Whole body protein metabolism in children with cancer

Whole body protein synthesis and catabolism were measured using the [ring-2H5]phenylalanine and [1-13C]leucine primed constant infusion technique in 32 paediatric patients with cancer at different stages of treatment. Rates of synthesis (S) and catabolism (C) derived from the [ring-2H5]phenylalanine and [1-13C]leucine models were 4.7 (SD 1.3) (S) and 6.0 (1.5) (C) g/d/kg, and 5.5 (0.8) (S) and 6.8 (1.2) (C) g/d/kg, respectively. These results show that these two tracer techniques give similar results in this study population. Comparison of these values with results previously reported for groups of control children using the [ring-2H5]phenylalanine model (S = 3.69 and 3.93; C = 4.09 and 4.28 g/d/kg) and the [1-13C]leucine model (S = 4.32; C = 4.85 g/d/kg) show that rates of synthesis and catabolism were higher in cancer patients than in controls. Thus whole body protein turnover is increased in children under treatment for cancer. Other indices of metabolism such as plasma amino acids and intermediary metabolites were also measured and showed that, although subjects were in isotopic steady state, there were significant metabolic changes during the course of the primed constant infusions used to measure protein turnover.     

Protein nutrition, faecal flora and iron metabolism: the role of milk-based formulae

This paper explores the role of milk-based formulae in achieving four aspects of nutritional health in infants and toddlers: in the suckling, to mimic the amino acid metabolism and the faecal flora of a breast-fed baby; in the weanling, to achieve adequate protein intakes in later infancy and beyond and to achieve satisfactory haemoglobin concentrations in the early toddler years. Milk-based formulae have two roles in infant nutrition: as so-called breast milk substitutes and as a safety net during the weaning period; the latter role may be the more important.     

PAROXYSMAL TACHYCARDIA IN INFANCY AND CHILDHOOD I. Paroxysmal Supraventricular Tachycardia

A 1 to 30 year follow-up study of 54 infants and children with paroxysmal supraventricular tachycardia is presented. In 28 cases the first attack occurred in infancy, and in 18 of these already in the first months of life. Nine patients had organic heart disease. The WPW syndrome was diagnosed in 30 cases. When first seen, most of the infants presented signs of incipient or manifest congestive heart failure, which was very unusual in the children, most of whom had only minor symptoms. Four children had experienced brief syncopes during attacks. Digitalis was effective against congestive heart failure and, when continued, may have prevented failure during subsequent attacks. Whether digitalis and other anti-arrhythmic agents facilitated conversion to sinus rhythm could not be established in this study. Vagal stimulation was only rarely effective. Preventive treatment with digitalis or other antiarrhythmic drugs seemed to have little if any effect on the frequency of recurrent attacks. Out of 23 infants who were followed for at least 5 years, 17 had been free from attacks during the last 3 years and 13 of these had had their last attack before the age of 6 months. Out of 23 children followed for 5 years or more, only 3 had been free from recurrences during the last 3 years. Patients with the WPW-syndrome had a somewhat higher incidence of recurrent attacks.     

Immunohistochemical analysis of BRCA2 expression in normal human buccal cells

Previously we demonstrated that protein coded by the BRCA1 gene was expressed in normal human buccal cells. The present study confirmed that BRCA2 protein was similarly expressed in these cells. Messenger RNA for BRCA2 was detected with sequential use of two primer sets. Pooled cell samples from healthy donors reacted strongly with two commercially available antibodies, I17 and C15. Immunoreactivity was present in both cytoplasmic and nuclear compartments. We conclude buccal cells will provide a suitable model for exploration of normal BRCA function.     

Hand rehabilitation after great toe transfer for thumb reconstruction

A comprehensive rehabilitation program for patients who have undergone a great toe to hand transfer for thumb reconstruction can significantly affect eventual functional outcome. When the thumb is amputated near the metacarpophalangeal joint, such a transfer provides a useful and aesthetic thumb substitute. Goals of rehabilitation are to promote optimal functioning of the reconstructed hand by maximizing range of motion, preventing reduction of the first web space, facilitating adequate sensory return, and maximizing strength, coordination, and endurance. Therapeutic modalities include edema control, passive and active exercises, static and dynamic splinting, massage, sensory reeducation, and graded functional activities. Emotional adjustment and vocational adaptation are additional therapeutic concerns. Case histories of two patients are briefly reviewed along with pre- and posttransfer assessments of range of motion, strength, sensation, and dexterity.