Transanastomotic feeding tube after an operation for duodenal atresia.

UNLABELLED: The aim of this study was to answer the question whether or not, after an operation for duodenal atresia, a transanastomotic feeding tube reduces the time to full preanastomotic feeding. The method used was a retrospective study and a prospective observation. 18 consecutive newborns with duodenal atresia, nine from each of two different centres of paediatric surgery, were studied retrospectively. The patients in one centre received a nasogastric tube and a transanastomotic feeding tube during the operation, while in the other centre only a nasogastric tube was used. Seven control patients with duodenal atresia treated postoperatively with a nasogastric tube and a transanastomotic feeding tube were prospectively observed. The main outcome measure used to compare these two groups was the time required to achieve full preanastomotic feeding. RESULTS: The patients who were treated postoperatively with the transanastomotic feeding tube needed significantly less time to achieve full preanastomotic feeding than those with a nasogastric tube only (P < 0.001, Mann-Whitney U test). CONCLUSION: The use of a transanastomotic feeding tube, after an operation for duodenal atresia, leads to earlier full preanastomotic feeding.

Proctocolitis in exclusively breast-fed infants.

UNLABELLED: We present nine exclusively breast-fed, full-term infants with mild rectal bleeding due to proctocolitis. The mean age at the onset of symptoms was 5 weeks (range 1-8 weeks). Rectosigmoidoscopic examination was performed in all the children within 2 days after admission, showing inflammatory changes such as oedematous mucosa with petechial haemorrhages. Rectal mucosal biopsy specimens were obtained in eight cases and revealed intra-epithelial eosinophilic granulocytes in seven and a diffuse increase of eosinophils in the lamina propria in six. Allergy to cow's milk protein transferred to the infants via the breast milk was believed to be the cause of the inflammation. The intake of cow's milk protein was then restricted in seven mothers. Following this regimen, symptoms were relieved within 4 weeks in the six infants who were seen at follow up. One child recovered spontaneously without dietary restrictions. Considering the beneficial effect of the diet regimen in addition to the histological findings, allergy to cow's milk protein is possibly the aetiology of the proctocolitis seen in these nine exclusively breast-fed babies, although no challenge tests were performed to confirm this suspicion. CONCLUSION: This report shows that proctocolitis occurs in exclusively breast-fed infants. It is speculated that allergy to cow's milk protein may have played a role in the pathogenesis.

Plasma-cell gingivitis in children and adults. A clinical and histological description.

Plasma-cell gingivitis (PCG) is a rare, non-symptomatic lesion found in the attached gingiva. In the county of Södermanland 14 cases of PCG were identified during the last 13 years. Clinically, the PCG is a sharply demarcated red area within the attached gingiva. Abundant plasma cells are found in the connective tissue beneath a thin epithelium. Lesions with similar clinical appearance were also found in the genital mucosa of five of the patients with a PCG. An extensive bacterial plaque was frequently found on the gingiva and teeth in the affected areas. Although an improved oral or genital hygiene did not heal the lesions, an allergic reaction to the bacterial plaque may be the cause.

Expression of beta 1- and beta 2-receptor genes and correlation to lipolysis in human adipose tissue during childhood.

beta 1- and beta 2-adrenoceptor (bar1 and bar2) mRNA levels were measured in adipose tissue obtained from children (between 1 month and 10 yr of age) and adults during inguinal hernia operations. Bar1 mRNA levels were constant in all age groups studied. In infants and children less than 7 yr old, bar2 levels were twice as high (P < 0.01) as those in adults, and in infants 1-4 months old, bar2 mRNA levels were higher than bar1 levels (P < 0.01). The bar2/bar1 ratio gradually decreased, and in adults, there was 2.3-fold higher bar1 mRNA expression (P < 0.01). In infants 1-5 months old, the lipolytic sensitivity to noradrenaline was 5 times lower (P < 0.05) than that in adults, whereas the sensitivity to adrenaline and isoprenaline was unchanged. The maximal lipolytic response to adrenaline was higher than that to noradrenaline in infants (P < 0.01), whereas the opposite was found in adults (P < 0.01). The lipolytic sensitivity to the bar1-selective agonist dobutamine was not influenced by age, whereas the sensitivity to the bar2-selective agonist terbutaline was 10,000 times higher in infants than in adults. In conclusion, these data indicate subtype-specific developmental changes in bar expression, with higher bar2 mRNA levels accompanied by increased bar2-induced lipolysis during infancy.

Gray-scale sonography in torsion of the testicular appendages.

The reliability of gray-scale ultrasonography in diagnosing torsion of the testicular appendages was studied in a series of 54 boys with acute non-traumatic scrotal pain. All boys were operated upon, and the appendages extirpated irrespective of their appearance at exploration; the final diagnosis was based on histological examination. Forty-two boys had appendicular torsion, 2 had testicular torsion and 10 had other diagnoses. Using the sign of appendicular torsion--an echogenic extratesticular structure situated between the head of the epididymis and the upper pole of the testis--as the criterion, 37 displayed a true positive, 9 a true negative, 3 a false positive and 5 a false negative diagnosis. Thus, the sensitivity was 88%, the specificity 75% and the positive predictive value 93% respectively. The echogenic mass varied in size from 3 to 17 mm in diameter. In 34 of the 42 cases of appendicular torsion extratesticular fluid was present, and 19 patients showed enlargement of the head of the epididymis. It is concluded that gray-scale sonography is an accurate and valuable tool in diagnosing torsion of the testicular appendages.

Inhibition of lipolysis by agents acting via adenylate cyclase in fat cells from infants and adults.

The in vitro lipolytic effect of catecholamines is poor during infancy because of enhanced alpha 2-adrenoceptor activity. The mechanisms behind this were investigated in isolated fat cells obtained from 1- to 4-mo-old infants and from adults. The cells were incubated with agents that inhibit lipolysis through distinct receptors coupled to adenylate cyclase via the inhibitory GTP binding coupling protein, Gi. The sensitivity to the alpha 2-adrenoceptor agonist clonidine was 14 times higher in the infant group as compared to the adults, whereas that to an adenosine analogue was 14 times lower. The sensitivities to prostaglandin E2 and nicotinic acid were similar in both age groups. Preincubation of the adipocytes with pertussis toxin abolished the antilipolytic effects of all agents. The density of alpha 2-adrenoceptor binding sites determined with [3H]yohimbine was increased by about 25% in the infants. In conclusion, the antilipolytic sensitivity of adenosine and alpha 2-adrenoceptors develops separately and may play different roles in the regulation of lipolysis in man. Furthermore, the enhanced alpha 2-adrenoceptor sensitivity during infancy seems at least in part to be due to an increase in the number of receptors.

Changes in catecholamine-induced lipolysis in isolated human fat cells during the first year of life.

Catecholamine-induced lipolysis in isolated human adipocytes during the first year of life was investigated. During this period fat cell size increased markedly. Basal and catecholamine-induced glycerol release were positively correlated with age when lipolysis was expressed per cell. However, when lipolysis was expressed per unit of cell surface area (micrometer squared), this correlation was observed only for noradrenaline. Basal lipolysis and the effect of the pure beta-agonist, isoprenaline, were identical in infants and adults. From 0 to 2 mo of age noradrenaline had very little lipolytic effect. The addition of the alpha-2-adrenoceptor antagonist, yohimbine, to noradrenaline equalized lipolysis per micrometer squared in infants and adults and the alpha-2-adrenoceptor sensitivity was significantly enhanced in infants. In both groups the lipolytic adrenoceptor was of the beta-1 type. In conclusion, adipocytes from infants have a poor lipolytic response to noradrenaline partly because of the small fat cells but mainly because of an enhanced alpha-2-adrenoceptor activity.

Role of alpha-adrenoceptors for adipocyte size in man.

Catecholamines have dual effects on lipid mobilization in man. Lipolysis is stimulated via beta-adrenoceptors and inhibited via alpha 2-adrenoceptors. The relationship between fat-cell size and catecholamine-induced lipolysis (expressed per cell surface area) was investigated in vitro in subcutaneous adipocytes of thirty-five non-obese subjects between 1 month and 45 years of age. Fat-cell volume showed a positive correlation with noradrenaline-induced lipolysis (r = 0.7). Furthermore, fat-cell size showed a negative correlation with the alpha 2-effect of noradrenaline (r = 0.8) but no correlation with the beta-effect of the hormone (r less than 0.1). Although age showed a positive correlation with noradrenaline-induced rate of lipolysis (r = 0.6) it did not contribute to the relationship between cell size and the catecholamine effect. There was no relationship between adipocyte size and the basal (unstimulated) rate of lipolysis (r less than 0.1). In conclusion, ageing in non-obese subjects is associated with enlargement of fat-cell size and enhancement of the lipolytic effect of catecholamines. The latter is due to diminished alpha 2-anti-lipolytic effect of the hormones. This modulation of the alpha 2-adrenoceptor activity may be of importance for the regulation of adipocyte size in man.

Regulation of interstitial cell function by seminiferous tubules in intact and cryptorchid rats.

The effects of experimental cryptorchidism on seminiferous tubule secretions and interstitial cell testosterone production were studied in vitro. Spent media obtained from incubations of seminiferous tubules (SMST) from cryptorchid rats caused a significant increase in testosterone production when added to interstitial cells isolated from intact rats. The previously noticed inhibitory activity of the SMST from stages VIII-XI of the spermatogenic epithelial cycle gradually disappeared after the induction of experimental cryptorchidism. SMST obtained from both sham-operated or cryptorchid rats stimulated basal testosterone production when added to interstitial cells from cryptorchid rats. SMST from rats had been cryptorchid for 7, 14 and 28 days stimulated testosterone production when added to interstitial cells prepared from intact animals. Seminiferous tubules from cryptorchid rats therefore appear to be the source of a heat stable, trypsin-resistant factor with an apparent molecular weight of between 5000 and 10,000 daltons which stimulates testosterone production when added to interstitial cells in vitro. Its activity could not be blocked by an LRH antagonist. This factor enhances both basal and LH-stimulated secretion of testosterone in contrast to the inhibitory activity which involves only a partial blockade of LH-dependent steroidogenesis.

Changes in germ cell adenylate cyclase and protein carboxyl methylase activities in rat testicular tissue during bilateral cryptorchidism and after orchidopexy.

Soluble Mn2+-dependent adenylate cyclase and protein carboxyl methylase are two enzymes that are primarily localized in haploid germ cels of rat testicular tissue, and both enzymes exhibit an increase in activity in association with sexual maturation. Experimental cryptorchidism (surgery at 17 days of age) in immature rats prevented the age-dependent increase in the activity of these two testicular enzymes. After orchidopexy at 34 days of age the activities of these two enzymes increased to normal control values in association with testicular growth. These observations show that biochemical markers such as soluble Mn2+-dependent adenylate cyclase and protein carboxyl methylase can be used to follow germ cell differentiation.

Maturation of the juvenile rat testis after surgical treatment of cryptorchidism.

Rats were made bilaterally cryptorchid at 17 days of age and bilateral orchidopexy performed at 34 days of age. The epididymal content of androgen binding protein (ABP), the weight and morphology of the testis, the cross-sectional area of seminiferous tubules and the testicular concentration of testosterone were then studied at 34, 42, 59 and 120 days of age. Cryptorchidism was followed rapidly by progressive inhibition of spermatogenesis and testicular growth as well as by decreased Sertoli cell secretion of ABP. Orchidopexy resulted in a gradual restoration of spermatogenesis, and all impaired parameters seemed to improve at the same, fairly slow rate. Restoration was not complete, but by 120 days of age the morphological appearance of the testis was compatible with recovery of normal fertility.

Changes in isoproterenol-stimulated adenylate cyclase activity in rat testicular tissue during cryptorchidism and after orchidopexy.

Cryptorchidism was associated with increased responsiveness of the isoproterenol-sensitive adenylate cyclase in membrane particles from rat testis. Abdominal testes from uni- and bilaterally cryptorchid rats showed the same activities. The change in isoproterenol-responsive adenylate cyclase was independent of the age at which the animals were made cryptorchid. The isoproterenol response was maximal 3-4 weeks after the rats were made cryptorchid. By 2-3 months after orchidopexy the isoproterenol response in the rat testis had decreased to normal control values.

LHRH treatment in unilateral cryptorchidism: effect on testicular descent and hormonal response.

Fifty unilaterally cryptorchid boys aged 3 to 8 years were randomly and blindly allocated to treatment with luteinizing hormone releasing hormone or placebo intranasally. In the treated group, no significant descent of the undescended testis was found, whereas a minor downward movement of the scrotal testis occurred (P less than 0.001), probably as a result of decreased retraction by the cremaster muscle. Basal serum testosterone concentrations and testicular volume increased after treatment (P less than 0.01 and P less than 0.001, respectively). The response to an acute LHRH test, 100 micrograms/m2 body surface IV, before and after treatment, showed an increase in the luteinizing hormone peak value and a decrease in the follicle-stimulating hormone response in a significant number of patients (P less than 0.001). In the individual patient, there was a positive correlation between the increase in basal serum testosterone concentration and the degree of downward movement of the undescended testis (P less than 0.05).

Testosterone concentration within the tunica vaginalis of boys and adult men.

The testosterone level in fluid contained in the tunica vaginalis has been determined in 25 adult men referred for infertility and in 20 boys aged 0-10.5 years operated on for hydrocele. The median concentrations of testosterone were found to be 392 nmole/1 (range 78-957) and 1.1 nmole/1 (range 0.16-182), respectively. The median value for adult men was 20 times the concentration of testosterone found in the peripheral blood of that group while the median value for the boys was 4 times that found in their peripheral blood. It is concluded, firstly, that the high level of testosterone in the peritesticular space of adult men strongly indicates that diffusion of testosterone through the testicular capsule does take place. Secondly, testosterone levels in fluid from the peritesticular space which significantly exceeds those in peripheral blood in prepubertal boys furnishes evidence of testicular secretion of testosterone in that age group. Consequently, the peritesticular tissues such as the epididymis, gubernaculum and scrotum are exposed to quantities of testosterone far exceeding those brought by the general circulation.

Studies on the scrotal testis in unilateral experimental cryptorchidism in rat and guinea pig.

The effects of experimental unilateral cryptorchidism on the scrotal testis regarding weight, morphology and secretion of tubular fluid and the sertoli-cell specific androgen binding protein (ABP) were studied. In the intact guinea pig testis and epididymis an androgen binding component similar to rat ABP was found. In juvenile and adult rats cryptorchid for 17 and 21 days, respectively, and in guinea pigs cryptorchid for 11 weeks, the scrotal testis seemed unaffected regarding all parameters studied. With reference to previous findings of lowered fertility in unilateral cryptorchidism in man the possible mechanisms by which unilateral cryptorchidism may influence the scrotal testis are discussed.

Recovery of testicular functions after surgical treatment of experimental cryptorchidism in the rat.

When rats were made unilaterally cryptorchid at 17 days of age (before spontaneous descensus), the further maturation of the testis was prevented. At 34 days of age, the abdominal testis was smaller than the scrotal testis and showed less secretion of the Sertoli cell specific androgen binding protein (ABP). In 120-130 days old rats that were made bilaterally cryptorchid at 17 days of age, testicular weight, histology, secretion of fluid and ABP were restored and testosterone secretion and fertility were normal if orchidopexy was performed at 33 days of age. If the orchidopexy was delayed until 59 days of age, the recovery of testicular function and morphology was only partial. The results show that in the rat, the testicular damage caused by cryptorchidism is reversible, if the abdominal testis is surgically descended during early sexual maturation.

Aspects on appendiceal abscess in children with special reference to delayed appendectomy.

A series of 52 children with appendiceal abscess is presented. The general policy of treatment was initially conservative regime followed by delayed elective appendectomy. Ten patients had a recurrence before appendectomy was performed. In 2 patients, potentially malignant conditions were discovered at appendectomy. There were no significant postoperative complications. Delayed elective appendectomy is recommended after an interval of 4-6 weeks.