Hypocobalaminaemia in dogs with acute gastrointestinal diseases.

OBJECTIVES: The objectives of this study were to investigate the prevalence of hypocobalaminaemia in dogs with acute gastrointestinal diseases and to evaluate its relationship with disease severity and outcome. MATERIALS AND METHODS: Medical records of dogs presented for acute gastrointestinal signs that a serum cobalamin concentration measured between September 2019 and 2021 were included in this study. Hypocobalaminaemia was defined as serum cobalamin concentration <200 pmol/L, and low-normal cobalamin was defined as serum cobalamin concentration of 200 to 295 pmol/L. Duration of clinical signs prior to presentation, Acute Patient Physiologic and Laboratory Evaluation (APPLE) fast score, length of hospitalisation and outcome were recorded. RESULTS: Thirty-three dogs were included. Seventeen dogs were diagnosed with acute gastrointestinal disease of unknown aetiology, seven dogs with parvoviral enteritis, three dogs with acute haemorrhagic diarrhoea syndrome and six dogs with miscellaneous diseases. The prevalence of hypocobalaminaemia in this population was 30.3% and low-normal cobalamin concentration was detected in 18.2% of dogs. There was no statistically significant relationship between the detection of hypocobalaminaemia or low-normal cobalamin and the duration of clinical signs before presentation, length of hospitalisation or Acute Patient Physiologic and Laboratory Evaluation fast score on admission. Mortality rate was 3%. CLINICAL SIGNIFICANCE: Hypocobalaminaemia and low-normal cobalamin are common findings in dogs with acute gastrointestinal diseases. The therapeutic significance and potential implications for prognosis of hypocobalaminaemia in these patients requires further investigation.

Hepatic granulomas in children. A clinicopathologic analysis of 23 cases including polymerase chain reaction for histoplasma.

In a 15-year period at the Riley Hospital for Children, granulomas were found in 23 (4%) of a total of 521 liver biopsies. An etiology was identified in 87%: Histoplasma was diagnosed in 15 cases (65%) by polymerase chain reaction (PCR) on paraffin-embedded tissue, serology, and special stains; sarcoidosis was diagnosed in four cases; and schistosomiasis was diagnosed in one case. Serial liver biopsies were available from five patients; granulomas occurred in only one biopsy of the series from each patient. Extrahepatic tissue from six patients contained granulomas, and an etiology for the liver granulomas was identified in all six patients (four histoplasmosis, two sarcoidosis). The extrahepatic tissue from two patients with Histoplasma was diagnostic. We made the following conclusions: that PCR is applicable to archival material and greatly increases the yield of specific infectious diagnoses of liver granulomas compared with conventional diagnostic methods (65 versus 22%); that the infections causing liver granulomas are those that are endemic in a community (e.g., Histoplasma in Indiana); that Histoplasma can coexist with a wide variety of systemic and primary liver diseases; that the likelihood of identifying a cause of liver granulomas is increased if there are extrahepatic granulomas; and that hepatic granulomas may have a limited life span. Treatment of liver granulomas should be determined by the clinical setting and directed at the underlying cause.

Helicobacter pylori infection in recurrent abdominal pain in childhood: comparison of diagnostic tests and therapy.

OBJECTIVE: To determine the role of Helicobacter pylori infection in children with recurrent abdominal pain and the usefulness of serologic tests in screening H pylori infection and monitoring treatment of H pylori-associated gastritis. METHODS: During a 3 year period, we investigated the presence of serum immunoglobulin G (IgG) antibody to H pylori in 456 children using the high-molecular-weight cell-associated protein H pylori enzyme immunoassay kit. Among the 456 children studied, 218 (age range, 3 to 18 years; mean age, 9.5 years) had symptoms of recurrent abdominal pain (RAP syndrome) with or without vomiting, and the remaining 238 (age range, 3 to 18 years; mean age, 9.8 years) had no RAP (non-RAP syndrome). We performed upper gastrointestinal endoscopy on 111 consecutive children of the 218 with RAP syndrome and obtained mucosal biopsies for culture, histologic analysis, CLO test (Delta West, Perth, Australia), and H pylori detection by polymerase chain reaction. RESULTS: Thirty-eight (17.4%) of 218 children in the RAP group and 25 (10.5%) of 238 children in the non-RAP group were seropositive for H pylori. Of the 111 children endoscoped, 95 were found to be negative, and 12 were positive by all five assays. Specimens from 2 children were negative by culture and the CLO test but positive by the other three assays. Specimens from 1 child were negative by histologic analysis but positive by all other tests. The remaining child was positive for anti-H pylori IgG but negative by all of the other four assays. Upper gastrointestinal endoscopy detected 14 children with peptic ulcer disease (9 duodenal ulcer and 5 gastric ulcer) and 12 with antral nodular gastritis. Only 4 of the 14 diagnosed with peptic ulcer were H pylori positive by all five assays, whereas all 12 children with antral nodular gastritis were H pylori positive. Nine of the 12 H pylori-positive children were treated with a combination of bismuth subsalicylate, amoxicillin, and metronidazole for 2 weeks. Sera obtained at 2, 4, and 6 months after treatment from all 9 children showed a decrease in anti-H pylori IgG titer. Three H pylori-infected children who did not receive any treatment served as control children, and their IgG levels remained elevated or increased over time. CONCLUSION: The results from our study indicate that screening for the serum IgG antibody to H pylori is a practical method for diagnosing H pylori infection in children, and that serial measurements of the H pylori IgG antibody are useful for monitoring treatment of H pylori because of its high sensitivity and ease of performance. Only 4 of the 14 children diagnosed with peptic ulcer disease were confirmed to be infected with H pylori, whereas all 12 children with antral nodular gastritis were found to be infected by H pylori. These observations suggest that H pylori infection is more frequently associated with gastritis than with peptic ulcer disease in children, and that H pylori gastritis is a cause of RAP syndrome in children.

Fetal tissue derived from spontaneous pregnancy losses is insufficient for human transplantation.

OBJECTIVE: To determine if sufficient fetal tissue with desirable transplant characteristics can be obtained from spontaneous abortions. METHODS: A survey of fetal tissues collected from newly diagnosed spontaneous pregnancy losses from three Indianapolis hospitals was conducted from December 1992 to September 1993. Forty-nine of 356 mothers (13.8%) with spontaneous abortions or ectopic pregnancies consented to the evaluation of their products of conception by gross and microscopic pathologic examination, bacterial culture, cytogenetic analysis, cell culture, and maternal serologic tests. RESULTS: Forty-nine pregnancies (gestational age range 5-30 weeks) provided four identifiable embryos, 12 second-trimester fetuses, and one third-trimester fetus. Nine samples (18.4%) were of excellent or good quality on pathologic grading. Twenty-five of 38 samples tested (66%) grew pathogenic bacteria. Maternal serologic tests were negative for antibodies to human immunodeficiency virus, human T-cell lymphotropic virus, syphilis, and hepatitis B in all cases. One of 43 sera was reactive for hepatitis C, and 33 (77%) were positive for cytomegalovirus. Cytogenetic abnormalities were found in 25% of cultured samples. Five fetal brain samples had cell viabilities of 50% or more. Few viable fetal hepatocytes were found. Only two fetal brain samples (4.1%) were potential candidates for human transplantation. CONCLUSION: Spontaneous pregnancy losses yield minimal usable tissue for human transplantation because of a lack of embryonic or fetal tissues, delayed collection, decomposition, genetic abnormality, and bacterial contamination.

Neuropathy and vasculopathy in colonic strictures from children with cystic fibrosis.

Colonic strictures are rare in patients who have cystic fibrosis, but recently have developed in those who have been treated with delayed-release high-dose pancreatic enzyme supplements. Colonic strictures from eight such pediatric patients showed neural abnormalities consisting of ganglion cell hyperplasia and ectopia, and intermyenteric plexus hyperplasia. Cholinergic and adrenergic stains of mucosal nerve fibers were more prominent in histological sections of the cystic fibrosis strictures than in sections from colons of children without cystic fibrosis. The mean grade of staining with acetylcholinesterase in the lamina propria of the strictured cystic fibrosis colons was 2.38 +/- 1.25, compared with .93 +/- .93 (P < .055) in bowels from children without cystic fibrosis. The mean grade for tyrosine hydroxylase staining in the lamina propria was 2 +/- .97 in the strictures and was .79 +/- .81 (P < .05) in the bowels of children who did not have cystic fibrosis. Vasoactive intestinal peptide staining in bowels from children with cystic fibrosis with and without stricture did not differ significantly from that of children without cystic fibrosis. Vasculopathy consisting of fibrointimal hyperplasia in submucosal veins and mesenteric arteries was found only in colonic strictures owing to cystic fibrosis. Colonic strictures in patients with cystic fibrosis who received high-dose pancreatic enzyme supplements contain ganglion cell abnormalities, and mucosal cholinergic and adrenergic activity may be increased in these strictures. The stricture vasculopathy may be drug-related and/or related to increased catecholamine activity.

Spatio-Temporal Analysis of Soybean Root Colonization by Fusarium solani f. sp. glycines in Fields.

Soybean roots were sequentially collected from two no-till fields from June 1997 through December 1998. Roots were ground to isolate and enumerate the fungus Fusarium solani f. sp. glycines, the causal agent of soybean sudden death syndrome (SDS), to obtain CFU per gram of root. The log CFU [log10(CFU + 1)] versus sampling time was used to produce the pathogen population curve, and the area under the pathogen population curve (AUPC) was calculated for each plot. The average log CFU from all plots for each sampling date was used to fit the logistic equation. Plot data of log CFU at each sampling time of the growing season, AUPC, and foliar disease index (FDX) were correlated with each other. Correlations among the log CFU in root residue in the winter of 1997, the log CFU and FDX in the 1998 growing season were also conducted. Geostatistics was applied to determine the spatial dependence in root colonization for different lag distance in the fields using semiviograms. Spatio-temporal autocorrelations of root colonization were studied using a computer model STAUTO. During the growing season, pathogen population in roots followed logistic growth in both fields. Pathogen populations in root residue decreased during the winter of 1997 and increased slightly in the spring of 1998 prior to planting. AUPC significantly correlated with FDX in both fields in 1997. Pathogen populations in root residue at three sampling dates in the winter of 1997 significantly correlated (r = 0.47 - 0.53) with FDX of the 1998 growing season in one field. No spatial dependence in root colonization was detected early in the growing season. However, some spatial dependence in certain directions of the fields was detected later in the growing seasons. Spatial dependence in AUPC in the across-rows direction was detected in both fields in 2 years. Spatial lag orders 0 and 1 were significantly correlated with temporal lag order 1 in both within-row and across-row directions in field 1 in 1997.

Response of Soybean Sudden Death Syndrome to Subsoil Tillage.

The soilborne pathogen Fusarium solani f. sp. glycines causes sudden death syndrome (SDS) of soybean. Previous research indicated that soil compaction related directly to disease foliar symptoms. Therefore, we hypothesized that decreasing soil compaction would increase soil porosity and provide a more aerated root zone that would hinder root infection by the fungus and decrease SDS foliar symptom severity. Two experimental areas (110 by 120 m) were established to evaluate the relationship between soil variables and SDS. Across the experimental area, strips (9.14 m wide) were subsoiled perpendicular to soybean rows to a depth of 40 to 45 cm, which alternated with strips that were not tilled. In both 1999 and 2000, subsoiling dramatically reduced foliar symptoms of SDS. Compared with no-till plots, subsoiled plots had lower soil bulk density, greater soil porosity, and less soil moisture. In areas where SDS occurs and soil compaction exists, the use of subsoiling can be used to reduce severity of foliar symptoms of SDS.

Soybean Yield Loss to Sudden Death Syndrome in Relation to Symptom Expression and Root Colonization by Fusarium solani f. sp. glycines.

Field studies were conducted to determine the relationships between soybean yield and foliar disease index (FDX) of sudden death syndrome (SDS) as well as root colonization by Fusarium solani f. sp. glycines, the causal agent. Single-row plots in a soybean field with relatively uniform SDS incidence and severity were identified at growth stage R6 on cultivar Pioneer 9492 in DeSoto, IL, in 1997 and 1998. For each plot, foliar disease index (FDX), yield, and yield components were determined. In 1997, linear relationships between yield (Y, grams per meter of row) and FDX were obtained from the wide-row (Y = 207.84 - 1.09 FDX) and narrow-row (Y = 126.66 - 0.745 FDX) plots, respectively. A linear relationship (Y = 124.23 - 1.11 FDX) also was observed in 1998. Increase in each FDX unit caused yield loss from 18 to 29 kg/ha (0.7 - 1.1 g/m of row). FDX was negatively correlated with seed weight (grams per plant) in both years and with seed size (grams per 100 seeds) in 1997. A no-tilled field at Southern Illinois University planted to soybean cultivar Asgrow 5403 was divided into 25 plots in 1997 and 40 plots in 1998. Root samples were taken from each plot at five or six sampling times during the seasons. Roots were used to isolate and enumerate F. solani f. sp. glycines on a selective medium to obtain the CFU. FDX was assessed and soybean yield was obtained from each plot. Soybean yield correlated negatively with FDX in both years. Both yield and FDX correlated significantly with CFU from slightly before growth stage R1 to R2 in both years, and with area under the pathogen population curve (AUPC) in 1997. An increase in one unit of AUPC or CFU per gram of root at R6 was associated with yield loss of 0.19 or 0.014%, respectively.

Recurrent abdominal pain in children--a retrospective study of outcome in a group referred to a pediatric gastroenterology practice.

Recurrent abdominal pain (RAP) affects a significant number of children each year. We reviewed our experience over a 2-year period to determine the outcome of patients who were referred for pediatric gastroenterology consultation. We identified 356 patients, 149 (42%) male and 207 (58%) female. All patients underwent a thorough interview and complete physical examination. Patients suspected of having irritable bowel syndrome (IBS) were treated as such without further initial evaluation. Others underwent an initial blood and urine evaluation. When these initial screening studies were negative, additional studies were performed including abdominal ultrasonography, radiography, and/or endoscopy of the upper gastrointestinal (GI) tract if the history suggested a possible diagnosis that could be excluded or confirmed by such tests. There was no identifiable diagnosis in 43.5% of the patients studied. IBS was diagnosed in 25.8% of all patients. Constipation was diagnosed in 3.7%. Miscellaneous causes, including GI mucosal lesions, and renal and pancreatic disorders were found in an additional 27% of patients. In a follow-up survey, more than 70% of the treated respondents were improved (i.e., their RAP had resolved or was markedly improved). We conclude that most children with RAP have a functional disorder. Patients with an organic cause for pain can be identified and treated in a cost-effective manner with carefully planned evaluation.

Prevalence and demographics of the MYBPC3-mutations in ragdolls and Maine coons in the British Isles.

OBJECTIVES: To determine prevalence and demographics of two myosin-binding protein C (MYBPC3) mutations that affect ragdolls (R820W) and Maine coons (A31P) in the British Isles. METHODS: From the database of a genetic testing laboratory samples from 2018 ragdolls and 742 Maine coons were analysed with respect to mutation status, age, sex and county of origin. The actual prevalence was compared to the expected Hardy-Weinberg prevalence by chi-squared test. RESULTS: The prevalence of the R820W mutation in ragdolls was 27% (25·6% heterozygous, 1·4% homozygous), and that of the A31P mutation in Maine coons was 39·4% (36·4% homozygous, 3% heterozygous). There were more female cats (69·5% ragdoll, 70·3% Maine coon). The median age was 6·4 months (ragdolls) and 5·9 months (Maine coons). Cats from more than 60 counties were represented for each breed. The difference between the expected and observed allele frequency was significant in Maine coons (P=0·047) but not in ragdolls (P=0·092). CLINICAL SIGNIFICANCE: This is the first report of prevalence and demographics of the R820W and A31P mutations in ragdolls and Maine coons, respectively, in the British Isles. The prevalence is high, which is of relevance for breeding and screening programmes. The significant difference in genetic distribution may suggest early death of homozygous Maine coons.

Cyclic vomiting syndrome in adults.

Cyclic vomiting syndrome (CVS) was initially described in children but can occur in all age groups. Cyclic vomiting syndrome is increasingly recognized in adults. However, the lack of awareness of CVS in adults has led to small numbers of diagnosed patients and a paucity of published data on the causes, diagnosis and management of CVS in adults. This article is a state-of-knowledge overview on CVS in adults and is intended to provide a framework for management and further investigations into CVS in adults.

Gastrointestinal problems in the handicapped child.

Gastrointestinal issues are a major chronic problem in 80 to 90% of children with cerebral palsy and in children with neurodevelopmental disabilities who are at special risk of developing malnutrition because of uncoordinated swallowing, gastroesophageal reflux, and constipation. In addition to poor linear growth, there is a decrease in muscle strength and coordination, impaired cerebral function leading to decreased motivation and energy. Significant neurodevelopmental progress can be achieved with improved nutritional status. A multidisciplinary approach, with input from neurologists, gastroenterologists, nurses, occupational therapists, and dieticians, can make a major contribution to the medical wellbeing and quality of life of these children. Different neurological diseases ( eg, spinal dysraphism, syringomyelia, tethered cord syndromes) can give rise to gastrointestinal dysfunction and symptoms that may need different gastrointestinal or surgical management. The introduction of new drugs, including proton pump inhibitors and innovative endoscopic and surgical techniques in the management of gastroesophageal reflux disease and constipation also may have an impact on the treatment of neurologically handicapped children in the future.

Electrogastrography in cyclic vomiting syndrome.

Children with cyclic vomiting syndrome have a characteristic periodicity, and this could be due to abnormal gastric myoelectrical activity detectable by cutaneous electrogastrography (EGG). Fifteen children, aged 4-15 years, with CVS (eight symptomatic and seven asymptomatic at the time of study) underwent EGG and were compared to five normal and four disease control children. The relative tachygastria activity (RTA) or power ratio was calculated in each group. Five of the eight symptomatic CVS children showed marked episodes of tachygastria preprandially and all showed tachygastria postprandially. The asymptomatic CVS children showed tachygastria only postprandially after the test meal. RTA index and or power ratio of symptomatic children was significantly different from the asymptomatic CVS children (P = 0.001), normal (P = 0.007) and disease control children (P = 0.006). In a subsequent study, 2-hr gastric emptying 99mTc scintiscans were performed in 28 CVS children and compared to eight healthy control children. Twelve of 16 CVS children (75%) showed abnormal gastric emptying, and 7 of 28 (25%) showed abnormal EGG with significant tachygastria. The CVS children had significantly higher RTA both preprandially (P < 0.05) and postprandially (P < 0.05). Our results demonstrate that accelerated gastric rhythm was seen during the acute episodes of half of the CVS patients studied. Abnormal EGGs and higher RTA or power ratios were associated with delayed gastric emptying in the CVS children. Abnormal gastric myoelectrical activity may play a role in the pathogenesis of CVS syndrome.

Ginseng--is there a use in clinical medicine?

Panax ginseng occupies an important place among the tonic remedies of Oriental medicine. Pharmacological investigations show that crude ginsenosides can increase non-specific resistance of an organism to various untoward influences. The effects of purified derived derivatives have only recently become better studied in immunological and cell growth studies in animals and in man. This has now provided some evidence to suggest that ginseng is a drug that contains many derivatives with different pharmacological properties, which could be useful in clinical medicine.

Prevalence of immunoglobulin G to Helicobacter pylori among endoscopy nurses/technicians.

The purpose of this study was to compare the prevalence of Helicobacter pylori (HP) seropositivity among gastroenterology nurses and technicians with that of the general population. Nurses attending the 1996 Indiana Society of Gastroenterology Nurses and Associates Spring and Fall Education Courses were asked to complete a checklist regarding employment, current symptoms, and use of universal precautions, and to have 3 ml blood drawn. These 138 blood specimens as well as 112 serum samples from generally age- and sex-matched blood donors (representing the general population) underwent qualitative HP antibody testing. Results showed that the prevalence of seropositivity for immunoglobulin G (IgG) antibody for HP among the gastroenterology nurses and technicians was 19 of 138 (13.8%), which was less than that of the blood donor control group, whose seropositivity was 20 of 112 (17.9%). However, this difference failed to reach statistical significance. Seropositivity tended to increase with age, but there was no association between clinical symptomatology and seropositivity. Likewise, there was no difference in seropositivity between nurses assisting with endoscopic procedures for more than 10 years and those assisting for less than 10 years. Although the differences were not significant, these findings refute those of an earlier study in which the researchers found 122 gastroendoscopists and endoscopy nurses significantly more likely to be positive for HP antibodies. Therefore, the findings reported here provide important information.