Multi-Filter Clustering Fusion for Feature Selection in Rotating Machinery Fault Classification.

In the fault classification process, filter methods that sequentially remove unnecessary features have long been studied. However, the existing filter methods do not have guidelines on which, and how many, features are needed. This study developed a multi-filter clustering fusion (MFCF) technique, to effectively and efficiently select features. In the MFCF process, a multi-filter method combining existing filter methods is first applied for feature clustering; then, key features are automatically selected. The union of key features is utilized to find all potentially important features, and an exhaustive search is used to obtain the best combination of selected features to maximize the accuracy of the classification model. In the rotating machinery examples, fault classification models using MFCF were generated to classify normal and abnormal conditions of rotational machinery. The obtained results demonstrated that classification models using MFCF provide good accuracy, efficiency, and robustness in the fault classification of rotational machinery.

Fatal hyperammonemia associated with disseminated Serratia marcescens infection in a pediatric liver transplant recipient.

Hyperammonemia is a rare and important complication post-liver transplantation. We review a case of a 5-month-old boy with biliary atresia who received a split liver transplant following a variceal bleed. The transplant was complicated by recurrent portal vein thrombosis. Colonized with Serratia marcescens pretransplant, he developed disseminated infection associated with very high levels of ammonia that led to his death. It is important to be aware of serum ammonia levels in patients with portal vein thrombosis, particularly in the setting of gastrointestinal bleeding and sepsis.

Prospective Incidence of Paediatric Inflammatory Bowel Disease in New Zealand in 2015: Results From the Paediatric Inflammatory Bowel Disease in New Zealand (PINZ) Study.

BACKGROUND: The global incidence of paediatric inflammatory bowel disease (IBD) is increasing. Much of the evidence attesting to this has arisen from North America and Europe. There is a relative paucity of information on the epidemiology of paediatric IBD in the Southern Hemisphere. The present study aimed to document the prospectively collected incidence of paediatric IBD in New Zealand in 2015. METHODS: All patients younger than 16 years of age and diagnosed with IBD in New Zealand between 1 January 2015 and 31 December 2015 were identified. Demographic and disease phenotypic details were collected and entered into a secure database. Age-specific population data for New Zealand were obtained and national incidence rates for IBD and its subtypes were calculated. RESULTS: The prospectively calculated incidence of paediatric IBD, Crohn disease, ulcerative colitis (UC), and IBD unclassified in New Zealand in 2015 were 5.2 (95% confidence interval 3.9-6.8), 3.5 (2.4-4.8), 1.0 (0.5-1.8), and 0.7 (0.3-1.4) per 100,000 children, respectively. CONCLUSIONS: Incidence rates of paediatric IBD in New Zealand are comparable to the highest rates published in the literature from Western Europe and North America. Ongoing prospective ascertainment of the incidence of paediatric IBD is required to better understand the environmental factors, which are accounting for this increase in disease burden.

Prospective Evaluation of the ESPGHAN Guidelines for Diagnosis of Celiac Disease in New Zealand Children.

OBJECTIVE: The 2012 European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guideline for diagnosis of celiac disease (CD) questioned the requirement for intestinal biopsy to confirm the diagnosis. The guideline recommends that in symptomatic patients with consistent human leukocyte antigen (HLA) subtypes, the diagnostic accuracy of strongly positive serology is sufficient to confirm the diagnosis. We prospectively assessed these guidelines in a "real-life" clinical setting. METHODS: One hundred and four children referred for evaluation of possible CD were prospectively recruited. Following informed consent, blood was drawn for serological testing and HLA analysis at upper gastrointestinal endoscopy. Histological findings according to Marsh criteria were correlated with blood results and the accuracy of the guideline analyzed.The study also examined the role of deamidated gliadin peptide (DGP) in the diagnosis of CD. RESULTS: For symptomatic patients with consistent HLA subtypes, strongly positive serology (as described in the ESPGHAN guidelines) accurately predicted biopsy-proven CD in >95% of cases. DGP was positive in fewer patients than anti-TG2 or EMA. Incorporation of DGP as a second confirmatory serological test in place of EMA was associated with maintained predictive value of guideline, but fewer patients fulfilling criteria for biopsy-free diagnosis. CONCLUSIONS: The ESPGHAN guideline performs well in our population. Adoption of the guideline would reduce the number of patients requiring endoscopy without compromise in diagnostic accuracy. The involvement of pediatric gastroenterological expertise, however, remains key to diagnosis of CD.

Diagnostic utility of modified gliadin peptide antibody assays in New Zealand children.

OBJECTIVE: The aim of the present study was to evaluate a panel of different antibody assays, including second-generation antigliadin kits, in a local paediatric population thought to be at risk for coeliac disease (CD). METHODS: Seventy-nine children, who tested positive for immunoglobulin A (IgA) antibodies to tissue transglutaminase (TG), underwent duodenal biopsy. At endoscopy, serum was collected from all of the patients, and 9 different coeliac antibody assays were performed, both as isolated assays and in combination. These included immunoglobulin A (IgA) anti-tissue transglutaminase (TGA), and IgA plus IgG anti-deamidated gliadin peptide (DGPAG). A diagnosis of CD was made if the biopsies showed Marsh grade 3 lesions. RESULTS: Twenty-four of 79 children had CD confirmed histologically. Only 39 of 79 were positive for Inova TGA, and 35 of 79 were positive for Inova DGPAG. Twenty-four of 39 who were TGA positive and 24 of 35 who were DGPAG positive had confirmed CD on biopsy. There was good correlation between TGA and DGPAG-positive predictive values. None of the modified gliadin tests produced false-negative results, and neither did the TGA. CONCLUSIONS: The Inova DGPAG and TGA assays have similar use in predicting CD in a selected paediatric population; however, in children who are positive for TGA when screened for CD, more than half have negative TGA serology when repeat testing is done at the time of biopsy. Those with persistent TGA positivity have only a 61.5% probability of having histologic CD, compared with 68.6% of those children positive for DGPAG.

Does the severity of bilateral carpal tunnel syndrome influence the timing of staged bilateral release?

A retrospective chart analysis was performed of 66 patients with bilateral carpal tunnel syndrome (CTS) who underwent either single endoscopic carpal tunnel release (ECTR) or staged bilateral ECTR to determine the frequency and timing of contralateral surgery. Bilateral CTS patients with contralateral severe CTS underwent bilateral staged ECTR 86% of the time and the second operation was performed 6 ± 5 weeks after the initial ECTR. Patients with contralateral moderate CTS underwent bilateral staged ECTR 74% of the time with a mean of 11 ± 3 months between operations. Patients with contralateral mild CTS underwent bilateral staged ECTR 20% of the time and averaged 7 ± 3 years between procedures. For patients with bilateral CTS, the severity of CTS on the contralateral side to the initial release affects both the frequency and timing of the contralateral surgery. This information may be used to establish guidelines for treatment with bilateral simultaneous CTR.

Capitate shortening osteotomy with vascularized bone grafting for the treatment of Kienböck's disease in the ulnar positive wrist.

PURPOSE: Decompression surgery combined with revascularization surgery may provide better results than either alone in the treatment of Kienböck's disease. This study describes our experience with capitate shortening combined with vascularized bone grafting for the treatment of Kienböck's disease in ulnar neutral and ulnar positive variant patients. METHODS: Between 1996 and 2004, patients diagnosed with Lichtman stage II or stage IIIA Kienböck's disease with ulnar neutral or ulnar positive wrists were enrolled in this prospective study and had capitate shortening osteotomy with concurrent vascularized bone grafting. Preoperative and postoperative clinical evaluation included wrist arc of motion, grip strength, and overall satisfaction score. Preoperative and postoperative wrist radiographs and preoperative magnetic resonance imaging were performed. Radiographic measurements of preoperative and postoperative ulnar variance and carpal height ratio were also evaluated. The average follow-up period was 41 months (range, 26-65 months). RESULTS: Fourteen patients with an average age of 25 years (range, 16-39 years) were studied. The results show significant improvement in grip strength (58% to 78% of the normal side), satisfaction score, and satisfactory arc of motion. The average carpal height ratio was maintained. Average time to osteotomy healing was 48 days. CONCLUSIONS: Capitate shortening osteotomy combined with vascularized bone graft is effective in the treatment of ulnar-positive Kienböck's disease prior to the onset of radiocarpal arthrosis.

Scapholunate interosseous ligament reconstruction: results with a modified Brunelli technique versus four-bone weave.

PURPOSE: To compare clinical and radiographic outcomes in patients with chronic scapholunate dissociation treated with a modified Brunelli technique versus a 4-bone tendon weave. METHODS: A retrospective cohort study was performed. Twenty-three patients presented with chronic scapholunate dissociation and were treated with the 4-bone tendon weave technique as described by Almquist and colleagues. A separate group of 21 patients were subsequently treated with a modified Brunelli plus reduction-assisted scapholunate ligament technique. All patients had preoperative radiographs demonstrating scapholunate ligament disruption and positive magnetic resonance arthrograms. All were treated by the senior surgeon (T.E.T.), who initially performed the 4-bone tendon weave and later the modified Brunelli procedure plus temporary screw fixation. Evaluation included radiographic changes, pain and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, grip strength, and range of motion. Data were analyzed using the Wilcoxon signed rank test for preoperative-to-postoperative comparisons and the Wilcoxon-Mann-Whitney test for comparison between the 2 treatment groups. RESULTS: The scapholunate angle decreased in both groups (mean 15 degrees +/- 5 decrease for the Brunelli group; 10 degrees +/- 4 decrease in the 4-bone tendon weave group). Mean pain and DASH scores preoperatively and postoperatively demonstrated greater improvement for the modified Brunelli group (pain scores rated on a visual analog scale of 1 to 10: mean difference Brunelli group = 4.8 cm; 4-bone tendon weave group = 3.2 cm; mean difference 1.6 cm; DASH scores: mean difference Brunelli group = 31.5 points; 4-bone tendon weave group = 14.2 points). The Brunelli group also experienced greater postoperative motion as a percentage of preoperative motion (mean 86% +/- 7 vs 60% +/- 12) and significant increases in postoperative versus preoperative grip strength (mean 2 kg vs 1 kg; increase of 1 kg). CONCLUSIONS: The modified Brunelli technique for scapholunate interosseous ligament reconstruction compared with the 4-bone tendon weave technique has improved outcomes in pain relief, DASH scores, range of motion, and grip strength at 2.5 years follow-up. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Wrist level and proximal-upper extremity replantation.

Since Malt and McKhan's first successful arm replantation in 1962, upper extremity replantation surgery techniques have been refined and spread worldwide. Nevertheless, replantation at or proximal to the wrist, referred to as wrist-proximal replants, remains a daunting challenge that presents the hand surgeon with an array of difficulties distinct from digital replantation.

Point Prevalence of Pediatric Inflammatory Bowel Disease in New Zealand in 2015: Initial Results from the PINZ Study.

BACKGROUND: The incidence of pediatric inflammatory bowel disease (IBD) around the world is increasing. However, there is a scarcity of data on the epidemiology of pediatric IBD in the Southern Hemisphere. This study aimed to document the point prevalence of pediatric IBD in New Zealand on June 30, 2015. METHODS: All patients in New Zealand, under 16 years of age, with a diagnosis of IBD on June 30, 2015 were identified. Demographic and disease phenotypic details were collected and entered into a secure database. Age-specific population data for New Zealand were obtained and national and regional prevalence rates were calculated. RESULTS: The point prevalence of pediatric IBD, Crohn's disease, ulcerative colitis, and inflammatory bowel disease unclassified in New Zealand on June 30, 2015 was (95% confidence intervals) 21.7 (18.9-24.8), 16.5 (14.0-19.2), 3.3 (2.2-4.6), and 1.9 (1.2-3.0) per 100,000 children, respectively. There was a striking disparity between the prevalence rates in the North and South Islands. CONCLUSIONS: The point prevalence of pediatric IBD in New Zealand represents the first-ever national, population-based prevalence rates of pediatric IBD published. Results from the Paediatric IBD in New Zealand (PINZ) study are also the first to show markedly higher prevalence rates of IBD in the southern part of a country compared with its northern counterpart. Ongoing prospective ascertainment of the incidence of pediatric IBD is required.

Auckland paediatric liver transplant experience 1990-2000.

AIMS: New Zealand is establishing its own Paediatric Liver Transplant Service. However there have been no readily available data on the experience of New Zealand paediatric transplant recipients to date. The aim of our study was to determine numbers and indications for transplant at present, current outcomes and to estimate the likely demand for the service in the future. METHODS: A retrospective search of computerised records was performed on children cared for at Starship Hospital from 1990 to 2000. RESULTS: Seventeen children received eighteen transplants. The indication for transplantation was biliary atresia in the majority of patients (11/17, 65%). A higher proportion of Maori and Pacific Island children received transplants than would be expected from their proportion in the population (59 vs 29%, p<0.01). Significant and often multiple complications occurred post transplantation in the majority of children, but overall outcomes were good. CONCLUSIONS: A New Zealand Paediatric Liver Transplant Program is likely to perform about six transplants per year.

Perioperative management of antidepressants and herbal medications in elective plastic surgery.

BACKGROUND: Patients seeking elective aesthetic surgery often use herbal medications and/or antidepressants. As the popularity of these medications grows, the plastic surgeon must become familiar with these drugs and their potentially harmful effects during the perioperative period. METHODS: The authors performed a PubMed search to identify commonly used herbs and antidepressants and their effects on patients during elective cosmetic surgery. RESULTS: Case series, studies, and reviews for 29 of the most common herbs and antidepressant medications were obtained from this search. On the basis of the existing data, the authors established recommendations for the management of these medications before elective cosmetic surgery. CONCLUSIONS: Most commonly used herbs and antidepressant medications have potentially deleterious effects on the patient during surgery, ranging from increased risk of bleeding to fatal interactions. The plastic surgeon must be familiar with these drugs to manage these patients appropriately.

Live donor liver transplantation in New Zealand: a report on the first 20 cases.

BACKGROUND: Liver transplantation (LT) is established treatment for adults and children with acute or chronic liver failure, however there are insufficient donor organs to meet demand and 14% of New Zealand patients have died waiting or were de-listed due to deterioration whilst on the waiting list. Live donor liver transplantation (LDLT) offers an alternative graft source that enables timely transplantation, but also carries the risk of morbidity and mortality for the donor. AIM: To report the initial experience with LDLT in New Zealand. METHODS: Review of donor and recipient outcomes for the first 20 cases. RESULTS: 129 potential live liver donors were assessed for 68 recipients. Donors were evaluated according to a multi-step protocol including independent donor advocacy. Twenty LDLT were performed on 7 adults and 13 paediatric recipients using 5 right lobe, 2 extended left lobe, 2 left lobe, and 11 left lateral section grafts. Five donors (25%) experienced postoperative complications, none of which were life-threatening. Four recipients had acute liver failure and 16 had chronic liver disease including one retransplant. There was a high rate of recipient biliary complications (40%) but graft and recipient survival is 100% to date. CONCLUSION: LDLT has been successfully introduced in New Zealand with good donor and recipient outcomes.

Paediatric inflammatory bowel disease in New Zealand.

AIM: To determine the incidence, presentation, and initial management of paediatric inflammatory bowel disease in New Zealand. METHODS: A prospective study in collaboration with the New Zealand Paediatric Surveillance Unit was undertaken between 2002-2003. Paediatricians and healthcare professionals working with children were surveyed monthly for cases of paediatric inflammatory bowel disease. RESULTS: There were 52 cases(30 males); 34 (66%) Crohn's disease, 9 (17%) ulcerative colitis, and 9 (17%) inflammatory bowel disease type unclassified. The estimated incidence of paediatric inflammatory bowel disease, Crohn's disease, and ulcerative colitis were 2.9, 1.9, and 0.5 per 100,000 per year respectively. Mean age at diagnosis was 11 years with a delay of 8.4 months from clinical presentation to diagnosis. 85% were European, while no Maori or Pacific Islanders had Crohn's disease or ulcerative colitis. The most common symptoms at presentation were abdominal pain (63%), rectal bleeding (57%), diarrhoea (55%), and weight loss (43%). 39% of Crohn's disease patients had perianal disease at presentation. Only 18% of the Crohn's disease patients presented with the classic triad of symptoms-abdominal pain, weight loss, and diarrhoea. Haematological laboratory abnormalities were more common in Crohn's disease. 5-aminosalicylic acid agents were the most common initial therapy followed by systemic steroids. 25% of the paediatric inflammatory bowel disease cohort received immunomodulators. CONCLUSIONS: The incidence of paediatric inflammatory bowel disease in New Zealand is comparable but at the lower end relative to North America and United Kingdom. There is more Crohn's disease than ulcerative colitis and only a minority of Crohn's disease patients presented with the classic triad of abdominal pain, weight loss, and diarrhoea. 5-aminosalicylic acid preparations and steroids as first line treatment of Crohn's disease were much more common than nutritional therapy. It is rare for New Zealand Polynesian children to develop paediatric inflammatory bowel disease.

MOC-PSSM CME article: Metacarpal fractures.

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Identify the fracture patterns and types of metacarpal fractures. 2. Recognize when surgery is indicated for a given fracture. 3. Discuss the pathophysiology of Bennett's fractures and treatment. 4. List surgical treatment options and their relative advantages and disadvantages. 5. Be familiar with pediatric metacarpal injuries and when surgery is indicated. BACKGROUND: Metacarpal fractures are among the most common injuries seen in the emergency room and a staple for the hand surgeon. Knowledge of the types of fractures that occur and the appropriate treatment options is critical core knowledge for the hand surgeon. With the advent of superior implants and intraoperative fluoroscopy, powerful treatment options exist for metacarpal fractures and are at the disposal of the informed hand surgeon. METHODS: Closed reduction and cast immobilization, Kirschner wires, lag screws, plate fixation, and other techniques are all available to the hand surgeon. Bone grafting in highly comminuted fractures also deserves consideration. RESULTS: The majority of metacarpal fractures can be treated closed and do well with compliant hand therapy. Those fractures requiring operative intervention likewise do well, provided that the appropriate technique is used for the situation. For example, long oblique shaft fractures are optimally treated with lag screws, whereas short oblique fractures do better with Kirschner wires or plate fixation. When the correct therapy is tailored to the injury, most metacarpal fractures can be treated with predictably good outcomes. CONCLUSIONS: Metacarpal fractures are common occurrences in the office of the hand surgeon. The different types of injury patterns must be recognized by the surgeon and appropriate treatment then executed to serve both the patient and hand surgeon optimally.

The detailed anatomy of the 1,2 intercompartmental supraretinacular artery for vascularized bone grafting of scaphoid nonunions.

PURPOSE: To describe the configuration of the 1,2 intercompartmental supraretinacular artery (1,2 ICSRA), including the location of the perforators, and to discuss the clinical use of the 1,2 ICSRA for vascularized bone grafting of scaphoid nonunions. METHODS: Thirteen fresh-frozen cadaveric forearms were used to evaluate the variations in the anatomy of the 1,2 ICSRA. After injection of red latex, the 1,2 ICSRA and its perforators were characterized and measured. Pedicle length and distal reach of the transposed 1,2 ICSRA pedicle was evaluated. We noted the relationship of the 1,2 ICSRA to the dorsal scaphoid branch of the radial artery. Another 10 specimens were injected, frozen, and sectioned to evaluate vascular penetration into the dorsal distal radius. RESULTS: The 1,2 ICSRA branched from the radial artery 1.9 mm proximal to the tip of the radial styloid (range -6.3-3.2 mm), on average. The average pedicle length was 22.5 mm (range 15-31 mm), which permits its application for both dorsal and volar scaphoid. The relationship between the origin of the 1,2 ICSRA and the dorsal scaphoid branch was categorized into 3 types, including--separate, combined, and shared. The average number of perforating vessels arising from the pedicle was 5.5 (range 3-7), with an average of 2.75 (range 1-7) perforators overlying a 1 by 0.5 cm block of the distal radius bone graft. A graft located between 8-18 mm proximal to the articular surface of distal radius would incorporate the greatest numbers of perforators. The most notable vascular penetration of the distal radius was demonstrated at 10.0 mm proximal to the radial styloid. CONCLUSIONS: The detailed anatomy of the 1,2 ICSRA presented in this study may guide in planning and dissection to maximize the vascularity of a pedicled bone graft based on this vessel for the management of scaphoid nonunions.

A comparison of polyglycolic acid versus type 1 collagen bioabsorbable nerve conduits in a rat model: an alternative to autografting.

PURPOSE: Severe nerve injury with segmental loss requires nerve graft or conduit repair. We compared 2 synthetic, bioabsorbable nerve conduits with the gold standard of autogenous nerve grafting using histopathologic and neurophysiologic analyses. METHODS: A 10-mm segment of the sciatic nerve of 45 Sprague-Dawley rats was resected, leaving a gap defect. Three experimental groups were used: 15 coaptations using type I collagen nerve conduits, 15 coaptations using polyglycolic acid (PGA) nerve conduits, and 15 coaptations using the excised segments as autogenous nerve grafts. The contralateral legs were used as unoperated controls. After 15 weeks, nerve regeneration was evaluated by measuring isometric muscle contraction force, axonal counting, wet muscle weights, and histology. RESULTS: Statistically significant differences in the isometric muscle contraction force, axonal counts, and wet muscle weights were found between type I collagen conduit and nerve graft compared to the PGA conduit. Axonal sprouting was less organized and less dense with the PGA conduits when compared to nerve reconstruction with the type I collagen conduits and nerve grafts. CONCLUSIONS: Type I collagen conduits and autografts produced comparable results, which were significantly better than PGA conduits. The use of type I collagen conduit is a reliable alternative to nerve grafting for gaps up to 10 mm in length.

Paediatric liver transplantation in New Zealand: the first 5 years.

AIM: To report the first 5 years of paediatric liver transplantation (LTx) undertaken by the New Zealand Liver Transplant Unit. METHODS: The records of all patients aged 0 to 15 years assessed for LTx between 1 January 2002 and 1 November 2006 were examined. Demographics, criteria for listing, waiting time, transplant-hospitalisation details, and outcome to date are reported. RESULTS: Thirty-eight children were assessed for LTx, of whom 33 were listed. One improved and was de-listed, 3 died on the waiting-list, and 1 remains on the list currently. Twenty-eight children have undergone 29 transplants; there were 25 primary and 4 re-transplants (3 had their primary transplant in Australia). The median wait-time was 122 days and median age at transplantation was 2 years 6 months. Fourteen (50%) were European, 10 (36%) Maori, 3 (11%) Pacific (mostly of Samoan, Tongan, Niuean, or Cook Islands origin), and 1 (3%) Asian. The most common diagnosis was extra-hepatic biliary atresia (59%) followed by alpha-1 antitrypsin deficiency and acute liver failure (14% each). There were 6 whole liver grafts and 23 partial liver grafts including 7 live donor and 10 split LTx. Median time in the Paediatric Intensive Care Unit (PICU) was 2 days and median hospital stay after LTx was 25 days. Time spent in Auckland immediately pre- and post-transplant for families from outside the region was a median of 14 weeks. Postoperative morbidity includes biliary leaks or strictures in 10 (36%), vascular thromboses in 7 (24%), and culture positive bacterial infection in 14 (50%). Twelve (43%) experienced one or more episodes of acute rejection, 3 developed chronic rejection, and post-transplant lymphoproliferative disorder (PTLD) occurred in 2 patients. Despite these problems, graft survival is 97% and patient survival is currently 100%. All patients of school age are currently attending school. CONCLUSION: Liver transplantation is now established in New Zealand as the treatment of choice for end-stage liver disease and acute liver failure in the paediatric population. Excellent outcomes that compare well with large overseas centres have been achieved.

Alloderm stabilization of zygomatic arch fractures.

Zygomatic arch fractures, particularly when comminuted, are unstable fractures that may lose their reduction after operative manipulation. This case study describes the use of Alloderm as a postoperative stabilizing agent in two patients.

Coeliac disease diagnosed at Starship Children's Hospital: 1999-2002.

AIM: To retrospectively review the clinical presentation and serological testing of children diagnosed with coeliac disease at Starship Children's Hospital (Auckland, New Zealand) over a 4-year period between January 1999 and December 2002. METHODS: A review of Starship Hospital medical records of all children diagnosed with coeliac disease by small bowel biopsy between January 1999 and December 2002 was conducted. Patients had anti-gliadin, endomysial, and tissue transglutaminase antibodies performed prior to small bowel biopsy. RESULTS: There were 48 patients, median age of 6.9 years (range 1.6 to 15.7 years). Comparing symptomatic age groups older and younger than 5 years, the former age group presented significantly more often with abdominal pain (p=0.005) and the latter age group presented significantly more often with failure to thrive (p=0.02). Screening at-risk groups yielded nine children (19%) with asymptomatic disease. Thirty-three of 36 (92%) patients tested positive for the anti-endomysial IgA antibody, and 26 of 27 (96%) patients tested positive with the anti-tissue transglutaminase IgA antibody. Three patients (aged 3, 4, and 6 years of age) were negative for anti-endomysial antibodies (including one also negative for anti-tissue transglutaminase antibody), but all three were positive for anti-gliadin antibody. CONCLUSIONS: Our study found that children with coeliac disease are being diagnosed at an older age. Older children also presented with more abdominal pain while younger children presented with more failure to thrive. At-risk groups for coeliac disease may be asymptomatic and form a significant group of patients diagnosed with coeliac disease. Anti-endomysial and tissue transglutaminase antibodies are reliable tests for coeliac disease. However, in younger patients or if there is a high clinical index of suspicion of coeliac disease, small bowel biopsy should be performed even if the anti-endomysial and tissue transglutaminase antibody tests are negative.