Inhibitory effect of a polychlorinated biphenyl (Aroclor 1254) on aflatoxin B1 carcinogenesis in rainbow trout (Salmo gairdneri).

Duplicate lots of 120 rainbow trout (Salmo gairdneri) fingerlings were fed for 1 year semipurified diets containing 6 ppb aflatoxin B1 (AFB1), 100 ppm Aroclor 1254 (a polychlorinated biphenyl), and 6 ppb AFB1 plus 100 ppm Aroclor 1254. Appropriate controls were also maintained. Samples were taken at 1, 2, 4, 6, 9, and 12 months to monitor tumor incidence, Aroclor 1254 accumulation, and histopathology of liver, spleen, and kidney tissues. At the end of the year, 26 of 37 (70.3%) trout fed 6 ppb AFB1 had hepatocellular carcinomas, compared to 14 of 46 (30.4%) trout fed 6 ppb AFB1 plus 100 ppm Aroclor 1254, a highly significant reduction in tumor incidence in the trout on the Aroclor 1254-containing diet. None of the control or Aroclor 1254-fed fish had liver tumors. Levels of Aroclor 1254 increased rapidly during the first 6 months, then plateaued at approximately 80 ppm on a whole-fish basis. AFB1 inhibited growth but Aroclor 1254 did not. Glycogen depletion of hepatocytes and hyperemia, and white pulp depletion of the spleen were the only changes induced by Aroclor 1254.

Hormone and metabolic profiles in children and adolescents with type I diabetes mellitus.

Diurnal concentrations of glucose, the major regulatory hormones, and selected biochemistries were measured serially throughout a 25-h period in 38 healthy type I diabetic patients, 25 patients with acute ketoacidosis, and 20 normal subjects. Poor glucose control, meal intolerance, and hypercortisolemia were the dominant abnormalities in the healthy diabetic subjects. Ketonemia due to elevated plasma beta-hydroxybutyrate concentrations without ketonuria (nitroprusside reaction) was a frequent finding in a group of poorly controlled diabetic subjects. In the patients with acute ketoacidosis, the dominant abnormalities were overproduction of epinephrine and cortisol. High glucagon and growth hormone concentrations were documented in about one-half of these patients. We conclude that (1) the hyperglycemia, meal intolerance, and abnormal ketone body metabolism seen in these patients are caused by inadequacies in their insulin regimens; (2) ketone body underutilization contributes to diabetic ketosis; (3) epinephrine and cortisol overproduction are important components of acute ketoacidosis; and (4) the complex hormone-metabolic interactions in type I diabetes can best be explained by a multihormonal hypothesis with the primary defect being loss of beta-cell function.

Elevated plasma beta-hydroxybutyrate concentrations without ketonuria in healthy insulin-dependent diabetic patients.

Plasma beta-hydroxybutyrate (beta-OHB) concentrations and simultaneous urine tests for ketonuria (nitroprusside reaction) were evaluated every 4 h throughout a 24-h study in 10 healthy insulin-dependent diabetics who had poor control based on home urine tests and elevated hemoglobin A1C. Concurrent measurements of the major carbohydrate regulatory hormones were made in the diabetic group and in a control population of 20 age-matched subjects. In the diabetics, 73% of the beta-OHB measurements were elevated. Only 43% of the abnormal beta-OHB values were associated with ketonuria. The diabetic subjects also showed exaggerated diurnal patterns for plasma beta-OHB and cortisol. There were no significant differences for the other regulatory hormones in the diabetic and normal groups. We conclude that 1) abnormal plasma beta-OHB levels without ketonuria are prevalent in poorly controlled diabetics; 2) negative nitroprusside tests for ketonuria underestimate the presence of ketonemia due to increased beta-OHB concentrations; 3) both insulin deficiency and glucocorticoid excess may influence ketone body metabolism in insulin-dependent diabetic patients.

Vertical transmission of the neurofibromatosis/Noonan syndrome.

We are reporting on a boy and his mother with neurofibromatosis and manifestations of Noonan syndrome, including short stature, ptosis, midface hypoplasia, and short neck. Developmental delay was noted in the son, and the mother was noted to have a heart murmur. There was a family history of café-au-lait spots, and photographs of several of these relatives showed a facial appearance suggesting Noonan syndrome. The presence of neurofibromatosis associated with Noonan syndrome manifestations in our related patients suggests presence of a unique disorder sharing characteristics of both conditions.

Mesobiileal shunt in an infant for control of bleeding from gastroesophageal varices.

There are various means to control bleeding gastroesophageal varices in children: sclerotherapy by injection, esophageal transection and variceal ligation, and different portosystemic shunts. Because of a high incidence of shunt thrombosis in children, many clinicians prefer other forms of therapy. However, only a successful shunt will lower the elevated portal venous pressure and eliminate the varices. This report describes a type of portosystemic shunt that will remain patent, even in an infant.

Esophageal atresia. Critical analysis of 39 cases.

Knowledge of the factors that affect morbidity and mortality in the treatment of congenital malformations of the esophagus should result in better planning of their surgical management with increased likelihood of success. In 39 infants studied, associated anomalies, low birth weight, and postoperative respiratory complications were the factors responsible for morbidity and mortality. Infants with associated anomalies had a longer hospitalization than those with none, a mean of 17 vs 12 days.

Anterior sacral meningocele presenting as abdominal mass.

Anterior sacral meningocele is a rare entity. It arises from a congenital defect of the sacrum and the coccyx through which herniation of the caudal portion of the meninges and their contents occurs, forming a cyst-like structure. The cystic mass, which lies between the rectum and sacrum, produces a variety of symptoms depending on its size and contents and constitutes a diagnostic problem. A case of anterior sacral meningocele is presented, including the physical signs, differential diagnosis, and the dangers of aspiration or surgical intervention.

Hyperreninemic hypertension secondary to radiation nephritis in a child.

Radiation injury to the kidney, first reported almost eighty years ago, may vary from subclinical changes in renal blood flow or enzyme activity to clinically significant hypertension and/or renal failure. A child with radiation-induced hyperreninemic hypertension was cured by nephrectomy. The microscopic, subclinical, and clinical changes of irradiation injury are reviewed. The etiology of radiation-induced hypertension, methods of radioprotection, and early detection of radiation renal damage are discussed.

Intussusception following resection of Wilms tumor.

Postoperative intussusception is a documented complication of pediatric surgical and pediatric urologic abdominal operations. In contrast to "primary" intussusception's triad of crampy abdominal pain, palpable abdominal mass, and "currant jelly" stools, postoperative intussusception is generally characterized by abdominal pain and vomiting. An abdominal mass is not usually palpable, and few children have bloody stools. Proper diagnosis and treatment may be delayed because of similar abdominal symptoms in children who may be receiving radiation and chemotherapy, or with prolonged ileus. Two children operated on for Wilms tumor demonstrate the need for awareness of this potential problem in the postoperative patient.

Jejunal interposition for recurrent gastroesophageal reflux in children.

There is limited experience with surgical treatment for recurrent gastroesophageal reflux after an antireflux procedure. In four pediatric patients with recurrent reflux after surgical therapy, interposition of an isoperistaltic segment of jejunum produced excellent short-term results. Further follow-up is needed as experience broadens. At the present time, this procedure merits consideration in patients with recurrent gastroesophageal reflux.

Evaluation of factors in high risk neonatal necrotizing enterocolitis.

Fifty-four neonates with necrotizing enterocolitis (NEC) were separated on basis of outcome. Of 35 factors compared between a high-risk and a low-risk group, only six were found to be statistically significant and useful in the development of a NEC score: number of days before beginning enteral feedings; blood pH; serum bicarbonate concentration; white blood cell differential; abdominal tenderness; and presence of portal vein gas. All laboratory values and physical and radiographic findings were from the initial presentation of NEC. Neonates with a score of 3 or more are at an increased risk of developing severe NEC with a greater than 50% mortality. The study suggests that enteral feedings should be withheld from neonates at risk of developing NEC for the first 12 days of life.

New developments with the heavy metal vapor lasers for the dermatologist.

In controlled studies the heavy metal vapor lasers are important for dermatologic surgery, for vascular lesions, and for skin malignancies, especially those malignancies which cannot be treated by conventional means. The flexibility of the fiberoptic system for transmitting the lasers lends itself to laser vascular surgery, cancers of the skin, and mucous membranes. The heavy metal vapor laser is one of the few laser systems for clinical practice which include two different systems, thereby increasing applications.