Reference values of gastric intramucosal pH in children

To determine the reference values of gastric intramucosal pH (pHi) by tonometry in paediatric patients, we studied 17 children (nine males, eight females) with no systemic or gastrointestinal disease, aged six months to 12 years undergoing minor reconstructive surgery. Following anaesthetic induction a sigmoid tonometry catheter was inserted (Tonometrics, Inc.) into the stomach of the patients under direct vision. All children were normoventilated and were haemodynamically stable. After an equilibration period of 30 min, gastric pHi was calculated by applying the Henderson-Hasselbalch equation on the Pco ₂ obtained with the tonometer and the bicarbonate from the arterial blood gas analysis. The mean gastric pHi in our patients was 7.35±0.06 (sd ). The normal pHi in the general population is estimated to be 7.31–7.40, with a confidence interval of 99%. No correlation was found between pHi and arterial pH, bicarbonate or base excess. Under conditions of normal ventilation and haemodynamic stability, healthy children during general anaesthesia have gastric intramucosal values similar to those of adults.     

Protective immunity in the rat model of congenital toxoplasmosis and the potential of excreted-secreted antigens as vaccine components

Toxoplasma infection is a major cause of severe foetal pathology both in humans and in domestic animals, particularly sheep. We have previously reported the development of an experimental model to study congenital toxoplasmosis in the rat. Here we demonstrate that, as in humans, total protection against congenital toxoplasmosis can be achieved regardless of the strain of Toxoplasma gondii used to infect rats, or when initial and challenge infections were carried out with different strains. Chronic infection is associated with a highly specific immunity that involves both B-and T-cell responses beginning at day 10 postinfection. The antibody isotype analysis revealed that whereas immunoglobulin (Ig)G2b is the major elicited isotype, no IgG1 antibodies are detected. T cell proliferation was assayed using crude Toxoplasma extracts or excretory-secretory antigens (ESA). The analysis of T cell supernatants showed the specific secretion of both interleukin-2 and interferon-gamma by activated T cells. Immunization of rats before pregnancy with either crude Toxoplasma extracts or with ESA elicited a B cell response that included antibodies of the IgG1 isotype and conferred on the newborns high levels of protection. Preliminary experiments of immunization using two HPLC-purified ESA, GRA2 and GRA5, conferred, a significant protection although to a lesser extent. This experimental model represents an attractive model for the identification of future vaccine candidates against congenital toxoplasmosis.     

The cell cycle in psoriasis

The cell cycle has been determined in eight in-patients with psoriasis. The cell cycle time for the germinative cell compartment has been found to be 91 h, and the turnover time for the epidermal compartment, beneath the keratin layer to be 120 h (5 days). The duration of the S phase (DNA synthesis) has been found to be 10 h, and that for mitosis 30 min. If it is accepted that the turnover time for the keratin layer is 2 days, then the turnover time for the epidermis in psoriasis is 7 days, and not 3–4 days as previously described.     

GASTROCAMERA STUDIES IN ROSACEA

SUMMARY.— Ten patients with rosacea were examined with the gastro-camera. No abnormality of the gastric mucosa was found. Gastric biopsy in 5 of the patients showed no histological abnormality and histochemically the succinic dehydrogenase content of the parietal cells was also normal.     

Improvement of scleredema associated with IgA multiple myeloma after chemotherapy

The presence of a monoclonal gammopathy in patients with chronic scleredema is a recently described, unusual association of unknown significance. There have been very occasional reports of multiple myeloma in such patients. We now report a patient with long-standing scleredema who developed an IgA-κ multiple myeloma. Once chemotherapy for the myeloproliferative disorder was instituted, scleredema improved significantly, suggesting a pathogenetic link between the two conditions.     

A multidisciplinary approach to the management of psychosocial admissions to a general paediatric ward

Abstract This study investigated the cheracteristics of all new in-patients with major psychological and/or social problems admitted to a medical ward over a 4-week period. Fifteen successive patients were studied prospectively. The professional time spent by the medical and paramedical personnel involved in the initial assessment and management was reviewed, and the children followed-up 6 months later.
The study found that the patients readily fell into two major groups. Group I were infants and children who had been maltreated or were at risk for child abuse. Group II were older children who presented with psychosomatic symptoms arising from disturbed family or environmental backgrounds. The medical, psychiatric and social work input was considerable for both groups (19 vs 27 h per patient respectively). Their hospital stay was prolonged (15 vs 21 days respectively; the hospital average was 4.4 days). The outcome differed in the two groups. Patients in Group I failed to attend follow-up appointments in most cases unless such attendance was legally mandatory. In contrast, Group II patients usually kept their follow-up appointments, the intervention generally being successful.