Comparative reliability of D-xylose absorption and serum beta-carotene measurements in small intestinal disease

Comparative reliability of D-xylose absorption and serum beta-carotene measurements was studied in 63 healthy and sick children suspected of having proximal small intestinal disease. Group 1 included children with newly diagnosed celiac disease (CD) who were on a normal diet (xylose, n = 46; carotene, n = 43); group 2 included children with CD in remission (xylose, n = 17; carotene, n = 15); group 3 included children with CD in remission, but who were exposed to a gluten-containing diet for an average of 1.4 years (xylose, n = 19; carotene, n = 17); and group 4 included 17 healthy children, insofar as this study is concerned, in whom serum carotene was examined. The means of serum xylose of groups 1 and 3 were significantly lower than the mean of group 2 (p less than 0.001 in both cases). D-Xylose had a sensitivity of 76.9% and a specificity of 100%. The mean serum carotene concentration for group 2 patients with CD in remission was equal to the mean of group 4, which included healthy children. The means of groups 1 and 3 were significantly lower than the means of groups 2 and 4 (p less than 0.001 in all cases). Serum beta-carotene had a sensitivity of 95% and a specificity of 87.5%. The use of these two serum tests in combination would give a specificity of 100% and a sensitivity of 94.1%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Vertical diplopia following peribulbar anesthesia: the role of hyaluronidase

PURPOSE: To estimate the incidence of vertical diplopia following peribulbar anesthesia in otherwise uncomplicated cataract surgery and to establish whether the use of hyaluronidase in the peribulbar injection mixture affected the likelihood of this complication. METHODS: Nine hundred forty consecutive phacoemulsification procedures using peribulbar anesthesia were retrospectively reviewed to identify cases of postoperative vertical diplopia. Case notes were reviewed to establish the nature and timing of the onset of diplopia, the anesthetic technique, and whether hyaluronidase was used. The patterns of progression as demonstrated by serial Hess charts were compared. RESULTS: There were 6 cases of vertical diplopia (incidence, 0.64%). All showed an immediate postoperative hypertropia in the injected eye changing during a 4- to 6-week period to hypotropia with restriction of upgaze. All applications of anesthesia were administered by consultant anesthetists, associate specialists, or residents under their direct supervision using 25-mm, 25-gauge needles with 2% lidocaine. Hyaluronidase was included in the injection mixture for 435 (46%) of the cases and was not included for 505 (54%) of the cases. All 6 cases of vertical diplopia occurred in the group in which hyaluronidase was not used, which has a significant association (chi-square test, 5.22; P = .023). CONCLUSION: Hyaluronidase should be included in peribulbar anesthetics to reduce the risk of postoperative vertical diplopia.     

IgE-mediated allergic reaction to hyaluronidase in paediatric oncological patients

Hyaluronidase has been gaining increasing interest as a spreading factor for better penetration of chemotherapeutics into CNS tumours. Five out of 16 patients with CNS tumours treated with hyaluronidase in addition to chemotherapeutic agents developed symptoms of immediate type allergic reactions, therefore we sought to characterize the harmful allergenic proteins of the bovine testes hyaluronidase enzyme preparation (Neopermease). The role of specific IgE for the allergic reaction was investigated. Using an immunoblotting technique, we investigated sera from 16 children treated with Neopermease (5 of them having developed anaphylactic reactions), 5 patients with atopy (atopic eczema) with high total IgE levels and 4 healthy children. SDS-PAGE of hyaluronidase preparation Neopermease revealed two major bands at 73 and 41–43 kDa. In all 5 sera from patients with adverse reactions, binding of specific IgE antibodies to the 73 and 41–43 kDa bands was found. Two patients reacted with the 73 kDa band exclusively, two patients reacted with both bands, one patient displayed IgE only to the 41–43 kDa band. A specific inhibition of IgE-binding to both bands was achieved after preincubation of the sera in four out of five patients with partially purified bovine hyaluronidase. Furthermore preincubation with gelatin, a stabilising agent in the commercial extract, led to a partial inhibition in the sera of three patients. No specific IgE binding was detected either in the sera of atopic patients, or in the control group. Conclusion IgE mediated allergic reactions to hyaluronidase may occur in paediatric oncological patients treated with hyaluronidase. Whether these children are sensitized by intravenous hyaluronidase treatment or by cross-reactivity of other preformed IgE antibodies, yet to be specified, remains to be elucidated. Received: 25 May 1996 / Accepted: 24 September 1996     

透明质酸酶治疗新生儿头颅血肿的疗效观察

目的 探讨透明质酸酶治疗新生儿头颅血肿的疗效.方法 将新生儿头颅血肿随机分为透明质酸酶治疗组及对照组(自然吸收),观察比较血肿消散的时间及并发症的发生.结果 1.治疗组22例血肿平均消散时间为21.37±5.65 d,对照组血肿消散时间为82.25±10.59 d,两者差异有统计学意义.2.治疗组无感染及遗留颅骨不平等并发症,对照组2例并感染,5例出现颅骨不平.结论 透明质酸酶治疗新生儿头颅血肿可缩短其消散时间,避免并发症发生.     

Iron absorption in infants: high bioavailability of breast milk iron as indicated by the extrinsic tag method of iron absorption and by the concentration of serum ferritin

Breast feeding is thought to result in a lower incidence of iron deficiency than does the use of unfortified cow milk forumalas, but there is scant documentation for this belief. The relationship of breast and cow milk feeding to absorption of iron and to iron status was investigated in a total of 45 term infants at about six months of age. Iron absorption was measured by total body counting. Laboratory assessment of iron status was based on the serum ferritin, hemoglobin, mean corpuscular volume, and transferrin saturation. The results indicated that infants fed breast milk during the entire first six to seven months of life attained greater iron stores than did those fed a cow milk formula. Breast-fed infants absorbed an average of 49% of a trace dose of extrinsic iron administered during a breast feeding in contrast to about 10% reported to be absorbed from cow milk under similar conditions. The data indicate that term infants who are breast fed may not require routine administration of supplemental iron.