Milk-sensitive eosinophilic gastroenteritis in a 10-day-old boy.

Eosinophilic gastroenteropathy in children is a rare, idiopathic disease characterized by eosinophilic infiltration of the gastrointestinal tract. We describe a 10-day-old boy with aspecific clinical manifestations (unconsolable crying). Treatment with a semi-elemental diet was successful, suggesting a "milk-sensitive enteropathy", although he had been exclusively breast fed. Recent literature is reviewed.

Penetration of cefoperazone into ascites.

The pharmacokinetics of cefoperazone was studied in eleven cirrhotic patients with ascites after i.v. administration of a single dose of 15 mg.kg-1 (n = 7) or after three doses of 15 mg.kg-1 given at 12 h intervals (n = 4). The concentrations of cefoperazone in serum and ascitic fluid were determined by HPLC. The peak serum cefoperazone concentration after a single i.v. injection of 15 mg.kg-1 was 96.0 mg.l-1. The serum elimination half-life was longer (5.0 h) than in normal subjects. The penetration of cefoperazone into ascites was satisfactory (32.3% and 58.3% after single and repeated injections, respectively). Ascitic fluid concentrations of cefoperazone exceeded 5.4 mg.ml-1 from 0.5 to 6 h after the single i.v. injection, levels which are well above the MIC of most pathogens found in spontaneous bacterial peritonitis. Adjustment of the dose of cefoperazone in cases of severe hepatic insufficiency does not appear to be necessary provided that renal function is normal.

Vasoconstrictive effect of portal blood in isolated dog kidney.

Humoral vasoactive substances coming from portal blood have been considered as a possible cause of renal dysfunction in cirrhotic patients. We have thus investigated the effect of perfusion of portal blood from anesthetized dogs on the isolated kidney functions. Both kidneys of a dog were simultaneously perfused on 2 Nizet's pump oxygenators, one kidney serving as control for the other. Renal blood flow was decreased in kidneys perfused with portal blood, as compared to the paired control kidneys perfused with sus-hepatic blood (group A experiments). Addition of polymyxin B to the portal blood restored the renal blood flow to the control level (group B experiments). No significant changes appeared between experimental and control kidneys for glomerular filtration rate, urine output, sodium and water excretion, renin activity, angiotensin II levels, plasmatic PGE2 levels, in group A as well as in group B. We conclude that portal blood of dogs contains vasoactive substances reducing renal blood flow; their action is mediated neither by the renin-angiotensin system nor by changes in renal PGE2 production. The complete abolition of this effect by Polymyxin suggests that these substances may be endotoxins.

Comparison of elastase-1 with amylase, lipase, and trypsin-like immunoreactivity in the diagnosis of acute pancreatitis.

Serum elastase-1, amylase, lipase, and trypsin-like immunoreactivity were measured in a group of 17 consecutive patients with acute pancreatitis. When assayed within 24 h of the onset of symptoms, all enzymes were found to be elevated, thus showing similar sensitivity. Elastase-1 did not improve the diagnostic score of the other enzymes studied. Owing to their much quicker and less expensive determinations, amylase and lipase should be considered the best initial markers of pancreatic injury. However, during the course of pancreatitis, amylase and in a lesser degree lipase returned to normal in more cases than elastase or trypsin; both were still elevated in 90% of the patients 10 days after the onset of the symptoms. Thus, trypsin and/or elastase-1 should be reserved for cases of doubtful or delayed diagnosis. The specificity and the positive predictive value of these enzymes need to be evaluated.

Malabsorption of liposoluble vitamins in a child with bile acid deficiency.

A male born to first cousins presented at 12 months with hypocalcemic convulsions, rickets, epistaxis due to vitamin K deficiency, and extremely low serum levels of beta-carotene and vitamin A. Liver function was altered moderately (glutamic-oxaloacetic transaminase, 55 U/L; glutamic-pyruvic transaminase, 37 U/L; lactate dehydrogenase, 255 U/L; alkaline phosphatase, 437 U/L). To correct the deficiencies, 8,000 IU vitamin D/day, 10,000 IU vitamin A/day, and intramuscular administration of vitamin K1 were required. At 9 years, he presented signs of neuromuscular affection, and the serum vitamin E level (measured for the first time) was extremely low. Classic lipid malabsorption syndromes (abetalipoproteinemia, chronic cholestasis, mucoviscidosis, coeliac disease, Whipple's disease) were excluded by appropriate examinations. Composition of duodenal bile acids was characterized by undetectable levels of cholic acid metabolites, and only chenodeoxycholic acid metabolites were present. Serum total bile acid concentration was normal, with an atypical low cholic acid/chenodeoxycholic acid ratio and abnormal presence of 3 beta-OH-delta 5-cholenic acid and 6-OH-bile acids. Urinary bile acid composition was also characterized by elevated 6-OH-bile acids. Known enzymopathies of the bile acid synthetic pathway were excluded (cerebrotendinous xanthomatosis, cerebro-hepato-renal syndrome of Zellweger, coprostanic acidemia). Bile acid pool sizes were determined by using stable isotopes: cholic acid pool size [2.90 (N, 32 +/- 16) microM/kg] and chenodeoxycholic acid pool size [10.8 (N, 32.6 +/- 9.9) microM/kg] were extremely low; fractional turnover rates of both bile acids were in a normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Whole gut lavage for colonoscopy--a comparison between two solutions.

The clinical efficacy and patient acceptability of a new solution containing mainly sodium sulfate and polyethylene glycol (solution II) compared with a balanced standard electrolyte solution (solution I) for whole gut lavage prior to colonoscopy were evaluated in 240 ambulatory and hospital patients randomly allocated to receive either of the two solutions. On the basis of the quality and rapidity of the bowel preparation and the good results obtained by clinical and biological parameters, we found that the newly designed solution was superior.

[Comparative effects of oral water load of different mineral compositions on the excretion of ions and oxalic acid]. / Effets comparés sur l'excrétion des ions et de l'acide oxalique de charges orales en eaux de compositions minérales différentes.

The effects on urinary excretion of a 1500 ml daily load of three drinking waters with different ionic contents were studied in six normal subjects. Diuresis was similarly increased by the three waters of an amount equal to the load. Urine output of urea, creatinin, uric acid, phosphate, potassium, magnesium was not significantly modified by the three waters as compared to a control period. Natriuresis was significantly increased following the intake of the water which contained sodium as well as calciuria with the water containing calcium. Urine output of oxalate was increased by the three waters in correlation with the free water content of the load. This effect is probably due to a reduction in passive tubular reabsorption of oxalate since a similar effect was observed with an equivalent water load given by intravenous route. Nevertheless, due to the dilution of urine, the index of urine saturation for calcium oxalate was diminished by the three waters.

Blood anions and electrolytes during ritodrine infusion in preterm labor.

Seven patients with threatened premature labor and six nonpregnant female control subjects were studied for 12 to 24 hours during ritodrine infusion in order to re-evaluate the effects of this beta-adrenergic tocolytic agent on blood anions, electrolytes, and acid-base balance. Dexamethasone was given intramuscularly in all patients and three control subjects at the beginning of ritodrine infusion. Lactate, pyruvate, betahydroxybutyrate, sodium, potassium, chloride, bicarbonate, pH, glucose, and insulin levels were measured in blood samples obtained at intervals of 2 to 6 hours. While pH remained in the normal range, increases in lactate and pyruvate levels and decreases in bicarbonate values resulted in a significant increase in anion gap 4 to 6 hours after the beginning of treatment. The blood potassium level fell simultaneously. These effects were transient, lasting less than 10 hours, despite continuation of ritodrine infusion and maintenance of tocolysis and tachycardia. Although larger increases in the blood glucose level were observed with combined therapy in control subjects, dexamethasone had no additional influence on potassium concentrations. Monitoring of patients treated by intravenous ritodrine should include routine measurements of blood glucose and electrolyte levels in order to detect its potentially harmful metabolic side effects for mother and fetus.

Determination of reference standards for adrenal steroids excretion in normal prepuberal children.

An improved method of gas-liquid chromatography (GLC) for routine estimation of adrenal steroids in urine is presented. It was applied to the exploration of steroid output in 120 normal prepuberal children to both sexes aged 3 months-12 years. Urinary data were compared to plasmatic values of adrenal hormones estimated by radio-immuno-assays (RIA). Analysis of the relationships between steroids outputs and bone age revealed that the excretion of cortisol catabolites was expressed by a saturation curve whereas that of delta 4-3 keto androgens catabolites were expressed by geometrical pregression curves; urine dehydroepiandrosterone (DHEA) and plasma DHEA-sulfate showed outbreaks of high values beyond 6 years of age which ruled out all curve fitting attempts. The computation of these relationships allowed to determine the confidence belts of the various regressions which appear as a useful tool to estimate the delayed or accelerated character of adrenal activity in prepuberal childhood. Comparison of the various urinary (GLC) and plasmatic (RIA) parameters enabled us to comment on adrenal puberty.