DEFECTIVE JEJUNAL BRUSH BORDER Na+/H+ EXCHANGE IN LETHAL FAMILIAN PROTRACTED DIARRHOEA

The clinical spectrum of disease associated with the recently described defect in jejunal brush border membrane (BBM) Na+/H+ exchange remains poorly defined. We describe a further, lethal case of protracted diarrhoea in a child from a family in whom 2 previous siblings died of protracted diarrhoea at 2 and 11 months. The patient, a boy, was born at term weighing 2.9 kg and was admitted at 6d with profuse watery diarrhoea, severe dehydration and metabolic acidosis. Parenteral nutrition was started but the diarrhoea persisted, and he developed severe necrotising enterocolitis requiring an ileostomy. A high-output secretory diarrhoea persisted during nil by mouth (ileostomy fluid mmol/l: Na+ 1…

The diagnostic significance of IgG cow's milk protein antibodies re-evaluated

The effect of different feeding regimens, notably the use of hydrolysed cow's milk formulas, on the development of allergic reactions and the development of cow's milk protein-IgG antibodies is still disputed. We prospectively compared the development of allergic manifestations and cow's milk protein-IgG antibodies in a total of 702 infants who were divided into six groups: Cow's milk protein antibodies were determined by an indirect immuno-fluorescent test. Antibody titres rose slowly in groups 1, 3 and 6. Children in group 5 showed two high peaks. There were no significant differences in the frequency and type of allergic manifestations between the groups. Introduction of cow's milk formu…

Galactose increase in an infant whose mother is heterozygous for peripheral uridine diphosphate galactose‐4‐epimerase deficiency

Use of the polymerase chain reaction to demonstrate hepatitis B virus DNA in serum of children with chronic hepatitis B.

The polymerase chain reaction was used to investigate the presence of hepatitis B virus DNA in sera of 61 children with chronic hepatitis B and negative results on dot biot hybridization tests. Our results demonstrate that most chronic carriers of hepatitis B surface antigen in childhood have hepatitis B virus DNA detectable by polymerase chain reaction in their serum and must be considered infectious.

Diagnostic Significance of Epithelioid Granulomas in Crohnʼs Disease in Children

Out of 528 children with Crohn's disease in a Multicenter Paediatric Crohn's Disease Study Group, 37 cases had epithelioid granulomas but did not fulfill defined radiographic criteria of the disease. Follow-up studies including clinical, biochemical, radiological, endoscopic, and histological investigations were done in these patients. Initially, all patients showed clinical symptoms and 27 of them had biochemical signs of chronic inflammation. After a mean follow-up of 3 years, all 37 children treated for Crohn's disease got a complete upper gastrointestinal series with small bowel followthrough and 8 children in addition had barium enemas. Colonoscopies were done in 23 patients. Radiograp…

CHARACTERIZATION OF CHRONIC HEPATITIS B IN CHILDHOOD USING MOLECULAR BIOLOGY TECHNIQUES

The introduction of molecular biology techniques in the diagnostics of chronic hepatitis B virus infection proved HBV DNA to be the most sensitive marker of viral replication and infectivity. The aim of our study was to characterize the HBV DNA status in children with chronic hepatitis B with various molecular biology techniques in relation to conventional HBV markers. Methods: 206 sera of 172 and liver tissue of 108 children with chronic hepatitis B infection were investigated by dot blot-, Southern blot-, and in situ hybridization. In dot blot and Southern blot negative specimens polymerase chain reaction (PCR) was performed. Results: 111 of the 206 sera were positive for HBV DNA by dot b…

Analysis of the RET, GDNF, EDN3, and EDNRB genes in patients with intestinal neuronal dysplasia and Hirschsprung disease

BACKGROUNDHirschsprung disease (HSCR) is a frequent congenital disorder with an incidence of 1 in 5000 live births, characterised by the absence of parasympathetic intramural ganglion cells in the hindgut resulting in intestinal obstruction in neonates and severe constipation in infants and adults. Intestinal neuronal dysplasia (IND) shares clinical features with HSCR but the submucosal parasympathetic plexus is affected. IND has been proposed as one of the most frequent causes of chronic constipation and is often associated with HSCR.METHODSWe examined 29 patients diagnosed with sporadic HSCR, 20 patients with IND, and 12 patients with mixed HSCR/IND for mutations in the coding regions of …

Cellular cytotoxicity against autologous hepatocytes in children with different forms of chronic hepatitis B.

Cell-mediated immune reactions play the most important role in the pathogenesis of chronic viral and auto-immune hepatitis. Cellular cytotoxicity (CC) of peripheral blood lymphocytes against autologous hepatocytes isolated from liver biopsies was studied in 29 children with different types of hepatitis B surface antigen (HBsAg)-positive hepatitis. Children with chronic hepatitis B showed higher cytotoxicity than control patients. However, a correlation of cytotoxicity to serum amino-transferases, HBeAg-/Anti-HBe-status, and hepatitis B virus DNA in serum could not be found. Children with a higher percentage of hepatitis B core antigen (HBcAg) expression in their liver tissue presented lower…

IN SITU HYBRIDIZATION FOR DETECTION OF HEPATITIS B VIRUS GENOMES IN LIVER TISSUE OF CHRONIC INFECTED CHILDREN

Detection of hepatitis B virus (HBV)-DNA in the liver of chronic infected patients is presently the most sensitive marker of viral replication and infectivity. In situ hybridization (ISH) allows the direct visualization of HBV infected liver cells and distribution of the viral sequences. This study was done to establish ISH and correlate the findings with conventional markers for HBV infection. Methods. Liver biopsies of 50 patients (28 ♂, 22 ♀) aged 0.5-20 years (mean 10.3) with various histological diagnoses were tested by 1SH. The HBV-DNA probe was labeled by nick translation with 35S-CTP to a specific activity of 3-5×108 cpm/μg DNA. Results. HBV-DNA/mRNA could be demonstrated in 38 pati…

Defective jejunal brush border membrane sodium/proton exchange in association with lethal familial protracted diarrhoea.

The spectrum of clinical disease associated with specific defects in jejunal brush border membrane sodium/proton exchange is poorly defined and only two patients have been described so far. Jejunal brush border membrane transport studies were performed in a boy who presented with lethal familial protracted diarrhoea in the first few days of life. Using jejunal brush border membrane vesicles prepared from conventional jejunal biopsy specimens, initial sodium uptake under H+ gradient conditions was found to be only 6% of the mean control value. In contrast, sodium stimulated glucose uptake was normal. Our data confirm the importance of a congenital defect in this exchanger as a cause of sever…