Pediatric management of severe treatment-resistant encopresis

Chronic fecal soiling is a distressing condition that often is associated with inappropriate psychological symptoms. This case report illustrates that a medical approach focusing on intensive "demystification" of the symptom and careful follow-up can successfully treat a child who initially might have been referred for psychiatric or even surgical consultation.     

Biochemical analysis of specific histamine HI and H2 receptors on lymphocytes

It is increasingly clear that histamine mediates a variety of lymphocyte functions. Further understanding of these mechanisms requires a method for the analysis of histamine membrane receptors on the lymphocyte surface. We report now a biochemical technique for the identification and quantitation of specific histamine H1 and H2 receptors of lymphocytes. The method can be performed on small numbers of formaldehyde-fixed cells. The data this assay yields, together with that resulting from the flow cytometric analysis of histamine receptor distribution (a technique we have previously described), will be a powerful tool in the study of histamine mediation of lymphocyte function.     

Development of a Purified Cholera Toxoid II. Preparation of a Stable, Antigenic Toxoid by Reaction of Purified Toxin with Glutaraldehyde

Evidence is presented which confirms that cholera toxoids obtained by reaction of purified toxin with Formalin possess the ability to partially reactivate both in vivo and in vitro. At the same time, conditions are presented for the preparation of stable, antigenic cholera toxoids by reaction of purified toxin with glutaraldehyde. Treatment of purified cholera toxin with approximately 200 mol of glutaraldehyde per mol of toxin at pH 7.8 reproducibly resulted in the preparation of toxoids which: (i) possessed less than 20 bluing doses per 100 mug; (ii) did not reactivate in vivo or in vitro; (iii) precipitated with, and neutralized antitoxin; (iv) elevated prolonged serum antitoxin in immunized rabbits; (v) protected immunized guinea pigs against toxin skin challenge; and (vi) lent themselves to enhanced antigenicity by means of an in situ adjuvant system which may be suitable for man. Acrylamide gel electrophoresis and molecular sieve chromatography of a series of glutaraldehyde-derived toxoids suggested that the reaction products consisted of monomeric and polymeric species and that the proportion of higher-molecular-weight species was determined by the relative concentrations of toxin and glutaraldehyde. The results suggested a relationship between complete and irreversible elimination of toxicity and the formation of higher-molecular-weight toxoids.     

Tumors of the facial skeleton in children. Growth patterns after maxillectomy and mandibulectomy.

Thirteen children who had major extirpative surgery of the maxilla or the mandible were followed up an average of five years postoperatively. They ranged in age from three months to eleven years. Facial and oral photographs, cephalograms and cephalometric analysis, and plaster dental models were used to document longitudinal and cross-sectional growth patterns; Our experiences in this limited number of cases has indicated the following: (1) Extensive extirpation of facial bones may be performed in children without significantly jeopardizing function or growth. (2) The roots of healthy teeth may be resected without fear of their noneruption or early loss; loss of sensation with continued viability is the rule. (3) The use of an iliac bone crib with particulate grafts has proved a highly successful means of reconstruction of the mandible in children. (4) Particulate bone has proved to be an effective means of reconstructing large contour defects of the mandible caused by enucleating large tumors in children.     

Phosphorylation of a 43 kdaltons protein from rat heart by a calmodulin-dependent protein kinase

The Ca2+ -dependent phosphorylation of proteins has been recognized as a major regulatory mechanism of biological processes. In the heart, protein kinases that are activated by Ca2+ include phosphorylase kinase, myosin light chain kinase, phospholamban kinase [review in 4], and the kinases responsible for phosphorylation of endogenous proteins in the membrane [11] and soluble [6] fractions of the cell. All of these Ca2+-dependent enzymes require the presence, either as an enzyme subunit or as a cofactor, of calmodulin, a Ca2+-binding protein which is involved in various other Ca2+-requiring reactions or processes [review in 3]. We demonstrate here the presence, in the rat heart, of a soluble calmodulin-dependent protein kinase which seems different from those already described in this tissue. The substrate for this enzyme is a 43 kdaltons protein, present in the same soluble fraction.     

Effects of theophylline on behavior and learning in children with asthma

This study examined the potential side effects of theophylline on behavior, attention, memory, and fine motor function in children with asthma. Seventeen children of normal intelligence who were intermittent theophylline users were recruited. Each was not taking medication at the initiation of the study. During the study, each child took the study medication (Theo-Dur tablets, 14 to 16 mg/kg per day or their usual dose, whichever was higher, or placebo) divided every 12 hours for 3 1/2 days (seven doses). A double-blind crossover design was employed such that each subject was randomly assigned to a group receiving theophylline/placebo or placebo/theophylline. After the first period, subjects were tested on a neuropsychological battery designed to assess cognitive performance, while the children, parents, and teachers filled out questionnaires concerning behavior and attention. The same procedure was repeated two weeks later (period 2) under the opposite drug condition. Data were analyzed by means of an analysis of variance, with time (period 1 vs period 2 [performance]) as a repeated measure and medication group as a between-subjects factor. Dependent variables consisted of 27 measures of performance, behavior, and attention. Only one of the 27 analyses revealed a significant group by time interaction. This analysis suggested a significant improvement in memory while taking theophylline; however, a different form of the same test showed no effect. Children and parents also completed a side-effects scale under both drug conditions. When the children were taking theophylline, parents and children noted that the children had more stomachaches and children noted more "shaking hands." The following observations suggest that the failure to find significant behavioral side effects while taking theophylline is not due to the relatively small sample size: (1) Almost all of the analyses fell far short of statistical significance, with findings indicating no trends toward poor performance while taking medication. (2) Correlations between the theophylline level and change in performance clustered around zero, with positive and negative values occurring with about equal frequency. (3) Neither parents nor children could accurately guess the child's medication condition. Thus, although there have been numerous reports on the behavioral side effects of theophylline, such reactions were not revealed in this study.     

A study of treatment resistance among children referred for encopresis

This study reports on some of the distinguishing characteristics of children with persistent encopresis who have proven, at long-term follow-up, to be resistant to intensive pediatric-based treatment at a referral outpatient clinic. Resistant children differed from responsive children primarily in two respects: they tended to have less stool retention at initial presentation, and their accidents occurred at all hours of the day. Additional information suggested that early success or failure did not presage long-term resistance and that parents' attributions of the cause of their child's soiling were related to outcome. Discussion centered on enumerating important high-risk factors that signal the need for more intensive intervention and follow-up.     

Autogenous calvarial bone dust for mandibular reconstruction

Calvarian bone dust was used as the autogenous graft for reconstruction of a resectioned mandible. A titanium tray and titanium screws were used as the framework. Postoperatively, the patient was functioning adequately with a satisfactory cosmetic appearance when she was lost to followup.