Otoacoustic emissions and tympanometry in children with otitis media.

OBJECTIVE: To examine otoacoustic emission and tympanometric findings in children with surgically confirmed middle ear effusion (MEE). DESIGN: A total of 102 children aged 0.7 to 11.4 yr undergoing surgery because of otitis media were included in the study. A tympanometric examination and transient evoked otoacoustic emission (TEOAE) measurement were performed on each ear before myringotomy. MEE was aspirated, weighed and classified as mucoid or nonmucoid. TEOAE measurements were compared with the quantity and quality of MEE and to the tympanometric findings. RESULTS: Fifty (72%) ears out of the 65 ears containing effusion showed reduced TEOAE. The quantity of effusion was associated significantly (p < 0.001) with the TEOAE responses, and mucoid effusion reduced the emissions more than nonmucoid. The sensitivity of tympanometry in identifying the ears without recordable TEOAE was 73% and the specificity 81%. CONCLUSION: MEE results in a significant reduction in TEOAEs even when the effusion is nonmucoid. This suggests that transmission of acoustic energy to and from the middle ear is altered in children experiencing any form of otitis media with effusion.

Rotaviral antibodies in the treatment of acute rotaviral gastroenteritis.

The efficacy of hyperimmune bovine colostrum received from cows immunized with simian rotavirus SA11 in the treatment of rotavirus gastroenteritis was compared in a randomized double-blind trial to colostrum and ordinary milk preparations. One hundred and thirty-five children aged 6-30 months with rotaviral gastroenteritis received either hyperimmune bovine colostrum (n=42), ordinary colostrum (n=42) or milk (n=41) as a 100 ml solution four times/d for 4 d. Even though the differences were in favour of hyperimmune bovine colostrum in all the variables evaluated [greater weight gain (403 vs 343 g), shorter duration of diarrhoea (3.1 vs 3.6 d), fewer stools during 6 d (11.5 vs 13.6) and fewer stools during the first 3 d (9.3 vs 11.3)], all the differences were statistically insignificant. Differences of this size are clinically unimportant in well-nourished immunocompetent children, but we suggest that the hyperimmune bovine colostrum tested in our trial had some effects in the treatment of acute rotaviral gastroenteritis and should be evaluated further.

Lack of association between copper, zinc, selenium and blood pressure among healthy children.

Contradictory results have been published about the relation between copper, zinc and selenium and blood pressure (BP). To evaluate the role of these trace elements in BP regulation, we analysed the correlations between BP and copper, zinc and selenium, measured from serum, diet and hair among 3596 healthy children in a 6-year follow up. Fasting blood samples were used in serum copper, zinc and selenium analyses. The dietary intake of trace elements and energy were determined by the 48-h recall method. The hair copper and zinc analyses were performed from the naturally coloured hair samples. Correlation analysis was used to show the relation between BP and copper, zinc or selenium in each study year and during a 3- or 6-year follow-up period. The zinc-to-copper ratio in serum, diet and hair was calculated. In the correlation analyses the data was adjusted for weight and the daily intake of energy. Neither serum and diet copper or zinc, nor the zinc-to-copper ratio correlated uniformly with BP measured in the same year (correlation coefficients varying from -0.12 to 0.18) or in the subsequent years. Hair copper and zinc correlated weakly negatively with BP (correlation coefficients varying from -0.17 to -0.01). Serum selenium correlated weakly positively with systolic and diastolic BP measured in the same year (correlation coefficients varying from 0.03 to 0.14), but not with subsequent BP measured in the second or third survey. Dietary selenium had an inconsistent effect on BP (correlation coefficients varying from -0.14 to 0.26). In conclusion, copper, zinc, their ratio or selenium did not associate with BP, nor did they have any effect on subsequent BP.

Use of micronutrients and alternative drugs by children with acute lymphoblastic leukemia.

The use of alternative therapies is thought to be common among cancer patients. To clarify the popularity of micronutrients among children with cancer, we performed a controlled follow-up survey. The use of micronutrients and alternative drugs by 15 families of children with acute lymphoblastic leukemia (ALL) receiving chemotherapy (62 members) and 26 control families (106 members) was monitored by means of daily diaries from November 1987 to December 1989. Forty percent of children with ALL (6 of 15) and 7.7% of their controls (2 of 26) took alternative medicines, the usage among the children with ALL being statistically significantly more common (difference, 32.3%; 95% confidence interval for difference [CI] 7.1, 57.5%; P < 0.04). All children with ALL and 50.0% of the control children (13 of 26) took vitamins (difference, 50.0%; 95% CI, 20.4-79.6%; P < 0.01). A total of 27.7% of the other members of the ALL families (13 of 47) and 11.1% of their counterparts in the control families (10 of 90) took alternative medicines, the usage in the index families being statistically significantly more common (difference, 16.6%; 95% CI, 3.4-29.7%; P < 0.03). The malignancy increased the use of alternative medicines among all members of the family and of vitamins and trace elements among the affected children.

Neonatal jaundice and fatty acid composition of the maternal diet.

The role of serum fatty acid composition in neonatal jaundice was studied by comparing the incidence of jaundice among 332 newborn infants receiving breast milk from mothers on a diet with either a low (0.1, n = 145) or a high (1.5, n = 187) polyunsaturated to saturated fatty acid (P/S) ratio. The diet was started immediately after delivery. The composition of fatty acids in the breast milk and sera of the mothers and in the sera of the newborns was evaluated from a random sample of 15 mother-newborn pairs on the control diet (low P/S ratio) and 19 pairs on the experimental diet. Five days after delivery the relative amounts of fatty acids, especially that of linoleate, in the sera of the mothers differed significantly depending on the diet. Differences were also observed in breast milk samples taken three, four or five days after delivery and in the sera of the newborns sampled at the age of four or five days. Nine of the 145 newborn infants (6.2%) in the control group had to be treated with light therapy compared with 12 out of 187 (6.4%) of the newborn infants in the experimental group (high P/S ratio). Serum bilirubin concentrations were 142.5 mumol/l (SD 65.8) and 140.7 mumol/l (SD 73.5) in the experimental and control groups, respectively, at the age of five days. It appears that the changes in the composition of serum fatty acids reached in this study had no effect on the neonatal jaundice.

Fatty acid composition of serum cholesteryl esters in 3- to 18-year-old Finnish children and its relation to diet.

The composition of fatty acids in serum cholesteryl esters (CE) was analyzed gas chromatographically in 1348 boys and girls aged from 3 to 18 yr. A dietary survey was carried out simultaneously using the 48-h recall method. The dietary P/S ratio had highly significant correlations with CE fatty acids: positive with linoleate (0.567) and total omega 6 fatty acids and negative with saturated, monounsaturated, and omega 3 polyunsaturated fatty acids. The highest mean percentage of CE-linoleate was found in 15-yr-old girls (52.7, SD 4.68%) and lowest in 3-yr-old girls (48.1, SD 5.00%). Age, sex, and the degree of puberty had no independent effect on CE-linoleate after it had been adjusted for the effect of dietary P/S ratio by analysis of covariance. These results indicate that the fatty acid composition of serum CE depends on the quality of dietary fat and that CE-linoleate is a useful reflector of the dietary P/S ratio. The negative correlation between CE omega 3 fatty acids and dietary P/S ratio may be due to displacement of the omega 3 acids in serum CE by the much higher proportion of dietary linoleate.

Renal structure and function in chronic experimental aortic coarctation in dogs treated with antihypertensive drugs.

The possible damaging effect on the kidneys of antihypertensive therapy in aortic coarctation was evaluated experimentally in eighteen canine puppies. Aortic coarctation was carried out in 13 puppies at the age of two months while sham-surgery was carried out on five control puppies. Six coarctated dogs were treated with hydrochlorothiazide, propranolol and prazosin. Antihypertensive therapy was started two months after the operation. Seven coarcted puppies did not receive any treatment. The dogs were followed up for 7 months after which fixation of the kidneys was performed. Antihypertensive therapy decreased blood pressure significantly although the level seen in the control dogs was not attained. There were no signs of deterioration of renal function. Neither light microscopic analysis nor electron microscopy revealed morphological abnormalities in the kidneys of any of the dogs. The present results show that active antihypertensive therapy in experimental coarctation, although not resulting in a normalization but in a significant lowering of blood pressure, is safe and does not cause any morphologic damage in the kidney before corrective surgery. The absence of juxtaglomerular hypertrophy supports the hypothesis that the renin-angiotensin system is not activated in chronic coarctation of aorta.

Serum iron, copper, zinc, ferritin, and ceruloplasmin after intense heat exposure.

Twelve voluntary adult subjects twice took a 30-min sauna bath, at a temperature of 80 degrees C with a 30-min rest between each, every 12 h for 1 week. Measurements of serum iron, copper, zinc, ferritin and ceruloplasmin were performed before the experiment, after the first and second 30 min in the sauna and at the end of the week. The first two sauna baths did not significantly change the concentrations of the trace elements measured. After the week the mean serum copper concentration had decreased from 15.0 (SD 1.7) mumol x 1-1 to 13.5 (SD 2.0) mumol x 1-1 (p less than 0.02). The mean zinc concentration decreased from 13.8 (SD 2.4) mumol x 1-1 to 9.8 (SD 1.8) mumol x 1-1 (p less than 0.001) during the week of the experiment. At the beginning of the study period two subjects had zinc concentrations below the reference values and after the week nine subjects had zinc concentrations below the reference values. The concentration of serum ferritin decreased from 142.2 (SD 103) micrograms x 1-1 to 111.3 (SD 89) micrograms x 1-1 (p less than 0.02) whereas the values of ceruloplasmin remained unchanged. Our findings confirm the earlier suggestion that heavy exposure to heat can cause a loss of some trace elements, especially zinc.

Acute phase proteins, humoral and cell mediated immunity in environmentally-induced hyperthermia in man.

The effects of repeated hyperthermia, caused by a Finnish sauna bath over 1 week, on the serum levels of some acute phase reactant proteins and on both humoral and cell-mediated immunity on twelve healthy young volunteers are presented. The mean rise in rectal temperature during each 30-min period in the bath was about 1.3 degrees C. Heat exposure caused significant increases in the serum concentrations of two of the acute phase reactant proteins, alpha1-antitrypsin (from a mean value of 1.8 (0.1) to 1.9 (0.2) g X l-1, p less than 0.01) and transferrin (from a mean value of 36.9 (3.4) to 38.3 (4.4) mumol X l-1, p less than 0.05), but no changes occurred in immunoglobulins or cell-mediated immunity. These findings suggest that environmentally induced hyperthermia can initiate the acute phase reaction associated with fever.