THE GASTROINTESTINAL ABSORPTION OF PENICILLIN V IN CHILDREN WITH SUSPECTED COELIAC DISEASE

Abstract. The gastrointestinal absorption of penicillin V (pc-V) was investigated in 6 children, 6–12 months old, with suspected coeliac disease. The diagnosis was set after small bowel biopsy and absorption tests of vitamin A and d -xylose. As control groups served 7 children with diarrhoea but with normal small bowel biopsy and/or absorption tests and a group of 9 children with upper respiratory tract infection of the same ages as the children in the test group. The absorption of calcium pc-V in oil suspension (Penicals®) was impaired in the patients with suspected coeliac disease compared to that of the control groups. There was no significantly different absorption of pc-V between the control children with diarrhoea and those with upper respiratory tract infection. After 6–8 months of gluten free diet in the children with suspected coeliac disease their absorptive ability of oral calcium pc-V in suspension form was equal with that of a control group.     

THE BIOAVAILABILITY OF ORAL PENICILLIN V. A COMPARATIVE STUDY OF THE ABSORPTION OF DIFFERENT SALTS OF PENICILLIN V IN CHILDREN

ABSTRACT. Different salts of penicillin V (pc-V): potassium pc-V (Calciopen® and Kåvepenin®), calcium pc-V (Penicals®) and benzathine pc-V (Meropenin®) were given to 37 children (age 2 months to 4 years) with upper respiratory infections. The gastrointestinal absorption of the drug given in a mixture was followed for three hours after administration by determination of the serum levels from capillary samples. Administration of the mixtures containing the potassium pc-V resulted in a more rapid absorption and in significantly higher plasma concentrations at 30 min than did administration of the preparations containing the calcium and benzathine salts. In four children with coeliac disease, verified by intestinal biopsy, the absorption of potassium pc-V (Calciopen®) was compared with that of calcium pc-V (Penicals®). A decreased absorption was found and this was most pronounced when the calcium salt was given.     

Socio-Economic Variables and Pregnancy Outcome

ABSTRACT. The effects of various social indicators on infant and child mortality were studied in Sweden with the use of a medical birth register to which census information was linked. Two years were studied: 1976 births linked to the 1975 census, and 1981 births linked to the 1980 census. Survival was followed to the age of 5 by linkage of the birth register with the death certificate register. The only statistically significant effect of a single socio-economic variable was that of housing conditions on perinatal death rate and postperinatal death rate up to the age of one. The family situation (e. g., cohabitation or not) had some effect, although it was not statistically significant. On the basis of cohabitation status and other social indicators, including housing conditions, we selected two groups: one privileged and the other underprivileged. Using crude mortality rates, we found no definite difference. There was evidence that the mortality rate had decreased more between 1976 and 1981 in the privileged than in the underprivileged group, but the difference may have been coincidental. After standardization for maternal age and parity, however, a difference appeared with a ratio of 1.14 between the underprivileged and the privileged groups, which was valid for deaths up to the age of one. After that age, no difference was seen. Following standardization for birthweight, the opposite was found: a higher weight-specific mortality rate in the privileged group than in the underprivileged group. The interpretation of these findings is discussed.     

Eosinophilic pustular dermatosis: an early skin marker of infection with human immunodeficiency virus?

Two cases of eosinophilic pustular dermatosis are reported and both were associated with infection by human immunodeficiency virus (HIV-I). We suggest that eosinophilic pustular dermatosis may occur as an early sign of infection with HIV.     

Tuberculous Meningitis: Immune Reactions within the Central Nervous System

Cerebrospinal fluid (CSF) lymphocytes from two patients with tuberculous meningitis proliferated stronger than the corresponding peripheral blood lymphocytes (PBL) when stimulated with tuberculin purified protein derivative (PPD) in the lymphocyte transformation test after 3 days of culture. This might indicate an accumulation of specifically primed lymphocytes within the central nervous system. CSF lymphocytes and PBL from nine of ten patients with acute aseptic meningitis investigated as controls showed no or low responses when stimulated with. PPD, whereas the remaining patient displayed a significant proliferation of CSF lymphocytes, which was more pronounced than that of PBL. Stimulation with the mitogens phytohaemagglutinin, concanavalin A, and pokeweed mitogen gave lower proliferation of CSF lymphocytes compared with PBL in tuberculous and aseptic meningitis. Evaluation of the proliferative response of CSF lymphocytes compared with PBL on stimulation with PPD might be a useful complement in the diagnosis of tuberculous meningitis.     

Plasma noradrenaline correlates to sympathetic muscle nerve activity in normotensive man

Recordings of multiunit sympathetic activity were made in muscle branches of the peroneal nerve in 22 healthy subjects at rest in recumbent position. Nerve activity was quantitated in terms of burst incidence (number of pulse synchronous sympathetic bursts per 100 heart beats or per min). In a separate session, 4–45 months later, blood was drawn from an antecubital vein for noradrenaline analysis. Both sympathetic activity and plasma concentrations of noradrenaline varied widely between subjects and both parameters increased with age. There was a significant positive correlation between a subject's level of sympathetic activity and his plasma concentration of noradrenaline. It is suggested that overflow of transmitter from sympathetic terminals in muscles contributes significantly to plasma levels of noradrenaline at rest.     

“I've not asked him,you see,and he's not said”: understanding lay explanatory models of illness is a prerequisite for concordant consultations

Method — An extended qualitative analysis of a single case. Objective — To illustrate the complexity of patients' explanatory models and their significance in underpinning experience of illness and response to disease. Key findings — The case demonstrates how lack of professional awareness and understanding of patient models limits the capacity to provide effective health care and reduces patients' ability to cope with the experience of illness or to participate constructively in the management of disease. The distance between patients and health professionals is likely to increase, as also is the rate of “non‐compliance”, if laypeople continue to become increasingly well informed outside the consulting room, but retain the traditional role of passive and acquiescent patient within it. Concordant consultations are characterised by attention to the patient's illness as well as disease. It is not enough that technical issues and disease problems should be dealt with. The patient's subjective experience of symptoms, and the personal significance of his or her illness should be set out. The interpretation of meaning should be a collaborative endeavour involving both doctor and patient. Increased professional awareness of patient models of illness and associated concerns could be an important lever in changing the culture of the consultation. Conclusion — Concordance offers a way of developing a more equal and meaningful relationship between patients and professionals and of generating more positive outcomes in medical consultations as a result.     

Structure and Protective Capacity of Tetanus and Diphtheria Antibodies Produced During Human Pregnancy and Transferred to New-Born

PROBLEM: The structure and protective activity of antibodies against tetanus (anti-T) and diphtheria (anti-D), produced during human pregnancy and transferred to new-born, was studied. METHOD: Antibody levels were measured by ELISA in non-pregnant women (control group), primiparae, and multiparae, and in their children. The proportion of symmetric and asymmetric IgG molecules was determined and their respective protective capacity evaluated. RESULTS: The quantity of asymmetric anti-T and anti-D antibodies in mothers at the time of delivery was roughly four- and three-fold that of the control group, respectively, dropping significantly 1 month later. A similar proportion of these antibodies was observed in the new-born. The lower neutralizing capacity of asymmetric molecules was demonstrated in vivo. CONCLUSION: Results show that during pregnancy there is a modulation of the immune response with an increase in the production of asymmetric molecules of lower protective capacity.     

Nonalcoholic Steatohepatitis in Obesity: A Reversible Condition

ABSTRACT Nonalcoholic steatohepatitis is a rare complication of obesity with laboratory and histological features indistinguishable from alcoholic hepatitis. Three patients with 50–60% overweight and steatohepatitis are reported. All responded with normalization of the biochemical and/or histological changes after modest weight reduction.     

Body Temperature in General Population Samples

ABSTRACT Oral body temperature was measured in 816 men, 57 and 67 years old, sampled from the general population of Göteborg, Sweden, and 22 physically highly active men, sampled on clinical grounds. The measurements were taken in the morning for 14 months. After adding 0.3°C to the readings to make them comparable with rectal readings, the mean body temperature was 36.8±0.4°C. There was a seasonal variation with a peak during the winter and a trough during the summer. Body temperature was inversely correlated with height and positively correlated with weight and body fat but not with lean body mass. High physical activity and sensitivity to heat were associated with a higher than average body temperature. Sensitivity to cold was associated with a lower than average body temperature. Smoking prior to the measurements did not appear to affect body temperature.