[Acute abdomen among children and adolescents. A retrospective study of 470 children and adolescents with acute abdominal pain]. / Akutt abdomen blant barn og unge. En retrospektiv undersøkelse av 470 barn og unge med akutte abdominalsmerter.

The causes of acute abdominal pain among children admitted to a surgical department were few and the fraction that needed surgical treatment was low (37%). The surgical intervention rate was age-dependent, rising from 11.4% (zero to three years of age) to 48.9% (12-15 years of age). The increase in surgical intervention rate was due to increasing incidence of acute appendicitis while the incidence of intestinal obstruction was unchanged during childhood. No child below the age of four had appendicitis, and the rate of perforated appendix among children seven years and younger (41.7%) was significantly higher than among children eight years and older (20.4%). For acute appendicitis, the surgeons' diagnostic accuracy was 77.9% and there was no significant difference between complications after appendectomy for appendicitis and complications after negative laparotomy. The diagnostic value of biochemical measurements was limited. However, the combined evaluation of C-reactive protein measurements and leucocyte counts possibly supports further observation rather than immediate operation.

[Meckel's diverticulum. Symptoms, diagnosis and treatment]. / Meckels divertikkel. Symptomer, diagnose og behandling.

Meckel's diverticulum is a rare, but serious cause of acute abdominal pain. The prevalence of Meckel's diverticulum is 2% and lifetime risk of illness in a diverticulum is 4.2%. The risk declines with age and approaches zero after the age of 70. Morbidity after resection of symptomatic Meckel's diverticulum is 11.1-17.6% with 6.0-7.5% mortality. The morbidity rate for resection of incidentally discovered diverticulum is 1.2-8.9%. Symptoms and complications are related to age. Below the age of one year the most prevalent complication is gastrointestinal obstruction. Later in childhood the most dominating complication is peptic ulcer with serious gastrointestinal bleeding, while various kinds of gastrointestinal obstruction and diverticulitis are most prevalent in adults. The treatment of symptomatic Meckel's diverticulum is resection. However, the treatment of incidentally discovered Meckel's diverticulum is a subject of dispute. After a thorough study of the literature we conclude that resection should be the routine for all incidentally discovered Meckel's diverticulums in persons younger than 40. After this age resection should be reserved for patients with palpable stigmata of heterotopic tissue, diverticulums of some length and the presence of omphaloenteric- or omphalodiverticulare chords.

The mechanism of decline of age-dependent enzymes in the red blood cell.

Buoyant density centrifugation on discontinuous gradients separates red blood cells (RBCs) according to age, as shown by radiolabelling experiments both in vitro and in vivo. Changes observed in these gradients reflect in vivo rates of decline. A progressive metabolic decline may render the RBC incapable of surviving stresses in the circulation. It was hypothesized that changes only take place at the reticulocyte-mature RBC transition. RBC hexokinase (HK) has two isozymes, one predominant in reticulocytes, the other in mature RBCs. We compared its decline in the density gradient, with that of pyrimidine-5'-nucleotidase (P5N), glutamate-oxaloacetate transaminase (GOT) and pyruvate kinase (PK). The decline of HK and P5N was clearly biphasic; for GOT and PK instead there was a single slope. Thus changes taking place at the reticulocyte-RBC transition are clearly identified by a biphasic slope in the gradient. The view of a progressive metabolic decline in vivo for the RBC therefore remains valid.