The effects of MMPI-A T-score elevation on classification accuracy for normal and clinical adolescent samples.

In this investigation we examined the ability of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992) to classify accurately both clinical and normal adolescents using 2 different T-score elevation ranges, T > or = 60 and T > or = 65, and using 2 different clinical base rates for the occurrence of psychopathology. A clinical base rate of 50% and 20%, respectively, were created by comparing a clinical sample of 203 adolescent inpatients with cooccurring substance abuse and psychiatric disorders with 2 subsamples from the MMPI-A normative group. These subsamples consisted of 203 adolescents matched for sex and age, and a larger subsample of 1,015 adolescents proportionately matched for sex and age, with the clinical group. Classification accuracy analyses revealed that although clinical base rate did affect the accurate classification of cases, a T-score cutoff of 65 resulted in higher levels of accurate classification overall while minimizing the misclassification of both clinical and normal cases. Implications of these findings for the recommended use of the MMPI-A "gray zone" are presented, and the relative areas of strength and weakness of the MMPI-A are reviewed in the identification and description of psychopathology.

Weight loss and changes in energy metabolism in massively obese adolescents.

OBJECTIVE: To investigate the energy metabolism modifications induced by energy restriction and weight loss in massively obese adolescents. SUBJECTS: Ten massively obese girls (179 +/- 31% of ideal body weight; age, 13.3-16.4 y) after 2-5 weeks on a low-energy diet and 4.5-11.5 months later, that is, after a substantial weight loss, and eight controls. MEASUREMENTS: Resting energy expenditure (REE) and carbohydrate-induced thermogenesis (CIT) after a sucrose load (by indirect calorimetry), plasma glucose and insulin before and after the sucrose load. RESULTS: After 2-5 weeks on a low-energy diet, REE (7415 +/- 904 kJ/d) was lower than the expected value calculated from the regression equation of REE on fat free mass in controls (P = 0.005). After a 37 +/- 17% reduction in excess weight, REE decreased (6405 +/- 613 kJ/d) and remained lower than the expected value (P = 0.005). At the early stages of weight loss, the area under the plasma glucose response curve was negatively correlated with CIT (r = -0.80, P = 0.01) and was higher in the six obese adolescents with low CIT than in the four with normal CIT (396 +/- 52 vs 283 +/- 26 mmol.l-1.min-1, P = 0.01). After substantial weight loss, the area under the plasma insulin response curve decreased by 32% (P = 0.02), and both CIT and the area under the plasma glucose response curve became similar in obese patients with low and normal CIT prior to weight loss. CONCLUSION: These results indicate that in massively obese adolescents, REE for fat-free mass is decreased at the very beginning of the process of losing weight and remains decreased as long as energy restriction and weight reduction carry on. They also indicate that the impaired CIT sometimes observed returns to normal after weight reduction suggesting that it is secondary to a decrease in glucose uptake induced by obesity-associated insulin resistance.

Stability and compatibility of teicoplanin in parenteral nutrition solutions used in pediatrics.

AIMS: To investigate teicoplanin added to pediatric parenteral nutrition solutions in terms of its stability, its compatibility with parenteral nutrition solution components, and its diffusion through an antibacterial filter material. METHODS: Three binary solutions with and without teicoplanin were studied. Different solution compositions and teicoplanin concentrations were used: A (98.3 +/- 8.2 mg/l), B (116.3 +/- 12.4 mg/l), and C (162.7 +/- 16.2 mg/l). Concentrations of teicoplanin and of solution components, osmolality, and pH of each solution were measured at H0, after 24 h at room temperature, after 24 h at +4 degrees C followed by 24 h at room temperature, and after 144 h at +4 degrees C followed by 24 h at room temperature (H168). Teicoplanin concentrations were also measured before and after passage of each solution through a 0.22 micro filter. RESULTS: Teicoplanin concentrations remained unchanged from H0 to H168 in solutions A (99.6 +/- 8.3 mg/l), B (116.9 +/- 12. 3 mg/l), and C (162.4+12.9 mg/l). During the H0-H168 interval, iron and methionine were the only components that showed significant decreases, which were similar in solutions without teicoplanin [iron, -6.1% (A), -6.8% (B), and -4.5% (C); methionine, -7.3% (A) and -8. 7% (B)] and in those with teicoplanin [iron, -6.2% (A), -7.1% (B), and -4.0% (C, nonsignificant); methionine, -10.5% (A) and -10.7% (B)], indicating that they were not dependent on the presence of teicoplanin. Teicoplanin levels after filtration were identical to prefiltration values in solutions A (86.4 +/- 5.0 vs 89.8 +/- 3.4 mg/l) and B (112.6 +/- 4.3 vs 115.3 +/- 9.0 mg/l) but were 10.0% lower in solution C (161.6 +/- 3.9 vs 145.4 +/- 4.0; P << 0.001). CONCLUSIONS: Teicoplanin can be added to pediatric parenteral nutrition solutions to treat central venous catheter-related infections due to teicoplanin-susceptible organisms since its concentrations and those of solution components remain stable over time.

[Allergy to cow's milk protein hydrolysates: apropos of 8 cases]. / L'allergie aux hydrolysats de protéines due lait de vache. A propos de huit cas.

BACKGROUND: The use of extensively hydrolyzed protein formulas is the best alternative for children with cow's milk allergy, though cases of allergies to hydrolyzed proteins have been reported. The aim of this study was to clarify from our experience the diagnostic, evolutive and therapeutic aspects of allergies to extensively hydrolyzed protein formulas. PATIENTS AND METHODS: We report eight cases of allergy to extensively hydrolyzed protein formulas seen between 1985 and 1998. The diagnostic criteria for allergy were either the appearance of immediate anaphylactic reactions after the ingestion of protein hydrolysate or a positive challenge test with the protein hydrolysate. RESULTS: Four children developed immediate anaphylactic symptoms after ingesting protein hydrolysate, and four children demonstrated subacute or chronic gastrointestinal symptoms. All children who developed acute anaphylactic symptoms had positive skin tests and specific IgF, antibodies (RAST) to cow's milk and/or hydrolyzed proteins. Conversely, in the four children with chronic gastrointestinal symptoms, skin tests and specific IgE antibodies were negative in three cases, but intestinal histology was abnormal in all of them when they were fed with a protein hydrolysate; this became normal after excluding the hydrolysate (data available in only two cases). Three children tolerated another protein hydrolysate form (whey vs. casein), four children had a favourable outcome when fed with human milk, and an amino-acid-based formula was successfully used in the most recent case. Nonhydrolyzed cow's milk proteins were tolerated after the age of 18 months in six children. Other atopic symptoms were observed in six children. CONCLUSION: Allergy to cow's milk protein hydrolysate is rare. The diagnosis is usually easy in children who develop acute anaphylactic symptoms, though intestinal histology is generally necessary for the diagnosis of allergy with chronic gastrointestinal symptoms. Treatment is based on the use of either another protein hydrolysate form (whey vs. casein) or an amino-acid-based formula.

Occurrence of myeloproliferative disorder in patients with Noonan syndrome.

We report four cases of Noonan syndrome associated with chronic myelomonocytic leukemia in childhood. These children shared some hematologic features: thrombocytopenia, splenomegaly in the first months of life, occurrence of chronic myelomonocytic leukemia without abnormalities of the initial bone marrow karyotype, and, in three cases, improvement of the hematologic disease. A common pathophysiologic process in such patients is suggested.

Relation of apolipoprotein E polymorphism to lipid metabolism in obese children.

To determine whether the risk of obesity-associated dyslipidemia in children is influenced by apolipoprotein E (apoE) polymorphism, we studied 137 obese, nongenetically related children aged 2.2-14.4 y (mean age, 9.9 +/- 3.1 y) with a weight-for-height excess of 43.7 +/- 17.9%. The apoE genotype was determined by studying specific DNA restriction patterns. Total cholesterol, HDL-cholesterol, and triglycerides were assayed in plasma before dietary treatment initiation. ApoE allele and phenotype distributions were comparable to those reported in the Caucasian population at large. Fifty-five children (41%) had elevated lipid levels. Compared with obese children with the epsilon3 or epsilon4 allele, those with the epsilon2 allele were more likely to have hypertriglyceridemia (19.5% versus 52.9%, p < 0.05) and had a higher mean triglyceride level: children with the epsilon4 allele were more likely to have a LDL-cholesterol elevation (34.7% versus 13.4%, p < 0.05). Our data demonstrate that, even in childhood, obesity is associated with a marked increase in the risk of lipoprotein abnormalities and that the latter are influenced by apoE polymorphism.

[Digestive manifestations in hemolytic uremic syndrome in children]. / Les manifestations digestives du syndrome hémolytique et urémique de l'enfant.

BACKGROUND: Gastro-intestinal manifestations are relatively frequent during the course of hemolytic uremic syndrome (HUS), some of them requiring special supportive care. This work was aimed at retrospectively studing gastrointestinal manifestations of HUS and determining their place in the prognosis. PATIENTS: Thirty-seven children aged 4 months to 11 years (22 girls and 15 boys) were included in the study. RESULTS: All children but one had gastrointestinal prodromes. During the course of HUS, various manifestations were seen: bloody diarrhea in 32% of patients, ileo-ileal intussusception in 3%, rectal prolapse in 8% and hepatic cytolysis in 38%. Seven patients with bloody diarrhea had a complicated course, lethal in one. Comparison between these seven children and the 30 others revealed some indicators of severe gut involvement: female sex, short duration of gastrointestinal prodromes, hemorrhagic colitis with rectal prolapse, high WBC count, high neutrophils count and less important degree of anemia at admission. Severity of the gastrointestinal lesions was correlated with that of the outcome of the renal disease. CONCLUSION: Gastrointestinal tract is frequently affected in HUS and severe complications can appear, potentially leading to death. Total parenteral nutrition could prevent occurrence of gastrointestinal complications. Severe gastrointestinal lesions are associated with a poor renal outcome.

[Sarcoidosis in children with digestive manifestations]. / Sarcoïdose de l'enfant à révélation digestive.

BACKGROUND: Gastric involvement is the least rare among digestive localizations of sarcoidosis, as well in adults as in children. When it is to be seen at the beginning of the disease, it may cause difficulties in the diagnostic, especially with Crohn's disease. CASE REPORT: Gastric ulcers were detected in a 12 year-old girl, of African origin, who complained about epigastric pain. Eighteen months later, diarrhea, poor growing, uveitis and inflammatory biological signs led to a probable diagnostic of Crohn's disease. Endoscopy seemed to confirm this diagnostic with granulomatous lesions on gastric biopsies. The absence of radiological anomalies of the digestive tract and the poor efficiency of the medical treatment led to question this diagnosis and to assert that of sarcoidosis. CONCLUSIONS: This case allows to emphasize the rare involvement of the digestive tract in sarcoidosis and the aspects common both to Crohn's disease and sarcoidosis.

Energy balance in children and young adults receiving haemodialysis for chronic renal failure.

This study was designed to determine the contribution of energy expenditure to the energy imbalance seen in uraemic children. Resting energy expenditure (REE) was measured using open-circuit indirect calorimetry in eight uraemic haemodialysed subjects aged 9.3-20.4 years and in 10 healthy children. Linear correlations between REE and both body weight and fat-free mass as measured by anthropometry were found in both controls and uraemic subjects (respectively: r = 0.76 and r = 0.88 for body weight and r = 0.73 and r = 0.90 for fat-free mass). Measured REE in uraemic patients was not different from the value predicted by using actual body weight and fat-free mass in the regression equation of REE on body weight and fat-free mass in controls (paired t test: p = 0.70 and p = 0.19 respectively). These data suggest that the energy imbalance seen in uraemic children is not due to increased energy expenditure and is therefore probably due to decreased food intake.

Resting energy expenditure in infants with cystic fibrosis.

To evaluate the contribution of energy expenditure to the energy imbalance seen in cystic fibrosis patients, resting energy expenditure was measured using open-circuit indirect calorimetry in eight infants with cystic fibrosis, aged 2-7 months (mean, 4), without overt lung disease and in 10 healthy age-matched controls. In both groups, we found close, significant, linear correlations between resting energy expenditure and body weight and between resting energy expenditure and fat-free mass as measured by anthropometry. Cystic fibrosis patients had a 26% increase in resting energy expenditure per kilogram of fat-free mass as compared with controls and a 32% increase in resting energy expenditure as compared with predicted values for fat-free mass. These data from young infants free of clinical symptoms suggest a constitutional metabolic disorder in cystic fibrosis and support the need for early nutritional therapy in cystic fibrosis patients.

[Antigliadin, antireticulin, antiendomysium antibodies: value in the diagnosis and follow-up of celiac disease in children]. / Anticorps antigladine, antiréticuline et antiendomysium: intérêt dans le diagnostic et le suivi de la maladie coeliaque chez l'enfant.

In recent years, the clinical spectrum of coeliac disease has changed and forms with mild aspecific symptoms are today frequent. Therefore many infants are submitted to jejunal biopsy in order to exclude coeliac disease or to allow an early diagnosis. This has led to a search for a simple and reliable diagnostic test of coeliac disease in order to limit the use of jejunal biopsy. Recent data suggest that the study of serum antigliadin, antireticulin and antiendomysium antibodies may possibly play the role. In this paper the working group on coeliac disease of the Groupe Francophone de Gastroentérologie et Nutrition Pédiatriques expresses its view on the place of the dosages of these antibodies in the diagnosis and follow up procedures of coeliac disease in infants and children. At the present time, although it allows a simplification of the procedures, these dosages are presently not sufficiently reliable to serve as a substitute of jejunal biopsy.

[Value of individualized rehabilitation at the ventilatory threshold level in moderately severe chronic obstructive pulmonary disease]. / Intérêt du réentraînement à l'effort individualisé, au niveau du seuil ventilatoire, au cours de la bronchopneumopathie chronique obstructive de sévérité modérée.

In order to study the efficiency of individual training programs at the ventilatory threshold level, twenty COPD patients were randomized into two groups and studied over a two-month period. At the start, during, and at the end of the study all subjects performed incremental exercise tests. The trained group (59.60 SEM +/- 2.75 years) walked four times a week at the heart rate corresponding to the metabolic level of ventilatory threshold. The other group served as controls (58.2 +/- 1.80 years). A marked increase in the symptom-limited oxygen consumption (+/- 25%) (p < 0.01), the maximal ventilation (+20%) (p < 0.01), and the ventilatory threshold (+19%) (p < 0.05) was found in the trained group. No modification was recorded in the control group. The ventilatory pattern at submaximal intensities expressed in percentage of the initial oxygen consumption showed significant differences between groups, the trained-group ventilation decreased at 50% and 75% VO2 sl (p < 0.05). The breathing frequency also decreased at 50% and 75% VO2 sl (p > 0.05). Moreover, we observed an increase in the oxygen pulse at 50% VO2 sl (p < 0.05). In conclusion, this study demonstrates that individualized training at the ventilatory threshold level increases exercise tolerance and produces better ventilatory comfort in COPD patients.

Resting energy expenditure and food-induced thermogenesis in obese children.

Nineteen overweight girls 14.54 +/- 0.38 years of age were studied. Results were compared with those obtained in eight age-matched (14.07 +/- 0.51 years) and sex-matched normal weight controls. Energy expenditure (EE) was determined using open-circuit indirect calorimetry at rest, both after a 12-h fast and after an oral sucrose load of 3 g/kg ideal body weight. Food-induced thermogenesis (FIT) was evaluated by computing the area under the curve of the EE response above resting energy expenditure (REE) during the first 3 h after the sucrose load, REE (kcal/day) was higher in the overweight patients (1,818 +/- 46 vs. 1,527 +/- 67; p = 0.002); REE standardized by fat-free mass (FFM) (kcal/kg FFM/day) was lower in obese children than in controls (35.2 +/- 1.0 vs. 44.9 +/- 1.9; p = 0.0001). A linear correlation between REE and FFM was evidenced in both controls and overweight subjects (r = 0.78 and 0.68, respectively; p = 0.05 and p < 0.001, respectively). Actual REE in the obese children was significantly lower than the value predicted by applying the regression equation of REE on FFM in controls to the actual FFM in obese children (paired t test; p = 0.003). FIT was identical in overweight and normal weight subjects, regardless of whether it was expressed in absolute value, as the percentage calorie intake, or standardized by FFM.(ABSTRACT TRUNCATED AT 250 WORDS)

[Reactions to iodine contrast media]. / Réactions aux produits de contraste iodés.

Contrast media are used in many radiological examinations, but they are responsible for 4.6 to 8.5 percent of the toxic or anaphylactoid adverse reactions observed. The early contrast media were hyperosmolar, whereas those in current use are isosmolar and either ionic or non-ionic. The patient's age, the presence of a pre-existing disease and a history of adverse reactions to contrast media are the most important risk factors. Seventeen to 35 percent of these reactions recur. Several physiopathological mechanisms have been blamed for adverse reactions to contrast media, including complement activation, histamine release, recruitment of inflammation mediators, and antigen-antibody reaction. There is no paraclinical examination that can diagnose or predict such reactions. Various preventive tests have been studied and applied to individuals with or without history of reaction. In a population of patients with previous reaction, the administration of corticosteroids 12 h and 2 h before the radiological examination resulted in a significant reduction of the number of reactions. In patients at risk (i.e. those with previous reactions of this kind) the results varied, but in these 2 groups of subjects non-ionic products given either alone or with corticosteroids or H1-antihistaminics reduced to 1 percent the incidence of reactions. So far, tachyphylaxis has virtually played no role compared with these preventive treatments. It is concluded that patients with a history of anaphylactoid reactions who must receive another injection of contrast medium, a non-ionic product and/or the H1-antihistaminic-corticosteroid combination should be used.