MICROBIAL FLORA OF STOMACH AND SMALL INTESTINE IN INFANTILE GASTROENTERITIS

Abstract. Bishop, R. F., Barnes, G. L. and Townley, R. R. W. (Department of Gastroenterology, Royal Children's Hospital, Melbourne and Department of Paediatrics, University of Melbourne, Victoria, Australia). Microbial flora of stomach and small intestine in infantile gastroenteritis. Acta Paediatr Scand, 63: 418, 1974.–Microbial flora of mouth, stomach, duodenum and faeces was examined in 39 infants with acute gastroenteritis. Only one recognised pathogen, Salmonella typhimurium , was isolated. No enteropathogenic strains of Escherichia coli were isolated. There was an increase in abundant growth of Candida albicans in stomach and small intestine of infants with gastroenteritis compared with the control group.     

C-reactive protein test

Summary Results of C.R.P. test evaluation as an index of disease activity are reported in 10 cases of acute rheumatic fever, 18 cases of rheumatic heart disease and three cases, of rheumatic chorea. C.R.P. test seems to be a sensitive index of disease activity and a reliable guide to the management of cases. It faithfully reflects the activity and is not affected by drugs, a distinct advantage over E.S.R. However, being non-specific, it is not very helpful in diagnosis. From the Department of Medicine, K. G. Medical College, Lucknow.     

Book Reviews

CHILD ABUSE AND NEGLECT: WHAT HAPPENS EVENTUALLY? by Kim Oates; 1985. Sydney: Butterworths; Melbourne: Blackwell Scientific Publications (Aust.) Pty Ltd. NUTRITION FOR CHILDREN, by Dorothy E. M. Francis, foreword by Barbara Clayton; 1986. Oxford: Blackwell Scientific Publications TEXTBOOK OF NEONATOLOGY, by N. R. C. Roberton; 1986. Cambridge: Churchill Livingstone, Melbourne: Churchill Livingstone. CRYING FOR HELP: HOW TO CURE YOUR BABY, by Carol Young; 1986. Melbourne: Lothian Books SELF-ASSESSMENT FOR PAEDIATRIC EXAMINATIONS, by David Isaacs and Christopher D. Mitchell; 1986. London: Churchill Livingstone HUMAN EXPERIMENTATION: A GUIDED STEP INTO THE UNKNOWN, by William A. Silverman; 1985. Melbourne: Oxford University Press RESPIRATORY DISORDERS IN THE NEWBORN, by Victor Y. H. U; 1986. Great Britain: Churchill Livingstone LANGUAGE ACQUISITION, THE STATE OF THE ART, by E. Wanner & L. R. Gleitman; 1982. Melbourne: Cambridge University Press HOME CARE FOR THE HIGH RISK INFANT, by Elizabeth Ahmann; 1986. Aspen Publications. SUDDEN INFANT DEATH SYNDROME: THE POSSIBLE ROLE OF ‘THE FEAR PARALYSIS REFLEX', by Birger Kaada; 1986. Norway     

PERINATAL CAMPYLOBACTER FETUS SS JEJUNI ENTERITIS

ABSTRACT. Vesikari, T., Huttunen, L. and Mäki, R. (Department of Clinical Sciences, University of Tampere; Department of Paediatrics, Central Hospital of Päijät-Häme, and Department of Microbiology, Tampere Central Hospital, Finland). Perinatal Campylobacter fetus ss jejuni enteritis. Acta Paediatr Scand, 70:261, 1980. –A 2-day-old breast-fed male infant developed mucoid and bloody diarrhoea, and Campylobacter fetus ss jejuni was isolated from the stools but not from the blood. The probable source of transmission was his mother in whom symptoms of Campylobacter jejuni - associated illness began one day earlier. Both showed IgM, IgG and IgA antibody responses to autologous and reciprocal strains of Campylobacter jejuni as studied by ELISA.     

Inositol phosphatase in developing rat duodenum, jejunum and ileum

Inositol phosphatase and phytase activities in different segments of the rat small intestine were measured during postnatal development. In the duodenum and jejunum, inositol phosphatase activity (units/g tissue) was low during the suckling period and increased at weaning, reaching a peak of activity at 4 weeks of age. In the ileum, peak activity was observed during the suckling period with a sharp decline at weaning. Phytase activity was very low during the suckling period in all segments, and increased to exhibit a peak at 4 weeks of age in the duodenum, and to a lesser extent in the jejunum (low activity was maintained in the ileum). The content of inositol phosphatase activity in the duodenum increased rapidly during the suckling period to reach its maximum at 4 weeks of age. This suggests a relationship to cell proliferation rate in the small intestinal mucosa.     

Book Reviews

BASIC PRINCIPLES FOR CONTROL OF ACUTE RESPIRATORY INFECTIONS IN CHILDREN IN DEVELOPING COUNTRIES, a Joint WHO/UNICEF Statement; 1986. Geneva: World Health Organization
BASIC FAMILY THERAPY, by Phillip Barker 2nd edn; 1986. London: Collins.
THE NORMAL CHILD, 9th edn, by Ronald S. Illingworth; 1987. Melbourne: Churchill Livingstone
LECTURE NOTES ON PAEDIATRICS, 5th edn, by J. R. Meadow and R. W. Smithells; 1986. Melbourne: Blackwell Scientific Publications.
NEUROSONOGRAPHY OF THE PRE-TERM NEONATE, edited by Edward G. Grant; 1986. New York: Springer-Verlag
CLINICAL PAEDIATRIC NEPHROLOGY, edited by R. J. Postlethwaite; 1986. Bristol: Wright
DIAGNOSIS AND MANAGEMENT OF THE FETUS AND NEONATE AT RISK. A GUIDE FOR TEAM CARE, 5th edn by Martin L. Pernoil, Gerda I. Benda, S. Gorham Babson: 1986 Portland, Oregon: CV Mosby Publications.
PROBLEMS IN OBSTETRIC ANAESTHESIA. PERINATAL PRACTICE, Vol.3, edited by Barbara Morgan; 1987. Chichester
FLUID THERAPY IN CHILDHOOD, by T. L. Chambers, with a chapter by R. W. Griffiths; 1987. Oxford, England: Blackwell Scientific Publications
PAEDIATRIC ONCOLOGY: An Illustrated Introduction, by W. R. McWhirter and J. P. Masel; 1987. Sydney: Williams and Wilkins.
TEXTBOOK OF CHILD NEUROLOGY, 3rd edn, by John H. Menkes; 1985. Philadelphia: Lea and Febiger.     

Achalasia of the cardia in children

Twenty children with achalasia of the cardia were seen at the Royal Children's Hospital, Melbourne in the years 1953 to 1986. The clinical presentation, investigations, and treatment are discussed. Ten children have been followed for 10 or more years and their late follow-up results are reported. The majority are symptomatic, and this is usually related to oesophageal dysmotility rather than gastro-oesophageal reflux.Offprint requests to: R. G. Taylor     

Serum cytosolic beta-glucosidase activity in a rat model of necrotizing enterocolitis

The diagnosis of necrotizing enterocolitis (NEC) is made from a combination of clinical and radiographic findings. There are no useful screening biochemical markers of intestinal injury. The serum concentration of cytosolic beta-glucosidase (CBG), an enzyme found primarily in enterocytes, is markedly elevated in animal models of ischemia and bowel obstruction. We hypothesized that in a rat model of NEC, serum CBG activity would significantly increase before microscopic evidence of severe intestinal injury. Cohorts of 2-wk-old Sprague-Dawley rats (n = 10/cohort) were anesthetized and underwent laparotomy with occlusion of the superior mesenteric artery (SMA). Platelet-activating factor (200 microg/animal) was injected in the proximal duodenum. Serum and intestinal samples were obtained at time 0 (control) and 30, 60, and 90 min of ischemia (I) and after 90 min of I followed by 60 min of reperfusion (I/R). Histopathologic injury was categorized as either no or minimal injury or mural necrosis by two masked investigators and CBG activity was measured by ELISA. Data were analyzed with Fisher's exact test and ANOVA. Only the I/R group had significantly greater mural necrosis compared with the control group (90% versus 0%, respectively, p < 0.001). In contrast, CBG activity was significantly elevated after only 90 min of I and after I/R (15.1 +/- 5.6 and 16.4 +/- 4.3 units/mL, respectively, p < 0.05). We conclude that serum CBG is elevated before transmural intestinal injury in this model and may have utility as an early marker of ischemia in patients at risk for NEC.     

DETECTION OF LIFE THREATENING INBORN ERRORS OF METABOLISM DURING INFANCY

The application of the techniques of high voltage electrophoresis (HVE) of amino acid and gas liquid chromatography (GLC) of organic acids to urine samples from patients with acute metabolic illness in infancy is described. Inborn errors of metabolism have been diagnosed in 8 patients in Melbourne in 2 years. Lactic-pyruvic acidosis has been the most frequent group of conditions (3 cases), but no therapeutic success has been achieved in these babies or in 2 babies with severe non-ketotic hyperglycinaemia. Remarkable success has been achieved in a baby with severe citrullinaemia and in a newly described defect in phenolic acid metabolism.     

Effects of neonatal undernutrition and subsequent nutritional rehabilitation or administration of thyroxine and hydrocortisone on the inositol phosphatase activities in rat intestine

Undernutrition during the suckling period imposed by maternal protein deficiency during lactation resulted in elevated inositol triphosphatase activity (units per gram of wet tissue) in the ileum and lower phytase activity in the duodenum and jejunum. Activities of inositol triphosphatase in the duodenum and jejunum and phytase in ileum were unaffected. Postweaning nutritional rehabilitation resulted in elevated specific activities of both enzymes in all segments; however, activities of whole segments were similar to the corresponding control values. Elevation of inositol triphosphatase (ileum) and decline of phytase (duodenum and jejunum) activities due to undernutrition were reversed by the administration of hydrocortisone or thyroxine during undernutrition. These results suggest that maturation of activities of inositol triphosphatase in ileum (by hydrocortisone) and phytase in all segments (by both hydrocortisone and thyroxine) is under hormonal regulation, and the effects of neonatal undernutrition may be partly due to hormonal imbalances.     

Primary omental torsion in children

Objective : A retrospective review was conducted to establish the prevalence and clinical features of omental torsion or infarction as a cause of acute abdominal pain in childhood.
Methodology : The case records were analysed for all patients admitted with primary omental pathology to the Department of General Surgery, Royal Children's Hospital, Melbourne, between January 1975 and July 1994.
Results : From 1975 to 1994 (20 years) 13 children were admitted to our General Surgical Department with primary omental disease. There were nine males and four females under 16 years of age. The presenting complaint was abdominal pain with vomiting or diarrhoea. Four children had major medical conditions. Pre-operative diagnosis in all cases was acute appendicitis. Appendicectomy and omentectomy were performed without complication in all cases. Histology of the omentum demonstrated torsion, infarction or haemorrhage.
Conclusions : All children presented with features of acute appendicitis, a majority were male, and two out of the 13 patients were obese. The absence of any children under 4 years was consistent with the relative paucity of omental fat in younger children. We found no clear mechanism for primary omental torsion, although rotation around the right epiploic artery was observed.     

Lysosomal enzymes in the intestine of the newborn lamb

In the newborn lamb, activities of lysosomal enzymes are lower in the duodenum and jejunum than in the ileum. In contrast, there are only minor differences, if any, in activities of lysosomal enzymes between the regions of the small intestine of 5-day-old lambs. In the duodenum, jejunum and ileum, activities of hexosaminidase, alpha-mannosidase, beta-mannosidase, alpha-L-fucosidase and phosphodiesterase are greater in newborn than in 5-day-old lambs. Only in the distal part of the small intestine are activities of beta-glucuronidase, alpha-glucosidase, alpha-galactosidase, beta-galactosidase, acid phosphatase and cathepsin B higher in the newborn than in 5-day-old lambs. Cathepsin B activity is lower in the duodenum and jejunum of the newborn than in 5-day-old lambs.     

Ontogenic Expression of Somatostatin-Messenger RNA in the Intestinal Tract of Neonatal Rats

Ontogenic expression of somatostatin (SRIF)—messenger RNA (mRNA) in the gastrointestinal tract was examined in neonatal rats aged from 1 day preterm to 60 days postpartum in comparison with that in the hypothalamus. SRIF-mRNA in the hypothalamus was already expressed in prenatal rats and its developmental change was relatively small. In contrast, a unique pattern of SRIF-mRNA expression was seen in the different intestinal regions, gastric antrum, duodenum, jejunum and colon. In the duodenum, SRIF-mRNA level was low at birth, markedly increased during the postnatal 3 days and declined to the previous level by day 21. Jejunal SRIF-mRNA was found in neonates but progressively decreased in a similar way to duodenum. On the contrary, gastric SRIF-mRNA level, which was low during early development, rose rapidly to a peak on day 21 and gradually declined to an adult level. In the colon age-related change was not conspicuous, remaining at a low level. These results indicate that (1) expression of SRIF gene in the intestinal tract is regulated by local factor(s) as well as developmental stage, and (2) shift of SRIF-mRNA pattern occurs during weaning from the duodenum-dominant infantile pattern to the gastric-dominant adult pattern.     

PRENATAL DIAGNOSIS OF METHYLMALONIC ACIDURIA

Abstract. Mahoney, M. J., Rosenberg, L. E., Lindblad, B., Waldenström, J. and Zetterström, R. (Departments of Human Genetics and Pediatrics, Yale University, New Haven, USA, the Department of Clinical Chemistry, University of Gothenburg, Gothenburg, Sweden and the Department of Pediatrics, Karolinska Institutet, St. Göran's Hospital for Children, Stockholm, Sweden). Prenatal diagnosis of methylmalonic aciduria. Acta Paediatr Scand, 64: 44, 1975.–Prenatal diagnosis using amniocentesis was sought in two midtrimester pregnancies, each at risk for a different type of inherited methylmalonic aciduria. In one pregnancy a normal fetus was diagnosed from studies of cultured amniotic fluid cells and the diagnosis confirmed after the baby was born. In the second pregnancy a fetus with a methylmalonyl-CoA mutase apoenzyme defect was found. The diagnosis was based on Cultured cell studies and supported by an elevation of methyl-malonate in both amniotic fluid and maternal urine. Confirmatory studies were obtained using cultured cells from the aborted fetus. At the present time, assays of cultured amniotic fluid cells are imperative for firm diagnosis. With more experience, quantities of amniotic fluid and maternal urine methylmalonate may prove sufficient if differentiation among the various types of methylmalonic aciduria is not required.     

Effectiveness of resistance training in combination with botulinum toxin-A on hand and arm use in children with cerebral palsy: A pre-post intervention study

ABSTRACT: BACKGROUND: The aim of this study was to investigate effects of additional strength training after use of Botulinum Toxin-A (BoNT-A) in the upper limbs of children with cerebral palsy (CP). METHODS: Ten children with CP (range 9 - 17 years, Manual Ability Classification System II) with unilaterally affected upper limbs were assigned to two intervention groups. One group received BoNT-A treatment (group B), the other BoNT-A plus 8 weeks strength training (group BT). Hand activity was measured with Melbourne assessment of unilateral upper limb function (Melbourne) and Assisting Hand Assessment (AHA). Measures of muscle strength, muscle tone, and active range of motion were used to assess neuromuscular body function. Measurements were performed before and two and five months after intervention start. Change scores and differences between the groups in change scores were statistically tested in SPSS version 18, using Mann-Whitney U test and Wilcoxon Signed Rank test, respectively. RESULTS: Both groups had very small improvements in AHA and Melbourne two months after BoNT-A injections, without differences between groups. There were significant, or close to significant, short-term treatment effects in favour of group BT for muscle strength in injected (elbow flexion strength, p=0.08) and non-injected muscles (elbow extension and supination strength, both p=0.05), without concomitant increases in muscle tone. Active supination range improved in both groups but more so in group BT (p= 0.09). There were no differences between the groups three months after training ended. CONCLUSIONS: Strength training strengthens non-injected muscles temporarily and may reduce short term strength loss that results from BoNT-A injections without increasing muscle tone. Moreover, additional strength training may increase active range of motion to a larger extent than BoNT-A alone. None of the improvements in neuromuscular body functions further improved hand activity. Larger clinical trials are needed to further investigate whether strength training can counteract strength loss caused by BoNT-A, whether the combination of BoNT-A and strength training is superior to BoNT-A or strength training alone in improving active range of motion, and whether more task-related strength training is a more effective approach to improve hand activity.     

HIGH VOLTAGE QRS COMPLEXES IN CHILDREN WITH INNOCENT, "VIBRATORY" HEART MURMUR

Abstract. Michaélsson, M. and Tuvemo, T. (Department of Paediatrics, University Hospital, Uppsala, Sweden). High voltage QRS complexes in children with innocent, "vibratory" heart murmur. Acta Paediatr Stand, 64:119, 1975.–The electrocardiographic findings in 86 four-year-old children with innocent murmur of the so-called vibratory type are described. The electrical axis, the Q, R and S waves in the right and left precordial leads were compared with figures from the literature and with a control group of 4-year-old children without signs of somatic disease. The most significant findings were higher amplitudes of Q and R waves over the left precordium in children with vibratory murmur. Many children in this group had amplitudes of these waves exceeding accepted normal limits. There were no findings compatible with organic heart disease and the difference as compared to normal values and controls is probably a matter of variations in the position of the heart.     

SERUM LYSOZYME ACTIVITY IN CHILDREN WITH HEMATOLOGICAL AND MALIGNANT DISORDERS

ABSTRACT: Moe, P. J., Haneberg, B. and Finne, P. H. (Department of Paediatrics, University of Tromsø, Tromsø and Department of Paediatrics, University of Bergen, Bergen, Norway). Serum lysozyme activity in children with hematological and malignant disorders. Acta Paediatr Scand, 64: 830, 1975.–Pretreatment serum lysozyme activity was high in 2 children with myelomonocytic leukemia, 800 and 1000'/ig/ml, normal in all 10 cases of acute myelocytic leukemia and subnormal in 21 of 34 cases of acute lymphocytic leukemia. Normal values were found in all but one case of acute lymphocytic leukemia during complete remission including 8 cases after all therapy had been discontinued. All 8 are still in complete remission. Low serum lysozyme activity was found in 5 patients with acute lymphocytic leukemia in complete relapse, this could possibly be helpful in the diagnosis of early relapse. Activity was subnormal in 5 of 17 children with malignant tumours, and in 3 of 65 cases of various benign hematological disorders.     

The Height and Weight Changes of Melbourne Children Compared with Other Population Groups*

Bowden, B. D., Johnson, Jill, Ray, L. J. and Towns, Joan (1976). Aust. paediat. J., 12, 281–295. The height and weight changes of Melbourne children compared with other population groups. Serial height and weight records of 120 Melbourne children from 2 to 20 years of age have been compared with figures for 323 Melbourne University students, Meyers' 1956 Australian standards, the 1973 New South Wales survey, a South Australian survey, British standards, United States data and with Aboriginal data. Significant differences are shown at selected ages between the Melbourne groups and the other Australian studies, which seem related to definite varying population groups. The Melbourne group appear to be slightly ahead of the British group in maturation and growth but appear minimally behind the American group. The differences in maturation between population groups could produce clinically significant errors in assessment of growth trends if standards are interpreted too freely.     

Acute hemiconvulsive encephalopathy of childhood with prominent unilateral delta activity in the electroencephalogram

Twenty children with an acute hemiconvulsive encephalopathy are reported who had a sudden onset of focal epileptic seizures. The majority had clinical evidence of hemiparesis which was transient. All had very prominent unilateral delta activity in the EEG which also cleared gradually but at a rate much slower than the clinical symptoms. The initial picture of these children was similar to those with post-convulsive acute hemiplegia of childhood but the subsequent course was benign with regards to neurological deficit, intellectual performance and recurrence of seizures. It is emphasized that prompt control of convulsions in such patients may prevent further cerebral damage secondary to the seizures themselves which may have been responsible for poor prognosis previously reported in similar patients. Presented in part at the American EEG Society Meeting, Dearborn, Michigan, 1976 This study was supported in part by grant from the Indiana Department of Mental Health