Celiac disease. "To biopsy or not to biopsy. That is the question!".

Great progress has been made in the field of celiac disease (CD). During the past 50 years we have come to understand a great deal about the pathogenesis, clinical spectrum, and treatment. Great advances have been made in the technology of diagnosing CD. Heretofore, the gold standard used for diagnosis of CD is the small intestinal biopsy. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition has recently issued guidelines that state that some patients do not require a biopsy for diagnosis. This review traces the history of CD with a particular attention to the evolution of the technology involved in the field. The question of the need for biopsy or not is discussed.

Use of neomycin as the prophylaxis against recurrent cholangitis after Kasai portoenterostomy.

Ascending cholangitis after portoenterostomy for biliary atresia often leads to significant morbidity. The long-term prognosis also involves recurrent and frequently recalcitrant bouts of cholangitis. Attempts at prophylaxis with use of oral antibiotics are frequently unsuccessful. The authors describe three patients who, after successful portoenterostomies, were plagued with recurrent bouts of cholangitis, despite the use of a variety of antibiotics. The authors instituted oral neomycin as prophylaxis and nearly eliminated this serious complication.

Prolonged gastric retention of a swallowed coin following pyloromyotomy.

Ingestion of foreign objects is a common problem in children 6 months to 3 years of age. Of swallowed objects reaching the stomach, 97% will pass through the remainder of the gastrointestinal tract. The following is a report of a child who had a pyloromyotomy for pyloric stenosis as an infant and had prolonged retention of a swallowed penny.

Infantile colic: a review.

Infant colic is an extremely common but poorly understood symptom complex, causing great distress for infant, parents, and physician. Many theories have been suggested to explain this entity, but none are widely accepted. Numerous therapies have been proposed; however, few are helpful. A review of infant colic is presented which focuses on suggested etiologies and therapies, either of historic interest or practical significance. An approach to management is suggested which the authors have found to be valuable.

Thrombocytopenia and hypofibrinogenemia in association with inflammatory bowel disease.

There are many extra-intestinal manifestations of inflammatory bowel disease (IBD), some which are very uncommon in the pediatric age group. Coagulation abnormalities occur infrequently. Both hypercoagulability and hypocoagulability have been reported in adults (1). The hypercoagulable state is reflected in a general increase in concentration of clotting factors. This is observed most frequently in patients with poorly controlled intestinal disease and can lead to thromboembolic phenomena, including pulmonary and cerebral embolism. Conversely, patients with hypocoagulability may present with bleeding manifestations. We report a young patient with an abnormal coagulation profile as well as with thrombocytopenia in association with IBD.

An analysis of six patients with Parkinson's disease who have been unresponsive to L-dopa therapy.

Six patients diagnosed as Parkinson's disease on a clinical basis alone are described, and their response to L-dopa and to alpha methyl dopa hydrazine (MK 486) and L-dopa. They are compared with 239 other patients with Parkinson's disease treated in the same time period. These six patients were unusual in that they did not have a clinical response to L-dopa, nor did they develop dyskinesias on L-dopa or on L-dopa with MK 486, although they showed high blood levels of L-dopa and high homovanillic acid levels in the spinal fluid. Unresponsiveness to L-dopa is attributed to a specific brain mechanism and not to problems of transport of L-dopa to the brain or to abnormal peripheral metabolism of L-dopa. The term `motor unresponsiveness to L-dopa' may be useful to describe such patients who may eventually be shown to be suffering from diseases other than Parkinsonism.