Diagnostic delay in Crohn's disease

The interval between the onset of symptoms and confirmation of the diagnosis of Crohn's disease in children is often many months or years. A number of factors contribute to this diagnostic delay, but the most significant appear to be delay in the patient seeking initial medical help and failure of the medical practitioner to consider the diagnosis at the time of the first medical contact. In this review of 55 children with Crohn's disease the intervals between onset of symptoms, first presentation and diagnosis were examined and the causes of diagnostic delay determined. The main reason a diagnosis was not made at first presentation was because of ignorance of the fact that Crohn's disease could occur in children. In older children, the combination of tiredness, lethargy and iron deficiency anaemia with vague or intermittent abdominal pain was a frequent cause of diagnostic difficulty. However, even in the absence of major gastrointestinal symptoms, the significance of growth failure and delayed puberty was usually recognised if the patient was referred to a paediatrician. Diagnostic delay could well be reduced if medical practitioners involved in the primary care of children were educated to recognise the various ways in which Crohn's disease presents in this age group. Offprint requests to: S. W. Beasley     

Children's perception of temporally distorted sentential approximations of varying length.

The purpose of this study was to investigate the abilities of second-grade and fourth-grade children to auditorially process three orders of three- and five-word sentential approximations, which had normal interstimulus intervals (ISI) and ISIs of 200 and 400 ms. Results showed that percent correct scores decreased as a function of increasing sentence length and ISI, and decreasing order of sentential approximation and grade level. The results are discussed relative to theoretical notions of short-term memory and auditory perceptual processing as well as potential clinical applications.     

Trigeminal neurinoma presenting with trismus

We describe a patient with trigeminal neurinoma whose main presenting symptom was trismus. This has not previously been reported in the literature. We review the previously described symptoms and signs of trigeminal neurinoma.     

Hereditary multiple glomus tumours.

A 9 year old girl presenting with multiple glomus tumours is reported. Multiple glomus tumours are rare, often asymptomatic lesions, with a familial tendency and found in a more proximal location than their solitary counterparts. In our report four close relatives had similar lesions. Indications for surgical excision are discussed.     

Serial liver biopsy observations in hepatitis B antigen carriers by light and electron microscopy

Liver morphology and function were restudied after an interval of 1^1/2–2 years in 21 Chinese men with hepatitis B antigen (HB_sAg). Antigenemia and mild liver histopathology disappeared in one individual who developed antibody to HB_sAg (Anti-HB_sAg). 20 subjects who were chronic carriers of HB_sAg had mild histological abnormalities which were usually persistent and were more commonly lobular than portal. Particularly striking were focal necrosis, eosinophilic bodies, ground-glass cytoplasmic change, and, by electron microscopy, microtubular structures within cytoplasmic membranous cysternae. Interval development of chronic aggressive hepatitis was observed in only one subject. This study suggests that the great majority of HB_sAg carriers have a good prognosis at least over a 1^1/2–2-year period, and that liver biopsy is most indicated in those with persistent liver function abnormalities.