ISSN:0277-2116    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Summary:Trypsin‐binding immunoglobulin G (TBIgG) is found in the sera of a high proportion of patients with cystic fibrosis. We previously reported that TBIgG preferentially binds human cationic trypsin rather than trypsin from other animal species. Binding affinity is enhanced by complex formation with bovine pancreatic trypsin inhibitor, which is known to induce characteristic conformational modifications in the active site region of the trypsin molecule. To identify the human trypsin‐like antigen associated with TBIgG, we have studied the effects of conformational changes of cationic trypsin induced by limited proteolysis based on competitive binding studies. It is shown that the most likely TBIgG‐related self‐antigen is an 11,000‐dalton fragment that is a cleavage product of the complex formed by trypsin and &agr;1‐protease inhibitor. This result emphasizes the occurrence of circulating trypsinogen activation and is interpreted to be a consequence of the protease‐antiprotease imbalance, which has been well documented by previous investigators in cystic fibrosis and also in other lung diseases associated with an inflammatory state.

ISSN:0277-2116    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Summary:Although dehydrated obstructing mucus is thought to account for the obstructive pathology involving the lungs, the pancreas, the reproductive system, and the intestinal tract, its relationship with CF‐associated liver disease remains largely hypothetical and little is known about possible risk factors. Complete clinical and autopsy records were available in 38 of 73 deaths occurring over a 10‐year period. The liver was normal in only five cases, and they were all infants. Steatosis was the only lesion present in 9, hypoxic liver disease was documented in 8, and biliary cirrhosis in 16 (focal in 10 and multilobular in 6). There was no relationship between the presence of cirrhosis, gallbladder abnormalities, age at death, and clinical status recorded during the year precoding their demise. Mucus plugs characterized by amorphous eosinophilic material within proliferated bile ductules were present in 75% of children with focal or multilobular biliary cirrhosis as opposed to 14% in those without (p = 0.015). A history of meconium ileus or its equivalent was recorded more frequently (p = 0.038) in those with cirrhosis. Finally, biliary cirrhosis was invariably present when there was a history of meconium ileus or its equivalent and when mucus plugs were noted. These findings suggest that patients with intestinal obstruction are at greater risk for the development of cirrhosis and that strategies should be developed to increase the detergent capacity of bile and its flow in order to decrease the viscosity of mucus in the biliary tree.

ISSN:0277-2116    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Summary:Thirty to 50% of very low‐birth‐weight infants have parenteral nutrition‐associated cholestasis. To test the hypothesis that the incidence of cholestasis would be decreased if parenteral amino acids were avoided and protein given enterally, infants with a gestational age of <30 weeks were randomized to two groups. One group received amino acid‐free parenteral nutrition and whey protein enterally with added premature infant formula. The control group received standard parenteral nutrition with amino acids and enteral premature formula. At the end of 3 weeks of parenteral nutrition, infants who had a direct serum bilirubin level of >3 mg/dl were considered to have significant cholestasis. Twenty‐nine infants required parenteral nutrition for 3 weeks, 17 in the whey group and 12 in the control group. No instances of significant cholestasis were observed in the whey group (0/17), whereas seven of 12 infants (58%) in the amino acid control group had cholestasis (p < 0.001).

ISSN:0277-2116    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Summary:To determine whether gastroesophageal reflux (GER) might be a factor in the pathogenesis of apnea in certain infants, we analyzed the frequency of prolonged central apnea (>15 s) and of numerous irregularly repeated short apneas (5‐15 s) (“respiratory dysfunction”) in infants with an apparent life‐threatening event (ALTE) (group 1, n = 62), in control infants (group 2, n = 387), and in infants with GER pathologic findings (group 3, n = 60). Finally, the incidence of GER was analyzed in 76 infants with a respiratory dysfunction during sleep (group 4). Gastroesophageal reflux was investigated using 24‐h esophageal pH monitoring; respiration during sleep was investigated by polysomnography. The pH monitoring data and results of sleep investigation were analyzed in a double‐blind study. A great number of infants who had an ALTE appeared to suffer from GER (42%, 26 of 62 infants), especially if the ALTE occurred while the infant was awake (52%, 14 of 27 infants). In the control infants, pH monitoring data were abnormal in 8.5%; respiratory dysfunction was observed in 5%. In those with a respiratory dysfunction, GER was detected in 75% (15 of 20 infants). In those with GER, respiratory dysfunction was observed in 45% (15 of 33 infants). In groups 3 and 4, respiratory dysfunction was associated with abnormal pH data in 40‐43%. If, in the infants with a respiratory dysfunction, the GER pathologic symptoms were treated efficiently (normalization of pH data), respiratory dysfunction disappeared in 92%. If GER was resistant to therapy, respiratory dysfunction persisted in 81% (13 of 16 infants). Results failed to show any causal relationship between prolonged apnea and GER. We conclude that GER in infancy is often associated with a typical breathing pattern during sleep characterized by multiple irregularly repeated short apneas. The recognition of this breathing pattern in (control) infants screened for risk of sudden infant death syndrome should result in GER investigations. We recommend studying GER in all infants with an ALTE.

ISSN:0277-2116    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Summary:Twenty‐four‐hour continuous esophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux. Agreement has been achieved that acid gastric content reflux into the esophagus constitutes a major cause of reflux esophagitis; we therefore calculated the “area under pH 4” (A) in 560 consecutive pH monitorings in infants 1‐12 months old and related this parameter (A) to the reflux index (RI): RI < 10%: A 185 ± 295 (mean ± 1 SD); RI 10‐19%: A 1,046 ± 1,206; RI 20‐29%: A 1,967 ± 2,038; RI 30‐39%: A 3,307 ± 2,955; RI > 40%: A 7,977 ± 7,227. A higher RI is associated with a greater area under pH 4 (p < 0.001); the high SD obtained in each group, however, illustrates the great variability in surface (or acidity of the reflux episodes) in all groups. Esophagoscopy and biopsy were performed in 112 infants (20%). Specificity in the prediction of (mild) esophagitis was higher for the area under pH 4 (88%) compared with the RI (50%). The sensitivity of both parameters was comparable (96 versus 93%). Our results strongly suggest that in young infants, the acidity of the reflux episodes (the area under pH 4) is a determining factor in the prediction of esophagitis. These data need to be confirmed by more studies before general application of this parameter can be advised.

ISSN:0277-2116    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Summary:The duodenal juice and fecal aerobic microflora was investigated in 54 patients with persistent diarrhea (age ≤2 years). The duodenal aspirates yielded increased aerobic bacteria (>105organisms/ml) in 28 (51.9%) of the patients. Established enteric pathogens were isolated from the duodenal aspirates of 12 (22.2%) of the 54 patients, viz., enteroadherentEscherichia coli(EAEC) (5), enterotoxigenicE. coli(ETEC) (3), enteropathogenicE. coli(EPEC) (1), nontyphoidalSalmonella(1), andGiardia lamblia(2). The total aerobic bacterial count was >105in all 12 patients positive for specific pathogens apart from one case in whomE. colishowing diffuse adherence to HEp‐2 cells were identified. Among the remaining 42 specific pathogen‐negative patients, 19 (45.2%) also had >105aerobic organisms/ml in the small bowel. Eight strains ofKlebsiellafrom four of the patients were negative for enterotoxin production in a rabbit ileal loop assay and for adherence to HEp‐2 cells. In contrast, 28/54 (51.9%) of the same patients had known enteric pathogens in their stools, viz., nontyphoidalSalmonella(8 or 14.8%),Shigella(2 or 3.7%),Campylobacter(1 or 1.9%), ETEC (4 or 7.4%), EPEC (2 or 3.7%), EAEC (7 or 13.0%), andG. lambliaandEntameba histolytica(3 or 5.6%). Further search for potential virulence factors among aerobic bacteria colonizing the upper small intestine in persistent diarrhea is warranted.

ISSN:0277-2116    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Summary:The susceptibility ofCampylobacter pyloriwas determined for the two topical anesthetic agents commonly used prior to gastroscopy.Campylobacter pyloriproved to be extremely sensitive to the anti‐infective activity of benzocaine, the active ingredient in most commonly used topical anesthetic agents, with minimum inhibitory concentrations of 0.14 mg/ml. However, lidocaine‐containing agents did not interfere with the growth of this microorganism. Specifically, in patients with histologic evidence ofC. pylori,the bacterium was recovered from significantly more patients anesthetized with lidocaine than with benzocaine. Thus, the use of benzocaine‐containing topical anesthetic agents limits recovery ofCampylobacter pylorifrom clinical specimens and might account for the low colonization rates reported in some recent publications (1‐4,8).

ISSN:0277-2116    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Summary:We compared the results of various noninvasive tests with small bowel histology in 61 children with celiac disease. The most sensitive predictors of small bowel histology were serum levels of anti‐gliadin antibodies (AGAs) (90%) and the urinary excretion of polyethylene glycol (PEG) (69%). The sensitivity for the fecal fat analysis was 61% and for the d‐xylose test 34%. The specificity was 96% for both the PEG and the d‐xylose tests, 92% for the fecal fat, and 68% for AGAs. The predictive value of the PEG test was significantly better than that of d‐xylose (p < 0.05). The best combination of tests for the prediction of small bowel histology was the PEG test and the measurement of serum levels of AGAs. Agreement in the results of these two tests helps to time appropriately the second and third small bowel biopsies.

ISSN:0277-2116    

出版商:OVID    

年代:1989

数据来源: OVID