bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multifocal Adenocarcinoma of the Stomach in a Child With Common Variable Immunodeficiency
Authors: Conley Mary Ellen , Ziegler Moritz M. , Spencer Borden IV , Huff Dale S. , Boyle John T. 
Published: January 2024

SummaryThe clinical course of a child who developed an adenocarcinoma of the stomach at 11 years of age is described. At 6 years of age, the child was evaluated for abdominal pain, weight loss, and vomiting. She was found to have hemorrhagic, atrophic gastritis, achlorhydria, and panhypogammaglobulinemia. The gastritis improved with corticosteroid therapy, but relapsed each time that the steroid dosage was tapered. The clinical course was marked by severe growth failure, recurrent infections, and intermittent abdominal pain. Radiographic studies done when the patient was 11 years of age demonstrated a large fungating mass on the lesser curvature of the stomach. Endoscopy and biopsies done 1 year previously had not revealed any sign of malignancy. A radical gastrcctomy was performed. Microscopic studies revealed multifocal adenocarcinoma of the stomach with no evidence of invasion of the submucosa or local lymph nodes. The patient died of Candida septicemia and pneumonia 6 months after the gastrectomy. There was no evidence of recurrence of the tumor on autopsy. The relationship between common variable immunodeficiency and gastrointestinal disease is described.
Prognostic Value of Serum Pepsinogen I in Children with Peptic Ulcer
Authors: Oderda Giuseppina , Altare Franco , Dell'Olio Domenico , Ansaldi Nicoletta 
Published: January 2024

SummarySerum pepsinogen I (PG I) levels were determined by radioimmunoassay in 23 children with peptic ulcer disease (PUD) before and after treatment with ranitidine and in 44 children who were being investigated for recurrent abdominal pain. Upper gastrointestinal endoscopy was performed in all. No lesions were detected in controls, while 18 patients showed a duodenal ulcer, 4 had an antral ulcer, and 1 had both. An 8‐week course of ranitidine healed PUD in 93.5% of them, while long‐term (1–5 years) endoscopic follow‐up showed a 41.9% ulcer relapse rate after stopping treatment. Gastric acid secretion after pentagastrin stimulation [maximal acid output (MAO)] was tested in all controls and in 22 PUD patients: While controls had normal MAO values for their age. 65% of patients had a secretion above the normal range. No significant correlation was detected between serum PG I and MAO either in controls or in patients. Mean serum PG I concentrations were not significantly higher in the whole patient group than in controls, but PUD patients who relapsed after discontinuing ranitidine treatment had shown on admission significantly higher PG I levels when compared both with those who did not relapse and with controls. All patients who relapsed, but only 42.8% of those who did not, had a serum PG I concentration above the normal upper limit for a pediatric population (56.7 ng/ml). None of the PUD patients who had serum PG I levels under this limit relapsed. Our results suggest that pretreatment serum PG I levels in children with PUD may predict fairly accurately which will not relapse after attaining ulcer healing by a short‐term ranitidine course.
Localized Intestinal Perforation Following Intravenous Indomethacin for Patent Ductus Arterious
Authors: Scholz Thomas D. , McGuinness Gail A. 
Published: January 2024

SummaryWe describe a very low birth weight infant given intravenous indomethacin for a symptomatic patent ductus arteriosus who subsequently developed a gastrointestinal perforation. Although this is a well‐known complication of enteral preparations. it has not been described with the intravenous form. Various mechanisms described in the literature by which the intravenous route of administration may compromise the bowel are presented. Although rare, gastrointestinal complications with intravenous indomethacin may become more prevalent with its increased use.
Metoclopramide Pharmacokinetics and Pharmacodynamics in Infants with Gastroesophageal Reflux
Authors: Kearns Gregory L. , Butler Helen L. , Lane Judy K. , Carchman Susan H. , Wright George J. 
Published: January 2024

SummaryThe pharmacokinetics and pharmacodynamics of metoclopramide oral solution were evaluated in six infants (0.9–5.4 months) with gastroesophageal reflux (GER) following the initial and 10th dose of 0.15 mg/kg administered every 6 h. Metoclopramide pharmacodynamics were assessed by pre‐ and post‐dose comparison of esophageal pH monitoring data and clinical evaluation of improvement in GER symptoms. A significant reduction in the number of episodes of pH <4 for greater than 5 min and the longest episode of GER was seen between the predose and 10th dose (steady‐state) evaluation periods. Four of the 6 patients had a 75% reduction in reflux time and demonstrated improvement in clinical symptoms by the 10th dose. Metoclopramide pharmacokinetics were best characterized by a one‐compartment open model following the first and 10th doses. Metoclopramide serum concentrations (mean ± SD) ranged from 56.2 ± 23.5 to 32.7 ± 13.2 ng/ml within a 6‐h dosing interval at steady state. There were no significant differences between the first versus tenth dose values for Tmax (2.0 ± 0.5 versus 2.2 ± 0.4 h), Kel (0.14 ± 0.03 versus 0.17 ± 0.04 h−1), Vdarea, (4.9 ± 0.4 versus 4.4 ± 0.6 L/kg), or clearance (0.66 ± 0.16 versus 0.67 ± 0.13 L/h/kg). The youngest subject (3.5 weeks) had a metoclopramide t1/2, of 23.1 h following initial dose, which decreased to 10.3 h at steady‐state. Care should be exercised in using the 0.15 mg/kg dose in infants less than 1 month of age as prolonged clearance may produce excessive serum concentrations.
Developmental Changes of Lactose Malabsorption in Normal Chinese Children
Authors: Ting Chi‐Wen , Hwang Betau , Wu Tzee‐Chung 
Published: January 2024

SummaryThe malabsorption of a physiological dose of lactose (0.5 g/kg body weight) was studied in 726 healthy Chinese children, ranging in age from 3 to 18 years, using the breath hydrogen test. The prevalence of lactose malabsorption was found to increase with age: it occurred in <15% of preschool‐age children and in — 45% of younger school‐age and 60% of older school‐age children. Approximately 70% of adolescents measured showed malabsorption. The critical period of change was from 6 to 7 years of age. with the lactose malabsorption rate rising abruptly from 12 to 43%. The incidence of lactose intolerance in teenagers and adolescents was 27 and 33%, respectively. The great majority of them had only dull abdominal pain. No case of lactose intolerance was seen in children <9 years of age. These results indicated that preschool Chinese children can absorb a physiological dose of lactose (equivalent to the average amount of milk consumed daily) without any adverse effects. In contrast, one half of school‐age children and two thirds of adolescents were malahsorbers.
Pancrease Gastroresistance
Authors: Lenaerts C. , Beraud N. , Castaigne J‐P. 
Published: January 2024

SummaryIn order to avoid inactivation in the stomach, pancreatic enzymes have been prepared as pH‐sensitive, enteric‐coated microspheres (Pancrease). An in vitro study was performed to evaluate the pH‐related dissolution of Pancrease and to confirm its resistance to gastric acidity. Two assay methods were used with three different batches of Pancrease: (a) Enzyme absorbency at 280 nm was measured at unit pH intervals from pH 1 to pH 8 and at 0.5 pH intervals from the start of dissolution to pH 8. (b) Proteolytic activity was measured at pH 6.8. Significant enzyme dissolution started at pH 5.5 and was maximal at pH 6.0. At pH 6.8, the pH of simulated intestinal fluid, dissolution was complete in less than 15 min. At pH 5.0, no dissolution occurred within the first 10 min and only 13% dissolution was observed after 2 h. At pH 7.0, 100% dissolution was seen within 10 min. Results of the two assay methods were comparable with all three enzyme batches assayed. This study confirmed the gastroresistance of Pancrease. Because of the enteric coating of Pancrease, liberation of enzymes occurs in the duodenum and jejunum, providing maximal enzymatic efficacy in exocrine pancreatic insufficiency.
In Vivo and In Vitro Studies of Microsphere Pancreatic Supplements
Authors: Littlewood J. M. , Kelleher J. , Walters M. P. , Johnson A. W. 
Published: January 2024

SummaryOver the past 5 years, the Leeds Regional Cystic Fibrosis (CF) Unit has provided comprehensive annual assessments of CF patients that include dietary assessments and fat absorption studies. Enteric‐coated microsphere pancreatic enzyme preparations (micro‐sphere preparations) were compared to conventional enzymes as therapeutic agents for these patients. Presently in the U.K., two microsphere preparations are licensed for use and a further two products are likely to receive licenses in the near future. The success of these preparations is dependent on the ability of the microsphere coating to resist dissolution until the pH exceeds approximately 5.5 and thus prevent inactivation of lipase in the acid environment of the stomach. A study comparing Pancrex V Forte, a conventional enzyme preparation, to three microsphere preparations, Pancrease, Creon, and pancreatin Merck, confirmed the superiority of Pancrease and Creon over Pancrex V Forte and pancreatin Merck with regard to control of symptoms, and nitrogen and fat absorption. Because of differences in the physical characteristics of various microsphere preparations, the dissolution rates of Pancrease, Creon, and pancreatin Merck were compared in vitro. In aqueous buffers, striking differences among the preparations were seen at pH 5.5; whereas only 25% of available lipase was released from Creon, both Pancrease and pancreatin Merck show almost complete dissolution at this pH. Only at pH 6.5 and above do all three preparations show complete dissolution. In duodenal juice, as in aqueous buffers, lipase release from Creon takes place at a lower rate than with the other two preparations until pH 6.0 or higher is attained. Bile salts at pH 5.75 accelerate lipase release from Creon microspheres but not from those of Pancrease or pancreatin Merck. Albumin at pH 5.75 had no effect on the dissolution rate of any of the three microsphere preparations.
Malabsorption in Cystic Fibrosis
Authors: Bouquet J. , Sinaasappel M. , Neijens H. J. 
Published: January 2024

SummaryMalabsorption of nutrients in cystic fibrosis (CF) has a multifactorial origin. The factors involved in malabsorption include malfunction of the exocrine pancreas and liver, bile acid metabolism, and disordered intestinal resorptive processes. Therapeutic measures presently employed are only partially effective. Improvement of fat malabsorption is attained by using a pancreatic enzyme supplement consisting of pH‐sensitive, enteric‐coated microspheres (microsphere preparations) that prevent enzyme degradation in the stomach and travel with the chyme to the small intestine. Microsphere preparations, however, do not improve bile salt deficiency. The detergent Tween‐80, given orally to simulate bile salt activity, does not improve fat absorption. The mucus viscosity is probably enhanced in the intestinal epithelium of CF patients and can be decreased by N‐acetylcysteine, which breaks down sulfide bonds. However, the addition of a high oral dose of this mucus solvent to pancreatin preparations does not improve fat absorption. Further studies on the disturbed intestinal resorptive mechanism seem warranted since recent investigations point to an abnormal chloride secretion as the primary defect in the intestinal epithelia of CF patients.
Three‐Year Growth and Developmental Follow‐Up of Very Low Birth Weight Infants Fed Own Mother's Milk, A Premature Infant Formula, or One of Two Standard Formulas
Authors: Cooper Peter A. , Rothberg Alan D. , Davies Victor A. , Horn Juana , Vogelman Lloyd 
Published: January 2024

SUMMARYA cohort of 40 very low birth weight (VLBW) infants was followed until they reached 3 years of age. These infants were originally part of a feeding trial in the early postnatal period whereby they were fed either their own mother's milk, a standard whey‐predominant formula, a casein‐predominant formula, or a premature formula. Those fed the latter formula grew significantly better while in the hospital and had no biochemical derangements. At 3 years of age, there were no significant intergroup differences with respect to growth or development. There was a positive correlation between head growth in hospital and weight at 3 years, but there were no other significant relationships between early postnatal growth and growth parameters at 3 years. Socioeconomic status was the only predictor of developmental scores at 3 years of age. No adverse effects from early metabolic acidosis or alterations of amino acid profiles during the neonatal period were detectable at 3 years of age. However, the small sample size of this study may have missed true differences in outcome measures at 3 years, and larger studies are required to examine these questions further.
Nutrient Balance in the Preterm Infant. 3. Effect of Balance Duration on Outcome Measurements
Authors: Cooke Richard J. , Paule Chuck , Ruckman Karen 
Published: January 2024

SUMMARYTo determine the effect of balance duration on outcome measurements 18 84‐h balances were performed in a group of formula‐fed preterm infants (birth weight = 1,362 ± 125 g; gestational age = 32.3 ± 1.7 weeks). Each 84‐h balance was broken into contiguous 48− and 36‐h periods. Comparisons (paired t tests, paired variance tests, and linear regression analysis) were made between the 48‐h and 36‐h (paired t and F tests) and between the 48‐h and 84‐h collections (simple linear regression). Nitrogen absorption (mean ± SD) during 48‐h collection (365 ± 58 mg/kg/day and 87 ± 3%) was not significantly different from that of the 36‐h collection (381 ± 66 mg/ kg/day and 84 ± 4%). Nitrogen retention during the 48‐h collection (301 ± 59 mg/kg/day, 72 ± 6%) also was not significantly different from that of the 36‐h collection (318 ± 64 mg/kg/day, 72 ± 6%). Moreover, nitrogen absorption and retention during the 48‐h collection were significantly related (p < 0.0001 for linear regression comparisons) to that of the 84‐h collection. Similar observations were noted for calcium, phosphorus, magnesium, zinc, and copper absorption and retention. We conclude that a 48‐h collection may be used in place of an 84‐h collection without compromising the accuracy of the balance data in the enterally fed preterm infant.
Cervical Esophageal Perforation Diagnosed by Endoscopy in a Premature Infant
Authors: Vandenplas Yvan , Delree Marc , Bougatef Adel , Sacre Liliane 
Published: January 2024

SUMMARYA case of cervical esophageal perforation in a premature infant by an orogastric polyvinyl chloride (PVC) tube is reported. Perforation appeared as an esophageal atresia, suspected because of the inability to aspirate gastric secretions. Initially, atresia was confirmed by an esophagogram, but endoscopy revealed a “double esophagus” with a normally located and developed esophagus and a blind mediastinal fistula starting at the opposite side of the glottis. The “double esophagus” was confirmed by an esophagogram, followed by a contrast study in the pharynx. Esophageal perforation in the neo‐nate is an iatrogenic disease that may mimic esophageal atresia. We recommend endoscopy instead of contrast studies for suspected esophageal atresia.
Crohn's Disease Lesions in the Upper Gastrointestinal Tract
Authors: Mashako Mamba Nyenya Léonard , Cezard Jean Pierre , Navarro Jean , Mougenot Jean Francois , Sonsino Elise , Gargouri Abdellatif , Maherzi Ahmed 
Published: January 2024

SummaryThe incidence of Crohn's disease (CD) lesions in the upper gastrointestinal (GI) tract of both adults and children is frequently underestimated. In this prospective study, a total of 31 children suspected of having Crohn's disease were systematically examined to identify upper digestive tract lesions. They all underwent barium transit endoscopy with multiple‐level biopsies. Typical clinical symptoms suggestive of upper GI tract involvement were found in 5 children (16%), radiological signs in only one child (3%), endoscopic lesions in 13 children (42%), and specific granulomas in 12 children (39%). In eight of these 12 children, the biopsies were taken from macroscopically normal areas of the esophagogastroduodenal mucosa. One of the 31 children had no abnormal radiological and endoscopic features suggestive of CD on the distal small bowel and the colon. There was no correlation between the clinical, radiological, and histological data. Endoscopy plus biopsy provided a positive diagnosis in 39% of cases and a confirmation of the diagnosis in 87% of cases. Endoscopic and histological evidence of CD of the upper GI tract is often present despite an absence of clinical symptoms or radiological changes. Upper GI tract endoscopy with multiple biopsies may be important in the evaluation of this condition and even in some cases for the establishment of the diagnosis.
Amyloidosis in Children with Inflammatory Bowel Disease
Authors: Kahn E. , Markowitz J. , Simpser E. , Aiges H. , Daum F. 
Published: January 2024

SummaryReactive systemic or secondary amyloidosis occurs in 1–29% of adults with Crohn's disease, but only sporadic cases of amyloidosis have been recognized in children with inflammatory bowel disease. We therefore have studied operative specimens (ileal, ileocolonic, and colonic) from 46 children (30 with Crohn's disease and 16 with ulcerative colitis) to determine the frequency of amyloid deposits. Sections of bowel, skin, and lymph nodes (n = 940) were stained by Congo red and examined by light microscopy and by polarized light. Amyloid deposits were found in only one of 46 subjects, an 18‐year‐old girl who had had Crohn's disease for 6 years. Intestinal amyloid deposits, present 16 months before the clinical diagnosis of amyloidosis, were patchy and seen predominantly in the intestinal mucosa. We conclude that amyloidosis is rare in children requiring surgery for Crohn's disease and ulcerative colitis. Examination of Congo red‐stained sections can detect even subclinical amyloidosis. The amyloid deposits in our patient, which were both patchy and consistently mucosal, suggest that multiple endoscopic biopsy samples, not necessarily containing submucosa, are sufficient for diagnosis.
Efficacy and Safety of a Diazepam and Meperidine Combination for Pediatric Gastrointestinal Procedures
Authors: Nahata Milap C. , Murray Robert D. , Zingarelli Josephine , K. Li B. Ulysses , McClung H. Juhling , Lininger Barbara 
Published: January 2024

SummaryLittle has been published about outpatient sedation for pediatric patients. We designed a study to evaluate the efficacy and adverse effects of diazepam and meperidine in combination for sedation in ambulatory pediatric patients undergoing endoscopy, colonoscopy, or liver biopsy. Thirty patients (7 months‐20 years) were observed. Each patient received a single combined dose of intravenous diazepam and meperidine. The standard dose was 0.1 mg/kg for diazepam and 2.0 mg/kg for meperidine. In patients weighing >100 lb, set doses of meperidine (100 mg) and diazepam (5 mg) were used. The time to achieve sedation and the vital signs were measured; cooperation, emotional state, and drowsiness were rated before, during, and after procedures. The amnesic effect was noted, as were any adverse effects. Diazepam and meperidine were effective in 26 of 30 patients, with sedation generally produced within 2–3 min. Cooperation and emotional state improved significantly following drug administration (p < 0.05). When a prospective 24‐h telephone follow‐up study was instituted in 40 consecutive patients receiving diazepam and meperidine no significant adverse effects were noted. Only 20% of patients old enough to be questioned remembered the procedure. Diazepam and meperidine in combination appear to be effective and safe in pediatric patients undergoing gastrointestinal procedures. Prolonged monitoring of patients does not appear necessary in this patient population.
Episodic Vomiting Due to Intermittent Duodenal Intussusception
Authors: Johnston J. Martin , Harnsberger Janet K. 
Published: January 2024

SummaryCyclic vomiting is a psychosomatic syndrome, but it is also a diagnosis of exclusion. Before such a diagnosis can be made, an organic basis for the episodes of vomiting must be ruled out. We describe a case of episodic vomiting in a school‐aged girl. Endoscopic examination eventually confirmed a diagnosis of intermittent duodenal intussusception due to an enteric duplication. Removal of the duplication abolished the episodes of vomiting. The differential diagnosis of episodic vomiting is discussed, and the literature on intussusception is reviewed. Endoscopy should be considered in a child with a history of episodic vomiting.
Breath Methane Production in Children With Constipation and Encopresis
Authors: Fiedorek Stephen C. , Pumphrey Cindy L. , Casteel Helen B. 
Published: January 2024

SummaryBreath methane excretion is uncommon in children compared with adults. Certain intracolonic conditions, however, have been associated with enhanced methane generation. We hypothesized that encopretic and constipated children, who have abnormal colonic transit times, more likely would excrete methane than healthy children. To determine the prevalence of methane excretion among children with encopresis or simple constipation, we performed breath methane analysis on such patients and age‐, race‐, and sex‐matched control subjects. Encopretic patients (mean age, 8.3 ± 3.0 years) had daily, involuntary passage of feces and clinical evidence of constipation. Constipated patients (mean age, 7.1 ± 2.9 years) had a history of hard stools and at least one of the following symptoms: infrequent defecation, dyschezia, hematochezia, difficult stool expulsion, or abdominal pain during bowel movements. Methane excretion was present in 26 of 40 (65%) encopretic patients versus 6 of 40 (15%) control patients (P < 0.001). In contrast, 3 of 27 (11%) constipated patients were methane excreters, versus 2 of 27 (7%) controls (P = 0.4). Fourteen asymptomatic encopretic patients were retested after successful therapy; eight were methane excreters initially, but five of eight did not excrete methane after treatment. We conclude that methane is produced in a large number of children with encopresis. Treatment appears to alter metha‐nogenesis in such patients. The prevalence of methane producers among constipated children is not different from the prevalence in healthy subjects. Methanogenesis in encopretic patients may be enhanced by prolonged colonic transit time or abnormal intracolonic conditions.