Sociodemographic differences in the prevalence of self-reported stomach pain in school children

The study considered the prevalence of experienced stomach pain in a nationwide random sample of 2161 Icelandic 11–12 and 15–16-year-old school children. It found an 18.4% prevalence of at least weekly stomach pain and a 53.4% overall prevalence. The prevalence of stomach pain was significantly higher among younger children (P 0.001). Higher prevalence (P 0.001) of stomach pain was seen in girls in the overall sample and the gender difference was significant in both age groups. No overall class or residential differences were detected. However, the findings suggest some age-related links between social status and the experience of stomach pain. The frequency of stomach pain was moderately and significantly associated with medication use. The theoretical and clinical implications of the results are briefly discussed.     

Age-dependency of alpha- and beta-adrenoceptors on thrombocytes and lymphocytes of asthmatic and nonasthmatic children

Among the possible mechanisms which may cause wheezing or asthmatic episodes a genetically determined -adrenoceptor blockade and a hyperresponsiveness of -andrenoceptors has been postulated. Evidence to support this hypothesis stems from an increased bronchial sensitivity to -blockers, a reduced formation of cyclic AMP in response to -adrenergic stimulation and enhanced -adrenergic responses in asthmatic subjects. The recent development of techniques for measuring the specific, high-affinity binding of radiolabeled -and -adrenergic antagonists made it possible to study - and -adrenoceptors in vitro. Based upon the assumption that a change in the number and/or affinity of adrenergic receptors might be a general phenomenon, we have performed - and -receptor binding studies on lymphocytes and platelets from wheezing infants and asthmatic children as well as of infants, children, and adults not suffering from these diseases.Using ¹²⁵[I]-cyanopindolol (ICYP) and ³[H]-yohimbine (HYOH) as highly specific ligands for - and -adrenoceptors, the following results were obtained: (1) Lymphocytes and platelets from control subjects and asthamatics bound similar amounts of ICYP and HYOH and thus showed no differences either in the number or the affinity of - and -adrenoceptors. Lymphocytes and platelets of wheezing and nonwheezing infants also bound the same amounts of the radioligands. (2) In asthmatic children receiving 4×2 puffs salbutamol -adrenoceptor were down-regulated and this may mimic -adrenoceptor blockade. (3) When subjects were divided into four categories according to age (0–5, 5–10, 10–20 years, adults) the number of -adrenoceptor binding sites showed an age-dependent increase. The number and affinity of -adreneceptor binding sites on platelets was neither influenced by age nor disease.It is concluded that the - and -adrenoceptors of wheezing infants and asthmatic children at least on blood cells are normal. However the -adrenoceptors show an age-dependent maturation process, which may account for an unresponsiveness to -adrenoceptor agonists in wheezing infants.Supported by a grant from the Ministerium für Wissenschaft und Forschung, NRWPresented at the 19th Workshop for Pediatric Research, University of Göttingen, March 10–11, 1983     

The value of the routine chest roentgenogram in the cardiological evaluation of infants and children. A prospective study

The value of the routine chest roentgenogram was studied in 284 patients, newly admitted to our paediatric outpatient department. Emergency patients were excluded from the study. In 141 cases the initial diagnosis after history, physical examination and ECG was no heart disease, while in 143 cases it was heart disease. After a follow up of up to 4 years, 170 children appeared to have no heart disease and 114 definite heart disease. In 7.7% of cases the chest roentgenogram made at the first visit to the outpatient department led to a change in policy, whereas in only 3.8% was the chest roentgenogram in someway helpful in establishing the correct diagnosis. Amongst those children with initial diagnosis of innocent murmur, the chest roentgenogram led to a diagnosis of heart disease in only 2.8% of cases. It is concluded that for the differentiation heart disease or no heart disease, a chest X-ray film is not indicated. In children with heart disease the chest X-ray film is also of little value, and is mostly to be used only for documentation.Partly presented at the Jahrestagung der deutschen Gesellschaft für pädiatrische Kardiologie, Düsseldorf, 1–2 Oktober 1984     

Influence of short- and long-term inhalation of salbutamol on lung function and β2-andrenoceptors of mononuclear blood cells in asthmatic children

Clinical observations have shown that some asthma patients develop tachyphylaxis to -sympathomimetic drugs. As down-regulation of the number of -adrenoceptors in different human tissues after exposure to catecholamines and -adrenergic drugs is well known, we investigated whether a interrelation exists between -adrenoceptor down-regulation and clinically detectable -adrenergic subsensitivity during -sympathomimetic treatment. The following results were obtained: 1. ₂-Sympathomimetic inhalation treatment with salbutamol in therapeutic doses led to a significant downregulation of ₂-adrenoceptors and consecutive cyclic adenosine monophosphate response to isoprenaline. This effect was already detectable after short-term treatment of 3–7 days in 9 asthmatic children. 2. In the long-term study over 6 months, salbutamol inhalation in 12 asthmatic children led to a significant down-regulation of -adrenoceptor binding sites on mononuclear blood cells (MNC) from 1539±91 to 1115±99 after 14 days, remaining in this range thereafter. 3. The mean airway resistance (R_aw) of these 12 patients decreased significantly within 14 days from 8.1±0.8 to 5.7±0.5 cm H₂O/l/s to remain stable throughout the 6 months of salbutamol treatment. The differences in R_aw before and immediately after inhalation of 0.2 mg salbutamol (2 puffs) were unchanged during the study period. It is concluded, that long-term inhalative treatment with salbutamol over a period of 6 months does not result in refractoriness to -adrenergic drugs in the airways of asthmatic children, even though a significant down-regulation of ₂-receptors on peripheral MNC occurs.     

Evaluation of delta-aminolaevulinic acid excretion in random urine samples of children

Urinary delta-aminolaevulinic acid (-ALA) excretion was evaluated in random urine samples of 191 healthy children, aged 2–14 years, with blood lead levels <0.8 mol/l (mean ± SD: 0.34±0.13), erythrocyte zinc-protoporphyrin <70 mol/mol haem (mean ± SD: 50.4±8.0) and blood haemoglobin >6.8 mmol/l (mean ± SD: 8.2±0.5). It was found that uncorrected -ALA concentration and -ALA/creatinine ratio are age-dependent, whereas the ratio of -ALA/logarithm of creatinine concentration (mean ± SD: 55.3±13.5 mol/log mmol) is independent of age and sex. The authors recommend the use of this parameter for the assessment of -ALA excretion in random urine samples in children     

The developmental change in the Gγ and Aγ globin. Proportions in hemoglobin F

The proportions of ^G and ^A globins in hemoglobin F were determined in fetuses around the 20th week of gestation, newborns, and children 3 weeks to 5 months of age. In the last group, the ^G/^G + ^A ratio decreased continously; there was a good correlation between the decline of ^G with respect to total and the decline of Hb F (r=0.88). In contrast, there was virtually no difference in the globin composition of Hb F between the fetuses and the newborns, i.e. in late pregnancy, the decrease in the synthesis of both globins appears to be proportionate. The ^G and ^A globin genes may be inactivated in a sigmoidal fashion with time, thus producing a ^G/^G + ^A ratio which at first changes only slightly and then declines linearily.Supported by a grant from the Deutsche Forschungsgemeinschaft (Je 56/10)     

Amine im menschlichen Stuhl

Zusammenfassung Die p- und m-Tyraminausscheidung wurde quantitativ im Stuhl von Neugeborenen, Säuglingen und Schulkindern unter verschiedenen Kostformen untersucht. Der p-Tyramingehalt von normalen Säuglingsstühlen (Naßgewicht) lag zwischen 0,030–0,460 Mol/g Stuhl, der normaler Stühle von Schulkindern zwischen 0,005 und 0,102 Mol/g Stuhl. m-Tyramin ließ sich in Säuglingsstühlen nicht nachweisen. Die Konzentration im Stuhl von Schulkindern überschritt sicher nicht 0,008 Mol/g Stuhl.

---

Summary The excretion of para- and meta-tyramine in faeces was estimated in newborns, infants, and children during the application of various diets. The p-tyramine content of normal stools of infants (wet weight) amounted 0.030–0.460 moles per gr. faeces and that of children 0.005–0.102 moles per gr. m-Tyramine was not detected in the faeces of infants. If this substance is found at all in faeces of children it does not exceed 0.008 moles per gr. of faeces.

---

---

Mit Unterstützung durch die Deutsche Forschungsgemeinschaft.     

The outcome of childhood obesity management depends highly upon patient compliance

Over the last 20 years, obesity in childhood and adolescence has become a major public health concern due to dramatically increasing prevalence rates. We evaluated the outcome of 294 children (135 girls, 159 boys) aged 6–16 years (median 10.9 years) enrolled in a single centre outpatient obesity intervention programme consisting of periodical visits to the outpatient unit with regular medical and dietetic counselling aiming at a modification of dietary and activity patterns of patients and parents. The average number of visits to the outpatient unit was 3.6 (SD 2.7) with a mean visit interval of 62.1 days. A mean drop-out rate of 27.5% between each scheduled appointment occurred. In a stepwise regression model, neither reduction of the standard deviation score of patients body mass index (BMI-SDS) nor dietary counselling contributed to the total number of visits. The only significant contributor was the patients initial BMI-SDS explaining 4.6% of the variance of attended visits adjusted for age and sex. Segregation of the patients into an obesity (initial BMI-SDS 90th percentile, at least three visits attended, n =59) and an excessive obesity (initial BMI-SDS 99th percentile, at least four visits attended, n =75) subgroup showed a mean reduction of BMI-SDS in the obesity group at visit three of 0.14 (SD 0.21, P <0.0001), and in the excessive obese group at visit four of 0.17 (SD 0.22, P <0.001). In a stepwise regression model, the mean interval between visits and regular dietary counselling explained 11.7% of the variance of BMI-SDS reduction at visit three in both subgroups. Conclusion: there is an urgent need for efficient strategies to improve adherence of outpatients to obesity treatment since, in terms of reduction in body mass index standard deviation score, a beneficial outcome can be achieved for compliant obese children and adolescents.Abbreviations BMI body mass index - BMI-SDS body mass index standard deviation score     

Ureteral reimplantation en bloc for refluxing duplicated ureters

Vesicoureteric reflux (VUR) is a major problem in completely duplicated ureters. So far, the treatment of choice has been the reimplantation of the two ureters in their common sheath, the ureterocystoneostomy en bloc according to Politano-Leadbetter's or Cohen's procedure. In recent years, some pediatric surgeons and urologists have questioned the efficacy of this method. We therefore analyzed 62 children with 69 duplicated ureters treated en bloc by Politano-Leadbetter's procedure during the 20-year period 1971 – 1990. Postoperative follow-up was up to 16 years. We noted only 1 recurrence of reflux as well as 2 stenoses. Long-term results as far as function was concerned were also favorable in 40 duplicated renal units. Thus, ureteral reimplantation en bloc remains a simple and safe procedure for treating VUR in completely duplicated ureters.     

Detection of late onset steroid 21-hydroxylase deficiency by capillary gas chromatographic profiling of urinary steroids in children and adolescents

Patients suffering from late onset 21-hydroxylase deficiency (LO-CAH) excreted only slightly higher amounts of 17-hydroxypregnanolone (17-OH-PO), pregnanetriol (PT) and 11-oxo-pregnanetriol (11-O-PT) than age-matched healthy controls. To discriminate between LO-CAH and virilization of unknown origin and precocious pubarche, we calculated the following ratios: (1) pregnanetriol to tetrahydrocortisone (PT/THE), (2) the sum of 17-OH-PO, PT and 11-O-PT (OHP-M) to the sum of THE, tetrahydrocortisol (THF) and allotetrahydrocortisol (a-THF) (C-M) and (3) 11-O-PT to C-M. The following patients were studied: 9 patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency-non-salt losing (CAH-NSL), never treated; 8 patients with CAH (NSL/SL: 3/5) off treatment; 10 patients with LO-CAH; 11 patients with virilization of unknown origin (prepubertal/pubertal: 5/6) and 9 patients with precocious pubarche. Healthy individuals and obligatory heterozygote carriers of comparable ages served as controls. LO-CAH showed increased ratios (median (range)) of PT/THE: 2.27, (1.15–9.09), OHP-M/C-M: 2.30, (1.24–8.15), and 11-O-PT/C-M: 0.24, (0.13–1.23) compared to healthy individuals and heterozygous carriers: PT/THE 0.28, (0.03–0.57), OHP-M/C-M 0.23, (0.06–0.46) and 11-O-PT/C-M<0.01, (<0.01–0.06), respectively. The calculation of ratios, rather than absolute amounts seems to allow the detection of LO-CAH in a single spontaneously voided urine specimen. The clinical and measurable hormonal manifestations of LO-CAH occur at the same time.Abbreviations LO-CAH late onset 21-hydroxylase deficiency - CAH congenital adrenal hyperplasia due to 21-hydroxylase deficiency - SL salt losing - NSL non-salt losing - p.p. prepubertal - p. pubertal - 17-OH-PO 17-hydroxypregnanolone (5-pregnane-3,17-diol-20-one) - PT pregnanetriol (5-pregnane-3,17,20-triol) - 11-O-PT 11-oxo-pregnanetriol (5-pregnane-3,17,20-triol-11-one) - THE tetrahydrocortisone (5-pregnane-3,17,21-triol-11,20-dione) - THF tetrahydrocortisol (5-pregnane-3,11,17,21-tetrol-20-one) - a-THF allotetrahydrocortisol (5-pregnane-3,11,17,21-tetrol-20-one) - OHP-M 17-OH-PO+PT+11-O-PT - C-M THE+THF+a-THF Dedicated to Prof. Enno Kleihauer, Ulm, on the occasion of his 60th birthday     

Tumour necrosis factor in neonatal listeriosis: a case report

A newborn with fatal neonatal listeriosis developed septic shock, neutropenia, thrombocytopenia and profound hypoxaemia due to severe pulmonary hypertension. Tumour necrosis factor , interleukin-1- and interferon- serum concentrations were markedly elevated, suggesting the participation of these cytokines in the aetiopathogenesis of shock induced by Listeria monocytogenes in the neonate.Abbreviations IFN- interferon- - IFN- interferon- - IL-1 interleukin-1 - MPA monocytosis producing agent - TNF- tumour necrosis factor      

„Ich habe alles nur aus absolutem Mitleid getan“

ZusammenfassungHintergrund Eine Form der systematischen Tötung somatisch oder psychisch Kranker zurzeit der nationalsozialistischen Herrschaft ist die Kindereuthanasie in Kinderfachabteilungen, die durch einen Reichsausschuss eingesetzt wurden.Methoden Die Auswertung von Krankengeschichten, Korrespondenzen Vernehmungs- und Sektionsprotokollen gibt für eine Kinderfachabteilung Bayerns, Kaufbeuren-Irsee, Aufschluss über deren Beitrag zur und dem Umfang der Euthanasie im nationalsozialistischen Medizinwesen.Ergebnisse Zwischen 1941 und 1945 wurden dort 221 Kinder durch Applikation von Pharmaka (Veronal, Luminal, Skopolamin) und Nahrungsentzug ermordet. Die Kinder der Anstalt wurden zudem Opfer von Tb-Impfexperimenten. Ihre Organe waren Gegenstand medizinischer Forschung im Hirnpathologischen Institut der Deutschen Forschungsanstalt für Psychiatrie, München.Schlussfolgerungen Die Ergebnisse lassen sich auf Grundlage weiterer Studien verallgemeinern: Kinderfachabteilungen leisteten einen systematischen Beitrag zur Euthanasie, waren Labor für Humanexperimente und Organpräparatelieferanten.Die hier dargestellte Version des Beitrags weicht in folgenden Punkten von der am 26. Juni 2004 publizierten ab:In der am 26. Juni 2004 publizierten Version des Beitrags wurde im Abschnitt Humanexperimente, im Abschnitt Neuropathologische Forschung sowie im Literaturverzeichnis die Referenz 13a versehentlich nicht angegeben.     

Effects of immunoglobulin and gamma-interferon on the production of tumour necrosis factor-α and interleukin-1β by peripheral blood monocytes in the acute phase of Kawasaki disease

Abstract In order to study the in vitro effects of intact immunoglobulin (Ig) and gamma-interferon (INF-) in patients with Kawasaki disease, the production of tumour necrosis factor- (TNF-) and interleukin-1 (IL-1) was measured in peripheral blood monocytes (PBM) both before and after intravenous immunoglobulin (IVIG) therapy. Spontaneous production of TNF- and IL-1 both before and after IVIG therapy was significantly higher than in healthy controls. Intact Ig enhanced in vitro the production of TNF- and IL-1 both before and after IVIG therapy approximately 3–4 times as compared to the spontaneous production. INF- did not affect the production of the two cytokines. Ig enhanced IL-1 mRNA expression in PBM of KD by 3–8 times more than that of spontaneous production.Conclusion These results suggest that: (1) the mechanism of action of IVIG therapy in KD is not to cut down the production of inflammatory cytokines such as TNF- and IL-1 andf that (2) the changes of these cytokine levels may be related to the clinical effectiveness of high dose IVIG.     

“Inborn errors of metabolism” and “chemical individuality” two ideas of Sir Archibald Garrod briefly revisited 50 years after his death

Two ideas of Sir A. Garrod, chemical individuality (1902) and inborn errors of metabolism (1908) have proved fundamental for the development of medical knowledge. The latter idea was more fortunate than the former which, however has been extremely heuristic. On the other hand the two ideas are not entirely independent of each other: in fact, a third Garrodian concept, inborn factors in disease, represents a significant link between them. Inborn errors of metabolism revived the laws of genetics and opened the way to interpretation of the molecular diseases with all their inherent practical modern implications (neonatal screening, prenatal diagnosis, and in perspective, genetic engineering). Chemical individuality still constitutes a valid premise for knowledge of biological individuality (in other words, the biological ego) fundamentally programmed for conservation of self and for continuous discrimination of self versus non-self.     

Serum iron,serum transferrin and transferrin saturation in healthy children without iron deficiency

Serum iron, serum transferrin and transferrin saturation were studied in 253 healthy, non-anaemic children 4, 8 and 13 years old, and in 60 healthy, non-anaemic adults having serum ferritin values 15 g/l. One hundred and ninety-six children had serum ferritin values 15 g/l (i.e. replete iron stores), 35 had intermediate ferritin values from 10–14 g/l and 22 had ferritin values <10 g/l (i.e. depleted iron stores). Iron replete children showed a gradual rise in serum iron and transferrin saturation values with age. Serum iron and transferrin saturation values were lower (P<0.001, P<0.0001) and transferrin values high (P<0.0001) in iron replete children compared to adults. Iron replete children had a 2.5 centile transferrin saturation value of 5%; 19.9% of these children had saturation values <15% and 8.2% had values <10%. In iron depleted children a transferrin saturation value <7% yielded the highest diagnostic efficiency as regards exhausted iron stores, although with a low predictive value of a positive test. The transferrin saturation is unsuitable as a single diagnostic criterion in the evaluation of iron deficiency in children and should always be combined with other indicators of iron status.     

Small bowel volvulus in children: Its appearance on the barium enema examination

Two children with small bowel volvulus diagnosed on barium enema examination are reported. In one patient the volvulus was associated with malrotation and in the other patient there was a post-operative peritoneal adhesion. In both cases the diagnosis was based on beaking of the head of the barium column at the site of volvulus. Radiographic demonstration of a beak sign in the small bowel on barium enema examination should suggest a diagnosis of small bowel volvulus, and indicates the need for immediate surgery.     

Relationship between café-au-lait spots as the only symptom and peripheral neurofibromatosis (NF1): A follow-up study

We re-examined 21 children with the possible diagnosis of peripheral neurofibromatosis (NF1) based on the presence of cafè-au-lait (CAL) spots as the single clinical finding. We evaluated whether typical or atypical appearance of the spots was important for the final diagnosis and whether the co-existence of other nonspecific signs (e.g. pectus excavatum) were of any significance for the final diagnosis. In 8/14 (57.1%) cases with typical CAL spots, the diagnosis of NF1 was finally established on the basis of other criteria. For the other 6 patients the diagnosis is not yet definitive but highly probable on the basis of the presence of macrocephaly, pectus excavatum and/or MRI findings. Only one patient among five with atypical CAL spots possibly has NF1.     

Fatty acid composition of phospholipids of plasma and of mononuclear blood cells in children with allergic asthma and the influence of glucocorticoids

Fatty acid (FA) composition of plasma phospholipids and phospholipids extracted from peripheral mononuclear white blood cells (MNC) was investigated in 11 allergic asthmatic children (age 8.9±4.6 years), in 10 age-matched non-allergic healthy controls and in 14 allergic and non-allergic children with an acute attack of asthma, who had received prednisolone medication for 2–4 days. In allergic asthmatics eicosapentaenoic acid (205n–3) was significantly elevated in both plasma and MNC. The relative amount of 205n–3 in MNC as well as in plasma correlated positively with increasing levels of total serum IgE (P<0.02). The pattern of the other FAs in plasma and of MNC phospholipids did not differ between allergic asthmatic and non-allergic control children. In children with an acute attack of asthma, who had been treated with glucocorticoids (2 mg prednisolone/kg body weight for 2–4 days), distinct changes of relative FA composition of phospholipids were restricted to plasma, where some very long chain FA (224n–6, 225n–6) were elevated. No significant changes in FA from MNC phospholipids could be observed after glucocorticoid treatment. These findings may indicate a possible role of 205n–3, the precursor of group 3 eicosanoids, in allergic asthmatic children.     

IL-1β induces an exaggerated pro- and anti-inflammatory response in peritoneal macrophages of children compared with adults

Children have a lower incidence of acute lung injury (ALI) compared with adults. Because ALI appears to be the end result of systemic hyperinflammation, children may either have 1) an attenuated pro-inflammatory response or 2) an augmented anti-inflammatory response compared with adults. The purpose of this study was to determine the IL-1-induced pro- and anti-inflammatory response of pediatric vs. adult peritoneal macrophages (PMs). We hypothesized that pediatric PMs would have an enhanced anti-inflammatory response compared with adult PMs. Human PMs were collected during elective laparoscopic procedures, cultured, and stimulated with IL-1. IL-6, IL-8, IL-10, and TNF production were determined by ELISA. Statistical analyses were by ANOVA; a P <0.05 was significant. Our results showed that IL-1 induced an 11-fold increase in IL-10 production in pediatric PMs (659±103 vs. 60±25 control, P <0.05). There was no IL-10 production in IL-1-stimulated adult PMs. IL-1-induced TNF production was greater in children compared with adults (2152±166 vs. 592±188, P <0.05). Similarly, IL-1-induced IL-6 production was greater in pediatric PMs compared with adults (532±3 vs. 444±52, P <0.05). There was no difference in IL-1-induced IL-8 production in children compared with adults. The IL-10:TNF ratio after IL-1 stimulation was 0.306±0.056 in pediatric macrophages and 0.020±0.015 in adult macrophages ( P <0.01). In conclusion, IL-1-induced IL-6 and TNF production were greater in pediatric than adult PMs. Furthermore, pediatric PMs had an 11-fold increase in IL-1-induced IL-10 production, while adult PMs did not produce IL-10. Therefore, IL-1 induces both a pro- and an anti-inflammatory response in pediatric PMs, whereas adult PMs produce only pro-inflammatory cytokines in response to IL-1. The exaggerated anti-inflammatory IL-10 response in children may be an important factor in the observed differences in ALI between children and adults.Presented at the International Symposium for Pediatric Surgical Research, Marseille, France, 3 October 2003Research supported by NIH Trauma Center Grant #P50GM49222–10 and NIH Training Grant T32 GM08315–12     

Impact of different doses of ethinyl oestradiol on reduction of final height in constitutionally tall girls

Fifty-two tall girls were treated for constitutionally tall stature with different ethinyl oestradiol (EE) dosages. They were divided into three different treatment groups: group B (100 g EE/day;n=11); group C (300 g;n=25) and group D (500 g;n=16) and compared with an untreated group A (n=21) matched for age, height, bone age (BA) and height prediction. Using the height prediction method TW II, EE treatment reduced final height compared with the untreated girls in a weak dose-dependent manner, 2.3 cm (100 g/day), 3.0 cm (300 g/day), and 3.8 cm (500 g/day). Such a dose dependency was not found on applying the Bayley-Pineau height prediction method (100 g/day: 4.1 cm; 300 g/day: 4.2 cm; 500 g/day: 4.5 cm). However, there was a striking inverse correlation of the BA at the onset of treatment with the height reduction achieved using the TW II method (r: –0.43;P<0.001). Importantly, girls with a BA below 12 years at the onset of treatment experienced a height reduction of more than 6 cm.The EE dose used in the range of 100–500 g/day is not crucial for the amount of height reduction in tall girls. In general high dose EE treatment should be given restrictively, and especially so in girls with a BA (TW2 RUS-ZH) above 12.0 years.