Different beta-casein fractions in Icelandic versus Scandinavian cow's milk may influence diabetogenicity of cow's milk in infancy and explain low incidence of insulin-dependent diabetes mellitus in Iceland.

OBJECTIVES: To compare children with insulin-dependent diabetes mellitus (IDDM) with controls in Iceland regarding their consumption of cow's milk in infancy, and to investigate the beta-casein fractions in Scandinavian and Icelandic cow's milk. The A1 variant of beta-casein has been shown to be diabetogenic in animal studies, and suggestions have been made that the B variant of beta-casein acts similarly. Differences in the relative proportions of beta-casein fractions might explain the lower incidence of IDDM in Iceland than in Scandinavia. METHODS: A retrospective case-control study on IDDM patients and matching controls was performed in Iceland to compare their diets in infancy. Fifty-five children with IDDM born in Iceland over a 16-year period and randomly collected controls (n = 165) were recruited to the study. Mothers of the children answered questions on breastfeeding habits and on when cow's milk products were introduced. Samples of cow's milk from randomly selected milk batches from the largest consumption areas in Iceland and Scandinavia were collected. The milk samples were freeze-dried and their beta-casein fractions were analyzed using capillary electrophoresis. RESULTS: No significant difference was found between IDDM patients and controls in the frequency and duration of breastfeeding or the first introduction of cow's milk products. The analyses of milk samples showed that the percentage of the A1 and B variants of beta-casein in Icelandic milk was significantly lower than in the milk from the Scandinavian countries. CONCLUSIONS: Cow's milk consumption in infancy is not related to IDDM in Iceland. The lower fraction of A1 and B beta-caseins in Icelandic cow's milk may explain why there is a lower incidence of IDDM in Iceland than in Scandinavia.

[Enuresis amongst schoolchildren in an Icelandic town.].

Enuresis is defined as uncontrolled voiding during day or night after normal control is expected. It is a common disorder, which can be divided into primary and secondary. We looked at the health files from children born between 1986-1988, written when they started school. There were 62 children which were said to have enuresis matched with 62 controls of same sex and from the same class. Questionnaires were sent to the parents of each child. That way five more children were found. A total of 101 took part in the study, 52 patients and 49 controls. The prevalence of enuresis was 9.8%, boys being almost two thirds. 69% had primary enuresis, 56% only/also at daytime. Over 44% of patients had a parent with history of enuresis and 48% other relatives too. 88% said that the disorder influenced their children's lives. Many parents worried and sought advice. Urinary infection was commoner among patients but not other diseases. Many children were evaluated and therapy attempted in 54%, mostly drugs and/or alarm device. Permanent results were disappointing. Our results are similar to other studies. Most of our patients still had enuresis when the study took place but 15-17% should spontaneously cure each year. A few still might have this problem in adulthood.

[Pneumatosis coli - A case from the department of obstetrics and gyneocology.].

UNLABELLED: A 36 year old woman, pregnant 41 weeks and two days was admitted to the hospital in labour. The course was slow, foetal distress was seen with foetal heart monitoring. Cesarean section was performed and a healthy boy delivered. Three days later she developed abdominal pain and passed extensive flatus. Fever was 39 degrees C rectally. Abdominal x-ray showed signs of mechanical ileus and laparotomy was performed. Appendix was swollen and therefore removed. Post operatively the woman developed massive diarrhea. Acute colonoscopy showed air-filled vesicles in distal colon, macroscopically diagnosed as pneumatosis coli. The treatment was 50% oxygen initially but was increased to 70% because of slow improvement. P02 was kept at 250-300 Hg and colonoscopy on the 24th day showed almost full recovery. DISCUSSION: Pneumatosis cystoides intestinalis is a rare, benign disease, characterized by subserosal/ submucosal vesicles, varying in size and number. Aetiology is unknown but it has been associated with some gastrointestinal diseases, abdominal surgery, and lung diseases. The pathology is unknown but three main theories exist. Symptoms can be abdominal pain, diarrhea, flatus and rectal bleeding. Diagnosis is by x-ray, CT scan or colonoscopy. Treatment is high oxygen doses for one to two weeks but if another disease is underlying surgery might be needed. The prognosis is good but a certain chance of relapse exists.