ULTRASOUND IN THE INVESTIGATION OF DISEASE OF THE KIDNEY AND URINARY TRACT IN CHILDREN

Based upon the use of the ultrasonic investigation of diseases of the kidney and urinarytract in 100 children it can be concluded that it is a very useful method in the demonstration of the anatomical changes that occur in these organs during certain diseases. The reliability of this new diagnostic method awaits further evaluation, but so far the ultrasonic investigation has been found to be a valuable complement to radiology in the primary diagnostic approach, as well as in the supervision of the subsequent changes in kidney and urinary tract diseases in children.     

THE SECULAR TREND IN THE AGE OF MENARCHE IN AUSTRALIAN SCHOOLGIRLS

Statistics derived from a sample of 1391 schoolgirls drawn from both state and private schools showed the mean age of menarche to be 12.65 years. Selected schools were included to give a representative sample in terms of geographical and social class distribution. The onset of puberty was found to be normally distributed within the age range 9 years to 15 years 8 months. After an examination of the results of previous Australian studies, evidence was found which suggested a secular trend in the onset of puberty with fluctuations paralleling times of economic crisis.     

COMPLICATIONS IN THE TREATMENT OF HYDROCEPHALUS IN CHILDREN

ABSTRACT. Two homogenous materials of hydrocephalic children operated upon during a 20-year period (1961–1980) are compared. During the first half of the period the ventriculoatrial shunt was the only type used in 103 patients. After that there was a change to the ventriculoperitoneal shunt which was used in 104 patients, whereof 35 were converted from ventriculoatrial to ventriculoperitoneal shunts. Thus the material consists of 172 patients. The complications were less serious and the mortality rate much lower with the ventriculoperitoneal method. The revision rate, however, was about the same for both types of operation, but the revisions and the operative procedure for peritoneal shunts were generally much more simple and more rapidly performed. Therefore it is our opinion that in children the ventriculoperitoneal route is preferable to the ventriculoatrial route. With better knowledge of the underlying cause of distal obstructions in the former route we think that it will be possible to reduce the complication and revision rates even further.     

TEST-MEAL IN THE DIAGNOSIS OF MALABSORPTION IN INFANCY

A test-meal containing 2 g of glucose per kg body weight (minimum of 20 g), 0.5 g of D-xylose per kg, 8 ml of standardized cream (12% fat) per kg and 7 500 IU of vitamin A palmitate per kg was administered through a nasogastric tube. During the next 10 hours capillary blood samples were obtained and analysed for glucose, D-xylose, triglycerides, and vitamin A using microanalytical methods. The results in 16 normal infants aged 1 to 20 months are reported. The results for all parameters determined, except D-xylose, were comparable to those previously reported using single tolerance tests. The variability related to age was pronounced for glucose, triglycerides and vitamin A. In patients with malabsorption syndromes (cystic fibrosis, extrahepatic biliary atresia, intrahepatic cholestasis, and gluten-induced enteropathy) the results were also comparable with those earlier observed using single tolerance tests. A combined test-meal has certain advantages over the examinations now used in infants with symptoms suggesting a malabsorption syndrome: a series of tolerance tests is avoided, and it is therefore easier to follow the absorption of fat and carbohydrates during the course of a disease and during a therapeutic regimen.     

HYDROPS OF THE GALLBLADDER IN THE NEONATAL PERIOD

Abstract. Appleby, G. A. J., Forestier, E. and Starck, C. J. (Department of Paediatrics, Sundsvalls Hospital, Sundsvall, Sweden). Hydrops of the gallbladder in the neonatal period. Acta Paediatr Scand, 70:117, 1981.–A case of hydrops of the gallbladder in the neonatal period in which the diagnosis was made with the help of ultrasonography is described. To our knowledge this is the first case of gallbladder hydrops that has been described in the newborn period.     

MYOELECTRICAL ACTIVITY IN EXPERIMENTAL AGANGLIONOSIS OF THE COLON IN THE RAT

ABSTRACT. Experimental aganglionosis of the colon was produced in rats by an experimental "aganglionosis producing" procedure. Radiological examination of the aganglionic colon showed a narrow segment distal to a dilated megacolon. Histologically, a transverse section of the aganglionic segment showed 3-4 ganglia in contrast to 32-40 ganglia per section in the normal colon. The myoelectrical activity of the normal colon presented two fast activities, a fast activity with a frequency of 25-40 cycles per sec superimposed over a medium-fast activity of 4-7 cycles per sec. However the aganglionic colon showed only the fast activity with complete absence of the medium-fast activity. Thus the experimental aganglionosis produced a characteristic alteration in the myoelectrical activity of colon. This confirms our earlier findings in children with Hirschsprung's disease. It also suggests that the causative mechanism for the production of a narrow segment in Hirschsprung's disease may not be the hyperactivity or the absence of any specific neuronal mechanisms as proposed earlier.     

THE USE OF INSULIN IN THE TREATMENT OF JUVENILE ONSET DIABETES

Abstract. Insulin is a major tool in the treatment of juvenile onset diabetes in spite of the impassibility of giving it in a physiological way. Dosage must be individualized with the help of mixing short- and longacting types of non-immunogenic insulin preparations. Procedures vary with the stage of the disease, whether at the onset of diabetes, during the remission period or thereafter. Rapid normalization of blood and urine sugar is recommended in the first stage, which may partly preserve beta cell function. After the first two years of diabetes practically all patients require insulin twice daily. To achieve satisfactory metabolic control in diabetic teenagers is difficult and requires an experienced team of paediatricians, nurses, dietitians, psychologists and teachers, as well as informed, motivated and cooperative patients.     

TAURINE IN THE NUTRITION OF THE HUMAN INFANT

Gaull, G. E. (Department of Human Development and Nutrition, Institute for Basic Research in Developmental Disabilities and Department of Pediatrics, Mount Sinai School of Medicine of the City University of New York). Taurine in the nutrition of the human infant. Acta Paediatr Scand, Suppl. 269:38, 1982. — The precise biological role of taurine is unknown apart from its conjugation with bile acids and xenobiotics. Evidence is accumulating, however, that taurine may have a more general biological role in development and membrane stability. Furthermore, there is a dietary requirement for taurine in the human infant. Whether or not it is "essential" in man, awaits further study.     

VISCOSITY OF THE BLOOD IN THE NEWBORN INFANT

ABSTRACT. Bergqvist, G. (Department of Paediatrics, Karolinska Institutet, St Göran's Hospital for Children, Stockholm, Sweden). Viscosity of the blood in the newborn infant. Acta Paediatr Scand, 63: 858, 1974.—Whole blood viscosity has been measured with a Brookfidd LVT viscometer on newborn infants with varying hematocrit values. Normal term infants appropriate for gestational age, preterms and small for gestational age infants were studied during the first week. Viscosity/hematocrits varied enormously both in different infants, but also between groups, i.e. terms, preterms and SGA. Marked variations occurred during the first week of life. The normal viscosity values were found to be roughly twice as high as in adults, whereas the plasma viscosity was the same or rather lower. The difference in viscosity in relation to adults seems to be due almost entirely to the higher hematocrit values. With late clamping of the cord, infants (and especially small for gestational age infants) may have extremely high hematocrit and viscosity valUS.     

PLASMA CONCENTRATIONS OF PHENOBARBITAL IN THE TREATMENT OF SEIZURES IN NEWBORNS

ABSTRACT: Jailing, B. (Departments of Paediatrics and Clinical Pharmacology, Karolinska Hospital, Stockholm, Sweden). Plasma concentrations of phenobarbital in the treatment of seizures in newborns. Acta Paediatr Scand, 64:514, 1975.–The plasma concentration of phenobarbital given as anticonvulsive treatment in the newborn period has been followed in 18 infants. With constant daily doses, the drug accumulated for at least 5 days. After intramuscular injection of a single dose, 90 % of the peak concentration was reached within 4 hours in 8 of the 10 infants. The peak concentration (in µg/ml) approximately equalled 1.3 × the dose (in mg/kg). Absorption after oral administration was less reliable. In 12 of the infants the clinical course allowed attempts to evaluate the anticonvulsive effect of phenobarbital. In 4 cases the convulsions continued. In those 8 infants where phenobarbital seemed to be effective, the approximate range of phenobarbital concentration when convulsions ceased was 12–30 µg/ml. Phenobarbital half-life ranged between 59 and 182 hours. In some infants the rate of phenobarbital disappearance from the plasma varied considerably from day-to day. The pathological conditions causing seizures probably influence the distribution, metabolism and excretion of the drug. For the often seriously ill infants with convulsions it is therefore difficult to construct rational maintenance dose schedules, and optimal dosage must be based on repeated determinations of the plasma concentration.     

LEVELS OF ORGANOCHLORINE CONTAMINANTS IN HUMAN MILK IN RELATION TO THE DIETARY HABITS OF THE MOTHERS

ABSTRACT. The levels of p, p'-DDT, p, p'-DDE, dieldrin, α- and β-hexachlorocyclohexe (α-HCH, β-HCH), hexachlorobenzene and polychlorinated biphenyls (PCBs) were determined in milk fat from mothers with different dietary habits. The categories studied comprised mothers eating a lacto-vegetarian diet (18 milk samples), a mixed diet (20 milk samples) and a mixed diet which regularly included fatty fish from the Baltic (11 milk samples). The lowest levels of p, p'-DDT+p, p'-DDE and PCBs were found in milk from lacto-vegetarians and the highest levels in milk from mothers who regularly consumed fatty fish from the Baltic. Factors other than the diets which could influence the levels of the organochlorine compounds are discussed, e. g. mother's age, amount of milk produced and mother's weight loss.     

THE MANAGEMENT OF HIRSCHSPRUNG'S DISEASE IN THE NEONATE

Most cases of Hirschsprung's disease can be detected in the newborn period at which time the mortality is highest. Our experience with 24 consecutive cases in the newborn is discussed and in the management of aganglionosis in this age group the approach to diagnosis and treatment should be one of urgency; laparotomy should be done with frozen sections available and, if possible, with the bowel previously deflated; a Sieber-Kiesewetter operation is recommended and the colon distal to the colostomy should be cleared of faeces before the patient is discharged from hospital.     

THE INCIDENCE OF PKU IN FINLAND

Guthrie's bacterial inhibition test was applied to 71 135 newborn infants from different parts of Finland. No cases of PKU were diagnosed. In addition, 3 685 mentally retarded patients, mostly idiots and imbeciles, have been screened in Finland with the same method. With two cases of PKU among them, a prevalence of 0.54 per 1 000 is obtained. The incidence of the disease among the newborn is estimated to be less than one per 100 000.     

THE ROLE OF ALDOSTERONE IN HYPERNATREMIC DEHYDRATION IN INFANTS

In a previously healthy, 11-month-old infant acute gastroenteritis and dehydration developed following a minor operation. Oliguria was observed after 2 days complicated by hypernatremia, hypokalemia, elevated blood pressure and one generalized convulsion. Aldosterone excretion was increased considerably remaining elevated even after clinical improvement. Hypernatremia complicating dehydration in infancy usually is thought to result from disproportionate loss of water and sodium. The role of aldosterone in this situation is not known. If hyperaldosteronism proves to be involved in causing and sustaining hypernatremia therapeutic use of aldosterone blocking hormones would be indicated.