[Nosocomial virus infections in pediatric departments. Rotavirus and respiratory syncytial virus]. / Nosokomielle virusinfektioner i børneafdelinger. Rotavirus og respiratorisk Syncytialvirus.

Rotavirus and Respiratory Syncytial virus are common causes of acute gastroenteritis and upper and lower respiratory diseases among infants and toddlers. Both viruses occur as epidemics during the winter season. The symptoms may be quite severe and often lead to hospitalisation in paediatric wards i.e. about 2,000 children per year. The viruses frequently give rise to nosocomial infections in the infant/toddler wards about one third of the cases being nosocomial. Recent studies have revealed that both viruses are spread via contaminated hands. The density of virus in faeces and upper respiratory secretions is very high less than one microgram being sufficient for spread of the disease. The traditional precautions (i.e. handwashing and isolation) have failed to reduce the numbers of nosocomial infections to an acceptable level. However, the routine use of gloves have been shown to reduce the spread of RS virus effectively. This method is suggested in paediatric wards during the winter since it presumably will also reduce the spread of Rotavirus.

[Pseudotumor cerebri caused by Lyme borreliosis]. / Pseudotumor cerebri forårsaget af Lyme-borreliose.

Lyme borreliosis may cause a wide range of clinical symptoms. The two previously described paediatric cases of Lyme borreliosis with symptoms of pseudotumor cerebri were associated with characteristic cutaneous symptoms. A case of seven year-old girl with six weeks of headache, vomiting nausea and fatigue as the only symptoms was shown to suffer from pseudotumor cerebri with papilloedema and increased intracranial pressure caused Borrelia burgdorferi. Specific treatment with intravenous penicillin and later intravenous ceftriaxone (due to development of penicillin allergy) for a total of ten days caused the symptoms to gradually disappear over following three to four weeks. Hence, even if pseudotumor cerebri is the only symptom, it is recommended that testing for Lyme borreliosis should be carried out.

[Glucose-galactose malabsorption. The first reported case in Denmark]. / Glukose-galaktose-malabsorption. Det første beskrevne tilfaelde i Danmark.

The first diagnosed case of glucose-galactose malabsorption (GGM) in Denmark is presented. GGM is an autosomal recessive disorder characterized by neonatal début of severe osmotic diarrhoea. Untreated, GGM is potentially fatal. The disease is chronic and caused by a defect in the Na+/glucose co-transporter, SGLT1, located on the jejunal brush border. Diagnosis is based upon oral glucose tolerance test, stool reducing substances, and may be substantiated by genetic analysis. Treatment consists in eliminating alimentary glucose and galactose. Nurtured on this diet the patient will develop normally.

[Giardiasis in children with chronic diarrhea. Incidence, growth, clinical symptoms and changes in the small intestine]. / Giardiasis hos børn med kronisk diaré. Incidens, voekst, kliniske symptomer og tyndtarmsforandringer.

During a six-year period, 29 children (aged 0.7-13.5 years, mean 3.3 years) suffering from chronic diarrhoea due to giardiasis were studied. The incidence of this illness was 81 per 1,000,000 per year among children aged 0- < 7 years. According to growth charts, relative height and weight of the patients decreased significantly (both approximately 0.5 SD) from before the onset of diarrhoea to the time of diagnosis and subsequently increased up to the end of catch-up growth. Small intestinal mucosal specimens were studied. Two patients had severe villous atrophy, 8 moderate abnormalities, 6 only slight changes and 13 biopsies were normal. D-xylose or lactose malabsorption was detected in 25% of the patients. The lactose malabsorption was due to hereditary low lactase levels. None of the patients with a Danish ethnic background showed lactose malabsorption. D-xylose absorption and the relative weight loss of the patients correlated with the degree of mucosal damage. Patients with persistent diarrhoea (n = 19) were younger and had a shorter duration of diarrhoeal illness and a more significant weight reduction than those with intermittent diarrhoea (n = 10). However, the age at onset of symptoms was similar in the two groups (medians 1.3 years). Seven patients contracted the disease abroad. They all developed persistent diarrhoea and had a more severe course of the illness than those who acquired the disease in Denmark.

[Meconium ileus equivalent]. / Meconiumileus-aekvivalent.

Meconium ileus equivalent (MIE) can be defined as a clinical manifestation in cystic fibrosis (CF) patients caused by acute intestinal obstruction by putty-like faecal material in the cecum or terminal ileum. A broader definition includes a more chronic condition in CF patients with abdominal pain and a coecal mass which may eventually pass spontaneously. The condition occurs only in CF patients with exocrine pancreatic insufficiency (EPI). It has not been seen in other CF patients nor in non-CF patients with EPI. The frequency of these symptoms has been reported as 2.4%-25%. Pathophysiologically, MIE is probably caused by a combination of EPI, increased intestinal transit time, and abnormal intestinal mucus. The treatment should primarily be non-operative. Specific treatment with N-acetylcysteine, administrated orally and/or as an enema is recommended. Enemas with the water soluble contrast medium, meglucamine diatrizoate (Gastrografin), provide an alternative form for treatment and can also serve diagnostic purposes. It is important that the physician is familiar with this disease entity and the appropriate treatment with the above mentioned drugs. Non-operative treatment is often effective, and dangerous complications following surgery can thus be avoided.

[Neonatal mortality, morbidity and late sequelae in infants with birth weight under 1.501 gr or gestational age under 31 weeks, primarily admitted to a central hospital]. / Den neonatale mortalitet, morbiditet og senfølger hos børn med fødselsvaegt mindre end 1.501 g eller svangerskabslaengde mindre end fulde 31 uger, primaert indlagt på et centralsygehus.

The purpose of the study was during a three year period from 1990 to 1992 to describe the neonatal mortality, morbidity and the late complications of 75 very low birth weight infants primarily treated in the neonatal department of a County Hospital. The study was performed retrospectively. The mean birth weight was 1292 g in (range 755-2046 g) and the mean gestational age 29.9 weeks (range 25-37 weeks). The primary choice of treatment was nasal continuous positive airway pressure (nasal-CPAP) and "minimal handling" regime. When needed surfactant administration and/or mechanical ventilation was used. Twenty neonates (27%) received mechanical ventilation, and 14 (19%) were treated with surfactant (Curosurf). The mortality (8%) (95% confidence limits 2.9%-16.6%) and morbidity is low. Late complications such as cerebral palsy or mental retardation were seen in eight infants (12.1%) (95% confidence limits 5.4-22.5%). The results of our treatment seem acceptable, and confirm an increasing survival among very low birth weight infants.

Folic acid absorption determined by a single stool sample test--a double-isotope technique. The folic acid absorption capacity in children.

The fractional folic acid absorption (FAFol) was determined in 66 patients with various gastrointestinal diseases by a double-isotope technique, employing a single stool sample test (SSST) as well as a complete stool collection. The age of the patients ranged from 2.5 months to 16.8 years (mean 6.3 years). The test dose was administered orally and consisted of 50 micrograms of [3H]folic acid (monoglutamate) (approximately 20 muCi), carmine powder, and 2 mg 51CrCl3 (approximately 1.25 muCi) as the unabsorbable tracer. The whole-body radiation given to a 1-year-old child averaged 4.8 mrad only. The stool and napkin contents were collected and homogenized by the addition of 300 ml chromium sulfuric acid. A 300-ml sample of the homogenized stool and napkin contents, as well as 300 ml chromium sulfuric acid (75% vol/vol) containing the standards, were counted for the content of 51Cr in a broad-based well counter. The quantity of [3H]folic acid was determined by liquid scintillation, after duplicate distillation. Estimated by SSST, the FAFol, which employs the stool with the highest content of 51Cr corresponding to the most carmine-colored stool, correlated closely with the FAFol based on complete stool collection (r = 0.96, n = 39, p less than 0.0001). The reproducibility of FAFol determined by SSST was assessed from repeated tests in 18 patients. For a mean of 81%, the SD was 4.6%, which corresponded to a coefficient of variation of 5.7%.(ABSTRACT TRUNCATED AT 250 WORDS)

Reliability of a new technique for the determination of vitamin B12 absorption in children: single stool sample test--a double isotope technique.

The fractional vitamin B12 absorption (FAB12) was determined in 39 patients with various gastrointestinal diseases by a double-isotope technique, employing a single stool sample test (SSST), as well as a complete stool collection. The age of the patients ranged from 2.5 months to 16.2 years (mean 5.0 years). The test dose was administered orally and consisted of 0.5-4.5 micrograms of 57CoB12 (approximately 0.05 microCi), carmine powder, and 2 mg 51CrCl3 (approximately 1.25 microCi) as the inabsorbable tracer. The wholebody radiation to a 1-year-old child averaged only 20 mrad. The stool and napkin was collected and homogenized by addition of 300 ml "chromium sulfuric acid." A 300-ml sample of the homogenized stool and napkin, as well as 300 ml chromium sulfuric acid (75% v/v) containing the standards, were counted in a broad-based well counter. The FAB12 determined by SSST employing the stool with the highest content of 51Cr (which corresponded to the most carmine-colored stool) correlated closely to the FAB12 based on complete stool collection (r = 0.98, n = 39, p less than 0.001). The reproducibility of FAB12 determined by SSST was assessed from double assays in 19 patients. For a mean value of 12%, the SD was 3%, which corresponded to a coefficient of variation (CV) of 25%. The excretion of 57Co and 51Cr in the urine was examined in six patients with moderate to severe mucosal damage and was found to be low.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of the exocrine pancreas in early-onset vitamin B12 malabsorption in gluten-challenged celiac children.

The fractional absorption of vitamin B12 (FAB12) was measured by a double-isotope technique specially adapted for children. In six celiac children on a strict gluten-free diet and with a normal small intestinal biopsy, the FAB12 performed in the fasting patient averaged 30% (23-40%). After gluten challenge for a mean of 2 months (range 1-4), when mucosal damage was demonstrated by biopsy, the average fasting FAB12 in these patients decreased to 10% (0-17%) (p less than 0.05). However, when the FAB12 test was repeated by means of stimulation by a B12-free meal 1-3 weeks later, while the patients were still on a diet containing gluten, a significant increase was observed (mean 21%, range 14-27%) (p less than 0.05). In four of the six patients the B12 absorption was further evaluated by repeating the FAB12 test by means of intravenous cholecystokinin (CCK) stimulation (n = 3) or by administration of exocrine pancreas enzyme supplementation (EPES) (n = 2) or cobinamide (n = 1). These tests all showed FAB12 values within the range of the meal-stimulated FAB12. Moreover, in eight gluten-free celiac children with normal biopsies, no difference was found between fasting and meal-stimulated FAB12 values. Therefore, it is likely that the early-onset B12 malabsorption observed in the gluten-challenged celiac child with upper-small-intestinal mucosal damage is in part due to an insufficient stimulation of the exocrine pancreas when using the standard fasting B12 absorption test.(ABSTRACT TRUNCATED AT 250 WORDS)