Collection of duodenal bile in infants and children by the string test

Present methods for collection of duodenal bile may be difficult to perform and may involve the use of sedation and roentgenograms. The string test (Entero-Test Pediatric, HDC Corporation, Mountain View, CA) has replaced the need for intestinal intubation for diagnosis of giardiasis and bacterial overgrowth. The present study investigated the use of the string test for collection of duodenal bile. Fifteen children were administered string tests. No complications were encountered. The distal end of the string had yellow pigmented fluid that contained bilirubin conjugates in quantity and quality compatible with duodenal bile. The study demonstrates that the string test is a useful procedure for collection of duodenal bile samples in infants and children.     

Left ventricular myocardial mass determined by cross-sectional echocardiography in normal newborns,infants, and children

Summary Changes in left ventricular muscle mass may be an important diagnostic or prognostic finding in children with congenital heart defects, but there are no data on normal mass as determined by cross-sectional echocardiography (CSE) in children. Fourteen newborns, 12 infants, and 69 children (1.5–17 years old) with a structurally normal heart were studied. Enddiastolic and end-systolic volume and mass were calculated from biplane-paired echocardiographic imaging planes—apical two-chamber and apical four-chamber views—using both an area/length and a Simpson's rule geometric method. Data were compared with M-mode measurements. There was a good correlation between area/length and Simpson's rule method [r=0.94, standard error (SE) 4 g/m²].To validate the measurements, interobserver data were gathered and end-diastolic and endsystolic mass measurements were compared. Interobserver variability for the measurements on the echocardiographic recordings was low at 4.8%; for end-diastolic mass the correlation between two observers wasr=0.99 (SE 3.3 g/m²) and for end-systolic massr=0.97 (SE 7.6 g/m²). Correlation between end-systolic and end-diastolic mass was acceptable (r=0.88, SE 5.9 g/m²) for the CSE mass determination, but poor for the M-mode measurements (r=0.51, SE 20.2 g/m²). Similarly, correlation between M-mode mass and mass estimated by CSE was poor, atr=0.58 for end-diastolic andr=0.094 for end-systolic mass. In newborns and infants the ratio of end-diastolic mass to end-diastolic volume was higher than in the older children, mainly because of a smaller ventricular volume in relation to body surface area in this age group.In the 26 newborns and infants, left ventricular mass was 48.7±10 g/m² and volume was 34.6±7 ml/m², yielding a mas to volume ratio of 1.41±0.03. For the 69 children (mean age 7.4±3.8 years), left ventricular mass was 63±10 g/m² and volume 59±10 ml/m² with a mass to volume ratio of 1.07±0.2. Left ventricular end-diastolic mass and volume strongly correlated with age (r=0.9) and body surface area (r=0.98 and 0.97, respectively). As CSE is easy to perform and repeatable, these normal values should provide a valuable database for further longitudinal studies of the development of left ventricular mass in patients with various cardiac abnormalities.     

Evaluation of esophageal transit in children and in infants by means of Krypton-81m

This paper presents the results of Krypton-81m esophageal transit study in a series of children and infants presenting various esophageal disorders. The advantage of Kr-81m, compared to other radionuclides, is that the radiation dose to the patient is extremely low. The study can therefore be repeated as often as necessary and a high dose can be given to ensure good quality results. The method is very easy to perform and allows a quantitative assessment of esophageal transit in physiological conditions. The method gives information about the severity of altered transit and it is particularly useful in studying the effects of treatment.