Weanling diarrhoea in The Gambia: implications of a jejunal intubation study.

Abnormalities in jejunal flora and bile salt metabolism were most marked in the youngest members of a group of Gambian village children in the weanling age group. These may be linked with the profound change in diarrhoeal morbidity, particularly diarrhoea-induced growth impairment, which occurs as soon as breast-fed infants are regularly supplemented. The pathogenesis of these changes is not understand. The presence of small bowel colonization did not appear to be a causal factor but, it is speculated, its appearance may mark the development of a post-enteritis enteropathy which is responsible for the weanling diarrhoea syndrome and which is caused and perpetuated by traditional weaning foods.

Intestinal bile salts in cystic fibrosis: studies in the patient and experimental animal.

The quantitative and qualitative distribution of bile salts in the duodenal juice of 13 patients with cystic fibrosis (CF) was studied after a test meal. The effects of triolein (TO), bovine serum albumin (BSA), and ricinoleic acid (RA) on the absorption of taurocholate (TCA) in the distal ileum of the rat in vivo was also studied. The mean (and ranges) of total bile salt concentrations, glycine: taurine conjugate ratios, and percentage of dihydroxy bile salts in the patients with CF and pancreatic insufficiency were 3.5 (1.3--6.6) mmol/l, 8.6 (greater than 10-3.1), and 37 (10--60) compared with control values of 7.4 (3.0--16.0) mmol/l, 3.0 (1.3--4.5), and 61 (52--70) respectively. The differences between the control and CF values were statistically significant (P less than 0.01--P less than 0.001). Three of the 13 CF patients had total bile salt concentrations less than 2 mmol/l, 8 had much higher glycine: taurine ratios, and 8 had a reduced percentage of dihydroxy bile salts. In 2 patients with normal pancreatic enzyme activities, duodenal bile salts were both quantitatively and qualitatively normal. TO (10 and 30 mmol/l), BSA (3%), and RA (5 mmol/l) had no inhibitory effect on the ileal absorption of TCA. These results show pronounced abnormalities of duodenal juice bile salts in CF with pancreatic insufficiency consistent with a broken enterohepatic circulation (EHC); such abnormalities may contribute to defective lipid absorption in CF. The data in the experimental animal do not support the suggestion that unhydrolysed dietary substrates play a role in the pathophysiology of the broken EHC.

Test meal for assessing intraluminal phase of absorption in childhood.

A test meal for assessing the intraluminal phase of absorption in childhood has been validated. 132 test meals were administered to 110 patients aged 2 weeks to 18 years (mean age 4.3 years). 10 children with suspected malabsorption, who were proven to be normal after extensive investigation, constituted the control group. The activities of pancreatic enzymes, and the total and individual bile salt concentrations are presented for the control subjects, and pancreatic enzyme levels in this group are compared with those seen in children with pancreatic insufficiency (cystic fibrosis). The test meal has been designed so that it can be administered to children with suspected gluten, cows' milk, or disaccharide intolerance. The control data provided a basis for the interpretation of information obtained from the application of such a test meal to the clinical investigation of children with suspected malabsorption.

Malnutrition and gastroenteritis in The Gambia.

There is a strong association between failure to thrive and diarrhoeal disease in young Gambian children. The high prevalence of diarrhoeal disease seen is not due to frequent attacks of "acute infantile diarrhoea" of viral orgin. The picture of protracted diarrhoea is almost certainly due to colonization of the upper bowel and the high prevalence demonstrated to be at least partly due to the environment to which the children are exposed, particularly in terms of food and water hygiene. Until this cycle of upper bowel colonization and protracted diarrhoea is broken, a diet-based nutrition programme cannot be expected to function effectively.

Urinary outputs of oxalate, calcium, and magnesium in children with intestinal disorders. Potential cause of renal calculi.

24-hour urinary outputs of oxalate, calcium, and magnesium have been determined in a total of 62 children aged 3 months to 17 years who fell into the following groups: (i) 16 normal controls, (ii) 3 with primary hyperoxaluria, (iii) 9 with small and/or large intestinal resections, (iv) 9 with untreated coeliac disease, (v) 5 with pancreatic dysfunction, and (vi) a miscellaneous group of 20 children with a variety of intestinal disorders. Taken as a whole, 58% of patients with intestinal disorders had hyperoxaluria, and of these 7% had urinary outputs of oxalate which fell within the range seen in primary hyperoxaluria. The proportion of children with hyperoxaluria in the different diagnostic groups was as follows: intestinal resections (78%), coeliac disease (67%), pancreatic dysfunction (80%), and miscellaneous (45%). 35% of the patients with hyperoxaluria had hypercalciuria, whereas magnesium excretion was normal in all subjects studied. In 2 patients treatment of the underlying condition was accompanied by a return of oxalate excretion to normal. These results indicate that hyperoxaluria and hypercalciuria are common in children with a variety of intestinal disorders, and that such children may be at risk of developing renal calculi without early diagnosis and treatment.

Congenital cytomegalovirus infection after maternal renal transplantation.

Congenital cytomegalovirus infection was found in an infant whose mother had a successful renal transplant and was treated with immunosuppressant therapy before and during pregnancy. Although so far not experiencing any untoward infections, the child had impaired T-lymphocyte function and subnormal serum-IgA.

Spinal cord compression in Paget's disease.

Three cases of spinal cord compression secondary to Paget's disease of the spine are reported. In two of the cases a relatively short history with pain as a prominent feature suggested initially a diagnosis of extradural malignancy. The usual clinical features of this rare disorder are discussed and the characteristic radiological findings are emphasized.

A year's experience with a mobile coronary resuscitation unit.

A mobile unit for the emergency treatment of cases of coronary thrombosis in the patient's home and for their supervised conveyance to hospital has been operating in the City of Newcastle upon Tyne for a year. In that time 134 cases have been attended, and of these 39 benefited appreciably from use of the unit. The value of such a unit must be balanced in relation to the current mortality of the disease outside and inside hospital and the staff available

Properties of succinate oxidation in tomato fruit mitochondria.

Mitochondria from tomato fruit (Lycopersicon esculentum Mill.) exhibited a respiratory control ratio of 2.5 and an ADP:O ratio of 1.3 for succinate oxidation for 24 hours after isolation. They also showed a delay in response to the first addition of ADP. The addition of ATP and ADP before succinate eliminated the delayed response as did chelation of endogenous cations with ethylenediaminetetraacetic acid. The addition of ATP after succinate resulted in a longer delay in response than that obtained with ADP. Exogenous oxaloacetate in low concentration inhibited respiration in states 3 and 4 with succinate and resulted in delayed response to ADP. The function of adenine nucleotide during the delay in response may be to promote the metabolism of oxaloacetate or to decrease the affinity of oxaloacetate to its site of inhibition.