Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior.

Twenty-one children with migraine and/or hyperkinetic behavior disorder which was successfully treated with an oligoantigenic (few-foods) diet also suffered from nocturnal and/or diurnal enuresis. On diet, the enuresis stopped in 12 of these children and improved in an additional four. Identification of provoking foods was by sequential reintroduction of the foods that were avoided on the oligoantigenic diet. In eight of the 12 children who recovered on the oligoantigenic diet and in the four who improved, reintroduction of one or more foods provoked a reproducible relapse of the enuresis. Nine children were subjected to a placebo-controlled, double-blind reintroduction of provoking foods. Six children relapsed during testing with incriminated foods; none reacted to placebo. Enuresis in food-induced migraine and/or behavior disorder seems to respond, in some patients, to avoidance of provoking foods.

Few food diets in the treatment of atopic eczema.

Sixty six children with severe atopic eczema were treated with highly restricted ('few food') diets followed, if they improved, by serial reintroduction of excluded foods. Twenty four patients (36%) improved considerably during the few food phase of the diet. Fifteen of these (23% of the study group) maintained this improvement on dietary treatment, of whom three abandoned the diet after periods ranging from six to 10 months, despite continued benefit, because they found the dietary restrictions too arduous. Thus 12 out of 66 children (18%) with severe eczema experienced prolonged and useful benefit from this dietary manoeuvre. Double blind food challenges performed in 10 patients failed to establish that parental identification of provoking foods is reliable. A search for historical and in vitro predictors of diet responsiveness was unsuccessful in this series.

Oligoantigenic diet treatment of children with epilepsy and migraine.

We studied the role of oligoantigenic diets in 63 children with epilepsy; 45 children had epilepsy with migraine, hyperkinetic behavior, or both, and 18 had epilepsy alone. Of the 45 children who had epilepsy with recurrent headaches, abdominal symptoms, or hyperkinetic behavior, 25 ceased to have seizures and 11 had fewer seizures during diet therapy. Headaches, abdominal pains, and hyperkinetic behavior ceased in all those whose seizures ceased, and in some of those whose seizures did not cease. Foods provoking symptoms were identified by systematic reintroduction of foods, one by one; symptoms recurred with 42 foods, and seizures recurred with 31; most children reacted to several foods. Of 24 children with generalized epilepsy, 18 recovered or improved (including 4 of 7 with myoclonic seizures and all with petit mal), as did 18 of 21 children with partial epilepsy. In double-blind, placebo-controlled provocation studies, symptoms recurred in 15 of 16 children, including seizures in eight; none recurred when placebo was given. Eighteen other children, who had epilepsy alone, were similarly treated with an oligoantigenic diet; none improved.

Meningitis caused by Absidia corymbifera.

A 56-year-old man developed mucormycotic meningitis caused by Absidia corymbifera and which followed a penetrating head injury. Antibodies to it were detected in the cerebrospinal fluid at titres higher than those found in the serum, thereby suggesting local production of antibody in the subarachnoid space.

Neutrophil mobility during anaesthesia in children. A trial of ascorbate premedication.

In 20 healthy children undergoing elective surgery, mobility of neutrophils, both unstimulated and stimulated by endotoxin, was studied using a millipore filter system with microscopic determination of leading front migration. Paired samples were incubated with 10(-2) mol l-1 calcium ascorbate and ten children also received 10 mg kg-1 ascorbic acid before premedication. Stimulation of mobility was reduced after the opioid premedication (P less than 0.05) in the ascorbate group only, but not significantly during anaesthesia and surgery. A few individuals showed persisting abnormally low values. No effect of ascorbate in vivo or in vitro was demonstrated. There were no infections.

Hypogammaglobulinaemia and malakoplakia: response to bethanechol.

A second patient is described with the syndrome of hypogammaglobulinaemia and malakoplakia; he too responded dramatically to bethanechol treatment and remains well on it.

A dietary management of severe childhood migraine.

We describe in detail a dietary treatment which has been shown to be effective in most children with severe migraine. Potential adverse nutritional and allergic effects are outlined; because of the diet should be undertaken only in those ill enough to justify it. In the first stage very few foods are given, and if the child responds to this oligoantigenic diet, foods are reintroduced one by one at weekly intervals. In this way foods causing symptoms are identified and eliminated. Research is urgently needed to establish simpler empirical diets and diagnostic tests.

Infant feeding and subsequent risk of atopic eczema.

An attempted controlled trial of exclusively breast fed neonates with atopic parents, to assess the effectiveness of breast feeding in preventing atopic allergy, was not successfully achieved. Analysis of the data as an observational study, however, provided evidence that breast feeding offers some protection against eczema in genetically vulnerable infants. Feeds of soya preparations were associated with eczema as often as cows' milk based feeds.