the diurnal PEFR variability (r= ‐0.43, r= 0.47 and 0.41, p < 0.001, respectively), these variants did not improve the regression model. The baseline FEV1, FEF25‐75% and PEFR and their responses to salbutamol also had a slight but statistically significant correlation with the methacholine threshold, but the symptom score on the diary card did not show comparable correlations with either the diurnal PEFR variability or the methacholine threshold (r= 0.09, NS, and r= 0.05, NS, respectively). These results indicate that both baseline lung function and the response to the bronchodilator test correlate with the severity of childhood asthma more appropriately than does the symptom score on a diary card. Since many of these correlations were rather weak, however. the assessment of the severity of childhood asthma cannot be reliably based solely on spirometry in all patients.
Retrospective longitudinal growth study of boys and girls active in sport
Authors: Malina RM , Bielicki T
Published: January 2008

Longitudinal records from the Wroclaw Growth Study and the Wroclaw Longitudinal Twin Study were screened for individuals who were active in sport during childhood and adolescence and who were active in sport as young adults. The resulting sample was 25 boys and 13 girls. Heights and weights of the active boys indicated a growth pattern characteristic of early maturers. which was verified in advanced skeletal, sexual and somatic maturation during adolescence. The pubertal progress of active boys suggested no differences in tempo compared to nonathletic boys. In contrast, girls active in sport presented a pattern of growth and maturation characteristic of average maturing individuals, but were taller and heavier than local reference data. Skeletal and chronological ages of active girls did not differ, and the active girls did not differ from local reference data in sexual maturation. PHV, however, was reached later by about one‐half of a year. The pubertal progress of girls active in sport did not differ from that of nonathletic girls.
Urinary excretion of lactose and oligosaccharides in preterm infants fed human milk or infant formula
Authors: Rudloff S , Pohlentz G , Diekmann L , Egge H , Kunz C
Published: January 2008

At present, not much is known about the absorption and metabolism of human milk (HM) oligosaccharides in term and preterm infants. We investigated the renal excretion of lactose and complex oligosaccharides in preterm infants fed HM (n= 9, mean actual body weight 2290 g) or a cow's milk‐based infant formula (n= 9, mean actual body weight 2470 g). We found that the renal excretion of lactose in HM‐fed infants was slightly lower than in formula‐fed infants (14.0 ± 7.4 versus 20.4 ± 8.7 mg kg‐1 day‐1, mean ± SD). The excretion of neutral sugars deriving from oligosaccharides was similar in HM‐fed and formula‐fed infants (3.8 ± 2.1 versus 2.9 ± 0.9mgkg‐1 day1‐); the difference between means was not statistically significant. The separation and characterization of oligosaccharides by high‐pH anion exchange chromatography with pulsed amperometric detection (HPAE‐PAD) and subsequent analysis by fast atom bombardment‐mass spectrometry (FAB‐MS) revealed a more complex pattern in HM‐fed infants compared to the formula‐fed group. Lactose‐derived oligosaccharides characteristic for HM (e.g lacto‐N‐tetraose, and lacto‐N‐fucopentaoses I and II) were excreted in HM‐fed but not in formula‐fed infants. These results indicate that nutrition has a significant impact on the oligosaccharide composition in urine of preterm infants.
Intrathecal baclofen for severe torsion dystonia in a child
Authors: Paret G , Tirosh R , Zeev B Ben , Vardi A , Brandt N , Barzilay Z
Published: January 2008

The successful use of intrathecal baclofen, a structural analogue of γ‐aminobutyric acid, is described in the treatment of a 9‐year‐old boy with intractable torsion dystonia, not responding to conservative treatment. To our knowledge, this is the first reported case of continuous intrathecal baclofen for hereditary torsion dystonia. This case suggests that a continuous intrathecal infusion of baclofen may facilitate remission of intractable torsion dystonia, and provides a basis for further investigation of the treatment of intractable childhood dystonia.
Comparison between broad‐band ultrasound attenuation of the calcaneum and total body bone mineral density in children
Authors: Mughal MZ , Langton CM , Utretch G , Morrison J , Specker BL
Published: January 2008

We measured broad‐band ultrasound attenuation (BUA) in the calcaneum using the prototype Paediatric Contact Ultrasound Bone Analyser (CUBA) and total body bone mineral density (TBBMD) using dual‐energy X‐ray absorptiometry (DXA) (Hologic QDR‐1000W) in 58, 7 17‐year‐old healthy children and adolescents. Calcaneal BUA was significantly related to TBBMD (r= 0.74, p < 0.001), and both the calcaneal BUA and TBBMD were significantly correlated with age and body weight. We conclude that calcaneal BUA reflects bone mineral density (BMD) in healthy children and adolescents; however, BMD measured by CUBA appears to be less sensitive than that measured by DXA. Since BUA reflects structural properties of bone, as well as density, it may complement radiological techniques of bone density measurement in the assessment of paediatric conditions associated with fracture risk.
C‐Reactive protein in viral and bacterial gastroenteritis in childhood*
Authors: Borgnolo G , Barbone F , Guidobaldi G , Olivo G
Published: January 2008

To differentiate bacterial from viral infections the level of C‐reactive protein in serum samples was studied in three groups of children under 5 years of age with gastroenteritis. Of the 53 children with bacterial infection, 41 (77%) had C‐reactive protein levels ≥ 12mgl‐1, 32 (66%) ≥ 20mgl‐1 and 24 (45%) ≥ 35mgl‐1. Of the 35 patients with viral infection, 4 (11%) had C‐reactive protein levels ≥ 12mgl‐1, 3 (9%)≥20 mgl‐1 and 1(3%) ≥ 35mgl‐1. The best balance between sensitivity and specificity of C‐reactive protein was obtained for a cut‐off level ≥ 12mgl‐1 (sensitivity 77%, specificity 89%) as compared to ≥ 20mgl‐1 (sensitivity 58%, specificity 97%) and ≥ 35mgl‐1 (sensitivity 44%, specificity 97%). Our results suggest that the determination of C‐reactive protein values may be a useful tool for predicting bacterial gastroenteritis in children.
Reactivity of skin blood flow and heart rate to thermal stimulation in infants during the first postnatal days and after a two‐month follow‐up
Authors: Jahnukainen T , Lindqvist A , Jalonen J , Kero P , Välimäki I
Published: January 2008

The reactivity of skin blood flow and heart rate to periodic thermal stimulation was studied in 10 term small‐for‐gestational age (SGA) infants, in 9 preterm and 8 term normal‐sized infants during the first two postnatal months. During the first postnatal days, the increase in thermally stimulated skin blood flow oscillations was absent in SGA infants but was clearly present in both preterm (p < 0.01) and term (p<0.01) normal‐sized infants. The responsiveness of SGA infants improved during the follow‐up (p < 0.05). The response of the periodic heart rate variability of SGA and preterm infants was inferior to term normal‐sized infants until the age of 2 months. The cardiovascular responsiveness of growth‐retarded infants seems abnormal during the first days of life, and may impair their ability to meet stress, e.g. changes of ambient temperature.
The influence of feeding regimens on endogenous digoxin‐like immunoreactive substance concentrations in infants
Authors: Kurugöl Z , Özyürek R , Levent E , Parlar A , Egemen A , Tuǧlular I
Published: January 2008

The aim of this study was to investigate serum digoxin‐like immunoreactive substance (DLIS) levels in 60 healthy term infants when they reached 1–6 months of age with regard to feeding regimen. Group I consisted of 30 infants fed exclusively on breast milk. Groups II and III each consisted of 15 infants fed on formula and cow's milk, and on formula and cow's milk supplemented by breast milk, respectively. Mean serum DLIS concentrations were 0.03 ± 0.05, 0.18 ± 0.09 and 0.15 ± 0.09 ng/ml in groups I‐III, respectively. The difference between the DLIS levels in groups II and III was not significant. Serum DLIS levels of infants in groups II and III, on the other hand, were significantly higher than in group I (p < 0.05). These findings were interpreted to suggest that artificial nutrients may cause volume expansion and an increase in endogenous DLIS levels. The latter response is possibly a protective mechanism to decrease volume expansion in groups II and III.
Dietary factors influencing levels of food antibodies and antigens in breast milk
Authors: Lovegrove JA , Morgan JB , Hampton SM
Published: January 2008

The effect of a milk‐free diet during late pregnancy and lactation, on levels of cows’milk specific antibodies and antigens in breast milk, was examined. Women with an allergic condition (defined as atopic) were randomly allocated to a milk‐free diet (n= 10) or an unrestricted diet (n= 12). Twelve non‐atopic women followed an unrestricted diet. A significant reduction (p < 0.001) in β‐lactoglobulin‐specific immunoglobulin A and α‐casein‐specific immunoglobulin A levels was observed over the first 5 days in all groups. The mean level of β‐lactoglobulin antigens in breast milk from women who adhered strictly to the milk‐free diet was significantly lower than the levels of the atopic group on the unrestricted diet (p < 0.02). The allergy incidence in the infants born in the atopic diet group was significantly lower compared with that of the atopic group on the unrestricted diet.
Relations between age, metabolic control, disease adjustment and psychological aspects in insulin‐dependent diabetes mellitus
Authors: Lernmark B , Dahlqvist G , Fransson P , Hägglöf B , Ivarsson SA , Ludvigsson J , Sjöblad S , Thernlund G
Published: January 2008

The relations between age, metabolic control, disease adjustment, and psychological factors in boys and girls with recently diagnosed insulin‐dependent diabetes mellitus (IDDM) were studied. Older girls had significant higher postremission glycosylated haemoglobin A (Hb Alc) levels (p= 0.008). Girls with more hospitalizations had a lower developmental level (p= 0.05), and had significantly more problems in the behavioural rating (p= 0.05). Boys with more hospitalizations had a more external locus of control (p= 0.01), more difficulties with disease adjustment, more emotional problems, and were also clinically assessed as having more behavioural problems. Boys showing more difficulties in psychological adjustment to the disease also had higher postremission Hb A1clevels (p= 0.02). Although Swedish children with IDDM of short disease duration do not differ from healthy children in important psychological aspects, older girls and a small group of problematic younger boys are at risk of developing metabolic imbalance after a short disease duration.
The influence of some perinatal variables on neonatal blood pressure
Authors: O'Sullivan MJ , Kearney PJ , Crowley MJ
Published: January 2008

Adult hypertension has been linked to fetal growth. This study investigates whether this link is evident in the newborn. We measured blood pressure by oscillometry in 248 healthy neonates on day 3/4 of life. Antenatal data and neonatal measurements were obtained from hospital records. Elevated neonatal blood pressure correlated with higher birthweight. There was no correlation between placental weight and blood pressure. Babies born by caesarean section had lower systolic blood pressure. Babies of maternal smokers had higher diastolic blood pressure, but their mothers (45% of this study) had lower blood pressure than non‐smokers. Thus, smoking was associated with a significant change in both maternal and neonatal blood pressure, and may be an important influence on the developing cardiovascular system.
Oral sweet solution reduces pain‐related behaviour in preterm infants
Authors: Abad F , Diaz NM , Domenech E , Robayna M , Rico J
Published: January 2008

To evaluate the effectiveness of oral sucrose in the prevention of pain‐induced crying in preterm infants, a sample of 28 healthy neonates (15M, 13F; gestational age at procedure less than 37 weeks) who were having routine blood drawn by arm venipuncture was studied. Infants were randomly allocated to receive by mouth, using a syringe, 2 ml of one of three solutions: spring water (group W) and sucrose 12 and 24% w/v (groups S12 and S24, respectively), all in water vehicle. After 2 min, while awake, arm venipuncture was performed and duration of crying was measured. The time spent crying was reduced in the group treated with the sweetest solution (S24, n= 8, mean =19.1 s). No difference was observed between the S12 group (n= 8, mean = 63.1 s) and W group (n= 12, mean = 72.9 s). Physiological measurements were recorded at different time points to evaluate excessive basal and procedural distress.
Antiepileptic drug treatment during pregnancy and neonatal screening results
Authors: Wide K , Winbladh B , Guthenberg C , Döbeln U von
Published: January 2008

Many antiepileptic drugs induce hepatic metabolic enzymes and thus enhance metabolism of steroid and thyroid hormones. Antiepileptic drugs readily cross the placenta and the foetal liver is metabolically active. We therefore evaluated the neonatal screening results of TSH and 17‐hydroxyprogesterone in 34 study children and their matched controls. There were no statistically significant differences in the results between the groups.
Hereditary spastic paraplegia and Evans's syndrome
Authors: Ahmed FE , Qureshi IM , Wooldridge MAW , Pejaver RK
Published: January 2008

Two brothers with hereditary spastic paraplegia and Evans's syndrome are recorded. Rapid deterioration of functional motor ability followed the development of Evans's syndrome.
A new model to predict final height in constitutionally tall children
Authors: de Waal WJ , Stijnen Th , Lucas IS , van Gurp EAFJ , Keizer‐Schrama SMPF de Muinck , Drop SLS
Published: January 2008

In order to develop new height prediction models for children with constitutionally tall stature, 55 such boys and 88 girls were recalled for measurement of adult final height (FH). Data on height (H), age (CA), and target height (TH) were collected from the hospital charts and radiographs of the left hand and wrist were retrieved and used for bone age (BA) determination [BA according to the methods of Greulich and Pyle (BAGP) and Tanner and Whitehouse (BARUs)]‐ Standard multiple regression techniques were used to develop prediction equations for FH. In addition, to test the validity of the new equations, FH was measured in a second group of constitutionally tall children (n = 32) and compared with the predicted FH according to our models. In addition, a comparison was made with other prediction methods. Mean (SD) FH was 196.0 (4.9) cm in boys and 180.5 (3.8) cm in girls. The ultimate regression equation was FH (cm) = 216.07 + 0.75 × H + 0.25 × TH ‐ 11.09 × CA ‐ 14.02 × BAOP+ 0.74 × (CA × BAGP) for boys and FH = 161.42 + 0.73 × H + 0.15 × TH ‐ 8.41 × CA ‐ 8.83 × BARUS ‐ 2.45 × M + 0.55 × (CA × BARUS) for girls. The models showed satisfying accuracy: the mean (SD) errors were −1.4 (3.2) cm for boys and −0.5 (3.1) cm for girls with corresponding mean (SD) absolute errors of 2.7 (2.2) cm and 2.0 (2.4) cm, respectively. Compared with the current prediction methods, the new models were quite promising. Their clinical validity has to be ascertained in larger groups of tall children.
Cerebrospinal fluid concentrations of leukotriene B4 in bacterial meningitis
Authors: Santer R , Sievers E , Schaub J
Published: January 2008

We investigated whether leukotriene B4 (LTB4), a granulocyte inflammatory mediator, is detectable in cerebrospinal fluid using a high performance liquid chromatographic method. In non‐pleocytotic cerebrospinal fluid (n = 5) and in cerebrospinal fluid from children with aseptic meningitis (n = 8). LTB4 concentrations were below the detection limit (<0.2ngml 1). In the range 0 20ngml 1. the recovery rate of LTB4 that had been added to non‐pleocytotic cerebrospinal fluid was >90%. In cerebrospinal fluid with a polymorphonuclear leucocyte (PMN) count higher than 1,000/ml, LTB4 was detectable in six out of seven specimens with a concentration of 0.35‐3.3 ngml−1. LTB4 concentration was significantly correlated with PMN number. These results, together with observations in animal models, are discussed with regard to a pathophysiological role of LTB4 in bacterial meningitis.
Randomized trial comparing intravenous immunoglobulin with methylprednisolone pulse therapy in acute idiopathic thrombocytopenic purpura
Authors: Rosthøj S , Nielsen S , Pedersen F Karup ,   The Danish I.T.P. Study Group
Published: January 2008

Forty‐three children with newly diagnosed idiopathic thrombocytopenic purpura (ITP), platelet count (PC) below 20 × 109 1−1, and either continued bleeding or failure to show a spontaneous rise in the PC after a 3 day observation period were randomized to treatment with either intravenous immunoglobulin (IVIG) infusions I gkg−1(n = 23) or intravenous methylprednisolone pulse therapy (MPPT) 30mgkg1(n = 20) on two consecutive days. After 72h, IVIG had induced greater platelet responses (mean PC 188 × 109 versus 77 × 1091−12p < 0.001) and raised the PC to a haemostatically safe level above 50 × 1091−1 more frequently (91 versus 50%, one‐sided e×act p = 0.003). Children responding poorly were then given the alternative treatment in addition. After 6 days, a normal PC of over 150 × 1091−1 had been obtained more frequently in the group given first‐line IVIG (70 versus 50%, p = 0.16). The relapse rates during 6 months of follow‐up were not significantly different (26 versus 40%, p = 0.26). Cross‐over treatment in 11 children with relapse confirmed the superior response to IVIG. The treatment given was restricted to the two initial infusions more often in the IVIG group (70 versus 35%, p = 0.05). These results indicate that IVIG may be preferable to MPPT as the initial treatment for ITP.
The natural history of cardiac rhabdomyoma with and without tuberous sclerosis
Authors: Bosi G , Lintermans JP , Pellegrino PA , Svaluto‐Moreolo G , Vliers A
Published: January 2008

The aim of the present study is to contribute to the knowledge of the natural history of cardiac rhabdomyoma in children with and without tuberous sclerosis. In a retrospective study, 33 children with cardiac rhabdomyoma were collected from three pediatric cardiology centres. In 30/33 patients tuberous sclerosis was associated. High prevalence of cardiac rhabdomyoma was found in infancy, with 21/23 detected before the age of 1 year, and 11/33 before 1 month of age. Cardiac manifestations were present in 19 patients: cardiac rhythm disturbances were detected in 13; in 6/33 a Wolff‐Parkinson‐White syndrome was documented, of which 4 presented paroxysmal arrhythmias. Obstructive or regurgitative phenomena were present in 5; and in 2 patients surgical removal proved necessary. With the exception of one tumoural mass in the right atrium, all 77 tumours were located somewhere in the ventricles, including at atrioventricular valve level. Because of spontaneous regression of most of the tumoural masses, treatment should at first be symptomatic, while surgical removal is required only in life‐threatening conditions, as documented in 2 of our 33 patients.
Chlamydia trachomatis‐associated respiratory disease in the very early neonatal period
Authors: Colarizi P , Chiesa C , Pacifico L , Adorisiol E , Rossi N , Ranucci A , Annicchiarico L Sebastiani , Panero A
Published: January 2008

Of 103 preterm neonates admitted consecutively to the neonatal intensive care unit soon after birth for respiratory distress, 8 were found to be Chlamydia trachomatis‐positive as early as within the first 24 h of life. All these patients required mechanical ventilation and supplemental oxygen. Six infants had evidence on chest radiographs of hyaline membrane disease, one of pneumonia, and one of slight bilateral parenchymal changes. Our results suggest that the presence of C. trachomatis in preterm infants with neonatal respiratory distress is probably not an infrequent event.
Epidemiology of infant Kawasaki disease with a report of the youngest neonatal case ever reported in Japan
Authors: Tsuchida S , Yamanaka T , Tsuchida R , Nakamura Y , Yashiro M , Yanagawa H
Published: January 2008

Our objectives were to describe epidemiological pictures of infant Kawasaki disease (KD) and to report the youngest patient ever reported in Japan. A Japanese database of 105 755 KD patients reported in the 25 year period since 1970 was analyzed. Of all the cases registered, there were only six cases aged 30 days or younger and 1768 cases (1.67%) aged 90 days or younger. We reported a typical case of KD (female, the onset at 20 days old) who was the youngest patient ever reported in Japan. The epidemiology of KD in early infants does not contradict the infection theory of the etiology; the rare incidence in the neonatal period can be explained by the protective effects of the passive immunity transferred from the mother and by exposure to the unknown infectious agents.
Renal magnesium handling in infants and children
Authors: Ariceta G , Rodriguez‐Soriano J , Vallo A
Published: January 2008

Renal handling of magnesium (Mg) has been incompletely studied during infancy and childhood due to the difficulty, until recently, of measuring the diffusible fraction of plasma Mg. In the present investigation this methodology has been used to assess Mg homeostasis in 45 healthy infants, aged 1 to 12 months, and in 63 healthy children, aged 1 to 15 years. When compared to children, infants had significantly higher plasma values (mean ± SD) for both total (0.76 ± 0.08 versus 0.70 ± 0.06 mmol 1 1; p <0.001) and ultrafilterable Mg (0.51 ±0.07 versus 0.49±0.04mmol l‐1; p <0.05). No significant correlations were present between values of plasma Mg and plasma concentrations of calcium, creatinine, total protein or albumin. The ratio UMg/UCr, calculated in the second morning urine (median, 3rd‐97th centiles), was also significantly higher during infancy (0.023, 0.009‐0.07 versus 0.015,0.006‐0.04;p < 0.001). On the contrary, fractional excretion of Mg (median, 3rd‐97th centiles) was identical in both age groups and did not correlate significantly with age (infants: 3.2, 1.0‐7.8%, children 3.4, 1.6‐8.1%;p= NS). During a Mg infusion, carried out in six children, we could establish an approximative value for renal Mg threshold (plasma ultrafilterable Mg = 0.50 mmoll‐1) close to that found in adults. These results indicate that no functional immaturity is present during infancy for renal tubular reabsorption of Mg and that the high UMg/UCr ratio observed in this age group is a phenomenon not dependent on a higher urinary Mg excretion but probably related to a lower urinary creatinine excretion per unit of lean body mass.
α‐Lactalbumin‐enriched low‐protein infant formulas: a comparison to breast milk feeding
Authors: Heine W , Radke M , Wutzke KD , Peters E , Kundt G
Published: January 2008

Tryptophan (TRP) is the limiting amino acid in low‐protein infant formulas. This is mainly due to lower α‐lactalbumin (αLA) content in cow's milk whey as compared with human milk protein. To study the effect of αLA‐enrichment on the TRP supply, cross‐over studies were carried out in 20 healthy infants up to 3 months of age. In this study, two protein‐reduced (1.3%) infant formulas (moderate TRP content of 1.88% and higher TRP content of 2.10%) were alternately fed over a 2 week period in two groups of infants. Serum TRP levels of the formula‐fed infants with the higher TRP content did not differ significantly from an exclusively breastfed control group of 11 infants (10.5 ±4.8 versus 10.9±4.7mgl‐1, p= 0.841), whereas levels of the formula‐fed infants with the moderate TRP content were significantly lower (7.4 ± 3.9, p= 0.038). The supplementation of αLA resulting in a higher TRP supply to low‐protein diets is a further step towards the production of infant formulas more closely adapted to human breast milk.
Radiation dose at small intestinal biopsies in children: results of a national study
Authors: Persliden J , Pettersson HBL , Fälth‐Magnusson K
Published: January 2008

The radiation dose delivered at small intestinal biopsies in children was investigated in a national study engaging 42 of 43 paediatric departments performing small intestinal biopsies. Measurements were performed with a thermoluminescence system at 257 biopsies. The results show a considerable variation of both duration of fluoroscopy (range 2‐660 s; department medians) and radiation dose (range 0.1‐14mSv; department medians). The median of all absorbed doses was 0.69 mSv and the median duration of fluoroscopy 30 s. The observed variation cannot be explained by differences in X‐ray equipment only. By optimization of all the technical conditions, such as X‐ray equipment, biopsy device and method of sedation, at least a 6‐fold reduction of radiation dose was obtained in one department. Especially if the operator is less experienced, it is worthwhile to optimize other factors to achieve the lowest possible radiation dose to the child.
Abnormal intestinal permeability in children with autism
Authors: D'Eufemia P , Celli M , Finocchiaro R , Pacifico L , Viozzi L , Zaccagnini M , Cardi E , Giardini O
Published: January 2008

We determined the occurrence of gut mucosal damage using the intestinal permeability test in 21 autistic children who had no clinical and laboratory findings consistent with known intestinal disorders. An altered intestinal permeability was found in 9 of the 21 (43%) autistic patients, but in none of the 40 controls. Compared to the controls, these nine patients showed a similar mean mannitol recovery, but a significantly higher mean lactulose recovery (1.64%± 1.43 vs 0.38%±0.14; P < 0.001). We speculate that an altered intestinal permeability could represent a possible mechanism for the increased passage through the gut mucosa of peptides derived from foods with subsequent behavioural abnormalities.
Cardiovascular risk indicators cluster in girls from families of low socio‐economic status
Authors: Bergström E , Hernell O , Persson LÅ
Published: January 2008

We evaluated tobacco use, physical activity, dietary intake and cardiovascular risk indicators (s‐lipids, s‐insulin, s‐ferritin, anthropometric measurements, blood pressure, physical fitness) in healthy 14‐ and 17‐year‐old Swedish adolescents in relation to socio‐economic status (SES) of their parents. Girls reported more smoking than boys (14‐year‐olds 10 and 3%, 17‐year‐olds 27 and 18%, girls and boys, respectively). Daily smoking was associated to low SES of the family, but was most strongly associated to smoking in peers (OR = 58.7). Tobacco use was considerably higher among adolescents attending vocational programs at secondary high school as compared with theoretical programs. Daily smokers had a more unfavourable serum lipid profile compared with non‐smokers. Adolescents from families with a low educational level of the mother had a higher relative dietary fat intake. Boys and girls from families of low SES had higher body mass index (BMI), and girls, but not boys, also had lower physical fitness. Clustering of high BMI, low physical fitness and daily smoking was more pronounced in girls from families of low SES. In conclusion, our study shows that in both boys and girls low SES and educational level of the parents are related to an unfavourable cardiovascular risk profile in Swedish adolescents. Furthermore, smoking in adolescents is more related to smoking in peers than to smoking in parents, implying that preventive efforts should focus on peer groups.
Growth and pubertal development in Down syndrome
Authors: Arnell H , Gustafsson J , Ivarsson SA , Annerén G
Published: January 2008

Growth retardation and gonadal insufficiency are well‐known features of Down syndrome. In this longitudinal study, 44 home‐reared children and adolescents with Down syndrome, aged 10‐24 years, living in the county of Uppsala, were followed yearly. The male patients had a mean final height above that reported previously, and a close correlation between target and final heights was found. The mean final height in the female patients was below that reported earlier. Mean peak height velocities in males and females were 8.5 and 7.3 cm year‐1, respectively, significantly lower than in healthy children. The mean ages at peak height velocity were 12.3 and 10.8 years, respectively, indicating early growth spurts. The serum follicle‐stimulating hormone concentrations, the small testes and the negative correlation between luteinizing hormone and testicular volume in the males may indicate some primary gonadal insufficiency. For the girls, mean menarcheal age corresponded closely to that of their mothers.
Where have all the American celiacs gone?
Authors: Fasano A
Published: January 2008

Celiac disease is a common cause of malabsorption in western countries, with significant geographic variation in incidence. Recent epidemiological studies using serology tests, however, suggest that the disease is more common than previously realized and homogeneously distributed in Europe. These studies have also demonstrated that the clinical presentation of the disease may greatly vary even between neighboring countries. Celiac disease remains a rare diagnosis in the United States. Whether the disease is underdiagnosed or is truly rare remains to be established. We have conducted preliminary studies, both on pediatric patients and adult blood donors, that seem to suggest that the prevalence of positive screening tests for celiac disease in the USA is equivalent to that reported in similar screening studies conducted in Europe. These data also suggest that the dimensions of the American celiac disease iceberg seem to be similar to those of the European one. The visible tip of the American iceberg, however, appears to be much smaller, since most of it still remains submerged. The reasons for these divergences remain unknown and may only be partially related to the limited attention to the disease by the American scientific community. Large, multicenter serological screening studies are needed to define the true prevalence of celiac disease in the United States.
The coeliac disease task force “Free from Gluten”“Improved knowledge to cure coeliac disease”
Authors: Greco L , Percopo S
Published: January 2008

Gluten has recently been introduced into the diet of the Mediterranean and European population, but a considerable proportion has not adapted to this change and has developed intolerance to gluten. At least one million EEC citizens are gluten intolerant. In Italy each year 12 million ECU is spent in the diagnosis of uncomplicated gluten intolerance, 10 million ECU for complex diagnosis and 32 million ECU for long‐term complications and malignancies. The total financial load of gluten intolerance, in its present state, is about ISO million ECU/year in Italy. Four million ECU is actually needed to develop a genetic probe, which may make the population screening feasible. A National Task Force “Free from Gluten” has been set up by the Italian Coeliac Society to stimulate fund‐raising activities supporting genetic and basic research on gluten intolerance.
The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school‐age subjects
Authors: Catassi C , Fabiani E , Rätsch IM , Coppa GV , Giorgi PL , Pierdomenico R , Alessandrini S , Iwanejko G , Domenici R , Mei E , Miano A , Marani M , Bottaro G , Spina M , Dotti M , Montanelli A , Barbato M , Viola F , Lazzari R , Vallini M , Guariso G , Plebani M , Cataldo F , Traverso G , Ughi C , Chiaravalloti G , Baldassarre M , Scarcella P , Bascietto F , Ceglie L , Valenti A , Paolucci P , Caradonna M , Bravi E , Ventura A
Published: January 2008

Background: Recent studies suggest that coeliac disease (CD) is one of the commonest, life‐long disorders in Italy. The aims of this multicentre work were: (a) to establish the prevalence of CD on a nationwide basis; and (b) to characterize the CD clinical spectrum in Italy. Patients and methods: Fifteen centres screened 17201 students aged 6–15 years (68.6% of the eligible population) by the combined determination of serum IgG‐ and IgA‐antigliadin antibody (AGA) test; 1289 (7.5%) were IgG and/or IgA‐AGA positive and were recalled for the second‐level investigation; 111 of them met the criteria for the intestinal biopsy: IgA‐AGA positivity and/or AEA positivity or IgG‐AGA positivity plus serum IgA deficiency. Results: Intestinal biopsy was performed on 98 of the 111 subjects. CD was diagnosed in 82 subjects (75 biopsy proven, 7 not biopsied but with associated AGA and AEA positivity). Most of the screening‐detected coeliac patients showed low‐grade intensity illness often associated with decreased psychophysical well‐being. There were two AEA negative cases with associated CD and IgA deficiency. The prevalence of undiagnosed CD was 4.77 × 1000 (95% CI 3.79–5.91), 1 in 210 subjects. The overall prevalence of CD, including known CD cases, was 5.44 × 1000 (95% CI 4.57–6.44), 1 in 184 subjects. The ratio of known to undiagnosed CD cases was 1 in 7. Conclusions: These findings confirm that, in Italy, CD is one of the most common chronic disorders showing a wide and heterogeneous clinical spectrum. Most CD cases remain undiagnosed unless actively searched.
Serological screening for coeliac disease: methodological standards and quality control
Authors: Stern M , Teuscher M , Wechmann T
Published: January 2008

To establish methodological standards for serological investigation and screening of coeliac disease, a joint venture has been launched by the European Medical Research Council and the European Society for Paediatric Gastroenterology and Nutrition. Before general screening can be recommended, robust methods and technical standards ought to be introduced. Joint test protocols were defined: an enzyme‐linked immunosorbent assay for IgG and IgA gliadin antibodies and an immunofluorescent test for IgA endomysium antibodies. Protocols have now been tested prospectively by one laboratory. Eighty‐eight Tuebingen patients were studied (47 coeliac disease on normal diet, 22 coeliac disease on a gluten–free, and 19 disease controls). Single tests did not produce acceptable levels, but combinations of IgA gliadin antibodies and IgA endomysium antibodies showed 98% sensitivity, 100% specificity and 98% predictive efficiency. Only standardized and refereed methods established by ring testing can serve as a reliable basis for serological coeliac screening.
Screening for coeliac disease in Dutch children with associated diseases
Authors: George EK , Mearin ML , Bouquet J , von Blomberg BME , Stapel SO , van Elburg RM , de Graaf EA , ten Cate R Hertzberger , van Suijlekom‐Smit LWA , Reeser HM , Oostdijk W
Published: January 2008

Our objective was to assess the frequency of coeliac disease in children with associated disorders in the province of “Zuid‐Holland”, The Netherlands. We therefore screened 115 children with Down's syndrome, 62 children with juvenile rheumatoid arthritis (JRA) and 46 children with diabetes mellitus for CD using the IgA‐ class of antigliadin, antiendomysium and antireticulin antibodies in serum, and a functional sugar absorption test. The antiendomysium antibody test was the screening test that performed the best. Every patient who had at least one positive test underwent a jejunal biopsy for the diagnosis of CD. No association could be demonstrated between CD and diabetes mellitus. The frequency of CD in Down's syndrome was 7.0%, which is much higher than that found from screening the general population. CD was found in one child with JRA (1.5%), who also had Down's syndrome. We recommend screening for CD in all persons with Down's syndrome using at least the antiendomysium antibody test.
Female fertility, obstetric and gynaecological history in coeliac disease: a case control study
Authors: Sher KS , Mayberry JF
Published: January 2008

Objectives: The purpose of this study was to investigate the incidence of infertility, abortions and perinatal mortality, age at menarche and menopause in coeliac disease. Method: This was a case control study in which patients and controls, matched for age and sex, were sent questionnaires about their fertility profile and other obstetric and gynaecological problems. All 80 patients and 70 controls replied, but only 68 pairs could be matched for this study. Results: The mean age of menarche in patients was significantly older (13.6 years) than in controls (12.7 years). The mean ages at menopause in patients and controls were 47.6 and 50.1 years, respectively. The mean number of children born to patients was significantly less at 1.9 (SD± 0.9) compared to 2.5 (SD± 1.2) in controls. Before diagnosis the mean number of children born to patients was 1.4 and 1.8 in controls. After diagnosis and treatment, patients had 0.5 children (SD±0.9) compared to 0.7 in controls (SD±1.2). It seems likely that the overall difference in fertility is due to relative infertility prior to diagnosis and its correction by a gluten‐free diet. Significantly more conceptions amongst women with coeliac disease (15%) ended in miscarriage prior to diagnosis than amongst controls (6%). After diagnosis and treatment the rate of miscarriage was similar. There were 120 live babies and 7 stillbirths to patients compared with 161 live babies and 1 stillbirth to controls. Conclusions: Patients with CD are subfertile and have an increased incidence of stillbirths and perinatal deaths.
Growth hormone treatment of short children born small for gestational age or with Silver–Russell syndrome: results from KIGS (Kabi International Growth Study), including the first report on final height
Authors: Ranke MB , Lindberg A
Published: January 2008

The response to growth hormone (GH) therapy was studied in children born small for gestational age (SGA; n= 593) and in those with Silver–Russell syndrome (SRS; n= 127) using data from KIGS (Kabi International Growth Study). For the SGA patients, median birth weight was ‐2.6 SD scores (SDS), treatment was started at a median age of 9.2 years, at a time when median height was ‐2.8 SDS while median target height was ‐1.4 SDS. For the SRS patients, median birth weight was ‐3.1 SDS, treatment was started at a median age of 7.0 years, at a time when median height was ‐3.4 SDS with a median target height of ‐0.1 SDS. GH treatment increased height SDS in both SGA children and patients with SRS; in 16 SGA patients treated to (near) final height with GH (median dose, 0.7 IU/kg/week), height minus target height SDS was ‐2.0 at the start of treatment and ‐1.0 at final height. In conclusion, the results obtained in KIGS indicate that GH treatment of short children born SGA is effective in increasing final height above the predicted height and in achieving the target height.
Effect of growth hormone treatment in children with craniopharyngioma with reference to the KIGS (Kabi International Growth Study) database
Authors: Price DA , Jönsson P
Published: January 2008

In children with craniopharyngioma, poor growth commonly precedes diagnosis, but is observed less frequently than neurological or visual symptoms. A deficiency of growth hormone (GH) is common before, and almost universal after, treatment of the tumour, and is usually treated with GH. However, a minority of these children with GH deficiency (GHD) grow well without GH replacement therapy but exhibit other metabolic effects of GHD that are correctable by GH treatment. This article provides a review of studies in 422 children with craniopharyngioma whose details have been entered into the database of KIGS, the Kabi International Growth Study. The response to GH during the first year of therapy was similar to that seen in children with idiopathic GHD (IGHD). Leg length was relatively greater than sitting height and this disproportion was maintained during treatment. Adiposity increased in some children receiving GH treatment. At the end of GH treatment in 82 patients, there was a median gain in height SD score of 1.51, with evidence of residual growth potential still remaining in the majority. Tumour recurrence occurred in 13.5% of the total group of patients with craniopharyngioma within KIGS, at a median of 3.9 years from diagnosis and 2.3 years from the start of GH therapy. Tumour recurrence was not associated with an impairment in height achieved, but there was a tendency towards greater adiposity in patients in whom recurrence occurred. Adverse events during GH treatment were more frequent in children with craniopharyngioma than in those with IGHD, and headache was commonly reported. The results of these studies suggest that GH treatment is recommended for the treatment of children with craniopharyngioma on the grounds of improved growth velocity, adult height and other GH‐dependent metabolic functions, and of the good safety profile of GH in these patients.
Respiratory syncytial virus pneumonia ventilated with high‐frequency oscillatory ventilation
Authors: Medbφ S , Finne PH , Hansen TWR
Published: January 2008

Abstract Four infants below 6 months of age with proven respiratory syncytial virus infection in need of assisted mechanical ventilation were successfully treated by high‐frequency oscillatory ventilation. One of the four infants fulfilled the criteria for extracorporeal membrane oxygenation before the start of oscillation, and one on the second day on high‐frequency oscillatory ventilation. However, extracorporeal membrane oxygenation was not needed in any of the infants. All survived, and three appeared to be without any pulmonary sequelae.
Self‐assessment of sexual maturity by mid‐adolescents based on a global question
Authors: Berg‐Kelly K , Erdes L
Published: January 2008

The objective of this research was to investigate the use of a global question for evaluation of body development relative to age‐mates in addition to graded statements on sexual maturity (SM) as part of self‐reports on pubertal development. In total, 4516 adolescents answered written questions on pubertal development and the global question. They represented a normative Swedish sample. To validate these results, 100 mid‐adolescents were asked to answer the statements regarding SM and the global question. This was compared with ratings made by two professional examiners for each young person. The outcome of the population study was evaluated against standard biological timetables and demonstrated adequate agreement. In the validation study, the inter‐rater agreement between the professionals was excellent and so were professional ratings against those of the adolescents, with one exception: boys' rating of their pubic hair. The global question alone gave the best agreement on pubertal progress. We can conclude that the global question is a valid tool for evaluation of pubertal development during mid‐adolescence in population surveys.
Congenital adrenal hyperplasia in Turkey: a review of 273 patients
Authors: Kandemir N , Yordam N
Published: January 2008

In this study the clinical and epidemiological characteristics of congenital adrenal hyperplasia were evaluated retrospectively from the records of 273 patients managed in our clinic over a 25‐year period. 21‐Hydroxylase deficiency was present in 234 patients (85.7%), simple virilizing form in 134 (110 F, 24 M), salt‐losing form in 85 (71 F, 14 M) and late on‐set form in 15 girls. 11β‐Hydroxylase deficiency was diagnosed relatively frequently (13.5%) among our patients with congenital adrenal hyperplasia; one girl had 17α‐hydroxylase deficiency and one boy had 3α‐hydroxy steroid dehydrogenase deficiency. The median chronological age of diagnosis was 12 months (1 day‐16.6 years) in patients with classical congenital adrenal hyperplasia. Chromosomal sex was 46, XX in a total of 221 patients and 46, XY in 52. Ninety‐one girls were considered to be male before diagnosis was established and male sex was assigned in 31 of them due to development of male gender identity at diagnosis. Parental consanguinity rate among families of patients was higher than the general population in Turkey (56.4% vs 21%). Our overall figures show that the incidence of congenital adrenal hyperplasia is expected to be high due to a high rate of consanguinity in our populations and the patients remain frequently undiagnosed during the neonatal period. Therefore screening may be beneficial in our population.
Cardiovascular disease risk factors and dental caries in adolescents: effect of a preventive program in Northern Sweden (the Norsjö project)
Authors: Larsson B , Johansson I , Weinehall L , Hallmans G , Ericson T
Published: January 2008

Since 1985 a 10 year prevention programme aiming to reduce cardiovascular diseases (CVD) has been running in the county of Västerbotten in Northern Sweden. The project started in Norsjö. The present investigation is a study on dietary intake, medical CVD risk factors and dental caries in five cross‐sectional groups of 15‐year‐olds during 5 years (1987–1991) of the “Norsjö project”. Most of the measured medical and dietary variables followed a similar trend, i.e. a positive trend during the first 3 years (1987–1989) and in the last 2 years (1990–1991) the averages returned towards baseline values. Dental caries prevalence followed a similar trend. Parental educational level did not have a major influence on diet or medical CVD risk factors, but higher caries scores were noted in adolescents with parents with “low” education compared with adolescents where the parents had higher educational levels. The results from the study also point to the fact that dental caries prevalence together with body mass index may indicate adolescents with CVD risk factors at unfavourable levels. Dietary counselling by dental personnel to adolescents with high caries and moderate obesity can be of advantage in reducing caries risk, as well as risk for development of CVD at higher ages.