Hepatitis B vaccination in children with thalassemia in northern Greece.

Sera from 101 children with thalassemia, aged between 6 months to 15 years, were examined for detection of HBV infection. Of these 101 children, 18 negative for all HBV markers were vaccinated against HB with "Hevac B" vaccine from the Pasteur Institute. Our results show that 3 inocculations at one-month intervals have induced an excellent antibody (anti-HBs) response in all vaccinated children, affording full protection against HBV infection. There were no noticeable local or general reactions to "Hevac B" vaccine. Our results, in accordance with other reports, have revealed that hepatitis B vaccine is highly immunogenic for children with thalassemia and is particularly well tolerated.

Virological and serological study in children hospitalized for acute hepatitis (detection of HBsAg, HAAg, anti-HAV and specific IgM-anti-HAV).

Serological methods were used to detect different markers of hepatitis A and B infection in a series of 36 children aged 3.5-13 years with acute viral hepatitis, hospitalized from August 1978 to October 1978. Hepatitis A was verified serologically in 30 patients (83.3%) with the demonstration of specific IgM-anti-HAV. Hepatitis B infection was serologically confirmed in only 2 patients (5.5%). After exclusion of hepatitis A and B as well as of hepatitis due to cytomegalovirus, leptospira and Epstein-Barr virus, 3 patients (8.3) were classified to have post-transfusion non-A non-B hepatitis, and 1 patient (2.5%) showed a sporadic non-A non-B hepatitis. The finding of HBsAg in 5 of 30 patients with hepatitis A suggests that the presence of HBsAg during the acute icteric phase of viral hepatitis is not sufficient for a diagnosis of HB. The presence of HAAg in one of 30 patients with HA confirms previous studies that faecal shedding of HAV stops with the appearance of jaundice. Finally, the above results establish the value of the new radioimmunoassay technique for detection of specific IgM-anti-HAV, which appears to be the best diagnostic test for hepatitis A.

Intestinal damage in rotavirus and adenovirus gastroenteritis assessed by d-xylose malabsorption.

The absorption of D-xylose infused into the duodenum was assessed in infants with acute gastroenteritis. 1-hour blood-xylose levels were low in 6 patients found to harbour rotavirus in the small intestinal aspirate. Normal levels (greater than 1-26 mmol/l) were obtained in the absence of virus particles in the small intestine in a further 6 patients: in 3 of these adenovirus or rotavirus was recovered from the stools. Three patients with adenovirus in the small intestinal juice and ill with acute gastroenteritis also had low xylose levels. This finding supports earlier epidemiological studies that adenovirus may be a causative agent of acute infantile gastroenteritis. The association between virus in the small intestine and xylose malabsorption may indicate mucosal damage. Formal proff of this is awaited.

Hepatic dysfunction in association with pancreatic insufficiency and cyclical neutropenia. Shwachman-Diamond syndrome.

A patient with pancreatic insufficiency and cyclical neutropenia is described who also has evidence of hepatic dysfunction. He and 3 other patients whose findings are given emphasize the wide range of abnormalities seen in this syndrome.

Evaluation of the intraepithelial lymphocyte count in the jejunum in childhood enteropathies.

Intraepithelial lymphocyte counts were evaluated in 131 jejunal mucosal biopsies taken from children with a small intestinal enteropathy arising from a variety of causes including coeliac disease, (untreated, after gluten withdrawal, and during subsequent challenge), giardiasis, cow's milk protein intolerance, and 'intractable diarrhoea'. The counts were compared with those from the biopsies of children referred for investigation but in whom no gastrointestinal disease was demonstrated and from healthy siblings of children with coeliac disease, investigated during a family study. Children with coeliac disease showed a raised count which fell after gluten withdrawal as has been demonstrated by others in adults. Lymphocytic infiltration of the epithelium increased rapidly during gluten challenge in such children, while no change was seen in those children proven ultimately not to have coeliac disease by the usually recognized criteria. In other enteropathies the range of counts was wide, overlapping with both normal and coeliac groups and indicating the nonspecificity of lymphocytic infiltration of the gut epithelium. The findings are discussed in relation to their significance and to further avenues of investigation to determine their possible diagnostic value in confirming the diagnosis of coeliac disease during gluten challenge.