Cytokine profiles in children with acute intussusception in South Africa.

Serum specimens of children hospitalized with acute intussusception (IS; n = 407) were analyzed for various pro- and anti-inflammatory cytokines to identify host markers specifically for IS compared to other surgical conditions (n = 235) or acute gastroenteritis (AGE; n = 68) in a cross-sectional study design. We showed that children with IS had elevated levels of pro-inflammatory cytokines IFN-γ, TNF-α, MIP-1ß, IL-1ß, IL-2, IL-6, IL-7, IL-8, and IL-17 as well as anti-inflammatory cytokines IL-1RA, IL-4, IL-5, and IL-13 compared to those admitted with surgical conditions or AGE symptoms, indicating these cytokines as markers for IS. In addition, we showed an increase in C-reactive protein (CRP) levels in children with IS. This study is the first to show a broad cytokine profile and identify cytokine markers in children with IS.

Serum substance P and vasoactive intestinal peptide levels in infants with acute intussusception.

OBJECTIVE: We aimed to investigate the role of the intestinal neurotransmitters vasoactive intestinal peptide (VIP) and substance P (SP) at different time points in infants with acute intussusception. METHODS: Thirty patients who were diagnosed with acute intussusception were enrolled in the study and classified as the experimental group. Another 30 patients with an indirect inguinal hernia who had no intestinal injury were included as the control group. Serum SP and VIP levels at different time points, including pre- and postoperation, were detected by enzyme-linked immunosorbent assay and compared between the two groups. RESULTS: Serum SP levels in patients with acute intussusception were significantly higher than those in controls. However, with recovery of acute intussusception, SP levels gradually decreased after treatment. Serum VIP levels in patients with acute intussusception were significantly lower than those in controls. However, with recovery of acute intussusception, VIP levels gradually increased after treatment. CONCLUSIONS: SP and VIP levels may have a potential relationship with the pathogenetic process of intussusception.

Serum intestinal fatty-acid binding protein: predictor of bowel necrosis in pediatric intussusception.

BACKGROUND/PURPOSE: Serum Intestinal Fatty-Acid Binding Protein (I-FABP) is a useful marker of bowel necrosis in pediatric intussusception. The aim of this study is to determine the sensitivity of this marker and correlate it with length of necrosed small bowel. METHODS: A single-centre prospective study of 50 children presenting to Lagos University Teaching Hospital, Nigeria, in whom a diagnosis of intussusception was made over 1 year was completed. Additionally, 25 age- and sex-matched controls (day case surgery) were recruited. They were grouped into three: 25 children with necrotic bowel, 25 without bowel necrosis, and 25 controls. The serum IFABP levels were compared between the cohorts with confirmed bowel necrosis at surgery and those with no necrosis, as well as controls. The cut-off values for the diagnosis of bowel necrosis were calculated using a receiver operating characteristic curve (ROC). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS: Twenty-five children were diagnosed with necrotic intussusception whose serum IFABP immunoassay has significantly higher median compared with those without necrosis and controls (2056.0ng/ml vs. 943.0ng/ml and 478.0ng/ml P=0.0002). Using a cut-off value of 1538ng/ml, the sensitivity, specificity, PPV, and NPV were 64%, 88%, 84%, and 71%, respectively. I-FABP titer greater than 1538ng/ml was found to have higher likelihood of necrotic bowel (p=0.002; odds ratio 13.04; 95% confidence interval; 0.618-0.891). CONCLUSION: Serum I-FABP is moderately sensitive for discriminating between bowel necrosis, and it predicts increased likelihood of bowel resectability in intussusception. LEVEL OF EVIDENCE: Level II - Development of diagnostic criteria in a consecutive series of patients and a universally applied "gold standard".

Are interleukin-6, body mass index and atopy crucial in infantile intussusception?

OBJECTIVE: To determine the role of inflammation related to body mass index (BMI) and atopy in the etiology of idiopathic intussusception (IS) which is seen more frequently in obese children and which is considered to increase in the allergy season. METHODS: The study comprised a study group consisting of 22 infants with IS and a control group consisting of 20 healthy infants with age and BMI matched. In both groups, gender, weight, height, month of birth, month of admittance (allergy season) of each infant were recorded. Information regarding whether or not the child had any skin rash, atopy, oral allergy syndrome, and whether or not the patient had been fed cow's milk and breast milk was recorded. Hemoglobin (Hb) levels, white blood cell (WBC) and eosinophil counts, interleukin-6 (IL-6) levels and allergy panel were studied in all patients. Additionally, cross reactive protein (CRP) and blood urea nitrogen (BUN) levels were determined in the study group. During statistical comparison p < 0.05 was considered statistically significant. RESULTS: Mean IL-6 levels in the control and study groups were 1.59 ± 0.15 pg/ml and 4.12 ± 5.04 pg/ml, respectively. IL-6 levels were statistically different between each groups and between cases with barium reduction and cases reduced manually by laparotomy within the study group. Both groups were similar statistically with regard to the others parameters. No atopy was detected by allergy panel. When binary logistic regression analysis with the cut-off value of IL-6 set as 1.6 pg/ml was applied to all data, statistically significant values were obtained only when the case was in the study group and when CRP levels were increased (p = 0.05 and p = 0.001, respectively). CONCLUSIONS: We demonstrated that IL-6 levels are increased in the study group, especially in the operated patients, however, that high BMI and atopy have no effects on this fact and that atopy is not associated with IS in the clinical study.

[Contents of serum albumin after surgical operation in children with acute intussusception].

OBJECTIVE: To study the changes of serum albumin contents after operation and investigate whether post-operational serum albumin contents are correlated with the disease severity in children with acute intussusception. METHODS: Serum albumin contents were measured using the automatic biochemistry analyzer in 32 children with mild acute intussusception and 21 children with severe acute intussusception 1 day after surgical operation. After 5 days combined treatment, serum albumin contents were re-examined. Thirty healthy children severed as the control group. The correlation between post-operational serum albumin contents and critical illness scores was evaluated. RESULTS: Serum albumin contents in the mild (34.2+/-6.5 g/L; P<0.05) and the severe intussusception groups (25.8+/-7.5 g/L; P<0.01) 1 day after operation were significantly lower than those in the control group (37.1+/-4.1 g/L). There were significant differences in serum albumin contents between the mild and the severe intussusception groups (P<0.05). Five days after operation, serum albumin contents in the mild intussusception group significantly increased (37.1+/-11.4 g/L; P<0.05), while serum albumin contents in the severe intussusception group did not differ from those 1 day after operation. There was a positive correlation between serum albumin contents on the 1st day after operation and the critical illness scores (r=0.879, P<0.01). CONCLUSIONS: Serum albumin contents decreased on the 1st day after operation and were correlated with the disease severity in children with acute intussusception. Hypoalbuminemia lasted for a longer period in severe cases. The post-operational measurement of serum albumin contents may be useful in the evaluation of the severity for children with acute intussusception.

[Lead point as a poor prognostic factor in the therapy of invagination in children].

UNLABELLED: Invagination is specific form of bowel opstruction that is seen in 1-4 children per 1000 births, usually in the period from 3 to 12 months of age. In 90-95 % reason for invagination in unknown so we called this forms idiopathic. In 5-10% invagination is caused by specific leading point. THE AIM of this retrospective study was to determinate prognostic valye of used biochemical tests (hemograms, glucosa, electrolites ( levels of Na+, K+, Ca+ and Cl-) and to prove bad influence of existing "leading point" in therapy of invagination (weather it will be surgical or hydrostatic desinvagination). METHODS: We analised 65 patients with invagination. We devided all our patients into 2 groups: first group consisted patients with idiopathic forms of invagination, and the other one were patients with invagination coused by specific leading point. RESULTS proved that leading point in invagination has great implications on clinical presentation, laboratory results, diagnostic and therapeutic procedure, and finaly in prognosis.

Delta-F508 cystic fibrosis mutation is not linked to intussusception: implications for rotavirus vaccine.

OBJECTIVE: To determine whether the cystic fibrosis (CF) delta-F508 gene mutation predisposes to intussusception, and so selects infants who should not receive rotavirus vaccine. METHODS: Stored neonatal screening blood spots, retrieved from 81 infants with intussusception and from 79 controls, were tested for the presence of the CF delta-F508 gene mutation. RESULTS: Prevalence of the mutation was similar in blood specimens from intussusception patients and from controls. CONCLUSION: Testing for the CF delta-F508 mutation at birth is unlikely to identify infants predisposed to intussusception, and therefore is not relevant to rotavirus vaccine programs.

[The role of hypergastrinemia in the pathogenesis of intussusception in infants].

From 1988 to 1992 the serum gastrin levels of 124 patients with intussusception and 20 normal infants and 15 patients with intestinal obstruction under 3 years of age were measured. Serum cAMP levels of 10 normal infants and 10 patients with intussusception were determined. In animal experiment study, the pressures of ileum cavity and ileoceal valve were determined before and after injectting pentagastrin into the veins of 8 young dogs. The levels of gastrin (219.9 +/- 100.6 pg/ml) and cAMP (32.4 +/- 7.6 pmol/ml) were higher in patient group than in the control group. (89 +/- 3 pg/ml, P < 0.05 and 22.2 +/- 7.5 pmol/ml P < 0.05). The result of animal experiment showed that the effect of gastrin and etiology of intussusception are identical. The main physiological funcitons of gastrin is to increase the intestinal peristalsis and relax the ileocecal sphincter. Our study showed that hypergastrinemia may be the basis etiologic factor of intussusception. Main clinical feactures were explained by this new theory.

Plasma beta-endorphin levels and childhood intussusception.

To determine whether childhood intestinal intussusception is associated with elevated plasma beta-endorphin levels, a series of patients was studied prospectively. Fourteen patients (age range between 3 months and 7 years) presented to two university pediatric emergency departments in Chicago with clinical symptoms and signs of intussusception. Venous blood (2cc) was withdrawn for plasma beta-endorphin determination, followed by barium enema. Plasma beta-endorphin levels were measured by radioimmunoassay. The mean beta-endorphin level of the 8 patients with barium enema proven intussusception was 14.1 +/- 12.0 pg/ml. Two of these patients presented with marked lethargy and had beta-endorphin levels of 7.5 and 21.2 pg/ml. The mean plasma beta-endorphin level of the 5 patients with negative barium enema studies was 18.1 +/- 10.0 pg/ml (P = 0.56). A sixth control patient had a plasma beta-endorphin level of 1569 pg/ml. In conclusion, childhood intestinal intussusception is not associated with elevated plasma beta-endorphin levels.

Intussusception in the Syrian golden hamster.

Of a series of ninety-six young male Syrian Golden hamsters, 13% developed lethargy, anorexia, diarrhoea and colocolic intussusception when their diet was changed from a basal laboratory-grade rodent chow to a nutritionally complete semi-purified diet. Histologically, the colon of the hamsters with intussusception had markedly reduced mucus production. Plasma levels of gastric inhibitory polypeptide (GIP) were reduced 80% (P less than 0.01) but peptide tyrosine/tyrosine and enteroglucagon in plasma were increased 290 and 526% respectively in hamsters with intussusception. Variations in dietary fatty acid composition had no effect but intussusception was not observed after changing the dietary carbohydrate from sucrose to starch.