Christmas: Years Like This. Ingested foreign bodies and societal wealth: three year observational study of swallowed coins.

OBJECTIVE: To examine the relation between coins ingested by children and the Dow Jones Industrial Average. DESIGN: Observational study. Main outcome measures Total value of coins ingested and number of incidents of coins versus other objects swallowed, measured before and after the stock market crash of October 2008. RESULTS: Eighteen objects, including 11 coins, were ingested (NASDAQ (numismatic and sundry detritus acquired) composite of 18). The total value of the 11 coins swallowed was $1.03 (FTSE 100 (fraction of the US$ or 100 cents) index of 103). The pecuniary extraction ratio (PE ratio) was 0.57 (9/16). Comparing values for a period before and after October 2008, the mean monthly NASDAQ composite (0.41 (SD 0.67) v 0.5 (0.85), P=0.75), FTSE 100 index in cents (2.3 (6.8) v 3.1 (7.8), P=0.77), and PE ratio (0.54 (0.52) v 0.66 (0.29), P=0.50) did not change. The mean end-of-month closing value of the Dow Jones, however, decreased significantly (12 537 (841.4) v 8388 (699.8), P<0.001) CONCLUSION: There was no detectable difference in the total value of coins ingested, or ratio of coins to other objects swallowed, before or after a massive stock market crash.

Eosinophilic "empyema" associated with crack cocaine use.

Smoking of crystalline cocaine, known as "crack" cocaine, has been associated with eosinophilic pneumonitis, but not with pleural effusions. We describe a patient with eosinophilic pneumonitis with an eosinophilic "empyema" after using "crack" cocaine. The illness resolved with corticosteroids. We hypothesised that his effusion would have increased levels of eosinophil cytokines that promote oedema, and found a marked increase in pleural vascular endothelial growth factor (VEGF) and smaller increases in interleukins IL-5, IL-6, and IL-8. In the setting of "crack" use, we suggest that a pleural effusion that appears grossly to be pus should be evaluated for eosinophilic inflammation. Such eosinophilic effusions may respond to corticosteroids alone, consistent with a non-infectious process driven by proinflammatory cytokines.

Cognitive behavioral interventions for adolescents with cystic fibrosis.

Examined the effectiveness of a cognitive behavioral intervention to help adolescents with cystic fibrosis (CF) cope with daily stressors. Five youths were referred for the therapy by medical staff because of perceived problems with anxiety or coping. Treatment impact was assessed on measures of coping, anxiety, perceptions of functional disability, and parental reports of behavior. A multiple baseline design across subjects was used. Reductions in anxiety, a decrease in maladaptive coping efforts with CF-related problems, and an increase in positive coping with CF-related problems were obtained. Youths also reported a decrease in functional disability due to CF after the initiation of the intervention. Follow-up assessment indicated that most youths maintained gains in anxiety and perceived functional disability, but not coping efforts. Results suggest that cognitive behavioral treatment is a viable intervention for anxious youths with CF.

Tetracycline-induced esophagitis in adolescent patients.

Ulcerative esophagitis may be caused by corrosive agents and by commonly prescribed medications. We report severe esophagitis in five adolescents after ingestion of tetracycline preparations with minimal water immediately before going to bed.

Long-term evaluation of esophageal and pulmonary function in patients with repaired esophageal atresia and tracheoesophageal fistula.

Patients who have undergone repair of esophageal atresia and tracehoesophageal fistula as infants have been noted to have residual esophageal dysmotility and pulmonary dysfunction during their childhood years. However, limited information is available about the long-term follow-up of these patients. In this study we performed esophageal and pulmonary function studies on 12 adults who had required surgical repair of these defects in the first week of life. Most patients had symptoms of dysphagia and heartburn at time of evaluation. Pathologic gastroesophageal reflux was documented in 67% of patients and esophagitis was noted in 34%. All patients had esophageal motility abnormalities characterized by low-amplitude nonperistaltic waves throughout most of the esophagus. In addition, although most patients had no respiratory symptoms, mild restrictive lung volumes were noted in many patients. However, airflow obstruction and airway hyperreactivity were not present. These data demonstrate that clinical symptoms and abnormal esophageal manometry and pulmonary function persist well into the third and beginning of the fourth decade after repair of esophageal atresia and tracheoesophageal fistula in infancy.

Abdominal abscesses in adolescents with Crohn's disease.

Little information is available about the development of abdominal abscesses in adolescents with Crohn's disease. We report the clinical presentation of five adolescents with Crohn's disease who developed this complication. The mean time from diagnosis until development of an abdominal abscess was 1.7 years. The admitting diagnosis was an acute abdomen in two patients and recurrent Crohn's disease in the other three. No features of the clinical presentation or laboratory data distinguished this group from other adolescents with Crohn's disease. The use of ultrasound and CT scanning was helpful in making this diagnosis preoperatively. Those patients with active Crohn's disease who do not respond promptly to medical therapy should be evaluated for the development of this complication.

Severe colitis in late-onset Hirschsprung's disease.

Most patients with Hirschsprung's disease have symptoms of constipation and abdominal distension in the first several months of life. The development of enterocolitis in these patients, characterized by diarrhea, abdominal distension, and vomiting, is most common in the first 3 months of life and has been associated with a 30-50% mortality. We report a child with previously normal daily bowel movements who first developed constipation at 16 months of age; only when severe colitis and chronic lower gastrointestinal bleeding appeared at 3.5 years of age was the diagnosis of Hirschsprung's disease made.

Pyoderma gangrenosum occurring at multiple surgical incision sites.

Ten weeks after subtotal colectomy and ileostomy for ulcerative colitis, a 16-yr-old girl developed wound drainage and back pain. Massive ulceration and skin separation occurred at the abdominal wound incision as well as at the incision sites of a previous central venous line. A diagnosis of pyoderma gangrenosum was made. High-dose steroid treatment induced prompt healing of the abdominal wound as well as the catheter sites. Pyoderma gangrenosum has rarely been seen in surgical wounds. To our knowledge, this is the first reported case of pyoderma gangrenosum occurring simultaneously in multiple surgical incision sites in a patient with ulcerative colitis.

Pancreatitis in Kawasaki disease.

Two children with Kawasaki disease presented with vomiting, back and abdominal pain, elevated serum amylase values, and ultrasonographic findings consistent with pancreatitis. In both patients, pancreatitis appeared after approximately two weeks of illness, and both patients underwent extensive evaluations, which yielded negative results, for other disorders associated with pancreatitis. We suggest that in the absence of acute infection, and in the presence of appropriate diagnostic criteria, pancreatitis should be considered in all patients with Kawasaki disease who have severe abdominal pain.

Characterisation of humoral trophic factors involved in intestinal adaptation using a 3T3 cell growth factor assay.

Indirect evidence has suggested that circulating trophic factor(s) are involved in intestinal adaptation. A 3T3 fibroblast cell culture system was used to more directly delineate the presence of such factors. Rats were divided into four groups; C-unop, those undergoing no surgery, S, those in which a dorsal slit was made; C-op, those in which the peritoneum was incised; and R, those undergoing 80% intestinal resection. At the time of death at 24 hours, one week and two weeks postoperative, stimulation of DNA synthesis in the 3T3 cells was noted after incubation with platelet free plasma from the C-op and R groups, and simultaneously an increase in ileal DNA specific activity occurred. Characterisation of the plasma fraction with growth factor activity revealed it to have a MW of greater than 6,000 and less than 14,000 d. The factor(s) was resistant to reduction with DTT, and was partially inactivated by heating to 60 degrees C. The use of 3T3 cell growth factor assay system allows further characterisation of circulating factors involved in intestinal adaptation.

Use of a 3T3 cell growth factor assay for the delineation and characterization of humoral trophic factors involved in intestinal adaptation in the rat.

Indirect evidence has suggested that circulating trophic factors are involved in intestinal adaptation. A 3T3 fibroblast cell culture system was used to more directly delineate the presence of such factors. Rats were divided into four groups: C-unop, those undergoing no surgery; S, those in which a dorsal slit was made; C-op, those in which the peritoneum was incised; and R, those undergoing 80% intestinal resection. At the time of death at 24 h, 1 wk, and 2 wk postoperative, stimulation of DNA synthesis in the 3T3 cells was noted after incubation with platelet-free plasma from the C-op and R groups, and simultaneously an increase in ileal DNA specific activity occurred. Characterization of the plasma fraction with growth factor activity revealed it to have a molecular weight of greater than 6000 but less than 14,000. The factors were resistant to reduction with dithiothreitol, and were partially inactivated by heating to 60 degrees C. The use of a 3T3 cell growth factor assay system now makes it possible to further characterize circulating factors involved in intestinal adaptation.

Development of carbohydrate absorption in the fetus and neonate.

Maturation of mechanisms for carbohydrate absorption occurs in a defined sequence during human fetal development. The intestinal enzymes, lactase, sucrase, maltase, isomaltase, and glucoamylase, are at mature levels in the term fetus. Mature levels of pancreatic amylase activity and glucose transport occur postnatally, and levels are low in both the term and preterm neonate. In the preterm infant, sucrase, maltase, and isomaltase are usually fully active, but lactase activity, which increases markedly from 24 to 40 weeks, may be low depending upon fetal age. Despite these developmental patterns, clinical lactose intolerance is uncommon. Postnatal adaptive responses to ingested carbohydrates lead to competent carbohydrate absorption. Inadequately absorbed carbohydrates are salvaged by colonic flora through fermentation of carbohydrates to hydrogen gas and short-chain fatty acids; the latter are readily absorbed by the colon. In this setting, carbohydrate tends to be absent from the stool. Noninvasive reflection of the status of carbohydrate absorption may be obtained from breath hydrogen testing, a technique of particular value in young infants.

Prolonged elevation of transaminase concentration in children with unsuspected myopathy.

Prolonged elevation of the serum transaminase concentration in an asymptomatic child is usually thought to be secondary to liver disease. Four children with unexplained persistent elevation of serum transaminase concentration were referred to a pediatric gastroenterologist for studies of liver disease. Subsequent evaluation disclosed abnormal muscle biopsy findings in all four patients. This experience suggests that an appropriate workup for occult myopathy is indicated in such patients before invasive diagnostic procedures for evaluation of liver disease are undertaken.

Are endoscopic changes predictive of histologic esophagitis in children?

Controversy exists regarding the value of gross mucosal changes of the esophagus at the time of endoscopy in predicting histologic esophagitis. Accordingly, we reviewed the records of 279 pediatric patients who underwent both an upper endoscopy and simultaneous grasp esophageal biopsy. Of those patients with no gross mucosal abnormalities, 30% had evidence of esophagitis on biopsy. Similarly, there was a poor association between the presence of endoscopic findings and histologic esophagitis. We conclude that gross esophageal mucosal changes are poor predictors of histologic esophagitis and that endoscopic evaluation alone is inadequate for children and adolescents in whom esophagitis is suspected. Esophageal biopsies should be obtained in all such patients, even when no gross mucosal abnormalities are found.

Search for organic and volatile inorganic compounds in two surface samples from the chryse planitia region of Mars.

Two surface samples collected from the Chryse Planitia region of Mars were heated to temperatures up to 500 degrees C, and the volatiles that they evolved were analyzed with a gas chromatograph-mass spectrometer. Only water and carbon dioxide were detected. This implies that organic compounds have not accumulated to the extent that individual components could be detected at levels of a few parts in 10(9) by weight in our samples. Proposed mechanisms for the accumulation and destruction of organic compounds are discussed in the light of this limit.