Vitamin D, calcium, and bone status in children with developmental delay in relation to anticonvulsant use and ambulatory status.

Reports of abnormalities in vitamin D, calcium, and bone status associated with anticonvulsant use are inconsistent and difficult to interpret because of widely varying study designs, particularly for ambulatory status. We examined the relative effects of anticonvulsant use and ambulatory status on vitamin D, calcium, and bone status in a large group (n = 338) of children who had either normal motor function (ambulatory) or were nonambulatory and either receiving anticonvulsants or not; all had developmental delays. Data included diet records, serum analyses (calcium and calcidiol), and hand-wrist radiographs evaluated for bone maturation and quality. Data were analyzed by using a general linear models (GLM) procedure. Dietary and biochemical data were compared with those of a group of 34 normal children. There were no differences in calcium or vitamin D intakes among the four study groups; however, a high percentage of intakes was below the recommended dietary allowances for calcium (56%) and vitamin D (70%). Vitamin D intakes were positively associated with serum calcium (P < 0.005) and calcidiol (P < 0.01) concentrations. Analysis of covariance indicated that ambulatory status but neither anticonvulsant use nor their interaction contributed significantly to the prediction of serum calcium (P < 0.009) and calcidiol (P < 0.0001), the Z scores for number of ossified centers (P < 0.008), bone age (P < 0.0001), and bone area (P < 0.003). A strong interaction between anticonvulsant use and ambulatory status was seen for percentage cortical area (P < 0.0008), which was entirely due to anticonvulsant use in nonambulatory children (effect size = 0.98). Results suggest that ambulatory status is more important than was recognized previously in relation to abnormalities in vitamin D, calcium, and bone statuses; that all nonambulatory children may be at risk for low serum calcidiol and osteopenia; and that routine monitoring of risk and consideration of prophylactic vitamin D supplementation are warranted.

Megavitamin treatment of mental retardation in children: a review of effects on behavior and cognition.

ABSTRACT Many forms of vitamin supplementation have been proposed for the treatment of behavioral and cognitive disorders in children with mental retardation. Except for nutrient deficiencies and selected inborn errors of metabolism, the efficacy of these treatments has not been established. Therapeutic supplementation with vitamin B(6) in Down syndrome and folie acid in fragile X syndrome was attempted following the identification of apparent biochemical aberrations involving the nutrients. Double-blind controlled trials have revealed no evidence that B(6) treatment was effective in Down syndrome. Very limited evidence, only among prepubertal subjects, suggested that behaviors improved with folie acid treatment in fragile X syndrome. There is less clarity of the scientific rationales for various combinations of vitamins (or vitamins and minerals) that have been promoted according to the concept of orthomolecular medicine. Well-designed controlled studies, with data presented in conformity with generally accepted scientific standards, have not supported the efficacy of megadose supplementation with 1) multivitamins in cognitive disabilities or attention deficit disorders, or 2) multivitamins and minerals in Down syndrome or other forms of mental retardation. Insufficient data are available to support claims made for vitamin B(6) and magnesium supplementation in autism. Research in the larger field of nutrient-behavior research has reinforced the need for studies to be more rigorously designed and to draw on the expertise of multiple disciplines. Evidence of toxic effects of nutrients continues to accrue, reinforcing the fact that megadoses should not be used indiscriminately or without physician monitoring. For children with mental retardation generally, assuring that established nutritional needs are met warrants primary consideration.

[Giant diverticulum of the urethra]. / Olbrzymi uchylek cewki moczowej.

A case is described of a giant acquired diverticulum of the anterior portion of the urethra. The cause was stricture of the penile part of the urethra. With time a large number of calculi developed in the diverticulum. The method of surgical treatment and the postoperative course are described calling attention to the importance of postoperative management of such cases.

[Fibrosis of the cavernous body caused by inveterate rupture of the penis]. / Zwlóknienie ciala jamistego w wyniku zastarzalego zlamania pracia.

A case is reported of inveterate fracture of the penis. During surgical treatment complete destruction of the corpus cavernosum was noted which was compressed by two encapsulated haematomas. At the site of the corpus cavernosum a scar was present. The authors think that early surgical treatment could prevent this complication.

Anticonvulsant medication use and circulating levels of total thyroxine, retinol binding protein, and vitamin A in children with delayed cognitive development.

Circulating thyroxine (T4), retinol binding protein (RBP), and vitamin A were measured in conjunction with nutritional status assessment of 707 cognitively delayed children, ages 3.0-9.0 y. Twenty percent were receiving anticonvulsant (AC) medication. T4 was lower and RBP and vitamin A were higher (p less than 0.0001) among AC than non-AC subjects. Molar ratios of vitamin A:RBP did not differ between the two groups nor did intakes of protein or vitamin A. Lower T4 and higher RBP were found among children who received diphenylhydantoin (DPH), phenobarbital, or AC combinations, but vitamin A was higher only among those who received DPH. RBP and vitamin A were lower (p less than 0.05) among children with infections and vitamin A was lower (p less than 0.05) among those with serum zinc less than 70 micrograms/dL (less than 10.7 mumol/L); differences between AC and non-AC subjects remained when other variables were considered.

Energy and nutrient values from different computerized data bases.

Twenty-four dietary records were analyzed using three computerized nutrient data bases. Differences in mean values were found for 9 of 19 variables evaluated. No one data base consistently yielded highest or lowest values for all nutrients. Mean values appeared to be most consistent among the data bases for energy and the energy-yielding nutrients, calcium, phosphorus, and magnesium. Even when mean values did not differ significantly, values for some individual diets were widely discrepant. Whether comparisons of calculated energy and nutrient values are within or between studies and based on a few or many days of dietary information, values should be recognized as estimates and their limitations and strengths respected.

Protein supplement resistant against ruminal degradation as a factor improving utilization of urea in ruminant feeding.

The metabolic and productive effects of the blood meal and formaldehyde (FA) treated casein supplements (5-10% of crude protein content) given with urea concentrates in sheep and fattening bulls were investigated. The blood meal has a similar composition of essential amino acids (EAA) to casein. The mean solubility of the FA treated casein and the blood meal after 6 hours of incubation in the sterilized rumen contents amounted 10.5% and 8.5% respectively. The average rumen ammonia concentration and plasma urea level was the highest in bulls fed urea ration without protected protein supplement. The supplementation of this ration with blood meal diminished the large daily fluctuation of plasma AA level and increased plasma EAA/NEAA ratio. The blood meal supplement improved the nitrogen retention in sheep (14%) and body gains in bulls (9%) but did not influence digestible coefficients and rumen protein synthesis in sheep.

Isokinetic testing in patients with hemiparesis. A pilot study.

The Cybex II isokinetic dynamometer was used to measure quadriceps femoris and hamstring muscle function in 15 patients with hemiparesis. Comparisons of isokinetic data obtained at 30 degrees/sec and 180 degrees/sec were made between the involved and uninvolved side of patients and the right side of 15 healthy subjects matched by age, sex, and weight. Peak torque of both muscles on both sides of the patients was significantly less than the peak torque of muscles of healthy subjects at both speeds. Other significant differences occurred on the involved side including decreased limb excursion, prolonged time factors related to tension development and the interval between reciprocal contractions, and fatigability at high speed. Results indicated that isokinetic testing can provide objective information about quadriceps femoris and hamstring muscle performance in hemiparetic patients.