Coeliac disease presenting as acute pancreatitis in a 3-year-old.

A 3-year-old boy presented with a history of intermittent abdominal pain and vomiting from the age of 1 year. Raised serum amylase and lipase levels supported a diagnosis of acute pancreatitis. Subsequent investigation confirmed coeliac disease. This is the youngest patient to be reported with this combination.

Cisapride in management of chronic pediatric constipation.

BACKGROUND: This study was conducted to explore the use of cisapride in the treatment of chronic idiopathic constipation in children. METHODS: Seventy-nine children were screened. Seventy-three of them met the selection criteria that included clinical, laboratory, radiologic, and histopathologic investigations. These patients entered a week-long phase I of disimpaction using lactulose. Four of them were noncompliant and thus were excluded from the next phase. In phase II sixty-nine patients were assigned to two treatment groups: 0.3 mg/kg cisapride four times a day versus matching placebo for 8 weeks in a double-blind study. The two groups that completed phase II were similar in age and duration of symptoms, confirmed by statistical analysis. Stool frequency was assessed weekly, beginning at the end of the disimpaction phase and continuing for 9 weeks. Total gastrointestinal transit time was measured twice, on completion of phase I and 9 weeks later. Transit time is the time required for a carmine marker taken orally after overnight fast to appear in the stool. RESULTS: There was a significant difference between stool frequency per week before and after cisapride treatment, stool frequency per week at the end of phase II with cisapride versus placebo, and total gastrointestinal transit time before and after treatment with cisapride (p < 0.05 for all values). No such difference was demonstrated when comparing stool frequency per week or total gastrointestinal transit time before and after placebo (p > 0.05 for both). CONCLUSIONS: Cisapride may have a role in the management of chronic idiopathic constipation in children.

A case report of spherocytosis presenting with choledocholithiasis in early childhood and a review of the literature.

This is a report of spherocytosis presenting unusually early with choledocholithiasis secondary to low grade haemolysis.

A Cryptosporidium parvum genomic region encoding hemolytic activity.

Successful parasitization by Cryptosporidium parvum requires multiple disruptions in both host and protozoan cell membranes as cryptosporidial sporozoites invade intestinal epithelial cells and subsequently develop into asexual and sexual life stages. To identify cryptosporidial proteins which may play a role in these membrane alterations, hemolytic activity was used as a marker to screen a C. parvum genomic expression library. A stable hemolytic clone (H4) containing a 5.5-kb cryptosporidial genomic fragment was identified. The hemolytic activity encoded on H4 was mapped to a 1-kb region that contained a complete 690-bp open reading frame (hemA) ending in a common stop codon. A 21-kDa plasmid-encoded recombinant protein was expressed in maxicells containing H4. Subclones of H4 which contained only a portion of hemA did not induce hemolysis on blood agar or promote expression of the recombinant protein in maxicells. Reverse transcriptase-mediated PCR analysis of total RNA isolated from excysted sporozoites and the intestines of infected adult mice with severe combined immunodeficiency demonstrated that hemA is actively transcribed during the cryptosporidial life cycle.