Comparison of total alkaline phosphatase and three assays for bone-specific alkaline phosphatase in childhood and adolescence

We compared serum levels of total alkaline phosphatase (TAP) and bone-specific alkaline phosphatase (BAP) as determined by three different assays (lectin affinity electrophoresis, immunoradiometric assay, enzyme-linked immunosorbent assay) in subjects aged 5–20 years suffering from X-linked hypophosphatemic rickets ( n = 14), chronic renal failure ( n = 10) and chronic cholestatic liver disease ( n = 16). Results were compared to controls of the same age and were expressed as standard deviation scores (SDS). TAP correlated significantly with BAP ( r > 0.9 for each assay; p <0.001) in controls. In children with cholestatic diseases, TAP (median SDS + 2.0) was elevated, but BAP, as measured by the electrophoretic assay, was within the reference range for most patients (median SDS: -0.4; p = 0.003 for the difference between the median SDS of TAP and BAP). In contrast, results for BAP as determined by the two immunoassays were not significantly different from TAP in any of the three patient groups ( p > 0.05 in each group for both assays). In this study, the two immunoassays did not have a detectable advantage over lectin affinity electrophoresis in the determination of BAP.     

Fanconi's anemia treated by allogeneic marrow transplantation

Eight patients with Fanconi's anemia were given cyclophosphamide alone (seven patients) or combined with procarbazine and antithymocyte globulin (one patient) followed by marrow grafts from HLA-identical siblings. All patients had engraftment. Seven developed acute and three chronic graft-versus-host disease (GVHD). Three patients died with GVHD and infectious complications (days 19, 56, and 82) and one with an intracerebral hemorrhage (day 540). Four patients are surviving 647- 3435 days after grafting, two are well, and two have chronic GVHD that is improving. These results show that Fanconi's anemia can be treated successfully by allogeneic marrow transplantation.     

Factors influencing aortocaval compression in late pregnancy

The circulatory effects of postural change in late pregnancy were investigated in 20 healthy pregnant women. Maximum stroke volume (93.2 +/- 11.9 ml) was recorded with the subject in the left lateral position and was significantly (p less than 0.001) reduced in the supine, right lateral, and lithotomy positions, but was largely unchanged in the standing motionless position (89.9 +/- 12.6 ml). Diastolic, systolic, and mean arterial blood pressures and total peripheral vascular resistance were significantly (p less than 0.001) increased in the supine, right lateral, lithotomy, and upright motionless positions when compared to the same variables in the left lateral position. The following factors were found to be significantly correlated to the hemodynamic response to the supine recumbent position: maternal age (p less than 0.05), the position of the fetus in the uterus (p less than 0.05), and systolic (p less than 0.001) and diastolic (p less than 0.001) blood pressures measured with the subject in the left lateral position. The implications of the present findings for modern obstetric delivery care and the etiology of the supine hypotensive syndrome are discussed.     

Laparoscopic surgery in Crohn's disease

Laparoscopic surgeons attempting to treat Crohn's disease must have experience working with inflammatory bowel disease and advanced laparoscopic skills. Nonetheless, laparoscopy is dramatically changing all aspects of gastrointestinal surgery and inflammatory bowel disease, including Crohn's disease, is likely to benefit, as well. This article defines the role of laparoscopy in treating Crohn's disease and outlines surgical therapy.     

Human milk as a carrier of biochemical messages

Not only does breast milk provides an ideal nutrient composition for the newborn, but it also contains a variety of substances that may actively influence growth and development of the infant and stimulate neonatal protection against gastrointestinal diseases. Hormones, growth factors, cytokines and even whole cells are present in breast milk and act to establish biochemical and immunological communication between mother and child. In addition, milk nutrients such as nucleotides, glutamine and lactoferrin have been shown to influence gastrointestinal development and host defense. The unique properties of milk as a mediator of biochemical messages will be presented and the clinical significance of breastfeeding in the prevention of neonatal gastrointestinal diseases will be discussed.     

Long-term outcome of resective epilepsy surgery in Norwegian children

Aim: The aim of this study was to evaluate the long-term results of resective surgery on children with difficult-to-treat epilepsy in Norway. Methods: In the period 1995–2004, 64 surgical procedures (54 resections and 10 functional hemispherotomies) were performed in 54 children. The children’s medical records were retrospectively reviewed at a minimum of 2 years after surgery. We sent a questionnaire regarding their epilepsy (seizures, usage of antiepileptic drugs) and general functioning (social situation, motor, language, cognition, behavioural or emotional problems, any remedial action) to the children/parents after a mean follow-up period of 7 years. Results: 55.5% of the children were seizure-free. The success rate varied according to the type of surgery. Best results were found after functional hemispherotomies and temporal lobe resections, as nine of 10 (90%) and 10 of 19 (53%) of these patients, respectively, became seizure-free. In addition to a better seizure control, 71% of the children/parents reported of a better cognitive and psychosocial functioning. Conclusion: The results of epilepsy surgery in this paediatric cohort are very edifying, and it is our impression that this treatment option is underused in Norway.     

The influence of a low-dose combined oral contraceptive on menstrual blood loss and iron status.

The influence of a low-dose combined oral contraceptive (ethinyl estradiol 30 micrograms + desogestrel 0.15 mg) on menstrual blood loss (MBL) was evaluated in 20 healthy, young women. MBL prior to commencing oral contraception was 60.2 +/- 5.6 ml (range 22-116 ml), and decreased (p < 0.001) to 36.5 +/- 5.2 ml (range 7-80 ml) and 33.7 +/- 4.1 ml (range 5-70 ml) after 3 and 6 months' oral contraceptive medication, respectively. The reduction in MBL during oral contraception was most apparent during the first two days of menstruation. Five women had an MBL > 80 ml prior to commencing oral contraceptive medication. In all of these women, MBL during the 6th menstrual period after commencing oral contraception was < 80 ml. All the women included in this study had a normal blood hemoglobin concentration, hematocrit and erythrocyte indices and there were no significant changes in these variables during the course of the study. Serum ferritin concentration prior to commencing oral contraception was 44.2 +/- 9.0 micrograms/l and was largely unchanged after 6 months' oral contraception (39.7 +/- 6.3 micrograms/l). On admission to the study, two women had a serum ferritin < 10 micrograms/l, indicative of low iron stores. Both these women had an MBL > 80 ml at the baseline assessment. Serum ferritin concentration increased during oral contraceptive medication in both women (from 8.5 micrograms/l to 12.0 micrograms/l and from 5.4 micrograms/l to 6.8 micrograms/l, respectively). The duration of menstruation (p < 0.01) and the number of women suffering from dysmenorrhea (p < 0.05) was reduced during oral contraception.     

The contribution of psychological distress to socio-economic differences in cause-specific mortality: a population-based follow-up of 28 years

Background  

Psychological factors associated with low social status have been proposed as one possible explanation for the socio-economic gradient in health. The aim of this study is to explore whether different indicators of psychological distress contribute to socio-economic differences in cause-specific mortality.     

A profile of the online dissemination of national influenza surveillance data

Background  

Influenza surveillance systems provide important and timely information to health service providers on trends in the circulation of influenza virus and other upper respiratory tract infections. Online dissemination of surveillance data is useful for risk communication to health care professionals, the media and the general public. We reviewed national influenza surveillance websites from around the world to describe the main features of surveillance data dissemination.