Increased abdominal fat mass and high fat consumption in young school children with congenital heart disease: results from a case-control study.

BACKGROUND: We have previously found that infants with complex congenital heart disease (CHD) experience growth failure despite high-energy dietary supplementation. This is a follow-up and comparison with healthy controls at 9 years of age regarding body composition and macronutrient intake, especially in relationship to the diet provided during infancy. METHODS: Anthropometric changes in 10 children with CHD at 12 months and at 4 and 9 years of age were analysed as Z-scores. To assess body composition and food intake at 9 years of age, a dual-energy X-ray absorptiometry scan and a 3-day food diary were completed and compared with age- and gender-matched controls using Wilcoxon's signed-rank test for matched pairs. RESULTS: Growth changes from 12 months to 9 years, converted to Z-scores for weight for height and height for age, were significantly different within the group of children with complex CHD, although no growth differences were seen in comparison with healthy controls at 9 years of age. However, the children with CHD had statistically higher abdominal fat mass index and higher daily intake of fat, particularly from saturated fatty acid in g kg-1 compared to controls. CONCLUSIONS: At 9 years of age, children with complex CHD with growth failure and high fat intake in infancy have normalised growth but increased abdominal fat mass and higher intake of saturated fatty acid compared to their peers. Nutritional monitoring in early childhood may detect unhealthy diet quality and prevent later health risks in this group.

Do not forget the parents-Parents' concerns during transition to adult care for adolescents with congenital heart disease.

BACKGROUND: Growing up with congenital heart disease (CHD) often means transfer to adult care and lifelong medical follow-up. An optimal transition process usually involves a multipart collaboration between the patient, their parents and other family members, and the healthcare providers. Taking an active role while knowing when it is time to step aside can be difficult for all the concerned parties, even the healthcare professionals. The aim of the present study therefore, was to explore parents' expectations and needs during their adolescent's transition to adult care. METHOD: Semi-structured interviews were conducted with 18 parents of 16 adolescents (aged 13-18 years) with CHD in 4 pediatric cardiology settings in Sweden. The interviews were analysed with qualitative content analysis. RESULTS: The analysis resulted in 2 main themes: (a) Feeling secure-the importance of being prepared and informed. This theme focused on the need to be prepared and informed about transition and future transfer to adult care. (b) Recognizing when to hand over at the right time. This theme addressed the process of handing over the responsibility from the parent to the adolescents and contained handing over from pediatric care to adult care. CONCLUSION: Being prepared and informed about the upcoming transition process was essential. The parents underlined the importance of being involved in the transition planning for gradually handing over responsibility to the adolescent. They also considered establishing contact with the adult healthcare team before transfer as important and needed to be assured that CHD-related information of importance for the young person's daily life would be given.

Ocular Motor Function in Children with Spastic Hemiplegia Evaluated by the Ocular Motor Score.

PURPOSE: To assess the ocular motor functions in children with spastic hemiplegia by using the Ocular Motor Score (OMS). MATERIAL: This study included 34 children, median age 11 years. The children were divided into 3 groups according to the underlying brain lesion; group 1 malformations, group 2 white matter damage of immaturity (WMDI), and group 3 cortical/subcortical lesions. METHODS: The OMS protocol consists of 15 different subtests evaluating ocular motor functions. The OMS is divided into 2 parts, a static and a dynamic. The results from each subtest are scored 0, 0.3, 0.5, or 1, according to the level of disturbance, where 0 corresponds to normal function and 1 represents the maximum disability in the certain subtest. A total OMS (tOMS) between 0 and 15 can be obtained. RESULTS: The median tOMS in the whole spastic hemiplegia group was 2.5 (range 1.3-5.8). The highest median tOMS 5.2 was seen in group 1, in the children with malformations. Strabismus was found in 45% (15/34) of the children, with an equal percentage in all 3 groups. CONCLUSIONS: The children with spastic hemiplegia had a median tOMS of 2.7 and the highest median tOMS was seen in children with malformations. The OMS protocol is easy to use clinically and gives a quick overview of the patient´s ocular motor functions.

Prevalence of Intracranial Aneurysms in Patients with Aortic Aneurysms.

BACKGROUND AND PURPOSE: Previous studies have suggested an association between aortic aneurysms and intracranial aneurysms with a higher prevalence of intracranial aneurysms in patients with aortic aneurysms. The aims of the present study were to evaluate the incidence of intracranial aneurysms in a large cohort of patients with aortic aneurysms and to identify potential risk factors for intracranial aneurysms in this population. MATERIALS AND METHODS: We included all patients with aortic aneurysms (either abdominal and/or thoracic) who had available cerebral arterial imaging and were seen at our institution during a 15-year period. We identified patients with intracranial aneurysms. Patient demographics, comorbidities, and aortic aneurysm and intracranial aneurysm sizes and locations were analyzed. Univariate analysis was performed with a χ(2) test for categoric variables and a Student t test or ANOVA for continuous variables. RESULTS: A total of 1081 patients with aortic aneurysms were included. Of them, 440 (40.7%) had abdominal aortic aneurysms, 446 (41.3%) had thoracic aortic aneurysms, and 195 (18.0%) had both abdominal aortic and thoracic aortic aneurysms. The overall prevalence of associated intracranial aneurysms in patients with aortic aneurysms was 11.8% (128/1081), with 12.7% (56/440), 10.8% (48/446), and 12.3% (24/195), respectively, in patients with abdominal aortic aneurysms, thoracic aortic aneurysms, and both thoracic aortic aneurysms and abdominal aortic aneurysms. Female patients had a higher risk of associated intracranial aneurysms (OR = 2.08; 95% CI, 1.49-3.03; P = .0002). There was a slight association between abdominal aortic aneurysm size and the prevalence of intracranial aneurysms (OR = 1.02; 95% CI, 1.01-1.03; P = .045). There was no significant association between the locations of the aortic and intracranial aneurysms (P = .93). CONCLUSIONS: The prevalence of intracranial aneurysms is high in patients with aortic aneurysms. Further studies examining the role and cost-effectiveness of intracranial aneurysm screening in patients are warranted.

Dietary intake in infants with complex congenital heart disease: a case-control study on macro- and micronutrient intake, meal frequency and growth.

BACKGROUND: Children with severe congenital heart disease (CHD) need considerable nutritional support to reach normal growth. The actual intake of macro- and micronutrients in outpatient CHD infants over a 6-month period in infancy is not described in the literature. The present study aimed to prospectively investigate the distribution between macro- and micronutrient intake, meal frequency and growth in children with CHD. METHODS: At 6, 9 and 12 months of age, a 3-day food diary and anthropometric data were collected in 11 infants with severe CHD and 22 healthy age- and feeding-matched controls. Macro- and micronutrient intake, meal frequency and growth were calculated. RESULTS: Compared to the healthy controls, CHD infants had a statistically significantly higher intake of fat at 9 months of age (4.8 versus 3.6 g kg(-1) day(-1) ), a higher percentage energy (E%) from fat, (40.6% versus 34.5%) and a lower E% from carbohydrates (46.1% versus 39.6%) at 12 months of age, and a lower intake of iron (7.22 versus 9.28 mg day(-1) ) at 6 months of age. Meal frequency was significantly higher at 6 and 9 months of age (P < 0.01). Mean Z-score weight for height, weight for age and body mass index for age were significant lower (P < 0.01) at all time points. CONCLUSIONS: Despite a higher intake of energy from fat and a higher meal frequency, the intake does not meet the needs for growth, and the results may indicate a low intake of micronutrients in CHD infants.

Millimeter wave silicon micromachined waveguide probe as an aid for skin diagnosis--results of measurements on phantom material with varied water content.

BACKGROUND: More than 2 million cases of skin cancer are diagnosed annually in the United States, which makes it the most common form of cancer in that country. Early detection of cancer usually results in less extensive treatment and better outcome for the patient. Millimeter wave silicon micromachined waveguide probe is foreseen as an aid for skin diagnosis, which is currently based on visual inspection followed by biopsy, in cases where the macroscopical picture raises suspicion of malignancy. AIMS: Demonstration of the discrimination potential of tissues of different water content using a novel micromachined silicon waveguide probe. Secondarily, the silicon probe miniaturization till an inspection area of 600 × 200 µm2, representing a drastic reduction by 96.3% of the probing area, in comparison with a conventional WR-10 waveguide. The high planar resolution is required for histology and early-state skin-cancer detection. MATERIAL AND METHODS: To evaluate the probe three phantoms with different water contents, i.e. 50%, 75% and 95%, mimicking dielectric properties of human skin were characterized in the frequency range of 95-105 GHz. The complex permittivity values of the skin are obtained from the variation in frequency and amplitude of the reflection coefficient (S11), measured with a Vector Network Analyzer (VNA), by comparison with finite elements simulations of the measurement set-up, using the commercially available software, HFSS. The expected frequency variation is calculated with HFSS and is based on extrapolated complex permittivities, using one relaxation Debye model from permittivity measurements obtained using the Agilent probe. RESULTS: Millimeter wave reflection measurements were performed using the probe in the frequency range of 95-105 GHz with three phantoms materials and air. Intermediate measurement results are in good agreement with HFSS simulations, based on the extrapolated complex permittivity. The resonance frequency lowers, from the idle situation when it is probing air, respectively by 0.7, 1.2 and 4.26 GHz when a phantom material of 50%, 75% and 95% water content is measured. DISCUSSION: The results of the measurements in our laboratory set-up with three different phantoms indicate that the probe may be able to discriminate between normal and pathological skin tissue, improving the spatial resolution in histology and on skin measurements, due to the highly reduced area of probing. CONCLUSION: The probe has the potential to discriminate between normal and pathological skin tissue. Further, improved information, compared to the optical histological inspection can be obtained, i.e. the complex permittivity characterization is obtained with a high resolution, due to the highly reduced measurement area of the probe tip.

Oral microflora and dietary intake in infants with congenital heart disease: a case control study.

BACKGROUND: Infants with moderate to severe congenital heart disease (CHD) are at a higher risk for growth failure and malnutrition due to increased metabolic demands and inadequate energy intake. This state requires meals that are more frequent and a special enriched diet, which may have negative implications on oral health. AIM: To examine the oral colonisation of some bacteria associated with caries development during infancy; mutans streptococci (MS) and lactobacilli (LCB) in infants with CHD and whether their dietary intake had an impact on the bacterial levels. DESIGN: This was a prospective case-control study. 11 infants with CHD and 22 healthy, age-matched infants were enrolled. Saliva samples and food diaries were collected at 6, 9, and 12 months of age. The total viable counts of MS and LCB in saliva were determined, and energy intake, meal frequency, intake of proteins, fat, carbohydrates and sucrose were calculated. RESULTS: At 12 months of age, the MS count was higher in the CHD group than in the controls (p<0.01), and MS constituted a higher ratio of the total viable count of oral bacteria (p<0.01). Meal frequency was higher in the CHD group at 6 and 9 months of age than in the controls (p<0.05). The intake of sucrose did not differ between the groups, while the total carbohydrate intake was higher in the control group at 6 and 12 months of age (p<0.05). Compared with the control group, which had six courses of antibiotic administration, the CHD infants had 21 courses (p<0.05). CONCLUSIONS: Infants with severe CHD have higher levels of MS at 12 months of age than the healthy controls. A higher meal frequency and use of diuretic medication and antibiotics may have influenced MS colonisation.

A population-based investigation of the autoantibody profile in mothers of children with atrioventricular block.

The objective of the study was to investigate the antigen specificity and occurrence of individual autoantibodies in mothers of children diagnosed with atrioventricular (AV) block in a nation-wide setting. Patients with AV block detected before 15 years of age were identified using national quality registries as well as a network of pediatric and adult cardiologists and rheumatologists at the six university hospitals in Sweden. Patients with gross heart malformations, surgically or infectiously induced blocks were excluded. Blood samples were obtained from the mothers and maternal autoantibody profile, including the occurrence of antibodies against Ro52, Ro60, La, SmB, SmD, RNP-70k, RNP-A, RNP-C, CENP-C, Scl-70, Jo-1, ribosomal RNP and histones was investigated in 193 mothers of children with AV block by immunoblotting and ELISA. Autoantibody reactivity was detected in 48% (93/193) of the mothers of children with AV block. In autoantibody-positive mothers, the vast majority, 95% (88/93), had antibodies against Ro52, while 63% (59/93) had autoantibodies to Ro60 and 58% (54/93) had autoantibodies to La. In addition, 13% (12/93) of the autoantibody-positive mothers had antibodies to other investigated antigens besides Ro52, Ro60 and La, and of these anti-histone antibodies were most commonly represented, detected in 8% (7/93) of the mothers. In conclusion, this Swedish population-based study confirms that maternal autoantibodies may associate with heart block in the child. Further, our data demonstrate a dominant role of Ro52 antibodies in association with AV block.

Saliva profiles in children using heart failure medication: a pilot study.

AIM: To study the saliva profiles in children with severe heart disease taking heart failure medication compared with the saliva from healthy age and gender matched controls. STUDY DESIGN: Cross sectional case-control design. METHODS: Twenty-four age and gender matched pairs of children, mean age 12.0 years participated. Stimulated saliva was collected in a standardized way before lunchtime and the subjects were asked to refrain from all eating, drinking and tooth brushing 90 mins before sampling. Stimulated salivary secretion rate, buffering capacity, total salivary viable count of bacteria, mutans streptococci and lactobacilli, calcium, chloride, magnesium, potassium, sodium and salivary IgA were determined. RESULTS: There were 7 of the 24 children in the cardiac group who had secretions below 0.5 ml/min compared with no child in the control group (p<0.01). Lower [corrected] total viable counts of bacteria (TVC) were detected in the cardiac group 1.4x106 ± 1.2x107 vs. 2.7x106 ± 2.9x107 in the control group (p<0.05). Mutans streptococci (MS) in the cardiac group were 5.2x104 ± 1.5x105 vs. 8.1 x10³ ± 1.3x104 in the control group, (p>0.05) and MS ratio of TVC constituted 0.11±0.35 per cent compared to 0.01±0.02 per cent for the control group (p>0.05). STATISTICS: Continuous data were analysed by an analysis of variance (ANOVA) and categorical data by chi-square test. CONCLUSION: Reduced salivary secretion could be a caries risk factor in children taking heart failure medication.

Can analysis of heart rate variability predict arrhythmia in children with Fontan circulation?

The aim of this study was to examine whether changes in heart rate variability (HRV) can predict arrhythmias in children who have undergone the Fontan procedure. The study included 15 children with total cavopulmonary connection. All examinations included echocardiography and 24-h ambulatory electrocardiogram with power spectral analysis of HRV and Poincaré plots (plots of each R-R interval as a function of the previous R-R interval). Six patients developed supraventricular tachycardia (four or more consecutive supraventricular beats). One patient was excluded from the study due to the development of bradycardia, necessitating placement of a pacemaker. Compared to the arrhythmia group, the patients without arrhythmias (n = 8) exhibited a significant difference in the standard deviation of instantaneous beat-to-beat R-R interval variability (p = 0.02). Poincaré plots of patients without arrhythmias showed a typical torpedo- or comet-shaped pattern, whereas the arrhythmia group showed a more complex pattern. Although this study examined only a few subjects, needing confirmation by larger studies, it does indicate that patients who develop arrhythmias after receiving the Fontan procedure show a different Poincaré pattern compared to the nonarrhythmic group-even before the arrhythmia can be detected using the conventional Holter procedure. Routine follow-up using the Holter procedure and Poincaré plot analysis could help detect early arrhythmias.

Evaluation of accommodative Insufficiency with the Visual Analogue Scale (VAS).

PURPOSE: The purpose of this study was to evaluate whether asthenopic symptoms in schoolchildren diagnosed with accommodative insufficiency (AI) and graded with the Visual Analogue Scale (VAS) could be correlated with the degree of accommodative deficiency in these children, and to investigate if VAS grading of the asthenopic symptoms could be used as an instrument to indicate the level of improvement of AI. METHODS: Forty-nine children (mean age 10.2 years +/- 2.7) diagnosed with AI graded their degree of asthenopia on the VAS before and after a 12-week treatment period wearing individually dispensed reading glasses. RESULTS: The improvement in accommodation after treatment was statistically significant (p < 0.001) and 83.7% of the children obtained normal accommodative amplitude in relation to age. The reduction in asthenopic symptoms as graded with the VAS was also statistically significant (p < 0.001) after treatment and 89.9% of the children obtained a normal VAS score. However, no correlation between the degree of accommodative deficiency and the VAS grading could be found, neither before nor after treatment. DISCUSSION: Based on these results we conclude that the visual analogue scale (VAS) cannot be used as an instrument to indicate the degree of accommodative deficiency nor can it be used to indicate the level of improvement during the course of treatment. However, the VAS can be used as an instrument to verify and document whether or not asthenopic symptoms are present, and therefore also to indicate when symptoms have been relieved.

Attitudes about dental care among parents whose children suffer from severe congenital heart disease: a case-control study.

OBJECTIVES: To examine attitudes and experiences of parents whose children have complex congenital heart disease (CHD) with respect to dental health information and advice, dental care, and service and to compare the results with data from an age- and gender-matched control group without any medical problems. SETTING: Faculty of Medicine (Paediatric Cardiology and Paediatric Dentistry), Umeå University, Umeå, Sweden. SAMPLE AND METHOD: Each group comprised parents of 33 children; the children's mean age was 9.4 years. All the cases and the controls resided in the county of Västerbotten, northern Sweden. Data were collected with a questionnaire with 20 joint questions to both groups and four additional questions to the CHD group. RESULTS: Of the 20 joint questions, significant differences were displayed in the following areas: the professional group that provided the parents with dental health information and advice (P < 0.01), attitudes to reception at the dental clinic, and experience of sedation before operative dental treatment (P < 0.05). Parents to 11 children with CHD who were patients at a specialist clinic for paediatric dentistry scored the reception at the dental clinic as excellent in nine cases and satisfactory in two, compared to excellent (3), satisfactory (11), decent (4), and poor (4) among those who were patients in general dental practice (P < 0.01). No statistically significant differences in educational level or in parental experience of dental health were noted between the two groups (P > 0.05). CONCLUSION: Children with CHD in northern Sweden mainly receive their dental health information from a physician or a dentist, and healthy children mainly receive information from a dental hygienist indicating that children with CHD are given priority in the dental care system. Parental attitudes to reception in the dental service differed, and parents of healthy children scored the reception at the dental clinic better than parents of children with CHD. It is suggested that children with severe CHD should receive dental care in clinics for paediatric dentistry, particularly at early ages.

Contrast sensitivity in 10 year old preterm and full term children: a population based study.

AIMS: To determine the contrast sensitivity (CS) in 10 year old prematurely born children, previously included in a population based study on the incidence of retinopathy of prematurity (ROP), and in full term controls. METHODS: This study included 205 prematurely born children and 215 children born at term, from the same geographical area and study period. CS was assessed monocularly with the Vistech 6500 test at five spatial frequencies (1.5-18 cycles/deg). RESULTS: Prematurely born children had statistically significant lower CS at all frequencies, compared to full term ones. The mean differences in logarithmic CS were 0.03 (1.5 cycles/deg), 0.09 (3 cycles/deg), 0.10 (6 cycles/deg), 0.12 (12 cycles/deg), and 0.19 (18 cycles/deg). Even when the children with ROP and neurological disorders were excluded there was a difference between the two groups. Children who had been treated with cryotherapy had the lowest CS. CONCLUSION: CS was lower in 10 year old prematurely born children than in full term ones of the same age. Whether this finding affects their visual function in daily life is uncertain.

Dental caries experience in children with congenital heart disease: a case-control study.

OBJECTIVES: To compare the dental health of a group of children with complex congenital heart disease with that of age and gender matched healthy controls. DESIGN: Case-control study. SETTING: Faculty of Medicine and Odontology/Pediatric cardiology and Pedodontics, Umeå University, Sweden. SAMPLE AND METHODS: All the cases and their controls lived in the county of Västerbotten in northern Sweden. Each group comprised 41 children with a mean age of 6.5 years. Data were collected from medical and dental records while all bitewing radiographs were read separately by one of the authors. RESULTS: Children with congenital heart disease had significantly more caries in their primary teeth than the control group. The mean dmfs-value was 5.2 +/- 7.0 in the cardiac group compared to 2.2 +/- 3.5 in the control group (P < 0.05). Twenty-six of the children had all four 6-year-molars, and their mean DMFS-values were 0.9 +/- 1.9 in the cardiac group compared to 0.3 +/- 0.6 in the control group (P > 0.05). The children with congenital heart disease had received more caries prevention based on the use of fluorides than the control group. There was a significant correlation between the number of fluoride varnish treatments and the dmfs value of the child (r = 0.411, P < 0.01). Fifty-two per cent of the children in the cardiac group had been prescribed fluoride tablets on one or more occasions compared to 17% in the control group (P < 0.01). Number of months on digoxin medication and the dmfs-value had a significant correlation (r = 0.368, P < 0.05). Ten of the children had been on digoxin medication between 6 and 87 months; this subgroup had a mean dmfs-value of 10.1 +/- 8.5. CONCLUSION: Swedish children with complex congenital heart disease have poorer dental health than healthy age and gender matched controls in spite of intensive preventive efforts. In many cases, intervention had been given when caries were present. A closer cooperation between paediatric cardiology and paediatric dentistry is needed.

Heart rate variability in children with Fontan circulation.

Heart rate variability (HRV) can be used to study cardiovascular autonomic control. This study examines HRV in children with Fontan circulation and its change over time. Thirty-four children in two groups were examined. Group A consisted of 10 patients who had undergone total cavopulmonary connection. Group B consisted of 24 healthy children/adolescents matched for gender, height, and weight. To analyze HRV parameters, all examinations included echocardiography and 24-hour ambulatory electrocardiogram. Comparing all patients and controls, there were no significant differences in HRV parameters. Analyzing subgroups of patients younger than 10 years old, two of the HRV parameters were significantly different compared to controls. For the group of patients older than 10 years, eight of the HRV parameters were significantly reduced. Most significant differences were found regarding low-frequency range (p < 0.008) and high-frequency range p < 0.008. This study confirms the finding of earlier studies that patients with Fontan circulation have a reduced HRV, and our findings indicate that there is a progressive reduction of HRV over time.

Electrocardiographic ST segment depression and clinical function in children with Fontan circulation.

Previous studies noted that Fontan patients have electrocardiographic ST depressions during exercise tests and on 24-hour ambulatory electrocardiographic (ECG) monitoring. This study investigated whether the ST depressions were correlated to clinical function (NYHA Functional Classification). Forty-five children in two groups were examined--15 patients with Fontan circulation and 30 with a structurally normal heart, matched for sex, height, and weight. Clinical and echocardiographic examinations were performed. The clinical state was defined as NYHA functional classes I-IV. All 45 children underwent 24-hour ECG and an analysis of ST changes was performed, with ST segment depression > 0.20 mV at ST 60 regarded as significant. Twelve of 15 patients had significant 24-hour ECG ST depressions; in 9 of 12 patients these occurred on more than one occasion. Comparing 24-hour ECG recordings from patients in NYHA I with patients in NYHA II or III showed a significant difference in depth (p = 0.0023), duration (p = 0.0016), and number of ST depressions (p = 0.0001). None of the matched healthy children showed ST depressions. Repeated ST analysis on 24-hour ECG shows that the ST depressions seem to be correlated to functional status and this may be a useful tool in clinical praxis.

Gastric IgA in cystic fibrosis in relation to the migrating motor complex.

BACKGROUND: Gastrointestinal symptoms in cystic fibrosis are frequent, but little is known about the underlying pathophysiology. Mucosal secretion of IgA is important for the immunologic function in the human gastrointestinal tract but has not been studied in cystic fibrosis. The aim of this study was to quantify the release of IgA by the gastric mucosa in relation to interdigestive motor activity in patients with cystic fibrosis with different genotypes. METHODS: The study included 7 healthy adult volunteers and 10 adult patients with cystic fibrosis, all Helicobacter pylori-negative. All patients had pathological sweat tests and clinical symptoms and signs of cystic fibrosis. All but one were colonized with Pseudomonas aeruginosa. Three patients were pancreatic sufficient. The investigation was performed using intragastric perfusion and gastroduodenal manometry. RESULTS: During the investigation, 8 of 10 patients with cystic fibrosis showed the characteristic pattern of interdigestive motility. The patients had significantly lower levels of gastric IgA compared to healthy subjects during phases II and III of migrating motor complex, median (range) 120 (67-442) and 36 (6-299) microg/5 min. 382 (40-1176) and 56 (4-398) (P = 0.03 and P = 0.04), respectively. Only one patient with genotype R668C/unknown showed IgA levels within the normal range. There was no correlation to gastric presence of duodenogastric reflux markers. CONCLUSION: The interdigestive motility pattern was normal in most patients with cystic fibrosis. The low levels of IgA released from the gastric mucosa in the patients might indicate a defective gastric transmucosal IgA transport in cystic fibrosis.

Development of a new method for the determination of immune responses in the human stomach.

The discovery of the gastric pathogen Helicobacter pylori has created a need for accurate methods to study immune responses locally in the human stomach. Therefore, we have developed a quick and easy method for extraction of antibodies from gastric biopsies using saponin and compared this method with the more laborious analysis of antibody-secreting cells (ASCs) from gastric biopsies. We have also analyzed the antibody content in gastric aspirates, saliva and plasma. There was a strong correlation between the total IgA levels in the biopsy extracts and the frequencies of IgA-secreting cells. In addition, the IgA and IgG levels against a H. pylori whole membrane preparation and purified urease in the biopsy extracts correlated well with the frequencies of specific IgA and IgG secreting cells. However, the antibody levels in gastric aspirates, saliva and plasma specimens did not correlate with the frequencies of corresponding ASC in the gastric biopsies. Thus, the saponin extraction method is suitable for monitoring local antibody responses in the stomach, while analyses of gastric aspirates, saliva or plasma are not appropriate for this purpose.

Electrocardiographic ST-segment depression in children with fontan circulation.

Despite successful operation, many patients palliated with a Fontan-type procedure continue to show effort limitation. We previously observed that these children showed electrocardiographic ST depression during exercise tests. The purpose of the study was to investigate whether electrocardiographic ST depression is a common finding in children with Fontan circulation. Forty-two children in two groups were examined: group A consisted of 14 patients who had all undergone a modified Fontan procedure, and group B consisted of 28 children with a structurally normal heart, matched for length, weight and gender to group A. Complete echocardiographic examinations were performed in all patients and controls. All 14 patients and all 28 healthy children underwent standard 24 h ambulatory electrocardiographic monitoring. All the recordings were analysed by a PC-based Holter system where an analysis of ST changes was performed. Seven patients and 14 matched healthy children were exercised on bicycle ergometers. Four patients and eight matched healthy children underwent exercise testing by walking/running a treadmill. Ten of 13 patients analysed had significant ST depressions on ambulatory electrocardiogram (>0.20 mV). Three of the 10 patients with ST depression were on digoxin. Three patients showed depressions of the ST segment in the electrocardiogram during exercise, with a maximal depression of 0.20-0.35 mV. None of the 28 matched healthy children showed electrocardiographic ST depression on the ambulatory 24 h ECG. These findings indicate that ST depression in daily activity is a common finding in children with Fontan circulation.

Assessment of contrast sensitivity in children aged 3 years 9 months - 6 years with normal vision, visual impairment due to ocular disease and strabismic amblyopia.

The contrast sensitivity function was assessed in children and adults with normal vision, visual impairment due to ocular disease, and strabismic amblyopia. The methods used were: the LH contrast vision test and the ability to detect raisins, puffed rice and white and black sugar strands against a white and black background. The aim of the study was to see whether any of the tests could be used in the detection of subnormal vision, and to compare the results between the different groups of patients. The following parameters of contrast sensitivity function (CSF) were measured with the LH-test: the maximum contrast sensitivity, the total area of CSF, and the area of 8 spatial frequency bands. Difficulty in detecting an object with low versus high contrast was measured with the sugar strands. Subjects with subnormal vision due to ocular disease and strabismic amblyopia had lower contrast sensitivity than subjects with normal vision measured as the total area of the CSF or the area of a specific frequency band. However, the maximum contrast sensitivity value that could be measured with the test was not significantly different between the groups. No subject had difficulties in the detection of raisins and puffed rice on a white and black background. Difficulties in detecting sugar strands on a white background were not seen in the normal children, but approximately 65% of the children with visual impairment had difficulties, as did approximately 25% of the children and adults with strabismus. Most of these subjects also had low visual acuity, but there was no correlation between the level of reduction of visual acuity and the difficulty in detecting sugar strands.