P. A. Krasilnikoff

INTERMITTENT MUSCULAR WEAKNESS, EXTRASYSTOLES, AND MULTIPLE DEVELOPMENTAL ANOMALIES A New Syndrome?

A description is given of an eight‐year‐old boy with extrasystoles, seizures of muscular weakness, and multiple developmental anomalies (dwarfism, scaphocephalic skull, hypertelorism, bilateral ptosis, low‐set ears, broad nose, mandibular hypoplasia, aplasia of a number of teeth, defect of both the soft and osseous palate, inward bending of the fifth fingers, single transverse palmar crease of both hands, and cryptorchidism). These findings suggest a specific syndrome, but no similar description was found in the literature. The investigations disclosed no signs of either a chromosomal, a neuromuscular, or an endocrine disease.

Striking differences in the incidence of childhood celiac disease between Denmark and Sweden : a plausible explanation

Summary Among 771 children (381 Swedish and 390 Danish) investigated between 1972 and 1989 because of suspected celiac disease (CD), 179 proved to have the disease. Surprisingly only 24 CD patients were found among the Danish children, compared with 155 in the Swedish group, despite the close ethnic, geographical, and cultural background of the two populations. The Swedish CD children were diagnosed at an earlier age than the Danish children (mean, 1.5 vs. 5.5 years). The symptoms of the Swedish patients were dominated by failure to thrive (93 vs. 71%), whereas a higher proportion of the Danish CD patients suffered from stomach pain (21 vs. 5%). Breast-feeding habits were comparable. The estimated content of gliadin in the officially recommended diets of the two countries in 1987 differed substantially, the Swedish diet containing more than 40 times more gliadin than the Danish (4,400 vs. 100 mg) at the age of 8 months, and 4 times more (3,600 vs. 900 mg) at the age of 12 months. The Danish infant diet differed significantly from the Swedish in containing a larger amount of the lower gluten-containing rye flour. The earlier introduction of food items with a high gluten content in the Swedish compared with the Danish diet seems to be an obvious explanation for the great difference in incidence and symptomatology of CD between the two populations.

High prevalence rates of adult silent coeliac disease, as seen in Sweden, must be expected in Denmark.

Aim: To disclose the prevalence of adult “silent” coeliac disease in Denmark and Sweden. Experimental design: 1573 Danish and 1866 Swedish healthy blood donors were screened for the presence of serum anti‐gliadin antibodies (AGA) by enzyme‐linked immunosorbent assay. AGA‐positive serum samples were further analysed for IgA anti‐endomysium antibodies (EmA) by indirect immunofluorescence microscopy. Main results: The Danish donor population had a higher mean age than the Swedish (41.4 years versus 37.6 years) and a higher proportion of females (41% versus 32%), and had a lower mean level of AGA (17.3 units versus 20.6 units). Sixty‐one (3.9%) Danish donors had AGA above the cut‐off limit, and four of these also had positive EmA tests. Sixty (3.2%) Swedish donors had AGA above the cut‐off limit, and five of these also had positive EmA. Coeliac pathology was proven by biopsy in all five coeliac disease‐suspected Swedish donors. No small intestinal biopsy was performed in the coeliac disease‐suspected Danish donors. Conclusions: Based upon the finding of EmA in AGA‐positive serum samples, silent coeliac disease may be suspected in 1 per 394 Danish blood donors (2.5 per 1,000). A similar rate was proven in 1 per 373 Swedish blood donors (2.7 per 1,000), indicating no major differences in the prevalence of adult silent coeliac disease between the two neighbouring countries.

Steady-State Kinetics of 5-Aminosalicylic Acid and Sulfapyridine during Sulfasalazine Prophylaxis in Ulcerative Colitis

Fifteen adult and 19 pediatric outpatients with ulcerative colitis were studied to determine the steady-state kinetics of 5-aminosalicylic acid (5-ASA) released from salazosulfapyridine (SASP). Results of excretion in adults (mean 24-h recovery of 5-ASA, 21% in urine and 57% in feces) were compatible with those of healthy volunteers. Since mean SASP dose/kg body weight (about 50 mg/kg) and compliance (reflected in sulfapyridine recovery) were equal in adults and pediatric patients, the results of the patient groups could be compared. Near-complete azo reduction of SASP occurs in children. Absorption and excretion of 5-ASA and metabolism to acetyl-5-ASA did not differ statistically between pediatric and adult patients. However, the fecal excretion of the drug and its metabolites was significantly lower in young patients, although fecal concentrations were the same. The present results demonstrate that SASP is an excellent sustained-release drug for the delivery of 5-ASA to the lower part of the bowel system and provide a reference for comparison of 5-ASA kinetics after treatment with newer 5-ASA preparations.

Antibody response in serum and intestine in children up to six months after a naturally acquired rotavirus gastroenteritis.

Summary The aim of this study was to provide detailed information about the local and systemic antibody response and their relationship following a rotavirus gastroenteritis. Rotavirus-specific immunoglobulins were analyzed by enzyme-linked immunosorbent assay (ELISA). The study included 49 children referred to hospital with rotavirus gastroenteritis and 16 children with nonrotavirus gastroenteritis. The concentrations of rotavirus immunoglobulin A (IgA) in serum increased within the first 2 weeks and those of rotavirus IgG within the first month after the onset of diarrhea. Thereafter, they remained unchanged during the 6-month observation period. Rotavirus ScIg (i.e., antirotavirus immunoglobulin-containing secretory component) appeared in serum almost exclusively within 7–14 days after onset (i.e., 85% of the samples). After the first 2 weeks, rotavirus IgA could be detected in the majority of fecal samples, even up to 6 months after the disease. However, rotavirus ScIg was absent in the majority of fecal samples. The severity of illness correlated only with the increase of rotavirus IgG in serum. Conclusively, there is a longstanding immune response after a naturally acquired rotavirus gastroenteritis. Moreover, with the present methods, measurements of rotavirus IgA and IgG in serum can be safely used for serodiagnosis, even when samples are taken with 6-month interval. It is suggested that trials with rotavirus vaccines include measurements of rotavirus IgA and ScIg in serum and rotavirus IgA in feces.

Acute gastroenteritis in children attending day-care centres with special reference to rotavirus infections. I. Aetiology and epidemiologic aspects.

Acute gastroenteritis (GE) among 214 children (aged 6 months – 7 years) attending day‐care centres (DDCs) in the Copenhagen County was studied during a 12‐month period. A total of 197 cases of GE was observed in 109 children (i.e. 51% of the participants). The aetiology was as follows: rotavirus (n=48) (24%), pathogenic bacteria (n=11) (6%), Giardia lamblia (n=3) (2%), while the aetiology of 68% remains unknown. The pathogenic bacteria included Yersinia enterocolitica, thermophilic Campylobacter, Clostridium difficile (±toxin) and enteropathogenic E. coli. In 4% of the GE the infections were multiple and Cryptosporidium was seen in one of these cases. The rate of GE declined with age from 1.35 GE per child per year (age group 1.0– <2.0 years) to 0.36 (6.0 – <8.0 years). Serum sampled at the start of the study period showed that the frequency of detectable rotavirus IgG increased with age from 48% in the 6 months – <1.0 year group to 96% in the 4.0 – <7.0 year group. The highest rates of rotavirus GE occurred from January to April (i.e. the rotavirus season). Moreover, rotavirus GE was almost absent after the age of 4. Hence, the rates of rotavirus GE per rotavirus season per child were 0.80 (age group 6 months–<1.0 year), 0.32 (1.0–<2.0), 0.14 (2.0–<3.0), 0.16 (3.0–<4.0), 0.06 (4.0–<5.0) and 0.04 (5.0–<6.0). Only 2 out of the 48 rotavirus GE were reinfections. The 32 children with asymptomatic rotavirus infections and those with rotavirus GE showed a similar distribution of age and season. A cross‐sectional study of the prevalence of rotavirus excretion during the rotavirus season revealed only a single true asymptomatic excretor.

Treatment of Helicobacter pylori in Children With Recurrent Abdominal Pain

The role of Helicobacter pylori remains unclear in children with recurrent abdominal pain (RAP). In this study children with RAP were included in a double blind treatment study to elucidate whether symptoms disappear in children with a H. pylori infection and RAP, if the bacteria are eradicated.

Interobserver variation in diagnosing coeliac disease. a joint study by Danish and Swedish pathologists

There is an almost 40‐fold difference in incidence rates of symptomatic coeliac disease between Denmark and Sweden. In an attempt to explain this difference, the present study focused on the interobserver agreement when pathologists were assessing small intestinal biopsy specimens from children suspected of suffering from coeliac disease. The study was performed on 90 biopsy specimens from 73 children. Most of the biopsies came from children who turned out not to suffer from coeliac disease after a clinical evaluation including small intestinal biopsy. Using the kappa methodology, the interobserver agreement between two Danish pathologists and one Swedish pathologist, all of whom were experienced, was “moderate” to “substantial” or 0.57–0.75. Kappa indices when the pathologists evaluated selected histological elements were in the interval from 0.24 to 0.67. A comparison of a previous routine diagnostic assessment of the 90 biopsies (14 pathologists) with the results of the experienced pathologists in the present study gave kappa indices of from 0.53 to 0.57. The study could prove no major differences in the histopathological assessment of small intestinal biopsy specimens made by Danish and Swedish pathologists. The difference in clinical presentation of coeliac disease in Denmark and Sweden does not relate to differences in the histopathological assessment of small intestinal biopsies.

Rapid versus Gradual Refeeding in Acute Gastroenteritis in Childhood: Energy Intake and Weight Gain

Fifty-two children aged 6–46 months (mean 19 months), hospitalized for acute gastroenteritis (GE), were randomized after oral rehydration to receive 7 days of either traditional gradual refeeding (GR) or rapid refeeding (RR), the latter consisting of a full-strength lactose-limited diet, including lactase-treated whole milk. The study focused on the effect of a high energy intake, excluding possible negative effects of lactose. Both dietary regimens were well tolerated, the only difference in the clinical symptoms between the two regimens being a higher stool frequency within the RR group(p < 0.02). The total energy intake, as well as energy derived from fat and protein, was significantly higher in the RR than in the GR group (p < 0.0001). The mean daily energy intake of the latter group never reached recommended daily allowance (RDA) levels, while that of the RR group did on day 5. Moreover, during the whole period of dietary regimen, the RR group exceeded the RDA protein requirements (mean intake ranged 175–252%), while the GR group did not reach this RDA level until day 4. Milk was a major source of energy in the RR group, providing 47–59% of the daily energy intake. The short- and long-term weight gains in the RR group were only a little higher than those of the GR group, the difference being insignificant. The chief asset of RR compared with GR was, therefore, psychological, in the sense that after rehydration the hospitalized child with mild to moderate GE can, by and large, be offered the quality and quantity of food and drink that he/she prefers without the fear of negative effects on the outcome.

Intestinal and serum immune response to a naturally acquired rotavirus gastroenteritis in children.

Seventeen children (mean age: 2.0 years, range: 36 days-8 years) hospitalized with acute gastroenteritis were investigated. Thirteen children had a rotavirus infection while four did not. Rotavirus serum IgA as well as ScIg, i.e., antirotavirus immunoglobulin containing secretory component, increased rapidly after rotavirus infection. While rotavirus IgA persisted in serum for at least 6 months, rotavirus ScIg disappeared from serum in less than 4 months. Rotavirus IgG could be detected in serum during the early stage of the infection and was still high after 6 months. The patients with nonrota-virus acute gastroenteritis did not show any of the above-mentioned serological hallmarks of those with rotavirus infection. The amounts of rotavirus ScIg found in serum about 1 week after the infection correlated to the amounts of rotavirus ScIg in duodenal fluid. Six months after the infection, rotavirus IgA was found in the feces of the majority of the patients while rotavirus ScIg could be detected only in one patient. The amounts of rotavirus IgA in sera and intestinal secretions showed identical patterns in the acute phase of the disease as well as after recovery. The same applied to rotavirus ScIg. These findings could be useful in future evaluations of vaccines and immunity against rotavirus infections.