Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children.

In a randomized, double-blind controlled trial, 42 children with irritable bowel syndrome (IBS) were given pH-dependent, enteric-coated peppermint oil capsules or placebo. After 2 weeks, 75% of those receiving peppermint oil had reduced severity of pain associated with IBS. Peppermint oil may be used as a therapeutic agent during the symptomatic phase of IBS.

Tetracycline-induced pancreatitis.

Tetracycline has long been implicated as a causative agent in acute pancreatitis. Early reports of acute pancreatitis after tetracycline administration were associated with liver dysfunction attributed to the drug's ability to induce fatty degeneration of this organ. At present, few data are available to suggest that tetracycline-induced pancreatitis may occur in the absence of overt liver failure. We report here, the third and fourth cases of acute pancreatitis after the administration of oral tetracycline in patients without evidence of liver abnormalities. A review of the relevant literature is presented.

Modification of the adult Blakemore tube for use in children with bleeding esophageal varices.

A modification of the adult-sized Blakemore tube is described for emergency use in children with bleeding esophageal varices. Inexpensive, readily available, heat-labile tubing was used to adapt the esophageal balloon for use in small children, keeping possible complications at a minimum.

Depressive symptoms in children with recurrent abdominal pain and in their families.

Our purpose was to evaluate depression in children with recurrent abdominal pain and in their families. A self-report measure, the Children's Depression Inventory, and a psychiatric structured interview, the Child Assessment Schedule, were administered to 25 children with recurrent abdominal pain (RAP) as well as to 67 behaviorally disordered (BD) and 42 healthy children. Parents of all three groups completed the Beck Depression Inventory. On both measures, scores for RAP children were not significantly different from those of healthy children and were significantly lower than those of BD children. In contrast, the mothers of both the RAP group and the BD group had significantly higher depression scores than the mothers of healthy children. There were no group differences for fathers. The data suggest that although depression is not prevalent in children with RAP, depressive characteristics in the family may play a role in the origin of their abdominal pain.

Life events occurring in families of children with recurrent abdominal pain.

Thirty children with recurrent abdominal pain (RAP) were compared to 67 behaviorally disordered (BD) children and 42 healthy children on number of life events experienced within the last 12 months and on amount of readjustment necessitated by these life events. The parents of these children were also compared on these variables as well as on a subjective rating of stress which they assigned to the life events. The results revealed that the children in the RAP and BD groups had significantly more life events and more stress associated with them than did the healthy children. However, the children in the RAP and BD groups differed in type of life events, with the RAP group more likely to have experienced life events related to illness, hospitalization, and death. There were no significant differences between the parents in the RAP group and the parents of the two comparison groups. Due to methodological limitations of the study, caution should be exercised in drawing conclusions from these findings until such time that future research provides confirmatory data.

Membranoproliferative glomerulonephritis and alpha 1-antitrypsin deficiency in children.

Two white girls had reduced serum concentration of alpha 1-antitrypsin (alpha-AT), phenotype ZZ, and liver disease. Hepatocytes exhibited the microscopic criteria of alpha-AT deficiency. Hypocomplementemia, elevated circulating immune complexes (patient 1), clinical signs of renal disease, and the histologic findings of membranoproliferative glomerulonephritis (MPGN) type I developed. Immunoglobulin A (but not alpha-AT) was demonstrable immunologically as a component of glomerular deposits in patient 1. Among 53 patients with MPGN but without clinical signs of liver disease, none had Pi type Z. Among 23 patients with phenotype ZZ but without clinical signs of kidney disease, six had abnormal complement protein levels, but the pattern did not resemble that of idiopathic MPGN type I. These results are consistent with the conclusion that MPGN in the two patients reported here is a consequence of their chronic liver disease and is not directly related to the presence of the allelic alpha-AT variant PiZ.

Arginine deficiency syndrome. Its occurrence in carbamyl phosphate synthetase deficiency.

A child with carbamyl phosphate synthetase deficiency was studied. During attempts at dietary control, a peculiar rash and cessation of growth were noted concomitant with a very low serum arginine level. A prospective study was designed so that the only variable would be the addition of 400 mg of arginine to his diet. During the two-week period without arginine, the rash and growth failure recurred and paralleled a drop in the serum arginine level from 0.048 to 0.034 nmol/mL. Then with the addition of arginine, his rash dramatically cleared and he resumed normal growth. Later, it became necessary to raise his arginine intake to 800 mg/day to maintain continued growth. These data support the concept that arginine becomes an "essential" amino acid in persons with urea cycle defects, which may partially explain the extremely variable clinical manifestations and courses seen in these patients.

Abnormal pyruvate and alpha-ketoglutarate dehydrogenase complexes in a patient with lactic acidemia.

Activities of pyruvate decarboxylase (PDC), alpha-ketoglutarate decarboxylase (KGDC) and both the pyruvate and alpha-ketoglutarate dehydrogenase complexes (PDH complex and KGDH complex) were measured, and kinetic properties of PDC were studied in fibroblasts derived from normal individuals and from a 2-yr-old girl with congenital lactic acidemia and severe retardation of growth and development. The activities of PDC, KGDC, PDH complex, and KGDH complex in the patient were 1.12 +/- 0.12, 2.33 +/- 0.42, 9.00 +/- 0.50, and 16.46 +/- 1.57 and in controls 3.10 +/- 0.16, 5.36 +/- 0.56, 24.13 +/- 1.61 and 44.95 +/- 3.72 nmole/mg protein/hr. The optimum pH (6.0) and Michaelis constants (Km) for pyruvate of PDC (1.0-1.6 X 10(-5) M) were similar in fibroblasts of the patient and controls. PDC activity was more sensitive to denaturation by heat in the fibroblasts of the patient than those from controls, while heat denaturation curves of KGDC were similar in the patient and control. Higher concentrations of thiamine pyrophosphate (TPP) were required to protect PDC from heat denaturation in the patient. TPP was more easily removed from PDC in the patient than in the control by washing the fibroblasts with alkaline buffer. These results suggest that the PDC enzyme of the patient is in an altered molecular form, to which TPP is loosely bound. This particular constellation of abnormalities has not previously been reported in patients with lactic acidemia.